CNOs must be role models in a healthy work environment, says this nursing leader.
There is an overwhelming sense of nurse dissatisfaction in the industry, due to exhaustion from heavy workloads, staffing shortages, workplace violence incidents, and other external disruptors.
A healthy work environment is necessary for nurses to thrive, and for patients to get the highest quality care and experience when visiting a health system.
As part of our coverage on healthy work environments, we sat down with Vicki Good, Chief Clinical Officer at the American Association of Critical-Care Nurses (AACN), to learn more about the AACN's six standards for a healthy work environment, and the new Health Work Environment National Collaborative program.
Stephen Ranjan believes teamwork is just as crucial as technology in building successful digital healthcare solutions in the pharma space
Stephen Ranjan learned how to be innovative while growing up in India.
"Living in India, you learn to be resourceful," the global head of digital health at Roche Pharma recalls. "You don't have access to everything, and yet you still find ways to solve the challenges that you encounter. I brought that attitude with me when I came to the U.S."
When Ranjan moved to America to attend college, he found a market for his skills, and a career was born.
"In the U.S., if you can help people solve problems, they will give you opportunities to do so,” he says. “I ended up working at the help desk of my university. I built software that allowed the help desk to track student loaner laptops. This job paid for my college."
At his first job at Epic Systems, Ranjan was introduced to how software can enable efficiency in healthcare. He says he wanted to introduce those technology solutions to the pharma industry, where there were plenty of problems to be solved.
He's had plenty of opportunities. Prior to joining Roche, Ranjan held positions at Merck & Co. and Johnson & Johnson. He says he has seen digital health technology advance, but it still has many more opportunities to improve the patient's health journey.
"About 15 years ago, the industry was just beginning to dabble with technology in the form of websites, social media, and those types of things," he says. "But over the years, pharma has gone through a transformation. The uptake at first started on the sales and marketing side, but in the last 10 years, there has been more investments in the R&D side, especially right now with AI. That has been a huge, huge transformation."
Ranjan says most of the advancements in patient care have been made in cardiovascular, metabolic disease, and mental health, where technologies like continuous glucose monitors are helping patients self-manage their care.
A Lifetime of Experience
Today, Ranjan is using his years of experience to steer the company toward more digital health innovations that improve patient health management. Before he became global head at Roche, he was responsible for the Roche Diabetes Care Digital Health business, where he was instrumental in the growth of engaged users on mySugr and the Roche Diabetes Care Platform.
Ranjan says one of his biggest achievements happened in 2017, while he was working at Merck. He and his team collaborated with the Alexa team at Amazon and Luminary Labs to create an open innovation challenge in diabetes. The task for contestants was to discover a way to use voice technology to help diabetes patients manage their disease.
The challenge generated an increased focus on voice technology worldwide and spurred more companies to develop their technologies to become more healthcare-compatible.
"We're seeing a lot more voice applications being developed," Ranjan says. "The highlight for me from running a challenge like this was to see the impact ripple across the globe and motivate the market to think more about solving some of these problems."
Teamwork Over Technology
Ranjan has focused often on building new teams that can carry out the mission of the company.
"I've learned a lot about how to build teams," he says. "I don't invest in ideas. I invest in teams who are solving complex problems."
He believes his approach to building teams has influenced their success. And although the technology they use is an important part in reaching goals, he says building teams that can work together well to create solutions is a bigger priority.
Building a strong team, Ranjan says, requires hiring people who are equipped to bump up against a brick wall and still persevere, and to get creative and find other ways to make things work.
"Great team members are willing to learn new things and adjust to the new learnings,” he says, “because [in] this area [that] we're in, there's never a straightforward answer.”
"You have to be willing to try and experiment and maybe even fail,” he adds, “but [you] learn from it so that you can get better at making decisions the next time around.”
According to Ranjan, team members need to possess the potential and willingness to learn and grow as they face problems within the business or other challenges in an organization. Tolerance for failure and moving on are also important.
"The last bit for me, personally, has been patience," he says. "This is a long game. If we really want to impact patient lives and use technology to impact them, you can't rush through these things.”
Staying on the Path to Innovation
Ranjan sees a bright future ahead.
“For me, this is such an exciting space,” he says. “We are working to empower patients to manage their disease and live a better life, and that's the vision that I'm excited about--watching our teams push and innovate. We will have some successes, but we will also have a lot of learnings. And that's going to become all part of the innovation."
Ranjan and his family recently moved to Switzerland, where he's taking advantage of the Alpine scenery and climate, as well as the cycling culture.
"I'm not quite as good at cycling as people here [in Switzerland]," he says. "But I'm embracing it and I'm enjoying bike rides with my boys. My other hobby is I love to take photos of birds in flight. There's something about the way birds fly and how they move that's fascinating to me, and I love capturing those moments."
Ranjan's long-term vision is to continue using digital health to overcome obstacles and better the lives of those dealing with chronic diseases.
"We, as an industry, still have a long ways to go in digital health and I'm hoping that I can continue to lead teams to figure out new ways to meet the needs of patients,” he says. “Because at the end of the day, what motivates me is knowing that we are resolving problems for patients, but potentially also for someone we know. We are really in the service of helping people."
The agency is warning that no devices have been approved that can accurately measure a user’s blood glucose without piercing the skin
Federal regulators are hitting the pause button on digital health advancements for diabetes care management.
The U.S. Food and Drug Administration (FDA) has issued a safety alert indicating that smartwatches or smart rings that claim to measure a user’s blood glucose levels without piercing the skin should are not reliable and should not be trusted.
“The FDA has not authorized, cleared, or approved any smartwatch or smart ring that is intended to measure or estimate blood glucose values on its own,” the agency said.
Some 38.4 million Americans live with diabetes, according to a 2021 report from the American Diabetes Association (ADA), and experts say that population is the fastest growing chronic care population in the nation. Care management includes monitoring blood glucose levels throughout the day and taking immediate action (such as injecting insulin) when those levels are out of particular range. A trending high or low blood glucose level could lead to serious health issues, including coma and death.
Digital health advances have greatly improved care management for diabetes over the past two decades, including wearable sensors that can track blood glucose and administer doses of insulin when needed and AI-enhanced tools that can identify trending blood glucose levels before they become dangerous or are even noticed.
While the industry has been working on wearables that can accurately measure blood glucose without pricking the skin, that technology hasn’t yet been perfected.
“The FDA routinely monitors the medical device market and became aware of unauthorized products being marketed to consumers,” the agency said in its alert. “The agency is working to ensure that manufacturers, distributors, and sellers do not illegally market unauthorized smartwatches or smart rings that claim to measure blood glucose levels. Additionally, the FDA is alerting consumers about this issue and making the public aware that smartwatches and smart rings should not be used to measure blood glucose levels.”
The technology won’t be valuable if it isn’t interoperable
Editor’s Note: Missy Scalise, MD, is an internal medicine physician, associate program director of the IM residency program, and chair of the Clinician Well-Being Committee at Ascension-St. Thomas in Nashville.
The medical profession faces a looming crisis on two related fronts: clinician burnout is at an all-time high, driving many to leave medicine or seek early retirement, while a shortage of clinicians choosing to practice medicine (specifically, primary care specialties) is causing patient access imbalances, especially in lower-income areas across the country.
Generative AI can significantly improve the quality of life of clinicians and help make primary care more appealing. Its ability to quickly and accurately document visits is crucial, but there are difficulties in integrating this technology into the current clinical platform.
Since electronic medical records (EMRs) became standard with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, clinicians have spent more and more time on documentation and other administrative tasks, which in turn contributes to decreasing clinician well-being. The integration of AI into EMRs will free clinicians from these tasks and allow us to use our knowledge and energy on the part of medicine we enjoy most: Connecting with patients, thinking about their problems, and helping solve them.
Before adopting an AI tool for EMR documentation, I would spend at least two hours per clinic day documenting patient visits, often during my free time (that’s a lot of “clicks” per day). On the weekends, I would wake at 5 a.m., before my children were up, to finish my documentation.
Now, with help from AI, I can sleep AND still spend time with my family.
Missy Scalise, MD, is an internal medicine physician, associate program director of the IM residency program, and chair of the Clinician Well-Being Committee at Ascension-St. Thomas in Nashville. Photo courtesy Dr. Scalise.
After getting my patients’ permission, I can activate an AI clinical assistant and then speak to my patients naturally. The tool, listening in the background, will pull the most relevant parts of the conversation and generate notes, which are then pushed into the EMR. Instead of staring at my computer while speaking with my patients, I can maintain eye contact with them the entire time. After we talk, I review the AI-generated note, editing a few words (turning plain language into medical terminology, for instance). My notes are automatically uploaded into the EMR with one click, and I am done.
In my estimation, this technology has reduced my paperwork load by 80% to 90%. This allows me more time to focus on patients as well as spend more time with my family. I’m not exaggerating when I say it’s changed my life.
If these AI tools are adopted at scale, I believe clinician efficiency and well-being will improve across the board. With increased well-being, clinicians are less likely to make mistakes and more likely to be engaged, thereby improving healthcare outcomes.
However, not all EMRs allow for smooth integration with AI-powered tools. Support for the integration of third-party applications ranges from not working at all, to only enabling schedule access, to allowing the two-way sharing of information between tools and the EMR in real-time.
EMRs are complicated software that must prioritize the privacy and safety of the patient data they contain, and thus third-party integrations are complex and often protracted. But these legacy EMRs need to adapt to the times. Integration of AI tools must be a priority going forward. At the same time, AI vendors must find ways to partner with EMR providers to build the level of integration they need.
The commitment to integrating these tools, regardless of the time and resources required, is a non-negotiable step toward better healthcare. Solutions that can fully integrate with EMRs promise enhanced patient care through more accurate and comprehensive data and increased efficiency in clinical workflows. This level of integration is more than a technological advancement, it’s a critical part of an evolution in healthcare.
AI has shown me a better way to work, and there’s no going back. I now advise residents to ask about AI tools while negotiating for positions. Anecdotally, I’ve heard from other doctors pushing their employers toward more open EMRs so that they, too, can leverage AI-powered tools in their day-to-day work. One gastrointestinal practice, for example, shifted from a gastroenterology-specific EMR to a specialty-agnostic EMR because the latter allowed for integration with third-party tools.
As the U.S. healthcare system faces shortages and clinician burnout, adopting technology can act as a salve for many of its ills. I’ve experienced firsthand how using AI tools improves my workflow and makes me a better doctor. As more doctors learn about these tools, they will surely push for their integration, and EMR companies and vendors alike must act swiftly to listen.
Safe patient handling programs help reduce nurse injuries.
Working in healthcare poses many safety concerns, including exposure to illness, physical injury, and workplace violence.
According to the Occupational Safety and Health Administration (OSHA), in 2020, hospitals recorded nearly three times more work-related injuries and illnesses for every 100 full-time employees than in all industries combined.
CNOs must ensure that there are proper safe patient handling procedures in place so that nurses avoid sustaining injuries. Here's what you need to know about safe patient handling.
In today's episode, we're joined by John Zabrowski of VHC Health, to discuss the development of the system's 15-year RCM partnership, how the system and vendor plan to work together, and goals for the first year.
The New Jersey health system is partnering with care.ai to scale a pilot program in one med-surg unit to all of its hospitals
Virtua Health is partnering with an AI company to scale a new Virtual Nursing program across the enterprise.
The New Jersey-based health system is collaborating with care.ai to integrate its virtual care technology throughout Virtua Our Lady of Lourdes Hospital in Camden following a pilot program launched late last year in one med-surg unit. Virtua executives say the platform will eventually be scaled out to all hospitals in the health system.
"By embracing the transformative potential of artificial intelligence and ambient intelligence, Virtua is pioneering a new era in patient care," Tarun Kapoor, MD, MBA, Virtua Health’s senior vice president and chief digital transformation officer, said in a press release.
The partnership is part of a nationwide trend of health systems and hospitals adopting virtual nursing platforms for one or more of three primary reasons:
Many are using virtual care technology to address staffing shortages and reduce stress and burnout by assigning virtual nurses administrative tasks and allowing on-site nurses to focus on care management.
They can also target improved administrative and clinical outcomes through round-the-clock patient monitoring and data entry and analysis.
Some are also using the platform to mentor newer nurses and give older nurses a new opportunity to stay in the workforce.
Virtua executives say the platform aims to streamline patient care “from routine admit and discharge activities to documentation, fall prevention, and clinician safety.” It enables floor nurses to focus on patient interaction while the virtual nurse handles other tasks, while ambient AI sensors in the rooms keep an eye on patients at all times.
“Our focus is not just on integrating cutting-edge technologies, but on enhancing the human aspects of healthcare,” Michael Capriotti, Virtua Health’s senior vice president of integration and strategic operations, said in the press release. “By swiftly adopting optical cameras and ambient sensors, we’re poised to markedly enhance the patient and care team experience, ensuring a safer, more efficient, and empathically connected healthcare experience.”
CNOs must know how to define healthy work environments in order to build them.
On this week’s episode of HL Shorts, we hear from Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals, about the qualities of a healthy work environment. Tune in to hear her insights.
A recent OIG audit of evaluation and management (E/M) services provided by telemedicine during the pandemic found that providers generally followed the rules for Medicare reimbursement. But they did make some documenting errors
Healthcare providers who use telemedicine often rely on reimbursements to support the platform. And according to a recent audit, they did a pretty good job documenting those virtual encounters during the pandemic.
The report, prepared by the Health and Human Services Department’s Office of the Inspector General (OIG), analyzed $10.3 billion in E/M services billed to Medicare between March and November of 2020, of which $1.4 billion, or about 14%, were conducted by telemedicine. The OIG found that providers “generally complied with Medicare requirements” to a point that the agency made no recommendations for changing or improving the coding and reimbursement process.
That being said, the OIG audit identified five common errors in documenting for an E/M visit conducted via telemedicine. They are:
Documenting how a service was provided. Some providers didn’t document whether the service was done in person or through either an audio-only or audio-visual telemedicine visit.
Documenting the location of the telemedicine visit. Some providers did not document where the provider or patient were located during the encounter.
Identifying the telemedicine product used. Some providers documented the use of audio-visual telemedicine for an E/M visit but didn’t identify the platform used (such as Zoom, Microsoft Teams, or a telemedicine vendor). The federal government relaxed both CMS and HIPAA guidelines during the pandemic to enable providers to use more telemedicine platforms, including public-facing products. Now that the pandemic and the public health emergency have passed, the government is again cracking down on telemedicine products that don’t meet rigid privacy and security guidelines and pushing providers to use platforms that are secure.
Clarifying the telemedicine modality. Some providers documented that they used audio-only telemedicine for the E/M encounter but used an audio-visual telemedicine CPT code, which is different from the audio-only CPT code. The government expanded the use of audio-only telemedicine during the pandemic to expand access to healthcare services but has been pulling back since then to focus on more secure audio-visual telemedicine platforms.
Documenting problems with the technology. Some providers reported that there were problems with the technology during a telemedicine visit, such as an unreliable internet connection or issues using video. They therefore conducted the visit via audio-only telemedicine but documented the visit as an audio-visual visit.
According to the OIG report, the problems weren’t big enough to indicate the need to take action, but they point to areas of concern that could affect future telemedicine policy. For example, CMS may wish to issue guidance in the future on how providers should deal with technology issues and how they should document the encounter.
Creating a safe patient handling program can help reduce injuries and time lost due to injury.
Working in healthcare poses many safety concerns, including exposure to illness, physical injury, and workplace violence.
According to the Occupational Safety and Health Administration (OSHA), in 2020, hospitals recorded nearly three times more work-related injuries and illnesses for every 100 full-time employees than in all industries combined.
One concern for nurses is the use of equipment to handle patients who are less mobile and need assistance, says Deana Sievert, Chief Nursing Officer at Ohio State Wexner University and Ross Heart Hospitals.
“Nurses are utilizing many different pieces of equipment to complete patient care,” Sievert said. “Those pieces of equipment can be very heavy or difficult to move.”
“It is more common than it should be for nurses to sustain musculoskeletal injuries such as pulled or strained muscles, and damage to bones or joints,” Sievert added, “and these can range from small sprains to career ending injuries.”
CNOs must ensure that there are proper safe patient handling procedures in place so that nurses avoid sustaining injuries.
Policies and procedures
Sievert believes CNOs need to build a culture focused on safety, where nurses have the tools they need to be successful. The policies created for safe patient handling should promote the concepts of a no-lift environment, and treat the use of safe patient handling equipment as a non-negotiable.
“Creating a ‘no lift whenever possible’ culture is something each CNO should strive for,” Sievert said. “It is imperative to ensure that nurses have [the] appropriate pieces of equipment that assist with lifting, repositioning, increasing mobility, walking aides, and emergency equipment when lifting may be necessary.”
Sievert recalls one of the most successful no-lift cultures she worked in, where there was a safe patient handling coordinator who visited each department and made the no-lift expectations clear. The safe patient handling coordinator also evaluated each department and identified needs, providing the appropriate equipment for each kind of care.
“Safe patient handling equipment was in all areas of the hospital including ambulatory areas,” Sievert said, “and the hospital had overhead patient lifts in each patient room.”
Additionally, there were safe patient handling coaches on each unit, according to Sievert.
“These coaches were key to departmental culture,” Sievert said. “All of this body of work helped significantly drive down injury costs and days lost to injury.”
According to OSHA, having a written safe patient handling policy ensures implementation and continued success. Programs will work when there is consistent leadership making safe patient handling a visible priority, and when nurse managers and frontline staff members are involved during the development stage.
OSHA provides a safe patient handling checklist that health systems can use to evaluate their programs. The checklist is broken up into several sections:
Policy development
Management and staff involvement
Needs assessment
Equipment
Education and training
Program evaluation
CNOs can use this resource to see which areas in their safe patient handling programs are well developed and which components of the programs might need more attention.
Training
To make safe patient handling programs a success, CNOs need to make sure that nurses receive the proper training, and that they understand the equipment and procedures to the fullest extent.
Sievert recommends that training follow the resources the organization has in place to address physical hazards.
“Training should be crystal clear in regard to the culture the organization wants to create, the expectations, and resources available,” Sievert said. “Creating that culture is key to success, and training and retraining is critical.”
According to OSHA, all staff, including physicians, must be trained in safe patient handling, through onsite demonstrations of equipment use and maintenance and broader education programs. OSHA provides the following recommendations to create a safe patient handling training program.
Train all relevant workers on using mechanical lift equipment
Refresh, remind, and require ongoing training
Use mentors and peer education
Train caregivers to check each patient’s mobility every time
Engage patients and their families
For more information on OSHA’s recommendations for safe patient handling, click here.
