As a variety of developments and trends in healthcare intensify the demand for patient care organizations to use clinical and other data to analyze and improve clinical and financial performance and overall effectiveness, the chief medical information officer (CMIO) role is becoming more and more firmly entrenched in patient care organizations of all kinds, a new survey released at the AMDIS Physician-Computer Connection Symposium this summer in Ojai, Calif. confirms.
Presenting findings from an online survey of the membership of the Association of Medical Directors of Information Systems (AMDIS), Vi Shaffer, research vice president at the Stamford, Conn.-based Gartner, and Dick Gibson, M.D., Ph.D., chief healthcare informatics and intelligence officer for the Oregon Region of the Portland, Ore.-based Providence Health Systems, on July 14 provided the assembled CMIOs with a snapshot of where their profession stands at this key juncture in healthcare.
Opening the joint presentation, Shaffer said that the survey, which netted 74 respondents and closed just before the Symposium began, confirmed a significant maturation of the CMIO role within hospitals, large medical groups, and integrated health systems. “This decade brings a second wave of major change for the CMIO,” Shaffer told the assembled audience.
“By and large, the previous decade was about an understanding of the need for this position and the gaps involved in functions leading to it. Wave two is very significant: it is an evolution of responsibilities, both within the EHR and beyond; it is growing needs and specific informatics resources-specifically a growth of the CMIO position to harvesting high value from the EHR and information and communications technology overall. That is significant, and it is a stretch of time and responsibilities from before,” she said.
These are among the key findings:
Among survey respondents, 64 percent are currently in their first CMIO position, down from 81 percent in 2010, meaning that more experienced CMIOs are moving to posts beyond their first CMIO positions.
Among respondents, 56 percent are 50 years old or older, while 44 percent are between 30 and 49 years old.
THERE MUST BE A MATRIX RELATIONSHIP; AND THE CHEMISTRY BETWEEN THE CMIO AND CIO IS VERY IMPORTANT.-VI SHAFFER
In terms of where they're headed, 71 percent want to stay in their CMIO job long-term (though 14 percent want to move to a different institution); 7 percent would like to become CIOs; another 7 percent would like to become CEOs or COOs; and 4 percent would like to become CMOs.
There continues to be a very wide range of compensation levels, ranging all the way from $150,000 to above $500,000, but with most survey respondents clustered within two swaths: $250,000 to $300,000 and $345,000 to $375,000.
Within those compensation levels, 41 percent receive a straight salary, while 49 percent receive a salary plus some kind of bonus.
Meanwhile, compared with physicians in their medical specialty and with a similar level of experience, 67 percent make more than such physicians, while 15 percent make the same and 17 percent make less.
In terms of their organizational type, 81 percent report that they work at integrated health systems with affiliated medical group practices, while 9 percent work in standalone hospitals; most have enterprise-wide responsibilities.
MU, ACO CHALLENGES NOTED
Shaffer reported that the top three concerns of respondents over late-stage meaningful use were: challenges with assembling and reporting the required data (by a wide margin); complexity or confusion about the criteria; and a lack of executive leadership and change management in their organizations.
Meanwhile, with regard to the development of accountable care organizations (ACOs) under federal healthcare reform, survey respondents cited the following as their biggest challenges: inadequate compensation to their organization relative to the risk; gaps in information systems for care management; gaps in business, clinical analytics, or reporting; and confusion over criteria.
Gibson shared data from the survey regarding reporting relationships. At this point in time, he reported, 61 percent of CMIOs surveyed now have staff reporting to them, anywhere from one person to 125 people, with a majority reporting in the two to 25 range.
To whom do CMIOs themselves now report? The survey found that 47 percent of those responding report to the CIO of their organization; 29 percent to the chief medical officer (CMO); 5 percent report dually to the CIO and CMO; while 19 percent report to the CEO or COO. Gibson noted several advantages to reporting to the CMO. Among them:
The CMO is more likely to be able to affect change in the organization;
Reporting to the CMO puts the CMIO in a politically stronger position with the physicians;
CMIOs universally report easy relationships with CMOs, while fewer say that about their relationships with CIOs;
The CMO-CMIO relationship was reported as optimal in terms of supporting the quality department;
Reporting to the CMO was cited as being helpful in terms of achieving practice and workflow changes for doctors;
CMOs were seen as frequently involved with local implementations, and they were seen as better-positioned to spur the use of a clinical information system after implementation.
THE REAL WORLD OF RELATIONSHIP COMPLEXITY
Still, as one CMIO interviewed by Healthcare Informatics noted, “When it comes down to it, my being in the IT department has strengthened my ability to get things done; and I also have budgetary responsibility and staff.” That CMIO reports dually to the CMO and CIO in his organization. And that kind of arrangement, Shaffer told Healthcare Informatics in an exclusive interview, is really the way things are moving for many CMIOs these days.
As Shaffer explained it, “There are new changes in our recommendations around reporting relationships. On the one hand, it's been true for a while that CMIOs, if you ask them to whom they should report, they will say the CMO. But more and more are acknowledging that the reporting relationship must be a hybrid between the CMO and CIO. The CMIO is very intertwined with and interdependent on the CIO; it must be a non-competitive co-creation, as they say at the Harvard Business Review.”
Shaffer also noted that “There must be a matrix relationship; and the chemistry between the CMIO and CIO is very important. Our old prediction” with regard to recommending where the CMIO should report “was towards the CMO; this is our new one-this is the advanced CMIOs and advanced CIOs recognizing this” with regard to a matrix or dual reporting relationship to the CMO and CIO, she said.
MOVING AWAY FROM THE ‘GEEKY DOC SYNDROME’
CMIOs attending the symposium agreed that the CMIO role is maturing. John Lee, M.D., who is one of three lead medical informaticists at Edward Hospital & Health Services, an integrated health system in the Chicago suburb of Naperville, Ill., told HCI that “CMIOs' role continues to expand in terms of the usability of the systems, in harvesting value for the EHR; and evolving role in data analytics, in IT governance, and in the use of business analytics, but also in the connectedness between the capabilities of the EHR and CPOE and documentation and clinical decision support; and analytics.”
And Bobbie Byrne, M.D., Edward's CIO and a pediatrician by specialty, said, “I think we're at this point where there are still CMIOs who are the classic ‘geeky hospital docs’; but that situation is changing, and there now are some really strategic CMIOs who are really helping to plan things.”
Given that she herself is a physician, how would Byrne advise non-physician CIOs about how to help their CMIOs be successful? “For those CIOs who are not physicians, I would say, ‘Get to know your CMO,’” she said. “Get elbow-to-elbow with your CMO, and figure out how to make your organization's CMIO position work. And if you don't have one, you'd better get one. And it can't just be the geeky hospital doc who likes computers.”
Added Lee: “You almost want to kind of poll the docs and figure out who, by consensus, is the most clinically efficient doc and the most astute doc, and then see if you can get him or her to be your CMIO.”
Healthcare Informatics 2011 October;28(10):32-46