The Chief Medical Information Officer (CMIO) role has existed in health systems for years but the position is on the rise globally. In the past, the responsibilities of the CMIO might have included managing a health system’s IT department, serving as a liaison between the IT department and clinicians, and—in more recent years—overseeing the adoption and implementation of electronic health records.
The complexity of the role, and the demand for individuals with both clinical and technical acumen, has grown considerably as the convergence of software, Big Data, and biological and technical advancements (i.e., rapidly falling costs of genome sequencing) continues to transform healthcare worldwide. CMIOs are now expected to provide leadership and develop strategic plans across several new domains:
- Protecting health systems from large scale security breaches
- Ensuring the security of patient-level data, including the secure transfer of patient data
- Leveraging big data in all aspects of care – improving quality of care, reducing hospital a acquired conditions, increasing patient satisfaction as well as predictive analytics and population health management (e.g., claims-based risk stratification)
- Determining which new applications and technology to adopt
- Operationalizing and integrating personalized medicine into routine clinical care
- Overseeing the transition from traditional IT environments to cloud computing
Providing leadership in the era of data breach protection and “workarounds”
Protecting a health system from major security breaches and complying with HIPPA requirements are among the highest priorities of health systems. One increasingly common challenge that health systems face is the employee “workaround.” Workarounds occur when employees rely on personal devices (e.g., tablets and smartphones) in the workplace, and use these devices to bypass an organization’s systems and processes.
A recent national HIMSS/Intel survey of 674 frontline workers indicates that workarounds are not uncommon: 20 percent of respondents reported that workarounds happen “daily” and 30 percent of respondents reported they happen “sometimes”. While the intent is generally not malicious—the most common reason employees engage in workarounds is because they believe it is more efficient—the consequences of letting workarounds go un-checked can be severe. They can result in patient data being stored and shared on non-secure networks, and can increase the likelihood of large scale security breaches.
The CMIO plays an important leadership role in bridging the gap between IT, clinical, and front line staff. This is key in the context of workarounds, as the CMIO can 1) help to educate employees about security risks associated with workarounds, 2) facilitate engagement and seek continuous input from these different groups, which can help curb feelings among end users that technology is burdensome or being imposed, 3) identify ways to improve workflows, adopt different devices and take physician preferences into account in future planning activities.
The importance of the CMIO in achieving the “Quadruple Aim” and value-based care
Since Don Berwick articulated the three pillars of the “Triple Aim” (improve patient experience, improve health, and reduce costs), there has been growing recognition that these goals will only materialize if clinicians and frontline staff have the capacity to provide adequate care. In this era of expecting healthcare clinicians and staff to do more with less, identifying ways to reduce unnecessary burdens in clinical care and help frontline staff avoid burnout are critical. As technology solutions continue to demonstrate promise for improving care with greater efficiency and potentially at lower cost, the CMIO will be largely responsible for ushering these solutions into the clinic setting in ways that are beneficial to both patients and providers.
What CMIOs need to be successful: multi-disciplinary teams and evidence-based research
Of course, technology by itself is not enough. Processes and workflows will determine its success in ultimately improving care and lowering costs. Support from multidisciplinary teams with expertise in policy, regulatory, clinical research, implementation science, systems engineering, among others, will be needed to realize the full potential of emerging healthcare technologies.
As CMIOs will increasingly be expected to generate the value proposition from the vast array and constant stream of new technology options, findings from health outcomes research in combination with cost and comparative effectiveness studies that evaluate technology will be important.
If health systems do not already have a CMIO as part of their management team, they likely will in the future. As new requirements and priorities emerge in the wake of healthcare reform and Meaningful Use, and as the move towards value-based care continues—much of which hinges on using technology in effective ways—demand will undoubtedly increase for leaders with clinical, technological, and health informatics experience.