When being a CMIO is a 50-50 proposition

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 - 50-50

Rod Tarrago, MD, has served as CMIO at Children’s Hospitals and Clinics of Minnesota since 2007, and is also a practicing pediatric intensive care doctor, having joined Children’s Respiratory & Critical Care Specialists in 2004. He took some time to talk with CMIO.net about the challenges involved in splitting time between his clinical care and CMIO responsibilities.

How did your move into the CMIO position evolve?

I’m a pediatric intensive care doc and I did my clinical care training at Children’s Hospital of Pittsburgh. I’ve always been interested in the technology and quality aspects of healthcare and happened to be a second-year fellow in the pediatric ICU in Pittsburgh when it went live with Cerner’s CPOE. I was involved with that go-live, mostly from a super-user standpoint and helping with some order sets. But I was able to see what worked well, and what didn’t work well.

When I came to Children’s Hospital in Minnesota initially I concentrated on my clinical duties, but pretty quickly  got involved with information management and technology issues and when our CMIO at the time decided to leave I first helped out a little bit and then applied for the job formally. That happened to coincide with a time in which I became a partner in my practice, which allowed me a little bit more flexibility and time, and in 2007 I officially became CMIO.

How much time do you spend on each role?

By the official definition I’m “50-50.” So, according to the hospital, that means about 20 hours a week on CMIO duties. It ends up that I spend about 25 hours a week on CMIO duties, which are added on to my clinical practice.

In my clinical practice I still do a full complement of daytime service, which is one week a month in the pediatric ICU. Then I’ll do anywhere from four to six overnight calls a month in the pediatric ICU and I’ll fill in for my partners whenever there is a gap. So it’s a little bit all over the place and varies depending on projects we have going on, what go-lives we have, and how much clinical time is needed. I end up doing about 3,000 to 3,200 total hours per year.

The 20 hours a week was a bit of an artificial choice based on what my practice thought my availability would be. Most of the CMIOs I talk and associate with use significantly more time for that duty—closer to the 60, 80 or 90 percent range, so I think 50 percent is a little low. My hope is to eventually dedicate more time to my CMIO duties yet still maintain enough of my clinical practice to keep up my skills.

What are the major challenges in splitting time between the two?

Several years ago our practice made a decision—based on the fact that people were getting older and getting tired—that when we take overnight call we won’t have any clinical duties the day of or the day after. This means that when we do an overnight call, which is 5 p.m. to 7 a.m., we have the day off until 5 p.m. and then the next day after 7 a.m.

The challenge for me clinically is that any overnight call really sort of blows two days. So if you take the seven days of service time I do during the month, and if I take five or six overnight calls a month, that really ends up being 7 days plus another 10-12 days, which only leaves me 10 days or weekends to work. I end up doing a lot of work at night, or pre- or post-call, which can be hard,  particularly if I had a difficult night on call. And you never know when that’s going to be, so I do end up scheduling a good number of meetings pre- and post-call and sometimes have to cancel them because I just didn’t get enough sleep the night before.

Then there’s the issue of just staying up to date in both clinical and administrative areas. As the informatics specialty—and it’s now a board-certified specialty—expands, there is more and more literature on which you have to stay up to date with. At the same time I still have to stay up to date clinically. As a matter of fact I’m retaking my clinical care boards this year, so it’s something I have to study for and somehow blend into the rest of my schedule.

Do you think it’s important for CMIOs to stay involved with clinical care?

I do—especially if you are younger. It will give you more credibility with the rest of the hospital population if you can let them know that you’re not just legislating or building things, but that you are experiencing them as well. So, that’s huge, particularly if you haven’t been in practice for 20 or 30 years and haven’t established that credibility with some of the older clinicians.

The other thing is that when you use the system you are able to find things out about the system you might not otherwise be aware of. If you ask our IT department if they can tell when I’m on service in the pediatric ICU they can tell you exactly. That’s because the number of requests for changes, tweaks, improvements and enhancements skyrocket each week I’m on service because I’m there using the system and finding things that no one else sees, or if they see them don’t say anything.