CNOs need to be clear and transparent in communication surrounding AI, says this nurse leader.
AI has been all over the news recently, especially when it comes to nurses.
Many have questions about implementation and ethics, and it is up to CNOs and other nurse leaders to communicate with their workforce about what AI means for nurses.
Concerns
According to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, there are three main concerns that nurses have with AI. The first is about the ethics of generative AI.
"We've not explored this too much in nursing workflows," Rocchio said, "so taking a look at some of those ethical considerations and getting out ahead of it may help us a little bit."
The second concern is job displacement.
"While we have no plans on it taking out jobs, I do think it is informing, a little bit, how we practice," Rocchio said, "which can make some just a little bit nervous."
The third is loss of human touch and connection with the patients.
"Nursing depends on us being up close and personal with the patient," Rocchio said. "Sometimes nurses think that some of these automated, generated things may get between that relationship with the patient."
Nurses also have concerns about how AI will integrate with their workflows. Since AI implementation is so new, many health systems do not know where they will use it yet.
"That unknown entity of how we might use it in the future might be driving some of the trepidation behind AI," Rocchio said.
Settling doubts
The purpose of generative AI implementation in nursing, according to Rocchio, generally consists of these three key points:
"I think the purpose is going to be around leveraging technology to optimize nursing practice to assist some nurses with [getting] information out of our EHR directly to the front lines, [and] to help us improve outcomes for patients," Rocchio said.
Rocchio mentioned three ways that Mercy is communicating to their workforce, to help nurses understand AI's relationship with their workflows.
The first is through education and training. Nurses are used to receiving a lot of education and training, Rocchio explained, but not usually around process issues.
"We're going to have to start thinking about [incorporating gen AI] into our training programs," Rocchio said. "There are going to be applications where we use it in healthcare and many nurses may not even be aware that we are using it in certain circumstances today."
The leaders at Mercy are also trying to emphasize that when AI is placed into workflows to help quicken information delivery and documentation processes, it frees up nurses to spend more time with patients.
"That [loss of] human touch they're so worried about can be mitigated [by] giving them back more time at the bedside," Rocchio said.
Additionally, Rocchio said they try to engage nurses directly with the AI implementation process on the front lines.
"When you're thinking about what may help them at the front lines, [in] that implementation phase," Rocchio said, "they should be directly responsible and [involved] in some of that."
Beyond AI
It's important for nurse leaders to communicate about all new forms of technology and integration, beyond just AI, so that nurses can understand what's coming next. According to Rocchio, one of the best things to do is talk about what regular communication patterns will look like between leaders and nurses.
"Nurses need to know what to expect and where the communication source is coming from," Rocchio said, "not just from nursing leadership, but [also from] our office of transformation."
Nurse informaticists and the rest of the digital team should be a part of the communication process as new technologies are deployed. Rocchio said that the communication patterns that come from nurse leadership and digital leadership should be consolidated into one single framework so that nurses can consume it.
Mercy has also launched a learning module around some of the new technologies.
"Nurses are starting to learn that there are going to be different ways to do things within our learning management system," Rocchio said, "so we're using what they're used to getting education and communication patterns with…to talk about AI."
Transparency
CNOs must be clear with nurses about the implementation process, goals, and outcomes, Rocchio explained.
"Being transparent about our plans for the new technologies as well as our timelines and goals and our expected outcomes," Rocchio said, "and then making sure we provide regular updates on [if we are] hitting the goals."
Leaders also need to be clear about when problems arise.
Rocchio explained how when they launched their emergency department to inpatient handoff process with AI, they did not get it right the first time. When the pilot was launched on one unit, the AI had a couple "hallucinations," where the incorrect data was pulled into the format.
"We were very transparent with the nurses," Rocchio said. "We showed them how it happened, and we went back and corrected it, so they could see ethically that we were doing the right thing."
Leadership visibility and accessibility are also key.
"When we launched our workforce platform with AI in the background, the other thing we did was make sure that leaders and individual caregivers were there to make decisions around how that AI was put into the system," Rocchio said.
"I think both of those things are really important to make sure that those key messages are consistent across all platforms," Rocchio said.
Creating the workforce of the future is one of the biggest challenges for nurse leaders, says this CNO.
Dr. Jesus Cepero, PhD, RN, NEA-BC, has spent his entire career in nursing leadership roles, and is passionate about the care of babies, children, and moms. Cepero earned a doctorate in nursing from Catholic University in Washington, D.C., and a Master of Science in Nursing from Kean University. He also holds a Master of Public Administration from Seton Hall University.
Most recently, he served as chief nursing officer for the University of Michigan’s Mott Children’s Hospital and Von Voigtlander Women’s Hospital in Ann Arbor, MI. He was responsible for leading all aspects of nursing administration across the two hospitals. He developed a nursing philanthropy committee, implemented a system-wide program for senior leadership rounding, and co-led a response to the opioid crisis.
Now, Cepero serves as the CNO at Stanford Medicine Children's Health, where he provides nursing and patient care leadership across the entire enterprise, partnering with leaders in the outpatient, treatment center, and inpatient areas.
On our latest installment of The Exec, HealthLeaders sat down with Cepero to discuss his journey into nursing, and his thoughts on trends in the nursing industry. Tune in to hear his insights.
Healthcare organizations have to look beyond the money and focus on culture and innovation to bolster the workforce, said panelists at this week’s HealthIMPACT Forum
To take on workforce shortages across the enterprise, healthcare organizations have to be innovative. And that means looking past the money.
“We can’t get into a bidding war,” said Kirk Larson, Aspirus Health’s Chief Technology Officer, noting the Wisconsin-based health system can’t match IT salaries offered by the likes of Microsoft, Amazon, and Apple.
And it’s not just IT talent that health systems are struggling to find. Mike Mosquito, CHCIO, MBA, PMP, CDH-E, who heads emerging technology & innovation special projects for the Northeast Georgia Health System, said he has to be creative to draw doctors and nurses from the more affluent Atlanta area to the south.
The two healthcare executives were part of a panel titled “Solving Your Clinical Talent Shortage” at this week’s HealthIMPACT Forum in New York City. Their discussion hit on a topic familiar to every health system and hospital: Trying to keep the employees you have and create an environment to attract new employees.
The challenge lies in making healthcare an attractive career decision beyond the thorny issue of pay. And that means adding perks that appeal to employees seeking a better work-life balance and a good work environment, such as work-from-home opportunities, child and senior care benefits, and of course better workflows.
Healthcare innovation plays a significant role in that strategy. Health systems and hospitals are using virtual care and digital health tools to improve those workflows, aiming to reduce stress and burnout in the workforce and enable doctors and nurses to work at the top of their license—in other words, in front of patients rather than in front of a computer. Some health systems are using virtual care as a hiring perk, with the idea that clinicians can on occasion work from home and senior staff can virtually mentor young recruits and work from a desktop in a telemedicine command center.
Just as important, the panelists said, are collaborations between healthcare organizations and academic institutions. At the college level, health systems need to actively support healthcare curricula and create opportunities for students to experience what they’re studying to become, from job-shadowing to internships.
That effort should extend into high school as well.
“Help [students] understand where the jobs are,” said Larson, referencing programs that highlight the culture and responsibility of the healthcare industry and the opportunities to apply for positions that are open. He and the other panelists also suggested an easier process for students to apply for jobs—like a blue button for healthcare.
“Don’t always have a money grab,” added Mosquito, noting that some of the coolest, most innovative technology—like robots—is also being used in healthcare.
The panel, which included Sandra Bossi, Senior Director of Clinical Operations Administration at LiveOnNY and moderator Shahid Shah, chairman of the HealthIMPACT Forum, stressed that healthcare organizations need to “speak the language” of today’s emerging workforce.
“You’ve got to attract the kids [and help them to see] this is the path for you,” Mosquito said. “Not everyone’s going to be a TikTok millionaire.”
CNOs are responsible for making sure their nurses stay safe and healthy at work, both mentally and physically.
Editor's note: Mary Beth Kingston is Chief Nursing Officer for Advocate Health, the third-largest non-profit health system in the country.
Being a nurse requires so many skills.
They are patient and understanding when we’re suffering and recovering. They are experts, knowing the latest medical advances and care techniques. They are always available and ready when we need them the most.
They also need to be safe.
And yet nurses and health care workers are among the professionals most likely to face violence on the job in America.
According to the American Hospital Association, 44% of nurses have been subject to physical violence, and 68% reported verbal abuse. The Bureau of Labor Statistics shows that health care workers are five times more likely than others to be physically attacked on the job.
As the Chief Nursing Officer for one of the nation’s largest health systems, I’ve unfortunately heard these stories frequently from the nurses who have experienced these traumas. Somehow, because they’re so committed to caring for people, many victims of this violence press on.
Health care leaders like me must continue to support them, especially at a time when our industry is recovering from the stress and staff shortages exacerbated by the pandemic. Here are three key ways.
First, we need to listen to nurses.
We’re proud of the programs we have at Advocate Health to help prevent violence and help nurses with their wellbeing. The best ideas come directly from them. When I’m rounding in our hospitals and talking to the people who care for patients every day, I make sure to ask them what they need. What is going well and what isn’t? They’re doing the work every day, so they know better than anyone.
Nurses often tell me that – like so many other workers -- they find their greatest supporters in their teammates and direct leaders. So we must keep investing in training great nurses and nursing leaders.
Second, we must prioritize patient safety and worker safety at the same time. For health care providers, safety is paramount. We spend immense amounts of time, energy and resources working to ensure patients receive the safest care possible at our hospitals and clinics.
Violence prevention and addressing violence-driven injuries should be a priority for health systems as they look to advance health equity in their communities. For example, Advocate Health has several programs that are dedicated to helping patients recover after experiencing trauma and mitigating violence-related injuries. So we’re equipped to offer this support to our teammates, too.
And while the strategies are different, we need to prioritize our workers’ safety in the same way we do with patients. Nurses who feel safe at work provide great, safe care to patients.
Third, we need to ensure high-level leaders know how important this issue is to nurses and workers on the ground. June 7 was the American Hospital Association’s Hospitals Against Violence Day, a national awareness campaign that highlighted how America’s hospitals and health systems combat violence in their workplaces and communities. This work continues every day.
Among the leaders who must prioritize this issue are federal officials, who should advance the Safety from Violence for Healthcare Employees Act – known as the SAVE Act. This legislation would give health care workers the same legal protections against assault and intimidation that flight crews and airport workers have under federal law.
This law alone won’t solve the problem of violence in health care, but it will be an important tool and powerful statement to support all the work that’s being done locally to protect our nurses and health care workers.
Through the most difficult and trying times of our lives, they come through for us and ensure our safety. We must continue to come through for them.
Editor's note: Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content.
The University of South Carolina is launching a remote patient monitoring program aimed at reducing the state’s high maternal mortality rate of 32.7 deaths per 100,000 births
The University of South Carolina is launching a remote patient monitoring program aimed to improve care management for new mothers and their children.
The university is partnering with digital health company Rimidi to launch the program through an affiliated multispecialty clinic. Funded by The Duke Endowment, the platform will help care providers monitor blood pressure for patients in underserved communities following a high-risk pregnancy.
“Our partnership with Rimidi aims to address a critical maternal health challenge in South Carolina – reducing complications from postpartum hypertension,” Nansi Boghossian, an Associate Professor at the University of South Carolina who is spearheading the RPM program, said in a press release. “Through this collaboration, we are committed to improving patient care and enhancing the health of mothers in underserved communities.”
The program aims to tackle South Carolina’s high maternal mortality rate, which a recent report put at 32.7 maternal deaths per 100,000 births, by addressing key health concerns like preeclampsia, gestational hypertension, and chronic hypertension. That’s a high rate in a country whose 2022 maternal mortality rate of 22.3 deaths per 100,000 live births is one of the worst of all developed nations.
Through the health system’s Epic EHR, care teams will focus on metrics like blood pressure ascertainment during the first six weeks postpartum, in-person postpartum visit attendance, hospital readmissions through 12 months postpartum, program acceptability, retention, satisfaction, and cost-effectiveness.
RPM platforms give care providers an opportunity to monitor patients after they leave the hospital, clinic, or doctor’s office. By using connected devices to gather data from patients at home, they can spot trends, adjust care management plans, and even intervene if a patient is showing signs of developing a serious health concern.
A new program from the Digital Therapeutics Alliance and DirectTrust is betting yes.
Healthcare’s acceptance of digital therapeutics (DTx) continues to be a long and winding road. Two organizations hope to change that. DirectTrust and the Digital Therapeutics Alliance (DTA) are creating an accreditation program for DTx applications and platforms. The program will independently evaluate DTx products for their efficacy, and for data privacy, security, transparency and interoperability.
These characteristics are key for DTx regulatory approval (when required) and for another kind of approval: that of payers. DTx requires confidence: that it can improve outcomes as well or better than traditional therapies and thus be worth including in treatment recommendations, benefit designs, formularies and reimbursement.
DTx accreditation program details
In the new accreditation program, DirectTrust will administer and the DTA will develop the DTx evaluation criteria.
DirectTrust — a non-profit alliance that develops, promotes, and helps enforce healthcare data rules and best practices — already offers DTx evaluation services but is expanding them for the new accreditation program.
“This collaboration will add to DirectTrust’s growing suite of programs designed to assess the diverse digital health app and platform market,” said Scott Stuewe, DirectTrust President and CEO. Accreditation assessment will include data privacy, security, transparency — as well as interoperability to create “effective, scalable [DTx] connections to national health networks using the FHIR standard.”
The DTA is a non-profit trade association that promotes DTx understanding, adoption, and integration in healthcare.
“As the digital therapeutics industry grows, an increasing number of U.S. clinicians, provider systems, health plans, employers, and patients are evaluating how to best incorporate DTx products into their care plans to provide the highest quality of care,” said Andy Molnar, CEO of the DTA, in the program press release.
Making these decisions requires regulatory and reimbursement support.
DTx evolution: Approval and payment
Just as regulatory and reimbursement changes supported telehealth expansion during the pandemic, DTx products and developers need these tools to grow and scale.
Regulatory: Not all DTx products require regulatory approval. For those that do, the U.S. Food and Drug Administration (FDA) offers multiple pathways to demonstrate safety and efficacy, with the 21st Century Cures Act helping to further speed review. HIPAA and theThe HITECH Act govern most but not all DTx data privacy, security, and transparency requirements.
Reimbursement: “Yes, but limited” is how the DTA describes the status of most DTx reimbursement — when it occurs at all. Among public payers, Medicaid and Medicare Advantage offer more flexibility than traditional Medicare while employer-sponsored coverage requires negotiation.
According to BGO software, the FDA approved 50% more digital therapeutics in 2023 than in 2022.
There have also been setbacks and advances. Pear Therapeutics, one of the most promising DTx companies to emerge, declared bankruptcy in 2023 — just two years after going public with a $1.6 billion valuation and after securing multiple Medicaid contracts. Conversely, the Centers for Medicare & Medicaid Services (CMS) approved a new reimbursement code for AppliedVR’s DTx product that combines virtual reality hardware and software and likely helped expand the company’s partnership with the Veterans Administration.
Overall, digital health investment has cooled since the pandemic due to continued economic uncertainties, but as any private equity firm will tell you: there is a lot of dry powder in search of valuable investment. Could accreditation make DTx a stronger bet?
Why it matters: Trust and economics
The DTA’s CEO Molnar continues: “With an overwhelming number of products touting a wide range of clinical rigor, it is critical that we set a high bar to build trust.”
Efficacy is one hurdle. Providers and payers must have confidence that DTx options are as good as or better than or a worthwhile companion to traditional treatments.
Another hurdle is sustainability: Does DTx not only demonstrate but sustain outcomes in a way that makes it a sound investment? That answer will vary — by condition and treatment, by product and business, and by payer.
All of the above impact payer DTx decisions: Whether to cover it, how to cover it (medical or pharmacy benefit, formulary placement), and how to pay for it.
Will DTx accreditation matter?
Bigger changes must occur for DTx to become more integrated into healthcare’s delivery system and reimbursement framework. Is accreditation one of them?
As a baby step, maybe. Accreditation does lend credibility, particularly to new directions and initiatives. For example, there's the NCQA’s newer Health Equity Accreditation (HEA) and HEA Plus programs for health plans and health systems — designations that reflect an organization’s ability to create a health equity culture, to collect vital race, ethnicity, and language (REaL) data to support patients’ needs, and to identify equity needs overall.
Accreditation signals that key frameworks are in place that support strong healthcare practices and continuous improvement. The DTA and DirectTrust hope that accreditation will achieve the same for digital therapeutics.
A new study aims to replace BMI with BRI, giving care providers a better way to measure a patient’s fat content
Could a new measurement of obesity replace BMI and give healthcare providers a more accurate representation of their patients’ weight issues?
A new study published this month in JAMA, co-authored by researchers from China and Brown University in Providence, Rhode Island, makes the argument for what is called the body roundness index, or BRI. Whereas BMI, or body mass index, measures a person’s height and weight, BRI adds in waist circumference to gain a better understanding of where fat is distributed on the body.
The difference could affect how providers develop innovative programs to address obesity and other weight-related health concerns. With a better idea of how a body is proportioned and where fat is located, providers can develop better treatments and gain a better idea of those programs’ effectiveness.
It’s a key element to care management at a time when obesity and weight-related issues are a popular topic of conversation. From the effect that weight has on chronic diseases like diabetes, asthma, and heart disease to the popularity of Ozempic and Wegovy, both consumers and their care providers are keenly interested in how to address excess body fat.
BMI has been considered the standard for body fat measurement since the 1980s, but critics have long questioned whether it’s an accurate assessment, since it doesn’t take into account organs, bone, muscle and water. The JAMA study takes this one step further, arguing that providers need a better measurement “to decipher population-based characteristics and potential association with mortality risk.”
“Besides weight and height, BRI additionally considers waist circumference, and hence it can more comprehensively reflect visceral fat distribution,” the study’s authors note. “BRI was found to be superior over other anthropometric indicators in estimating the risk for various clinical end points, including cardiometabolic disease, kidney disease, and cancer. Furthermore, longitudinal studies have shown that high BRI was associated with the significantly increased risk of all-cause mortality and cardiovascular disease-specific mortality.”
The study, using data from almost 33,000 U.S. adults taken from the National Health and Nutrition Examination Survey (NHANES) and NHANES Linked Mortality File, compared a person’s all-cause mortality risk based on BMI and BRI, and found BRI to be more accurate. This was especially true for muscular people and the elderly, who tend to have inaccurate BMI measurements because of their body shape.
Those findings, the authors said, “provide compelling evidence for the application of BRI as a noninvasive and easy to obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies.”
Nurse managers are a critical piece of the workforce puzzle, and they are spread too thin.
On this episode of HL Shorts, we hear from Rudy Jackson, senior vice president and CNE at UW Health, about what needs to change in health systems to give more support to nurse managers. Tune in to hear his insights.
A report issued earlier this year by the Bipartisan Policy Center offers a blueprint for expanding remote patient monitoring opportunities and coverage
Remote patient monitoring (RPM) has the potential to improve clinical outcomes by giving providers the ability to improve care management outside the hospital or doctor’s office, but its growth is being stymied by low reimbursement.
A report released earlier this year by the Bipartisan Policy Center gives the government and the healthcare industry a blueprint to address that roadblock.
While RPM has seen tremendous growth coming out of the pandemic, its future is in question. The Centers for Medicare & Medicaid Services (CMS) offers only a handful of CPT codes for remote physiological monitoring and remote therapeutic monitoring, enabling care providers to recoup, according to one study, as much as $170 per patient per month from Medicare. To make matters worse, the American Medical Association’s CPT Editorial Panel, which governs CPT codes, has hit a roadblock on new codes that would expand reimbursement opportunities.
The reimbursement issue could prompt healthcare organizations to avoid launching or expanding RPM programs, figuring the effort to support the program is too much for the amount of money that would come back in.
To improve the playing field, the Bipartisan Policy Center report lists five recommendations for service coverage:
CMS should work with medical specialty societies to evaluate the evidence and determine appropriate coverage mechanisms to guide the optimal use of RPM, including for which patients and over what duration. This work could include collaborating with Medicare Administrative Contractors (MACs) or issuing National Coverage Determinations (NCDs).
As more evidence emerges about the appropriate use of RPM devices, the Health and Human Services Secretary should recommend a diverse set of billing codes so providers have more options for the time they spend on the data and the number of minimum days of data required.
CMS should clarify current policies regarding appropriate coding and billing of RPM and RTM. It should also require providers not enrolled in risk-based models to attest to medical necessity for patients’ continued use of remote monitoring—at a frequency deemed appropriate by the HHS secretary and based on condition-specific clinical guidelines.
CMS should work with the AMA and relevant medical specialty societies to develop additional RTM billing codes to allow for use cases beyond musculoskeletal, respiratory, and cognitive behavioral therapy—as the evidence supports.
Congress should request the Medicare Payment Advisory Commission (MedPAC) to report on the impact of remote monitoring on clinical outcomes and cost by disease state, and on any new billing thresholds or code durations, at least every three years.
The goal of these recommendations is to move the needle forward on RPM and give more healthcare organizations—especially smaller hospitals and health systems with limited resources and those working with underserved populations—a chance to expand their reach.
Virtual nursing will address workforce shortage issues, say these nurse leaders.
Virtual nursing will open up a whole new realm of possibilities.
From admissions and discharges to patient monitoring, mentoring, and even at-home care, virtual care technology will push healthcare into the future.
The HealthLeaders Virtual Nursing Mastermind program participants met last week in Atlanta to discuss their virtual nursing programs and outcomes. There are several key points that CNOs can take back to their health systems and integrate into their own virtual nursing programs.
Building the workforce
First and foremost, virtual nursing is going to expand the capabilities of the nursing workforce. Many of the participants agreed that virtual nursing is one of the only answers to the nursing shortage.
According to the participants, tenured nurses are able to extend their careers virtually when working at the bedside is no longer a viable option. New graduate nurses from the next generation who expect to work digitally will be able to do so, and licensed nurses from all over can work remotely and provide care to other parts of the country.
Health systems should do what they are capable of when it comes to operationalizing virtual nursing programs. Some participants use a central telemedicine hub in their health systems for the virtual nurses, while others use telemedicine stations on or near the floor. Some are also exploring work-from-home strategies.
Many of the virtual nurses in the participants' health systems are centralized and working off of a task queue, and can move freely throughout the system to complete their work. Several of the participants agreed that shift flexibility is also necessary, to give nurses who have external needs the opportunity to work when it is best for them.
Choosing the technology
Technology is obviously one of the largest pieces of the virtual care puzzle. It is critical that CNOs and other leaders invest in the right technology that will help them meet their goals, while also remaining cost effective. Leaders should not be surprised, however, to get it wrong on the first try.
According to the participants, leaders have several options for virtual care technology. Many started simply with iPads and carts, which they said aren’t long-termbut do enable them to get their programs off the ground.
When upgrading technology or starting at the beginning, several participating health systems outsourced to a third-party vendor, while others developed the technology in-house. One dilemma is whether to lease or buy the technology, since new devices are frequently updated to include the newest bells and whistles.
Most importantly, CNOs and other leaders should invest in technology that will actually be used by the care team. According to the participants, the nurses' experience with the platforms should provide them with a better, more efficient experience, because if they don't like the technology, it will not be used.
Gaining buy-in
One of the biggest challenges that CNOs and other nurse leaders will face when implementing virtual nursing programs is gaining buy-in from the rest of the C-suite.
CEOs and CFOs are largely concerned about ROI and how virtual nursing programs will save money. The participants recommended starting with concrete metrics like decreased discharge times to prove ROI. However, most metrics will depend on each health system's needs, and how they define ROI.
CNOs also need to provide their support to virtual nursing programs. According to the participants, there have been some concerns about ratio changes and nurses getting taken off the floor, and about how the technology will interfere with nurse workflows, which worries the nurses. This is why proper messaging, education, and a clear roll-out plan are critical, according to the participants.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
