UPMC’s Rasu Shrestha, MD, MBA: Improving the Value Proposition of Imaging Informatics

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The University of Pittsburgh Medical Center (UPMC), with 20 affiliated hospitals and 30 imaging centers in western Pennsylvania, could be seen as ground zero in the effort to digitize medicine. From its innovative financial and development partnership with IBM to a recently announced pact with Google to develop a personal electronic health record (EHR), UPMC is blazing multiple trails for electronic communications in medicine. Radinformatics recently discussed the value of imaging informatics in medicine with Rasu Shrestha, MD, MBA, medical director of digital imaging informatics at UPMC, radiologist, and the steward of imaging informatics across disciplines, as well as the enterprise.

Radinformatics: As a radiologist and the medical director of informatics in one of the nation’s most wired hospitals, does radiology get better than average support, or is it fighting just as hard for resources as everyone else? Describe radiology’s relationship with information services. Shrestha: We believe in the policy—or the reality—that there is one bucket. You might take out resources from one place and put them in another, but at the end of the day, it does go back to that one bucket. What is definitely true is that bettering health care starts with first having the right infrastructure and the right tools in place. Overall, whether in the clinical departments or information services division, we are a driven bunch of folks. The relationship between radiology (and any of the other -ologies) and information services is extremely complementary, and it is structured for efficiency and innovation.

I am charged with strategizing for all of digital imaging informatics, including radiology, cardiology, pathology, ophthalmology, and any other -ology that entails imaging, which could mean otorhinolaryngology, gastroenterology, and wound care. It’s fairly unique and focused, as opposed to having fiefdoms across the board. The idea here is to have more of a unified strategy for digital imaging.

With radiology charging ahead as PACS matures/evolves, we bring along the lessons so feverishly learned over the past dozen-plus years in radiology to the rest of the enterprise, whether they are successes that can be replicated or things absolutely not to repeat as more of the -ologies embrace the digital era. This confers more of a synergistic strategy for imaging and how it meshes with the rest of the electronic medical record. That is where we are at UPMC.

Radinformatics: Does the radiology department at UPMC have its own IT department?Shrestha: There is a larger enterprise imaging team in radiology—consisting of support personnel, system analysts, and developers—just as there are other teams within other departments. These teams do fall under the information services division, except that they are all driven by the same motivation as the clinical departments—to better patient care, constantly improving the coordinated delivery of care across the UPMC enterprise. There are teams under these divisions, and I oversee these teams across the -ologies. We work hand in hand with each of the clinical departments to serve that master goal.

I work extremely closely with information services. I wear many hats, and this is essential, especially in a complex environment like ours here at UPMC (and, arguably, in other institutions as well).

I function not just as the person charged with working with the various teams and leadership to come up with the strategies for enterprise imaging across the board and how it meshes with the EHR world, but also, at a basic level, as a translator. I am the clinician who can relay any downstream effects of IT decisions that are made—not just outside the reading rooms and in clinical corridors, but to the hospital.

—Rasu Shrestha, MD, MBA

At the same time, when we either make demands or experience pain points in the clinical environment, I relay those. I have worked very closely with the CIOs across all of our hospitals, directly under the CMIO, and, at the same time, with our physicians on the ground.

Radinformatics: With hospitals focusing on efficiency and cost, how much of your section’s resources are going toward serving those masters? What are some of the initiatives you’ve launched lately?

Shrestha: There is no doubt that these masters need to be served. We strive to have what is in the best interest of efficient and effective patient care drive our decisions and the actions that might result.