Yesterday decision-makers met in a White House summit to chart a way toward health care reform. But the first major health care initiative of the new administration is already in process, and Newt Gingrich—the leader of the “Republican revolution” that took over Congress in 1994—thinks it’s great.
Part of the federal stimulus package, the HITECH Act (Health Information Technology for Economic and Clinical Health Act) includes $19 billion to promote health information technology and in particular electronic medical records. Gingrich calls that $19 billion one of only two good things in the stimulus.
And the health information technology vendors are raring to go, ready to cash in on this windfall. Already their websites are full of offers to help health care organizations tap the big pools of funding.
Tech changes in health care will accelerate significantly, and it’s taken for granted that this tech infusion will cut costs and improve quality—without an oversight mechanism, without worker input, without any conversation about the impact on the health care workforce, without a real plan for reforming health care.
As a friend once said: “If technology is the answer, you are probably asking the wrong question.” And focusing on the wrong problem.
If Newt Gingrich and Barack Obama are giving the same answer, we know that something is wrong.
Powerful interests, with an eye on markets and dollars, have been successfully pushing technology as the answer for our health care woes for a long time. George Bush mentioned it in several of his State of the Union Addresses, and now President Obama is on the program.
Many politicians fall for the allure of simplistic technical solutions to a complex social problem. They fail to recognize many things.
Technological fixes tacked onto failed organizational structures can just make those structures worse. After the voting catastrophe of 2000, for example, many localities tried to throw technology at the problem. Where are those Diebold electronic voting machines now, and where is the money taxpayers spent on them? Once money is spent on technologies, taking on the real systemic issues can become more, not less, difficult.
IT vendors are looking to get their piece of the public pie, and not looking out for health care. They will be hard at work pushing health information technology designs in directions that meet their needs for profit.
The health care workforce stands to lose out. New workplace technologies are almost always applied in ways that undermine skills, monitor the workforce, eliminate jobs, and increase top-down control and standardization. Standardization is particularly problematic in a care setting. Already, nurses complain that computer systems are poorly designed and difficult to use, and lament that they spend valuable time looking at the computer screen when they should be looking at their patients.
When the workforce is kept out of technology decision-making, two things are ignored: workers’ needs and workers’ knowledge and understanding of the actual work process.
THREAT AND OPPORTUNITY
The fact that so much public money is being spent represents both a threat and an opportunity. The threat: tech change that’s bad for both patients and workers will be massively accelerated. This is almost inevitable. Electronic medical records are so much more than a digital file. They are the digital backbone for a technological transformation of health care delivery, driven by profit rather than care. The HITECH Act mentions, for example, remote patient monitoring, telemedicine (web-based health care) and self-service applications (ATMs for health care), among other technologies.
The opportunity is that, with a labor-sensitive administration, the workforce should be able to have a voice in the policies that will soon be implemented.
But this will not happen without concerted and rapid action. What should labor be doing?
Workers need a place at the table. Health information technology policy and standards committees are established by the HITECH Act. Only one member of the Policy Committee is required to be “from a labor organization representing health care workers.” Unions need to demand more.
Unions need to be ready, and they aren’t. Unions are, in general, ill-prepared, to play a role in a giant tech change process. They are handcuffed by years of accepting “management rights” and hampered by a lack of practical experience in inserting workers’ voice into technological decision-making. Unions need to quickly develop their capacity to bargain over tech change.
Funding is needed for training so that workers can be involved in developing and implementing tech change. Portions of the $19 billion should be set aside for unions to develop mechanisms for worker input.
Analysis of impact on the workforce must a part of all implementation. The Act currently includes no mandate to look at the impact of health information technology on the health care workforce, or even to listen to input from that workforce. Unions should be involved in gathering workers’ voices for ongoing evaluation of the impact on workers.
Technologies should serve health care reform, not prop up the existing system. This is a time when sweeping reform of the health care system is presumably on the table. But new technologies that assume continuation of a profit-based, insurance-based system could be a conservative force. Electronic medical records, for example, are touted as a way to eliminate “paper-shufflers” and unwieldy administration—ignoring the much more effective approach of eliminating insurance companies in favor of a single-payer plan.
We have a model for looking at the social impacts of new technologies. Over the last several years, the federal government has funded nanotechnology to the tune of $1.5 billion per year. Tens of millions of dollars have been set aside to examine the social impacts and societal implications of nanotechnology. Why isn’t this happening with the electronic medical records initiative?
Newt Gingrich’s involvement is especially ironic. His Center for Health Transformation has two “Hot Topics!!” on its website. The first is enthusiastic support for the HITECH Act’s $19 billion for health care technology. The second is an attack on the Employee Free Choice Act.
Do we get the point?
Charley Richardson teaches at the UMass Lowell Labor Extension Program.
