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At Your Service

October 1, 2007
by Daphne Lawrence
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Mid-size hospital CIOs discuss the classic user-adoption question — who ultimately owns a system implementation?

"We have a little phrase at UT Anderson," says Lynn Vogel, Ph.D., CIO of 905-bed University of Texas M.D. Anderson Cancer Center in Houston. "There's no such thing as an IT project." Others with similar positions similar to Vogel's seem to echo that sentiment. Today, the IT department doesn't own the implementations, small and large, it only shares them with clinical end users.

Jim Stadler

Jim Stalder

Many say that today, for a CIO to be successful, there needs to be a paradigm shift in the role of the IT department, namely getting IT out of the priority-setting business.

"Our IT department is run as a service organization," says Allana Cummings of Children's Hospital in Omaha, Neb., (242 beds.) "In implementing a new system, the leadership is driven out of the clinical or operational area. IT is a support resource to enable that implementation."

Glenn Galloway

Glenn Galloway

Most CIOs agreed that IT should be responsible for technical deliverables, and in supporting, not driving the change process. "The CIO needs to be very accountable for making sure the right structures are in place to make it happen," says Healthia Consulting (Minneapolis) CEO Glenn Galloway, a former CIO himself. "There should never be a CIO who's accountable for the CPOE project — but they can sponsor the infrastructure."

Pamela McNutt, senior vice president and CIO of 850-bed Methodist Health System Dallas has embraced that concept when her hospital implemented nursing documentation and bar coding. "We were accountable for making sure the technology pieces were working correctly, but as far as whether the nurses are using it appropriately, the nurse managers have to make sure their staff is using it, and using it correctly."

So if the IT department doesn't sponsor systems, who does? "I think the key is that you always partner with other stakeholders," McNutt says. "It's never my system. And it's not necessarily their system. It's a partnership."

Jim Stalder, CIO of 230-bed Mercy Health Services in Baltimore, Md., says partnerships are the right model for large implementations. "I am equally accountable with my counterpart who is getting the technology. Our systems are readily adopted and I think that's because we work with the clinical or financial teams up front, not after the fact."

For most, that goes for system selection all the way to adoption. "The department directors are the business owners of these projects," says Charles Christian, CIO of 232-bed Good Samaritan Hospital in Vincennes, Ind. "For implementation we're always partnered up — a member of my staff and someone in the operational area."

Because IT implementations today are omnipresent, with a new project seemingly every week, this idea of partnership as governance is spreading. "Three years ago, we revamped our governance structure to focus on the users," Vogel says. He says it was changed because the kinds of IT investments needed today are best evaluated by people who are involved on a day-to-day basis — the users. "They're the ones who make the final recommendations on where we're going to spend our money, and they're responsible every month for the accountability of the project."
Charles Christian

Charles Christian

The decider

Lee Carmen

Lee Carmen

When it comes to deciding which projects should take priority, how big a say does the CIO have? That depends. Most agree that an IT strategic plan lined up with the hospital's overall goals is essential. "There's no point putting in technology if it's not going to support the business objectives of the organization," says Christian.

A good IT strategic plan should address this issue. "Our systems integration group gets together on a monthly basis to work out the priorities for the organization and how we're going to pay for it," says Del Dixon, vice president and CIO at 310-bed South Shore Hospital, Weymouth, Mass. "Some people make out, others don't. But everyone's marching toward the same end goal, so there's not a lot of contention."

Most agree that final say on RFPs is typically a joint decision between IT and the business users. "We want to be sure the business users take ownership of system selection, and we take ownership of institutional standards regarding technology," Vogel says.

The actual selection process should be a group effort as well, say most. "When it came to system selection, we raised the literacy level of everybody in the organization — including the board of directors," says Lee Carmen, CIO of 680-bed University of Iowa Health System in Iowa City, Iowa. "First we did the education, then we worked on defining requirements. I was only the tip of a very large iceberg. We told everyone, 'If you want to be involved there's a way for you to be involved.’”

Getting doctors involved can be a special challenge — especially when they want the latest toy a colleague at another institution may have. For some, a physician leader in the role of chief medical informatics officer (CMIO) is an effective way to deal with physician challenges.