As the printing press fueled a transition from the Dark Ages to the Renaissance, Social Networking (SN) will be the transformation catalyst of our century. Johannes Gutenberg invented movable type to improve the production of books, which at the time were handwritten. He altered history. Seeing that SN could have the same power to enhance life as we know it -- from personal and private lives to science, business and culture at large -- I have thrown open wide the gates of SN.

As with any type of reformation, new ideas will encounter opposition, even violent reactions. Traditions and the philosophy-of-the-day are challenges to overcome. Sections of the population will fail to adjust; others will dedicate their lives to discouraging and resisting change.

I don't blame or look down on any who question today's technological advancements, or changes. SN in particular. Resistance is natural, understandable. Sometimes it comes from personal discomfort -- having to learn something new. Other times one is simply trying to make sense of SN in the confines of the corporate structure, assessing benefits, costs, risks and productivity. As with all things new, proceed with caution.

But the operative word is proceed.

I am a proponent of SN for a variety of reasons, both personal and professional. Although I will focus on the professional aspects, I do not subscribe to the theory that there is a distinct separation between the two.

Why SN?

Training. All over the country we are implementing electronic health records and other disruptive technologies. One significant barrier common to all is a lack of basic computer skills, especially amongst older workers. I speak with many clinicians and I can tell you that those active with SN have an easier time adopting computer-related technologies. The fear of the unknown has been removed. So, if it's FaceBook that helps them to grow comfortable with how computers work then let's be friends!

Recruiting. My division reaches out purposefully through multiple SN media. We have already recruited a couple individuals via FaceBook and LinkedIn. Potential candidates see our organization as innovative and our leaders as active with SN. They capture a glimpse of the culture and openness. Our institutional Fan Page has also drawn many, and sharing the benefits of a career with our organization on YouTube and Twitter is also bearing fruit.

Employee engagement. Transparency accelerates relationships and engagement. This past week, one of our 18,000 employees reached me through the chat feature of FaceBook. In summarizing her words, this person saw my profile and determined that I was safe to approach. She shared with me some circumstances in her life, and I was able to help her. This interaction significantly exemplified the promise our organization holds dear: "Individuals caring for Individuals, Together." Since we have moved toward a virtual office environment, SN keeps us connected with one another. We can see what is taking place in each other's lives so when we do meet, we can skip the small talk about weather and touch on more meaningful subjects.

Educational community. Weekly, someone reaches out directly to me for assistance. If asked questions specific to medicine that I can't address, I connect them to the proper authority. Other times, I've assisted college students with projects related to health care information technology. On the receiving end, I regularly access information about the latest in our field that helps me develop professionally and add direct value to my employer and customers. I have greater choice and flexibility in how I aide my development.

Transformation. We need constant input of various sources to enable transformation. The confluence of ideas and innovations is what often lead to a Glorious Mashup. SN is the ideal tool to receive and share a wide variety of information that will lead to the next small and big change. I process and apply what I take in on a daily basis. With SN there are no limits or boundaries.

Culture. As much as we resist, we have new generations entering the workplace and they are looking for a new kind of organization and leader. SN is an effective venue to demonstrate the transparency, flexibility, and collaboration required to successfully compete for talent.

Fear. The root motivator that causes administrators to seek tighter controls. Choruses for restrictive policies often become the norm. Critics cite loss of productivity, too much openness, and security risks as reasons to abstain. Resistance based on these judgments doesn't outweigh the benefits. Check what's happened recently in Iran. Leaders can no longer legislate values or write policies to seek control. People are relying more on influence and leadership than on strict rules and regulations.

The road to SN is frustrated by hedges of fear and hurdles of tradition, thus a CIO needs to lead the way confidently and smartly. Follow generally accepted SN guidelines as you advance through the opposition. Expose the lack of understanding in institutions stuck in conventional wisdom of the past.

Still hesitant? Consider a recent exchange I had with a CIO colleague who works where SN is forbidden. I sent him a birthday greeting via FaceBook; he replied shortly thereafter. How? Via his hand-held of course! Even where SN is shut down, people still find ways to engage. The advanced world is moving toward SN. No one can stop it.

Don't be left behind. Worse yet, don't let your organization fall behind. Lead the way!

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

I ran a "night before vacation" errand to Lowe's. As I completed the purchase, the store manager interrupted on the overhead, "Employees and customers, head immediately to the break room. A tornado has been spotted and is headed our direction."

The tornado never materialized and we were cleared to leave. The rains were torrential, coming in successive waves, each one more violent than the previous. The storm died down but then kept returning. Over the next 24 hours, we had enough rain and lightning to shut down the airport for several hours, delaying our trip...which gave me time to create this post. We may have set a record for precipitation. I don't believe we will need to water our lawn for the rest of the summer.

There is another type of watering that does not saturate but dilutes. We use concentrates that require adding water to dilute the mix, making it less powerful. Coffee is a good example. I like strong coffee, so I often add more grounds than required. Others like to pour half a cup and then fill with water. This dilutes the intent of the coffee, and as a card-carrying Starbucks aficionado, I find the practice almost heretical.

The official definition of "meaningful use" will emerge this month. As a health care executive and taxpayer, I will be offended if the clarified meaning waters down the intent of the original language. Indications are that, as a byproduct of our political process, the official definition will lack the intended punch that could truly advance the adoption of health care information technology to improve outcomes. In other words, it will be watered down. Given the incentive nature (increased payments) for meaningful use, it's hard to understand why anyone would set the bar so low. If the goal is to accelerate change, we need to shake off the political pressures and do the right thing.

Contemplate the following. CPOE would not be required for a couple of years. Initially, a 50 percent order rate would be considered meaningful. Health information exchange is considered achieved if you are able to send and received scanned documents. Clinical decision support, arguably the "holy grail" when it comes to clinical benefit realization, may not be required until 2015. That's 6 years away! Incentives should be a stretch goal, not something already achieved by a majority of hospitals today.

I recommend taking an activist approach and pushing for higher standards. Do we want change, or not? As health care executives, we can exert profound influence in our communities, professional societies, affinity groups and government to ask for more meaningful meaningful use. Let's push ourselves and our broken health care system to accelerate the adoption of health care information technology.

Who drinks watered down coffee anyway?

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

I dreaded visits from Battalion HQ. Bravo Company operated fine without Big Brother coming down and creating more work. As a 20-year-old platoon leader, I had to gauge what level of involvement was beneficial versus what was busywork. I understood the need and benefit of our association with well-intentioned HQ, but at times, enough was enough before they only caused agitation. I made every effort to keep standard operation policies from becoming the frontlines. HQ existed to help my troops complete their mission, not create diversion and roadblocks.

I recall with trepidation my promotion to Captain with orders to HQ. As the Battalion Motor and Movement Officer, I was responsible for the readiness and mobility of the $40 million worth of vehicles in our five line companies. Operating my unit and making sure our companies were prepared to deploy at a moment's notice while contending with the inherent HQ bureaucracy of my position was tough.

Over time, I became...one of them. I found myself so focused on my HQ efforts that I lost site of the reason for my position. I was building a world-class organization and process but inadvertently choking our line companies' agility required for mission execution.

Those Army leadership experiences shaped my belief that corporate exists to serve those who do frontline work.

As our country emerged out of the American Revolution, similar conflicts took place. Our young republic was deeply concerned about the national government growing too large and powerful to the point of snuffing out state rights. Conversely, federalists were worried that too much state independence and freedom would unravel the fragile democracy. Perhaps the greatest balance was brought forth not by the constitution itself, but in the principles espoused in the Federalist Papers. Two hundred years later, these papers still carry important lessons and ideas for corporate America. They help bring perspective and balance to the relationship of corporate HQ versus line company relationships.

It's easy for those of us who hold HQ positions to forget that we exist to serve line companies. In health care, the frontline is anywhere care is delivered. In a single hospital, clinics and departments see patients. In multi-hospital systems, the hospitals themselves interface with patients. I continually struggle with this reality. In and of themselves, the strategies, structure and process I create are important. At the same time, they become hurdles too high for frontlines to jump, thereby impeding progress. When HQ is physically separated from the frontline, the challenge is exacerbated. In such cases, be extra vigilant.

Here are some actionable ideas to help us remember our appropriate HQ role...

• The frontline is where care is delivered and what drives revenue:

o Beyond government/accreditation/safety mandates, are your requirements perversely impacting clinical care?

o Beyond government/accreditation/safety mandates, are your requirements perversely impacting revenue?

• HQ by definition is overhead, a "tax" burden on the frontline:

o Keep costs low as possible.

o Keep demands on frontlines to a minimum.

o Regularly question your own demands and those of your peers.

• Seek to understand before striving to be understood:

o Leaders, spend equal amounts of time on the frontlines as you do in your safe, remote office.

o Send staff routinely to the frontlines to gain customer perspective and understanding.

• Engage frontlines in all aspects of your area and avoid mandates:

o Include them in strategic planning.

o Be extremely transparent with costs.

o Provide options with well-thought-out pros and cons.

o Discuss and gain perspective before making mandates.

o Ask them the tough question "am I helpful?" and then listen.

• Analyze policies and procedures:

o Eliminate as many policies as possible.

o Stop creating new policies unless absolutely necessary.

o Develop common operating principles.

o Say "yes" more than you say "no."

Many governments, armies, and companies grow the complexity of HQ at the expense of frontlines and eventually lose their sense of purpose. Their pride turns into arrogance as HQ shines brightly, yet the dull of the frontlines quickly tarnishes any fleeting glory. I plead guilty on all counts! Balance is a must. Once you become more concerned with your area performance than with frontline success, you have lost your reason for existence.

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

I landed on the bottom of the ocean, staring up at the surface. Before I could process what happened to me, I was ripped out into the watery abyss. I paddled toward the light, broke through, and gasped for breath. Only seconds before, I'd been standing high upon a rocky outcropping along Kauai's Na Pali coast.

Spring Break of '88 began well. Free tickets to Kauai to visit my in-laws and introduce them to our baby boy. During his grandparent cuddle time, my wife and I made our way down Kauai's north shore to get an intimate look at the magnificent Pacific. We took advantage of a photo op before heading back up the lone path. I stood at the edge of the rock several meters above the ocean surf. I smiled, said "cheese," and a second later, we were both overcome by a wave that took me out to sea.

Bloody knees, winter surf, rocky shoreline, I was in danger. Swimming parallel to the shore while outmaneuvering the breakers was not easy. Pummeling waves and the force of the undertow zapped my energy. I was scared. Gradually working my way closer to shore, I prayed the waves would not crush me against a wall of boulders lining the island. Three to four people met death that way every winter on Kauai. After much prayer, my feet touched solid ground. I scrambled up cliffs before the tide reclaimed me.

Although I'm an active tri-athlete, I've purposefully avoided the ocean. I've tackled lakes and rivers but never the open sea. I'm still afraid. Then an opportunity opened up for me to race in one of the sport's foremost events, Escape from Alcatraz. I considered passing it up but instead said yes. If I didn't face my fear, it would own me. On June 16, I hope to swim across San Francisco Bay from the famous island, avoiding all sharks and undertows.

I once feared public speaking, too. Now I love it. Despite a familiar nervousness that arises before each gig, I press on. To practice and hone the skill, I now look for speaking opportunities.

I feared challenging business peers, respectfully, of course. After I overcame that, I conquered a fear of challenging my managers. Iron sharpens iron, as they say. We experience growth by pushing each other onward toward a greater purpose.

Many who feel "stuck" in their careers are likely limiting themselves out of fear. Are you afraid to rock the boat? Do you comply dutifully with every request even though you know a better way? One way to accelerate your career is to continually pursue growth; second, is a willingness to combat fears -- not letting them own you.

Do you fear getting fired for speaking up? How about being wrong or laughed at? I've been there, too. Others fear success and the additional performance expectations that come with it. Embrace your fears. Confront them. Then experience freedom.

One of my current fears is dancing an entire song with our Argentine Tango instructor. I can handle learning an individual move, but the pressure of a complete dance with an expert just kills me. I sweat. I forget how to speak. I even forget the move we just learned. But I'm smart enough to understand that unless I tackle this head on, my skills will not grow beyond what I know today. And that is unacceptable. I won't tolerate complacency. You shouldn't either.

Reflect and write down your fears. Be brutally honest with yourself. Then attack them one-by-one, with purpose. You will be amazed at the results. And I'll bet you'll find you're not alone. Not only will you grow, but so will your family and employer.

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

To Teach, To Heal, To Discover -- Six words that captured the essence of the mission of the academic medical health system where I served as CIO. Along with our affiliate Case, we consistently ranked in the top 10 of NIH grant awardees. We had the infrastructure, bench and leadership to move quickly on opportunities and maximize value. Non-academic centers attempting to secure grant funding faced incredible odds against giants like us. We grew at their expense. Grant-funded organizations are well-oiled machines.

Today, I serve in a largely non-academic, community-hospital-based environment, but our vision is equally compelling. As ARRA/HITECH releases numerous incentives and billions in grants, academic centers are best prepared to apply for and secure those dollars. They have the infrastructure, primary investigators and experience that granting organizations look for. But are they the venue best for accelerating innovation? I'd argue that community hospitals are the "new" best venue for taking ideas from bench to bedside.

Community hospitals don't have costly infrastructure, professional staff overhead (whose sole focus is securing grants and conducting research), nor the incentive to keep applying for grants. Rather, community hospitals operate on the frontlines. They can accelerate the pace of change by bringing forth products based in the reality of where the majority of care is delivered -- the non-academic settings. Am I saying that great contributions from academia are futile? Never! But, it is time to purposely expand grant opportunities to include community hospitals.

Shortcomings in the community hospital model are easily overcome by forming collaboratives with other members of the health care community. For instance, in our market, we have created joint applications with area universities, vendors and governments. Where we are weak, our partners are strong, and vice versa. Our broad-based applications include multiple stakeholders. Grants pursued will lead to a practical application of technology that can be adopted universally, not just in one particular institution.

Community hospitals are leaders in the adoption of modern HIT. At Texas Health Resources, we have surpassed many academic contemporaries in areas such as CPOE and quality outcomes. Davies and Baldrige winners are largely non-academic. HIE leadership in our area is driven by community hospital management, not academia. While "rock star" CIOs often come from academic institutions, they largely play symbolic, albeit, important roles. Traveling, speaking and creating vision. Whereas community hospital CIOs are typically close to the ground dealing with the practical realities and bringing translational research leadership to bear.

Both types of organizations have an important place. As government and non-government agencies begin the arduous process of selecting grant applications, my hope is that they will understand the importance of funneling some of the dollars toward community hospitals and accelerating HIT adoption.

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

To date, I've had the privilege of holding three CIO positions. First, for a physician managed services organization. Second, in an academic-based multi-hospital system. And currently, as CIO for a large faith-based community hospital system. In my first C-suite gig, we talked about CHINs, which morphed into talks of RHIOs, while today we discuss HIEs. All of these have had the big, hairy, audacious goal to exchange information on increasing quality and decreasing costs.

Clinical, financial and now federal incentives generate a noble rush to participate. As I dug into details of certain opportunities at current and former organizations, I discovered that neither technology nor the sustainable business model posed the greatest challenges. Instead, the information exchange within the walls of my own institutions verged on nonexistence or lacked vision. We talked at high levels about exchange while knowing full-well we had not yet achieved this nirvana internally. Much work needed to be done at home, and we had to act with purpose to prepare for HIE.

In 1995, at Parkview Episcopal Medical Center, we reached advanced stages of interoperability. First, we implemented strong inpatient clinical systems and practice EMRs. We began sending electronic scripts to the local pharmacies. Participating physicians received a 10 percent discount on their malpractice insurance. We stopped printing and sent all reports to our medical staff electronically. Only after getting our own house in order could we achieve this exchange.

At University Hospitals, our team was awarded the very first NHIN grants. We freely exchanged data with other sites across the country. We exchanged clinical information with our joint-venture hospitals, with federally qualified health centers, and with others. We achieved our increased quality and reduced costs objectives. Our success came after we laid a firm internal foundation and developed our own portal.

At Texas Health, we've used a similar approach. Because we had disparate applications early on, we built a portal that essentially mimics an HIE but fits our health system. We exchange externally but on a limited basis. We're just now completing our overall HIE strategy that might be as simple as plug-and-play going forward. Despite the years of futile conversations regarding data exchange taking place in the region, we would not have been ready without the current portal.

HIE is a critical component of our American health care landscape. It's the right thing to do. Caution! First look in the mirror and ensure that you're exchanging data internally before placing your expectations externally. We don't want to find ourselves saying "do you remember the word HIE," just like we do today with CHIN.

Take action now.

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

My family will host our 6th foreign exchange student this fall. Anne will join us from Germany and stay through the academic year. Our "extended" family has expanded over the years, and these former students are now doctors, teachers and actors. We keep in touch with several of the girls and have even visited a couple here and abroad. The experience of a single exchange -- the families, students, cultures -- has enriched our world.

I serve on the global health care CIO council for a fortune 50 company. Each year a dozen of us gather from around the world to help drive corporate strategy. We get a glimpse into the future and where the industry is headed as it relates to technologies on the horizon. We share challenges and solutions. We commiserate. We learn. We advance the corporation, our employers and ourselves. It is rich.

Around the table this past week, I sat with CIOs from Brazil, Japan, the United States, Singapore, Greece, the United Arab Emirates, Taiwan, Bulgaria, Mexico, Canada, Australia, and England. (How fitting that the International Olympic Committee shared the conference facility with us in Chicago.) Although we contributed and advanced the mission of the council, the biggest benefit came from the transparent sharing amongst CIOs. I'm not able to share council specific outcomes or where my organization is headed strategically, but I can offer these key areas of discussion:

• Innovative ideas to remove culture as obstacles to transformation
• Creative organization hierarchies that enable velocity
• Leading from the center
• Progressive management of vendors
• The world is flat and we have more in common than you think
• Negotiating the C-suite more effectively
• Leveraging specific technologies to enhance mobility
• Expanded vision

I gained more from this intimate exchange than I could have attending a week-long mega-conference or reading a year's worth of subscriptions. I established relationships with 11 peers who I can call on as needed. We forged budding bonds through time spent together and found that we have a common burden and shared passion. Their diverse backgrounds opened my eyes to fresh thoughts and strategies. Some of us have already exchanged additional ideas and materials to further our organization's success.

The council sponsor benefitted and they will develop enhanced products and services to meet our future needs. Our employers will benefit from this investment as we bring back executable ideas for both strategic and operational advancements. And I, like my peers, have personally benefited through this mutual exchange of ideas, cultures and personalities. It may sound trite, but I believe the world is a better place now.

Seek opportunities on different levels to share in global exchanges. I'm looking forward to what we'll learn from Anne this forthcoming school year.

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

One year ago, I posted Culturally Relevant Leadership. Not a key performance indicator, but a lifestyle. I was so proud of my new office furniture that I posted pics on FaceBook and even bragged, "Look! No room for paper or pen."

Now I believe even this is passé.

Then I smugly considered myself advanced as an executive who worked at home two days per week. Whoa, what a concept. Lately I've wondered, Why do I have an office in the first place?

I asked the same question of peers and staff and received many reasons why we couldn't possibly liberate ourselves from the box. I have yet to hear one reason that I couldn't logically counter. I'm all about forcing myself to learn new ways of operating and leading. I'm also into adopting and leveraging emerging technologies. But now I must commit to expanding self-imposed boundaries. Pushing the organizational culture. Releasing myself -- and my staff -- from unjustified fears.

A healthy leader spends little time boxed in an office. We're out visiting our customers and our people. If you're worried about losing contact with your staff, read Staying Tethered to a Disconnected World. At home or, anywhere outside the box, I get more done in less time. That leaves margin to network with staff, round more with customers, and focus.

Let's ignore for a minute the actual cost of building out space and look at the operational budget impact. Average office space costs might range from $20-$40 per square foot per year. Assuming your office is 200 square feet, that is $4,000 - $8,000 per year. In the 24x7x365 world we live in, what is your percent occupancy time? It should be tiny, probably under 5%. Now expand this analysis for your staff and your entire office footprint. The amount of waste is self-evident.

On March 31, I'm turning my rhetoric to action and entering a month-long trial with my courageous Chief Medical Information Officer. We will shutter his office and share the space formerly known as the CIO Office. We've already eliminated office phones. For the times we do need physical space -- or so we rationalize -- we will have one. Otherwise, we'll conduct our business from our "virtual offices." Armed with mobile devices, we carry with us everything we need. Our office is us. Not some physical space with borders.

Presuming a successful trial, this will become our method of conducting business. I'll expect my direct reports to follow, and we'll go from 5 offices to 1. I envision a cascading effect throughout my division. We will save close to a half-million dollars for each floor we clear. Employee satisfaction, productivity and retention will climb.

You can't reach a specific benchmark, get the tattoo to prove it, and then stop evolving without losing relevance. If you don't believe it, reread Tradition.

Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."

IT performance and costs symptomized our health system's deterioration. The then-new CEO appointed me interim CIO with the following charge: "Immediately improve IT performance at a lower cost."

Success meant the job was mine. Failure would prove I squandered my opportunity.

Although I had several ideas to jumpstart IT in concert with the health system at large, my biggest obstacle would be the nature of our outsourced IT operations. Two years prior, we had completely outsourced to three companies who had formed an "unholy" alliance of sorts. All parties had competing agendas. I had to get everyone on the same page, fast.

We narrowed the outsourced parties down to two, then eventually to one manageable vendor. Deploying numerous strategies and tactics, we lowered costs and improved services. During this process, we identified and addressed the single biggest, critical factor: winning the hearts and minds of our staff. The outsourced vendor held allegiance to their stakeholders; the line staff was torn between their new corporate parent and the health system. We had to align allegiances and ensure everyone was of one mind and one vision toward the health system and its patients. This proved key to our success.

We achieved a modicum of success working with the vendor leadership, but it wasn't happening fast enough. So we started spending a few minutes of each staff meeting reviewing chapters of relevant books with the intent of getting everyone focused on doing the right things. For many, this was the first time they'd opened a book since graduate school. Some were transformed by what they learned.

Why did dictators burn books, we wondered?

Time pressures for our turnaround continued to build. We were improving services and reducing costs but had very little margin for experimental failures. We needed to do more. What if we provided books to all the staff and kindled a great awakening? Since we were already reaping moderate results from our leaders why not target all of IT? While applying pressure from the top down, couldn't we also encourage radical change from the bottom up, even create a revolution? I was confident that somewhere in the middle we would win hearts and minds and become one of the best leveraged IT organizations in present-day health care.

It worked. Fast. We offered four classes per quarter, and each filled within days of availability. We taught leadership, teamwork, customer service, change management, finance, and more leadership. Staff copied portions of their books, brought them to their managers and directors, and started asking questions, making suggestions. Some started covert studies of their own with teammates. They started changing their approach to work.

Revolution had begun, and nothing could stop it. We continued lowering IT costs while improving services. Our overall health system performance exceeded expectations. We were winning the local market. Wall Street took notice of our financial recovery and prosperity. But most important, our clinical outcomes ranked among the best in the nation.

Our book studies didn't end there. In fact, my greatest joy came during our 6th cycle when, for the first time, all four classes were taught by line staff. No supervisors, managers, directors, or VPs. During my four years as CIO, I witnessed the completion of over 30 distinct book studies and trained over 400 staff. We lowered apples-to-apples costs for IT by over 25 percent and quadrupled our externally validated customer satisfaction scores. Revolution at its zenith!

When I became CIO of my current health system, one of my first strategies was to deploy "book studies." I started with my direct reports, and today we hold four classes, 4 quarters per year. I taught the majority of classes the first year so I could meet as many staff members as possible and share my philosophies and passions with them directly. After one year, we had a complete quarters-worth of classes taught by non-leadership. Today, I continue to teach or attend at least one class per quarter to maintain my professional development.

Now you know why dictators burn books. They fear the power that comes through knowledge and enlightenment. They are afraid of how the written word can cause change, and, if done well, bring revolution.

From a practical standpoint, here is what seems to work well:

• Charge a modest fee for the class. Return the fee for 80 percent attendance. Non-returned fees are donated to United Way.
• Lead the first sets of classes yourself so you can model the process. Then delegate teaching to your direct reports. Expand to line staff as you find alignment between a person's passion, ability to teach, and the general need for the topic.
• Classes early in the day seem to have the most traction.
• Books with associated workbooks work especially well.

Here is a sample listing of the books we have leveraged through the years. While we have our reliable classics, we always scan for new books:

• Purpose Driven Life
• Hospital Management (inhouse)
• First, Break all the Rules
• 17 Irrefutable Laws of Teamwork
• 21 Indispensible Qualities of a Leader
• Emotional Intelligence
• Innovators Prescription
• Social Intelligence
• Disintegration
• Servant Leadership
• Finance for Dummies
• Financial Peace
• Good to Great
• Built to Last
• 360 Degree Leadership
• Competing on Analytics
• Human Sigma
• The Leadership Challenge
• How to Give a Damn Good Speech
• Leadership (Giuliani)
• Inside the Magic Kingdom
• Leadership Secrets of Atila the Hun
• Fish
• Blown to Bits
• The Heart of Change
• The Fifth Discipline
• Jack; Straight from the Gut
• Now, Discover Your Strengths
• Please Understand Me (Myers-Briggs)
• 21 Irrefutable Laws of Leadership
• Developing the Leader Within You
• Thinking for a Change
• The Art of War
• Lincoln on Leadership
• A Message to Garcia
• The Fred Factor
• If Disney Ran Your Hospital
• High Five
• The No A--hole Rule (title edited)
• Churchill on Leadership
• Drucker on Leadership
• Raving Fans
• The World is Flat
• Gung Ho!
• Five Dysfuntions of a Team
• Death by Meeting
• Who Moved my Cheese
• It's Your Ship
• The Five Temptations of a CEO
• The Four Obsessions of an Extraordinary Executive
• Technical Stuff for Non Techies (inhouse)
• Application Stuff for Non Apps (inhouse)
• James and the Giant Peach
• Several others...

Sounds trite, I know. Some will accuse me of simplemindedness. Others will say this high school football-coach philosophy is dangerous. I agree, but still embrace.

In my thirties, I got back into playing tennis and started thrashing on the courts with some friends from work. As we verged on competitive levels, I realized we needed to pick up the intensity. A consistent first serve was the performance key. Reliance on the second serve would allow your opponent to take the offensive. Although a high, first-serve percentage alone would not make you a Wimbledon champion, you'd at least guarantee yourself a quarterfinal match. We practiced at 6 a.m. thrice weekly, but I showed up at 5 a.m. to serve buckets and buckets of balls. I'd chase them down and start over again. No pain, no gain.

Now in my forties, I'm taking on the challenge of perfecting the Argentine Tango with my wife. In addition to a weekly two-hour lesson and a monthly milonga, we practice. Even if for only twenty minutes, we practice every evening. We have to, because the Argentine Tango happens to be the most artistic, intellectual and difficult dance ever created by man. If I catch my partner's foot too late, we miss our sweep. If we're too far apart, one of us loses balance. I figure if we aim for expert, we might reach proficient by the time I'm eighty.

Like our dancing, my relationship with my bride of twenty-four years has been full of ups and downs. The overall trend slopes upwards to the right, but it's interrupted with numerous peaks and valleys. Some downturns take years to correct, yet we keep at it. Annual strategic planning vacations, numerous marriage conferences, lots of books, prayer and counsel. We've fought hard to reach the point we're at today, and there is more pain to endure, I'm sure. Had we chosen not to push through the pain during any of the valleys, who knows where our marriage would be? Certainly not growing, not gaining.

And what about a career? Can you ascend the leadership ranks by good luck or good looks? Not in my case. It took pain -- blood, sweat and tears. Which meant not taking shortcuts. Not submitting C-level work. Not shaving time here and there to start the weekend early. But it's so tempting!

I hear you. But do you want to reach the fulfillment of your calling? Then sacrifice. Love the pain.

A few years back, I had to spend a significant amount of time on the road. The librarian at Parkview Episcopal Medical Center (CO) supplied me with endless materials, from business books on tape to vocabulary-building materials. While driving, I'd listen to these resources over and over until they became part of my intellectual fabric. Would have I preferred to listen to U2 or another favorite band? Of course. But to grow, I needed to take advantage of every morsel of time. I also volunteered for everything in my path; some related to IT, others benefited the hospital or another department. Would I have preferred to go home early or have a smaller to-do list? Certainly. But to maximize my potential and opportunity, I needed to self-sacrifice -- so far as it didn't harm my family. Plus, it was only for a season. Every season brings different opportunities, which require fitting sacrifices.

Today, I've made sure we have a library of materials available for our staff to check out. Hundreds of books and CDs on tape. We have subscriptions for "book of the month," a concept I leveraged from the Parkview librarian. Just as serving thousands of balls to ghosts at the break of dawn paved the way to winning several tournaments, or investing the time and money to improving my tango to keep me on the dance floor, pain brings gain.

Don't expect to just show up on the dance floor and look like a pro. If you want someone to ask you to dance, practice.

No pain, no gain.

One objective of this blog is to give a transparent window into the life of a health care CIO. Certain aspects of being a CIO, which generally apply to the entire C-suite, are the numerous external "other duties as assigned." The list is by no means complete and only reflects what I've grown to understand from working at two large health care systems. But I suspect every CIO operates in one if not most of these assignments. (I will remain purposefully vague as to which role is current or former.)

Politics. Be involved. Get out there and shake hands to further the cause of health care and your institution. Sometimes this means attending fundraisers for a politician who represents health care or for your city or state hospital association. Take part in advocacy efforts and help educate our governing bodies.

Fundraising. Lead by example through the opportunities that come your way. Create margin in the household budget. In addition to established opportunities, we created our own annual IT fundraiser for a children's hospital that raised over $100,000 this last year.

Parties. Important social gatherings pop up often, and attendance is not always voluntary. I started out naïve; now I own a tux.

Appointments. Consider these an honor and an opportunity to give back to the larger community. I have held very formal state-level appointments as well as less formal city and county appointments on behalf of my employer. But don't be a wallflower. Speak up. Invest yourself to further the cause. Otherwise, don't bother accepting the position.

Boards. Many organizations are in dire need of talented people to help provide direction and ensure accountability. These boards can range from an international for-profit corporation to a local, not-for-profit homeless shelter. Always check for potential conflicts of interest first.

Task forces. Often times these are directly related to health care but in a broader community sense. For instance, you might join a task force to research the feasibility of a regional HIE.

Advisory councils. My all-time favorite was serving on the College of Design and Merchandising (fashion) Council at Colorado State University. I was the only non-model, non-designer asked to join the judging panel at the annual fashion show. Lights, models, cameras, crowds -- and me sitting at the runway's end with a tie that didn't match my suit.

Professional associations. It's critical to remain actively involved to advance our profession. I have served on several national HIMSS committees and as state chapter president (TN and OH). I have spoken on behalf of HIMSS and CHIME throughout the country.

Speaking and publishing. There is a healthy expectation that we add to the body of knowledge by sharing best practices, evaluated experiences and tangible results. I have spoken on behalf of and been published in and outside of health care. The bonus: It contributes to your growth.

The common thread among these "other duties as assigned" is what makes them so valuable and important and why you need to take an active role. They:

• allow you to give back to the broader community at large;
• provide a framework for you to help advance a specific organization or initiative;
• enhance your own personal and professional development;
• broaden your networking and social contacts;
• enhance your organization's position in the community and profession;
• force you to think outside of yourself; and
• ideally make the world a better place.

The roles of a CIO are as varied as the companies and sectors they serve. Even within these roles are multiple combinations and permutations that are expressed according to circumstance. The moniker "CIO" itself is not limited to "Chief Information Officer." No, to be effective in our calling we must stretch the traditional definition beyond this commonly accepted interpretation. This post continues a series on how the "CIO 2.0" will push the boundaries of conventional thinking surrounding the role. We continue with the "Chief Innovation Officer."

Neglecting science credits finally caught up with me my senior year of high school. I'd hoped to coast through my last year and focus on non-academic pursuits. Instead, I was stuck taking physics while friends took basket-weaving, underwater-firefighting and equivalents. Deep into the first semester, my grade sunk low enough to negate my eligibility for tennis and soccer. I became desperate. While negotiating with my teacher, he said if I came up with a unique physics project that would blow his socks off, he'd consider it extra credit worth one letter grade.

Partnered with a classmate in a similar predicament, I set out to demonstrate how human energy could be converted to electricity to power an appliance. For a couple of 17-year-olds with little experience and no formal instructions, this required some serious innovation. We found an old bike and welded it to a stand. We purchased a used car alternator, pirated a battery and "borrowed" an appliance. With some help from my classmate's dad, our prototype worked. We impressed our teacher enough to raise our grade and keep us in good standing with parents, coaches and our future universities.

Innovation is not reserved for youth. On the contrary, it is the price of admission for the CIO 2.0. We must have the talent to innovate, or at the very least, the vision for innovation. If we are unable to innovate, we must gather others around us who have this core talent, and then give them the freedom required for success.

I previously described an innovation that came about via a Glorious Mashup. We codenamed the innovation "CareTube" and trusted it would revolutionize training, especially for time- and pride-sensitive clinicians. It would also enhance our already high CPOE adoption rates. More recently, we worked with Microsoft and Infusion to create a new model for enhanced physician and patient communication. At a Gartner conference, our model was voted the most innovative application of technology. (For more detail, see ADVANCE's January 2009 print edition, page 30.)

For IT to become strategic and make a difference, IT leaders must innovate constantly. Remain decidedly against the status quo. Always ask, "How can this be leveraged or improved?" "What new use can be created out of...?" "What if...?" Change scenery regularly. Play games like Cranium or build with Rokenbok, anything that stimulates you to piece the world together differently. Read insatiably then set aside time to think, giving absorbed knowledge time to sift and settle. Understand when is the right time for the right innovation.

Are you innovating? If yes, model for others and replicate yourself. If no, then begin to or find and release those who are.

I admit it. I don't like doing annual reviews. Few people enjoy them. Even fewer are good at them. I wish I were the anomaly, the freak. Sure, I've read all the theories and attended requisite training classes on how to make a review a non-event and make it productive. But this is supposed to be CIO Unplugged, right? Not CIO Fantasyland.

Most believe they are a star and, whatever your rating scheme, they should qualify as the poster child for the "top box." Many of us desire to be number one in all our endeavors. Though I do appreciate the self-esteem and confidence this attitude exhibits, can everyone be "top box"? Should they?

No.

It's easy to cave into temptation and give overly optimistic reviews to avoid discomfort. I've done it; I'm tempted every year. Then I kick myself for giving in because ultimately I've benefited no one. In fact, I end up undermining my employee and my organization. Worse yet, if I'm not modeling appropriate and accountable reviews, my subordinates will follow my poor example. (Ouch, I feel the pain as I write.)

Therefore, this post is as much encouragement to me as it is to you. Since it's that time of year again, we the leaders are going to invest the time and energy to make the review honest and meaningful. You with me?

Here are 3 tips:

1) Think of spandex -- man's brutally, honest friend. If you want to know where you stand with weight management, pull on a pair. I can try to fool others in terms of fitness, but the single best test I have is spandex. Someone can tell me I'm fit, but when I see the rolls of fat hanging over the spandex... This sort of accountability keeps me on the right path. We need spandex attitudes in our careers to ensure our performance is in check. Give honest feedback even when it's uncomfortable. Your employee deserves to know the truth no matter how brutal. Nobody likes flab.

2) Satiate the hunger. While I did say we tend to believe we are top dog, deep down most of us long to improve. If I can give my subordinates one tangible thing to improve, most will clutch it like a pit bull clenching a bone. Imagine if your boss gave you one strength to focus on every year to help you move to the next level, and you really did something with it. You might become CEO! That annual performance review might start to look pretty admirable.

3) Break it down. Two years ago, I switched to doing performance reviews quarterly. This helped make the annual review less dreadful. When you're tracking progress, evaluating and encouraging throughout the year, there are no surprises to contend with. In fact, I leverage this same format with my manager monthly! I desire constant feedback. My recent annual review ended up uneventful, and I got a nice big bone to chew on.

My final reminder to myself and a word of encouragement to you: Not only is it our responsibility to our organizations to give accurate and meaningful reviews, but aren't our people worth the effort, despite potential discomfort?

Editor's note: CIO Unplugged author Ed Marx encourages your interaction through this blog (use the "add a comment" function below). You can also connect with him directly through his profile pages on LinkedIn and Facebook.

In Nicholas Carr's 2003 opinion piece for the Harvard Business Review, he threw a grenade on the IT dinner table. Carr argued vehemently that IT no longer mattered. He leveraged this high-profile editorial into a best-selling, thought-provoking book in 2004, Does IT Matter? Carr's central argument states that the strategic importance of IT has diminished over time; that IT has become nothing more than a commodity providing little competitive advantage. Consequently, according to Carr, companies should rethink their investment in IT. He also laid out his agenda for IT management, examining implications for business strategy and organization. Carr's thesis was both embraced and vilified.

Written in the IT boom years' post-Internet "bubble," does the economic downturn change the game?

As I observe and research, I see fatalists and opportunists at odds. The fatalist has accepted Carr's pronouncement as fact and has become complacent, allowing the administration to marginalize IT. Opportunists, on the other hand, see the circumstances as the tipping point to reinforce -- or for the first time, position -- IT as strategic.

I interpret Carr's compelling arguments as a call to action. During these dour economic times, IT has a heroic opportunity to be a catalyst for prosperity, a key differentiator. This means I cannot sit back and accept current fate, allowing IT to dissolve into a simplistic commodity. To advance my organization, I hunt for and seize strategic opportunities. The economy will not determine my destiny if I choose to leverage it as a clarion call and make every effort to expand our services while lowering costs.

I have my department reaching out to select vendors and changing our value proposition from transactional to transformational relationships. It's not about broad generalizations. Success is about the individual organization, its circumstances and, ultimately, you -- the IT leader.

As organizations look to cut spending, IT is not immune. As discussed in my post "Brigades, Battalions and Budgets," continual across-the-board expense reductions will underscore IT as a commodity and a cost center to be managed -- Exhibit #1 for Carr. Call me competitive, but I believe that companies who lay low and marginalize their IT will have a much lengthier recovery period. In contrast, those companies that seize the opportunity and invest in IT strategically will not only perform better but do so at the expense of their competitors. Some of our current work is going to change our competitive dynamic.

Think. Brainstorm. Mashup. Research and develop strategies that will propel your organization forward. Even if your company is panicking and relying solely on expense-reduction tactics, present ideas that demonstrate bottom-line reduction and top-line growth. Insist on having your voice heard. Demonstrate ROI through IT's transformative and innovative power.

For competitive reasons, I cannot share details, but we are doing these things. A risk-free example from my past happened at a community hospital. Our historic 45 percent market share in this two-hospital town was starting to plunge. Our across-town rival was replete with cash given its enviable position as part of a regional health system. Our board decided that the best antidote was not to reduce expenses but to make strategic investments in IT. One year after the implementation of affiliated practice-based EMRs, clinical inquiry application, and software to link referring physicians, our market position flipped. We saw a 20 percent swing, especially in hearts, births, orthopedics and neurosurgery. We were featured nationally. 

I have additional career examples, but I believe the point is made. Yes the economy is tough, and the fatalists are seeking to marginalize IT. But the time is right to forcefully lay hold of this opportunity and (re)establish IT as strategic and foundational for your organization's long-term success.

Demonstrate the strategic power of IT.

It matters.

Given my affinity for pushing myself physically (some would say punishing), I am proactive with prevention. For instance, 6 months prior to the Ironman, I underwent a battery of cardiovascular and VO2 tests to ensure I was healthy enough to compete at an elite level. Like most people, I am diligent about annual physicals and eager to compare my year-over-year results in order to make necessary lifestyle adjustments.

During my most recent physical, the nurse kept rechecking my pulse until I explained why it was only 40 beats per minute. The subsequent EKG put everything in perspective. The physician then put a smile on my face when he declared that the digital exam was no longer necessary given the advances in prevention and prediction. They drew blood, collected fluid, and I was out the door in less then one hour. Sweet.

A week passed and still no test results. I thought, I could look them up myself if we had a personal health record deployed. I comforted myself with the hope that in a year or so we probably would. My assistant called the physician's office on my behalf to check into the results status. After a few days of phone tag, the nurse urged her to have me set a follow-up visit to get the disturbing results in person. I immediately called the office and found that my lab results indicated serious issues from cancer to high cholesterol. I made the follow-up appointment.

Sitting on the exam table, nervously awaiting the news, I contemplated my uncertain future. My wife and I were nearing the empty nest stage, and we had grand plans to exploit our impending freedom. I then thought about walking my daughter down the aisle some day. Will I still be around? I wanted to do an Ironman with my son and attend his college graduation. Trying not to let anxiety rule, I prayed.

The physician came in and reviewed all the results in the paper chart. He paced back and forth, scratching his head. And then he said it. "I am really sorry Mr. Marx, but another patient's lab results were inadvertently placed into your chart. You're fine. In fact, your results are rather remarkable for someone your age, yet understandable considering your lifestyle choices."

I left that appointment on an emotional rollercoaster. Relieved but angry, bummed yet hopeful -- and highly sympathetic for the person with the terrible lab results. Then I contemplated the pushback, locally and nationally, on EMRs. The opposition cites the potential for automation errors. Excuse me? What about manual, paper-based errors? My experience only boosted my ardent sense of support for an EMR. I will push for automation because no patient should experience what I did when an antidote exists.

My physician is now in the queue to implement an EMR. Demand the same of your physicians. Fight for patient needs. You are in the position to influence.