Health IT from the CIO’s Chair 12/8/15

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

My 2016 HISsies Nominations Recommendations

I live in Los Angeles. Folks around here think the big awards are the Oscars, Golden Globes, Emmys, or Grammys. But in HIT, the nomination ballots have been released for the coveted HISsies, so I thought I would fill mine out publicly. Here it goes.

Smartest vendor action taken

CVS and Walgreens, for partnering with Epic to obtain a leading EMR for their retail clinics and enabling them the ability to partner with a large array of leading health systems.

Stupidest vendor action taken

IBM’s acquisition of Phytel. I think IBM is a great company that is undervalued in the market. They have a history of acquiring some great organizations. Among the best they have picked up in healthcare is probably Initiate. But in a yet-to-be-established population health IT market, any company is destined to get lost in the portfolio of a giant like IBM.

Best healthcare IT vendor or consulting firm

I’m admittedly biased. Epic. The scope and scale of what they have accomplished continues to be amazing.

Worst healthcare IT vendor or consulting firm

I’ll interpret worst as most underachieving. I’ll award this to GE and Philips for their lack of ability to leverage their market share in medical devices into something meaningful in the health IT space.

Best leader of healthcare IT vendor or consulting firm

One word : Judy.

Best provider use of healthcare IT (hospital, practice, etc.)

I admire the hard-working folks from my organization, so I’ll name Cedars-Sinai. But I’ll call out a few others Kaiser, Ochsner, Mercy, and Memorial Hermann.

Most promising new technology (in general – not a specific vendor product)

I’ll name three: the field of non-invasive diagnostics, biosensors (not wearables for well people, but technology that can monitor the chronic and acute), and actionable clinical decision support that can leverage the historic investments we have made in EMRs and data warehouses.

Most overrated technology

EMRs. Don’t get me wrong — they are essential and are the foundational agile technology base on which most of our health technology aspirations will ride. But the potential of the EMR alone has been overrated and over demonized.

Most overused buzzword

Pilot. A software pilot is supposed to be feasibility study, but instead has become a phrase to represent the first phase of a project that has already been decided and is seeking to start slowly in hopes of gaining engagement.

Most influential person in healthcare IT, i.e. “When ______ talks, people listen.”

As the late Tip O’Neill said, “All politics are local.” The most influential person in health IT is the CEO, so get him or her on board with any important initiative.

Most effective healthcare IT executive in a provider organization

I’m privileged to get to work with some great peers from all over the country, so I’ll name a few to offer some choices. Stephanie Reel, CIO at Johns Hopkins, is widely regarded among the best around and for good reason. Her list of accomplishments is long and admired by many (myself included). Scott Joslyn, CIO at Memorial Care in Orange County, CA installed Epic before it was the obvious choice and helped pioneer much of what we all take for granted today. It is worth noting he also led his system to be the first in the country to go live with Care Everywhere. It was available to all customers at the time, but he had the vision to see the benefits that now seem obvious to the rest of us. Daniel Barchi, new CIO at New York Presbyterian, knows how to get things done. He has accomplished great things at not one complex system, but two large systems, Carilion and Yale. it is clear NYP is now destined for great things ahead under his leadership.

Most effective clinical informatics professional in a provider organization

I’ll again name three. All are triple threats — they are effective clinical informatics professionals, effective healthcare IT executives (CIOs), and super smart. Pravene Nath, MD, CIO at Stanford; Mike Pfeffer, MD, CIO at UCLA; and Jeff Ferranti, MD, CIO at Duke.

Industry figure you’d most like to see on stage at HIStalkapalooza

Jonathan Bush, to hear what he might say. I love the irony that he is playing the Donald Trump role in the EMR debates.

Industry figure with whom you’d most like to have a few beers

Carl Dvorak.

Industry figure in whose face you’d most like to throw a pie

I’m with Judy – I don’t like to waste good pie.

HIStalk Healthcare IT Lifetime Achievement Award (recognizing a life-long body of industry work.)

Ivo Nelson. If you need an expert in healthcare, a mentor, a connector, or just some great advice, Ivo is your guy.

HIStalk Healthcare IT Industry Figure of the year

I’ll go with a controversial pick: Elizabeth Holmes.

Make your nominations here and subscribe to the HIStalk email for your chance to vote.

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.

Health IT from the CIO’s Chair 11/4/15

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

Left or Right?

I recently participated in a panel discussion on the topic of collaboration tools in healthcare. While I was probably invited to extol some wisdom as a so-called expert, I found myself instead being educated by others on the panel and the audience.

I was reminded that as EMRs get little love in a crowd of doctors, CIOs equally get little love in a mixed crowd of venture capitalists, digital health CEOs, and the usual big vendors in the “helping healthcare move from fee-for-service to value” game.

The lack of love actually extended beyond just the CIO — it was aimed at the whole IT enterprise. The words “disruption” and “innovation” were thrown around in a context that implied the establishment (enterprise IT led by a luddite CIO) just needs to get out of the way.

My first reaction was of course to minimize the feedback and chock it up to folks that don’t understand the nuance and complexities of healthcare delivery. But as the panelists spoke and the audience reacted, it was not so easy. The trouble was, these folks were making great points.

I often get asked what I do as a CIO. My well-rehearsed answer is that I manage teams that help translate workflows and build engagement to advance our organization’s use of enabling technologies. My old answer was I fix computers, so the new one is better, right?

Anyway, when I break down the work our teams do and really think about how much time we spend on change management and building engagement, I’d say that easily more than half of the time is spent around some form of convincing people to adopt technology. Contrast that with users choosing to use new technologies on their own. You start to wonder: can corporate users as consumers bring their own adoption to work alongside their BYODs?

I heard someone say a while back that we love new technologies at home and hate them at work. My fellow panelists made this same point. When technologies emerge that make your life easier, corporate users — who are consumers at home — will choose them and use them across their digital lives. I always try to remember that I used Dropbox before it was allowed by corporate policy.

Below is a chart that shows the most-blacklisted and deployed apps in the workplace. While not a perfect lineup, it is not a coincidence that the ones on the blacklist (left) are consumer driven and the ones most deployed (right) are enterprise sponsored. Again, not perfect alignment by each company listed, but I bet in a straight up poll the blacklisted would win the popularity context by a wide margin.

I’d offer up a few observations. The first is that productivity tools are different from rich-functioning workflow applications. The list includes primarily collaboration tools — you don’t see vertical applications, line of business transaction systems, or customer-facing business apps.

The second is that “land and expand” works. If you give people what they want, they will use it, and once a tipping point is achieved, the solution morphs into an enterprise one. Let’s give Aaron Levie, CEO at Box, a ton of credit for building a really credible enterprise business from early roots of “land and expand.” I bet if you asked him, he would tell you how hard it was and how many nuanced features had to be built that not a single consumer would appreciate.

Translating this to the landscape of digital health, I think it means that enterprise IT needs to better recognize emerging tools that consumers are driving into the company and find ways to adopt them – faster! I also think it means that vendors with a “land and expand” approach need to think about how they will transition from the left side of the chart to the right. While consumers seek instant usefulness from point features, healthcare organizations — like all corporations — need a lot of integration and complete feature sets.

My advice to left-side digital health companies is to find an enterprise partner, a healthcare organization that loves the idea of your product and wants to help you learn the nuance and complexities. But most importantly, one that will help you understand how to architect for a complete feature set. It may take a while, but the hard work and the longer road taken will pay off. The overnight success healthcare software vendors I meet all tell me they became an overnight success after years of hard work building the product.

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.

Health IT from the CIO’s Chair 2/4/15

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

IT and the Big Rooms

Talking about change in IT is nothing new, but it feels like less has been written about the changing role of IT in the C-suite and at the board. Since I believe we are in the midst of a new shift, I wanted to raise the topic.

For the most part, the makeup and composition of C-suites and boards defies generalization. Company size, business sector, and stage — combined with the wide breadth of talent and backgrounds that compose these groups — makes them all unique.

But if I were to generalize, I would say that the trait that cuts across most C-suites (and certainly most boards) is the aversion to risk. IT has delivered many successes over the years and certainly in the last decade, but it is still often seen though this lens of risk.

If risk is the language, how can we leverage the opportunity?

Change, Change, Change

In the 1960s, the MIS manager (remember that title?) was a stranger to the big rooms like the C-suite and board. In fact, the common habitat of MIS was in an office in the basement near the IBM mainframe.

In the late 1970s with PCs, networking, and user interfaces that finally were not just green or amber, the groundwork was laid for a fresh look at the governance role of IT as the number of computer users started to grow.

By the mid to late 1980s, the IT executive began to emerge, MIS started giving way to IT, and our first CIOs were anointed. But the real shift in the C-suites, while not yet really inviting IT to the table, began the change to centralize IT budgets and gave large amounts of control to the IT head (MIS manager or CIO, depending on how trendy the company wanted to be back then).

In the 1990s, the big rooms still viewed the discussion of IT to be mainly approving the annual IT capital budget. For the most part, they did not really react much to the explosion onto the scene of little things like distributed computing, the World Wide Web, and the mobile phone.

Then came Y2K. The big rooms now had to deal with not just risk from IT, but material risk. In many companies, this was among the first active involvements of IT in the business conversation. While not thought of at the time, it also laid the groundwork for the IT executive to begin to not just solve operational issues, but to help lead the conversation about what could be next.

As we passed through public financial scandals (Enron, et al.) government regulation came pouring in. IT was seen as the builder of the key infrastructures to support the bevy of new mandates. Again, IT was back in the big room solving operational issues and laying the groundwork and credibility to help lead the business.

By the mid and late 2000s, IT became intensely preoccupied with the complex roles of shifting to the distributed computing era, solidifying IT’s role delivering function through ERPs and other key business applications, managing the still-steady stream of regulatory requirements, and coping with the rise of the Internet.

As the 2010s rolled around, IT risk conversations in the big rooms began to shift from asking “What will be the risk if something bad happens?” to “What is the risk if we don’t act?”

Today, the crazy mix of social, cloud, analytics, and mobile has everyone’s attention. IT firmly has shifted from the 1990s — when only 10 percent of the leading 4,000 companies in the US even had a CIO — to greater than 50 percent of CIOs today reporting to the CEO and having accountability to at least one board committee. IT is in the room.

So Now What?

I think IT has never been in a better place.

The big rooms will still want to manage risk and ask how IT will provide stable, resilient, and dependable systems and infrastructure. But the opportunity is to exceed expectations when answering these questions and use the credibility to pitch for new investments in digital innovations that can underpin growth and expansion. IT needs to present these ideas not in terms of technology, but frame them in terms of revenue (yes, revenue).

The Next Two Big Things

1) The digitization of EVERYTHING

2) The next cyberthreat

The C-suite and board will want to know how they are effectively managing the risk that new competitors and business models won’t wipe out overnight key lines of services delivered today. This creates an unprecedented opportunity for IT to not just be part of the next conversation, but to lead it. As our friends in Silicon Valley warn us that “Software will eat the world,” IT must help our companies not defend against the thread of digitization, but lead an impressive assault forward.

Finally, cybersecurity has marched into a new era. The big rooms — primary the board — will not just ask, but expect regular updates and leadership in this area. If they are not satisfied, it will be achieved through other sources – they will get answers. IT either has to lead or we will see 80 percent of the CISOs that report into the CIO today shift directly to chief compliance or risk officers. Cybersecurity is not a concern, it is a fear.

IT is fully positioned to leverage these great opportunities. The big room is looking right at us and asking us to innovate, deliver, and lead.

Let’s not screw it up!

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.

Health IT from the CIO’s Chair 1/21/15

Fine print: the views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

Predictions

January brings the new year and the new year reliably brings two things: resolutions and predictions. I’ve already broken my New Year’s resolutions, so I’m going to try my hand at predictions.

For them to be any fun, I think they need to be as specific as possible and sufficiently bold so they don’t state the obvious. “I predict there will be a lot of change in the healthcare system in the year ahead” is not a prediction – it’s a campaign promise.

Here goes, in no particular order.

1. Provider healthcare organizations will move into the cloud by adopting Office 365 and moving email off premise at record rates. Hospitals historically wanted grand atriums (often with pianos) and big, shiny data centers. No prediction on the pianos, but not only will the tipping point occur on cloud-based email in 2015, but this will be the start of the shift away from “everything needs to be managed by hospital tech staff” and will pave the way for ERP and EMR to be next (in that order).
2. While I’m on the topic of Microsoft, I predict that when it comes to Windows, you will hear two things in 2015: (a) “What happened to Windows 9?” and (b) “I hate to say this aloud, but Windows 10 is kind of cool.” Microsoft has a lot of ground to make up to win the hearts and minds of their base, the enterprise user. But Windows 10 will bend the curve back in Microsoft’s favor.
3. Security will be in the news and will shape everything, period, everything. The focus on cybersecurity — with the help of Apple, who is making fingerprints mainstream — means we will see biometric everywhere. Two-factor authentication will become the norm. Your finger will be your password by the end of 2015.
4. Wearables. We are all growing tired of the huge number, but this spring will bring the iWatch. It will spur the market and create the needed tipping point that has been missing – software and apps to make wearables worth the effort. The iWatch will be huge, no, I mean really big! Apple will not be able to make them fast enough and waits will be measured in weeks. Innovation will abound and the Internet of Things will all start to make sense.
5. Virtual reality will capture our imagination. Magic Leap will forever change things this year. The “cinematic reality” startup raised over $500 million from names we know. We will all soon understand why. Our imagination will be captured as we think about new ways we never imagined we could interact with a computer.
6. Big data will stay flat. By the end of 2015, we will have nothing new to report. We will be using the same buzzwords and holding the same optimistic promises. 2015 just won’t be the year we figure it out. I do predict we will stop using the term “data lakes,” but I can’t tell you why.
7. HIE obsessions will give way to FHIR talk. The HIE interoperability goal was moving the record from Point A to Point B. The yardstick has shifted and will be defined by how we can integrate workflows from site to site. FHIR will gain even more steam and be the talk everywhere.
8. The VA decision will change everything. It won’t go to Allscripts, Cerner, or Epic (which will be unfortunate), and while the project will be huge and take many years to deliver, in 2015 it will act as an engine to drive standards and data structure conversations as a new open source style system will be born.
9. 2015 will continue to set records in terms of health IT startup funding. Many major health systems will become more active by investing directly in companies in an attempt to capture the value they believe they help create. At least one health IT software company will IPO in 2015, setting a record. Cerner, McKesson, The Advisory Board, Allscripts, and Athenahealth will all continue to exercise one of the few advantages they have over Epic in the EMR space — they will continue to buy strategic assets to innovate at the fast pace required.
10. Cerner will seek to divest the Device Works division so that it may become a company that can compete in the whole market, not just in Cerner accounts. The new entity will become a powerhouse and take market share from both Philips and GE.

Think my predictions are wrong or ridiculous? Don’t tell me why. Instead, leave me a comment and give me yours. Remember: be specific and be bold.

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.

Health IT from the CIO’s Chair 10/6/14

Health IT from the CIO’s Chair 10/1/14

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

Security Might Be the One Thing

I often get questions like, “What keeps you up at night?” or “What are your top priorities?” Invariably I cite items from our IT strategy, and almost always I remember to add security.

But I think it is time for me to admit I have it wrong. Security should be at the top of my list, not just on the list. It should have an etched place in the number one spot. If I was going to be kept up at night, there is no better topic to evoke fear than security.

Let’s face it: the healthcare industry has been terrible at managing security. Since 2009, more than 900 reports of breach have occurred, covering a staggering 30 million patients. Half of the data loss is a result of us losing things, which essentially translates to the realization that we are not very good at keeping our patients’ data safe when practically no one is trying to take it.

But that is changing. Statistics are a little shaky, but let’s say that roughly 3 percent of reported data loss is a result of people intentionally trying to take it. This Pandora’s box has been opened and we should expect it to stay open and become a growing threat. The incidents with Boston Children’s, Community Health, and the “playful” attack on Healthcare.gov are all windows into our future.

Bad people will try to get data from an industry that has minimally demonstrated its ability to hold onto it. If there ever was a time to get our ducks in a row, it is now.

We have moved from the ‘70s, ‘80s, and ‘90s — when healthcare’s IT data was made up of registration, scheduling, lab, radiology, and maybe some pharmacy — to the 2000s with robust EMR data. But the stakes are rising as we are duplicating the EMR data outside of our transaction systems into massive stores for mining. We are setting the data free by making it available any time from any place and from practically any device – hello, BYOD. The risks are greater and stakes are high. We will need to climb the learning curve rapidly and without a net as each breach is a CEO, board, and/or public event.

Luxury goods manufacturers long ago realized they don’t just sell products, but rather an experience. Similarly, healthcare organizations might say that they don’t just provide care, but trust. With so much talk about healthcare’s move into patient engagement, let’s start with the most basic way to engage our patients – keeping their data safe and maintaining their trust.

We all have work to do.

Vendors

1. Innovate. We need new products. We don’t need more companies built around missing bells or whistles for our EMRs. We need new product in a category underserved – security and privacy.
2. Build your products with security baked into the DNA of the product to promote doing the right thing. Make it impossible to download an unencrypted file or develop ways to track and remote erase lost data.
3. Accelerate your plans to host our data. We clearly need your help. But once you get our data, do a better job protecting it than us.
4. Almost 20 percent of reported breaches came from issues with a business associate. Don’t be one of those — we are depending on you. You can build the scale and make the investments in security that are not always practical for individual healthcare organizations.
5. If you are not in the healthcare space, come on in. We need your help.

Providers

1. Partner with vendors to innovate. They need our help to understand the nuances and complexity of healthcare.
2. Make security not just a priority, but the priority.
3. Allocate spending like it matters.
4. Differentiate between security and privacy and focus on each separately.
5. Providers contributed to a greater than 130 percent increase in patient records lost in 2013. We all know we can do better. Let’s bend the curve.
6. Treat patient data security with a similar focus to how we treat patient safety.

Government (yes, it has a role, too)

1. Modify the breach notification rules to be more specific to the types of breaches. We have desensitized a nation to data loss warnings. I would bet that most readers or someone they know has received a letter regarding a loss or breach of their data and offering a credit monitoring service. These notifications are essentially based on the theory that we can’t prove something did not happen, so we must notify. Let’s focus our attention on when we know something has happened. This is the important place that needs our collective attention.
2. Create a safe harbor for healthcare organizations to use advanced tools to proactively determine if risks or breaches have occurred. Here are a couple of examples. Tools exist to retrospectively scan if PHI was shared from our email systems. If we run these tools to educate and teach ourselves how to do better, we are open to reporting. Security experts say there are two types of organizations, ones that have had their networks penetrated and those that don’t know it yet. If we deploy advanced tools to study our networks in partnership with the best companies, we would be open to massive reporting requirements.

I had the pleasure recently to speak to an audience hosted by NIST, OCR, and HHS. I asked the audience how many have received a text, email, or call relating to possible fraud on a credit card. Most raised their hands. I asked how many had ever received the same notification related to their own electronic health data. No one had.

Like barcodes from manufacturing and real-time alerting from the financial sector, let’s adapt tools and products that work in other sectors to help healthcare become excellent.

Let’s engage our patients by building and keeping their trust!

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.

Health IT from the CIO’s Chair 9/10/14

Fine print: the views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

EMRs – Application or Platform?

It is hard to go very far these days with out someone looking to dismiss EMRs as “just the transactional system.” It seems every new IT innovation or idea is the next big thing that will do us the favor of connecting with our installed systems, but do so much more. Population health, analytics, mobility, and patient engagement are all the new platforms to focus on.

Wait. EMRs are depended on every minute of every day to enable care delivery through zillions of transactions and are the result of years of hard work and untold dollars. They aren’t a platform? Really?

I want to believe that our enterprise EMRs are really agile platforms on which care delivery can be transformed. They are just works in progress. Oracle, SAP, Facebook, and Salesforce.com all started as applications and grew into platforms. Some better than others, but it was a journey.

In my mind, our industry’s EMRs are on this same path. I think that the EMRs brought to us by Epic, Cerner, and Meditech (which I will refer to as the Gang of Three) all have a shot to truly be called a platform.

If the Gang of Three want to be seen as a platform and not just an application, they will need to evolve as did their big brothers in the ERP world.

Demonstrate market share dominance through rapid growth, consolidation, and the other vendors pivoting their business models in other directions as not to compete head to head. A goal here is to establish enough customer mass that effective and brilliant “group think” could take place. The market moves buyers to want enterprise all-in-one solutions instead of best-of-breed department ones.

I’m going to give the Gang of Three a grade of A on this one.

Demonstrate innovation of function, design, and features. Basically, they should be darned good — maybe even outright awesome — at transactions. Expect to see massive investments in R&D and lots of co-innovation with customers.

I’m going to give the Gang of Three” an A on this one, too.

Be regarded as having deep industry capabilities, clear and comprehensive road maps, and embedded best practices. Other software vendors from other industries would view the vertical as too complex to enter based on the learning curve.

The Gang of Three earns a split grade on this one. Deep healthcare knowledge, A. Comprehensive roadmaps, B. Embedded best practices, C.

Provide analytics. This would be translated as performance suites with end user-centric dashboards, complex and robust data integration suites, comprehensive data quality tools, and the real belief that they are enabling massive amounts of information to be transformed to competitive knowledge.

The Gang of Three gets a B+ for focus and initial efforts, but a C for execution.

Support mobility. This would be demonstrated by enabling wireless workflows across the organization. Optimized work can be done from anywhere, at any time, and on any device. Costs and tools matter in this space, so device management and security are key parts of all offered solutions.

The Gang of Three earns a C. Good progress on vision and good early applications, but with lots of work ahead.

Demonstrate reliability, flawless uptime and performance, and sub-second response times. Terabytes of data managed and delivered at the speed of thought. The paradigm of all information available in real time would be realized and would drive the enablement of new workflows never imaged before the system was installed. With the reliable availability of information, new business models to share and move data around the ecosystem would emerge.

I’m going to give the Gang of Three a B+.

Platforms are not just about function, but equally about cost. They would need to enable the shift within the IT organization of today that typically has 80 percent of costs on tactical IT delivery and 20 percent on strategic initiatives to at least a 50/50 split. IT operational costs consuming the majority of resources are lowered through hosting, cloud, and other leveraged services to allow for greater spending on innovation. Support costs are predictable and fall over time. Costs act as a consolidation driver as much or more than workflow.

This earns a B for the Gang of Three.

The toughest and probably the most important area for our gang to distinguish themselves as a platform is to create choice by building a leveraged open ecosystem. Choice would be fully realized by creating open APIs to access data models and workflows. Customers and third-party vendors would look to solve problems by building solutions within the system and innovation would be an open challenge to solve for everyone.

The Gang of Three gets a D-. This alone isn’t the definition of a platform, but it is crucial to the mix. This is the biggest area in which our gang needs to improve.

So, Gang of Three, it is time to get everyone involved to help us solve problems. Talk to your customers and third-party developers, court them, and encourage them to build their applications in such a way that they have a technology dependency on you. Risk some value you may create on your own, but balance it by figuring out how to extract value from your new workforce – your third-party developers.

It is time to enable choice!

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.

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

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.

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.

Health IT from the CIO’s Chair 6/18/14

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.

Mary Meeker’s 2014 Internet Trends

Each year Mary Meeker publishes a report describing Internet trends. I’m not sure I know the full history of the report, but she traditionally presents it in the spring at the AllThingsD conference (formerly run by WSJ) and now at the new version of the conference called <re/code>.

It is hard to imagine how much research and data must be collected to produce such a data-rich report. I have never seen her present it live, but I’m told she shares the whole thing in an action-packed 15-minute presentation.

The full report is available here. It is truly amazing and is one of my favorite things to read of its kind.

Since my world is healthcare IT, here are a few of my own opinions of how the larger trends described will have an impact.

Trend #1

Tablets are growing at a faster rate than PCs and laptops ever did, with a growth rate of 52 percent. With only a 6 percent population penetration or 439 million global units, we will likely soon see tablets pass both desktops and laptops. I think this will translate to at least three things in the healthcare setting: (a) the mobile shift has another big wave coming; (b) like smartphones before tablets, the unit growth will be propelled by BYOD; and (c) users will expect to use multiple devices in one setting and be able to easily navigate between them.

Trend #2

Cyber threats are intensifying along all dimensions. They occur more frequently, happen faster, and result in more serious implications. An exposed machine is likely to be compromised in 15 minutes or less. While healthcare has struggled to not lose information and has achieved a mostly failing grade, we are in for a major shock wave as new entrants begin to seek the data we have.

Trend #3

I hope healthcare is really at the inflection point predicted. The backdrop plays out as follows:

• Providers have underutilized technology historically.
• HITECH Act brought billions in spend.
• 52 percent of consumers want access to tools to manage their care and data on quality, satisfaction, and reviews of doctors and hospitals.
• 84 percent of hospitals have EMRs.
• 51 percent of doctor’s offices (and rising) have EMRs.
• 62 percent of consumers/patients want to communicate via email.
• Venture fund investing in health IT is up 39 percent to $1.9B.

Some of the hottest spaces will be employer engagement, telemedicine, adherence tools, and chronic disease management platforms.

Trend #4

While our existing client-server and even our cloud-based healthcare applications will continue to struggle with interoperability (of workflow, not so much around data), everyone will get a new chance at building it right. The mobile platform will create an environment to have single purpose, best-of-breed apps working in a unified way in a dynamic user-initiated platform.

Trend #5

The term “big data” is overused, misused, and probably overhyped. But that is probably because it is still early and it is hard to get actionable results today. From a trend perspective, it could be the most exciting thing to watch in healthcare in the years ahead. It will pose complex challenges around transparency and privacy, but we should imagine a healthcare world that is filled with sensors producing troves of data that we can analyze and problem solve in real time.

Trend #6

Privacy will drive new approaches to have data that is uploadable and shareable without being findable. This trend will probably help us get around complex privacy concerns in the short term by making the data single use.

Trend #7

It won’t be just about what wellness or health sensors we have on our bodies or even in our bodies. Our smartphones will sense things for us. We might not need a fitness band if our phones can tell us the same thing. Samsung’s new device has 10 sensors. Apple’s new iPhone will likely match or surpass that.

Trend #8

Bigger, cheaper, and faster. Compute measured by $ per 1mm transistors from $527 in the 90s to $0.05 now. Storage measured by $ per Gigabits from $569 in the 90s to $0.02 now. Bandwidth measured by $ per 1,000 Mpbs from $1,245 in 1999 to $16 now. All the while, use of the cloud is rising. It is getting hard to imagine why any healthcare organization would be thinking to build a new massive data center of the past.

Trend #9

Beautiful new interfaces aided by data-generating consumers will not just be the new standard, but the only standard. As consumers and employees continue to use a host of well-designed apps in their daily lives, tolerance for poorly designed UI will plummet. As consumers continue to engage in managing their health information through provider-based portals, the EMR titans will either rapidly evolve their UI or be disrupted by those who can.

Trend #10

Precision medicine is on the way (period).

Mary Meeker’s whole report is 144 pages (with an additional 20 pages in the appendix – referenced as the slides she ran out of time to talk about). I recommend you give it a read.

Let’s not just find a better mousetrap. Let’s disrupt the whole idea. Mary’s report should challenge us all to re-imagine!

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.

Health IT from the CIO’s Chair 5/14/14

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.

Hockey and Health IT Innovation

I grew up in Montreal, Canada, so hockey is in my blood. With the playoffs in full swing, I thought I would write my post themed to my hometown sport.

(There was no reason to include this photo, it just seemed like a fun thing to do.)

Innovation is on everyone’s mind in healthcare today. Much of that focus is either directly or indirectly tied to IT. As healthcare models continue to evolve, many believe that given the rapid pace expected, IT innovations will be needed to fuel the change.

As health systems prepared in the past to meet the demand for EMRs, what will they need to do differently to meet this growing expectation of delivering innovation?

Using hockey as a backdrop, here are eight themes.

1. Learn to skate. Learning the fundamentals is clichéd advice for a reason. In health IT, this means implementing an electronic medical record. EMRs can be big, complicated projects and can lead to great things, but having an EMR only means you can skate. It is the starting point to becoming a hockey player. Innovation starts after the go-live.
2. You have to lose a lot to win. The teams with the best regular season records won just 56 of 82 games this season, which means they lost 34 percent of the time. To innovate, you have to be prepared to fail. Hospital cultures are not set up up for this mindset. On the other hand, new entrepreneurial companies are often forced to pivot to new models to stay alive — it is in their DNA by design.
3. Icing is a delay-of-game penalty. Delays or failing to make a decision will not work in today’s rapidly changing healthcare environment. Yesterday’s news was the need for change. Today’s news is improving our velocity of change. Health IT innovation needs to be supported around a model adoption. This is what a health system team can do best. Others who are better equipped to iterate might need to create the innovations themselves.
4. Three referees are on the ice during the whole game. Like hockey, healthcare has rules, regulations, and operating procedures. They are in place to help protect everyone. But that does not mean you can’t play aggressively, increase your tempo, and skate hard. Playing hard also does not mean the rules don’t matter. Health systems are experts at operating procedures. Find a way to be part of the process without feeling the need to own it.
5. The team is more that just a star player. Healthcare is no doubt a team sport, but sometimes the team needs to viewed as being beyond the four walls of the hospital. The innovation team should not be viewed as just employees, but also all of your great partners. If you don’t have great partners, it is time to make that a priority.
6. If you can’t make the shot, pass. Making the great shot is often about being in position. If you are not in the right position, then pass to someone who is. Some of the best hospital IT departments I have seen are amazing at implementing and understanding the complex workflows of healthcare. That does not mean they are best positioned to develop new software.
7. Skate to where the puck is going to be, not where it has been. What has worked in the past for healthcare and health IT will not necessarily work in the future. The puck has moved.
8. You miss 100 percent of the shots you don’t take. Innovation in health IT is all about taking the shot (and the risk.)

Game on!

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.

Health IT from the CIO’s Chair 4/30/14

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.

The Budget Paradox

Hospital IT budgets come in two forms: capital budgets (one-time project expenses) and operating budgets (staff and ongoing expenses.)

I probably don’t need to write much by way of background to make the case of why hospitals are under pressure to reduce expenses. It would be fair to add that the pressures are more intense these days. The larger problem involves how we deliver care, but that does not mean that hospital systems aren’t equally focused on cutting expenses.

To be more precise, most budget reduction efforts are macro projects to either hit a specific target or to “bend the curve” such that operating expenses don’t rise or rise at a slower pace. This can be particularly vexing for IT for a number of reasons.

The first big one relates to how organizations view information technology. Often, to the chagrin of IT leaders, IT is seen (or willed) to be a magic bullet. As such, solutions are ordered in increasing numbers, creating scenarios of increasing IT demand. Often these systems are justified around the capital budgets alone, with the operational budget implication not fully understood until a year or two later.

If IT shops were standalone businesses, this increased demand would be a good thing (more customers! ) But IT shops aren’t standalone business, so they often have loose ROIs to carry. The resulting consequence is more weight added to the operating budget.

This in itself does not really create a paradox, but it does add to the pressure of trying to meet a budget target. The budget paradox is tied to a changing philosophy and approach around IT pricing.

Before I tie the pieces together, let me talk about Meaningful Use. Forget for a moment stages and government regulations. At its core, MU was a great idea to reward or incent organizations not for just installing IT, but for using IT. Some ideals and subjective concepts were added to aim beyond “use” and to strive for something higher (Meaningful Use), but that aside, of the things MU did was legitimize the pricing strategy that IT software could (and maybe should) be measured by use, not by installation.

Prior to this thinking, most hospitals bought large IT purchases around capital budgets and booked the expense based upon install. Reflecting the early days of IT, we took credit for simply getting a system in.

I support and like the idea that we should get credit for success upon use. While it’s hard to measure and define what might be “meaningful use” versus “use,” I think as long as we are generally focused on having IT measured beyond the install, we are aiming in the right direction.

Back to the budget paradox. Traditional thinking around operating budgets is that as you continue to operate, you should be able to control or reduce costs. Experience, efficiency, and maturity of operations should all lead to cost reductions. This manifests itself in common year after year quests to either keep operating budgets flat or reduce them. 

But as IT pricing models have shifted to use-based or volume-based, and with the magic venture capital words of “recurring revenue,” the idea of year-over-year reductions and rising costs from growing use begin to conflict.

Take the following example. A hospital deploys an EMR. Over the course of the year, it builds upon its success and increases its user base. Let’s imagine more orders entered, more concurrent users, and maybe even new modules and functions turned on. Juxtapose this against an expectation to achieve operating maturity and flat or reduced budgets. You are aligned for a paradox as you pay new fees for new use.

Of course, like every good CIO, I keep great records for my “guilty but with an explanation” budget list. I use sophisticated spreadsheets to demonstrate that on a “same-store basis,” my budget is trending down. But none of this matters if the organization’s macro demands are for budget control.

How do we solve our paradox? How can we continue to grow and contain costs? 

No doubt the answers are different for everyone and deeply tied to specific situations, but I think we need to work on a few themes.

1. We need to get as good at turning off older systems as we are at turning new ones on. Incremental gains don’t much help here. A discipline of measuring off or on must be applied.
2. We need to look at ways to leverage infrastructure at scale beyond our own individual sizes.
3. We need to find ways to use more of what we have to gain richer functionality from the systems (and costs) that we already own.
4. We need to be close to our labor costs and understand how best to balance all the levers.

The challenges ahead are complicated and will require us to think about things in new ways. The hospital IT budget is only going to be faced with new demands. It’s time to get innovative.

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.

Health IT from the CIO’s Chair 4/9/14

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.

ICD-WHEN …  But It Is Not Fair!

I have an 11-year-old daughter (I have a nine-year-old daughter too, but she is not part of this post, which ordinarily would be a problem except that HIStalk has a fairly low readership among the nine- to 11-year-old girl demographic, so I’m probably safe just referencing one kid.) My wife and I hear a very common phrase from our 11-year-old, which is, “But it is not fair!” (as you read the line, insert a foot stomp, a hand on the hip, or some exaggerated facial expression.) The good news is I’m told that challenging fairness or having an exaggerated sense of being wronged are normal things for a girl her age.

So why I am raising this?

A couple of weeks ago, our daughter told us the ultimate “But it is not fair!” story at the dinner table. She had a lot of homework and had stayed up late doing it, only to be told by her teacher the next day that since many kids complained, everyone would be given an extra day to complete the assigned work. She had strong feelings that, “But it is not fair!”

Let’s fast-forward to the shocking news we all heard on Thursday, March 27. The House had voted to delay ICD-10. Emails were flying around. Some were forwarded by well-intended people thinking they were breaking the news by passing on various listserv posts. Most were from leaders or team members deeply involved in the ICD-10 project. These emails — while sometimes containing more colorful language – essentially proclaimed, “But it is not fair!”

As I have thought about it, I guess that really is the right phrase to describe our ICD-10 delay situation. The root of the issue is that those organizations that have been preparing and working really hard at ICD-10 and sacrificing other things to get ICD-10 done feel wronged. We studied hard for the test, we made the sacrifices, we checked in with our bosses to be sure this was something we really had to do. Then, without warning, poof! Another delay.

Others feel ICD-10 has not been fair all along. This point of view would say that a break is needed from all the bureaucratic burdens, especially for small hospitals and solo physician offices.

So how do the pros and cons of this all play out?

On the cons side:

1. Momentum. Many organizations had made room for the project and spent a lot of money to get ready. It will be hard to rally the troops again for the big ICD-10 project now that it has been delayed. ICD-10 with its many delays can officially be called ICD-WHEN? It will be hard  to insist with credibility to physicians and others that we have to aim for a new hard date.
2. ICD-9 was developed in 1979. That kind of stands on its own. That was 35 years ago. Things have changed, but the ICD codes have not.
3. Monies have been invested and spent on training. Training, like computer hardware and milk, just don’t age well.
4. We have transparency problems in healthcare today. Better coding was not going to solve that in itself, but it was going to help.
5. Better analytics will come from better data. ICD-10 was going to help us get better data.
6. It will be hard to quantify the opportunity cost of ICD-10. Since we all thought we had to do it, we skipped doing other things. More importantly, our vendors skipped doing other things. I bet folks have an impressive list of opportunities on their to-do lists.
7. Many of our systems are now in limbo. Code is loaded and tested, but now those systems need to stand down.

On the pros side:

1. Folks who need the extra time will have it.
2. Heck, I guess ICD-11 is just around the corner.
3. I suppose some version of phased go-lives might be possible with systems at larger hospitals on track.
4. More dual coding data means more testing. It’s hard to say more testing is bad.
5. With our extra time, we can find more obscure ICD-10 codes and make fun of them, like “V95.43, spacecraft collision injuring occupant.”

I’m disappointed that ICD-10 was delayed, probably equal parts for the delay itself and the way it was delayed. But in the end, I think this one is best summarized by my daughter: “But it is not fair!”

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.

Health IT from the CIO’s Chair 3/26/14

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.

Writing a Blog – HIStalk Style

I like Monday morning headlines as they keep me informed about a range of things with a relatively quick glance. I thought I would try to emulate and see if I could round up some interesting information from around the Web.

On March 21, the CMS Medicare Shared Savings Program sent out a warning email to each participating MSSP ACO that they only had two business days left to submit complete and accurate reporting or risk losing incentive payments. They included the statistics above, which leaves you to wonder how many might have missed the reporting deadline.

Despite lots of rumors from Apple around wearables, Google beats Apple to the punch with an announcement around Android Wear. While Apple got a quick start in healthcare, it looks to be Android’s game as enterprise customers struggle with their love/hate relationship with Apple.

Google CEO Larry Page says his billions should go to Elon Musk. On the one hand, this could be seen as quite odd given all the worthwhile causes out there and the many great problems to solve. But on the other hand, perhaps this should be taken as a statement that we really need to invest in innovation. This makes me think that solving our healthcare problems won’t be just about reducing costs (which we certainly need to do) but also about innovating our way out.

Healthcare.gov quietly drops the online chat customer service function. You can check out the old link at this cached page that shows the now-obsolete chat window. Seems like a really odd move given all the problems, but maybe someone was trying to improve their help desk statistics.

Windows XP support is officially ending on April 8. I bet lots of hospitals will need to make alternate plans. There has been a lot of press around ATM machines struck in time on XP. The same will be true for some medical devices.

Remembering passwords is a problem in many settings and it is especially challenging in healthcare. Check out www.pingrid.org and its approach to getting us to remember a pattern instead of a complex traditional password. If you were good at Simon, this might be for you.

Stanford’s James Cybulski, James Clements, and Manu Prakash have invented a microscope that costs 50 cents that is capable of magnifying up to 2,000 times and helps medical professionals in developing countries diagnose diseases like malaria. Check it out at www.foldscope.com

The headlines read that Facebook has bought a virtual reality company. But the real news is that Facebook has now entered the hardware business with its $2 billion acquisition of Oculus. (On a related note: best fake headline related to this news … “Yahoo! Buys Viewmaster.”)

When IBM’s Watson beat Ken Jennings at Jeopardy in 2011, it was big news and propelled the journey of artificial intelligence in healthcare. The latest news is that a Lego robot has set the world record in solving Rubik’s cube. I’m not really sure what this means for healthcare, but I’ve always been impressed when someone (or something) solved the cube.

The top 100 CIOs to follow on Twitter are available here, with about half a dozen healthcare folks on the list. I’m not really sure why I’m not on the list; I’ve tweeted over 10 times in the past two years.

Many lessons from the Target data security breach, two of them for me are: first, it is unlikely we have a clear picture of what has happened by following the news reports. With the intense pressure on Target IT teams, I’m sure there is more relevant detail and nuance to be shared, but PR crisis folks are heavily involved in trying to manage the story. The second and most important is that people and process are as important as technology.

Google has announced significant drops in both cloud storage and cloud computing. This will likely move the market as others will follow. While large health systems still have a way to go before this will have an impact due to the current architecture of many HIT systems, the pressure is mounting.

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.

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

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.

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.

Health IT from the CIO’s Chair 2/19/14

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.

Why the Healthcare.gov Website Reminds Me of a Big Hospital EMR Project

Despite the old adage that “there is no such thing as bad press,” I think all CIOs would agree keeping your IT project off the front page of the newspapers is a good thing. When the Gealthcare.gov website stuff made the news, it got me thinking that perhaps the project had some traits in common with large hospital EMR projects.

Then my family and friends outside of work — who only vaguely really understand what my job is, anyway — lumped the Healthcare.gov IT project into my past explanations of EMR projects and asked me for my opinion. I decided I might be on to something. Here are my top 10 reasons why the two initiatives could be the same.

10. Apparently, despite lots of dollars spent on IT, failure is an option. Over the years, is has amazed me how many people assume a big budget means success. While a big budget can mask many things, the core project still has to be sound.

9. Strong desires to get it done combined with an important mandate from the top really just creates a lot of pressure, not a sound strategy or rational tactics.

8. A short timeframe due to an artificial deadline (see #9) drives a go-live date. That go-live date will then be a function of the math. That does not mean you have the right go-live date — just that you can count days correctly on a calendar.

7. Slow response times will elicit feedback from everyone who has ever used a computer. Everyone will be an expert. Everyone will compare your slow site to ones that are fast (probably Amazon.com). The hardware and software just have to work. PERIOD.

6. What programmers think is clever does not mean end users will find it to be a good experience.

5. It is a simple order. Vary the steps and you will fail. First the goal, then the workflow, then the specs, then you build. Cheat the order and you run the risk of everyone who once used a computer explaining to you how and why you got it wrong (or why your project is not as good as Amazon.com.)

4. Testing. Do it. If you ran out of time in your project plan, then you missed your go-live date. It was not in the plan to represent make-up days.

3. Workflow, workflow, workflow. You need to configure or build an experience that matches how end users approach and think about their work. When you find your electronic experience intuitive, it is not because something radical was presented to you. It is because the experience followed what you were expecting. The workflow matched your work. It was intuitive.

2. If you stumble, listen to your users. Transparently explain the problem. Do not explain why you made the mistake. Engage your users and fix it. Don’t stop communicating.

1. Listen and involve the people who will use the system. Shadow their workflows and apply it to the new paradigm. Accept that Steve Jobs and Henry Ford were exceptions in not caring what the customer wanted. They knew better. The rest of us mere mortals simply need to listen to our customers.

The politics of Healthcare.gov aside, it broke a bunch of the top 10 reasons above. It was rushed to hit a date. It was not well tested, It experienced software and hardware bugs. Most importantly, it failed to deliver an expected workflow to participants, probably because the initial goals were not clearly defined.

Big EMR projects over the years (and some currently) continue to stumble with the same top 10. Big IT projects are complicated and always involve a lot of hard-working people behind the scenes scrambling to make it work. I’ve rarely observed the problem that the IT team did not work hard enough or care enough. It is everyone’s job to make sure the team is positioned to win, so follow the rules.

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.

Health IT from the CIO’s Chair 1/29/14

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.

Prologue

Two CIOs before me have written regularly for HIStalk. I’m honored to follow or join in their footsteps. I hope I can be a tenth as insightful as John Glaser was under his regular/irregular column of the past. I also promise to stay away from the leadership and life lessons offered up by Ed, as I could not come close to being that inspirational.

Instead, my focus will be observational healthcare IT industry stuff offered up with a style best described as, “A mix of sarcasm, adequate grammar, and poor spelling.”

Epic Bingo

One of the many things I enjoy in my role as a CIO is the ability to hear about new ideas from new companies.

In a given week, I likely participate in 2-5 calls or meetings related to new products from startups. I learn a lot, I see many emerging concepts taking shape, and I get to observe trends as patterns of companies start to form to fill new gaps.

Sometimes sitting through the presentation is an exercise in patience, as the product idea falls flat.  But it all becomes worth it when you can discover the right thing to fill the white space between or within our current application portfolio. It really is encouraging how many smart people are working on solutions to solve problems in healthcare these days.

How do we find the 1-5 cool products a year among the 200+? Good question. Perhaps I will address that in a future column.

But for now, let me offer up the observation of Epic Bingo. Not just a trend, but a fun new game to play when talking to startups. I’ll offer some advice, too.

I think conservative numbers would put Epic market share at 40 percent. It feels higher to me, but admittedly I work at a place that has Epic, so I hear a lot about them. Epic customers tend to share traits. A key one is the vision of a single patient record. Epic’s tagline (“One Patient, One Record”), workflow, and single pane of glass are keywords that Epic clients to focus on.

When a new company comes to pitch their wares at an Epic site, they are keenly aware of needing to answer the “integration with Epic” question. The result is what I would like to call the new game of Epic Bingo. Here’s how you keep score during the pitch.

Score Card

• Saying Epic. No points for the first five times, but a quarter point every mention after.
• Using “Judy” or “Carl” in a sentence. Half a point (everyone can do that.)
• Using “Madison” in a sentence. Half a point. Double points if “Verona” is used.
• Saying Epic is closed and based on MUMPS. Half a point. No originality.
• Making reference to open.epic.com. A full point just for being current.
• Stating you have one or more former Epic employees working for you. Two points each. This can really add up!
• Telling a story about actually meeting or talking to Judy or Carl. 2-5 points. Depends on the story. Charming and funny earn extra.
• Dropping other Epic employee names. 2-3 points, depending on the employee. Using “Sumit” or “Stirling” and spelling them right gets five full points each.

Have fun with it. See how your questions of the presenter may generate more points! A good score is 10 or more.

Advice

While I am writing this with Epic in mind, I bet it applies to Cerner and other systems as well.

1. Hospitals can be segmented along lots of criteria. One is those that have deployed enterprise EMRs and those that have not. Know your customer. If you are presenting a new solution to an enterprise customer, be sure it really fills a new space.
2. If you have an idea to compete with a core function of an enterprise EMR, your difficulty is not integration, it is competition.
3. A single better feature does not make a product. Not every product idea can actually become a company. Make sure you have scope and scale.
4. Go six degrees to the left or right of the core vendors. Don’t pitch a better mousetrap — pitch an idea disruptive to the mousetrap itself.

In the mean time, have fun playing bingo.

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.