Throughout healthcare systems nationwide, leadership roles and responsibilities keep evolving just as the industry landscape continues to shift. One example of this is how the chief medical information officer (CMIO) role has grown over time, from a liaison between the clinical and technical staff to one that has become less technical and more operational.
According to the 2019 Leadership and Workforce Survey from the Chicago-based HIMSS, about seven in 10 provider respondents representing acute care hospitals said their organization employs a senior clinical IT leader (e.g. CMIO, CNIO, CHIO), a percentage that has not increased or decreased much over the last three years, according to the HIMSS research. What has changed, however, is the level of responsibility that the CMIO has taken on.
Going back 10 to 15 years, CMIOs, or clinical IT leaders before they were officially called CMIOs, were seen as the bridge between the IT department and the clinical community. Since they have always had the rare one-two skill set combination of clinical experience while also being well-versed in medical informatics, they were initially brought into healthcare systems to facilitate the implementation of electric health records (EHRs) while training clinicians on those systems. Dave Levin, M.D., former CMIO at Cleveland Clinic and current chief medical officer at health technology company Datica Health, said in a 2018 story covering the evolution of healthcare C-suite leadership that in the early days of EHR deployments, folks saw the CMIO as the person that should go deal with the “angry physicians.”
Similarly, Angela Tiberio, M.D, a physician executive/clinical solutions leader at consulting firm Impact Advisors, and a former CMIO herself, says the original chief medical information officer role was essentially “an army of one that grew out of the need to help physicians begin their journey towards advancing advanced health IT tools to practice medicine.” Another complicit component of this, Tiberio notes, was that CMIOs were often hired by CIOs [chief information officers], and “the underlying message was often that you had to keep the physicians in line because you [needed] to keep the system live. It was about getting them in in line, on-board, and [up-and-running on the EHR]. That was the biggest focus for the first decade or so.”
From there, CMIOs generally turned from being the ones who pacified physicians to implementers of EHRs and other health technology systems, especially once Meaningful Use—a federal program designed to incentivize providers to impactfully use EHRs—emerged. “The list of things CMIOs were responsible for kept growing, and now we are at a point where people really do understand that we offer much more than just technical ability or getting physicians in line,” says Tiberio. The more advanced organizations with respect to their CMIOs view them as integral strategic partners, looking to the future, and helping to strategically plan. It’s been a significant evolution.”
Today, while some healthcare systems will bring their CMIO to the executive table, that is far from the universal truth, notes Tiberio, who took her first CMIO position in 2002 when she was reporting to a CIO. But even back then, the CIO recognized the potential value of having the CMIO sit at the executive table. “I didn’t have to fight for that; he was very visionary in his view of what the role could be. But I wouldn’t say that this is universally correct, and in some cases, I have even seen some CMIOs stepping back from the executive table. That worries me a lot because I think that’s a reflection of old-school thinking.” Unfortunately, Tiberio contends, some executives still view CMIOs as “the geeky docs who help us get the systems live. But that’s not why we went into the field; we went into the field because we wanted to make care better. So now that implementations are waning, if you will, people are saying ‘OK, maybe I don’t need a CMIO anymore,’ but that couldn’t be further from the truth,” she says.
What it takes to be a successful CMIO
For those organizations looking to hire CMIOs today, what skill sets and other traits should they be looking for? Tiberio outlines what she refers to as the “six Cs” that make a qualified CMIO:
Clinical experience: Tiberio notes that this doesn’t mean someone who left medical school early and decided to work in healthcare technology instead. Rather, she says, “If I am in a position of interviewing for a CMIO position, I am looking for bonafide practice experience,” even if that person isn’t still practicing today.
Communication: Tiberio attests that a core element of the CMIO’s job is to help his or her colleagues understand the complexities of these technology systems, while simplifying things for them at the same time. “So if I go in and start talking about relational databases, forget it, I am done. But if I start talking about why we need to see this [specific] body of information if we are admitting a patient with a stroke, for example, it totally changes the dynamic. Communication at the executive level is also exceedingly important. Most physicians don’t learn that, and it’s something you kind of learn when you get into these positions.”
Customer service orientation: The CMIO’s job is to serve the clinicians and ultimately the patients of the organization, and to take care of them better by leveraging this technology, says Tiberio. We know that at times the technology can make things worse, so we have a very important customer service role dealing with folks who are burned out and unhappy. [You want to] help people understand that they do have an ally here to help them.”
Creativity: The first part of creativity relates to analytical skills, and that doesn’t mean writing database queries, but more so being able to look at a situation and investigate it deeply, understand root causes and issues, and then use that information along with data appropriately to solve problems and make things better, says Tiberio. And then there is also creativity from the standpoint of futurism. “As we become more strategic in our organizations, we need to be looking forward,” she remarks.
Convening: Says Tiberio, “When I am coaching CMIOs, I try to help them understand who the [necessary] people are that you need to get around the table to solve problems, make things better and improve care.
Computer prowess: Tiberio says she intentionally left this as the last “C” on the list because being a good CMIO is not about being a good “techie.” She notes, “If I am interviewing someone and all they talk about is how they can’t wait to get in the system to build and test, I almost automatically cross them off the list of candidates. It’s about how we use the technology to serve our customers, patients and colleagues better,” she says.
Still, says Tiberio, even though identifying these desired traits is a great first step, finding someone who has all six of these skill sets “is very challenging when you think about everything involved with them.” Also, she adds, “A lot of organizations don’t even understand what they need or the potential for the position. They may be recruiting for a CMIO but they may not understand that they actually need someone who’s much more than a glorified technologist who can get physicians in line. So these organizations don’t really know how to go about defining that position or setting it up for success.”
