CMIO works toward standardized definitions

Dirk Stanley, MD, MPH, CMIO, Cooley Dickinson Hospital, Northampton, Mass.

“Healthcare is having a hard time with basic nomenclature,” said Dirk Stanley, MD, MPH, CMIO and hospitalist at Cooley Dickinson Hospital in Northampton, Mass., speaking to CMIO about his concerns with the costly problem in the current U.S. healthcare system.

To address the problem, Stanley has been working to create a “CMIO’s framework”—a help manual of sorts to establish standardized definitions and a reference guide for health IT tools. “For example, there are a lot of different ideas about protocols, standing orders and order sets,” he said. “People misuse words all the time and a phenomenal amount of time and money has been wasted just trying to develop the basic tools people need to operate."

The project’s nickname, the "I91 Informatics" project, refers to the interstate that runs from Vermont and New Hampshire down through Massachusetts and Connecticut. “Rather than competing, I wanted to focus on a common road that ties a bunch of us together and helps us all.” 

Stanley has found that blogging about the topic hasn’t produced too much in the way of results, so he hopes a workgroup of experts will be more effective. To date, the number of contributors has been relatively low which he attributes to people being “a little daunted by some of the questions.” Asking “what is an order?” leads to other questions such as “what is an order set and what is a chart, which leads to other challenging questions.” Plus, a set of new standardized definitions could result in “some hospitals having to reengineer their tools,” he said. “No one wants to be responsible for setting a standard that requires so much work.”

Eventually, Stanley hopes to  create a series of documents and help pages to manage the various health IT tools, so that rather than spending a lot of time figuring out how to manage these tools, there is one place to find expert opinions and already-established best practices. “The manual would be a reference guide for people to have a better understanding of the tools to improve their safety through standardization, design, management and use.”

The lack of standardized definitions is “a legitimate problem that is quietly costing our healthcare system in productivity and efficiency.”

Rather than a strict regulatory standard, Stanley envisions more of a roadmap for the various processes for developing and maintaining these tools. “As a CMIO, it’s my responsibility to help make sure the right information gets to the right person at the right time in the right place in the right way. If I get those five things right, I’m improving the safety and efficiency of healthcare. We need to look for ways to get all five of those right as we take care of patients.”

Although the CMIO role has existed since the mid-1990s, it’s still an evolving and expanding role, said Stanley. He’s been in the position for four years and has noticed that different hospitals use their CMIO in different ways.

“It’s clear that every hospital has a different understanding of what to do with informatics,” he said. That’s another reason he calls his project a framework—because “at the same time we develop definitions and guidance, we could help reinforce the understanding that the CMIO can be enormously helpful in implementing this framework of definitions, and making meaningful change in an organization.”

“Informatics has a branding issue,” he said. While most people have a clear vision of what a doctor or a nurse does, “when you say informaticist, people sometimes give you a glassy-eyed stare.  Part of the problem is that informatics is sometimes confused with IT, data analytics or physician championing. The informatics role incorporates pieces of all three, and more. It’s very broad.”

Given the current efforts underway regarding educational programs and association initiatives, Stanley said that by the time he retires, he hopes that successes from trained informaticists will help others better understand the field.

Cooley Dickinson’s IT implementation and meaningful use experience has helped drive Stanley’s efforts to work on standardized definitions that could eventually help healthcare on a global level. He is preparing to attest for Stage 1 and learning much along the way. “The ability for healthcare leaders to use the Internet to share best practices and lessons learned with others will help providers around the world.”

Closer to home, Stanley serves as chairperson of the Physician Engagement Committee of the Massachusetts Health Information Exchange (HIE). “There’s still a lot of work to be done before the rollout of the statewide HIE, but it’s an exciting time.” Accountable care also offers a “remarkable opportunity,” he says. “I don’t know that anyone has a crystal clear vision of the ACO model at this point, but a lot of it is designed to help improve efficiency and safety. I think these are noble efforts that deserve our support.”

With all of the efforts tied to healthcare reform, Stanley said he “loves being a part of it. I’m very passionate about helping to make a better healthcare system. I have two young sons. I hope what I do today helps make a system that lets them afford great healthcare when they get older.”