Curbside Consult with Dr. Jayne 10/28/24

I recently had the opportunity to participate in a roundtable discussion with other CMIOs. As one would expect, “what is your organization doing with AI tools” was one of the questions given for discussion. It seemed like AI-assisted or ambient dictation was the most commonly used technology, with AI-driven patient engagement solutions in second place.

Although people initially talked with some enthusiasm about their projects, the conversation drifted to the topic of budgets and how much money is being dedicated to AI-based solutions. Although the CMIOs felt that they would be able to deliver a solid return on investment for those two solutions, there was quite a discussion of other tools that they are implementing that feel more like AI for AI’s sake rather than being focused on pressing problems.

Several individuals at the table discussed their ongoing needs for budgetary support to continue doing what they consider to be the basics, such as optimizing EHRs that they have spent hundreds of millions of dollars implementing, but that need funding to keep them current and to take advantage of new features. One spoke of her organization’s ongoing implementation fatigue, where not only is the informatics team running ragged, they feel that physicians are not tolerating the pace of change because IT projects are being deployed at the same time as operational projects around coding and compliance and clinical quality.

Another CMIO spoke in follow-up about the need to ensure that change management tasks are included in any proposal for new solutions. His hospital has a tendency to roll out new things without funding to cover the time that is needed to build consensus, ensure buy-in, and identify those on the medical staff who might openly sabotage an effort before it even gets out of the gate. His clinicians are tired of “too many solutions with too many promises and not enough improvements” to the point where they will vocally oppose changes to the system that introduce any new clicks or expanded work for the clinicians.

Another mentioned that his institution had been implementing a separate solution to help manage chronic conditions through a partnership with one of their payers. Although he originally voiced concerns about patient matching and data integrity, he was reassured that everything would be fine and that the payer’s solution had experience integrating with his particular EHR. Unfortunately, the system’s ability to integrate had been grossly overstated. After months of dealing with patient matching issues, the project was placed on hold while they worked to sort it out. It seems that at this point in the evolution of clinical informatics, we should have a solid handle on patient matching, but it’s often more difficult than it needs to be. Lack of a universal patient identifier in the US continues to be one of the difficulties.

One of the CMIOs mentioned ongoing problems trying to reconcile gaps in care across his organization. They’re a large health system and have acquired multiple independent physician groups over the last couple of years, slowly working to integrate all the platforms. His predecessor didn’t ensure due diligence with data mapping and adjustment of clinical quality reports, which means that physicians aren’t getting credit for their patients having appropriate screening tests or treatments because the system isn’t recognizing them properly.

After doing some digging, he discovered that certain reports were looking for particular character strings in the names of lab tests rather than looking for test codes or even something more standardized like a LOINC code. Since there were variations on the test names sent by outside systems that are now inside, they had to embark on a large project to fix the issue. Of course this wasn’t part of the 2024 budget, so now he’s scrambling to get it fixed as quickly as possible before end of year reports are generated while simultaneously cutting other projects they had planned to finish before 2025.

Others at the roundtable mentioned that they would like to be able to implement new features of existing systems, but simply don’t have the money to do so. One mentioned going through the budget cycle for 2025 and being concerned that he will likely receive about 60% of the funding that he requested since the hospital is running with negative margins.

That led to a discussion of which health systems have been in the news for laying off IT and other non-clinical teams. That got heated since several at the table are in positions of having to trim headcount and are trying to do it through retirements or other more natural sources of attrition rather than having to conduct a layoff.

One of the topics that had nearly everyone participating was that of workforce planning for clinical informatics. Although the majority of those in the conversation believe that we need more experienced clinicians helping with informatics projects, they agreed that their organizations don’t necessarily want to provide financial support in exchange for the expertise of those clinicians. One mentioned that his organization’s non-clinical leadership has an attitude that physicians should be grateful for the opportunity to have input on clinical technology and should not expect to be compensated because the solutions don’t benefit anyone else.

I thought this was an interesting comment, but didn’t have time to dig into it. Does it mean that physicians aren’t involved in multidisciplinary projects, or is the organization not doing any multidisciplinary projects? Either answer would indicate some less than ideal priorities.

Another mentioned the influx of physicians who are burned out in their original specialties and are looking at informatics as a way to potentially get out of the clinic. The majority of those individuals don’t have formal informatics training and don’t understand why they are not selected when roles open. Some are not willing to put in the time to complete informatics courses and build a more formal skillset. Others think that they can command the same salaries as they would earn in their clinical specialties even though they don’t have any experience.

It sounds like it makes for many difficult conversations between experienced informatics physicians and those who are trying to use it as an escape. I’ve certainly run into those folks myself, and they always seem shocked that I’m not willing to bring them on as highly paid consultants simply because they’ve used an EHR.

The group is scheduled to meet again in six months, and it will be interesting to see whether the overall priorities are the same or whether there have been small changes or even dramatic ones. I enjoy building these kinds of relationships over time and was thrilled to be part of the roundtable, so I’m looking forward to catching up in the spring.

If you’re a CMIO, what do you think of these topics? Are you dealing with the same issues or do you have completely different ones drawing your attention? Leave a comment or email me.

Email Dr. Jayne.