Jefferson Informatics: Chapter 1) CIO: Career is Over

The healthcare IT environment is staffed by traditional IT roles in healthcare, as well as numerous emerging roles in healthcare IT that are new to the landscape. Through research on career opportunities postings from healthcare organizations and professional associations, as well as market and data research from consulting organizations (i.e. Deloitte) and third-party analysts (i.e. Becker’s Hospital Review), we’ve found several jobs that interested MHA students may want to consider after completion of the program. We suggest that individuals interested in healthcare IT/IS jobs review these resources for job opportunities.
Many healthcare organizations are adding chief officer positions in their C-suites. Increasingly, we are seeing the roles of Chief Medical Information Officer (CMIO), Chief Technology Officer (CTO), Chief Information Officer (CIO), Chief Analytics Officer (CAO), and Chief Innovation Officer (another CIO). These emerging roles are responsible for leading IT strategy for healthcare organizations, overseeing data utilization and management, developing new tools, clinical applications, software and IS infrastructure, in addition to assuring physician and all healthcare providers’ acceptance and ongoing use of the EMR.

The CIO:

Chief information officers (CIOs) first came into existence in the late 1980s. Technology was a growing tool in most industries, and people believed that it was time for someone to represent IT in the boardroom. CIOs were essentially just IT managers at first, with little to no influence over other C-suite executives. They were simply technologists who understood machines, how they worked, and how they could be utilized. As technology improved, the CIO role transformed into a type of liaison between IT departments and business owners. The CIO would translate business needs into a manageable application that could further industry workflow. But today, the CIO role is going through yet another transformation focused on interoperability. CIOs have finally found their way into the boardroom as their involvement in strategic decision making has become integral to the success of an organization.

Because healthcare was slow to adopt technology, it was also slow in understanding the true value of a CIO. Originally healthcare CIOs were kept busy with EHR implementation and meeting meaningful use requirements. As technology has become more ubiquitous, however, healthcare organizations have been expanding the scope of CIO responsibilities to also include compiling data on population health, coordinating data-sharing, supporting care management, improving patient experience, integrating telehealth, and investigating the state of other big data approaches. It is important to note that technology is now found in nearly every aspect of the healthcare system, and the reach of the CIO surpasses that of the organization's technology to allow for technological advancements. It is for this reason that the involvement of healthcare CIOs in strategic decisions is vital.

According to a panel of current CIO's interviewed by Becker's Hospital Review "the role of the healthcare CIO has been, and continues to evolve to meet changing organizational, clinical and population health-related demands with increasingly capable and innovative technology. As the CIO's role continues to adapt to these forces, it is becoming increasingly strategic and relationship-oriented." Having strong interpersonal skills is and will continue to become an important skill of a CIO. This is because people and organizations will need help adjusting to the changes of the healthcare industry, and it is the CIO they will look to for support and guidance.

7 Key Attributes of High-Performing CIO (CHIME 2008):

Sets Vision and Strategy
Integrates information technology for business success
Makes change happen
Builds technological confidence
Partners with customers
Ensures information technology talent
Builds networks and community

The competencies required for a good CIO are not dramatically different from those you would expect to find from a good CEO. Perhaps the most important part of their position is guiding the vision and strategy of the organization and getting people on board with that vision. The only difference is that for the CIO this vision is limited to the IT infrastructure rather than the whole of the organization. Some level of technical expertise is certainly expected but general leadership and management skills are also required. Technology and information systems have become a dominant part of the changes in healthcare over the past several decades. Effectively managing technological change by ensuring the support of key stakeholders both above and below the CIO is essential.

Despite some of the similarities to the qualities found in a good CEO, the CIO ultimately must report directly to the CEO under most organizational structures. While a CIO does not have to understand all of the intricacies of the technology used at the organization, such as being able to write the code for a new piece of software, they must understand the technology well enough to be able to understand its function and communicate it thoroughly to the CEO and the board. The CIO must recruit forward thinking individuals in order to make sure the CEO has a clear picture of both the current IT infrastructure as well as its role in the long-term future of an organization. The CIO as well as the rest of the IT leadership team should be aware of relevant external trends such as changing Meaningful Use regulations to allow the rest of the C-suite to make the best possible decisions for the future of the organization.

All of these skills are necessary in order to have a truly great CIO. The increasing role of integrated technology systems into the care delivery process means that collaboration is completely necessary in order to achieve success. The CIO must understand the clinical needs of care providers across the organization as well as the structural needs of other essential services such as finance and integrate them into one unified vision. A CIO’s success will ultimately be defined by their ability to navigate the organization through a changing landscape of technology and provide the foundation necessary for organization-wide strategy to be created and implemented.

Other New Additions to the C-Suite:

While working through a case study to determine which candidate Team Jefferson would recommend hiring for the position of Chief Informatics Officer (CIO), we came to the conclusion that there are a significant number of other questions that we needed to answer in order to determine who was the most appropriate candidate to recommend. One such question is who will work with the CIO and is there a need for other senior leadership in the technology department such as a Chief Nursing Informatics Officer (CNIO), Chief Medical Informatics Officer (CMIO), or a Chief Technology Officer (CTO). To understand and answer this question, we needed to gain a better understanding of the roles of a CNIO, CMIO or a CTO.

The Chief Nursing Informatics Officer’s role may be best summarized as a bridge builder. It is the responsibility of the CNIO to bridge the gap in understanding and manage the process between those who understand electronic health records and those who are proficient in nursing care delivery. The rise in prominence of the CNIO role came about due in part to the Bush administration calling for a move from paper charting to electronic medical records, and the momentum only increased when financial incentives were aligned with this calling (Kirby, 2015). While implementing EHRs, a realization rapidly came to light that there was a need to map the clinical process and incorporate technology into this process, and arguably more important, there is a need for clinical advocacy at the executive table. This is the role of the CNIO. As EHRs continue to advance and technology becomes increasingly intertwined in clinical care the need for strategic clinical technology informatics leadership is growing.

Technology has been utilized in hospitals and health care delivery systems for a number of years. However, the application of technology to the clinical setting and the widespread adoption of electronic health records is a relatively new trend and as such the need for a Chief Medical Informatics Officer is a comparatively new role (Wager, Lee, Glaser, 2013). A significant role of a leader for clinical technology integration is change management. A leader who is in charge of the implementation of clinical technology not only needs to understand the technology, but they also need to understand the work and have the respect of those affected by the change in order to get everyone on board and attain organizational acceptance of the new technology. This is one of the major reasons for a CMIO, since a CMIO is often a physician who understands the importance and potential of the technology and are able to spread that understanding among staff and those affected. They are also the one responsible for advocating on behalf of the clinical staff during the implementation process. The CMIO typically heads the training process and procedures upon implementation.

The Chief Technology Officer is responsible for a number of activities that occur in the hospital, but their primary role according to Healthcare Information Systems, A Practical Approach for Healthcare Management, “is to guide the definition and implementation of the organization’s technical architecture” (Wager, Lee, Glaser, 2013). The reference to architecture by Wager is particularly interesting to the role of a CTO in that it is the responsibility of the CTO is to ensure that the organizational technology fits together just as an architect would ensure that all pieces of a construction project fit together in order to achieve the desired outcome.

Although all of these chief officers have roles that are inherently connected and may often find overlap in the application of their roles, they do each bring a unique perspective and skillset to the implementation and management of technology at a health care facility. Whether or not an organization will have a need for all of these positions will vary from one organization to the next, however as a rule of thumb a good way to assess the need for officers beyond the CIO will depend on the size of the facility. A CIO at a critical access hospital may manage all of the said responsibilities effectively, yet as the organization increases in size and scope the need for other officers to take on some of the responsibilities increases.

The Rest of the IT Shop:

Under these healthcare leaders, other available positions include analysts, such as Business Intelligence/Operations Analyst, Business Systems Analyst (specifically Revenue Cycle, etc.), Reporting Analyst (ex. Inpatient Analytics), Support & Optimization Analyst, Clinical Applications Analyst, and Meaningful Use Business Analyst. In addition, there are network and infrastructure administrators, such as IT Security Administrator or IT Network Administrator. Program and Project Managers such as ICD-10 Conversion Project Manager, Risk Adjustment Coding Manager, Quality Assurance Program Manager, or Project Managers in charge of IS projects are important to the organization, through their work leading implementation of IS improvements and changes. Digital assets and Digital healthcare operations directors carry huge responsibilities as well, as healthcare organizations increase foray into telemedicine and digital strategies. Finally, Clinical Informaticists, Clinical Documentation Specialists, Clinical Applications Trainers/Educators and Medical Coders, work closely with clinical providers to ensure the organization’s activities and tools best support clinical operations needs. Each of these individuals plays an integral role within the organization, as healthcare operations relies heavily on healthcare IT/IS.

Healthcare employers are clamoring for individuals who have not only an expansive knowledge of IT; they are also looking for individuals who have an understanding of the unique needs of the healthcare industry. Fast moving technology in healthcare translates into a rapid recruitment effort. According to healthITjobs.com, 10.5% of their job postings are for software developers. In addition, sometimes unmanageable amounts of data that flow through EMR systems within healthcare organizations. Therefore, program and application support professionals are also in high demand for this reason. Another IT position that is crucial to a healthcare organization is information and network security. There have been an enormous number of cyberattacks resulting in data breaches, therefore organizations have had to quickly hire individuals with a specialization in security to protect their patients’ information against this threat. According to a study conducted by Kaiser Permanente in 2015, there were nearly 1,000 large data breaches reported between 2010 and 2013 that affected more than 29 million individual health records. 42.5% of the breaches were attributed to cyberattacks, and the amount of breaches will only increase in the coming years. Therefore, healthcare organizations understand that they must continue to hire security specialists to insure patient information is protected, and HIPAA regulations are complied with.

The complexity that happens in planning and executing large and small projects in healthcare requires an IT professional that has a background in project management. The art of planning and executing an IT project in a structured fashion is an in demand skill due to the risk of projects stalling and not moving forward. With the transition to electronic healthcare records, organizations are using IT project managers to oversee large projects to ensure they are executed correctly, completed on time, and completed on budget. The demand for IT project managers will only increase as new software systems are implemented. Last year, product manager positions placed number eight overall on Glassdoor's Best Jobs in America for 2015.

Healthcare organizations are essentially looking for highly skilled individuals to help them make sense of the vast amounts of data they accumulate on a daily basis. Many healthcare organizations are turning to cloud computing to help them manage and store large quantities of data. They also see this service as a way to decrease startup expenses such as: hardware, software, networking, personnel, and licensing fees. With the adoption of this new technology, comes a need for individuals who have experience managing applications and development tools hosted through this service. Another IT professional that aids in the management of data is an analytics manager. This individual is charged with making conclusions about the data, therefore playing the crucial role of aiding the organization in strategic planning, and how to best care for their patients.

Regardless of the organization, the HIT department aims to facilitate the exchange and distribution of information across the organization. For this reason, HIT is an essential part of the strategic goals of all health care organizations. What is not common is a standardized structure for organizing the HIT department. This is mainly because health care organizations vary in size and personnel. Size contributes to the complexity of responsibilities needed to fulfill the organization’s strategic plans and influences the number of staff hired. Some factors impacting the complexity of responsibilities include contracts with software and application providers, scale of outsourced responsibilities, utilization of internally developed systems, and the centralization of computer systems throughout the organization. It is up to the CIO to structure the HIT department as it best fits the organization.

All HIT departments must staff professional, technical, and clerical personnel. Depending on the size of the organization, these roles may be fulfilled by one person or many. It is not uncommon that HIT staff will report to managers not related to the HIT department. This may be due to a number of reasons such as budgeting and HIT focus, but it nevertheless adds another layer of complexity and requires meticulous coordination. In a large health system, the HIT department is typically organized where the CMIO will facilitate communication and relations between HIT and the clinical staff. In a smaller enterprise, a single person may take on multiple positions and roles to fulfill the responsibilities needed.

The size and complexity of an organization impacts the organizational structure of the health IT (HIT) department. Unfortunately, there are often staff shortages across all organizations when it comes to HIT. Shortages are largely due to budget limitations, but also due to the overall growth of IT systems. The HIT department must include talent not only in technical programming, but those who can work creatively and effectively with people. An example of this is the HIT department working closely with regulatory and compliance experts in the organization to ensure they are within the lines of the law.

Sample Organizational Chart of a HIT Department in a Large Organization (Source: Glandon et. al)