Every Thursday night at 9pm EST, I tune into the latest episode of The Pitt on HBO . The Pitt is the most realistic medical show (from my perspective) in my 25 years as a nurse and healthcare professional. As you watch, you almost forget that Dr. Robbie is really Noah Wyle, an actor, instead of the Chief ER (Emergency Room) Attending MD of your hospital.

In last week’s episode, The Pitt is under a potential ransomware cyberattack. As a preventative measure, the IT systems are all shut down within seconds of the ER staff hearing about this unplanned downtime.

You see Dr. Robbie announce to the ER staff, “We’re going old school… analog.” Below is a 55 second clip of that part of the episode.

As I watched that episode, it brought back memories of the exact opposite: transitioning from paper to computers.

Now, many of you reading this may have never worked directly from paper based medical records. However, that was the standard of practice for decades up until the 2000’s when there was an effort to digitize patient records across the United States.

Due to the complexity, cost, resources, and several other factors, federal incentives were needed to move the digital health needle forward. This occurred through the HITECH Act (Health Information Technology for Economic and Clinical Health) Act and the EHR (Electronic Health Record) Incentive Program.

Yet, such transitions from paper to digital platforms were less than easy to do. Additionally, many were just as hesitant to digitize as they are in this clip to turn to paper based records. Significant training and preparation (after years of development efforts) was necessary for each healthcare professional that needed to interact with the new form of a patient chart.

Now, we see this sense of fear in the staff of The Pitt on how to effectively care for their patients without any significant warning that the systems would be offline. [This is called an unplanned downtime… the name alone should tell you that no one favors these offline breaks].

Imagine what that would be like to have no data on any of the patients if all of it is digitized… you would feel a myriad of emotions as many depicted in the clip above. However, there are downtime plans that are created for just these types of situations. Additionally, IT teams are behind the scenes working to bring the system up as quickly as possible.

Hours and hours between many meetings and discussions review how to support staff in clinical care situations when an unplanned downtime occurs. As a result, you do not need to have someone on shift like Dr. Joy with a photographic memory to recall all of the details on the digital board. Instead, you need to know the procedures to gain access to the downtime reports.

Whether health records are digital or paper based, this episode depicts how essential access to patient data and information is in order to effectively provide patient care.

~ Dr. Kelley

People are complex. Every healthcare professional knows this and is trained on how to assess a person. That assessment is for the purpose of evaluating the patient’s health status. However, that assessment extends into how to approach that person as well. Every person is an individual that has nuances beyond the diagnosis that is given or being ruled out at that time. Every person knows when they are being treated as an individual versus a diagnosis. They may never say it to you, the healthcare professional. However, having experienced being treated as both a patient and a ‘reason for visit’ myself, I can tell you that they (e.g., patients) know. That differentiation between being seen as a person over a diagnosis is what makes the difference for that person’s experience in that setting and perhaps healthcare overall.

Now, here we are in an elevated landscape around how to maximize technical product scalability coupled with a daily reminder that AI is coming at us fast (if not already here). In my 20+ years in this field, I have always advocated to have the tech meet the needs of the person rather than having the tech drive how the person works. This may sound nuanced but when in the throes of care delivery, you know instantly when it interferes with how you want to work. This is still an ongoing challenge as healthcare is complicated. I say that and those that are not in the field may think, “how complicated could it be?” Far more complicated than you would imagine I would say.

Are there opportunities to reduce the complexity? Absolutely and yes please! However, this must be done with an understanding and appreciation for who is at the center of healthcare delivery and that is people, not the technology. People are humans, not algorithms. People can benefit from algorithms that are designed to meet the needs of human. This is a critical distinction that must remain in the forefront of our minds as healthcare becomes more digitally integrated with care.

~ Dr. Kelley

We often hear the term ‘information age’ used in conversation, at conferences, and even in marketing press. Information consists of data that are organized in a meaningful way to be used by humans and computers (or machines) to form insights. When used with computers, the information is intended to be available to assist humans in decision making (not make the decisions).

However, more information does not always equate to being better informed on a topic. At a certain point, one starts to feel overwhelmed with how much information is available to access. To relate this to an everyday example, consider when out at a restaurant and given a menu. Some restaurants have a menu with pages and pages of different choices to choose from for a meal. An abundance of options to review in a few minutes of time can lead to decision fatigue. ‘What should I get? Did I see everything? I don’t want to hold everyone else up. I need to pick something.’ Other menus might have just a few options to choose from that makes the decision a bit easier (as long as you find something you’ll eat and like! ). The decision fatigue can feel a bit paralyzing and may not necessarily lead to selecting the optimal choice for the person.

Today, we have pages and pages and pages of endless information available to us as consumers. Yet, not all of it is necessary to know. Additionally, when sources are conflicting or providing confusing information, what does one rely on to learn about a health condition or treatment?

Information science has two concepts around information flow that one may not even realize is occurring on a daily, hourly, and perhaps at times, minute-by-minute basis. The two concepts are referred to as push and pull. Information can be either pushed to the user or pulled from a source. Both processes are necessary.

While I was a student, across all my degree programs, I needed to physically go to the library in order to find sources I needed for assignments, projects, and of course, my dissertation. I spent many hours and days in different libraries. I even had to travel to a few other libraries that had a source I needed to review and add to my work. This action is considered an information pull. One is looking for something specific. Today, one can access such resources from the internet and largely without having to physically be in a library. (This has some benefits in terms of time savings but I often enjoyed my study hours hiding away someplace quiet and sinking in to the material without interruption).

Traditional information pushes include, but are not limited to, commercials, billboards, advertisements, and mailers. However, with the internet and increasing global use of social platforms, the opportunity to push information now has many potential places to live and grow. Unfortunately, we now have the push and pull sources largely living in the same digital interweb space. This leads to a confluence of information available to know, that may not be necessary to know for the person or the purpose at front of mind.

As we move to use large language generative artificial intelligence models more frequently, we enter another layer of uncharted territory. What is available to know for that particular model is used to generate a response for a pull request <insert head exploding emoji >. The person is pulling a response that is a summation of pushed resources for something they may need to know. However, is what is in that model accurate, reliable, and valid? How do we as the user know? More specifically, how does one as a patient know how to differentiate what they need to know versus what is available to know?

Taking this back to healthcare and from a patient perspective, I will often ask, ‘Why do you need to know that?’ when I am asked a question either upon scheduling an appointment or at the start of a visit. Is every question being asked relevant to the reason I am there? I do not always believe so. Sure, I can answer the question for you, but I do not always see the relevance of some questions to the visit.

All of this is to say that we depend on technology today for information. One would be challenged to find the necessary data and information solely on paper based resources to be effective for oneself or for ones patients. Yet, our methods for differentiating between what we need to know from what is available to know remains an opportunity to explore further.

~ Dr. Kelley

Every year, since 1976, the Gallup Poll releases Ethics Rankings for American Professions. On January 12th, the Gallup Poll’s 2025 rankings were released and again ranked nurses at the top of the list for ethical standards. This result is the 24th consecutive year of ranking at the top of the list of professions.

I speak on this often but why this year feels different is due to the continued socio-technical challenges we face with finding the right balance between what humans can do (and should do) versus what technology can do (and should do) in healthcare.

I started my career as a bedside nurse. Every shift I strived to give the best possible care available to each of my patients. Sometimes this meant refusing patients because the ones I had needed me too much to take on another one. Sometimes this meant pushing the medical or surgical team to decide who was responsible for the patient because the data I had did not look quite right to me. Sometimes this meant spending hours sifting through papers to figure out when the newly transferred ICU patient was due for meds because it just was not at all as clear as it could be. “It’s all there” I might hear. (Yes, it is all there buried in dozens of pages of small print).

Your decisions are guided by what is best for the patient as well as what is ethically sound. The nurse patient relationship is essential to know that patient and for the patient to know one’s care. Establishing trust is critical for that relationship as patients are vulnerable to the care they receive and who is providing that care.

Therefore, as we advance technology such as artificial intelligence that is more complex for the population, there must also be awareness on how these tools do or don’t work. Any technology tool that is used becomes an extension of the human’s care delivery. With approximately 50% of the U.S. population concerned about the use of AI in daily life, this creates a potential for mistrust in the care environment if AI is not articulated, understood and effectively used consistently for care.

Thus, as nurses and healthcare professionals, it is critical that we advocate for the tools that can assist in ways that improve our experience in delivering quality patient care rather than replace core functions of what it means to be a nurse. The patients depend on it, even if they do not say it.

~ Dr. Kelley

If I were to ask you the question, “when does healthcare start?”, what comes to mind?

I have asked this question many times to different audiences of nurses and healthcare professionals. I typically will get a silent pause to start.

That silent pause is an indication that thought is going into the answer (and perhaps there is some unknown as this may not be a common question).

Several years ago, when I first started asking this question, the most common answer was with one’s insurance card or at the hospital.

I know that I had that thought as well for the first decade or more of my career. As a registered nurse, I am considered a healthcare professional. Hospitals were the primary place of employment for registered nurses when I graduated from my undergraduate program at Georgetown. Hospitals are also the primary place of employment for registered nurses today.

However, one day I was listening to a presentation about healthcare that shifted my perspective. I am a person before I am a healthcare professional. As a person, I will have healthcare needs. I also have some agency around decisions I make each day regarding my health.

This agency is around what is called, modifiable risk factors. Modifiable risk factors are choices we can make each day that can impact our health in the short or long term. Examples include whether or not one smokes tobacco, drinks alcohol, is active or sedentary, and to some degree food choices. Non-modifiable risk factors also affect our overall health. Examples of non-modifiable risk factors include our genetic composition (e.g., inherited diseases and/or carriers for diseases), age, race and ethnicity.

As humans and people, our daily choices can influence our modifiable risk factors. Thus, our daily choices can influence parts of our health but not all of it.

In areas where we do not have the ability to modify our risk factors, healthcare expertise, diagnosis, treatment, care and intervention can be of great value. There are three levels of care: primary, secondary and tertiary care.

Often, when someone needs to go to the hospital, that is seeking out tertiary level care. Primary care is preventative in nature. The goal of primary care is to prevent or identify any potential health issues before the need for greater intervention.

Therefore, as you navigate your day to day, consider if there may be one action you take today, tomorrow or the day after that you think about as it relates to your short and long term health.

~ Dr. Kelley