Chief information officers of hospital organizations are highly likely to be satisfied with the value derived from information technology initiatives and are just as likely to conclude that key executives, board members and system users enjoy the same level of satisfaction, according to a just-released survey of CIOs.
But other survey findings raise concerns that top management and boards are not clear about what IT initiatives should be accomplishing and that perceptions of satisfied leadership are not always supported by other evidence.
Despite the bullish view of IT value from completed initiatives, the road to successful implementation is a rocky one: Nearly one-third of responding CIOs report a major delay or failure of an IT-related business initiative in the past 18 months, and nearly 60% of surveyed organizations postponed or rejected plans for an IT initiative during that time.
The management committees set up to guide implementations through completion and gauge their success often don't do a good job. Almost one-third of the executive steering committees charged with leading an IT endeavor were rated ineffective by CIOs in providing leadership, taking ownership or resolving conflicts with physicians and other key users of new software.
About 23% of the steering committees did not have a physician or clinician representative. "It's hard to understand how they're doing anything, much less IT, without physician representation," says William Bria, chairman of the Association of Medical Directors of Information Systems.
When the IT plans failed or fell short, the problems were rarely caused by technical failures or poor performance by vendors or consultants-the usual suspects in years past. Instead, the most prevalent reasons for disappointing results stemmed from inadequate high-level planning and execution of business strategies behind IT initiatives.
Those findings and others in the survey point to issues of leadership as the prime factors in making or breaking IT implementation, says Jim Adams, executive vice president of advisory services for Healthlink, a Houston-based healthcare IT consulting firm.
Healthlink conducted the survey of CIOs belonging to the College of Healthcare Information Management Executives, an Ann Arbor, Mich.-based trade group. The Web-based survey attracted 73 respondents, about 8% of the group's total membership of 880. Results were shared exclusively with Modern Healthcare.
The survey sought to measure views on IT value and obstacles to realizing the potential of computerization, a growing concern as the healthcare industry comes to rely on IT to drive fundamental change in business and clinical operations.
Computer system implementations were once mainly the province of IT departments and judged by their timely completion with minimal glitches and without cost overruns, Adams says. But now that IT has become a strategic element of healthcare improvement, the end of an implementation is just the beginning of the effort to favorably affect the care process and use well-defined objectives to measure the ongoing impact, he says. "These are not IT projects. These are IT-related business initiatives."
That should broaden the responsibility for producing IT value to other executives and governance leaders at the top of the organization as well as key users of the new systems such as physicians, Adams says. But most CIOs continue to assign themselves primary responsibility for making sure IT initiatives produce value. "It's amazing to me that they think they need to do it themselves," he says.
Nearly three out of four CIOs say they have primary responsibility, while the rest give themselves significant responsibility. Only 35% say the chief executive officer has primary responsibility in their organization; 65% say the CEO has significant responsibility.
In organizations where the CIO continues to lead the IT charge, problems can arise in reconciling plans with the expectations of top management and the needs of front-line users if the chief information executive does not have close ties with the leaders who determine and evaluate strategy. "CIOs need to be fully functioning members of the executive team ... not just the IT guy," Adams says. But the consulting firm's experience with hospital clients often finds otherwise.
Chief executives and their top operating and financial officers often are unfamiliar with information technology and its link to addressing their business problems. "If they are aware of it, they're really uncomfortable playing in this arena," Adams says.
That in turn complicates communication to governing boards about the potential of IT and the merits of investing in it. CIOs don't typically enjoy the same visibility and board access that others in the executive suite have, says Karma Bass, vice president of member relations at the Governance Institute, a research and advisory firm for hospital governing boards.
When they do gain access, "Many of the CIOs are not very good (at) speaking to their boards in terms they can actually understand," Adams says.
Without a true meeting of the minds, CIOs might be "not perceptive about whether the CEO and board are really satisfied," he says. More than 90% of CIO respondents say their organization's board and top executives were satisfied with the value derived from IT-related business initiatives, but the lack of communication can give CIOs an overly rosy impression of how well they perceived and satisfied the expectations of their superiors, Adams says.
The disconnect can have consequences for IT initiatives. Failures most often were the result of not connecting the implementation with adequate understanding of what it was supposed to achieve for the organization, according to survey findings. The most prevalent complications included inadequate process change, lack of executive ownership and insufficient understanding of business benefits.
But unless leaders at the executive management level are engaged enough in the planning process to clearly articulate strategic goals, CIOs have no choice but to pursue the objectives as they see them, says Elaine Roach, CIO of Northern Michigan Hospital, Petoskey. If CIOs grab primary responsibility, "It's because nobody else has stepped up to the plate," Roach says.
A respondent to the survey, Roach says she disagrees with the tendency of CIOs to put the onus for IT value on themselves. "I think it's the entire executive team that's responsible," she says. The CIO may be the driver of the discussion because of familiarity with the technology's capabilities, but "Boards need to be involved at the strategic level. They need to set the goals for the organization."
Once that's done, upper management has to "build business objectives into the workplan" and come up with measures to produce evidence of value for the money, says Roach, who works for CareTech Solutions, a firm that manages IT services for hospital organizations under outsourcing arrangements. Under a contract between CareTech and Northern Michigan, Roach is currently the executive in charge of the account and holds the title of CIO.
Executives and boards must be educated about IT and its capacity to improve clinical operations and save money, Roach says. "They're still getting used to the idea that IT can uncomplicate their lives instead of complicating them, if used properly," she says.
Problems result from an overly broad notion of business objectives, Adams says. Goals such as patient safety and greater efficiency don't get specific enough to guide CIOs or evaluate whether a goal has been achieved. For example, "Under patient safety there could be 10 subinitiatives to support that," Adams says. Things will begin to click when leaders identify such objectives as automation-assisted medication administration and computerized nursing documentation as components of the larger goal to improve patient safety, he says.
Governing boards also have some catching up to do, Bass says. Not a lot of board discussion has linked patient safety and the investments made in IT, she says. "Boards are still trying to get their arms around their quality responsibilities in the first place."
Until they do, lack of capital priority will remain a chief obstacle to IT deployment. Insufficient capital funding was the biggest reason for organizations postponing or rejecting an IT-related business initiative, cited by 79% of CIOs. Close behind was the higher priority of other capital priorities, cited by 60%.
Physicians and various community constituencies are strong advocates for capital equipment purchases or for maintaining certain services, but IT hasn't been elevated to a high enough level to compete for board awareness, Bass says.
"It's hard (for IT advocates) to be heard over the roar of all these other issues," she says. "There are not a lot of people at the grass-roots level saying, `I can't believe you don't have an electronic medical record.' "