Tuesday, October 22, 2013

Losing the Popularity Battle, but Winning the Career War

CIOs are typically not very popular and are not known for their charismatic leadership i.e.

How do you distinguish an introverted CIO from an extroverted CIO?

An introverted CIO stares at his shoes.   An extroverted CIO stares at your shoes.

In the past, I've been able to achieve reasonable levels of popularity through rapid innovation and responsive agile application development, often delivering discretionary projects to individual departments.

As I navigate FY14, creating project plans that allocate resources and time, it's clear that I cannot deliver any discretionary projects.   If the Main Thing about leadership is To Keep The Main Thing The Main Thing (Stephen Covey) then I have no choice to but to keep IS resources focused on the Federal regulatory agenda that has been prescribed for FY14 and nothing more.

Now that I'm back from China/Japan/Taiwan, I will accelerate my efforts to communicate with stakeholders at all levels that the Federal government has set the strategy for healthcare IT departments in FY14 and as unpleasant as it sounds, IT management and healthcare stakeholders really have no flexibility to prioritize departmental projects.    Here's what I mean:

ICD10 - this federal requirement is pass/fail and involves the entire inpatient/outpatient revenue cycle.   Every piece of software, workflow, and process needs to modified.    It will cost the country billions, have limited benefits, and should be considered high risk, given the coordination needed among payer/provider organizations.   It's bigger than Y2K for healthcare and has a firm October 1, 2014 deadline that no one in government is willing to change.    Assume ICD10 will consume a majority of your IT resources for the next year.

Meaningful Use Stage 2 - this federal requirement is focused on stimulus in the short term, but penalty avoidance in the long term.   Hospital margins throughout the country are slipping, so it's very hard to turn down millions in Medicare/Medicaid stimulus.    ICD10 trumps Meaningful Use work, but hospital management really expects IT departments to deliver Stage 2 Certified software for everyone to use.   Eligible professionals who have already attested to stage 1 are looking to IT departments to provided updated  software so they can attest and claim the remainder of their $44,000 stimulus.    Meaningful Use Stage 2 has a 2014 deadline for hospitals and clinicians who attested to Stage 1 in 2011.

HIPAA Omnibus Rule/Compliance and Audits -  not a day goes by without a new audit by someone - OCR, OIG, DPH, internal, CMS.   I've heard that some IT departments are hiring full time staff just to respond to audits.  As with ICD10, these audits have limited benefit and consume resources that would have been applied to innovation in the past.   However, the work must be done.

ACA - The Affordable Care Act has required many new IT applications - health insurance exchanges, health information exchanges, quality registries, care management systems, and business intelligence infrastructure.  The Affordable Care Act required work is likely to improve efficiency and value in American healthcare.   However, the work displaces departmental priorities by consuming resources that might have been applied to local workflow enhancement projects.

Business imperatives with deadlines that cannot be missed - Healthcare reform has spawned a flurry of mergers and acquisitions that include fixed IT deadlines such as opening a building, extending networks, installing phone systems, merging clinical data, and expanding email coverage.  Although these are beneficial, the effort to support mergers and acquisitions takes resources away from optimizing local workflow and infrastructure.

What is the implication for CIOs?   Spreading a message that ICD10, MU2, HIPAA/Audits, ACA, and mergers have consumed all available IT resources for the next year is not going to be popular.   I truly expect many stakeholders to acknowledge that these priorities are reasonable as long as their departmental needs are also met.   The needs of the many are good as long as they don't outweigh the needs of the few.   Unfortunately, the answer for the next year needs to be "not now" if institutional survival is the main thing.

So over the next few months, I expect my waning popularity to wane even further.   I will lose the popularity battle.   However, when the regulatory mandates are done and the institution's longevity is assured, my career will be intact.   Losing the popularity battle but winning the career war for the benefit of the institution sounds like right long term strategy but certainly will require strength of will, a thick skin, and constant communication.


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