One of the healthcare leaders I’ve consistently turned to whenever I’ve been sorting through some of the pressing questions around the forward evolution of clinical informatics processes in the current environment is David Levin, M.D. Formerly the CMIO of the Cleveland Clinic organization and now a consultant, Dr. Levin (who insists on being addressed as “Dave,” which fits with his unpretentious, always-welcoming personality) has been particularly helpful in providing insight for me around the evolution of CMIOs in today’s healthcare.
It was great to speak with Dave Levin as I interviewed industry leaders while preparing one of our Healthcare Informatics 2015 Top Ten Tech Trends, this one on the idea of “Generation 2.0 Clinical Informaticists.”
David Levin, M.D.
With the demands on providers coming from the purchasers and payers of healthcare for greater accountability, transparency, and responsiveness from providers, and especially improved patient outcomes, cost-effectiveness, and patient and community satisfaction, Dr. Levin agreed with everyone else I interviewed that the era of the part-time, “tech-head” CMIO who primarily helps select and lead the implementation of a first-generation electronic health record is quickly passing, and indeed, has already passed, in many patient care organizations nationwide.
As Dr. Levin told me in an interview I did with him in November for the Tech Trend article, “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. 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… of continuously improving the quality of clinical outcomes, improving the cost-effectiveness of health care, and enhancing the patient and community experience. So,” he told me, “you’re starting to see CMIOs begin to morph and migrate. They’re migrating into roles around strategy and performance management. In some cases, CMIOs are becoming CIOs. In other cases, they’re creating new roles, like that of the chief health information officer [CHIO].”
What’s fascinating is that even as some CMIOs “aim for higher office,” as one would say in the political world, the reality is that their own “office,” their own role is now being elevated higher and higher in many patient care organizations—particularly in multi-hospital, integrated health systems, and in academic medical centers and other teaching hospitals. Indeed, more and more CMIOs are now reporting either to CMOs or COOs or even to the CIOs of their organizations; and the large teams of clinical informaticists who might previously have reported to the CIOs of those organizations are now reporting to them, the CMIOs.
I know of numerous patient care organizations in which such dramatic shifts are taking place. I’ve even heard of a few organizations in which the CIO is now reporting to the CMIO. So the decade-ish-old question of to whom the CMIO should report is already being turned on its head in many ways these days.
And the real question, as Dave Levin and others pointed out in that Tech Trend article is not so much to whom CMIOs should report in their organizations, but rather, what kind of role they want and need to play. Because this is now, in most patient care organizations, no longer about implementation, or at least certainly not about first-time, first-generation, implementational issues. Instead, as Dr. Levin told me, “We started out purpose-driven, focusing on getting the EHRs in. Now, organizations are moving towards results-driven work around benefits optimization, and so on. The final level of this really is about transformation and vision—how do we see ourselves in the future, what do we want to be as an organization?”
And in that healthcare system-operational, and professional, landscape, questions of reporting relationships really do taken on a small-bore cast, overall, in comparison with issues around the ever-increasingly-important opportunities and challenges facing CMIOs, as they are looked to by their colleagues as key leaders who are being asked to help their organizations achieve the true clinical transformation needed to push U.S. patient care organizations into the new healthcare.
The challenges and the opportunities here are equally massive. And honestly, for “2.0-generation” CMIOs willing to take on both, the world really is their oyster.