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

November 30, 2015
by Mark Hagland
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UPMC’s Rasu B. Shrestha M.D is bullish about the future of radiology and imaging informatics to truly add value to healthcare

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?