Beth Fredette, CIO, The Children’s Medical Center of Dayton, Chapter 1

In an era where job changes are becoming increasingly common, and skilled IT leaders are in high demand, it’s rare for a CIO to remain at an organization for a decade and a half. But that’s the path Beth Fredette has taken — or, perhaps more accurately, stayed on — and she has “no regrets.” In this interview, Fredette talks about the unique challenges Meaningful Use poses for children’s hospitals, the organization’s plans to expand, and how her team is working to facilitate data flow. She also discusses the clinical transformation at Dayton Children’s over the years, the “collegial” network of pediatric CIOs, and the new leadership role that has made her life easier.

Chapter 1

• About Dayton Children’s
• Partnership with Greenway
• Using Medicity to connect with community docs
• Epic’s Care EveryWhere Network & Ohio’s CliniSync HIE
• MU hurdles: quality measures & patient access
• Success with MyKidsChart
• Destination 2020

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Bold Statements

Having implemented Epic put us in a really great position to be able to apply for funds under Medicaid a couple of years ago.

The relative size of our organization and the IT staff size always pose a challenge for us to meet really big initiatives or accomplish what we do with the small staff that we have.

Is it important for a dermatologist to look at blood pressure or to even record that? We have to evaluate that and make sure we meet the needs of the broadest spectrum of our specialists that we can.

We’re working on all the cool technology that we’ll be able to house in the new tower. What a great opportunity to be able to build all of that from the ground up.

Gamble:  Hi Beth, thank you so much for taking the time to speak with us today.

Fredette:  You’re welcome. It’s my pleasure.

Gamble:  So to get us started off, can you give the readers and listeners some information about Children’s Medical Center of Dayton — where you’re located, number of beds, things like that.

Fredette:  We are a small pediatric facility located in Dayton, Ohio. We have 155 beds. We do roughly 75,000 ER visits every year, about 300,000 outpatient visits, and roughly 7,300 admissions every year.

Gamble:  Do you have any affiliations?

Fredette:  We do not. We are a freestanding pediatric hospital. We do have some alliances or relationships. We do some joint things with other facilities, but we are a freestanding pediatric hospital.

Gamble:  As far as the physicians, do you have both employed physicians and physician offices that you affiliate with?

Fredette:  We do. I think we have roughly 80 employed physicians, but we have 250 active staff physicians. We do not currently own any pediatric offices in the community, but we have relationships and connectivity with a number of them in the community.

Gamble:  So we’ll get into that a little bit more, but first, as far as the clinical application environment, you have Epic for clinicals?

Fredette:  We do. We have been an Epic shop since about 2006. That’s when we signed an agreement with Epic. We run Sunquest for our laboratory and we have our GE PACS for radiology, but we’re largely Epic for all of our order entry and documentation both on the inpatient and ambulatory side.

Gamble:  What about the physician practices that you do work with — are most of or some of them on Epic? How does that work in terms of data exchange?

Fredette:  Very few of them of are actually on Epic. Most of our community practices are running Athena or Greenway. We actually recently started helping some of the physician practices in the area. We partnered with Greenway to do an EMR for physicians who do not have an EMR in place today.

We’ve got actually a great product. We use Medicity to connect with community practices who are interested primarily for results delivery. We are able to accept in-bound orders for those pediatricians who wish to use our laboratory or radiology services when they refer their kids over here. So then we can directly send results back to their EMRs and that enables them to stay within their EMR and choose our lab or our other diagnostic services for their patients.

Gamble:  Are you part of the Care Everywhere Network?

Fredette:  We are. In addition, we are actually also part of the State of Ohio CliniSync, the HIE that is connected to a number of Ohio hospitals. Our physicians, primarily if they want to get information from other folks, they use the Care Everywhere Network to do that.

Gamble:  You mentioned CliniSync — that seems to be one of the HIEs that has a pretty high level of participation and engagement. There are a couple dozen hospitals involved, and that’s something a lot of states are having trouble with. What do you think has been the key to getting that engagement?

Fredette:  Their underlying infrastructure is also Medicity, which I think is a pretty solid platform for that exchange. They sort of seem to have figured that out. Right now, there are a number of us sort of contributing to that. I’m not sure how many people draw on information from that — it’s still somewhat in its infant stages, but so far we’ve been pretty successful with that.

Gamble:  How long have you been part of CliniSync?

Fredette:  I would say for probably around 12 to 18 months.

Gamble:  How are your positioned for Meaningful Use?

Fredette:  We have received our stage 1 funding. Having implemented Epic put us in a really great position to be able to apply for funds under Medicaid a couple of years ago. We have a number of things to finish before we apply for stage 2 money, but we actually had our 90-day period and then the whole year of application, and we’ve been successful in obtaining those funds.

Gamble:  As far as stage 1, was it something that was fairly straightforward or were there like particular challenges for you?

Fredette:  For the most part, it was fairly straightforward. Some of the challenges for us were that all of the quality measures were for non-pediatric diseases, such as stroke and DVT. We really don’t have patients that have those things. We’ve had challenges with the release of information for adolescents. The fact that our kids have proxy access by their parents has been a little bit of a challenge in just deciding what age is appropriate for all of that. And then this is not necessarily attributable to Meaningful Use, but the relative size of our organization and the IT staff size always pose a challenge for us to meet really big initiatives or accomplish what we do with the small staff that we have.

Gamble:  What’s the approximate size of your staff?

Fredette:  For IT and telecom, we have about 80 full-time employees.

Gamble:  As far as the quality measures piece, is that something that was revised at all for stage 2 in terms of the challenges it presents for pediatric hospitals?

Fredette:  With stage 2 they’ve added some pediatric measures, but we’ll have to analyze those measures because selecting an objective that meets the broader spectrum of all specialists that we have, we just want it to be meaningful and important to them. For example, is it important for a dermatologist to look at blood pressure or to even record that? We have to evaluate that and make sure we meet the needs of the broadest spectrum of our specialists that we can.

Gamble:  The access to information piece you brought up is interesting because, as you’ve said, you’re dealing with teenagers, some of whom want to access their information, and we know that they are largely tech-savvy. How is this something that you’re working to address just as far as when they get to see that information and how that works with their parents and family members?

Fredette:  We’re currently evaluating and revising those policies, but in general, a teen over the age of 12 can have access to their information. At 14, we ask them, ‘Do you still want your parent to have access to your information,’ and it’s largely up to them to make that decision. It’s a challenge, and it’s hard to explain to parents of minors that they may not be allowed to have access to that based on their child’s answer, so we’re currently reviewing all that. More to come on that for sure.

Gamble:  Yeah, that sounds like that could get really tricky.  Is there a patient portal at this point?

Fredette:  We do. We use Epic’s MyChart. We call it My Kid’s Chart, and that’s actually been very successful for those patient populations that we’ve rolled it out for. The parents really love being able to see their children’s results, make appointment requests, and refill prescriptions. They can even communicate with their providers. This has been a very successful implementation for us.

Gamble:  Are you doing anything with Telehealth at this point or do you have plans to do so in the future?

Fredette:  We actually are kicking off a series of meetings to talk about really what our business strategy is going to be relative to Telehealth. I anticipate that we will have a strategy probably in the next year relative to that.

Gamble:  That’s an exciting thing. You said you’re just starting to talk about it, so of course it’s in the early stages. That’s something that I know a lot of organizations want to get into, but then you just have to tackle the big issues — the cost issue, and whether you’re dealing with physicians who have to cross state lines, things like that.

Fredette:  Right, and reimbursements and all of that good stuff.

Gamble:  Yeah. Now in terms of data warehousing, what’s your strategy as far as data management, and do you have any plans to do anything with analytics?

Fredette:  Currently, we have not really done anything with that. We do general reporting out of all of our core systems, obviously Epic being the biggest one at this point. We actually just went live on July 1 with Epic’s Revenue Cycle, so now there’s a greater opportunity. We’ve got all of our financial and clinical data housed in the same system.

We’ve actually been talking a bit about analytics and business intelligence and where do we go from here. Again, we are incredibly small and don’t have the large staff to do all of that. So we’ll really look to Epic and what tools they can afford us and how we’ll be able to start mining some of that valuable data that we have. We need to understand really what our business needs are, what kind of data they want to be able to make those outcome decisions. We’re just starting down that path as well.

Gamble:  What did you previously have in place for revenue cycle?

Fredette:  We were on an old McKesson series system.

Gamble:  So it’s just easier to go with the vendor you’re already using for clinicals and things like that.

Fredette:  Correct. Because we’re so small, our strategy is really not a best-of-breed strategy. We have a core set of vendors that we try to use.

Gamble:  That makes sense. I saw seen some information on the site about Destination 2020 and some of the plans there for a new patient tower. Is this something that’s still in the early planning stages at this point?

Fredette:  We’ve actually started tearing things down. One of the things with the new patient tower is that my data center has to move — not a lot of people have that wonderful opportunity to move a data center. We’re actually in the process of building a new data center, which actually should be available to us in the October timeframe, so then we’ll start staging all of that. But all of our staff were located where they’re building the new patient towers, so we’ve moved roughly 200 people to a new location to accommodate that. And they’ve started tearing down buildings, so definitely all the plans are complete. We’re working on all the cool technology that we’ll be able to house in the new tower. What a great opportunity to be able to build all of that from the ground up. We’re targeted to open I think in 2017 with that with the new tower.

Gamble:  I would think that’s a really cool opportunity, especially when most of the time you’re dealing with buildings that aren’t necessarily old but are older.

Fredette:  Right, and trying to retrofit. This is the perfect time to implement cool new stuff.

Chapter 2