George Reynolds, Former CIO, Children’s Hospital & Medical Center, Omaha
I was a CMIO for several years and reported to the CIO. When she decided to move to another organization, I was offered the CIO role in addition to my CMIO responsibilities. I asked if I could have her paycheck in addition to mine. When the laughter died down, I agreed to do both jobs anyway. I’m often asked what was the biggest change I experienced in taking on both roles. My standard answer: the number of arguments between the CIO and CMIO were about the same, but they were usually much quieter.
If you are a CIO at a healthcare provider organization, I’m going to go out on a limb and suggest that the single most important relationship you need to manage is your relationship with your CMIO. Likewise, if you are a CMIO, the nature of your connection with your CIO is the single best predictor of your success.
For healthcare provider organizations, there is an inescapable truth that is rarely expressed: Doctors are the source of the organization’s productivity. Since I’ve got an MD after my name, it’s easy to chalk that statement up to the sort of arrogant, self-centered world view that is often attributed to doctors — at times with good reason. However, the person who taught me that particular fact was my CFO. And he’s right. Doctors admit patients to your hospital, they operate on them, they order tests and treatments, they see them in the clinics. Not much happens in your organization that isn’t instigated, directed or determined by a doctor.
I’ve heard some suggest that Value-Based Care (VBC) will change all that. As we shift from managing patients to managing populations, the key to productivity will be reducing the volume-driven care dictated by doctors’ orders. With all due respect, I don’t buy it.
Now more than ever, physician alignment is going to be the lifeblood of every organization. However, regulations, quality measures and the sheer pace of change are all causing members of your productivity engine to burn-out at an alarming rate. Change is hard for all of us, but it is pretty much impossible for a frustrated, tired and angry doc. If the docs don’t buy into the changes our organizations must make, we’re toast.
Which brings me back to the CIO-CMIO relationship. In many industries, IT has been a key driver of innovation and enhanced productivity. In general, that has not been the case in healthcare. Yes, there have certainly been some very promising exceptions, but I would argue that healthcare hasn’t seen anything close to the doubling and tripling of productivity that has been seen in other industries. And that has to change.
The tools are all in front of us. Telehealth, patient portals, asynchronous “e-visits,” team-based care and a host of other innovations all hold the promise of greater efficiency, better access, and more engaged, healthier patients. But all too often, the workflows associated with these new tools are poorly thought out, and they become burdens rather than boons to the “source of our productivity,” aka, the docs.
The CIO, the CMIO, and the teams they work with are uniquely qualified to fix this. Together, they are usually the only people in the organization that understand both the technology and the workflows. Their partnership is critical if we are going to simplify, eliminate wasteful activities, and shift necessary activities to the right people. The doc who endlessly complains about the number of clicks needed to perform some routine task is often a pain, but that doesn’t make him wrong. And waiting for the EHR vendor to fix it in the next upgrade isn’t the right answer either.
Instead, the CIO and CMIO need to work together, engage the docs and other stakeholders, and ruthlessly prioritize those innovations and enhancements that truly add value. There will always be more good ideas than there are resources; the key is to pick the ideas that line up best with the organization’s strategy.
[Formerly the CIO and CMIO at Children’s Hospital and Medical Center in Omaha, Neb., George Reynolds, MD, is now part of the faculty for the upcoming CHIME/AMDIS CMIO Boot Camp, which will be held June 19-21 in Ojai, Calif. For more information on the program, click here.]
craigjoseph says
George, brilliant post! My CIO tells me that with a CMIO, she is like one hand clapping. (I think that means that she is less than fully effective without a physician partner, but since I’m just a doctor, sometimes my concrete thinking gets in the way of me understanding what you highfalutin CIO people are talking about!)