“I tend to have a pessimism and skepticism around technology.”
It’s not every day a healthcare IT executive utters those words (at least, not publicly). But for Erik Pupo, who recently took on the role as CIO at Columbia University Irving Medical Center, it doesn’t mean being averse to technology, but rather, taking a more realistic approach to what it can and can’t do. At least, not until the right pieces are in place.
Recently, Pupo spoke with healthsystemCIO.com about the priorities on his plate, most of which revolve around plans to move to a single EHR platform, and creating the infrastructure and governance to make that a reality. He also talks about how his diverse background has helped prepare him for his first CIO role, the two-way street that needs to happen with change management, and the potential mobile health offers in improving care delivery.
- Past experiences in consulting & government – “I’ve seen what works and what doesn’t.”
- Key role of governance in driving change
- His admitted “pessimism and skepticism around technology”
- Value of working with “diverse, challenging groups”
- Mobile health goals – “We’re focused on how we can get more out of the data.”
- Working with NY Quality ACO to incorporate SDoH
- Columbia & NYP – “It’s a technology test bed.”
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It always comes down to the ‘how.’ We can say we’re going to do certain things, but how we do it — how we involve others in doing it — is very important.
You start to learn, with technology, what it can and can’t do. You start to learn about how many problems relate more to behavior than to a technology solution, and you can apply that across other types of challenges.
I tend to have a level of pessimism and skepticism about technology, which is unique. The CIO is supposed to run around and say, ‘technology is the greatest thing ever.’ I’m much more selective about what it can and can’t do, and trying to target technology to specific areas.
There are also opportunities where it hasn’t been applied — or hasn’t been applied well. I like being in those types of environments, because there’s an opportunity to turn things around and have technology play a role in changing behaviors.
Gamble: I’m sure there are challenges being new to an organization. But it seems you haven’t faced too much resistance in driving change.
Pupo: For me coming in, there hasn’t been a tremendous amount of resistance because of my background and having worked in a lot of different healthcare organizations, and a recognition that there are a lot of things we need to do. They’ve been very receptive, from the entire executive leadership team to the departments. It always comes down to the ‘how.’ We can say we’re going to do certain things, but how we do it — how we involve others in doing it — is very important.
Gamble: Let’s talk about what you were doing in your most recent roles. I know you have a pretty diverse background.
Pupo: I’ve worked for almost 20 years in various roles in consulting, and in the vendor software space. I’ve even done projects at the Internal Revenue Service. So I have a very broad background — not just in healthcare but in information technology overall, working with clients from the payer community, life sciences, medical device manufacturers, and providers. I’ve done work with various federal health operating divisions as part of the Department of Health and Human Services, the VA, and the Department of Defense and Military Health. And so part of my mandate for change, and my strategy for selling it, is that I’ve seen a lot of what works and what doesn’t work. As a CIO, frankly, I’ve participated in things that don’t work, and I’ve been responsible and accountable for them in saying, ‘We didn’t do the job we needed to do.’ As a consultant, I’ve had to say, ‘We didn’t give the right advice.’ It’s important when you participate in failure to learn from that; learn what can and can’t work so that you can build a better strategy and vision for moving forward.
Gamble: I’m sure the experience with the VA was really interesting, because you’re dealing with so much complexity. But that’s true for many aspects of healthcare.
Pupo: Yes. I always use that stat of healthcare being 20 percent of the GDP. Everyone throws that around, but there’s a lot of complexity. There’s a lot of process. There’s a lot of people and technology involved. There are a lot of opportunities and a lot of projects people undertake that end up being more successful than others, and so you can start to learn things. You start to learn, with technology, what it can and can’t do. You start to learn about how many problems relate more to behavior than to a technology solution, and you can apply that across other types of challenges.
So we deal with that at Columbia. For example, with governance, there’s a certain way to do it based on read and analysis of the people environment you’re in. There has to be willingness to change. Governance has to be tailored to the environment to make sure it’s actually going to be effective and is going to be something people will follow through with.
Gamble: It’s not easy stuff. And you were also senior adviser for ONC. I’m sure that was really interesting, and that having an understanding of policy comes in handy, especially since regulations are such a big part of the CIO role.
Pupo: Yes, very much so. I had great mentors and great colleagues at the Office of the National Coordinator. I saw, in such large groups of diverse healthcare stakeholders, with all the specific opinions and thoughts people had and the positions people had, where they were coming from, because they represented a wide range of interests. I could also see the linkage of the development of policy and the development of much of the agenda that went into National Health IT, because ONC was very closely with CMS, with other operating divisions within HHS, and with the White House.
You could see how it was positioning technology and its impact on policy, and learn from that. In some cases, it was expected that technology could drive more changes than it ended up doing, and in other cases it was a major impact. That’s a lesson you learn, and you can take that and apply it to other roles.
That helps me a lot as a CIO, because I tend to have a level of pessimism and skepticism about technology, which is unique. The CIO is supposed to run around and say, ‘technology is the greatest thing ever.’ I’m much more selective about what it can and can’t do, and trying to target technology to specific areas of success versus acting like technology solves everything, or that if we just digitize healthcare and share data, magic will happen and everybody will be happy.
That’s not reality. I learned from my experience at ONC how to work with very diverse, very challenging groups where there wasn’t a lot of agreement, and there were group discussions that were very hard to reconcile.
Gamble: That’s a really unique perspective. Looking at Columbia, and at NewYork-Presbyterian in general, the organization doing a lot in cutting-edge areas like telemedicine. Did that affect your decision to come to CUIMC?
Pupo: Yes. NewYork-Presbyterian is investing a lot in newer technologies, and there’s a willingness, certainly from our Columbia colleagues, to embrace various technologies. A lot of the medical technology in clinical care tends to be device-driven, and so we’re working with Epic to focus on how we can get more out of the data from devices, share that data, and use it as part of a broader operational and financial strategy. We’re also looking at how we can integrate much more with what’s happening in mobile health.
As an organization — and I’m referring to Columbia, not NYP — we don’t have a big mobile health presence. And so I’m focusing on fixing that, because in a hospital, or any healthcare environment, people are always on their phones. I always notice people walking through the hospital staring at their phones — there’s an opportunity to interact with them and help them get engaged in their care. But as an IT leader, I also need to think about how we can better serve customers across the medical center campus who are using IT, and one way to reach them is through their phones.
Gamble: Really interesting. What about social determinants — what are you doing in that space?
Pupo: We’re definitely focused on that. We serve a very diverse community. Being located in Upper Manhattan, we’re very diverse in terms of income, and we have a very diverse representation of various cultures. We experience that firsthand in the care that we deliver and the patient population that we’re serving.
Through our work with the New York Quality ACO, we’re looking at how we can integrate with community health services and social services throughout our area, and then also how we can share data across that ACO to make sure care is provided in a fashion that’s very much driven by data and by evidence. And I think that’s been very successful. We’re still thinking about social determinants — what we can do more of and what we can do better, especially with Epic, because of what we’ll be doing with population health as a joint consortium. That’s going to be a lot of work.
Gamble: It’s interesting; we’re starting to see more hospitals working with organizations that aren’t necessarily traditional healthcare facilities, but can have a big impact on patients’ health and well-being.
Pupo: Very much so. Another thing that attracted me to this job, in addition to a willingness to change, is that it’s a technology test bed. Technology is being used in a lot of great ways, but there are also opportunities where it hasn’t been applied — or hasn’t been applied well. I like being in those types of environments, because there’s an opportunity to turn things around and have technology play a role in changing behaviors. Whether it’s through analytics or various emerging technology areas, there are ways to improve things, automate things, and make it better overall.
It goes back to the experience I’ve had working in so many different organizations. I’m able to teach individuals within Columbia — which is an academic institution — about what works and what doesn’t. I’ve actually taught health IT to students, and some of the questions that came in were about my background and what I’ve learned. A lot of it is that you have to fail in healthcare, sometimes several times, before it works. If you don’t fail the same way twice, and you’re trying different approaches, that’s a good start.
Gamble: Sure. Now, with this being your first CIO role, did you reach out to certain anyone to try to learn about the nuances of this role?
Pupo: Yes, definitely. I asked John Halamka, who I know from having worked in ONC, along with several colleagues from HIMSS and organizations I’ve worked for in the past. A lot of them said, ‘I think it’s a great fit.’ Some said that I need to be prepared for the adjustment; that it would be very different than anything I had done in the past. But I think you always have to do that. You have to be very open in terms of what you think you’re good at and what you may not be good at, which I felt I was focused on in preparing for this role.
Gamble: And then lastly, what about adjusting to New York City? You were Florida before, correct?
Pupo: Yes. I lived in a small place called Lighthouse Point just north of Fort Lauderdale. My wife and I moved to the Upper Eastside in July. But I’m used to traveling, working, and consulting. Most of my career was spent in Florida, with a short stint in Washington, D.C. for my work with HHS and ONC, but most of the time I’ve been traveling. So it’s been an adjustment, but it’s been a great.
One of the unique things with a job like this is I wake up every day and say, ‘I work for the Ivy league. I work as part of a huge community of Ivy League CIOs — incredibly smart people within Columbia University.’ We have a tremendous amount of talent in data science and medical technologies. I get to work with those people every day, which is one of the things that really attracted me to this organization. If it has to be in New York and in the cold, if it has to be in a different location for me, then it’s worth it. It’s almost like going to college again and spending some time to learn from others and take on new challenges and see them through.
Gamble: Hopefully this winter won’t be too brutal, but I can’t make any promises. I worked in New York for a while and it can be tough, but it’s a great city and great opportunity.
Pupo: It is.
Gamble: Well, I think that that wraps up what I wanted to talk about. I’d definitely like to follow up, especially as you get further along toward the go-live. Thank you so much for your time, I really appreciate it.
Pupo: My pleasure. Thank you.