My first formal introduction to medical informatics came in the mid-1990s. My institution, Loma Linda (Calif.) University Medical Center, had finally gotten around to hiring a chief information officer. During his first week, three physicians presented themselves to his office (unannounced) while he was unpacking to tell him what was wrong with his system. His first response was probably to think about repacking his belongings, but his second was to form an information systems, or IS, committee and to place those three physicians on the committee. He then told us--I was one of the three--to go fix our system.
At that time, various titles were thrown around for physicians who took on administrative roles relative to IS. Early on, physicians did not have formal, compensated roles, and the title of "physician champion" was popular, though to me it always sounded more like one of the horses my daughter rode. Personally, I preferred the term "medical informatics gadfly." This seemed to accurately depict both the function and the level of authority many of us had.
Over time, "director of medical informatics" and "chief medical information officer" have become the most widely recognized titles, and clinicians in these roles are now frequently compensated for their efforts.
Whether CMIO or gadfly, the clinicians in these positions are being acknowledged for the key roles they play. CIOs tend to be well-versed in the business side of IT, with limited exposure to clinical medicine. Chief medical officers are usually respected clinician leaders but generally have minimal experience in informatics.
It is not an overstatement to say that CMIOs are the catalysts for clinical IS transformation. Their primary function is to guide and prioritize IS decisions, balancing their clinical importance with technical and financial realities. The role encompasses a wide variety of clinical, technical and business functions. By acting as the liaison between the medical leaders (along with the CMO) and the CIO, the CMIO can be very effective in ensuring the success of IS ventures.
The role of the clinician in informatics leverages on the size and type of the entity. In small medical practices, he is the visionary, the business partner, the project director and the implementer all in one. It's not uncommon to find these clinicians under desks installing networks.
The larger the institution, the more specialized and sophisticated the role becomes. The CMIO is frequently the visionary and change-management agent for clinical IT projects. He or she can work with the CIO to develop a business plan to support the vision and to sponsor it to the administration. Simultaneously, he or she facilitates the requisite buy-in of the medical staff.
The best CMIOs are respected, practicing clinicians who truly comprehend the benefits (and the risks) of applying information technology to clinical situations. In addition to being able to provide excellent care for an individual, they understand the importance of evidence-based medicine and have the ability to extend their mental reach beyond the individual patient and use evidence-based medicine to create an infrastructure to incorporate best practices to truly improve the health of all the patients for whom the entity provides care.
The knowledge base from which the CMIO works is not taught in many medical schools. Even if the schools wanted to train medical informaticists, there are few professors and even fewer textbooks. There are fellowships in medical informatics available, but these are few in number.
Fortunately, numerous organizations have formed to provide parts of the requisite education. The Physician-Computer Connection, run by the Association of Medical Directors of Information Systems, or AMDIS, is now in its 13th year. The symposium is in San Diego this year, running July 14-16, and is an excellent place to meet and learn from physician informaticists. The Healthcare Information and Management Systems Society and the Medical Group Management Association partnered with AMDIS to put on a one-day physicians' symposium in March at the annual HIMSS meeting.
Many of us have had to learn at the "school of hard knocks"; a lucky few have had the benefit of a knowledgeable mentor. In a mentorless world composed of healthcare organizations that have been slow to realize the importance of the CMIO, this education has been hard-bought.
Clinicians interested in a career in medical informatics have been predominately on their own to provide the time and financial support to go out and learn what they need to know. Fortunately, the government and many healthcare organizations are beginning to realize the importance of medical informatics and CMIOs to their long-range success and to the health of their patients.
For information about the 13th annual Physician-Computer Connection, visit amdis.org or call 530-596-4477.
Howard Landa, M.D., graduated in 1983 from the University of Medicine and Dentistry of New Jersey-Rutgers Medical School. He was a resident at New York University Medical Center, University of California-San Diego and Texas Children?s Hospital. He cut his teeth on informatics under Robert Blades, CIO of Loma Linda (Calif.) University Medical Center. He practices pediatric urology and medical informatics with the Hawaii Permanente Medical Group, and informatics with Kaiser Permanente nationally.