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Long-term planning and short-term solutions for healthcare burnout and turnover are critical to healthcare’s ability to deliver patient care. A solid identity infrastructure can ensure that nurses and others can access relevant care information at the right time. Automating access is essential for quick onboarding during surges and avoiding long-term technology frustration and security issues. In this session, we’ll speak with leaders about the challenges of delayed access and the temptation to “rubber stamp” provisioning.
Updated protocols for an evolving staffing model to accommodate travel nurses, nurses with multiple roles, and the changing roles of nurse leadership. Beyond multi-factor authentication - creating a deeper understanding of identity governance to ease staffing challenges Educate to avoid dangerous workarounds like using the same access or over-provisioned clinicians to prevent breaches that impact the delivery of care Discover, secure, and manage identity to help clinicians get on the front lines faster by providing frustration-free access to the application, systems, and data at the right place and time.
Scott Raymond, MHA, INF, BSN, RN Chief Information & Innovation Officer Nebraska Medicine
Rob Sebaugh, Healthcare Strategist SailPoint
Victoria Tiase, Ph.D., RN-BC Assistant Professor University of Utah
Matthew Holt, Founder THCB Moderator
Reducing Friction for Fast and Secure Clinical Onboarding
Matthew Holt: Hello, I'm Matthew Holt. I'm the publisher, founder or author at the healthcare blog, and thrilled to be here on this Health Impact Session. And we're gonna talk a lot about the friction that lives in the world of onboarding and working in hospitals for nursing staff. And have a great lineup to talk with you about that.
So, I have with me today Vicki Tiase, she's distributed director for digital health and a bunch of other stuff. And a nurse informaticist at the University of Utah. Scott Raymond, who is the Chief Information Innovation Officer at Nebraska Medicine and also a pediatric nurse. Rob Sebaugh, who is the healthcare identity strategist at SalePoint, a consulting company, but previously was at Centine, the large government-based managed care company.
So welcome to all of you. We are gonna dive in eventually to looking at some technology solutions for onboarding, reducing friction, and sort of making the workplace, and work life better for for nursing and other staff in the hospital. But I wanna start off with everyone's been through just a two to three years especially those of you working in and working with people at the at the leading edge of, you know, dealing with covid. We're only now, literally just coming out to three years of, of what's been an extraordinary time especially inside the falls, the hospital with rugby in healthcare.
So, and I've noticed all of you recent recently, le left your previous jobs and are doing something different. So I don't know Vicki, I know you moved to Salt Lake City for the skiing, but you were a new president before. Before. Why don't we start with you, just give, gimme a quick flavor of what the last two to three years have been like for you and what the challenges you've seen.
Victoria Tiase: Yeah, absolutely. Thank you. And, and yeah, suspending the last few years in New York City, you know, certainly was difficult on many levels. But certainly the most difficult part for me as a nurse was just seeing the impact on our frontline staff and our leadership as well. You know, I think one of the things that.
you know, I thought a lot about reflecting back on the time is that, you know, flexibility is critical and I think that. You know, think moving forward, preparing for flexibility and ensuring we have that in our health system is going to be very important. And I think about that from travel nursing to virtual nursing you name it.
So, excited to talk about some of the specifics here today. And specifically that flexibility around our technology as well.
Matthew Holt: Yeah, we'll definitely get into the, the nursing crisis. Cause it still is a crisis. And I, I saw some data today that when we're assured a hundred thousand nurses under the age of 45, something like that.
So, you're probably a better data than than me on that. Scott talk about, talk about nursing. You, you said before we came on board that you, are you, you haven't touched a patient in a while. You still keep your license up. Should you talk a little about what, and you've also recently moved in the last few years.
So tell me a little bit about what your experience has been the last two to three years.
Scott Raymond: Yeah. I think the pandemic changed a lot of things. Both from a frontline clinician and provider perspective, but al also from the support needed to support clinicians and patients. So, when the pandemic started, I had to move rapidly, 500 IT folks from on-prem to remote.
And what that looked like. Fortunately, we were kind of prepared cuz we had already had implemented flexible work. Not only from a shift perspective, but also two days from working from home. So most of my 500 folks already had laptops, already had things to support the organization during the pandemic.
So I, I managed the first wave, managed moving people off, but I think it changed. The way we do clinical care and even that some of that is held over today. So I think Vicki mentioned, you know, tele nursing telehealth, that changed not only from the pandemic perspective inside the four walls. We were using telehealth to reduce PPE and reduce the number of staff having to be exposed to kind of reduce that, that friction as well.
And also to provide the ability to. Have family members reach out to their loved ones that were not gonna be able to be visited or weren't gonna come home. Right. And I think it's carried over. So a lot of folks are transitioning back. But the impact on nursing remains, and I think you mentioned the nursing shortage.
We're having a hard time staffing the hospital without travelers and that's created , an impact on the organization as a whole. And not only the nurses themselves, the staff nurses, but I think we're gonna talk a little bit about nursing management and what it it did to that. But I think the pandemic has changed us forever.
But we are kind of moving back to some semblance of normal and moving some IT folks back in to support clinicians, cuz clinicians on the front line didn't get to see some of their partners in other parts of the organization for a long time. So reintroducing and starting to provide that support at kind of the elbow is a change for a lot of organizations, including ours.
Matthew Holt: Yeah. Meeting your friends and colleagues sometimes for the first time, you know? And before I Rob, I want to go to you in a second before I go, Vicky and Scott, one of the things that's, that's happened a lot, obviously in the, in the, in the sort of the venture world that we see and in the sort of digital health companies, is there's been a tremendous amount of capital thrown at.
Essentially nurse, new types of nurse staffing agencies. I can think of four or five or off the top of my head that a raise is given more than 200 million each. Obviously you mentioned travel, nursing, remote nursing, and all the rest of it. How, how much do you think that that aspect of sort of nurse.
Management of staff management has changed. And how much are these new companies, you know, playing a role? And Scott you mentioned travel nurses. We've had lots of stories about travel nurses even in the same state or the same city, sort of, you know, moving across town for a lot higher pay and jealousy and workplace issues because of that happening.
So can you gimme a flavor between the two and your organizations? How this new way of sort of nurse recruiting, nurse management, even before we talk about what happens when they get onto the floor, how that's playing out.
Scott Raymond: You wanna start Vicky, or you want me to go?
Victoria Tiase: Sure, sure. I'll start. I think there are a couple things there.
So I think, you know, one, having these new staffing agencies and you know, models if you will, I think is important because. We realize something has to change. I think that's one thing that has become apparent. And I would say unfortunately, a lot of what we're seeing across nursing are organizations trying to revert back to old models of staffing.
And so I don't think we fully made the transition yet. So I think this is an important time to pause and understand what we. Learned over the past couple of years and how we need to pivot in order to move forward. I think having. Some sort of gig nursing economy is gonna be important, and I don't think it's clear as to what that looks like yet.
I briefly mentioned virtual nursing and there are quite a number of organizations moving in that direction. So I think understanding how we can use or transition staff into that virtual nursing role is going to be important to understand as well. So, I don't know. From my perspective, I think the verdict is still out as to how we're gonna move forward.
Scott Raymond: Scott? Yeah, I would agree with Vicki completely. I think , there's some very fortunate things that happen with staffing agencies for the ability to staff and to augment staff, especially during the height of the pandemic. I think the end result though is a difficult proposition for organizations to manage now because the cost of travel nurses is tremendous.
It's three to four x of a staff nurse. And so that's putting economic pressure on a lot of organizations across the country. And it's kind of, I think Vicki hit it, right? It's, it's a gig economy of nursing and younger nurses. A lot of nurses outta school want the ability to travel, don't wanna be stuck in one location.
They don't, they're usually healthier and younger, so they don't need access to some of the benefits of an organiz. So I think a lot of organizations are struggling on how do we have that as a component but also how do we recruit nurses back into staff positions not only to reduce the cost, but to reduce continuity of care.
So, you know, some. Organizations have floors that have 80% of their nursing is outsourced to travelers and only 20% are a staff nurses. That's pretty difficult from a nurse manager perspective to manage, especially as those folks cycle in and out on 12 or 13 week contracts. And so, . A lot of those staff nurses are seeing new faces a lot and, and a lot of the staffing or a lot of the travel nurses don't have an investment in the organization as a whole.
So that creates a challenge. And then I agree at Vicki that , it's like I'm old enough and been a nurse long enough where I trained in team nursing, I trained on a paper chart. And now, you know, the transition electronic chart, the transition to primary care nursing and B S N led primary care nursing and.
Organizations looking at how do we reintroduce travel nurses? The only problem with that is, and Vicky, I'm sure you guys see this, there's not a whole lot of certified nursing assistants and there's not a whole lot of lvn or LPMs to create a team nurse. So, that, that challenge or that nursing shortage goes across as well.
So, how we do care redesign is gonna be really important. And I do think technology is gonna play a role. I think Teles, sitting tele nursing, how do we manage sub-acute care? How do we manage folks kind of more in a, a cohesive way and reducing the burden of having, you know, the staff ratios or patient to staff ratios consistent.
So I think there's a huge challenge, and I think we're all looking at it in the same vein, but maybe a little bit different depending on your demographic. The shortage is less on the east coast and west coast, and you can imagine in the, in the flyover states or in the Midwest, it's, it's different. All right.
Matthew Holt: What do you, I mean, real quick, what do you say the, the, the new flavor of sort of nurse nurse hiring communities, you know, the ones who have been like shift and incredible health have been raising all this money. Any, you know, is there a noticeable difference in the way you manage nursing using these organizations versus the old line staff agencies?
Or was it pretty much the same in the line problems? .
Victoria Tiase: Well, I think that's the, that's the trick. And, and Scott alluded to this, this the challenge with travel nursing I would argue we have to, you know, look at it a little differently and that perhaps we need to rethink the way we staff nurses and managed nurses I think we saw in New York City that we.
You know, we're we easily adopted to bringing in staff, nurses and, you know, ensuring they had the technology that they needed putting in processes to quickly onboard them. So I think it's really thinking differently about how we onboard staff and how we manage you know, Staff, nurses, travel nurses, virtual nurses, all the above.
Rob Sebaugh: All right,
Matthew Holt: Rob, probably a good moment to bring you in here. You've been working for you, you, you are the, you and me are the two token non nurses on the panel. , you, you, you, there are an experts. You have to know something unlike me. So, uh, you worked for many years at a, at a, at a major health plan on the health web services side within the site.
Now you're working in, in particularly in identity management and and manufacturing authentication. In a worldwide this right where things are changing so quickly for nursing organizations, how do you you know, what kind of things are you seeing now that you didn't used to see that, you know, that, that, that are different before for organizations delivering healthcare?
Rob Sebaugh: Sure. So look, all of the points are valid. One, one thing that Scott and Vicky and, and every other, candidly, every other health system globally, Has at this point is, is we've, we now have this kind of hybrid work model. That is completely new to anything that existed before. Right? So like Scott had said, I believe 500 people or so had to move over overnight.
We, we actually, believe it or not, we moved about 40,000 people over to remote in the span of like three days. Right? I mean, it's a, it, the, the stress on technology is pretty crazy. But then you think about the. Hybrid roles that clinicians have been forced into. You think about all your security policies and things that you, you know, you control your four walls and the things that you need to do to ensure you're safe to operate, and you've just blown those up, right?
We've said, well, we gotta stretch this here and allow this access, and we don't have enough people, so we gotta you know, have multiple people Do you know, more than one thing? And so what's become very, very common across health systems is this concept of multiple roles per single. I. So you're one mortal user, but you're asked to be in this facility two days a week in another facility, three days a week, volunteering on weekends, and a student by night and whatever it might be.
All, all of this then compounds a job like Scott's because you've gotta find a way to allow people to work. You don't wanna frustrate people so that they leave. We've just talked about how difficult it is to you know, to retain people and find people and, and whatever. So you have to do all of this in a way that enables people to work, but doesn't make you vulnerable, right?
So, thi this is, this has just exploded over the last few years.
Matthew Holt: So before we, we, we, we will dive into, you know, some of the, the, the specifics and technology tricks around that in a little bit to, in the middle of the, the end of this se segment. Before we get in there, there's a whole piece that we haven't really talked about, which is, what does this means for leadership?
And you know, we could probably have an entire conference on . What, what is the change in leadership and how, how are you managing these organizations now that it's no longer just inpatient versus outpatient or what have you? But, but Vicky, what are the kind of bigger. Problems and, and theories of leadership that, you know, you've seen bubbling up both in New York and now in in Utah.
You know, how has this changed the way you think about, you know, what is the job of a senior nurse leader such as yourself?
Victoria Tiase: Yeah, absolutely. It's, it's certainly changed. So I think as, as Rob alluded to this idea of nurses with multiple roles, and I think we saw that you know, throughout the past couple of years nurse leaders being asked to step into new roles and responsibilities that they may have not had in the past or may have not done in a long time.
And I would say, you know, the hard part for. Nursing leaders is that there has been. You know, I real difficulty in managing the polarity of protecting and preserving your staff and then also being able to respond to the demands of, you know, upper level management. And I think unfortunately what we've seen is a real shortage in nurse managers.
So we've seen a lot of nurse managers leave and then we've also seen a lot of nurse managers. You know, step into that role without a ton of experience. So we have a lot of new nurse managers trying to navigate this environment, and that's everything from, you know, the placement of staff. So I think anything that we can do on the technology front to support that piece, how can we you know, leverage technology in a way that makes it easier.
For nurse managers to assign the appropriate staff to the appropriate roles, appropriate floors, et cetera. So again, helping out with that, that flexibility and moving staff as needed. Uh, And then, and then also the provisioning of new staff members coming on board. So I think that has been challenging for nurse leaders.
You know, there are some units that, that I encountered where the most experienced nurse had been there for just two years because of the amount of staff turnover. So I think that's especially challenging on the. Front, especially when we're looking at some of the E H R training concerns.
So I think there's just a lot more on the plate of nurse managers who I said are, you know, very new to their roles and, you know, are in need of as much support as possible.
Matthew Holt: Scott, you alluded to this a little bit, obviously there was the, the, you know, same question but with a slightly different flavor.
You've got the you, you've got the issue of, of supporting with I an IT organization that's got. All these different changes in the nursing environment. There's issues there with, and you've gotta lead your own IT organization. And of course it hasn't been a stationary three years for the IT world.
huge suck up from the tech world at the start of the process and probably a huge vomiting outer talent from the tech world now. So I dunno if that's impacting you know, you all on up, you're obviously probably negotiating a more distributed team than you were. How, how do you think about, you know, leadership of an it part of a healthcare organiz?
Scott Raymond: Yeah, I think it's, it's similar challenges a little bit different. There's you know, you can use managed services to take over some of the functions. Like you could use travel nurses to take over some functions. I think just like nursing, it's really recruitment, retention, and engagement, and how can you do that effectively to keep your staff engaged.
From my perspective, most of my staff continue to be remote. And so how do you engage not only your leadership team, but how do, how do you give them tools to engage folks when they're not in the office? Nine to five. And how do you create a culture and an environment where those folks that are now outside of the hospital or not in a building adjacent, how do you keep them tied to.
The, the end of their keyboard all the way down to the patient care that's being given by clinicians. So how do you make that connection from a culture perspective? And I think that's been a challenge. And then just from our nursing leaders, the feedback or the comments that Vicki made are really true.
So how do you manage a budget when you're using contract labor that's so expensive? How do you keep your nurses engaged? How do you keep them. To stay. So stay interviews, recruitment enhancing nurses that left the organization to come back. What incentives can you provide that other organizations aren't providing?
And what stability or what benefits can you provide that the, that the staffing agencies aren't providing? So, I think a lot of parallels with, you know, how you manage folks. Both with nursing and it, but more importantly for me, how do I bring. My folks that are outside of the organization now back in and, and c connect them to the, the care that's being given on the floors.
And it's, you know, the burnout on both sides is real cuz Covid made nurses work 24 7 and a lot of extra shifts. And IT folks including IT managers have been working really 24 7 on Zoom. You know, I remember when we first transitioned to Zoom, our first manager's meeting, I got on at seven in the morning.
I didn't get off till six 30 at night. And, you know, I didn't, I wasn't comparing us to nurses who were, you know, living the pandemic and, and those pressures and. You just are never off. And so how do you manage that both from a nursing perspective and a and an IT perspective?
Matthew Holt: Yeah, zoom and real fatigue is, is really in both cases.
Rob, so, you know, we, we I I've heard a lot of questions from Scott there. Do you have do you, what are the, kind of the answers to some of those, how, how are some of the work that you've been doing? You know, around identity management and general, he general Tech Services helping answer some of those questions.
Rob Sebaugh: Yeah. Look it's easy to fall to the conversation of, oh, you have to be secure and you gotta follow policy and you gotta do X, Y, and z. I'm a big believer that if you're managing identity right, and, and by identity I mean the flow of a user accessing the things that they. At the right time to provide the right care, et cetera, right?
If you're managing it properly, you're, you're gonna be secure as a byproduct, right? This is really, it's, it, it's so much of an end user component then it is a security or as much as it is a, as a security component, right? You're really looking at how do I build roles, right? Collections of access. That I can provide somebody on day one so that somebody who took a risk in leaving their organization and joining mine can start their training.
Day one can enroll in benefits, day one can start their career day one and not wait on the, you know, potentially manual effort. To provision access and provision services and equipment. It's, it's, it goes back to, you know, all these, all these pressures in it certainly exist, all these pressures at the, at the patient bedside exist.
We, as IT professionals have to get better at finding ways to leverage technology to enable those efficiencies, right? And that will reduce the burden and friction on clinicians at the bedside, right? I mean, it. End of day, I mean, in some cases we are talking life or death in this industry. Right?
Matthew Holt: So what, what are the practical things around sort of, you talked about.
Easy. Onboarding, easy identity, identity, managing management. We mentioned multiple roles, who want identity? What are some of the practical tools that you are seeing being adopted? And then perhaps we can go to Vicky and Scott and figure out, you know, how that's working, where they are. you're looking across the industry and they're obviously a deep, deep dive in a co in, in one place for a couple places.
Rob Sebaugh: Yeah, absolutely. So, look, we, you, you start with, you consider your populations right, whether you're talking. Employed physicians. Contracted physicians, students, right? Know where they are and know how they're governed, right? How do you know, what's the event that says, oh, we've got a new hire, or, oh, somebody terminated out, like, security professional, put your hat on.
You don't want terminated users to have active accounts, right? I mean, that's a, that's a security problem, right? So know your populations. And then in terms of making things easier, Look at your roles, integrate your clinicals. Think about how you provision access into your clinical systems, your, your EHRs.
Think about how that day one user experience should be holistic. Should be, I've joined, I've got my equipment if I need it, I've got my access if I need it. Et cetera. And then the other kind of things that kind of play along with that are think about you know, things like single sign-on. You know, you want to be able to sso into things.
You want to, you know, to, to access things with logging in one time. You know, it's asking users to manage you know, multiple credentials and multiple things gets really challenging. The other thing that we're seeing a lot of, and I don't know if either of you are impacted by it, we see a ton more merger and acquisition in healthcare.
These. And now you have these problems where user and you know, system A needs access to application and system B. How do you facilitate that if you haven't provided a trust between those networks? Right. There's, there's technology and capability relative to identity that can support that workflow, that helps enable business to accelerate.
It helps enable those integrations to accelerate, but at the end of the day, it helps enable those clinicians to do their job.
Matthew Holt: Vicky Scott, how perhaps I'll pick on you first, Scott. Rob said a lot of great stuff, a lot of solutions there, which sound like they can work for all those problems. I guess two questions.
First is how much do you think about that set of problems amongst all the other technology problems you have to think about for nursing? And then secondly, how, how easily apparent are how, how easily available in the parent have those solutions been? Or are we kind of stuck like we often are in health call health, healthcare way behind the eight ball.
Scott Raymond: Yeah, I know Rob and I could geek out for hours on this subject. And I agree with a lot of things he says. So let's just, let's just hit identity management and access management. So having a single system to onboard and onboard people easily and securely. And importantly, how do you give access to folks to the things they need immediately?
So Rob alluded to that. So role-based access is key. And I know Vicky's probably gonna squint at me or wink at me, but with those nurses that are on that do cross multiple departments and may have access, different access, having a access management system, you can manage that pretty easily. And then I look, we talked about a little bit, we, you know, in our pre-meetings together, This idea of, of dual authentication inside and outside.
So Rob hit on it. So tap badging with single sign on, using virtualized desktops using a virtualized environment to give a certain amount of access so I can tap in in the morning, authenticate myself. And I can provision that access for the amount of time. So maybe give four hours before you have to reauthenticate or in some areas less or more.
And having that management and being able to take that authenticated workspace including Epic with you to the next workstation, super important. And that can take away that friction. And if you just look at the er, the amount of times a physician and nurse log into different works stations to take care of the.
You know, revolving patients in that environment. Having that ability to do that really increases the the satisfaction with the tools, even though, you know, most clinicians are still burdened with documentation. So at least if I can take away the burden of access and take away. The burden of control from the IT folks and the security folks by having a management system for access and identity, I think is, is key.
And again, Rob and I, we could, we could talk about this probably for three hours.
Matthew Holt: So, so in that, in that world, what, what would you give your, I mean, you've been to a number of organizations and, and Vicky, same for you. How, how would you market? I mean, is this something a problem that we've lit now or is this a problem which the industry is just getting into grips.
and how are your organizations doing? Have you know you got, are, are you happy where you are in that situation? Or does, do you have more work to do?
Scott Raymond: Vicky, you, you go first. .
Matthew Holt: Oh, Vicky. Okay. He's done this on you, Vicky
Victoria Tiase: Yes, I, I, I am happy with, with where it is. But I, I do wanna make a few more comments, but I'll please, I'll, I'll let Scott respond unless he's.
Scott Raymond: The question go on forever. No, I won't. No. Yeah, no, I think you're right. I, I think depending on what organization you're at and their IT maturity depends on whether they're behind the eight ball or on the, on the front.
I think a lot of organizations from an access perspective and a tap badging perspective, I think. A lot of healthcare institutions have adopted that and are leveraging that to take away that access friction at least.
Victoria Tiase: And I also just wanted to circle back to, to Rob's comment around access and patient safety and patient care.
And also connect this to our travel nursing discussion. So, this happened in a number of places I. California is where we saw it in the press the most. But if travel nurses are not getting the access to the systems that they need, they will quit. Right. So they come on and they're not getting the access, not being provisioned appropriately, they're gone.
Right. And that is, that is something that I think will continue to happen in terms of travel nurses being onboarded to new organizations. I don't think we've seen the end of it. So making sure that access is available during that onboarding is key. Because. That only delays and causes more issues with getting the workforce that's needed.
And I think in terms of. What organizations can do. You know, I really see two paths that that took place over the last couple of years. You can either actually design your device programs for travel nurses, so when they come on board that they have a device that they can use, you know, that is secure for that organization.
You know, or you maintain the same security protocols that you have for your current staff, which is. , you know, two F two factor authentication, your, you know, password protections, et cetera. So I think that's important for our organizations to think about and not cut corners in those areas. Make sure that you have a very clear strategy and then that onboarding is working properly so that you're not losing the new nurses that you are bringing onboard.
Rob Sebaugh: I would I would layer that just one level deeper too, and that look, getting into the workstation and getting into the applications, that, that authentication piece is critical, right? Then there's that. What am I actually authorized to do now that I'm in there and more of the nuance exists for clinicians in that authorization layer?
Do I have the right entitlements to do what I need to do? And, and oftentimes it means, it, it's, it's, no, I. So I have to open a service request, and that request sits in a queue, waits for a human being to do something, and that cycle of time can be. Quite ridiculous in certain scenarios. Right. So,
Matthew Holt: so Rob, I was gonna ask you about that scenario, that, that same scenario, but just for the onboarding part, right.
Are we, wait, are we waiting on some other departments, some other human, human resources system or something else to get that individual travel nurse or whoever that new person is onto the system? I mean, Vicky said they don't get access. They, they, they quit. I mean, is that something that sit, you can sit in a queue for days and how do we automate that away so that that power gets given?
Whoever the hiring manager is or whoever's responsible.
Rob Sebaugh: Yeah. It, it's a super common problem. Right? And, and some organizations, look, if you're only hiring 20 people a. Probably do that manually. Right? But if you're hiring 200 a week, that's a little harder. You know? And if you're at multiple facilities and whatever it might be, it, healthcare has these, you know, nuances, right?
But yes, exactly. You can have a manual queue for getting your ad account created a manual queue for getting a laptop provisioned or mm-hmm. , you know, a thin client or whatever it is. You need manual q4, X, Y, and Z. And, and look, there's a lot of orchestration in placing that you can. IT service management platforms to orchestrate the routing of those tickets.
So it's more efficient to deliver, but there's also capabilities that allow you to automatically provision and deprovision those types of access and automatically create ad accounts, automatically generate emails, automatically get people assigned to a role and working again, day one. Back to that user experience piece.
Scott Raymond: Yeah, I agree with you, Rob. I think the, I think the role-based, if you, if you're sophisticated in your organization and you've really honed in on role-based access, you can onboard people pretty rapidly. And if you have, like Vicki talked about, nurses that have multiple roles, you can layer on different roles in that access.
So day one, they have access to the, the tools they need. And I can't agree with you more automating. The onboarding from signing the application through your first day of orientation. Super important to, especially to your point, if you're hiring hundreds of people a week or thousands of people a year, you can't afford to have manual processes anymore.
It just doesn't work.
Matthew Holt: So one, one. Quick question is, we've all, we've all seen this, you know, the the, the password written on the sticky note and handed around, or the multiple, the one identity handed around to multiple people, or, or the, the single, you know, the , the sign or the OR device that gets, that's supposed to be signed to one person that gets passed around.
Where do you think we are in terms of, you know, under the, the cultural understanding of that level of security over, over the last couple of years, especially with all these new people coming in,
Victoria Tiase: I, I honestly have not seen an issue with. At least amongst nurses. And I think that also comes down to the device strategy, right?
So I think for nurses that have their own devices, they, they already have their method of, of knowing how to log on and, you know, not sharing desktops. So I think, you know, fortunately being in an organization that has a mobile device strategy for nurses I don't think it's as prevalent, but perhaps in organizations where they are still relying on desktops that might be very,
Matthew Holt: So a problem that's been solved.
Scott Raymond: Question mark? Yes and no. I think it depends on the sophistication. So, you know, if you have sophisticated passwords that expire every 90 days if you don't have self-service deployed to reset your password without having to get a hold of the service desk, I think you're gonna, you're gonna struggle, especially around the physicians.
And I also think, you know, being able to tap badge in kind of smooths that out. But I think Vicki's point is well taken. People understand security, they understand, you know, they've, their lives have been electronified, so they have, you know, sign-ons for banking, sign on for almost everything that they manage.
And fishing and stealing of credentials is, is not something hidden in the background. Everybody kind of knows about it now. So I think as long as you're thoughtful about the access and you provide that self-service it's not that big of an issue. I
Rob Sebaugh: totally agree actually. And I, and I I love the point cuz I think we are getting more security aware, right?
Even my kids, you know, amaze me sometimes, you know. That said, I think some of the challenge. We see on health systems are, and I realize the numbers are changing, but there's some really long timers in the organizations, right? People move around, they get, they take new roles, they, they move away from one thing, do a different thing, but they retain that access along the way.
And then inevitably somebody joins and says, well, I want new nurse Susie to look like Nurse Sally . And all of a sudden Susie has. 12 years of access that she shouldn't have. You know, it's really, I, if you're, if you're creating roles accordingly, and you're assigning them accordingly, you know, via, you know, a, a department ID or a job code or whatever you're using Susie looks like Sally in the right, that she can do everything Sally needs to do relative to that job.
Do you, you
Scott Raymond: see what I mean? Yeah, that role base is super important. I agree with you.
Matthew Holt: Is the eventual evolution of this, that everybody sort of manages this themselves with their own. We own devices and somehow this has, there's a central outsource function for each organization that sort of gives people different roles as they go in and out.
Given the, given that, Vicky, you were saying right at the start, that we're not gonna go back to the old world of, you know, the same nurse being there for 20 years. People are floating around, people are going to inpatient and outpatient. Much more. There's, there's obviously mo organizations emerging all the time.
And yet we still hear about cyber attacks and ransomware attacks, you know, happening all the time in healthcare. How do you think this ends up? I'll start with you, Vicki. Hmm.
Victoria Tiase: Well, You know, yes, I do think there will be some sort of self-management, and I'll take that opportunity here to promote something which I think is very important, which is the unique nurse identifier.
So I think there's an interesting you know, piece to this This picture here in that, you know, for physicians there is a an N P I. So there is a way to identify a physician, cross organizations for nurses. There isn't. And I think this is an opportunity to really think about and. You know, certainly nationally we are working to promote this from organization to organization, but really thinking about how we use the NC S B N, which is the national state Board identifier that nurses get when they take their license.
How can we use that so we know what a particular nurse is provisioned for from one organization to another organization. So I think there, there's more work we can do in this area and I think that's one piece to this puzzle in thinking about how we can know what a nurse is, is trained and you know, specialized in you know, across organizations and across states.
Matthew Holt: Yeah. We, so nurses need identifiers. Doctors already haven't, let's not introduce the one that the patient identifiers, because that'll be another free hour session. I know. Plus several acts of Congress and revolution and gone down someone else. Anyway. Scott, where do you think is gonna sort of, come out?
What is your role gonna evolve to and what is this particular aspect of it gonna evolve to be taken away to somebody, to somebody else and be as a completely different managed service? Or how do you think this?
Scott Raymond: Yeah, I don't, I'm not sure. I think you're looking into the, into the crystal ball of the future a little bit there.
I think Vicki hit a, a really nice point having a national database of, you know, where there's some states that are, that if I have a nursing license in California, I can practice in Arizona. And having a national number like a physician does or call it a credentialing, knowing what I have, what my specialty is and what I should be able to do I think we would've been able to avoid kind of that scandalous thing that happened with people buying a nursing school and get, and taking the NCLEX and getting a license.
So, but it would be interesting that it's really thought provoking. I'd love to hear what Rob says about it, but from. From a identity management and at least access or zero trust perspective. It'd be really interesting if we can identify people across organizations. I think the tricky thing is we don't have a universal E H R, so kind of access in Epic looks a little different than Access and Cerner or in or in Meditech.
So I think that that might pose a unique challenge, but I think from a credentialing perspective, That would be a great challenge for nursing to the RNs to get together and assign me a number. That tells me what I've, what I've certified in, what I can do and what I can't do from a nursing practice perspective.
Yeah.
Matthew Holt: Not to mention, I just saw The Good Nurse, which is the movie came out last year about the, the, the nurse transferred to hospital to hospital, hospital back in the late nineties, early two thousands. Who was killing all the patients cuz he was bored. , which probably not, not something you wanna encourage, but Yeah.
Hard, hard to find. Right. Way they end on, on
Scott Raymond: positive. There it was, it was a good movie.
Matthew Holt: Jessica Chastain was great. Also was reminded that she was still working away and hiding her heart condition cuz she didn't get automatic health insurance back then. That was only 2003, 2004 times have changed for the better a little bit anyway.
Ron brig us home here. How is this gonna look in the future? And how can we'll find you to, to find out more about this?
Rob Sebaugh: I agree. All very valid points. I think. Look, we've gotta get better. Understanding, you know, our own identity. I've said, I've said for a long time that we all have social security number as an example.
Like a nine digit number doesn't scale forever, right? Like we've gotta figure out another method for proving who we are, how we're credentialed. I love the idea of some type of national identity provider to give me some type of information to vet against, but I will say as an organization if Scott, you know, if I'm you, if I'm sitting as CIO of an organization, I, you know, it's your brand, right?
At the end of the day, if you get breached, it's your brand that takes the hit. So you've gotta have a way to correlate your identity context of what you know about people on your network to that, you know, universal information and marry that correctly. And I think we're, we're, you know, headed in the right direction for those things.
So company like SalePoint that I work for look, we're an identity security platform. You know, we're here to help with that type of thing. I will say, company aside, like it, it bothers me how excited I get to talk about this kind of stuff. So please reach out. I'm happy to and it's, it's, it's fun.
So this has been great. Thank you.
Matthew Holt: And how someone find you Rob?
Rob Sebaugh: I am LinkedIn. I think it'll be shared. I, I'm not much for social media, so LinkedIn is as much as I have.
Scott Raymond: You're pretty good at count down on social media. I know how to find my sales sport, my sale point resources. So now Rob,
now Rob's one of them, so that's great.
Matthew Holt: Rob's put himself available. Anybody cares about this problem, which is, which, you know, is, I think everyone has lawyers who's involved in the running of a big healthcare organization these days and, and many others because I know identity manage. Overall, the security, the audit is, is ramping up. Even some of the consult the companies I consult with in the sort of health IT business and I doing things, it's like sending me dedicated laptops so I don't have their stuff on my, on my laptop, which is a real pen in the ass if you're a consultant.
But I understand why. And their audit staff are saying, if you're gonna handle data, someone in your organization, you know, you can't have anybody in the organization who, who who is, you know, going rogue in any way. And these things, these things are gonna be increasingly part of our lives. And yeah, someone wants to tell me, Rob, that that national identity number is gonna be the phone.
Everyone has one of those. Maybe, maybe that's it. But
Rob Sebaugh: those, those change pretty often. I'd be terrified of that. .
Matthew Holt: There is, there's maybe you're just gonna sign a phone number, tendered at phone number at Ber and . At least you can now move those between, unlike Cerner and Epic. At least you can move those between your phone companies now anyway.
Alright, well, that's been a really enlightening discussion here about , the perils and challenges of, of running organizations and nursing. Not to mention all that security concerns and onboarding concerns. I wanna thank Scott Raymond from the Chief Innovation and Information Officer at Nebraska Medicine.
Vicki Tiase, who's the strategic Director of Digital Health at Ity, Utah. And Rob Sebaugh, who is the healthcare identity strategist at SalePoint. I'm Matthew Holt from the healthcare blog saying Thanks for spending some time with us.