When does healthcare start?

January 13, 2026

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

It is all about the process.

May 06, 2015    |   , , , , ,

I am a nurse, an informaticist, and at times, I am also a patient. Last summer, I made an appointment for a vision exam. I was getting into my car to drive to the office when I noticed I had a voice mail. The voice mail was from the office letting someone else know that her glasses were in and she could come pick them up. I thought, ‘well that is strange, I’ll have to let them know when I get there that they called the wrong number’. What I should have done was call right back. Had I called back, I would have found out that my appointment needed to be rescheduled due to a malfunction with the equipment that day. (Instead, I drove to the office and found out in person). Although, had I called when I got the voicemail, I wouldn’t have identified the informatics challenge I saw upon arrival to the office. Read more

The Opportunity to Use Technology to Effectively Engage Family & Friends

May 06, 2015    |   , , , , ,

Promoting patient-provider relationships and patient engagement in one’s own health care delivery are two topics that often come up for current discussion. I believe both are necessary for quality patient health outcomes. However, establishing a patient-provider relationship and engaging the patient are both areas that require continuous efforts from the providers and the patients. We as health care professionals are responsible for educating patients and their families about the patient’s health condition. Yet, the patient (and family) is also responsible for ensuring an understanding of his or her health condition, as well as asking questions to clarify the disseminated information. Read more

“Where’s my sheet?!”
Introducing Know My Patient™

May 06, 2015    |   , , , , , , , ,

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“Where’s my sheet?!”

Nurses, you know the sheet I’m referring to…you also know the feeling of panic that rushes over you when you can’t find it. “Where did I leave it? I need that to know my patients!” This sheet is a piece of paper that is the nurses’ daily lifeline to knowing their patients.

Read more

I have an idea.

May 06, 2015    |   , , , , , , , ,

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Hopefully that sentence resonates with you. Everyone has ideas that come to us – all of a sudden – and usually when we are faced with a challenge. Ideas are important because they are the currency for innovating – for developing new solutions to existing problems. Without ideas we would be limited in creativity, change, and improvements in our lives. In health care, ideas have led to new solutions that transform the way we collect, communicate, exchange, analyze, and evaluate information. Yet, we need more ideas that lead to new solutions that can even further improve the structure, process, and outcomes of quality health care delivery.

A few months ago, I was invited to guest lecture to graduate nursing students at Northeastern University about innovation. I asked each student to formulate a problem that they see each day while working and bring it to class. During class we identified each problem and then I asked each nursing student to formulate a potential solution. Every student had a very real problem they are faced with each day at work – some were more complex than others – but we were able to form solutions that were reasonable and achievable with the right support, enthusiasm, and guidance. The nursing students felt empowered to work to address the identified problems. I hope that they did follow up and begin the process toward improving the desired outcomes.

I offer this scenario to encourage others to develop their ideas and foster further innovation in health care. Each day I see new problems that need to be solved. This blog, Know My Voice™ started as an idea. I wanted a way to share my informatics perspective, or voice, with a larger and broader audience than I could physically reach in the same amount of time. I look forward to seeing the future developments and impact of Know My Voice™ over time.