As technology works its way into nearly every corner of hospital operations, health system CIOs are confronting a practical question: If an initiative touches technology, does IT have to own it?
Sheri Strobel, CIO of Temple Terrace, Fla.-based Chapters Health System, said she learned the answer through experience. A pharmacy implementation showed her that the chief medical officer was the better owner for a project that reshapes clinicians’ work, she said during a panel at Becker’s 11th Annual IT + Revenue Cycle Conference in Chicago in September.
“We all could lead up a project like that, right? With enough experience and knowledge. But should we? And the answer is no,” she said.
With the CMO in charge, Ms. Strobel said, physicians had an executive accountable for the budget and outcomes who could step in directly when ordering problems surfaced. IT’s role shifted to support.
“The way I looked at it with her is I had her back every day. … But no, I wasn’t the one with the name behind it,” Ms. Strobel said.
Tom Gordon, senior vice president and CIO of Marlton, N.J.-based Virtua Health, said he distinguishes between owning the technology and owning the business outcome, which don’t always need to belong to the same person.
“I usually start with one question: Who is accountable for the outcome we are trying to change? That person should generally own the initiative,” he told Becker’s. “The mistake is making ownership synonymous with who buys or implements the technology.”
That principle shapes how Virtua handles AI. The health system leads its enterprise technology and AI roadmap centrally, bringing Epic, Oracle and Microsoft together rather than treating them as separate vendor agendas, Mr. Gordon said. Individual AI use cases are a different matter.
“If we are deploying AI into a clinical workflow, finance process or patient access experience, that business leader has to own the outcome and adoption. IT cannot do that for them,” he said.
King of Prussia, Pa.-based Universal Health Services takes a similar approach to AI in its revenue cycle. Vice President and CIO Eric Goodwin said new AI-enabled capabilities for prior authorizations, denial appeals and accounts receivable workflow are sponsored and led by revenue cycle executives, with IT working alongside them.
“While IT provides essential technology expertise and support, these initiatives are sponsored and led by revenue cycle executives because their success ultimately depends on improving revenue cycle performance,” Mr. Goodwin said in a written response.
On the clinical side, UHS’ chief medical informatics officer leads efforts to use AI and other technologies to optimize clinical workflows, he said.
Not every initiative splits so cleanly. David Ingham, DO, senior vice president and chief digital and information officer of Minneapolis-based Allina Health, said the right owner depends on an initiative’s scope.
“Every project requires a different balance of CIO and a clinical or operational champion, and projects get into trouble when you don’t have the right balance,” Dr. Ingham said.
He pointed to two recent examples. Allina’s new functionality to improve patients’ estimated date of discharge was led by clinical and operational leaders; though a big project, it affected a fairly narrow set of end users who didn’t need to change much. By contrast, Allina’s major digital hospital deployment is led by Dr. Ingham’s team because it “crosses many service lines and care spaces and would not have been successful without my informatics team leading,” he said.
Dr. Ingham weighs three factors when deciding who should lead: the breadth of an initiative’s impact, the enterprise risk if it falters and its strategic importance to the organization. Narrow projects favor an operational or clinical executive, while broad, high-risk ones call for more CIO involvement.
Some health systems have built the split into their structure. At Clearwater, Fla.-based BayCare Health System, every technology initiative has a vice president sponsor outside IT responsible for the business plan and operational readiness, and a director sponsor inside IT, who ensures delivery and walks the project through governance.
“This director is the VP’s partner in all things IT, so our organizational departments don’t have to keep track of all the different departments within IT,” said BayCare CIO Lynnette Clinton.
Those initiatives go through an IT governance process led by Ms. Clinton. An IT vice president serves as sponsor only in a few exceptions, such as integration engine replacements, data analytics and major EHR projects.
Others are formalizing co-ownership at the executive level. Scott McEachern, CIO of Bandon, Ore.-based Southern Coos Hospital & Health Center, said he is selecting a fleet of IV pumps with his organization’s chief nursing officer.
“It’s a shared responsibility and accountability piece. So it’s not just falling on one person, which is nice,” Mr. McEachern said at the Becker’s panel discussion.
Mark Gilliam, senior vice president and CIO of Louisville, Ky.-based ScionHealth, told Becker’s the answer also depends on the maturity of an organization’s business and clinical leaders and its project delivery. In mature organizations with a structured methodology, he has seen clinical or business leaders chair initiatives. In others, he has taken a larger leadership role to provide structure, while insisting that a business leader “must be a co-champion and sitting at the table.”
Where the CIOs drew a firm line was the technology foundation itself.
“CIOs need to own the enterprise technology foundation: cybersecurity, infrastructure, architecture, interoperability and integration, data platforms, technical standards, resilience and recovery, and the overall technology portfolio,” Mr. Gordon said.
Dr. Ingham said CIOs should own anything that “involves technology platform decisions, has impact to cybersecurity profile, or creates tech debt.” Mr. Gilliam pointed to infrastructure first, along with consolidations of software and technical systems that are heavy on technical work.
Several said governance belongs with the CIO precisely because so many initiatives are now led elsewhere. Mr. Goodwin described IT’s role as making sure solutions are built on a strong foundation, scale across the organization, align with enterprise standards and avoid unnecessary duplication.
“Increasingly, the CIO’s role is also to create the technology foundation and governance that allow other leaders to successfully own transformation within their areas,” he said.
Dr. Ingham noted the balance also depends on the CIO. An innovator-style CIO tends to own and lead more, while a more technical, operator-style CIO may leave the vision to others, and either can work.
“Both those can work well in an organization, but vision and innovation need to be driven from somewhere and tech expertise needs to sit somewhere too,” he said.
Mr. Gordon put the division of labor more simply.
“IT owns the foundation and enables the change; the business owns the outcome. For the biggest transformations, neither side can succeed independently,” he said.
