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resource for employers in their quest for control. They help management take surveillance to a new depth. The time of every entry into an EMR is recorded, and deletions are recoverable. Based on analyses of how and when EMRs are used, management can redesign nursing practice and other work processes to increase technical efficiency and productivity. Electronic documentation requirements serve these objectives. RNs end up between a rock and a hard place. You're more vulnerable to scapegoating if the hospital is sued, so you have to be more vigilant in your documentation. At the same time, management uses EMRs to intensify your work. With a heavier workload, you can only document as expected at the expense of patient care. It's a terrible choice. Management can also tap EMR data to compare RNs in efficiency and compliance with "best practices." It can use the information to divide them and discipline those who resist routinization of their practice. Because younger RNs often lack experience nursing without HIT, they're less likely to resist it, and management exploits this generational difference. By favoring younger RNs, managers can upset RNs' natural informal authority structure based on experience and divide them generationally. Revenue capture Employers also adopt EMRs as a "revenue capture" technology. They help ensure that everything that can be billed will be billed, so hospitals can extract greater profit from • public health insurance programs, • insurance companies, • employers who provide insurance, and • patients. Documentation over care Because EMRs are designed in the interest of hospitals rather than patients, they prioritize documentation over patient care and threaten RNs' exercise of professional judgment. Of course, documentation is important for patients as well as hospitals, but is it ever more important than skilled nursing care? 2. clinicAl DeciSion SuppoRt SySteMS (cDSS) orientation Evidence-based medicine (EBM) aspires to synthesize the latest research on each medical issue into guidelines for patient treatment and care. Based on the patient data entered, clinical decision support systems implement EBM by generating • diagnoses, • prognoses, or outcome predictions, and © Copyright IHSP 2009. All rights reserved. III Can advocating for patients get you targeted for discipline? I s do c u menta ever mo tion i mp o r t r e for pat ant than s k ients nu rsing illed care?