Latest / Becker’s Healthcare - Clinical Leadership Podcast / Daniel Nigrin, MD, Chief Information Officer at MaineHealth

Transcript

Daniel Nigrin, MD, Chief Information Officer at MaineHealth · Becker’s Healthcare - Clinical Leadership Podcast

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  Would you like to exchange best practices and ideas to improve care,
• 0:03
  enhance operational efficiency,
• 0:05
  and address financial challenges with your peers?
• 0:08
  Becker's Healthcare is facilitating these conversations at their eighth annual
• 0:12
  health IT digital health and RCM meeting.
• 0:15
  You can check your eligibility for complimentary attendance at the Lincoln,
• 0:19
  the description. We are excited to welcome you in October.
• 0:23
  This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Daniel Nigra,
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  chief Information Officer at Maine Health. Dr. Nigra,
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  it's a pleasure to have you on the podcast today.
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  Thanks so much, Laura. Thank you for having me.
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  Now, I know we have a lot to talk about. There's so much happening in health IT,
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  and especially with technology advancing as quickly as it is right now.
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  But before we dive into my questions,
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  can you tell us a little bit more about yourself and your background?
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  Sure. Uh, I'm one of those unusual CIOs that also has a clinical background.
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  Uh, I am a pediatric endocrinologist by training and, uh,
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  practiced for a long time, almost 30 years or so. Um, so I, I like to,
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  I like to always mention that and lead with that actually,
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  because I'm a clinician first. Um, and it's only, uh,
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  only second that I, that I do this CIO thing. Um, I spent a long time,
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  um, in my career at Boston Children's Hospital,
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  where I was a CIO for about 20 years,
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  and I'm now in my third year up at Maine Health, which is, uh,
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  northern New England's largest, uh, health system, and, uh,
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  also serving as CIO there.
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  Got it. Wow, that's fascinating. You know, and indefinitely jumping from that,
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  uh, physician in clinical role into CIO is somewhat common today,
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  but I can imagine when you first did it 20 years ago, there weren't a ton of,
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  uh, physicians and clinicians becoming CIOs or, or am I wrong?
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  No, you're absolutely right. In fact, I remember early on in those, uh,
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  first years, uh, when I assumed the role,
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  I think I counted less than one handful of, uh, of at least, uh,
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  physicians that were also CIOs. Um, now you're right there,
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  there are definitely more, and obviously with the evolution of the CMIO role,
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  there's, uh, a lot more presence of, of clinicians in those roles as well.
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  But yeah, early on, uh, I, I did feel like a little bit of a,
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  of an unusual, uh, kind of, um, person in the role,
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  but it's been enormously helpful for me. In fact,
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  I always used to comment to my colleagues, like,
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  I didn't understand how they could do their job without having that clinical
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  background that I was lucky enough to bring, uh, bring to the role.
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  Absolutely. And, you know, having that, like you said,
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  clinical background and that, um,
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  experience working with patients and understanding how those interactions go,
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  I can imagine is invaluable when you're thinking through the technology strategy
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  and what's gonna really work for the care providers on the ground.
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  Absolutely, yeah. You know, I, I, I feel their pain often because I was,
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  uh, a user, um, as well as, uh, you know,
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  the person in charge of rolling these things out.
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  So I definitely could commiserate and, and understood when, uh,
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  when there were complaints about things. At the same time,
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  it was helpful in the exact opposite direction when there were complaints about
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  this or that. Um,
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  and I knew from working with the system myself in my clinical capacity that they
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  were complaining about a trivial little non-issue, um,
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  and so I would push back on them. So it was, it was helpful in both directions.
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  Absolutely. Well, considering where you're at right now at Maine Health,
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  what are some of the big opportunities you're looking at as well as the
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  headwinds you have your eye on?
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  Well, the headwinds are, are ones that unfortunately I think are very similar.
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  As you look across pretty much every health system around the country, um,
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  we're facing incredible, uh, difficulties in terms of finances these days. Um,
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  the pandemic did not help, uh, in terms of, uh,
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  of the labor situation. We've got labor shortages, um,
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  and obviously those in turn have led to enormous, um, uh, salary,
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  uh, increases, whether for existing staff or for, uh, traveling, uh,
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  kinds of roles to, to fill, you know, clinical positions that,
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  that we can't just, uh, find enough folks for. So, um,
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  those things, couple,
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  the labor shortages together with the resulting financial situation that, that,
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  that has put us all in, um, really are,
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  are forcing organizations to, to be pushed into, um,
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  situations that they've not been in for quite some time, if ever, frankly. Um,
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  and so that's obviously resulted in all kinds of constraints
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  around, um, you know, our ability to, to hire folks, uh, to, to have,
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  uh, the right numbers of people on our teams. Um,
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  and this is all in the face of an environment where the pace of
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  change, uh, continues to, uh, increase enormously.
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  So especially within it,
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  we're being asked to do more and more and to solve for so much, uh,
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  more and yet to do so with a pretty constrained, um,
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  set of resources to, to do all of those things. So I think those are,
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  those are the, you know, the, the, the headwinds and, and the challenges that,
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  that we, and I know many other places are facing. Um,
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  but in terms of the opportunities, I,
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  I'll actually cite all of those things as potential opportunities for us. Again,
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  especially within it,
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  I think it has the ability to address many of those things with respect to,
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  for example, the, the labor shortages. Um,
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  there's been all kinds of creative ways that organizations have,
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  have used technology to, um, to at least, you know, make their,
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  their existing clinical teams more effective, um, to be able to do more,
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  um, with the assistance of technology or in some instances, to substitute for,
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  uh, for the lack of, of talented, you know, care team members who,
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  who can do the jobs. So I do think it has an ability to,
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  to help in that regard. And also with respect to, um,
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  other things just in terms of rethinking overall workflows. Um,
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  we've always done things in medicine in a certain way in healthcare,
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  but that's not always the best way. Uh,
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  and especially these days where technology can help with, um, re-imagining,
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  uh, workflows and, and doing things differently, um,
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  and in many ways more efficiently. Uh,
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  I think there's a lot of opportunity there.
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  So those are the kinds of things that we're focused on, and, um,
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  the ways in which we're trying to address those,
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  those headwinds that we mentioned.
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  That makes a lot of sense. And a, as you mentioned,
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  so many of those challenges are, um, felt across the country.
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  I can imagine many people listening at home, nodding their head,
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  and then thinking through some of their more recent, uh,
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  conversations with their executive teams. So when you look at,
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  as you were talking through those challenges, then the technologies that,
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  you know, can help support, um, bridging the gaps that you're seeing and really,
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  um, keep the organization running well despite these challenges, you know,
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  what does that look like?
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  Can you pull out one or two examples of ways that you're able to, uh,
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  support the overall health system and growth and add value, um,
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  to either the clinician or the patient experience?
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  Sure. I mean, the obvious one that we saw with the pandemic is the,
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  is the presence and, and the, um, development of virtual care, right?
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  So this was obviously technology that we had already, and yet it exploded,
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  uh, with the start of the pandemic and has continued. And I think, um,
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  what's interesting is to see that, um,
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  this is now no longer felt to be some, you know, um, um,
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  esoteric kind of thing. And in fact,
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  many organizations are using this in creative ways to solve some of those
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  challenges that I mentioned before.
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  So we're starting to hear a lot more about virtual nursing scenarios,
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  remote ICU kinds of care and monitoring. Obviously,
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  care at Home has taken a strong foothold,
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  remote patient monitoring all of these things that, again,
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  we're not new with the pandemic,
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  but the pandemic certainly helped China spotlight on those and make
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  organizations realize that they were viable adjuncts to the way that we had been
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  delivering care up until now. And, um, and again, with the financial pressures,
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  um, more and more organizations are realizing that these,
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  these have to be the ways that we augment the,
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  the ways in which we're caring for our patients, um,
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  simply from a fiscal perspective. So that's one great example of, uh,
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  of technology that we think is, uh,
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  incredibly valuable to our organization. And I'm sure to many others around the,
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  around the country. Um, you know, there's, uh,
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  there's other automation that we could talk about, uh,
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  robotic process automation, rpa, and, um, you know,
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  that's one approach to, um, automating some of the more administrative tasks,
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  uh, that we often find our care team members having to, uh, manage, um,
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  especially in, in some of the administrative areas, uh,
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  but also within clinical care, we can envision, um, using some automation,
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  automation to, uh, allow our,
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  our team to do essentially more with less with the assistance of technology.
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  And of course, you know, with all of the rage that, um,
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  the last few months have brought around, uh,
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  large language models and chat G P T and things like that,
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  those are absolutely going to, um, figure more and more, um,
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  prominently within our systems, I think as the technology matures.
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  That's such a great point. And definitely, you know,
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  looking at automation seems like the name of the game as much as possible,
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  and then bringing in,
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  whether it's artificial intelligence technologies or anything else that'll be
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  able to connect, um,
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  patients in multiple ways with their care providers in the organization overall,
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  um, will just, you know, be so beneficial. Um, when you look at, uh,
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  some of those opportunities, whether it's artificial intelligence or automation,
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  bringing that into the healthcare organization,
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  what are those conversations like either, um, with the executive team or,
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  or with the, um, you know, departments and clinicians, um,
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  and workers on the ground? What are they feeling about all of this?
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  Is their excitement, is their nervousness?
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  Yeah, I, I think I'm, maybe I'm, um, uh, blessed in this regard, but I,
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  I will say that there's an absolute excitement level and a,
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  and almost a, a, um,
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  expectation that we start doing this stuff now.
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  And I'm not sure whether that's just because, uh,
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  it's been so prominent in the media. Uh, you know,
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  obviously folks are able to go out and try some of these things on their own
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  now, and in many instances it's a pretty jaw,
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  jaw-dropping experience when you do try it. And so I think that's, um,
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  helped a lot of people sort of come to grips with the fact that, hey, this,
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  this new technology is, is here and,
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  and we've gotta start to capitalize on it. So I do think that, uh, that we're,
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  we're an organization that very much wants to adopt and is planning to adopt a
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  lot of this tech.
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  Now we have to do so in a pretty responsible way. We can't do,
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  you know,
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  just the throw chat g p t everywhere and think it's gonna solve all of our
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  problems. Uh,
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  I do think the path to success with some of these new tools is gonna be not a
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  straight line, but, uh,
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  a one that's pretty crooked and takes all sorts of twists and turns. And,
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  and so I'm quite confident,
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  confident that we'll have some missteps along the way. Um,
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  and we absolutely need to go in with eyes open, but at the same time,
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  I'm absolutely also convinced that,
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  that these technologies are gonna be absolutely critical within the provision of
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  care moving forward. Um,
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  and I'm sure in many ways that we can't even envision yet. Um, right now,
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  obviously, it's, uh, it's helping in, in things like, uh,
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  clinical documentation, um, you know, some of the ambient, uh, uh,
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  documentation systems that are out there, um, you know, patient facing,
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  uh, tools, whether it's symptom checkers, um, you know,
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  allowing patients to do a little bit of investigation on their own,
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  whether it's, um, doing some automation with regard to clinical, um,
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  clinician patient interactions, um, you know,
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  looking at the burden of all of the, um,
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  secure messages that are going back and forth now between patients and providers
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  and the burden that that's placing on them. So I, I think there's a lot of, uh,
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  opportunity for some of these systems to, to start to play a role and,
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  and, uh, I'm very excited by it.
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  I love that. I, I think that is great to hear and definitely something that,
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  you know, will make it so much easier as the technologies evolve and really, um,
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  put them into a place where they can be working for you and for the betterment
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  of the overall system. Now, as you mentioned earlier, I know that, um,
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  right now we're in a financially challenging time and having a hard time finding
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  staff there. Some organizations might be going through burnout.
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  So when you look at, um, just the idea of, you know,
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  continued growth as much as possible,
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  what is one risk or investment that's still worth making, even though, you know,
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  you have limited resources in every dollar is precious.
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  I, I do think the one that, that we were just talking about, the, you know,
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  these large language models and the, uh,
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  sort of artificial intelligence based tools, I, I think that's the one that if,
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  if I were a betting man that I would bet on, um, as I said, there's,
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  there's gonna be problems. It's not gonna be perfectly smooth sailing,
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  but I cannot, I cannot see a future in which some of this, um,
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  um, knowledge and, um,
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  and technology is not used in a healthcare setting and it,
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  to begin with, it may be on some more mundane things, you know, some,
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  like I said, administrative tasks or nonclinical, um, use cases.
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  But I think that that's only the beginning.
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  I do think ultimately it's gonna start to, to, uh, have a role in, uh,
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  assisting clinicians in their, in their care for patients.
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  And so I think that that's the bet that I'd place, uh, um,
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  a wager on, and that I think health systems should, uh,
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  similarly start to really take a focused look at. Um, I know that we are.
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  Great to hear, um, in, in just really fantastic insight. Now,
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  I wanted to look just a little bit further into the future as well. Um,
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  where do you see as,
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  as being some of the best opportunities over the next two to three years for
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  growth yourself as a cio as well as the technology teams that you're working
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  with?
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  Um, you know, this, the, the, the landscape that, that we're talking about here.
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  It's, it's so, um, it's so exciting to me. Uh, again,
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  I've been in this role now for about 25 years, all in all,
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  and I can't tell you a time where there's been more excitement in the air
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  about, um, the role that, that technology and,
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  and IT in general can play within healthcare and in fact needs to play
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  because of all of those issues that we talked about before.
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  I think there's an expectation that that, you know,
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  technology is going to help to, um, you know,
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  allow organizations to survive, to be able to function with, uh,
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  with fewer resources and to become more efficient. So, you know,
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  whether or not it's,
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  it's that it is going to help with growth or rather that it is just gonna
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  help us stay afloat, frankly. Um, either way,
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  I'm absolutely convinced that, uh,
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  this is a fantastic time to be within healthcare it. And, um,
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  as I said,
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  I'm incredibly excited to see how the next several years unfold because I
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  think we're at a, a key juncture in the use of,
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  of technology within medicine.
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  Dr. Niagaran, I really appreciate it.
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  It's been so fun to speak with you and definitely we're looking forward to
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  having you at our Health IT Digital Health and Revenue Cycle event in October.
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  I know a lot of these discussions will continue on and with the technology,
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  whether it's chat GTP or others evolving so quickly,
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  it'll just be fascinating to have, um,
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  those real-time discussions and see what everybody's doing.
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  Absolutely. Laura, I'm looking forward to it.
• 16:20
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