Q&A with Former CIO Bill Spooner: “IT Can Change Its Ways”

Perhaps the most compelling development to emerge from healthcare organizations’ response to the pandemic was how quickly IT departments were able to move. “We’ve always been a cautious industry,” said Bill Spooner, former CIO at Sharp HealthCare. “But when push came to shove, we figured out how to make a change,” whether it was revising order sets, converting teams to remote, or rolling out telemedicine.

That change, however, comes with challenges, many of which are hitting CIOs and other leaders more than two years after the initial wave of Covid. “Now that we’re past the crisis state, how much of that ability to move quickly is retained? What risks did we take in our fast-track decision-making?” And, perhaps most importantly, what are the ramifications going forward in terms of cybersecurity, vendor partnerships, and talent retention?

During a recent interview, Spooner, who remains very active in the health IT space through his consulting work, as well as participation in the CHIME Opioid Task Force, shared wisdom on how leaders can manage the myriad challenges brought on by Covid. He also provides perspective on the proliferation of digital leadership roles, and how CIOs must continue to evolve to meet changing needs.

Q&A with Bill Spooner, Former CIO, Sharp HealthCare

How Covid changed the CIO role

“We can make quick decisions”

During the pandemic, I think we all learned that we could make decisions quickly when we had to. It was a cultural thing; historically, we’ve tended to machinate over things and make sure we had everybody’s input, including the paper boy. But when Covid hit and we needed to do things, whether it was creating an order set or doing analytics around risk, we made quick decisions.

Cutting the “14-week process”

At Charleston Area Medical Center in West Virginia [where he held an interim leadership role], we had slowly been rolling out televideo capabilities for practices. It was a 14-week process, which seemed excessive. When the pandemic started, we were doing it in two or three weeks, sometimes faster.

Most of it related to making decisions — people were able to quit messing around and just get to it. Now that we’re a little bit past the crisis state, how much of that ability to move more quickly is retained? What did we lose? What type of risks were we taking in our fast-track decision making?

The telemedicine “hype” machine

During the pandemic, it was everywhere. You could turn around and, within 10 minutes, get three or four different hype messages on telemedicine, telehealth, whatever you want to call it. And it was necessary during the pandemic. It was the only safe way to see your doctor.

But we haven’t seen a lot of thoughtful analysis in terms of the types of services that can be done effectively through telehealth. We see reports every day about how much telemedicine use has dropped since the pandemic got out of its crisis stage, as though there’s something wrong with that. I’m not sure there is, because I still haven’t heard anyone say, ‘this is good for telemedicine and this is not.’ There hasn’t been enough research around that.

“IT can change its ways”

In healthcare, we’re clearly learning that IT can change its ways. We’ve always been a cautious industry. We don’t want to tick off any one doctor, or any two nurses. And so, we got lots of input. But when push came to shove, we figured out how to make a change.

 

The cybersecurity ramifications of Covid

“It’s part of our lives”

There’s so much happening in the world in terms of ransomware and hacking attempts; I have mixed views of it. I think it’s part of our life. I don’t think the pandemic caused it by any means, but it’s more challenging now. And it’s taking more energy and resources than it did 10 years ago. It’s real.

Third-party apps

If I were an active CIO, I’d be really concerned about the requirement for me to provide data to any app in country, without having perfect understanding of the cyber practices of that organization, or a perfect understanding of how well they’re going to protect the data. Because if it comes out of my hospital or my medical group and it ends up on ABC app and then it ends up out on the dark web, they’re still going to say it came from my organization. They’re not going to say it came from an Apple watch. They’re going to blame me for it. That’s the dilemma that we have.

“Pressure to adopt”

The other part — and this has been going on for years — is that every vendor is figuring out a way to make money on IT, and so they’ve created lots of different apps. Some of them are really good, and some may not be good. But there’s so much pressure to adopt, and they always have great marketing departments, and so they make it look as though you’re going to save every life if you buy their application.

But if you’re a leader, how do you know which ones are going to bring you benefit? How much will it help your patient base? It can be intimidating to health IT leaders — ‘You need to do this, or you’ll be lost.’ Some leaders jump in and do it, but I’m not sure that we’re looking at it from a perspective of what helps the patient or what helps my organization deliver care more effectively and efficiently, as much as the mantra of ‘we have to be digital.’ To me, that’s troublesome.

 

Vendors under pressure

Making sure vendors are “capable & committed”

You want to be able to look someone in the eye, shake their hand, and know that the vendor is capable and committed. Vendors are under a lot more pressure because they’ve had to change the way they deliver services.

But in terms of getting the most from the relationship, clear expectations and are key; that’s what lets you go beyond the documentation.

Documentation versus flexibility

The eternal struggle is that some people’s approach is to document every single little detail, and others like to have more flexibility. I remember dealing with contracts at a hospital more than 30 years ago, and our legal counsel said, ‘don’t get so precise. You need to write the contract so it has enough flexibility that you can interpret it to get what you want. If you put too much detail in it, and you forget something, that’s gone forever, because you specifically outlined the deliverable.’

It works the same with vendor relationships. I’ve seen situations where they would mess up a delivery and we would either get financial compensation from them or other concessions, and that wasn’t in our contract. But with the flexibility we had in the contract, it was the right thing to do, and they lived up to it.

I think different vendors have different approaches, and you have to be prepared to deal with that.

 

Rebuilding the workforce

I’m lucky that I don’t have to deal with it today, but I’m hearing about it a lot. You have the normal geographic issues, which get exacerbated by the remote workforce.

When I was doing an interim CIO role a few years ago, we had a lot of remote contractors because we couldn’t get people to move there. I’ve talked to people who have had to contract IT workers, and it’s hard. But it’s part of the environment. A lot of organizations have difficulty recruiting, and so, you have to either accommodate remote workers or find other people to fill your teams. And that’s just IT — nursing is just as bad, if not worse.

Recruiting clinicians to IT

A lot of IT leaders are recruiting clinical people to their teams to help manage Epic, Cerner, or whatever system is used, because they know their domain, whether it’s nursing, respiratory care, or laboratory. Many of them believe that whereas before, they were helping one patient at a time, now they can help hundreds of patients because of what they’re doing with the system. They believe in the mission.

 

Digital leadership roles

We’re seeing more people with chief digital officer titles; I’m not sure why that has emerged. I keep wondering if the CIO role will disappear with a different name.

“IT doesn’t move fast enough”

When we first started building out portals and other web apps, there was some contention between marketing and IT about who owned it. I think the right answer was that IT supported it, and marketing folks were expected to work with consumers to determine what needed to be built. But there’s always a belief that others can do it faster; that IT doesn’t move fast enough.

Some of that might be true, but I think the proliferation of new titles may be seen as a failure on the part of the IT leadership — that somehow we, as IT leaders, weren’t connecting with our constituents in a way that they felt well-served. It’s easy for somebody else to come in and say they could do it better.

“Same leadership, different technology”

When I first became a CHIME member many years ago, we were complaining that we didn’t have a seat at the executive table. And in some ways, things haven’t changed very much. We talk about CIO 2.0 or 3.0, but sometimes I think that if we’re doing our jobs, it would just be ‘CIO.’

Now, we have chief digital officers and chief digital information officers, and it’s hard to make sense of it all. It’s not as though CIOs went back for more training. It’s doing similar tasks and providing the same leadership to the organization, but using different technology.