There are opportunities for innovation in healthcare, but how can hospitals and doctors balance patient focus against economic considerations? Dr. Rasu B. Shrestha, chief innovation officer at the University of Pittsburgh Medical Center, tells CXOTalk why we need digital transformation in healthcare, how to commercialize innovation, and the complexities behind delivering high-quality patient treatment outcomes.

As CIO for UPMC, Dr. Shrestha plays a leading role in driving UPMC’s innovation strategy, serving as a catalyst for transforming the organization into a more patient-focused and economically sustainable system. He also serves as the executive vice president of UPMC Enterprises, the innovation and commercialization arm of UPMC.

Dr. Shrestha has been recognized by Becker’s Hospital Review as one of the 26 “Smartest People in Health IT,” and InformationWeek named him one of the “Top 20 Health IT Leaders Driving Change” and a “Top Healthcare Innovator.” He is a frequent speaker at national and international health care, innovation and technology conferences. He also serves as the chair of the Informatics Scientific Program Committee at the Radiological Society of North America and is also a longtime member of the Advisory Board of KLAS Research.

Transcript

Michael Krigsman: Innovation in healthcare is arguably one of the most important topics of our time. We all care about our healthcare and, without innovation, we stand still. This is a great time for innovation in healthcare. I'm Michael Krigsman. I'm an industry analyst and the host of CxOTalk. Today, on Episode #285, we are speaking with one of the world's top healthcare innovators.

Before we begin, I want to say a thank you to Livestream. They support us and support CxOTalk. They provide our live streaming video infrastructure. If you go to Livestream.com/CxOTalk, they will even give you a discount on their plans.

Now, I want you to please, right this moment, tell a friend; tell a friend to watch and be sure you subscribe on YouTube. This is important. Subscribe on YouTube.

Without further ado, I'm so excited and honored to introduce Dr. Rasu Shrestha, who is the chief innovation officer at the University of Pittsburgh Medical Center. Rasu, how are you? Thank you for being here.

Dr. Rasu Shrestha: Thank you. Thank you for having me, Michael. I'm doing great. You know this is the Friday the 13th special episode, I guess, so it's a pleasure to be here. Thank you for having me as a guest.

Michael Krigsman: Well, thank you. Please, tell us about your work. You're the chief innovation officer, and you're also responsible for the University of Pittsburgh Medical Center Enterprises, and so tell us about the things that you're doing.

Dr. Rasu Shrestha: Yeah, so I'm all but part of a larger team that really makes the magic happen at UPMC. UPMC is a large payer-provider organization. We're 80,000 employees, $20 billion in annual revenue, so we're a large organization.

But, my role, really, you can condense it down to, I'm a bridge builder. What I do is build bridges. I work with a team that I have across UPMC to build bridges between healthcare as we've known it in the past to healthcare as it needs to be; bridges between the science and the medicine and the discipline of really pushing healthcare forward to entrepreneurship, to creating companies, to making commercial successes of innovations that we know have to be sticky; and bridges between computer systems, zeros and ones, AI algorithms, and human beings, patients, clinicians, just human beings that need to be utilizing these solutions at the back end. In a nutshell, call me a bridge builder.

Michael Krigsman: Okay, so you're a bridge builder among these various groups, technologies, and data. But, give us; maybe drill down and tell us. You're building these bridges. What is the goal? What is the end goal of this bridge making that you've described?

Dr. Rasu Shrestha: One of the things that we look at with the lens here at UPMC is, how do we continue to challenge the status quo and get healthcare from where it is to where it needs to be? We're a large, dynamic system that continues to really push the envelop forward in terms of value-based care. There's a lot of buzz around value-based healthcare models and really moving away from fee for service to fee for value.

What's interesting is, as a payer and a provider system, as an integrated delivery financial system even, we're not just talking about this. We're living and breathing it on a day in, day out basis. We're focused, and this is where the innovations naturally tend to focus themselves as well. We, as a system, are focused on pushing excellence forward in medicine, in science, bringing technology to aid in that pursuit, but marrying that with a strong business acumen, a keen entrepreneurial zeal, an enthusiasm to not just create innovations and adopt innovations that are cool, but to create innovations, think outside the box, and implement these solutions that will be sticky, that will make a difference, [and] that'll move the needle in remarkable, transformational ways.

Our goals, really, Michael, are several fold. Our goals are to move that needle forward, improve patient outcomes, [and] improve

Michael Krigsman: Innovation in healthcare is arguably one of the most important topics of our time. We all care about our healthcare and, without innovation, we stand still. This is a great time for innovation in healthcare. I'm Michael Krigsman. I'm an industry analyst and the host of CxOTalk. Today, on Episode #285, we are speaking with one of the world's top healthcare innovators.

Before we begin, I want to say a thank you to Livestream. They support us and support CxOTalk. They provide our live streaming video infrastructure. If you go to Livestream.com/CxOTalk, they will even give you a discount on their plans.

Now, I want you to please, right this moment, tell a friend; tell a friend to watch and be sure you subscribe on YouTube. This is important. Subscribe on YouTube.

Without further ado, I'm so excited and honored to introduce Dr. Rasu Shrestha, who is the chief innovation officer at the University of Pittsburgh Medical Center. Rasu, how are you? Thank you for being here.

Dr. Rasu Shrestha: Thank you. Thank you for having me, Michael. I'm doing great. You know this is the Friday the 13th special episode, I guess, so it's a pleasure to be here. Thank you for having me as a guest.

Michael Krigsman: Well, thank you. Please, tell us about your work. You're the chief innovation officer, and you're also responsible for the University of Pittsburgh Medical Center Enterprises, and so tell us about the things that you're doing.

Dr. Rasu Shrestha: Yeah, so I'm all but part of a larger team that really makes the magic happen at UPMC. UPMC is a large payer-provider organization. We're 80,000 employees, $20 billion in annual revenue, so we're a large organization.

But, my role, really, you can condense it down to, I'm a bridge builder. What I do is build bridges. I work with a team that I have across UPMC to build bridges between healthcare as we've known it in the past to healthcare as it needs to be; bridges between the science and the medicine and the discipline of really pushing healthcare forward to entrepreneurship, to creating companies, to making commercial successes of innovations that we know have to be sticky; and bridges between computer systems, zeros and ones, AI algorithms, and human beings, patients, clinicians, just human beings that need to be utilizing these solutions at the back end. In a nutshell, call me a bridge builder.

Michael Krigsman: Okay, so you're a bridge builder among these various groups, technologies, and data. But, give us; maybe drill down and tell us. You're building these bridges. What is the goal? What is the end goal of this bridge making that you've described?

Dr. Rasu Shrestha: One of the things that we look at with the lens here at UPMC is, how do we continue to challenge the status quo and get healthcare from where it is to where it needs to be? We're a large, dynamic system that continues to really push the envelop forward in terms of value-based care. There's a lot of buzz around value-based healthcare models and really moving away from fee for service to fee for value.

What's interesting is, as a payer and a provider system, as an integrated delivery financial system even, we're not just talking about this. We're living and breathing it on a day in, day out basis. We're focused, and this is where the innovations naturally tend to focus themselves as well. We, as a system, are focused on pushing excellence forward in medicine, in science, bringing technology to aid in that pursuit, but marrying that with a strong business acumen, a keen entrepreneurial zeal, an enthusiasm to not just create innovations and adopt innovations that are cool, but to create innovations, think outside the box, and implement these solutions that will be sticky, that will make a difference, [and] that'll move the needle in remarkable, transformational ways.

Our goals, really, Michael, are several fold. Our goals are to move that needle forward, improve patient outcomes, [and] improve patient satisfaction, all of the things that a lot of health systems obviously are very incentivized to do. But, our goals also are to really innovate [and] create products, solutions, [and] companies that we would implement these technologies here at UPMC that we call the living lab. We would then commercialize with our partners, we would take out to market, and we would scale these solutions to impact healthcare at a much broader level.

Michael Krigsman: Why this emphasis on building companies and business? What about healthcare, and what about your mandate, leads to this?

Dr. Rasu Shrestha: That's a really interesting question, Michael. I dig back to why I even started this in the first place. I'm a physician. My background [is] I'm a radiologist by training. I went through med school, went through all of my training, and then did an informatics training as well.

As I pursued leveraging the power of data and informatics to better the care experience, to create solutions that would actually make a difference in the lives of physicians and patients, the bug really bit me. One thing that I learned early on, and this is, I'd say, almost 20 years ago, is it's one thing to innovate. It's another thing to make those innovations sticky, to have a level of cultural change that's really required to scale these innovations, and to make sure that they're able to get the level of impact that we know a lot of these great ideas and great innovations can actually bring to fruition.

In order for you to do that, yes, you've got to create the right product. You have to maybe have the right set of services. You have to have the right teams. There are lots of components to that, but you also have to, in many ways, make sure that you're building it in a way that it's sustainable over time, which oftentimes does translate to business success [and] commercial success.

That really is sort of the mantra that we have here at UPMC and at UPMC Enterprises, which is our innovation and entrepreneurship arm is to make sure that we're able to really home in on these unmet clinical and operational needs and create successes that we would implement here at UPMC, but where we would also take these successes and scale them at a level that others across the industry would also be able to enjoy some of the successes that we've been able to push forward at our institution.

Michael Krigsman: Business building then is a core part of what you're doing.

Dr. Rasu Shrestha: Yes. Yes, absolutely. It is. Yeah, I like to say that put our money where our mouth is. If we say we're going to move from volume to value, value-based healthcare is important. Here's how we're pushing things forward, not just in the newer care models that we're creating at UPMC, the pathways that we're weaving into place and implementing across the care delivery institution that is our hospitals and our long-term care facilities, our senior care facilities, but also a payer-provider system looking at the business models, the revenue models, the financial models behind this, and with the level of entrepreneurial focus to this to say, "All right, how do we make this sticky? How do we really scale this, and how do we synthesize some of these algorithmic imperatives into more of a business imperative, create companies, products, and solutions that again we can really take out there?"

Michael Krigsman: Why is this so important, especially in healthcare, because you're talking about business, yet it's also, at the same time, very clear to me that your ultimate goal is patient outcomes?

Dr. Rasu Shrestha: Absolutely. What I'm looking at with the team at UPMC is really the perfect intersection between the imperative that we have to better patient outcomes, to better patient experience, to perhaps even redefine the very notion of what healthcare is really all about and refocus healthcare from it being just about surviving to it really being about thriving. We are trying to redefine what healthcare is all about. But, while doing that, in order for us to make it sticky, in order for us to scale it, in order for us to make sure that this is not just a once and done, we need to make sure that we're able to do this in a way that it actually can scale. The business success side of this is really important.

The other facet to this, Michael, really is also in terms of making sure that the innovations that we're creating aren't just UPMC centric. As healthcare organizations, and there are many of my peers across the industry who know exactly what I'm talking about because, when you're part of a healthcare institution and you're creating solutions that you're trying to fit into the integrated workflows, the complexities of your specific environment, you very often run into the slippery slope of coding it, codifying it to such a specific level that it only works in your institution. The way that we've been approaching innovation is to say, "All right, let's really look at this not just for our institution, but really with a mindset to make sure that it's able to interface with multiple different clinical information systems in a manner where you could have multitenancy, you could scale it, you could really take it to the next level, and enjoy a level of outreach that you would otherwise not have been able to had you been sort of custom coding it to your specific environment.

Michael Krigsman: I want to remind everybody that we are speaking with Dr. Rasu Shrestha. Right now, there is a tweet chat taking place. You can ask questions and share your thoughts and comments using the hashtag #CxOtalk.

Rasu, what makes this particularly difficult or challenging in the healthcare environment as opposed to in other fields? Why is healthcare; why is innovation in healthcare so particularly difficult?

Dr. Rasu Shrestha: Yeah. It's not just particularly difficult, but it's also so particularly important, right? I believe there is nothing more personal, nothing more humane than really the pursuit of excellence in healthcare. Perhaps because it is so personal, it's not just work. It's not just something that you're tasked with doing. It's personal to you, to me, to everyone that's listening in on this today.

It's about their lives. It's about their loved ones. It's about the people that they care for. Because it is so personal, I think we've made it so darn complex. Because we've made it so darn complex, it is so much more difficult to really innovate and take it to where it really needs to be.

Complexity is the bane of our existence in healthcare. It really is. I mean you look at the billing codes. You look at the complexity of the interfaces that we have at the back end. You look at the complexities of the workflows that we've managed to hash out over the last many decades. You look at the complexities of the interfaces that we've been rolling out in terms of these clinical information systems even in the last two decades and more.

Complexity is the bane of our existence in healthcare. But we also believe, and this is where UPMC Enterprises comes in, if complexity is the bane of our existence, then really design thinking is perhaps the cure. We're trying to put on a design thinking hat and the mindset of really innovating despite and in spite of those complexities, but really trying to take the approach of moving away from the complexities and simplifying healthcare, really trying to say, "All right, look. It's not about adding bells and whistles. It's not about adding tabs, buttons, and features. It's about taking things away; making it as simple as possible; making it so darn simple that it just becomes so intuitive that you, at the end of the day, are able to then just focus at the tasks at hand."

That's what healthcare and healthcare innovation should really be about. It's a moving away from sort of the reality of complexity that we're inundated with today to where it needs to be, which is really focusing in on the most humanistic aspects of what it means to speak to a patient, to make sure that there is a level of communication that happens between the provider and the patient, that there is a level of understanding and empathy that speaks to what that patient and the consumer really wants. Healthcare then really becomes about not just taking a pill and hoping you get better but, when you're discharged from a hospital, that you're doing all of the right things so that you never hopefully ever have to go back to that hospital ever again. That becomes the new business imperative. That becomes the new reality of the future of healthcare.

Michael Krigsman: How does what you're doing, the innovation, lead to that? If I may voice a skeptical perspective in healthcare, how is what you're describing even possible, and how does innovation lead us there?

Dr. Rasu Shrestha: That's a great question. Therein lies the approach that we're trying to put in place here at UPMC. We're very cognizant of the fact that everything that I just described to you, the painting that I just put in front of you, is a complex one. It's dynamic. There are many things that are changing in real time right now. But, at the same time, the approach that we've tried to craft here at UPMC and through UPMC Enterprises is one that we believe really puts us in a position of strength and gives us perhaps an unfair advantage to capitalize in on who we are at UPMC and where we are in this day and time in our industry.

Let me elaborate a little bit further. For us at UPMC, we really see innovation as a strategic imperative. It's not just this thing that we're doing on the side and let's play around with this for a while. If it works, great. If not, then we've got our core business to really focus in on.

This is where we're putting in all of our chips as a system across the board and saying, "Look. We are really focusing on this as the future of UPMC," and the way that we've done this at UPMC Enterprises is we have, I call it, a servant leadership sort of a model where there's the provider organization, the health services group. There's the payer organization, our UPMC health plan. Then there's UPMC International. Then the fourth entity, that's UPMC Enterprises, works on behalf of and with the rest of the living lab that's UPMC.

What we've done at UPMC Enterprises, and I think this is really the way to approach this, at least in an organization like ours, is we've created a safe space; a safe space for us to ask those hard questions; a safe space for us to perhaps make those mistakes that you know need to be made; not just will be made, but need to be made in the pursuit of excellence in healthcare; and a safe space for us to have a level of undue focus on those pain points that I was referring to earlier, those clinical and operational pain points. Bring in the discipline that's required around design thinking, around agile development methodologies, around a culture of fail fast, and an appetite, as I mentioned earlier, to put our money where our mouth is. It's because of the tight levels of alignment that we have across our organization and the tentacles that we're building to further capitalize on the outreach efforts and the excellence that exists within the region here and nationally as well with sort of the entrepreneurial startup community and others within the healthcare industry that are as motivated as we are or share the same level of urgency and have the shared sense of vision and passion as we do, together go at this journey and create these innovations that are sticky and scalable.

Michael Krigsman: How extraordinary that a major medical center is not only paying lip service to this idea of innovation but, in a very meaningful and tangible way, has staked its future on this commitment. I speak with many executives from senior execs from different organizations and, quite frankly, sometimes they're doing innovation because it sounds nice but, really, it's business as usual.

We have some questions from Twitter. Let's begin with John Nosta, who was a guest, who has been on this show, and I know you know John Nosta, somebody who we respect a great deal. He asks, "Who is harder to change, the doctor or the patient?"

Dr. Rasu Shrestha: That's a very John Nosta question. I love it. At the end of the day, we're -- when I say "we," both the physician, as well as the patient -- we're both human beings. Human beings, John, as you know, have this level of inertia where, if things are working, let's do more of it. From that perspective, I think it's difficult to change for both the physician in their own light. They've gone through years of training, and they're at a place where they have a specific set of mandates that we've put in front of them, so it's very difficult for them to change. At the same time, patients have a mindset that they've grown to expect.

I think the real answer to this is it's difficult to change for both of them but let me turn this around and really get to where our head is. I believe, John, that where the industry is right now, and I'm not just talking about the last 20, 30 years that we've been rolling out health IT solutions, but really for centuries at a time --and this speaks specifically to the question you're asking in terms of change and the doctor and the patient--the healthcare industry has really been very paternalistic, right? It's been about paternalistic care. We need to move away from what we've known healthcare to be, which is one where we're pushing paternalistic care forward, to one where we really push participatory care forward.

Paternalistic care needs to move to more of a participatory care approach. That really is the new reality. When we approach healthcare with the lens of more of a participatory care, an intelligent participatory care approach, then what we do is we suddenly incentivize and make it easier for both the physician, as well as for the patient/consumer, to really not just want to change, but have to change. Therein lies the difference.

I think, today, because of the complexities that we just talked about earlier, because of the constraints that we've built around the systems that define healthcare today around the technologies and the IT solutions that really shackle us to the realities of the workflows that we're constrained to today, we continue to march down this path of a very paternalistic approach to care. But, if we're able to really turn it on its head, innovate, and think about these newer care models, think about these newer business imperatives, think about the newer definitions of what healthcare should really be about, then this newer paradigm of an intelligent participatory care model actually makes a lot of sense. A longwinded answer, but I think John deserved it. Thanks, John.

Michael Krigsman: Okay. A great answer, this notion of moving from a paternalistic approach to healthcare to a participatory approach. I want to get to some more questions, but I have to say that begs an entire discussion again of how you drive that kind of change in a meaningful way given the profoundly deep fabric of paternalist attitudes. Actually, let me ask you that. How do you do it? How do you even begin to accomplish that?

Dr. Rasu Shrestha: That's a great question. It's really where our head is at UPMC Enterprises in one of our focus areas, which is really looking at consumerization of healthcare and marrying that with the realities of what's happening in terms of clinical care and population health. One of the things that we truly believe in, and you're seeing this really across the board in the industry today, is consumers, and they could be patients, are leaning in in a way that they've never leaned in before. They're more engaged. They're more incentivized to take charge of the wallet that they're now suddenly tasked with in terms of their healthcare spend.

They're going to see Dr. Google before they come in and see a Dr. Shrestha. They're really concerned about the specifics of not just their treatment options, but their outcomes and their quality of life. There's a level of leaning in, participation, if you'd call it that, that you haven't seen in the past.

At the same time, what you have are capabilities from a technology perspective. We're struggling with some of these components, but there are capabilities that would allow for consumers and patients and clinicians not just to participate passively, but really actively in the care processes. How do we empower patients to better take charge of their data, not just give them data, free the data, give patients access to the data? Yeah, that's really important, but it's not just about giving them access to the data. It's also empowering them, giving them a right set of tools and capabilities to make sure that they're able to participate in the intelligent shared decision making that needs to happen around what's most important to them and to their loved ones. You're seeing that shift happen. What we need to do is to really catalyze that shift with the innovations that we're creating and then, after that, the specific business models that would really make this sticky and make this the new reality of what healthcare needs to look like.

Michael Krigsman: Changes across various key points ranging from economics to culture through the entire ecology, ecosystem of healthcare, essentially, is what you're saying.

Dr. Rasu Shrestha: Correct.

Michael Krigsman: We have some more questions from Twitter. Pablo Pinto is asking, "Is it possible to solve the lack of electronic medical record portability? How can technology and the industry empower and let users and patients have more control over their own data?"

Dr. Rasu Shrestha: That's a really, really good question. My answer is, yes, it is possible. The reality is we've been struggling with this for a while here in healthcare. We're still at a point where it's much easier for me when I travel to stick in my bank card at any ATM and take out money in the local currency from my account here in Pittsburgh than it is for me to get my health data moving in a way that would perhaps help save my life or the patient's life that's in front of me.

We still have a lot of struggles. We still have a lot of challenges at hand. But, the reality is that's the imperative. That is what needs to be done.

When we talk about the struggles of interoperability and where we've been the last decade and a half in this journey of interoperability in healthcare, we've really been just focused in on the specifics of interoperability around the electronic medical record systems. That's important, there is much work yet that needs to be done, and we're seeing some remarkable advancements being made with the opening up of these capabilities at the back end with the Argonaut Project leading the charge around HL7 FHIR and creating capabilities for us to have specific data points and access points to data elements in ways that we just hadn't had access in the past.

There's some progress that's being made, but what we really need to do to make that actually a reality is for us to scale this, for us to open things up in a way that we just haven't been able to open up in the past, for us not just to pay lip service. I'm not looking at any one vendor; I'm looking at the industry as a whole when I address this challenge that we have. We shouldn't just pay lip service and say, "Yep, we've checked the box. We're doing FHIR," or, "We're doing interoperability." It's not about that. It's about looking at not just a handful of specific, say, FHIR-based resources that need to be opened up, but the entirety of what is actually required to enable a smoother, say, care transaction to happen, to enable a specific set of workflows around, say, Telestroke or around transitions of care.

When we look at those specific set of requirements and we say, "Hey, look. It's not just read-only type capabilities that we need [to be] opened up. It's also perhaps write-back capabilities. We need more of a bidirectional, more fluid sort of interfaces, a set of interfaces that need to be put in place," when we try to specify what those needs and imperatives are, then we start making progress.

We start going from this handwaving vagueness that we seem to be stuck in today of, "Hey, we've got to open up. Hey, let's do interoperability. Let's get interoperability right," to the specifics of, "Here's exactly what we need. The customers are actually demanding this. Here are the specific set of clinical and business imperatives that are equated directly to these specific set of asks." That's when the industry starts coming together to really make that the data liberation challenge that we have in front of us a reality.

Michael Krigsman: We have a couple of questions from Twitter that are related to this. Zachary Jeans and Arsalan Khan are asking, "How do we spark new thinking among physicians and, at the same time, how do we get physicians to think about technology beyond just being a user, but actually harness that technology?" I'll even inject, what about data, get physicians to be thinking about the role of data?

Dr. Rasu Shrestha: I vehemently believe that data science needs to be a new specialty in medical school, right? [Laughter] I think, in this day and age, we're talking about 2018. 2020 is literally less than 2 years away. It is so important for us to have data science engrained in the practice of how we're actually pushing healthcare forward. Physicians, nurses, and other care providers really need to be bought into this, pharmacists and others included.

How do you do this? That's the big challenge. Today, physicians, unfortunately, are an afterthought when it comes to health IT rollouts. I say this because I've seen this happen in front of me where, with the right intent in mind, with the right intentions in mind, you have an RFP process. You go out and you say, "All right. Here's the best in class products around, say, a clinical information system, an ERM or a PACS System."

You do all of the due diligence to decide perhaps the finalist, and you go and sign the contract. When you're about to go live with that solution, you say, "Hey, let's bring in our physicians. Let's have a go-live event. Let's put in some training. Let's buy them pizza. Let's create cheat sheets." That's not the time to engage physicians. That is way too late in the cycle to engage end users.

The approach that we're taking at UPMC and at UPMC Enterprises really is where we engage end users first. Before we've even written a single line of code, we're sitting down with physicians. We're sitting down with patients. We're sitting down with nurses. We're whiteboarding, we're brainstorming, and we're talking about not what solution they want created, but what their pain points really are.

The notion of design thinking mandates that you really start first with empathy. You put yourself in their shoes. You sit down with them in their environment, not in a sterile, fancy room somewhere else in Silicon Valley, but really in the hospitals, in the trenches where they're seeing those pain points being experienced day in and day out.

You sit down with them, put yourself in their shoes, and really empathize with them. But, get them involved in the care processes. Train them to really understand why it is that you're actually pushing for these data elements to be connected together, why it is and how it is that you're actually creating these solutions. But, get their insights. Get their buy-in. There's no better way to get the buy-in of physicians than to really engage them early on, but to have them be part of the process.

Physicians, in general, are very bright people and they're very inquisitive. They want to do what's in the best interest of patients. There's no doubt about that. But, they're constrained. They're handcuffed with the solutions that we've given to them, with the set of mandates that we've put in front of them. If you open up those set of handcuffs and say, "Hey, look. You can be part of the solution. Let's create a blank canvas. Let's pull you in and really sit down and talk about the pain points that you currently have, and then we'll talk about the solutions, the technologies, the approaches that we need to put in place," engaging them right from the onset and keeping them engaged in the process of innovation, that's the way to really make sure that mind shift changes actually happen at the physician level.

Michael Krigsman: Okay. I'm continuing to jump into Twitter because I love answering questions on Twitter. I want to remind everybody we are speaking with Dr. Rasu Shrestha. At this moment, there's a tweet chat taking place using the hashtag #CxOTalk. Please, ask your questions.

We have a really good comment from Jared Jeffery. I want to address this one because it's sort of fundamental to this. He asks, "What are the gamechanger innovations, the major game-changing innovations in healthcare today? Is it AI? Is it blockchain? Is it other things that we may not be aware of?" Where's the focus of innovation today?

Dr. Rasu Shrestha: Jared, great question. Thank you for that. The problem with healthcare today, and not just healthcare, but really the reality of the age that we live in today, is that there is just so much hype. There's a lot of hype around AI, smart dust, and blockchain. It's less about the technology. It's more about what the technology can really do, in our case, to better the pursuit of healthcare.

Is AI important? Absolutely, it's important. AI has been around, however, for a long time. The set of capabilities to make AI sticky and scalable, which is sort of the mantra that I've been harping on now for the duration of this talk, it's more real today than it's ever been before. Is AI an example of an innovation that would really be important for us in healthcare? It absolutely is. Less because of the buzz surrounding AI, blockchain, smart dust, augmented reality, or anything else, but more because of how we can actually use that technology to effect change, how we can use technology to really affect behavior, and how we can actually move the needle in the way that we're pushing care forward.

Let me give you an example. Yes, AI tends to be a buzzword, and there's this notion of, "Hey. Run for the hills. The machines are coming," but AI, used well, could really help in augmenting the care that we're providing to our patients. Around clinical decision support, for example. As a clinician, we're able to maybe synthesize a couple of streams of data, 10, 12, 2, 15 streams of data at any given point in time, let's say. But, computers, algorithms can synthesize and compute thousands, hundreds of thousands, perhaps millions of streams at a given point in time. If we're able to use the power, the computational power of these AI algorithms to really look at vast troves of data, connect these silos of databases in a way that they've just not been able to be connected before, and give us the insights that we could then use to make decisions as physicians and as human beings to connect with the patient that's sitting in front of me and to contextualize it to the specifics of what may or may not work precisely for that patient or that consumer that's sitting in front of me, therein lies the perfect intersection of technology and use case.

Is AI sort of the next big innovation? I'd say no, it's not. It's what you can build out of AI, the things that you can build atop of AI, blockchain, and augmented reality. It's those things that really are the innovations that we should be focusing in on.

Michael Krigsman: Applications using tools, techniques, and approaches like AI or blockchain, for example, and then applying them, making them domain specific and useful in a practical and meaningful way.

Dr. Rasu Shrestha: That's exactly right, Michael. Put it another way, I'm a big believer of innovation, if done right, makes technology invisible. Our focus shouldn't really be the technology. Yes, as technologists, that's where we gravitate towards and, absolutely, we need to make sure that we have the right database, the architecture, the right set of technological bells and whistles. But, the focus in terms of how we actually push these innovations forward and make them sticky should really be on those use cases, should really be on the specifics of how we actually do what we need to be doing, whether it's around medication adherence, whether it's around clinical decision support or, in my case, reading a study as a radiologist.

Michael Krigsman: Thank you for the shout out to enterprise architecture because we had a comment from Arsalan Khan specifically on that point. We have another really interesting question and an important one from ikay_obion. Ikay asks, "Is there a standard framework for innovation that UPMC uses?" How do you manage the financial implications of innovation given the fact--I'm interpreting this person's question--that innovation by definition involves an investment today with a potential future outcome, which may distract or divert resources away from the immediate needs and pressing needs today? How do you balance and the long- and the short-term?

Dr. Rasu Shrestha: Yeah, so a great question. There are essentially two questions to this. I'll try to be short in my answer.

There is no one size fits all approach to innovation. Is there a way; is there a specific blueprint in how we're innovating at UPMC? There absolutely is. Engage with us online. We're online all the time, #UPMCinnovates. Look at us on our website, UPMCEnterprises.com. Come visit us in Pittsburgh. We're happy to host you here. We're an open book in terms of how we're pushing the needle forward in terms of innovations.

But, there is no one size fits all approach to innovation. Our approach to innovation may not work in your specific reality, your organization, in your institution, in your hospital, in the facility that you belong to. But, there are some best practices. There are some specific things that should be done, and there are many other things that perhaps shouldn't be done that we know have worked in our pursuit of innovation. The second part of the question there was really around this challenge. It actually costs money to perhaps innovation and, you're so busy doing the thing that you're doing, that you don't perhaps have the time to devote resources to something that might have outcomes that will be seen only down the road.

My take on that, and this is our take at UPMC, really, is because you're busy, because of the ambitions that you have around growth and the aspirations that you have around improving care and really challenging the status quo, because of all of that, you cannot afford not to innovate. You have to have buy-in, and that's one of the things that we've seen to be of tremendous benefit to us at UPMC, buy-in from the top down. This starts really at the very top of your organization, at the board level, and it percolates downwards to the rest of the organization, a level of buy-in that this really is of strategic importance to your organization that we're actually going to invest significantly because we believe that this is how we're going to continue to differentiate ourselves from the rest of the competition that exists out there. If you don't have that buy-in, and there are many other components to this but, if you don't have that level of buy-in, then it becomes all the more challenging.

What I'd say is, "Look. You don't have to boil the ocean day one. You start by showing early success and build on those early successes. But also, focus in on creating a culture of innovation. This is a topic that we could talk for a very long time. But, it's important for us not just to "innovate" for the sake of innovation, but really for us to use this as an opportunity to create a mind shift, to engage end users and show them the benefits of really embracing innovation in a way that would help them do the things that they feel most passionate about.

Michael Krigsman: Okay. We're almost out of time, but you're involved in a couple of very interesting projects, and I think we really do need to talk about them at least briefly. Number one is, you have been asked to lead the VA, the Veteran Administration's opened API pledge. Please tell us about that.

Dr. Rasu Shrestha: Yeah, really exciting, Michael. The VA is about to pull the trigger on what would perhaps be the most significant. By significant, I mean not just in terms of monetary value, upwards of several billion, but also significant in terms of the impact that it'll have on the veterans and their families and, quite honestly, the industry as a whole. They're about to pull the trigger on an electronic health record modernization mandate that's in front of them.

What's happening right now is there are academic organizations, healthcare organizations, so UPMC, we're all in on this, and we have the likes of Partners, Mayo, Roche, Intermountain, and many others that have really come together as the original signatories around this open API pledge. My role really is to work with my colleagues across the industry to really pull them together, to get them excited around this imperative that we have in front of us, which is, as the VA contemplates the specifics of rolling out a large, commercial solution, and making sure that we're able to continue to innovate for the sake of our veterans and their families, how do we use this as a nidus, an inflection point to not just better the quality of the applications, the workflows, and the solutions that we'll be implementing at the VA, but really use this as an opportunity to perhaps get interoperability right once and for all for the entirety of the industry, for the entire industry.

The opportunity at hand is tremendous. What I'm seeing is a level of leaning in, not just from the original dozen or so signatories, but now more than 100 others that have really pledged. If you go to the open API pledge website on VA.gov, you'll have an opportunity to get more information on this and to actually join us in this pursuit. You'll see that there is a level of leaning in, Michael, that I've just not seen in the industry before. You've got large organizations that are committing to this. You have vendors, small, medium, and large entrepreneurs, systems integrators, organizations like HiMSS that are pledging and saying, "We're behind this 100%. Let's do this." I'm really excited about this, and I'm looking forward to making this really sticky for the industry as a whole.

Michael Krigsman: You know we're almost out of time, but maybe you can come back, and we can do an entire show on this set of issues you were just talking about. Before we go, please tell us also about the Health Datapalooza. I'm looking at their website. I see other names of amazing CxOTalk guests like Michelle Dennedy, who is the chief privacy officer at Cisco, and Milind Kamkolkar, who is extraordinary, from Sanofi Pharmaceutical. Please, tell us about the 2018 Health Datapalooza.

Dr. Rasu Shrestha: I'm really excited about this. I'm privileged to be a co-chair of Health Datapalooza, along with Kelsey Mellard, who is my fellow co-chair as well. The Health Datapalooza is going to be happening in just a couple of days, April 26th and 27th in D.C., a perfect intersection of public and private and policy really coming together, talking about all of the things that we just talked about here on this show, the imperative to capitalize on health data, but really move the needle in healthcare.

It can't happen; that cannot just happen when you're in your own private bubble, whether you're in your organization unto yourself or you're in a different conference where you just have all of the vendors on the public side coming together or the private side coming together. It has to be where all of these entities are coming together and having open discussions about best practices, what's worked, what's not worked. But also, how do we scale this? How do we take it to another level?

This year, [I'm] especially excited about the level of leaning in that we're seeing from the patient population, so a lot of patient engagement--this is a patients-included conference--but also, the who's who in terms of effecting change across the industry. From the private sector, you've got key speakers coming in from Twitter, from Amazon, and many other organizations that are really effecting change. You've got other speakers and remarkable leaders coming in from payer and provider organizations, from the startup community, but also from the government, from the FDA, from CMS, from the Health and Human Services. All of these remarkable leaders are really coming together and talking about how we collectively lift the boat together.

I'm really excited about Health Datapalooza, hashtag #hdpalooza for those of you online. Follow along, but I hope to see all of you in Washington, D.C., for this really important conference.

Michael Krigsman: Okay. Wow! What a very, very fast 45, 50 minutes this has been. Dr. Rasu Shrestha from the University of Pittsburgh Medical Center, I can't thank you enough for taking your time to be here with us today.

Dr. Rasu Shrestha: Thank you, Michael. A pleasure.

Michael Krigsman: Everybody, you have been watching Episode #285 of CxOTalk. Now is the time. Tell your friend to watch. The replay is up. Be sure to subscribe on YouTube. Thanks, everybody. Go to CxOTalk.com. We have many more shows coming up. Thank you to Dr. Rasu Shrestha. Have a great day, everybody. Bye-bye.