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.”
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.”
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