By John Halamka, MD
Twitter: @jhalamka
Over my 8 years of blogging (since 10/21/07) I’ve written many posts about IT leadership, career development and re-inventing yourself (something to do every 5-10) years. As a CIO for nearly 20 years, I’ve seen the nature of the role undergo remarkable evolution.
In the early days of my CIO career, it was really important to be a technologist. Networks were unstable, servers were unreliable, desktops were difficult to manage, most vendors did not have enterprise-grade products, and it was often challenging to make infrastructure buying decisions.
As products became more reliable, attention turned to functionality. It was really important to be an informatics expert to translate business owner workflow into application automation. As data became more digital and larger attack surfaces appeared, hackers found healthcare more attractive and it became really important to understand security technology/policy.
Once security was improved, interoperability because the major focus (and that is where we are today), since care coordination and reducing total medical expense requires population health, community-wide data sharing, and alerts/reminders between organizations.
As I’ve written about, interoperability is improving and with the new standards, enabling infrastructure, and refinements in policy, we’re headed toward a good place. What will be the next great challenge for CIOs? Governance, priority setting, and managing a portfolio of services, many of which will be procured, not provisioned.
What do I mean?
Let me start with a story. I live at Unity Farm in Sherborn, MA. Nearby is a ‘feed and seed’ supply store. Over the weekend I bought grain for the poultry and behind the counter, the saleswoman showed me the new retail management system she built for the store in one afternoon using off the shelf components from Apple, Square, and Amazon. She has comprehensive inventory control, full credit card processing, management information reports, supply chain controls, and security protections, all created for under $1000. Upgrades and new features are just a click away on the app store.
This is the new expectation in a world of IT consumerization. Long gone are proprietary systems from NCR and IBM. Long gone is the expensive maintenance contract, the need to call for service, and weeks long implementation. Such experiences in our every day lives with products that leverage mobile, cloud, and social networking technologies suggest to us that healthcare IT organizations should deliver with the same agility, efficiency, and low cost. How long does it take to build 30 servers, install all security controls, implement disaster recovery, add applications, and go live with licensed software – 6 months? a year? How long does it take spin up 30 servers fully configured with an application on Amazon Web Services? About an hour with zero capital investment.
The new expectations of customers will require CIOs to procure services such as hosting, storage, and application services rather than provision them locally. Upgrades will be continuous and instantly available for all customers of such services. Budgets will shift from capital projects to subscription operating expenses.
CIOs need to convene multi-stakeholder steering groups, agree on a finite list of important projects, and get buy in for the time/resources/scope necessary to deliver those projects. New regulatory/compliance requirements need to be ‘owned’ by the steering groups so that any external factor causing project delays is not considered an IT failure.
I’ve said before that in 5 years, the IT department will be replaced with the ‘Cloud Services’ department and the CIO will be the air traffic controller to identify and coordinate the services procured.
In my IT Town meeting, I outlined a vision for the future that includes new IT governance/steering/workgroups, new strategic planning and communication tools, and enhanced air traffic control. I promoted my second in command, Manu Tandon, to be the full time CIO at BIDMC Medical Center, enabling me to serve as the CIO of the BIDMC System, which I’ve been doing part time.
The work ahead will be exciting and different. In just one organization, I’ve experienced a journey as engineer, informatician, security officer, interoperability expert, and now air traffic controller/cloud broker, ensuring that we have all the planning processes in place to be successful in every part of the BIDMC empire.
Manu will bring new focus to BIDMC’s governance, priority setting and portfolio management. There will be many blog posts to come about his efforts at the academic medical center and my efforts in the heterogenous system of care that includes community hospitals, primary care practices and urgent care clinics. The adventure awaits.
John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.