Healthcare IT Leadership: Boiling The Frog

Is the job of the CIO becoming an impossible one?

John D. Halamka, MD, MS, Professor, Medicine, Harvard Medical School; CIO, New England Healthcare Exchange Network

November 19, 2013

4 Min Read
Photo: © 2010 <a href="">J. Ronald Lee</a>. (Creative Commons, CC-BY)

In October of 2013, I had the opportunity write a book about healthcare IT leadership, national IT policy, and work/life balance.

As I assembled its 300 plus pages, I read through all my daily social media posts for the past decade. I re-experienced the challenges, difficult decisions, and conflicts of my career. Along the way, I realized that life as an IT leader is just like boiling the frog.

Although not literally true, some leaders describe the unwillingness to react to significant change by noting that a frog placed in boiling water will jump out, but a frog placed in cold water that is slowly heated will be cooked to death.


IT professionals have experienced constant change so gradually over the past decade that we're not aware of the boiling water we live in every day.

The pace of change is accelerating to the point that scope, time, and resources can no longer be balanced with demand, expectation, and sustainability.

Here are a few examples.

The scale of our work is expanding exponentially. At a recent securities analyst meeting, HP CEO Meg Whitman noted that from the beginning of time until 2003, mankind created 5 exabytes (5000 petabytes) of information. Today, we create that much information every 12 hours.

Technology life cycles are increasingly short. In 2009, my entire enterprise communicated via Blackberry. Today, we have less than 10 Blackberry devices left in my organization.

The burden of regulation is crushing. Since I have been a CIO (1998), over 70,000 new federal regulations have been enacted, consuming over 350,000 pages of the Federal Register. These regulations have replaced innovation and have become the all-consuming majority of our daily work.

Expectations are challenging to manage. Today, I have under an hour of downtime per year and no data loss. I'm asked how I can sleep at night, given the damage to the organization done by that hour of downtime.

Miracles are harder to achieve. So you run a cloud-hosted, mobile friendly, software-as-a-service enterprise, with high security and low cost. Boring. Isn't there an app for that?

If we compared our jobs in 2013 to our jobs in 1998, we'd leap out of the boiling water. However, the journey from 1998 to 2013 has been so gradual that we're just enjoying the warmth of being slowly cooked every day.

What are our choices?

1. Give up -- The job of an IT leader may soon be impossible given the mismatch of supply and demand, agility imperatives, and technology expectations. Farming sounds good.

2. Change the rules -- Work with all our stakeholders to reduce burdensome regulations, reduce the scope of services, and more aggressively manage demand by limiting functionality/choice. All of that sounds good and may work over the long term, but it's as politically impossible as asking Congress to work together in the interests of the greater good.

3. Outsource the problem -- If IT leaders become managers of outsourced services, they can always put the pressure and blame elsewhere. Although this sounds good, my experience is that the cloud is just "your mess, outsourced, with less reliability." Users ultimately blame the local IT leader for any outsourcing issues.

4. Acknowledge that burn out happens -- Expect higher turnover rates/shorter life cycles for IT leaders. As a volunteer leader of many Washington activities, I've watched many colleagues begin their tenure with energy and conviction, only to crawl away after two years of government service. With fresh energy through leader replacement every few years, maybe the pace will be sustainable.

5. Spread the burden via delegation -- In my view, the role of a leader is to hire delegates to do the work the leader is accountable for. The work of the leader should be to serve the delegates and support their success. Since I believe the role of CIO is no longer viable in many industries, a reasonable choice is to break up the position into an "Office of the CIO" containing a Chief Information Technology Strategy Officer, a Chief Technology Officer, a Chief Administrative Officer, a Chief Information Security Officer, and a Chief Innovation Officer. With five people to replace the work of one, the burden of any issue or event is shared. Accountability per person is reduced to manageable chunks, and coverage is available by the team to improve everyone's work/life balance.

My advice to the industry is simple. We're boiling the frog, and we may not notice the psychic and physical damage we're experiencing as IT leaders. It's time to rethink the role of the CIO and create a scalable team to do a job which has become impossible.

Remote Patient Monitoring: Don't let all those Fitbits fool you. Though remote monitoring technology is sound, it's still far from widespread clinical adoption. Read the new InformationWeek Healthcare Digital Issue.

About the Author(s)

John D. Halamka

MD, MS, Professor, Medicine, Harvard Medical School; CIO, New England Healthcare Exchange Network

John D. Halamka, MD, MS, is a professor of medicine at Harvard Medical School, Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the national HIT Standards Committee, Co-Chair of the Massachusetts HIT Advisory Committee, and a practicing Emergency Physician. As CIO of Beth Israel Deaconess Medical Center, he is responsible for all clinical, financial, administrative, and academic information technology serving 3,000 doctors, 14,000 employees, and 2 million patients. As Chairman of NEHEN, John oversees clinical and administrative data exchange in Eastern Massachusetts. As Co-Chair of the HIT Standards Committee, he facilitates the process of electronic standards harmonization among stakeholders nationwide.  As Co-Chair of the Massachusetts HIT Advisory Committee, he engages the stakeholders of the Commonwealth to guide the development of a statewide health information exchange. 

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