The changing role of the CMIO and 4 trends to watch in the future: Geisinger Associate CMIO Dr. Richard Schreiber

Associate CMIO of Danville, Pa.-based Geisinger and CMIO of Geisinger Holy Spirit Richard Schreiber, MD, has participated in multiple EHR adoptions during his tenure.

He now sees his role becoming more focused on implementing artificial intelligence and developing a workforce of formally trained informatics clinicians to support Geisinger in the future. Here, he answers three questions about his current role and the biggest trends for the future.

Question: What initiative are you most proud of having led or participated in as a CMIO?

Dr. Richard Schreiber: I led the charge to adopt an EHR at our community hospital, starting in 2005, with particular emphasis on CPOE. Then when we transitioned to another vendor EHR, I again led the charge and advocated for physicians (and other professionals) to ensure that we closed the gaps and enabled the best workflows.

So, I am most proud of my participation and leadership in the installation, adoption, optimization of an EHR, and then repeating the process during EHR transition.

Q: How has your role evolved over the past 12 to 24 months and where do you see it headed in the future?

RS: The timeline of my role has evolved as follows:

• CMIO 1.0 in 2005-2010 was all about adoption and EHRs.
• CMIO 2.0 from 2010-2014 was all about meaningful use.
• CMIO 3.0 from 2014-2016 was supposed to be about optimization (but in my view was thwarted by meaningful use and other regulatory burdens, such as ICD-10)
• CMIO 3.1 from 2015-2017 (at least in my case) was all about EHR transition to another vendor produce

CMIO 4.0 from 2017-present deals with optimization, improvement of informatics governance, development of more robust population health, a focus on usability, and improving remote information gathering. Note I didn't say interoperability, because if with the latter, the former is suboptimal.

CMIO version future will have to focus on all of the above, plus:

• Role of artificial intelligence
• Robust information sharing (again, not the same as interoperability)
• Predictive analytics
• Usability — we need a vigorous attack on the lack of usability issues of EHRs
• Workflow improvements
• Removal of burden regulations afflicting all of U.S. medical care
• Role of formally trained informatics clinicians as they enter the CMIO workforce
• Genomics

Q: What are the two to three biggest trends in healthcare affecting your decision-making process as a CMIO?

RS: The biggest trends I see today include:

• Current research in clinical decision support
• Artificial intelligence, including machine learning, natural language programming, diagnostic assistance
• Genomics, including pharmacogenomics and genetic scoring
• Role of whole exome sequencing

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