It is in response to an article entitled "The Chief Medical Informatics Officer: Past, Present and Future" by two well-known healthcare IT recruiters (I know the latter from her time at Hersher Associates) in the Sept. 2008 edition of "Advance for Health Information Executives", a non-technical journal for those involved in management of HIT.
This question also comes to mind: can you get the future right when you have the past wrong - and were wrong in the past?
On having the past wrong:
To: firving@advanceweb.com, rmitchell@advanceweb.com, dolsen@advanceweb.com, shatfield@advanceweb.com
Date: 09/13/2008 12:53PM
cc: lhodges@wittkieffer.com, aanschel@wittkieffer.com
Subject: Re: "The CMIO: Past, Present and Future", Sept. 2008
Dear Advance for Health Information Executives,
I enjoyed reading the article "The CMIO: Past, Present and Future" by Linda Hodges and Arlene Anschel (Advance for Health Information Executives, Sept. 2008, p. 45-46). It was reasonably well done.
The following paragraph, however, contains factual errors:"Prior to 1997 no true CMIO roles existed . Physicians as executives were part of a broader set of roles such as CMO or CEO. The physicians dabbling in health care delivery information systems lacked C-suite awareness and sponsorship; beyond a defined initiative, they also lacked specific responsibilities, expectations and accountabilities. They worked on a limited part-time basis in IS, often uncompensated for systems endeavors."
In fact, such roles did exist. I held one at Medical Center of Delaware in 1996, later Christiana Care Health System, hired by the CEO and reporting to the CMO, after holding a managerial role in a major municipal quasi-governmental organization. My colleagues held similar CMIO roles in other healthcare systems, some as early as 1991 and before. We had quite well-defined and fully-developed job descriptions and accountabilities with clear expectations.
In fact, through "dabbling" (by utilizing significant computer expertise dating to the early 1970's combined with clinical expertise) we were able to reverse projects that had turned into organizational nightmares and/or were threatening patient well-being, the latter being due to the clinical IT inadequacies of the identified IS leadership (see example case studies on this issue here and here).
It was puzzling to us that IT leadership was generally opposed to clinician involvement at a leadership level. Just as psychiatry and neurosurgery are two different specialties dealing with the same organ (brain), clinical computing is a very different specialty than management information systems. Both involve IT, but the commonalities in development, implementation, lifecycle and management diverge widely after that point.
We were, in fact, CMIO pioneers. An early version of my current website "Common Examples of Health IT Difficulties" that I began in 1998 was entitled "Medical Informatics and Leadership of Clinical Computing" and called for an expansion of roles such as ours, and empowerment of the CMIO role as a strategic imperative. My 1998 web site (and now the current site as well), have been read by thousands of healthcare and IT professionals worldwide.
I believe it and other writing by myself and others in the role pre-1997 helped fuel a shift in thinking about the strategic nature of the CMIO (e.g., "Strategic value of Informaticists", Healthcare Informatics, Nov. 1997, and "Broken Chord", Healthcare Informatics, Feb 99 , and a section of "Medical Informatics: Friend or Foe", Advance for Health Information Executives, May 2002 as examples of my own writings). The "strategic value" essay had been noted by The Advisory Board Company at the time of its publication and led to a long discussion with them on an issue of which they had been unaware.
In fact, access patterns to my current web site on HIT difficulty, tracked via a public web logging facility at extremetracking.com, show many direct queries on "healthcare IT failure" or similar concepts (see my 2006 poster here). Worldwide interest in this topic, and the need for more effective clinical IT leadership, is accelerating.
Finally, I continue my informatics advocacy writing at the multi author blog "Healthcare Renewal ." A recent MHRA-sponsored research project (MHRA is the Medicines and Healthcare Products Regulatory Agency, the UK's FDA-like agency) shows the thought-leadership impact of healthcare blogs to be significant, and that of Heathcare Renewal itself to be higher than several mainstream medical media outlets. The MHRA report is at this link (PDF).
I shall continue to call for leadership roles for healthcare informatics professionals, especially those with rigorous graduate and post-doctoral credentials from accredited organizations of higher learning (as opposed to the pseudocredentials offered by organizations such as HIMSS and others, see my essay "Is the HIMSS CPHIMS stamp substantive, or just alphabet soup?" at the Healthcare Renewal blog site at this link).
Finally, considering how the healthcare system can ill afford healthcare IT misadventure which can actually waste funds needed to care for the underprivileged, I ask the healthcare system "what took so long?" to realize that it takes a doctor to properly lead the creation of virtual clinical instruments.
I would argue that "what took so long" was obstructionism to progress caused by the territorial conceits of the IT and other components of the health IT ecosystem, for reasons both psychological and pecuniary.
These battles were and are waged, of course, at patient expense.
I am also concerned about the use of the term "dabbling" to describe the activities of the pioneering informatics physicians and nurses. That is a pejorative term indeed for the challenging and patient-centered efforts of many brilliant cross-disciplinary clinicians.
A more appropriate term that might indicate a more genuine "evolution" of views by the headhunters would have been "explorer", "pathfinder" or something similar.
If anyone was "dabbling" it was the hospital IS directors and IS personnel, entirely devoid of clinical education, knowledge and experience, who were dabbling with clinical medicine. They were uncritically importing their card punch tabulator mentality from the early days of data processing (explanation here) under the ill-conceived and bizarre (and opposed by the "pathfinders") notion that that mentality was appropriate for clinical medicine.
In fact, that mentality and all that went with it, tactically, srategically and operationally, was quite harmful. In my own direct observations as CMIO at Christiana Care Health System, I watched in horror as "IS dabblers" put the sickest patients in an ICU at great risk of iatrogenic infection with airborne pathogens (link), and caused chaos in an invasive cardiology facility performing the majority of cardiac procedures in an entire state, Delaware (link). I should not fail to mention the waste of resources and money that also occurred.
The people behind these atrociously mismanaged clinical projects, some the "darlings" of the aforementioned recruiting companies and of the glossy HIT journals of the time, were never held accountable and in fact moved on to other organizations.
This style of clinical IT mismanagement continues to this day, and is an international phenomenon, at both the local level and the national, e.g., UK (link) and Australia (link).
Finally, on HIT recruiters being wrong in the past in addition to having the past wrong:
Here is what prominent HIT recruiters wrote approximately at the time I was a CMIO. From an article "Who's Growing CIO's" in the journal “Healthcare Informatics”:
I don't think a degree gets you anything," says healthcare recruiter Lion Goodman, president of the Goodman Group in
These were not helpful attitudes towards clinical leadership of HIT. In fact, the HIT recruiters were effectively serving as enablers of clinical IT failure and potential patient harm through such "degree doesn't get you anything" ideologies, stunningly alien to biomedicine.
One wonders just how many "from the school of hard knocks" HIT leaders were pushed by these recruiters onto healthcare organizations, and the harm such leadership may have done to healthcare and to patients.
These attitudes are definitely "not where the money is" today in HIT recruiting, but one wonders if the biases linger.
Have the recruiters truly learned their lesson? Perhaps, but perhaps not. Having been sent by the second author of the ADVANCE article last year into this unpleasantness -- incidentally while discussing with her the need for an article about the changing roles of CMIO's and giving her ideas for same - and then being chastised by her as "unprofessional" for writing my interview experience up in an anonymized fashion so that others might learn from it, I can only wonder. [Translation of unprofessional: "your writing this up could get back to the employer or other candidates and hurt my future recruiting business. Education, knowledge sharing, and ultimately patient care be damned." - ed.]
It seems medical professionals who dabble in patient-centered activism to bluntly point out deficiencies in the lively, profitable HIT industry are simply acting unprofessionally, according to these experts.
My attitude is somewhat different, along the lines of the wise words of my early medical mentor, cardiothoracic surgery pioneer Victor P. Satinsky, MD at Hahnemann Medical College. Dr. Satinsky's simple mantra was:
"Critical thinking always, or your patient's dead."
-- SS
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