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the description. We are excited to welcome you in October.
This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Daniel Nigra,
chief Information Officer at Maine Health. Dr. Nigra,
it's a pleasure to have you on the podcast today.
Thanks so much, Laura. Thank you for having me.
Now, I know we have a lot to talk about. There's so much happening in health IT,
and especially with technology advancing as quickly as it is right now.
But before we dive into my questions,
can you tell us a little bit more about yourself and your background?
Sure. Uh, I'm one of those unusual CIOs that also has a clinical background.
Uh, I am a pediatric endocrinologist by training and, uh,
practiced for a long time, almost 30 years or so. Um, so I, I like to,
I like to always mention that and lead with that actually,
because I'm a clinician first. Um, and it's only, uh,
only second that I, that I do this CIO thing. Um, I spent a long time,
um, in my career at Boston Children's Hospital,
where I was a CIO for about 20 years,
and I'm now in my third year up at Maine Health, which is, uh,
northern New England's largest, uh, health system, and, uh,
also serving as CIO there.
Got it. Wow, that's fascinating. You know, and indefinitely jumping from that,
uh, physician in clinical role into CIO is somewhat common today,
but I can imagine when you first did it 20 years ago, there weren't a ton of,
uh, physicians and clinicians becoming CIOs or, or am I wrong?
No, you're absolutely right. In fact, I remember early on in those, uh,
first years, uh, when I assumed the role,
I think I counted less than one handful of, uh, of at least, uh,
physicians that were also CIOs. Um, now you're right there,
there are definitely more, and obviously with the evolution of the CMIO role,
there's, uh, a lot more presence of, of clinicians in those roles as well.
But yeah, early on, uh, I, I did feel like a little bit of a,
of an unusual, uh, kind of, um, person in the role,
but it's been enormously helpful for me. In fact,
I always used to comment to my colleagues, like,
I didn't understand how they could do their job without having that clinical
background that I was lucky enough to bring, uh, bring to the role.
Absolutely. And, you know, having that, like you said,
clinical background and that, um,
experience working with patients and understanding how those interactions go,
I can imagine is invaluable when you're thinking through the technology strategy
and what's gonna really work for the care providers on the ground.
Absolutely, yeah. You know, I, I, I feel their pain often because I was,
uh, a user, um, as well as, uh, you know,
the person in charge of rolling these things out.
So I definitely could commiserate and, and understood when, uh,
when there were complaints about things. At the same time,
it was helpful in the exact opposite direction when there were complaints about
this or that. Um,
and I knew from working with the system myself in my clinical capacity that they
were complaining about a trivial little non-issue, um,
and so I would push back on them. So it was, it was helpful in both directions.
Absolutely. Well, considering where you're at right now at Maine Health,
what are some of the big opportunities you're looking at as well as the
headwinds you have your eye on?
Well, the headwinds are, are ones that unfortunately I think are very similar.
As you look across pretty much every health system around the country, um,
we're facing incredible, uh, difficulties in terms of finances these days. Um,
the pandemic did not help, uh, in terms of, uh,
of the labor situation. We've got labor shortages, um,
and obviously those in turn have led to enormous, um, uh, salary,
uh, increases, whether for existing staff or for, uh, traveling, uh,
kinds of roles to, to fill, you know, clinical positions that,
that we can't just, uh, find enough folks for. So, um,
those things, couple,
the labor shortages together with the resulting financial situation that, that,
that has put us all in, um, really are,
are forcing organizations to, to be pushed into, um,
situations that they've not been in for quite some time, if ever, frankly. Um,
and so that's obviously resulted in all kinds of constraints
around, um, you know, our ability to, to hire folks, uh, to, to have,
uh, the right numbers of people on our teams. Um,
and this is all in the face of an environment where the pace of
change, uh, continues to, uh, increase enormously.
So especially within it,
we're being asked to do more and more and to solve for so much, uh,
more and yet to do so with a pretty constrained, um,
set of resources to, to do all of those things. So I think those are,
those are the, you know, the, the, the headwinds and, and the challenges that,
that we, and I know many other places are facing. Um,
but in terms of the opportunities, I,
I'll actually cite all of those things as potential opportunities for us. Again,
especially within it,
I think it has the ability to address many of those things with respect to,
for example, the, the labor shortages. Um,
there's been all kinds of creative ways that organizations have,
have used technology to, um, to at least, you know, make their,
their existing clinical teams more effective, um, to be able to do more,
um, with the assistance of technology or in some instances, to substitute for,
uh, for the lack of, of talented, you know, care team members who,
who can do the jobs. So I do think it has an ability to,
to help in that regard. And also with respect to, um,
other things just in terms of rethinking overall workflows. Um,
we've always done things in medicine in a certain way in healthcare,
but that's not always the best way. Uh,
and especially these days where technology can help with, um, re-imagining,
uh, workflows and, and doing things differently, um,
and in many ways more efficiently. Uh,
I think there's a lot of opportunity there.
So those are the kinds of things that we're focused on, and, um,
the ways in which we're trying to address those,
those headwinds that we mentioned.
That makes a lot of sense. And a, as you mentioned,
so many of those challenges are, um, felt across the country.
I can imagine many people listening at home, nodding their head,
and then thinking through some of their more recent, uh,
conversations with their executive teams. So when you look at,
as you were talking through those challenges, then the technologies that,
you know, can help support, um, bridging the gaps that you're seeing and really,
um, keep the organization running well despite these challenges, you know,
what does that look like?
Can you pull out one or two examples of ways that you're able to, uh,
support the overall health system and growth and add value, um,
to either the clinician or the patient experience?
Sure. I mean, the obvious one that we saw with the pandemic is the,
is the presence and, and the, um, development of virtual care, right?
So this was obviously technology that we had already, and yet it exploded,
uh, with the start of the pandemic and has continued. And I think, um,
what's interesting is to see that, um,
this is now no longer felt to be some, you know, um, um,
esoteric kind of thing. And in fact,
many organizations are using this in creative ways to solve some of those
challenges that I mentioned before.
So we're starting to hear a lot more about virtual nursing scenarios,
remote ICU kinds of care and monitoring. Obviously,
care at Home has taken a strong foothold,
remote patient monitoring all of these things that, again,
we're not new with the pandemic,
but the pandemic certainly helped China spotlight on those and make
organizations realize that they were viable adjuncts to the way that we had been
delivering care up until now. And, um, and again, with the financial pressures,
um, more and more organizations are realizing that these,
these have to be the ways that we augment the,
the ways in which we're caring for our patients, um,
simply from a fiscal perspective. So that's one great example of, uh,
of technology that we think is, uh,
incredibly valuable to our organization. And I'm sure to many others around the,
around the country. Um, you know, there's, uh,
there's other automation that we could talk about, uh,
robotic process automation, rpa, and, um, you know,
that's one approach to, um, automating some of the more administrative tasks,
uh, that we often find our care team members having to, uh, manage, um,
especially in, in some of the administrative areas, uh,
but also within clinical care, we can envision, um, using some automation,
automation to, uh, allow our,
our team to do essentially more with less with the assistance of technology.
And of course, you know, with all of the rage that, um,
the last few months have brought around, uh,
large language models and chat G P T and things like that,
those are absolutely going to, um, figure more and more, um,
prominently within our systems, I think as the technology matures.
That's such a great point. And definitely, you know,
looking at automation seems like the name of the game as much as possible,
and then bringing in,
whether it's artificial intelligence technologies or anything else that'll be
able to connect, um,
patients in multiple ways with their care providers in the organization overall,
um, will just, you know, be so beneficial. Um, when you look at, uh,
some of those opportunities, whether it's artificial intelligence or automation,
bringing that into the healthcare organization,
what are those conversations like either, um, with the executive team or,
or with the, um, you know, departments and clinicians, um,
and workers on the ground? What are they feeling about all of this?
Is their excitement, is their nervousness?
Yeah, I, I think I'm, maybe I'm, um, uh, blessed in this regard, but I,
I will say that there's an absolute excitement level and a,
and almost a, a, um,
expectation that we start doing this stuff now.
And I'm not sure whether that's just because, uh,
it's been so prominent in the media. Uh, you know,
obviously folks are able to go out and try some of these things on their own
now, and in many instances it's a pretty jaw,
jaw-dropping experience when you do try it. And so I think that's, um,
helped a lot of people sort of come to grips with the fact that, hey, this,
this new technology is, is here and,
and we've gotta start to capitalize on it. So I do think that, uh, that we're,
we're an organization that very much wants to adopt and is planning to adopt a
lot of this tech.
Now we have to do so in a pretty responsible way. We can't do,
you know,
just the throw chat g p t everywhere and think it's gonna solve all of our
problems. Uh,
I do think the path to success with some of these new tools is gonna be not a
straight line, but, uh,
a one that's pretty crooked and takes all sorts of twists and turns. And,
and so I'm quite confident,
confident that we'll have some missteps along the way. Um,
and we absolutely need to go in with eyes open, but at the same time,
I'm absolutely also convinced that,
that these technologies are gonna be absolutely critical within the provision of
care moving forward. Um,
and I'm sure in many ways that we can't even envision yet. Um, right now,
obviously, it's, uh, it's helping in, in things like, uh,
clinical documentation, um, you know, some of the ambient, uh, uh,
documentation systems that are out there, um, you know, patient facing,
uh, tools, whether it's symptom checkers, um, you know,
allowing patients to do a little bit of investigation on their own,
whether it's, um, doing some automation with regard to clinical, um,
clinician patient interactions, um, you know,
looking at the burden of all of the, um,
secure messages that are going back and forth now between patients and providers
and the burden that that's placing on them. So I, I think there's a lot of, uh,
opportunity for some of these systems to, to start to play a role and,
and, uh, I'm very excited by it.
I love that. I, I think that is great to hear and definitely something that,
you know, will make it so much easier as the technologies evolve and really, um,
put them into a place where they can be working for you and for the betterment
of the overall system. Now, as you mentioned earlier, I know that, um,
right now we're in a financially challenging time and having a hard time finding
staff there. Some organizations might be going through burnout.
So when you look at, um, just the idea of, you know,
continued growth as much as possible,
what is one risk or investment that's still worth making, even though, you know,
you have limited resources in every dollar is precious.
I, I do think the one that, that we were just talking about, the, you know,
these large language models and the, uh,
sort of artificial intelligence based tools, I, I think that's the one that if,
if I were a betting man that I would bet on, um, as I said, there's,
there's gonna be problems. It's not gonna be perfectly smooth sailing,
but I cannot, I cannot see a future in which some of this, um,
um, knowledge and, um,
and technology is not used in a healthcare setting and it,
to begin with, it may be on some more mundane things, you know, some,
like I said, administrative tasks or nonclinical, um, use cases.
But I think that that's only the beginning.
I do think ultimately it's gonna start to, to, uh, have a role in, uh,
assisting clinicians in their, in their care for patients.
And so I think that that's the bet that I'd place, uh, um,
a wager on, and that I think health systems should, uh,
similarly start to really take a focused look at. Um, I know that we are.
Great to hear, um, in, in just really fantastic insight. Now,
I wanted to look just a little bit further into the future as well. Um,
where do you see as,
as being some of the best opportunities over the next two to three years for
growth yourself as a cio as well as the technology teams that you're working
with?
Um, you know, this, the, the, the landscape that, that we're talking about here.
It's, it's so, um, it's so exciting to me. Uh, again,
I've been in this role now for about 25 years, all in all,
and I can't tell you a time where there's been more excitement in the air
about, um, the role that, that technology and,
and IT in general can play within healthcare and in fact needs to play
because of all of those issues that we talked about before.
I think there's an expectation that that, you know,
technology is going to help to, um, you know,
allow organizations to survive, to be able to function with, uh,
with fewer resources and to become more efficient. So, you know,
whether or not it's,
it's that it is going to help with growth or rather that it is just gonna
help us stay afloat, frankly. Um, either way,
I'm absolutely convinced that, uh,
this is a fantastic time to be within healthcare it. And, um,
as I said,
I'm incredibly excited to see how the next several years unfold because I
think we're at a, a key juncture in the use of,
of technology within medicine.
Dr. Niagaran, I really appreciate it.
It's been so fun to speak with you and definitely we're looking forward to
having you at our Health IT Digital Health and Revenue Cycle event in October.
I know a lot of these discussions will continue on and with the technology,
whether it's chat GTP or others evolving so quickly,
it'll just be fascinating to have, um,
those real-time discussions and see what everybody's doing.
Absolutely. Laura, I'm looking forward to it.
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