G Daniel Martich, M.D., is chief medical information officer and vice president, physician services, at the 20-hospital University of Pittsburgh Medical Center (UPMC) health system. His key focus has been on deploying clinical information technology across one of the nation's largest integrated delivery networks. He spoke recently with HCI Editor-in-Chief Mark Hagland regarding the evolution of the concept of the clinician informaticist and of clinical informaticist teams. Below are excerpts from that interview.
Healthcare Informatics: How many clinician informaticists are there altogether at UPMC?
G. Daniel Martich, M.D.: There are at least 50, including 40 people who are designated as clinical informatics leads in each hospital-a nurse and a physician lead in each of our 20 hospitals. And there's a group of at least 10 ambulatory people also, and they're working on things like preparing physician offices on meaningful use and such.
HCI: How many would you say are on your team specifically?
Martich: The physician informaticists on the hospital side and the ambulatory folks report to me, so that's about 40. And all the nurse informaticists report to Mary Ann McConnell, R.N., who is essentially a CNIO, and she reports to the CNO.
HCI: Do the reporting relationships matter that much in terms of the success of a clinical informaticist team in an organization?
Martich: Earlier, I might have said that reporting relationships didn't matter; but now I report to Dan Drawbaugh, the CIO of the health system; previously, I had reported to the head of the physician division, who also happened to be the CMO.
Dr. Martich will headline a panel on leading clinical informatics teams during the HCI Executive Summit, to be held May 11-13 in San Francisco. For more information go to www.HCIExecutiveSummit.com.
HCI: Why was the change made?
Martich: From a high level, the thought on the part of the CEO of the organization was that we could probably coordinate things better, as our team got bigger and bigger. So there was some of that, that we were a large corporation that should be acting like a multitude of smaller organizations. The other aspect of this is that we have always been trying to be cutting-edge in terms of patient safety and in terms of healthcare IT. And we do have this technology center, created as an arm outside the traditional tracks. And in order to leverage all these things, what we do need to also be more tightly intertwined with this technology development center, which is working on such areas as clinician mobility.
HCI: Has your work changed at all?
Martich: Not really. The work remains the work, and everyone's still focused on delivery. And I do think there's more coordination.
HCI: Certainly, you still speak to the CMO, obviously?
Martich: Absolutely. He's one floor away from me, and we talk all the time.
HCI: Industry-wide, we're still working out a standard job description of what CMIOs and clinical informaticists do, aren't we?
Martich: I think that's true. And I think the CMIO role has evolved in the same way and along the same trajectory as the EMR has. People early on didn't know what to make of the EMR-was it a billing tool, a quality tool, a clinical tool? That's how health IT has grown, and the CMIO role has lagged behind that evolution, until very recently.
SPEAKING OF SHORTAGES
HCI: It appears clear now that the demand will outstrip the supply of qualified people going forward, as the demands of meaningful use and other factors come into play, doesn't it?
Martich: Yes, that's already happening. We had one full-time physician and one working 75 percent of time. One was Lou Penrod, M.D., the medical director of clinical decision support for our enterprise. The other was Bill Fera, M.D., who was vice president of interoperability and IT solutions, and he was lured away into consulting. And those kinds of talents, unfortunately, are plucked away all the time. To give you an example, we've been looking for nearly a year for a medical director of the physician services division for information technology; that person would be responsible for all the ambulatory sites. That individual would supervise, among other elements, HealthTrack, our patient portal, which was customized considerably from Epic [the Verona, Wis.-based Epic Systems Corp.]. It's a leadership position, actually, looking at specialty or primary care roll out, as well as supervising the patient portal, as well as the operations group.
HCI: That really speaks to the difficulty of getting the best people; you're a prestigious organization.
Martich: Yes, but we're also very picky. I've interviewed eight people; and none of them have quite rung the bell for me the way I've hoped for. They've got to be thoughtful, but also have to have the right personality.
ADVICE ON ATTRACTING CLINICIAN INFORMATICISTS
HCI: What are your thoughts and advice for attracting physician informaticists and CMIOs, and then all other clinician informaticists?
Martich: First, there has to be a commitment on the part of senior leadership in the organization. If you start out by saying, we're going to ‘pilot’ you and have you spend 10 percent of your time, or a day a week or whatever-and please don't fill your schedule on Thursdays-well, that's a non-starter. And if you're that new CMIO, and you're practicing in a community hospital and in a smaller community, and you don't see patients on Thursday, you'll see a big drop-off in patient volume once word gets out that you don't see patients on Thursday.
And if in senior management, you do initiate this in a very tepid way and say, we'll fund you for the next three years because of meaningful use-well, meaningful use is not an endgame, it's an incentive program. And this is a journey that's not going to end. That's why attracting the best and brightest sometimes is difficult; because you might say, you know, I'd really like for us to hire that cardiologist.
HCI: Who now makes $350,000 a year?
Martich: Exactly. And in contrast, if you say, OK, we'll pay somebody right out of medical school $20,000 a year to take one piece of their practice away and work on this part-time, well, you'll get what you put into it. And the same thing comes with nursing and pharmacy, though with differences. For one thing, those nurse informaticist support positions have existed for a long time. And for that kind of work, you really do need to upset the applecart. This technology enables things to be done differently; you want someone who has the clinical background, and who can say, we want to do things differently. So, for example, we're getting some pushback now on the physician office side, because of the patient history and other documentation needs. CPOE's been comparatively easy.
LESSONS LEARNED ALONG THE JOURNEY
HCI: Are there any ‘secrets’ you've learned in the past decade, about building strong, multidisciplinary clinical informaticist teams?
Martich: It's like Sun Tzu's The Art of War. He said you needed different types of warriors. You want the warrior who will go out there and fight the 5,000 himself; but you also need the warrior who will be thoughtful, and go around the back side and pick people off; and the warrior who will negotiate while they're out there fighting.
HCI: So you also need different temperaments among your clinical informaticists, then?
Martich: Yes, you need the impassioned, screaming coach, as well as the Tony Dungy [the head coach of the Tampa Bay Buccaneers from 1996 to 2001] type who never raises his voice. And with regard to cohesion, as long as everyone pulls their weight, it becomes a team approach.
HCI: Do you feel you've built a team that has the level of cohesion you need to get things done?
Martich: I think I do. Still, we're missing a couple of key people on the ambulatory side, as I've mentioned. On the hospital side, it's a little easier. On the ambulatory side, when you go into a one-doc practice where the spouse is the practice manager and you have a part-time MA [medical assistant], you're lacking the infrastructure. So as I mentioned, we need a strong ambulatory physician leader, who practices one day a week, but spends more than 80 percent of their time on IT. Among other things, we need to pre-populate the EMR for the physician so that it's served up before the physician sees it.
So for example, if you've had an operation, even if you've had a pre-surgical history, they'll call you the night before and go through everything. When it comes to new patients, you're faced with what's called an ‘empty EMR’ that has to be filled out. Much of that information had been filled out by patients on clipboards. And because we have 400 different sites, we don't have a uniform policy on this.
HCI: So part of this is that you're looking for an implementer/standardizer, then?
Martich: Yes, and someone who would be working with a full-time medical director on issues like this. And the other thing I'd love would be something like a clinical IT operations SWAT team that could run in and fix problems. Those happen with executive IT support in most organizations, but not necessarily at the mid-level.
HCI: In terms of everything we've just discussed, what do you see happening in the next few years nationwide?
Martich: We'll see growth in EMR use, on a baseline level; and the need for more and more clinical informaticists as we go forward. And we'll also see an increase in the need for experts around interoperability, if you will, because health information exchange will require that-individuals who can both from a technical standpoint and a persuasion standpoint, make this work, so that institutions or doctors fighting for the same patient can find some common ground, so that we can serve our population better.
Healthcare Informatics 2011 April;28(4):41-43