If you aren’t willing to say ‘no’ once in a while, perhaps the CIO role – especially at a relatively small pediatric organization – isn’t for you. Because the reality is that it’s going to happen more than once in a while, and so being able to make tough decisions is a requirement.
There are, however, advantages when you’re a David in a sea of Goliaths. For one thing, “you get used to McGyver-ing things at a smaller facility,” said JD Whitlock, CIO at Dayton Children’s. “It’s nice to have those tools in your tool box.” Another benefit is being able to move quickly, he noted in a recent interview, during which Whitlock discussed his team’s strategy in adopting an enterprise imaging architecture, how Dayton is collaborating with pediatric organizations through an innovation incubator, and why he believes it’s “irresponsible” for leaders to focus 100 percent on Covid.
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- Participating in an innovation “incubator” with other pediatric hospitals enables organizations like Dayton Children’s to “collaborate intelligently without having to stand up a whole separate accelerator.”
- The worst mistake organizations can make when using solutions like MyChart? Failing to turn on all the functionality. “You’re screwing up digital health if you’re going out and buying a bunch of bolt-ons.”
- Smaller organizations have to “make hard choices about what to do and what not to do,” and part of that includes engaging individuals with good ideas and steering them in the right direction.
- At this point, leaders can’t still be 100 percent focused on Covid; the focus should be on operationalizing in a new reality, while dealing with budget constraints.
Q&A with JD Whitlock, Part 2 (Click here to view Part 1)
Gamble: I’m going to guess that you don’t have a huge innovation center, but are there different ways or different channels that people can go through if they have an idea?
Whitlock: Two things there. We do have an academic affiliation — the Boonshoft School of Medicine — which is also in Dayton, Ohio. We have a number of research shops going on in the facility and the residency program, and we have a very mature quality improvement culture. We have a year-long quality improvement class in which clinicians and managers across the organization are invited to participate, and every year we have a crop of really good quality improvement projects that come out of it. Those are the types of things we can move quickly on.
Another thing I’m excited about is KidsX, which is the first pediatric digital health accelerator program. It’s run out of Children’s Hospital Los Angeles, and has several member children’s hospitals from across the country and a lot of incubators. Health systems come together and do a Shark Tank-type of thing where we vote on the most promising innovation and then pilot some of the best opportunities we see. It enables us to collaborate intelligently without having to stand up a whole separate accelerator by ourselves, which would not really be feasible for us.
Gamble: Very interesting. In terms of pediatric digital health, what are some of the trends you’re seeing?
Whitlock: The number one thing is, you have to actually turn on all the functionality in MyChart. You’re screwing up digital health if you’re going out and buying a bunch of bolt-ons. If you do that, you’re not doing MyChart well. That’s the first thing that comes to mind when people ask me about digital.
Another thing we’re doing is we recently installed a chatbot on our website. We have open scheduling because we want to make it easy for new patients to reach us before they’re on MyChart. Most places are doing that now. We use GetWell Network on the inpatient side so that providers can, for example, prescribe education videos for patients and families to watch it in their hospital room, and that then goes back into Epic. They can also order meals — it’s all in one really nicely put-together patient experience package.
We’re about to go live with the WELL Health to provide a more capable texting platform. Obviously, the parents of our patients are at the age where nobody answers their phone, and now we’ll be able to accommodate that. We’re also about to go live with Microsoft’s Customer Insights Platform, which is similar to Microsoft Dynamics CRM, although it’s not technically part of the same platform. But it does provide a CRM-type functionality in a way that was affordable for us.
I know a lot of health systems are spending a lot of money on Salesforce or Dynamics based systems. This is a way of taking the important encounter-based Epic data, plus data from phones, and creating a picture of how we’re interacting with our patients to help our clinicians, our call center staff, and our marketing team have a better understanding of our patients. We’re excited about that.
Gamble: Very interesting. You talked before about creating a quality improvement culture — any thoughts on how leaders can foster that in an organization?
Whitlock: Sure. Because of that academic affiliation and quality improvement culture, there’s no shortage of people who want to do innovative things. It goes back to the earlier comment about how we can move fast on innovative ideas that don’t take a lot of money or labor.
Other times, however, somebody has a good idea that sounds like it ought to be straightforward and easy, but sometimes in the Epic world, things that seem like they ought to be easy take a significant build effort, and we have to make hard decisions. We can’t do everything. We have a small Epic build team compared to bigger facilities, and so we have to make hard choices about what to do and what not to do, and part of it is engaging the people with the good ideas and steering them toward the most efficient way of getting that innovation done.
Gamble: It seems like there’s an interesting balance you have to strike, because you want to get all you can out of the Epic tools you do have and make sure you’re using that functionality.
Whitlock: Exactly. The worst thing you can do with MyChart is sign patients up, tell them to use it to communicate with their doctor, and then not respond in a timely manner.
I’m not saying we don’t do that. We generally do good job of that, but you have to make sure you’re doing the right thing — adding technical functionality and also following through on all the operational things that have to happen. The silver lining with Covid, of course, is the great acceleration of telehealth, particularly those organization that have been able to implement video visits and integrate it with the EHR.
We were able to implement video visits and integrate it within our EHR workflow. In fact, we had just finished with that integration before Covid hit. We got a little bit lucky there. Not everybody was able to do that. You might have video visits, but then the appointment has to be scheduled in the EHR, and separately through the video platform. If you’re integrated, you don’t have to do it.
That has dramatically increased the percentage of our patients that are on MyChart in the first place, and that has helped with other things we want to be doing on MyChart that have been slower because we have a smaller percentage of our population. And of course, we’re a specialty pediatric hospital; we don’t a lot of primary care practices, and so we’re not going to have a super high MyChart percentage compared to an integrated delivery network with a high percentage of primary care. So if your kid breaks her arm and comes to our ED one time, you might not sign up for MyChart. But if your kid has cystic fibrosis and you come see the pulmonologist on a regular basis, you’re going to sign up for it.
Gamble: Right. You said earlier that your region wasn’t affected too much by Covid, but did you have to change protocols just in terms of visits?
Whitlock: As a pediatric organization in Ohio, we didn’t see a lot of Covid patients. However, like every hospital in the United States, we implemented an incident command center for a period of about two months where we were struggling with both virtual health and remote work challenges.
We were preparing to take adult Covid patients if we needed to. I saw a headline that Texas Children’s is in the middle of a hotspot right now, and they’re accepting adult Covid patients because no community wants to do what New York had to do where you’re opening up the local convention center with seriously ill people. We were preparing to do that, and that meant a bunch of additional Epic builds because obviously, that’s not something we would normally do, and so that slowed down some other things we were doing for a couple of months while we were getting prepared. Thankfully, we didn’t have to do that. But if it came to that, or if it does in the future, a lot of the preparations we went through could be used again if we had to.
Gamble: So you have to be ready in the event of a surge, but when you’re in an area that most likely won’t get hit, can that be challenging from a leadership standpoint?
Whitlock: Yes, it can be. We have to be smart. We want to do everything we reasonably can. Obviously in the early days, everybody was 100 percent focused on that. At some point, however, you’re being irresponsible as a leader if you’re 100 percent focused on Covid going forward, and you stop doing everything else you have to do to run your health system and take care of all the rest of your patients. The question becomes, how do we operationalize and support, through the use of technology, this new reality, while dealing with a constrained budget environment? How do we do that while taking care of all of our patients, not just the very small percentage of patients that have Covid?
Gamble: Are there any other priorities we haven’t touched on, either now or in the future?
Whitlock: I talked about a lot of the big ones. We did put a few other things on hold because of the budget. I would love to be able to do a real identity and access management initiative with single sign-on and tap badges to create a better experience for our clinicians with getting into applications securely and make it easier. That’s a big project; it was expensive and we had it ready to go, at least from a planning perspective, but we had to punt on that because we just don’t have the money at this point. Hopefully, we’ll be able to kick that off during the next fiscal year. That’s a good example of something I’d love to be able to do, but we just can’t right now.
Gamble: In some ways, it’s almost an advantage that you’re accustomed to dealing with budget constraints, and it might be easier for organizations that traditionally maybe haven’t faced budget constraints. Is it a good thing being accustomed to having to be careful with priorities?
Whitlock: Yes, I would say it is easier when you’re used to McGyver-ing things at a smaller facility. Sometimes it’s nice to have those tools in your tool box. The other side of that is some of the things were doing aren’t exactly cutting-edge technology. Those are things other systems already have in place. In a sense, we’re falling farther behind by putting that on hold.
Gamble: Great. Well, I think that’s about it for now. I really appreciate your time, and hope to speak with you again.
Whitlock: It was fun. Thanks a lot, Kate.