About 40 percent of hospitals and health systems employ a CMIO, according to HIMSS' 2014 Leadership Survey. While a definite increase from the one-third of organizations that reported having a CMIO on the payroll in 2013, CMIOs are still a relative newcomer to the C-suite.
CMIOs are becoming increasingly necessary as hospitals and health systems struggle not only with the adoption and use of electronic health records and other IT systems but then with using the trove of data IT systems provide to improve care delivery. Usually physicians, CMIOs fill a unique niche of being a tech-focused executive with a deep knowledge of patient care processes, allowing them to bridge the gap that often exists between clinical and IT departments.
Below, three CMIOs share their thoughts on how the new role is already changing, their biggest challenges and proudest moments and advice for other CMIOs.
Question: From your point of view, how has your job or the role of a CMIO changed over the past few years? How do you expect it to change in the next few years?
Mary Dallas, MD. CMIO of St. Charles Health System (Bend, Ore.): The role of the CMIO continues to evolve, but in different ways across different organizations. For me, it originally felt like an advisory role in a way, acting as a translator between physicians and IT staff. The goals were to help configure systems to fit into clinical workflows, drive consensus on content and build across colleagues and work on technical projects as a clinical representative member of a team. 
Today, the role feels more strategic in nature, such as managing an informatics department with resources focused on using technology to achieve adoption and desired outcomes. This includes a deeper functional understanding of the technology environment and planning alongside clinical and technology leadership to optimize existing systems as well as invest in development of new ones. The need for managing information to both drive better clinical practices and for measurement and reporting has put a big focus on analytics as well as clinical decision support.
Neil R. Kudler, MD. Vice President and CMIO of Baystate Health (Springfield, Mass.): At Baystate Health, the role of CMIO was first created in March 2012 after successful execution of meaningful use stage 1. While meaningful use had been the key focus of the medical informatics team, so too was the deployment and cultivation of the organization's enterprise EHR.
Over the last 2-plus years, the role of CMIO has become defined by participation in and leadership of a variety of strategic objectives, many, though not exclusively, IT-related. Design, development and deployment of various health IT tools is an essential component of the CMIO role.
Over the next few years, the role of CMIO is sure to become more strategic as new tools make their way into healthcare delivery. Defining the IT/informatics three-year roadmap, in collaboration with my partner CIO, will be critical in order to scout and anticipate the necessary resources for population health, predictive analytics, software as a service to provider end users, leveraging health IT for clinical research and more.
Mark Wess, MD, MSc. CMIO of Greenville (S.C.) Health System: The role of CMIO has been increasingly recognized as facilitating transformation of healthcare processes and improving data management. In addition, it has been heavily relied upon to address needs for incentive programs (e.g., meaningful use), payment reform (e.g., accountable care initiatives) and improved outcomes. The role has changed from a more tactical and project-oriented one to one that is focused on strategy and leading teams.
In the next few years, I anticipate that data management and reporting will increase under the direction of the CMIO to serve the multiple constituents. They will continue to work closely with the CIO and IT to refine the application portfolio. In systems with good foundation applications, the emphasis will be on optimization and efficiency.
Q: What is the most useful skill a CMIO can have?
Dr. Dallas: The most useful skill is being able to be an effective change agent.
Dr. Kudler: Communication skills are the most critical. The ability to speak to a variety of audiences and tell the story of HIT should never be undervalued. Writing skills are also crucial for ongoing communication. And openness to new or divergent ideas — a 'receptive' communication style — is also highly useful.
Dr. Wess: The most useful skill is communication. The effective CMIO must listen to the needs of his or her stakeholders and then translate those needs across business units. The successful individual needs to facilitate the discussion to next steps and then translate that into action. For large initiatives, the CMIO must keep leadership and staff informed of objectives, timelines, milestones, roles and progress. These communications assist in engaging the appropriate resources and facilitating the transformation.
Q: What is the biggest challenge you're facing right now?
Dr. Dallas: Leveraging technology and driving adoption of EHRs to achieve a growing list of requirements, many of which don't actually make clinical care better. The level of reporting and data needs make documentation complex in the EHR, and drives physicians, nurses and other caregivers to feel like they are treating the computer and not a patient. This is very frustrating, and there are no easy ways around these requirements, regardless of which EHR product(s) you use. As the requirements increase, the level of satisfaction from clinical end users decreases, and it is difficult to keep these balanced.
Dr. Kudler: The biggest challenge I am facing is to accomplish a growing list of objectives, large and small, with limited human and financial resources. My team receives EHR enhancement requests on a daily basis and, in spite of a sharp and talented IT shop, we are unable to keep pace with the organization's appetite for new. Currently, there are over 400 requests on the list, and these only pertain to day-to-day functionality of the EHR.
Dr. Wess: In our integrated delivery system, we have a multitude of large scale projects, all of which are needed and have significant risk. Examples include transitioning to an enterprise EMR (replacing more than three dozen legacy applications); upgrading and implementing applications to support meaningful use; selection and implementation of clinical integration network/ACO solutions; a data warehousing initiative including master data management; and additional reporting for multiple enterprise initiatives.
Our biggest challenges with existing products are shifting targets and quality of products. Examples of shifting targets include meaningful use, payment reform timeline and ICD-10 timeline. As for the quality of the vendor products, we experience challenges with usability, lacking functionality and quality of support.
Q: Over the past year, what has been your biggest accomplishment?
Dr. Dallas: The successful transition of a hospital EHR system from one product to another, in four hospitals concurrently, to move to a single database EHR model.
Dr. Kudler: Doubling the projected revenue recognition of our clinical documentation improvement program. Launching the Pioneer Valley Information Exchange, the regional health information exchange of western Massachusetts.
Dr. Wess: If I had to pick just one, I feel the biggest accomplishment has been to gain a better understanding of my new organization, which I joined in 2012. Through this understanding of the business needs, I have been able to add value.
Q: What's one piece of advice you'd offer to other CMIOs?
Dr. Dallas: Keep patient care front and center with workflow and technology design decisions. We often get distracted by things we think, or perhaps are, what clinical end users want as the driver, and that does have to be considered. When there is a struggle to pick the best path, default to what is best for the patient so everyone can move forward in a positive way. 
Dr. Kudler: Maintain your identity as a physician. It is the most critical part of this role in terms of credibility and communications. Physicians who go into administration typically relieve themselves of that identity, choosing to stop seeing patients and/or interacting with docs as docs. The CMIO should always use the tools they promote, and make that known to provider colleagues. Docs are not impressed by C-suite or VP titles; ;they are hungry for advocacy. I often refer to a fourth component of the triple aim; improving the experience of the healthcare provider.
Dr. Wess: My one piece of advice would be to adopt servant leadership. Given the accountability and responsibility, I feel this philosophy and set of practices ensures that the constituents’ needs are represented best in the activities. In the healthcare model, the patient's needs are primary and the healthcare staff is next. It creates a sound foundation of decisions and an effective and highly capable team. It also facilitates change.
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