Confusion on Leadership Positions in Health Informatics
This is a no-nonsense
article describing profound confusion in hospital and healthcare system HR and
IT departments, as well as in recruiter organizations, about healthcare
informatics and leadership roles in clinical IT.
One can only scratch one's
head at a health care management philosophy and practice that, in essence,
operates on the principle that in managing technology investments of hundreds
of millions of dollars and a major cultural shift to electronic medical
records, a difficult shift that has often proven perilous, there's such a
thing as too much talent within an organization.
Some tough questions and
observations for the Healthcare Management world:
Read the job description below, posted to the website of the national
organization for informatics in the
Confidential
Position Specification
Director, Clinical Informatics
Our client is a multi-institutional [religious denomination] health system
headquartered in the greater [large city] area. The system includes 46
freestanding and hospital-based long term care facilities, 28 acute care
hospitals, 44 home health/hospice agencies, 3 long term acute care hospitals,
14 assisted living facilities, 7 continuing care retirement communities, 4
behavioral health and rehabilitation facilities, and numerous ambulatory and
community-based health services. Incorporating ## states, from [state 1] to
[state 2], the system employs approximately ##,### full-time employees.
A new position within the organization, our client is seeking a Director,
Clinical Informatics to help lead and define of the clinical IT vision and
roadmap for the organization. He/she will drive the direction for clinical
information systems by facilitating councils, educating internal
stakeholders, conducting research, tracking industry trends, monitoring
government sponsored initiatives and collaborating with clinical and IT leaders
to plan, develop, implement and monitor the effectiveness of advanced clinical
systems. In collaboration with the corporate and local senior executive
team, as well as, clinical and IT leadership, this executive will provide thought
leadership for clinical system initiatives in support of organizational
goals to improve patient safety, quality of care, operational efficiencies,
patient/physician convenience, patient, physician and colleague satisfaction
as well as meet regulatory requirements, such as JCAHO and other industry
accepted standards.
The candidate will be a highly talented professional with a strong executive
presence who will bring a broad knowledge of the healthcare information
technology industry and an in-depth understanding of current state of clinical
system development and adoption, and evolving third party clinical data
services and knowledge resources. One should have progressive experience
successfully managing clinical information solutions in a multi-hospital
environment and/or healthcare IT consulting organization using a defined
project management methodology. Specific experience implementing clinical
documentation systems, CPOE, and ambulatory electronic medical records (EMRs) is ideal.
Previous
clinical experience and a Bachelors Degree in a clinical area are required.
Note that nowhere in the job
ad is formal postdoctoral education in medical informatics called
for, such as is
sponsored and paid for at a number of prominent universities by the U.S.
National Institutes of Health, and provided at many other private
universities on their own funds.
The tough questions and candid observations start now:
Do this healthcare organization's executives think they have nothing to
learn from the NIH about healthcare computing? Do they know about these
training programs? Should they know about them? If they don't know, why not? If
they do know, do they think such credentials not worth specifying? Do they hire
neurosurgeons in the same way? If not, why not?
Putting the above issue aside, when I inquired about this role with the large
national firm's recruiter retained by the healthcare system to conduct the
search, I received an initial positive response on my voice mail the very next
morning. Then, I found I could not contact the recruiter for several days, only
getting voicemail, and the recruiter was not returning my calls.
I finally reached the recruiter a few days later, and the response I received
was unexpected and disappointing: "the organization was looking for a
nurse and they would not even talk to a physician." Then, just to rub salt
into the wound, I was then asked if I could provide 'leads' to nurses qualified
for the role. (Of course, for free.) This was a simply stunning request in context.
Not being in the business of supporting large recruitment companies with gratis
leads, I suddenly suffered an acute amnesia...
In any case, the MD exclusion was a surprise. The ad certainly didn't say
"MD's need not apply", but it seemed it should have. I have nothing
against a nurse-informaticist for this role, but let
the competition for the role be fair and inclusive, not biased based on one's
degree!
How to explain this?
Was there a "preferred internal candidate" who just happened to be a
nurse with a bachelor's degree? Is this yet another way healthcare management
will try to usurp physicians, through control of clinical IT via nursing or
other specialty group? Does it reflect lack of knowledge about MD informaticians? Was it a skimping on compensation - a very,
very bad area in which to skimp? (I have always marvelled
at the utter stupidity of organizations that skimp on salaries for specialists
whose function will make or break millions of dollars of technology and affect
patient lives, while of course rewarding non-clinical executives with lucrative
packages.) Was it my background that scared the daylights out of the CIO or
other officer there? Or does the MD exclusion reflect someone's sheer lack of
competence about what is really needed for successful clinical IT
implementation? You be the judge.
I inquired of the
organization's CEO and CIO about this MD exclusion which I considered rather
unusual. I am always astonished to observe that healthcare Informatics often
seems like Bizarro World:
In
the Bizarro world, a cube-shaped planet known as
"Htrae" ("Earth" spelled
backwards), society is ruled by the Bizarro Code,
which states "Us do opposite of all Earthly things! Us hate beauty! Us
love ugliness! Is big crime to make anything perfect on Bizarro
World!". In one episode, for example, a salesman is doing a brisk trade
selling "Bizarro bonds. Guaranteed to lose money
for you". Later in this episode, the mayor appoints Bizarro
#1 to investigate a crime, "Because you are stupider than the entire Bizarro police force put together". This is intended
and taken as a great compliment.
Here are the responses I
received to my inquiry about physician-informaticist
exclusion from a Healthcare Informatics leadership role in a large healthcare
system:
[From
a Sr. HR Associate]:
Thank
you for your interest in our Director of Clinical Informatics position here. We
are working with [recruiter] at [recruiter firm] in the recruiting for this
position. Please contact [recruiter] regarding your interest in this position.
Thank you again for your interest in [our organization].
Are they a little confused here? I replied to the Sr.
HR Associate, with CC: to the CIO and CEO.
Dear [Sr. HR Associate]:
It was indeed[recruiter] who told me of the MD exclusion. As Member at Large of
the AMIA Clinical Information Systems working group, and as former Director of
Clinical Informatics at Christiana Care Health System in
I then received an email
from the Chief HR Officer:
[From Chief HR Officer]:
I am responding to the email you sent to [our CEO] regarding the
above-referenced position. Thank you for sharing your perspective on our search
and the possible field of candidates. Our focus on candidates with a nursing
background is driven by several factors. Our preference is to have a nurse or
physician in this position as they can provide the broad clinical knowledge and
leadership compared to other focused clinical specialties. Unfortunately, [our]
salary structure for this position is lower than that of credentialed
physicians who have practiced medicine. While physicians working in an academic
setting may find the salary range for the position acceptable, we have a
preference for candidates with direct patient care experience who can relate to
[our] clinical leaders about their operational realities. [We are] fortunate to
have [name] in the CMO role as [name] is able to provide physician IT
leadership based on his prior experience at [another large organization]. With
these factors in mind, [our] Chief Information Officer decided to focus our
recruiting efforts on qualified candidates with a nursing background. However,
we are not opposed to considering physicians that meet the qualifications and
are amenable to compensation within our salary range. This has been discussed
with the search firm assisting [us] to fill the position. We welcome your
suggestions of candidates for consideration, and thank you again for sharing
your perspective.
It
appears it didn't matter that I have all of the above, as it is - academia,
industry, patient care, IT, NIH postdoctoral fellowship in medical informatics,
etc. Unfortunately, this spin-control-sounding response raised more questions
than it answered, such as (for starters):
1. Regarding a preference
for candidates with patient care experience as opposed to academic settings -
what physician would not have had patient care experience in academia?
2. What is so unusual about their hospitals and other facilities that they
require "special experience" to "relate to" clinical
leaders and operational realities - is something unusual going on at them?
3. Is there something strange about their operational realities that are
untenable for people who've spent some time in academia? Does academia make
them unable to handle the realities? Is so, this is unusual, and it would be
good to know how this could happen, because if so, we need to fix it! (We can't
have doctors who can't relate to operational issues after spending time in
academia.)
4. Is the amount of leadership needed to be provided so small and so
insignificant as to be easily performed by one CMO? That presumes that this amount
of leadership will not grow, expand, or be a significant burden on the CMO.
5. If an organization is serious about recrutiting,
shouldn't there be a good understanding about who they want to hire, and
shouldn't they act transparently in a way that cannot be perceived as
deceptive?
6. Is this a decision based on cost-cutting, and not a decision based on
providing excellence in care? Don't hospitals have a public responsibility to
provide the latter? In my experience I have seen actions taken by CIO's to cut
costs at the expense of quality of medical care.
7. "We are not opposed to physicians" - that they should even
consider "opposition" in the same sentence as "physician"
betrays some sort of bias in hiring policies highly inappropriate for a hospital.
8. "With these factors in mind, our CIO decided"... since some
of these factors are incorrect, the CIO perhaps needs to reconsider his
decisions. Clearly one sided and provincial, making a decision on weak factors
can only result in a weak decision. More effort and care should have been spent
on defining the premises and analyzing them behind the formulation of this
position.
9. What expert in the field of Medical Informatics was consulted with, or did
this organization feel there's nothing these experts have to tell them?
10. Why do they say nurse or physician on one part, but then that the CIO
prefers a nurse? Clearly this response does not articulate in a focused manner
what they want. Perhaps they need to go back to the table and reach a clear,
lucid concensus on what they want to do.
11. While they have the prerogative to run their hospital as they see fit, they
also have the obligation to run it in the best possible interests of the
public, something other private institutions are not obligated to do.
Irrespective of who owns the organization, because the public interest is at
stake, critical decisions they make need to be able to withstand scrutiny by
the public.
12. Corporate spin control mumbo jumbo is not a confidence builder; rather, it
is an indication of subjectivity and even perhaps duplicity.
I'd addressed most of the quite unoriginal points in the HR response almost a
decade ago on a page entitled "Fighting stereotypes and
politics that impede informatics leadership" such as:
Medical Informatics is too academic
Medical Informaticists
are "techies"
Medical Informaticists
need to be seeing
patients
Doctors don't do
things with computers
Doctors don't have enough experience
Doctors don't have IT leadership
skills
Doctors don't understand business
Doctors don't have personnel
management skills
Doctors are not team players
Doctors can't manage projects
Doctors don't think
strategically
Doctors in clinical computing
projects should report
to MIS
The only thing
that's clear is that the MD exclusion originated with the CIO. Seems the CIO felt
one doc was enough (god forbid two docs leading clinical IT). My response was polite but firm:
Dear
[Chief HR Officer],
Thanks for the response.
My concerns did not have to do with your selection of qualifications which is
certainly your organization's prerogative. It had to do with submitting my
expression of interest and receiving a next-day positive response from the
recruiter. Then, several days later after her not returning my calls (I presume
your organization reviewed my resume during that period), I reached her and was
simply told your organization "was not seeking physicians." Period,
end stop. The recruiter was rather final about it and immediately asked if I
could refer nurses to her. That was surprising and disappointing, to say the
least.
Just as it is your organization's prerogative to make decisions about hiring, I
live up the road from one of your hospitals and in that regard am a
stakeholder. I think we can agree it is my prerogative to express myself. I
intend to write your Board of Directors about what I feel is an
interestingly-timed about-face on your organization's part, and on the overall
strategy as you outlined below for such a critical change transformation as
clinical information technology.
Finally, I received this from same Chief HR Officer:
[From
Chief HR Officer]:
While you have an absolute and unfettered right to contact our Board, I want to
assure you there has been no “interestingly-timed about-face” on this matter by
[us]. Until your email below informed me, I was completely unaware of your
interest in the position. We are in the early stages of the search and we have
reviewed no resumes to date. As is typically the case, resumes are not
presented until a slate of candidates has been developed. I will contact the firm
to discuss their process and to review our requirements. I regret that you were
given an incomplete response. Thank you for sharing your perspective.
To which I replied:
Dear
[Chief HR Officer],
The recruiter indicated she spoke to someone in the organization before saying
[your organization] was not looking for a physician informaticist.
It sounds like there are multiple breakdowns in communication. That said, I
thank you for the response.
Is this a "doctors
don't do things with computers" moment, mismanagement, territoriality,
miscommunication, ineptness, or above-board, state-of-the-art strategic and
tactical planning for major healthcare informatics activities in a large
healthcare system?
I report, you decide.
Addendum:
I periodically receive
solicitations for health IT positions from recruiters at large hospitals.
Here's just the latest two, quite typical of what I receive on a regular basis.
Keep in mind that I completed an NIH postdoc in
clinical IT, have been a CMIO (Chief Medical Informatics Officer) in a 1000+
bed regional medical center reporting the the Sr. VP
for Medical Affairs, been a Group Director of informatics in a multinational pharma overseeing a staff of 50, and am now a professor of
informatics and IT (for the second time in my career).
#1, from the largest medical center in the
Systems Analyst
Physician Practices Ambulatory EMR systems experience required.
Full-time,
including support call rotation
You’ll implement and support
clinical systems for Physician Offices for one of the busiest hospitals in the
·
Familiarity with
Eclipsys Sunrise Clinical Manager and/or Ambulatory Care Manager and Misys
Vision would be assets
·
Experience with
project management, electronic medical records, help desk and implementing
process changes
·
Troubleshooting,
problem resolution and creative thinking a plus
Troubleshooting, problem resolution and creative
thinking "a plus?"
Troubleshooting, problem resolution and creative thinking probably can
come in handy when dealing with clinical IT project management, doctors,
process change, and EMR's, especially when doing Help
Desk support as a lowly Systems Analyst.
#2 comes from a recruiter
for a
Description: Manager of Clinical Support Systems, CPOE,
Clinical Manager in CA Hospital. The successful candidate will have a clinical
background (nurse, but not essential) and really know the ancillaries
and understand their strategic importance to the execution of all the “in
vogue” IT projects like EMR and CPOE. The successful candidate in this role
will be very smart and take extreme pride in delivering results!
Why in the name of heaven
would anyone seriously think of sending me a JD for a manager-level position,
at least two levels below my previous hospital and pharmaceutical positions? I
also received a personal phone call from this recruiter as well as an
email. This was not computer-generated
spam.
Do I see that a clinical background is really not essential? I imagine it could indeed be useful in such a
role to be "very smart" and take pride in one's work.
Infrequently indeed do I see requirements for formal healthcare informatics or
IT training. In some ads, only a bachelor's in IT is called for.
These ads probably do result in hiring of clinical IT personnel, who clinicians
increasingly depend on for tools essential to clinical care (if only in the
sense that clinicians are ordered to use them).
I would not enjoy imagining what would occur if neurosurgeons were hired
in the same way.
Paraphrasing Bill Hersh, it seems the following
philosophy is all too common: "While it's unwise spending millions on
Electronic Medical Records without investing thousands in medical informatics
expertise ... we'll do it anyway."
This reminds me of a line on irrational
arguments from former engineer/comic artist Scott Adams:
Ignoring the Advice of Experts Without Good Reason
Example: Sure, the experts think you shouldn't ride a bicycle into the eye of a
hurricane, but I have my own theory.