When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.
Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?
What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.
“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.
So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.
Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.
Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.
Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.
“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”
The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).
ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.
“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.
As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.
The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.
A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.
“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”
Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.
“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”
It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.
One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.
CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.