Matthew Kull, SVP & CIO, Parkland Hospital, Chapter 1

One component that cannot be overlooked when planning a project? The need for agility, according to Matthew Kull, who says that when Parkland Hospital’s newly opened campus was designed 7 years ago, the strategy was to build a platform to support technology — but defer decisions on which devices would be implemented. It’s this kind of decision-making (which may have avoided having a hospital full of BlackBerries) that has made Parkland one of the most respected hospitals in the country. In this interview, Kull talks about the organization’s strategy to move away from customization, how his team tests technologies in mock environments, and their big plans with big data.

Chapter 1

• Parkland’s 870-bed safety-net hospital
• Upgrading to Epic version 2015
• Back to basics — “We’re focused on getting back to the Epic foundation.”
• Data exchange with CareConnect
• IT’s role in Parkland’s 2020 strategic initiative
• “We’re deeply embedded in each of the core enterprise strategic objectives.”
• Facility planning — “The industry changes so quickly.”
• Need for agility with mobile strategies

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Bold Statements

We’re focused on getting back to the Epic foundation on a lot of our areas where we had customized early on for capabilities that they didn’t have. As Epic has caught up and expanded the platform, we’re doing our best to go back to their products.

We’ve aligned our projects and our roadmap to the 2020 Parkland strategic initiative. We also work with all of our business constituents to ensure that their plans and their initiatives in line with Parkland’s overall strategic objectives are not only technically sound, but can be done in a fiscally responsible way utilizing technology that we are already have in-house.

We are deeply embedded in each of the core enterprise strategic plan initiatives; we don’t separate them. IT, operations, clinical, and finance all have a fairly tight relationship, and we work in concert and conjunction with one another as opposed to splitting initiatives off and running them in their own track.

There are clinical paradigms that have been defined and developed and well-proven, and there are procedures and treatment plans which will continue to be utilized, but it’s really through the application of technology that we’re able to apply those clinical procedures in an appropriate manner so that we are really staying ahead of the curve of illnesses.

When we were talking about a mobile strategy, we discussed it a year and a half before the hospital opened as opposed to seven years ago when the hospital was designed. Had we picked it seven years ago, the hospital would be full of Blackberries.

Gamble:  Hi Matt, thanks so much for taking some time to speak with healthsystemCIO.com.

Kull:  Thank you for having me.

Gamble:  Let’s start by getting some general information about Parkland, starting with bed size and then the ambulatory clinics you have.

Kull:  Parkland Memorial Hospital is Dallas County’s public hospital. We are the safety net for Dallas County. We just completed the opening of a 2.5-million-square-foot campus to serve Dallas County’s most underserved patients. We’re licensed for 870 beds and we see about 1 million outpatient visits a year.

Gamble:  We’ll get into the new campus in a bit, but first, in terms of the clinical environment, you have Epic in the hospital and clinics?

Kull:  Yes. We are a single implementation of Epic for our hospital as well as our community outpatient clinics.

Gamble:  How long has it been in place?

Kull:  We are just approaching 10 years of our EPIC lifecycle. We were a fairly early adopter.

Gamble:  Definitely. What version are you on?

Kull:  We’re currently on 2015.

Gamble:  When was that upgrade?

Kull:  We finished the upgrade in the middle of this past year.

Gamble:  Was that fairly cut and dry, or were there major changes that came with it?

Kull:  It was typically pretty cut and dry. As an early adopter, we’re focused on getting back to the Epic foundation on a lot of our areas where we had customized early on for capabilities that they didn’t have. As Epic has caught up and expanded the platform, we’re doing our best to go back to their products, and over the course of the last several years of this taking place, the upgrades have gotten significantly easier for us.

Gamble:  Are you exchanging data with other Epic organizations through CareConnect?

Kull:  We certainly are. I believe we’re at over a million exchanges a year, and we’ve exchanged data with 47 of 50 states.

Gamble:  And are you part of any HIEs?

Kull:  We are not.

Gamble:  It seems like things run a little smoother when you have something like Epic CareConnect.

Kull:  It certainly does. I don’t know if you follow the HIEs in Texas, but we had a number of them that didn’t quite get off the ground, and I don’t think that has completely settled here. It is something that we’re exploring with some of our closer partners, but right now, we purely connect through Epic.

Gamble:  Are you using Epic’s data warehousing solution?

Kull:  We are. In fact, Epic’s data warehouse is the foundation for our entire analytics platform. We federate data from about 180 different sources, but Epic is our main source of reference.

Gamble:  As far as long-term plans, I noticed on the website that Parkland has a 2020 strategic plan, and I imagine that a whole lot of that involves IT. Have you had input either in creating or updating this plan?

Kull:  Certainly. Either I, or one of the other leaders from my division, sits on each of the five Parkland 2020 pillars. As a result, we’ve aligned our projects and our roadmap to the 2020 Parkland strategic initiative. We also work with all of our business constituents to ensure that their plans and their initiatives in line with Parkland’s overall strategic objectives are not only technically sound, but can be done in a fiscally responsible way utilizing technology that we are already have in-house where possible.

Gamble:  Do these discussions go through a formal process for the 2020 initiative?

Kull:  There’s an executive sponsor over each one of the 2020 pillars, and with that, there are a series of panel and focus groups that are involved in not only building the roadmap for each one of the top level strategic initiatives, but also to ensure that they make progress. And that executive sponsor is responsible for reporting out to organizational executive leaders on the ongoing status and progression.

Gamble:  Is there a separate IT strategic plan?

Kull:  We have a strategic plan that’s more of an underpinning for our consolidation work for our technical delivery roadmap that has to do with software lifecycles and upgrade and refresh iteration. We are deeply embedded in each of the core enterprise strategic plan initiatives; we don’t separate them. IT, operations, clinical, and finance all have a fairly tight relationship, and we work in concert and conjunction with one another as opposed to splitting initiatives off and running them in their own track.

Gamble:  This certainly seems like an efficient way to do things. But was this a fairly recent development or is this kind of pretty much how the organization has been the strategy that’s been used?

Kull:  I think that the depth of partnership has certainly evolved over the last 12 to 36 months. I think Parkland historically had not had that type of collaboration with its technical group. A lot of our clinicians are becoming more technically savvy. A lot of our administrators have a better understanding of the impact of technology, so that partnership and that closeness has definitely evolved.

To tie it back to the new hospital we’ve built, we believe we have one of the most technically advanced hospitals in the country — if not the world — and every single component or operating feature of the hospital has some connection to the technology group. It’s gotten to the point where the lighting systems have servers in the data center. There’s more dependency, and I think because of that dependency, we realize that we’re all co-reliant on one another to bring successful outcomes to our patients. What was once nascent has turned into real-life collaboration.

Gamble:  I’m sure it takes time to make something like that happen and make it a sustainable strategy.

Kull:  Certainly. There are clinical paradigms that have been defined and developed and well-proven, and there are procedures and treatment plans which will continue to be utilized, but it’s really through the application of technology and technical constructs that we’re able to apply those clinical procedures in an appropriate manner — almost in a predictive manner — so that we are really staying ahead of the curve of illnesses and taking care of the patient in a way that we were unable to some years back without the application of advanced technology.

Gamble:  You mentioned building the new hospital. This seems like a situation where there was a drastic change from having an older building. I want to talk about that, but first, you joined the organization in 2014?

Kull:  Yes, about two years before the go live of the new hospital.

Gamble:  At what point were the building plans? Did you have to jump right in and take on that role?

Kull:  The plans were underway but they were not finalized in all areas two years before the hospital had opened. One thing that some of the early designers of the organization realized was that the hospital itself had to have robust infrastructure, and it had to have a platform upon which many technologies could be deployed. When the hospital was in its design phase seven years ago, it was realized that technical decisions couldn’t be made at that point on what devices were going in and what software packages would be used, because the industry changes so quickly.

When we were talking about a mobile strategy, we discussed it a year and a half before the hospital opened as opposed to seven years ago when the hospital was designed. Had we picked it seven years ago, the hospital would be full of Blackberries. So it really was a wise decision to build digital infrastructure, to build wireless connectivity, to build easy access to fast bandwidth between sites. A lot of the technical decisions on what platforms were going to be implemented actually happened within the two years prior to the hospital opening.

Gamble:  Are there challenges when you have to be agile with planning and be able to fill in some of those blanks later in the game?

Kull:  I always use the analogy of the iPhone. The iPhone is a great computer; it’s a great device. It didn’t have maps on it until somebody built a maps app. It didn’t have a camera on it until somebody built a camera. It didn’t have a flashlight until somebody built a flashlight app. That’s the approach that some of the early designers took with the hospital — let’s build a platform that creates capability for a lot of different things, and then put those things on the platform close to its go-live.

I think the agility really came down to having the right decision-makers from the operating side to participate and understand the plan was to accelerate the decision process around selecting technologies later as opposed to spending a lot of time on the drawing board early when it came down to kind of the actual logo that went on the software package or the device. It definitely took a certain discipline.

Chapter 2