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Physicians and their office staff are tired of calling insurance companies to inquire about the status of their claims. They often spend endless hours on phone calls, only to be told that the “claim is being processed” or the “check is in the mail”. Busy surgeons or procedure oriented practitioners call and go through a long process to obtain authorization for procedures – many practices requiring additional staff for, this purpose. In addition, different health plans utilize different codes – for anything from procedures to reasons for denials and changes in reimbursement. Each plan also assigns a different ID number to a participating provider. Now, under the Health Insurance Portability and Accountability Act (HIPAA) rules, a single coding system must be used by all healthcare payers.

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Physician leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined. The authors conducted structured interviews with five physician information technology leaders, or Chief Medical Information Officers (CMIOs), at health systems that broadly used health information technology.

The study aimed to identify the individual skills and organizational structure necessary for a CMIO to be effective. The interviews found that the CMIOs had significant management experience prior to serving as a CMIO and were positioned and supported within each health system similar to other executive leaders; only one of the five CMIOs had formal informatics training. A review of the findings advocates for the CMIO to have a strong background and role as a physician executive supported by knowledge in informatics, as opposed to being a highly trained informaticist with secondary management expertise or support.

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