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As IT and clinical processes become more intertwined in healthcare, a nationally known healthcare researcher is concerned that todays hospital CIOs are at risk of falling down the leadership ladder.
"Ive recently become very, very worried about the CIO position," Vi Shaffer, research vice president and industry services director for healthcare providers at Gartner, said Monday at WTN Medias Digital Healthcare Conference
Shaffer came of age in the healthcare industry at the time CIOs were reaching executive-level positions for the first time. "What I see that worries me is an erosion of the position in many health systems," she said. Shaffer also indicated that she sees "extreme variance" in role of CIO and in the ability of healthcare organizations to get value out of the CIO position.
The earliest electronic health records (EHR) implementations were led by IT and executives, Shaffer noted. These organizations now are further behind later adopters in terms of computerized physician order entry (CPOE) and other advanced functions because they didnt have enough "clinical juice" behind them," the Centreville, Va.-based researcher said.
Now, with clinicians more involved in technology projects, Shaffer believes IT has to get better at scoping and communicating its resources and capabilities, and not just approving everything doctors want. "IT doesnt say no. The business has to say no," Shaffer said.
And if things seem complicated now, just wait.
"Over the next 10 years, the practice of medicine is going to profoundly change. Im sure of it," Shaffer said during her keynote presentation to kick off the ninth annual Digital Healthcare Conference. "The past decade is just setting the stage."
Shaffer told CIOs something they likely already know: "Youve got way too many projects." With EHR implementations, chasing federal incentives for "meaningful use" of EHRs, more stringent HIPAA requirements and the conversion to ANSI X12 version 5010 electronic transactions and ICD-10 coding, IT departments have full plates, Shaffer said. Expectations are high for IT to address some of the most vexing problems in healthcare, including what Shaffer called the "most perverse," problem, changing demand for physicians.
When you find yourself in a hole, stop digging," Shaffer advised. "We are managing our projects in the trees, and executives need to manage the forests."
According to Shaffer, the healthcare industry is rapidly moving toward what well-known medical informaticist Dr. Blackford Middleton, corporate director of clinical informatics R&D at Partners Healthcare System in Boston, has called "high-velocity medicine," and toward what Shaffer has termed a "real-time health system."
It creates a new paradigm of medicine, which a lot of people characterize as personalized medicine and what I call pattern-based medicine," Shaffer explained.
"A couple of things have become more certain," Shaffer added. Healthcare payment will become more value-based as the fee-for-service model loses favor, and telemedicine and other "virtual" technologies will free a large portion of healthcare delivery from the constraints of proximity.
Despite what the general public may have been led to believe about healthcare reform, there will not be more money available for healthcare services. Value-based purchasing will entail bundled payments, accountable care, bundled payment and telemedicine for rural areas, communities lacking in specialists and, on a broader scale, poor countries.
Gartner's modeling shows that healthcare in the future will fit into one of four models: today's "herky-jerky," uncoordinated care for when "illness overcomes convenience"; centered care, otherwise knowns as the patient-centered medical home; continuous care, where patients are monitored remotely; and convenient care, which relies heavily on telemedicine.
We will have healthcare that fits into one of these four working models, Shaffer said. Each will require different core competencies. "In continuous care, were unbinding the patient from the provider," she said.
As payment schemes and location-based care shift, healthcare will be speeding toward "high-velocity medicine," fueled by EHRs with real-time clinical decision support and interoperability. Price transparency, clinical effectiveness research, sensors, predictive business intelligence, patient-direct telemedicine and apps, genomics and "lifestyle" research also will accelerate transformation, Shaffer said. EHRs will produce real-time data and allow organizations to "harvest more data for research, according to Shaffer.
A real-time health system will require "enterprise agility," Shaffer said, and will be characterized by the mastery of critical, core processes.
Within five to 10 years, the hospital starts to look like the evolution of manufacturing, Shaffer said. Expect to see a system that understands processes and predicts failures before they happen. IT infrastructure supports more data from more sources, with more analytics and more actions, and "kind of creates a hub of information," she said.
"This is one of the reasons why I worry about the future of the CIO," Shaffer said. Theres so much going on in a system not merely supported by technology, but defined by it.
Shaffer offered three things CIOs will never regret doing: Developing a comprehensive enterprise IT business value/risk approach; advancing the maturity of project, program and portfolio management; and building expertise in IT-related workforce planning, development and retention.
"Resource constraint is the mother of invention to me," the Gartner analyst said. Medical professionals will know more and discover more, while patients will demand more, and sooner. "The challenge is: How do you change in the midst of being really busy and being mired in the [old ways of doing things]?"
Peter Strombom, former vice president and CIO of Meriter Hospital suggested that healthcare look outside for technical leadership and a fresh perspective. "I think we need more CIOs from other industries," he said.
Research Vice President and Global Industry Services Director Healthcare Gartner
Vi Shaffer is Research Vice President and Industry Services Director of Healthcare for Gartner, the worlds leading IT research and advisory firm. As such, she advises healthcare executives around the world in the areas of strategic planning, IT governance, change management, and organization structure/roles. She is particularly well-known for her long-standing study of the Chief Medical Informatics Officer role and the CIO-CMIO relationship. Based in Washington, D.C., she actively monitors US federal healthcare reform, accountable care and Pay for Performance initiatives
Ms. Shaffer is a well-known 40-year industry veteran, having played executive, consulting and senior strategist roles in IT and healthcare. She is frequent speaker and author on the fusion of healthcare and technology. She has lectured in executive and academic programs at the Harvard School of Public Health, the Wharton School of the University of Pennsylvania and at leadership seminars sponsored by the College of Healthcare Information Management Executives (CHIME). Prior to joining Gartner in 2004, she served as an executive of several healthcare IT-oriented companies, including APACHE Medical Systems, Cerner, Competitive Advantage Services and MEDSTAT.