In this article I interview three high-level executives who made the transition from the clinical IT setting—running hospitals—to digital IT settings that develop health apps and services. I asked these industry leaders why readers might want to move into a CIO-type position in a health IT firm vs a hospital or health system, what makes a good candidate for such a position, and what to expect after the change.

Raymond Gensinger, MD, who is senior vice president and chief medical officer at the consulting firm Tegria, points out the number of medical experts at IT firms has burgeoned over the past decade or so. Electronic records, workflow changes, big data, and AI have drawn hundreds of companies into this potentially lucrative industry, and they all need guidance from people who know health care well.

Why Leave the Clinical Setting for Health IT Development?

The response to this question was universal: You make the move in order to bring your expertise to a wider audience. The trajectory presented by my interviewees located digital IT as part of an evolution for someone who wants to learn new skills, as well as guide an exciting young industry forward, after mastering the needs of a clinical environment.

Gensiger said that as an internal medicine doctor, he could expect to touch 30 to 40 thousand lives during his career. Normally, clinicians step up by moving to bigger institutions in health care, then by going to Washington and joining the policy wonks. An alternative way to affect more people positively is digital IT—in his case joining a consulting firm.

Edward Marx took a longer path. After serving as a CIO at hospitals, he took his expertise as CIO to digital vendors and joined boards as well. He now runs his own consulting firm.

Stephanie Lahr, CHCIO and president of the process automation firm Artisight, says that moving from a clinical to an IT setting opens doors without closing any. You can still participate in forums and on boards in clinical settings and share your expertise—and she recommends that you do so.

Who Makes a Good CIO for a Digital IT Firm?

Although answers from my interviewees to this question overlapped somewhat, each also highlighted a somewhat different priority.

Lahr advises senior managers to “consider your mission-driven goals.” Find a vendor that looks well-positioned to further your main goal: for instance, to improve the patient experience.

Marx has his own take on this question: he would like to see more “cross-pollination” between industries. He believes that the C-level role is most of all a question of leadership. It can be done by anyone who is strong in such leadership skills as articulating a vision and influencing people.

To offer important fresh perspectives, therefore, a digital health company should bring in leaders from outside the field. But the person shouldn’t be hired at the top level, Marx says: He’s seen such people burn out and leave. Instead, have the person report to a senior manager and gradually learn what’s unique to health care. (Some of the unique features of IT in health care were explored in my recent series, How Digital Health Companies Attract Software Engineers.)

Marx believes that leadership is 80% innate nature and 20% learning. To stay at the top of their form, leaders need mentoring, education, and constant self-evaluation: “Never lean back,” he says.

What Might Surprise You

Lahr is an internal medicine doctor who first made a large transition by becoming CIO in a clinical setting. Going to work for a vendor was for her a smaller mental shift. Regarding the IT company, she says, “Everything in clinical settings has a governance process and rules, whereas in a small, early stage company, there are fewer procedures.” She says that one of the benefits she brought to the IT firm she joined was more discipline: knowing what process to follow to accomplish logistical tasks.

Furthermore, in clinical settings everyone sticks to their specialty, whereas in a small IT firm people wear many hats. For instance, CIOs in IT firms might have to participate in funding campaigns. Marx says, “You are the chief marketer, the chief strategist, the chief sales person.”

Lahr also says that in an IT firm, the CIO interacts more with the board than at a hospital. Marx emphasized this as well. Managing board expectations takes longer than most incoming CIOs expect, he says, because board members take their responsibilities seriously and put a lot of time into learning about the firm.

Marx advises the incoming C-level manager to research carefully the background of board members and what their main concerns are. Does the board contain founders of the firm, for instance? Former CEOs?

Pressures at a digital IT company are different from those at a clinical setting. Certainly, the clinical setting is usually high pressure, because the institution has to stay up and running all the time and because people may die if systems fail.

At an IT firm, in contrast, the pressure revolves around financial expectations. As in a clinical setting, quality matters, but it is defined as error-free product behavior.

Gensinger sees IT firms as comparing favorably to clinical settings, where the IT staff is “always pushing a rock uphill.” At an IT company, the infrastructure tends to be managed better and you don’t have to support legacy devices.

As a clinician and CIO in a hospital, Gensinger did a lot of listening and facilitating others in expressing their ideas. As a consultant, he’s expected to be more of the expert at solving problems. So he advises people in digital companies to keep up their knowledge through a lot of reading, because this industry is evolving “lightning fast.” Also vary your sources: “Don’t fall into echo chambers.”

Lahr has encountered several lifestyle and cultural changes when moving into a digital company. She travels much more now (almost every week), to meet with current and potential clients while staying active in national groups that she had joined while in the clinical setting.

She also says that clinicians view you as more invested in a vendor’s success when you work for a vendor, no matter how much you try to express unbiased views. It’s important to contribute to the field and show that you care about more than signing contracts. You might have to give up some leadership positions because you’re seen as having a point of view.

In conclusion, many of the skills that you learn in a clinical setting are valuable in an IT company, but you have to alter some of your habits and expectations in making the move. The timing may be good right now, as the promises of digital records, objective measurements, and analytics are finally starting to show results.