Most people are familiar with the role a CIO plays in a health system but the mention of a CMIO would likely elicit questioning looks or shoulder shrugs from many. As one of the newest members of the healthcare executive suite, the Chief Medical Information/Informatics Officer (CMIO) has a complex job description that's evolving in parallel to the shift from volume-based to value-based care.
"With digitalization of healthcare the job goes far beyond EHR. All the systems that touch that platform, or even touch our clinicians, are things that the CMIO can have influence over." Luis Saldana, MD
As we begin 2017, healthcare organizations nationwide will be tapping their CMIOs to provide strategies around MACRA, MIPS, physician satisfaction, and more. We recently chatted about the evolving role of the hospital CMIO with Luis Saldana, MD, Chief Medical Information Officer, and Medical Director of Clinical Decision Support at Texas Health Resources, one of the largest faith-based, nonprofit healthcare delivery systems in the United States.
The ever-changing role of the CMIO
At Texas Health Resources (THR), the reason the CMIO job was added was the same reason many hospitals added a CMIO in the age of Meaningful Use – to drive the system-wide push toward electronic health record (EHR) implementation. That multi-year implementation project was a huge success at THR as measured by its 95% physician satisfaction rating and its HIMSS Davies Award win.
Though the core EHR platform was the initial reason the CMIO role was created, Dr. Saldana continues to evolve the job definition of a CMIO. "With digitalization of healthcare, the job goes far beyond EHR. All the systems that touch that platform, or even touch our clinicians, are things that the CMIO can have influence over," said Dr. Saldana.
Related: Listen to the complete podcast to hear in Dr. Saldana's own words what the CMIO job is like.
Life in the post-EHR era
Now that Texas Health Resources has implemented the EHR as its core clinical platform, the organization has moved past stabilization, through a few cycles of workflow optimization, and right into the thick of the volume-based to value-based care transformation broadly taking place today. The CMIO's role is shifting right alongside that transformation.
The roadmap going forward is driven by three major things: healthcare regulation, defining success as a healthcare organization, and effectively engaging physicians in workflow optimization cycles. "True optimization is about improving the workflows," Dr. Saldana explained. "That means rolling up your sleeves and digging into specific and individual workflows and really optimizing those."
To do that effectively, THR has found the need to continually engage physicians in the optimization process. "That entails workflow mapping and going back and redesigning care or redesigning the workflow, then doing some usability testing, getting buy-in, and then implementing that again. In fact, optimization is always a reimplementation of certain workflows, so you are just digging in a little bit deeper," said Dr. Saldana.
It takes a village
One of the key characteristics of an effective CMIO is the ability to collaborate with many different people, both inside and outside the organization. Dr. Saldana relies on a network of colleagues, vendors, and peers to explore how others solve similar problems. "I take every opportunity when I go to HIMSS, CHIME, or other forums to really connect with the people that I know are leaders in different areas." He also relies on industry organizations, like the American Medical Informatics Association® (AMIA), to get ideas and answers. I think it is important for a CMIO to get out there and not just stay cloistered within healthcare, but really be out there," Dr. Saldana added.
Bringing 2017 into focus
There's a paradigm shift taking place in healthcare today and CMIOs are emerging as direct decision-makers or champions for some of the newer technologies around the EHR, for example, platforms for bundled payments and new digital health solutions. "If we are successful at creating the platform that engages our patients and our providers and delivers the best care for them, that's the ultimate goal," said Dr. Saldana.
Here are some of the key things Dr. Saldana is thinking about as CMIO in 2017:
- MACRA. Just as they did with Meaningful Use, THR is planning to create a steering committee with multi-area representatives from both the technology and clinical sides of the fence. Dr. Saldana has this to say about MACRA, "If you've done Meaningful Use well, you will be well prepared for MACRA. It's going to be how you organize as to whether you are successful or not."
- Cybersecurity. As is true in most healthcare organizations today, minimizing risk continues to be a top concern at THR.
- New EMR workflows for patient engagement. In 2017, THR is thinking about what is necessary to provide patients with access to their data.
- Improving value. A big part of improving value is reducing costs and looking at how the EMR can do that. Dr. Saldana said, "The point of ordering is always seen as the first place you can have an impact. Ordering for imaging, lab ordering, medications — all of those will be critical for us as we decide what the MACRA program will look like at THR."
- Investigating cognitive technologies and AI. Technology advancements THR is looking into are in the areas of cognitive technologies, artificial intelligence, and machine learning.
Staying focused through it all – putting physicians first
After spending thirty years as an emergency physician, Dr. Saldana serves as a representative voice of physicians in his organization. "You see emergency physicians get into informatics since there are a lot of parallels with emergency medicine and informatics in terms of the process."
Physician burnout can be avoided by having someone like the CMIO be the sounding board for those physicians. Dr. Saldana says a big part of his job is vetting new technology ideas through the eyes of a physician, looking specifically at whether or not that new technology will make them more efficient and effective, and if they have the change readiness to take on the burden of change.
Dr. Saldana concludes, "The CMIO role is the bridge between the clinical and the technical. I think one of the things that we see now is that we are in a constant state of change in healthcare, which is obviously disconcerting. Having both the organizational and clinical barometers is important for a CMIO. Then you can be the voice on both sides to say whether something is good for an organization or not in terms of technologies."
Datica explores innovation in healthcare through a series of interviews with the industry's top thinkers and doers. Follow along with us as we uncover insights to catalyzing change in healthcare by subscribing to the innovation podcasts.