31 Aug 2016

The Opportunity for Nursing Informaticists in the Face of Technological Disruption

By Ian Chaves, RN, BScN, MACT
*Written for NIAA's N-Form Newsletter, May 2016 edition.
I had the fortune of attending the National Institute for Nursing Informatics at the Bloomberg Faculty of Nursing, University of Toronto, in February 2016 (NINI 2016).
It was an exciting opportunity to learn from some of the most innovative and brightest minds leading Nursing Informatics (NI) in Canada, and to connect with nursing contemporaries eager to participate in the wave of change which comes with technological disruption. 
I expected to be captivated with the real-life stories of successful NI projects: projects illuminating the standardization of nursing terminologies and their significance in uncovering the value of nurses; projects demonstrating the application of telehealth to empower patients and providers to stay healthy within their communities; and projects demonstrating how the use of mobile devices and apps allow nurses to reach greater potential as knowledge workers at point-of-care. The narratives shared about these topics during NINI 2016 did not disappoint.
However, I wasn’t prepared for a brilliant and thought-provoking call to action by Dr. Richard Booth, Assistant Professor at the Faculty of Nursing, Western University.   Dr. Booth began his session with a role call of various technologies that fall within our cursory stream of consciousness — technological feats we acknowledge, but likely don’t spend enough time marvelling at because of the ubiquitousness of information and communication technologies (ICTs) and the seemingly light speed pace of technological change and product life-cycles.
For example:
  • You ever use the self-check out at Safeway? In some US grocery chains, you will not find a human grocery store clerk at all.
  • Curious about your genetic code? You can go to 23andMe, a personal genomics biotechnology company, to order a kit you use to submit a saliva sample. They test for a range of DNA types, like your predispositions to having fast-twitch muscles, consuming caffeine, and growing a unibrow. 
  • Do you text while your drive? If you do, you should really stop — but will it really matter when Google’s self-driving car begins to chauffeur us around? 
  • After carrying a Japanese communication satellite in space, Elon Musk’s SpaceX (a venture seeking to create reliable reusable rockets), landed on an offshore self-positioning ‘droneship' in the Atlantic Ocean. 
Meanwhile, I’m still learning how to change the toner at my office. 
I can’t fathom the out-of-the-box-paradigm-shifting type of thinking necessary to engineer some of these feats. Regardless of my own shortcomings, it's not just me -- the pervsaviness of paternalistic in-the-box-paradigm-saving types of  thinking in some healthcare systems is also of influence.
When Dr. Booth surveyed his second year BScN students about whether patients/consumers should be given access to their electronic health information, 65% answered “yes”. However, when asked whether patients/consumers should be allowed to edit or add content to their electronic record health record, 93% of them answered “no”.
Emerging healthcare ICTs functions are intended to open up communications, but a paternalistic view of patient engagement by providers cancels that out -- and if we close this corridor, other ones open (or already exist) for patients.
New consumers technologies are allowing health consumers to create new forms of health data. Are you currently wearing a Fibit? How many steps did you take today? Multiply that by 6.7 million users, and now Fitbit has a rich database of health data — valuable data that is OUTSIDE of the traditional healthcare system. 
Okay, so if the healthcare system no longer monopolizes health data, surely the healthcare system continues to stake its claim on ‘healthcare intelligence’? You still need experts to make sense of the data, do you not?
Let’s take a sobering look at what’s happening with Watson OncologyWatson, IBM’s cloud-based cognitive "super" computing system, is being used at various Cancer Centers in the US and Canada to analyze the DNA fingerprints of patients’ tumours. It will sift through thousands of mutations to identify what drives a patient’s tumour, and cross-reference these findings to best-practice data from thousands of research articles, to identify a personalized treatment plan. What would take oncologists years to perform, now takes IBM’s Watson a matter of minutes (Also, Watson will beat you quite handily at Jeopardy).
Wait, what? Technology is even creeping into our space of healthcare intelligence?
With the emergence of Watson Oncology, one begins to appreciate the idea of the technological singularity — the hypothetical event where artificial general intelligence would be capable of recursive self-improvement, or of autonomously building ever smarter and more powerful machines than itself. What is the likelihood that cognitive computing, a precursor to artificial intelligence, will soon obsolesce health care knowledge workers?


Let's assume that computers will be performing certain functions and tasks with greater speed and accuracy than their human counterparts. Where does that leave nurses (and for that matter, other health knowledge workers)?  
Before you go out to gather pallets of water and rations of SPAM in anticipation of a dystopic future where we're ruled by cybernetic machines, Dr. Booth provides a voice of reason. Dr. Booth argues that rather than conceding passively to technological determinism, nurses must see this as THE opportunity to redefine their value and contributions to the health of patients, families, and communities. It’s time to reconsider our paradigms within nursing in the face of technological disruption. Health(care) is no longer just the domain of health care organizations and providers. Patients, machines, and new industries are now active participants in healthcare, because of the new ways we transfer,share, and interpret information, ideas, and data.

Dr. Booth uncovers that, all around us, disruption is ALREADY occurring -- the ways we act and see the world are changing. Using a quote from Smythe (2014), Dr Booth asserts, “The problem is that unless we are willing to re-evaluate the actual processes of care (such as who or what delivers the actual care, where care is delivered, and what level of care is delivered to whom, etc.), the changes we are seeking will not occur.”
One of the key messages I found most important from Dr. Booth's session is that healthcare leaders must begin to be aware of the nature of this disruption and begin to take lead to redefine processes in a health system that tends to work at glacial speeds. Classic models of nursing and nursing informatics should be adaptive, and must be re-evaluated and re-designed as technologies emerge and evolve.

Dr. Booth asserts, “Technology itself is not important. The changes technology enables is the variable we should be exploring. We have focused almost exclusively on ‘shiny objects’.”
The other key message? What an exciting time this is for nursing, especially for those involved in the health ICT space. This is a momentous opportunity for nurse informaticists to shape the future of healthcare delivery and authour in new narratives of how healthcare providers and patients approach health.
Dr. Booth references Annette Wollowick who prognosticated (astounding in the 1970s) that because of increasing computerized care and shifts in the division of labour, roles of necessity will change in healthcare. For the nursing profession, this will result in the opportunity to provide new dimensions of patient care:
"If nursing accepts the latter (this) opportunity, a new concept of nursing will merge: one that will require a redefinition and revision of how nurses are to be prepared and how they are to practice in the future.”
During National Nursing Week, lets divert attention from these shiny new objects. Instead, lets acknowledge, celebrate, and inspire the talented nursing professionals who explore the applications of health care ICTs, how these technologies enable better patient care, and how these technologies create new dimensions for the profession of Nursing. 
To all of you working in Nursing Informatics — as technology continues to disrupt, your talent and foresight is what will help healthcare and Nursing not only sustain an important role in our society, but also discover new role niches and dimensions in care. In doing so, you are agents for change, not just in the sense of supporting the implementation of shiny new objects and helping providers use them for classical processes, but in terms of your importance to empowering Nursing to be future-facing and ready — to discover and embrace emerging processes and skills that new technology makes possible or society now requires.
As Nurse Informaticists, you are accepting an opportunity to lead Nursing with the crucial steps forward towards an unwritten, but exciting future. Perhaps the Fitbit will let you count these steps. Otherwise, Google's car will drive you there. 

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