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September 18, 2006
At a time when increasingly more healthcare organizations are considering undertaking an expensive IT project, the position of chief medical information officer has seen its standing grow in influence. A growing number of healthcare organizations are deciding it’s time to set up another desk in the executive suite. This one is reserved for the chief medical information officer (CMIO), a physician with expertise in informatics. The CMIO may just be the most important person a hospital boasts when it comes time to plan, implement, and operate electronic medical records (EMRs) and other clinical information systems. “It’s one of the most exciting, dynamic roles in medicine in terms of leadership,” says William Bria III, MD, CMIO at Shriners Hospitals for Children in Tampa, Fla. “We’re leaders in organizations, change agents. We’re focused on links between the practice of medicine and the information world,” adds Bria, who is also president of the Association of Medical Directors of Information Systems (AMDIS), an organization of CMIOs and other physician informaticists that lists approximately 2,000 members, up from 1,300 just two years ago. “The market now is huge,” says Betsy Hersher, a healthcare executive recruiter in Northbrook, Ill. She sees demand from all types of hospitals and integrated delivery networks that are looking for someone to manage clinical change during a technology roll-out. “Within the past two years, this position has taken off dramatically,” confirms Linda Hodges, vice president and IT practice leader for Witt/Kieffer, an executive search firm in Oak Brook, Ill. This observation mirrors studies that show a marked increase in EMR usage in the same time frame. The decision to purchase an expensive IT system takes a significant commitment from the CEO and board of directors. If the technology includes EMRs, computerized physician order entry (CPOE), or other clinical components, an IT project must be viewed as a major change-management initiative, Hodges says. A CMIO can help with the difficult process of clinical process improvement. “If they are going through some sort of clinical transformation, they need physician leadership,” says Hodges, even if the job requires only a portion of one physician’s time. “It’s a need that’s been recognized by the administration, by chief information officers [CIOs], and by chief medical officers [CMOs].” And that gets to the heart of the role of a CMIO, who is at the nexus of executive, medical, and technology leadership. “Trust and communication [are] the key to CMIO success. You are very much a bridge role,” Vi Shaffer, healthcare research vice president at Stamford, Conn.-based Gartner Inc., said at this summer’s Physician-Computer Connection, the annual AMDIS symposium. The CMIO job used to be merely a liaison between medical and IT staffs, says Hersher, then it evolved to include an educational component. Now, CMIOs must be collaborators with all parties, which is not easy for physicians. “They are making technology-based business decisions,” Hersher says. Physicians in the CMIO role must inform top management about the business and clinical worthiness of IT purchases. Also, says Bria, no longer are CMIOs physicians who write software code to solve a single problem, as he did early in his 25-year career in medical informatics. CMIOs are true leaders in their organizations, according to Bria, converting data to information used in strategic and tactical decisions. “We’re becoming ombudsmen,” Bria says. “We’re navigating many spaces,” from the practice of medicine to information systems (IS) and quality of care. A sign of the maturation of the CMIO job is the fact that informatics studies now routinely show up in general medical journals, not just those focused on technology, according to Bria. “We’re no longer just cheerleaders, though we always have to be,” he says. Richard Ferrans, MD, whose title of vice president, medical information officer, at Memorial Hospital in Gulfport, Miss., effectively makes him a CMIO, says that being a link between IT and medical staff is indeed only part of the story. He must work with nurses, case managers, quality officers, pharmacists, imaging technicians, and other care-related personnel at the 420-bed community hospital. “My view of my role is that I’m a liaison between all of those clinical staff and the IS department because the complexity of what we do really requires the coordination of all those people, not just at the care level, but also at the information level,” Ferrans says. For example, orders involve physicians, nurses, pharmacists, laboratory staff, and clerical staff, plus the business office. “All of that information needs to be shared,” according to Ferrans. “That is why we are strong believers in information integration. It is not because we are dazzled by technology. It’s because the board decided that this was the path forward to delivering the highest quality of care to the community.” The board and other executives are key to a CMIO’s success, say Ferrans and others. “I think it’s misleading to think, somehow, that the MIO is going to be this single, transforming agent in a hospital if the board and the management allow it to happen,” Ferrans explains. At Memorial, the board sets the hospital’s vision. “Our job is to execute against it.” He cites a management structure in which Memorial’s vice president of medical affairs focuses on quality improvement, allowing Ferrans to run the clinical IT functions, but for the two to work in tandem to set their ideas in motion. “When you put those two things together, that, I think, is how you enable transformation,” says Ferrans. “You’re not going to find many MIOs who really have enough experience in quality,” he continues. “You’re not necessarily going to find medical affairs specialists, quality specialists who are physicians. They may be very familiar with the information systems that drive a lot of their products but not with the operational information systems. You put those two things together and then you have at the management level the organizational will to go forward.” For example, Memorial vice president of medical affairs Nancy Downs, MD, can talk about best practices, while Ferrans works with her to show where clinical decision support and order sets and automated data collection for benchmarking against core measures fit in. “Those are really the two halves of the equation,” Ferrans says. “My experience in other hospitals is often [that] quality is relegated to a departmental level, to a project level, and the whole reason why we’re doing what we’re doing is to try to make that the way that we operate,” he continues. Memorial, which never shut down or lost any data despite being directly in the path of Hurricane Katrina last year, is fully committed to a strong bond between IT and clinical quality improvement, says President and CEO Gary G. Marchand. “It just ripples through the whole organization,” he notes. Ferrans actually didn’t join Memorial until after Katrina, but because the hospital first brought on an MIO when it began installing a McKesson EMR in late 2002 and had its quality protocols in place, it was able to ride out the storm without interruption, even though the key MIO job was vacant from June 2005 until April 2006. “It’s hard to find the talent,” explains Marchand. “People like Dr. Ferrans aren’t at every corner of every community. They aren’t on every medical staff.” Yes, physicians with informatics expertise most definitely are in demand today. “It’s unusual to see someone in this role earning less than $175,000,” executive recruiter Hodges says. The majority earn at least $250,000 plus bonuses, she says. “We’re seeing in the last couple of years a real increase in compensation for CMIOs,” says Arlene Anschel, senior vice president of Hersher Associates. Preliminary results from this year’s survey of AMDIS members bear out these observations. Total annual compensation for CMIOs—even those not giving 100% of the time to informatics—tends to be greater than $225,000 annually, reports Gartner’s Shaffer, who conducted the study. Just don’t expect a CMIO to keep up much of a clinical practice. “If you want to practice 75% of the time, it ain’t gonna work,” Hersher advises. Within a large health system, the heavy workload may make it impossible for a CMIO to continue practicing medicine. A CMIO doesn’t necessarily need a degree in informatics but does need to have practical experience with IT systems, as well as with managing others. “Being a techie is not what you are looking for,” Hodges advises. “You will be interfacing with people.” An effective CMIO needs excellent communication skills and a passion for change. Passion for a project is “infectious and contagious,” says Hodges. “It’s no longer for those who are merely fascinated with tools and toys, but we’re more disconnected from patient care,” says Bria. The job cannot be that of a “medical cheerleader” or someone brought in only for a technology implementation, according to Bria. Effective CMIOs help entire organizations focus on quality indicators by advising leadership on medical and technology issues alike. “They understand the data and the entire healthcare domain,” says Bria. “People in this space really need to communicate.” For their part, CMIOs would rather not have to be cheerleaders, says Ferrans, who had been CMIO at Tulane University in New Orleans before moving to Gulfport earlier this year. “From my side of the street, I can tell you that myself and my colleagues, what we always look for in an opportunity in a hospital or a medical organization to serve is one where the board and the medical team already understand the value of information technology and have a history of financing projects and executing projects,” he says. “Those are the opportunities where people like me feel that they can make the greatest difference, and that’s why I’m here.” Memorial Hospital went outside its ranks to find Ferrans, but Shaffer observes that CMIOs tend not to be job-hoppers. Among early respondents to the AMDIS survey, roughly four in every five are in their first CMIO position, and the majority have been with their current organizations for at least three years—and wish to stay put for a while. “Most of you really like your work,” Shaffer told the group. “Sometimes, people will fill this position internally,” Hodges notes. But two other good sources of CMIO talent are IT vendors and healthcare consulting firms because physicians in those arenas often grow tired of all the travel and sales responsibilities, she says. From Hodges’ observations, CMIOs tend to report either to the CIO or the CMO. “In some cases, it’s matrixed to both,” a situation that could be the source of frustration, says Hodges. “People are experimenting with different things,” she says, while noting that “many would prefer to report to the medical staff.” The preliminary AMDIS survey results indicate that nearly one half of today’s CMIOs are below the CIO on the organizational chart, but more would like greater access to their organization’s top executives, including the CEO and the chief operating officer. A year ago, the same poll said a majority of CMIOs preferred reporting to the chief medical officer. “CMIOs generally are comfortable with their level of authority,” says Dick Gibson, CMIO for Providence Health System in Portland, Ore., and a longtime AMDIS member. He says CEOs have so many responsibilities that they may not make the best bosses for physician informatics specialists. But alas, the rules may be on the verge of changing. Within five years, “I think CMIOs are going to become CIOs,” predicts Matt Murray, MD, who currently serves as CMIO at Cook Children’s Hospital in Fort Worth, Tex. He says there is a perception in some health systems that only other doctors can convince reluctant physicians that EMRs and CPOE are the wave of the future. “The non-physician executive believes a physician executive can deal with the physicians who are upset,” says Murray. This change actually may come even sooner. Hersher says the next two years will see the retirement of many hospital CIOs brought in to oversee management-side IT projects in the 1980s and 1990s. With the focus of HIT shifting to the clinical side, physician informaticists need to be prepared to take over as CIOs. “You don’t have time to be a newbie,” she advises. — Neil Versel is a journalist in Chicago specializing in HIT.
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