Dirk Stanley, M.D. has been CMIO at Cooley-Dickinson Hospital, a 140-bed community hospital in Northampton, Mass., for more than three years. He continues to practice part-time as a hospitalist (his medical specialty is internal medicine), spending 25 percent of his time working some nights and weekends on Cooley-Dickinson’s floors and in its ICU. Nevertheless, through his leadership and that of his colleagues, Cooley Dickinson was, as of late this summer, at 65 percent adoption of computerized physician order entry (CPOE). Stanley spoke recently with HCI Editor-in-Chief Mark Hagland regarding his perspectives on the evolution of the CMIO role in hospital organizations.
Healthcare Informatics: You believe the CMIO role needs to be more fully formalized?
Dirk Stanley, M.D.: Absolutely, and the clinical informatics role in general needs to be formalized. Interestingly, I’m having trouble finding even basic definitions of very common terms, like what an order set is; nor can I find definitions of what a CMIO is. It’s shocking, the whole informatics industry suffers from a tremendous lack of definitions. Which is curious, since we’re supposed to be the people who care about these things.
HCI: Do you believe we need more consistency in the CMIO role, or more clarity around the role, or both?
Stanley: We need both. Unfortunately, part of the reason that I think CMIOs aren’t standardized in their roles is that hospital administrators, as a whole, aren’t really standardized in their training. Usually, [on the path to the CMIO role,] people sometimes get an MBA, or they’re a doctor who ‘learns informatics’; but there’s really no standardized schooling for all administrators. As for how you find or hire a CMIO or write a job description for a CMIO? There are just no good standards - yet. I’m working on it. [laughs]
HCI: There seem to be three elements to me in the CMIO role—relationships, strategy, and implementation. Your thoughts?
Stanley: Yes, those three are all core. My general feeling is, if you’re reporting to the CIO, usually, you don’t get that involved in the strategy discussion, and the role becomes more like a physician champion. If you report to the CEO of the hospital, then you get more involved in translating among physicians, IT, and administration, and the associated strategic budgeting issues. Flexible budgeting a common pitfall. Many hospitals do this: the salespeople say, this software and initial training will cost $10 million, and so administration puts aside $10 million. But unfortunately, they usually won’t tell you the hidden added costs of EMR implementation.
HCI: What if you report to the CMO?
Stanley: Then I think you have a better chance of getting your arms around the budgeting decisions and organizational issues. But they may not have as much patience for the technical issues, which sometimes limits your effectiveness with the IT staff.
HCI: Is there an ideal reporting relationship?
Stanley: I’m not sure. I currently have a reporting relationship to several administrators, but my only solid line is to the CIO. I’m lucky to have a good CIO; but together, we sometimes struggle to make changes on the clinical side. And budgeting issues can still sometimes be challenging. Unfortunately, I think that’s one of the biggest challenges about EMR implementation - if you don’t budget for the gas after your EMR goes live, the car won’t drive well. Overcoming this takes work.
HCI: I’ve spoken recently with recruiters who say that CMIOs right now are wildly unprepared or under-prepared for what they will have to take on right now.