Rawpixel.com - stock.adobe.com
From the CMIO to the CHIO: the evolution of the health IT C-suite
Although the chief medical informatics officer plays an important role in hospitals, the chief health informatics officer role is evolving with broader responsibilities to bridge silos.
In February, Cedars-Sinai Health System in Los Angeles promoted Dr. Shaun Miller from chief medical informatics officer to chief health informatics officer. As CMIO, he held a narrower role in expanding virtual care models amid the COVID-19 pandemic, implementing telehealth solutions and integrating AI scribes into clinician workflows at the health system.
At the same time Dr. Yaron Elad was named the health system's new CMIO and Lisa Stephenson was named chief nursing informatics officer. In a sign of the evolving role of the CHIO as overseeing an entire health system, Miller was tasked with overseeing all clinical informatics and training teams for its enterprise information services.
"This new role for our organization, the chief health informatics officer role, represents more of the opportunity to bring the teams under the CMIO, under the CNIO, and even some of the patient-facing teams and other things together in a more functional way," Miller said.
He added, "Having those two roles under me really helped me scale, and they have their own teams. Then I could stay at that strategic level a little bit more and help be their voice at the board level, at the executive level, and across the leadership level for physicians and nurses and a lot of clinicians."
As Miller explained, the CMIO is not going away, but the CHIO role at Cedars-Sinai was added to have an IT leader with a broader role that can oversee areas such as population health strategies and quality initiatives. As CHIO, Miller will also have more involvement in overall strategy than he did as CMIO.
"I think that was also helpful to have my role established, so I can spend more time at the strategic level and help map out the future vision for Cedars-Sinai with regards to technology and our clinicians and not have to be brought into too many of the technical troubleshooting and the problem solving and system design," Miller said.
Previously there were many specialty applications for labs, imaging and the ICU that would require clinical experts, according to Miller. Before Cedars-Sinai transitioned onto a single EHR platform with Epic, many of the specialty areas were still siloed, he said.
"When you make a change to one platform, it affects downstream or upstream workflows, and so with all the clinicians getting together, I think there's an opportunity for informatics and our IT teams to all come together and be a lot more efficient and synergistic when we're trying to design and optimize different systems," Miller said.
With the introduction of AI technologies like ambient AI, clinicians need to work together to vet the new technology, and the CHIO is responsible for bringing these teams together, he said.
The deployment of ambient AI and documentation has provided Miller with visibility into both worlds as the health system deploys ambient AI for both nurses and physicians, he said.
As the CHIO, Miller will ensure that various teams are "speaking the same language" as they work on complex systems and manage multiple workflows, he said.
"I think that creates a lot more opportunity to be more efficient, to better understand the workflows and to better implement a lot of the new technology coming our way," Miller said.
The CMIO and the CHIO: Distinguishing the roles
The more overarching view of healthcare that the CHIO holds also applies to clinics, urgent care centers, telemedicine and health information exchanges, according to Rema Padman, trustees professor of management science and healthcare informatics at Carnegie Mellon University's Heinz College of Information Systems and Public Policy.
"I see the role of the CHIO as connecting all these aspects of care delivery and administrative function management," Padman said. "So it's really system-level responsibilities and governance and management of digitization initiatives, both within a hospital, across hospitals, connections to the home, connections online, social media and health information exchanges."
She sees CHIOs acting as informatics officers that "connect all of the pieces." That includes governance, maintenance and decision-making in coordination with individual hospital CMIOs.
CHIOs ensure that data standards are adopted and oversee the implementation of technology and standards compliance when it comes to data management. Whether a health system has a CMIO or a CHIO depends on the size and complexity of health systems, Padman explained.
"For health systems that have 40-plus hospitals, it's really difficult for the CMIO to really handle all of the 40 systems, so they have CMIOs at all of the major hospitals, and then they have a CHIO that works across all of them," Padman said. "But for a smaller health system with just a few hospitals, it may be possible for a CMIO to really be a CHIO on the clinical side across the smaller health system."
Some of the responsibilities of the CHIO and CMIO overlap with some physicians serving as CIOs and chief digital innovation officers.
"I think we are also seeing the CMIO and the CIO roles merging," Padman said. "In the past, the CIO role was purely the technology side of things, but I think in the hospital setting, we are seeing those two merge."
In addition, chief health AI officers have emerged. For example, at Cedars-Sinai, Mouneer Odeh is chief data and AI officer.
"Right now, I'm spending a ton of time on AI solutions, but there may be a need to have that interface with the chief data AI officer and his team," Miller said.
The future of the CMIO and CHIO
The role of the CMIO is not going anywhere. In fact, some health systems have multiple CMIOs, according to Miller. That could mean CMIOs for inpatients and outpatients.
"I think a version of the CMIO is absolutely still needed in most places," Miller said. "There's still a large physician-specific way of interacting with technology, with the field of clinical informatics," he said.
Miller noted that physicians can get board-certified in clinical informatics.
As CHIO, Miller looks to tap into his view of the entire health system to oversee innovation in areas of AI, including ambient AI.
"I'm really hoping I can be an advocate for clinicians across our whole health system when it comes to investing in newer technologies like ambient to make clinicians happier, more efficient, and deliver better quality care," Miller said.
Brian T. Horowitz started covering health IT news in 2010 and the tech beat overall in 1996.
