October 2008 FEATURE ARTICLES
The Healthcare CIO
Andy Crowder
Chief Information Officer, Florida Hospital
Andy Crowder is senior vice president and chief information officer for Orlando-based Florida Hospital, an 1,800 bed, seven-hospital system. Prior to joining Florida Hospital, he also served in various engineering roles with IBM from 1987-1994.
QHMT: What are some of the chief responsibilities of the healthcare CIO, in terms of helping a healthcare organization maintain and improve upon a high level of quality care?
“This is an industry that’s under significant scrutiny and significant pressures, both from a business perspective, as well as a financial point of view and across the board. The healthcare CIO has to fully understand the intricacies of patient safety and quality initiatives down to a very discrete level. In many other organizations, the CIO is the tool person; an organization has a particular business need and determined it needs a particular tool, so the CIO keeps the lights on, keeps the infrastructure running and keeps the network up.
“I believe the healthcare CIO is much more about outcomes rather than just tools; they have to validate the business strategy, and be a part of that business strategy development and alignment.”
QHMT: What are some of the challenges facing healthcare CIOs today?
“Some of the most challenging issues that we’re facing right now are patient safety issues such as NQF, the National Patient Safety Goals, The Joint Commission changes and regulations, the declining payment stream, the uninsured; those are all real issues for the CIO because they require technology solutions that quite honestly aren’t as mature as they need to be for the industry.
I think that some of the other challenges that exist here today are healthcare organizations and entities where you’ve got such variation in standard care and core processes, that it is very difficult to align business strategies and define scope for outcomes. You’ve got more regulations and yet greater variety in standard business operating procedures and processes. Trying to wrap people, process and technology together in that incredibly variable environment is incredibly challenging.”
QHMT: What are some trends you can see emerging in healthcare IT?
“There has been a significant push all the way down to frontline patient care. Traditionally, information is taken off of some type of monitor or pump and from that a chart is produced. It’s hoped that data can then be abstracted and the information used to retrospectively try to change something. Most of that data is from abstraction points of things that have already occurred — medication events or those types of activities.
“The push now, and the way that the technology is evolving, is for there to be alerts to those things before an adverse event occurs, and changes to a behavior before it becomes a negative patient safety or patient care issue. That creates an environment where the behavior changes at the point of care, as opposed to looking at something and trying to put manual processes in place after the fact. That’s where the technology is headed.”
QHMT: What advice can you give to your peers? What should they be focusing on?
“A couple of fundamental principles is that they need to make sure that they are integrated and part of the executive leadership of the healthcare organization. They need to be at the table with the CEO, the COO, the chief nursing officer, the chief medical officer and the chief process officer. If they aren’t part of the business strategy, they will fail. They can’t be down below some CFO and not be at the table from a strategic planning point of view.
“If you look at the investments and cost of IT, you’ve got to make sure that they’re aligned. You ought to be able to look at every business objective and show how every one of your resources — your capital investments — are aligned to executing on those goals from an organizational point of view.”
QHMT: You said that a lot of this technology still needs to mature. What do you mean by that?
“With a lot of the vendors, especially in the biomedical space, and a lot of the large EMR vendors, there aren’t as much open standards as you would hope to be there. They’re trying to protect their market share and the person that suffers in that is the healthcare provider and, ultimately, the patient, because they’re protecting revenue streams that are declining. The banking industry is full of base standards that exist for data exchange and the passing of information. That isn’t so in the healthcare industry.”
QHMT: You said that a lot of this technology still needs to mature. What do you mean by that?
“I think you’re going to see the title even change. I spend more of my time, today, on business process and outcomes, than I do on technology. I have accountability on performance improvement across seven campuses. There are many CIOs taking on the role of chief process officers.”
QHMT: What advice would you give those working at healthcare organizations, both large and small around the country, as IT directors, or IS directors or managers, those seeking to progress towards the role of CIO?
“My advice to them is they need to fundamentally understand every aspect of the healthcare business and the environment that they work in. The leadership ranks inside of IS ought to be able to walk out of their IS role and go run an operational area in the healthcare continuum.
“Today, the vice president over all application services in many healthcare organizations is a Masters-degreed clinical informatics person who has developed their IS skill set to be able to provide the right strategy. Imagine a technology person going to have a conversation about scoping a patient safety initiative. It’s going to be an incredibly difficult process if they don’t understand the healthcare business and industry. We are really morphing the roles of the healthcare IT leadership.”