 |
| Sarah B. Brown |
As hospitals increasingly use technology to increase health care quality, organization leaders have a growing need for a liaison between clinical practice and information technology. The chief medical information officer role has emerged to bridge this gap, and the position is shaped by a variety of factors, including professional background, reporting relationships and the decision to continue to practice medicine.
Growing Job Description
The CMIO is still a relatively new position. The Association of Medical Directors of Information Systems claims approximately 2,000 members, most of whom are physicians, and a recent survey by the College of Healthcare Information Executives found that 34 percent of responding CIOs employed a CMIO at their organization. While responsibilities vary by institution, in general the CMIO is responsible for overseeing the implementation of electronic patient record systems, focusing on quality, safety, usability and process improvement issues, and ensuring physicians and other hospital staff are fully engaged in these processes.
CMIOs have varied backgrounds, though most candidates are hired because of their familiarity with the health care organization, their clinical experience and their professional interest in IT. An effort to standardize the CMIO career path seems to be emerging through the growth of academic degree programs in health informatics. The American Medical Informatics Association lists more than 80 academic and training programs related to health informatics.
Still, success in this role doesn’t depend on an educational background, according to faculty at the recent CHIME LEAD Forum in San Francisco. The panel of hospital leaders, including several CIOs and a medical director of informatics, discussed the keys to success in the CMIO role. The main factors are practice experience and credentials, and recent formal or informal experience with clinical IT projects. The panel also cited the ability to collaborate and engage other physicians, and the presence of strong leadership skills. Importantly, the panel placed very little emphasis on the need for IT experience, though this may change as clinical information technology evolves.
Who Reports to Whom?
The CMIO’s placement in the hospital’s organizational structure also varies. In the most common structure, the CMIO reports to the CIO. However, the CMIO might also report to the chief medical officer or report directly to the CEO alongside the chief nursing officer and the CIO. Some institutions may replace the CIO position with a CMIO, giving him or her informatics staff as direct reports. But the most balanced structure, according to Ronald Strachan, vice president and CIO at HealthEast Care System, St. Paul, and a member of the panel, appears to be one in which the CIO, CMIO and CNO are equal but collaborative positions, with each individual leading his or her own staff.
Panel member David S. Muntz, senior vice president and CIO, Baylor Health Care System, Dallas, suggested that a more effective model might be the establishment of an “office of CMIO” led by a physician or nurse chair to better reflect the multidisciplinary backgrounds of clinical professionals and allowing more representation from clinical fields.
The panel members unanimously agreed on one requirement: the CMIO and CIO must form a partnership in order to be effective. Strachan called this collaboration the “most critical relationship” when it comes to the success of the CMIO and stressed that the “CMIO is important to the survival of the CIO.”
A 2006 Gartner-AMDIS survey reveals CMIOs’ preferences for reporting relationships and responsibilities. The survey of 50 CMIOs representing hospitals, physician practices and midsize to large integrated delivery systems came to the same conclusion as the CHIME panel: that CMIOs must be both collaborators and leaders, with open lines of communication among C-suite executives.
The Gartner-AMDIS survey found that 48 percent of the respondents held the title of CMIO, and other titles included vice president of medical or clinical informatics, director of medical informatics and medical director of information systems. The respondents were asked to whom they reported as well as to whom they thought they should report, with fewer respondents choosing the CEO/COO as a direct supervisor than the number of CMIOs who already report to those positions.
|
|
% of respondents reporting to |
% of respondents recommend reporting to |
|
CEO/COO |
46 |
32 |
|
CIO |
18 |
28 |
|
CMO |
18 |
28 |
|
Other |
8 |
12 |
Regardless of reporting structure, the surveyed CMIOs cited “regular access to top leadership” as the most important factor in organizational success.
The Gartner-AMDIS survey also found that education in informatics is prevalent, with 70 percent of respondents having graduate-level degrees in addition to medical degrees (in a similar 2005 survey, only 58 percent of respondents had additional graduate-level degrees). Of these, 24 percent had medical informatics degrees and 16 percent had public health degrees. More telling than educational backgrounds, however, is the fact that 84 percent of responding CMIOs had prior administrator responsibilities, demonstrating leadership experience.
“Practice Credibility”
More than half of the CMIOs surveyed indicated that they continue to practice medicine and, when asked if CMIOs should continue to practice, 64 percent answered yes. Survey respondents suggested that CMIOs devote a minimum of 20 percent of their time to medical practice. CHIME panelist Strachan called this “practice credibility” and said that it is critical to working with the physician community and helps the CMIO “better respond to health care IT needs.” Forum attendees agreed. Dennis Sato, vice president and CIO at Salem (Ore.) Hospital said clout, or a doctor’s visibility to other medical professionals, is a vital part of the CMIO role.
During the survey overview at the CHIME LEAD Forum, Violet L. Shaffer, vice president and agenda manager at Gartner, Centerville, Va., said, “CMIOs worry about maintaining their clinical status” and that “the biggest factor is time” when it comes to managing the position’s dual responsibilities. Still, Shaffer noted that she had not “encountered a CMIO who wants to return to full-time medical practice.” Gartner-AMDIS survey data supports this: 74 percent of the respondents indicated a desire to stay in the CMIO role, either at their current organization or another organization.
As clinical information technology evolves, so too will the CMIO role. Health care organizations that have already embraced this position find that the value of the CMIO lies in his or her ability to meet the needs of an organization’s clinicians and IT experts while advancing the goal of better patient care.
Sarah B. Brown is Most Wired project specialist for Health Forum.
GIVE US YOUR COMMENTS!
HHNMostWired welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to Most Wired Magazine Editor at (312) 422-4500, or mail them to Editor, Most Wired Magazine, Health Forum, One North Franklin, Chicago, IL 60606.
If you would like a FREE Subscription to Most Wired OnLine, please click here to register.
This article first appeared on September 19, 2007 in HHN's Magazine online site.
To respond to this article, please click here.
