# Presentation: 135725

## Welcome to: 173“What is a Clinical Informaticist?”(OK, we realized we should have called it:“CMIO Success Strategies”

- Steve Kastin, M.D.
-  W. Paul Nichol, M.D.
- Chris Lopez, M.D.
- Brian Laufer, D.O.  Doug Rosendale, D.O.

## Round 1

**What is a****Clinical Informaticist?**
**CMIO?**

## Steve Kastin, MD

- Chief Information Officer and
- Chief Health Informatics Officer, VISN 3
- Chair, VHA Radiology Informatics Committee

## Informatics Leadership Titles

- CMIO = Chief Medical Informatics Officer
- Sometimes also called “Chief Medical Information Officer”
- CHIO = Chief Health Informatics Officer
- DCI = Director of Clinical Informatics
- MDIS = Medical Director of Information Systems
- ACOS/MI = Assoc Chief of Staff for Medical Informatics (VA only)

## Informatics Leadership Titles

- What they all have in common is that they (are supposed to) indicate:
- Overall responsibility for informatics issues
- Oversee development of informatics-related policy
- Authority to implement informatics policies and initiatives
- Sometimes, the title goes without the authority

## Informaticist vs. CMIO/CHIO

- Being an informaticist is analogous to being, say, a cardiologist
- It means you DO informatics
- Being a CMIO or CHIO is analogous to being the *Chief* of Cardiology
- It means you oversee all informatics operations and are responsible to assure that everything relevant to informatics is being taken care of

## Informaticist vs. CMIO/CHIO

- Most VA sites have someone doing informatics
- It’s become a necessity
- Most VA sites probably do NOT have a CMIO yet, in the true sense of the word
- Since the “Informatics Dept” is usually a department of 1, the lone informaticist is often called the CMIO, CHIO, or even ACOS/MI

## Informatics & Informaticists

- To understand what an Informaticist is, need to understand what Informatics is.
- Many definitions
- Many “flavors” of Informatics
- Many aspects of Informatics

## Definition

- From NAS/IOM Medical Informatics Workshop 5/1/06: "Health informatics is the application of principles of information science, knowledge management, computing, and telecommunications to:
- The health and health care of individuals and families,
- The health monitoring and health services afforded to populations,
- The advancement of biomedical research,
- The education and work processes of health professionals and scientists, and
- The health education and health practices of the public.”

## Simpler Definition?

- The science of how information is gathered, recorded, structured, and retrieved.
- Informatics existed BEFORE computers!
- “Medical Records” staff were some of the first to deal with informatics in a healthcare setting.
- Advent of computers makes informatics that much more critical.

## “Flavors” of Informatics

- Health (Healthcare) Informatics
- Medical Informatics
- Clinical Informatics
- Bioinformatics
- Also specialties:
- Nursing Informatics
- Pharmacy Informatics
- Dental Informatics
- Many others

## Aspects of Informatics

**Applied Informatics**
- Development of policy
- Setting of parameters
- Clinical IT Implementation (?)
- Vendor analysis/selection/options
- Informatics Research
- Informatics Education
- Programming/development
- Development of Standards (e.g. HL7)
- Others

## Why is Informatics Important?

- “In a series of reports the IOM has identified informatics as a critical infrastructure for advances and improvements in public health, clinical practice, patient safety, personal health management, health professional education, health care financing and administration, and health sciences."

## Why is Informatics Important?

- Most organizations are driven by information, but healthcare industry is arguably more information-driven than any other industry.
- information needed to properly diagnose and treat the patient (clinical aspect)
- information needed to keep the medical centers operational (business/operational aspect)

## Where do Informaticists Come From?

- Graduate Degree Programs
- Harvard, Stanford, etc
- Fellowships
- CDC (Public Health Informatics)
- NIH-sponsored
- Medical Schools
- 8 VA programs (Boston, Indy, Menlo Park, Portland, SLC, Seattle, West Haven, Nashville)
- Home Grown
- Informatics is still new enough that many (most?) informatics leaders are home grown

## Career Path – Steve Kastin

- Late 1970’s – Use HP9830a in research lab – hooked on Basic!
- Early 1980’s – programming courses in college (COBOL, Fortran, Pascal)
- Mid 1980’s – Med School computer room, IT Steering Cmte
- Late 1980’s – Nuc Med residency (lots of computers!)

## Career Path – Steve Kastin

- Early 1990’s – Nuc Med attending at Bronx VA
- Radiology ADPAC
- Information Mgmt Cmte member
- Chair, IMC
- Director of Clinical Informatics, Bronx VA
- Director of Clinical Informatics, VISN 3
- CIO, VISN 3 (2006)

## Career Path – Steve Kastin

- CPRS Clinical Workgroup
- Internet Mgmt Review Board
- VA Healthcare Security Cmte
- Chair, VHA Radiology Informatics Cmte
- Member, VHA Informatics & Data Management Cmte (IDMC) (formerly ITAC)
- Others

## Duties of VISN 3 CHIO (DCI)

- Chair, VISN 3 Clinical Informatics Council
- Develop VISN 3 Informatics Policy
- Oversee implementation of VISN and National informatics policies/initiatives
- Oversee implementation of all clinical IT in VISN
- Chief liaison between IT and clinical staff
- Attend clinical councils (Imaging, Lab, Primary Care, etc)
- Brief Leadership on Informatics issues
- Member of ELC, COS Council, AD Council

## Duties of VISN 3 CHIO (DCI)

- Prior to VA IT Re-org, aligned under VISN CIO
- Worked very closely with CMO
- Work with VISN ISO on clinical IT security issues
- Member of HT/HC Equipment Council
- Help assure that equipment purchases are aligned with VA IT environment and security concerns

## Duties of VISN 3 CHIO (DCI)

- Act as liaison between VISN and facilities on all informatics and clinical IT issues
- Problem is lack of facility CHIOs
- No one to “own” informatics issues at the sites
- No one person to assure implementation of informatics policies/initiatives at the sites
- No single definitive source for informatics info from the sites
- CAC’s do not have complete scope

## W. Paul Nichol, MD

- Associate Chief of Staff/ Clinical Information Management
- VA Puget Sound Health Care System
- National Director Medical Informatics
- Patient Care Services,  VHA

## 1968-69 Programming Fortran in High School
1969-1973 Computer Science College Courses
1973-1980 Med School and Internal Med Residency
1980 First personal computer – Apple II
1980-Present VA physician with computer interest
1982-1985 Clinic Director
1985-89 Chief of Staff
1989-1997 ACOS Ambulatory Care
1997-2001 Director Primary Care
2000-2001 Sabbatical Medical Informatics
2001-Present ACOS Clinical Information Management
2007-Present National Director Medical Informatics/ Patient Care Services

**1969-1973 Computer Science College Courses**
**1973-1980 Med School and Internal Med Residency**
**1980 First personal computer – Apple II**
**1980-Present VA physician with computer interest**
**1982-1985 Clinic Director**
**1985-89 Chief of Staff**
**1989-1997 ACOS Ambulatory Care**
**1997-2001 Director Primary Care**
**2000-2001 Sabbatical Medical Informatics**
**2001-Present ACOS Clinical Information Management**
**2007-Present National Director Medical Informatics/ Patient Care Services**

- Career Path – W. Paul Nichol

## National Director Medical Informatics, PCS
Represent PCS IT needs in national forums
IDMC, HISEB, MHV CAB, CPRS Advisory Board, various workgroups
Liaison with CO Programs, field groups, VHA OI, VA OI+T, non VA organizations
Other duties as assigned
ACOS/Clinical Information Management
Provide leadership for local implementation of IT/IM resources
Supervise CIM Team – CACs, Telemedicine Coordinator
Committees – CIM Steering, Med Records, Security/Confidentiality, CEB, VISN groups
VA DoD Data Exchange Project
Research – usability, safe medication use
VA Informatics Fellowship – local co-director
State IT activities involvement

**Represent PCS IT needs in national forums**
**IDMC, HISEB, MHV CAB, CPRS Advisory Board, various workgroups**
**Liaison with CO Programs, field groups, VHA OI, VA OI+T, non VA organizations**
**Other duties as assigned**
**ACOS/Clinical Information Management**
**Provide leadership for local implementation of IT/IM resources**
**Supervise CIM Team – CACs, Telemedicine Coordinator**
**Committees – CIM Steering, Med Records, Security/Confidentiality, CEB, VISN groups**
**VA DoD Data Exchange Project**
**Research – usability, safe medication use**
**VA Informatics Fellowship – local co-director**
**State IT activities involvement**

- Duties

## Medical Informatics

*The integrative discipline that arises from the synergistic application of computational, informational, cognitive, organizational, and other sciences whose primary focus is the acquisition, storage, and use of information in the health/biomedical domain. (William Hersh)*

## Clinical Informatics

*A sub-field of *_[medical informatics](http://en.wikipedia.org/wiki/Medical_informatics)__. It focuses on __[computer](http://en.wikipedia.org/wiki/Computer)__ applications that address medical data (collection, analysis, representation). Clinical informatics is a combination of __[information science](http://en.wikipedia.org/wiki/Information_science)__, __[computer science](http://en.wikipedia.org/wiki/Computer_science)__, and __[clinical science](http://en.wikipedia.org/wiki/Clinical_science)__ designed to assist in the management and processing of data, information and knowledge to support the practice and delivery of clinical care. (Shortliffe/Perreault)_

## HEALTHeVET PORTFOLIO

- _[Security](slide4.xml)_

**Archive**
**Service**

**Organization**
**Service**

**Audit**
**Service**

- _[Deployment](slide6.xml)_
- _[Toolkit](slide6.xml)_

**Common**
**Services**

**HEALTHeVET PORTFOLIO**

- Social Work

- Primary Care
- Management
- Module

- Voluntary
- Service
- System

- Imaging
- System

- Surgery

- Spinal
- Cord
- Dysfunction

- Release of
- Information
- (DSSI)

- Radiology/Nuclear
- Medicine

- Prosthetics

- Police &
- Security

- Oncology

- Nutrition
- And
- Food
- Service

- Nursing
- Service

- Mental
- Health

- Library

- Veterans Personal
- Finance
- System
- (VPFS)

- Incident
- Reporting

- Home Based
- Primary Care

- Dental
- Record Manager

- Fee Basis

- CAPRI
- (AMIE)

- Blind
- Rehabilitation

- ASISTS

**Credentials Tracking**
- VetPro

**HeV**
**Desktop**

- _[Messaging/](slide5.xml)_
- _[Enterprise ](slide5.xml)_
- _[Service](slide5.xml)_
- _[Bus](slide5.xml)_

**Administrative**
**Data**
**Repository**

**Enrollment**
**Application**
**System**

- _[Laboratory](slide9.xml)_

- _[Pharmacy](slide10.xml)_

- _[PIMS](slide12.xml)_

- _[Scheduling](slide14.xml)_

- _[Workload](slide11.xml)_
- _[Management](slide11.xml)_

- Ophthalmology

- QUASAR Audiology & Speech Analysis

- Adverse Reaction
- Tracking

- Authorization/
- Subscription
- Utility

- Automated
- Info Collection
- System

- Bar Code
- Expansion
- Project

- Care
- Management

- Clinical
- Case
- Registries

- Clinical
- Decision
- Support

- Clinical
- Device
- Connectivity

- Clinical
- Procedures

- Clinical
- Reminders

- Consult/Request
- Tracking

- Discharge
- Summary

- Emergency
- Room

- Employee
- Health Record

- Health Summary

- Healthcare
-  Acquired
- Infection &
-  Influenza
- Surveillance

- Implant
- Management

- Intake/Output

- Standardization
- And Terminology
- Services

- Order Check
- Expert

- Order Entry/
- Results Reporting

- Outpatient
- Clinical
- Care

- Problem
- List

- Progress
- Notes

- Remote Order
- Entry System

- Text Integration
- Utilities

- Vitals/Measurements

- Women’s Health

_**Operations & Management**_
- Application Monitoring
- Device Manager
- System Monitoring

_**DoD Systems**_
- Bed Contingency
- Interfaces to AHLTA

_**Emerging Technologies**_
- Home Telehealth
- Health IT Sharing

_**eGov**_
- _[DFAS](slide15.xml)_
- _[FLITE](slide8.xml)_
- _[HR Shared Services Center](slide7.xml)_

_**National/Regional Database Stores**_

- _[RISE](slide14.xml)_

**Health Data**
**Repository**

- COMPUTERIZED CARE DELIVERY SUPPORT SYSTEM

- Patient
- Advocate
- Tracking
-  System
-     (PATS)

- Beneficiary
- Travel

- Incomplete
- Record Tracking

**LEGEND**

- Phase 1

- Phase 2

- Phase 3

- Phase 5

- Phase 4

- Phase 6

**Business**
**Rules **
**Engine**

**Workflow**
**Engine**

**Clinical Data**
**Warehouse**

**Report **
**Writer**

- _[Person](slide13.xml)_
- _[Service](slide13.xml)_

- Enhanced
- VA/DoD
- Seamless
- Care

- Joint
- Inpatient
- Electronic
- Health
- Record

- My
- Health_e_Vet

## VA Puget Sound Organization

- ACOS/CIM reports to COS at Puget Sound
- Supervise CACs and telemedicine coordinator
- Nursing CACs report to Nursing Informatics Coordinator
- CIM Section is part of larger Information Support Service that includes HIMS

## Slide 30

## Slide 31

## Chris Lopez, MD

- Chief of Informatics
- Orlando VA Medical Center

## My Informatics Milestones

- Doing informatics for 6 years
- 2001 – Chair of Clinical Computing Committee
- 2003 – Performance Measures Implementation Manager
- 2006 – Member of VISN and local Information and Data Management Committees
- 7/30/07 – Chief of Clinical Informatics

## Major Roles

- No other clinician in Orlando does informatics like I do
- CPRS expertise
- Ability to customize CPRS
- Added access to build menus, shared templates, quick orders, manage reminders and create reports
- Huge impact on the flow of information and communication
- Design or redesign processes
- Examples:  HIV testing, setting up new clinics, medication reconciliation, new performance measures, promoting ACA principles
- Clinical Reminder reports

## Reporting Process

- I share clinical reminder reports via SharePoint, providers meetings, and committee meetings to leadership and stake holders.
- Several people have ability to run different reports which are shared as necessary
- Clinical applications coordinators
- Lab supervisor
- Quality manager
- Pharmacy
- HAS
- Counterparts from Tampa

## Informatics Roles and Responsibilities

- One of the go-to guys for figuring out problems with CPRS, reminders
- Analyze performance
- Consider other practices
- Present information regularly to providers
- Input into the computer education of providers
- Understand goals of the facility

## Informatics Related Committees

- Former chair of a clinical computing committee
- Former chair performance measures committee
- Member of performance measure corrective actions committee
- Member of Joint Commission survey prep team
- Member VISN 8 Information Data Management Committee
- Getting involved in a national provider reports pilot
- VeHU Provider track planning committee

## Skills/Relationships

- Ability to obtain useful information that no one else in the clinic can do
- Sharing information with peers
- Problem solving
- Working closely with CACs, QM
- Designing/redesigning of processes
- Building tools/shortcuts
- Building consensus
- Organizing champions
- Teaching

## Time Allocation

- For the past 4 years, I have been 50% clinician and “50%” informaticist
- Responsibilities growing

## Baby Informaticist

**Notes:**
Click on bottom right rectangle.

## What have I gotten myself into?

- _[Security](slide4.xml)_

**Archive**
**Service**

**Organization**
**Service**

**Audit**
**Service**

- _[Deployment](slide6.xml)_
- _[Toolkit](slide6.xml)_

**Common**
**Services**

**HEALTHeVET PORTFOLIO**

- Social Work

- Primary Care
- Management
- Module

- Voluntary
- Service
- System

- Imaging
- System

- Surgery

- Spinal
- Cord
- Dysfunction

- Release of
- Information
- (DSSI)

- Radiology/Nuclear
- Medicine

- Prosthetics

- Police &
- Security

- Oncology

- Nutrition
- And
- Food
- Service

- Nursing
- Service

- Mental
- Health

- Library

- Veterans Personal
- Finance
- System
- (VPFS)

- Incident
- Reporting

- Home Based
- Primary Care

- Dental
- Record Manager

- Fee Basis

- CAPRI
- (AMIE)

- Blind
- Rehabilitation

- ASISTS

**Credentials Tracking**
- VetPro

**HeV**
**Desktop**

- _[Messaging/](slide5.xml)_
- _[Enterprise ](slide5.xml)_
- _[Service](slide5.xml)_
- _[Bus](slide5.xml)_

**Administrative**
**Data**
**Repository**

**Enrollment**
**Application**
**System**

- _[Laboratory](slide9.xml)_

- _[Pharmacy](slide10.xml)_

- _[PIMS](slide12.xml)_

- _[Scheduling](slide14.xml)_

- _[Workload](slide11.xml)_
- _[Management](slide11.xml)_

- Ophthalmology

- QUASAR Audiology & Speech Analysis

- Adverse Reaction
- Tracking

- Authorization/
- Subscription
- Utility

- Automated
- Info Collection
- System

- Bar Code
- Expansion
- Project

- Care
- Management

- Clinical
- Case
- Registries

- Clinical
- Decision
- Support

- Clinical
- Device
- Connectivity

- Clinical
- Procedures

- Clinical
- Reminders

- Consult/Request
- Tracking

- Discharge
- Summary

- Emergency
- Room

- Employee
- Health Record

- Health Summary

- Healthcare
-  Acquired
- Infection &
-  Influenza
- Surveillance

- Implant
- Management

- Intake/Output

- Standardization
- And Terminology
- Services

- Order Check
- Expert

- Order Entry/
- Results Reporting

- Outpatient
- Clinical
- Care

- Problem
- List

- Progress
- Notes

- Remote Order
- Entry System

- Text Integration
- Utilities

- Vitals/Measurements

- Women’s Health

_**Operations & Management**_
- Application Monitoring
- Device Manager
- System Monitoring

_**DoD Systems**_
- Bed Contingency
- Interfaces to AHLTA

_**Emerging Technologies**_
- Home Telehealth
- Health IT Sharing

_**eGov**_
- DFAS
- FLITE
- HR Shared Services Center

_**National/Regional Database Stores**_

- RISE

**Health Data**
**Repository**

- COMPUTERIZED CARE DELIVERY SUPPORT SYSTEM

- Patient
- Advocate
- Tracking
-  System
-     (PATS)

- Beneficiary
- Travel

- Incomplete
- Record Tracking

**LEGEND**

- Phase 1

- Phase 2

- Phase 3

- Phase 5

- Phase 4

- Phase 6

**Business**
**Rules **
**Engine**

**Workflow**
**Engine**

**Clinical Data**
**Warehouse**

**Report **
**Writer**

**Person**
**Service**

- Enhanced
- VA/DoD
- Seamless
- Care

- Joint
- Inpatient
- Electronic
- Health
- Record

- My
- Health_e_Vet

## HEALTHeVET PORTFOLIO

**Security**

**Archive**
**Service**

**Organization**
**Service**

**Audit**
**Service**

**Deployment**
**Toolkit**

**Common**
**Services**

**HEALTHeVET PORTFOLIO**

- Social Work

- Primary Care
- Management
- Module

- Voluntary
- Service
- System

- Imaging
- System

- Surgery

- Spinal
- Cord
- Dysfunction

- Release of
- Information
- (DSSI)

- Radiology/Nuclear
- Medicine

- Prosthetics

- Police &
- Security

- Oncology

- Nutrition
- And
- Food
- Service

- Nursing
- Service

- Mental
- Health

- Library

- Veterans Personal
- Finance
- System
- (VPFS)

- Incident
- Reporting

- Home Based
- Primary Care

- Dental
- Record Manager

- Fee Basis

- CAPRI
- (AMIE)

- Blind
- Rehabilitation

- ASISTS

**Credentials Tracking**
- VetPro

**HeV**
**Desktop**

**Messaging/**
**Enterprise **
**Service**
**Bus**

**Administrative**
**Data**
**Repository**

**Enrollment**
**Application**
**System**

**Laboratory**

**Pharmacy**

**PIMS**

**Scheduling**

**Workload**
**Management**

- Ophthalmology

- QUASAR Audiology & Speech Analysis

- Adverse Reaction
- Tracking

- Authorization/
- Subscription
- Utility

- Automated
- Info Collection
- System

- Bar Code
- Expansion
- Project

- Care
- Management

- Clinical
- Case
- Registries

- Clinical
- Decision
- Support

- Clinical
- Device
- Connectivity

- Clinical
- Procedures

- Clinical
- Reminders

- Consult/Request
- Tracking

- Discharge
- Summary

- Emergency
- Room

- Employee
- Health Record

- Health Summary

- Healthcare
-  Acquired
- Infection &
-  Influenza
- Surveillance

- Implant
- Management

- Intake/Output

- Standardization
- And Terminology
- Services

- Order Check
- Expert

- Order Entry/
- Results Reporting

- Outpatient
- Clinical
- Care

- Problem
- List

- Progress
- Notes

- Remote Order
- Entry System

- Text Integration
- Utilities

- Vitals/Measurements

- Women’s Health

_**Operations & Management**_
- Application Monitoring
- Device Manager
- System Monitoring

_**DoD Systems**_
- Bed Contingency
- Interfaces to AHLTA

_**Emerging Technologies**_
- Home Telehealth
- Health IT Sharing

_**eGov**_
- DFAS
- FLITE
- HR Shared Services Center

_**National/Regional Database Stores**_

- RISE

**Health Data**
**Repository**

- COMPUTERIZED CARE DELIVERY SUPPORT SYSTEM

- Patient
- Advocate
- Tracking
-  System
-     (PATS)

- Beneficiary
- Travel

- Incomplete
- Record Tracking

**LEGEND**

- Phase 1

- Phase 2

- Phase 3

- Phase 5

- Phase 4

- Phase 6

**Business**
**Rules **
**Engine**

**Workflow**
**Engine**

**Clinical Data**
**Warehouse**

**Report **
**Writer**

**Person**
**Service**

- Enhanced
- VA/DoD
- Seamless
- Care

- Joint
- Inpatient
- Electronic
- Health
- Record

- My
- Health_e_Vet

**Notes:**
Green circles represent areas that I’m fairly comfortable in and have a decent understanding.  
Yellow circle mean that I’ve heard about it and could probably say a few things.
Red circles mean I don’t have a clue really.  Need a crash course.

## Needs

- Expansion and organization with clearly defined roles
- More important than ever with building a new hospital and losing previous support
- What additional core skills do I need?

## Brian Laufer, D.O.

*Alaska Healthcare System and Regional Office*
*Chief, Clinical Informatics*

## Diplomate American Academy of Family Practice
ACOS Education
Employee Health Provider, Special Registry Coordinator 
Associate Chief Primary Care
CPRS Clinical Implementation Manager

- ACOS Education
- Employee Health Provider, Special Registry Coordinator
- Associate Chief Primary Care
- CPRS Clinical Implementation Manager

- Career Path – Brian Laufer

## Organizational Chart

## Future Organizational Chart

## Organizational Structure

- Realization that data integration and management requires formalized structure
- Baldrige – “*The Quest for Excellence*”
- Leadership
- Strategic Planning
- Market Focus
- Measurement & Analysis
- Process Management
- Organizational Results

**Notes:**
Realization that data integration and management requires formal structure
EFAB – data integrity issues, patient safety from external partnerships (info sharing), community liaison and standard development, clinical equipment purchases and evaluation, 
Baldrige – “The Quest for Excellence”
Leadership (Data driven medical decisions), Strategic planning (from VI integration to DoD ICU handoffs), market focus (reminder reports: Iraq, Alaskan native, etc), Measurement & Analysis (performance improvement service data), Process Management (optimization of resources and pt. safety integration: RCA, FEMA, CC Consults), Results (best in VISN for QM measures).
Business process integration
How can we leverage clinical technology to improve both Admin and Clinical =  formal structure provides representation to identify organizational needs and develop solutions. Prior to structure, we were left out of key service meetings, communication, etc.

## Communication

## Formal Reporting Structure

## Doug Rosendale, D.O.

- Enterprise System Manager-Provider Systems (acting)
- Washington OIFO
- (aka “Hank Rappaport’s old job)

## Career Path – Doug Rosendale

- Worlds only surgeon/informaticist?

## Round 2

**How are ****Clinical Informaticists Organized?**

## Kastin: Organization

- VA is lacking a field-based structure for informatics.
- It is not even mandated that every site or VISN have an informaticist (or even just someone to oversee informatics)

## Kastin: Organization

- In 2000, VISN 3 CIO realized increasing role of informatics and clinical IT in delivery of healthcare.
- Created position of VISN 3 Director of Clinical Informatics
- One-man shop; reported to CIO & CMO
- Currently: CHIO/CIO, Deputy CHIO, 2 PMs

## Kastin: Organization

- No direct reach into facilities
- All facilities in V3 have informaticists, but only one has a formal DCI (part time)
- 1 informaticist from each site is on VISN CIC, but:
- No authority at facility to implement policy
- Not involved with all informatics/clinical IT initiatives, so not able to provide all needed info at CIC

## Kastin: Organization

- Plan is to require CHIO/DCI (likely MD) at each facility
- Empower DCI to implement policy
- Facility CHIO Chairs local CIC or IMC
- Facility CHIO accountable for meeting VISN and facility informatics goals
- Facility CHIO familiar with all local informatics and clinical IT initiatives
- Plan to be presented to VISN 3 ELC

## Nichol: Organization

## CAC OCWG: Background

**Registered Nurse/Nurse Practitioner****	****	****	****	**
**ADPAC****	****	**
**Specialist, Other****	****	****	**
**Programmer/Analyst****	****	****	**
**Lab Technologist****	****	****	**
**Administrative Officer****	****	**
**Registered Pharmacist****	****	****	****	**
**Medical Records Specialist (RHIA)****	****	**
**Educator****	****	****	****	**
**Social Worker (MSW)****	****	****	****	**
**Corpsman****	****	****	****	**
**Masters, Health Administration****	****	****	****	****	**
**Radiology Technologist****	****	**
**Therapist****	****	****	****	**
**Chaplain****	****	****	****	**
**Computer Operator****	****	****	**
**Registered Dietitian****	****	****	****	**
**MAS Specialist****	****	****	**
**Speech Pathologist****	**** **

## CAC OCWG: Roles and Responsibilities

**Customer Support / Trouble Shooting****	****	****15.7%**
**Clinical Tool Development****	****	****	****14.3%**
**Education / Training / Mentoring****	****	****	****11.4%**
**Program Implementation / Project Management****	****10.6%**
**Consulting****	****	****	****	****	****9.7%**
**Non – CAC Functions****	****	****	****	****8.1%**
**Data Analysis****	****	****	****	****	****6.4%**
**Leadership****	****	****	****	****	****6.0%**
**Package, Testing & Support****	****	****	****5.2%**
**Account / Access Management****	****	****	****5.2%**
**Other****	****	****	****	****	****	****4.0%**
**Emergency Preparedness Planning****	****	****2.0%**
**Research****	****	****	****	****	****1.6%**
**Total ****	****	****	****	****	****	****100.2%****	**

## Slide 61

## Slide 62

## Round 3

**Thoughts and Philosophy:**
**What is the Skill Set**
**Needed To Succeed**
**as a CMIO/CHIO?**

## CMIO/CHIO Skill Set

- CMIO/CHIO skill set different from informaticist skill set
- Focus on ability to be a successful change agent
- Motivate staff to embrace change
- Manage change
- Build consensus whenever possible
- Mentor leadership on need for informatics
- Skilled politician

## Round 4

**                ****Thoughts and Philosophy:****What is the****Optimal Alignment of the CMIO/CHIO?**

## Organizational Alignments

- At site level
- Reports to COS
- Reports to IRM Chief
- Reports to Director
- At VISN level
- Reports to for CMO
- Reports to CIO (difficult now)
- Reports to Network Director/CEO (C-level exec)