CIOs haven\u2019t had much authority, historically, over the medical side of healthcare, but \u201cmeaningful use\u201d of IT\u2014the centerpiece of the estimated $27 billion earmarked for health IT in the American Recovery and Reinvestment Act (ARRA)\u2014is shifting more responsibility to IT departments at hospitals and other healthcare organizations and giving technology executives a more strategic role.\n \n Starting this month for hospitals and in January for physicians, healthcare providers will have to demonstrate they are using IT effectively to earn bonus payments through the federal Medicare and Medicaid programs. Anyone who isn\u2019t doing so by 2015 can expect financial penalties.\n \n Merely installing an electronic health record system (EHR) won\u2019t cut it. Hospitals and doctors must also, among other things, write prescriptions electronically, incorporate test results into patient records and report to federal officials on compliance with various quality benchmarks. In the future, they will have to coordinate patient care between inpatient and outpatient settings and demonstrate actual improvements in health outcomes to pass federal scrutiny.\n \n \u201cI don\u2019t go a day without a conversation about quality of care,\u201d says Barry Blumenfeld, a physician and CIO of Portland, Maine-based MaineHealth.\n \n Quality of care used to be the nearly exclusive realm of the chief medical officer. Now, the CIO or the chief medical informatics officer (the executive in charge of clinical data) should also be involved with developing a strategy for quality metrics, clinical decision support and quality improvement, says Pam Arlotto, president and CEO of Maestro Strategies, a health care consultancy. The CIO, she says, often partners with physician and nursing leaders.\n Strategic ChangeBill Fawns, CIO with Kern Medical Center in Bakersfield, Calif., had a more tactical role when he came aboard in 2007. He focused on installing a digital imaging system, moving more staff training to the Web and tracking patients in the emergency room. He was also responsible for planning a future EHR system. But until ARRA\u2014better known as the stimulus bill\u2014passed in February 2009, the hospital had put off investing as much as $20 million in EHR. \u201cPrice tags kind of held us back,\u201d recalls Fawns.\n \n \n \n Then hospital officials realized they had to find a way to convert from paper to electronic charts. They chose an open-source product from Medsphere Systems, and they assembled a leadership team consisting of Fawns, the chief medical officer, the COO, the chief nursing officer and the director of outpatient clinics. Fawns\u2019s daily routine is now evenly split between managing existing IT operations\u2014the traditional CIO role\u2014and working on the EHR project, which began in January. The EHR system, Fawns says, will become so ingrained in the organization that it eventually will affect more than 80 percent of employees, so it was important to include both clinical and technical people.\n \n Chains of command are changing, too. \u201cWe believe so strongly in the close relationship between technology and quality that the CIO has reported directly to me,\u201d says Andrew Morley, senior vice president and chief medical officer of Georgia\u2019s Columbus Regional Healthcare System. Morley also oversees patient safety and a new division of clinical transformation, encompassing performance improvement, informatics and decision support.\u201cIt\u2019s not a technology transformation,\u201d Morley explains, but a business, clinical and cultural transformation embedded within IT.\n \nNeil Versel is a freelance writer based in Illinois.