Alistair Erskine, M.D., has held various roles within healthcare leadership throughout his career. As he has been practicing hospital medicine for nearly 15 years, Erskine has also been climbing up the clinical leadership ranks, becoming chief medical information officer (CMIO) at Virginia Commonwealth University (VCU) Health System, before being appointed associate dean of medical informatics there. Now at the Danville, Pa.-based Geisinger Health System, Erskine, who is also board certified in clinical informatics, holds the role of chief informatics officer—different from the CMIO and different from the CIO (chief information officer).
“Ironically, we are not for a lack of CIOs at Geisinger; we have four of them,” Erskine jokes, referring to the titles of the four “CIOs” at the integrated Geisinger Health System with 1,600 employed physicians, 12 hospital campuses, and serving some 3 million patients: chief informatics officer; chief innovation officer; chief information officer; and chief integration officer. Indeed, as traditional roles inside the C-suite are now evolving and in some cases, transforming, Erskine admits that as the healthcare landscape becomes more consumer-centric and technology-focused, it’s no longer business as usual when it comes to organizational leadership.
“When I was CMIO at VCU in 2005, that was still a pretty new position,” Erskine recalls of his time at Virginia Commonwealth University in Richmond, Va. “The kinds of things in the job description for that role were being politically savvy, being a clinical and IT double agent, understanding clinical workflow, having empathy for doctors, understanding technical capabilities, and seeing how to connect the dots between the two,” he explains. There was also the design configuration of EHRs (electronic health records) and compliance with Meaningful Use, he adds. “That was the typical set of activities for the CMIO. So you ended up being the doctor in the IT department, helping them realize what they needed to turn on and off. Whether or not a CMIO is a good idea inside an organization is not a debate anymore. You need a doctor who knows something about IT to work with your CIO,” Erskine says.
Alistair Erskine, M.D.
New Roles, New Skillsets
But now, the focus inside healthcare organizational leadership is again shifting, this time to areas around optimization, transformation and innovation. And with that shift is the evolution of the chief informatics officer position, or sometimes called the chief health informatics officer (CHIO), says Hillary Ross, a principal with the Oak Brook, Ill.-based executive search firm Witt/Kieffer. Ross, who specializes in the recruitment of senior-level physicians and other clinicians, and who conducts searches for CMIOs and CHIOs, reiterates Erskine’s thoughts that first generation CMIOs were liaisons and translators between the clinical and technical staff. They were seen as the bridge between the IT department and the clinical community. They facilitated implementation of EHRs, and trained the clinicians on those systems, she says.
The CHIO, Ross says, needs to be a new position with different skills from those of the CMIO. Ross wouldn’t call the position the “CMIO 2.0,” instead referring to the role as the “data-driven CMIO.” In other words, while CMIOs can become CHIOs, there are additional skills that will be needed, she says. “Now that these systems that organizations have spent millions of dollars on are generating lots of valuable data, the conversation turns to, ‘What are we going to do with this data?’ It’s about taking the data and turning it into actionable knowledge. That’s a big difference between the CMIO and the data-driven CHIO,” Ross says.
Erskine wouldn’t call the new informatics role in the C-suite a CMIO 2.0 either, saying if anything, it’s more like a CIO 2.0. “If you apply three different lenses onto an organization—the technical lens, the political lens, and the cultural lens—the CMIO was primarily focused on the technical lens with win-win advantages by configuring the system one way and having doctors be happy about it. But as the role evolves, the political and cultural lenses become much more important,” Erskine says. “You have to learn how to manage scarce resources that you are responsible for, allocate them appropriately, and compete for other resources. This requires more savviness.”
Erskine, who has been in the chief informatics officer role at Geisinger for about three years, says that it has evolved into a position with various functions. “You have the data analytics for the organization, so the kinds of things a chief data officer would typically oversee, and then you have the clinical information systems, so the things a CMIO would oversee, and then you have the CNIO [chief nursing informatics officer] who tends to have more of a role with the backend of a system, and all of those roles—as well as the chief research information officer—essentially roll up to the new chief informatics officer. This role is much more around strategic planning for the organization, using IT as a strategic asset,” he says. Witt/Kieffer’s Ross adds that the new position “will require leadership, innovation and transformation by someone who can set and drive strategy.”
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