Healthcare CIO
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A Framework for the Healthcare CIO

See if you can relate. I was named CIO of a $5.5B health system and hit the ground running. At the 2-month mark, I was sitting on the deck of my friend’s home. When he asked me how it was going in my new role, I paused for a little bit and then gave him a resolute answer of, “I don’t really know.”

I was busier than in any role I had ever had. I was attending more meetings, putting in more hours, meeting with the user community, building my staff into a team, and handling the hundreds of requests that had come my way. The expectations were a bit overwhelming. I began to wonder if the role of the healthcare CIO was a well-defined role. I didn’t really have time to figure that out, so I decided to come up with a framework to help me get my bearings.

A Simple Framework

I believe in simple frameworks. They help me to organize my thoughts and to provide a means for evaluation. They aren’t designed to be comprehensive, just a guide. Here is a framework that has served me pretty well over the last six years. A healthcare CIO needs to do three things: keep the trains running on time, lay new track, and build airplanes.

Keep the trains running on time

The ‘trains running on time’ metaphor refers to the work every CIO does to make sure the operation is sound, secure, and efficient. An expectation is that the systems will run, information is secure, and they will work well when the clinicians use them. Neglect this work at your own peril. I have found that if you define the right architecture, processes, and hire well, it should work. Spend too much time in this area and you won’t be a CIO for long. This is the basic blocking and tackling of IT.

Lay new track

In addition to the important work of keeping the trains running on time, the IT organization is constantly asked to make things better, provide better workflows, and improve the organization’s ability to achieve their mission. I lump these incremental improvements into the category of “lay new track.” Projects that build on the existing infrastructure to enable new destinations to be reached fall into this category. Most healthcare CIOs are focused in this area. This is a form of incremental innovation. The challenge here is to remain aligned with the desired mission/business outcomes. Projects for project sake are rampant in healthcare, but remember: activity does not equal progress. A CIO must evaluate projects for relevancy often.

Build airplanes

Finally, we are called to consider transformational innovation. The airplane didn’t make the train obsolete, but it changed travel. A CIO must always question how things are being done today, and look for ways to fundamentally change the game. Perhaps not the 10X improvements that is popular to talk about, but much more than an incremental improvement we often call transformative. The healthcare CIO needs to remain in front of these conversations. I’m seeing a host of new jobs pop up, which leads me to believe that the CIO is not doing this role. There are innovation officers, experience officers, digital officers, as well as others that are filling the gap that is being created by CIOs who choose not to move beyond the trains and track categories.


How did this framework help me? It helped me to organize my time. You have to do all three. I would look at my calendar after a busy stretch to determine what I had prioritized. It would give me an indication as to what I was communicating to my team — usually, it meant that they also were narrowly focused.

I also noticed that my priorities were seasonal, which allowed me to cut myself some slack. If there was an outage or a security issue, I may appropriately become focused on operations. During budgeting, there were more strategic conversations going on, and more of my time would be spent dreaming with my peers about what was possible. Most of all, it helped me to remain balanced. A healthcare CIO needs to be operational, strategic and visionary in order to be effective in the rapidly changing healthcare landscape.

Hope this helps, drop me a note if you want to discuss further.  Contact Us or follow me on Twitter  @thePatientsCIO