As IT's importance grows, CIO's role expands

For most of his 20-year career running information technology systems for hospitals and health systems, Edward Martinez was just “the computer guy” to his C-suite colleagues. He reported either to a chief operating officer or a chief financial officer and was rarely invited to weigh in on big-picture matters.

But now Martinez, who has been senior vice president and chief information officer of Miami Children's Health System for seven years, reports only to CEO Dr. M. Narendra Kini and is involved in “just about every” aspect of the organization, from expansion plans to population health initiatives.

Being the computer guy has become a much bigger job, with significantly more influence and responsibility.

“I'm now sitting in (the boardroom) because IT has become the center of all business,” Martinez said. “Today there isn't an element in a hospital environment that isn't controlled by some IT. That puts (me) at the forefront of at least being asked, 'Ed, what do you think?' ”

Kini said he and Martinez are “linked at the hip.” They text and talk multiple times a day, every day, about all areas of the business.

This isn't unusual. As in other industries, CIOs in healthcare are becoming key advisers to the CEO and important figures in board meetings, a dramatic shift from less than a decade ago. The change reflects the sprawling role technology now plays in the overall operational and strategic viability of hospitals and health systems.

The increasingly complex organizations now rely on electronic health records, data and analytics to track and improve the quality and safety metrics they will need if they want to thrive under new reimbursement models like bundled payments and accountable care. They also depend on their IT prowess to offer patients new ways to interact with clinicians, such as telehealth and remote patient monitoring.

“It's all so integrated, so it really takes a CIO who is tuned into the whole executive suite,” said Jim Cavanagh, a former CIO who's now a healthcare IT consultant at Comport. Cavanagh says the best CIOs know the financial, operational, clinical and strategic goals of the organization so they can implement and invest in technology the system needs and can afford.

At Henry Mayo Newhall Hospital in Valencia, Calif., where Cindy Peterson has been CIO for 14 years, CEO Roger Seaver meets with Peterson one-on-one twice a month to discuss the IT department's current assignments and future projects. The hospital is in the thick of updating its Meditech EHR system to a newer version.

Peterson also attends monthly board meetings with the rest of the executive team. She will often raise cost and performance concerns based on data her team collects. No other department in the hospital analyzes quality metrics at such a detailed level, so Peterson is called on to identify inefficiencies such as how well drugs are administered to patients.

“As we implement systems, we're digging deep into the operational workflows of departments, so we're very much aware of what's going on,” Peterson said. “That is great knowledge to have at the C-suite table.”

It's relatively new for CIOs to be responsible for addressing clinical and performance outcomes, according to Adrienne Edens, vice president of education at the College of Healthcare Information Management Executives and former CIO at Sutter Health. Integrated EHR systems have provided hospitals and systems with a wealth of data that's essential in a value-based reimbursement climate.

CIOs “have always been good project managers, and now leaders want them to bring that to the table and say, 'How do we reduce cost? How do we create a better patient experience?' ” Edens said.

In a 2016 survey by the Healthcare Information and Management Systems Society, 95% of respondents said IT is a critical strategic tool to help systems and hospitals. About 73% of respondents reported IT integration was needed in clinical settings, and 68% thought it was needed to meet man-dated quality metric improvements.

Randy McCleese, vice president of information services and CIO at St. Claire Regional Medical Center in Morehead, Ky., has seen his role change drastically since 1996 from primarily a software installer to a strategic adviser.

He also started teaming up with other system leaders. St. Claire Regional, a 133-bed hospital, is part of the Kentucky Health Collaborative, a statewide partnership that includes nine other providers including Louisville-based Baptist Health and Brentwood, Tenn.-based LifePoint Health.

He and the CIOs of the other participating systems are hatching ways to share data and reduce operational costs. McCleese said such partnerships have become essential.

But the job can be overwhelming because the strategic expectations are layered onto the traditional privacy and software duties of a CIO. “We're adopting technology at warp speed, but then we've got all these security issues like ransomware,” McCleese said. “It's like we're being asked to do everything all the time.”

Sometimes the bigger scope comes with a commensurately bigger budget and staff, and sometimes it doesn't. About 71% of respondents to the HIMSS survey (the vast majority of whom work for hospitals and systems) said they expected their IT budgets to increase in the next 12 months.

Martinez said his budget at Miami Children's has at least doubled in the 20 years he's been in healthcare IT. On average, IT accounts for 8% to 11% of the $800 million operating budget at the system, which consists of a 272-bed hospital and 10 outpatient centers.

At St. Claire Regional, McCleese said, the IT department's piece of the $365 million operating budget has held relatively steady for the past seven years at about 3%. (According to data collected by HIMSS, information services account for about 3.9% of hospital expenses.)

Because EHRs have become integral to running a hospital, CEOs are actively engaged with projects involving those systems. Although University of Utah Health Care CIO Jim Turnbull reports to COO Quinn McKenna, former CEO David Entwistle (he left in May to lead Stanford Health Care) was intimately involved with the four-hospital system's three-year Epic EHR rollout. Much of last year was spent addressing more than 400 complaints from physicians and staff—physicians generally complained of too many pop-ups and not enough automation in the software.

Now University of Utah Health Care has called on Turnbull to help with the early stages of telehealth initiatives. “There are very few strategies and tactics that don't involve IT in one way or another,” Turnbull said. “The relationships with the C-suite have really matured as a result.”

In addition having to a bigger say in those leadership discussions and decisions, CIOs are dealing more closely with clinicians.

St. Claire Regional, for example, is integrating its three EHR systems because physicians have been frustrated that it's so difficult for them to look at their clinical performance. And Martinez at Miami Children's has been working closely with physicians for the past two years to help them navigate a new reimbursement model.

“Before, physicians were only asked to take care of patients,” Martinez said. “Now we're asking them to understand the way to operate a business to maximize revenue for themselves and the system.”

Martinez says there has been a learning curve for him and for physicians. Physicians have various ways of documenting information, and he is still trying to find a way to standardize the process so it's efficient.

All of this comes as providers are asked to do more with less without sacrificing quality, he said.

“It's more of a challenge than I thought it would be,” Martinez said. “But most CIOs probably embrace it because we've always been left out of the boardroom. Now that you have the opportunity to be in it, you're not going to turn your back, even if you have to work double time.”