Claire Bonaci
You're watching the Microsoft US health and life sciences, confessions of health geeks podcast, a show that offers Industry Insight from the health geeks and data freaks of the US health and life sciences industry team. I'm your host Claire Bonaci. On this episode guest host Molly McCarthy talks with Dr. Vickie Tiase, Director of Research science at New York Presbyterian Hospital. They discuss the future of nursing 2020 to 2030 Health Equity report, and how technology can assist in achieving the goals discussed in the report.
Molly McCarthy
Hi, good morning. It's great to be here back on confessions of health geeks. And with me today I have Dr. Victoria Tiase. She's the director of research science at New York Presbyterian. Welcome Dr. Tiase. It's great to have you here.
Vickie Tiase
Hi, Molly. Thank you. It's great to be with you. And certainly please feel free to call me Vicki, thank you for hosting this and really elevating the visit visibility of the reports. I'm excited to talk with you about it.
Molly McCarthy
Great. Thank you. I would love to give our listeners a brief background of yourself. And how you became involved with the future of nursing 2020 to 2030 charting a path to achieve health equity report.
Vickie Tiase
Yeah, absolutely. So you know, it was certainly my my honor and privilege to represent nursing specifically with technology and informatics expertise on this report. And you know, a little bit about my experience leading into the report kind of, you know, serves as a context for answering your question. So, you know, probably about 10 years ago, we had an effort in New York City called the New York City digital health accelerator, it was formed with this idea of bringing healthcare startups into New York City and have them be mentored by area hospitals. So at the time, I served as our hospitals mentor for that program, and I had a keen interest in piloting mobile health technologies, with our Washington Heights and Inwood patient populations, an underserved area in northern Manhattan. And there were two solutions that stood out. One was collecting medication data through an app called the actual meds using community health workers. And another one was called new health, where we provided the National Diabetes Prevention Program through a mobile app. And in both of these examples, it was, you know, really amazing to see the engagement from these patient populations. And, you know, I know there is great potential in technology, intervention equity, but we really need to gather evidence and share findings, and really think about using community acquired and patient generated health data in our nursing practice. So these are concepts that I wanted to infuse into the report. And I think given that experience and the intersection of some of my National Nursing informatics roles, within hims, and the alliance of nursing informatics, I was nominated for this committee, and then approached regarding my interest in serving, which I gladly said yes, it has been an amazing experience. Two plus years now working on the report with a very diverse interdisciplinary committee, and given COVID we actually received a six month extension to work on this report. So while we were initially slated to have the report out in December of 2020, it just came out last month, early May of 2021. So although it was an arduous process, I'm you know, super proud of the work that's been done.
Molly McCarthy
Well, congratulations. I've been watching the the process and actually participated in the town hall on technology back in August of 2019. So I'm really excited to see the report, but probably even more excited to see how we as nurses can move these recommendations forward and actually take action. The ultimate goal of the report is the achievement of health equity in the United States built on strengthen nursing capacity and expertise, and I know there were multiple recommendations within the report around that and the role that nurses play. I think the report totaled around 503 pages from one I looked at again last night. From your perspective, and looking at the recommendations, do you have a sense of where the biggest opportunity is for nurses in terms of technology? And as well as roles for nurses and education for nurses, and just wanted your thoughts around that? Because I know that's been your focus?
Vickie Tiase
Yeah, absolutely. Before I get to that question, I just wanted to say thank you for participating in that high tech, high touch Town Hall, it was, you know, really helpful for the committee to go across the country and really hear from the experts and gather evidence. This, I found to be very challenging from a technology and innovation perspective, since a lot of the work that we do in healthcare I.T. is implementing solutions very quickly, without a focus on publishing findings. So it was, you know, really helpful to hear from experts like yourself. But turning question, yeah. But turning to your question and the opportunities, you know, again, just to really, you know, Center, the purpose, and the vision for the report here, on everything that we did, as a committee was really looking through that health equity lens. And, you know, one of the big opportunities I see in the technology and informatics space is really linking to data. So I feel like that is first and foremost. So in order to address health equity, nurses need data, right, we can't change what we can't measure. So I think this is a real opportunity for screening tools that can collect social and behavioral determinants of health. You know, in short, social needs data. And it's not only collecting it, but facilitating the sharing across settings, especially with community based organizations, which we find are not always electronic. So I think this is a real opportunity for us to think deeply about that interoperability component. And figuring out how, you know, nurses are, are generally bridge builders, like that's what we do. So how can we leverage that talent and expertise of bridge building in a way that facilitates the sharing of data so that we can incorporate them into nursing practice in a meaningful way?
Molly McCarthy
Yeah, I love that. The bridge builder analogy, and I actually, you know, I think about nurses and I think about some of the roles I've played in my career. And it's, I always use the analogy of the the hub of a wheel and all the spokes out to the different components of the care continuum. And really, that nurse is at the center with that patient. So how can we facilitate that patient throughout the system, as well as the data moving from from place to place, whether that's patient generated data or data from an EMR, etc. So I think that's a really important point that you bring out.
Vickie Tiase
Yeah, I like that. I think that idea of that that hub and spoke model also is connected to what I think is a another big message in the report, you know, globally, you know, around paying for nursing care. Right, so thinking about transitioning to value based reimbursement models. Nurses are already doing this stuff, right. But how can we measure the nursing contribution to that value? Right, so it's often super difficult to measure and, and sometimes invisible even within our electronic systems. So one of the things that the report highlights is the need for a unique nurse identifier and how this is critical. You know, this can help us with a lot of things. It can help us associate the characteristics of nurses with patient characteristics within large data sets. And it can measure the nursing impact on patient outcomes, look at efficiencies, clinical effectiveness. So from my perspective, this is a huge message in the report that has the potential to make a really big difference as to how we look at health equity and look for mechanisms, especially around payment mechanisms to incentivize and move this work forward.
Molly McCarthy
Right? You know, I think that's so important. And I'm definitely a proponent of the unique nurse identifier really from the concept of thinking about the cost of care and understanding the different costs of care. So that, you know, there's appropriate reimbursement, quite frankly, for nursing care, but also from the perspective of a consumer, understanding the costs of care, so that there's, you know, leading to price transparency, you know, understanding as a consumer, what we're paying for care, and I think having an understanding of of nursing and our our role and what we do and the value, and $1 assigned to that I think it's so important and moving healthcare forward. So I appreciate you pulling that out. And I know there was one other area that we were thinking about too from the report. And so I wanted you just to give you a few more minutes to talk about that third area.
Vickie Tiase
Absolutely. I think that the third big area, and you know, certainly this was front and center in this past year is, you know, the use of technology to effectively manage patient populations. So the use of telehealth, which includes telemedicine visits and remote patient monitoring and other forms of digital technology to increase patient access has just been, you know, transformative. But the trick here is that we, we really need to think about how to involve nurses in these processes. And especially, especially when we think about nurse practitioners, there are, believe it or not, still 27 states where, you know, nurse practitioners are not able to practice at the top of their license. So where their scope of practice limitations. So thinking about how those barriers that were lifted during COVID can be made permanent moving forward. I think that's going to be important. And I think the other piece related to technology, which I know is something that you're quite passionate about Molly is that the report also emphasizes that nurses can not only use these novel technologies, but also constructively inform and design the deployment and development of these technologies. And you know, from a health equity perspective, ensuring that they're free of bias, and can augment our nursing processes rather than create additional burdens, right? So really using these in a way that matches nursing workflows, and getting nurses involved and engaged from the very beginning.
Molly McCarthy
Yes, yes, yes. I often say, you know, nurses need to be at the table, they need to be involved in the design and development of these solutions. And that's kind of on a personal note where I've spent a lot of time in my career. So. So I think that I appreciate you highlighting that because I do think it's, you know, as we look across the the technology continuum, so to speak, from the from even just, you know, concept to launch, nurses really need to be part of that discussion. And clinicians need to be part of that discussion, so that we're coming up with solutions that make sense from a technological perspective, but also a clinical workflow perspective, as well as thinking about cost and patient outcomes. So that's fantastic. The one as we close out here, and I know that we could spend a couple of hours talking about this. But thinking about that, recommendation number six, and I'm going to read it all public and private healthcare systems should incorporate nursing expertise in designing, generating, analyzing and applying data to support initiatives focused on social determinants of health and health equity, using diverse digital platforms, artificial intelligence, and other innovative technologies. That's a lot in one recommendation, and what what is your takeaway from that? What is your as you think about that goal, as we think about nurses, what would be your Action around this?
Vickie Tiase
Sure, absolutely. So first of all, I am just so excited that we have a recommendation around this. For those that might know the first report well, back in 2010, there was one little mention of the EHR. And other than that there was almost nothing around technology. So I am I'm thrilled that the committee, you know, came up with this recommendation. And so in terms of the action steps, there are actually a couple of sub recommendations related to this, that is, you know, within chapter 11, for this recommendation. So the first one is that, you know, as I mentioned earlier, accelerating interoperability projects, so figuring out how we can build that nationwide infrastructure, specifically thinking about integrating SDoH data. And then related to that the second sub recommendation is thinking about the visualization of SDoH data. So how can we use standards and other ways to ensure that this isn't an extra burden on nurses and these are brought into our nursing clinical decision making in a meaningful way? The third one, which I think is, which is also a ambitious recommendation is employing more nurses with informatics expertise. So I think in order to do this recommendation, that's going to need to happen. So we're going to need nurses that have informatics expertise to look at the large scale integrations, thinking about how to improve individual and population health using technology. And, and right now that that is lacking in parts of our country, right. And then the last two, so so one that we mentioned, ensuring that nurses and clinical settings have responsibility and the resources to innovate, design and evaluate the use of technology. Right. So it's really empowering all nurses to do this. So I think that's an important one. And then lastly, providing resources to facilitate telehealth delivered by nurses. So I think there's a lot of pieces to this, as you mentioned, this is a big ambitious recommendation. But I think that the real point is that this is about looking at the evidence where we need to go and and we've got a decade to figure this out, hopefully sooner rather than later. But I think the next step here is really working on that roadmap and action items to collectively move this forward.
Molly McCarthy
Great, thank you. I know that we're out of time, but I personally look forward to working with you and other of our nursing informaticists colleagues, really throughout the spectrum, whether they're in a healthcare setting. You know, the other big piece that we didn't get to touch on today is just the education, whether that's undergraduate, masters, prepared PhD, you know, I'm a big proponent of bringing in technology and informatics into the undergraduate curriculum. And again, we don't have time to go on to go into that today. But I look forward to continuing the partnership. And I know that Microsoft is really supportive of nurses and want to thank you for all the work that you've done on behalf of nurses.
Vickie Tiase
Thank you, Molly. Thanks for having me on and again for elevating the messages in this report. I look forward to working with you on this in the future. Thank you.
Claire Bonaci
Thank you all for listening. For more information, visit our Microsoft Cloud for healthcare landing page linked below and check back soon for more content from the HLS industry team.
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