Accountable Care Heightens Importance of CMIO Role

Not only is the relatively new role of the chief medical information officer (CMIO) becoming more widely accepted, healthcare reform drivers like quality reporting and accountable care organization development are adding new emphasis to the role, said CMIOs who participated in a panel that tackled the changing CMIO role at the Healthcare Informatics Executive Summit on May 7.

“Today, with the idea of ACOs, quality metrics and reporting, meaningful use, and so many other dimensions, you really need to understand the medical process,” said Bill Bria, M.D., the vice president and CMIO at the Tampa, Fla.-based Shriners Hospitals for Children, and the co-founder and president of AMDIS (the Association of Medical Directors of Information Systems), the nation’s main CMIO association.

Bria, who moderated the “Evolution of the CIO-CMIO Relationship and of the CMIO Role” panel, one of several discussions at the HCI Executive Summit  in Orlando, Fla., said the CMIO role was changing due to the fact the usage of information tools has been significantly changing, from a focus on the business of medicine and simply getting the IT systems implemented, to that of healthcare reform and clinical transformation. The CMIO title, which is a rather new appellation, Bria said, is now gaining more traction as organizations are increasingly having to demonstrate the value and success of the IT systems they have implemented. The role is also gaining more codification, he said, as the process for board certification of the CMIO role as a medical specialty is created.

“There will be actual acceptance of this [role] within the medical profession,” said Bria. “That’s why the test is important. It’s not because it is a great test and will change everything, but it’s ultimately that medicine is a very conservative clan.”

As HCI Editor-in-Chief Mark Hagland reported in his April cover story on CMIOs, CMIOs are asking for, or being asked to accept, dual-reporting relationships, with the CMO and CIO of their organization, to achieve optimal influence.  

Early on, CIOs had to really lobby for the CMIO position in their organizations, said Linda Hodges, IT practice leader at the Oak Brook, Ill.-based Witt Kieffer, another HCI Executive Summit panelist, but now it’s a no-brainer for healthcare organizations. Hodges said that a survey her firm conducted last year of 140 CMIOs showed that 30 percent of respondents reported to the CIO, with a dotted line to the CMO, while 27 percent reported to the CMO, with a dotted line to the CIO. She said that in the 16 CMIO searches her firm conducted last year, eight of the positions reported to the CIO, while six reported to the CMO. “The one thing we hear from candidates, both CIOs and CMIOs,” Hodges said, “[is that] the CIO and the CMIO [connection] has to be a very collaborative, close working relationship.”

Ferdinand Velasco, M.D., vice president and CMIO at the 14-hospital, Arlington, Texas-based Texas Health Resources (THR), said that CMIO reporting relationships will continue to evolve. Velasco, who was THR’s first CMIO when he joined the organization nine years ago, has a triple reporting relationship to the COO, chief clinical officer, and the CIO. He said rather than reporting relationships, it is more important how much exposure the CMIO has to the board and how much decision-making influence he or she has.

CMIOs are deeply involved in clinical transformation, said Velasco. “While intrinsically it is a very technical role, it’s also a very political role,” he added. “It’s a very key role in how a healthcare system engages with its medical staff. Emotional intelligence, the ability to interact effectively with not only the physicians, but the other clinicians as well, is another competency I want to underscore.”

Bria added: “Today, the idea of who the CMIO reports to, whether it’s the CMO or the CIO or whatever, I think is less relevant than the local culture from whence they sprang.”

Brian Patty, M.D., vice president and CMIO, HealthEast Care System, has had four different reporting structures in six years and currently reports to the CEO. “Culture is a big part of it, and the comfort and savviness of the CIO is also a part of it,” he said. Patty added that his system’s CIO had the foresight to create an informatics department that reports to the CMIO and that has added to the role’s importance.

Velasco sees future variations in the CMIO role, with some CMIOs focusing on clinical informatics, while others focus on the behind-the-scenes analytics and back-end research support. One way to address this natural fragmentation, he said, is to enlist a cohort of medical informaticists that can satisfy all the organization’s needs. At THR, Velasco has an associate CMIO who focuses on clinical decision support, which frees him up to address other areas of IT.

Hodges sees a trend toward a new CMIO role that focuses on optimization, analytics, and quality, with quality departments reporting to that new role.