Ever since the 1996 enactment by Congress of The Health Insurance Portability and Accountability Act (HIPAA), healthcare professionals have been required to use electronic data systems in managing the treatment of their clients and patients.
In the 20 years since HIPAA enactment, ever-more intrusive forms of electronic record-keeping have been justified in terms of better care and more efficient practice, although most end-users believe that these systems are not superior to the more traditional forms that staffers utilized in very busy practice settings. All too often, in the extremely expensive process of building highly capable integrated information systems, what’s missing is not the technology, but the people—the crucial input of the people themselves, those in need of healthcare and those providing it.
One recent example of such difficulties is that of Boston-based Partners HealthCare, the largest owner of hospitals and clinics in New England, which has provided to its 68,000 employees a new customized software program intended for them to use in tracking patients’ medical care. First installed at two Partners hospitals about a year ago, the system is described by some of its users as a “disruptive presence” that results in more work for the staff and longer waits for patients. The system, which requires 24” screens to display the typical data-set, has recently been rolled out in three more Partners hospitals. Non-profit Partners HealthCare paid $1.2 billion to Epic Systems Corp. of Verona (WI), for the electronic info system. At Massachusetts General Hospital, where the new system is newly installed, Dr. Thomas J. Lynch Jr., CEO of the physicians’ group, commented, “It’s a huge change. It’s not an intuitive program; it’s incredibly complex.”
The new system may well work out for the best at Partners HealthCare’s hospitals and clinics; but in many instances the results are not positive. In developing new information systems, healthcare companies and their software contractors seem to prioritize the “hard” elements like data-collection and management processes over “soft” aspects like ease-of-use by providers and better overall experiences for patients. As built by contracting companies that are not part of a healthcare enterprise, the electronic systems will tend to reflect the software engineers’ expertise (and the business imperatives of the contractor) rather than healthcare professionals’ needs and values; but that is no excuse for a high-tech outcome that is low on human service. No health professional, in the name of data-collection and MIS, should be forced to adapt to a system that might go against effective practice or undermine the best interests of clients and patients.
Although it is obvious that a new, pervasive information system in a healthcare setting should reflect the values and needs of the end-users, this is an area that is ripe for advocacy. Clinical social workers should urge their employers’ contracting committees to set priorities for new info systems by reflecting on the profession’s values. They would benefit greatly from systems reflecting the person-in-environment approach and the primacy of client need. In such cases, the persons/clients are the system’s healthcare staffers themselves.