Hetz is an industry veteran with over 30 years of experience in health IT leadership. Before joining Advisory Board, Hetz was the Senior VP and CIO at Asante Health System for 24 years. Hetz has also served as a founding board member and officer of the Reliance eHealth Collaborative, a statewide health information exchange, and a founding board member of HIT Commons, a public/private corporation established to promote and manage statewide health IT initiatives.
Question: Going into 2020, what do you think will be the dominating theme for health IT?
Mark Hetz: In IT terms, interoperability will be a dominating theme. As seen from a business perspective interoperability means supporting partnerships with payers, other providers, community-based organizations, and transparency with consumers regarding pricing and quality. The business models are in flux and health IT will need to be nimble in how it shares, digests, and ingests data from other organizations. If you are trying to be successful in value-based payment arrangements, you either need to have market dominance or access to data beyond your organization.
Q: Which technology do you see finally delivering on its promise for hospitals and health systems in 2020? Which technology is still overhyped?
Hetz: A technology that is now clearly delivering is telehealth—specifically video visits. It's not that the technology has advanced as much as the business models, regulatory environment, and consumer acceptance have all matured significantly in the last few years and will continue to do so. It doesn't hurt that major vendors are now providing the integration points for an improved user interface to video visits for providers and consumers.
From a technology perspective, 2020 will be the year for the Fast Health Interoperability Resources (FHIR) standard. Organizations that have not at least begun to develop their capabilities regarding FHIR may find themselves behind the curve. It's not going to replace decades of legacy HL7 2.x interfaces, but it will be essential to meet the increasing demand and complexity of the integration requirements facing providers—especially those with a robust consumer digital strategy.
Remaining at the top of the list of overhyped technologies must be blockchain. I am certainly not saying that it doesn't have a place in health care, just that the business-case and proof-of-concept implementations are not there yet. This is a technology, like many, where health care will likely be (and should be) a laggard. Once banking and manufacturing supply chain providers have adopted, refined, and demonstrated the value proposition, then it will begin to get traction in our industry. The first inroads into health care will likely be related to the pharmaceutical supply chain.
Q: What technology issues should be keeping CEOs up at night?
Hetz: Cybersecurity and infrastructure resiliency are the obvious and perennial answers. Beyond that, the two biggest concerns are managing the exponential increase in IT complexity and bending the IT cost curve.
We all drank the Kool-Aid that the monolithic vendors (Epic, Cerner, etc.) were going to simplify our application portfolio. Few of us have experienced it. We replaced a few ancillary systems and perhaps consolidated our revenue cycle and EHR platforms, but in return we have seen hundreds of add-on applications come through our front door and occasionally the back door. While some actually deliver on the "easy integration," each has its own contract management, security management, and life cycle management workload.
At the same time that the environment grows ever more complex and IT is raised to the level of strategy-enabler, CIOs are being asked to maintain operating budget growth to the same level as other support functions – sometimes less. While everyone points to reduced cost of storage and cloud-based solutions as reasons for reduced IT expenditures, these potential savings are overwhelmed by the tsunami of new costs related to new systems, competition for talent, and increased demand for analytics. For example, I recently spoke with a CIO whose organization had made its telehealth/video visits strategy its top strategic priority for the year and yet his request for an FTE to support it was denied.
Q: Say you're a CIO today and your CEO hands you a blank check to do your job—what's the first thing you do?
Hetz: That's easy and fun to think about: I would create an endowment to fund the recruitment and retention of the best team, and provide for their ongoing training. In the end, a good team is more important than a good suite of systems. I would define a good team as service-oriented, technically talented, having mutual respect, and sharing a common vision of their role in the organization. If the check were big enough, I would also fund for ongoing training of staff, especially clinicians, to help them get the most out of the tools available.
Q: How do you see the role of a health system CIO evolving alongside the emerging Chief Transformation/Innovation/Digital Officers?
Hetz: This is going to depend largely on the size, complexity, and culture of the organization. It will also, frankly, depend on the talent and interests of the CIO. For small to mid-size health systems, a CIO who has the experience and desire may fill all or some of these new roles. For many organizations, it will depend on the CIO's historical involvement in strategy development. Where the CIO has been at the strategy table, then a partnership or potential mentorship with the CXO position is likely. Where the CIO has been seen as the leader of a support function, then these new roles are likely to erode the CIO portfolio. The end game may be that the CIO has lost all influence on the new and interesting work and is left with infrastructure and application support. The takeaway is that CIOs should best position themselves as a strategy and innovation enabler.