National Nurses United

J U N E 2 0 1 4 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 11 R emember all those promises that electronic health records (EHRs) and the clinical deci- sion software (CDS) connected to them are the magical elixir for fixing medical errors and other hospital health woes? Can we have a mulligan on that? In a rather stunning, and unreported admission, the public agency that accounts for nearly 40 percent of total national healthcare expenditures now says, never mind. A letter in March from the Centers for Medi - care and Medicaid Service (CMS), in response to a Freedom of Information Act request, posted obscurely on the Internet, includes this startling concession—"We do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives." Wait, run that by us again? The systems that hospital giants are spending hundreds of billions of dollars to implement, promoted by widely hyped promises that they are the cure-all for our healthcare system, may not save a single life? The March 14, 2014 letter is signed by Michael Marquis, director of the Division of Freedom of Information for CMS, in response to a request for "all documents (including emails) that support or refute the claim that a broader adoption of electronic health records can save lives." So, if they are nothing more than untest- ed, experimental technology, why exactly has CMS already handed out tens of billions so far in gifts to big hospitals and other providers to implement EHRs? The incen- tives were a little-reported provision of the American Recovery and Reinvestment Act of 2009, also known as the stimulus bill. You might well wonder how major hand- outs to corporate healthcare giants worked their way into what was generally described as a jobs bill for American families devastat- ed by the Wall Street collapse. The simple answer: massive lobbying by the medical device manufacturers and other healthcare lobbyists who have enormous influence in Washington, aided and abetted by a public relations wave promoting EHRs by industry-aligned policy wonks and many supposed experts in the media. But it's becoming an ugly hangover for a lot of people just starting to wake up from the binge spending, and now noticing what nurses who are tasked with using the EHRs have been saying for a very long time. EHRs and the CDS systems that automate a patient diagnosis, prognosis on whether to pro - vide or withdraw care, and prescribe treatment protocols are increasingly interfering with the work of RNs and physicians, overriding their autonomy and professional judgment, and ex - posing patients to new risks of the very medical mistakes they were allegedly supposed to fix. Some of those flaws are exposed in our national public advocacy campaign, cap - tured in videos and ads that can found at our InsistOnAnRN.org website. Those are a summary of what many RNs now experience on a daily basis, such as RNs in Sutter Health's East Bay, California hospitals in August 2013 who were left in the dark without access to critical patient information on medi - cal history, medication orders, and other care essentials when the $1 billion Epic system at their hospitals crashed for up to eight hours. Or ask the RNs at Affinity Medical Center in Massillon, Ohio, part of the giant Community Health Systems chain, which is the recipient of $40 million in CMS dollars to implement its EHR system, Cerner. CHS is now moving forward to use this system throughout 206 hospitals in 29 states. At Affinity, the RNs note, nurses are regularly pulled away from patients for the computers, required to devote from 60 to 75 percent of their time at the bedside entering and responding to computer data. Patients in critical care units may need to have new data typed in every two or three minutes, making it virtually impossible for the RN to continually monitor very ill patients. Physicians have increasingly begun to cite sim i lar problems. The New York Times in January cited a fall 2013 study that found ER physicians in a community hospital spent 43 percent of their time entering data, clicking up to 4,000 times during a 10-hour shift, compared with only 28 percent direct- ly caring for patients. In a survey at Affinity, RNs report widespread problems of constantly shifting directives from the computers, failure of the systems to meet the needs of individual patients, frequent problem with scanning of medications which delays access to meds, and difficulty in overriding the system when RNs make a clinical assessment based on their expertise and professional judg- ment that varies from the automated protocols. And more and more hospitals are pressur- ing nurses, and doctors, to comply with the dictates of the computers (the FRANK of our video), and threatening them with discipline if an entry is missed, a code not entered, a treatment not ordered, or a medication not recorded. Why? Because every entry into the computers shows up on the patient's bill. So at a Sutter hospital last July, a manager threatened to discipline RNs in the women's health department, writing that an OB patient was provided care "for free" (horrors) because not all the data was entered into the computer. "If you do something that is chargeable, charge for it!!!" she commanded. In January 2014, a report by the Office of the Inspector General for the Health and Human Services Department lambasted hospitals for failing to set in place proper safeguards to pre - vent EHRs from being used for inflating costs and overbilling. Who would have guessed? The New York Times article, citing the re port, quoted the professor of health policy at the Harvard School of Public Health who gave voice to those now raising objections. The boosters of electronic health records "spent a lot of years over- hyping and overselling it," said Dr. Ashish K. Jha. Nice to know CMS is now reminding us that EHRs may not even save a single life. RoseAnn DeMoro is executive director of National Nurses United. RoseAnn DeMoro Executive Director, National Nurses United Questioning the value of electronic health records

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