CIO Unplugged : Technology

Embrace the Cloud

Edward Marx — Tue, 20 Oct 2009 20:59:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. Friends of mine recently returned from a trip abroad. The advanced wireless infrastructures...(read more)

The Politicalization of Health Information Technology

Edward Marx — Tue, 22 Sep 2009 20:26:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. Admit it. Health information technology (HIT) deployment is headed nowhere fast. Despite the...(read more)

Health Care Passion Refueled

Edward Marx — Tue, 08 Sep 2009 14:55:00 GMT

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...(read more)

Secret of Successful CPOE Adoption

Edward Marx — Wed, 26 Aug 2009 15:59:00 GMT

Before revealing the secret, let me establish credibility. I first implemented electronic health records in 1995. A few years later, while CIO at University Hospitals , we achieved a 95 percent CPOE rate at our academic medical center. Currently, with...(read more)

Social Networking: Why Every CIO Must Open the Gates

Edward Marx — Tue, 30 Jun 2009 14:56:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. As the printing press fueled a transition from the Dark Ages to the Renaissance, Social Networking...(read more)

Health Information Exchange Begins at Home

Edward Marx — Tue, 21 Apr 2009 23:09:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. To date, I've had the privilege of holding three CIO positions. First, for a physician managed...(read more)

Does IT Matter…Five Years Later?

Edward Marx — Mon, 22 Dec 2008 16:41:00 GMT

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

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.

Now It’s Personal -- The EMR Imperative

Edward Marx — Mon, 08 Dec 2008 16:09:00 GMT

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

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.

Got Clinicians?

Edward Marx — Fri, 13 Jun 2008 19:42:00 GMT

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

If you don't, you should. How many credentialed clinicians should a healthy IT department have? We currently have 20 percent -- MDs; RNs; radiology, medical and pharmacy techs; pharmacists; therapists and a smattering of other less common specialties. I'm pushing to raise that figure.

I was recently requested to be the keynote speaker at a Nurses Week celebration at one of our system's hospitals. Being a keynote is an honor in itself. But for me, speaking to the caregivers of our patients put this opportunity over the top. Although my presentation did not rank at what I'd have labeled top-notch, preparing for it proved invaluable. It reinforced my admiration for caregivers, especially nurses. It also reminded me to permeate my IT staff with clinicians to ensure that our labor is accomplished with the caregiver in mind.

I long for the day clinicians are present throughout IT, including technical domains such as networking, data center and other atypical areas. True, they are more dominant in application areas, but why limit the potential? The blending of clinicians with technologists could lead to higher levels of transformation and innovation. Here is our most recent revolutionary venture: We just added a physician employed by our organization who possesses clinical and technical skills and leadership talents, and who will work closely with our CTO. I'm watching eagerly for the effects to unfold over the next few months.

Okay, so you've read the existing articles on how clinicians benefit an IT staff. But once you have them, how do you best position them and your traditional IT staff for success? What are the inherent challenges for clinicians and IT?

Note: Are you aware? When a clinician comes aboard as an IT staff member, it is equivalent to starting a brand new job.

Think back to your own job changes. Could a swim coach apply her swim skills to her new waitress position? What about a massage therapist employing his talent in a paralegal job? Keep in mind this concept as you read the following practical tips on clinicians joining IT as shared by one of our clinicians, Diana Gibson, RN.

Adapting to the office environment

Cubes vs. nursing station reduces the sense of teamwork
Use of meeting rooms is equated with loss of casual social interaction
Taking work home
Going out to lunch vs. grazing between patient care tasks

Difficulty recognizing accomplishments/results

Need to understand the bigger picture (see beyond the patient)
IS systems are configurable with lots of gray areas; reduced workflow focus
No more rapid results (average patient length of stay is 3 days)
Used to implementing changes quickly
Giving up precision and timing on tasks

Loss of familiarity generates stress.

Learn new tasks, find new resources and create a new employee network
Learn basic IT software (no more IVs)
Fight pressure to understand IT on the first day of work
Assimilate IT language/acronyms

Facilitation skills are not in the typical nursing repertoire

Scheduling appointments
Creating agendas
Taking minutes
Using a meeting room to solve problems as opposed to on-the-spot interactions

Common conflict areas and issues of concern

IT staff is generally unaware of clinician's former environment and the required adjustments
Lack of training for clinicians in IT subjects
Clinicians are expected to already know what to do
Downtime scheduling affects issues regarding patient care
Clinicians have an inherent desire for more testing on software/applications (like testing a drug before giving it to a patient)

Bridging the gap and investing in clinicians encompasses the following areas, according to Gibson:

Preceptor program

Increase depth of typical IT orientation
Pair new clinical staff with experienced IT person; identify future clinician leaders
Document and publish referable guidelines
Create Web-based training on IT tools

Project management training

Create PM processes to which nurses/doctors can relate
Help user/clinician visualize the big picture and break it down into tasks

Professional development

Develop a facilitation/leadership class
Provide continuing education credits (CEU)
Create internal training opportunities specific to clinical IT
Develop clear development pathways, like a clinical ladder
Clarify the position's responsibilities

Embrace the significance of melding clinicians with IT. Be more intentional with it, maximize the value, and encourage further adoption. A healthy mix is a key to a high performing health care IT organization.

Got clinicians?

My Journey to CIO

Edward Marx — Mon, 03 Dec 2007 15:30:00 GMT

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

As a 16-year-old sanitation engineer (they called us janitors back in the 80s) working the evening shift at the 21st Medical Group Clinic at Peterson Air Force Base, I never envisioned myself having a health care career. I was more concerned about adjusting the volume on my new Sony Walkman than how dirty the floor looked. That is, until I met Tech Sergeant Samuelson. Samuelson worked in the ED where I signed in and out for each shift. He loved his job and it showed in his smile. He had a passion I did not. Unknowingly, Samuelson seeded my vision to serve in a profession where I could impact the lives of people -- as he did mine.

The summer prior to college, I enlisted in the Army Reserves and became a combat medic. Although I had limited opportunity to serve others in an actual crisis, I relished the time I spent training soldiers for the worst. It was more than a job. As my university studies progressed, I left the medical corps to be commissioned as a combat engineer officer. I enjoyed the challenge, but I missed giving shots and driving an ambulance. In a job that appeared to be a diverging footpath in graduate school, I gained an appreciation for technology and its ability to enhance processes and enable transformation. Consider it another experience that laid another slab in the foundation of my future. The question was how my passion for health care would meld with my emerging interest in technology.

As providence guided, I landed a position at a community hospital as an anesthesia aide. I had applied for dozens of senior positions, but because of my lack of relative experience, I couldn't land any interviews. As an anesthesia aide, I honed my clinical experience and learned more about patient care processes. This season was key to my future. I developed relationships with clinicians and administrators and was eventually offered a position in administration. Unlike the traditional CIO, I rose up through the business ranks while attaining both clinical and technology experience. In leveraging these three divergent disciplines, I discovered my niche but, moreover, I allowed my vision and passion to move me forward into my calling.

My career soared and afforded me many cherished memories of institutions and people about whom I will write. I have served as a leader in academia, single hospitals and IDNs, for-profit and not for profit, the last 5 years as a CIO. But what stokes my fire each day is knowing in my heart of hearts that what you and I do as professionals in health care information technology has a significant impact on those whom we serve, primarily our collective patients. Stay tuned to "CIO Unplugged."