The healthcare industry is changing, and the CIO role is changing along with it. Once considered IT chiefs, CIOs are now an increasingly indispensible member of the C-suite, a leader relied upon to both lead hospitals' swelling IT departments as well as help their organizations find success in an increasingly technology-driven world.
Below, seven hospital CIOs share their thoughts on their jobs, challenges and successes.
Question: How has your job changed over the past few years? How do you expect it to change in the next few years?
Mike Canfield. Vice President of Operations and CIO of Firelands Regional Medical Center (Sandusky, Ohio): Several years ago, CIOs were talking about aligning IT strategy with their business partners' and being a strategic partner in the C-suite. While this is clearly still important, our focus has been forced to shift toward regulation and incentive programs. Where we used to develop plans primarily based on our organizations' needs, we now plan primarily based on regulatory incentives and requirements. The two drivers are not diametrically opposed, but they are not completely aligned either.
Assuming data reporting and interoperability requirements move from a standalone program into an ongoing structure like value-based purchasing, this new challenge of balancing the organization's strategic needs with federal requirements will be the new normal.
Steve Hess, CIO of University of Colorado Health (Aurora): With the increased maturity and adoption of our IT tools, there isn't much that we try to do as an organization that doesn't include some component of IT. From strategy, to outreach, to patient engagement to process improvement, our IT tools are a foundational component of those discussions. This is daunting and challenging, but also so rewarding in that we feel we are finally using IT to drive efficiencies, impact care and improve the patient experience in a way that has been envisioned for years, if not decades. Because of this, my role, and the role of healthcare CIOs everywhere, is one that is directly and indirectly involved in just about everything going on across the organization.
We need to know a lot about a lot of things and attempt to be a thread that helps weave the strategy and execution together. I don't see this changing in future years, and will more than likely only expand. This demands that the CIO has a team that really understands the organizational strategy and can connect the dots quickly. It is imperative that the IT team understands where the organization is going and how the IT projects and deliverables fit in. It is also imperative that the IT team is structured in a way to focus on the key objectives of the organization. This creates agility and the ability to work on many major initiatives, the right major initiatives, simultaneously.
Dan Kinsella, Executive Vice President and CIO of Cadence Health (Winfield, Ill.): I started my career as a CIO in September of 2012, prior to that I spent 32 years in the industry as a consultant, focused on IT. So, in many ways, my job changed dramatically. My sense of the changes across the country in the same period are that most CIOs have seen dramatic changes in the expectations of their output: Not just doing more with less, which implies prudence and efficiency, but more importantly providing insight as a member of the management team, versus [providing] only a baseline level of assurance that applications will be highly available. Providing that insight requires looking at existing operations with fresh eyes and anticipating where the business is headed before they know it from the news. Insight creates opportunities for innovation and clever solutions that sustain market advantage.
William Lewkoski, CIO of Metro Health (Wyoming, Mich.): We have moved beyond going digital (implementing our Epic electronic health record), meeting meaningful use and planning for ICD-10, to [being an organization] focused very strategically on the future of healthcare delivery. We are working with our physician partners and developing our organization to be a much more horizontal clinically integrated health system that proactively manages our population of patients.
We certainly need to continue to be focused on quality, safety, patient satisfaction and cost efficiencies, but we also need to ensure great value to those [who] purchase and receive healthcare. This will be our focus over the next several years.
Richard Ong, Vice President and CIO of Saint Vincent Hospital (Erie, Pa.): There's a greater collaboration that's happening now between healthcare CIOs and their senior executive counterparts because IT is involved in so many departments. We're exposed to so many different opportunities and nuances because of our work with a wide variety of information [systems] and processes, and we're asked to be more involved and integrated with the opportunities faced by a hospital, and asked to help the hospital be more innovative in the way we conduct the business.
I wouldn't be surprised if this type of involvement leads to CIOs being asked to help lead these initiatives more directly. Rather than being supplemental to discovering these opportunities and nuances, [the CIOs would be] more active in achieving enterprise goals.
Craig Richardville, CIO of Carolinas HealthCare System (Charlotte, N.C.): A decade ago, IT was an expense item. Now, IT has become a vital enabler, no longer an expense, but an essential investment. It is integral to nearly all strategy and operations — there are no more silos, very few "IT" projects. IT has become threaded throughout the organization and a critical element at present to support the business and clinical strategy and operations of the enterprise.
Moving forward, we're looking to drive strategy as healthcare becomes more of a digital industry. We have caught up quickly, very quickly, in my opinion, to other industries such as banking, and will need to continue to learn more with the intent to surpass other industries, such as retail… some retailers, like CVS, Wal-Mart, Target and Walgreens are now our competitors. My colleagues and those we compete with are no longer only in the traditional healthcare industry, but many of my interactions and peers are across many digitized industries.
Ryan Smith, Senior Vice President and CIO of Banner Health (Phoenix): A primary change in the CIO role over the past few years has been focused on positioning the organization for innovation, growth and consumerization of our industry. Naturally, we all must continue our focus on the successful delivery of highly visible initiatives such as meaningful use and ICD-10; however, we are in a new era where healthcare organizations are in pursuit of new revenue streams and reducing operating expenses through technological innovation.
In addition, the consumerization of healthcare is rapidly evolving and a differential service experience is becoming the expected norm. These changes are requiring the CIO to develop new skill sets if the IT organization is to remain relevant to the business environment we're now operating within. We will continue to see these themes play out for the foreseeable future, requiring a new level of strategic partnership between the CIO and the rest of the executive team.
Q: What is the most useful skill a CIO can have?
Mr. Canfield: This must be building the right team. No one CIO is going to have all the skills necessary to manage the technology, set the strategy, be an active part of the senior leadership team, manage the vendors, keep up with regulatory changes and a myriad of other responsibilities. Knowing your own strengths and weaknesses and building a team to adequately cover all the requirements is necessary.
Mr. Hess: The healthcare CIO needs to have an ability to see the big picture and the small details that make up that big picture. Many IT leaders can see the big picture or the small details, but I feel the best CIOs have the ability to see both. The ability to create strategy and oversee execution to help remove barriers is incredibly important.
Mr. Kinsella: In my opinion, teamwork is the most important skill. Note that it does not always mean team leadership — though it often does — but sometimes, being a sounding board or a good follower is equally important. Part of teamwork is having the experience to appreciate how individuals contribute effectively to team objectives, which requires communication, process standards, etc. But it's recognizing that on our best days we are leaders of the band — not soloists.
Mr. Lewkoski: CIOs need to be involved in the strategic planning process. That requires large, [visionary] thinking that doesn't get tangled in the weeds. We must be able to think beyond the challenges of operations, high-demand integration issues and deadlines. You need to surround yourself with a great team to not only handle the day-to-day, but [to be] ready to tackle the ever-increasing project load.
Mr. Ong: I'd say one of the greatest skills a CIO can have is an understanding of the healthcare business. Our business of being a CIO is to align the technology with the goals of the organization, and if you don't understand how a hospital operates, the value you can bring is diminished.
Mr. Richardville: There is not just one, but several. [A CIO] needs to be a strategist, teacher, student, collaborator, contributor, challenger, thought leader — many of the same skills any senior executive needs to have. You can't just bring the technology knowledge.
Mr. Smith: The ability to communicate up, down and sideways is arguably the most important skill for CIOs today. Helping the business understand the critical role technology must play for enabling effective care coordination, managing the health of populations, fostering business intelligence, removing variation and cost and providing a great customer experience is a tall order. To make that case in non-technical business terms requires that the CIO and IT organization learn how to communicate in business terms. Managing strong relationships is a close second.
Q: What do you see as the most "disruptive" technology in healthcare today? How are you responding or how do you intend to respond to it?
Mr. Canfield: The ubiquitous nature of mobile connectivity devices and the expectations they create with our customers. We operate in a somewhat rural and [financially] depressed area and have the benefit of not needing to be early adopters or leaders in the development and deployment of these technologies. We are monitoring what is happening across the country and have regular discussions about what and when we will deploy.
Mr. Hess: There seems to be a plethora of disruptive technologies right now in healthcare from mobility advances to device integration to location services to telehealth to surveillance and many others. I see two technologies that are still early in their maturity that will truly be game-changing once we figure out how to harness the power of them.
Display and visualization technologies will change the traditional computing experience for clinicians and patients. The movement from desktop PCs and tablets to even smaller form factors (e.g., smartphones, wearable devices, etc.) will require different methods for displaying the applications, data and information, and we are starting to see some early capability that will be revolutionary once matured.
[The other advancement is] truly advanced clinical decision support embedded in the EHR. Everyone does some form of clinical decision support, whether through order sets or alerts, but when we can transform data into learning and then inform the clinician and the clinician experience in a way that integrates well with his/her workflow, we can and will make a difference.
Mr. Kinsella: Certainly the Internet has been the story over the past decade, removing constraints of time and place. Looking down the road, I am excited about the translation of genomics to commercial and clinical applications such as personalized medicines and predictive analytics. I see that as incredibly disruptive, in both positive and negative ways. Our preparation for the future includes continued investment in infrastructure, clinical integration and analytics.
Mr. Lewkoski: Mobility and mobile apps are a very promising way to improve patient engagement, but this also includes large challenges with integration, patient team continuity and security and privacy. We are addressing this in several ways, but do not want to get way out in front and experience serious mishaps.
Mr. Ong: From the technology side, the cloud continues to be an area of opportunity to deliver solutions as well as achieve operational efficiencies. That continues to be "disruptive," even though it's been around for a while.
More advancements with the patient portals, too. Given our need or perceived need to achieve better patient engagement, we have to look at the technical modalities a patient would favor. We found patients visit our website 50 percent of the time using a mobile device… it's about how they engage with their care, from scheduling appointments to interacting with caregivers or paying their bill. All of those things need to be that much more advanced as we engage with patients.
Mr. Richardville: There are many in this space as well, but I would say both mobility and virtual care are two technologies that are enabling us to provide access and deliver care in places that, five years ago, not many would have predicted to be possible. They surfaced at the same time, and often don't see one without the other. Traditionally, the patient has come to us for care, now we can go to the patient.
Things like a mobile patient portal allows a patient access to information as well as mobile virtual visits — you can see a provider at any time, which allows you to engage in your care. With wearables, you can upload information into your personal health record that allows to understand your compliance and see how engaged you are — these are all things we're doing right now.
Mr. Smith: That's not an easy question to answer, as our industry is seeing many different forms of disruptive technology evolving at a rapid pace. In practical terms, mobile is shaping up to be a significant disruption across multiple healthcare audiences: the consumer, providers and the workforce. Mobile devices and apps are transforming the way healthcare services are provided, enabling physicians and other clinicians to care for their patients in new and innovative ways. Examples include the remote monitoring and digital interaction with high-intensity patients in the home setting. Other examples include offering mobile patient self-service capabilities, like remote check-in, scheduling, bill payment, hospital way-finding, e-visits, symptom checkers and many more. Tablets will become pervasive in our care settings, replacing cart-based laptops and in-room desktops.
Q: Over the past year, what has been your biggest accomplishment?
Mr. Canfield: Although not very exciting, I think the work I did this past year that will pay the most consistent dividends is refining and improving our internal IT processes and governance. Defining the roles and processes by which we set priorities, refine strategy, manage clinical content and protect our systems has been time-consuming and challenging, but it is an absolutely necessary foundation for the challenges we now face.
Mr. Hess: Being a newly formed integrated health system comprised of three legacy health systems, we have used IT and consolidation of the EHR and enterprise resource planning tools across the health system to help bring our new health system together. The IT integration efforts have sparked collaboration, innovation, standardization, efficiencies and other operational and clinical advancements that may not have happened, or happened as quickly as they have. IT has been part of bringing the system together, and that is extremely rewarding.
Mr. Kinsella: I feel that over the past year I have established solid relationships with members of our health system leadership team (many also new in the past five years) that are foundational to my personal and professional success. This includes assembling my own team of talented direct reports in an Office of the CIO. Now that my 'new guy card' has been shredded, I am personally challenged every day to meet the commitments that we make to deliver the highest value solutions to the enterprise.
Mr. Lewkoski: I am extremely pleased to see my leadership team blossom and become very effective. I also have spent a good deal of time helping our CEO develop a corporate-wide project management office.
Mr. Ong: Saint Vincent's is in a unique situation. As of July 1, 2013, we are officially affiliated with Allegheny Health Network [in Pittsburgh] and became one of its seven hospitals. We were a standalone hospital, and we became part of an integrated delivery network. Our greatest goal has been developing a greater collaboration with the IDN, and we've increased the IT governance and vision at Saint Vincent's as a result.
Mr. Richardville: I do not keep track of "my" accomplishments, because there is nothing that I can accomplish alone. But as a team, our greatest accomplishment has been to embrace this future, to have the courage to stay the course and to set our chosen strategy and to drive and lead the transformation of our industry. I am very proud of our team, all our teammates, and feel extremely fortunate to be a part of it.
Mr. Smith: I'm still relatively new in my CIO role at Banner Health, but a key accomplishment has been the development and endorsement of a three-year IT strategic plan to consolidate and integrate our EHR systems and enhance our consumer digital experiences.
Q: What's one piece of advice you'd offer to other CIOs?
Mr. Canfield: You can't do it alone. You must build effective relationships with other leaders in your organization and with your peers in other organizations.
Mr. Hess: Don't be afraid to stretch the boundaries of being a CIO. I love being a CIO, but much of what I do is not what you would think of a traditional IT leader doing. There is a lot of work in the areas of operational/clinical strategy, process improvement, organizational change management, outreach, merger/acquisition, accountability structures, building physician relationships and many other things. There is nothing better than making IT work and work well, but without connecting the people and the processes, the information technology itself really doesn't matter. Don't just focus on the IT delivery, focus on the total picture.
Mr. Kinsella: As a "recovering consultant," I had a rule of thumb that continues to apply on this side of the desk: Don't ask customers about what they want — because often they really don't know. It's better to work to understand what they are looking to accomplish and come back to them with solutions, including options varying in effort, cost and time to deliver.
Mr. Lewkoski: Partner close with your physicians. It's extremely important that they believe the technology and systems are there for them and they have a very active role guiding their usage.
Mr. Ong: I think we, as healthcare CIOs, have to understand health IT is an enabler, and health IT can be a differentiator. As we focus on EHRs, the focus goes from the transactional EHR to a 'smart' her, and it becomes integral to us delivering quality and efficient care. As we focus on EHRs from a business perspective, we also have to look at how to reduce risk and ensure the availability of appropriate care and manage the patient flow. It's about having the right care at the right time in the right place. Though, many of my peers already know this.
Mr. Richardville: Get a flak jacket – because we must continue to thrive to lead our organizations and move our industry forward. There is a lot of change, and a lot of change at one time. Change management is difficult, defining new standards of work are difficult, working with new technology is difficult, and someone has to take the heat. But [your organization needs] to transform, we have to transform. We [as CIOs] need to lead the transformation and keep our organizations relevant and focus first and foremost on our patients.
Mr. Smith: Establish a solid partnership with key business and clinical executives to mutually develop and set the strategic IT direction for the organization. Leverage those partnerships to help set the IT vision and "sell" the organization on becoming a technology-enabled business.
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