The Role of the CMIO

Although my business cards and my CV list the title Chief Information Officer, I was given the title Chief Medical Information Officer (CMIO) when I was hired at BIDMC in 1998.   Today, I serve four kinds of roles:

CIO - Responsible for strategy, structure, staffing, and processes for a 300 person IT organization with 83  hospital, ambulatory, and emergency/urgent care locations
CTO - Responsible for the architecture and operations of our applications and infrastructure, ensuring reliability, scalability, and affordability
CMIO - Responsible for the adoption of the applications by clinicians, optimizing quality, safety, and efficiency in their workflows
CISO - Responsible for the security and data integrity of all applications and infrastructure, supporting regulatory compliance and maintaining privacy

Although I've been able to balance these roles because of the extraordinary IS staff at BIDMC, good governance, and a supportive CEO, it's challenging for one person to perform all these tasks.  Many hospitals and health systems are expanding their management team to include a CMIO.

Here are a few thoughts about the role of the CMIO.

*Clinical applications are only as good as the processes they automate.   Automating a broken process does not make it better.  Clinician stakeholders working with a CMIO should re-engineer workflows, document requirements, then begin software implementation.  

*Achieving consensus among clinicians is challenging.   Medical education is an apprenticeship that is part art and part science.   It's unlikely that one automated best practice, care plan, or guideline will be acceptable to everyone.   The role of the CMIO, as a trusted practicing clinician, is to create consensus around software configuration and decision support rules.

*Selecting new applications can be a daunting experience.   Integrated or interfaced?  Complete or modular? Best of suite or best of breed?   What may be the best solution for a department may be less than optimal for the entire institution.   The CMIO can weigh the pros/cons, cost/benefits, and the overall  integration into the enterprise portfolio during application selection.

*Nothing is perfect and clinical systems implementation will always be a journey, balancing compliance, security, ease of use, automation of manual processes, and safety.  Clinicians have constantly evolving needs and they will frequently feel that the IT organization does not have the supply to meet their short term demands.   The CMIO can run processes which engage clinicians in priority setting and resource allocation decision making.    Although the projects they want will likely be done at a slower pace than they'd prefer, they will understand the balance of time, resources, and scope because they were involved in creating the plan.

*Often, there are no right answers in clinical IT.   Given fixed time and resources, what is the top priority - Meaningful Use, ICD-10, healthcare reform, Joint Commission mandates, or quality improvement agendas?   Some may answer, all of them.   The CMIO can advise senior management how to phase an endless stream of projects so that the greatest good is done for the greatest number over the long term.

Who should the CMIO report to?  Choices include the CIO, the CMO, the COO, the CEO, or some governance group i.e. the Medical Executive Committee.     Every organization is different and the reporting relationship should be a function of where the CMIO can have the greatest impact, visibility, and support.

In my view, Meaningful Use, increasing demands for clinical workflow automation, and healthcare reform necessitate that every hospital larger than 50 beds have a  full or part time designated CMIO.    Given the daunting array of clinical IT requirements over the next 5 years, CMIOs will be increasingly important.