CMIO Magazine interviews Dr. Newman

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

Dr. Newman: I do not have any formal IT training, but have always considered myself a Geek when it came to technology.  As a chief resident at Boston Medical Center in 2003,I worked on a project developing a educational and administrative website for our residents.  As a junior attending in 2004 I began an research project that involved engaging with Information Technology at Boston Medical Center.  . As a result of that project, right around 2004, I was named the physician consultant to work on our Ambulatory EHR.  I developed and implemented standardized clinical documentation forms across the medical center’s outpatient clinics.  I should note that as each year went by, I devoted 10% more of my time to IT and informatics.  In 2007, I became a manager within IT focused on our Knowledge Management Services and, finally, I accepted the CMIO role in 2009. After much research, we developed our own job description for the CMIO poisition expanding my focus from being predominately ambulatory to the entire hospital.

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

Dr. Newman: I view my role as focused on two major areas: Clinical Informatics and Academics.  On the clinical informatics side, I am the key liaison between IT and the providers.  I assist with educating the clinical staff around EHR’s capabilities and reinforcing that this is a tool where we have an opportunity to deploy best practices for optimal patient experience.  I also help with developing strategic goals for IT, providing direction, and prioritizing clinical initiatives.  I am heavily involved with our overall governance structure and ensuring adequate provider input for our projects .  It is very important that the clinical systems usage be driven by operations and not viewed as simply “IT projects”. As a result, I work closely with our CMO and CQO on patient safety and quality projects and making sure IT is empowered to support operations. On the academic side, I work closely with our residents that have an interest in informatics.  I provide them with opportunities and projects to enable them to grow within the organization.  I also work on various grants and 20% of my time is still spent providing care to patients.  I should mention that the transition can be a challenge and it can take months before one can feel balanced in both the CMIO and practicing physician roles. 

CMIO Magazine:  Who do you report to?

Dr. Newman: I report directly to the CIO and have working relationships with our CMO and CQO.

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

Dr. Newman: There are few factors that have made my role a success at Boston Medical Center and they are not in any particular order: Being a practicing physician is essential to my credibility with other providers, allowing me to have in depth discussions with end users as well as assisting and solving design and workflow issues.  I have a very supportive management team including our CIO.  My technical background has been an asset to be able to communicate to IT, solve problems, and contribute tremendously toward the design or our clinical systems. Assisting with developing and enhancing our governance structures and making sure clinical projects are not perceived as IT projects have contributed to my success. In addition, I am also currently pursuing my MBA.    

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

Dr. Newman: Yes – I view these roles as differing in focus, one more clinical and the other more business oriented, and having one individual responsible for both can be overwhelming.  I believe these roles need to work side by side and a true partnership needs to be formed.

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

Dr. Newman: We have been using CPOE since 2001, and for the past 9 years, I have seen tremendous value in using this. One of the obvious ones is the ability to have access to patient charts throughout the hospital and even remotely so providers can access essential patient data in a quick and timely manner.  We’ve developed our own order-sets and clinical pathways to make it easier for physicians to enter orders, expedite workflows and improve outcomes.   It is important to recognize that focused clinical decision support and provider engagement and collaboration among all disciplines are critical to a successful CPOE implementation.  

CMIO Magazine: Any closing remarks?

Dr. Newman: The CMIO role is a great position and I have certainly enjoyed the opportunity.  I believe anyone in this position needs to develop a thick skin and set realistic expectations with clinicians.  As I mentioned earlier, if one is also a practicing provider, the transition from scaling back seeing patients and transforming into the CMIO role can take time.  It is important to remember that medicine is changing quite rapidly politically, financially and clinically and IT has the power to contribute to and be the enabler to support these changes.  However, because IT clinical systems are a very obvious and tangible part of the changing landscape of medicine, they are often blamed as the cause of and not seen as the product of these changes.  Learning to listen to clinicians’ frustrations and weed out the true IT issues from anger and frustration at larger policy issues in medicine is key to being successful in this role.

Interview with Dr. Chris DeFlitch of Penn State College of Medicine, Penn State Milton S. Hershey Medical Center

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.