“The people that are providing care are so frazzled and busy trying to get the care done and fill out the boxes [in the EHR], they’re less and less likely to override a clinical best practice because it takes time, so they go with the path of least resistance,” she says.
In the campaign, the NNU cites other EHR-related concerns, such as the potential for serious patient harm resulting from system outages, data entry errors or inadequate staff training. According to a press release, NNU members “witness first-hand the serious problems and unanticipated risks that patients are subjected to as EHRs and CDS systems are rolled out in our hospitals with too little training, testing or safeguards and even less thought to the potentially catastrophic consequences for patients of system errors and outright failures.”
These concerns have lead the NNU to blast the Food and Drug Administration for recommending just moderate regulatory oversight for EHRs, and to call on CMS to stop incentivizing hospitals to adopt EHRs through the meaningful use program “unless and until we have unbiased, robust research showing that EHRs can and do, in fact, improve patient health and save lives,” according to a NNU press statement.
The NNU is not the first to raise patient safety concerns regarding EHRs. A recent RAND report, while acknowledging EHRs’ patient safety benefits, also identifies them as a new source of medical errors, and Maryland’s department of health has similarly found EHRs and related apps to have contributed to incidences of patient harm.
However, recent studies have generally shown EHRs and related systems to improve patient care. A study in the Journal of General Internal Medicine and one conducted by the Robert Wood Johnson Foundation show EHRs to be associated with improved care, and a recent literature review in Annals of Internal Medicine found CDS systems were mostly associated with quality improvements in the 85 studies reviewed.
This evidence has not been enough to convince the country’s largest nursing union of the merits of EHRs and health IT, and like the ad campaign, highlights what is nurses’ greatest trait: unwavering focus on each patient’s care. They are not satisfied with technology being generally or mostly associated with improved patient care — this campaign is about not settling for less than technology that is assured to help every patient, every time.
But the false dichotomy set up by the “Nurse vs. Computer Care” ad, even if it is a spoof, sets the stage for the wrong fight. It’s not clinicians against technology; it can’t be, not in the paperless 21st century. The NNU should be focusing on getting the best technology into patients’ rooms, because the computers aren’t going to get out of the way.
