WHEREAS:

The American Recovery and Reinvestment Act of 2009 includes many measures to modernize our nation’s infrastructure and amends the Social Security Act by establishing incentive payments to eligible professionals (EPs) and eligible hospitals to promote the adoption and meaningful use of health information technology (HIT) and electronic health records (EHRs); and

WHEREAS: 
The Health Information Technology for Economic and Clinical Health (HITECH) Act creates incentives in the Medicare fee-for-service, Medicare Advantage and Medicaid programs for demonstrating meaningful EHR use, and payment adjustments in the Medicare programs for not demonstrating meaningful EHR use. Under all three EHR incentive programs, EPs and eligible hospitals must utilize “certified EHR technology” if they are to be considered eligible for the incentive programs; and

WHEREAS:
The incentive payments are part of a broader effort under the HITECH Act to accelerate the adoption of HIT and utilization of EHRs; and

WHEREAS:
The priority of the Health IT Policy Committee, a federal advisory committee, is improving quality, safety, efficiency and reducing health disparities. The committee identified the following care goals: provide access to comprehensive patient health data for patient’s health care team; use evidence-based order sets and computerized provider order entry; apply clinical decision support at the point of care; generate lists of patients who need care and use them to reach out to those patients; and report information for quality improvement and public reporting; and

WHEREAS:
The introduction of new technology into the health care workplace will significantly alter the way that front-line health care workers record and document the patient care activities they perform; and

WHEREAS:
Development and implementation of technology should be a multidisciplinary effort with front-line workers involved in the process. In many health care systems, however, the parameters of a new system are defined by the business-side and the technology-side, with little input from clinicians.  Decisions are made to facilitate billing rather than care delivery. Millions of dollars have been wasted on systems that were incompatible with the health care duties and tasks; and

WHEREAS:
Planning and development of electronic systems have not focused on nursing-centered activities. When data is analyzed, nursing tasks are invisible and, therefore, not counted and not measured when quality indicators are measured; and

WHEREAS:
There are many benefits to HIT, including the promotion of better care coordination, reducing medical errors and providing data for research to improve quality. HIT can reduce the amount of time nurses spend on routine, non-direct care activities and improve patient safety; and

WHEREAS:
There are numerous workforce issues as a result of HIT implementation, including inadequate training and preparedness before “going live,” deskilling of nursing activities, the potential for Health Insurance Portability and Accountability Act (HIPAA) violations and accusations of fraud when information is coded incorrectly; and

WHEREAS:
There is a lack of continuing support, engagement, and involvement for clinicians, most notably nurses in post go-live changes in work flows, system content, utility, functionality and process improvements.

THEREFORE BE IT RESOLVED:
That AFSCME International engage with the federal agencies that are developing criteria for HIT systems to ensure that the voice of front-line health care workers is heard; and

BE IT FURTHER RESOLVED:
That AFSCME assist affiliates in educating their health care members about scope of practice, licensure and privacy issues that arise as a result of implementation of EHRs; and

BE IT FURTHER RESOLVED:
That AFSCME support affiliates that represent workers in health care settings by providing educational materials, information on funding opportunities and implementation updates to their members about the HIT activities of the federal government; and

BE IT FINALLY RESOLVED:
That AFSCME work in collaboration with other health care worker unions to collect model contract language and to develop recommendations and best practices that can be disseminated to affiliates.

SUBMITTED BY:
Kathy J. Sackman, President and Delegate
Barbara Blake, Secretary and Delegate
UNAC/UHCP/NUHHCE, AFSCME Local 1199
California