Curbside Consult with Dr. Jayne 2/10/14

I’ve made some really good friends in health IT over the last couple of years. One of them shared a great story from a recent get-together he hosted. It made me chuckle enough to want to share it.

We had another family over for a the Super Bowl last week, which was really just a kid-friendly play date and some chatting as the game was awful and the adults were slap-happy from being snowed in with their kids for the last several days. 

“So I am thinking about interviewing for for the new chief medical information officer job at the hospital" said one of the docs, who is a hospital-based physician.

"You mean informatics, right?" said the pernicious techie, cringing at yet another sentence starting with “so.”

"Yeah, sure. So that would be exciting. I am just afraid of being the complaint desk for all Vendor issues. Do you think there is a way to integrate Vendor A and Vendor B?" he said, looking at me, even though the two other adults (which makes three out of four) are employed physicians at the same hospital.

"You can integrate any two things, but the question I would ask is, ‘What things do you feel need to be concatenated for the benefit of patient care and physician happiness?’ since just combining data recklessly can be worse than what you currently have," said the now aghast techie, who wonders whether current employees are being paid to interview for positions they are unqualified for.

"Well, it is a part-time job and I think it would be cool to help improve workflow at the hospital," said the hospitalist.

"Sure, I mean, great. It is really progressive for the hospital to go after a CMIO position. I mean, for them, this is big stuff. I have some friends who are CMIOs that maybe you can speak to. One even finished her sub-specialty Boards recently. The other is an ER doc, but he also has a degree in computer science."

My friend concluded that there is a significant gap between what needs to happen in clinical informatics and what will likely happen. I see this more often than I would like.

I recently helped a local hospital craft a job description for a CMIO-type position. Like many others, they refuse to call it what it is, and instead are hiring for a “Medical Director of Informatics – Ambulatory.” The job description looked good and they posted it. I was shocked when they immediately narrowed the field down to two in-house candidates, both of whom are hospitalists with virtually no ambulatory experience.

Only one had any formal informatics training and that was a three-day continuing education course focusing on public health informatics. The hospital has over 150 employed ambulatory physicians and I was surprised that none of them made the short list. They have been on EHR for half a decade and have a handful of strong physician champions who would have been great in the role. I’m sure there are other political factors at play, but I can’t imagine what they would be that the organization would risk going with an unproven commodity with minimal experience.

My friend had the same sentiment about his party guest. “Why would a hospital that has invested over $20 million in the past five years in inpatient and outpatient technology, keeps buying up practices, and is undergoing a shift to PCMH & ACO across the board leave its CMIO position up to people who have absolutely no idea what they could do, should do, or can do in that role? When do we accept that the needle won’t be moved very far in improving any of the triple-aim’s intended targets?”

Since it was Super Bowl Sunday, he drew the analogy that it is similar to thinking that a baseball player is also a good ping-pong player because they are both sports. I agree with his conclusion that this is a problem for physicians who lack real representation in technology and for administrators who are clueless to the practical requirements of IT in their environments.

I’ve seen a couple of articles recently on the importance of developing effective leadership in healthcare organizations. Leaders need to not only be confident and inspiring, but they also need to know the material at hand. That’s difficult to do when you’ve never practiced in the environment you’re trying to lead. I’m not saying you can’t learn it, but starting in a position where the deck is stacked against you is a challenge.

Let’s suppose my local hospital chooses to hire one of the hospitalist candidates. He is being set up to fail, as the employed physicians will immediately claim that his lack of ambulatory experience makes him unqualified. Even as a practicing outpatient physician, my first physician champion role led to claims I was inadequate because I didn’t see as many patients as my peers or my patients weren’t as sick as theirs. I can’t imagine what it would be like to be thrust on the scene as a hospitalist.

My initial advice for this physician who thinks that part-time informatics work might be “cool” would be to dig deeper into the job description and determine areas of strength and weakness. Even though this physician would be just beginning his informatics career and therefore would not be eligible to sit for the Clinical Informatics board exam, I would encourage him to attend the AMIA board review course, as it is does a great job illustrating the breadth of material that falls into our realm. He could also choose one of their 10×10 courses to dig further into areas where his employer wants him to focus.

Should he actually be offered the job, I would recommend pushing to have these kinds of courses paid for as part of the informatics role, as well as dedicated time for continuing medical education (CME). When I took my first informatics post (part-time), I was able to use standard physician continuing ed hours and funds to accomplish this. However, when I went full time, that week of CME time and the money that went with it vanished in their initial offer and had to be negotiated back into the agreement.

It was good catching up with my friend. I usually see him at HIMSS but he’ll miss it this year unfortunately. He did have some good advice for me, however, in response to my recent question about how administrative physicians decide whether it’s time to give up practice:

You asked if you should give up treating patients recently. My advice: no, you should not stop treating patients. You should instead redefine who your patients are. No longer should you spend time with booboos and flu shots and diabetes. You should now look at the sick hospitals, clinics, and IPNs (there are still some out there) that really need a checkup, a care plan, and an intervention. Your patients are out there and your patients are very ill. They may even compensate you, and like the great feeling you get when you catch appendicitis early, you will change the health of your patients in ways we will benefit from for years to come.

I really appreciate the pep talk and have to say it came just at the right time. Listening to his story, I remember what it was like being a fledgling informaticist. It makes me want to go out and win one for the Gipper.

Have a health IT pep talk to share? Email me.

Email Dr. Jayne.