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.
- Early roots in pediatric endocrinology
- Merging clinical & IT roles — “I could speak both languages”
- Benefits of being an MD
- Collaboration among children’s hospital CIOs
- Patient engagement — the “next set of challenges”
- ICD-10 testing with the Mass Health Data Consortium
- Expanding telehealth pilots
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As time ticked on and we started to automate more and more and put more systems in place and had more and more interaction with clinicians throughout the organization, I realized I was no longer doing everything you would expect a CMIO to do.
We routinely get 20 to 30 CIOs who meet on a twice-yearly basis to talk about issues that are top of mind for us all — some struggles, some successes — and we really have a nice collaborative relationship.
We’ve got to be sensitive to those kinds of needs, either for legal reasons or for patients or families’ best interests. And that throws an additional wrinkle into things like patient portals.
Telehealth technologies can really help facilitate and improve the care that we provide, potentially at a lower cost as well. We’re working hard now to build a technology infrastructure to facilitate that.
Gamble: How long have you been at Boston Children’s?
Nigrin: I’m a physician as well, and I started as a pediatric endocrinology fellow in 1995. It was during that fellowship that I pursued my informatics training, and where I really got interested in IT and the intersection of healthcare with IT. I started as CIO in 2001, and I’ve been in that position about 12 years. Actually, it’s getting close to 13 years.
Gamble: I’m sure it’s flown by.
Nigrin: It has flown by.
Gamble: So you kind of took an interest in the informatics part of it, and things just went from there?
Nigrin: I had always been interested in computer science and computers in general. I had not really formally studied it through my college or graduate studies — obviously I was focused on the medical aspect of things. But I never really lost the interest in it, and when I started my fellowship here at Boston Children’s, I realized that I would really love it if I could merge these two interests that I had always had in medicine and in information technology. It was really only then, in 1995 or so, that I discovered this field. I was fortunate enough here in the Boston area to be able to take advantage of a formal medical informatics fellowship and training program that was in place between Harvard and MIT, and so I had the ability to do some more formal learning. And the more I got interested in it, the more I really fell in love with it.
I kind of stumbled into the operational side of things basically because as my fellowship came to a close, I had all this newfound knowledge that I had gotten through that program, and I wanted to try and see if I could start to apply it to some of the systems that we had in place here at the hospital. And so I started to get into more and more discussions with our existing IT staff around making some of those improvements. I was asked eventually to step in a role which I think today would be called a CMIO role — back then it was called the Director of Clinical Computing.
Essentially, I think my role at that point was to serve as the bridge between the IT folks and the clinical folks. I could speak both languages. I knew some programming. I obviously knew the medical side of things, and I think that was helpful for all sides. It gave the clinicians a way to be able to communicate their ideas back to the information technology folks, and vice versa. I could translate some of the medical lingo and needs back to the IT folks who were developing applications. And then one thing led to another, and I eventually was asked to step into the CIO role.
Gamble: And of course the role has evolved quite a bit since you took it.
Nigrin: Definitely. I mentioned CMIO — at the outset, since I had the medical background, I didn’t necessarily feel the need to bring on anyone else. I said I could do both jobs. But clearly as time ticked on and we started to automate more and more and put more systems in place and had more and more interaction with clinicians throughout the organization, I soon realized that I was no longer doing everything that you would expect a CMIO to do. At that point I solicited some additional help, and so now, despite the MD after my name, we also have a CMIO here at the hospital.
Gamble: I’m sure even now, having the clinical experience, especially in pediatrics, benefits you.
Nigrin: Absolutely. I can’t stress how much it helps me be able to do my job better. Being on the other side of the fence is just always so valuable. My team knows when I’m in clinic seeing patients, because invariably at the end of that day, I fire off a bunch of emails about this or that that needs to be improved or this or that doesn’t really work that well, and so on. There’s nothing like having to use the same systems that you have other people use.
Gamble: Right. Now, the other thing I wanted to ask you about goes back to when I saw you briefly back at the CHIME Fall Forum. You talked about how some of the children’s hospital CIOs meet and have your own meetings. I wanted to talk about that because I would think that your needs are really pretty specific, and I’m sure it’s really helpful getting to talk about the issues that are specific to your group.
Nigrin: Absolutely. This is a group that was originally hosted by the Child Health Corporation of America. They sponsored a CIO forum. That organization has since merged with another pediatric organization called NACHRI, and the combined organization is now called the Child Health Association (CHA). We continue to host this CIO forum that meets twice annually, and it’s comprised of the CIOs from freestanding children’s hospitals across the country. I think there are about 40 or 50 of those. I could be easily wrong on that number, but regardless, we routinely get 20 to 30 CIOs who meet on a twice-yearly basis to talk about issues that are top of mind for us all — some struggles, some successes — and we really have a nice collaborative relationship.
In some ways, it reminds me a bit of what I described about the Boston area and how we all share and work collaboratively. It’s a very similar feeling in this group. We all know each other by first name and joke around with each other and have fun, which is important, but we also really like to share with each other and recognize that we all don’t do everything well. We generally learn a lot from each other.
Gamble: One of the things you touched on before was dosing and having such a wide range of patients in terms of size. I’m sure that with things like that, it’s really helpful to get around other CIOs who deal with it as well and share best practices and things like that that are unique to your patients.
Nigrin: I think that particular issue was what we were probably talking about five, six, or seven years ago when more of the organizations were in the throes of implementing CPOE. I think most of us have now crossed that threshold and so, we’re now talking about the next set of challenges.
I’ll give you a great example. We talked a bit before about personal health records — patient portals and things like that. Within pediatrics, we have this additional challenge that the patient is not always necessarily the consumer who’s going to be coming on to your portal. In most instances, it’s the parent. That becomes challenging when your patient is a teenager; when you’ve got a 16 or 17-year-old patient who, in many instances, is starting to think about their own health and be the overseers of their own health. And so there are confidentiality issues where by law, you’re not allowed to necessarily share things with a parent that you would share with a teen patient, and it goes both ways. There are instances where kids may have certain diagnoses that parents decide they don’t want their children to know about. Most often this comes up with things like genetic disorders, for example. We’ve got to be sensitive to those kinds of needs, either for legal reasons or for patients or families’ best interests. And that throws an additional wrinkle into things like patient portals. So it’s these types of discussion that we routinely have with the CIO forum group that are incredibly helpful because we always learn from each other.
Gamble: As far as the CIOs that are your area in Boston, do you have meetings with them occasionally or are there certain groups or topics, like HIEs or things like that? Or are they more like informal meetings?
Nigrin: We always do informal. I think it’s a small enough community that we invariably can pick up the phone or email, and it’s always received warmly when we do that. But we do have formal gatherings. We also have a CIO forum that’s sponsored by an organization called the Mass Health Data Consortium. This is a group that meets regularly and we talk about general issues that all of us as CIOs are wrestling with, but it’s not just talking about things. We actually are doing things as well.
As an example, this is the group that’s coordinating our ICD-10 testing efforts. Importantly, the Mass Health Data Consortium CIO Forum is not just comprised of provider organization CIOs; payer organization CIOs are there. Government agency CIOs are there. It’s the whole healthcare regional environment. With all of those folks at the same table, we can really put into action some important organizing groups. And in some instances, things like ICD-10 testing, where we are coordinating between all of the payers and the providers to try to streamline some of this challenging work that all of us are struggling with now.
Gamble: I know we talked about a lot that you’re doing and what you’re looking at, but I didn’t know if there was anything else major you have on your to-do list, which I can imagine is quite long.
Nigrin: It’s a long list. Obviously we’ve got ICD-10, which I just mentioned, along with Meaningful Use. I wish I could ignore them, but unfortunately, I can’t. Like everyone else, those things are very much top of mind for us.
One other area that is very much a focus of our work these days is around telehealth and taking more advantage and implementing more broadly our telehealth activities. In the past, we’ve done several pilots. Through our innovation program, we’ve had several telehealth pilots over the last few years in place, but we’ve realized that as we try and expand our scope beyond just our region and do a better job nationally and internationally, and even for patients within our general vicinity, telehealth technologies can really help facilitate and improve the care that we provide, potentially at a lower cost as well. We’re really working hard now to build a technology infrastructure to facilitate that.
We’re also working hard from an advocacy point of view to try and talk with our payers around why they should be supporting this work, why they should pay for it — because that’s not universal by any means yet, and why in the end, this is likely going to save them money, save society money, and not to mention, offer our patients better care in a more convenient way for them. Broadly speaking, it’s a general area that we’re very focused on.
Gamble: Right, and it’s something where, like you touched on, there needs to be a shift in the thinking in that yes, there are costs upfront, but this is something that in the long term is going to lead to better outcomes. That has to be factored in as well.
Gamble: Okay. I could easily talk to you for a while longer, but I don’t want to take up too much more of your time. I really want to thank you. It’s been interesting hearing about everything going on there at Boston Children’s and really great to hear your perspective on some of the big topics today.
Nigrin: It’s been a big pleasure talking this morning. Thanks, Kate, for having me.
Gamble: All right, thanks so much, and I hope to catch up with you again down the road.
Nigrin: All right, take care now.