Successful CIO, CMIO partnerships must present united front
CHICAGO--CMIOs and CIOs must foster and project a unified ideological approach to manage the IT infrastructure within an organization, which, if successful, can translate into improved results for the organization, according to a presentation Tuesday at the Healthcare Information and Management Systems Society (HIMSS) conference.
Two sets of CIO and CMIO teams came together at HIMSS to discuss their relationships and processes that have developed at their separate institutions. Patricia Skarulis, vice president and CIO at 440-bed Memorial Sloan-Kettering Hospital in New York City, which is entirely dedicated to cancer treatment and research, was accompanied by David R. Artz, MD, its medical director of information systems. Also, Rick Schooler, vice president and CIO at Orlando Health, a 1,780-bed regional health center with eight facilities, was accompanied by its CMIO Steven Margolis, MD.
For CMIOs, reporting structures have arisen as a source of concern, because in many institutions, there is no clear person to whom the CMIO reports--it is distinct to each organization. An April 2008 report from Witt/Kieffer and the Association of Medical Directors of Information Systems (AMDIS) found that 26 percent of CMIOs report to the CIO of their organizations and 24 percent to the CMO. While only 19 percent of respondents answer directly to the CEO, 31 percent said that they should.
Schooler said that if an organization is struggling with this and if the reporting structure is unclear to the CMIO, then "there is going to be a problem." He added that he and Margolis speak multiple times a day. "Technically, Steve reports to me, but it cannot appear that way to the other people at the institution. Extensive dialogue between the two people in those roles is tremendously important to projecting a unified front, and these conversations should be a natural part of the daily routine," Schooler noted.
"We keep our discussions behind closed doors, where we work out our varying opinions, and only reveal a unified approach to the rest of the staff," Margolis said. While it is very important that the CIO and the CMIO have separate domains, he said, both individuals have to appear as a team because they have to work in tandem. "For example, it's the CIO's job to get the various technologies easily rolled out, and it's the CMIO's job to make sure that the CIO is successful at that," he added.
Skarulis and Artz concurred that it is supremely important that the CIO and CMIO operate as a team, adding that they have adjoining offices and often speak throughout the day. She advised CIOs who are hiring CMIOs to be particularly conscientious of how the CMIO is perceived by the rest of the medical staff. Artz stressed the importance of CMIOs gaining "a seat at the table" for organization's executive and policy committees.
While the role of the CMIO will vary based on the organization, it is important to clearly define that position. In fact, the Witt/Kieffer-AMDIS survey revealed that 56 percent of CMIOs found the "ambiguities of responsibilities" the most common challenge in their organization. Of note, 37 percent reported the "lack of seniority of position" the most common challenge.
Margolis noted that his job at Orlando is "not to control the networking structure, nor to make sure that the IT applications are running smoothly. That would be the role of a CTO." However, he said that his responsibility is to ensure that the "clinical team have the information they need to best take care of their patients, wherever they need it. This would involve clinical decision support, for example, and I also need to make sure that the team is properly trained for the equipment and devices." He concluded that "if we can't get the clinical team to use the systems properly, then we cannot attain meaningful use."
For the nursing department, Margolis said that while he does not make any nursing decisions, he often works with the nursing managers about the various systems they are using.
Margolis noted that most of his responsibilities are operational. Schooler added that Margolis "has the inside connection with the medical staff and with the IT staff, and as a result, has a comprehensive understanding of what can and cannot be accomplished," and serves as a conduit between the CIO and the staff.
At Sloan-Kettering, Artz said that he guarantees that the staff is following along with the appropriate guidance "to make sure that they are using the systems and equipment properly." Artz also is a practicing clinician at Sloan-Kettering, so "he is able to have immediate knowledge of how the systems are being used," according to Skarulis.
Both Artz and Margolis said that their biggest challenge as a CMIO was vendor-based. For Artz, it's a challenge to find the right solution for problems that arise, due to the limitations on the market. Margolis added that his "job is to get meaningful use out of the systems, which is sometimes difficult, because outlying physicians do not want to adhere to the established protocol because their incentives are different."
Margolis added that some of the "electronic tools are not as usable as we would like, due to multiple logins and the lack of interoperability. Having said that, we have the best tools money can buy. With this, the problem is getting the vendor to change their priorities to match with our priorities."
Because of these challenges, building a relationship between the CIO and the CMIO is integral, Schooler said. "Staying on the same page, despite hearing a lot of feedback from multiple parties, requires a strong working relationship and a great deal of trust."
"You have to have each other's back," Skarulis concluded.
Two sets of CIO and CMIO teams came together at HIMSS to discuss their relationships and processes that have developed at their separate institutions. Patricia Skarulis, vice president and CIO at 440-bed Memorial Sloan-Kettering Hospital in New York City, which is entirely dedicated to cancer treatment and research, was accompanied by David R. Artz, MD, its medical director of information systems. Also, Rick Schooler, vice president and CIO at Orlando Health, a 1,780-bed regional health center with eight facilities, was accompanied by its CMIO Steven Margolis, MD.
For CMIOs, reporting structures have arisen as a source of concern, because in many institutions, there is no clear person to whom the CMIO reports--it is distinct to each organization. An April 2008 report from Witt/Kieffer and the Association of Medical Directors of Information Systems (AMDIS) found that 26 percent of CMIOs report to the CIO of their organizations and 24 percent to the CMO. While only 19 percent of respondents answer directly to the CEO, 31 percent said that they should.
Schooler said that if an organization is struggling with this and if the reporting structure is unclear to the CMIO, then "there is going to be a problem." He added that he and Margolis speak multiple times a day. "Technically, Steve reports to me, but it cannot appear that way to the other people at the institution. Extensive dialogue between the two people in those roles is tremendously important to projecting a unified front, and these conversations should be a natural part of the daily routine," Schooler noted.
"We keep our discussions behind closed doors, where we work out our varying opinions, and only reveal a unified approach to the rest of the staff," Margolis said. While it is very important that the CIO and the CMIO have separate domains, he said, both individuals have to appear as a team because they have to work in tandem. "For example, it's the CIO's job to get the various technologies easily rolled out, and it's the CMIO's job to make sure that the CIO is successful at that," he added.
Skarulis and Artz concurred that it is supremely important that the CIO and CMIO operate as a team, adding that they have adjoining offices and often speak throughout the day. She advised CIOs who are hiring CMIOs to be particularly conscientious of how the CMIO is perceived by the rest of the medical staff. Artz stressed the importance of CMIOs gaining "a seat at the table" for organization's executive and policy committees.
While the role of the CMIO will vary based on the organization, it is important to clearly define that position. In fact, the Witt/Kieffer-AMDIS survey revealed that 56 percent of CMIOs found the "ambiguities of responsibilities" the most common challenge in their organization. Of note, 37 percent reported the "lack of seniority of position" the most common challenge.
Margolis noted that his job at Orlando is "not to control the networking structure, nor to make sure that the IT applications are running smoothly. That would be the role of a CTO." However, he said that his responsibility is to ensure that the "clinical team have the information they need to best take care of their patients, wherever they need it. This would involve clinical decision support, for example, and I also need to make sure that the team is properly trained for the equipment and devices." He concluded that "if we can't get the clinical team to use the systems properly, then we cannot attain meaningful use."
For the nursing department, Margolis said that while he does not make any nursing decisions, he often works with the nursing managers about the various systems they are using.
Margolis noted that most of his responsibilities are operational. Schooler added that Margolis "has the inside connection with the medical staff and with the IT staff, and as a result, has a comprehensive understanding of what can and cannot be accomplished," and serves as a conduit between the CIO and the staff.
At Sloan-Kettering, Artz said that he guarantees that the staff is following along with the appropriate guidance "to make sure that they are using the systems and equipment properly." Artz also is a practicing clinician at Sloan-Kettering, so "he is able to have immediate knowledge of how the systems are being used," according to Skarulis.
Both Artz and Margolis said that their biggest challenge as a CMIO was vendor-based. For Artz, it's a challenge to find the right solution for problems that arise, due to the limitations on the market. Margolis added that his "job is to get meaningful use out of the systems, which is sometimes difficult, because outlying physicians do not want to adhere to the established protocol because their incentives are different."
Margolis added that some of the "electronic tools are not as usable as we would like, due to multiple logins and the lack of interoperability. Having said that, we have the best tools money can buy. With this, the problem is getting the vendor to change their priorities to match with our priorities."
Because of these challenges, building a relationship between the CIO and the CMIO is integral, Schooler said. "Staying on the same page, despite hearing a lot of feedback from multiple parties, requires a strong working relationship and a great deal of trust."
"You have to have each other's back," Skarulis concluded.