October 10, 2019/Nursing/Nursing Informatics

New Knowledge, Innovation & Improvements: The Transformation to Digital Nursing Care

Agility is key to implementing new technologies


The relationship nurses have with technology is entering the digital frontier says Nelita Iuppa, DNP, MS, BSN, RN-BC, NEA-BC, FHIMSS, Associate Chief Nursing Officer for Nursing Informatics. Her team is working to ensure that Cleveland Clinic nurses are adapting to this new world.


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“The enterprise strategy for digital nursing care across a patient’s lifetime and encounters is a vast landscape of opportunity,” says Dr. Iuppa. “Moving from simply being automated, or electronic, with current tools to becoming digital is a completely different nursing experience. It is fundamentally changing how, when and where we interact with our patients and also, our care team colleagues.”

Cleveland Clinic nurses are among the many health system clinicians who are transforming their practices. With the explosion of new technology platforms commonly referred to as the Internet of Things (IOT), nursing is leveraging a number of connected health devices and applications to transform patient care. New technologies include machine learning, artificial intelligence, layered mobile applications, predictive analytics, smart sensors, wearable technology, and a virtual presence delivered from remote locations.

“These technology solutions introduce a new dynamic for how our nurses interact with and manage digital device and sensor systems,” says Dr. Iuppa. “We also find that digital solutions are actually freeing up nurses’ time, allowing them to have more time to provide compassionate care, which remains core to our mission.”

Digital Nursing Transformation

Several recent projects have launched the transformation to digitalized care in the Nursing Institute. Dr. Iuppa notes that these projects differ from technology automations of the past, which focused on moving from paper to electronic solutions, and in the best of circumstances provided some additional clinical support when fully implemented. “The digital technologies we are implementing today are actually disrupting the way we provide care by changing how we interact with patients and our fellow caregivers. They are game changers.” Here she describes some of the technologies.

Secure text messaging: Cleveland Clinic nurses are now able to send and receive secured contextual patient messages within the electronic medical record, establishing a robust new communication channel. Nurses, providers and other members of a patient’s care team can now send care updates and treatment recommendations, thus enabling more empowered and timely patient care.

Nurses have been great adopters of this form of communication. On average, there are 4,000+ messages sent every 14 days. Nurses send approximately 26.28% of messages, APNs send 6.29%, and together health unit coordinators and nursing assistants send approximately 3.94% of all messages in the system, as of June 1, 2019.

Wireless temperature monitoring: Used to monitor refrigerator temperatures for patient medications, laboratory specimens and food storage. Wireless monitoring eliminates the need for manual logs. Instead, automated alerts are sent to health unit coordinators and charge nurses when temperatures go beyond an acceptable range for too long so immediate action can be taken. The transformation ensures that patient medications and specimens are always stored based on the highest level of quality control.


Mobile phone apps: These are quickly emerging as one of the most helpful tools, Dr. Iuppa says, by eliminating documentation and speeding up processes. One example is the wound care mobile app, which measures and documents skin consults in the electronic medical record. “Having the ability to visualize patient’s skin condition over many days by all caregivers along with expert recommendations for interventions helps our nurses provide optimal care for wounds and allows them to synchronize their approach to the patient’s plan of care.”

Another dedicated nursing documentation mobile app allows nurses to document frequent tasks and scan medications quickly as they move between rooms, without having to access a computer to complete these steps. “This solution has decreased demand on our workstations on wheels [WOWs] during peak periods and it has improved our real-time documentation compliance scores for frequent tasks such as hourly rounds,” says Dr. Iuppa.

Agile Nursing Informatics Workforce

Partnering with nurses on the digital journey requires new approaches to how technology is deployed and maintained. “As new technologies are conceived and eventually introduced, it is clear that the fundamental practice of informatics must also adapt to the changing digital landscape,” says Dr. Iuppa. She explains that the Office of Nursing Informatics along with their IT colleagues recently transitioned to a new practice model known as Agile. This methodology provides a framework to provide quicker and more meaningful IT project results to nursing staff.

Historically the IT approach to projects was a “waterfall method,” meaning first they would analyze what needed to be done and go through all of the major steps in a project, one after another. This meant that it could take many months, and sometimes years, for projects to be completed. Also IT staff would take initial input from clinicians to build out systems. Checkpoints for validation of the solutions along the way were infrequent, which could lead to an end product that was not quite what caregivers had envisioned.

At the core of the Agile approach, the Nursing Informatics team begins their work with a conversation with nursing staff to understand the end goals. The next step is to move into a sprint cycle, which is a two week period of rapid design, development and testing for a small portion of the end product.

“From this sprint cycle, we are able to demonstrate a minimum viable product to the nursing stakeholders during a showcase meeting where the next set of deliverables are defined and the next sprint cycle begins again,” Dr. Iuppa explains. “This process takes a bigger project and breaks it into a more rapid and frequent feedback process.”

The benefits of being Agile are that nurses now have a product they can start to use sooner and they are more effective partners for technology initiatives during the course of a project instead of at the beginning and end.


“Internally for our nurses, Agile principles have created an environment that is conducive to team collaboration, peer accountability and better output efficiency,” says Ryan Bush, BSN, RN, a program manager in the Office of Nursing Informatics (pictured above). “Externally, Agile principles increase transparency back to the nurse through an iterative process and ensures that the end product meets nurses’ expectations. Ultimately, it provides the best caregiver and patient experience possible.

The role of the specialty nurses working in Nursing Informatics continues to change as the digital experience introduces new uses cases, devices and technology solutions to transform nursing care. Together with the front line, all nurses are creating a new future for the relationship that technology plays in digitizing patient care.

The Future for Digital Care

Moving forward, nurses can expect greater interconnectivity among their own IOT, from patient interactive solutions such as automated white boards in patient rooms to wearable technology and natural language processing.

Says Dr. Iuppa, “It won’t be long before our nurses and patients are using voice assistive technology devices to obtain information from medical records and other connected systems to set reminders, answer questions or complete documentation. The digital future is convenient, predictive, interactive, smart and portable. These solutions will continue to change how we approach patient care and our newly agile informatics nurse workforce is ready to partner with our nursing peers along this journey.”

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