A recent survey found that the majority of health systems (57 percent) aren’t reaching their goals when it comes to digital transformation. One of the biggest points of frustration is the fact that there isn’t a senior level role focused how emerging digital technologies can transform the patient experience, because most of the focus is on implementing and optimizing EHRs.
It was precisely this point that came up during a discussion Nick Patel had with HIMSS CEO Hal Wolf back in 2017 – a discussion that ended up transforming Patel’s career. Shortly afterwards, he pitched the idea of chief digital officer to his CEO, and was offered the job. Since then, the role has grown, both in numbers and notoriety, and Patel believes it will continue to do so as digital health becomes a bigger priority.
Recently, Patel spoke with Kate Gamble, Managing Editor of healthsystemCIO, about his team’s core objectives, particularly when it comes to remote monitoring; his thoughts on how disrupters and startups are changing the game; his journey from practicing physician to CDO; and the traits he believes are most important in digital leaders.
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- Initiatives like online scheduling can go a long way toward improving patient satisfaction — but only if it goes beyond analog to create a “true digital experience” that puts the patent at the center.
- For Patel, going to medical school and seeing how far behind healthcare was in terms of automation and efficiency “was like stepping back 50 years.”
- Digital transformation is key to the success of healthcare organizations; but only if it’s done right. “You have to be very prescriptive in how you do it,” Patel said. “It needs to be done in a seamless way and it needs to be continuous.”
- Without clearly defined governance and reporting structures – and a reasonable budget – it’s not possible for CDOs, CIOs, or any leaders to push the vision forward.
- To be successful, the CDO must be a strategist who understands how to maximize the use of the EHR, and how to bring it to the front door to improve patient care.
Q&A with Nick Patel, MD, CDO, Prisma Health, Part 2 [Click here to view Part 1]
Gamble: Going back a little bit, you mentioned that one of the first initiatives involved online scheduling for providers. Why did you decide to start with that particular area?
Patel: The first part was that we didn’t have a good website presence around who we were and who our providers were. We really wanted to build a provider directory that also had the reputation score or star rating, as well as a personal story about the provider. We wanted the ability for people to do keyword searches, so if they put in ‘diabetes,’ it will show everyone in that area who’s qualified to treat diabetes. It’s hard to find a provider; traditionally, you essentially had to search Google or ask a friend who is good and who isn’t, and where is the best place within a 20-mile radius. This allows you to do that all in one place.
But that only gets you the information. It only gets you to so far; you’ve had this digital experience all the way up to here. You know which provider you want. You saw his video, you his credentials, and you like his ratings. But now you need an appointment, and so you have to call a phone number. Converting from digital to analog is where you lose customers. We wanted to be able to say, here’s the actual provider you chose. Click here to find a convenient time to set up an appointment, instead of calling a practice, going through a phone tree, and waiting for them to come back to you and say, ‘that person isn’t available for two or three weeks.’ When it’s done this way, the patient has to accommodate the provider.
We wanted to add the ability to click in and schedule yourself. Not just to see a primary care physicians, but to schedule a mammogram, get a bone scan—all of those types of self-service that are convenient for the patient and put the patient at the center, not the provider.
Gamble: Right. Now, you started as a practicing physician. How did you make the leap to chief digital officer? Is that something you had been interested for a while?
Patel: It’s a long story, but I’ll try to keep it brief. Before I went to medical school, I took a year off and worked as a Unix programmer. I’ve always really liked technology, ever since I was a little kid playing on my Commodore 64. And then all the Mac products came on the scene. That’s what I’ve always loved.
One of the biggest pet peeves I have is inefficiency. When I decided to go to medical school, after being in the tech industry and seeing how efficiently things work there, going into healthcare was like stepping back 50 years in time. Not in terms of how we provide care and the advances that have been made in medicine, but really how we actually deliver that care and how we communicate with each other.
When I went to medical school, I remember having to round. There was a carousel with charts in it, and you had to find that chart before your round. The pink sheets were notes written by doctors. You had to find the chart and write your note before you rounded with your attending. Well, sometimes the patient is getting a CT scan, and the chart goes with the patient, so you have to scramble to find it. You couldn’t do anything without that chart.
It was amazing. I remember thinking, why don’t we have digital records for patients? It’ll get rid of errors. We’ll be able to measure metrics and do data analytics. Of course, as a medical student and then resident, it would’ve been impossible to do a startup, but I always was interested in it, and when it happened, it was great to see.
And so I went from paper charts to multiple EHRs along my journey, and I can tell you there were a lot of unintended consequences and disruptions that occurred with those deployments. Burnout went up, and productivity dropped between 25 and 33 percent. Then we saw optimization accelerate, especially in the last five years. We’ve seen interoperability really accelerate in the last two to three years. And now we’re seeing this massive up-curve in digital health innovation.
It’s been great to have been on that whole journey, but it’s like having a Ferrari as your first car. You’d never know what it’s like to drive an old car; you’d never know the difference. The good news is that I was able to see everything from nuts to bolts when it was being built.
Rules of digital engagement: “You have to be very prescriptive”
But you have to be very prescriptive in how you do it. You’re not going to go after the nice, shiny toy every single time. As long as you start with the patients’ needs in mind, and you understand the workflows and make sure it’s not as disruptive as EHRs have been, then you’re going to be successful. But it needs to be done in a seamless way. It needs to be continuous and it needs to feel like one thing connects you to something else. It’s can’t be, ‘I have to click here 10 times and then go here and click 10 times.’ It needs to be something that is easy to use and makes you want to use it because it’s going to make your life easier. That’s really what’s very dear to my heart, because I’ve lost many providers to deployment of EHRs. Some of them were my mentors, who were wonderful docs who could have practiced another 10 years, but decided to hang up the white coat because they just didn’t want to deal with it.
It’s amazing what we’ve done. Now we even have Scribes for our providers who do most of the documentation and sign off on it at the end of the day. It has always been core in my heart outside of taking care of patients, because I think I can be a better doctor if I have the right technology. The number one tool for any provider is information; that’s how we come up with the diagnosis and treatment. I really am a major advocate; not just for patients, but for our providers to be able to use technology that’s meaningful.
Gamble: Interesting. You just did a nice job illustrating the value that physicians can bring to the CDO role. Do you think we’ll start to see more physicians become chief digital officers?
Patel: I think so. It’s interesting; from what I’ve seen in the CDO role, a lot of them are not even providers. A lot of them didn’t even come from healthcare. If you look at Kaiser Permanente, the CDO came from Home Depot. If you look at Baptist South Florida, the CDO came from Disney. It shows you that you really need to put your retail hat on and you really need to understand workflow and how we deliver that retail experience. But you definitely have to have a clinician involved in same way, and so I do think you’ll see more clinicians in the role. Some of the roles have been called chief digital officer, some are chief digital transformation officer, some are chief experience officer. There’s a lot of new roles that are springing up. But the key to the success of that person, irregardless physician or non-physician, is setting up the appropriate governance in order to be effective.
Gamble: That actually just leads right into the last thing I wanted to ask: for organizations that are looking to hire someone in this role, what are the most important things they should look for?
Patel: I think you need to have someone who is experienced, who understands the objectives of the health system. If you look at the job descriptions, there’s about a 60 percent overlap. But there are also people that don’t understand the CDO is not really supposed to augment the EHR as part of the strategy, but not leading by it. You’re not trying to be the CMIO.
CDO as a “strategist”
You have to define clearly the reporting structure. The CDO needs to be somebody who is in between the CIO and CMIO. The CMIO is laser-focused on the EHR — its optimization and utilization. The CIO is focused on making sure it all works from a computer, software, networking, and security perspective. The CDO really needs to be a strategist who understands that we have these foundational systems; we have this EHR, but this is how we’re going to maximize the use of that EHR. This is how we’re going to bring in the digital front door to improve patient experience, and bring in other emerging technologies into the mix to provide better care.
In a lot of health systems now, the CDO role reports directly to the CEO. They’re lockstep in terms of that digital strategy, both operationally and clinically, to understand how we’re going to get there. What I do see is variance is that some CDOs answer to CIO, some answer to the chief administrative officer. My role has even been changing recently in terms of reporting.
Two keys to helping CDOs succeed
At the end of the day, you have to make sure you’re enabling this person to be successful. Number one is governance. Number two is budget; make sure you have enough money earmarked for those initiatives that your CDO is going to be in charge of.
Where I see this role fail, is where it’s more lip service and influencer than anything else. Those things are great to get people riled up, but you’re not going to be successful doing it that way. You have to be able to execute. A vision without execution is just a dream. And so you have to be able to execute, but make sure you have a solid budget to empower that person. A lot of organizations out there have done that. And again, it’s understanding and working closely with the providers as well as your marketing and experience folks to make sure you have a true pulse on things.
Gamble: It’ll be interesting to see what happens in the next few years, but it certainly seems like healthcare is taking positive steps.
Patel: I believe so. I’ll tell you, I haven’t been this excited to be in healthcare in a long time. Even though we’re going through Covid and it’s a mess, and there are lot of things going on in the world that need to improve, it’s really been a breath of fresh air to see health systems starting to talk more about digital innovation, digital transformation, and digital health.
It was a huge topic at HIMSS as far as how people reacted to Covid and what they’re doing now. One of the surveys showed that 57 percent of health systems still don’t feel that they’ve really done what they need to do for digital transformation and digital health. So there are a lot of health systems out there that are only starting this journey and really haven’t moved forward with it the way they should have.
Gamble: True. That’s why we appreciate you sharing your story. I think a lot of people are going to benefit from hearing about it. So thank you so much for your time, and I hope we can catch in the future.
Patel: Absolutely. This was fun.