Confessions of a first-year CMIO

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 - Judi Binderman, MD
Judi Binderman, MD

After more than a dozen years as a healthcare consultant—much of it information technology based—involving several interim CMIO stints, Judi Binderman, MD, took the plunge last October and took a permanent CMIO position with St. Francis Medical Center in Lynwood, Calif.

Not only was it Binderman’s first permanent CMIO position, but she became St. Francis’s first CMIO as well. Part of the appeal of the job, she said, was that St. Francis had already implemented its EMR (QuadraMed), “so I didn’t have to go through getting them live, but I would have the opportunity to come in and help with optimization, analytics, quality and process redesign.”

From the medical center’s perspective, the decision to create the CMIO position gave its CEO a point person to interact with the medical staff as St. Francis moved towards Meaningful Use Stage 2, ICD-10 and issues relating to quality improvement. What helped to make the situation challenging, Binderman said, is that her path to the position was on the less traditional side.

“A lot of CMIOs tend to grow up in an organization and take on informatics and physician champion roles, go through EHR implementation and eventually become a CMIO,” she explained. In her case, one of the first things she needed to do was to gain the trust and respect of St. Francis’s medical staff “because I hadn’t practiced here and was no longer clinical.”

So, she spent her first three months on the job doing a lot of what she refers to as “foundational relationship building.” She went to medical department meetings, went on rounds, reached out to the key formal and informal leaders at the medical center, and even rejuvenated a dormant physician IT committee.

What she also had to do in those first few months was to learn the EHR because she hadn’t worked with QuadraMed before. “I was walking a fine line because I wanted the [medical staff] to know that I was receptive and willing to hear their complaints and concerns, but that I didn’t know enough about the system originally to answer their questions one way or another,” she said. “They had to know that it was going to take me several months to figure out solutions as I learned the system's capabilities."

Unfortunately her grand design for a clinical IT strategy that could really support physician workflow and improve quality had to be somewhat curtailed when it was announced that the entire Daughters of Charity Health System—of which St. Francis is a part—was up for sale.

“[The grand design] has been kind of truncated,” she said. “My goal now is to finish optimization, get us through Meaningful Use 1 or 2, depending on what the final rule is, and to bring voice recognition dictation into system. But everything I’m doing has to be portable—I can’t bring in new technology if we’re not going to be able to switch to another vendor or be part of another system. Having worked with clients across the country that are involved with mergers and acquisitions, I know that there are a number of healthcare systems where within the first 100 days you convert to whatever their EMR system is—so it’s a rip and replace."

“My situation is somewhat unique,” she pointed out. That said, she has learned several lessons that could be beneficial to other CMIOs moving into new positions.

For example, Binderman said she was surprised at the level of operational responsibilities her position entails. “If the CMIO is truly a member of the executive team—and in some places they are and some places they aren’t—the amount of operational involvement is tremendous, and I think that’s something many of us didn’t expect or anticipate.” Whether it’s working on position justifications, job descriptions for net new positions, or even who to call when there's a total power outage and security systems don't come back when power is restored, these are things that could be a real “eye-opener” for a CMIO who becomes part of the executive team, she said.

Another operational aspect that’s “pretty interesting” she said, and probably much different than what many aspiring CMIOs are used to, has to do with finance. Dealing with an annual clinical informatics budget planning for staffing, ongoing education and new initiatives is going to be much different than planning a budget for a specific IT project, Binderman said.

She also suggested that new CMIOs will learn quickly about the need of establishing a “partnership at every level between nursing and the CMIO,” and that if a CMIO is coming from outside of an organization that it’s not only important to gain the trust and respect of medical staff, but to manage their expectations as well, “because if you don’t, it’s going to be tough.”

Finally, she said, if you are coming from a consulting background like hers, it’s important to understand that “you’re not dealing with a cadre of consultants who are used to taking some project and turning it around in 18 hours."

“Timeframes are different for permanent employees,” she pointed out. “You need with work within that structure and understand that while you can hold people accountable, they are not going to be solely dedicated to what your vision of the day is—they have other responsibilities within their roles.”