Not just an EHR liaison: What has changed most about the CMIO role

From strictly implementing EHRs to now overseeing a variety of digital health initiatives and having growing leadership and strategic positions within health systems, the job of chief medical information officer has evolved quite a bit over time.

Becker's recently asked CMIOs from across the country what has changed most about the role in recent years.

Note: Their responses have been lightly edited for clarity.

Usman Akhtar, MD. Virginia Hospital Center Health System (Arlington): The CMIO role has changed from a luxury "nice to have" to a critical role necessary for a health system to thrive.

Phil Bernard, MD. University of Kentucky Healthcare (Lexington): The role of the CMIO has changed from being an implementation champion in the past. We no longer have to convince the clinician of the power of the EHR.

In the current role, the CMIO is the key clinician leader tasked with increasing clinician efficiency to improve patient outcomes. We embed workflows to maximize quality metrics. We eliminate non-value-added activities to increase physician wellness. We are the effector arms that allow our physicians and advanced practice providers to function at the top of their licenses.

James Blum, MD. University of Iowa Healthcare (Iowa City): I would say the CMIO role has evolved from one of a physician leader of EMR implementation, to then a provider-EMR satisfaction champion, to now a leader of healthcare practice innovation that uses IT as their toolkit. Their focus is now less about EMR configuration than it is on the application of systems, technologies and analytics to drive care.

J. Clay Callison, MD. University of Tennessee Medical Center (Knoxville): Early on, the role of the CMIO focused primarily on EMR evaluation, implementation and adoption. Although EMR expansion and conversion are still happening under their leadership, the CMIO now can focus more on innovative and strategic initiatives that improve patient access, patient and physician engagement, timely data exchange, and ultimately better outcomes for the patient. 

Put another way, now that we have the blocking and tackling down, we are able to work on the deep pass downfield that scores a touchdown.

Neal Chawla, MD. WakeMed (Raleigh, N.C.): CMIOs today need to know a little less about deep tech and more broadly about how tech is used and integrated across all parts of the health system.

John Chelico, MD. CommonSpirit Health (Chicago): The CMIO of today has moved from concentrating on how individual providers are using technology to how every facet of the healthcare continuum is interacting with the systems we manage. CMIOs today are focused on using technology to improve the care of the communities we serve when they are in and out of our patient care facilities.

Scott Cohen, MD. Bassett Healthcare Network (Cooperstown, N.Y.): Looking back 10 to 15 years ago, the CMIO/informaticist served as the traditional EMR champion and architect as well as IT liaison and translator. With health informatics now the "way we do business," we have seen the CMIO position transform into an integral part of the healthcare leadership team. Rarely does a project or initiative go ahead without IT and informatics playing a critical role. With the "great resignation" a huge part of our lexicon, automation, clinician efficiency and patient self-service have become critical pathways to help us weather our staffing crises and are likely the new normal.

Jordan Dale, MD. Houston Methodist: I would say the initial CMIOs were focused on implementation, or getting their clinicians across a finish line of major go-lives — which naturally pivoted to optimization of workflows, support and design of EHRs and other clinical applications. Today, many CMIOs now focus more on health system strategy, growth and alignment with other senior leaders to maximize value by using a core set of clinical applications to achieve the health system's goals — reducing workforce burden, improving quality/safety, reducing costs, etc.

David Danhauer, MD. Owensboro (Ky.) Health: In my tenure as CMIO over the last 10 years, the greatest change I have seen in the role is the transformation from an EHR implementer to a clinical IT strategist.

The CMIO is now integral with the other IT leadership and organizational clinical leadership, guiding the best visionary approach to IT optimization and technology purchases.

Chris DeFlitch, MD. Penn State Health (Hershey, Pa.): The role of the CMIO has developed over the years from a physician champion for EMR conversion, to an optimizer for technology and process, to now a trusted senior leader in mature health systems that understand the depth and breadth of technology to better patient, provider and systems outcomes. 

Anthony Dunnigan, MD. Valleywise Health (Phoenix): In my nearly eight years as our system CMIO, there have been many changes. I initially came aboard largely to help mature and optimize our EMR, which the system had been on for four years. This was a combination of provider support/efficiency; discipline around functions such as documentation and billing/coding; and exploration of other underutilized features such as patient engagement tools (our patient portal), population health functions and advanced data and analytics.

I still perform many of those functions, but like other CMIOs, my role has become more strategic in ensuring we are aligning, changing and expanding EMR functions to strategy — particularly where third-party vendors are involved and a regulatory spin is in place. A great example is the recent information blocking regulations, which required new technical build on the documentation side to ensure the right types of notes and results would become available to the patients in their portal, as well as strong engagement with the providers on best practices and awareness of the availability of this information to the patients.

I've played a similar role as our clinical decision support tools have evolved. Probably most impactful were the sudden changes in rules and regulations around telehealth that occurred in March of 2020. We were able to get a platform up and running in 38 hours and went from zero to over 500,000 televisits in 24 months. These examples hopefully highlight the burgeoning role of the CMIO as a key strategist.

Farhan Fadoo, MD. San Joaquin General Hospital and San Joaquin County Clinics (French Camp, Calif.): CMIOs have taken on greater levels of strategic leadership in managing health system innovation through evolving digital health portfolios, expanded roles in business intelligence and analytics, and executive responsibility for achieving population-level health outcomes. These responsibilities have been layered on top of the legacy CMIO duties that relate to EHR implementation, adoption, usability and optimization.

David Fleece, MD. Temple University Hospital (Philadelphia): I think the pandemic brought a few issues to the forefront for us in this role: virtual patient care, the need for nimbleness, and the degree of provider frustration and burnout in healthcare. Much has already been said about the rapid increase in telemedicine, so I won't recapitulate that here. In terms of nimbleness, we had to rapidly stand up not just telehealth but also mass immunization programs, large amounts of new data reporting to public health and governmental agencies, a field hospital, and new policies and processes within the [emergency department] and hospital units.

Patrick Guffey, MD. Children's Hospital Colorado (Aurora): The CMIO of the past was focused on EHR implementation and securing provider support. Now, the CMIO is an integral member of the leadership team, leveraging the EHR to solve problems and improve patient outcomes.

William Harvey, MD. Tufts Medicine (Boston): Over the last five to eight years or so, there has been an evolution in the potential roles that CMIOs play. Some CMIOs, usually those more junior, are focused on issues like system implementation, clinician support and training, and serving as a liaison between the clinician community and the IT department. That has evolved into CMIOs whose responsibility includes system design and data analytics. They may, for example, supervise physician-builder programs and support quality improvement through design and implementation of clinical decision support and analytics.

The most recent iteration is sometimes termed chief health information officer. This role typically involves managing larger teams who work on all the domains noted above, but also may include leading multidisciplinary informatics teams including pharmacy, research or nursing. CHIOs may also be distinguished by their role in helping to determine organizational strategy as members of a more senior executive team. Regardless of title, a CMIO's role continues to evolve over time from that of a physician liaison to an executive leader.

Diane Hunt, MD. Chief Health Information Officer (and former CMIO) of Deaconess Health System (Evansville, Ind.): Over the last 10 or so years, the role of the CMIO has changed dramatically. Back when I moved into clinical informatics as a specialty, I was seen as the physician liaison who could get doctors engaged and excited about the transformation to an electronic health record.

Once we got over that hurdle, the CMIO role grew to include the job of finding ways to optimize the use of various clinical software solutions and developing new and innovative ways to improve the business of caring for patients. Recently, over the last two to three years, we have evolved once again to be much more strategically focused. I no longer spend my days working in the EHR and analyzing workflows or clinical decision support build. We now have a seat at the table for most health system initiatives, generally from both the clinical informatics and data analytics perspectives.

Data has become the key to our organization's success, and as a health system CMIO it is the responsibility of our team to ensure we implement workflows and tools that allow us to accurately collect, visualize and ultimately analyze that data. It has been a fun ride, and I definitely look forward to seeing how we continue to adapt to changes in the healthcare world moving forward.

Allen Hsiao, MD. Yale New Haven (Conn.) Health and Yale School of Medicine: There are arguably few roles that have changed and evolved over the last decade as much as that of the chief medical information officer. For many of us, we started off as the uber physician champion for EHRs, willing to take some time away from clinical care to help usher in a new era where doctors and nurses weren't jockeying for the paper chart, or worse, couldn't even locate it in time for a patient visit, to where healthcare data is now all digitized.

Now CMIOs are focused on a few things: how we can better refine and optimize EHRs to be easier to use and minimize clicks and chart bloat; advancing clinical decision support to be increasingly sophisticated and comprehensive (so the system can identify opportunities to improve care, taking into account variables, results, social determinants of health and even genomics); how to transform data into information; and identify ways we can automate tasks to save clinicians time.

The transition from paper to EHRs hasn't been easy or smooth — and there is still much to do to improve and refine systems to make them easier for physicians to use, especially to be compliant with compliance and regulatory rules, Cures Act, etc. — but we now have the digital foundation in place to really begin to improve patient care, and the delivery of it, in ways that we couldn't have dreamed before. And I believe CMIOs will be — and need to be — right in the thick of that important work.

Maia Hightower, MD. Chief Digital Technology Officer of University of Chicago Medicine (and a former CMIO): What has changed the most about the role of CMIO in recent years is the variability in the scope of responsibilities of the CMIO by organization. Each CMIO has shaped the role to meet organizational needs matched with individual strengths. The core responsibilities of the CMIO remain the same, including optimizing the EHR experience for providers. In addition, many CMIOs have expanded into the broader digital transformation ecosystem, including digital transformation strategy, digital health, data and analytics, AI and population health.

Julie Hollberg, MD. Emory Healthcare (Atlanta): As multiple healthcare markets consolidate, many of us are leading EMR transitions from one vendor to another, which involves change management on a much larger scale than smaller implementations within our own institutions.

Jeffrey Hoffman, MD. Nationwide Children's Hospital (Columbus, Ohio): For many organizations, the CMIO role was created primarily to help implement EHR systems and assist other physicians in adopting the new technology. In the past several years, however, the CMIO role has undergone significant changes, which were further accelerated in response to the pandemic. At the same time, EHRs themselves began to mature from pen-and-paper replacements for paper charts to full-featured patient and population management systems. 

Today, CMIOs are often thought leaders and strategic partners at their organizations, working to leverage advanced analytics and sophisticated AI tools to transform patient care and reshape the care experience, while simultaneously addressing health disparities, balancing innovation with patient safety, and addressing the looming crisis of widespread physician burnout.

Steven Magid, MD. Hospital for Special Surgery (New York City): I am not sure if the role is actually changing, or if the environment is shifting and the role must respond.

The CMIO's role was, and will continue to be, acting as an agent of change; helping to translate between clinicians and IT (who often speak different languages); and representing clinicians and their patients at the budget and IT table.

But as the world changes, the CMIO's role must respond: The best example is, of course, COVID. As an integral part of the response team, the role changed overnight. "Digital" and its myriad of meanings were barely on the horizon a decade ago. Now CMIOs have to keep up with the economics of the "value proposition" and the entire patient journey; evolving the system to keep up with best practices, as well as hospital expansion; and new regulatory challenges such as the 21st Century Cures Act, etc.

Being a modern CMIO is no longer simply about implementing an integrated EHR. It has shifted from being tactical to being more future-oriented and strategic, looking for opportunities to implement the hospital and exam room of the future; interacting with the internet of things; moving more care to the home and patient environment; and perhaps even connecting to the "metaverse" (whatever that is).

I suspect that I have also changed over the years along with the role. It is a true blessing to always have new opportunities and challenges with the same goal of improving the health and lives of the patients we serve.

David McSwain, MD. University of North Carolina Health (Chapel Hill): The simplest answer is that the focus has moved well beyond simply the electronic health record. The modern CMIO is more strategically oriented, more proactive and less reactive. The role is about integrating multiple existing and emerging technologies into a coherent whole that streamlines and improves the experience of healthcare for patients, families, providers and healthcare team members.

Accomplishing that type of integration successfully depends on the ability to develop collaboration and alignment, understand the roles of people and teams across the organization, and successfully leverage the talents and skills of your teammates and colleagues toward strategic goals. You have to develop a strong team, which includes not only the people who report to you but teammates from across the institution and even beyond.

Ednann Naz, MD. Saint Agnes Medical Center (Fresno, Calif.): The CMIO role is ever-changing. CMIOs are finally being asked to sit at the strategy and business development table. From analytics, telemedicine, long-term care, digital health, population management and [clinical decision support], these leaders help empower clinicians to improve healthcare with information, processes and tools. Gone are the days of pure implementation and support, as IT/[medical doctor]. True enterprise informatics teams now have [chief health information officers] with various CMIOs or medical directors advocating as catalysts of actionable improvement.

Gregg Nicandri, MD. University of Rochester (N.Y.) Medical Center: The CMIO role has evolved significantly in recent years. I think, for many organizations, the position was created to assist in driving the implementation of the electronic health record. Once EHRs became established and organizations focused on their contribution to burnout, the primary focus of the CMIO shifted to optimization and enhancement.

Though that remains a significant part of the role, the explosion of technology broadly, and digital health technology specifically, has led many of us to take on a more strategic position within our organizations. Instead of focusing solely on how we can make the EHR better for our partners and colleagues, we are also developing institutional strategy for things like digital transformation, data and analytics. This often includes helping our systems develop relationships with less-traditional partners (Big Tech, [business to business], [business to consumer], and value-based care companies) to drive disruptive healthcare innovation. It is certainly an exciting time to be a CMIO!

Jeana O'Brien, MD. Baylor Scott & White Health (Dallas): From my perspective, the role of the CMIO in larger healthcare organizations has transitioned to responsibilities and scope across clinical disciplines and venues of care inclusive of digital and analytics to encompass the changing landscape of technological care delivery as a continuum — sometimes even referred to now as [chief health information officer] or chief transformation officer.

Brett Oliver, MD. Baptist Health (Louisville, Ky.): I think the biggest change in my role over time is the recognition that technology touches nearly every part of the patient care continuum, and as a clinician in IT we have become a valuable intermediary to connect all things technology to the clinical and operational needs involved in patient care. No longer is it just about optimizing EHR use, but rather the global technology picture and how can we improve the care of patients and the lives of the caregivers inside and outside of our facilities.

Claude Pirtle, MD. West Tennessee Healthcare (Jackson): The CMIO role has evolved and will continue to evolve over the next few decades. A number of years ago, the traditional CMIO was looked upon to aid in creating foundational workflows and structural processes while healthcare systems matured into an electronic ecosystem. We served and continue to serve as that bridge between clinical operations and technology.

As most systems have completed electronic health record implementations and upgrades, the focus of the CMIO role is shifting and becoming more strategic, innovative and data-driven. We are at the forefront of leveraging data harnessed from the EHR platform to empower clinicians, promote health equity, and drive value in the data collated from diverse sources. Data is the future — and CMIOs will be pivotal in designing high-value experiences, optimizing the current state and leading future strategies.

Sophia Saleem, MD. Northwell Health (New Hyde Park, N.Y.): In my experience, the CMIO role started as being EMR implementation, process reconciliation, and then EMR optimization. Somewhere along the way, CMIOs became heavily involved in data capture and standardization for quality reporting and research while we continued to support upgrades, acquisitions and EMR transitions. Over the past two to three years, the digital transformation of healthcare has taken hold of most health systems that realize consumers expect to do everything digitally, including obtaining healthcare. This demand created a stronger relationship between my role as a CMIO and our patient experience teams to support integrated in-person and virtual care delivery.

Another more pressing facet of the CMIO portfolio is an increased focus on provider experience and burnout. An entire body of literature is emerging with EMR data-driven studies about provider burnout. These studies indicate it's more complicated than blaming provider burnout solely on the EMR. My job as CMIO has certainly evolved into a strategic partner understanding how we continue to support EMR operations while also supporting our most important assets — our clinical teams and our patients.

Joseph Schneider, MD. Assistant Professor of Pediatrics and Informatics at University of Texas Southwestern Medical Center (Dallas) (and a former CMIO): Some CMIOs are taking on much more responsibility for population health, data management and artificial intelligence introduction. It's becoming less about EHR conversion and optimization, although that remains important.

Marcus Speaker, MD. Associate CMIO of Carilion Clinic (Roanoke, Va.): The role of the CMIO has expanded in past years in many organizations. The role has moved from one of simple EMR governance to overseeing the EHR, data analytics and cognitive computing, telehealth initiatives, and in some instances driving innovation and clinical transformation. There remains a good deal of variation, but the role has definitely expanded.

Andy Spooner, MD. Cincinnati Children's Hospital Medical Center: A lot has changed about the CMIO job. Early on — early to mid-2000s — it was all about implementation, since so much had to be built from scratch to get something useful in place. Now we can go live in many clinical areas with 90 percent less design work.

Now it's almost all about how to expose information to the right party, and not expose information to the wrong party. Our goal before was to share everything with every legal recipient upon request; the notion of "information blocking" never crossed our minds. The 21st Century Cures Act introduced underdeveloped definitions of what should be held back, which has spawned thousands of varying interpretations of what we can share and what we should not, especially when it comes to the care of adolescent patients.

Throw in the regulations from 42 CFR Part 2 for drug-use treatment, state laws about confidentiality that conflict with federal standards, heightened interoperability capabilities across the industry, and greater expectations from everyone that everything should be doable online, and one can spend most of one's day trying to figure out the paradoxical goal of sharing and protecting information simultaneously.

Dusadee Sarangarm, MD. University of New Mexico Health (Albuquerque) as told to Becker's in July: The CMIO role a decade ago centered mainly on moving paper processes to electronic ones (i.e., documentation and order entry). Now CMIOs are leading the rollout of entire EHRs for health systems, as well as new bolt-ons like telehealth platforms, patient apps, secure text messaging and artificial intelligence tools.

Our role has become logarithmically more complex as we continue to manage the EHR design at our institutions while at the same time shaping the strategic decisions of some of the largest acquisitions for a health system. As such, we are integrated into the C-suite more than we were previously. In short, 2012 CMIOs were a nice-to-have. In 2022, we are an absolute necessity if a health system wants to keep one of its most expensive assets, the electronic health record, in good condition.

Jonathan Thierman, MD, PhD. LifeBridge Health (Baltimore): The CMIO role had traditionally focused on implementing and optimizing the electronic medical record system. Here alone, there was ample work needed to help providers transition from a world of paper notes and verbal orders, to electronic records and computerized provider order entry as incentivized by Congress through meaningful use and the HITECH Act of 2009.

More recently, as healthcare undergoes a digital revolution, the CMIO role has broadened to include everything digital from apps to interfaces. The CMIO works with SMART on FHIR apps that function within the EMR platform and third-party apps running on bedside tablets.

The CMIO also manages the flow of clinical data through interfaces between the EMR and health information exchanges, medical wearable devices, or third-party platforms that unify the patient experience, such as the "digital front door" many health systems have developed.

There is also the field of data analytics to make sense and derive meaningful information from the massive amounts of clinical data now recorded. AI and predictive analytics are gaining traction in the healthcare IT space for predicting patient outcomes and providing clinical decision support for providers to intervene before a medical condition becomes more serious.

Finally, many CMIOs are deeply involved with telehealth and work to implement and develop telemedicine programs for their health systems to serve patients remotely for their healthcare needs. Together with my team of medical informaticists, I work in all of these areas in my current role and enjoy working in the fascinating and ever-changing crossroads of technology and clinical medicine.

Allison Weathers, MD, and Eric Boose, MD. Enterprise Associate CMIOs of Cleveland Clinic: Although always key, with the pandemic the physician leader roles — CMIO, associate CMIO, medical director of IT — felt like they became even more critical. Physician IT leaders were able to provide the necessary guidance and direction to ensure that the right work was prioritized and that needed solutions were quickly developed and implemented.

The role of "translator" between the IT departments and clinicians/providers — which has always been an important part of these jobs — was even more crucial with all of the fast-paced changes that occurred. Now with the challenges that health systems are facing post-pandemic (staffing shortages, etc.), CMIOs and other IT physician leaders help ensure that the focus is on projects and initiatives that align with the mission and values of their health systems and advance strategic goals.

Emily Webber, MD. Indiana University Health and Riley Children's Health (Indianapolis): CMIOs have definitely changed in the last several years. Most have seen their roles expand to include technology supporting health outside of the clinic and hospital walls — whether this is telemedicine and digital health during the urgency of COVID, or supporting the Cures [Act] final rule and promoting interoperability, or establishing remote home-monitoring programs. I think the CMIO role has always been aligned so closely to the electronic health record and the leadership around leading change in that area. It makes sense that informatics skills and experience have grown in innovative ways to support patients and communities.

Mark Weisman, MD. TidalHealth (Salisbury, Md.): The CMIO role has taken on more strategic significance in the last few years. Initially, the CMIO was instrumental in the success of an EMR implementation, but that work is mostly behind us now. A CMIO can bring the clinical, business and technology perspective that senior leaders need to position their organizations for future success. We are seeing an increase in the number of physician CIOs for this reason. Those roles are starting to blur.

Alan Weiss, MD. BayCare Health System (Tampa, Fla.): I think the work of CMIOs initially was focused on the implementation of EHRs, which meant establishing governance, exploring technical configurations and massive amounts of training across the enterprise. Sure, CMIOs are still optimizing their EHRs, and that work is going to always be there, but our work has now shifted to help become change agents within organizations. We now help with the development of population health and value-based care; we lead our health systems in analytics used to refine our approach to patient care; and we are integral in changing transformation efforts to improve quality, increase efficiency and reduce costs.

Kirsten Zeitler, MD. Edward-Elmhurst Health (Warrenville, Ill.): Out of all medical leadership roles, the role of the CMIO has evolved more than any other role in the last several years. No longer is the focus on evaluating and implementing an EHR; the CMIO now assists the organization in a multitude of capacities. With the vast breadth of data and innovative solutions in healthcare, the CMIO has become truly a steward of progress. The CMIO helps navigate their health system through rapidly growing amounts of data, regulatory changes, as well as the logarithmic growth of artificial intelligence capabilities. They do this while supporting their providers, clinical staff and administration with the technology available in their system.

I view the role of the CMIO as a bridge between medicine as we currently know it to what medicine will become over the next several years. Having a leader who is able to understand, balance and communicate the evolving progress and innovations in healthcare defines the focus of the CMIO role today.

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