Penn Medicine is a Philadelphia-based $3.5 billion enterprise consisting of the University of Pennsylvania School of Medicine and the University of Pennsylvania Health System, which includes three hospitals — the Hospital of the University of Pennsylvania, Pennsylvania Hospital and Penn Presbyterian Medical Center. Recently, HCI Associate Editor Kate Huvane had a chance to chat with vice president and CIO Michael Restuccia, who was named to his dual role at Penn Medicine in March, 2008 after serving as interim CIO for a year.
KH: How many beds are based in the University of Pennsylvania Health System?
MR: There are 1,527 in-patient beds. We’ve recently purchased Graduate Health System from Tenet Health, which had Graduate Hospital associated with it. Those beds are coming back online in July of this year, but they’re not coming online as inpatient beds. Instead, the facility will consist of a long term acute care unit, a major rehabilitation unit and a hospice unit.
KH: That’s a pretty-good-sized system.
MR: Yes. Our primary challenge surrounds the breadth and depth of services provided by the health system and the information systems support that is required. Tied to that, the health system moves at an outstandingly fast pace, so our information systems (IS) organization needs to match — if not exceed — this pace across all segments of the health system.
KH: Now, you were recently promoted to CIO after spending time as interim CIO under a consulting contract. How did this process unfold? When and how did you initially begin the consultant role, and how were you promoted to CIO?
MR: I started in December of 2006 in a consulting role to perform IS leadership activities. The former CIO was an individual by the name of George Brenckle. George announced he was resigning in February of 2007 and departed in March of 2008. At that point, the health system asked if I would step in and become the interim CIO because there were so many projects that were in a state of flux and needed guidance. In June, the health system embarked upon a national search for a permanent CIO. In March of this year, they announced that I was their selection.
KH: Before you were asked to serve as interim CIO, had you had an association with Penn Medicine?
MR: Not as an employee — but I had worked for First Consulting Group in the mid 1990s, and had been working with the health system then. In 2001, I formed a consulting firm (MedMatica Consulting Associates). Through MedMatica, I had the opportunity to serve as interim CIO of one of UPHS’ previously owned facilities, Phoenixville Hospital. Based upon that effort, and some recent needs at the health system, I was asked to assist at UPHS in an independent manner.
KH: So things worked out, and when the opportunity presented itself you felt that it was the right move for you.
I’m not sure about the other candidates that were considered by UPHS, but I know that with any position, trying to uproot your family and relocate — with new schools, new friendships, and activities — is a lot of strain on families. This was keeping it all the same for me, so it was great fit all around.
KH: But you had served as interim CIO previously, correct?
MR: As mentioned, I was interim CIO at Phoenixville Hospital in Phoenixville, Pa., and at that time, the University of Pennsylvania Health System owned Phoenixville Hospital. But while I was there, the health system sold off Phoenixville Hospital to Community Health Systems. I remained with Phoenixville Hospital to transition the IT activities to Community Health System. This experience did give me a bit of exposure to the health system back then. I say a bit of exposure because when you’re the far-out suburban hospital in a predominantly center city-based health system, you don’t get a lot of attention out there; particularly if things are going well.
KH: I can imagine. And Phoenixville is pretty far out from the city, right?
MR: It’s about 30 miles, maybe a little more. In comparison, I’m sitting in my office as we speak, and I’m looking at both HUP (Hospital of the University of Pennsylvania) and Presbyterian Medical Center right now. The facilities are that close. So after Phoenixville Hospital, I moved into the interim CIO position at Doylestown Hospital in Doylestown, Pa., which is an independent hospital.
KH: So as someone who has some CIO experience, how different do you think it will be holding a permanent position, especially in a health system the size of Penn Health?
MR: I think a few things. One, the first year of being interim CIO really introduced me to the health system and gave me the chance to understand the pace and the scale of the health system. That interim time frame really was a transitionary period and it was a blessing in many ways. It allowed me to understand the culture, the people, and the pace, just because it is so fast-paced. That allowed me to figure out if this was a good environment for myself, and vice versa; did they think I was the right person for the health system.
I do know the health system performed a national search, and there were clearly candidates with more experience in this type of setting than I had. But I think there’s a unique fit for each situation out there. George Brenckle was very good at planning, strategizing and organizing. He positioned many projects for deployment and implementation, and my background is deployment, implementation and team-building, that type of thing. So, in many ways, that interim role was my interview. During the interview process, several individuals said to me, “We already know you, we already know what you can and can’t do — do you have anything else to share with us?” That was the gist of several of my interviews.
KH: What were some of the projects that were in flux when George was resigning?
MR: The biggest activity, and this was quite critical, was that the health system was in the middle of evaluating its outsourcing agreement from an IT perspective. For six years prior, the health system had outsourced its applications, project management and infrastructure IT activities to First Consulting Group (FCG). Infrastructure activities included IS data center, help desk, LAN, WAN, and desktop support. After six years, the health system was evaluating that arrangement and came to a final decision. Number one, we were no longer going to outsource the IT applications and project management services, so that meant we were going to re-insource this group of approximately 110 employees. It was no small task, particularly since we had a handful of people who had been Penn employees prior to the outsourcing, who then went to work for First Consulting Group, who were now coming back to Penn.
In addition, the health system decided that they were going to transition the outsourcing of infrastructure support from FCG to Computer Science Corporation (CSC). For timeline purposes, George Brenckle left in the beginning of March of 2007, and we announced at the beginning of April that we had selected CSC. I got involved at the tail end of that decision, which was good and bad. But from the beginning of April until the beginning of October, we needed to perform all the necessary transitional activities. All of our computer system servers that resided in one data center in Pittsburgh needed to be moved to the CSC data center in Newark, Del. It was a lot of work.
There were 110 employees that transitioned from FCG back to UPHS. If you estimate each employee has at least 10 unique job-related or human resource type questions, issues, whatever, that’s a lot of questions that need to be addressed. You’re comparing healthcare plans, you’re comparing benefits, you’re comparing salary, and you’re comparing how incidentals were covered. So that was a pretty large endeavor. And then you had to have a management team here to be able to manage the employees who came back to UPHS. So that needed to be in place. And tied to all that, you had all the normal, day-to-day health system activities taking place. UPHS is rapidly rolling out the Epic ambulatory EMR in some very, very complex departments — surgery, GI, pulmonary, medical oncology, radiation oncology. We have found the Epic product to be a first-rate solution. Our initial investigations indicated that many existing Epic clients were using Epic in the family medicine arena, which is a pretty straight forward implementation. But when you’re in the surgical department or medical oncology or radiation oncology, it’s far more complex. You’re dealing with varying workflows, instrumentation, lab results, other types of results, and all that needs to be embedded into the workflow to use the Epic solution.
So making sure we didn’t miss a beat on those particular implementations was critical for the health system, because as all this is going on, we are building a new, 360,000-sq.-ft. ambulatory center adjacent to the Hospital of the University of Pennsylvania. It’s called the Perelman Center for Advanced Medicine. That building will house many of our physician practices that are presently scattered throughout the southwestern Philadelphia landscape. Right now we have cardiology in one building, dermatology in another building, oncology in another building, and lab in another setting. If you’re a patient and you need to visit more than one site, you’re walking all over the place. This will centralize — much like many other health systems have done — all our needs under one roof. This convenience should be a huge patient satisfier.
From an IS perspective, one of the keys is that the Center is pretty much a paperless building designed with minimal paper storage. In order to move into the Perelman Center for Advanced Medicine, these departments had to be up on the Epic application six months prior to the move.
KH: That seems like a better way to roll things out.
MR: Yes, we don’t want the practices moving and coming up on a new application at the same time. If you can sort of diffuse out the change then the practices can better absorb it. The building opens in June of 2008, which is just a month away, and the practices will begin moving in through a staggered timeframe through about December.
KH: With Epic, are you using a suite of products or do you operate with a best-of-breed philosophy?
Coming soon: Part II