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CIO Unplugged – 11/15/09

November 15, 2009 Ed Marx 1 Comment

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Why Healthcare IT Lags
By Ed Marx

Last week, one of our hospitals went live on CPOE. My boss and I were there as part of the ribbon cutting ceremony and to commend IT and the hospital for their hard work. When we met in the entryway, he eyed my attire with surprise. I was wearing scrubs, a violation of the dress code.

“Ed,” he said. “I bet you caused a lot of trouble growing up.”

“Yes, I did.” I liked coloring outside lines then; and I still do today.

But, why do I? Shouldn’t a leader be a good model to his followers?

I attended a national meeting with my healthcare IT (HIT) peers. Had you been a casual observer, however, you would not have pegged us as technology leaders. For all anyone could tell, we were glockenspiel salespersons. Our celebrated keynote, the government czar encouraging the adoption of HIT, was relying upon paper notes—yes, the physician who rightly wants our nation to lose the paper chart in favor of the electronic health record used hardcopy notes. And the audience was copiously taking notes…on paper. Need I say more?

Besides coloring outside the lines, I’m a fierce competitor. I aim to win every race I start. I’ll only accept defeat gracefully if I know I’ve poured my all into the competition. When I cross that finish, my tank had better be empty. In the same way, the lack of HIT progress aggravates the heck out of me.

Why are we so far behind other industries? Look in the mirror. That’s right. Time to come clean. It’s because of you and me. Granted, there are numerous other valid excuses, and I will touch on a few. But at the end of the day, the buck stops with us. When I lose a race, I don’t blame my blister, my clothes, the event management, the weather, the course, the timing chip, my equipment. I lost because of me.

Stop reading and let this sink in. You and I are the reason HIT lags.

But there’s hope. If HIT lags because of us, we can reverse the situation and make IT strategic in our industry and career.

When I asked my Tweeters and Yammers for ideas, here’s what they sent. Thanks to all of you.

Some reasons why we lag:

· Leadership

CIO’s not leading

CIO’s not culturally relevant

CIO’s reporting to CFOs

C-Suite not understanding or acknowledging HIT strategic value

CIO’s fear of failure

Leaders tend to be older and less receptive to technology

Decision makers often have clinical backgrounds, an area that has a bias for rigor, analysis, and is slow to change

· Healthcare Complexity

Burdensome government regulations stifle attention and consume financial resources

Payment systems and processes

Lack of standardization

Piecemeal approach to application deployment

Clinical and legal liability

Fragmentation – hospitals are silos of individual services, often used by independent practioners, all with differing cost and profit structures

Complexity is so great that leaders don’t want to deal with it

Incentives to innovate and minimize inefficiencies, if they exist, are contained to a specific workstream – not the entire ecosystem

Adoption of any new treatment or procedure in medicine has traditionally been slow because of the need for long-term testing and proving of safety and efficacy. This approach has transferred to the adoption of anything “non-medical”, new or different like HIT

· Financial Resources

Lack of margin to focus on innovation

HIT investments are not appropriately correlated to outcomes

Historical under investment

· Healthcare Culture

Healthcare by nature is precise, protocol-driven, and we teach the need to be "in control" at all times. While this is true for clinical care, the same mentality in other areas (IT) hinder change

A corollary to the above- By nature, people with these characteristics self-select into healthcare, making the climb that much more steep

A schism exists between IT and those who provide hands-on caring service to patients

Much like the traditions connected with our clinical training counterparts, HIT leaders are still promoted and recognized for experience and longevity

Social-cultural issues; change resistant

"High touch" aspect of healthcare views HIT as intrusive

HIT must be proven safe before it can be used, where as in other industries, if you test and fail there’s little harm

Waiting for next big thing

Lack of market-driven demand

Knowing and holding information is power and HIT threatens that power by enabling easy sharing of information

CIOs are in a unique and coveted position that allows us to observe and tie together the healthcare ecosystem, first within our own gates, and then beyond. The single biggest change agent to move HIT from laggard to leader is not healthcare reform. It’s you.

Ways to reverse our situation:

· Stop throwing up your hands and blaming the environment

· Take responsibility

· Take calculated risks and color outside the lines

· Take proactive actions internally and externally at the local, state, and national levels

· Challenge the status quo

· Tackle the tough issues and demonstrate HIT investment value realization

· Model innovation and technology use

· Get deeply involved with your clinicians and live their processes

· Be disruptive

· Stop traditional hiring and promotion practices. Instead, favor talent

· Look outside of healthcare for new ideas

By the way, I wore scrubs at the GoLive so no one would mistake me for a chaplain, a lawyer, or a glockenspiel dealer. The color matched the rest of the IT team on the ground and fosters a close working relationship with clinical staff. I was proud to wear it, to show I cared. And because I love to surprise my people.

So…I commission you to help your organization and physicians understand the strategic value of HIT. You hold the salve to heal what ails healthcare today.


Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

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Currently there is "1 comment" on this Article:

  1. I would like to think the category of Leadership was purposely placed at the top of this list. Although I do not like engaging in blame games, I feel it necessary to at least vent frustration on that category because it is one major obstacle in IT that the common worker cannot change and should not be blamed for. So, I hope anyone that calls themselves a leader will take the time to read these discussions with my IT co-workers.

    We can’t make leadership lead. Hell, I wish I could. We can’t even submit a negative survey without leadership asking us to take it again. I wish I could honestly evaluate the Directors and above in my “chain of command”. I imagine they would take notes and nod their heads. Action items would be drawn up. Other meetings would be scheduled – or at least discussed. Nothing would change, mind you – if it were possible for leadership to change, they would have done it already and “leadership retreat” sales would sadly decline in this country.

    I’m in my 30’s and, like many, have already become so cynical of management. I guess I expect positive change when new powers come into being, but have been tricked into what that change means too often. Change does not seem to mean listening to the little guy, the common worker, anymore and I find that extremely disappointing. For all the surveys and focus groups and manager talks with their people, Upper level managers just do not really and honestly listen to people anymore. They can ask 10 great questions about a new strategy or vendor, but when they are face to face with a worker that has been separated by eight layers of management, these leaders can be so awkward and patronizing to the point it is really pathetic. Why? How did we so completely lose focus on the needs of the majority of the people?

    I have a theory that upper level management types today are just plain scared of what the common employees will say and they have little or no use for any vision at the bottom layers. This is not simply an awkwardness between different social/economic/educated classes. This is a legitimate problem that has been downplayed and forgotten and neglected in order to focus on any of the other 100 reasons that “we” lag in IT. The lack of passion for the workers is also evident and exacerbated by the endless corporate “propaganda” spewed out in any given month. We grow tired of hearing slogans such as “transformational mountain”. We don’t care to hear about the “journey” we will be taking if it involves us being treated as the pack mule – whipped into submission with the endless saddlebags of projects. I can’t expect any leader to comprehend this – dismissive, mousy, and arrogant leaders are unable to grasp the concept of low morale. Why then, Lord, are those characteristics so common in leaders?

    It does not matter how well I do my job, I will always fail here if the leaders don’t lead and leaders will always be failures if they do not listen. Leaders: Learn to understand people – try to care if possible. Learn to say no or “not right now” to projects – yes, even if it is a state-of-the-art heart center – ignore the fools that cannot distinguish between taking a risk and unsound reasoning. Learn to stick up for your people for God’s sake – bonuses and KPI’s be damned! Most importantly, know that the difference between the title of leader and a real leader is that the former only hears the feedback of the “Yes men”. A true leader has the guts to solicit and listen to criticism and decide how and when to act on it.







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