G. Daniel Martich, M.D. has been at the 20-hospital University of Pittsburgh Medical Center (UPMC) health system for nearly 23 years now, and has been CMIO at UPMC for the past 15 years.
During that time, Dr. Martich has helped lead a broad team of informaticists, clinical informaticists, and clinicians who have implemented electronic health records (EHRs) across the large, integrated health system, have connected affiliated and salaried physicians and teaching and community hospitals, have developed strong clinical decision support systems to support physicians in practice, have created health information exchange mechanisms to facilitate data exchange among UPMC’s clinicians, and have moved ahead to enhance interoperability, optimize physician documentation, and create electronic visits and messaging between physicians and patients.
Meanwhile, Dr. Martich has chosen to transition to a new role, beginning on May 15, when he will become system chief medical officer at the West Virginia United Health System, based in Morgantown, West Virginia.
Dr. Martich spoke recently with HCI Editor-in-Chief Mark Hagland, as he reflected on his years at UPMC, his and his colleagues’ accomplishments there, and the challenges and opportunities facing clinical informaticist leaders and U.S. healthcare in general. Below are excerpts from that interview.
This must be an interesting moment for you, as you look back on nearly 23 years of innovative work at UPMC, and look forward to your new system CMO role at West Virginia United Health System. When you look, Janus-like, at the recent past, and at the present and future, doesn’t it feel rather as though this is an inflection point in the evolution of U.S. healthcare?
Yes, I agree wholeheartedly that it’s an inflection point, and that we need to think differently. It’s a bit like the Apple world—everything you thought was true is up for renegotiation and revisiting. And that goes for the electronic health record, too. It was foundational; but as we go forward, we may be looking at it differently, and how so, I’m not so sure. But a lot of the feedback we’ve been getting on the AMDIS listserv and elsewhere, as CMIOs, is that perhaps we shouldn’t be so proselytizing.
G. Daniel Martich, M.D.
And Bob Wachter’s [Robert Wachter, M.D., professor and associate chair, Department of Medicine, University of California San Francisco, and author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age] quote in the Wall Street Journal was great; he said you can’t think thoughtfully about healthcare’s future without thinking about IT, but how far we push IT for IT’s sake is a different matter—that this is about better care and wellness for people. And just because you have a heart doesn’t mean you need bypass surgery. So now is a good time to look back and reflect on healthcare in general.
There’s a great book called Anti-Fragile, by Nicolas Talib. He talks about how events and people are fragile, but they make the industry better. So some would say that all the medication errors and the non-checking for allergies caused harm. And clearly, per the IOM report [the Institute of Medicine’s 1999 report, To Err Is Human], they have caused harm. But what they’ve done is to help the healthcare industry learn and grow and become less fragile. And I think that Anti-Fragile epitomizes what healthcare is becoming, a truly learning system.
The U.S. healthcare system has to evolve forward into an intense continuous learning system, correct?
Yes, from every standpoint. Providing the right care may mean not always providing more care. And those kinds of things, and then back into the wellness arena. We were focused on disease and illness. We need to focus on wellness-getting people to eat the right foods and walk their 10,000 steps a day. Sitting is the new cancer. And we’re going to bankrupt our country over the expenses. So I think there’s a real opportunity now to reflect and pause.
Would you agree that clinician leaders and clinical informaticists will be vital to efforts to build the new healthcare?
Yes, they will absolutely be essential. There will still be a role for the tech-wiz clinical informaticists; but more and more, we’ll need clinical informaticists who are thought leaders. It’s really going to be about how we look at how we deliver care. And one field of fodder for clinical informaticists will be meshing the EMR and genomic care.
The people who understand core clinical processes, operational processes, and who can lead, will be absolutely at the fulcrum point, yes?
Absolutely. You need to know the workflow, work processes, where the pitfalls of that are, and that is the standard to which many of the young CMIOs should hold themselves, because that will be where things will change. And you really need to look at the system level, because care is shifting towards the ambulatory sphere.
Blair Childs of Premier Inc. told me recently that he believes that all of the major healthcare legislation that will be passed on the federal level going forward will somehow be linked to population health, value-based purchasing, and similar concepts.