Information technology has two broad roles at UPMC. First, it must improve the operations of the company's hospitals and health insurance plan, improve the care of patients, and drive down the company's costs. Second, technology should make money for UPMC -- it's not just a cost center.
At most companies, that second goal is a nice-to-have if things work out that way. But under the leadership of CIO Dan Drawbaugh, UPMC is explicit that its IT organization will develop unique technologies that it can sell to other healthcare providers and insurers.
A clear example of the two roles coming together occurred in March, when electronic health records vendor Allscripts acquired dbMotion, which makes software that helps healthcare providers share medical information across software platforms. UPMC was the largest shareholder in dbMotion; it bought a stake in the company in 2006 and then helped develop the software for its own and others' use. UPMC's take from the Allscripts acquisition: $67.8 million, on an original investment of $30.5 million.
UPMC (formerly University of Pittsburgh Medical Center) is one of the country's largest integrated healthcare companies, a nonprofit with fiscal year 2013 revenue of more than $10 billion. It operates more than 20 hospitals and 400 physician offices and outpatient sites in Pennsylvania, and it's also one of the state's largest health insurance plans with more than 2.1 million members. In its role as both provider and payer, it takes an aggressive approach to implementing and developing technology to make healthcare more effective and efficient. For its track record of executing on that IT strategy, InformationWeek chose UPMC as the No. 1 company in this year's InformationWeek 500 ranking.
A Haven For New Development
Observers can see UPMC's technology ambitions in action at its Technology Development Center, a tech incubator/lab located in a hip area of Pittsburgh. (TDC is housed in the same renovated bakery building as Google's Pittsburgh office. Look for the yellow, red and blue picnic umbrellas on the roof.)
There, about 120 employees -- it plans to hire 80 more over the next two years -- search for the next dbMotion. "Everything we do here is done with an eye to bringing a product to market," says TDC president Rebecca Kaul.
UPMC's model is to first try to use off-the- shelf technology to meet the needs of its clinicians, insurance teams and other business groups. It uses EHR systems from Cerner and Epic, for example. But if it can't quite find the technology it needs, TDC will look to develop it, often in a joint venture with a large vendor or by taking a stake in a startup, in which case UPMC can influence development.
For example, TDC is developing a telemedicine platform called Virtual Care Collaboration. By combining videoconferencing with medical records, UPMC is hoping it can kick-start the much-discussed but little-used practice of telemedicine. For UPMC, that initiative could add revenue if more rural Pennsylvania residents -- people who wouldn't have braved the congested bridges and tunnels around downtown Pittsburgh for an in-person visit -- use UPMC specialists for video consults.
The pieces of the browser-based VCC system aren't unique, but TDC thinks it can bring them together in a unique way. VCC so far is used in two UPMC hospitals and several of its clinics.
The big obstacle to telemedicine isn't the technology, Kaul says. It's the business model. Health insurance plans often won't pay for telemedicine consultations, and licensing rules can prevent doctors from treating patients across state lines. But UPMC Health Plan and some other insurers are starting to cover telemedicine appointments.
As for UPMC's business model for VCC, Kaul is undecided. Is this a technology platform it should sell? Or is VCC part of a telemedicine service that lets UPMC sell its clinical services to new markets?
Cloud Computing Ahead
Cloud software and infrastructure aren't very popular in healthcare because they require patient data to leave the healthcare provider's own data center. But having done the math, UPMC CIO Drawbaugh is pretty sure that providers have to get over their cloud fears.
UPMC has about 5 PB of data today, and that volume is doubling every 18 months. So in about three years, it will have 20 PB of data, including medical images, genomic data and remote patient monitoring data. Drawbaugh doubts that UPMC can afford to build enough conventional data center capacity to cope with that data. "My gut is we have to partner," he says.
Partnering means UPMC buying infrastructure-as-a-service from vendors such as Amazon Web Services, Hewlett-Packard, IBM or Oracle so it doesn't have to spend tens of millions of capital dollars on data centers. Any of those vendors can provide the underlying hardware, Drawbaugh says. "Then you look at the value add."
That's when UPMC's entrepreneurial IT tendencies kick in. Can UPMC help one of those IaaS vendors build a cloud infrastructure tuned to the needs of healthcare providers and insurers? Drawbaugh's on the case.
Analytics At The Heart Of Healthcare
Under one of the industry's most ambitious IT initiatives, UPMC plans to spend $100 million over the next five years to create a data warehouse that combines clinical, genomic, insurance, financial and other information from more than 200 sources. It's partnering with Oracle, IBM, Informatica and dbMotion.
The initiative ties into the aspect of U.S. healthcare reform that aims to change how care is delivered and paid for. Under this notion of population health and accountable care, providers will get paid to keep a group of people -- say, all the employees at a company -- healthy, creating financial incentives for providers to step up their preventive care and minimize mishaps that lead to hospital readmissions.
"You can't do that without analytics," says Dr. Steve Shapiro, UPMC's chief medical and scientific officer. For example, in a recent UPMC study of the use of a particular catheter, it found that the catheter wasn't used consistently, but that on average it led to better outcomes. But the device is also more expensive, leading to the next layer of clinical data research to understand which patients benefit under which circumstances. All that data will eventually be presented to doctors to help them make decisions. (UPMC created a company, Evolent Health, with the Advisory Board Co. to market population health services and technology.)
That type of benefit-cost analysis is just the start. Researchers such as Adrian Lee will push UPMC's IT department to do much more with data, to allow personalized medicine based on a patient's individual genome.
Lee, director of the Women's Cancer Research Center at the University of Pittsburgh Cancer Institute and Magee-Womens Research Institute, is studying the role of hormones such as estrogen and progesterone in the development of breast cancer. His work focuses on genomic data unique to each patient. That research will start to home in on particular genome combinations for certain types of cancer, applying to only four or five cases even for an operation as huge as UPMC. In order to create large enough data sets to study such small subsets, UPMC has no other option but to find better ways to share data with other healthcare providers. "It will force sharing," Lee says.
Change And Challenges
UPMC is no health IT nirvana. Chief medical information officer Dr. Dan Martich acknowledges that in the rush to implement EHRs to comply with government mandates and financial incentives, "we broke a lot of things." By letting physicians cut and paste in e-records, for example, an in-hospital progress note that used to neatly sum up the patient's daily status in half a page now can run 19 pages. "What we've created, unfortunately, is an ongoing patient blog," Martich says.
How frustrated are doctors? Physicians are notorious for ignoring internal communications, so Martich had low expectations when he sent staff physicians, residents and other clinicians a survey about EHRs. One-fourth responded, and about 1,000 of them included comments.
So Martich is leading an "e-record simplification" initiative aimed at capturing the data needed for quality, compliance, billing and patient use in the most efficient way.
A lot of change is being forced on the U.S. healthcare industry, and technology lies smack in the middle. Amid those changes, UPMC is determined to find new ways to put health IT to good -- and lucrative -- use.