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Health IT from the CIO’s Chair 3/12/14

March 12, 2014 Darren Dworkin 3 Comments

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers. Objects in the mirror may be closer than they appear. MSRP excludes tax. Starting at price refers to the base model; a more expensive model may be shown.

Attending HIMSS Made Me Wonder: Does IT Matter?

Flying home from HIMSS after spending a week in Orlando and reflecting on the conference it made me think about Nicholas G. Carr’s book from over 10 years ago that made everyone it IT defensive. Mr. Carr asked, with a provocative title, Does IT Matter?

After spending a few days on the HIMSS show floor, the collective group of exhibitors might have colluded to try to make Mr. Carr’s point.

Before I run the risk of losing my secret CIO decoder ring (which gives me wide, sweeping powers to say “no” to things, an important task of a CIO), let me skip to the end and say, “Heck yes, I think IT matters.” But it sure was hard to see at this year’s show.

Let me add context. Mr. Carr never claimed that IT didn’t matter. People who only read the title of the book argued thinking that, but his main point was that IT yielded diminishing returns as a continuing source of strategic differentiation.

Since I already shared that I don’t agree with his thesis and I think that IT does matter, let me explain more why it was hard to hold my ground at HIMSS.

I believe that real strategic value from IT comes from cumulative and sustained use of our systems.

The show floor at HIMSS is best at being a live shopping catalog. If strategic value comes from health systems hunkering down and “just using what they own,” it really means we should all be at our core vendor’s user group to get focused instead of out shopping. This is not to say that there weren’t some interesting new ideas and companies at the show, but I would contend that most health system should be implementing, optimizing, or perfecting the use of their existing systems.

The problem with not staying focused is that it makes us forget that IT is only a tool, not a panacea. Shopping for the latest technology because it can be installed now does not usually translate to having our problems magically solved. 

Especially for those institutions that have achieved MU Stage 1 or HIMSS EMRAM Stage 6 or higher, the goal really needs to be to make use of everything we have by using our systems more deeply. Most big vendors I talk to often complain that they have trouble getting their existing customer base to either stay current on latest versions or to implement and use all of the already-live functionality.

But it is not simple. New technologies will continue to give companies the chance to differentiate and first movers who take risk will gain advantage. But understanding the opportunity and deciding when the right time to make the bet is not for the faint of heart. It is among the toughest choices for CIOs and the rest of the C-suite to make these days, with constrained budgets and scarce ROI from previous large IT projects.

Mr. Carr makes the claim that widespread adoption of best practices through the use of IT software makes advantages disappear. It is obvious to me that Mr. Carr never spend time trying to enforce common content in a large health system. If he saw our slower pace, he would certainly declare we had a long way to go and had a low risk of IT not mattering.

The reality is that a lot of the IT mystique has been eliminated as consumer use of technology continues to grow. IT teams now need to play by the same rules as other business units by having clear objectives before money is spent. The age of technology for technology’s sake is probably in the rear view mirror. As technology infrastructure becomes a commodity (the cloud), how we use our tools or the depth of our use of IT will define and create our advantage.

Adding to the challenges of the CIO will be the realization that just because we find a new innovation, it does not necessarily mean that it will pay to be a pioneer. Our focus might be better spent on hunkering down and optimizing.

If we are going to make IT matter, as a mentor once told me,“Let’s get ‘er done.” Then we can go shopping.

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 are "3 comments" on this Article:

  1. While I agree that new technologies should not be implemented without a thorough assessment of their value and safety, I wonder what Nicholas G. Carr may have thought about the concept of IT eventually extinguishing most of the need for its support services? Software is ultimately useful when it has become so efficient that end-users / customers can manage and maintain at least 80% (an arbitrary assessment on my part) of the maintenance and troubleshooting without as large a support service as is currently provided by institutions.

    In my humble opinion, although HIT may not self extinguish, it will need to re-define its future purpose. The need for updates in technology should to be driven by the need for higher levels of service to the patient rather than competition for business and leadership among HIT vendors. It seems like currently, business based competition is driving the amount of funds spent on enticing customers. I ask with trepidation, if this is not a concern for compromising the ethical standards of institutions and healthcare providers ? After all, customers that have been pampered tend to feel obligated to purchase the services and products of the promoting / pandering vendors. It took a while to limit the expensive gifts and pseudo-professional talks-for-pay from Pharmaceutical companies used to lure providers into buying their products. Should HIT vendors be exempt from this ?

    Forgive me if I got carried away and veered away from the topic of your blog.

  2. Not sure that I agree with this one but I understand the position.

    When one spends hundreds of millions of dollars on an EMR, I can fully appreciate the mentality to “hunker down and optimize”. BUT, I think that some of the comments are truly too near sighted. These big boy EMRs (I’ve worked for one before) simply do not provide the tools, UI, content, etc.. to optimize to the extent that best of breed products do.

    The definition of optimization leads me to the main reason why I disagree with aspects of this piece. From Merriam-Webster; Optimization: an act, process, or methodology of making something (as a design, system, or decision) as fully perfect, functional, or effective as possible. Thus, the possibility obviously exists that an optimized product still may not perform as well as a product that is even used in a sub-optimal fashion.

    I have seen it over and over where hospitals try to fit the proverbial square peg in the round hole because God forbid, this tool that we bought for lots of money, will do every darn thing whether to perfection or not, will be used. I’ve seen solutions firsthand that would save MASSIVE hours of staff time, produce more quality results and possibly provide more patient safety over the status quo. Yet, and maybe justly so, someone isn’t willing to call their baby ugly.

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