Edward Marx, Healthcare CIO Of The Year

Texas Health Resources CIO Edward Marx started his career with a commitment to healthcare, not technology, but he settled on promoting the effective implementation of technology as the way he could make the biggest contribution to healthcare.

Figure 1: Edward Marx, CIO
Texas Health Resources

Last week, he was named the recipient of the 2013 John E. Gall Jr. CIO of the Year Award, which will be presented at the Annual HIMSS Conference and Exhibition in Orlando, Fla., on Feb. 25. The winner was selected by the boards of the Healthcare Information and Management Systems Society (HIMSS), the healthcare IT leadership organization; and the College of Healthcare Information Management Executives (CHIME), which is specifically for CIOs. Marx is senior vice president and CIO at Texas Health Resources in Arlington, one of the largest faith-based, nonprofit healthcare delivery systems in the United States and the largest in North Texas by patients served.

In an interview earlier this week, Marx said the award was as much a reflection on all the people he works with as on himself. "Even though I'm not an IT person by training, I am a leader," he said. He has succeeded by surrounding himself with good people and by understanding the business and clinical aspects of healthcare well enough to know how technology can contribute.

Marx got his first hospital job in high school working as a janitor and saw healthcare as an industry he wanted to be involved in "because it's about people -- about helping people." When he joined the Army Reserve to help pay for college, he initially wanted to be a combat medic for that reason, although he wound up as a combat engineer instead. "As I was in school, it became clear I wasn't going to be a doctor or anything like that," he said.

Still, when it came time to pick a civilian career, he chose to become an anesthesia technician. It was a job that was probably below what he was expected to take as a college graduate and Army officer, "but it got me in the door and gave me some experience in a clinical setting." From there, he sought out a variety of leadership roles -- until the day a personal crisis focused his attention more sharply on technology.

Technology becomes personal
"I had a very personal event, where a child of mine was born in very difficult circumstances, and it was actually technology that saved her life," Marx said. You can read his blog post about the experience, but here's the short version he shared with me: "My daughter was born without life. They resuscitated her, but then we were faced with a major choice: whether to take her to a children's hospital a couple of hours away where she would get better care, but there would also be a lot of risk from the flight. My wife was also hospitalized from trauma associated with the birth." He didn't want to separate mother from child or take unnecessary risks if he could help it.

All this happened in the hospital where Marx was working at the time as a physician services coordinator and had just begun to do some work with the hospital's IT group. The doctors at the children's hospital said they could consult remotely if given an automated way to collaborate, but this was in the early 1990s when such things were not common. Yet Marx and the IT team figured out a way to make it happen over a 2400-baud modem.

"We were able to give the physicians at the childrens hospital access to dial into our clinical systems and consult in real-time, see all the data while they were talking with the docs at our hospital." With that remote assist, his daughter survived the crisis. This year she turned 18.

"That really was a trigger point," Marx said, an event that showed him the potential of health IT to make a difference in people's lives. He has also blogged about a more recent event, the death of his mother, and how seeing the shortcomings of the information available to her care team made him recommit to achieving what he calls "meaningful, meaningful use" of health IT.

First to achieve "meaningful use"
As a healthcare technology leader, Marx says it's his job "to enable superior business and clinical outcomes." He took on his first CIO role at Parkview Medical Center in Pueblo, Colo., and later served as CIO of University Hospitals of Cleveland, with another IT leadership role at HCA in between. He arrived at Texas Health Resources as CIO in October 2007.

"I always had a great team, but when I arrived at Texas Health, everything came together -- an excellent organization, a very proactive culture, a great team of leaders, and a great IT organization. While I had leadership capabilities, it was really those things coming together that made the difference."

One key achievement: "We implemented EHR very, very well, and at the time we did it, five or six years ago, most people did not implement well. We were first in the country -- or tied for first in the country -- to achieve meaningful use," he said, referring to the federal incentives program for effective use of health IT. Texas Health implemented Epic electronic health record software across a network of 14 hospitals.

The Texas Health IT team also has received a number of awards for innovation, most recently the HIMSS Davies Award.

Perhaps more importantly, the most recent physician engagement scores, a measure of satisfaction with IT systems, are well over 90%, he said. "That's ridiculously high," he chortled. "Physicians, for one thing, are very difficult to satisfy, so to have that level of satisfaction with IT systems is pretty unheard of." Broader surveys of hospital users, he told us, put satisfaction at over 80%.

Making a national mark
"I'm not a big techie, but I believe in surrounding myself with knowledgeable, excellent people, including excellent technologists," said Marx. "I also have a national perspective. I blog a couple of times a month, and those blogs are very, very popular. Most of my blogs are about leadership and developing leaders. It's one thing to do healthcare IT well, within your own organization -- that's really good, that's really important -- but if you really want to make your mark, you need to go outside the boundaries of your institution. To add value externally, to others -- that's like the ultimate to me."

Awards like the ones from HIMSS and CHIME "are a good sign for me that I am making that mark," said Marx. He has been active in both HIMSS and CHIME, as well as taken on state-level health IT leadership roles. Since 2008, he has chaired the Texas Health Services Authority, a public-private partnership for health information exchange.

Marx is also proud that several of his former direct reports are now CIOs in their own right, while another was recently named COO and is in line to become a hospital president.

Asked why the Texas Health's EHR project succeeded as well as it did, Marx first pointed to the organizational culture embodied in the slogan "individuals caring for individuals, together." When implementing something hard like an EHR system, it's important to have people committed to working together to achieve a positive outcome, rather than finding ways to resist change, he said.

The second thing that made a difference was strong physician leadership. "At the time, I had physicians on my team -- a CMIO [chief medical information officer] and two deputy CIOs. They're the ones who led the project."

The IT team includes nurses and other clinicians as well who can talk peer-to-peer about programs like computerized physician order entry. "You don't want the CIO out there telling people the benefits of CPOE -- that's ridiculous. I would have our CMIOs do that."

That emphasis on peer-to-peer education about technologies is a change he instituted early in his tenure. When he first arrived, the IT organization was in the process of educating or marketing the coming EHR implementation with a series of videos, which featured the previous CIO talking about the wonders of the technology. Marx got rid of all that and made clinicians the stars. "The less visible the CIO, the better, when it comes to the clinical organization."

Justifying the budget
Another way Marx has been leading is by trying to change the relationship between the IT organization and the people who fund it, with what he calls evidence-based budgeting. CIOs typically present a budget based on all the things they would like to do, while warning of the dire consequences of what will be missed if they don't get the funding they want, he said.

"It's all sort of true, but it's all sort of gut. But we're in the era of analytics now. We're all about electronic health records and how do you pull levers to increase quality and decrease costs. We do all that with data. So why aren't we taking our own medicine and relying on data to make our point when it comes to budgeting? So finally I said, 'Let's stop all this nonsense.' If we can take the same tools we use for analytics and apply them to budgeting, then we take all the emotion out of the argument."

The IT budget at Texas Health is bigger than the budgets of some of its hospitals, Marx says. "The question is, how do you prove you're being a good steward of that money?" His strategy is to start budgets at zero and "build from the ground up" to show how much money is needed for each function, demonstrating along the way how efficient that operation is.

"This is new in the past two years, and it's been really helpful. Usually, we used to go through the budgeting process 10 times where you had to go back and cut. Now, I think we've been through maybe one instance of that."

While some other healthcare CIOs bemoan the number of regulatory deadlines they face in 2014, Marx doesn't think this year will be so different for his organization. "Because we were a little bit ahead of time on some of these things like electronic health records, [we have a] little more freedom to work on some forward-looking things like mobile health, population health management, care management, transitions -- those sort of things. So it's going to be an exciting year."

Texas Health is already working with a couple of accountable care organizations and expects to add some additional ones, while "really doing progressive things with population health," says Marx. "I'm so happy and thrilled to work in healthcare IT -- it's always changing and really improves people's lives."

David F. Carr is the Editor of Information Healthcare and a contributor on social business, as well as the author of Social Collaboration For Dummies. Follow him on Twitter @davidfcarr or Google+.

Though the online exchange of medical records is central to the government's Meaningful Use program, the effort to make such transactions routine has just begun. Also in the Barriers to Health Information Exchange issue of InformationWeek Healthcare: why cloud startups favor Direct Protocol as a simpler alternative to centralized HIEs. (Free registration required.)