• August 2008 FEATURE ARTICLES •
The Healthcare CIO
John Halamka, M.D., MS
Chief Information Officer, CareGroup Health System
John Halamka is responsible for all
clinical, financial, administrative and academic information
technology serving 3,000 doctors, 14,000 employees and 2
million patients throughout the
CareGroup Health System. He’s also CIO and Dean for
Technology at Harvard Medical School where he oversees all
educational, research and administrative computing for
20,000 faculty and students. Halamka holds appointments as
Chairman of New England Healthcare EDI Network and CEO of
MA-SHARE, supervising ongoing administrative and clinical
data exchange efforts in Massachusetts. In addition, he has
the responsibility of coordinating the process of electronic
standards harmonization among stakeholders nationwide as
Chair of the Health Information Technology Standards Panel
(HITSP).
Q HMT: What’s it like today to work as a
healthcare CIO?
"What usually happens in careers of CIOs
is that about every two to three years the CIO is changed
out. And, why is that? It’s because the last guy just wasn’t
aligned with the needs of the business. You can get into
this paralysis of CIOs getting recycled. I’ve seen this in
several organizations, and so one of my challenges over the
11 years that I’ve been CIO for this hospital is to never
have an agenda of my own. Clearly, I use IT as a set of
tactics to execute the organization’s strategy and,
admittedly, there are certain elements that I champion, but
when it comes to which application to develop and what
features will be included, I make every decision according
to the requirements of the organization.
"There are two kinds of projects in IT —
those that take a year or two to actually implement and
those that come from ‘the Joint Commission just declared
that you have to do X,’ or a sentinel event happens, or
pay-for-performance requires you to do that. The problem is,
inevitably there are so many of these ‘tyranny of the
urgent’ projects, that it can be sometimes challenging for
the CIO to say, ‘Hey guys, remember a year ago when we all
agreed on this giant project that we have to do to really
move us forward, we gotta do that too! So, it’s a
fascinating balance of constantly aligning the needs of the
organization, and addressing urgent needs, but not losing
sight of the long-term projects that everyone in the
organization agrees you have to do, though they may not be
glamorous. And, of course, doing all that with increasing
demand for IT and budgets that don’t grow at the same pace
as the demand grows."
Q HMT: Talk about that for a minute.
Why is the demand outpacing the budget?
"What’s happened over the last couple of
years is that the culture has changed so that there’s this
recognition that it may actually be more painful to do
prescribing or note-charting electronically, but the payback
when the patient comes back for a return visit is that
there’s a comprehensive decision support-based record that
delivers safer, faster quality care. What’s also happened is
that the hospital itself recognizes the value in being much
more automated, whether the compliance environment is The
Joint Commission or HIPAA. There’s certainly continuous
pressures from the board to enhance quality and, inevitably,
when somebody says a quality issue occurred, the second
sentence will be ‘What IT enhancement do we need to prevent
that from happening in the future?’ So, it’s doctors,
administrators and the board driving more automation. And,
yes, the budgets go up, but it’s not as if in healthcare
there is an infinite amount of capital and the IT budgets
are unlimited, so you have this quizzical issue where the
capital availability of the hospital is relatively fixed,
but the automation demands are increasing. It’s a balance
that takes a lot of work and constant vigilance."
Q HMT: How important is it for CIOs to be mass communicators?
"Part of my job description at this point
is internal and external communications. I have 5,000 daily
blog readers (http://geekdoctor.blogspot.com), who are a
combination of people in the industry, vendors and internal
folks. I write 1,500 words every single day about the
struggles and issues we’re dealing with. In this morning’s
blog, I wrote about working with clinicians in the community
who articulated a strategy for data-sharing. It was clear
because of the evolution of the community and the doctors
involved, the original strategy we articulated wasn’t right.
So we revised it based on real-time feedback and constant
communication between internal and external users.
"Every Friday, I send an e-mail to 18,000
users saying what we did this week, here’s what’s coming up,
and constantly seeking feedback. I ask at the bottom of the
e-mail every week, ‘tell me if there’s anything further we
can do.’ I also participate in numerous public speaking
engagements both internally and externally, about 200
speeches a year, at everything from the local hospital and
the Harvard environment to an engagement I had in Istanbul
recently."
Q HMT: How do you view the role of the healthcare CMIO?
Will it replace the traditional CIO?
"Well the challenge is, for
one person to be able to juggle budgets and leadership and
clinical requirements requires somewhat of an unusual
educational background. The
question a healthcare organization has to ask is, although
CMIOs are expert clinicians who understand IT, do they have
the breadth of leadership ability, people skills and budget
skills to be able to be the whole package? And admittedly,
this is why an organization may continue to require two
distinct roles, with a CMIO and CIO functioning as
partners."
Q HMT: What would you advise IT directors and future CIOs
to prepare for in the next 2 to 5 years?
"The learning never stops. You have to
continually embrace change. I’m a voracious reader and I’m
constantly scanning the journals, both the academic and the
commercial publications, looking at new technologies every
week. It’s critical to constantly embrace innovation and
keep aware of the new trends. Also, as the CIO or an IT
professional, don’t ever be the rate-limiting step, rather,
you should be embracing of innovation. Of course, budgets and limited
scope of departments will continue to be limiting factors,
but for a CIO to refuse to consider a technology, or to say,
‘We’re doing it this way and that’s the way we’re going to
keep doing it because it’s proven successful,’ — that’s an
attitude indicative of a person’s limitations for learning.
That’s when the CIO probably finds they have outlived their
usefulness."
Q HMT: Do you have any advice for today’s healthcare CIOs?
"Embrace change and conflict. One of the
challenges we have as CIOs is that we have to maintain total
reliability, and, at the same time, embrace all of these new
technologies and new implementations. So, I describe it as
changing the wings on a 747 while it’s in flight. The
challenge, as CIOs, is that we have to continually learn —
constantly be at the top of our technology game — and keep
delivering on time and on budget. If you expect that your
day-to-day life is going to be filled with change and
conflict, when those challenges arise, you’ll be prepared to
address them.
Change and conflict just come with the territory."