As medical records go online worldwide, there has been increasing scepticism amongst consumers regarding the safety of our personal data. In the UK, care.data was cancelled in 2016 after it was found that drug and insurance companies could buy data about individuals health histories, and Google’s Deep Mind could access records without patients permission. Australia is charging ahead with My Health Record regardless of warnings about cybersecurity concerns. Now Queensland Health’s ieMR (Integrated Electronic Medical Records), a new electronic system of documenting patients and health workers every move, will feed digital databases with ease.
However, of equal concern is where this is taking the workforce in a workplace that is meant to be founded on compassion and empathy. A workplace traditionally requiring human interaction. Yes, I’m talking about robots replacing health workers.
The brave new world of ieMR
The ieMR system integrates records from surgery, emergency, outpatients, pathology, radiology, medication management…pretty much every corner of health delivery, and feeds that information into the central database. It requires patients in hospitals to have an individual bar code on their ID wristbands. Nurses, doctors, and other healthcare workers have to swipe the barcode with smart cards in order to give medication, take vital signs, write progress notes, in fact, any interaction with the patient has to be ‘swiped’ before it can be done. If these tasks aren’t done according to a certain timeframe, the reason has to be documented in the electronic record.
Task oriented care
Before nurses studied for degrees in universities, the work was considered ‘task oriented’. University degrees promised a more ‘holistic’ form of patient care where a nurse could deal with a patient’s psycho-social needs as well as physical needs. Along the way more drugs, more technology, newer surgeries and procedures, and more complex pathology and radiology emerged with the promise of better treatment. But patients seemed to get sicker, and the paperwork that came with all these spangly new treatments ballooned. Time to complete the new mechanistic form of ‘care’ became scarce in the race to discharge patients as early as possible all in the name of cost effectiveness.
Completing the tasks of the day has been the priority of healthcare workers in hospitals since hospitals were invented. The holistic model was a nice idea, and if you look at any hospital checklists (there are numerous), that outwardly still appears to be the case. The truth is, ticking off checklists and performing onerous tasks are the reality of any health worker’s life. Compassion and empathy are merely an added bonus for the patient whose progress is primarily measured by clinical outcomes, such as reduced drug costs and reduced healthcare acquired infections, afforded by technological advances.
ieMR, AI and robots
ieMR is meant to reduce the amount of time healthcare workers spend documenting notes and free up time to spend interacting with patients. Fair enough. However, there’s no mention anywhere in the literature about the stressors placed on the humans using the system to get tasks done on time, the feeling of shame at having to record excuses for not having done tasks according to a timeframe, the constant flow and large numbers of temp staff from agencies who have little access to the extensive training to use the complex system and the frustration and stress that causes permanent staff, and the fact that outcomes are measured by numbers, with little importance placed on emotional wellbeing of patients or staff.
Dr Richard Ashby, CEO of Lady Cilento Children’s Hospital in Brisbane stated in an interview with Healthcare IT News, “That is just the foundational piece” when discussing ieMR. Machine learning, artificial intelligence (AI), and augmented intelligence are natural progressions in healthcare. In pharmacy and surgery where robots already perform healthcare tasks, it’s easy to see how humans can become obsolete, especially with AI in the mix. Machines that can learn (AI) could easily replace humans in certain healthcare settings. Townsville Hospital is already trialling a humanoid robot as a concierge. But what about nursing?
Kindness and Compassion
Research from Stanford University Centre for Compassion and Altruism Research concludes that kindness and compassion lead to better patient outcomes as well as having positive impacts on staff, and reduced costs. Traditionally, nurses, who are employed around the clock in hospital settings, are the people who spend the most time with patients and see them at their most vulnerable. Nurses are the ones delivering the most compassion. The problem with that is that labor costs are the largest single expense for running a hospital. Ergo, where there is little value placed on kindness and compassion, and enormous value placed on mechanistic, clinical outcomes to reduce costs, the door is open to robot nurses equipped with artificial intelligence to start looking after patients. The robot itself could be connected to the ieMR system so no room for error there. It would perform the tasks required by ieMR far more efficiently than any human nurse. With machine learning, it could anticipate its patients physical needs with far greater accuracy. Robots don’t need a salary and don’t take sick leave.
Trouble is, empathy is generally felt from the heart. Compassion comes with intuitively understanding another’s emotions and responding in a way that may defy the logical brain.
Give me a human nurse any day.