Leadership: The CIO

1
Leadership The CIO

• HSPM J713

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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

3
Chief Information Officer

• Leadership
• Human resources
• Management expertise
• Not just running things, but also planning for
  future.
• transitioning

4
Leadership and management

• Too much required knowledge for any one person
• Managing and coordinating the content experts

5
CFO and CIO

• Years ago, the chief financial officer was chief
  information officer
• Reflects ITs start in handling
• Payroll
• Accounts payable and receivable
• Communication with payers
• All involve money flows

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CIO as separate job

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

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Successful organizations do this with IT

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

8
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

9
Successful organizations do this with IT

• Actively design governance
• Focus on goals and objectives of the
  organization, not just the IT dept.s operations

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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

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Successful organizations do this with IT

• Involve senior managers
• Bring senior management into technology decisions
• Bring, to senior management, technology decisions
  with strategic implications

12
Successful organizations do this with IT

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

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CIOs functional responsibilities

• Reports directly to the CEO
• Enterprise planning
• Leadership
• Management oversight
• Human resources
• Financial management

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CIO responsibilities

• Careful planning process
• Master plan
• updated annually
• Linked to organizations strategic plan

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CIO responsibilities

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

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CIO responsibilities

• Recruiting
• Competent personnel
• Vendor selection

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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.

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CIO responsibilities

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

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CIO responsibilities for new projects

• Establish interdisciplinary teams to design new
  systems
• Systems analysts and computer programmers fit in
  here
• CIO doesnt have to have their expertise, but has
  to be able to understand them
• User-driven focus rather than technology-driven
  focus

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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

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CIO responsibilities for new projects

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

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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

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CIO responsibilities for new projects

• Maintenance
• Must be planned for

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CIO responsibilities for new projects

• Audits and formal evaluations

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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?

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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

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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 CIOs
  report to CEOs.
• 38 report to CFOs (reflecting old IT focus)
• 25 report to COO, chief medical officer, or other

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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

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IT organizational chart
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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.

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Info Systems Operations functions

• Systems
• Maintenance
• Analysis
• Programming
• Software evaluation
• User support
• Operations
• Computer
• Network
• Data preparation

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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.
• Thats how USC operates
• Complicates leadership role of CIO
• Departmental decisions affect the whole
• But the responsibility is local

33
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

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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

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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

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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

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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?

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Benefits of outsourcing

• Less in-house staff
• Less in-house capital equipment investment
• More flexibility as requirements and technology
  change
• Youre not stuck with old stuff
• Faster to get a solution thats already developed
• Predictable costs

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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

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One authors 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.
• Dont jump at the low bid.

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Accounts receivable as candidate for outsourcing

• Outsourcing doesnt reduce costs, but outsources
  are more ruthless and more consistent at
  collecting
• Collecting is outsourcers business, so they have
  more specialized expertise
• Collecting is outsourcers business, so they have
  more appropriate technology
• You can focus on health services, rather than
  bill collecting

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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

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Outsourcing survey

• gt30 outsourced
• Web site
• Dictation and transcription
• lt20 outsourced
• Project management
• Help desk
• Database management
• telecommunications

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Near-term issues for CIOs

• 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

45
Near-term issues for CIOs

• Changing technologies
• Radio identification (RF) replacing bar codes
• smart phones replacing PDAs

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Near-term issues for CIOs

• Interoperability
• Standardization, driven by national policy, is
  coming.
• Confusion meantime, because we can only guess
  what the standard will be

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Near-term issues for CIOs

• Ambulatory settings
• Integration of electronic medical records

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The CIO in the organization

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

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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

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The CIO in the organization

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

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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

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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)

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Other coming challenges

• Security
• Breaches and leaks
• Regional information exchange
• With public agencies and other providers
• Web-based applications
• Outsourcing

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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 ITs role.
• CIO must work up, horizontally, and internally