Q&A: HealthTech Influencer Sherri Hess on Key IT Trends and Listening to Nurses

HEALTHTECH: How did your experiences as an RN inform your perspective on healthcare IT?

HESS: I chose information systems from the perspective of having the flexibility to work from home, the ability to do some traveling and the availability of leadership positions. At that time, in the mid-90s, there weren't really informatics roles, at least that I was aware of.

When I graduated in 2000, I went to work for [healthcare technology company] McKesson in the development of EHRs. There was somebody in one of my graduate classes who said, “There’s a company in Boulder that develops EHRs. You should talk to my boss.” I called him up and he said, “You’re a nurse with an IT degree? I’m going to hire you on the spot.”

I didn’t go into this thinking I wanted to be a CNIO one day. It developed over the next 22 years. In 2008, I left McKesson and ended up working for multiple health systems in the Denver metro area, building informatics teams and taking what I learned not only at the bedside but from my IT experiences as well. I always knew that I could speak the language of a nurse and by having an IT degree and working with my partners, I could speak both languages. It helped solve problems because, many times, our IT partners would get frustrated at our clinicians and vice versa. When I could bring them together, that’s when we really saw those synergies.

WATCH: Learn how technology is transforming nurse workflows.

HEALTHTECH: How have conversations around healthcare interoperability evolved in your experience? How can nurses’ perspectives better inform interoperability approaches?

HESS: Over the years, what I’ve seen is, while we’ve pivoted from the best-of-breed to a single vendor, there’s not going to be any one vendor that can solve everything. I think it’s key to have some entrepreneurs and small businesses along with our large vendors. And, really, we need to listen to the voice of that nurse who’s doing the work. And the key here is being at an organization where they really embrace that. At HCA Healthcare, they do look at it from that perspective. We have nursing councils where we can get the voice of the nurse — we bring together those end users to listen and get that feedback, not just in those best-case scenarios but to have them think through, is this going to meet your need or is it going to create barriers?

HEALTHTECH: How have you seen the field of nursing informatics change over the years? What do emerging leaders need to learn now that they weren’t learning five to 10 years ago?

HESS: When I started doing this, it was all about EHR implementations because that’s where we needed to go with the HITECH Act. What the emerging leaders really need to be thinking about now is all that data that comes from our EHR and other technology to improve efficiencies. The key is focusing on those outcomes, improvements and qualities.

Are we implementing technology to just implement technology? Are we truly doing it to focus on improving our patient outcomes and improving our nurse satisfaction? That’s key. There are some nurses now, when looking for new jobs, they may ask what technology they have. If they don’t, they may realize when they come, “Hey, this is taking me more time away from my patients.” The emerging leaders really need to focus on the outcomes/return on investment of what the technology is going to be. If we find that a technology is not working, we need to stop and be honest with ourselves. We have to embrace failure. We don’t do that very well, and we could end up continuing to waste money.

Another focus for emerging leaders is our nursing informatics scope and standards of practice through the American Nurses Credentialing Center. Your teams should be certified. The goal is for nurses to work at the top of their license, whether they’re at the bedside or doing informatics. At HCA Healthcare, we do focus on nurse-centered IT initiatives; we have nurses that come forth with ideas. I’m excited to be involved in the nursing-specific hackathon this year. There very much is that push to listen to bedside nurses and hear what they’re saying, what ideas they have to improve efficiency.

One other important aspect is having a CNIO role at your organization. You don’t always see that, even in some large health systems. There may be a chief medical information officer role, but it’s so important to have the largest workforce backed with that CNIO role that really understands the technology and how it can improve efficiency and outcomes. There's one thing that HCA Healthcare has invested in, ensuring the CNIO role is a vice president-level role, and that I'm at the table with all executive leaders when decisions are being made.

HEALTHTECH: How have conversations about clinician burnout changed? Where are you seeing successes in tackling burnout, and where are you seeing areas that still need improvement?

HESS: When I was at the bedside, no one ever said burnout. I find the game-changer is we’re talking about it. It’s out there, and it’s acknowledged, and so putting that at the forefront shows there’s a need to address it.

From a national perspective, nurses are spending 30 percent of their day in the EHR or interacting with technology, and only 17 percent of their time in direct patient care. I’ve talked to other CNIOs across the U.S., and the data supports this, that we’re all spending too much time caring for the technology and want to flip those statistics. We went into healthcare to focus on our patients. It’s key that we acknowledge that there’s burnout.

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I think we have a long way to go as an industry on how to best support clinicians. Here at HCA Healthcare, we provide financial and emotional support for the nurse and their family through many ways, one of them being counseling available 24/7. One area to look at as an industry is, what do you do in that moment? Maybe I’m having a bad day — is that being recognized? I’ve heard of recharge rooms before, so is there a chance to take five to 10 minutes away and actually go in and recharge? Many of us, we feel what our patients feel. We hurt when they hurt. I think acknowledging that and having leaders really look into that is top priority.

HEALTHTECH: Can you share some successful approaches to nurse-centered IT initiatives?

HESS: HCA Healthcare leaders have made nursing care a top priority. We have more than 93,000 nurses, and we’ve deployed almost 100,000 smartphones. We want to give that mobile experience. We know that in healthcare, we’re behind the technology at least by 10 years, maybe more, than other industries. The nurses love the phones, and they’re not just using voice and text; they’re getting important notifications and can easily take photos for documentation.  

As I talk to our vendors, I’m asking that they offer more innovation to help nurses focus more on patients. 

HEALTHTECH: What are the top three trends you’re following right now in healthcare IT?

HESS: The virtual RN model utilizes an RN that is remoting into the patient room through a video camera to interact with the patient. This would encompass anything that doesn’t need hands on from the nurse. For example, the admission history, patient teaching, reassessing for pain or discharge planning are perfect for this scenario. Seasoned nurses would be the virtual RN. They could also help mentor new grads. You want this program to keep that seasoned nurse at your organization longer, so they don’t have to be on their feet for 12 hours and can work virtually. People have been dabbling in this concept for a few years. An opportunity with this model is to not increase the number of patients the bedside nurse would take. That's not going to improve nurses’ satisfaction.

I’m also looking at ambient technology. As a nurse, I shouldn't have to touch a computer. I'd like to come into a patient’s room and have it known that I’m the RN tending to Mrs. Smith, see the chart electronically and start an assessment activated through voice. That could really get the patient involved and think of the patient satisfaction for that. How do we have that voice recognition for nurses?

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The third is artificial intelligence and machine learning. We've talked about it for so long and we're not there in many spaces. Let’s look at it for something as basic as fall scales. As nurses, we answer a few questions in a scale that tells us whether a patient is at high, medium or low risk of a fall. But how about instead of doing that there's AI in the background that knows a patient’s medication, the last time they walked, those high-risk things that could make her a fall risk? That's a very simplistic one, but we've continued to add to nurses’ burdens, so what more can we do to lessen that?

HEALTHTECH: Anything else to add?

HESS: My goal as a nurse was to help people. I didn't say, “Hey, I'm going to be CNIO one day” – even 22 years ago, that wasn't even my goal. I knew I wanted to work on strategy. I knew I wanted to help our nurses in a way to give them more time back at the bedside. I am very proud to be a nurse and of all the nurses – the most trusted field for over 20 years.