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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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What it Takes to Be a Change Leader: A Conversation with CIO of the Year Ed Kopetsky

January 22, 2019
by Rajiv Leventhal, Managing Editor
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The health IT veteran reflects on his years of experience as he discusses what winning the CIO of the Year Award means to him

Earlier this month, two leading health IT trade associations—the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS)—named Ed Kopetsky, CIO of Lucile Packard Children’s Hospital Stanford and Stanford Children’s Health, the 2018 John E. Gall Jr. CIO of the Year award winner.

The award is given annually to a healthcare CIO who has shown significant leadership and commitment to the industry during his or her career. Kopetsky’s career has spanned the sector, from CIO of three prominent healthcare systems to partner in a consulting firm specializing in healthcare IT and process improvement. He joined Stanford Children’s as CIO in 2009, and under his leadership, Stanford Children’s received an array of health IT achievements: the HIMSS Stage 7 Acute Care and Ambulatory Awards; Most Wired recognition from 2015 to the present; honors for having one of the best healthcare IT departments in 2016; and the international HIMSS Davies Award in 2017 for improving patient outcomes and care processes using health IT and analytics.

Kopetsky recently spoke with Healthcare Informatics Managing Editor Rajiv Leventhal to discuss what the award means to him, the keys to his successful CIO leadership, and what’s top-of-mind for healthcare CIOs these days. Below are excerpts from that interview.

First of all, congratulations on this excellent achievement. What does winning this award mean to you as a healthcare IT leader?

I knew I had been nominated and it was a wonderful thing to hear [that I won], but first and foremost, I felt that it was a win for the team I work with here and [a testament] to all our accomplishments. I have been at [Stanford Children's Health] for 10 years and we are a very high-end, quaternary medical center for children, and now we are [moving] out to the community. We have built up a health system, and we want to advance medicine and science for children worldwide. I believe we are doing that here—that’s what this award says.

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We have only been a health system for four or five years, and our whole information systems [IS] department has made that happen with patient data, analytics, and using that to improve patient outcomes. It’s a huge honor to get the CIO of the Year Award; it reflects long-term commitment across different venues.

You have been involved in some great health IT accomplishments over the years, spanning across multiple health systems. At Stanford Children's Health, what IT project or projects are you most proud of?

Everything we have done since I got here has really been “leading edge” in every space we went into. First, it was securing our business systems; and that precedes our EHR [electronic health record] conversion and becoming a health system. In just four months, we converted the entire enterprise, both inpatient and ambulatory, in 2014. Just a year later, we were acknowledged with HIMSS Stage 7 [recognition], but we also launched analytics in an academic research teaching environment. That’s a big part of what we do here, and it’s really integrated. We work as partners with the CMIO and the clinical informatics department. You need the analytics—finding the best outcomes and applying that to new approaches.

The best award is probably the HIMSS Davies Award that we won [in 2017], which was the [culmination] of using the EHR and [leveraging] analytics to improve outcomes. And the highlight of all this is that last year we opened a new hospital, which is the highest-acuity children’s hospital in the U.S. We’re very high on technology, and biomedical technology is also integrated and is part of the IS program here. We have enabled our innovation to become preeminent.

We also are an adopter of Lean [management], which I helped the organization launch before applying it. It has been a tremendous shift in culture; we changed the name from IT [information technology] to IS, to emphasize that we are here for patient care. We have this great deployment of Lean culture, and we have service leaders for every major area of our enterprise. I believe I have one of the best IS leadership teams in the U.S. They are “CIO-ready.” The team that I helped build here and that I am part of is what it’s all about—building the next generation of leaders. We have hit the pinnacle.

Can you talk about some of the specific challenges you have encountered with pediatric health IT?

Well, in California, there are privacy rules that prevent parents from seeing adolescent records after the age of 13, so that’s unique. For our high-end inpatient clinical care and for all children’s care, we have different medication management and oncology protocols. With medication management, for instance, our whole systems have to be engineered for weight-based dosing, and that’s not the case for adults.

We are expanding our digital health strategy, and we are trying to involve leading-edge technologies and extension access where we can continuously connect to patients as needed without long-term travel and waiting rooms. Our high-end specialists are very limited in number in the U.S., so an improved digital and virtual care [environment] is where we [want to go].

We did 1,000 virtual video visits last year, which was the first year of our launch. But also for in the home, we have implemented two [apps], which are in the Apple Store: one for glucose monitoring of Type 1 diabetes for children, and another for congenital heart patients, [the latter in which] those patients might need three surgeries over a [shorter] period of time, and we are now getting data so we can see when [care] is needed ahead of time.

As a healthcare CIO in this current environment, what are a few core issues that you are grappling with on a day-to-day basis?

In our environment, and this is true across the U.S., we are challenged with talent, development, and retention—attracting employees to say that this is a great place to be at. That’s a primary role I have and if I fail, it puts everything else at risk, such as leadership, trusted relationships with other organizations, clinicians, executives, and other partners.

I was interviewed after our [EHR conversion] go-live and when asked what the [experience] was like, I said, “Imagine changing the engine on the plane when you are in-flight.” We didn’t shut our hospital down [during the conversion]. Many patients here are at the ICU level, which means you have to be so accurate and reliable to pull this [project] off. And that type of [pressure] is there almost every day, since everything is now so dependent on these systems.

As a CIO for so many years, in the last five years, security has also become a top priority. It is really unfortunate and it’s a tough issue when you are constantly under siege and under attack. Email spam is a great example; it’s a huge problem and you have to hire the best people and be ahead of it. Within CHIME, we started a CISO group to share best practices and exchange knowledge.  As we expand virtual care and digital health [capabilities], and as we go outside our own firewalls and networks, this security issue has to be addressed.

What advice can you offer your CIO colleagues as they continue to navigate the new healthcare?

First and foremost, you have to assume that you are one of the top executives in the company. When these hard issues come up such as physician efficiency, or interoperability that gets stymied, as we got so focused on automating EHRs over the years, fundamentally, it comes down to being a partner with the enterprise. And whether that’s the board, executive management, or the doctors themselves, you need a trusted partner.

The whole is bigger than the parts. When you blend executives’ thoughts with clinicians’ thoughts, and the technology workflows, you can create new solutions and innovate. When it is just about putting in technical capabilities, it never works. I wouldn’t be here without the CMIO, the heads of our patient care systems, or our CTO, and their similar partnerships with their base of doctors, nurses, outpatient care [providers], etc. I could never do this work as just a technology department.  

So, I would ask my peers, are you positioned as “technology-only?” If so, you are at high risk. If you are really a change leader, it has to be about business change and clinical process change. And there is no way to do that alone. I have been here for a long time, and I know many CIOs who got into bad situations—either it wasn’t the right mix, or the organization wasn’t ready to take the next step to make [IT] a strategic asset. You need people to lead change and have partners along with them.


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Ed Kopetsky Named CHIME-HIMSS CIO of the Year

January 7, 2019
by Heather Landi, Associate Editor
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Ed Kopetsky, CIO of Lucile Packard Children’s Hospital Stanford and Stanford Children’s Health, has been named the 2018 John E. Gall Jr. CIO of the Year award recipient by the College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society (HIMSS).

The award—named after John E. Gall Jr., who pioneered implementation of the first fully integrated medical system in the world in El Camino Hospital in California in the 1960s—is given annually to a CIO who has shown significant leadership and commitment to the healthcare industry during his or her career. The recipient is selected jointly by the boards of CHIME and HIMSS.

“I have had the great fortune to work with and learn from many healthcare executives and IT leaders, and to have talented teams working alongside me throughout my career,” Kopetsky said in a statement. “I am honored to have been nominated, and to have CHIME and HIMSS select me for this award.”    

Kopetsky’s career has spanned the industry, from CIO of three prominent healthcare systems to partner in a consulting firm specializing in healthcare IT and process improvement. He joined Stanford Children’s as CIO in 2009, after working as a partner at the professional services organization Healthlink, which was acquired by IBM in 2005. He was senior vice president and CIO of Centura Health from 1996 to 2000 and CIO of Sharp HealthCare from 1986 to 1996. Under his leadership, Stanford Children’s received the HIMSS Stage 7 Acute Care and Ambulatory Awards, Most Wired recognition from 2015 to the present, honors for having one of the best healthcare IT departments in 2016, and the international HIMSS Davies Award in 2017 for improving patient outcomes and care processes using health IT and analytics.

Over the decades, Kopetsky has helped launch and sustain numerous initiatives that have helped the industry grow, according to officials from the two associations. He was a founding member of CHIME in 1992 and has been an active member of HIMSS since 1987. He started and chaired a HIMSS chapter in San Diego in 1988 and three decades later joined the HIMSS Executive Institute. His contributions to CHIME include board member (1996-1999) CHIME chair (1998) and CHIME Foundation Board member (2002-2005). After losing his son to an accidental opioid overdose in late 2017, he helped launch the CHIME Opioid Task Force in 2018, which he co-chairs.

“Ed is one of the most courageous people I know,” Russell Branzell, president and CEO of CHIME, said in a statement. “Ed has turned a personal tragedy into a mission for CHIME and our members that already is saving lives. He has a vision of what can be achieved when healthcare IT leaders work together, and with his leadership we are making inroads against this devastating opioid epidemic.” 

“Ed Kopetsky epitomizes the values and traits that all in health strive to achieve,” Hal Wolf, president and CEO of HIMSS, said. “Mission driven, technically innovative and highly respected among his peers. A longtime HIMSS member and contributor, Ed has focused his personal passions into improving the lives of countless individuals. It is a privilege to honor Ed as our CIO of the Year.”

As a CIO, Kopetsky has successfully led several large-scale projects and mentored many staff members, according to CHIME and HIMSS officials. At Sharp HealthCare, his team completed implementation of one of the first integrated patient care systems supporting a multi-hospital and physician network. At Stanford Children’s he oversaw the implementation of enterprise systems, including an integrated electronic health record across Lucile Packard Children’s Hospital Stanford and Stanford Children’s Health. He is credited with developing top-notch IT teams and serving as a role model and mentor throughout his career.

Kopetsky will be honored on Feb. 11 at the 2019 CHIME HIMSS CIO Forum in Orlando, Fla. He will officially receive the award at the HIMSS19 conference that runs Feb. 11-15 in Orlando.

 

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Providence St. Joseph Health Hires Microsoft Exec as CIO

January 2, 2019
by David Raths, Contributing Editor
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Health system continues to draw from Seattle-area tech giants
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Renton, Wash.-based Providence St. Joseph Health, the nation's third-largest health system, has hired Microsoft executive B.J. Moore as its chief information officer effective Jan. 28, 2019. 

Moore joins several other executives that 51-hospital Providence St. Joseph Health has hired away from Seattle-area tech giants. Other additions have included Chief Digital Officer Aaron Martin, previously of Amazon, who joined in 2014, and Chief Financial Officer Venkat Bhamidipati, formerly of Microsoft, who joined in 2017. Moore will report to Bhamidipati.

In a statement about Moore’s hiring, Providence St. Joseph Health President and CEO Rod Hochman, M.D., explained why the health system is targeting tech executives such as Moore. "With data, cloud computing and artificial intelligence poised to enable and improve the way care is delivered, health systems need leaders who are well versed in the technology fields. B.J. has the depth and experience to guide our organization through this period of transformation, which will include collaborating with technology companies, as well as adopting enterprise-wide solutions that will modernize healthcare operations."

Moore spent close to 20 years at Microsoft, where he served as Vice President, Enterprise Commerce and Compliance, Cloud and Artificial Intelligence and Vice President, Enterprise Commerce, Windows and Devices Group. 

Besides its 51 hospitals, Providence St. Joseph Health has 829 physician clinics, senior services, supportive housing and many other health and educational services. The health system and its partners employ more than 119,000 people across seven states – Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Formed in 2016, the Providence St. Joseph Health family includes the founding organizations, and in Texas, Covenant Health and Covenant Medical Group; California, Facey Medical Group, Hoag Memorial Hospital Presbyterian and St. Joseph Heritage Healthcare; Washington, Kadlec Regional Medical Center, Pacific Medical Centers, and Swedish Health Services.

 

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