Q&A with CIO Jim Daly, Part 1: “We Can Only Go as Fast as Folks Can Execute.”

A little trepidation isn’t such a bad thing.

In fact, Jim Daly believes it can be quite beneficial, when channeled properly. “Being scared can be good. It lights a fire under you to absorb and ask a lot of questions,” he said during a recent conversation with healthsystemCIO.

Daly speaks from experience, having stepped into the role of CIO at Washington Regional Medical System in July of 2020, smack in the middle of the Covid-19 pandemic. On top of that, he had only been with the organization — and the provider world, for that matter — for three years, having spent the previous decade on the payer side.

Those three years, however, helped prepare him for the position, largely due to the mentoring he received from Becky Magee, who retired this past summer after 20 years with the organization. “She really invested in me and helped me learn and grow,” noted Daly, who hopes to provide the same career growth opportunities for others.

During the interview, Daly talked about the biggest challenges he has faced since taking on the CIO post, his thoughts on what it takes to manage change successfully, and how his prior career experience has helped shape him as a leader. He also discusses the organization’s core objectives, including migrating to a single platform to create a “true longitudinal record,” and their plans to “refresh” the IT strategy.

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Key Takeaways

• After more than a decade of growth, which resulted in multiple EHR systems, Washington Regional is consolidating onto a single platform, with the goal of providing “a more seamless experience.”
• One of the keys in selling the board on a major initiative during Covid was to highlight the interoperability challenges that were exacerbated during the pandemic.
• Rather than relying on outside expertise to lead the implementation, Washington Regional made it a priority to utilize internal staff. “It’s important that our employees are the ones that are leading us towards the future.”
• The importance of governance during a rollout can’t be understated, said Daly, who made sure physicians were represented in the decision-making process.
• When it comes to change management, Daly’s approach is to “create an environment where people had flexibility and felt they were supported and making sure that we had clear direction.”

Q&A with Jim Daly

Gamble:  Can you start by providing an overview of the organization?

Daly:  Sure. Washington Regional Medical System is the only not-for-profit, community-owned and locally governed health care system in Northwest Arkansas. We’re located in Fayetteville, and we have a 425-bed medical center and more than 55 clinic locations across the northwest corner of Arkansas.

We have over 3,200 employees and a little more than 400 providers on our medical staff. We have the region’s only heart institute and Level 2 trauma center, and we also have a neurosciences institute with a comprehensive stroke center certification. We offer a broad line of services to make sure our communities are well served with health care.

 

Migrating to a single EHR platform

Gamble:  In terms of the EHR, what do you have in the hospital and the clinics?

Daly:  We have Cerner Millennium In the hospital, and in the ambulatory space, we have a number of different EHRs. Over the past 10 to 15 years, we’ve grown our clinics through acquisitions; as part of that, we’ve allowed providers coming into our system to stay on their own EHR. We’ve spent a lot of time and resources to try to make those interoperable.

Last year, we made the bold decision to consolidate to a single platform. We started an initiative to move our entire enterprise to Cerner: acute, ambulatory and our patient portal. By doing so, we’re able to create a true longitudinal patient record, which will help solve some of the interoperability challenges we’ve had across our clinics, and deliver a more seamless experience for both providers and patients. That’s something we’re really excited about.

 

Using a “phased approach”

Gamble:  I imagine that’s an involved process. What are the next steps in terms of moving that initiative forward?

Daly:  It’s a multi-year program. We’re taking a phased approach in bringing our clinics onto Cerner, starting with our specialty clinics. Many of those providers work in the hospital and are already familiar with Cerner, and so we thought the change might be more seamless for them. We also wanted to take advantage of that interoperability and the longitudinal patient record for those specialists.

The next two phases are bringing over the family practice clinics and OB-GYN services. We hope to finish that by the middle of 2022; our first go-live is scheduled for September of this year. As you can imagine, it’s been a challenge to launch that project while dealing with the pandemic and making sure we’re making steady progress.

 

Selling a project during Covid-19

Gamble:  You mentioned the pandemic — being in the midst of that, was it difficult to sell the migration initiative to the board?

Daly:  That’s a good question. When we went to our board last year, it was important for us to talk why we needed this now. Our thinking was, ‘we’re in the middle of a pandemic, and there’s a lot of uncertainty around what’s coming in 2021.’ We talked through some of the key challenges we had in terms of provider visibility in the patient record and patients accessing their data in a seamless way. Those challenges were exacerbated by the pandemic, and so we used it as a call to action to say, ‘why not now? We can offer support pandemic response while we’re making progress towards moving to our future.’

We received a great vote of confidence from the board, from our executive leadership, and from our physician community, and then we began really thinking through how we can carve out the bandwidth in our team. We believe it’s important that our employees are the ones who are leading us toward the future, versus hiring a group of consultants to come in and handle the implementation for us.

 

Leveraging internal resources

Gamble:  That makes a lot of sense. Can you talk more about how you’re finding that bandwidth?

Daly:  We’re taking a strategy where we’re using our internal employees. This is a key enterprise initiative, so we’re putting a high priority on it, and leveraging contract resources to backfill our employees where needed, to make sure we’re providing support for our legacy systems while we’re moving forward.

It’ll be challenging, but so far we have really embraced it across the enterprise — not just our IT team, but also our clinician leadership and our executive team. That helps ensure we’re all moving in the same direction and have the full support of the community behind us.

 

Gamble:  And you touched on, you need to make sure there are enough resources to keep things running in the meantime. Can that be challenging?

Daly:  It is. Our applications team is able to provide the support we need. And I have to say, Cerner has really stepped up the plate as well. The other thing that’s interesting is that I’ve been part of many system implementation projects, particularly on the health plan side where you have 100 percent custom development of a solution. And then there’s the other end of the spectrum, where you’re taking things out of the box. With custom solutions, you’re building from ground-up; that takes a lot more effort and time to implement as opposed to taking something out of the box.

I think we’re striking a good balance in terms of our approach. Cerner brings tons of expertise in terms of build configuration and templates that we can leverage, and so one of our objectives is to standardize as much as possible so that we can gain some efficiencies along the way. By taking that approach, we’re able to streamline the implementation.

Don’t get me wrong; it’s still a big effort. It takes a lot of resources and a lot of time. However, I think that approach of aiming toward standardization, and leveraging industry best practices we get from Cerner, will help us meet the objective of delivering a high-quality product. One of our clinician leaders had a great line and said, we want to make sure that when we built the toaster, it makes good toast. You don’t want a toaster that does something else. That’s one of our mantras at the moment.

 

Gamble:  I like that. And so, based on how the first phase goes, will you plan to make adjustments, if needed, with the planning of the subsequent phases?

Daly:  That’s a great question. When we build out Cerner, one thing we don’t want to do with the first phase is build ourselves into a corner. We’ve got a large group of stakeholders across our clinics that will need to address the decisions that are made in that first phase. We’ve addressed that through governance; and so we have physicians who will represent their groups in the phase 2 and phase 3 go-lives and participate in that decision making.

I’m sure we’ll need to make adjustments along the way, but our hope is that we don’t get ourselves in a situation in phase 2 where we need to redesign and rebuild something because it won’t work for those providers. We’re taking some of the resources from the future phases and bringing them forward in our current phase to make sure we mitigate that as best we can.

 

Stepping into the CIO role

Gamble:  From your perspective, all of this is happening as you stepped into the CIO role. Talk about how you managed that.

Daly:  My predecessor, Becky Magee, had been with Washington Regional for 20 years, and prior to that had a very distinguished career in consulting, and a wide range of experience. She announced her retirement early in 2020, about 30 days before the pandemic hit.

So one thing we tried to do early on was to anticipate that I would succeed her in that role. We were working in lock-step, which enabled me to accelerate my learnings in terms of the transition. That was important, as we knew the future months were going to be fast and furious with activity.

At the beginning of the pandemic, we had to stand up multiple Covid screening clinics, scale a remote workforce, implement the telemedicine solution, and provide general support so that we could continue service not only our Covid patients, but all patients.

Our objective is to meet the needs of the entire community. It was pretty incredible of what our team accomplished last year, and I’m super proud of them. We did that through collaboration with our stakeholders and spending time to make sure we understood the workflows that were being requested and aligning the technology to make sure we that need.

 

Keeping security top of mind

Daly:  The other piece is that when there is so much change in terms of technology, whether it’s remote work or telemedicine, information security can sometimes go by the wayside. We purposely made agreements not to do that. We made sure our director of information security was involved in all of our technology decisions, and provided guidance to us, not just in terms of implementation, but also working with our vendor partners and providing them with input so that the solutions we implemented to support those capabilities didn’t put us at a greater risk from a security perspective.

Doing all those things while acclimating to a CIO role was certainly challenging. I was able to do that because we have such great executive leadership, and great teams — all 3,200 Washington Regional employees are fantastic people who are really dedicated to our community and striving to make sure we’re doing everything we can to provide the best patient care possible.

 

Gamble:  I can imagine that even though you were familiar with the organization, it was still an adjustment to step into the CIO role. What was your approach? Did your relationships change?

Daly:  As you mentioned, I had been with the organization for almost three years at that point, and so I had already established a lot of relationships. But we’ve had a number of retirements over the last couple of years, and so I had to form new relationships. I realized I needed to build relationships at a different level and develop C-level relationships, and so my focus was making sure I was really listening to those leaders and understanding their needs, and we continue to do that. I believe the value I can bring is in making sure I understand the organization’s priorities and being able to distill those in the objectives I give my team to execute.

For me, going from a director role where I lead the execution, to more of a strategic role, felt pretty comfortable. I’ve had some strategic roles in the past; but this time, I was trying to manage all of that while understanding that my team was dealing with a lot of change at the same time. Not only was I moving into a new role, but there were organizational changes I wanted to make, and so there were changes for some of the staff who were now reporting to new directors.

 

Creating an environment for flexibility

And of course, everyone is dealing with changes at home, whether you’re dealing with remote learning, or you’re part of the stay-at-home mandate and now have six family members who need internet access. There’s been so much change for all of us in every aspect of life and work. My approach is to acknowledge that, and create an environment where people have flexibility and feel they’re supported, and to make sure we have clear direction and priorities so that folks know what we’re focused on. That has been my approach, and I think it has worked pretty well.

One thing I had to come to terms with is that my style is really to focus on results and try to get those results as quickly as possible so that we can move on to the next thing. I try to be self-aware, and I realized that sometimes I failed to recognize that we can only go as fast as folks can execute. I didn’t recognize that we could only go as fast as folks can execute, and so I had to figure out when, as leaders, we can push, and when we need to back off and let people acclimate to the change we were trying to push forward. It’s very challenging from a leadership perspective, and something I hadn’t had a lot of practice with coming into the role. So there was a lot of learning, which is good. I like to learn.

Part 2