Mark was telling me, that he's spoken to recruiters recently, who had several things to say about CMIOs in general :
- The CMIO role lacks formality in the industry (there is a wide variation of job duties among CMIOs)
- The CMIO role lacks training in "how an organization works" (a valid criticism for some)
- That most CMIOs start the job totally unprepared for the realities.
As for Informatics training, there are certainly informatics training programs out there, the most popular being the AMIA 10x10 class, but there are lots and lots of other "informatics training" programs out there too. It's certainly valid, however, that many CMIOs don't have formal informatics training. My own guess : Many of these informatics training programs are targeted for non-physicians too (since Informatics is not just a -physician job - Nurses have informatics needs, respiratory therapists have informatics needs, dietitians have informatics needs, pharmacists have informatics needs - Anyone who works clinically and wants to manage a clinical process can benefit from this sort of training.)
And as for training about "how an organization works", I'm not sure where one would best get that training. It's not just the CMIO that struggles with this! Some people point to MBA programs, but in all honesty, anyone who has worked in business, student government, and maybe understands Microsoft Office really well has at least some idea about how organizations operate. (Is this really some national secret? Committees and paperwork are more than just conspiracy!) I think this is one of the reasons many CMIOs are Internal Medicine, Hospitalists, or Emergency Medicine docs - These are specialties that are very, very affected by "how the machine runs" - You learn quickly, as a Hospitalist/ED doc, about how an organization runs (or doesn't). :)
Finally - the statement that "most CMIOs are totally unprepared for the job they're getting into", I will admit there is probably some truth to that. (Although the same could be said about any job - Who walks in knowing their job on day #1??)
I suppose if there is a "stereotype" to most CMIOs when they start (myself included), it's that of the "tech-savvy doc", waving around his/her iPhone, talking about who they friended on Facebook last night, tweeting at Starbucks while they order some crazy drink and look down their nose at people who have voice-only cell phones. They read Wired magazine, and seem the most "tech-friendly" of all of the docs in their hospital, and like to see themselves as open-minded and friendly, chanting the mantra, "Think Differently". They're often the first to buy a hybrid car and the latest gadget at Apple, and show it off to all of their friends. And according to CMIO magazine's recent job survey, apparently many are Internal Medicine physicians, male, ages 51-55 years old. (Curiously, 9% are not licensed physicians - Did they not complete a residency? Or just not physicians? Hmmm...)
Anyway, I would say that I fit this stereotype to some degree, when I started, except I worked for several years in the software industry before I went to medical school, so I didn't walk in totally naive about how hard it is to maintain a network and software for a large company.
What I didn't realize, when I got into the position in healthcare, is that unlike private industry, healthcare is much more challenging to implement a large-scale IT project :
- In private industry, budgets are much more forgiving about technical snafus that arise. In healthcare, budgets are tight all over.
- In private industry, everyone works 9a-5p. In healthcare, employees work 24/7, in different shifts, so training is much more difficult.
- In private industry, if you have to train all employees, it's not such a big deal to close a unit of a company for 2-3 days while you train everyone. In healthcare, you can't close the ED for 2-3 days while the doctors and nurses learn the software.
- In private industry, it's acceptable if the system works 98% of the time. In healthcare, it's unacceptable if the system works 99.5% of the time. (Engineers will tell you how easy it is to make a system that works 95% of the time, and how hard it is to make a system to work 99.9% of the time.)
These are some of the lessons I learned in my first year performing my job.
So now there seem to be a LOT of CMIOs being hired (for good reason!), and after speaking to a bunch of them, I've been asked to help "train our new CMIO so they hit the ground running". And the first thing I try to tell them is : Yeah, the iPhone and Facebook and Twitter are all great, but you won't be using any of them in CMIO land.
(It's a crushing defeat to the ego, often, but it's the truth.)
These are the things, new CMIO, you should instead look forward to :
- You will spend a lot of your time trying to strategize politically about how to get physician buy-in to your informatics platform.
- You will spend a lot of your time trying to strategize politically about how to get administrative buy-in to your informatics platform.
- You will spend a lot of your time reading CMS and Joint Commission and State laws about medication delivery, ordering privileges, and such.
- You will read a lot about industry guidelines in building your front-line informatics tools : Policies, protocols, order sets, documentation, and templates.
- You will almost certainly encounter technical boundaries that you'll have to explain to docs who may never be satisfied.
- You will almost certainly encounter financial boundaries that you'll have to explain to docs who may never be satisfied.
- You will almost certainly encounter political boundaries that you'll have to explain to docs who may never be satisfied.
- You will often be asked to be responsible for large, complicated systems, and hopefully, you will also be given proper authority to make changes. (Many CMIOs I speak to say they are hired but not given real authority - See the administrative buy-in problem I speak about in #2 above.)
- You will spend time reviewing workflows, and analyzing them, and mapping them on flowcharting software, and developing project timelines and managing your informatics team. (If you're lucky - Some CMIOs have no informatics team to work with.)
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