Wednesday, September 8, 2010

Who works in Health Informatics?

So I have had a number of people recently talk to me about health informatics jobs. Being a physician, they are mostly physicians looking for informatics jobs.

The interesting thing is, I get the sense the healthcare industry NEEDS informatics, but isn't really ready for it. The CMIO position, despite being almost 20 years old, is still too new to most healthcare administrators, and from what I see and hear, many hospitals don't really know what to do with one. The job functions, from hospital to hospital, vary so widely.

And then there is the question about exact titles - what's the difference between a "CMIO", a "CNIO", a "Physician or Nurse [Embedded] Informaticist", a "Physician Champion", and a "Superuser"?

I will attempt to wax philosophic here, just in the name of starting the discussion on formal titles and formal job descriptions - which the healthcare industry needs badly, if it wants to take advantage of informatics help. Perhaps eventually this will turn into the holy grail of formalization - An actual Wikipedia page. :)

1. The CMIO (Chief Medical Informatics Officer) - Yes, you do informatics, so you have to believe in political neutrality. Yes, you try to guide the rest of the hospital about informatics issues.  You talk about EMR strategy, you help discuss budgeting issues for a solid informatics platform, you stress the importance of proper training. You monitor and guide the politics of CPOE and EMR in the Medical Executive Committee. You worry about administrative, physician, and nurse buy-in. You may do some training, but mostly you guide the education process. You may do some data mining and quality work. You get involved in project management, and help develop physician and nurse informaticists to work with you. This position is heavily involved in policy, however, and you should prepare to analyze and write a great deal of clinical policies. Lots of regulatory work too. In a smaller hospital, your salary line will probably come from a clinical line, and you will still work clinically. In a larger multi-system hospital, your salary line may come from an IT line, or other administrative line, and you probably won't be working clinically anymore.

2. The CNIO (Chief Nursing Informatics Officer) - The nursing equivalent of the CMIO. Yes, there is a big need for this role. The CNIO worries about administrative and nursing buy-in, and continues to work clinically.

3. The Physician or Nurse Informaticist (aka Embedded Informaticist or my affectionate term, Clinical Jedi Informaticist) - Think a mini-CMIO, but in an individual department. A physician informaticist (or nursing informaticist) is a slightly broader term, and could be an outside consultant called in to help the informatics development of a department in your hospital. The much cooler (and reliable and useful position) is the Embedded Informaticist, the doctor/nurse in a clinical tribe whose paid responsibility it is to develop the informatics platform for their clinical tribe. If the CMIO still works 25% clinically, the embedded informaticist works 75% clinically (and 25% informatics). In an ideal world, the hospital CMIO gets to work with an embedded informaticist in each clinical tribe, to coordinate the workflows between different departments. The embedded (physician or nurse) informaticist then analyzes their own tribe's workflows, maps them, redesigns them, and sees the changes through committees, policy work, and brings them to the Clinical IT staff to make it happen. Since they are embedded, they can also easily train and support the new workflows in their tribe. And because they are embedded, buy-in is never a challenge. The EMR works better, the docs and nurses feel more loved. This is an extremely effective model, by my experience. (If it's supported by administration.) This, I think, is the position that is going to explode in demand in the next year or two. Look out for it. The AMIA 10x10 class will train most of these embedded informaticists. 

4. The Physician Champion - This is a physician who is asked, or paid, to rouse the troops. Your main mission is to be a cheerleader. You encourage the docs around you, and you may get involved in training directly. Exposure to policy and strategy discussions will probably be minimal. You probably won't have the pay or time budget to do much data mining, and you won't be managing other informaticists. Your ability to motivate is much more important than knowing every detail of every workflow. For reasons I don't understand, nursing usually doesn't need a champion, but this may change.

5. The Superuser - This is probably the most misunderstood positions in healthcare informatics today. The superuser is a really, really advanced, highly-skilled educator. They need to know the details of the software and every detail of every workflow. Think of the superuser as an embedded informaticist without the workflow redesign responsibilities. Superusers have to be patient and love education. They don't get involved in the politics or budgeting discussions. And they need to be available, especially at the time of new software or hardware rollouts, to help smooth the transition between classroom training and the clinical front. Superusers are worth their weight in gold, and you can never have enough of them. Not having well-trained superusers makes any clinical go-live a challenge.

Unfortunately, these are all roles in healthcare informatics, but only the CMIO has any semi-reliable job descriptions and pay data. (And trust me, even for CMIOs, the human resources data is still pretty scarce.) Eventually, these all should be recognized, formal roles, but I'm having a hard time imagining a want ad saying :


So until we formalize the CMIO, the CNIO, the physician and nurse informaticist, the physician champion, and the superuser - Healthcare won't really be able to take advantage of these very important positions.

In the meantime, I'll keep working on it. :)

1 comment:

Amers said...

EXCELLENT POST!! I can't agree with you more about the utility of having the so-called "embedded informaticists" (75% clinical/25% Informatics). Not only does this structure eliminate the issues involved with adoption, it also helps reduce the workflow design issues that all too often lead to errors and delays and lost revenue. I'm an APN that recently decided to swap out my clinical role for that of a Nurse Informaticist role at a new Medical Center. I'm not allowed, nor is anyone else in my organization, to do both hats. It's really unfortunate. Although I understand medicine, it takes time to understand the culture and unique workflows specific to a particular hospital; not to mention, the time it takes to make relationships. All of these barriers would be eliminated if these roles were embedded so to speak. Look forward to more great posts!! So glad I found this site!