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Healthcare CIO: A Plan to Increase Headcount

I was sitting in a class in college once when the professor asked a question. Immediately, a friend of mine raised her hand and these words came out of her mouth: “I’ve got the answer. — what was the question?”

We still laugh about it to this day.  She was wicked smart and the statement was true 99% of the time.I It didn’t matter what the question was; she usually did have the answer.

I’m going to take her approach and write this article in reverse. First, I’ll give you the answer and then explore the questions.

The answer is agility. Agility is the ability to respond quickly to changing conditions in dynamic ways. To be agile is to have options; the lack of agility reveals creativity.

I mean creative in “the dog ate my homework” kind of way—giving creative excuses for why an organization can’t do something or why they are doing things in a way that is clearly compensating for something.

Here goes.

Q1. I have too many projects and not enough resources, what am I supposed to do?  Answer: Agility.

We made a move to the cloud as a drive for agility. This had three impacts.

  • We no longer asked for resources in isolation.  In my first week as CIO, I was told that we needed $15M for data center updates. These kinds of requests, which are not tied to any specific business outcome, are extremely hard for executives and boards to swallow.
  • We were able to improve our response times by an order of magnitude.  The organization’s experience was greatly improved.
  • We introduced a level of efficiency that increased staff availability for higher value projects.  A new server and compute platform that used to take 4-6 weeks to provision was now done in 2 days (and even less if you already had approvals). The amount of non-value-added busy-work was greatly reduced.

The benefit of adopting an agile model within the infrastructure team was the freeing up of over 14,000 hours of time. That is the equivalent of almost 7 full-time staff members.

How much would that help in your own company?

Q2. Our clinical workstations are old, we need to upgrade many of them with a limited budget, what say you to that?  Answer: Agility.

Ask yourself this question: when was the last time Apple sent a technician to your home to upgrade the IOS on your phone?  Have you ever wondered how many people they would have to hire if they did upgrades that way?

All of our clinical workstations needed to be replaced when I arrived. The project that was put in front of me cost roughly $12M. Here is where designing for agility first came into play.

We could have purchased a boatload of workstations, installed the image on them, rolled them out, and called it a day. However, designing for agility looks past the acquisition cost to the maintenance cost. It also factors in real dollars as well as staff time. In the end, the solution looks very different.

Six years ago, we decided to go with virtual desktops. This reduced our hardware cost by half and allowed us to invest in the network and server infrastructure. We killed two birds with one stone.

There were new workstations for all the clinicians and an infrastructure that could be maintained centrally. Upgrades were automated. For the same investment, we were able to free up 10s of thousands of man hours in support. Plus, he future upgrade project (which is always right around the corner) would cost a fraction of the originally projected $12M.

I realize this isn’t news in 2017, so let me add my thoughts about the future of clinical workstations.

A new level of agility will be attained when we don’t need workstations in the patient rooms. We explored Amazon Echo and Google Home, as well as docking stations for mobile phones in the patient rooms. We imagined a future where voice was the primary input mechanism into the EHR, and the gap technology was mobile devices that stayed with the clinician. The level of agility in this picture is even greater.

Design for agility to avoid frittering away money on workstation support and future upgrades.

Q3. The business is asking for things that our vendors don’t have yet, what am I supposed to do?  Answer: Agility.

Let me start by saying that you are not going to replace your EHR platform. However, your reliance on your EHR vendor has become slightly co-dependent. You should always look to use the EHR vendors solutions when they are available and meet the needs of your system.

However, when you hear the word “roadmap,” that is the equivalent of a partner saying, “It’s ok to date other people.”  There is very little (if any) commitment on their part to solving your problem.  I suggest you run things through this grid.

Is EHR integration required, yes or not?


If the need for integration to the medical record is nonexistent, you can explore standalone apps. Every app will need to fold into your data sharing, analytics, and user experience framework, but without medical record integration, your options increase and costs generally decrease.

If Yes, is the need for integration with the EHR bi-directional, yes or no?


If bi-directional support is not required your options remain pretty high.  Getting information out of the EHR for use in third party applications is fairly easy and options abound.


If you need limited, bi-directional EHR integration, you can explore vendors which utilize HL7, ADT, FHIR, custom interfaces, and Vendor APIs.  If it is complex, your options are very limited.

This represents a simplified framework for sure, so let me tell you what we were able to do in this area.

The Moves We Made

We created a data and application architecture, which exposed key services in order to provide agility to the organization. Once our architecture was stood up, we were able to utilize internal and external development partners to fill in the gaps between our EHR vendors strategy and our consumer-oriented system strategy.

We developed native patient experience applications to improve the consumer experience. These worked to reduce the level of friction of our transactions, such as reducing office wait times and eliminating redundant paperwork. This kind of foundation is critical for those organizations considering digital transformation.

You should have an architecture that enables you to engage partners into developing for the gaps of the EHR vendors. Don’t think this is possible? There are at least three very large health systems that I’ve spoken with this year who all have such an architecture in place.

This will give you access to entrepreneurs and students, who know how to utilize APIs to build great user experiences. If done right, the potential increase in people working on your system’s problems s significant.

Agility is a mindset. Instead of just solving today’s problem, you are looking to reduce or eliminate the same problem from a potential future. This is the shortest path to creating margin for your staff in the future.

That’s all for now.  I hope this helps, and as always, please reach out if you want to discuss this further. @thePatientsCIO