Memo from the CEO: Why You Need a Physician as a CMIO

When asked why it is important for a hospital to have a chief medical information officer (CMIO), Pam Brier, president and CEO of Maimonides Medical Center in Brooklyn, N.Y., prefers to have the question phrased in a different way: Why is it important to have a physician serve as a CMIO?

Of course, Maimonides didn’t follow a traditional path when it came to filling the role of CMIO. In fact, the center doesn’t have a full-time executive devoted to the position. Instead, as it does with most of the physicians who serve as chairs of its clinical departments, the facility has given its CMIO multiple responsibilities. Steven Davidson, MD, not only serves as Maimonides’ CMIO, but is its chair of emergency medicine as well.

No matter which hat he’s wearing—emergency department head or CMIO—Davidson reports to Brier, although she says it seems he spends the bulk of his time with the vice president for management information systems. He also chairs the hospital’s medical informatics committee and is the lead physician representative and spokesperson on its IT/MIS advisory committee.

HIT point person

So how did Maimonides settle on this hybridized version of a CMIO model? “Even though we’ve been in the black for the last 13 or 14 years, we’re not a wealthy hospital,” says Brier. “So each person has a couple of jobs, and Steve early on said, ‘I’m interested in technology, I’m knowledgeable about it, and I want you to use me as the go-to-person.’ So he’s been in that role for a long time.”

Fourteen years, in fact, by Davidson’s reckoning, dating back to when he was first hired by Maimonides. One of his conditions for coming to work at the hospital was that Maimonides implement electronic medical records (EMRs) in the emergency department.

His demands met, Davidson very quickly immersed himself in the ED’s IT requirements. “A number of us really took the lead in pressing for institutional CPOE implementation,” Davidson recounts. “We were able to implement a PACS and, meanwhile, I was implementing an offline, back-end system in support of both billing, but, more importantly, some data warehousing and management based on analytics. By doing that we were able to substantially refine what was happening in the emergency department, and we demonstrated that both from a community acceptance measure and with the financial improvements we brought to the hospital. “

The acceptance and financial wins gave him more credibility, Davidson says, as a leader in IT implementation as the hospital moved toward the implementation of a full EMR in the emergency department. (By unfortunate coincidence, the ED EMR system went live on Sept. 11, 2001, at 7:30 a.m., and came down about 2 hours later after two passenger jets rammed into the World Trade Center towers, just across the river from Maimonides in Manhattan. “We had other fish to fry that morning,” recalls Davidson, and it took a couple of months before the EMR went back online permanently.)

Davidson’s success in implementing the ED EMR, as well as his interest in, and passion for IT, marked him as Maimonides’ point person in matters of health information technology. “I just had this capacity to move between the technology folks, the clinical system implementers in IT, and the clinical leaders in the hospital,” says Davidson.

“He’s become the public champion for using information technology as an important management tool,” says Brier. “And I think that it’s important to have a senior physician be the champion, the expert, the person who can talk to other doctors.”

And someone who can talk to her as well, Brier notes. His HIT views are often powerful and passionate, she says, and that “sometimes he surprises when we meet and he pushes me in one direction or another, giving something to think about.”

It’s not that Brier believes that non-physician managers can’t talk to doctors—she doesn’t. She does think, however, that in terms of getting hospital personal to buy into a new system or information process, it helps “as a practical matter” to have a senior physician serve as the hospital’s IT point person. “What I am saying,” she says, “is that nobody knows a doctor’s business like a doctor.”

For example, Maimonides is about to install Eclipsys’ Sunrise Clinical Manager solution, and, according to Brier, as a “doctor-focused” hospital, Maimonides will not implement a system that doctors dislike or won’t use. Having Davidson serve “as the designated leading spokesperson and champion” for the Sunrise Clinical Manager implementation will help assure widespread physician acceptance of the solution, Brier says.

She says it also helps that Davidson is not only focused on emergency medicine, but on other areas such as primary care and inpatient services as well. “So he knows a lot about care outside of the emergency room, which makes him a really good person to work on these IT issues because he is immersed in what goes on outside of his own area,” Brier says.

Davidson points out that most hospitals have mission statements that start out with a pledge to serve patients, their families and the communities in which they live, adding that his job is to ensure that Maimonides’ clinicians “face the patients more and the systems less.”

“I’ve never met a doctor or a nurse working at the bedside who really wanted to be playing computer games,” observes Davidson. “In the role of CMIO, I have sympathy for the view that clinicians are concerned about their patients and we must support that concern and the capacity for the clinician to render care. And that means that IT systems must be easy and facilitate fluency, rather than confound and lead to conflict.”

And clinicians need to support that effort, Davidson says, adding that while many of his IT colleagues “are wonderful folks, they don’t have the experience of walking a mile in a clinician’s moccasins.”

Into the future

The increasing use of information technology to help manage the care of patients means that “it’s going to be even more important for doctors to be meaningful users of information technology,” says Brier. “I think Steve will have to be a champion for that—a proselytizer if you will—and I can see him involved more on the frontline of some of these issues.”

Davidson sees his role revolving as he gets older (he’s just shy of 60), and he notices the age difference every time he attends an AMDIS (Association of Medical Directors of Information Systems) conference where it appears that most of his colleagues are appreciably younger than he is.

“I’m pretty savvy on the technology, and I think I’m pretty nimble on my feet,” he says. “But I think my biggest value going forward is in mentoring some of the not quite or just 40 year-olds who are really going to be knitting the technology and the high-touch aspects of care together in their own leadership of integrated healthcare delivery, whether it’s here [at Maimonides] or elsewhere.”