Judy Murphy, chief nursing officer for IBM Global Healthcare, is at the forefront of exciting, cutting-edge technologies that will make life easier for patients and practitioners alike. But when she started her nursing career in 1975 on a medical-surgical unit at Aurora Health Care in Milwaukee, Wisconsin, computers were absent from the hospital nursing units, and their use for clinical care was nonexistent.
While working as an assistant head nurse at one of Aurora's hospitals, Murphy became interested in serving as a preceptor for new nurses, which brought her into the in-service education department. It was in that role that she first got a taste of working with information technology (IT).
"We didn't call it IT then, we called it computer systems," she says. Aurora was installing computers on the nursing units for order entry and charging, and Murphy was tasked with training the nurses and unit secretaries. "I dipped my toe in the water," she says, "and I thought, oh, this is interesting-this may change how we do our clinical work."
Eventually, the unit began to use computers for results retrieval as well. It was then Murphy noticed that the way the computers presented laboratory results wasn't helpful to nurses, as they were only presented by date. "You can look at a lab result one day, but anyone who is clinical knows you have to look at that lab value in context, in terms of the test that was done the day before, so you can evaluate trends." When she explained this to the computer department, it was a "revelation" to them, she says. "It started me thinking that as we automate processes, we need to do it in a way that's logical to the people using them."
Murphy thought it would be helpful to have a person who could act as a liaison between the computer programmers and the clinical staff. And in 1982, when Aurora started merging hospitals, and computer departments as well, that role was created. Murphy moved into the computer services department, which had a team of 30, as a clinical systems analyst. In 2011, when she left Aurora, the department had grown to 750 and the position she vacated was vice president responsible for electronic health record (EHR) applications.
THE RISE OF EHRs
While EHRs and mobile devices are now commonplace, in the late '80s and early '90s they were nonexistent. There was no World Wide Web, Wi-Fi, Windows, or even a mouse. Batteries weren't as powerful as they are now, so having a movable terminal was next to impossible. "We had cords coming out of the ceiling," Murphy says. "You could move a terminal only 10 feet in any direction, and it weighed over 100 pounds." Eventually Windows, the Internet, PCs, and laptops emerged, and in the mid-'90s EHRs as we know them were developed.
When asked if nurses were initially resistant to these systems, Murphy says that in general people were excited, especially because of the "anytime, anywhere access." But still there was apprehension. "We were rolling this out in the '90s, and people didn't have PCs at home. They were learning how to use Windows and to navigate a computer at work, so there was a big learning curve." And nurses were afraid to use this technology in front of patients. "Nurses worried that the computer would get between them and their patients. But over the years, as the technology and hardware changed and computers got smaller and more portable, the role they played as a barrier between nurses and patients changed as well."
While EHR technology has greatly improved, Murphy says many nurses feel there is still a burden of documentation they wish could be lifted. "We kept adding on to what needed to be documented and we never stopped to ask if we needed all this," she says. "We have to figure out what we need to do from an evidence-based standpoint, then document from an evidence-based standpoint, and then simplify the documentation."
Making sure the "nursing narrative" or "patient story" isn't lost among the drop-down menus and multiple screens is another future EHR improvement. The solution, Murphy says, could involve cognitive computing, which can pull information from both structured and unstructured dictated notes, using natural language processing.
NEW HORIZONS
As Murphy became known nationally as a pioneer in nursing informatics, her reputation became a stepping-stone to her next job. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act, created to stimulate the adoption of EHRs, was signed into law by President Obama as part of the American Recovery and Reinvestment Act. The HITECH Act gave the Office of the National Coordinator for Health Information Technology (ONC) the authority to manage and set standards for this EHR stimulus program. The ONC formed two advisory committees, and Murphy was one of two nurses nominated to be on one of the committees, which involved monthly meetings. These committees helped to define the criteria and standards for the definition of "meaningful use" and the distribution of the incentives for adoption of EHRs. Eventually, Murphy was hired as deputy national coordinator for programs and policy for the ONC, during which time she helped administer the "meaningful use" program, under which health care providers would be offered financial incentives for demonstrating meaningful use of EHRs.
During her third year in that position, Murphy learned of an opportunity at IBM; and in 2014 she took a role created for her, her current role at IBM Global Healthcare, where she helps other health systems improve their IT solutions and care coordination programs. "I was really excited about telehealth, medical device interoperability, and wearables, and IBM seemed like a good match," she says.
In her role, Murphy doesn't work only with nurses but with all aspects of health care. "I help put together the right sets of solutions for our health care providers. This includes training, consulting, and visits to clients to talk about how our solutions can help them achieve certain health goals."
One type of solution Murphy described are mobile applications to help providers and to augment the technology health organizations already have. For example, let's say clinicians are getting alerts every time new laboratory results come in, flooding them with a constant stream of information they may not have time to look at during their workday. Murphy is helping to develop an application that uses natural language processing to read these alerts, determine which are critical, and pass through only those, saving the others in a queue for later, a kind of digital triage.
IBM is also creating solutions for patients. One is to integrate a patient portal, where patients can access their health and test results, with a patient's wearable device. Another, in partnership with Medtronics, is an application that monitors a patient's insulin pump, showing the patient when the pump is giving insulin. "If the patient tracks his food, or takes pictures of his food and uploads that information," says Murphy, "the pump can predict when a problem might occur with the patient's food-insulin load."
Another IBM initiative is a Cognitive Call Center. When a patient has a question, she or he can call this center, which uses natural language processing and understands both words and sentiments. The system can then route the patient to a person (a nurse or physician) or simply to an answer, such as information on insurance coverage. "When things are easy to do, we tend to do them more often," Murphy says. "This way of integrating health and wellness into our lives feeds into population management, and will improve the health and wellness of all of us as a country."
NURSES' UNIQUE ROLE
Technology plays a prominent role in the future of health care and population health management, but so does nursing, says Murphy. "There's a lot of us-more than 3 million-and on top of that we are the most trusted health professional. We can help with this transition from an illness-transaction-oriented model to a wellness-health-oriented model." This means patients don't only go to a health care provider when they have a problem, but instead that health care and wellness checks are integrated into our everyday lives. "Nurses are uniquely positioned to share that story and to help change that culture," she says, stressing that we need to lower the costs of health care. "All of us need to get health care and stay away from expensive procedures-pick up on the cancer earlier, pick up on the chronic disease earlier, manage it, prevent it from happening in the first place if we can. This is the power we have and we are just starting to realize it."-Amy M. Collins, managing editor