Electronic Health Records

EHR backlash: What happens when your staff rebels?

There’s a problem brewing at Affinity Medical Center in Massillon, Ohio.  The hospital is set to go live on its brand new Cerner EHR system this weekend, but the registered nurses are feeling undertrained, short staffed, and unprepared for the transition.  Hospital administration doesn’t want to delay, after pouring time and money into their EHR adoption.  They’ve provided the training hours recommended by their vendor and have done their due diligence.  But can they dismiss the deep misgivings of their primary users?   Can they afford to ignore the nurses unions who are backing their members’ patient safety concerns?  What should a provider do when the staff simply isn’t on board after months of preparing for EHR implementation?

“EHR backlash” is a term that’s becoming all too familiar to physicians, nurses, and administrators mired in the EHR Incentive Program, facing an onslaught of federal requirements for EHR use, a parade of eager vendors hoping for their patronage, and a staff that often has mixed feelings about the design, usability, and workflow challenges of EHR software.

At Affinity Medical, those concerns include the fact that workstation placement requires them to keep their backs to patients while documenting, a system that has crashed with only 17 users online at a time, and a general lack of comfort with the amount of training provided to them on the system, which makes the nurses fear for their ability to do their job. “This is serious,” said Michelle Mahon, a representative based in Cleveland for National Nurses United, the union representing Affinity’s nurses. “[They] are concerned about patient safety.”

“I have been chosen as a ‘super user,’” Amy Pulley, RN said in a news release provided by the union. “I’m not sure what makes me ‘super’ with the limited training for this complex system that I’ve received. I’m concerned that the manner in which this technology is being implemented may pose serious disruptions in patient care.”  Pulley says that she has received the same training as every other nurse, but is expected to take time from her daily duties to directly teach others about the system without having any more advanced knowledge of the EHR.  The requirements have left her endoscopy unit short staffed.

While the hospital vigorously denies putting patients at risk or providing inadequate training for the EHR, they have refused to accept or reply to letters of concern put forward by the nurses union, which is threatening to take further action if the administration doesn’t hear them out.  “To suggest that Affinity has not provided sufficient training or adequate staffing — or that we would ever put patients at risk — is blatantly false and irresponsible,” says Susan Koosh, vice president of marketing and community relations at Affinity.

While Affinity has provided the 16 hours of nurse training recommended by Cerner, has set up computer labs for training, and is accommodating physician requests for further education before bringing the system online, the fact remains that the nurses are unhappy and feel unprepared.  Can the hospital deny that this is the case and force them to use the system anyway?  Patients are bound to notice nurses filling out their union’s “technology despite objection” forms every time they log on to the computer.  They’ll notice when the union goes to the local news.  How can other providers prevent such a sour situation from rearing its ugly head during their own implementation?

The conflict at Affinity is a perfect example of how important it is to bring staff on board early to ensure their comfort and familiarity with the technical and workflow requirements involved in EHR adoption.  Education about the upcoming changes should be provided well in advance of go-live, and bringing members of the clinical staff into meetings during vendor selection and implantation planning can do a great deal to ease the transition and make the primary users of the system feel listened to and involved.  A physician or nurse champion can explain the benefits of an EHR to their peers, and demonstrate the details of how the new system will affect their daily workflow.

While conflicts and reluctance are more or less unavoidable during a large-scale overhaul like an EHR implementation, working collaboratively with all members of the hospital before it gets to the point of union negotiators and public rebukes is critically important.  How Affinity Medical Center resolves its issues remains to be seen, but other providers can learn from their experience before getting trapped in a war between clinical staff and administration that has no winners.

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