Alright, can we just come out and say it? Picking out a so-called “tech-head” doc and designating her or him as the new CMIO at your organization is just so last century. Really. Because, while such an ad hoc tactic, used to help move a first electronic health record (EHR) implementation forward, 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.
The demand will only continue to intensify for clinical informaticists able to help their organizations lead true clinical transformation, leverage IT and analytics for population health and accountable care organization (ACO) development, and satisfy demands for value-based care delivery, readmissions reduction, and other initiatives coming out of both federal healthcare reform processes and demands U.S. healthcare system-wide by purchasers and payers for increased value for expenditure, as well as from newly energized healthcare consumers.
What kinds of people will be needed? Individuals with solid clinical (medical, nursing, pharmacy, etc.) backgrounds, as well as interest, ability, and familiarity with informatics and IT, plus a (very solid) dose of leadership ability, who are systems thinkers and ready to help bring together all the diverse stakeholders around the transformational-change table. And yes, we’ve got shortages.
David Levin, M.D., who was CMIO at the Cleveland Clinic Health organization from 2011 through 2014, and who is now consulting as founder and partner in Amati Health, a Suffolk, Va.-based consulting firm, explained the forward evolution of the CMIO role specifically this way: “We as a healthcare system have been about implementation the past five years, getting the infrastructure into place. And we’re not done, but we’re well down the road,” he said. But now, the CMIO role “is starting to converge with the roles of the chief quality officer or chief medical officer, roles that are about performance management, about envisioning a better future and achieving better performance, including around concepts of the Triple Aim,” which is the idea being promoted by the Institute for Healthcare Improvement of continuously improving the quality of clinical outcomes, improving the cost-effectiveness of health care, and enhancing the patient and community experience. As a result, Dr. Levin believes that what has until recently been framed as the CMIO role has begun to “morph and migrate” into roles around strategy and performance management. “In some cases, CMIOs are becoming CIOs,” he told me. “In other cases, they’re creating new roles, like that of the chief health information officer.” Nor is the CHIO going to be limited to working with physicians, he emphasizes. Some senior nurse informaticists will also inevitably rise into CHIO roles, he believes.
Dr. Levin was part of a team led by consultant Pam Arlotto, president and CEO of the Roswell, Georgia-based Maestro Strategies consulting firm, who published a white paper entitled “From the Playing Field to the Press Bo: The Emerging Role of the Chief Health Information Officer,” the publication of which was highlighted via an interview between myself and Arlotto and Levin published on the Healthcare Informatics website in October 2014.
In the interview, Arlotto noted that part of what is happening now is a transition from an early focus on technology to a focus on information, and ultimately, among the most strategically advanced U.S. patient care organizations, to a focus on value. Transitioning through those shifts, Arlotto emphasized in the interview, “You really need to shift the type of leadership you need.”
All this, she noted, is strongly correlated to the overall level of advancement of any particular patient care organization. As Arlotto said in the October 2014 interview, “A 1.0 organization is still very fee-for-service-oriented and fragmented, a 2.0-level organization is beginning to integrate and do care and population health management, and a 3.0-level organization—the most advanced, according to her team’s schematic—“is about risk management and population health management.” Further, she noted, “The biggest difference between a 2.0-level organization and a 3.0-organization is that the 3.0-level organization is really about integrating informatics and quality improvement; they’re really converging those roles and functions together, and having those leaders collaborating, as opposed to them all being in their silos and functional areas.”
In other words, as patient care organizations advance towards what will ultimately be full-risk contracts for broad member populations, what will be absolutely essential will be the operational integration of care and case management processes with strong population health management strategies, intensified data analytics processes,
Brian Patty, M.D., vice president and CMIO at the Health East Health System in St. Paul, Minn., is definitely seeing the shifts in dynamics, and he believes that current CMIOs are totally caught up in the changes taking place. “You really end up being the catalyst or glue across the whole organizations,” he says. “A lot of patient care organizations are heavily siloed. Now that modern EHRs truly cross the continuum of care, oftentimes, what I’m finding is that the CMIOs are driving the conversation around how their organizations can connect enterprise-wide, not just through the EHR, but via our workflows, how we engage patients, and through processes, and so on.” In other words, there’s no question about the fact that senior clinical informaticists in patient care organizations nationwide are going to need to step up their game.
At the Falls Church, Va.-based Inova Health, Ryan Bosch, M.D., the organization’s vice president and CMIO, and Patricia Mook, R.N., M.S.N., its CNIO, are wading through heavy waters there as they help lead their organization into and through ACO and population health development in a rapidly changing metro market. Helping to lead hundreds of colleagues in continuous change at their five-hospital, 16,000-employee health system, they fully embrace the “clinical informaticists 2.0” concept; indeed, Bosch says he believes he was among the earliest clinical informaticists to use the phrase in public presentations. In any case, Bosch and Mook are living the challenges and the opportunities, and they agree that they and their fellow CMIOs and CNIOs are going to need to ramp up their capabilities to unprecedented levels.
Senior clinical informaticists are going to need to “understand workflow, understand business process redesign and total quality management, in the Lean sense of the term,” Bosch emphasizes. And Mook says, while “You need that baseline knowledge of clinical care and some informatics, “Ryan hit the nail on the head,” she says: “you have to understand the needs of operations, including the business side of the organization, and be able to marry the business and clinical sides.”
And working with data at a deeper level, emphasizes George Reynolds, M.D., CIO and CMIO of Children’s Hospital Medical Center in Omaha. “The informaticists 1.0 model was about the collection of data, getting people to adopt the EHR and use it and fine-tune it,” says Reynolds. “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.”
Summarizing the thoughts of the other clinician informaticists leaders interviewed for this article, Scott Weingarten, M.D., M.P.H., senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles, puts it this way: “You know how Lance Armstrong wrote a book titled, It’s Not About The Bike? Well, I don’t think this is about the computer; it’s really about the patient care and business needs of the organization; and the technology is an enabler to help achieve the clinical and financial goals. So I think the clinical informatics leader of the future will understand healthcare delivery quite well, and patient care, and the changes from fee-for-volume to fee-for-value, will understand risk-based payment and accountable care, and will view technology as an enabler to achieve those goals; to me, that’s clinical informatics 2.0.”