With healthcare providers largely having electronic medical records systems in place, traditional roles for top information technology executives are evolving.

CIOs now see chief medical information officers ready to take on new responsibilities, particularly as the provider organizations that employ them are counting on them to play a key role in using information systems to support value-based care and other quality initiatives.

The pivotal role of the CMIO in shining a light on the clinical side of the business should be reflected in standing alongside the CIO. Experts say that increases the odds of reaching understanding with the all-important physicians and other clinicians in any shift of practice priorities.

In fact, both CIOs and CMIOs now need to be heavily involved in the clinical operations of healthcare organizations, relying on the CMIO for guidance for how to adapt IT to serve clinical purposes. That can be a challenge for some CIOs, who typically have deep technical knowledge but may not have clinical knowledge or know exactly how HIT can be applied to improve clinical performance.

But because relationships between CIOs and CMIOs are evolving, in some cases frustrations are rising because of changes in their roles.

CMIOs can be frustrated that CIOs have the bulk of the budget and staff, with the missive to the CMIO to “Go out and get the doctors to do what I need them to do,” says George Reynolds, recalling encounters with CMIOs during his instructional sessions as a CHIME Boot Camp faculty member. But they lack the “positional authority” to have the desired impact.

CIOs, meanwhile, can see CMIOs as difficult to work with, Reynolds says. “Both sides sometimes talk past each other, and one of the things we focus on is how do you develop a partnership if you’re a non-physician CIO. Do you get viewed as a solution-maker or a problem-creator?”

Providing resources is a first step to that working relationship. “Convincing CIOs to give up some budgetary authority, some control in order to support the CMIOs is sometimes a tough sell, but it’s the right thing to do--making the CMIO your partner,” Reynolds asserts.

Stanford Children’s Health CIO Ed Kopetsky was clear from the start that Christopher Longhurst, MD, had equal standing when he was made CMIO seven years ago.

“I told Chris when I hired him that I didn’t want anything but a partner . . . which means we’re going to make decisions together, we’re going to share confidential information, we’re going to go to meetings that we’re going to represent each other at.”

Stanford Children’s Health

Kopetsky makes himself visible and engaged in the clinical environment regularly. Besides serving on a patient safety committee and other instances of direct interaction, he gets out of the office every week to see clinical processes. The CMIO still is his main contact, but he says part of his job is to have credibility, gained by going out to ask what problems clinicians have that he can help with. That’s how to get support. “Don’t delegate credibility. You’ve got to earn it.”

In the emerging value-based archetype, “Healthcare IT shops are really healthcare first and IT second,” says Longhurst, who is now CIO of University of California San Diego Health, having left the CMIO post at Stanford Children’s Health.

Longhurst was put in charge of implementing computerized provider order entry at Stanford—twice. Initially operated on a Cerner platform, the children’s hospital and its physicians had to go through a switch to an Epic system as part of an organization-wide IT replacement, and Longhurst’s physician champion role was sorely needed, says Kopetsky.

With the EHR in place for a few years, though, it became just another tool to help provide care, and Longhurst’s role went from champion to team leader in a rapid evolution from a focus on implementation to one emphasizing outcomes and optimization.

This type of shift in responsibilities is likely to continue because reimbursement approaches are changing in healthcare, and that presages a change in how IT will support care delivery. For example, applications are already rolling out in markets that are rapidly moving from fee-for-service reimbursement to methods of payment based on meeting quality and cost performance targets.

At the minimum, a shift to illness prevention and early intervention requires the ability to design and make good use of registries that define the patients with specific conditions to monitor and manage.

But like EHRs, registries just set the stage for the new work that will be critical to the success of healthcare delivery in an environment of clinically integrated networks, pressure for efficiency and adherence to agreed-upon best practices. Only a partnership between CIO and CMIO, and an overlapping grasp of each other’s realm, can make this type of operation truly work, says Reynolds, a retired CIO and CMIO who is on the faculty of the CHIME Boot Camp program.

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