AI can help clinicians manage complex conditions and relationships, says the CMIO of Stanford Medicine Children's Health
Pediatric healthcare is a complex undertaking. The doctor-patient experience is far more complicated, involving not just patients of various ages but parents, grandparents, siblings, other caregivers, maybe even a pet or two, real or imaginary. The old standard ‘How are you doing today?’ usually doesn’t do the job in this environment.
“So much of pediatric care is about connection, and about preventative medicine, and about ensuring that you understand the complex interactions between the child, the parent and the provider, and so, so much of that kind of subtle nuance about what is the child doing during the evaluation,” she says. “So much of what we’re assessing is the child’s behaviors [and] the child’s interaction with other people in the room, the child’s body motions. And if you're sitting at a computer and typing the whole time, you're missing all of that very rich data.”
Children’s hospitals have a rich history of embracing innovation, often because the tried-and-true ways of care management for adults don’t necessarily work for kids. Clinicians often have to take new ideas and technology designed for adults and modify them for their own patients.
That’s also true of AI, which, Pageler says, needs to evaluated differently.
Natalie Pageler, MD, CMIO of Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
Take ambient scribes, which are designed to capture the doctor-patient encounter for the medical record.
“We did a rigorous evaluation of how that affected the interaction for children and families, because most of it was developed in the context of a single provider and a single patient,” Pageler says. “Of course, in pediatrics, it's often the patient, a couple parents, a couple kids running around the room screaming. We really wanted to do that evaluation to understand [whether] it could have the same impact for children and families.”
The potential value of these tools for pediatric clinicians is clear. In that busy exam room, a doctor or nurse needs to be attentive to the children as well as the parents, picking up on subtle clues and interactions that could play an important role in diagnosing and treating underlying health concerns.
“We need to make sure they are addressing the true needs of the patient and the family,” Pageler notes.
Just as important, she says, is the connection between the clinician, the patient and the patient’s family, a key dynamic in any healthcare experience but critical to those working with children. Pageler says AI is helping to take the technological barriers out of the exam room and making children and their parents feel more comfortable.
“We’ve had several patients walk out of the room and say, ‘Wow, my provider looked at me the whole time and we got to really talk about this complex challenge I'm having with my child's behavioral issue,’” she says.
Pageler says some doctors have even decided to use AI instead of having a scribe in the room or listening to the conversation from another location. In some cases, she says, Ai is less intrusive to parents and children who want to talk about personal issues and don’t want another person listening to that conversation.
Aside from ambient listening opportunities, Pageler says AI can be a valuable support tool for doctors who are treating patients as young as infants and as old as teens. Different ages often call for different treatments, and the technology can help clinicians gather the information they need to guide their conversations with children, adolescents, parents and other caregivers.
“The relationships are so complex,” she notes. Clinicians have to be “extremely thoughtful” in how they share information with different patients and family members.
Pageler expects clinician decision support to be the next wave of AI innovation, helping clinicians find and use the right data to improve care management and coordination. That’s especially true as healthcare organizations set their sights on health and wellness and prevention opportunities.
As she sums up the value of AI in the pediatric care space, Pageler says the technology enables doctors and nurses to interact with patients, their families and others without the intrusive presence of computers and scribes.
“AI should make care more human, not less,” she says. It will “allow for more humanity” in care management.
Vanessa Ryan, senior vice president of operations at TruBridge Analytics, talked with HealthLeadres about the ways oversights in data analytics cause health systems to miss out in the revenue cycle...
These nurse leaders are coming together to share leadership strategies in celebration of nurses everywhere.
The nursing industry has grown and changed in many ways, especially in the past five years.
Heavy workloads, burnout, and workplace violence challenges persist, and nurses are departing from the industry, leaving staffing gaps and shortages behind. Despite these challenges, innovation in nursing has taken off, with AI and virtual nursing at the forefront of many CNOs' strategies.
This week is National Nurses Week, meant to celebrate the essential contributions that nurses make in communities worldwide. HealthLeaders is participating in the celebration with a week full of events, beginning with the next webinar in our The Winning Edge series.
Retention is the new recruitment
In the face of staffing shortages, retention is just as important as recruitment for CNOs. To truly build a resilient workforce, nurse leaders must focus on retaining nurses at every stage of their careers, from new graduate nurses contemplating life at the bedside to seasoned professionals nearing retirement and everyone in between.
The Winning Edge for Keeping Nurses Happy will explore innovative retention strategies that CNOs can use to foster career growth, prioritize wellbeing, and create a more sustainable work environment.
G Hatfield, Event Moderator and HealthLeaders CNO Editor
This isn’t just another webinar—it’s your chance to learn from the best in the business and walk away with strategies you can implement immediately. Join us as we face the problems, share solutions, and help you reboot your retention strategy.
Supporting nurse wellbeing is another key consideration for CNOs who want to build a sustainable workforce. Cheryl Reinking, CNO at El Camino Health, recently spoke to HealthLeaders about nurse turnover rates and how they are impacted by burnout and workplace violence.
For CNOs who want to improve retention, Reinking believes the culture of recognition at the frontline is key. Workplace violence prevention is another critical piece of the strategy. Reinking also said they brought in a nurse retention specialist in 2024 to help build professional career development plans for nurses.
For Nurses Week, Reinking will join Alicia Potolsky, associate CNO at El Camino Health, on a panel moderated by Joel Ray, chief clinical advisor at Laudio, where they will discuss how El Camino Health successfully addressed key workforce challenges and improved wellbeing for its nursing staff.
Virtual nursing, AI, and other technological advancements have taken the nursing world by storm with the promise of reducing burdens for nurses at the bedside. Virtual nursing has proven valuable in shortening admission and discharge times, and it provides support at the bedside for patient observation and education.
For Nurses Week, the following leaders in nursing and technology are coming together to discuss the natural progression of virtual patient observation, from focused observation to broader clinical applications, and to demonstrate how virtual nursing creates new clinical pathways for delivering expert care while addressing staffing challenges and maximizing the impact of existing nursing resources.
Nurse turnover rates have been high since the COVID-19 pandemic, and it's important for CNOs to reflect on what they can learn from that time.
HealthLeaders spoke to Cheryl Reinking, chief nursing officer at El Camino Health, about how the health system reduced its nurse turnover rate to 5%. Tune in to hear her insights.
A bill introduced in both the Senate and House would Improve Medicare reimbursement for rural providers using RPM technology.
While adoption rates are growing for remote patient monitoring (RPM), rural and remote providers are holding back, due in large part to low Medicare reimbursement. A new bill before Congress aims to change that.
The Rural Patient Monitoring Access Act, introduced this week by U.S. Senators Marsha Blackburn (R-Tennessee) and Mark Warner (D-Virginia) in the Senate and by U.S. Reps. David Kustoff (R-Tennessee), Mark Pocan (D-Wisconsin), Troy Balderson (R-Ohio) and Don Davis (D-North Carolina) in the House, would set a geographic payment floor for RPM reimbursement, enabling rural providers to recoup expenses from Medicare at the same rate as their urban and suburban counterparts.
Supporters say the bill would also ensure that providers are capable of responding to health concerns detected by RPM and that the RPM technology can promptly transmit biometric data at the EHR. It would also give the Centers for Medical & Medicaid Services (CMS) a pathway for reporting data to the Health and Human Services Department (HHS) to evaluate costs savings generated by RPM.
The proposed legislation has a number of supporters, including Marshfield Clinic, Lifepoint Health, SSM Health, Ascension, the University of Virginia Center for Telehealth, the American Telemedicine Association (ATA), the National Rusal Health Association, HIMSS, and the Alliance for Connected Care.
According to a summary of the bill, RPM reimbursement via Medicare is lowest in areas where the prevalence of heart disease, hypertension and diabetes are above average and where access to care providers is problematic.
“Patients in rural and underserved communities deserve the same opportunity to manage their health as those in more resourced areas,” Christ Frost, Lifepoint Health’s CMO and Chief Quality Officer, said in a press release. At Lifepoint, we’ve seen firsthand how high-quality remote patient monitoring can help bridge long-standing access gaps and drive meaningful clinical improvement, especially for chronic conditions like hypertension and diabetes.
The bill comes just two weeks after the Peterson Center on Healthcare released a study that called for improvements to RPM reimbursement, including coverage that aligns with specific services that have shown the most value, improved access to high-impact RPM services and improved data collection from RPM devices.
The study also found that hypertension, diabetes and heart failure are the most common conditions being monitored through RPM.
“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”
Jefferson Health, a participant in the HealthLeaders Virtual Nursing Mastermind program, is strategically expanding its program as it looks for sustainability
Jefferson Health launched its virtual nursing program in 2023, and is expanding its strategy to broaden the virtual observation footprint and include inpatient provider consults. They’re also exploring opportunities to integrate other care team connections, such as diabetes educators.
“For nursing specifically, we completed a second pilot, applied key learnings, and officially launched a formal program with a dedicated, permanent team,” Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, the health system’s Nursing Informatics Officer and a second-year participant in the HealthLeaders Virtual Nursing Mastermind program, said in an e-mail Q&A. “We have refined the virtual nurse’s core tasks and workflows to enhance support for bedside teams and have collaborated closely with our vendor to optimize the technology. In addition, we have identified other areas across our system where virtual care can further improve patient support and clinical workflows. As we continue to expand, our goal is to integrate virtual care more seamlessly into inpatient operations to enhance efficiency and patient outcomes.”
This includes using the virtual platform for more care team functions. Beyond the first use cases for provider consults, Gartner says they want to expand inpatient consults to help hospitals access specialists in other locations and reduce the need for transfers, which can be stressful and time-consuming. They’re also working to integrate this and other virtual functions into their EHR platform, so that virtual nursing isn’t an added function that complicates nursing workflows.
These additional services cost time and money, though, which is a tough sell in this economy.
Laura Gartner, AVP and Nursing Informatics Officer at Jefferson Health. Photo courtesy Jefferson Health.
“One of the biggest challenges we’ve faced with the virtual nursing program is securing sustainable funding,” says Gartner. “There is strong interest in implementing virtual nursing across various units, as the benefits—such as improved workflow efficiency and enhanced patient support—are widely recognized. However, integrating a virtual nurse into staffing models requires a financial investment, and identifying consistent funding sources has been a barrier. Aligning financial priorities with program expansion remains a key focus.”
To prove that ROI, Gartner says they’re tracking process metrics such as average number of virtual nursing sessions per shift, overall number of sessions, time per session and overall, and the reason for accessing a virtual nurse. They’re also tracking outcomes, including the 30-day readmission rate, falls, falls with injury, HCAHPS scores, voluntary nurse turnover, discharge times, LOS, and incidental overtime, among others. To date, she says, they’ve seen improved HCAHPS scores, shorter LOS times, a decrease in incidental overtime and reduced discharge times.
They’re also on track, she says, to double the use of their meds to beds program, which aims to improve patient education and medication management.
The program also has value that can’t be measured in a metric. Gartner says virtual nursing has had a positive effect on the nurse-patient relationship.
“One of the best parts [of the program] has been hearing the virtual nurses connect with patients,” she says. “These are truly incredible nurses, and through this program, they’re able to spend more focused time with patients than they often could at the bedside. It’s been rewarding for both the nurses and the patients, and a great reminder of the value of meaningful interactions in care.”
Gartner says she was surprised by how nurses were initially apprehensive about the program.
“Even though virtual nursing has a benefit of reducing bedside staff workload, it’s still a big change from how things have traditionally been done,” she says. “Some nurses were worried that we were taking a nurse away from the unit, rather than adding support.”
In fact, the health system has changed its staffing strategy as the program evolves. Where Jefferson Health first used two enterprise resource nurses on temporary assignment, Gartner says, they’ve now switched to two permanent staff members and have plans to add more.
“I’ve found that building trust and understanding takes time, and that’s been a valuable reminder of the importance of clear communication, collaboration, and involving frontline nurses early and often,” she added. “What’s been most encouraging is that, as nurses see the impact firsthand and hear positive feedback from peers, acceptance and enthusiasm grow organically. It’s a journey, but one that’s already showing great promise.”
CNOs should focus on reducing burdens, including staff, and partnering with informaticists when implementing AI, according to these nurse leaders.
The door is wide open for AI in healthcare, and as nurse leaders determine the best ways to utilize it, it's important to focus on the goal.
At the 2025 HealthLeaders CNO Exchange, the participating members discussed how AI should exist in nursing to support the work that nurses already do, at the bedside and beyond. AI is capable of providing the whole picture in the EHR, which can lead to impactful workflow redesign.
Most importantly, staff must be involved in implementation. Technology integration is at its best when it happens with nurses at the helm, as they will likely be using the technology most frequently and are tuned in to workflow gaps.
With all of this in mind, here are five things CNOs should focus on when integrating AI.
The Arizona-based health system's new SVP of Partnership and Venture Development sees the value of collaboration and being proactive instead of reactive.
As healthcare adapts to a changing landscape and the presence of disruptors, the idea of “traditional” healthcare is being replaced by a network of collaborations and partnerships focused on the consumer’s care journey.
To Mark Garvin, Banner Health’s new Senior Vice President of Partnership and Venture Development, that’s fertile ground for the value-based care system of tomorrow. And it’s his job to steer the Phoenix-based health system in the right direction.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Garvin has a background in ambulatory care—as chief operating officer for United Surgical Partners International from 2001 until 2020, he oversaw the company’s evolution from a start-up to the nation’s largest developer of short-stay ambulatory surgery centers and hospitals. Now he’s guiding the six-state, 33-hospital network toward a future where care is accessed in many locations.
Banner wants to expand its service offerings and geography “beyond just the acute [care] side,” he says. “What we want to do is grow the diversification as a percentage of the overall business in things that are outside of the traditional acute” care spectrum.
Expanding that footprint means looking beyond “traditional” healthcare to new ideas. Garvin says Banner should not only be open to innovation—they should be leading the way.
Mark Garvin, SVP of Partnership & Venture Development at Banner Health. Photo courtesy of Banner Health.
“Why wait for someone else to come to the table?” he asks. “Why not be part of the creation, either [as] an owner or a partner or in a joint venture?”
One example of the joint venture is Banner Health’s partnership with Select Medical, which began in 2018 and has led to the development of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy centers. The hospitals, which are run by Select Medical under the Banner name, address a growing need for inpatient rehabilitative care for patients who are recovering from strokes, traumatic brain injury and other medical conditions.
“These are people that wake up every single day and this is what they worry about,” Garvin says of Select Medical. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin sees more of those types of arrangements in the future, as health systems and hospitals look beyond their own walls to transform care delivery. He says Banner has to be strategic, as the health system attracts a lot of innovators and start-ups that are looking for Banner to “put them on the map.”
“Is there something real here that we think makes a material difference?” he says. “Does it give us the ability to do things that perhaps in the in the past took a lot more labor and time to get accomplished? We have to ask those questions.”
“We have to do due diligence,” Garvin adds, noting that a good idea now might very well be outdated in 12 months. And while the pace of innovation (think AI) might force healthcare leaders to rush into things, he wants to slow it down a bit.
“Don’t get in too much of a hurry,” he says. “That’s where the mistakes will come in.”
CNOs must commit to continuing wellbeing programs once they invest in them, says this nurse thought leader.
On this episode of HL Shorts, we hear from Diane Sieg, Registered Nurse, Author, Coach, and Creator of the Well-Being Coaching Initiative, about what CNOs can do to continue their wellbeing programs. Tune in to hear her insights.
Targeting burnout and workplace violence can help CNOs lower nurse turnover, according to this CNO.
Nurse turnover rates have been high since the COVID-19 pandemic, and as the five-year anniversary passes, it's important for CNOs to reflect on what they can learn from that time.
During the pandemic, nurses were feeling burnt out, and according to Cheryl Reinking, CNO at El Camino Health, overburdened both emotionally and physically. Now, burnout is still a critical issue in nursing, along with heavy workloads, documentation burdens, and workplace violence.
"We're coming out of that," Reinking said. "We’re still challenged with continuing to address the needs of the workforce as it pertains to burnout."
Since the pandemic, there have been some positive changes in nursing. Despite the continued prevalence of workplace violence incidents, Reinking cited the increased focus on flexibility and work-life balance, which Reinking calls "work-life integration."
"I think [work-life integration] is a great new term because I'm not sure there's ever any balance," Reinking said."
However, turnover rates continue to be a significant issue for many health systems. While many CNOs are still working towards solutions, Reinking and the leadership at El Camino Health have found the path forward.
What happened at El Camino Health?
According to Reinking, El Camino Health had a turnover rate of less than 5% before the pandemic. That number increased to about 12.7%.
"That's the highest it's ever been, and I've been here for 37 years, and I've never seen it that high," Reinking said. "Now that's lower, in fact, than half of what the national rate was at the time. However, for us that was tremendous."
The health system's turnover rate has since dropped back to 5%.
El Camino is a relatively small to medium-sized organization, Reinking explained, so they wanted to understand the contributing factors and root causes of the spiking turnover rate. One of those factors was engagement and recognition.
"[We make sure] we have recognition programs in place to address those many important activities and care practices that nurses bring to patient care and to the bedside," Reinking said.
Workplace violence prevention is another critical piece of the strategy. Reinking also said they brought in a nurse retention specialist in 2024 to help build professional career development plans for nurses.
"What we found is that nurses want a trajectory of advancement…especially the Gen Z [nurses] who are now in our workforce, they want to know what's next," Reinking said. "We want to make sure we create a plan for them to know what's next in their career trajectory while staying at El Camino Health."
Improving retention
For CNOs who want to improve retention, Reinking believes the culture of recognition at the frontline is key. To help increase that effort, El Camino Health is leveraging Laudio's software platform so nurse managers can recognize individuals for their birthday, work anniversary, or for working an extra shift.
"That's been tremendously well-accepted and has really been seen as boosting our engagement of our nurses," Reinking said.
To combat burnout, the health system hired a licensed clinical social worker who is trained in mental health support. That way, when something traumatic happens to a nurse, there is someone on staff who can help them work through the incident.
"This employee support specialist can meet in the moment with our clinical staff and help to be that decompression that they need, and that person they need to talk to about what just happened during their shift," Reinking said.
To mitigate workplace violence incidents, El Camino Health also implemented the CALM team, to address patients who begin to escalate their behavior. The program brings in mental health professionals in a proactive way to help address any unmet needs the patient might have, which according to Reinking is usually the reason why patients begin to escalate.
"We can help make sure that we're providing that unmet need through that mental health support at the bedside," Reinking said.
Ultimately, Reinking believes it takes a combination of strategies to lower retention rates.
"I wish there was a magic bullet, but we've been trying to understand all the different things and what's made the biggest difference," Reinking said.
