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January 31, 2008
by Mark Hagland
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Sitting at the nexus of healthcare and I.T., CMIOs are in a unique position to ensure both sides of the aisle are on the same page

As the implementation of clinical information systems accelerates across hospitals and health systems nationwide, the need for physicians with a combination of clinical backgrounds and informatics understanding is becoming clearer every day, say industry experts.

And whether they carry the title chief medical information (or informatics) officer (CMIO) or not, these clinician executives are becoming as essential to organizational success as CIOs have been in the past two decades.

It's not surprising that CMIOs should be in great demand right now, say observers. After all, look at the systems being implemented across healthcare: EMRs, computer-based provider order entry (CPOE), electronic medication administration record (eMAR), and picture archiving and communications systems (PACS), and other advanced clinical information systems.

But what is making the CMIO role increasingly a core IT executive position is the fact that as patient care organizations go electronic, the information systems that run them become core operational technologies (OT).

This is precisely what has happened in industries such as manufacturing and transportation, says Vi Shaffer, research vice president and agenda manager in the Healthcare Providers division at Gartner Inc., Arlington, Va. “OT is what makes the business run,” Shaffer says. “And what has happened now, between medical technology and computer systems, is that we now have real OT in patient care, as we move the patient through the system, place orders, and so on, through automation. Medical management is very intimately tied to IT operations now.”

As a result, she says, only those organizations with strong physician leadership in IT will extract the full value from systems they implement.

Shaffer produces an annual survey and report regarding the views and perceptions of CMIOs who are members of AMDIS — the Association of Medical Directors of Information Systems.

“We've just done a series of predictions for 2008,” she says, “and one of them is that the CMIO role will ultimately move out of the IT organization, with most CMIOs reporting to chief medical officers (CMOs) rather than to CIOs.” In other words, she ultimately sees those CMIOs now “embedded” in their IT groups shifting back over to the clinician teams from whence they first emerged.

William Bria, M.D., chief medical information officer for the 22 Shriners Hospitals for Children (Tampa, Fla.) and the president and co-founder of AMDIS, says that regardless of to whom the CMIO reports, the point is this: “In the old days, you'd just be a physician champion, making everyone feel jolly about going through the change without necessarily knowing what it was.” But the growing professionalism required of CMIOs will transform the role in the next several years, just as the CIO role has become more formalized over the past two decades.

CMIOs who are evolving in their own positions say the role is evolving rapidly. “The real role is to be as sophisticated as your counterpart in the CIO role, and to understand the business case for technology adoption,” says Shahram Partovi, M.D., medical director of medical informatics at the Barrow Neurological Institute, Phoenix, and for the San Francisco-based Catholic Healthcare West system. “The first crop were just M.D.s who happened to be good at tech, and until project management and business skills become standard training, the greatest challenge to CMIOs will be to realize that their job is to support the medical delivery of care through technology, as opposed to just being advocates of the medical staff,” Partovi says. “In other words, to think like businesspeople.”

Stephanie mills, m.d.

Stephanie Mills, M.D.

J. michael kramer, m.d.

J. Michael Kramer, M.D.

Partovi himself actually reports to the CEO at his organization, though he has a dotted-line relationship with its CIO.

Stephanie Mills, M.D., CMIO at Our Lady of the Lake Medical Center in Baton Rouge, La., says that CMIOs are especially important as hospital organizations seek to operationalize tools, like CPOE, that have widely been misconstrued as being akin to “plug-and-play” information technologies, when in fact, they require intensive customization.

The best example of this, she says, is the building of order sets to support CPOE. Not only is that set of tasks essential and doable only by clinicians, it also requires an understanding of workflow, data flow, and information flow that only CMIOs can lead the process of determining.

It is this combination of clinical and IS-related tasks that will fall increasingly to CMIOs and their staffs (yes, they're going to need their own clinical staffs), say those in the trenches. “I probably spend 75 percent of my day talking about clinical design and such things as data standards and the optimization of the clinical architecture,” notes J. Michael Kramer, M.D., vice president and CMIO at the 43-hospital Trinity Health System, based in the Detroit suburb of Novi, Mich.

In fact, it is the special combination of design management, clinical content management, and organizational knowledge on the part of CMIOs that will move their organizations forward, Kramer says. “IS design and clinical content all have to be evaluated, refined, and hardwired before you're done implementing the system,” he says. “And if you don't understand what an order set is, how can you manage evidence-based design content?”