KH: The announcement that you were stepping down officially hit last Wednesday (March 26), and it was one of those e-mails that really generated a lot of discussion. I can imagine that you’ve received quite a few messages from media outlets and colleagues.
SW: Yes, definitely. That’s been most of the last few days for me. I realized when I left the Alliance that I had 1,400 names in my contacts list so there were a lot of people to notify — and I’ve discovered that Gmail will only you send 500 e-mails a day. I’ve had to do all this work to clean up my list, but it’s been worth it. The number of emails and calls that I’ve gotten from people has really been wonderful. The sentiments have made me feel very good.
KH: I’m sure that the decision to leave was not an easy one for you. What were the primary motivating factors?
SW: It sounds cliché, but it really is the right time for me to go and do some new things. I think that we, as a field, have moved far enough that we really can see that health IT is not single-handedly going to save the world. But it is a facet of what has to be done more broadly in the transformation of care. I want to move back into the for-profit sector because I just find that to be a more comfortable space. But also, I want to be able to address broader issues around the restructuring of healthcare that I really couldn’t do within a single-issue organization.
KH: So you felt that you had done all the work you could in this particular capacity?
SW: Yes. The Alliance was really built around the idea of engaging senior leaders from all of the different healthcare sectors in the issue of healthcare IT. If you go back five years, the need was to mainstream the issue. I used to joke that five years ago, a lot of healthcare leaders couldn’t spell healthcare IT if you spotted them the word ‘healthcare.’ And now, it’s something that I think everybody really understands. The centrality of information management in care is no longer epiphanous. What has to happen now is a lot of very detailed work that isn’t at the senior level and also pits one group against the other and asks questions like who’s going to pay? Who’s going to compromise? Who’s going to sacrifice? My feeling was that didn’t play to the skill set that I had in running the Alliance. That I couldn’t be as effective in that environment as I had been in the last five years, so it was time to go into a different place to do some of that.
KH: What was it like to have such a key leadership role during a time when health IT was blowing up and really hitting the mainstream? I would think it was very exciting but also very exhausting.
SW: It was exhausting. I completely wore myself out a couple years ago and had a heart attack. It definitely was an all-consuming kind of a thing, but it was exciting. You get a limited number of opportunities in life to really change the world, and I think that there were some real world-changing things that happened in the health IT space. We got the certification commission going. We really mainstreamed people’s understanding of healthcare IT. We got the commission report out there. It was all really significant stuff that was only feasible because it was such a tumultuous time.
KH: When you look back at what you were able to do during your tenure, which accomplishments give you the most satisfaction?
KH: And also, of course, rebuilding the New Orleans healthcare system.
SW: The work we did in New Orleans is really important and was really formative for me in terms of contemplating the next step. The issue in New Orleans is not health information; the issue is: what is the appropriate structure of a care delivery system? And the more I started getting into that, the more I was fascinated by it, but also the more that I felt limited because we were chartered around a single, very specific issue.
KH: How can the NAHIT become more effective going forward? What changes do you think it needs to make?
SW: I’ve made a really clear agreement with the Alliance that I won’t comment on what they’re going to do.
KH: In a more general sense, what specific changes do you think need to be made in the current system as far as the structure of healthcare delivery?
SW: I think that we have to fundamentally redesign the way that the healthcare system is broadly structured. What I got out of my five years running the Alliance was a lot of experience across the spectrum of healthcare — working with payers, with providers, with the vendor community, with the clinical community — to really start to see healthcare as a broad system rather than as a series of silos. And I think that the opportunity exists now as people are becoming aware of how unsustainable the current system is. I think the opportunity to help formulate some dramatically new structures is now, and that’s what I want to work on.
KH: In what capacity do you see yourself doing this?
SW: I’ll continue to do the same thing in a lot of ways that I’ve been doing. I want to continue writing and speaking. I like the area of thought leadership around all of this, but I think there are some good opportunities to do it on the for-profit side.
KH: What advice do you have for CIOs as far as the type of structure or environment that will enable them to be most effective?
SW: I think that CIOs are increasingly recognizing the breadth of their role and the need to influence widely the perceptions about information management and how information management fits within the broader structure of care. If you go back five years ago, the issue was to get the senior leadership teams to recognize that information was really important. I think that now, in a lot of ways, their role has shifted to getting people to be more realistic about what IT can and can’t do.
The persistence of what I always refer to as the pixie dust perception — that if we just go and sprinkle some computer systems around, we will have transformed care — I think is a really dangerous idea, and nobody is better equipped to address that than the CIOs. Computers don’t deliver care, people do. And they do it through processes, so it’s really a matter of looking at those processes.
KH: It sounds like you have a lot of great ideas and that it’s going to be a very exciting time for you as you start to pursue these new goals. In the meantime, how are you keeping yourself busy?
SW: I’m involved in some initiatives with Blue Cross Blue Shield of Tennessee. It’s fun and it’s interesting and they’re really wonderful people and I believe so fundamentally in not-for-profit healthcare, that it’s important to do. But gosh, does it take a lot of time.
KH: So you’re not out practicing your golf game?