Interview with Fallon Clinic’s CMIO

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

Larry Garber: I started as a computer geek about 37 years ago in High School.  In other words, I started with a strong computer science background and then I went to Medical School.  When I started at Fallon Clinic 23 years ago, I had a strong interest in Information Technology and how it could be applied to Medicine.  At that time no one else had a major interest in Medical Informatics at Fallon Clinic so I took it upon myself to get involved more with IT and Medicine.  In 1993, as a fulltime internist and with the help of a few other doctors, we designed a homegrown system, QuickChart, which was a Results Review repository system.  That project gave me the recognition to be the key liaison between clinicians and our IT department.  Consequently, in 1998 when we were affiliated with a Hospital looking into implementing a paperless system, I pitched myself as the Informatics person and I received the role as the Medical Director for Informatics that year.  I ended up defining my own roles and responsibilities as the CMIO of the organization.

Around 2001 we began the journey of implementing an EMR system in our group practice with 23 sites in Massachusetts.  I led physician educational sessions with respect to an EMR system, EMR vendor selection and implementation of it.   I participated in leadership meetings with the CIO and COO and other leaders to get funding for the EMR project.  We signed the EMR contract in 2004 and my role became more of a full-time CMIO on the EMR project but still maintained about third of my time practicing medicine.  I completed the EMR vendor’s certification program so that I could help build the system as an analyst on the team.

CMIO Magazine:  How would you categorize your Roles and Responsibility as the Medical Director for Informatics/CMIO of Fallon Clinic?

Larry Garber: I am responsible for two things.  Creating the vision for the use of information technology to help practice medicine for all people involved at Fallon Clinic and not just the physicians.  And then leading the implementation of the vision.  I also play a key role with respect to communication between the EMR vendor and our organization.  I am a hands-on CMIO, sitting in a cubical in the IT department rather than an office, so I can hear all issues related to the EMR solution and the interfaces to other clinical systems alike.  I am immersed within our IT teams and facilitate decisions around our clinical solutions.  I also do some of the build within our EMR.  I built our Diabetes Disease Management Program.  I do most of the clinical mapping for our interfaces.  Right now I am designing one of our interfaces to one of the new Hospitals that we’re connecting to.

CMIO Magazine:  Who do you report to?

Larry Garber:  I report to both the CMO and CIO.  I started reporting to CIO when we selected our EMR solution and then it morphed to me reporting to the CMO as well.  In reality, I’ve always been responsible to both.

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

Larry Garber: Yes.  The CIO is dealing with issues related to, for example, budget and personnel.  They don’t have enough time to work with the technical team and focus on the details around an EMR solution; for example which fields in our EMR system we need to capture and report off of; the CIO doesn’t have time for that level of details. 

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

Larry Garber:  Absolutely.  As far as CPOE goes, there has been a reduction of mistakes in order entry with medications and other order types.  Our order entry communication is much more efficient.  With CPOE’s alerts, we can eliminate prescribing wrong medications to patients; for example, if my patient is allergic to a certain drug, the system gives me an alert.  I may have missed that in the paper world.   

CPOE is a small portion of the overall benefit.  A significant benefit for us has been the electronic interface to so many organizations gathering information on a patient allowing me to know far more about the patient than they know about themselves.  We have complete electronic records on patients starting in 1993.  So it looks just like we’ve been live for 16 years.  With the EMR I can filter through these years of data and find exactly what I need to know.  I can access information in a more meaningful way and I can trend data and look at trajectories that I couldn’t see before.  I can now review PSAs on a young patient and realize the trajectory doesn’t look good and can alert my patient accordingly. We’re much more proactive with disease prevention and management.

 We’re constantly evaluating our CPOE build and optimizing it with respect to workflows which provide added value to our clinical teams.


Interview with Dr. Schneider, CMIO at Baylor Health Care System

Q: How did the CMIO role evolve for you?

Dr. Schneider: My career followed a slightly different path than most.  After finishing college in the 70s, I ended up in Business School rather than Medical School as originally planned.  I worked for about fifteen years in accounting, finance, and manufacturing.  My last position was as a General Manger of a “paperless” manufacturing company.  There I had extensive exposure to paperless workflows where engineers exchanged files and shared data electronically.  When the company was sold, I decided it was finally time to go to medical school. My first rotation as a student in a hospital was a complete step back.  We used paper forms for everything.  I became a doctor with an eye for technical innovations in HealthCare IT.  I wanted to combine my business experience with my clinical expertise to make a positive impact on patient care while improving the work environment for my colleagues. These endeavors lead me to do some healthcare IT consultancy work with a small personal health record company before I accepted my first official CMIO role at a pediatric hospital in Dallas.  After 4 years, I accepted my current CMIO role at Baylor Healthcare System in Dallas.


Q: How would you categorize your roles and responsibilities?

Dr. Schneider: I consider myself as Chief Clinical Information Officer.  I like to represent all clinicians whether they be physicians, residents, nurses, pharmacy or other staff.  We’re all in it together and IT solutions impact not just the physicians but all the constituents providing care for our patients.  Part of my role is being a “thought facilitator”, i.e., allowing clinical teams to work together, design systems and make good decisions.  My role is to make sure that our EHR governance is working and that good decisions are being formed in the best interests of our patients. Another role is around timely communication with senior leadership.


Q: Describe an average day for you?

Dr. Schneider: Aside from the day to day issues of EHR decisions, I currently spend a significant amount of my time looking working on tactical and strategic planning around implementing our clinical systems in reference to the new stimulus package.  I also am involved with vendor selection for our ambulatory practices.  I support our new EHR governance structure to help ensure that good decisions are being made at the right time.  I also put out fires when necessary and try to ask the right questions to cultivate good answers from our teams.


Q: Is there an opportunity for a CMIO if the CIO has a clinical background?

Dr. Schneider: It depends. If an organization has a strong CIO with a good clinical background and he/she surrounds themselves with strong physician champions who can own the process and assist on an on-going basis, then maybe a formal CMIO role isn’t needed.  Although when an organization has a CMIO,  it sends a message that they have identified an individual to be the point person and responsible to be the voice for the physician and clinical community.  I see tremendous value in having a CMIO.


Q: Do you see a value behind a CPOE system?  What are the obstacles?

Dr. Schneider: In the informatics world, we know that it’s not CPOE that brings quality – it’s the use of good decision support at the point of care and workflow, easy-to-use physician documentation, workflow-friendly order sets, customizable viewers, meaningful actionable alerts, etc.  I’m very concerned that by just saying CPOE we won’t get all the other things that are needed.  There are tremendous obstacles, but one – physician readiness – is declining steadily.  Give them good systems to work with and they will use them. 


Q: We would like to get your last closing remarks.

Dr. Schneider: There is tremendous value in getting clinical practitioners involved from the very beginning of any clinical IT solution.  The practitioners need to own the solution and IT needs to support them and the solution.  Otherwise, there will be lots of re-working after the implementation.  Rework is very expensive and is disruptive.  We need to be more patient focused in arriving at design decisions.  We need to challenge vendors to make sure they share the same vision.