Thursday, March 11, 2010

So you want to be a CMIO?

So I recently had an interesting discussion with a physician actually asking me, "How do I become a CMIO?".

So far, all of the other CMIOs I know have very interesting stories about how they got into the position. Most of them sound more like accidents than planned career choices, mine included.

Still, I'm totally happy being a CMIO. Yes, it's tough. The hours, balancing clinical and administrative time, can be brutal. And sometimes you feel like you're endlessly herding cats, trying to get people to play nicely as you move your EMR implementation forward.

So I thought tonight I'd write a little bit about the CMIO role.

Question 1 : "What does it take to be a good CMIO?"

I think there are some personality traits that are conducive to being a good CMIO.
  1. First, you have to believe in change. And you have to know, and accept, a basic truth : Change is hard. It it was easy, people wouldn't be interested in paying you to do it.
  2. It also helps to be nice. If your personality is too strong, people will see you as authoritarian and paternalistic. If you're too weak, you'll never get anything done. You want to be the middle of the road. Top of the bell curve.
  3. You need to be able to tolerate ambiguity. If you're the sort of person who needs an idea super-well formed, before you start working on it - You'll never survive. If you're the sort of person who needs every hour of every day planned out - You'll never survive.
  4. You need patience. A lot of the job deals with policy and regulatory minutiae. If the idea of writing policies or reviewing CMS regulations makes your skin crawl, this may not be the job for you.
  5. It helps to be super-passionate about technology. While Informatics is, in itself, not related to IT (a common mistake!) - It really is important to embrace technology, warts and all.
  6. A good CMIO knows when to be detail oriented, and when to let go. Part of the skill is knowing when to be which.
  7. A good CMIO is an awesome teacher. There's a big difference between people who call themselves teachers, and people who are teachers. Real teachers are a valuable commodity. Remember, we're all students and teachers all our lives. CMIOs are committed to real teaching.
  8. A super-talented CMIO will have "Jedi Skills" when it comes to personality management. Sometimes you have to negotiate politically between competing clinical areas, to reach an agreement, and this can mean some tricky political discussions. They should strive to be as Yoda-like, or Obi-Wan-like, as possible, when it comes to these discussions. Being forceful right out of the gate is often a big mistake. Subtlety and humor are two powerful tools, if used the right way.
  9. Finally : It helps to keep a foot in the door clinically. While it's not entirely necessary, realize that the currency that a CMIO spends, to get the job done, is physician buy-in. If the physicians don't respect your opinions, you'll have a hard time.
CMIO magazine recently had an excellent article on CMIOs : Who are they, where did they come from, what do they get paid, etc : See it at (or via their web site at ) I highly recommend reading this article if you're considering moving into a CMIO position.

Question Two : "How do I get myself into a CMIO position?"
This is the hard part. Most CMIOs I know have stories about falling into the position. Either they were hired almost by accident, or they were the "loudest complainers" in their hospital, or they were super-involved in their IT department meetings. I think they all share a common pathway : They demonstrated real passion and commitment to change.

The reason it's still hard, is because of the common budgeting pitfalls :
  1. Most hospitals don't know what a CMIO is.
  2. Most hospitals aren't really sure what Informatics is, so they don't budget for it. (The truth : Most hospitals lump informatics together with IT.)
So when you go looking for a CMIO position, they don't happen often. An organization looking for a CMIO will generally be progressive, have a good understanding of what Informatics is, and have budgeted for informatics. If they didn't do all three, they probably aren't going to be looking for a CMIO.

So my advice : Look for a progressive hospital that knows what Informatics is. And they probably will either have a CMIO, or potentially be looking for a CMIO. And if you're already at a hospital that needs a CMIO, you can create the position by first spreading the word of how important Informatics is for your EMR implementation, and then let your current leaders create a budget for this. (Then recommend yourself for this position.)

That's how a lot of people got into the position - They were active and vocal when the hospital realized they needed someone to help implement their EMR.

Next post, I'll talk about some common pitfalls for CMIOs, and how you can rapidly get seasoned in this new, emerging position.

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