A driving force in the evolutionary process is the need to adapt to new environments and changing situations. Healthcare is facing such an evolutionary process today and this change is reflected in C-suite transitions. While there is a great deal of change underway through healthcare reform and differing opinions on how to manage it, one thing seems clear—executive support for healthcare IT is here to stay.

Achieving meaningful use of electronic health records (EHRs) as part of the mission to improve outcomes has become one of the top strategic missions of most health systems. The increasing importance of healthcare technology in the strategic landscape is changing the manner in which hospitals operate. It also has accelerated the demand for a clinical IT skill set and physician IT leadership.

In these uncharted waters, it has become necessary for healthcare systems to have physicians who are familiar with these technologies help build support among their colleagues, and, more importantly, assess the true impact that clinical systems can have on patient care outcomes. Physicians are stepping into the role, often referred to as the chief medical information officer (CMIO), and moving these initiatives ahead without the benefit of a playbook or roadmap. As the role grows in importance, we see it evolving.

A recent survey conducted by Atlanta-based SSi-SEARCH, a retained executive search firm that specializes in healthcare technology leadership, produced some interesting findings in a CMIO survey conducted in the first quarter of 2012. A strong response to the survey, 280 healthcare leaders, shared their thoughts on the role. In addition, many of the healthcare leaders offered comments. The majority of the responses (72 percent) were equally divided between hospital CIOs and CMIOs; of the 280 respondents, 89 held the title of healthcare chief information officer (CIO) and 89 held the title of CMIO. With an equal sample of both groups weighing in on the same topics, we see congruence and some incongruence in how the role is perceived. (Additional respondents to the survey, which was conducted between October 2011 and January 2012, were: informatics directors, 17.8 percent; chief medical officers (CMOs), 6.5 percent; CEOs, COOs, and CFOs, 3.7 percent.)

CMIO: A RISING STAR
The study showed there is consensus across all groups that CMIOs are becoming more important in healthcare IT and critically important in the delivery of an EHR; 93.9 percent of all respondents agree with the statement: “The CMIO is critical to the successful deployment of an EHR.”

To support this, the survey shows most health systems have already engaged or plan to engage a physician leader for the implementation of an EHR. Nearly ninety percent (89.3 percent) of the respondents indicated they have engaged or will engage a CMIO or physician IT leader to assist in the deployment of an EHR.

Opinions begin to differ, however, on reporting structure. In terms of leadership, the CMIO works closely with the CMO and the CIO. Balancing these two areas, what role can a typical CMIO expect to play in the healthcare delivery process?

Today the primary objective for the CMIO in the deployment of the EHR is to facilitate buy-in and use of any new clinical IT systems with other physicians and clinicians. Translating the value an EHR can bring in the future must be communicated clearly to offset the difficult transitions physicians experience from workflow disruptions during the implementation process. This is key to gaining physician acceptance and successful demonstration of meaningful use of an EHR.

When respondents were asked, to whom should the CMIO report? we see clear division. Since the role is continuing to evolve, the jury is still out on this decision, as respondents were evenly divided on the issue. Of the 280 healthcare executives surveyed, 39.5 percent stated the CMIO should report to the CMO, 32.9 percent indicated to the CIO, and 27.6 percent said to the CEO.

Looking more closely at the data, specifically from the CIOs and the CMIOs, we see that CMIOs responded that they largely felt the role should report either to the CMO (46 percent) or the CEO (39 percent). CMIOs that responded that the role should report to the CIO accounted for only 13 percent of the sample. Though the survey did not list this as an option, 9 percent of CMIOs stated that a dual report to the CMO and CIO would be preferred.

One CMIO who responded that the role should report to the CEO added, “CPOE and EHRs are not IT projects. They're change projects (change of culture, change of the way information is captured, stored and transmitted, etc.). IT is only one of the tools that are used to affect the changes—the digitization of the information is one of the steps in the process, not the goal. People who don't get that are doomed to fail.”

In contrast to the CMIOs, over half (52 percent) of the CIOs responded that the CMIO should report to the CIO. Following that, 17 percent of the CIOs stated the CMIO should report to the CMO. Only 10 percent responded that the CMIO should report to the CEO.  Though it was not listed as an option, CIOs also created a new category in the study: 16 percent stated that a dual report to the CMO/CIO would be preferred.

AN EVOLVING ROLE
In today’s healthcare environment, which is focused on the deployment of an EHR, we see the role of the CMIO evolving, so what does the future career path look like?  Looking beyond the deployment of the EHR, we see a need to achieve useable information from clinical information systems to improve patient care and facilitate revenue enhancement. In that scenario we anticipate the role of the CMIO will have the capacity to grow in new directions and take on greater responsibilities. Those are still yet to be defined.

No matter where a hospital decides the CMIO position should reside, with the burgeoning number and sophistication of today’s clinical IT applications, this is an important evolutionary change which hospital CEOs must embrace and evolve purposefully, or let it happen organically. Either way, support for health IT initiatives seem here to stay and support for the CMIO role appears to be following suit.

Pamela Dixon 

Pamela Dixon is founder and managing partner of SSi-SEARCH, executive search for health technology leadership. Prior to launching SSi-SEARCH, she had 17 years of experience in the healthcare technology industry, with the promotion and delivery of EHRs. She has worked with mature healthcare technology companies such as Cerner and VHA, as well as emerging technology companies. She holds two bachelor degrees and has authored numerous articles on health IT leadership.

 
Roberta Rochman, R.N. 

Roberta Rochman, R.N., MBA, is an executive search consultant and director of the clinical informatics practice for SSi-SEARCH. Prior to joining SSi-SEARCH, her career spans more than 20 years in healthcare as a practicing nurse, transitioning into clinical informatics with organizations including as Eclipsys, followed by executive search. She is an influential public speaker, educator and author, and has been a liaison with academic institutions, consulting firms, and industry analysts.