Only a few years ago in many U.S. patient care organizations (and still today in some), CMIOs were picked out of the crowd of their fellow practicing physicians in hospitals and given part-time CMIO duties and a CMIO title, based on being “tech-head docs” who could help their colleagues in IT and administration select electronic health record (EHR) products and help lead the implementation of a first EHR for their organization.
And while such an ad hoc approach to clinical informaticist hiring and promotion might have been acceptable in a community hospital 15 years ago, the reality is that the emerging healthcare system is increasingly demanding the emergence of a new generation of clinical informaticists willing to take on a dizzying range of new roles and responsibilities, particularly as new titles like chief health information officer, chief clinical information officer, and chief clinical transformation officer, emerge.
Given all the trends moving forward around the need for clinical transformation, whether for accountable care organization (ACO) development, participation in value-based care delivery and payment, readmissions reduction, and the like, it is not surprising that the editors of Healthcare Informatics selected the topic of “Clinical Informaticists 2.0” as one of the magazine’s Top Ten Tech Trends for 2015.
Among those interviewed for that article was George Reynolds, M.D., CIO and CMIO of Children’s Hospital Medical Center in Omaha. Dr. Reynolds (who was preparing to retire in January of this year) would know as well as anyone in the industry what it will take in order to help find and nurture the “2.0” clinical informaticist leaders needed for the future of healthcare. Below are excerpts from Editor-in-Chief Mark Hagland’s interview with him last fall. Below are excerpts from that interview.
Where are the gaps right now in terms of the kinds of clinical informaticist leaders needed as the industry moves forward into the new healthcare?
The informaticists 1.0 model was about the collection of data, getting people to adopt the EHR and use it and fine-tune it. 2.0 is about how you present data. We’re talking about interoperability, so that people can get information from all sorts of different places; and we’re talking about the need to better present data. There’s a whole piece here around data visualization and the psychology of data presentation that we’ve just begun to scratch the surface on, in order to support population health and quality improvement.
The problem is that clinicians have so little time. How will we provide data and information to the emergency room doc very quickly and conveniently? We’ll have to do better than simply creating physician and patient portals—there’s a whole piece of data visualization and the psychology of data presentation that we’ve just begun to scratch the surface on. Now that we’ve got this data, how are we going to present it in ways that support population health and quality improvement? Just the fact that it’s in the EMR isn’t enough. If it’s in a document that’s 100 pages and you haven’t got the time, how is that going to work?
Clinical informaticists leaders are going to have to help everybody figure out how to optimize data for clinical workflow, correct?
Yes. “Optimize” is an over-used word, and it’s bigger than just reducing the number of clicks. We’ve worked so hard to get data into the electronic medical record, and to reduce clicks; but finding information and having the software be intelligence enough to find the information—the analogy I use is the Amazon analogy. Amazon knows way, way too much about me, knows the things I like and ways to present information to me that I might be interested in. So the next challenge for clinical informaticists is to help present data in ways that will help clinicians.
I’ve got a whole team of people working on dashboards and analytics, and they’re wonderful people—but one of my data analysts loves tables—she’s a trained database analyst, not a trained graphic designer. We need to pull in the people knowledgeable about graphics design and human factors. We’ve got a great analytics program here—I’ve struggled with this for a long time—but a lot of people don’t know how to use it. They’re the subject matter experts—they know how to run a pediatric ICU or a med-surg floor or a business office. For a long time, I thought it was an education deficit and we just needed to train people better. But I’ve come to the conclusion that we need to present it better—so we can get people to get involved in analytics and use data better.
What about the leadership development gaps? As we all know, most physicians now in practice were trained to be clinical “lone wolves,” yet these newer, higher clinical informaticist positions are going to require executives with very refined leadership skills and experience.
Have you ever noticed that there are an awful lot of intensivists in informatics, and hospitalists? I think one of the reasons for that is that both of those specialties really are team-based specialties—you care for patients as part of a team—and you know how to lead a team. I think there are plenty of people out there with leadership skills. Being a primary care provider is in some ways a lonely job; you see plenty of people but can go days without seeing another physician.
Different types of competencies needed for these positions, then, that many physicians trained for practice do not have?
Like anything else, it’s a function of personality and intellect. These tend to be pretty bright people, some have the right temperament.
As people trained for clinical practice go into these leadership positions, what should they know or do?
They should know how to develop a team, build consensus, and establish relationships of trust. More than anything else, it’s about building team trust.
What can CIOs do to help move things forward?
That’s particularly relevant for me. Any success in the CMIO role starts with interest, passion, and enthusiasm. Then, how do you deal with the negative or disruptive physician? How do you maintain trust when things don’t go well or there’s a problem? How do you communicate effectively professionally? Those are all skills people can learn.