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Ramping Up to Leadership: CMIOs’ Profile Keeps Growing

March 21, 2012
by Mark Hagland
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CMIOs take on new responsibilities as patient care organizations move through the quality journey

As physician informaticists rise into CMIO titles, the CMIO role itself is gradually being transformed, particularly in more advanced patient care organizations, from its early “tech-head doc” function to a management role focused on implementation, to increasingly, a transformational leadership role. CMIOs and industry experts agree that the skills needed to help lead change on a broad scale are pushing medical informaticists to new levels of professional development.

The evolution of the CMIO role has been a fascinating one. CMIOs have emerged out of the ranks of physicians as “lone-wolf” information technology advocates; over time many have evolved into part-time implementation facilitators, full-time managers, and senior lieutenants over squadrons of clinician informaticists. Now, those in the most advanced patient care organizations nationwide have taken on the role of senior leaders helping to move their organizations forward on the quality journey.

It would be understandable if some CMIOs, variously known either as “chief medical information officers” or “chief medical informatics officers”—both formulations are common—didn’t have whiplash from all the rapid-fire changes and shifts in their working environment. Just 10 years ago, only a tiny minority of hospitals, medical groups, and health systems even had CMIOs—and those who were named CMIOs were most often only doing medical informatics part-time, while still pursuing patient care. What’s more, only the very largest organizations, mostly academic medical centers, had someone designated with the title.

Fast-forward to the present: at a time when the need for patient care organizations to meet the meaningful use requirements under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, plus the data reporting requirements for several mandatory and a few voluntary programs under the Affordable Care Act (ACA), is pushing hospitals, medical groups, and health systems into overdrive, CMIOs are being compelled forward into ever-higher levels of responsibility.

Michael Shrift, M.D.

Indeed, it is hard to imagine organizations like the 11-hospital, 100-plus-clinic Allina Health in the Minneapolis-St. Paul metro area being able to push ahead with comprehensive quality improvement initiatives (see also “Ready To Catch the Next Wave? The New Accountability Agenda in Healthcare,” December 2011) without leaders like Michael Shrift, M.D., the organization’s CMIO and vice president for clinical knowledge management. Not only is Shrift heading up a team of 45 clinical informaticists; the work that he and his colleagues have plunged into in the last few years is complex, difficult work of reengineering core care delivery processes, using clinical IT to facilitate patient safety and care quality improvements. By definition, it quickly becomes very granular. Without a strong CMIO—and, nearly always now, a strong team of clinician (physician, nurse, pharmacist) informaticists—such change becomes impossible to achieve.

But is getting an MBA—something many CMIOs have done—enough? In fact, all those interviewed for this article agree, making the transition to a true leadership position requires multiple shifts and developmental processes. Says Shrift: “I know few CMIOs who haven’t had leadership coaches and mentors; and Gawande [Atul Gawande, M.D.] was just writing in The New Yorker about that.” In fact, he says, “For CMIOs, having formal leadership training is essential right now; things are just too complex, and the changes are accelerating.”

One of the most important challenges, all those interviewed for this article agree, is for physician informaticists to make the shift from the culture nearly all of them were trained in, in medical school and beyond—one that trained physicians to be “lone wolves” ready to diagnose and treat individual patients using their judgment, skills, and experience—to working in team-based environments, particularly as they assume broader management and leadership roles. “It’s a great challenge for doctors to learn to think collaboratively for success in complex leadership environments; and some doctors can’t make that transition,” Shrift reflects. “For myself,” he adds, “when I looked in the mirror and was brutally honest, the real work was learning to stuff my ego, and to really feel and embrace humility; that I don’t have all the answers, and can’t do it all myself. That’s hard for everyone, but it’s a tricky journey for many primary care physicians, specialists, and proceduralists.”

Arlene Anschel

Yet though they remain quite a small group overall, “There are physicians now who have been in operational roles [as medical informaticists], who have been somewhat strategic, for the past five to eight years; and those physicians are getting ready to take that next step into the optimization and transformation roles,” says Arlene Anschel, an executive search consultant at the Oak Brook, Ill.-based Witt Kieffer.


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Terrific article. I know Tom, Arlene, Bill and Vi very well and they exemplify the professionalism that great CMIOs and other executives bring to their roles.

The other evolutionary factor with CMIOs is that the medical model communicated with the "M" in CMIO is out-dated. We are evolving to care delivery that is gapless, with perfect hand-offs. We are also evoling to care delivery that is context aware, to issues of high blood pressure, diabetes, and to the mundane such re-infection risks of tooth brushes with strep throat. Great care requires great orchestration; we are far past order and results management, with rudimentary deployments of static CPOE systems with little attention to metrics.

This is perhaps best captured by CHIO Jim Walker's HealthAffairs article, From Tasks to Processes, available here:

As you know, Jim is a member of the HIT Standards Committee, and provides facilitation (as described by Tom Tinstman in your article) at Geisinger Health Systems as the Chief Health Information Officer.

To build on Vi Shaffer's important survey work on CMIO reporting, I know several CMIOs (functioning as CHIOs) who report directly or in a dotted line to the organizations CEO. A truly visionary CEO would have it no other way. The title of CMIO loses some of that.