There is one point on which everyone agrees, and that is that the CMIO-CIO working relationship must be a close partnership. David Artz, M.D., medical director, information services, and Patricia Skarulis, vice president and CIO, at Memorial Sloan-Kettering Cancer Center in Manhattan, have honed the partnership concept to a high level. Artz (who has a dual reporting relationship with both Skarulis and with the hospital's physician-in-chief, who is the senior medical officer over both the hospital and its clinics) says his partnership with Skarulis is a foundational bedrock for his success as a CMIO. When asked what he needs out of the CIO-CMIO relationship, Artz says, “You have to make sure that the IT organization can stay focused on the appropriate prioritization of their projects. And if a clinician has a problem that needs to be solved and you want to solve it, that you know you can go back and do that.”

Skarulis adds that the CIO-CMIO relationship “has to be rooted in a sincere respect for each other. I daily seek out Dave's guidance on things, and we brainstorm together. And if that respect were not there in both directions, it would be obvious, and you just wouldn't get that kind of partnership.” That level of partnership was clear to the attendees of the HIMSS 2009 Conference session that Skarulis and Artz participated in, along with Hodges and Anschel.

To practice or not to practice?

One area of controversy remains whether a CMIO should continue in clinical practice to some extent or not, and if so, why. Executive and clinician leaders in different organizations have diverse points of view on this, and every organization is working out the answer to the question individually. Of course, 10 to 15 years ago, this question was mostly beside the point: the first CMIOs were active physicians who were asked to set aside a part of their work-time to “help out” the CIO and the IT staff with clinical IS implementations. And because IT budgets had not yet evolved to allow for full-time physician informaticists, the question of whether the first CMIOs should remain, at least part-time, in clinical practice was largely moot.

Nowadays, however, most larger facilities and teaching hospitals have both the budget and the need for full-time or mostly full-time CMIOs, so the question of clinical practice becomes a strategic one. And the reality is that whether or not an organization's CMIO keeps a hand in clinical practice or not will depend on the strategies, culture, and needs of each individual organization. And what's right for one hospital or health system may simply not be right for another.

For James Altomare, M.D., CMIO at the 1,800-bed Methodist Hospital in Houston, having a background as a hospitalist has been useful in numerous ways. Not only is it quite possible to readily dip back into hospitalist practice - “I squeeze it in about a weekend a month,” he says - but Altomare believes that background “was perfect for building order sets” and understanding similar types of processes that CMIOs must oversee. Does his practice status really matter? Altomare reflects that, “Unless you're a full-time doctor, you're a suit” to other physicians once you take on an administrative role. Still, the fact of having practiced at some point in one's career is essential for credibility, he adds.

Another CMIO whose clinical specialty lends itself to occasional practice is James Levin, M.D., Ph.D., of Pittsburgh Children's Hospital, which is a member of the 20-hospital UPMC Health System. “I do inpatient pediatric infectious disease consulting, in four one-week blocks of time, a year,” Levin reports, who says keeping a hand in practice helps his credibility and uncover system glitches.

Meanwhile, when it comes to reporting relationships, the options are dizzying. Some CMIOs are reporting to CIOs; some to CMOs; a few to CEOs; and many have dual reporting relationships to CIOs and CMOs, sometimes with one of those relationships being a “dotted-line.”