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As Healthcare CIOs Evolve, Leadership Concerns Abound

June 15, 2017
by Dan O’Connor, vice president of client relations, Stoltenberg Consulting
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CIOs must constantly assess trends in value-based reimbursement, analytics, security and IT staffing

From new cybersecurity threats to government mandates and reimbursement program adjustments, healthcare IT is constantly evolving. Occupying a position that’s full of competing projects and high budget scrutiny for electronic health record (EHR) overhauls, today’s hospital CIOs work hard to keep up in the transition to value-based care.

New trends in EHRs represent some of the biggest changes—and challenges. By 2025, the global EHR market is expected to reach more than $33 billion, according to Research and Markets. Within the United States, KLAS cites that the shift in EHR system purchases heavily leaned toward small community hospitals, which accounted for 80 percent of EHR decisions for 2016. This prompted growth of community-specific EHR platforms, while standalone hospitals with fewer than 200 beds preferred web-based solutions. As vendors change system offerings and EHR version certifications become vital for programs like the Medicare Access and CHIP Reauthorization Act (MACRA), providers must consider if they need to jump ship from current systems.

Beyond the EHR landscape, several industry trends stand out as vital influencers toward the evolving hospital CIO role. Consider these four health IT issues impacting new leadership responsibilities:

1. MACRA. In the new physician-reimbursement landscape, CIOs hold the key to vital MACRA Quality Payment Program (QPP) reporting data. Hospital-affiliated physicians view the program as an added revenue opportunity with patient care promise, but 66 percent are unprepared for managing and executing MACRA initiatives without health system support.

Only through the IT department can provider organizations pull, maintain and effectively analyze data to identify reporting gaps, while working with clinical and financial departments to identify measures best fit for reporting proficiencies. It’s also up to the IT department to make sure EHR vendor certifications and capabilities are up to speed with reporting requirements down the road, since MACRA alignment requires multi-year strategic planning and pick-your-own-pace options end in 2017. If technology isn’t up to par, the CIO must lead the decision to fill in the gaps.

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2. Analytics. As EHRs evolve with optimizations, vast amounts of data increase at exponential rates. Virtually every CIO I have spoken with has targeted increasing spending on data analytics for 2017, which is currently a $6 billion market expected to reach $24.55 billion by 2021.

CIOs and CMIOs will need to the focus on evaluating current products and possibly expand tool sets with new offerings. Considering the importance of better decision making in the future, predictive analytics stands out as the top wish-list item, followed closely by clinical analytics or clinical operational analytics. These tools tie into demand to align with programs like MACRA and electronic Clinical quality measures (eCQM) in the transition away from fee-for-service care.

3. Information security. With the infusion of new technology into the marketplace, security continues to be high on the list of CIO priorities in 2017. The traditional areas of focus have been on network security, data encryption and mobile device security, but as interoperability expands, many devices are being integrated into networks. This creates complex structures with increasing vulnerabilities. More than half of healthcare providers do not test medical devices for security, while 60 percent of device makers don’t disclose information and security risks with clinicians and patients.

Moving forward, traditional measures such as two-factor authentication, which is one of the foundations for e-prescribing and password safety, will continue to be important. However, we’re seeing an increased need for employee training, throughout all levels of an organization, that’s centered on how to keep both data and networks safe. As threats from ransomware attacks continue to hit healthcare hard, a robust, holistic security program is essential. Ransomware now tops the list of threats to data security for healthcare, followed by advanced persistent threat (APT) attacks and phishing attacks, making security a major stress inducer for CIOs in 2017.

Know that once one ransomware method makes headlines, new malignant techniques will evolve. Consider the recent WannaCry attacks on Windows-based operating systems. Conduct a full network assessment to identify any devices or servers operating from outdated Windows OS or missing the MS17-010 security patch. Work with vendors to implement validated security patches with full process documentation aligning with set risk mitigation processes.

4. Talent management and retention. According to the fifth annual Health IT Industry Outlook Survey, eight out of 10 healthcare organizations struggle with finding qualified health IT support, stemming from issues with budgetary limits (44 percent) and a lack of qualified, experienced candidates (43 percent). The health IT talent pool is limited, especially as care standards advance, requiring IT staff whose expertise spans clinical, financial and operational capabilities.

Areas like analytics and security present competing projects across sectors, driving up cost and forcing CIOs to look at creative ways to attract and keep talent. IT leaders must better utilize flexible scheduling models, remote work opportunities and incentives built into performance metrics to attract the right talent for key staff positions. CIOs must also set effective work culture, showing staff engagement from the top down, utilizing internal training and recognition programs with strong communication channels. Staff need to feel their work is valued, relevant and impactful toward personal career progress and overall organizational goals. Finding and keeping quality talent will prove to be an area that can propel or hinder an organization’s success moving forward.

As patient expectations advance in a more consumer-driven healthcare market, CIOs stand at the helm of the overworked IT department, gathering, maintaining and utilizing data for more effective patient care and hospital operational efficiency. In their progressing leadership role, CIOs must constantly assess trends in value-based reimbursement, analytics, security and IT staffing to best serve patient communities and establish solid footing for provider organizations in the future.

Dan O’Connor, R.N., is vice president of client relations of Stoltenberg Consulting with 19 years’ experience in healthcare and clinical informatics. His areas of expertise include strategic and project planning, clinical transformation and workflow design and IT management and budgeting.


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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.


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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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