CMIO Roundtable, Part 3: It’s All About Communication

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 discussion, we talk about 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 1

Chapter 2

Chapter 3

• Care transitions — “It’s where the real opportunities are to do harm or add value.”
• Making decision support about “the health and well-being of patients,” not checking boxes
• Intermountain’s step back to move forward
• Innovation vs. “organizational creativity”
• Key attributes: interpersonal skills, emotional IQ & building relationships
• Being “best friends” with the CIO

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Bold Statements

The time is going to come when they’re going to say, ‘Okay, we’ve been good soldiers. We’ve shouldered some new responsibility in getting this installed and we’ve changed some workflows to accommodate that. Now can we get back to doing things that really help us?’

Everyone seems to have a sepsis algorithm these days; how about instead of just looking at sepsis, we look at operations and how do we understand our variation by using some of the new big data, network analyses, or machine learning algorithms?

We’re so good at getting the people who know how to use their smartphone and apps and Apple Watches to engage. The problem is, those aren’t the people with four different chronic healthcare problems that really need the help. We need far simpler, far more patient-friendly ways to reach those people.

So much of this role is change management and helping people deal with change. Sometimes it’s figuring out a good way to deliver bad news.

The power base of the CMIO is the medical staff.  If they’ve got your back, you have real authority and real influence in the organization. If they don’t feel you’ve got their back, you’re nowhere.

Kate Gamble:  George, based on your experience, does that sound about right just as far as that evolution that the role has seen?

George Reynolds:  I agree with everything Brian said. I think the role traditionally has been mainly more hospital-focused — or if it was a large physician practice group, then it would be ambulatory-focused — but there was this division. Now, the successful CMIO really is working the transitions. The transitions of care are where the real opportunities exist to do harm and to be inefficient, or to add real value and really make a difference for patients’ lives and clinicians’ lives.

I think the other area that I see successful CMIOs have a real active part in is analytics, and this is going to become even more important with the shift from volume to value. Being able to not just implement decision support tools but actually demonstrate that the tools you’re implementing have the desired outcomes, and it needs to be about outcomes as opposed to process, which is traditionally where we’ve been focused — did we check this box, did we measure this laboratory test? Now, it needs to be much more about the health and well-being of our patients.

The successful CMIOs have an active piece — or maybe in some organizations, they actually have the analytics group reporting up to them, but it’s so important that as they work through these transitions, that they’re measuring the impact they’re having.

Gamble:  Right. Stan, has that been your experience as far as seeing more of a role in the analytics arena?

Stan Huff:  For us, this is déjà vu. In other words, we had a very rich legacy system and all the things that people are talking about now are things that we’ve done for over 10 years in terms of the whole scope of the organization — data analytics, of implementing clinical decision support, and verifying that we’re changing outcomes, and improving the quality of care that we provide. And we actually took a step back as we went to Cerner, because we don’t have that same rich set of applications in place yet. So I agree with everything that’s said.

In our case, it was like going back to the future. The environment people are describing now is something that we were riding the crest of for the last 10 years. Then for the last three years while we’ve been installing Cerner, that part has been on hold. Now we want to get back to all of those things that we were doing in terms of population health, analytics, support for accountable care organizations, and really listening to clinicians to know how we can optimize workflows and work on advanced decision support that improves patient care, all of those things. So I couldn’t agree more, but in our case, it’s getting back to the future. It’s not the first time we’ve been there.  It’s getting back to that place now with a new environment, with a new platform that we’re working with.

Gamble:  I can imagine it was a difficult thing to deal with as a leader in helping people to think that it’s not a step backwards, when that’s what it probably feels like.

Huff:  It is. And I don’t want to paint too dark of a picture. By installing Cerner, we got new functionality that we didn’t have, but it was certainly a tradeoff. There were things that we could do in the past that are more difficult to do now. We’re in an interesting situation in that the clinicians clearly understood the importance of getting the new system installed. But I think there’s going to be pent-up demand because they’ve been taking one for the team while we get this new thing installed, and the time is going to come when they’re going to say, ‘Okay, we’ve been good soldiers. We’ve shouldered some new responsibility in getting this installed and we’ve changed some workflows to accommodate that. Now can we get back to doing things that really help us?’ So we’re going to have a challenge getting their satisfaction back given our new situation.

Gamble:  Right. That definitely does sound like a challenge. In doing some research for this discussion, I was looking at what some of the recruiters and consultants have said about the CMIO role, and that magic ‘innovation’ word kept popping up. What does that mean in terms of your role in trying to foster that?

Maia Hightower:  There are different types of innovation. You can think of it as organizational creativity and figuring out how we can create our care teams so that we redistribute the work. That’s more just plain old creativity. But then there’s innovation when it comes to analytics and how do we use data and develop new tools that haven’t been invented before. One area I found to be important is in having access to a lot of data. Most of our researchers or faculty members don’t necessarily have as much access to the data. I know where to get it. I know who to ask, and so it’s partnering with some of the data scientists on the other side of the river.

Being part of an academic medical center, we have the School of Business and the School of Public Health, both of which are heavily involved in data science, and so it’s being able to partner with some of our data scientists from other disciplines to be a conduit to where data is, and be a business analyst that actually knows what these data elements actually mean, and how they’re helping create new tools for operational efficiency, operational improvement — for example, new algorithms and analytics for sepsis. Everyone seems to have a sepsis algorithm these days; how about instead of just looking at sepsis, we look at operations and how do we understand our variation by using some of the new big data, network analyses, or machine learning algorithms? Or for that matter, on a more practical level, how do we look at AI and big data? I’m not a data scientist, but I can partner really well with them and help ask all the questions, because I have a lot of questions of the data as well.

Clinical decision support is another area where there’s a lot of innovation on how do we share what we’ve built. Many of our organizations have been investing heavily in developing our own knowledge assets. Now that we’ve developed them and they’ve been working well within our environment, is there an opportunity to share that in a commercial way with other healthcare systems that have similar questions, but may not have the resource or expertise or understanding of the EMR tool to build it themselves? Is there a marketplace for BPAs or other sets of knowledge assets?

Gamble:  Right. I like how you put that into the different buckets, which we need to do when it comes to something as broad as innovation, and really break it down more practically into what that means for your role. Anybody else want to share a perspective on that?

Reynolds:  I have to admit to sounding like a bit of a Luddite on this subject. I couldn’t agree more with all of the things Maia had mentioned, particularly with relationship to the analytics and data scientists. But that being said, I think sometimes people focus on the bright and shiny objects — the cool new toy, the in-home monitoring kind of activities — and they miss the bigger picture. So much of what I don’t think anybody really considers to be innovation is simply adopting best practices that the innovators have already done, whether it’s OpenNotes or using the patient portal — or the website that patients use to access their information — to reach patients in a meaningful way and connect with them and communicate with them, as opposed to pushing out laboratories three days after you get.

All these things are things are already available, and the vast majority of organizations are just scratching the surface in terms of what they could do with existing technologies, as opposed to inventing new technologies.

Gamble:  Well said. I think the portal could be its own discussion.

Reynolds:  Yes, the whole subject of patient engagement. We’re so good at getting the people who know how to use their smartphone and apps and Apple Watches to engage. The problem is, those aren’t the people with four different chronic healthcare problems that really need the help. We need far simpler, far more patient-friendly ways to reach those people.

Gamble:  Right. And of course you get into factors like connectivity, which is taken for granted when you’re in certain areas.

Reynolds:  Yes.

Gamble:  All right. Well, we’re nearing the end of the discussion, and I wanted to see if anybody else had any thoughts on what you believe are the characteristics that CMIOs are going to need to possess going forward. I know we’ve touched on it in some of the conversations, but what do you really think are the important attributes to have?

Brian Patty:  I’ll take a first shot at that. One is having good interpersonal skills, because so much of this role is change management and helping people deal with change. Sometimes it’s figuring out a good way to deliver bad news. There are a lot of skills, but a lot of it really comes down to being able to communicate well, no matter what the situation is. As I look at my associate CMIOs, a lot of times people come to me and say, ‘this guy is really computer savvy, but when you talk to him, he can barely talk his way out of a wet paper bag,’ and that’s not the person that I need. I’d rather have somebody with good interpersonal skills, which is a good foundation for a leader, and teach them the technical side of things. I can’t train somebody with no interpersonal skills.

That’s really what I look for the most in my team. I don’t know what others have to say about that, but that’s my approach to things. I can train the technology much easily than I can train interpersonal skills.

Hightower:  Absolutely.

Reynolds:  Absolutely. Emotional IQ and communication skills are critical. The other thing is that the ability to build relationships and maintain relationships across a broad set of stakeholders is critical. The power base of the CMIO is the medical staff.  If they’ve got your back, you have real authority and real influence in the organization. If they don’t feel you’ve got their back, you’re nowhere.

The other side is your CIO, the IT side. The CIO needs to be your best friend, and I say exactly the same thing on the opposite side when I’m talking to CIOs. If you don’t have a strong relationship with your clinician leaders — with your CMIO and your CNIO — you’re nowhere, because as the role is evolving, it really is about providing healthcare. That’s the business we’re in. We’re not in the business of providing PCs.

Gamble:  Right.

Huff:  Those things came to my mind. The only other thing I would add is that at least in a large organization like Intermountain Healthcare, the CMIO is playing a role that in other organizations would be almost like a CEO in the sense that they have to be aware of all of the business issues and be concerned about strategic planning, about budgeting for a lot of people that need to be organized, and about the ability to delegate responsibility so that you don’t become a bottleneck for progress in the organization. So it’s all about the skills that people have talked about in terms of being essentially a good leader and being effective in communicating with those around you and being able to delegate and manage.

Hightower:  And on top of that, it’s having resilience and the ability to bounce back, because there is always going to be some naysayer or critic or some catastrophe that is going to require a cool, calm, level-headed approach. If you can regulate those emotions and be resilient, that’s critical. I think it really helps to be more of a rock and less of a rock that sinks. You need to be a stable force.

And it’s also about taking care of yourself. I think we all need to take care of ourselves and make sure we have those healthy habits that we’re hoping to emulate for our teams as well as for our peer physicians.

Gamble:  Very good point. Well, that about wraps it up. I could definitely speak to all of you guys longer because there’s so much to cover, but I really appreciate your time. It’s been really interesting for me, and I think that this is a perspective that our readers really will benefit from. Thank you all so much.