Being the CIO of a children's hospital has challenges that an IT executive at a regular health system might not encounter.
For one, health IT software is often developed with adult patients in mind, with kids as an afterthought, according to Denise Zabawski, CIO of Nationwide Children's Hospital in Columbus, Ohio. But that ends up giving leaders like her input on the design of pediatric programs.
Becker's did a Q&A with Ms. Zabawski, who has been with the hospital since 1999 and CIO since 2013, about the big issues she's spending her time on today and what makes her job unique compared to other hospital CIOs.
Note: The conversation has been condensed and lightly edited for clarity.
Question: What has changed most about your role since 2013?
Denise Zabawski: It's definitely more strategic. I have more input on the organization's strategic plan.
Data has become a very big deal: how we can better collect, use and do research with our data.
The partnerships with my peers — either at the VP, senior VP level or the C-level — have changed drastically over the last five years. There's a lot more engagement at the leadership level.
Q: Are you focusing on digital health as well as health IT?
DZ: All of that falls to me. Because of our new strategic plan — a year-plus old — there is a very large focus on digital health, patient and family experience, provider and employee experience. So we have been spending a lot of time on that.
Q: What new initiatives are you particularly excited about?
DZ: I would say taking advantage of the tools in our EHR and turning on a lot of those features in the patient portal: things like online bill pay, online statements, the ability to communicate with your provider, the ability to see your results, to schedule appointments. Those have been very well received by our patients and families as we've turned those on, and we have many other things to turn on. We have a ways to go. But it's all been very positive so far.
Q: Where do you see your role and health IT going in the future?
DZ: Our patients and families want to be able to navigate their care without technology getting in the way. Often there are multiple entry points into the system that require an app for this, an app for that and a phone call for something else. Making the whole care experience streamlined from beginning to end is one of my big focuses. I've seen it work in other organizations. So I know that we have a lot of opportunity.
Q: How does your job differ from that of a CIO at a general hospital or health system?
DZ: Probably the biggest difference is because we're smaller when it comes to working with vendors, the adult systems have a lot more power to inform a vendor's development path. Because they've got more volume. So very often, they may select a product that looks really great but only works for adults. And they don't really have the pediatric content. And we see that with the EHRs as well. The big EHR developers are going to focus on adults first and then they'll go back and add the pediatric content later. The one positive is we often get some input into that pediatric development, which is good.
Q: What are the biggest challenges you're facing today?
DZ: The demand for projects, the demand for change from our end users, is an ongoing challenge probably for all of us. We just can't go fast enough to meet the desires of our requesters.
It's a very weird time for staffing right now. We've seen an escalation in compensation, but at the same time, there've been companies in central Ohio that have laid off IT staff. So we're in a watch-and-wait mode when it comes to recruitment and making any changes to our base pay or benefits. Are there going to be more layoffs? Where is the bottom of this whole economic place we're in?
Cybersecurity is always there. There is so much work to do that a lot of it is in the background. So the nonsexy stuff — like vulnerability management and patching and application lifecycle management and keeping things current — is a huge amount of work that really goes under the radar. Everyone's always talking about ransomware and protection and recovery, which are also super important. But there's all this work that needs to go on in the background as well to create a secure environment overall. So that's an ongoing challenge.
Q: How are economic pressures impacting your job?
DZ: Vendors are raising their prices just like everyone else. With software and equipment, supply-chain delays are still a huge issue. We're looking at nine to 13 months right now for network gear. The desktop gear cycle has shortened a little bit — it's closer to six weeks, which has helped.
And then a lot of our vendors don't have staff either. We tried to start a project in the first quarter of this year, and the vendor came back and said, "I don't have the staff. We're not going to start till next year, 2023." So that often causes a rework of plans, priorities, timelines. Fluidity and adaptability are very important right now.
Q: Where does Nationwide Children's stand with cloud migration?
DZ: We're taking a hybrid strategy to the cloud. We had to make this decision in 2016 and get buy-in from our board of trustees. We needed to relocate our data center, and the board wanted to know why we didn't want to put everything in the cloud. At the time, we decided we really wanted critical clinical systems and diagnostic results to stay on campus. And that we would look at the cloud for everything else.
Many of our vendors are only offering their solutions in the cloud. So we're seeing more and more of our software applications moving to the cloud, which so far has been OK. We haven't really moved anything that would impact patient safety yet. So it's just a constant balance of risk versus reward. We evaluate every new purchase or acquisition against, should it be on premise, should it be in the cloud, or is there some other solution that we should be considering?
Q: Why did you decide not to put that clinical and diagnostic data into the cloud?
DZ: We had some negative experiences probably 10 years ago, where we tried to do scheduling with a cloud vendor. And the latency and downtime really impacted our operations. So we've been a little wary of going that route.
For example, we are running Epic in our data center. We're currently running radiology and lab in our data center as well as pharmacy. But a lot of our other systems are moving to the cloud. We're going to continue to assess as we upgrade, replace and change systems. The vendors can make all of the assertions of five-nines availability, but they can't control the internet. And that is our biggest concern.
Q: What are you doing to retain tech talent?
DZ: While we're doing remote work, like many, we don't plan to bring staff back. We gave them the option of "you can work on campus, you can work at home if your job allows it, or you can work hybrid." It's really up to them as long as their manager approves. Having that control and flexibility has been a real plus. And I know we're not alone in that.
We're doing a lot of internal promotions. So if we have qualified candidates internally for an open manager position, we really need to ask ourselves, "Why would we bring in an external candidate if we have a good candidate internally?" Before COVID, we'd want to interview a couple external, a couple of internal, and pick the best of the best. And we've shifted to show our support for internal promotion, whether it be from a junior level to a senior level or a senior level to a manager.
And then we're working on career paths, really building competencies for each of the jobs and communicating with staff what they need to accomplish to move to the next level. Because when most of our staff leave for different job opportunities, they're going to another organization and they're getting a promotion along the way.
We're focusing on really defining our culture. We believe we have a lot of very positive things about our IT team. We have a great culture across the whole hospital organization. But we want to really highlight what's great about our division.
Q: How is your hospital leveraging big data and artificial intelligence?
DZ: Part of my responsibility is the research information systems team, and that's where our data scientists live. We agreed a couple of years ago that we wanted to recruit data scientists, but they needed to work together. We didn't want them spread all across the organization. And that has been a really good model. They've worked well with clinicians to develop some predictive analytics with some machine learning built in around sepsis and deterioration. They're working on some other projects now as well.
We've had our own data warehouse since even before I started. It's continued to grow and mature but we're at the next level of maturity — which will be a really big shift from the traditional reporting and relational database to that data lake environment, to the user interfaces that will really help our leaders engage in the information versus just getting a report. It's part of our strategic plan, and we're working on the specific data strategy over the next few years.