I want to focus on one example -- the working relationships between doctors and nurses. In some places relationships are harmonious, but in other hospitals there may be substantial tension between doctors and nurses over a variety of issues. Almost certainly, both sides feel that they are not listened to.
Although what nurses do helps doctors treat patients, a request for such an action is seldom preceded by a doctor saying "Jeanne, could you help me here?" or "Nurse Franklin, could you help me here ... " nor is it followed with a "Thank you .. that helped!" The fact that the nurse's job includes helping is taken as a given, which often makes the nurses feel like furniture or something. To facilitate operations, the doctor's orders for a drug for a patient may simply be handed over without a word, or with some brief non-cordial comment such as "room 217", or dropped in a hopper on the nurses station front desk. At least the doctor is vaguely aware of and reminded that nurses are human beings and are located over there and help dispense medications. The doctor has an opportunity to stop and chat and ask about the kids or not, possibly to joke or flirt, but at least to have human to human contact.
That is, until the CPOE arrives. With a CPOE, the doctor will not give medication orders to a human being, or even an in-basket near a human being's desk -- he will "enter them" into a computer. As far as the ape with the upright spear part of the human doctor is concerned, he is asking the computer to assist him. The computer is cold, all-business, and not interested in human chatter about how his day is going.
And, as far as the doctor can tell, some robot is dispensing the medication. It's all further out of sight. The doctor sees nurses less frequently, and when he does see them, it will more frequently be because something went wrong.
The nurses, on their side, will see less of the doctor than ever before. He won't come around where they can grab him and get his attention on some issue or question, because he won't need to -- he can do all his ordering by remote control from his office or some other place.
There will be far fewer occasions to reaffirm the common humanity of nurses and doctors. There will be fewer occasions to flirt or chat or sympathize or ask how his day is going and be prepared to help him cope.
What there will be instead is a line on a computer screen that lists medication information for a patient. As far as the human animal is concerned, the computer is the one asking for the medication to be given.
There is, in other words, a new level of screening, shielding, and separation put between doctors and nurses, making it harder to overcome the barriers with spontaneous chatter at unexpected times.
Now, you have to recall that one reason people become nurses is because they have a strong desire or need to "be appreciated" and to "make a difference". In general, nurses are "people people" who enjoy interacting with other human beings. In general, they take a great deal of pain trying to cope with a system that forces them to make hard trade-offs all day, while their feet and back are killing them. In general, they feel unappreciated, but look forward to the occasional shining moment when a patient or doctor is overflowingly thankful and appreciative for their hard work.
What they will get more of is only seeing doctors when it's bad news time. They will feel treated as if they are some kind of medication-delivery-robot, which gets "messages" about "events". There will be no "human touch" involved. There will be even less appreciation than there was before.
This is no small thing. This is going to interfere with performance, lead to more depression, and lead to higher turnover. If the job is designed for a robot, more-senior patient-centric human beings will tend to leave it to go find some other job, and new-hire robot-like humans who don't care about human reinforcement will move into the job. Overall, in a thousand small ways, patient care will suffer.
What is so dangerous about this kind of thing is that it is almost silent. It is very hard to trace or track down. In one recent case study, the effect on lab technicians of installation of a "computerized lab-order system" was to entirely remove their human connection to the people on the floor, which removed their sense of meaning and belonging and mattering, which led to people quitting their jobs.
If we stand back and look at what's going on here, on the one hand the system designers are effectively saying "we want this to run more like a well-oiled machine" and the people in the already dehumanizing system are saying "I've had about enough of being treated like a machine instead of a person."
A sense of belonging to a care team, and jointly healing patients is important for retention and for caring how well someone does their job, and determines whether they will "go the extra mile" or not a hundred times each day. Nurses, IT staff members, and other "lower level staff" already typically feel they are forgotten, kept in the dark, isolated, and carrying out thankless tasks. Regardless what problems a CPOE might fix, it is almost certain to have a negative impact on this sense of camaraderie and team.
And that's important for someone to deal with and think about.
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