The following Guest Commentary is by Charley Richardson, Director of the Project on Technology, Work Reorganization and Continuous Bargaining of the Labor Extension Program at UMass Lowell. For over 20 years, Charley has been working with unions in all sectors of the economy, providing training, education and strategic support on issues of changing technology and work restructuring. Charley is consulting with HPAE on health information technology issues and will be leading a workshop on the subject at the October 1st Professional Issues Conference. Charley welcomes your feedback and questions.

• Resources
  Treat it as Continuous Bargaining: Dealing with the Changing Workplace
  Contract Language on Workplace Change
  Legal Principles on Mid-Term Bargaining Rights
  Information Request Factsheet

Electronic Medical Records and other Health Information Technologies: Challenges and Opportunities for Healthcare Workers and Unions

A freight train is barreling down the tracks. They’ve just turbo-charged the locomotive and it is accelerating in your direction.

Electronic Medical Records (EMR) and other Health Information Technologies (HIT), pushed for years by large stakeholders ranging from IT vendors such as Intel, GE and Microsoft, to insurance companies such as Blue Cross Blue Shield, to large health care purchasers such as AT&T and UPS, are receiving a boost in the form of $17 billion worth of incentives in the federal stimulus package for hospitals and other providers to implement HIT. Those who fail to adopt EMR’s by 2015 will suffer penalties in the form of lower Medicare/Medicaid reimbursements.

HIT is coming our way, which is for certain. Electronic Medical Records, more than simply the digitalization of information currently stored on paper, are the digital backbone for a series of transformations that are on the horizon, including telemedicine, robotics, work restructuring and outsourcing – a true Health Information Technology revolution. Electronic Medical Records and other HIT such as automated pharmacy systems, time and attendance systems, location monitoring devices and telemedicine will have a huge impact on health care workers and their unions.

So what should health care workers and their unions do? How can unions and the health care workers they represent have a voice in the technology decisions that are so critical to their futures and the future of health care?

As a start, we need to understand all of the new technologies that are being introduced or are on the horizon and recognize both the positive and negative impacts that HIT can have on health care workers and patients.

Computerized physician ordering systems and medication bar codes can, if properly designed and implemented, help to reduce errors, telemedicine can provide specialist expertise to remote or hard-to-reach patients, and EMRs can facilitate interdisciplinary consultation and communication and provide ready access to critical patient information.

At the same time, we’ve already seen that as HIT is implemented:

• Jobs can be eliminated.
• Job duties and work processes change.
• New skills are required, while “old” skills may be de-valued.
• Workers’ location, movements, and “productivity” can be monitored electronically.
• Work may be moved to remote locations.
• Poor software design can make it harder for caregivers to access the information they need, when and how they need it.
• Health and safety problems, including stress and repetitive strain injuries arise.
• Time spent interacting with patients and their families at the bedside is replaced with time in front of the computer screen, and the quality of caregiver-patient interaction and the quality of patient care can suffer.

Because of the profound impact the HIT revolution will have on patient care, working conditions and labor-management relations, there needs to be a knowledgeable, informed, strategic and strong union voice at all the tables where discussions and decision-making about HIT are taking place. But this won’t happen simply because it is right.

The time to take action is now. When it comes to EMR’s and HIT, the reality is that: It is always too late, because we should have been acting on this long ago, and it is never too late, because we can still affect the future and delaying action would be disastrous.

While some employers have held vendor fairs to solicit individual worker input into the selection of HIT hardware or software, our challenge is to insert a collective union voice into all HIT discussions. Specific steps that need to be taken include:

1) Demanding information about all new technologies that are being introduced or are being planned. This information should be available prior to implementation.
2) Researching the new technologies and their impacts on the members, patients, and the union.
3) Demanding to bargain over all aspects of the introduction and implementation of HIT into the workplace.
4) Providing training and education for the members on the impact of HIT on patient care and working conditions.

The time is now to demand a real seat at the table (at all of the tables) where HIT discussion and decision-making is taking place. The time is now to develop internal capacity and activity. The time is now to develop a clear union agenda on HIT and a strategy for getting a worker/union voice heard.