UPMC’s Rasu Shrestha: Innovation is About Behavior Change, Technology Should be Invisible

March 9, 2016
At HIMSS16 in Las Vegas last week, Rasu Shrestha, M.D., chief innovation officer at UPMC, spoke to Healthcare Informatics about all of the innovation that is in the air at UPMC and what the healthcare IT world looks like from the eyes of an industry leader.

The University of Pittsburgh Medical Center (UPMC), a 20-hospital integrated delivery network, is no stranger to innovation and strategic IT partnerships. Just last week, the health system announced that it will become a majority partner and investor in medCPU, a New York City-based vendor with real-time clinical decision support solutions.

What’s more, in January of this year, UPMC announced that they had come together in a strategic partnership with executives of the Salt Lake City-based Health Catalyst, a data warehousing, analytics, and outcomes improvement vendor, “to combine technologies and front-line personnel in an unprecedented effort to help health systems solve one of their most vexing and urgent problems – how to measure and analyze the true cost of healthcare delivery for each patient.”

Indeed, as HCI Editor-in-Chief Mark Hagland wrote, also back in January, leading into an interview with Talbot C. “Tal” Heppenstall, president of UPMC Enterprises, “While several other large integrated health systems are pursuing the path of technology development incubation, and sometimes, of commercialization, of internally developed technology solutions (among them Cleveland Clinic and Intermountain Healthcare), senior executives at UPMC have for a number of years been moving forward to develop and to co-develop, with partnering organizations, solutions that might gain traction across healthcare.

As such, at the HIMSS16 conference in Las Vegas last week, Rasu Shrestha, M.D., chief innovation officer at UPMC, spoke to Healthcare Informatics Managing Editor Rajiv Leventhal about all of the innovation that is in the air at UPMC and what the healthcare IT world looks like from the eyes of an industry leader. Below are excerpts of that interview.

What is especially new on the innovation front at UPMC?

One of the biggest things we are doing in terms of innovation at UPMC is the way we are bringing our strengths and expertise to the table in partnering with the right [people] to transform the way healthcare is being delivered. Through UPMC Enterprises, we’re coalescing and co-creating, and opening up the living lab that is UPMC with the 20-plus hospitals, the 3,800 physicians, the payer-provider integrated delivery system that we are, the data, and the use cases. We are opening all that up so that we can bet on innovating and transforming the way we are delivering care.

Can the integration that you’re talking about create blurry lines in the healthcare market?  

I wouldn’t say it blurs the lines, in fact I would argue that it’s quite the opposite. We are providing a lot more clarity in terms of we understand where the pain points are. We’re not just talking about it in an office building somewhere, we are living and breathing these pain points on a day-to-day basis. We are leveraging the people who are living and breathing these pain points on a daily basis, designing principles, and architecting the solutions that work best for not just us, but organizations like us. I think we are providing more focus and doing this with a purpose. We are putting our money where our mouth is, and also putting our resources where we believe the future of healthcare needs to go towards.

Rasu Shrestha, M.D.

Out of all the innovative work at UPMC around IT, what are you most proud of?

Knowing how complex healthcare is, one of the ways we are thinking is, how do you address all of these complexities? How do you move from complexity to simplicity? I think in healthcare, we pride ourselves in wrapping ourselves in complexity; we find comfort in it. We confuse complexity with better, and I truly think innovation is about not adding more things, but taking things away. So simplifying care processes, simplifying information visualization, simplifying how we connect the dots between multiple siloes of information, that’s what we’re really about. In leveraging data as an asset, connecting the dots across disparate data siloes—whether its claims data, clinical data, other types of data, financial data, performance, data, patient-entered data—you have all these other data sources that we haven’t really embraced in healthcare. And then taking that and building the right solutions to enable behavior change. At the end of the day, innovation is really about behavior change, whether it’s a clinician putting in an order, that radiologist making a specific diagnosis or call on a finding, or the patient making a decision to eat that muffin versus going for that salad. Innovation is about behavior change.

Of particular interest is the partnership with Health Catalyst around developing a costing analysis solution. Can you explain that further?

Cost is something that we know is really critical in the delivery of healthcare. Costs continue to escalate while quality and access continue to be questionable, and this is the three-legged stool of the Triple Aim. So we created an activity-based costing solution at UPMC that would be implemented in our hospitals, and we actually got benefits out of that. So we took that entire package, all the IT around that, and put it directly into Health Catalyst as part of the expanding relationship that we have with them, and over the next few months, we will be building it directly into the Health Catalyst platform. Then they will be going out and selling this to the rest of the world.

How does the world of population health and analytics look to you as it stands today?

I think healthcare has been slow to change, obviously. We have seen that across the board. There is very little actual conversation about patients on the HIMSS floor; you’re not really seeing too many physicians here either. There is a lot of talk about technology, pricing models, and the cloud, all of the buzz words that you get blinded with. At UPMC Enterprises, we’re trying to embrace this notion of designed thinking, bring patients and physicians into the design of the solutions, and leveraging data as an asset to rethink healthcare. One of the biggest impediments to healthcare is going with the tried and tested. We don’t like change in healthcare, and innovation is all about change, in large parts. Change for the sake of change is dangerous, but engaging the patients and physicians—it might not be in an ivory tower somewhere—but doing it in an iterative matter, like we are at UMPC Enterprises, is the right way.

You bring up an interesting point about physicians at HIMSS. Do you think physicians across the country are embracing technology as much as they should be?

To be honest, physicians generally speaking are tolerating technology to do the things they know need to be done, but the opportunity is there for them to leverage technology to enable these things. And that’s not what we are focused on right now as an industry; you shouldn’t just tolerate technology. The purpose of innovation, and what we are pushing for, is that technology should really be invisible, it should go in the background. As a clinician, I should have technology feed me contextual information that is relevant so I can focus and have a conversation with the patient, and emphasize with the patient. In its current form, technology is an impediment because you are more focused with doing the task of documentation and ensuring that you put the right components in your notes so that the billing happens.

Part of the reason for this, in the last decade or more, we have moved from analog to digital, and in healthcare we were quick to embrace digital, but in doing that, in embracing the digital form factor, what we did was replicate the analog workflows. We essentially digitized paper so we have folders in our EMRs. In radiology we still call them hanging protocols or wet reads. This culture of analog is still very prevalent in healthcare today, and we’re trying to rethink that. One of the biggest challenges is, and physicians like me know this, having gone through go-lives, is getting this cultural change. It was a big transformational change, so we purposely designed our systems to replicate the analog workflow. It was almost a necessary evil, but this is now where the opportunity lies. How do we leverage these digital assets to move to the next level of analytics and intelligent visualization?

How much of a concern are regulatory mandates at a health system like UPMC?

We are concerned and cognizant of these mandates that are out there, they are there for a reason, so we obviously pay attention to them and do everything we can to meet and exceed these regulations that are out there. But for us, they are more guidelines, as we try to go above and beyond what is required. Meaningful use has been at the top of mind for a few years now, and vendors might argue that it has impeded innovation. We are also focusing in on what matters to clinicians, which is workflow, visualization, and making a difference in the care we’re providing.

What will push interoperability to the next level?

At UPMC, we have been pushing for interoperability and innovating in this space for a decade, before interoperability became the buzz word that it is today. We have pushed the boundaries of semantic and syntactic interoperability. There isn’t one silver bullet, but if you look at where things are moving towards, if vendors are incentivized to interoperate with each other, unlike 10 years ago, things could be different. It starts with provider customers and patients asking for access to data. When there is enough of a demand, vendors will have to comply. Providers choosing vendors that embrace open APIs (application program interfaces) and HL7's FHIR (Health Level Seven's Fast Healthcare Interoperability Resources) standard will move the needle.