The role of a chief information officer (CIO) has evolved well beyond handling billing and communications for a health system or the more recent role of getting an electronic health record (EHR) up and running. What CIOs now struggle with is convincing other members of the C-suite that hospitals have to keep updating and investing in technology.

Michael Marino, DO, MBA, has been both CIO and chief medical information officer (CMIO) of the 23,000-employee St. Joseph system with 16 facilities throughout California, Texas and New Mexico. He's now its chief of information security (IS) operations and clinical systems. Marino spoke with HealthExec about how the CIO role has changed, whether it’s still a one-person job and the technological problems he’s heard about at smaller systems.

HealthExec: What is the state of technology investment in healthcare—and are the investments paying off?

Michael Marino, DO, MBA: Hospitals and health systems have certainly got the message that it’s important and have invested a significant amount in core systems, EHRs, PACS (picture archiving and communication systems). I think the part that’s been missing—and I think St. Joe’s may be different—is that it’s going to require ongoing investment. It’s not one-and-done.

That is both in the software space and in the hardware space. So in order to roll out an EHR for any hospital to hit MU (meaningful use), hospitals had to make the big investment [and] have servers or come up with a partner to host it. You had to roll out multiple PCs, but anybody who works on a PC knows they’re good for, what, two years, three years?

It’s just like the phone we have in our pocket. Does anybody have a phone older than three years?

So I think when you’re going back to leadership and saying it requires an ongoing investment, [that's why] a lot of systems are struggling. We don’t necessarily struggle with the innovation part of this bend, but with some of the core infrastructure. It’s hard to convince CFOs you’ve got to buy PCs every three years.

St. Joseph covers a much larger geographic region than many providers—do you think ongoing investment is a harder sell to the leadership at smaller, more localized providers?

I do. I have conversations with colleagues or you look at other hospitals, smaller hospitals or systems—sometimes they’re working with outdated systems.

St. Joe’s has Meditech currently. When you talk to Meditech about other clients or their user meetings, there are a lot of people using outdated versions. People aren’t moving forward.

With all the ongoing investment and changes needed, how do you see the role of the CIO evolving?

Originally, it was the systems that kept the transactional parts of the hospital up—what they needed for billing, some kind of communication, then it was the basic infrastructure over the past 10 or 15 years for an EHR. Now, it’s that plus mobility, plus engagement. We want to partner with startups, so a huge part of my workflow is managing multiple relationships with companies that are new to the space. Some of those we have investments in because we’re trying to diversify and some are just startups, but it’s much different to deal with multiple new companies versus the diehards, whether you have a relationship with Meditech or Cerner or GE, when it’s tried and true and you’re just buying pieces.

A lot of our relationships now are with companies that are still doing work in development, so you’re managing on a development cycle versus just buying a software platform and waiting for next year’s upgrade.

Should all those responsibilities still be handled by one person in the C-suite?

I would advocate that you’re better off with one person overarching. You can’t be in the weeds.

As we’re coming together with Providence, it has a split model. They have an innovation leader and a CIO leader. Occasionally, you can get cross purposes or, if your innovation folks aren’t connected enough with the work, you can have innovation for innovation’s sake. Then they’re looking for a place to deploy it, and it may not fit in the overall operational strategy.

So I think having one person over it is a better model than it being separate pillars.