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Noticed how little in the healthcare debate we hear one word that should be at its center – care?

Nurses have noticed, and are alarmed at worrisome changes now putting patients at risk.

A new video from National Nurses United starring the decidedly non-personal “FRANK” is a humorous or not so humorous glimpse into one of the most troubling mutations.

Largely away from the media focus on websites and insurance markets, hospitals, with a helping hand from insurers and other corporate interests, are, dramatically altering your ability to get the care you need.

They’re even re-defining what it means to be sick.

For those reasons and more, NNU has launched a public advocacy campaign as an alert about sweeping changes in the healthcare delivery system that are occurring far outside the media spotlight, but frighteningly real to nurses and many patients alike.

To highlight these startling mutations, NNU is sponsoring radio ads, videos, legislation, and holding rallies, marches and other street actions across the country to warn patients and communities what they may face the next time they are at their most vulnerable.

One of the biggest dangerous developments is the proliferation of unproven medical technology.

“FRANK” and company shine a light on computer care at the bedside with only a modicum of hyperbole.

You may think “Frank,” as in “Formatted Recognition Analysis, Non-Human Konclusion,” bears little resemblance to reality.

But every day RNs see “clinical decision” type systems on which hospital executives are spending hundreds of millions of dollars that spit out an instant diagnosis, prognosis and treatment protocol that may bear little correspondence to your actual condition and treatment need.

Increasingly, the computers rely on a concept known as “population health,” in which the diagnosis, prognosis and treatment recommendations are based on factors common to a broad swatch of similar people.

When the patient in our
 “Personalized Care” ad
asks for a registered nurse – not the computer and its algorithms – the hospital executive blandly explains the algorithms “tell us what disease you should have based on what other patients have had.”

“That makes no sense. I’m not other patients. I’m me!” our patient says crying out for help.

“Look it’s not all about You!” the executive retorts. “We’ve spent millions on algorithms, software, computers.”

So, you’re only as sick, as someone else with a similar symptom, regardless of what other health problems you may have. And your outlook for recovery, and what care, if any, you receive, is increasingly determined by others that fit your “profile,” not your own health status.

Thus the crux of this trend with individualized care fading away as hospitals spend instead on experimental medical technology.

Much of the medical technology is being promoted as the cure all for everything that ails our broken healthcare system from medical errors to how to cut healthcare costs.

Too often technology fails on all those counts. Unsafe staffing is a far more common cause of medical errors, and, as noted, when hospitals spend millions, even billions system-wide, on unproven technology, they are driving up costs, not cutting them.

Spurring this on are are substantial federal financial incentives within the 2009 stimulus bill. The federal government has handed out more than $23 billion in incentive payments to hospital implementing Electronic Health Records systems, which are linked to the bedside computers, since 2011, it was reported last week.

It’s worth emphasizing that the device manufacturers and other industry lobbyists pushed for the federal handouts, as the Washington Post noted, “in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery.”

Many hospitals are lurching past the federal encouragement – and federal penalties for non-compliance with putting the EHRs in place – to pursue their broader goals of displacing the professional judgment of RNs at the bedside and the critical role they play in advocating for the patient’s health, not the employer’s bottom line.  

Our video has a happy ending, when an actual registered nurse, Bonnie Castillo (above) enters the room and tells the hospital billing director, “FRANK,” and “Steve,” the “highly cost-effective computer technician” to “Move! Now!,” get out of the way and get human help.

The ads are a reminder that “when it matters most, insist on a registered nurse.” That’s one way to respond to the latest assault wave on care from a depersonalized system that is far more focused on its profits than your care.

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Comment Preferences

  •  Tip Jar (19+ / 0-)

    National Nurses United, (AFL-CIO): the new RN "super-union" representing 150,000 nurses from all 50 states!

    by National Nurses Movement on Mon May 19, 2014 at 02:11:39 PM PDT

  •  It's funny, but sad too (12+ / 0-)

    Here at this site, all of us are pretty much at ease with computers.  And there is a tendency to think that anyone who resists a larger role for computers is just some regressive luddite.  But, in health care, the computer is not just a tool.  It's a tool with an agenda and that agenda is to decrease and ultimately eliminate the role of human skill - both doctor and nurse - and the role of human caring.  All in the name of cost control.  Data is a powerful thing, but humans - especially sick humans - are not interchangeable parts that can be counted on to respond the same way to the same input.  We need to fight to keep the human role in all its aspects.

    "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verité et de la dire" Jean Jaures

    by Chico David RN on Mon May 19, 2014 at 02:37:19 PM PDT

    •  As someone who is "at ease with computers" (9+ / 0-)

      and far from luddite, I wouldn't trust computers with ANY mission critical tasks.
      I'm appalled by the idea of putting the control of the electrical grid online.
      Electronic voting, not even a life&death thing, nope.
      Publish my bankcard number on a hackable network (the Web)? I don't think so.
      Trust an algorithm to determine what several doctors so far haven't been able to agree on? Are you nuts?
      I'd be glad to have those doctors and nurses have all available information at their fingertips but not cut them out of the process.

      If I ran this circus, things would be DIFFERENT!

      by CwV on Mon May 19, 2014 at 03:08:56 PM PDT

      [ Parent ]

  •  I don't understand why you are trying to tie (7+ / 0-)

    Electronic Healthcare Records (EHR) to computerized diagnosis and treatment programs.

    The big push for EHR is for a very important, patient-centric reason: doctors can only diagnose and treat a patient properly when they have the correct information about the patient.

    EHR access ensures the doctor sees the current and prior medical history on the patient AND that the data is indeed about this particular patient.

    For older patients especially, transfer from home to hospital to skilled nursing care to adult-family home-based care and back again can often result in lost records or faulty, out-dated information on medications - which can lead to bad outcomes or death of the patient.

    None of which has anything to do with replacing nurses or physicians with diagnostic-algorithm enabled devices.


    "I like paying taxes...with them, I buy Civilization"

    by Angie in WA State on Mon May 19, 2014 at 03:01:58 PM PDT

    •  I think I agree (2+ / 0-)
      Recommended by:
      FindingMyVoice, kaliope

         I've been retired for a few years, but EHR / EMR have many great attributes.  

           From my early years in Healthcare:   when you hear hoof beats, think horse....not zebra.  

           But when it proves not to be a horse, keep thinking.    

           Great diagnosticians are worth their weight in gold - unfortunately, they are becoming a dying breed.    

    •  But there are problems (2+ / 0-)
      Recommended by:
      Another Grizzle, cotterperson

      In an attempt to save money many facilities have medical records employees enter resident information into the EHR. When this is just a matter of scanning records into the record, there is no problem.

      The mistakes come when a MR person enters medication into the system.

      It is not uncommon for medications that were ordered EC or ER to be entered wrong. Or the reverse, where the resident medication is ordered ER Q8 hrs.

      Lab results are another issue. When the MR employee scans them into the system, faxs them to the MD then files them away they don't get reviewed by nursing in a timely manner. When the nurse recieved the hard copy first, we were required to note on the lab that we had reviewed them and initial the lab. Now sometimes our first hint of a problem is when the MD calls.

    •  EHRs are often coupled with diagnostic "tools" so (2+ / 0-)
      Recommended by:
      AJayne, semiot

      I think there is a credible link to EHRs and computer diagnoses that this diary is exploring.  In my experience in health care, watching the takeover of computers over the last 30 years (takeover is a better term than implementation in many instances) the human decision making process has been slowly nudged out - both in bedside care and ancillary services (labs, radiology, etc).  Patients are more frequently diagnosed on algorithms which do not take into consideration personal history (a 29 y/o female heart attack?  no way, statistics show that it is less than "10%" likely so we won't even consider it or check labs, etc, odds are it is just indigestion.  Autopsy showed that she had a congenital problem?  oh well, it still fits the statistics: we win some, we lose some, can't control for outliers).  

      While I do believe that computers and logical decision making pathways are useful, they become dangerous when they take the place of critical thinking by those who we entrust to care enough about us to spend a few minutes seeing the person in front of them and not looking to a computer screen to do the job for them.

      I am wary of the way that medicine is going in regards to this issue and I think the nurses are right to start balking at the ubiquitous infiltration of computer diagnosticians.  This is not simply fearing replacement and losing jobs; this truly is about advocating for the patient.

    •  Not all created equal (4+ / 0-)
      Recommended by:
      AJayne, semiot, Mdfog10, katnurseadvocate

      So here are some items to think about.
      There are very good things in computerized records - with a few caveats about security etc.
      Good:
      1. That I can call up quickly things like the doctor's history and physical from a previous admission.
      2. That I can access an x-ray or lab result from anywhere with a terminal rather than having to go to where a piece of paper is or wait for it to be brought to where I am.

      Not so good:
      first a general word: human beings, even with the best of intentions, respond to incentives.  If you make it just a little bit easier to do it wrong and just a little bit harder to do it right, more people will do it wrong and fewer people will do it right.  We might wish it were not so, but it is and always will be.
      So: You are in a hospital room 2 days post surgery and 5 hours since your last pain med and your pain is beginning to increase.  You put on your call light and a disembodied voice responds.  They ask what you need and you say you need pain medication.
      Unbeknownst to you, your nurse has just logged into a computer program to chart some data on another of her 5 patients.  In order to do this, she had to log onto the work station, then log onto the server, then log onto the particular program she wanted - this is, by the way, the exact truth of how it works at my hospital.  Each of those log-ins required a password and a 30 to 60 second wait.  Now she's gone through 4 screens in the program to get to the one she wants and has just started to chart what she needs to chart.  It will take her 10 minutes to do it.  She gets the word that you have asked for pain medicine.  If she leaves the computer workstation to go get your medicine, she is required to log out of the station and she will lose all the time she has spent getting into the necessary screen.  So: is she going to jump up and get your pain med, or is she going to finish her charting first?  In the day of paper charting, she would have made your pain her first priority.  But now?  quite likely not.
      next scenario: Your doctor has just examined you and asked about how you are feeling.  He goes to a computer work station and logs on.  He's been on duty for 10 hours, and has 4 more patients to see before he can go home.  For each body system - heart, lungs, digestion, neurological, etc., he is presented with a menu of descriptive terms to categorize how you are doing.  He can choose one with a check box or he can type in his own narrative.  For some of the systems, one of the descriptors is just right.  But for others, none of the descriptors is quite right, but one is sort of close.  He can either take one second to check the box with the one that is sort of close or he can spend a minute typing in a description that is exactly right - which is he going to do?  You would hope for the second, but human nature argues for the first.
      This is only scratching the surface, but it is reality.  When I walk onto a nursing floor today, all to often I see nurses staring into computer screens, not nurses caring for patients.

      "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verité et de la dire" Jean Jaures

      by Chico David RN on Mon May 19, 2014 at 08:25:20 PM PDT

      [ Parent ]

      •  Yes. All technologies offer us enablings and (1+ / 0-)
        Recommended by:
        katnurseadvocate

        constraints - they make some things easier to do and others harder. Unfortunately in introducing technical systems it is quite common for potential constraints to be ignored or for those who point them out to be derided as anti-technology whiners or luddites.

        Courage is contagious. - Daniel Ellsberg

        by semiot on Tue May 20, 2014 at 05:09:32 AM PDT

        [ Parent ]

  •  We need nursing care (6+ / 0-)

    Hospitals spend millions on unproven technology while cutting nursing staff.

  •  Patients are not widgets.... (1+ / 0-)
    Recommended by:
    Mdfog10

    .....and one size does not fit all.  I am an intensive care unit nurse.  I am capable of using a computer.  My work now demands I care for a computer.....and the very sick patient comes second. The time I spend at the computer has replaced the time I use to spend with my patients......giving them a bath, which is a good time to do a head to toe assessment, and  keeps them clean.  I can talk with the patient and educate them about what is wrong with their body, and what is happening with their care when providing a caring bath.  Note the word "care" here.  This change and take over of our healthcare by IT is destroying nursing practice and safe patient care.  The boxes we check go directly to billing....we are billing agents.  2/3's of my time is spent with this task master computer, which tells me what to do.  Why do I need the ability to think critically any longer?  Why would anyone need a nurse?  The computer knows all....NOT!  It use to be the other way around....most of my time was spent with the sick patient and their families.....not any more.  Wonder why your loved one in the hospital smells bad, and feels neglected?  Look to the nurse who sits staring into the computer....they can tell you.  If that nurse does not march to the IT drum they will be disciplined, and fired.  This is what happens when healthcare becomes a for profit business in this IT age.  This is what happens when healthcare is directed by health insurance companies.  Did you know those health insurance companies wrote the PPACA?  There is a huge difference between healthcare "insurance", and healthcare "access".  Having insurance first does not mean one has access to care.

    Without a struggle, there can be no progress. .........Frederick Douglass

    by katnurseadvocate on Tue May 20, 2014 at 08:28:56 AM PDT

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