EXECUTIVE SUMMARY:

As healthcare moves towards new, more accountable paradigms, CMIOs in patient care organizations nationwide are finding their positions becoming more and more focused on clinical transformation and process improvement. With such evolutionary changes are coming increased staff support, new reporting relationships, and even title changes.

What’s going on at Texas Health Resources (THR), the Arlington, Texas.-based integrated health system, is emblematic of what’s happening more broadly in healthcare, as CMIOs—alternatively designed as chief medical information or chief medical informatics officers—at patient care organizations nationwide are seeing their profiles raised ever higher. At THR, Ferdinand Velasco, M.D., who has been CMIO for 10 years, in June became chief health information officer (CHIO) of the 24-hospital, 4,100-bed health system, and reports to three different THR executives. Velasco will continue to report to the organization’s CIO, Ed Marx, but now also reports to the organization’s chief operations officer and chief clinical officer, two individuals whose office combines joint responsibility for the clinical and operations sides of the entire organization. Meanwhile, the individual who had been the associate CMIO has been promoted to CMIO and continues to report to Velasco, while the chief nursing information officer (CNIO) also continues to report to him.

Ferdinand Velasco, M.D.

At first blush, this might sound like a whole lot of organizational musical chairs, but Velasco notes that, at THR, "The focus has been on engaging physicians and getting them to adopt the electronic health record. The CHIO role will encompass the physician areas," he says, "but will also broaden out to all clinician stakeholders, across both the inpatient and ambulatory spheres and into the home. People tend to think of ambulatory as clinics and physician practices. Now, with health IT, you’ll have the capability to extend the reach into the home and anywhere people are connected." What’s more, he notes, a few other pioneering organizations have already taken the step to broaden out the CMIO role to a "CHIO" role; he cites the Danville, Pa.-based Geisinger Health System and the Oregon Health & Sciences University Hospital, in Portland, Ore.

If expanding the CMIO role out into the far reaches of integrated health systems is a natural transition, so, too, is the broadening of the CMIO role into transforming care delivery and becoming intensely involved in quality and performance improvement. That’s what’s happening at the St. Paul, Minn.-based HealthEast Care System, where CMIO Brian Patty, M.D. is leading a healthcare informatics team of more than 40 clinical informaticists that is leveraging clinical IT in the pursuit of the organization’s quality improvement goals.

Brian Patty, M.D.

"Our primary focus is to work closely with our quality department, and really find out what their priorities are," Patty says. "We focus the decision support tools that we deploy based on what we feel will best help us focus our quality work. So where are the pain points in some of our quality initiatives, and what can we do with our EHR and with some of our clinical decision support tools, to help out?" For his team’s exceptional work in all these areas, the HealthEast Care System healthcare informatics team won the Healthcare Informatics/AMDIS IT Innovation Advocate Award for 2012, sponsored by HCI and by the Association of Medical Directors of Information Systems.

Among other things, Patty’s team has facilitated several comprehensive implementations, including a full-replacement computerized physician order entry (CPOE) system, a broadly interoperable clinical documentation system; barcoded medication administration, pharmacy management, and a comprehensive physician portal; has developed an advanced clinical decision support (CDS) system to incorporate innovative web-based physician order sets; and has implemented a data warehouse in an online analytical processing (OLAP) environment, to facilitate financial, operational, and quality retrospective analytics.

A Strategic, Process-Oriented Role

Industry experts agree that CMIOs are rapidly moving into a new era in which they are leading clinical and organizaitonal transformation. The position, says Mark Van Kooy, M.D., director of clinical informatics at the Denver-based Aspen Advisors, "has gone from soneone who was just the link to the docs, someone trying to bring the docs along, to a role that really has to help meet the expectations created by the entire data-based infrastructure for managing value-based care," says the Sewell, N.J.-based Van Kooy, who recently served as a CMIO for five years before joining Aspen. "So that really compels the physician to be in the hot seat for transformation." Van Kooy, who is a master black belt in Six Sigma and has consulted on that methodology, adds that he believes that CMIOs will increasingly need to be highly fluent in improvement methodologies and process leadership in order to be effective in their increasingly transformation-focused roles.

Mark Van Kooy, M.D.

Kip Webb, M.D., M.P.H., executive director of Accenture Clinical Services, the global clinically oriented practice of the New York-based Accenture, says the growing focus on transformation is also of necessity altering CMIOs’ positions in their organizations, in line with what THR’s Velasco and HealthEast’s Patty have been experiencing. "It’s evolving, and I think, in some very hopeful ways," says the San Francisco-based Webb. "Historically, the CMIO has been a chief with no Indians; so they’re typically a younger doctor, although not necessarily. And they’re typically pretty tech-oriented, but historically have not had either the clout in terms of staff, or the organizational clout, to get things done, so they’ve historically focused on the technology."

Now, as the CMIO position is becoming more and more strategic, "They are starting to build up groups of informaticists who can help them to execute," Webb emphasizes. Most importantly, he says, "Their institutions have started to value what they can deliver; they’ve said, this is core to what we need to do." Fortunately, at the same time as their CMIOs’ roles have been maturing, CMIOs have been reaching out to each other through such channels as the AMDIS listserv.

Given these developments, all of those interviewed for this article agree that the C-suite executives, including CIOs in patient care organizations, will need to think as broadly and strategically about the CMIO role as possible, particularly as their organizations move forward into the new healthcare world. "My advice," concludes THR’s Velasco, "would be to conceive of the CMIO and the CHIO roles in the context of the accountable care transition, rather than simply as an implementational leader; because while the implementation aspects are important, they need to be embedded in the work towards population health, analytics, and quality and care management."