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Governance Guidance

April 30, 2008
by Mark Hagland
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The growing involvement of boards in IT strategy means CIOs must learn to communicate in all directions

For CIOs across the healthcare industry, times are changing in the area of IT governance, and the time is now to position themselves and their organizations for the future. With core clinical implementations such as EMR, CPOE, and other complex technologies going live and costing millions, the whole concept of IT governance is undergoing fundamental change. And with so much money on the line — as well as so many careers — the smartest CIOs are rethinking how they relate to CEOs, senior management teams, and boards of directors. The result? Boards in particular are becoming engaged as never before in strategic IT issues.

Heartland Health in St. Joseph, Mo., is one example of an organization whose leaders, including its CIO, have recently made the shift. Leaders of the 350-bed integrated health system decided at last year's annual board planning retreat that it was time the board became more closely engaged on strategic IT issues, and approved the founding of a technology committee of the overall system board. That committee, with five board representatives (one each representing the component medical center, physician group, foundation, and health plan boards, plus a chair from the system board) held its first meeting in March.
Helen th ompson, cio, heartland health, st. joseph, mo

Helen Th ompson, CIO, Heartland Health, St. Joseph, Mo

How did it go? “The committee members interacted together very well,” reports CIO Helen Thompson, who has been CIO at Heartland Health for the past six years. (Thompson does not have the title vice president. “We have a very flat organization here,” with only four layers of management, she notes.)

She and Heartland's COO — the two executive staff members of the new board-level committee — were eager to hear committee members' thoughts and share their own perspectives with the board members on the committee.

“We had wonderful dialogue about what it is you need to know, how you get everyone on the same page of music, how you level the playing field in terms of knowledge, and what have been the long-standing guiding principles of technology, applied to our current situation at hand,” she says. “And there was a lot of good dialogue about what it is they want to see, and how we can create a set of healthcare IT best practices within our organization going forward.”

A nationwide shift

What's happening at Heartland Health is increasingly taking place nationwide, say industry experts and observers. Indeed, as budgets, expenditures and risks grow daily, it's only natural that boards are becoming more engaged in strategic IT issues. The choice for CIOs is to either engage as well or take an ostrich-like approach.

Dave garets

Dave Garets

Indeed, says Dave Garets, president and CEO of HIMSS Analytics, a division of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), “What we're finding in our research and studies of the subject is that the best practice in this area is to have an IT subcommittee of the overall board of directors” of a hospital or health system. The Blaine, Wa.-based Garets and HIMSS Analytics Director Mike Davis have been studying IT governance for years and have found there are specific aspects of establishing such a committee that are additional best practice-type success factors.

“What we're talking about here is different from having a steering committee composed of department managers and a token physician,” Garets clarifies. He says most IT steering committees are essentially the executive management team plus one doctor added for good measure. “The reason for putting a subcommittee of the board over this is that there are only three kinds of resources available for anything,” he says, “financial resources, human resources, and information. That's it. And if you look at the composition of a healthcare organization board, you'll find a finance committee, which is usually the most powerful committee of the board. You'll more often than not find a human resources committee, but rarely do they have an IT committee. The percentage of hospital organizations with an IT committee of the board is under 10 percent. But we came up with a whole list of things that such a committee or subcommittee needs to be responsible for, including executive sponsorship issues.”

In other words, he says, if a nursing documentation project is taken on, the vice president of nursing should be the executive sponsor of that project, with board responsibility for overseeing that executive sponsorship.

Another example of a hospital board taking on strategic IT issues is the 259-bed Rady Children's Hospital and Health Center in San Diego, where the committee was established a year ago (May 2007), according to vice president and CIO Albert Oriol.

“I think it's a great idea,” Oriol says. “But it wasn't mine. It was the idea of one of the board members, who basically said we have a task force for our other largest investment, which is our facilities investment, and we're getting ready to turn the corner and make some major investments in information technology.” Oriol says the idea was, “Shouldn't we have an oversight board that provides the same level of governance and oversight over IT?”

The Rady Children's Hospital board-level IT committee has five members, one is a physician, and the others are board members who represent the community at large. The committee is staffed by the CIO, CEO, CFO, and CMO.