Industry Voices—The 2nd-generation CMIO/CHIO is evolving into a strategic role and team leader

The chief medical informatics officer 2.0 is a key partner of digital transformation and, in some cases, will be the leader. (ESB Basic/Shutterstock)

Several years ago, we began talking and writing about the CMIO 2.0. The second-generation chief medical informatics officer was distinguished from the first generation in that the position was no longer charged with primarily implementing electronic health record systems but had expanded to include more emphasis on transformation and innovation. As retained search consultants in health IT, one of the most common questions we are asked is, what is the CMIO 2.0 and what is the role?

As CMIOs have continued to evolve and expand their leadership responsibilities, the answer is not always clear-cut, but a broad pattern has emerged. We see several major trends in CMIO 2.0 leadership. (We use CMIO 2.0, but please note that in many organizations the title of CMIO 2.0 is synonymous with chief health informatics officer or CHIO.)

In addition, the CMIO 3.0 is beginning to emerge as the areas of artificial intelligence and predictive analytics evolve.

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What's in a title? The CHIO vs. the CMIO 2.0

The distinction between the CHIO and the CMIO 2.0 is, oftentimes, semantic. The reason for the change to the titling of CHIO coincides with the CMIO 2.0's evolving into a strategic role and team leader.

The "health" in the CHIO title suggests the CHIO is focused on engagement at all levels of the organization, from the patient to providers to operations teams. The CHIO title reflects that the position has moved well beyond translating techie speak to the physicians and physician speak to the techies. It requires a leader who can take a broader view and understand how technology in a health system will align with service lines, frontline care providers that include nurses and physicians and larger health system strategic goals.

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It's a much broader skill set than the CMIO 1.0 and requires an informatics leader who can interact not solely with the frontline clinicians and technology team but also senior leadership and boards of directors. 

Where does digital transformation fit in?

The CMIO 2.0 is a key partner of digital transformation and, in some cases, will be the leader. As digital transformation and the consumerization of healthcare have begun to take hold, the CMIO 2.0 sits at the crossroads of clinical understanding and technological know-how.

A strong CMIO 2.0 will be positioned to lead those efforts through bringing together telehealth, the patient portal, mobile, population health and analytics into a larger cohesive digital strategy that will make their health system all-inclusive for healthcare needs. The transformation a CMIO 2.0 leads either directly, or indirectly, helps prepare a health system for what healthcare will look like in future years.

Does the CMIO 2.0 have a team?

The short answer is, yes. A true CMIO 2.0's role has gotten much too large for them to be an individual contributor and be effective. A CMIO 2.0 needs to have a team that can include associate CMIOs, physician champions, analysts, nurse informaticists or a combination of each to really be successful in a complex organization. A dedicated team is necessary for a CMIO 2.0.

Are analytics the CMIO 2.0's responsibility?

This one is a bit more complicated. This depends on the health system culture, strategic priorities and a CMIO 2.0's own leadership skill set. If a health system's clinical culture is focused on population health to drive improvement, the CMIO 2.0 is a natural choice to lead that team and oftentimes does in many health systems.

If analytics is still seen as a back-end operations function to improve efficiencies in revenue cycle and reporting, then the CMIO 2.0 probably isn't the right person to lead those efforts. It also depends on the CMIO 2.0's own skill set. Not all informatics leaders have the background to lead a team of data analysts or, if your health system has invested well, a data science team.

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The new generation of CMIOs with that skill set is growing and, in time, the CMIO 2.0 may be a natural leader for analytics in a health system on the clinical side of the house. This is also where more formal training in medical informatics and data sciences would be very valuable. 

What's my budget?

This depends, but CMIO 2.0s tend to have greater budget autonomy in the form of a direct budget or having a portion of the chief medical officer's or chief information officer's budgets through collaboration. It is still not highly common, and if the CMIO 2.0 does have a budget, it tends to cover the cost of their teams and smaller capital projects. Larger capital projects still tend to flow through the CMO or CIO office.

The CIO or CMO, who do I report to?

The CMIO 2.0 will more often report to the CMO as opposed to the CIO. Why is that? A health system looking for a CMIO 2.0 has typically been through an implementation project and now finds itself focused on optimization.

The report to the CMO shows the CMIO 2.0 to be a leader that other physicians will want to collaborate with and brings the informatics leader into the fold of medical leadership. There are still instances where the CMIO 2.0 will report to the CIO, and reporting structure success is very dependent on organizations and individual CIO/CMO personalities, but the report to a CMO is a general trend that has been seen over the last several years for CMIO 2.0s.

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In some health systems we have worked with in the last few years, the CMIO 2.0 is now beginning to report to the CEO, although it has yet to be seen whether this will become a broader trend and is still very much the exception.

Questions that need to be answered for CMIO 3.0 to evolve

As we look to what the CMIO 3.0 will look like in the coming years, some questions to consider include:

  1. What part will the CMIO 3.0 play in leading advanced technologies like AI and predictive analytics?
  2. Will it become a broader trend that the CMIO 3.0 will have a separate budget line for their teams and projects?
  3. As other specialized roles like the chief digital officer, chief analytics officer and others emerge, will informatics leaders become increasingly specialized?
  4. Is clinical practice, or some percent, required to be effective in this role?
  5. Will advanced degrees in medical informatics and board certification be a requirement?

While there is not yet one mold of what a CMIO 2.0 or CHIO looks like, the general trends in the last several years are telling in terms of how far the role has come and where it is going.

The second-generation CMIO has gone from being the doctor who liked technology to a true strategic partner at the highest executive level. The current work in digital optimization will only amplify this further as we now begin to talk about what the CMIO 3.0 will look like.

Zachary Durst is a senior associate in Witt/Kieffer’s IT Practice. Hillary Ross is a senior partner and leader of Witt/Kieffer's Information Technology Practice. She focuses on identifying CIOs, CDOs, CISOs and other information technology leaders for hospitals, healthcare delivery systems, academic medical centers, colleges and universities, vendors and consulting firms across the country.

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