MD to CIO – Making the Transition with Joel Klein, Lee Milligan & Stephanie Lahr

Stephanie Lahr, MD Monument Health This Week in Health IT

Top Health Experts Discuss Becoming a CIO on This Week in Health IT

Dr. Lee Milligan of Asante Health, Dr. Stephanie Lahr of Monument Health, and Dr. Joel Klein of the University of Maryland Medical System shared how their journey practicing medicine led them to becoming CIO of their health systems.

Where Did the Transition Begin?

These great minds, brought together by Sirius Healthcare, reflected on their transition into administration. Each were driven by a similar desire to address an issue within their health system.

“It started out just trying to make the system better,” Milligan explained. 

Lahr, both CIO and CMIO at Monument Health, started as a hospitalist in a private practice in Coeur d’Alene, Idaho. Through this, she became a part-time advisor for the EHR. As time went on, she realized that she can have an impact on a greater scale. 

“I can now, instead of slamming my head against a wall for 15 patients, I can try and fix things so that nobody has to slam their head against the wall,” Lahr said. 

Klein, first an emergency department doctor, began his transition when he was tasked with dividing his team’s incentive compensation pool. When he had to redo it completely, he gained more IT experience, which later led to assisting other hospitals.

What it Takes to Make the Leap

The jump from physician to CIO included several new concerns, such as finances, security, technical knowledge, and management styles. 

According to Lahr, physicians do not often learn the inner-workings of finances within the medical system. To adapt, she listened to the advice of experienced directors on her team to navigate new situations she needed to make decisions for, like budget management and tax implications. 

Financially, the management and negotiating of contracts are standard and require communication and negotiation skills. According to Klein, he has to sign and negotiate for every contract coming through the system. He found this to be a steep learning curve.

Similarly, Milligan recalled the addition of 18 cost centers and the responsibility of a $50 million annual budget was a stressor, because he needed to handle the finances effectively to show team executives that he was a good steward of the funds allotted.

“I try to focus on transparency, and I tried to focus on specific areas where we could identify opportunity, take action, and then really call it out,” Milligan said. 

Additionally, communication as a whole changes in an administrative role, Klein explained, which worried him at the beginning. With more employees and responsibilities, he had to learn how to delegate duties and allow people to do their jobs without interfering. To delegate these jobs, however, it is essential to hire great employees. 

“If you settle for less than A players, especially on your leadership team, it drags your whole thing down,” Klein said. 

Lahr also noted that one part of the transition involved personally selecting and readjusting responsibilities and roles for her team. 

“It built my competence that I could think strategically about how the teams would be best aligned, how we could best serve the organization. It also then put sort of the stamp of Stephanie on the organization early on,” she said. 

Lahr and Klein both emphasized that readjusting the team to reflect and distinguish the transition in leadership is essential in the beginning steps of the transition. 

In fact, Klein notes that he did not realize how incidental computers were to the overall position. Even more important than understanding the tools was knowing people. 

Does Having a Clinical Background Help?

Host Bill Russell inquired whether having a clinical background can both assist and hinder a CIO,  but Lahr explained the clinical knowledge proved beneficial. In fact, it has made communicating and building bridges between the clinical and administrative sides much easier.

“There is always a clinical thread going on as to what are the impacts, what do we need to do, and how are we going to make it better,” Lahr said. 

Klein stressed the importance of balancing the clinical and administrative knowledge. Overplaying the “doctor card” can negatively affect a CIO’s ability to advocate for other key groups, like employees and patients, he warned. 

Navigating employee relationships was similarly a surprise for Milligan. At first, he did not realize how his actions influenced his staff’s motivation. He found that it is vital to encourage and present feedback to employees.  

“I would say that’s probably one of the most important things I do as CIO is identify and do my very best to … rally my leaders to give that kind of feedback to folks so that they know that they’re doing great work,” Milligan explained. 

For Lahr, she needed to learn that a CIO management style and view of their position impacts how well they perform. Her CEO taught her how to prioritize her roles. 

“I remember him telling me and all of us that were in the senior executive team, ‘You are a leader of this organization and a part of this senior team to set strategy and to set the path for the entirety of the organization…That comes before whatever you’re the ‘C’ of,’” Lahr recalled. 

Her first job is to be a collaborator on the senior executive team, she continued. When this responsibility is managed well, the second role as an IT executive is easier. Milligan agreed with this statement.

“I say it a little bit different over here. Which is, half of my job is to be CIO. The other half of my job is to solve my CEO’s problems,” he said. 

Advice for the Next Generation

For the next generation of health leaders, Lahr advised them to keep an open mind about which path in the medical system they choose. Klein gave some practical advice on how to make these decisions.

“I think you’ve really got to know yourself, and you’ve got to listen to your voice…‘Do I like what I’m doing?’, ‘Do I like the day-to-day of what I’m doing?’, and ‘What do I notice around me about people that I admire who look like they’re enjoying their day-to-day,’” he said. 

The future generation should not feel locked into one set direction, according to Lahr.

“A physician path does not look like any one thing,” she said. 

To learn more about this episode of This Week in Health IT, watch the full interview at

Tess Kellogg – Editor-in-Chief
Katie Talpos – Staff Writer

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