In collaboration with CHIME, Becker's Hospital Review'snew "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 series, please contact Helen Gregg (hgregg@beckershealthcare.com).
An interview with Steve Robertson, CIO and executive vice president of revenue management and IT. (Interview has been edited for length and clarity.)
Question: You've been CIO of Hawaii Pacific Health for 12 years. How has your job changed since you began?
Steve Robertson: When I first started, my job was necessarily focused on building, standardizing and providing IT services. I say "necessarily" because we were a newly merged organization of three health systems. All my time had to be spent on Maslow's bottom rung of "physiological needs," which meant building integrated systems across all of our hospitals and clinics while taking out costs to survive [these projects]. We were tactical, and it had to be that way.
Over time, as the organization became more financially stable, my focus shifted to a very non-traditional CIO role. My responsibilities expanded to include patient accounting for our hospitals and physician groups, patient access in our hospitals, health information management, charge systems, revenue integrity and privacy and security. Most recently, I have been given executive responsibility for implementing and supporting our accountable care organization strategy. A few weeks ago, as my CEO and I were talking about our ACO operations, he joked with me that my title is becoming less and less relevant. I laughed — but I was quick to reassure him that I like my CIO title. 
Q: In your time with Hawaii Pacific Health, what has been your biggest accomplishment?
SR: Not getting fired — and I'm only half joking. There was a lot of truth to the old joke "CIO = Career is Over" when I took my job. The CIO has an obligation to be a change agent and to have a working knowledge of every aspect of their health system's operations. You also have to have a backbone to help prioritize the ever increasing onslaught of IT related work. Most importantly, you must be able to work collaboratively with your customers and peers and earn their trust through results and transparency. If you cannot do all this, you will lose the confidence of your staff and the confidence of your senior leadership.
The great thing about this job is that you get things done and you get to build things you're proud of. But when I look back on what I'm most proud of, it would have to be the global implementation of our electronic health record system. HPH has four hospitals, 49 outpatient centers, three physician groups, a clinically integrated physician hospital organization and more than 200 community physicians using our EHR for their practices. We were able to achieve true electronic integration across [all these entities] and across multiple islands. We regularly hear stories about how the system has helped save lives and improved care. I'm not necessarily proud of the technology itself, but of these results we've achieved after the implementation. [Editor's note: In December 2013, HIMSS Analytics recognized HPH's EHR achievements with a stage 7 award.]
Q: What do you see as your biggest misstep or mistake?
SR: Sometimes I think that part of our job as CIOs is to screw up on occasion, so it's hard to pick one. I think we should have done more to optimize and standardize our EHR after each of our hospital implementations. To make progress on a difficult journey like this, and to stay on budget, it's important to move forward and to recognize that perfection prevents progress. Our motto was "perfection is the enemy of good enough." The downside is that as we got better with our implementations, we never took the time to go back and retrofit many improvements. As a result, hospitals that received their EHRs later in the project tended to have better or different workflows. We are now spending a lot of time and effort driving improvements and standardizing workflows across all of our hospitals and clinics.
Q: Looking back over the past month, what has taken up the majority of your time?
SR: Without question, it is our ACO. We created a clinically integrated physician hospital organization last June and signed a five-year contract effective in January with Blue Cross Blue Shield that aligns financial incentives for cost and quality outcomes for the organization. I've been heavily involved in hiring the executive and medical directors and getting the ACO up and running. We have had to build or enhance our analytics capabilities and our population outreach, and establish education programs to drive immediate results. Fortunately, we have very strong physician leaders and very good collaboration with our medical staff. We are on track and are already seeing good results.
Q: What is the biggest challenge you're facing right now?
SR: The biggest challenge that our health system faces is the same as what we are all facing nationally: How do you drive down costs, optimize utilization and improve quality without going bankrupt? Also consider that this needs to be done at the same time you are adding IT costs to support a fully integrated EHR, expanding analytics, implementing health information exchange, achieving or maintaining meaningful use, complying with ICD-10 and a whole host of other requirements. This is what makes the job fun, and I think our system is more than meeting the challenge.
I had no experience in healthcare prior to working for Hawaii Pacific Health. I was unfamiliar with hospital and clinic operations. I survived it because I was lucky to have a staff to carry me and to help me learn quickly, and I had the support of our leadership team. We have an "ohana" [Hawaiian term for family] here at HPH that enables each other's success, and I am thankful for it.
Q: What is one lesson you've learned during your tenure you'd like to share with other CIOs?
SR: Have a sense of humor, focus on the things that matter and be creative about it. Don't focus on IT. Instead, focus on the operational areas you know you could help improve, and don't wait to be asked. The benefits of doing this is that you proactively make others successful while improving the company's performance.
As an example, I was faced with the impossible task of getting more resources in a year of negative operating margins. Timing was bad. There was no way we could afford it given the budget projections, yet I knew we had to have these resources for the health system to meet its long-term clinical integration goals. Rather than focus on cutting IT expenses to meet the operating targets, I focused IT efforts on improving our net revenue by reducing our write-offs. In partnership with the revenue cycle staff, we focused on root cause analysis to provide better workflows by eliminating bottlenecks and the paper chase that often plagues the business offices. Now there's much more transparency and accountability. I can see a biller's work queue from my office and can see if they have a backlog. This gives us the chance to investigate and see if there's something there we can fix. By quantifying those improvements and holding ourselves accountable for the results, I was able to more than offset the added IT costs. And by being successful, it was easier to get resources later because we had a proven track record.
I think that all CIOs, over time, will make this kind of transition [from IT to strategy/operations] as it becomes less about the oven and more about the meal. My prediction is that there will be a tendency to give CIOs the responsibilities that would benefit most from technology. There will be less focus on the technology itself. It's still important, but there are bigger fish to fry.
More Articles in the "Life of a Healthcare CIO" Series:
The Life of a Healthcare CIO: Summa Western Reserve Hospital's Pam Banchy
The Life of a Healthcare CIO: Children's Hospital Colorado's Mary Anne Leach
The Life of a Healthcare CIO: Baptist Health's Roland Garcia