Introduction

Health systems often struggle with digital transformation efforts, resulting in systemic inefficiencies1. Many digital solutions are developed without considering actual bedside workflows, or systems are slow to adopt novel technologies2. Compounding this challenge, complex and interrelated factors such as workforce challenges, financial pressures, and siloed decision-making lead to digital initiatives that fail to meet the needs of the organization or meaningfully impact patient care. Furthermore, the absence of clear, strategic vision for digital transformation in some health systems leads to disjointed efforts and lack of direction1.

Extending the care continuum beyond hospital settings with technology may address some of these challenges. Growing evidence supports the use of digital tools to improve patient outcomes, reduce readmission rates, and manage chronic conditions more effectively3. These tools can also enhance cost efficiency by integrating home care, outpatient services, and telemedicine, which are more affordable alternatives to hospital stays4. Introducing the capabilities of smart hospitals, smart homes, and interoperability is crucial for this extension5. By leveraging technology across the care continuum, health systems can offer more personalized and proactive care, reduce the burden on hospital resources, and lower healthcare costs. However, regulatory and reimbursement constraints often limit the capacity to provide resources beyond formal clinical settings6. Developing innovative care delivery methods is vital for creating a more efficient, effective, and equitable healthcare system.

Strong, adaptable leadership is critical to navigating the future of healthcare. As the largest and most visible profession in the healthcare workforce, nurses are uniquely positioned to shape the future direction of health systems to meet the holistic needs of patients. Nurse leaders act as change agents and are instrumental in care redesign7. Their roles in interdisciplinary collaboration and leadership enable them to influence decision-making and drive strategic initiatives related to digital transformation projects8. Additionally, their adaptability to new technologies makes them well-suited to support the integration of digital tools in various care settings8. By involving nurse leaders in digital transformation, healthcare organizations can leverage their unique perspectives to create more effective, patient-centered, and sustainable technology investments across the care continuum.

In this editorial, we explore the perspectives of nurse leaders in driving digital transformation within healthcare systems. To gain insights, we interviewed three prominent nurse leaders from major health systems in the United States in November 2024: Nelita Iuppa, Associate Chief Nursing Officer at Cleveland Clinic; Patricia Mook, Senior Vice President of Nursing Operations at Advocate Health; and Anna Schoenbaum, Vice President and Chief of Digital Applications at Penn Medicine (University of Pennsylvania Health System). Nurse leaders describe their vision for using technology across the care continuum and how the nursing profession is poised to lead. We asked them a set of questions on areas for improvements, smart hospitals, translational research, and future wish list.

Focus areas for improvements

The trio of nurse leaders share a unified vision for improving healthcare delivery through patient-centered innovation, clinician wellness, value-based care, and technological advancements. Anna Schoenbaum highlights the investment in digital health solutions, such as streamlining access to patient data to support continuity of care, online scheduling, mobile check-ins, telehealth, remote monitoring, and clinical decision support driven by artificial intelligence (AI), to enhance patient outcomes and care experiences. Schoenbaum emphasizes, “we are prioritizing value-based care by aligning initiatives to focus on quality outcomes, enhancing population health management, and emphasizing preventive care.” Nelita Iuppa echoes this focus on value-based care, advocating for aligning incentives with quality outcomes, enhancing population health management, and emphasizing ‘using technology alongside preventive care to reduce hospital admissions. Patricia Mook underscores the importance of interdisciplinary collaboration and leveraging technology and innovation, including virtual nursing, hospital-at-home programs, and school-based virtual clinics. Mook believes that “strong communication and teamwork among healthcare professionals leads to more coordinated and effective care.” Her work focuses on leveraging technology and innovation, integrating electronic health records with advanced diagnostic tools to streamline processes and improve efficiency.

Advancing smart hospitals

A smart hospital is an immersive clinical environment that enhances care delivery efficiency, ensures safety, and removes administrative burdens by leveraging advanced technologies like AI, robotics, and telemedicine to automate tasks, optimize workflows, and personalize patient care. A key aspect is achieving “true interoperability and standardization across systems” to facilitate communication and collaboration, ultimately creating an interconnected ecosystem where data flows seamlessly, enabling real-time decisions and personalized care. Nelita Iuppa stresses “partnering with industry vendors to make medical equipment smarter”. Nurses play a pivotal role in harnessing the full potential of such digital tools. Patricia Mook also states, “smart hospitals represent the future of healthcare, where advanced technologies create a more efficient, effective, and patient-centered environment.” Mook also believes, “nurses, as central figures in health care, will play a crucial role in this transformation, leveraging their expertise to harness the full potential of digital health initiatives”.

Closing the research to practice gap

Real-time data sharing, AI, and machine learning can accelerate the integration of new research into clinical workflows, ensuring that clinical decisions are informed by the latest evidence. Anna Schoenbaum states, “These tools bridge the research-to-practice gap, ensuring that clinical decisions are informed by the latest evidence. However, it is also important to align technology with clinical workflows, advocate for quality health information exchanges and leverage augmented and artificial intelligence to support clinical decision-making”. Patricia Mook emphasizes the role of innovation hubs in nurturing partnerships and developing new technologies. These concepts are being realized in Charlotte, North Carolina with the opening of “The Pearl” innovation district to shape the future of care delivery. These facilities will provide state-of-the-art virtual learning tools, advanced robotics, and simulation training to facilitate the faster development and implementation of new therapies into clinical practice. Patricia Mook concludes, “Nursing is positioned perfectly to coordinate and enhance each of the elements we need to translate research findings and technology into improved clinical outcomes. Who better than nurses to drive progress and, ultimately, improve patient care?”

Wish list for health IT

Each of the nurse leaders emphasizes the need for robust evidence to guide healthcare decisions and improve patient outcomes. Anna Schoenbaum highlights the importance of understanding AI’s impact on health access, assessing the effectiveness of various care models - such as traditional in-person care, hybrid approaches, and fully virtual care, and evaluating the long-term clinical and financial impacts of digital health interventions like telemedicine and remote patient monitoring. She states, “More evidence is needed to understand AI’s impact on health access, particularly in determining whether it reduces inconsistency in care access or inadvertently introduces biases that widen existing gaps.” Nelita Iuppa underscores the need for evidence on clinical workflows and time spent on tasks to better correlate with patient outcomes. Iuppa believes that understanding the minor activities and thought processes that lead to major results can help tailor nursing practices and digital tools to promote the best care nurses provide. Patricia Mook calls for more evidence on the practical implications of technology in healthcare, focusing on efficacy, cost-effectiveness, and patient acceptance of telemedicine and remote monitoring. She notes, “While technology has the potential to revolutionize healthcare, we need more evidence on its practical implications.” Additionally, there is a need for timely evidence to address the growing demand for behavioral health services and improve health system performance. Mook concludes, “Health system performance is so important to the future, as I see it. We need to continue to gather and compile more evidence on what makes health systems efficient, resilient, and sustainable, and we know those who serve as nurses will play an integral role in achieving that, while always providing compassionate and high-quality care in every patient encounter”.

Comparative analysis

The perspectives of these nurse leaders reveal common themes, such as the need for nurse involvement in digital solution development and the challenges of technology adoption. However, each leader also brings unique insights. They emphasize the importance of digital health solutions, interdisciplinary collaboration, and smart hospitals that leverage AI, robotics, and telemedicine to enhance care delivery. Real-time data sharing and AI can bridge the research-to-practice gap, ensuring clinical decisions are informed by the latest evidence. They also stress the need for robust evidence to guide healthcare decisions, improve patient outcomes, and address health equity. Nurses play a pivotal role in this transformation, leveraging their expertise to harness the full potential of these innovations and drive progress in healthcare.

As large language models, machine learning, and other forms of artificial intelligence advance, healthcare organizations and clinicians must evolve in both mindset and practice. Success will require more than simply adopting these tools - it will depend on active engagement in their development, governance, and thoughtful application to improve patient outcomes. Each of these new competencies will become an inherent part of clinical reasoning and practice model redesign in shaping how care is delivered in the future.

Conclusion

Insights from nurse leaders underscore the importance of involving nursing professionals in digital transformation efforts. Their frontline experience, holistic perspective, and patient-centered approach make them well-equipped to drive meaningful change. With a deep understanding of clinical workflows, nurse leaders help ensure that technology solutions improve efficiency while fostering adaptability as workflows evolve. As catalysts for digital transformation, nurse leaders are essential to creating effective and sustainable change across health systems.