1. CMIO-CMO:
Collaboration Strategies
Abha Agrawal, MD, FACP
Chief Medical Officer
Kings County Hospital
Clinical Associate Dean
SUNY Downstate College of Medicine
Brooklyn, NY
CMIO Summit | Boston | June 10 2011
2. Kings County Hospital Center
650-bed academic
tertiary hospital
Level-1 Trauma
Center
26,000 discharges
750,000 clinic visits
130,000 ED visits
3. New York City Health & Hospitals
Corporation
Largest municipal health system in the
country
11 acute care hospitals
>100 diagnostic and treatment centers
7,700 beds
23,000 deliveries
227,000 admissions
8. ‘Kǘbler-Ross’ Stages
CMIO to CMO transition
I - Denial “My calendar is wrong”
II - Anger “Who messed it up?”
III - Bargaining “The calendar may be right; but someone needs to fix it”
IV - Depression “The calendar is right; but there is no way I can live with it”
V - Acceptance “I accept the reality of the CMO job”
Adapted from Donald Berwick, MD, IHI 2004 Frontiers of Healthcare conference
11. “Waste, Danger, and Death”
1954 speech
Appalling state of
“waste, danger, and
death” in nation’s
highway system
12. Waste in US Healthcare
• 40-50 % waste
• Overuse
• 7 services alone- $33 – 62 billion waste / yr
• Preventable complications
• HAIs, medication errors
• Process inefficiency
• locating and waiting, poor access
13. Medicare OIG study Nov 2010
780 Medicare beneficiaries discharged in
Oct 2008
– 13.5 %: adverse events
– Additional 13.5% - temporary harm
– 44% preventable
– 1.5% - contributed to their deaths = 15,000
Medicare beneficiaries in a month (based on
~ 1 million in a month)
14. • 55% received recommended care for their
condition
• Condition-specific rates varied from 10-79%
19. CMIO – CMO Intersection
Medical staff
information / Knowledge
Quality
Analytics – Data /
EHR
Safety
CPOE - Decision
Support Regulatory
Meaningful Use Research
E-documentation Care
management
Health reform
- ACO/ PCMH
20. CMIO Role Has Evolved From
Implementation, Analytics,
training of HIT Reporting, and
Dashboard
23. Collaboration points
EHR implementation
Quality and Safety: achievable only
through EHRs
PCMH / ACO: EHR / health IT are critical
Regulatory requirements: achievable only
through HIT
Performance and productivity
measurement: achievable only through
data analytics
24. “Smart” discharge summary
MD documenting inpatient
discharge summary
Medical Service patient All Other Services
HF anywhere in Problem List? HF as Principal Discharge Dx?
No Yes
No further Check for ACEI / ARB Rx
action
Yes No
No further MD prompted to
action write a Rx
OR
Document
contraindication
25. Reducing CAUTI
• 2009 – 7.3 per 1000 cath days
• 2010 – 4.3 per 1000 cath days
• total number of cath days also reduced
to half.
28. CPOE: Fondaparinux
To order fondaparinux, patient must have a cr clearance of
>= 30 ml/min, determined from the most recent weight and
serum creatinine results. If any of these three are missing
or not recent, enter or order the appropriate values.
29. CMIO - CMO
Both working toward the same goals /
same strategic priorities of the
organization.
Alignment is absolutely mandatory – even
more so than now.
33. Concluding thoughts
Health IT is vital to achieving
organizations’ strategic goals
CMIO and CMO are two key clinical
leaders – their alignment is natural and
essential.
