The traditional health system IT department runs on analysts and infrastructure specialists who build, configure, and maintain the systems clinicians depend on. Will Landry, senior vice president and CIO at FMOL Health in Baton Rouge, La., thinks that model is becoming obsolete, and has spent more than a year trying to implement the FMOL Health at-the-elbow model to replace it.
What the FMOL Health At-the-Elbow Model Actually Changes
The shift Landry is pursuing isn’t primarily about headcount; it’s about what expertise his department leads with. Where FMOL Health’s IT team has historically been built around technical specialists who know the systems and can configure them, Landry wants a team built around workflow expertise, including staff who can sit alongside clinical and operations colleagues, understand business processes, and deploy technology rather than the other way around.
Why These Skill Sets Are Changing So Quickly
“Those skill sets are changing, and they’re changing pretty quickly as far as what’s needed,” Landry said. “We need to be way more focused on business systems, end-to-end workflow systems, being able to go in and being more subject matter experts where we’ve traditionally been, like, technology experts.”
How the FMOL Health At-the-Elbow Model Works in Practice
The practical expression of this shift is moving IT staff off build work and onto floors and into clinics, working alongside clinical and operations teams to identify workflow problems and fix them in real time. “We’re going to be probably less focused on build and more focused on at-the-elbow optimization with workflows,” Landry said.
Why the Direction Is Clear but Execution Has Lagged
The direction is clear, but the execution has been slower. Structural changes to the IT organization have been made, but the shift hasn’t moved at the pace the original plan called for. “I’ve been talking about it with my senior leadership team now for over a year, and we’ve made some changes in our org structure, but nothing like we thought we would initially,” Landry said. “It is easier said than done, and you’ve got to find the right mix of moving pieces and moving strategy over time.”
Why the Same Pressures Driving This Redesign Also Slow It Down
Part of what makes the transition difficult is that the pressures creating the need for change are the same ones that limit its pace. Budget constraints tied to HR-1 and Medicaid changes are tightening, self-pay volumes are rising, and legacy systems and technical debt from earlier implementation years still demand the resources Landry would rather redeploy toward workflow-focused staff, even though the underlying build work doesn’t disappear simply because the strategy has moved beyond it.
A Historical Analogy for Navigating This Tension
For a framework on navigating that tension, Landry looks outside healthcare, specifically to George Washington, for inspiration on strategic restraint, noting that Washington fought and retreated from many battles before ultimately succeeding in gaining independence. “It’s not about the battles,” Landry said. “It’s about the end goal. It’s about where you’re trying to get. And sometimes you have to take retreats. Sometimes you have to change.”
What This FMOL Health At-the-Elbow Model Means Going Forward
Given Landry’s candid acknowledgment that this transition has taken longer than originally planned, other health system CIOs pursuing similar workforce redesigns may want to build more conservative timelines into their own planning, particularly if they face comparable budget pressures tied to Medicaid policy changes and rising self-pay volumes. Landry’s framing of strategic retreat as a legitimate management tool, rather than a sign of failure, may offer other IT leaders useful language for communicating incremental progress to their own senior leadership teams during a similarly extended transition.
What to Watch Going Forward
As FMOL Health continues its shift toward the at-the-elbow model, industry observers will likely watch whether the pace of structural change accelerates once current budget pressures ease, or whether legacy technical debt continues competing for resources indefinitely. Given the broader industry pressures Landry cited, HR-1 and Medicaid-related budget constraints affecting health systems nationally, this FMOL Health at-the-elbow model transition may offer a realistic, cautionary case study for other CIOs who assumed similar workforce redesigns could move faster than the underlying financial and operational constraints actually allow.
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