In the “early days” of the evolution of the CMIO role—just a few years ago in many U.S. patient care organizations, and still the case in some even now—the first CMIOs in hospital-based organizations were largely picked out of the crowd of practicing physicians based on being perceived as “tech-head docs” who enjoyed information technology. And the focus was on their helping to select first electronic health record (EHR) solutions and implementing those first EHRs.
Yet all the activities around clinical informatics have been shifting into overdrive, as the demands on clinical informaticists to help lead clinical transformation, to reduce avoidable readmissions, to help lead participation in value-based purchasing, and to help lead the clinical aspects of accountable care organization and patient-centered medical home development, and to bend the cost curve, have all come to the fore in the industry. It is in the context of all those trends that the editors of Healthcare Informatics selected the topic of “Clinical Informaticists 2.0” as one of the magazine’s Top Ten Tech Trends for 2015.
Among those interviewed for that article was Brian Patty, M.D., vice president and CMIO at the Health East Health System in St. Paul, Minn. Patty, who in March transitions over to Rush University Medical Center in Chicago as vice president and CMIO for that organization, spoke with HCI Editor-in-Chief Mark Hagland in November for the Top Ten Tech Trend clinical informaticist article. Below are excerpts from their extended interview.
Has the role of CMIOs and other top clinical informaticists become more demanding? What is now required?
Yes, absolutely: the level of profile and responsibility that the CMIO is much higher than it was even five years ago, and its profile extends up to the board level. These days, as a CMIO, you really end up being the catalyst or glue across the whole organization. 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.
Given all the expanded demands on CMIOs, what capabilities and skill sets do they need to succeed nowadays?
You really need negotiation skills, because oftentimes, you’re dealing with various factions within the organization that need to be brought together and enabled around these issues. Sometimes senior leaders do a good job of that, but oftentimes, it falls to the CMIO to do that bringing together.
To get to that high level, what does the CMIO have to develop in her/himself?
What I’ve educated myself on are a number of topics, including organizational finance. You have to understand operating via capital revenue; you have to understanding the financing of the organization and the functions involved in that financing. The other thing is a more global knowledge of the healthcare system. And I’ve learned that over time by being engaged at the leadership level. But a CMIO coming in would benefit from, if not a whole MBA or MHA, at least MBA or MHA coursework around healthcare strategy and policy.
There's also a leadership training or self-education that has to occur, right?
Yes, absolutely. The job is no longer about convincing physicians to use EHRs; that’s been played out. Now, it’s engaging people in the organization around strategic goals, and engaging people around how to do that.
What will happen in the next few years?
If you look at the Gartner study that just came out, on overall, looking at where CMIOs are right now, in terms of reporting structure, etc., the reporting structure is actively changing. Fewer and fewer CMIOs are reporting to the CIO; more and more are reporting to the CMO and even the CEO. That shows you how the role is changing.
In your view, then, to whom should the CMIO report?
I still think either directly to the CEO, or to the CMO, are the two best reporting structures for the CMIO. The goal has really changed from that technical IT focus to more of a strategic focus in the organization.
What advice would you have for CMIOs and for other clinical informaticists going into these top roles?
As much as possible, get exposure to the hospital leadership leading the agenda, and pay close attention to the strategic goals of the organization, and how the EHR and other systems—a lot of CMIOs have leadership over data warehouses and analytics systems, too—how those systems can fulfill the needs of the organization—figuring out the prioritization.
Would anything about that advice and those perspectives be different for CNIOs?
I don’t think so, and a lot of organizations are now creating a single role, the CHIO. And quite frankly, that’s what my role is; my title is CMIO, but I function as a CHIO of the organization. The focus of the job is really much more global both in terms of whom you report to and your scope of work.
