Beyond the data

Once thought of as an advisory post best-suited for “techie” physicians, the role of clinical informaticist is quickly evolving into one that involves high-level decisionmaking and careful consideration of clinical culture and workflow.

And within the context of new federal programs that incentivize health information-technology adoption and use of clinical information for quality improvement, clinical informaticists are growing fast in both prominence and prevalence.

View a photo gallery of this year's Top 25 Clinical Informaticists

“This used to be the role for a geek doctor, but recently there's been much more of an understanding that these positions require expertise in change management and leadership,” says Christopher Longhurst, chief medical information officer at 272-bed Lucile Packard Children's Hospital at Stanford University, Palo Alto, Calif. “And the introduction of HITECH and meaningful use have also elevated the role of CMIO because health IT is now a source of revenue.” HITECH refers to the Health Information Technology for Economic and Clinical Health Act, which is part of the stimulus law enacted in 2009.

Longhurst spearheaded Lucile Packard's implementation of a computerized physician-order entry system and, earlier this year, he co-authored a study in the journal Pediatrics that demonstrated the first-ever association between CPOE implementation and a subsequent reduction in mortality.

Those achievements earned Longhurst a spot on Modern Healthcare's inaugural list of Top 25 Clinical Informaticists, a list that recognizes healthcare professionals who have successfully used clinical data to improve performance while serving as a critical bridge between IT staff and clinicians.

Indeed, the provisions of HITECH have cemented clinical informatics as an essential component of a healthcare organization's overall strategic planning, says Khiet Trinh, associate vice president for medical affairs and the first-ever CMIO for 138-bed Ephrata (Pa.) Community Hospital, another of this year's Top 25 Clinical Informaticists.

“We're gaining respect as full-fledged hospital executives, and I think most hospitals are beginning to see CMIOs as vitally important,” says Trinh, who led Ephrata Community's adoption of an electronic health record. “It's not about loving computers. It's about sharing the vision of improving patient care.”

And as the duties of clinical informaticists have changed, the people who hold those roles have been able to undertake evermore challenging projects. At 13-hospital Texas Health Resources, for instance, Ferdinand Velasco, vice president and CMIO, has led the system through a $200 million EHR implementation. Velasco is another honoree among the Top 25.

That's a far cry from a decade ago, says Velasco, when CMIOs mostly sat on physician steering committees and advised the hospital's chief information officer. “It's a much more proactive role now, and one that is necessary as we prepare for new models of care delivery.”

Not only have recent policy changes made clinical informatics more relevant to administrators, they've also made clinical practice more appealing to informaticists.

Richard Snow, medical director of performance improvement at 191-bed Doctors Hospital, Columbus, Ohio, stopped practicing family medicine in 2005 so he would have enough time to devote to clinical informatics projects.

But recent trends—such as the growth of patient-centered medical homes and new ways of managing chronic diseases—have convinced Snow, who also made this year's list, that now is the right time to return to direct patient care.

“Several factors conspired to make primary care more interesting, and I wanted to be a part of it,” says Snow, who says he will see patients part-time. He also plans to work with a family-practice clinic to develop teaching tools that use health IT. “To me, clinical informatics is like a candy store. There is so much opportunity as we reshape the way we provide care and the way we pay for it.”

This year's honorees say their clinical background has proved critically important in their roles as informaticists. Twenty of the Top 25 have medical degrees, while four more winners have extensive nursing experience. According to Sandy Savino, a clinical systems analyst and team leader of the clinical content team at five-hospital Catholic Health Services of Long Island, Rockville Centre, N.Y., her years of direct, patient-care experience have lent her credibility among physicians and nurses.

“As a team leader, they trust me because I was a nurse and a nurse educator,” says Savino, who also is one of this year's winners.

That time spent in the “trenches” also enables informaticists to push through large-scale IT projects without sacrificing quality and efficiency, says another winner, Elizabeth Johnson, vice president of applied clinical informatics at Dallas-based Tenet Healthcare Corp.

“You understand the way a clinician works and you can take that knowledge and look to technology to support it,” says Johnson, who led implementation of an EHR at the 53-hospital system. “Technology does not drive the process, and I think a clinician really understands that.”

Clinical experience also comes in handy when conveying clinical concerns to IT staff and vice versa, says Reid Coleman, medical informatics officer at four-hospital Lifespan, Providence, R.I. While directing Lifespan's implementation of a closed-loop medication administration system, one of Coleman's most important roles was translator, he says.

“I needed to explain to clinicians what the technology was capable of doing for patient care, and I had to make sure the tech people were knew what physicians and nurses needed,” Coleman says. “I like to say I'm trilingual. I speak doc, geek and admin.”

Maureen Gaffney, another of the Top 25, says she thinks of herself as her organization's “clinical conscience” because she evaluates each new technological tool based on its ability to provide patient-centered care. Gaffney is the CMIO and senior vice president of patient-care services at 504-bed Winthrop-University Hospital, Mineola, N.Y., where she has overseen the implementation of CPOE and other systems.

Earlier systems were often designed and implemented by IT people, Gaffney says, which led to workflow issues and distrust among clinicians, she says. “IT people do not always understand that clinical practice does not go by the book,” Gaffney explains. “The way we get to our end point will vary and that's OK. Systems have to have that flexibility.”

Training new clinical informaticists also is a high priority. At Tenet, Johnson has led the system's Improving Patient Care Through Technology, or IMPACT, program, which educates clinical leaders in health IT and helps them to understand the most effective ways to use technology to improve patient care. As part of the program, Tenet created a clinical informatics academy with training in nomenclature, workflow, adoption and other topics, with the goal of placing informaticists in all of the system's hospitals.

Jeff Rose, vice president of clinical excellence, informatics, for 75-hospital Ascension Health, St. Louis, gives instructional talks and teaches in-person and online informatics courses for the American College of Physician Executives. Rose, who also made this year's list of honorees, says his work as an educator is one of the most rewarding parts of his job.

“Teaching people the value of informatics is so important because it makes it more likely that technology will be used appropriately, and that means hospitals are able to harvest those gains in quality and safety,” Rose says.

This year's list of Top 25 also included one full-time informatics educator, William Hersh, who chairs the department of medical informatics and clinical epidemiology in the school of medicine at Oregon Health & Science University, Portland. The department, which offers on-site and distance learning in informatics, has grown as the field has grown, Hersh says.

Five years ago, Hersh partnered with the American Medical Informatics Association for the “10 x 10” initiative, which aimed to train 10,000 medical professionals—using a repackaged version of the university introductory medical informatics course—by 2010. They have fallen short of that goal, he acknowledges—just 1,000 have completed the program so far—but the program is highly visible and the numbers are growing, at least in part because of monetary incentives, he says.

Financial remuneration is there to get providers' attention and motivate them to expand their use of health IT, but it's the improvements in quality that will keep them on board, says William Bria, CMIO for 20-hospital Shriners Hospitals for Children, Tampa, Fla., and co-founder and president of the Association of Medical Directors of Information Systems. AMDIS partnered with Modern Healthcare on the Top 25 Clinical Informaticists program.

“CMIOs are practicing medicine,” he says. “The tools they are promoting can improve care, but it is a continuous battle. There's no such thing as ‘set it and forget it.' You must continue to revisit, refine and measure impacts, and that's confusing for tech people, who aren't used to the vagaries and nuances of the practice of medicine. That has to be our rallying point because it ensures that this technology is designed and continues to function in the service of patients.”