Joe Bengfort, CIO, UCSF Medical Center and Campus, Chapter 1

Want to know the secret to being CIO at a large academic organization? Fear. “If I wasn’t a little bit worried about being able to deliver what the institution needs, it would mean I’m not paying attention,” says Joe Bengfort. But that, of course, is just part of an equation that also includes a confident knowledge of IT functions, a willingness to engage in the business side, and an ability to apply lean methodologies to situations like consolidating IT departments. In this interview, he talks about UCSF’s clinical enterprise strategy — and the infrastructure required to support it; his team’s “incremental approach” to analytics; the challenge academic organizations face in securing data without stifling creativity; and how he believes the CIO role will continue to evolve.

Chapter 1

• About UCSF Medical Center
• Heavy focus on ACOs
• 3-legged clinical enterprise strategy
• Applying research to the clinical setting “in near real-time”
• 2 years into Lean
• Optimizing Epic “in synchronization” with CPI initiative
• Interoperability challenges

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We want people to learn more about what it means to be in an EHR environment and what’s required to leverage data and analytics in the process of care. And so we think by working across the three missions of the institution, it puts us in a great position.

It’s trying to move care from a tertiary quaternary focus to a proactive management of health — let’s keep people out of the hospital. However, we have hospitals, and a lot of our research is around these very complex diseases, and so it’s important that we care for patients in that realm as well.

Healthcare, historically, has been a rather inefficient enterprise. There’s a lot of opportunity to improve the processes that not only take out waste, but they reduce the cost of care and ultimately, in fact, improve outcomes.

These implementations are extraordinarily taxing on an organization, so typically when you roll out, you try to roll out in a fairly standard way, and then you have to go in and do a good deal of optimization in the environment.

We have a particular challenge here in terms of interoperability for our ACO partners, so we’re working now to develop strategies on how to accommodate that diversity across the continuum of care.

Gamble:  Hi Joe, thank you so much for taking some time to speak with us today.

Bengfort:  It’s my pleasure. Thanks for the opportunity.

Gamble:  To give our readers and listeners some background, can you just talk a little bit about UCSF Medical Center in terms of what you have for hospitals, clinics, things like that?

Bengfort:  University of California is made up of five different medical centers; I happen to be here at the San Francisco Medical Center. We’re evolving very quickly; we’re probably about a 650-bed hospital system. It’s a tertiary quaternary hospital primarily. We’re part of an academic medical center here. We have a hospital in the Parnassus part of San Francisco and we’ve just built a new hospital over in Mission Bay, close to where the world champion San Francisco Giants play, along with a new children’s hospital, cancer center and women’s hospital. Over the last year, we acquired the Children’s Hospital of Oakland, which is now the Benioff Children’s Hospital of Oakland.

So we’re expanding in that fashion, and we’re currently in the process of getting much more engaged in the accountable care organization-type structure. So whereas we’ve been very much an inpatient and research facility, we are pushing quickly into affiliations with outside parties to establish an accountable care organization and to get more into the proactive management of health — more on the front end of care versus the tertiary quaternary end of care.

Gamble:  And is that something where there’s a specific ACO you’re looking to join or are you forming your own organization?

Bengfort:  We’re going to form our own. We’re not going to do it so much through acquisition; the Benioff Children’s Hospital of Oakland acquisition is a little bit different, I think, than what we intend to do at large. We are developing a relationship right now — and it’s publicly known — with John Muir Hospital System over in the east bay and that will be the genesis, the core of starting the accountable care organization here in Northern California, and then we expect to bring in other parties over time.

Gamble:  And now as far as physician practices, do you have ones that are owned or affiliated with the system?

Bengfort:  Yes. Most of our physicians are from our school of medicine faculty, so we have a faculty practice where many of our physicians come from. And then we have foundations and affiliations with other physician groups, both in pediatrics and the adult and various specialties.

Gamble:  And now you’ve been with the organization for four years, correct?

Bengfort:  That’s right. As a matter of fact, it’s four years as of this month.

Gamble:  Okay, great. Congratulations.

Bengfort:  I started here specifically on the medical center part of UCSF and then after probably two years, there was another CIO here at UCSF responsible for the research and education parts of the institution who retired. And with that retirement, I’ve now taken on that responsibility as well. So that gives me an opportunity to learn much more about the full mission here at UCSF. Our research enterprise, it’s a $1.5 to 2 billion enterprise. It’s quite large in and of itself. And our schools — we have school of medicine and nursing and pharmacy and dentistry. That’s all we do; we’re a health sciences campus here, and all four schools are rated in the top five in the country, and we are number one in terms of funding from the NIH for public institutions. So it’s quite a powerhouse in research and education here as well.

Gamble:  Does having that combined, campus-wide CIO role, is that also kind of a reflection of what the organization is doing to meet the changing care models?

Bengfort:  It is. In fact, our intention is to get the research, the time between discovery and application of that to clinical practice — we’re trying to shrink that, just as everyone else is. We just happen to have it all in-house here, and by starting to collapse some of the support organizations like information technology, it’s providing the infrastructure that’s needed to get more collaboration done across the institution.

And that applies to the education side, too. We want people to learn more about what it means to be in an electronic health record environment and what’s required to leverage data and analytics in the process of care. And so we think by working across the three missions of the institution, it puts us in a great position for something that we call precision health. Precision health involves the use of genomics and proteomics and all the other ‘omics’ that I don’t have much insight into, but the research that we do in all of these areas is computing intensive, it’s data intensive, but it can result in findings that can be applied in near real-time in the clinical setting, in the patient care setting, and also in the education setting. So it’s quite a powerful combination.

Gamble:  Right, and that kind of dovetails with one of the things I wanted to talk about, which is the long-term strategic plan. I saw some information on UCSF’s website about like the 2014-15 plan, with one of the goals of implementing a clinical enterprise-wide initiative to improve operations delivery and clinical outcomes. I just wanted to talk about some of the big things that have been done to move toward that goal.

Bengfort:  I’ll fill the picture in just a little bit more. There are three major legs to the strategy for the clinical enterprise here. Part of it involves establishing a population health capability and accountable care organization and being more proactive about managing the health of a population. That’s a huge initiative in and of itself. The second piece, if you think about that part of the initiative, it’s trying to move care from a tertiary quaternary focus to a proactive management of health — let’s keep people out of the hospital. However, we have hospitals, and a lot of our research is around these very complex diseases, and so it’s important that we care for patients in that realm as well.

So another leg of the strategy is something called destination programs, where we take these specialties that we have and we establish either contractual relationships or at least marketing relationships with firms, with states, even considering other countries where we can bring in those type of patients into our care system. So that’s the destination program leg of this.

And the third piece is what’s called continuous performance improvement. In any healthcare delivery system, there are inefficiencies. Healthcare, historically, has been a rather inefficient enterprise. There’s a lot of opportunity to improve the processes that not only take out waste, but they reduce the cost of care and ultimately, in fact, improve the outcomes of care.

So we have a large initiative in place to implement lean. If you’re familiar with the lean methodology, it comes out of the Toyota culture. We’re fairly early on in that process; I guess would say we’re two years in on training of the executive leadership team, and we’re running multiple Kaizens per quarter at this point. And so we’re just starting to get that part of the culture ramped up.

One thing that’s important to support all three of these areas is data access, data analytics and data warehousing, so that is a fundamental infrastructure to support the new strategy that we’re diligently working on at this moment.

Gamble:  So a lot of stuff there. And actually, I should probably back it up a little bit and ask about the electronic record initiative and where that is at this point.

Bengfort:  Sure. We are an Epic shop. We went live with Epic back in 2012. As a matter of fact, I think it was June of 2012, so this month is a good milestone for us here. We’re live with Epic throughout our ambulatory setting — in all the clinics, and in most aspects of inpatient. We’re going live with a few new modules still, like the oncology module, Beacon, and we have a few other specialties that are still lined up down the road. But we’re quite mature in this regard.

We, along with most others who have implemented electronic medical record, are trying to turn some focus to its optimization. These implementations are extraordinarily taxing on an organization, so typically when you roll out, you try to roll out in a fairly standard way, and then you have to go in and do a good deal of optimization in the environment. That process is going to happen in synchronization with the continuous performance improvement that I spoke about earlier. But we’re a pretty mature electronic medical record shop. In fact, there’s a growing desire from other regional partners, whether they’re county hospital systems or even some of our commercial partners, who are interested in leveraging the medical record environment that we’ve established here. And so we are looking at hosting medical record systems for outside entities that are affiliated with us in some way.

Gamble:  Right. And of course, that kind of lends itself to wanting to get into population health more in terms of having other systems on the same EHR.

Bengfort:  It’ll be very helpful in that regard. I would say that our situation is much more difficult than like Kaiser. Kaiser owns the continuum of care from end to end and can implement a standard medical record environment. Many of our partners and, in fact, future partners, will have their own medical record environment, and it may or may not be Epic. And even if it is Epic, they’re typically implemented in quite unique ways. We have a particular challenge here in terms of interoperability for our ACO partners, so we’re working now to develop strategies on how to accommodate that diversity across the continuum of care in the ACO without having to try to force one medical record system and one set of processes across that continuum of care. It’s a particular challenge for us.

Chapter 2