It’s amazing. You can find four CMIOs (three currently in the role and one retired) from four very different organizations, but the primary goal is the same: to help accelerate EHR implementation and guide optimization to ensure that systems are being utilized to their full potential, all while seeking to prevent physician burnout.
It’s a rather lofty goal, and it requires an individual with solid interpersonal and communication skills, participating in strategic planning, a solid understanding of the business, and of course, a strong knowledge of both the IT and clinical departments. It takes a certain type to fill this role, and we found four of the best in the industry — Maia Hightower, Brian Patty, Stan Huff, and George Reynolds — to talk about the challenges they face as CMIOs, how the role has evolved, and the skillsets all health IT leaders will need going forward.
In this three-part roundtable discussion, we’ll discuss why it’s critical to get to the root of physician burnout and dissatisfaction; the balancing act CMIOs have in working with vendors to determine where responsibilities fall; the need to act as a bridge between IT and clinicians; how the role of CMIO has gone from “checking boxes” to focusing on the health and well-being of patients; and it comes down to 90 percent communication, 10 percent technical.
Chapter 2
- Shifting from implementation to optimization
- “It’s a balancing act”
- Downside of moving to value-based care: “It creates more decision support & more documentation requirements.”
- Post-implementation — “Now the real heavy work is starting”
- Bridge between IT & clinical
- CMIO as change agent — “It isn’t just about flipping a switch.”
- Aligning cultures
- Evolution from CPOE adoption leader to global leader
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Bold Statements
The bright people that we have are not interested with simply fiddling with the configuration switches within Cerner. They’re going to go somewhere else if they can’t find more engaging work. So that’s a challenge for us.
Some of the work we’re doing with care team management is really taking that team approach to care and taking as much administrative burden off of our providers as possible so we can get them back to talking with their patients and caring for their patients — not caring for the EMR.
I’ve talked with CMIOs who have completed an implementation and find themselves out of a job because the organization failed to understand that now the real heavy work is just starting, rather than being completed. Finding ways to demonstrate value while not putting ridiculous burdens on your physicians is much more challenging than just getting them to use the EMR.
Part of my job is to empower my team and to provide those leadership skills so that they can help be change agents within their micro cultures; that they’re able to speak the language of IT and organizational behavior, as well as the individual cultures they’re coming from.
Kate Gamble: As far as that shift from implementation training to really looking at optimization, is that something that you’re pretty heavily involved with at this point?
Stan Huff: Yes. We’re having discussions now to say how we can change the actual organization reporting lines and direct report responsibilities to optimize for enhancing the system as opposed to the implementation, and we haven’t got an answer yet. I wish I could say more. But it’s a very active conversation because there are lots of questions about how much we contract for Cerner resources to do things, versus what can we do with a relatively large group of smart, good developers that have produced our legacy systems in the past? They actually get a lot of fulfillment out of knowing that they’re building software that helps people get better — how do we keep their jobs interesting so that they feel like the work that they’re doing is worthwhile? Quite honestly, the bright people that we have are not interested with simply fiddling with the configuration switches within Cerner. They’re going to go somewhere else if they can’t find more engaging work than that. So that’s a challenge for us.
Gamble: Sure. It’s not just simply flipping a switch and saying, okay, here’s what everyone’s going to be focused on now, and it’s going to fit all your skill sets perfectly.
Huff: Exactly.
Gamble: Now, Brian, you touched a little bit on some of your focus at Rush in terms of looking at the transition to value-based care, and I want to talk a little more about what you’re doing there. We’ve spoken with [Rush University Medical Center CIO] Shafiq Rab about some of the work that Rush is doing with population health. Is something you’re involved in as well, and can you talk a little bit about that?
Brian Patty: Yes, kind of deeply, in fact. One of the things we’ve done over the last several years since I arrived here was really beef up both our analytics and EMR capabilities in the population health realm, really looking at getting our registries and reporting functionality up and running and taking advantage. We’re an Epic shop as well, and Epic has a nice suite of applications that they’ve pulled together under the umbrella of Healthy Planet. So we’re really beefing up our team and taking full advantage of the population health tools that Epic provides and then matching them. We have a clinically integrated network at Rush Health, and they’re heavily involved in designing care teams and care management focused around population health.
And so we’re matching our analytics and our EMR tools to the workflows that are needed by those care teams and care managers, and really trying to optimize the system as a whole, which can be challenging. Because just as there are challenges with Cerner, there are challenges with Epic. The software is designed for a host of organizations; therefore, it doesn’t fit perfectly with any organization. And so you have to take advantage of the things that do work and figure out how you can configure things that don’t quite work for your organization. You have to work with both your EMR vendor and with your analyst teams to take advantage of the tools much as possible, and then reconfigure where you need to.
It’s a balancing act, and it all circles back to the physician burnout piece. Some of the work we’re doing with care team management is really taking that team approach to care and taking as much administrative burden off of our providers as possible so we can get them back to talking with their patients and caring for their patients — not caring for the EMR and caring for the billing pieces, which is a challenge. Because, as George pointed out, more and more documentation requirements come from CMS, from Joint Commission, from all of our payers, in order to show that we’re doing the work that we’re doing and that we deserve to get paid. And those burdens tend to fall on the providers unless we can figure out creative ways to work on care team documentation and care team management to take some of that documentation burden off of our providers. It all comes together.
George Reynolds: I’m just going to add to what Brian just said that the shift to value and the creation of accountable care organizations and the governance structure around ACOs also creates more decision support and more documentation requirements as the ACOs seek to demonstrate value that they can then show to third-party payers or directly to employers. So they’re seeking to also create additional documentation and additional analytics and data that they can use, and often that too comes back to the providers to create new documentation. It can add to the challenge.
I’ve talked with CMIOs who have completed an implementation and find themselves out of a job because the organization failed to understand that now the real heavy work is just starting, rather than being completed. Finding ways to demonstrate value while not putting ridiculous burdens on your physicians is much more challenging than just getting them to use the EMR.
Patty: The implementation is just the beginning.
Reynolds: Yup.
Gamble: Right. Do you find the old cliché to be true where building that bridge between IT and clinical is something that really is still a significant part of the CMIO role especially when it comes to matching tools to workflows and things like that?
Reynolds: It is the work. That is the job, is understanding both sides of the equation and being able to find ways that understand workflow and find ways to optimize that workflow.
Maia Hightower: I would say it’s not only the technical aspect of solving the problem of the workflow integration, but also being a change agent and helping the providers adapt to change. We know that it isn’t just about flipping a switch, but really about understanding the role of the clinician and what drives our clinicians’ happiness and professional performance, and being able to make those linkages between the clicks that really are necessary, that are value-added, that only the clinician can do, that drive value for their patients, and that are so important.
And so that adapting to change piece, which is less of a technical skill and more of leadership skill, is so important for those CMIOs that have already done an implementation and have been in the weeds with those technical changes. Now it becomes, how do we leverage our clinical background, our background as leaders, to help our clinicians transition to this new era.
Reynolds: Yeah, the job is 90% communication and 10% technical, not the other way around.
Huff: I agree.
Patty: Agreed.
Gamble: Of course, you’re all doing it with different organizations and you have different experiences, but I would imagine there’s no one-size-fits-all way to do help ease the burden for clinicians.
Patty: Culture is everything. If you do come in and try to apply a one-size-fits-all solution, you’re going to fail. You have to understand your organization’s culture, both from a provider standpoint and from a leadership standpoint, and also the culture within your IT shop. Oftentimes, those three cultures don’t align, and some of your work is doing a bit of a dance to get as much alignment as possible so that your IT culture, your leadership culture in the organization, and your physician culture can come to better alignment. And it can be very, very challenging, but you have to understand that there’s not just one organization culture. There are micro-cultures within your organization, and you have to understand those and approach those with that knowledge. Otherwise, you’re destined to fail.
Gamble: Right.
Hightower: And to build upon that, it’s recognizing that it’s not just about the CMIO. I’m very fortunate in that I have a pretty big team of physician informatics officers and assistant CMIOs who understand those micro cultures. And so part of my job is to empower my team and to provide those leadership skills so that they can help be change agents within their micro cultures; that they’re able to speak the language of IT and organizational behavior, as well as the individual cultures they’re coming from, whether it’s surgery, primary care, or any of the specialties.
Patty: It sounds like you and I have a similar approach. I have six associate CMIOs, a hospitalist, an anesthesiologist, a surgeon, an emergency physician, a primary care physician, and pediatrician, and they all help me with those micro cultures, because each of those areas uses the EMR differently. They have different needs, and there’s no way a single person can understand that. Having that team assist me with those things is absolutely critical, and so I’m blessed that I at least have that support from the organization, to have those providers in those various areas helping with the work that we’re doing.
Gamble: One of the other things I wanted to look at was how the CMIO role has evolved. We’ve talked a lot with our audience how the CIO role has changed, with a lot of this coming in the past five or 10 years. Stan, do you want to comment on what you think is the most significant change you’ve seen in the CMIO role?
Huff: I’m not sure how to answer that.
Patty: I can take a shot at it. I’ve been in three different organizations in a CMIO or a medical director of informatics role. My first role back in 1999 through 2002 at Fairview Health Services was really about building out CPOE and getting doctors to use CPOE — that was the extent of my role. That was it. As I took on a new CMIO role at a new organization with new challenges, it became much broader. At that point, I was really just a physician consultant to IS — the person out there trying to get doctors to use CPOE and doing that change management work.
Then at my new organization, I had the whole EHR team reporting up through me, and it became more of a global role. Rather than a chief medical informatics officer, I was really chief health informatics officer, because not only was I dealing with physician workflows and physician issues with the EMR, it was nurses, it was pharmacists, and down the line — really the entire healthcare team.
And so my role became much more global, which was good because you understand how all of those workflows need to work together within this milieu that is the EHR. And now as we expand even further to population health, it’s not just seeing the EMR in the hospital or the EMR in the clinics, it’s really how does the EMR look across the entire continuum of care, including the home. The role has expanded as the needs of organizations have expanded. Now, my scope is across the entire continuum of care, from home to clinic, to hospital, to SNF, to home health, and back to home. And so the role has expanded exponentially over the last 10 to 15 years.
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