The University of Pittsburgh Medical Center’s Chief Innovation Officer, radiologist Rasu Shrestha MD, MBA joined me to talk about all of the cool things going on in that hotbed of innovation.
Pat: Rasu, please tell us how innovation fits into the overall business strategy at UPMC.
Rasu: UPMC has been an innovative organization for a long time now, pushing the boundaries of medicine, science, and technology. We’ve also created companies. But what’s really interesting is the way that we’ve organized ourselves over the last several years, positioning innovation as a strategic imperative for the organization.
UPMC is both a payer and a provider. We call it an integrated delivery financial system. Innovation is really important for us not just what we do in terms of running the day-to-day clinical and operational aspects of running the health system, but also in how we are reinventing the future of healthcare.
We are putting all of our chips into this innovation bucket, [working on how] we can capitalize on the Living Lab that is UPMC and put a force field around these pain points, such as unmet clinical needs and the operational challenges of being a payer-provider system that is really on the bleeding edge of the newer care models that we are formulating.
We’re bringing in capital right now, so we are putting our money where our mouth is. These ideas may come to us from clinicians, patients, entrepreneurs, or startups. We are leading A-B type rounds into companies as well. We not only want to push our business models forward at UPMC but also help create companies that we believe will continue to do really well in the marketplace.
Pat: Are you also an accelerator as well as a healthcare delivery system and payer?
Rasu: In many ways, we are all of the above and none of the above. We are not just a standalone accelerator or incubator. We not only have the keen business acumen to bring to the forefront, but we marry that with strong academic and scientific rigor. We also bring in the discipline of human-centered design as well as agile development methodologies.
I have a team of 250 individuals just at UPMC Enterprises, our innovation or entrepreneurship arm. A lot of them are technologists, data scientists, and engineers. So we’re not just co-investing but we’re also co-creating solutions.
Pat: Sometimes when I talk to doctors, they really aren’t as excited as you and I are [about all of these changes]. They kind of like the way they were doing things in the past. A common complaint is “how can you keep changing this stuff on me? I can barely keep up as it is.” There’s a certain clinician rigidity to change. I’m wondering how you deal with that, in particular, with your clinicians at UPMC.
Rasu: That’s a great question. Innovation, in large part, is all about change. So, we think it’s important to manage change really well. Change management is a key ingredient to getting innovation right. What’s important for us and something that we’ve been addressing head-on at UPMC and UPMC Enterprises, our innovation and entrepreneurship arm, is that we work with our clinicians, our technologists, and our patients. We first and foremost acknowledge the fact that there really is a culture clash in the pursuit of healthcare today. We’ve got clinicians like you and I who have been trained to go with the tried and tested, evidence-based guidelines and clinical best practices and protocols.
Pat: Excuse me, I was trained not to be the first one to try that new thing, that new medicine, that new device.
Rasu: Exactly right. If it’s worked before, we should do more often, right? Yet, here we are, with innovators, entrepreneurs, and startups coming to us and saying “hey, here’s this brand new way of doing things, trust us it will work.” No wonder there is a culture clash. What we’re trying to do at UPMC Enterprises in our approach to innovation is to tackle this clash head-on. We are doing this by leveraging the principles of the ethos of human-centered design and design-thinking starting first of all with empathy.
We engage end-user clinicians, not just once a product is ready but before even a single line of code is written. We’re engaging them as we’re strategizing around these pain points that we’re hearing about and sensing. They are involved in the very design of the solution and in the iterative processes of development. We use fail fast methodologies and a safe space that we’ve created where we are able to make mistakes. We also take successes with the force field that we’re providing around these specific efforts. That’s how we bring in the notion of human-centered design to address change management issues, making sure that we have buy-in. The product, services, and solutions that we are creating are not being pushed at our clinicians, but rather, our clinicians have a strong thumbprint in creating them.
Pat: That sounds really good and may solve the resistance to change issue. Another big concern about the advent of artificial intelligence that I have heard doctors express is that it’s doing the job that I used to do and, by the way, it might be doing the job I used to do even better than I used to do it. So in this brave new world, I want to know how you address this issue of what the human clinician is going to be doing once you’ve deployed all this cool stuff?
Rasu: That’s a great question and one that is getting asked more today than ever before. When AI is used in my field, radiology, you have algorithms that are looking at pixel data and coming up with diagnoses even faster than I can as a human being. It raises the question of whether my specialty is going to become irrelevant moving forward. And, it’s not just radiologists, this is true for other clinicians across the board as well. It’s an important question and it’s one that I think needs a level of contemplation. Our perspective to AI and the pursuit of innovation that keeps on marching forward is innovation, if done right, will make technology invisible.
Technology today is more of an impediment to care—we’ve got pop-ups on EMR screens, we’ve got these alerts, we’ve got all of these things that are buzzing left, right, and center calling our attention. And, the technology in large part was built for billing and documentation. It requires us to turn our backs on the patient, and so it’s become an impediment to care. We want to understand how we can use technology to enable better care. How do we use technology to make us better clinicians, to augment the care that we’re providing? And, perhaps, to humanize the care process and bring out the most humanistic aspects of care that we absolutely can.
So, our view to AI is not AI as artificial intelligence but AI as augmented intelligence where these technologies can do the scut work, the hard work that human beings shouldn’t have to spend too much time doing. It can free time for us as human beings, as clinicians, to connect with the patient, to empathize, to build trust, to engage in shared decision-making, communication and collaboration—the most humanistic aspects to care. Leave the computers, the AI algorithms, machine learning algorithms to crunch data at a scale that our human mind absolutely cannot do today right. We might be bringing forward two or three maybe ten data points as we’re making a decision around a care pathway. Computers are able to look at thousands, millions of data points at any given point and come up with suggestions and recommendations. We need to embrace this new reality, embrace the droid, embrace the artificial intelligence and the algorithms, and not be afraid of them. Rather, we should utilize them in a way that makes us better and best take care of the tasks at hand. More importantly, we should embrace the fact that it allows us to accentuate the most humanistic aspect of the care that we provide to our patients; allowing us to connect with our patients and consumers in ways that were just not been able to do before. So, that’s our view to how AI should really be tackled and how, in this brave new world, the role of the human being will continue to evolve but will just not go away.
Pat: What I love about what you said is that one of the things that doctors complain about—and doctors complain about a lot of things—is that technology and the way that it’s been implemented in the recent past has disrupted the patient-doctor relationship. What you’re saying is let’s quit having doctors do the things that a machine could do and do the things that only a human can do: empathize, think right, and connect and engage with the patient. I want to thank you very much, Rasu, for joining us and for all the work that you’re doing on behalf of UPMC and on behalf of the doctors and patients of the world. And I look forward to following the kinds of progress that you’re making going forward.
Patricia Salber, MD, MBA
Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.
Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.
She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.
She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.
She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.
Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.
Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.