Eighteen years ago this week, my wife and I matched together in Denver. She went into OB/GYN. I went into Family Medicine. Same hospital. Same city. We felt like we’d won.
I had no idea that envelope was also going to give me a career in informatics.
What I Brought Without Knowing It
Medical school in New York City means rotating through a lot of hospitals. Big academic centers, community clinics, safety net ERs. I moved through about 15 different EHR systems or parts of systems during those years. I thought I was just surviving rotations. New logins, figuring out where the labs lived in yet another interface, credentialing paperwork.
I didn’t frame it as building a foundation. It wasn’t. It was just the texture of training.
But when St. Joseph’s Hospital in Denver announced it was going live on Epic, something clicked. I recognized the challenge in a way I couldn’t fully articulate yet. I raised my hand to be involved — not because I had credentials in informatics, not because I had a title or a plan. I just knew I cared about making this better for the people using it.
That has always been the North Star: make medicine better for doctors so they can deliver the best care for their patients. Simple. Hard to execute. Worth chasing.
The Meeting I Never Forgot
I was one of only a few residents invited to sit on the Epic planning committees. I remember listening to the rollout structure being laid out and having a very specific, quiet thought: Why are they planning to do it this way?
I knew my place. Second-year resident. Newest person in the room. I didn’t say anything.
But I also recognized something in myself that afternoon. I had instincts about this. I could see the gap between how the system was going to be configured and how it was actually going to be used at the bedside. The workflow wasn’t going to match reality. The personalization wasn’t being prioritized. People were going to fight the tool instead of use it.
I didn’t have vocabulary for it yet. I just had the feeling.
We went live on Epic without Order Entry the first year — still putting orders on paper alongside a partially implemented EHR. That was actually how Epic recommended phased go-lives back then. Imperfect. We got through it.
The Favor That Had a Career Inside It
Here’s where it actually started.
While I was still a resident, the sister hospitals in our system began their own Epic rollouts. They didn’t have house staff. They needed someone to help their attendings build templates, set up personalizations, and work through the anxiety of a major technology transition. They asked residents from St. Joe’s.
I said yes immediately.
That work was different from being a user. I was sitting across from attendings who had practiced medicine for 20 years, watching them feel uncertain about a login screen. Listening to frustrations that weren’t really about the software. The fear underneath most EHR resistance isn’t about clicking. It’s about identity. Whether the tool is going to make them feel competent or exposed in front of their patients and colleagues.
My job was to listen first, then help them build something that reduced that gap.
I didn’t know what to call what I was doing. Nobody handed me a title. The work just needed doing, and I found I was good at it.
Last weeks Sunday Share I made the argument that Clinical Informaticists have been doing product work for years without ever being called product people. Denver is where that started for me.
CMIO and CPO Are Not the Same Role
I’ve thought a lot about how the CMIO role compares to a Chief Product Officer, because the gap between them explains a lot about where I’ve landed.
The CMIO lives inside constraints by design. The EHR you have, the modules your contract covers, what’s technically possible within a vendor’s roadmap. That isn’t a failure of imagination. It’s the reality of enterprise healthcare. You’re optimizing within a bounded system, advocating upward, translating between clinical and IT, moving an enormous organization one workflow at a time.
The CPO gets to zoom out. You’re building toward an end state defined by what users actually need, not what the current platform supports. You own the vision and the outcome directly. If the product doesn’t work, that lands on you in a way that doesn’t distribute across a committee.
The accountability architecture is different. The CMIO is tied to organizational goals with many owners. The CPO owns the product outcome, full stop.
I didn’t understand that distinction eighteen years ago in that planning meeting. I was just a resident with instincts and a raised hand. But every role since traces back to that afternoon. The curiosity. The frustration with how things were being built. The belief that the gap between clinical reality and system design was closeable if someone cared enough to close it.
Denver gave me a career. I didn’t see it coming. That’s probably why it worked.
What was the moment you realized you’d accidentally found your path? Drop it in the comments.