Dr. Alistair Erskine on Mass General Brigham’s digital health goals, investments

Alistair Erskine, MD, is the chief digital health officer at Mass General Brigham in Boston, responsible for the health system’s data management.

His role is crucial to clinical care and the system’s health plan enterprise, and he said he is leading the system toward a more patient-centered strategy for digital health with consumerism trends in mind. Dr. Erskine joined the Becker’s Healthcare podcast to discuss how Mass General Brigham used data in new ways during the pandemic and what key investments to expect in the future.

Below is an excerpt from the conversation, edited for clarity and length. Click here to download the full podcast and subscribe today.

Question: Really thinking about the pandemic, how has it affected your short- and long-term goals? What is essential?

Dr. Alistair Erskine: Virtual is the new black, and data is king. Those are some of the lessons that came out from the pandemic, and that is helping us think through how we improve the convenience of the healthcare services we provide for the patient. How do we better tune artificial intelligence in an unbiased way toward all patients we take care of so that we can help with decisionmaking? How do we drive the decision-making going forward, especially in real time, as it was necessary during COVID to be able to get a situational awareness of what is going on when resources are getting tight?

Short term during the pandemic, we needed to boost a number of virtual visits we could handle. We needed to increase the adoption of people using our patient portal, and we needed to find new ways to treat patients in isolation. There was a huge shortage in PPE, and that meant in our case we decided to put tablets on an IV pole in the rooms of patients that were isolated to keep them connected to their healthcare teams and family members when visitation was a problem.

We also needed to generate a huge number of new real-time dashboards to understand what was available in the health system as a whole and redistribute our assets across the system. We saw a huge uptick of people taking advantage of those dashboards.

The other thing is that we needed to be really good about innovating at the front line to be able to understand the new tools we could use. We had employees that were using attestation statements before they came into the hospital to make sure they were COVID-negative, for example. We were looking carefully across all the digital health tools to see if there were things we could implement quickly to fill some of the care gaps.

Finally, Mass General Brigham has been a leader …. [in] making sure that researchers can compare notes and use the same data structures to collaborate internally, but also with external parties in a way that’s safe, and then making sure there were ways for us to reach out to patients who were not contacting us, but we knew were at risk. We had ambulatory remote patient monitoring programs and virtual nurse navigators that called patients to make sure they were OK. These were all things that ended up being important in the short term and will be solidified over the longer term.

Q: What are the essential investments you still plan to make in the next year?

AE: The pandemic certainly has been a catalyst to some extent in terms of the digital health tools we use. It didn’t necessarily dramatically change all the things we were planning on doing. The kinds of investments that we plan on making in digital patient experience, things like patient portals or the ability to check in and do online scheduling and looking through a directory to find a doctor that is right for the patient, consumer relationship management tools and the digital front door, all those types of investments continue as a means to be able to make sure that patients get to enjoy the same experience that they do in other industries in the healthcare space.

Patients are appropriately pushing us to try to mirror, to some extent imitate, the way that they experience other digital surfaces offered by retail and any number of other places. That will continue for sure. I think that we have to take into account the digital clinician experience and address the burnout and fragmentation the clinician feels by reducing the number of clicks, making sure we invest in conversational AI and have a way of interacting with the system that doesn’t require a keyboard and a mouse.

[The documentation systems] can have more natural language [for voice activation] in the way you speak with Siri or Alexa, in a way that keys up data for specialists rather than leaving a specialist to hunt through the charts looking for the things they commonly pull together. We also want to make sure that those interfaces are convenient to them, and they can have more time spent with direct eye contact with the patient and then think about what is the next best thing for the patient rather than having to hunt through the record.

We also need to think about modernizing the way we train clinicians and staff in the use of our systems, moving away from the more traditional classroom environment, which hasn’t been feasible with COVID-19, which taught us how to do virtual training. We need to think about ways to do more just in time and real-time access, where if someone gets stuck and they’re using the system, they can call a number and then have one of the managers swoop into their section as they are using it and show them how to place an order or write a note or look up a result.

Investments that are going to be really critically important are in a data ecosystem that in some ways centralizes the data management that is required from all the transactional systems that we use in healthcare and distributes in a higher normal form data for advanced analytics that occurs closer to where the patient is. We want to make sure the advanced analytics occurs right within the clinic and right within the hospital with people who have the best sense of what it really means to be analyzed, but those folks aren’t the ones stuck having to data manage and prepare the data for that analysis.

I also think we’ll see investments that turn to AI to solve operational challenges for things that are sometimes in the background, such as supply chain issues or even patient schedule optimization, pharmacy management and ambulatory situational awareness through remote patient monitoring. Having a good understanding of the patients that show up in your clinic, and importantly, also the ones that don’t need additional help, will be critical. We also want to have ways to make sure we capture that population to ensure that everybody is taken care of.

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