Podcast Q&A: CIO Dan Nigrin on Momentum, User Education & “Eye-Opening” Experiences

Winston Churchill famously said, “Never let a good crisis go to waste.”

In healthcare, that crisis, of course, is the Covid-19 pandemic, which has played a critical role in advancing digital tools — and changing the way care is delivered. “It has been eye-opening,” said Dan Nigrin, MD, who has served as CIO at MaineHealth since January.

The challenge going forward will be to ensure that the industry doesn’t lose momentum, which would certainly be a waste, noted Nigrin, who has more than 25 years’ experience as a pediatrician. Instead, he believes healthcare has an enormous opportunity to leverage the lessons learned during Covid-19 and create “a new standard of care.”

Recently, Nigrin spoke with healthsystemCIO about how his team is working to optimize and streamline processes to improve the experience for both patients and providers, and why physician satisfaction should be top of mind for all leaders. He also talked about transitioning from pediatrics – and city life in Boston – to a large system in Maine, and what his team is learning by participating in the Arch Collaborative.

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Key Takeaways

• Despite the enormous impact telehealth services have had during the pandemic, its future still remains uncertain, which makes it critical for healthcare IT leaders to use their voices.
• When it comes to digital health, “the genie is out of the bottle,” with skeptical patients and providers changing their tune and accepting new ways of connecting.
• One of the key priorities for CIOs is to ensure momentum isn’t lost, and that the expeditious way in which decisions were made – and executed upon – during Covid continues.
• As organizations move forward, it’s critical to reflect on “all the ways in which we optimized and streamlined processes,” and ensure that capabilities like digital check-in and mobile payments become the standard.
• The most important steps leaders can take to improve clinician satisfaction? Provide education and ongoing support of the tools that are in place.

Q&A with Daniel Nigrin, MD, Part 2 [Click here to view Part 1]

Gamble:  You touched on a lot of things, one of them being that telehealth isn’t an option for a lot of the population, which is why something like phone visits is so important. It seems like that has been received pretty well.

Nigrin:  Yes. Off course, we will have to see what happens with payment and how that’s all going to play out post-emergency measures.  We also have to see what occurs with the regulatory landscape in terms of what technologies are going to be acceptable to be used. We’re going to be actively looking at all of these things, realizing that we need to be nimble and pivot when and if we need to as these rules change. Like many places, we’re actively participating in the lobbying world, trying to appeal to our administrative folks in the government to ensure these things don’t go away post-pandemic.

The phrase I’ve heard a lot is that ‘the genie is out of the bottle’ with this stuff. I think people have really realized that these technologies can be useful, but it’s not for everything. You’re not going to have brain surgery tomorrow over the computer, but in many areas, having a virtual interaction is really a positive experience. You get done what you need to get done. And that’s from both perspectives. Patients who were a little bit reluctant have now sort of seen the light, if you will. And many of those folks are now converts; the same goes for clinicians.

Both at Boston Children’s and in my time at MaineHealth, we had some of the fiercest opponents to this. They would say, ‘with my patients and the disorders I follow, there’s no way that could lend itself to a virtual visit.’ And yet, when we were pressed into it and we had no choice, people suddenly realized, ‘you know what? I can’t do everything, but I can do a lot of important things in a virtual way to care for my patients.’ Those folks have also come to see the light, if you will.

I do think that there’s really no going back to our pre-pandemic state; it’s really just a matter of where we steady out. What’s the right balance between in-person and virtual? What things are most readily and helpfully serviced in a virtual way, and what ones do still require that in-person visit? I think we’ll all work together to find out what that balance is and hopefully we’ll all achieve it in short order.

 

“This has been eye-opening”

Gamble:  As a physician, you’ve had a unique perspective on what has happened in the past year and a half in terms of digital and the role it plays with patient engagement — and how it has affected clinicians in the way they practice. I would think that it’s been really an interesting thing for you to be part of.

Nigrin:  It has. I will say that through this, my background as a physician has been an eye-opening experience, just as it was for all of my colleagues. I never thought I would be conducting a visit with a patient and his mother, for example, as they were driving in the car, but it worked. In this case, the patient’s mom was driving, and the patient had his iPhone up. He was talking and his mom was talking in the background, and we got done what we needed to do. Granted, I’ve known the patient for a long time. It’s a chronic disorder and so we see each other every three months. For those reasons, it worked.

But from their perspective, I’m sure they were thrilled to be able to do the visit that way. They didn’t need to carve out time from their respective schedules; instead, it fit into their lives. That was an experience that I won’t soon forget.

Technology providing a “connection”

There are also experiences within the hospital. We were seeing patients in dire circumstances and away from their families; technology helped allow patients to have some connection to their loved ones through video interactions. We also set up virtual rounding within the hospital to allow for teams to minimize their interaction with patients in order to decrease their risk of exposure. We used it when we were in dire straits with PPE to conserve that. All of those things that technology helped with was remarkable for me to see, with both of my hats. Obviously we helped enable it on the IT side, and as a user, it was really satisfying for me to see the fruits of those efforts.

 

Digital health’s future

Gamble:  So I guess the big question is, what happens next? Now that we’ve seen this big shift, how will digital continue to influence healthcare?

Nigrin:  I think the most important thing is that we don’t lose momentum. Again, I don’t think we’ll ever get back to the pre-pandemic state. I would hate for us to go back to that plodding tempo that we had traditionally taken with some of these things. As many of us all experienced, we did things with lightning speed during those early months, because we were singularly focused on what we needed to do to get through this. We put other things aside. Our decision-making was expeditious. I’d love for us to take some of those experiences and some of those lessons learned to our post-pandemic world. Let’s not take a year to decide that we’re going to do something; let’s go ahead and do it. We’ll make mistakes along the way, and that’s okay. Just as we did during the pandemic, we optimized and tweaked as we went. I think that same approach can definitely be taken on in a post-pandemic world. That momentum and speed — that decision-making ability — is my hope for the future, and what I’d love to see us capitalize on.

A new standard of care

There was also quite a bit of technology deployed during this period that I do think will be beneficial for us in the long term. So now we’re thinking about all the ways in which we optimized and streamlined processes for patients so that if they come in for an ambulatory appointment, they don’t have to go into a waiting room. We can send them a message saying, ‘okay, we’re ready for you,’ and they can spend time in the cafeteria or wait in their cars.

Let’s do a digital check-in so that they don’t have to interact with the person at the front desk. Let’s ensure that all of the payments can happen on a mobile device. Let’s eliminate clipboards and the providing of information at the time of visit. Let’s do all of that digitally before the visit through our portals or other mechanisms. These things aren’t new; we’ve had them in place. We were piloting and doing them in smaller ways before. Let’s use this opportunity to catapult those things and make them the standard of care, and have that be the way it just happens now, everywhere.

I think we all would benefit from that. It’ll make us more efficient on the provider side of things, but also, in the end, it’s also what our patients want. It makes life that much easier for them. I would really hope we can use this time that we’re in now to capitalize on these things that we put in place quickly and that will have the benefit for us in the long term.

 

“Burnout is still very real”

Gamble:  On the clinician side, we all read the powerful stories about everything that frontline workers have been through, and the burden and exhaustion they’re still dealing with. What do you think can be done to address it, even after Covid?

Nigrin:  Burnout is still a very real issue; Covid did nothing to help our cause there. We had the strain of a high volume of patients for a long period of time who went through really awful situations. That put a lot of emotional stress on our providers; we’re going to have our hands full as we try to tackle this. We’re very focused on the educational aspect of things with regard to our providers and our clinicians in general, and how they interact with the EHR. The Arch Collaborative work being done through KLAS has shown very clearly that education and ongoing support of our providers to help them understand how to best use the tools we have in place, is one of the most important things we can do to improve their satisfaction. It can also improve their efficiency and their ability to get work done and not need to bring it home after the day is done.

And so, because we’re approaching that point in time in which the big go-lives and rollouts are behind us, that’s going to become one of our primary goals over the course of the next several years — to really focus on addressing the educational aspect. I do think that, in many instances, we already have systems in place that can help them. They’re either not aware of them, or they haven’t yet been taught how to use them optimally. So I do think that will help quite a bit.

Part 3 Coming Soon…