CIOs Sit at the Nexus of Tectonic Shifts

At times like these, I am grateful not to be in the CIO’s chair, wondering which miracle of IT I should hit the organization with first. I am not sure what year this is in the Chinese calendar, but in the IT calendar this is the year of seven loaves and seven fishes.

Among those loaves is EHRs, Meaningful Use, ACOs, IC-10, and Patient Experience Management. There is plenty to do, and for those who hate repetition and boredom, this year, along with the next several, should be neither repetitious nor boring.

What to do first?  Is there a logical first miracle to tackle?  Conventional wisdom would point towards EHR and Meaningful Use — get the loudest monkeys off your back. Permit me to suggest conventional wisdom can be unwise.

I am willing to bet hospitals have something akin to a plan in place to address EHR and Meaningful Use. Some will have a plan for tackling ICD-10. Fewer still will have one for turning your organization inside out to adapt it for ACOs, and a smattering may have jotted down a few lines about Patient Experience Management. Some have none of the above.

Let us talk about strategy for a few moments. The hospital’s business strategy (its strategic plan) and the CIO’s IT strategy (the IT strategic plan). Note, the IT strategic plan should not be confused with the EHR implementation plan. Stepping out on a limb, assuming that both the hospital’s strategic plan and IT’s strategic plan actually exist, there are a few questions to be addressed.

• Were the two plans developed in concert
• What the hospital’s plan for ICD-10
• What is their plan for becoming an ACO
• What are their expectations of IT for making these a reality
• What resources have they allocated for these initiatives

From those with whom I have spoken, it appears most strategic plans have two alarming faults; they are neither plans nor strategic. Unfortunately, that does not get the office of the CIO off from having to achieve the hospital’s ill-defined, if not unspoken, imperatives.

This is where it is helpful for the CIO to hire someone as their Director of Clairvoyance. You know you are going to be held accountable for delivering these loaves and fishes. Your best shot at making this happen is for you to write the plan telling the C-Suiters what you will need to even have a shot at making their dreams a reality.

There are a few ways to approach this planning initiative. One way is to write one plan for EHR/Meaningful Use, one for ICD-10, and one for ACO. Doing it this way, the combined plans will have the half-life of a fruit fly.

The only department in the hospital which can pull together an understanding of the crossover implications of and perils each strategic initiative is IT. It is one matter to define what must be done were ACO and ICD-10 stand-alone initiatives, and another to understand what must be done to enable all of these initiatives to work in concert.

There are not a lot of people one can turn to who have implemented successfully any of the listed miracles. There is no clear understanding of the implications of reform or what the likely impact of changes to Medicare and Medicaid will be and how all these will impact EHR, ICD-10, and Meaningful Use. All that is known is that they will.

For these initiatives to be of any value five years from now requires a great deal of planning and less doing. This is the CIO’s Lazarus moment. If there was ever a time for CIOs to take the lead in their organization this may be it. Nobody is going to support the notion of spending six months writing a real strategy, but it when all blows up, someone is going to ask to see yours.