Health information technology, or health IT, is not widespread, but it will be coming to hospitals and healthcare facilities eventually. While other industries have been able to harness information technologies to the benefit of consumers, healthcare has been slow in this process. Currently, only 20 percent to 25 percent of hospitals and 15 percent to 20 percent of doctors' offices have a health IT system.

Health IT comes in many forms, including electronic health records, clinical decision support systems, and computerized provider order entry systems (for electronic prescribing and order creation), all of which allow healthcare providers to manage medical information that can be shared securely with healthcare consumers and other providers. The most common form of health IT is the electronic health record. The key components of the electronic health record are providers' notes, laboratory and radiology results, and electronic prescribing.

When it is done right, health IT can significantly improve the quality of care, prevent medical errors, reduce healthcare costs, increase administrative efficiencies, decrease pa-perwork and expand access to affordable care.

AFT Healthcare believes locals need to make sure their members have a say in the implementation of technology. The best way to do that is to play an active role in labor-management committees when they discuss health IT issues and strategy.

Frontline healthcare workers are a critical part of the successful adoption of heath IT. "It is important for healthcare workers to get involved to ensure that the system supports the work process," says Westra.

"Making your voice heard has a significant impact on patient care," says Bonnie Westra, PhD, RN, assistant professor at the University of Minnesota's School of Nursing.

Unfortunately, the most common problem she sees with implementing health IT is the lack of worker involvement.

"Nurses have a lot of power in the process," says Westra. "They can help management look at what's working and what's not, and fix the system accordingly. You don't want a system that is going to replicate what has been done on paper. You want it to match the way nurses work and think."

The learning curve
It has been a little more than a year since the Albany (N.Y.) Visiting Nurses Association converted from paper to electronic records. Mary Goyette, president of the Albany VNA/Federation of Nurses and Health Professionals, was excited about the promise of a new technology, but soon discovered the pitfalls that can come with it.

"I was really looking forward to the switch," says Goyette. "There is a lot of redundancy in medical charting, and I thought computerizing would reduce this but it hasn't."

At least half of the nurses had no computer experience, including Goyette. In her opinion, the training the hospital provided was inadequate and did not take into account the range of computer experience the nurses had.

"We were all trained together," says Goyette. "You can't take someone with no computer experience and put them in a class with computer literates and expect they will be off and running."

"I don't think the hospital did the best it could in implementation. It has been a trying year and some of us are still struggling," she says.

Also, the nurses did not get enough time to become comfortable with the equipment and software. "We were given laptops and went through training, but we were not given any time to practice," Goyette points out. "It was months before I knew how to refresh my screen."

Goyette says she is much more comfortable with the system now because she took the time to explore the equipment. "I learned a lot on my own, but some nurses are afraid to try anything new with the computer."

The union addressed many of the problems that stemmed from the new system. For example, in the beginning, the nurses were encouraged to synchronize patient records with the VNA while they were at home, but the process took too long. "We were not compensated for the time it took to synch records, even though it interfered with our personal lives, says Goyette. Now, the union recommends that nurses do their synching at work.

The lack of proper training led Goyette to call for a labor-management meeting where she asked for copies of the training manual. Goyette also fielded complaints from nurses who found that their desks and chairs were unsuitable for their laptops. "We had nurses propping laptops up on phone books," recalls Goyette. At the union's request, the hospital gave nurses desks and chairs that were compatible with their new equipment.

Integrating IT
Whether electronic health records are helpful depends on the approach taken by the hospital, says Adam Seth Litwin, a researcher for the Institute for Work and Employment Research at the Massachusetts Institute of Technology.

"Union leaders can move hospital management in the right direction when it comes to health IT by calling for a system that will benefit everyone—not just workers but patients too.
"Partnership on some level is important. Without worker representation it could take a long time for information to travel up to management," he says. "Nurses are so concerned about what is good for the patient-they are more apt to be tolerant of a bad situation, to make the best out of a bad situation."

Hospitals and their healthcare workers must consider and discuss several key elements before implementing the new technology, says Litwin. Workers should feel engaged and involved in the planning and outcome of any new system that will be put in place, he explains. In addition, they should be assured they will not be replaced by technology. Most important, time and money should be spent upfront on the new system and its implementation.

"IT's success depends on how well it's integrated. It's important to take things slowly and deliberately," advises
Litwin. "When employers impose technology with little or no attention to employment relations, the technology doesn't delivery anything close to its value."

According to Litwin, transitions are always rough. There may be a dip in performance at the beginning, but union leadership can be helpful in the transition by creating workplace structures for dealing with the frustrations of using new technology.

Not a quantum leap
In Burlington, Vt., Fletcher Allen Health Care is preparing to roll out a new technology system, and it is happening with the oversight of several nurses from the union, the Vermont Federation of Nurses and Health Professionals. "Our hospital created a committee of nurses from around the hospital and the union had to approve their choices," says VFNHP president Jennifer Henry. "We stay in touch with this group to make sure they are using their union-nurse voices," says Henry, noting how easy it is to start thinking like management in meetings.

The union has taken the additional step of setting up a communication network with the implementation team to stay updated on progress and share with other members.

The union's fight will be to make certain they have a system that accommodates how we work, not the other way around, Henry explains. "It's a different world for nurses. I don't want a system that changes what we do. I'm a professional. I can make an assessment," she says. "Patients should always come first—not documenting."

"Technology needs to be flexible enough to allow room for professional judgment," says MIT's Litwin. "That flexibility should be incorporated at the beginning of technology and workforce planning."

The bottom line is that, when it comes to health IT, everyone has to be on the same page, says Westra, from the University of Minnesota's nursing school. "Everyone should have realistic expectations and there must be consistent communication. Recognize that we all have visions of where we want to go, but it is not a quantum leap. That's why it's so important for staff to be involved and for them to clearly articulate: This is how we work."

A change for the better
Beth Pardee's hospital, the Indiana (Pa.) Regional Medical Center, transitioned to health IT nearly a decade ago, and it took most of the decade to turn the system into something nurses could use. The nurses were involved in some of the decision-making from the beginning. Although the transition from paper to computer wasn't easy, the nurses did have their say.

Most of the 240 registered nurses had limited experience with computers, including Pardee. She resisted the change
at first, but she is happy with the system now.

"I'm old-school," says Pardee. But times have changed and Pardee, a telemetry nurse at with 29 years of experience under her belt, understands that. "The philosophy is different now, we no longer chart the way I was taught-but the new system allows us to incorporate some of the old ways."

The nurses learned to maneuver the system and then helped each other by sharing the things they learned.

"There are still some glitches, but the nurses have actively worked at making the system more ‘nurse-friendly,'" notes Pardee, who is a member of Indiana Hospital Professional Employees Association-Healthcare PSEA/AFT Healthcare. "The change is better ... charts are legible. Now we just need to get the doctors on board so it doesn't take three nurses and a secretary to determine the doctor's written orders."