What are some of the main challenges facing CIOs right now, in the evolving operational landscape of U.S. healthcare? Tom Andriola, vice president and CIO for the University of California System and UC Health, shared his perspectives on the subject on Thursday morning, in his keynote presentation, “Managing the Changing Role of the Chief Information Officer: Clinical Transformation, Governance, Workforce Development,” at the Health IT Summit in San Francisco, sponsored by Healthcare Informatics, and being held Thursday and Friday at the Palace Hotel in downtown San Francisco.
Andriola directs IT strategy for the University of California System and UC Health; UC Health encompasses five University of California health systems—at San Francisco, Davis, Los Angeles, Irvine, and San Diego), accounting for $11.3 billion in annual patient revenues, and which trains 50 percent of California’s medical students and medical residents, and performs more than half of the organ transplants in the state every year. It is the fourth-largest health system in the state.
“There’s never been a better time to be in the business of technology, because IT is having more and more influence on the way we work,” Andriola told his audience. “And, as IT leaders, we have to start thinking more broadly, because there are more and more questions we have a role to play in.” An absolutely key element in CIO success, he emphasized, is that “We need to be in the right conversations at the right times, and to be ready to ask the right types of questions, to help our organizations engage in asking the questions about where we go next” in healthcare.
Andriola summarized some of the “dramatic changes taking place in U.S. healthcare,” focusing on some of the major challenges facing patient care organizations around “revenues, cost structure and payer mix”—where, he noted, “we have a huge challenge in cost structure around our academic setting”—as well as “care quality, patient mix and access,” and the increasing “consumerization” of healthcare. “It’s not just what’s going on in the Epic booth or the Cerner booth any longer,” he said, referring to disruptive entities coming into healthcare from all quarters. “The consumerization element and the broader recognition of who can actually help me with healthcare, that’s starting to change, and there are alternatives to getting care that will take revenues out of our pockets,” he said, referring to non-traditional providers of care that are emerging from outside established patient care organizations. “Now,” he said, “you’ve got disruption happening everywhere. There are disruptive outside forces around value-based care models, scientific advances, technological advances. The world has gotten more complex,” he added. “It used to be that competitors were well understood,” meaning traditional fellow providers. But incumbents are rapidly being gained on by new insurgents in the industry.
The impacts are multi-dimensional, and span the strategic to the practical, Andriola noted. Just to cite one very practical consequence of some of the disruptive changes affecting the healthcare CIO environment in California, he noted that “Very few people understand both the clinical science of healthcare and the data science around AI”—artificial intelligence—“and we have had a hard time keeping those people” within the UC Health system, he reported. “They get offered huge salaries to go work at technology companies across the Bay Area, with Silicon Valley ever-present in his hiring management calculations. The disproportionality of scale is a considerable issue, he noted, between what the public sector, including the state university system, and government, can offer skilled data scientists and other informatics experts, and what the private sector can offer them. “One of my colleagues,” he said, “recently pointed out to me that the entire budget of the National Science Foundation is $10 billion a year, whereas Amazon, Google, and Microsoft alone are investing $100 billion right now in cloud infrastructures”—and hiring data scientists, data engineers, and informaticists to help build out those architectures.
What should CIOs be doing right now?
“What should CIOs be doing today, and what should their contributions be to the organizations be?” Andriola asked his audience. “And what will advice to CIOs look like in 2025? One of the things I poke fun about is the fact that we CIOs now get way, way too much advice,” he said, “from Gartner, from CHIME”—the Ann Arbor, Mich.-based College of Healthcare Information Management executives—“and from everybody else. And some of what some of those organizations are saying is confusing.” He showed a slide from Gartner that he testified was very confusing. It was an unusual graphic showing a CIO’s “old job,” and then a cluster of bubbles showing “actions” the CIO should take, including “preempt disruption,” “define your new job,” “live your new job,” and then a final bubble labeled “new job.” “I’m not sure what this graphic even means!” he noted.
Importantly, Andriola said, “CIOs need to focus on the fundamentals.” First, “Can you be an effective leader? Understand what it means to be an effective leader.” Second,” In your environment, can you drive, coordinate, facilitate, effective collaboration, working outside boundaries?” It’s time, more than ever before, is to break down silos.
Third, “How do we innovate? Innovation is really about moving a set of people or organization forward, whatever that might be—through new solutions, or incrementally—but do you know how to create an innovation process in your organization?” And fourth, “Can you create value for your organization’s mission and goals? How do you help your organization’s leaders create something of value? And are you relevant in your organization? Having a CIO title doesn’t make you relevant. And being invited to the off-site meeting for two days doesn’t make you relevant, if you sit silently on the sidelines. Can you help people to work together?”
In that, Andriola said, “You’ve got to mold consensus. And in the executive search world, there’s a lot of talk about seeking diverse perspectives, finding people who can seek out diverse perspectives and find common ground, and bend the curve on costs and other things.” At the same time,” he said, “CIOs still face headwinds, and continue to have to fight for their place in important and relevant conversations” in health system c-suites.” Indeed, the sad reality, he said, is that many health system c-suite executives perceive CIOs in very narrow, cramped terms, as operational managers, technology consultants, and budget managers—in other words, as non-leaders. But, he added, it is up to CIOs themselves to break out of that narrow box that some of their c-suite executives put them in.
And, per breaking out of the box of limitation, he said, “It starts by changing what you think. Network latency is not a value metric,” he asserted, though he quickly added that it is also true that “We have to fix our operational issues before we start trying to align on more strategic initiatives.” Meanwhile, he said, “Why do we say that ‘IT must learn to align with the business? Does your CFO or CPO talk like that? We’ve created this perception that we’re not just a part of the business.” In fact, he said, “’The business’ is neither IT’s ‘customer,’ nor its ‘partner.’ A better metaphor is this: we’re just part of the team.” In fact, he said, even would-be thought-leader organizations like Gartner reinforce the idea of IT’s apartments with slides that say things like, “CIOs must close the gap with top executives.”
Importantly, he told his audience, “If you want to be relevant, stop talking like a technology person, talk like a businessperson. I work hard to understand how my executives talk, understand what they’re saying, and when I’m talking with them, use their language.” And, as he said that, he shared a slide that showed a graphic that said, “100-percent geek-speak-free.”
Is data an asset—or a form of currency?
One important point that Andriola made for his audience had to do with how CIOs should define the importance of data within a patient care organization. “Is data an asset or a currency?” he asked. “ An asset is a little bit more fixed, more binary as a concept—either I’m using it or not using it, as with a hospital bed. Currency is something a little bit more fluid, like dollars; I can be using it in multiple ways at the same time; it’s a form of exchange. Data for us now is much more of a form of currency,” he insisted.
What’s more, Andriola said, “We’re starting to realize that the data we collect isn’t necessarily the data we need. We’re realizing we’re leaving a lot of data out in terms of capturing data at specific data points. Where do we need to capture data in the life cycle of data? And data only gives you insights; we have to turn those insights into action,” at the point of usage.
At the University of California Health, Andriola said, “The way we think about our data environment, is that we’re trying to leverage data by building an unparalleled ‘learning health platform,’ in order to transform healthcare delivery through data-informed services and better enable the ecosystem.”
One example he cited was that “We have about 140,000 cancer patients throughout our system—one of the biggest populations of cancer patients anywhere.” And, per that, he said, “We can use our data to improve patient outcomes, better manage populations, and create better real-world evidence- and real-time-based feedback. For example, a pharmaceutical company approached us around how we’re prescribing medications for certain types of patients in cancer registries. And we said, why don’t we bring in images? They were very interested. So we’re thinking about new transformative care models: how can we disrupt our own care models, and use data differently.”
Such situations speak to some of the new ways in which the CIOs of patient care organizations can reframe what they and their colleagues in IT do, and how they use the building blocks of their work. “I think many times, we think we’re in the technology business, that our job is bringing technology to the organization, when really, we’re in the business of influencing change. So what is the change we’re looking for, what is the desired outcome, and how can technology be the lever in a way that makes sense and adds value?” he asked. “Unfortunately,” he added, while we may have had a strong business or technology foundation in our careers, most of us don’t get formal training in managing change; we learn that on the job. And in any domain, there is a body of research here on what works, and how to do this.” For example, he noted, there is the classic schematic of the “Eight Steps for Leading Change,” created by John P. Kotter, Ph.D., which he presented in a slide. Those eight steps are: create a sense of urgency, build a guiding coalition, form a strategic vision and initiatives, enlist a volunteer army, enable action by removing barriers, generate short-term wins, sustain acceleration, and institute change.
Change cannot be forced from the top, Andriola emphasized. It must be nurtured, guided, and led. What’s more, he said, “We have roughly 7,500 IT people across the entire UC enterprise”—academic, healthcare, etc.. “How do we get 7,500 people energized to go transform the mission of the University of California? And how do we think about growing the organization’s capability to drive change? Organizations are so complex now, it’s not possible to think about how the CIO can create all the change.” In the end, he said, “It’s about leadership, collaboration, and innovation.” And in all that, he said, CIOs will have to develop leadership within the IT ranks of their organizations.