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Full Transcript
[00:00:00] Liat: Today we have Robert Bart, CMIO at UPMC Health Services Division, who I had the chance to meet in person actually at Becker's annual meeting in Chicago this year. Robert, so great to have you with us.
[00:00:19] Robert: Thank you. Thanks for having me, Liat, I look forward to chatting with you and your listeners.
[00:00:24] Liat: Thanks so much. And we know that under your leadership, Rob, at UPMC, you've increased a national reputation of innovation in medical informatics that improve patient care. And you also continue to see critical care pediatrics patients, correct?
[00:00:36] Robert: Correct. I'm down to one week a quarter. So about four weeks a year in the pediatric ICU. As my sort of daytime job, so to speak has takes over most of my duties.
[00:00:47] Liat: You're doing a lot. And before we actually dive into our questions, I do want you to share about your journey in healthcare, how it all began, and then we'll dive into our questions today.
[00:00:57] Robert: Yeah. I've been involved in healthcare for 30 plus years now and healthcare IT or technology probably for about 25 years. And being an intensivist, working at pediatric ICU when I was in training at Duke university I was involved in sort of one of the first electronic flow sheets that was using the ICU space and that sort of peaked my interest during my training. And then while I was at children's hospital, Los Angeles, there was a gentleman who was a CIO, John Patterson, who recognized my interest and my skillset, and asked me to get engaged with their journey through an electronic health record. From there, the rest of my career blossomed I stopped on the vendor side, working as a CMO for the Cerner corporation. I was a chief medical information officer at the Los Angeles County department of health. Now I'm a chief medical information officer here at UPMC.
[00:01:53] Liat: Quite a journey. Can you share with us what the most important thing you're working on today when it comes to the digital patient experience?
[00:01:59] Robert: I think the experience has really accelerated sort of healthcare's transition from a traditional, somewhat digital, somewhat analog world where everything was digital. In the sense there was phone-based. People were using websites, but a lot of the interactions were facilitated by a person in the middle - patient or potential consumer or customer reaching out to the healthcare system.
They may use the website to identify something, but at the end of that, there was a phone number. They ended up having to call someone, there was an interaction, and then something else digital happened that may have come back to them in their patient portal on their smartphone. I think one of the areas that's most interesting to me in the area that we're really focused on here at UPMC is how do we take that whole process, eliminate all of the manual human steps, and create an end to end digital process that allows consumers or patients to actually be much more self-service, in the way that they seek care.
There's some evidence as it relates to missing appointments, which unfortunately happens, that if someone actually has the control to schedule their own appointment, there's fewer missed appointments than one where you call a call center, or when they ask you as you're leaving the current visit to schedule your next visit.
Certainly in that experience, I'm one of those people, when they ask me to schedule my next visit, they shout out some date and time and I'm like, yeah, that works. And then I get home and realize, yeah, that's not gonna work. And so then I have to go through something, but if I actually can control that experience in interacting with the healthcare system, I think we'll have customers and patients who are much more engaged, but also much more satisfied with the type of service they get.
[00:04:41] Liat: That is what today's world is all about. I think it's almost a given by now that this is what should be in place these days. What tools are you using to make this a reality?
[00:04:48] Robert: We've embarked early on in the pandemic. We actually turned on a new, Find a Doc physician solution. And that, and just embarking on that within the first two or three months of that pandemic, in the May-June timeframe of calendar 2020 that was a huge transition for us. That then allowed us to actually transition into new tools to allow some digital self scheduling directly from that solution. But I think that's only one mechanism of reaching out to consumers and current patients. I think that we need to look at many other tools that layer, or wrap on top of that, that allow us to engage consumers who might be patients or current patients in future interactions with us. That's the piece that I think is most intriguing to me. I'm interested in solutions that are much more of a platform that allow you to plug and play the things that will work well for your environment, as well as to curate them in a manner that works well for how UPMC wants to deliver healthcare.
[00:05:07] Liat: So we talked about this when we sat together at Becker's. And I am interested in knowing -when you embark on these digital transformation projects, what is your process for defining KPIs to guarantee a successful outcome?
[00:05:18] Robert: I think one of the main considerations is that the first step is the digital process. They have to be adopted and integrated and owned by operations. I think one of the mistakes I've certainly made in my career, anI think other individuals in healthcare systems have made is they have the traditional delivery apparatus or access apparatus, and then they try and stand up a digital apparatus in parallel. I think the current state of the industry that doesn't work well, you actually have to figure out how the current process and apparatus transforms itself into what the new is gonna be. So that's the first step it's really getting that integration and the operational ownership. This shouldn't be something that I do as a technologist or an inform.
It should be something that is a shared ownership between the operations and the people that I work with and represent in, in pulling this together. I think the KPIs have adjusted over time. And they actually aren't that different to the traditional KPIs of how many appointments are scheduled, how many, what's the third next visit time period.
All of those traditional ones should actually be the same ones. Sometimes when people embark on these digital journeys, they get attracted to things like net promoter scores and other aspects that represent use of the digital tool set or solution. But at the end of the day, it's not the use of it that's important - it's how many of those activities actually translate into scheduled appointments? How many of those activities actually translate into someone Identifying the clinician they need, and then identifying the type of templated appointment they need to therefore schedule? So, it goes back to very traditional, scheduled appointments, completed appointments, no show rates, all of the traditional metrics of apps, excess of care, all the traditional metrics of the efficiency and effectiveness of an ambulatory care aspects of a healthcare system. The metrics really haven't changed. It's the mechanism of how we get someone to complete the process, to generate those metrics. I think we end up getting finer detail and higher quality information, because every step is digitally captured as opposed to in the analog model.
But at the end of the day, it's really, how many appointments were scheduled, how many appointments were completed? How many were noshows? Why were those no shows, trying to understand that and trying to understand how we can facilitate each step of the process.
[00:07:58] Liat: Interesting. And a great aspect of AI is that it provides us with these actionable insights, from behind the scenes and a hyper-focused lens on what is actually going on and what is being seen through from a to Z. So, luckily we have those tools as well, that don't necessarily need a human to be involved.
Now what's a challenge that healthcare executives like yourself in charge of these patient journeys face that isn't being talked enough, in your opinion?
[00:08:24] Robert: I think it's the cultural change of the healthcare system. Although we've added technology over the last 50 years, they've predominantly functioned in the same mechanism of care delivery. I think that's particularly true here in the US. You can go into multiple different numbers of the top 10 or top 20 healthcare systems in the US - they might have a slightly different flavor, but they're still all doing about the same process. And I think that, to me, that signifies, there's a big shift in the culture of how we think about healthcare, and how we think about accessing and delivering healthcare that needs to occur.
A simple example is for many years, a given physician or a APP schedule it was referred to as the physician schedule or the a APP schedule. So it was predominantly structured frequently around that individual's preferences. My preference as a physician might not meet the needs of the patients who want to seek care from me. We have to strive to, to reach a different balance where it does meet my needs as a clinician and how I want to deliver care, but I'm also reaching out and meeting the needs of how the patient wants to access and wants to receive care. And we have to create a better balance in that Interaction and that conversation. That's actually one of those cultural points that needs to change, and we really, I think when you ask a physician or an APP, they always say they're here for the patient, but we now have to represent that. And how we interact with the healthcare system to be there so that the patient can interact with us.
[00:10:13] Liat: How do you overcome then those gaps? How does one overcome and create a more streamlined process?
[00:10:20] Robert: It's definitely a challenge. I think, there's all these adages about how, culture eats strategy, et cetera. It starts with aligned messaging at the top of an organization. Constant and consistent messaging from the leaders within the organization, that's pushed down throughout all of the multiple layers, getting to the people who are actually at the edge of care delivery. And I think it's consistency and constancy over time. That is what's most important. You'll have in any transition of culture, you have those who are the willing early adopters. They hopefully can be some of the proselytizers of those people who are next to them, but you also have those Starwars who are like, I've seen this story before and I'll wait it out. And you have to be more patient than they are. There will be a point, I think, that when you can convert your culture enough, that those last remaining groups that are stragglers. There'll be a point where I like to think of this as a train, going by a bunch of stops. You'll have a stop. You'll have an opportunity to get on the train at many different stops in the culture change. At some point, there will be a last stop and those stragglers will have to decide to get on, or if they're never gonna get on, then the organization's gonna have to make decisions about them, and that's the unfortunate reality, but it's something that will take time. I'm and I'm not talking about this train only takes 90 days. This is cultural change. Like this it's a multi-month multi-year endeavor.
[00:12:01] Liat: It's funny you mentioned, because my next question was like, how do you think a conversation would look like between yourself and another CIO in five years? And then I said, five years is nothing in the healthcare industry. Let's say 10 years.
[00:12:14] Robert: Yeah. it's interesting. There are change seems to be a challenging within healthcare, especially with the adoption of technology and new. But I think I think COVID has the pandemic has taught healthcare systems that they can change pretty radically pretty quickly when they align and set their mind to it.
I think the other thing coming out of this pandemic is there, there are now financial pressures across the us healthcare. and the financial pressures to me, actually, they signify an opportunity. You can look at them as, oh my gosh, what are we gonna do? Or you can look at 'em as, this is an opportunity to actually define change because we are, whether we want to or not, we are gonna have to change. So let's take the bull by the horns and actually define the strategy of how we're gonna accomplish that change. As well as the pace
[00:13:12] Liat: Speaking of change, we are now gonna play a fun game called bullish or bearish. So it's time for you to place your digital bets. I'm gonna be naming a technology in healthcare, and you're gonna tell me if it's bullish or bearish.
All right. Let's start with the first one. Number one, Telehealth,
[00:13:28] Robert: Bullish. As long as the government aligns its support. That's the main issue that's still remaining. The PHE or public health emergency declarations has been the license to allow Telehealth to continue to occur in its sort of expanded manner.
We have yet to actually at the federal level, make some of the governmental changes that would allow this to continue in and as open spirited as a manner as it has during the. Once the public health emergency declarations end. So I, and I do think the government will do it. They're just not being forced to do it as these PHEs continue to be executed.
[00:14:12] Liat: Okay. Number two, bullish or bearish - Wearables.
[00:14:18] Robert: I'm bullish wearables. I paused a moment because wearables generate an incredible amount of health data. And we have to be cognizant about how that health data gets consumed by a health system. If it comes in as completely unsolicited information or data that creates a challenge for health systems in being able to make sure that they're reacting and responding to it, because there aren't intelligent triggers built into many of our platforms and solutions today. I think as that segment matures, the opportunity in the wearable space will really skyrocket.
[00:15:04] Liat: Conversational AI.
[00:15:05] Robert: Big growth. So I'm bullish and conversational AI for sure. I was a huge fan earlier adopter of conversational AI when it was called, just called NLP. And then it became NLU and then it became conversational AI. So I've been following it for over a decade, probably about 15 years. I think we're on the cusp of it. There's certainly been a large growth in the number of companies in healthcare specific conversational AI. I think we're starting to see some of those companies take an early lead because not all conversational AI is equal.
I think some of them have pretty significant limitations in how their concept of how they construct the interaction. I think we're gonna start seeing, my belief is the latter half of 2022, we will see somewhere between two and six of the companies in this space really start to delineate themselves separately from the tens to hundreds of other companies in this space, because of how they how they use intelligence to create the richness of the context. But also allow the looseness of the conversational interaction. What
[00:16:13] Liat: What do you think would be the differentiator that kind of breaks apart? The best from the rest?
[00:16:18] Robert: The ability to efficiently and effectively ingest new knowledge mapping and context creation. For example, you mentioned you're from you're with Hyro. So Hyro is partnering with a find the doc, scheduling type of application Kyruus, and the ability to ingest all of the content that's generated from that, and then have that mapped into the intelligence that you're using. If you can do that more effectively and efficiently than other entities, I think it will separate you from that. And so I think there, there are some really interesting opportunities and use cases, whether it's Hyro or some of the other Conversational AI companies, I think. And then there's also a couple different flavors. I think there's companies like yourselves and others that most people would look at sort of the front end of the clinical experience or the administration of getting into the clinical experience, there's also some companies that are much more in the mix of the clinical interaction. And I think they're, they could be merged into one domain. But what I'm seeing right now is that most of the entities are choosing to be in one domain or the other. They're not trying to do both all at once. That may be just more of a maturation of these companies and of the solution set and just the state and time that we're at. We may see that all coalesce into a single entity company that can actually do all of that. That remains to be seen though.
[00:17:51] Liat: What do you think of the phrase "digital front door"?
[00:17:56] Robert: I'm not a big fan of of digital front door. Sometimes it makes me think of smoking mirrors. There's this fancy digital front entry, but then you get inside and everything is like carbon based, very manual. I really I'm much more interested in not only just having a digital access, but an engaging digital experience. And the front door aspect. I think that, unless there's something on the other side of that door that continues the digital experience that we're not really completing the thought and therefore the experience for the patient or the consumers that sort of engage.
I think that we need to get beyond just on digital front door. Cause I'm quite frankly I'm tired of looking at that companies offer that are digital in one aspect, but result in a bunch of manual workflow queues on the back end. We want, not only should it be a digital experience for the patient, but it should be a digital experience for the people who work within the healthcare system to execute and for as much of it to be automated as possible.
[00:19:14] Liat: Automated and integrated, and a door that leads to a digital hallway that leads to a nice room. I see what you mean. Very interesting. Our second to last bullish or bearish - Remote patient monitoring.
[00:19:26] Robert: I'mbullish on remote patient monitoring. I think it's been around for a while. I think it got a big lift during the pandemic, but I think the other thing that's occurred. It's on one end of the spectrum, which people are starting to create now where you have remote patient monitoring, maybe going all the way to hospital at home at the other end. And there's this continuum that's gonna leverage different components of a platform, different components of technology.
We touched on wearables. Telehealth is all through this space embedded within it. So I think I think RPM is just gonna, is one segment of a growing sort of footprint in a changing world related to sort of new venues of care delivery. And many of those new venues of care delivery are gonna be, from the comfort of your own as opposed to you having to come to the healthcare system
[00:20:22] Liat: You're being very nice today with your bullish four to five. So let's see if this last one makes it through augmented reality.
[00:20:30] Robert: Probably bearish in 2022. I think if you asked me the same question in 2024, it'd be a little bit. It, it's a little bit of, I think it's a challenging space because people are they're approaching AR in a way that it's very endpoint solution driven as opposed to platform for use.
And that creates a lot of problems for someone like me. When you have multiple different surgical disciplines. Who are all bringing a different end point to you that, and then, you can't implement all of them. So I think it's a little bit of a fragmented space right now, just because of the state of maturity it is in. But I do think that as it matures over the next couple years, that will change even with augmented reality. There's concepts of sort of digital twins and healthcare. They're starting to come. Where you could construct a personalized health plan based on who your digital twin is. I think all of that will it, it needs more percolation time, I think.
And as opposed to, Hey, here's new technology let's try and throw it at this. I think there needs to be more thought around it. That's frankly, what happened with telehealth through the pandemic. It forced a lot of thought around it and how to better integrate it because in many healthcare systems, telehealth, coexisted with traditional care delivery and then the pandemic forced them to merge into part of how the operations deliver care. And so I think, it's a point in time, maturity within that realm will, I think change from something that I think is bearish today to bullish in the future. Are there any
[00:22:10] Liat: emerging technologies on your wishlist when it comes to the digital patient experience, something you wish that you know existed today?
[00:22:18] Robert: I think the challenge that I have today and I think many of my colleagues do is we've got. Technologies from multiple different generations of technology, life cycles and many of the newer technologies that we just chatted about. They're very focused on a narrow segment and they're not taking a more holistic or platform approach. And so it creates a lot of challenges in integration. And stringing all these things together. And so I'm much more interested. I think as this, as the different segments mature, I am hopeful that there will be someone who, or multiple entities that end up creating platforms that allow us to plug and play on top of that.
So we can sculpt and create sort of the UPMC curated experience, which might.
What I would hate to see is that all of the experiences look and feel exactly the same, because I think that all of the healthcare systems, they potentially do have something unique to offer and how they interpret healthcare delivery, how they manage the culture that they have in care delivery. And I wanna make sure that piece that's unique to UPMC is able to get within the platforms we use. So I think it's taking these pieces. Hopefully they congeal into some sort of a platform approach, allow us to then leverage our multi-generations of different technologies into something that creates a seamless experience, both for our clinicians, as well as the patient consumer.=
[00:24:05] Liat: What is the best career advice you've been given?
[00:24:07] Robert: Don't limit yourself. So I think the other one is don't be afraid to say no, I think and early on in my career, I think I was so eager. I said yes, to too many things that diluted my ability to be successful at all of them. And I think that that's a trap that many of us fall into. Certainly I did. And I think you have to be willing to say no to certain things. And then I think the last thing is reserve the opportunities that fit your unique skill set for you. I think that's really important to try and really focus on what are the things as my role or my skills or what I'm asked to do, what are unique that I can do and focus on those.
And don't be afraid to ask others to partner. And the aspects that might not be unique to you, but might be unique to them. I think you ultimately get better collaboration and you also get a better end product or end result for your organization, which translates into better results for the clinicians and patients.
[00:25:15] Liat: Very nice. I love that question. It always people always give a very refreshing answer.
And lastly, Rob who do you view as a trailblazer in the healthcare it industry that you'd actually like to nominate as a future guest on our podcast?
[00:25:28] Robert: I think David Feinberg his role as the CEO of Cerner and his past experiences would be a unique. One, I think I just saw today that the Oracle acquisition of Cerner completed so one of the other people that I think would be quite interesting is Mike Sicilia. He's the executive VP at Oracle who is gonna oversee. the relationship of Cerner underneath that acquisition. And so I think a lot of people would like to not just understand Mike's past experiences within te technology, but how he sees his role in Oracle facilitating how Cerner moves forward.
Another person that I work with a fair bit, who's also in the conversational AI space is Shiv Rau. Dr. Rau is a cardiologist here at UPMC. Who's also the CEO company named the bridge. I think he is a unique leader within the conversational AI space. And he shares the same sort of passion on what. And how we think appropriately capturing conversations could actually move healthcare forward in a very significant manner. I think those are those two or three individuals would be who would be wonderful to have in the future.
[00:26:45] Liat: So my three Musketeers David, Mike, and Dr. Rau, we are coming for you and Rob, I want to thank you so much again for sharing your invaluable insights. And it was great meeting you in person at Becker's, hopefully see you at the next Becker's and perhaps ViVE? What is the next industry event you'll be attending?
[00:27:03] Robert: I just went to AMIA's Clinical Informatics conference in Houston about two or three weeks ago. I think it might be ViVE or HLTH coming up in the early fall. And I think I'm also, I just saw an email might be going to the Becker's CEO seventh annual health IT and revenue cycle. They were reaching out about having a conversation of the importance of sort of CMIOs and how CFOs should think about partnering and working with them.
[00:27:43] Liat: Amazing. We will see you there. We'll be at health that's in November, ViVE is in Nashville in April. Thanks again for everything Rob, and we'll see you soon.
[00:27:52] Robert: Okay. Thank you, Liat. Bye-bye.
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