JOB DESCRIPTION

Medical Director of Information Systems

Introduction:

In March of 1998 the University Medical Center (UMC) and its affiliates signed a contract with a large information systems vendor for a clinical information system. This system will replace a significant part of the current system and provide many new features. It is essentially a computer-based patient record (CPR) and much more. This system will be used predominantly by clinicians and thus it is very important that it be designed, in substantial part, by these clinicians.

Major features of the new system include:

1. Enterprise-wide Master Population Index (EMPI)
2. Clinical data repository (CDR)
3. Results reporting
4. Physician order entry
5. Decision support
6. Clinical pathways

• Clinical data repository (CDR)- The CDR will provide a single centralized location (database) for all patient information, clinical, demographic, etc. This is where we will look in the future for clinical research and outcomes analysis. Physician involvement is critical to be able to ensure that the information we can get is the information that we need.
  
  
• Enterprise-wide Master Population Index (EMPI)- This will insurer a unique medical record for each patient throughout the UMC, the Faculty Medical Office (FMO), and affiliated satellites and hospitals.
• Results reported- This will replace some of the functionality of CHAIS and provide a tailored user interface for different clinicians. The look and feel of the entire clinical information system is predicated on this module. The goal is to provide the clinicians with the information needed to take care patients in a simple, straightforward, and very rapid matter. When a physician signs-on the system he should be within two mouse clicks away from the majority of information needed relative to any given patient. Coupling the information a physician needs to the way his work flows is of the utmost importance. This is a non-trivial challenge. Physicians are needed to help design the system and make sure is acceptable to all those who need to use it.
• Decision support- This system can provide direct feedback to physicians to assist in providing care for their patients. If the physician places an order for a medication to which the patient is allergic, he will immediately be made aware of the problem. He will be alerted to drug-drug interactions and such "trivial" problems as non-formulary medications. The system can warn the physician of renal insufficiency when he's prescribing a potentially nephrotoxic medication, and suggest alternative medications or an alternative dosing schedule. The system can even check your antibiotic order against the patient's bacterial sensitivity. In order for this system to be useful it to must be designed by physicians. There must be appropriate physician/information communication without the presence of unnecessary, unimportant intervention. These rules must be researched and documentation/references be provided.
• Clinical pathways- These pathways are essentially combinations of detailed physician order sets (see below) and complex decision support rules (see above). Clinical pathways can be used to improve patient care, evaluate outcomes, and improve efficiency. These goals can only to be met, however, if physicians are involved in the creation of these pathways. Obviously, the involvement of many others including nurses, ancillary personnel, and " bean counters" will be required.
• Physician order entry- In order to obtain these benefits, physicians will have to place patient's orders directly into the system. The idea of physician order entry is what is referred to in information systems circles as a paradigm shift. This is also what is called an understatement. To quote the president of Cerner "culture eats technology for lunch." We believe that physician involvement in this area is extremely important in obtaining the necessary buy-in of the medical staff. The order entry process must be efficient, accurate, and very easy to learn.

Job Description

Physicians need to be involved in the Medical Center IS strategy at many levels. It has been proposed three medical directors of IS be established, beginning with the three physicians who have been most involved with IS projects over the last two years.

Medical Director of Information Systems-Ancillary Services (MDIS-AS)

Medical Director of Information Systems-Inpatient Services (MDIS-IS)

Medical Director of Information Systems-Outpatient Services (MDIS-OS)

These physicians will be responsible for supporting the design and development of clinical information systems that assist clinicians in the delivery of patient care. They will participates as members of both the Electronic Patient Record and IT Steering Committees in representing the needs and requirements of the physician community and serve as an advocate of management in promoting the use of information technology in the clinical setting. They may serve on committees that reflect the areas of sub-specialization of their positions (e.g. MDIS-OS on the UHC information systems committee.

The job description for all Medical Directors of Information Systems includes but is not limited to:

1. Participates in clinical advisory groups to provide broad-based input into the design of the clinical information system

2. Participates in clinician advisory groups in the design of clinical systems to support excellence in both patient care and research. Engages patient care providers with varying roles including physicians, nursing practitioners, nursing staff, ancillary department personnel, and medical records professionals to contribute to the development and use of the clinical information system. Develops empathy and understanding of physician needs and builds relationships with physicians to gain support of IT initiatives. Is responsive to users needs, including training, to assure wide spread acceptance and provider use of the clinical systems.

3. Reviews medical informatics trends, experiences and approaches, develops technical and application implementation strategies and assists in the development of strategic plans for clinical information systems.

4. Works in concert with Information Systems (IS) to design and implement systems supporting both patient care and research activities.

5. Leads design of clinical pathway models with physician, nursing and administrative leadership, and will assist in modification of these models to gain maximum efficacy and support for patient care and research protocols.

6. Leads development of clinical "rules" supporting patient care and protocol research as well as the design of clinical system features supporting protocol management and the use of the system to leverage the clinicians' time and maximize communication with affiliates and referring physicians.

7. Participates in the development and deployment of solutions that evaluate clinical outcomes. Designs and evaluates collection of data for clinical purposes, including tracking and interpretation of outcomes.

8. Leads development of clinical documentation user interfaces and their interrelationship with other clinical information relative to "rules" and HCFA coding/billing issues.

9. Participates in clinical activities:

Provides patient care in appropriate clinical setting.Reviews patient assessments and management plans.Participates in applicable clinical research.

Has active medical practice in area of specialty.

10. Participates in research relative to clinical information systems.

Special Skills for MDIS positions

1. Should possesses excellent interpersonal skills and be able to work effectively with a diversity of personalities Must be approachable, and be able to present data with effective communication and presentation skills. Must be an effective consensus builder.

2. Possesses good grasp clinical work flow in both inpatient and outpatient settings, and have an interest in clinical information systems and outcomes measurement.

3. Must have the ability to develop flexible, transferable models for pathways of care.

4. Is a strong leader with a mature sense of priorities and solid practical experience who can design and implement systems within the framework of technical boundaries.

5. Is politically savvy, has a high tolerance for ambiguity and can work successfully in a matrix management model.

6. Is a systems thinker with strong organizational skills.

7. Is a strong manager who is adaptable and has strong collaborative management style, a creative thinker with high energy and enthusiasm, and a team player who promotes the concepts of people working together versus individual performance.

8. Is a contemporary clinician who understands major trends in healthcare and managed care, and is familiar with point of care products and medical informatics trends and tools.

If anyone would like to contribute another sample job description, please contact me at my_last_name@informatics-review.com

© 1999 The Informatics Review

dfs 29 Oct. 1999