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CNO Leadership in Digital Health

A decade ago, healthcare as a business existed mainly on paper. Then, paper charts gave way to EMRs, followed soon after by a shift from paper-and-pencil scheduling to nurse scheduling software that puts the convenience of a staff self-scheduling app right in the clinician’s pocket. Similarly, the refrain from consumers on managing their health seems to be, “There’s an app for that!”

Today, COVID-19 has presented new challenges for healthcare operators, and 81% percent of CFOs and senior leaders said there is an immediate need for digital transformation for long-term survival of their healthcare organizations. CNOs must partner with CIOs and play a vital role in the expansion of digital health. But what is that role? And what does “digital health” actually mean?

What is Digital Health, Anyway?

Defining the term “digital health” has become a bone of contention for those actively involved in the research and development of healthcare software. Attendees at the J.P. Morgan Healthcare Conference in January, 2020, expressed concern about the lack of a clear definition for the “over-hyped” term “digital health.” Does it mean enterprise-level clinical decision tools? Does it mean a wellness app anyone can download to their cell phone?

Determining the parameters of “digital health” matters because, on the one hand, physicians and medical students say they want to embrace data and technology tools to improve their practice, but on the other hand, clinicians at the J.P. Morgan conference said they worry about recommending unproven – and in some cases, even untested – software apps to their patients.

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Fortunately, CNOs and other executives in healthcare organizations don’t need to wait for the digital health industry to set its own definitions. The FDA already defines digital health as “…categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine.” The agency goes on to name “[technologies] from mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning” in its interpretation of the term “digital health.”

Using this definition, then, what role can CNOs play? Because digital health involves technology, you might think the responsibility for evaluating and deploying these tools lies with your IT department. But CNOs actually play a vital role in directing the development of any digital health apps, medical devices, or tools used in the organization.

Ensuring Patient Privacy

Clinicians and healthcare executives may take for granted that any digital tool they’re deploying complies with patient privacy regulations, but consumers themselves aren’t so sure about that. A 2019 chatbot study revealed that many healthcare users expressed concern about whether or not the apps being tested in the study were HIPAA compliant. They especially doubted the privacy of their personal health information when entering it into apps created by unknown brands or those that contained spelling errors.

Medical devices also continue to exhibit vulnerability to exposing patient PHI. Not only can software-driven devices be hacked by bad actors, but routine tasks like migrating data from one vendor server to another can unmask private patient data to the world.

As CNO, you play a crucial role in ensuring that any digital medical devices or other health tools adopted by your organization comply with HIPAA and that you have protocols in place to cope with any PHI exposure by your own organization or a vendor.

In addition to privacy concerns, patients also sometimes voice their skepticism regarding the accuracy of information provided to them by digital health tools like apps and chatbots. This is another area where CNOs can play a role.

Setting Standards for Sharing Health and Wellness Information

Some chatbots in use right now interact with patients to assess symptoms and offer a potential course of treatment. For example, if a person interacts with a chatbot and describes the symptoms of a sprained ankle, the chatbot might “diagnose” this injury and offer the patient a link to a web page that outlines the RICE protocol for self-care.

However, the chatbot survey referenced above noted that consumers often felt skeptical about the information and links chatbots provided. As a CNO, you can see this skepticism as an opportunity to cement your health system’s reputation in the community as a trusted source of health and wellness information.

One way to accomplish this is to develop evidence-based standards and policies for linking to external sources. Perhaps you restrict linking only to government websites, like the NIH. Or maybe you broaden the field to include professional medical associations, like the American Academy of Orthopaedic Surgeons’ website. Alternatively, you can develop your own health and wellness content, host it on your health system’s website and link only to those resources.

In addition to setting standards for external linking, you also must be deeply involved in directing the workflows your organization’s chatbots or other digital health tools like automated patient texting programs adhere to.


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Directing Digital Health Workflows

Many healthcare systems today use automated texting or chatbots to deliver crucial patient information. Simple texting programs might offer a link to click to confirm or reschedule an appointment, but chatbots may be used to deliver more complex, interactive information like pre- and post-op patient instructions.

That can become somewhat complicated, because any nurse who’s ever worked with a surgeon knows that each one has developed her own unique protocols for patients to follow. When you deploy a chatbot for this type of service, you’ll need to be able to script the customized information to be delivered, based on input from the physician, nurse or other clinician whose patients will be affected. You’ll also need to determine pathways for the patient’s interaction with the instructions, such as providing one pathway with a link the patient can click to acknowledge they’ve followed the protocol and a different pathway with a button they can click to signal they have a question. CNOs can play a key role in this process by creating work groups that map out the precise workflows these chatbots follow.

And the situation will become even more complex as chatbots adapt more fully to artificial learning. Some chatbots already possess the capability to delve into an individual patient’s medical record and correlate existing data with new symptoms and then direct the patient to take a specific action, such as calling for an appointment. As CNO, you absolutely must be involved in directing the flow of these steps in order to protect patient safety. At what point should a patient’s interaction with a chatbot be escalated to a nurse line, for a conversation with a human being? At what point should the chatbot recommend dialing 911?

These decisions obviously are crucial for delivering the best patient care. But let’s not discount the liability aspect, either. No one wants to read about a patient who experienced a dire outcome because a chatbot recommended drinking more fluids instead of calling an ambulance.

Curating Health and Wellness Apps

Beyond enterprise-level digital health tools, a vast sea of health and wellness apps are available to anyone who wants to download them to a smartphone or tablet. And people increasingly are adopting these apps – for everything from counting their daily steps to managing their medications to charting their fertility. These apps can be developed by anyone who knows how to program software, regardless of whether or not they have any healthcare background. So, how can your clinicians know which of these apps actually pass medical muster, and which deliver information that might be described as questionable, at best?

According to NBC News coverage, at the J.P. Morgan conference current AMA CEO John Madara “called for better curation of these apps so that doctors know whether they can recommend these new technologies to their patients.” Madara no doubt was referring to curation by the digital health industry, as a whole, but CNOs can establish standards and guidelines at the institutional level to help your clinicians know which apps to recommend to patients – and which to avoid.

The task may not even be as large as it sounds. A working group of physicians, nurses, pharmacists and others likely could quickly develop a list of apps that appear to provide evidence-based medical information to patients. After identifying a handful of such apps, each one could be further evaluated to ensure it could benefit patient health and wellness.

Not only might your doctors and other clinicians appreciate having a curated list of apps to refer to, but your patient community might like it, as well.


With a CNO’s Involvement, Digital Health can Benefit Both Patients and Organizations

Digital tools of all kinds will only continue to expand in number and scope, bringing great change to healthcare organizations. CNOs must play a vital role in determining which types of tools will best serve patients and health systems, as well as ensuring such tools safeguard patient privacy and enhance patient care instead of detracting from it.

While virtual health and telemedicine are high on many organizations’ lists, ShiftWizard represents another essential investment in digital technology. ShiftWizard has consistently helped health systems and hospitals operate more efficiently and has better positioned them to navigate COVID-19. Reduced scheduling time and dynamic shift monitoring restores precious hours to your nurse managers and minimizes burnout and OT. And ShiftWizard’s powerful communication center improves accountability, teamwork, and results.

Contact us today for a demonstration of how ShiftWizard nurse scheduling software can benefit your hospital or health system.

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