CMIOs—chief medical information officers or chief medical informatics officers, depending on how their organizations articulate their titles—are being looked to more than ever for leadership in IT and informatics, as they help lead their colleagues and their organizations forward on initiatives that include EHR (electronic health record) optimization, clinical transformation, broad-scale analytics for clinical performance improvement, population health management, care management, avoidable readmissions reduction, and a host of other initiatives.
And yet, CMIOs themselves say, they and their roles are often misunderstood, across the spectrum, on the part of their fellow physicians, as well as on the part of their fellow clinicians, on the part of non-clinical IT executives and professionals, and on the part of non-clinical administrators in hospitals, medical groups, and health systems.
That much was clear on Tuesday morning during HIMSS17, the annual conference taking place this week at the Orange County Convention Center in Orlando, Florida. In a pair of educational sessions that followed each other in succession—first, “Medical Informatics and the C-Suite: Aligning Forces to Positively Affect Patient Care,” and then, the “CMIO Roundtable: Creating an Impactful Informatics Department,” CMIOs parsed some of the challenges and opportunities facing them individually, and as a group.
In the first session, three medical informatics leaders shared their perspectives on what needs to happen to help CMIOs help patient care organizations reach their strategic goals. Howard Landa, CMIO at the Alameda Health System in Oakland, Calif., was joined by Richard Gibson, M.D., Ph., who currently serves as executive director of the Health Record Banking Alliance, and in the past has served as CMIO at Providence Health System, Oregon Region, among other leadership roles; and Luke Webster, M.D., who is CMO at Jvion, and formerly served as CMIO at the Dallas-based CHRISTUS Health. The three medical informatics leaders discussed a broad range of topics around how to optimize the effectiveness of CMIOs. Discussing the centrality of the CMIO role to efforts at clinical transformation and the optimization of care delivery processes, as leveraged through the application of health IT, Landa noted that “Physicians have a unique view of healthcare delivery, based on the physician-patient interaction. And it’s a view we should never lose. At the end of the day,” he said, “it’s the patient experience that matters. And whoever went from the Triple Aim to the Quadruple Aim, that was great--and we physicians and nurses are all in this, too. I think a lot of the burnout of physicians and nurses ended up being blamed on the EHR [electronic health record], when the EHR stepped in early on these processes” of clinical transformation and optimization of care delivery, he said. And having that physician perspective on technology and strategy—we often report to the CMO, and we keep them informed—we need to keep the focus on patient care-based perspectives that CMIOs can bring to the table” in all these sorts of discussions, he emphasized.
In response, Webster said, “One of my former colleagues said that part of our job is to light a candle in the darkness, as opposed to just screaming in it. And how can you begin to do the clinical transformation needed, without physician informaticists?”
“All of this was clear to me,” Gibson said, “when a big employer came to us and said, ‘We’re tired of the high costs, what can you do about it?’ And our organization chose to bring 12 private orthopedists to go take on joint bundles. In that case, the fact that the CMIO had colleagues among these orthopedists, and understood the challenges, and how implants are sold to the orthopedists, was very important. And the fact that the CMIO understood why there was such a wide range of implant cost, with some orthopedists using implants that cost $3,000, and others using implants that cost $6,000, and the ability to understand how perioperative operations work—all of those are areas in which CMIOs’ knowledge and awareness are important. There’s also a level of judgment and finesse required in how to present data to your colleagues across the organization and in the c-suite; those are all important.
“I’m going to tell a story,” Webster said. “In my previous role at CHRISTUS, I helped lead an organization-wide digitization of clinical documentation, including replacing our radiology reporting system, as well as implant reporting. It took a while to convince our c-suite that we should invest in a voice-recognition solution. I came to the conclusion that we needed that solution for documenting well. This really relates to being able to demonstrate a return on investment. And being in the middle of a strategy between our CIO and our vendor, and negotiating issues to make it happen, was very important. It went extremely well, mostly because we worked for a couple of years on the strategy. Without the appropriate representation in the c-suite, it wouldn’t have happened as well. That’s just one example of how having informaticists in the c-suite worked well.”
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