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description. We are excited to welcome you in October.
This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Rob Bart,
chief Medical Information Officer at U P M C. Dr. Bart,
it's a pleasure to have you on the podcast today.
Thank you for having me, Laura.
Now, I know we have a lot to talk about healthcare and digital technologies in
healthcare, um, are are rapidly evolving and the field is moving quickly.
But before we dive into my broader questions,
can you tell me a little bit more about yourself and your background?
Yes, I'm happy to. So, uh,
clinically I'm a pediatric critical care physician and I've been doing that
for, I guess over 30 years now.
And it was about the time of my pediatric critical care fellowship that I got
involved in healthcare technology. Um,
I was training at Duke and Duke was one of the early adopters of,
uh,
digital flow sheet for care delivery and documentation in the ICU
environment.
And so I was involved in the implementation deployment, um,
in my critical care fellowship,
and that sort of got me very interested in healthcare technology.
And as my sort of career progressed across the country ending up
at Children's Hospital Los Angeles, um, I was involved,
um, with an enterprise electronic health record deployment back in
2002,
which partly seems not too long ago and partly seems a long
time ago. Um,
but that ultimately led me to a physician as a chief medical physician
at, uh, Cerner Corporation. So I've worked on the vendor side for a few years,
and then prior to joining U P M C,
I was the Chief Medical Information Officer at the Los Angeles County Department
of Health Services where we sort of transformed and transitioned care there
to a new, um, electronic health record. And in the summer of 2017,
I came to U P M C, um, never really thought I'd leave Los Angeles County.
I, I really enjoyed and I think thrived on on the mission there,
but I think I've also,
Dr tried to drive myself to always learn more and the opportunity
to come to U P M C where they had a large in insurance services arm
as well as a group called U P M C Enterprises,
which does a lot of technology hibernating investing.
Um, it just made U P M C a very attract attractive environment to,
to come to and to,
to learn some of the things that I didn't know about healthcare technology.
That makes a lot of sense and what a fascinating career journey,
being able to obviously start off as a physician, a critical care physician,
and then, um,
get into the technology role doing some integrations over to the vendor side
with Cerner and then LA County. Um, from your perspective,
when you really look at the breadth of what you've been able to experience, um,
where do you see the technology really, um, headed?
What are some of the opportunities that are on the horizon right now as well as
the headwinds that you have your eye on?
A a lot of the technology that we've implemented within,
um, the healthcare delivery, I'll focus on sort of the delivery part of it.
First, um,
really was the digitization of healthcare processes
that had been developed over generations of care being delivered using
pen and paper, you know,
maybe fax machines using triplicate forms, et cetera,
which some of my colleagues will probably remember,
but we didn't in, in many respects,
the technology footprint didn't advance healthcare as much
as I think at least I expected it to. I think that we,
we predominantly, um, did change,
did improve care by digitizing it,
but we didn't sort of make this sort of
Olympic leap to the next level,
which I think that's what I sort of thought I was doing back in 2002.
And I think that we're now at the point with being able to inject
intelligence into the technology platforms that I think what I thought
we were doing 20 years ago is something we potentially can be doing
from, you know, today going forward. And so that's what I,
I look forward to is, you know, the,
is potentially the future of what we're gonna do, um, based on sort of
the base or platform of what we've implemented within u the US healthcare
delivery systems over the last 20 years or so.
Absolutely. That's really fascinating and I know, um,
what you've been able to do there at U P M C,
it really has a sophisticated platform being able to incorporate a lot of
different technologies. And so, you know, it it, it's awesome to see where,
how far things have come, especially from those days of, you know, uh,
primarily using fax machines in the triplicate, um,
copies and trying to do everything, um, along those lines. So, you know,
once you have that foundation, um, in place, what's the next step in in,
if you have a quick minute to or thought for hospitals and health systems that
mm-hmm. , you know,
maybe are still on the stage of trying to inform that base of a great platform
or, uh, something that they can really rely on before, um,
launching into the future. You know,
what's important to know about building that strong platform, um,
for any type of healthcare organization?
Yeah, so, so I think that, so U P M C sir has two,
um, there, there's one, one aspect that's somewhat unique. Um, uh,
for those of you who are familiar with U P M C,
we are an organization that's predominantly concentrated in the state of
Pennsylvania with a small outpost in,
in New York state and a small outpost in Maryland. When I say outpost, we,
we have hospitals in those states,
but most of our core care deliveries in the state of Pennsylvania,
and it's grown over the years through acquisition. Um,
the acquisition and that process has been healthy for the organization to meet
critical amass, but it also means that we've incurred a fair amount of,
of technical debt. Um, and what I mean by that is our electronic health records,
um, we have, I have more than one, I have mul multiple EHRs.
And so I think our challenge will be a little bit unique in that
we need to sort of modernize our care
delivery infrastructure at the same time that
we sort of keep our eye on being able to make sure that our current
platforms and future platform we'll be able to leverage intelligent
intelligence within the platform. Um,
we're very interested in artificial intelligence, which, you know,
I'm sure most of my colleagues in in healthcare IT are,
are interested in and most interested in it in areas that will help improve
the efficiency and effectiveness of care delivery. Um,
I know that there's been a lot of focus on artificial intelligence in the
clinical decision making space, but I, I think that,
that we have to build sort of comfort with artificial intelligence within
care delivery and comfort also means trust.
And I think leveraging artificial intelligence and what it can
provide us in being able to optimize the efficiency and
effectiveness and throughput and care delivery, for example,
is one way that we can develop comfort and trust with it. You know, imagine,
you know,
solutions that help you optimize the number of patients you can see
in a clinic day,
or the number of patients that can go through one of our facilities
ORs in a very safe, effective manner, um,
that allows us to create better scale with the limited human and physical
resources we have. I think that's one of the challenges in healthcare,
but that,
that opportunity then allows healthcare as a,
as an industry to become much more comfortable and trusting
of artificial intelligence.
I think those are sort of the building blocks that we'll need
as we're starting to develop that trust,
then being able to turn it back into some of the, uh,
care, clinical care decision making processes that I think a lot of people are
targeting artificial intelligence with aiding clinicians. Um, in,
in that instance, I, I don't think,
I'm not one that believes that clinicians will be completely out of the loop.
I think, um,
maybe the a in the a in artificial intelligence should actually be referred to
as augmented intelligence helping me as a physician make a better
and faster decision as opposed to replacing my
ability to make a decision. But as I said, the, I think the,
the stepping stones to that are being comfortable in letting artificial
intelligence really help us tune our operational efficiency and effectiveness.
That makes a lot of sense. You know, and it's really fascinating to look at,
especially how artificial intelligence has evolved in the past few months and,
um, really become part of the everyday workflows in many cases and,
and lots of new opportunities there as well. Uh, from your perspective,
how do you think about growth and adding value to the health system overall?
Is it focused on some of the things you were mentioning terms of the, the, um,
clinical technologies and artificial intelligence or,
or where else do you see as being really great ways that you as the C M I O
of U P M C can really make a difference?
I, I think one of the, the big areas of in,
in adding value to an organization and,
and in my instance specifically the U P M C,
is to be able to sort of discern
the tens if not hundreds of technology opportunities out there.
And really identifying the ones that have
value both in improving or maintaining the high quality of
care we deliver,
or improving or maintaining the experience we wanna offer patients and
consumers while at the same time being able to offer a
true financial return on investment. Um,
and you really have to turn over a lot of stones in technology to identify those
opportunities, but I think tho that's where you really achieve, uh, you know,
value for your organization. Um, you know, I'm a little wary,
as much as I mentioned, talked about artificial intelligence a little while ago.
I'm a little wary that it'd be probably pretty easy to spend,
I don't know, a hundred million dollars on a bunch of artificial intelligence
and not have a lot to show as far as return on investment either from a
quality of care or a return on investment financially.
And so I think that although there are a lot of opportunities out there,
we have to be really thoughtful about which technologies truly bringing
value to the process of care delivery for U P M C as well
as value to the patients and consumers who seek to get their care here.
And um, you know, and that's something, uh,
a comment I think when I, when I worked at Cerner, which you know, was a,
is a publicly traded company at the time, um,
I think one of the things I learned there was that you have to be able to
deliver value.
And so as I look at that and whether it was a LA county prior to coming to U P M
C or here at U P M C,
even though we're a private not-for-profit entity, the,
the thing that always, um,
is driving me is does that drive the best value for the organization in
accomplishing the goals that we want for our patients or the goals that we want
for our clinicians and being efficient and effective in care delivery.
Um,
as well as always looking at an opportunity where that can potentially return a
financial investment. I, I think if you,
if you don't put those as some of the requirements when you're trying to solve a
problem that you're presented with, you'll come up with a solution,
but it might not be the highest value solution for your organization.
I, I think that makes a lot of sense and I'm sure will resonate with a lot of
hospital health system leaders as they're talking through, you know,
what AI strategy really makes sense for them,
how they should be thinking about it in, in being very thoughtful in terms of,
um, how they're using their healthcare dollars.
I know right now I is really an important time in healthcare.
A lot of organizations are facing tighter budgets than,
than they have in the past and slimmer resources, both manpower and otherwise.
So, uh, given that, do you see any areas that it's, uh,
really important to continue to make investments or, you know,
maybe a risk worth taking in the next year, uh, to just to make sure that um,
the hospital or health system really is in a place that it can grow going
forward?
I, I, I think, um, you know, a couple areas I I,
I've sort of hammered on the point of of efficiency within your organization and
looking at technology that relieves
the individuals who are, um,
involved in moving patients through the care continuum and really aids and
supports that, I think that is worth definitely investing in.
Cuz I think there's,
there's this balance of improving the process but at the same time trying
to decrease some of the burden of effort in all of the
individuals who are involved in streaming together care delivery, you know,
whether that's the clinician at the frontline or the technologist
supporting the clinician or even the back office finding those
investments that in this instance it might not have
the most direct financial reward to the organization or returns to the
organization,
but if it really decreases burden of effort,
which I think every healthcare system is, is struggling with this challenge,
you know,
as we're sort of in this prolonged emergence from the COVID 19 pandemic,
that's an investment worth making cuz I think it's important to also realize
it's important to invest in the processes that people are involved in
because at the end of the day, healthcare, no matter how much technology it has,
is ultimately gonna depend on having people who are happy and
proficient in the care delivery process.
And easing that burden is gonna help them be a little,
hopefully a little happier and hopefully a little more proficient in the process
of care delivery.
That's a really great point and definitely is something to keep your mind on
and, um, your eye out for, for the healthcare delivery team, I know it's been,
uh, definitely a rough few years and certainly, um, being able to make things,
uh, easier for them and more efficient and and more seamless in the care
coordination I can imagine, um, is really,
really impactful on the organization overall.
Yeah, I, I absolutely, I think, you know,
there's so much focus on machines and artificial intelligence and we,
there will all be always be humans in, in the care delivery process and, and,
uh,
I think you cannot replace sort of the healing factors related to, to,
to human interaction, human touch that occurs in,
in healthcare and, um, you know, that's,
we need to be able to sort of relieve the burden so that peace can actually
resonate and come through to all the patients who receive care,
whether it's at U P M C or at other organizations.
Absolutely. I I love that idea and thought. Um, Dr. Bart,
before we wrap up our conversation here, I wanted to ask,
where do you see the best opportunities for growth and development in the
future?
What does that look like for yourself as well as the teams that you work most
closely with?
That, that's actually probably the hardest question you've asked. Uh, I think,
you know, from an organizational perspective, I think U P M C,
we see a lot of the future of care delivery being in, um,
in the ambulatory, both traditional ambulatory and,
and the post-acute space and,
and the footprint of acute care or hospital based care,
I think is gonna shrink or we at least we believe it's gonna shrink over the
next few years. So I think that's where,
where the growth opportunities are gonna be. Um,
and I think to, to support that, you know,
we've certainly seen a movement away from,
uh, patients and consumers interacting with healthcare systems in sort of
traditional manners as in, you know,
prior to the pandemic.
And I think along with that move into
new models of ambulatory care or new models of post-acute
care and even acute care that may not occur within hospitals. I think that,
that it's gonna require, um,
a new form of sort of digital interaction with patients
and consumers.
And I think we've certainly seen sort of a huge interest
from patients in wanting to interact with healthcare systems through their
smartphone and through other devices. Um,
and so I think as those administrative duties start to become more
digitized and much more, uh, seamless with, with patients,
I think that you'll see new care models come out of that,
that that really a,
allow the new footprint of technology with some of the new
intelligence that's being pushed into healthcare technology to allow
opportunities for growth. Um, I think, you know,
we're aggressively explor exploring sort of new models of outpatient
care. Um, things that, uh, we wouldn't have considered prior to the pandemic,
but I think the,
the pandemic forced us to see
opportunities or, or, um,
experiences that we previously wouldn't have thought of.
And we've realized we can do this very safely in this new
venue of care that's not a hospital.
And I think that's where a lot of the growth is gonna occur. You know, it's
maybe, maybe the future will include more, you know,
home visits, which is from, from doctors,
whether they're virtual or physical. Um, you know,
not too different from a hundred or 150 years ago when physicians
predominantly made house calls. Um, maybe that is sort of a,
a sort of back to the future sort of vision, but there's gonna be some,
some construct around that. The,
what we have done and traditionally moved into acute care in the shape of
hospitals a lot,
I think a lot of that's gonna get deconstructed into new models of care in
venues that are much more comfortable for the patient to receive their care in.
That really makes a lot of sense, you know, and it is a great, uh,
vision of the picture that you're painting, um, in terms of, you know,
where healthcare is headed and how really, uh,
physicians and clinicians can be most impactful on patient care. Dr. Bart,
thank you so much for joining us on the podcast today.
This has been really fun conversation and I'm excited to see you as well at our
event in October for health IT Digital Health and Revenue cycle, uh,
five event in Chicago.
I think it's gonna be a lot of fun and I'm looking forward to continuing the
discussion then.
Oh, I, I appreciate you taking the time to, uh, spend a few moments,
be Laura and I look forward to, to meeting you, um,
in October during that event.
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