The CMIO role will evolve as health systems' needs change
These days, chief medical information officers tackle a lot more than just EHR implementation.
About 71% of hospitals and health systems employ a senior clinical IT leader, according to HIMSS’ 2016 Leadership Survey. While their numbers are growing, CMIOs are still a relative newcomer to the C-suite.
Initially brought on to help implement EHRs, CMIOs are increasingly involved in a range of activities, from privacy and cybersecurity to patient outcomes, population health management process improvement, compliance and more.
“Ten years ago, CMIOs were frequently managing transitions from paper process to IT, or from separate to integrated solutions,” says Bruce Darrow, vice president for IT and CMIO of Mount Sinai Health System in New York. “Today, CMIOs are more involved in partnering with clinical and business leaders to understand how to improve patient care and how to bring the tools of technology to bear toward the greatest opportunities.”
The biggest challenge facing CMIOs is prioritizing all of the possible uses of technology to improve patient care, Darrow says. “It’s hard to do all of them at once.”
Colin Banas, CMIO at VCU Medical Center in Richmond, VA, agrees. As regulatory mandates and business models change, and as technology evolves, CMIOs and IT staff get a lot of pressure to deliver and innovate in ways that use technology to enhance care and workflow, he says. “Demand management is a never-ending tsunami,” he says.
Tackling that “takes a lot of collaboration with senior leadership and key stakeholders to get everybody on the same page so that when that tsunami of demand comes our way we can all be singing from the same song sheet in terms of prioritizing and committing to accomplishing what is being demanded,” Banas tells Healthcare Dive.
He sees the CMIO role evolving from what he affectionately calls CMIO 1.0 — a clinical champion who helped rally clinicians around EHR adoption — to the CMIO 2.0, who is involved in bigger issues like population health and big data analytics.
Promoting infrastructure investment
“If the payment model is going to shift towards quality or towards outcomes and prevention, you really need to have robust investment in the sort of infrastructure that can support a population health program or you need to be able to ask the appropriate questions of your own data about where should I be investing further,” Banas says. “Do I have a heart failure problem? Do I have a readmission problem? Where should I be spending limited resources?”
Whether 1.0 or 2.0, EHRs continue to occupy a good portion of most CMIOs’ role. Not only do they run a team to implement and expand the EHR, they must also optimize existing users and meet new clinical and regulatory demands, notes CT Lin, CMIO at UCHealth in the greater Denver area.
“If implementing an EHR was constructing the basement of the house, we now have demands on building the first, second and third floors,” he says. “How do we innovate to reduce costs, increase quality and reduce physician burnout all at the same time?”
To address those needs, UCHealth has compiled a team of 20 physician informatics, drawn from across medical and surgical specialties. Each of them focuses on a particular component of the EHR and is involved in IT decisions to ensure patient engagement, Lin says.
The CMIO, with their knowledge of clinical requirements and documentation needs as well as technology, is crucial to the success of any EHR implementation, says Ann Meehan, director of information governance at the American Health Informatics Management Association. “Whether we are talking about the physician practice EHR, the hospital EHR or the ever-growing emergence of telemedicine and other technologies for gathering patient-related data, CMIOs have to work between the C-suite, including the CMO, IT staff, providers and technology vendors.”
Lin calls CMIOs “’sine qua non’ crucial” to the survival of hospitals and health systems in today’s value-based care environment. “You need great data and feedback systems to understand how you provide care now, and how you will do a better job in the future,” he tells Healthcare Dive. “And you won’t get great data, nor will you have acceptable feedback systems, unless your physicians help you design them well.”
What can hospital administrators do to help better support CMIOs? “Continue to recognize the importance of IT as a lever for change,” says Banas, noting that IT is often viewed as a cost center rather than something that can help drive business and reduce costs.
What’s the most important skill a CMIO can have? Listening, says Darrow — to patients, family members, doctors, nurses, care team members, IT colleagues and their own staff. “I work at the intersection of so many communities that being out of touch with the realities of all of them makes me less effective as a CMIO.”
In addition, they should be “humble, good communicators, good leaders, good managers, have a strong vision and have a strong supporting team,” adds Lin. “Informatics is a team sport.”