When it comes to innovation at Penn Medicine, 'just about everything is in bounds,' according to Chief Innovation Officer Roy Rosin

As the chief innovation officer of Philadelphia-based Penn Medicine, Roy Rosin manages a far-reaching team: The Center for Health Care Innovation is staffed by clinicians, innovation managers, designers, coders and behavioral economists — to name just a few.

This diverse team works closely with a group of "passionate, mission-driven clinicians," as well as Penn Medicine's legal, strategy, finance, information services, research and administration departments to accomplish its lofty goal of designing, developing and deploying solutions to "dramatically improve patient outcomes, experience and the value of care," according to Mr. Rosin, who added, "It's a broad portfolio of work!"

That innovative work is enabled by both technology and manpower, he explained. While their IS and IT partners facilitate the team's use of data and install digital platforms that reduce the costs of interventions, just as crucial to the innovation team's success are leaders willing to both allot funding to their ambitious projects and advocate on the behalf of that ambition.

Here, Mr. Rosin discusses the obstacles to and successes of Penn Medicine's work to transform high-value healthcare delivery — a realm in which "just about everything is in bounds."

Editor's note: Responses have been lightly edited for length and clarity.

Question: What does innovation look like at Penn Medicine? What are your goals and priorities for your role?

Roy Rosin: Innovation is thriving across Penn Medicine, far beyond the innovation center. I'm inspired by the work my colleagues are leading on a broad range of fronts, from immunotherapies and gene therapies to novel surgical techniques. Within the innovation center, we focus on care delivery. Our teams seek to design, implement and scale changes to dramatically improve patient outcomes, experience and the value of care.

My goal as chief innovation officer — working closely with David Asch, our executive director, as well as our CEO and close partners including our CMIO and CIO — is to enable teams to rapidly experiment, testing new approaches quickly at low cost. Changing the way care is delivered remains challenging, but we've seen material improvements are well within our grasp. Helping reveal that new models have potential and are worth pursuing — often by enabling early evidence of what that different outcome looks like — means we can translate novel insights into actions, pilots and, ultimately, scaled practices.

Q: What is the focus of the Center for Health Care Innovation's work?

RR: Within the realm of reimagining high-value care, just about everything is in bounds. As Penn signed a readmissions warranty with our largest payer partner we've done quite a bit of work reducing readmissions. Recently, we saw some powerful wins in the areas of integrated behavioral health and better treatment for patients with opioid use disorders. We're seeing strong progress in moving care to higher-value sites, working closely with our home care team and clinical leaders to design how to safely shift time from the hospital to home settings.

In other projects, we've been able to increase screening rates, align end-of-life care with patient preferences, detect symptoms and issues earlier to avoid ER visits and morbidity, change care team behaviors to more consistently adhere to best practices and see better outcomes for our most vulnerable patients, as our IMPaCT program continues to address social determinants of health to reduce hospitalizations.

What high-impact innovation looks like at Penn is results, like IMPaCT reducing hospitalizations 65 percent for this population or our Heart Safe Motherhood team reducing readmissions and morbidity by 80 percent among women at risk for preeclampsia. On top of all that, our medical device accelerator has enabled some truly breakthrough devices.

Q: What are some barriers to healthcare innovation? How do you overcome these obstacles?

RR: Barriers exist everywhere, from payment models introducing friction to risk adversity, staff having little free time to try new things and even just the inertia of having done things a certain way for some time. Luckily, effective antidotes do create paths around those obstacles.

Our favorite of these antidotes would likely be rapid experimentation methodologies that reduce the time required to generate evidence and reveal whether something is worth doing and can be done safely. Essentially, this is just hypothesis-driven experimentation where the methods simply allow for testing ideas faster at lower cost. We do try to find footholds where value-based models dictate that better performance translates to both better patient outcomes and financial viability. We've invested in platforms that allow for faster testing of new ideas outside of enterprise decision processes, and we're working closely with enterprise leaders to make sure experimentation is given intentional consideration within formal resource allocation mechanisms.

Good innovation leadership hygiene still matters across the board, such as by choosing appropriate metrics that initially focus not on scale but on whether something new worked, so we can then scale what works. We try to align innovation work with existing priorities instead of adding something additional to clinical partners' plates.

And, of course, we work hard to avoid ever throwing new things over the wall once they're baked, which means identifying the right clinical and executive champions from the outset and working closely with them upstream. Finding those right champions to partner with is essential, as the chances of success go up a good bit when the right people are pulling for change instead of us pushing.

Q: What's the biggest mistake players in the healthcare industry are making when it comes to innovation?

RR: It's only possible to judge mistakes in hindsight, since when you're trying to do something new it feels fraught with mistakes all along the path. That being said, there's certainly a discernable pattern of practices that more often lead to good results or bad.

Scaling new interventions or new technologies prematurely, before securing evidence you're heading in the right direction, is one. Likewise, thinking cool pilots equals good innovation is equally flawed, as inadequate investment in scaling the changes that register strong early signals means you're unlikely to achieve material impact. Failing to understand how to situate and design solutions so they don't add more time or effort to already overburdened clinicians' plates is another. I'm also still seeing a failure to focus adequately on accelerating long sales cycles, where the industry could use more innovation, and generally weak evidence attempting to support business models.

Finally, I see mistakes along the lines of trying to build too much into existing EMRs before you really know what to build. That's not the fastest path, nor one that's particularly designed for rapid iteration. Groups operating under the belief that it's acceptable to simply check things off a feature checklist, as if the functionality either existing or not is what matters — as opposed to that functionality achieving specific measurable outcomes — won't fare well in an increasingly demanding environment where performance and economics get scrutinized.

Q: What's an innovation initiative you're especially excited about? 

RR: I love so much about the work I see emerging from our teams' efforts; it's really hard to pick just one. One recent project that blew me away was led by Kat Lee, MD, and Lauren Hahn of our Center for Digital Health and Mike Tecce, DO, of our plastic surgery team, supported by an incredible cast, to completely reimagine the patient experience around breast reconstruction surgery.

Traditionally, patients had to return to the clinic for five follow-up post-operative visits for issues ranging from surgical drain removal to inspecting the surgical site. Rather than merely trying to make each visit faster, more convenient or more pleasant, the team moved four of the five post-operative follow-up visits from the clinic to the home. To do this, Kat, Lauren and Mike worked with our home care group to transition drain removals to the home setting. They also introduced conversational two-way texting to stay connected to the patients and remain in a position to monitor and detect emerging issues remotely. With each visit taking patients up to five hours from leaving to returning home, this transition saved patients and their families 20 hours of effort — along with associated costs and inconveniences.

An element of their work that I think was brilliant was their recognition that the in-person visits delivered values such as reassurance and empathy that we didn't want to lose, so they designed elements of emotional support and education back in to the new path.

My favorites of their solutions — besides the ability to identify and address any concern quickly and at any time using the automated texting service — were based on insights garnered from both the struggles and the successes of prior patients that were previously not in focus for clinical teams. They learned about how uncomfortable it is to have drains pulling on your skin all the time, how hard it is to shower and how plastic seat belts go right across the surgical site, causing more soreness and aggravation. These insights led them to assemble best-in-class products, such as a soft robe with inside pockets supporting the drains, a waterproof device to make showering with the drains more manageable and a padded seat belt cover, so patients can resume daily activities with improved comfort.

Transitioning 80 percent of required follow-up visits to the home also, of course, created significant capacity to get more new patients in much faster, improving both access and the division's economics. The work with home care both introduced meaningful convenience for patients who could remain comfortably at home and drove appropriate revenues for home care. There were wins across the board, with delighted patients, great clinical outcomes and improved finances.

More articles on innovation:
Emory Healthcare adds Musculoskeletal Institute to innovation district
Cerner, MU Health Care innovation institute turns 10
VCU spearheads $50M study on tech, innovation to treat veterans' brain injuries

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