A: It was in 1989 when I really took a change in career direction. I'd been a chief operating officer of a five-hospital system up in Canada. When I look back to that period of time, there wasn't that much of a focus, it was just starting to emerge, on the electronic medical record and the clinical side of healthcare. Certainly that is center-stage nowadays. The interesting part to me, in moving from Canada to the states, is that in Canada we were already focused on the clinical side because they didn't have to worry about the financial side. We had 1.5 full-time staff in our patient accounting department in a five-hospital system up in Canada. It was quite eye opening to come down here and view the magnitude of the overhead that exists in the American health system just to get a bill out the door, and get payment too. The thing that I see happening right now is we're so engaged in every strategy for the organization as we move through meaningful use. The incentives to do this are a different spin on things, but it hasn't changed our strategic direction in any way. We were going to do it anyway, so it's nice to have the financial support from the federal government. We may have done these things anyway, but we probably wouldn't have paid as close attention to achieving certain goals and measuring the outcomes.

Q: What has been your proudest achievement?

A: The thing that really puts a smile on face is seeing my staff achieve things that they might have thought were not possible to do. Just seeing individual accomplishments. There have been many of them, but those are the things I'm most proud of. I've encouraged a lot of my staff over the years to seriously consider returning to school and upgrading their academic credentials. Many of them have thought I was crazy when I proposed this to them. But they've gone back, and they've graduated from different programs. It's just so amazing to see that quiet smile of accomplishment. They're very proud of themselves, and I'm proud them. The technical stuff is all very interesting, but it's the personal achievement that makes me most proud of my team.

Q: What has been your biggest challenge?

A: Where it's frustrating for me  -  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.

Q: Is there anything you would change about today's EHRs?

A: The most frequent concern I hear from the physicians is they are not intuitive, and I would totally agree with them. They're all not friendly to navigate. The functionality is there, there's no doubt they all ought to be more user-friendly from the physicians perspective. We need to keep pushing on that side of it. They all say the same thing: 'I can use any application on the iPad almost immediately, why can't I do that in the most important part of my life?' The user interface is the biggest challenge. 

Q: What keeps you up at night?