The AMDIS Connection: The Incredibly Reluctant Interim CIO

I have spent almost two decades in CMIO-esque roles, but six months ago I had thrust upon me the additional role of interim CIO. I’ve always had incredible respect for CIOs. They have been mentors, friends, supporters and confessors. But, standing in the CIO’s shoes has opened my eyes in many ways. It has been very challenging but, in many ways, I believe it has made me a better CMIO. 

As a physician informaticist, I have always had to be aware of budgets and timelines, scope and milestones, and the need to get the best out of people. As the CIO, however, I am now responsible for actual budget compliance, management of project timelines and the hiring, firing and rewarding of the people who truly do the work. As the CMIO, I certainly have considered the trade-offs between the resources that need to be invested and the outcome of a project.

Now, in my dual role, what used to be an internal dialogue evaluating pros and cons has become a schizophrenic monologue arguing aloud about whether patient safety and physician experience trump system limitations and budget constraints. I have never been so acutely aware of the impact to my staff of even seemingly small decisions. When I finally shuffle off this CIO coil, my future interactions with all the leaders in my organization will certainly be tempered by these experiences.

On the other hand, the experience has galvanized my understanding of the importance of clinicians in all areas of medical informatics. I have said many times that if, as a CMIO, you are not told frequently “Oh, you can say that because you’re a doctor,” then you are not advocating for patients, physicians and the practice of medicine often enough.

Administrators will never know what it feels like to deliver devastating news to a patient or his or her family; and they will never really understand the depth and trust inherent in the personal relationship between a physician and their patient. They also will never experience the impact a system has on a clinician when it does not provide the necessary information, decision support or efficiencies that are required to be a provider in today’s world.

We need to constantly remind ourselves that our role as clinical informaticist is to provide an environment for our fellow clinicians to care for their patients. We provide the support to those who provide the care, and this “once removed” relationship does not separate us from our responsibilities as care providers even when this care is essentially provided by proxy. In many ways, that is what truly defines the chief medical information officer.