One-On-One With Donald Wegmiller, Chairman, C-Suite Resources

DW: Obviously, it will vary in different organizations. But these implementations will be what nursing positions used to be—they’ll be exempted from cuts. We have no alternative. Now, could we slow down the development of CPOE from tomorrow to the day after tomorrow? Yes, certainly, we’ll see some slow-downs. But will we see any of the really crucial core clinical implementations shelved entirely? I don’t think so. We can live for another year or two without the latest widgets. But we can’t do it without the core clinical information systems, for pay-for-performance, or anything. And what do you want to do, sit at night and manually accumulate data? Clinicians will say, forget it. And if the only way we can get to clinical outcomes and meaningful data is via the implementation of CPOE, then that’s what it will take. We may have to prioritize, but we will not eliminate.

MH: Would you say that ROI will become more of an element in our conversations, per core clinical information systems?

DW: Yes. We will talk about ROI in every conversation. That doesn’t mean that we have or will shortly have precise measurements of ROI in everything. But will we attempt to do so? Interestingly, we’re embarking on an initiative at the Scottsdale Institute around ROI with our members. So yes, it has to be a part of every conversation. The challenging part is, as every CIO will tell you, I can come up with what I think is a reasonable definition of ROI on something for our organization. And CEOs will ask, how does that analysis compare with what’s happening in the organization down the street? But the idea that numbers can’t be compared won’t fly anymore. CEOs will demand some level of comparability; right now, it’s still going to be a conversation. It’s going to move, maybe not next year, but the following year, to leading-organization benchmarked data.

MH: In all this, do you see IT as a facilitator of standardization of care processes?

DW: It will be at least a facilitator; and it may in fact be a driver, because clinicians, who are scientists, will use information systems to change care processes. And we will soon have clinicians demanding that information technology be stronger and broader. An example, CEOs are increasingly demanding information technologies to improve patient safety. What’s more, this demand for information technology and the information that comes out of it, is now coming from the bowels of the organization: the night nurse on Five East is now demanding this. That nurse is saying, I saw this demo’ed at a conference, and I want it and have got to have it. And I think CEOs are definitely supportive of this, because they’d much rather do things based on data rather than on subjective conversations. And so you’ll get the best stuff in the business. Now they’ll want to know, how does the data coming out of our tools compare with the folks down the street? Are we making fewer medication errors? How many times did we attempt to get the wrong drug out? And is our score better than the competition? And if so, will our training be better? So IT will play a really, really broad role; and I think that’s wonderful. We’re moving into an objective world now in clinical care. And that strongly resonates with clinicians, but it also resonates with the modern-day executive, who comes out of graduate school saying, you’ve got to make these decisions based on objective data, not subjective opinions. And in the past, no one ever talked to each other around a large table and figured out how better to do things.

MH: What would your core advice to CIOs be for the next two years?

DW: The first thing I would say to CIOs is, go back to the basics of articulating in some clear, detailed fashion what it is that we are trying to achieve with our information technology and information systems budgets, and then support every piece of that with, a strong rationale. Two, be realistic about the fact that some of those priorities may have to be rearranged; some may have to be delayed; but start with the idea that we must do this; start with the goal we’re trying to achieve, and remind everybody, let’s not get off the path here. So, let’s look at other areas before we start looking at the core of our enterprise, for cuts. And I will submit to you that information systems and technology are at the core of the enterprise right now. But be realistic; on your wish-list of five things, you’ll get three things. But start by making the case all over again. Don’t assume everybody already understands.