1. Background and Significance
The role of the Chief Research Informatics Officer (CRIO) is emerging in academic
health centers to address the challenges faced by clinical researchers in our rapidly
evolving, data-intensive healthcare system [[1]]. CRIOs are involved in activities such as implementing informatics tools to facilitate
clinical research, designing data warehouses and workflows to improve the secondary
use of electronic health record (EHR) data, developing infrastructures for advanced
data analytics, bioinformatics and precision medicine research, and balancing the
need for data security and privacy [[1], [2]].
Despite the rapid growth of biomedical research informatics needs across healthcare
systems, the emergence of the CRIO role is very recent. There are certainly other
leadership roles that are responsible for the research informatics needs across an
academic health center, but only a handful of institutions have made a commitment
to elevate this role to the chief officer level. To date, there is very little published
information about this role and the individuals who serve it.
3. Methods
3.1. Survey
3.1.1. Design, Setting and Participants
The survey was a cross-sectional, anonymous survey. Invitations to participate in
the survey were sent to the professional e-mail account of all the CRIOs and CRIO-equivalents
in academic health centers in the United States who were identified through an extensive
search. A CRIO-equivalent was considered as a leader at the chief officer level whose
primary responsibility was to oversee the research informatics activities in their
organization. The search included colleague referrals, online search engine queries,
and professional networking directory searches. The identified CRIOs were invited
to participate in the survey a maximum of three times.
The REDCap survey module at the University of Missouri-Columbia was used to conduct
the online survey [[3], [4]]. The University of Missouri-Columbia and The University of Chicago Institutional
Review Boards approved this study.
3.1.2. Survey Development
The survey was developed in two stages. In the first stage, a draft survey was developed
by three of the co-authors (LNSP, ASMM, KFH) using two prior surveys of Chief Medical
Informatics Officers as a models [[5], [6]]. In the second stage, three CRIOs were invited to review the survey and suggest
changes.
Topics covered by the survey included the CRIOs background and training; experience,
time distribution and salary; reporting structure and funding; and future opportunities
and challenges.
3.1.3. Analysis
Survey responses were analyzed descriptively and simple proportions are provided.
The free text answers to open-ended questions were analyzed qualitatively by three
of the co-authors (LNSP, ASMM, KSH) and the responses were grouped in high-level themes
for interpretation.
3.2. Expert Panel
The Clinical Research Informatics Working Group convened an expert panel of CRIOs
during the 2016 AMIA Annual Symposium. Three expert CRIOs were invited to participate
in the panel: Peter Embi, MD, of The Ohio State University; Umberto Tachinardi, MD,
of the University of Wisconsin-Madison; and William Barnett, of the Regenstrief Institute
and Indiana University School of Medicine/Indiana Clinical and Translational Science
Institute. The invited panelists responded to a set of structured questions designed
to address some of the key success factors related to their CRIO roles, and they also
answered questions that spontaneously arose from the audience during the course of
session. The structured questions addressed four topics:
-
factors associated with the success of the role;
-
growing the research informatics enterprise; innovation and new technology; and
-
data sharing and collaboration.
The panelists’ utterances were captured in the form of field notes and analyzed qualitatively
by three of the co-authors (LNSP, ASMM, KSH). The responses were grouped in high-level
themes for interpretation. The topics discussed and themes that arose are summarized
in the results.
4. Results
4.1. Survey
A total of twenty-five CRIOs were identified through the search and were invited to
participate. Sixteen completed the survey (64% response rate). The actual professional
titles of the CRIOs had some variations, including: Chief Research Informatics Officer,
Chief Research Information Officer, Chief Clinical Research Informatics Officer, and
Chief Research and Academic Information Officer.
4.1.1. Background and Training
All of the CRIO respondents reported having at least one doctoral degree (either MD,
PhD, or both) as their highest level of education. Half of the CRIO respondents were
physicians (two of whom also had a PhD), and the other half were non-physicians with
a PhD (►[Figure 1]).
Chief Research Informatics Officers (CRIOs) at al glance. *Clinical time calculated
only for physicians. **Salary distribution calculated using data from the CRIOs who
provided that information.
88% of the CRIOs who were also physicians had an additional Masters-level degree.
Out of the eight physicians, four were pediatricians or pediatric subspecialists,
three were internists and one was a family medicine practitioner. Three of them had
a board certification in Clinical Informatics through the American Board of Preventive
Medicine.
One of the non-physicians PhDs had additional Masters-level training outside of their
primary training. The academic background of the non-physician PhDs included computer
science, molecular biology and bioinformatics, microbiology, archaeology, and biomedical
informatics.
94% of all respondents had some formal educational training in biomedical informatics
including graduate-level courses, Masters degrees, fellowships, and PhDs.
4.1.2. Experience
Half of the CRIO respondents reported more than 15 years of experience in biomedical
informatics, however 69% had been in the CRIO role for less than 3 years (►[Figure 1]).
88% of the respondents were the first CRIOs to hold that position at their institutions.
Nine respondents had prior leadership roles in biomedical informatics before becoming
CRIO, four had other leadership roles outside of informatics and three had no prior
leadership experience. The titles for the leadership roles held prior to the CRIO
role included: Director of Biomedical Informatics, Director of Research Informatics,
Director of Bioinformatics, Director of Translational Bioinformatics, Director of
Biomedical Information Technology Core, and Chairman of the Department of Biomedical
Informatics.
4.1.3. Organizational Structure and Challenges
According to the respondents, most CRIOs report directly to their academic health
center’s Chief Information Officer (38% of respondents), Vice President for Research
(38%), or the Dean or Vice Dean for Research of the Medical School (31%). 40% of CRIOs
reported to more than one senior leader in their organization, with the combinations
Chief Information Officer/Vice Dean and Vice President for Research/Dean as the most
common. CRIOs had a median of 9 people reporting directly to them (interquartile range
[IQR] 5 to 24 people).
The most commonly reported challenges faced by CRIOs in their organization included:
securing funding (63% of respondents), dealing with data governance issues (56%),
building data analytics capabilities (50%), leveraging electronic health records for
research (44%), dealing with data privacy and legal issues (44%), and securing senior
leadership support (30%).
4.1.4. Funding of Research Informatics
All the CRIOs reported that research informatics activities was funded at least in
part as a cost center for the organization, that is, a center within the organization
that generates value but no revenue. 69% also reported that Clinical & Translational
Science Awards (CTSA) and Cancer Center grants were used to fund their activities.
63% had a charge back model for some of the research informatics services. 50% of
CRIOs reported that their activities were funded with a combination of all three sources
(organizational, grants, and charge backs).
4.1.5. Time Distribution and Salary
Respondents reported a median of 50% of time devoted to the CRIO role (IQR 30 to 70%).
Other activities include: research (30%, IQR 15 to 45%), other administrative roles
(10%, IQR 5 to 15%), and teaching (5%, IQR 5 to 10%). Physician CRIOs reported a median
of 10% of their time devoted to clinical practice (IQR 0 to 10%) (►[Figure 1]).
Respondents reported that within their role as CRIOs most of the time was devoted
to developing and managing infrastructures, such as data warehouses, high-performance
computing, or biobanks (a median of 20% of their time); managing clinical research
services, such as clinical trial management systems, i2b2, or REDCap (20%); developing
and managing core services, such as bioinformatics pipelines, natural language processing,
and ontologies (10%); managing data requests services (10%); data governance activities,
such as committees or policy development (5%); and data security activities (5%).
When asked what they would rather be doing with their time as CRIOs, the most frequent
themes in their responses, in order of frequency, included: working on innovation
and new technologies, consolidating and expanding the research informatics capabilities
and training in their organizations, increase multi-institutional and industry collaboration,
improve advance analytics capabilities, and increase their role in their organization’s
strategic planning.
Thirteen respondents reported their salary. The median CRIO salary reported was between
$250,000 and $299,000 of total compensation. 31% of CRIOs reported a salary greater
than $350,000 (►[Figure 1]). There was a correlation between the primary medical specialty and experience of
the CRIOs and their salaries.
4.1.6. The Future of Research Informatics and the CRIO Role
CRIOs were asked to list three challenges and three opportunities in research informatics
and their role as CRIOs in the next 5 years. For the challenges, the most common themes
identified were: funding and sustainability; data policies, security and governance;
integration of research informatics with the clinical enterprise; keeping up with
technological and analytical advances; and dealing with lack of leadership support.
Among the opportunities, the most common themes included: the Precision Medicine Initiative
and the Cancer Moonshot; advances in Big Data analytics and data science; and increased
data sharing.
4.2. Expert Panel
During the 2016 AMIA Annual Symposium, three experts were invited to discuss their
experience as CRIOs and answer questions from the audience. The topics discussed included:
key factors to succeed as a CRIO in the organization, the funding of research informatics,
and the role of the CRIO in managing information technology (IT) services. What follows
is a summary of these discussions:
4.2.1. Achieving Success as a CRIO in the Organization
A key factor to achieving success is to think of research informatics and the CRIO’s
role as a service to the organization and to provide strategic IT leadership. Developing
a detailed business plan and securing a firm commitment from the senior leadership
is important.
One way to ensure organizational support is to align the research informatics activities
with the strategic planning of the organization, which might include goals such as
increasing competitive success in federal funding for medical research, improving
services to the research enterprise, or developing precision medicine and Big Data
programs.
An important factor to take into account is that the CRIO role crosses many boundaries,
such as responsibility for data security and privacy, IT, research, clinical informatics,
etc. Keeping in mind those boundaries and the individuals involved is important. In
particular, one of the CRIOs highlighted how keeping a good alignment and purposefully
avoiding conflict with chief information security and privacy officers can be tremendously
beneficial. The role of honest brokering between the security and confidentiality
of data needs of researchers is a key responsibility of the CRIO.
4.2.2. Funding Research Informatics and the CRIO Role
When establishing a new CRIO position, it is important to negotiate dedicated resources
up front. Resources must include some seed funding with some ongoing investment overtime
that will be supplemented by grants and charge backs. This supplemental revenue can
be used to grow the research informatics enterprise, hire additional personnel, and
increase the service lines, but it cannot take the place of some ongoing support from
the organization.
In regards to the ongoing financial support of research informatics and the CRIO role
as a cost center, one factor that should be considered is the opportunity cost around
the risk of research data breaches. The mechanisms developed and managed by CRIOs
to minimize the risk of research data and personal health information loss or misuse
can represent a huge value for the organization, and this should be taken into account
in the negotiations for ongoing support.
One final advice from the expert CRIOs in regards to the negotiation of ongoing support
is to use the federal grant’s request for application requirements as a way to justify
research informatics expenses. An organization that cannot meet the increasing research
informatics requirements for federal grants will lose competitive advantage.
4.2.3. Management of IT Services for Research
There does not seem to be a universal model of the CRIO’s role in managing IT services
for research. While some CRIOs are in charge of managing the technical infrastructure
and data pipelines involved in research data warehousing, high-performance computing,
and delivery of research software services, not all CRIOs do so. For example, some
CRIOs might be in charge of managing the access and use of research data, while their
organization’s Chief Information Officer (CIO) is in charge of maintain the IT infrastructures
that support those activities. This overlap between CIO and CRIO varies widely between
institutions.
One trend that all three experts agreed on is the move towards cloud-based services
for the organization’s IT needs, including for research, and concurrent reduction
in the need for local IT services.
5. Discussion
We have presented the results of a national survey of Chief Research Informatics Officers
(CRIOs) and a summary of an expert panel discussion. CRIOs come from diverse backgrounds
with an even split between physician and non-physicians. Most have advance training
and extensive experience in biomedical informatics, including leadership roles, but
most have been CRIOs for fewer than three years. Indeed, the first CRIO appointed
in the US was Dr. Embi, who was named CRIO at The Ohio State University in the October
of 2010.
The reporting structures of CRIO’s also vary, but seem to reflect their dual allegiances
to both the medical center (with direct reports to the Chief Information Officer or
Vice President for Research) and the medical school (with direct report to the Dean
or Vice Dean for Research). Most CRIOs spend at least half of their time in their
CRIO role and many of them maintain a substantial amount of research time for their
own projects. CRIOs identify funding, data governance and security, and building advanced
data analytics capabilities as their major challenges. If they could, they would like
to be doing more work in innovation and new technologies, and establishing external
collaborations with other academic health centers and industry partners. CRIOs seem
to remain optimistic about the future and see the Precision Medicine Initiative and
advances in data science as opportunities for growth of the research informatics enterprise
and their role in academic health centers.
As shown in the survey, most current CRIOs are the first officers in their institutions
to hold that role. CRIOs appear to fall into two major categories. In many cases,
CRIOs are the research counterparts of the Chief Medical Information Officer (CMIO),
a role that emerged in healthcare organizations more than two decades ago [[7]]. A recent AMIA Task Force reported its recommendations regarding the knowledge,
education, and skillset requirements of the Chief Clinical Informatics Officer (CCIO)
roles, which encompass CMIOs as well as the Chief Nursing Informatics Officers (CNIOs)
and their pharmacy and dental counterparts, and sometimes fall under the purview of
a Chief Health Informatics Officer (CHIO).[[8]] Some of these roles are now well established and standardization of their training
and knowledge requirements is starting to take place. The CRIO role remains less well
defined, but it can be expected that as the number of leaders in this role grows,
standardization of their training and skillset will also take place. CMIOs and other
CCIOs have played a key role in establishing operational informatics programs, implementing
clinical information systems, and developing clinical decision support applications,
all of which has contributed to laying the foundation of the digital infrastructure
in healthcare [[5], [8]]. As the CRIO workforce grows and the importance of the research informatics mission
increases, it can also be expected that CRIOs will have an equally impactful role
in the future of healthcare.
CRIOs who span both the academic and clinical enterprises at academic health centers
often have similar roles to CMIOs and other CCIOs, only focused on the academic health
center’s research missions rather than the clinical ones. Alternatively, some CRIOs
focus mainly on the operational research sides of the enterprise. In those cases,
CRIOs function more like counterparts to academic CIOs, emphasizing infrastructure
for basic, translational, and clinical research, but with less emphasis or oversight
of clinical information systems’ use to support research. In all cases, CRIOs augment
the capabilities and effort of their CCIO and CIO counterparts, advancing goals in
of the academic health centers research mission, especially important in this era
of rapidly evolving biomedical research opportunities including Big Data, advanced
analytics, the emergence of large clinical data research networks, the evolution of
clinical trials, and the push for precision medicine [[9]–[15]].
This paper has several limitations. First, the survey results include responses from
a limited number of CRIOs. However, because of the small size of the workforce and
the fact that almost two out of every three CRIOs identified in the US completed the
survey, the results can be considered representative. Also, the expert panel discussion
summary presented represents the opinion of three individual CRIOs, but because of
their diverse background and extensive experience, their opinions can be considered
very informative. A similar paper discussing the emergence of the CMIO role more than
a decade ago had information from only five participants and yet it remains the most
cited paper about the CMIO role, which signals its usefulness to readers [[5]]. Finally, not all the important topics related to the CRIO role were included in
the survey or discussed in the expert panel. Topics that can be included in future
surveys and studies about the CRIO role include: the working budget of the CRIO, measures
of success and added value to the institution, and the role of the CRIO in biobanking
strategies, amongst other. We hope this paper will be helpful for aspiring and newly
named CRIOs, as well as the leaders in academic health centers who are considering
creating a chief officer-level position to develop and manage their organization’s
research informatics activities.
