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," says 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 notes. The primary distinction, he says, is physicians, who account for 85% of expenses, 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 says. "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., late last month. The survey was underwritten by Lawson Software.
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, says 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.
"There is nothing to document what should be done or what is being done," says Shelli Williamson, executive director of the Scottsdale Institute. The necessary involvement of clinicians in implementing and, most importantly, integrating an IT system into a hospital organization further complicates the situation for hospitals. "The complexity of the data that healthcare is trying to manage is far greater than financial transactions and (ID) numbers," she says.
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, chief executive officers, chief operating officers and chief financial officers -- representing 4,000 hospitals and healthcare systems in the U.S. Names were drawn from HIMSS Analytics and Scottsdale Institute databases.
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, according to 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 says. Too many of the responding organizations didn't "have good governance processes in place that allow them to understand the business value they are getting from their IT investment."
In the same vein, too many senior-level executives think CIOs should be in charge of process change. 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 says. The CIO and staff play a support role as facilitators.
Echoing the findings of the Scottsdale Institute's survey, CIOs say 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 late last month. 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%).
The same survey also found that CIOs aren't routinely included on quality and performance improvement committees, with only 51% being members of such committees.
Sioux Valley was identified as one of the successful organizations. Two years ago, the system began evaluating "where we were at and what direction we wanted to go," says Arlyn Broekhuis, Sioux Valley's CIO. The organization knew it wanted to implement a clinical information system with an electronic health record, so a planning committee was formed.
The committee interviewed clinicians across the system to find out "what we were doing right and wrong," Broekhuis says. 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.
Jerry Massmann, vice president and CFO at Children's Hospitals and Clinics, describes much the same scenario. The system has a steering committee that includes line executives such as the chief nursing officer, and the steering committee reports to top leadership, which in turn goes to the board's finance committee, he says. Children's Hospitals and Clinics' funds IT out of its operations budget, investing about $5 million annually, in addition to recurring capital of another $2 million or $3 million, Massmann says.
"I would argue we've been successful because we had a very good vision and we didn't veer from that," he says. "We didn't try to do it overnight because we would have failed. It's just too much."