Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Robert Bart, Chief Medical Information Officer at University of Pittsburgh Medical Center

Transcript

Dr. Robert Bart, Chief Medical Information Officer at University of Pittsburgh Medical Center · Becker’s Healthcare - Clinical Leadership Podcast

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  Would you like to exchange best practices and ideas to improve care,
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  enhance operational efficiency,
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  and address financial challenges with your peers?
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  Becker's Healthcare is facilitating these conversations at their eighth annual
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  health, IT digital health and R C M meeting.
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  You can check your eligibility for complimentary attendance at the link in the
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  description. We are excited to welcome you in October.
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  This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Rob Bart,
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  chief Medical Information Officer at U P M C. Dr. Bart,
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  it's a pleasure to have you on the podcast today.
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  Thank you for having me, Laura.
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  Now, I know we have a lot to talk about healthcare and digital technologies in
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  healthcare, um, are are rapidly evolving and the field is moving quickly.
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  But before we dive into my broader questions,
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  can you tell me a little bit more about yourself and your background?
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  Yes, I'm happy to. So, uh,
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  clinically I'm a pediatric critical care physician and I've been doing that
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  for, I guess over 30 years now.
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  And it was about the time of my pediatric critical care fellowship that I got
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  involved in healthcare technology. Um,
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  I was training at Duke and Duke was one of the early adopters of,
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  uh,
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  digital flow sheet for care delivery and documentation in the ICU
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  environment.
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  And so I was involved in the implementation deployment, um,
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  in my critical care fellowship,
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  and that sort of got me very interested in healthcare technology.
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  And as my sort of career progressed across the country ending up
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  at Children's Hospital Los Angeles, um, I was involved,
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  um, with an enterprise electronic health record deployment back in
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  2002,
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  which partly seems not too long ago and partly seems a long
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  time ago. Um,
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  but that ultimately led me to a physician as a chief medical physician
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  at, uh, Cerner Corporation. So I've worked on the vendor side for a few years,
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  and then prior to joining U P M C,
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  I was the Chief Medical Information Officer at the Los Angeles County Department
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  of Health Services where we sort of transformed and transitioned care there
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  to a new, um, electronic health record. And in the summer of 2017,
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  I came to U P M C, um, never really thought I'd leave Los Angeles County.
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  I, I really enjoyed and I think thrived on on the mission there,
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  but I think I've also,
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  Dr tried to drive myself to always learn more and the opportunity
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  to come to U P M C where they had a large in insurance services arm
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  as well as a group called U P M C Enterprises,
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  which does a lot of technology hibernating investing.
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  Um, it just made U P M C a very attract attractive environment to,
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  to come to and to,
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  to learn some of the things that I didn't know about healthcare technology.
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  That makes a lot of sense and what a fascinating career journey,
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  being able to obviously start off as a physician, a critical care physician,
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  and then, um,
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  get into the technology role doing some integrations over to the vendor side
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  with Cerner and then LA County. Um, from your perspective,
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  when you really look at the breadth of what you've been able to experience, um,
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  where do you see the technology really, um, headed?
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  What are some of the opportunities that are on the horizon right now as well as
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  the headwinds that you have your eye on?
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  A a lot of the technology that we've implemented within,
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  um, the healthcare delivery, I'll focus on sort of the delivery part of it.
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  First, um,
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  really was the digitization of healthcare processes
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  that had been developed over generations of care being delivered using
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  pen and paper, you know,
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  maybe fax machines using triplicate forms, et cetera,
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  which some of my colleagues will probably remember,
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  but we didn't in, in many respects,
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  the technology footprint didn't advance healthcare as much
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  as I think at least I expected it to. I think that we,
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  we predominantly, um, did change,
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  did improve care by digitizing it,
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  but we didn't sort of make this sort of
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  Olympic leap to the next level,
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  which I think that's what I sort of thought I was doing back in 2002.
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  And I think that we're now at the point with being able to inject
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  intelligence into the technology platforms that I think what I thought
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  we were doing 20 years ago is something we potentially can be doing
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  from, you know, today going forward. And so that's what I,
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  I look forward to is, you know, the,
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  is potentially the future of what we're gonna do, um, based on sort of
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  the base or platform of what we've implemented within u the US healthcare
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  delivery systems over the last 20 years or so.
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  Absolutely. That's really fascinating and I know, um,
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  what you've been able to do there at U P M C,
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  it really has a sophisticated platform being able to incorporate a lot of
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  different technologies. And so, you know, it it, it's awesome to see where,
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  how far things have come, especially from those days of, you know, uh,
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  primarily using fax machines in the triplicate, um,
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  copies and trying to do everything, um, along those lines. So, you know,
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  once you have that foundation, um, in place, what's the next step in in,
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  if you have a quick minute to or thought for hospitals and health systems that
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  mm-hmm. , you know,
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  maybe are still on the stage of trying to inform that base of a great platform
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  or, uh, something that they can really rely on before, um,
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  launching into the future. You know,
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  what's important to know about building that strong platform, um,
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  for any type of healthcare organization?
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  Yeah, so, so I think that, so U P M C sir has two,
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  um, there, there's one, one aspect that's somewhat unique. Um, uh,
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  for those of you who are familiar with U P M C,
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  we are an organization that's predominantly concentrated in the state of
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  Pennsylvania with a small outpost in,
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  in New York state and a small outpost in Maryland. When I say outpost, we,
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  we have hospitals in those states,
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  but most of our core care deliveries in the state of Pennsylvania,
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  and it's grown over the years through acquisition. Um,
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  the acquisition and that process has been healthy for the organization to meet
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  critical amass, but it also means that we've incurred a fair amount of,
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  of technical debt. Um, and what I mean by that is our electronic health records,
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  um, we have, I have more than one, I have mul multiple EHRs.
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  And so I think our challenge will be a little bit unique in that
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  we need to sort of modernize our care
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  delivery infrastructure at the same time that
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  we sort of keep our eye on being able to make sure that our current
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  platforms and future platform we'll be able to leverage intelligent
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  intelligence within the platform. Um,
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  we're very interested in artificial intelligence, which, you know,
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  I'm sure most of my colleagues in in healthcare IT are,
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  are interested in and most interested in it in areas that will help improve
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  the efficiency and effectiveness of care delivery. Um,
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  I know that there's been a lot of focus on artificial intelligence in the
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  clinical decision making space, but I, I think that,
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  that we have to build sort of comfort with artificial intelligence within
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  care delivery and comfort also means trust.
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  And I think leveraging artificial intelligence and what it can
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  provide us in being able to optimize the efficiency and
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  effectiveness and throughput and care delivery, for example,
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  is one way that we can develop comfort and trust with it. You know, imagine,
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  you know,
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  solutions that help you optimize the number of patients you can see
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  in a clinic day,
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  or the number of patients that can go through one of our facilities
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  ORs in a very safe, effective manner, um,
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  that allows us to create better scale with the limited human and physical
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  resources we have. I think that's one of the challenges in healthcare,
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  but that,
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  that opportunity then allows healthcare as a,
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  as an industry to become much more comfortable and trusting
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  of artificial intelligence.
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  I think those are sort of the building blocks that we'll need
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  as we're starting to develop that trust,
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  then being able to turn it back into some of the, uh,
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  care, clinical care decision making processes that I think a lot of people are
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  targeting artificial intelligence with aiding clinicians. Um, in,
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  in that instance, I, I don't think,
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  I'm not one that believes that clinicians will be completely out of the loop.
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  I think, um,
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  maybe the a in the a in artificial intelligence should actually be referred to
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  as augmented intelligence helping me as a physician make a better
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  and faster decision as opposed to replacing my
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  ability to make a decision. But as I said, the, I think the,
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  the stepping stones to that are being comfortable in letting artificial
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  intelligence really help us tune our operational efficiency and effectiveness.
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  That makes a lot of sense. You know, and it's really fascinating to look at,
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  especially how artificial intelligence has evolved in the past few months and,
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  um, really become part of the everyday workflows in many cases and,
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  and lots of new opportunities there as well. Uh, from your perspective,
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  how do you think about growth and adding value to the health system overall?
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  Is it focused on some of the things you were mentioning terms of the, the, um,
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  clinical technologies and artificial intelligence or,
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  or where else do you see as being really great ways that you as the C M I O
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  of U P M C can really make a difference?
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  I, I think one of the, the big areas of in,
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  in adding value to an organization and,
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  and in my instance specifically the U P M C,
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  is to be able to sort of discern
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  the tens if not hundreds of technology opportunities out there.
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  And really identifying the ones that have
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  value both in improving or maintaining the high quality of
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  care we deliver,
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  or improving or maintaining the experience we wanna offer patients and
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  consumers while at the same time being able to offer a
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  true financial return on investment. Um,
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  and you really have to turn over a lot of stones in technology to identify those
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  opportunities, but I think tho that's where you really achieve, uh, you know,
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  value for your organization. Um, you know, I'm a little wary,
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  as much as I mentioned, talked about artificial intelligence a little while ago.
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  I'm a little wary that it'd be probably pretty easy to spend,
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  I don't know, a hundred million dollars on a bunch of artificial intelligence
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  and not have a lot to show as far as return on investment either from a
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  quality of care or a return on investment financially.
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  And so I think that although there are a lot of opportunities out there,
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  we have to be really thoughtful about which technologies truly bringing
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  value to the process of care delivery for U P M C as well
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  as value to the patients and consumers who seek to get their care here.
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  And um, you know, and that's something, uh,
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  a comment I think when I, when I worked at Cerner, which you know, was a,
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  is a publicly traded company at the time, um,
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  I think one of the things I learned there was that you have to be able to
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  deliver value.
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  And so as I look at that and whether it was a LA county prior to coming to U P M
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  C or here at U P M C,
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  even though we're a private not-for-profit entity, the,
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  the thing that always, um,
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  is driving me is does that drive the best value for the organization in
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  accomplishing the goals that we want for our patients or the goals that we want
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  for our clinicians and being efficient and effective in care delivery.
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  Um,
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  as well as always looking at an opportunity where that can potentially return a
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  financial investment. I, I think if you,
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  if you don't put those as some of the requirements when you're trying to solve a
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  problem that you're presented with, you'll come up with a solution,
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  but it might not be the highest value solution for your organization.
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  I, I think that makes a lot of sense and I'm sure will resonate with a lot of
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  hospital health system leaders as they're talking through, you know,
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  what AI strategy really makes sense for them,
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  how they should be thinking about it in, in being very thoughtful in terms of,
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  um, how they're using their healthcare dollars.
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  I know right now I is really an important time in healthcare.
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  A lot of organizations are facing tighter budgets than,
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  than they have in the past and slimmer resources, both manpower and otherwise.
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  So, uh, given that, do you see any areas that it's, uh,
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  really important to continue to make investments or, you know,
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  maybe a risk worth taking in the next year, uh, to just to make sure that um,
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  the hospital or health system really is in a place that it can grow going
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  forward?
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  I, I, I think, um, you know, a couple areas I I,
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  I've sort of hammered on the point of of efficiency within your organization and
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  looking at technology that relieves
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  the individuals who are, um,
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  involved in moving patients through the care continuum and really aids and
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  supports that, I think that is worth definitely investing in.
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  Cuz I think there's,
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  there's this balance of improving the process but at the same time trying
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  to decrease some of the burden of effort in all of the
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  individuals who are involved in streaming together care delivery, you know,
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  whether that's the clinician at the frontline or the technologist
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  supporting the clinician or even the back office finding those
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  investments that in this instance it might not have
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  the most direct financial reward to the organization or returns to the
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  organization,
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  but if it really decreases burden of effort,
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  which I think every healthcare system is, is struggling with this challenge,
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  you know,
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  as we're sort of in this prolonged emergence from the COVID 19 pandemic,
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  that's an investment worth making cuz I think it's important to also realize
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  it's important to invest in the processes that people are involved in
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  because at the end of the day, healthcare, no matter how much technology it has,
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  is ultimately gonna depend on having people who are happy and
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  proficient in the care delivery process.
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  And easing that burden is gonna help them be a little,
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  hopefully a little happier and hopefully a little more proficient in the process
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  of care delivery.
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  That's a really great point and definitely is something to keep your mind on
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  and, um, your eye out for, for the healthcare delivery team, I know it's been,
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  uh, definitely a rough few years and certainly, um, being able to make things,
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  uh, easier for them and more efficient and and more seamless in the care
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  coordination I can imagine, um, is really,
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  really impactful on the organization overall.
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  Yeah, I, I absolutely, I think, you know,
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  there's so much focus on machines and artificial intelligence and we,
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  there will all be always be humans in, in the care delivery process and, and,
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  uh,
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  I think you cannot replace sort of the healing factors related to, to,
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  to human interaction, human touch that occurs in,
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  in healthcare and, um, you know, that's,
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  we need to be able to sort of relieve the burden so that peace can actually
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  resonate and come through to all the patients who receive care,
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  whether it's at U P M C or at other organizations.
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  Absolutely. I I love that idea and thought. Um, Dr. Bart,
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  before we wrap up our conversation here, I wanted to ask,
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  where do you see the best opportunities for growth and development in the
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  future?
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  What does that look like for yourself as well as the teams that you work most
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  closely with?
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  That, that's actually probably the hardest question you've asked. Uh, I think,
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  you know, from an organizational perspective, I think U P M C,
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  we see a lot of the future of care delivery being in, um,
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  in the ambulatory, both traditional ambulatory and,
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  and the post-acute space and,
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  and the footprint of acute care or hospital based care,
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  I think is gonna shrink or we at least we believe it's gonna shrink over the
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  next few years. So I think that's where,
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  where the growth opportunities are gonna be. Um,
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  and I think to, to support that, you know,
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  we've certainly seen a movement away from,
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  uh, patients and consumers interacting with healthcare systems in sort of
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  traditional manners as in, you know,
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  prior to the pandemic.
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  And I think along with that move into
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  new models of ambulatory care or new models of post-acute
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  care and even acute care that may not occur within hospitals. I think that,
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  that it's gonna require, um,
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  a new form of sort of digital interaction with patients
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  and consumers.
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  And I think we've certainly seen sort of a huge interest
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  from patients in wanting to interact with healthcare systems through their
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  smartphone and through other devices. Um,
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  and so I think as those administrative duties start to become more
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  digitized and much more, uh, seamless with, with patients,
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  I think that you'll see new care models come out of that,
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  that that really a,
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  allow the new footprint of technology with some of the new
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  intelligence that's being pushed into healthcare technology to allow
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  opportunities for growth. Um, I think, you know,
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  we're aggressively explor exploring sort of new models of outpatient
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  care. Um, things that, uh, we wouldn't have considered prior to the pandemic,
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  but I think the,
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  the pandemic forced us to see
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  opportunities or, or, um,
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  experiences that we previously wouldn't have thought of.
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  And we've realized we can do this very safely in this new
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  venue of care that's not a hospital.
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  And I think that's where a lot of the growth is gonna occur. You know, it's
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  maybe, maybe the future will include more, you know,
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  home visits, which is from, from doctors,
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  whether they're virtual or physical. Um, you know,
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  not too different from a hundred or 150 years ago when physicians
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  predominantly made house calls. Um, maybe that is sort of a,
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  a sort of back to the future sort of vision, but there's gonna be some,
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  some construct around that. The,
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  what we have done and traditionally moved into acute care in the shape of
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  hospitals a lot,
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  I think a lot of that's gonna get deconstructed into new models of care in
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  venues that are much more comfortable for the patient to receive their care in.
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  That really makes a lot of sense, you know, and it is a great, uh,
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  vision of the picture that you're painting, um, in terms of, you know,
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  where healthcare is headed and how really, uh,
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  physicians and clinicians can be most impactful on patient care. Dr. Bart,
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  thank you so much for joining us on the podcast today.
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  This has been really fun conversation and I'm excited to see you as well at our
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  event in October for health IT Digital Health and Revenue cycle, uh,
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  five event in Chicago.
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  I think it's gonna be a lot of fun and I'm looking forward to continuing the
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  discussion then.
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  Oh, I, I appreciate you taking the time to, uh, spend a few moments,
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  be Laura and I look forward to, to meeting you, um,
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  in October during that event.
• 21:36
  It's so important for leaders at the top of organizations to keep learning,
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