Nurses recruited from international communities help increase diversity in the workplace and care delivery in rural communities, says this nurse leader.
The former Banner Health and Intermountain Health CIO will become Chief Digital and Information Officer in early 2025, succeeding Craig Richardville, who departed in July.
Intermountain Health is bringing a familiar face back into the fold to serve as the health system’s new Chief Digital and Information Officer (CDIO)
Ryan Smith, who spent more than 20 years with Intermountain and served as its Chief Information officer from 2020-2022, will take over as CDIO in early 2025.
Ryan Smith, Intermountain Health's new Chief Digital and Information Officer. Photo courtesy Intermountain Health.
“This opportunity is deeply meaningful to me,” Smith said in a press release. “I'm excited for the opportunity to make healthcare an easier, safer experience for patients, members, and caregivers alike.”
“I’m confident that Ryan is the right leader to help Intermountain successfully navigate both opportunities and obstacles as a model health system in the complex world of healthcare that lies ahead,” Rob Allen, Intermountain Health’s president and CEO, said in the release. “He will lead DTS to support our mission, vision, and strategy to simplify, expand proactive care, and improve the healthcare experience for our caregivers, patients, members, and communities.”
Smith served a number of roles at Intermountain from 1994 to 2013, then became Banner Health’s SVP and CIO from 2013-2018 before joining Health Catalyst as an SVP and executive advisor. After his two-year stint as Intermountain’s CIO, he joined the digital health non-profit Graphite Health as its Chief Operating Officer in 2022, then became interim president and CEO this past February.
Smith succeeds Craig Richardville, who was SVP and CDIO of SCL Health from 2019 to 2022, became SVP and CDIO of Intermountain in 2022 when it acquired SCL Health, and left the health system this past July.
Smith will report directly to Intermountain’s Chief Strategy Officer, Dan Liljenquist, and serve as a member of the health system’s Enterprise Leadership Team. He’ll lead Digital Technology Services (DTS), including DTS Operations, Digital Services, Data Services, Clinical Informatics, Cybersecurity, Application Services, and Information Technology.
Jon Handler and Roopa Foulger of OSF HealthCare, participants in the HealthLeaders Mastermind program on Ai in clinical care, say the healthcare industry still has a lot to learn about ROI.
The trick to embracing Ai for clinical care is managing expectations. That includes understanding what ROI really means with this technology.
“The ROI piece is always interesting,” says Jon Handler, Senior Fellow for Innovation with OSF HealthCare. “There’s this concept of hard costs and hard ROI and soft ROI. … At the end of the day, the real-world impacts on the bottom line are the same regardless of how hard or easy it is to measure it.”
Jon Handler, Senior Fellow for Innovation, OSF HealthCare. Photo courtesy OSF HealthCare.
Handler and Roopa Foulger, Vice President of Digital and Innovation Development for OSF HealthCare, are taking part in the HealthLeaders Mastermind program on the use of AI in clinical operations. They say the Illinois-based health system is looking to be reasonable in finding the value of new tools and programs, with an eye not only on the bottom line but also long-term clinical value.
“How do we measure it?” Handler asks. “How do we assess it? How do we validate it? And I think that gets harder, not easier, with some of the new large language models and the generative AI that’s out there. Because now, instead of algorithms built on a use case by use case basis, you’ve got this general purpose model – how do you evaluate all the things that it can do?”
“There are so many other ways to measure the value that is created,” he concludes. “Determining the right things to measure, which may not always be the easiest things to measure, is critical.”
Foulger says the health system has been using AI in several areas, including some clinical programs around mortality and risk prediction and imaging reviews. Through OSF Innovation, they’re looking at small startups with unique ideas, in addition to implementing AI tools provided by their EHR vendor.
“We’re encouraging what might be different that we should keep an eye on,” she says. “At the same time we’re asking, ‘Why try to build something already available?’”
Both Handler and Foulger say they’ve been surprised at how fast AI has worked its way into healthcare, even as the industry has been using automation and predictive algorithms for more than a decade. But while they’re seeing adoption in several departments and showing success in improving efficiency and reducing administrative stress, they’re also seeing a lot of strong use cases fail to make an impact.
Roopa Foulger, Vice President of Digital and Innovation Development, OSF HealthCare. Photo courtesy OSF HealthCare.
“I’m surprised at what is working and what is not working,” says Foulger, who notes that AI tools have shown value in revenue cycle and finance by handling complex processes that take a lot of time and effort. She wonders if healthcare organizations are embracing new ideas too quickly, and not giving these tools time to prove their efficacy.
Handler says he’s surprised that some promising projects, like using AI to transcribe the doctor-patient encounter or generate draft replies to inbox messages, have seen mixed results in published literature. There may be a disconnect between the outcomes some expect from these new tools and the benefits they might more consistently provide, like reduced stress and burnout.
It may also be, he says, a good indication that healthcare still has a lot to learn about AI.
“It’s hard to know when you’re dealing with something that’s overhyped or not,” Handler says, noting the internet was once a shiny new tool that received mixed predictions of its impact before becoming universal. “So any prediction about the future [of AI] … is treading on dangerous territory because people who make predictions are very often wrong.”
“In addition to unexpected upsides, there may also be downsides that that we haven't anticipated or been able to manage because of the speed with which these things are happening,” he adds. “These are really, really important questions to wrestle with.”
Foulger sees a future where AI is part of smarter healthcare ecosystem, giving patients and providers instant access to decision support, best practices and health and wellness tips. She notes that the industry has access to vast amounts of data, but until now it hasn’t had the tools to make use of that information.
The key, Handler adds, is to find the right way to use those tools.
“My biggest hope is that we capitalize on it as effectively as possible to help improve the service we can provide to our fellow human beings.”
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Nurses should lead innovation so that it happens with them, not to them, says this CNE.
It’s an exciting time for innovation in the healthcare space, as new technologies pop up across the industry that can improve care delivery.
Health systems everywhere are experimenting with several new innovations, all with the goal of streamlining processes and removing unnecessary burdens from nurses and physicians alike.
Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, said nurses should get involved with innovation and leaders must use their seat at the table to advocate for nursing technology.
Here are the four reasons nurses should lead innovation, according to Vozzella.
Research finds that a telehealth platform is more effective in helping suicidal patients than similar treatment delivered in person.
Critics of telehealth have long said a virtual visit can’t replicate in-person treatment, especially for serious concerns like treatment of patients considering suicide. But a new study from The Ohio State University’s Wexner Medical Center and College of Medicine finds that virtual care is an effective platform.
In a randomized clinical trial of 96 patients between 2021 and 2023 with recent suicidal ideation or suicidal behavior, counselors using brief cognitive behavioral therapy (BCBT) via telehealth were able to cut suicide attempts by 41% compared to present-centered therapy (PCT).
The research lends strength to the argument that effective treatment isn’t based on the mode of delivery, and that virtual care is a suitable platform for those unable or unwilling to access in-person care.
“For those suffering with suicidal thoughts and behaviors, we have good, tested treatments that will lead to significant symptom reduction and improved quality of life,” Craig Bryan, PsyD, professor in Ohio State’s Department of Psychiatry and Behavioral Health and director of its Suicide Prevention Program and a co-investigator in the study, said in a press release. “Even with lessening restrictions, many therapists are keeping a portion of their telehealth practice post pandemic. This study has the potential to increase access to needed evidence-based treatments for those in rural and hard-to-reach areas.”
Justin Baker, PhD, a clinical psychologist at Ohio State-Wexner, clinical director of the health system’s Suicide and Trauma Reduction Initiative (STRIVE) and the study’s principal investigator, said high-risk patients are historically excluded from virtual care due to risk and liability concerns. But the pandemic forced health systems and hospitals to shift to an almost all-virtual strategy, leaving many patients with no in-person access.
“We wanted a way to ensure that those who needed care the most were able to receive care during the pandemic,” he said in the press release.
According to the study, published in JAMA, 768 people were asked to participate, 112 were assessed for eligibility and 98 were eventually selected, with 52 undergoing virtual care and the other 46 seeing a clinician in person.
“A strength of this study is the use of an active, evidence-based treatment as the comparator instead of treatment as usual,” the study reported. “The use of an active comparator in this study provides a higher level of internal validity than previous studies, thereby enabling us to conclude with greater confidence that reductions in suicide attempts are likely attributable to the skills-training focus of BCBT, which prioritizes targeting core underlying vulnerabilities in how patients regulate emotions and cognitively reappraise stressful situations.”
Amid a flurry of outsourcing activity, one rev cycle VP says RPA, AI, and other emergent tools are "making us all rethink" traditional cost-saving measures.
Whether outsourcing revenue cycle management to a new vendor or offshore team, cost is typically a driver, but "tech's making us all rethink that," says Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, a 12-hospital system headquartered in Boston.
Mercurio holds a distinctive vantage point: Aside from managing a team made up of on- and offshore FTEs, he helps other health systems automate their RCM processes as co-founder and executive vice president of strategic relationships at an AI-based medical coding company that launched in 2019 to commercialize the computer-assisted coding solution developed by Mass General Brigham's physician organization billing office.
The intersection of automated and outsourced solutions only stands to grow as nascent tech gains ground in healthcare. Whether it's robotic process automation (RPA), regular ol' automation, or the "complete revolution that's coming in the next three to five years based on AI," Mercurio says these tools are "going to really change, I think, a lot—if not most—of the way we do things, especially in the rev cycle."
Consider a hybrid approach
Just as Mercurio's role straddles vendor and provider, so too does his stance on outsourcing. Instead of contracting with a single entity for wholesale RCM support, he partners with "individual vendors that might do pieces and parts" based on Mass General Brigham's goals, as well as cultural, financial, and operational needs.
Today, roughly 40% of his team's FTEs are offshore, a proportion that he expects to increase in the coming years. "It's going to continue to be a big part of our footprint."
At the same time, though, tech stands to take over much of the RCM work handled today by humans, regardless of their organizational affiliation, says Mercurio, pointing to one of his team's RPA bots that, since its implementation a year ago, has assumed duties previously handled by 10 offshore folks.
Integration and automation are further streamlining performance in house, too. Mercurio just finished combining Mass General Brigham's hospital and professional billing teams. The two-year initiative involved integrating workflows and operations, creating a shared culture, and figuring out how to "act and function like a team," he says. "We're still in that process."
Additionally, the system's rev cycle team is automating more than 80% of their radiology-related coding activity. "The quality is excellent," says Mercurio. "We've seen a reduction in denials and therefore a reduction in cost on the back end, which we've been able to pass back to our practices or reinvest in ourselves by redeploying staff to areas [that] need it."
Beyond radiology, it’s tool now covers pathology, evaluation and management, endoscopy, and surgery, and Mass General Brigham is seeking to expand their use cases "so that we can get a bigger bang for the services that they're providing to us," Mercurio says.
It reflects a larger vision to maximize value from existing solutions, including those used to outsource operations. "Oftentimes, you buy one product, and you don't realize that there are other offerings that that company might have that would be really beneficial to implement," he explains. "So we want to really take a hard look at any of our existing partners if we're trying to do something new in a space or expand with a technology, because it's a lot easier to, you know, add a new statement of work than it is to bring someone new inhouse."
Hold your horses
All this merging and streamlining and automating and innovating means up to 30–40% of current revenue cycle roles might not exist in the next three to five years, Mercurio says.
He's struck in this moment by a quote from Henry Ford: "If I had asked people what they wanted, they would have said faster horses."
In other words, we humans are famously bad at envisioning the future.
"I don't think anybody had space shuttles or electric vehicles in mind in the early 1900s when cars started to become really popular," Mercurio says. "And so I don't think we can really appreciate what's coming next for AI that hasn't been thought of, it hasn't been developed, it hasn't been rolled out or no one's using it, but it's going to massively change the way we do a lot of things."
To stay competitive, he recommends that RCM professionals of all walks sharpen skills that are still distinctly human. "One thing that the AI doesn't demonstrate itself to be really good at yet is critical thinking and problem solving when it requires understanding workflows between physicians and insurance companies and the software used to communicate between the two," he explains. "The folks that can understand a problem … will be the ones that will have opportunities for advancement or staying in an organization because … those are the folks we want on our team anyway — even without AI — are critical thinkers and problem solvers."
Technology can help take tasks away from nurses so they can get back to value-added work, says this CNE.
On this episode of HL Shorts, we hear from Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, about how technology can help unburden nurses at the bedside. Tune in to hear her insights.
HealthLeaders Senior Editor for Innovation Eric Wicklund talks with David Newman, MD, CMO of virtual care at Sanford Health, about the health system's brand-new, 60,000-square-foot Virtual Care Center. The new center gives the South Dakota-based health system a key resource for improving healthcare access across Sanford Health's vast rural coverage area.
International recruiting begins with strong communication and partnerships, according to this nurse educator.
CNOs are searching everywhere for nurses at all stages of their careers to help fill the critical workforce gaps left by the nursing shortage.
International recruitment can be a solution, if it is done mindfully and strategically.
In 2022, about one in six registered nurses (RN) were immigrants, and 32% of hospitals accounting for nearly half of all hospital beds say they hired foreign-educated RNs, according to KFF. According to Dr. Yolanda VanRiel, the department chair of nursing at North Carolina Central University, there are many benefits to recruiting nurses internationally, as well as some challenges.
Why international recruiting?
First and foremost, internationally recruited nurses help fill staffing gaps, both in the short and long term. Nurses from different countries also enhance diversity in the workplace, VanRiel explained.
"They bring unique cultural perspectives that can improve the care for diverse populations," VanRiel said. "They might bring a different viewpoint, a different healthcare perspective or approach, and it might lead to some new ideas, practices, and efficiencies in patient care.”
International nurses will also go into rural and underserved communities, according to VanRiel.
"They’ll go into areas that are underserved, such as rural areas," VanRiel said, "whereas I knew nurses, [where] they graduated and…they want to go straight to the big city areas."
Why not?
One pitfall to international recruiting is that it can take talent away from other communities, VanRiel explained.
“We don’t want to ‘brain drain,’ a phenomenon where we have those highly skilled nurses from the lower income countries that come to wealthier nations,” VanRiel said, “and so we don’t want to leave that home country where they’re also in a staffing shortage.”
CNOs should follow these guidelines to ensure that they are not taking nurses from other communities and leaving them with less or no healthcare resources.
Language barriers and cultural differences can be a challenge, according to VanRiel. There can also be differences in credentialing and licensing, and some differences in education.
“It might be that they might not get their license in time,” VanRiel said. “Also, if they’re coming here, maybe they didn’t have some education that we offer here.”
International partnerships
To streamline pipelines into the nursing industry, health systems should partner with international organizations and educational institutions to come up with a customized training program, VanRiel said.
“It might be that you say, ‘okay, you can bring your students here for a little while or we can bring faculty members there’,” VanRiel said. “There are all sorts of ways that you can develop those partnerships, and I think…that might be a good way to do it because then you are influencing what’s being taught there and bringing that [here].”
VanRiel also recommended partnering with organizations in the United States as well. Some organizations do mission trips, and CNOs can partner with an organization’s Office of International Affairs if they have them to get aligned with the correct programs.
“That’s one of the good things that we’re starting to actually look at,” VanRiel said, “as [we try to get] more students to [have] that global experience.”
Finding the balance
It’s critical that CNOs strike a balance between recruiting from local and international sources, which according to VanRiel, includes developing a local talent pipeline, adhering to ethical recruitment practices, and fostering diversity and inclusion.
“You [have] to strategically plan for both the short-term and long-term workforce needs,” VanRiel said, “so I think by maintaining a healthy balance between local universities or international recruitment, health systems can build a sustainable, diverse, skilled workforce.”
CNOs should also invest time in creating cross-cultural communication workshops, according to VanRiel, and work with both the universities and hospitals in the international community to determine what their needs are.
“You’re not competing, everybody is feeling the pinch with staffing,” VanRiel said. “Talking with that other health care system is one of the best things you can do to establish that relationship.”
The nursing workforce is plagued with many of the same challenges, so it's time for nurse leaders to switch strategies.
Editor's Note: This is an excerpt from a larger cover story, which can be found here.
Today, workforce growth and development are still the greatest challenges facing nurse leaders everywhere, and the old strategies are no longer working.
Even though many are working on creative fixes, health systems are still in dire need of solutions that improve both recruitment and retention. Workplace violence is as prevalent as ever, and burnout is cited as a huge reason for nurse leader turnover.
Back in May, HealthLeaders spoke with four nurse leaders who are taking on these challenges to find out what workforce growth strategies need to be put to rest and explore four ways CNOs can move forward and build a strong, healthy, and happy workforce.
So, what went wrong?
As everyone in healthcare knows, the industry is suffering from a national nursing shortage. Allison Guste, corporate vice president of nursing and clinical services and LCMC Health and CNO at University Medical Center New Orleans, said this issue isn't new.
"I think as long as nurses have been around, there's also been a nursing shortage," Guste said. "So how do we think about it differently than we have in the past?"
"There are nursing schools who have space within their programs," Croland said, "but they are limited in the growth of those programs because we don't have enough people to either teach [in the] classroom or teach in the clinical setting."
Additionally, many nurses are leaving the industry and taking their degrees elsewhere.
"We're seeing people who are being innovative and looking at how they can use their degree in a different way," Croland said. "Maybe they're getting into informatics [or] maybe they're just leaving the profession altogether."
D'Andre Carpenter, DVP, RN, senior vice president and chief nurse executive at Allina Health, added that there is an imbalance in the workforce between experienced RNs leaving the workforce and new-to-practice RNs coming into the industry for the first time.
"Before, it was because of the competitive nature [of nursing] and being able to recruit and retain experienced registered nurses," Carpenter said. "Now, there's this added complexity with burnout and RNs actually leaving the workforce."
"We really do need to focus on those three [issues] particularly if we want to change the future for nurses, and with the younger generations coming in," Mensik Kennedy said.
Out with the old
The first thing CNOs need to do to combat these workforce issues is take a long look at their current practices to see what is effective and what isn't, especially with recruitment and retention. Carpenter described the idea of being a little disruptive and looking at strategies differently.
CNOs need to look at academic pipelines and how they can improve diversity, equity, and inclusion. Guste emphasized that patients deserve to have someone treating them that they can relate to and who looks like their community.
"What doesn't work is not doing anything about it," Guste said. "You have to address it head on and you have to see where [your gap is]."
Care delivery models are also due for an update. Mensik Kennedy talked about how team nursing and primary nursing are models of the past, and how oftentimes "new" care models being proposed are just old ones being brought back that are not actually innovative.
"We do need to modernize our care delivery models," Mensik Kennedy said. "We need to look at how we fold in nursing practice with virtual care, with remote care, and really understand how we can provide nursing practice."
Rigidity and being strict with shifts or what roles nurses can fill will no longer work. Croland discussed how CNOs need to be open-minded about staff schedules and specialty positions, and having flexibility to better accommodate each nurse's needs.
"I think we have to think very differently as to what our workforce [and] our potential applicant pool is looking for," Croland said, "and then respond better to that."
