<v Jordan Cooper>We're here today with Don McMillan, senior director of Information Services and regional CIO for main Health Central region. Don, thank you so much for joining us today and welcome.</v>

<v MacMillan, Donald D>Thanks, Jordan. Appreciate you having me.</v>

<v Jordan Cooper>Yeah. So, Don, one of your primary roles is to manage your relationship between IT and hospital executives, consulting leaders on strategies, consulting leaders on strategies to leverage technology to meet organizational and operational objectives. What are some of the challenges of bringing together people, technology and business objectives?</v>

<v MacMillan, Donald D>Uh, some of the the challenges is often there can be a disconnect between what you know IT is.</v>

<v MacMillan, Donald D>A plan on doing and what the business is planning on doing and and so I make sure that.</v>

<v MacMillan, Donald D>Uh, I the IT organization understands the priorities and initiatives of and problems at the senior management teams are trying to solve at the at the hospitals and also making sure that the senior management team understands what the IT department is working on and why. And so I I'm that glue between the two and I can understand the technical.</v>

<v MacMillan, Donald D>The concepts and explain it in plain language that the senior leadership team can can understand.</v>

<v Jordan Cooper>So a lot of times on these episodes people are listening and they're commute to work and the car and it's very helpful if when guests illustrate a particular concept with an anecdote from their history. Is there an example, Don, that you can share with our listeners about your role as an Ombudsman and and how you were able to bring people together, perhaps what would have happened if you hadn't done that, like, where were they different and different levels? And then what the outcome was?</v>

<v MacMillan, Donald D>Sure. Yeah. One the more complex technical projects that we have more recently was a collapsing one of our Active Directory domains. So main health start off kind of like a Federated system where we had brought together several different hospitals in Maine and over time, we grew into a healthcare system. And as we brought together those.</v>

<v MacMillan, Donald D>No hospitals we brought on their technologies and so we had at 1.5 different Active Directory domains. We end up collapsing those down into two and the last one would be collapse was our the Active Directory domain servicing main Medical Center and mostly the central region in in Maine and it was their largest Active Directory.</v>

<v MacMillan, Donald D>That we had in the system. So we really need to get that down to one. So we could start to do more advanced projects like moving to Microsoft 365 in the cloud, again our EPIC system off premise and into the cloud as well. It was you know we need to be on one Active Directory domain to do that. But as you can imagine, it's a significant change when you're doing this and the impact to the practices.</v>

<v MacMillan, Donald D>And the hospital was significant. So part of what my role was here is is being that communication and helping people understand, you know, why we're doing this? What is an Active Directory domain anyways? And communicating the schedule and delays and what to expect is things were happening and knowing that we are going to have technical glitches, we just knew that, yeah, it wasn't going to.</v>

<v MacMillan, Donald D>Yeah. Be sunshine and roses as we were, you know, moving each group over. And we were doing it in batches and yeah, it was it could be impactful. And it was a matter of setting expectations with the customer, prioritizing issues that were present as they would come up, so that our technical teams knew what was the most important thing to focus on and really making sure that we had that VIP list.</v>

<v MacMillan, Donald D>Of of people together and you know, understand also.</v>

<v MacMillan, Donald D>There were certain devices in the clinical environment that we knew we could not do automatically. We had to do manually, particularly in the procedural areas. And so I was making sure to review our project plan for that and ensure that, yeah, they the team had accounted for those devices and we had properly engaged our clinical engineering.</v>

<v MacMillan, Donald D>My teammates on this and it was end up being a very long project overall. You know very successful and we got it done.</v>

<v Jordan Cooper>So congratulations on that, Don. What I'd like to say though is there.</v>

<v Jordan Cooper>Maybe CIO's listening this episode right now, and they're saying, you know, I'm working on a bunch of projects and I've had problems working with the business teams in, in my organization. I've had some pushback from some different important key stakeholders. I've heard you say, Don, that it's very important to set expectations, determine why something's happening, explain communicate schedules and introduce transparency. Are there any common pitfalls that you've seen CIOs fall into when they're trying to push a?</v>

<v Jordan Cooper>Advance of project forward and just kind of there's some issues with moving people and meeting business objectives. I guess my fundamental question is what can CIO do to better facilitate projects and alignment with business objectives?</v>

<v MacMillan, Donald D>But I think that.</v>

<v MacMillan, Donald D>Most people that get to CIO level of of learned.</v>

<v Jordan Cooper>Umm.</v>

<v MacMillan, Donald D>This lesson a while ago. Otherwise you wouldn't be in that role, so maybe it maybe for the emerging CIO or the person that's growing into that. But you know and it's really all about relationships and yeah, developing those personal relationships with your customers, understanding what their goals and objectives are and what's important to them and being able to have, you know, frank conversations with them.</v>

<v MacMillan, Donald D>About things and making sure that you're listening to what their concerns are. Often I've seen it with, you know, people in technology, they'll say, yeah, look, we just need to get this project done. We. Yeah. Here's our timeline to do it and it's like, OK well, did we take a step back and share this plan with our customer and consider the impact that it's going to have on the customer and the things that they're working on because.</v>

<v MacMillan, Donald D>They may. the IT teams may not realize that there is planned to be a Joint Commission survey or, you know, the the magnet organization coming into visit the organization around the same time that we're planning on making, you know, a significant change and and so if you've got those relationships with your customers and you're bringing the plans forward to them and giving them an opportunity.</v>

<v MacMillan, Donald D>To look at it and you know.</v>

<v MacMillan, Donald D>The technical details aside, helping them understand that impact then they can, you know, be better advised and be a partner in the change. And that's really what is going to help you to be successful going forward is making sure that you've got those relationships and you're treating your customers as partners.</v>

<v MacMillan, Donald D>Right.</v>

<v Jordan Cooper>I loved on your emphasis on relationships and on the topic of partners and change. Maine Health has partnerships with the tough School of Medicine and the Rue Institute. I believe, Don, you initiated a project to analyze waveform data to better predict adverse events before they happen and also engage in ambient dictation for key ambulatory practices to reduce physician documentation time. Can you speak about the initiation of those projects? How?</v>

<v Jordan Cooper>How the partnerships have evolved over time and what your what your accomplishing, what the rollout has been, what the objectives are.</v>

<v MacMillan, Donald D>That well, just to be clear, you know, I I wouldn't say that I initiated these projects. I've been a advisor for folks on working on these projects and we do have a great relationship with tough School of Medicine and the main Rule Institute and Maine Health also has the main health Research Institute that does a lot of really interesting medical research and they're doing some great work and we're excited to see this.</v>

<v MacMillan, Donald D>A partnership continue to evolve.</v>

<v MacMillan, Donald D>And yeah, I was approached about the project with.</v>

<v MacMillan, Donald D>The Tussin and the ruins stitute by are.</v>

<v MacMillan, Donald D>A medical director of academic affairs and yeah, he said. Hey, we've got some researchers that wanna start looking at, you know, waveform data and doing some research using AI and.</v>

<v MacMillan, Donald D>Putting things through, doing more with big data analytics and you know what do you think? Is this something that can be done and and you thought? Yeah, absolutely. You know, other organizations have have done it. This is a huge shift in.</v>

<v MacMillan, Donald D>You know healthcare IT is, you know having you know more, there's a ton of data out there that is available to be analyzed in, you know, real time and but also retrospectively. And it's a matter of setting those systems up and.</v>

<v MacMillan, Donald D>I yeah. Enabling. Yeah, that that data to be available to researchers and it's that if you just look at.</v>

<v MacMillan, Donald D>How many times a a nurse in an ICU is recording a patients vital signs into the medical record it sometimes it may be every 15 minutes and that may be for an hour or you know every 30 minutes for four hours, but then it starts to be more routine, like every eight hours. And so that's a limited set of data points. When you start to then take the.</v>

<v MacMillan, Donald D>Data and from bedside monitors waveforms and start to push them into an.</v>

<v MacMillan, Donald D>Artificial intelligence, or big data analytics engines. Then you can start to get live data feeds and you've get, you know, hundreds of data points per second or millisecond. And so it's much higher fidelity amount of data that they're able to analyze. Now I'm I'm not a data scientist, but I understanding the general concepts here. That's a lot more data that is available to them.</v>

<v MacMillan, Donald D>And once you've identified that the algorithms and have a general understanding of, you know, hey, we notice that when a patient demonstrates, yeah, this type of breathing pattern, you know, in combination with their blood pressure and heart rate. Yeah, this is a indicator that they are going to be developing serves. And if we can.</v>

<v MacMillan, Donald D>That identify that pattern and send a message out to providers in in real time. Yeah, you can impact and save a lot of lives. So that project is in the early planning stages.</v>

<v MacMillan, Donald D>We're working with our partners at Phillips to get the.</v>

<v MacMillan, Donald D>That yeah, architecture set up and also working with the reinstitute on the work to set up the data analytics engine. So a lot of planning is going on, but they've done a lot of great initial research on kind of planning out what it is that they want to accomplish. Another organizations that I've been at have accomplished.</v>

<v MacMillan, Donald D>I the the exact thing that they're hoping to do, so it's not new, but it's so I I wouldn't say old hat. You know, it is an emerging field in healthcare. IT is to leverage the amount of data that we have available and use that to impact care because you can't have.</v>

<v MacMillan, Donald D>Physicians constantly, you know, monitoring the data in real time. They get distracted, they get pulled away. But a AI machine doesn't sleep, doesn't take PTO, doesn't have a bad day, and is constantly watching that data stream. So it's a huge step forward for providing better care to our patients.</v>

<v Jordan Cooper>You've also been working on centralizing Tele sitters.</v>

<v MacMillan, Donald D>Yeah. So one of the the biggest challenges that all the health care organizations around the country are experiencing is staffing challenges.</v>

<v MacMillan, Donald D>You you can't hire. We had a nursing shortage before the pandemic. The nursing shortage. The pandemic exacerbated that nursing shortage and you know, just hiring people into healthcare has been a real challenge. So combine that with increased lengths of stay gained, sicker patients coming into the hospital.</v>

<v MacMillan, Donald D>You know you need to better leverage your staff. And several years ago, Maine Medical Center started a telecenter program we had.</v>

<v MacMillan, Donald D>About 18 cameras that we had in the patients room, some of them were in psych units that were ceiling mounted cameras and we were watching those patients continuously to make sure that they are staying safe and.</v>

<v MacMillan, Donald D>A. Avoiding any potential self harm.</v>

<v MacMillan, Donald D>And also protecting the the staff that would go in and provide care those patients but also and the non psych units putting them into rooms where patients who are had a high fall risk and yeah you can have one, Telus sitter watching 11:50 cameras at a time versus having one.</v>

<v MacMillan, Donald D>Person in each one of those rooms. So you're literally cutting your staffing requirements down by 1/10 of what you would normally need, and that program was super successful. They did a fantastic job and as we're experiencing these staffing shortages, we said, you know, what can we do to better serve our our organization?</v>

<v MacMillan, Donald D>And make use of the staff that we have and we the natural extension was well we need to.</v>

<v MacMillan, Donald D>Expand this telecenter program so we moved our setters out from Maine Medical Center and to a central location still located in in Portland. Then that location's got generator backup if anything were to happen. So they've got data and power backup and.</v>

<v MacMillan, Donald D>Expanding the number of actual telecenters are available, so we're able to watch more patients at at at a time and we're rolling out additional cameras to our partners. So we literally have.</v>

<v MacMillan, Donald D>You quadrupled the number of cameras that we have out in our environment. So we're providing Tele sitting services to our.</v>

<v MacMillan, Donald D>Hospitals on the in the coastal regions and in the southern regions of Maine and the Midcoast regions of Maine, and we'll be expanding it out to our other local health systems in Maine health and it's a huge step forward and is really going to help us to provide better care. And one of our key.</v>

<v MacMillan, Donald D>Metrics is reducing falls with harm and this is a great way to do that because we can get eyes on patients, make be more efficient with our staffing and reduce overall cost to care for the organizations.</v>

<v Jordan Cooper>Well, Don, we are approaching the end of this podcast episode. We've covered different programs that offer some sort of monitoring in order to take action, whether it be live telecast sitting, monitoring of patients or whether it be kind of ambient waiting for wave form data collection with streaming data streams that would produce an alert for adverse events.</v>

<v Jordan Cooper>I think many of our listeners are also doing different various degrees of monitoring programs as well. And I think they may be wondering.</v>

<v Jordan Cooper>How do you implement these programs? How do you evaluate the effectiveness and the benefits of these programs and and taking action based upon these data streams? What would you say to those members of the audience? Would be asking that right now.</v>

<v MacMillan, Donald D>While we're work with your clinical partners in advanced identify, what are the metrics of success before you even start the project? You should have an idea of what it is.</v>

<v MacMillan, Donald D>That you're trying to impact. What's the problem that you're trying to solve? Are you trying to prevent false with harm? Are you trying to prevent the onset of sepsis in the hospital or you trying to reduce your length of stay in the critical care unit, reduce readmissions? What are those clinical metrics that you're trying to impact and that should be your measurements of success that it is just a tool. It's not the.</v>

<v MacMillan, Donald D>That. Yeah, rolling it out and rolling out the solution is not that the actual measure of success, the measure of success, is the outcomes that result from the technology.</v>

<v Jordan Cooper>Well, thank you very much Don for joining us today again for our listeners. This has been Don McMillan, senior director of Information Services and regional CIO for Maine Health Central Region. Don, thank you very much for joining us today.</v>

<v MacMillan, Donald D>Thanks for having me.</v>