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Back to School

April 27, 2009
by Mark Hagland
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Top CIOs are spending as much time developing their teams as their IT strategies

Orlando health's dr. p. phillips hospital

Orlando Health's Dr. P. Phillips Hospital

At the seven-hospital, eight-facility Orlando Health System, Vice President and CIO Rick Schooler doesn't just encourage his reports to focus on professional development; he creates opportunities for them. Schooler, who manages a team of 282 IS professionals (plus nearly 500 FTEs across several divisions), advocated for full CHIME memberships for his three direct reports two years ago, a time when non-CIO memberships in the Ann Arbor, Mich.-based organization were the exception, not the rule.

Schooler was able to get his CMIO, CTO and chief applications officer (CAO) into the CHIME CIO Boot Camp workshops that the organization offers twice a year, sessions that this year were opened to CMIOs and to chief nursing informatics officers (CNIOs). (For more information, see sidebar, p. 46).

As a result, Steve Margolis, M.D., Alex Veletsos, and Drew Cobb, Orlando's CMIO, CTO, and CAO, respectively, attended the Boot Camp sessions, and all report having very positive experiences. More broadly, all three say, Schooler has made it clear that ongoing professional development is important, both for his staff members' current positions, and for any future positions. Indeed, Cobb, who has been at the health system for two years, says he'd like to become a CIO at some point; and further, that he came to Orlando Health specifically to work for Schooler, because of his well-known mentoring capability.
(from left) orlando health's alex vestos, cto, drew cobb, cao, steve margolis, m.d., cmio and rick schooler, cio

(from left) Orlando Health's Alex Veletsos, CTO, Drew Cobb, CAO, Steve Margolis, M.D., CMIO and Rick Schooler, CIO

“Working in healthcare IS, you learn about the various CIOs around the country,” Cobb says. “And I had heard of Rick Schooler before coming here as a consultant. When he was looking to fill this chief applications officer position, I talked to him and eventually was hired. But I had specific goals in mind. He's very good at governance in IT; and he's put together fabulous structures around IT here. And I wanted to learn about IT governance across the system.” Most importantly, Cobb says, “If we want to be CIOs, he wants us to become CIOs.”

For Schooler, this approach comes naturally. “I was raised in the world of athletics,” he explains. In addition to playing football, basketball, and baseball in high school, he also coached his sons when they were younger. “And in that environment,” he says, “I learned pretty early that when you get your shot, you've got to get up and perform. So one of the principles that guides how I work now is that I focus on helping prepare people to get their shot and fulfill their potential. There are times when I have to be on stage as a leader; but what's really important to me is to help others get up on stage.”

Tim zoph

Tim Zoph

And Schooler is just fine knowing that two of his three direct reports aspire to CIO positions. Indeed, he says, when they ultimately obtain those positions, he will take pride in their ascendancy. Schooler makes it clear to all of his managers and executives that they should be constantly reading, learning broadly, and having experiences that are pushing the envelope of their professional development. For Schooler, that's a key element in being an effective CIO.

A variety of approaches

Increasingly, Schooler's approach to management is becoming the norm in hospital organizations across the country. What's more, even getting onto an IS executive team is requiring more formalized education and preparation. Schooler, for example, makes it a requirement that any direct report to him already has an advanced degree. This has become common at hospital organizations nationwide, particularly at teaching hospitals and multi-hospital systems.

There's a clear logic to such requirements, says Tim Zoph, vice president and CIO at the 897-bed Northwestern Memorial Hospital in downtown Chicago.

Linda hodges

Linda Hodges

“Increasingly, advanced degrees for senior leaders in health IT are important,” says Zoph, who prefers that his direct reports either already possess, or choose to pursue, a master's degree. It has become critical, he says, that “the IT leaders of the future have advanced management degrees, not only because the nature of the role is changing and the level of responsibility is increasing, but also because the need for enhanced business capability is important, in terms of understanding an organization and its operations, and in terms of the layering of technology onto operations for adding value into the system. So if you're working for me, I want you to have the capability to someday run an organization as CIO. And I'm in a very good position to mentor young leaders. I've had five people working for me at Northwestern Memorial who have gone on to be CIOs; in my mind, that's a very good thing.”

Strategic beneficence

CIOs, however, aren't developing their reports solely out of the goodness of their hearts (though most agree it's the right thing to do). Other trends pushing forward the coaching/mentoring/professional development trend include the following:

  • In order to successfully implement clinical information systems (EMR, CPOE, eMAR, pharmacy, etc.), CIOs must assemble very large teams, composed of highly trained and prepared professionals, some with clinician backgrounds and some with traditional IS backgrounds. Leaders of those teams who have clinical backgrounds are going for (or have already gotten) advanced management education and training; those with traditional IT backgrounds increasingly have management education as well, and occasionally also train in clinical informatics.
    Betsy hersher

    Betsy Hersher
  • As the CIO role becomes more strategic, those just below that level - CTOs, CMIOs, CAOs and network, infrastructure and help desk directors - are seeing their jobs move to higher operational and managerial levels.

  • And as the CIO role becomes more defined, so do several positions below that level, including the CMIO and CTO jobs in particular. Not surprisingly, formalized education and training, especially in management, is becoming obligatory.

As a result, say leading IS executive recruiters, formal advanced education is increasingly becoming a must-have for those one and even two rungs below the CIO. “A lot of people are now going for MBAs, if they don't have one yet, because in almost every search we're being asked to do, a master's degree is now required or preferred,” says Linda Hodges, vice president and IT practice leader at the Oak Brook, Ill.-based Witt Kieffer.

Meanwhile, Betsy Hersher, president of the Deerfield, Ill.-based Hersher Associates, reports that those who are already CIOs - primarily at smaller and mid-sized hospitals - are quickly getting MBAs (if they don't have them already).

The position evolving faster than any other is the CMIO job, notes Arlene Anschel, a consultant in Witt Kieffer's IT practice who works alongside Hodges. And the CMIOs who are moving fastest to add to their knowledge of organizational systems and management are those who arrived in that role as “physician champions” of IT, with little or no previous systems or management knowledge, she says.
Julio silva, m.d.

Julio Silva, M.D.

Parsing the CIO-CMIO connection

The CMIO position is also a major focus of professional development from the perspective of most CIOs. Among the reasons is that CMIOs are becoming the key “go-to” people in helping to lead clinical implementations at the day-to-day level, along with CNIOs/vice presidents of clinical informatics. Indeed, says Orlando Health's Margolis, who came to the organization with an MBA and years of consulting experience, the CMIO is becoming a change agent in hospital organizations, as they leverage EMRs and other systems to improve patient safety and care. Thus, Margolis has been training in Lean Six Sigma techniques in the past year, and expects to receive his master black belt by the end of the year.

And regardless of whether they see themselves as CIOs someday (Margolis says he does not harbor that ambition), CMIOs agree that continuous professional development will be important. “It's going to have to be a part of the job,” says Julio Silva, M.D., associate vice president and CMIO at the 613-bed Rush University Medical Center in Chicago. “In particular,” he says, “as many organizations get beyond implementation, they're going to be looking at the value they can gain from their information systems, so it will shift the focus” of the CMIO role towards leveraging that value.

John glaser, ph.d.

John Glaser, Ph.D.

Of course, there are already a handful of former CMIOs nationwide who have become CIOs. Among them is Dick Gibson, M.D., Ph.D., senior vice president and CIO at the six-hospital, 1,200-bed Legacy Health System based in Portland, Ore. In fact, he has three advanced degrees - a medical degree, a doctorate, and an MBA.

Arlene anschel

Arlene Anschel

Gibson, who practiced for a number of years as a family physician and emergency physician, obtained a Ph.D. in informatics at the University of Utah in Salt Lake City, before working as a consultant, then becoming a CMIO. He then came to Legacy as CIO in April 2007.

Gibson credits the encouragement of Rick Skinner, who was CIO of the five-state Providence Health System (based in Portland, Ore.), while Gibson was CMIO (and was among the first crop of full-time CMIOs in hospital organizations, he notes). Most of all, Gibson emphasizes, regardless of title or position, the most important thing is to figure out, “what your passion is.” The CIO can be a key mentor for the CMIO in that journey, regardless of to whom the CMIO reports, he emphasizes.

The relationship can also work both ways, according to Patricia Skarulis, vice president and CIO, and David Artz, M.D., medical director of information systems at Memorial Sloan-Kettering Cancer Center (MSKKC) in Manhattan. “I would say we mentor each other,” says Skarulis. “That's particularly true since we both came here around the same time” (Skarulis has been at MSKCC for seven years, Artz for six). Meanwhile, Artz, who has an MBA, agrees with Orlando Health's Margolis that such education will become more important for CMIOs, as the focus turns to quality and performance improvement. “My role is already very strategic and advisory,” he notes. “And I'm already involved tremendously in all our quality initiatives and solutions.”

For those looking for education and training, there are many healthcare-specific options (see sidebar, p. 46), in addition to the traditional MBA and other programs. Still, many CIOs agree that practical experience can often be the best teacher. Like Orlando Health's Schooler, John Glaser, Ph.D., senior vice president and CIO of the eight-hospital Partners Health system in Boston, recommends that executives who are working on self-development have someone in the C-suite observe them. “You can ask the CIO specifically, or someone else from the C-suite, to give you feedback,” Glaser says.

Always learning

As for CIOs, they can ask for the same kind of observation-based feedback, whether from the CEO or another C-suite peer, Glaser notes.

And of course, there's always the possibility of further education, even for CIOs. Larry Stofko, senior vice president and CIO at the 14-hospital St. Joseph Health System, based in Orange, Calif., is “halfway through” a master's degree in medical informatics, via a distance-learning program sponsored by Northwestern University (Evanston, Ill.). Why? “I just think that continuous learning is very important, whether for myself or for my staff,” Stofko says.

Healthcare Informatics 2009 May;26(5):44-48

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