Reflections on AMDIS 2013: CMIOs “In the Weeds” with their Full Agendas

June 30, 2013
It was fascinating to watch the dialogue unfold at the annual Physician-Computer Connection Symposium this week, as CMIOs shared with each other their challenges, frustrations, and hopes, at a time when CMIOs and other medical informaticists are faced with an avalanche of demands and requirements

It was fascinating to watch the dialogue unfold earlier this week, as Jacob Reider, M.D., chief medical officer, and David Muntz, deputy national coordinator, both at the Office of the National Coordinator for Health Information Technology (ONC), fielded questions and comments from the audience gathered at the Ojai Valley Inn and Spa in Ojai, Calif. on June 26, for the Physician-Computer Connection Symposium 2013, sponsored by the Association of Medical Directors of Information Systems (AMDIS).

Every year, many of the nation’s leading medical informaticists gather for the AMDIS symposium, and the tenor and overall thrust of the discussions seem to provide a good barometer of where CMIOs and other medical informaticists are at the time of the gathering. I had to put a label on this year’s discussions, it would be a phrase something like “deep in the weeds”/’in the trenches,” right now. What’s clear is that CMIOs and other medical informaticists are virtually overwhelmed by all the mandates hitting them right now, from those coming out of the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act, to those deriving from the Affordable Care Act (ACA); the requirements linked to the transition to the ICD-10 coding system; and now, those related to the new enhanced data security requirements under HITECH Act known as the “Final Omnibus Rule” under HIPAA (the Health Insurance Portability and Accountability Act of 1996).

And those sets of mandates don’t even include the requirements related to the voluntary programs their organizations are getting involved in, including accountable care organization (ACO) and bundled-payment contracting development, both as part of the official federal programs under healthcare reform, and under the auspices of private health insurers.

So how is all of this hitting CMIOs and other medical informaticists right now? Like a ton of bricks, basically. As Colin Banas, M.D., CMIO at VCU Health System in Richmond, Va., told me, the comments made by attendees in response to the Reider/Muntz session “reflect how difficult MU2 is,” and CMIOs’ anxieties over tackling Stage 2 of meaningful use in 2014. “We’re a very advanced organization in terms of CPOE, and everyone thought Stage 1 would be a cakewalk for organizations like ours—and it wasn’t,” Banas told me. “Meanwhile,” he added, “MU2—the quality reporting requirements are on steroids. And as advanced as we are, MU2 is turning out to be very, very challenging for us.” Still, he said, there is a basic acceptance that the meaningful use process is not going away. “It’s all about the process challenges now,” he added.

In other words, attendees at this year’s AMDIS gathering seemed to have come to accept the requirements they’re facing (and some are  actively embracing those requirements), even as they struggle to fulfill them. Process-wise, they are totally “in the weeds” right now, and will remain so for the next five years at least, until this current “transition time” has been completed. Of course, the reality is that endless transitions lie ahead; still, this current time is a particularly pressured one for CMIOs and other medical informaticists, as they move to put into place the systems—and the processes—that will be required to help their organizations move towards the new healthcare.

On top of everything else, the CMIO role continues to evolve forward, with CMIOs moving into positions that are more and more about leadership, particularly as they are finding it absolutely necessary to lead whole teams of medical informaticists in order to accomplish everything that’s being required of them these days. There are pluses and minuses involved here, of course, as on the one hand, CMIOs are finally beginning to get some of the human resources they so desperately need—at least in larger patient care organizations; on the other hand, the professional self-development required of the current crop of CMIOs looks like a steeper learning curve than ever.

Ultimately, this is all rather a “glass-half-full-or-glass-half-empty” kind of situation, isn’t it? CMIOs are getting more respect and recognition than ever before; but they’re also needing more support and more resources than ever before, as an avalanche of requirements and demands is hitting them all at once. And, overall, all medical informaticists are feeling the heat, as their work is more in the limelight than ever before.

It will be fascinating to look back on things a year from now, and to see how CMIOs and other medical informaticists feel, as a group, in June 2014. No doubt, they’ll all still be feeling they’re riding the tiger—but perhaps one can hope the tiger ride might feel a tiny bit smoother a year from now. Remember (and sorry to mix metaphors here) the Greek myth of Pandora, the girl who opened a box that unleashed all the evils of humanity? The very last thing that flew out of her box (actually, a jar in the original myth) was hope, after all.

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