Leadership: The CIO

1. Leadership: The CIO HSPM J713

2. 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 IT’s start in handling • Payroll • Accounts payable and receivable • Communication with payers • All involve money flows

6. CIO as separate job • New requirements beyond money control • Clinical information systems • Regulatory compliance • Strategic planning and decision support

7. 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

10. 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

11. 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

13. CIO’s functional responsibilities • Reports directly to the CEO • Enterprise planning • Leadership • Management oversight • Human resources • Financial management

14. CIO responsibilities • Careful planning process • Master plan • updated annually • Linked to organization’s strategic plan

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

16. CIO responsibilities • Recruiting • Competent personnel • Vendor selection

17. 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.]

18. CIO responsibilities • Assure that legal and ethical obligations are met • Confidentiality • Patients • Medical staff • employees

19. 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

20. 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

21. CIO responsibilities for new projects • Careful scheduling of all activities • Periodic progress reports • Plan for training of personnel on new system

22. 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

23. CIO responsibilities for new projects • Maintenance • Must be planned for

24. CIO responsibilities for new projects • Audits and formal evaluations

25. 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?]

26. 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

27. 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

28. 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

29. IT organizational chart

30. 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.

31. Info Systems Operations functions • Systems • Maintenance • Analysis • Programming • Software evaluation • User support • Operations • Computer • Network • Data preparation

32. 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

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 …”

34. 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

35. 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

36. 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

37. 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?

38. 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

39. 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

40. 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.

41. 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

42. 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

43. Outsourcing survey • >30% outsourced • Web site • Dictation and transcription • <20% outsourced • Project management • Help desk • Database management • telecommunications

44. 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

45. Near-term issues for CIO’s • Changing technologies • Radio identification (“RF”) replacing bar codes • [smart phones replacing PDAs]

46. 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

47. Near-term issues for CIO’s • Ambulatory settings • Integration of electronic medical records

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

49. 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

50. The CIO in the organization • Responsibility shifting back to CFO because of Sarbanes-Oxley reporting requirements?