University of Utah Health’s Victoria Tiase on Digital Health & Nursing: “We’re at a Real Inflection Point.”

The level of innovation happening in healthcare is off the charts. Digital tools are being leveraged to transform the way care is delivered and increase efficiencies — that is, when it’s done right.

Unfortunately, that’s not always the case. As the pressure to advance is ratcheted up, solutions are increasingly being developed without input from those in the trenches, and as a result, often stumble out of the gate.

University of Utah Health aims to change that with the Digital Health Initiative, which was established in 2022 to “cultivate a thriving research community” and provide the guidance needed to “get transformative tools to the bedside and do it in a scalable way,” according to Victoria Tiase, who serves as Director of Strategic Development. The differentiator for DHI — and a significant selling point in her decision to move from New York to Utah to help lead it — is involvement from nursing leaders.

Nurses “are in the room having conversations with patients and families,” she said during a recent interview with Kate Gamble. “Can you imagine capturing all of that data and being able to very quickly understand the needs when a patient is discharged and getting all the appropriation done in advance? There are huge efficiencies that could be gained there.”

At Utah Health, harnessing those efficiencies is a core objective, according to Tiase. During the discussion, she spoke about how the organization strives to foster innovation and help guide ideas to fruition by providing “digital health domain expertise.” She also talked about the tremendous value nurses bring to the leadership table; the catch-22 when it comes to innovation and burnout; her participation in the Future of Nursing 2030 initiative; and her message to vendors.

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Bold Statements

The fact that we are not always including clinicians is a problem. Researchers are designing these tools without the bedside folks, patients and clinicians, and then asking them to try them. And they might provide very valuable feedback that might not go anywhere.

We had a couple of listening sessions last year and we thought, let’s bring that in-house and let’s stand up a software development core and see if that might help if we put money and resources behind it; that way, it can serve as a resource for digital health researchers.

‘For any of you in the audience who are looking to fund a project or create some sort of tool, it’s all on the care coordination space. We still don’t have good tools for that. If you can figure out how to do that and consult with nurses on the best ways to do it, that would be a huge win.’

The way we fix the documentation burnout and burden is by having tools that can help support nurses and create efficiencies. The hard part is that we don’t have time right now for them to provide input. It’s a really tricky balance.

Nurses are in the room with patients and families way more than physicians. They’re having conversations with patients and families. Can you imagine capturing all of that data and being able to very quickly understand the needs for when the patient is discharged and getting all the appropriation done in advance?

 

Q&A with Victoria Tiase, Strategic Director, Digital Health & Assistant Professor of Biomedical Informatics, University of Utah

Gamble:  Hi Vicky, thanks so much for joining me. It’s been a while since we last spoke. So, you started with University of Utah in June of 2022. Did you move to Utah or are you hybrid?

Tiase:  I ended up moving to Utah. I’ve been here about a year and a half now. COVID was tough in New York City. It seems like everybody was trying to figure out where to move outside of the city, and while we were doing that, an opportunity came up where they were starting the Digital Health Initiative. Basically, it’s an academic medical center-wide initiative focused on how to connect research and practice and make sure they’re getting tools to the bedside and doing that in a scaleable way.

I thought it was a great opportunity to try something new. I also liked the fact that they were looking at a nurse for the role, which I thought was important.

 

Innovation in isolation

Gamble:  I definitely want to talk about what you just touched on, which is the importance of having nurses in digital health roles. But first, can you talk a bit more about the Digital Health Initiative and what you’re doing there?

Tiase:  Sure, happy to. It’s technically a research initiative in terms of funding, but the idea is for it extend across the academic medical center. I don’t think that’s unusual from what I’ve seen between hospitals and academic medical centers. You have researchers building, developing and designing digital health tools, and a lot of times it’s done in isolation. They’re not involving the clinicians at the bedside when they’re doing the design and development.

And then gets piloted, tested, or prototype-tested in the clinical setting. But when the research dollars are gone, it basically falls off the proverbial cliff, and the clinicians are like, ‘Wait a minute — where did that tool go that we were using.’

I feel like there has been this rift. Granted there are other issues around research given the pace and funding and things like that, but I think the fact that we are not always including clinicians — and I’m also going to loop in patients and caregivers, because we’re thinking about that with the initiative — is a problem. Researchers are designing these tools without the bedside folks, patients and clinicians, and then asking them to try them. And they might provide very valuable feedback that might not go anywhere.

Making it scalable

There are a couple of things we’re looking to solve with this initiative. One of our goals is to make sure we include end users in the process. Digital health can be big, and so, we’re scoping it as tools that bedside clinicians might use and tools that patients, families, and caregivers might use. Certainly, we recognize that digital health is much, much larger than that, but we are looking at that microcosm.

The other piece is thinking about how we then scale it. Not only make it so that it’s production-ready for our healthcare system, but making sure it’s on a platform that’s scaleable on something that can be extended once the research is completed.

Another component, which has been a little harder than I had hoped, is commercialization. Utah and Salt Lake are very business friendly. Given some of the work I did in New York City with the digital health accelerator that Mayor Bloomberg set up many moons ago, the thought was how we could extend some of those principles here — build up an ecosystem where researchers are supported in that commercialization pipeline. The first part, which included clinicians forming partnerships with hospital operation folks, has actually had a little bit of traction.

The commercialization piece has been tougher, particularly around how to incentivize. It’s thinking about some of the structures already in place that might not incentivize moving your company — how the university does their market-share policies and how to get patents. There are all sorts of pieces we’re working through. Fortunately, we have a surgeon who actually has set up his own company. He has now taken a new role in our transfer office, and so hopefully we can make some strides to support clinicians in starting up a business, getting venture funding, connecting them with the right people, and giving them some of the financial training around setting up a small business. That’s the gist of it.

Pilot Grant program

And then, at a basic level, it’s community building. That’s been eye-opening for me. Now bringing in the nursing lens, I would say the majority of the folks on the health science side that are interested in doing work in the digital health space — and actually have tools that can be used in the clinical setting — are in our college of nursing. We have everything from some types of telehealth, remote patient monitoring work that’s happening to actually a lot on the community front. We also have a pilot grant program to support faculty in the digital health space. And in fact, two of our seven recipients were from the college of nursing, and now we have another two in the second round. I think that’s illuminating as well.

Connecting with the community

A lot of their solutions are focused on connecting with communities. One that has gotten a lot of local press here is a tool that connects to Utah-211, a United Way program that connects people to the services they need, such as housing assistance, food resources, and legal aid. It supports patients as they are being discharged from the hospital by helping them understand which services are available and how to connect with those services. It’s automatically built into the app. It also lets patients stay connected with their social worker and get answers to their questions. What’s interesting is that without even trying, we have nursing folks front and center in this initiative.

 

Keeping it in-house

Gamble:  It’s not surprising because nurses are at the forefront, and they know what the needs are. But when there is an innovation, going from idea to concept to market are some pretty big jumps. Is that where your team comes in?

Tiase:  Yes. We offer a few things. One, for lack of a better word, is a consultation service. We have an email and a form that people can fill out. If they have a digital health idea and they’re not really sure what to do with it or where to go with it, we’ll meet with them, talk them through it, and point them in a particular direction.

One thing we realized is that our researchers and clinicians were going outside of the university. They were connecting with different people, getting different types of feedback and different types of quotes. Some people spending way more than they should be spending. And so, we had a couple of listening sessions last year and we thought, let’s bring that in-house and let’s stand up a software development core and see if that might help if we put money and resources behind it; that way, it can serve as a resource for digital health researchers.  Sometimes in those consultation services, we’ll meet with somebody and say, ‘we want to connect you with the software development core. Here is a list of services; we think you’ll be better served talking with them.’

Now, they also have consultant hours very much from the technical side. As DHI leadership, we’ll provide more of the digital health domain expertise. We might send them to the software development core for that technical expertise because it might be a great idea, but we don’t know how to do it, so we’ll send you to the director there.

Innovation in nursing school

On a national level, there’s a gap in training from a nursing perspective. At a basic level, how do you introduce innovation in nursing school? How do you introduce nursing students to the concept that, ‘you’re seeing things; you know what problems need to be solved. This is how you might get that idea going.’

We’re starting there and then moving into Master’s in Nursing Informatics or PhD in Nursing Informatics — that’s where we see it most. Then, how do you get into that ideation and move your idea into something bigger? Those programs are few and far between. University of Pennsylvania School of Nursing, for example, is doing an amazing job; I believe they even have a Master’s course in innovation and design thinking — that’s important because it doesn’t come naturally to most people.

Addressing the true gaps

It’s a space that requires some work. I think the most valuable piece that clinicians bring to the table is that initial idea. I recall from my days with the New York City accelerator that people would come up with ideas and bring them to us at the hospital. We’d say, ‘where did you come up with this idea? Do you have clinicians on your team? Did you consult with any?’ If they said, ‘no,’ we’d say, ‘this idea is not going to work. Go back to the drawing board.’

Interestingly enough, I think some of the areas in which we’ve struggled have not changed dramatically over time. I brought this up at ViVE back in February; someone from the audience had a question about where nurses bring the most value, or something along those lines. And I said, ‘For any of you in the audience who are looking to fund a project or create some sort of tool, it’s all on the care coordination space. We still don’t have good tools for that. If you can figure out how to do that and consult with nurses on the best ways to do it, that would be a huge win.’

 

Nursing involvement & the “tricky balance”

Gamble:  It seems that as digital transformation is reshaping the industry, there’s more of a need to involve nursing. What would you say to a CIO or chief digital officer about the importance of getting that input for things like design, workflow, implementation, etc?

Tiase:  Honestly, I find that to be difficult right now. We have a new Digital Transformation Officer here. She’s fantastic; I talk with her every two to three weeks. She is super interested in bringing clinicians — especially nurses — on board. I think the hard part is that there’s a protective mechanism from nurse leadership right now because they know that nurses are over-burdened. We have this ridiculous burnout problem, and we haven’t really figured out how to even make a dent in it yet. And so, such nurse leaders are very hesitant to give the time of the nurses away, and I think nurses are really struggling overall.

We’re in a not great place at the moment because the way we fix or make a dent in some of the documentation burnout and burden is by having tools that can help support nurses and create efficiencies. The hard part is that we don’t have time right now for them to provide input. It’s a really tricky balance at the moment.

We’ve been having some discussions within the nursing informatics networks around how can we step in. Generally, we’re not at the bedside. We are working at a desk or working at a computer. The challenge is in how we can be the go-between, perhaps rounding on the floors, getting ideas from nurses and bringing that to folks who are doing the design and development or the CIOs who are making decisions. But yes, it’s really tricky time right now.

A win-win for nursing and innovation

Gamble:  It sounds like a catch-22. So I guess the question is where do you go from here?

Tiase:  It is. And then you throw in hospital budgets, which is another challenge. Strangely, I view the hospital budget situation as somewhat favorable to design and development. It makes me think of like 15 years ago when we were in the same boat where we couldn’t look at third-party solutions because we couldn’t afford them. And so, we had to do a little more internal development or be creative and come up with new ways to do things.

One idea to alleviate some of the burden — and I know some hospitals are playing around with this — is to give bedside nurses an afternoon away from the bedside every two weeks where they can think about new ideas, talk with IT folks, or participate in brainstorming sessions. That would be a win-win because we then have a way to get those ideas and we give them a little bit of relief at the bedside. At this point, though, there aren’t too many folks willing to take that gamble.

 

“A lot of rich information”

Gamble:  You mentioned the big transformation many organizations went through. I imagine that you’ve been able to draw from your experience as a staff nurse going from paper to electronic and apply that to the current environment.

Tiase:  Yes, 100 percent. And in fact, that’s exactly when I got into informatics. I always say I was at the right place at the right time. When we were getting off of paper, I immediately realized this was going to be huge. This was going to be a game changer. But now we’re starting to get into the documentation burden space. I work on the AMIA 25X5 Task Force, which is focused on reducing documentation burden by 25 percent in 5 years. We’re now approaching 5 years and really haven’t made much progress. We just keep adding to the electronic record without thinking about how to make it more efficient.

‘What about nursing?’

In some ways, I feel like we have now reduced a lot of those efficiencies moving to paper to electronic. We need to think about this with new technologies. It’s very exciting to be at HIMSS and hear all the talk about how we can leverage ambient AI and other technologies. However, when we viewed a demo from a vendor using ambient AI to put physician notes together, I said, ‘that’s great, but what about nursing? What do you have there?’ They said, ‘what do you mean? What can we do with nurses?’ I told them, there’s a lot of rich information. Nurses are in the room with patients and families way more than physicians. They’re having conversations with patients and families. Can you imagine capturing all of that data and being able to very quickly understand the needs for when the patient is discharged and getting all the appropriation done in advance? There are huge efficiencies that could be gained there. In one conversation, a vendor said, ‘oh yes, we’re working on automating the discharge note for the nurse,’ and I said, ‘okay, Epic or any EHR vendor already does that. That’s probably the easiest thing for the nurse. Can you try something harder?’

 

Gamble:  Right. They should be focused on what are the biggest challenges for nurses.

Tiase:  Again, how do we find those care gaps? How do we look for those discussions that happen with the family members and make sure we have all that information as the patient gets discharged so that they don’t come back? they are not coming back? How do we get all those resources in place? It’s having all those external connections and also connecting the clinicians internally, which I think nurses are very skilled at seeing all of the different providers or specialists that might be treating a patient and pulling that story together. So yes, I think there’s a lot that can be done. But we’re at this real inflexion point of figuring out where we go next, because I think it’s going to be very important.

Matching vendors with nurses

One of the other pieces that we’re trying to address at the national level is the fact that we have nurses leaving the bedside. How can we put them in positions where they are still benefitting nursing? Because we don’t want them to leave the profession. They want to leave the bedside, but we don’t have really strong glide paths to put them into positions where they can support nursing.

For instance, something that we’re working on in health IT space is IT vendor management. We need to ask vendors, ‘do you have nurses on your team? Do you have nurses on your board? If the answer is no, let’s think about how we connect you.’ There is a Nurses on Boards Coalition. Let’s get your information and enter it into the system. If we find a nurse that’s interested in this board service and who meets your criteria, let’s get it going. And so, we’re really starting some grassroots efforts to have nurses question vendors and make sure they’re represented.

 

Gamble:  That’s such a good point. I’m glad you brought it up. Because it’s something that might seem obvious but clearly it’s still an issue with nurses being left off of boards and executive teams. It reminds me of burnout — physician burnout has been a big topic, but the awareness with nurses hasn’t been there.

Tiase:  Absolutely. I think the other piece which is equally important is this transfer of burden. To your point, there’s been a hyperfocus on physician burnout, but it’s actually higher with nursing because they’re spending more time in the record than any physician group. Is their burden actually increasing because of this? That balance is going to be quite important.

 

Future of Nursing 2030

Gamble:  Right. I also want to talk about the National Academy of Medicine’s committee, the Future of Nursing 2030, which you’re involved with. Can you talk about that initiative and what you’re doing there?

Tiase:  Sure. It’s quite interesting; the report was commissioned in early 2019, before Covid, which is when I was asked to participate. One exciting part is that they did not have a nurse informaticist or a nursing technology person of any sort on the first report. In the second, they wanted one. I think the first report was envisioned before the iPhone came out; it was a totally different world.

A few comments about the report. One, it’s hyper-focused on health equity. When Robert Wood Johnson brought it to the National Academy of Medicine, it was with the intention that it was not going to be a Future of Nursing Report Part 2. It was going to be how can nurses tackle health equity or, to take that a step further, how nurses are best positioned to impact health equity and lead in this space. That is the common theme throughout the report—nurses are already doing this work and nurses should naturally be leading if we want to make a dent in health equity.

Then of course, Covid happened, and it became more critical to think about health equity. From a technology perspective, interestingly enough, we’re first thinking about whether it would have its own chapter, which is what I was prepared for. But as the committee work progressed, we decided to make sure it was a thread — in hindsight, I’m glad that we got to that point, because we showed how we can use informatics and technology throughout all areas of nursing to create an impact. We talked about everything from how to show nursing value by using our data and information, to how we create a national nursing identifier, which we have for physicians but not for nurses.

We start with some of those chapters and then we get into nursing education, which covers a lot of what we talked about already — how do we infuse more data science into the nursing curriculum? And actually now, in the latest ACN Essentials, all nursing schools will have informatics as a domain as part of their accreditation. That’s so exciting. Hopefully, we’ll get on that path.

Emergency preparedness

A new chapter we added as a result of Covid is emergency preparedness. How do we set up a public health infrastructure that’s supported with data and information? We’re thinking about how we get a public health nurse informaticist together because most of our public health departments do not have a very strong technology infrastructure.

And then it gets into some of the specifics around nurse leadership. We bring forward that piece around nurses in technology companies and we get some of the examples that exist today. Last but certainly not the least is nurse well-being, which is a chapter that I did quite a bit of work on, really thinking about not only freeing up nursing time so they can do some thinking and brainstorming, but on the flipside, make sure we’re managing technological stress. That’s everything from documenting to alarm fatigue, which is still a thing, and also app fatigue.

App fatigue for nurses

What we saw during Covid is that all of these various apps were thrown at nurses with no training, no nothing. I equate it to the same thing as what we did with alarms. It was, let’s throw out a ton of alarms and not think about how it affects nursing workflows, and then it was, let’s throw in a bunch of apps. ‘Here, call the family member using this app or that app. Here’s your new virtual care app,’ and we really did very little training or preparation.

It’s thinking about all of the pieces that need to be tackled in this next decade. It’s called Future of Nursing 2030 so we can get nursing to where we need to be in 2030, in a way that, again, leads to that area of health equity.

 

ChatGPT questions

Gamble:  That’s really interesting.

Tiase:  Fast-forward to now; the newest piece I added is around ChatGPT. That didn’t exist when we wrote the report, but it does now. We have patients and families coming to the bedside asking the nurse questions about ChatGPT—‘how do I use this? What does this mean?’ — and our nurses are not prepared to answer those questions. It’s hard to catch up.

 

Gamble:  It is. On a positive note, I was at ViVE this past year, and it was really encouraging to see the focus on nursing. I really hope that’s the trend going forward. There is a need to talk about issues specific to nursing.

Tiase:  It is, and I should be grateful. But it took some time for ViVE to recognize that they need to bring nurses to the table. But we’re there, and now we have to figure out how to use that platform in the best way possible, and to your point, make sure that continues.

It’s an important space. ViVE is so different from HIMSS because of the focus on start-ups and venture capital. The challenge is how we bring nurses into that earlier and how do we get more nurses in that entrepreneurship space.