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CMIO Success Strategies

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Title: CMIO Success Strategies


1
Welcome to 173 What is a Clinical
Informaticist? (OK, we realized we should have
called it CMIO Success Strategies
  • Steve Kastin, M.D.
  • W. Paul Nichol, M.D.
  • Chris Lopez, M.D.
  • Brian Laufer, D.O. Doug Rosendale, D.O.

2
Round 1
  • What is a Clinical Informaticist?
  • CMIO?

3
Steve Kastin, MD
  • Chief Information Officer and
  • Chief Health Informatics Officer, VISN 3
  • Chair, VHA Radiology Informatics Committee

4
Informatics Leadership Titles
  • CMIO Chief Medical Informatics Officer
  • Sometimes also called Chief Medical Information
    Officer
  • CHIO Chief Health Informatics Officer
  • DCI Director of Clinical Informatics
  • MDIS Medical Director of Information Systems
  • ACOS/MI Assoc Chief of Staff for Medical
    Informatics (VA only)

5
Informatics Leadership Titles
  • What they all have in common is that they (are
    supposed to) indicate
  • Overall responsibility for informatics issues
  • Oversee development of informatics-related
    policy
  • Authority to implement informatics policies and
    initiatives
  • Sometimes, the title goes without the authority

6
Informaticist vs. CMIO/CHIO
  • Being an informaticist is analogous to being,
    say, a cardiologist
  • It means you DO informatics
  • Being a CMIO or CHIO is analogous to being the
    Chief of Cardiology
  • It means you oversee all informatics operations
    and are responsible to assure that everything
    relevant to informatics is being taken care of

7
Informaticist vs. CMIO/CHIO
  • Most VA sites have someone doing informatics
  • Its become a necessity
  • Most VA sites probably do NOT have a CMIO yet, in
    the true sense of the word
  • Since the Informatics Dept is usually a
    department of 1, the lone informaticist is often
    called the CMIO, CHIO, or even ACOS/MI

8
Informatics Informaticists
  • To understand what an Informaticist is, need to
    understand what Informatics is.
  • Many definitions
  • Many flavors of Informatics
  • Many aspects of Informatics

9
Definition
  • From NAS/IOM Medical Informatics Workshop 5/1/06
    "Health informatics is the application of
    principles of information science, knowledge
    management, computing, and telecommunications
    to
  • The health and health care of individuals and
    families,
  • The health monitoring and health services
    afforded to populations,
  • The advancement of biomedical research,
  • The education and work processes of health
    professionals and scientists, and
  • The health education and health practices of the
    public.

10
Simpler Definition?
  • The science of how information is gathered,
    recorded, structured, and retrieved.
  • Informatics existed BEFORE computers!
  • Medical Records staff were some of the first to
    deal with informatics in a healthcare setting.
  • Advent of computers makes informatics that much
    more critical.

11
Flavors of Informatics
  • Health (Healthcare) Informatics
  • Medical Informatics
  • Clinical Informatics
  • Bioinformatics
  • Also specialties
  • Nursing Informatics
  • Pharmacy Informatics
  • Dental Informatics
  • Many others

12
Aspects of Informatics
  • Applied Informatics
  • Development of policy
  • Setting of parameters
  • Clinical IT Implementation (?)
  • Vendor analysis/selection/options
  • Informatics Research
  • Informatics Education
  • Programming/development
  • Development of Standards (e.g. HL7)
  • Others

13
Why is Informatics Important?
  • In a series of reports the IOM has identified
    informatics as a critical infrastructure for
    advances and improvements in public health,
    clinical practice, patient safety, personal
    health management, health professional education,
    health care financing and administration, and
    health sciences."

14
Why is Informatics Important?
  • Most organizations are driven by information, but
    healthcare industry is arguably more
    information-driven than any other industry.
  • information needed to properly diagnose and treat
    the patient (clinical aspect)
  • information needed to keep the medical centers
    operational (business/operational aspect)

15
Where do Informaticists Come From?
  • Graduate Degree Programs
  • Harvard, Stanford, etc
  • Fellowships
  • CDC (Public Health Informatics)
  • NIH-sponsored
  • Medical Schools
  • 8 VA programs (Boston, Indy, Menlo Park,
    Portland, SLC, Seattle, West Haven, Nashville)
  • Home Grown
  • Informatics is still new enough that many (most?)
    informatics leaders are home grown

16
Career Path Steve Kastin
  • Late 1970s Use HP9830a in research lab
    hooked on Basic!
  • Early 1980s programming courses in college
    (COBOL, Fortran, Pascal)
  • Mid 1980s Med School computer room, IT
    Steering Cmte
  • Late 1980s Nuc Med residency (lots of
    computers!)

17
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18
Career Path Steve Kastin
  • Early 1990s Nuc Med attending at Bronx VA
  • Radiology ADPAC
  • Information Mgmt Cmte member
  • Chair, IMC
  • Director of Clinical Informatics, Bronx VA
  • Director of Clinical Informatics, VISN 3
  • CIO, VISN 3 (2006)

19
Career Path Steve Kastin
  • CPRS Clinical Workgroup
  • Internet Mgmt Review Board
  • VA Healthcare Security Cmte
  • Chair, VHA Radiology Informatics Cmte
  • Member, VHA Informatics Data Management Cmte
    (IDMC) (formerly ITAC)
  • Others

20
Duties of VISN 3 CHIO (DCI)
  • Chair, VISN 3 Clinical Informatics Council
  • Develop VISN 3 Informatics Policy
  • Oversee implementation of VISN and National
    informatics policies/initiatives
  • Oversee implementation of all clinical IT in
    VISN
  • Chief liaison between IT and clinical staff
  • Attend clinical councils (Imaging, Lab, Primary
    Care, etc)
  • Brief Leadership on Informatics issues
  • Member of ELC, COS Council, AD Council

21
Duties of VISN 3 CHIO (DCI)
  • Prior to VA IT Re-org, aligned under VISN CIO
  • Worked very closely with CMO
  • Work with VISN ISO on clinical IT security
    issues
  • Member of HT/HC Equipment Council
  • Help assure that equipment purchases are aligned
    with VA IT environment and security concerns

22
Duties of VISN 3 CHIO (DCI)
  • Act as liaison between VISN and facilities on all
    informatics and clinical IT issues
  • Problem is lack of facility CHIOs
  • No one to own informatics issues at the sites
  • No one person to assure implementation of
    informatics policies/initiatives at the sites
  • No single definitive source for informatics info
    from the sites
  • CACs do not have complete scope

23
W. Paul Nichol, MD
  • Associate Chief of Staff/ Clinical Information
    Management
  • VA Puget Sound Health Care System
  • National Director Medical Informatics
  • Patient Care Services, VHA

24
Career Path W. Paul Nichol
  • 1968-69 Programming Fortran in High School
  • 1969-1973 Computer Science College Courses
  • 1973-1980 Med School and Internal Med Residency
  • 1980 First personal computer Apple II
  • 1980-Present VA physician with computer interest
  • 1982-1985 Clinic Director
  • 1985-89 Chief of Staff
  • 1989-1997 ACOS Ambulatory Care
  • 1997-2001 Director Primary Care
  • 2000-2001 Sabbatical Medical Informatics
  • 2001-Present ACOS Clinical Information
    Management
  • 2007-Present National Director Medical
    Informatics/ Patient Care Services

25
Duties
  • National Director Medical Informatics, PCS
  • Represent PCS IT needs in national forums
  • IDMC, HISEB, MHV CAB, CPRS Advisory Board,
    various workgroups
  • Liaison with CO Programs, field groups, VHA OI,
    VA OIT, non VA organizations
  • Other duties as assigned
  • ACOS/Clinical Information Management
  • Provide leadership for local implementation of
    IT/IM resources
  • Supervise CIM Team CACs, Telemedicine
    Coordinator
  • Committees CIM Steering, Med Records,
    Security/Confidentiality, CEB, VISN groups
  • VA DoD Data Exchange Project
  • Research usability, safe medication use
  • VA Informatics Fellowship local co-director
  • State IT activities involvement

26
Medical Informatics
  • The integrative discipline that arises from the
    synergistic application of computational,
    informational, cognitive, organizational, and
    other sciences whose primary focus is the
    acquisition, storage, and use of information in
    the health/biomedical domain. (William Hersh)

27
Clinical Informatics
  • A sub-field of medical informatics. It focuses on
    computer applications that address medical data
    (collection, analysis, representation). Clinical
    informatics is a combination of information
    science, computer science, and clinical science
    designed to assist in the management and
    processing of data, information and knowledge to
    support the practice and delivery of clinical
    care. (Shortliffe/Perreault)

28
HEALTHeVET PORTFOLIO
Operations Management Application Monitoring D
evice Manager
System Monitoring
Emerging Technologies Home Telehealth Health IT
Sharing

Adverse Reaction Tracking
Authorization/ Subscription Utility
Womens Health
Vitals/Measurements
eGov DFAS FLITE HR Shared Services Center
Voluntary Service System
Enhanced VA/DoD Seamless Care
Veterans Personal Finance System (VPFS)
Automated Info Collection System
Text Integration Utilities
Joint Inpatient Electronic Health Record
My HealtheVet
Surgery
ASISTS
Standardization And Terminology Services
Bar Code Expansion Project
Remote Order Entry System
National/Regional Database Stores
Spinal Cord Dysfunction
Beneficiary Travel
Administrative Data Repository
Health Data Repository
Blind Rehabilitation
Care Management
Social Work
Progress Notes
Workload Management
Clinical Data Warehouse
Archive Service
CAPRI (AMIE)
RISE
Workflow Engine
Clinical Case Registries
Security
Audit Service
Problem List
Release of Information (DSSI)
Dental Record Manager
Common Services
Enrollment Application System
Business Rules Engine
Person Service
Scheduling
Radiology/Nuclear Medicine
Employee Health Record
Clinical Decision Support
Outpatient Clinical Care
Organization Service
Deployment Toolkit
QUASAR Audiology Speech Analysis
Messaging/ Enterprise Service Bus
Fee Basis
HeV Desktop
Laboratory
Clinical Device Connectivity
Home Based Primary Care
PIMS
Order Entry/ Results Reporting
Prosthetics
Primary Care Management Module
Report Writer
Imaging System
Pharmacy
Clinical Procedures
Order Check Expert
Incident Reporting
Police Security
Patient Advocate Tracking System (PATS)
Incomplete Record Tracking
Clinical Reminders
Intake/Output
Nutrition And Food Service
Library
Ophthalmology
Mental Health
LEGEND
Oncology
Nursing Service
Consult/Request Tracking
Phase 1
Implant Management
Phase 2
Discharge Summary
Healthcare Acquired Infection Influenza Su
rveillance
Phase 3
Health Summary
DoD Systems Bed Contingency Interfaces to AHLTA

Phase 4
Emergency Room
Phase 5
Credentials Tracking VetPro
Phase 6
29
VA Puget Sound Organization
  • ACOS/CIM reports to COS at Puget Sound
  • Supervise CACs and telemedicine coordinator
  • Nursing CACs report to Nursing Informatics
    Coordinator
  • CIM Section is part of larger Information Support
    Service that includes HIMS

30
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31
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32
Chris Lopez, MD
  • Chief of Informatics
  • Orlando VA Medical Center

33
My Informatics Milestones
  • Doing informatics for 6 years
  • 2001 Chair of Clinical Computing Committee
  • 2003 Performance Measures Implementation
    Manager
  • 2006 Member of VISN and local Information and
    Data Management Committees
  • 7/30/07 Chief of Clinical Informatics

34
Major Roles
  • No other clinician in Orlando does informatics
    like I do
  • CPRS expertise
  • Ability to customize CPRS
  • Added access to build menus, shared templates,
    quick orders, manage reminders and create
    reports
  • Huge impact on the flow of information and
    communication
  • Design or redesign processes
  • Examples HIV testing, setting up new clinics,
    medication reconciliation, new performance
    measures, promoting ACA principles
  • Clinical Reminder reports

35
Reporting Process
  • I share clinical reminder reports via SharePoint,
    providers meetings, and committee meetings to
    leadership and stake holders.
  • Several people have ability to run different
    reports which are shared as necessary
  • Clinical applications coordinators
  • Lab supervisor
  • Quality manager
  • Pharmacy
  • HAS
  • Counterparts from Tampa

36
Informatics Roles and Responsibilities
  • One of the go-to guys for figuring out problems
    with CPRS, reminders
  • Analyze performance
  • Consider other practices
  • Present information regularly to providers
  • Input into the computer education of providers
  • Understand goals of the facility

37
Informatics Related Committees
  • Former chair of a clinical computing committee
  • Former chair performance measures committee
  • Member of performance measure corrective actions
    committee
  • Member of Joint Commission survey prep team
  • Member VISN 8 Information Data Management
    Committee
  • Getting involved in a national provider reports
    pilot
  • VeHU Provider track planning committee

38
Skills/Relationships
  • Ability to obtain useful information that no one
    else in the clinic can do
  • Sharing information with peers
  • Problem solving
  • Working closely with CACs, QM 
  • Designing/redesigning of processes
  • Building tools/shortcuts
  • Building consensus
  • Organizing champions
  • Teaching

39
Time Allocation
  • For the past 4 years, I have been 50 clinician
    and 50 informaticist
  • Responsibilities growing

40
Baby Informaticist
41
HEALTHeVET PORTFOLIO
Operations Management Application Monitoring D
evice Manager
System Monitoring
Emerging Technologies Home Telehealth Health IT
Sharing

Adverse Reaction Tracking
Authorization/ Subscription Utility
Womens Health
Vitals/Measurements
eGov DFAS FLITE HR Shared Services Center
Voluntary Service System
Enhanced VA/DoD Seamless Care
Veterans Personal Finance System (VPFS)
Automated Info Collection System
Text Integration Utilities
Joint Inpatient Electronic Health Record
My HealtheVet
Surgery
What have I gotten myself into?
ASISTS
Standardization And Terminology Services
Bar Code Expansion Project
Remote Order Entry System
National/Regional Database Stores
Spinal Cord Dysfunction
Beneficiary Travel
Administrative Data Repository
Health Data Repository
Blind Rehabilitation
Care Management
Social Work
Progress Notes
Workload Management
Clinical Data Warehouse
Archive Service
CAPRI (AMIE)
RISE
Workflow Engine
Clinical Case Registries
Security
Audit Service
Problem List
Release of Information (DSSI)
Dental Record Manager
Common Services
Enrollment Application System
Business Rules Engine
Person Service
Scheduling
Radiology/Nuclear Medicine
Employee Health Record
Clinical Decision Support
Outpatient Clinical Care
Organization Service
Deployment Toolkit
QUASAR Audiology Speech Analysis
Messaging/ Enterprise Service Bus
Fee Basis
HeV Desktop
Laboratory
Clinical Device Connectivity
Home Based Primary Care
PIMS
Order Entry/ Results Reporting
Prosthetics
Primary Care Management Module
Report Writer
Imaging System
Pharmacy
Clinical Procedures
Order Check Expert
Incident Reporting
Police Security
Patient Advocate Tracking System (PATS)
Incomplete Record Tracking
Clinical Reminders
Intake/Output
Nutrition And Food Service
Library
Ophthalmology
Mental Health
LEGEND
Oncology
Nursing Service
Consult/Request Tracking
Phase 1
Implant Management
Phase 2
Discharge Summary
Healthcare Acquired Infection Influenza Su
rveillance
Phase 3
Health Summary
DoD Systems Bed Contingency Interfaces to AHLTA

Phase 4
Emergency Room
Phase 5
Credentials Tracking VetPro
Phase 6
42
HEALTHeVET PORTFOLIO
Operations Management Application Monitoring D
evice Manager
System Monitoring
Emerging Technologies Home Telehealth Health IT
Sharing

Adverse Reaction Tracking
Authorization/ Subscription Utility
Womens Health
Vitals/Measurements
eGov DFAS FLITE HR Shared Services Center
Voluntary Service System
Enhanced VA/DoD Seamless Care
Veterans Personal Finance System (VPFS)
Automated Info Collection System
Text Integration Utilities
Joint Inpatient Electronic Health Record
My HealtheVet
Surgery
ASISTS
Standardization And Terminology Services
Bar Code Expansion Project
Remote Order Entry System
National/Regional Database Stores
Spinal Cord Dysfunction
Beneficiary Travel
Administrative Data Repository
Health Data Repository
Blind Rehabilitation
Care Management
Social Work
Progress Notes
Workload Management
Clinical Data Warehouse
Archive Service
CAPRI (AMIE)
RISE
Workflow Engine
Clinical Case Registries
Security
Audit Service
Problem List
Release of Information (DSSI)
Dental Record Manager
Common Services
Enrollment Application System
Business Rules Engine
Person Service
Scheduling
Radiology/Nuclear Medicine
Employee Health Record
Clinical Decision Support
Outpatient Clinical Care
Organization Service
Deployment Toolkit
QUASAR Audiology Speech Analysis
Messaging/ Enterprise Service Bus
Fee Basis
HeV Desktop
Laboratory
Clinical Device Connectivity
Home Based Primary Care
PIMS
Order Entry/ Results Reporting
Prosthetics
Primary Care Management Module
Report Writer
Imaging System
Pharmacy
Clinical Procedures
Order Check Expert
Incident Reporting
Police Security
Patient Advocate Tracking System (PATS)
Incomplete Record Tracking
Clinical Reminders
Intake/Output
Nutrition And Food Service
Library
Ophthalmology
Mental Health
LEGEND
Oncology
Nursing Service
Consult/Request Tracking
Phase 1
Implant Management
Phase 2
Discharge Summary
Healthcare Acquired Infection Influenza Su
rveillance
Phase 3
Health Summary
DoD Systems Bed Contingency Interfaces to AHLTA

Phase 4
Emergency Room
Phase 5
Credentials Tracking VetPro
Phase 6
43
Needs
  • Expansion and organization with clearly defined
    roles
  • More important than ever with building a new
    hospital and losing previous support
  • What additional core skills do I need?

44
Brian Laufer, D.O.
  • Alaska Healthcare System and Regional Office
  • Chief, Clinical Informatics

45
Career Path Brian Laufer
  • Diplomate American Academy of Family Practice
  • ACOS Education
  • Employee Health Provider, Special Registry
    Coordinator
  • Associate Chief Primary Care
  • CPRS Clinical Implementation Manager

46
Organizational Chart
47
Future Organizational Chart
48
Organizational Structure
  • Realization that data integration and management
    requires formalized structure
  • Baldrige The Quest for Excellence
  • Leadership
  • Strategic Planning
  • Market Focus
  • Measurement Analysis
  • Process Management
  • Organizational Results

49
Communication
50
Formal Reporting Structure
51
Doug Rosendale, D.O.
  • Enterprise System Manager-Provider Systems
    (acting)
  • Washington OIFO
  • (aka Hank Rappaports old job)

52
Career Path Doug Rosendale
  • Worlds only surgeon/informaticist?

53
Round 2
  • How are Clinical Informaticists Organized?

54
Kastin Organization
  • VA is lacking a field-based structure for
    informatics.
  • It is not even mandated that every site or VISN
    have an informaticist (or even just someone to
    oversee informatics)

55
Kastin Organization
  • In 2000, VISN 3 CIO realized increasing role of
    informatics and clinical IT in delivery of
    healthcare.
  • Created position of VISN 3 Director of Clinical
    Informatics
  • One-man shop reported to CIO CMO
  • Currently CHIO/CIO, Deputy CHIO, 2 PMs

56
Kastin Organization
  • No direct reach into facilities
  • All facilities in V3 have informaticists, but
    only one has a formal DCI (part time)
  • 1 informaticist from each site is on VISN CIC,
    but
  • No authority at facility to implement policy
  • Not involved with all informatics/clinical IT
    initiatives, so not able to provide all needed
    info at CIC

57
Kastin Organization
  • Plan is to require CHIO/DCI (likely MD) at each
    facility
  • Empower DCI to implement policy
  • Facility CHIO Chairs local CIC or IMC
  • Facility CHIO accountable for meeting VISN and
    facility informatics goals
  • Facility CHIO familiar with all local informatics
    and clinical IT initiatives
  • Plan to be presented to VISN 3 ELC

58
Nichol Organization
59
CAC OCWG Background
  • Registered Nurse/Nurse Practitioner
  • ADPAC
  • Specialist, Other
  • Programmer/Analyst
  • Lab Technologist
  • Administrative Officer
  • Registered Pharmacist
  • Medical Records Specialist (RHIA)
  • Educator
  • Social Worker (MSW)
  • Corpsman
  • Masters, Health Administration
  • Radiology Technologist
  • Therapist
  • Chaplain
  • Computer Operator
  • Registered Dietitian
  • MAS Specialist
  • Speech Pathologist

60
CAC OCWG Roles and Responsibilities
  • Customer Support / Trouble Shooting 15.7
  • Clinical Tool Development 14.3
  • Education / Training / Mentoring 11.4
  • Program Implementation / Project
    Management 10.6
  • Consulting 9.7
  • Non CAC Functions 8.1
  • Data Analysis 6.4
  • Leadership 6.0
  • Package, Testing Support 5.2
  • Account / Access Management 5.2
  • Other 4.0
  • Emergency Preparedness Planning 2.0
  • Research 1.6
  • Total  100.2

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63
Round 3
  • Thoughts and Philosophy
  • What is the Skill Set
  • Needed To Succeed
  • as a CMIO/CHIO?

64
CMIO/CHIO Skill Set
  • CMIO/CHIO skill set different from informaticist
    skill set
  • Focus on ability to be a successful change agent
  • Motivate staff to embrace change
  • Manage change
  • Build consensus whenever possible
  • Mentor leadership on need for informatics
  • Skilled politician

65
Round 4
  • Thoughts and Philosophy What is
    the Optimal Alignment of the CMIO/CHIO?

66
Organizational Alignments
  • At site level
  • Reports to COS
  • Reports to IRM Chief
  • Reports to Director
  • At VISN level
  • Reports to for CMO
  • Reports to CIO (difficult now)
  • Reports to Network Director/CEO (C-level exec)
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