Several readers have sent words of encouragement after reading about my last few weeks in the CMIO trenches. I definitely appreciate all of my virtual colleagues, even those who just write to say they understand and to wish me calmer seas. It sounds like many of us are going through the same trials and tribulations even though some of ours may be a little messier than others.
Our hospital is part of a larger health system that has announced its intent to replace all the clinical systems with a single vendor platform. I’m taking a couple of days off this week to really put my thoughts around whether I want to stick around to watch it happen.
I understand the need to consolidate systems. Our IT department is larger than nearly any other except for nursing. The budget for maintaining this “ultimate best-of-breed nightmare” is exorbitant. Many of our systems feel like they’re held together with duct tape, baling wire, and bubble gum. Some of them are just plain old. And several hospitals are on a platform that is being sunset by the vendor, so their systems simply have to go.
Being part of the larger project to turn this new single-platform vision into a reality is potentially exciting. But it also looks a little bit like a bottomless pit of long hours with not enough staff to work at a pace that would allow us to deliver a quality system without burnout. It’s also difficult to know that the health system has plans for how they plan to handle legacy clinical data that will not make our ambulatory physicians very happy.
Those of us that are “in the know” about the strategy have to keep quiet until it’s formally announced. I’m not used to being told what I can and can’t say to the physicians I serve.
It’s also bittersweet to watch systems be torn out when you’ve spent the better part of your professional career building them. We’ve held our users’ hands while they learned them and while they coped with upgrades. We’ve been at the other end of plenty of angry phone calls, but we’ve also heard the appreciation when we started to provide data to help proactively manage complex patients and to identify gaps in care. Of course our new system will also do this, but it was special to see how physicians reacted the first time they realized it was possible. Now those features have become old hat.
In addition to consolidating systems, our leadership also plans some pretty radical consolidation among hospital leadership and medical executives. We’ve always functioned as a federation, but this is taking us much more towards a centralized clinical and financial model and it’s not entirely welcome. A couple of chief medical officers have already moved on and I suspect a couple of hospital-level CMIOs and CNOs are planning to move as well.
On the non-clinical side, however, mid-level administrators seem to be proliferating. The number of buzzwords in an average hour of meetings has skyrocketed. We have four different consulting companies involved and they’re stepping all over each other with contradictory advice.
I’m not sure I want to leave the provider aspect of the CMIO game. There are definitely opportunities out there, but I really don’t want to relocate unless something pops up in Hawaii, in which case all bets are off – the idea of living in a place where the difference between winter and summer is 10 degrees does have a certain appeal. I just started clinical work with a new group that has a lot of promise and an extremely low chaos factor, which is a welcome change. I also spent the fall doing a ton of work on my garden and can’t imagine walking away.
There are some interesting vendor opportunities that don’t require relocation, but I’m not sure about crossing that bridge. My friends in the vendor space seem less stressed than those of us on the provider side (except during Meaningful User certification testing, in which case I recommend either steering clear or providing copious amounts of wine and moral support). It will be interesting to see if any new opportunities arise as we get closer and closer to Meaningful Use Stage 3.
Consulting is also an option, but I’m not sure I can handle being on the road as much as most of the larger firms expect. I’ve also heard the horror stories about being on the billable hours hamster wheel. I’ve dabbled in consulting over the last several years and would consider going out on my own as long as I have some ongoing clinical work as a financial safety net. I’m not enamored of what clinical practice has become in the last decade, however, so going full-time is not an option.
Today was my day to relax and think about nothing work related, but tomorrow is my day to sit down, run the numbers, and see if I can come up with a business plan that might fly. Wednesday I’m getting together with a couple of colleagues in the same boat, where we can trade ideas and see if anyone else has come up with a better plan. Thursday I’ll be back in the office, and it will be interesting to see how that plays since I’ve pledged not to touch my email or answer my phone while I’m out. Appropriate backup resources are in place, but I know my boss isn’t used to being unable to reach me. He’ll just have to get over it.
Here’s to crunching the numbers and hopefully to some new ideas about my next career move.
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