Leadership: The CIO

HSPM J713

Chief Information Officer

– This chapter was at end of 6th edition

• Learning objectives– Job duties and responsibilities of CIO and CEO and

other leaders– Key knowledge, skills, abilities that CIO must have– Various paths to becoming CIO– Organizational chart for HIT– Future challenges to CIO

Chief Information Officer

• Leadership• Human resources• Management expertise

• Not just running things, but also planning for future.– transitioning

Leadership and management

• Too much required knowledge for any one person

• Managing and coordinating the content experts

CFO and CIO

• Years ago, the chief financial officer was chief information officer

• Reflects IT’s start in handling – Payroll– Accounts payable and receivable– Communication with payers

• All involve money flows

CIO as separate job

• New requirements beyond money control– Clinical information systems– Regulatory compliance– Strategic planning and decision support

Successful organizations do this with IT

• Actively design governance• Know when to redesign• Involve senior managers• Make choices• Have an exception-handling process

Successful organizations do this with IT

• Provide right incentives• Establish “ownership” and accountability• Design governance at multiple levels in the

organization• Transparency and education• Implement common mechanisms across the

“six key assets”

Successful organizations do this with IT

• Actively design governance– Focus on goals and objectives of the organization,

not just the IT dept.’s operations

Successful organizations do this with IT

• Know when to redesign– CIO must design procedures for reviewing what IT

does• Involves teamwork outside of IT

– Lead the review

Successful organizations do this with IT

• Involve senior managers– Bring senior management into technology

decisions– Bring, to senior management, technology

decisions with strategic implications

Successful organizations do this with IT

• Provide right incentives• Establish “ownership” and accountability– Encourage a broad view of the organization,– Not turf protection

CIO’s functional responsibilities

• Reports directly to the CEO

• Enterprise planning• Leadership• Management oversight• Human resources• Financial management

CIO responsibilities

• Careful planning process– Master plan – updated annually– Linked to organization’s strategic plan

CIO responsibilities

• User-driven focus– Active involvement of personnel at all levels• In choosing technology• Designing installation and transition• Operation• Evaluation

CIO responsibilities

• Recruiting– Competent personnel– Vendor selection

CIO responsibilities

• Integration / interoperability of– Data files– Interfaces

• Especially tricky for complex organizations with subsidiaries

• [The prospects for interoperability must be considered for any proposed acquisition.]

CIO responsibilities

• Assure that legal and ethical obligations are met– Confidentiality• Patients• Medical staff• employees

CIO responsibilities for new projects

• Establish interdisciplinary teams to design new systems– Systems analysts and computer programmers fit

in here– CIO doesn’t have to have their expertise, but has

to be able to understand them– User-driven focus rather than technology-driven

focus

CIO responsibilities for new projects

• Careful systems analysis must precede implementation

• Preliminary design specifications for technology applications must fit with master plan

• Lay out all details before implementation starts

CIO responsibilities for new projects

• Careful scheduling of all activities• Periodic progress reports• Plan for training of personnel on new system

CIO responsibilities for new projects

• Always test system before going live• Test must be comprehensive– Software and procedures– Personnel training– User reaction– Effectiveness at meeting stated objectives– Cost in practice compared with initial projections

CIO responsibilities for new projects

• Maintenance• Must be planned for

CIO responsibilities for new projects

• Audits and formal evaluations

What makes a successful CIO

• Skills in– Business– Clinical processes– Leadership– Administration– Communication– “technical savvy” [downplayed? Or is this reacting

to past tendency to promote a geek to CIO?]

What makes a successful CIO in practice (well-regarded within

organization)• Business basics– Getting things done on time and on budget

• Involvement in broader goals less often cited• Successful CIOs have active support and

involvement of CEO.• Work experience in health care IT cited– [geek with management training and experience?]

• Clinical experience less often found

Organization of IT department

• This book advocates that the CIO should report to the CEO directly– Broadening responsibilities, centrality of IT

• A survey finds, however, that only 37% of CIO’s report to CEO’s.

• 38% report to CFO’s (reflecting old IT focus)• 25% report to COO, chief medical officer, or

other

Organization of IT department depends on:

• Centralization/decentralization of computer systems– Book seems to advocate centralization for

interoperability

• Systems developed in-house vs. purchased software or systems developed by outside application service providers

• In-house vs. outsourced functions

IT organizational chart

IT organizational chart

• In large organizations, each block is a manager with staff

• In small organizations, each block may be one person. One person may share functions.

Info Systems Operations functions• Systems – Maintenance– Analysis– Programming

• Software evaluation• User support• Operations– Computer– Network– Data preparation

IT organization

• In many organizations, IT people lower in the organization chart report to clinical departments rather than, or in addition to, up the ladder to the CIO.– That’s how USC operates– Complicates leadership role of CIO• Departmental decisions affect the whole• But the responsibility is local

Staffing the IT department

• Taking qualifications seriously. For example, the head of health information management should be experienced and certified http://www.ahima.org/certification/

• With “broad knowledge of information flow and electronic health records …”

Professional personnel

• Systems analysts– Tech knowledge– Must be able to deal with people• Human-machine interaction

• Computer programmers– More technically focussed– Shifting from mainframe to networks with

distributed computing• Highly creative processes

Technical personnel

• Technical leadership– Up on latest technical developments– Financial manager– Interpersonal relationships

• Professional and technical staff have grown and are expected to grow more

Budgeting and IT

• Direct spending 2.5% of budget, typically– But impact is much broader

• Labor costs – table of 2006 typical salaries– CIO $150,000– Info Sys director $104,000– Systems analyst $63,000– Help desk operator $46,000

Outsourcing vs. in-house

• When you read those requirements for personnel and expected salaries, staffing that IT organizational chart can look daunting.

• Buy better than Make?

Benefits of outsourcing

• Less in-house staff• Less in-house capital equipment investment• More flexibility as requirements and

technology change– You’re not stuck with old stuff

• Faster to get a solution that’s already developed

• Predictable costs

Dangers of outsourcing

• Dependent on vendor, who may go broke or make changes to meet other market demands

• Vendors can charge $$$– Especially once your business model depends on

them

• Contractors not intimately familiar with your organization

One author’s suggestions

• Seek long-term commitment from vendor– [But there goes your flexibility]

• Require relevant experience• Develop performance measures– [In general, outsourcing is more manageable if the

product is well-specified.]

• Don’t jump at the low bid.

Accounts receivable as candidate for outsourcing

• Outsourcing doesn’t reduce costs, but outsources are more ruthless and more consistent at collecting

• Collecting is outsourcer’s business, so they have more specialized expertise

• Collecting is outsourcer’s business, so they have more appropriate technology

• You can focus on health services, rather than bill collecting

Outsourcing example

• Jefferson Regional Medical Center (Pittsburgh) and Siemens Medical Solutions– Billing and clinical support– Worked with functional departments as an in-

house IT operation would– PDAs for physicians• Technology changing fast

Outsourcing survey

• >30% outsourced– Web site– Dictation and transcription

• <20% outsourced– Project management– Help desk– Database management– telecommunications

Near-term issues for CIO’s

• Low hospital budgets for IT– Particularly regarding electronic medical records

and clinical applications

• Need to argue for increased budgets based on – Accountability measures that need to be designed

and implemented

Near-term issues for CIO’s

• Changing technologies– Radio identification (“RF”) replacing bar codes– [smart phones replacing PDAs]

Near-term issues for CIO’s

• Interoperability– Standardization, driven by national policy, is

coming.– Confusion meantime, because we can only guess

what the standard will be

Near-term issues for CIO’s

• Ambulatory settings– Integration of electronic medical records

The CIO in the organization

• CIO’s do not directly use technical skills, but probably need technical skills to go up the ladder.

The CIO in the organization

• Up– Relations with CEO and Board of Directors

• Horizontal– Relations with Chief Financial Officer, Chief

Medical Officer, head of nursing

• Internal– Management of the IT unit

The CIO in the organization

• Responsibility shifting back to CFO because of Sarbanes-Oxley reporting requirements?

Near-term application development

• Reduction of medical errors and enhancing patient safety– Computerized physician order entry– Computer-based records

• Patient-provider communications– Information– Monitoring systems for patients at home

• New national priorities– Y2K and HIPAA took over for a while

4 levels of interoperability

• Data not in electronic form (must be read or spoken)

• Word-processor data (must be read by people)

• Data files with incompatible formats (require conversion that never works 100% automatically)

• Data files with different formats (require translation)

Other coming challenges

• Security– Breaches and leaks

• Regional information exchange– With public agencies and other providers

• Web-based applications• Outsourcing

Big points

• The CIO position has evolved into a top executive position

• Broad organizational skills required• IT has broadened in its reach. Internal and

external pressures increase IT’s role.• CIO must work up, horizontally, and internally