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Becker’s Healthcare Podcast
Dr. Rita Shane, Vice President and Chief Pharmacy Officer at Cedars-Sinai
00:16:25
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- [00:00]
A
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Rita Shane, Vice President and Chief Pharmacy Officer, as well as professor of Medicine at Cedars Sinai and Associate Dean, clinical pharmacy at UCSF School of Pharmacy. Dr. Shane, it's a pleasure to have you on the podcast today.
- [00:18]
B
Oh, thank you. Thank you for having me.
- [00:21]
A
Now I'm really looking forward to our discussion because I know there's so much happening in pharmacy right now and in particular you're doing cool things at Cedar Cyanide. So I'm looking forward to digging in there. But before we begin begin, can you please introduce yourself and tell us a little bit about your background?
- [00:37]
B
Sure. Happy to. So I can actually go back many, many years when at the age of 16, I decided I needed to figure out what my career path would be because I. I felt I needed to have a purpose and I needed to know what it was. And I remember speaking to my then boyfriend's mentor who was a psychiatric resident, who said to me that perhaps I was a little obsessive compulsive at 16, having to find a career path. And at any rate, I had gone through and determined I wanted to be in health care and at that time requested all of the curriculum for various healthcare professions and landed on pharmacy. California had a PharmD degree available anyway. And I'll fast forward ended up at Cedars Sinai as a pharmacy intern in pharmacy school. Was told that I would never last here. It was too intense, too difficult, too much work and I would be burned out. And that was when I was 22 and I'm still here. So that many, many years ago my career path started out in pediatrics because I fell in love with that area while I was a student, had wonderful role models in my training and last year pharmacy school. And I guess if I was to just characterize my career path is that I'm never content with the as is. If I see a problem, I feel the need to solve it. When something doesn't feel right, I feel the need to change it. And so I think that was kind of the impetus for my entire career, both within here at Cedars Sinai and roles that I've had in leadership and progressively advanced roles, work I've done in advocacy throughout my career and both, both the legislative and regulatory areas, both at the state and national level and just who I am, I'm just not content with the as is. And I think medications are so complicated, patients are so vulnerable, and we have such a significant role we play in partnership with the healthcare team to support safe medication use. And then the financials are so complicated as well and create challenges as well as ways that we as pharmacists can determine how to support the financial challenges and headwinds we're facing. So long run on sentence, but hopefully I answered your question.
- [03:04]
A
Absolutely no. That's amazing to hear. And what an incredible career journey. I love that kind of mentality you have of not being content, always wanting to solve problems and feeling the need to make changes when you see something that's arise. So I think that's an incredible asset and a leader in anybody who's especially working in healthcare because there's a lot to do within the healthcare space. So I think if you were to narrow down right now the top three trends that you're following or three things that are most impactful for you, what would those three things be?
- [03:35]
B
So. Well, I mentioned the economic headwinds. I think the economic headwinds have always driven how we deliver healthcare. And so what is happening daily is clearly top of my mind. And I'm always thinking about the implications not just for our pharmacists pharmacy program, but for the organization in general. So that. That's one I mentioned. Vulnerable patients I have always found. And I guess even when I think about why I went into pharmacy school, it's like I recognize the complexity of medications and the harm that they could provide. And I've witnessed throughout my career what I call the poly problem. We have patients with multiple chronic diseases. Especially as patients get older, they often seek help from multiple physicians and then they end up on multiple drugs. So I call it the poly problem. Poly disease, polydoc polypharmacy and the ability to support safe, effective use of medications. Which sounds trite, is. Was true when I decided I wanted to go to pharmacy school because I really don't like medications. What I want to do is prevent harm from medications and make sure they're being taken properly and that the orders are really carried out with the intent the physician had when he or she determined the diagnosis and created the treatment plan. So the work that I've done for many, many years that I am obsessed with is transitions of care because I see the vulnerability from the time patients are admitted throughout their course in the hospital, and then at discharge and post discharge. So that's, I would say, number two and three is navigating these. What has now been coined by the American Society of health system pharmacists as advanced therapeutics, therapeutic innovation, cell and gene therapy and biologics that really are making a difference in diseases that in the past we couldn't treat. And how we navigate the complexity associated with the cost, the efficacy, the durability and the financing of that is fascinating to me. In our organization, we have an oversight committee I established two years ago and I basically characterized it as we're going to build the plane as we. As we fly it.
- [05:53]
A
Absolutely. You know, I think all three areas that you mentioned are just such an important aspects of health care today and really truly top of mind, you know, for anyone working in the industry. I think looking at just the economic situation and everything that's happening is, is huge in maintaining access to care and then figuring out how to, you know, solve those complex challenges for patients that are coming with multiple chronic diseases. As you said, I think the last area that you mentioned in terms of some of those advanced therapies and innovation offer a lot of excitement and opportunity. Where do you see some of the areas that you're most excited about there? Are there any treatments that you see as being exceedingly valuable or what do you see as time goes on, kind of becoming the norm? I guess when you look at some of those advanced and innovative therapies, I.
- [06:43]
B
Think the methodology by which we evaluate them is even more important than which of the therapies we're going to offer. Because we have this kind of have development going on currently in three key areas, but we're seeing it expand beyond that. For example, oncology really is at the forefront. Anything that starts in oncology then tends to evolve further into other areas. Cell and gene therapies often begin in the cancer space and we're seeing huge, huge advances there. We are also seeing the CAR T which was the original cellular based therapy in oncology, now being used for things like lupus. The immune system, and I call it immune bartending is fascinating. A lot of the drug therapy innovation in that space. The other area that's growing rapidly is neurology. And there's so many dimensions of neurology that we're still pioneering in terms of how do we manage these debilitating diseases. Then there's pediatrics and then there's crossover between the three. And we're now seeing advances in some cardiac areas with treatment for amyloidosis in that population, which really can cause severe heart failure. I would not say any one therapy is better than the other. I think it really requires a robust team of clinicians and executive leadership to navigate this. This is probably the most complex time. And going forward, how we're going to Ensure access agnostic of insurance, you know, people's payer status is going to continue to challenge us. In our committee, we have a physician who represents bioethics, we have a number of people from executive leadership and we're trying to make the right decisions for the patients we treat. And we may in some instances say that we may not offer the treatment. If we have specialty here, the physician may be seeing the patients, but which treatments we offer and when are going to be a decision that's made in collaboration. So we set about creating a blueprint for this. We actually published it in the Journal of Clinical Neurology when we evaluated one of the first treatments for Alzheimer's disease. And the treatment itself was not that expensive, but with all of these therapies, it's not just that the treatment, it's the total cost of care. So our focus was on what, what that can mean for, for us here at Cedars Sinai, given the population of Alzheimer's patients in the LA area and how many might have been candidates for the therapy, which was, which was pretty significant. So we set about creating a blueprint and a very thoughtful process, working with neurologists and a number of other specialties to navigate how to offer the treatment and really learn about it. Because a lot of these treatments have unintended consequences. And the safety profile of the agent was significant enough that we had to be very, very cautious with respect to the administering. It's given every other week and it has a pretty significant prevalence of adverse events that need to be closely watched. So, so I guess my, my, my, my summary is, is that I think it's an exciting time to try to figure this out. And our, our CEO, who just retired last year, said health care is a team sport. I think navigating these drugs is a team sport.
- [10:15]
A
Absolutely. I think that, you know, it's so critical and just to have everyone working together in order to figure out, as you mentioned, how to develop these treatments, but then get them paid for. And access to the broader patient community is so critical. I'm cur most excited about right now at your organization.
- [10:32]
B
I really enjoy the collaboration. I get the opportunity to work with some of the best clinicians from around the world. I've been at Cedars, as I've told you since many years and counting, and I've always appreciated working with the medical staff and I feel the same way about working with our executive leadership. So the collaboration is phenomenal. Getting together with brilliant people to figure out how to deal with complex problems is what I thrive on. I like big, ambiguous, difficult situations because I find it's an opportunity to really learn from each other. When I reflect on Covid, which was such a terrible, terrible time for the entire world, I remember thinking that if it wasn't that so many people were dying, the work that we did to figure out therapeutics was, was really so stimulating and so satisfying and it was all about collaboration. So we had a Covid therapeutics committee that we convened under a pharmacy therapeutic structure that was co chaired by our P and T chairman, a physician who happened to be infectious diseases, which was serendipity. I've had the privilege of working with him for decade, decades and myself. And then my team would bring together whatever data was clinically available, which changed by the moment. I think initially we met almost every day and then it was three times a week. And we had an outstanding physician representation. We had physicians showing up to help figure out what we were going to treat, what we were going to have available in terms of guidelines and what we weren't because there wasn't sufficient data. And, and at that time it was really an art because as I said, the data and the, you know, things that were changing so quickly. So anyway, in summary, I think it's the collaboration with amazing people that makes me the most excited and the ability to have a, have a, an idea or recommendation about something and actually be able to bring it to fruition. And so I've, I've had that privilege many times. Right now what I'm excited about with respect to transitions of care is work that I started many years ago because my father had medication errors associated with transfer to another hospital. So I worked with a Senator back in 2018 and we were able to bring passion about inaccurate medication lists to fruition because we had a law that passed requiring that in the state of California, high risk patients admitted to hospitals, over 100 beds have to have their medication history taken by a member of the pharmacy staff. So it can be a pharmacy technician or a pharmacist. So I had wanted since then to have that regulation include and discharge. And I was able to work with the state board who invited me to educate around the topic when I recommended it at a meeting. And, and currently we're hoping that it will also become law in California. So we will be the only state that actually has a law requiring medication histories to be obtained by pharmacy at admission and a review of medications at discharge because that's where the harm begins because of the complexity of the patients we treat.
- [14:12]
A
Absolutely. Wow, that's fascinating. And really amazing to see that level of collaboration and working together in order to provide better care for patients. And so really, really intriguing and definitely helpful to understand everything that goes into that and make a difference. Now, before we wrap up here, I was curious, how are you thinking about growth over the next 12 months or so?
- [14:35]
B
So I think if I think about the first decades of my career and most of my career has been focused on the acute care setting because we're a big, you know, huge facility and over the last few years, and as we started even transitions of care before that, I think we began our program about 14 years ago, I'm seeing what started in my career as the physician, pharmacist, relationship evolve to not only continue with pharmacist, physician, nurse and all of the members of the healthcare team, that's essential, but more and more it's a pharmacist patient, vulnerable patient, kind of where I started and I think if I was to look at where we really are focusing is how do we support these patients outside of the organization as they're discharged? Patients who have chronic diseases, we have a specialty pharmacy, infusion therapies. Again, chronic diseases these days are being treated with infusion therapies for life. It's not just a self administered oral medication or injection like insulin. So our ability to not only provide those therapies safely to the patients, but actually and engage with them to see how they're doing, follow up and see if they're having side effects. Leveraging our technicians to support and ensure that they are getting their medications that they have, they've been able to have access to the medications, supporting them with patient assistance. It's really patient centered and that's what we are driving towards and that's Amazing to hear.
- [16:12]
A
Dr. Shane, thank you so much for joining us on the podcast today. This has been a really fun conversation. I look forward to connecting with you again soon.
- [16:20]
B
Thank you for the opportunity.