The Association of Medical Directors of Information Systems returned to beautiful Ojai, Calif., for its Physician-Computer Connection Symposium this year, after several years absence due to the closure of the popular Ojai Inn Resort and Spa for renovations.
About 150 physician informaticists, aka geek docs, flocked back to Ojai for the 16th annual meeting for two and a half days late last month. There was some discussion about changing the name of the organization, since very few, if any, of the members still have the title of medical director of information systems. But after some rumination, the idea of a rebranding the group to something more modern and inscrutable was discarded in favor of the quaint and practical notion that someone reading the organizations name should have a fair understanding of what its members do.
That said, a good two hours or so of meeting time this year was devoted to that very topicjust what is it exactly that physician leaders of their facilities efforts at applied medical informatics really do? Part of that discussion centered on the preliminary results of a survey of AMDIS members conducted by the information technology research and consulting organization Gartner Group.
Violet Shaffer, a research vice president and the global agenda manager/healthcare providers at Gartner, made a presentation on the survey, based at the time on responses from 47 AMDIS members. More AMDIS members took the survey at the conference, so the numbers will be beefed up a bit and their responses will be included, Shaffer said, in her final report. For the purpose of the survey, physician informatics leaders were called chief medical information officers.
Shaffers best laugh line came when she repeated a comment from one CMIO surveyed.
Being a chief medical information officer is different than being a physician, that CMIO had said in droll understatement.
Although use of electronic medical-record systems in ambulatory care remains low, in acute care, where most CMIOs work, their institutions have passed the tipping point for IT system adoption, particularly for patient record systems and imaging archival systems, Shaffer said.
In that light, Shaffer said, "The delightful news for job security is we're leaving the era of the hard stuff (selection of clinical IT systems and their implementation) and entering the era for the really hard stuff," that is, leveraging clinical data to reduce variance in care processes and quality, and achieving process agility to be able to react quickly to incorporate new medicines, techniques and research-driven ideas to improve care.
Some key points in the survey results thus far are:
The need to report to power is a common theme, Shaffer said.
And thats not surprising, according to David Milov, a pediatric gastroenterologist and the chief of clinical information systems for the Jacksonville, Fla.-based Nemours healthcare network, including the Nemours Childrens Clinic in Orlando, Fla., where he is in part-time clinical practice.
Milov said he has been involved in healthcare IT for 10 years and is working on a masters degree in biomedical informatics at Stanford University. Milov said that he took the survey and understands the dissatisfaction of the many CMIOs who are reporting to a CIO but want to report to the boss of bosses.
They are the enlightened ones, Milov said. They realize their role is a change agent and how they can be most effective is as a change agent. Theyre moving from the tactical role on advising on and implementing (IT) systems to a strategic role on how system optimization supports the overall organizational strategy."
The one role is the project manager, he said. You create a project plan and place the people into the plan, you put up the milestones and then you implement it. You have multiple human resource issues; you meet budget and a timeline.
The much more exciting role is to move into the strategy and demand there is a payout doing it, because there is a lot of suffering going on to do it, he said. There are some people very good at the tactical aspects. They can drill down on a list and check things off. And there are others that are very good on the strategic aspects.
Milov said CMIO strategists are the people who decide what data fields are the most important to look at and how to use the data from those fields to change physician behavior and improve care.
If you want to change physician behavior, give them a report card, he said. You align incentives with that, so there are differential payments. But money is not the primary motivating factor, he said.
I believe that physicians inherently want to do the best job they can for every one of their patients. And if theyre shown that these systems can do the best job for their patients, I think they would suffer any indignity to do it as long as you can demonstrate to them that it is working, he said.
AMDIS Chairman William Bria, a pulmonologist and CMIO for the Shriners Hospitals for Children health system, said CMIOs are a new breed of physician leadersexperts in both medicine and clinical computer systemsand they dont want to choose between one path or the other.
They see themselves migrating to a totally different position than a CIO; thats why they don't want to report that way, Bria said. Unlike many other physicians that go to the CEO or COO or CIO, the idea is that a CMIO, as we have envisioned it over the years, is a role that retains its medical roots.
At the meeting, Bria solicited volunteers to draft a white paper that will help define the new role of the CMIO.
Its always been a translators job between two worlds, and it's always been done by risk-takers because you've decreased your time in clinical practice, he said. So your income is at risk, and youre engaged in the C-suite, where there are sharks and politics.
Both Bria and Milov said the desire to continue to see patients goes beyond a need to maintain clinical credibility with fellow physicians.
There is nothing that provides more instant gratification, that is more elevating, than taking care of patients, Bria said. Its intense. Its personal and its a satisfaction that drives you through all eight years or more (of medical training). Have you ever been on stage and had applause? Its like that.
More than Bria, Milov said that he thinks keeping their street cred is a factor that drives many physicians to work both jobs, as healer and as CMIO.
It wasnt until the first World War that the generals stopped leading their troops into battle, Milov said. I think there still is a basic human idea that the effective general knows what it is to hear the bullets whizzing around (his or her) head; that in battle, they can use the same tools that you do and win. There is an authority conferred by that.
But like Bria, Milov said the main reason most CMIOs still see patients is personal, not organizational.
This is going to sound corny, Milov said. Its a privilege and an honor to be a doctor. The reward cycle takes 15 minutes and you leave with a good feeling and a good relationship. Anybody who has done it doesn't want to not do it.