Robbie Freeman, RN, MSN, NE-BC

The convergence of digital technology, artificial intelligence (AI), and informatics is revolutionizing the health care landscape, bringing forth unprecedented opportunities to transform health care. For the nursing and clinical community, this evolution presents a chance to enhance practice, streamline workflows, and improve outcomes.

In health care, AI typically refers to the ability of computers to independently convert data into knowledge to guide decisions or autonomous actions. AI can provide support for nurses that includes risk prediction, clinical decision support, mobile health technology, and voice assistants. Each of these augments nursing practice and has the potential to transform health care.

Robbie Freeman, RN, MSN, NE-BC, is Vice President of Digital Experience and Chief Nursing Informatics Officer (CNIO) at the Mount Sinai Health System. Mr. Freeman leads a team of experts who function much like translators—acting as conduits between clinicians and technology teams. As a system Vice President, he leads the digital experience and clinical data science teams that have built out a portfolio of digital and AI products. When it comes to the development of AI tools, he says, “This team is one of the leading data science teams in the country in terms of the scale and impact.”

Mr. Freeman began his nursing career at Mount Sinai in 2009 as a bedside medical-surgical nurse. As he moved into management and leadership roles, he became particularly interested in systems and how they functioned to support nurses and other health care staff.

In 2015, Mr. Freeman moved into a newly created position in technology and quality to develop a vision for how Mount Sinai could use technology and improve patient experiences. As Vice President of Clinical Innovation at The Mount Sinai Hospital, he built machine learning products to improve patient safety and hospital operations while also serving as administrator for the Emergency Department and Respiratory Care. Beth Oliver, DNP, RN, FAAN, Senior Vice President, Cardiac Services, and Chief Nurse Executive at Mount Sinai Health System, along with Kristin Myers, MPH, Executive Vice President and Chief Digital and Information Officer, shifted Mr. Freeman’s role to that of a systemwide Vice President for Digital Experience, and named him the Chief Nursing Informatics Officer in 2021.

“I oversee three teams,” he says. “In my CNIO role, I oversee our nursing informatics program. We have nurses embedded in our hospitals, ambulatory setting, and service lines.”

Mr. Freeman is pursuing his doctorate in nursing practice at Yale University, where his research interest is the application of artificial intelligence products to reduce health disparities. He holds a Master of Science in Business Analytics from New York University’s Stern School of Business and a Master of Science in Nursing from Excelsior University, New York, specializing in clinical systems management. He is also a graduate of the Mount Sinai Phillips School of Nursing, where he serves on the Board of Trustees.

“I did not study computer science, but I’ve always had a passion for leveraging technology to solve problems,” he says. “My father was an artist and founded a photo retouching company here in New York City. Teams of artists would manually retouch photos by hand in a long, complex process. Growing up, I watched his company get revolutionized by computerized photo-editing technology. That showed me how technology can transform an entire industry; the people and processes had to evolve drastically. Looking back, this early life experience shaped my world view for reimagining systems and processes through technology.”

Mr. Freeman is the chair of the American Nurses Association’s (ANA) Innovation Advisory Board. “I’ve been working on advocacy nationally with the ANA for the safe and ethical use of AI. One of the things we have done at Mount Sinai was implement an overarching governance structure to make sure the tools we develop, and the vendors we partner with, think about the ethical use of this technology.” He adds, “We do not want to create disparities. We need to be sure AI tools do not disenfranchise minorities and at-risk communities.”

Social determinants of health are incorporated into the CNIO strategic plan and included in the work of the nursing informatics team. “We take a co-design approach with our front-line team to create tools that allow us to get the right resource to the right patient at the right time,” says Mr. Freeman. “These efforts have resulted in an AI tool that identifies malnourished patients who would benefit from a registered dietitian consult, and an AI-driven assessment tool that identifies patients at higher risk for falls. These innovations allow nurses and other providers to focus their time and energy on those patients who will benefit from specialized care.”

Mr. Freeman has described the opportunity for artificial intelligence applied to nursing processes as “precision nursing,” a technology that can support nurses in their practice. “One of the things we recently rolled out on pilot units at two hospitals is voice system AI so we can use voice-based assistants to help our nurses with tasks,” he says. “This technology enables voice-based documentation to free up our nursing team from manual documentation.”

Mr. Freeman and his team have created a road map for digital transformation across the Health System. “We have disseminated mobile phones to nurses in every Mount Sinai Emergency Department, so they have the tools needed to support their practice,” he says. “We are in the process of expanding further into the hospitals later this year.”

“When we talk to patients we hear about gaps, including patients not being sure when to seek care, or follow up with their primary care provider, or schedule an appointment,” says Mr. Freeman. “Our team turned the feedback into a digital advisor, a product that can help patients navigate where they need to go if they are experiencing symptoms, and then based on those symptoms, provide options for patients to be able to make informed decisions.”

“Nursing plays a critical part in providing education for patients following a visit or stay in the hospital. With artificial intelligence and digital, we can really supercharge that work and scale our impact and patient outcomes.”

Jemilat Siju, DNP, MSN, Vice President and Chief Nursing Officer for Ambulatory Care

Where can a nurse deliver culturally sensitive, age-specific nursing care for adult and pediatric patient populations while performing assessment, screening, patient education, and direct patient care? Ambulatory Care at the Mount Sinai Health System.

Jemilat Siju, DNP, MSN, RN, ANP-BC, OCN, is the Vice President and Chief Nursing Officer for Ambulatory Care for the Mount Sinai Health System. Dr. Siju says, “Care within the ambulatory setting is multispecialty and a place to learn and grow. If you are a nurse and looking for an exciting, collegial environment in which teamwork flourishes and nurses have a voice, ambulatory care is for you!”

Ambulatory care nursing is a unique realm of nursing practice that addresses health care needs for entire communities, population groups, families, and individuals. The ambulatory setting is not about delivering episodes of care, but rather, looking at the holistic patient.

Patients enter the ambulatory world with complex health issues they must grapple with while living in their communities and homes. Social determinants of health are at the forefront as each ambulatory nurse determines how the patient’s prescribed medical plan impacts the patient’s quality of life, well-being, and overall health in their home setting.

“In my role, I am trying to achieve an ideal ambulatory care platform that is a place where nurses feel empowered and have a voice, as the voice of the nurse is extremely important to  patient care quality and outcomes,” Dr. Siju says. “The goal is to create alignment and standardization across ambulatory, so that the care looks and feels the same as much as possible, regardless of what part of the Health System you are in.” She adds, “It is not cookie-cutter, but the core of the care we bring to our patients must be of the highest quality.”

The newly established Ambulatory New Graduate Fellowship Program at Mount Sinai immerses RN fellows in the growing ambulatory sector. The first cohort of students has started, with continuing plans to admit fellows twice a year.

“A nurse might be hired into pediatrics, but while in the fellowship program you get exposure to other ambulatory specialties—for example, adult health, ambulatory surgery, cardiology, etc.—with the aim of supporting you in discovering your true niche,” Dr. Siju says. “We are educating you in the classroom and providing built-in rotations where you may spend a day in the life of a cardiac nurse, even though you are working in pediatrics.”

Exposing new graduates in the fellowship program to ambulatory care helps them identify personal strengths and their desires for professional fulfillment. Dr. Siju says, “We can facilitate the process for new graduates to find their niche—sometimes we think we know what specialty we would like to work in, but later find out that we are built to do something else. Ambulatory Care at Mount Sinai supports you in finding your professional niche.”

Nursing ambulatory fellows rotate through several specialties with advanced team members, including rounds with Infection Prevention and learning about their preventive role in ambulatory care. Towards the end of the program, RN fellows have an opportunity to work with nursing leadership on a departmental quality improvement project or an evidence-based practice project to advance their leadership and research capabilities. In addition to the fellowship program for new graduate nurses, Mount Sinai has a robust supportive clinical environment for our experienced nurses as well.

She continues, “Nurses get an enriched experience in ambulatory care. Patients are still complex enough with their health care needs and nurses can address what happens to them in their community and how this impacts their health and access to care.”

Dr. Siju says, “I went through nursing school the long route—starting in an associate degree program, then obtaining my bachelor’s and then master’s degrees. When doing my associate degree, I worked as a nursing assistant on a surgical floor and really thought I wanted to be a surgical nurse; I loved it and I loved the nurses. But one day the Chief Nursing Officer looked at me and said, ‘You will be a great oncology nurse,’ and I thought if she saw that in me, then why not?” Following 18 months of work in oncology, her nurse leader suggested she consider a role in nursing leadership and so she did, working as a nurse manager for two years and growing in leadership experience since.

Dr. Siju joined Mount Sinai in 2012 as Nurse Manager for Mount Sinai Beth Israel’s Oncology Ambulatory Infusion Program and transitioned into ambulatory care in 2017. She pioneered the Nurse Leadership Course for the Mount Sinai Phillips School of Nursing and serves as an adjunct faculty member.

Dr. Siju has worked for Mount Sinai longer than any other employer because, she says, “Mount Sinai has created a growth pathway for me. When I feel like I need to continue growing and want something to keep me on my toes, Mount Sinai has been successful in making that happen for me. Every time I have felt like I needed to grow, I have had an opportunity here to do so. Many others have invested in my professional growth, and I am committed to paying it forward by doing the same for others. I look forward to an opportunity to work with you in ambulatory care.”