Guerra On Healthcare: Implementing EMRs Despite Reluctant LeadershipGuerra On Healthcare: Implementing EMRs Despite Reluctant Leadership

It's been said in countless presentations, manuals, and interviews: transformative clinical IT implementations cannot be led by the CIO. The IT department must support the change, but it cannot force clinicians to do anything -- that impetus must come from both the clinical leadership and the hospital administration (think CEO, COO, CFO).

I have absolutely no doubts this is an accurate recipe for success, but what happens when you're missing a key ingredient, such as a willing leader in the aforementioned positions? What happens when CEOs won't lead the electronic medical record (EMR) implementation, when they are either too busy or (more likely) too risk-averse to put their stamp on a project which has tons of potential to make very powerful people angry (think high-revenue-generating independent physicians).

At that point, the tried-and-true axioms of success break down, because no one goes beyond the premise, "IT can't lead this." When the people who must lead refuse, what's a CIO to do?

First off, we must assume that, in this scenario, the CIO has no intention of throwing in the towel, no intention of conceding, "the person who had to lead would not, so that's why the project was unsuccessful." In the scenario I'm crafting, failure is not an option.

This means the only course for the CIO is not to lead, but to make the leader lead, to make the CEO, COO, and/or chief medical information officer understand what role they must play in the process. This means e-mails, phone calls, stopping by the office, grabbing coffee, talking to people who have influence over them, cajoling, communicating, educating, scaring ("This is how much failure will cost"), and, if necessary, going over their heads (to the board) to get the message across.

Make no mistake about it, as CIO, you will be blamed for a large-scale clinical IT implementation failure, despite the fact you cannot lead it. Let's start with this premise (reality) and move on. If you cannot overtly lead it, but you will be held responsible for it, then you must, somehow, lead indirectly. If the public-facing leader is reluctant, weak, or cowardly, that's not a "Get out of jail free card." You must play the cards you've been dealt, and make that leader lead. You must do whatever it takes.

Ironically, some people reach the pinnacle of corporate success by being consummate responsibility-evasion artists. You know them, they are the ones who never really commit to anything, always kicking the can down the road with phrases like, "That's an interesting solution. I think we need to consider the downside involved before we move forward. Let's revisit it at the next meeting." When it comes to EMR and computerized physician order entry (CPOE) implementations, these people are kicking your career down the road. Don't let them get away with it.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].