Saturday, June 10, 2006

Technology and Its Discontents

Healthcare and technology almost seem inseparable these days. Everywhere one turns, technology has improved (and often complicated) healthcare workers' and patients' lives. Where are the points where technology breaks down, where human interaction is negatively impacted, and where technology gets in the way? Where also are the places where the enhancements provided by technology are undeniable and documentable? And when are new technologies simply not worth the cost of their operation, both personal and financial?

I've never worked in a hospital, but I've spent enough time visiting hospital floors to understand that technology rules the roost, whether it's the documentation of vital signs or the administration of meds. The hospital with which my agency is affiliated uses laptops on wheels which the nurses roll through the corridors, entering meds and patient data, as well as retrieving orders and consults. Medications are dispensed from a robot in the nurses' station wherein the nurse enters an ID code and PIN with the corresponding patient data, and the med is then delivered on a tray, labeled with the medication strength, dose and frequency, as well as the patient's name and date of birth. It's like a pharmacological ATM but the currency ranges from atenolol to zithromax rather than in tens of dollars. It has apparently cut down on medication errors enormously, a benefit that cannot be denied

At the clinic where my agency is housed and with which we are even more intimately affiliated, the hospital system is piloting an electronic medical record. Our clinic "went live" last week---only one of three sites to do so at this juncture---and IT staff swarmed over the place for the first five days, providing technical support to the often frustrated doctors as they began using the system in real time. Will it improve patient care, productivity and job satisfaction? The jury is out, and we all understand that the learning curve is high, with the first six months a party of trial and error. The benefits of prescribing electronically with the computer system automatically faxing prescriptions to the chosen pharmacy was a great selling point to the docs, who will have less and less need to use hand-written prescriptions which can be lost (and illegally altered).

Within our agency, we have two programs. The one for which I endlessly toil uses an electronic database for tracking medications, some lab values, and demographics, but our visit notes are still hand-written in prehistoric fashion. We are all required to carry company-issued cell-phones and alpha-numeric pagers, and almost all of us carry Palm Pilots with our schedules, address books, and medical software which we download from the Internet. (I highly recommend ePocrates, a free program which allows one to carry the entire list of FDA-approved medications with dosages, side effects, interactions and costs, not to mention herbs and home remedies, insurance formularies, as well as additional software for diagnosis and treatment available for a fee. There is also a desktop version of ePocrates available for free.) Our other program uses an interactive electronic medical record which we occasionally envy, except when it crashes and we hear no end of complaints from the other side of the office. At times like those, I like my handwritten notes just fine, thank you.

On any given day, I carry my company-issued and mandated pager and cell-phone which we must have on and within reach from 8:30am until 5:00pm when the on-call nurse takes over. I also carry my aforementioned Palm Pilot, pens, business cards, sticky notes, and keys, and that's just the equipment that I actually have on my person all day. We each also have a networked desktop computer. That said, we all feel fairly content with our technological set-up, although we sometimes feel burdened by it at times.

Our manager has decided to purchase each of us a "Blackberry", a pocket device which performs the combined tasks of beeper, cell-phone, Palm Pilot, and wireless email access. We'll be expected to carry (and not lose) these $500 toys as we go about our daily work, hi-ho. But there is mutiny in the wind. Over the last few years, a number of us have lost our cell-phones and pagers and Palm Pilots from time to time. We all know pagers and phones are a dime a dozen, made with throw-away materials, easily and relatively inexpensively replaced. Those of us who choose to carry Palms do so at our own risk and expense since they're not essential to carry out our duties. I have argued---to no avail---that these Blackberries are too expensive, too risky, and bound to eventually be lost, stolen or broken. Our supervisor has informed us that we will need to be especially vigilant since we will be personally and financially responsible to replace a lost device. This is a point at which I say,"If it's not broke, don't fix it." Up until now, if someone loses a cellphone, they at least have a pager through which they can be reached, and vice-versa. Now, with an all-in-one device, a loss will mean the individual loses phone and paging capablilites along with Palm Pilot interfaces, and the cost of replacement is astronomical and born by the employee. This technological change has us up in digital arms.

Change---whether it be the development of the wheel, the advent of the cellular phone, or the invention of the outdoor gas grill---brings with it challenges and hopes for the future. Tired of charcoal and lighter fluid, the post-modern hunter-gatherer can simply buy a tank of propane and barbecue the night away with no muss, no fuss, and no gaseous fumes. That same hunter-gatherer can roll along the highway on rubber pneumatic tubes at 80mph, talking to far-flung friends and family as a way to avoid making tedious telephone calls at home (except where cell service is spotty, that is--"Damn you, T-Mobile!"). Now, the itinerant nurse, continually tethered to the office by an electronic umbilical cord, is forced to adapt to a new technology which may be super cool, but offers very little in terms of added value when measured against calculated risk and relative cost. This nurse, using the wheel and the cell-phone to offer individualized care to those in need, now faces the daunting task of protecting and obsessing over a device with which (s)he would rather not be encumbered, especially in light of the substantial financial cost of momentary forgetfulness or disorganization. At this moment, unnecessary change is maddening.

What then does this itinerant nurse do? Refuse to carry said device with risk of being told there is no other choice? Take the risk of carrying said device and spending several days' wages to replace it if lost? Or does the nurse band together with his or her coworkers and demand the right to be part of the decision to make such drastic and apparently useless change?

These are the questions I ponder this weekend, wondering how my coworkers and I will handle this dilemma. We all agree that technology is useful and convenient in many forms, and adapting to new technologies simply de rigeur in this digital world. But is such adaptation palatable when delivered with the force and finesse of an unwanted intubation? Stay tuned, dear Readers, as this battle of wills dramatically unfolds in an office not-quite-near you.

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