News and Analysis

LAS VEGAS – At HIMSS21 earlier this month, Dr. Robert Bart, who has served because the chief medical data officer at Pittsburgh-based UPMC since 2017, spoke with Healthcare IT Information about his to-do listing throughout this busy previous yr and a half, and what he is eyeing when it comes to medical priorities as he seems to be towards the subsequent yr and past.

Among the many matters we mentioned: the worth of voice recognition, the trail towards efficient resolution help, constructing a much bigger consolation degree for machine studying and the way forward for value-based contracting.

Q. We simply wrapped up a sequence at HITN centered on CIOs and CMIOs nationwide, and the teachings they’ve realized over the previous 18 months of the pandemic. What have been a few of yours?

A. I do not know if there’s one thing referred to as post-pandemic. I am not personally satisfied but. However I feel most likely the factor that I’ve realized essentially the most up to now 18 months is simply the adaptability of individuals. Folks nonetheless wanted to obtain care, and clinicians felt it was their responsibility to ship care. We have been a kind of organizations that flipped over to telemedicine fairly seamlessly.

Q. How a lot of a rise was that over what you had in place earlier than? There have been some fairly eye-popping percentages when it comes to scale-up.

A. We most likely had about 3,000 individuals who have been authenticated to ship and use our telemedicine platform. Over the last two weeks of March in 2020 … and the primary two weeks of April, we went as much as about 16,000. We have been doing about 250 day by day consumer-facing telemedicine visits pre-pandemic.

“A technique healthcare can grow to be way more comfy with machine studying and AI is that if we use extra instruments within the medical operations space: driving effectivity in scheduling [and] throughput of sufferers and utilizing good studying algorithms that assist us handle the operations of healthcare. As we get extra comfy with synthetic intelligence in that house, I feel the consolation inside the medical realm will comply with.”

Dr. Robert Bart, UPMC

By about April 1, we’re doing about 10,000 a day. And throughout our system, we peaked at someplace within the 15,000 vary, plus or minus slightly bit. We did ended up doing over 1.25 million telemedicine go to for ambulatory care final yr.

Q. That is a reasonably substantial change.

A. We’re not doing the identical quantity anymore, not figuring out when the tip of the pandemic goes to come back, or whether or not there actually can be a post-pandemic. What I am seeing is there is a truthful variety of our affected person inhabitants that actually favor, ‘If issues are calm sufficient proper now that I can see my clinician nose to nose, I will go try this.’

And so we’re nonetheless monitoring at about, I might say, 15% our peak of telemedicine visits, which continues to be considerably larger than our pre-pandemic primarily based baseline. Nevertheless it definitely will not be close to what we have been doing twelve months in the past, 15 months in the past.

Q. Nevertheless it’s nonetheless going to be a bit of the pie, going ahead?

A. Oh, yeah, I feel so. The pandemic was only a forcing operate, proper? Some individuals want care. You have to do it. That is how we will do it.

However what I do not wish to grow to be is: This clinician’s desire is to do telemedicine; this affected person’s desire is to do visits through telemedicine. However we do must consider slightly bit, I feel, on the patient-preference aspect.

Actually the high-level, constant use of it we’re seeing is within the behavioral well being house. And that is simply because in rural Pennsylvania, there’s not plenty of behavioral well being specialists out in these communities. 

The truth that they will get remedy and interplay with a behavioral well being specialist through telemedicine – particularly if a part of your problem is you have got nervousness – with the ability to ship it to you whilst you’re sitting in your house in your sofa, and did not have to stress about driving and parking, it is a actually good factor.

What we’re attempting to do to present form of telemedicine, some staying-power, or legs, popping out of that is attempting to work with every of the medical specialties and surgical specialties on how can we finest place telemedicine inside the care-delivery fashions that work effectively for the illnesses they handle. It turns into a part of the built-in care-delivery course of.

So if a Kind 1 diabetic sometimes is seen by their endocrinologist as soon as each three months, can each different go to, at a minimal, possibly be accomplished through telemedicine? So that you’re seen face-to-face twice a yr as an alternative of 4 instances a yr. Or possibly even three of the visits are telemedicine, and also you’re seen face-to-face as soon as a yr should you’re in any other case doing effectively.

That is, I feel, what we wish to do is bake it into the cadence of the kind of medical specialty you’re, the kind of sufferers you handle over a long run interval, and work out what that opportune mixture of face-to-face and digital care is.

There’s slightly bit of a better bar to go over, as a result of nobody units requirements on, like, what’s the suitable cadence of face-to-face? You will get 10 endocrinologists or 10 cardiologists who’ve the identical affected person in entrance of them, and a few of them will say, ‘I simply must see this affected person every year.’ Some will say twice a yr. Some will say three or 4 instances. It varies fairly a bit by follow.

What we’re being requested to do with telemedicine – and that is, I feel, so much by the payers, who’re attempting to additionally perceive how that may change entry to care – is to ensure that we’re utilizing it in a way the place we’re offering worth to the affected person, however we’re not additionally doing it simply to drive a number of the price of care.

So I feel there is a approach to do it the place you possibly can truly derive improved well being for the affected person, whereas not driving vital prices within the system. And that is actually what you wish to do. I might wish to get past, like, managing the illness – however actually to the purpose of utilizing digital care to assist push somebody in the direction of a more healthy existence, a more healthy life, pushing them in the direction of one thing the place we’re managing wellness.

Q. Is UPMC additionally getting extra deeply concerned in distant affected person monitoring and hospital at dwelling?

A. We have been a long-term utilizer of distant affected person monitoring. We have got a reasonably broad follow. We focus so much on sufferers with congestive coronary heart failure, sufferers with inflammatory bowel illness.

As a result of, particularly with IBD, there is a medical element, however there’s additionally, as a result of it is a pretty heavy way of life burden, there is a psychological element. And in order that distant affected person monitoring and that frequent contact, I feel, actually helps the behavioral well being side of it.

And you then talked about hospital at dwelling. We’re shifting in that route. Hospital at dwelling, I feel, you are most likely going to see individuals shifting into it relying on how the payers in every area of the nation help it, fairly frankly.

We have had vital discussions. We have developed a prototype program that begins doing a number of the hospital at dwelling varieties of care, so we will begin shifting into that house and actually find out about it as we transfer nearer and nearer to a real hospital at dwelling, not less than as CMS outlines it.

The opposite space that I feel we’re fairly fascinated about, as a result of we do personal some post-acute amenities at UPMC, is the SNF at dwelling – form of the post-acute care sort of expertise that may be accomplished at dwelling, totally different from simply the normal dwelling well being nurse.

It does the check-ins, however is way more concerned, way more supportive of all of the issues that happen. And in order that’s one of many issues we’re fascinated about actually exploring.

Q. Clearly, the pandemic has additionally actually put a highlight on social determinants of well being.

A. UPMC may be very fascinated about social determinants of well being. I personally have a robust curiosity in it: My function instantly previous to becoming a member of UPMC 4 years in the past, I used to be the CMIO on the Los Angeles County Division of Well being.

In order the second-largest city authorities well being care system within the nation, you possibly can think about that social determinants of well being is an enormous element of the care-delivery course of.

In Pennsylvania, the place we’re at UPMC, there’s nonetheless a good quantity of fee-for-service care supply. And social determinants of well being are essential and impactful, even within the fee-for-service fashions of care supply, however not almost as essential if you begin shifting into the value-based contracting.

In value-based contracting, the place you are getting per member, per 30 days charge for some cohort of people, you are very a lot incentivized to grasp and play an lively or interventional function inside the social determinants of well being for these people.

We have examined fairly a couple of totally different corporations in that house, in addition to attempt to actually enhance the varieties of data that we’re gathering on our sufferers throughout ambulatory visits, in order that we will perceive how you can make care selections extra impactful to who they’re and what their dwelling circumstance and expertise is.

In the event you’re not conscious of these issues if you’re attempting to assist them make the most effective selections on care, I feel that we will make poor suggestions for that particular person. There’s a proper advice, possibly from a medical/medical perspective, however they are not essentially that executable or straightforward for that particular person to comply with by way of, given the social circumstances. And we have to truly issue that piece in. And we’re attempting to do this higher with the knowledge that we’re harvesting from the digital well being data.

Q. Let’s speak about EHRs slightly bit. How can they do higher?

A. We wish to get to the purpose the place we’re beginning to use extra AI-driven workflow. The 2 main distributors within the EHR house I am a shopper of, and so we’re truly going by way of tasks with each of them in modernizing and optimizing their footprints.

Each of these platforms have been at UPMC for greater than 20 years, and, you understand, we’re not simply freshening it up like a brand new coat of paint. That is eradicating partitions, transforming, all very concerned on each ambulatory and acute care platforms.

And doing it, I feel, with one of many keys in thoughts: As we’re doing this, can we additionally enhance or lower doctor stress and enhance doctor wellness?

One of many issues that we did after we began on this program a few yr earlier than the pandemic began, within the spring of 2019, I requested the doctor who oversees our doctor wellness at UPMC. I requested her to sit down on our committees for each of our tasks, so we might be desirous about what we have to do from an informatics perspective – however ensuring that we’re getting suggestions from her about how that may impression the doctor workflow.

I feel the opposite factor that we acknowledge and notice is voice is an enormous saver right here. It is form of this enormous equalizer. It is a time saver. And due to pure language processing, the leverage you can get from the discrete information inside the dictated or voice recorded observe could assist you to fill out or full many different work-related required issues for billing or regulatory necessities that may be harvested from the observe, versus counting on the doctor doing a bunch of various duties.

So we’re very closely pushing on voice is likely one of the issues as we modernize our platforms. We have used it constantly over the previous few years, however we’re now taking it to an entire different degree, leveraging a number of the AI that our voice companion has embedded of their answer.

Q. I’ve written so much through the years about varied precision drugs initiatives at UPMC. What’s new on that entrance?

A. One of many causes I got here to HIMSS this yr was to do a presentation. I work very intently with a PharmD by the identify of Phil Empey, and we did a presentation on genomics, and actually drilled in on pharmacogenomics. I am actually enthusiastic about pharmacogenomics and the flexibility to enhance care by getting the drug-gene pairs proper.

So we ingest the information in a discrete method from the outcome, so we will make the most of medical resolution help. As a result of one of many challenges is it is such a brand new discipline that the majority of our physicians do not actually perceive the interpretation of the outcomes.

On high of that, it is such a brand new discipline that what was the suitable interpretation of a outcome, final yr, with new information is perhaps totally different this yr.

We actually assume that, if you’re shifting into the world of pharmacogenomics or genomic drugs, that you actually need to embed resolution help into your digital well being document. And that it’s important to actually insist on taking the outcomes solely in digital format.

So if we get exterior outcomes from reference labs, we do not need PDFs. We wish to truly discrete information, so we will set off the choice help, in addition to present supporting content material for interpretation by our clinicians – and the content material so the affected person can perceive what that outcome means for them.

One of many causes I am so excessive on pharmacogenomics is that there is usually a large profit on remedy adherence. There is usually a large profit in the price of medicines, ensuring that somebody’s on the suitable remedy for no matter is being handled. And the payers are very fascinated about pharmacogenomics, and have been very supportive of the reimbursement of this testing.

So there is a good alternative the place the payers are aligned, as a result of they really feel there’s monetary profit in healthcare. The medical aspect is aligned, as a result of they really feel that they will get higher remedy and therapeutic remedy for the affected person. And the sufferers are aligned as a result of they need the suitable remedy on the proper dose for them personally. So I feel it is a very nice alternative.

Q. It is thrilling. Do you assume it will proceed to type of be the province of massive educational medical facilities like UPMC, or do you assume finally it should filter right down to smaller hospitals – and possibly finally grow to be the usual of care?

A. Undoubtedly pharmacogenomics will filter down and grow to be the usual of care. With extra of the whole-genome genomics, I am unsure how a lot that can get right down to the usual care as we give it some thought.

There’s two varieties of healthcare techniques: There can be these which can be shoppers of the knowledge, which is perhaps the majority of the healthcare system, standalone hospitals, these varieties of issues, after which there will be healthcare techniques which can be concerned in producing genomic outcomes.

UPMC proper now’s at the moment a hybrid. We do eat some exterior outcomes, however we even have our personal genome heart and produce our personal genomic outcomes. We wish to get increasingly more to being a producer, and fewer and fewer of being a client. However, significantly within the pharmacogenomics house, there’s alternative for all ranges of healthcare techniques to be concerned in that.

Even for sure elements of genomic sequencing, there will be a few of that – significantly, say, if any hospital has an oncology service. That is definitely going to have tumor genomics as one thing that is being supplied, and studied fairly aggressively.

I feel we did see a form of stagnancy with genomics by way of the primary 18 months of the pandemic. However I feel individuals are rekindling their curiosity, and we’re seeing it form of get increasingly more centered, even over the course of the summer time right here of 2021.

Q. Any closing ideas?

A. There’s two areas that I am significantly fascinated about. We speak so much about machine studying and AI in healthcare. However, as you most likely know, the acceptance of use of it within the actually medical diagnostic house, may be very slim.

A technique healthcare can grow to be way more comfy with machine studying and AI is that if we use extra instruments within the medical operations space: driving effectivity in scheduling [and] throughput of sufferers and utilizing good studying algorithms that assist us handle the operations of healthcare. As we get extra comfy with synthetic intelligence in that house, I feel the consolation inside the medical realm will comply with.

The opposite space that I am fairly fascinated about is robotic course of automation. Plenty of different industries have been utilizing it for fairly a couple of years and have gotten plenty of profit in areas the place there’s heavy, redundant human labor.

By automating it, they will do away with a lot of the redundant duties. Healthcare hasn’t accomplished that as a lot. And I do assume robotic-process automation is an space the place I am actually excited to see way more of a stronghold, or develop some legs and want to make use of it – not simply within the care supply course of, however possibly plenty of the again workplace processes inside healthcare techniques.

Twitter: @MikeMiliardHITN
Electronic mail the author: mike.miliard@himssmedia.com
Healthcare IT Information is a HIMSS publication.