Connecting Dots

Where Technology meets Disruption

Updated: Nov 16

Speaker highlights from Edgility’s second annual Nursing Symposium hosted with USF College of Nursing on October 12, 2022.



Opening the event was keynote speaker Judy Murphy, a nursing executive and health IT leader with a long and distinguished history in health and nursing informatics. Judy was Chief Nursing Officer (CNO) at IBM Global Healthcare, where she built relationships and expanded business across the healthcare industry. Judy served on the AMIA and HIMSS Board of Directors and is a Fellow of the American Academy of Nursing and the American College of Medical Informatics, and is a HIMSS Lifetime Fellow. Judy has received numerous awards, including the AMIA 2020 Virginia Saba Informatics Award, the HIMSS 2018 Most Influential Women in Health IT, the AMIA 2014 Don Eugene Detmer Award for Health Policy Contributions in Informatics, the HIMSS 2014 Federal Health IT Leadership Award, the HIMSS 2006 Nursing Informatics Leadership Award.



Digital Health Companion


Converging forces of Healthcare Disruption

Judy’s introduction focused on the American Recovery and Reinvestment Act (ARRA - Stimulus Bill) of 2009. This bill included the Health Information Technology for Economic and Clinical Health (HITECH) Act, providing incentives to stimulate the adoption of HealthIT, especially Electronic Health Records (EHRs). In addition, Judy highlighted the Affordable Care Act (ACA), which supports innovative medical care delivery methods designed to lower healthcare costs. Judy also dissected consumerism and engagement, proposing that consumer expectations must be considered in population health management. Highlighting that self-service, digital interaction, and online engagement is expanding and expected in all industries - especially in healthcare - seamless, frictionless experiences must become the norm.



Key priorities going forward

  1. Telehealth's changing role is replacing the office visit, reimagining how and where healthcare is delivered.

  2. 2. Social determinants of Health (SDOH) categories. SDOH affects various health risks and quality-of-life outcomes. SDOH includes education access and quality, health care access, the neighborhood, and built environment, the social and community context, and economic stability - in short, the environment where people are born, live, learn, work, play, worship, and age.

More on this topic: https://health.gov/healthypeople/priority-areas/social-determinants-health)


3. The industry is changing - Judy discussed how healthcare communication and vocabulary are changing (see image below).



The Call to Nursing

Judy discussed passages from “Charting a Path to Achieve Health Equity (2nd NASEM Report),” which highlights how the nursing profession will advance and the critical role nurses will play in the future of healthcare. The passages she referenced read:

  • “The decade ahead will test the nation’s nearly 4 million nurses in new and complex ways. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. ​”

  • “A nation cannot fully thrive until everyone can live their healthiest possible life, and helping people live their healthiest life has always been the essential role of nurses.”

Below are five key recommendations Judy lists to help strengthen nurses today:

  1. Create a shared agenda for addressing social determinants of health and achieving health equity​.

  2. Support nurses to advance health equity more comprehensively, regardless of practice setting.

  3. Capitalize on nurses’ potential to address social needs and social determinants of health by improving health care assessment, quality and value.

  4. Employ technology to integrate data on social determinants of health into nursing practice

  5. Build the evidence base to describe the impact of nursing interventions on health equity and nurses’ health and well-being

Vision for the Future


EHR should become a Plan for Health rather than a medical record. The EHR should deliver AI-enabled information to providers and patients instead of merely clinical transaction documentation​. Healthcare data should support a comprehensive view of the individual for personalized, patient-centered care, engaging the patient as partners in their health and healthcare.


Everyone should have an AI-supported care plan with personalization, clinical decision support, and predictive analytics that help determine the most effective mix of interventions.


Nurses are the key to this future vision.


Judy ended her presentation with this closing quote from Leah Binder, President & CEO of The Leapfrog Group: “Nurses’ work is as much about promoting patients as advancing nursing. When you are a patient facing the fight of your life, you will discover that a great nurse is the best friend you will ever have. Indeed, nurses are the nation’s BFFs. As we emerge from the pandemic, our BFFs are the secret to solving the most urgent issues we face.”





Creating Digital Solutions for Care

Next on the agenda was a panel discussion with Amanda Kolter, Chief Nursing Officer and Senior Vice President at Asante Health System, and Jodi Arth, Outcomes Director for Edgility, about “creating digital care solutions.”


Some of the highlights from their discussion include:

  • Carefully and thoroughly identify what various stakeholders value.

  • Get ahead of the curve - identify what staff needs before they know they need it.

  • Innovation arises when leadership at all levels is able and willing to make changes.

  • Ensure nurses know they must find their voice to empower change - you don’t have to be a C-level executive nurse to implement change and integrate technology at the micro level.

  • Respect and acknowledge resilience; it is something nurses are truly good at.

  • How will you convince the financially oriented (often Operations Leadership<, the CFO, for example) to buy into what nurses need?

  • Promote all leadership styles - different styles bring different strengths - optimizing the maximum range of solutions.

  • How are we seeing nursing in the future?






Successful Disruption in Today’s Healthcare


Finally, Melissa Cole, Healthcare Executive & Nurse Leader, closed the symposium by speaking about her experience as a nurse leader, specifically around her role in implementing a Hospital-at-Home at University Hospitals powered by Edgility’s technology. The key learning objectives were understanding the factors influencing innovation and change in healthcare, the difference between innovation and disruption, the importance of nurses in developing new care models, and the importance of telling a compelling story.


Everyone is preparing for seismic site-of-care shifts.




Innovation

  • The etymology of innovation stems from the word innovate, meaning “to change; to renew” and is from the 1540s (Online Etymology Dictionary, 2021).​

  • “Electric light did not come from the continuous improvement of candles”, by Oren Harari (Peuc, 2017)

Disruption

  • Disruption is “a disturbance or problem(s) which interrupts an event, activity, or process and/or a radical change to an existing industry or market due to a technological innovation” (Oxford, 2022). ​

  • A Disrupter is “a person or thing that interrupts an event, activity, or process by causing a disturbance or problem” (Oxford, 2022). ​

  • Disruption displaces an existing market, industry, or technology and produces something new and more efficient, and worthwhile (Christensen, 2011)



Hospital-at-Home

Melissa shared her hospital-at-home (H@H) initiative at University Hospital. A H@H program is defined as providing an acute-care level of services in the home - traditionally only available and delivered in a hospital environment as defined by the CMS waiver program (CMS, 2020).​ If determined to meet clinical and social eligibility requirements, the patient must also agree and consent to the program. ​


Some of the questions Melissa and her team wanted to answer included the following:

  1. What is the main difference between a COVID-19 traditional hospitalization and a COVID-19 hospital-at-home hospitalization length of stay (LOS)?

  2. What is the difference between the 30-day readmission rate of a COVID-19 hospitalization versus a COVID-19 hospital-at-home admission?

Melissa and her team determined no statistically significant difference between the two groups for either LOS or 30-day readmission rates. The following was some of the data she provided:

LOS median: H@H 4.0 days; Traditional 5.0 days​

T-test: p-value = 0.95​

30-day readmission rate: H@H=1; Traditional=1​

Fisher’s exact test: p-value = 0.99

A few of her H@H takeaways included:

  1. The H@H model improved reimbursement from payers;

  2. H@H increased utilization of both telehealth and remote patient monitoring at home and in the hospital setting - a benefit during staff shortages;

  3. H@H can help decant volume from brick-and-mortar hospitals, reduce costs with a 1.0 shorter LOS, and leverage virtual RNs and physicians – eliminating additional hires.


Her closing thoughts emphasized that healthcare professionals and leaders are now at a chasm and need to be forward thinkers. Melissa asked the crowd, “why are we not adopting things faster? We will fall behind if we sit at the chasm for much longer.” Lastly, she told the crowd that we need to start telling more stories about disruption, particularly from the point of view of nurses.