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Would you like to exchange best
practices and ideas to improve care,

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enhance operational efficiency,

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and address financial
challenges with your peers?

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Becker's Healthcare is facilitating these
conversations at their eighth annual

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health IT digital health and RCM meeting.

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You can check your eligibility for
complimentary attendance at the Lincoln,

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the description. We are excited
to welcome you in October.

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This is Laura Dedo with the
Becker's Healthcare Podcast.

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I'm thrilled today to be
joined by Dr. Daniel Nigra,

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chief Information Officer
at Maine Health. Dr. Nigra,

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it's a pleasure to have
you on the podcast today.

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Thanks so much, Laura.
Thank you for having me.

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Now, I know we have a lot to talk about.
There's so much happening in health IT,

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and especially with technology
advancing as quickly as it is right now.

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But before we dive into my questions,

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can you tell us a little bit more
about yourself and your background?

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Sure. Uh, I'm one of those unusual CIOs
that also has a clinical background.

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Uh, I am a pediatric
endocrinologist by training and, uh,

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practiced for a long time, almost
30 years or so. Um, so I, I like to,

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I like to always mention that
and lead with that actually,

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because I'm a clinician
first. Um, and it's only, uh,

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only second that I, that I do this
CIO thing. Um, I spent a long time,

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um, in my career at Boston
Children's Hospital,

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where I was a CIO for about 20 years,

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and I'm now in my third year up
at Maine Health, which is, uh,

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northern New England's largest,
uh, health system, and, uh,

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also serving as CIO there.

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Got it. Wow, that's fascinating. You
know, and indefinitely jumping from that,

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uh, physician in clinical role
into CIO is somewhat common today,

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but I can imagine when you first did it
20 years ago, there weren't a ton of,

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uh, physicians and clinicians
becoming CIOs or, or am I wrong?

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No, you're absolutely right. In fact,
I remember early on in those, uh,

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first years, uh, when I assumed the role,

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I think I counted less than one
handful of, uh, of at least, uh,

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physicians that were also CIOs.
Um, now you're right there,

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there are definitely more, and obviously
with the evolution of the CMIO role,

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there's, uh, a lot more presence of,
of clinicians in those roles as well.

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But yeah, early on, uh, I, I
did feel like a little bit of a,

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of an unusual, uh, kind
of, um, person in the role,

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but it's been enormously
helpful for me. In fact,

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I always used to comment
to my colleagues, like,

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I didn't understand how they could do
their job without having that clinical

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background that I was lucky enough
to bring, uh, bring to the role.

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Absolutely. And, you know,
having that, like you said,

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clinical background and that, um,

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experience working with patients and
understanding how those interactions go,

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I can imagine is invaluable when you're
thinking through the technology strategy

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and what's gonna really work for
the care providers on the ground.

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Absolutely, yeah. You know, I, I, I
feel their pain often because I was,

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uh, a user, um, as well as, uh, you know,

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the person in charge of
rolling these things out.

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So I definitely could commiserate
and, and understood when, uh,

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when there were complaints
about things. At the same time,

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it was helpful in the exact opposite
direction when there were complaints about

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this or that. Um,

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and I knew from working with the system
myself in my clinical capacity that they

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were complaining about a
trivial little non-issue, um,

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and so I would push back on them. So it
was, it was helpful in both directions.

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Absolutely. Well, considering where
you're at right now at Maine Health,

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what are some of the big opportunities
you're looking at as well as the

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headwinds you have your eye on?

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Well, the headwinds are, are ones that
unfortunately I think are very similar.

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As you look across pretty much every
health system around the country, um,

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we're facing incredible, uh, difficulties
in terms of finances these days. Um,

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the pandemic did not
help, uh, in terms of, uh,

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of the labor situation. We've
got labor shortages, um,

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and obviously those in turn have
led to enormous, um, uh, salary,

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uh, increases, whether for existing
staff or for, uh, traveling, uh,

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kinds of roles to, to fill, you
know, clinical positions that,

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that we can't just, uh, find
enough folks for. So, um,

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those things, couple,

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the labor shortages together with the
resulting financial situation that, that,

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that has put us all in, um, really are,

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are forcing organizations
to, to be pushed into, um,

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situations that they've not been in for
quite some time, if ever, frankly. Um,

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and so that's obviously resulted
in all kinds of constraints

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around, um, you know, our ability
to, to hire folks, uh, to, to have,

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uh, the right numbers of
people on our teams. Um,

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and this is all in the face of
an environment where the pace of

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change, uh, continues to,
uh, increase enormously.

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So especially within it,

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we're being asked to do more and
more and to solve for so much, uh,

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more and yet to do so with
a pretty constrained, um,

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set of resources to, to do all of
those things. So I think those are,

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those are the, you know, the, the, the
headwinds and, and the challenges that,

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that we, and I know many
other places are facing. Um,

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but in terms of the opportunities, I,

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I'll actually cite all of those things
as potential opportunities for us. Again,

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especially within it,

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I think it has the ability to address
many of those things with respect to,

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for example, the, the labor shortages. Um,

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there's been all kinds of creative
ways that organizations have,

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have used technology to, um, to
at least, you know, make their,

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their existing clinical teams more
effective, um, to be able to do more,

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um, with the assistance of technology
or in some instances, to substitute for,

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uh, for the lack of, of talented,
you know, care team members who,

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who can do the jobs. So I do
think it has an ability to,

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to help in that regard. And
also with respect to, um,

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other things just in terms of
rethinking overall workflows. Um,

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we've always done things in medicine
in a certain way in healthcare,

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but that's not always the best way. Uh,

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and especially these days where technology
can help with, um, re-imagining,

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uh, workflows and, and doing
things differently, um,

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and in many ways more efficiently. Uh,

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I think there's a lot
of opportunity there.

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So those are the kinds of things
that we're focused on, and, um,

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the ways in which we're
trying to address those,

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those headwinds that we mentioned.

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That makes a lot of sense.
And a, as you mentioned,

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so many of those challenges are,
um, felt across the country.

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I can imagine many people listening
at home, nodding their head,

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and then thinking through
some of their more recent, uh,

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conversations with their executive
teams. So when you look at,

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as you were talking through those
challenges, then the technologies that,

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you know, can help support, um, bridging
the gaps that you're seeing and really,

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um, keep the organization running well
despite these challenges, you know,

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what does that look like?

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Can you pull out one or two examples
of ways that you're able to, uh,

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support the overall health system
and growth and add value, um,

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to either the clinician
or the patient experience?

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Sure. I mean, the obvious one that
we saw with the pandemic is the,

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is the presence and, and the, um,
development of virtual care, right?

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So this was obviously technology that
we had already, and yet it exploded,

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uh, with the start of the pandemic
and has continued. And I think, um,

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what's interesting is to see that, um,

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this is now no longer felt
to be some, you know, um, um,

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esoteric kind of thing. And in fact,

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many organizations are using this in
creative ways to solve some of those

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challenges that I mentioned before.

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So we're starting to hear a lot more
about virtual nursing scenarios,

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remote ICU kinds of care
and monitoring. Obviously,

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care at Home has taken a strong foothold,

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remote patient monitoring all
of these things that, again,

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we're not new with the pandemic,

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but the pandemic certainly helped
China spotlight on those and make

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organizations realize that
they were viable adjuncts
to the way that we had been

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delivering care up until now. And, um,
and again, with the financial pressures,

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um, more and more organizations
are realizing that these,

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these have to be the
ways that we augment the,

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the ways in which we're
caring for our patients, um,

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simply from a fiscal perspective.
So that's one great example of, uh,

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of technology that we think is, uh,

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incredibly valuable to our organization.
And I'm sure to many others around the,

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around the country. Um,
you know, there's, uh,

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there's other automation
that we could talk about, uh,

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robotic process automation,
rpa, and, um, you know,

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that's one approach to, um, automating
some of the more administrative tasks,

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uh, that we often find our care team
members having to, uh, manage, um,

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especially in, in some of
the administrative areas, uh,

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but also within clinical care, we can
envision, um, using some automation,

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automation to, uh, allow our,

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our team to do essentially more with
less with the assistance of technology.

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And of course, you know, with
all of the rage that, um,

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the last few months
have brought around, uh,

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large language models and chat
G P T and things like that,

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those are absolutely going to,
um, figure more and more, um,

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prominently within our systems, I
think as the technology matures.

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That's such a great point.
And definitely, you know,

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looking at automation seems like the
name of the game as much as possible,

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and then bringing in,

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whether it's artificial intelligence
technologies or anything else that'll be

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able to connect, um,

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patients in multiple ways with their care
providers in the organization overall,

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um, will just, you know, be so
beneficial. Um, when you look at, uh,

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some of those opportunities, whether it's
artificial intelligence or automation,

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bringing that into the
healthcare organization,

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what are those conversations like
either, um, with the executive team or,

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or with the, um, you know,
departments and clinicians, um,

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and workers on the ground? What
are they feeling about all of this?

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Is their excitement, is their nervousness?

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Yeah, I, I think I'm, maybe I'm, um,
uh, blessed in this regard, but I,

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I will say that there's an
absolute excitement level and a,

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and almost a, a, um,

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expectation that we start
doing this stuff now.

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And I'm not sure whether
that's just because, uh,

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it's been so prominent in
the media. Uh, you know,

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obviously folks are able to go out and
try some of these things on their own

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now, and in many instances
it's a pretty jaw,

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jaw-dropping experience when you do
try it. And so I think that's, um,

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helped a lot of people sort of come to
grips with the fact that, hey, this,

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this new technology is, is here and,

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and we've gotta start to capitalize on
it. So I do think that, uh, that we're,

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we're an organization that very much
wants to adopt and is planning to adopt a

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lot of this tech.

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Now we have to do so in a pretty
responsible way. We can't do,

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you know,

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just the throw chat g p t everywhere
and think it's gonna solve all of our

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problems. Uh,

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I do think the path to success with some
of these new tools is gonna be not a

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straight line, but, uh,

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a one that's pretty crooked and takes
all sorts of twists and turns. And,

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and so I'm quite confident,

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confident that we'll have some
missteps along the way. Um,

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and we absolutely need to go in with
eyes open, but at the same time,

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I'm absolutely also convinced that,

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that these technologies are
gonna be absolutely critical
within the provision of

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care moving forward. Um,

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and I'm sure in many ways that we
can't even envision yet. Um, right now,

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obviously, it's, uh, it's
helping in, in things like, uh,

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clinical documentation, um, you
know, some of the ambient, uh, uh,

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documentation systems that are out
there, um, you know, patient facing,

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uh, tools, whether it's
symptom checkers, um, you know,

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allowing patients to do a little
bit of investigation on their own,

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whether it's, um, doing some
automation with regard to clinical, um,

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clinician patient
interactions, um, you know,

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looking at the burden of all of the, um,

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secure messages that are going back and
forth now between patients and providers

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and the burden that that's placing on
them. So I, I think there's a lot of, uh,

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opportunity for some of these systems
to, to start to play a role and,

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and, uh, I'm very excited by it.

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I love that. I, I think that is great
to hear and definitely something that,

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you know, will make it so much easier as
the technologies evolve and really, um,

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put them into a place where they can be
working for you and for the betterment

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of the overall system. Now, as you
mentioned earlier, I know that, um,

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right now we're in a
financially challenging time
and having a hard time finding

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staff there. Some organizations
might be going through burnout.

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So when you look at, um,
just the idea of, you know,

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continued growth as much as possible,

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what is one risk or investment that's
still worth making, even though, you know,

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you have limited resources
in every dollar is precious.

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I, I do think the one that, that we
were just talking about, the, you know,

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these large language models and the, uh,

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sort of artificial intelligence based
tools, I, I think that's the one that if,

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if I were a betting man that I would
bet on, um, as I said, there's,

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there's gonna be problems. It's not
gonna be perfectly smooth sailing,

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but I cannot, I cannot see a
future in which some of this, um,

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um, knowledge and, um,

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and technology is not used in
a healthcare setting and it,

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to begin with, it may be on some
more mundane things, you know, some,

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like I said, administrative tasks
or nonclinical, um, use cases.

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But I think that that's
only the beginning.

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I do think ultimately it's gonna
start to, to, uh, have a role in, uh,

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assisting clinicians in their,
in their care for patients.

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And so I think that that's the
bet that I'd place, uh, um,

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a wager on, and that I think
health systems should, uh,

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similarly start to really take a
focused look at. Um, I know that we are.

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Great to hear, um, in, in just
really fantastic insight. Now,

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I wanted to look just a little bit
further into the future as well. Um,

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where do you see as,

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as being some of the best opportunities
over the next two to three years for

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growth yourself as a cio as well as the
technology teams that you're working

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with?

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Um, you know, this, the,
the, the landscape that, that
we're talking about here.

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It's, it's so, um, it's so
exciting to me. Uh, again,

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I've been in this role now for
about 25 years, all in all,

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and I can't tell you a time where
there's been more excitement in the air

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about, um, the role that,
that technology and,

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and IT in general can play within
healthcare and in fact needs to play

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because of all of those issues
that we talked about before.

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I think there's an expectation
that that, you know,

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technology is going to
help to, um, you know,

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allow organizations to survive,
to be able to function with, uh,

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with fewer resources and to become
more efficient. So, you know,

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whether or not it's,

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it's that it is going to help with
growth or rather that it is just gonna

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help us stay afloat,
frankly. Um, either way,

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I'm absolutely convinced that, uh,

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this is a fantastic time to be
within healthcare it. And, um,

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as I said,

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I'm incredibly excited to see how the
next several years unfold because I

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think we're at a, a key
juncture in the use of,

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of technology within medicine.

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Dr. Niagaran, I really appreciate it.

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It's been so fun to speak with you and
definitely we're looking forward to

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having you at our Health IT Digital
Health and Revenue Cycle event in October.

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I know a lot of these discussions will
continue on and with the technology,

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whether it's chat GTP or
others evolving so quickly,

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it'll just be fascinating to have, um,

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those real-time discussions
and see what everybody's doing.

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Absolutely. Laura, I'm
looking forward to it.

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It's so important for leaders at the
top of organizations to keep learning,

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00:16:24,450 --> 00:16:26,140
stay sharp, grow their networks,

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00:16:26,530 --> 00:16:29,620
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00:16:29,720 --> 00:16:33,660
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00:16:40,010 --> 00:16:44,700
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