The University of Pittsburgh Medical Center (UPMC) Health System co-presented, along with a number of allied organizations, the European Telemedicine Conference 2014, held October 7-8 in Rome. In late September, before flying to Rome to give a keynote speech at that conference on the topic, “Extinct Species: Why Hospitals Will Be Obsolete and Medicine Will Be Digital,” G. Daniel Martich, CMIO and associate CMO of the UPMC Health System, spoke with HCI Editor-in-Chief Mark Hagland regarding the subjects he was planning to address in his keynote speech.
The conference, held at the Parco dei Principi Grand Hotel & Spa in Rome, stated on its website that the conference would “combine the efforts of several leading European healthcare organisations into one powerful event,” and would address, among other things, “how telemedicine is working to improve healthcare; evaluate applications of telemedicine and telecare; assess the sustainability of services; learn how research will be translated into real improvements in the delivery of health and care,” and help attends to “understand what infrastructure is needed to enable cost-effective telehealth and telecare delivery.” It was co-presented by a wide range of organizations, including HIMSSEurope (a division of the Chicago-based Healthcare Information and Management Systems Society), the NHS 24-Scotland’s National Telehealth and Telecare Organisation (part of the British National Health Service), the Norwegian Centre for Integrated Care and Telemedicine (Nasjonal Kompetansetjeneste for Telemedisin), Badalona Serveis Assistencials, Odense University Hospital (Denmark), and UPMC.
Below are excerpts from the late-September interview with Dr. Martich.
Your keynote address has an intriguing title. What are you planning to discuss in Rome?
I’m basically going to walk people through the Darwinian theory of survival, and that if you’re smart, you’ll survive. But it’s not just smart and strong, but those creatures that are adaptable to change. I’ll give natural examples like the sabertooth tiger and the dodo bird. And then I’ll share a video from ABC News about the subway dogs of Moscow. They come in from the suburbs, they ride the subway, and have learned behaviors. They ride the subway as passengers to get into the city to get food from people in the city, and then get back on the subway and go back to suburbia, where they live. They’ve figured out how to get their food.
So then, I’ll transition from the animal kingdom to our own, talk about the horse-and-buggy era, the car, the steam engine the cotton gin. And I’ll show a picture of Pittsburgh and what Pittsburgh was. And then a picture of Pittsburgh in the 1980s, when it was largely decimated, and then how we transitioned to a meds-and-eds city and a technology city. And I’ll talk about how healthcare is at a crossroads now. These days, 60 percent of people would prefer an in-home test to avoid a doctor’s visit, and more than half of people would like to e-mail a photo to their dermatologist, and people would prefer to have their pacemakers checked over the phone.
The fact is that healthcare is going mobile. There are smartphone apps and connected devices, and there’s Ford, which is partnering with Medtronic and a company called IMS Health, doing continuous glucose monitoring. There are some skin sensor technologies that would appear on the dashboard, where you get your satellite radio. And I attended a conference at Nissan a few years ago. Some bright people from Carnegie Mellon and some bright people from Japan were meeting in Pittsburgh, and talking about a lot of different things, how cars might be able to sense response times in drivers, per elderly drivers.
And then I’ll talk about social media and how many consumers, HIPAA notwithstanding, want to share data over social media. And there’s another survey of doctors finding that over half believe social media can improve care quality. And social media can help with smoking cessation. And there’s the idea of virtual lifestyle management, around weight.
How do we get hospital-based leaders to begin the transformation, when, financially speaking, the bulk of their revenues still comes from fee-for-service medicine or near-FFS medicine?
That’s going to be a hard transition, no question about it. But it will be about “follow the money.” And with payment systems changing, it will be less and less profitable to be in the hospital business rather than in the healthcare business. Part of what’s going to happen is, there’s this pie of payment, and it will become more and more restricted. And second, it’s going to be alignment of incentives. For one thing, consumers are going to be required to pay more out of their pockets; and there will be incentives to get care at less intensive levels. So I think we’re already starting to see movement in that area. And what this says is that however many beds we have in the 5,500 hospitals that remain, there will be far fewer of them. There will be greater and greater consolidation of hospital and healthcare organizations, so that we can capture as many of those dollars as possible, while running our organizations as efficiently as possible.
So it’s about the new Triple Aim: aligning incentives, optimizing care, and providing the highest-quality care as possible. Doctors have been comfortable about providing as much end-of-life care as possible. And I don’t know the data, but the volume of palliative care is increasing tremendously.
What should CMIOs and CIOs be doing, as these trends evolve forward?
We should be thinking about getting our hospitals as efficient and effective as possible, and then thinking about how to extend EHR [electronic health record] connectivity into patients’ homes. Judy showed a slide yesterday… during a one-week window, there were 185,000 employees of 12 hospital organizations who logged into patient records during that period. During that same time, 1.5 patients logged into their personal health records associated with those organizations. The point is that patients, individuals, are becoming more active in their health. And they want spirometry, glucose checks, various kinds of monitoring, they want that connectivity to be mobile.
So that’s part of the message to CMIOs: you need a mobile strategy; you need to be sure it ties into your electronic health record. And our own technology center is developing some of these records. And there are smart people out there developing the next FitBit for everything. And we can’t have a zillion different interfaces to all these devices. So we’ll need a toolkit.
There is so much work that needs to be done to truly transform the current U.S. healthcare system. At this point, are you more of a “glass-half-empty” or “glass-half-full” person on where we are as a system right now?
I’m definitely a glass-half-full person on that. To give you an example of some of the change involved, my clinical background is as a critical-care medicine physician; and now I practice outpatient care. Certainly, there will always be a need for critical care medicine. But things are changing now rapidly from how they were when I joined the faculty 23 years ago. And in terms of end-of-life services, we’re going to see more of those services provided not only by physicians, but by nurse practitioners, because there won’t be enough of us physicians to provide the services, and we’re expensive. So it’s going to be a tough transition, but it will be required for healthcare in general, and in particular for American healthcare, because we’ve been expensive, and we don’t have the outcomes to show for it.
What can consumers do to participate in the transformation?
Consumers should ask providers about the personal health record option; and if they don’t offer one, you might think about getting a new provider. This is their data.
How can CMIOs educate themselves around the big picture?
I think CMIOs need to start thinking outside the hospital. The hospital’s been great, it was what it was… but it’s going to be changing. I think it will adapt. And even large hospitals will still be big, but there won’t be as many hospitals, and there won’t be as many smaller hospitals around them. And interoperability will be the watchword in terms of IT, just as at UPMC.
