G. Daniel Martich, M.D. has been at the 20-hospital University of Pittsburgh Medical Center (UPMC) health system for nearly 23 years now, and has been CMIO at UPMC for the past 15 years.
During that time, Dr. Martich has helped lead a broad team of informaticists, clinical informaticists, and clinicians who have implemented electronic health records (EHRs) across the large, integrated health system, have connected affiliated and salaried physicians and teaching and community hospitals, have developed strong clinical decision support systems to support physicians in practice, have created health information exchange mechanisms to facilitate data exchange among UPMC’s clinicians, and have moved ahead to enhance interoperability, optimize physician documentation, and create electronic visits and messaging between physicians and patients.
Meanwhile, Dr. Martich has chosen to transition to a new role, beginning on May 15, when he will become system chief medical officer at the West Virginia United Health System, based in Morgantown, West Virginia.
Dr. Martich spoke recently with HCI Editor-in-Chief Mark Hagland, as he reflected on his years at UPMC, his and his colleagues’ accomplishments there, and the challenges and opportunities facing clinical informaticist leaders and U.S. healthcare in general. Below are excerpts from that interview.
This must be an interesting moment for you, as you look back on nearly 23 years of innovative work at UPMC, and look forward to your new system CMO role at West Virginia United Health System. When you look, Janus-like, at the recent past, and at the present and future, doesn’t it feel rather as though this is an inflection point in the evolution of U.S. healthcare?
Yes, I agree wholeheartedly that it’s an inflection point, and that we need to think differently. It’s a bit like the Apple world—everything you thought was true is up for renegotiation and revisiting. And that goes for the electronic health record, too. It was foundational; but as we go forward, we may be looking at it differently, and how so, I’m not so sure. But a lot of the feedback we’ve been getting on the AMDIS listserv and elsewhere, as CMIOs, is that perhaps we shouldn’t be so proselytizing.
And Bob Wachter’s [Robert Wachter, M.D., professor and associate chair, Department of Medicine, University of California San Francisco, and author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age] quote in the Wall Street Journal was great; he said you can’t think thoughtfully about healthcare’s future without thinking about IT, but how far we push IT for IT’s sake is a different matter—that this is about better care and wellness for people. And just because you have a heart doesn’t mean you need bypass surgery. So now is a good time to look back and reflect on healthcare in general.
There’s a great book called Anti-Fragile, by Nicolas Talib. He talks about how events and people are fragile, but they make the industry better. So some would say that all the medication errors and the non-checking for allergies caused harm. And clearly, per the IOM report [the Institute of Medicine’s 1999 report, To Err Is Human], they have caused harm. But what they’ve done is to help the healthcare industry learn and grow and become less fragile. And I think that Anti-Fragile epitomizes what healthcare is becoming, a truly learning system.
The U.S. healthcare system has to evolve forward into an intense continuous learning system, correct?
Yes, from every standpoint. Providing the right care may mean not always providing more care. And those kinds of things, and then back into the wellness arena. We were focused on disease and illness. We need to focus on wellness-getting people to eat the right foods and walk their 10,000 steps a day. Sitting is the new cancer. And we’re going to bankrupt our country over the expenses. So I think there’s a real opportunity now to reflect and pause.
Would you agree that clinician leaders and clinical informaticists will be vital to efforts to build the new healthcare?
Yes, they will absolutely be essential. There will still be a role for the tech-wiz clinical informaticists; but more and more, we’ll need clinical informaticists who are thought leaders. It’s really going to be about how we look at how we deliver care. And one field of fodder for clinical informaticists will be meshing the EMR and genomic care.
The people who understand core clinical processes, operational processes, and who can lead, will be absolutely at the fulcrum point, yes?
Absolutely. You need to know the workflow, work processes, where the pitfalls of that are, and that is the standard to which many of the young CMIOs should hold themselves, because that will be where things will change. And you really need to look at the system level, because care is shifting towards the ambulatory sphere.
Blair Childs of Premier Inc. told me recently that he believes that all of the major healthcare legislation that will be passed on the federal level going forward will somehow be linked to population health, value-based purchasing, and similar concepts.
Yes, I agree. And we’re going to have to make sense of all the different programs and initiatives. I was reading that by 2019, in theory, based on Secretary Burwell’s pronouncement, 50 percent of payments will be value-based or quality-based. So, follow the money. And we as providers will absolutely have to follow the money. And I’m so glad that things are consolidating together. Right now, there’s this kind of morsel-ization of all these initiatives going on. And that’s a problem. People are running around doing so many things. And there’s no question SCHIP measures are great, and all the other things are so great, but things need to coalesce, absolutely.
How should physicians be reacting to the broad trends evolving forward right now? In particular, the trends coming out of the realization of exploding costs. For example, the Medicare actuaries predicted last autumn that U.S. healthcare costs would explode from a little over $3 trillion currently to more than $5 trillion within the next decade.
There are a few key things they should be understanding. First, patients are going to be empowered, whether physicians like it or not. I just did a little speaking tour of New Jersey the last couple of days, and New Jersey’s a progressive state. And yet the physicians were like, oh my gosh, you’re going to share open notes and lab results, even cancer results, as well as even pricing, with patients?? We need to get to where we no longer see ourselves as the be-all and end-all. And I say this as a man who’s married to a dietician-nutritionist, and frankly, dietician-nutritionists do a better job of counseling patients on nutrition, better than most endocrinologists. And frankly, given the so-called doctor shortage, some of that will go away if we can carve out duties and responsibilities that don’t have to fall on physicians.
Helping clinicians work at the highest level of their licensure?
Well, to the high end of their licensure. I don’t want people to take undue risks. Then again, I don’t know that doctors should be seeing 40 patients a day; maybe they should be seeing the sickest 20 patients and you they could get paid incrementally more for them. Doctors need to let some others see these as well.
What do CIOs and CMIOs need to be doing in the next few to several years?
They must think more about how the technology is impacting the future of medicine, and get beyond protocols and such. They need to think a bit like actuaries; think about population health, think about finding ways to support wellness rather than just sickness. And telemedicine and so on—how do they leverage all the new technologies for home-based care and everywhere else? They need to think outside their comfort zone their box. Because most of the CMIOs I know grew up in the inpatient sphere.
What are you proudest of in terms of the work you've done at UPMC?
I’m proudest that I took a leap back in 1992 and joined the faculty and helped implement the EMR in the ICU. It’s not sexy. But really, it was a big change for me, I was going outside my comfort zone in terms of the technology, even while I was an intensivist by specialty. But that helped me see outside what was going on in the ICU. It helped me to leap forward. Just being willing to take the risk when no one was doing this sort of thing.
Is there anything you’d like to add?
I’ll pat myself on the back a little bit. I would say that if it weren’t for the work I shepherded, that UPMC wouldn’t be the organization it is today in terms of cohesiveness. Because it was a hodgepodge. And until you can get everyone looking at the same patient record, it’s hard to get everyone to trust one another and truly work together. So that’s something that likewise I’m proud of, leveraging the technology for leadership.
