The Pivotal Podcast: Marc Perkins-Carrillo | Moffitt Cancer Center

Welcome to the Pivotal Podcast. In this episode, we're joined by Marc Perkins-Carrillo, Chief Nursing Informatics Officer and Director of Clinical Informatics at Moffitt Cancer Center. We'll explore Marc's extensive career journey from nursing to leadership in informatics, focusing on the challenges and opportunities of managing healthcare communication and data in a fast-growing healthcare organization. 

For nurses looking to leap into informatics, Marc's advice is worth its weight in gold. It's not about the degrees on your wall but the hands-on experience you gain and the connections you forge within the informatics community. He pulls back the curtain on the future of health informatics, where Artificial Intelligence stands as a promising yet cautious advancement. Marc's parting thoughts remind us of the profound satisfaction that comes from using informatics to enhance patient outcomes and streamline healthcare processes—a sentiment that's sure to resonate with healthcare professionals and tech enthusiasts alike.

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Transcript

Speaker 1: 0:13

Welcome to the Pivotal Podcast. Today, we're joined by Mark Perkins-Carrillo, chief Nursing Informatics Officer and Director of Clinical Informatics at Moffitt Cancer Center. In this episode, we'll explore Mark's extensive career journey from nursing to leadership in informatics, focusing on the challenges and opportunities of managing healthcare communication and data in a fast-growing healthcare organization. Hey, mark, thank you so much for joining me today.

Speaker 2: 0:36

Thank you for having me.

Speaker 1: 0:38

Yeah, I'm really excited about our conversation, so I'm going to just dive right in. I would love to hear, I guess, first off, what drew you to nursing initially, and then how did your experiences across clinical settings lead to a career in healthcare informatics?

Speaker 2: 0:57

So you know it's interesting because I did not choose nursing. I guess nursing kind of chose me. I started out as my major in marketing and business and I grew really bored quickly Wow.

Speaker 1: 1:12

That's so unexpected.

Speaker 2: 1:15

So I started there and so I said I have a scholarship, so I've got to switch it up and I don't know what I want to do. And I got into the nursing program and I started my career as an lpn, um licensed practical nurse, or what I like to refer to as low paid nurse.

Speaker 2: 1:31

Uh you have to do a lot of the same jobs and and you and you don't have the same respect or the um, the same pay. But, um, my dad was actually really disappointed. He told me he thought that I was too smart to be a nurse. And and I told him I said I am actually really smart because I chose not to be a doctor. So and that's not not to be bad. It's just that you know nursing, you don't have the on-call and you don't have all of those things that that really interferes with you having a personal life sometimes, and so you get to have that patient interaction and I just love that patient interaction, so I think you also wanted to know something about my clinical experience, yeah, so tell me a little bit more about those clinical experiences and how those led to informatics.

Speaker 2: 2:18

So I have to say I think of myself as being very lucky. I have a very varied background in clinical care, so primarily emergency room and critical care Spent many, many, many years in that. But I've also done some ambulatory stuff. I ran a busy GI practice. I've done pediatric immunization clinics just a little bit of everything worked inpatient rehab, done a lot of different things. And I guess how I got into informatics is this big term that everyone loves to hear is CPOE computerized provider order entry. I was a super user at one of the large organizations I worked for and they were going to go in and implement CPOE back during the meaningful use stages and they said, hey, you're really good with computers, what do you think about joining us? And I said I don't know, maybe that could work out for me. So we decided give it a little spin and, lo and behold, I moved right in and had to implement CPOE for one of our largest, for our largest hospital in the, in the system and then I was recruited up to our corporate office.

Speaker 1: 3:32

Wow, wow, that's amazing. So now, how did that lead to what you're doing now at Moffitt Cancer Center?

Speaker 2: 3:41

So I would say that my path has been across the country. I started out in California in informatics and I kept advancing. I went from an analyst to a manager and from manager to a system region director and so over an entire area, and before I decided I just kept moving further and further south. I moved across country and I moved down to Moffitt and just felt that there was an immediate connection with Moffitt and so I had actually left informatics for a short period of time and did some other quality initiatives and other nursing aspects. But informatics is my heart and so when the opportunity came back with Moffitt I jumped on it and, very happy, yeah, that's amazing.

Speaker 1: 4:40

So you have dual roles right now, right? Cnio and director of clinical informatics, is that?

Speaker 2: 4:45

accurate.

Speaker 1: 4:51

I do, I do. What's the difference in like your responsibilities as a CNIO versus director of clinical informatics?

Speaker 2: 4:55

So a CNIO really should be focused solely on nursing and making sure that all of nursing's needs are being met. It's really a high-level position where you should be looking strategically at the near future and the distant future of where nursing needs to be in technology and in workflows. The director of clinical informatics is very much a hands-on in-the-moment making sure that current projects are going live and that things are staying on track, and so you have almost a competition between the two things that I need to get accomplished in strategic and in daily operations. So challenging, but it's working, yeah, yeah. Do you ever fight with yourself?

Speaker 1: 5:41

You're like I need this right now and you're like no, but for the long-term we have know it's working. Yeah, yeah. Do you ever like fight with yourself? You're like I need this right now and you're like, no, but for the longterm, we have to do it this way.

Speaker 2: 5:50

Yes, and it also. But you know, knowing that over the director of clinical informatics, I'm also responsible for other operations other than just nursing, so I'm pulled now. I have to, I have to weigh out, to weigh out. I really want to give all my effort to nursing, but I have to actually provide some of that effort to the providers and to laboratory and all these other areas that need that same attention.

Speaker 1: 6:17

Yeah, absolutely Very cool. So we talked a little bit about this before, but you you mentioned before a scoring system for prioritizing tickets and projects, right? Can you tell me about that?

Speaker 2: 6:30

So you're going to mention my favorite favorite thing. That's one of my favorite tools. You know, um, every change that someone requests has emotion. Right? You didn't? You didn't just sit around and think, gosh, what could I make Mark and his team do this week. You had a reason that you thought this would make your life easier or better, would help something, but you have a lot of emotion and you only have your point of view as the requester. This is what I need. It's not looking at from a system standpoint of what is best interest of us to expend resources on.

Speaker 2: 7:07

And so we prioritize our tickets by using the scoring tool that you just mentioned. And the way we do that is we break it into a category first, and I'll talk about my favorite three patient safety, revenue and regulatory. Those are the top three that we work. Those are our highest categories. So if you get landing in one of those, it means that your ticket's probably going to be worked faster than something that would just be an optimization oh, it's a nice to have.

Speaker 2: 7:35

And then, in that, we actually score each ticket based on these categories and these classifications and it gives it a point system, and I believe our point system is now at around 60. So you can score as low as zero points or as high as 60 points. So underneath that, so say, you're a patient safety, which is our highest priority and you score a 48 and some other ticket scores a 12. Well, we're definitely not going to work the 12 before we work the 48. So it just gives us an indicator of how soon the priority should be on these tickets and it prevents that cherry picking. Hey, I like to be a ticket closer and I want to close all my tickets really fast, so I'm going to take all the easy tickets. That doesn't get to happen, because now we prioritize the work by the level of the importance to the organization.

Speaker 1: 8:27

Yeah, that I love that. I mean anytime you can quantify impact, that I don't know, I just think you're able to measure it. So what gets measured gets done and then it gets improved and it's going to be a lot more effective that way and it's going to be a lot more effective that way. And I know that I was really, really intrigued and impressed by your mention before of having a conversation with the requester of the ticket and showing them their score. So they had transparency into that and I thought that was really neat because it let them understand. Okay, this is maybe why, if my ticket's not being worked right now, why it's not being worked.

Speaker 2: 9:08

Yeah, everybody wants to say theirs is a patient safety. Right, because everything that we do in the hospital touches a patient or in the clinic touches a patient at some point, so it's always a patient safety. But really understanding what patient safety really means and we actually have quantifiable numbers of what has to happen in order to be classified as a patient safety ticket, it just can't be. I feel like this is a patient safety, so you're going to work it as a patient safety and we have that frank conversation. And it is nice because to me, it would be so much better if someone tells me look, your ticket's never going to get worked. We can leave it in this queue and it's never going to get worked. Or here's where your ticket would land, and so you can expect it not to happen until X.

Speaker 1: 9:55

Yeah, so does that ever happen? I mean, if it's like a fairly low score but it's something that would be good to do, and higher scoring tickets keep coming in on top of it, is there a situation where maybe something's just not going to get done? Or is it like, okay, well, no, we'll build it in eventually, because we have like small blocks of time that are reserved for lower priority things.

Speaker 2: 10:16

I wish there was extra time. There is no extra time in life. That just does not work. My ticket backlog is quite extensive. We have a lot of tickets in backlog and there are times where tickets are and I'm very frank with people. I'm like I think this would be great for you, but it's only going to benefit you. And I've got to look at 9,000 people and how does that really benefit the organization? And so I'm very frank with them in saying that this probably will never get worked. Sometimes they'll say, okay, well, if it's not going to get worked, let's just close it. Other times they're like no, I want you to keep it open and eventually you'll get to it. And I'm like okay.

Speaker 1: 10:56

And we will eventually. Yeah, wow, now this image of bills in Congress and things just came to mind and I'm like do people ever try to redo those things by rolling them into other tickets so it all gets worked as a package? They're like, okay, well, maybe if I rolled these two things together it would have a higher priority.

Speaker 2: 11:16

So it's interesting that you say that People will try anything to get their ticket moved ahead, right, yeah, yeah, it's human nature, we want what we want.

Speaker 2: 11:26

And so they will tell me well, this is regulatory, you must do it. And our answer back and we're very adamant about this is provide us the show us where it's required. And so they actually have to give us the exact reference so that we can go back and research it and pinpoint it to say are we compliant with or without this? If we're not compliant without it, then we're going to have to move that ticket to a regulatory category. It may have just been an optimization before, but now that you've provided this extra input, it becomes a regulatory ticket. And I think that's what's very nice about having that open communication with the customer is it's very quick for us to look at and go nope, optimization. But if we have that conversation with them and they can provide extra information and we guide them to that, we're begging for that because we want to be able to give you what you need. But we also have to follow the rules.

Speaker 1: 12:23

Sure sure. So okay, tell me a little bit. You touched on patient safety. Tell me a little bit about the Moffitt MAC ambulatory centers and then tell me, I guess, first off, like what are those? And then how do those work hand-in-hand with the informatics team to improve patient outcomes?

Speaker 2: 12:44

So a MAC, as we refer to them, is a Moffitt Ambulatory Center, and Moffitt is very passionate about bringing the best cancer care to our patients in their community. And that's exactly what a MAC lets us do. At one of our MACs you can go in and see an oncologist, you can have your laboratory, your radiology testing completed there, you can receive your chemo infusions and it's all close to your home receive your chemo infusions and it's all close to your home. So one of our latest macs that we're about to we're gearing up to open, is down and we're calling it the south shore, moffett south shore. That's down around the ruskin area.

Speaker 2: 13:24

So imagine you live in ruskin and I think everybody in the tampa area knows the i4 interchange is not a fun place to have to go if you need to get to downtown to get to Moffitt and it just adds a lot of inconvenience to you. And cancer patients are sick, they don't feel good and after a treatment they may feel even worse. Those chemo drugs are just really hard on your body. Chemo drugs are just really hard on your body and being able to get home quickly and then start to recover and rest is so much better than being stuck in a car in traffic in Tampa, and so that's what we do with the Macs.

Speaker 2: 14:04

I think that you know it allows us just to really be able to touch the patients where they are, and so, with clinical informatics, you ask what we do with that. They are. And so, with clinical informatics, you ask what we do with that. So our team works out with the clinical teams and they develop the best workflows. One of the workflows that we have in one of our clinics on the hospital may not work for the ambulatory centers. Maybe we don't have a certain piece of equipment that we would want to have, and so we need to make sure that we incorporate that in so that people aren't ordering that. Or they know, oh, if you order this, we're going to need to transfer the patient to this other location for care. And so I think that that is the benefit of having clinical informatics is making sure that we take into consideration before we have a patient sitting there in front of us and we go, oh, we can't, we can't do that here.

Speaker 1: 14:58

Yeah, absolutely Optimizing that care for them in real time is so important, and I love what you guys are doing with the ambulatory centers, especially just because my mom is going through chemotherapy right now, actually, and just last week so I live in South Carolina.

Speaker 1: 15:17

Now last week I was visiting her in Arkansas and got to take her for an infusion and then I ran some errands for her because it was going to take a few hours, and so I I went to the pharmacy for her and she had a you know a couple of prescriptions she needed to have picked up, and the pharmacy was right around the corner from where she was getting her infusion. It was a short drive, but it was still a separate stop, and when I went into the pharmacy I wound up waiting for 20 or 30 minutes, probably like standing there waiting while they filled one of the orders, and especially on a day that she's just had an infusion like she wouldn't have the energy to do that. You know, I mean she's not feeling well enough to stand there and do that. Um, like just standing is actually even a challenge for you know. So so the service that you guys are providing really does have a positive and necessary impact on the quality of treatment for patients, so it's really really worthwhile yeah, people don't realize that.

Speaker 2: 16:16

So it's really really worthwhile. Yeah, people don't realize that when, when it's not like going to your regular doctor, when you go for cancer care, it is not a quick 15 to 30 minute visit, it's, it's sometimes it seems like an all day excursion. You see an oncologist, you have labs drawn, you have to wait for the results. Then you get your. Those results determine whether or not we can give you that, that infusion, and, as you said, the infusion takes sometimes three to four hours, depending on what you're getting, and so it is an ordeal and a lot of that. That time factor and everything. Informatics looks at that to figure out where's the best place that we can insert something extra or remove something that's not beneficial to the patient, in this case, yeah, absolutely and exactly what you're saying.

Speaker 1: 17:01

I mean, she experienced all those things, right, I think from the time we arrived until the time she left. It was like 830 to 330 or four, maybe even 430. It was, it was a full day and that wouldn't have included the pharmacy stop. If I hadn't been there and hadn't been able to go do that on her behalf, you know that would have been an extra thing she had to do.

Speaker 1: 17:20

And something else that I was actually thinking about informatics, while I was there, because we had to check in at two different desks and one of them we had to see twice. So I was like we basically had to come up to the counter three different times to different counters, you know, making sure, hey, we're on the list to go get the next step accomplished. And it seems like, you know, with workflows, there could be a better patient experience, right, if it was like, oh, I could go in and say, hey, this is my name, I'm here for this today, you check these boxes and I don't have to talk to anybody else until it's time to see the doctor get labs drawn or go for my infusion.

Speaker 2: 17:56

Ben, see the doctor, get labs drawn or go for my infusion. Ben, you're so right, Healthcare is not like the hospitality industry. We have been, we're here and you need us, not the other way around, and we're trying to switch that mentality. I think that that is what you're going to see in the future is that things are really meant to streamline your work as a patient, though it will mean more work on your part sometimes.

Speaker 2: 18:18

You know, I was looking at how do we get the right person putting in the right information into the system so that we don't have to ask that information over and over and over. You know, is it right to have the patients enter their medications ahead of time so that those then interface with our EHR and we look at it and say, oh, I see you updated this yesterday. Have you got any new medications, Did you start any new medications or do you have any changes in your medication, Instead of the nurse who's standing there typing in the name of the medication when you last took it, all of that information which you know as a patient, should we be taking that ahead of time, so that when you last took it, all of that information which you know as a patient. Should we be taking that ahead of time so that when you get there your visit is much faster and we can move you through this process to get you to the next step?

Speaker 1: 19:05

That's interesting, yeah, I mean I could see that as being beneficial, especially if the patient's able to do it from home when they've got the medication sitting right there, because in the office it's like, you know, it was a little pink pill and then the nurse is like, oh okay, we're going to have to do some Sherlock Holmes work to figure this out.

Speaker 2: 19:25

You're correct, because I go to the doctor just like everyone else and they'll ask me about a medication and I tell them the name of the medication. They go. What's the dosage on that? And I'm like it only comes in one dose. I don't know what the dosage is, but it only comes in one, and I don't have it right in front of me because I'm not carrying a list of my medications around. I should, but I know the reason. I should, but I don't do it, and so I think that this would be a way of offsetting it. I think that this would be a way of offsetting it. I think anything that you can do before you have to get in front of someone and be put on the spot is so much easier to do at your own leisure.

Speaker 1: 20:02

Yeah, no, that's true, because just a couple of weeks ago I experienced that myself. I mean, I'm relatively young and healthy and I checked in for an appointment online right in advance, and then, when I got to the appointment, they were asking me questions about the medications I was on and I remember the names, but again, I couldn't remember the dosage. I had no idea, and it came in multiple doses. So it was like, oh, we have to figure that out later actually, because I'm not really sure. Um, but then again I was as a patient. I was wondering. I was like, but it was your office that prescribed it to me, so you should have that information. I haven't changed anything right, so I don't know. So let's go back to just your role, specifically as an informatics leader. What results are you accountable for? And then, how do you measure success?

Speaker 2: 20:53

It's a challenging question. So, as a leader, I'm responsible for ensuring that our costly resources are producing value for the organization. I mean, everything is beholden to the almighty dollar. Unfortunate, but it's the truth of life. There's a very good statement out in healthcare no margin, no mission. So if you don't have any money coming in, you can't actually perform your mission, and people don't think of healthcare as a business, but it is. If you don't have any money to run your business, you can't run the business, it closes. And so I would say that that's one of my primary things.

Speaker 2: 21:39

Historically, we've been valued. Our value has been in informatics, has been measured by adoption and soft dollars. Oh, it feels good because Dr So-and-so or Nurse Jane is doing whatever in the EHR and it's and it's made their workload a little bit lighter. But I'll be honest that those days of soft dollars are gone and we're really emphasis. The emphasis is on generating money or cost avoidance and and my favorite finally still clinical burden reduction. Every single day there's a new regulation coming out, there's something new that someone wants the nurse or the doctor to document, and at some point, where does the documentation burden end if we're actually going to be able to take care of patients. If we're only checking boxes, we can't take care of patients, and so we have to figure out how we do this more efficiently, and so that's what my team does, but, as for me, it's really making sure that we're utilizing the resources appropriate and that we're not spending money on the next shiny object.

Speaker 2: 22:48

Everybody sees something from a vendor or from a. They go to a demo and they see something and like, oh my gosh, if we only had this. My whole world is going to a demo. And they see something and they're like, oh my gosh, if we only had this, my whole world is going to be changed and it's going to be so much better. And then you implement and you realize that sometimes it makes it a little bit better, but it doesn't solve all the problems. And then you also have we buy all this fancy stuff, and then people don't adopt it and they're like, oh well, it was easier, just to do my old job, I'm not going to continue. I'm not going to do that. So you've wasted more money. So making sure that we're not wasting money and that we can do our jobs in the most efficient manner is what my responsibilities are.

Speaker 1: 23:29

Yeah, wow. How do you even go about predicting?

Speaker 2: 23:40

that how can you figure out what kinds of things will people actually utilize and implement if we bring them, if we bring these resources on board? So you know, what I would say is is trying to figure out if, if you can get customer buy in first, you pitch it to them. You talk about what the what the benefit to them is going to be. They got to have that what's in it for me and they have to understand that it's going to benefit them. Otherwise, it's just one more thing that leadership wants. Right. I mean, get that verbal yes, I'm going to do it.

Speaker 2: 24:15

You also have to have some leadership push down saying, okay, if we spend $1.2 million for this new shiny object, then we are going to expect that you're going to do it. So there has to really be some buy-in from both sides. It needs to be a leadership push that, yes, we're going to commit to it and this is going really be some buy-in from both sides. It needs to be a leadership push that, yes, we're going to commit to it and this is going to be our new way of doing business. But it also has to be that customer who is in the field that says, yes, okay, if we do it, then we're going to go ahead and and buy in.

Speaker 1: 24:50

Yeah, yeah, that makes total sense, are there? Yeah, yeah, that makes total sense.

Speaker 2: 25:05

Are there any challenges that are unique to you as a leader in a rapidly growing organization? Yeah, I mean, it goes back to that shiny object. Everybody sees something. They always want it, and you know my job is building relationships with the clinical customers. Right, I've got to go back and I've got to deliver what they're asking, or at least give them something close to what they're asking for. But there's also the times that I have to say no, we're not going to do that. I just met with a physician yesterday and I said I agree with you that what you're asking for would make your life easier, but it would also slow down the system. There's no way for us to ensure that what you're doing meets copyright rules and regulations. And so I said no to him and I gave him options of what we could do to help get him partially there. And you know, I think that that was really a win because it wasn't a hard no, but I think that that's it was something that we had to do.

Speaker 1: 26:06

Yeah.

Speaker 2: 26:07

And the other thing is just making sure that again I go back to that money. I mean, I know it sounds terrible in healthcare to think about that, but everything is costly, and so I have to make sure that we're using our money wisely and that we're not going to buy something that we're not going to use.

Speaker 1: 26:23

Sure, yeah, I mean it might sound bad to go back to that, but if we don't steward finite resources well, no one benefits, right? No patients will receive. If Moffitt had to close next week because of misuse of resources, then how many patients would, would you know, fail to receive the benefits that they would otherwise be receiving right now?

Speaker 2: 26:44

6% of Florida's cancer population.

Speaker 1: 26:47

I can tell you that number. Yeah Right.

Speaker 2: 26:50

But the reason I say it sounds bad is because I'm a nurse and in nursing school we're not taught about cost. We're not taught about if it's a, if it's a outpatient, we do this, and if you're on this insurance plan, we can only give you this treatment. And there's all these things that we're just not accustomed to feeling, because nursing is a feeling. Right, you want to help that patient, you want to do the right things, control payers and governmental regulations, and things make us do things that we don't want to do, that we don't feel like is the best option for that patient. You know, I have patient nurses that tell me Mark, I don't think about the fact that this one is an observation patient and the patient in the room next to them is an inpatient. To me they're just a patient. You can't, you know, unless I go and look up your financial class, I don't know what your status is.

Speaker 2: 27:50

I just assume that you're an inpatient just like everybody else, but these rules dictate different things that we have to do for different pain populations.

Speaker 1: 28:00

Yeah, wow. So something you just touched on there was the difference between how you came up through nursing education and through training to be a nurse and the kinds of decisions you're faced with in informatics right Moffitt Informatics Trainee Program, and how you're helping overcome some of those gaps. I guess that would exist through a traditional nursing education to prepare them to become an informaticist.

Speaker 2: 28:34

It's a shining star at Moffitt. I think that the trainee program is amazing. To my knowledge this is the only trainee program of its kind in the United States. I have not seen any other thing. We were just published in the American Informatics Nursing Journal, gin, for our work that we're doing with our trainee program. So our trainee program is interesting in the fact that so many people want into informatics.

Speaker 2: 29:07

It's crazy the number of people every day that says, oh, I want to be in informatics. And I hear people tell me all the time well, I have a master's in informatics and I can't get a job. You're correct, you can't. Long gone are the days where you were just good with a computer, like I was, and you get pulled into something. Now there is this overwhelming amount of informaticists out there that you can snatch that has years of experience and it's hard to say. Why would I hire someone that has no experience when I can hire someone from another organization that has three years of experience? There's a large training curve.

Speaker 2: 29:46

So what we've done is we've developed a training program where we take nurses who want to get into informatics and we put them in a training program for two years. We pay them a good RN salary and they do less work. So it's a hard sell for the organization as to why I need more of these when they can do less work than hiring a full-time informaticist who has already been trained. But over that two years they learn all the skill sets of being an informatician how to manage projects, how to manage customer expectations. They are ready at the time of graduation to your point. They are ready to be either apply for a position on the core team our core informatics team or, if we don't have a position, they can leave our organization and go out and join the ranks of other informaticians somewhere else because they have that informatics experience, or they can actually just stay put.

Speaker 2: 30:45

They don't have to leave. They love working for Moffitt, which we love people to say. Then they can actually stay in that trainee program. It stops us from hiring a new one, but we don't move them and we don't. It's not like a graduation and thank you for your time at this time and you're gone. So I just think that it's a really interesting program and we've had really great success with it. It feeds. It feeds not only us, but we've had some of our trainees actually leave and go work for another organization. So we're we're helping our community of informaticists also with this program.

Speaker 1: 31:23

Yeah, absolutely so with that program do people come in individually or do you bring in cohorts, or how does that work?

Speaker 2: 31:30

So it depends, it really depends. We love to bring them in all at the same time, so it's only. Mind you, it's not a giant program. I wish it was 15. I wish it was 20 people, but it's three, three per two year period. But sometimes people decide that informatics is not really where I wanted to be. I actually rounded recently in the hospital and one of the nurses told me they were like oh, I want to get in informatics. Two nurses actually told me sitting at the same spot. They said, oh, I both want to get in informatics. I'm like we need people here at the bedside too. But and I said, what do you think informatics does? And they told me, and I said that's part of it. And then I asked him, I said, and I told him, I said you know, a lot of this is talking to people and convincing people that this would be a better path if we did it taking their idea and modifying it to become a better idea and selling it.

Speaker 2: 32:28

I told them that half your job is a used car salesman. And this person says oh, I don't like having to talk to people. And I said well, informatics is not for you. So I was able to quickly weed one out. Right, there was no reason for that person to apply. But if someone does leave during the time, during that period we will then rehire that position and they'll start at a different, a different point. But we have, we have the skillset that we can bring them in at different levels and keep going.

Speaker 1: 32:57

Sure, what would you say is a common challenge in training and developing informaticists in this program? Like what do you most often run into?

Speaker 2: 33:09

Nurses were pleasers. We want everyone to be happy, and so I have a real strict policy of saying this is not Burger King, we don't just take orders. We hired a nurse because you need to have clinical knowledge of how something works. And we're hiring and we're training you to be informaticians, to think outside the box. So if everybody was an informatician then we wouldn't be needed. So while John Smith may have the greatest idea in the world, I bet you if we, if we use collective brains, we can come up with something even better. So I think trying to get them out of the mindset of just doing what they're told or what they're asked is one of the first challenges. But you know it's hard because you're not used to project management in bedside nursing and so you've got to learn all of these new concepts and thoughts that just aren't commonplace in nursing.

Speaker 1: 34:14

That's so interesting because I would think that, from the outside and an uninformed perspective, it's logical to me that transitioning from a clinical role into a role that's more technology focused, or seems to be more technology focused the technology itself or learning to interact with it, would be one of the bigger challenges. But it sounds like one of the bigger challenges is actually the soft skills and the learning to lead people.

Speaker 2: 34:40

I think. I think the soft skills are way people are drawn into informatics because they already are techie. Right, they're techie. We have the latest phone, we have multiple different computer systems and applications that we use, and so that is usually not the problem. I will say that some people are challenged with some of the business portions of it. You know, using Microsoft Excel and using PowerPoint. Those are not things that you do repetitively in nursing. Now, so you know if you're doing a presentation or something maybe, but presentations in nursing is not that often.

Speaker 1: 35:22

Yeah, you're not doing that commonly for a patient you're caring for, you know, like powerpoint for why we're administering this type of care today correct you're not, you're not creating a brand new powerpoint and then trying to convince the patient to take their medication.

Speaker 2: 35:35

Medications you're, you're, you're going to convince them in a different method, but um so yeah, I think that's probably the the biggest yeah absolutely.

Speaker 1: 35:45

Well. What about, on the flip side? What's been particularly rewarding? That you've seen as like a success going through the program.

Speaker 2: 35:56

So historically we've had a challenge getting informaticians to come and work right. I mean, while I said there's a plethora of them, there's a plethora of ones that want to be informaticians not always the ones that actually have that years of experience and Moffitt has a very high standard to be an informatician. I will you know, I hear people tell me all the time well, you've made it impossible for new people to start, and I said not completely, because I do have a training program, but I for new people to start, and I said not completely because I do have a training program. But I do agree with them that it is difficult for someone I wouldn't qualify previously to come work for moffitt you know, in my initial entry in.

Speaker 2: 36:38

But the world has changed and so I think the most rewarding is the fact that with our training program, when we do have openings, it's a fast transition from trainee into our core team because you've been exposed to what the core team does, you understand how those relationships work, you've built on that and you're knowledgeable about the organization. So it's a no-brainer. If I have to choose between hiring someone outside who has five years of experience or versus hiring one of my trainees that only has two years of experience, I'm going to pick my trainee, probably because they already have some of those relationships the hardest parts already cemented in place, so all I need to do is bring them in. It is really taken away from that onboarding time. We can really quickly transition a trainee to full-fledged implementation in a matter of weeks, versus a matter of months that we do with a new hire outside.

Speaker 1: 37:43

Yeah, wow, yeah, that's definitely a win. So, with that being the case, and with the really limited number of slots available for the trainee program, what advice would you offer to clinicians who are interested in transitioning into informatics?

Speaker 2: 37:57

Man, oh man. I get this question almost every day, and so I would say reach out to your informatic at your site. Ask them if you can shadow. First off, it tells you whether or not. After watching for a day or two, it tells you if you really want to do this.

Speaker 2: 38:15

It's not easy, it's not. It's not something I tell people all the time. My job is getting yelled at a lot, and it's not that they're that they're mad or anything. It's not that they're mad or anything, it's just that everybody didn't get everything they want. And again, it's not Burger King.

Speaker 2: 38:31

We don't follow that mentality of you're going to get everything your way. It's got to be right for the organization. And so shadow with your informaticians. If you have a very robust clinical informatics team, ask them to be a super user. Have them teach you something that you can then go back and teach your cohorts on your unit. The other thing that I would say is join your local informatics chapter. Join your local informatics chapter. So here I am, the president-elect of the Central Florida ANIA chapter American Nursing and Informatics Association and you have now just quadrupled your exposure to informaticians.

Speaker 2: 39:21

So you hear informaticians and when we're on meetings we're always saying, oh well, I have a new position position or we're going to be opening this and so you can then possibly name recognition matters, Right? I mean, when people have seen you being dedicated, coming to these events or coming to the education sessions, interacting, those things get you noticed and that's how you're going to get in. Um, I know that a lot of people would be not happy that I say that having a master's in informatics is not the most important thing. I don't discount education, but I think that that relative experience is also necessary. So definitely having that experience getting in and then getting the master's, possibly because I feel so bad when people tell me that they've spent all this money to have a master's degree and haven't been able to break in. I spoke to someone recently who told me they had been waiting. They have been trying for two years and they have a master's Wow, and so I gave them the exact same advice.

Speaker 2: 40:34

It's about name. It's about showing that you're committed to informatics and that's how you get in.

Speaker 1: 40:37

Wow, and that's really good insight. I mean, because what you're saying I've heard a little bit of like, I've heard the shadowing and becoming a super user, but I think that this might be the first time I've heard somebody say, hey, go join an association. And I guess it probably wouldn't have occurred to me that you could join one as a non-informatician to then surround yourself with those people, and it's an opportunity for learning but also an opportunity to build relationships.

Speaker 2: 41:06

And it's an opportunity for learning but also an opportunity to build relationships. And I know I plugged Aenea and I think I've plugged them twice now, but I will also say HIMSS and then also AMIA. So that's the American Medical Informatics Association, which doesn't seem like it's nursing, but there is a big contingency of nursing in that also. So those are some organizations that I would recommend. Some are more expensive to join than others, but it's it's. It's it's about networking.

Speaker 1: 41:37

Yeah, that's what I'm going to say, yeah, sure, and maybe the shadowing is a great first step so that you're going and really deciding, hey, is this something that's a good fit for me before you're committing your you know your resources and your time and everything to the other organizations. But, yeah, that's a. I think that's a really good, tangible set of next steps that somebody could take.

Speaker 2: 41:59

The other.

Speaker 2: 42:00

The other thing that may be something that is a possibility and it's it's hard because again it's we're talking about dollars and budgets again is talking to your nurse manager and saying, hey, would it be possible every month or maybe every couple of months that I take four hours of my time, get paid for it and work with informatics to help bring some of that education, bring that adoption to our unit?

Speaker 2: 42:32

It's a win for them, but it's also a cost and you know cost outside of productive hours is not really loved. But sometimes if you have a nurse manager who really wants to see their adoption rates and compliance go up, they may be willing to consider that and so it wouldn't be all on your dollar. Because shadowing oftentimes, I tell people, is you know you want to get into informatics, so you may end up having to take a loss of your time and no money as you shadow for that day. But it's up to you. That's the choice that you get to make as an individual. That's another option is thinking about trying to convince your nurse manager of the value add for their unit.

Speaker 1: 43:16

Yeah, so they could see it as more of an investment than a cost, maybe Correct Interesting. Let's shift our focus a little bit. I know we don't have a ton of time left, but what do you see, as an informatics leader, regarding the trends that are unfolding in informatics? And then, how is Moffitt adapting to these changes?

Speaker 2: 43:43

The phrase of the day AI artificial intelligence.

Speaker 1: 43:47

Sure.

Speaker 2: 43:48

I mean, we couldn't possibly go without talking about that, and I haven't been to a session yet where I don't get to talk about AI or hear someone else talk about AI. I think that that is going to be our largest opportunity in health care, and there's different types of AI. I know that most people don't realize that, but you know, even your Roomba, the robot, has AI. It's a learned algorithm, right, so there's things that it does. It doesn't generate news, so there's generative, and then there's more of the rule-based algorithms that AI follows, and I think that there's just a lot of things that we need to, and I think that there's just a lot of things that we need to investigate and really inspect before we jump full feet into AI.

Speaker 2: 44:31

We want to make sure that it's providing safe patient experiences, and so what we're doing at Moffitt is we're ensuring that we vet all of this through our formal governance structure. So every product, every new change that we go through, goes through a change process, and so we are making sure that it goes through our governance and that it's as safe and that we have validation, especially with generative, because generative means that it's going to change down the road right and so it could learn a new way of doing something and you validated it on on this model, but it's learned to do something new on its own. So you have to have some kind of mechanism of continual checks and balances on your generative ai, and so we're building that into our governance structures and we're we're just like everybody else. We're chomping at the bit to figure out how ai can can solve a lot of our problems. We're looking at some stuff right now that we're in almost in pilot stage. We've got it through most of the governance now.

Speaker 1: 45:32

Wow, that's awesome. That's really exciting, super good. So you've mentioned a couple times about competing priorities and limited resources, right, and the importance of making money so healthcare is sustainable, right. Can you tell me a little bit about how informatics delivers a return on investment and why it's crucial for healthcare organizations?

Speaker 2: 45:54

Yeah, so I'll give you an example. First so I think it's about two years old now we identified a division of our organization that had just decided that they didn't like the process. So they just modified their process on their own, and what this process modification did was eliminate billing. So they're doing the work, we're spending the money and we're doing the care. We're just not getting paid for any of it.

Speaker 1: 46:29

Wow.

Speaker 2: 46:30

And so when I questioned it and we did the investigation, we found this and said, wow, this doesn't make sense. How would this happen? And so we investigated, figured out what it was, and it actually ended up being approximately about a million dollars annually that we were losing. So we found a million bucks reoccurring every single year. Yeah, a million bucks pays for a couple of different petitions, if you're wondering.

Speaker 1: 46:58

Yeah, yeah.

Speaker 2: 47:01

So that is one of the value adds. We look at process and we question it because we're if all of our billing is done through X and you're not using X, how are we billing? And then when they can't tell you, that indicates that there's a problem, and so return on investment is not always hard dollars. As I said, it's alleviating that burden If we don't have to have the nurses ask every single medication and type them in individually, and we could offset that where the patient who has that information in front of them does that information up front in a more accurate manner. Of ben, do you remember the dose? No, okay, we're going to guess that it's five. No, that's not going to be very helpful and so offsetting that workflow. So we've alleviated the burden from the nurse of doing that and we put the power and control inside the patient's hands yeah I think there's a lot of roi um.

Speaker 2: 48:04

Informaticians are terrible, terrible about documenting it. I'm I'm actually um writing a paper right now that can get published to help other informaticians show their CFOs and their CEOs. Informatics does pay. It costs money, but it really has a huge return on investment if it's done correctly.

Speaker 1: 48:26

Wow, wow, that's amazing. So, with that in mind, what would you say keeps you motivated in the work you're doing? And then, is there anything that's currently keeping you awake at night, work related?

Speaker 2: 48:44

So I think you're asking about work-life balance.

Speaker 1: 48:47

Sure.

Speaker 2: 48:50

Is there such thing? But no, really, I would say there's no on and off switch for my job, right, my head's always in it. Even when I'm out and about, as I'm seeing, as I'm going to my primary care doctor or I'm going to a specialist appointment, I see inefficiencies and it makes me question do we have those same inefficiencies at our organization? Should we look at those? But the reason that I do informatics is I love patient care. Let's be, let's, don't get it wrong. I love patient care but I'm a little older. My body's not as strong and robust as it was once ago. But I also realized that in informatics I have the ability to touch more lives than I would have ever been able to touch when I was standing at the bedside taking care of in the ICU one or two patients.

Speaker 2: 49:46

In the emergency room. I saw quite a few more, but let's be honest in informatics I have the ability to touch so many more people with just a simple change. One change could mean the difference between a patient actually surviving a hospital stay versus not surviving a hospital stay.

Speaker 2: 50:05

Because you remember everything is patient care right. We go back to that patient care things. There are things in systems not always but there's flaws, right? We see about it in the news all the time, about the flaws of healthcare systems and these things. So we can try to drive out as much of that as possible. And then, as for what keeps me up, hmm, what keeps me up at night? You know, I guess what keeps me up at night is really trying to make sure that we figure out how we do more with less.

Speaker 2: 50:49

Clinical informatics is not cheap. I mean, you got to think about it. Most everybody on my team is either a nurse or a physician. Right, those are not cheap salaries. And if you look at our budget, all I am is a cost center. I cost the organization money because all the money that's contributed to informatics or from informatics is actually contributed to someone else's department it's not mine.

Speaker 2: 51:19

And so I try to figure out how do we, how do we do more with less? But how do we also advocate saying that the reason you're making a million dollars more is because we identified this and we worked on the workflow to get it incorporated back in, but while not killing my information staff and and saying I need you to produce more, more, more, more, more, more, and I know that there's only so much that they can do in a given day. You know, everybody's human, we, we can't keep going and going and going. So I need my job in this and what I need to do a better job of is helping paint that picture for leaders as to what the real value of informaticians are and why it's necessary for the organization.

Speaker 1: 52:06

Yeah, yeah, being a big as the leader, I guess you are the advocate for your department.

Speaker 2: 52:12

Absolutely.

Speaker 1: 52:13

Yeah Well, mark, I know that's our time today. Thank you so much for joining us and for sharing your journey and insights with us. I've really really enjoyed our conversation.

Speaker 2: 52:22

I appreciate it. It's been fun sharing time with you and talking through this. I mean, I can talk about informatics all day long. I have a vision of where I want it to go and I think that we're moving in that direction, so I appreciate the opportunity.

Speaker 1: 52:38

Yeah, that's so exciting To our listeners. We would love to hear your thoughts and experiences on this episode. Share your comments on LinkedIn or directly on the podcast website at pivotalbuzzsproutcom, and if you know somebody in healthcare who'd find this episode inspiring or beneficial, share it with them. They can listen live on LinkedIn or anywhere you get your podcasts. Stay tuned for more episodes here on the pivotal podcast.