As IT’s im­por­tance grows, CIO role grows with technology’s reach

Modern Healthcare - - NEWS - By Maria Castel­lucci

For most of his 20-year ca­reer run­ning in­for­ma­tion technology sys­tems for hospitals and health sys­tems, Ed­ward Martinez was just “the com­puter guy” to his C-suite col­leagues. He re­ported ei­ther to a chief op­er­at­ing of­fi­cer or a chief fi­nan­cial of­fi­cer and was rarely in­vited to weigh in on big-picture mat­ters.

But now Martinez, who has been se­nior vice pres­i­dent and chief in­for­ma­tion of­fi­cer of Mi­ami Chil­dren’s Health Sys­tem for seven years, re­ports only to CEO Dr. M. Naren­dra Kini and is in­volved in “just about ev­ery” as­pect of the or­ga­ni­za­tion, from ex­pan­sion plans to pop­u­la­tion health ini­tia­tives.

Be­ing the com­puter guy has be­come a much big­ger job, with sig­nif­i­cantly more in­flu­ence and re­spon­si­bil­ity.

“I’m now sit­ting in (the board­room) be­cause IT has be­come the cen­ter of all busi­ness,” Martinez said. “To­day there isn’t an el­e­ment in a hos­pi­tal en­vi­ron­ment that isn’t con­trolled by some IT. That puts (me) at the fore­front of at least be­ing asked, ‘Ed, what do you think?’ ”

Kini said he and Martinez are “linked at the hip.” They text and talk mul­ti­ple times a day, ev­ery day, about all ar­eas of the busi­ness.

This isn’t un­usual. As in other in­dus­tries, CIOs in health­care are be­com­ing key ad­vis­ers to the CEO and im­por­tant fig­ures in board meet­ings, a dra­matic shift from less than a decade ago. The change re­flects the sprawl­ing role technology now plays in the over­all op­er­a­tional and strate­gic vi­a­bil­ity of hospitals and health sys­tems.

The in­creas­ingly com­plex or­ga­ni­za­tions now rely on elec­tronic health records, data and an­a­lyt­ics to track and im­prove the qual­ity and safety met­rics they will need if they want to thrive un­der new re­im­burse­ment mod­els like bun­dled pay­ments and ac­count­able care. They also de­pend on their IT prow­ess to of­fer pa­tients new ways to in­ter­act with clin­i­cians, such as tele­health and re­mote pa­tient mon­i­tor­ing.

“It’s all so in­te­grated, so it re­ally takes a CIO who is tuned into the whole exec-

“I’m now sit­ting in the board­room be­cause IT has be­come the cen­ter of all busi­ness. To­day there isn’t an el­e­ment in a hos­pi­tal en­vi­ron­ment that isn’t con­trolled by some IT.

ED­WARD MARTINEZ Se­nior VP and CIO Mi­ami Chil­dren’s Health Sys­tem

“There are very few strate­gies and tac­tics that don’t in­volve IT in way or an­other. The re­la­tion­ships with the C-suite have re­ally ma­tured as a re­sult.” JIM TURN­BULL CIO Univer­sity of Utah Health Care

utive suite,” said Jim Ca­vanagh, a for­mer CIO who’s now a health­care IT con­sul­tant at Com­port. Ca­vanagh says the best CIOs know the fi­nan­cial, op­er­a­tional, clin­i­cal and strate­gic goals of the or­ga­ni­za­tion so they can im­ple­ment and in­vest in technology the sys­tem needs and can af­ford.

At Henry Mayo Ne­whall Hos­pi­tal in Valencia, Calif., where Cindy Peter­son has been CIO for 14 years, CEO Roger Seaver meets with Peter­son one-onone twice a month to dis­cuss the IT depart­ment’s cur­rent as­sign­ments and fu­ture projects. The hos­pi­tal is in the thick of up­dat­ing its Meditech EHR sys­tem to a newer ver­sion.

Peter­son also at­tends monthly board meet­ings with the rest of the ex­ec­u­tive team. She will of­ten raise cost and per­for­mance con­cerns based on data her team col­lects. No other depart­ment in the hos­pi­tal an­a­lyzes qual­ity met­rics at such a de­tailed level, so Peter­son is called on to iden­tify in­ef­fi­cien­cies such as how well drugs are ad­min­is­tered to pa­tients.

“As we im­ple­ment sys­tems, we’re dig­ging deep into the op­er­a­tional work­flows of de­part­ments, so we’re very much aware of what’s go­ing on,” Peter­son said. “That is great knowl­edge to have at the C-suite ta­ble.”

It’s rel­a­tively new for CIOs to be re­spon­si­ble for ad­dress­ing clin­i­cal and per­for­mance out­comes, ac­cord­ing to Adri­enne Edens, vice pres­i­dent of ed­u­ca­tion at the Col­lege of Health­care In­for­ma­tion Man­age­ment Ex­ec­u­tives and for­mer CIO at Sut­ter Health. In­te­grated EHR sys­tems have pro­vided hospitals and sys­tems with a wealth of data that’s es­sen­tial in a value-based re­im­burse­ment cli­mate.

CIOs “have al­ways been good project man­agers, and now lead­ers want them to bring that to the ta­ble and say, ‘How do we re­duce cost? How do we cre­ate a bet­ter pa­tient ex­pe­ri­ence?’ ” Edens said.

In a 2016 survey by the Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety, 95% of re­spon­dents said IT is a crit­i­cal strate­gic tool to help sys­tems and hospitals. About 73% of re­spon­dents re­ported IT in­te­gra­tion was needed in clin­i­cal set­tings, and 68% thought it was needed to meet man­dated qual­ity met­ric im­prove­ments.

Randy McCleese, vice pres­i­dent of in­for­ma­tion ser­vices and CIO at St. Claire Re­gional Med­i­cal Cen­ter in More­head, Ky., has seen his role change dras­ti­cally since 1996 from pri­mar­ily a soft­ware in­staller to a strate­gic ad­viser.

He also started team­ing up with other sys­tem lead­ers. St. Claire Re­gional, a 133-bed hos­pi­tal, is part of the Ken­tucky Health Col­lab­o­ra­tive, a statewide part­ner­ship that in­cludes nine other providers in­clud­ing Louisville-based Bap­tist Health and Brent­wood, Tenn.based LifePoint Health.

He and the CIOs of the other par­tic­i­pat­ing sys­tems are hatch­ing ways to share data and re­duce op­er­a­tional costs. McCleese said such partnerships have be­come es­sen­tial.

But the job can be over­whelm­ing be­cause the strate­gic ex­pec­ta­tions are lay­ered onto the tra­di­tional pri­vacy and soft­ware du­ties of a CIO. “We’re adopt­ing technology at warp speed, but then we’ve got all these se­cu­rity is­sues like ran­somware,” McCleese said. “It’s like we’re be­ing asked to do ev­ery­thing all the time.”

Some­times the big­ger scope comes with a com­men­su­rately big­ger bud­get and staff, and some­times it doesn’t. About 71% of re­spon­dents to the HIMSS survey (the vast ma­jor­ity of whom work for hospitals and sys­tems) said they ex­pected their IT bud­gets to in­crease in the next 12 months.

Martinez said his bud­get at Mi­ami Chil­dren’s has at least dou­bled in the 20 years he’s been in health­care IT. On av­er­age, IT ac­counts for 8% to 11% of the $800 mil­lion op­er­at­ing bud­get at the sys­tem, which con­sists of a 272-bed hos­pi­tal and 10 out­pa­tient cen­ters.

At St. Claire Re­gional, McCleese said, the IT depart­ment’s piece of the $365 mil­lion op­er­at­ing bud­get has held rel­a­tively steady for the past seven years at about 3%. (Ac­cord­ing to data col­lected by HIMSS, in­for­ma­tion ser­vices ac­count for about 3.9% of hos­pi­tal ex­penses.)

Be­cause EHRs have be­come in­te­gral to run­ning a hos­pi­tal, CEOs are ac­tively en­gaged with projects in­volv­ing those sys­tems. Although Univer­sity of Utah Health Care CIO Jim Turn­bull re­ports to COO Quinn McKenna, for­mer CEO David En­twistle (he left in May to lead Stan­ford Health Care) was in­ti­mately in­volved with the four-hos­pi­tal sys­tem’s three-year Epic EHR roll­out. Much of last year was spent ad­dress­ing more than 400 com­plaints from physi­cians and staff—physi­cians gen­er­ally com­plained of too many pop-ups and not enough au­to­ma­tion in the soft­ware.

Now Univer­sity of Utah Health Care has called on Turn­bull to help with the early stages of tele­health ini­tia­tives. “There are very few strate­gies and tac­tics that don’t in­volve IT in one way or an­other,” Turn­bull said. “The re­la­tion­ships with the C-suite have re­ally ma­tured as a re­sult.”

In ad­di­tion hav­ing to a big­ger say in those lead­er­ship dis­cus­sions and de­ci­sions, CIOs are deal­ing more closely with clin­i­cians.

St. Claire Re­gional, for ex­am­ple, is in­te­grat­ing its three EHR sys­tems be­cause physi­cians have been frus­trated that it’s so dif­fi­cult for them to look at their clin­i­cal per­for­mance. And Martinez at Mi­ami Chil­dren’s has been work­ing closely with physi­cians for the past two years to help them nav­i­gate a new re­im­burse­ment model.

“Be­fore, physi­cians were only asked to take care of pa­tients,” Martinez said. “Now we’re ask­ing them to un­der­stand the way to op­er­ate a busi­ness to max­i­mize rev­enue for them­selves and the sys­tem.”

Martinez says there has been a learn­ing curve for him and for physi­cians. Physi­cians have var­i­ous ways of doc­u­ment­ing in­for­ma­tion, and he is still try­ing to find a way to stan­dard­ize the process so it’s ef­fi­cient.

All of this comes as providers are asked to do more with less with­out sac­ri­fic­ing qual­ity, he said.

“It’s more of a chal­lenge than I thought it would be,” Martinez said. “But most CIOs prob­a­bly em­brace it be­cause we’ve al­ways been left out of the board­room. Now that you have the opportunity to be in it, you’re not go­ing to turn your back, even if you have to work dou­ble time.”

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