CIOs (10)

Thirteen CIOs from leading USA healthcare organisations joined the annual Scottsdale Institute 2015 Spring Conference CIO Breakout session. They pondered eHealth optimisation, and came up with seven ways to achieve it. The report says they’re:

  1. Work with senior leadership teams to define optimisation for your organisation
  2. Prioritise optimisation processes for your organisation’s vision and strategic priorities
  3. Develop methods to differentiate the need for increased adoption of current build with training and support from needs to optimise work flows or ICT build
  4. Create multidisciplinary teams including people from operations, ICT and performance improvement teams to maximise optimisation efforts
  5. Develop effective methods to roll out optimisation
  6. Stay attuned to changes in healthcare’s environment and develop an agile and flexibility capability
  7. Develop Key Performance Indicators (KPI) to measure the success of your optimisation endeavours.

With this emphasis on optimisation, it’s important to be clear on what it is. The Scottsdale breakout group says that optimised ICT should minimise the intrusion and impedance of information system to patient care workflows, while simultaneously providing a platform and supporting for operations. The group estimates that ICT’s hardware is only 25% of its activity.

There’s a requirement on executives too. Optimized information systems require healthcare organisations to shift from traditional silo working, to working in multidisciplinary teams to achieve streamlined workflows and processes supported by ICT that mirrors and automates workflows and enhances patient care by presenting information that users can quickly convert into right action.

Much of this has been said many times since the turn of the century. That CIOs need to keep saying it seems like a sign that it’s extremely difficult to achieve, especially as the ICT component of eHealth keeps moving ahead. It’s an important lesson for African countries.

In his blog in the CIO Journal, part of the Wall Street Journal (WSJ) John D Hamalka, CIO at Beth Israel Deaconess Medical Center, says that choosing and using a cloud vendor needs a strict assessment. CIOs must be sure that the service is updated frequently, updates are relevant and important and that security is rigorous but doesn’t limit functionality.

CIOs mustn’t transfer their data problems to the cloud. They should fix them first. The cloud doesn’t provide automatic solutions to internal problems and challenges of the combination of business processes, people, and technology. He sees the objective here as Outcomes as a Service (OaaS), an initiative as a variation to Software as a Service (SaaS).

SaaS is a software licensing and delivery model where software is hosted centrally and licensed to users for subscription. Hamalka sees procuring cloud services as similar. It’s widely used for management and specialised information.

It’s part of the cloud offering alongside similar concepts, such as infrastructure as a service (IaaS), platform as a service (PaaS), desktop as a service (DaaS), backend as a service (BaaS), and information technology management as a service (ITMaaS). These tend to describe resources. With Hamalka’s OaaS concept, it helps focus on the benefits and performance of the cloud.

As Africa’s healthcare looks increasingly to the cloud for some of its ICT investment, performance is a vital criterion. Ministries of health could develop and expand their own OaaS version.

Implementing an Electronic Health Record (EHR) system is tricky. They are costly, and sometimes don’t deliver all the promised benefits. For African countries with their very limited resources, optimising their EHRs is critical. A report in Healthcare IT News summarises a paper by the American College of Physicians (ACP) Medical Informatics Committee offering twelve recommendations for clinicians, hospitals, ICT vendors and policymakers to improve clinical documentation and EHRs themselves.

ACP’s recommendations for better clinical documentation are:

  1. The primary purpose of clinical documentation is to support patient care and improve clinical outcomes through better communication
  2. Physicians should work with their care delivery organisations and medical societies to define professional standards and practices for clinical documentation
  3. The primary purpose of EHRs is to facilitate patient care, improve outcomes and contribute to data collection for analyses
  4. Structured data should be captured only where it’s useful or essential for quality assessment or reporting
  5. Data content and formats for prior authorisations and l other documents needed by other entities should be standardised
  6. Patient access to doctors notes and their EHRs may provide a way to improve patient engagement and healthcare quality.
  7. ACP also calls for further research to:
  • Identify best practices for systems, improve information accuracy and records and the value of information presented to other users
  • Study the authoring process and encourage the development of automated tools that enhance documentation quality
  • Understand the best way to improve medical education and learning so that clinicians can keep track of the growing uses of health information technology and recognise the importance of their responsibility to document their observations completely, concisely, accurately and in a way that supports their reuse
  • Determine the most effective methods of disseminating professional standards of clinical documentation and best practices.

Its suggestions to improve EHR design are:

  1. EHR developers need to optimise EHR systems to facilitate longitudinal care delivery
  2. Clinical documentation in EHR systems must support clinicians’ cognitive processes during the documentation process
  3. EHRs must support the concept of write once, reuse many times to identify the original source of information when used after its creation
  4. Wherever possible, EHR systems should not require users to check a box or indicate that an observation has been made or an action has been taken if the data documented in the patient record already substantiates an action
  5. EHR systems must facilitate the integration that patients generated, and must maintain the identity of the source.

These firm tips and ideas enhance the usability and outcomes of EHRs. They offer African countries an invaluable check list that they can apply during supplier assessments and procurement.

A few CIOs met at the Scottsdale Institute. Information security was one the topics they discussed; and they’ve set out three core requirements in Information Requirements for the Competitive Healthcare Marketplace Strategies from the Scottsdale Institute 2014 Fall CIO Summit.

With the growth in healthcare cyber-attacks, it’s a constant high priority. The CIOs’ view is that it’s not a matter of if their health systems will be breached, it’s when. Maybe how could’ve been added. They came up with three core strategies:

  • Implement end-to-end security standards and focus pro-actively on protecting data by working with suppliers to design and outline end-to-end security standards
  • Train end users on information security practices and monitor compliance with policies
  • Proactively monitor using security logs and network endpoints for unusual patterns and be able to respond promptly to security breaches.

African countries may not currently experience the same proportions of cyber-crime as the USA. If they don’t monitor it, it remains unknown. As eHealth expands, it’s likely that cyber-crime will expand with it. This short amount of time gives African countries a good opportunity to tool up.

As eHealth expands with innovation, creating more opportunities, and sometimes more problems, how does CIOs keep up and develop their roles? Randy Davis, CIO and vice president of support services at CGH Medical Center in Illinois has a few ideas in an interview with Becker’s Health IT and CIO Review

He says:

  • The biggest challenge is putting the right team together. It’s about the people
  • The budget for eHealth operations is about 4.1% of CGH’s total budget
  • The budget percentage for data security and general securityis paltry at less than 0.5%, excluding security improvements embedded in upgrades and network replacements where data security is part of each eHealth project
  • CIO’s should stop seeing themselves as the head geek and should be part of the clinical teams in identifying and anticipating the eHealth resources they need
  • CIO’s should recruit the right people then agree explicit, clear goals with them
  • Don’t use governmental regulations as an excuse for eHealth initiatives
  • Leadership experience in healthcare is ther most important attribute for CIOs
  • There’s not one greatest eHealth, there are several:  helping CEOs and boards understand the need for sustainable eHealth resources, implementing a coherent strategy to integrate  different systems to make life easier for clinicians, recruiting the right people, finding finance to meet users’ expectations
  • CIOs need a broader knowledge of healthcare.

How do you compare with Davis’s profile? Are you a head geek, eHealth leader, or a bit of both? Clinicians, executives and managers will still turn to CIOs and their teams for ICT and informatics knowledge and information. They’ll also need CIOs to lead them through the eHealth morass of choices and solutions as part of healthcare transformation. What they don’t want are CIOs who believe that “There are 10 types of people in the world: those who understand binary, and those who don’t.”

For years, business entities have had CFOs and CIOs. By now, it seems reasonable to expect that they should have worked out how to work together for the good of the business. It might be a bit surprising that CFO, an online journal, has a post saying that CFOs and CIOs need to collaborate and understand each other to maximize their companies’ performance.

Relationships between CIOs and CFOs have changed over the years. With technology increasingly embedded in businesses, the two positions need to understand each other more than previously.

CFOs are growing in their roles as technology influencers, according to the 2013 Gartner FEI CFO Technology Study. It found that 44% of respondents said their influence over ICT investment had increased over the last two years, and that 39% of ICT organizations report to the CFO.

The CIO and CFO relationship can range from friction to respect to collaboration. CFOs want a return on investment, not a top priority for an ICT department. They can also differ on how much to invest in new technologies, and CFOs who do not have a good relationship with the CIO will remain ignorant to where technology is headed and what it can do for the company.

So far, so tricky, but it is not enough. All this is in addition to the CIOs’ new relationships with CDOs, reported by ehna. It seems that the CIOs working life may be managing a new set of working relationships and their companies’ information and ICT too. It also means that CFOs need to develop new relationships with CDOs and marketing directors, a new link that the post does not deal with.

All this change needs superb executive leadership. The CEOs are the central players in this. They have a role in managing and developing the working relationships in their executive teams. For eHealth, this extends to political and clinical leadership too.

ID is more than identity. Business is starting to see it as two distinct roles, information and digital, according to a report in the Financial Times (FT). It seems that the D bit is becoming popular with companies. Gartner, a global ICT research company, distinguishes I and D as CIOs doing ICT strategies that support companies; business strategies. CDOs do digital strategy aiming to change the business to take advantage of new digital opportunities, such as social media and big data.

George Westerman, a research scientist at Massachusetts Institute of Technology (MIT) Sloan’s Center for Digital Business, a USA-based research partnership with industry, says that “There is an awful lot of angst in the CIO community, as they feel they could become subordinate to the CDO role”. The FT report goes on to say that the CDO could take over the CIO role, or, the CIO role could become less attractive, running legacy systems running, while the CDO does the big-picture strategies and plans. Others think that CIOs will survive the CDO cuckoo in the nest. A good scenario is collaboration between the two roles.

The Economist covers the Gartner report too. It has more examples of the CIO v CDO roles.

Ehna has recently identified the possible impact of big data and analytics on health informatics. If the commercial sector is experiencing it now, healthcare will on a few years. This gives everyone time to prepare. How long will it take for the first CDO to turn up in one of Africa’s health systems?

As eHealth progresses steadily towards the horizon, like all expeditions, the horizon manages to maintain its distance. This is true for eHealth, but the Harvard Business Review (HBR) says that the role of the CIO is changing too, making the horizon’s perspectives more complicated to grasp. CIOs are seen as coping with five generations of workers; digital natives, digital immigrants, digital vagabonds, digital voyeurs, and analog holdouts. But, it seems they are simultaneously transforming themselves along a Darwinian continuum towards Chief Infrastructure Officer, Chief Integration Officer, Chief Intelligence Officer and the ultimate conversion to Chief Innovation Officer, conveniently, all CIO, so no need to change abbreviation on the office door. They are wrestling with three concepts; organizational DNA, accountabilities and budgets, and complaining of a trend of CIOs being accountable to Chief Financial Officers (CFO). As if this is not complicated enough, there are four drivers of change that they can operate in as leaders: 

  1. Cautious Adopters (50%)
  2. Market Leaders (5%)
  3. Laggards (30%)
  4. Fast Follwers (15%).

Two themes make this fascinating for eHealth News Africa:

  1. The combined percentage of marker leaders and fast followers of 20% closely matches the 21% of SSA countries that top Greenfield’s combined eHealth Regulation Readiness Index (RRI), so eHealth in Africa may not be that different to a global ICT profile
  2. What does all this mean for CIO’s in Africa who are facing wide-ranging eHealth challenges every day? What kind of CIOs and eHealth leaders do they have to become to succeed in the future?

eHealth News Africa will be exploring these issues with articles on leaders and leadership.

Woody Allen said, “I am not afraid of death, I just don’t want to be there when it happens.” The increasing fear and anxiety now generated by cyber security may encourage CIOs to adopt a similar aspiration about breaches. It is not just a technology challenge. Increased costs of cyber-security and regulation pose the classical question for eHealth decision-takers. How do I afford cyber-security and still have the sustainable net benefits from eHealth?

Now that cyber-security and regulation are rapidly climbing the eHealth priorities chart, the economic and financial implications are becoming a bit clearer. The first approach is to adopt the eHealth definition that tinTree uses: ICT and organisational change. Generally, ICT is just less than half the cost over a ten-year timescale.

The economic analyses of eHealth over the last decade generally reflected security as part of the cost of ICT and compliance with regulation as part of the cost of change, mostly through training. Acfee has reviewed its eHealth economic database of 57 eHealth economic evaluations and updated its model. Relative to the total cost of ICT and change, the cost of better cyber security and regulation compliance are not high. Effective eHealth has high net benefits, the socio-economic return (SER). This is resilient to the extra costs over long timescales. The SER is a bit lower, and the time to reach a net a few months longer. Good eHealth is still good value for money. For weak eHealth, there is no hope. The bad value for money just deteriorates.

Affordability is the biggest challenge. Where do organizations find the money? African countries have few choices. Their main one is to review their eHealth strategies and investment plans and redeploy finance by changing the pace of change. If cyber-security is minimal, the eHealth risks rise and new eHealth projects start to look a bit shaky: not a good place to be. eHealth News Africa will report on the effect of increased risks for eHealth decision-taking in a few days.

The next step is for the cyber-security experts to provide estimates of better performance that tinTree can use to refine the prospective data its eHealth economic model described in the eHealth News Africa story costs, benefits and economics of eHealth.

It’s an expanding practice, and healthcare CIOs and regulators need to respond to it. New technologies bring new practices, leading to anxieties then guidance to help to calm the nerves of custodians.

For Bring Your Own Devices (BYOD) guidance is plentiful. Two examples are from Kony, a platform provider that empowers developers to build apps, and mas360 by Fiberink, a firm providing enterprise mobility management solutions. They both have White Papers proving guidance for BYOD.

Kony’s Mobile Application Management Meeting the BYOD challenge with next-generation application and device management sets out five principles:

  1. Management primarily at the application, not hardware or firmware layer
  2. Management based on policies, rules and roles
  3. Management as collaboration
  4. Configure once, run everywhere
  5. Visibility everywhere.

Maas360’s White Paper The Ten Commandments of BYOD has, predictably ten measures

  1. Create Thy Policy Before Procuring Technology
  2. Seek The Flocks’ Devices
  3. Enrollment Shall Be Simple
  4. Thou Shalt Configure Devices Over the Air
  5. Thy Users Demand Self-Service
  6. Hold Sacred Personal Information
  7. Part the Seas of Corporate and Personal Data
  8. Monitor Thy Flock—Herd Automatically
  9. Manage Thy Data Usage
  10. Drink from the Fountain of ROI

This type of guidance gives healthcare CIOs and regulators in Africa a quick start to the issues and practices they need to deal with BYOD and its continuing growth constructively. Downloading the White Papers needs registration.