How CMIOs can ease the pain of IT transitions

The role of Chief Medical Informatics Officer may have been born out of frustration, with "going rogue" an unspoken part of the job description—if there was one.

The American Board of Medical Specialties approved the Chief Medical Information Officer (CMIO) subspecialty in 2011 and as of late 2015, only three cohorts had taken the American Board of Preventive Medicine's exam.

All that is currently required for eligibility above and beyond ABMC certification and a valid medical license is demonstrated experience in informatics, usually cobbled together by physicians at their wits end with their organization's IT systems.

Doctors want to make systems better. They're asked to communicate their requirements to technical people but they don't speak the same language. There is a need for doctors who can speak their language.

Agitators for progress are perhaps the best qualified for the broad role, of which change management is a major—yet not often emphasized—part. "They don't teach this stuff in school," says Reston. That's why he wrote Clinical Informatics Board Review: Pass the Exam the First Time.

Whether you're a relatively seasoned CMIO, new to the role, or thinking about getting in, chances are you could stand to learn more about getting your co-workers through IT transitions less painfully.

Getting to a Desired Future State
If change management is a transition into a desired future state, we must first evaluate the current culture. This involves asking some basic questions, such as what is the physical environment, and some not so basic, like what stories surround the organization and who are the heroes and villains? Even if your organization's culture appears obvious, this activity will likely yield surprising results.

Once you've identified the particular traits of your organization and its people, there are several management theories relevant to health care to help you guide them through transition.

• Precede-Proceed: Although not an organizational change theory but rather a theory for improving public health outcomes, this theory focuses on results over activity and the agency of individual participants.

• Social Influence: You can think of this one like a domino effect. If change were to happen from one person to the next, who might you select as change agents and how would they tip the rest of the dominoes—through likability, conformance, or obedience?

• Complex Adaptive Systems: Organizations are made up of complex, partially connected micro-systems. Adaptation is critical to their survival, and disequilibrium will either cause them to die to reintegrate. This theory directs change managers on how to use disequilibrium to the advantage of the organization.

Getting change to stick requires committing to training on the new systems, communicating success and remaining open to feedback and even criticism, and periodic reevaluation. If your organization continues to resist, you may be working against culture rather than with it and starting over may be necessary.

You can force people to use software but to get them to use correctly and consistently you have to really get them on board.

Rocky Reston is a health IT executive and consultant currently engaged as the Chief Medical Informatics Officer for Cognitive Medical Systems. He is Board-certified in clinical informatics and anesthesiology and has a Ph.D. in electrical engineering. He is also a former Colonel in the Air Force.

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