Dr. Robert W. Warren is an Epic Emeritus CMIO and holds a doctorate in cellular immunology. Among other positions, he previously was chief medical information officer at Charleston, South Carolina-based MUSC Health.
The key focus of Epic’s emeritus program is working with healthcare organizations to use informatics to improve care. While some activities are Epic-specific – like at-the-elbow support for providers and leaders during their Epic go-lives – other activities are more general.
Warren has many lessons learned to share over the course of his career and as an Epic Emeritus CMIO. He says bridging healthcare and IT with innovation and with discovering, managing and assessing critical change is fundamental to being a successful CMIO.
He goes on to say that CMIOs should help bring constituency balance into real life. And that the CMIO must be comfortable and capable of making command decisions, yet also be a superb partner, team member and facilitator. Further, CMIOs must fluently speak and live the languages of the constituencies they serve.
What’s more, he advises, advocating for balance and bridging across constituencies in the context of organizational goals and priorities is something CMIOs must strive to do. Here he shares all these bits of wisdom with healthcare CMIOs and other IT leaders.
Learning the ‘languages’ of others
Warren said when CMIOs are working on projects or talking strategy, they have to know exactly what their constituencies mean – and therefore must speak their “languages.”
“If you’re a patient, then what do you expect, for example, in an exam room?” he asked. “And on the next step, the doctors, how can you talk as a CMIO to other physicians in a language they understand? Same thing with health IT, tech people, same thing in the C-suite.
“An example,” he continued. “You’re going to put a computer in an exam room. What does that mean to a patient? Well, if the doc is stuck in a corner working on a computer, and let’s say she’s not even looking at the patient, you’re not engaging the patient with what’s going on at all. That has both the perspectives of a patient as well as the doc.”
As a doctor, Warren, some time ago, was working in an exam room where the computer was stuck in a corner. He told the IT people he needed a long wire on his keyboard. Then he sat there with the keyboard in his lap and typed, talking directly to the patient.
“What does that example mean to health IT and the C-suite?” he asked. “Well, let’s talk then about what equipment we need and how we should arrange exam rooms so computers are helpful from the perspective of both the patient and the doctor, and not disrupting the clinical flow.”
Bridging different priorities
On another front, Warren said that for these various constituencies, CMIOs have to push for balance and bridging when it comes to IT and organizational goals.
“What goes on is CMIOs are flooded with great ideas, sometimes from patients, sometimes from health IT professionals, absolutely from their colleagues who want the best special thing in their mind in technology to improve their clinical process and their work, even if that, for example, is in research or quality and analytics,” he explained.
“So, what is really important in this is an example of what I mean by bridging,” he continued. “First, you have a project requesting process, which absolutely reflects organizational goals, but it welcomes others. There is a path, I hope, for patients and their advocates to make requests of a healthcare organization for physicians and everyone in the community. And then a project request evaluation process, which has all those elements.
So, for example, will this proposal improve patient satisfaction with the care they get? Is that going to help one patient? Is that going to help patients in one clinic? Or is that going to help patients throughout the organization? Warren said CMIOs have to know the answers to these questions.
“Same thing for provider satisfaction,” he noted. “Think about how to measure that and how many people it helps. When we think about health IT, of course, that’s more likely to be about how much it costs, how quickly and how many human resources it takes to implement it? When we talk about the C-suite, they’re mostly after cost and they’re after return on investment in concrete terms.
“So put all those things together,” he added, “weigh those factors in the context of organizational priorities.”
The CMIO’s many roles
As a C-suite officer, the CMIO must be capable of making “command decisions,” yet also be a superb partner, team member and facilitator, Warren advised. So how does someone fit these various roles?
“You’ve got to play different roles in different circumstances,” he said. “For example, if you’re dealing with a data privacy issue, most likely that’s urgent, and the CMIO is going to very rapidly decide what the impact is in clinical care.
“Where does that work into a team where the CMIO might be a leader or on the other hand a team member?” he asked. “I just talked about project proposal evaluation. It’s not necessarily the case that that evaluation team would be led by the CMIO. That might be the COO who leads a project review group. But the CMIO is a member and a partner with the CFO, with the CIO, etc.”
Back to patients: Where’s the time the CMIO is in front of the public or family liaisons? he asked. That could be in a leadership role, but it’s more likely hearing the advice of others and figuring out how to integrate that into real life, he said.
“It’s a handful,” he noted. “I have to tell you, there were times when doing this myself where I needed to begin a conversation with a group of people with one hat, then another hat for another group, and for this conversation I’m in charge of gathering advice, and for this conversation I’m making a command decision.
“I may say, ‘Tell me in a very brief set of words what your advice is and why,'” he continued. “Realize I may not take your advice. Then a different role: ‘Hi there. I know I’m the CMIO, but what I’m here for is just to be a member of this group. My voice is no stronger than anyone else’s.'”
A balancing act
Then comes a tricky part of the job. The CMIO should help bring constituency balance into real life, Warren advised.
“Let’s take that project proposal example,” he explained. “Now, the added part to that is, if you have project proposals that are welcomed from all sources, be transparent with all sources about what the factors are that lead to the evaluation. And balance is actually about what the most senior leaders in the organization say is most important.
“For example, regulatory requirements typically overshadow everything else,” he continued. “They get more points out of 100 than almost anything. If a project is the highest priority of the organization’s CEO, that’s obviously going to be very high up there. On the other hand, figuring out where patient and provider satisfaction fit, where quality of care issues fit – all that is about obtaining that balance.”
But it’s not the CMIO’s job alone to figure out the different weights to achieve balance – it’s the job of the C-suite as a whole, he added.
Some fundamentals to success
Bridging healthcare and IT with innovation – and with discovering, managing and assessing critical change – is fundamental to being a successful CMIO, Warren said. There are various ways CMIOs today can accomplish this weighty task.
“To start with, as the underpinning of this, you’ve absolutely got to be tied in with what the organization’s goals are,” he explained. “You’ve got to live with them every single day because that is the key, the foundation about which other decisions are going to be made.
“But you’ve got to also be in tune with what’s going on in science, in medicine, in health IT,” he added. “Let’s pick artificial intelligence as an example. What does AI mean for a healthcare organization? Well, there might be a foundational organizational goal about that. We want to be up there innovating in all areas of our healthcare endeavor.”
But what does AI mean to a patient? Maybe a microphone sitting in an exam room, or being in tune with issues concerning patient privacy. Who is going to know what is said in the exam room other than the doctor? Further, there is accuracy. How does the patient know what’s being pulled together in ambient AI is really what they said?
The patient’s perspective
“Think about the CMIO saying, ‘Well, if I think about it from the patient perspective, then I really want the summary that comes out of ambient AI approved by the doctor,'” Warren said. “Okay, got that. And available for the patient to easily see through the patient portal.
“But also, the CMIO has got to be thoughtful about the impact of something like AI across all specialties,” he continued. “You’ve got to have some awareness of what life is like for docs in all kinds of specialties. So, me, I’m a pediatrician. I don’t live the life of a neurosurgeon. So how might I get a window to how something like AI might be a part of what a neurosurgeon might experience?”
How? Go talk to a neurosurgeon, watch what happens in the neurosurgery clinic, go to the OR, have experiences that make sense, he added.
“Then there’s a kind of continuing education you might imagine for health IT,” he said. “The CMIO needs to be aware of what life is like for a CIO, but also for those directors and frontline IT folks.
“If the CIO says, ‘Let’s put in ambient AI,’ then what does that mean for the IT organization?” he continued. “The same thing applies to the C suite. How does a CMIO learn how to look at things through the eyes of a CFO or a COO? Again, opportunities to work directly with these folks can really help in continuing education.”
Warren added that CMIOs should consider mentorship with other professionals in the field.
“Friendships, obviously,” he concluded. “Think about professional organizations like HIMSS and so on, where you get sounding boards and networking that can help you through some of these very complex issues and help you see things through different perspectives.”
Click here to view a brief video containing bonus content where Epic Emeritus CMIO Warren explains the varied paths to the CMIO office and how training, continuing education and more can lead a new CMIO to success.
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