CMIO for the Future

What a Strange Journey it’s Been!

Judi Binderman, MD MBA MHSA

VP CMIO

Community Medical Centers

Where is Clovis/Fresno, CA?

Community Medical Centers

Clovis Community Medical Center

Fresno Heart & Surgical

Hospital

Community Behavioral Health Center

Community Regional Medical Center

Snapshot:

• Central California

• 1100 Beds & growing

• 58,000 Admissions

annually

• 172,000 ED visits

• 1300 Affiliated physicians

• 300 Residents

• 350 Med Students

• EPIC EMR x 5 years

Definitions

• Informatics

– noun plural but singular in construction

– The collection, classification, storage, retrieval,

and dissemination of recorded knowledge

• Chief Medical Informatics Officer

– A healthcare executive generally responsible

for the health informatics platform

– Supports the efficient design, implementation,

and use of health technology within a

healthcare organization.

Within an Organization

• Reports to either CMO, CIO, COO, or

CEO.

– Role and responsibilities vary widely

– Typically include at least one of the following: – Strategic planning

– EMR Governance and Policy development

– Systems development and implementation

– Stakeholder engagement

– Capacity Building

– Informatics education and platform development

– Data mining and quality reporting

– Education, Training and curriculum design

The Runway

“By the time Doctors woke up to the potential of

the computer in medicine, territorial imperatives

were firmly established. …the CIO and his staff

were firmly in charge.”1[Stark, 1998]

“CPOE is probably the first IT initiative being led

by people outside of IT,” and “Physicians are key

leaders.” 2 [Classen, 2004]

“Clinical knowledge management remains an essential

CMIO responsibility, but new areas of responsibility at

some organizations include analytics and population

health management leadership.” 3 [Advisory Board, 2015]

Essential Skills/Knowledge

Analytics

Population Management

Strategic Planning

Technical Comfort

Process Design

Clinical Leadership

People Skills

Clinical Knowledge

Today’s Focus*

• EMR Liaison

– Champion for adoption

– Engagement for design

– Optimization / New modules

• Clinical Knowledge Management

– Serve up best practices

– Leverage technology

• Operations Management

– Resources

– Budget

*Advisory Board-CMIO Role in 2015

Today’s Focus*

• Analytics – Metric Development

– Disease Management

– Good data in = good data out

• Population Health Management

– Risk stratification

– Data aggregation

– Resource utilization

– Value over volume

– Continuum of information

• Patient Engagement

– Patient Portal

– Secure messaging

*Advisory Board-CMIO Role in 2015

Daily Frustrations

• Unhappy physicians

– Loss of productivity

– Constantly changing systems

– New workflows

• IT projects thrown over the fence

• Fighting for validation and commitment

• Over-commitment in organization

CMIO 2.0

• “The first-generation CMIO was a change agent, an implementer… [providing] operational heavy lifting with creating order sets, engaging physicians in new systems, and overseeing training and education”

• “This next generation is more strategic and visionary... searching for the type of initiatives to leverage the healthcare system’s investment in EHRs, focused on population health, improving patient safety and care and lowering costs.”

H. Ross, in Healthcare Informatics, the Rise of the Second Generation

CMIO

My Path to CMIO

Doctor Consultant

CMIO

Reimbursement

Quality Regulations

Technology

Patient

Satisfaction

Documentation

Coding

Population

Management

EMR Best

Practices Analytics

Reimbursement

Process

Efficiency

Patient System Client

Milestone 1: Meaningful Use

• Stage 1 – Difficult to get started

– Fairly straightforward to achieve

• Stage 2 – Hard to maintain the wins

– Moving targets

– Competing priorities

• Stage 3 – Optional 2017

– Required 2018

– Encourages electronic submission of CQM

– Alignment of reporting for Medicare/Medicaid

– Move to Merit-Based Incentive Payment System (MIPS)

Milestone 2: ICD 10

• Multiple delays loss of interest

• Training

– Just in time

– Specialty focus

– Online modules

– Reciprocity with other facilities

– EHR tools to leverage

• Tracking revenue impacts

• “A non-event” for CMC

Milestone 3: Governance

• Too many requests for improvement and change with too few resources

• Elimination of multiple pathways for requests Single funnel point

• Prioritization of requests with sound estimates of work effort

• Return ‘guidance’ back to operations and clinical leadership

• Engagement and understanding by leadership

Governance Model

Informatics

Executive

Committee

Joint Informatics

Council

Ambulatory

Oversight

Council

Inpatient

Oversight

Council

IT Management

Advisory Council

Medical

Informatics

Committee

(CIEC)

Medical Executive

Committee

Clinical Service Groups/ Service Line Workgroups

Once Prioritized

CSGs: • Oncology

• Peds

• Emergency

Med

• ID

• Neuroscience

• Medicine

Milestone 4: Analytics

• Reporting vs Data Mining

• Real-time vs normalized, delayed

• Foundation for information about ‘things’ – Patients

– Physicians

– Diseases

– Behaviors

– Components

• Interpretation and utilization for decision-making

Milestone 5: Utilization Standardization

• Training/Onboarding

– Initial training

– Follow up support

– Reinforcement of standards for utilization

• Feedback on Compliance

– Dashboards

– Shadowing

– Reporting previews

Milestone 6: Foundational Optimization

• Optimization of EHR

– Responding to requests

– Allocation of resources

– Rate of change with loss of stability

– Cross-facility task forces

• New Modules implementation

– Tier 3 applications

– Expanded focus on utilization of EHR

• Right-size training/support foundation

Looking Ahead

• Population Management

– Functionality within EMR

– Capitated risk joint venture with Adventist

• Data Curiosity

• Service Organization

• Ongoing maintenance

Informatics

Analytics

IT

In Summary

• Meeting the expectations

• Looking ahead to new ways to utilize

technology

• Collaborative partnerships

• Understand operational planning

• Staying connected

Questions?

• Judi Binderman, MD

– jbinderman@communitymedical.org

– 559-259-8256

– @docbindy

– Linked in: judi-binderman-7b99176

References

1. Friedman CP, Frisse ME, Musen MA, Slack WV, Stead WW.

How should we organize to do informatics? Report of the ACMI

debate at the 1997 AMIA Fall Symposium J Am Med Inform

Assoc1998;5(3):293-304

2. Bria W, Rydell R. The Physician-Computer Conundrum. Get

Over It!. Health Information Management Systems Society;

2004.

3. Peter Kilbridge, The CMIO’s Role in 2015, The Advisory Board

Health Care IT Advisor, 2015.