Modernizing EHR Workflows and Virtual Nursing with Adventist Health CNIO Karen Hunter

This is part of our weekly executive insights series where Elion CEO Bobby Guelich speaks with healthcare leaders about their tech priorities and learnings. For more, become a member and sign up for our email here.

Role: CNIO

Organization: Adventist Health

Can you give us a brief overview of your role and current technology priorities?

I have a background in nursing and spent the first 16 years of my career in operations, which is where my passion lies. For the past 15 years, I’ve focused on the intersection of clinical practice and technology, particularly electronic health records (EHRs). Currently, I serve as the Chief Nursing Informatics Officer (CNIO) at Adventist Health, leading a system-wide transition to Epic. My primary focus is on preparing our non-provider staff—especially nurses and ancillary professionals—for this significant change.

As you begin this Epic conversion, what steps are you taking to ensure a smooth transition for the staff you’re focusing on?

Readiness is my top priority. We can’t simply overlay Epic onto our existing workflows and expect everything to function as before. This transition is an opportunity to truly transform how we operate, by enhancing efficiency, improving patient safety, and reducing variability. In the past, we often tried to replicate paper processes within the EHR, which didn’t fully leverage the technology. I liken it to how my mom wanted a smartphone but still uses it just like a landline, sitting in her kitchen talking to friends. We need to go beyond using new tools for the same old tasks.

How are you applying this shift in thinking to your Epic build process?

One example is integrating ambient listening for nurses. Picture a nurse conducting morning rounds and asking the patient about how they’re feeling, their pain levels, mobility, or sleep during the night. Instead of manually entering this information or writing it down, the system captures these details through ambient listening. Of course, this means nurses must adapt to speaking out loud more often, which is a change in practice. However, the potential is enormous—saving time and reducing the need for manual documentation, which can occupy up to 40% of a nurse’s day.

Besides ambient listening, what other workflows are you looking to enhance with technology?

I’m particularly excited about the potential of artificial intelligence (AI). We’ve had AI for a while, but it wasn’t always timely or useful. Now, we’re reaching a point where AI can run continuously in the background, analyzing vast amounts of patient data and flagging potential issues. It’s akin to the instinct that experienced nurses develop, but with AI, it’s more precise and accessible to all nurses, including newer members of the workforce. This could help us detect problems earlier and improve patient safety, which is our ultimate goal.

Virtual nursing has been gaining traction recently. What are your thoughts on its potential?

We’re actively exploring virtual nursing at Adventist Health. I’ve seen it implemented effectively in a previous organization, where the approach was to ask the units how virtual nursing could best support them, and then design the program around those needs. It worked well because the virtual roles were filled by our own nurses, fostering trust. Virtual nursing also allows experienced nurses, who might not have the stamina for bedside work, to continue contributing their expertise remotely. It’s particularly useful in areas like wound care and will likely become essential as we face ongoing nursing shortages.

Were there any challenges with virtual nursing that you think need to be addressed?

The technology infrastructure can be a challenge, especially in older buildings that lack reliable Wi-Fi or communication tools. There’s also the need for high-quality cameras. From a team dynamic perspective, building trust is key. If the bedside nurse doesn’t feel confident delegating to the virtual nurse, they might try to handle everything themselves, which isn’t sustainable. Clear roles and responsibilities are crucial, particularly in high-pressure situations like codes. It’s also complicated by the rise of a gig workforce, with nurses bidding on shifts and having more flexible schedules, so teams aren’t always working with familiar faces.

You mentioned scheduling, which is a space seeing a lot of innovation with AI solutions. What’s your view on this?

Scheduling is a significant challenge in nursing. When you factor in personal preferences for weekends and holidays, alongside the need to maintain autonomy, it becomes a complex puzzle for our nurse managers. AI could help balance the needs of full-time staff, float workers, and external agencies, while ensuring proper coverage every day within acceptable cost frameworks.

Any additional insights for health system executives?

One key issue is the generational divide in technology adoption. At CommonSpirit, we experienced a cybersecurity event where our systems went down, and some younger nurses struggled because they’d never worked with paper records—they couldn’t even read cursive handwriting! Meanwhile, some experienced nurses were still relying heavily on paper and hadn’t fully embraced EHR and AI capabilities. We need to help older nurses adapt to new technology while also ensuring younger nurses are utilizing it to its fullest potential. This will be an important focus during our Epic implementation.