Joe Diver is senior vice president and CIO at the Brockton, Massachusetts-based Signature Healthcare, an integrated healthcare system that encompasses Signature Healthcare Brockton Hospital, the 150-plus-physician Signature Medical Group, and the Brockton Hospital School of Nursing.
Diver, who joined Signature Healthcare in March 2024, has been leading the organization forward in strategizing to leverage health information technology in order to maximize the organization’s efficiency, effectiveness, and patient outcomes. He will join Healthcare Innovation Editor-in-Chief Mark Hagland in a panel discussion on the top challenges and opportunities facing CIOs and other senior health IT leaders, on May 19 in Boston, at our Boston Healthcare Innovation Summit. Below are excerpts from Hagland’s recent interview with Diver, on the top issues facing senior patient care organization leaders right now.
CIOs and other senior healthcare IT leaders are faced with tremendously long “to-do” lists, financially based limits on budgets, difficulties recruiting and retaining staff, and other issues right now. What in your view are the biggest challenges facing CIOs and other senior HIT leaders?
The biggest challenges facing us involve driving efficiencies leveraging technology, and helping the organization reduce administrative costs, while also streamlining clinical processes for efficiency, which includes optimizing patient access.
One of the biggest challenges seems to be to maximize and optimize the time of physicians and nurses during their workdays. Clinicians are hugely crunched for time, and many feel overwhelmed by all that they have to accomplish every workday.
Yes, that’s all correct. And with regard to giving them back more of their time, we have a physician scorecard for tracking their pajama time [the time that physicians need to spend in the evenings in order to complete their documentation from their patient visits during the day, but were not able to complete during the workday]. It’s not only the efficiencies of the day, but after-hours work. We support a virtual scribe program, using remotely based human scribes, but the expense is tremendous. So we’re going to be moving into the direction of ambient listening this spring, to take the friction for the doctors out of the picture, for physician efficiency, so they can go home and enjoy their lives at the end of the day, but also to help us with administrative costs. Certainly, it’s an administrative burden.
The remotely based scribes represent an exorbitant cost?
Yes, on average, it costs $24,000 per provider per year. Some physicians are still using regular dictation, so their needs aren’t represented in that $24,000 figure. The cost will be only $6,000 per year per physician, when we shift over to ambient intelligence; that represents a huge savings.
What is your sense of the “temperature” of physician burnout in your organization?
They’re kind of in the middle of the pack along that dimension. And that’s because we have very good engagement, and we’re helping them to understand the limitations of what they can and can’t do. We hear from some higher-volume providers more often than not, around operational or EHR workflow. We did a survey of our providers, measuring the sense of burnout on a scale from 1 to 5, and we found that the average feeling was about a 3.1. But the ones who have been providers for a much longer time, are much more frustrated than those only out of medical school for a few years.
Those frustrated have been practicing longer?
Yes, that’s right. And one of the major frustrators for sure is the regulatory issues. And also, the inbox messaging. So we’ve analyzed the volume of inbox messages and noticed our high frequent users from a patient perspective, and are educating consumers so they’re not hitting them with emails 20 times a day.
In that regard, I know you’re aware that some organizations have begun leveraging AI solutions in order to help physicians and nurses with “starter” replies to patient queries, while others are creating the rules-based routing of messages to the correct types of people—messages meant for physicians to answer, versus those that a nurse could answer, or in some cases, a clerical person.
Yes, we’re exploring that possibility now with a vendor. I’m very interested in it.
Another challenge exists in the area of data analytics and data science, in terms of attracting and retaining qualified specialists, correct?
Yes, that’s a great question. Part of our strategy for the next few years will be leveraging the data for analytics. So the issue is teaching our colleagues what the data actually means. We’re never going to be able to afford a formal data scientist in our organization. But I’m beginning to recruit for a director of data analytics. And the number-one objective in that hire will be to work with our senior leaders to interpret the data and drive data definitions. We started this process back in September, and there was such a gap between what folks understood and what they thought the data was telling them. And the senior leaders need insight both for financial and clinical data. It’s definitely a challenge.
And you are competing with organizations that can pay more, correct?
Yes, that’s right. And we’re in the market where the Steward Healthcare fiasco impacted us. We’re competing for that patient population and are leveraging our loyalty and patient engagement strategies quite a bit. We’re fortunate in that our patient base was loyal to us after the fire that took our facility down [in February 2023].
How long was the inpatient hospital shut down?
Eighteen months. So people were receiving care in all sorts of different places. And as part of the fire recovery, we had to open up urgent care locations, and patients came south to Brockton for care. So there absolutely was a silver lining.
What does your landscape look like as CIO for the next couple of years?
Per cost and money, our focus will be around optimizing the technologies we have, and making sure that we’re fully utilizing our current technologies. Second is to look at our growth strategy, and to leverage technology for urgent care and virtual care and telehealth care growth, whatever the feds will do come March [when the temporary extension of the telehealth flexibilities must be renewed by Congress]. We still believe that remote care will be a core part of our strategy. And to continue with analytics. And we’ll be focusing on throughput, supporting our throughput capacity on the inpatient side, leveraging our technology there and in terms of virtual consults. And to give our team members tools—one will be a unified clinical communication strategy, across our entire enterprise including in our medical groups. Per follow-up visits, critical alerts, values, etc. A lot of pieces are involved; and of course, we’ll be moving into AI [artificial intelligence] over time.