What Are You Going to Do Now, CMIO?

The role of Chief Medical Information Officer (CMIO) has a relatively short history. So it is not surprising that the role continues to evolve rapidly and the deliverables of the role vary so much from one healthcare system to another.

When I was asked to be CMIO in July 2013, I was told my primary responsibility was to ensure we successfully attested for Meaningful Use Stage 1.

That deliverable was joined over the next six months by the following:

• Interact with the consultants assessing our IT department and all of our applications, and respond to the restructuring recommendations in their report.
• Put together and lead a task force to evaluate and recommend a new integrated EHR solution.
• Assist the interim CIO and participate in the search for and selection of a new CIO.
• And, work with the consultant and our CFO to develop a five and ten-year total cost of ownership pro forma for the top two EHR contenders.

The amazing thing to me was my story, while differing in details, was very similar to the experience of other CMIOs I met. CEOs and C-Suites now knew that they needed us, but were fuzzy on the details and apt to add duties ad lib and ad nauseum. The system is struggling with hospital acquired infections? Get the CMIO on that! There’s inadequate patient engagement? Have the CMIO lead a group to revamp the patient portal! And on it went. None of these requests/expectations were inappropriate; they were simply ungoverned.

Five years later, though most of us are through our EHR implementations and MU has given way to MIPS and MACRA, the rate of change and the risk of getting buried under the to-do avalanche is even greater. If a CMIO is going to survive the challenges of value-based care and thrive in the environment of population health initiatives, they must function strategically and develop their skills in governance. How and why projects are accepted, who is brought onto the clinical IT team, and which physician leaders and executives you will rely on — all must be considered through a repeatable, scalable process, and assessed for coherence with the system strategies. It is a daily discipline and will require regular and clear communication with the system executive team and the Board.

Peering into the future is always a foggy view, but EHRs are here to stay, value-based reimbursement and population health will continue their erratic and destabilizing evolution, and margins are going to continue to be stressed. CMIOs would do well to work on the following five areas:

1. Read more broadly in healthcare; finance, patient safety, quality, nursing operations, etc. This will help you “anticipate where the puck is going” and be proactive rather than reactive.
2. Develop your integrative and strategic thinking skills, and ensure you are involved by the Board and CEO in strategy development. This is the equivalent of the offense that provides defense.
3. Deepen and broaden your relationship with key physicians in your system. They will not always be the previously designated “physician leaders.” You need to find the critical thinkers, prescient individuals, and those who both naturally excel at using IT applications and — maybe even more crucial — those who have developed excellence through struggle. This takes getting out of the office and into the wards and clinics, listening closely to who fellow physicians and nursing staff look to when IT issues arise, and engaging these colleagues, sharing your vision and seeking to understand their point of view. These physicians will be your champions and some will become your physician builders. One of them should become your succession plan.
4. Be a student of digital developments and be clear as to whether they can advance your and your system’s strategies. This is your best hope of preventing fruitless, expensive, and distracting chases after the latest “bright and shiny.”
5. Continue to develop your skills in change management. You have the opportunity, in collaboration with your CIO, to help your entire system grow into a digital mindset, but it requires that you be the best change agent possible. This may even help your system avoid adding another “bright and shiny” and expensive C to the already over-large administrative team; the Chief Digital Officer (CDO).

There are not pat answers or canned programs that will prepare CMIOs for what is next, because that will be different for every system. However, if you focus on these five broad areas, you will be able to respond and do good things for your system, and most importantly, for the patients you serve.

[Currently working as a freelance consultant, David Bensema, MD, was previously both CIO and CMIO at Baptist Health Kentucky, where he led the implementation of an enterprise-wide EHR system. Bensema has served in various physician leadership roles and has a strong passion for advancing healthcare IT to improve patient care.]