Christopher J. Roth, MD: I Almost Got Fired as the Enterprise IT Doc

At this time, culture and governance was working well at the highest levels in our organization, but on the front lines, it wasn’t easy to know when you needed to engage somebody for a governance problem—I was overconfident.

Christopher Roth, MD, MMCI
Vice Chair, Health Information Technology and Clinical Informatics
October 7, 2020

Christopher Roth, MD, MMCI, was one of six courageous physician imaging informaticists who shared lessons learned during “Radiology Informatics Mistakes and War Stories from the Front Lines,” an RSNA 2019 session moderated by Peter Sachs, MD, a diagnostic and interventional radiologist at the University of Colorado Hospital, Denver, CO. Dr. Roth's tale featured the hubris of youth—apparently so common that it has been labeled the Icarus Syndrome.

Dr. Roth, a neuroradiologist and vice chair for health information technology and clinical informatics atJ.  Duke University Radiology, shared the painfully honest story of the seduction of career and ambition in a newly minted informaticist and how the fallout intersected both his professional and personal lives. Considering the onrush of life that followed his residency—he married, completed a fellowship, started a faculty position, and learned he was expecting his first child all within two years—Dr. Roth was on a fast track. Then he doubled down, professionally. 
“In my first neuroradiology division faculty meeting, I told everyone I was going to get a master’s degree in informatics during a daytime business school program—which was remarkably popular—and, I grew to become the radiology IT physician with a role that was crystallizing on the enterprise side to lead the electronic health record deployment,” he shared.  
Two years later, his daughter had arrived, the master’s degree was complete, the EHR was installed, and early radiology faculty jitters were behind him. “At this time, culture and governance was working well at the highest levels in our organization, but on the front lines, it wasn’t easy to know when you needed to engage somebody for a governance problem—I was overconfident,” he said.  
After two years of deferral due to the EHR deployment, Radiology needed an image sharing application to move trauma DICOM images to and from referring sites. Dr. Roth had his eye on one particular vendor due to the ease of trauma study footprint deployment in North Carolina, but the nationally known chair of neurosurgery was partial to a different application, cardiology favored yet another app to move and view huge TAVR studies, and a new telehealth service line needed to move non-DICOM dermatology images. 
In 2014-2015, after the new CMIO and radiology chair got approval for an image-exchange application, Dr. Roth envisioned all departments on one application. “I began talking it up within my own hospital, and within the state,” Roth recalled. In retrospect, he recognized the following: 
he over-talked what his application could do, meanwhile using his influence to undercut the preferences of others the vendor overpromised what the application could do easily, and cited other organizations using the application he didn’t dig deep enough into references 
While he did speak with representatives of other hospitals in North Carolina who had installed the application, he later discovered that those hospitals were barely using it—even though the vendor assured that the system met the needs of every department.
“We started running very public tests, and my application flunked spectacularly,” Dr. Roth acknowledged. “We knew having a single app was important for use by non-Duke stakeholders because we didn’t want to have App A for radiology and App B for something else, but I didn’t recognize that the needs of the other specialties were different.” 
Ultimately, his brand took a hit, his job description changed, and his competency was questioned. “We kept the app, which did its job in radiology, and with a little elbow grease, it is now used for other purposes,” he noted. “But everybody around the enterprise had learned a lesson here—if you know me, I am something of a governance wonk as a result.” 
The personal costs of over-focusing on professional life at an important time in his family’s life tested Roth’s marriage as well.  “I am happily married right now, but my wife occasionally lets me know and remember that I messed up back then because I didn’t have my eye on the ball,” he shared. 
Lessons Learned 
1. Communication and outreach are more important than speed or agility. 
2. People need to know what your vision is—you need to work with them to deploy it not impose it on them. 
3. Test your apps really hard within your workflow before you buy them or at least before you over promise and call references early on. “Can it do it” is very different than “can it do it well here.” 
4. Know when to pull in help: “Instead of going on my own to push this, I should have engaged my CMIO earlier.” 
5. Protect what matters in your life: “All of us have a support group at home and it is really easy to get caught up in your job—I did, and it did hurt.” 

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