LIVE FROM RSNA: UPMC’s Shrestha: A Time of “Resurgence” Among Radiologists

Nov. 30, 2015
On Monday morning at RSNA, UPMC’s Rasu B. Shrestha, a national thought-leader in imaging and imaging informatics, is bullish about the future of radiology and imaging informatics to truly add value to the healthcare system

As tens of thousands of attendees gather for the annual RSNA Conference, sponsored by the Oak Brook, Ill.-based Radiological Society of North America, and taking place as always at the vast McCormick Place Convention Center in Chicago, all those involved in diagnostic imaging and imaging informatics are looking to the future of healthcare in the U.S. and globally, and watching the broader trends that are reshaping this area as so many others. Indeed, according to the RSNA Daily Bulletin’s Monday headline, “Radiology Must Embrace Innovation.” The Daily Bulletin quoted Ronald L. Arenson, M.D., RSNA’s president, as having said on Nov. 29 that, “While some of you may feel like we are already living in a ‘strange new world,’ the point is that change is upon us. Like Earth in the 23rd century, our profession has reached a time of great challenge. It’s a time that requires us to be bold explorers and to seek our own version of ‘new life and new civilizations,’” Dr. Arenson said, referencing Star Trek language, under the heading of his keynote address Sunday, “Going Boldly Into Radiology’s Technological Future: Why Our Profession Must Embrace Innovation.”

One of the most respected thought leaders in US. Imaging and imaging informatics, Rasu Shrestha, M.D., chief innovation officer at the 20-plus-hospital UPMC (University of Pittsburgh Medical Center) Health System in Pittsburgh, sat down on Monday morning, Nov. 30, to talk exclusively with HCI Editor-in-Chief Mark Hagland about this moment in time for the RSNA Conference (the 101st for the association), and for radiologists and imaging informatics professionals. Dr. Shrestha is also for the second year in a row, chair of the Informatics Scientific Program Committee at RSNA. Below are excerpts from that interview.

From what you’ve been seeing the past day-plus, what’s the atmosphere like this year at RSNA versus at past RSNAs?

I think what we’re seeing is a bit of a resurgence in how we’re approaching innovation, in how we’re approaching change, in the value that imaging can bring to the enterprise. I’m seeing a sense of increased confidence in purchase decisions, and in the radiology community in the role that we radiologists play in the enterprise.

Rasu B. Shresta, M.D., of UPMC, at RSNA15

What kinds of conversations are you having with radiologists now, and what are they like, around the need for radiologists to add medical-economic value to healthcare?

What’s happened in the past decade or two is that both radiology itself and imaging IT, has transformed itself from being a departmental solution to being an enterprise system. What’s happening now is that the concept of “enterprise” is changing. It was the whole hospital. Now it’s defining and quantifying value. How can we add value to the healthcare enterprise as a system? How can we add value to the patient in their journey? Not just as exemplified by what ends up in that report that we generate, but in the continued engagement with other clinicians. Not just in the report itself; but where the imaging report becomes a catalyst to a broader dialogue. It’s not just this thing we create, it’s not an end goal. It’s a catalyst for us to bring more value to the entire healthcare system.

How will this transformation take place across the U.S healthcare system, outside of pioneering organizations like UPMC, and even in typical community hospitals in the U.S.?

It’s not just UPMC leading change; the market is changing, reimbursement is changing. So it’s time for everybody to wake up and smell the roses. We’re moving away from the old value-based metrics, based on report turnaround time and productivity (how many studies we produce). Quality metrics, and satisfaction scores, all of those phenomena are evolving forward; and they’re happening regardless of what’s happening at UPMC.

Is the coming mandate for referring physicians to use clinical decision support and appropriateness criteria when ordering imaging studies, even though delayed now beyond January 2017, spurring thought change now?

It is. A lot of people are already starting to work on this, which is important. I always say that innovation in radiology shouldn’t just be about making life simpler for radiologists, even though I’m a radiologist. Because if change only happens in the reading room for the radiologist, it’s too late; I call that “after the scene of the crime.” It’s not enough to look back, retrospectively, at that bad study or inappropriate study that shouldn’t have been ordered in the first place. So how do you leverage data in context, and intelligent communication, and front-end decision support? And how do we influence the front-end decisions made by the referring physician, “at the scene of the crime”? We’re pushing for appropriateness and utilization.

You must get pushback from some radiologists, as you urge them forward, correct?

Yes and no, because I’d say all good radiologists have always been playing this role. So we’re leveraging innovation and IT to make this into a process, to make this easier and the norm for radiology. Because all good radiologists have always said, for two decades or more, have been picking up the phone and calling the ordering physicians and saying, I wouldn’t do that study, it’s inappropriate. But what we’re doing is we’re leveraging  technology to proactively do this right…

What are your perceptions of the exhibit floor, this year versus last year?

This is 101st year of RSNA, and the exhibit floor this year is vibrant. There is a sense of not if, but when, specifically around value-based imaging, specifically around enterprise-wide value.

Are the vendors’ marketing pitches different this year compared to last year?

In past years, the pitches were around buzzwords like cloud, mobile, and VNA. This year, the pitches are more substantive—how can we enable value-based care, and move from on-prem—on-premises— to cloud? And how do we leverage the cloud to enable better communication and collaboration?

What are you hearing about cloud, in particular?

What people are realizing is, here’s what the possibilities are, and what technologies can do for me I always see technology not as the end goal, but as an enabler for change. And that’s what we’re seeing this year at RSNA.

When it comes to innovating to create greater value, are vendors starting to move, now?

Yes, they are. There are three types of vendors. There are vendors who are laggards, and good luck to them. Then most of the vendors, to be quite honest, are me-too vendors, learning off each other, and finding out where the market is going and who’s writing the checks. And then there are the innovative vendors that are skating to where the puck is headed. And it’s those vendors who patient care leaders are going after. Because the very definition of what we buy and how we buy it, is changing. And I’m seeing that at RSNA this year. In the past, we’ve come to RSNA and have been very eager to purchase products, the 8-slice versus the 16-slice versus the 64-slice versus the 256-slice. In air quotes, no one goes out to buy  a “product” anymore. They buy into partnership, into value, into quality, into experience. So that’s what we’re seeing on the floor at RSNA this year. And if all you’re doing is competing to trying to sell products on the basis of product features, then you’re lost the battle already.

Two or three years ago, people were jittery here at the RSNA conference. There was a palpable air of nervousness. You sound optimistic.

Yes, I am; and it’s not just me, it’s the industry. We have to be optimistic. We’ve always led the charge in radiology. We were the first to build digital, to go enterprise, to embrace PACS and clinical information systems. We’ve always led the charge; it’s time for us to lead the change now.

Given everything we’ve been talking about here, what would your advice be for CIOs and CMIOs right now?

I think it’s critical for CIOs and CMIOs to understand the value that imaging and imaging informatics bring to the enterprise, in improving value, in decreasing costs, and overall, increasing access to care across the board.

What do you think RSNA will be like next year?

It’s going to be interesting next year, to look at which vendors continue to “get it.” My bet is that it’s the vendors who are not just doing “me, too,” but who are really innovative, who are looking at what we need as a specialty and how we can come to be valued by the rest of the organization. I think it’s those vendors who will really be prominent at next year’s show.