IMPLEMENTING INFORMATION TECHNOLOGY IN THE HEALTHCARE INDUSTRY

WHEREAS, the federal government has committed nearly $50 billion to accelerate the adoption of electronic health records by hospitals and physicians; and

WHEREAS, the potential benefits of electronic health records may include reduction of medical errors, improvements in coordination of care, assistance in diagnosis and the data necessary to determine the most effective treatments; and

WHEREAS, there is, however, a long history of mismanaged and badly implemented technological change in many industries resulting in waste, inefficiency and failure to optimize the potential benefits of the new systems often because the end users of the new technologies were excluded from the design process and implementation planning; and

WHEREAS, the same pattern is being followed in many health facilities with decisions about new technologies being made by those with little experience and knowledge of the actual work processes; and

WHEREAS, in order for the potential benefits of the new healthcare technologies to be fully realized, nurses and other members of the clinical team must have a meaningful voice in the selection of equipment, design of the system, training and implementation plans:

RESOLVED, that the American Federation of Teachers advocate for the following "best practices" to be widely disseminated and to be included in contract language, standards, regulations and recommendations governing the introduction of health information technology:

• Representatives of job categories that will use the new computerized systems should be engaged in discussion about the purpose and design of the systems before a request for proposals is issued and before purchasing decisions are made. Representatives of frontline workers should participate in all relevant decisions including selection of hardware and software, selection of training packages and development and application of training and implementation plans.
  
• Where unions are present, representatives should be selected throughout the unions. The union should be given advance notice of any proposed introduction of new technology. Through all stages of design, development and implementation, management should negotiate with the union regarding the impact of the technology and related changes in work processes on wages, hours and working conditions.
  
• Representatives of frontline workers, together with management, should be provided with the education necessary to make informed choices about the design and implementation of the system. All those involved in decision-making should have equal access to system designers, technical support staff, consultants and advisors.
  
• System designers and implementation planners need a thorough understanding of current work processes within which health information technology systems will be implemented. This is a key reason that workforce representation is critical. Computerized systems should not lock into place nonfunctioning or ill-designed work processes for which formal and informal work-arounds have been developed.
  
• Changes in work flow that will result from the new systems should be clearly explained and discussed with frontline workers prior to implementation. Management must recognize and acknowledge that the new systems will produce major changes in the traditional work flow. Difficulties adjusting to the new systems should be viewed as opportunities for education rather than disciplinary action.
  
• Training programs should recognize the varying degrees of computer competence in the current workforce. Training programs should be based on an assessment of current skill levels, and education plans should be appropriate for every level of knowledge and competence.
  
• Workforce training and education programs should include a full description of the purpose of each component of the health information system and an explanation of how it will be used to improve the quality of patient care.
  
• Workers on all shifts should have the same level of access to training, resources and support before, during and after the system's "go-live."
  
• Additional staff should be provided when nurses and others are being trained on the new systems and during the implementation itself so that the health and safety of patients and frontline caregivers are not compromised.
  
• No systems should be implemented that do not allow manual overrides of the system when necessary. Prior to implementation, clear policies should be developed on downtime documentation.
  
• The design and development of electronic health systems continues long after the initial "go-live." The principles of inclusion, continuous training and full explanation of the impact of all changes on the quality of patient care should remain in force as the system evolves.
  
• A permanent labor-management committee, work group or other structure should be established in each facility to oversee design and implementation of the technology, to correct problems, to process feedback from end users, to consider suggestions for improvements and to plan extensions and adaptations of current systems. Where end users are represented by a union, the union should select the representatives to serve on the committee, work group or other structure.
  
• Electronic health systems can be valuable tools for reducing medical errors, improving the quality of patient care and providing necessary data for development of evidence-based improvements in patient care. Electronic health systems should not be designed as tools to enable reductions in workforce or promote personal surveillance of the workforce beyond the standard audit and accountability processes.
  
• If workers are displaced by the new systems, every effort should be made to retrain them for equivalent positions within the institution. When that is not possible, services should be provided to assist them to apply and/or train for new jobs.