The Life of a Healthcare CIO: Legacy Health's Dr. John Kenagy


In collaboration with CHIMEBecker's Hospital Review's "Life of a Healthcare CIO" series features leading hospital and health system CIOs from across the country who are sharing their experiences, best practices and challenges.

To recommend a CIO to be featured in this series, please contact Helen Gregg (

An interview with John Kenagy, PhD, senior vice president and CIO of Legacy Health in Portland, Ore. (Interview has been edited for length and clarity.)

Question: You've been CIO of Legacy Health for a little more than two years, and a healthcare CIO for more than 20 years. How has the role of CIO changed during your career?

Dr. John Kenagy: At the beginning of my career, IT was about selling a future vision of a world where IT enabled clinical and business processes. Now we're there, to the point where they're frustrated when the IT doesn't work. [Laughs]. So instead of being the chief marketing officer for IT, which there is still an element of [in my job], I'm now the COO of the organization's management of information, and that's been wonderful.

Twenty years ago, we [in IT] had a desire to impact the core business. When I started, there was a lot of automation in the office; administration functions like payroll were all automated. But the core function — that dyad of patient and provider, the clinical experience — was so far removed [from the office automation]. Now it's 2014 and you can't do anything in the organization without somehow connecting to IT, for good or bad.1010KenagyJohnPRINT 512x640

Q: In your time with Legacy Health, what has been your biggest accomplishment? 

JK: We have had a revolving door of CIOs here, and I think the two things that have been my biggest accomplishment have been sides of the same coin, that is the healing within information services and inspiring good feelings. Employee engagement, pride in your work and celebrating successes are hard when you have three different CIOs within five years. So there was a hunker-down mentality, a bunker mentality, in IS. And to change that required a sweeping cultural change, but people were so hungry to be proud of their work.

The other side of that is that pride and success being deserved, because [we got] our customers feeling positive about IS, that we are here to help. Yes, we're under-resourced and it takes a long time but [they know now] it's not because of a skill deficit or a disconnect from the business needs, it's because things take a long time sometimes and there are limited resources. That has been my grandest accomplishment.

Q: What do you see as your biggest misstep or mistake?

JK: The biggest mistake, or the thing that I had hoped would be more successful, is the journey we're taking on business intelligence. It's proven harder than I thought. In my enthusiasm about the relationships and the vendors I may have oversold our ability to accomplish more in a short period of time. It's like a bike chain that's fallen off; you're pedaling and the chain's moving but not the wheels. It's not the people's fault, but it's been difficult. I definitely underestimated how massive an effort analytics and BI would be.

Q: In the past month or so, what project has taken up the majority of your time?

JK: A replacement for our time and attendance system. We have an old and end-of-life solution now for time and attendance. Through a good partnership between IT, human resources and payroll, we're taking the opportunity to take a look at the system and our pay practices.

It's a big project for three reasons. One, the size of the project and capital involved mean it has board visibility. It will touch every employee; everyone who gets paid will be impacted when it goes live next year. And, it is highly political because it does impact so much and will mean a lot of change management. It's a complex project and deeply technical, but also very operational.

Q: What is the biggest challenge you're facing right now? 

JK: A big challenge that came to mind immediately is the recruiting and retaining of outstanding talent. We live in Portland, in the epicenter of a lot of Epic IT deployments. There is increasing tension and competition here for really good Epic clinical and IT people, for either someone who has an IT background and understands the clinical side or a clinician who has learned IT. It is a rare commodity and we strive to make this a good place to work, but there's a lot of competition from other organizations and consulting firms.

Adding to that challenge, about a quarter of my staff has more than 20 years of experience at Legacy, and over the course of the next five to seven years I'm facing the retirement of people who really know so much. I am replacing not only their talent, but their passion and knowledge. These are people who started in the lab and are now managing our lab deployment; they eat, drink and sleep knowledge of how things work here.

So that's why the competition for skilled resources is on my horizon, because of the impending brain drain to retirement. And that's the CIO role. A good CIO is looking three or four years down the road, spending 10 hours a week or at 3:00 in the morning when you wake up in the middle of the night, thinking about not just tomorrow but four years from now.

Q: What is one lesson you've learned during your career that you'd like to share with other CIOs?

JK: I think for CIOs there's a gap between what the other leaders think you are and what you should be. My colleagues think I'm the chief technology officer, so I always get a pit in my stomach when I'm in a large room with other leaders because when the projector fails, they always turn to me and say, "Aren't you the chief tinkerer?" I say no, but then I fix it anyway and it just reinforces that. [Laughs].

From my perspective, there are two things a good CIO needs to be — a financial manager and a marketing officer for what IT does. Good marketing is understanding what people's needs are. When people hear 'marketing' they think advertising, and it's really developing a product and placing it in front of people who want it. If they don't know they want it yet, listen and talk and promote it until they can't live without it.

And then transparent, open financial management. We have a very large budget that is spent on complex things. [The rest of the organization] has to have the perspective of "I trust you, you have my back." That is make-or-break for a CIO.


More Articles in the "Life of a Healthcare CIO" Series:

The Life of a Healthcare CIO: St. Bernards Healthcare's Mark Odom
The Life of a Healthcare CIO: Dignity Health's Deanna Wise
The Life of a Healthcare CIO: Seattle Children's Wes Wright

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