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The CMIO: 'Defender of Physician Work Flow'


So what makes IT right for doctors? For starters, software that was designed from the outset with physicians in mind, and for physicians to use - which, unfortunately, most current health information systems (HIS) were not.

I didn’t study computers in medical school, and I didn’t become a doctor because I love to work with software. My interest was practicing medicine; my passion was caring for patients.

But I have come to appreciate how valuable the right information technology (IT) can be in helping physicians practice medicine – in their direct care of patients, and in the administrative aspects of what doctors do every day.

Take entering patient charges, for instance. Electronic charge capture software has dramatically improved both the speed and accuracy of this traditionally manual administrative process. Look at writing orders - another routine aspect of practicing medicine. Automating this particular process is a sore point with many physicians, who are perfectly happy scribbling orders on paper, or calling them in to a nurse. Believe it or not, software truly can streamline the ordering process for physicians… if the software is done right.

And on the flip side, IT can be a useful tool in sharing the end product of those orders. For instance, using a smart phone or an iPad, a doctor rounding at a hospital or working in the office can display test or lab results to a patient in real time.

So what makes IT right for doctors? For starters, software that was designed from the outset with physicians in mind, and for physicians to use - which, unfortunately, most current health information systems (HIS) were not. That simple fact explains why today, some 40 years after CPOE (computerized physician order entry) systems were first introduced, less than one-sixth of U.S. hospitals are doing even nominal CPOE with commercial software, and less than six percent of hospitals have all their physicians engaged with their CPOE system. And that’s in an environment with heavy government incentives to adopt CPOE.

Organizationally, getting physicians to “meaningfully use” IT systems at hospitals and medical practices requires a strong, medically-savvy IT advocate who has physicians’ best interests at heart. Enter the Chief Medical Information Officer (CMIO), a title increasingly found at hospitals, healthcare networks, and medical groups nationwide.

CMIOs are partnering with Chief Information Officers (CIOs), the organization’s senior-ranking IT executive. Historically, the software that CIOs often tried to “sell” doctors on using typically wasn’t designed with physician users in mind. Some of these applications end up taking more of the physician’s time than the good old paper way of doing things. And the CIO, who is not a physician, can’t fully appreciate how cumbersome, distracting and unproductive a traditional hospital information system (HIS) can be for a physician. Indeed, physicians love a CIO who enables them to focus on their patients, not technology.

The hard truth is computerized systems that don’t fit into the physician’s work flow don’t stand a chance of being readily adopted by physicians - and that includes systems like CPOE, which are part of ARRA/HITECH “meaningful use” requirements. Reluctant or grudging physician adoption is therefore a big problem not only for CIOs, but for the entire executive leadership team at provider organizations, because now it impacts regulatory compliance and revenue.

And that is precisely why CIOs increasingly are not being left to operate alone. A growing number of institutions are “teaming” the CIO with a CMIO, a physician who offers exactly what the CIO needs: someone deeply enmeshed in the hospital’s clinical systems who can be a credible and effective liaison and technology advocate with physicians. The CIO never studied medicine, and the CMO never studied IT, so employing a CMIO gets providers a blend of complementary skills, and an invaluable partner for the CIO. As a team, they are sitting at the “big table,” making strategic, multi-million dollar purchase decisions for their organizations related to IT projects that may take years to implement.

Many healthcare providers have come a long way in a relatively short time. No longer is the CIO merely a tool of the CFO, trying to force physicians to use a multi-million dollar HIS that the board of directors was persuaded to purchase.

When I ran a health network in Western Massachusetts, I suggested that the role of the CMIO should be “the defender of physician work flow.” The key for provider organizations is to make physicians want to use their HIS systems, rather than be forced to use the systems. Beating doctors over the head with a stick hasn’t worked - witness the single-digit adoption rate of commercial CPOE systems over the past 40 years - and it isn’t going to work now.

As provider organizations look ahead to Stage 2 and Stage 3 “meaningful use” requirements, it will become even more essential that doctors willingly use the core health information systems. CMIOs will play a greater role in ensuring this happens by keeping IT focused on what matters most: providing “physician-friendly” productivity tools to doctors that streamline their workflow and that deliver more useful and timely clinical information, which can be applied to improve patient outcomes and let doctors focus more of their time on patient care. Most physicians may not care to become IT experts, but they can appreciate - and will use - a good thing when they see it.

Donald Burt has more than 20 years of clinical, medical management, and medical information technology experience. He has previously served in leadership roles for health systems, consulting firms, and a provider-owned HMO and is an assistant professor of medicine at the University of Massachusetts Medical School. Burt currently serves as chief medical officer for PatientKeeper, Inc.
Editor's Note: This post contains materials previously used in a blog authored by Dr. Burt.

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