It was wonderful to spend time in late April with a panel of industry luminaries to talk about the concept of the “CIO 2.0.” There have been countless conversations in the healthcare industry in the past several years around this “2.0” idea, which has been applied to every type of senior leadership position in the industry—CIOs, yes, but also CMIOs, CNOs, CNIOs, COOs, CFOs, CEOs—the list of “Os” goes on forever.
And what does it mean? The idea of the “Executive 2.0” is, put very simply, this: with pretty much every senior position in hospitals, medical groups, and health systems these days, we need individuals to evolve forward very rapidly, to develop their skill sets, understandings, and perspectives, in order to help lead the U.S. healthcare delivery system forward.
And what about CIOs, specifically? We need to go back to the late 1980s and early 1990s, to get a sense of perspective on this subject. Back in the “old days,” the first individuals to be designed chief information officers, had evolved out of data and information systems managers. Those people, as absolutely needed as they were, basically ran the computer systems keeping hospitals going; and, that far back in time, very, very few hospital-based organizations had electronic health records (EHRs) to begin with; back in those days, we were talking primarily about ERP systems, financial systems, and limited, discrete clinical information systems inside specific departments and service lines.
Later on, in the late 1990s and early 2000s, CIOs became the shepherds of EHR implementation and the implementation of other core information systems. And then, of course, came EHR optimization. But now?
What’s becoming clear is that CIOs, to be successful going into the future, will need to be true organizational leaders, able to sit down with their fellow c-suite executives as peers, and to be able to help them understand what types of technology, and what specific technological tools, can help them achieve both overall organizational objectives, as well as the broadest objectives of the purchasers and payers of U.S. healthcare, as they demand more and more vociferously that providers provide them with value for the $3.6-trillion-plus that they’re spending now every year—with that $3.6 trillion expected to go up to $6 trillion a year in the next several years.
In other words, the “2.0” CIO has to be the farthest individual possible from the circa-1989 “tech order taker” manager. She or he must be a true, organization-wide, leader. And the kind of leader needed now in patient care organizations is one at a very, very high level indeed.
So it was great, on April 28, to be joined by Christopher Longhurst, M.D., CIO and associate CMO of UCSD Health in San Diego; Sue Schade, interim senior vice president and CIO at Boston children’s Hospital; Tim Zoph, a former CIO, and a strategist at the Naperville, Ill.-based Impact Advisors consulting firm; Chris Gervais, chief technology officer and chief security officer at the Boston-based Kyruus; and David Logan, CTO at Aruba, an Santa Clara, California-based Hewlett Packard Enterprise Company.
At the outset of the discussion, I asked the panelists how they saw the COVID-19 pandemic impacting the strategic and operational landscape for CIOs. “The first thing we all recognized was that information technology and informatics were crucial to our response at the organizational level and at the public health level,” Longhurst said. “So it’s no secret that the role of the CIO become more prominent” in such a context, “as we sent much of our workforce out to work remotely; we built COVID dashboards, employed secure messaging to avoid entering patient rooms unnecessarily, leveraged artificial intelligence, and so on. I wouldn’t say it changed the fundamentals; a lot of it came down to things like good governance,” he noted. And it was that good governance that allowed the leaders at UCSD Health to very, very quickly shift to telehealth-delivered patient care, for example. In addition, he reported, “We had also deployed an AI solution to diagnose COVID on chest x-rays. We had a technician who had an algorithm ready, based on research out of Wuhan. And we quickly put the algorithm into production and used it at a mass level. These things are built on leadership principles.” In that work, he emphasized, “Our journey towards Lean management has been very important, including through the use of daily tiered huddles, which helped us deal with a broad range of all types of issues. Within five days, we were able to set up a vaccination station, for example. So really, I don’t think it’s a new skill set,” he said; “it’s more prominent and visible, and there was an opportunity for IT leaders and others to step forward and really make a difference.”
In response to my noting that COVID definitely showed how quickly patient care organizations can move when necessary, Sue Schade said, “I hear from CIOs about ‘COVID speed,’ that ability to get things done quickly. It’s a bit of a double-edged sword now, with raised expectations,” she said. “But there’s a positive effect: we saw the difference that focus makes, when you take away distractions and other priorities.” And in that context, Schade said, “A lot of the projects that had been put on hold are coming back now; and governance is more critical than ever.”
“Work done out of necessity will continue if it’s logical,” Zoph offered, “And in picking up the pace, per agility, I think we’ve discovered new ways to deliver on things. I had an opportunity to work in life sciences these last few months, and they’re discovering what we’ve discovered. And leaders need to be exceptional at communications skills. And I think there’s an expectation that the pace will continue.”
The concept of the CIO has changed
I noted to my fellow panelists that the very concept of the CIO has evolved forward tremendously from when the first information systems managers were promoted “out of the basement,” to be named “CIOs.” And the shift that’s taken place since then has been from perceiving the CIO as an “order-taker,” to becoming a true organizational leader, an individual who can help lead her or his fellow c-suite executives forward, to leverage technology to move their organizations forward on key strategic priorities.
“I always say that technology moves very fast, and organizations move very slowly,” Zoph said. “So CIOs are building the business and technological literacy of their teams, because you can’t afford to have white space between the strategy and technology, any longer. So there’s a real set of expectations now around CIOs, in terms of co-creation. And CIOs need to understand the consequences of choices—not only delivering on the technology, but participating in the change—and understanding how important it is to get it right, and how technology is almost a survival strategy right now. You’ve really got to be that leadership, strategy, and confidence-building, source of trust, to help lead the organization.”
What’s more, said Aruba’s David Logan, “When we’re engaged with CIOs, we want to help them understand the experiences that need to be delivered, and who the constituencies are for those experiences. We’ve dramatically shifted who we need to care about and how to deliver to them—so much so that we’ve shifted away from centralization, and now, patients, providers, vendors, are all defining the experiences that will be delivered digitally; so the role of the CIO involves embracing the ability of all constituents to contribute to and take advantages of all the systems. It’s a balancing act and is very difficult.”
“And along with the changing leadership experiences, there’s this perspective change,” Kyruus’s Chris Gervais noted. “There’s a broad range of things we could do, and it’s the ability to connect that tech portfolio to the business needs. You’re like an investor; you’ve got to invest in solutions and get a return from them. It’s been great to see that type of business orientation become so primary. Some CIOs we see have actually dramatically changed their teams in the past year or so,” he noted, adding that “I hope we see that movement continue.”
I was able to ask UCSD Health’s Longhurst about the phenomenon of more and more physicians and nurses taking on the CIO role, and whether or not they’re fully prepared to take on that role when they enter it. “I’ve had terrific mentors who are not clinicians, and I don’t think it will be a requirement for the position to be a clinician,” Longhurst emphasized. “I think each of us will bring different skill sets and experiences to the role. For me, in medical school, I remember attending a delivery on my pediatric rotation, where I was responsible for resuscitating the baby, and our first job was to enter notes on the mom, and we had to enter the notes manually. And I remember thinking, gee, there’s got to be a better way to do this. So the perspective I bring is a patient-centered and quality-centered perspective,” he said. “Everything we do should involve improving the clinician, staff, and patient experience. One of the things that you highlighted was constant quality improvement. We want our 10,000 employees to be 10,000 problem-solvers, as we move forward on our Lean journey. If you look at other industries outside HC, the CIO at Wells Fargo also oversees the process reengineering work. Those kinds of things create opportunities in terms of stretching outside just IS.”
What’s more, Longhurst noted, “As you see new and different titles emerging, such as chief digital officer, chief, innovation officer, and others, I think there’s opportunity for CIOs to add additional scope, to help drive the organization’s goals.” Schade agreed with that point. “I think you’re going to see new and different roles expanding,” she said. “It will depend on the size of the organization. I think the trend in the past year—I’m seeing more CIOs with expanded titles—chief information and digital officer, chief information and analytic s officer, chief information and innovation officer.” In fact, she said, “there are a number of reasons that organizations are combining existing and new titles. One reason is not wanting to add new positions to organizations, with finances as they are right now; but it’s really going to vary, and we’re going to see that expansion” of titles and roles nonetheless.”
All of those observations by such leading-light figures in the industry validated and affirmed everything I’d been hearing for years, and that I and my fellow editors have been hearing in interviews with CIOs and others who are sharing their perspectives on the ongoing evolution of senior healthcare IT leadership roles. I well remember the early 1990s, when the first IS directors were named CIOs. I remember how many people weren’t exactly certain about what a CIO actually was—including even some who had just been designated as CIOs. Indeed, the role ultimately ended up evolving forward relatively organically, based on the needs of patient care organizations.
And now, at this inflection point in U.S. healthcare, when hospitals, medical groups, and integrated health systems are being told to do more—much, much more—with fewer resources and greater needs among their key stakeholder groups—CIOs and all those who work them at senior levels in healthcare IT are facing their own astonishing “moment” in the spotlight. They have an astonishing opportunity to become among the top heroes of their organizations, as they help guide their colleagues forward into the “new healthcare”—however one defines that term. In any case, CIOs are in a position to truly help their organizations succeed. But they need to become true strategists and true thought leaders in their organizations—senior executives who can help their c-suite colleagues work together to make their organizations highly successful at a time when both triumph and disaster are possible.
And, as my fellow panelists agreed on April 28, all the ingredients for success are there—but they will require personal leadership in order to turn potential into actual success. And yes, the CIOs who succeed will indeed be the “2.0” CIOs—senior executives with vision and drive—and light years away from the “Joe from the basement” data managers of three decades ago. So yes, the “2.0 thing” is for real. And only those who understand what’s needed, will be able to deliver what’s needed, as healthcare lurches forward into an uncertain, yet exciting, new future. Clearly, it’s a time of risk and reward for CIOs and other senior healthcare IT leaders. Time for “version 2.0.”
