Dirk Stanley, M.D., M.P.H., has been chief medical informatics officer at Cooley Dickinson Hospital in Northampton, Mass., for over two years. In some ways, Stanley, whose clinical background is as a hospitalist and a nocturnist, is typical of an emerging generation of younger hospital CMIOs, physicians who combine strong backgrounds in both informatics and medicine. Stanley says he’s delighted to work as a CMIO, and to fill a critical role at the 142-bed community hospital. Cooley Dickinson, with 400 affiliated physicians and a staff of 1,800, has been recognized by the Institute for Healthcare Improvement and the Betsy Lehman Center for Patient Safety and Medical Error Reduction, both based in Boston, as a top-performing hospital. Stanley recently spoke with Senior Contributing Editor Mark Hagland regarding his perspectives on medicine, informatics, and the role of the CMIO. Below are excerpts from that interview.
MH: Tell me about your path to this CMIO position.
DS: This is my first CMIO position; before this, I had spent 100 percent of my professional time in clinical practice. I actually got into this in a bit of a weird way. I started out as a computer programmer; in fact, I was adept enough at programming that I had landed my first software job at 16, doing Unix administration while still in high school. I got a degree in business management, worked for IBM for a while, then ran my own consulting company. Then I got a little disillusioned with the computer industry in general; and a friend of mine whose mother was a nurse, said, why don’t you try volunteering? So I started doing some volunteer work at a local hospital; and at age 22, I started doing epidemiology work for that hospital. And over time, I became curious about the numbers that I was working with. So I went to medical school and did my residency.
And one thing that influenced me was that, as a resident, I would ask patients, what medications are you on? And somewhere between 30 and 50 percent of people actually have no idea what medications they’re on. And it became painfully clear to me over time as to why doctors have so little information at their disposal.
I finished residency at age 36, practiced as a hospitalist for a year, and then came across Cooley-Dickinson, which was about to implement an EMR. That’s how I came here. I practice 50 percent of the time, and spend 50 percent of my time on informatics. In practice, it’s really more like 50 percent clinical practice and 70 to 80 percent IT work on top of that; it’s more than just one full-time job put together.
MH: Some say that a physician needs to practice clinically for several years before jumping into a CMIO position, but your experience would seem to contradict that assumption.
DS: Well, actually, when I first came here, I practiced entirely clinically, as they really needed a hospitalist. And we’re still trying to hammer out some of the details of who I report to and my compensation. Technically, I report to three people—our CIO, our CMO, and our director of hospitalists. Now, some might argue that you have to have worked clinically for years, but medical residency itself can provide part of an excellent training experience for a potential CMIO, since you’re interacting with so many specialists from so many different clinical specialties. Also, in this particular case, the hospital’s need for a CMIO was such that they were not in a position to continue to search indefinitely for a CMIO.
As for my particular specialty, I think being hospitalist has been excellent for me as a CMIO. As a hospitalist, I continue to work with a very wide range of specialists from across the spectrum of specialties.
MH: What do you see as the critical success factors for CMIOs?
DS: Patience, diligence, and flexibility, as well as being good at politics, are the key personal characteristics a CMIO needs. What’s important, really, is to be politically neutral; let me explain. If the physicians think you’re “too IT,’ you’ll fail; equally, if the IT people think you’re “too doc,” you’ll fail. That’s why continuing in 50 percent clinical practice has worked for me, because you don’t want to lose your street credibility with either group. When it comes to actually implementing all this technology, it always ends up being a political discussion, and the political discussion always derives from the financial issues involved. And there’s a very delicate system of checks and balances between any hospital and its physicians. So you have to use a delicate balance of politics and charm; and it’s a hard line to walk, because if they see you too much on one side, you become ineffective.
MH: Is it very different executing the role of a CMIO in a community hospital from doing so in an academic medical center?
DS: Yes; the operational environments are very different. At an average community hospital, the specialists can easily take their patients to another hospital if they don’t like what’s going on. On the other hand, at the large academic medical centers, the workflows can be extremely difficult to figure out; and just putting together a meeting at which all the people impacted by one particular workflow can become almost impossible.
MH: Of course, most community hospitals struggle with resource issues around clinical IT implementation.
DS: True, though that’s a struggle everywhere. I don’t think hospitals really want to be in the IT business; but when you don’t invest, bad things happen. And some hospital administrators learn the hard way that not investing in IT ends up impacting the bottom line eventually.