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| William F. Bria, MD, CMIO at Shriners Hospital for Children in Tampa, Fla., and chair of the Association of Medical Directors of Information Systems (AMDIS) Source: doctorshelping doctorstransformhealthcare.org |
The Association of Medical Directors of Information Systems (AMDIS) released the results of its annual CMIO survey on June 28 at the Physician-Computer Connection Symposium in Ojai, Calif. Moving beyond the numbers, William F. Bria, MD, chairman of the AMDIS board and director of informatics at Shriners Hospital for Children in Tampa, Fla., shared his thoughts on the survey with CMIO.
110 CMIOs participated in this year's survey, which was administered by Gartner. The vast majority, 79 percent, work at an integrated delivery system.
What was the biggest difference between last year’s and this year’s results?
The obvious thing is that the number of physicians becoming CMIOs is increasing markedly. Meaningful use has had an impact on that, but every significant change is a logical change if you understand the historical context: the fact that a lot of health IT systems and products have reached a maturity level where they’re ready to go; the fact that U.S. healthcare, from an economic and political standpoint, is front and center; the fact that the relationship between healthcare and financial status is in a different place than it was just eight years ago.
All of these things make the increasing interest in using automation and leveraging the information that it provides common sense. There are areas of health IT that we’re still pioneering, like population health, but this spike shows we are in the early days of better integrated clinical workflows.
What was least surprising to you about the results?
A significant change that has been taking place over time has been the CMIO reporting relationship. The number of CMIOs reporting to CMOs is increasing. As the field matures, it is becoming less about implementation and more about integrating health IT tools and health data into the practice of medicine.
Thirty-six percent of CMIOs report solely to a CMO or to both a CMO and CIO, compared with 32 percent that report solely to a CIO. It’s totally unsurprising that the home for the CMIO or the trajectory for the CMIO career path is going to be clinical rather than technical. Seventy-six percent want to stay CMIOs with an expanded role; the role they’re thinking of is often CMO. We are doctors—we are just more articulate and well-versed in the use of a particular instrument in the pursuit of the core profession.
What was the most surprising to you about the results?
Only 8 percent of CMIOs advised a CIO-only reporting relationship. The recommendation was much stronger than what I expected. It seems like they’re getting pretty fierce about it. They are strongly encouraging young ones coming up to seek a different kind of reporting relationship. Looking at the survey results, it is still common for CMIOs to report only to a CIO, but the advice we’re giving to younger colleagues in terms of the reporting relationships they should seek, it is pretty stark. That’s not really so much an indictment of CIOs as it is, again, a realization that individuals going into CMIO careers really hold their medical credentials and backgrounds with high regards.
What was most encouraging to you about the results?
The futures that CMIOs see for themselves. Now, only as CMIOs? No, they want to do that and start to climb the ladder with regard to clinical leadership. They want to be CMOs. That’s really encouraging because, even just to aspire, it indicates strong leadership skills, training and vision.
What was least encouraging to you about the results?
While we didn’t poll them, I believe that if you look at the group of CMIOs who have taken the job in the last 12 to 18 months, they’re not sure they want to do this forever because of the still present CIO reporting relationship. We were risk takers, but the older generation of CMIOs did not jump fully into the role early on because it was too risky. There was no evidence that it would be a long-term opportunity. Now that is no longer true. What we need to do is advise and counsel our colleagues as they come up and give them advice for career management that we would have liked when we started.
How is the CMIO role changing?
There’s an interest in analytics, in the idea that the engagement between the practice of medicine and the use of health IT does not end once an EHR has been implemented or all three stages of meaningful use completed. Analytics are forever, continuously requiring improvement and refinement. As new interventions and discoveries are made, we need to properly integrate them into the fabric of healthcare systems. There’s no such thing as a set-it-and-forget-it system, or a self-learning system that corrects its mistakes. We’ve got to sit and watch it like a hawk. It’s an awesome challenge.
When do you expect priorities to shift from EHRs to other areas?
If you include clinical data repositories in the EHR category, then that part will last forever. You may get a better laboratory data display, but that will occur rarely and will only make small differences. Analytics has to be dynamic. There’s no such thing as saying, “We ran those reports.” Well, do it again. Change it a bit and move to the next level.
What advice do you have for other CMIOs?
Get connected. The most time honored and effective tradition of learning in medicine is from our colleagues. It always has been, ever since the days of Hippocrates. In this modern age, I’m not talking just about the tips and tricks for getting physicians to use clinical decision support. We need to communicate with each other about ways to introduce quality, effective practices to whole hospitals and healthcare systems. The best way to be successful in this role is still to take an apprenticeship as a medicinist. It is up to the new generation to learn more than we ever did, to pick up and build off of all the wisdom and useful information from their forebears.
