The Rise of the Healthcare CIO

As hospitals and health systems reinvent themselves in one of the most challenging times in our history, the position of chief information officer is emerging as a crucial element to their success.

“The CIO is probably one of the most critical executive leadership roles in healthcare right now,” says Daniel Nigrin, MD, MS, senior vice president and CIO at Boston Children’s Hospital.

David Chou, senior vice president and CIO at Harris Health System in Houston, concurs. But recruiting and retaining the right CIO and positioning that leader correctly in the organization is its own challenge, says Chou, a board member for the College of Health Information Management Executives (CHIME).

Although their responsibilities have grown steadily as technology has proliferated throughout their organizations, many CIOs still serve more in the role of an IT director than that of a strategic leader.

“The majority of chief information officers in healthcare have not been trained in hospital operations or mergers and acquisitions and cannot speak the language of the hospital business,” Chou says. “That definitely causes a lot of frustration.”

Frustration surfaces when a CIO’s priorities do not mesh with those of his or her peer leaders.

“You need to be sure that your CIO and your technology side are aligned with the clinical and operational goals of your organization,” Bruce Levy, MD, associate chief medical informatics officer at Geisinger Health, says. “I’ve seen too many places where they’re not in alignment and you end up with both sides thinking they are the dog wagging the tail.”

Today’s CIO Job Description

Interviews with top healthcare technology leaders make one thing clear: There is no current “best practice” for a CIO’s scope of responsibility or reporting structure in healthcare organizations. As health systems and hospitals reposition themselves for the future, each must create the job description that will best address the organization’s particular situation. That said, these leaders have identified several traits that CIOs need to succeed in today’s environment:

Strategic leadership. The CIO should report to the CEO or COO and share responsibility in guiding the organization toward adopting new care-delivery models like telehealth and compete with new entrants like CVS and Walgreen’s.

“CIOs absolutely play a role in helping organizations to understand what’s going on, but also to help with a transformation internally,” Nigrin says. “Just because this is the way that an organization has always delivered care, there’s nothing that says we can’t disrupt ourselves and adapt to these new expectations that our patients and consumers are looking for.”

Entrepreneurial thinking. The CIO does not need to be a hospital’s top technology expert; other members of his or her team can share their expertise in keeping technology on track. “That’s still your responsibility, but that is not your job anymore,” says Sarah Richardson, vice president of IT change leadership at Optum. “The CIO today is truly an entrepreneur.”

Richardson, a member of the CHIME board, has served as CIO in three health systems, including Davita Medical Group, which joined Optum in 2019. In light of technology’s role in healthcare — and the investment in technology made by every health system — she thinks CIOs should be seen as running a profit center.

“Think of all the revenue that IT brings in the door,” she suggests. “That helps you start thinking about IT as a revenue-generating group in an organization where everyone is innovating and transforming together. That’s a powerful platform for determining how to manage technology within your organization.”

Ability to influence others. A thorough understanding of both enterprise technology and hospital operations is essential for his success, Chou says, but his most important skill is the ability to advance the CEO’s strategic plan. “My job is to influence my peers and everyone else in the organization to work toward a specific objective,” he says. “The CEO needs someone who can bridge the gap between technology and the business side, while shepherding and spearheading movement in a specific direction.”

Forward-thinking perspective. A successful healthcare CIO may have been in that job a long time, but he or she must be hurtling toward the future.

“Whether it’s deploying cloud technologies, having a laser-sharp focus on optimizing the consumer experience, or whatever else is needed, they have got to have a mindset geared toward this future state that we’re moving to,” says Nigrin, also a member of the CHIME board. “Being receptive to change and embracing it is probably one of the primary things that I want to see in a CIO.”

Attuned to what’s new. Healthcare leaders are looking for inspiration from their IT team, Richardson says, and counting on the CIO to inject a spirit of innovation into their organization. “So you look to what others are doing,” she suggests. “Innovation doesn’t mean you have to invent something from scratch; it means you have to think of a way of doing something better or differently that works well for your own environment.”

Master communication skills. A CIO can succeed only if other leaders understand how to support him or her. “Many chief information officers struggle to tell a story,” Chou laments. “They cannot go to a board room and explain a scenario without using technical language.”

CDO? CTO? CMIO?

Just as the CIO title implies various responsibilities from one organization to the next, so do other “chief” titles such as chief innovation officer, chief digital officer (CDO), chief medical information officer (CMIO), chief nursing information officer (CNIO), and others.

Chou explains that the job description of chief technology officer (CTO) is perhaps more uniform than others, but it still needs some explaining. Outside healthcare, the CTO title generally equates to the CIO position in hospitals and health systems. Inside healthcare, the CTO reports to the CIO and is responsible for making sure the organization’s technology infrastructure — hardware, end-user devices, wireless network, telecommunications, and other technology — is functioning smoothly.

Beyond that, no technology job title is universally linked to a specific set of responsibilities. For example, in many health systems, including Boston Children’s, the CMIO and CNIO focus primarily on optimizing the electronic health system, Nigrin explains. They work closely with clinicians to improve their workflows, to find ways the EHR system can improve patient safety and quality, and counter technology-induced burnout.

By contrast, at Geisinger Health, the CMIO’s primary responsibility is informatics — that is, using data and information to improve healthcare delivery — and data analytics, which refers to analysis of data to identify trends and patterns. With a dotted-line relationship to Geisinger Health’s CIO, the CMIO team resides in Geisinger’s Steele Institute for Health Innovation.

“The CMIO helps set strategy, not just for our clinical systems, but our overall technology strategy,” Levy says. “And innovation — How do we increase access? How do we improve safety and quality? — is a big part of what we’re engaged with.”

In some health systems, the positions of CIO or CDO have emerged as organizations seek to rapidly develop consumer-facing technologies to meet the customer-service expectations set by Amazon, Uber and the like. Chou is skeptical of that approach, believing a CIO should have the skill and mindset to deploy technology that drives the new business models.

“CEOs may think they are doing the right thing by bringing someone in to lead the digital initiatives, but they are failing to recognize that it creates an overlap” with the technology team, he says. “The work has to be a collaborative effort, and it still needs the coordination of the technology team to be able to execute.”

How to Find the Right CIO

There is no “best” CIO; there is the “right” CIO for a specific organization. “Figure out what you want from that person because you can’t just expect it,” Richardson advises. “For example, if you really want digital innovation, then hire somebody who has some background in digital innovation.”

She encourages CEOs to analyze the performance of those who have been successful — and not successful — in the previous CIO role and understand why. That allows a candidate to make an informed decision before accepting a position, and it increases the likelihood that the organization will make the best hire. “An organization needs to have enough humility to say, ‘It was us — we’re terrible at making decisions’ or whatever led to a problem or ‘It was this person’ and discuss what happened and the factors involved,” she says.

Recruiting a CIO from outside healthcare may be worth considering, Nigrin says. “A talented CIO from outside our industry could bring important things that we have not considered or implemented in the past,” he says.

That said, any outside-the-industry hire would need significant support from other leaders — CMO, CMIO, and CNIO, for example — to learn the complexities of the healthcare industry.

Chou echoes that concern. In addition to the learning curve, technology leaders accustomed to working in other industries may struggle to understand the healthcare culture.

“We move based on consensus, and many things are decided based on committee, requiring the ability to influence 20 to 25 senior leaders to seek alignment,” he says. “Some folks just cannot adapt to healthcare.”

Although some CIOs — including Nigrin — are medical doctors, even a physician-led organization like Geisinger Health does not consider that to be essential, Levy says. “It’s difficult to find individuals who would have the sophistication on both the technical and the clinical side,” he says. “Most health systems are much better off having a partnership of a CMIO and CIO, ideally with a CNIO working together as a team.”

Tips for Success

Help the CIO succeed. Chou encourages every CMO to spend time educating the CIO about healthcare operations. Even those who have spent their careers in healthcare may not have been trained in how the business works as seen from the clinicians’ perspective. “Lots of CIOs do not have that knowledge,” he says. “Helping them to understand that perspective will allow them to support the chief medical officer better with technology and data, and they will have more of a collaborative approach.”

Avoid creating silos. Hiring a chief digital officer to immediately pursue digital initiatives may be worthwhile, but Nigrin, the Boston Children’s CIO, offers a word of caution. That individual needs to be “locking arms” with the existing CIO and existing infrastructure to avoid having parallel systems that create more work for clinicians, he says. “It’s not as though you can just completely reinvent medicine off on the side and flip a switch and ask providers and staff to immediately go and use that new model,” he warns. “You’ve got to figure out a way to shoehorn these innovations into the existing frameworks and allow providers and staff ways in which to transition to them.”

Innovation is a team sport. The CIO must always have a “transformational lens,” regardless the size of the organization. That individual must have a broad network of trusted advisers and the ability to engage all key stakeholders in decision-making. “When we decide to do something, everybody needs to have skin in the game,” she says. “It can’t be ‘IT failed’ and therefore the CIO is out the door.”

Give permission to fail. The CIO is expected to help the organization make disruptive changes that carry an inherent risk of failure. “Many of these things may not work out quite the way that we hoped and expected them to, and that’s okay,” Nigrin comments. “That’s the environment that we’re in now. Organizations that are willing to make attempts and fail a few times in the process are going to be the ones that hit upon the things that really do make a difference.”

Alignment is essential. Technology experts and physicians are both highly intelligent, but they don’t always see things in the same way. The CEO must make sure the technology team is aligned with the clinical and operational goals of the organization and that effective communication and collaboration is embedded in the culture. “Sometimes there is tension between the physicians and the technical leaders,” Levy warns. “There can be a little professional jealousy on both sides and, for the CEO of a health system, it’s important to make sure that doesn’t happen.”