The CIO's transformational role: 3 execs share how the position has evolved to 'COO by proxy'

The acceleration of digital transformation in healthcare is disrupting operational processes and transforming the roles of C-level leadership, posing the question of the CIO's traditional responsibilities and its emerging reputation as the new "COO by proxy."

While the COO typically oversees an organization's strategy and risk management, CIOs are increasingly being expected to take on more operational accountability as companies undergo digital transformations, The Wall Street Journal reported.

By 2024, one quarter of CIOs working in large, traditional enterprises are expected to become the "COO by proxy," and will oversee operational responsibilities including recommending enterprisewide digital projects for approval and deciding which activities to fund and those that should be discontinued, according to research and advisory firm Gartner's annual list of top strategic predictions.

Healthcare's CIO is no stranger to this emerging phenomenon. As hospitals and health systems grappled with scaling digital operations this year from rapid telehealth rollouts to expanding data reporting and analytics, the CIO has taken on a more strategic role. A mutual understanding between them and the rest of C-level leadership has emerged as they have witnessed technology's ability to move the business forward, according to Joel Vengco, senior vice president and chief information and digital officer at Baystate Health in Springfield, Mass.

Digitally enabled operations are inevitable across all businesses, particularly healthcare, as the evolving CIO role is focused now more than ever on optimizing operational effectiveness and growing revenues through a digital foundation backed by data, he told Becker's Hospital Review.

"This focus is where the CIO and the COO truly interlock," Mr. Vengco said. "The COO and CIO must educate the business on how to extract the value of IT to achieve its goals, and the COO must partner deeply with the CIO to optimize and effectively transform operations through the redesign of processes and the empowerment of people fueled by technology and information."

The COVID-19 pandemic jolted a newfound, stronger reliance on technology – normalizing remote work setups, bringing telehealth to the forefront of care and serving as a facilitator of socially distanced communications. With technology continuing to touch nearly every item in a healthcare system, the "modern CIO" must have a sound understanding of operations, financials and clinical and nonclinical workflows, according to Raymond Lowe, senior vice president and CIO at Los Angeles-based AltaMed.

Like Mr. Vengco, Mr. Lowe agrees that the CIO and COO must work in tandem on digital transformation as it affects the entire organization and shouldn't be considered as "just an IT project." As healthcare ramps up adoption and deployments of IT best practices, Mr. Lowe said it is important to get inspiration from outside of the organization as well, which serves as a driving factor in the difference between what makes a CIO good versus great.

"You cannot expect all things to come from within the organization," Mr. Lowe told Becker's. "A good healthcare CIO must be mindful of technologies and how they can be deployed in different settings. A great CIO can work across industries to determine fit and lead workflow transformation."

Building on the digital transformation efforts catapulted this year, as the COO by proxy, Mr. Lowe plans to lead his office to focus more on patient-centric care in 2021. This includes expanding the health system's mobile-first strategy, promoting provider satisfaction and allowing them to work from anywhere. Applying IT to help drive the values of the quadruple aim – improving patient experience, population health, provider experience and reducing the cost of care – is a critical responsibility for CIOs.

The CIO can improve both patient and provider experiences through IT, Mr. Lowe said, offering up the following example: with patient-centered care and televideo visits, what happens if the patient needs to go to the clinic or the emergency department? This type of scenario, he said, requires an operational workflow change within care delivery operations, in which the CIO's role is designing a system that provides the patient's transportation and scheduling needs while ensuring a seamless transfer of their EHR information.   

Healthcare organizations today now see the importance of strategic alignment and the value that the CIO's involvement can bring to the overall system.    

"The CIO's traditional role in providing technology enablement to support the transformation still exists; however, many different expectations around day-to-day operations have changed for the CIO," he said. "The CIO's transformational role is an exciting one, and leading business transformation and driving disruptive growth versus incremental growth will be a difference-maker for the healthcare system."

While the pandemic has acted as an accelerator for digital transformation, new tech initiatives had already been well underway at hospitals and health systems across the country. At Mammoth Hospital, CIO Mark Lind has been overseeing operational responsibilities from technology selection and project management to lab and medical imaging reporting since the Mammoth Lakes, Calif.-based hospital's previous COO retired about five years ago.

Rather than replacing the former COO's position, the hospital, which has about 500 employees, chose to divvy the duties of the job between the CEO and other executives. However, the rebalancing proved difficult for the CEO to juggle, as he was then required to directly manage building projects and facilities-oriented tasks in addition to leading the organization, Mr. Lind told Becker's. Over time, as more people moved around and the CEO retired, the responsibilities of the COO were passed on eventually among the CFO, CMO and CIO.

Mr. Lind, who had been promoted from IT director to the CIO role to head up the hospital's EMR transition consequently absorbed those IT and operational tasks that intersected – a move that he considered relatively unusual at the time for a CIO.

"We thought it was a little bit of an outlier. Generally, the CIO and CTO roles are very focused and not necessarily operational in that context, so we felt it was a little unusual," he said. "But I had some bandwidth having completed our EMR conversion and I was able to take on the responsibilities in terms of just having the time to give to the different managers and the focus they needed. But, honestly, I wasn't aware that the industry was going this direction at all. It was more perhaps an opportunity for me to grow in the role."

For Mammoth Hospital, the decision to have Mr. Lind take on responsibilities including long-term facility and infrastructure master planning as well as operational strategic goals around growth wasn't necessarily the idea of having the CIO become the COO but rather more of an answer to the question "who can pick up these different areas and what makes sense?" he said.

As he looks to the year ahead, Mr. Lind said while Mammoth Hospital does have a lot of long-term planning going on, the day-to-day is often consumed by its COVID-19-related response. From planning and reorganization of the facility itself to messaging, screening, communications and lab testing, his daily focus "is all around the pandemic."


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