Rasu Shrestha, M.D., the chief innovation officer at the 21-hospital University of Pittsburgh Medical Center (UPMC) Health System, and president of the UPMC Technology Development Center, is a healthcare IT leader immersed daily in issues around clinical transformation via technology and innovation—even his title points to that fact. Dr. Shrestha, who is helping to lead technology-facilitated IT and technology innovation at the vast health system that serves a huge swath of western Pennsylvania, spoke with HCI Editor-in-Chief Mark Hagland shortly after the conclusion of HIMSS15, the Annual Conference and Exhibition sponsored by the Chicago-based Healthcare Information and Management Systems Society (HIMSS), which was held last month at the McCormick Place Convention Center in downtown Chicago.
Shrestha, who has attended more than a dozen HIMSS Conferences, shared his perceptions of this year’s conference, and HIMSS15’s connection to important trends in the healthcare industry. Below are excerpts from that interview.
What was your overall experience like at HIMSS this year?
I think this was an important HIMSS, given where we are as an industry. We’ve just celebrated a decade of interoperability, where we as an industry have been pushing for interoperability for about ten years. And the question I asked myself going into HIMSS was… Normally, you go into these conferences as a CIO, CMIO, director, or anyone saying I’ve got to learn this, got to learn that, find out what the competition is doing, etc. … But this year, I challenged my team on how much unlearning we needed to do. We need to challenge ourselves as an industry in that regard, because we’re being blinded by buzzwords. It’s always a buzzword blizzard at the HIMSS Conference.
But moving from paper to analog and then learning the digital form factor, and so on—there’s so much of an opportunity for us to unlearn preconceived notions about end-users need what is the norm, etc. You’ve got the patient record, with problem lists and so on; we’ve got to decide what should be in the patient record. And with regard to interoperability, did we get it all wrong in the past decade? Perhaps we did. And we’ve made some great progress in terms of deployment of EMRs; the adoption rate has gone through the roof, which is good, but in terms of interoperability, have we gotten better about understanding what patients need from that? There has been some discussion about FHIR, etc. But a lot of this will be about unlearning.
And really, we need to focus on the patience experience. Do we really engage the patient in the designing of our systems? We talk about patient engagement, but patients are people.
And what are the implications of that, per the keynote address that Humana CEO Bruce Broussard gave at HIMSS15, and per healthcare informaticists?
Our mission truly is to enable behavior change. It’s not just to document something that we can bill properly; it’s about behavior change. And if that’s the point, we need to think about the persons whom we treat—about how they engage in their health and wellness. In many ways, how they are engaged will determine the extent to which our collective efforts work, and we need to rethink how we deliver healthcare, and intelligent healthcare.
CMS Acting Administrator Andy Slavitt and National Coordinator Karen DeSalvo, M.D., offered strong policy clarity in terms of what they want providers to do, in the final keynote session of HIMSS15. What did you think of their statements in terms of providers needing to really leverage IT to change care delivery processes?
I think they’re onto something. I’ve said for a while that at the end of the day, the rise of the empowered patient, the engaged patient, the connected patient, is what we’re talking about. That’s the empowered patient that they were referring to. And I think the rise of the empowered patient should rightly threaten the status of physicians. We’re sitting on the cusp of the rise of the empowered patient, and that should threaten the previously unchallenged stature of the physician a s the sole decision-maker. We should empower them to make the right decisions and become engaged in their own wellness. We’re moving the needle from disease management to wellness management.
What leaps do we need to make in leveraging IT in the next few years in all this?
I think it’s going to require leveraging data as an asset. We’ve moved data from analog to digital to a large extent; but now how do we put this to work? I say we’ve tamed the data beast; but now do we put this beast to work for us? We need the insights and analytics at the point of care that will maybe change behavior. That’s one of the biggest imperatives and opportunities for us.
Did you participate in any educational sessions at HIMSS15?
I had my own session around semantic data harmonization at UPMC [“Beyond the Hype: Achieving True Semantic Interoperability”]. And talked about the great work we’ve done at UPMC, where for the first time in all of medicine, we’ve harmonized all mappable data codes across healthcare, and about how that is such a foundational component to push true interoperability forward. And I was surprised—I had a full house. They put me in a bigger hall, and there was 80 percent capacity. And I finished the lecture in about 38 minutes, and we had a Q&A session, and people asked really brilliant questions. And at the end of the hour, people spent 45 minutes lining up to further discuss the subject with me.
What got people so engaged?
What got people so engaged was that I challenged us to challenge the status quo. And I was talking about truly exchanging meaning from data, as opposed to just sharing CCDs. With a bare-minimum approach where we’re looking at numerators and denominators and “gaming the system,” we get to just enough information to meet specific needs. And that leads to “just enough healthcare,” which isn’t good enough healthcare, and which isn’t good enough for the patient. And I said, we’re really trying to push for meaningful data to be extracted from our systems at the back end, and here’s what we need to be thinking about to push the needle forward.
Can you provide an example of truly extracting meaning, in this context?
Just enough data would be if you’ve got a medications list, and a patient is transferred from facility A to facility B, and the patient has a CCD [continuity of care document], and needs a particular med, and we say, OK, sure, we’ll get that information on that med to the new facility, and we’ve met a bare minimum requirement on what to do for that patient. And that’s good, but not good enough. I want to know what’s really going on with that patient. What else is happening to that patient? How does that med relate to the labs, to the social history, to the family history, to the genomics, of the patient? I want to make an intelligent decision that’s truly meaningful. And for us to do that, we need a level of semantic data harmonization.
As you walked the exhibit floor at HIMSS15, was it your sense that the vendors moving in the right direction?
Some of the vendors are. Generally, they are. One specific example is that more vendors are talking about FHIR [Fast Health Interoperable Resources]; I’d love to see next year how they’ve applied it and can talk about success stories. I think we’re still early on in terms of improving workflow. But generally, vendors are pushing things in the right direction. Surescripts announced a national record locator service with eClinicalWorks, Epic, and Greenway; that’s good. The IBM announcement positions IBM strongly, especially their acquisitions of Explorys and Phytel; it gives them some movement in the right direction.
What should fellow healthcare IT leaders do as they look at vendor offerings now on the HIT market?
I think it’s going to be critical to think beyond the buzzwords and think deeply about what’s critical from an organizational perspective, to move towards the broader mission of improving patient care. We have the most professional people, the most highly rated vendors in healthcare, all in one place, with 43,000 people, and we’re resorting in magicians and games of chance to bring people into booths. But that’s HIMSS.
What would you like to see happen at HIMSS16?
I think it would be huge if we had more of the voice of the patient being highlighted, and not just as a clever cover or in marketing buzzwords, but truly in terms of how healthcare is impacting their daily lives, and in terms of where we can move things forward. I think that would be huge.
