Where Art Thou, CIO?

by John Moore and Donald Trigg

CHIME, the trade association for health system Chief Information Officers (CIOs), changed their vision statement in 2015 to “Exceptional Leaders Transforming Healthcare”.

CHIME got it right: the opportunity for technology leadership has never been greater. And as Epic CEO Judith Faulkner stated in her executive address to UGM’22 attendees: “Healthcare is data.”

But the tough question is: will the CIO be leading this transformation?   

Forces of Change Accelerated By COVID

In The New Health Economy: Ground Rules for Leaders, a core contention is that the first order impact of any crisis is an acceleration of trends already playing out. Health systems were slowly transitioning to a digitally enabled enterprise over the last decade. Passage of the HITECH Act and Affordable Care Act (ACA) set these organizations on a forced march to adopt and use IT. COVID was a step-change accelerant.

Virtually overnight, health systems’ use of telehealth went from virtually zero to 60-80% of all visits. Such technology ensured patients received the quality care they needed during the shut-down. And while it was episodic, COVID proved the strategic value of a strong technology backbone — and strong technology leaders — for the enterprise.

However, while new roles in the health system C-suite have proliferated, less time has been spent on technology roles. Health system CEOs need to consider a more active and accountable role for their CIO: one of a leader with both technology and strategic chops. 

Business Strategy > Organizational Structure

There are three shifts, accelerated by COVID, that loom large: mergers and acquisitions among health system as they seek scale advantages; rising consumer expectations; and growing competitive risks.    

Over the course of the last decade, the size and scale of the top 100 health systems has grown. Banner Health is now as large in terms of revenue as Marriott. Providence Health is the size of Kraft Foods (The New Health Economy, p. 109). The recent announcement of Atrium combining with Advocate Aurora Health may be a harbinger of multi-region consolidation.

Second, customer expectations are growing larger — COVID being but one accelerant. The aging of the Boomers into Medicare is leading to increasing demands around experience. Employers and employees alike continue to seek better affordability. Generation Z — true digital natives that have a high bar for mobile-first engagement — will put these expectations into hyperdrive.

Finally, at nearly 20 percent of U.S. GDP, health care is a huge market with countless opportunities for both incumbents and new market entrants. Traditional competitive boundaries are blurring, with United Health Group now the largest single employer of physicians. Big caps — “out-in” players like Amazon and Walmart — are building physical-digital health network strategies of their own. Large inflows of venture and private equity capital are populating an entrepreneurial forest floor. Health systems are feeling the competitive heat. 

It’s Getting Crowded in Here

Health system CEOs and their boards have reacted to these market and competitive changes through C-suite addition. As CHIME was seeking to reimagine the CIO role, leading health systems were adding new ones that often overlap with traditional CIO responsibilities. 

The Chief Digital Officer is almost uniformly found across large health systems and leads the digital strategy for transformative business models. As the Chief Medical Information Officer is a data-focused complement to the Chief Medical Officer, the Chief Data Officer serves a similar role for the CEO. Finally, the risk of data breaches has given cybersecurity board-level visibility. The Chief Information Security Officer (CISO) manages that enterprise risk. 

Expanding business strategy has also elevated other C-level voices. The Chief Financial Officer frequently owns venture investment and value-based care partnerships. The Chief Marketing Officer is driving the consumer facing side of the health system, which is increasingly digital. The Chief Strategy Officer is managing multi-year planning.

All too often, this growing list of technology roles and C-suite stakeholders muddles operational ownership. This can stymie enterprise-wide decision velocity and introduces execution risk.

Clarity, Alignment, Focus

With the growing importance of technology and data to the enterprise, health system leaders must bring greater clarity, alignment and focus to the technology plan. It is not simply about adding new C-level roles; it is equally about role clarity and accountability.  

“Exceptional Leaders Transforming Healthcare”

Robert Frost talked about two roads diverging and pondering the direction to take. Scott Peck took it farther with “Road Less Traveled”. At this juncture, there are two ways forward.

The first is the CIO as Chief Infrastructure Officer. This is an essential enterprise role for managing the technology infrastructure and servicing the data and technology needs of key internal clients. But this role is limited and non-strategic.

The second road — The Road Less Traveled — imagines the transformative impact of information on the health system writ large. The Chief Information Officer becomes a transformative driver of the enterprise, leveraging data and technology to reimagine the delivery of care.

To remain highly relevant in the boardroom, the CIO of today and tomorrow must step up to take the strategic, technologic reins. It will require solid business acumen, an ability to build the business case for needed investment, and having the collaborative IQ to engage non-technical members of the C-suite to drive consensus. If CIOs do not develop such skills, they will be relegated to maintaining the infrastructure — basically “keeping the lights on”.

Will the CIO emerge as the strategic leader of needed health system transformation?  We are rooting for them to travel that less-worn path. In our minds, the soundings from CHIME in 2015 had the right ring.  The demands of the New Health Economy have never been greater, nor the need for transformative change more pressing. Who better than the savvy, strategic CIO to lead it? 

John Moore is the founder of Chilmark Research. Donald Trigg is the former President of Cerner Corporation and co-author of the recently released The New Health Economy: Ground Rules for Leaders (Georgetown University Press).