Delivering on the Promise of Healthcare Innovation

Widely regarded as one of the world’s leading experts on strategic innovation in healthcare, Rasu Shrestha, MD, MBA, has pursued his career across multiple continents and a diverse range of disciplines. As the Chief Innovation Officer for the University of Pittsburgh Medical Center (UPMC), he discusses the shift toward more participatory healthcare in an exclusive interview with American medical writer Peter Jaret. “Patients have already checked out Dr. Google before they see a Dr. Shrestha,” says the renowned doctor.

Photos: Frank Walsh

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Housed in the historic former Nabisco bakery in Pittsburgh, UPMC Enterprises promotes strategic partnerships, joint development agreements, and investments in healthcare startups, while working with clinical partners throughout UPMC, a 19 billion USD provider-payer that includes more than 40 hospitals and 3.4 million insurance members. In September, while programmers hunched over glowing monitors and strategists plotted out new initiatives on whiteboards in sunlit conference rooms, Dr. Shrestha sat down to share his thoughts on the best practices for nurturing and implementing innovative technologies.

How did you first become interested in healthcare innovation?
My specialty is radiology, which set the pace for the industry early on in moving from analog to digital and in developing picture archiving and communications systems (PACS). Radiology has also been a leader in using algorithms and AI to support diagnostic decision-making. So I guess I’ve always been interested in innovation. Today, of course, across the healthcare spectrum, technological innovation holds out the promise of really transforming the practice of medicine for the better.

What are the biggest challenges?
Healthcare is littered with challenges. I mean, if you’re a sucker for a challenge, come to healthcare, right? One is the sheer complexity of healthcare. There’s the complexity of medical research. The complexity of the healthcare system we’ve created. The complexity of human beings – not just our biology, but our behavior and what drives behavioral change. Unfortunately, some of the technologies in healthcare today only add to that complexity. So one of our starting points is to recognize that innovation isn’t about adding more bells and whistles. It’s about making the tools we design as simple as possible.

Another challenge is a clash of cultures between healthcare providers and innovators. In healthcare, in large part for the right reasons, we resist change. That’s what evidence-based guidelines, clinical protocols, best practices are all based on: Let’s test to see what works and stick with it. We’re slow to change because making a mistake in healthcare can be a matter of life or death. Innovators, on the other hand, want to disrupt things. Innovators say, “hey here’s a brand new way of doing things. Trust us, it will work.” There’s an inherent clash between those cultures. We’re trying to find ways to bridge these cultural differences by embracing the core value of design thinking so that we can approach the challenge of culture clash in a radically pragmatic way.

Video: Rasu Shrestha on bringing back the human element to healthcare

How do you encourage these people with very different perspectives to work together?
We ask ourselves and the people we work with to understand the perspectives of the other people involved. We don’t necessarily start with the pain points. And we definitely don’t start by jumping straight to the solutions. We start with empathy. We involve the key stakeholders in the conversation right from the beginning, and we keep them engaged in an iterative process. The goal isn’t to develop a fully fledged product for the enduser right from the start. We’re not running a marathon. We’re doing short sprints of development, where we have the opportunity to fail fast, but scale successes. That way, we get active feedback, rapid iterative cycles that encourage the right type of innovation to bubble up to the top.
 

We also choose partners – innovators, entrepreneurs, collaborators, and team members – with a real passion and determination to make meaningful changes. It takes a special breed of doers and believers to make change happen and to scale it up, to make it sticky. We’re not interested in some sexy-sounding new technology just because it’s cool or the latest thing. We look for strategic alignments that will allow us to make a real difference in the quality, efficiency, and cost of healthcare.

Where do you see innovation making the biggest difference, in terms of better outcomes at lower cost?
There are multiple wedges that the hammer of innovation can strike. I want to mention here that we’re ideally positioned to nurture innovation at UPMC. We’re an integrated delivery network, which means we provide coverage through our health plan, and we provide healthcare services through our provider network. We make sure that the incentives to provide value and control costs are aligned to make the right decision not just for the patient but also for the healthcare plan member.
We think of UPMC as a living laboratory. Our model is not just patient-centric but really a person-centric approach to care, which is a different perspective altogether. The goal is to keep people out of the hospital, to cut costs by keeping people well.

Another example are chronically ill patients. Too often, they’re seen in the hospital, discharged, and before long they’re back in the hospital. In a new initiative at UPMC, we’re discharging patients with not just a bag of pills and a discharge summary but with wearable devices and other technologies that allow us to monitor their condition – with their permission, of course. There’s a lot of data being pulled into an intelligent data hub, which enables us to monitor chronically ill patients and recognize when things are starting to go wrong, so we can intervene before they have a crisis and end up in the ED. We improve care and cut costs.

How will innovation transform a patient’s experience of healthcare?
Increasingly, healthcare will be less about treating a specific episode of illness and more about promoting well-being. Healthcare will be more pervasive in people’s lives because it will be focused on keeping people within the magic circle of wellness, not just treating them when they’re sick.

The relationship between patients and physicians will also change. Medicine has always been traditionally very paternalistic. Patients went to the doctor expecting the doctor to tell them what needs to be done, to order tests, to give them medications. We’re already seeing a shift toward more participatory care. They’re more aware, more engaged, they’re leaning in. One of the goals of innovation must be to capitalize on that engagement and empower these people to take charge of their health. It’s not just a matter of giving people access to their health data. It also means giving them the tools and capability to make the data useful and meaningful to them, in their circumstances, and to their preferences and drives.

The practice of medicine is also being transformed, and change can be threatening. What’s your message to the next generation of doctors?
The fear out there is that “AI is coming, so run for the hills!” I don’t think that’s how we should think about it. Instead of artificial intelligence, we should call it “augmented intelligence.” Designed and used wisely, emerging technologies like AI will enable doctors do what they do best – and what they truly want to do best, which is to care for patients.

AI is really good at data crunching. It’s really good at looking at multiple different data points – not just two or three or four but tens of thousands, parallel processed at the same time, something we humans can’t do. AI will be a powerful diagnostic tool for doctors. If managed right, it will make us smarter and give us the space to nurture trust, a sense of community, and a sense of collaboration with our patients.

The role of doctors and nurses as communicators and counselors will become more important than ever. We’ll have the opportunity to practice much more holistically, to get to know our patients better, not just when they’re sick but, just as importantly, when they’re well. I think healthcare providers will be much more involved in innovation, in helping to shape the technologies so they provide real value.