Healthcare IT: fictional hospital CTO interview questions and responses

CIO Interview -- Lakewood Hospital

How were you trained or and how did you decide upon your career?

I received my formal technical training in the Midwest. I hold a Bachelor of Science in Computer Engineering from Loyola University in Chicago, and completed a Master of Science in Information Systems from Michigan State University several years later. I have held many positions over the years, moving from helpdesk service internships during my college career to IT Director level positions by the time I enrolled in graduate school.

It has been an interesting ride -- I have seen the evolution of technology over the past decade and still find it exciting. My interest and passion for technology has always been there and I landed within the healthcare space and have found that it suits me well. Not just in terms of the types of technology, but also in terms of the needs that our technical solutions fill. I know that the work our department does impacts the lives of everyday people -- babies, the ill, the recovering, and the staff that serve them. Technology has transformed the way we collaborate and communicate in healthcare settings today; it has been a joy to work with new technical tools that meet the unique needs of the industry.

What implementation failures have you seen in your career? What lessons were learned?

When it comes to implementing clinical IT, we try to make sure we do things well, but our initial launch of a computerized physician order entry (CPOE) system two years ago failed. Strategic Decisions to move in this type of direction are always complicated, and given the myriad market options available and our unique needs, we attempted to self-develop. Both planning and physician support for the project was a bit poor, and we ultimately failed.

We learned the importance of involving clinical teams during the prospecting phase for such solutions vs. keeping things more IT-centric (Janicic et al., 2011). Engagement and training must be solid and there needs to be a senior level champion to help drive adaptation in the organization. We also came to understand the importance of more realistic timelines to implement and using a pilot to truly inform your launch so that you work out the kinks and modify before moving forward. We went back to the drawing board with a new vision and fresh approach. Today, our new CPOE system, EPIC, has 90% utilization and end users are happy. We learned a great deal from the missteps we made during that first attempt.

Do you have any experience in disaster planning for IT?

Yes. My initial introduction to disaster planning in IT came in 1999 when everyone was biting their nails over Y2K. The organization I was with at that time took all the necessary steps and partnered with IBM to help ensure infrastructure resiliency and network availability in the event of a catastrophic event. Of course Y2K came and went without the world ending, but as a plus it did create a focus on disaster preparedness in the industry. Today, Lakewood, like many other institutions, works to ensure we always have a plan that reflects our current IT structure and can support our needs. We know that patient's lives depend on the decisions we make and our ability to equip staff to continue serving despite disasters or any major hiccups that might occur.

What are the systems to assure redundancy and security in case of floods or other disasters? Do you have off- site back up?

We routinely conduct a business impact analysis (BIA) to identify the impact to operations in the event of a disaster. We also examine the impact to patients and care delivery. We flag any possible points of failure and plan around those vulnerabilities. The use of a remote data center is currently being explored for increased protection in the event of a disaster or system failure. We will incorporate data replication strategies that are most appropriate for Lakewood once we finalize our decisions.

What are the benefits of our IT systems when compared to other facilities for which you have worked?

The IT systems at Lakewood are built around a fundamental desire to deliver quality patient care. Systems operate well and there is an emphasis on continuous improvement. I think we have done a great job of leveraging EHRs can connect with specialists, labs, imaging facilities (X-rays, CT Scans, MRIs), and other hospitals. Adoption of such systems has allowed our doctors to share up-to-date information with patients and improved the speed at which we receive test results and other information. There are still many institutions out there that have not taken the plunge with EHR solutions or if they have, have not done it very well.

How does our IT system promote patient safety and privacy?

The privacy and security of patient information will always be a top priority in healthcare (Janicic et al., 2011). Lakewood Hospital follows all Health Insurance Portability and Accountability (HIPAA) rules to protect our electronic information. Staff is trained in ways to properly access, share and use such information. In addition, all HIPAA covered entities have a contingency plan in place to ensure continued access to electronic protected health information in the event of a system failure. This is an important part of our emergency mode operation plan.

Are you interested in Cloud computing and is that a planned direction for the future.

Absolutely! It is really an imperative for our industry. The "cloud" takes advantage of economies of scale and resource pooling and can offer us massive amounts of storage and computing power (Janicic et al., 2011). It is still very new in computing, but I do think that it will transform healthcare. I see this happening most through improved data security options, easier service upgrades, and trends towards mobile health. For instance, as Lakewood moves towards more partnerships with other organizations, data may be needed in two places at once. This would allow us to synchronize and share in real time with greater speed. I see great possibilities. We are actually talking about a Lakewood Hospital app that could be downloaded by patients to tablets, iPhones and other devices and used to interact with us.

The use of care-tracker has been an enhancement to the quality of care provided to patients; do you measure the return on investment on use of care-tracker?

We do look at our ROI in this area. Since implementation, we estimate that we save over 60 hours a month by using care-tracker to review goals, programs, services, and nursing information. In the old days, mountains of paper documentation were kept in multiple places with no real owners. At times forms would be forgotten or lost. In short, it was messy and patient care suffered. Care-tracker has proven a sound investment and has helped eliminate inefficiencies and improve employee communication.

What are the top challenges you see with AristaCare and how are they being addressed?