The director of medical informatics: a new physician leader for IT initiatives - information technology - includes related article on the Brigham and Women's Hospital - Integrated Delivery Systems

Healthcare Financial Management, Oct, 1998 by James M. Malloy, Thomas A. Benoit

Integrated delivery systems (IDSs) recently have invested substantial financial resources in information technology (IT) initiatives. But the return on that investment for many IDSs in terms of improved productivity and reduced costs has been less than anticipated. Therefore, to improve or enhance the success of IT initiatives, some IDSs have sought to encourage more physician support of such efforts by creating a new executive position - director of medical informatics - designed to be filled by physician leaders who have knowledge and skill in managing information systems. The director of medical informatics, who typically reports to the CEO or CIO, coordinates IT initiatives that address physician concerns and promotes physician buy-in.

Over the past decade, integrated delivery systems (IDSs) have spent millions of dollars on information systems. In most instances, these information technology (IT) investments focused initially on meeting the IDS's financial information needs; developing clinical information capabilities came second. The ordering of these priorities may have been due, in part, to the fact that the key decision makers for such initiatives have been CIOs and CFOs, individuals whose background rarely includes clinical experience.

As these decision makers now have assumed responsibility for integrating clinical and financial information, many have found that the initial results of such efforts are not achieving anticipated outcomes. Therefore, they have begun looking for new ways to ensure or enhance the success of clinical information initiatives.

One possible solution is to facilitate more physician input into IT initiatives, since physicians understand their own information system needs better than anyone else in the health system. Obtaining such input before implementing a new technology. can help ensure a smoother transition to systemwide physician acceptance and adoption of the technology.

To this end, some IDSs, including Partners Healthcare System in Boston, Massachusetts, and the University of Southern California Medical Center in Los Angeles, California, have incorporated the position of director of medical informatics into their organizational structures. The individual who fills this position is a physician leader with both clinical and healthcare management training who has knowledge and skill in managing information systems and who, therefore, better understands and can articulate physicians' IT needs and expectations.

The Director of Medical Informatics

A candidate for the position of director of medical informatics first and foremost should be a physician; a graduate degree in business administration also is desirable. A degree in an IT-related area is desirable but not essential if the individual's demonstrated IT knowledge is sufficient. To help potential candidates achieve the requisite skills, some major institutions of higher learning, such as Harvard University and the Massachusetts Institute of Technology, both in Cambridge, Massachusetts, have developed two-year fellowship programs in medical informatics.

Candidates typically are recruited from organizations such as academic medical centers, teaching hospitals, and large IDSs that have considerable experience with major IT investments and initiatives. An IDS can expect to pay a full-time director of medical informatics $155,000 to $200,000 a year.

Key responsibilities of the position include being a champion among clinicians for adoption of information technologies, streamlining report processes, coordinating IT projects to address physician concerns, and working to implement process changes that promote higher-quality, more humanistic patient care.

Being a champion among physicians for adoption of information technologies. The director of medical informatics can bring reasonable clinical and corporate insight into articulating why physicians should adopt a new information technology.

Streamlining report processes. The director of medical informatics should review on an ongoing basis the processes used to create and disseminate various reports - including radiology, emergency department, outpatient, preoperative, and postoperative reports, as well as inpatient discharge summaries - to identify potential process improvements and implement them.

Coordinating IT projects to address physician concerns. The director of medical informatics should act as a liaison between physicians and information services during IT projects to ensure that physician concerns are addressed and that such projects remain on track. In addition, he or she should help to educate physicians about the use of the new technology.

Working to implement process changes that promote higher-quality, more humanistic patient care. Ultimately, the goal of the director of medical informatics is to ensure that medical data are accessible wherever needed to enhance the quality of care provided throughout the health system. The IT initiatives that will achieve this end will require physicians to make significant process changes. As the liaison between physicians and IT decision makers, the director of medical informatics educates physicians about how such process changes can help them provide more effective, higher-quality care, while ensuring that new information systems infrastructures support that purpose as effectively as possible.