CMIOs and Innovation: A culture change needed?

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In a recent interview with CMIO, Sameer Badlani, MD, secretary of the Board of Directors of the Association of Medical Directors of Information Services and CMIO at University of Chicago Medicine, observed that he hoped that an increasing number of CMIOs pursued innovation, since that is something the field “desperately needed.”

One of the concerns express by Badlani is that, for most CMIOs, the burden of dealing with issues like Meaningful Use (MU) or trying to comply with the Affordable Care Act leaves very little time for innovation. But it could be more complicated than that, says Ryan Bosch, MD, VP and CMIO of Inova Health System in Falls Church, Va.

“We’re all very busy, so I think it’s very rational to have the concern that this might preclude innovation,” says Bosch. “But it may be more a case that we’re reluctant to innovate because it’s not in the culture of our healthcare IT system. I’ve been quoted as saying that our IT leaders—and I include myself as one as a CMIO—fear innovation, and the reason we fear it is that we’ve never had the capacity to deal with it.”

Bosch says that when it comes to innovation it’s always been an area that’s been left to vendors, “so the concept of innovation is really less about being too busy for it, and more about the cultural change that needs occur in healthcare to actually accept and embrace innovation.”

At Inova, Bosch says, the way the organization is trying to effect that cultural change is through education—ensuring that Inova’s IT leadership is aware that the complexity of MU and accountable care, and value-based care means that the ability to innovate in these areas is beyond the capacity of any single vendor.

“They [vendors] are much better than they were a decade or so ago, but when the day is done they give you the technology, and in the end you have to understand, develop and improve it, and take on some ownership, rather than feeling like you’re just a liaison to the vendor,” he said. “I think that culturally, that is our biggest issue.”

But, when it comes to IT most innovation still comes from the vendor, “so true innovation from a health system is often very negligible,” he says. “Most of the innovation involves the application of some other vendor’s software, not in how we can design a process from the start. I’ve been in this business for 15 years and I think the situation is changing.”

When you compare the classic high-tech company with a healthcare system, one should be able to understand the formidable barriers that an IT leader such as a CMIO faces, Bosch says.  “That high-tech company is putting 20 percent into research and development—into new software and new applications—and that’s something that just can’t be done in healthcare.”

Yet, Bosch points out that things are changing, simply because we are discussing the question of innovation. “We are starting to realize that you just can’t force people to do things a certain way because that is how the software is made,” he says. “People in Washington are changing the paradigm around payment, where value is becoming more important, and the more important it becomes, it also becomes a better motivator for folks to own their own process.”