Healthcare leaders at the CHIME16 CIO Fall Forum took to discussing the biggest trouble areas for CIOs today, what actions should be taken to avoid these minefields, and how to survive if they do occur.
The panel discussion took place on Nov 2. at the JW Marriott Phoenix Desert Ridge Resort in Phoenix, Ariz., the setting for the 25th CIO Forum from the College of Healthcare Information Management Executives (CHIME). The panel consisted of two CIOs, a CIO recruiter and a consulting firm CEO. They were, respectively: Keith Perry, senior vice president and CIO, St. Jude Children’s Research Hospital (Memphis, Tenn.); Chris Belmont, vice president and CIO, University of Texas MD Anderson Cancer Center in Houston; Chris Wierz, R.N., principal Witt/Kieffer; and Dana Sellers, CEO, Encore, A Quintiles Organization.
Sellers, who moderated the discussion, began by telling personal anecdotes of how her CIO friends have gotten “trapped” in these minefields, ranging from: a CIO getting a call from her hospital about a security breach that occurred on New Year’s Eve, meaning limited resources were available to remedy the situation; to another CIO friend who had a Microsoft audit done on her organization, only to find that the institution was using licenses that weren’t paid for; to another CIO whose organization was dealing with a merger and felt he or she might be on the short end of the stick after the deal’s completion. The lesson learned from all this? “Surround yourself with people who are smarter than you,” Sellers said half facetiously.
Witt/Kieffer’s Wierz has seen plenty of these occurrences in her time as a CIO recruiter. In her role, she also hears the stories firsthand from CIOs coming to her. Wierz attested that while there are not many times when these minefields become fatal for a CIO’s career, there are things that can be done to avoid them. Also, she asks, “How do you handle them and come out on the other side? At the same time, the pace of change and technology is moving so quickly, so these things are on the board's agenda, and minefields are becoming much more public and prevalent,” she said. Wierz noted four of the biggest minefields CIOs ought to watch out for:
Privacy and security: These are the most visible and expensive, she said. Wierz noted a global CIO study that found CIOs feel even less prepared today to handle security year-over-year compared to before. “We have seen people get fired for security incidents. But it depends on the level of failure and response to the incident. Was the reason for the firing that security incident or something on top of it that leadership didn't say anything about?” Wierz asked.
Disasters and downtime: “No matter how well you do your backups, redundancies, and procedures, you are made the scapegoat,” she said.
Troubled projects: Many of these troubled or failed projects go unreported, in addition to what's in the media and what’s public knowledge, Wierz noted. It’s important how to handle this from an accountability and transparency aspect, she said.
Leadership change: “New leadership is sometimes inevitable. Be transparent as possible, work through it, and understand why change is happening,” Wierz said.
Drilling down on the first of these four areas, MD Anderson’s Belmont said frankly that he doesn’t like to talk about security, for one. “How do you make your information systems easy to use, accessible and also be on ‘lockdown,’ too? That's the situation we're in and it's almost impossible,” he said. “It’s not about the tools but about how you use them.” Belmont reflected on when his organization was changing its storage network and lost a large amount of raw genomic files. “Our researchers depend on that since you have to be able to repeat your research. So not having raw files causes problems. We did fix it quickly, though,” he said, simply urging CIOs in the audience to get out in front of it, work with partners and just “figure it out.”
Further touching on security, St. Jude’s Perry said that in the little more than a year he has been at the patient care organization, he has been working with his CISO in elevating that role. He insisted that it’s not about who's reporting to who, but rather having a conversation with the CISO while walking down the hall about him or her taking a stand to leadership on architecting the network, Perry said, offering an example.
To this end, Wierz said the CISO market is “a very active one.” She noted, “We get requests for CISO searches on a regular basis. So if you don’t have one, I would say hire one quickly. We are seeing these individual salaries go up by $50,000 each month,” she said, drawing a reaction of shock from attendees. As far as who the CISO reports to, Wierz mentioned that it varies: sometimes it’s to the audit committee or the board, and sometimes it’s to the CIO, but overall, changes are occurring within that reporting structure. She also advised CIOs and organizational leaders too look outside of healthcare for hiring a CISO. “Folks say that they would like to do that but when push comes to shove they don't make that commitment. I think it's important to do that now,” she said.
Regarding disasters and downtime, Perry spoke about a storage outage at a company he was working with at the time that resulted in clinical systems being disabled, thus affecting patient care. “After we brought it back up in a few days, I talked to my CISO about being transparent about what happened during the downtime and why, and we brought in a company to do a root cause analysis, which we then took to our executive board. That was a good thing; we instilled trust in the process that we're engaged in the conversation and take these things seriously,” Perry said.
MD Anderson’s Belmont had the most significant disaster experience among panelists, having closely witnessed Hurricane Katrina in New Orleans. “We ran out of disaster planning by page 10, so we kept writing down more as we were going along,” he said. But Belmont also said going through that kind of situation can also lead to an overreaction for the next time. “We ran out of fuel to power the generators so we brought in this [military fuel] and we didn't know what to do with all of it. So it’s important not to look at disasters as predictable events that all run the same way. Find out who those leaders are that you want to be in the trenches with,” he advised. “And how do you recover? With a hurricane, you might spend a week or more [hunkered down], so make sure you have a relief staff to get you through it.” For some disasters, Belmont noted, there simply isn’t a script to follow or a book to look something up.
Meanwhile, on the troubled project front, Belmont said that often it might be the perception of a problem that the CIO has to deal with as much as the actual issue itself. With an EHR (electronic health record) transformation, for example, there are growing pains and perceptions that stem from that, he said. “You might read in the paper about financial problems due to an EHR implementation, and you have to manage the perception and the news that's out there,” he said, likely referring to press reports that MD Anderson’s income took a hit after a recent EHR implementation. “The reality is that you have to lead your way through it, and this isn't a single event; it’s a journey. We had a couple of loud doctor voices in the room and others who were [easier to work with]. So find your champions to work with and don't be defensive,” he said.
When a CIO is going through a troubled project, Perry said there is often a lack of vision. “Ask yourself, where's the value for why I started this effort to begin with? You need to get people back to the value you're trying to create for the organization,” he offered. Belmont, meanwhile, said it’s okay to step back from a troubled project and re-evaluate. “Don't be afraid to hesitate, hit the brakes or stop all together. A reboot can be a good thing. We once took a year off from a project, and came back stronger,” he said.
Leadership change, the fourth minefield that Wierz noted at the top of the discussion, can be a very difficult thing, and Perry said that it’s important to not be beholden to the technology that’s been implemented and leveraged in the past since the new leader might have a different approach in mind. “You want to be that person’s trusted advisor,” he said.
Belmont added, “Ask yourself if you’re a good fit for the organization. You need to reflect on yourself and ask if you're doing best to serve the mission of the institution,” he said. “Be the right person for the job, and make adjustments for yourself and the team. I can't control what happens above me; changes happen without us all the time,” he said.