Ask the Expert: Nurse to Health IT Manager
Joy Huss, on how to move from “getting it right” in the EHR, to health IT interoperability, to make care providers’ lives easier and patients’ lives better
Joy Huss is a Product Manager who joins Bridge Connector by way of South Dakota. Her background as a medic in the U.S. Army Reserves and, later, as a nurse with over 30 years of experience, segued into a career in health IT, where she has been a fierce advocate for improving caregiver workflows and the patients’ experience, largely through health IT interoperability. When she’s not working from our Nashville office, she is likely working from her home in South Dakota. She also manages the home while her wife works as a software engineer and with her mom at their farm, which has been in her wife’s family for generations, where they work cattle and plant soybeans, wheat and corn. They like to “take a break” at the lake or beach, as a family, with their six children ages four to 19 during the summer and for vacations. Below, Joy defines her life of service, how one can be passionate about something as technical as “interoperability,” and how “making people feel better” has been the through-line of her career.
Q: Tell us more about your background, what you studied in school, and what your career ambitions were.
A: I am currently licensed in the state of South Dakota as a nurse. I have been a nurse for 30 years, but the journey for me really started when I was a little girl. My dream was always to be a nurse. I loved caring for others. I had this great “want” to take care of patients and to be a part of making people feel better. As a teenager, I volunteered at a hospital every Saturday and Sunday as a “candy striper” volunteer, and would help with basic things like taking vital signs, charting, and assisting patients with meals. I fell in love with the health care industry.
On top of that, I also have a love for the military and our country. My grandfather was a veteran, and I had other family members who had been in the service. At age 16, I enlisted into the United States Army Reserve and took on the title of a “91 Alpha,” which was a combat medic. I graduated from high school in Missouri, and I had finished my basic training at Fort McClellan, Alabama, which is a military base that’s since been retired. Then, it was on to my combat medic training in San Antonio, Texas, at Fort Sam Houston.
I came back, started living my life working as a patient care technician on a cardiac care unit, and quickly decided to go to nursing school. I did this through an Army program but through a civilian school, and emerged as a “91 Charlie,” a nurse. This was a combination of both military and civilian nursing training, and I did that in Kansas City, Missouri. During nursing school, I was put on active duty, and the Army paid for my nursing training. I graduated as valedictorian of my nursing class.
I moved to the Dakotas in my early 20s, but I was born and raised in Missouri in the Kansas City area.
Q: What did the next few years look like for you, in terms of career experiences?
A: I did emergency/cardiac care as a technician before becoming a nurse. After completing nursing school, my first job as a nurse was in long-term care. But shortly after getting that first job, I was deployed to Desert Storm. So I am a veteran. I served in Desert Storm, sometimes referred to as Iraqi Freedom, from September 1990 through June of 1991. I was stationed in Iraq to support the 159th MASH unit out of Fort Polk, Louisiana. MASH stands for Mobile Army Surgical Hospital, and we supported the Third Armor Division during the ground war. We treated both U.S. soldiers and EPWs, Enemy Prisoners of War for 10 months. This was working in a combat setting, so many of the things you see are life-changing. It’s quite the juxtaposition from your typical hospital setting.
It was a quicker war than some of the ones today where there are long deployments to Afghanistan or similar countries, but it was still quite intense. When I got home, I just went back to my nursing job as a long-term care nurse. And since then, over the span of 30 years, I’ve done all kinds of nursing — long-term care, acute care, clinic, surgery, home health, emergency department. I became a nurse informaticist at a small critical access hospital in South Dakota around 2004, which is when I began my career in the EHR industry. I loved it because I was compelled to make a difference in the transition from paper to electronic charts — so much that I became a Clinical Services Consultant with Healthland, which was later acquired by CPSI in 2016.
Q: There is so much to unpack about caring for patients in each of these settings. At your core you’ve been very passionate about this. Can you tell us about how each of these settings called on maybe slightly different skill sets?
I have a love for many areas of nursing, but at the end of the day my favorite aspect is taking care of the patient and all of their needs, whatever setting you’re in. Whatever medical setting or environment, be it your home, the hospital, the emergency department, I just love taking care of patients and making sure that they get the best care and what they’ve needed at that moment in time, and also helping them through the emotional aspects of being in a medical care setting. The common denominator in how I interacted with my patients, regardless of the setting, was to be able to listen and respond to their needs, acting as their advocate in every situation.
We’re finally understanding more context, even beyond the various care settings, about how to address all of the patient’s needs that ultimately affect their health — what has been referred to as social determinants of health (SDoH). These factors are so important, because the hard part is, you can take care of your patients the best you can when they’re in the hospital, clinic, LTC setting, and so forth. But when a patient goes home, what else do they need? How do you make sure they get their home health care, or that they follow up with their clinic appointments? Maybe they need to get connected to a social worker, or they need durable medical equipment to take care of themselves, such as oxygen tanks. Or they simply need rides to the doctor or help with their meals. They may just need a simple referral to say, “Hey, I need to be a part of the senior meal program,” so that they’re getting at least one meal a day that’s nutritious and already prepared for them. This is so super, super important. I love our name, Bridge Connector, because we do help bridge these sorts of critical gaps in care, and our SDoH product coming out soon is a great application to address all of these needs.
Q: You really got to see the digital transformation of the health care industry with EHRs, so how did that touch your role as a care manager?
Becoming a nurse informaticist was interesting to me, because that role fields the transition from paper to electronic. So you are literally blending nursing with information systems and technology, managing patients’ data to better ensure that they’re getting the best quality care, that critical information is being documented and not falling through the cracks.
As a nurse, I think it’s really important to note that, sure, it’s all great that it’s on the computer — but it also has to have a good workflow. Because you have to address the patient’s needs while you’re interacting with the EHR. You don’t want to lose that patient focus, as you’re refining your processes to go from paper to electronic. You don’t want to lose that human interaction and focus on care. That’s what really got me interested in health IT.
I started at Healthland as a Clinical Services Consultant and then transitioned to Client Care (Support). In performing these roles, I got to see “hands-on” how an electronic record affected the patient, how it affected the nursing staff, the providers, the billing process — and even more relevant to what I’m doing now, how that all integrated and worked together, and where the systems were breaking down, where the various data systems were not connecting.
It was hard because I sometimes felt like the voice of the nurse or the provider was not being heard when we were building these EHRs. It took longer to take care of our patients. There were safety concerns. Because of these concerns, I wanted to keep advocating for the patient experience amidst all of the technological innovation. That’s why I applied my experience as a care provider and went into the development side of the industry. I became a business analyst, a product owner, and then a product manager.
Q: There has been much written about physician stress and burnout, and how EHRs contribute to this. So how much of that work load, actually working in the EHR, falls on nurses within the larger ecosystem of care managers?
A: I would say, early on, the burden of an EHR fell to the nurse and ancillary users. But because of different government initiatives, such as Meaningful Use and the EHR Incentive Programs, their focus is changing to include more provider interaction and to also facilitate interoperability. Because of this, Medicare recently changed the name of their program to the “Promoting Interoperability Program,” where you receive financial incentives or penalization for not following certain standards for interoperability.
I learned a lot about these programs and led efforts to get customer sites through their reporting periods. I was also instrumental in the achievement of ONC certification as part of my job at Healthland. Again, the hospital’s responsibility to report to these programs and take part of these activities originally fell a lot to nurses, IT, and ancillary staff. But as government policies have evolved through the years, they’ve identified that interoperability is also the provider’s responsibility. I think that the EHR “division of labor,” if you will, is starting to be more equal now.
Not only is health IT “interoperability” the nursing and ancillary departments’ responsibilities, but it’s also the provider’s responsibility. That in itself requires systems to be interoperable across departments, which speaks to what we do at Bridge Connector. There has to be that link between different systems, whether they’re clinical, financial, or third-party, to get that patient data on the same page. If you can get data quickly and accurately, it helps take care of the patient. Otherwise, you have providers playing detective, wasting valuable time, or missing critical information and updates.
What I’m currently really passionate about is, can we get the right information from one hospital, clinic or other entity to the next, or say, from a hospital to Uber or Lyft, because they’re providing transportation to a doctor’s appointment. Or can we get information from a third-party vendor like a patient portal or a pharmacy, and then back to a hospital? Interoperability and having correct data is so, so important. That’s where I’m most passionate about my role here at Bridge Connector, because, as a nurse, I understand we should get data from one place to the next, but also make that data meaningful. Does the convergence of data service the actual workflows, to make it meaningful?
Q: I’ve never thought about it the way you said this a moment ago, but when care providers are working with disconnected data systems, they are often put in a position of having to play “detective.” What a waste of time! But let’s assume data systems are connected, and that the resulting patient data has been presented in a useful, meaningful way. What does that feel like, walking in to deal with a patient when you’re already armed with their information? And how does this improve care providers’ lives?
A: It improves it dramatically, because your focus can then be one-on-one with the patient. Say, for example, you were to get a patient in the emergency room and all you knew was their name, and they couldn’t speak with you. I could spend hours trying to find out data from other places, such as where the patient had been at other facilities, or other things that were reported during prior visits to your facility, such as getting their allergies, their medications, and medical history. But if you are working from connected data systems, you don’t have to worry about that. My time can be better spent, one-on-one with the patient, making that patient experience the best that it can be.
Q: Given your experience, you’ve probably worked on just about all of the major and some of the more boutique, specialized EHRs. What has been your experience with CRMs, as a way to help manage some of these processes as well?
A: Yes, I’ve worked with quite the assortment of different EHRs, and I did use Salesforce extensively in my last job as our chosen CRM solution. That’s where the customer placed their cases and incidents, if they had a problem with their EHR. We used that for all of our account managers and client success managers to keep track of what was going on, and it was fantastic. Salesforce has gone deeper into health care with Health Cloud since then, but even before Health Cloud, there was great functionality where a customer could place comments in the ballot box to say, “Hey, I would love for this to change. I would love to see this improvement in my EHR.” From that, we were able to see what was the top-voted item for a customer, what mattered the most, which then helped us prioritize the most important enhancement that a customer needed for their facility.
Q: Your knowledge base, having worked as a nurse and now on the health IT side is so interesting. Tell me more about what your previous nurse informaticist role involved.
A: They have the knowledge and the expertise of a nurse. They implement standards of care to help within that EHR, so it’s a variety of roles. A nurse informaticist is responsible for managing, seeing what the day-to-day interaction, with an EHR looks like. They make sure that updates go out correctly and identify technical things that may go right or wrong with the EHR. They also support evidence-based practices, patient safety and clinician workflow. So nurse informaticists are bridging that gap, managing care providers’ frustrations and divided responsibilities as they’re saying, “Now all I’m worried about is the computer. How do I take care of my patients?
Nurse informaticists bridge the gap between the computer and the provider, whether that provider is a doctor, a nurse, a radiologist, a lab technician, or whoever — we work within that. There’s an inherent passion for both patients and data, because if the data’s not right, someone could die. It’s not just about taking the care of the patient, but it’s about taking care of the patient with the right information.
If you don’t have the right allergies listed, the right medications in an emergency situation — in any situation in health care — then you can’t take the best care of your patient. Of course, Bridge Connector’s responsibility and our passion is exactly what David (David Wenger, Bridge Connector CEO) and I talked about when we first met. We are passionate about making sure that we get the correct data from place to place, and that patients are taken care of.
Q: So that helps bring us up to speed with your current role, that of Product Manager at Bridge Connector. There is a direct correlation with some of your expertise as a nurse informaticist.
Correct, there is a lot of crossover. It’s super-important for data to be accurate, for it to be presented in a consumable format, and that the workflow is correct. That all falls into line with what I do.
As a rule, I am not as technical as a software engineer, but I do feel like that there’s a time and a place for providers to have a voice as we’re developing products and solutions. Engineers can and do write code, and we can move that data. But if it’s not handled in a manner that relates to medical workflows and practices, then at the end of the day, it really doesn’t mean anything.
Q: You are enthusiastic about solving interoperability in the right way, and the energy and purpose you bring to finding solutions is palpable — I “get” your commitment even more, understanding how your background has led you here. Can you share what Bridge Connector was doing differently that made you want to come work with us?
A: I think what got me excited the most, first of all, are the values of the company. The core values of Bridge Connector just speak a lot to me, particularly the transparency, continuous improvement, and resiliency values. These were reaffirmed when I met with David, and we connected about how we just need to make a difference. We’re a company that ultimately wants to make sure that patients are taken care of. Interoperability is a fairly new word and focus in the industry, and social determinants of health care is also a newer concept, but such an important one.
To think about where the breakdowns have been happening in health care, to have the industry start to think more about how we make sure patient information moves from a hospital encounter to the next clinic, to a ride-sharing service that is taking them to that appointment, to a social worker who needs to set up additional services for the patient in the community — we cannot move to the next level in health care until we conquer interoperability across all of these touch points in the patient’s journey.
It’s great that we’re “getting it right” in the EHR, but now we’ve got to get it right beyond that data platform, when we send data from place to place, from one endpoint to the next. Bridge Connector is building the engine that can take us there.