No one can say that Vinay Vaidya, M.D., didn't know what he was getting into when he interviewed to be the first CMIO at the 345-bed Phoenix Children's Hospital (Ariz.). During his 11 years in medical practice post-residency, all at the University of Maryland-Baltimore, Vaidya had been involved in medical informatics, helping to implement the pediatric portion of UMB's CPOE system, and developing a variety of other pediatric information systems.
What most interested Vaidya in the position, though, was his desire to use clinical IT to impact patient care on a level beyond what he could personally accomplish as an individual clinician. With nearly 15 years experience in critical care, including four years as a fellow and 11 as a faculty member, “I quickly began to realize that, as a critical care physician, you can do one-on-one care and save one life at a time. But by being involved in IT implementations, that work can touch many more lives at once. So I had been feeling the need to go less clinical and more IT,” he says.
And Vaidya was exactly what Vice President and CIO Bob Sarnecki was looking for. “We were looking for demonstrated expertise in using technology to solve clinical problems,” says Sarnecki, who has been at Phoenix Children's for four years. “Dr. Vaidya showed he had that: he was not just a ‘tech-head’ using computers; he understood the technology and the medicine,” at a strategic level. “It was actually harder to find a qualified candidate than we had thought. Most we had talked to either lacked the experience with IT we needed, or were traditional tech-head docs who were user-champions. Dr. Vaidya's expertise,” in contrast, is broadly based, he says.
And though Vaidya has only been in place at Phoenix Children's since late January, he already knows he made the right choice. “It's a wonderful job,” he says, and reports that he's already in the thick of things, handling the CPOE go-live and many other tasks (Phoenix Children's is using an EMR/CPOE solution from the Atlanta-based Eclipsys Corporation). As for CPOE itself, Sarnecki notes that the outcome has been positive, with 95 percent of orders being entered directly by physicians, and the remaining 5 percent being entered into the system by RNs (these include telephone, verbal, and transcribed orders).
Hiring meets implementation
Nationwide, the number of hospital organizations hiring CMIOs (the acronym stands for either “chief medical information officer” or “chief medical informatics officer”) is surging, driven by the rapid acceleration in implementations industry-wide of advanced clinical information systems. In fact, when Healthcare Informatics surveyed its readers in April, 59 percent of respondents reported that their organization had a CMIO in place, while 41 percent did not have one (see figure, page 50). What's more, most seem to agree that, very soon, few large or even medium-sized U.S. hospital organizations will be able to complete clinical IS implementations without CMIOs.
The profile of the emerging CMIO continues to evolve. While the first CMIOs were essentially part-time administrator/super-users who were consulted for their advice on earlier clinical IT implementations, today, most CMIOs spend at least 75 to 80 percent of their time on CMIO duties (including those who continue to keep a hand in medical practice). And now, they are increasingly managing teams of clinical informaticists.
Linda Hodges and Arlene Anschel, recruiters of CMIOs at Oak Brook, Ill.-based Witt Kieffer, see the CMIO role changing rapidly. “We're involved in an evolutionary process,” says Hodges, whose title is vice president and IT practice leader. “Originally, it was ‘tech-heads’; then it became the facilitator or champion type” who was the typical person hired into a CMIO position. “And at the HIMSS 2009 Conference in Chicago, in our panel discussion, we talked about how the role will continue to evolve. The feeling was that, as organizations complete their initial EMR implementations, that's when the job really begins to shift, and move towards patient safety and quality issues.”
And Anschel, whose title is consultant, IT practice, notes that the pool of job candidates with three to five years or more of CMIO experience is already deep, whereas 10 years ago, there were “almost none” to choose from.
Diverse views on some key issues
The increasing formalization of the CMIO position in hospital organizations is a welcome development, many say. Yet on several key issues, widespread disagreement remains. Among these:
Should CMIOs continue to spend part of their time in clinical medical practice? Some CMIOs believe that maintaining clinical practice, even at a level of 5 or 10 percent of one's hours, remains important for credibility with other physicians, to maintain familiarity with clinical systems, or for other reasons. But doing so is not practical for all CMIOs, and depends partly on the clinical specialty in question.