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Foundation Members:
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CHIME Presents:
The CIOs Guide to Implementing EHRs in the HITECH Era
CHIME Member Comments on
Chapter 7: Considering New Role Players for EHR Implementation
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Question posed to members:
Have you added a CMIO or CNIO to your implementation team? If so, why? What have they added to the
implementation effort? If you havent added these positions, who is taking the lead in interacting with clinicians?
Comments:
We have a CMIO who has been in place for several years, and was instrumental in leading us through our EMR and CPOE implementations. We also are blessed with a Chief Medical Officer (CMO) who also leads and owns our EMR efforts, and chairs our EMR Governance Committee. Having this type of medical leadership (and ownership) has been a major success factor for us. In addition, we have several physician champions and sponsors, and a few (partially funded) physician roles in IT to help provide critical insight, feedback and leadership.
On the nursing front, while we dont have a CNIO, our Chief Nursing Officer (CNO) and Associate CNO are both active participants in EMR Governance, and there are several full time positions, within nursing, that provide IT support.
Yes we have added both. CMIO needed for physician adoption and leadership. CNIO for outcomes reporting, quality reporting, workflow improvements, data assessment. Both have added strong skills and leadership in the areas we had hoped. Both have received strong support from the organization and both have significantly helped the EMR project move forward.
No
CMIO is part of I/S Team to provide leadership in implementing automation solutions that improve quality and safety of care. CMIO interacts with physicians on clinical workflow matters and helps vet options so decisions can be made and/or issues addressed.
We do not have CNIO but Clinical Informatics is part of Nursing but aligned with I.S. again for many of the reasons the CMIO is key to physician leadership.
Both function partner with I/S to enable transition from paper to digital records.
We have not added a CMIO, but we have added a CMO with some CMIO duties. He is helping to lead the charge on a couple of IT initiatives including the continued rollout of CPOE. As such he is the clinical voice to the project. We also have our CNO as the co-executive sponsor to the project to lend weight to the clinical staff. The three of us together are helping to lead all advanced clinical initiatives
I have a physician, reporting directly to me, as part of our team as well as Clinical nursing informatics. They do not have the titles of CMIO or CNIO. They are responsible for working with the clinical team to identify process changes that need to occur as well as provide guidance to any technical changes we need to make to ensure compliance to meaningful use, as it stands today.
No we have not added these positions, clinical interactions are led by manager of clinical informatics
Several years ago, when we began planning our E H R, we hired an informatics nurse. Weve since augmented her with 3 other contract nurses. They manage clinician training, clinical application development and testing, physician interaction, etc. They are not chiefs in the hierarchy, but rather talented, credible clinicians with significant IT knowledge.
Our hospital does not have either a CMIO or CNIO, however, does have close relationships with both the CNO, CMO and their teams. They are the executive sponsors for implementations that involve their respective areas.
We have added a part time [starting at 50% and migrating to 70%] CMIO. Title here is Clinical Director for Informatics to be consistent with Clinical Director model deployed for medical staff integration in clinical quality improvements by service. Our physician provides direction related to communication, education and system design for our primary electronic health record [focus almost entirely on inpatient system at this point].
We do not have these roles. We interact with the VP Medical Affairs and UR Committee chairperson for lead roles with physician efforts.
We do not have a formal CMIO however we do have a physician that fills that role. The value of this position is the relationships between the other physicians and him. He can relay the benefits of our changes to the physician groups and communicate them more effectively. He also provides valuable input to IT on the needs and potential pain points we must address for a successful role out.
We have not used titles as noted, however we do use RNs to lead our Nursing and CPOE efforts. The nurses are long service nurses who are respected by the physicians and their nursing colleagues.
We have had a CMIO within our organization for over 8 years. The role was initially brought on to facilitate the physician dialogue during the selection of the hospital EMR. He also has a physician informatics team reporting to him, extending his reach. We do not have a CNIO within our organization. However, we do have a clinical informatics member staffed in each hospital.
Our CMIO is actively involved in the planning and implementation effort. Our VP/CNO is the executive sponsor of the MU project. The CMIO is taking the physician lead and communicates regularly with the Physician Advisory Group as well as the entire Medical Staff. Having the CNO involved means we have nursing engaged and responsible, a major difference from previous projects.
Yes. Just about all new diagnostic medical equipment has a data component to it. The rate of procurement by the DoD acquisition agencies has outstripped the hospitals IT department to integrate (train and support) this new equipment into the current infrastructure. As a result, clinical IT leadership has been stood up to champion these projects. The CMIO has dramatically improved communication between the clinical staff and IT services.
No, our Chief Medical Officer and Chief Nursing Officer are actively engaged in our implementation efforts
Nope, not yet. No serious discuss at the moment but I am looking for a manner to include someone of this sort in the process. For the Nursing documentation project, we coaxed the local physician over our Hospitalists to act as champion. When doing anything in the OR, we involve the medical director and he usually jumps in with both feet because he is so inclined. The bottom line is, we look for those who we have learned are generally interested, engaged, and capable. Its worked so far but I believe we need to pay someone for their time
its about to get more demanding.
We are in the process of hiring a Medical Director (CMIO) and Clinical Informatics Director (CNIO) for this regional implementation. We consider the clinical leadership key to the entire process. The Dr. to Dr. and nurse to nurse dialogues are the single greatest influence on buy-in for our stakeholders. No matter how much experience and skills you bring to the project, your credibility in the clinical arena will never be what these two clinical leaders will bring.
No. We have a "champions" team that has a physician champion (a Hospitalist), a Nursing Champion (one of our RNs/Directors) and a Nursing Integration Champion (an RN/Informaticist/Duirector) - this one focuses on the integration of the workflow, etc between nursing and the other clinicians/ancillary and outpatient groups.
I have a CMIO on my team who coordinates all activities with physicians and leads the physician it steering group aimed at simplifying the user interface between doc and machines. Also I have a physician on the team who works with physicians on improving quality
We have had a CMIO for a few years. We recently added a CNIO (although not with that title) to organize workflow issues, promote standardization and advance informatics generally.
Our organization has a physician liaison in the IS department. He works closely with our physicians on our CPOE and EMR projects.
We have added a CMIO and he has the lead to achieve meaningful use.
At our organization, we have added a corporate CMIO, as well as in the process of hiring CMIOs for each of our 9 regions. This position is key to our success for driving change with clinicians and possessing the
credibility so that it is not an "IT initiative" but truly a clinical transformation.
We have not....we have a Strategic Steering Committee with physician representation, and a Development Committee that implements solutions..the Dev group has a core set of RN's that interface with the clinicians, with support from fellow team members, which include a pharmacist, radiology rep, lab rep, etc....In addition we have senior level representation at several key medical committees, where clinical automation is a frequent topic..members include our COO, CNO, and CMO typically.
We've added a CMIO and a Nurse IT Executive to build relationships with the respective groups. The CMIO has taken charge of developing new and maintaining old order sets.
We've also enlisted medical students (4th year) to be trained as superusers and to assisted the faculty in the adoption of the EMR,.
Upon the start of implementation, our organization (several years ago) added a CMIO. This year, weve added a CNIO
weve just started the on-line nursing documentation process. Obviously these professionals add much more credibility to the process changes, the waste-removal efforts, and the connection between IS professionals and clinical professionals. Invaluable across the board.
We have not added either a CMIO or CNIO.
We added a CMIO. He has been instrumental in setting up governance structures with the physicians and other clinicians, recruiting physician champions, and guiding the Physician Advisory team.
Our organization has a Director of Clinical Transformation (reports to the CNO with a dotted line to the CIO) and a Medical Director of Informatics (reports to the CIO), which are tantamount to a CNIO and CMIO. They have been invaluable in our IT-related transformation efforts and serve as the key liaisons between the nursing and physician communities and the Information Services Department. They are both accountable for key aspects of the EHR implementation, e.g., Nursing Documentation, Plans of Care, CPOE and Physician Documentation. They work mainly with "design" and "testing" teams and help with developing ongoing enhancements to our IT strategy.
We did add a CMIO because we felt there were enough MD issue that we need a Ύ position to focus on this. Unfortunately the individual in the position did not work out and we are without a CMIO at this time. Our VP MA is doing double duty in the role. We are searching for a new CMIO because we still feel with CPOE, documentation and other uses of the EMR we need a physician leader and sounding board.
No we have not added these positions we have a very flat management structure with limited executives that fits our organization
We are multi-hospital and have medical execs at our hospitals that are involved for communications we have CNOs IT works very closely with including myself the CIO and we have a Director in IT that oversees the physician IT applications that is very involved.
We have someone who works 75% of their time on IT activity. We do not use the CMIO title but it is essentially the same role. He reports to me with a dotted line to the CMO. His remaining time is in the role of a hospitalist. He has taken the primary lead on physician/clinician interaction.
No. We are a small hospital.
We have added a CMIO to our initiative. With most of our implementation behind us, the question of Why seems so obvious
we simply couldn't have done it effectively without it. Physician to physician issues can become a non-issue and dealt with in a much more effective manner. Proving one-on-one physician support when needed and gaining overall support from the physician community is amongst the key roles they play. Additionally, providing physician perspective to meetings and system build was much more efficient with this model. I precluded us from trying to get time on a physicians schedule and then trying to bring them up to speed on the issue at hand.
Yes we have. We have actually added 3 equivalent CMPOs! What is a CMPO? Chief Medical PROCESS Officer. We believe that process trumps information and we are hoping that this makes the point! Each of the three help to strengthen the message and each has a particular line of influence across our organization.
We have not added a CMIO, but we realize one is sorely needed; we hope to be able to incorporate it into our 2011 budget. Most of the physician interaction has been lead by IT; most of the non-physician clinician interaction has been led by the Clinical Informatics group, which reports to Nursing.
No, but we did create a medical directorship to do 20 hours/week to support our CPOE effort.
No to both. Due to the size of our organization, we havent felt the need to add these positions. Im taking the lead on working with the clinicians and that is working out nicely. I already know all the medical staff and nursing leadership, so those interactions are going well. I am partnering with our VP of Medical Affairs and the Chair of our Health Informatics Committee (both physicians).
We have a formal CMIO (full time) and another 3 physicians who compromise another full FTE reporting to our CMO. We also have a nursing informatics team with 4 RN's who report to our CNO. The director of that team is called the Director of Clinical Practice Applications but functionally she is the CNIO.
No. The lead is taken by our head IT guy, which is me (IT Director).
Yes, CMIO has been added. The CMIO has provided great insight in to the clinical perspective, he interacts directly with other clinical care providers, he provides instant credibility to the implementation process
We had a part time CMIO and a full-time director level CNIO from the outset of our implementation. Both of these individuals were instrumental in the vendor selection process.
Yes we have and I am that person. I have the credibility with physicians to work with them and assist with their compliance with the EHR and communicate their needs to the IT team. I report to the Chief Medical Officer with a dotted line to the CIO.
No, the Chief Information Officer and Clinical Information Systems Manager
No, we havent added anyone. We do have some physicians that will gladly help us sell the implementation but they are not part of the implementation team. Since we are not receiving any money up front and reimbursement amounts are not increasing this just isnt something we can afford to do.
Yes, we have a CMIO and CTO. No CNIO.
We are a medium sized community hospital. We have a CPOE Steering Committee, which includes our part time CMIO, VP Patient Services, VP Quality/Information Technology, and our VP Medical Affairs, as well as key members of the clinical IT staff. It actually meets weekly as we continue to strategize for increased CPOE adoption. We also have CPOE Physician Leadership Committee which provides valuable input and recommendations for improvements. The technical portions of the MU requirements are being addressed by a Meaningful Use Task Force thats working from the HIMSS MU Self-Assessment spreadsheet. That document has proved to be very valuable in guiding our efforts. Of course, it may be all for naught if the final regulations change much, but weve made a strong start.
We added a 4 hr/week physician to our team back in 2001. In 2006 he became half time with direct reporting responsibility over both our inpatient and ambulatory EMR (Clinical IT) efforts. He reports to the CIO with a dotted line to the CMO. He is the point person along to the medical staff and presents to the board with the CIO. He runs the clinical sponsors committee, which includes the CIO, CNO, COO and key directors. This committee sets the priorities and timelines for clinical deployment.
Here at our, two hospital system we went live with CPOE Dec 2009 at both hospitals. Our CMO has taken the physician lead in the development of approximately 210 Physician Order Set which we have loaded into our vendor system. Our CMO has taken the Physician Leadership role for CPOE from all aspects and within two months, we have over 90% of physicians placing orders. Just this month, we hired a CMIO. We feel that the implementation of CPOE is just the beginning of our journey the real value will becoming by using the automated tools in the long term evolution of Clinical Decision Support System (CDSS) which we define as the use of automated tools to promote the behavior of Clinical Quality Improvement. Our new CMIO will take this primary responsibility to work with our physician community to promote the use CDSS for Clinical Quality Improvement.
Yes, I had a CMIO at prior health system which is now a HIMSS Level 7 organization. I am now CIO at another facility and have recently hired a CMIO to help lead the EMR implementation here. Invaluable in lending credibility to the effort, voice to physicians, creating a physician structure to ensure involvement in design decisions, implementation strategies, adoption, and communications.
We have positions in place that dont have these job titles but do provide these functions. The Medical Director of Informatics has taken the lead on our CPOE project. He chairs the medical staff committee for Clinical Informatics which also serves as our project steering committee. Our Director of Clinical Informatics (an RN position) leads the hospital side of the project specifically from the nursing perspective. We have had these positions in place for over 10 years.
Added cmio and cmio positions, they have added peer to peer communications and creditability
No we all ready had Nursing IS Liaisons in place who fill that role as well as three RN analysts on the IS staff.
We have had a Medical informatics committee since 2004 as went live with CPOE.... the head of this committee, which reports to the medical board in the last two years has been given a hospital title of Director
of clinical informatics and executes in most of the capacities of CMIO... we also have VP medical affairs and as chief medical quality officer is actively involved...
We have not added a CMIO or CNIO to our organization. We are forming a Physician Advisory Council to guide us in the clinical aspects of major projects (such as CPOE and advanced EMR functionality). We are still trying to figure out how to compensate the participants of this Council and how to divide the work. We also plan to include PAs and NPs to lead some of the teams. We have a CMIO and we are thinking of tapping that person to help us in the formation of our Council.
No. Our CMO and CNO are taking the lead along with other key physicians and nurses.
Our CMIO is acting as the Medical Director of our Meaningful Use program. We do not have a CNIO yet, so we created an MU program Nursing Director who may move into the CNIO role post-task force. The system CMO is a sponso, as well.
Not exactly. We had our Vice President of Medical Affairs step up and take charge. He selected close to 12 physician champions that have worked with him for close to 6 months to be a part of the file build.
We have a very physician driven organization and did EHR a long time ago. Since then we have added four CMIOs, Outpatient, Inpatient, Cancer and Quality. I know if we had had these they would have made a difference. IT staff dont have the street credibility to negotiate tough decisions. We do a boot camp for McKesson clients and if they dont have a good CMIO, they usually have tough time. Just having a CMIO isnt enough. The CMIO has to have the credibility across the organization, thats why we have so many. Also they have to be an honest broker of the relationship and be capable of pushing either IT or the business to do the right thing.
We went live with an EMR in 2005 so many of these comments are historical. We did not/do not have a CMIO or CNIO. The V.P.of Patient Services was the nursing lead and the Medical Director was the physician lead. The Medical Director and three other physicians were active participants in the effort. There were several nursing managers who took the reins of guiding the implementation for their portion of patient care. The implementation team membership represented all disciplines and departments as we went live with 20+ applications at once (Big Bang method).
Yes we have added a CMIO and his work has been essential to the CPOE and MD Doc projects. He chairs our Physician Advisory Committee and he is also heavily engaged on our Evidence based Medicine efforts (standardization of order sets, etc.)
We dont have a formal CNIO however the Asst VP of Nursing operates in this role and chairs the Clinical Advisory Council which oversees all activities concerning clinical documentation, rx order strings, and our Evidence Based Practice efforts for standardizing care plans.
No, my director of Clinical Applications and our clinical informatics team handles the interactions
We have developed a position description for a CMIO and have engaged a search firm to begin recruitment. We used the a third-party survey and a number of interviews with other organizations to develop our position description. We feel it is essential that our EMR implementation have a dedicated physician leader, and expect to put all informatics (pharmacy, clinical/nursing, and medical) in a group reporting to the CMIO.
We have added both roles in the last 2 years.
- Yes, CMIO ad Manager of Patient Care Informatics.
- Two legs to the three legged stool - IT is the third leg - need to move the EMR adoption forward. These two groups are the liaisons with physician and nursing staff and represent their needs to IT.
No.
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