It is widely acknowledged that healthcare lags behind most industries in implementing information technology, but just how clumsy and painful is the evolution?
It's not pretty.
Senior executives are naively ignoring the basic tenets of good management, according to the results of a survey of healthcare IT leaders who were asked about their organizations' IT governance and the evolving role of C-suite executives in implementing IT. Too few senior executives identified governance as critical to IT success, and a surprising number of chief information officers -- people who should know better -- say they are the ones responsible for driving the value of IT-enabled business processes.
"CIOs are giving themselves too much responsibility," said David Garets, president and chief executive officer of HIMSS Analytics. "They are, we think, a bit misguided. We think they are setting themselves up to fail. They can't control these things."
To be fair, no other industry is like healthcare, Garets noted. The primary distinction is physicians, who account for 85% of expenses, he said, yet often don't even work for the system incurring them. "There's a huge difference, and it has a huge impact on governance," he said. "You have to get the docs involved."
Results of the survey, conducted by the Scottsdale Institute, a not-for-profit corporation that provides an information management sharing ground for healthcare organizations, and HIMSS Analytics, a wholly owned subsidiary of the Healthcare Information and Management Systems Society, were released at the institute's spring conference in Scottsdale, Ariz., last week. The survey was underwritten by Lawson Software.
The groups released the results exclusively to Modern Healthcare, Modern Physician's sister publication.
The need for a survey on the subject of IT leadership and governance became clear when the Scottsdale Institute got a call from an unnamed hospital member asking which C-level executive CIOs should report to, said Ralph Wakerly, vice president of market research services at HIMSS Analytics. Though laggards in adopting technology, hospitals are now rapidly integrating IT into their organizations, and there are not a lot of road maps for getting there.
The findings were based on the responses of 235 individuals to a Web-based survey conducted in February and March. Invitations were extended to 14,000 individuals -- chief medical officers, chief nursing officers, CIOs, CEOs, chief operating officers and chief financial officers -- representing 4,000 hospitals and healthcare systems in the U.S.
Based on a set of criteria established by HIMSS Analytics, the survey identified 29 "successful organizations" among the respondents. HIMSS Analytics subsequently interviewed four of those 29 organizations to develop case studies of what successful organizations are doing right. The four case-study hospitals include a teaching hospital, Northwestern Memorial Hospital in Chicago; a community hospital, Sioux Valley Hospitals & Health System in Sioux Falls, S.D.; a large healthcare system, Christus Health in Irving, Texas; and a specialty hospital, Children's Hospitals and Clinics of Minnesota in Minneapolis and St. Paul.
Implementing an IT program may be complicated, but developing a plan is a fairly simple matter of following well-established management techniques -- leading from the highest levels but engaging managers at all levels of the organization in the governance structure, said Garets. Yet some of the survey's findings run counter to what many would consider fundamentally good business management practices.
For example, one of the most startling findings for Garets was that only 16% of responding organizations said they believe that governance is critical to the success of their IT programs. Contrary to that, all of the case-study hospitals identified governance as a critical, high-priority issue.
"It all starts with governance," Garets said.
Some of the survey findings validated what Bertram Reese, vice president and CIO at Sentara Healthcare, Norfolk, Va., said he already knew. Reese, a participant in the Scottsdale conference last week, has 30 years of experience in the healthcare IT industry. "I think the surprise for me was the larger impact," he said. "If you don't have the right culture in place, will you be successful? ? People complain they don't have the money to do it, but ? no one talks about what you need to do to get ready even if you have the money."
Too many senior-level executives think CIOs should be in charge of process change, Garets said. Nearly all the respondents -- 91% -- indicated that the CIO is managing the information systems department. In contrast, successful practice organizations identified by the survey relied on so-called line executives -- the manager in charge of a specific business area such as nursing, materials management or pharmacy -- to be ultimately responsible for driving value from the IT investment, he said. The CIO and staff play a support role as facilitators.
The buck stops here
Likewise, too many executives -- 73% of all responding CIOs -- believe the buck stops at their door for driving the value of IT-enabled business processes. More disturbing, according to Garets, 20% of the CIOs believe that it is proper that they should be responsible. "This percentage has to drop precipitously because CIOs can't be responsible for driving the business value because they are not getting the business," Garets said. Again, the line executives, such as the vice president of nursing, "ought to be on the hook" for achieving value in their particular areas, he said.
Neil Johnson, a physician and vice president of medical informatics at Cincinnati Children's Hospital Medical Center and a participant in last week's conference, noted that IT is a doctor's tool just like a scalpel or imaging machine. Financial management wouldn't think of running radiology, yet in some organizations, the CIO is put completely in charge of the IT system. "Many CIOs think they are in charge of process change," he said. "They can't be, they shouldn't be, and if they are offered the job, they should push it back."
Echoing the findings of the Scottsdale Institute's survey, CIOs said they believe they would be more effective if they reported directly to the hospital's CEO, but only 29% do, according to a survey by the College of Information Management Executives and First Consulting Group released last week. Thirty-seven percent reported to the CFO, according to the survey, a traditional reporting structure probably reflecting IT's roots in financial operations. The remainder of the individual hospital CIOs reported to the COO, CMO or another official. System CIOs more frequently reported directly to the CEO (49%).
Arlyn Broekhuis, CIO of Sioux Valley, said he doesn't even recall responding to the Scottsdale Institute's survey, though he routinely participates in surveys. Nevertheless, Sioux Valley was identified as one of the successful organizations. Two years ago, Sioux Valley began evaluating "where we were at and what direction we wanted to go," Broekhuis said. The organization knew it wanted to implement a clinical information system with an electronic health record, so a planning committee was formed that included Broekhuis, the chief clinical officer, the CFO, the IT director and the president of the physician division. The hospital's CEO sits on the system IT committee, which oversees the planning committee.
When it came time to select an IT vendor, the planning committee interviewed 40 clinicians across the system to find out "what we were doing right and wrong and where we needed to go," Broekhuis said. After a road map was developed, the organization set about looking for a vendor to supply the solution needed. The selection process involved 100 clinicians from across the system. The system is about a year into a five-year project requiring a $36 million investment.
As the Scottsdale Institute advocates, Broekhuis said the line executives and clinicians are driving the IT-enabled business processes at Sioux Valley.
"Ultimately I'm responsible for the value that (the information system) is going to drive into our organization, but if IT people think they can do it on their own, they are wrong and they are not going to succeed. You need clinical people. They are the ones that really understand their business needs and understand what is in the best interest of the patient," Broekhuis said.
Broekhuis also rates governance at the top of his list for guaranteeing success, and he described his role as a facilitator. "You've got to keep people excited and you've got to keep it No. 1 on your list," he said. "This is a long-term commitment. It's a journey."
At a Scottsdale Institute workshop last week, Timothy Zoph, vice president of information services and CIO at Northwestern Memorial, spoke about the importance of the IT department "achieving citizenship," making IT part of the overall business culture of an organization. IT departments must "build trust and demystify how IT works," he said.
Kerra Guffey, who recently moved into her position as senior vice president and CIO at Memorial Health System in Springfield, Ill., said she had a "real ah-ha" moment when Zoph stressed IT's role in tracking of quality measures. It's not about reinventing the wheel, Guffey said. At her own hospital, she emphasizes that each IT staff member is "a healthcare professional, not an IT professional."
"It's hard to move to a higher level of thinking. Instead of seeing yourself as just part of IT, you are part of the organization. That's where we are going. That's the vision. But I'm at the beginning of the journey, and (Zoph is) at the end," Guffey said.
This story originally appeared in the April 25 issue of Modern Healthcare and the May 2005 issue of Health IT Strategist.