The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.
If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.
This question this time: As you look back on the education, experience, and effort that led you to your current position, what advice would you offer to others who aspire to a similar role?
My role is CIO and CMIO, and I used to think my path was pretty unique. But I had lunch last week with another doc trained in the same specialty who is now doing the same thing, so we’re starting a club. If we get another member, we’ll make it a professional society. As for advice, I think my path has much more to do with leadership ability than it does with specific IT training. Obviously, one has to have relevant knowledge and skills, but running an IT department isn’t that different from running an ICU.
Director of IT. Three pieces of advice. Best advice — education and experience outside of IT and/or outside of healthcare are invaluable. I have degrees in political science and foreign studies and graduate coursework in international relations. I went to work during summer break for a mortgage banking software company. Learned technology from the ground up, worked in basically every department, and eventually moved to a larger firms in manufacturing (pet care products), focusing on continuous improvement and project management.
I found my current position volunteering for the hospital and was pulled in by the CEO. I remember facing a huge roadblock in the first group interview when they were concerned that I didn’t have a background specifically in healthcare IT. I had grown up in a family of nurses, so I spoke healthcare pretty well. But my response was, "I didn’t know how to make dog food until I went to work for Purina, either." The point I made, and which eventually got me the job, was that interpersonal skills and a solid understanding of information technology are completely transferable. Bringing to the table the knowledge of how other industries manage IT and its challenges can be a huge strength. Political science is essentially understanding how people work together (or not) in a group. I use every bit of that every day in my current role.
Second piece of advice — stay connected, keep learning. There’s not a day that goes by that I am not exploring something new, even if it doesn’t seem to directly connect to healthcare IT (yet). Eventually, everything does. I’ve developed expertise in HVAC, low voltage systems, change management, public speaking, and many more areas that I’m sure all of my counterparts are also familiar with.
Third piece of advice – love what you do. Find that place you can put your heart and soul into and do it. You and your employer will be well rewarded.
In a CTO role with a vendor organization, I’ve found it beneficial to have worked outside of healthcare previously and experience how technology and data systems are deployed and used in other industries. But in the transition to healthcare, do not underestimate the subtlety of relationships in HIS data. Ensure that healthcare data systems can remain healthy and recover when poor or unexpected data is encountered.
I am sure that coming from hospital clinical operations was the best and most significant experience that has lead me to the role of the highest ranking IS professional in the hospital. The CIO, or IS director if there is no CIO title, must first know the business. Not being a clinician, but having an in depth knowledge of clinical process and challenges was key, then learning the applications and helping adapt them to the workload has been critical to my success. Learning the business side is the second most important.
Spending time with Managed Care, Finance, and Coding was the next most important step. IT knowledge is important, but as my CEO has always said, the further up the chain you get, the less important the technical is and the more important the relationships get.
I chose healthcare as an industry after working in financial services and realizing that the organization’s mission matters to me. I serve as a CIO for an integrated delivery organization with 1,200 ambulatory physicians in 60+ clinics and four hospitals. Best education choice I made was to go for an MBA after getting my foot in the IT world. I applied business skills and knowledge to practical IT issues and communicated better with finance people. I’ve been laid off and otherwise dismissed twice and both times the moves to new positions, while scary and a bit challenging, turned out way better than staying in a situation lacking a solid fit. I’ve quit a couple of positions that didn’t fit to move to other, more challenging situations. I value the breadth of industry experience these changes have provided me.
I’m a CIO and spend a disproportionate time on contracts and talking to lawyers. This time commitment has increased over the years. I’d strongly recommend a business law class or two. I came up on the application side of the IT department, as opposed to the technology side. I think the ability to explain and understand applications to C-suite, physicians, housekeepers, etc. will serve you better than the ability to explain or understand the underlying technology of a Cache’ data structure vs. a SQL Server database.
I’m a managing director with an advisory company (an HIStalk sponsor, of course!)
Like it or not, credentials and degrees help, but they only open doors, not land the position. A varied but productive track record helps immensely. I think I am much more attractive having done a fair amount in multiple entirely different situations than if I had plugged away in the exact same position for the entire time. Plus, it lets me tell stories and derive lessons from several different backgrounds. Cross-pollination, connecting dots, etc. can often be the extra value that you can give to a prospective employer.
You create your own opportunities. It’s impossible to know what efforts will pay off. Will a meeting/conference be a waste of time or will you happen to meet that one critical contact? Get out there and find out. Sorta like investing: sometimes you lose, but you may very will win big. If you do the job you’re told to do and do it well, you’ll continue to do that job. Identify a need (ideally your boss’s pain points) and do that job and you’ll see your stock go up much higher.
Read, read, read. What’s going on in the industry? If you were introduced to a group at a conference, could you jump right into their conversation about the latest developments, chat about where things are headed, etc.? If not, get up to speed. Even if you feel it’s hard to know where to start, keep at it long enough and you’ll accumulate that background before you know it.
I’m one of the minority of CMIOs with formal medical informatics training (masters’ degree from a very academic NLM Fellowship program ), but perhaps my best education came from the school of hard knocks working for major consulting firm. Boy, did I learn a lot that they don’t teach you in the ivory tower — project management, change management, managing up and down, working on a team, presentations, client relationships, how big organizations function, etc. It was a tough couple of years, but it was like a mini-MBA. There are plenty of ways to achieve a CMIO role, but it helps to either have solid preparation in a real-world informatics environment, or to be the right person at the right place at the right time (i.e., be the anointed physician champion during the CPOE implementation and get a battlefield promotion).
Role: CIO. Today’s healthcare CIO needs a combination of technical, administrative, and business skills. It is more important to have an understanding of healthcare and the rapidly changing role of information systems than an in-depth knowledge of a single vendor’s system. The CIO should be seen as understanding the overall mission of the organization and how IT can contribute to and support that mission. Vendor and contract management, astute use of financial resources, and quality of care are all primary aspects of the job. Being an enabler rather than a naysayer are traits the organization expects.
As a CIO, I would ask someone aspiring to this role the following (with long pauses at the commas): "What, exactly, are you thinking?" In general, I give career advice by first referencing a quote attributed to Dwight D. Eisenhower: "Plans are nothing; planning is everything." The process of figuring out what you want to do, what you want to become, and what you are willing to give up is vital in pursuing a career that you’ll find rewarding. But, you need to continuously reevaluate that plan as new opportunities arise and your life changes.
Some of the best career decisions I’ve made came from opportunities I did not have in my plan. I reevaluated and adjusted as I went. It’s good to focus on end goals and priorities, but there are many different paths you can take to reach that goal. On top of that, your priorities change over time that affect the balance you need in your life between career, personal, and family time.
I entered the CMIO role about nine years ago after 25 years of clinical practice. In my opinion, the best way to get here is to keep your ears open and learn everything that is put in front of you. I was very attentive to all of the IT presentations while I was in practice and had a good basis when I assumed this role. The other asset that this position requires is the ability to get along with everyone; you have to get used to physicians taking their frustrations out on you, even though it isn’t personal.
In my role as CMIO and medical director of performance improvement, I have the privilege of being on the front line of both technology and quality for our organization. This is truly the sweet spot of HIT. Blending the power of data with the power of information has the potential to provide great potential for improvement in near real time. I would encourage others to pursue educational and practical experience opportunities in wide reaching areas of both technology and quality. Focus on how to tie all your efforts back to the care of the individual patient. In addition, study and apply Lean Six Sigma techniques in the myriad of processes you will encounter along your journey.
My role is CTO. Recommended experience — multiple industries. I was in both banking and government before healthcare. Each industry has different priorities and different levels of IS maturity. Taking the best from each industry or not doing the things you see that don’t work allow you to help make your department or division more productive which in turn helps you progress your career.
Education. For healthcare, especially now, classes like finance or even something softer than that like management or marketing are key. Anyone can learn hard core technical skills, the ones who move forward are the ones who understand the business, how IS fits in it, and can interact with others.
Don’t be afraid of hard work or long hours. Remember IS is 7x24x forever. Be available, be involved, and most of all have fun with it.
As an academic attending physician with an interest in informatics, I would suggest getting the strongest possible clinical training as well as a formal solid foundation in the core areas of informatics, including a good understanding of clinical information systems, decision support, usability and interface design, human-computer interaction, computer databases, project management, and organizational behavior. It’s possible to learn about EHRs on the fly, through practical experience and by apprenticeship, especially with a strong background in clinical practice and in the use of technology. But formal training in each is a huge advantage.
I benefitted a great deal from attending top programs for my clinical and informatics training due to the quality of the education, but also the people who I met and the lifelong connections that I made. Networking through professional organizations and meetings can be a big plus, as is staying up to date by reading great prose such as HIStalk.
I am the CIO/security officer of our organization. My path has been unique in that I started out as a nurses’ aide/unit clerk. I’ve spent over 30 years in hospitals and a couple of years on the vendor side. Knowing the business of my customers first hand has given me a perspective and credibility that CIOs coming from the technology side struggle to achieve. Advice to those striving for a similar role — know the business of the organization front to back. There isn’t any work process that is too insignificant for you to understand. Also, I believe that a MHA or MBA is more valuable than an advanced degree in technology.
Just like mileage on a car, your actual results will vary. With that said, I think there are a few steps aspiring CIO’s would want to consider. First, a mental health evaluation would be in order, as this job is not for everyone and it rife with risk, stress, and the potential to develop bad habits one does not have currently.
More seriously, a graduate level degree is almost a requirement. PMP certification would be a nice add-on, as would Six Sigma or Lean certification at some level. Clinical experience is a plus, and for more and more organizations, those with a significant clinical background that have come over to IT have a leg up on the rest of us. Working as a consultant can help as it teaches you skills you would not get otherwise, from presentation and report writing (communications) to exposure to many more situations than if you stayed with a single employer (experience). Work in more than one of the IT disciplines also is helpful.
You will have to move into a leadership role at some point or have already done this in your past. There is no substitute for this. Don’t be afraid to move for an opportunity or travel for a while, but make sure your family, spouse, partner understand what this means as it is a big step. Have a career mentor if you can find one — I wish I had one in the past and serve as one today. Finally, you need to have a little luck. Sure, part of this is creating your own luck or maybe recognizing an opportunity when it presents itself and having the courage to act on it. But sometimes things line up just right and you have to act.
Finally, humility is very important. Remember that nobody achieves success without help from others. I owe much of my success to those that I have worked with and dare say "led." I would be nothing professionally without investing in the people that really get the work done and the results that go with them. I cannot possibly overstate how important this last point is.
To be a successful CIO, you need to pay your dues. I started as a computer operator in a data center. I continued my education while looking for opportunities to move up. I volunteered for everything, even if it was outside of IT. I learned the business of healthcare, not just the business of healthcare IT. I became a supervisor then a manager then a director over a 10- year period. I can definitely empathize with my staff and leadership since I have held or managed most of their positions.
The leap from director/VP to CIO is a little tougher. A director’s/VP’s job is 80 percent operational and 20 percent strategy. A CIO’s job is just the opposite. Strategic thinking and operational thinking are two very different disciplines. The healthcare IT field is littered with the remains of excellent directors/VPs who should have stayed as directors/VPs instead of reaching for the CIO brass ring. Assuming you make it to a director/VP level position, think long and hard before applying for the CIO position. Understand your strengths and weaknesses. Ending your career as a successful director/VP is more preferable than ending it as a failed CIO. Lastly, above all, BE NICE!
As a non-traditional CIO in an academic environment, I find my clinical, financial, and operational background in healthcare that occurred before my turn to the technical to be invaluable. I use it every day. I can converse fluently with just about anyone in any part of the organization regarding what they do on a daily basis. Understanding the business of healthcare, the issues that it is facing both now and in the foreseeable future, and how technology can both facilitate and support the changes that are occurring brings incredible value to my organization and to the senior management team that I am a part of.
My best advice — it is always about customer support. The best system in the world will be an implementation nightmare if the support is bad. The worst system in the world can still work if the support is superb. People will understand software shortfalls, hardware interruptions if they know you are behind them and will be there for them. Folks will accept that you don’t know if you will tell them you will find out and get back to them in a realistic timeframe. But then you have to follow up every time. I guess what it boils down to is accountability and the relationships that you build. Always remember, it is all centered around the patient.
Head of a business unit within a HIT company. I think my diverse experience in HIT has prepared me in a unique way for my current role. I started my career as a phone support person helping clients with issues from technical problems to how-to questions. From there I moved on to training, implementation, sales, operations, and business development. Along the way I was promoted into various management roles and my responsibilities increased accordingly. I say all this because most of us work in very complex organizations with many functions across the span of control.
In my opinion, you will be better prepared to lead if you have had experience, or maybe exposure, across a broad set of functions. This is why many companies move their management through a number of different areas as they rise through the organization. Embrace those opportunities and take roles in departments that take you out of your comfort zone. Also, pursuing my masters degree really helped me in two ways. First it gave me confidence in the knowledge that I already had and filled in the gaps in areas that I didn’t have the necessary skills. Secondly, it made me more marketable for executive roles.
I am the CMIO, but effectively am the chief clinical Information system officer. My advice for new or aspiring CMIOs/CCIOs/CNIOs is to establish your core clinical competence first, so that you never feel like you are a hostage to keeping your informatics job (i.e., you have something to fall back to if it gets so bad that you have to quit.) Study the quality literature — Deming, Juran, others — and apply Deming’s 14 points as much as possible. Make sure that there is a single person responsible, directly or indirectly, for all aspects of clinical informatics at your organization. Make sure that you have clinical leaders and a boss (preferably not the CIO) who understands the importance of what you do.
Get some business background so that you have a good understanding of strategic planning, budgets, and accounting. Contribute to the national dialogue on HIT and try to help bring Washington to its senses. Examples include contributing comments on Meaningful Use through your state or national professional societies, supporting the movement for physicians to use SNOMED for coding instead of ICD-10 (which is outdated and bloated), belong to AMDIS (the listserv and Ojai meeting are wonderful things).
Read HIStalk regularly. My knowledge of HIT issues went up immensely when I became a regular reader. You are a national treasure.
Get to know all the different stakeholders (internal and external) in healthcare for they are your constituents. Learn and understand their professional and personal challenges in the work they do. Caring for others is the culture of healthcare. Be sincere, humble, and transparent to establish and maintain trust. Once you lose trust and/or credibility in healthcare, your chances for success on individual projects / tasks and your career are very limited. Establish a personal goal or mantra of what you would like to accomplish in your healthcare career; not for your personal benefit, but for the benefit of the constituents you serve in healthcare. (i.e. patients, nurses, physicians, etc.)
I am an HL7 interface analyst with clinical experience. I have a long history of working with computers prior to going to nursing school. Coming out of nursing school, I knew I didn’t want to be a clinician. So while working as a nurse, I immediately returned to school and got my master’s in management information systems. I worked as a nurse, hoping that this experience would make me a better computer person. After a year of nursing and some very rude remarks from a thoracic surgeon, I left bedside nursing for a posting of clinical systems analyst that I found on our hospital job board.
As a clinical systems analyst, I observed the integration team in all their glory. Ours were all-powerful divas who drove the rest of the department crazy, so I made a note to self to try to remain kind and real. I went to my boss and asked her to send me to school for our HL7 engine. She said that she would if there were enough money in the budget, and in a happy coincidence (I had been partially responsible for the budget that year), we had plenty of money for education. She sent me to the vendor-led class. Meanwhile, the divas had all left and been replaced by a single consultant.
Later that same year, our hospital system joined a larger consortium and they created an integration team from those who were qualified and I applied. For the past 12 years I have enjoyed being the only clinician on the HL7 team for them and then a subsequent hospital that wanted to pay me what I was worth. I really enjoy working with clinical systems integration because I feel that I bring unique qualities to each project. When people ask me how I got here, I tell them to grab the brass ring and don’t let go. You need to see the future, make a step-by-step plan, and go for it. Hold yourself accountable and make it happen. Ignore everyone who tells you that you can’t. I encountered several of those, and most are still doing what they were doing when I started. Read inspiring books. My favorite was Why Good Girls Don’t Get Ahead, But Gutsy Girls Do. Watch inspiring movies — my favorite was “Working Girl.” You can do this!
Role: IT manager. First years of my career were in nursing, and have an MSN. Also had teaching and supervisory experience. Always loved the software application stuff, though. Started volunteering for testing/other IT projects whenever nursing input was needed. Became the IT liaison, working with them on any software upgrades/issues. When ambulatory EMRs starting being introduced, found a position with an organization who was looking for someone with nursing expertise and some basic software skills. Now the ambulatory EMR world is red-hot — jobs all over the place. It’s a good time to get into this field. So volunteer, work with IT, learn the language, the testing, and the processes needed to be successful in IT. Then look for that great job — they are out there now.
Professor: (but also corporate researcher in the past). Try to get an internship or at least try to see how people doing the job you aspire to, actually work on a day-to-day basis.
My role now is jokingly referred to as the garbage pail. If you don’t know what else to do with it, give it to me, and I’ll figure out who should take care of it. Any given day, I could be working on a security risk assessment, a patient data report, Medicare medical necessity, and administrative strategic planning. I don’t do hardware work or OS troubleshooting as much any more, but that is mostly because it has been a long time since I’ve needed to, and both have become more specialized over the years. I’ve done everything from cleaning out printers to educational presentations at international conferences.
Education-wise, I have a college degree that bears no relationship to what I do (social sciences, with an emphasis in geography & history). Its only purpose is to prove that I could stick it out and get the degree. I am living proof (or was 20+ years ago) that it was possible to be on academic probation and still graduate college.
The effort? Never be afraid to accept a new challenge. I "do HIPAA" because my boss in 2001 was looking for something to get me re-engaged and not lose me to another job. I’m glad I did, because it has given me a lot of opportunities I wouldn’t have had otherwise.
Don’t be afraid of "tall poppy syndrome." Be willing to go above & beyond, even though you may risk alienating people who don’t want to expend the effort. Give your best. Develop your writing & speaking skills. All the technical skills in the world can’t help you if you can’t communicate the information. A major piece of the failure of the space shuttle Challenger goes back to an inability of the engineers to make everyone else understand what was wrong. An extreme example, but it can be no less vital in healthcare. Lives may be on the line if you can’t make yourself understood.
I love what I do, and I can’t imagine doing anything else. Every day, I get to have an impact on the direction the industry we work in is moving. I can help people who have lives in their hands get the information they need to make those lives better. How many people outside of healthcare get to say that?
Do what you love, love what you do — there are no absolutes. For example, I am a physician in HIT who still very much enjoys seeing patients part-time because I love doing that and because it helps me with my job. But if you don’t love seeing patients, or your job simply is too all-consuming for patient care, then it does not make you a bad CMIO if you can’t do it. With that said, there are some things you don’t know unless you try them, and to be a truly great CMIO, I do think you need to have at least 5-10 years of clinical experience to understand how you really feel about it and to see enough to have both the credibility and experience to speak and represent on the topics of clinical IT.
I am currently an interim Corporate CIO for a multi-hospital system. I spent 10+ years as a CIO prior to this interim contract. As a healthcare CIO, I think it is very important to develop a business acumen and understand the healthcare industry as well as the healthcare IT industry. My career path began in operations and then as an analyst/DBA/web developer.
Once I moved into IT management, my technical skills were diminished. The first CIO position I interviewed for was difficult as I knew that I would be giving up all of my technical skills if I was hired. Not only did I transition to a business leadership position, but I had to learn how to work with clinicians and understand their needs. In my opinion, if a CIO is not a clinician, they should partner with one (or more) to be successful. That is the strategy that has been most successful for me.
My career always progresses best when I help the careers of those around me first.
Success = Q x P x V, where Q = quality of your work, P = the productivity levels of your work, and V = the visibility of your work. Someone has to see and appreciate the work that you perform, and they have to attribute that work to you. If any one of these three variables — QPV – falls to zero, so does your professional success.
The only two metrics that really matter are employee satisfaction and customer satisfaction. Every other metric is a means to those ends. And employee satisfaction must come first.