Tuesday, October 22, 2013

Losing the Popularity Battle, but Winning the Career War

CIOs are typically not very popular and are not known for their charismatic leadership i.e.

How do you distinguish an introverted CIO from an extroverted CIO?

An introverted CIO stares at his shoes.   An extroverted CIO stares at your shoes.

In the past, I've been able to achieve reasonable levels of popularity through rapid innovation and responsive agile application development, often delivering discretionary projects to individual departments.

As I navigate FY14, creating project plans that allocate resources and time, it's clear that I cannot deliver any discretionary projects.   If the Main Thing about leadership is To Keep The Main Thing The Main Thing (Stephen Covey) then I have no choice to but to keep IS resources focused on the Federal regulatory agenda that has been prescribed for FY14 and nothing more.

Now that I'm back from China/Japan/Taiwan, I will accelerate my efforts to communicate with stakeholders at all levels that the Federal government has set the strategy for healthcare IT departments in FY14 and as unpleasant as it sounds, IT management and healthcare stakeholders really have no flexibility to prioritize departmental projects.    Here's what I mean:

ICD10 - this federal requirement is pass/fail and involves the entire inpatient/outpatient revenue cycle.   Every piece of software, workflow, and process needs to modified.    It will cost the country billions, have limited benefits, and should be considered high risk, given the coordination needed among payer/provider organizations.   It's bigger than Y2K for healthcare and has a firm October 1, 2014 deadline that no one in government is willing to change.    Assume ICD10 will consume a majority of your IT resources for the next year.

Meaningful Use Stage 2 - this federal requirement is focused on stimulus in the short term, but penalty avoidance in the long term.   Hospital margins throughout the country are slipping, so it's very hard to turn down millions in Medicare/Medicaid stimulus.    ICD10 trumps Meaningful Use work, but hospital management really expects IT departments to deliver Stage 2 Certified software for everyone to use.   Eligible professionals who have already attested to stage 1 are looking to IT departments to provided updated  software so they can attest and claim the remainder of their $44,000 stimulus.    Meaningful Use Stage 2 has a 2014 deadline for hospitals and clinicians who attested to Stage 1 in 2011.

HIPAA Omnibus Rule/Compliance and Audits -  not a day goes by without a new audit by someone - OCR, OIG, DPH, internal, CMS.   I've heard that some IT departments are hiring full time staff just to respond to audits.  As with ICD10, these audits have limited benefit and consume resources that would have been applied to innovation in the past.   However, the work must be done.

ACA - The Affordable Care Act has required many new IT applications - health insurance exchanges, health information exchanges, quality registries, care management systems, and business intelligence infrastructure.  The Affordable Care Act required work is likely to improve efficiency and value in American healthcare.   However, the work displaces departmental priorities by consuming resources that might have been applied to local workflow enhancement projects.

Business imperatives with deadlines that cannot be missed - Healthcare reform has spawned a flurry of mergers and acquisitions that include fixed IT deadlines such as opening a building, extending networks, installing phone systems, merging clinical data, and expanding email coverage.  Although these are beneficial, the effort to support mergers and acquisitions takes resources away from optimizing local workflow and infrastructure.

What is the implication for CIOs?   Spreading a message that ICD10, MU2, HIPAA/Audits, ACA, and mergers have consumed all available IT resources for the next year is not going to be popular.   I truly expect many stakeholders to acknowledge that these priorities are reasonable as long as their departmental needs are also met.   The needs of the many are good as long as they don't outweigh the needs of the few.   Unfortunately, the answer for the next year needs to be "not now" if institutional survival is the main thing.

So over the next few months, I expect my waning popularity to wane even further.   I will lose the popularity battle.   However, when the regulatory mandates are done and the institution's longevity is assured, my career will be intact.   Losing the popularity battle but winning the career war for the benefit of the institution sounds like right long term strategy but certainly will require strength of will, a thick skin, and constant communication.


Anonymous said...

It's nice to see someone with more credibility who is so candid about what's really causing the slow pace of US healthcare IT innovation (excessive regulatory burden.) I think it's possibly the most depressing thing about being in medicine right now.

-HMS3 (Would love to chat with you some time, if you ever get free time)

Medical Quack said...

Thanks for bringing a bit of reality into the forest, gosh knows it's needed. The average consumer has no idea as to what's on the plate of a healthcare CIO and that might even go further than healthcare these days. The government and public I think have almost gone beyond "bliss" when it comes to what is really going on with Health IT and there's a bunch of missing links here and you are right when you address the expense and of course vendors are going to keep pushing it to the edge with ICD10 and other issues as that's their profits and so the reality of a well engineered system gets skewed right and left.

I said thanks to health insurance exchanges that the government and the general consumer are learning a real cold hard lesson about the world of complexities with IT infrastructures today and in some areas we are kind of boxed into corners. I liked the old days of writing code before all went to the web as at least you could create solutions easier, but I'm not living in the past by any means as those days are forever gone and we live in the "connected" world today.

The politics of all of this have made it worse by all means and we have lawmakers and entities in government to include Congress that have no clue on how this all works. For at least a year I have been promoting the Sunlight Foundation of reinstating the Office of Technology Assessment for Congress as they would have a non partisan agency to help them understand some of this as all you have to do is read the news and it's apparent that there's some education lacking there and thus we end up with the political side shows. Maybe a bit of a rant but I said digital illiteracy is running hog wild in government today and both government and consumers are getting a real hard lesson in the realities of the complexities of IT infrastructures today that we live with and it's not getting any easier and the pressure on CIOs and technologies with the old thinking that solutions are "quickly" created still seems to permeate, perceptions that are not the reality of what we have out there today and that I feel keeps feeding the political cycles as they just don't understand.


Anonymous said...

John, doesn't this just further accelerate the trend towards departments creating their own tools, specifically mobile apps? If so do you think it's in the CIO's best interest to "go with the flow" by finding and recommending best do-it-yourself development tools.

Jim Thompson MD said...

The regulatory burden for the EHR was supposed to result in a single Main Thing: Better care, more efficiently delivered.

It has instead become its Own Thing: regulatory compliance. To your point, there are no resources left for anything else.

There is not a ghost of a chance that the government--however well meaning--can bring cost savings and improvement of care to our industry by centralizing developmental direction of the EHR. What was supposed to be a non-burdonsome oversight to drive better data exchange and reporting/analytics has instead become a bureaucratic monster that sustains only itself and accomplishes almost nothing of substance.

This Emperor has no clothes. It is time for more strong voices to join yours in acknowledging how stifling and unproductive is this regulatory burden. We have created a giant jobs program but we have nothing of substance to show for it that would not have been better accomplished simply by establishing a handful of key objectives (i.e. "You must be able to interoperably exchange the following 100 EHR data elements using the following vocabulary standard") and then letting the free market figure out how best to execute the objective.

Unknown said...

Thank you for this post, though I am a bit late in responding. Your message of focusing on the 2014 mandates and deferring discretionary work is sound and something that I am forwarding to other CIO's. Best of luck as you navigate your Organization through 2014 and beyond.