Judi Binderman, Vice President, Corporate CMIO, Community Medical Centers - Speaker at the marcus evans National Healthcare CIO Summit 2016 held in Las Vegaas, NV

1. CMIO for the Future
What a Strange Journey it’s Been!
Judi Binderman, MD MBA MHSA
VP CMIO
Community Medical Centers

2. Where is Clovis/Fresno, CA?

3. 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

4. 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.

5. 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

6. 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]

7. Essential Skills/Knowledge
Analytics
Population
Management
Strategic Planning
Technical Comfort
Process Design
Clinical Leadership
People Skills
Clinical Knowledge

8. 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

9. 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

10. 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

11. 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

12. My Path to CMIO
Doctor Consultant
CMIO
Reimbursement
QualityRegulations
Technology
Patient
Satisfaction
Documentation
Coding
Population
Management
EMR
Best
Practices Analytics
Reimbursement
Process
Efficiency
Patient SystemClient

13. 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)

14. 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

15. 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

16. 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

17. Once Prioritized
CSGs:
• Oncology
• Peds
• Emergency
Med
• ID
• Neuroscience
• Medicine

18. 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

19. Milestone 5: Utilization Standardization
• Training/Onboarding
– Initial training
– Follow up support
– Reinforcement of standards for utilization
• Feedback on Compliance
– Dashboards
– Shadowing
– Reporting previews

20. 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

21. Looking Ahead
• Population Management
– Functionality within EMR
– Capitated risk joint venture with Adventist
• Data Curiosity
• Service Organization
• Ongoing maintenance
Informatics
Analytics
IT

22. In Summary
• Meeting the expectations
• Looking ahead to new ways to utilize
technology
• Collaborative partnerships
• Understand operational planning
• Staying connected

23. Questions?
• Judi Binderman, MD
– jbinderman@communitymedical.org
– 559-259-8256
– @docbindy
– Linked in: judi-binderman-7b99176

24. 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.