When I began my career as a CIO in 1997, success was function of the basics - email delivery, network connectivity, and application functionality. I personally wrote code, experimented with new operating systems, and created analytics using web servers, SQL, and ASP pages.

In 2011, CIO success is much more complex to measure.  

Infrastructure success can be defined as 99.99% uptime of all systems and no loss/corruption/breach of data. The magical belief in the cloud sets expectations that IT infrastructure should be like heat, power, and light - just there as a utility whenever it is is needed in whatever amount is needed.

Application success could be defined as on time, on budget delivery of go lives according to project plans. Two important forces make this more complex:

1. Consumer software stores set expectations that enterprise software should be easy - we need to fix revenue cycle workflow, isn't there an app for that?
2. As the economy forces downsizing and efficiency gains, there's an expectation that workflow automation is a pre-requisite to organizational change so there is more pressure on the IT department to deliver application solutions quickly.

This all sounds impossible - deliver massive infrastructure with constant change but keep it entirely reliable and secure. Deliver applications that support business processes in increasingly short timeframes with limited IT and business owner resources.

Thus, the modern CIO is no longer a technologist or evangelist for innovation. The modern CIO is a customer relationship manager, a strategic communicator, and a project manager, delicately balancing project portfolios, available resources, and governance.  

Modern CIOs have little time to get infrastructure and applications right, so they must "skate where the puck will be", thinking more like CEOs about business needs and future strategies, so that critical information technology is deployed by the time it is needed.

What am I doing in FY12 to become a more effective modern CIO?

1.  I've defined key business customers (BIDMC senior management and chiefs). I'm meeting with each one to ensure their priorities for the next year and beyond are reflected in the FY12 IT operating plan and the 5 year IT strategic plan. Planning much more than 5 years in IT is problematic given the pace of technology change. Working with the governance committees, I will trim this list into those projects that have the greatest impact on business strategy, quality/safety, and efficiency.

2.  I'm standardizing communication so that key customers receive monthly updates about their priority projects.

3.  I'm defining a process for managing IT projects across the enterprise that includes standardizing the IT Project Intake Process, the IT Project Life-cycle, and Project Management tools ( project documentation, project plans, and status reports).

It's my hope that by focusing on customer relationship management, communication and project management that I will create a positive working environment for the IT staff with a more limited set of well-defined projects and more engaged customers. Doing fewer projects with greater speed and depth which meet the most critical needs of the business is much harder than agreeing to do many niche projects and moving forward slowly on all. Given that the supply of IT resources is likely to be fixed since healthcare budgets are under increasing pressure from healthcare reform, the modern CIO should be judged on demand management and achieving reasonable levels of customer satisfaction despite having to focus on a narrower project portfolio delivered at a faster pace.

John Halamka, MD, blogs regularly at Life as a Healthcare CIO.