As vice president of medical information technology and medical director for interoperability and imaging informatics at the vast University of Pittsburgh Medical Center (UPMC) health system, Rasu Shrestha, M.D. is involved in myriad initiatives. And, as of this week, Dr. Shrestha has added still more to his already-full plate: he has just been named chair of the informatics scientific program of the Radiological Society of North America, for the RSNA Conference for 2014, 2015, and 2016.
In that role, Dr. Shrestha will be helping to guide the informatics-related offerings at the next three RSNA Conferences. He also spoke on Monday, Dec. 2 at RSNA 2013, currently being held at Chicago’s McCormick Place Convention Center. In the midst of all this activity, he sat down on Tuesday, Dec. 3 with HCI Editor-in-Chief Mark Hagland to share his perspectives on imaging informatics and its place in the new healthcare of population health management, accountable care, and value-based purchasing. Below are excerpts from that interview.
You spoke twice here yesterday. Please tell me about your presentations.
Yes, I gave two keynotes yesterday. One was on the challenges and opportunities in imaging informatics; that was a scientific program, entitled “Enterprise Imaging Challenges and Opportunities.” And also yesterday, KLAS Research had their big awards ceremony, with awards in RIS [radiology information systems], PACS [picture archiving and communications systems, modalities, and other areas, so I keynoted that also.
What did you say in your RSNA keynote address?
The big message there was, we’ve done a lot of things in the last 10-15 years in imaging informatics. And in order for us to think about the future of imaging, you have to pay homage to PACS, and also learn from your mistakes. And we’ve created tremendous innovations—we’ve moved from film to filmless and from paper to paperless, and created a digital environment. An that’s amazing. But we’ve also essentially replicated the old workflow, with a digital lightbox and “hanging protocols,” and we still perform “wet reads,” except that they’re digital. So it remains, let’s do a series of images, rather than, let’s treat the patient as a whole. So the question is, how do we bring this to the next level? At UPMC, I keep asking, how do we reach a stage of data liquidity? Because right now, we have images and data and everything else, tied to specific systems like PACS, RIS, EHRs [electronic health records], etc. And we’re doing population health and analytics. And we basically have data as hostages. So how do we free the data, to put it to work for us, so we can get to population health?
So phase one was the analog and film and paper world. And phase two was what we’ve done in the last 10-15 years, which is filmless, paperless, digital. Phase three is where we need to be: population health, interoperability, and analytics, and elevating ourselves above the EHR, and really thinking from a patient-centered, population health perspective. And many of us have hung the “Mission Accomplished” banner! And I’m saying, it’s way too early to do that, guys. There’s so much yet left to do.
Are most or even a significant plurality of radiologists, beginning to see this?
I know they are. And let’s focus on two challenges. One challenge is that of what I call efficiency pressures; everyone is being challenged to do more with less. And the other type of pressure is quality of care pressures. And that means you’re being challenged to make sure to give the appropriate treatment to a patient at the point in time of care. So even if we focus on these two specific challenges, for that average Joe radiologist or chief of radiology or CMO—the average radiologist knows he’s being judged on his throughput and productivity. But what that’s evolving into is being measured on value.
The problem is that in today’s siloed systems, it’s very difficult to measure real value. So you have metrics that say, I read 40 studies and yesterday, I read 50. Does that make me less valuable? If the outcomes were better today, and I was able to close the loop better with the ordering physician, or able to communicate test results more efficiently, that’s value. And without data liquidity, if the transformation of healthcare is in the balance, we need to have the right metrics in place. So what’s my value score at a particular point in time? Where are my peers, and what’s my target? I need a dashboard and I need it to be ingrained into the fabric of my workflow. So I know that radiologists are seeing that. And I know that the division chiefs are seeing it.
What’s the tools discussion here, then, for CIOs, CMIOs, CMOs, and imaging informatics leaders? How do they strategize to create the IT infrastructures and provide the tools, that will support value-based care delivery?
The message I have for a lot of folks is, don’t just focus on the tools; focus on the workflow. And every workflow is different. So focus on that. And whether it’s in the realm of VNA [the vendor-neutral archive], or universal viewer, or decision support, or population health, focus on the workflow. One sliver is what I call intelligent collaboration and communication. And what I mean by that is, as we look at how healthcare is evolving, intelligent communication and collaboration will be the catalyst that will transform healthcare into population health-based and value-based healthcare. So whether it’s a zero-footprint-client universal viewer, or whatever, the key thread is how I can optimize workflow and use this catalyst to drive decisions forward? That’s the big theme.
An example of this would be around stroke management. So if a patient shows up in the ED with aphasia and is showing signs and symptoms of stroke, every second is loss of gray matter. So how do we ensure that we have the right protocols in place for intelligent collaboration and communication between the stroke management specialist, the ED nurse, the neurosurgeon, and the neuroradiologist, to basically figure out what’s going on with that patient? Do I give him TPA or not? And whether you have a VNA or not, whether you have a universal viewer or not, a lot of your decisions should be based on your workflow. So if you’re a stroke management center of excellence, how do we ensure that we capture patients presenting with aphasia earlier, that we have that communication and collaboration ability, in terms of actual communication? So we can have the relevant clinical data available to the stroke management team, the same data available to the radiologist looking at the images?
So as much as VNA vendors and infrastructure vendors try to sell you stuff—you’ve got to focus on the workflow and on the collaboration and communication. If it doesn’t work, and it doesn’t flow, it’s not workflow. And if it’s more of an impediment, then that doesn’t help you.
So for organizations without the resources of a UPMC or without the strategic foundation developed yet, what would your advice be?
Yes, at UPMC, we have resources, and we’re a payer-provider organization, and we need to lead transformation to continue to sustain our trajectory of growth. But the reality is that we’re also amalgamation of smaller groups. We have some smaller community hospitals, and smaller physician practices, so the needs and challenges of those smaller hospitals aren’t actually different from those of independent community hospitals. And what leaders at those organizations have to look at, and I’ll tie it back to the theme of RSNA this year, the power of partnership. So if you’re a smaller player, you’re afraid of the competition, right? So instead of competition, focus on “coopetition,” cooperation in the midst of competition. And we’re all doing it.
So these smaller groups, the smaller practices and hospitals, need to think about how we can work more closely together with other satellite hospitals,, etc., and larger hospitals, to collaborate on HIE [health information exchange], to create better flow, and create stickiness—looking at the geographic dispersal of patients. And you find that, hey, 90 percent of our patients also end up at the hospital down the road. So if we look at the power of partnership to transform the way we work, as opposed to building the walls higher against the competition, only to be bought up later—that’s where the focus needs to be.
The power of partnership, which is the theme of RSNA this year, also comes into play in terms of how you can partner with vendors, with other organizations, and with the care team, are patients.