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."
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.)