Vi Shaffer is research vice president of the healthcare providers division at Stamford, Conn.-based Gartner, Inc. She was lead author of Gartner’s Top 12 Actions for the CIO, a report released this past spring in which the company presents its annual top initiatives that healthcare CIOs should pursue to stay strategic and improve business value. According to Gartner, these actions "are especially significant in a year of increasing IT infrastructure and operations pressure." Recently, she talked with HCI Associate Editor Kate Huvane about the key findings from the report.
KH: What are some of the most important takeaways from this report?
VS: I think the key finding is that in the United States, many organizations are down the road on their journey related to clinical investments and clinical automation. With that comes an explosion of demand and expectations and challenges to really be world class in IT operations, and so about half of the recommendations are around things we feel they want to give extra time and attention to this year to make sure that they are running a world class IT shop that the users — and now the physicians and nurse users — can be confident in.
And then the other half is that because we’re in the midst of many of these multi-year implementations, all the way from the start of databases to physician documentation, and because of all these related infrastructure and IT management demands, the CIO has to be very sure that they carve out time to stay strategic to build those executive relationships to demonstrate their business value as innovators. So that tells you that how they spend their time, what they expect and how they carve out the senior management team under them are all things that are very important. So our 12 actions are couched within the light of those two very important imperatives. Number one, attend to IT operations excellence, and number two, stay strategic.
KH: Those are both extremely critical, particularly the part about staying strategic. How can CIOs go about doing that?
VS: We spend a lot of time talking about making time. Some of these are simple things; they need to be very aware of how they are spending their time, because personal productivity is important as well — is the CIO finding him or herself to be a prisoner of email, that kind of thing. It sounds silly because you’re talking about very senior executives, but you can get sucked in. Also, as the organizations have grown and IT has grown, you have to scrutinize your direct reports and say, 'have I been developing them? Am I spending my time brokering and making decisions between two of my own managers because they don’t know how to resolve conflicts, because they don’t know how to mutually evaluate the situation?' Those are the kinds of things personally that they need to do.
Professionally, they need to become ever more understanding of medicine and medical technology, what nurses do, what physicians do, walk around, get out, and this is true of senior staff as well. Because a CIO who does not have effective relationships with medical and nursing leadership and does not effectively meet their needs cannot be successful.
KH: Can you run through the top 12 actions and tell me the key points from each?
VS: Sure. The first one is the core competence and care process management. Here, we’re acknowledging that the CIOs and CMIOs must still attend to this ongoing implementation and optimization of the use of computer-based patient records. We also remind them that competence and care process management means also investing in ongoing knowledge and content management for decision support, and also what some call clinical intelligence — the reporting and analysis to help understand the care processes. That is a closed loop system; a processed system with an active feedback loop.
The second, mobility and unified communications strategy, touches everything — all the caregivers. It’s a high priority for communications, it’s a high priority for nurses, it’s a high priority for physicians, and CIOs need to lead insuring that they’re pursuing a unified communications strategy; looking at skating to where pucks are going to be in wireless and PDA, all these different aspects across the enterprise.
And then we have nursing and nursing workflow support. In the document, we felt it was very important to put attention to nursing very high on the list of actions. It is usually true that we talk — very high on the list — about serving physician needs, and that’s always important, and there’s a lot of power there. We highlighted nursing overall in our report because there’s a lot going on with very complex nursing workflow. We have a group of professionals who are one of the largest components of one of your largest budget programs, labor. They’re in short supply, their workflow is complex, and we know for sure that they’re absolutely critical to keeping the wheels on patient throughput and patient quality and hospital settings. We know all that. And we know that IT can do things to help this.
The next one is our insistence that healthcare organizations look into adopting information technology infrastructure library (ITIL). ITIL is essentially a set of IT best practices. It’s a framework for best practices and it’s important; version 3 works very well in healthcare for a variety of reasons. We recommend a set of steps, that they begin as a three-year program for adoption of ITIL. This is part of being world class now; this part of being a big IT shop that is essential to the business. When the CEO asks the CIO, how do I know you’re being effective and spending money appropriately? How do I know I can count on you? This is one of the answers.
Next, we recommend that CIOs must themselves pay attention to what CMS and the Joint Commission are doing on the quality front. They often get this information second-hand from the quality department and physicians from medical literature. This is coming closer and closer to ITE — not just the information management criteria, JCAHO, but because of decision support, because of reporting requirements, because of the information governance required, that they really need to check in and get that on their radar screen directly. For example, they should know what’s in the April 14th notice of proposed rulemaking from CMS in terms of where they’re going with quality, where they’re going with value-based purchasing, and then, make sure that’s incorporated into strategic and tactical plans.
The next one is to cut costs in IT. The reality is we’re in an economic slowdown that impacts healthcare on a different cycle and that impacts healthcare differently depending on what geographic areas you serve. The IT organization must do two things: they must help that organization. If you’re in a more serious cost-cutting mode, the IT organization is good at helping the organization understand the consequences of irrational cuts. Suppose you want to shut off an implementation that has high impact on the end and is staffed by people who are hard to find — the recovery from that cost cut is much more difficult, so you want to help the organization assess the value and impact of cost cutting. And then within IT, starting with strong project management and through IT operations, IT should aggressively be looking at strategies and techniques that can reduce the operating costs of IT.
And the next one is connecting with your patients and attending to, increasingly, the administrative and convenience needs that follow the patient-provider electronic relationship; moving toward administrative scheduling, bill payment self-service, kiosks for conveniences, PHRs, electronic visits, and those sorts of things. That’s the sign of a strategic CIO; that they’re paying attention to the patient experience — not just thinking 'I need a portal or I need a kiosk,' but really thinking about patient experience management.
Similarly, we indicate that they should be preparing for PHRs, understanding what Google and Microsoft Health Vault are up to and how that fits into the strategy. This is related to managing the patient experience, but this is more keeping your eyes on what competitors are doing and what these big brands are doing, both technically and strategically.
The next one is to dust off the CTO’s security plan. Every week in the news there’s some sort of maleficent selling patient’s records, like what happened to Farrah Fawcett in California. It happens every week, so clearly the Joint Commission is paying attention to security and CMS/HHS are doing potentially more surprise audits for security. There’s a lot of visibility that allows the CIO to explain why investments of security are needed. This is always going to be an issue, but it clearly has heightened attention, and depending on the degree to which you identify weaknesses in your security plan, now is a good time to vet it because there’s so much information at exposure.
The three things here for the CIO to stay strategic, is rather than piecemealing topics, to create a unified strategy. The first is communication, the second is security and the third is storage.
With imaging systems, with electronic records, we have this massive increase in storage which creates a massive increase in expense. You need a strategy; we call it an information life cycle management strategy, to manage that information through the journey of accessibility and long-term retention. There are lots of requirements — we now have massive amounts of data you have to keep for a really long time. You need kind of an information stewardship around the life cycle of the information, what this might convey.
Our next one is service-oriented architecture. It’s something we talk about all the time in terms of fundamental underpinning of modern systems development; there is more and more evidence the benefits of it are clear. It has been more driven by the vendors but we’re saying the CIOs need to understand it. The most advanced organizations are leveraging it. Educate yourself and apply the principals in your internal development and as you're selecting these systems and use it when integrating systems.
Our final one we call "provide for community physicians." It’s pretty clear that because of the desire to bond with physicians, because of the increase interest and in some cases pressure for physician practices to have EMRs, and because of the Stark relief, that a lot of institutions are looking at this, you don’t want to be the last one in your market to do it.
KH: All of these actions are obviously extremely important as far as what CIOs should keep in mind as long-term goals, but can you offer advice as far as what they can do on a daily basis in order to be the most effective leaders?
VS: Our advice to the CIO is this requires prudent business-case scrutiny of the total cost of ownership, understanding of what the physicians’ needs really will be, and things like how then are you going to incorporate their future needs into your strategic planning, governance and management processes. It’s kind of a combined strategic decision between the organizations’ top leadership and the CIO. You don’t want to get stuck holding the bag for promises and expectations that are then underfunded. This is one area where the good CIO can create the fabric that does assist the patients’ convenience and connect the physician with the facility in a strengthening long-term relationship.
The other obvious advice is to make sure you’ve got meticulous accounting, make sure you have legal advice and make sure you stick to the absolute letter of the Stark legislation.
Obviously there are lots of other things that CIOs are doing on a routine basis, but if they’re doing all the routine management and they attend to these things, communicate on them, work with their business and clinical leaders, and work within their staff to understand these kinds of operational and strategic issues, they’ll have a good year. They’ll have a good decade.
Most organizations are doing some of these things. They’re doing different ones, with different levels of energy and enthusiasm, but none of these is such a breakthrough that they’re impossible tasks. They’re all quite within the realm of either this year’s plan or the strategic plan window.