JM: I would say that’s often a clear characterization. John clearly is somebody who’s been an outstanding leader in the field for some time, so I would say that his status within this organization is — I don’t quite know how to say this but — probably somewhat higher than the typical CIO. I mean, he’s built up through the years respect not only from the other administrative leaders but the various clinical chiefs of these large teaching hospitals. So John is somebody who comes with a fair amount of, as I say, “throw weight” into any conversation. My main contribution when I came was to support putting even more money behind the dissemination of the electronic records and trying to really spur John and the team to move forward with it, and if anything to move forward with it faster than had originally been planned. In that part of the relationship, I would say that I was clearly supporting the direction that he wanted to go in initially and, if anything, encouraging him to go even quicker and providing the funding to do that.
I would say the second, and the most important, aspect to that relationship is that it’s not just having the IT, it’s getting the docs to use the idea, actually, use the electronic record, and to use the algorithms and to use the disease management programs that we built. So we spent a lot of time talking about how you translate the capabilities of the record and how you modify the capabilities of the record so that they do adhere to the clinical capabilities that you want to put in place and make real.
AG: I’ve had CIOs tell me about two general types of CEO. One would be the CEO that you appear to be, which is one who values IT as creating patient safety. And the other views IT as a cost center. As a CEO, is it important to have a real balance?
JM: I think that’s a fair characterization. I think there are a lot of people who do fall into that latter category and, in fairness to them, a lot of times it’s because, A) we have the advantage of having a reasonable base of resources here at our institutions. We’re not the wealthiest in the nation, but we’re certainly well beyond the kind of situation many other hospitals in the country are in, like the public hospital I ran for years. We do have the resources here, but there are a lot of CEOs that are really pinched for capital, and they’ve got a lot of other demands for radiology equipment and new space and that sort of thing.
So I think there is a focus and concern on the economic impact, and I think there is also some skepticism out there, which is understandable and in many instances appropriate, about the real value of these clinical applications. I’ll tell you the reason that I’m understanding of that is because it really takes both electronic records plus the ability to shape the culture of clinicians. Now we’re in a reasonably better position to do that because we’ve got these physicians who have strong loyalties to the system, so they’re willing to work with this team and adopt EMRs. That’s a lot tougher in the community hospital where you’ve got scattered community practitioners who don’t necessarily feel that kind of link or loyalty to your culture and to adapting to the guidelines and algorithms that you’ve got in your electronic records.
AG: Let’s say John left the organization. What would you look for in a new CIO? What are the most important qualities?
JM: Well I would start with the generic qualities that I’d be looking for, whether a CIO or a CFO or a chief nurse. I mean, those generic qualities in my mind have always started with judgment, and it’s one of the hardest one’s to get out of a resume, but you want somebody who’s judgment you can be fairly confident of. I don’t mean to sound defensive, but somebody you can be reasonably sure is not going to make major mistakes or anything. So I usually start with judgment and intelligence, experience. I’m more likely to look upon somebody who’s done a similar thing in a smaller organization or something of that sort. So I would say judgment, intelligence and experience.
And then, two, other generic things are the ability to work with other folks, people skills, and then communication skills because these are large organizations where you have to be able to speak and write to get your message across to others. In terms of things more specific to the CIO’s world, again you’d want somebody who is fully versed in the field and the technical knowledge. Now, my finance officer by definition knows more about finances than I do, and the nursing officer knows more about nursing, but even to a greater extent I’d say the potential language gap or knowledge gap between the CEO and the CIO can be larger, so you want a confidence that they understand the technical aspects of the field. And then the second one is the ability to relate to and work with these clinicians and understand that the record is not just about the records itself but it’s about allowing better medical care. So I think somebody who’s very open to dialogue and consultation is another important thing that I would look for.
AG: What about budgeting and forecasting abilities? Seeing as CIOs can have responsibility for huge budgets, how important is that skill?
JM: It very much is important. I guess in a way I encompassed it within experience, but I think clearly to identify those specific things is entirely appropriate. I mean they are large parts of an institution to splice, so somebody who’s familiar with and experienced with budgeting, and then with managing to a budget, is something you would be looking for.
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