Podcast: CIO Dan Nigrin on Note Bloat, “Constant” Training & His Move to Maine

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

• One of the biggest workflow challenges facing many organizations is note bloat, which MaineHealth hopes to address by leveraging tools like voice and ambient listening.
• Most optimization issues stem from that the fact that organizations were focused solely on getting EHRs live, and not on getting maximum use of the technology.
• Vendors are continually working to improve functionality and provide new features, but without the right education and support in place, “it’s all for naught.”
• Although Nigrin admitted to having “some trepidation” about leaving Boston Children’s after 20-plus years to work for a larger organization, the opportunity was too “exciting” to pass up.
• Contrary to popular belief, the vast majority of care does not, in fact, occur in “large academic health centers located in big-city environments.”

Q&A with Daniel Nigrin, MD, Part 3 [Click to view Part 1 and Part 2]

Nigrin:  We’re also looking at new technologies. We’re doing some bleeding-edge things like Voice and Ambient Listening to see whether or not there’s a component of the documentation piece that we could take off of providers’ plates and allow them to either decrease — or, in an ideal world eliminate — that documentation burden that we all have after the visit is complete. That’s incredibly exciting new technology. It’s still evolving and being optimized, and we’ll have to see how quickly that can be perfected. But we want to be part of that perfecting process.

And so, like many organizations, we’re planning to pilot this work with small groups of providers over the course of the coming year. Our hope is that it’s successful and that we’ll be able to broaden it to more of our providers. Those are some of the ways in which we’re trying to tackle this.

Easing the documentation burden

There’s not going to be a silver bullet for this. Part of it is also the regulatory requirements around what documentation needs to be in the note; what components need to be in there. Again, part of it is education. I think our providers believe that the kitchen sink needs to be in their documentation when, in fact, it probably doesn’t. And so it’s a big focus of ours to address that.

 

Gamble:  You mentioned the Arch Collaborative earlier. It’s pretty simple concept, but seems to be having a big impact in terms of optimization and usability.

Nigrin:  What happened is that many organizations were heads down just trying to roll these systems out. They were just trying to get them live and not have a huge financial disaster occur, and so the focus for a long time had not been on getting maximal use out of these tools. It was on getting them up and running.

There’s also the training aspect. The idea that you can train folks once at the time of go-live and then you’re all set — that’s clearly not the right approach, because these systems are changing. They’re not static.

User training – “It needs to be constant”

The vendors are doing a much better job at continually improving the functionality, and so there’s a there’s a steady stream of new features and improved features. But if you roll those out and don’t educate the people who are going to benefit from them on how to use the system, it’s all for naught. It really does need to be a constant and outright. It needs to be a focus moving forward in every organization. This takes people and it takes effort; it’s not something that’s easily done. But it has to be a priority, because that’s where the real wins will come.

 

Gamble:  Sure. So it’s fairly obvious what drew you to the organization, but did you have any trepidation about leaving Boston Children’s and coming to Maine? What were your thoughts going in?

Nigrin:  I was at Boston Children’s for 25 years, first with my clinical hat on, and then for the past 20 years serving as its CIO. So yes, I’d be lying if I said that I didn’t have some trepidation for sure. But I really wanted to work for a larger organization, and I wanted to work at the system level. Boston Children’s is great, but it’s a single organization. I wanted to experience what it was like having to work with multiple hospitals and multiple hospital presidents, from 650-bed, academic, tertiary care facilities all the way down to 25-bed critical access hospital in rural Maine. I didn’t have any experience with the latter, and I wanted to see what it was like to have to wrestle with making things work from an EHR perspective. That was a big draw for me; it was probably the biggest reason that I looked to MaineHealth as an organization.

Branching out from Pediatrics (and Boston)

I also wanted to see what the adult world was like, having worked at a pediatric organization for my entire career. That was exciting to me; I wanted to expand my boundaries a bit there. I also wanted to see what life was like outside of Boston. We had a tendency to live in a little bit of a bubble. Obviously, Boston is blessed with many of the leading healthcare facilities in the country. Not to mention the groundbreaking informatics-type organizations where a lot of the early efforts in IT and its relationship with healthcare were made.

But I recognize that there is a large amount of healthcare delivered outside of Boston. And in fact, the vast majority of care does not occur in these large academic health centers in the middle of a big city-type environments. I had a desire to see what life was like outside of that environment. And I will say, the people are fantastic at MaineHealth; they’re extremely warm and welcoming. I couldn’t have asked for a better environment.

I’m also enjoying exploring Portland. I’ve never seen so many fantastic restaurants and pubs in such a small geographic area. It’s incredible; you can eat at a different, world-caliber place every day for a month and not go to the same place twice. That’s been fun for me to explore as well.

 

Gamble:  I don’t think I’ve known anyone who regretted moving to Maine, so it sounds like it was the right choice.

Nigrin:  As I visited all the facilities, especially the ones in some of the more rural parts of the state, just traveling around has been fantastic. I can imagine that as each season goes by, I’m going to want to redo those trips because the scenery will change and be that much more impressive each time. That’s another aspect that’s been really nice.

 

Gamble:  I know you’re a music person. Have you explored that yet?

Nigrin:  To be honest, I haven’t had a chance to do that yet. Things are only really starting to open up now, but that’s something I’ll look forward to. It’s funny; I let my colleagues know about this aspect of my life and they’re all extremely interested. Several of my team members have let me know that they, in fact, have some of my music that I released way back when, which was a while ago.

 

Gamble:  That’s very cool. I had the pleasure of going to Portland about six years ago, and I have to get back. It’s a great city, and I can see why you like it there.

Nigrin:  It really is great.

 

Gamble:  I want to thank you so much for your time. It’s been great catching up, and I hope to do it again soon.

Nigrin:  Thanks so much, Kate. I appreciate the opportunity.