Podcast
Health Tech Horizons: Navigating Nursing Challenges & Innovations
Kelly Aldrich, MD
Director of Innovation, Vanderbilt University
With over 35 years of experience in clinical, academic, and leadership roles across nursing and healthcare, Kelly Aldrich is a tremendous HIT strategist, innovator, and thought leader who has consistently demonstrated a strong commitment to leveraging advanced technology to improve nurses’ lives and patient outcomes. Kelly joins host John Farkas on this Healthcare Market Matrix episode to discuss her healthcare experience, building solutions for nurses, and the importance of patient-centered care.
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Transcript
Introducing Kelly Aldrich
John Farkas:
Welcome to Healthcare Market Matrix, a podcast to help you see your market clearly. We dive deep into the challenges faced by healthcare organization leaders that technology has the chance to help them solve. It’s all about gaining the kind of understanding you need to effectively connect with your market. Join us as we explore the healthcare market matrix.
Hello everybody, and welcome to Healthcare Market Matrix. I’m your host, John Farkas, CEO of Ratio, and today I am excited we have the honor of talking with the Dr. Kelly Aldrich, who is a highly accomplished and board certified informatics nurse specialist. And she comes to us with over 35 years of experience in the clinical, academic and leadership roles, just a tremendous HIT strategists, slash innovator, slash industry thought leader who has consistently demonstrated a strong commitment to leveraging advanced technology to bottom line, make nurses lives better, and thus improve the outcomes of the people that nurses care for.
Kelly is presently the director of innovation and associate Professor of Nursing Informatics as a part of the faculty at the Vanderbilt University School of Nursing. We’re going to get into some of her long and illustrious career history here in a little bit. But I’ll just say, I got to know Kelly in the context of, I don’t even know how to describe what we were involved in Kelly, but a consortium of people really interested in exploring interoperability and what that means in the context of healthcare. Kelly was involved for a long time and is currently at the Center for Medical Interoperability.
What I appreciated about Kelly in getting to know her in that context was her very direct, no nonsense, real world perspective of what has to happen in healthcare in order to make things make sense. She has been very skilled in bringing those ideas forward. It’s why I see her valued as a thought leader in this field and why I’m excited that she is part of Ratio’s advisory board and helping to bring perspective to health tech companies that are wanting to make a difference in this world. Kelly, welcome to Healthcare Market Matrix.
Kelly Aldrich:
Thank you. It’s a real pleasure to be here. I look forward to our discussion. Of course, lots of follow-up discussion on this topic. This is a great topic of really understanding the marketplace and healthcare technology solutions and how best to be successful. So, thanks for having me.
Kelly’s Healthcare Background
John Farkas:
Yeah. Glad you’re here. I would love for you to tell us a little bit of your backdrop. How did you get to where you are? And I know we could spend the whole episode just recounting the steps that it took you to get the perspective and the backdrop that you have. But give us the flyby from where you started as a bedside nurse to what has become quite a platform that you’ve established in your role.
Kelly Aldrich:
Thank you. I feel like I need to have a scrolling timeline with year markers because I’ve been very fortunate and very blessed to be able to serve patients. I started when I was 16 as a nursing assistant, so I go way back, and always loved what I have done and been excited by new opportunities in the healthcare profession. But I started in Chicago as a open heart recovery liver transplant nurse at Rush University. I loved working at the bedside, always being challenged, but a group of us decided to leave Chicago for the winter and move to Hawaii. I think that’s actually what started my career in understanding the variances and the process changes that are just throughout healthcare that actually serve as pain points and failure points because no one really does anything the same, which has a huge impact on technology and patient safety, quite frankly. We went to Hawaii and I became a neurotrauma ICU nurse. Spent some time there. I think I was a traveling nurse before it was really cool back in the early ’90s, but [inaudible].
John Farkas:
It was pretty cool going to Hawaii. That was a cool, strategic decision going from Chicago to Hawaii. Let’s face it.
Kelly Aldrich:
For the winter, mind you.
John Farkas:
Yeah, that was very strategic.
Kelly Aldrich:
Went to UCLA for a while, and then down at the military hospital in San Diego, I served as a CVICU nurse. Moved on away from traveling nurse and moved to Florida for a while. That’s really where I dug into a community hospital away from teaching facilities and again, was able to really create a foundation in the variances of care delivery and the different models of care and operations efficiency. I was a bedside nurse there for some time, went back and did some graduate work. I received about three graduate degrees in nursing and then on to get my doctorate, but I was the ER director for some time, which was fascinating. I worked with the state and the local authorities around hurricane preparedness. And this, again, was what kind of broadened my perspective of things that impact operations and systems of care just outside of the walls of the hospital.
I was asked to be the chief nursing officer there. I was the chief nursing officer for some time while I was in an informatics program and just wanted to return to the operations efficiency by using data. I will tell you, the experiences of having been hit by a hurricane, Hurricane Charley. It was a massive hurricane. It shut down our entire hospital and operations. And I remember my CV surgeon coming through the door when we had no electricity, and he said, “All my medical records are blowing down the street right now.” And he said, “Kelly, that’s why you’re going into informatics.” And not at the bedside because I got a lot of slack from people leaving the nurse practitioner program in CV to do informatics. I got a lot of challenges from people. Grew into that role, wanted to do more informatics, so I moved into Nashville. And eventually, over time under Dr. Jonathan Perlin became the chief nursing informatics officer at HCA.
So, I was the inaugural CNIO there. I was invited into that role, I guess because of the impact that I was having through our many hospitals in innovation. It was not the word at the time, it was just really taking care of the nurses and the patients with technology. I was in that role for just a little less than 10 years, moved on to the Center for Medical Interoperability where my true passion lied, as you had said John, around interoperability and what were we doing with technology to serve reducing burden on the care team and the patient coordination of care. That is beyond huge and anyone who’s impacting in that area has got to know what an amazing job that they’re doing in impacting lives, and I’m very passionate about that.
I still to this day, do keynotes in interoperability and working with various groups around this. I’m currently doing a lot of consulting for various companies, international companies around informatics, healthcare informatics, workflow impacts, safety, reducing burden. And then I’m at Vanderbilt. I’ve been at Vanderbilt teaching for over 10 years, but recently, about two years ago, took their director of innovation role and been working with a lot of immersive virtual reality experiences, both in mindfulness. I created a MIND Lab, it’s called Mindful Immersive Nursing Demonstration, so MIND Lab. With that, we’re also experimenting on immersive simulations for empathy training for new nurses coming into the field so that they have experiences before they actually interact with patients. Wow, I tried but yeah, that’s where I’m at. That’s a little bit of my background.
I sit on several national advisory councils, including interoperability standards with the ONC. I’ve served about five or six terms there. I sit on a cybersecurity council that I have done for many years. I’m fascinated with the impacts of clinicians and actually the burden that cybersecurity puts on clinicians and the negotiating factors that we have to have there. That’s me and I run a pottery business.
John Farkas:
Because something has to help you stay sane, right?
Kelly Aldrich:
I love my pottery
John Farkas:
And it’s a great mindful exercise, as every potter that I know has communicated. That’s awesome.
Kelly Aldrich:
You didn’t know that, did you, John?
John Farkas:
I didn’t know that that was part of your backdrop, but I love that that’s part of who you are. I can see the thread there. As you were talking, what came really clear to me was that you were caring for patients at the time when a lot of founders of health tech companies were born in the hospitals that you may have been serving in. At a point that clearly predated electronic medical records, where records were able to literally be blowing down the street in the heavy wind. So, you have seen a remarkable move in this realm. You were there for the birth of healthcare informatics. So, your perspective on this, I’ve got to think, has been pretty mind-blowing. I can’t imagine going from where you started to where you are now in this realm.
My question is knowing what you’ve experienced and what you’ve seen going from the conventional paper charts and what you experienced as a nurse on the floor in the days prior to technology, what I know is everything has gotten, in many ways, more complicated for nurses, especially with what insurance is requiring from reporting and coding and all the different things that need to happen in a nurse’s life to ensure that they’re checking all the boxes that they need to check in today’s compliance and regulatory environment.
The Critical Nature of Nurses in Operations
John Farkas:
What would you have to say to a leader of a health tech company who’s trying to interject a new piece of technology onto the floor? What would be the flag you would want to wave in front of them to make sure that they’re carrying in their forefront? What would you want to say to them?
Kelly Aldrich:
To me, that’s an easy one. It really is about having the clinicians that you’re hoping will use your technology, be involved in the design of the technology. That’s a real easy one to me, and that’s one that is so often missed. As a matter of fact, yesterday I was on a call with an old friend who’s a startup guy, and he was like, “Hey, could you talk with this company? They’ve developed this technology for nurses, but they don’t have a nurse on their team.” I think that it’s really-
John Farkas:
Step one, get nurse on team.
Kelly Aldrich:
That’s a very serious miss. I see customer success roles, I see sales, I see entrepreneurs, and it’s amazing. They have amazing ideas, but will it fit within the workflow of the many different healthcare providers that you’re trying to affect? You have so many variances in that space. Do you really understand the workflow or even the thought flow of the clinicians that would reduce burden for them that would get to meaningful adoption of a technology solution? Or is it something that is being introduced into the environment that quite frankly, that will cause a workaround to do something within this product and therefore create more burden for the team? Not only does it create burden, but it creates a non-reliable, non-repeatable, non-scalable solution, and that will fail.
John Farkas:
Yeah, it’s definitely a critical component that I see and it’s become, for me, I know one of the questions that I ask when we’re looking at client potentials because I’ve recognized that that orientation, that focus is so critical that if you don’t have it, that your opportunity at getting product market fit, at your opportunity at getting credibility is really compromised because everybody right now that has a solution that touches clinicians, the demands are extremely high because we’re dealing with one of the most taxed parts of the health system and introducing any complicating factor is a non-starter. It has to smooth the path. It can’t add friction. There’s no room for friction and anything that looks like friction can’t move forward. So it seems like a non-
Kelly Aldrich:
Well, that would be my number one thing. I recall saying when I was working at HCA, I really had the opportunity. Dr. Perlin was very supportive, by the way, he’s now the CEO of the Joint Commission. He served as the undersecretary to the VA before he joined HCA. So, he’s a very, very visionary, impactful leader, chief medical officer, and now CEO, again, of the Joint Commission. He never got in my way. He always encouraged me to create a proposal and invited nurses to the table, always so respectful. But the point being is when I would come up with an idea… I created something called Vitals Now back in 2008, and it was at the time my doctoral project. What I did was I actually worked with a company but worked with the nurses at the bedside to find out all the caveats of all the problems that they may have in implementing this tool that automated vital signs into the medical records. So, created all the requirements and standards. That’s now an industry standard that’s international standard.
I called it Vitals Now as a joke just because it was like, hey, vitals now. Vitals are vital for a reason. And where I’m going with this is sometimes the best ideas are the most simple ideas that if you understood workflow or if you understand some of the burden challenges, you would know that it’s just these simple tweaks or these simple automations that need to occur that will really increase the value of that product delivery. It could just be one thing. So, when I would be asked to come into meetings with various people that would come into HCA, I would always say, “Who’s the nurse in the room? Is there a nurse with them?” And I guess it was because I was so… It got to be a lot telling people what their products could do for nurses or physicians or pharmacists, any of our healthcare providers that really are a team.
We look at ourselves as teams. It’s the other people that separate us. It’s really interesting. I would actually get to the point where I was not accepting meetings where they didn’t have a clinician on the team. Gosh, that was over 10 years ago. That was a lot that a minute ago, because it was that important to understanding product development. And my investment team would text me during meetings and say, “Stop talking. You’re costing us millions of dollars.” At first, I was offended by that because I would just go, “I’m just asking simple questions that are not here that I need to know.” And I would get the text message, “Stop talking.”
It got to be like this crazy loop of, well, if I can’t ask questions, how can I know what this product does? That’s why I always would say, “Could you please bring a nurse?” And the reason why I say a nurse is I’m a huge nurse advocate, as a nurse. I love my physician counterparts, many, many friends of mine, but it’s the nurses who understand and run the hospitals and they understand the operations. And quite frankly, they don’t get the respect that they need in understanding the impact that their roles in understanding care coordination. That’s why I always focus on the nurses.
John Farkas:
If there’s an area that I have grown in my understanding and respect in the last several years as I’ve got to know what it takes to make healthcare happen. It’s the critical nature of nurses in operations. It is the conduit between clinical and operations. They’re the ones that are running interference and doing the primary interface and most consistent interface with the systems that have to make things run. Certainly, physicians do, and I’m not discounting that. Every physician I know talks about all the time and effort they’re spending in system, in systems and documentation, and that’s a huge, huge burden. But when you take the next step down into operations, nurses are tighter in that integration and it’s got to work for them. When I hear statistics like 30% or 33% or something like that of a nurse’s time is spent on the keyboard, that’s terrifying to me. It shouldn’t be that way. And it needs to be less of that, especially as nurses continue to get more and more burdened and there’s fewer and fewer per patient, we have to find ways to free them up to be focused in that realm.
Kelly Aldrich:
Yeah, if I can add to that. I think that’s a great observation and boy, I’m on board with that. When I said before, it’s mostly the simple things. It’s not these sexy innovation ideas. It’s really the simple things to optimize what’s going on. I had a visit the other day from a perioperative director who runs about 55 ORs, and she’s like, “Can you just come with me and I’ll walk you around and show you the opportunities? How about just putting a stoplight in the OR room that indicates that we’ve done our timeouts? Or flash up a sign that shows who’s in the room because they’re wearing these masks and they have all this garb on and you can’t see, don’t know who your team is.”
She was just coming up with all these simple ideas, and I’m just shaking my head going, “When are the nurses going to be heard?” Here’s another caution. It seems as though if you sell your idea to the CFO that somehow you think you have it in, and that’s not necessarily true. You may have gotten a contract, but your system may fail because you didn’t include the nurses and what did they actually need?
Why Implementations Must Be Highly Reliable, Repeatable, and Scaleable
John Farkas:
Let’s talk about that a little bit because I know one of the challenges I see pretty frequently for health tech companies is in the implementation phase of things. It’s one thing to win a trial, win a contract, it’s another thing to succeed in that endeavor. I’ve heard lots of horror stories about great opportunities that have gone wrong because of failure to execute. What’s important in that? Clearly, and I hear you saying you’ve got to be in there and understanding what’s going on on the frontline, but talk about what are some of the practical steps and what are some of the things that you, as a nursing leader in a healthcare organization, what are some of the boxes that you want to see checked and is going to give you the assurance that who you’re interacting with knows what the heck’s going on here?
Kelly Aldrich:
I think for sure there’s a lot of great ideas out there, but I’m going to go back to really the implementation science where we have to look at high reliability of the product, and I’ll explain that, high reliability, repeatability of its use and scalability. Everybody should make a checklist and see how are they meeting these things? Because it’s okay to have a product, but trust me, one unit or one inpatient or outpatient episode of care is not like the other. There are no two hospitals alike, even though everyone goes, “Okay, I know you’re all special.” But it’s true. They have different staffing models, they have different floor plan layouts, they have different closet locations for equipment. You have to think about these things. And when something is not highly reliable, not repeatable, not scalable, it creates workarounds. I will tell you, this is my hill that I’m going to die on is that I am making workarounds never events.
If you know anything about the healthcare joint commission regulatory space, we talk about never events. And never events are patient safety, patient harm events where someone has died, seriously injured. They’re reportable events. There is a great lift in work to prevent these sort of sentinel events. It is my commitment to make workarounds from technology never events because they introduce the variables that are not supporting safe, reliable, efficient care that reduces burden. If anybody could just replay that part and understand the underpinnings of that, I think it would be so important because to understand and to get to that piece where the implementation is repeatable and then therefore scalable, that is when you have a win, that’s when you have a success, and that’s when you know that you’ve really been transformational.
Innovation is great. I’ll give you a punch in the arm, you’ve got an innovation idea. But you know what? If it’s not transformational, meaning that it actually did one of those things to improve the care environment to allow a few minutes back to that nurse or that physician to be able to maybe hold somebody’s hand who’s laying in that hospital bed, who needs that comfort? If you have ever been a patient yourself, or if someone you love has ever been a patient, they’re scared out of their minds. And just to save a little bit of time for that clinician to be able to do that, we may see some reduced moral injury that is driving our healthcare professionals away from the bedside.
John Farkas:
Wow, that’s such great perspective, Kelly. I’ve thought about this a number of times recently, and you just said it, innovation in a lot of ways in our world right now is cheap. It is becoming easier and easier to create technology solutions that are quote, unquote, “transformational.” And I think that what is really going to mark successful companies is can you take that transformation into a really well-founded, implementable, scalable and practically applicable world? Can you transpose it? Can you take that whiz-bang, cool innovation and make it work? Because making it work is more of the end, and it seems like so many organizations look at the technology and the innovation as the end. Making it work in the real world and communicating to the market that you know what it means to make it work, that you’ve done the work to make it work in the real world, seems to me to be one of the primary pursuits right now for some of these innovative companies.
Why You Can’t Afford a Failed Implementation
Kelly Aldrich:
Yeah, you’re spot on with it, John. When I was doing the Vitals Now development with the company and then with HCA, which… If anyone has seen a vital sign machine that has a barcode scanner on it, that’s because the nurses at HCA demanded that. I was relentlessly advocating for that change in the industry so that they were mapping. What normally happens with vital signs, and I’ll tell you what-
John Farkas:
Able to connect the dots.
Kelly Aldrich:
Yeah. Right. Before we weren’t able to, we would have to hand write the vitals on a piece of paper and then type them into the computer, which we found was taking about six hours. But what happened was every time we turned a corner, the wireless wasn’t working properly or the machine was caching the vitals because it couldn’t hit the wireless [inaudible]. I would hold up the implementation, I would stop it. Our pilots, no. I’ll tell you the truth. I had engineers crying because I kept stopping the project until they fix the technology. Because the one time that you lose your audience and something is not reliable, and there’s one piece of data missing like a person’s temperature, that’s it. You’re done. Nobody will use your technology. That information gets spread like wildfire, like, oh, walking out of the hospital, hey, did you see that thing that didn’t work? There’s another waste of millions of dollars that got introduced to our company that should have been for my pizza party or whatever nonsense. But really, that’s what it comes down to.
John Farkas:
Hearing you say that, Kelly, it underscores to me that these organizations that are working to bring this stuff to the market need to have internal whistle-blowers that are willing to take those hard lines and say, we don’t need to go any farther until we fix X. We have to fix X. It has to be reliable, it has to be every time because we can’t afford one of those failure events, it’s going to expose us. We were talking to Bill Russell a few episodes ago on this podcast, and he just underscored, you cannot afford a failed implementation in today’s world. You just can’t. All these people talk to each other.
If you’re going to go in and you have a great idea and a great piece of technology, it better be buttoned up and you better have all the answers, and you better have elbow to elbow people ready to clean up whatever may not work. And you better recognize what you said earlier, that every one of these systems is different. If you built your framework in utopia, you better have the infrastructure ready to transpose into 50 different types of implementations because that’s just the beginning.
Kelly Aldrich:
Right. It would be like releasing digital marketing campaign with spelling errors.
John Farkas:
Yeah, because that’s going to inspire confidence, right?
Kelly Aldrich:
Exactly right.
John Farkas:
You can’t afford it, and so-
Kelly Aldrich:
Can’t afford it.
What Kelly Looks for in Potential Partnerships and Solutions
John Farkas:
That’s part of, from my vantage point, the critical nature of the marketing team being very tied to product development. You have to have that clear relationship. You have to have the feedback loop, and you have to work with your product team to clearly articulate what you’re going to do to assure success, because that has to be part of what you put forward. You can’t just assume that in today’s world. You have to declare it and you have to help people understand because if I’m hearing you right, Kelly, you’ve got your guard pretty far up. You’re staring at lots of opportunities of technology to come in and change things, but you’ve learned as a person in the seat. You’ve learned to be skeptical. You’ve learned to have a high bar because nobody’s got time for this stuff.
For organizations coming in to be able to let you know, here’s what we’ve done to assure X, and have that flown on their masthead so that you can look at it and go, okay, if they’re saying this, that must mean that they’ve done this diligence. I think that that would be important. Talk about what are some of those things that… We’ve talked about, some of them clearly, but talk about what some of those entry points look like. What are some of the gates that you have up that you’re wanting to make sure… One, you said very clearly, “Where’s the nurse on your team?” That’s going to be an important one, past that pedigree. What else are you looking at?
Kelly Aldrich:
Yeah. That’s a good question. I think what’s the problem you’re trying to solve? And not only what’s the problem that you’re trying to solve, can you actually articulate that in healthcare speak so that people know that you actually understand what you’re talking about. And if not, be humble enough to say, we think we have an idea here. We think we can partner with someone and we would like to partner to make this better, to reduce the burden on the caregivers. That ultimately impacts the care environment. I think that sometimes that’s really important. Believe me, that will get… I’m working with a physician right now who is a critical care physician, and he created a company to use accelerometers from the smartwatches to improve CPR compression rate and depth. I’ve known him for years. And the reason why I’m helping him is because he has such passion for improving patient care.
You will hands down, get further by pulling in clinicians that way than trying to create some dazzlement that doesn’t exist in the vapor wears. Really, get into the thought flows of the clinicians by working with them. I’ll tell you, one of the things at the Center for Medical Interoperability that we were really targeting and hoping to do was to create a innovation area where people could bring their products in and test their products out with clinicians. That was the targeted goal for the transformation learning center area. So, establishing something like that is what I’m seeing a trend right now, John. Over the last couple of years since COVID, frankly, is that these large companies are asking advisory councils because they can’t afford a full-time clinician or that just doesn’t fit in their team model, but they can afford these collaborations and advisory councils.
I am seeing that quite a bit. I’m seeing it in the virtual nursing care environments a lot right now, where they understand that they don’t have the right mix of people. So, I think that that’s an angle. An angle is partnering with some of these simulation environments. At Vanderbilt University School of Nursing, VUSN, we have a simulation area. We have people come to us with products frequently through the [inaudible] or through just knocking on the door. That’s a potential to work with schools of nursing to understand potential research opportunities and really get some foundational evidence behind your solution because it shouldn’t just be a great idea. It should be proven, but how do you get to that proven? Will you partner with people? The education environment is huge if you’re not within an organization.
Kelly’s Experience in Academic, For-Profit, and Not-for-Profit Organizations
John Farkas:
Talk about the difference, in your experience, from an educational and academic and a for-profit and HCA. Talk about the difference in orientation between those two and what you’ve experienced there. How would you compare, contrast as it pertains to-
Kelly Aldrich:
How much time do we have?
John Farkas:
… bringing in new technology?
Kelly Aldrich:
I’ve been very [inaudible].
John Farkas:
Yeah, because you are schizophrenic in that regard. There’s not too many people who have lived as deep in both arenas as you have.
Kelly Aldrich:
I’ve been in a decade of for-profit, over a decade of for-profit, almost a decade at not-for-profit, and then also the same in academic arenas. And boy, talk about huge differences in those environments. Academic is so interesting. University arenas, they want to work on grants. They’re looking for grants, they’re looking for opportunities to really show and publish on the evidence. I think that that’s an amazing opportunity for a company that actually believes in their solutions to be patient enough to take the time to build that evidence.
John Farkas:
To invest in those relationships. Yeah.
Kelly Aldrich:
That’s really important. The not-for-profit arena is interesting because they have a little more leeway to create their strategic and tactical plans that are probably more mission-oriented. I think that there’s many, many, many duplications of nonprofits looking at these sort of things. There’s so much duplication. And what we’re missing, quite frankly, is the policy engagement, the lack of policy, and the people actually passing bills like HITECH Act who completely missed interoperability with meaningful use. We made some individuals, and I won’t say her name, a $7.4 billion net worth by not looking at interoperability, but that’s the option of the free market. Then you have for-profits that will really look to internal teams and don’t do a lot of publications, and it’s harder to get in the door.
I remember one time we had a CIO when I first started at HCA and she said, “Don’t come to HCA with a new idea because we’ll crush you.” And that was not negative. And anytime I repeat that, and I know anybody from HCA who hears me say this, they’ll know who I’m talking about. But she used to say that because… At first when I first heard it, I was horrified. I was like, “What kind of statement is that?” But the idea is that that organization being in so many different states with so many different regulatory issues that impact the clinicians and therefore products have to be known. So, her point was you have to really know what you’re doing in scaling and reliability and repeatability in order to be successful and not to be crushed and burned out, which is why they created the venture capital arm to actually invest in the companies that were chosen for solutions so that they could put-
John Farkas:
They can put some resources behind-
Kelly Aldrich:
Yeah, resources to help-
John Farkas:
… the enterprise readiness?
Kelly Aldrich:
Yeah, to do all of that work. Yeah, very, very different paradigms, very different, but so much opportunities in all three areas. Again, really, really fortunate. I go back to, and I’ll just say it again, what’s the problem that you’re trying to solve?
Longterm Care and Continuum of Care
John Farkas:
Yep, that’s great perspective. As you look at the horizon right now and look at the landscape of the frontline clinician, when you look at technology and marrying it between technology and innovation with what’s going on in the front line, what are some of the innovations that you’re most excited about? What are some of the things that you see as must haves, must develop, must work to meaningful implementation here in the near term?
Kelly Aldrich:
Yeah, really great question. Again, we could probably go on for a long time, but I’d like to flip that and say, could we actually look at the opportunities for person-centered longitudinal coordination of care? Meaning, could we get out of the four walls of the hospital and start looking at someone’s experience in their health journey through rehab, through homelessness, through continuum of care into long-term care or aging facilities that is like a silent shadow market that people have not even considered until they’re the person in that episode of care or their parent or someone. So, I think that the opportunity really that’s on the horizon and where I’m advising my students to go is not necessarily to be chasing hype, but to be looking at where are the failure points in healthcare. And those failure points are in facilitating continuum of care coordination. My husband is a disabled veteran, and I look at the care that he receives, and quite frankly, how much better the VA has gotten at delivering care by looking at the person, the veteran, as opposed to when you present with your episode of care.
And that’s a longitudinal thing. That’s a holistic approach. Again, I think these whiz-bang solutions are amazing, they’re sexy, they’re fun. That’s why people like doing this sort of work because it’s fun. But the real work is in the grind of what meaningful impact do you have and what are you trying to solve? Long-term care, I think is something and the continuum of care that we have failed at by the lack of interoperability around the person as a nation. And I think that because we have to repeat so many lab tests, and when you go into a doctor’s office or into the hospital, you’re unknown. Nobody knows who you are. If you came from another state, you’re unknown. So, how can we create that person-centered?
There’s countries that have done this, Estonia, the e-citizen. I’ve been working with a group of nurse informaticians on the RN digital citizen so that we can actually respect portability of their competencies and looking at how that impacts care so that you’re a known caregiver who’s giving the best outcomes and so forth. Lots of opportunities if you look at the landscape and you look at not just maybe a one-off solution because a one-off solution will break something else.
John Farkas:
Absolutely. If you’re looking at some of the, we’ll talk about stateside success stories or things that you’re seeing right now that are forming that are promising in that arena, what are you seeing happen that you’re excited about?
Kelly Aldrich:
I do think that using some… What am I excited about seeing right now? Right now, I think that we’ve gotten over the implementation phase and we’ve moved into the optimization universe, and that’s where we need to be. And what I mean by that is where could we use our voice to text? Where can we use our voice to documentation? Where can we use some of these prompt engineering or generative artificial intelligence like model languaging to help with documentation burden that’s actually compliant, that helps with the whole cycle of provider satisfaction and reducing burden?
I think that the promises there, we need a lot of work in this space, but I think that that’s probably the most interesting to me right now is having these… And I don’t want to use the hype word AI, because I just spoke at the National Academy of Medicine on this. They asked me to come and speak on artificial intelligence, and I said, “No, thank you anyway. I don’t want to, but I will speak about interoperability and the lack thereof that is driving so many failures in our system because the interoperability is what we’re missing.” I think if I had my wish list, I would see something like C4MI being re-funded by government so that-
John Farkas:
Which is Center for Medical Interoperability.
Kelly Aldrich:
Yeah. That has been defunded due to COVID hospital prioritizations. And I think that without a centralized lab, we’re just going to keep repeating, rinse and repeat everything that we’re doing. And I think that that’s an opportunity. I just keep getting so many requests around this topic that I believe that that is an opportunity that should be paid attention to.
John Farkas:
Yeah, I would tend to agree with you, Kelly. I think that AI has sort of stolen center stage. If we’re looking at the nexus of dysfunction right now, it really is about the failure of systems to work together towards creating a patient-centered experience.
Kelly Aldrich:
Person-centered. Right. It’s about you.
John Farkas:
Yeah, person-centered. The ability to create that is going to continue to be increasingly important, especially as we start confronting the population aging curve in greater acuity because that’s going to only… Our aging population is going to be the next COVID as far as healthcare, as far as what that’s going to require of the system. Our ability to get around that and try and effectively address and put the systems in place that will afford us the opportunity to handle what is coming is going to be really important.
Addressing the Nursing Shortage by Reducing Burden
John Farkas:
What are you seeing as needing to change in reference to that curve? What are some of the pain points that… Interoperability, pretty clear, person-centered focus on how we are handling information. What are you seeing needing to change soon that will help our preparedness for some of that curve as it gets more acute?
Kelly Aldrich:
Yeah. I’m trying to come up with the great idea, but I see that it’s deteriorating. I think that we would be irresponsible to not be paying attention to the trends of losing healthcare providers from the profession. Like you say, it’s like a COVID epidemic. This is very, very real when we have the experience level of nurses at the bedside being less than three years and they’re leaving. I remember when my mom was in the hospital, my niece who is a registered nurse who left the profession after three years, she was talking with the ICU nurse over my mom, and he said, “Well, I’ve been here for four years.” And she said, “Wow, you’ve been at the hospital. You have so much experience. You’ve been there for so long.” I just remember being horrified because I thought that’s the experience level. Because what people don’t realize is it’s the caregivers who are standing between patient harm and their ability to improve in wellness. And I remember being horrified by that.
I think that we should pay attention to looking into things like this MIND Lab that I’m pushing with meditation immersive experiences that will help with resilience and coping. I think we need to invest in the care teams, and I would ask that people stop calling them heroes. That’s actually kind of insulting because they’re not heroes. They experience moral injury. They’re humans. They are going to work to take care of humans, which is what they devoted their careers to. `I know myself and many others that that is not looked at as a positive when they get a sign in the lawn and out front of their establishment calling them heroes. They’re looking at, hey, let’s look at the staffing models. Let’s look at where the failure points are. Where can technology come in and actually improve care? Where can some of these virtual models actually infuse and take a quality perspective or a safety perspective?
One time I was talking with some people and they had said, “Well, what if we created this net of safety around a patient’s bed that maybe if you came into that zone and you hadn’t washed your hands or you brought the wrong blood product or the wrong medication that it just signaled you and you could back out of that zone.” Those sort of things would be helpful. There has to be a better way to improve the safety and care delivery by reducing burden. Much like we know in today’s world. I’ll make one more point, and I’ve said this a number of times. We look at a typical critical care unit and we see IV poles and we see ventilators and we see ECMO machines or kidney machines or whatever it is, about 12, 13 different devices around this patient.
What people don’t realize is that the nurses are logging into each one of those and then hand entering them into the electronic device. That would be just like you having 10, 12, 13 different phones that you would… Anytime you would want an app, your phone would have an app, and so you would’ve to log into 13 different phones in order to coordinate your life. I think that, again, there are so many glaring, obvious issues that we have in care coordination and the continuum of care that introducing some of these solutions really have to be thoughtful. I would say, again, work with the clinicians. What I used to do is I used to go to the risk management profile and see where were we having patient harms and where could we then apply technology to improve it. I used to do that in several organizations that I was in because those actually told the stories of where the opportunities were.
Closing Thoughts
John Farkas:
We are nearing the end of our time here, and I’m sitting here with about 50 other questions, maybe not 50, but several, and so it just begs a follow-up here. I think that your emphasis and the critical understanding of what are the real failure points and how are we going to create solutions that are mitigating that effectively and certainly avoiding it and ideally rid us of it, I think is really a great underscore and something to be aware of. I think that what you brought forward about the critical nature of having a very empathetic perspective from the clinician’s point of view as you are bringing solutions forward and being ready for the variation that exists in real world deployments, that’s so important and an area that a lot of, especially early stage companies just don’t have a… And you do hear it. You hear it if you’ve implemented it in one healthcare facility. You’ve implemented in one healthcare facility, and people laugh that off. Well, no, it’s real.
The understanding of that and what it means to be enterprise ready doesn’t just mean got enough server space to handle the load. It means you’ve got a team that is ready to customize, to adapt, and to afford the opportunities and sit with an organization until it is working flawlessly. That is what needs to happen. And just going into that eyes open is super important. So much great perspective here, Kelly. And a great affirmation to me of why we’ve got you on our advisory board because there’s a lot that our folks have the opportunity to learn from you.
Thank you for taking some time with us today. There will be more opportunities for conversation. I’m going to listen back to this and say, okay, what’s one point we could spend an hour talking about, because there’s several of them. But certainly, you can see Kelly’s expertise here and her passion. Kelly, thank you for the investment you’re making, and when I hear that it’s going past what nurses are doing on the floor, but for really caring for their mental wellbeing and who they are as people, your investment on that focus and realizing what it means for people to get perspective and hold perspective and stay centered in what is a very demanding, in many cases, heart-wrenching profession is super important and grateful for your investment on that front too. And I want to see some of that pottery.
Kelly Aldrich:
Sounds good.
John Farkas:
Thanks for joining us today.
Kelly Aldrich:
It’s a real honor and thank you. Don’t give up. Don’t take this as a wet blanket. Look at it as these are key points to avoid the failures and really embrace and engage with your clinicians to help you be highly reliable, having a repeatable and scalable solution because I’m sure your great ideas, maybe with just a little tweaking or something could be really phenomenal and have an extraordinary impact. Thanks for letting me share some of my thoughts with your audience. I do appreciate, I’m very honored.
John Farkas:
Thanks, Kelly.
Transcript (custom)
Introducing Kelly Aldrich
John Farkas:
Welcome to Healthcare Market Matrix, a podcast to help you see your market clearly. We dive deep into the challenges faced by healthcare organization leaders that technology has the chance to help them solve. It’s all about gaining the kind of understanding you need to effectively connect with your market. Join us as we explore the healthcare market matrix.
Hello everybody, and welcome to Healthcare Market Matrix. I’m your host, John Farkas, CEO of Ratio, and today I am excited we have the honor of talking with the Dr. Kelly Aldrich, who is a highly accomplished and board certified informatics nurse specialist. And she comes to us with over 35 years of experience in the clinical, academic and leadership roles, just a tremendous HIT strategists, slash innovator, slash industry thought leader who has consistently demonstrated a strong commitment to leveraging advanced technology to bottom line, make nurses lives better, and thus improve the outcomes of the people that nurses care for.
Kelly is presently the director of innovation and associate Professor of Nursing Informatics as a part of the faculty at the Vanderbilt University School of Nursing. We’re going to get into some of her long and illustrious career history here in a little bit. But I’ll just say, I got to know Kelly in the context of, I don’t even know how to describe what we were involved in Kelly, but a consortium of people really interested in exploring interoperability and what that means in the context of healthcare. Kelly was involved for a long time and is currently at the Center for Medical Interoperability.
What I appreciated about Kelly in getting to know her in that context was her very direct, no nonsense, real world perspective of what has to happen in healthcare in order to make things make sense. She has been very skilled in bringing those ideas forward. It’s why I see her valued as a thought leader in this field and why I’m excited that she is part of Ratio’s advisory board and helping to bring perspective to health tech companies that are wanting to make a difference in this world. Kelly, welcome to Healthcare Market Matrix.
Kelly Aldrich:
Thank you. It’s a real pleasure to be here. I look forward to our discussion. Of course, lots of follow-up discussion on this topic. This is a great topic of really understanding the marketplace and healthcare technology solutions and how best to be successful. So, thanks for having me.
Kelly’s Healthcare Background
John Farkas:
Yeah. Glad you’re here. I would love for you to tell us a little bit of your backdrop. How did you get to where you are? And I know we could spend the whole episode just recounting the steps that it took you to get the perspective and the backdrop that you have. But give us the flyby from where you started as a bedside nurse to what has become quite a platform that you’ve established in your role.
Kelly Aldrich:
Thank you. I feel like I need to have a scrolling timeline with year markers because I’ve been very fortunate and very blessed to be able to serve patients. I started when I was 16 as a nursing assistant, so I go way back, and always loved what I have done and been excited by new opportunities in the healthcare profession. But I started in Chicago as a open heart recovery liver transplant nurse at Rush University. I loved working at the bedside, always being challenged, but a group of us decided to leave Chicago for the winter and move to Hawaii. I think that’s actually what started my career in understanding the variances and the process changes that are just throughout healthcare that actually serve as pain points and failure points because no one really does anything the same, which has a huge impact on technology and patient safety, quite frankly. We went to Hawaii and I became a neurotrauma ICU nurse. Spent some time there. I think I was a traveling nurse before it was really cool back in the early ’90s, but [inaudible].
John Farkas:
It was pretty cool going to Hawaii. That was a cool, strategic decision going from Chicago to Hawaii. Let’s face it.
Kelly Aldrich:
For the winter, mind you.
John Farkas:
Yeah, that was very strategic.
Kelly Aldrich:
Went to UCLA for a while, and then down at the military hospital in San Diego, I served as a CVICU nurse. Moved on away from traveling nurse and moved to Florida for a while. That’s really where I dug into a community hospital away from teaching facilities and again, was able to really create a foundation in the variances of care delivery and the different models of care and operations efficiency. I was a bedside nurse there for some time, went back and did some graduate work. I received about three graduate degrees in nursing and then on to get my doctorate, but I was the ER director for some time, which was fascinating. I worked with the state and the local authorities around hurricane preparedness. And this, again, was what kind of broadened my perspective of things that impact operations and systems of care just outside of the walls of the hospital.
I was asked to be the chief nursing officer there. I was the chief nursing officer for some time while I was in an informatics program and just wanted to return to the operations efficiency by using data. I will tell you, the experiences of having been hit by a hurricane, Hurricane Charley. It was a massive hurricane. It shut down our entire hospital and operations. And I remember my CV surgeon coming through the door when we had no electricity, and he said, “All my medical records are blowing down the street right now.” And he said, “Kelly, that’s why you’re going into informatics.” And not at the bedside because I got a lot of slack from people leaving the nurse practitioner program in CV to do informatics. I got a lot of challenges from people. Grew into that role, wanted to do more informatics, so I moved into Nashville. And eventually, over time under Dr. Jonathan Perlin became the chief nursing informatics officer at HCA.
So, I was the inaugural CNIO there. I was invited into that role, I guess because of the impact that I was having through our many hospitals in innovation. It was not the word at the time, it was just really taking care of the nurses and the patients with technology. I was in that role for just a little less than 10 years, moved on to the Center for Medical Interoperability where my true passion lied, as you had said John, around interoperability and what were we doing with technology to serve reducing burden on the care team and the patient coordination of care. That is beyond huge and anyone who’s impacting in that area has got to know what an amazing job that they’re doing in impacting lives, and I’m very passionate about that.
I still to this day, do keynotes in interoperability and working with various groups around this. I’m currently doing a lot of consulting for various companies, international companies around informatics, healthcare informatics, workflow impacts, safety, reducing burden. And then I’m at Vanderbilt. I’ve been at Vanderbilt teaching for over 10 years, but recently, about two years ago, took their director of innovation role and been working with a lot of immersive virtual reality experiences, both in mindfulness. I created a MIND Lab, it’s called Mindful Immersive Nursing Demonstration, so MIND Lab. With that, we’re also experimenting on immersive simulations for empathy training for new nurses coming into the field so that they have experiences before they actually interact with patients. Wow, I tried but yeah, that’s where I’m at. That’s a little bit of my background.
I sit on several national advisory councils, including interoperability standards with the ONC. I’ve served about five or six terms there. I sit on a cybersecurity council that I have done for many years. I’m fascinated with the impacts of clinicians and actually the burden that cybersecurity puts on clinicians and the negotiating factors that we have to have there. That’s me and I run a pottery business.
John Farkas:
Because something has to help you stay sane, right?
Kelly Aldrich:
I love my pottery
John Farkas:
And it’s a great mindful exercise, as every potter that I know has communicated. That’s awesome.
Kelly Aldrich:
You didn’t know that, did you, John?
John Farkas:
I didn’t know that that was part of your backdrop, but I love that that’s part of who you are. I can see the thread there. As you were talking, what came really clear to me was that you were caring for patients at the time when a lot of founders of health tech companies were born in the hospitals that you may have been serving in. At a point that clearly predated electronic medical records, where records were able to literally be blowing down the street in the heavy wind. So, you have seen a remarkable move in this realm. You were there for the birth of healthcare informatics. So, your perspective on this, I’ve got to think, has been pretty mind-blowing. I can’t imagine going from where you started to where you are now in this realm.
My question is knowing what you’ve experienced and what you’ve seen going from the conventional paper charts and what you experienced as a nurse on the floor in the days prior to technology, what I know is everything has gotten, in many ways, more complicated for nurses, especially with what insurance is requiring from reporting and coding and all the different things that need to happen in a nurse’s life to ensure that they’re checking all the boxes that they need to check in today’s compliance and regulatory environment.
The Critical Nature of Nurses in Operations
John Farkas:
What would you have to say to a leader of a health tech company who’s trying to interject a new piece of technology onto the floor? What would be the flag you would want to wave in front of them to make sure that they’re carrying in their forefront? What would you want to say to them?
Kelly Aldrich:
To me, that’s an easy one. It really is about having the clinicians that you’re hoping will use your technology, be involved in the design of the technology. That’s a real easy one to me, and that’s one that is so often missed. As a matter of fact, yesterday I was on a call with an old friend who’s a startup guy, and he was like, “Hey, could you talk with this company? They’ve developed this technology for nurses, but they don’t have a nurse on their team.” I think that it’s really-
John Farkas:
Step one, get nurse on team.
Kelly Aldrich:
That’s a very serious miss. I see customer success roles, I see sales, I see entrepreneurs, and it’s amazing. They have amazing ideas, but will it fit within the workflow of the many different healthcare providers that you’re trying to affect? You have so many variances in that space. Do you really understand the workflow or even the thought flow of the clinicians that would reduce burden for them that would get to meaningful adoption of a technology solution? Or is it something that is being introduced into the environment that quite frankly, that will cause a workaround to do something within this product and therefore create more burden for the team? Not only does it create burden, but it creates a non-reliable, non-repeatable, non-scalable solution, and that will fail.
John Farkas:
Yeah, it’s definitely a critical component that I see and it’s become, for me, I know one of the questions that I ask when we’re looking at client potentials because I’ve recognized that that orientation, that focus is so critical that if you don’t have it, that your opportunity at getting product market fit, at your opportunity at getting credibility is really compromised because everybody right now that has a solution that touches clinicians, the demands are extremely high because we’re dealing with one of the most taxed parts of the health system and introducing any complicating factor is a non-starter. It has to smooth the path. It can’t add friction. There’s no room for friction and anything that looks like friction can’t move forward. So it seems like a non-
Kelly Aldrich:
Well, that would be my number one thing. I recall saying when I was working at HCA, I really had the opportunity. Dr. Perlin was very supportive, by the way, he’s now the CEO of the Joint Commission. He served as the undersecretary to the VA before he joined HCA. So, he’s a very, very visionary, impactful leader, chief medical officer, and now CEO, again, of the Joint Commission. He never got in my way. He always encouraged me to create a proposal and invited nurses to the table, always so respectful. But the point being is when I would come up with an idea… I created something called Vitals Now back in 2008, and it was at the time my doctoral project. What I did was I actually worked with a company but worked with the nurses at the bedside to find out all the caveats of all the problems that they may have in implementing this tool that automated vital signs into the medical records. So, created all the requirements and standards. That’s now an industry standard that’s international standard.
I called it Vitals Now as a joke just because it was like, hey, vitals now. Vitals are vital for a reason. And where I’m going with this is sometimes the best ideas are the most simple ideas that if you understood workflow or if you understand some of the burden challenges, you would know that it’s just these simple tweaks or these simple automations that need to occur that will really increase the value of that product delivery. It could just be one thing. So, when I would be asked to come into meetings with various people that would come into HCA, I would always say, “Who’s the nurse in the room? Is there a nurse with them?” And I guess it was because I was so… It got to be a lot telling people what their products could do for nurses or physicians or pharmacists, any of our healthcare providers that really are a team.
We look at ourselves as teams. It’s the other people that separate us. It’s really interesting. I would actually get to the point where I was not accepting meetings where they didn’t have a clinician on the team. Gosh, that was over 10 years ago. That was a lot that a minute ago, because it was that important to understanding product development. And my investment team would text me during meetings and say, “Stop talking. You’re costing us millions of dollars.” At first, I was offended by that because I would just go, “I’m just asking simple questions that are not here that I need to know.” And I would get the text message, “Stop talking.”
It got to be like this crazy loop of, well, if I can’t ask questions, how can I know what this product does? That’s why I always would say, “Could you please bring a nurse?” And the reason why I say a nurse is I’m a huge nurse advocate, as a nurse. I love my physician counterparts, many, many friends of mine, but it’s the nurses who understand and run the hospitals and they understand the operations. And quite frankly, they don’t get the respect that they need in understanding the impact that their roles in understanding care coordination. That’s why I always focus on the nurses.
John Farkas:
If there’s an area that I have grown in my understanding and respect in the last several years as I’ve got to know what it takes to make healthcare happen. It’s the critical nature of nurses in operations. It is the conduit between clinical and operations. They’re the ones that are running interference and doing the primary interface and most consistent interface with the systems that have to make things run. Certainly, physicians do, and I’m not discounting that. Every physician I know talks about all the time and effort they’re spending in system, in systems and documentation, and that’s a huge, huge burden. But when you take the next step down into operations, nurses are tighter in that integration and it’s got to work for them. When I hear statistics like 30% or 33% or something like that of a nurse’s time is spent on the keyboard, that’s terrifying to me. It shouldn’t be that way. And it needs to be less of that, especially as nurses continue to get more and more burdened and there’s fewer and fewer per patient, we have to find ways to free them up to be focused in that realm.
Kelly Aldrich:
Yeah, if I can add to that. I think that’s a great observation and boy, I’m on board with that. When I said before, it’s mostly the simple things. It’s not these sexy innovation ideas. It’s really the simple things to optimize what’s going on. I had a visit the other day from a perioperative director who runs about 55 ORs, and she’s like, “Can you just come with me and I’ll walk you around and show you the opportunities? How about just putting a stoplight in the OR room that indicates that we’ve done our timeouts? Or flash up a sign that shows who’s in the room because they’re wearing these masks and they have all this garb on and you can’t see, don’t know who your team is.”
She was just coming up with all these simple ideas, and I’m just shaking my head going, “When are the nurses going to be heard?” Here’s another caution. It seems as though if you sell your idea to the CFO that somehow you think you have it in, and that’s not necessarily true. You may have gotten a contract, but your system may fail because you didn’t include the nurses and what did they actually need?
Why Implementations Must Be Highly Reliable, Repeatable, and Scaleable
John Farkas:
Let’s talk about that a little bit because I know one of the challenges I see pretty frequently for health tech companies is in the implementation phase of things. It’s one thing to win a trial, win a contract, it’s another thing to succeed in that endeavor. I’ve heard lots of horror stories about great opportunities that have gone wrong because of failure to execute. What’s important in that? Clearly, and I hear you saying you’ve got to be in there and understanding what’s going on on the frontline, but talk about what are some of the practical steps and what are some of the things that you, as a nursing leader in a healthcare organization, what are some of the boxes that you want to see checked and is going to give you the assurance that who you’re interacting with knows what the heck’s going on here?
Kelly Aldrich:
I think for sure there’s a lot of great ideas out there, but I’m going to go back to really the implementation science where we have to look at high reliability of the product, and I’ll explain that, high reliability, repeatability of its use and scalability. Everybody should make a checklist and see how are they meeting these things? Because it’s okay to have a product, but trust me, one unit or one inpatient or outpatient episode of care is not like the other. There are no two hospitals alike, even though everyone goes, “Okay, I know you’re all special.” But it’s true. They have different staffing models, they have different floor plan layouts, they have different closet locations for equipment. You have to think about these things. And when something is not highly reliable, not repeatable, not scalable, it creates workarounds. I will tell you, this is my hill that I’m going to die on is that I am making workarounds never events.
If you know anything about the healthcare joint commission regulatory space, we talk about never events. And never events are patient safety, patient harm events where someone has died, seriously injured. They’re reportable events. There is a great lift in work to prevent these sort of sentinel events. It is my commitment to make workarounds from technology never events because they introduce the variables that are not supporting safe, reliable, efficient care that reduces burden. If anybody could just replay that part and understand the underpinnings of that, I think it would be so important because to understand and to get to that piece where the implementation is repeatable and then therefore scalable, that is when you have a win, that’s when you have a success, and that’s when you know that you’ve really been transformational.
Innovation is great. I’ll give you a punch in the arm, you’ve got an innovation idea. But you know what? If it’s not transformational, meaning that it actually did one of those things to improve the care environment to allow a few minutes back to that nurse or that physician to be able to maybe hold somebody’s hand who’s laying in that hospital bed, who needs that comfort? If you have ever been a patient yourself, or if someone you love has ever been a patient, they’re scared out of their minds. And just to save a little bit of time for that clinician to be able to do that, we may see some reduced moral injury that is driving our healthcare professionals away from the bedside.
John Farkas:
Wow, that’s such great perspective, Kelly. I’ve thought about this a number of times recently, and you just said it, innovation in a lot of ways in our world right now is cheap. It is becoming easier and easier to create technology solutions that are quote, unquote, “transformational.” And I think that what is really going to mark successful companies is can you take that transformation into a really well-founded, implementable, scalable and practically applicable world? Can you transpose it? Can you take that whiz-bang, cool innovation and make it work? Because making it work is more of the end, and it seems like so many organizations look at the technology and the innovation as the end. Making it work in the real world and communicating to the market that you know what it means to make it work, that you’ve done the work to make it work in the real world, seems to me to be one of the primary pursuits right now for some of these innovative companies.
Why You Can’t Afford a Failed Implementation
Kelly Aldrich:
Yeah, you’re spot on with it, John. When I was doing the Vitals Now development with the company and then with HCA, which… If anyone has seen a vital sign machine that has a barcode scanner on it, that’s because the nurses at HCA demanded that. I was relentlessly advocating for that change in the industry so that they were mapping. What normally happens with vital signs, and I’ll tell you what-
John Farkas:
Able to connect the dots.
Kelly Aldrich:
Yeah. Right. Before we weren’t able to, we would have to hand write the vitals on a piece of paper and then type them into the computer, which we found was taking about six hours. But what happened was every time we turned a corner, the wireless wasn’t working properly or the machine was caching the vitals because it couldn’t hit the wireless [inaudible]. I would hold up the implementation, I would stop it. Our pilots, no. I’ll tell you the truth. I had engineers crying because I kept stopping the project until they fix the technology. Because the one time that you lose your audience and something is not reliable, and there’s one piece of data missing like a person’s temperature, that’s it. You’re done. Nobody will use your technology. That information gets spread like wildfire, like, oh, walking out of the hospital, hey, did you see that thing that didn’t work? There’s another waste of millions of dollars that got introduced to our company that should have been for my pizza party or whatever nonsense. But really, that’s what it comes down to.
John Farkas:
Hearing you say that, Kelly, it underscores to me that these organizations that are working to bring this stuff to the market need to have internal whistle-blowers that are willing to take those hard lines and say, we don’t need to go any farther until we fix X. We have to fix X. It has to be reliable, it has to be every time because we can’t afford one of those failure events, it’s going to expose us. We were talking to Bill Russell a few episodes ago on this podcast, and he just underscored, you cannot afford a failed implementation in today’s world. You just can’t. All these people talk to each other.
If you’re going to go in and you have a great idea and a great piece of technology, it better be buttoned up and you better have all the answers, and you better have elbow to elbow people ready to clean up whatever may not work. And you better recognize what you said earlier, that every one of these systems is different. If you built your framework in utopia, you better have the infrastructure ready to transpose into 50 different types of implementations because that’s just the beginning.
Kelly Aldrich:
Right. It would be like releasing digital marketing campaign with spelling errors.
John Farkas:
Yeah, because that’s going to inspire confidence, right?
Kelly Aldrich:
Exactly right.
John Farkas:
You can’t afford it, and so-
Kelly Aldrich:
Can’t afford it.
What Kelly Looks for in Potential Partnerships and Solutions
John Farkas:
That’s part of, from my vantage point, the critical nature of the marketing team being very tied to product development. You have to have that clear relationship. You have to have the feedback loop, and you have to work with your product team to clearly articulate what you’re going to do to assure success, because that has to be part of what you put forward. You can’t just assume that in today’s world. You have to declare it and you have to help people understand because if I’m hearing you right, Kelly, you’ve got your guard pretty far up. You’re staring at lots of opportunities of technology to come in and change things, but you’ve learned as a person in the seat. You’ve learned to be skeptical. You’ve learned to have a high bar because nobody’s got time for this stuff.
For organizations coming in to be able to let you know, here’s what we’ve done to assure X, and have that flown on their masthead so that you can look at it and go, okay, if they’re saying this, that must mean that they’ve done this diligence. I think that that would be important. Talk about what are some of those things that… We’ve talked about, some of them clearly, but talk about what some of those entry points look like. What are some of the gates that you have up that you’re wanting to make sure… One, you said very clearly, “Where’s the nurse on your team?” That’s going to be an important one, past that pedigree. What else are you looking at?
Kelly Aldrich:
Yeah. That’s a good question. I think what’s the problem you’re trying to solve? And not only what’s the problem that you’re trying to solve, can you actually articulate that in healthcare speak so that people know that you actually understand what you’re talking about. And if not, be humble enough to say, we think we have an idea here. We think we can partner with someone and we would like to partner to make this better, to reduce the burden on the caregivers. That ultimately impacts the care environment. I think that sometimes that’s really important. Believe me, that will get… I’m working with a physician right now who is a critical care physician, and he created a company to use accelerometers from the smartwatches to improve CPR compression rate and depth. I’ve known him for years. And the reason why I’m helping him is because he has such passion for improving patient care.
You will hands down, get further by pulling in clinicians that way than trying to create some dazzlement that doesn’t exist in the vapor wears. Really, get into the thought flows of the clinicians by working with them. I’ll tell you, one of the things at the Center for Medical Interoperability that we were really targeting and hoping to do was to create a innovation area where people could bring their products in and test their products out with clinicians. That was the targeted goal for the transformation learning center area. So, establishing something like that is what I’m seeing a trend right now, John. Over the last couple of years since COVID, frankly, is that these large companies are asking advisory councils because they can’t afford a full-time clinician or that just doesn’t fit in their team model, but they can afford these collaborations and advisory councils.
I am seeing that quite a bit. I’m seeing it in the virtual nursing care environments a lot right now, where they understand that they don’t have the right mix of people. So, I think that that’s an angle. An angle is partnering with some of these simulation environments. At Vanderbilt University School of Nursing, VUSN, we have a simulation area. We have people come to us with products frequently through the [inaudible] or through just knocking on the door. That’s a potential to work with schools of nursing to understand potential research opportunities and really get some foundational evidence behind your solution because it shouldn’t just be a great idea. It should be proven, but how do you get to that proven? Will you partner with people? The education environment is huge if you’re not within an organization.
Kelly’s Experience in Academic, For-Profit, and Not-for-Profit Organizations
John Farkas:
Talk about the difference, in your experience, from an educational and academic and a for-profit and HCA. Talk about the difference in orientation between those two and what you’ve experienced there. How would you compare, contrast as it pertains to-
Kelly Aldrich:
How much time do we have?
John Farkas:
… bringing in new technology?
Kelly Aldrich:
I’ve been very [inaudible].
John Farkas:
Yeah, because you are schizophrenic in that regard. There’s not too many people who have lived as deep in both arenas as you have.
Kelly Aldrich:
I’ve been in a decade of for-profit, over a decade of for-profit, almost a decade at not-for-profit, and then also the same in academic arenas. And boy, talk about huge differences in those environments. Academic is so interesting. University arenas, they want to work on grants. They’re looking for grants, they’re looking for opportunities to really show and publish on the evidence. I think that that’s an amazing opportunity for a company that actually believes in their solutions to be patient enough to take the time to build that evidence.
John Farkas:
To invest in those relationships. Yeah.
Kelly Aldrich:
That’s really important. The not-for-profit arena is interesting because they have a little more leeway to create their strategic and tactical plans that are probably more mission-oriented. I think that there’s many, many, many duplications of nonprofits looking at these sort of things. There’s so much duplication. And what we’re missing, quite frankly, is the policy engagement, the lack of policy, and the people actually passing bills like HITECH Act who completely missed interoperability with meaningful use. We made some individuals, and I won’t say her name, a $7.4 billion net worth by not looking at interoperability, but that’s the option of the free market. Then you have for-profits that will really look to internal teams and don’t do a lot of publications, and it’s harder to get in the door.
I remember one time we had a CIO when I first started at HCA and she said, “Don’t come to HCA with a new idea because we’ll crush you.” And that was not negative. And anytime I repeat that, and I know anybody from HCA who hears me say this, they’ll know who I’m talking about. But she used to say that because… At first when I first heard it, I was horrified. I was like, “What kind of statement is that?” But the idea is that that organization being in so many different states with so many different regulatory issues that impact the clinicians and therefore products have to be known. So, her point was you have to really know what you’re doing in scaling and reliability and repeatability in order to be successful and not to be crushed and burned out, which is why they created the venture capital arm to actually invest in the companies that were chosen for solutions so that they could put-
John Farkas:
They can put some resources behind-
Kelly Aldrich:
Yeah, resources to help-
John Farkas:
… the enterprise readiness?
Kelly Aldrich:
Yeah, to do all of that work. Yeah, very, very different paradigms, very different, but so much opportunities in all three areas. Again, really, really fortunate. I go back to, and I’ll just say it again, what’s the problem that you’re trying to solve?
Longterm Care and Continuum of Care
John Farkas:
Yep, that’s great perspective. As you look at the horizon right now and look at the landscape of the frontline clinician, when you look at technology and marrying it between technology and innovation with what’s going on in the front line, what are some of the innovations that you’re most excited about? What are some of the things that you see as must haves, must develop, must work to meaningful implementation here in the near term?
Kelly Aldrich:
Yeah, really great question. Again, we could probably go on for a long time, but I’d like to flip that and say, could we actually look at the opportunities for person-centered longitudinal coordination of care? Meaning, could we get out of the four walls of the hospital and start looking at someone’s experience in their health journey through rehab, through homelessness, through continuum of care into long-term care or aging facilities that is like a silent shadow market that people have not even considered until they’re the person in that episode of care or their parent or someone. So, I think that the opportunity really that’s on the horizon and where I’m advising my students to go is not necessarily to be chasing hype, but to be looking at where are the failure points in healthcare. And those failure points are in facilitating continuum of care coordination. My husband is a disabled veteran, and I look at the care that he receives, and quite frankly, how much better the VA has gotten at delivering care by looking at the person, the veteran, as opposed to when you present with your episode of care.
And that’s a longitudinal thing. That’s a holistic approach. Again, I think these whiz-bang solutions are amazing, they’re sexy, they’re fun. That’s why people like doing this sort of work because it’s fun. But the real work is in the grind of what meaningful impact do you have and what are you trying to solve? Long-term care, I think is something and the continuum of care that we have failed at by the lack of interoperability around the person as a nation. And I think that because we have to repeat so many lab tests, and when you go into a doctor’s office or into the hospital, you’re unknown. Nobody knows who you are. If you came from another state, you’re unknown. So, how can we create that person-centered?
There’s countries that have done this, Estonia, the e-citizen. I’ve been working with a group of nurse informaticians on the RN digital citizen so that we can actually respect portability of their competencies and looking at how that impacts care so that you’re a known caregiver who’s giving the best outcomes and so forth. Lots of opportunities if you look at the landscape and you look at not just maybe a one-off solution because a one-off solution will break something else.
John Farkas:
Absolutely. If you’re looking at some of the, we’ll talk about stateside success stories or things that you’re seeing right now that are forming that are promising in that arena, what are you seeing happen that you’re excited about?
Kelly Aldrich:
I do think that using some… What am I excited about seeing right now? Right now, I think that we’ve gotten over the implementation phase and we’ve moved into the optimization universe, and that’s where we need to be. And what I mean by that is where could we use our voice to text? Where can we use our voice to documentation? Where can we use some of these prompt engineering or generative artificial intelligence like model languaging to help with documentation burden that’s actually compliant, that helps with the whole cycle of provider satisfaction and reducing burden?
I think that the promises there, we need a lot of work in this space, but I think that that’s probably the most interesting to me right now is having these… And I don’t want to use the hype word AI, because I just spoke at the National Academy of Medicine on this. They asked me to come and speak on artificial intelligence, and I said, “No, thank you anyway. I don’t want to, but I will speak about interoperability and the lack thereof that is driving so many failures in our system because the interoperability is what we’re missing.” I think if I had my wish list, I would see something like C4MI being re-funded by government so that-
John Farkas:
Which is Center for Medical Interoperability.
Kelly Aldrich:
Yeah. That has been defunded due to COVID hospital prioritizations. And I think that without a centralized lab, we’re just going to keep repeating, rinse and repeat everything that we’re doing. And I think that that’s an opportunity. I just keep getting so many requests around this topic that I believe that that is an opportunity that should be paid attention to.
John Farkas:
Yeah, I would tend to agree with you, Kelly. I think that AI has sort of stolen center stage. If we’re looking at the nexus of dysfunction right now, it really is about the failure of systems to work together towards creating a patient-centered experience.
Kelly Aldrich:
Person-centered. Right. It’s about you.
John Farkas:
Yeah, person-centered. The ability to create that is going to continue to be increasingly important, especially as we start confronting the population aging curve in greater acuity because that’s going to only… Our aging population is going to be the next COVID as far as healthcare, as far as what that’s going to require of the system. Our ability to get around that and try and effectively address and put the systems in place that will afford us the opportunity to handle what is coming is going to be really important.
Addressing the Nursing Shortage by Reducing Burden
John Farkas:
What are you seeing as needing to change in reference to that curve? What are some of the pain points that… Interoperability, pretty clear, person-centered focus on how we are handling information. What are you seeing needing to change soon that will help our preparedness for some of that curve as it gets more acute?
Kelly Aldrich:
Yeah. I’m trying to come up with the great idea, but I see that it’s deteriorating. I think that we would be irresponsible to not be paying attention to the trends of losing healthcare providers from the profession. Like you say, it’s like a COVID epidemic. This is very, very real when we have the experience level of nurses at the bedside being less than three years and they’re leaving. I remember when my mom was in the hospital, my niece who is a registered nurse who left the profession after three years, she was talking with the ICU nurse over my mom, and he said, “Well, I’ve been here for four years.” And she said, “Wow, you’ve been at the hospital. You have so much experience. You’ve been there for so long.” I just remember being horrified because I thought that’s the experience level. Because what people don’t realize is it’s the caregivers who are standing between patient harm and their ability to improve in wellness. And I remember being horrified by that.
I think that we should pay attention to looking into things like this MIND Lab that I’m pushing with meditation immersive experiences that will help with resilience and coping. I think we need to invest in the care teams, and I would ask that people stop calling them heroes. That’s actually kind of insulting because they’re not heroes. They experience moral injury. They’re humans. They are going to work to take care of humans, which is what they devoted their careers to. `I know myself and many others that that is not looked at as a positive when they get a sign in the lawn and out front of their establishment calling them heroes. They’re looking at, hey, let’s look at the staffing models. Let’s look at where the failure points are. Where can technology come in and actually improve care? Where can some of these virtual models actually infuse and take a quality perspective or a safety perspective?
One time I was talking with some people and they had said, “Well, what if we created this net of safety around a patient’s bed that maybe if you came into that zone and you hadn’t washed your hands or you brought the wrong blood product or the wrong medication that it just signaled you and you could back out of that zone.” Those sort of things would be helpful. There has to be a better way to improve the safety and care delivery by reducing burden. Much like we know in today’s world. I’ll make one more point, and I’ve said this a number of times. We look at a typical critical care unit and we see IV poles and we see ventilators and we see ECMO machines or kidney machines or whatever it is, about 12, 13 different devices around this patient.
What people don’t realize is that the nurses are logging into each one of those and then hand entering them into the electronic device. That would be just like you having 10, 12, 13 different phones that you would… Anytime you would want an app, your phone would have an app, and so you would’ve to log into 13 different phones in order to coordinate your life. I think that, again, there are so many glaring, obvious issues that we have in care coordination and the continuum of care that introducing some of these solutions really have to be thoughtful. I would say, again, work with the clinicians. What I used to do is I used to go to the risk management profile and see where were we having patient harms and where could we then apply technology to improve it. I used to do that in several organizations that I was in because those actually told the stories of where the opportunities were.
Closing Thoughts
John Farkas:
We are nearing the end of our time here, and I’m sitting here with about 50 other questions, maybe not 50, but several, and so it just begs a follow-up here. I think that your emphasis and the critical understanding of what are the real failure points and how are we going to create solutions that are mitigating that effectively and certainly avoiding it and ideally rid us of it, I think is really a great underscore and something to be aware of. I think that what you brought forward about the critical nature of having a very empathetic perspective from the clinician’s point of view as you are bringing solutions forward and being ready for the variation that exists in real world deployments, that’s so important and an area that a lot of, especially early stage companies just don’t have a… And you do hear it. You hear it if you’ve implemented it in one healthcare facility. You’ve implemented in one healthcare facility, and people laugh that off. Well, no, it’s real.
The understanding of that and what it means to be enterprise ready doesn’t just mean got enough server space to handle the load. It means you’ve got a team that is ready to customize, to adapt, and to afford the opportunities and sit with an organization until it is working flawlessly. That is what needs to happen. And just going into that eyes open is super important. So much great perspective here, Kelly. And a great affirmation to me of why we’ve got you on our advisory board because there’s a lot that our folks have the opportunity to learn from you.
Thank you for taking some time with us today. There will be more opportunities for conversation. I’m going to listen back to this and say, okay, what’s one point we could spend an hour talking about, because there’s several of them. But certainly, you can see Kelly’s expertise here and her passion. Kelly, thank you for the investment you’re making, and when I hear that it’s going past what nurses are doing on the floor, but for really caring for their mental wellbeing and who they are as people, your investment on that focus and realizing what it means for people to get perspective and hold perspective and stay centered in what is a very demanding, in many cases, heart-wrenching profession is super important and grateful for your investment on that front too. And I want to see some of that pottery.
Kelly Aldrich:
Sounds good.
John Farkas:
Thanks for joining us today.
Kelly Aldrich:
It’s a real honor and thank you. Don’t give up. Don’t take this as a wet blanket. Look at it as these are key points to avoid the failures and really embrace and engage with your clinicians to help you be highly reliable, having a repeatable and scalable solution because I’m sure your great ideas, maybe with just a little tweaking or something could be really phenomenal and have an extraordinary impact. Thanks for letting me share some of my thoughts with your audience. I do appreciate, I’m very honored.
John Farkas:
Thanks, Kelly.
About Kelly Aldrich, MD
Dr. Aldrich is a highly accomplished board-certified Informatics Nurse Specialist with over 35 years of experience in clinical, academic, and leadership roles. As an HIT strategist, innovator, and industry thought leader, Dr. Aldrich has consistently demonstrated a strong commitment to leveraging cutting-edge technologies to enhance patient care and alleviate the burden on Nurses.
With a proven track record of transforming the strategic technical direction of major healthcare organizations, Dr. Aldrich is widely respected for driving industry innovation and improving clinical care environments. Driven by a passion for operational efficiencies and simplifying nursing/care team functions, Dr. Aldrich consistently achieves ambitious patient care goals.
Dr. Aldrich’s primary focus lies in leveraging innovation and Nursing Informatics to reduce the burden on care teams, enhance patient safety, and promote the concept of Digital RN Citizen using the Unique Nurse Identifier. By creating and advancing IT solutions, Dr. Aldrich actively contributes to the advancement of the healthcare industry.
If you have any opportunities or initiatives aimed at transforming healthcare through technology and Nursing Informatics, Dr. Aldrich is eager to connect, collaborate, and help drive positive change.