CIOs in every industry play tug of war with their executive peers. For healthcare CIOs, the game's often even more one-sided. In addition to pulling against the marketing, operations and finance departments, among others, they can face opposition from the medical side of the business.
They can, but they don't have to. At Flagler Hospital in St. Augustine, Fla., as it turns out, the CIO and the chief medical informatics officer (CMIO) stand together. That helped the 355-bed community hospital address clinical needs as it embarked on important software decisions.
Whenever buying something, CIO Bill Reiger says, "The decision has to go back to the patient in the bed." If Reiger and CMIO Dr. Michael Sanders can't agree, they bring in someone else to get them to agree. "We both fundamentally understand that that's what it's all about."
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That was especially true of last year's electronic health record (EHR) implementation. Many physicians see the inherent value of EHR systems, Sanders says; the challenge is taking a system that can be immature and making it conform to physicians' needs.
Software Purchases a Balancing Act
Flagler's coordinated approach to software purchasing is "not as common as you'd think," says Dr. Diane Bradley, chief quality officer with Allscripts. (Flagler uses Allscripts' Sunrise EHR platform.) Organizations that focus solely on the IT during EHR implementation, and not the practice, will start to see downsides, she says. Meanwhile, those who focus solely on the practice, and not IT, may never go live.
Instead of pitting "margin vs. mission," as Bradley puts it, "balance those poles a lot better." Make quality patient care as critical to a successful software launch as, say, revenue cycle, billing and physician alignment. Pay attention to meaningful use criteria, but don't lose sight of usability and workflow.
Engaging clinicians eases this process, Bradley says. Traditionally, EHR vendors allowed (and even encouraged) clinicians to "tailor content to their view of the world." Today, though, the conversation has "matured" to instead cover evidence-based best practices. With less customization, end users have less to learn, Allscripts has fewer features to design and the whole implementation process takes less time.
The idea of involving a physician "super user" in vendor selection isn't new, Bradley says, but organizations increasingly see value in involving that physician from the beginning. That way, EHR optimization -- getting back to one's original vision and desired outcomes -- happens sometime between six and 12 months, when the typical EHR implementation remains in process.
CIOs Must Practice Humility
Appointing a super user or standing beside a CMIO requires a healthcare CIO to be humble, Reiger says. Physicians respect the words of other physicians, whose knowledge of clinical processes, not to mention the human body, trumps that of any IT professional. "They want someone who understands what they're going through," he says, "I need to put somebody in front of them who does."
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Sanders, for his part, says Reiger took the time to build rapport with Flagler's physicians -- to the point that, "When [Reiger] says something, the medical staff have come to believe him."
This level of trust will help hospital leaders as they strive to elevate Flagler's EHR system, and physicians' use of it, to the next level. The aim, Sanders says, is bringing a single, evidence-based record to the bedside, whether a patient's at home, in the hospital or in another care setting. "Yes, we need to record the discrete data we need for government reporting and core measures, but we need to preserve the patient story," he says. "Without it, we lose."
Physicians also want the same mobility they enjoy from consumer technology, but Flagler (along with many a facility) struggles to keep pace. "We don't yet have all the good tools we need," Sanders says. "How do we constrain that to some reasonableness while we undergo this transition?"
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