The Exec: HCA Vigorously Develops Technology to Increase Nurse Efficiency

Reducing administrative burden for both clinicians and nurse leaders is a top pain point, HCA Healthcare CNE says.

HCA Healthcare nurses are using ever-developing technology that has enhanced communication, decreased administrative burden, and provides skill development—all with the goal of improving patient care, says Sammie Mosier, DHA, MBA, BSN, NE-BC, CMSRN, senior vice president and chief nurse executive.

Mosier, who has led the Nashville, Tennessee-based healthcare system’s 93,000 RNs since the end of 2021, spoke with HealthLeaders about how HCA vigorously embraces technology to decrease redundant or unnecessary documentation so nurses can increase the time they spend with patients.

This transcript has been lightly edited for clarity and brevity.

HealthLeaders: What are some of the top technology solutions that HCA has implemented?

Sammie Mosier: One we have implemented very wide scale is our iMobile platform where smartphones are deployed to caregivers, or nurses and beyond, to improve communications. It has secure text messaging, so they can send that without worry. Obviously, they can make phone calls, but then the platform also has the ability to provide some updates from our EHR so they get those alerts directly to their phone. Any critical labs for the patient or other necessary information are right there at their fingertips. Our nurses love that technology, and it has enhanced communication among the care team.

We’ve continued to invest in that platform so that we can improve the workload for other areas. One example that we did last year was wound care imaging, so that after a nurse takes the photo, it's a seamless integration with our EHR. Prior to that, nurses had to take a photo, print it off, and scan it in, which took about 20 minutes per image. It removes time for administrative tasks so the nurse can focus on patients.

The technology even ensures that our nurses have skill development tools and resources right there at their fingertips. We are also leveraging that for patient assignments; we call it our CTA—Care Team Assignment platform. Nurses once had to log into multiple systems to provide patient care and Care Team Assignment is the ability for the nurse to log in once and that assignment is leveraged by all the other technologies, so again, it’s seamless for them.

HL: What are the top pain points at HCA that technology can help with?

Mosier: Reducing administrative burden for both our clinicians and nurse leaders, as well. Leveraging automation and other technologies to push that information appropriately to the right care team member so they can take action versus having to look through the data. That's a big focus right now, especially with our nurse leaders. They have multiple reports that they have to navigate through to find whatever is necessary to run that unit, and if we're able to push that to them in a more holistic view, then that allows them more time to spend with their staff. Our focus is to get those nurse leaders engaged with the staff as well as our patients.

HL: How do you test new technology?

Mosier: It's elbow to elbow with frontline staff. We have an innovation lab here in our corporate office where our informatics teams can work to do those initial tests and then move out into the field where we’re able to work side by side with clinicians to get their perspectives—the good and the bad—to make sure that it is a technology that we believe in and that we want to pilot. We do work with our vendors to improve the technology. I would also add our care transformation innovation teams have departments and a couple of hospitals that are identified as hub hospitals, which means those departments and hospitals serve as test labs for the technologies.

Sammie Mosier, senior vice president and chief nurse executive, HCA Healthcare / Photo courtesy of HCA Healthcare

HL: What new technologies would you like to see introduced at HCA?

Mosier: Virtual nursing and the ability for a remote nurse to come into the patient room through video and interact with the patient to reduce some of the workload burden and administrative tasks for the practicing staff nurse at the bedside. We are piloting that in a couple of our hospitals right now and looking to expand that. What we're seeing is the ability to have a virtual nurse handle admission, discharge, and other use cases to assist and take away administrative burden from the bedside nurse. So that's really exciting.

Our pilots are going well. We're seeing a lot of both nurse and patient satisfaction; about 85% of our patients are receptive to that model.

HL: Why is patient satisfaction higher with virtual nursing?

Mosier: When we first started, it was because the remote nurse didn't have a mask on. It was part of the perception of seeing that smiling face. As we've evolved, we're seeing that the virtual nurse can spend a little more time with the patient, particularly in the discharge area. While that physical nurse is there removing IVs and lines and getting the patient prepared, that virtual nurse is doing the education, answering the questions, and we're seeing that patient satisfaction for discharge is improving.

HL: How much of HCA’s technology is innovated and developed by HCA?

Mosier: It’s a mix. We call for innovation, so we’re more progressive in this space. We have a dedicated week called Coding for the Caregivers, and that is an opportunity for our nursing team and our informatics teams to work together to fast-track ideas around technology. Our IT colleagues pause for a full week and work to bring the ideas of our nurses together to develop more of a proof of concept. That’s a very exciting week we have here. I know a lot of vendors do this innovation exercise, but this is one we've been doing in-house, and this will be our third year.

It’s a great opportunity to understand the pain points that the nurses are facing and then those potential solutions they identify. They then work with our IT colleagues to see if it's something we can build in-house or if we need to leverage a partner to do that. And a couple are selected as winners, and they are funded to bring to a pilot.

HL: What are the most-challenging barriers to healthcare tech innovation?

Mosier: Most of our nursing technologies are focused on reducing that workload burden, but sometimes things are created without the nurse in mind. A particular technology may work very well for another clinician, but sometimes that puts more workload on the nurse. We need to make sure that we have nurses incorporated on the front end of all these designs, so that they can call out those barriers and we can have a better product. So that would be my No. 1 barrier.