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Navigating CMIO Enterprise Challenges Through the Technology Maelstrom

GE Healthcare and Roche recently sponsored a webinar which featured an interview with Dr. Stacey Johnston, MD, Vice President and CMIO at Baptist Health, a healthcare system in Northeast Florida. The discussion focused on the evolving role of the CMIO in an era of rapid healthcare technology innovation. What follows are highlights of that conversation.

Q. What are the challenges and benefits of balancing two perspectives, the IT side, and the clinical side?

A. The CMIO is at the center of a triad relationship; clinical and operational on one side, technical on the other. The CMIO bridges the gap by bringing the end-users together. I work with our physicians and other clinicians to make sure that the technology is meeting their needs. I also work with IT in evaluating the impact of new technology on workflows, processes, and procedures.

Q. Is it that health systems need CMIOs because IT doesn’t really understand clinical workflow and the clinicians don’t want technology disrupting clinical decision-making?

A: It’s important for our providers to understand what we are looking to gain from new technology and the value it’s going to add since they will be responsible for ultimately adopting and utilizing the technology.

Q. What about the introduction of a new initiative or new idea such as artificial intelligence? (AI)

A. Where I work, we are really trying to be cognizant of advancements in technology both operationally and clinically, as well as evaluate how we can advance AI. I found one algorithm fascinating in terms of its ability to identify those patients most appropriate palliative care and the benefits of that care. I could have involved the AI committee, but I actually needed the clinicians to drive this, so I engaged the Clinical Transformation Workgroup on Palliative Care and they also found it had value. It became the perfect first case use of advancing our use of AI. So, I see the introduction of new ideas as helping to facilitate conversations between our technology teams and our physicians, the end-users.

Q. How do you see your role in relation to clinician satisfaction, retention, and the burnout issue, especially in regard to advancing technology?

A. As a member of the Physician Burnout Committee, we know physician satisfaction and burnout aren’t just caused by the EMR, even though studies have shown that anywhere from 50 to 70 percent of burnout is related to technology. While technology can help facilitate their work, if it’s not implemented well or the users trained inadequately, it can actually add to their burden. We try to address physician satisfaction and burnout in a multitude of ways; team-based care, trying to identify burnout earlier by using matrix scores, addressing burnout at the time orientation, and taking away the stigma. And, of course, addressing the technology and how it either contributes or alleviates burnout.

Q: Have you ever come close to burnout? Do you understand what that feels like?

A. Part of the problem with burnout is it’s hard to recognize. What I temporarily experienced was a diminished sense of empathy toward my patients. That was hard because I’m naturally very empathetic and compassionate. Unfortunately, the solution is not just cutting back in your hours; it’s autonomy; being able to choose your schedule and delegate your workload. Once we started making some adjustments to scheduling, I was able to help identify the need for delegation that helped me to address temporary signs of burnout.

Q. How do you interact with other C-level roles—Chief Application Officers, Chief Data Officers, Chief Innovation Officers, and deal with challenges in communicating your desired clinical initiative?

A. If I could say one word, I’d say texting. It’s really about being timely and responsive; making sure that you’re open with your communication and responding to emails and calls in a timely manner—making sure people know that you’re available to be included in their communications and that they are included in yours.

Q. You mentioned texting and email as a means of communicating. What about email? Do you become overloaded? What works?

A. I think we definitely have a significant amount of email strings. If there are too many emails going back and forth, I’ll pick up the phone have that quick call. One way that I do utilize email is to keep the physicians informed. It could be something like, hey, there’s new functionality coming, or by the way, we’re going to Epic. We send an email to the physicians with some kind of information at the end of each week.

Q. How do you position a new groundbreaking technology initiative to leadership and to the clinical and operational teams?

A. I love taking ideas that have worked for other organizations that can work here. For instance, at the Healthcare Information and Management Systems Society (HIMSS) meeting last year, I heard a great presentation on patient wearables and using that data to help make clinical decisions. I first broached the concept with my CEO, who suggested I bring it to the consumer team. We’re now actually in the process of developing and implementing these app bars called healthy living centers because I first brought it the CEO who led me to the right team within the organization.

Q. How important and how difficult is it to connect your technology to the business objectives of the organization?

A: It’s really important for the CMIOs to participate in the strategic planning process and propose technology initiatives or business objectives where they find value. For example, two areas where I see opportunities for business and technology to connect are: caring for the caregiver and caring for the patients as customers. In a business sense, our patients are our customers.

Q. As a CMIO currently involved in implementing new software, you hope to make the Electronic Medical Record (EMR) work for you. What messaging is most useful for other CMIOs?

A. It is not just about the system, it’s also about the mastery of the system and how well the workflows are designed and how much time is spent in personalization. Then, of course, how training will help your end users become masters of the EMR by helping them to design that system to meet their needs.

Q. What’s the biggest challenge you see on the horizon that has not yet been vetted in the general healthcare community?

A. Obviously, technology is going to continue to advance our clinical knowledge, making it hard to keep up, especially in precision medicine. Embracing cognitive algorithms can help facilitate the end-user to make the right decisions based on a patient’s particular genomic marker at the right time and using the treatment. A brain can’t process all that information, but technology can. The hardest part is staying ahead of your clinical decision support–and staying ahead of AI.

Q. Do you have any other advice for CMIOs, or those aspiring to the role, on how to be successful?

A. Keep learning, keep challenging yourself. In fact, I just went through Information Technology Infrastructure Library (ITIL) training. If my project managers are expected to know this process, then I should know it, too. It’s important in this role to step out of your comfort zone and expand your horizons.