Future of Global Informatics_Episode 12_Debra Graham: 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:
All right! Hey, y’all! Hey, y’all! Good day! Good day, and welcome to another episode of The Future of Global Informatics. It’s your girl, TJ Southern, and today we have Debra Graham, yay! We have Debra Graham. All right, Deb, tell the people about yourself, tell them who you are.
Debra Graham:
Who I am, I’m Debra Graham. I’m a wife, a mother, a nurse, a follower. I’m, I’ve been in now, this career, I’ve said 15 years, for over 15 years, TJ So I’m in, now approaching my 40th year in nursing, so please don’t shut the podcast off at this point. I can’t operate my phone, and I did reset my, a new, set up a new network in my house yesterday, so I do have some skills. I didn’t ever want to be a nurse. I didn’t grow up like Mary Ellen Walton from the Waltons Mountain, and that’s my age bracket. I didn’t grow up like her. I didn’t always want to be a nurse. I grew up really not knowing what I wanted. And so I embraced that, that now nursing is such a career development, it is such a great aspect that you don’t go to school for one little bit and then come out something. That was, my basic education was a bachelor’s in nursing. I came into informatics quite, in a coincidence of someone leaving a role, that I’m very thankful. I mean, she left that, she’s successful, we stay in touch, but because of her life choices, I had a choice to leave management intensive care directorship in education, take on informatics. And from that was the foray of the electronic medical records, early our mid-nineties, late nineties into charting for the nurse and for then to bedside med verification. So that was really my path into it. So many young folks want to know, how did you get into it? Well, it really evolved to me, I didn’t set out, hey, I want to do informatics. So I’m of that age that it evolved, so I love to say to people, I make my living in a career that didn’t even exist when I graduated from college. So, career development, keep learning, keep pursuing, and so, and now my current role is I’m just recently promoted to the vice president of Clinical Informatics, I work for a group of physicians that, and nurse practitioners, in Florida. So I’ve home officed 13 years or so now, made my living in East Tennessee on a cattle farm with my husband, and so I’m not mobile, I’m not relocatable, so this Internet world has helped a lot with that, I travel quite a bit. We supply medical services to long-term care and assisted livings, skilled nursing facilities, long-term care facilities, and we are boots on the ground day-in and day-out in those facilities and with physicians and nurse practitioners, and imagine all of the communication informatics silos within those systems.
TJ Southern:
Oh, my God. Oh, my God. Okay, so listeners, y’all know, I always tell y’all when y’all listen to my podcast, make sure that you grab a pen and a piece of paper because Debra there gave us a mouthful already, okay? Let me tell you, I love my veteran nurses, veteran nurse informaticists, because they have a well of knowledge to give to us. So I absolutely love the fact that you’re A, here spending your precious time with us, and B, I love the fact that you are so truthful that nursing was not even on your radar. Let me be honest, same thing with me. Nursing was not on my radar, I wanted to be a pharmacist, okay? And I couldn’t get into pharmacy school because, y’all, I’m a let y’all in a little secret, I love to party, I party too hard, but my GPA was 1.79, and by the Grace of God, Marion College University allowed me into their nursing program.
Debra Graham:
Thank you, Marion.
TJ Southern:
Thank you! So I love the fact that you are totally transparent to say the informatics was not, and nursing as its core was not something that you chose, but that it chose you. So that to me is just, that’s amazing, the fact of what it is that you do. So you have worked remote before the pandemic?
Debra Graham:
Oh, yes, long before, long before.
TJ Southern:
Way before the pandemic. So that is just key right there for a lot of people who are just not working at home, you know, before the pandemic, and they’re struggling working at home. Look, guys, we have had people that have worked at home for almost 15, 20 years already, so there you go. All right, Miss Debra, what is it that inspires the work that you do currently?
Debra Graham:
Well, currently, and I think always when you are not a direct caregiver, the American Nursing Informatics Association, their mantra maybe, or one of their catchphrases is, at the intersection of the bedside and technology. And while that may be a little trite, it’s so true, it is just so true. And so what inspires me is, while I do work with, that I’m employed, to make my physicians’ and nurse practitioner’s lives easier, but in my telemed, which we do after hours, that’s a huge part of my world is the support we do after hours when we leave the building, is to make a difference to that staff nurse. I still think that my motivation, my inspiration, my greatest gift is translating practice at the bedside to that staff nurse. What technologies do they need but not makes their life harder? And maybe that will be a different question, but that’s a whole other term on long-term care. But so, I didn’t realize after most of my time in acute care and then with two different technology companies, I worked in sales. But when I came back to a private business to realize that the Recovery Act money, the Meaningful Use money, what we talked about in incentives and all that, mental health and long-term care did not get it, did not get. And so I didn’t know that, you know, you don’t know what you don’t know. And I mean, it was I just assumed everybody got that, but they’re held to the same standards. So you’re held at the same HIPAA standards and you’re held to that you’re supposed to communicate with these hospitals and physician’s offices, and it, they’re just one simple little thing, TJ, there’s no audit trail. Those medical records didn’t have to meet those standards. They didn’t have to supply all that to get those meaningful use dollars. So if I want to see who did something in a record as a user, as a paid prescriber, subscriber of those EMRs, I have to submit a ticket to get them to look at it for me. And so that’s just one little thing that it’s, I was like, what? What? That we have set the staff nurse at, most staff nurses in long-term care, most, now I’m big broad strokes do not, most staff nurses do not have email from the facility.
TJ Southern:
I can believe it.
Debra Graham:
They don’t have it. So I was like, oh, we can deploy this telemed software. You send it to their email that, no, no, they don’t have it.
TJ Southern:
Oh my God, you know what? The thing about this is that was just on another episode talking to someone else about the EMR situations in long-term care and talking about this same topic that you just said. When all of those dollars came flooding down, long-term care was like, totally missed, totally missed. And then, so now here we are all of these years later, and now they’re like, well, long-term care needs to get on. Nobody’s been thinking about them this whole time? So, yes, it’s a huge disparity in that discipline, in that lane, in that market, long-term care. So, oh, my God. Oh, my God.
Debra Graham:
Now, Florida does a really good job, in all of the facilities we serve have an EMR. So I mean, there is a lot of progress. There is a lot of attempt to integrate. There are HIEs in that market, but we rely on the facility, so we can’t subscribe to them as a practice. So still there’s, I mean, it’s beyond silo, and in sometimes, the labs, the radiology are not integrated into the EMR. So yes, there’s the staffing. Yes, there’s, who’s working? There’s COVID, of course, but within the system. So that’s what inspires me to what can like so single sign-on, oh my goodness. What, just what a blessing it is to be able to not have, one Saturday last year in the fall, I followed a staff nurse at one of our facilities at a long-term care facility. I just shadowed and followed her around for the day and it was, now, not everything was an electronic access, but, well, I mean, it is, but it was like a fax code, a long distance code. A code to a door, the code to the automated drug delivery. This person had 14 different somethings to remember to do their work. You know, and so it’s just, it’s, we have just set them up to, you know, or some facilities because of restrictions and what they think they’re doing the correct thing, and they’re worried about their cell phone use. But, you know, there is, HIPAA doesn’t even mention text, the word text isn’t in it. But I’m not saying it’s great, I’m not advocating it, but they have locked things down to the point that it makes it very difficult for them to do their job. So I can’t call the physician and stay at the desk for them to call back. So it’s just, you know, so just putting those tools like secure communication, integrating those orders, just giving them the support that they need, that inspires me.
TJ Southern:
I love the fact that you are like, I’m just going to say it. You are like a modern-day Robin Hood in modern care because, and that’s the biggest, that is the biggest caveat to our role is that we are problem solvers, especially in that technology space. The extra added benefit that you have is that you’re a nurse. So, yes, you’re trying to make it easier for your colleagues, right? They’re having 14 different codes to do our job, like, I would be like, I’m … done for the day.
Debra Graham:
Yeah, and people do, and people just keep their phone with them when they’re not supposed to, not because, and this is nursing as advocates for nursing, not because we’re, want to break the rules, but because at the end of the day, the nurse will do what it takes to take care of the patient, and I just, and yeah, are some of those not best practices, yeah absolutely, but sometimes we also set them up. And let me give you one of my biggest mistakes of 2021, okay, so in telemed, I thought that rolling carts, carts with stethoscopes, carts with toys on them would, were the best thing. I thought that it was an infection control thing, you roll it in the room, it’s a bigger screen, that it would be a better experience for the patient who are elderly, not sometimes not even able to communicate. Well, it was a horrible idea, TJ, because, well because there was only one, you know, or maybe one on each long haul, so then you had to go find it. Then you know, then it wasn’t plugged in, then it wasn’t working. And so in the midst of that, at a technology that’s supposed to help me, I’m just going to ignore it. I’m not going to use it because it’s too much trouble for me. So I’ve come now to see the other day, I read a question on a listserv about doing BARC, with a medic … lab specimen, specimen collection in an ED, and my response to it was more than anything is, you’ve got, do not skimp on the equipment. You have got to have access points, and so now I’ve gone from, forget the cart, to iPad, iPhone, and sadly not everything’s Android compatible, but the more access points increase my utilization.
TJ Southern:
I love it, I love it. I love the fact that you are not afraid to actually pivot once you saw that you made the mistake because that is common practice to get a cart on wheels. That’s very common practice, right? Especially in the acute facility. So I know …
Debra Graham:
Acute, acute maybe there’s one hanging on the wall. I mean, maybe there’s many more of them. I mean, their needs are probably completely different, but in my market, I’ve come to know that it’s, the secure communication and the video is, trumps, if you will, and still in our care for years, I’m listening with the stethoscope. I’m communicating, you know, we didn’t ever have well, maybe we had phone protocols, but we didn’t have phone competencies. You know, we didn’t have to train people maybe to, you know, maybe what they were going to say, but these are things that we have learned as a practice, and I shouldn’t be this long, what time is it? Before I’ve mentioned evidence-based practice, so let me, but the evidence told me through searches that I was confident and the expectation of how I could reduce readmissions and transfers. So the evidence told me that, but the evidence didn’t tell me how. Like, it didn’t say like, you know, like in the technology and the equipment in, you know, in the period of time in training. So I look much more now to transformation science, implementation science, and trying to write my own manual of best practices.
TJ Southern:
Man, let me tell you this. Okay, for the informaticists and for the nurses that are out here listening, I love the fact that Debra has given us another avenue to go into. Y’all hear her say transformation, right? The how? Writing your own evidence-based practice, that’s another area. I continue to say it, and I’m going to keep saying it, nursing informaticists, research. There’s a lot of us that are not in research, evidence, evidence-based practice. There are a lot of us that are not in evidence-based practice, and as Debra has so eloquently put, here we go. The research and the evidence has told her that this is a good thing, but nothing told her how. Of course, you cannot get a how when you don’t have a nurse that is familiar with technology to help with the how, okay? So there are a lot of pieces that nurse informaticists can pick up and run with, okay? There are a lot of pieces, so I’m going to ask you on that front, Debra, what opportunities do you see for nurse informaticists coming in? You’ve been in this industry for quite some time, you’ve seen it evolve. So what opportunities do you see for new coming in?
Debra Graham:
Well, I definitely think in, and as a brand new person, you know, it’s, people ask me all the time, what can I do? What can I do? Is that you, like right now, I am not a formal teacher, I’m not a professor, I’m not adjunct faculty, but for anyone listening, I am interested, but so to put yourself into the role, so to make your own opportunities. Anything that I have done, most of the time, I put myself out there, I asked and asked. When people say, How did you get that? I asked for it. And so what I see in the future, I think, is that role, again between the bedside and technology. So what is that for you? Is that transforming with an electronic record? Is that teaching like maybe part of a practice to that informatics role at the practice that teaches the parents of the pedes how to use telemed, of teaching elderly how to do that, of being that, the change agent to move them toward the technology. And you know I have close friends that call themselves informaticists that spend their entire time in reports and tableau and data biz which I love, I love all of that, but that’s just a whole other facet or, you know, healthcare informatics. So population health and, you know, in just disease management and predictive kind of things, big data, all of that is nothing Deb does. I don’t do any, well, I do, data visualization is a huge love of mine, so I do try to tell a story with the information that I present. But, so lots, lots of things, and TJ, I’m approaching my last decade in nursing, so. No, no, no. I am, I mean, I’m, I want, you know, I’ve got ten more years I think I want to work, and so the future is huge, and I also think that nursing is such a great start for many, many career paths. You know, in informatics, in clinical informatics, I’ve worked with a lot of medical technologists for some reason, with pharmacists, with some physical therapists, so there’s lots of disciplines that set, but the nursing per se, to me, where we must fight for our place is to be that guardian of what the technology does to bedside practice. And if it’s helping, great, but if it’s not, it’s not, it will be abandoned.
TJ Southern:
Let me tell you, Debra gave us the whole life cycle of a nurse informaticist in a nutshell. I mean, as she has told you, there are so many facets to nursing informatics and you just need to choose. The thing that I love that you have told the listeners, Debra, is the fact of you asked. Don’t be afraid to ask. If you want something, go after it. Because there are a lot of nurse informaticists that I hear day in, day out, well, I can’t find a job, well, I can’t do this, they want all of this. Ask, merely ask, and that is the part that I so love. So what excites you the most about your role?
Debra Graham:
Getting the information to the providers that they need to see. Just this morning, we’ve got, and I’m not email expert, I mean I’m not, you know, we are, I think involved in enough things to know a little, right, but, so this morning, I have a new facility that uses Citrix servers, and so our EMR that we use in our practice won’t run in a Citrix environment. You can’t copy from the Citrix and paste to my environment in any place that I found yet, so I’ve been researching that. So that facility right now can’t email us to what the new admissions are so something’s blocking that, so I think a lot of it is dispatch, if you will. It is, okay who can take care of that? Who do we need for this? And oh, that’s not all, that’s not me, or you need to, so a lot of it is traffic cop.
TJ Southern:
Yes, I have said that before. I have said that before. We are information stoplights. We tell information.
Debra Graham:
Yeah, or yesterday, another one of our, we are, we’ve grown this year so much. We are, we started with four facilities and we’re as of September, we’ll be up to 14, and we’re just in growth mode, and it’s fabulous, it’s exciting. And is too, one of my calls yesterday was, hey, in April you said this was budgeted to get these labs integrated into your system, we can’t see them, and we have three different sign-ons to try and dig and find which system they’ve been recorded in. Not to mention what that does to patient care teaching.
TJ Southern:
Yeah, yeah, yeah, it definitely breaks the continuity of patient care. Oh, my God. Oh, my God. Okay, so a couple of things. I want to know where people can find you, A. Y’all heard, PSA for y’all universities that are listening to me. PSA, we have an educator that wants to be an educator, years of experience, here we go. I’m gonna go on this soapbox just for a minute. Educators, we need you. Universities, you need to have nurse informaticists teaching the classes that have real-life, real-world experience. Here we go, Debra has put herself out there, so I need somebody to contact her because I know y’all need us. That’s A, Debra, tell people how they are to contact you. Tell them how they are to contact you.
Debra Graham:
Well, sure, I’m on LinkedIn. It’s Debra Barrett, B A R R E T T Graham. So I’m there. I’m, that’s probably the easiest way. And then, do you want, is that fine, or do you want my email?
TJ Southern:
That’s that is perfectly fine. They can holler at you on LinkedIn.
Debra Graham:
They can.
TJ Southern:
Now, one thing that I want you to tell us, give us some encouragement to leave us with, or do you have any final thoughts for us?
Debra Graham:
Keep learning. Keep seeking. Keep that to, inspire to read. I mean, even if it’s, I’m reading The Count of Monte Cristo right now, but just to immerse yourself in learning and sharing and community with that, the informatics group I’m part of NIWG through AMIA. I’m in the Nursing Informatics Association. I’m a member of HIMSS. So immerse yourself in those that are doing, you know, what’s that, dress for the job you want? Put yourself in the room with the people that, or virtual room, or podcast room of the people that you want to be mentored by or, at some point, that you could mentor others, so keep learning.
TJ Southern:
I love it, I love it. And guess what? You are the second person to say that on this cast. So it’s important, y’all, learning, reading, networking, reaching out, asking people. I love that, I love that, I love that. Debra, thank you so much. When I tell you, I appreciate it from the bottom of my heart for you giving us your time today, telling the people about yourself, giving them some background, helping walk them through this journey of informatics, I love every bit of it. I love every single bit of it. All right, y’all!
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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