CMIOs in the Spotlight

Howard Landa, M.D.

CMIOs-chief medical information or informatics officers-in the nation's patient care organizations are entering the health system spotlight as never before. Given the meaningful use requirements under the ARRA-HITECH (American Recovery and Reinvestment Act of 2009/Health Information Technology for Economic and Clinical Health Act), as well as some of the provider-related provisions of the sweeping healthcare reform legislation passed by Congress and signed into law by President Barack Obama in late March, there is no question that CMIOs will be key individuals that their organizations will need in order to lead change and fulfill such policy mandates.

So, how ready are CMIOs as a group to lead such change? Editor-in-Chief Mark Hagland spoke recently with Howard Landa, M.D., chief medical information officer at Alameda County (Calif.) Medical Center, and a practicing pediatric urologist, for his perspectives on his colleagues' readiness to lead change. Landa is program director for the Association of Medical Directors of Information Systems (AMDIS), and has led the development of the program for AMDIS' 19th Annual Physician-Computer Connection Symposium, to be held July 13-16, 2010 in Ojai, Calif. For further information on that event, please go to: http://www.amdis.org/pcc.htm

Healthcare Informatics: What do you see as the biggest current challenges and opportunities for CMIOs nationwide?

Howard Landa, M.D.: Obviously, meaningful use is something everyone is chomping at the bit to deal with. And what does it mean to the organization? Does it mean simply meeting the meaningful use criteria in order to get some of the dollars? One of the challenges to me is explaining to people that the investment involved will inevitably not match the federal funding we're pursuing. In fact, many physicians simply won't get a strong return on investment in purely monetary terms. Let's say a physician earns $500,000 a year; implementing an EMR [electronic medical record] inevitably means a 10 percent productivity hit, which means $50,000-which is what they would get from the federal stimulus funds. So some physicians who are 55 or 60 years old may make a calculation about what to do in that case.

There are two monetary reasons to do this-the potential return on investment, and the improvement in productivity. But we all got into this business to help patients, and that's really where we should focus.

So, quality and patient safety are one big element; but the other is, can we actually provide better care at a lower cost? The dollars involved are kind of the elephant in the room. But certainly, patient care has to be the core motivator here.

HCI: What is your reading of the temperature of your CMIO colleagues nationwide?

Landa: Certainly, the racehorse at the gate is an apt metaphor. Everyone is ready to change healthcare. But there's a fear factor here; we now know that we have to do what we said we should all be doing! So we're all looking at what we're being asked to do, and saying, wow, they're calling our bluff. And the resources aren't all there yet. And that's an issue. People are wondering, will we have the troops needed to do this?

HCI: Do you believe that you CMIOs are you being listened to within your organizations?

Landa: Well, its actually very frustrating, because [hospital and health system] executives aren't realizing the extent both of the human resources involved, and the change management requirement. I think the change management piece of it, and the operational support, will be a critical factor. And depending on the culture of your organization and how the goals are incentivized, sometimes you have what you need, and sometimes not. I work at a county hospital, and that's great, because the physicians desperately want to do this.

But not all practicing physicians are as enthusiastic. And by the way, physicians have a valid point-I don't know of too many organizations that have put in really strong systems with significant physician input. And when it comes to CPOE [computerized physician order entry], physicians are saying, ‘Do you realize how expensive I am as a secretary?’

HCI: Are physicians realizing that CPOE really has to happen?

Landa: They're all paying lip service to the quality, patient safety and efficiency elements involved, and they understand it intellectually. But they're already showing up early in the morning and staying late in the evening, and are busy all the time, and they perceive this as just one more thing I have to do. And information systems shine a huge spotlight on things you're not doing right. In the past, we've quietly relied on a whole team of people, especially nurses, and now we're being asked to do things right the first time, and it becomes clear that we're not all prepared as physicians. So there is a level of inefficiency at the human level that has to be addressed.

HCI: So what will be the hottest buzz at Ojai?

Landa: Obviously meaningful use, and as program director, I'm going to do everything in my power not to use that phrase! I believe the final rule will be released in June. But I'm going to actively to push people into the other elements of this, such as ROI. And we've been so heads-down about meaningful use in the past year that we've not focused on the other issues that will go beyond this period, including some very important ones, including natural language processing, real decision support, business intelligence, and care improvement.