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The CTO's Turn

December 1, 2008
by Kate Huvane Gamble
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Rather than being chained to the server, today's CTOs are assuming a key role on the CIO's executive team

Doris crain

Doris Crain

Of all the changes that have impacted health system governance over the past decade, one of the most compelling — and perhaps least talked about — has been the evolution of the hospital's chief technology officer (CTO) from a “tech geek” to a bona fide member of the CIO's cabinet. CTOs are entering a new era; and while many are still involved in the selection of maintenance of IT equipment, the idea of the CTO who is knee-deep in hard drives and gigabytes is becoming as outdated as dial-up Internet connections. Today's CTOs are business-savvy leaders who actively participate in strategic discussions, utilizing their intimate knowledge of technical systems to guide key decisions and map out enterprise-wide plans.

Fernando martinez

Fernando Martinez

According to Scott Grier, founder and CEO of Sarasota, Fla.-based Preferred Healthcare Consulting Inc., the evolution of the CTO can be attributed largely to the growth that the CIO role has experienced. “If you're going to talk about the CTO position,” he says, “first you have to talk about the CIO position and how it has morphed” (see sidebar).

Today's CIO is focusing less on the limitations and frustrations of IT, and instead is acting as a visionary and a driving force in connecting all the moving parts within the hospital community, Grier says. “The CIO has to have incredible communication skills to make a point to the C-suite and to the board level, and also to understand the economics and the impact of the plans that are being put into place.”

Grier says the CIO is able to do this when he or she has a CTO who takes the lead in recommending IT systems and guiding implementations, freeing up large chunks of CIO time to deal with broader, more strategic issues. “The CTO should be the right arm of the CIO,” he says. “The CIO should have a vision that's so broad and progressive that he's out-thinking what technology can actually accomplish. It's the CTO who should be feeding the CIO with the information that says, with all of the visions you have, here are the ones that we can accomplish, here's how we can accomplish it, and here's what it will cost to accomplish it.”

Andy crowder

Andy Crowder

That kind of partnership is precisely what Doris Crain, vice president and CIO of Broward Health, had in mind when she accepted the position in December of 2006. Broward, a six-hospital, 1,529-bed community health system, was putting together a team that could lead the implementation of a clinical information system from Kansas City, Mo.-based Cerner Corporation. To Crain, the right team had to include Fernando Martinez, a colleague with whom she worked when both were employed under the large umbrella of Catholic Health East (CHE), a multi-institutional Catholic health system based in Newtown Square, Pa. Crain was regional vice president of information technology for CHE's Southeast Florida division, while Martinez was CIO at Mercy Hospital in Miami, one of its member organizations.

Although Martinez was then working as CIO at Mercy, a 483-bed acute care hospital, Crain says she felt he would be a perfect fit for the CTO post at Broward, a large organization that had very ambitious IT plans. In fact, she was so confident in his aptitude — and so determined to have him on board — that she accepted the CIO position on the condition that Martinez would be offered the CTO job.

“It was a package deal; I wasn't going there if he wasn't,” Crain says. “I know my limitations; I'm not a technologist. I'm very much healthcare applications and operations-focused, and Fernando is the technologist — that's why we work so well together. We complement each other.”

But like many CTOs in today's health system environment, Martinez — who also serves as chief security officer (CSO) — is more than just a technologist. While it's true that a major part of his duties entails driving the tactical day-to-day IT operations, another key aspect is helping to map out IT strategy. He does this, Crain says, by providing insights based on his knowledge of different systems and applications, and acting as a “technology strategist.”

Interestingly enough, Martinez says his experience with the plumbing of technology allows him to see the bigger picture and assist in long-term planning. It was that unique skill set, Crain says, which made him the ideal choice to guide the roll-out of the Cerner system.

According to Crain, Broward purchased a suite in 1995 that included an EMR, a clinical repository and a nursing documentation application. But more than a decade later, the system still hadn't been implemented. That, Crain says, is where she and Martinez came in. “They were hungry for technology,” says Crain, referring to the clinicians who craved automation and the executives who were tired of shelling out maintenance fees for an EMR that sat unused on a shelf. “They wanted results, and they wanted them fast.”

Fortunately, it wasn't long before the IT team, led by Crain and Martinez, made significant headway. In a year-and-a-half, the organization's system jumped from stage 2 to stage 4 as designated by Chicago-based HIMSS Analytics' EMR Adoption Model.