In chess, the positional play is characterized by long-term maneuvering -- strategic moves. It's exactly what is being required of healthcare CIOs today. Over the past decade, the role has changed from technology manager to valued strategic player, one who helps drive transformational change and who is welcome at the executive table.

Expectations are high and getting higher for today's healthcare CIO, who continues to be deluged with "do-it-now" projects at a time when, more than ever before, she or he is expected to bring top executive skills, the long view and strategy to the table.

It's not enough to excel in the role. Executives at the top of many healthcare systems are looking for their "IT guy" to be a transformational leader.

At the same time, surveys show that CIOs are feeling underutilized – hamstrung when it comes to their strategic skills.

"What we see is what everyone knows," said Pamela Dixon, founder and managing partner of SSi-Search, a national executive search firm. "CIOs are now managing enormous budgets. They're leading deployments, which could be in excess of a billion dollars, and they're managing large teams with hundreds of reports."

As Russell Branzell, CEO of CHIME, sees it, "there has been a transformation that's occurred from the original tech manager – data processing manager – to the drivers of transformational change with the appropriate use of IT as the leverage point for that."

To offer a sense of the scale of some CIO jobs, consider that Bill Spooner, vice president and CIO at Sharp HealthCare had 450 people reporting to him, including three vice presidents and dozens of clinicians.

"I think the main changes have been from technologist to strategist and business leader," said Judy Kirby, president and CEO of national healthcare recruiting firm Kirby Partners. "We look back and it was all about the technology, which was seen more as a utility. It was sort of like your lights. It was either on, or it was off. That's not the case anymore. It's more complicated."

Today, Kirby said, healthcare IT touches every aspect of healthcare, while not so long ago it was far more focused on automating the financial piece. Today's CIO has to be well versed in both clinical and business needs.

[See also: CIOs gauge decade of health IT headway.]

Understanding the needs of the clinical side has been a career-long challenge for Spooner, who recently retired.

"What has probably tested me the most is being a non-clinical person when your whole mission is providing technology support for clinical practice," he said. "I almost never go through (the hospital) without recognizing how much I have to learn. It's just so important to be able to partner with the clinical side of the business to be able to really do the best work for them."

SSi-Search recently conducted a survey of 200 CIOs, interviewed 20 leading CIOs and, with CHIME, assembled a panel of CIOs to get feedback on the SSi-Search survey. The results are in a white paper titled "Why the CIO is Healthcare's Million Dollar Man." The "million dollar" alludes to the cost of projects CIOs manage – millions to billions of dollars. There's a lot at stake if things go wrong.

Frustrations
It appears that despite the expectation from top executives that the CIO will participate in strategy discussion and contribute to the vision, it's been hard for some organizations to shed the "IT guy" perception.

"If you look at the long-term frustration of CIOs, many of them have been frustrated that their strategic abilities haven't been leveraged as much as they feel it should have," said Dixon. "They feel that they've earned a seat at the executive table in terms of strategy setting, but they feel they aren't there. That's the greatest frustration that CIOs voiced during the course of the survey and the white paper."

"They have to be able to be part of the executive table," Kirby said, "and they have to be able to still get back in the weeds when need be."

James Turnbull, CIO at the University of Utah Health Care in Salt Lake City, is among the frustrated.

"Where it's frustrating for me," he told Healthcare IT News in a February 2013 interview after he was named the CHIME/HIMSS John E. Gall Jr. CIO of the Year, is "I've got a tremendous amount of operational experience. I've got a lot of strategic planning experience from some of the roles I've had over the years, but being CIO you're still considered the IT guy. I feel like a V-8 engine running like a little V-6. I have not been able to crack through this barrier of being seen as the IT guy despite a wealth of experience and knowledge in these other fields. It's more of a personal frustration. I have a feeling of frustration of not being able to use all of my capabilities."

"I feel like a V-8 engine running like a little V-6."
James Turnbull

Turnbull came to UUHC about six years ago. Before that, he served as senior vice president and CIO at the Children's Hospital in Denver from 2000 to 2007, and senior vice president and CIO at Sarasota Memorial Hospital in Florida from 1993 to 2000. His career spans 37 years, and it includes work as chief operating officer of a five-hospital system in Canada.

He has a bachelor's degree in organizational psychology, an MBA and a doctoral degree in health administration.

The findings of the SSi-Search survey indicate that Turnbull is not alone in feeling frustrated.

"The most interesting thing that came up was that their greatest frustration was that their strategic abilities, which they consider their second greatest ability -- almost on par with their operational -- is underutilized, and that's a tremendous frustration for CIOs," Dixon said. "We've heard that for many years, but with the landscape in healthcare technology having changed so dramatically over the last five years -- and technology itself is a strategic initiative for -- you know, it's a tool, and it's a key to transforming healthcare. So, it's understandable that the CIO feels underutilized strategically."

[See also: James Turnbull, CIO of the Year.]

Workload expands

Over the past several years, the work of the healthcare CIO has multiplied, spurred in large part by the HITECH Act and the Affordable Care Act.

How much has the workload expanded? So much so that the über-productive John Halamka, MD, CIO at Beth Israel Deaconess Medical Center in Boston, took notice.

"In 2014, my work role has evolved to convener, communicator, mediator, navigator and load balancer instead of technician, architect, programmer, informatician and clinical expert," Halamka wrote in his January 15 blog. "Not that the evolution is bad. In the modern era, we all have about 5 careers in our lives. What's amazing to me is how many careers I can have without changing my position as CIO!"

In a Nov. 19, 2013 commentary published by InformationWeek, Halamka wrote: "The pace of change is accelerating to the point that scope, time, and resources can no longer be balanced with demand, expectation and sustainability."

The situation reminded Kirby of a Far Side cartoon by Gary Larson: Two deer are standing in the woods. One has a birthmark on his chest in the form of a red and white target. The other deer says: "Bummer of a birthmark, Hal!"

"I feel like today's CIO has that target on their chest because they do a lot, and they're doing a lot more with less in some cases," Kirby said. "And when things go right and when things go well, they don't get a whole lot of recognition. But the least little thing goes wrong and they've got that bummer of a birthmark, where they've got that target on their chest."