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Tales From the Ranch

January 1, 2007
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Disjointed care delivery systems, leadership and consumerism dominated the CHIME Forum in Arizona.

Responding to recent criticisms of the U.S. healthcare system, Robert Kolodner, the interim national coordinator for health IT, takes exception. "The health system is not broken. It is absolutely not true," he said at the College of Healthcare Information Management Executives (CHIME) Fall Forum in Scottsdale, Ariz. "To be broken you have to have a system. We don't have a system, so it can't be broken." Robert Kolodner

Stressing the need for transparency of costs, Kolodner urged the attendees to take off their "corporate hats" and take the question of healthcare personally. And speaking to the state of disparity and lack of incentives to drive change, Kolodner reassured the CIOs: "There's no business case for interoperability. What we're about at the national level is to make sure you have a business case — and that the needs are aligned."

Other highlights from the forum included keynote speakers, F. Warren McFarlan, Baker Foundation Professor, Harvard Business School, Boston, and Lowell Catlett, Ph.D., professor, New Mexico State University, Las Cruces.

Naming healthcare as a major priority in today's economic environment, McFarlan outlined the dimensions of leadership required for survival and pointed to contemporary leaders. Although his citations crossed industries, he singled out John Halamka, CIO of CareGroup in Boston, as a transformative leader in healthcare. (Read more about the Healthcare Informatics' 2006 Innovator in the September issue, page 38, or online at http://

Consumerism was the central theme for Catlett as he discussed new frontiers in healthcare. In a consumer world, expectations are very different, he said. "They are not wrong or right, they are just different." And the five trends that will influence the future — economic, geographic, iPods, cellphones and nutrigenomics.

To be sure, Catlett reminded the audience, consumer expectations will change the world. For example, he remarked, "The power and healing value of pets is well known and 31 percent of Americans have pets ... but hospitals don't allow pets."

CIOs confront change

As medical devices and diagnostic imaging become ever more IT-centric, Stephen Clark noted more departments are reporting to the CIO, the vice president and CIO, University of Colorado Hospital, Aurora, Col., told his audience. Once independent and territorial departments, among them the image-intensive radiology and cardiology departments, are turning to their CIOs for direction and oversight of the increasingly complex systems and equipment.

It's still too early to converge all the "ologies" onto one platform, the changes are going beyond what can be accomplished with technology, Clark said. Organizational restructuring is often required. For example, one academic medical center responded by creating an office of imaging, which handles all imaging modalities.

Let's make a deal

In one forum, CIOs shared vendor negotiation practices and strategies, including partnerships. "Not all vendor relationships are worthy of partnership status," said Zed Day, associate vice president for IT and associate hospital director/CIO, University of Kentucky Chandler Medical Center, Lexington.

Pat Skarulis, vice president and CIO, Memorial Sloan-Kettering Cancer Center, New York, agreed. "You can have a partnership only with a very few vendors, no more than four or five," she warned. She has three.

Skarulis also shared her organization's strategy to contracts. "We have a 'mini-master' agreement — a single approach for every vendor. When we do any negotiations, we start there. To do business with us, a vendor must agree to work from our contract."

Contract length is also an important consideration in negotiations. Systems can't be implemented in under two years, so a five-year contract is not long enough to make the partnership worthwile, added UCLA Medical Sciences' interim CIO Rod Dykehouse. "The contract must be comfortable enough that the vendor can move forward, too."

Author Information:

Charlene Marietti

Mark Hagland is a contributing writer based in Chicago.