A meeting with Michael Zaroukian, MD, PhD, FACP, FHIMSS, CMIO at Michigan State University

CMIO Magazine: How has the CMIO role evolved for you?

Michael: I wear two hats with the same overarching purpose for two distinguished organizations; I am the CMIO for the Michigan State University (MSU) HealthTeam as well as the Medical Director of Clinical Informatics and Care Transformation at Sparrow Health System.  In both organizations, I’m the strategic physician lead for EHR implementation, optimization and best use. I like to think of myself as an information technology optimist who is also grounded in the realities of what works and what doesn’t in healthcare settings, always looking to leverage HIT to improve care and satisfaction in our practices. 

My interest in computers has always depended on a sense that a particular device or application could help me solve a clinical problem, not because of any “coolness factor” per se.  My interest in medical computing started when I began my internal medicine residency and PhD program in 1981, the year that the first IBM personal computer was just being introduced to the masses.  I could immediately see the potential of this device and accompanying software to help me deal with the impossible task of keeping in my head all of the information I would need for patient care, a problem made worse by paper charts that were too often poorly organized and incomplete, and medical knowledge resources that could not fit in my pockets or be easily be accessed to meet the patient-specific demands of the moment.  It was an exciting new era to have PCs with screens and the ability to manipulate data, so I began to test what was possible, creating patient flowsheets and electronic topic summaries, initiating electronic communication with colleagues, trainees and patients, and learning command language MEDLINE literature searching.  In so doing, I rapidly became aware of both the power of medical computing, the limits of existing technologies and the importance of direct physician interaction with computer systems; physician input would be needed to improve the capabilities, use and usability of computers and software in healthcare. 

My path to becoming CMIO began with my strong advocacy for implementing an EHR solution in the late 1980s.  I also began to identify and network with other like-minded peers to understand barriers and share strategies on assessing readiness and leading organizational change.  I also drew upon the increasing recognition that medical schools had a responsibility to teach students to use EHR systems to prepare them for 21st century practice.  So I started by role modeling appropriate HIT use in my patient care, teaching, administrative and research work. I then began mentoring interested colleagues and worked with the National Library of Medicine to improve the usability of a new tool called “Grateful Med” to enable physicians to do their own MEDLINE searching. I then created a residency rotation in medical computing, introduced PDAs for resident use, and began teaching physicians in practical clinical computing skills at national professional meetings.  By 2001, the two Institute of Medicine Reports, “To Err is Human” and “Crossing the Quality Chasm” made it clear to MSU leadership that implementing an EHR was essential to its quality, safety and efficiency goals.  Due to my longstanding EHR advocacy, consistent HIT use, clinical credibility, and experience developing and implementing HIT educational programs for physicians, I was selected to direct the resulting EMR implementation project at MSU.  Once the basic EHR functionality was implemented throughout the faculty group practice, I moved on to become the CMIO in 2005. 

CMIO Magazine:  How would you categorize your Roles and Responsibilities?

Michael:  I see my major roles and responsibilities as CMIO as falling into four major categories.  First, I work to help ensure that the IT staffs I work with implement quality EHR and other HIT systems on a sufficiently robust and stable IT infrastructure so they work the way they were designed and are as reliably and almost as rapidly available as turning on a light switch.  Second, I work to help lead the organizational change needed to ensure realistic expectations, get buy-in, motivate process redesign, engage physicians and achieve the kinds of wins that build and lock-in future successes.  Third, I continuously look for opportunities to optimize existing systems and introduce new functionalities that make it easier to deliver high quality care with a particular focus on data capture, information sharing and clinical decision support. Finally, I try to ensure that improved quality, satisfaction, outcomes and reputations are the natural consequences of appropriate HIT use.

As such, I’m a strategic leader for optimizing our EHR solution.  I am also responsible for leveraging HIT to help us achieve our quality goals, whether by introducing clinical decision support based on nationally-recognized guidelines or locally developed best practices.  I get involved with policy making, interacting with vendors and government representatives, as well as serving on several national professional organization committees that guide national HIT policy.  I am responsible for helping to shape the vision for when and how HIT can be best used, looking into the future and devising strategies to help position the organizations to be premier healthcare delivery sites with information technology tools that support their mission, vision and values.  I also make sure that whenever possible, EHR implementation strategies, policies and procedures are set at the enterprise level to support shared goals and objectives and save costs and resources through standardization and simplification.  I am involved in change management activities and work with project directors, managers and staff, as well as my physician peers to make sure we use appropriate project management tools and techniques to effectively deliver our EHR solutions.  Given the newly available government stimulus initiatives, I have recently spent time helping to shape the “meaningful use” definitions, objectives and measures that will be used to ensure that the final rules for reimbursement advance the nation’s quality and efficiency goals while making sure that the criteria are appropriate and realistic for the organizations I serve and the physician colleagues I work with.

CMIO Magazine:  Who do you report to?

Michael:  As the CMIO at MSU, I report to the CEO of the MSU HealthTeam. In my role as Medical Director of Clinical Informatics and Care Transformation at Sparrow Health System, I report to the CIO.

CMIO Magazine:  If the CIO is clinical, is there a need for a CMIO?

Michael:  It depends.  It’s still uncommon to find a CIO with deep experience on the IT side and sufficient recent clinical experience to keep their knowledge of clinical practice current.  At a minimum, I would say that if the CIO is not a physician, a CMIO is important to helping the CIO and IT division succeed, as well as helping to maximize the organization’s return on its HIT investment.   While there is considerable debate among CMIOs on the need for ongoing clinical practice, I personally think most CMIOs can best establish and maintain their credibility with other physicians and leverage their medical, HIT and clinical informatics expertise by  ongoing use of  the  clinical software that they have helped plan and implement to care for their own real patients in the field.  Another reason why there is often a need for both a CIO and CMIO in an organization is that the roles and responsibilities of a CIO and CMIO are large enough and different enough that it is hard to imagine having time to do both jobs well in a large organization without additional executive level support.  

CMIO Magazine:  You have published experience demonstrating a strong return on investment from EHR implementation in your practice.  Do you see CPOE as adding significant value in this regard?

Michael:  Well, this is a very good question.  MSU hasn’t yet rolled out CPOE so I don’t have personal experience on the costs and benefits of implementing CPOE to share with your readers.  However, as is true for many other paper-based clinical processes, efficiency and quality problems currently exist, as well as problem of overuse, underuse and misuse of tests and treatments. As a result, there is much reason to believe that HIT-enabled, decision-supported computerized order entry is likely to yield significant improvements in quality, cost and safety if implemented correctly and used consistently.  However, the physician-centric nature of CPOE and the complexities of developing order sets, redesigning care and achieving physician buy-in and regular use make having a strong project manager, effective physician champions, skilled trainers and influential executive sponsors essential to implementing CPOE on-time and on budget while ensuring patient care quality and safety.   

 CMIO Magazine: Any closing remarks?

Michael:  I would just close by commenting on the important role that CMIOs will play in the next few years in the area of “meaningful use” of EHR and associated HIT systems.  The conviction that many of us CMIOs have that quality and costs can both be improved by implementing and making meaningful use of appropriately designed, interoperable EHR systems will be put to the test, and the nation is betting over $17B that we are correct.  I believe we will do well by initially focusing squarely on what I see to be the first steps in meaningful physician EHR use – consistent and appropriate data capture and sharing.  My perspective is that the most important 2011 stretch goal for physicians and hospitals is to ensure that all physicians and staff become regular and appropriate users of EHR systems to capture electronically or directly enter problems, medications, allergies, histories, prescriptions, vital signs, office progress notes and patient-related messages, and then to share relevant information electronically with patients and providers as appropriate. Structured data capture of important clinical information will also set the stage for the next phase of meaningful use, including EHR/HIT-supported advanced clinical processes, robust clinical decisions support, chronic disease management, quality reporting and improved outcomes.