Running in place? With IT budgets still lagging and both patient safety and legislative mandates knocking at their doors, healthcare CIOs remain challenged to deliver solutions that fill the many bills of internal audiences

Health Management Technology, Dec, 2004 by Robin Blair, Mike Hilts

Each year for the past six, Health Management Technology has surveyed the top IT guns at hospitals, clinics and health plans throughout the U.S. Each year, we pick the brains of technology leaders to learn what's shaping their daily activities and long-term plans--and how much control they have in implementing their tech solutions or in simply coping with the challenge du jour.

If we left the answers to CIOs alone, some might summarize the past year with the truism, "The more things change, the more they remain the same." They might even be willing to deep-six the romantic notion of themselves as visionaries managing dynamic horizons and fast-paced, fluid environments.

Another year of data piled onto the first five does magnify the conclusion that the healthcare CIO is different than his or her counterparts in other fields. Some are clearly entrenched in positions that, while mentally stimulating, represent static landscapes resistant to change. Still, healthcare CIOs are loyal to healthcare. They come to the field and stay in the field for the intrinsic rewards more than the financial compensation. Their challenges remain consistent: financial restraints, the "corporate culture" of healthcare and, of course, increasing demands from internal users.

And yet, while the data reveal the constancy of a day in the life of a healthcare CIO, HMT's new survey does identify a few, and possibly key, trends taking shape. The most prominent shift is one that leapfrogs patient safety-related projects ahead of other priorities. Another is the possible "cooling off" of the hot button of the recent past: return on investment. The need to show ROI has seemed to fade against the need to show clinical improvements.

Don't Get Around Much Anymore

CIOs who come to healthcare stay here. At one level, that's reassuring. It means the same captains are steering the IT ships from one year to the next, or that when they do change jobs, they bring with them a wealth of experience. This year, 173 CIOs, IT directors or equivalent senior executives from hospitals, integrated delivery networks, health plans and physician group practices or IPAs answered HMT's survey. Of them, two-thirds indicate they have been in healthcare for more than a decade, with the largest block--39 percent--claiming to have been in healthcare for more than 20 years. In addition, 21 percent have been in the field from six years to 10 years.

Beyond being fixtures in healthcare, senior IT officials surveyed also are fairly entrenched in their current jobs. Thirty-six percent of CIOs said they have been in their current positions for six or more years, including 15 percent who have stayed put for 11 to 20 years or more. These answers are similar to our 2003 survey, when 37 percent had been in their posts for more than six years. Still, the biggest block are CIOs who have been in their posts for two to five years (41 percent of this year's respondents, and 40 percent of the respondents in 2003).

Demographics: Who Are the Top Guns?

In 2004, 65 percent of respondents worked at single or multi-system hospitals and medical centers, 15 percent came from physician group practices, 5 percent from health plan or payer organizations and 12 percent from other healthcare organizations such as visiting nurse associations, county public health departments and community mental health centers.

The average age of respondents was 46--exactly the same as last year. But something has changed: 23 percent were female, up from 17 percent in 2003. Thirty-eight percent reported having B.A. or B.S. degrees, while 42 percent said they had master's degrees.

CIOs from all sizes and types of healthcare organizations responded to the HMT survey. From provider organizations with beds, 19 percent came from facilities with fewer than 100 beds, 14 percent with 100 to 199 beds and 12 percent with 200 to 299 beds. At the higher levels, 14 percent reported 400 to 499 beds, 12 percent reported 500 to 999 beds, and 11 percent reported 1,000 to 1,999 beds. Only 4 percent of respondents came from IDNs with more than 2,000 beds.

Of those reporting from physician practices, 39 percent came from practices with nine physicians or fewer, and another 39 percent came from practices with 10 to 49 physicians; 12 percent worked in practices with 50 to 99 doctors, and another 12 percent came from practices with more than 100 physicians.

Respondents from the payer side for the most part emanated from small organizations, with 63 percent covering 250,000 or fewer members. Countering them, 13 percent worked for health plans with 750,000 to 1 million members, and another 13 percent for plans with between 1 million and 3 million members.

Overall Budgets and IT Spending

In every healthcare organization, info tech competes for its share of the budgetary pie with myriad organizational needs, requirements and special projects.

The good news comes from a drill-down of the survey data: CIOs seem to be winning the tug of war, getting more money to work with, albeit only slightly more. Only 9 percent of reporting healthcare organizations cut back on IT spending from their 2003 levels, while almost half (48 percent) say their IT spending increased in 2004, up from the year before, which saw 42 percent as gainers. More important, where spending did rise, the average increase was almost 20 percent, eclipsing 15 percent improvement seen in 2003. The bottom line result was about an overall 8 point increase in IT spending across all responding HCOs.