The pace of changing being forced upon the industry by government programs such as Meaningful Use, ACOs and ICD-10 is proving all too much for those tasked with implementing them, according to the August healthsystemCIO.com SnapSurvey, in which a majority said the required tempo does not allow for technologies to be implemented in a safe, secure and controlled manner. A majority also agreed with the prognostication of Beth Israel Deaconess Medical Center CIO John Halamka, M.D., that the position of chief information officer will become “untenable” due to ever-increasing demands. And with such demands on their plates, it’s no surprise most also need additional senior IT staffing immediately, though a number related that funding for such positions did not exist. But, luckily for the hospitals that employ them, only a quarter of respondents plan to look for new, less-stressful roles during the next three years, with more than a few proclaiming the stress that plagues them also invigorates.
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)
1. In a recent interview with healthsystemCIO.com, John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center in Boston, said, “There’s going to come a point in time at which the CIO role is untenable.” Do you agree?
We are passed the breaking point because expectations are beyond reasonable. We are experiencing a lack of seasoned resources with the healthcare and technical depth required, budget limitations and the inability of vendors to provide quality and experienced staffing for implementations. I have no doubt this has impacted the morale and health of many IT staff. If I hear, “Do more with less,” one more time, I will vomit. In all of this, the patient will lose as we do EMR implementations on-the-cheap. “Just slam it in and move on to the next site.”
It’s always been ‘untenable.’ As we get business leaders more involved in the design and use of the technology, our leadership will become more complicated.
Of course, this can be fixed in more than one way. Organizations must shift from their traditional structures and commitment levels in order to support the rate of change we are experiencing today.
Unless you can create a solid CMIO, VP structure and governance process that works and distributes responsibility for success to other leaders.
We are pretty close to being there. I think few people can really understand the frenzied volume of activities, decisions, etc. And, in many places, the CIO/IT Lead is not at the table for many of the more strategic conversations. It will be tough to navigate this going forward …
Not so much because of the numerous projects which must be done but, because of the rapid pace, core principles of I.T. (architecture, data management, etc.) are being fragmented and “outsourced” to vendors. Perhaps now is exactly the time we should be updating our I.S. strategic plans!
Perhaps in need of redefinition in either roles or responsibilities and certainly requiring of much more fungible skills, but untenable seems really strong.
I’ve been in the CIO role for 21 years and it has been one of constant change. We started out defining the role, and I think we probably still are. We’ve moved from widget implementers to business, process, and change practitioners/experts. I think the position will continue to evolve. One thing for sure, if you are not a business leader, you may not survive long nor will you be effective.
It will be very challenging, but not untenable.
The incumbent CIO needs to always manage expectations of those stakeholders he or she supports (including other C-level executives).
The role of the CIO should evolve, as should all executive roles, to meet the needs of the organization and industry. The role, as it is today, is different than it was 10 years ago and should be different 10 years from now.
It may be an issue with some organizations, but I don’t think it is generic.
While the role will shift, I don’t think at any point it will become untenable. That’s like saying in the future there will be no more need for the patent office.
I’m not sure the context of the comment, but I feel the CIO role will grow. The person in the role may have more combined clinical and technical responsibilities and skills.
Without more context, this isn’t clear. However given that other sectors in the global economy seem to still have CIOs, what specifically is the point? It’s not scale.
Not any more so than any other senior leadership role in an organization. A great deal of change lies ahead, but it will not by any means be restricted to the healthcare technology field. I think there is an absolute necessity for CIOs to become CXX’s. . .able to understand the challenges of all members of the executive team.
The CIO role is certainly evolving, and those who are “old school” CIOs will certainly find themselves in an untenable position. But if you can move toward the strategic skill sets required by a CIO in today’s healthcare environment, you will not only survive, but become a more valuable and valued member of the management team.
2. Do you feel the rate of change being forced upon the industry by both government (MU, ICD-10, ACO) and clinicians (think iPad and iPhone usage requests) is too rapid to be implemented in a safe, secure and controlled manner?
This is all moving far too fast and somehow Finance thinks the investment and support ends with the capital purchase of the solution. Somehow this all magically works without security, without staff, without ownership by the user community.
Too much too quick can cause an organization to miss the details.
Too rapid based on available resources (people, time, and money) to do it right.
It could be, depending on the current state of organizations.
There will lots of failed efforts in the future.
Yes, doing this fast and doing this well are two different things. Doing it well is very expensive and requires a lot of deliberation, consensus-building, training, etc. There’s no time for that. We are all racing to check boxes to get money (that we’ve already spent and more).
Not so sure that I would say too rapid to be safe and secure. I would agree that it is difficult to control. Healthcare is a place of constant change; we are always finding better ways of providing safe and effective care. The regulatory environment has given me an adult case of ADD; there are days that I’m uncertain as to which priority needs the focus. This is where you need to partner well with all the leadership and communicate well so you won’t miss it.
I believe we will advocate the pace of change and reality will also set in by evidence.
The safety challenge is not with IS, it is with the physicians, nurses, and other care givers. When the rate of change becomes too much for them to handle we have a serious issue. Commitment to education, training, and staff “downtime” is key.
Government regulations generally are announced well in advance. Software vendors must build more flexible products that can be modified rapidly to meet new requirements, but this can be accomplished by standardization of platforms and processes. As far as devices go, we should all be moving toward a device-agnostic strategy where security is maintained at the core.
Anything is possible with the right vision and the right leadership.
It can be done – but it is complex. What’s really suffering (and will suffer even more) is research and development – both within I.T. and in clinical operations. As more vended solutions define these processes, point-of-care improvements will become increasingly burdensome.
3. Do you have an immediate need for additional senior IT staffing to handle all the projects on your plate?
We had this need for more than a couple of years.
But not the adequate funding to sustain (long term).
But no budget to handle the salary.
Absolutely. Structure with the ability for team members to focus is the key.
I could use one or two experienced project managers. We have to defer a lot of worthy projects due to bandwidth constraints.
Recruiting for VP, another Director and CMIO.
And it’s a finite resource …. community college grads with HIT certificates will be helpful in 5-6 years….
But no dollars to support it.
I think we’re okay. Adding players that are new to the game (at least your game) might have a negative short-term effect on the projects. Long term, I think the need for additional team members will be a given. With more to care and feed each day, it will require more hands on deck.
I have a need but no funding.
More staff yes, not managers.
The technical change is very possible, it is the resultant cultural change that is slow to be adopted.
4. If you do have major concerns regarding the above issues, have you communicated such with your senior management?
Our senior manager is quite supportive and understands the challenges and needs. However the funding of resources and infrastructure upgrades is lacking due to financial challenges. This will only get worse as we add more complex technology, more community physicians, more applications, more clinical devices and not provide the investment is support services.
Frankly, they see this already and are concerned ‘for me/us’.
And we are getting resources, also pushing tasks downward.
Guess what – IT is not the only part of the organization with too much on its plate. So make the best of it!
Although not major concerns, we have certainly discussed the work and ramifications to the patient and organization.
We have a good team that understands you can’t do everything.
Yes, but it’s difficult for them to understand the level of complexity involved and, until they see it spill over into other things like ACO capabilities, value-based purchasing, ICD-10 fall-out, it’s hard to visualize.
With much at risk, if you are not communicating on a regular basis, I think you are doing a disservice to the organization and your career, IMHO. This is where partnering well comes into play. I’m uncertain that senior management can be aware of the items you listed without also being aware of the IT requirements and impacts.
The bigger issues are what the care community does or doesn’t do with the tool.
5. If you do have major concerns regarding the above issues, will you look to transition out of your current role during the next three years and into one less stressful (for example, a CIO role at a smaller organization or a non-CIO role)?
When talking to peers, almost everyone believes the health of themselves and staff have been negatively impacted by this dramatic increase in expectations of do more with less. One institution was considering a study of the IT staff after seeing an increase in illnesses, reflux, stress, sleep deprivation and depression. The long hours both weekdays and weekends, not to mention availability while on vacation, is a common complaint I hear from peers. The stress is killing morale.
Perhaps, but I’ve been doing this for 40 years.
Likely. Consulting is more lucrative, rarely do you have ongoing operational requirements/headaches… There is huge demand for senior, strategic, experienced people who really understand all this stuff. HIT is very complicated and multi-faceted…. a big barrier for CIOs from other industries. So, the pool of qualified people to do this work is not getting any bigger, and the work is endless.
I don’t think that CIOs in smaller organizations have it any easier. I think it’s worse.
Personally, I’m already at a community hospital and I can share with those in larger organizations that the stress and pressures of the CIO position, although different, are no less present.
Although reducing stress would be nice.
I love the challenge!
Who can say whether another job will be more or less stressful? Here I have a familiar environment and know the players, limitations, opportunities, and risk tolerance of the organization. A different organization will have its own stressors.
This is what I love about my job — it’s not static and offers both challenges and opportunities on a daily basis. It will demand of me, in order to succeed, that I constantly grow myself and learn the organization better both in terms of breadth and depth.
No, I have the skill sets required to lead my organization into the future state.
As crazy as it sounds, I would like to transition to a larger, more complex organization.
Still too fun!
I’m unsure. That said, I am being hammered by recruiting activity so I suspect anyone with interest/ability to change will do so.