Rasu Shrestha, Chief Innovation Officer, UPMC, Chapter 2

We’ve all heard the expression, ‘don’t put all your eggs in one basket,’ and in any industry like healthcare where costs are skyrocketing, it seems like sound advice. But if you strongly believe that the basket — in this case, innovation — is the future, perhaps it’s time to rethink it, particularly if your organization has invested so much time and resources in this area.

For years, UPMC has worked to build a foundation for innovation that focuses on “substance backed by academic and scientific rigor to create products that are effective,” says Rasu Shrestha, who holds dual roles as Chief Innovation Officer at UPMC and Executive VP of UPMC Enterprises. In this interview, he talks about how the organization is leveraging its innovation arm to develop better care models, the ‘how’ and the ‘why’ when it comes to acting as one strategic group, and the ultimate goal of making technology “as invisible as possible.” Shrestha also discusses what it will take to improve interoperability, and why he’s excited about where the industry is headed.

Chapter 1

Chapter 2

• UPMC’s living lab
• “There isn’t a one-size-fits-all approach to innovation”
• Leading with strategic alignment
• Ensuring a “strong level of commitment” with any initiative
• UPMC Enterprises’ philosophy: “We’re a strategic partner that brings in capital”
• Addressing EHR usability challenges – “We’re trying to make technology as invisible as possible.”
• Collaboration with Lantern

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Bold Statements

We lead by talking about the pain points we’re experiencing across UPMC, and how that resonates with the specific skill sets and attributes that these startups, entrepreneurs, physicians, and others bring to the table. It’s also how we make sure we’re able to align those interests to really take it to the next level.

It might take a little bit longer, but at the same time, I think it’s the right way to go. It best leverages the insights and capabilities that we’re able to bring as an organization.

The idea is, we’re not just a group that signs checks. We’re a strategic partner that brings in capital. And as we’re bringing in capital and co-investing in these solutions, we’re also co-creating these solutions.

We’re working really hard to make sure technology disappears into the backdrop, and we’re able to address some of the specific challenges we have around things like physician burnout, documentation, and how we interact with computer systems and clinical information systems.

There’s always room for improvement, but I believe that by embracing the principles of design thinking, starting with empathy and really engaging end users in ways we’ve not been able to do before, we’re getting a level of not just buy-in, but superiority in the design and makeup of our products.

Gamble:  Having a ‘living lab,’ as you talked about, presents a quicker way to pilot something that’s come up in UPMC Enterprises, and get to do it in a care environment. Is that the appeal?

Shrestha:  Absolutely. It’s interesting, our approach to innovation differs in many ways from some of the other approaches I’ve seen across the board. And again, there isn’t a one-size-fits-all approach to innovation. But our approach is that we don’t actually lead by pilot. When we’re talking to innovators, physicians, or even patients across the UPMC network, or externally, where we’re specifically talking with start-ups, entrepreneurs and other companies and entities that want to work with us, we lead by talking about strategic alignment.

We lead by talking about the pain points we’re experiencing across this living lab at UPMC, and how that resonates with the specific skill sets and attributes that these startups, entrepreneurs, physicians, and others bring to the table. It’s also how we make sure we’re able to align those interests to really take it to the next level — to put a force field around those pain points and find champions internally who are able to not just bring a level of expertise, data, and other elements to this, but also are able to stick with it long-term.

In doing so, as we’re defining those alignment areas and really focusing from a strategic perspective, we tend to build a business case around it, and we’re then able to articulate the specifics of a more iterative, agile process to look at how we address those challenges with solutions that might be sticky, and then the pilot comes naturally. The pilot becomes part of that as it survives the vetting processes, and it iterates through the process that we’ve defined internally.

It’s slightly different from some of the approaches I’ve seen. It might take a little bit longer, but at the same time, I think it’s the right way to go. It best leverages the insights and capabilities that we’re able to bring as an organization, and that living lab we talked about earlier. It also best positions the partnerships we’re trying to form, both internally and externally, in the right light, and ups the chance of success and the longevity that’s required. The runway needs to be longer. The appetite needs to be broader and deeper because healthcare is challenging. So that’s what we’re trying to bring — that special mix and that formula that I just described, that I think in many ways makes us stand apart from some of the other efforts that I’ve seen.

Gamble:  One of the downsides we hear with pilots is that there’s a start and end date, and sometimes even if the pilot is a success and people want it, it doesn’t mean that it’s necessarily going to be applied into their practice. So certainly a downside to doing it the traditional way.

Shrestha:  Absolutely. One thing I always try to push for is anytime we expend any level of time, money, and resources, we want to make sure there’s a strong level of commitment to implement the solution. The software speak that we use internally is that we drink our own champagne. But the idea is, we’re not just a group that signs checks, much like VCs or other firms do. We’re a strategic partner that brings in capital. And as we’re bringing in capital and co-investing in these solutions, we’re also co-creating these solutions. We’re bringing in human center design experts. We’re bringing in engineering. We’re bringing in data scientists, clinicians, analysts, and others across again the living lab that I referenced earlier.

Within UPMC Enterprises, our team has continued to grow to a point where today we’re close to 250 employees, and that’s not counting the dozens of employees that have left to join the many startups we have across our portfolio. Our team continues to grow, but in that makeup, I’d say about 70-plus percent are technologists, data scientists, and engineers.

We bring in a strong acumen around co-creation, which is really important as well. We tap into the expertise we have across the enterprise, then add that back to the specifics of the products we’re creating. So, as we’re creating products and implanting solutions, we’re able to perfect the product or the set of attributes we’re working on. Not only that, but before we take it out to market either directly or through some of our startups and portfolio companies, we’re able to talk to it not just as an investor and a co-creator, but really as customers.

We’re talking not just about the technology or the product; we’re talking about the vision. We’re talking about the story. We’re talking about the specifics of the outcomes and the benefits and value we’re getting from some of those products and attributes. And so it really becomes a different level of not just co-creation, but being able to understand the value of these solutions when we then talk to our peers and our portfolio companies. We are then able to see if there are fits with other organizations that may have needs for those types of solutions and products.

Gamble:  Very interesting. Now, one of the things you mentioned before was about digital health, and using it make the clinicians lives easier. As much positive has come from EHRs and the whole effort to digitize records, it’s been very challenging for physicians. Are there certain areas in which you’re looking to improve usability? How are you approaching that particular issue?

Shrestha:  As a radiologist by background and a clinician at heart, usability is something that absolutely is near and dear to me, and to our efforts at UPMC and UPMC Enterprises. In many ways, we feel that in the last 10 to 20 years of rolling out digital solutions, we’ve replicated the analog form factor — film and paper and files and folders to digital film and e-files and e-folders. Even the nomenclature is very similar. In many ways, the first generation of solutions were built so that it there’s an air of similarity with the analog culture that we are still embracing, and haven’t really let go of.

It’s led to some benefits, obviously. A lot of it is digital. We’re able to share records across large geographies in ways that we’ve not been able to do in the analog world, but there’s also been a lot of focus on documentation, billing, and the challenges around interoperability that I alluded to earlier. They are front and center when it comes to clinician usability and clinicians interacting or struggling with them.

As much as technology has aided efficiencies and effectiveness of care, it has also, in large part, become an impediment to care. We’re trying to address all of that and say, how do we make technology as invisible as possible? How do we bring in capabilities, such as natural language processing, pattern recognition, artificial intelligence, and chatbot technologies and bring the focus back on the patient? We’re bringing the focus back on the human element of the care that we’re trying to provide; things that technology in many ways is not able to replace — for example, trust. Communication, collaboration, and care coordination are other examples. These are all human elements that I believe we need to accentuate with technology.

So we’re working really hard to make sure technology disappears into the backdrop, and we’re able to address some of the specific challenges we have around things like physician burnout, documentation, and how we interact with computer systems and clinical information systems. The human computer interface is an area that’s really ripe for innovation because we’ve just been stuck with how we’ve done things for the last decade, or more. Those are specific areas where, from a usability perspective, we really believe we can take things to the next level, and we’re actively working towards a number of those different areas.

Gamble:  In terms of burnout, do UPMC and UPMC Enterprises have specific ways of communicating with physicians and trying to get to those pain points? How are you doing that?

Shrestha:  That’s a very good question. It is something we’ve been really trying to perfect over the last few years, and we’re at a point where we don’t start on any project — any project whatsoever — without engaging our end users. And that includes clinicians, but it could also be patients, technologists, and others as well.

Clinicians are very much front and center in a lot of the efforts we’re continuing to push forward at UPMC Enterprises. I’ll give you two examples; the first is in the space of mental health. I believe there’s a strong stigma associated with mental and behavioral health. There’s also a lack of access to expert resources across the board for mental health resources. And so we’re working with a company called Lantern out of San Francisco. We led a $17 million Series A round with them, and we’re working with mental health experts and physicians here at UPMC who are just really at the frontier, and are at the top of their skill sets of mental health and behavioral health. We’re co-creating a set of solutions and piloting these solutions across the board. That’s just one example of how we’re tightly integrating clinicians in the design of these solutions.

Another example is in the space of imaging. We’re creating what will be called the next-generation imaging platform. In doing so, we’re working cohesively with our radiologists and imagers — they actually rotate through our innovation center. We have a reading room environment set up where they’re able to come in, read studies, and interact directly with our human centers design experts, our analysts and data scientists, and our usability experts.

At that level of interaction, where it is raw and it is real, we’re able to see them in the their natural element, through their struggles, as well as the joys and the delights they may see in certain types of capabilities as we finesse them and bring them to the front of their workstations, in the workspace they’re interacting with. The level of interaction that we have with clinicians is bar none. There’s always room for improvement, but I believe that by embracing the principles of design thinking, starting with empathy and really engaging end users in ways we’ve not been able to do before, we’re getting a level of not just buy-in, but superiority in the design and makeup of our products and solutions to a level that we’ve not been able to achieve previously.

Chapter 3