Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast from Works, healthcare's flexible staffing platform. Today we're excited Dr. Brian Weirich, a true innovator in the nursing field. In returning to The Handoff, Dr. Weirich is the Chief Nursing Innovation Officer for Bon Secours Mercy Health, where he leads efforts to integrate emerging technologies into care teams and explore new models of healthcare delivery. With a rich background that includes leadership roles at Banner Health, Indiana University Health, University of Colorado Health, Ohio State Medical Center, and the Cleveland Clinic, Dr. Weirich has made a profound impact on healthcare innovation. Brian holds a doctorate in healthcare administration from the Medical University of South Carolina and a Master's in Healthcare Administration from Ohio University, where he also earned his bachelor's degree in nursing. He is certified in executive nursing practice and holds a certification in artificial intelligence from Northwestern's Kellogg School of Business.

In addition to being an author and speaker, often advocating for the millennial tech generation, Brian is the co-author of The Nurses' Guide to Innovation and a founder of two health startups. His expertise and passion for healthcare innovation have earned him recognition, including the prestigious Advancement in Medicine Innovation Grant from IU School of Medicine. He's also a founding member of the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders. Today, Dr. Weirich joins us to discuss the transformative potential of ambient voice technology in nursing care and the future of healthcare work. Welcome back to The Handoff, Brian.

Brian: 

Wow. Yeah, thank you for having me. That was quite the intro. I feel like we need a movie trailer to go with that. That was very nice and gracious of you. Thank you.

Joni: 

Absolutely. Absolutely. You've done a lot in our profession, so I thank you for the work that you have done and continue to do. So. Brian, I'm just going to jump right into it. Thanks for being a repeat guest on The Handoff. We don't have too many of those. You joined us in 2023 and your episode, which is Episode 96, “How AI and Machine Learning Are Transforming Nursing”,  for anyone who hasn't had the opportunity to listen to it yet, gave us an overview of how you made your entry into workforce technology and an overview of your work with Arnie, an AI-enabled registered nurse voice technology. Now, a lot has happened in the world since that episode. A lot's happened in your work, as well as in the ambient voice technology space. So for listeners who are new to this topic, can you explain what ambient voice technology is, how it's currently being used in healthcare settings, particularly in nursing, and why you're so passionate about this technology? So a loaded question, Brian, to start off. 

Brian: 

Yeah, there's a lot to unpack there, but this space is moving very, very quickly, so we may have to have more frequent episodes together just to keep people up to date on how quick this is moving. 

So to unpack your question, let me start with a couple definitions so everybody can be on the same page. The first is ambient listening. So this refers to the practice of passively or continuously monitoring sounds in a surrounding environment and especially without any focused attention. So in technological context, it typically involves devices like a smart speaker, a voice assistant, or surveillance systems like cameras in the room. These are constantly “listening” for specific triggers like a wake word or background information. And again, examples of this are Amazon Echo, Google Home, anything that is always passively listening. That's the first definition. 

The second one would be generative AI or gen AI for short. So these are algorithms that generate new outputs, so new and novel outputs based on data that they've been trained on. So unlike traditional AI systems that are designed to recognize patterns and make predictions, this content generation is novel, something not done before, not looking at a pattern, but what they've been trained on to be able to give an output. And this can come in the form of conversation, art designs, everything under that umbrella. 

The second part of your question, how is this currently being used? So it's being used in every help system. We probably don't even know it, but a couple examples of this would be virtual assistance, specifically chat bots. That's a term that we're probably familiar with. Those are used a lot of times in the ambulatory emergency departments, urgent cares, but that's leveraging this generative AI technology. Also communication devices. Any hospital that uses the V badges have a lot of success with those. People love that they're hands free. That's a part of this. Ambient listening, smart speakers I had mentioned. Anyone who's got an Amazon Alexa device or Google Home at a nurse's station or even in a patient room, that's another way. 

And then our physician partners, they're quite a ways ahead of us on this journey, so we've probably seen them use it, and we're quickly following behind them. But anytime they use large language models for documentation within their charting, we're using these algorithms to pull out coding. If they use a keyword that goes to a billing cycle, it'll pull that out. But these are all these algorithms behind the scenes, that are helping us, that are helping to augment our work and make it easier. 

And the last part, why am I so passionate about this? This is the future and I'm really excited to be a part of it. So now we can solve old problems in new ways. How many years have we focused on recruitment and retention action plans and decreasing nursing workload? And we just had the same tools. We kept passing back and forth to each other, but this has changed the playing field. It's a whole new playing field. So again, we can solve old problems in new and novel ways, and this technology is moving very fast. So a lot will be coming. It already is here, and the next five and ten years are going to be very, very exciting and I'm looking forward to being a part of it and contributing to solutions that we can all use.

Joni: 

Yes, I love your passion for this topic, Brian. I'm right there with you. And I think you made a great point that our physician colleagues are a bit ahead of us in this space. And many companies have largely focused on physicians. And I really do believe that the organizations, the groups, the companies that really figure this out for nursing will just change the game and disrupt it because the nursing workflows are a little bit different than our physician colleague workflows. So can you share some examples? Maybe go a little bit deeper. Who is working in this space? Where has it already made an impact and oh my goodness, for my DNP heart, if you have any implementation data, even better.

Brian:

Yeah, that's another big question. Let me kind of unload it. Peel the layers back. So first, especially with this ambient listening solution, and I'll go into more clearly to define what that is, but why is this important? How can it help? The answer to that is this is going to allow us to rehumanize nurses' time. We cannot print more nurses and the shortage continues to worsen. We have done, we being myself and peers across the country, we have had what I think are some of the best recruitment and retention action plans pre pandemic, during the pandemic, and post pandemic. But we know what the data says and we have to think differently. So some of the data that people are familiar with, we know that more than 30% of the nurses plan to leave the workforce in a year. By the year 2030, just over five years away, the nursing shortage in the US alone could reach five million and it could be greater than 5 million globally. We know that we can't keep trying to solve the nursing shortage, that needs to be a part of it, but how else can we help 'em? And within the nurses that we do have, a big reason for why they leave is the workload. And when you look at the workload, it is the documentation burden. So depending on the study, and there's several of 'em out there, there you can see data come back that nurses spend between 19 and 50% of their time on documentation. So, that's a large range. Let's take that right in the middle and call it 35%, right? If nurses are spending 35% of their shift doing documentation, that's one of our greatest opportunities to help give them time back. And again, rehumanize nurses time. 

We as nurse leaders, we can't say we want nurses working top of scope or top of license and then have them spending four hours a shift doing data entry. And that is what documentation is. It is a data entry. I often give the example or analogy like multiple hours of shift doing data entry. And if a nurse is documenting in the room, which most leaders encourage, their face is to a computer and their back is to the patient. And nowhere in any model of care does anyone want that to become the norm. And imagine doing that for hours, a shift, and then the patient, the bed, there's the curiosity. What are you typing over there? So we can start to mitigate all that. And if we could give those hours back in a shift, what could a nurse do with that time? 

So now we can focus on those quality bundles. Every patient can be given appropriate patient education when it comes to complex wound care. Let's have the time and take the time to do that, right? Or allow nurses to focus on personal growth and education. Let's have really robust unit practice councils because nurses have time to go and meet and drive practice on the unit. And in every one of those examples, the patient wins. That's where we want to be.

Joni: 

I love that, Brian. That's beautiful. 

Brian:

The second part of that question, who is already working in this space? Let me pause and just give major kudos and sincere thank you to anyone who is working in this space. This is the right problem to solve and we need you, tech entrepreneurs, nurses, this is the right problem. We need your help. So thank you for even considering and any time and effort you've put into this already. Again, my sincere gratitude, those that I think are leading in this space right now, for one, they have been in the space solving for physicians and they have decided to make a pivot. They're kind of ahead of the curve because they've got a lot of resources. They understand there are four items here or four pillars that really I think put them ahead. If they've been in the provider space, they have obvious knowledge and have done significant due diligence on the problems being solved.

They typically have a proven product, albeit for physicians, but we're talking about the same technologies here. So the learning curve is shorter for them. The best of the best have nurses on the team already, or they're planning to hire nurses on the team. You can't solve nursing problems without having nurses' voices and input. And the fourth pillar is they have existing relationships with electronic health records and health systems who already have team members on their various platforms. 

So I'll go through a couple examples or I'll highlight a couple vendors or companies who are leading in this space. So the first of which is Microsoft, they acquired Nuance a couple years ago. Over the summer they put out a press release or a blog kind of giving an update on where they are. And it's very clear that this has been a multi-year project for them. Their approach for what they're calling “Project Nursing” was really like a Manhattan Project approach. . And I love that. I think that's what it's going to take to solve some of these problems. So they have nurses hired, they have teams dedicated to solving this problem. And in the article (view the article here) they highlight nine health systems who are currently using their solution, their Project Nursing solution in this ambient space. So Advocate Baptist Health in Florida, Duke Health, Intermountain, Mercy, Northwestern, NYU, Stanford, and Tampa General are the nine hospitals they call out in this blog. So that to me is super.

Joni: 

Never heard of them, Brian. 

Brian: 

Yeah, right, exactly. What a list. Yeah. So these are people who have embraced what is going to be a new model of care and for Microsoft to have a solution already being tested in the term they use is “private preview,” which I think is a level above a pilot, right?

Joni: 

Sure.

Brian:

But they're still working out some Kingston Workflow questions, but they've got nine hospitals who are using that now. So that's impressive. But there are others. Over the summer, around a similar timeframe, the company Abridge had a press release where they have formed a partnership with Epic and the Mayo Clinic to build a nursing solution to solve ambient documentation. They have positions posted on their website, so they're starting to hire nurses up for this. Abridge was on the Forbes AI 50 list as one of the leading companies in this space.

They just raised 150 million in a series C. They've got an investment from Nvidia, who we've been, we've heard a lot about and read a lot about. So they're well funded, well backed, building a nursing team. They have a solution for providers. They can make that pivot pretty quick. Another one is Ambiance Healthcare. They have a very impressive physician platform up and running. Their approach is a little unique. They've got broad scale adoption across several physician specialty areas, and they really think of every specialty as almost like an entirely different solution that is customizable. So ambulatory, the ED physicians, hospitalists, cardiologists, it's very different, unique and specialized. So their approach to nursing should be the same way starting with med-surg. And then intermediate or progressive care will be very different workflows, different teams working on it. And then to go to the specialty areas, women and services and the emergency department. But that is theirs. That's their path forward. And they've had a lot of success with physicians. Their solution for physicians is also integrated with CDI. So they've got these algorithms that are verifying anything that comes in. They see those as being very advanced. Kudos to them. If we can make that jump to nursing and have that success, we'll be on a very good path forward.

Another company out of California is Suki. So in November, Suki is going to be announcing their nursing consortium with six design partners. What makes them unique is they are across all different electronic medical records. So they've got partnerships with all of these companies. They're building a solution on every platform. Their solution is going to be very similar to what they call Suki Assist is what they have for their physicians. This assistant's available everywhere and every form factor inside and outside the EHR. So they want nurses to be able to look at it on desktop, workstation on wheels, Android, iOS communication badges like Vocera or a different hardware. They want to incorporate theirs throughout everywhere. So a nurse can be anywhere, potentially even ambient listening in the room if you have a hospital smart room. And the last company I'll highlight is AIVA. They have a partnership with Amazon and Alexa already. They have Alexa devices deployed throughout the hospital, really focusing on patient experience. 

So this is the patient in the bed who can say, “Hey, Alexa, turn my TV on.” Or things like, “Open the blinds,” “close the blinds,” “call the nurse,” “order food.” But that's great because their entry to the market is already really there. They already have devices deployed. They're started to pivot into this space of nurse documentation and if they have devices in the room, that could be a quick jump as well for them. So those are five companies that I think in my mind, my opinion are kind of ahead of the curve in this space. Although there are dozens and dozens others and all of this. My closing point would be none of this can take place without a partnership with an electronic health record.

Epic has really come out and embraced this technology. Doctors have been using voice recognition within Epic for some time now. They now want to pivot for nursing too, but they're not looking to build a solution. They want BYOB “bring your own vendor,” so a health system can partner with a vendor. And Epic has said, yeah, let's build on our platform. A couple of weeks ago at their annual conference at UGM, they announced 100+ AI projects that are underway to enhance workflows all over Epic. Not just nursing, but clinical access, patient experience. So they have really embraced this technology and they know nursing is a pain point for most health systems. They also made the comment that I love, they said they see a future where nurses can complete their documentation without touching a keyboard in the patient's room. I see that future too. So we have a company like Epic saying “here's the path we're going down because that's where we want to be in the future.” That's where we want to be as well. So those are one electronic health record company and five companies who are really innovating in this spot, and they kind of check those boxes that I started with.

Joni: 

For someone like you who has been in this space for several years now you're working on it immediately. You kind of see all of the places where this is happening. And the chief nurse executive who is balancing all of the spinning plates, keeping all of the balls in the air, probably knows some of this is happening in the periphery, but it does still feel very far in the future maybe to some in nursing leadership. And so for a large part of my career, I've kind of had a foot in today and a foot in tomorrow, kind of this dichotomy of innovation, but practical operations. And I know that's a space that a lot of our nurse leaders live in trying to push forward while also being in the day-to-day operations. And so for those who are more operationally focused and maybe they haven't spent a lot of time in this space, and of course we all have a reference with Echo and Alexa and those sorts of pieces in our day-to-day life, I'd love to get down into some of the, maybe it's too granular, but I think it will help some of our listeners who are trying to think through strategy over the next 1, 2, 3 years.

Maybe they're not a part of an academic or integrated health system, maybe they are in the community. I want to try and help some of those leaders think through some practical pieces of this work. And so let's, you gave us a great overview of how this technology can really help support the clinician as well as patients. Really everybody wins when we focus on the patient. So let's talk about a couple of different things. I want to talk about reducing workload first and then talk about assisting with real-time data collection and documentation and how it improves patient outcomes. 

So let me get my thoughts together for this question. We could probably combine it together, Brian. So how can ambient voice technology help reduce the workload? So if you can maybe practically walk through what that might look like for allowing nurses to focus more on patient care and then how can the technology assists with real time data collection and documentation to benefit patients. And so you talked generally about some of these things, but can you go just a layer deeper maybe for some of us?

Brian: 

Yeah, sure. So first with the administrative tasks, we hope to eliminate or automate all of those. So this would be like phone calls or a chat bot, taking chatbots to the next level, which would be a generative AI making those discharge phone calls, doing patient education in the room via the phone or an iPad. So again, automating and thereby eliminating or reducing that work is one. And there's a lot of companies out there focusing on this and some health systems have even brought this internally and started hiring people from these tech companies because we know this is where the future is going to go. So everything, we should look at everything as a process that can be eliminated, simplified, or improved. That was the case historically, and we used Lean Six Sigma a lot to eliminate waste. That shouldn't change. But now we've got this new technology coming into the equation, how can we leverage that to help reduce these mundane tasks? A good example of this is Moxie the robot.

Joni: 

Yeah.

Brian: 

So Moxie is a robot, kind of looks like R2D2 and it goes around the units, but it can also take labs from one place, one location to another, take blood from one location to another. Stock linens, these are all things that are busy work for a nurse. And if you don't have a hospital tube system and you have nurses, techs or anybody walking, getting their 10,000 steps in to drop labs off, let's automate that process so they can have that time back. 

The other big part, and I'll go back to this, is really that documentation burden. So what this would look like, I talked about some stats on why this is such a pain point and the alternative to that is it's a pain point, but it's also one of our greatest opportunities for hours of shift. So an example for this would be if a nurse performs a skill, they have to go update the electronic health record that that was done. So they might be able to just say either into a smartphone, into a desktop computer, into a smart speaker in the room, into a smart camera in the room that has two-way audio. They could perhaps just say, “I just inserted an 18 gauge IV and the left ac, the dressing is clear, dry and intact.” That took me three seconds to say that. And if it could pull that and then go chart it in real time, I don't have to go back and chart that later, log into the computer, even if you've got tap and go, you have to go to a desktop, go to a computer on wheels, drag it in with you.

So this would allow us to say that action, say that assessment and automatically get pulled into the electronic health record. Now when we put, that's kind of the narrative form, right? We're speaking using large language models. When you have true ambient listening in the room, it could be a conversation between Nurse Brian and patient Joni and I could say, “Hey, how are you feeling today” And when you tell me, “Not good, I've got a throbbing headache.” So the headache is one. “Okay, just tell me about the headache.”... “Well, I've had it for the last two hours. It's a pounding pressure on the front of my head.” Okay, that's two things I have to go chart. Okay, great. “On a scale of one out of 10, how would you rate your pain?” And you say it's a nine out of 10, that's just nurse and patient having a conversation.

But if there is any kind of ambient listening or technology, hearing that conversation connected to the electronic health record, it can listen to that conversation and pull out three key points. You have a headache, you described it for me and you rate it a nine out of ten. All three of those things are something the nurse has to go document because now I'm going to treat that with Tylenol or something. So I have to go document that so it could listen, hear that, and then go document it for me. Which is, I mean, that would be amazing.

Eventually when we have hospital smart rooms with cameras, if that interaction takes place on camera, they could recognize patterns or behaviors and then go document that. We'll start small, this patient was brushing their teeth and then go document it. And I can go document it, a nurse has to verify all that at some point. So part of the workflow is, okay, I'm going to have to go sit down just like I'm checking an LPMs documentation. Yep, yep, yep, yep. Check, check, check. And if it's not right, we have to correct it. But that's part of machine learning. It'll improve upon itself the more we do this. So those are two examples, and I'll give you two stats. This is already taking place in some form or another, pilots, one way or another really across the world. And I've done pretty extensive lit reviews. And I'll give you two stats that have come out. One company for one study said based on 80% reduction in pain score documentation from three minutes to 33 seconds and this time saved $11,000 per nurse per year. Now maybe that doesn't sound like a lot, but this is just using voice recognition for only the pain score documentation. They're saving two and a half minutes and that quantified out to $11,000 per nurse per year. Those are numbers that CFOs need and they're going to quantify that math very quickly. And another study reported that voice recognition methods save nurses 2.3 minutes in simple scenarios and 6.1 minutes when documenting a complex scenario. So six minutes per assessment per patient, 24 hours a day. This adds up and is time that we could give nurses back to truly be nurses. And I'll go back to that term. We want to rehumanize the nursing care delivery and the time and this would do that.

Joni: 

I love that. Brian.

Brian: 

The other part of your question was about data collection. And I'll focus on one area here. We want our nurses to document in real time. That's not always realistic. We're very, very task focused. You're in one patient's room and your communication devices are going off and the call light down the hall is on so you don't have time. And then we're going to bundle our documentation when a nurse has time to have a sip of coffee and sit down. We don't really want that though, but we know that's how the work works. But this would allow us to truly have real time documentation if you are documented in the room or walking from one room to the next and you can just verbalize what just happened and they'll go document it for you. How can that assist with patient outcomes? Well, that real-time documentation, but one is key because the interdisciplinary care team is always looking at that documentation to make decisions.

A hospitalist on another unit and another tower is looking at that. And what they want to see is the patient's status in real time at that time. And often we're 3, 4, 5, 6 hours behind. Also, if we have any kind of early warning system, sepsis is probably the one that's most common. You have any kind of early warning for patient decompensating or anything. All that information is pulled off the story being told in the chart at that given time. So if key data is missing or being put in four hours behind, we're not going to be on time to respond to these early warnings. And that defeats the whole purpose. So I think by allowing nurses or providing a vehicle for nurses to have real-time documentation a hundred percent of the time, all of these clinical deterioration models are going to work so much better. And we have these because the data says they're effective and they save lives. And that's where we can make a big difference in patient care. But not only that, but appropriate discharges, appropriate patient education, we can decrease readmissions, but we accomplish those too. So there's a very large array of how we can use the use cases for this that'll impact patients directly and outcomes.

Joni: 

Yes, that's exactly what I was looking for, Brian. I think that you gave quite a few examples to help nurses who maybe aren't as familiar with this technology and in this space to start chewing on and thinking through use-case scenarios that they might be able to work on in their setting. And so now you've kind of shifted into a space that I think a lot about and I enjoy stepping into, and that's clinical decision making because we've got a lot of data these days, but if it's not timely data, that of course impacts our clinical decision making. But you mentioned early on generative AI, which we can combine with this technology, or at least we can think ahead and think through some use cases. So in what ways are you seeing or maybe even envisioning that ambient voice tech can support nurses in an informed clinical decision making at the point of care?

Brian: 

This is really the exciting part. This is kind of next level, but it's been done in the physician world, so we know it's possible. So this is really, we should think of this generative AI as a virtual assistant or co-pilot in the nurse's pocket. You could get rapid Q&A or say hospital policies or drug questions for compatibility and titration. You could ask any question and get an answer immediately. And these can be customizable per the health system. So when I say hospital policies, like, how often do we need to change IV tubing, and just get the answer? You don't need to go look it up, but you have to know that because there are reasons that those are put in place. Or titration questions or compatibility questions. “Hey copilot “Are fentanyl and ativan compatible together?” for a nurse in the ICU who has limited access. And then to get that answer and where it came from, you don't have to go look it up. That is going to also save time. That's going to help with clinical decision making that can happen right now or in the future to have these generative AI algorithms running behind the scenes. They can look at trends that a nurse can't see. So daily weights or a hemoglobin, a nurse draws a hemoglobin on a Monday and they're not looking back to next Wednesday and Thursday prior. But something with this technology can do that and then can send an alert or a prompt - those are the two terms I like to use. Or as a nurse is documenting, put in their daily documentation and there can be a recognition, “Hey, your patient sounds like they're having anxiety or they're having pain. Here's a care plan recommendation. Would you like to open a care plan for that?” And here's the recommended interventions of course, and this is all happening with a chat bot, the co-pilot in their pocket. Two really big places I think this can make a big difference would be nurse driven protocols.

So I'm going through my day to day and certain criteria are met unbeknownst to me because just putting in my vital signs and updating my patient status or maybe a lab comes back. So then to get this clinical prompt, “Hey, your patient has met criteria for the nurse-driven protocol, foley removal.” Okay, great. Now I know instead of at lunch when I have time to get in the chart, I might notice this or I might not notice this. Or worse, like a quality assurance nurse is also, this is their whole job looking at these sorts of things.

Joni: 

Yeah, yeah. You're a hundred percent right. 

Brian: 

Lemme take it even a step further. So I'm a nurse, I'm a day shift nurse and night shift through their routine labs and my potassium came back low at three. I may not be checking if I'm on a med-surg floor, I may not be checking my labs first thing in the morning because I'm busy with breakfast and blood sugars and all the things up in the chair and all of that. So now I get this clinical prompt or nudge, “Hey, your labs are back, your potassium is low.” If I have a standing order to replace it, “Hey Brian, replace this at a level of three, please replace with this.” There's a standing order. Okay, great. If there's not, it could even say “the recommendation is to replace, would you like me to open a secure chat with Dr, so-and-so and let them know?” … “Yes, please do that.” So that happens. And then if the physician reads that and puts a replacement order, a one-time replacement order in, that's the copilot in your pocket, again, telling me an order has just been placed to replace the potassium, they would like a redraw afterwards. There's an order for BNP for a redraw afterwards. Okay, great. “Hey, copilot, what color tube is a BMP?” … “It's a red cap.” That whole conversation can happen and can be escalated in two minutes without having to go to a computer on wheels, log in, open the secure chat, call the physician. It can just help. Again, I'll use, it's a vehicle to help move all of that along very, very, very efficiently.

Joni: 

Yes. Oh my goodness. Great examples. Great examples, Brian, because, and even as you're stating some of these statistics that we see in the literature, 2.3 minutes or 4.6 minutes, I think everyone in nursing realizes how quickly that stuff adds up. But so does the one and a half minutes it takes to look for a charge nurse or your lab tech to say, what color is this tube? So it's beautiful to see the micro changes that can happen that add up to a significant amount of work in your words, to rehumanize nursing work and care. That's great. Now, you kind of touched on this with an earlier answer that you've mentioned, particularly around it's the nurse's role to, I always like to say, we need to trust but verify. It's our responsibility to go back and to check through these things. And I have a colleague who shared a funny story just recently with me in which she was using some ambient voice technology in an ambulatory space, and it was just her in the room and she went back to check her notes. And it was so funny because she realized she had music on and the documentation was picking up pieces of the music lyrics. And so great point, trust, but verify for sure, for sure. 

Brian: 

Yeah. Yeah. I can see how that can create a problem. And for that, we'll definitely want to remove the Taylor Swift lyrics out of the permanent electronic health record for sure.

Joni: 

Definitely. But it's interesting because all of these groups, they're doing the right thing. I agree with you. This is the right problem to solve. And they're doing the right thing by making sure that the voice of the nurse is embedded in this work. Now there's a growing divide that's getting some attention in healthcare and nursing about artificial intelligence applications and platforms for a variety of reasons. And so nurses being a part of these groups is key. I'm curious from your perspective, what are some of the challenges that you've seen in getting nurses to the table or training nurses to use ambient voice technology effectively and how can we overcome these in our profession?

Brian: 

Yeah, change is tough with anything we do with this specifically. It is so new. I'm reminded, and I often share the quote by Henry Ford where he said, “If I had asked people what they wanted, they would've said faster horses.”

Joni:

One of my favorites. 

‍Brian:

Me too. I use it all the time. And it emphasizes the idea that groundbreaking innovations often come from thinking beyond what people can currently imagine or ask for. So leaders need to be very good about painting that picture, the art of the possible…what if…can you imagine? Because things are tough right now. It's not perfect. So no nurses are saying, “it's not broke, don't fix it.” It's broken. So we need to bring those solutions. Words matter. We have to choose our words. None of this is ever going to replace nurses. I don't see a future and I live in this world where that is ever the case. We're never going to replace that human touch, but we would love to have nurses have the time to give that human touch. 

I'm going to give an example of this. I'm often reminded of this story and it kind of conflicts with nurses working top of scope. But many years ago I was a nurse manager on a medical oncology floor and the patient population, these nurses or these patients rather, would come in for treatment. And I would often have young women who would come in and have a mastectomy and then the chemo, they would lose their hair. So they were dealing with a true identity crisis. And when nurses had the time to paint their fingernails, it made all the difference in the world to these patients just to feel human again. I think about this all the time. You cannot replace that. And maybe that's not a nurse working top of scope, but our patient care techs who are equally as important, we have to be able to do that to get to a point. No one has done that lately, I don't think.

Joni: 

Yeah, I would argue, Brian, that those nurses were probably practicing at the epitome of their licenses because they were doing a lot while they were painting those fingernails. But I am an oncology nurse, so I'm totally biased. 

Brian: 

Oh, and you're right, having that conversation and reducing anxiety and pain and educating, that's all part of that. But that made such a difference. And those patients would nominate those nurses for DAISY awards and it was a recurring theme, the impact that made on those patients. So we want to get to that. We're never going to replace nurses. We need nurses. We need nurses to have time to have those interactions. And that's what this can do. Your question about what barriers do we see? I started with change is tough for this specifically ambient listening for documentation. It's really, really tough. And I say that because we've got nurses who have practiced for 1, 2, 3, and 4 decades and they're using clicks and they can go through the clicks without even looking at it now. And now we're saying, I want you to deliver care in a totally different way that's going to feel very unnatural.

So what we see in an adoption curve is a rapid spike and then a rapid descent and then a slow steady growth. And this makes sense because introducing the shiny new tool and we're using terms like ambient listening and generative AI. So everybody wants to use it. And then when they're in the moment, it feels unnatural as they want to go to the computer and click. And we're saying you don't, don't even have to look at the chart anymore. So imagine someone says you got to start writing with your non-dominant. That is tough. And as busy as our nurses are, they're very task focused. The minute you feel like you're behind, you're going to regress to what's comfortable. So I often use the term with nursing leaders, if you're going down this path and either you are now or you'll be, you can't approach this like a pilot. This is a commitment. If you roll this out like a pilot that says, “Hey, for six months we're going to try this and then we'll look at the data,” you're going to go through that adoption curve that we see and nights when they're working short, which is probably frequently, or days when they're working short, they're going to regress to what's comfortable. So that's where it really comes into a commitment similar to how people have taken to virtual nursing. If you have virtual nursing on a unit and you're interviewing new nurses on this unit, the model of care we deliver is one that incorporates virtual nursing. And if that's not for you, this is maybe not the unit for you. At some point you won't have that choice. But for now it's about adoption and support and working through those early kinks.

Joni: 

That is excellent. Brian, thank you so much for that. So I'm curious, because again, you've been in this space for a while, you're actively working on it, you're thinking about it ongoing. You're on the edge of this work, and so I'd like to kind of pull back the curtain of your brain and pick it a little bit and see from your perspective, what future innovations in ambient voice tech do you foresee and how might they further transform nursing care? So I really want to hear what you're envisioning and dreaming even as far-fetched as what it may seem like to some people. I want to hear it.

Brian: 

Perfect. I think about this a lot too. My wife is a nurse. We met in nursing school, so this is pillow talk for us, right? This is what I'm putting in her brain before we go to bed. RTLS– so real time location tracking. This is going to play a huge role in our future for all the reasons we just discussed. But when nurse Brian enters the room for patient zoning, it's already going to know who's in the room and what room it is. And if we go into ambient listening, I don't have to log in anywhere. It knows Brian's in this room for this patient, and then we start talking and I go through that headache example, it's just going to pull that and it's going to pull the two people and I'll need to verify later. But that's going to be huge. Also, we're still in this pattern of documenting Joni, “oh, you just walked, how far did you go?”...I went to the nurses' station and there's blue tape on the floor. Oh, that's 25 feet. Lemme go document that. We're going to get away from that again with this realtime tracking. Patient gets out of bed and they go to the nurses' station and fill their water and they come back. We will be able to know this patient was out of bed for seven minutes and they took 85 steps and they'll document that in real time. And ambulation is a key for a lot of people to help prevent readmission. So this is important. 

Ambient listening is going to be prevalent throughout nurses stations in the patient rooms. We are going to be being listened to, and this is not big brother, this is truly going to help deliver better care pattern recognition. I'll go back to that. 

I gave the example of the patient brushing their teeth. That's a good one. But there's already companies who are using this for fall recognition or if a patient is laying in bed and they haven't turned for two hours, regardless of what the documentation says, if they've been on that right hip for two hours, it's going to be that copilot in your pocket that says, “Hey Brian, your patient in room seven is at risk for pressure injury for everything that's in the chart and they haven't moved for two hours off that right hip.” That's an immediate intervention that needs to take place. So you can go and do that. 

Lastly, I think touchscreens are going to play a role. I like an Epic quote that says, “you won't even need to log into a computer.” You won't have that. But we have these smart rooms. We have patients getting education on the TV that turns into education videos. Eventually that's going to be a touchscreen for patient education and for the nurses. I was told recently, and this resonated well, our current generation of nurses is a generation that watched their music and that resonated with me. 

So if they want to open up, maybe not the chart but a version of it that gives a visual. We live off our iPhones and apps, so to walk into a room and that current whiteboard becomes a digital whiteboard, becomes a touchscreen whiteboard where I can put orders in. It's listening to me talk and watching me and the patient interact and documenting that. And if I want to, before I walk out of the room, see a list of it just recorded to submit and save that trust and verify I can do it right there on a touch and I'm swiping right and left and I can put items in. But that is going to be very, very, very fast and efficient. 

And then the copilots that I mentioned are going to get more and more and more advanced and robust and we're going to become more and more dependent on them because they're going to make our lives very, very unique.

Joni: 

Yeah, I love that. There's so much opportunity. The future is bright. I mean when we think about RTLS, wearables, invisibles, all of those things, my goodness, what a great opportunity and nurses are in prime spots to really propel this work forward in pragmatic and practical patient care ways. I really believe that nurses rule the world. A lot of times we don't realize it honestly. I mean we are a powerful profession and powerful in our workplaces because we are always with the patient. And so this is a thread that we have kind of incorporated throughout Season 10 is empowering and emboldening the voice of nurses in all practices and all settings, particularly around moving technology forward in real world implementation settings. So from your perspective, Brian, how can nurses be involved in the development and implementation of ambient voice technology to ensure it not only meets their needs and enhances their practice, but also moves the quintuple aim of patient care forward in all the ways that we need it because we are nothing if not protective of our patients through our vocation. So what's your perspective on nurse involvement here?

Brian: 

Nurse involvement is a must. This is a great opportunity to be a part of the solution. We need new solutions and with new technology is going to bring new workflows that need to have new policies to support and reflect them. So really be an innovator and help build the future even on the units. We need to have a culture of innovation and creativity and those frontline nurses are who build culture. So be open to ideas and fail fast with early implementation and pilots, that is crucial. Also, I tell every vendor demo that I see that has a nursing solution, who are the nurses on your team?

Joni: 

Absolutely.

Brian: 

And a lot of them don't have them. So I tell 'em, you need to go hire nurses, be me and my teams. So there are a lot of nursing positions even for advisory councils, get on these advisory boards, be an advisor to a health tech startup, give your insights and give them a dose of reality. No, this will never work and a nurse will not use this because they don't all know that now they're trying to help us and solve problems. They know where the pain points are, but really get out there and connect and again, help be part of this solution.

Joni: 

That's great. Brian. I work with quite a few tech companies too, and I'm always amazed when they have a nursing solution without any nurses part of the team. And I tell 'em the exact same thing as well. And it's always fun when they get their first sort of dose of nurse feedback. It can be incredibly humbling but also quite invigorating because, my goodness, nurses are experts at identifying a problem and figuring out the solution. Like, “Hey, this might not work this way, but have you thought about X, Y, and Z?” And so I've had numerous tech companies just kind of be mind blown with nursing feedback because nurses are so generous and experts at what they do. So, beautiful perspective, Brian.

‍Brian: 

I would also add on that our time is valuable, so don't let it be taken advantage of. Don't be generous with your time. Offer it. Be very critical quick, if it needs to be, but be protective of your time. We don't have a lot of free time.

Joni: 

Agreed. Nurses are experts and need to be valued as experts. Absolutely.

Brian: 

Yeah, absolutely.

Joni: 

Well, I ask every guest on The Handoff the same sort of final three questions. The first being, I love talking with nurse leaders and edge runners in spaces, and I'm always curious about the layers that make these leaders, how do leaders become stronger leaders? What are they reading or doing or listening to sharpen their skills forward, think and propel our profession forward? So Brian, what are you reading? What are you learning about or doing these days, whether that's just for your thinking or just to nourish your soul and creativity? Do you have any recommendations for us?

Brian: 

Yeah, this is a great question. I have a really robust circle of mentors around me, and I've had this for years and as technology has evolved, my mentors have now grown outside of nursing. So people, strictly in the tech space, that we can even have reverse mentorship moments and I can tell them that's the dumbest idea ever. Or “Hey, I love how you're thinking about that.” So connect with people, identify mentors, have those conversations. Don't just be in nursing because this is going to solve problems outside of nursing, but really for healthcare in general, but it has to include nursing. That's one.

I read. I read a lot… articles, blogs, books, pretty much anything I can get my hand on. I have this fear of failure of falling behind and this is growing so fast. So sometimes I get overwhelmed, but I'm one of those that have a stack of books on my nightstand that I haven't started or I'm somewhere in the middle.I think that's key to identify that. And if I can make two recommendations, one would be a podcast by the New England Journal of Medicine called AI Grand Rounds. This is a great one. It's a monthly podcast with experts all along the industry, what they're working on, how they're solving problems, and leveraging artificial intelligence. So that's great. 

Even before that, I might start with a YouTube video called “The AI Dilemma” that was published in March of 2023. It's got like three and a half million views. Anyone who has seen “The Social Dilemma” on Netflix, it takes a similar approach. It'll scare you a bit, but it's a good dose of reality and introduces you into the technology, not just healthcare specific, but more from a broad scale of where it could go really good and where it could go really wrong. We do have to have good governance and guardrails in place with this technology to protect ourselves and the patient. So having that broad overview initially is great. And then dive into the AI Grand Rounds and then read everything you can get your hand on.

Joni: 

Great recommendations. Brian. It's a thread that we not only see in literature spanning industries that we've certainly seen across The Handoff as well is curiosity helps spur leaders in our profession forward. So I love that we have such curious thinkers in our profession. So Brian, we have talked about quite a few things today. I love it. I would not have it any other way. Ultimately, what would you like to hand off to nurse leaders at all levels and in every setting?

Brian: 

I'm going to steal a word that you just shared. I would tell everyone to be curious, be very curious, stay curious, ask a lot of questions. Nobody has all these answers and what is true today may not be in a couple weeks or a couple years. So stay curious, be open to trying new technology, sharing your lessons learned with the rest of us. I'll continue to do the same, but that's how we can together move the profession forward.

Joni: 

So good, Brian. So good. So lastly, I know that people are going to want to connect with you or follow you to either engage in conversation or maybe even lurk in the background and just listen and learn. So where can people follow or connect with you to listen and learn or find more of your work?

Brian: 

I'm happy to share my email (bweirich@mercy.com), anyone can reach out anytime, even just to have a whiteboarding session. “Hey, I'm thinking about this.” I love those. I've got a lot of energy. So if we can get on and have a quick think tank, it'll benefit both of us. So happy to do that. Please reach out anytime. I'm not super big on social media. I'm going to try to be better, but you could follow me on LinkedIn and that's about the only platform I'm on right now, but I'll try to be better at that. But you can also connect with me there as well.

Joni: 

Excellent. Everyone be sure to find Dr. Brian Weirich on LinkedIn as well. He's there. He's going to try and do better, but you could always spur him in conversation first when you connect with him. So Brian, thank you so much for the work that you've done in this space for thinking about this space for nurses and ultimately for patients, which is really why we all do what we do. I appreciate your time, your energy, your expertise, your passion. Thanks for sharing it today to help us refocus on rehumanizing nursing work and care through ambient voice technology. Thank you so much, Brian.

Brian: 

Yeah, this has been great. Thanks for having me.