A conversation with Brian Wells, Penn Medicine
Penn Medicine by any standard is a behemoth. With total revenues last year of over $5 billion, Penn Medicine is inclusive of the University of Pennsylvania Health System and the Raymond and Ruth Perelman School of Medicine, the nation’s oldest medical school established in 1765. In addition to the over 2000 medical school faculty and 3000 students at Perelman, the chart below shows Penn Medicine by the numbers for 2015.
One person with significant responsibilities across both the Perelman School of Medicine and the University of Pennsylvania Health System is AVP Brian Wells. Brian and I served together on the Delaware Valley chapter of HIMSS Board of Directors, where he was known for his sharp wit and experience as a health IT entrepreneur as much for his tremendous knowledge of healthcare and IT and loyalty to Penn Medicine. Mr. Wells is currently responsible for software development along with academic computing informatics and infrastructure. Previously at The Children’s Hospital of Philadelphia he was the Project Director of two large Epic implementations – Patient Access/Revenue Cycle and Specialty Care. Beginning in 1997, he was the founder and Chief Technology Officer of InteHealth Incorporated. Mr. Wells earned his MBA from Villanova and his undergraduate Computer Systems degree from Rochester Institute of Technology.
Stevens: You joined Philadelphia’s Penn Medicine in 2007 as Chief Technology Officer (CTO). Tell us about your professional background leading up to taking on this role, and how it prepared you – or not – for the work you’ve since been doing at Penn? Also, Penn was an early adopter of EMRs, beginning with an initial rollout of EMR software for ambulatory care in 1998. What new IT implementations are underway, and what more do you foresee?
Wells: Prior to joining the provider side of the healthcare industry, I spent 24 years on the vendor side writing software and leading software product development teams. Building software products, especially those that do not operate in SaaS mode, requires a much more disciplined approach to building and shipping software. It demands a high level of quality engineering because it is much harder to fix once the product is running in the data centers of your customers. Quality must be designed, coded and tested into the software before it leaves the factory.
The role at Penn was not a typical health system CTO focused only on infrastructure. The Penn role was initially focused on building in-house developed applications, data integration solutions and analytics solutions. I had already mastered these skills on the vendor side. It was a perfect fit for me. My teams have been able to build quality solutions at Penn that are widely adopted and used by thousands of users every day. In a way, developing solutions from within a provider environment is even more rewarding because you see the fruits of your labor up close, every day.
In spite of our focus on moving to a single, integrated EMR, there will continue to be opportunities for my software development and data analytics teams to extend our EMR functionality. In the years ahead we expect to build out solutions in the areas of patient engagement, telemedicine, population health, predictive analytics, molecular decision support, natural language processing in-building navigation and the Internet of Things. There is no shortage of end-user demand and opportunity to keep Penn Medicine in the forefront of precision medicine, cancer immunotherapy, patient satisfaction and care coordination.
Stevens: At the time of your joining Penn Medicine, your CIO, Mike Restuccia, gave your portion of the IS department the mantra “Aggregate, Integrate and Innovate”. How did that manifest itself in your work, and how since has your focus perhaps changed?
Wells: Back in 2007, Penn Medicine’s information systems portfolio consisted of solutions from many vendors. To keep all of the systems communicating with each other, to provide easy real-time access to all the disparate data or systems and to provide clinical and operations analytics, we had to build many home grown solutions. Prior to my arrival Penn had already built a powerful clinician portal.
We had no clinical data warehouse and there were no off-the-shelf data warehouse vendors with robust data models. The demand for more real-time interfaces was unquenchable. We met these challenges by building strong development teams, adopting “agile” methodologies and hiring smart, energetic developers. By consolidating all software developers (apps, integration and analytics) under one leader we have been able to achieve amazing synergies, productivity, quality and end user adoption. We have also made, in hindsight, very wise selections of development platforms and tools that continue to pay off.
As Penn evolves to an integrated EMR system, I expect my team’s challenges will change slightly. We will be more dependent on our vendor’s ability to provide access to real-time data through web services and FHIR interfaces and we may see more of our data warehousing efforts shift to their data warehouse platform. Penn’s migration from a “best-of-breed” to an “integrated EMR” approach will gradually eliminate the need for some of the home grown extensions we made to our previous EMR suite. The analytics migration will be a little trickier as there is a need to retain historical data while leveraging “out of the box” vendor analytics tools. I expect that within 5 to 7 years our existing clinical data warehouse will no longer be needed.
Stevens: In 2011, you switched roles to your current one of AVP with additional responsibilities at Penn’s Perelman School of Medicine. How have you combined both roles, and are you part of a broader synergy between the medical school and the health system? If so, what have been the ramifications for clinicians, students and patients?
Wells: I have combined the roles and they really fit perfectly together. My role straddles both halves of Penn Medicine and for initiatives like translational medicine and precision medicine it works very well. Both of these initiatives require large amounts of data and information technology that can quickly move from bench to bedside. Penn Medicine’s senior leadership and faculty saw this requirement coming years ago and decided the most logical group to integrate was Information Systems. Our success in consolidating IS has paved the way for additional synergies with functions like finance, marketing and human resources.
The benefits to our end user communities are broad and diverse. We have achieved efficiencies in data center usage, network integration, funding models, clinical research informatics integration, application development, end user desktop support, analytics, warehousing, research computing and many more. Leadership has been much more open to investments in research computing, educational systems and clinical research tools once they were comfortable that enterprise solutions would be purchased and made available to all faculty and staff. The investment in the school of medicine IS team, applications and infrastructure is significantly larger than in all the years before consolidation began.
Stevens: Penn has a growing footprint in the Delaware Valley. Please explain Penn’s growth strategy, and what additional moves we can expect to see in the future. Additionally, you currently have about thirty (30) IT professionals in your analytics group. What role do you see analytics playing in that growth?
Wells: Penn’s strategy is to leverage our position as the only fully integrated health system in the region – inpatient, ambulatory, post-acute, rehab and home care. This enables us to focus on improving care management in a coordinated way for patient populations with chronic disease and the “acute expression of chronic disease”. We develop long-term relationships with these patients which yields improved outcomes that matter to patients and their insurers. I am not at liberty to discuss future growth moves but I expect they will be ones that support and enhance this strategy.
Because of our investment in large clinical, administrative and research data warehouses and the associated analytics, Penn Medicine has become a data driven organization. Analytics consumption is at an all-time high. Aggregation continues as a key mantra for my team as Penn merges or partners with more regional providers. Our leadership expects the existing one-stop-shopping analytics experience to apply to all clinical, financial, population and administrative data regardless of its source. So our circle of aggregation grows wider and more diverse (claims data, HIE data, patient provided data, etc.). We will continue to leverage our tools and best practices which consist of:
- Working with stakeholders to understand their data and information use cases
- Ensuring our data model, update frequency, data retention, data mapping, data standards and data access tools will meet those use cases
- Using industry standard extract, transform and load (ETL) technologies along with data base technologies that provide open access
- Developing web sites for each data asset that clearly define the rules around access, how to access the asset and the detailed data model for the asset Indexing unstructured data and providing tools to search or mine the unstructured content
- De-identifying data following HIPAA standards
- Providing self-service tools and one-on-one support to users
- Tracking access to data to ensure we are seeing a return on the ongoing investment in the asset.
Obviously as you widen the net the challenges related to data quality, semantic interoperability, patient identification and reliability also increase. We are confident our success at meeting these challenges will continue.