Since the advent of the HITECH Act in 2009, hospital CIOs have been given more responsibility and power to directly influence their organization's compliance, finances and quality of care. With the pressure on for hospitals to implement meaningful use of electronic health records, electronic prescribing and other technologies, hospital CEOs have a bigger stake in the leadership abilities of their CIOs. No longer can health IT and its leaders in the hospital operate separately from other clinical, financial and operational initiatives. This new era in healthcare calls for strong CIO leadership and the inclusion of CIOs as key players in hospital decision-making. Hospital CIOs most adept at fulfilling this role observe the following seven leadership practices.
1. Spearhead system-wide changes. HIT has become pervasive in the healthcare environment; it is a tool for communication between hospital departments, between physicians and patients and between different health systems. CIOs can thus have a much greater effect on the industry than before. "Changes [from health IT] are no longer departmental or smaller changes, they're enterprise-wide changes," says Tim Tarnowski, associate vice president and CIO of UK HealthCare in Lexington, Ky. "The broad impact requires much more of an ability to lead the change than it has in the past."
CIOs' expanded role may require them to gain additional skills and education that go beyond HIT. "It's going to require flexibility and the willingness to change, and it will require acquiring additional skill sets," says C. Martin Harris, MD, CIO of Cleveland Clinic.
Mr. Tarnowski says another important skill for CIOs is "the ability to take a problem or an idea and shape it into a change initiative. The change initiative will include the technology, but also clinical and operational changes. [There are] a lot of influencing and negotiating and persuading that needs to go on to get from start to finish."
Michael Krouse, senior vice president and CIO of Columbus-based OhioHealth, suggests CIOs form a relationship with other CIOs in the country who are in similar organizations with similar goals to discuss challenges and strategies. "Leverage that to your benefit in finding new ways to lead," he says.
2. Align goals with the organization's strategic plan. "[CIOs] are required to be more of a business person than an IT person," Mr. Krouse says. "That means they need to have all the right seats at the strategic business level of an organization." Federal mandates on electronic medical records and health information exchanges have forced healthcare providers to consider HIT projects as a priority and as part of their overall goals for the organization. "You cannot make a business decision in healthcare without having an IT implication," Mr. Krouse says. Therefore, CIOs need to work more closely with the hospital's top executives to understand the organization's business objectives and how their expertise can contribute. "Today, the CIO has to be part of the front-end decisions so [he or she] can formulate the best solution from an IT perspective and translate that business decision into an enabling infrastructure," Mr. Krouse says.
Mr. Tarnowski says CIOs can support the hospital or health system's strategic plan by aligning HIT projects with specific goals. He evaluates HIT requests based on their alignment with UK HealthCare's "signature metrics:" growth, quality and safety, satisfaction; finances; and efficiency. For example, currently the health system's biggest project is automating its ambulatory clinics. This project fulfills the quality and safety metric because automation can decrease medical errors. It meets the efficiency metric by speeding processes and streamlining workflows. "There is a lot of pressure around publicly reported data, healthcare costs and pay-for-performance models," Mr. Tarnowski says. "We have to try to align our data collection initiatives that will feed into those types of external activities we will be held accountable for."
3. Demonstrate value. Dr. Harris says the shift in healthcare to a pay-for-performance model is one of the main causes of CIOs' changing role in healthcare. "We're in a transitional period from a CIO leadership point of view," he says. "[It] is primarily driven by the transition from a model of care that was paying for the volume of service [to] a period where we will be paid for the value of the service that we deliver to patients." Dr. Harris says CIOs will need to consider HIT's value to the organization more than its acquisition and implementation. "[CIO] leaders will not be as focused on the technology in a general sense, but rather on helping our business partners demonstrate the value they deliver through the management of information," he says.
As an example, he cites a study the Cleveland Clinic published in The New England Journal of Medicine. Researchers analyzed the difference in quality outcomes for diabetic patients who were treated at facilities with EHRs compared to those with paper records. "[The study] didn't look at traditional measures for assessing HIT, which would have been things like uptime, response time and direct financial return. Rather, it looked at how well we could care for a population of patients," Dr. Harris says. "They never really mentioned anything about the computer or the network or even the software, but rather, were really focused on what data we would need to be able to demonstrate [the] difference [in care]."
4. Create a multidisciplinary governance structure. As CIOs work more closely with top hospital executives and contribute to strategic plan development, they will need to create a governance structure that includes stakeholders from multiple areas. CIOs' first step in forming a multidisciplinary team should be developing relationships with other hospital leaders. "[They] need to build trust and establish and sustain strong relationships throughout the organization," Mr. Tarnowski says. "Without that, [they're] not going to get anywhere with this magnitude of change."
In UK HealthCare's IT governance model, Mr. Tarnowski is a member of a team that includes the CFO, CNO, CMO, physicians and other stakeholders. The team, which is co-led by a physician and CFO, oversees the organization's IT strategies and priorities. Mr. Tarnowski is the only voting member representing IT, allowing input from other departments to help shape IT's role in meeting the organization's overall goals. "The CIO is facilitating the ability for the organization to articulate the vision rather than being the sole voice of what that should be," Mr. Krouse says. Because IT is becoming central to all operations of the hospital, CIOs need to understand the workflows and day-to-day processes that IT can improve. A multidisciplinary team with representation from different areas of the hospital or health system can provide this information, Mr. Krouse says.
Dr. Harris also sees a trend towards a more integrated IT governance structure. "The mix of people and the kinds of teams that [CIOs] will need to lead will be very different. In the past decade, you had lots of teams that had a very heavy technical influence. I think that influence will get smaller [and] the operational people on the teams will be more varied and in larger numbers," he says. Successful CIO leaders will thus need to be able to communicate effectively with different kinds of people and broaden their focus from the technical aspects of IT to the business and clinical applications.
5. Build clinical knowledge. Technologies such as telehealth, HIEs and computerized provider order entry have the potential to directly impact patient care. The link between HIT and care delivery indicates that CIOs will need to build their knowledge of clinical operations to best serve their needs. Mr. Tarnowski says there is a high demand in hospitals' and health systems' IT departments for "people who understand clinical and operational workflows and the IT implications and help us communicate with clinicians and operational teams in terms of making the new technology part of the DNA of that department."
The need for CIOs to understand clinicians' workflows is becoming increasingly important, according to Mr. Krouse. While CIOs' multidisciplinary team can support them in their application of HIT to the organization, CIOs will not be top leaders unless they understand clinical workflows themselves. "They have to be committed to understanding and engaging on the clinical side," Dr. Harris says. "Being facile with the entire cycle of care, from the home to the physician's office to the hospital to the post-acute setting and back home again, is what's going to be required," he says.
6. Prioritize projects. Prioritizing projects is and will continue to be one of the greatest challenges for CIOs, Mr. Krouse says. "The role of the CIO is to translate the [organization's] business goals, strategy, vision and mission into an IT investment path that mirrors the top quality, safety and business priorities of the organization," he says. "That's one of the hardest tasks to do." CIOs can overcome this challenge by working with their multidisciplinary teams and the hospital's or health system's top executives to determine what the organization's priority is.
HIT's stronger relationship with the business side of hospitals and health systems will also mean that IT projects will be competing against other initiatives for resources. "You're not just comparing an IT project against another IT project," Mr. Tarnowski says. "Now you're comparing it against all the organization's initiatives." Prioritizing the IT projects will help CIOs manage their time and optimize their use of limited resources. "You will never have enough resources, you will never have enough money," Mr. Krouse says. "You have to approach it in a prioritized way."
7. Develop strong staff. Hiring and training skilled HIT staff members is another challenge hospital and health system CIOs are facing due to the competitive environment and expanded responsibilities of HIT in the organization. Mr. Tarnowski suggests offering a competitive compensation package as part of the hiring strategy. In addition, CIOs can work with current staff members to strengthen the IT team. Mr. Tarnowski is developing a mentoring program that includes succession planning and cross training to better understand the overall organization. For example, the IT staff can do rounding to understand physicians' workflows.
Mr. Krouse says mentoring is crucial both for training staff on new skills and for developing one's own leadership skills. He suggests teaching the staff how to think strategically, putting the mind of the patient or the experience of the physician first. He emphasizes taking the time every week to talk one-on-one with each direct report to teach them about the business of healthcare, from the changing regulatory landscape to the paradigm shift of healthcare delivery. He teaches his team to articulate these areas and challenges them by asking questions to assess their understanding. "If you aren't spending that kind of time each week teaching your staff, then you're probably not doing enough to truly lead them," he says.
SSM Health Care CIO Tom Langston: Emerging Role of Health IT in the System's Strategic Plan
Brigham and Women's Hospital CIO Sue Schade: Top Health IT Priorities
1. Spearhead system-wide changes. HIT has become pervasive in the healthcare environment; it is a tool for communication between hospital departments, between physicians and patients and between different health systems. CIOs can thus have a much greater effect on the industry than before. "Changes [from health IT] are no longer departmental or smaller changes, they're enterprise-wide changes," says Tim Tarnowski, associate vice president and CIO of UK HealthCare in Lexington, Ky. "The broad impact requires much more of an ability to lead the change than it has in the past."
CIOs' expanded role may require them to gain additional skills and education that go beyond HIT. "It's going to require flexibility and the willingness to change, and it will require acquiring additional skill sets," says C. Martin Harris, MD, CIO of Cleveland Clinic.
Mr. Tarnowski says another important skill for CIOs is "the ability to take a problem or an idea and shape it into a change initiative. The change initiative will include the technology, but also clinical and operational changes. [There are] a lot of influencing and negotiating and persuading that needs to go on to get from start to finish."
Michael Krouse, senior vice president and CIO of Columbus-based OhioHealth, suggests CIOs form a relationship with other CIOs in the country who are in similar organizations with similar goals to discuss challenges and strategies. "Leverage that to your benefit in finding new ways to lead," he says.
2. Align goals with the organization's strategic plan. "[CIOs] are required to be more of a business person than an IT person," Mr. Krouse says. "That means they need to have all the right seats at the strategic business level of an organization." Federal mandates on electronic medical records and health information exchanges have forced healthcare providers to consider HIT projects as a priority and as part of their overall goals for the organization. "You cannot make a business decision in healthcare without having an IT implication," Mr. Krouse says. Therefore, CIOs need to work more closely with the hospital's top executives to understand the organization's business objectives and how their expertise can contribute. "Today, the CIO has to be part of the front-end decisions so [he or she] can formulate the best solution from an IT perspective and translate that business decision into an enabling infrastructure," Mr. Krouse says.
Mr. Tarnowski says CIOs can support the hospital or health system's strategic plan by aligning HIT projects with specific goals. He evaluates HIT requests based on their alignment with UK HealthCare's "signature metrics:" growth, quality and safety, satisfaction; finances; and efficiency. For example, currently the health system's biggest project is automating its ambulatory clinics. This project fulfills the quality and safety metric because automation can decrease medical errors. It meets the efficiency metric by speeding processes and streamlining workflows. "There is a lot of pressure around publicly reported data, healthcare costs and pay-for-performance models," Mr. Tarnowski says. "We have to try to align our data collection initiatives that will feed into those types of external activities we will be held accountable for."
3. Demonstrate value. Dr. Harris says the shift in healthcare to a pay-for-performance model is one of the main causes of CIOs' changing role in healthcare. "We're in a transitional period from a CIO leadership point of view," he says. "[It] is primarily driven by the transition from a model of care that was paying for the volume of service [to] a period where we will be paid for the value of the service that we deliver to patients." Dr. Harris says CIOs will need to consider HIT's value to the organization more than its acquisition and implementation. "[CIO] leaders will not be as focused on the technology in a general sense, but rather on helping our business partners demonstrate the value they deliver through the management of information," he says.
As an example, he cites a study the Cleveland Clinic published in The New England Journal of Medicine. Researchers analyzed the difference in quality outcomes for diabetic patients who were treated at facilities with EHRs compared to those with paper records. "[The study] didn't look at traditional measures for assessing HIT, which would have been things like uptime, response time and direct financial return. Rather, it looked at how well we could care for a population of patients," Dr. Harris says. "They never really mentioned anything about the computer or the network or even the software, but rather, were really focused on what data we would need to be able to demonstrate [the] difference [in care]."
4. Create a multidisciplinary governance structure. As CIOs work more closely with top hospital executives and contribute to strategic plan development, they will need to create a governance structure that includes stakeholders from multiple areas. CIOs' first step in forming a multidisciplinary team should be developing relationships with other hospital leaders. "[They] need to build trust and establish and sustain strong relationships throughout the organization," Mr. Tarnowski says. "Without that, [they're] not going to get anywhere with this magnitude of change."
In UK HealthCare's IT governance model, Mr. Tarnowski is a member of a team that includes the CFO, CNO, CMO, physicians and other stakeholders. The team, which is co-led by a physician and CFO, oversees the organization's IT strategies and priorities. Mr. Tarnowski is the only voting member representing IT, allowing input from other departments to help shape IT's role in meeting the organization's overall goals. "The CIO is facilitating the ability for the organization to articulate the vision rather than being the sole voice of what that should be," Mr. Krouse says. Because IT is becoming central to all operations of the hospital, CIOs need to understand the workflows and day-to-day processes that IT can improve. A multidisciplinary team with representation from different areas of the hospital or health system can provide this information, Mr. Krouse says.
Dr. Harris also sees a trend towards a more integrated IT governance structure. "The mix of people and the kinds of teams that [CIOs] will need to lead will be very different. In the past decade, you had lots of teams that had a very heavy technical influence. I think that influence will get smaller [and] the operational people on the teams will be more varied and in larger numbers," he says. Successful CIO leaders will thus need to be able to communicate effectively with different kinds of people and broaden their focus from the technical aspects of IT to the business and clinical applications.
5. Build clinical knowledge. Technologies such as telehealth, HIEs and computerized provider order entry have the potential to directly impact patient care. The link between HIT and care delivery indicates that CIOs will need to build their knowledge of clinical operations to best serve their needs. Mr. Tarnowski says there is a high demand in hospitals' and health systems' IT departments for "people who understand clinical and operational workflows and the IT implications and help us communicate with clinicians and operational teams in terms of making the new technology part of the DNA of that department."
The need for CIOs to understand clinicians' workflows is becoming increasingly important, according to Mr. Krouse. While CIOs' multidisciplinary team can support them in their application of HIT to the organization, CIOs will not be top leaders unless they understand clinical workflows themselves. "They have to be committed to understanding and engaging on the clinical side," Dr. Harris says. "Being facile with the entire cycle of care, from the home to the physician's office to the hospital to the post-acute setting and back home again, is what's going to be required," he says.
6. Prioritize projects. Prioritizing projects is and will continue to be one of the greatest challenges for CIOs, Mr. Krouse says. "The role of the CIO is to translate the [organization's] business goals, strategy, vision and mission into an IT investment path that mirrors the top quality, safety and business priorities of the organization," he says. "That's one of the hardest tasks to do." CIOs can overcome this challenge by working with their multidisciplinary teams and the hospital's or health system's top executives to determine what the organization's priority is.
HIT's stronger relationship with the business side of hospitals and health systems will also mean that IT projects will be competing against other initiatives for resources. "You're not just comparing an IT project against another IT project," Mr. Tarnowski says. "Now you're comparing it against all the organization's initiatives." Prioritizing the IT projects will help CIOs manage their time and optimize their use of limited resources. "You will never have enough resources, you will never have enough money," Mr. Krouse says. "You have to approach it in a prioritized way."
7. Develop strong staff. Hiring and training skilled HIT staff members is another challenge hospital and health system CIOs are facing due to the competitive environment and expanded responsibilities of HIT in the organization. Mr. Tarnowski suggests offering a competitive compensation package as part of the hiring strategy. In addition, CIOs can work with current staff members to strengthen the IT team. Mr. Tarnowski is developing a mentoring program that includes succession planning and cross training to better understand the overall organization. For example, the IT staff can do rounding to understand physicians' workflows.
Mr. Krouse says mentoring is crucial both for training staff on new skills and for developing one's own leadership skills. He suggests teaching the staff how to think strategically, putting the mind of the patient or the experience of the physician first. He emphasizes taking the time every week to talk one-on-one with each direct report to teach them about the business of healthcare, from the changing regulatory landscape to the paradigm shift of healthcare delivery. He teaches his team to articulate these areas and challenges them by asking questions to assess their understanding. "If you aren't spending that kind of time each week teaching your staff, then you're probably not doing enough to truly lead them," he says.
Related Articles on Hospital and Health System CIO Leadership:
Virginia's Centra Health CIO Ben Clark: 6 Lessons Learned From EHR ImplementationSSM Health Care CIO Tom Langston: Emerging Role of Health IT in the System's Strategic Plan
Brigham and Women's Hospital CIO Sue Schade: Top Health IT Priorities