May 5, 2023: CIO Daniel Nigrin shares some of the challenges, innovations, and experiences of MaineHealth. What are some of the challenges that Maine Health is facing financially, and how is it affecting patients? How is Maine Health utilizing telehealth to address its challenges? What are some priorities for 2023 and 2024 for Maine Health? How has Chime changed since it was founded, and what is its mission and vision now? In what ways has the VIVE conference evolved and improved since its first year, and what changes were made to enhance the attendee experience? What role does networking and idea-sharing play in Chime's mission, and how has this aspect of the organization evolved over time? How has the growth of healthcare and digitalization impacted the importance of Chime and its role within the industry?
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Today on This Week Health.
we're really at an interesting time within healthcare it, right? We joked about ChatGPT, but things are changing fast and there's gonna be new entrance into the market that we've gotta pay attention to and we need to learn about.
Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.
All right. Today we are joined by Daniel Nigrin, CIO at Maine Health in the state of Maine. Daniel. How are you, bill? Oh, I'm looking forward to the conversation. How how's the transition to Maine? You enjoying it up there?
Yeah, it's been fantastic. I hadn't moved up until this past summer.
I was still commuting from coastal New Hampshire, just over the mass, New Hampshire border, which was where I lived. I used to commute down into Boston which was never fun. So I reversed my commute and I came north instead, a much easier commute. Still about an hour or so. My youngest son finished up his high school years though this past this past year.
So the time was right. For me to move. So I've been here since the summertime. Oh, last summer. Last summer.
Were you coming up from Portsmouth? Is that where you're coming up from?
Just below Portsmouth. Yeah. Hampton, New Hampshire. Yeah.
There's we lived in my wife and I lived in New Hampshire for a year when we were first married and we used to drive down to Portsmouth.
You can get lobster right off. I literally right off the boats and take 'em home and have just wonderful main lobster there. I don't know if it's Maine or New Hampshire Lobster, but it was called Maine Lobster and it was just fantastic.
Yeah, there, there's no shortage of lobster around here and you know the best.
Pretty much the best lobster rolls you'll ever have.
Yeah, absolutely. All right. So, new health system, you were with Boston Children's before. Tell us a little bit about Maine Health.
So Maine Health is nonprofit integrated healthcare deliveries system here based in Portland, Maine.
It's the largest health system in northern New England. We're about 12 hospitals. All the way from big academic medical center in Portland all the way down to small 20 bed rural critical access hospital and everything in between basically. So in, in fact, this is one of the really nice aspects of the system that drew me to make the move.
From Boston Children's, I wanted to get more of that system level experience and see what the challenges were in managing the it, not just at the big sort of academic medical center but at some smaller places too. So it's been a great transition for me that way. We've got a, we've got a large behavioral health network home healthcare agency diagnostic services.
Pretty much everything you could imagine. About 1700 employed physicians in one medical group and about 23,000 people within the healthcare system.
Wow. And you're pretty much urban and very rural in, in some cases. Yeah.
Yeah. You look as much as you can call Portland, Maine Urban.
It's a great city, but it's not Boston, it's not New York obviously but yeah, from a setting like that, but all the way up to, rural Maine
Yeah, I mean, we'll get into some of those challenges. I'm curious what are some of your priorities as you're heading into 2023 and looking into 24 now?
Yeah. Bill we're no different than many of the other folks who I know are on your show. We're struggling from a financial perspective. We've not recovered from Covid and all of the subsequent things that have changed in our environment. So, from a financial point of view, this is in my 25 years of doing this role.
I don't remember it as. As tough as it is now we've certainly had periods where we needed to tighten the belt and so on, but it's bad now. I mean, so systems are all, all around the country and even in our neck of the woods are reducing services. They're not delivering babies they're not doing real things that, that means stuff to our patients.
Just to be able to survive and that, is a tough situation to be in.
How does that manifest itself to a patient? Does that just mean they're gonna have to drive further to deliver a baby or drive further for some care. I mean, if they're a chronic condition or, even oncology and whatnot, are they just gonna have to drive down to Boston or drive to Portsmouth or, what does it look like?
Yeah, I mean, in some situations that's the case. We're trying to avoid that as much as possible. And in fact, at Maine Health, we've been fortunate in that we've not had to go to that extent yet. But the discussions are happening, right? Do we need cardiovascular specialists in all of our locations or could they be centralized in one or the other place?
Things like that are definitely on the table at this point. We hope we don't need to get there.
It's interesting when we talk about telehealth, everyone just assumes we're talking patient to physician communication, but there's a whole section of telehealth that is clinician to clinician.
It's bringing expertise into the room and whatnot. We were a 16 hospital system. We were doing that in some of our. Remote areas. I'm curious how you guys are implementing that.
Yeah, no, we definitely are doing that. Even during a pandemic and pre pandemic, but even more so now for the reasons that we've just been saying it's critical and we're doing it in our critical care environments.
In some ways we're helping out in some of our emergency departments when we need some specialists to, to weigh in and be able to give their. Their sense of does this patient need to get referred to the A M C in Portland? Or can they be managed locally? So we're definitely doing that kind of thing, bill.
Yeah. Yeah. I, we did a telestroke across locations. We did telepsych as well. It was interesting cuz we used to have a psychiatrist in each one of our eds every night. And they were fairly underutilized. I mean, we're talking about Southern California. I mean, this is a fairly well populated area, but they were fairly underutilized and we went to a telepsych program and we were able to really consolidate that down to one or two.
People who worked in that capacity. As you're thinking about cost savings and whatnot, are there certain projects from an IT perspective that are bubbling to the top?
Yeah. It's interesting. It is one of these places where as all this belt tightening I refer to as happening in a paradoxical way, it is one of the places that's being looked to, to help solve a lot of the challenges that we're having, right?
And so, we probably are the place that need to get greater degrees of investment in so that we could in turn. More effectively make our existing staff more efficient and utilize their resources in a variety of different ways. So, that's, the story that I'm trying to tell locally is that, look,
don't be slashing my budget because I'm part of the solution to all of this. So whether it's, virtual nursing, being able to have a single nurse be able to monitor a large number of patients who need eyes on them at all times and doing that much more efficiently than having a person literally in the room or just outside the room.
That's a great example, right? Where we need the technology to enable us to survive with fewer clinical people or fewer team members in general. So, whether we'll be able to do that or not. I don't know. Thankfully, I the leadership in our organization is very much in sync with that.
I think they appreciate that. Although it's not, the Silver Bowl at tech isn't, the answer to everything, but in a lot of instances, I think that technology is part of the answer.
Daniel ChatGPT answers all things. Now. Just, you just go to it. As a cio, you type it in, Hey, we need to do this, and it'll give you the answer.
I'm sorry I half joke cuz we just finished the conferences. And everyone wants to talk about chat, g p t four or some aspect of applied ai. is there an area where you guys are trying to push the envelope with regard to technology or innovation?
Oh yeah. We're joking about it, but in fact we definitely are doing this.
So we are adopters of, ambient clinical documentation systems. We're using one from Nuance, but there's a few on the market. And in fact, you, we all heard that that Nuance and slash Microsoft are getting ready to roll out their G P T four backed dragon what is it called?
Dragon Express. Yeah. Yeah. So, this is a first use case and so, we're planning to be early adopters, hopefully in the summertime to start to kick the tires. I know there's a few organizations around the country who have been doing so already and. I think it's a great example.
Another one that we were starting to work on ourselves until we got wind of the fact that that Microsoft and Epic are working on it. Also is inbox management, right? The flood of patients getting to, trying to reach their providers to ask questions that way. And and whether or not some of the G P T based stuff could.
Help with that and offload some of the tasks or at least, make it a little bit more expeditious to do so. So we were starting to work on experiments to do just that. And it's reassuring to me that the big players are thinking along those lines too now. You gotta proofread that damn thing really well, I know, because we all know how well they can all hallucinate and before you know it, you've said something egregiously wrong.
So we're gonna need to make that point with our clinicians for all of these new technologies. But I absolutely think there's some there. I don't think this is this is just idle tech. People, doing stuff that's not gonna bear fruit. I think, yeah, we've gotta get the bugs out. We've gotta proceed cautiously, but there's definitely gonna be benefit to us.
Yeah it's interesting, I've seen people start to take the medical record and get a summary. So they're pumping in 30 pages of PDFs and it's pumping out a summary. And my first thought as a cio, I don't know if this is your first thought. You might think of it from a clinician lens, where I'm thinking about from an IT lens, I'm like, Did you just pump in 30 pages of p h i into a, a model that we don't have a, b a with?
Is that what just happened? Yes. That's my first
thought. Oh yeah. No, this is exactly the thing that I know our CISO and our privacy folks are just mortified about and what we've already started to message internally within our organization around the absolute. Need to to not put in any p i or p i or anything sensitive into these tools because, they're just, it's a straight pipeline into into Microsoft or Google or whomever
I, I do want to, I'm gonna come back and talk to you from a, I want to get clinician perspective, especially around technology adoption. But I also want to, I wanna visit the ViVE Conference. So you were pretty active at the VI conference. Are you the current board chair?
Yeah, I'm the current chime board chair this year.
It seemed like it like went on and on, like it was a five-year post at one point. I think that was covid related. Is it a two-year term? Is that what it is? Oh, so
you serve one year as the board chair and then you serve the following year as the foundation board chair.
You're right. There was a period in the midst of the pandemic where we didn't appoint new officers. To the leadership. We just continued an extra year. So I was on the board at that time, although I wasn't in the board chair or chair electoral, but still I served an extra year on the chime board for that reason.
I wanna talk to you about, first of all, serving in that capacity, and then I wanna talk to you about the Vibe Conference. So in, in terms of serving in that capacity, what are you seeing and how do they tap into your expertise? I mean, how are you contributing to the industry by serving on that board?
Yeah. Well first of all, as a board member or board chair for that matter, we're not involved in the day-to-day operations of Chime in any way. That's the role of the staff that be,
be because you have a job. Because
have jobs and that's not any board, right? It's how the, it's how boards are designed.
Fiduciary responsibility. It's strategic directions. And that's really where, I, we try and play the largest role is to think about, step back for a minute, like what's time's purpose? And I know for myself and my career, It was instrumental at really getting me up to speed quickly.
As a newcomer to to an administrative role and to the c i o role. I learned so much at Chime both from the educational opportunities that, that we make available, but also from the networking. In fact, I think that's, Time's strongest point actually is just serving as that convening function where I've got people all around the country who are doing the exact same thing that I'm doing and who I can bounce ideas off of, compare notes with commiserate oftentimes, and that was incredibly valuable to me back when I started.
And still to this day as. And so I think that's to me, one of the prime missions of China, that educational aspect. And that's what I want to ensure that we continue to keep our eye on. So clearly that's one of the board's responsibilities is to just make sure that we're adhering to those to the mission and the vision overall for what chimes all about.
How has it changed over the years from when you first got engaged to now as board chair?
Yeah. One of the things that I've heard a lot since I've been in, in the board role, but also that I can honestly say I've sensed myself, is as it's grown and it has grown quite a bit over the years, that it's lost a little bit of that intimacy that
ability to network and it's felt a little bit more impersonal. And I can say that I felt a little bit of that myself. At the same time, I think that when Chime, 20 years ago was there, I. Think about it in general, within healthcare, we did not have the importance that we've got now within our organizations.
There was not as much that was automated. If there was a downtime, it, yeah, it was inconvenient. But the hospital didn't stop running. Nowadays, if you get ransomware to whatever, that's like shut the doors of the hospital or the system. And so I think with that increase in importance, We've seen more people need to be involved in the field, and accordingly, that chimes place in that environment has increased as well.
Yeah, That's a great point. I was talking to John Glasser about this. C stands for college, so the education part of it is so important. But he was talking about when it first started, He's like, bill, like people didn't even know who we were in the organization. It was like we, oh yeah, there's a computer, we have a computer guy on staff, and it's like, and our departments were like one 10th of what they are today because we just didn't have, everything wasn't digitized, things weren't going that direction.
We weren't trying to engage the consumers through digital tools. And so yes, the whole enterprise of it within healthcare. It, I mean, healthcare has just grown so significantly, so naturally chime would grow as it evolves. Talk to me about the ViVE Conference. And the, I talked to Russ after the first one.
I did not get a chance to talk to him after this one because there was the shooting and a bunch of other things that happened in Tennessee. But after the first one, the first one was sort of the. Everyone was asking was it successful, and I think it was a successful experiment. The second one, it's like you saw all the things that were a little wonky in the first one, and it really adjusted.
So what was your, I mean, adjusted, I think for the positive. What was your, yeah, your take on vibe this year.
Yeah. So, my personal take was that I thought it was fantastic and it was a extremely successful endeavor for Chime for health. The co-founder of and By all accounts was a success.
I do appreciate you pointing out, bill, that we learned a lot after that first year about things that were not quite right. For one, we were trying to jam too much chime stuff in. The chime members who were trying to, get to all of the events and see all the things, just, we were sort of strung out from, the moment you woke up all the way till you went to sleep and there was just no time in between.
So we really scaled back the the times where there were conflicting things or where there were just too many activities going on. So that was felt to be a much better experience this year. We also in the first one we had the chime events in a physically separate part of the facility.
So you were schlepping back and forth and back and forth, and you just lost a lot of time just. Trying to figure out where to go next. So I'm not sure if you felt it or not, but everything this year was right on the floor including all the presentations at the the four corners. When Russ and the Chime team first let the board know that this was the plan, of having these open air.
Presentations, we were like, what? This is gonna be cacophony, you're not gonna be able to hear anything. And they reassured us. The health team reassured us, and sure enough, it worked beautifully. I don't know how they did it, but it was fantastic. And if the presentation wasn't quite what you expected it.
To be, it was very easy to just walk out, go to another presentation around the corner, or maybe just walk the show floor a little bit and see what some of the vendor offerings were like. So that felt really good.
Yeah, it's it. After the first one, I said to Russ that it felt like there was two conferences near each other and there was some synergies between the two conferences.
Yeah. And the second one did not feel like that at all. It felt like, Hey, you know what? The people I wanna see are, milling about right here. And I agree with you. I've been to every health conference and they. They originally did this concept of integrating the booths and all that other stuff with the presentations in the four corners, as well as some in the middle.
But they do a great job of it. It's just, it feels natural. It feels right to be there and I think the sponsors appreciate it as well, cuz. You're filtering in the same area, so they get to have more conversations.
Yeah. The other thing that I really enjoy about vibe both the first year as well as this year is I call it the equalizing function.
There's no mega boost. Yeah, there's some that are bigger than others for the larger firms but even some of the younger startup firms are right there. First of all, they're not segregated away somewhere else, a different floor or a different space. They're right there. And in many instances, they're right next to that more well-established vendor.
And I think that's important. And this for me is another important aspect of vibe generally, which is that we're really at an interesting time within healthcare it, right? We joked about ChatGPT, but things are changing fast and there's gonna be new entrance into the market that we've gotta pay attention to and we need to learn about.
And I think the ability to bring in some of these new corporate company entities that are gonna be sort of. Thinking about new ways of doing things and introducing new products. That's important for us to get exposure to as CIOs. And so I love the fact that it's not just the same old vendors all the time, or that you don't need to go to a special startup sector to go check 'em out.
They're right there for everyone to see.
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now, back to the show.
Yep. All right. Let's talk about technology adoption with. Clinicians and physicians specifically. It's interesting. So I became a CIO in healthcare in late 2011. So that's now 12 years ago. And I will say that when I came in, I was kind of surprised how leery the clinicians were of technology.
Now I've come to learn that a lot of that was cuz we didn't do necessarily a good job of bringing the technology into the organization. And. In some cases it was not customized, it was hard to use and whatnot. But I've did consulting for 20 years prior to that. It's the only industry I ever went into where people weren't excited when the new technology sort of came out.
What, how is that evolving? How is the perspective of a clinician evolving and how are we getting better at taking the, not only implementing the technology, but getting it used.
Yeah. Well, you've probably saw this as well, bill in your, years that you spent there, docs in general are not opposed to technology.
In fact, quite the opposite. I found that most physicians are actually. Excited by it. Just the same as, all other industries and most people they embrace it. But it's gotta be tailored to their workflows, it's gotta actually help them when it's got,
that's the key right there.
It's gotta actually help.
Yeah. It's not technology for technology's sake because that will annoy them. Right. And rightfully so. But if you can provide a tool, a technical offering that actually assists them, they will jump all over that. And thank you for it too. And so, I never lead any kind of discussion with with the clinician community.
We're talking about docs but honestly the same is for nurses, the same as for any clinician I talk about. What problem are we trying to address that I know that they have. And again, this is where my experience as a clinician that was practicing where I could relate, right? I felt the same things that my colleagues were feeling.
And so I could say, look, when I'm in clinic and I'm seeing a patient, I know that documenting on the computer is painful while you're in front of the patient. It distracts you from actually listening to them. And yet I also know that going home and writing notes for three hours at the end of the day that sucks too.
And so let me show you this incredible new tech. Call in clinical documentation, which is meant to address that. You've got their attention and hell if it works. After all that too, then you've made a friend for life. So I think, addressing these things from the clinical mindset and trying to explain to the clinician what problem you're solving and how you propose to do that with technology.
When you do it that way and when the technology actually, supports them in those workflows, I think you find that people are pretty quick to adopt it.
Let's talk about specific problem. Let's talk about pajama time. As you said, the three hours of documentation at night. I mean, do you guys have a metric that you're keeping an eye on right now in terms of documentation outside of clinical hours?
Yeah. Oh yeah. We measure pajama time. We've got our Epic system. Epic actually helps in their signal data do it for you. So yeah, absolutely. We're watching that.
I mean, is there a target, like we wanna reduce that by 10%, 40 per I'm sure the clinicians are like, reduce it by a hundred percent would be the best.
And then what are things you're doing to reduce that amount of time?
Well, in general, we want to like I said, deploy sufficient amounts of technology to assist them at the point of care. Right? In an ideal world, we're all looking for that G P T like experience, where somehow, magically by the end of the visit, it's just done.
And they can proofread it and they'll be all set.
We saw that from nuance, didn't we had Like a year and a half ago at HIMSS, they had like a demo where they were showing. Now this was the whole ambient thing, and I think people are more going to the phone and the mobile aspect, but they had the ambient room.
The clinician was talking and the note was just sort of a appearing right there. I mean, are we there yet? Or is that still sort of We're close.
We're close. And so the short answer is that right now there's still a human QA reviewer after the AI spits out what it thinks is the summary of the visit.
And the QA reviewer's got a recording of the encounter that they can listen to and they validate to make sure that the AI is documenting things appropriately and they tweak as necessary. So that does mean that there's a little bit of an interval of time between when the visit is done and when the provider sees the draft of the note that they can sign off on.
That said As the AI improves, as it learns, the provider's approach to the patient encounter it it gets better. And so we at Maine Health, we're not far enough along in our journey with this. Technology, but I've been told that some of the organizations that have been using it for a bit longer, when providers get up to, a thousand encounters where they've used the tech the AI is accurate enough that they feel comfortable in essentially delivering the AI result directly to the clinician to review.
And that is essentially immediate now with the G P T stuff that's been announced and and hopefully available later this year. That is the goal. So there's no more human intervention. It's just giving you the output immediately. And then you review it. If it's accurate, you sign it and you're done.
We're essentially replacing the scribes of old with technology. And you had mentioned another use case earlier on I think it was nurse sitter is, or nurse sitter, or was it, anyway, it was that whole concept of we don't have enough nurses to go around. How do we augment, talk a little bit about how we're addressing that specific problem of not enough nurses to go around right now.
Yeah, well, the one that I was referring to is not an AI backed solution at all. It's just literally a video in patient rooms and centralizing those feeds so that a single individual could monitor them. But hey, let's keep going with the ai con discussion. Why does it have to be a human in the room?
Looking at all of those video feeds. Can't technology start to analyze those video feeds and do some of this detection on its own and then alert a human, if it sees something apparent or of concern. And in fact you, we both know that there are companies that are starting to do some of this stuff.
I think it's still early days. They're far from perfect, but it's getting there. Yeah. And it's been there fast though.
Yeah, I, well, I think Stephanie, Laura wants to talk to everybody about that, but the. Here's the question, and I maybe this will be the closing question.
We're coming up on time here, and I know you've got a lot of stuff going on, but it feels to me like I'm using chat g p t for almost every day. I mean, I paid for the subscription. I'm using it every day, and I am thoroughly impressed. I mean, it's rare that I got, like the first time I delved into a technology that I couldn't identify, like the 10 things that were wrong with it.
Now I can see, we need to be, we need to put guardrails around it, need to make sure we're not putting in private information in healthcare or intellectual property. And that I, I see all those guardrails that need to be put around it. But generally as I'm using it, I'm, every time it spits out an answer, I look at it and I go, Man, that's so impressive.
Does it feel to you like we're on the cusp of a dramatic change in how technology gets applied in healthcare?
I. Yeah I absolutely think that Bill and not just in healthcare really scary. I can't remember where I heard it, but the analogy a person was making was essentially the internet and how that changed the world, basically.
And in a relatively short period of time, right. These kinds of new AI-based developments that we're seeing. Obviously they didn't happen overnight. This is a culmination of years worth of work, but it's reached a tipping point and that tipping point is gonna open floodgates, I think, and really revolutionize a lot of industries.
And and existing jobs is gonna create new jobs for sure. But I think we are at a very pivotal point in humankind in our existence.
John Glasser said, in his career there was four seminal moments. One was the introduction of the pc the second was the introduction of the internet.
The third was the introduction of the mobile phone. And he believes that the next one is the introduction of AI into into just all aspects of everything we do. Yeah. And when you think about those, I mean, the mobile phone changed everything. The PC changed everything. The internet changed everything.
And it really does feel like we're sitting here going. Oh my gosh. It's a fun time to be in your role.
I think. Yeah. I it's exciting to me. A little bit nerve-wracking, a little bit scary, but exciting. All the same.
Yeah. Because everyone's looking, they're looking at the CIO saying, Hey, what does all this mean?
Like, how are we gonna, and you gotta take 'em back to where we started, which is like, Okay. What problems are we trying to solve? Yeah. Like, and maybe the problems we can take 'em back and the problems the lens changes so dramatically that we say, Hey, you know what, we could never do that before, but we can now do something that sort of looks like that.
And it really changes things. Daniel, always great to catch up with you. I really appreciate your time and sharing your experience with the community.
Thanks so much, bill. It's always great chatting with you and look forward to doing it again soon. Sounds
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