Physician informatics and the chief medical information officer [PODCAST]

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This episode is sponsored by Athelas, the number one provider of remote patient monitoring.

“At the beginning of my time as a CMIO, I needed to remain clinical to build camaraderie with my colleagues. This proved essential as the health system was going through a transition to a new EMR. The medical staff needed to know that every decision I made affected me as much as it affected them.

As time went on and the EMR matured, it became less relevant if I practiced and more critical to perform as a change agent. However, I elected to still practice in a part-time fashion because of my love for orthopedics. I also recognized the importance of a minority surgeon for the community.”

Nathan Gause is an orthopedic surgeon and former CMIO. Afua Aning is a physician informaticist.

They share their stories and discuss the KevinMD article, “Innovation and the ever-changing role of the CMIO.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

This episode is sponsored by Athelas, the number one provider of remote patient monitoring.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Nathan Gause and Afua Aning. Nathan is an orthopedic surgeon and former CMIO, and Afua is a physician informaticist, and together we’re going to talk about innovation and the ever-changing role of the CMIO. Nathan, Afua, welcome to the show.

Nathan Gause: Thanks for having us.

Afua Aning: Absolutely, thank you.

Kevin Pho: So I’m going to ask each of you to just share briefly your story and journey to where you are today. Nathan, why’d you go first?

Nathan Gause: Sure. So like you said, I’m Nathan Gause. I am an orthopedic surgeon by trade. I hail from Cincinnati, Ohio, where I did most of my training and my residency for orthopedics, and then did a foot and ankle fellowship at Campbell Clinic at the University of Tennessee in Memphis. From there I moved to Iowa, where I ended up practicing for about a decade. During my time there, I was introduced to the C-suite. We were undergoing a major overhaul of our EMR at that time, and they needed a physician leader to sort of step in. So that’s how I was, I guess, introduced into the world of informatics. I loved it. I had actually done some informatics-type work in residency and then just built on that, and I was able to take the lead, take charge, and formally become the CMIO for the health system for the remainder of my time there.

And that kind of leads me to today, where I was able to then transition. I was the pandemic kid; I thought it was time to make a change, and I moved to Kansas City, where I still dibble and dabble in informatics, and I lead a physician information technology group here, always trying to refine and update our current EMR. But it’s been quite a journey. I’m excited to be here to talk about it.

Kevin Pho: And Nathan, why is it so important for physicians to be involved with informatics?

Nathan Gause: You live and die by informatics, is what I’ve learned. If you don’t have your backbone, the backbone of your practice, set, and if you don’t have a say in it, then it will have a say in what you do, versus vice versa. I’ve always thought that, and it’s come to fruition many times, over and over again. When we have input, then we can make our lives that much easier. If our lives are that much easier, then we’re able to focus on patients that much more, which improves the lives and quality of our patients.

And so I think it all goes hand in hand. If you’re not involved in it from the beginning, or at least at some point during the process, then I think ultimately you’re going to be unhappy. I think your rate of burnout will be increased as well. So you’re really protecting yourself for longevity, as well as providing better care for your patients.

Kevin Pho: And Afua, we’ve had you on the show before, but for those who didn’t get a chance to listen to our first episode, briefly share your story and journey to where you are today.

Afua Aning: Sure. I specialize in physician informatics. I am the physician whisperer, and I’m a founder of a company called My Just Checking In, where we help health care organizations realize the full potential and value of their electronic medical records investment.

Kevin Pho: Tell me how you first got interested in informatics, because I’m sure you didn’t go to medical school, or maybe you did, saying, “I want to do informatics.” Tell me about your interest and how you got involved with it.

Afua Aning: Yeah, so it was interesting. Through my journey, I kind of fell into it, where a colleague of mine introduced me to the informatics world, and that’s where I started from, with the University of Michigan in Ann Arbor. So it’s been a journey, and it’s been an exciting journey.

Kevin Pho: So let’s talk more about the article, where you actually interviewed Nathan. It’s titled “Innovation and the ever-changing role of the CMIO.” Nathan, tell me about your experiences when you were the CMIO of that health system. What was it like?

Nathan Gause: It was tenuous at first. So I was the first CMIO of the health system. Prior to that, they really had no one in that seat or in that role. So it took some convincing on my part, a lot of extra energy that I had to expend, just to show the importance and the value of having a physician leader help guide the process of transitioning from one major EMR to another. So it was not fun at first, to be quite honest with you. I second-guessed myself a lot, wondering, “So, let’s go back into full-time practice and leave this side alone.” But again, and we sort of touched on that earlier, the importance of being involved just superseded my own feelings, if you will, my own affect there.

As time went on, I began to love it. As we got the EMR implemented, there were the growing pains there, but getting to the stage of optimization, really making the electronic health record hum, making it sing, making it work for nursing staff, making it work for the other clinical staff, I just got a lot of satiety in being able to be involved in those projects, as well as spreading the word about the importance of just being involved in informatics in general.

Kevin Pho: And Nathan, you’ve said at first it was difficult making that transition. What kind of skills did you need to learn to make that transition a little bit easier, and did you have those skills as a physician coming in?

Nathan Gause: I’ll answer the last question first: No, I did not have the skills going into it. I had to learn a new lexicon, to be quite honest with you. So I was fortunate enough that the role was termed the chief medical information officer, and so I had a seat at the table in the C-suite, but I had no idea what was going on. I didn’t understand the business speak that was happening in the room. And so I had to do a lot of studying outside of actual day-to-day meetings, and a lot of one-on-one meetings, to understand: What was the goal there? What were we trying to accomplish? Where could I have done better? So it took a lot of my own free time, if you will, in between seeing patients and doing the role of CMIO, to really understand what was happening.

And then just knowing whom to speak to: Who were the true decision-makers? A lot of people were talking, but who’s actually making decisions and understanding, and would be able to support the initiatives that I was trying to push forward? So that was a whole new world for me, something I had never learned in medical school, something I hadn’t learned in undergrad or in life in general. So that was probably the biggest challenge, which is why I was frustrated in the beginning on not too rare occasions.

Kevin Pho: And Afua, you are a physician informaticist, and you label yourself as the doctor whisperer. Tell me about some of the challenges that you face in your role every day as a physician.

Afua Aning: Yes. So there are times where the system is not functioning as it’s supposed to, and then there’s a delay in getting the necessary fixes, and that could be overwhelming for the physicians that you’re training. So that’s something that I experience on a daily basis.

Kevin Pho: And what are some of the things that you do to help facilitate some of those obstacles that physicians face?

Afua Aning: Yeah, so I try to find a better workaround. But there are sometimes issues that you just have to put in a ticket for, because it’s a hardware issue, or it’s something that has to be escalated to an analyst to deal with. So allowing providers to voice their frustration, and just helping them and guiding them, I think is very important. And just taking your experience from all the other hospitals that I’ve been at, and just helping them navigate through the system.

Kevin Pho: Afua, as a consultant to many different hospitals and medical systems, I’m sure you interact with a lot of CMIOs across the country. So in general, what’s your experience with CMIOs? Do you note any variability in terms of their expertise and how accepted they are?

Afua Aning: Just like clinical medicine, it varies. So there are smaller hospitals, medium-sized, and larger-sized. So it all depends on your task and who they are working with. But it also depends on how long they’ve been on that software, whether it’s Epic or Cerner, and how comfortable they are with the system.

Kevin Pho: Give me a sense of the range of what you see, Afua. What’s the range of the systems you see in terms of how well they’re implementing EMRs? Just give us a case study, for instance, of some of the different cases that you see on the ends of the spectrum.

Afua Aning: Again, it varies. For example, I’ve been to big, large systems where they’ve been on Epic for nearly 10 years, and the next one I’m going to, they’re new to Epic, right? So there’s a difference. There’s a difference in the structure of whatever hospital organization you’re dealing with.

Kevin Pho: All right. And Nathan, as a CMIO, I always get the impression that you guys are caught in between the medical staff and the administrative staff. You have the medical staff; they always complain about the EMRs, and they want this and this done, and they want these shortcuts. And then you have directives from the administrative staff; they want this from the EMR. So do you feel like you’re caught between those two worlds?

Nathan Gause: In a word, yes. However, I don’t see that necessarily as a negative. I enjoy bridging any gaps that might be present. I think that’s part of our roles as clinicians, so we’re trained well to do that. I do find that I was able to be a better go-between because I remained in clinical practice, such that if a decision was made that wasn’t so popular or wasn’t necessarily enjoyed, I could always hang my hat on this: “This is affecting me just as much as it’s affecting you. And so this might not be the best scenario; it may be a compromise of some nature. However, we’re going to get through it together. I’m right here in the trenches with you, and I’m able to make it happen.”

Likewise, I’m able to sit at the C-suite and say, “You know, I’m seeing this from a vantage point that you might not be seeing it from, and so understand why the compromise is being proposed in the first place.” And so to be able to have those conversations, to be able to speak both languages, if you will, and to be fluent in both languages really helps one to excel in that space. But yeah, to answer your question, in a word, yes, you’re definitely a go-between.

Kevin Pho: And Nathan, if you were to do this journey all over again, going from clinical medicine into the C-suite, is there anything that you would have done differently?

Nathan Gause: Absolutely. Thank you for asking; I have a dissertation prepared to answer. Yes, so what I wish I had known, or did know, and I sort of alluded to that earlier, is the business of medicine. I wish I had understood exactly who it is that I’m negotiating with at the table. What is their mindset? I know nothing of income statements or balance sheets. I know nothing about cash flows and the importance of that in order to help keep a health system running or to help keep a practice running. That wasn’t taught in medical school.

So if I could go back and do it all over again, I would focus more on understanding business. How does this country run? What’s important to people? What’s being successful? One person’s definition of success is likely different than mine, coming from a medical framework. So I certainly would go back and have a better handle on the business of medicine prior to matriculating into actual practice.

Kevin Pho: And how does one go about doing that, for those physicians who are interested in going to the C-suite or just going into informatics? How do they get that business information? Is this something that they need an MBA for? Do they need formal training? Is it something that is read on the internet? How would you recommend they go about getting that training?

Nathan Gause: I think it depends on the scenario. I was fortunate enough to be in a smaller town where human capital was less readily available, and so someone like me could step into the role and sort of learn on the job. And I think in those situations it’s not as important for you to have mastery of the lexicon, to understand exactly what you need to know to be successful, because you typically have folks around who can help you get there. In a larger setting, such as where I am now, I think having some formal training is probably more important, particularly on your resume, if you’re looking to try to get into a role such as that. Notably, I’m currently pursuing my MBA in hopes that at some point I’ll probably get back into it.

Since I’m in a larger city, I think that’s more important now. I didn’t think it was four or five years ago. If you’d asked me, “Hey, do you think formal training is important?” I would have said, “Heck no. Do it, do your best, and just depend on your brains in order to be successful.” However, now I think in this scenario specifically, it’s important to have that backing, to have that understanding, to take things to the next level. But I don’t think it’s always important to have some sort of formal training.

To answer your question maybe a little bit better: Be willing to be a sponge, just like you were in medical school. Be willing to learn. Don’t assume that you know. Be willing to look at other people’s viewpoints in order to help make better decisions, or at least to help guide, if you feel like you have an opinion that’s worth mentioning or saying out loud, and know when to shut up. I think that goes a long way. I’ve learned that the hard way, unfortunately; I didn’t always shut up when I should have. But I think that’s equally important in this journey.

Kevin Pho: Afua, I’m going to ask you a similar question. For those physicians who are interested in going into informatics or simply learning more about the space, what kind of resources and recommendations do you have for them?

Afua Aning: I would agree with Nathan’s assessment about the business. I feel like I’m learning a whole lot about business, the business aspect of informatics, and it’s something that you don’t learn in medical school, you know? And that’s what I had to be on pace with and learn a great deal about.

Kevin Pho: And Afua, I’m going to ask about some of the tips that you have. We have physicians all over the country. I think most of them already are on electronic medical records, but sometimes we switch between systems, and every few years there’s a new system or a new Epic upgrade, and that requires wholesale changes in workflows. So what kind of tips do you have for these physicians and medical systems to make that transition into another electronic medical record system, or even the transition from paper to EMR, much more seamless? What kind of tips do you have for them?

Afua Aning: Well, change is not easy, you know? And so what I would say, for a hospital organization that is transitioning from paper to electronic medical records, and I don’t think that there are that many out there, is just have the information available for them, meaning all the medical records at the tips of their fingers, because it can be very frustrating when physicians don’t have all the information that they need to treat a patient. And the pandemic, too, brings up another element and frustrations, and physicians are swamped with dealing with a number of issues. So just having information available for them is, to me, the number one thing that hospital organizations need to do.

Kevin Pho: We’re talking to Nathan Gause and Afua Aning. Nathan is an orthopedic surgeon and former CMIO, Afua is a physician informaticist, and we are discussing innovation and the ever-changing role of the CMIO. Now, I’m going to ask both of you the same final question. Afua, where do you see the future of medical informatics to be? And then you can end up with some take-home messages.

Afua Aning: I would say the take-home message is that big data is giving us a wealth of information, and information about patient type, and that could improve patient care, especially for diverse communities.

Kevin Pho: And Nathan, I’m going to ask you that same question. What do you see as the future of that intersection between medicine and informatics? And also some take-home messages.

Nathan Gause: I think that intersection, and I have to sort of echo what Afua is saying, I think the intersection is going to deal a great deal with AI and taking data and having it in real time to make the best decision for the patient possible. I do see that it can be a great benefit, but I can also see there could potentially be a detriment, particularly for the underserved populations, if they don’t have access or other funds to be able to use that type of technology or get into places that have that type of technology. I think overall it will be a benefit, and I see using data intelligently, more thoroughly, because we’ve amassed so much data over the last 15, 20 years that we now need to, I think, put it to better use than what we’re doing currently.

My take-home message for the listeners, and I think about this as I have listened to other take-home messages from your other podcasts, is this: Always remember the importance of self-care. Always take the time to re-evaluate your priorities. And you can do that by assessing, and that’s what I do. I assess: Where is my time most spent, and is that a priority? And if it’s not, I need to change some things. And that’s why I changed jobs in the middle of the pandemic, because my priorities were not what they should have been. So I can’t iterate that enough, the importance of self-care, helping to prevent burnout, because as clinicians, we’re on the front lines, and it is very important that we stay healthy in order to keep others healthy.

Kevin Pho: Nathan, Afua, thank you so much for sharing your time and insight. Thanks again for being on the show.

Nathan Gause: Thanks for having us.

Afua Aning: Thank you very much.

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