Transcript Leadership: The CIO

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
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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
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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
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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
CIO
Management
Engineering
Info Systems
Operations
Communications
Health
Information
Management
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 inhouse 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