David Seo, M.D., senior vice president and chief digital and information officer at Nicklaus Children’s Health System in Miami, is leading a journey there to create a unified digital experience for patients and families. He recently spoke with Healthcare Innovation about his conception of digital transformation and why creating a seamless experience for consumers in healthcare is so challenging.
Last year, Nicklaus began working with a company called Gozio Health to develop the MyNicklaus App, a digital health platform that brings together all consumer-facing access points into a single mobile app.
HCI: Why did you think it was important to add digital to your title a few years ago?
Seo: There was this concept of digital transformation that everybody kept talking about, but it never was very clear to me what it meant. I was reflecting on projects we’d done that were successful and those projects that perhaps were implemented well but maybe the adoption level wasn't so great. It occurred to me that digital is really about people. You can employ all the technology you want; unless it's what people want and what people believe in and they feel it's valuable enough to incorporate into their daily workflow, it's really not particularly useful, right? I thought perhaps I can help to crystallize the efforts of the business transformation part. The IT part is important, but it's really that transformation of the way you do business. The employees have to really own it. They have to have a vision of what it's going to do for them.
HCI: Do you also have a strong culture of nursing and physician leadership to work on EHR customization or other digital health initiatives?
Seo: Whether it's the EHR, the patient portal or a wayfinding application, that is part of the IT portfolio. But we say, ‘Let's get together and make sure it's truly something that we want, and we all understand what it will require.’ Then, any decision-making about it needs to be done together, where we have a matrix of what everybody's roles and responsibilities are. There are choices to be made, and compromises that are always required. There are workflows that have to be evaluated. All of that goes together into a shared approach to implementation and a shared approach to go-live, training and ongoing maintenance.
HCI: As you look across health systems or talk to CIO colleagues at other institutions, are there some common issues that they struggle with in terms of creating a digital presence that ties together a lot of services and gives them a unified look and feel?
Seo: The regulatory environment, the revenue cycle environment, the privacy issues and the fragmented nature of medicine all make it very difficult to come up with some unified platform. The sheer number of functions that one has to cover in the healthcare space on the part of a patient is huge, so no one group has really been able to come up with a unified platform that serves all needs. Obviously, the EHR vendors, Epic and Cerner, started with patient portals, but that's not necessarily a core competency. They're not built out for consumer engagement areas; they're built to bill and to document. Everybody wants to get in on the digital bandwagon. but everybody has only a piece of it; nobody has the full thing. So how do you stitch all this together into something that patients and families see as intuitive to use and that fulfills their requirements? It's a very difficult nut to crack.
HCI: Last year, Nicklaus launched a MyNicklaus App working with a company called Gozio. Does it start to pull those things together?
Seo: The reason we picked Gozio is because they started with their core functionality which is wayfinding. It's very easy to use, and it really is a turnkey solution. So you build upon the concept of a database of clinicians, a database of rooms and the use of RFID, Bluetooth and other technologies. But Gozio also built in from the beginning the concept of serving as a hub or a platform for other applications to live well together. They've done a ton of work with Epic using a lot of the Epic web services. Now they are figuring out the best way to do that with Cerner, too. That's why we decided to go with Gozio — to make that platform meld together with the Cerner patient portal, and with our physician and clinician database. More recently, realizing that most of us are dealing with a dozen or more different applications, Gozio is opening up their platform. We can do development directly within the framework of what they've put together. That will allow us to put those Lego pieces together in the way that meets our needs. We can begin to plug and play different things, and try to make things look more seamless and more integrated.
HCI: Have you tracked the uptake of the app and user satisfaction since this launch?
Seo: We have gotten some really great feedback. The patients who are using it are really appreciating it. We have made some major pushes into adoption and use of the system. But I will tell you that we have not gone full-on yet because we want to get our patient portal platform and our registration and scheduling to catch up to where we need to be with the MyNicklaus App. Now that we've got those in much better shape, and are melding them together, our plan is to make the major enterprise-level push once we have a more comprehensive platform.
HCI: Are there more challenges in patient portal issues in a pediatric setting than in a regular acute care hospital?
Seo: I'd say the major one is around proxy access. You've got to allow parents and guardians to have access to the chart. But then once they reach the point around age 13, you have the additional concept of what level of access do the parents have to that adolescent’s record because that's the time when other factors come into play. That's one to work on with adolescent medicine to see ethically and experience-wise what is the best thing.
HCI: I saw you quoted as saying you were looking forward to working on adding things like built-in entertainment options and the ability to order food through the app too. Is that something still in the future?
Seo: Yes. The concept here is building blocks. Once I'm in the hospital, say I have certain food allergies. I want to pick my meals for the day. I would like to schedule time to have animal therapy. There's a schedule of events. We have some sort of building activity here or a movie that's being shown. It is the concept of being an app that is not just for clinical purposes, but for more engagement purposes.
HCI: Are there any other digital projects you want to mention?
Seo: Everybody always says, ‘Well, David, can’t you just make Open Table for healthcare? As I have said, it is a very complicated environment. And there's a lot of regulatory and other things you have to follow. But I would say that I'm really excited because of the changes and advancements that Gozio has put together combined with some projects that we've been working on as well as things Cerner has made some strides in. You combine that with cloud cybersecurity, now I can see it all begin to coalesce into a truly engaging mobile platform with not just the clinical side, but the entertainment activities, ordering food, etc., so it is an exciting time to see it all begin to come together for the patients.