Myra Davis, SVP & CIO, Texas Children’s Hospital, Chapter 2

If you ask Myra Davis, there’s a big component many leaders are missing when it comes to leveraging data: education. An organization can have all the coolest tools and technologies, but if clinicians don’t understand what exactly is available and how they can interpret it, the data just isn’t worth much. In this interview, the CIO of Texas Children’s Hospital talks about how her team has dealt with clinician expectations when it comes to data, and how they’re utilizing education and dashboards to help them get the most out of it. She also talks about the work her organization has done to implement an EDW and their plans going forward, how breaking down silos between IS and clinical has helped empower users, her strategy when it comes to fostering innovation, and why still thinks the industry is “a lot of fun.”

Chapter 1

Chapter 2

• Dashboard education
• “The ability to understand technology is where we’re falling short.”
• Focus on evidence-based guidelines
• IS participation in care groups — “They realize they speak very different languages.”
• Adopting a clinical liaison model
• Plan, do, study, act — “If it’s not working, we’ll figure out how to make it better.”

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Bold Statements

It’s not that we have a shortage of the technology — we have that. The organization’s ability to understand the technology is where we’re falling short. So we’re really working closely with them on their structure and to educate them on what’s available.

We’ve been slow behind the eight ball on that one, but that’s something we’re focused on as a part of this effort. Because again, we have the data, but to pull the science and the methodology together associated with analyzing the data is an area of opportunity for us.

What I hear from the clinicians is that it’s been very valuable to have our IS team members participate as a part of their collaborative team, because they realize that they talk very different languages. And we do.

We’re really pushing the concept of self-service, education on tools, and working with our quality group to establish clinical liaisons who can be resources available to assist providers in understanding how to utilize the tool and interpret the data.

We are always looking to identify what’s not working, how can we make this better, let’s go through another cycle, let’s do a validation. That’s very positive about this organization — if it’s not working, we’ll figure out how to make it better.

Gamble:  When you talked about dashboards, I guess that’s kind of one way of taking it by chunks and maybe solving one issue at a time. Is that one way you’re doing it?

Davis:  Yes. What we have are dashboards for clinical care and operations. So for operational leaders, we have dashboards that speak to work hours per unit of service for hourly staff so that our leaders are able to really analyze operationally how they’re doing from a staffing standpoint. We have financial dashboards where every leader in the organization is able to see how they’re doing financially. So there are no excuses for running significant variances in your shop, because that data is available to you. These dashboards are all self-service too. We have a place — a SharePoint site — where you can go, if granted access, to these particular dashboards, depending on your role, and get that information.

When you look at it operationally, with the type of data that the organization is using, there’s a level of maturity there because they understand it. When you flip over to the clinical side, because there’s just so much and so many ways to do it, we have some dashboards available where providers can go and explore particular populations and get lists and just understand how many patients do I have that are hemoglobin, etc., so there are certain things they can do. But again, if they don’t know they can do it, then they say there’s nothing available to them. It’s not their fault; they just don’t know. So we’re working very closely with our quality group who are committing to assist and take a lead in establishing the true structure that can really be a core structure to deploy to the organization and make available as resources to help providers understand all of the tools that are available.

Because again, it’s not that we have a shortage of the technology — we have that. The organization’s ability to understand the technology is where we’re falling short. So we’re really working closely with them on their structure and to educate them on what’s available and then allow them to educate the masses. And we actually believe that this could happen. We’ve seen this model in other organizations and it seems to be working really well, so we’re going to give that a shot.

Gamble:  Are you mostly speaking about the clinicians on the hospital side, as far as accessing the data?

Davis:  Yeah, it’s hospital and ambulatory.

Gamble:  Alright, so a lot involved there. And I really like the point you’re making about the education component, because I think that’s something that gets lost when people are talking about this whole process.

Davis:  It does. I think we made the same mistake. We just assumed everybody understood and they knew what to do and, well, we shouldn’t do that. You know what happens when you make assumptions. It happened to us.

Gamble:  Yeah. In terms of evidence-based guidelines and creating the processes that follow the evidence-based guidelines, is that something that’s also challenging as far as staying on top of those, because they are guidelines that can change, especially as different research comes out?

Davis:  One of our physicians, Dr. Charles Macias, runs our EBOC group, our evidence-based outcomes center, and he and that team track guidelines. We have one really good evidence-based guidelines for septic shock that was created not by Dr. Macias, but Dr. Eric Williams and some of the other resources, and it was a team effort. We need to do more of that and then feed that into whether we’re going to do BPAs in Epic or guidelines or health maintenance plans. That’s an area we need to also get better at. We’ve been slow behind the eight ball on that one, but that’s something we’re also focused on as a part of this effort. Because again, we have the data, but to pull the science and the methodology together associated with us analyzing the data is an area of opportunity for us as well.

Gamble:  When you talk enterprise data warehousing and the transformation going on there, is it a challenge when you’re involving IT and other stakeholders, and if so, how do you kind of address that? You talked before about the difference between operations and clinical, even with things like dashboards. Is that something where you have to form different teams or how did you approach that?

Davis:  That’s a really good question. I had mentioned the care process teams that we formed by different cohorts, and there’s an enterprise data architect and there are Epic analysts that participate on the team. What I hear from the clinicians on the teams is that it’s been very valuable to have our IS team members participate as a part of their collaborative team, because they realize that they talk very different languages. And we do. And so, it’s been very beneficial to have them all together when they’re talking about specific cohorts, etc., about what the analyst is seeing in the warehouse or in the table schema — the feel may be something very different, and the provider is just saying, ‘Is the data in there?’ So there’s been some really comical stories about how they’ve come to terms of what data really means and how they have interpreted data. So that’s been proven to be very beneficial.

What’s not beneficial is when we have our reporting analyst sitting on the floor and a call comes in asking for a report of some sort, and the analyst will generate that report and give it back to the requester and then the requester will say, ‘That’s not what I asked for.’ And the analyst will say, ‘That’s exactly what you asked for.’ That’s a classic case of how it’s not working when you think all you have do to is make a phone call to someone who’s looking at so many ways to interpret your question and extract that information, to where you’re constantly going back up and forth, and by the time the data is given you, it’s very stale, it’s not fresh. And so, therefore you as the requestor say, ‘It’s useless.’ It makes no sense to call IS if it’s totally useless.

Well, the report is useless and the process is extremely useless and inefficient. That’s why we’re really pushing the concept of self-service, education on tools, and working with our quality group to establish clinical liaisons who can be resources available to assist providers in understanding how to utilize the tool and interpret the data. That was a lot.

Gamble:  So ideally, the clinical liaisons have some kind of familiarity with both groups — they have the clinical knowledge but then also enough IT know-how to be a go-between?

Davis:  Yes. And again, we don’t have that group established, but that’s the model that we’ve been studying at some other organizations, and we’re looking to adapt that model ourselves. But the goal would be that they understand and have that knowledge, have a little bit of both. Enough to be dangerous, but also enough to be extremely helpful.

Gamble:  So what would you say are the next steps you’re working toward with all of this?

Davis:  The quality leader is building the structure; she’s appointed the leaders to build the structure. The good news is that we realize we actually have people in the organization today, but we’re very disparate and siloed, and so she’s changing that up and building a good structure, and we’re really excited about it.

Gamble:  So again, that ongoing process.

Davis:  It’s plan, do, study, act — PDSA — over and over again. Let’s do it again and again. And the good news is that we are always looking to identify what’s not working, how can we make this better, let’s go through another cycle, let’s do a validation. That’s very positive about this organization — if it’s not working, we’ll figure out how to make it better.

Gamble:  Yeah, that kind willingness to look at different options.

Davis:  Right.

Gamble:  You mentioned once or twice about models that other organizations are trying. How do go about reaching out to other people?

Davis:  As CIOs, we identify things that we’re struggling with and we just ask around, ‘hey, what are you doing?’ I was at a recent Epic user group meeting and sat in on a couple of sessions where they were talking about reporting. I identified those because I knew the challenges we were having, and I identified where they were doing something different. These organizations had different structures in place, and I said, ‘You know, we need that. That could be what we’re missing.’

And then some physicians that Texas Children’s had gone to some other organizations and came back with an idea, and so that’s how we do it. We just call around or we go to sessions and we learn different things and we bring it back. And again, the good news is that our organization, Texas Children’s, is always open to making ourselves better, so we listen, and if it’s worth it, we’ll give it a shot. What can go wrong? And that’s sort of how we look at it. It’s not working now, so you can’t go wrong by trying something different.

Gamble:  Right. I guess you really need to have that collaborative spirit right now?

Davis:  Yes.

Chapter 3