J.D. Whitlock, CIO, Dayton Children’s Hospital, Chapter 1

When J.D. Whitlock started at Dayton Children’s Hospital back in January, it may have been his first CIO role, but he’s no stranger to healthcare IT — or to leadership roles. And so he expected to face challenges, especially with an organization that’s restructuring to lay the foundation for growth. But he also realized the enormous opportunity it presented to help determine the right strategy going forward.

In this interview, Whitlock discusses the many priorities on his plate, including planning for both an Epic upgrade and infrastructure refresh, and putting the analytics building blocks into place to support population health. He also talks about why he’s happy to engage with clinical leaders when it comes to EHR functionality, how he’s dealing with gaps in cybersecurity knowledge, and the many ways in which he has benefited from his experiences with Mercy Health as well as the U.S. Air Force.

Chapter 1

• Dayton Children’s (170-bed freestanding hospital)
• Reorg focused on improving governance
• Telehealth: “We’re exploring different use cases.”
• Upgrading to Epic 2018
• “It doesn’t make sense to invest and not take advantage of everything it offers.”
• New features & functions – “It’s like eye candy to clinical leadership.”
• Building dashboards with Workfront

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Bold Statements

We’ve recognized the problems it has caused in the past and we’re trying to rectify those, because there’s so much great functionality available. It doesn’t make sense to make the big investment in Epic, and then not take advantage of it.

It’s stepping through all the new functionality and what are things we can easily to take advantage of that we’ll get as part of 2018, versus other things that would require a build and plugging into our governance efforts.

As with all things governance, you need to make sure you have the right people make decisions at the right level of granularity with what you’re doing.

We’re building dashboards within that tool to manage it so that when we get together with our customers, we can efficiently rack and stack, prioritize, and give visibility to all the work that’s going on for our application coordinators who are doing their build.

Gamble:  Hi J.D., thank you so much for taking some time to speak with us today. I think the best place to start is with some information about Dayton Children’s Hospital — what you have in terms of bed size, where you’re located, things like that.

Whitlock:  Sure. We’re located in Dayton, Ohio. We have a 170-bed hospital, with about 130 employed physicians. There’s one main campus, and a south campus with ambulatory, surgery, and an emergency department, and then outlying campuses with some urgent care and imaging and other ancillaries.

 

Gamble:  And it’s a freestanding hospital, correct?

Whitlock:  Yes. We have a large rural service area to the north of us, and then to the south of us is one big suburb between Dayton and Cincinnati. We’re in the same general neck of the woods as two topped ranked children’s hospital, Cincinnati Children’s and Nationwide Children’s in Columbus, and so we both collaborate and compete with them.

 

Gamble:  Interesting. That’s something we’re starting to see more of across the country as far as collaborating while competing. And you’ve been with the organization since January?

Whitlock:  Yes.

 

Gamble:  Okay. I wanted to get some of your thoughts on those first few months and how you approached the role in terms of getting to know the organization and staff, and starting to prioritize tasks.

Whitlock:  The way we’re structured, I have a staff of about 100. That consists of the traditional IT staff, as well as the Epic team. It does not include analytics — like a lot of organizations, we have an analytics groups outside of IT on purpose. But it does include the data governance and data management pieces of that. In fact, I was just recently having a chat with our analytics lead about how, in the Epic world, things that look like analytics to the customers are handled very differently inside the application. There are things that my Epic team does that her analytics people don’t do. And so we obviously need to work together to seamlessly help our customers.

 

Gamble:  Has that been the strategy for a while to have analytics sit outside of IT?

Whitlock:  Not for a long time. I don’t have specific knowledge of how things were done before my time. My boss, who is the CFO, has worked with consultants on some reorganization, including things like a clinical informatics group, which will report to our chief medical officer, so that we can create better governance. There had been a lack of good governance, which always causes problems. And of course it’s never done, but we’re working on it. We know we need to pay more attention to it.

Another priority is telehealth. That’s huge. We’re exploring what that means and looking at different use cases. We’re getting together with industry analysts on telehealth and getting some of our senior clinicians together to talk through our use cases and what does that drive in terms of technology needs. Things like the video plugin to Epic so we can do video visits within MyChart, to dedicated telehealth hardware for remote facilities that are not part of our organization and are on other EHRs, to simple use cases we’re already doing. We’re a Cisco shop, so it’s using WebEx and Cisco endpoints that try to make it easier for clinicians to talk between our different campuses.

There’s also the Epic 2018 upgrade. We’re on Epic 2015, so we’ll be doing a double upgrade in November. It’s always a major life event. This, of course, is the last major life event, because after the 2018 upgrade Epic is going to quarterly updates instead. One thing we have not done a great job of in the past was making sure we were always on Epic standard build, and so our hope is that 2018 will help us catch up. We’ve recognized the problems it has caused in the past and we’re trying to rectify those, because there’s so much great functionality available. It doesn’t make sense to make the big investment in Epic, and then not take advantage of all the great stuff. And of course, if you don’t do that, people will go find other bright shiny objects to use instead, which is not optimal.

 

Gamble:  And as far as Epic going to quarterly updates, I don’t want to say it might be easier, because it’s never easy, but do you think it will be more manageable?

Whitlock:  More manageable, yes. I definitely think it’s a good strategy. But I agree that it’s not necessarily easier, because you have to manage it constantly. Instead of using resources on a big go-live, you have to have people working on it, essentially, all the time.

But it does make a lot of sense. I was just joking with my team — we recently did a technical kickoff for the Epic 2018 go-live, and I was telling a story about my previous organization, which was an Epic shop. I remember being at a user conference a couple of years ago where somebody would show off a new functionality and a hand would go up in the back of the room and they’d say, ‘are you going to update that functionality of Epic back to the version I’m on, which is like three versions ago?’ The poor Epic people would shake their heads and say, ‘I’m sorry, you’ve got to stay updated.’ Hopefully help with that.

 

Gamble:  And in terms of the upgrade planned for the fall, where do things stand now? I’m sure that will ramp up soon.

Whitlock:  Absolutely. We’ve already started. From an infrastructure standpoint we’re due for some refreshes anyway, and we’re doing all that in conjunction, so that’s going to be a pretty big investment for us. And then of course it’s stepping through all the new functionality and what are things we can easily to take advantage of that we’ll get as part of 2018, versus other things that would require a build and plugging into our governance efforts. Epic has a 3 or 4-page executive overview of all the new features in 2018 — it’s like eye candy to clinical leadership. They’ll say, ‘That sounds interesting, we want that,’ and we’ll go figure out exactly what that is, what it does and doesn’t do, what the build requirement is, and how we get that all done.

 

Gamble:  Right. And the reorg you mentioned — I can see how that can really help facilitate something like going through a major upgrade and having the right governance structure in place.

Whitlock:  Yes, absolutely. As with all things governance, you need to make sure you have the right people make decisions at the right level of granularity with what you’re doing. You can’t have one governance group that’s dealing with individual report requests on the one hand. On the other hand, you have to have senior leaders making decisions about expenditures of resources for new capabilities or major reporting projects that are trying to mash together data from different places, or integrate new applications, or big ticket things like that. And then some things fall in the middle, where you get clinicians together and talk about what our clinical needs are and how we should prioritize those things.

At the lower level, how do you efficiently deal with all those individual, small Epic build tasks, reporting tasks, and break-fix issues? We use Workfront for our project management software. It does a nice job extending out some smaller tasks in addition to true project management. We’re building dashboards within that tool to manage it so that when we get together with our customers, we can efficiently rack and stack, prioritize, and give visibility to all the work that’s going on for our application coordinators who are doing their build.

 

Gamble:  And when you have Epic (and I’m sure this is true with other solutions), I’m sure it can be a challenge when the users are aware of all these things that Epic is capable of, but the organization is not quite ready for the upgrade. How do you work through that?

Whitlock:  I would much rather have an issue where we’ve got clinical leadership banging on the door wanting new Epic functionality that they saw at the Epic conference or on an Epic user page, and have to explain why it will take a little while to get there. ‘Here’s what we need to do. We’ve go to do this build and then that build and then connect the dots over there, and then we can do that several months from now.’ I’d much rather have that problem than clinical leaders who don’t go to the Epic conferences and see all this stuff, because then they go find other solutions, and that’s a harder conversation to have.

We have XGM coming up here in a couple of weeks. We’re bringing a bunch of folks, including a few of our clinical champions and our governance group, which haven’t been to any events like that in the past. We’re taking them to the physician advisory council, and we’re taking another group to UGM in the fall. We have not done a very good job in the past getting our clinical leadership to those events, and so we’re trying to change that.

 

Gamble:  It seems like even though it can bring some challenges, you’d rather have physician leaders and others who are engaged and want to know more about functionality and things like that.

Whitlock:  Absolutely. People want functionality — it’s a matter of where they’re looking for it first. Sometimes you don’t know what’s available. There are certain pieces of functionality that Epic is rolling out that people wouldn’t know are available until they see it on that little list of new features, and then they say, ‘That’s awesome, we need that.’

Chapter 2