Running head: CHIEF MEDICAL INFORMATION OFFICER

Role of Chief Medical Information Officer Laurie Burke, Jalandria Gurley, Suzanne Neff, Rachael Thomas Texas Woman’s University

HSM 5003 Management of Health Service Organizations Pat Driscoll July 31, 2013

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Role of Chief Medical Information Officer Information technology (IT) has impacted health care delivery and will continue to be responsible for ongoing changes. One of the biggest challenges is integrating the complex data accumulated from sophisticated computer models to simplified real time use. Integrating clinical, financial, and administrative information to comply with meaningful use and other emerging government guidelines has been challenging. The healthcare industry is moving from volume-based reimbursement to value-based reimbursement that is aimed to provide higher quality, lower cost, and better patient experience (Edelstein, 2013). New systems are needed to assimilate information, science, computer technology, and medicine as well as to collect, organize, and secure information systems and health related data. It involves the use of computer hardware, specialized software, and communication devices which are used together to form complex computer networks to collect, analyze, and transmit medical data. These tools include assimilation of clinical directive, understanding of formal medical terminology, storage of data, and transmission of clear communication. Data use in health care is a continuously evolving area of predictive computer modeling. This is known as Clinical Analytics, which uses predictive computer modeling to translate patient health care data into proactive patient care. The integration of predictive computer modeling can use evidence-based medicine and new technologies to reduce costs and encourage more personalized patient care. (Edelstein, 2013) Healthcare institutions, insurance companies, and government agencies such as Medicare and Medicaid find integrating information into meaningful use to be the biggest challenge in driving good medical care. The healthcare industry is bridging this gap of collecting information and not knowing what to do with it with an emerging role titled Chief Medical Information

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Officer (CMIO). The CMIO role is a combination of the more traditional roles of Chief Medical Officer (CMO) and Chief Information Officer (CIO). The CMIO is a liaison between the clinical and IT departments. The primary attributes of a CMIO include the following areas of expertise: •

Tap data mining expertise with the capacity to examine data from different angles (Edelstein, 2013)

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Translate clinical analytic technology to clinical operations (Edelstein, 2013).

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Exhibit leadership to facilitate the process change (Edelstein, 2013).

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Utilize knowledge and experience to improve outcomes, increase cost efficiency, decrease risk, and streamline operations while making timely evidenced-based decisions (Edelstein, 2013).

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Demonstrate development of a business plan incorporating clinical applications and business profitability (Saldana, Health2 Seminar, 2013)

The importance of the CMIO role in the clinical analytics field has led to the discussion of qualifications and skills needed for this position. McKinney (2010) states “The role has expanded from an adjunct person who helps to compile lists of medications to someone with authority who has a deep understanding of outcomes measurement, workflow and the impact of clinic IT” (p. 41). The purpose of this paper is to discuss of the evolving role of Chief Medical Information Officer in the current healthcare environment. Literature Review Clinical Analytics is unfolding as one of the most important mechanisms in the collection and processing of patient care data in the healthcare field. Analytics are essential to identify trends in patient population, healthcare quality and efficiency, risk stratification, and predictive modeling. Business applications can help reduce costs, track network utilization of services, and

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prevent unnecessary hospital admissions, readmissions, and emergency department visits. The clinical applications of analytics can be used to trend disease causes and possible new treatments as well as increase the quality of patient care. (Saldana, 2013). A primary aspect of Clinical Analytics is the use of computer predictive modeling. Data use in health care is an evolving area of predictive computer modeling. Clinical Analytics employs predictive computer modeling to translate patient health care data into proactive clinical patient care. The integration of predictive computer modeling utilizes evidence-based medicine and new technologies to reduce costs and encourage more personalized patient care. (Weinstock, 2013). One of the most relevant purposes of predictive modeling is reduction of hospital readmissions. Edelstein quotes a 2012 survey by the eHealth Initiative (EHI) and College for Health Information Management Executives (CHIME), which states: “…half of respondents reported use of exploratory data analysis and online analytical processing. Only 23.6% of respondents reported use of predictive modeling and 58.3% reported that they focused on resources in retrospective analysis.” This lag in proactive use of predictive modeling puts pressure on the Chief Medical Information Officer to advance the use of this important tool. It will be essential for future healthcare models to help: •

Prevent and reduce hospital admission and readmission rates.

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Reduce healthcare fraud.

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Provide more informed and concerned clinical care.

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Reduce costs and increase revenue of healthcare business costs. (Edelstein, 2013) The literature review was initiated by searching for keywords through the Texas

Woman’s University online search databases and the World Wide Web. The databases used

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include CINAHL, ProQuest, and Cochrane. The specific keyword, Medical Subject headings (MeSH), and word combinations used in the search include healthcare informatics, data utilization, CMIO, CMO, and clinical analytics. The search excluded articles published prior to 2007. College of Healthcare Information management Executives (CHIME) states that one of its visions is “to see an enabled healthcare system that is integrated in clinical and business IT systems” (2013). CHIME is an organization that represents over 1450 Chief Information Officers (CIOs) and other top information executives at hospitals and clinics in the United States. Their goal is to “advance the role of health information technology in support of care coordination” (2013). In a letter responding to questions from the Center of Medicare & Medicaid Services (CMA), CHIME states that there are several challenges in advancing the goals of IT integration in healthcare. Some of these challenges are: •

Developing certification requirements and standard protocols that enhance accurate patient identification, privacy, and data transport. Known as meaningful use, the goal is to promote the spread of electronic health records (EMR) to improve health care. The CMS Incentive Programs has defined the set of standards that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria (HealthIT.gov)

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Ensuring patient data match accuracy

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Developing strategies to enhance local flexibility in technical standards, services, and policies.

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Avoiding mandates involved in specific statewide and nationwide exchanges, and

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keeping local market needs at the forefront. •

Focusing on policies that mandate data transport, vocabulary and content

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Advancing standards that enable Health Information Exchanges (HIEs) to interconnect and interface at all levels as a certification requirement.

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Monitoring policies that inhibit exchange.(HIPAA and AN-kickback regulations) (Chime, 2013).

Healthcare institutions have a vested interest in hiring the right people to guide and develop their IT and analytics department. The person who leads this vital department will impact the success of the institution. Determining the best CMIO candidate encompasses several factors. A breakdown of these considerations includes knowledge in clinical areas, analytics, human resources, leadership, and management. Expectations for the emerging CMIO role will incorporate the following: •

Understanding of technology and the ability to work with models of care and operations (Larkin, 2010).

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Aptitude to work in concert with the health care system to design and implement systems as well as build relationships with physicians to gain support of IT initiatives (Saldana, Health2 Seminar, 2013)

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Capability to refine and instill quality of clinical resources (McKinney, 2010

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Understanding of clinical workflow, and external and internal outcome measurements (McKinney, 2010)

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Understanding the full impact of information technology on clinical practice (McKinney, 2010)

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Medical degree with strong clinical background (McKinney, 2010).

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Expert knowledge of clinical application of medicine with the incorporation of meaningful use technology (McKinney, 2010)

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Ability to use strategy to interconnect clinical goals with evolving information technology (McKinney) Methodology

An interview survey was developed and distributed to hospital administrators with the goal of discovering the role and qualifications that each facility looks for in identifying a CMIO (See Appendix A for the survey). The population targeted for survey included CMOs from hospitals as well as other influential individuals in the medical and information technology field (See Appendix B for a list of those surveyed). The answers were collected, reviewed, and tallied to determine the qualifications and anticipated responsibilities for a CMIO. Ten surveys were sent to hospital administrators. Six surveys were sent to physicians working with informatics, one was sent to the President and CEO of CHIME, one to a hospital President/CEO, one to a senior director of technology, and one to a senior director of technology and innovation of a consulting group. Of the ten surveys distributed, five were returned. The combined responses are varied and indicate a range of traits important for a CMIO, including skills in programming and electronic medical records, clinical and management experience, and Board certification. All surveys returned indicate that the CMIO is responsible for healthcare informatics. The general consensus for years of formal analytic training is three to five years, although all surveys suggest that past experience is more important than formal training. All respondents agree that the CMIO is responsible for implementation of a plan to utilize the data collected on patients. One respondent indicated that the CMIO should be the executive sponsor for the plan, but suggests that success is

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dependent on leadership and support from the clinical, operational, and financial administrators. Responses to the question of what the future holds for informatics all indicate that improved data collection will become more important and the CMIO role will continue to evolve. One respondent indicated that predictive analysis based on other personal lifestyle data tracking (FitBit, Nike+, DNA, etc) will become important in clinical care. One respondent also indicated that analytics will contribute to the ability to coordinate clinical trials and epidemiological studies. Conclusion The role of CMIO is expanding. Records show a 300% increase in the position since 2007 (McKinney, 2010). It is imperative that a CMIO integrate data, facts, and diplomacy to achieve better patient outcomes (Lynch, 2006). It is important to point out that CMIOs play an integral role in connecting hospital data and information technology to ensure the systems are relevant to patient care (McKinney, 2010). Present research and data collection clearly show that CMIOs are not required to be experts in the field of information technology, but need to know how to use the data and technology (Lynch, 2006). The ability to improve health is dependent on the CMIO’s understanding and the application of that knowledge in the prevention and treatment of disease (McGowan, Grad, Pluey, Hannes, Deane, Labrecque, & Tugwell, 2009). Because the role of CMIO is so new, there is insufficient evidence to indicate what specific attributes will make an effective CMIO. McGowan et al (2009) recommend that future studies be conducted to strengthen the evidential links between changes in clinician’s knowledge and behaviors and meaningful use of healthcare information technology. This evolving role will continue to develop and adapt as data analysis and use undergoes significant changes in an effort to improve patient care and reduce healthcare costs.

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References CHIME, (2013, April 18). Response for request for information on advancing interoperability and health information exchange. Retrieved from http://www.cio-chime.org/ Edelstein, P. (2013). Emerging directions in analytics. Health Management Technology, 34(1), 16 Fact Sheet (2007). Retrieved from http://www.healthit.gov/newsroom/fact-sheets Larkin, H. (2010). Who'll run your IT? Hospitals & Health Networks, 84(2), 22-4, 33, 1. Retrieved from http://ezproxy.twu.edu:2092/docview/215296887?accountid=7102 Lynch, T. (2006). The new chief medical officer: A bridge to your hospital's future. Trustee Journal, 59(3), 26-32. McGowan, J., Grad, R., Pluye, P., Hannes, K., Deane, K., Labrecque, M., Tugwell, P. (2009). Electronic retrieval of health information by healthcare providers to improve practice and patient care. . Cochrane Database of Systematic Reviews, (3) doi:10.1002/14651858.CD004749.pub2 McKinney, M. (2010). CMIOs steadily on the rise. Hospitals & Health Networks, 84(3), 41-2, 2. Retrieved from http://ezproxy.twu.edu:2092/docview/215296561?accountid=7102 Saldana, Health2 Seminar, 2013 Weinstock, M. (2006). IN SEARCH OF THE RIGHT CMIO STUFF. Hospitals & Health Networks, 80(2), 46. Retrieved from http://ezproxy.twu.edu:2092/docview/215306212?accountid=7102

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Appendix A Dear I was wondering if you could help us with a graduate class project. It is for our graduate class (Management of Health Services Organizations). We are doing a field research survey on the role of the Chief Medical Information Officer in healthcare institutions. We are surveying a population of people who are in the healthcare field. The survey is not long and is a series of questions. Your input would be very valuable to our study. Would it be possible for you to be a part of this study? I sure appreciate your consideration. I am submitting the survey with this request. Our project due date is July 31st so any feedback would be appreciated as soon as possible. Please feel free to reply back with your feedback if you would like to participate. Respectfully, Suzanne (Neff), BSDH

------------------------------------------------------------------------------------------------------------------------------We are graduate students at Texas Woman’s University conducting a field research survey on the evolving role of the Chief Medical Information Officer. We are interested in learning how healthcare institutions view this role. Would you be willing to take a few moments to

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participate in our survey? We would appreciate your consideration and input.

Laurie Burke RNWHNP-BC Jalandria Gurley MS. FNP-BC Suzanne Neff, BSDH Rachael Thomas • What traits are most important to see on a resume for a CMIO position?

• Is the CMIO responsible for healthcare informatics/clinical analytics coordination with patient care?

• How many years of formal analytic training do you think is required?

• Is the CMIO responsible for implementing a plan to utilize the data collected on the patients?

• What do you see as the future of healthcare informatics/clinical analytics?

CHIEF MEDICAL INFORMATION OFFICER Appendix B •

Dr. Timothy Brannon, MD, MS Children’s Medical Center Neonatologist Medical Informatics Dallas, Texas [email protected]

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Dr. Joseph Schneider, MD Vice President, Chief Medical Information Officer And Medical Director for Clinical Informatics, Baylor University Health Systems Dallas, Texas

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Dr. Duwayne Willett, MD. Chief Medical Information Officer UTSouthwestern Medical Center Dallas, Texas [email protected]

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Dr. Robert “Stan” Taylor, MD Chief Medical Officer-Ambulatory Services UTSouthwestern Medical Center Dallas, Texas [email protected]

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Russell P. Branzell President & CEO CHIME (College of Healthcare Information Management Executives) [email protected]

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Ken Finch President & CEO Texas Health Huguley Fort Worth South [email protected]

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Vincent Zimmern [email protected] Mark Kraemer Senior Director Technology and Innovation AmerisourceBerger –Specialty Group [email protected]

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Dr. Frank Vittimberga, MD FACS Chief Medical Officer, Methodist Charlton Medical Center Chairman, Dept. of Surgery, Methodist Charlton Medical Center

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Dr. Saldana

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