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.
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.