The pressure is on CIOs and others in the health IT C-suite to become organizational leaders, while delivering in ways different from ever before
The healthcare CIO is the correct initialism for “chief information officer,” but as the landscape continues to shift—with the focus now on digital and strategic optimization, transformation and innovation—some observers are now wondering if “information” is really the most appropriate word for all that encompasses the modern-day CIO.
For the past two decades, Chuck Podesta has been a healthcare CIO, spending the last four years at UC Irvine Health, the integrated health system at the University of California-Irvine in Orange County, California. Podesta recalls the days when the CIO had a more IT-based title and financially-related job in healthcare, since clinical IT wasn’t a strong focus at that time. But with the evolution of EHRs (electronic health records), says Podesta, “The focus became clinical and the job suddenly had a broader scope. It’s not just the day-to-day running of the systems anymore; the CIO is now needed from the standpoint of strategy development because he or she is affecting the entire organization.”
Some would refer to the early-day healthcare CIO as an IT engineer of sorts, someone very technology-focused whose core responsibilities centered around hardware and software implementations, and getting servers up-and-running within the organization. Then came the influx of EHR deployments across hospitals and health systems, and now that there is near-universal possession of EHRs in U.S. hospitals, the tide is once again shifting.
“In the past, the CIO had more of a technical role and the focus was more on the operational side of the house—things such as enterprise resource planning (ERP) and the billing cycle. But the widespread advent of EHRs changed so much of that,” says Dave Levin, M.D., a former chief medical information officer (CMIO) at Cleveland Clinic and current chief medical officer at health technology company Sansoro Health. “When you deployed the EHR, it tightly linked clinical operations to IT. And that’s obvious. But it also put IT in the middle of enabling all kinds of activities and strategies. So, this requires strong enterprise governance and strong IT governance, and it requires that they fit together. A lot of organizations are struggling with that, and that’s reflected in the role the CIO plays,” Levin says.
Podesta notes that when the CIO title first came about, many directors of IT in healthcare organizations wanted the “chief” designation. But to Podesta, there was a key difference between IT directors and CIOs: good directors of IT spend 80 percent of their time managing day-to-day operations and 20 percent of their time on strategy, but for “true” CIOs, it’s the opposite, he says. “There was a period where there was a ‘filtering out’ of individuals who tried to become CIOs, but were really IT directors and couldn’t make that leap into the strategy world. That led to a changing of the guard,” he says, adding that much of the new focus turned to developing EHRs and then becoming an equal player in the C-suite on the strategy teams. “You have to be able to work on IT strategy and develop it in conjunction with the business strategy,” Podesta attests.
Today’s CIO—One of the Scariest Jobs in Healthcare?
For the modern CIO, priorities are indeed changing and becoming more complex, and with that comes increased pressure. For instance, in addition to all of the technical aspects of the job, today’s healthcare CIO must also stay out in front of various up-and-coming health IT innovations, while maintaining a much-needed big-picture view of how digital transformation will affect business operations.
And then there is the cybersecurity factor; a 2016 survey of 100 healthcare CIOs from Spok and the College of Healthcare Information Management Executives (CHIME) revealed that 81 percent of CIOs said strengthening data security was their top business goal for the next 18 months. Put all together,
“The CIO role in healthcare is one of the scariest roles there is because of the high risk involved, and the fast pace of technology,” offers David Butler, M.D., founder of healthcare consulting firm Calyx Partners, and a former clinical IT executive at Sacramento-based Sutter Health. “The cost of healthcare IT has gone up tremendously. [The days of] just buying Epic’s EHR and having your job be safe are long [gone],” Butler adds.
Butler notes that an EHR go-live, and the optimization that follows, are typically the most transformational things that occur in a CIO’s life, and the audience for these deployments are what he calls the CIO’s "golden geese”—physicians and nurses. “So there is more pressure on the CIO than ever before,” Butler attests. He adds that in addition to all of the clinical and IT considerations, it’s unfair to expect CIOs to be privy to all of the regulatory requirements that come from CMS (the Centers for Medicare & Medicaid Services) as well. “There is just no way that CIOs can know all these things. I think expectations need to be reset,” Butler says.
As such, experts believe that the “new” healthcare CIO must have a broader understanding of healthcare. “Smart organizations are looking for a more strategic role for the CIO, and think that they should be in the C-suite and in the middle of strategy discussions,” says Levin. "CIOs need to understand both where the organization is going—so that they can think about the technology that can enable that [vision]—while also informing and expanding on the thinking of the folks that are considering strategy—things that might not have been considered without that [CIO] expertise in the room,” he adds.
A core part of a healthcare organization’s vision going forward will certainly involve strategies on transitioning to a value-based care environment. Indeed, the emphasis on accountable care has increased the need for hospitals and health systems to collect and analyze data to drive improvements in quality and efficiency—leading many hospitals to ask more of their CIOs.
To this end, Podesta notes that the industry has been operating in a fee-for-service world for so long now, and in most cases, IT is an enabler of the business strategy, so once the business strategy starts to move toward value-based care, IT needs to come into play from a strategy perspective. “If you don’t have that background or the ability to understand it, you will be left behind,” he attests.
Podesta adds that in some instances, he is seeing CIOs play in both the medical provider and payer world, since lots of healthcare systems also have their own insurance companies. “You will see more and more of that in the future, and as a CIO, you will need to understand what risk means and how to manage risk,” he advises. “It’s a completely different way of caring for patients, and being able to sift through all the technologies out there for your organization, without making huge mistakes and spending the money in the wrong place, will certainly be a challenge,” he adds.
What’s more, all the sources interviewed for this article were quick to point out yet another new business consideration for CIOs: the influx of non-traditional players looking to move into healthcare. Podesta brings up the new Apple Health Records feature that allows patients of hundreds of hospitals and clinics to access medical information from various institutions organized into one view on their iPhone. “Lots of organizations are signed up for [this], and we have actually started to create apps; five years ago, you wouldn’t have been thinking about that. But now you have to model your organization to make sure you have the people to utilize these technologies as they are coming out,” he says, adding that hiring the right people who can work in these environments will be crucial. “The time for the sequel programmers is coming to an end. You need data scientists now.”
And as Butler bluntly puts it, “Apple, Amazon, Google and Microsoft have been watching this $3 trillion [healthcare] prize for a long time, but have not touched it because of HIPAA and other over-regulated [barriers] that prevented them from innovating in this space. But then you had deductibles go from $1,000 to $7,000 before the insurance kicks in, so the patient turned into the customer. And these disruptors said to themselves, ‘We know customers, we don’t know patients. So now we will go for it.’”
The CIO-CMIO Partnership
As CIOs continue to take on more responsibilities, experts believe that another clinical IT role in the C-suite, chief medical information officers, or CMIOs, are also ready to take on an increased role, especially as IT becomes much more critical to support value-based care and other quality initiatives. Indeed, as CMIOs have become more engaged in healthcare organizations, the interaction between these key IT players is expanding and continuing to evolve.
Levin recalls that in the early days of EHR deployments, folks saw the CMIO as the person that should go deal with the “angry physicians.” But now, post-deployment, as the tide turns to thinking about getting the most out of these IT systems, the partnerships between CIOs and CMIOs are stronger and more equal, Levin says.
“You are even seeing CMIOs migrating into the CIO role, which was rare in the past, but becoming more common. You are also seeing CMIOs migrate into other C-suite-type roles such as chief health information officers, chief quality officers, chief transformation officers, and in some cases, chief medical officers. And that makes sense, since there is an increasing emphasis on the intersection of clinical and operational, and the role of IT in supporting all of that,” he says. Podesta agrees with Levin’s premise; quite a few CMIOs are becoming CIOs, he notes. “A lot of them have gone back and gotten MBAs to understand the business side [of healthcare].”
Podesta is also seeing another trend: that some organizations, such as academic medical centers, are struggling with clinical IT, and are thus recruiting for CIOs who are physicians, to get a level of credibility with doctors to help them with issues around physician adoption and EHRs. “I get lots of calls from recruiters, and when I talk to them about different positions out there, many are looking for clinically-oriented people. I am seeing that more and more,” he says.
To some, the evolution of the CIO-CMIO relationship also paints a bigger picture of just how tightly linked everything has become—particularly the dependency that a healthcare organization has on IT for its success. “It’s never been greater,” says Levin, who believes that the CMIO “is a unique beast, and one of the few healthcare roles in which you sit at a crossroads and have a view of the world that is different from other C-suite leaders.” He adds, "And that view might not be better; it’s complimentary. The typical CMIO has practiced clinically, has been involved in IT, and many have had operational backgrounds as well, or a medical affairs background. They are kind of ‘unicorns’ in a way, and I think they match up nicely with the way the governance and strategic needs of the organization overlap,” he says.
What the Future Looks Like
In a myriad of different ways, it’s been quite the evolution for CIOs, CMIOs and others in the healthcare IT C-suite. With all of the challenges and increased pressure that experts believe have mounted in recent years, comes opportunity for certain individuals to thrive.
Levin says the qualified CIO going forward will need the necessary “soft skills,” leadership ability, and strategic knowhow. It will be less about the technical aspects of the role. “The ultimate challenge everyone is facing is the pursuit of the Triple Aim and doing it efficiently, so a lot of the [job] is about how you can do more with less,” he says.
These roles also have another kind of unique balancing act, in that so many of them try to maintain a clinical practice, which Levin notes “is admiral,” but because they have also taken on these important administrative and leadership roles, he has seen many of his colleagues struggle with the balancing act. “Too often, they think the clinical/administrative ratio is 50:50, but in reality, it’s 75:75 and they are working at 150 percent capacity,” he says.
Adds Podesta, “It’s not just understanding the IT world—the programming and the infrastructure—but you have to understand the business side as well. To be in that C-suite and in those meetings, you need to be able to add value to items that maybe aren’t under your control. But you need to be that thought leader within the C-suite—just like the chief operating officer, chief medical officer and others are.”
Podesta believes that the “information” part of the chief information officer title is simply no longer indicative of all the CIO must do now, and what will be required of the role moving forward. “People view the CIO role as ‘you must work in medical records’ or even that you are in marketing, so yes, I think we probably do need a better title,” he acknowledges. Podesta notes that titles such as chief digital officer are making the way into healthcare organizations, and given the digital landscape, it’s actually more appropriate. “The CIO might move to ‘chief innovation officer,’ and that makes a lot of sense,” he says.