For this edition of “C-suite conversations” I sat down for a long chat with Donette Herring, the CIO of ECU Health. ECU Health is a comprehensive healthcare system in eastern North Carolina, consisting of nine hospitals and over 14,000 employees. It provides emergency, primary, and specialized care across its network of hospitals, outpatient centers, and clinics. Affiliated with East Carolina University, it integrates academic and clinical care for advanced patient outcomes.

Key Takeaways

• Donette’s career was heavily influenced by the leadership style of one of her first bosses, a partner at a large consulting firm who built in her the confidence that she could accomplish anything.
• The CIO title does not reflect Donette’s full scope of responsibilities at ECU Health. She leads the transformation execution office, where the majority of the projects are about operational strategy and performance improvement, not IT.
• Because resources are limited, CIOs need to figure out how to give more responsibility for technology back to business partners so that the IT team can focus on value-added activities that have to remain in IT.
• Having a CEO who once served as its CIO makes her job a little easier. She feels she gets more support as a result.

Q & A with Donette

Judy Kirby: You started your career as a nurse. How did you end up with a successful career in technology leadership?

On the advice of a career counselor at my undergraduate alma mater, I pursue an MBA. I had to write software for a computer science course that was part of the program, and I wrote what I knew as a nurse. That led to a job in the IS department working on a new software implementation.

I worked in the IS department by day, went to school at night, and kept up my clinical skills by working part-time in critical care. When we reached support mode, the vendor whose product we had implemented recruited me. It seemed exciting to go and work for a vendor to do more of what I had done at the hospital. But even then, I wasn’t sure that I saw my career path in IT.

JK: When did that change?

DH: There were two defining moments that made me more confident that technology would be an appropriate career path.

After working for the vendor and finishing my master’s degree I joined a large consulting firm. The partner I worked for has been a strong influence in how I lead. It was how he led that gave me confidence that I could do anything, really. We were constantly in situations where we were proposing new work and engaging with clients, doing work that hadn’t been done before, all in healthcare. He gave all of us the confidence that if you apply yourself, you can essentially figure anything out. And so, it was a result of that experience that I had a greater degree of confidence and began seeing what a potential IT career could be like, especially inside a healthcare provider.

One of the engagements we had was with a vendor evaluating how their product could be used at the patient’s bedside. Up until that time, clinical systems were only ever used from a central nursing station. Going through that process and helping the vendor reposition their product in the industry was extremely thought-provoking and challenging.

So, that was the first defining moment. The other one was, after a seven-year career in consulting, and recently married, I felt I needed to get off the road and have some semblance of a personal life. So, I stepped into the position of Director, System Development for a health system.

After a year and a half, we merged with two other health systems to form Catholic Health Initiatives, now one of the major faith-based health systems in the country. It was divided into five regions, and I was approached about becoming CIO for the eastern region. They saw something in me that I didn’t necessarily see in myself, which caused me to take a step back. Through my consulting days I had had exposure to CIOs and what they did in their jobs, so I thought, “Why not me?” That was the other defining moment, Judy – having someone see the potential in me, willing to invest in my professional growth and development, and to take the risk on me.

JK: In your current CIO position, you report to a CEO, Dr. Michael Waldrum, who is a physician but also was COO and CIO earlier in his career. How does his background affect your role?

DH: The COO and I often debate whether our CEO’s prior experience as both a CIO and the chief operating officer of an academic medical center in a health system makes our jobs easier or not. Dr. Waldrum would argue that it makes our jobs more difficult. We feel that it makes our jobs easier because he’s walked in our shoes and understands what it’s like to serve in the role, even though the technology has changed significantly since when he was CIO.

JK: Can you provide an example?

DH: An example would be our clinical EHR IT transformation program, OneTeamCare, a few years ago. We had been the customer of our EHR vendor for many years and had really fallen behind on taking advantage of all the capabilities and features. So, we designed the EHR clinical IT transformation program, branded it, and Dr. Waldrum did the kickoff and stayed engaged throughout the program implementation. At the kick-off, he communicated the message in a way that really got everyone engaged and set the program up for success. He emphasized system thinking that supported better and more rapid decision making. Seven years later we still refer to his quotes from that time, like “everyone is special, but no one is different.” What he said was that it is basically on operations. IT will make sure that the lights are blinking, the data is flowing, but if this initiative is not successful, it’s all in operations. Not that he let IT off the hook, but that’s the type of support that I have from our CEO, who has lived the experience both as a COO and CIO.

Another example is when we were deciding whether to replace our disparate lab systems with a solution integrated with our EHR. Despite compelling quality and safety reasons to consider a new system, we hesitated due to the comfort of the familiar. After confirming that the EHR-integrated lab system met or exceeded the capabilities of our current systems and could handle the complex operations of an academic medical center, our CEO, who has experienced ‘best of breed’ systems, decided to move forward. Although aware of potential consequences, he knew it was the right decision for the organization. Reflecting on this decision, our CEO and I have acknowledged that our COVID monitoring and response would have been significantly more difficult without the new enterprise lab system, which went live in November 2019.

JK: How do you see the CIO role evolving over the next three to five years? And what might some new responsibilities or job qualifications be?

DH: There is an increasing recognition that CIOs have to have broad organizational knowledge in order to be effective in our roles. We really need to understand the business of healthcare, because essentially, it’s all around how we align our technology with business strategy and operational imperatives.

I think there is broad recognition too that the business and patient care environment are technology dependent. Everything we do now is enabled in some way by technology. So, it’s about applying IT capabilities for business benefit and competitive advantage with a laser focus on business outcomes, being able to clearly articulate business outcomes and have other leaders able to articulate the benefits as well.

JK: What else?

DH: Putting IT responsibility back in the business. In IT there’s usually not enough bandwidth to address all the organization’s technology enablement needs. So CIOs need to figure out how to let go of that, but still have all of the necessary controls in place, especially in cybersecurity. A new CIO skill is striking the balance and allowing the business to assume some of the responsibilities that IT has had in the past so that the capacity you do have can be focused on value-added activities you cannot embed elsewhere.

JK: With the continued financial pressures on healthcare, how do you meet the rising demands and costs of technology? And how often are you able to track a true ROI?

DH: I think some of it goes back to the recognition that digital is really an implicit part of business sustainability and optimization. We can’t look the other way anymore. Financial pressures are such that we need to apply technology to drive as much efficiency as possible. But digital is also important to the growth strategy. There has to be rigor in place when looking at those IT investments, and well-defined business cases, and understanding what the true investment is compared to the benefit, both upfront and ongoing, before pulling the trigger. In situations where this may not be the case, but compelling reasons exist, a proof of concept can be orchestrated, with active engagement from clinical or business operations. This will require more time to iterate on process and technology design, with an uncertain outcome.

In healthcare we sometimes let emotion get in front of our rational decision-making, and we say, “We’re a mission-oriented organization. These are the right things to do.” We are highly focused on making sure that we’re fulfilling our responsibilities to our community, but that doesn’t mean that you don’t need to use rational decision-making. If you make investments where the return may not be as concrete and quantifiable, you should know that going in and continue to monitor and make sure that you’re fulfilling whatever the original intention was.

We’ve put in place much more rigor around business cases, around how we make decisions, how we rationalize the funding that we do have available. We’ve also put in place some new governance committees containing cross-sections of leaders in the organization so we can make those trade-offs.

JK: This is especially important given some of the price increases coming from vendors that I am hearing about.

DH: It is one of our biggest challenges, Judy. Technology companies that we depend on, many of which are publicly traded, are all about maximizing their profits. In most cases, there is not a corresponding increase in value of the product or service – just repackaging. I was on a Gartner call yesterday, and CIOs reported they are seeing price increases of up to four times with some vendors. Interestingly, we aren’t seeing the same high price increases from privately held vendors.

Some of us are highly dependent on certain vendors but we have no choice but to look at alternatives because we can’t afford the price increases.

I’ve had conversation after conversation with some of these vendors, and they talk about the need to meet their margin targets. I try to explain the situation that we’re in in healthcare, especially the nonprofit side, and that we have a fixed income. We can’t pass those rising costs along to our customer like they can. So, I think we’re in a real quandary.

JK: How is generative AI impacting your organization and your strategy?

DH: We took a step back as an organization and educated ourselves, and had conversations at the senior leadership level. We realized that we cannot allow AI to negatively impact the quality and safety of care for our patients. We took a pretty firm position early on, communicated by our CEO, that while we had a strong interest in the potential of AI, we do not want anyone using commercially available AI tools. However, we invited people who were interested in AI to let us know, whether in clinical or non-clinical.

We had a little over 100 people step forward, a mix of clinical and nonclinical people in the organization. We have formed an AI community of practice, and we are equipping them with tools. We have created a secure, controlled environment where these people can use AI and there is collaboration and sharing of how they’re using generative AI in their specific domains. They have to publish their work internally to contribute to our organizational learning about AI.

We also started an AI in Medicine committee that is chaired by our chief medical informatics and digital health officer. Their focus is the clinical application of AI for internally identified use cases. They are also responsible for reviewing all third parties we do business with that claim to have applied AI to their product or solution.

AI hasn’t yet caused any changes to our organizational structures or models other than some of the governance committees. We haven’t identified an AI leader for the organization. Our VP of enterprise data and analytics and our chief medical informatics and digital health officer are co-leaders of the AI work.

We are firm believers that AI is the future, and we are early on with some experimentation, putting structures in place to make sure that we’re not creating any undue risk or exposure for our patients and the organization. We very much subscribe to responsible AI.

JK: Turning back to the future of the CIO, what about the actual title itself: Chief Information Officer? We are seeing more Chief Digital Officer, Data Officer, CMIO. What are your thoughts on the title for the top technology leader in healthcare?

DH: This topic is very timely and relevant. It’s important to approach this in terms of roles rather than titles, as roles and responsibilities evolve over time based on industry trends, breakthrough innovations like generative AI, and organizational characteristics. There’s no one job description or consistent definition for what these roles are and what they do. I question whether or not these new positions are needed in every organization and wonder if the expectations for them couldn’t be part of an expanded role for an existing position in an organization. Having distinct roles may be more appropriate in exceptionally large national health systems where specialization is possible.

Dr. Waldrum and I had this conversation when we needed to recruit a new CMIO here at ECU Health. We decided to expand the role to digital health officer, because essentially, when we’re talking about digital and digital health, it’s all about clinical. Wouldn’t you want a physician or a clinician leading that effort? It’s really the next evolution of a physician informatics leader, because EHR implementations, for the most part, are behind most organizations. Now we’re optimizing the EHR and applying generative AI, machine learning, and predictive models. We’re in a whole different environment today.

So, I think about whether the responsibilities that organizations are looking for in these new leadership positions shouldn’t be assumed by other leaders. Not to mention, who can afford to fund all these new senior positions? Also, they’re going to have some overlapping responsibilities, creating conflicts between them, because they may define strategies targeted at accomplishing the same thing. And ultimately, they all need resources to execute.

I have no idea what the CIO should be called today. I have peers in other organizations who have taken on the title of digital health officer or innovation officer, etc. I think it’s because the CIO has been recognized as someone capable of expanding their responsibilities.

In my case, the CIO title no longer reflects my scope of responsibilities. In the last couple of years, we combined our IT project management office with our enterprise PMO to form the transformation execution office. That rolls up to me, and probably two thirds of the projects that are being led by our TEO are not IT projects. They are supporting execution of operational strategy and leading performance improvement initiatives. I have also picked up responsibility for formalizing our approach to shared services that includes governance, and development of service level agreements and KPIs. Does the CIO title reflect that? Not necessarily.

JK: One of the things I hear all the time in the healthcare industry is that there is a lack of talent coming up and being groomed for the CIO role. Succession planning is a responsibility of all senior executives. Can you talk a little bit about the status of your succession plan and the approach you’ve taken?

DH: My focus has been on developing the team and providing as much opportunity as possible for them to expand their scope of responsibility and to get as much exposure as possible, because that will generate confidence in them as leaders with the potential to step into my position. I don’t want to create organizational risk by relying on one person because they could make an alternative career decision themselves.

An interesting thing, Judy, is that I hear that some may not want the position, even if they’re qualified for it. I hear things like, “I don’t think that I want your job. I see some of the things that you have to do.” So, I wonder if it’s truly a talent gap, or if it’s a matter of people lacking desire or aspiration. One of Dr. Waldrum sayings that I absolutely love is, “The higher you go the windier it gets.” And it’s true. You’re very vulnerable. As a top leader you have to feel very comfortable with that vulnerability, and that vulnerability exists every day but you can’t let it hold you back.

JK: How do you manage that?

DH: I have a little fearlessness in me. You may not know this about me but I am a little fearless and I feel no career risk. I’ve accomplished more in my career than I ever expected to. It has turned out to be an advantage because it allows me to always do what’s right for the organization. There’s no self-interest in any of it. I don’t worry about how a decision may impact me personally. My fearlessness also aligns with my personal core value of integrity. I’m going to make the decision in the best interest of the organization. I think that’s why I’ve been tapped for new opportunities over the years, because there’s confidence that I am going to make the best decisions for the organization.

JK: If you hadn’t become an IT leader, what other career do you think you were cut out for?

DH: Early on, I thought I wanted to be an attorney. Before I went back for my MBA, I also considered law school, but that was full-time and I needed to be able to work and support myself. So, law school wasn’t an option for me, but I think I would’ve been a good lawyer because I wanted to advocate and represent patients. I still have a lot of strong feelings about that based on my mother’s experience with the healthcare system not too many years ago.