As we approach the end of the year, many of us are reflecting on our accomplishments for the year. Maybe we’re proud of the work that we’ve done, or perhaps we are forced to reflect because of end-of-year performance reviews. I enjoy thinking through how I spent my time and how it might have impacted patients.
I asked some of my CMIO colleagues what they are most proud of this year. Many of the projects were predictable, but at least one was surprising.
The first CMIO who weighed in was a little embarrassed about his accomplishment. Apparently his organization never got the memo about the benefits of having proximity cards or other non-password technology to help reduce the burden of multiple logins for its clinicians. Mandatory EHR upgrades or replacing a solution that was about to be sunset always took precedence. A couple of recent cybersecurity events had also consumed a good chunk of the budget and pushed other needs and wants aside. I certainly understand having to spend money on that.
Regardless, the clinicians are happier not having log in while going back and forth to the workstations in patient rooms, so that’s a win for the year.
The next physician leader was passionate about expanding virtual physician services in the emergency department. His organization’s busiest hospitals put a physician assistant in the triage bay. They worked closely with nursing staff to perform workups on patients who were still in the waiting room. The PA examined the patient and entered orders.
When wait times were at their worst due to bed shortages elsewhere in the hospital, some patients were actually discharged from the waiting room without ever making it to a regular emergency department bed.
The twist this year was using virtual technology to expand that to hospitals that didn’t have the volumes to support the provider-in-triage concept. He felt that it was a win all around. Patients were happier to get their care started more quickly, emergency department staff members were happier because they had fewer patient complaints, and emergency providers were happier because they could opt in to the remote shifts for a break from the ED’s physical grind.
This is a great strategy. I am surprised to see so few facilities creating programs like this. It improves key metrics like the door-to-doctor time, addresses bed turnover issues, improves satisfaction, and provides options to keep physicians in the game when they might be ready to retire. The physician workforce crisis isn’t going away anytime soon, and anything that we can do to maintain those folks and their expertise is good.
I know of another system that has implemented this paradigm. Remote shifts are staffed by people who might otherwise be on medical leave due to orthopedic issues or pregnancy complications, or who need to travel to another part of the country to support family members.
It’s inexpensive since the major investment is a workstation and cameras. Even if you have to do a little rearranging to accommodate a gurney in the triage area, it’s cheaper than building more emergency beds. Another significant factor is probably that hospitals can make a lot of money billing the provider portion of the visit rather than having patients leave without being seen.
Multiple CMIOs said that ambient documentation was the best solution that they implemented all year. Most of them had pilot cohorts that tested the technology first, and at least a couple of them went through a bake-off process where they trialed solutions from different vendors before making their final selection.
One CMIO said, “This is one of two things that I’ve ever implemented that my physicians thanked me for.” Most of them are implementing the technology in ambulatory environments. Only one who I spoke with had a significant project for inpatient wards, and that is in a facility that has 100% private rooms for its patients.
I loved the idea that one correspondent shared about how her facility trained the ambient documentation tools. They created a curriculum called “Caring Out Loud” that addressed how physicians needed to change their history-taking and examination skills for the best outcomes with the technology. Some physicians felt like “talking to themselves” made them seem less professional, but only two of them chose to go back to traditional documentation.
Virtual nursing was also a big win for one CMIO who responded. In a plot twist, this CMIO is a nurse practitioner. Although I’ve seen people in similar roles elsewhere in the industry, she’s the first non-physician CMIO who I’ve gotten to know personally.
Her facility has been able to move approximately half of the steps involved in the nursing admissions process into a virtual workflow, which has been helpful as they continue to have staffing challenges. At their facility, all nurses work at least one virtual shift per month so that everyone is cross-trained. All of the virtual nursing work happens on site, which is different than other models where virtual nursing is used to retain staff that otherwise might be ready to leave bedside nursing.
One respondent’s biggest project was a deterioration prevention system that identifies patients who might be heading towards a crisis. I was surprised to learn that one of the major challenges in that effort was the change management piece. It was not designed to bypass human intervention, but people felt that its use might discourage them from raising an alarm if they suspected that patients were having issues.
The hospital held listening sessions so that staff understood what the system was designed to do, and what it was not. They were made aware that they needed to still rely on their internal “Spidey sense” if they felt that a patient was at risk.
I was surprised that AI projects, other than ambient documentation, were far down the list for many of the people I spoke with. That could be an artifact of budgeting processes, where priorities for 2025 may have been set in the summer of 2024. Or, perhaps skepticism remains around AI and how it should fit into the bigger picture of patient care.
I also think that many facilities are playing catch-up around operational and quality debt and therefore have less time to spend on shiny new things. I’m glad to see those institutions focusing on the basics, because if you don’t have a good foundation, everything else is just window dressing.
What are you most proud about in your work during 2025? Do you have a focus you’re excited about for 2026? Leave a comment or email me.
Email Dr. Jayne.
