EXECUTIVE SUMMARY

In many larger organizations, the day-to-day challenges of information technology have fallen increasingly on the chief technology officer, as the CIO's role becomes almost entirely about broader strategic development. What is it that CTOs are adding to these health systems as they begin their march toward meaningful use? And how have successful organizations learned to optimize the CTO role?

As health systems increase in size and strides toward meaningful use are being taken, the landscape is primed for the chief technology officer (CTO) to step in and take the reins of day-to-day IT operations. The emergence of the CTO role in healthcare is a rather new development, but those in the industry say that CTOs will be integral to coordinating an enterprise-wide approach to technology infrastructure in today's complex healthcare delivery environment.

ENTERPRISE TECHNOLOGISTS

As a formal role, the CTO title is relatively young, and the CTO him- or herself represents a rather new breed of strategic animal, only coming into existence in the past decade and a half. His native environment has most often been other sectors, such as high-tech, computer, and research organizations; production companies; service providers; and government agencies. The healthcare CTO is now generally found in larger multi-campus health organizations, and has the important role of unifying all technology across the enterprise and creating strategies with regard to data storage, disaster recovery, data sustainability, and infrastructure scalability.

WE WILL STEP BACK AND LOOK AT THAT REQUEST AND SEE HOW IT FITS ACROSS THE ENTERPRISE; AND IF WE DON'T LOOK AT THAT NOW, THEN I AM GOING TO END UP RE-ARCHITECTING THAT SIX MONTHS FROM NOW OR GET A WHOLE NEW SOLUTION.-ALAN GREENSLADE

Most importantly, as the CIO in most larger organizations has seen his or her role shift almost entirely to broad strategic planning, the CTO in many patient care organizations is now the person in charge of day-to-day operational management. Over time, the CTO has made his way up the food chain to become an executive member of the CIO cabinet, along with other informatics executives, including the chief medical information officer (CMIO), the chief nursing informatics officer (CNIO), and the chief pharmacy informaticist. “I think that [the CTO] role is also someone who is, if it's the right fit, a good advisor to the CIO,” according to Chris Wierz, R.N., a consultant at the Oak Brook, Ill.-based healthcare executive search firm Witt Kieffer. “CIOs rely on CTOs to catch them if they make a mistake, and keep them updated with the latest technology.”

While the CIO sets the strategy for information systems in the organization, the CTO's focus is on the nuts and bolts of the IT closet-the hardware and software-and on developing a strategy to link all the technological infrastructure, says Linda Hodges, senior vice president, information technology practice leader at Witt Kieffer.

Alan Greenslade, CTO at the 968-bed, Dallas-based Parkland Hospital & Health System, summarizes the CTO role as, most importantly, “establishing a sustainable technology lifecycle.” He says the CIO has a more global focus with the applications and overall vision for the organization, while the CTO has to take that vision and make it happen, by finding the right technology to provide a long-term lifecycle for the technological assets employed. For instance, when Greenslade receives a departmental request, he looks two years ahead to determine the sustainability and the scalability of that technology request. “We will focus on that request, however, we will step back and look at that request and see how it fits across the enterprise; and if we don't look at that now, then I am going to end up re-architecting that six months from now or get a whole new solution,” he says.

Greg Johnson wears two hats as CTO and director of IT technology and engineering services at the Richmond, Va.-based VCU Medical Center, which has 779 beds. He notes that the CIO generally operates on the clinical or the customer-facing side, driving adoption of the electronic medical record (EMR), while the CTO “focuses on the strategic direction that the technology is taking in support of the business direction, which is where the CIO tends to focus most of his time.”

One appealing facet of the CTO role, according to Wierz and Hodges, is that the position doesn't have to deal with the level of politics that the CIO‘s does, because the CTO role generally doesn't report to the CEO. Still, even if the CTO might not have to deal with as much political maneuvering as the CIO, the CTO still has to be a true partner of the CIO: a strong manager, project manager, and consensus-builder, according to Hodges. The CTO also has to be able to communicate to the board the technological needs of the organization, while keeping an eye on cost containment.

Nader Mherabi, CTO and vice president for IT product solutions at the 602-bed NYU Langone Medical Center in New York, feels that CTOs can offer healthcare organizations the ability to standardize enterprise architecture and focus on integration at the enterprise-level. CTOs are “also looking out for technology that can overall enhance the use of technology in the healthcare setting,” he adds.

EMRS DRIVE CTO ROLE

The genesis of the CTO starts with his counterpart, the CIO. Originally, the technology head in a healthcare organization was the director of IT or director of networks, but about 20 years ago, as hospitals became more reliant on technology, the strategic CIO emerged as an organizational role. As EMRs has become more widespread during the last 10 years, the CIO's role has become increasingly strategic; and the technological responsibilities of the healthcare organization or multi-system hospital has become too much for one person to handle, providing an entry for the CTO. “As the CIO evolved into a much more senior leader, strategy person, this technology person's role has also been elevated to that chief technology officer,” Wierz says.

Greenslade also notes the development of the EMR as the impetus for the development of the CTO role. “With the push for EMR, you have to have someone who understands how to implement that type of solution sustainable and scalable, and normally the CIO doesn't have the technical expertise to do that,” he says. “They may understand the technology, but when it comes down to the nuts and bolts of it, that's where the CTO steps in.”

OUTSIDE EXPERIENCE ENRICHES ROLE

According to Hodges and Wierz, there's less of a need for a CTO to have a healthcare background than for a CIO, who is increasingly expected to know the legislation and regulations regarding patient data. As healthcare continues to lag technologically behind many other industries, selecting a CTO from another sector can often bring the organization someone with more advanced expertise. “Some of our clients are insistent that they only want CTOs who have worked in healthcare organizations, even if it's only one other time,” Hodges says. “But many of our clients are open to a chief technology officer coming from another industry.”

Hodges also frequently tells clients who are interested in moving into a healthcare IT leadership role that it's often much easier to move into a health system as a CTO, rather than a CIO. In fact, all CTOs interviewed for this story came into healthcare from other sectors. Before coming to NYU in 1999, for example, Mherabi worked in financial services at Citibank, where he was a software developer. Johnson spent 30 years in the high-tech sector as an engineer and software developer, and migrated to healthcare after the '90s dot-com bust.

ON THE JOB

VCU's Greg Johnson acknowledges that the physicians in his organization don't care what the cause of a brown-out or black-out is; their priority is providing their patients with quality care, even when there is system downtime. Yet a recent fire in Richmond provides a good example of how Johnson's role in disaster recovery management provides the support that physicians need to do their jobs. Recently, a power conduit under the street malfunctioned, shutting off power to one of university's data centers. The Internet was down for eight hours, which caused the VCU Medical Center to lose the public IP address that linked it to the area's rural hospitals. Consequently, the medical center made a decision to get a redundant Internet link to ensure business continuity during an outage.

“The old style infrastructure technology isn't going to cut it because there's absolutely no tolerance for downtime,” Johnson says. “You have to provide for business continuity, where you build in high availability and in-fault tolerance throughout that entire technological ecosystem from the data center to the end point.”

THE BOTTOM LINE REALLY IS [THAT] IN HEALTHCARE DOWNTIME CAN MEAN LIVES. MORE AND MORE ORGANIZATIONS ARE GOING TO NEED [A CTO].-GREG JOHNSON

Johnson notes that he has recently secured board approval to build a brandnew Tier III data center, 25 miles away from the campus, so it will be on another power grid in case of a power outage. “You're literally dealing with life or death situations, and you are dependent on being able to provide that level of redundancy and high availability,” he says.

Greenslade of Parkland Hospital notes another important part of the CTO role: the ability to build partnerships at the manufacturing level, rather than being dependent on a vendor. He notes that he has consulted with the manufacturer about a design or build material, thereby putting the manufacturer in the game. “While I understand the [vendor] partners that these manufacturers have are very good, to me there's nothing like that manufacturer's resource,” he says. “They will also help you future-proof your investment.”

ONE MORE FOR THE MU ROAD

All those interviewed for this story agree that the CTO role will only grow as organizations travel down the road toward meaningful use. Greenslade notes that with the government's push to make technology sustainable, scalable, and affordable, CTOs will flourish. He predicts that the CTO role is going to be one of the hottest role in demand for the next four to five years, both because of the pressures of meeting meaningful use, as well as the consequences of not meeting the requirements, he says.

NYU Langone's Mherabi sees the true asset of the CTO as a bearer of standards for architecture, integration, and workflow processes. He also sees the CTO as playing a key role in eliminating silos of data in different information systems, so data can flow out to healthcare providers more efficiently. “I think more and more medical centers will see the need for this role,” he says. “Healthcare is full of a lot of software and vendor products; the more you leverage your standard digital platform, the more you can reduce those redundant software products and integrate them in a digital platform.”

Johnson of VCU not only sees meaningful use as a galvanizer for the CTO, but healthcare's lack of tolerance for server downtime. “The bottom line really is [that] in healthcare, downtime can mean lives. More and more organizations are going to need [a CTO], because they're going to need to have someone who is strategically focused on where they are going and who has a good handle on how they make it all work,” he concludes.

Healthcare Informatics 2011 February;28(2):36-39