One of the most important components of the CMIO role is to act as a bridge between two worlds — clinical and IT — that can seem worlds apart, at times. It requires a willingness and ability to “listen to what people in IT are saying and translate it into clinical speak, and then translate clinical speak into IT language.”
It’s the type of skill that doesn’t come naturally for most people. It did, however, for Dirk Stanley, MD, who grew up in a bilingual household, with an American father (who was a former military interpreter) and a German mother. “I learned how to translate from one culture to the other.”
He also learned that it’s not just about getting about the words right; it’s about getting the message right.
Recently, Stanley spoke with Kate Gamble about his key objectives as CMIO at UConn Health, how he has incorporated the concept of Blueprints Before Build into the strategy, and what he believes are the keys to securing buy-in from end users. He also discussed his early career frustrations as someone who was interested in both clinical and IT — but felt like an outsider in both worlds, and why he chose to start a blog.
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- A core component of the CMIO role is the ability to “hear what the IT people are saying and translate it into clinical speak, and then translate clinical speak into IT language.”
- Another is to listen to the concerns providers might have, and if necessary, readjust blueprints before going forward with a plan.
- When the need for clinical informaticists become clear after the passage of Meaningful Use, it felt like “the clouds opened up” to Stanley. “I had finally found a place where I fit.”
- The reason he started writing a blog? To provide a training pathway for physicians and “take the mystery out of things like how to build a workflow.”
Q&A with Dirk Stanley, MD, Part 2 [To view Part 1, click here]
Gamble: When you look at the CMIO role, it clearly has evolved. I want to get your thoughts on the direction it has taken, and where it will go in the future.
Stanley: I’ll give you a general observation. When you’re a doctor who works in IT, the IT people look at you and say, ‘You’re a doctor; you’re not really an IT person. You don’t really understand what we’re talking about.’ And the clinical people say, ‘You’re an IT person; you don’t really understand the clinical stuff we’re talking about.’ The first part is accepting that you’re in this world between clinical and IT, and your job, at least half of it, is to be a translator between those two worlds. You need to be able to hear what the IT people are saying and translate it into clinical speak, and then you need to be able to translate the clinical speak into IT language.
Growing up in a translator role
That came naturally to me, since I grew up in a bilingual household. My father, who was a military interpreter before he became a language teacher, married a woman from Germany. And so, I learned how to translate from one culture to the other. When my wife and I go to Germany to visit my relatives, I’m the translator (she doesn’t speak German and they don’t speak English. I’ve always been in that role.
I follow the same set of standards and rigor that professional translators do, which is to make sure you’re translating as effectively as possible. I also have the awareness that certain things can’t be translated. You have to use your judgement as to how you provide that translation. So that’s the first part.
Engaging with all stakeholders
Another is engaging with providers. But my role isn’t just to worry about the doctors. I worry about nurses, pharmacists, and respiratory therapists — pretty much everyone who works clinically. If any of those people raise their hand in a meeting and say they’re concerned about point B, I listen to them and I meet with them. I say, ‘Tell me why you’re concern about point B.’ Often, those concerns are very real and very valid, and it requires readjusting the blueprints before we initiate construction. And so, it is very important to engage with all those stakeholders.
“Connecting providers with the care they want to deliver”
My primary focus is obviously on provider engagement, but a close second are all of the other clinical people — and even the patients. I have patients who reach out to me about the MyChart patient portal. Ultimately, it’s about connecting clinical providers with the care they want to deliver and making sure that care is in alignment with what the patients expect. It’s achieving alignment and agreements on a lot of these things.
The architecture behind the workflow
The other part is also providing some architecture services. Because in that translation of getting people into alignment so that we can actually build something, it’s very important to have an architect who stands behind the workflow. Every blueprint I provide, from order sets to documentations to best practice alerts, must be in alignment to support the workflow that everyone wants. When I develop blueprints, I stand behind that. This is how deliverable A is going to function in conjunction with deliverable B and deliverable C. I then present the whole picture: ‘For this workflow, here are the seven deliverables and here is how work together. Here is how we’ve achieved alignment on them.’ Some people argue, ‘You don’t need to do that. We have one analyst who can just build deliverable B quickly and then we’ll figure out deliverable A and deliverable C later.’ That’s where you get disjointed workflows.
As a result of this work, we actually save a lot of time down the road because the analyst isn’t building and rebuilding. You don’t have a situation an order set has to be pulled out of production. When that happens, it’s a waste of time and resources. And so, doing that upfront preparation and having some rigor around it is very helpful at preventing downstream problems and unexpected outcomes.
Gamble: It’s really interesting what you said about being a translator, because for that to work, both sides need to trust you. They need to believe that their needs are being represented. I’m sure it can be difficult.
Stanley: Every interpreter must have a good relationship with the people they serve. The United Nations argues that good interpreters actually need to spend time in both worlds to be able to translate effectively. I spend my time going between the two worlds, but I also read New England Journal of Medicine and other medical journals to try to keep up with everything.
In many cases, however, I’m not the clinical expert. I depend on frontline department chiefs and others to provide the clinical expertise. But I will often ask them to show me the journal article or the data that support what they’re saying. That way, we can ensure we’re all in agreement that we have good evidence to support what we’re building.
Starting at the IT helpdesk
Gamble: Looking back at your early career, what first made you interested in pursuing the CMIO role?
Stanley: I actually started in IT. I was 15 years old when I got my first job in high school working the helpdesk for a software company. I was the one installing PCs and laptops and maintaining a network patch panel for a Unix server in a small software company in Hartsdale, NY, where I grew up. It had about 100 employees and I learned all about security and support. In fact, I was actually the person who had to deal with angry calls from salespeople. They call me in the middle of a million-dollar sales pitch and say, ‘Dirk, my PC isn’t working. You have to get it up and running!’ And I’d frantically try to do that.
When I went to college, I continued in that vein. I interned briefly at IBM as a data network technician, where I translated and helped troubleshoot for a global data network (this was before the internet). I worked with the other network operators around the globe, and because I grew up speaking German, I often interacted with German network operators. I realized that information is very important, and as it’s transmitted from one place to another, we need to make sure that information gets to the right place.
Filling the data analyst role
After college, I continued doing IT computer work and consulting, but I got burnt out and didn’t know what I wanted to do. At this point, I was basically living at home in my parent’s basement, which they reminded me was not an acceptable arrangement. I knew had to get a job, but I didn’t know what I wanted to do. I had a friend whose mom was the patient representative at Westchester Medical Center in Valhalla, NY. She asked if I wanted to come in and volunteer. When they looked at my resume, they saw that I had computing experience, so I started working for the IT department at Westchester Medical Center as a volunteer. As fate would have it, one of their data analysts in the quality department had just resigned. I was offered the position of a medical data analyst, which I gladly accepted.
Unanswered medical questions
During meetings, I would ask questions like, ‘What is vancomycin-resistant enterococcus? I know there are studies about it, but I don’t really understand it.’ And, ‘why does the central line keep getting infected, but not the line on the left or the line on the right?’ The doctors basically told me to stick to my spreadsheets. It was, ‘We’ll do the medicine, and you do the computer stuff.’ But I remember thinking, ‘I don’t even know what it is I’m studying. I want to understand this better.’ And so, I started volunteering with local Ambulance Corps, and that led me to apply to medical school.
The irony is, when I was applying for medical school, they looked at my application and said, ‘You’re a computer person. Why would we want a computer person in medicine? You’re over here, and we’re over here.’ And so, after two unsuccessful attempts getting in, I took my father’s advice and applied to schools overseas. I graduated from St. George University in Grenada and went to a little island in the Caribbean, where I finally learned what a vancomycin-resistant enterococcus is.
Two worlds not colliding
Two years later, I came back to New York with my white coat and stethoscope, feeling energetic about my med school rotation. I saw people working with computers and was like, ‘Wait a second. You’re typing something into database A and printing it out, and then putting it into database B and printing it out, and then putting it into database C, and you have no identifiers. You’re creating duplicate records. You can’t do that.’ And they’d say, ‘You do medicine. We do computers. You belong in this box, and we belong in that box.’ I remember thinking, two years later, and they don’t want me here either.
Enter clinical informatics
Anyway, I did my residency in internal medicine at Albany Medical Center, and it kept happening; people would have problems, and I knew how to address those problems. A year after I graduated, I applied for a job at Cooley Dickinson Hospital, my former employer. Informatics wasn’t even in my vocabulary at that point. But while I was applying for a hospitalist job, they looked at my résumé and said, ‘You’ve done data analysis and computer consulting — you have a whole background in IT. Have you heard about Meaningful Use?’ As it turned out, they were looking to implement an electronic medical record, and they needed a CMIO.
I went home and immediately googled, ‘clinical informatics.’ This was around 2007 — there wasn’t a lot of information on the internet. But it said clinical informatics is a discipline where you can combine both clinical care and data management in a harmonious discipline called clinical informatics. It was like the clouds opened up and the birds started chirping. I had finally found a place where I fit. That’s how I ended up here.
Gamble: It must have been so satisfying to see those two worlds come together.
Stanley: It finally made sense. When I was applying to medical school, I didn’t know how to answer why we need a computer person in medicine. Now I have a much better answer.
The dancing bumblebee
Gamble: So it was persistence on your part, but the timing with Meaningful Use didn’t hurt.
Stanley: It logically fell into place in the right moment in history. There’s a video for the song ‘No Rain’ by Blind Melon where there’s a little girl dancing in a bee costume. She’s all by herself, then finally she opens the gates there are all these other people wearing the same costume. That’s what it was like for me. Suddenly there was a world full of bee outfits.
Diving into the blogging world
Gamble: That’s great. The last thing I want to talk about is your blog. What made you decide to do that? What do you get out of it?
Stanley: I started doing that early in my journey. When you’re a physician and you’re put into a leadership role, there’s not a great training pathway for that. There are classes that you can take for being a physician leader, but they require time and effort and resources. In full transparency, I’ve taken some of those classes, and I’ve learned so much by doing that. But there were a lot of times when I learned something along the journey and thought, ‘this would be helpful to someone else.’ Or, if I can prevent one person from making the same mistake, that would be helpful.
And so, I started blogging. For all of those people wearing the bee costume, I want to create a place where they can share and access those lessons learned. A lot of it is about applying the rigors of engineering and process engineering. I seem to get along very well with project managers, Lean and Six Sigma people, and industrial engineers. We all speak the same language. But all those people had their own training pathway, whereas there’s not really a great training pathway for physician leaders.
Removing the “mystery”
I wanted to take the mystery out of things like, how do you build a workflow? How do you know the workflow is complete? How do you know you’ve identified all the deliverables and all the stakeholders? How do you know it’s safe, properly budgeted for, and would pass regulatory muster? These questions are not mysterious. Once you start to understand how change management works, it’s very logical. I wanted to take the mystery out of it for other people.
That’s when I started blogging. It doesn’t require complex rocket science. It’s not mysterious. It’s not taboo. It’s fundamental change management written in a way that hopefully other clinical people can understand and appreciate.
A better foundation of healthcare knowledge
Gamble: It’s really an interesting way of looking at it. There never seems to be time to stop the machine, especially in the last year and half.
Stanley: It’s amazing if you think about it. Healthcare has been open for business 24/7 for the 250 years. There’s never been a time when it could close. For example, if Starbucks wants to retool their HR policy, they close. We don’t have that opportunity.
I think if we don’t make some effort to really talk about the infrastructure and all of these fundamental principles, people might still learn about them. But they’re learning because something went wrong — maybe they raised their hand and had an embarrassing response to their question. That’s not the way it should happen. We should be giving people a good solid foundation of questions like, what is healthcare? Who are the people inside it? What do those people do? There are so many fundamental things that can be developed and improved.
Gamble: Definitely. Well, I want to thank you so much for your time. It was great to speak with you.
Stanley: My pleasure. I want to thank you and Anthony on behalf of myself and every other clinical informatics person. I learn so much by going through your site and reading about what other people are doing. It provides tremendous insight.