At the 20-plus-hospital UPMC health system, a massive integrated health system that encompasses more than 1,000 care locations and more than 60,000 employees, things are moving forward in numerous areas. One particularly interesting arena is that of the tech development test bed that is UPMC Enterprises. Here’s how the leaders of UPMC Enterprises explain what this business division is all about: “UPMC Enterprises believes that the smart integration of technology within the health care industry is an opportunity to both improve the quality and lower the cost of health care. As a leading integrated delivery and finance system (IDFS),” the organization’s website notes, “we harness the strength of our clinical, technical, business, and capital resources to develop, test, and deploy health care products and services that improve the lives of patients across the globe and reduce costs.” And there is a clear rationale for this development work, leaders note. “With more than 20 hospitals and a 2.5 million-member insurance company, UPMC understands the importance of both providing care and paying for care,” UPMC Enterprises’ website notes. “UPMC works to maintain the health of its insurance company members, while also caring for patients in a variety of circumstances.”
One of the many clinicians involved in development work at UPMC Enterprises is Shivdev (Shiv) Rao, M.D. Dr. Rao, who is director of clinical innovation strategy at UPMC Enterprises, still sees patients 20 percent of his time each week, and is a faculty member in the Cardiology Department at the health system’s Heart and Vascular Institute.
Recently, Dr. Rao sat down with HCI Editor-in-Chief Mark Hagland, in the development offices of the organization, in the Bakery Square neighborhood of Pittsburgh, to talk about what’s going on at UPMC Enterprises, and his role in its activities. Below are excerpts from that interview.
Tell me a little bit about how UPMC Enterprises is organized?
We organize ourselves here into four domains. One is infrastructure-oriented; the others are our payer, provider, and consumer domains. And we collaborate across all four. There’s a small cohort of doctors who embed themselves here and spend a significant amount of their time here. I spend the most time here, 80 percent of my time; and then 20 percent in patient care. I went to medical school here at the University of Pittsburgh, and then, I was at the University of Michigan for my residency. And it seemed to me at the time that there was a limited number of professional routes to take—the clinical investigator route, the clinical scientist route, the clinical educator route, and the clinical administrator route—those were the paths I saw in front of me. But I never saw a clinical innovator route. And as overused as the term innovation is, that is what excited me.
Shivdev Rao, M.D.
My clinical interests are around patient safety and disease prevention. But I also have interests around research and technology. And I love to explore and connect the dots around all of those realms. And here at UPMC Enterprises, we have a broad scope. At various times, it feels like we’re a venture fund, an innovation shop, or a tech accelerator. But what that gives me the opportunity to do is to grow across all those different skill sets. And that offers people like me, physician innovators, opportunities to grow. And it’s the payer-provider piece that differentiates everything we do here. It goes well beyond the traditional clinician lens.
How do you see the role of physician innovators like yourself, in the context of the way in which medicine has historically been practiced? You’re really expanding the scope of what physicians with medical training can do to impact patient care delivery, on rather a broad scale.
Yes. The thing that distinguishes UPMC Enterprises is our ability to have doctors, patients, and people from the health plan embedded in our activities, to make sure that our innovations “fit.” And that’s a loaded word. To me, that means that the innovations that we invest in and build need to sell themselves, so that their adoption does not involve additional overhead for providers. We try to work backwards from a vision of what we think a highly aligned, patient- and consumer-centric, future-looking patient care system looks like, and we try to invest in existing companies that are moving in that direction. But where we see green space, we’ll build it ourselves.
For example, a little app I’m looking at right now on my smartphone, tells me when any one of my patients is in the emergency department, is admitted as an inpatient, or is discharged. Where did this idea come from? Well, historically, what would happen to me is that I’d end up in clinic and see ten patients who’d already been in the hospital, and had had their cardiac meds had been changed without informing me. On the surface, this appears to be a very simple application, but behind the scenes, making it successful requires connecting a lot of dots between our inpatient system, our outpatient system, and our ADT system, pulling demographic data on these patients; and it requires pulling a care team together around these patients. So I now get actionable notifications. I can choose to call the ED, the patient, or any other doctors on the team.
It will tell you the change of medication lists that a patient is now on, once that patient has had an ED visit, been admitted, or been discharged?