Medical Informatics and Leadership of Clinical Computing: Ivy League University Decides On An Enlightened Approach

It is not often that the Healthcare Renewal blog offers praise to large healthcare organizations, but this is one such case.

In late 1998, ten years ago almost to the day, I initiated a web site entitled "Medical Informatics and Leadership of Clinical Computing." (That site has evolved into its present form here and is now subtitled "Medical Informatics, Information Technology Leadership, and Clinical IT Success.")

In that 1998 site I explicitly called, perhaps for the first time, for actual leadership of clinical IT initiatives by Medical Informatics professionals, who were formally educated and experienced in that domain, as opposed to the traditional leadership model by business IT personnel. The latter most often had backgrounds only in management information systems and lacked biomedical credentials and experience.

I created the web site, in fact, after a number of years as Chief Medical Informatics Officer at a large healthcare system and as faculty at an academic medical center, where I was exposed to alarming healthcare IT mismanagement. The first two stories at the current site chronicle several of my experiences. Further, my attempts to improve the situations and protect multi-million dollar IT investments from rejection and failure - and protect patient lives - were often met with opposition in the form of active or passive aggression by powerful CIO's and other IT staff, with (at best) passive and unsupportive responses by senior management. I realized there was almost no literature to turn to regarding this phenomenon and thus started the site.

I've experienced a degree of ostracism even within my own professional community for "airing the dirty laundry" and speaking my mind, and even today the website remains nearly unique. A google search on "healthcare IT failure" or similar expressions demonstrates that. (One could - hyperbolically speaking, of course - argue that only the National Security Agency does a better job of keeping information out of the public eye...)

Yet despite these efforts and that of others in writing about health IT difficulties, informaticists in similar roles experience the same issues, a decade later.

I therefore view with great interest a major Ivy academic healthcare system that has apparently decided to "do healthcare IT the right way", as evidenced by the following position solicitation seen at the Association of American Medical Colleges website AAMC.org (link). Note bolded passages in this excerpt:

Founding Director, Penn Institute for Biomedical Informatics and Associate Dean, Information Technology

The University of Pennsylvania School of Medicine invites applications for the position of Founding Director of a new Penn institute focused on biomedical informatics. This new institute is intended to span from clinical informatics, to translational informatics, to public health informatics, and bridge as well to library sciences, computational biology, and bioinformatics. This new leader will establish the institute, bring together current informatics-related faculty from several School of Medicine departments, hire new School of Medicine faculty, and reach out to informatics faculty in other Penn schools.

The successful applicant will have a distinguished international record in biomedical informatics, with experience in leadership appropriate for a center director. Applicants must have an M.D. and/or Ph.D. and have demonstrated outstanding expertise in education, research, and leadership ...

... As Associate Dean for Information Technology, the candidate will oversee Penn Medicine’s Chief Information Officer, jointly with the Chief Administrative Officer of the University of Pennsylvania Health System. In this role, the candidate will have a leadership role in formulating and implementing an enterprise-wide vision for research and administrative IT in the School of Medicine, and for clinical IT for the health system.

A leader with a distinguished academic record in biomedical informatics overseeing a healthcare system CIO (who most often have a traditional business IT background) is a bit of a precedent. While there may be other examples, this is exactly the type of organizational arrangement I have been calling for now for a decade. Clinicians will no longer be answering to business computing personnel.

I applaud the University of Pennsylvania for taking the initiative and creating this role in this manner. I can only hope the role will be supported by senior health system management and university administration when the inevitable sociotechnologic issues arise between clinical practitioners and researchers, and IT personnel.

Finally, while my aforementioned web site and this June '08 Healthcare Renewal post probably played no role in Penn's formulation of the new role, I can imagine that someone there read them (there have been hits from U. Penn from time to time) and at least might then have had a greater inclination to support such a position formulation.

That's how the introduction of new ideas that challenge the dominant paradigm (a.k.a. "subversion") works, I suppose.

I also hope other healthcare organizations will begin to follow Penn's lead.

-- SS