Executive Voices: Bimal Desai, M.D., of CHOP

The Children’s Hospital of Philadelphia’s (CHOP) digital health team is looking for ways to use technology to enhance the patient experience, connect its experts to other providers and fuel research efforts. With several pilot projects underway, the innovators are examining the potential of digital tools such as video visits, self-scheduling, virtual reality and wearable technology.

But CHOP’s digital health leaders aren’t toying with technology for the sake of it. They want better outcomes and greater efficiencies — and adoption. That’s why the team partners with clinicians, researchers, entrepreneurs and technologists across the hospital to solve its patients’ most pressing problems.

I interviewed the digital health team lead, Bimal Desai, M.D., assistant vice president and chief health informatics officer at CHOP, to learn more about how the health system is navigating the digital transformation through its digital health program.

Desai serves as the director of the healthcare software development group. He oversees a multi-year project to implement and optimize components of a comprehensive electronic health record (EHR). A graduate of Washington University School of Medicine, Desai’s areas of expertise include biomedical informatics and web-based educational tools for clinicians.

Editor’s Note: This interview has been slightly edited for length, clarity and style.

Samara Rosenfeld: How is CHOP navigating the digital transformation?

Bimal Desai: In 2016, we established an office of digital health, specifically to think beyond the EHR and to understand the other touchpoints for technologies as they might impact patients — or parents, in our case, since we are a pediatric organization — or even our own staff. We launched that program under my leadership as a chief health informatics officer.

There is a mobile health team, a web and application development group and portfolios in digital therapeutics, telemedicine and many other resources to support that.

S.R.: And how did you help to start this program?

B.D.: CHOP has always been a forward-thinking organization, especially with regard to research discoveries. Our CEO felt strongly about excelling in this area. I think that pediatric organizations like CHOP are well-poised to take advantage of the digital transformation, just considering that our patients and their parents have grown up in and around technology and are expecting it in other aspects of their life.

Health systems have to really think about these technologies as ways to drive care, improve value and ultimately remain competitive. That was the inception of the digital health team: What can we as an organization do to transform pediatric care through technology?

Our CEO, Madeline Bell, had this vision which she coined as, “high-tech, high-touch care,” where we use the technology to support patient engagement, interactions between the providers and the patients and other members of the care team.

S.R.: What separates CHOP’s digital health program from similar ones?

B.D.: I have spent most of my career as an applied informaticist, deeply embedded in the operations world. My additional role, beyond this, is to oversee the clinical informatics program at CHOP, which is the group of physician informaticists who partner with frontline clinicians and the EHR team to make sure that the solutions we build are safe, high-quality, effective and actually achieve their clinical outcomes.

From my standpoint, that’s the background that I want to bring to my role as chief health informatic officer. I think that grounding a digital health program in this rubric of patient care and driving for value and quality is very important.

We are judicious about how we choose technologies that we want to put in front of patients and providers, recognizing that the cost of healthcare delivery is extravagantly expensive. We believe strongly that we should not worsen that problem. We need to find technologies that help us deliver high-quality care and to prove that they have value and a return on investment.

S.R.: What are some obstacles that you have experienced when implementing new technologies into a physician’s workflow?

B.D.: There are things that people want to try in healthcare because it sounds clever or it sounds like it might be useful. And the minute you put it into a busy clinical enterprise, you realize that it is not functional. Maybe the user-interface doesn’t work quite right. Maybe the provisioning step for the device is too cumbersome for a frontline provider to actually perform. Maybe it’s novel but not actually useful. So clinicians use it a few times and then get bored.

We have definitely had technologies where, on the surface, they sound like they are going to work, but then we find they don’t.

The design of these systems is very much an exercise in empathy. If you’re designing a new clinical user interface, a workflow, a process, you really have to understand what all of the parties in that process are trying to achieve. It’s deceptively easy to just plop a new technology into a clinical workflow and hope that it’ll achieve its goal.

Unfortunately, that’s a lot of the buzz in digital health right now. It’s like, “Oh, if only we had blockchain, we could solve all of our woes.” But in reality, it will be much harder than that to show the value.

Given how high-stakes healthcare delivery is, especially at very busy organizations, I don’t think we have the latitude to introduce technologies in less-than-rigorous ways. The clinicians will be the first to tell us that they may already be overwhelmed with the workflow burden that’s placed on them from other domains in healthcare. Part of our job is trying to find opportunities to simplify that.

One of the benefits that my team and I can bring is that most of our physician and nursing champions who are embedded on these projects are all still practicing. There’s this mantra in software design, “You should eat your own dog food.” If you are not willing to use the tools you’re deploying, why would you expect somebody else to use them?

S.R.: So, what are your priorities for the implementation of health tech?

B.D.: One of our major focuses for next year is to expand our telemedicine program. We are hoping to partner closely with our care coordination groups and the departments of surgery and anesthesia to show that we can use technologies to reduce the need for face-to-face visits for populations of patients that may be driving very long distances to get to CHOP, while still maintaining high-quality care.

For example, our division of orthopedics medicine showed that for routine post-op knee surgery follow-up visits, we can save patients on average 50 to 100 miles of driving in either direction.

For families who have a follow-up visit that doesn’t require as rigorous of an exam, the information needed can be gathered from a visual exam and maybe a range of motion assessment on a video camera. That’s a great option that we would love to offer them.

On the care coordination side, the biggest opportunity for us is that we know there are patients who would benefit from having more consistent touchpoints with the health system, either from care coordinators or from sub-specialists themselves. So, we are exploring how we can actually use telemedicine to help keep those kids healthier in their own home setting by partnering with the families through telemedicine.

Our other major focus will be to continue to add valuable products and features into our mobile patient portal. We use Epic as our enterprise EHR, and we rolled out MyCHOP, which is our locally rebranded version of MyChart, Epic’s mobile portal. We have started to add more and more features that families are finding useful. Scheduling has been a huge success — just the ability to request scheduled appointments without having to call the office. We’ve added the ability to see local wait times at urgent care centers so that parents can make more educated decisions about where to seek care. We have also done a lot of work to use chatbots for interaction with patients and just confirmation of upcoming visits.

There are a lot of patient-facing technologies that we are starting to ratchet up with more sophisticated use cases.

S.R.: What should other chief health informatics officers be doing to leverage technology?

B.D.: The most important thing is to be clear on what your goals are. In my mind, there are technologies out there that are ready for research, meaning it’s a method that you’re trying to prove has utility in healthcare. There are technologies that are ready for innovation and entrepreneurship, meaning that they are so new, we just need to try a proof of concept and see if there is anything applicable in healthcare that is even worth exploring. There is a very small subset that are truly ready for enterprise deployment.

There are pros and cons to all three of those mandates.

Hospitals need to be clear when they invest in digital health if their ultimate goal is to build a lot of prototypes and see what sticks or to improve their day-to-day operations with scalable enterprise solutions. Is it something in between? Being clear on that upfront is extremely valuable because it gives you the guidance on what to invest and not invest in.

S.R.: Are there any technologies on your radar?

B.D.: I’m very eager to see what happens in the deep learning and computer vision space. In our lifetimes, I think we are going to certain fields of medicine completely transformed.

For example, radiology and pathology. I don’t think we are going to see these specialists lose their jobs, but they are going to have very different duties in the future. A lot of their work will be augmented by computer vision algorithms.

I also think that we are going to see major and much- needed transformations in the design of EHR user interfaces, with things like adaptive user interfaces that can adjust the visual display according to the acuity of the patient or the needs of that specific provider. Maybe they will offer more interactivity through voice recognition and voice commands. I think they are going to be less like the robust database and data entry systems that they resemble today and much more like a personal assistant.

There is an unresolved question that many organizations have, which is: How do they know whether the problem they are trying to solve can be solved natively with the tools they possess, whether they need to buy a third-party solution that might exist on the market or whether they need to create something from scratch? All three of those have very different project life cycles and some are easier than others. Hospitals are going to need a structure in the middle to identify the problem and how it will be addressed.

S.R.: How do you make that decision?

B.D.: My goal is to bring all of those stakeholders together. If I can have people from the informatics research space represented alongside the quality improvement and safety leaders, alongside my digital health web team and the application development space and maybe even representatives from the innovation and entrepreneurship group, together we have the right skill sets and backgrounds to vet opportunities and say, “Yes that’s such a huge problem, and none of our specific tools meet that need, so we need to go to an outside vendor to find a solution.”

The risk is that you decide to make a giant investment in an outside company for a specific solution, but you realize that your EHR could have done something similar for a fraction of the cost. Collaborating can avoid some of those costly mistakes.

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