Eric Raffin, CIO, San Mateo County Health System, Chapter 2

When Eric Raffin took on the role of CIO at San Mateo County Health System in 2013, he knew it would be a challenge, and not just because he’d be the first to hold the positon. The organization needed someone who could help create a sense of unification — not an easy task in a best-of-breed environment where there was little communication between departments. But nearly two decades with the Department of Veterans Affairs helped prepare Raffin to take on the challenge, and four years later, SMCHS is making great strides.

In this interview, he talks about his approach to being the new CIO (which involved “a lot of listening” and learning), how he worked to incorporate change management strategies into the IT governance framework, and the question his team asks to help prioritize projects. Raffin also discusses how they’re laying the groundwork to facilitate data sharing and improve outcomes, why his EHR 2.0 strategy involves much more than just the EHR, and what it’s really like to work in a public health setting.

Chapter 1

Chapter 2



* Creating an EDW environment with “normalized” data

* Role of EMPI in “simplifying” information

* Data governance challenges

* Being the first CIO: “There weren’t a lot of synapses firing between different divisions.”

* Goal to create a sense of “systemness”

* 1 standard for patient consent

* Social determinants: “It’s just data, and we can get to it.”



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Bold Statements

We’re really trying to simplify what we do with the information, both in the hands of our providers at the point of service, and also how we use it to improve our programs and decision-making.

We’ve had folks both on my team as well as across all the other divisions that have been willing to come to the table to have meaningful debate, rational discourse, and produce something better in a workflow or a business process.

There are a lot of companies that say, ‘we have this nailed; we’ve figured it all out.’ And I’m thinking, I don’t know how that is, because most healthcare delivery organizations don’t really deal with social determinants of health — not because they don’t want to, but because the framework hasn’t existed.

It’s about how do we transform this data so that other people who might derive great benefit from having it at their fingertips, are able to consume it.

It sounds really small, but at the end of the day it’s not, because the way we look at it, every single one of these interactions is very important. We’re excited about making some headway in this area.

Raffin:  And at the end of the day, this new health information exchange is like a proxy. It’s a read-only proxy for a unified electronic health record, which means I can use that for contingency planning, because it’s not hosted here. It’s hosted in a very secure data center. So when we deploy it, we’ll have a web-based way for folks to be able to get to a contingency EHR platform, and I get a normalized clinical data repository in the background.

Going back to the question about information, now we have a fresh data environment that’s clean and unified. We already have our behavioral health information juxtaposed with clinical information — we have all of that mapped, indexed out, and ready to be analyzed. We’re really trying to simplify what we do with the information, both in the hands of our providers at the point of service, and also how we use it to improve our programs and decision-making by creating a new enterprise data warehouse environment where we have normalized information. So,