There is no reliable data on how many health systems and medical schools employ a chief research informatics officer, or CRIO — sometimes called chief research information officer or something similar — but by all accounts, those with the right skill set are in high demand as organizations grapple with the exponential growth in and evolution of biomedical data.
Jeffery Smith, vice president of public policy at the American Medical Informatics Association, described CRIOs as "executives who are in charge of leveraging clinical data for research," including clinical trials. "They also use informatics related to the secondary research use of clinical data," including information from electronic health records and laboratory results, including genomic tests, Smith said.
No small factor in the explosion of data managed by CRIOs is the growth of whole-exome and whole-genome sequencing and the move into proteomics, metabolomics, and other molecular omics beyond merely DNA sequencing. "That kind of tricks my own thinking, because when I think we can see the plateau in how much data they need on genomics, now they are talking about genomics at the cell level," said Umberto Tachinardi, chief information officer of the Regenstrief Institute in Indianapolis, a health IT research organization affiliated with Indiana University School of Medicine.
Though his title is CIO, Tachinardi effectively serves as CRIO, and actually holds a dual appointment as dean of clinical research informatics at IU. He also was CRIO at a previous job at the University of Wisconsin-Madison's UW Health.
The CRIO role "means someone who is more concerned about innovation, use of data for research or generation of data of research, and implementation or innovation in the use of electronic systems, clinical systems, or innovations in EHR systems," Tachinardi said. "Usually this is what all of us have in common."
Smith has seen the role, scope, and prevalence of CRIOs expand greatly even in the last year or two. He said that no longer are only large academic medical centers and research institutes hiring CRIOs or the equivalent.
"Increasingly, larger community hospitals are going through similar maturity models to try and figure out how to better leverage the data that they create at point-of-care visits for research purposes," Smith said.
In 2017, members of the AMIA Clinical Research Informatics Working Group produced an article in Applied Clinical Informatics that reported results of a survey of CRIOs and equivalents.
That survey, conducted in 2016, had just 16 respondents of the 25 CRIOs or equivalents whom AMIA identified and reached out to. Titles of respondents included chief research informatics officer, chief research information officer, chief clinical research informatics officer, and chief research and academic information officer.
Of those 16, 88% were the first CRIOs their institution had ever hired, and 69% had been on the job for no more than three years at the time.
Firas Wehbe, CRIO of Northwestern Medicine in Chicago and director of the Applied Research Informatics Group at the Northwestern University Clinical and Translational Sciences Institute, said that there had been some "buzz" about CRIOs before the Applied Clinical Informatics paper appeared in 2017. But there were not many more than the 25 CRIOs nationwide that AMIA identified for that research.
Wehbe has been with Northwestern since 2015, but became CRIO at the beginning of 2018. Shortly thereafter, he was asked to help draft a CRIO job description not only for himself, but at a couple of other institutions that were considering adding CRIOs of their own, he said.
In writing his own job description, Wehbe took cues from upper management, which had an idea of what they needed. "But I think they also wanted my help in telling them what they needed but didn't know they needed it," he said.
The authors of the Applied Clinical Informatics paper said that Peter Embi became the first CRIO in the US when Ohio State University appointed him in October 2010. Embi, who is now president and CEO of the Regenstrief Institute, was one of the authors.
Three years after that article and a decade after Embi pioneered the job, Smith told GenomeWeb that Bethesda, Maryland-based AMIA has made a concerted effort in 2020 to recruit more CRIOs to its ranks. AMIA, an academic-heavy association for biomedical and health informatics specialists, is about as close as there is to a professional organization for CRIOs.
Smith said that an online CRIO discussion forum for AMIA members has grown to nearly 100 people. The Clinical Research Informatics Working Group, which is open to all AMIA members regardless of title or role, now has more than 525 members.
Smith has not only seen growth in the number of individuals fulfilling these responsibilities, but a diversification of titles and roles. "This follows a very similar path to what we saw with the growth of chief information officers initially within healthcare and then CMIOs," he said.
The chief medical information officer (CMIO), which emerged in the 2000s and became mainstream in the healthcare world in the 2010s as EHRs became ubiquitous, started as a liaison between medical and IT staff. Now, many CMIOs have risen to the same level as the CMO and CIO on organizational charts.
Smith would not predict whether CRIOs would find themselves on a similar trajectory in the next few years.
Reporting relationships vary. In hospitals, the CRIO's boss might be the CIO or chief data officer, according to Smith. Some at academic medical centers actually report to deans rather than to a higher C-level executive.
Other titles he has seen in the last couple of years include director of research informatics, associate dean for informatics, assistant provost for data science, research CIO, chief research technology officer, VP of research technology for health, chief research technology officer, and CRIO for clinical research.
"There is obviously a lot of overlap with those titles referring to people in academic research organizations," said Tachinardi, one of the authors of the 2017 Applied Clinical Informatics article.
Often, political considerations go into the title. An organization with a CIO at the university or the medical school or the health system might not want to have someone with the same title for anyone else within the enterprise.
"Sometimes CRIO is a more specific term for people [who] support research with IT and an informatics background," Tachinardi said. "It varies a lot."
Some CRIOs or equivalents are closer to the healthcare systems than others, depending on the structure of the organization. When Tachinardi was at the University of Chicago a decade ago, the president of the university also was president of the healthcare system.
At Wisconsin, UW Health was legally separate from the UW School of Medicine and Public Health, but the dean of the med school was chair of the board of the health system, and thus had a hand in choosing leadership at both. Plus, revenue from UW Health helped fund education and research on the academic side.
There is more distinction at IU. "There is a friendship, but it's not a true marriage," Tachinardi said. "They share the building… but it's not a real, true connection."
Additionally, Regenstrief, which was founded in 1969, effectively serves as the departments of biomedical informatics or data sciences or biostatistics for four academic entities. In addition to the IU School of Medicine, Regenstrief has faculty from Purdue University, Indiana University-Purdue University Indianapolis (IUPUI), and the IU Richard M. Fairbanks School of Public Health at IUPUI.
Tachinardi's role is to serve the researchers at Regenstrief and at affiliated schools who rely on informatics as a resource.
"The clinical researchers or basic science researchers that we support campus are not true informaticians, but they need data. They need applications. They need analytics," Tachinardi said. "We give those things to them."
He has similar relationships with external partners, including drug developers Roche and Eli Lilly. "I oversee the team that provides resources and support to them," Tachinardi said.