From the kitchen calendar to the nurse's worklist

My grandmother had heart failure for the last three years of her life. She weighed herself every morning in her bathroom in Toledo and wrote the number on the kitchen calendar, because the nurse at her discharge had told her to. Nobody read the calendar. When she was admitted again in the winter of 1991, the weights showed she had gained seven pounds in five days. I was sixteen, and that calendar is still the clearest product specification I have been given: the measurement was right, the patient did her part, and the numbers reached nobody.

I trained as a nurse at Tillmore College of Nursing in Toledo, graduating in 1997, and joined the cardiac step-down unit at Harwell Memorial Hospital in Cleveland. For eight and a half years I cared for patients with heart failure and arrhythmias and for those recovering from cardiac procedures, and from 2001 I ran shifts as charge nurse on a 32-bed unit. I co-wrote the unit's heart-failure discharge teaching, including the daily-weight instructions my grandmother would have recognised. In 2004 I became a super-user for the hospital's first electronic medication administration pilot, and I watched skilled nurses invent workarounds within a week because the software asked for things in an order the bedside did not follow. I studied health informatics part-time at Lindale Ridge University and finished my master's degree in December 2005.

In 2006 I moved to Wexley Valley Health System, three community hospitals in north-central Ohio, as a clinical informatics nurse, and from 2008 I managed the team. We introduced barcode medication administration on 19 inpatient units and trained 1,450 nurses through 120 bedside super-users. In 2010 I represented nursing when the system chose its first full electronic health record under the federal incentive programme. That selection taught me where the design decisions that shaped a nurse's shift were actually taken. They were taken at the software company, by people who had rarely seen a night shift.

So in 2011 I joined Quarrystone Health Systems in Louisville, which sold electronic records to community and critical access hospitals, first as product manager for nursing applications and from 2013 as director of product for clinical applications. I timed nurses on fourteen units completing our admission assessment and cut it from 212 fields to 96. I also learnt my most useful lesson about alerts. We released a sepsis screening alert that nurses overrode 93 per cent of the time. Its logic was sound, and it still failed, because it interrupted a task and asked for information the nurse did not yet have. We withdrew it and rebuilt it as a two-step prompt.

In 2016 Pellmore Medical, a NYSE-listed maker of implantable cardiac devices in Minneapolis, hired me to lead product management for its remote monitoring service, and in 2018 I became vice president of product for connected cardiac care. Device clinics were receiving more transmissions from patients' pacemakers and defibrillators than their staff could review. We built a triage view that put the urgent ones first, moved 410,000 patients' bedside monitors from landlines to cellular connections, and made every change inside a design-control and quality system that I came to value rather than tolerate. I also saw what a coordinated vulnerability disclosure demands of a product team when the device concerned sits inside a patient's chest.

I joined Ardenwick as chief product officer in March 2021, when the company monitored 31,000 patients and measured itself by kits shipped. Its co-founder and chief executive, Thaddeus Brannigan, wanted a product organisation that clinicians would trust. I lead 112 people across product management, design and research, clinical content and data science. Our clinical informaticists, most of them nurses or pharmacists, review every default that touches an alert. Every product manager spends a shift with our monitoring nurses each quarter, and our researchers visit patients' homes before any change to the kit or the printed material that comes with it.

Inside the industry I am probably known for three positions that have each cost Ardenwick money in the short term. A reading schedule should follow the patient's condition, not the billing month. A risk score that a nurse cannot check belongs in the device pathway, with the evidence that requires. And no new condition should go on general sale before a pilot has shown that the alerts it creates lead to care. I hold those positions because I have seen the alternatives on the ward and in the device clinic.

I present to Ardenwick's board every quarter and report twice a year to its Quality and Regulatory Committee. Since 2019 I have also served, unpaid, on the board of Marlowe Avenue Community Health Center in Columbus, where I learnt how much and how little a director can know from a board pack. I am now preparing for a single independent directorship alongside my role at Ardenwick.

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