Not every employee at Dayton Children’s Hospital gets a proximity badge, at least at the moment. The authenticators that allow healthcare professionals to log in to their workstations with a tap, tap, taparoo are still in the process of being deployed.
Dayton Children’s, established just over a century ago, now sees more than 300,000 patients a year—many of whom are young patients with leukemia or other cancers and need a variety of treatments like chemotherapy. The western Ohio hospital has the same needs as larger health systems but not the same resources or budget, which means the smaller staff, including its chief information officer (CIO), must be thoughtful and selective about which technologies get deployed first—and patient.
“The kinds of things that we may be a little behind on are some of the ‘nice-to-haves,’” J.D. Whitlock, CIO at Dayton Children’s, the only Level 1 pediatric trauma center in the region, told Healthcare Brew.
Another “nice-to-have” deployment in the works for Whitlock and his team of about 125 IT employees: digitization of paper oncology records. For the effort, developers must sit down with clinicians and place hundreds of individual chemotherapy instructions—also known as infusion protocols—into an oncology module called Epic Beacon (from healthcare software company Epic Systems).
So why didn’t the hospital implement the system earlier?
“We’re small. We have four oncologists. And it was a pretty heavy lift,” Whitlock said.
For comparison, Dayton Children’s has roughly 4,000 employees, including about 300 or so doctors—a small number compared to big sites like NewYork-Presbyterian (which has around 27,000 staff) or Mass General Brigham (which has a total staff of approximately 74,000).
Part of a CIO’s job is to ease the workload—both by convincing business leaders to bring in valuable medical technologies and checking in on the implementation along the way. The job is especially important in smaller facilities with limited resources.
“We want to and need to deliver the same care and the same IT capabilities as larger health systems,” Whitlock said.
Healthcare by the hard numbers
The operating revenue for Dayton Children’s in 2022 was just under $600 million, and the IT budget makes up roughly 5% of that total, Whitlock said. That means the hospital has to be creative and cost-conscious with its technology choices—cutting a redundant project management tool here, adding a contractor instead of a full-time employee there.
Another important priority for the smaller hospital is value-based care, which incentivizes doctors and hospitals to keep patients healthy and out of the hospital so on-premise resources can be used on those most in need and save the healthcare industry money.
Whitlock, who began his career as a healthcare administrator in the Air Force, has experience working with fixed military budgets.
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“You don’t get paid more money if you do more surgeries,” Whitlock said. “I grew up and learned healthcare in that world.”
Part of Whitlock’s job is to “tee up” the pitch for a technology deployment, articulating the benefits, costs, and required personnel for a given project to the decision-makers, like the chief medical officer, chief nursing officer, chief medical officer, and CEO.
Some implementations like the Epic Beacon oncology module, though beneficial, don’t exactly make the hospital any money. As CIO, Whitlock must define the required resources and costs to implement a deployment that just might be the right thing to do; in the case of Beacon, that meant getting documentation of care into each patient’s electronic health record.
“I put together the dollars and the cents and let that conversation happen between our senior clinical and business leaders—that this was the right thing to do for the organization,” Whitlock said.
Gimme an “M”
Whitlock often teams up with Abiodun Omoloja, the chief medical informatics officer. Omoloja is a physician who checks in with the doctors and nurses about resource or tech challenges related to a given deployment. For a project like Epic Beacon, that means asking: Has the team been given an opportunity to review protocols in the system to make sure that the digital and paper records are identical? Does the team have the training it needs?
One major difference between CMIO and CIO: that M. The CMIO is a physician; Whitlock is not.
“We bring different perspectives,” Omoloja told Healthcare Brew. “He doesn’t see things from the medical standpoint. I don’t see the nitty-gritty of the technical standpoint. So it’s important we collaborate.”
Dayton Children’s is about two-thirds complete with the Epic Beacon implementation, according to Whitlock. It’s part of a long list of technologies that both Omoloja and Whitlock have worked on together, including a secure chat, additional Epic modules like the radiology information system tool Radiant, and a voice dictation tool called Dragon. And there will be more to come. Part of the job for Dayton Children’s CIO will be to figure out which deployments make it into that 5% of the budget.
“Sometimes what that means is I have to go back to our operational leadership and say, ‘I know you asked for these three things. You said they’re all really important. But you’re going to have to decide which one is the most important because they’re not all going to happen at the same time,’” Whitlock said.
Some deployments—maybe even a tap badge—will have to be set aside for another day.