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Interview Spotlight: Dr. Larsen, CMIO at Hennepin County Medical Center.
Q: How did the CMIO role evolve for you?
Dr. Larsen: Hennepin has had a CMIO for about 12 years. My journey began during my medical school and residency in 2000 when I became involved with various IT projects such as moving physician schedules on-line and as a Medical Director; I was involved with claims data initiatives. I was involved with health services and health data record initiatives which gave me great exposure working with our IT staff. As a result, I got invited to be on the IT committee at around 2004 during which time we decided to replace a homegrown clinical system with enterprise software for EHR and CPOE. Hennepin is a government based Hospital which meant, we had bid against 15 vendors for the selection process. As a physician champion, I became heavily involved with the selection process with about 15 clinical software vendors. The RFP process further enhanced my working experience with our IT leadership including the CMIO and staff alike. Our CMIO left during 2007 and I was appointed the interim CMIO and officially became the CMIO in early 2008.
Q: How would you categorize your role and responsibility?
Dr. Larsen: We are a large hospital with extensive outpatient services. We had a very aggressive clinical implementation plan and within less than 2 years, installed ambulatory clinical systems and hospital CPOE. In fact, we’re considered a stage 7 so we’re pretty paperless. I am the only physician on the project who is reimbursed to be on the deployment. The majority of my role is physician liaison amongst the physician groups, IT Leadership, and the EHR teams.
I also motivate physicians with the adoption of CPOE. I set direction for on-going EHR projects and identify key strategic proposals for any clinical decision support initiatives. I have been invited to sit on the IT Chair Committee and the EHR Committee. We have about 100 interfaces to our clinical system and I participate in those discussions. I assist with curriculum development of training programs for our EHR/CPOE system. We also have a knowledge management initiative for data governance and my involvement is focused around data quality and access. I need to ensure that technical interfaces support our physician community. For example, physicians need to have reliable access to our EHR/CPOE system via their home office. And last but not least is my work around various quality improvement projects such as medication reconciliation.
Q: Is there an opportunity for a CMIO if the CIO has a clinical background?
Dr. Larsen: In fact our CIO has a nursing background and yet her involvement tends to me more on the business side of the IT equation. I am very involved with the clinical decision making process for our CPOE and any clinical system. I also do a 0.2 FTE clinical rotation which provides tremendous value working with other end users of the CPOE since I have hands on experience with the challenges they face. There is an absolute need for the CMIO role as we drive patient safety initiatives and we need IT to support those projects with an eye on clinical quality and outcomes.
Q: Do you see a value behind a CPOE system? What are the obstacles?
Dr. Larsen: Not in and of itself. CPOE becomes valuable when combined with appropriate clinical decision making at the point of care which provides better care and makes life safer. CPOE does provide tremendous value to make better clinical decisions but most software solutions are not designed for complex scenarios. What would make CPOE systems more effective is having the capability to handle complex ordering processes and workflows; when they can handle multi-stage ordering support. When a CPOE solution is able to deliver current, high quality, accurate information at the point of care, the value proposition is achieved. The ordering process in a healthcare setting is a very complex environment that changes frequently and the software needs to keep up with the pace. In some cases we’re asking an ordering physician to answer 30 questions before an order is placed; this is very time intensive for our physicians.
Q: We would like to get your last closing remarks.
Dr. Larsen: The residency program was a stepping stone towards the CMIO role for me. It was a launching pad to get introduced to the academic medical center environment which is rather complex. Understating the educational programs, residency demands and protocols have helped me to be a more effective CMIO.