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UPMC’s New CMIO on the Transformative Role of CMIOs in Health System Change

June 5, 2017
by Mark Hagland
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Robert Bart, M.D. shares his perspectives on CMIOs’ role in health system change

On June 1, senior leaders at the vast, 20-plus-hospital UPMC health system based in Pittsburgh, announced that Robert Bart, M.D. had joined UPMC as the new chief medical information officer (CMIO) of the health system’s Health Services Division. Dr. Bart will oversee the health system's efforts to advance the use of electronic health records (EHRs) and other technologies to improve the quality, safety and efficiency of patient care.

Bart, 55, has come to UPMC after serving for five years as CMIO for the Department of Health Services for Los Angeles County, with a population of more than 10 million. In that role, he oversaw IT management across four hospitals and 18 large, multispecialty ambulatory locations, including hospitals affiliated with the University of Southern California and the University of California Los Angeles. Prior to joining the department, he was chief medical officer for pediatrics and academics at the Kansas City-based Cerner Corporation.

In announcing the appointment, Joel B. Nelson, M.D., chief clinical officer of the Health Services Division at UPMC, said, “Dr. Bart brings a unique set of technology and people skills that will drive our efforts to adopt smart technology that improves care and the patient experience. We are excited to welcome him to a team with a long history of technology leadership and innovation.”

In addition to his role as CMIO, Bart has been appointed associate professor with the University of Pittsburgh School of Medicine’s Department of Critical Care Medicine and University of Pittsburgh Physicians, and will work clinically as an intensivist at Children’s Hospital of Pittsburgh of UPMC. Bart received his medical degree from the University of Hawaii in 1990, then completed a pediatrics residency, a pediatric chief residency and pediatric critical care fellowship over the next seven years, all at Duke University Medical Center.

Shortly after the announcement, Dr. Bart spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding his arrival at UPMC, and his aspirations for his there. Below are excerpts from that interview.

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What made you move to UPMC, and how do you envision your role at the organization?

Prior to my position at Los Angeles County, I was chief medical officer for the Cerner Corporation, and in that capacity, I worked with Children’s Hospital of Pittsburgh quite a bit during the 2007-2010 time period. So I was sort of familiar with Pittsburgh, and very familiar with Children’s Hospital. And I saw Children’s Hospital go through its alignment with UPMC. So I had that background. And UPMC holds a very good reputation nationally, if not internationally. There are aspects of it that remind me of Duke, where I did my training. So when Dr. [Joel] Nelson, the chief clinical officer at UPMC, asked me to come out and interview, I didn’t hesitate. Reputation was one of the big drivers. Also, opportunity: UPMC has always been seen as a leader in healthcare information technology, both as a consumer of solutions, and also as an innovator, through UPMC Enterprises.


Robert Bart, M.D.

When you look at your role as CMIO at the Los Angeles County Department of Health Services, what do you think you might bring to UPMC from your experience there?

I was actually the very first CMIO for Los Angeles County Health Services. And leaving there was not an easy decision, because I think it was a remarkable place. And at least one of the things I learned there was the incredible passion and will of the people working there to deliver high-quality clinical care to anyone who comes in the door into the hospital or their emergency department. And I met a gentleman named Mike Grace, president of UPMC-Mercy. And they probably do the largest proportion of indigent-care services within UPMC. And meeting with him was a key point for me, because it also got me to see that there was a compassion and an ability to deliver services to the underserved, even in a non-governmental environment. And we talked about the percentage of uninsured receiving services. Pre-Obamacare, uninsured was around 23 percent, and it’s a much smaller percentage now.

And one of the things that Mike had shared with me was that UPMC is working with just over a 4 percent uninsured rate, perhaps at UPMC-Mercy or at the Oakland campus. But in any case, one of the things I saw was that there was an ability to deliver that kind of care through the UPMC system. Another draw for me is that UPMC is really trying to change the model of care delivery through the integration of its insurance division and health services division. I think that’s really a unique model, and that was also an attraction for me, because I want to learn and understand that.

I see CMIOs as nexus people, in terms of the need for the U.S. healthcare to undergo clinical transformation, and their role in as change agents and facilitators in their organizations. How do you see the CMIO role in that context, and frame it?

You framed that well. A lot of the past decade has been spent on implementing and installing electronic health records, to the point that at least in the acute-care space, the penetration is greater than 90 percent. And the electronic health record is great at creating a one-on-one relationship, supporting that relationship, between the individual clinician and patient. What it’s not good at, though, is creating a many-to-one relationship, and you alluded to that in your reference to population health management.

Now, population health management means many things to many different people. But a core meaning is managing the care of a group of people who I’m seeing based on managed care contracts. UPMC is not going to manage the population of all the individuals in Pittsburgh, or in Pennsylvania, of course; we’re going to manage the population of people we have the fortune to care for in the managed care world. And that is going to be the focus both at UPMC and across most of the U.S. healthcare system. Because the opportunity to be proactive in the lives of individuals we care for, will be one of the goals. Creating tools and dashboards for clinicians, so that they can interact with individuals at home even before they come to see us, is important, and should decrease healthcare expense.

And, in that regard, how do you see the CMIO role in the context of CMIOs’ helping to facilitate the transition to team-based, consensus-driven care?

You’re talking about the patient-centered medical home, which is focused on ambulatory primary care delivery. And that’s where the greatest change has taken place in the past five years and will do so in the next five years. So the CMIO’s role will be to help to create the tools needed to develop and manage the patient-centered medical home. Interestingly enough, the provider’s use of the information set may not change that much; they may still focus on the individual patient in front of them. But that care team—that mid-level practitioner you were talking about, may be doing more of that looking at that population. Within that population there are 400 patients with type 2 diabetes, and 30 haven’t had a hemoglobin a1c in the past six months, that mid-level provider will probably charged with making sure those patients get in. So CMIOs will need to help get the tools and solutions in to help providers manage those populations.

In that context, I see clinical informaticists as being something akin to U.N. interpreters, between pure IT people and pure clinicians, and as important conveners. What’s your view?

I agree. I aways tell people I’m a functional informaticist. And part of the reason I’m interested in this is in creating a seamless connection between the person and the technology they’re using. So yes, the CMIO does need to be a translator-interpreter between the groups, so you come up with a solution that helps the end-user clinician to deliver the best care.

I’m presuming you won’t be able to do clinical practice?

Actually, I will. I trained as a pediatric critical care physician, so I worked in a pediatric ICU. And I’ll be spending my clinical time in one of the ICUs at Children’s Hospital of Pittsburgh—probably four days a month, and the nights that go with them.

And how do you see your role as a change agent in physician culture?

I do think that maintaining clinical practice does provide for greater credibility, since you’re a user of the systems. A CMIO is definitely a change agent, in most organizations, if not all. And physicians don’t even have to be that grumpy—physicians are people, we sometimes forget that. And people have the tendency to not want to change. The perception is always, at least this works for me, I don’t know if that will. But I will say that over the last decade, that resistance has become less and less. There are fewer and fewer physicians who challenge that; and I think frankly, as many of the younger people come through training as physicians, the issue is, our technology looks antiquated to them. They’re whipping through 28 applications on their smartphones every day, and then they look at the electronic health record systems we use in the hospital, and the younger physicians ask, why can’t this be more like my apps on my smartphone?

So you have an older cadre of physicians for whom the EHR and clinical IT is the newest technology they’ve ever been exposed to in their lives, but they’re not as facile as the younger physicians who say, I want everything on my iPhone, on my Galaxy. So you’re working with two extremes. One group, the older physicians, you’re trying to push forward with the technology, and the younger group, they’re impatient, because the technology isn’t smart enough.

It's like being in the sandwich generation, isn’t it?

Yes, it is. So you have to manage both ends of the spectrum, as a change agent.

Is there anything you’d like to add, per the first year you’ll be at UPMC?

UPMC has a long history of informatics, and I look forward to meeting the individuals who have been doing these things at UPMC for many years, understanding what motivates them and why they’re doing it, and then harnessing them into a stronger alignment and vision that UPMC has. I suspect that that will take more than a year, but that’s one of my main goals.


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Rasu Shrestha Leaving UPMC to Join Atrium Health as Chief Strategy Officer

December 18, 2018
by Heather Landi, Associate Editor
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Industry thought leader Rasu Shrestha, M.D., formerly Chief Innovation Officer at the vast 40-hospital University of Pittsburgh Medical Center (UPMC), is leaving Pittsburgh to join Charlotte, North Carolina-based Atrium Health has the new executive vice president and chief strategy officer.

For the past 11 years, Shrestha has held various roles at UPMC, including, most recently, executive vice president and chief innovation officer, responsible for driving UPMC’s innovation strategy. In addition to leading innovation at UPMC, Shrestha also served as executive vice president of UPMC Enterprises, the venture capital arm of UPMC.

According to a press release from Atrium Health, a 40-hospital health system previously named Carolinas HealthCare System, in his new role Shrestha will lead enterprise strategy, including planning and tactical direction for Atrium Health’s strategic roadmap. In addition, he will spearhead a renewed focus on innovation, launching new healthcare inventions, discoveries and ideas to benefit Atrium Health patients and the communities it serves.

Shrestha will officially join Atrium Health in February 2019, reporting directly to President and CEO Eugene Woods. He will take on the position formerly held by Carol Lovin, who was promoted to executive vice president and system chief of staff.

“It is our honor to welcome Dr. Rasu Shrestha into the Atrium Health family,” Atrium Health president and CEO Eugene Woods, said in a statement. “As Atrium Health looks ahead to how we can reimagine a brighter and bolder future for care, Dr. Shrestha will help us develop the strategy and innovation to bring health, hope and healing to more people.” 

A respected thought leader and visionary in the field of healthcare information technology, Shrestha was recognized as one of the “Top 20 Health IT Leaders Driving Change” and as a “Top Healthcare Innovator” by InformationWeek, according to the Atrium Health press release. In addition, he is chairman of the Healthcare Information and Management Systems Society (HIMSS) Innovation Committee, and co-chair of Health Datapalooza.

“I am awestruck by the ambitions of Atrium Health to fulfill their mission to improve health, elevate hope and advance healing – for all,” Shrestha said in a statement. “I look forward to working with this incredibly talented team to forge ahead with meaningful strategies, partnerships and opportunities – and to support this organization’s commitment and dedication to its patients and communities.”

Shrestha announced the move to Atrium Health via Twitter Tuesday afternoon and also posted several comments on LinkedIn. “I find myself in a reflective mood, as I contemplate leaving the many teams I’ve had the honor of making an impact in, the culture that I’ve had the privilege of being able to help craft, and an organization I love, in a city my family and I have called home for the last 11 years since moving here from Southern California. I am humbled with the honor of having worked with some of the most brilliant leaders and doers I have met, and proud of the many accomplishments we have made as a team here at UPMC and across the industry,” Shrestha wrote. “It is this purpose-driven passion that will be a recurring theme, as we continue to cross paths and push ahead through the many challenges and opportunities.”

He remarked that he was drawn to the “human ambitions” of Atrium Health to “improve health, elevate hope and advance healing - for all.”

“What a remarkable place to start my next chapter forward. I know that when we put our hearts and minds together, anything is possible,” he wrote.

Shrestha received his medical degree from CCS University in India, completed his fellowship in informatics from the University of London and earned his MBA from the University of Southern California.

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Early Career Physicians, Pharmacists, Keen on Working in Tech, Survey Finds

December 18, 2018
by Rajiv Leventhal, Managing Editor
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A survey of 502 early career U.S. physicians and pharmacists revealed that 47 percent of these healthcare professionals are interested in working in the technology sector.

A LinkedIn survey, conducted in October, queried 502 physicians and pharmacists in the U.S. who completed their degrees within the last five years. The participants, all of whom have LinkedIn profiles, were chosen at random and reflect different specialties and years of experience.

Thirty percent of respondents said they were “somewhat interested” in working in tech, while 17 percent said they were “very interested.” Another 21 percent said they were “somewhat uninterested,” and 20 percent said they were neutral. Just 11 percent of respondents said they were “very uninterested.”

Participants were also asked to share their views on why they would or wouldn't consider working in the technology sector. Fifty-eight percent of respondents cited substance of the work, 57 percent said total compensation, 50 percent said working hours, and 49 percent said the impact of the work.

Notably, 85 percent of survey respondents said that having peers with their background represented at tech companies could lead to innovation for “traditional” industries.

Another 48 percent of respondents said the technology sector has an allure that makes it difficult for other industries to compete for top talent. Meanwhile, 47 percent said that those who move into tech from a different industry are more interested in “big impact.”

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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.


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