Facing Fundamental Transformation: David Levin, M.D. Reflects on CMIOs’ Challenges and Opportunities

Feb. 28, 2015
David Levin, M.D., an industry leader and the former CMIO of the Cleveland Clinic, shares his perspectives on the transformational challenges and opportunities facing not only U.S. patient care organizations in general, but also facing CMIOs and other senior medical informaticists going forward

As anyone who isn’t living in a healthcare cave these days knows, the roles of clinical informaticists in U.S. healthcare are rapidly being transformed. One of the roles undergoing the fastest and most thorough of transformations is that of the CMIO. Just a few years ago—and still today in some patient care organizations—CMIO development was still relatively simple—and primitive. Practicing physicians known to be “tech-heads” by their fellow doctors got tapped on the shoulder by CIOs to help select electronic health record (EHR) solutions and lead their initial implementations, or to provide handholding for other physicians as EHR implementations progressed.

None of those simple approaches is sufficient any longer at any but the smallest or least-evolved patient care organizations in the U.S., as the emerging healthcare system is increasingly demanding the rapid grooming and professional development of physician and other clinician informaticists able to take on senior leadership and management positions and lead their colleagues forward into accountable, transparent, value-based care delivery.

In that regard, one of the Healthcare Informatics 2015 Top Ten Tech Trends was focused on “Clinical Informaticists 2.0”—on the need for a more sophisticated, evolved cadre of clinical informaticists going forward in advancing patient care organizations across the U.S. And one of the industry leaders interviewed for that article was David Levin, M.D., who served as 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.

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 Box: The Emerging Role of the Chief Health Information Officer,” the publication of which was highlighted via an interview between HCI Editor-in-Chief Mark Hagland, and Arlotto and Levin, published on the Healthcare Informatics website in October 2014.

Dr. Levin spoke again with HCI Editor-in-Chief Mark Hagland in November for the Top Ten Tech Trend. Below are excerpts from that interview.

What kinds of gaps do you see right now between what is needed in CMIOs and other senior clinical informaticists, and the availability of people with the skill sets needed to help move healthcare forward?

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,” 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.

David Levin, M.D.

So 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].

And it’s the convergence of those traditional roles with the CMIO that is particularly interesting. The advantage of coming at it from having been a CMIO is your understanding of the technology, whether the analytics for performance improvement, or of the EMR, to collect data and use it to get the work done.

But let me also talk out of the other side of my mouth on this. The skill set docs like me were selected for originally for—the doc who was geeky and liked technology—that’s not necessarily going to translate fully into the new role. On the implementation side, it’s largely about technical understanding or IQ; now, with transformation, you’re talking about your strategic IQ—these are high-level leadership skills, not technical skills. So what I think we’ll see happen is that the CMIOs who have that kind of talent or can develop it, are migrating it into the CIO role.

What about the transition from CMIO to CMO? Some CMIOs are making that shift also.

I think a few are, yes. Either way, the CMIO position, or whatever role you give that person, will be a much more strategic role, will be sitting in the c-suite, with people reporting to her or him. It’s becoming a far more elevated position over time.

Something like what happened to the CIO, needing a CTO, then, perhaps?

Yes, exactly. And I’m beginning to see this in my peer group; they did great work on implementation, and have the potential to migrate up and they are doing that. And some guys are self-selecting to stay down in the engine room, as it were. And God bless, we need those folks! So, more controversially, I want to choose my words carefully. I see a lot of CIOs struggling with this, because on the one hand, as a traditional CIO, I could understand how you might be threatened by this. But I’m also seeing that forward-thinking, progressive, self-confident CIOs, are embracing this. They recognize that this is what their organizations need going forward.

And they’re willing even to see the CMIO elevated above them?

Yes, they might be willing to do so And the typical CIO has often not been elevated to the c-suite—which is a mistake, because it’s one of the reasons we have had that disconnect between IT and enterprise strategy. So the top clinical informaticists, and the clinical informatics, need to be closer to the strategy. So in some cases, I’m seeing CMIOs being let go, because the implementation has been completed, and they don’t know what to do with them anymore. But I’m also seeing the opposite, where the CIO is becoming the champion for having a strong CMIO or CHIO.

And visionary leaders in pioneering organizations realize this is now about leveraging clinical information systems for true transformation, correct?

Yes. And organizations evolve over time. 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 what will the roles be? And now let’s talk about analytics and technology, to accomplish that.

To give you a sense of how serious I am about this, at my consulting firm, I’m putting my money where my mouth is. And we’re putting together a very formal methodology and we’re working with partners to help them assess where the organization is on this. And we’ve also launched a formal physician executive coaching service—to help CMIOs and others develop and think strategically. And we’re getting some nice interest in that.

What would your advice be for existing people in existing roles? What should they be doing?

That’s a great question. Here’s what I say to my clients every day: let’s pause for a moment, and stop talking about technology just for a few minutes. Because the conversation usually starts with, I need a thing; or my thing is broken. And we’ve had too much faith in the ability of simply implementing technology to solve our problems. At this level, my advice to people is to stop talk about technology for a moment and start first with a conversation about what your vision is for your organization. And what is your enterprise strategy for the next three or four years? And how do you propose to get there? And then we’ll have a conversation about the technology.

And to have that kind of conversation, it has to be at a high level; that kind of conversation needs to take place in the c-suite, with the CFO, COO, CNO, CMO, CIO, CMIO, and CNIO. And together, there should be a kind of back-and-forth conversation. I’m not against CIOs, and we’re going to need CIOs. But I don’t think the typical CIO is going to be able to do this without a strong clinical partner. So they have to find one or partner with the CMO or with other members of the c-suite. The CIOs have got a lot of stuff on their plates—but are also tasked with doing all the basic blocking and tackling on technology, too. So either you need an individual, or a group of individuals, who have the clinical backgrounds and understandings, to partner with non-clinical CIOs and other senior healthcare IT leaders, to make the necessary transformation happen.

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