Optimal Training and Background for a Hospital CIO

Many of the hospital CIOs I have interacted with over the years have been ineffective leaders and avid supporters of the purchase of commercial healthcare applications. Mr. HIStalk helps to explain the problem in the following recent passage on his blog:

One camp [concerning hospital CIO training] says hospital CIOs should be doctors and nurses, another says they should be the same kind of person you’d want for COO or even CFO, while the old-schoolers says the CIO should know the bits and bytes. I’ve yet to see a convincing correlation between CIO effectiveness and their background since so much depends on leadership style and the organization they work for. I do believe that hospital CIOs are too cozy with the idea that everything revolves around vendor software, often because that’s all they know. Look at how chummy CIOs are with vendors with HIMSS and CHIME – is that an admirable win-win position or is it an incestuous relationship? Either way, that’s why it’s an uphill battle for open source applications, internal development, or simply optimizing the use of what’s already been bought. Those less-sexy efforts rarely get you on the A-list of advisory boards, speaking engagements, and rah-rah magazines. Plus, lemming hospital executives are swayed by vendorspeak, too (“vision centers” are for non-IT execs looking through a gauzy and deceiving lens, for the most part, not CIOs) and not encouraging their CIOs to blaze any trails.

I concur with Mr. HIStalk that the natural instincts and training of the majority of hospital CIOs today is to select new systems, particularly EMRs, from a short list of the products available in the market. The majority, continuing in this same vein and quoting from him, are unready or unprepared to manage open source software, develop some software internally, or more fully integrate their myriad legacy systems. For the most part, this "buy over make" strategy will be solidly endorsed by their hospital executive colleagues, including CEOs. The latter know little if anything about IT and themselves have a limited bag of tricks -- managing reimbursement from payors, purchasing other hospitals, and managing new building projects. Or, in today's, challenging financial environment, shutting such projects down.

I explained the failure of hospital CEOs and CIOs to purchase adequate systems, or enhance their current systems, in a previous note  (see: EMR Failures and a Recipe for Their Avoidance in the Future)

For their part, EMR vendors continue to pursue their short-term strategy of selling inadequate and poorly designed systems that that are difficult to install, don't scale up, or perform inadequately. CIOs and CMIOs keep buying inadequate EMRs, despite the long  history of failure of these systems, because they are paid to deploy "modern" systems and there are few if any in the market that respond to their wish lists.

Given this background, it's easy to understand why the channeling of more federal money to hospitals to "enhance IT" is a recipe for a disaster. Here's a quote on this same topic from a previous note (see: Possible Adverse Consequences of Increased Federal Investment in HIT):

HIMSS execs will certainly be staking a claim on the newly available federal money on behalf of their favorite EMR companies. Hopefully, the hospital CEOs and CIOs will be able to withstand these efforts to purchase and install proprietary "pre-Internet era software" and hold out for the next generation of what hopefully will be superior products.

Where I come down on this issue of hospital CIO preparation and training is that the technical component is more important than the managerial one, both are required in some measure, and that people of this caliber are simply unavailable in most areas.

Comments

[Karl Robstad, MD]

HA! I just posted about this over at 1xO. You are so right! Good on you!