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CMIO Viewpoint: Path to Professional Growth

September 27, 2011
by Mark Hagland
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One physician leader discusses his multiple transitions into the CMIO role

A cardiologist by training and medical practice, Michael Bakerman, M.D. has enjoyed a varied career. After 18 years in clinical practice, Dr. Bakerman received his master’s in medical management degree in 1998, and beginning in 1999, he spent several years working for different consulting firms, working in areas of medical management and leadership consulting, and then shifting more fully into clinical informatics consulting work.

From 2008 until the beginning of 2011, Bakerman was associate medical director for the Needham, Mass.-based Community Healthcare Partners, Inc., where he led the management of that organization’s 18 regional services organizations (RSOs), encompassing 1,000 primary care physicians and 5,000 specialists. In January of this year, Bakerman became CMIO of the five-hospital UMass Memorial Healthcare, based in Worcester, Mass.

This summer in Denver, Dr. Bakerman spoke on a panel discussing “The Role of the CIO and CMIO in EMR Adoption,” at the 2011 Health Care Forum, which was sponsored by The Breakaway Group, a Denver-based healthcare IT consulting firm. He spoke recently with HCI Editor-in-Chief Mark Hagland regarding his experiences around the transitions from medical practice to consulting to the CMIO role. Below are excerpts from that interview.

You’ve gone through a lot of transitions already in your career. Do you still have all your limbs?

I do. I’m a tough old gnarly veteran at this point.

Have there been any surprises coming into the CMIO role, after spending years as a clinical IT consultant, on the outside of patient care organizations?

I’m fortunate in some ways in that it’s exactly what I thought it would be. There are so many fragmented elements in healthcare that it’s very difficult to align incentives or goals. For each set of physicians, depending on what department they’re in, whether primary care or specialist, and for non-physicians, whether they’re nurses or administrators, etc., each group has different goals. And we all say we want to be patient-centric, but everyone’s measured based on their individual departments’ metrics. So it’s very difficult to galvanize [multidisciplinary teams].

Michael Bakerman, M.D.

Is it correct to say that they were already live with an EMR at UMass Memorial when you arrived?

It’s complicated. We have three academic campuses and four community hospitals. The majority of the member hospitals are on a very old Meditech system that will clearly not suffice for meaningful use or for the 5010 [transition]. They use Allscripts Enterprise on the outpatient side [from the Chicago-based Allscripts]. On November 1, we’re doing a big bang in terms of implementing Soarian Clinicals [from the Malvern, Pa.-based Siemens Healthcare]; one hospital, Health Alliance, in Leominster, Mass., is already live on Soarian, and is out in front. And we’re planning, as our HIE [health information exchange] intervention, to use [the Pittsburgh-based] dbMotion in that middle space, to combine that data. dbMotion is up and running, but we have to go live on Soarian.

Have there been any surprises in the challenges of preparation for go-live?

They had never had anyone in my role here, and IS recognized that they needed clinical leadership. Prior to my arrival, they had had no central advocate or someone who could lead meetings; they had relied on part-time volunteer involvement. So prior to my coming, the discussions had been more around implementation than adoption, about hitting dates and such. One of the problems was that IS was vulnerable, because the IS people could do the technical build, but didn’t have the clinical expertise.

So it’s a combination of diplomacy and linguistic interpreting, right?

Exactly. And every day, I practice in the mirror, and say, ‘OK, we’re going to do this today.’ But to the credit of the healthcare system, they get it, they understand this is going to be hard; but they’ve all been putting up with a lot the last year—physicians, nurses, administrators, all of them. To put in a new clinical and financial system shakes a healthcare organization to its roots. And before I came here, the message was that any functionality in Meditech would translate directly into Soarian. And I got here and said, wait a minute, just because we could do something in an outdated system doesn’t mean we should replicate it precisely in the new system.

And by background, I’m a cardiologist; and I took care of everyone in the ED, the ICU, etc. I still do a hospital shift six times a year. Admitting, doing floor rounds, write orders, etc. It’s a 12-hour shift, six times a year. So I get to admit a whole different group of patients, and see general medicine admissions.

Have any cranky doctors challenged your credibility at all?

They don’t pick on my credibility, because I bring enough value to the conversation. But through the [Tampa, Fla.-based] American College of Physician Executives, I got my master’s in medical management (MMM), which focuses on all those leadership and governance skill sets; I got a CPE (certified physician executive) certification through them, and I currently sit on the board at ACPE. And through my experience with that group, you gain significant experience about how to lead meetings, set agendas, talk to providers—in general, I almost never get questioned regarding my credentials or credibility.

And one of the things I’ve been working on at ACPE is helping them to develop a health information technology certification. What they’ve been good at is developing CMOs and VPMAs. And systems are looking almost for the CMO to transition into a CMIO position, and they’re really totally different skill sets, around implementation, etc. So we’ve created an HIT-focused program so they can work cooperatively with IS, etc. That program was launched early this summer.

How do you see your role evolving over the next five years?

Right now, my role is all about adoption of technology; and the day you go live, it’s about, well, I need this report, or how do I put the data in, or what’s the standardized way to manage order sets? So it’s all about management, governance, and support. And we’re not going live with the CPOE [computerized physician order entry] until May—and then once that goes in, you step through those order sets—you walk your medical staff through how you adopt those order sets. So I see my role as managing that adoption, helping the staff; and beyond that, we’ll need to integrate care under some sort of accountable care framework.

And leveraging IS and data for quality, right?

Yes, there’s a whole data stewardship aspect of the role, too. And I have different teams looking at panels of doctors differently, and looking at different resources. So I have a family medicine initiative around managing population health or registries; I have a primary care integration workgroup looking at how we integrate care; and then I have IS, which is leading the meaningful use initiative. Different people are working those.

And who are you reporting to?

I report to my CIO. We had talked a lot about that when I got hired; because as the CMIO role evolves, you could perceive some inherent conflicts between the CMIO and CIO. And George Brenckle is my boss, and he’s been wonderful. He’s got all the right personal characteristics in terms of being a consensus-builder. But in some situations, you have a CIO who’s just thinking about their implementation, costs, etc., and the CMIO can really struggle in that case.

Do you have any dotted-line to the CMO of your organization?

In my case, my dotted-line relationship is to our COO, who is a physician. But suffice it to say, I work very closely with the CMO at the university level and at the CMOs at the facility levels.

So you’re glad you took the job?

Oh, yes. One of the things that ACPE taught me years ago was that, unless you write it down, it doesn’t happen. And so I wrote down my own vision and mission goals for myself in the late 1990s, and realized that the CMIO role was what I wanted. And I live in Massachusetts, so this is a great opportunity. And UMass is really the only healthcare system out here, and it’s got really great people out here, so I’m very happy.

And from my standpoint, what we really need to be doing more and more is educating the physicians on how we provide better care to the patients; not giving the doctors everything they want, but showing them that if they persevere, their care delivery and efficiency will get better, and ultimately, we’ll be doing a better job for patients. And that resonates with them.

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