The CMIO Survival Guide: A Handbook For Chief Medical Information Officers and Those Who Hire Them Second Edition Rydell
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The CMIO Survival Guide
A Handbook for Chief Medical Information Officers
and Those Who Hire Them
Second Edition
The CMIO Survival Guide
A Handbook for Chief Medical Information Officers
and Those Who Hire Them
Second Edition
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lisher cannot assume responsibility for the validity of all materials or the consequences of their
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Introduction........................................................................ vii
Editors................................................................................... ix
Contributors......................................................................... xi
1 The Evolution of the CMIO in America....................1
RAYMOND ALLER AND RICHARD L. RYDELL
v
vi ◾ Contents
Index........................................................................... 147
Introduction
vii
viii ◾ Introduction
the EHR has become its lightning rod. Most will admit that an
EHR is truly required to access the information necessary to
provide the best care, but we all acknowledge that the systems
have not kept up with increasingly complicated patients who
expect more and more from modern technology. We are on
the crest of a wave that will leverage AI (artificial intelligence)
and machine learning; advanced imaging; and enhanced
analytics to finally deliver on the promise of improving quality,
efficiency, and both patient and clinician satisfaction. It is these
tools that will be available to the progressively greater number
of young men and women we see extending their training in
medicine to preparation for leadership in medical informatics.
And it is to them that this book is dedicated; and to those who
would seek to understand why they have made this career
choice, to those who hire them in these roles, and hopefully
to assist them in this transformation of healthcare.
The structure of this book is brief, targeted, and to the
point, in keeping with the new literary style that has appeared
in the last decades with the advent of the World Wide Web. It
is our intention to periodically update and revise the contents
of this manual, in keeping with the rapidly changing field of
medical informatics, and the roles of the CMIO.
The authors of this book represent many of the leaders of
AMDIS, but we would be remiss if we did not recognize the
wisdom that is provided by all the members of our esteemed
organization that provided for the core knowledge that we
share with you today.
ix
x ◾ Editors
Contents
Bibliography................................................................................. 9
1
2 ◾ The CMIO Survival Guide
The laser drilling head was lowered on five hundred feet of minute
cable, which had tremendous tensile strength. The vaporized moon
substance boiled out of the hole and condensed above the surface,
settling as fine dust. As the hole deepened, the condensation
products coated the upper portions of the hole and the cable. To keep
the hole from thus being closed, the cable was vibrated at a
frequency that shook loose the condensing rock products, and the
laser head was raised with beams shooting upward to clear the hole.
Jim found that a very special technique was required to raise and
lower the head at the proper intervals to keep the hole clear and
prevent loss of the drilling head. A spare was carried, but he didn't
want to face the loss of even one. After three weeks, he felt confident
in his operation and began lowering the drilling head to depths of two
hundred and three hundred feet.
As he had expected, along with the lunar geologists who were
participating, the moon showed a definite pattern of stratification. But
the differences between the layers seemed slight. Chalky, calcium
compounds were abundant. Some were powdery; others were
pressed into brittle limestone formations. No really hard rocks such as
granite were encountered, however. The boundaries between layers
were ill-defined. No one knew what to make of it. The observations
were interesting. Explanations were wholly lacking.
Then, after five weeks of probing, on the edge of the four-hundred-
foot level, Jim found something new. He sought out Sam at the end of
the day.
"A few years ago," he said, "scientists were startled to find chemicals
that were the product of life, inside meteors from outer space."
"I understand they've even found bacteria which they have been able
to bring to life," said Sam.
Jim nodded. "More than four hundred feet deep on the moon I've
found the same kind of chemicals—hydrocarbons that must be the
product of living cells."
"Four hundred feet deep on the moon—" said Sam musingly. "And
maybe the moon came from billions of billions of light years across
space. So wherever it came from there was something living. What is
it? Traces of bacteria, or chemical remains of plant life like our coal
mines?"
Jim shook his head. "I don't know yet. I'm not sure we can find out
until we go there. But, as you say, it means the moon was once the
scene of life—wherever it came from."
"One thing I haven't understood," said Sam, "is why the moon
stopped here if it had been traveling through space for so long. Why
didn't it keep on going?"
"It was just a combination of factors," said Jim. "The moon happened
to be traveling at just the right speed. The earth was in just the right
place at the right time. As a result, the moon fell into an orbit around
the earth. Pure accident."
"A lucky accident!" said Sam.
Jim looked up at the pale moon above their heads as they walked
toward the parking lot. "I hope so," he said. "We will soon know
whether it was a lucky or an unlucky accident."
The moon laboratory had not been designed for extensive organic
chemical analysis. There were only a few things it could do with
organic compounds. But these were sufficient to convince Jim that
the moon had once been the scene of life.
Why so deep? he wondered. Nothing had been found in the upper
levels, unless he had missed it—he would have to check that out
later.
As the drilling head moved slowly downward, the evidence of fossil
hydrocarbons increased. There seemed to be an almost geometric
increase in concentration after he passed the four-hundred-foot level.
He was certain the drill was penetrating a bed of fossil remains of
some form of life that flourished the little planet that the moon must
have been incalculable eons ago.
The more he thought about his theory, however, the more difficult it
became to explain all the factors. If the moon had actually been a
planet of some far distant system, what had torn it loose from its
parent sun and sent it careening through space? Had its sun
exploded, blasting whatever planets the system held into the depths
of space? Such an occurrence might explain the sterility of the
moon's surface, but why was the evidence of life buried so deep?
Perhaps the upper layers of the moon's surface consisted of debris
blasted from the exploding sun. Such debris would have been molten,
flowing about the moon's surface, cremating everything living. Finally,
it would have shrunk in the cold depths of space and wrinkled into the
vast mountains and cracks that laced the moon's surface.
It was one way it could have happened, but it seemed so fantastic
that Jim had difficulty in convincing himself that it was true.
He doubted the accuracy of his analyses. There were so many
tenuous links between the substance on the moon and his own
senses that an error in any one of them could destroy the accuracy of
the results. But he had no reason to doubt.
He began making calibration checks before and after every analysis.
It added scores of hours to his work. Sam sat beside him, checking
and verifying the accuracy of the telemetering circuits constantly. The
operation was as foolproof as their science could make it.
"You've got to believe what you find," said Sam. "There's no other
answer."
And then, one day, Jim found an answer that was utterly impossible
to believe. His mind balked and closed up completely at the thought.
Sam had been watching him for almost three hours, aware that
something had perturbed Jim exceedingly. Sam kept his mouth shut
and leaned quietly against the desk of his own console, keeping
check on the circuits while he watched Jim grow more and more
distressed. Sam didn't understand the processes, but he was aware
that Jim had been going over and over the same analysis for almost
two hours. At last Jim's face seemed to go utterly white, and his
hands became motionless on the console.
Sam waited a long time. Then he asked, "What is it, Jim? What's the
matter?"
Jim continued to stare at the panels of the console, then answered as
if from some far nightmare distance. "Two chemicals, Sam," he said.
"One of them a big molecule, something like hemoglobin. And neither
of them could exist as fossils. Their structure would have broken
down long ago. They could exist only in live tissue!"
He continued staring. Neither of them moved. Sam felt as if he had
just heard something in a nightmare and had only to wait a minute
until he woke up. Then it would be gone.
Jim turned his head at last and faced Sam. He gave a short, harsh
bark of a laugh that sounded half-hysterical.
"We'd be off our rockers, wouldn't we Sam? Clear off our rockers to
believe there could be something alive five hundred feet inside the
moon!"
"Sure—and if it were alive, it wouldn't be sitting still while the laser
beams drilled a hole into it. Besides, we just couldn't be lucky enough
to lower the drill right smack into some cave where a moon bear was
hibernating. All the circuits must have busted down at the same time.
We'll fix it tomorrow. Let's get the girls and have a night on the town."
It was a very unsuccessful night on the town. Jim and Mary, and Sam
and his wife went to a show and a nightclub.
"You're moving like a zombie. What's the matter?" said Mary as she
and Jim danced together.
"Feel like a zombie. Why don't we give it up and go home? I want to
get down to the lab by five in the morning."
"That's the trouble. You've done nothing but live in the lab since the
Prospector landed. So we're not going home. Sam and Alice are
having a good time. You dance with Alice next, and make her think
you're enjoying it!"
So Jim didn't go to bed at all, but he was at the lab by five in the
morning. The night crew were still at work. He had steered them
away from the analyses he was doing so they were unaware of the
shattering results he had found.
He took over the controls, and resumed work alone.
There was no doubt about it. If any of the methods they were using
were accurate, then he had discovered almost indisputable proof that
some living tissue existed five hundred feet below the surface of the
moon.
Since the laser drilling head sealed the walls of the hole with a
coating of frozen lava, it was necessary to probe horizontally for
samples. Small extension drills, capable of reaching five feet on
either side of the hole, were carried in the head for this purpose.
Jim lowered the head through the last twenty feet of its drilling limit.
Every six inches he sent the horizontal probes to their limits. The tell-
tale chemicals existed at every point. He computed the volume he
had probed, and felt numb.
By the time Sam had shown up, Jim had withdrawn the probe to the
surface and was moving the Prospector slowly across the moon's
surface.
Sam saw the motion on the television screen. "Where are you going?
I thought we were going to check out the hole we were in."
"It's been checked," said Jim. He hesitated. His original plan had
been to move the Prospector a distance of fifty feet and probe again
to the five-hundred-foot level. Then, decisively, he pressed the control
that kept the Prospector moving. He stopped it a hundred feet from
the previous hole and began the long, tedious job of drilling again to
the limits of the Prospector's equipment.
Sam spelled him off during the day. By evening, they had hit the four-
hundred-and-fifty-foot level. Jim took his first analysis in this hole. The
chemicals were there. In greater concentration than at the same level
in the previous hole.
Jim turned to Sam. "We have circuits for measuring potential
differences on the lunar landscape. Could we make a reading at the
bottom of this hole?"
Sam considered. "It'll take some doing, but I think we can manage it.
What do you expect to find from that?"
Jim didn't dare tell him what was in his mind. "I don't know," he said.
"But it might be worth trying—if there is anything living down there—"
By the following afternoon, Sam had made the necessary equipment
arrangements so that potential readings could be obtained in the
mass from which the chemical samples were being removed. The
telemetered report was connected to a recorder that plotted the
variations against a time scale.
As soon as the circuit was set up and calibrated, the recording meter
showed a response. A very slow, rhythmic pulsation showed in the
inked line on the paper.
Jim felt as if his breathing must have stopped for an infinite length of
time. "That's what I thought we'd find," he said at last.
"What?" said Sam. "I don't understand what you're talking about.
What do you think those pulsations mean?"
"Did you ever hear of an electroencephalograph?" said Jim, gravely.
"Electro—Sure, brain wave recordings. Jim! You don't think these
waves—!"
In silence, the two men stared at the wavering pen and the sheet of
recording paper that slowly unrolled beneath it.
Dr. Thomas Banning had been a class mate of Jim Cochran when
they were both in their first couple of years of college. Banning had
gone on into medicine, specializing in brain studies, while Jim had
turned to chemistry. The two had been out of touch for several years.
Tom Banning was the first one Jim thought of, not only because of
their old friendship, but because he had read recent papers
describing some of Tom's new work on the frontier of
electroencephalography. He called first on the phone, then arranged
for a personal visit. Sam went with him. They had closed down all
Prospector work while they were to be away.
Tom met them and was introduced to Sam as he ushered them into
his own modest laboratory. "This isn't the plush sort of surroundings
you've become used to," he said as he showed them around. "The
Government isn't spending billions these days trying to find out how
the human mind works."
Jim could well understand Tom's bitterness. Doing research on the
frontiers of the mind, he was forced to spend his own money for much
of his laboratory equipment.
"I can sympathize, but that's about all," said Jim. "I just work here
myself."
"Tell me about your problem. On the phone, that sounded interesting
enough to make a man's day brighter. You said something about an
unknown life form with electrical pulses that might be related to brain
waves?"
Jim nodded. "That's the way it looks to me."
"But where does this life form exist? Surely it can be identified!"
"If I told you, you'd throw me out or call the paddy wagon. Look at
these, first."
Jim and Sam spread out the long folds of chart they had accumulated
through days of recording. "Does it look like anything to you?" asked
Jim.
Tom Banning frowned. "Well, it certainly could be an EEG record of
some kind. The apparatus—"
"The apparatus was nothing but a single electrical probe, and the
signal was transmitted under very unsatisfactory conditions."
"Signal transmitted, you say? Just where did this come from, Jim?
You didn't come all this way just to pull my leg."
"No," said Jim wearily. "If anybody's leg is being pulled, it's mine. I
wanted to see if you could recognize it as having any similarity to an
EEG. Then I wanted to ask about your work you reported in your last
paper. The one on 'EEG as a Brain Stimulus and Communication
Medium'."
"Yes? What did you want to know about that?"
"You've had some success in taking the EEG waves of one person
and applying them to the brain of another person so that the latter
understood some of the thoughts of the first person while being
stimulated by his brain waves."
"Yes."
"Would it be possible to do that with this record?"
Tom studied the record silently. "Any cyclic electric impulse can be
applied as a stimulus to the brain. Certainly, this one can. My
question still remains, however, what kind of a creature generated
these pulses? If it is so alien you can't even identify it, we can't really
be sure that these are brain waves. I can only say they may be."
"That's good enough for me," said Jim. "How about setting it up so
that we can see if these tell us anything."
"I think I ought to make you tell me where you got these, first."
"Afterwards, please, Tom."
It took the rest of the day to transcribe the record to the format
required by Tom's light-intensity reader. They set the following day for
the experiment.
Both Sam and Jim were to participate. Tom applied eight electrodes
to the skull of each man. They reclined in deep sleep-back chairs,
and Tom suggested they close their eyes.
Jim began to feel a sense of apprehension as he heard the first faint
whine of the equipment. He knew the transcribed tape was unreeling
slowly beneath the photo-electric scanner. The resulting fluctuating
current was being amplified, filtered, gated to the proper level, and
applied to the electrodes on his skull. He felt nothing.
"Just like a ride on the merry-go-round," he said in disappointment.
Then it struck.
Like a fearful, billowing blackness rising out of the depths of Hell
itself, it washed over him. It sucked at his very soul, corroding,
destroying, a wind of darkness where the very concept of light was
unknown.
He was not conscious of his screaming until he heard his own dying
voice and grew slowly aware of the sudden rawness of his throat. He
heard another screaming and it sounded like Sam. Dimly, he
wondered what had happened to Sam.
Tom was bending over him, patting his face with a cold towel and
murmuring, "Wake up, Jim! You're all right now. You're all right."
He opened his eyes and saw Tom, white-faced. He turned and looked
at Sam, whose head lolled sluggishly while a low whimpering came
from his lips.
"I'm all right," said Jim weakly. "Take care of Sam."
Exhausted, he leaned back and closed his eyes another moment.
Sweat oozed from every pore of his skin, cold, fear-inspired sweat.
Jim took his seat at the console and watched the slow progress of the
Prospector across the moon's surface. It was winding its way through
an area of small, low crags. Ahead was a smooth, level plain. Jim
determined to halt there and make the next probe.
Out of the corner of his eye he saw Hennesey moving toward them.
He could think of nothing that would make the day more unpleasant
than Hennesey's presence.
The Project Director scanned the panels and the meters that showed
the distance traveled by the Prospector.
"Why have you moved the machine so far?" Hennesey demanded.
"You've used up valuable machine time that could have been used in
additional probes. We may be approaching the end of the useful life
of the Prospector very rapidly."
"I am aware of that," said Jim icily. "The stock of reagents aboard is
nearly exhausted. I wanted to make at least one comparison probe at
a considerable distance from our original site."
Hennesey grunted and remained silent, watching. Then, suddenly he
cried out, "Look out! You fool—!"
Jim had seen it, too. At the edge of the crags was a ten-foot wide
fissure spreading darkly on either side of the Prospector. The drives
of the machine were upon it before he realized it was there. In fact,
the crazy thought echoed in the back of his mind that it wasn't there
an instant before.
He slammed his hand against the switches that sent out a reversing
signal to the drives of the Prospector. But it was too late. The worm
drives bit into nothingness as the machine toppled slowly at the edge
of the crevasse. And in that moment, as the image on the television
screen teetered crazily, Jim had the impression that he was looking
into the black depths of utter horror. There was a blackness oozing
and writhing faintly in the depths—that could have been thirty or a
hundred feet deep. But he had seen just such a black horror once
before.
When the EEG signals from the moon first smashed into his brain!
He glanced at Sam. Sam was staring in a kind of intense horror that
told Jim he recognized it, too.
The image tilted abruptly against the black moon sky. Then the
screen went dark. And Jim had the feeling that the blackness had
closed over him.
But Hennesey had sensed nothing of this. He was cursing and raging
beside Jim. "You blind, brainless fool! You wiped out a billion-dollar
experiment because you weren't looking! You're through, Cochran!
Get everything that's yours and be out of here in ten minutes!"
Hennesey whirled and strode away, his rage reeking through the
atmosphere of the room.
Jim stood up and moved to the back of the panel. He opened the
plastic doors and clipped the last ten feet from the spool of TV
recording tape and slipped it in his pocket. When he returned to the
other side of the console, Sam was waiting for him.
"Where are you going?" said Jim.
"With you."
"Where's that?"
"I don't think you know, but I do. I'll tag along and see if I'm right."
"You're crazy. Didn't you just hear Hennesey fire me?"
"Yeah. I quit at the same time."
"You're really crazy."
Jim had a few textbooks and scientific papers in his desk. He
arranged for one of his men to clean them out. He didn't feel that he
could endure remaining in the station any longer.
Tom Banning followed them out into the sunshine of the parking lot.
"I'm sorry," he said, "but it looked as if what happened back there was
rather inevitable."
"It was," said Jim. "I'd have kicked his teeth in sooner or later. It's
better this way."
"What will you do now?"
"Ask Sam. He seems to think he has some crazy idea of what I'm
going to do next. I sure don't."
"The news conference," said Sam. "You'd better call it right away
before news of your dismissal gets out. They may think you just want
to unload some sour grapes if they hear of that first."
"Yeah, I guess you're right. Will you back me up in the conference,
Tom?"
The doctor nodded. "Gladly. It's pretty hard to believe, but you've got
me believing."
They kept him for another two hours with questions and demands for
further information. He gave them everything he knew, and when they
finally left, he felt that a sane and correct story of his findings would
be published. He waited for whatever results would be published by
the news services the following morning.
He waited.
There was nothing.
Eddie Fry called him two days later. Eddie was the reporter who knew
him best. "They killed the story," said Eddie. "We had to clear it with
government sources, and they persuaded every press association
and newspaper that knew about it to kill it. They said it would destroy
the national economy that was being built up on the space program.
We tried to make them believe it, Jim, but we couldn't do it. It was
hard enough to be convinced when we were listening to you. Second
hand, it just wouldn't go over. You really can't blame them.
"They're doing something else, too. They're really going to nail you for
this thing. A story is being released about your dismissal. It is said
that you were released for fantastic and unreliable theories and for
incompetence that resulted in the loss of the Prospector. I'm sorry as
hell, Jim. I wish we could kill that one, but there's not a thing we can
do for you."
"It's o.k., Eddie," said Jim. "I know how it is."
Crackpot. He was finished.
He called Allan at his base that night. His brother-in-law's voice was
icy as he answered. "What do you want, Jim?"
"Come down over the weekend, can you, Allan? I've got something
important I want to talk to you about."
"Listen, Jim. Stay away from me! Don't call; don't try to see me. Don't
send me letters or telegrams. Nothing! Do you understand that?"
"What the devil—?"
"They're investigating me. Because of you. They want to know how
much I've been listening to your crackpot notions. They're afraid
maybe it will produce an instability that will make me unfit for the
moon trip. If I lose out, it will be because of you!"
"That's what I want to talk to you about. Allan, you've got to listen to
me! You won't get off the moon alive—"
The phone went dead. Jim hung up slowly and went back to the living
room where Mary sat in tense, white fear. She had heard Jim's side of
the conversation. She guessed what Allan had said.
"It's no use," said Jim. "Don't try to reach him. He'll hate you forever."