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Speeding Forward Along the CMIO Track

August 2, 2011
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Are patient care organizations advancing fast enough to meet emerging demands?

If anything was clear last month in Ojai, California during the AMDIS Physician Symposium, it was that CMIOs as a group are at a very significant crossroads professionally, both as individuals, and within the broader context of the evolution of the U.S. healthcare system.

Indeed, their status as a group could be summarized in a series of paradoxes. More sought-after than ever before, they are also under more pressure than ever before to deliver on high-minded promises of clinical transformation. While sought after partly for their clinical backgrounds and for at least some level of informatics understanding and interest, their success more than ever will rely on leadership skills and the ability to negotiate complex collaborations among diverse stakeholder groups in patient care organizations. And though many are new to their jobs and roles, and most lack the teams of informaticists and robust budgets they need to accomplish everything front of them, more concrete results are being demanded of them than ever before.

A lot of these paradoxes came strongly into view in the results of the online survey conducted just before the symposium by Vi Shaffer of Gartner and Dick Gibson, M.D., Ph.D., of Providence Health Systems. On the one hand, this year, 64 percent of respondents to their survey indicated that they are currently in their first CMIO position, down from 81 percent in 2010, which means that more experienced CMIOs are moving into positions beyond their very first CMIO jobs.

Meanwhile, compensation levels and arrangements remain wildly diverse, ranging all the way from $150,000 to $500,000 among survey respondents, with most between $250-300K or $345-375K; and with 41 percent receiving straight salaries, and 49 percent eligible for some kind of bonus.

One of the most interesting trends has to do with reporting relationships. While the survey found that 47 percent of respondents currently report to CIOs in their organizations, and 29 percent report to CMOs, and while only five percent have dual reporting with CIOs and CMOs, Vi told me in an exclusive interview that it’s becoming clear that for many CMIOs who are strongly tuned into the Zeitgeist, a dual or hybrid reporting structure is becoming the way to go. In fact, she says, a few years ago, she and her colleagues were recommending that CMIOs report to CMOs; but as the complexity of the sets of tasks before them is becoming more and more apparent, the need to attach themselves to their organizations’ IT team (and its budget and human resources) is becoming equally obvious. (In fact, a small number of CMIOs have already been made coequal with their CIOs; but those informaticists are also being given the human and budgetary resources to manage their newly broader responsibilities.)

At the same time, CMIOs are finding that retaining their credibility as physicians is as important as ever. In that regard, I found the statistic of more CMIOs in their second CMIO job to be quite fascinating. The received wisdom just a couple of years ago was that the vast, vast majority of CMIOs would continue to emerge organically from their own organizations, partly because hiring outsiders for this role simply would not work. Is that logic now changing?

The hard reality is that the difficult slog towards meaningful use success is ramping up faster and faster these days, as the months tick down to the end of stage 1 and towards stages 2 and 3. And let’s face it, some patient care organizations are simply not organically creating the conditions necessary to nurture homegrown CMIOs and fellow physician informaticists at the pace that they need to. So while it might seem “alien” to hire from the outside, I think increasingly, many hospitals and health systems will have no choice but to do so, as they fall behind their scheduled goals for MU—not to mentioning ACO development, bundled payments preparation, readmissions work, development of the patient-centered medical home, and go-live on the transition to ICD-10—and find themselves needing professional CMIOs with the management and leadership skills, along with the medical practice and informatics backgrounds, that they absolutely need.

So the next year will be a fascinating one. It will be truly intriguing going into next year’s AMDIS Physician Symposium, to see how things develop in the coming months. What’s clear to me now is that, more than ever, CMIOs are both in the driver’s seat in certain ways in their organizations, as well as simultaneously in the “hot seat.” And with success being far from guaranteed, their fortune within individual organizations could turn sharply one way or the other at the speed of light.



Once again, terrific post. Thanks for assembling the notes from AMDIS. I brought Dr Bill Bria into my world last week as well, to take a deep dive into these important issues over several days.

One step away from reporting relationship trends you touched on is the nature of the work. Are the CMIOs accountable for one-on-ones, feedback, coaching, and delegation? Do they have the time and training built into their roles to execute communication strategies like nominal group technique, participate in design review and validation, or facilitate dialogue mapping, even during their one-on-one interactions where appropriate.  In my experience, these skills are uncommon amongst physician executives and CMIOs, although training is available in both from organizations like ACPE and ABCo.

Relationship building takes time and skills which are rarely budgeted for, especially by people who don't have or practice those skills themselves. Often, CMIOs are not only practicing medicine, they're clinically active 15 or more shifts per month. As a result, the pre-go-live work for stage 1 MU is not adequately done, with go-live dates either delayed or de-scoped where possible.

Rather than frame the CMIO as in a drivers seat or a hot seat, in terms of project work, CMIOs driving in a distinctly different vehicle. A fire truck with separate steering wheels and drivers for the front and rear wheels. They're steering those rear wheels, with a project that is moving forward rapidly, a fire truck covered in wet paint, down roads that were not designed for fast moving, long, big, and clumsy trucks. And AMDIS provides the best available driving school for those of us who find ourselves behind that rear steering wheel !