Computers and Compassion: How Healthcare Technology is Reshaping the Clinical Experience for Nurses and Patients Alike

Podcast Transcript

Carol Pehostky:

As nurses, we sometimes think of technology as something that is happening to us, or the opposite, we think of it as something that should be able to fix all our clinical problems and issues. But, what if instead, we considered technology as a partner or as a member of the healthcare team with one goal of helping make life better for our patients? I joined today by Nelita Iuppa as we discuss this more.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough, on-the-job issues. We're so glad you're here. I'm your host, Carol Pehostky, Associate Chief Nursing Officer of Surgical Services Nursing.

Well, hello everyone! Today's topic is all about nursing and technology. And as I think back to my own career as a nurse, there's been quite a bit of evolution there. The phrase, I'm so old as a nurse that when I first came into nursing, there were DOS-based order systems. Most of this was paper charting; our pumps were certainly not smart, and there were a lot of manual processes. And interestingly enough, perhaps, one of my first leadership roles was as a "super user" as we started launching the journey into electronic health records. And within that, so everything from nurses saying, "I will quit before I use that computer to document," all the way to people who were like, "Oh good, this can take care of all of my problems and then some." And ironically or not, that was also the same week that we all got a postcard in the mail from our employee systems program talking about alcohol counseling services, and we all were suddenly afraid that somebody had been looking into our houses as we implemented our electronic health record. But in all seriousness, I've been guilty of saying, "It's a computer, just make it do something," when really that isn't necessarily the right approach, even with all the amazing advances in technology we've seen.

Our guest today is Nelita Iuppa, Cleveland Clinic's associate chief nursing officer for nursing informatics. Nelita is a leading innovator in our organization, as well as the driving force behind countless emerging technologies designed to improve the lives and careers of nurses everywhere. Nelita, we're so happy to have you join us.

Nelita Iuppa:

Oh, thank you so much, Carol! I am so delighted to be here today. This is a really big passion area and topic for me. And like you, I'm a B.C. nurse. And what I mean by that is "before computers."

Carol Pehostky:

Yes.

Nelita Iuppa:

So, it's nice to have a fellow B.C.-er here with me today.

Carol Pehostky:

Absolutely. So, as I sort of alluded, I am guilty of some myths around electronic documentation and around informatics, and so I'm trying to be better about that. I'm also guilty of, in my head, lumping nursing informatics with the electronic health record, but there's so much more to it than that. Do you mind sharing with our audience everything that nursing informatics can entail?

Nelita Iuppa:

Sure. Sure. So, let me take you back in time a little bit.

Carol Pehostky:

Okay.

Nelita Iuppa:

So, nursing informatics was really first established as a nursing specialty in the late '80s.

Carol Pehostky:

Really?

Nelita Iuppa:

But it really came into popularity just before the turn of the century. And the reason for that is that, for several years, we have been preparing for the new millennium and the year 2000.

Carol Pehostky:

Yep.

Nelita Iuppa:

Lovingly back in the day we called it Y2K. And you know, there were a lot of unknowns that were gonna happen with the technology at the stroke of midnight, and we were just newly introducing electronic health records into healthcare. And so that really birthed the need for this type of role. And what I mean by that, and you're not alone in your thinking that it's all about EHRs, but really, the introduction of healthcare technology and electronic health records has become the nucleus for so much of the work that we do today.

That being said, there were a lot of other automations that came out of that same time frame, such as workstations on wheels, web-based applications and wireless technologies, as the clinical environment tried to adapt to what was happening. That was the foundation that was laid from this initial EHR framework. So, healthcare really needed clinical experts to look at what these emerging technologies were doing to the space, what was happening to practice as a result of that, and really match up the practical-use cases against the technical requirements.

So, specialized skillsets were needed to bridge these two worlds in the essential space that healthcare was now becoming fully automated, and we needed somebody to make sense of all that. And so, informatics and a lot of that technological people who were once clinical started to all come out of that time period.

Carol Pehostky:

And so, digging a little bit deeper into that, do you have to be a nurse to be a nursing informaticist?

Nelita Iuppa:

You do not have to be a nurse to be a nursing informaticist. And many are going into clinical informatics from all walks of healthcare. But what I always say to those who are considering the area of nursing informatics is that it's a really unique specialty in that you become a caregiver for other nurses. You are a nurse’s nurse, if you will.

Carol Pehostky:

Sure.

Nelita Iuppa:

And it allows you to broaden your nursing perspective to give back to the profession from the standpoint that you are giving your knowledge and your expertise, and the whole call and the draw to the profession of nursing, the act of caring, back to those who are performing the care. So, it really does help to be a nurse in this space. You definitely get the broadest perspective of what nursing is. One of the things I love about nursing informatics is that I'm not just in one dedicated nursing specialty or area.

Carol Pehostky:

Sure.

Nelita Iuppa:

It really requires me to have a broad perspective, to reach from home care to outpatient, inpatient and beyond, between procedural areas and so forth. So, it really does broaden your horizons and allows you to be a caregiver for others. And that to me, along with the technological nature of it, the problem solving, all of those technological skillsets that go into making sure that these systems work for others is really what the draw was for me.

Carol Pehostky:

Well, and what a way to advocate for nurses to make sure that this host of technologies works for the nurse who's going to use this.

Nelita Iuppa:

Yeah.

Carol Pehostky:

Fantastic. So, within the nursing workforce today, you know, we're not gonna linger on the generations of nurses, that's a whole separate topic, but we know, and maybe not even related to the generation I am or am not in, we also know there's a full gamut of nurses in terms of comfort with technology. People who, you know, are very comfortable, it's part of their daily life at home and at work, to people who say, "I'll quit before." Whether that's EHR or any other technology. So, knowing that we have people that are that full spectrum, let's linger on the people who are not super excited about technology, we'll say, whether they're not savvy or they just aren't comfortable with it, or a conversation I had with a colleague this morning around, "I'm gonna get my tin foil hat out because I don't trust that." But we'll focus on that group first. What advice would you give those nurses to help make existing healthcare technology work for them?

Nelita Iuppa:

Yeah, so you hit on a really good stereotype to begin this question, and that was really on the different age ranges.

Carol Pehostky:

Right.

Nelita Iuppa:

It is very much untrue that your age is dependent on how well you adapt to technology or how much you embrace technology. It is very much a myth that younger generations embrace technology, more than more-seasoned nurses, if you will. You know, over the years, I've been in countless auditoriums, conference rooms, nursing huddle conversations, where we had, you know, nurses of all ages, frustrated, just disappointed in general because technology did not meet what they expected to be delivered. And the best way that I can describe this is an analogy between a person buying a house and maybe a house flipper, if you will.

Carol Pehostky:

Okay.

Nelita Iuppa:

Let me take you through this. So, the person buying the house, or the nurse, if you will, goes into it with a list of desired characteristics and features. They look for the aesthetics and the amenities, and they try to picture themselves interacting in that space for what feels right.

Carol Pehostky:

Sure.

Nelita Iuppa:

A flipper on the other hand, or the informatician, the technologist, whatever you want to call them, really goes in with an eye for structure and flow, form and function. They assess what is possible and practical given what the site's limitations are, and then they develop a plan on how to best meet that unique skillset and circumstances. So, they aid nurses when there is an unrealistic expectation that a door needs to be somewhere, or that they can't have a pool because it wasn't zoned correctly for that type of lot. And really, what it all boils down to is that nurses ultimately get most disappointed with technology when they jump in with the end state in mind.

Carol Pehostky:

Interesting.

Nelita Iuppa:

They neglect to look at technology solutions as a problem statement. And so, stopping to ask exactly what I am trying to solve, versus immediately jumping to a solution, is ultimately that missing connection or the link, and that's really where I believe nursing technologists really help in space. It's one simple step, but it totally makes the difference between, you know, a happy home and buyer's remorse.

Carol Pehostky:

I love it. Fantastic. So, let’s talk about the other end of the spectrum, the person whose house is smart. They might be super comfortable with it, but they may also go to that spectrum that says, "This is everything that technology can do for me at home, so why can't it do it at work? Tell that computer to do something! Make it a cure all." What would you say to that group of nurses?

Nelita Iuppa:

You know, I get asked that question all the time. And there, and really, you know, as we have adapted technology in healthcare, our personal lives have become completely automated.

Carol Pehostky:

It's crazy, yeah.

Nelita Iuppa:

And, you know the birth of things like social media and smartphones and all of these wonderful technologies that we get to benefit from in our personal lives really come with an expectation of, "Why can't I apply this in my workplace setting?"

Carol Pehostky:

Right.

Nelita Iuppa:

Right, so healthcare on the other hand is not a predictable, not a very routine type of environment, right? Each day comes with its own set of unique challenges. Each clinical practice is different. Actually, the relationship that each caregiver has to the EHR is very different. You, Carol, look at the EHR very, very differently than how I go in to look at the EHR.

Carol Pehostky:

Sure.

Nelita Iuppa:

And it has come to mean so many different things to so many different people. And long gone are the days where it was just a record of truth to keep everybody organized and have a legible set of orders. Now it is really a place where you store financial data, and you store information for regulatory purposes or governmental requirements. So really, you cannot take the types of ways in which you use technology in sort of a consumer base and apply it in healthcare as easily. I like to say it's the difference between learning how to fly a drone in your backyard versus piloting a spaceship into outer space, right?

Carol Pehostky:

Sure.

Nelita Iuppa:

It's a little bit different. Both are flying, but it's completely, the set of circumstances are so much more unique, complicated, and really have a lot of other competing variables that have to be considered. And that's why I think people get frustrated that we don't have what we see in our common lives here at the workplace.

Carol Pehostky:

Certainly. And it also doesn't help when they see it in other industries.

Nelita Iuppa:

Absolutely. And those industries oftentimes are much simpler and easier to, again, those routine, predictable types of things, where you know, piloting new technologies, embracing emerging tech is really the way to go.

Carol Pehostky:

Sure. And other industries maybe aren't as focused as protecting the confidentiality of their customers, in this case, our patients.

Nelita Iuppa:

Right. And yeah, I mean, with the exception of possibly the airlines, really the outcomes have to be considered.

Carol Pehostky:

Right. Yes. Absolutely.

Nelita Iuppa:

You know, the stakes are so much higher in healthcare.

Carol Pehostky:

Absolutely. So, let's linger on that nurse a little bit. They have an idea, again, they think they could maybe see an application for outside world technology in healthcare. What would you tell that nurse? How would they take that energy, where should they go with it?

Nelita Iuppa:

So, again, I go back to form and function and asking yourself, what is it that you're trying to solve, right So, oftentimes, we use a lot of tricks in the technology world to try to dig in a layer deeper, because oftentimes, again, people go back to what they have seen work.

Carol Pehostky:

Sure.

Nelita Iuppa:

And then, you know, "I want a Siri or an Alexa."

Carol Pehostky:

Yes.

Nelita Iuppa:

"I want, you know a smart watch that will do all of these things."

Carol Pehostky:

Right.

Nelita Iuppa:

And really, going beyond the solution to what is it that you're trying to solve? And, ultimately, then we will get to the right answer in time. And knowing that, we do have to wait for technologies in healthcare to catch up to where the consumer market is at. So, while it might be FDA-cleared for usage in your home, it's going to be another 10 years or so.

Carol Pehostky:

Sure.

Nelita Iuppa:

Hopefully not that long, but a longer period of time before it's cleared for healthcare.

Carol Pehostky:

Right. Well, and you raise a good point, you know, Nelita and I both come from a variety of backgrounds, including perioperative services, and I can't tell you how many times I've had people say, "Well, we just need Alexas in the operating room, and then they could document and they could help you order supplies." It's like, "And they will listen to every single thing that is said in there!" And they say, "Oh." And so, it's that, again, piece that it's, there's good intentions there, but really how do we make that technology work for safe outcomes for our patients and help our caregivers focus on what matters most?

Nelita Iuppa:

Absolutely.

Carol Pehostky:

Yeah. So, let's say I'm a bedside nurse and I'm working in an organization that's discussing a major tech implementation. Let's say it's smart IV pumps or remote patient monitoring. With the pandemic, I know there's a lot of chatter around, "Well, let's just have a nurse sitting at home monitoring patients as a way to solve staffing issues," right? So, whatever that is, what advice would you give me to ensure the bedside nurse that that voice is being heard to ensure that tech implementation includes an assessment of the impact on the nurse?

Nelita Iuppa:

Yeah, I love this question. So, two things, I think. For every single nurse, no matter what your role, where your work environment is, you need to get involved. I think the reason nurses often feel so powerless against the systems and feel like things are being done to them is because they are not engaged in the process to help evolve them.

So, recognize first and foremost that technology is fundamentally iterative in nature, and therefore it is a constantly changing thing. I think that's something that often surprises people, because they come at us with, "Why are you changing this so much?" That's actually the nature of technology. It's a good thing. You want change to happen fast and iteratively. And the reason for that is that you get to benefit from those solutions very quickly. And in healthcare, where we have this fast-paced environment, you want solutions at a faster pace.

Carol Pehostky:

Sure.

Nelita Iuppa:

So, think about it maybe in different terms than historically your lens or your view has been. And while it can seem like sometimes nurses don't have the power to control these things, they actually do if they get involved. So, embrace evolutions as they come about, and treat technology as you would a new clinical therapy or a colleague on your team. Become agile as you start to think about these rapid-development cycles. And get into the mindset and a cultural shift, if you will, that emerging healthcare technology is a good thing that is here to stay.

Carol Pehostky:

Sure.

Nelita Iuppa:

It is not something that is one and done, the train rolls through and it's over. It will be here with us for the long part. And I think the second piece of advice I would give people is sort of a soap box or a personal crusade, if you will, that I've been on for about the last five years, and that's really to embrace technology as another member of your care team.

And what I mean by that is you need to consult, incorporate and interact with technology as you would routinely or naturally with any other colleague. Technology doesn't have to be something that's done to us that leads to stress or burnout. It really is fundamentally something that you should incorporate into your day and act as a partner alongside with. So, culturally, I believe we are on the precipice of just starting to change in terms of clinicians embracing technology instead of feeling burdened by it. And so those would be the two pieces of advice I would give.

Carol Pehostky:

That's fascinating. Technology as a care team member, that's wow, you've blown my mind. But that's a great point, and, and when I think back to that nurse who says, again, as somebody who might have said that in her career, of like, "Just fix it, make it work, make it cure things," is just, we wouldn't say it to another member of the healthcare team, "Cure this patient! Take care of it on your own."

Nelita Iuppa:

No, you'd say, "How can we work together to make this happen?"

Carol Pehostky:

Absolutely.

Nelita Iuppa:

"What problem are we trying to solve? And let's get there together."

Carol Pehostky:

That's fantastic. So, to wrap up a little bit, I'm curious to pick your brain, and again, this could be a whole separate episode, but what gets you excited about the future of new technology, specifically for nurses?

Nelita Iuppa:

Oh, my goodness, the horizon is so incredibly promising, Carol, I will tell you, I get excited. I get jazzed. And, yes, we could make a whole other podcast about this one. But really, we're looking at a new resurgence in terms of healthcare technology now. So similar to Y2K, which brought a lot of promising new ideas and concepts, we are now on the precipice of something very, very new in healthcare. There are many, many emerging technologies all over the place that really offer promise to transform care. Some examples that I think about often, we've spoken to a little bit here today, natural language processing, the ability not only to enter data through speech but to query for answers or to provide surveillance in a space that otherwise a caregiver would have to provide. Augmented intelligence in terms of our systems that will learn as they go, and then offer, again, like a clinical care partner some support and the ability to complete routine and predictable tasks on behalf of caregivers in the future. I think that leans a lot into some of the spaces where we have automated care environments, lights and sound and, temperature, and that sort of thing, as well as robotics and real-time locating of not only people but equipment and supplies and that sort of thing. So really making us a more efficient and integrated set of tools in the future. I think the key to all of this is really for those who'll be interacting with technology to be present and engaged in the process. Every clinician, and most especially nurses, has to be front and center for designing this future, right? So, look at these emerging technologies; get engaged, be educated. Engage with your clinical informatics resource or nursing informatics friend, and really be part of that conversation. There are so many ways in which this technology can be used, but ultimately, as we've learned from our past, it's really about how we want to solve the problems that exist in applying that technology that will ultimately lead to our success. And nursing is so central to all that. That is truly my core and what I believe and why I believe so strongly that nursing informatics has such a prominent place on the table for the future.

Carol Pehostky:

Absolutely. When it comes to any change, you want to be part of that change and not have it happen to you.

Nelita Iuppa:

Exactly.

Carol Pehostky:

And the way to do that is to lean in. We don't have necessarily a lot of influence over the iPhone upgrade and the features of it, but we also grumble about it for about 24 hours and then we settle into it. But this is a place where we can make a difference and we can have our voice heard. So, if you're listening to this podcast, you all have homework, which is to go to your organizations and find out who your informaticist is. And we are very blessed at the Cleveland Clinic to have a whole department of nursing informatics. And in your hospital, you may not, but you have somebody, so go find them, buy them a cup of coffee or tea or whatever their favorite beverage is, and find out how you can be part of that change.

To wrap it up, you've shared so much with us about who you are as a nurse informaticist and as a leader, Nelita, but I'm hoping you'll help us get to know you a little bit as a nurse. So, just a few speed-round questions, if you don't mind. We'll start with, what's something you wish you knew as a brand-new nurse?

Nelita Iuppa:

It's okay to ask questions.

Carol Pehostky:

Absolutely.

Nelita Iuppa:

I think the most shocking thing was my first day as a nurse when I got my patient assignment, I said, "Oh, my goodness, they're all mine, and they're all mine." And I, you know, what an incredible amount of responsibility hit me in that moment! So, it's okay to continue to lean on others and ask when you need help.

Carol Pehostky:

Absolutely. It's not real 'til it's really real. When it's time to unwind for the night, what's your go-to media? Are you a podcast listener? Do you like TV or books? What are you reading right now or listening to?

Nelita Iuppa:

You know, all of the above. I'm a big crime junkie and I love my podcasts, right? It's my way of escaping, but it's also my way of staying very focused on problem-solving and keeping those engines firing, even through the night. So, I love to use true crime to help me unwind, if that makes any sense at all.

Carol Pehostky:

It does.

Nelita Iuppa:

But more so, from keeping myself stimulated in terms of problem-solving; it really does help me in my everyday job.

Carol Pehostky:

I'll tell that to my husband when he's like, "What are you listening to? That's so gory. I'm working on my problem-solving skills." And finally, what brings you joy?

Nelita Iuppa:

Oh, my goodness, so many things bring me joy. Obviously, faith and family bring me the most joy. I think in terms of my professional life, really being there for others, remembering the words of Maya Angelou and others that, you know, it's not really what you do or what you said, but it's how you made people feel. And I hope that in my professional life as well as my personal life that I bring people joy with what I do and how we perform in terms of our nursing informatics service to others.

Carol Pehostky:

What a perfect ending to our time together. Thank you so much for joining me today, Nelita.

Nelita Iuppa:

It's been my pleasure.

Carol Pehostky:

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other. The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.