Unsolicited Email From a Canadian Nurse Working in Healthcare IT

As a result of my writings I receive feedback from those involved in health IT. I reproduce this email from a Canadian nurse with her permission and without additional comment, because it speaks for itself about the ecosystem of healthcare IT:

Dear Dr. S,

I've reached your site while doing research about privacy and electronic medical records. I am an RN in Canada and have for the past 5 years been working towards integrating computer systems into health care practices. It has been quite the experience and ended with my being laid off.

I've only had opportunity to quickly scan a few of your articles as yet but see a familiar theme. When I started in this area, I was convinced practitioners and patients would reap enormous benefits from computer assisted care.

A major shortcoming I experienced in the IT community was a general lack of respect for the knowledge and experience that health care professionals bring to the table. I was not successful in explaining the health care industry's milieu and particular differences from the regular 'business world' to most of the IT professionals I worked with. My first accountability is to the welfare of my patients, not the ease of design and cost savings for the IT department.

As an RN working to improve efficiencies and reduce stress for my colleagues, my accountability is first to my workplace, not the IT departments ease of control and maintenance. There were small, quiet pockets of understanding and agreement with what it means to design systems that support work flow efficiencies and meet patient/provider needs. Sadly, these small pockets were not the 'deciders' in my workplace.

I am now in the process of re-evaluating my belief in the benefits of computer technology to patients and providers. Not because the technology is lacking, but because the IT community seems at odds with my professional responsibilities. (ie: there are no secrets: I must fully report any mistakes/incidents I make or uncover.)

I'll be reviewing your site more closely in the months to come. I feel better knowing I'm not the only one questioning what the heck is going on here and trying to pull back the curtain.

I asked her why she was laid off. Here is the reply:

Why did the team get laid off?

That is something we've all asked ourselves. So here is a bit of a long story....and remember it's from a jaded source.

The official reason is we were redundant. We found that hard to fathom because 2 of us are clinicians and there was a very small number of clinicians working on the EHR. We went around the leadership to get a job at hand done. We had very limited funding, no support etc. We suspect we were the victims of our own success.

(The acute care systems here get all the dollars and attention. Community and chronic disease very little. Why? Who knows when 80% of our time/resources is for CDM patients.) [chronic disease management - ed.]

We went to the clinical community and designed with them leading the way. We enlisted the stats dept to help us as well as all allied professionals working in chronic disease. We had key indicators, outcome measurements etc in a configurable dashboard so each clinician could choose the reports they needed, in the view they wanted.

There were drill downs to different levels of info. It was very helpful to managing a patient population as well as individual patients. It also allowed the clinician to review their practice, make 'to do' lists etc.

Our 3 IT experts were fantastic. They're only goal was to make the clinicians happy so patient care would be improved. It was a joy to work with them. We demonstrated it could be done as bpg ["baseline process guide", I think - ed.] - as much as there are in IT - would suggest. ITIL principles in practice led to overwhelming clinical engagement and approval.

Of note, the staff would not fully engage with the system in actual patient care until the leadership gave it complete approval. They said too many times they started using something, found it useful and then IT decided to decommission due to time required to support it. Indeed. That is what happened again.

Surprise...the clinicians protested the cancellation of the tool to the leadership and the government (which 'owns' health care here). The team started being laid off when the pilot project was finished and the political began.

But, to be fair, I and my colleague, a pulmonary therapist, were thorns in the IT leaderships side: we argued for what we believed in, we asked for performance indicators from the IT dept, we asked for ITIL lite for clinicians and Healthcare 101 for IT, we said quite clearly that IT is to support clinicians in their work by designing good tools, that IT in itself is not the goal or is their job to police clinicians. (Our clinicians refer to the IT help desk as the 'helpless desk' and IT security as the 'gestapo'.)

I was told several times to speak the official line: IT is good, clinicians need to listen to & trust IT professionals to make the right decisions. I was told we were to allow clinicians to voice their desires/needs but to steer them to the decision IT wants them to make. That was my job.

I disagreed: my first priority is patient care and it is my duty as an RN to stand up and speak out when something compromises patient care or negatively affects the provider's ability to provide quality care.

Either they didn't understand or it was of no benefit to the dept. Maybe I'm a difficult, demanding person to work with or just can't express thoughts clearly enough.

Funny now, but when I first started in the IT dept the RN's I contacted to say 'hey...what's the issues?' scoffed at me. They had absolutely NO trust in the IT dept or systems. I gave them pep talks and tried to convince them they were just afraid of change but change could be good for all.

I'd be their voice to make sure clinical needs were first priority.

One of the older RN's I knew then tiredly said I'd see what she was talking about soon enuf. Geesh. Could I have been any more delusional?

The RN's told me do not bring anymore pilots to their depts. They were sick and tired of being asked for their opinions when it was obvious to them no one listened or took them seriously. They'd say 'here's what we need' and IT would say 'uh-no'. Here's what you get.

The staff bluntly told me they do not have time for token engagement and get a rubber stamp of approval somewhere else. I was stunned.

IT has squandered much good will they once had. I expected so much more.

The number of RN's I know personally who believed in and worked for the EHR and now not only don't/won't but are skeptical of realizing any good out of it in our lifetime keeps growing. Yet, we all know health care will continue to be delivered with or without IT. Even if every computer in the world crashes and dies, health care will continue.

IT worries about paper cuts and we're dealing with a failing health care system that is harming people and exhausted, discouraged staff doing their best to save patients from pain, suffering and untimely deaths.

I know full well, that there are excellent IT professionals out there who could be a helpful part of the care team.

They just have to be very, very quiet if they want to keep their IT jobs. At least here and now. It seems, so do health professionals. sigh...it is what it is.

Thanks for listening. I know this is nothing new to you or your students. But the pain of it all is still quite fresh for me.

Venting felt good and I hope you find something helpful in there somewhere.

I replied that indeed my students, colleagues and other health IT workers facing similar circumstances shall benefit from this cautionary tale.

-- SS