Jim Venturella has spent three years so far in his position as CIO, Hospital and Community Services Division, at the 20-hospital University of Pittsburgh Medical Center (UPMC) Health System. In that time, he has been a key player at the massive, integrated health system, collaborating with colleagues to help lead the ongoing clinical transformation of that organization.
UPMC has been recognized as a national leader (including by this magazine) in clinical IT innovation. What does it take to help lead an organization forward and maintain its standing as a steadfast pioneer among health systems? Venturella spoke recently with Editor-in-Chief Mark Hagland regarding UPMC's ongoing progress, and his perspectives on lessons learned along the way.
Healthcare Informatics: What lessons have been learned so far at UPMC from your advances to date in clinical IT?
Jim Venturella: I would say that the biggest lesson is that all the initiatives are a major journey. Within IT, we tend to focus on the particular initiatives, and on moving from hospital to hospital on the implementations. But all those elements are really just pieces of the bigger journey. What we're beginning to be able to focus on really is the value that we're getting out of the systems, the benefits. One good thing is that the adoption has gotten increasingly easier over time; in terms of CPOE [computerized physician order entry], for example, we've achieved 80-percent adoption right off the bat.
And, as we've moved forward over time, many things have happened. First, the hospital executives have been able to be more firm with the physicians on CPOE; and the medical staff leadership has gotten firmer around this. And the clinical informaticists, the nurse and physician informaticists, have really gotten much more comfortable doing the implementations. So we're fortunate, in that we've got a well-oiled machine working now.
HCI: Are all 20 hospitals live on CPOE now?
Venturella: They will be by next May; I have four facilities left to go-one in Allegheny County here; and the other three are smaller, regional facilities.
HCI: Tell me about getting the value out of CPOE, and about optimization of clinical IS, post-rollout?
Venturella: Once we've got the physician order sets out there and we're getting the physicians to use them, the next challenge is how we build the other reporting requirements we have to meet, into the order sets, to drive improvements in practice. Because anytime we deliver order sets to the physicians, they just want to get going and use them. But we've got the health information management people, including coders and billers, who have things that need to happen. So how do you incorporate those new elements into it? We've developed what we call an E-Practice Guidelines Committee, composed of 12 to15 physicians, who meet regularly and discuss these things. And then we've built a repository of all our guidelines. We download from [the Kansas City-based] Cerner [Corporation], and customize our guidelines. And it's a way to track the changes and the tie to evidence; and we use the same database to track order set utilization, and we analyze the physicians’ utilization. And so we use the process to help give feedback to the physicians on that.
HCI: One constantly hears that community hospitals and teaching hospitals are completely different from each other, culturally in general, and in terms of IT implementation. What are your thoughts?
Venturella: I actually think that they're much more similar than one hears. We got back a culture survey from two different facilities, Presbyterian and Shadyside [the former an academic medical center, the latter a community hospital]-and the highest-rated and lowest-rated cultural issues were identical in both facilities. And so we may be perpetuating perceptions in the industry. Now, they definitely are different types of organizations; it's certainly easier to get residents to enter orders directly than to get affiliated physicians to do so, some of whom might be “splitters.” But we're getting the same levels of CPOE adoption at the community hospitals as at our teaching facilities, so that says something. Now, it is true that the complexity of building clinical information systems is greater at academic medical centers, because of differences in practice among the specialties and subspecialties, than at the community hospitals.
HCI: What advances in quality and patient safety have occurred, and what have you learned, in the facilities in which CPOE and the other advanced clinical information systems have been in place the longest?
Venturella: I'll tell you, we've learned that we still have a lot to learn.
HCI: So it's that continuous loop of implementing, analyzing, and continuing to change practice as a result, that is core to clinical transformation?
Venturella: Yes. Now, our quality group has done a lot of work, but the effort involved to analyze utilization and issues is very manually intensive at this point, so we're focusing somewhat on that going forward.
HCI: What are your perceptions of the challenges at the hospitals that are way behind the curve right now in terms of meaningful use, such as for CPOE implementation?
Venturella: I'm glad I'm not at one of those organizations now. It takes people from all the disciplines to make these things happen; plus, it takes a lot of capital to make things happen. And in terms of the final rule, I think ONC [the Office of the National Coordinator for Health Care IT] did the best they could to write the rule just right, not too difficult and not too easy. But when you combine the payment changes coming out of the healthcare reform legislation with the meaningful use requirements [from the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act], it will be very daunting, and very hard for some standalone hospitals to remain standalone or in business, because while you're getting some money from HITECH, you're getting some taken away from the payment system, so at the end of the day, you're not really getting stimulated.
HCI: What would your advice in terms of prioritization, to those CIOs whose organizations are just getting going now, per meaningful use?
Venturella: The very first thing that you need to do is to educate the executive team, because you're going to be completely involved in this, this will be completely absorbing, and not a “side project,” if you will. Second, you've got to get the right clinical informaticists in place right away. And the third thing, I would probably be considering what outside support I can get, whether it's going to a larger health system to tap into what they've done, or going back to my vendor. Because a third party can help you with some process elements, but they can't do the core work for you; you as the CIO have to be the glue and make sure everything gets connected. And you as a CIO have to understand that this is a journey, and not a point in time. And Stage 1 is just the first phase of the journey; we're going to be living these meaningful use criteria for many years into the future.
HCI: Some vendors have developed “fast-track” methodologies for CPOE implementation-your thoughts on that?
Venturella: I think that technically, you can get some things done quickly. But operationally, you need the time to lay the groundwork. So I would be very skeptical about that kind of thing. But some of it also has to do with how well you can manage expectations. I think you can be successful in a short period of system by putting in a model system like that and then tweaking it over time. But the challenge is cultural and educational-everyone has to be on the same page, or you'll have real disconnects. To some extent, we're facing a similar set of issues in that we're giving the regional facilities our model; and they're not as hands-on involved in the same way. But they do have people involved who have participated in some other go-lives and in other informatics meetings; so we've been working over time to assimilate them throughout.
HCI: What will be the greatest challenges and opportunities for CIOs in the next three years?
Venturella: For me, personally, the biggest challenge remains balancing user requests with the money resources, making sure what we do is aligned with the strategic direction of the organization. That's been a challenge, and I don't see that changing. Because as people use the systems more, there are more requests, and those numbers aren't going down. And the greatest opportunity for us is to demonstrate the value: the promise is out there for improved quality, patient safety, workflow, and efficiency. The challenge now is for us to demonstrate those, and I think we will. We're starting to do that now, to shift gears and demonstrate why we did all this in the first place. We're also starting to see the value of what we've put into place. We have many horizons, including wanting to personalize the clinician end-users’ experience.
Healthcare Informatics 2010 October;27(10):51-52