LA Confidential

Dr Sajjad Yacoob uses a number of analogies to describe his work as a chief medical information officer. Arguably the most striking is the one he employs to characterise the role itself.

“I don’t know if you’re a Star Trek fan?” he asks with a smile. “The universal translator! As CMIO, you are that universal translator.” (For non-Trekkies, this is the device is used by Kirk, Spock et al to handily translate any alien language into their own).

“You are living in multiple worlds and trying to translate the needs and understandings from their lands and put that together to make one cohesive vision.”

Dr Yacoob has now spent five years as the CMIO of Children’s Hospitals Los Angeles, acting as translator in chief to the institution’s clinical and IT teams.

Prior to that, the practising paediatrician served six years as the hospital’s director of medical informatics. This means that a large chunk of his career has been spent finding technology which supports clinicians to deliver the best possible care.

Falling into IT

Dr Yacoob says this focus on healthcare IT – or what he prefers to call technology enabled process improvement – was never an entirely intentional one. But he also acknowledges that his areas of interest probably made it inevitable.

“Even as a resident [junior doctor] I was doing some auditing work. But to me it wasn’t really quality work. It was: ‘Sajjad, a bunch of the residents are fed up at the way things are happening. Let’s make it better.’

“We didn’t realise we were doing quality and process improvement, we just thought: ‘God, that’s really hard to do, let’s do it this way,’” he laughs.

“But as that came along, the then director of informatics said: ‘Hey, would you guys want to work on making these order screens better?’ on our old Eclipsys system.

“So we said: ‘Sure’, just to make our lives easier. It was more a selfish thing than anything else. So I started working on that and that’s how I sort of got into [this area].”

By the time he was an attending physician [consultant], Dr Yacoob was collaborating with colleagues on a white paper about health information. It detailed the difficulties of managing patient care given the complexity of data that the hospital then had.

“No deed will go unpunished, so in doing that of course they said: ‘OK, great, you get to be the physician champion for the new EMR [electronic medical record]!’” he says, with another laugh.

“It was a natural sort of progression for me because as much as I love technology it was never about the technology. Making it more efficient – that was the aspect I really enjoyed.”

This is why he is keen to discuss the 30% decrease in patient harm recorded at Children’s Hospital Los Angeles since the introduction of the new EMR. That, he says, is where the attention should lie: not on what has been installed.

“People get too caught up in measuring: ‘Oh, I did this, I was able to put this in’ or ‘I have this, and I’ve got 100 people using it’,” he says. “But what is the real outcome?

“The outcome is not a measure of getting people online. The measure is how that produced the effect you want, which is ultimately at the end patient care.

“The CMIO [is someone who] understands and recognises the limitations of the reality when using information systems,” he continues. “They are but a tool.”

Clinical leadership matters

Increasing numbers of US hospitals are deciding that this sort of contribution is a valuable one. While Dr Yacoob does not feel that CMIOs could yet be described as “widespread” in the US, he does say their existence is becoming more common every year.

It certainly remains some way ahead of the UK. EHealth Insider launched a campaign to bring chief clinical information officers to the NHS last year, and followed this up by launching the CCIO Leaders Network earlier this year.

The network exists to support the CCIOs in place, to encourage NHS organisations to appoint more, and to create a career path for young clinicians – doctors, nurses and allied professionals – interested in the role. It held its first annual conference at EHI Live 2012 in November, where Dr Yacoob was one of the speakers.

“If you look at any organisation – especially in the academic world – that wants to have information systems and managed data then, essentially, they go towards the CMIO model,” he says.

“It is true that there are variations in how people do it, but the fundamental fact is that you’re in an executive position. Whether you call it a board or an executive suite, the CMIO needs to be in a position to affect both priorities and the budget.”

When asked what other lessons UK healthcare providers can take from him and fellow US clinical information pioneers, Dr Yacoob offers a simple answer: just understand how important the role is.

“If you look at why IT implementations fail, there are two main reasons. Number one, of course, is resistance to change – which is where the CMIO helps physicians get over that hump. The other is a failure to execute properly.

“Successful execution relies on clinicians having the end goal in their heads. Technology folk and engineers work forward. I say as a clinician I’ve got to work backwards.

“[I start from]: ‘This is what I want, now work out how to build it for me’. It’s very different from: ‘Here’s what I’ve got, here’s how you’re going to use it,’” he says.

Driving a point home

Dr Yacoob expands on his point with another analogy. “I don’t know too much about London, but I know you have to have a great deal of knowledge to drive a cab there.

“You wouldn’t go ahead and just drive yourself around London and pick up passengers as you went. You would hire a cabbie. So you should [appoint] a CMIO who understands the pitfalls – the navigation on both the clinical side and the IT side – to make [projects] work.

“You just can’t do it by hoping technology will handle it or that the IT folks know, because they don’t. They’re not clinicians. They can hear about clinical work, they can see it, but they will never experience it and therefore know it.

“As a clinician, I’ve got to have control of the steering wheel. I’m driving.” And translating, too.