NEWS & LETTERS, April - May 2009
Workshop Talks
Computerization may deny care
by Htun Lin
Barack Obama's $800 billion stimulus package includes $20 billion, to be followed with another $30 billion, for computerizing health information. Analysts tout the value of hi-tech to bring quality healthcare, and point to medical groups like Kaiser HMO and Sutter Health, which have already digitized recordkeeping.
As one of the workers in that world, I know this is not the answer to providing quality care. We're drowning in technology. What's in question is its relation to actual patient care.
In reality, cost cutting, not delivering better care, is what motivates computerization. Karl Marx said labor under capitalism is split between abstract and concrete labor. For healthcare workers, computerization has intensified that opposition between abstract labor—the drive to cut costs and labor time—and concrete labor, providing quality care.
For example, recently a conscientious nurse expressed exasperation that enormous resources are expended for co-pay collections while no budget is set aside for mining data for infectious agents like TB. This task is critical to prevent further spread of disease. As a result, many patients are wrongly placed in shared rooms, where they spread TB, MRSA, and other types of communicable infections.
The computer technology fetish is further alienating the whole healthcare workplace, transforming everyone, including RNs and MDs, into appendages to the machine, feeding information to a vast database. A retiring nurse told me that computerization had nothing to do with the company's claim of improving care delivery, but was meant to keep track of their bottom line.
The computers are there not only to track our daily performance but also to mete out punishment based on statistical data. Evaluation is no longer "personal," but automatic and faceless. Even shop stewards feel they cannot argue with data given an "objective" aura by the computer, even though statistical facts reflect priorities, like revenue enhancement, programmed into the computer by management. In a disciplinary hearing often the manager and the shop steward sit on the same side opposite the employee who is advised by both on how to improve their performance.
For over a decade, our HMO has been as automated as possible. What they cannot escape is the fact that only living labor can provide the fundamental face-to-face human interaction that is the essence of healthcare.
As computers reached into all areas of the workplace, not only do we hear less from our union officials, but we workers have stopped communicating with each other in the ways we had before. Everyone is so worried about their own time-study ledgers, and concerned about "making the cut" and "career advancement," that our natural cooperation has been usurped towards enhancing the company's bottom line. The computer overlord isolates us from one another. Acting human has become time consuming and not cost-effective.
Many nurses are forced to neglect patients due to excessive focus on paperwork, and the obsession with their own time-study stats. The most significant, persistent neglect is institutionalized through efficiency methods such as floor managers practicing chronic short-staffing. Computers dictate to RNs and MDs alike what is the acceptable level of care to be offered to patients according to parameters of abstract labor, that is, labor time. A whole army of utilization reviewers, on and off site, is constantly looking, literally and virtually, over the shoulders of RNs and MDs to limit care so as to control cost. Concrete labor is thus confined within the limits dictated by abstract labor.
Obama's nationwide program to computerize the healthcare workplace will only intensify our conflicted work life. There is no other resolution to the current crisis except workers controlling their work free of the dictates of capital. The question of the hour that many are asking is "Can capitalism be saved?" But the real question many of us worker/thinkers, both employed and unemployed, want to ask is: Should capitalism be saved, and what is the alternative?
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