One of the biggest challenges facing hospitals and health systems is a lack of financial transparency — how much is being spent by which departments, and on which technologies. When Chris Akeroyd assumed the role of CIO at Children’s Health, it became immediately clear that there was a communications breakdown, which resulted in overinvestment in certain areas and underinvestment in others. “It was hard to find a strategy,” he recalled in a recent interview. And so, one of his first priorities was to initiate conversations that have been “eye-opening” and have led to reduced spending and a better understanding of the business.
However, for Akeroyd, who has been with the organization since 2015, it’s just one of many areas of focus for his team. During a discussion with Kate Gamble, Managing Editor of healthsystemCIO, he talked about how they’re leveraging digital tools to create a better experience for pediatric patients and their families; his philosophy when it comes to hybrid and remote work models; and the “immense opportunity” that drew him to the CIO role.
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That’s one of the key things with governance. While the new feature sounds great, is this something we’re ready to take on now? Is this the biggest focus for the organization in terms of what we need to be working on?
We’re looking at some automation opportunities there — are there ways we can automate and speed up the processes? Because we’re pushing digital more and more to the bedside as well.
They should be more thoughtful as to which ones they approve and whether we’re investing the right money in the programs that need attention now, or are we overinvesting in some areas? And so, it’s become a very dynamic and fluid conversation.
It’s very easy to put a project request in — if there’s no charge back to department, then what’s the harm in doing it? And so, when I say ‘investing the right way, I mean, if I told you it was going to cost you $10,000 to do your request, would you still ask for it?
Q&A with Children’s Health CIO Chris Akeroyd, Part 1
Gamble: Hi Chris, thanks so much for taking some time to speak with us. I look forward to talking about what your organization is doing. What are some of the key things on your mind right now?
Akeroyd: We’ve got a staffing shortage issue just like everybody else, and so, it’s imperative on us to help create efficiencies where possible; to shorten cycles and do more with less when it comes to people. And not just internally within IS, but also looking at burnout and satisfaction among nurses and physicians. We’re doing a lot with process automation and reengineering where we’re looking at technologies — what we own and what need to implement and drive forward. And on top of everything is finding ways to secure it all.
That’s at a very high level. There’s also patient experience. We’re doing a lot of work around our digital front door. We’re launching a new app that combines the patient portal with the digital front door we launched earlier this year, and taking that through iterations to improve it.
Gamble: So a lot going on. I definitely want to talk more about your digital strategy. Being a pediatric organization, I would imagine there are some different considerations.
Akeroyd: There’s a bit more complexity to it, especially when you look at all the different laws focused on who can and can’t have access — we now control and maintain that.
Gamble: Can you talk a bit more about the app? Has it been released or is it still in the works?
Akeroyd: We did release it. It’s in production now; it’s a revamped version of MyChart. Saying that probably doesn’t do it justice. It was built on the back end of MyChart, but it has the look and feel of Children’s Health, and it combines a lot of the patient experiences that you don’t get through a traditional patient portal. With this app, we’re providing all of the things people expect: lab results, scheduling, messaging, etc. But it also uses intelligence so that we know things about the patients. Because we know where their appointments are, we can help them with wayfinding from their house all the way to clinic and even throughout our buildings. We can also create an integrated experience when they become inpatients using the same maps.
We’re really trying to drive consistency in a one-stop shop so that our families can manage their child — or children, in some cases — through multiple appointments and experiences.
And how is that managed? Do you have some type of board or committee to make sure patients and families are getting their needs met?
Akeroyd: We’ve structured our governance group with operational leaders, and we back that up with the voices of our families through a family advisory network. Technology is probably the easier part of this. We can do almost anything, but is it impactful? Do we want to operationalize it? Because a lot of this requires a change in how we do business.
That’s one of the key things with governance. While the new feature sounds great, is this something we’re ready to take on now? Is this the biggest focus for the organization in terms of what we need to be working on? We’ve got a robust group of people and a cross-section of both of our hospital campuses, including our VP of patient experience, and leaders from revenue cycle, financial, marketing, nursing, and ED. We’re getting all those perspectives, so it’s pretty well-rounded.
Gamble: And there’s also the rules and regulations that need to be followed when it comes to accessing data. What’s the approach there?
Akeroyd: That’s an ongoing discussion, and it’s something we take very seriously. It takes a lot of time to vet, and so, we’ve devised methods where patients and families get access to data, but full access data until all that can be validated. We’re looking at some automation opportunities there — are there ways we can automate and speed up the processes? Because we’re pushing digital more and more to the bedside as well. If you come to the ED as an inpatient, you can now interact with your care team, see the plans for the day, order food, and access education. We’ve got to get children and families using these tools quicker upon admission. There’s a lot of focus on that right now.
Gamble: Is that something that was accelerated by Covid?
Akeroyd: It was. We developed a telemedicine solution internally called ‘virtual rounds’ when Covid first hit. We’re now migrating to an industry standard platform. Initially, it was about conserving PPE and enabling care providers to have conversations with patients or caretakes. During that time, we had limited numbers of visitors, and so, in many cases one parent would be at the hospital. We wanted to bridge the communication gaps and let everyone speak to the physician at the same time.
That’s when we came up with virtual rounds to enable calls to be made to and from the rooms. There was a lot of security wrapped around it, and it was a very controlled workflow. It allowed our rounding physicians and nurses to manage their patient population through a single dashboard using tablets we deployed throughout the room.
Gamble: You mentioned security — do you have a CISO or equivalent? How involved are you in that world?
Akeroyd: We have an equivalent role at the senior director level. And I’m extremely involved. It is such a critical conversation and such a critical responsibility to this organization and to our patients. It gets, uh, an immense amount of attention from me and from our board. And so yes, we do have a very strong security leader, but I’m engaged in those conversations, plans, and strategies on a regular basis.
Gamble: When you look your priorities now and what you’re looking to do in the future, what are you doing to make sure your strategy is aligned with business operations? It’s something that’s a big focus with our readers.
Akeroyd: That’s a fun conversation. We’ve done a lot of work on that from a few different angles. One thing I noticed when I took over as CIO were the number of project requests and asks coming through, and it was difficult to draw a correlation in the strategy. And these requests were being submitted by operational leaders, which told me that IS needed to get more engaged at that level. We have to help drive the strategy, but we also have to make IT not free. In our financial structure, we didn’t do chargeback; we did an allocation to each campus based on head count per peril hospital facility.
It was a big number, without a lot of definition around it when you look at our hospital leadership and try to run P&L. So we endeavored on a journey that we call technology business management, which is a term related to financial transparency – what are we consuming by service line?
We look it by condition. We look at cancer or cardiology, and we have conversations on the applications that are run, the cost to maintain those apps, the project requests, and the costs to fulfill these project requests. And what’s the runway rate on spend. Those conversations are devised at the level of a service-line leader to optimize that service line and open up those conversations as to where they want to go. Now, we’re able to have some more partnering conversations on strategy.
When you look at the market leader’s perspective, they look at the roll-up. How much does each service line run and are we investing the right way? Since they’re approving projects, they should be more thoughtful as to which ones they approve and whether we’re investing the right money in the programs that need attention now, or are we overinvesting in some areas? And so, it’s become a very dynamic and fluid conversation. It was eye-opening — a lot of our leadership didn’t even know the apps that they ran, even though they had that approved the projects to implement them. And so, level-setting that conversation has been eye-opening for both sides. It has allowed us to do some pretty good application rationalization and cut costs.
Gamble: That’s really interesting. Having that type of alignment should be foundational, but in so many cases, it’s not. Any thoughts on how CIOs can approach this, especially those who might be struggling?
Akeroyd: My suggestion is to just start the conversation. Even if you don’t have the financial numbers, open those conversations about the volume of projects and maintenance work that’s done for each group. You need to have those conversations with leaders — are we investing appropriately in each area? Those are eye-opening conversations when people really start to understand their consumption and hear the message that IT isn’t free. There’s a cost for labor. There’s a cost to each project. And so, I would start there.
Gamble: You talked about investing the right way. Has that been a challenge in your experience?
Akeroyd: When I say investing the right way, I mean that it’s very easy to put a project request in — if there’s no charge back to department, then what’s the harm in doing it? And so, when I say ‘investing the right way, I mean, if I told you it was going to cost you $10,000 to do your request, would you still ask for it? Of course, I’m not going to charge you $10,000, but knowing the number, is this a decision you would make?
When you look at it through a lens like that, how many patients will if affect, or what type of outcomes are we searching for, it really gets down to what are we trying to achieve? What are the results we expect and the results we want to measure? And are we putting enough or not enough money into that effort?