Daniel Nigrin, CIO & Senior VP of IS, Boston Children’s Hospital
The word “innovation” is tossed around a lot these days, but when your organization is located at “the nexus of IT” — a neighborhood in Boston that houses some of the most cutting-edge IT shops in the country — it’s not just a term; it’s a way of life. It means having a long history of development while also being willing to utilize (and customize) commercial products; it means developing an innovation program to help bring ideas to life; and it means partnering with other organizations when the right tools aren’t available. In this interview, Dan Nigrin talks about what it’s like to be a Cerner-Epic shop, his organization’s data warehousing and analytics strategy, the other “CIO” at Children’s, and the unique collaboration among children’s hospital leaders.
Chapter 3
- Childrens’ MyPassport app
- Extending the window of time patients have with clinicians
- Innovation as as strategy with FIT
- Letting people “kick the tires” on ideas
- BCH’s chief innovation officer
- “We don’t frown on failure”
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Bold Statements
It’s basically a way to extend the window of time that docs and nurses have while they’re in the room to allow for more interaction with patients and their families.
A lot of places have web-based portals that allow their patients to get access to data, but we’re finding increasingly that most patients are interested in having mobile versions of the data, because that’s where they find themselves more often.
For the successful initiatives that do have legs, we take those projects and we evaluate whether or not we can think about a way to deploy that project in a productive way across the whole organization and not just as a pilot.
We don’t frown upon failure as part of this innovation program, because we recognize that not all ideas will be successful, and that’s okay. But at least it gives folks the ability to try their ideas.
Gamble: Looking at things like patient engagement, you have a unique patient population. Obviously you have young patients, but you’re also dealing with your parents, and so I imagine it’s also a priority to make sure that they can get access to the information they need and be able to set up appointments, things like that. What types of things are you doing on that end? I saw something about an iPad app, MyPassport, but I don’t know if that’s in the piloting stage.
Nigrin: That’s been a really successful pilot that was run through our innovation program that we’ve established here at the hospital. Our chief innovation officer, Naomi Fried, she spearheaded that initiative. It’s a self-developed application here run on an iPad that essentially allowed families and patients to be able to get a little bit of a better window into their own care while they were patients within the hospital, including being able to see results of studies that were done on them right within the hospital.
More importantly, it’s simple things like being able to get pictures of their current team of nurses and physicians who are taking care of them in the hospital. Often there is a myriad of folks who come into your room as a patient who are overseeing your care, and sometimes it can get a bit dizzying to just keep track of all of them, especially if there are subspecialists and consultants and so on. This was a simple tool that basically showed pictures and identified who these folks were as part of their care team. Beyond that, it also allowed for patients to provide a place where they could ask questions. If they don’t think of questions that they have for the clinicians while they’re in the room, they can use this application to essentially type out a question that they want those clinicians to answer, and those clinicians respond back to them. It’s basically a way to extend the window of time that docs and nurses have while they’re in the room to allow for more interaction with patients and their families throughout their stay. It was a very successful pilot.
We’re now getting ready to implement essentially the same kind of functionality, but embedding it within our broader patient portal that we’ve already established. The patient portal is pretty traditional. It’s what you may have seen in other institutions where it allows you to view your results. The difference is now it allows you to view not only your ambulatory results that might have been generated while you were an outpatient, but also the labs that were sent while you were an inpatient, and with no delay as well. We’ve made a decision to not necessarily delay the results. The patient gets them just as soon as the clinicians get them. We obviously still do screen some sensitive results where we feel it’s in the patient’s best interest to be able to get that news directly from a clinician. So that’s all part of our patient portal.
We obviously have other things like appointment requests, demographic updates, secure messaging, and bill payment, but the idea is that we plan to expand the application to have a new section now, which is going to reflect their current inpatient stay. All of those care team identifying pictures and ability to communicate with your care team will all be comprised in this new section. We’re working on that now as a result of the pilot. So we do have big efforts focused around our patients and getting them more transparency to their own data and their own care.
Gamble: I imagine that’s a big priority, especially because you’re dealing with children, who are pretty sick in some cases and their parents are under a lot of stress. That’s something that can go a long way toward patient satisfaction and keeping them informed as much as possible.
Nigrin: Absolutely, and thinking about the modalities that we do this in is important too. A lot of places have web-based portals that allow their patients to get access to some of this data and do some of the things I described, but we’re finding increasingly that most patients are interested in having mobile versions of this data, because that’s where they find themselves more often than in front of a desktop or laptop computer. We’re now within the next several weeks planning to rule out native versions of our portal for iOS and Android platforms. We think that will be well received as well.
And again, for this patient population you can imagine we’re not dealing with 60 and 70-year-old folks. We’re dealing with young patients, some of whom are teens, and clearly teens are mobile platform-based these days. But it’s also their parents. Frankly, their parents are in their 30s or 40s or 20s, and all of those folks have either grown up with or rapidly adapted to these new devices. We have a generally young patient and family population that we have to care for, and so keeping up with these technologies is a part of that.
Gamble: Absolutely. You mentioned before about having an innovation department and having Naomi Fried as your chief innovation officer. That’s something that I can imagine must be just a tremendous benefit. How did that come about?
Nigrin: Several years ago, the hospital wanted to foster innovation as a specific strategy. Clearly, we’re an institution that’s been focused on innovation going back to our roots both in the research as well as the clinical realm. But we wanted to formalize it and underscore it, if you will. We wanted to facilitate individuals at our organization to be able to take innovative ideas that they had and give them a platform and an approach to try and realize some of those ideas. The innovation program was born as a result of that, and Naomi was brought on board as well as several staff to work under her.
One of the specific teams that Naomi has working within her group is called the FastTrack Innovation in Technology (FIT) team. Basically this is comprised of IT developers as well as project managers and analysts who work exactly as I described with clinicians and researchers or anyone in our organization who has an innovative idea and who wants to essentially kick the tires on that idea.
Through a grant process, we select folks who have submitted applications for this program to be able to get essentially three months’ worth of IT development time from these dedicated developers to pilot test their innovation. Clearly you cannot build big systems within a three-month period of time. But generally, the kernel of the idea that folks are coming forward with can be realized in that very quick and dirty way and enough so that we can see if the idea has legs or not. This is exactly how the MyPassport project came about; coupled with the technology innovation is a plan to implement a short pilot with an evaluation to go along with it.
For the successful initiatives that do seem to have legs, we then take those projects and we evaluate whether or not we can think about a way to deploy that project in a productive way across the whole organization and not just as a pilot. We’ve got a few instances now where a project started as a FastTrack Innovation in Technology project, was successful as a pilot, and has gone all the way through deployment as a production application. Now in some of those instances, the application needed to be rewritten or bolstered a bit to make it more redundant or reliable or what not.
But the idea is that the FIT team, as it’s called, gave the person who had the innovative idea a mechanism to give it a try and without a lot of risk involved. And we don’t frown upon failure as part of this innovation program, because we recognize that not all ideas will be successful, and that’s okay. But at least it gives folks the ability to try their ideas, which before the establishment of the program was done in a much more ad hoc and less supportive way.
Gamble: From your perspective I’m sure this is a really great thing to have at your fingertips just hearing these ideas — even the ones that aren’t immediately successful could lead to something else. I’m sure that that’s a nice thing to have.
Nigrin: Absolutely. In all instances, even ones where the result is less successful than others, you learn something along the way, and that’s important. We clearly work very collaboratively with Naomi’s team, and it’s been a huge success.
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