J.D. Whitlock, CIO, Dayton Children’s Hospital, Chapter 3

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

Chapter 2

Chapter 3

• His first CIO role — “It’s an opportunity to enjoy the strategic part.”
• Operations experience with the Air Force
• Getting “up to speed” on cybersecurity
• “We have to make smart decisions”
• Draw of health IT – “It tends to attract great people.”
• Challenges with MIPS & MACRA
• Value-based care: “It’s the only way forward.”

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Bold Statements

I’ve got my phone ringing off the hook with vendors who are going to help improve our security, but of course none of this is cheap, so we have to make smart decisions about what we’re doing.

It was an intentionally broad operational experience, which is really convenient to have. It’s convenient to have worked on the health plan side when you start talking about population health and claims data.

Now we’re taking a step back from the mandatory bundles, which I think is the right thing to do, because when you’re doing these bundles, you have to get people collaborating that don’t all work for the same organization. I’m not sure you can force people into that. It ought to be a voluntary thing. 

That’s part of the reason why value-based care is generally the only bipartisan issue in Congress. There’s really no other good solution. It’s not whether we should do it, but how can we actually get there and what policies can the government set.

Gamble:  What was it that drew you to this role? 

Whitlock:  Well, I now commute three miles instead of 47 miles.

 

Gamble:  That helps.

Whitlock:  Yes, it was a big draw. And it’s my first CIO role, so it was an opportunity to enjoy the strategic part and help clinical business leadership think through where we need to go to determine the overall clinical business strategy, and then translate that into Epic and IT services. The timing just made sense. It worked out well.

 

Gamble:  With this being your first CIO role, were there people you reached out to for advice, or things you did to beef up in areas where you may have lacked experience?

Whitlock:  I’ve been in healthcare IT for 20 years now. I started with IT operations when I was in the Air Force, and then got more into the analytics side. Actually, my job at Mercy had a lot of similarities to my last five years in Air Force in terms of supporting analytics for a large integrated delivery network; coincidentally, they had approximately the same size and revenue, even though the Air Force Medical Service is a global organization with a lot of clinics, not a lot of hospitals. Mercy has 22 hospitals in Ohio and Kentucky. And so I had a lot of experience in large integrated delivery networks.

One area in which I’m comparatively weak and trying to get up to speed on is cybersecurity. I have a general awareness just being in the industry for a long time, but I’ll sit down with my chief information security officer here, who by the way is really a part-time CISO — he’s also running the network team. Those are the types of challenges for a small shop. We need to make sure we’re leveraging technology.

Cybersecurity is an area where I’ve got my phone ringing off the hook with vendors who are going to help improve our security, but of course none of this is cheap, so we have to make smart decisions about what we’re doing with things like real-time monitoring. So yes, there are absolutely some knowledge gaps in areas where I have broad experience, but not detailed experience. I started out in healthcare administration with the Air Force before I got into IT; I didn’t come up through coding or IT infrastructure. But I’ve been around it long enough where hopefully I can have intelligent conversations with my CTO about what we need to do from an infrastructure perspective.

 

Gamble:  I can imagine you’ve taken quite a bit from your time with the Air Force in terms of leadership lessons. When I speak to people with military experience, they often talk about the experience and how valuable it was. Was that the case for you?

Whitlock:  Absolutely. My military career actually started in the Navy — and it wasn’t in healthcare, it was on ships. I was two years out of college and had a team of 40 people that were maintaining all the main propulsion machinery on a US Navy destroyer. We sailed around the world and were in Desert Storm. That experience will either turn you into a good leader and manager, or it will drive you insane — or at least away from the military. Hopefully it turned me into a competent leader and manager.

 

Gamble:  We’re learning that there are multiple paths to the CIO role. For you, it seems that path was in having different experiences in different areas.

Whitlock:  I ended up switching from the Navy to the Air Force, where I was a healthcare administrator. Part of what the military does is to make a generalist out of you, because when you need to pick up and deploy and fly across the world to set up a hospital in the desert or a mountain, you can’t have people be too specialized. The military makes you do different things. I did practice management, hospital administration, and even health plan management on the military track before I got into IT. It was an intentionally broad operational experience, which is really convenient to have. It’s convenient to have worked on the health plan side when you start talking about population health and claims data. I didn’t do that intentionally, I was just smart enough to hang out in the military, but I’m very glad I did. I’m very happy to be a retired military person. I get a check every month for doing that, and I have good health benefits. I’d definitely recommend joining the military — it’s the last of the good deals.

Healthcare IT really appealed to me. I love working with the people who are also attracted to that — my fellow geeks who enjoy working in this field. Hopefully there’s some societal good that comes from doing a good job instead of just making a buck by building widgets. That just tends to attract great people, and I love working with them.

 

Gamble:  Right. So, I’m going to close with kind of a big question. In terms of where the industry is heading now with the movement from fee-for-service to value-based care, are you encouraged by the process that’s being made?

Whitlock:  Yes, and no. Let’s unpack that a bit. On the one hand, you have CMS saying that we’re really going after value-based care, but that’s really hard. And there’s been a lot of controversy — for example, the Medicare Shared Savings program. Yes, some organizations are successful. A lot of other organizations are not successful. What does that all mean? Are we doing bundles? Are we doing mandatory bundles? Now we’re taking a step back from the mandatory bundles, which I think is the right thing to do, because when you’re doing these bundles, you have to get people collaborating that don’t all work for the same organization. I’m not sure you can force people into that. It ought to be a voluntary thing. 

And in terms of MIPS and MACRA, what are we doing? Here’s the tricky thing with population health and value-based care. You can’t manage to the lowest common denominator of that independent doc that are grumpily using EHRs in Stage 1, and that’s all they’re ever going to do. Yes, MIPS might be hard for them, but if we go the speed of the lowest common denominator, we’ll never get to that destination.

And there are other frustrations around that. One of my soapbox issues is if government and commercial payers want provider organizations to do population health, we really need to come up with some standardized clinical quality measures for measuring the quality part of the Triple Aim, and we haven’t done that. It would be reasonably straight forward to fix, but nobody seems particularly interested in fixing that. What tends to happen — and I saw this at Mercy — is you have 7 or 8 at-risk contracts from 7 or 8 different payers, and they all have different quality measures. There may be some overlap, but there are a lot of differences. Different commercial payers count things differently; even if you’re looking at breast cancer screening, there are 15 different ways to do it. That’s just impossible. You can’t do it. You can’t do hundreds of quality measures.

I am a huge fan of value-based care. I think it’s really the only way forward. As one analyst said, the reason we have to go forward with this, even though it’s painful, is because the only alternative is major rationing of care, which nobody wants to do. That’s part of the reason why value-based care is generally the only bipartisan issue in Congress. There’s really no other good solution. It’s not whether we should do it, but how can we actually get there and what policies can the government set.

I came from the adult care world where, there’s a lot of Medicare. In the pediatric world, where Medicaid is administered by the state, you don’t have that. In Ohio we have Medicaid Managed Care. There are five companies that do it — none of them are particularly interested in sharing risk with providers, and the state is not telling them to. We’re not really in the same place. I should mentioned that Anthem is working with us — we have a commercial Anthem risk plan. But we don’t have anything meaningful with the Medicaid Managed Care, which is really a shame.

 

Gamble:  It’s really complicated. These are really complicated issues. But as you said, value-based care is the only direction we can go in. It’s going to be interesting to see how things continue to unfold. 

Whitlock:  Absolutely.

 

Gamble:  And it’s an interesting perspective you bring from a pediatric organization, where there’s a whole different set of considerations in a lot of areas, but especially this one. Well, we’ve covered a lot of ground, and I definitely appreciate your time. Unless there’s anything you wanted to talk about, this is a good time to wrap things up. 

Whitlock:  Sounds great. It’s been a pleasure talking to you, Kate.

 

Gamble:  Thanks so much. I’d like to catch up down the road and see how things have gone with the upgrade and everything else.

Whitlock:  Sounds great. Let’s do it.

 

Gamble:  Alright, great. Thank you so much, J.D.