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Health IT from the CIO’s Chair 7/23/14

July 23, 2014 Darren Dworkin 1 Comment

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

Enterprise IT Says “No” (again…)

Nobody really likes to hear “no” as an answer. Unfortunately, I think it may be part of my job to give it. That does not mean I have to like it.

The role of enterprise IT differs across large healthcare organizations, but likely also has a few common threads. Here are three I would guess to be constants.

  1. To manage total spend on IT capital and operating budgets required to maintain the operations of dozens of existing applications (most of which are mission critical).
  2. To prevent any breach of security or privacy and ensuring adherence to a growing number of regulatory obligations.
  3. To be accountable to a wide range of diverse stakeholders with many ideas on how to do more with IT.

None of these things on their own drives IT to say “no,” but together they can create enough pressure to want to leverage “no” as the answer to slow or to temporarily stop the chaotic pace that many enterprise IT groups face.

This post is not meant to be a complaint about enterprise IT. I lead an enterprise IT organization and I think central IT groups can be integral to the core of any business. But IT is changing. It’s time we challenge how we approach the IT department itself. Here are some crazy ideas to try.


Problem: IT budgets are either constrained in growth, frozen, or expected to drift down year over year.

Idea: Reduce the central IT budget to cover just the basic shared services and infrastructure — help desk, user security, dial tone, and the data network. IT should be pushed to make this part of the budget more efficient. It should be subject to the same budget expectations as, say, plant operations. Everything else should live in a line of business operating cost center or a cost center dedicated to the initiative. For example, put the lab system in the lab cost center and the expenses for that new ACO initiative in a dedicated ACO cost center.

Enterprise IT Challenge: Without budget authority, IT will be included at the table with influence. IT will need to educate many on the challenges of not just the cost to acquire and implement, but the ongoing costs to manage and support.

Benefit: Less frequent need to say “no.” More stakeholders will be involved in the shared budgeting and fewer will ask for new toys when they are still helping to find ways to pay for their own existing ones.


Problem: New solutions must be secure and avoid introducing risk.

Idea: Approach risk like an auditor evaluates risk. Health systems are filled with some of the smartest people around. Someone can always come up with an obscure edge case to represent why it might not work, but that does not mean the whole idea is bad.

Auditors understand that risk is everywhere. The objective is to manage and mitigate high risk and to prioritize focus. Enterprise IT should start to evaluate the risk of a solution based not only if risk is possible, but if it’s likely. Some problems are so big that solutions are welcome even if they don’t solve all the issues.

By way of example, using a consumer cloud storage service is better than a USB drive and probably more secure than many laptops, even if the cloud does not meet every IT requirement.

Enterprise IT Challenge: Get comfortable with incremental improvements to pave the way for the big wins. Understand that a less-secure, easy-to-use approach that will improve what is used today is better than the higher-friction perfect one we are waiting on for tomorrow.

Benefit: Faster iterations towards solutions, more “yes” answers, and a greater appreciation and understanding when a less-frequent “no” is delivered.


Problem: IT has become part of so many pieces of the healthcare delivery system. Instead of celebrating this win, IT gets caught up in the constant stream of new demands for new things. IT just can’t do it all.

Idea: Decentralize more of IT and stop asking IT to do it all. If delivering care is more efficiently done in a team setting, why can’t IT be approached the same way? This will take work in establishing guidelines, tools, and governance, but it may just be time to reimagine enterprise IT. Reporting, clinical content, workflow optimization, and new products to pilot are all great candidates to experiment with decentralization.

Enterprise IT Challenge: Three things: change, trust, and infrastructure. Like most hard things to do, sooner or later it may just come down to trust. The goal of decentralizing IT is not to let everyone just do whatever they want, but rather to work as a larger team with shared responsibility to the same outcomes. This change takes careful planning and focus. If that is not hard enough, our IT systems are probably working against us in that we lack some of the tools and infrastructure to adequately matrix our work.

Benefit: Shared goals, shared outcomes, deeper penetration of IT in the organization, and over time, the best people working on each solution (some from IT, some from the rest of the enterprise). Maybe in the end there aren’t fewer “nos,” but fewer from just IT.


The role of IT should be to enable and encourage IT. It’s time to turn enterprise IT into more of a team sport.

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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Currently there is "1 comment" on this Article:

  1. Re: “IT budgets are either constrained in growth, frozen, or expected to drift down year over year.”

    So your suggestion is to redistribute the IT budget for ‘non-core’ IT functions to the business departments. OK, that’s basically acknowledging that the real problem with the IT budget is political and not a function of the business. Because if the requirement for IT funding was fundamental, redistributing the budget wouldn’t accomplish anything. However political problems are still problems and maybe this is a valid response to that, right?

    My concern is that I’ve seen many times (too many times!) when IT spending or responsibility was laid at the feet of the business departments and the outcomes were bad. How so? Lots of times you are dealing with unimaginative Line of Business managers who can only see the current way of doing things. They don’t ask for different because they don’t want different, or they are convinced that different cannot possibly work.

    Another common situation is the LOB manager for whom this new responsibility is seen as ‘the other’. It isn’t part of their training, it isn’t part of their experience, and it isn’t part of their worldview. How is this relevant in the current context?

    I have seen multiple clinical managers (who have risen through the ranks you understand) who have viewed IT as ‘the other’. They don’t want IT. They don’t like IT. They got into medicine to help their fellow man and they have a heart dammit! The computer doesn’t have a heart. Also it’s deeply intimidating for them and yet again, we have the response to the alien thing, the computer. Fortunately this is getting less common every year.

    What isn’t getting less common every year is priorities. Every clinical department that has to fund IT spending, is going to compare their clinical spend to their IT spend. Now where do you think their priorities are going to be? Oh sure, there will be the odd visionary, the occasional forward-thinking manager who sees that the business processes need updating, and the only practical way to do that is with technology. I’ve worked with a handful of those clinical managers too. Let’s just say, that’s not the average manager.

    So when business departments wind up paying directly for IT services, I’ve seen the most common result. That is seen as an ‘optimizable expense’, which is code for, cut that expense down to the bone. Which results in poor service to that department. Which often as not, then decides that IT is hopelessly incompetent and not even worth the money currently being spent. The net effect is a frozen and dysfunctional relationship between IT and the business.

    Now what problem were we trying to solve again?

    Doesn’t competition between IT spending and clinical spending happen anyway though? Sure it does! However when that competition is handled administratively, let’s say at the VP level, you at least no longer have the deep specialization and very narrow thinking that can engender. The macro issues of appropriateness of % of total budget spend can start to get a decent airing. And by the way, that narrow thinking can afflict IT just as much as any other department. So I’m not putting IT in some special category or asking for special treatment on that score.







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