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An Argument Against Giving CIOs Control Over Clinical Systems Projects

April 2, 2008 News 6 Comments

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in June 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

It’s hardly news that clinical system implementations in hospitals fail with astonishing regularity. Sometimes they explode in a huge fireball of organizational upheaval. Other times, they simply fail to deliver the benefits everyone expected. By failing, I’m referring to not just the IT part of the project, but the overall change management required to be successful.

It seems we as an industry don’t learn well from our past mistakes. We keep making the same ones over and over again. Many of those I’ve seen involve the role of the hospital CIO in the project.

CIOs rarely have a clinical background, most often having risen through the ranks of programming, managing, or consulting. I’m therefore postulating that they should not be given control over major clinical system implementations.

CIOs don’t always have the respect of physicians, nurses, and those other key clinical personnel actually carrying out the organization’s mission. They may be recognized as holding authority over needed hardware and software tools, but to most clinicians, the CIO is the besuited mid-level functionary whose job it is to say “no” to IT requesters who did not pay adequate homage when defining for themselves which technology tools would improve patient care. Since IT controls the budget, innovation is allowed only if committee-approved.

Some CIOs I’ve known made it their personal mission to set clinicians straight, convinced that without their wise paternal oversight, the wacky clinicians can’t be trusted with money or system selection power. Clinicians armed with reams of objective and factual system data are overridden with logic such as “It just doesn’t feel right” or “I know that company from another job or my peers,” which seems reasonable other than it fails to prevent the train wreck most of the time.

CIOs like to make executive decisions even when they’re ill equipped to do so. Since IT executives have little influence when they’re not making big decisions, they tend to relish the chance to buck convention or override carefully designed committees. Their veto power is absolute.

IT executives fear for their jobs, much more than they fear for the well-being of patients. They’ll override nurse informatics people nearly all of the time and MDs 50% of the time when it comes to delaying an implementation when faced with dangerous shortcomings. The most common reasons: (1) we’ve spent the money, so we have to go live; (2) it’s bad and not likely to get better, so we might as well go live, or (3) I promised my peers this system would work and I won’t tell them differently.

Should CIOs be involved in clinical systems projects? I honestly don’t know. Programmer-trained logic doesn’t add much value. Neither does having been involved with a similar project somewhere else or sporting an MBA. Golfing and free lunch vendor relationships seem to hurt more than they help.

Some of our big-name CIOs were directly involved in some of our big-name clinical systems failures, although the ensuing spin often hid that fact from everyone except the hospital employees and medical staff. Whether they made wise decisions or worried mostly about the Dilbert-esque world of timesheets and timelines I can’t say. But they’ve failed enough times that it’s worth trying something new.

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Currently there are "6 comments" on this Article:

  1. The article failed to mention that CIO’s use committee’s to buffer themselves from a clinical decision gone wrong. so they won’t lose their job’s. Basically a response of this was their choice and not the CIO’s. Realistically how does anyone in a healthcare system know which clinical system is best. Is it from all of their years of choosing solutions? I think not. Their jobs are to take care of patients so what it boils down to is who does the best demo and golf outings.

  2. Regarding the articial about CIO’s in Clinical Decisions; honestly, CIO’s that run their shops the way this article describes should not only not have input into clinical decision, but should be fired as well.

    It has been a good decade since we have had CIOs in the mold of CIOs’ described in that editorial. I was surprised to see it was from 2006. Failed projects are never the sole responsibility of the any one person, rather are a combination of factors. Trying to blame failed systems on CIOs is like a lawyer going after the person with the deepest pockets.

    Accountability is another matter all together. There has to be accountability. Hospitals are the most politically charged organizations I have ever been envolved with. Everybody has their little silos and talk about turf territory. Who does the CIO report to? Is it CEO, COO, CFO, CMIO, CNO? Were is the accountability for all of senior managers in decisions and failed projects.

    The hospital silos worked fine when it was paper and the final medical record is scanned. This all changes with EMR and it exposes everyone secrets and bad processes. A CIO inthe 21 century hospital has to be able to reach across all parts of the organization and help develop a strategy for 5 to 10 years into the future.

    With the focus on linking pay for performance and the revenue management with clinical solutions through the EMR, I would argue who better to faciliate that discussion than a experienced CIO with input from across the organization.

  3. For the last twenty years of so clinicians have put their trust in the skills sets of the hospital CIO. I believe the time has come for all good clinician to come to the aid of their hospital and devote full time focus on the life cycle of diagnostic information technology.

    I have recently created a position based on the College of American Pathologist posted job, Director of Diagnostic Intelligence and Healthcare IT Initiatives. The title is kind of a mouth full so I tinkered with the attributes and wrote a short white paper on the Diagnostic Information Officer (DIO); you’ve got to love the acronyms.

    Diagnostic Information Officer should focus on every hospital Point of Diagnostic Service (PODS) to include all the enterprise mashups of POCT, FOBT, HCG, ABG, Neonate, CDS, LIS, RIS, CIS, etc… The responsibility of the DIO would be to function (laterally) with the CIO to ensure provision of interoperability for patient diagnostic data which I have been told constitutes over 70% of the typical EMR. CMIO has not been functioning effectively for years or we would NOT be having so many reported vendor IT disappointments. If this functionality sounds naïve, then maybe we should start considering the simple things to fix in healthcare like accurately identifying a “person” a.k.a. Homo sapiens correctly in Admissions before we enroll them as “patient” and provide them their unique “number.”

    HIStalk is so cathartic!

  4. I’ve been around a long time, and I’ve seen some great CIOs and have also seen some that were clearly over their head. Fortunately, there are a number of organizations where we can learn from each other. I don’t think it’s a CIOs job to make all of the decisions, or to necessarily be the expert in every area that IT is used.

    Successful implementations (and the resulting benefits to the organization) come from effective collaboration, which can and should be fostered by the CIO. And the CIO does not have to be the primary project sponsor or champion to do that. In fact, most projects should be championed by an executive from outside of IT.

    Not being a clinically-oriented CIO has not been a problem for me because I have RNs (and other clinicians) in both staff and management positions within IT, and we have terrific clinical resources throughout our enterprise. But neither is a clinical system implementation just about clinicians. Again, it’s in the effective collaboration and gathering of various backgrounds and expertise, aligned to achieve a common goal that separates a successful project from one that’s not.

    As long as organizations view IT-related projects as the installing of hardware and software, with new and improved screens and reports, and with go-live being the ultimate “goal”, then the real opportunities will be missed. A new system is just a new system. Our real goal should be the enabling of positive change within our organizations through the effective use of IT.

  5. This is akin to engineers developing product requirements! The system would only be as good as the engineers skill set.

    I’ve been around too…been through several failed installs. The reasons are well known by those who frequent HIS Talk. We went through one where the clinicians had their say…over and over again…but adminstration never FORCED the docs to give up their paper charts. (I was a clinician at the time)

    Massive failure to the tune of 35M worth.

  6. Please don’t imply that only MDs or other clinicians are better CIOs than non-clinicians . Most of them have absolutely no computing, information technology, or project management experience. They believe vendor hype (no wonder vendors market them instead of of people who will actually USE the purchased product).

    I have been around a long time, too and have seen both types of CIOs. Both have huge knowledge and experience holes. At the minimum, it seems either type of leader must have some basic understanding of informatics, the difficulties of system implementation, the implications of implementing systems with no proven track record (just because everyone else is doing it), and the fact that enthusiasm alone does not a successful implementation make.

    And the 10×10 programs sprouting up everywhere – 1 introductory informatics course and suddenly you’re an expert! Yes, please, give me more MD CIOs who like to tinker with computers and have taken a whole course in informatics! This will REALLY solve the non-clinician CIO problem. Be careful what you wish for.

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