When executives at Saint Peter’s Healthcare System decided to hire a full-time chief medical information officer, they recruited a physician from outside of the medical staff.

For several years, the system had filled the position with a local physician, who did it on a part-time basis.  But as plans to transition to a new inpatient electronic health records system took shape, they realized they needed a full-time CMIO, says Frank DiSanzo, chief information and strategy officer at the New Brunswick, N.J.-based system.

As a part-timer, the first CMIO hadn’t been on site often enough “to act as an advocate as far as adoption,” DiSanzo recalls.

The health system, which includes a 478-bed teaching hospital, plans to move its inpatient EHR from McKesson Horizon to McKesson Paragon in October 2016. The system will continue to use a product from athenahealth on the outpatient side.

Before beginning the search, the health system’s executives decided on the qualifications of their ideal candidate. Topping the list was previous experience as a CMIO, including designing templates for order sets and quality reporting, and securing physician support for an EHR implementation.

On the other hand, the system wanted the new CMIO to be someone who hadn’t been removed from the day-to-day practice of medicine for more than five years. “We didn’t want the doctors to look upon this individual and say, ‘Well, the last time that person practiced medicine was so long ago that they don’t have and any credibility with me,’ ” DiSanzo says.

After conducting a search, the health system hired Eliot Heller, MD, in 2013. Before joining Saint Peter’s Healthcare, Heller had been a CMIO at both Mercy Health System in Conshohocken, Pa., and Bronx-Lebanon Hospital Center in Bronx, New York.

Liaison role

While some healthcare organizations, like Saint Peter’s Healthcare, have created a formal CMIO position, others are just now considering whether to formally establish the role. Some organizations, particularly small institutions, can’t afford to hire a CMIO, but they do designate a practicing physician to serve in this capacity on an informal basis, notes Richard Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).  

In a survey of 248 CMIOs, more than 85 percent said they had annual salaries of at least $201,000, with more than 10 percent reporting salaries of $350,000 or more. Executive search firm Witt/Kieffer, based in Oak Brook, Ill., conducted the survey with AMDIS and released the results in February 2015.

Depending on the organization, the right combination of education, skills and professional experience for the CMIO can vary. However, most, like Saint Peter’s Healthcare, want someone to serve as a liaison between the medical staff and the institution, particularly the information systems staff.

“This person is a leader and a change agent,” says Hillary Ross, a consultant at Witt/Kieffer who specializes in recruiting CMIOs and other IT executives. Successful CMIOs should be both diplomatic and visionary – they should be able to persuade physicians that a new information technology, usually an EHR, will benefit patient care and, therefore, is worth the time and effort required to design, install and optimize it, Ross adds.

Howard Landa, MD, CMIO at Alameda Health System in Oakland, Calif., agrees. “Really understanding how people change, and why people change and being able to manage that change is the earmark of successful CMIOs,” says Landa, who also is vice chairman of the board of AMDIS.

Good communication skills go hand-in-hand with leadership and change-management skills, he adds. “If you can’t communicate your message, managing change is impossible.”

Supporting IT

Assisting the other side of the physician-institution equation also is important. “CMIOs are such a support to an IT department. They really, really help the rest of the department think about what the other physicians are looking for, and what they need and what makes them happy,” says Bobbie Byrne, MD, vice president and CIO at Edward-Elmhurst Health in suburban Chicago.

Like Saint Peter’s Healthcare, Byrne says Edward-Elmhurst found that it was important for a CMIO to spend a lot of time on site. “Our campuses are 30 minutes apart, and it is really essential to have one on each campus,” Byrne says, adding that Edward Hospital has a full-time CMIO and Elmhurst Hospital has a part-time CMIO. A third CMIO works at the Elmhurst Clinic, a multi-specialty group practice.

Broward Health, a public hospital district in Broward County, Fla., also subscribes to the boots-on-the-ground approach. It has numerous part-time CMIOs—one at each of its four hospitals, one representing the ambulatory clinics and one for the doctor’s offices, according to Doris Peek, senior vice president and CIO of Broward Health.

But unlike Saint Peter’s Healthcare, Broward recruited all of its CMIOs internally because Peek believes that an existing member of the medical staff already has “inroads” with his or her peers and also understands the unique politics of the organization and the personalities of individual physicians.

Peek recruited the part-timers to replace a pulmonologist who had held the role but has since returned to practicing medicine full time. “He was a flagship personality,” she says, referring to Broward Health Medical Center, but he was not well known among physicians at the other hospitals, ambulatory clinics or physician offices. Based on that experience, she concluded that one person was unlikely to develop a rapport with all physicians.

Rydell, who refers to leadership, communication and change management skills as important competencies for any executive, says there is a lack of formal educational opportunities for CMIOs to learn these business skills. That’s why AMDIS plans to host a two-day course—CMIO Survival Guide: The Crash Course—twice in 2016, Rydell says.

Clinical integration

In addition to business competencies, CMIOs should be able to design clinical workflows and order sets.

Edward-Elmhurst CMIOs, for example, are designing new electronic order sets that incorporate the latest evidence-based protocols in medicine. Elmhurst Hospital, which uses MEDITECH’s inpatient EHR, will move to Epic’s inpatient EHR in October 2016. While Edward Hospital is already using Epic, its EHR will be updated to include the new order sets.  

Another important CMIO competency is a technical background, or at least an interest in information technology. Historically, CMIOs developed technical expertise through on-the-ground training, but formal education has become more common in recent years.

Landa, a pediatric urologist, has been working on information technology projects in a variety of roles since the 1990s. In 2009, he joined the staff at Alameda as the full-time CMIO, although he continued to practice medicine about four days a month until 2015.

Like Landa, Gregory Ator, MD, CMIO and senior medical director at the University of Kansas Hospital in Kansas City, also has learned by doing. However, he says the informal training process was likely easier for him than for other physicians because of his undergraduate education in electrical engineering. “That technical framework allows me to not be intimidated when we are in a system selection process,” Ator says.

Formal training

Formal training to become a CMIO through a fellowship program in clinical informatics is an emerging trend, according to Ross.  In the Witt/Kieffer survey of 248 CMIOs, 30 percent of the respondents said they had formal informatics training, and 32 percent said they were board certified in clinical informatics.

One way to obtain formal credentials is through certification in clinical informatics from the American Board of Preventive Medicine. Until 2018, physicians with at least three years of experience in clinical informatics may apply to take the exam. After 2018, the board will require candidates to complete an accredited, 24-month fellowship in clinical informatics.

“People who have been doing this for 20 years, and I am one of them, may not be particularly worried about getting a fellowship or getting board certified,” Landa says. But such training and credentials are important for physicians who are in the early years of their career, Landa adds. In the near future, “virtually everyone will have that if this is what they want to do. It really calls out the fact that you are committed to this—that this is a career choice as opposed to dabbling,” he says. 

And as organizations move beyond implementing and optimizing an EHR to developing strategies and predictive capabilities to oversee populations of patients, CMIOs also will tap into their analytical skills and their “basic understanding of data and how data can be used,” Byrne says.

Most CMIOs have honed these skills already through the practice of medicine, she notes. “Physicians are good at analyzing a lot of disparate data. You have to be able to weigh the different options and make a decision without 100 percent perfect information,” she says.

DiSanzo agrees, adding that CMIOs’ knowledge of medicine will prove invaluable as health systems incorporate predictive analytics into their population health strategies. “As those tools become more mainstream, they are going to have to be tweaked and overseen by the CMIO,” DiSanzo says.

While most institutions want to hire CMIOs with most or all of these skills, there is variation in the list of qualifications based on the culture of a given organization, Ross, the recruiter, says. For example, “someone with a community hospital background might not be successful in an academic medical center. If they haven’t worked with research before, they wouldn’t be a good fit for an academic medical center,” Ross says.

Ross offers two more examples: “A Midwest hospital client has an easygoing-type culture, and they have told us that someone with a hard-driving, tough and impatient personal style will not work well there. In some organizations, the CMIOs have to be comfortable with ambiguity, and some CMIOs don’t like working in that type of setting.”

“There are a lot of variables that go into the cultural fit,” she says.

When the match between institution and CMIO works, all stakeholders—physicians, executives, and IT department employees—benefit, Byrne concludes. “Usually with a good CMIO, everybody is happy when that person walks into the room.” 

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