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

Dr. DeFlitch:  I completed my medical degree at Penn State College of Medicine in the mid 90s and trained in emergency medicine at the University of Massachusetts Medical Center.  Up to that point I had had limited exposure to healthcare IT.  My primary goal was to provide outstanding care to patients that I saw in the ED.  While practicing medicine at a private hospital in the Pittsburgh area, I found that I had limited access to patient data, and, often times, I wouldn’t have all the data points (prior records, labs, EKG, etc) to make critical clinical decisions.    It was a rather frustrating experience and I knew there would have to be a better way.  As I transitioned back to work at Penn State, I got more involved with solutions that would result in better patient care.  Despite being recruited to start a residency program, I started by getting involved in the ED operations and administration.  I started to look at operations and process improvements in our ED department and inevitably healthcare IT solutions became part of my assessment. My first involvement in Healthcare IT was in the ED, using triage and tracking.  I then assisted with the process of electronic signature of transcribed dictations.  This process allowed for ED records to be visible to anyone across the campus with access to the Clinical Information System.

Meanwhile, right around 2002, our organization decided to embark on CPOE.  Our COO and CEO at the time saw the positive impact of electronic record sharing from the ED, as well as operational process improvements.  I was asked to participate and contribute towards the system selection, and subsequently became the “physician champion”, representing the physician clinical voice for Penn State Hershey.  I was joined by a nurse and pharmacist as the clinical leadership team.  Once the system was selected, we created a team of physicians, nurses, pharmacists and IT specialists to design, build, test, and implement the system.  As part of my role, we’ve infused existing hospital leadership committees with those with IT knowledge and created work groups to run the clinical IT projects.  Along with an IT professional, we lead the order management team, creating all orders and insuring that appropriate order-sets had been designed and built into the system.  In 2005, we successfully converted to true CPOE,  integrated nursing documentation and pharmacy processes.  Subsequently, we’ve expanded our application portfolio and we’ve shared our success with hospitals and health systems across the world.  With these successes, in 2008, I was appointed to the CMIO role.  I remain clinically active, working shifts in the ED which takes about 15% of my time.   The rest is devoted to the CMIO role, including health IT development and discovery, and ED administration.

CMIO Magazine:  How would you categorize your current roles and responsibilities?

Dr. DeFlitch:  I am a translator – I translate information technology language that is applicable to the clinical community and vice versa.  I help to develop the clinical requirements with our information technology (IT) team.  Together the clinicians and IT professionals assess, develop and implement solutions in an appropriate and timely manner.  I also am involved with our organization’s clinical and strategic vision, in which IT plays a big role.  We wouldn’t be able to achieve our business goals without our integrated IT approach.  It’s very critical that IT work with the clinicians and administration to shape that vision.  What we do well is optimize the clinical system for care delivery processes, rather than force the clinician to use an IT system.  In that role, I also need to mitigate any risk to our patients and delivery of care when there are system limitations.  This is an important role for me and the organization.

CMIO Magazine:  Who do you report to?

Dr. DeFlitch:  I report to our Chief Information Officer (CIO) who has a medical degree.  That being said, we’re a matrix organization so I also have collaborative responsibility with our Chief Medical Officer (CMO) and Chief Quality Officer (CQO).  It is essential to our success that our clinical and IT leadership are on the same page.

CMIO Magazine:  What would you describe as key factors for success in your role?

Dr. DeFlitch:  I work with some very incredibly smart and enthusiastic people.  Our IT department, across the board, is passionate about what we do; our institution is passionate about quality clinical care.  That’s what we do.  You can’t go wrong with that!  I would not be successful without the work of our director of clinical systems, assistant director, and IT team managers.  These intelligent and personally committed individuals make the work of clinical informatics very fulfilling.  Our relatively new data warehouse director and analytics group has also provided great inspiration  in obtaining data for secondary data use and optimizing clinical process outcomes.  We have excellent executive support of me and my role.  Our CIO has become my mentor, supporting me in every way possible.  We have a great team and we tackle every issue with a great deal of collaboration.  Our clinical IT leadership team, also known as the “architect” group, works very well together, makes decisions in a timely manner, and stays on top of the issues.  I also have a good relationship with our key vendors, including Cerner Corp. I think that is a very important success factor since we’re investing millions of dollars implementing their software, and their success is so closely tied to our success.   The ability to be successful in matrix decision making and reporting relationships I mentioned earlier is a key factor.  We are smarter together, than as individuals. 

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

Dr. DeFlitch:  The short answer is yes – Even though our CIO is a physician by background, his focus is much broader and complex in nature.  Overseeing the entire IT enterprise for a hospital, health system and college of medicine, in addition to a complex clinical information system is way too much for one individual.  Having the CMIO focus on clinical informatics and workflow, while the CIO has focus on the IT components has proven successful.  The workload alone would be too much for one person. 

CMIO Magazine: from a CPOE perspective, do you see a value behind it?

Dr. DeFlitch:  There is clear value in CPOE, if the processes of care and ordering are designed correctly for that institution.  The value in CPOE is in both the electronic order entry, and it’s the pace at which the care can be delivered.  It is a privilege to be able to interact with the ordering provider in real time.  Being able to provide clinical decision support (CDS) at the ordering conversation is invaluable.  We have to be careful not to overburden the clinician with too many “pop ups”, alert fatigue.  From the process perspective, we really concentrate on the patient and provider care workflow.   For example, patient care experience in the ED has been a challenge. Processes such as wait management, triage, and treatment based on acuity are attempted to be addressed in many locations.  We leveraged our IT infrastructure, including tracking, CPOE, and e-documentation to find opportunities for improvement.  With some advanced analytics, application of queuing theory, and simulation  technology, I created a new care delivery model of practice, called PDQ (Physician Directed Queuing)^TM.  I’ve re-designed our ED to meet our current and future demand, using operational data.  To give you an idea of the impact, the time to see a physician improved to about 15 min (press ganey states >3hr in many location). Despite volume of nearly 60,000 visits per year (up 15% from last year), the LWBS (left without being seen) rate dropped from over 5% prior to PDQ, to being <0.5% for the last 6 months.  All of the improvements occurred by adding value to the queue, without significant staffing changes.   We redesigned the physical plant based on Clinical IT and process, saving the institution more than 10 million in building costs.  In essence, we are leveraging our IT tools and systems thinking to improve the delivery system, and infuse this type of thinking into healthcare.  We work closely with Penn State University and our newly developed Center for Integrated Healthcare Delivery Systems (CIHDS) to develop new innovative delivery systems similar to the re-design of our ED department, and to develop the next generation of thinkers in this field. 

CMIO Magazine: Any closing remarks?

Dr. DeFlitch:  When we started the Clinical Information Systems project, we didn’t just look at the CPOE, physician order entry aspect of it.  We understood it’s the entire healthcare delivery system which is a multidisciplinary approach to the design and execution of CPOE.  It is also equally important to design the workflow processes and address the existing process issues up front; automating a bad process will yield bad results.  The system should look at the results of the process, the impact that it will have on those who are using the system, and most importantly, the impact it will have on patient care.  It’s not about the order, it’s about the care.  Mitigating the increased time to enter an order electronically with patient safety and user efficiency is important.  CPOE without clinically driven order sets will fail.  Ordering a medication electronically without involvement of nursing and pharmacy in the design will fail.  Using clinically relevant decision support tools in the right juncture can make care safer, more effective, and more efficient while improving the experience of both providers and patients.