High Demand Persists for Chief Medical Information Officer (CMIO) and Health IT Physician Champion Roles
Physicians with health information technology (HIT) implementation experience are in high demand for a variety of roles in organizations that are implementing clinical IT systems such as electronic medical records (EMRs). The roles and responsibilities of these physicians has been evolving and growing. IT physicians in the early 1970s typically served as clinical "subject matter experts" to ensure that clinician's needs were identified and met by IT projects. In the 1990s the need for IT physicians increased as more hospitals implemented clinical IT systems. Throughout the 1990s a series of studies on the high prevalence of medication errors and the ability of HIT tools to reduce these errors culminated in the 1999 Institute of Medicine report, "To Err is Human". This led to external pressure on hospitals to more aggressively pursue implementations of more advanced clinical technology tools such as electronic medication administration records and computerized physician order entry (CPOE). Some of these implementations failed and others experienced sub-optimal results. Strong clinical leadership, management and oversight at the executive level became recognized as a key factors in successful implementations. The project-oriented, physician liaison role was still needed but no longer sufficient. A new generation of IT physician leaders, the Chief Medical Information Officers (CMIOs), have been added to a majority of hospital executive staffs to meet these leadership needs.
The increase in complexity of EMR implementations is due to the development of HIT products that provide more advanced functionalities and more configuration options for users to evaluate and implement. This increase in the number of functionalities available creates more work to do during the design, build and testing of the systems. More importantly, the advanced clinical IT tools such as CPOE impact a greater number of direct clinical care processes including the daily work flows for patients, nurses and doctors. These changes to processes and work flows cross over cultural boundaries in a way that organizations have not previously experienced. The transformational effort needed to overcome these cultural boundaries requires strong clinical leadership, communication skill, consensus-building skill, political maneuverability, strategic thinking, adaptablility, strong interpersonal skills and sensitivity to the organization's nuances and uniqueness. These skills describe some of the ideal characteristics of today's CMIOs.
It is important to reiterate that physician champions who are clinical "subject matter experts" remain in high demand for clinical implementations in addition to the CMIO. These physicians essentially become part of an informatics team with the CMIO. Even in small organizations it is obviously not possible for the CMIO to be the subject matter expert for every clinician for every clinical project. The CMIO can, however, be the catalyst to get the right amount of clinician participation with the right clinical expertise into clinical IT projects. The CMIO can facilitate the redesign of hospital committee structures and roles to ensure ongoing support and governance of a new EMR. To be effective, then, the experienced CMIO manages time by differentiating between situations that require their expertise through close, detailed involvement from other situations that are best managed as a facilitator, educator or mentor.
The value of a multidisciplinary informatics team with physician, nursing and other clinical liaison members is recognized by organizations. Organizations today should therefore consider planning for a multidisciplinary informatics team not just for their initial major clinical implementations, but also for ongoing optimization and support of these expensive systems. This group is the source for clinical "subject matter expertise" during IT implementations. After the implementation this group of clinicians becomes an invaluable resource for the continual optimization and support of clinical technologies. Some members, such as the physician champions, will not need to spend as much time with the informatics team post-implementation, but their experience and expertise will be tapped into. Some hospitals have decided to attract physicians to this role by creating an inpatient Medical Director for the EMR / Computerized Physician Order Entry (CPOE) and an outpatient Medical Director of Ambulatory EMRs for their physician offices. Some are full-time positions and others are part-time, dependent on the size of the organization, and they work closely with or report to the CMIO.
The early physician IT champion role of the 1970s evolved into an executive level CMIO role as clinical technologies became more advanced, more costly and more complex to implement. CMIO positions have subsequently become common within hospital organizations. Physician champions, however, also remain in demand as clinical "subject matter experts" for their clinical IT systems. As organizations continue to implement, upgrade, optimize and support their expensive clinical IT systems, CMIOs and clinical IT liaisons including physicians, nurses, lab technicians and pharmacists will remain in high demand.