Off the Beaten Path: Jobs for Tech Doctors

Information technology is definitely the current “it” topic in healthcare. Supporters have touted its ability to do everything from increasing efficiency, safety, and favorable outcomes to decreasing costs, redundancy, and adverse events. As the benefits of health information technology (HIT) have become apparent—winning converts to the cause and expanding tech budgets—the rapidly growing, dynamic HIT industry is creating numerous exciting opportunities for physicians who are interested in moving beyond clinical practice.

Why would doctors, having gone through a minimum of seven years of postgraduate education and training, often followed by several more years of advanced medical training (in some cases bolstered by an additional graduate degree such as a MBA or MPH), seek a job in HIT? Judging from my own experience and discussions with many colleagues in the field, the routes to our current roles in HIT have frequently been somewhat circuitous. There do, however, seem to be several shared motivations: a strong sense of purpose, idealism, and a passion and vision for improving healthcare.

My own passion for HIT was ignited in the mid ’90s when I was working in a practice that had a rudimentary electronic medical record. Despite the limitations of the system, I perceived the transformative possibilities of HIT. Living in northern California at the time, I had many opportunities to become engaged in system development, as there were several HIT software vendors that were based there. I went to work for a small HIT software vendor. At the time, there were only three physicians employed by the company: a physician who worked full-time in sales, flying around the country demonstrating the system at sales calls; another who worked part-time in sales and part-time in development; and me. I was initially engaged to develop end-user, computer-based training systems, then moved to product management within the marketing department. This was an incredible education in the entire HIT vendor software development, sales, and implementation process. I was exposed to all facets of the business: helping to prepare the vendor responses to healthcare provider request for proposals, the software development process, implementations, and system data model design with the goal of data retrieval and “reusable” discreet data to be captured within the system’s database.

After several years working in the industry, I returned to the provider world, where I could be directly involved in HIT projects designed to improve healthcare delivery, conduct research to determine if the implementations were effective, and develop models of HIT implementation that could transform healthcare. I have continued to focus on the interface between software and the end-user’s workflow—designing and implementing software that truly supports end-users in their work and that makes the right thing to do also the easy thing to do. One example of this type of work involves systems designed to improve the process of prescribing and administering medications by alerting the prescribing physician to possible drug—drug or drug–allergy interactions, inappropriate dosing, and other potential adverse events. Such a system would also alert the administering nurse if there is any reason for the drug to be withheld.

I have continued to be involved in HIT while also working as a healthcare provider, participating in electronic health record (EHR), personal health record (PHR), and other e-health services implementations, as well as conducting grant-funded research in HIT. I continue to be committed to my original vision of using HIT tools to fundamentally improve healthcare. The HIT industry has seen exponential growth in the past 5-10 years, and this growth is reflected in both the expanding number and diversity of jobs available to physicians in this industry. The industry forecast is for continued significant growth and the development of additional positions to meet the demand created by clinical system initiatives. These initiatives have already had an enormous impact on nearly all healthcare constituencies and will continue to provide a fertile market for physicians with information systems expertise.

The following are several key venues and positions for “tech doctors.” We have separated the list by healthcare constituency group and ranked the jobs in each group according to influence and compensation level: the most influential and highest-salary jobs within each constituency group are listed first, followed by the more entry-level positions within that constituency.

HEALTHCARE DELIVERY

These positions pertain to the implementation, optimization, and maintenance of HIT systems within a healthcare delivery organization. They are based within the organization and do not generally involve extensive travel, beyond presenting at industry meetings and participating in vendor-user groups and forums. Salaries vary depending on the particular responsibilities, size of the organization, and geography, but generally are not as high—with the exception of CIO—as sub-specialty physician salaries.

Chief Information Officer (CIO)

This role is one of the fastest growing positions in hospitals. Physicians who have served as Chief Medical Information Officer and in other executive positions in information technology are assuming this role in greater numbers. Many organizations are beginning to recognize the importance and value of having a clinician lead their information technology initiatives. At the present time, however, it is relatively rare that a physician serves in this role, and those that do usually have advanced degrees beyond their MD, such as an MBA, engineering, or medical informatics degree, as well as extensive experience in HIT.

Chief Medical Information Officer (CMIO)

The position of Chief Medical Information Officer on the delivery side is the most prominent and most requested role to recruit. The position is rapidly assuming greater importance due to increasing rates of adoption and implementation of EHRs, computerized physician order entry (CPOE), and other clinical HIT systems and the concomitant need to oversee the continued enhancement and modification of these systems once they have been implemented. The role of CMIO varies depending on the status of an organization’s clinical systems initiatives. It is strategic, operational, and highly consultative in nature. The position generally requires extensive experience with provider-based HIT implementations, and the physicians who occupy this role also frequently have additional degrees, such as an MBA or medical informatics degree.

Chief Quality Officer (CQO)

Chief Quality Officer is typically an adjunct role to that of Chief Medical Information Officer. Physicians who serve as CQO are responsible for promoting clinical performance improvement and quality. CQO is a senior position that works with all departments and utilizes information technology, data, and outcomes as a foundation for performance improvement and quality initiatives.

Research

Physicians with academic and research backgrounds are assuming increased importance. There is a growing need for systems and methods that utilize data generated by and captured from HIT systems to provide accurate outcomes measurement, which is key to improving the quality of patient care. Th ese systems are also important sources of data for translational research.

Physician Champions

These doctors are essential to promoting and sustaining increased adoption of information technology in healthcare. They dedicate their time and energy to driving the rigorous and lengthy due diligence, selection, training, and implementation processes for EHRs and other clinical HIT systems at their practices and facilities, all while also maintaining their clinical practice. Frequently, these HIT “entry-level” physicians develop the interest and skills in this role that enable them to move on to the other roles described above.

HEALTHCARE SOFTWARE VENDORS

Th ese are the companies that develop and build the systems used by the healthcare delivery organizations. Travel requirements as well as salaries within these organizations vary widely; the salaries are quite dependent on the duties and responsibilities of the positions, and the travel may be considerable.

Executive Management

There are a few physicians occupying Chief Executive Officer and other C-Suite positions in smaller companies. In many cases, these physicians actually were the creators, or co-creators, of the software or systems that are the basis of the company. These positions demand strong entrepreneurial skills and business savvy, as well as a keen understanding of the particular healthcare niche their company’s product is designed to fill.

Physician Executives

Often, the physicians who hold executive positions within software vendor companies need to have experience using hospital clinical systems and information technology, as they are usually involved in the vendor sales cycle and may spend a significant amount of their time traveling to prospective clients for product demonstration and follow-up sales. These positions are ideal for physicians who are interested in HIT and may have used an EHR in their clinical role in the past, but who do not have formal training or HIT implementation experience.

Product Managers

HIT product design and development is attractive to physicians with engineering or similar backgrounds. Experience using HIT systems is preferred but often not necessary for entry-level jobs in this area. Clinical practice experience is essential.

Consultants

Physician consultants work at client sites and assist with implementation, staff training, and project management.

CONSULTING FIRMS

These firms help other constituencies in a variety of ways, from assisting an organization with determining its HIT needs, to vetting and evaluating systems, to performing all of the necessary tasks for implementation, optimization, and maintenance in the case of a healthcare delivery organization that has outsourced its HIT systems to a consulting firm. All of the positions listed below involve extensive travel. Consulting salaries are generally higher than the vendor or

provider constituencies and are dependent on seniority of positions.

Executive Level

These are senior, high-visibility positions filled by physicians with HIT experience who have often developed a national reputation and presence. These positions require strong client relations, client management, and business development skills. They usually involve extensive travel and often require additional educational

degrees, such as an MBA.

Management Consultants

These roles require strong aptitude in strategic analysis, evaluation, and provision of solutions. Management consultants also assist with business development and performance improvement. These positions generally require several years of industry experience.

Project Consultants

This is getting down to the pure delivery side of the business. Consultants offer hands-on support during implementation, optimization, and training. Other, still-developing arenas that provide opportunities for physicians with information systems, business, and technical skills include:

BUSINESS DEVELOPMENT AND VENTURE CAPITAL FIRMS

The physicians in this industry come from a variety of healthcare information technology backgrounds and possess valuable business and analytic skills. One famous entrant to this arena is Dr. David Brailer, the former National Coordinator for Health Information Technology.

GOVERNMENT

The growing federal HIT market is creating an opportunity for physicians to serve in a variety of capacities, including executive leadership for healthcare information technology projects and information systems analysts.

MAINSTREAM TECHNOLOGY FIRMS

The addition of healthcare branches and departments in fi rms such as Microsoft, Intel, Google, and Oracle has created tremendous opportunities for physicians.

Commercial opportunities for physicians committed to promoting wider acceptance of technology in so many venues of healthcare is a relatively new phenomenon. Therefore, there is a great deal of ambiguity in defi ning the roles, titles, responsibilities, and compensation. As the market demand increases and more positions are created and filled, physicians’ roles and responsibilities will be more clearly defined and accompanied by more substantive compensation. Organizations such as the Healthcare Information Management Systems Society (HIMSS), the Association of Medical Directors of Information Systems (AMDIS), and the American Medical Informatics Association (AMIA) are active in working toward this end.

Clearly, the opportunities for “tech doctors” are rapidly increasing and span the healthcare spectrum. The time is ripe for seeking these positions or gaining the necessary experience and training in order to be able to excel in this arena.

Holly Miller, MD, MBA, is Vice President and CMIO at University Hospitals, a community-based system that serves patients at more than 150 locationsthroughout northern Ohio. Prior to joining UH, she worked as a health information technology Managing Director for the Cleveland Clinic. She currently serves as chair of the HIMSS PHR Steering Committee, is one of the leaders of the newly formed HIMSS/AMDIS Physician Community, and contributes to the efforts of multiple HIMSS work groups and task forces.Arlene Anschel, MT, is Executive Vice President of Hersher Associates, Ltd, a healthcare consulting and executive search firm specializing in informationtechnology. She is a nationally recognized expert on the role of the physician in information systems.