Kings County Hospital Center is a 630-bed tertiary-care academic medical center in Brooklyn, N.Y. As medical director, Abha Agrawal, M.D., is responsible for providing leadership for its 850+ medical staff, while ensuring quality, patient safety, risk management, health information management and research. But that’s not all she does. Agrawal also finds time to serve as a board member of the NYCLIX RHIO and as a commissioner for CCHIT. A former CMIO, she recently took time to talk with HCI Editor-in-Chief Anthony Guerra about how her former role is evolving, and what she’ll be looking for in a replacement.
GUERRA: You said CMIOs must go out and work to sell a vision, but aren’t physicians used to having everyone come to them?
AGRAWAL: Absolutely. So it’s the same skill set that you want to see in any of the, let’s say, physician executives serving in CMO roles. Physician executives think they become more powerful but, actually, there’s really not that much power, even though there are a lot more people reporting to me now than the zero that were reporting to me as CMIO. I’m not into power, I’m far more into building consensus, bringing people to my point of view, and facilitating what they do, as opposed to dictating. So I think the CMIO’s attributes should be the same as any serious physician executive, whether they are serving in a CMO role, a CEO role, or even a CIO role.
The motivation and the selling and the cajoling I think falls a lot more on the CMIO than on the CIO. I see the CIO as having a very different approach, so it’s a critical value that the CMIO brings to the institution.
GUERRA: So we talked about the CMIO reporting to the CMO, but what should, on paper, the relationship be with the CIO?
AGRAWAL: In many hospitals, CIOs report to chief operating officers and, if we take this analogy further, there are CIOs reporting to COOs who generally report to the CEO. We have the CMIO reporting to the CMO who generally reports to the CEO, and that makes them sort of peers. I had strong convictions many years ago that a dotted line shouldn’t be from the CMIO reporting to the CIO. It could be a dotted line peer relationship, that’s fine. It could be formalized in many other ways. They could be, let’s say, co-chairs of the IT executive committee, for example, if there is one in the institution, they could have shared decision making, again, via a body that is responsible for making decisions. I am not in favor of the CMIO being, seen even in a dotted line, as underneath the CIO.
GUERRA: What can you tell me about how you are moving forward to find a new CMIO?
AGRAWAL: So far I haven’t moved forward strategically quite yet because (A), I’m fairly new at this job myself; and (B), in the hospital, we have had other very critical positions to fill that we advertised in the New York Times and other places, such as the chief of medicine, chief of ED and chief of ambulatory care. So my attention in this new job has been channeled to help find people for those far more critical positions.
Having experience as a CMIO would be a great plus, but if I find somebody who is, let’s say, an associate or assistant CMIO, someone who has gone forward where they have been involved with an informatics department or had people reporting up to them, or even a physician who has informatics training and some years worth of experience, that could be good. Even if they haven’t been a CMIO, but are a very good match for the organization, in terms of their style, their values, their integrity, their ability to lead, I think I would go for that.
I will check out my network relationships. We have an organization in New York called Med Info New York or MINY, we call it, M-I-N-Y. That’s a network of physician informaticists from hospitals, academia, and corporations, etcetera. So as its president for a couple of years I will look to some of my colleagues there. I would look towards AMIA. I would look towards the usual channels when we do decide to start the search.
GUERRA: Let’s switch gears a little bit. I noticed you’re a commissioner with CCHIT. How long have you been there?
AGRAWAL: I’ll finish four years in December.
GUERRA: Are you going to stay on or are you leaving?
AGRAWAL: Well, there’s a two-term limit, each term is for two years. So my term as commissioner will expire before the end of the year.