THE BEST OF THE BEST...FOR THE FUTURE OF HEALTHCARE

Transcription

1 THE HONEYBEE CHRONICLES: PART SIX THE BEST OF THE BEST...FOR THE FUTURE OF HEALTHCARE A conversation with Heather Ross, Instructor, ASU College of Nursing and Health Innovation By Claire Topal, Senior Research Consultant, Center for Sustainable Health Heather Ross is a Clinical Instructor for ASU s College of Nursing and Health Innovation. She is also pursuing her PhD in the Human and Social Dimensions of Science and Technology at ASU. She is also a Nurse Practitioner at Arizona Arrhythmia Consultants, and a Member of and volunteer for the Heart Rhythm Society. She plays several key roles in Project HoneyBee, including recruiting and managing the project s graduate research assistants, serving on the project s Waggle Committee, and running two Observational Clinical Trials. If you ve seen the movie Top Gun, you ll remember Commander Mike Viper Metcalf s speech to new students. That s the way I imagine Heather Ross approaching the graduate research assistants she recruits and manages for Project HoneyBee: You are the top 1 percent of all nurses. The best of the best. Project HoneyBee will make you better. To say that Heather is passionate about her work is like saying Pele was a good soccer player. She walks the walk. She is a clinician, a mentor and teacher, a PhD student, a writer, and she engages regularly with policymakers on Capitol Hill. Many things drive her to do more every day than many people manage to accomplish in a year. I talked to her about three of them the unique perspective of nurses; ensuring that innovative new healthcare technologies empower patients; and interprofessional healthcare education and where they come together: through Project HoneyBee, in which Heather plays several roles. Heather Ross (center) with Sharon Cooper and James Hetrick from Arizona Arrhythmia Consultants, looking at the AliveCor heart monitor. Super GRAs: Hands-on clinical research from day 1 All the graduate research assistants (GRAs) involved in Project HoneyBee are Doctor of Nursing Practice (DNP) students at ASU. Heather worked with HoneyBee staff to hand-pick the best of the best, invited them HONEYBEE CHRONICLES 1

2 for interviews, and then carefully matched each GRA to principal investigators of Project HoneyBee s Observational Clinical Trials (OCTs), which the Center for Sustainable Health at ASU s Biodesign Institute oversees within various local and national healthcare systems. These trials test the utility of commercial wearable devices for monitoring ambulatory patients. Disease areas include heart disease, COPD, atrial fibrillation, patient mobility, gait monitoring in hydrocephalus, and feasibility in diabetes patients. This GRA role for Project HoneyBee is no ordinary graduate student gig. All GRAs already have experience in the clinic; they are registered nurses who are in a doctoral program to become nurse practitioners. They obliterate any presumption about student researchers as paper-pushers. Each GRA has a comprehensive understanding of today s complex, interconnected healthcare system, and they understand patients better than many healthcare practitioners. Our graduate researchers are doing hands-on clinical research from day one, Heather noted. We provide the basic protocol, and the GRAs work with the PIs to go through the IRB process, recruit and follow study subjects all the nuts and bolts of making the trial work, and then move through the data analysis and dissemination of findings. In other words, these nurses are not just executing protocol for a principal investigator; rather, They re influencing our protocols in meaningful ways and bringing their truly clinical and personal focus into the trial. This clinical focus and experience is critical, and deliberate. In two current Project HoneyBee OCTs, the principal investigator is an engineer or a research psychologist, not a practicing clinician. The clinical approach and sensibility that GRAs contribute is important, Heather says, because a major priority is to find out whether and how the technologies we are studying can be integrated into a person s life. Since every GRA is a nurse, that priority is already embedded in their day-to-day thinking. And their experience working with patients and understanding their daily lives allows them to exert influence on the design and implementation of the OCTs. [Our graduate student researchers] are influencing our protocols in meaningful ways and bringing their truly clinical and personal focus into the trial. Usability in daily life I think there s a misperception that when a new technology comes around, you can just plop it into a healthcare system that the tech s wonderful bells and whistles will magically make everything more streamlined. But this just doesn t happen. Unfortunately, many non-clinicians tend to underestimate the impact of new technology on the clinician when they are in the room with the patient. Introducing new technologies into that patient-provider interaction is not straightforward. It takes a lot of time to analyze and interpret new data and then act on it. The real nuts and bolts, she added, are in the usability. How does a person actually use a new tool on a daily basis? How does a clinician basically interrupt and revamp their entire workflow process in order to deal with new, valuable data? Those are things that don t make the headlines. Both of the clinical trials she is running have patients looking at and interpreting their own data on a daily basis. Heather acknowledges that this is a departure 2 HONEYBEE CHRONICLES

3 from how wearable medical-grade technologies have typically been incorporated into medical settings, whereby the system collects the data, pushes it to the clinician, and then the clinician tells the patient what to do. In the above case the patient is a passive recipient of data. For Heather, that s a major missed opportunity. People are more and more interested in their data. We see it with the consumer wearables that you just go buy off the shelf, right? Nobody would buy a Fitbit or a Jawbone UP if they couldn t see their data. Making data actionable I think we re seeing people in general not those we would label as patients using and making modifications based on these data. But we re not seeing that sort of consumer experience quite yet in the medical setting. But it belongs in the medical setting, too. The real nuts and bolts are in the usability. How does a person actually use a new tool on a daily basis? How does a clinician basically interrupt and revamp their entire workflow process in order to deal with new, valuable data? Those are things that don t make the headlines. Heather thinks that consumer wearable devices can empower patients in the medical setting by showing them the data they re generating, helping them understand it, and ultimately encouraging them to make some changes either in their lifestyle considerations, or in their medical care in collaboration with their clinicians. More engaged and knowledgeable patients empower clinicians and medical systems, too, but all this really depends on actionable data, which brings us back to the critical role GRAs play. For many OCTs, it is the GRA s job to ensure that the data is clear and actionable for the PI and other study staff. Here s where Heather s mentoring role comes in. She regularly meets with each GRA to go over spreadsheets and strategize about how to make the data less cumbersome. Additionally, she brings all the Project HoneyBee GRAs together for a monthly colloquium, where everybody gives updates on their respective trials, including progress, successes, and ongoing challenges. To extend the honeybee metaphor, Heather reflected, it s incredibly valuable to be able to come back to the hive and get support from the rest of your colony. That s really the heart of Project HoneyBee. HONEYBEE CHRONICLES 3

4 Heather speaks with authority on all these issues for many reasons. In addition to recruiting and managing the GRAs and leading two OCTs, she also serves on Project HoneyBee s Waggle (Steering) Committee. I ve managed to embed myself everywhere, she acknowledges. And I hope that having a different lens into each of those different layers of Project HoneyBee will allow me to bring some insight that sitting in one but not all of those places might not otherwise afford. When Heather talks about insight, she doesn t just mean insight into the OCTs or even Project HoneyBee as a whole. She is thinking much bigger about the healthcare worker and health system of the future. And this is where her passion for interprofessional education comes in. Interprofessional education and the ideal health worker of the future I think that the ideal health worker of the future will have equally strong grounding in their particular health discipline, as well as in a culture of interdisciplinary or interprofessional practice. Toward that end, one of the things that [ASU is] starting to do now in a very concerted way is to incorporate interprofessional courses into our healthcare education programs. We re starting to see opportunities for students from nursing, social work, medicine, business, and engineering to collaborate in their learning. There are certainly unique roles they ll play in their separate pure disciplines, but there s also a lot of thinking that they re going to need to do together. How does this all connect? Beyond Project HoneyBee s Interdisciplinary Approaches for Innovating in Healthcare Technologies course, which is designed to provide advanced undergraduate and Master s level students in engineering, nursing, and business with an understanding of the foundations of healthcare, Heather also thinks that the technology Project HoneyBee seeks to validate is going to be essential to the healthcare worker of the future. She acknowledges that the healthcare professionals she hopes will engage in comprehensive interprofessional practice are already maxed out. We are expecting them to learn so much in so little time, and these are some of the hardest workers in any university system. The challenge for health education is to incorporate a whole other layer of learning for these individuals in an existing context of information overload. As a PhD student in Human and Social Dimensions of Science and Technology and DNP instructor herself, she understands information overload, as well as a shortage of time. But for Heather, not moving forward is almost the same as moving backwards. We re starting to see opportunities for students from nursing, social work, medicine, business, and engineering to collaborate in their learning. There are certainly unique roles they ll play in their separate pure disciplines, but there s also a lot of thinking that they re going to need to do together. 4 HONEYBEE CHRONICLES

5 I think it s very easy for education systems to say, It would be great if we could do interprofessional education, but our students are on different learning schedules and campuses, so it s just not feasible to bring them together. I get it. But it s also not that hard to embed that kind of thinking even into a single discipline course even if you can t restructure your entire course schedule. In reality, Heather explained, very little healthcare happens in academic medical ventures that are rich in both time and finances; most healthcare settings don t have the luxury of doing team rounds on a daily basis. However, the digital communication affordances we have with emerging technologies now make it possible to have other interprofessional inputs into our clinical work. The goal is practical, and also very urgent: to prepare the health worker of the future for the health system of the future. In academic medical centers and hospitals, she pointed out, we have more time for things like team rounds, where all the different clinicians who played a part in caring for a particular patient gather at that patient s bedside on a daily basis to exchange ideas and findings. Unfortunately, in most of healthcare, that kind of setting is pretty rare. Technology: check. Interoperability: still elusive While some great technology already exists to allow for this exchange, unfortunately we don t yet have the full interoperability between devices and medical systems to realize its potential in healthcare. To illustrate the importance of ensuring streamlining communication in healthcare technology, Heather brought up the recent, tragic Ebola case in Dallas. That Thomas Eric Duncan s West African travel wasn t initially communicated was actually a fault in the design HONEYBEE CHRONICLES 5

6 The digital communication affordances we have with emerging technologies now make it possible to have other interprofessional inputs into our clinical work. And yet policy is just one of the pieces to the larger puzzle. Heather s role in guiding the GRAs through the challenges of ensuring that innovative new healthcare technologies empower patients is another. Driving the best of the best to leverage the benefits of interprofessional education and practice is also critical to creating the ideal health workforce of the future. of the electronic medical records system. The travel history was segregated in the nursing workflow, and the nursing workflow was totally separate from the physician workflow; nurses never see the physician workflow and physicians never see the nursing workflow. That segmented communication directly led to a public health crisis. Similar to Project HoneyBee s honeycomb model, the puzzle is only fully functional when all the pieces fit together. Heather s ability to connect all these pieces and work energetically and insightfully to improve them makes her a truly health innovator. It also makes her the best of the best for Project HoneyBee. There is still a long, bumpy road ahead before we reach interoperability across devices and information systems. But Heather was optimistic, based on recent conversations she has had with members of Congress. I think that interoperability is high on the list of policy priorities. FOR MORE INFORMATION PLEASE CONTACT: SustainableHealth@asu.edu (480) HONEYBEE CHRONICLES