What to do differently

So what could Sutter Health officials have done differently? Three things, Hill says. 

First, better training on backup systems. Sutter has a paper backup system, but it’s typically used for outages lasting one to two hours, and nurses haven’t been thoroughly trained on it, said Hill. So, when an outage occurs for more than eight hours, and nurses have been poorly trained on the paper systems, issues are going to come up, he explained, and that's just not good for patient care. 

Secondly, good communication is critical, said Hill. "There really wasn’t any support from management on what was going on. They seemed to be lost and weren’t really providing any guidance to the nurses."

And third comes down to involving the nurses in the EHR design process so the system is optimized for both the nurses and patients. Hill explained that although the Sutter EHR system has an Epic Systems base, it’s been mostly modified and built by Sutter Health IT programmers who aren’t as familiar with the system as the actual Epic Systems IT programmers, which has ultimately led to poor designs, he opines.

He cited several examples. "You can sign on with your badge, and someone else’s name pops up. You can try to give blood and it pops up as a different type of blood than you’re giving and you can’t get it into the system," he said. And when the nurses go back to the IT staff, many times these requests aren't fulfilled in a timely manner, as the team already has a lot on their plates. Added Hill, "This system really wasn't ready to come out."

Gleeson, however, pointed out that Sutter physicians and nurses are very much involved in the EHR implementation and design process. "EHR configurations are designed by our physicians and nurses, configured by Information Services and then validated by our physicians and nurses," he explained. 

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                                         "This system really wasn't ready to come out."

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However, Gleeson said it really comes down to CNA opposition to the use of health information technology and ultimately misrepresented the situation. "It comes as no surprise given the fact that we are in a protracted labor dispute with CNA," he said. Gleeson also cited the uptime percentage for these systems as being 99.4 percent. 

Hill was quick to clarify: "CNA has never been opposed to technology because technology is part of what is going on." What some 5,000 Sutter nurses represented by CNA do have an issue with is the lack of inclusion in the design process, which is why they include a technology section as part of their contract. "Much of the language here says the hospital needs to involve the nurses from the very beginning because this technology involves what we do every day as nurses, so it needs to be nurse friendly, and it needs to be patient friendly," Hill said.