"One of our goals with digital programs is to eliminate systemic racism in healthcare"

Q. Adam, tell us a little about the populations you serve at Mass General Brigham.

Adam: First, I want to address our name. You may know us as Partners Health care but now, we are Mass General Brigham. This new name more closely reflects the world-renowned hospitals that make up our system—Mass General Hospital and Brigham and Women’s Hospital—which are really the foundation and heart of our healthcare system. At a high level, the Mass General Brigham vision is to build the integrated academic health care system of the future in which we have patients at the center transforming care, improving outcomes, and expanding our impact locally, nationally, and globally.

Currently, we see about 1.8 million patients per year. We have 80,000 employees. Our inpatient capacity is >3200 inpatient beds. What is also unique about our system is our research enterprise. We really focus on performing breakthrough innovations and translating those innovations to the world. We have about $2 billion in sponsored research, which includes over 2700 clinical trials across our five academic medical centers—MGB Rigor, McLean Psychiatric Hospital, Mass Pioneer and Spaulding Rehabilitation. All of them encompass our academic mission and focus.

Q. What are some of the top priorities and digital aspects that you’re currently working on as CIO?

Adam: I speak today on behalf of an incredible team of colleagues that really enables us to do what we’re doing not just in digital, but also in health care delivery, overall. I want to acknowledge that we’re led by a new Chief Information and Digital Officer, Jane Moran, my new boss who’s really helped us with our strategic planning and prioritization, some of which I’ll share with you now.

Our priorities now center around experiences of our user groups. While this is something we have not thought about this way, traditionally, and it is a little new for us, I really think it’s the right strategy going forward. The four groups that we’re prioritizing are patients, providers, researchers, and employees. We’re putting together a strategy for each of these groups that focuses on meeting their needs regarding digital technology. I’ll just share two examples of that.

First, for our researchers, like other academic medical centers, we are focused on increasingly enhancing their access to the wealth of clinical data that we have and using modern cloud technologies and platforms so that they can use that data for approved research projects.

For our providers or our care teams, we have a lot of work going on to improve their experiences. One of our key projects is working on the in-basket experiences for our providers and patients. One of the best things about COVID was that we, like other health care organizations, saw a tremendous increase in the use of our patient portal. In fact, during the last two years, we’ve seen a doubling of the number of patients signed up for our portal and more of them actually engage with it. We absolutely want to encourage that, but we recognize that the system, the actual technology, and our workflows were not necessarily designed for the increase in message volume that we’re seeing.

I am working with colleagues across the organization on approaches to improve the in-basket experiences. What’s nice about our chosen approach is that we recognize that we really need a multidisciplinary team—technology experts, members from our digital teams, and colleagues that can focus on policy as well as workflow and care redesign. We’ve brought these worker groups from across these areas to collaborate on how we can change levers and improve the in-basket experience.

At a high level, some of the things we’ve done is worked on removing non-value adds in basket messages. So, we’re turning off all duplicate notifications or acceptance notifications that aren’t needed. We’ve also worked on the policy side to set expectations for how our portal should be used with specific emphasis on results, review, and response by the clinical care teams. Gradually we’re working on making changes which we hope will improve the care team experience.

Q. Can you share one or two top priorities regarding improving the patient experience?

Adam: I want to emphasize that while I gave the example of providers, we are focused on enhancing the experience for the entire care team. Even on the in-basket side, while there is a focus on providers, we’re also thinking about how to improve the front desk workflows and make that as efficient as possible.

With regard to the patient experience, I think of one example which will be similar to many organizations that are working on this—the digital front door. How do we make it easier for patients to interact with us and get access to our services electronically? That’s one of our major priorities and one of my colleagues is leading our efforts in that space.

Q. What are you hearing from your patients when it comes to the kind of digital experiences that they’re looking for?

Adam: Many of our patients have a lot of expectations from us. I can share a couple of the key things they want. First, a fast and convenient experience. They don’t want to have to call us, wait on hold for long periods of time, and then, be transferred to multiple different people to accomplish what they want. They want to be able to interact with us quickly and easily. So, that includes being able to schedule appointments quickly, check their test results, correspond with their care teams, and do virtual visits. Those are all components of functions that we are trying to make as easy as possible as part of our digital front door work.

Second, our patients are appropriately concerned about security and privacy. So, I think it’s essential that for everything we do with our patients, particularly from a technology perspective, we must ensure that it is as secure as possible and that everything possible be done to protect their privacy.

Third, equity. This is something that our system has made a very significant commitment to. We’ve launched a United Against Racism campaign, which really acknowledges and calls out that our system believes that racism is a public health issue. It impacts our patients, our workforce, and the communities we serve. We are acting as a system to dismantle systemic racism, and this has important implications in our digital work.

Just to give you a couple of examples, when we’re talking about digital technologies, particularly for patients, we want to make sure that all patients have access to these services, especially these new digital tools. We’re increasing access to interpreter services through the virtual interpreter services. If patients doing virtual visits don’t speak English, we bring interpreters into that encounter to help with patient communication.

Another example concerns our team of digital access coordinators. These are additional resources to help our patients enroll in our patient portal. They speak multiple languages, take time out to answer patients’ questions and help them not just with enrollment but also how to use the portal’s services. That’s how we’re addressing equity in our patient experience.

Q. How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?

Adam: I’d say that I personally learned a lot about this during COVID because we recognized then that we needed technology to help us solve problems and design solutions around how we could make testing available to all our patients? How could we extend vaccination to them?

We also recognized if we used very sophisticated technologies, that could prevent some of our patients from accessing those services. As we think about our approaches, we bring in our experts from different backgrounds, so our team represents diversity, equity, and inclusion. Those team members are part of our solution and ensure that we consider all our patients’ needs. As we design solutions, the attempt is to enable as many patients as possible to take advantage of those services. For instance, we used quite a bit of text messaging. We found many of our patients, even our most vulnerable patients, had access to and in fact, liked interacting with us over text messaging. So, we use a lot of text messaging and web based tools. We have found them to be very, very successful.

We also found that we had a rather sizable population that didn’t have cell phones and that we only had landline phones for them. So, we used IVR tools with some additional AI capability to enable those patients to interact with an agent and even schedule appointments for vaccination directly over a landline phone.

We’ve baked into our solution process the need to ensure that our base technology solutions reach as many patients as possible. Where there are gaps, we address those with other solutions—sometimes, technology-based, and other times, just additional outreach and greater focus in those areas.

Q. What kind of technology, foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?

Adam: We absolutely think in terms of platforms, and this is something that Jane Moran has helped shape. In an ideal world, we want to leverage our existing platforms as much as possible to meet needs. But we also recognize there are limitations to those platforms which is why we need to consider other solutions.

As we think about patient experience, of course, our electronic health record forms the core there. We absolutely leverage our electronic health record. However, there are limitations to what that platform can do. So, we are also investing in a customer relationship management platform to help supplement our electronic health record.

We’ve also invested in additional tools—chat bots that sit on top of our electronic health record and have added some of these capabilities to help improve interactions with patients. We are in the early stages of using some of these technologies, particularly the chat bots, and so we’re really learning how well they work, for which use cases, and for which patients. We will continue to iterate and improve on those as we go.

Q. You started with the EHR and that’s what other health systems do as well, but they can’t do everything. Do you have a strategy that involves other best in class players, standalone point solutions, enterprise class platforms, or will you build some things yourself? How do you approach these choices?

Adam: Here’s how we are starting to think about this. We’re formalizing a process which we’re calling an Enterprise Architecture Review that we’ll go through when there is a new technology need to really consider and determine which solution, we’ll use to solve that need. First, we’re going to look at our existing enterprise platforms which may include our electronic health record. We’re building out a CRM system as well so that would be considered, too. Our HR and Finance systems are also platforms we’re looking to first, to solve requests that are coming in.

Then, if those major platforms don’t solve the issue, we might look to an existing product that might be in use across our enterprise because if we’re already using it, maybe we can extend that. If it’s already being used for this specific use case in another part of our organization so, we could look to sort of leverage that tool further.

If there really is not a tool that we have or an existing platform that would work, that’s when we’d look to another solution in the market. Ideally, there’s a solution out there that we could just purchase and use.

In some cases, we don’t find a solution that we can purchase and use. That’s where we’d love to find partners who want to co-develop and work with us to shape their tool to meet our needs. If it meets our needs, it probably meets needs from other healthcare systems out there.

Finally, if we cannot find a partner and if there’s nothing out there on the market, that’s when we would consider actually building the software ourselves. We do that from time to time, but we really want to have a rational approach to when we’re using those specialized resources.

I will put a plug in here. We did just write a paper on this, and I can share it with you. But for our listeners, we recently published a paper with a colleague, Jayson Marwaha, who was our first author on this paper. This was published in Nature Digital Medicine, and it really describes how we look at bringing new digital innovations into our organization. It summarizes what I was just talking about, more articulately—our process to look at innovations, where, which platform we’re going to use, and which technology leads.

Q. Adam, there is a lot of digital health innovation out there and billions in venture capital money. It can be quite confusing and can be quite risky to place your bets on one or more of these solutions. How do you go about at a very high level? How do you make sure all of these solutions work well together?

Adam: I feel fortunate that I have the opportunity to do some of this digital innovation. For many years, I oversaw the Brigham Digital Innovation Hub. Now, I oversee a small team across the enterprise. Our Digital Health Innovation team has been making some investments in collaborating with early-stage startups to improve health care delivery.

Perhaps the most important first step is identifying the problems that you want to solve and ensuring that there’s not already a robust solution to it. If there is a robust solution, that will meet the needs, you want to try to make sure you’ve looked at that solution first. Working with an early-stage startup can be really rewarding but has a lot of risks to it as well. So, before you’re looking at the new startups, check for established solutions that may exist.

There are so many new, exciting challenges in healthcare for which we don’t have solutions. There are exciting newer technologies that maybe doing things faster, better, and cheaper that we absolutely want to pay attention to in this space. But to your point, we want to have a rubric and a new way of approaching it.

So, while this may sound like an antithesis for people who like to innovate, we are actually going to add, as some of our strategic work in this space, more process to how we look at our investments in early-stage innovation. That’s because we want to be really systematic about it and increase our chances of success especially as we work with emerging technologies. We are going to try to proactively identify where the problems that we want to try to solve, are.

Second, the next step is to not be as opportunistic but have a process we go through to really look at the landscape of startups, critically, and evaluate them. In essence, what many of us are used to —doing RFPs or RFI—this really goes through that process with rigor. So, we’re looking at the startups, trying to select the best partner, and then, collaborating closely with them.

We want to understand what their experience is like, both on the technology side and in health care. What’s their leadership experience? How well do we work together? When you work in this area, what we’re really trying to do is work together to learn from each other and pivot, to try to find the right solution. So, both organizations need to be aligned on what are the problems that we’re trying to solve and how we are going to adjust over time to do that.

You need to get the right team that’s willing to make those changes, in place. Those are some of the things that I look for as we evaluate early-stage companies to work with and I continue to think that this is a really important area for us.

I will just add that we also have a $30 million AI Digital Innovation Fund, and we are specifically designed to be strategic investor, so this is reserved for early-stage companies that we are working with in some capacity. We will make moderate-sized investments at the series A and B levels in these partners.

Q. What specific capabilities or competencies do you think an organization like MGB needs to keep in-house and build out as you work with this ecosystem of technology partners? How do you bring it all together?

Adam: That’s a question that we’re trying to figure out, and I suspect many across the country are trying to identify as well. One context I’ll share is that the unique components of health care are that we work in a mission-critical organization. That’s 24*7*365. So, the technologies that we’re deploying have to work. We understand there will be some failures—some plans, some players—and when they happen, we have to be able to respond very, very quickly. Our traditional approach has been to in-source all of our expertise—our infrastructure expertise, our service desk, and our platforms really have been in-source.

We are like many organizations right now under significant cost pressures. So, we are starting to think about where we outsource. The questions that we’re trying to address, and I don’t have the answers yet, but I’ll welcome them from there, from you or from others that maybe listening is we can’t compromise on the quality and the service delivery aspect that we’re providing. But we’d love to be able to find ways of being more efficient in how we deliver those services. We’re still trying to identify if there are opportunities to outsource, where they are, or where they might be.

Q. What about the data and analytics infrastructure within Mass General? What kind of infrastructure are you building? What are those competencies focused on?

Adam: Like other organizations, we are also investing in our data infrastructure and more importantly, in moving our data infrastructure to the cloud. We have, for many years, had a very successful data lake and we’re now looking at what would it take to put that data lake into the cloud, to make sure all of our data is available, and ideally increase the amount of real-time data that are available. That’ll make it easier for internal users to access all of that data and use it to improve health care delivery. There’s infrastructure work going on to do that.

What I will share with you is, maybe a successful program that we’re leveraging the data from these environments via our Active Asset Management Program. This started at Brigham and Women’s Hospital a number of years ago. The concept around the program is how do we make efficient? For example, enabling efficient use of very high-cost fixed assets like operating rooms (OR). This program is really driven by operational leaders, but that requires data and data analytics to power it. So, our analytics team at the Brigham, led by Rob Horsford, pulled data from our electronic health record to start to show the utilization and you can imagine they broke that data down by day, time, service, and worked with the managerial leaders, including the provider leaders, to iteratively understand what data they needed to make management decisions. They got feedback on that and eventually created formal dashboards using Tableau and other tools to be able to display this data to the managers and hospital leaders, convene the right leadership stakeholders on a regular basis to review the data and more importantly, make management decisions based on this data so they could change staffing, reassign or blocks etc. timely.

Using the combination of the available data and management intervention, we were able to create more access for patients, which was great because they were waiting to have their procedures done.

There was also a revenue opportunity for the hospital. We’re now replicating this data and management system across Mass General Brigham and looking to use our new cloud-based data infrastructure as we scale this.

Q. What’s your advice or a best practice for your peers in the industry, especially smaller health systems that may not have the scale and the resources to do the kind of things that you’re doing? Likewise, what’s your advice for innovative and young technology solution providers that want to be a part of your journey?

Adam: I think the piece of advice that I will share for health systems and tech vendors is that we need to be agile. I really appreciated this during COVID, and I know there are a lot of definitions of agile out there, including that very specific technology initiative. But I think most health care organizations, including mine, when we approach technology, we want the technology solution to be perfect. So, we’d often spend months, if not years, planning projects, getting ready for the big implementation and then, implementing. Of course, because we’re talking about patient lives and patient safety, we absolutely still need to pay really close attention to the details and need to plan these initiatives carefully.

What I have found and what we proved during COVID is that we can work in a different way where we break projects down into smaller components. We roll these out more quickly, even on the order of days or weeks and follow that very closely. We check how that technology implementation is going and continue to tweak it over time, sometimes making changes every day in order to stabilize the system or correct issues that may have come up.

What I found during COVID is, we built phenomenal relationships with our operational partners. We were talking multiple times a day, working very closely with them, and delivering technology at an extraordinary pace. There were some unique aspects of COVID as well so, we focused all of our digital and operational resources on it and used a very different decision-making governance framework where we had incident command.

What I’m now seeing is that we’re going back to our old ways of working. I hope that I’m trying very hard to find somewhere in the middle, where we can be a little bit more agile and nimble and have these close relationships with our operational and technology colleagues and vendors so that we can move faster.

I think what we’re starting to see is that our health systems have a number of challenges. They are only coming faster. And technology is increasingly part of the solution for these, so we need to find ways of being responsive to all the demands coming toward us and continue to innovate. I think that this is kind of a huge opportunity for us as we think about how we work going forward.

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity