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Facing Fundamental Transformation: David Levin, M.D. Reflects on CMIOs’ Challenges and Opportunities

February 28, 2015
by Mark Hagland
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David Levin, M.D., shares his perspectives on the transformational challenges and opportunities facing not only U.S. patient care, but also CMIOs and other senior medical informaticists

As anyone who isn’t living in a healthcare cave these days knows, the roles of clinical informaticists in U.S. healthcare are rapidly being transformed. One of the roles undergoing the fastest and most thorough of transformations is that of the CMIO. Just a few years ago—and still today in some patient care organizations—CMIO development was still relatively simple—and primitive. Practicing physicians known to be “tech-heads” by their fellow doctors got tapped on the shoulder by CIOs to help select electronic health record (EHR) solutions and lead their initial implementations, or to provide handholding for other physicians as EHR implementations progressed.

None of those simple approaches is sufficient any longer at any but the smallest or least-evolved patient care organizations in the U.S., as the emerging healthcare system is increasingly demanding the rapid grooming and professional development of physician and other clinician informaticists able to take on senior leadership and management positions and lead their colleagues forward into accountable, transparent, value-based care delivery.

In that regard, one of the Healthcare Informatics 2015 Top Ten Tech Trends was focused on “Clinical Informaticists 2.0”—on the need for a more sophisticated, evolved cadre of clinical informaticists going forward in advancing patient care organizations across the U.S. And one of the industry leaders interviewed for that article was David Levin, M.D., who served as CMIO at the Cleveland Clinic Health organization from 2011 through 2014, and who is now consulting as founder and partner in Amati Health, a Suffolk, Va.-based consulting firm.

Dr. Levin was part of a team led by consultant Pam Arlotto, president and CEO of the Roswell, Georgia-based Maestro Strategies consulting firm, who published a white paper entitled “From the Playing Field to the Press Box: The Emerging Role of the Chief Health Information Officer,” the publication of which was highlighted via an interview between HCI Editor-in-Chief Mark Hagland, and Arlotto and Levin, published on the Healthcare Informatics website in October 2014.

Dr. Levin spoke again with HCI Editor-in-Chief Mark Hagland in November for the Top Ten Tech Trend. Below are excerpts from that interview.

What kinds of gaps do you see right now between what is needed in CMIOs and other senior clinical informaticists, and the availability of people with the skill sets needed to help move healthcare forward?

We as a healthcare system have been about implementation the past five years, getting the infrastructure into place. And we’re not done, but we’re well down the road. But now, the CMIO role is starting to converge with the roles of the chief quality officer or chief medical officer, roles that are about performance management, about envisioning a better future and achieving better performance, including around concepts of the Triple Aim,” which is the idea being promoted by the Institute for Healthcare Improvement of continuously improving the quality of clinical outcomes, improving the cost-effectiveness of health care, and enhancing the patient and community experience.

David Levin, M.D.

So you’re starting to see CMIOs begin to morph and migrate. They’re migrating into roles around strategy and performance management. In some cases, CMIOs are becoming CIOs. In other cases, they’re creating new roles, like that of the chief health information officer [CHIO].

And it’s the convergence of those traditional roles with the CMIO that is particularly interesting. The advantage of coming at it from having been a CMIO is your understanding of the technology, whether the analytics for performance improvement, or of the EMR, to collect data and use it to get the work done.

But let me also talk out of the other side of my mouth on this. The skill set docs like me were selected for originally for—the doc who was geeky and liked technology—that’s not necessarily going to translate fully into the new role. On the implementation side, it’s largely about technical understanding or IQ; now, with transformation, you’re talking about your strategic IQ—these are high-level leadership skills, not technical skills. So what I think we’ll see happen is that the CMIOs who have that kind of talent or can develop it, are migrating it into the CIO role.

What about the transition from CMIO to CMO? Some CMIOs are making that shift also.

I think a few are, yes. Either way, the CMIO position, or whatever role you give that person, will be a much more strategic role, will be sitting in the c-suite, with people reporting to her or him. It’s becoming a far more elevated position over time.

Something like what happened to the CIO, needing a CTO, then, perhaps?

Yes, exactly. And I’m beginning to see this in my peer group; they did great work on implementation, and have the potential to migrate up and they are doing that. And some guys are self-selecting to stay down in the engine room, as it were. And God bless, we need those folks! So, more controversially, I want to choose my words carefully. I see a lot of CIOs struggling with this, because on the one hand, as a traditional CIO, I could understand how you might be threatened by this. But I’m also seeing that forward-thinking, progressive, self-confident CIOs, are embracing this. They recognize that this is what their organizations need going forward.