One out of five IT staffers on the clinical applications team at Continuum Health Partners in New York is also a nurse, a pharmacist or another type of clinical specialist. For IT managers and directors, a clinical degree is a must.
At $1.3 billion Grange Insurance in Columbus, Ohio, CIO Michael Fergang exclusively recruits IT staffers with insurance industry experience.
Sam Lamonica, CIO at $750 million Rosendin Electric, has taken to luring experienced engineers and operations people in the field to work in IT. Lamonica also admits to "stealing shamelessly" from Rosendin's competitors.
It's not that San Jose-based Rosendin doesn't already have a fabulously talented and experienced IT staff, Lamonica says.
"We have a number of really smart analysts on our business applications team who are mathematics majors as well [as technologists]. The challenge is they're fairly clueless about what goes on at a job site on a given day," he says. And Rosendin typically is working more than 1,500 multimillion-dollar jobs simultaneously in any given month.
Candid CIOs from healthcare, financial services and manufacturing all tell a similar story. Fast-changing business processes, the need for speed, consumers' insatiable appetite for customization and the need to comply with a growing list of government regulations and industry standards are all working to complicate day-to-day operations beyond the most business-savvy technologist's ability to keep pace. Now what is critically necessary are not only technical skills and business knowledge, but also deep industry expertise, the kind that comes from calculating a quote and selling an insurance policy or calibrating and administering intravenous pain medication to a cancer patient, for example.
Think of it as IT-plus.
"At the end of the day, you need a person who gets it all," says Continuum CIO Mark Moroses.
Healthcare reform and the hyper-accelerated pace of change are two of the biggest factors driving the need for IT-plus credentials at Continuum, says Moroses.
"The healthcare industry is highly regulated," and adherence to those regulations is what makes or breaks the bottom line, he says. Under state and federal regulations, Continuum, a partnership of New York's Beth Israel Medical Center, St. Luke's Hospital and Roosevelt Hospital, reports to 11 regulatory agencies. On top of that, there are the hundreds and hundreds of regulations and reporting requirements imposed by insurance companies.
"Getting technical people to understand regulations is tough because it's a field they're not interested in," says Laurie Anne Buckenberger, Continuum's assistant vice president of corporate IT and a nurse practitioner. Clinicians, on the other hand, live and breathe healthcare regulations from the time they enter the field.
To retain certification, hospitals are required to follow and regularly report on 157 different quality measures. "On your first job as a staff nurse, you're taught about the requirements of the Joint Commission on Accreditation of Healthcare Organizations," Buckenberger says. "It's also embedded in you from the time you start [nursing] school."
Johanna Ambrosio speaks with IT leaders at this year's Premier 100 event to find out what types of people they are hiring to work in IT. More often, IT is going beyond technology skills to find the right pieces for their organizations.
That's why "you can't do it without clinical people," says Moroses. It's also why a clinical degree is a requirement for members of the applications support team at Continuum.
The need to work quickly is another key factor driving the clinical requirement, which Moroses says evolved over time.
"Before, programmers and analysts were separate. Then we took the IT person and put them in the business unit and called them a business analyst," Moroses says. "But at the end of the day, you need one person who gets it and does it. In healthcare, you need that clinical component and technical component. You have to eliminate the translation requirement because of the speed of business."
Consequently, Continuum has broadened the reach of its IT recruiting efforts. Company representatives now visit nursing schools to try to persuade students to consider careers in IT (see story below).
A nurse with firsthand clinical experience would, for example, be uniquely qualified to explain why a smaller, lighter tablet would be better than a laptop for a home healthcare provider, says Moroses. "In order to help the industry transform at this quick pace, you need this clinical part in IT," he says. "The [companies that] can transform the quickest [will have a] competitive advantage."
"It's hard for a pure IT person to understand what emergency departments and other clinicians need," he adds. "Yes, they need mobility, but not just mobility. They need mobility in certain ways."
IT-plus credentials can give IT staffers instant credibility in the eyes of users, says Moroses.
"If we're having a conversation about a system upgrade or bringing in new functionality, you need a nurse or physician talking to a nurse or physician," says Moroses.
Before Continuum started bringing clinical people into IT, "there was always skepticism that IT didn't really understand what we do," says Moroses. "The radiology group would have their own shadow IT department because they didn't trust anyone [in IT] to get the way things needed to be configured."
Now, in contrast, someone from IT "walks in with a clinical degree and there is a built-in credibility for talking to people in the clinical community."
At Grange, Fergang characterizes IT professionals with deep technical knowledge plus insurance industry experience as "foundational" to innovation.
"We have skunk works where IT people get together and come up with business solutions. We prototype these for presidents of divisions, but there's no business involvement. You couldn't do this without IT-plus business knowledge," he says.
In one of these projects, IT built a prototype that let Grange sales agents represent various policy alternatives in a single quote system. Agents could change key parameters such as deductible amounts, driver type and risk levels so customers could customize their own policies.
IT Plus
The New Face of IT
Laurie Anne Buckenberger, a veteran healthcare professional with a graduate nursing degree from Columbia University, has worked as a staff nurse, a nurse manager and a nurse practitioner. She got her start in IT as a so-called super user.
"Because I had worked [as a nurse] at NYU, where they had an electronic medical record, I got put on the EMR search committee at Beth Israel Hospital," she recalls. "I was very vocal about end-user workflow and what end users needed."
At the time, she was still treating patients. Today, Buckenberger is an assistant vice president of corporate IT and an active IT recruiter for Continuum Health. Her target hires are other nurses, pharmacists and lab technicians. She advertises in nursing journals.
"I'm actually looking for clinical people to teach them the technical side," she says.
"There have been a few technical people who have been successful in embedding themselves in the clinical workflow and understanding it, but a lot of technical people are really challenged because [healthcare] is a highly variable field," she says. "What you do for one patient you don't do for another. If an interface goes down at 7 in the morning, it's a crisis because it's rounds at the hospital. If it happens at 2 a.m., it has a completely different impact. Clinical people know this."
"Knowing our business, we could take a single quote and represent it in different ways," Fergang explains.
In another project, IT created a series of transaction-driven alerts for agents. The alerts notify agents about events that affect their customers and/or their sales performances. For example, an agent might be immediately alerted if a customer called the insurance carrier, rather than the agent, to make a change to his policy.
"We created the first six alerts knowing what the business needed," Fergang notes. Since then, there have been more than two dozen ideas for additional alerts.
"If you understand the business and the business strategy, I really do believe IT is in a unique position in that it can bring business solutions to the business that the business can't even imagine," Fergang says. But you have to have the right business aptitude, he adds. "My managers are better businessmen than technologists," he says.
Valuable Time in the Field
In the increasingly complex construction business, Rosendin's Lamonica says engineers and others from the field are much better qualified than IT specialists when it comes to building and supporting software applications and other automated tools used on job sites. They know about workflows, contractor scheduling and overall construction project management, he says.
This expertise is becoming even more important as the industry moves more toward the time-sensitive practice of installing prefabricated assemblies rather than building on-site.
"Prefabrications save a ton on time and money, and the project manager has to know when they have to go [on-site]," Lamonica explains. Most construction sites are space-constrained and don't have a lot of extra room to store an inventory of prefabricated modules. Instead, prefabricated components for big projects, like a 20-floor hospital building, are ordered, built off-site then shipped to the project site on a just-in-time basis. "We in IT wouldn't have a clue how that works," he notes.
Lamonica regularly dispatches technical IT staffers to the field to learn from construction workers who are using automated and mobile tools. He also recruits field staffers to spend a year or two in IT as a way to offer on-the-job training.
"These are people with construction experience" and knowledge that is critical to IT if the company is to design and deliver tools that are truly efficient and productive in the field, Lamonica says.
"But the big challenge is that we can have 1,700 jobs going on at the same time," which makes it very difficult to keep pace with demand, he says. On-the-job use of consumer and mobile technologies is making it even more essential for IT staffers to have bona fide construction and industry knowledge.
IT Plus
Turning the Tables on Vendors
Vendor management is one of the key areas where IT-plus credentials can yield a big payoff, according to Laurie Anne Buckenberger, assistant vice president of corporate IT and a nurse practitioner at Continuum Health Partners in New York.
For example, Continuum doesn't entertain canned sales pitches from software vendors. Instead, Buckenberger's team of clinicians in IT present vendors with very specific requirements, right down to the policies, regulations and individual workflows they need to have supported in automated systems used at Continuum's hospitals.
"All the software vendors have buttons to do X, Y and Z, but what we ask is if they can support our New York state regulations and the clinical outcomes we want to achieve," she says. "A clinical background helps tremendously."
This has been especially true in adhering to so-called "meaningful use" requirements set forth in federal regulations that funnel stimulus dollars to hospitals that comply with certain electronic health record standards.
Under the requirements, hospitals need to show not only that they are collecting patient information electronically, but also that they are using it in a meaningful way -- for example, by improving the ways in which they treat stroke patients. This requires the input of clinicians as well as IT professionals with deep clinical experience.
"It was truly a partnership between vendors, IT and clinical users, because you had to make the system useful to achieve the compliance goals," Buckenberger says. "It all adds up to millions of dollars."
"Our end-user community wants apps, and they want them fast and they don't care if they're well baked," Lamonica says. "In order to deliver what they need now, you need to know exactly what it is they're trying to do."
For example, a project manager will walk a construction site and plan the entire job with a mobile app. That information is automatically passed to a purchasing agent. "To build those kinds of mobile apps, you have to know intimately what they need and want," he says.
Pittsburgh-based Alcoa is a prime example of a company that relies heavily on IT-plus professionals.
"At its core, Alcoa is a manufacturing organization, and within the manufacturing processes, we win or lose against our competition," says CIO Nancy Wolk.
Alcoa has a broad initiative under way known as Smart Manufacturing, which Wolk says heavily leverages technology to drive profitability through efficiencies in manufacturing operations. IT staffers and process control engineers work side by side in a global 250-person information processes group. The group is headed by CIO Philip Morrissette, whom Wolk describes as an "IT-plus expert" who is "very much an expert in our vertical industry."
A 33-year veteran of the $23.7 billion manufacturer, Morrissette joined Alcoa with a computer science degree. After a few years, he moved to an IT manager's role at a smelting power plant and mining facility in Texas. At one point in his career, during a strike by unionized labor, he went to work on the plant floor, driving trains and setting controls, he recalls.
Now, about one-third of his team in the information and processes group is made up of predominantly IT people who spent time in the plants and now work on manufacturing execution systems. "They're growing with the job," Morrissette says, adding that the other two-thirds are process control engineers.
"Typically, you don't see engineers move into the IT space. They stay on the process side," he says. "But we certainly have IT individuals who came on board as programmers and are now sitting in the processes group performing engineering roles inside of our information processing systems."
At Alcoa's Power and Propulsion business unit, a project under way for the U.S. Air Force requires a highly detailed genealogy of every manufactured part that goes into each plane. "It helps the Air Force do a better job with predictive maintenance," explains IT director Phil Helal.
But to deliver that level of service, "you have to have IT professionals who understand every step of the [manufacturing] process in order to extract, store and manage all of the information," Helal says.
Additionally, and perhaps most important, there's "a huge financial incentive" for IT to deeply understand the manufacturing process, which also happens to be highly regulated, he adds.
For example, Helal's business unit is piloting software-based tools that will enable 2D and 3D representations of castings in progress as a way to more accurately identify and correct defects and variations in real time.
"A piece of scrap for us translates to millions of dollars over the course of the year, so you need people [in IT] who understand the process and work very closely with operators on the floor," he says. "They know enough that they could conceivably step in and do that job."
That's IT-plus.
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