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The Next Wave

June 24, 2012
by Mark Hagland
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In the new world of accountable, transparent care, CMIOs will be essential to organizational success


As healthcare moves towards new, more accountable paradigms, CMIOs in patient care organizations nationwide are finding their positions becoming more and more focused on clinical transformation and process improvement. With such evolutionary changes are coming increased staff support, new reporting relationships, and even title changes.

What’s going on at Texas Health Resources (THR), the Arlington, Texas.-based integrated health system, is emblematic of what’s happening more broadly in healthcare, as CMIOs—alternatively designed as chief medical information or chief medical informatics officers—at patient care organizations nationwide are seeing their profiles raised ever higher. At THR, Ferdinand Velasco, M.D., who has been CMIO for 10 years, in June became chief health information officer (CHIO) of the 24-hospital, 4,100-bed health system, and reports to three different THR executives. Velasco will continue to report to the organization’s CIO, Ed Marx, but now also reports to the organization’s chief operations officer and chief clinical officer, two individuals whose office combines joint responsibility for the clinical and operations sides of the entire organization. Meanwhile, the individual who had been the associate CMIO has been promoted to CMIO and continues to report to Velasco, while the chief nursing information officer (CNIO) also continues to report to him.

Ferdinand Velasco, M.D.

At first blush, this might sound like a whole lot of organizational musical chairs, but Velasco notes that, at THR, "The focus has been on engaging physicians and getting them to adopt the electronic health record. The CHIO role will encompass the physician areas," he says, "but will also broaden out to all clinician stakeholders, across both the inpatient and ambulatory spheres and into the home. People tend to think of ambulatory as clinics and physician practices. Now, with health IT, you’ll have the capability to extend the reach into the home and anywhere people are connected." What’s more, he notes, a few other pioneering organizations have already taken the step to broaden out the CMIO role to a "CHIO" role; he cites the Danville, Pa.-based Geisinger Health System and the Oregon Health & Sciences University Hospital, in Portland, Ore.

If expanding the CMIO role out into the far reaches of integrated health systems is a natural transition, so, too, is the broadening of the CMIO role into transforming care delivery and becoming intensely involved in quality and performance improvement. That’s what’s happening at the St. Paul, Minn.-based HealthEast Care System, where CMIO Brian Patty, M.D. is leading a healthcare informatics team of more than 40 clinical informaticists that is leveraging clinical IT in the pursuit of the organization’s quality improvement goals.

Brian Patty, M.D.

"Our primary focus is to work closely with our quality department, and really find out what their priorities are," Patty says. "We focus the decision support tools that we deploy based on what we feel will best help us focus our quality work. So where are the pain points in some of our quality initiatives, and what can we do with our EHR and with some of our clinical decision support tools, to help out?" For his team’s exceptional work in all these areas, the HealthEast Care System healthcare informatics team won the Healthcare Informatics/AMDIS IT Innovation Advocate Award for 2012, sponsored by HCI and by the Association of Medical Directors of Information Systems.

Among other things, Patty’s team has facilitated several comprehensive implementations, including a full-replacement computerized physician order entry (CPOE) system, a broadly interoperable clinical documentation system; barcoded medication administration, pharmacy management, and a comprehensive physician portal; has developed an advanced clinical decision support (CDS) system to incorporate innovative web-based physician order sets; and has implemented a data warehouse in an online analytical processing (OLAP) environment, to facilitate financial, operational, and quality retrospective analytics.

A Strategic, Process-Oriented Role