Community Medical Centers (CMCs) have provided healthcare to central California for nearly 120 years. But when Dr. Judi Binderman assumed the role of vice president and chief medical informatics officer, she became part of an organization that not only continues its tradition of care, but also embraces the technological future of healthcare.
CMC instituted the EPIC platform for its EMR system just over four years ago. Binderman arrived in the summer of 2015 and found a culture that was ready for innovative ways to leverage technology to improve workflow efficiency and optimize the continuum of care.
“New tools tend to dictate what users can do. We want to put control back in operational and clinical hands to be able to determine how we use those tools to reach our goals,” Binderman says.
Part of this drive can be attributed to Central Regional Medical Center (CRMC), a teaching facility affiliated with University of California, San Francisco. The school’s students, residents, and fellows grew up with digital technology and have been pushing for more functionality and capability. “They bring new possibilities to the table faster than we can keep up,” Binderman admits.
“An item that’s critical for a resident or attending physician, for example, may be inconsequential to a private clinician. So
informatics’ job is to bring all the parties and the associated data together to collaboratively figure out the underlying themes that will best serve all priorities.”
One of her first priorities for moving forward has been to develop an informatics roadmap to help unify central control within a single corporate-level department. Previously, each of the system’s four facilities managed activities independently.
The new department will be able to provide greater transparency for managers and executives as well as the individual facilities. Binderman looks forward to having a single governance structure through which decision makers can craft policy and priorities, and gain a more comprehensive view of where and when support is needed.
“Having more transparency and a global perspective means we can prioritize initiatives and allocate resources more precisely,” Binderman explains. That might sound like some priorities will be downgraded, but in reality it means we can address more projects through improved efficiencies and sharing resources for multiple initiatives.”
Changing Perceptions, Defining Problems, and Facing Ongoing Challenges
For all of the benefits, such changes are not without challenges. Binderman knows that hospital personnel can become impatient when their requests are not addressed as quickly as when requests were handled locally at each facility. To help with such concerns, she is working to raise data awareness across the enterprise.
“We’re emphasizing the importance of using informatics right from the start to quantify and define problems as well as the solutions that are expected to fix them. It’s a new way of thinking that creates a much greater likelihood of successful outcomes,” she explains.
This approach also provides care teams with quantitative information that can be used to compare their performance to others. In addition to this kind of objective assessment, the data will help CMC identify operational workflows that need attention, such as how many patient charts are awaiting physician signatures or the number of medical-records queries required to complete coding and bill processing.
As the informatics department helps support new analytics and data warehousing capabilities and capacity, Binderman faces the challenge of developing global applications that can still be customized to each CMC facility. Ranging from the academic service of CRMC and the small, private community practice at Fresno Heart and Surgical Hospital, to Clovis Community Medical Center and Community Behavioral Health Center, the mix of patients and staff requirements cover an exceptionally broad scope.
“An item that’s critical for a resident or attending physician, for example, may be inconsequential to a private clinician. So informatics’ job is to bring all the parties and the associated data together to collaboratively figure out the underlying themes that will best serve all priorities,” Binderman says. She points out that such a theme could turn out to be something as simple as a strategy for keeping in-baskets at each facility up to date.
Assessing the Future
Binderman anticipates that the informatics department, its systems, and CMC’s use of its expertise and capacity will grow substantially in the next five years. In addition to expanding the underlying technology infrastructure, that expansion will include increasing the number of the department’s trainers, builders, informaticists, and support staff by 50–60 percent.
Along with ongoing changes in the informatics industry, Binderman expects to be able to offer greater functionality, including self-service data queries, more intuitive user interfaces, and “smarter” software that provides clinical decision support that is more customized to individual patients than is currently available.
How will she know if all these efforts are succeeding?
“If more people are requesting changes to support best practices and corporate strategic plans and we’re accommodating quality projects for residents, those will be signs we’re moving in the right direction,” she says. “But it’s about more than just technology. Delivering the best care possible to our populations will be an indication that it’s all coming together.”