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Physicians Lead The Way On Quality Improvement Projects
Doctors who are taking on the role of CMIO are devising ways to use I.T. to achieve clinical goals
November 1, 2007
During the last 10 years, a growing number of physicians have taken the plunge into the world of information technology, spending at least part of their time on clinical automation projects.
At first, these pioneers had a variety of titles, including medical director of information systems, and their duties varied widely. "Most of us started as physician champions for I.T.," says Howard Landa, M.D., chief medical information officer at Hawaii Permanente Medical Group, Honolulu. "All we did was bother people until they got something done."
Today, Landa and others like him who carry the newer CMIO title are taking a leadership role in the effort to use I.T. to achieve tangible quality improvement results.
"The role has evolved from making sure clinicians' voices are heard in the selection and implementation of systems to making sure those systems are used to impact the quality of care," says Michael Blum, M.D., who is CMIO at University of California San Francisco Medical Center.
One illustration of the growing involvement of physicians in I.T. is the ballooning membership of The Association of Medical Directors of Information Systems, which represents physicians who are CMIOs or serve in similar roles. The 10-year-old association now has nearly 1,900 members, up from 150 in 1997.
A new AMDIS survey confirmed that CMIO's priorities are changing, with a focus on leveraging technology to improve clinical processes.
Ambitious Projects
Across the country, many CMIOs are taking a lead role in next-generation clinical automation projects designed to use technology to get better clinical results.
For example, UCSF Medical Center, which earlier installed the Centricity line of clinical systems from GE Healthcare, Waukesha, Wis., is now selecting and implementing a business intelligence system to provide near real-time assessments of clinical performance, Blum says.
Although UCSF, like many other hospitals, can conduct post-discharge analysis, the organization wants to analyze clinical data while a patient is hospitalized so it can optimize treatment, the CMIO explains.
"The new system will get data out of our clinical information system and analyze it to figure out whether patients now in the hospital have received all appropriate therapy based on clinical guidelines," Blum says. For example, the system could pinpoint heart patients who are not receiving a daily aspirin and validate that smokers are automatically enrolled in smoking cessation therapy.
Using I.T. to make sure care is delivered in a more consistent way is also the goal behind a clinical data warehouse project at Shriners Hospitals for Children, Tampa, which operates 22 hospitals across North America. The hospitals provide free care to children who need orthopedic and burn treatment.
Bill Bria, M.D., recently hired as the organization's first CMIO, is playing a key role in launching the beta test of the data warehouse from Cerner Corp., Kansas City, Mo. The technology will enable Shriner's to conduct outcomes research so it can refine treatment guidelines, the CMIO says.
"Informatics is really about information, not computers," Bria says. "We have to understand the cycle of information for health care, and then pick the right tools, including an EHR and ultimately a clinical data warehouse."
Laying The Groundwork
Before a quality improvement project can get started, a health care organization must have the infrastructure in place to gather the necessary data. Some CMIOs are continuing to help their organizations roll out the necessary technology to lay the groundwork for future projects.
For example, 12-hospital Centura Health, Englewood, Colo., has installed a new clinical system from Medical Information Technology Inc., Westwood, Mass., at four of its hospitals. The remaining facilities will go live by the end of this year, marking the start of a new era of uniform systems throughout the organization, says Michael Shrift, M.D., vice president of I.T. and CMIO.
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