During the past few weeks, so much has changed because of the COVID-19 outbreak. One thing that hasn’t changed — one thing that can’t change — is the CMIO’s core objective: to make life easier for providers, according to Mark Weisman, MD. For his team at Peninsula Regional Medical Center, that means removing hard stops and eliminating alerts that don’t provide value. “We still have the same priorities in terms of making this tool easier, even in the middle of a healthcare crisis.”
Recently, Dr. Weisman spoke with healthsystemCIO about how the organization is working to accommodate more patients during the pandemic while also maintaining quality care, whether that means ramping up telemedicine efforts or setting up makeshift clinics. He also discussed PRMC’s multifaceted strategy to address and reduce clinician burnout, the evolution of the CMIO from “buffer” to true leader, how he hopes the role will continue to grow, and the advice he offers for CIOs who want to develop stronger relationships with clinicians.
- Working closely with the COO
- Coming to PRMC after 18 years with Sentara
- The CMIO’s evolution from “buffer” to leader
- Areas of opportunity: finance, analytics & data visualization
- Protecting providers from being inundated with data – “We need to do a better job of that.”
- The future of robotic process automation: “I can’t wait.”
- Biggest fears: declining reimbursements & cyber threats
- Launching his own podcast – “It’s not about me; it’s about other CMIOs and what they’re doing.”
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The CMIO needs to advance across the country to a higher level, particularly in understanding the business of the hospital and the business of healthcare. That relates a lot to population health and how can we add value and use clinical decision support to deliver better outcomes.
Being able to say, ‘here’s the clinical problem,’ and helping that analyst produce the graphs and the data that tells the story, is so important. That’s another skill I think CMIOs should be focusing on.
As CMIOs, we need to protect our providers so that they don’t get inundated with data dumps into their in-box, where they’re getting hundreds of blood pressure readings, pulse oximetry readings, and Apple Watch telemetry readings. We need to do a better job of that.
I’m most excited about robotic process automation. Humans are doing so much of this manual process data entry garbage; I can’t wait until robots takes it over and we let the computers do this stuff.
It’s not just providing us with data, but with information. I don’t need to see every single glucose they had while they were in the hospital six years ago. I need to understand whether the patient is sick right now or not, and what it is I should focus on.
Gamble: You talked before about building relationships with other C-suite members, which is obviously so important. What’s been your strategy in doing that?
Weisman: The CMIO role is such a relationship-oriented role. The first relationship I thought was key to form was with my CNIO. She’s great. That’s a relationship I’ve continued to work on, and we learn from each other. She has a ton of nursing experience and understands parts of the organization that I had very little previous exposure to, and vice versa. We’ve been great resources for each other.
The resource I enjoy engaging with the most when I can get the opportunity is our chief operating officer, because she is so challenged with all the operational components that a CMIO can help with in terms of reducing length of stay, reducing readmissions, helping the OR run in a more streamlined fashion, helping providers reduce waste and order the appropriate tests, and looking at how we can guide them with order sets. It’s fantastic to work with a COO who’s really invested and understands the value we’re bringing to the table. Those are the relationships that I really treasure and work to develop on a regular basis.
Gamble: When you came to the organization, I imagine there was an adjustment period of getting to know the people and the culture. How did you approach that?
Weisman: Probably not as thoughtfully as I wish I had. My thinking was, let’s see who I can meet, what their troubles are, and where I can add value — that was my first approach. In retrospect, I could have been more thoughtful and took the approach of, how do I really understand, and what can I do?
One of our chief operating officer’s pain points was in analytics, an area in which I was particularly strong. But there was someone else in the organization who felt like they owned analytics and really wasn’t interested in someone coming in and chiming in with outside opinions. I needed to be more thoughtful about that. I think that was a learning point for me. But in terms of the role of analytics and how important that is to the organization, the COO had this great vision, and I really wanted to be a part of that. I see the value in it, and I still think it’s something our organization needs to do.
Gamble: Having a strong relationship with the chief operating officer is really a smart move, and it’s refreshing to hear that from a CMIO.
Weisman: It’s hard for me to get time on the COO’s schedule. I’m sure other CMIOs experience that, as well as CIOs. These people are busy. Sometimes I find if I can get with the service line leader, the head of cardiology or orthopedics, that’s great too, because their agenda — the major service line — is something the COO is also concerned with. I’ve been able to form good relationships there and, as a proxy, get to understand where the organization is going, and where I should be helping us get to in terms of moving the providers, the data, and the informatics behind it, to align with the COO’s vision.
Gamble: When you look at where the CMIO role is going — or where it should be going as healthcare continues to evolve, what are the skill sets that will be important?
Weisman: If you go back a decade or so, the original purpose of a CMIO was to be a buffer between angry providers and computerized order entry. That role has transitioned to more of the care and feeding of the electronic health record. That’s the informatics part — making sure we’re doing clinical decision support right, and helping out with analytics work.
I think the CMIO needs to advance across the country to a higher level, particularly in understanding the business of the hospital and the business of healthcare. That relates a lot to population health and how can we add value and use clinical decision support to deliver better outcomes. It’s how can we make the data transparent to other providers to show them where they’re being an outlier — whether that’s good or bad — and pushing that transparency issue.
The financial area is one where CMIOs tend to be weak and really need to buff up. We’ve got the informatics part down because we’ve been doing this for so long. I think analytics is an area where we can improve as well, particularly with something like SQL. You don’t have to know SQL, but you do need to be able to speak the language of the analysts, and in particular, data visualization. Understanding how the data should be presented to other C-suite executives is really important. A good analyst will know it, but not all analysts have that skill. Being able to say, ‘here’s the clinical problem,’ and helping that analyst produce the graphs and the data that tells the story, is so important. That’s another skill I think CMIOs should be focusing on.
And so, finance, analytics, and data visualization are the key tools, sitting on top of a foundation of really strong informatics, and the leadership roles that go along with that. I think CMIOs should be dealing more with direct reports, particularly the application teams. At this point, the CMIOs should be really well integrated with those teams and leading them, whether that’s directly or indirectly. But I think that those skills that come along with leading people, if it’s not something the CMIO has developed, they definitely need to have that, because the CMIO of the future should be leading large teams of people.
Gamble: Right. When you talked about data visualization, I can imagine that’s really coming into play now with everything going on.
Weisman: Data visualization can be a manipulative tool or an appropriate teaching tool. We’re getting to the point in healthcare where we’ve got enough data. We understand that; start giving us information. As CMIOs, it’s really important role for us to say, ‘give us good information.’ For instance, during this crisis, we’re doing a lot of remote patient monitoring. Everyone’s on their Fitbit and sharing their heart rates, their movements, their weight, and everything else we get through remote patient monitoring. That’s just data; and we get inundated with it all. We really don’t want data; we want information. Do me a favor, summarize all the pulse oximetry readings and tell me the patient who’s on a downward trend. That’s what I need to know. As CMIOs, we need to protect our providers so that they don’t get inundated with data dumps into their in-box, where they’re getting hundreds of blood pressure readings and pulse oximetry readings and Apple Watch telemetry readings. We need to do a better job of that.
Gamble: So it’s really foundational to the role of the CMIO to be that voice for the physicians. Even as the role evolves, that still has to be a core part of it.
Weisman: It is. And it’s also about partnering with the CIO. Everywhere I say ‘CMIO,’ just stick the word ‘CIO’ right there with it, along with CNIO. It’s a triad; the three are so closely aligned these days. There’s so much overlap that a good working partnership among the three is essential.
Gamble: I’m going to throw out a very vague question. When you look at the direction that healthcare is going, and all the change we’re seeing — the current situation notwithstanding — what excites you most and what scares you most?
Weisman: From a tech perspective, I’m most excited about robotic process automation. Humans are doing so much of this manual process data entry garbage; I can’t wait until robots takes it over and we let the computers do this stuff.
Think about manual scanning in of labs because we don’t have interoperability. For example, I have a patient that goes to the hospital across the street and their lab results come to me by fax. If I want to trend their hemoglobin A1c, their lipids, and their thyroid, I have to have someone manually enter those labs into discrete fields in order to make use of that data. I can’t wait until we’re out of that business.
That’s what I think is really exciting. I think it’ll happen in many fields all across technology in general, but healthcare is ripe for it. It’s a matter of making an investment, and having some trust that the computer is going to get it right, because you really can’t match patient data to the wrong patient. And so it has to be very fine-tuned.
What scares me most are cyber threats. Even now, there are scammers out there who are sending out coronavirus-related threats that people are clicking on, and downloading the software. They make it look like it’s coming from a CDC website or their own prevention officers who are saying, ‘we need you to click here to watch this video about coronavirus.’ People are downloading it and making themselves susceptible.
We’re in for a rough ride here. Not just with coronavirus, but cyber threats in general. What goes along with that is declining margins in healthcare, because that limits our ability to invest in the infrastructure we need to protect ourselves. So those are the two things that scare me most: declining reimbursements and cyber threats.
Gamble: Both very scary. But when you look at the progress that’s been made in terms of data being turned into information, I would think it’s pretty exciting to see, especially for someone who’s been in the provider role.
Weisman: Yes. And I think now that information blocking has blown over, and the privacy concerns are being addressed, we can really get to sharing data without EMR vendors being in the way. I’m really excited about that. I think we’ve got great times ahead where we’re starting to understand the journey our patients are on, and putting those pieces together for patients who go to different healthcare providers. If we can get a complete picture of the patient, we can do population health. It’s hard to do that when you’re seeing the patient through a soda straw, and there are so many activities going on that you don’t have visualization into.
Social determinants of health are a key part of that, as well as health plans. They know so much more than what the doctor in the exam room knows. We’ve got to be able to share that information, get it out of the silos, and put it in the hands of the patients so that they’re in control of their experience, and they can control who has their data and be able to make use of that in the EMR. Again, it’s not just providing us with data, but with information. I don’t need to see every single glucose they had while they were in the hospital six years ago. I need to understand whether the patient is sick right now or not, and what it is I should focus on. So we need some artificial intelligence to be working with us.
Gamble: That’s really exciting. The last thing I wanted to talk about is the fact that you do a podcast, which I think is very cool. But I also know that it’s a lot of work, on top of everything else you’re doing. Can you talk about what drove you to start doing this and what you enjoy most about it?
Weisman: Sure. I started CMIO Podcast less than a year ago. It began because I was looking for practical information; the hands-on stuff that CMIOs need to know. At the time I was starting to study for my informatics boards, which I am thrilled to say I passed. I highly recommend it. It’s a great course, but it didn’t teach the really practical things, like, what do you do when a doctor is really angry about a change you just made and has a voodoo doll with a pin going through your eyeball? That’s the kind of stuff that we want to know how to handle. That’s what we want to know how to handle, and that practical advice was something I just wasn’t getting. And so I decided to provide it. I wrote down 20 topics that I wanted to talk about and started reaching out to people, and I was shocked that people were willing to talk to me. I love it.
And I make it very clear that the show isn’t about me; it’s about the other CMIOs — the other guests, and what they’re doing to make healthcare easier for others. It’s about picking their brain, getting practical advice from them, and making it a nice relaxed casual conversation. You’re good at that too, by the way, which is why I love listening to your podcast. It puts people at ease so they can open up and say, here’s what I’m working on and here’s why I think it’s great. That’s what I try to do too with my podcast.
Gamble: That ability for your guests to be able to put things out there, whether it’s something they’re doing well or something where they’re looking for input, having these types of conversations is so important. We all have strengths and weaknesses; we’re all doing some things right and some not so great, and so we need to have these dialogues happening.
Weisman: Agreed. One of my favorite episodes that you did was when you interviewed Lee Milligan, who I’ve interviewed as well. Lee is a great guy; I went to med school with him, so we have that connection. Lee can explain topics so well, both from the provider side and the CIO perspective, and I’d love to see more providers in that CIO role. That might be a direction I want to go in the future, to help translate the technology problems we’re having. It’s bigger than just the clinical application; there’s so much more. I loved the interview you did with him and the points he raised.
Gamble: Thank you. I also think it’s interesting when we find CIOs who have had the CMIO role; it’s a great perspective. Do you plan to keep doing the podcast?
Weisman: Absolutely, for as long as I can. I really enjoy it. I’ve done 70 episodes now. The hard part is finding people who want to talk. I don’t want to always make it a vendor; in fact, I try to limit that. If someone has a good product that CMIOs should know about, I’ll get them on the show. But I want that practical advice. I like to get doctors on the show, and I’d like to get more CIOs. I have a hard time doing that, because everyone is trying to sell to them.
I’m not sponsored by anyone; it’s just me. My goal is to put information out there for the next generation of CMIOs, and so I’m hoping to find people who are willing to spend 30 or 40 minutes to share their insights and give back to the community a little bit. Everyone I’ve worked with so far has been really gracious with their time. I appreciate that because, as you know, these podcasts don’t always go according to plan, and technology doesn’t always live up to expectations. We’ve got challenges we have to get through.
Gamble: Absolutely. And this is a perfect example. For you to give us this time, with everything you have going on, we’re really grateful. I really liked hearing your insights. It’s so important for our audience that we get a broad perspective, so thank you so much for your time.
Weisman: My pleasure. I’m a big fan of the show. Keep up the good work, and let’s make sure we stay in touch.
Gamble: Of course. Thank you for the kind words!
Weisman: Anytime. And thank you, it’s been great being on the show with you.
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