Future of Global Informatics_Episode 5_AUpton: Audio automatically transcribed by Sonix

Future of Global Informatics_Episode 5_AUpton: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

TJ Southern:
Hey, y’all! Welcome to the Outcomes Rocket Network – The Future of Global Informatics Podcast, where we discuss global informatics through conversations with industry leaders and innovators so that you can understand what it is, what it does, and how it shapes the healthcare of our future. I am your host, TJ Southern.

TJ Southern:
Good day, good day, good day, everyone, and welcome to another episode of The Future of Global Informatics. I am your host, TJ Southern, and today we have such a special, special treat. We have Miss Amora Upton. Yay!

Amora Upton:
Hello.

TJ Southern:
We love Amora Upton! Good morning! How are you doing this fine morning?

Amora Upton:
Great! How about yourself?

TJ Southern:
I am doing wonderful, I am doing wonderful. So guys, what makes Amora so special is, a, I was able to meet her at HIMSS and connect with her at HIMSS, but b, she has such a vast well of knowledge. So today we are going to pick her brain, ask her all these wonderful questions about our world of informatics. So let’s go ahead and get started. Amora, tell the people a little bit about yourself. Who is Amora Upton? So that the listeners will know who you are.

Amora Upton:
Well, that is a loaded question. I am many things. Well, let me start off with I’m an Army veteran.

TJ Southern:
All right!

Amora Upton:
Yes. So before that, because that colors my world a little bit, so I’m also a mother, so that also colors my world, so I’m always multitasking. Keep, you know, I’ve got besides the stepmom of an older child that also is giving me grandkids, I also have a son of, it’s almost 12, and my twin daughters, identical daughters that are almost nine. So they’re always traveling with me because I like to travel in my RV. So I go all around the country, I like to travel around the country with, in my RV. I’ll, okay, also let’s see, I’ve been doing nursing for, oh gosh, I don’t want to say how much I’m aging myself here, so over 20 years. So let’s see, then, let’s see, I’ve taught nursing, I’ve been a pediatric nurse, I’ve been a public health nurse, but mainly I’ve always been into gadgets, and so I’ve been the gadget girl, always. So when I found out there was something called informatics, that was it. I was like, oh, that’s it, that’s me all the way. Because even in the army, you know, back in high school, they found out I knew, you know, I started typing, you know, I was taking a typing class. And so when the army, they found out that I knew how to type, they took me out of my MOS, which is what the job title you’re given, they took me out of it, and they said, hey, no, you know how to type, here. They took me out of the financial specialist I was in, and they pulled me out and they said we need you in this, with this over here. So they took me out and put me in S-3, which is basically the supply areas, and they took me into all these graphics programs, and help, they wanted me to help them. So they sent me to school for all the computer graphics programs and all the extra duties. So in the Army, they sent me all over to learn all these extra graphics programs and things like that that were just the cutting edge things in the Army at that time. So when I got out the Army, they said, you want to be a nurse? And I said, sure, that sounds like a promising career! It’s got a future. And so I was able to merge those two things together, those graphics programs and things I learned then to being a nurse now. So when I found out that was actually a career for that later, I said, ah, that’s it, that’s for me. So, and I, and since then, I’ve been a professor at different universities, and I’ve been teaching nursing informatics all over as well. So that’s just a little bit, a little bit about me.

TJ Southern:
Oh, my God. See, I told you that we had a treat today. I told y’all that we have a treat today. So, Miss Amora, what inspires your current work in healthcare? What inspires your current work?

Amora Upton:
Well, I am a nurse in the Department of Veteran Affairs, and I’ve been working at the Department of Veteran Affairs for a little over eight years. But before that, I’ve been an informaticist, oh gosh, for 12, 14, somewhere, 12 to 14 years on and off, just going all over. I did like my, it started off actually when I was working as a public health nurse, it started there. You know, doing a little bit of everything there, and that actually blew up from there. So I did my practicum at the Cleveland Clinic. You know, the head, I didn’t know who I was asking. You know, you just kind of shoot for the stars when you’re asking for who to, to sponsor you for your, you know, for informatics. And it turns out the person I was asking to sponsor me for my internship was the head of the Informatics of Cleveland Clinic, and they said yes, and they said yes. So they sent me to every Cleveland Clinic hospital all over, they sent me to every one to do the Hospital of the Future all over Cleveland Clinic. So it was a great experience, you know, so, and I did an extended internship all over the Cleveland Clinic.

TJ Southern:
Wow!

Amora Upton:
And then it turns, yeah. And it turns out that person, and then it turns out that person actually, in the future, left the Cleveland Clinic and went to head Cerner.

TJ Southern:
Wow!

Amora Upton:
So, yeah, yeah, her name is Susan Stafford. She left the Cleveland Clinic and went to head Cerner. Yeah, it was a great experience.

TJ Southern:
That is absolutely amazing. So y’all see what a strong preceptorship can do? You know, Miss Amora, this is the, these are the things that I’m making sure that I highlight while we’re discussing informatics, nursing informatics. You know that is one of the big pivotal items that I continue to hammer home is preceptorship, making sure that you have a strong preceptorship because it can really, really take you far places. It can take you far, it can catapult you. What are some of the biggest challenges or changes, so challenges or changes, that you have seen in informatics?

Amora Upton:
Oh, wow. There’s been so much. One of the things that even brings me to what I was going to talk about today, you know, starting off informatics, you know, I didn’t stay in the Cleveland Clinic system. I actually went to St, around the Cleveland area, there is in the downtown Cleveland area is, in the middle inner city, is a charity system, health system, that takes charity cases, and they have a couple sister-brother hospitals in the area. Anyway, because of that, it was a smaller health system which meant you had to build everything. So I was actually part of the IT department as a nurse informaticist. So after I graduated, you had to, I learned, I went to a Meditech system, so I learned Epic in Cleveland Clinic, and then I went to that system and learned Meditech. Went to Boston, everything, learned everything there. But since it was a smaller couple hospital system, you had to do everything for every program. Every program. You built it, you learned it, you built it, you taught the educators, you put it out. Six months later, you went to the next system, you learned it, you built it, you put it out there, next system, you learned it, you built it, you put it out there. So you went from system to system to system to system. So you did the entire medical record of, was there, was barcode medication system, whether it was a physician practice system, whether it was the nurse system, whether it was the emergency room system, it was every single system. You know you went from one system to the next to the next to the next, from one hospital to the next hospital, one system to the next system. So you did the entire electronic health record system from one to the other.

TJ Southern:
Basically, the entire life cycle.

Amora Upton:
Correct. They, each part of it. Now that was great hands-on experience. You had every part of it. Now, we had our, as a nurse informaticist, you had your foot in, since we were the IT department, one foot was in the IT world and one foot was in the nursing world, okay? And so we are always, they didn’t understand, IT really didn’t understand the clinical world and the clinical and the clinicians because they were going from paper to electronic, didn’t understand that. So, and historically that’s been the case.

TJ Southern:
Yes, it has.

Amora Upton:
Now, and if, a lot of the times if they, if another, systems, if they just gave you, other systems that just, some systems just gave you premade software. If they just gave you a commercial off software and gave it to you, it wasn’t built correctly for you. They just said, okay.

TJ Southern:
Occasions of your organization, yep.

Amora Upton:
Correct. They’re like, here. Here is software built for you. Here, it’s a box system, here you go, it’s made for you. And that’s often been the case with different software, Cerner, Epic, you know, things like that if it wasn’t built to your specifications. See Meditech, we built it. So we knew exactly because we built it for them because we went out, got all the data, got exactly the workflow. We built it exactly how the nurses and the physicians wanted it. You know, after finding all the data. Other systems, they said, no, this is what you get, here you go. Then when it doesn’t work, everybody starts making all the workarounds. Now, does that sound familiar? All the different workarounds? And then everybody is just like, because this isn’t us, this is not our workflow. We can’t work like this.

TJ Southern:
Yes.

Amora Upton:
So what happens when all those workarounds happen? Problems happen, right? Patients get, something happens with the patients because this isn’t how it works. The problem being in today’s world, we’re at that crux again.

TJ Southern:
Oh yes!

Amora Upton:
And now, we’re at that same thing, because in today’s world, now 2022, we have artificial intelligence, Internet of Things, blockchain healthcare. We’re at that same crux again. So where are the nursing informaticists? Are we at the table?

TJ Southern:
I’m telling you, this is like, oh my god, you are like, target dead on. I keep saying this, I’m going to keep saying this. If there are people out here listening, I am going to keep preaching this. Nurse informaticists have to be at the table. You healthcare systems, you’re building all of these beautiful, nice systems, but you do not have the proper people at the table. If, you as healthcare systems bring in nurse informaticists, I just talked with this about with Michelle Currie, I just talked with this about Tanya Lewis, I just talk with this about with LaDonna Grace. We are all saying the same thing, the same exact thing. We need to be at the table to help you properly implement, properly scope out your EMRs, properly look at the EMRs, look at the life cycle of the EMRs, making sure that all, that the EMRs are properly vetted amongst all disciplinary. Only a nurse would know that because it is our job to constantly be in contact with all of these disciplines because guess what, it’s patient-centered care. We know what housekeeping does. We know what dietary does. We know what labs and pharmacy do. We know all of these disciplines because it is our job to make that whole world turn for the patient. Now, here we are again in the EMR space, right? As Amora just mentioned, we have blockchain, we have the Internet of Things, cybersecurity is getting ready to be a new one. Cybersecurity is getting ready to be huge, and I am not hearing any Nurse Informaticist being invited to that table. Who knows the EMR better than, who? A nurse informaticist. I keep telling y’all, y’all need us. Y’all need us. That’s what we are here for. And we’ve been here for years. As Amora said, she’s been a nurse informaticist for 13, 14 years. I’ve been one for 14 years. We met, nurse informaticists here on this podcast that have been in NRs for over 20 years, and we are going again through this same cycle of a, trying to make sure that people understand who we are, what it is that we do, and trying to let healthcare systems understand how important we are, how vital we are to the success of your record. Hello? Hello? So in stating all of that, I’m gonna hop off my soapbox now.

Amora Upton:
It is highly needed. It is highly needed.

TJ Southern:
So now with that, what opportunities do you see that currently exist for nurse informaticists, and I come back to that point of what opportunities because that is the only way that I feel that we will truly show our value. I was talking to Tanya a couple of weeks ago and she stated the main thing was our discipline as nurse informaticists has not been legitimized, right? It took us a long time to even legitimize the discipline, right? And so now that we’re here and I hear this from the nursing student community all the time, well, how can I really get a job? Is it something that I can do? I’m going to school to get this degree, what is my ROI, return of investment? So can you speak to that for us, Amora?

Amora Upton:
It is, there is definitely an ROI. I know, again, I’m working at the Department of Veteran Affairs, so at the Department of Veteran Affairs, there is a large contingent of nurse informaticists, and there will continue to be a large contingent of nurse informaticists, especially as they move from CPRS, the current EMR there to Cerner. And they are actually hiring a lot of nurse informaticists. They will continue to do so because that is a big undertaking across the entire nation. They need more. It’s a heavy lift to change an entire, to shift the country from one infrastructure because basically they’re going, they have to be lockstep with the BOD, with the military.

TJ Southern:
Yes, they do.

Amora Upton:
So they have to be lockstep and that’s a heavy lift, and to keep it lockstep. So, and there’s so many parts, and what I am telling everybody else is because the Internet of Things is a thing now, it is not just, the Internet of Things is huge. Nurses have to, I don’t want to say upskill, but basically, they have to upskill. Internet of Things is not just, nurses have to know things. You know, it’s hill rom, it’s beds, it’s IV pumps, it’s knowing the appointments. It’s not just, it’s a highly skilled environment. And the first thing they do is they call the nurse informaticists because they’re stuck. It’s the … badges, it’s the communication devices, it’s everything. So the Internet of Things are the wearables, you know, and for the 20th year in a row, nurses have been, the Gallup poll said the nurses are the most trusted.

TJ Southern:
Profession.

Amora Upton:
The most trusted profession, once again. And there’s a reason for that. So who are they calling? The patients are calling nurses.

TJ Southern:
So are the doctors.

Amora Upton:
So are the doctors, everybody is calling the nurse and the nurses are going to go, and the nurses are going, I don’t know.

TJ Southern:
They don’t know.

Amora Upton:
Let me call my informaticist.

TJ Southern:
Yep.

Amora Upton:
And so the informaticist are going to say they put something out. What did they put out? Oh, I don’t know. Let me go track that down because they didn’t include me.

TJ Southern:
Exactly. Exactly.

Amora Upton:
And so.

TJ Southern:
And miss Amora, when I tell you, you were like, my soul is on fire, right?

Amora Upton:
….

TJ Southern:
Yes, because the systems cannot properly operate, period, without us. I mean, this pandemic that we are starting to slowly shift out of has shown, proven, solidified nurses being needed in the hospital system. The caveat to this is a lot of changes have been made in the hospital as it relates to the picture of the patient care, right? And we have not been involved in this. And now let me back the statement up a little bit. Yes, we do have chief nurse informaticists. Yes, we do have chief nurse officers. Yes, we do have all those chiefs in and nursing sitting at those seats. But at the core, once all that work trickles down, it’s okay to have a chief nurse informaticist, but it’s not okay if you don’t have the informaticist to support that chief, and that is what I’m trying to say. So we need nurse informaticists in the system actively working to be able to support the changes that are being currently made and sought after in the healthcare system. So with that being said, how do we support new nurse informaticists coming in, and or, how do we support those nurses who are just being plucked from the floor? Because now we have to we have two different fronts that are happening, right? We do have some organizations that know that they need a nurse informaticist, right? It’s this dark abyss hole that they’re like, oh, well, maybe we should just plug a nurse informaticist in there, okay? But the issue is they’re taking nurses off of the floor to plug them into an IT role, and then the nurse informaticist is either sink or swim. That’s what’s been going on. It’s a sink or swim thing. Also with the new nurse informaticist that are coming out of school, I am finding, and this is just my opinion, and while many people may not like it, but that’s okay, I am finding that the new nurse informaticists that are in school do not have a background in informatics, a, don’t even know what informatics is, b, and c, don’t know what this new job entails, they don’t know any of this. They are just going into informatics, oh, because they think it sounds good, or, oh, because they’re a techie person or they think, you know, or you have a lot of them that are being burnt out. And now they’re like, well, let me try something new and I’ll go over to nursing informatics. So how do we, as the grandmothers, yes, I’m considered a grandmother, we’ve been in this for over 15 years, how do we, as the grandmothers help the transition, help the new nurse informaticists coming in?

Amora Upton:
Well, as I transition from one informatics position to another, I consider it a junior position and a senior position, okay? So there has to be several levels, because as I tried to train my managers, because my managers have no idea what an informaticist is, and I’ve trained managers over and over because I keep getting managers that have no idea what informatics is. I keep getting managers, every manager I got, I have no idea what informatics is, so I keep training them. So, which is also a problem, okay? So it’s also a problem that we don’t have our own hierarchy of informatics. We don’t even know that … position is not giving us a hierarchy. We need to have our own, we need to fall under our own structure of informatics, that would help. If, it would help if we fell under our own hierarchy. If our junior seniors went down in that hierarchy, that would definitely help. But until then, our senior, or junior-senior formation, like the juniors, need to be the ones running out to the floor to fix, like, say, the med cards or something like that. Our juniors need to do that. Our seniors need to be the one on the calls, making the advice, be on the calls, in the meetings, saying what we need to be in there, giving the advice on the things.

TJ Southern:
I love that.

Amora Upton:
Because when I, this, in the past meetings, in my past where I just left, they kept trying to send me out to the floors to fix med carts and do restart to the computers. I said, look at my day-to-day jobs, I am in the artificial intelligence policymaking. Why am I leaving artificial intelligence policy calls to go restart a computer? I’m not a junior, I’m a senior. So I should, I’m making policy at the national level. I should not be leaving policy calls to restart a computer. So there’s a couple different levels here. So, and I’m trying to train my manager this, so we need to get juniors. So when you hire people, we have to get different levels in, so yes, when you hire some people, they need to understand the different levels of hiring. So, when, as you bring people in, know the different levels you’re looking for. Are we looking for a junior or a senior, okay? Are you looking for somebody to run to the floors to help the nurses fix med carts? Or are you looking for someone that can give advice on policy making? Are you looking for somebody to make those policies of informatics, to make the policies on how to, the … badges. Do you know what I mean? Are you looking for policies or, you know, so that is what we need.

TJ Southern:
Hmm. I love that. I love that hierarchy. I mean, and I didn’t even think about it. No, we don’t have it in nursing informatics. It’s funny because we have it everywhere else. We have it on the floor. We have that hierarchy on the floor, and we should have the same here in nursing informatics, we don’t have it. A lot of times organizations, they put out posts for nursing informatics and nursing informaticists, and they don’t even know what they need. They don’t even know what they need because we have not, as a discipline, there is no standard of what a junior level, a mid-level, a senior level, there is no standard with description of what that job entails. Nursing informatics.

Amora Upton:
We created one. We created one in the Department of Veterans Affairs.

TJ Southern:
Oh, I’m so glad.

Amora Upton:
We created one that what it looks like, where you can describe yourself. Say okay, at this level, it’s based off of the ANA, the ANA descriptions. So it’s not just something, we went across the nation, because like I said, we have a large contingent of nurse informaticists in the Department of Veterans Affairs across the nation. So we grabbed a council of senior leaders, of nurse informaticists, and we got those together. And we said, okay, based off the ANA criteria, what does this look like? You know, if you’re doing these standards, you know, the ANA standards one through ten or whatever, the ANA standards, what does this look like? You know, for the standard number one, what should you be at for a mid-level, beginner level, and a senior level. So you can get your competencies together, nursing informatics competencies. So you always be looking at always achieving a higher level.

TJ Southern:
I love that. I love that.

Amora Upton:
And if you’re, you know, you’re always looking at that level, you should be able to even judge yourself. Okay, I am, I can look at this and say, I am only at this. I don’t know how to do this yet. Where are you? You can be able to rate yourself.

TJ Southern:
I love that. I absolutely love that, man. Y’all heard it here first. There are organizations out here that are actually doing this. There are other organizations that have not done this, I would highly suggest that you do. It will help you when you get ready to look for an NI candidate because that is the first question that I ask, when I have organizations that come to me to ask me for NIs, I’m like, okay, well, what exactly is it that you want them to do? You have to tell me what it is that you want this person to do because there are six different things that this person can be an expert in as a nurse informaticist. We know that. You have trainers, you have policymakers, you have builders, you have testers, you have PMPs, PMs that are nurse informaticists. So what exactly is it that you want this NI to do? Organizations, you have to make sure. You can’t just put a job description out here and say, you know, this is just the umbrella of what it is that we want this person to do, because as Amora stated, what’s going to happen is you’re going to hire a senior person, then you’re going to say, well, we need you to go out to turn on this computer. That should not be their job as a senior level. It should be, you should either see an entry-level nurse informaticist or you should send an IT person to turn on a computer. Let’s be real. Let’s be real.

TJ Southern:
So what do you think needs to be talked about more or spoken about more to bring awareness to our role within healthcare data? What like, what do you feel needs to be done so that people understand that we are a, needed here in healthcare, especially when it comes to informatics, what do you think needs to be talked about?

Amora Upton:
Wow. Besides policy, basically policy. You know, I work often with an organization called the ACT-IAC. ACTIAC.org, if you want to look it up. It’s a public-private partnership through the government, again, since I’m a federal employee. It takes organizations from both sides of the House, so we can work on government employees and organizations from like Microsoft, Oracle, a lot of organizations on both sides of the House. So either the government or organizations to partner together so we can get the best of both worlds to volunteer and work on policy issues for, and we get together, and we give recommendations so that things that the government is asking for, and we give it back to them. So when the government is asking for like, if Congress is asking for something or if the president asks for something or something for, like anything IT related, or like when they ask for something artificial intelligence or something like that, so they asked for things like this and informatics. They ask for something for artificial intelligence, okay? When they asked for something in artificial intelligence, I went to a meeting in artificial intelligence, and I found out that there were no nurses in artificial intelligence meetings. And I said, why not?

TJ Southern:
Why?

Amora Upton:
Why weren’t there any nurses in artificial intelligence meetings? They were talking about things like, you know, for engineering and data scientists and things like that. And I said, you know, so we’re making these public policy presentations.

TJ Southern:
With no nursing backgrounds.

Amora Upton:
No nursing. I said, hold up. I am needed here because there is no representation. I said, for one, you’re making this too complicated. The nursing informaticists, the first thing they do is, they are the universal translator.

TJ Southern:
Yes, we are.

Amora Upton:
So without us, everything is too complicated. The first thing we do is make it simplified for the end user.

TJ Southern:
Yes, we do. That is our job. Mm-hmm.

Amora Upton:
And so, do you think the government people, in Congress, that you are writing this public policy for in artificial intelligence are going to understand what you just wrote? They don’t understand this either, you’re making it too complicated. So if I can’t understand what you just wrote, they can’t either. So my job is to understand everything you just wrote in artificial intelligence because also the end user has to understand it. And I also have to give a healthcare example, because you are writing artificial intelligence as if it’s only in that realm. Artificial intelligence is also used in healthcare.

TJ Southern:
Come on, now.

Amora Upton:
So nurses have to be at the table in every arena.

TJ Southern:
Y’all heard this, y’all heard this nurse.

Amora Upton:
We started writing, I started writing the public, the white papers in public policy. So this always, nurses have to be at every table. That is also where we’re also needed. We are needed everywhere.

TJ Southern:
Oh, so y’all nurse informaticists that are out there, new that are coming in, season vets, right, that have been out here for years, okay? We are needed. So I don’t want to see on these job boards and these forums, oh, can I get a job? Yes, you can. You can get a job. I’m going to tell you this. You need to make sure that you have a great preceptorship, a strong preceptorship, right? Start reaching out to people that are already nurse informaticists. You guys, we are here to help you. If we don’t know the answer, we have networks of other nurse informaticists that we will, that we can point you in the right direction to those other nurse informaticists that may be able to help you. Nursing informatics is not a one-shot, one thing, one all, be all. It does not fit into this little square check box. It doesn’t. As Amora just said, we are needed at every table. So policymakers, healthcare organizations, y’all need us. Y’all need us in AI, y’all need us in cybersecurity, y’all need us in the Internet of Things, any wearable device that connects to that EMR, y’all need us. I’m going to keep saying this and keep hammering this. We are needed, okay? We’re needed. Miss Amora, you got any closing thoughts for us? Any final words for us today?

Amora Upton:
If they keep closing doors, go around them.

TJ Southern:
Come on, y’all. That’s a good one. That is a good one. So she is saying be encouraged. To my new nurse informaticists that are trying to get in this field, if you really want to get in it, keep knocking on them doors. It will open, it will open. Thank you, Amora, for being with us today. I told y’all she was a treat, I told y’all she was a well of knowledge. I am so honored to have her here on the Future of Global Informatics with us today.

TJ Southern:
Hey, y’all. Thanks for joining us today for another episode of the Outcomes Rocket Network – The Future of Global Informatics Podcast. If your organization is looking for informatics talent, go to www.Beryllus.net. That is www.B E R Y L L U S.net, and we can assist you in finding some of the best nursing informatics talent this continent has to offer. We’ll talk to you later! Have a great day! See ya!

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