Healthcare technology has never moved faster. But according to Melinda Kidder, DHA, MSN, RN, CENP, MPHC, Chief Nursing Officer for the Office of the National Coordinator for Health IT, one critical mistake continues to undermine progress: building solutions without the clinicians who actually use them.
In this episode of Success in Chaos, Kidder joined Angela and Kandice to share lessons from her journey: from bedside nurse to Chief Nursing Officer for the Assistant Secretary for Technology Policy at the U.S. Department of Health and Human Services.
Her message was clear: nurses cannot be an afterthought in technology design.
Early adoption of electronic health records (EHRs) offers a cautionary tale. Organizations attempted to digitize existing workflows without rethinking them. The result? “We just traded one ink pen for a keyboard,” Kidder explained. Documentation became digital, but not more meaningful. In many cases, it added burden rather than reducing it.
That same risk exists today with AI.
Health systems are racing to adopt new technologies, often starting with the wrong question: What tools should we implement? Instead, Kidder argues, leaders must begin with a deeper inquiry: What problem are we actually solving?
Without that clarity—and without frontline input—organizations risk scaling inefficiencies instead of solving them.
One of the most consistent gaps Kidder sees is the disconnect between how technology is designed and how care is delivered. Vendors often build solutions first and seek feedback later. But nurses don’t have time to test products that weren’t designed with their workflows in mind.
The solution is not symbolic inclusion—it’s structural.
Kidder emphasizes that clinicians must be involved from the earliest stages of ideation through implementation and beyond. Effective governance includes:
- Validating the problem before selecting a solution
- Including multiple frontline clinicians, not just leadership
- Maintaining engagement through implementation
- Closing the feedback loop after go-live
This last step is often overlooked. When feedback isn’t acknowledged or acted upon, adoption suffers—and expensive tools go unused.
For leaders navigating constant change, Kidder offers a final mindset shift: break large transformations into smaller wins. Celebrate progress. Acknowledge setbacks. And always keep the focus on reducing the burden for the people delivering care.
Episode Chapter Guide:
01:13 Dr. Kidder’s Journey in Nursing and Technology
03:12 The Role of Nurses in Healthcare Technology
06:39 The Disconnect Between Technology Design and Nursing Workflow
12:28 Training the Next Generation of Nursing Informaticists
14:30 Governance Models for Effective Technology Implementation
19:49 Lessons from Meaningful Use for AI Transformation
22:53 Mindset Shifts for Leading Through Change
24:43 Closing Thoughts and Recommendations
Full Transcript
AI-generated transcript. Accuracy may vary; please excuse any transcription errors.
Angela Adams, RN:
Welcome to Success in Chaos, a healthcare podcast where each episode is dedicated to unlocking success amid rapid change and uncertainty. I’m Angela Adams, the CEO at Inflow Health.
Kandice Garcia, RN:
And I’m Candace Garcia, CEO of Tungstink UI Partners and the Quality Director of the ACR Learning Network.
Angela Adams, RN:
We are so excited today to have Dr. Mindy Kidder on with us. She is the basically America’s chief nursing officer is how I like to say it. The chief nursing officer for the assistant secretary of technology policy at the US Department of Health and Human Services. That packs a punch, right? With more than three decades of experience spanning bedside care, nursing leadership, informatics, national health technology policy.
She brings a powerful voice to the conversation about ensuring nurses are not just users of healthcare technology, but are co-designers of its future. Me and Candice could not be more excited to have this conversation. So Mindy, welcome to Success and Chaos.
Melinda Kidder, DHA, MSN, RN:
Thank you so much. I’m so happy to be here.
Angela Adams, RN:
So Mindy and I got to meet when we were at Vive this year in sunny Los Angeles and had a great conversation. We wanted to have her on the podcast. Mindy, as you know, we have mostly an audience of healthcare executives spanning all across the US and also technology executives. So I first want to start with
your background, really. You moved from bedside nursing to federal health technology policy. That is a journey right there in and of itself. You and I got to talk a little bit about that. When you think about that journey, how did that kind of lay the groundwork or your perspective for how you view technology and nursing today is where I would love to start.
Melinda Kidder, DHA, MSN, RN:
Well, as you said, and it kind of makes me feel old, but it is true. I have over three decades of experience. I started many years ago when I was a baby, right out of diapers into healthcare. I was in a nursing home, CNA, like forever ago, and just worked myself up through the ranks of nursing. It was about the time of Obamacare and Meaningful Use Stage One. Everybody was putting in electronic health records.
that I really got into IT. And that is something I’ve always kind of been a little bit of a geek, I guess you could say, you know, looking at computers. And so that seemed to fit very well. could put the love together of my computer love and my nursing love together. And that’s how I ended up in the health IT space. I think in the long run, it’s really helped me to be able to not only become a better nurse, but also a better person in IT.
because of having that critical care and recovery room and surgery background to be able to bring to my current role.
Angela Adams, RN:
That’s amazing. One of the comments that I wrote down from our discussion at Vive, which I would love to delve into a little bit more. First of all, want to address super inspirational story. And I think we hear from nurses all the time that they go into school thinking like, well, I’m going to be a bedside nurse, but nursing is such an incredible career for, I mean, the world is your oyster, really, whatever you want to do and wherever you want to take it. So I love that.
inspiration for going from a CNA working in a nursing home all the way to where you are today, which is phenomenal. Congratulations. One of the quotes that you made that I loved was that nurses should not be an afterthought when it comes to technology. So in practical terms, what actually happens inside an organization when they’re brought in too late?
Melinda Kidder, DHA, MSN, RN:
Thank you, thank you.
Angela Adams, RN:
would love to hear kind of your perspective on that whole continuum.
Melinda Kidder, DHA, MSN, RN:
You know, as I said, I got into IT back probably about 2008, 2009 as part of the moving everybody to electronic health records. And even going back to then, I remember that it was the C-suite or the IT folks that were looking at what software needed to be selected and how it was going to be used. And I can honestly say, you know, hindsight is 20-20. Looking back, we made mistakes and we made mistakes because we thought we could take
all the paperwork that we were doing at the time that clinicians were doing and just build that in a computer system and that was going to work. And that’s not, that’s not how, mean, it’s what we did, but in the long run, that’s not what actually made the record meaningful, which is what we were trying to do. You know, we could, we could do a lot of fancy things to where it would seem like it was a little better, but we really just traded one ink pen for a keyboard.
It really didn’t help, it didn’t produce burden, it didn’t do much for the profession as a whole. So over the course of time, I’ve seen a lot of developments that have, but looking back, I just think that those were the mistakes that we made and I think that that’s what happens when you don’t include clinicians from the beginning. I think we tend to see mistakes that are made of, we think this is how it’s done or we think this is how it will work. When really, if you bring nurses in from the beginning,
you can maybe catch some of those things and be able to say, okay, this may sound good, but this is not really how we do it, or this is not how it’s gonna work out. And I think that’s where a lot of organizations make mistakes is because they don’t include those frontline staff. They may even include nursing at a leadership level, but as many of us know, even if you have kids, a lot of times things happen behind doors that you don’t know about. It’s kind of the same with nursing. They have workarounds, they have things they do.
that even leadership may not be aware of to where when it comes down to brass tacks of is this going to work or is it not, a nurse can bring a different perspective or any clinician for that matter that’s actually working at the bedside level can bring in a different perspective to say, yes, that’s how it works. No, that’s not how it works and be able to set the project straight before it starts to stray too far off. And then by the time you figure it out, you may have spent a lot of money to end up not getting what you really need.
Kandice Garcia, RN:
my gosh, I could not agree more. I’m doing healthcare improvement with technology implementation and I just, you’re speaking to my heart so deeply about the involvement of the frontline staff and it’s really not implementation, it’s redesign. It’s design really when it comes to technology because it’s not just the work that you’re doing but now they also have to interact with the computer. They also have to interact with that station and
I think to your point, you have to rethink the reason why we’re doing the things that we’re doing in order to create an electronic system that actually supports them, not replaces what they were doing. Can you tell me, from where you stand, what is the most consistent disconnect between how the technology is designed and how the nursing workflows operate?
Melinda Kidder, DHA, MSN, RN:
When you were talking, it made me think about some of the things that we did, even as simple as counting the steps from a piece of equipment to a patient room or to the nurse’s station. And I mean, those are things that a lot of people sitting at a table looking to implement things don’t think about. They don’t think about how long it’s going to take to do something or how far down the hallway it is. But for me, when I was at HEMS a few years ago and I was in the new innovator section or whatever,
And one of the first things I would always ask them when I was talking to them about their tech was, so who’s your nurse on your project? Who do you have as part of your team? And they’re like, we don’t have a nurse. I’m like, excuse me? How do you create software without having nurses? That baffled me. I didn’t understand that. Their answer to me, and granted, this isn’t every company, but this was just kind of a generic overview.
But their answer was always, well, we build it and then we find a place to implement or test it. And then we let them give us feedback. And my first thought was nurses don’t have time for that. They don’t have time to test your software and give you feedback. So, you know, those are where I see a lot of the missteps. Now, I can say honestly, after being at Vive this past year, about a month ago, I think that that tide is changing. I think we are seeing more nurse developers
themselves. We’re seeing nurse innovators, but we’re also seeing people that maybe are in the healthcare space and they’re actually including those end users. They’re including the people that are going to use the software. And of course, we focus a lot on nursing because we are a big portion of the healthcare system at large. And so I always say nurses, but it could be anybody. could be respiratory therapist, dieticians, physical therapists. It’s not necessarily just nursing, but at the same time, that’s where I think we are seeing that tide change.
It was a huge thing at Vibe for them to be able to, you know, they were coming out and saying that. And I know that a lot of people heard that at Vibe.
Angela Adams, RN:
That’s amazing. As a nurse developer who’s developing AI for healthcare today, I can say that I am on a minority out there still. have mostly, you know, when I get in these innovation tech circles, they’re mostly technical by background and they don’t have any clinical background. And it’s exactly what you said. They like build this thing. And then they’re like, we’ll just build this thing and then we’ll go.
Kandice Garcia, RN:
Yeah.
Angela Adams, RN:
for feedback and I’m like, I mean, that’s like the absolute wrong, the wrong approach. I’ll give you an example. When I was in medical device, you guys are gonna crack up at this, had this medical device engineering team and they were like, Angela’s a nurse, Angela’s an ICU nurse. Like let’s show her the product prototype. And it was like a urinary measurement tool for the bedside in the ICU. And it could like tell you what your output was.
directly put it in the chart and I was like, all right, this sounds kind of cool. I’d love to see it. So I go and look at the device and the engineers are so excited to show it to me. And I turn the thing around and I’m like, well, where’s the batteries? How do you charge this thing? How is this going to sit at the bedside? And they were like, well, this big cord, this very long cord is going to be plugged in across the room.
And then you have a separate battery pack and the guy gets out one of those miniature screwdrivers and he’s like, you just have to unscrew these four screws. Battery pack. I looked in and like, have you ever been in an ICU? Number one, everyone is going to trip over this and you’re going to increase falls on the unit. And number two, there is no nurse that can find a screwdriver to get these tiny screws that are going to be lost the very first day on that unit to charge this. Your device has failed.
Kandice Garcia, RN:
You
you
Angela Adams, RN:
But like, they just would have had one nurse in that room, they would have been like, let me tell you what, from the very beginning, how that battery needs to work.
Kandice Garcia, RN:
Hahaha
Melinda Kidder, DHA, MSN, RN:
Yep, I would agree.
I would agree.
Yeah, that sounds like a nightmare.
Kandice Garcia, RN:
You know,
Angela Adams, RN:
Yeah.
Kandice Garcia, RN:
on technology though is a skill. It’s something that actually you don’t learn in nursing school. You don’t learn it in technologist school or even medical school. So I feel like this new world of technology innovation and even nursing informaticists who maybe were developing or kind of working on how they came together.
I think that interacting with products now and giving feedback and helping them grow and develop over time, continuous improvement, is actually a very specific skill that we don’t actually have as practitioners. Tell me a little bit about how do we train the next generation of nursing informaticists? Are we there? Is there more work to do? How do we make more of you?
Melinda Kidder, DHA, MSN, RN:
I think we’re getting there. know, back when, I mean, there were nurses that were doing this before me, so I was not in the pioneer of doing it, but I still was pretty early on considering where we were with the electronic health records. And I think that we are getting there. I think that nurses are becoming more tech savvy. I think they are becoming a little more able to give that feedback. But I think one of the biggest things is, you know, not…
when you have like a committee that’s looking at something, don’t just get one nurse. You sometimes it takes a handful of nurses to come together and a handful of clinicians to come together because they feed off each other. If you’ve ever been in one of those rooms where they’re actually evaluating a piece of equipment or a piece of software, you know, the one person says something and the other person’s like, oh yeah, and then what about this? And then the next one’s like, oh yeah, and then what about this? I mean, it’s like they feed off each other and can help pull that out of each other.
And I think that, you know, we have, as I mentioned, I started when I was a baby, so I’m not gonna say I’m old, but we have some of the more senior people like myself that can help guide some of the, you know, more not so senior, younger nurses, but they’re a little more tech savvy anyway with the iPhones and, you know, everything that they’ve grown up with that we didn’t have. So I think that we are getting to that point, but probably, like I said, the biggest thing for me is pulling your group together, not trying to base all your feedback.
off of just one person. And I think that’s where you’ll get your best feedback when it comes to the different projects that you’re working on.
Angela Adams, RN:
So you’re speaking to a group of healthcare executives and you’re giving them some sage advice on how to make this practical application instead of symbolic. Like what are the governance models that you’ve seen work? Like what would you coach them to do at their hospitals to get this type of feedback in a meaningful way at the right time in the beginning of a process so that those nurses are at the table and that they’re a voice at that table.
Melinda Kidder, DHA, MSN, RN:
Well, I think that it starts from ideation. So if you think you have a problem, you need to look at the problem and see, do you really have a problem? Or is it somebody thinking you have a problem before you even go to the point of trying to figure out, do I need to buy a new tool for this? Do I need to buy a new piece of software? I think it’s trying to actually figure out, is there truly a problem or is there something else happening that we could address that would fix it? So I think that’s really stage one. And then once you realize maybe you do have a problem and you do need to buy
a new piece of software or a new piece of electronic equipment, getting the staff that’s going to be using it in at stage zero. They need to be right in the selection process. They need to understand what problem you’re trying to solve. They may even be able to help you discover maybe the problem you thought you were trying to solve and you figured out what’s the problem, wasn’t really the problem and they can help guide a different direction. So I think they’re very, very important to have at the very beginning.
And then, you know, keeping them on board and engaged the entire time, clear up till implementation and, you know, the go live process. And then most importantly, the feedback after go live, you know, so many times we put these projects in place and we think, okay, we’ve solved the problem and we move on to the next big problem. really, you know, nurses aren’t the only ones, but I’m going to, I’m going to blend nursing at this point. decide, yeah, that wasn’t nearly as effective as we thought it was. We have some kind of work around and it gets thrown in a drawer and nobody looks at it.
And so then we’ve spent all this money on something that now is in a drawer that’s collecting dust. So I think that going back to the feedback loop of being able to say, okay, so what did we learn from this and where can we improve it? What’s working, what’s not working? And then the most important part is if you make changes, getting that back to the people that are using it. It’s closing that loop because so many times those that are using it say, well, this didn’t work and here’s why. And then they never know it was fixed.
they never know that their problem was addressed. So I think it’s making sure that we are closing that loop all the way around.
Kandice Garcia, RN:
Yeah, you know, you’re just speaking to, I, you know, I’m in the business of continuous improvement. And I think one thing that we don’t exactly is what we don’t realize is like technology implementation is actually just structured problem solving. Like you said, what is the problem? What is our analysis? Did we validate that that was actually a problem? And technology is actually just solutions, right? So those are our solutions that
Melinda Kidder, DHA, MSN, RN:
There you go.
Kandice Garcia, RN:
Once you put them in place, require ongoing PDSA cycles, ongoing testing, feedback and monitoring. Is it doing what we intended it to do? We have…
I run the ACR Learning Network where we’re helping organizations across the country solve global problems in radiology. And one of the things we’ve really been focusing on is partnerships with our vendors to say, hey, this is structured problem solving, but you’re not alone in this. Like the vendor needs to come participate on the team. You guys need to work together. You know, maybe there’s something that they can change that’ll solve your problem. Maybe there’s something you need to change in your workflow in order to solve the problem. But if we don’t do it together, there will be
the tech will never be optimized for what you need, then you will never be able to get the most out of it. I think that.
It’s not just the frontline staff, but finding vendors also who are willing to participate in continuous improvement in a meaningful way. Whatever they designed, even if it was the best idea to begin with, is never going to solve the problem on day one. It is always needs a little bit of tweaking here, a little bit of that there, move this here, and being able to respond and partner with your.
with your healthcare organizations will be the only way that that technology will actually be effective in what you’re trying to do.
Melinda Kidder, DHA, MSN, RN:
Yeah, I couldn’t agree with you more. I think that that’s where organizations and healthcare companies really drop the ball is after the fact of keeping up with it and making sure that it is truly meeting the need. And if it’s not being able to address that, I mean, I know that in the healthcare sector, don’t have millions and millions of dollars just to be thrown fist after fist at software and solutions. So we really need to make sure that we find the right solutions. And I know today,
A lot of that is AI, AI this, AI that. That’s the solution for everything, but AI is not going to solve everything. With AI, you really need to be careful to stay within that feedback loop. Keep that human in there, making sure that it’s working correctly, and making sure that if it’s not, that that feedback is getting back. There’s so much to the stuff that we’re doing today in healthcare that could potentially be detrimental if it’s not done right.
Angela Adams, RN:
I agree. In fact, my next question for you was around AI. So you led perfectly into that. You lived through meaningful use. In fact, you referenced that at the very beginning of the talk. Now with AI transformation coming, what’s lesson for meaningful use that we can’t afford to ignore right now that you feel like, hey, guys,
Melinda Kidder, DHA, MSN, RN:
There we go.
Kandice Garcia, RN:
Hahaha
Angela Adams, RN:
let’s not repeat history like we learned this lesson a long time ago. What can we pull forward right now in this very AI driven age that you would be like, don’t forget.
Melinda Kidder, DHA, MSN, RN:
you know, I mentioned a little bit earlier and it’s not just like trying to recreate the wheel in the same manner. I think with, with AI, number one, you need to determine if it’s truly going to solve your issue. I think that, like I said, right now it’s the buzzword. Everybody wants to go AI this AI that. And I think that you really need to figure out is it truly going to solve the issue you have. But then again, the issue you have, and, Candice, I think you mentioned it was redesigning the workflow. You cannot just take the workflow that we have today.
And that’s what we did with EHRs in the beginning. We took the workflow we had today and we put it in a computer format and was like, okay, here you go. They’ll make the world great. And as we see, it didn’t always work so well. mean, here we are how many years later and still talking about modernizing our healthcare system. And we thought that that was going to be the time we did that. But it’s one of those things where I think it’s the same with AI. It’s looking at it and making sure that we don’t try to just take
the same issues we have now and put them into AI because I think AI will only advance them further. So we can’t make that mistake.
Angela Adams, RN:
Yeah, I always tell people like, you said it earlier to start with the problem and truly validate the problem and understand what it is you’re trying to solve. Even with inflow health, I’m always like very focused on, hey, this is the problem that we solve. Is this a problem that you’re facing? Because if not,
then you do not need another layer of tech in here. Most often, you’re exactly right. People think that they have identified the problem, but when you keep asking those why questions, it starts to fall apart that that truly wasn’t the problem to solve. So I love that you framed it there because I feel like I have so many healthcare executive friends that come to me and they’re like, what AI tech should I be looking at right now? And I’m like, that’s the wrong question.
But my question is, what problem are you trying to solve right now? And then let’s reverse engineer into if this is an AI problem to solve, if this is an AI plus automation, if this is an AI plus automation plus tech enabled services, or if this is a human problem that you need to solve with human capital. And so that always surprises them because they think as a tech CEO that I’m going to be like, this is all the cool tech I know of right now.
But it really is about like, are your key challenges? But unfortunately, it very much is what’s the shiniest toy on the block? And can I like make that somehow into my problem? So one more question. And then we will wrap. For executives leading through constant change, we talked about chaos and the chaotic healthcare system all the time on this podcast.
Melinda Kidder, DHA, MSN, RN:
Yep.
Angela Adams, RN:
What mindset shift has helped you move organizations forward without overwhelming the people doing the work?
Melinda Kidder, DHA, MSN, RN:
I think that every project is a course of little projects within. So I think it’s as you’re moving through, looking at the little steps you have to take to get to the end and celebrating those. Being able to say, hey, we did that. That was great. Let’s move on to the next step. And showing where you’re benefiting, at least for me, first is the patient, next is the clinician, but where that benefit is coming. But keeping in mind the burden that you’re causing because
bringing in any new tech into any situation just increases the burden on that clinician. Some people do it a lot easier and a lot better, and others really struggle. I can remember back when we were doing the EHR implementations, you had, it was something that people didn’t even think about. You had nurses that were older nurses and you’re giving them, I mean, we had a lot of these little handheld things and everything, and they’re like, I can’t even read this. It’s so small. And those are things that when you’re implementing, you don’t think,
You don’t think about being able to read this like on an iPhone screen. I mean, you don’t always think about that. So, I mean, it’s being able to think of every little thing and celebrate all the wins with those that are implementing with you to be able to say, okay, we did it, here we go. And if you have a fallback, acknowledge you had a fallback, figure out how to come back from that and celebrate that you got through it, whatever it takes. But I think instead of looking at, we have this huge monstrosity of a
project in front of us, take it in little bites and little wins. You’ll get there. It just takes time.
Angela Adams, RN:
I love that. Well, thank you so much. In closing, we always ask our guests to share what are some, what is either one or two books that you’re reading or podcasts that you’re listening to that you feel like are giving you some aha moments at this moment.
Melinda Kidder, DHA, MSN, RN:
You know, I’m really good about trying to keep up with everything that’s happening in our world right now when it comes to healthcare, because I mean, I really need to be on that edge to be able to do my job effectively. But in the process of getting this position, I have met some great people. So people that have held this position before me like Judy Murphy, some other people that are big, you know, in the space like Commie Delaney and Susan Newbold. I mean, there’s a lot of people that have really helped push informatics.
to the forefront and I appreciate them. And those are the folks that I keep up with. I also keep up with professional nursing organizations. I meet with them regularly, trying to understand from their base, what kind of things that they’re seeing and doing. I mean, for me, I’m looking at it from a little different lens than the typical nurse leader or staff nurse. But the idea for me is to be able to understand what’s happening out there so that I can help make sure that at the government level,
we are not gonna hinder what they’re doing and try to help them best we can.
Angela Adams, RN:
That’s really good. Has anyone written a book on exactly what we talked about here today with like how to involve through governance, nurses and clinicians in that feedback loop of designing, whether it’s product or technology that you know of.
Melinda Kidder, DHA, MSN, RN:
There are some out here and you’ve put me on the spot and I know there’s one that I know I should have written it down. There’s one that’s specifically about nursing informatics. I think it’s on the eighth edition. It’s a textbook of all things, but I’m kind of geeky like that and read textbooks sometimes. So, I mean, it’s something that I think is good for us all to go back to our roots and understand the learning and how that learning is changing, especially as we’re bringing up the next generation. So I would recommend it, but I’ll have to, I can’t think of the name of it right at the moment.
Angela Adams, RN:
No worries, you still have time to look it up. can send it to us and we can link it into the podcast, but really, really appreciated having you.
Kandice Garcia, RN:
You
Melinda Kidder, DHA, MSN, RN:
Okay.
Thank you so much. It was great to be here.
Kandice Garcia, RN:
Thank you so much, Mindy, and thank you for joining us on Success and Chaos. Please be sure to like, follow, and share today’s episode on Spotify, Apple Podcasts, YouTube, or wherever you get your podcasts. And a special thank you to the Enflow Health team for their production support.
