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The Three Wise Men


By William F. Bria, M.D., Chief Medical Information Officer Shriners Hospitals for Children January 1, 2008

This is a story of the three wise men of health care information technology, the chief medical information officer, the chief information officer and the chief medical officer. These three have been, in large measure, responsible for the successes, failures and hopes for health care information technology. Understanding these three may help illuminate our HIT past and future.

The CMIO

The CMIO is the newest member of the three. He is most often a practitioner who has been interested in health care information technology and has been an enthusiastic advocate to his peers. His enthusiasm has been recognized by hospital leadership, usually at the time of planning the introduction of computerized physician order entry. He has been offered a part-time role and a title that has previously been known as "physician champion" or "medical director of clinical systems", but now takes on the four-letter acronym, CMIO.

He has known the bittersweet consequences of this new title, with previous colleagues regarding him with everything from suspicion to contempt. However, he is driven by another abbreviation: CDS (clinical decision support) to seek the golden integration of medical knowledge and information tools, available to all clinicians at the point of care.

Like the first radiologists of another era, the CMIO sees the potential of a technology in service of patient care, yet tragically lacks the manifest value of the radiograph. The CMIO aspires to continued growth in his role, even growth into further leadership responsibilities, if he is insightful enough to realize that the real treasure in HIT is not the technology, but the information.

The CIO

The CIO has a business or technology background. In the not so distant past, he was the data processing director or even vice president of information systems, but now he is pleased to be considered a member of the "C Suite."

Often there has been little explicit change in expectations, yet there has been a tremendous increase in both business and technical challenges as health care moves from I.T. for billing only to full implementation of electronic health records with the expectation of interoperability with a national health network.

As the focus has shifted from accounts receivable to clinical workflow, the CIO has often selected and brought the CMIO into his organization. The confident CIO has seen this new member of his team as a critical team member for success. The less confident are threatened by the very presence of a physician in their midst.

As the alignment between clinical performance and the success of a health system becomes explicit, the leading CIOs insist on the measurement of HIT value and closer scrutiny of the impact of systems on patient care and safety.

The CMO

The CMO in years gone by may have been the kindly pre-retirement physician, graciously willing to come into the office several days a week to sign committee minutes and speak to a troubled young clinician. Today the CMO is challenged to integrate the worlds of clinical practice, quality, health care economics and clinical decision support. HIT is an instrument of the highest importance to today's CMO.

Some may even have come from the ranks of the CMIOs. Most all have come with MBAs. Dancing over the hills and valleys of the quicksand that is U.S. health care today, the CMO is challenged to remain agile, yet steer the clinical direction of his organization with a steady hand.

The CMOs that inspire are those that retain the deepest roots in patient care. They are also those that understand the critical value of I.T. to assist in decision making based on information rather than opinion.

So there we have the story of three wise men. How will my organization survive in this changing world? Ask them.

I know what you're saying, "What about the CEO?" Never fear, she knows who's in charge.

(Editor's Note: Dr. Bria is also president of the Association of Medical Directors of Information Systems, a professional group representing CMIOs.)

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