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Leadership, Influence and the Ever-Evolving Role of CMIOs

June 22, 2017
by Rochelle Abbott, Hearst Health
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A report from the Scottsdale Institute’s CMIO Spring Summit

Executive Summary: During the Scottsdale Institute Spring Conference, 11 chief medical information officers (CMIOs) and former CMIOs convened for an exclusive discussion of the CMIO’s identity and mission within a health system. The discussion explored leadership strategies for influencing and effecting transformative changes in the way care is delivered. The group also assessed how the role has evolved, its career trajectory, and anticipated challenges for the future.

CMIO Summit Participants: S. Nicholas Desai, M.D., Houston Methodist; Anupam Goel, M.D., Advocate Health Care; Greg Hindahl, M.D., BayCare Health System; William Holland, M.D., Banner Health; Tim Jahn, M.D., Baptist Health (Kentucky/Indiana); Gil Kuperman, M.D., Ph.D., NewYork-Presbyterian; Jason Lyman, M.D., University of Virginia Health System; M. Michael Shabot, M.D., Memorial Herrmann Health System; Keith Starke, M.D., Mercy (Missouri); Ferdinand Velasco, M.D., Texas Health Resources; Alan Weiss, M.D., Memorial Hermann Health System

Organizer: Scottsdale Institute; Sponsor: Hearst Health; Moderator: Jeffrey Rose, M.D.

As the market surge to purchase and implement electronic health record systems (EHRs) moves to a denouement, the role of the CMIO is expanding beyond informatics. On April 19, 2017 at the Scottsdale Institute Spring Conference in Scottsdale, Arizona, a group of 11 CMIOs and former CMIOs met to discuss the expectations and challenges for this role. The discussion was a follow-on to the September 2016 Scottsdale Institute CMIO Summit, in which the group cited change management and leadership as central capabilities for the successful CMIO.

“CMIOs are unique in the C-suite because they must interact with IT, administration, finance, clinicians, and patients,” said the April meeting’s facilitator Dr. Jeffrey Rose. “In a post–meaningful use world, the most challenging part of a CMIO’s job may be embodying effective leadership and change management because they are tasked with changing hearts and minds.”

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The CMIO at the Heart and Center

The CMIO holds a unique position in the hospital or health system at the convergence of medicine, technology, quality, and executive management. This perspective, and its requisite professional capacities, positions the CMIO as a key leader in the transformation of care. “We know how important it is to have a CMIO because we don’t have one right now. As a result, we collectively spend a lot of time in translational communication, reframing questions, a role that the CMIO would ordinarily fill,” said Dr. Keith Starke of Mercy in St. Louis. “Clinicians are connectors; they are the only ones who understand all the different languages across these disciplines.”

CMIOs are called upon to lead transformative initiatives that reach far beyond the scope of venue-specific medical informatics, because they have skills and influence to bring about pervasive changes in the organization. “How do we change practice? How do we have a system that helps us do care redesign and implement change management along the way?” said Dr. Michael Shabot of Memorial Hermann Health System. “Also, there is going to be less money in the healthcare system. How do we tailor our systems to that reality? All of this puts the CMIO at the heart and center of changing practice.”

To lead their organizations through these profound changes, CMIOs employ two key strategies: incorporating change management as an organizational discipline and cultivating their influence throughout disparate functional teams.

Change Management and Being a Change Agent

A decade ago, CMIOs had focused on information system design, with attempts to inject decision support into automated medical record processes. “In the early days, it is amazing how much we changed practice doing simple things, like making a choice available and putting it at the top of the list. We changed prescribing behavior by taking lists of the top ten drugs that our docs order, and showing it to them in order of importance from quality and cost perspectives,” said Dr. Alan Weiss. “We were a small group called upon to be change agents, although often we were viewed solely as technology people.”

In the more mature CMIO role, the purview and mission has expanded to be one of effecting change more broadly and pervasively, now extending to comprehensive redesign of care processes. While inducing the behavior change to move from paper to computer use in medical practice was difficult and required a good deal of skill in teaching clinicians new methods of documenting care and ordering activities, the discipline around change management has become even more vitally important as the role has matured. “We are increasingly change agents for entire process redesign, though we often get misdirected or pigeonholed into working only on technology usability,” said Dr. Nicholas Desai of Houston Methodist. “Process redesign doesn’t really belong to anyone. The CMIO does indeed do usability work, but as systems have evolved and changed, process redesign has increasingly accompanied usability efforts. So, when we changed EHR systems, I ensured effective, tactical communication and change management were joined together and embedded in everything we did.”

Despite being frequently cited as critical to success, change management knowledge and techniques are often under-leveraged. “The success of an EHR implementation is more about change management than technology, yet it is so often the piece that’s missing,” said Dr. Shabot. “Usually it’s the people and process that makes a difference.” Operational methodologies from the manufacturing sector, such as Lean and Six Sigma, have gained favor in health systems as means of increasing efficiencies and effectiveness in use of new technology. When Baptist Health’s Dr. Tim Jahn was a CMIO overseeing an implementation, he saw broken processes everywhere, so he underwent training in Lean. “The minute you’ve gone live, it’s about process. Change management and process excellence works in other industries, so why not healthcare?”

Management vs. Influence

An ongoing philosophical discussion is whether the CMIO’s influence would be more effective with a reporting structure that is inclusive of the multiple disciplines who contribute to system-wide changes, such as project management and various clinical functions. “The CMIO has an opportunity to understand existing processes, how team members might do the work in the future, and how to measure success. But are we really the change agents? There is still a need for senior leaders to say ‘go,’” said Dr. Anupam Goel from Advocate Health Care. The CMIO has become a key part of the leadership team effecting systemic change in the complex processes of care delivery, which can become even more challenging if leadership relationships are confused or misaligned, particularly in large systems. “If your reporting structure is in the right place, you can have synergies and avoid fragmentation,” said Dr. Desai.

Grassroots Partnerships

Banner Health has cultivated an ecosystem of clinical consensus groups, which has been an effective means to develop change agents on the front lines of clinical practice. In this way, the CMIO can help colleagues make change acceptable and positive. As Dr. William Holland describes, “The people driving changes to alerts and logic in the EHR system cannot be simply ‘computer people.’ We have a process where we collaboratively define the problem we are trying to solve, and can turn out 40 to 50 impactful changes per year under this approach.” These partnerships with practicing physicians are an important mechanism of influence for generating desired changes in care delivery.

The CMIO can influence physicians by building partnerships at local levels. “We need to ask ourselves, ‘How do we support docs better?’ They want a relationship, not a number they can call,” Dr. Holland added. “I have a team that designs clinical decision support, where many of the ideas come from practicing physicians.”

The CMIO can also gain influence playing the long game of building trust over time. “Up to the last four to five years I have been blamed for everything,” said Dr. Greg Hindahl from BayCare Health System. “But now I am an infiltrator. I know how to practice medicine, I know how the technology works, so now anyone with a problem comes to me to help them fix it. You just learn through experience.”

EHR Optimization

For ongoing support and success of initiatives, the CMIO reinforces the partnership with clinicians by advocating optimization of the entire system, paying close attention in the post–meaningful use era to making EHR-related changes that will protect practitioners from technology-related burnout. “We have a savvy group of docs I meet with regularly, and it is amazing how differently each of them handles workflow,” said Dr. Jason Lyman of University of Virginia Health System. “We are trying to look at that data to see how providers are using their EHRs.” Drs. Goel and Holland stressed the importance of advocating for more resources to fix IT issues, though it is more challenging to explain internally how hard it is to retrain a physician when one leaves. “Making a case for implementing a system to drive performance is a more straightforward discussion,” said Dr. Holland. “Historically, discussions around physician retention and engagement have been more difficult to quantify, although that is starting to change across the industry.”

Additional Roles and Career Growth

With the CMIO’s level of influence and his or her breadth of perspective being at the convergence of medicine, technology, quality, and executive management, many CMIOs have found their roles have evolved and grown over the years. Putting systems in initially is hard, but as Dr. Alan Weiss of Memorial Hermann Health System noted, “Implementations never really end, but there are additional things we are asked to do that add breadth to implementations, and are very interesting—such as assessing data validity and creating automated methods to underpin population health.” Dr. Holland added, “Even in the short seven to eight years I have done informatics, my job has changed three to four times. For example, now I have responsibility for meaningful use and MACRA, and most of my meetings this week have been related to registration and scheduling processes. My role is definitely more strategy today and less clinical decision support; my goal is to inspire others to be the change agents.”

Much of the added responsibility reflects the growing and evolving needs in healthcare as a whole, such as market consolidation. “Consolidation in healthcare creates challenges for IT and also organizational complexity that can be addressed by IT. At many organizations, people naturally come to the CMIO to help manage these issues,” said NewYork-Presbyterian’s Dr. Gil Kuperman. But IT expertise is no longer enough, and it seems that when CMIOs have proven value in their difficult arena with clinical IT they often become go-to resources for other problems and challenges. “It always seems like there is a role in the organization that’s missing—and it becomes the CMIO’s job to do it,” agreed Dr. Weiss. Emerging needs in organizations reveal gaps in the realms of analytics and quality improvement, which have proven to be opportunities for advancement for many CMIOs. “There are opportunities and vacuums, and this has guided the trajectory of successful CMIOs,” said Dr. Ferdinand Velasco of Texas Health Resources. Many CMIO roles mature and grow from directors of clinical IT into more expansive roles: Chief Health Information Officer, Chief Innovation Officer, and Chief Clinical Officer.

Formal Training

How many of the 11 participants have had formal training in the following areas?

> Leadership – 10

> Analytics – 1

> Finance – 1

> Change Management – 3

Challenges for the Future

The phenomenon of change in responsibilities is expected to persist. The continued evolution of the CMIO role will include the challenges of:

  • Expansion of influence to payers. “Another audience that will need to be understood and influenced is payers, a realm where many CMIOs do not have experience.” – Dr. Velasco
  • Realizing the pragmatic view of system redesign. “CMIOs traditionally have worked on transactional aspects of care—the individual order, the individual document, etc.—but we need to work on systems of care: not just ‘(a) happens,’ but ‘(a) happens so that (b) happens so that (c) happens.’ Clinical decision support can help the transactional aspects of care, but optimizing care across care delivery settings is much more complicated.” – Dr. Kuperman

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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.


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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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