Through the eyes of a CMIO -- thoughts from Michael J. McCoy, MD

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As the trend of organizations employing CMIOs continues, Michael J. McCoy, MD, former CMIO of Catholic Health East (CHE), shares thoughts on the CMIO role, reporting structure, the value this physician leader offers, if and when to employ a CMIO, challenges and career path.

1) Describe your organization and your former responsibilities as CMIO.

CHE is among the largest Catholic health systems in the United States. The May 2013 consolidation of Trinity Health and CHE formed the second largest not-for-profit health system in the country, in terms of its combined $13 billion operating revenue. Only Ascension Health is larger.

I joined CHE as its first CMIO May 2010, about the same time my then boss, Judith Persichilli, was promoted to CHE President and CEO. Judy is now interim President and CEO of the CHE-Trinity Health, Inc. system.

The delivery of that care, safety, usability and process improvement formed the core tasks of my role. My responsibilities included working with certain departments (e.g., information services and clinical transformation) and leaders in selecting, developing and implementing electronic patient record systems across the health system. I also was tasked with ensuring that clinicians engaged in the process and adopted the technology.

2) What are key differences between the role of a CIO, CTO and CMIO?

In smaller organizations, you likely will not see many differences between the responsibilities of a CIO and CTO (if there is one). However, in larger organizations, the CIO generally is responsible for leading IT strategy, infrastructure and managing internal IT operations, including staffing and processing. A CIO’s role tends to be more technical; e.g., ensuring a data center is appropriately sourced, networks are operational and software is properly deployed. Complementing the CIO in larger systems may be a CTO, who looks toward identifying new technologies and how they may be used or integrated into the organization.

A few organizations have a CIO who is a physician, perhaps who came up through clinical ranks with exposure to technology, such as in an academic environment. These physician CIOs understand both clinical processes and technology. A possible analogy would be that a pilot may not know how to rebuild a jet engine, but understands general engineering concepts. An aviation mechanic, who also flies, may be better able to discern some nuances in diagnosing and repairing a malfunctioning jet engine. Similarly, an intricate knowledge of IT by a physician CIO is not mandatory, providing appropriate support by technology-savvy team members is present. However, these health-IT leaders must be able to connect the dots from informatics – to time, effort and capital required – to efficiency, execution and deliverables.

Basically, a CMIO is a physician who uses deep knowledge of clinical informatics to improve patient care and outcomes. An organization’s mission, how it is structured and the stage it is in along the path to computerization all impact this flexible role. For example, the stage the organization is in will determine how strategic this role needs to be. One organization may need a CMIO to help with physicians’ adoption of technology whereas another may need a CMIO to assess and implement consistent systems. Yet others farther down the electronic health record (EHR) path may ask their CMIOs to focus more on optimizing quality, safety, outcomes and efficiency from their existing systems.

3) What value does a CMIO bring to a healthcare organization?

This will vary based on whether the organization is a health system, hospital, academic institution, IDN, physician group practice, a combination – you
name it – and its mission. One thing to remember is that CMIOs are fundamentally clinicians at heart, who use technology to improve patient care.

Before the consolidation, CHE had 35 acute-care hospitals; four long-term, acute-care hospitals; 26 freestanding and hospital-based, long-term-care facilities; 12 assisted-living facilities; four continuing-care retirement communities; eight behavioral health and rehabilitation facilities; and 31 home-health/hospice agencies. You can imagine the smorgasbord of vendors clinicians used. While initially tasked to deploy an EHR that covered computerized provider order entry, physician documentation and clinician (nursing) documentation, CHE changed course when incentivized by Medicare and Medicaid and took advantage of meaningful use dollars.

To achieve meaningful use, you need patient and physician engagement, and the platforms in place to ensure continuity of care (e.g., from emergency to long-term-care facilities). No single vendor does all that … yet.

CHE’s vision is to offer person-centered care, not patient-centric care. The goal is to individualize care based on a person’s condition and risks, and coordinate that continuum of care throughout his/her life. We not only seek to improve patient care on a holistic level, but also to keep communities healthy. Caregivers are part of that equation as are technological coordination, connectivity and support. That was where I fit in.

4) What other challenges do CMIOs face?

A sentiment sometimes exists that physicians who are not practicing are not credible. I believe that physicians maintain their credibility if they have served their time in the trenches and truly empathize with their practicing physician colleagues.

In fact, a CMIO with clinical responsibilities may be alienated from other staff members if you also charge him/her with ensuring (potential referring) physicians are playing by the rules and complying with the expected use of new technology. You cannot underestimate the importance of having an engaged CMIO to properly manage physician interactions (with appropriate leadership support) if the hospital (including the CMIO) is to be successful in deploying or optimizing technology support solutions.

Another challenge relates to authority. Although responsibility and accountability are embedded in the role, sometimes sufficient authority is not. This can lead to slower or fewer achievements. In such cases, the organizational structure should be reviewed.

5) What advice would you give to physicians aspiring to become CMIOs?

Because knowledge of informatics is important, completing coursework or mastering in this subject is recommended; accredited institutions offer online fellowships. Physicians with MBAs also may be well positioned to lead. Embrace leadership opportunities. Other programs, courses and certifications may help with influencing skills, consensus building and physician adoption.

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