Opening Keynote Session “CIO and CMIO Dynamics: The Evolving Roles & Relationships”

iHT2

January 2012

Michael Bakerman, MD, FACC, FACPE, MMM

Chief Medical Informatics Officer

Richard Mohnk, MSA, MT(ASCP)

Associate Chief Information Officer

Institute for Healthcare Technology Transformation

UMass Memorial Health Care:

CIO and CMIO Partnerships

2 iHT2 January 2012

Disclosures

We have no disclosures

We have no conflicts of interest

Describe the UMass Memorial System

Define our Cornerstone Strategy

Illustrate CIO and CMIO differences and opportunities for

collaboration

Case Presentations and discussion

3 iHT2 January 2012

UMass Memorial Health Care

7 Hospital System

Clinical Partner to

UMass Medical School

13,500 employees

3,000 registered nurses

Approximately 1,600

physicians

1,111 beds

$1.4b in Annual Revenue

~60,000 inpatient visits

~1,000,000 outpatient visits

4 iHT2 January 2012

UMass Memorial Healthcare Information Technology

Cornerstone Initiatives

Fundamental Goal: Move from a predominantly paper environment to one that is predominantly electronic – Core Ambulatory EMR

– Inpatient EMR/CPOE

– Inter & Intra Enterprise Identification

– Inter & Intra Enterprise ‘Interoperability’

– Connected Healthcare Community

Improve Availability and Flow of Information

Improve Quality and Safety

Increase Efficiency and Effectiveness

5 iHT2 January 2012

Private Medical

Practice

Inpatient EMR

Outpatient Enterprise EHR

University

Memorial Hahnemann

Community

Medical Group

Clinton

Hospital

HealthAlliance

Hospital

Wing Memorial

Hospital

Marlborough

Hospital

Private Medical

Practice Private Medical

Practice / Affiliate

Hospitals

The Future State

Medical Group

5

Ambulatory EHRs

Data Integration Application

6 iHT2 January 2012

Oct/Nov/Dec

2011

Jan/Feb/Mar

2011

Apr/May/Jun

2011

Jul/Aug/Sept

2011 Jan/Feb/Mar

2012

Jan/Feb/Mar

2013

Apr/May/Jun

2012

Jul/Aug/Sep

2012

Oct/Nov/Dec

2012 Apr/May/Jun

2013

Enterprise MPI LIVE with IDX

Registration and Scheduling 8/11

Hyland OnBase LIVE at the Med Ctr,

Marlboro, Clinton and Wing

Allscripts Enterprise LIVE - continued roll-out of new CMG practices, additional functionality (Orders, Tasking, Dictation) to the hospital clinics and physician offices

90 day

reporting

period to meet

2011 Stage 1

Meaningful Use

Allscripts 11.2 Upgrade

COMPLETED

Soarian Financials scheduled Live 1/15/12

Soarian Clinicals scheduled Live 1/15/12

Picis (ORIS) scheduled Live post Soarian

dbMotion (Phase 1) LIVE 5/11

CPOE Roll Out scheduled Live 5/12

MAK Roll Out scheduled Live 3/12

Soarian WING scheduled Live Summer/Fall

2012

HealthAlliance dbMotion/Soarian

Smart Button Live

Soarian Upgrade

HealthAlliance

Enterprise MPI scheduled Live with

Med Ctr Soarian Reg 3//12

Salar LIVE Hospitalist Programs at Med Center / Clinton / /Marlboro - continued roll-out to additional hospital departments

Picis PulseCheck – ED

TBD

CORNERSTONE TIMELINE (rev 12/2011)

7 iHT2 January 2012

Prior Philosophy of Physician Behavior

7

Is this the best way to motivate highly skilled and

intelligent people?

8 iHT2 January 2012

But Why Would You Want To?

8

9 iHT2 January 2012

Hierarchical Management and Influence

CIO

CMIO

Medical

Staff

IT Staff

CIOs and CMIOs share

accountability for IS

projects

Their direct and indirect

spheres of influence

requires a delicate

balance between

voluntary participation

and direct managerial

supervision

Used with permission Jack Shlegel Consulting

10 iHT2 January 2012

CIO and CMIO Interactions

CMIO role is evolving

– Developed from traditional medical staff roles (CMO)

– Initially part time, but now fulltime

AMDIS 2011 Survey

– 64% are currently in first CMIO role, down from 81% in 2010

– 71% want to stay in CMIO role, 7% want to become CIO, 7% would

like to be CEO or COO and 4% would like to become CMO

– Wide range in compensation

• Largest areas range from $250,000 to $300,000 and $345,000 to $375,000

– 81% work at Integrated Health Systems, 9% work in stand alone

hospitals. Most have enterprise wide responsibilities

– Reporting structure

• 47% report to CIO

• 29% report to CMO

• 5% dually to CIO and CMO

• 19% report to CEO or COO


CMIO and CIO Can be True Partners

Extend each others influence

– Cover each others blind spots

– Let’s each do what they do best

– Teach each other

Understand the different perspectives

– Budget

– Personnel

– Project management versus clinical decisions

• Scope, resources and schedule

• Need for advocacy and accountability

Drive adoption of technology

– The journey is about adoption of technology and not simply implementation

– Understand the clinical workflow

– Know the strengths and weakness of the applications

– Work together to satisfy the end user (clinician, nurse, registration, etc)


Stylistic Differences Between CIO and CMIO

Physician I.S.

Time to process issues Rapid Requirement gathering

Authority Captain of the ship Diffuse

Need for closure

(gratification)

Immediate Longer term

Ability to deal with ambiguity Low Medium to high

Precision of data Intermediate (learned to

live with incomplete

data)

High

Clinical thinking skills High Low

Project management skills Low High

Primary

commitment/responsibility

To Patient To Organization


Life is what happens between the time you plan

and execute your plan

• The roadmap is about adoption of new technology, not

implementation

• What we are discussing are clinical applications and not

IT projects

• Process change without personal growth and education is

not sustainable

• Physicians must be leaders, but must accept responsibility

and accountability


Opportunity assessment and metric definition

Set future-state goals

Model economic impact

Incorporate Benefits Realization into committee

structure

Develop implementation plans

Focus resources on improvement goals

Establish baseline measures pre-live

Conduct post-live measurement at specified intervals

Interpret results and continuously improve

performance

Planning:

Establish Metrics

and Value Goals

Implementation:

Strategy,

Resources &

Implementation

Measurement:

Baseline and Post-

live Measures

IS Can Also Drive the Management and Analysis of

Data


Case Discussion

Roll out of Follow Me Desk Top

Device Deployment Selection and plan

Development of Sign out process

Web launch point


Roll out of Follow Me Desk Top (FMD) and Single Sign On

(SSO)

Together, the CMIO and CIO develop the project principles

– Build the case and vision

• Speed, efficiency, less clicks

• Stable environment

CIO is key to listening first and then building

– Build a proof of concept to garner feedback

– Don’t just ask what is desired

– Listen to the need

– Partner and participate with the CMIO in physician meetings

CMIO is key to articulate the value to clinicians

– Ease of access

– Clinical use cases

– Test and provide constructive feedback

– Listen and brain storm approach with CIO


Web launch point for Single Sign On (SSO)

It was apparent to CIO that we could develop a communication

device as well:

– Create method to communicate

– Build ease of access

– Enhance redundancy and system reliability


Demonstrate

Follow Me Desktop

http://umassvdi.umassmemorial.org


Device Deployment Considerations

Perfect storm

– overlapping technology devices that can be useful,

– Variety of operational, clinical, nursing and engineering teams

involved

– Capital Planning, regulatory and environmental concerns needed to

be considered

Required to support clinical process,

– However, regulations and permit requests could be a roadblock

Each group, in isolation, had their primary concerns and needs

Required teams to live in current workflow, but think in a future

state

No matter what we choose, the technology and equipment will

continue to change


Device Deployment Guiding Principles:

Place a device in a patient room or exam room – Required to support the clinical and administrative process of

patient intake and assessment

– Should provide FTF opportunity for nursing to interview and talk with patient

Workstations on wheels (WOW) and/or fixed devices – Recommendations made by each clinical area during walkthrough

– Reviewed by IS and Capital Planning

– Approved by CMIO

– Signed off by Capital Planning

– Approved by ACNOs and IS.

Caveats – Phase 1 focused on nursing and back office

– Favor mobile workstations over fixed

– Storage and hallway traffic are important system constraints

– Built into assumption was no new construction

20


Device Deployment Guiding Principles

Devices cannot be deployed (stored) in hallways except when installed in Wall-a-roos.. – Added to hallway congestion

– Safety and regulatory issue

Power will be addressed on a case by case basis – Need to access room when patients are not there

– Optimize install process

– Certain facilities need to be prioritized for Capital Planning

Included assessment and implementation of any peripheral devices to support EMR – Printers, embossers, etc.

21


No WOWs initially

recommended. Added 6

after review. Will need to

determine storage policy

22


Recommendation Based on Nursing Device

Fairs and Analysis

Work Station on Wheels (WOW) – Clear consensus choice

– Assist with emerging and yet-unknown needs

– Alternative non-powered or laptop configurations

– Supply line economies of scale

– Local vendor support

23


Development of Sign Out process

The new EMR application did not support current workflow

– A round peg in a square hole, just will not work!

– Residents and Attending were frustrated and resisting

CMIO

– Agreed with physicians with the need to develop something different

and develop guiding principles

– Used a separate, but integrated application to satisfy the clinicians

needs

– Created the environment were IS team could work with clinicians

CIO

– Supported with resources, technology and experience

– Overcame internal resistance to change project plan

– Participated in development of solution and provided feedback

Win Win for all


Creating Sign Out (Work) Lists

The process:

Log in

Search for patient

Add the patient to a team

Click on the Sign out button

Edit the sign out fields for each individual

patient on the team


Sign Out (Work) List

Area for

Text


27

We Can Speak a Common Language

We will focus on the adoption of technology to provide information to providers

We will collaborate with providers in developing workflow automation and improvement, based on evidence based medical information

We will assist in providing performance measurements to improve care, improve efficiency and reduce harm

Our goal is to provide seamless applications that improve efficiency and provider satisfaction

Underlying consistency in our relationship


Overcoming Challenges

Pulling together

– Allow the system to act as a system

Physician leadership and engagement

– Senior leadership fully engaged

– Super users identified and supported

Work in today’s world, but think in the future world

– Communicate the vision of the ideal future state and work

towards that goal

– Avoid recreating broken and fragmented solution

Existing processes and procedures will need to be

revisited and adjusted

– Be flexible, open-minded and creative

You will be connecting parts of your system that have

never before been connected – ‘connected healthcare’

is just that – all inclusive for technology and people

– Communication, communication, communication

– Understanding of different environments of care

– One size does not fit all

Q & A / Thank You

Opening Keynote Session “CIO and CMIO Dynamics: The Evolving Roles & Relationships”

Education

Transcript of Opening Keynote Session “CIO and CMIO Dynamics: The Evolving Roles & Relationships”