Health Care CIO Q&A

Q: What is the difference between CIOs and CTOs?

A: If you look at a typical IT health care department, they're comprised of two different areas, one is computer applications and the other is technology, which would be your PCs and telephones. In my organization, the CTO is responsible for all the technology, and he reports to me. I am involved with strategy. The CTO is responsible for the day-to-day operations, as well as developing strategies. The oversee the applications in my organization, and I have six IT directors, each over a separate subset of computer applications like physician offices, hospital systems, managed care systems and administrative systems. I rely on my CTO Rick Kopple to manage the day-to-day operations and set out our strategies. But I am involved in any approval process, and I am ultimately accountable for all the applications and technology.

Q: What gets you excited about your job?

A: I am looking out six to nine months in my IT organization. I get excited when a concept becomes reality and people actually get what you have been talking about. All the diagrams in the world cannot replace actual workflow experience. My favorite thing to do is to meet with a group of people from across the corporations we service and work through a difficult issue. I think people collaborating on an issue bringing different viewpoints to the final solution that actually helps personalize the final decision.

Q: Is your organization making any move to join forces with Google or Microsoft to broaden your electronic medical record (EMR) system?

A: We would love to, but we are too small for them. When you look at Google, they're looking at the major health care providers with name recognition like the Cleveland Clinics. But I think we're being very innovative here. We also continue to talk with Microsoft, and we want to be on the leading edge of their products.

Q: Indiana Heart Hospital is an all-digital hospital. How are you translating that technology to the other four hospitals in your network?

A: The Indiana Heart Hospital opened Valentine's Day 2003 as an all-digital hospital. It's a joint venture with physicians, who own a 15 percent piece and as such they wanted to differentiate themselves in the marketplace and from the four other heart hospitals in Indianapolis. What all digital means is the physicians use the computer 100 percent, with virtually no paper records. So the physician looks at patient results online, they put in orders and in many cases they do their own documentation online.

If you look at the Indiana Heart Hospital, it's a small specialty hospital focused on the heart, whereas a traditional hospital has multiple specialties and multiple physician groups. I've hired the chief medical information officer Dr. Harry Laws, who came onboard in the last six months. He's helping us evolve that culture in the other four hospitals to ready the physicians to use computerized physician order entry. We’ve created a network informatics committee of 25 people, where 20 of them are physicians from around the network, and we meet once a month to establish strategy for the future and work toward these issues.

Q: Can people who have EMR records in your system easily transfer their records if they move out of state?

A: We could send that information to another city, but it would depend on the interoperability standards of what the physician on the other end had. We could either provide a summary of that information so that they could take it with them or send an electronic copy to the physician by e-mail. We're currently linked to the Indiana Health Information Exchange (IHIE). IHIE is part of the national health record initiative that's in 10 cities. In 10 to 20 years the national health record will evolve and define standards for the national health record in terms of sharing information with the patient, as well as being able to transfer records electronically when people move. When Hurricane Katrina came through, all that population left New Orleans to other cities. That information would have been valuable if it was electronic. I think we're 15 years away from that full integration.

Q: What are some of the current projects you're working on?

A: We're actually developing a whole series of products geared around the patients' access of their EMR information, so we can link the patient too. We have a service that is in its infancy called mycommunity, which has a mycommunity electronic web site and a swipe card. We're developing a service where patients can view their high-leveled information called myfamily health record. We'll be rolling this out probably mid next year. We have 190 facilities we're outfitting, and next year we are going to do 25 of them since it's a very complex project. This project will allow the patient to self-register, go online and set up an appointment and come in to the doctor's office and swipe their card. All that information is stored electronically so the patient can access it.

Q: What kind of initiatives are you implementing as the industry moves toward Health 2.0?

A: Our vice president of HR runs an eCulture committee, and we are talking about personal productivity tools that allow better communication with employees. One of those initiatives is looking at Web 2.0 from an employee perspective and how we can move to more self-service methodology. We don't have any active plans now, but we're researching and following what other organizations are doing. I think you have to evolve a culture and that is really what this eCulture committee is about— to move people up the ladder of e-connectivity. We're trying to change the culture with our physicians, and that takes time.

Q: How has the economic downtown affected the health care informatics?

A: I think the demand for advanced informatics is on a steep upward slope and has been so for about five years. Now, our funding capabilities are what concern me. With the downturn in the economy and the stock market, a lot of our revenues come from investments of that nature. There will be less money to invest, but I think we're going to do a better job of prioritizing projects that provide the most value. It's going to take a lot more discussions to get things approved, and I've already experienced that at the board level on several projects.

I think most IT positions are fairly secure in the economic environment; there may be some capital cutbacks which require less people, but we are trying to run as lean as possible and cut projects before we add new people and then have to make cuts. I have never felt security in my job even in the best of times because of the many times I have to tell physicians and executives that I cannot do their proposed project at the present time due to resource constraints. This is where you need to negotiate expectations, and then deliver on these expectations. There have been times where I have felt that there was a line of people waiting in line to terminate me, as I tend to make decisions that are best for the entire corporation. I have excellent support from our executive management team and truly feel blessed to work with such a great organization that allows me to try new innovative things and tolerates occasional failures.

Q: What are the typical educational requirements for CIOs in the health care industry?

A: A master's is now becoming the requirement. I've got an MBA from Indiana University. Actually, a lot of CIOs are heading toward having a doctorate. It really depends on the complexity of the organization how much health care–specific experience is needed. If it's an organization as complex as this, I would say 10 years because there is so much business knowledge you have to understand. And it's not just hospitals; it's physician offices, managed care and homecare. In my organization I have hired what we're calling a chief medical information officer, who is a doctor who works with the informatics side and works with the physicians as we move toward computerized physician order entry and things of that nature.

As far as how I started, I got interested in computers and went to Purdue University years ago. I took an old-school approach—I started out as a computer operator, went into computer programming, was a systems analyst, became a helpdesk manager, then an assistant director, then a director and now a CIO. I've been in health care IT for about 35 years, and I've been in this role at Community for 20 years.

Q: What is the general salary range for people in health care IT?

A: Salary ranges vary by who you report to and how many areas of the network that you support (hospitals, physician offices, etc). I have seen salaries from $120,000 for a single hospital, all the way up to about $400,000 for a CIO position that oversees 17 hospitals.

Q: Do you have any advice for interested techies who aspire to be a CIO?

A: You definitely need an MBA or an MHA. The MBA program I went through really opened my eyes to global issues facing an organization. I think getting some real-life experience in a very complex organization in a No. 2 role readies you for a CIO position in a smaller organization. I've had a number of my IT directors leave over the years for CIO positions in smaller organizations. I put a lot of emphasis on leadership development with my staff and assign projects where they have to lead a group of people that don't report to them multidisciplinary across the hospital to reach a common endpoint. CIOs have evolved to be leaders, not just managers.