Guerra On Healthcare: The Art Of Being A Medical CIO

Today's tech leaders aren't judged on what they know about the technology but rather on who's happily using it.
The more CIOs I interview, the clearer it becomes that those executives are only superficially connected to the technology many think of as their second language. Don't get me wrong, they knew the technology when coming up through the ranks, and they have people who really know it working for them, but it's no longer their responsibility to jump into the programmer's chair and start banging away at the keyboard if someone calls in sick.

Today's healthcare CIOs are adept in the use of "soft" power, wielding the tools of consensus building, persuasion and coalition creation. They aren't judged according to their ability to select a technologically sound system, get it up and running and ensure infrastructure stability. Of course, they must do all of those things, but they don't get gold stars for that. Today's CIOs are judged according to only one measure: Are the physicians using the organization's e-medical record (EMR) and computerized physician order entry (CPOE) systems?

This one-criterion judgment is similar to how people gauge the success of a president—according to one measure that individual has little control over. In the case of our national leader, it's often about whether the economy has improved. In the case of CIOs, it's about physician adoption of advanced clinical applications to record care and issue directives.

With that end in mind, savvy CIOs are charting a course to reach the CPOE "pot of gold," as one whom I recently interviewed called it. Step one in this journey is defining what kind of hospital or health system the institution wants to be. If it's a standalone community hospital with 200 beds, a particular approach comes to mind; if it's a multihospital, multiclinic health system with its own ambulatory practices and no lack of cash, another makes sense.

After the CIO comes up with a short list of about five vendors, it's time to bring in the clinicians so they can pick the one with the most comfortable user interface. Why not bring them in at the beginning? Simple, because clinicians want what's best for their particular specialty or department, leaving the CIO stitching together dozens of apps with as many interface programmers—not an appealing scenario.

But they had better not give the clinicians too short a list, lest they feel left out of the process. Give them a nice choice of applications to review and let them make the final decision. By making them responsible for picking the system, doctors will feel bound to use it.

Be very public and transparent about the selection methodology so they know their input made the final decision. There's no use going through the exercise if they ultimately feel IT stuffed the ballot box to get its favorite toy, or finance rigged the election to get the cheapest one.

Now, it's time to put together a rollout and implementation plan. During this critical time, CIOs must keep one thing in mind above others: Make sure physicians are never going to be embarrassed using the system. They're people too, and then some. By that, I mean we're all sensitive to being embarrassed and, once a victim, will turn against whatever caused the embarrassment and those involved with making it happen. If anything, physicians are more prone to this sting. It's the CIO's role to develop an implementation plan with enough education so no doctor can claim they've been set up for failure.

The CIO role requires sophisticated project management, effective use of soft power and, yes, a high-level understanding of technology principles. But what's key is appreciating that the real measure of success is technology adoption. Understanding how to achieve it on paper may be a science, but noticing that a physician is struggling to enter an order and quietly providing some assistance is an art.

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected]

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