Dr. Justin Cross to oversee bold, new wave of digital technology

Chief Digital Health Officer appointed – a first for the healthcare network

An unprecedented surge in the use of digital technology is on the horizon for CIUSSS West-Central Montreal—and if you’re worried that this may mean more electronic devices and less human contact, Dr. Justin Cross has these words of reassurance: “In the end, they’re just tools—sophisticated and complex, but tools. They’re meant to support the human connection, not get in the way.”

Technology’s troubling potential to drive a wedge between healthcare users and clinical staff is not lost on Dr. Cross, who became the CIUSSS’s Chief Digital Health Officer in February, the first such appointment in the healthcare network.

However, he explains, the key to ensuring a strong bond between users and caregivers is not to place restrictions on the introduction of new technology, but to create the right circumstances to embrace it. That involves choosing the right software, carefully customizing it to meet an organization’s needs, and properly training employees in its use.

The ultimate goal for a Chief Digital Health Officer, Dr. Cross says, is to be certain that the technology serves and supports those who rely on it, and not the other way around.

“The tools that we choose will reduce the administrative workload and handle the sorts of tasks that don’t require human interaction,” he adds. “Once they’re in place and are running smoothly, staff will be free to devote more time to developing a meaningful connection with the patients, clients and residents who depend on them.”

Benefits to healthcare users

Dr. Cross’s appointment—plus the creation of the position of Chief Digital Health Officer—is central to a concerted push by the CIUSSS to implement and take full advantage of new forms of digital technology over the next couple of years.

In his view, this would allow improvements to occur at each step in a user’s contact with a healthcare or social services facility:

• Before seeing a care professional: “Digital tools will make it much easier for you to confirm the information about your visit, instead of you being put on hold for a long time or not being able to find the information at all.”

• Seeing the professional: “We’ve all experienced going to a doctor’s office or hospital, and having the staff ask the same questions over and over: ‘What are your allergies? What are your medications? What’s your medical history?’ Often, that’s because there isn’t a good flow of information. With a single electronic health record, it becomes much easier for information about you to be accurately verified.”

• Treatment and care: “Once you’re in the care process, digital tools can automatically check for things like allergies and contra-indications, based on your profile. This is something that users may not experience directly, but from a safety perspective, it makes the care experience much safer.”

• Follow-ups: “After users leave the care process, they might log in to see the results of a test or procedure, or possibly send a message to the care team.”

Dr. Cross recognizes that while the position of Chief Digital Health Officer is relatively new and may be unfamiliar to the public, it is becoming more widely accepted, especially in many of the larger academic medical centres in the United States.

“The Digital Health Officer takes a comprehensive view of an organization’s entire digital strategy,” he explains. “Then he or she thinks about which direction to take and which digital tools would be best for achieving the healthcare mission.”

A career in medicine and digital technology

Although Dr. Cross has practiced as a family physician with Johns Hopkins Community Physicians in Rockville, Maryland, his immersion in the digital world is actually a return to his pre-medical interests.

Initially, he majored in economics and minored in computer science in the U.S., becoming interested in health care only after undertaking a number of projects in that field as an IT consultant.

“Once I began practicing, I started coming up against inefficiencies in health records,” he recalls. “With my technology roots, I said, ‘I want to participate in fixing this.’ So when an opportunity with the federal government came up, I took my career in that direction.”

Just before coming to Montreal in late 2018, Dr. Cross had spent 3½ years in Washington, D.C., with the U.S. government’s Department of Health and Human Services (somewhat similar to Health Canada). In the Office of the National Coordinator for Health Information Technology, he worked on “the whole gamut of healthcare-related IT issues, including the usability and safety of electronic health records.”

Most recently, he served as Medical Director for Systems Safety, focusing primarily on health and safety as it relates to IT, including support for clinical decision-making, patient identification, interface usability, and policy and regulatory development.

(The move to Montreal came at a fortuitous time, since Dr. Cross’s wife—Dr. Emilia Falcone, a physician and researcher who was born and raised here—has been recruited to run a laboratory at the Montreal Clinical Research Institute.)

Key areas of interest

For the immediate future, Dr. Cross plans to fix his sights on five broad areas of interest to the CIUSSS: 

• Electronic health records: “Patients’ medical records now exist in different parts, in different places. A big advantage of going to a modern electronic health record is that it’s a single record, available throughout the CIUSSS. In terms of safety and efficiency, that will be a huge improvement.”

• Building a robust data infrastructure: “We need good data to understand where we’re doing well and where we need improvement. As well, a large data repository, incorporating all of our administrative and clinical information, can be used together with artificial intelligence and machine learning. This would help us identify, for example, patients at risk for re-admission or for a variety of ailments. By using this information, we can intervene at an earlier stage and prevent a serious deterioration in an individual’s condition.”

• Becoming an innovation incubator: Opportunities exist for the CIUSSS to enter into partnerships with external third parties, “such as cutting-edge start-ups or perhaps academics, who can refine their products in our environment. They may have fantastic ideas that could be useful for clinical care, but they don’t have access to a big healthcare data-set to work with. With the proper privacy and security protections in place, they can test and fine-tune their products, while we derive benefit from using them.”

• Tele-health: “We’re trying to determine how to best take care of healthcare users, no matter where they are—not necessarily in the hospital or a doctor’s office, but possibly in their own home or in a long-term care facility. The goal is to promote convenience and efficiency by being in digital contact with users, while cutting down on the number of unnecessary trips that they take.”

• Patient engagement: “We want to make it possible for people to use their phone for tasks like scheduling an appointment or requesting a refill of medication. We’d like them to be able to log in and view lab results, or perhaps even see other parts of the medical record, where technically feasible. We know that when patients are more engaged with their care, they have better outcomes—and digital technology can help make this happen.”

Involving staff in choosing the right technology

Dr. Cross says he’s aware that some members of staff may be unsettled about the imminent arrival of more digital technology, possibly because of reports from the U.S. about the additional and unexpectedly heavy workload that resulted after new technology was introduced in some American institutions.

In several of these instances, problems arose after inadequate software was implemented, Dr. Cross explains. In other cases, difficulties were associated with the complex documentation of the U.S. insurance system. Further problems involved the complicated way in which clinical notes are documented, and the way authorization is granted by insurers before treatment can begin.

“From a usability standpoint, the solution is first to choose software with a good user interface,” he says. “Then, as we install the software in various clinical departments, we’ll have our staff fine-tune the screens and the workflow to meet the employees’ practical needs.

“In addition, we’re learning some lessons from other institutions that have done this before. Since a lot of the big centres have been through this process, we’re well aware of many of the common pitfalls to avoid.

“The thing to keep in mind is that this is a big change-management project. It’s not just a question of, ‘Hey, we’re going to buy some new software and install it.’ This is going to require partnership with the clinical departments, along with a planning process, an analysis process and an implementation process.

“We’re also going to give employees the proper instruction—not throw them into the deep end and hope they’ll swim. And once we’re in the new environment, we don’t expect perfection on day 1, so we’ll actively continue the collaboration and partnership. We’ll have support staff on the floor as we start, and they’ll be there in the months to come.”

A close working relationship is also under way with Jacques Laporte, the CIUSSS’s Interim Chief Information Officer (CIO). To understand the division of responsibilities, Dr. Cross sees the CIUSSS’s technology and digital health system as a ship that is operated by the CIO (who oversees the computers and network) and steered by the Chief Digital Health Officer (who selects the digital tools and puts them into use), while working in close contact with the Chief Medical Information Officer (CMIO).

The latter position is held by Dr. Lawrence Rudski, who also serves as JGH Chief of Cardiology and Head of the Heart Centre. As CMIO, Dr. Rudski acts as liaison between the medical/clinical staff and the digital team, while having a key voice in the acquisition process for digital technology, and ensuring that any technologies chosen will meet the needs of clinical staff.

“There’s always a danger of people chasing shiny technology, because it’s the cool thing to do,” Dr. Cross says. “That’s why it’s essential for us to stay focused on our goals, the problems we’re trying to solve, and the solutions that will really work for us.”