Ramping Up to Leadership: CMIOs’ Profile Keeps Growing

In fact, one of the people she cites as having made the transition to a true leadership role is Tom Tinstman, M.D., vice president for clinical informatics and transformation, at the 11-hospital, Austin, Texas-based Seton Healthcare Family. Tinstman, who notes that he has actually never held the title of CMIO, is helping to lead intensive work in IT-leveraged clinical transformation; and he says there are some absolutely critical success factors as physicians move from being practicing clinicians to providing quality leadership in medical informatics.

“You have to understand the broad area of change management, and you have to know how to do process redesign with or without technology,” Tinstman says firmly. “And you have to understand how clinical knowledge is applied at the point of care. And that’s where having been a clinician is of value.” At the same time, he adds, “You have to understand adult learning because people have to learn new skills. And you have to have a conceptual model for understanding behavior in a service organization. If you’ve got those prerequisites, then you act as a facilitator for the organization, in how best to use the crowbar that is the EHR to create change. You don’t actually lead,” he adds.

Tom Tinstman, M.D.

And, Tinstman adds, the metaphor of the lone wolf, and the transformation of that orientation to a systems thinker and group leader, is a challenging one. “I’m a little bit crass about it,” he offers. “I say that clinical training actually trains you to be an opinion-based decision-maker who believes they’re fact-based. And to be successful in informatics, you have to be a fact-based decision-maker, in a group of people who like to be opinion-based.”

A CONFLUENCE OF INFORMATICS AND QUALITY WORK
If there’s anything that’s clear right now, it is that CMIOs are being hired and deployed across very diverse settings, from standalone community hospitals to multispecialty medical groups to vast multi-hospital systems. All of those types of organizations are facing similar challenges coming out of federal mandates, whether related to healthcare reform or meaningful use, not to mention private health insurers’ increasing requirements.

Charles DeShazer, M.D.

At Dean Health, an integrated system based on a network of more than 50 medical clinical locations in central Wisconsin, Charles DeShazer, M.D., holds the title of vice president, quality, medical informatics, and transformation. DeShazer, who like all the physicians interviewed for this article, spent years in medical practice before getting involved in medical informatics or quality work (DeShazer’s specialty was internal medicine), joined the Madison-based Dean Health in August 2010. “Soon after I joined Dean” as CMIO, he explains, “the vice president of quality decided to go back into practice; I had worked for Kaiser, and I was the medical director for quality there, and that fit what I wanted to do.”

In fact, the confluence of medical informatics and quality improvement work embedded in some of these new positions that has been gaining steam in the past few years—fueled by healthcare reform and meaningful use—doesn’t surprise DeShazer at all. “I think the movement towards value-based delivery systems is really pushing the change,” he says. What’s more, because of the accelerating demand for professionals with medical, quality, and informatics credentials, he adds, “What I see now is that  CMIOs are really beginning to take a seat at the business strategy table. And it’s a good fit, because the tools to drive business value under this new model are based on data, information, and enabling technology.”

Ferdinand Velasco, M.D.

Ferdinand Velasco, M.D., vice president and CMIO at the 14-hospital, Arlington, Texas-based Texas Health Resources (THR), would certainly agree. Velasco, who was THR’s first CMIO when he joined the organization nine years ago, adds that an absolutely critical success factor for CMIOs will be how the most senior leaders of their organizations conceive of the CMIO role and support it. “As the health system moves forward from a focus on implementing to a focus on leveraging the tools, the biggest challenge is the optimization of the electronic health record,” Velasco says. And, in that context, he asks, “How do they view the role—as a tactical one, or a strategic one, really helping to lead the medical staff in discussions on improving care?”

In short, he says, “The hard part is fully leveraging the transition, to make care better. And the challenge isn’t so much whether a physician has the skill set to do that as CMIO; I think that will sort itself out.” Instead, he emphasizes, “The biggest challenge isn’t intrinsic to the physician; it’s an organizational one. Do they recognize the CMIO as a medical leader? In organizations that are physician-led, it’s not that hard; they inherently understand that. But some organizations don’t have that much experience with physician leadership.”