Navigating Nursing and Technology (ft. Helen Lu)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences.

And now, your host, Ed Marx. Everyone, welcome to another edition of Digital Voices. I'm with my friend Helen Liu. Helen, welcome to Digital Voices.

Thanks, Ed. Thanks for having me. I'm really excited to join you today.

Yeah, me too, because we're going to talk about restaurants. It would be kind of fun. And I love what you wrote about restaurants, your restaurant experience. So I thought we should cover that. You know, your day job is in AI and healthcare, clinical informatics leader, an NP, nurse practitioner. So, so many cool things about you. But the most important question that I have for you today, Helen, is What are the songs on your playlist? What kind of music do you like?

I think it depends on my mood a lot of the time. On repeat, I listen to a lot of Billie Eilish because I think her voice is just really calming. It's hypnotic and just great for background music.

Yeah.

When I'm feeling more energetic and fun, I listen to Fisher and Dom Dolla. You know, they have very few— a few lyrics, but The beat is really good. So that's on my playlist now.

I love that. And what about a life message or mantra? Are there words that sort of guide how you live?

Yeah, I think I really try to lead with curiosity and, you know, making sure that I don't jump to conclusions about people or labeling people only because when you choose curiosity, you're asking better questions and And that mindset has really helped me build better systems, build trust with people, and just making people feel more seen and heard.

Yeah, I like that. And so tell us about you, like go way back from the beginning. Where did, where were you raised?

Yeah, I was raised in Sacramento. So my parents are first-generation Asian American. They're Chinese-Vietnamese refugees. So they were part of the boat people that fled Vietnam after the war.

Wow.

Um, so they were sponsored by the American Red Cross, and at the time my older brother was only 2 years old when they came to the US with no English or anything. And, you know, my mom's one of 11, dad's one of 12, so they really taught me the importance of relationships growing up and just pure resilience. Like, my parents growing up, they did whatever jobs that they, they could find at the time. You know, my dad was a cook, My mom was a seamstress while going to cosmetology school and to learn English, and then they ended up opening their own businesses as well. So I spent my childhood in the back room of my mom's hair salon doing my homework, sweeping the floors, answering the phones. And I think, you know, just growing up with that resilience of like figuring things out has really guided me to To what's important in life. Figure things out, be close to your family.

Yeah.

Be good to people.

Yeah. Now, I love the immigrant story, you know, because it always seems to be very similar that you come here with nothing and I'm first generation and you come here with nothing. And so you've got to make stuff happen. And it's that resilience that you're talking about and sort of the optimism, you know, and then, you Yeah, learning a language. Could you imagine that, Helen? Like, you doing that, like me doing that, going to another country that's totally different. It's not like it's similar, right? It wasn't from one Asian country to another. It's like night and day. And I have so much respect for, uh, people like your parents. And then the kids they produce are typically pretty amazing as well.

Absolutely. Absolutely. I think it's that, you know, that immigrant mindset of just pushing through and making things happen for yourself.

Yeah, that's very cool. So then, all right, so you have this experience, you're in high school. When did you start thinking about nursing?

So I started thinking about nursing probably pretty young. So my mom has lupus. She was diagnosed when I was around 2 years old after years of unexplained symptoms, delays due to language barriers, and really having limited access to healthcare. And I actually started out studying clinical nutrition because I was always worried, I was always curious about the pathophysiology of disease and the root causes. And it really came from watching my mom navigate the healthcare system with lupus. And, you know, I saw how easy it is for someone or for certain populations to be marginalized if they didn't speak the language or fit into like a very neat clinical box. At the same time, my brother was in medical school, so he's 10 years older than I am. And I saw how his training was very much focused on diagnosis and treatment. And I felt much more drawn to prevention and whole-person care. And I felt like nursing was, was the right path for me given that.

Yeah, that's, that's pretty cool. Were you the only child that your parents had after you came over? So there's 2 of you, or do you have other brothers and sisters?

Yeah, I have a middle brother, so he's 6 years older than I am, and he was born in the U.S.

Yeah, because I was just coming back to your parents had 23 siblings between the two of them. Yeah, I think, right? And so I was like, I wonder how many kids they had, but it's just the 3. They're probably like, uh, that's too many kids, uh, to have so many.

Yes, absolutely.

So then you become an NP. So tell me about What you were thinking, you know, to make that decision.

I think it came down to autonomy and advocacy. So when I was in college, I met my first nurse practitioner and she was an NP that worked at the UC Davis Care Center, which was a clinic for children who had been removed from their homes due to abuse or neglect. And so these kids would be brought to the center by Child Protective Services. to be evaluated before they went into foster care. And these were heartbreaking cases, you know, like kids with broken bones, sexual and physical abuse, really complex needs. And this nurse practitioner, and along with the caseworkers and the social workers, really tried to show up as best as they could for these kids who didn't know better that the lives that they were living were, were wrong. You know, they knew no better. And this nurse practitioner and the caseworkers, they They fought for them. They made sure they advocated for them, even when the system continued to fail to protect them. You know, a lot of the time these kids would come through multiple times because they would go to foster care and then the parents would be put into some classes and then they would be given back to the parents or whoever was their guardian. And you would just see them come through the system over and over again. And so I kind of, you know, I wanted to be that kind of provider who both was able to care for the patients, but also had the voice to advocate for them. And that's how I decided to be a nurse practitioner.

Yeah. Did you do that straight after your RN or BSN, or, or did you take a break and just practice?

Yeah, I went straight through, um, my nursing program. So I went to Columbia in New York, and the way that they've actually structured their, um, RN to master's in nursing program is while you're doing your master's, You're, you're still, you know, in the, the hospital doing inpatient bedside work.

Yep.

And then you're doing your clinical rotations at the same time. So it was a very, it was a, a structured program, but it worked. It was really hard. I'm glad I got through it. Yeah.

Yeah. It's kind of good. I always advocate, I know there's pros and cons, like getting your master's or doctorate later, but I always advocate, I did the same thing you did. Like I got my master's degrees, I kind of went straight through. And I was glad because I was done.

Yes.

Whereas I didn't want to be that 30 or 40-year-old, although there's nothing wrong with it, bless those people. But I didn't want to be that person that had kids and a hard career already and then going back to school. So it was kind of nice to get it done when we were super young.

Yeah, correct. I think I was done when I was like 24 or 25.

Yeah, that's young.

Which was awesome.

Yeah, that's really good. So How did you then make the transition? You know, cuz today you're this leader in clinical informatics. How did you go from sort of this, the clinical, you know, the type of nursing that we were just talking about to becoming this, what I call a digital guru?

I was always, you know, I worked full-time as a nurse practitioner in primary care and I did home health as well. And I kept running into the same frustrations where I felt like the systems were clunky. You know, documentation took a lot longer than the visit itself. I didn't feel like I was able to connect with patients and I didn't feel like the workflows were designed by anyone who actually had to use them. So, you know, for a long time I just worked around it and I became the clinician champion and helped train other people and learn all of the efficiency tools that were available with these systems. But, you know, I just kept asking like, why is it like this? Who's building these tools? Why aren't Why aren't clinicians part of that conversation? And it kind of led me through eventually getting included in informatics projects. And then I became that person who could translate clinical needs to technical needs and vice versa.

Yeah.

And so it just kind of evolved through that. But I didn't feel like I was stepping away from patient care per se. I just thought of it as scaling my impact. And instead of helping, you know, 20 patients a day, I was able to help hundreds and thousands of clinicians by improving the systems that they're able to use every day. And I think I've always loved technology as well. I started building websites when I was in middle school, you know, hacked my TI-83 calculator.

Wow.

So always had a knack for digital tools.

Yeah, I could sort of visualize this right now. You tinkering back on your TI. And that's why I love to ask that question. Sometimes it's something that just came as an adult, but for other people, it's something that those seeds were planted early. And that's great because I always felt the same way. It's like I hated when I was part of technology projects where we didn't include patients and we didn't include clinicians. And I would love to have worked with and have worked with people like you in all the different things that I've done. Now, before we sort of switch to AI, nursing and AI, let's talk about this pizza restaurant experience you had. You wrote about it and it was quite intriguing and sort of the lessons learned. So, because here we were, we were talking about, hey, tinkering as a kid, becoming a nurse, getting your NP right away, getting in the digital side, and all of a sudden you're opening up a restaurant.

Yeah. So I didn't actually want to do it. It was not my dream. It was my ex-boyfriend's partner and his brother's idea at the time. And I very clearly remembered saying, you know, this is going to be way harder than you think. And at the time, I felt like I didn't really get to sit on the sidelines, you know, so once they were committed, I had no choice but to be involved. And it was a Neapolitan pizza restaurant in downtown Sacramento, huge restaurant. We had like 30 staff members.

Wow.

And it opened 7 months before COVID Terrible timing.

Yeah.

So, you know, I did everything, built the website, trained the staff, set up the point of sale systems, designed the menus, mopped the floors, cleaned the bathrooms. During COVID created safety protocols and infection prevention protocols. And it was, it was a lot, you know, but I don't think I would open a restaurant ever again. It was just so hard.

Yeah, I, I can't imagine how hard all the regulations and yeah, a lot of different aspects to it. So what's your favorite pizza? Do you still like pizza?

Yeah, I really like, I do like the typical margherita pizza. So that's how I kind of judge other restaurants is if I order the margherita and see if that's good. But my favorite pizza from there was the chicken Alfredo pizza. It was different and it was really good. There's like bacon on it and white sauce. Yeah. And I like cracking an egg in it too.

Yeah. I love pizza with egg. Now I'm hungry. So after we're done recording, I'm definitely gonna go grab a pie or something. So no, that's, that's really cool. And I'm sure that diversity of experience has helped you both personally and professionally. So yeah, let's go to AI. What are one or two areas Where we've seen the greatest gains so far, in your opinion?

I think, you know, I think everyone's been talking about ambient documentation. That's probably one of the greatest gains. This is the first technology that I've ever implemented or worked on that clinicians actually want to use the tool.

Yeah.

I've been doing Epic or EMR training for years and years and Have, you know, created ongoing education programs. Nothing has made an impact like the ambient documentation space.

Yeah.

I use it myself when I work in the clinic, and it's, it allows you to be much more present with the patient. You're less distracted. And I would also say that, you know, it's reminded me how much time the EHR has really taken away from you. Because I don't think, you know, you just kind of chug along and go through your day and you don't realize how much it's taken your time.

Yeah.

Yeah.

Because it slowly crept up, right?

Yeah.

It was just a little bit. And then pretty soon it became like we were overburdening nurses for sure and physicians with everything that they had to do. So the Ambien has been really great. What about, where we are headed. What do you think? Any ideas on where we might be headed?

I think we're going to see the largest gains in, you know, agentic AI and kind of a shift towards more invisible technology. So like tools that quietly handle the tasks that people don't want to do. When you're thinking about invisible technology, and we're talking about ambient AI as well, right? It's what's so eye-opening is that You know, your EHR has become like having a disruptive dog in your office that's always pulling you to leave, barking for input, and then just getting in between you and your patient. And I think it's more, you know, the— with the future of AI in healthcare, it's not about adding more technology. It's about making the right tools kind of disappear back into the background so that It doesn't get in between you and your patient. So I do see that there's going to be more in that. And we're already seeing that happen, right? Like there's teenagers that are going back to using flip phones versus smartphones because of all the noise that is just in smartphones. And then people going back to paper planners and gratitude journals versus their like digital task apps and—

Yeah.

Journals. So. Yeah. See?

I still, I was just showing for our listeners, I was just showing Helen. I, I do, I do my task on paper. It just helps me. And then I, it's, yeah, I, that's one thing I, I consider myself like, I, I use a lot of digital tools, but there's a couple things, reading books and, and sort of my task list. I still keep manual. Same here.

It helps me remember better.

Yeah, I think it does. It's a visual. Q, right? That's always there. So what about nursing education? Do you think, and maybe it's been, you know, a couple years for you, but do you think that nurse education is keeping up with the pace of digital transformation?

I don't think so. You know, nurses make up the largest part of a healthcare workforce. They're usually outnumbering physicians like 4 to 1.

Yeah.

And they're interacting with the digital systems most frequently, right? And in a healthcare system. But I think most education programs still treat technology like it's a, like a, it's like a side topic and—

Yeah.

And something you'll learn on the job rather than a core competency. And it's also about, you know, it's not just about education, right? It's about leadership too, because in the US, only 40 to 50% of health systems have a CNIO or an equivalent nursing informatics leader. So your largest group of clinical users often has very little say in how the technology gets designed or implemented. And so, you know, we wouldn't dream of building an EHR without physician input.

Right.

So why are we building systems without nursing?

Yeah, no, well said. And I didn't realize the 50% number, but that makes a lot of sense that only 50% of organizations might have a CNIO. And yeah, then they lose that powerful voice of leadership that makes sure that nurses are well represented. My wife, Simone, maybe 3 years ago got her DNP, her doctorate. And I was very curious when she was going through that program, how much of it was tech enablement. And it really wasn't any.

Yeah.

And I was like, man. And she's very tech enabled. She's very much like you and has similar background. And You know, even she was wondering like, wow, why aren't we training on, you know, the advances in technology? But the sad fact could be what Helen, what you're sort of alluding to is like a lot of the hospitals aren't quite there yet. So you might work for a forward-thinking hospital and you're doing some cool things with Ambien, cool things with tech, but not everyone is there. And so education has lagged a little bit and yeah, it needs to, definitely needs to catch up. And some of these organizations need to get out of their sort of funk, if you will, and really rapidly transform and take advantage of all the new tools that are available. What advice would you have? So let's say, you know, a good portion of our audience are nurses or other types of clinicians, and maybe they're just starting out or mid-career. So I'll ask you 2 questions around that. You know, one is education. What sort of education are you a big proponent for them to continue on? Definitely get their BSN and maybe their master's or NP. What do you— What's your encouragement for them?

I would definitely say if they could take a class in informatics, it's really, really helpful because it gets you some systems thinking.

Yeah.

And, you know, the health system as a whole rather than each functioning little area, right? Because the work that you do in a healthcare system is all connected, inpatient, outpatient. So definitely learning as much as you can if you're not getting Informatics or technology education through your nursing program to take some classes after the nursing program. And along with that, you know, I had to do the same. I did my AMIA 10x10 courses. I did my AI in healthcare courses at MIT and just that continuous learning and getting involved, right? Raise your hand. Raise your hand to join all of these like governance bodies or work groups. And, you know, you can't just, just, you know, sit on the sidelines and think that there's somebody better to do this type of work. It's you that has to get involved.

No, I love what you're saying, Helen. And you're right. You have to make it happen. Don't sit back or else the future will become present and pass you by and you'll be in the past. And you need to like self-educate. You're a great example. People should definitely follow you, look you up and follow you because you're a great example of someone not, you didn't rest on your NP. You had your NP when you're like 24, 25. But you kept going back, MIT, learning about AI, learning about different technologies, and then volunteering. Like, you saw them implementing technology, there was no nursing involved, and you got involved. And you're like still that way, and you're a huge advocate. So I think that's great advice for new nurses, really anyone, doesn't have to be nurses, but new nurses and definitely people in mid-career. So let's talk about leadership. Was there Anything early in life, and you shared quite a bit about your upbringing, that prepared you for leadership roles?

Yeah, I think, you know, just that my immigrant family of entrepreneurs, my grandfathers going back to Vietnam were business owners as well. And one moment that actually really shaped me, I think, was when I was in high school. I was actually asleep when it had happened, but in the middle of the night, my dad's business caught fire and burned down.

Oh.

Yeah. And I had no idea. The next morning I woke up and my dad was coming home from being there. He was covered in smoke and he just said to me, he said very like half tired, half smile, weird, the shop burned down. And there was no panic in his voice. There was no anger. It's just very quiet resolve. And, you know, he said to me, if I built it once, I can rebuild it again. And then he drove me to school after that. Jeez. Yeah. You know, I think that moment just taught me everything. It was like, you know, it's really how you show up when things go sideways.

Yeah. What does your middle brother do?

He's in business. So he actually ended up taking over the family business. But now he's doing more like property management.

Yeah.

But yeah.

Your parents have got to be super proud of not just you, but your two brothers as well.

Yeah. Yeah. I think in Asian families, it's tough. You know, it's tough love. Yeah.

That's a good point. But yeah, they, you know, they raised great kids that are doing good things. So that's pretty awesome. How do you recharge? yourself? Like you're always educating yourself. You're super involved. You're doing new things. You're on a pod— this is your first podcast. Congratulations. First of many.

Thank you so much.

You know, how do you like chill?

I like switching gears a lot. So I like reading and learning from other fields like design, psychology, business. I started listening to a podcast on game theory. Just because I was interested. And I really like creating. I like cooking and baking. It's hands-on, it's tangible, has nothing to do with work.

Yeah.

And that's how I like to recharge. It's, it's just taking my mind off of work and what I'm doing.

Ellen, you're a remarkable person. Thank you.

You're a remarkable person.

I've always, you know, enjoyed our interactions, but as I learned more about you, and I'm so glad that you've taken the time to Ben, with our listeners, you know, you're just dropping a lot of great concepts and ways of living that will be really helpful if other people adopt it. This whole mindset of curiosity, the whole mindset of creativity, the whole mindset about continuous learning, experimentation, doing crazy things like off-brand. So doing a restaurant or reading about game theory, all the different things that you spoke about. And of course, you know, having the great lineage that you have. What else? What did we miss? Is there anything that you want to double down on? I'll give you sort of the last word as we close out.

Yeah, I think, you know, double down on the gaps, those everyday spaces between systems, roles, you know, different ideas, different pathways, and just, you know, the stuff that no one really owns, but everyone kind of depends on.

Yeah.

You know, like, especially in healthcare systems, you know, when, like when a patient is discharged and no one's quite sure who's supposed to follow up on, on the patient to get their lab work. Or, you know, when the nurse who just knows how to handle that form is out and suddenly no one knows how to move a, move something forward, right? In a healthcare system. And it's just things that are in between that you think that, you know, should fit into a workflow or a pathway, but doesn't necessarily.

Yeah.

There's a lot of, there's a lot of opportunity in that space.

Love it. Mind the gaps for sure.

Yes.

Ellen, thank you for being a guest on Digital Voices and for taking a risk since you've never done this before.

Yes. Thank you so much for having me. Thank you for listening to Digital Voices Podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.