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Week 4 Leadership: The Case of the Healthcare CIO

HCAD 610

HIT Leadership

Learning Objectives

List job duties and analyze functional responsibilities of senior healthcare leadership and the chief information officer (CIO).

Identify key knowledge, skills, and abilities of the CIO position.

Describe the alternative paths to leadership of healthcare information technology (HIT).

Create and explain an organizational chart for the HIT department or area of a healthcare organization.

Analyze future challenges faced by healthcare CIOs.

HIT Leadership: The CIO

Serve as a member of the executive management team—the C-suite

Traditionally reported to chief financial officer because of importance of financial reporting and billing

Increase in clinical information creates need for broader and independent function

Information technology and telecommunications

HIT Leadership: The CIO (cont’d)

Senior management role re: governance for successful organizations. They must:

Design governance to focus on organizational objectives and performance

Understand when to redesign

Be involved in HIT decisions

Make choices among conflicting alternatives

Clarify when special handling of information or systems is required

HIT Leadership: The CIO (cont’d)

Provide an appropriate incentive structure

Assign ownership and accountability

Design governance at multiple organizational levels

Provide transparency and education

Implement common mechanisms for oversight

The CIO and Management Skills

To succeed, the CIO must:

Be committed to leadership

Lead in a collaborative manner

Embrace the “soft” side by being open and caring

Forge relations in this people endeavor

Communicate effectively

Inspire others

Build/develop people

Responsibilities of HIT Leadership

Enterprise-wide planning

IT leadership

Management and oversight

Human resources management

Financial management

Knowledge, Skills, and Abilities of HIT Leadership

Collaboration

Understand nature of health system

Formulate HIT portion of strategic plan

HIT strategic business and market planning

HIT needs analysis

Organization’s HIT situation

HIT culture

State of industry assessment

Technology assessment

Evaluation, adoption, and implementation standards

HIT policy development

Characteristics of a Successful CIO

Monitor external activities, assess impact of external changes on HIT, and prepare organization to respond.

Understand clinical processes sufficiently to discuss issues with chief medical officer (CMO).

Communicate well with heterogeneous group of individuals within HIT.

Possess sufficient technical skills to gain respect of technical staff.

HIT Leadership: Variability

There is little standardization of scope of services. The organization depends on:

Degree of centralization/decentralization of computer systems

Use of in-house developed systems

Use of packaged software or contracts with application service providers (ASPs)

Extent to which functions/tasks are outsourced to contractors

CIO Reporting Relations

Highly varied reporting relations:

38.2% of CIOs report directly to the CEO

17.6% of CIOs report directly to the COO

26.4% of CIOs report directly to the CFO

Remainder report to CMO or other

Organization Chart: Large Organization

CIO

Chief Technology Officer

Chief Medical Information Officer

Health Information Management

Director

Information Systems Operations

Manager

Organization Chart: Small Organization

CIO

Management Engineering

Information Systems Operations

Communications

Health Information Management

Information Systems Operations

Systems Development

Programming

Systems Analysis

Systems Maintenance

Software Evaluation

User Support

Operations

Computer Operations

Network Maintenance

Data Preparation

IT Leadership: Staffing

Staffing should be consistent with organization of HIT (varied).

Directors often have more technical/operational knowledge than CIO (health information managers often have Registered Health Information Administrator [RHIA] certification).

Three common staff levels:

Professional

Technical

Clerical

IT Leadership: Staffing (cont’d)

Rapid staff growth in recent years

Shortages in many key areas:

Network and architecture support

Informatics

Process/workflow design

Application support/development

Staffing depends on outsourcing and degree of centralization

IT Leadership: Budgeting

Low share of organization budget but rapidly growing

Hospital spending on IT:

54% spend 2.5% or less of operating budget on HIT

14% spend 3.5% or more of operating budget

IT Leadership: Budget Increases

Most see budget increases because of:

HIT systems growth (68%)

Additional staffing needs (57%)

Overall hospital budget increase (43%)

CIO Salary by Type of Organization

Type of Organization $208,417

CIO—Multihospital/IDN $254,054

CIO—Stand-alone hospital $178,786

CIO—Academic health center $243,229

CIO—Hospital/clinic $187,410

CIO—Critical access hospital $125,573

CIO Salary by Level of Education

Education/Degree

MD $306,000

PhD $230,714

Master’s degree $213,705

Bachelor’s degree $194,473

Associate’s degree $175,250

High school diploma $140,675

CIO Salary by Region

Region

Pacific $232,181

New England $217,533

East South Central $213,341

East North Central $212,118

Middle Atlantic $211,959

West North Central $209,412

Mountain $191,076

South Atlantic $186,802

West South Central $186,429

Outsourcing and Multisourcing

Outsourcing function has benefits:

Reduce in-house staffing requirements

Smaller capital investment in equipment

More flexibility in meeting changing requirements

Reduced time to implement new applications

More predictable cost structure

Outsourcing and Multisourcing (cont’d)

Outsourcing function has risks:

Heavy dependence on vendors—What if one goes bankrupt?

Higher cost due to vendor fees and profits

Contractors do not fully understand operation and culture of organization

Outsourcing and Multisourcing (cont’d)

Extent of outsourcing:

Develop and maintain websites: 38%

Dictation and transcription services: 33%

Application development: 19%

Project management: 19%

Help desk and database management: 18%

Telecommunications: 17%

Future Challenges

Key priorities:

Achieve meaningful use

Develop clinical systems

Leverage information

Optimize current systems

Continue ICD-10 implementation, prepare for ICD-11

Future Challenges (cont’d)

Greater responsibility placed on leadership (CIO)

Source of CIOs may change as responsibilities transcend traditional HIT functions

Scope of responsibilities has expanded

IT Leadership: Future Challenges

Conceptual role of CIO:

Manage up—CEO/board involvement in strategic and operational planning

Manage horizontal—interact with other leaders throughout the organization (CMO, CFO, CNO)

Manage internal—direct the internal operations of the IT business unit

Web Resources

American College of Healthcare Information Administrators (ACHIA; www.aameda.org/Colleges/ACHIA/healthcareinformation.html).

American Health Information Management Association (AHIMA; www.ahima.org).

American Medical Informatics Association (AMIA; www.amia.org).

Applied Health Informatics Learning and Assessment (www.nihi.ca/hi).

College of Healthcare Information Management Executives (CHIME; www.cio-chime.org).

Healthcare Information and Management Systems Society (HIMSS; www.himss.org).

Health Information Technology and Quality Improvement, Health Resources and Services Administration, US Department of Health and Human Services (www.hrsa.gov/healthit/index.html).