Growing Demand for CMIOs

Andrew Froehlich, Network Engineer & IT Consultant | 1/31/2012 | 18 comments

Andrew Froehlich
If you've ever had an IT job that dealt directly with physicians, you would have found that a doctor's technical knowledge ranged anywhere between non-existent and all-encompassing. But more than likely, most would have been near the low end of the spectrum. That's quickly changing as newer generations of doctors are becoming more tech-savvy and are coming to understand the relationship between new technological tools and how they can improve healthcare.

Over the past 20 years or so, large healthcare organizations realized a need for a permanent position that understood both the clinical and the technological sides of the business. This role is referred to as a Chief Medical Informatics Officer (CMIO).

Historically, the duties of a CMIO were fairly broad, as they were the communications bridge between clinical and IT staff for all kinds of IT projects. And because the CMIO lived in both worlds (CMIOs often continue to practice medicine), it was their job to direct IT in terms of what IT projects are most important to physicians. These are the people who understand medicine, hospital policies, and the technology that can be used to create automated workflows. One of the major problems that healthcare IT staff face is the fact that very few have a crystal clear understanding of healthcare workflows, because they rarely see or fully understand the end game. That's why it is so important to have a CMIO who understands both worlds on an intimate level.

But over the past few years, the role of the CMIO has changed dramatically. Because of the new demands for electronic medical records (EMR) and electronic health records (EHR), the focus of the CMIO has not only narrowed, it has become far more crucial.

John D. Halamka, MD, is CIO at Beth Israel Deaconess Medical Center and Harvard Medical School. He briefly describes the different hats he wears while being CIO, CTO, and CMIO in his blog. He differentiates the three roles as follows:

    CIO - Responsible for strategy, structure, staffing, and processes for a 300 person IT organization
    CTO - Responsible for the architecture of our applications and infrastructure, ensuring reliability, security, and affordability
    CMIO - Responsible for the adoption of the applications by clinicians, optimizing quality, safety, and efficiency in their workflows

Dr Halamka then goes on to say "increasing demands for clinical workflow automation, and healthcare reform necessitate that every hospital larger than 50 beds have a full or part time designated CMIO. Given the daunting array of clinical IT requirements over the next 5 years, CMIOs will be increasingly important."

Suggesting that a CMIO is required for healthcare facilities with a few as 50 beds is a fairly radical statement, as most CMIOs are found in organizations with hundreds or thousands of beds. Most small hospitals today lean on the CIO/CTO in collaboration with a physician or two to direct IT projects. But due to the continued growth in EMR and EHR, a formal CMIO seems to be in order so the organization can properly engineer medical record workflows.

Be forewarned, the CMIO's role will not diminish as electronic record adoption is completed. Instead, I see the continued demand for a combination medical physician/IT-guru. I would even go so far as to say that health informatics training should be further refined to better groom physicians looking to develop the skills necessary to become a CMIO. It's not just about knowing medicine and technology but also the ability to articulate information between people with very different professional backgrounds.

If medical professionals choose to take a well planned path that leads to a CMIO role, hospital administrators won't have to haunt hospital hallways trying to find the computer geek doctor who can be groomed into a liaison between clinicians and IT staff.

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DBK   Growing Demand for CMIOs   2/2/2012 7:10:28 PM
Re: Bring on the CMIO
Andrew - Deal with it is a good term.  There are many challenges, money being one and government issued mandates with time lines.  Which the government is understaffed to meet the demand they placed on healthcare institutions.  So they have had to push out the deadlines.  Push out because it was unreal expectations to be met by all those healthcare institutions in the same time period.  Plus the financial implications are enormous.  Silly but very real
Andrew Froehlich   Growing Demand for CMIOs   2/2/2012 3:23:16 AM
Re: Bring on the CMIO
"Whatever the title, we need the expertise." @Dave -- I agree with this and also the power coming form a c-level exec title.  It really comes down to the need to have someone in power that can focus in at the micro level at high-priority tasks that requires an in-depth knowledge of clinical process flows.  I've never met a medical center CIO before that truly had this knowledge -- and thus the need for a CMIO.
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Andrew Froehlich   Growing Demand for CMIOs   2/2/2012 3:15:53 AM
Re: Bring on the CMIO
@DBK -- Not having worked at a California healthcare facility, I didn't know what you were referring to when you mentioned "seismic update mandates".  I did some research -- very interesting what med centers there are having to deal with at this time!  Thanks for the info!
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Andrew Froehlich   Growing Demand for CMIOs   2/2/2012 3:08:41 AM
Re: Bring on the CMIO
I'd think it wouldn't be very glamorous or lucrative in comparison to many things doctors gravitate towards.

@Dave -- I can here the cocktail party conversation now:

Person: "So what do you do?"

CMIO: "I'm an MD"

Person: "That's great, what field of medicine?"

CMIO: "computers"


Not exactly what most doctors have in mind when they go to med school but perhaps that will change one day?
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David Wagner   Growing Demand for CMIOs   2/1/2012 6:48:58 PM
Re: Bring on the CMIO
@Curt- Fair enough. And certainly we are adding CxO's like candy. It is an easy way for a CEO to solidify power. Bring in a bunch of C-types that owe their money and big salaries to him, give them the extra sense of power because they have a C in their title, and viola, instant power.

Whatever the title, we need the expertise. I'd be happy if decisions about roles and titles were made more rationally than they really are though.
CurtisFranklin   Growing Demand for CMIOs   2/1/2012 12:51:44 PM
Re: Bring on the CMIO
@Gigi, the role of generational differences can't be over-estimated. I've seen the phenomenon that you've described: younger doctors are eager to know about the devices I carry, and are often as advanced as I in their use. Older docs just shake their heads and write on the charts with a pen. They can't be bothered to learn the new systems, whatever they are.
CurtisFranklin   Growing Demand for CMIOs   2/1/2012 12:49:41 PM
Re: Bring on the CMIO
@PamR, I think you're absolutely right: If we automate processes that can be made more certain and consistent through automation, then healthcare professionals can spend their time and energy actually working with patients, and do so with better raw data.

The key will be arranging the interfaces to the systems so that the professionals see this as something that makes their lives easier, not something that adds another layer of complication and bureaucracy to their professional existence.
Gigi   Growing Demand for CMIOs   2/1/2012 4:00:34 AM
Re: Bring on the CMIO
Andrew, I think as of now the technological knowledge of most of the doctors are limited to the usage of computer or any other health related equipments usage. In one way that's enough for them in health care sector because they are spending most of the time to update themselves with medical related things. But now a day's, I know most of the youngster doctors are trying to understanding the working principles of such devices, they are handling regularly.
PamR   Growing Demand for CMIOs   1/31/2012 11:24:01 PM
Re: Bring on the CMIO
I can sort of apreciate why doctors aren't moving quickly into the adoption of certain technology. One minute we're knocking them for being cold and uncaring and not spending enough time holding their patients' hands. The next minute, they're spending all their time doing paperwork to meet insurance company demands. An intermediary, both of the kind discussed here and to oversee the flow of information coming in from the home monitoring devices discussed elsewhere today would allow physicians to retain their role as healers and not just data collectors.
Steel2179   Growing Demand for CMIOs   1/31/2012 11:16:07 PM
Two Backgrounds, One field.
"It's not just about knowing medicine and technology but also the ability to articulate information between people with very different professional backgrounds."

Great read.  It will be interesting to see how this path develops both in terms of education and with already practicing medicial professionals and technologists.  The merging of the two fields will definitley transform the landscape and provide even more opportunities for those who have the capacity for both areas.

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