In collaboration with CHIME, Becker's Hospital Review's "Life of a Healthcare CIO" series features leading hospital and health system CIOs from across the country who are sharing their experiences, best practices and challenges.
To recommend a CIO to be featured in this serious, please contact Akanksha Jayanthi (ajayanthi@beckershealthcare.com).
An interview with Doris Peek, PhD, senior vice president and CIO of Fort Lauderdale, Fla.-based Broward Health.
(Answers have been edited for length and clarity.)
Question: You were named CIO of Broward Health in 2006, but have an IT career spanning 25 years. How have you seen the industry change over your career?
Dr. Doris Peek: Each defining moment in the healthcare industry has brought change and necessary synergy to healthcare IT. In the late 1980s, when billing requirements moved from a charged-based structure to a diagnosis-related grouping structure, the industry turned to IT to drive the change and ensure compliance. In the late 1990s, the evolution of managed care and the government's requirement to reduce the cost of healthcare became key drivers behind the demands for clinical computerization and better documentation tools for the providers. In the early 2000s, business issues, medical errors and improving quality care once again gave impetus to IT.
In early 2000, when the Institute of Medicine gave the clarion call for the use of clinical decision support systems and automated alerts to reduce medical errors, IT responded to the national call to action by beginning the journey toward improved patient safety by implementing clinical documentation, positive patient identification, barcoded medication administration and computerized physician order entry. For the first time in my career, IT was engaged in managing and designing the way clinicians and physicians work. The paradigm shift in workflow required IT to become "clinical consultants" in patient care processes while still ensuring the underlying infrastructure was sufficient to support the change. In 2009, the American Recovery and Reinvestment Act brought more new business models. The IT department had to reinvent itself once again to support the unique operating model and value purchasing proposition.
My career has seen many twists and turns. Yet, when I recall the movement from the mainframe era (where I began) to today's complex ecosystem where legacy and leading edge technology have to coexist, the main focus — the patient — has not changed. By 2015, healthcare IT is estimated to grow $3 trillion dollars, driven by eHealth and the population demanding quality healthcare services. Through all these past, present and future changes, IT has grown in stature. IT is no longer considered "just an expensive cost center". Rather, IT is now a critical enabler of change. Healthcare IT drives innovation, provides the framework for organizational change management, is accountable for technology adoption and educates the enterprise on successful governance — all as a result of actualizing industry trends dictated by business and regulatory needs. IT is vital, and in my opinion (albeit biased), IT is the heartbeat of the enterprise.
Q: In your time at Broward Health, what has been your biggest accomplishment?
DP: There is no one accomplishment, but rather a cascading series of improvement initiatives. Some of the more important projects are for business continuity, disaster recovery, service delivery and clinical process automation. In the past two years, Broward Health was awarded an EMRAM score of 6 from HIMSS. We attested to both meaningful use stage 1 and stage 2 and were recognized as a finalist as an Innovator in Hospital & Healthcare Network magazine. Additionally, I was recognized as a Top 100 Premier Leader by Computerworld magazine. These are extraordinary achievements, especially given the short duration of the journey and the many changes resulting from healthcare reform we have encountered along the way. Broward Health IT is now at the epicenter of moving the hospital system from traditional fee-for-service to an accountable care organization model. So my biggest accomplishment today immediately fades into past with the next organizational change request that comes across my desk. As a healthcare leader in today's rapidly changing environment, I am certain that my biggest accomplishment is yet to come.
Q: What do you see as your biggest misstep or mistake?
DP: We are constantly striving to improve service delivery to our caregivers. In a recent physician satisfaction survey, 30 percent of the physicians gave IT an excellent ranking, 40 percent rated us as a good service organization, 20 percent scored us as average and 10 percent of the physicians rated IT as providing poor service. My remediation plan was centered on moving the good and average scores to excellent, ignoring the 10 percent who believed IT provided poor service. My approach was not founded in arrogance; rather, I was looking for a quick and easy win. Looking in my rearview mirror, I missed a great opportunity to nurture the physicians who ranked us as excellent and good and to learn why 10 percent of physicians believe we provide poor service. I should have had three different strategies: a strategy to nurture and retain the loyalty of the 70 percent who appreciate IT; a second strategy to address the physicians who see as average performers and another to better understand why 10 percent of the physician population sees IT as delivering poor service. This is a mistake I will not repeat.
Q: What is the biggest challenge you are facing right now?
DP: My biggest challenge is not attempting to keep up with the unprecedented changes in a rapidly evolving business environment. Rather, funding variability and availability are my biggest challenges. Healthcare IT infrastructure is costly and often underappreciated and misunderstood, which I am sure is the same in other industries, too.
Budget variability impacts IT strategy. The best laid plans for new systems and business processes may not be given the appropriate human or financial resources. Building the foundation to meet the vision and business goals of an organization that will not become reality for at least two or three years must be funded appropriately and in a timely fashion. Parsing the funding into small bites over the course of multiple years may result in an inferior foundation or an incomplete infrastructure that could result in business failure. Building the infrastructure for an ACO is even more critical; funding should not be broken into small bits and pieces.
Q: What is your favorite part of the health IT industry?
DP: If you look at the history of both healthcare and healthcare IT, you will see that IT has great dexterity in creating value from people, process and technology. The fact that IT had and continues to have critical influence in improving the quality of care to patients is great. Enabling a consistent standard of care through the collaborative processes and communication tools installed and supported by IT is priceless. At the end of the day, making a positive difference is all that matters to me.
Q: What is one lesson you've learned that you would like to share with other CIOs?
DP: Unwavering focus on operational performance requires a collaborative and holistic approach. To use a cliché, people, process and technology must be aligned. Innovation in managing analytics and patient engagement will help us to ride the current wave. Innovation takes guts and is not for the faint-hearted.
More articles in the "Life of a Healthcare CIO" series:
The life of a healthcare CIO: Truman Medical Center's Mitzi Cardenas
The Life of a Healthcare CIO: Legacy Health's Dr. John Kenagy
The Life of a Healthcare CIO: St. Bernards Healthcare's Mark Odom