On Jan. 13, the Ann Arbor, Mich.-based College of Healthcare Information Executives (CHIME) named William Spooner, senior vice president and CIO of the San Diego-based Sharp HealthCare, the recipient of the 2009 John E. Gall Jr. CIO of the Year Award. Spooner, who has been CIO at the five-campus, 2,000-bed Sharp HealthCare, oversees over 400 IT professionals at the integrated health system. Spooner spoke recently to HCI Editor-in-Chief Mark Hagland regarding the CHIME honor and his perspectives on the evolution of the CIO role.
Healthcare Informatics: What was your reaction to receiving the honor of being named CIO of the Year? What do you think it means for you?
Bill Spooner: Even though I’d had the opportunity to present the CIO of the Year award a few years ago, when I was CHIME board chair, I hadn’t really been all that familiar with the nomination and selection process. So I was excited when I learned I’d been nominated; and once I realized I had won the award, I was totally overwhelmed. To be mentioned on the same list as the past recipients and to have been chosen for the award, was rather humbling. I think it’s a recognition for my team; because my team has done a lot of great work. I take the credit for leading my team, but my team has done a lot of great work. And Sharp has been an innovator for a long time, in various niche areas, whether it be information technology or medicine. We were the first hospital to do open-heart surgery in San Diego County, in 1958.
HCI: So Sharp has long had a culture of innovation?
Spooner: Yes, Sharp has had a culture of innovation. And my boss came to recognize through all of our conversations that we have to look at it in a global sense. So he, our CEO, has been very supportive, and the board has been very supportive, in the last several years. And that’s really been the key to fostering success in enabling us to do what we’ve been able to do. So the award is as much a reflection on the organization as on me. And because I’ve got a really good team, I’ve been afforded the time to do some things outside, at CHIME and in other venues.
HCI: We seem to be at a very pivotal point in the evolution of the CIO role within the health care field. More and more CIOs are becoming, and need to become, senior leaders in their organizations. While retaining some technical knowledge will be important, for most CIOs, being a part of the executive management team and helping to steer their organizations forward on a far broader level than in the past seems to be what's called for. Your thoughts?
Spooner: That’s right, and the other piece of it is the role of the CIO on the executive team. The question is still being asked. I remember five years ago at CHIME, everyone was asking, how do we get the CIO in the c-suite, at the executive table? And I don’t think there are many CIOs who aren’t there at this point; there may be some. But certainly, there’s the recognition that they need to be there at the table. So I think you’ve got the transition of the title from director of IT to CIO; you’ve got the participation at the executive level; and you’ve got the reporting relationship upward in the organization. And there are more CIOs reporting to the CEO and COO than before.
HCI: And what the CIO does is more strategic than it was a few years ago?
Spooner: I couldn’t configure a server if my life depended on it. And I really don’t very often get down into the technical details; I get into the high-level architecture discussion; and into the hot-topic issues. But I rely more and more on a team with diverse skills while at the same time trying to understand what the direction of the organization needs to be, and trying to prod it forward in the right ways, including into the community, and in the position, I’ve been taking on more of a community role. In fact, more of us are taking on advocacy roles. I testified at a hearing of the California state Senate Health Committee a few weeks ago, regarding California’s position and progress regarding health information exchange. That wouldn’t have been common a few years ago.
HCI: What do you see as the biggest few challenges facing hospital and health system CIOs in the US right now? What are the biggest opportunities?
Spooner: There are near-term issues and longer-term issues. We all have the challenge of making our EHRs hum and qualify for the stimulus. And some of the meaningful use requirements, particularly around reporting indicators, may end up being trickier than we might have thought. But we have more and more opportunities for using automation to make it easier to do our jobs; and it’s a real challenge how to decide where to apply the resources. That’s the ‘today’ thing. I think down the road, it’s all of healthcare reform. And we know that there will be changes in reimbursement, towards such things as changes in reimbursement. We really have most of the infrastructure in place here at Sharp for ACOs [accountable care organizations]. And we don’t know exactly how healthcare reform will impact us. But it’s really the fact that, like it or not, and whether it’s this year or five years from now, we have to bend that cost curve, and that’s got to be top of mind for all of us. And we’ve got a board-level committee devoted to IT issues; I’d say only about 10 percent of hospital organizations have that so far. Now, we’ve got a couple of CIOs from for-profit corporations on our committee. And in healthcare, it’s more complicated; they seem to have the ability to move things along faster; there’s not as strong a drive to produce a more cost-effective, higher-quality widget, in healthcare. But as we’re sitting close to 17 percent of GDP, we’re going to have to think about how to bend that cost curve. It’s just a different culture. But it is kind of exciting as well. You’re being asked to do things in totally different, new ways.
HCI: What are the biggest challenges and opportunities facing you in your own organization?
Spooner: We’re striving forward on a lot of initiatives; we’ve got a lot of things on our plate. And we changed direction in terms of EMR four years ago; we decided to eliminate some of our best-of-breed products in favor of moving mainly towards Cerner. And in managing what had become pent-up demand, and with a high focus on some of our organizational initiatives, including Cerner and Allscripts in our medical group, the whole prioritization issue is a challenge.
HCI: How do you view the current situation with regard to the ARRA-HITECH legislation and federal stimulus funding?
Spooner: I’ve been following it fairly closely since the legislation was passed and the initial outline was drafted. I’ve probably taken a somewhat divergent view about certain things. I think we’ve protested, as an industry, more than is appropriate, in terms of some of the demands around CPOE. I think we spent a lot of time trying to fend off CPOE, to the point where we were only at 10 percent of implementation; but the functional and quality indicators have come out a little bit stronger than expected; but we might have achieved a slightly better balance if we’d been more aggressive or optimistic in terms of our ability to move CPOE. One of the things that’s been kind of interesting here at Sharp, and I’m pretty pleased with the outcome, but it wasn’t easy, is that when we decided to move to our new EMR with Cerner, there wasn’t room for paper charts anymore, so CPOE became a directive. We didn’t make it mandatory, but we had 50-55 percent CPOE adoption in the first month. And we went through the typically rebellion and pushback from the medical staff. Then we moved into the new hospital, and after 16-17 months, we were in the mid-80 percent range, and we’re now at about 90 percent. We brought Cerner up in November, and by December, we were at 83 percent CPOE utilization at our second hospital. And we’re not an academic medical center, we have community physicians doing CPOE.
Meanwhile, overall, I’d say that those involved in the HITECH work have done their job in terms of the meaningful use requirements. I think they’ve been pretty thoughtful. They’ve outlined some requirements that will raise the bar; I think they will challenge us, but in a good way.
HCI: What should your generation, the established generation, of CIOs be doing to help newer CIOs and those who are not yet CIOs, become effective leaders and executives?
Spooner: There are a number of things that we can and should be doing: clearly, helping to encourage up-and-coming leaders to get the right kind of education and experience. The CHIME CIO Boot Camp is an awesome training ground, because it not only gives them some very practical methodologies, proven by some very experienced CIOs, but it also establishes some networking and mentorship that you just can’t get anywhere else. I wish I’d had that available to me years ago. I’ve not heard anyone come out of that and not say it was outstanding. And give opportunities and challenges to people in your organization, so that they can grow, so that they have the opportunity to succeed, or to fail with forgiveness once in a while.
HCI: How do you see CIOs' relationships and interactions within their hospital organizations changing, particularly with regard to clinicians and clinician leaders?
Spooner: That’s absolutely true, we need to be able to speak the language of the clinicians. Still, try as we might, we’ll never understand clinician workflows in the ways that clinicians do. So we have to have clinicians coming into the dialogue. We have a CMIO. And in any significant interaction, you need a CMIO and you need system-level nurse informaticists involved. We’re recruiting for a system-level nurse informaticist now, and we’re looking for other nurse informaticists as well. They need not only to be involved in changing workflow, but also to drive change in the clinical setting. I’m a former CFO, and I could go in and say those things, and they’d look at me as though I’ve lost my mind. So partnering with clinician leaders in informatics will become more and more important going forward. And though the CIO more and more is out there as a change agent, more and more, the initiatives must be led be clinician leaders who are sponsors. So more and more, being a change agent means persuading the change leader to create the change.
HCI: How do you see the CIO role changing and evolving in the next five years?
Spooner: I think some of the conversation we’ve had so far leads to that, as far as being a change agent and agent of transformation is concerned. And among some of the skills we’ll need in the future, vendor management, for example, will become a skill set in itself. And just plain business leadership. And there’s the whole concept of sourcing. I have very little contract help in my department; I use some consultants. But we may find ourselves using some external, contracted support; or we may have people who are contractors or who are employees of offshore contractors who are doing development or support for you. So the focus will be not only on recruiting and retaining the best staff, but also the best contract resources. In other words, how do I get the job done? And that ties back to the conversation, as well, around pulling costs out of the organization. There have been articles in the local newspapers here about the City of San Diego changing its help desk, because they in their IT help desk can use an outside contractor. They use contractors for nighttime staffing. So as CIO, you’ll still have the responsibility for service, but you’ll be delivering it through different vehicles, and you need to keep good relationships between your own staff and outside contractors. So I think more and more flexibility will be required.
HCI: Any closing thoughts?
Spooner: It’s a tremendous honor to receive the award. And I had an e-mail from Bill Childs this morning. His message was, congratulations on winning the John Gall Award. In fact, Bill Childs knew John Gall for years. And it’s pretty exciting to be included on the list of accomplished leaders who have preceded me in this honor.
