March 3, 2021

Episode 47: The role of nurses as healthcare goes digital

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Description

For nurses with a passion for technology, the time has never been better to explore non-traditional career opportunities. Early in her career, our guest for this episode, Molly McCarthy, did exactly that -- stepping away from the beside to pursue her passion in medical device design and health technology. After stints at Philips and Natus, she landed at Microsoft, where she served as the Chief Nursing Officer for six years, and now leads a team that drives digital innovation for health provider and payor organizations.

In her conversation with Dr. Nurse Dan, Molly explores the ways that nurses can get involved as healthcare delivery becomes more and more digital, as well as how Microsoft is working to get more nurses involved in its design process for initiatives related to the vaccine roll out and virtual care.

Links to recommended reading:

Podcast

Transcript

Dan:
Molly, welcome to the show.

Molly:
It's great to be here, Dan. Thanks so much for having me.

Dan:
Would love to hear what you've been up to. I know you've had a role change within Microsoft, and would just love to hear what you're focused on at the moment.

Molly:
Where I've been the past, I would say year, is obviously heavily focused on COVID response and management over the past 12 months, but also really thinking about, right now, vaccine management and distribution. You had asked about my role change and just a little bit of background. I started my career in pediatrics and NICU. I've been in tech for quite some time, with Microsoft for seven and a half years. And really spent most of my time on the industry team focused on helping our sellers and business groups really understand the healthcare market. And that role really includes educating them internally, as well as influence in the markets, so speaking and writing. I'm working on a book chapter right now on virtual health, and then accelerating our customer's transformation.

Molly:
So spent many years doing that. And more recently, as of August, September, I took over management of the team. So I work with a team of subject matter experts who all have either a clinical or some type of healthcare background. I actually have four nurses on the team, a couple of physicians, former hospital administrators, former CIOs, so incredibly seasoned team. We're actually in the process of adding up all of our years of experience. I just need to make that final calculation. So very well seasoned group and I get the honor to lead them as we continue to evolve our industry team at Microsoft to really help providers and health plans make the transformation with technology.

Dan:
I love that. I love that, as a nurse, you're leading that. I've seen trends in other tech companies where they default directly to the physician colleagues, which have a great view as well, but I think there's something special about a nurse that kind of sees the entire complexity of the system and has to coordinate that as their daily work, being able to help educate and fix the system. I love that that's a role and a focus for you.

Molly:
Yeah, and I think it definitely is a challenge. I think too, as we think about the whole healthcare team, the physician, the nurse, even thinking about the other team members, social work, home health care, et cetera, it's really important to, as we start to broaden our perspective, really be more inclusive of who we're including in that technology design and development process.

Molly:
I've actually been recently speaking with a speech pathologist over in the UK who's done a lot of work in this particular area, digital health for patients, and really thinking about how can we bring along the entire group of healthcare workers. I just recently learned that in addition to year of the nurse in 2020, this year is year of health and the care worker. So really expanding our focus here at Microsoft to be more inclusive of the entire team member. Obviously right now, with vaccine management, thinking about pharmacy and quite frankly, employers, the HR and occupational health.

Dan:
Yeah, no. I think that's a great focus too. The team is definitely how care is going to be delivered and is delivered now, but in the future as well, because it's so complex. Not one profession can actually handle all the complexities and information to provide that care or even manage the system. So I think it really is that team approach.

Dan:
And that was something I was passionate about when I was at Kaiser and helped build their med school. That's what I focused on. How do you train them from day one as brand new nurse, brand new medical student? How do you work with teams? I don't think that was really done well in the past and now it's really now a focus. It's part of accreditation and I think that's just going to be to the benefit of the entire healthcare system.

Molly:
I agree with you a hundred percent. Not just that team approach. You can't expect, when you're teaching in a siloed environment, whether it's a pharmacist, a nurse, a physician, just to throw them into the workplace and automatically understand what it means to be part of a team. I always talk about my experience in business school. Everything we did, for better or for worse, it was a group project, a team event, et cetera, to the point where I'm like, "Ah,." It gets frustrating after a while, but that's the real world, especially in healthcare and especially now.

Molly:
And adding in complexities to that team, the patient, the family, just everyone surrounding that patient. That said, I still think that nurses are the best position on that healthcare team, if I can be biased here, to really advocate for that patient and to ensure that as we move them throughout the system, the continuum of care, that they can really continue to be the advocate for the patient.

Dan:
Yeah, yeah, totally agree. We were talking about virtual care as well and virtual health, digital health. How are things evolving in that space? Now COVID kind of catalyzed us into at least telemedicine a little bit faster than what was happening before. I know there's a lot of digital health tools coming out, but one of the places I see potentially maybe a gap, and would love your perspective on this, is a lot of them don't leverage the skillset of nurses I think. In telemedicine, it's very much the provider, the nurse practitioner, doing the visits. But that registered nurse has a role in using some of that telehealth as well, maybe in home assessments or education or medication teaching or whatever. I would love to hear your perspective on the landscape of virtual health and where nurses might play a role.

Molly:
So just to level set. When I hear all of those wonderful terms that you just used, I always like to make sure that we're speaking the same language. When I personally think about virtual health, I really think about many different things, and I think that's an important conversation even just to have with who are you talking with; the patient, the family, healthcare workers. It's really an umbrella term and if you look at some of the different definitions out there, it's I think really a couple of different things.

Molly:
One is those synchronous virtual visits that you might have with your provider or your nurse practitioner. It could be after you have the vaccine a nurse is doing a virtual visit with you to see if there are any adverse effects. That's going on right now. There's also the asynchronous communication that takes place, for example, through a portal, through a push through a text. There's remote monitoring that encompasses not just what happens at home, but also we've seen so much remote monitoring going on in hospitals, especially in light of COVID, with patients in isolation and having to perhaps not go into the room as much as you could in the past. And then just thinking about digital therapeutics.

Molly:
So it's very encompassing, but to your question of where nurses fit into this and where I really think the opportunity is, there really is a ton of opportunity here. One is that first piece that we talked about, remote patient monitoring. I know I worked in actually physiological patient monitoring and clinical informatics prior to Microsoft, I worked with Phillips. I did a lot of work setting up a remote command center. I mean, that's definitely something that exists out there today. I recently was at a children's hospital doing that in a CICU, but that's an area, thinking about remote patient monitoring for nurses either in the hospital, or quite frankly, from a population health standpoint, thinking about how nurses can work doing remote patient monitoring for patients in home.

Molly:
So for example, if you have a patient who has a chronic condition like diabetes or congestive heart failure, those measurements, those diagnostics, those vital signs coming in from that patient into perhaps a dashboard or some type of data aggregation, and it's presented to a nurse in a dashboard format so he or she can make decisions about, okay, that patient they're doing fine. They don't need to be seen for two weeks. Their weight is fine, their sugars are okay. Or even just doing a virtual visit with them instead of bringing them in, saving them time, saving the system money. So I really think that remote patient monitoring, regardless of where the patient is, or quite frankly, regardless of where that healthcare worker is, is a huge opportunity for growth. And thinking about that from a home health perspective.

Dan:
Where do you think the biggest opportunity is for nurses to play a bigger role in the virtual health landscape? Whether that's through digital health or command centers or telehealth or video visits or whatever. Where do you think nursing has the biggest opportunity?

Molly:
Well, I think about it in a couple of different ways. One is obviously how those systems are designed. And that's really how I got my start in technology. Going into a medical device company and working with the software and hardware engineers, as well as the clinical end users to create specifications for, for example, graphical user interface that the nurse or physician would look at for a specific device. I would say that the first opportunity is in the design from a product perspective. Having nurses as product managers.

Molly:
The second really is thinking about the development in terms of clinical trials and thinking about user experiences and feedback, working directly with hospitals. So for example, in a clinical role with some of these organizations or companies. And then the last more so is where we've traditionally been, and that's the deployment. Making these technologies work, whether you're in the home setting, the hospital setting.

Molly:
But I would like to see more nurses involved in that first part that I talked about, the design and the development. Not that we need to go out and become coders, but we need to be at the table in the conversations, directing and providing feedback on clinical workflows, patient experience, et cetera, so that the solutions that are proposed or even brought to market make sense for the clinical users and the patients.

Dan:
That's a great point. And that was something that I found really interesting when I was working in the innovation space. We'd meet with big and small companies all over the place and look at proof of concepts and pilots and evaluate technology. The assumptions made about clinical workflows were sometimes so off-base, and non-factual. That minute you get a nurse or a care provider in the room to start talking to it, they're like, "Oh, I had no idea that nuance or that little thing." So I think you're right. It's really important to have those clinical eyes on it.

Dan:
Again, they don't have to code the software. They just have to be able to translate the workflow into language that the engineers can then take and build into effective flows and that kind of stuff. One of our software engineers is a nurse.

Molly:
Oh, that's wonderful.

Dan:
She's a past NICU nurse, I think. Now she's one of our software engineers, which is the coolest thing. So it's great to have her know both sides and be able to put it in there.

Molly:
Yeah. That's an interesting point because you think, as a nurse, it's like, "Okay, you're educated for a specific role, et cetera," but there's so many skills and attributes of many different nurses and interests, quite frankly, for the profession. There's so many different ways you can go. But there are also so many skills that are transferable. Like you just talked about the NICU nurse working with the software engineer.

Molly:
One of the core pieces of design and development is communication and collaboration and being an advocate. And that is something that, for nurses, is a skill that can be transferred to so many different areas aside from bedside nursing. For example, I started out as a product manager. I was interfacing, like I mentioned before, with clinical users, with regulatory, with software, with hardware, and really being an advocate for the product I was representing almost as similar to as a nurse advocating for that patient. So there are many skills that are transferable. So that's really great to hear about your software engineer.

Dan:
Yeah. I mean, even our head of social media right now is a nurse too, so there's all kinds of different roles. We had an event recently where we talked about what are the non-traditional roles in healthcare and we had a number of maybe newer nurses or nurses that feel like they're in this track of patient care as the only way to express your nursing expertise and we opened their eyes. We mentioned your role at Microsoft, we mentioned Kristi Henderson who was at Amazon, now is that Optum and these interesting places that a lot of nurses have no exposure to. One of the questions that we got, and I would love your perspective, is if you're an ER nurse and you've got two, three, five years of experience, how do you even break into one of those non-traditional tech based roles?

Molly:
That's a really good question and I get that a lot, just people curious. One thing is you have to think about what gets you up every day as a nurse and what stimulates you, what keeps you curious. For me, it was tech and really asking, I have no experience, but I'll try that. Taking risk.

Molly:
But I think to answer your question about how do people get involved, think about the technology that's in your world that you're using. How do you interface, for example, with the different companies? When I was a pediatric nurse, I worked in cardiology and we used Hewlett Packard physiologic monitor. Well. Hewlett Packard became Phillips and lo and behold, 10 years later, I found myself working at Phillips. So look around in your environment. Who are you talking with? What technology are you using? But also look outside of the traditional space.

Molly:
We kicked off something in 2020 called the nurse hack for health. And the goal really is to do just that. It's to expose nurses at all levels, from bedside to the boardroom, to technology and to the process of solutioning alongside developers. So again, we're not asking nurses to be coders or to be deeply technical, but to come in with open minds and work together to hack over a weekend. We did this both in May and November this past year, and we did in partnership with Sonsiel, which is a nursing innovation group and Johnson and Johnson, and then a developer group called DevUp, and really expose these nurses to different technologies. Obviously we're Microsoft so we actually did the hackathon on Microsoft teams and used Azure and GitHub so it's open source, meaning anyone can go and take that idea and continue to build on it.

Molly:
We want nurses to understand that what they bring to the table is so important, especially in the pandemic. So specifically we were looking to address different pandemic problems within the first one. It was actually nursing, handoff, transfer and huddle. We were looking at remote patient monitoring in and out of the hospital, and there were some other areas too, but I'll send you all out to read more about that.

Molly:
And then for this past one, we were looking at, in November, more around vaccine management and really getting education information out, to your point, around social media. That's a huge area where we need right now to ensure that the information being provided is trusted. I think nurses, quite frankly, we're the perfect group to be relaying that information.

Dan:
Yeah, yeah. For sure. I think, yeah. I mean, again, we're voted for what? The 18th year in a row, as the most trusted profession again. I loved your advice about just start with what's around you. The monitors, you can get on committees and meet with those vendors. They come to the hospital a lot and so you can be a part of that. Maybe it's part of a shared governance thing.

Dan:
I remember how I got started was I was that nurse that was the first one to bring in the PalmPilot III and use Epocrates on it to look up drugs. People were like, "Oh, wait, I don't have to carry around this big book and do that." I was like, "No. This thing's great." And then into patient simulation and trying to figure out that kind of stuff. But yeah, I mean, it is really just kind of small. There wasn't a formal education track that I took to do that initially. And your interests can lead to really cool things like you mentioned.

Dan:
I love the hackathon piece too. So I'd love to learn more about that too. So we did a lot of hackathons at Kaiser as well and found some good value. What are some of the tangible things that spun out of it over the last couple events that you've had?

Molly:
A couple of things have come out of it. So the first hackathon really came to fruition in a very quick time period. Microsoft, going into year of the nurse, a midwife wanted to support nurses and elevate their voice and we're thinking about different ways. And have a hackathon was one of them and was already in talks with J & J about supporting the one in person later in the year. And then boom, COVID hit and we were literally meeting every day for about four to six weeks and launched the first nurse hack with the goal of bringing nurses to the table to produce solutions, what we would call a minimum viable product, so that others could take it and actually launch it, either as a business, or quite frankly, just as a solution for these nurses or health systems looking for ways to help nurses.

Molly:
I'll give you an example. For the second hackathon that we did, there were a couple of different solutions that really kind of stood out. One was an organization started by a nurse. Actually, she was a nurse who worked for Kaiser in Southern California. It's called Hello Harmony, and it was inspired by her daughter's suicide a few years ago, but really thinking about increasing rates of suicide during the pandemic. It was a proposed text bot that would allow young people to interact with a virtual friend through gamification addressing feelings of loneliness, shame, depression, fear. And that, to me, I actually did a podcast with Chris, was something that I think hit home for so many people on that call. Just because aside from their day jobs, just looking at their community and understanding the impact of COVID and the social isolation for teens, for seniors, for everyone, really.

Molly:
The other solution that stood out to me, and this is probably because of my NICU and [inaudible 00:20:45] background, but was a solution called for moms for health. It was a mobile pregnancy app aimed at decreasing complication risks and the mortality rate among vulnerable and underserved populations. There were some other great use cases too, thinking about artificial intelligence and some of the health bots.

Molly:
We've done a lot this past year with health bots. So for example, Microsoft, we created a coronavirus self-assessment checker that actually the CDC uses. But one group created a chat bot called nurse J and it was really to equip users with nonjudgmental and evidence-based responses to battle COVID-19 social media disinformation.

Dan:
Oh, I love that.

Molly:
Yeah. So that's just bringing it, circling around back to your idea.

Dan:
Yeah, that is awesome and those are great. Yeah, and I know [Chris Racinos 00:21:35] really well and did podcasts with her several months ago too. That's just another great example of a life experience that you can translate into something tangible, whether it's a business, an app, or an idea that you can get out there in the world. I think that's just another way to break in. It doesn't always have to be technology either. It could be a life experience that you want to solve for and you can bring people together to solve it, over a weekend sometimes, which is kind of a neat thing.

Molly:
Yeah. The other thing that I wanted to mention that I was starting to think about but, of course, got sidetracked in talking, but I think what we started off in May and where we ended up with November, it expanded and it will continue to expand. I actually hired a new chief nursing officer, [Kelly Rodkey 00:22:19]. She's taking it over. We're already planning for the next one, which is May 14th to 16th, and thinking about some of the solution areas. We've learned a lot and basing the next one on our learnings.

Molly:
But one of the learnings was to your question earlier, how can we get more nurses involved? I've done some guest lecturing in undergraduate programs and graduate programs on technology and it always amazes me and scares me what people don't know that they know. There's just a lack of education in our nursing programs around technology. So this past time we actually strategically invited different nursing schools and deans from around the country and had students come in and actually receive clinical credit for participating over the weekend.

Molly:
So our goal really is to continue to nurture our future nurses with exposure to these types of events and really build their confidence as we continue to see different paths for nurses. Again, you were mentioning before what your path was when you were a nurse, way back when it was essentially you got to get that one year of clinical experience in the hospital or it's not worth it. And I did have a couple of years of clinical work and then it was like, "Okay, well, you got to go and further your education." So now you have two choices; management or academia. I want people who are listening today just to realize that there are so many options. Follow your passion, follow what you're curious about, investigate, be a learn at all.

Dan:
Yep. I love that and I try and make that point as much as possible, which is there are multiple ways to grow your career in nursing, and it doesn't have to be charge nurse, manager, director, chief nurse if that's not what you're passionate about. In my own career, I've done everything but management. I've done the innovation technology stuff, I've done the education stuff, the academia stuff, I've done research stuff, I've done tech startup stuff. There's no right way to do it. It's really just finding what you're excited about and doing it.

Dan:
I think there's another good point that you made, which was nursing schools need to embed this technology understanding, and at least exposure, better into their curricula. And so I love that Microsoft took the initiative to bring students in and expose them to what's possible out there because that is definitely something. And I spoke at American Association College of Nursing in December about it, that nursing school is missing the technology boat a little bit and we can do more to embed technology as core.

Dan:
One of the ideas I proposed was what if you taught health assessment where you did the physical assessment, and then you took them in a room and you did it through video, and then you took them in a room and you did it through email, and then you did it through text, and then you did it... You could teach health assessment across all those modalities. Then when the student's out in the world, they can choose what information is relevant, how do they get it, what technology they use to get it. That would be just a really interesting way to embed it in something we're already doing. So I'm hoping that's where we move to.

Molly:
Yeah. I was going to talk a little bit about ambient clinical intelligence earlier, but I think I was going off on my remote patient monitoring when you talked about when we looked at opportunities. But to your point, we're working right now on an intelligent scribe and it's actually out in the market and in use. But I can be with a patient and I can be sitting there, I can be doing a physical assessment and I can be talking and someone's recording it. I don't have to sit there and chart or type everything into the computer and divert my attention away from the patient. So that's another area, and those are really good points because a couple things. One, people learn in different ways, so what works for them. And then people receive information and ingest information in different ways as well.

Dan:
Yeah, totally agree. I wanted to hit on one other topic that you mentioned at the very beginning, which was around the vaccine distribution. So I'd love to hear what your perspective is there, how Microsoft might be helping and what nurses role can play in getting this lifesaving opportunity out to the world.

Molly:
Yeah, so that's a really good question. I actually was just on a call with the CDC earlier today thinking about the whole process from vaccine management, tracking, follow up, et cetera. Especially thinking about our vulnerable populations. Obviously nurses are so well positioned for so many different aspects of this.

Molly:
So we actually, at Microsoft, have done a ton with the COVID-19. I think I talked about that earlier. But also thinking about the vaccine management and administration. We have a couple of different solutions that we are working on right now, both at the state and local government level, but then also at the individual hospital and health system level. The challenge of course, is that each state has different requirements, even down to the county or the city level. So there's no national directive right now in terms of the process. That possibly could change within the next seven days, eight days with a new administration. But really thinking about from that digital front door, all the way to that follow-up virtual visit.

Molly:
We actually got a call last week from a city asking us... We had to hire X number of employees or X number of contract employees, which is great for employment, that are specifically just calling people to see if they've had a reaction after the first dose or the second dose of the vaccination. And it's an incredibly manual and inefficient process. How can you help us with that? And so that's an area where thinking about obviously working to the top of your license, do you need to be dialing up people? How can we better do that assessment through technology, whether through a bot or having that questionnaire go out, et cetera. And then essentially aggregating that data and having their nurses look through the data. That's another incredible opportunity for nurses is just data and analytics.

Dan:
Yeah. We could probably spend a whole podcast just talking about opportunities there, but even the volunteer workforce and leveraging technology that you have access to like LinkedIn and pinging nurses on LinkedIn for possible vaccine administration roles that are popping up and those types of things. I think there's a whole lot of efficiencies that probably can be gained through different systems that, right now, seem to be, at least when I signed up a couple of days ago to the California Medical Corps, was very much a Google form kind of thing, or an Excel form that goes into some black box that someone manually has to do. And I know there's better processes there, so it's exciting that you're starting to break into that and get people a little bit more efficient because it's going to be needed as this continues to roll out nationwide.

Molly:
I think if you think about the whole vaccination process flow, just there's a point along that continuum for the nurse, whether it's part of that digital front door in terms of consent and scheduling or patient prioritization. How do I know if it's my turn for a vaccination and where can I go to ask? Just the scheduling, the reminders, the actual dose, the first dose, and then the check-in in between, and then that second dose. That's critical too as well, that second dose. How does all that information... Where does it go? How are we tracking that?

Molly:
We did just announced this morning a vaccination consortium with some other major tech companies. And it's so new I'm going to blank on the name, but essentially certifying that the vaccinations have happened. That's an area too, that we know is much needed because you won't possibly be able to fly. You might not be able to go to school, et cetera. So that's another area, school nurses.

Dan:
I was thinking about that today. You get that little paper card when you get the vaccine and that's not a really efficient way to track it.

Molly:
No, it's not. [crosstalk 00:30:37].

Dan:
There's lots of opportunity there.

Molly:
I remember the yellow card from when I was a child that kept all my vaccinations. Just the fact that every year, for my kids even, I have to get that form filled out for their physical. It's like, "Again?" Twenty-five dollars every year. It's got to be more efficient.

Dan:
There's got to be a better way. Well, Molly, thanks so much for being on the show. This has been awesome. One of the things we like to end off is that one nugget that you'd like to pass on to our listeners. So what would you like to hand off to The Handoff listeners today?

Molly:
I would just encourage everybody, as I mentioned before, to follow your passion and be a pioneer. If there's a position or an idea that hasn't been pursued or talked about before, don't be afraid to put it forward. I think many of the roles in nursing that have been created outside of the traditional roles were started by people who were curious or interested in taking that path less traveled. So be a pioneer.

Dan:
I love it. That's a great segment to end on. Molly, thanks so much for being on the show. We'll put your contact and LinkedIn information into the show notes, as well as some of the topics we talked about. Just really appreciate your time today.

Molly:
No, my pleasure. Thank you so much, Dan. And here's to a happy and healthy 2021.

Dan:
Thank you so much for tuning in to The Handoff. If you liked what you heard today, please consider leaving us a review and subscribing on Apple podcasts or wherever you listen to podcasts. For more information about Trusted, please visit trustedhealth.com. This is doctor nurse, Dan. See you next time.

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