The evolution and role of the Chief Medical Information Officer in healthcare

¶ … Chief Medical Information Officer (CMIO) initiated solely in the market value of clinical systems, it has developed into a dynamic category of its own. I will demonstrate how this CMIO position has become quite the cornerstone on the path to clinical prosperity.

How the CMIO Conceptualized:

Dating back nearly two decades, the overall concept of the CMIO has gradually yet immaculately cultivated into what it has become today. However, since its revelation, the CMIO has been quite the topic of praise along with a healthy share of disdain.

Like that old chicken / egg adage, the evolution of this position has developed right alongside the comprehension and the uniformity of all Information Technology (IT) employed; the Electronic Medical Record (EMR) and Computerized Physician Order Entry (CPOE) are still expanding and developing capabilities today unlike anything this industry has ever before seen. Accordingly, the lack of established education and comprehension. Also, this industry has seen many new jobs incorporated right along side with those positions that have been eliminated, and at a level never before seen. Skepticism inevitably restrains.

Regardless, once the smoke clears and emotions subside, greater development always comes about in the case of any advancement. The following list details such enhancement:

* Role of the CMIO "upgrades" right alongside the current IT. This creates job assurance while executing any intrinsically mundane weariness.

* Greater collaborative abilities

* Job assurance

* Up-to-date knowledge of several IT outlets

Itemized major "key points" in any written proposal:

1. Identify the audience (generalize various groups)

2. Be concise and descriptive (though not overly verbose) with the title

3. Be sure the summary is complete though to the point

Follow this link for a closer feel:

http://www.dof.ca.gov/fisa/bag/bcps.htm

(Summarized here)

Consider the following key points when writing your proposals:

KEY POINTS

• Know your audience.

• Have a succinct, descriptive title.

• Provide a clear and concise summary.

• Document needs/problems/opportunities, quantitatively, if possible.

• Quantify workload.

• Identify benefits to be achieved, quantitatively, if possible.

• Present and evaluate viable alternatives in terms of costs and benefits.

• Address history, risks and uncertainties.

• Document the required resources needed.

• Have an independent, skeptical person critically review the proposal before submission.

• Follow the instructions.

DISCUSSION

1. Know your audience. The primary audience within the Administration is your Department of Finance (DOF) Budget Analyst. The primary audience within the Legislature is your Legislative Analyst's Office (LAO) Program Analyst, and in some cases, fiscal committee staff. These are the people who must read and understand your proposal and explain it to others. Write the proposal based upon how much information will be needed to understand the request. Keep in mind that you are primarily trying to persuade the audience of your case.

2. Give the BCP a succinct descriptive title. The title and BCP number usually are the references to the request. It is helpful to have an easily remembered title for reference purposes for questions and discussions. This name usually becomes the title used in the DOF budget tracking system, which is used in various levels of Administration budget hearings.

3. Provide a clear and concise summary of the request. This should be a brief statement of what is being requested and why. This description should provide the minimum level of detail necessary for BCP discussion and decision meetings, and generally would be excerpted into the DOF budget tracking system. For these reasons, it is important that this narrative be brief, yet clear enough so that it can stand alone.

4. A well documented request will have self-contained answers in the analysis portion of the BCP to such questions and concerns as the following:

A. Nature of Request

What is the public need for the request?

What is being done now by your department and others to address the problem/need?

What resources are currently being expended in the base budget related to the request, i.e., dollars and positions?

Why can the problem not be resolved within existing resources?

What are the adverse impacts if this proposal is not approved? (Be realistic in this assessment.)

Why are current efforts insufficient?

How will the program be coordinated with other similar activities?

What is the priority of this request vs. other program activities in which the department is involved?

B. Background/History

What is the authority (state/federal law, regulation, Master Plan, etc.) for this program activity/service?

What clientele is being served, who benefits?

What is the history (recent) of similar proposals?

What have been recent program changes?

What other (similar) activities, past and present, address this general area and are they effective/efficient?

Are there examples from other States or institutions where this approach has succeeded?

C. State Level Considerations

What is the state policy (Governor, Legislature, Master Plan, Board of Trustees, etc.) concerning this issue, or a closely related one; and is this proposal consistent with such policy?

Why should the State assume responsibility for this change? (Why not private, federal, local, etc. )

What is the impact on other state departments?

D. Facility/Capital Outlay Considerations

What is the impact on facility/capital needs? (Will this program/positions require additional facilities? How will this need be met? Leasing, capital outlay project, other?)

E. Justification

How is this proposal consistent with the department's strategic plan? Be as specific as possible. At a minimum, identify the objective(s) this BCP will support.

Will this proposal actually solve the problem?

How does the proposal affect the quality of the governmental service being provided?

Is each component in the proposal absolutely essential or just desirable (needs vs. desires)?

Is this a high priority long-term need, and if so, how does the proposal affect the long-term problem?

Why is the recommended program level the correct one? Why does this have to be done now? Can it wait?

Are or can other non-state funding sources be made available?

Are program/proposal objectives set forth in quantifiable terms?

What facts and figures support the recommendation?

What statements/information from authorities and clients support the request?

What support/opposition is there to the request?

Any legal considerations?

Is the proposal technologically sound?

Include quantifiable workload/cost information, i.e., the basis for determining the level of activities that must be performed and the related number of personnel years (PYs) requested and the dollars requested. If the proposal involves a new program for which actual workload data are unavailable, the workload assumptions, and the basis for those assumptions, should be clearly set forth in the proposal. Provide functional descriptions of what staff or other resources will accomplish.

The BCP should identify what goal/objective is to be achieved and include a discussion or provide the criteria by which the success or benefits of the request can be judged. As an example, if a proposal were to establish a pilot or new program, the request should include evaluation criteria. That is, the proposal should set forth a plan including who will evaluate, how and when the evaluation will be conducted, and what will be measured. (NOTE: This may be more relevant in some program areas than others but certainly should be a consideration.)

F. Analysis of All Feasible Alternatives

Include an analysis of all feasible alternatives to addressing the problem. A position often taken by a department is that there are no other viable/possible alternatives. Such a claim is generally refuted, since DOF/LAO often suggest alternatives. Decisions on BCPs very often reflect these "other" alternatives.

A well documented proposal also provides alternatives and presents an analysis on why the selected recommendation best meets the problem/need, and indicates what adverse action would result if the request were denied. Such analysis should incorporate the assumptions/constraints, impact on benefits or quantifiable measures of effectiveness, risks and uncertainties (probability of success).

G. Timetable

Include a timetable for implementing the request -- steps necessary, PYs, and costs.

Expectancy

Equity Theory -- Stated that a person compares their outcomes and inputs with others. Sarah has a meeting to discuss the salary of the whole entire organization. They realized that women were low paid in comparison to the men. Sarah started comparing herself with one of her colleagues saying that she worked harder than him and she has been there longer than him.

Satisfaction performance theory -- Porter and Lawler (1968a) state that it is not a motivational model that had dealt with the relationship between satisfaction and performance. Sometimes any reward that an employee may get is not related and how well he/she performs their job. Although this case does not tell us what type of reward Sarah was getting for her job we can see that her level of satisfaction she had when doing her job. She perceived that a higher degree of effort on her part will lead to a reward.

Goal Setting Theory -- Latham and Locke (1983) suggested three steps to follow on this theory:

Setting the goal: In every meeting Sarah had to attend us observe that she was well organized. She has a goal to attend a meeting to discuss overall payroll, discuss issues with her assistant Maria, and deal with one of her new employees. In all of the meetings she knew exactly the issue and analyzes how to conduct it. It is very important for a manager to set their own goals as well as employee goals. If this does not happen the reputation on the manager may look suspicious or destruct. We need to give the example first.

Obtaining goal commitment -- Sarah has a meeting with Maria to discuss the performance. Maria was not the greatest employee but Sarah wants her to be more involved with others in her department since she is not a people person. Sarah can handle putting together a reward system to compensate her for obtaining the agreed-upon goals. Making Maria commit to her job will probably fix the situation.

Providing support elements- Sarah has a new employee, Janine who she has to tell her how to do everything and worries about her changing the rules. Sarah as the manager needs to apply this support element and has to provide an action plan of agreed-upon goals and rewards so it not to have any ambiguities in the processes. This is not a solution that will avoid the situation but can prevent the changing of process or rules. One thing that Sarah could avoid in order for her not to feel bad about Jenine's personal situation was to consult with her about the overtime hours.

Reinforcement Theory -- To avoid the situation Sarah has with Maria and Jenine she could follow the Reinforcement theory. This theory will help Sarah understand the changes. It is my opinion that Sarah should use positive reinforcement and negative reinforcement. As an example make Maria or Jeanine change their attitude with their job has given them a positive reward in order to see if they change, also sometimes a negative reinforcement will be helpful in order to eliminate some overtime.