Last week, one of our hospitals went live on CPOE. My boss and I were there as part of the ribbon-cutting ceremony and to commend IT and the hospital for their hard work. When we met in the entryway, he eyed my attire with surprise. I was wearing scrubs, a violation of the dress code.

"Ed," he said. "I bet you caused a lot of trouble growing up."

"Yes, I did." I liked coloring outside lines then; and I still do today.

But, why do I? Shouldn't a leader be a good model to his followers?

I attended a national meeting with my health care IT (HIT) peers. Had you been a casual observer, however, you would not have pegged us as technology leaders. For all anyone could tell, we were glockenspiel salespersons. Our celebrated keynote, the government czar encouraging the adoption of HIT, was relying upon paper notes -- yes, the physician who rightly wants our nation to lose the paper chart in favor of the electronic health record used hardcopy notes. And the audience was copiously taking notes...on paper. Need I say more?

Besides coloring outside the lines, I'm a fierce competitor. I aim to win every race I start. I'll only accept defeat gracefully if I know I've poured my all into the competition. When I cross that finish line, my tank had better be empty. In the same way, the lack of HIT progress aggravates the heck out of me.

Why are we so far behind other industries? Look in the mirror. That's right. Time to come clean. It's because of you and me. Granted, there are numerous other valid excuses, and I will touch on a few. But at the end of the day, the buck stops with us. When I lose a race, I don't blame my blister, my clothes, the event management, the weather, the course, the timing chip, my equipment. I lost because of me.

Stop reading and let this sink in. You and I are the reason HIT lags.

But there's hope. If HIT lags because of us, we can reverse the situation and make IT strategic in our industry and career.

When I asked my Tweeters and Yammers for ideas, here's what they sent. Thanks to all of you.

Some reasons why we lag:

• Leadership
• CIOs not leading.
• CIOs not culturally relevant.
• CIOs reporting to CFOs.
• C-suite not understanding or acknowledging HIT strategic value.
• CIOs' fear of failure.
• Leaders tend to be older and less receptive to technology.
• Decision-makers often have clinical backgrounds, an area that has a bias for rigor, analysis, and is slow to change.
  
• Health Care Complexity
• Burdensome government regulations stifle attention and consume financial resources.
• Payment systems and processes.
• Lack of standardization.
• Piecemeal approach to application deployment.
• Clinical and legal liability.
• Fragmentation -- hospitals are silos of individual services, often used by independent practioners, all with differing cost and profit structures.
• Complexity is so great that leaders don't want to deal with it.
• Incentives to innovate and minimize inefficiencies, if they exist, are contained to a specific workstream -- not the entire ecosystem.
• Adoption of any new treatment or procedure in medicine has traditionally been slow because of the need for long-term testing and proving of safety and efficacy. This approach has transferred to the adoption of anything "non-medical", new or different like HIT.
  
• Financial Resources
• Lack of margin to focus on innovation.
• HIT investments are not appropriately correlated to outcomes.
• Historical under-investment.
  
• Health Care Culture
• Health care by nature is precise, protocol-driven, and we teach the need to be "in control" at all times. While this is true for clinical care, the same mentality in other areas (IT) hinders change.
• A corollary to the above -- By nature, people with these characteristics self-select into health care, making the climb that much more steep.
• A schism exists between IT and those who provide hands-on caring service to patients.
• Much like the traditions connected with our clinical training counterparts, HIT leaders are still promoted and recognized for experience and longevity.
• Social-cultural issues; change-resistant.
• "High-touch" aspect of health care views HIT as intrusive.
• HIT must be proven safe before it can be used, where as in other industries, if you test and fail there's little harm.
• Waiting for next big thing.
• Lack of market-driven demand.
• Knowing and holding information is power and HIT threatens that power by enabling easy sharing of information.

CIOs are in a unique and coveted position that allows us to observe and tie together the health care ecosystem, first within our own gates, and then beyond. The single biggest change agent to move HIT from laggard to leader is not health care reform. It's you.

Ways to reverse our situation:

• Stop throwing up your hands and blaming the environment.
• Take responsibility
• Take calculated risks and color outside the lines.
• Take proactive actions internally and externally at the local, state and national levels.
• Challenge the status quo.
• Tackle the tough issues and demonstrate HIT investment value realization.
• Model innovation and technology use.
• Get deeply involved with your clinicians and live their processes.
• Be disruptive.
• Stop traditional hiring and promotion practices. Instead, favor talent.
• Look outside of health care for new ideas.

By the way, I wore scrubs at the GoLive so no one would mistake me for a chaplain, a lawyer or a glockenspiel dealer. The color matched the rest of the IT team on the ground and fosters a close working relationship with clinical staff. I was proud to wear it, to show I cared. And because I love to surprise my people.

So...I commission you to help your organization and physicians understand the strategic value of HIT. You hold the salve to heal what ails health care today.

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."

Special note: Mr. Marx will be keynoting HIMSS' "Takin' HIT to the Streets" program in Dallas on Dec. 4, 2009. In his address, titled "Bias for Action...CIO Mandate to Lead in the HITECH World," Ed will explain that while the details of HITECH are still in process, foundational principles are established. CIOs must break through institutional reluctance to ensure organizational preparedness and success.

You can register for the event by clicking http://www.himss.org/hitstreet/register.asp.

"It was the best of times, it was the worst of times; it was the age of wisdom, it was the age of foolishness; it was the epoch of belief, it was the epoch of incredulity; it was the season of Light, it was the season of Darkness; it was the spring of hope, it was the winter of despair; we had everything before us, we had nothing before us; we were all going directly to Heaven, we were all going the other way."

So begins Dickens's classic A Tale of Two Cities. With leadership comes the good and bad, day and night, the best and the worst.

We recently underwent layoffs, something I wish didn't exist. The impact affects all levels from analyst to deputy. As I agonized over these decisions, I reflected on the complex aspects of leadership. I've come to understand that the absolute worst is also the absolute best. One in the same. Let me explain.

Worst

Betrayal. Although I advocate "go to grow," I also preserve a spot for any employee with an interest to groom for a future role. I pour myself into that person. I invest time and resource. Then, despite the path I create, the person leaves prematurely. I once had a rising-star manager dump a promising position, and health care, for a few extra bucks.

Moral Failure. A breakdown of social conscience happens too often. A shining star burns himself, shearing the people around him and the company brand. Infidelity. Embezzlement. Integrity meltdowns. When this happens within my circle of influence, my heart breaks for all involved.

Discipline. Poor performance demands correction. Nevertheless, most leaders can't discipline much less give a decent annual review. I struggle with it, and I'm guilty on all counts. But long term, I know that effective discipline is a sign of true compassion and care. I call it tough love, and it's hard to administer consistently.

Best

Fruit. Seeing someone grow. You sow, then watch for the seedlings; you fertilize, and watch them blossom. Double best when they germinate others and replicate themselves. We recently promoted this analyst to director, and -- Shazam! -- a star was born. We looked like geniuses.

Team. Start with a mashup of individual players who can achieve good outcomes and shape them into a team that accomplishes great things. I've been on more than one turnaround, and it all happened because of the pooling of incredible individuals who were better together. 1+1 = 3.

Promotion. It brings me joy to promote someone, or to recognize that person publically, perhaps nationally, through a professional society. Double best if there is a significant salary bump/bonus associated.

Absolute Worst and Best

Sacrifice

The worst: I give up personal things to fulfill my leadership calling. I've given up the freedom of full expression as my actions are witnessed by many and monitored by others. I gave up my childhood dream career...

The best: ...Yet I've found myself in incredible places and roles. And, oh, what rewards! To lead is to serve, and sacrifice is the sacred prerequisite to serving.

Dying to Self

The worst: Pride and confidence. My reality -- I'm right and I'm not comfortable accepting other's opinions. The truth -- I don't know as much as I think I do, and I need others. Despite my experience, education and knowledge, I force myself to move from micro manager to macro manager. I resist the urge to jump in (most of the time).

The best: Failing forward. I set the vision then allow my people to strive, thrive and make mistakes. For all involved, humility is the key to growth.

Layoff

The worst: Telling someone he/she no longer has a job when it's not related to their performance. I agonize for days and don't sleep the night before. I understand the impact to career, self-esteem and family -- I've been there.

The best: But if it must be done, I want to be the one to deliver the news personally. I want to support my people in the most challenging career circumstances they face. I need them to know they matter, they'll make it, and I care. Love can be practical, yet it's too often forsaken.

Death

The worst: The death of an employee or a family member of an employee. I see your faces.

The best: I've tried to attend every funeral. I weep with those who weep and rejoice when they rejoice. If a person/family suffers, I want to offer support, lead them through it.

Leadership is never easy, never to be abused, and never for self-promotion. It's both pleasure and pain, joy and sorrow. Leadership is a calling.

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."

Friends of mine recently returned from a trip abroad. The advanced wireless infrastructures found in these third-world countries both astounded and pleased them. By unintentionally leapfrogging the technological revolution, these cities had bypassed the incremental advancements of the last 30 years and gone straight from laggard to leader. Societies that have not had a telephony infrastructure, for example, are suddenly delivering the highest per capita cellular subscribers.

Leapfrog advancement. Can we do it in health care IT? I believe we need to.

Does the fact that we trail our non-healthcare peers by 5-10 years embarrass you as much as it does me? Do you realize that we think of EHR as advanced when in fact it's an application that's been around since the ‘90s? We have various excuses for our delay of advancement, and some are valid. But they don't change the reality. We are behind.

We do nevertheless have an opportunity.

Cloud -- it's clearly the future of both software and hardware. And consistent with the past, it draws both resistance and hesitance, which perplexes me. We act as guardians, but have no basis for such. We pontificate more than we lead while the people we serve need us to advance.

I'm tired of employing self-depreciating humor to cover the glaring technology gap whenever I speak to non-healthcare audiences. I'm ready to leapfrog and bridge the gap using technology as a key lever. So let's embrace the cloud.

Lead!

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."

The first thing we boys did after disembarking the school bus was head north for the neighborhood 7-Eleven. Liberated from a day of junior high classes and a numbing 30-minute bus ride, we hungered for entertainment. Pinball was the current rage, and we all sought the coveted crown of The Who's "pinball wizard." Grasping the corners of the machine, I'd let my fingers become one with the flipper-buttons, slapping the ball into the pins and rails and racking up points. In the heat of the moment, I'd jiggle and rattle the sloped table, eager to outscore my buddies. And then...it happened. My overzealous manhandling would cause the dreaded tilt -- the machine disengaged -- and my silver ball drained straight down the middle. Even as I write this, I can hear and feel the ominous, skull-pounding buzz. I lacked the perfect touch between allowable manipulation and sheer force. Tilt!

We all go through life encountering a fair amount of tilt. The abundance of balls we're juggling come crashing to the floor because we can't manage them all. The contemporary word for the phenomenon today is "balance." Stores carry dozens of books on the subject, and magazines print oodles of articles trying to help us live balanced lives and avoid a tilt scenario.

As CIOs, our careers are demanding and change is a common constant. Yet families are our support and our hobbies provide fulfillment and, thus, both deserve our time. We desire to perform well in all aspects of life. It's how we're wired.

I never experienced as much imbalance, or tilt, until I tried to seek the elusive balanced life. I'd read all the articles and believed the myth. Like the man chasing the end of the rainbow, I found a pot of disappointment instead of gold. In my stressed effort, I tried to run faster.

At last, it occurred to me. In this information age, the balanced life is not achievable. Nor should it be. We fool ourselves into thinking that life is made up of set components with solid boundaries that stack neatly together like Tetris, with micro interfaces where convenient.

I advocate a different approach -- Life-Work Integration. We all look for ways in which to maximize areas of our lives without having a negative impact on our values and ideals. We all desire to live a life of significance. I had the privilege of speaking on this theory at a recent health care professional society meeting. The president had heard me touch on the subject a year back while giving a talk on mentoring; he thought the concepts would be of value to his society. Based on the session feedback, the ideas resonated with the majority of attendees.

Balance implies that you give up something on one side of a scale until both sides are even -- an exchange. Integration, on the other hand, is fluid and dynamic, bending and blending endeavors -- time sharing. I don't want to allocate 50 hours for work, 10 hours for fitness, 25 hours for family, 50 hours for sleep, etc. I want to bend and blend -- to work 60 hours one week but 30 the next. I want to symphonize the flow of all my roles and responsibilities. I may have a desire to get up early and complete an outstanding task, or catch all my daughter's daytime dance recitals. I may need an extra 10 hours per week to perfect the Argentine Tango with my wife, made doable by combining practice with our weekly date night. I don't turn off my connectedness to any aspect of life. It is fluid and dynamic, bend and blend.

Here are some everyday examples of integration. One that serves me well is my virtual office. This setup untethers me, further enabling bend and blend opportunities. I carry a single device, and my digital schedule reflects all of my life roles, including my "honey do" list. No more home phone, multiple e-mail addresses, or home PC to slow me down. I network socially through a single portal. Ninety-five percent of my athletic events have, in some aspect, included one or more family members. And I try to bring at least one family member on every business trip. I leverage systems, as well. I belong to an athletic club offering multiple locations. Depending where I start my day, I find the nearest club, all of which are preprogrammed in my GPS. Then there are repetitive tasks. You can hard-wire these so you have more time and energy to focus on things that will have greater impact. Andy Stanley states that "systems can have a greater impact on behavior than mission statements." For some tips on how to maximize the time you do have, see Green Standard Time.

A strong foundation will enable life-work integration and help avoid tilt. Some key aspects:

• Develop and maintain a strategic plan for your life.
• Make sure principles/values are well defined and unmoving.
• Ensure your life passion is identified and calibrated.
• Surround yourself with accountable relationships and mentors.
• Embrace technology to master time and leverage efficiencies; don't let them master you.
• Create margin and set boundaries.
• Develop systems to support your principles and plans.
• Expand your creative capacity.
• Adopt a consistent worldview and belief system. (For me, this is based on my faith.)
• Man up and make tough choices.

The last one is the hardest. Many people go through the process of prioritizing and discovery but then fail in the execution because they won't pull the trigger on the difficult choices that would propel them to the next level. No one can do everything; and creating healthy boundaries often means eliminating the "good" in order to keep the "great." Yet, out of a fear of change, of hurting others, or other perceived pains, some continue down the same path, trying to find an unachievable balance.

Take some time to reflect on this post and the possibilities of life-work integration. Review the elements of a strong foundation and how they might keep you from Tilt.

You can do it!

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."

Admit it. Health information technology (HIT) deployment is headed nowhere fast. Despite the evidence and supply-side rhetoric, demand wanes. Depending on whose study you believe and their definition of HIT, industry adoption of CPOE is languishing in the low teens at best. We can do better for our patients.

Before we dive in, I want to acknowledge the Office of the National Coordinator for Healthcare Information Technology (ONC). The National Coordinator plays a central role in how information technology transforms our care delivery system. The leadership is strong, and the ONC is blessed by a greater level of funding and authority than in the past. ONC is the principal federal entity charged with coordinating nationwide efforts to implement the use of the most advanced health information technology, including the electronic exchange of health information. The position of National Coordinator was created in 2004 through an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act [HITECH Act] of 2009.

Next to the ONC, the Centers for Medicare and Medicaid Services (CMS) is another powerful division of the Department of Health and Human Services. The CMS mission is "to achieve a transformed and modernized health care system." A key tool for success in the CMS workbench is leveraging information technology. CMS, a professional bureaucracy, was clearly the driver for federal HIT direction and investment until recent legislative changes codified ONC. The ONC and CMS will need to work in concert, finding unity of command and vision, in order to achieve their unsynchronized goals.

Complicating the situation is the legislative branch attempt to control health care reform and policy via HIT. On one hand, you have ONC laying out a firm HIT direction; they have the necessary framework, but it's juxtaposed to the quagmire of health care reform. Congress and the White House are materially on different sides of what to do, when to do it, and how. The only certainty is that HIT will be a key component. Unfortunately, due to the lack unity of vision and clarity of goals, HIT is quickly becoming a political lever. And that scares me. HIT is the means, not the end. 

Morphing into a government program, HIT could rank with cash for clunkers. We're incentivized to turn in the old and adopt the new. Although I'm a serious advocate of care transformation via IT, I fear that the motivation is becoming more political than substantive. Where the cash-for-clunker strategy is a onetime event, we should be investing long term (10-plus years) in HIT and looking for sustainable advocacy with demonstrable support. Incentives are misaligned.

We need to push for challenging meaningful-use criteria. What started out provocative and game-changing has since been watered down to a welfare-like program. The bar is set too low. Everyone qualifies! That means we're not demonstratively leveraging HIT. Instead of reaching high, expectations are lowered, thus removing the incentive to progress materially. 

Advocacy groups are also part of the equation. Although active dialogue is essential and everyone deserves a seat at the table, too much politicking will derail HIT. Potential is lost in the quagmire of uber-engagement, and special-interest groups tend to lower expectations and standards. Each group claims to represent a large number of constituents, but at the end of the day, hospital leaders are the ones who will need to make the tough decisions, and execute.

While I appreciate the private/public approach to forming advisory committees, we must intentionally set aside our personal biases to favor the common good. If you look closely at the outcomes derived thus far, you can trace the DNA back to some of the participating organizations. I face the same challenge at the state and city level. It takes a degree of maturity to set aside personal thoughts, prejudices and organizational goals to pursue the common good. Keeping the patient benefit foremost in our minds will yield the best outcome.

What can we do to help ensure ideal outcomes and prevent the politicalization of HIT?

• Actively support the ONC leadership.
• Contact senior staff of the House Committee on Ways and Means.
• Contact senior CMS leadership.
• Advocate for more meaningful meaningful use.
• Provide feedback to advisory committee members and pushback on tailor-made recommendations that may be of a minority interest.
• Lead by example by ensuring your organization is ahead of the curve.
• Actively participate in your region and state HIT efforts.
• Keep pressure on for health care reform

Do it while we still have the freedom to make these choices and influence government decisions.

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."

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries.  

My passion for health care sprouted in high school while working in environmental services at an outpatient facility; they called us janitors back in the 1980s. From that point forward, different encounters have renewed that passion. The most dramatic experience was personal.

A Journey Home. Three years ago this month, my mom traded her earthly rags for a robe of righteousness. After a courageous four-year fight against the ravages of ovarian cancer, Ida Wilhelmine Marx bid us farewell. The entire experience had a profound impact on me not only as a son but also in my profession.

My mom and I were tight. As I blindly plodded my way through adolescence, she represented mercy and grace. When I shoplifted, got arrested for joy riding (14 yrs old), set the house on fire, partied excessively and flunked junior high, she was there. I'm convinced that if it weren't for my father's discipline, balanced by my mother's care, I would not enjoy the successes of today in my education, career and family.

Radiance. Mom suffered much from illness her entire life. She took the cancer in stride: eight rounds of chemo, two rounds of radiation, and a couple of surgeries. Her sole desire before transitioning from this life to the next was to celebrate her 50^th wedding anniversary. When we transferred her to hospice, it became apparent that she would be a few weeks shy of reaching her goal. With my parents' permission, my brothers and sisters planned an early 50^th anniversary party and vow renewal -- the final celebration of Mom's life. Knowing our world would change the following day, that night we put on a heck of a celebration.

Hollywood could not have written a better script. Hospice physicians agreed to give my mom life-sustaining nutrients and fluids through the big day (normally not allowed). They arranged for a "Sentimental Journey" pass: a limousine (ambulance) service for my mom and dad to the picturesque Cheyenne Mountain Resort in Colorado. Two paramedics waited in the background just in case their services were needed. (They weren't.) They quipped how special my mom was because the only other person who ever received two paramedics as an escort was *** Cheney when he came to town.

All 7 of us children attended plus all 15 grandchildren. My parents invited their closest friends. With the backdrop of the Rockies and all the majesty of a traditional wedding ceremony, I had the privilege of walking my father to the front. My oldest brother, Mike, had the honor of escorting my mom in her wheelchair to join my dad at the altar. She looked ravishing; my sisters had dressed her to the "nines." Her dream was unfolding in real time.

Each of her children had a part in the ceremony as did each grandchild. Assigned to deliver the sermon, I decided not to use notes but instead prayed that God would intervene and deliver a message that would bless my parents and set vision for successive generations. The primary message: My parents had created a legacy of marriage that would impact not only the first generation (me and my siblings), but the grandchildren, and their grandchildren, and so forth. The fact that my parents stuck it out and endured a lifetime full of sickness and health is a testimony to the world: "Yes, it can be done."

The ceremony ended with the exchanging of vows. A co-worker of mine had arranged for a Papal blessing of the 50^th milestone as well, which touched my parents deeply. We printed the blessing in the renewal program. Unity candles, songs, prayers and standing ovations lent to the evening's incredibleness. But this was only the beginning.

One Heck of a Show. We then entered the adjoining room for a superb five-course meal. Taking advantage of the live music and dance floor, Dad rolled Mom out in her wheelchair to dance. My parents are fantastic dancers, and seeing my dad wheel my mom around was moving. Throughout dinner and beyond, we danced to our hearts' desires. All four sons danced with my mom, who was clearly delighted. Even my son, Brandon, danced with her, to which she commented: "You're not dancing. You're just shaking your ass!" Next came toasts and the garter ceremony, and all the similar accruements of a fine celebration. At that point, Mom addressed the room with loving words. Dad tried but fell apart. As a finale, guests and family formed a tunnel by joining hands. Dad wheeled Mom through as we hugged, kissed, cried and spoke blessings. Returning to her limousine, she was still beaming. My dad shared that as he laid Mom in her bed that evening, she said, "We sure gave them one hell of a show tonight, didn't we?"

Timing. During her illness, I flew out often to visit her. I wanted to be at her side when she transitioned, just as she had been at my side so many times. I missed by 8 hours. But that was okay. Over the years, I'd left no doubt in my mother's heart of my care, admiration, appreciation and love for her. Arriving shortly after her passing, I supported my brokenhearted father and assisted with the funeral arrangements.

Kiss. My mom had taken her last breath shortly after midnight. Two of my siblings and my father were at her bedside and described that, while painless, her body struggled for every last breath. As a result, her mouth was stuck wide open. The hospice nurse explained that, given the timing, the mortician would be the only one able to close Mom's mouth. My sister in-law, an ICU nurse manager, validated this.

Meanwhile, my dad knelt at Mom's bedside and held her frail body, the first time in months where he could hold her without causing her pain. He kissed her lips. Wept over her. Sometime in the next two hours, while they awaited the mortician's arrival, Mom's mouth closed...and she smiled. Comfort permeated the room and reinforced our belief that she had indeed transitioned to a happier place.

Passion Fueled. My mom's battle allowed me to spend considerable time in various care settings. I observed the processes, evaluated technology, and pondered how things could be improved to benefit caregiver, family and patient. The clinicians treating my mom lacked the communications and clinical decision support needed to deliver the highest quality of care. I was shocked by the lack of access to critical and timely clinical data. The wasteful amount of paper utilized and manual processing disappointed me. I swore it would never be this way in my work environment. As I took mental notes from the perspective of patient and family, my passion to leverage technology and transform the clinician and patient experience was renewed.

It's this passion that drives me in my daily work. This is why I'm tenacious in advocating technology, why I continually innovate and collaborate with clinicians, and why I blog. This is why I advocate for more meaningful, meaningful use. It's the heartbeat behind why I spend more time with my people on leadership, customer service, process, and passion than I do on bits and bytes. Until my people have a heart for patients and are in a position to empathize with their plight, the bits and bytes will be limited. The full potential of technology in the delivery of high quality health care comes with a transformed heart.

Thanks, Mom, for refueling my passion as a leader of health care technology.

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."

Organizations will spend millions on consultants, hoping to tap into some sort of magic sauce that they can liberally apply to ensure significant adoption. The majority of these consultants will have had no direct professional experience implementing or supporting the technology. The secret to successful CPOE adoption rides not on one silver bullet, but many. You can do better than a consultant can, and here is how.

The following 21 factors, when in synch, will bring your institution success with CPOE. You must be excellent at 18 or more of these to forge the secret.

• Senior Leadership Engagement- CEO must actively promote and reinforce, and receive regular reports. Base enterprise incentives on CPOE adoption levels.
• Hospital Leadership Engagement- Presidents need to be very visible and articulate. Same with directs.
• CMIO- This rare individual can bridge the gap between IT and medical staff. If IDN, recommend multiple CMIO approach. (Not an expensive tactic in the big scheme of things.)
• Project Leadership- Project leaders must walk on water and be clinicians. They are the face and brains of the operation. Surround them with grace and all the resources they ask for.
• Project Team- Majority should be clinicians. 90 percent of your team must be actively engaged. The road is long with many winding curves. Build up staying power.
• Clinical Staff- Can't be successful without engaged physicians and nurses. Sometimes you must facilitate their engagement if initially resistant.
• Culture- Culture eats strategy every day. Set up literal shared incentives for success. If IDN, culture must acknowledge but transcend individual hospitals.
• Relationships- Relationships cover a multitude of sins. Develop relationships with everyone from clinicians to support staff to leadership.
• Visibility- Key leaders must be visible during go-live and after. Most of our leaders participate in go-live support, even if just to answer phones.
• Agility & Velocity- Have a pool of highly trained staff who can respond to crisis at a moment's notice. Team should report to CMIO.
• Build- Lay a solid foundation from the onset to withstand the continual storms. Design must include clinical staff for usability and acceptance.
• Standardized Order Sets- Present CPOE as the ultimate tool to drive transformation and clinical quality, and to drive out costs.
• Governance- Set up an effective decision-making body on two levels: a senior executive team for strategy; a larger team for tactics and operations. Assign clinicians to key roles.
• Change Control Process- Control application evolution at a rate that introduces new features while maintaining an acceptable learning adaptation curve.
• Implementation- Keenly organized, with additional staffing at the physician's elbow.
• Marketing & Communication- Need a multi-dimensional, targeted strategy including actual customers. Don't limit yourself to traditional media; be innovative and leverage social networks.
• Training- Use multiple venues: traditional methods blended with modern, such as our video vignettes. Make access to applications dependent upon completion of training.
• Support- Post-implementation support must be impeccable and ubiquitous.
• Vendor Connections- Best relationships start at the top, with C-level execs exchanging strategy and vision. Establish escalation paths to solve issues quickly.
• Infrastructure- Monitor and tune to ensure optimal uptime and response speed.
• Software- Select a seasoned application. Test and retest enhancements and patches prior to releasing to clinicians.

If you can't deliver on the majority of the above factors, stop your project. Take the hit early where impact is limited rather than when you are too far down the tracks where a collision will occur. We took a three-month hiatus because our standardized order sets were suboptimal. We retooled. Today, we have 80 percent CPOE adoption with 50 percent of all orders coming from the standardized order sets.

A final point to remember. None of these factors is a one-time event. Each requires continual care and feeding. Indefinitely.

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Who taught you life skills? Did anyone coach you in the ways of culture and values? An uncle? Your grandma? The television?

I just watched the movie Gran Torino with Clint Eastwood. In a nutshell, Eastwood attempts to teach the immigrant neighbor boy how to be a man. He starts by teaching Thao the skill of carpentry: how to hold a hammer, and which tools to always have on hand. Then he comically endeavors to educate the kid on manly talk and on how to act like a man. Eastwood verbalizes it, then demonstrates it, and finally observes Thao doing what he'd learned. The mission took time, money, energy and the forging of a relationship, but it was worth it.

Some of us wish we had that mentoring experience. Speaking from experience, we all need mentors. When I became CIO of a large prestigious organization in my mid-30s, I was both elated and scared. My mentors accelerated my comfort and success. Even with my experience today, I simply can't grow without a mentor.

Dictionary.com defines mentoring as...an ongoing, planned partnership that focuses on helping a person reach specific goals over a period of time. Unfortunately, the art of mentoring has rarely caught on in the business world, health care included. We see this reflected specifically in the graying of existing leadership and the lack of succession planning.

This type of one-on-one interaction between individuals -- lost somewhere after the apprenticeships of the pre-industrial age -- has been replaced with short-term, focused leadership programs. These programs attempt to turbo-charge management education by cramming years of collective wisdom into a one-week synopsis. For example, the College of Healthcare Information Management Executives (CHIME) has an excellent leadership development program entitled "The CIO Boot Camp" that cannot keep up with the demand for enrollment. One reason for its popularity: It fills the mentoring void in today's organizations.

Is mentoring beneficial in health care? Done right, both formal and informal mentoring programs can promote patient safety and implement clinical process change. Mentoring is key to building alliances within an organization and to ensuring a new generation of trained leaders. Committing to mentor another person is an investment in the long-term success of an organization, a selfless act of service for the sake of the profession and the future of health care.

This type of partnering also offers something a person might not get directly from his or her supervisor: broader experience, organizational perspective and new skills.

For instance, an information technology professional will benefit greatly from having a CFO or CNO as mentor. Consider the differences between learning the technical aspects of one's position and career versus learning leadership from someone else in authority, regardless of his/her background. In other words, an IT person should not enter a mentoring relationship with another IT person, lest their focus becomes overly familiar to their specialization.

Determining the appropriate mentor. Examine your strengths and weaknesses. A professional who lacks a strong clinical background should seek out a CMO/CNO or another well-respected clinician. Conversely, someone who already has a strong clinical background may want to seek out a CFO in order to gain key insights into the health care financial world. Seeking such mentors within your own organization offers the advantage of proximity and familiarity. Furthermore, the development of such relationships assists in the overall development of teamwork and connectedness. (Mentors from outside of the organization or health care might offer a level of anonymity and broad perspective, but they would lack the context for key elements of discussions.)

Mentoring programs and recruiting. Job candidates respond favorably when they understand that the organization cares for their professional development and will enable them to achieve career success. Over time, as the mentoring program becomes a major differentiator in recruitment efforts, your organization will become an employer of choice. Gallop has statistically demonstrated that an organization with a high level of engaged employees significantly outperforms non-engaged workforces in areas including customer satisfaction and financial results; both employee and employer win. Clearly, such programs lead to improved health in the corporate setting.

Mentoring enables clinical, business and IT Success. Most IT leaders have a clear understanding of their task: to leverage technology to enable clinical and financial success.

Much of this understanding, however, resides in "head" knowledge, not in transformative experience. Clinical mentoring, for example, would facilitate the adoption and understanding of what really takes place in the clinical setting. The IT leader gets first-hand experience and sees with his/her eyes what he/she had merely heard and read about.

Partnering an IT leader with a CMO or CNO will expose them to new insights and understanding. One academic medical center I know sends its IT leaders on annual short-term mentoring assignments to all of its clinical departments including ED, Radiology, Lab, etc. The CIO began routine rounds with physicians and residents. In each case, the mentor allowed the IT leader to experience the specific clinical care setting, answered questions, and discussed the critical intersection of IT and quality patient care. Each IT leader came back with a new sense of purpose and motivation. Each leader, in turn, made immediate changes to IT systems and support to help ensure a higher quality of care.

Mentoring serves to develop future IT leaders. Given the limited pool of emerging leaders, mentoring becomes more critical than ever. Identifying and growing talent within our organizations is imperative. Our leadership effectiveness is not so much based on formal education and rigorous reading, but in real-life, on-the-job experiences. Partnering up-and-coming IT leaders with members of executive leadership allows for this real-life experience, accelerates growth and ensures critical succession planning.

Restoring the lost art. We are the sum of our collective inputs. I credit my success to my mentors. I have been deliberate in this process. On even years, I mentor someone; on odd years, I am mentored. I require each of my direct reports to do the same. I've been formally mentored by health system CEOs, COOs, CFOs, CMOs and hospital presidents. I have mentored many who have since moved into positions of authority. Check out the many resources available on establishing quality mentoring programs.

Resources. For your reference, I've provided a simple one-page mentoring contract you can use to facilitate your own relationships. I've also compiled a list of "golden nuggets," the bits of wisdom I have learned from being both a mentee and mentor. Click here to view my mentoring documents:  Mentor Contract and Mentor List of Golden Nuggets

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."

How can so many of us hold the title of leader, yet never be remembered? Why do some leaders make a difference while others do not? Fear.

Fear keeps us from making a difference. Too often leaders fade without notice or with merely a modicum of fanfare because of their longevity in a company, because they stuck with tradition, and perhaps they achieved small wins. Conversely, legacy leaders stick their necks out and occasionally go against the flow. They spin the roulette wheel while their peers play it safe. Anyone can play safe -- status quo. But legacy leaders fight fear, calculate options, then jump in with both feet. Leaders who leave legacies take risks.

No risk, no legacy. Our founding fathers pursued a risky mission, and look at the legacy they left us. Martin Luther King Jr. took risks that prematurely ended his life, but his legacy endures. Pause for a moment and think of a legacy leader who advanced with nothing at stake? Thought so.

I overhear leaders say they want to make a difference, want to transform healthcare locally and nationally. Yet health care is stuck in neutral, if not reverse. Decision-makers are overly conservative in their approach to innovation and opportunity. Paradoxically, some I know in management were risk-takers early in their careers and enjoyed success. For whatever reason, they shifted gears into a risk-averse posture and ran out of gas short of their destination. We as health care leaders must intrepidly drive forward, or surrender the wheel to someone who will.

I want to encourage and reward the courageous, and the best way to do it is to lead by example. Push the envelope. Try new programs, systems and services before they are mainstream. I don't settle for giving lip service; I fund and staff risk ventures. Then I reward my risk-takers publically, even in failure, because they gave it their all. Perseverance will eventually pay off.

Risk provides a competitive advantage. Do you want to create separation and differentiation in your marketplace? Risk. Tap into the creativity of those employees with a passion to innovate and transform. Yes, there will be failure. Use failure as a catalyst to increase your risk tolerance, not shy away from it. Learn and embrace failure. Edison did.

Stop analysis paralysis. Adopt Colin Powell's leadership lesson #15, "P@40 to 70." P stands for the probability of success; the numbers indicate the percentage of information acquired. Once the information is in the 40 to 70 range, go with your gut. Procrastination in the name of reducing risk actually increases the potential of failure or falling behind.

To those who favor remaining conservative: Do you fear losing your job? When you play safe, you're rewarded with keeping your position, right? But if you don't rock the boat or challenge the status quo, do you lose part of your soul?

A board vice chair told me, "Ed, if you do your job right, you won't be here a year from now." I took his comment as encouragement to take risks on behalf of our patients and providers. If I lose my job in the process, so be it. I do not operate under the fear of man but under the fear of not influencing my part of the world.

Risk is a lifestyle not just a work mode. When hiring like-minded staff, determine the risk quotient of potential candidates by finding out what they do outside of work. If they stick to the standard fare, move on. If they play it safe, move on. They won't act any different in the workplace.

What about you? Are you a legacy leader making a difference? Will anyone remember your years of effort? Will health care be transformed because of your actions?

What are you doing today that is risky? What are you doing today to encourage risk?

Demand it. Live it.

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."

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."