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CMIO Reflections

May 12, 2010
by Mark Hagland
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UPMC's G. Daniel Martich, M.D., Talks Workflow and Lessons Learned

G. Daniel Martich, the CMIO at the vast, 20-hospital University of Pittsburgh Medical Center health system in Pittsburgh, Pa., spoke recently with HCI Editor-in-Chief Mark Hagland about his long tenure at UPMC, which has spanned nearly two decades, and has seen the rise of multidisciplinary teams of clinical informaticists. Dr. Martich will be one of a number of clinical informaticist leaders featured in the July cover story of Healthcare Informatics. Below are a few excerpts from that interview.

Healthcare Informatics: How long have you been a clinical informaticist?

G. Daniel Martich, M.D.: In some way or another, ever since I joined the faculty here 18 years ago. It started with a modest ICU project, and it’s grown from there to being the CMIO about 11 years ago.

HCI: What have been the key developmental changes that have made you the CMIO you are now?

Martich: I wish I could identify one or two things. I’m reminded of the quote from Nietzsche, which says that what doesn’t kill you makes you stronger. Some of those moments were not successes at the time. What’s interesting is that some real wins have become routine. For example, when we brought CPOE up at Mercy Hospital, which is largely a community hospital, and achieved 90 percent physician adoption within a short period of time, that was a ‘ho-hum.’ Instead, what I’ve learned from is the pushbacks and the failures. One case that comes to mind is when we deinstalled a siloed ER product and put in the ER component of the Cerner product [the Kansas City, Mo.-based Cerner Corporation is the core inpatient clinical EMR product for UPMC], the chairman of the ER wanted the new product deinstalled that very same day. He was upset because the workflow wasn’t what he’d expected it to be. And that was a moment of failure for me, because I hadn’t given the physicians and nurses sufficient lead time and support [to make the rollout successful]. You sort of need a heavy-hand approach to support, as well as a very tech-advanced view of how to get the clinicians engaged. The key thing in that situation was that, even though we’re clinical folks, and even though we had gone in and done the pre-needs assessment and the gap analysis, we hadn’t walked enough in the shoes of the clinicians, nor had we provided them enough training ahead of time or made sure they really understood the training. So there’s a lot of handholding needed.

HCI: And as you’ve experienced it, that kind of situation is replicated many times over in a complex integrated delivery system like yours.

Martich: That’s right; it’s a very specialized place, and every medical specialization and sub-specialization involves a different workflow. So the glaucoma clinic is different from the anterior chamber clinic for ophthalmology. There are seven different specialties dealing with the eye, and we realized there were all these different specialized needs. The same is true with otolaryngology: each subset clinic or area within that specialty has different documentation needs or connectivity needs for different devices. And more generally, the workflow of a large academic medical center is different from a private-practice community center. So you’d better choose a clinical team that can understand all the different workflows.

HCI: What do CIOs least understand about making clinical informaticist teams successful?

Martich: One thing that most CIOs do tremendously well is that they have a management team, and they’re used to having a point-to-point reporting system, and when they speak, their managers generally follow in lockstep. With clinicians, it’s a different situation altogether. There’s largely an equal playing field, and everyone has almost an equal vote in how things should be run. Everyone’s got veto power.