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Know your chronic disease patients and coach them

The key to population health: Know your chronic disease patients and coach them

Written by Nick van Terheyden, MD, Chief Medical Officer, Dell Healthcare | February 15, 2016

Source: http://www.beckershospitalreview.com

In my column last month, I talked about the need for a new physician interface that sits on top of the EHR and integrates data from multiple sources. This interface could also help us make use of the vast amount of consumer-generated data headed our way, via fitness trackers, smart watches, and phone and tablet apps. But only if we integrate it carefully.

Few physicians are eager to have that data pouring into their EHR. What are we supposed to do with this stuff? How do we make it useful? We don’t need to know every step recorded by a Fitbit, and we don’t need all the data from healthy patients. That said, there is a place for some of this data within our efforts to create a healthier nation.

U.S. ranks low because we don’t manage chronic disease well

Population health is critical to the future of healthcare in the U.S. Compared with other developed nations, the U.S. has ranked poorly on cost and outcomes. This is predominantly our inability to effectively manage chronic disease, which shortens people’s lives, degrades their quality of life and costs the U.S. healthcare system enormous amounts of money. If we learn how to effectively manage chronic conditions, and avoid hospitalizations and serious complications, we can improve life for patients and greatly reduce the ballooning cost burden we all share.

Caring for patients with chronic conditions is one of the toughest jobs we face as physicians, because these patients need help every day, not just in the clinic. We need to coach them toward better health behaviors. To do that, we need two things: frequent contact with the patients and accurate data about their health and activities.

Using remote monitoring and telehealth

The combination of remote monitoring and telehealth can give us the power to really change lives. To use this new technology efficiently, though, the data needs to be a part of a physician’s regular workflow and the most relevant data needs to be presented in a clear, easy-to-use dashboard. If the data is hard to find, it won’t be used. Physicians are too busy already, and they don’t have the bandwidth necessary to work with a new system or decipher poorly presented data.

We also need to be cautious about the source and quantity of data we integrate. We don’t need every step from a Fitbit, and we don’t need all the data from patients who are in great health. They currently don’t need our help and coaching

What we need is precisely targeted data from reliable, medical-grade monitoring devices used by patients who need coaching. There is a place for data from activity trackers within the system, but it needs to be appropriately filtered and integrated with data from devices that monitor glucose, blood pressure, weight and other vital signs.

There also needs to be a carefully thought-out program of feedback and coaching to make this data meaningful to the patient. Ideally, the physician’s team should include a well-trained health coach to design a feedback plan for each patient (with the physician’s input). The coach doesn’t have to be on the physician’s staff, as there are plenty of options for delegating this task to an outsourcing company that specializes in telehealth and health coaching.

Data integration is pivotal
There are two interesting approaches to integrating this data: a new user interface that marries data from the devices with EHR data and presents a comprehensive dashboard; or an integration platform that sends data to the physician’s EHR and displays the dashboard there.

Whichever route is taken, the key is to provide a system that is seamless with caregivers’ routine workflow, so the data is instantly accessible, properly filtered and analyzed, and presented in a dashboard that gives relevant data to guide treatment and coaching decisions.

A real-life example that works

One example of a chronic disease management system that uses remote monitoring data and telehealth is at Baystate Health, a large community-based integrated health system in Western Massachusetts. Baystate is part of the Pioneer Valley Accountable Care Organization, which was recently designated as one of the first Next Generation ACOs in the country by CMS. Baystate developed an innovative program integrating remote monitoring and telehealth in care delivery. The program was led by TechSpring, Baystate’s technology innovation center.

It uses a solution from Health Net Connect to proactively monitor patients with diabetes in an effort to reduce or eliminate 30-day readmissions. Health Net Connect sends telehealth-equipped suitcases to diabetic patients. The suitcase contains tools needed to monitor the patient in their home, such as a tablet for virtual visits and a glucose meter.

Patient data is recorded by the tablet and sent securely via cellular connection to the Health Net Connect dashboard used by Baystate’s clinical teams.

It is critical that care managers are able to quickly view patient data from remote monitoring in the same interface with all the other patient data. No extra applications should be needed to access the data, no manual input required, no change to the clinician’s workflow. Easy access means less time wasted and more physician and patient engagement.

But making the data available within existing EHRs or care management platforms takes the right technology. Health Net Connect talks in JSON and an EHR might only speak HL7. (Disclosure: I work for Dell, the company that provides the integration engine used to do the translation from JSON to HL7 for Health Net Connect.)

The alternative to the EHR-based dashboard is a new application type being developed by a number of entrepreneurs, many of which are expected to hit the market in the next year.

Know them well, coach them daily

The success of population health and chronic disease management efforts hinges on a few key elements: identifying those at risk; having access to the right data about them; creating actionable insights about patients; and coaching them daily toward healthier choices. It’s not really rocket science, but it does require the right technology and a coordinated plan to make it effective and affordable.

The key to successful disease management requires integration into the clinical workflows and environment.’That was the focus of Baystate’s program, which requires trial and error. Technology is secondary; overcoming the barriers of adoption is the real work and real need.

40 Hospitals with Innovation Centers

As healthcare continues along its perpetual evolution, those in the industry are continually trying to get ahead of the curve and find solutions to the biggest issues facing patient care and delivery today. Increasingly, hospitals and health systems are making a commitment to innovation by establishing their own centers and institutes for innovation.

While innovation in healthcare is often discussed in the context of new tools and technology, it also applies to new ideas, workflows and training techniques. From established departments to organizations with their own separate governing board, below is an updated list of 40 hospitals and health systems with innovation centers.

Note: Innovation centers are presented in alphabetical order. This is not an exhaustive list of all innovation centers. Centers were selected by editorial research. Hospitals cannot pay to be included on this list.

Baystate Health in Springfield, Mass.

At Baystate Health in Springfield, Mass., CIO Joel Vengco launched the system’s health technology innovation center TechSpring in 2013. Many tech startups have partnered with TechSpring for product development, including CarePort Health and Medecision. TechSpring features an adoption accelerator, insight through focus groups and co-working space for individuals or teams working in healthcare or technology.

Boston Children’s Hospital

Boston Children’s Hospital fosters several initiatives to spur innovation. It established the Boston Children’s Innovation Acceleration Program in 2010 as resource for hospital employees to develop ideas. The hospital also opened a Technology & Innovation Development Office, which serves as the commercialization arm for researchers, biomedical innovations and technologies. Boston Children’s hosts the annual global Pediatric Innovation Summit, the only annual event centered on advancing innovation in pediatric care, as well.

Brigham and Women’s

Boston-based Brigham and Women’s launched its Innovation Hubin 2013. The hub, led by Executive Director Lesley Solomon, supports Brigham clinicians, scientists and employees in bringing their innovative ideas to fruition. Called iHub, the center hosts an annual Clinical Innovation Day, which unites clinicians, scientists and business leaders to share ideas for patient care improvements. iHub also hosts hackathons, codeathons and idea labs, where clinicians and scientists brainstorm ideas for a particular theme in healthcare in just 90 minutes.

Children’s Hospital Los Angeles

Children’s Hospital Los Angeles bases its pediatric research in its Center for Innovation. The Center also oversees the Consortium for Technology and Innovation in Pediatrics, an accelerator that received a $1.5 million grant from the FDA and houses more than 30 active technologies. CHLA also partners with the University of Southern California in an initiative to support development of technology solutions for pediatric patients.

Cleveland Clinic

Cleveland Clinic founded Cleveland Clinic Innovations in 2000.Since then, the commercialization arm has worked with 71 companies to move their innovation from thought to product. CCI has been involved with more than 500 licenses and 700 issued patents. It also developed the Global Cardiovascular Innovation Center Incubator, a facility to house startup companies focused on cardiovascular disease. Thomas Graham, MD, has served as CIO of CCI since 2010.

Columbus (Ohio) Regional Hospital

Columbus (Ohio) Regional Hospital opened its Innovation Center in 2011. The center combines technology development and clinical simulation in a central location. The Innovation Center’s Lean/Six Sigma and clinical simulation and education teams use tools in design, Lean and Six Sigma to collaborate, test and adopt best practices. The center’s simulation lab allows for rapid prototyping and testing of new ideas before they are used in patient care or in the community.

Detroit Medical Center developed The Center for Quality and Innovationat DMC’s Children’s Hospital of Michigan. The center has been responsible for a wealth of pediatric innovations that include: implanting the first mechanical heart pump ever received by a child in Michigan; helping develop the Genesis Stent, a life-saving device that opens blood vessels within children, eliminating the need for open-heart surgery; and identifying an infant cooling technique to reduce the incidence of disability and death in infants who failed to receive enough oxygen during birth.

Mountain View, Calif.-based El Camino Hospital’s Fogarty Institute of Innovation serves as an incubator for early stage innovators, and offers laboratory and engineering space for innovators and physicians to collaborate on ideas and developments. Thomas J. Fogarty, MD, inventor of the balloon catheter and recipient of the Presidential National Medal of Technology and Innovation in 2014, founded the institute in 2007. Since then, the institute has worked with 20 medical device startups, five of which have spun off.

The Innovation Lab at Orlando-based Florida Hospital functions as an incubator to foster and test ideas to improve the system’s healthcare services. Karen Tilstra cofounded the lab in October 2011, and she continues to serve as its director. In 2013, the lab received the Des Cummings Innovation Award, which is presented each year to a Florida Hospital organization for their efforts in advancing healthcare innovation.

Hartford (Conn.) Hospital, home to the state’s first medical simulation center, has since developed The Center for Education, Simulation and Innovation. The CESI facility offers a fully comprehensive range of robotic and high-tech training capabilities used to develop clinical techniques and educate medical school students. The center contains robotic and endovascular simulators, task trainers and five different simulated clinical environments.

Detroit-based Henry Ford Health System established its Innovation Institute in 2011. One of the most prominent innovations coming out of the institute is the newly designed Model G Patient Gown, which prioritizes patient comfort — notably the closed backside — while maintaining clinical function. Scott Dulchavsky, MD, PhD, is CEO of HFII. Mark Coticchia, vice president and CIO of Henry Ford Health System, leads the Henry Ford Innovations unit.

New York-based Hospital for Special Surgery opened its Innovation Center in September 2014 to support technological breakthroughs for musculoskeletal care, but HSS has been collaborating with commercialization partners since 1979. The center oversees ideas from generation to evaluation, acceleration and commercialization. In addition to traditional biomedical science and technology like implants and biomaterials, HSS Innovation Center also researches process innovations, digital health solutions, wearables and telemedicine.

At Houston Methodist’s Institute for Technology, Innovation and Education, healthcare professionals work to advance patient safety efforts with ongoing procedural skills training, skills acquisition research and technology and medical procedure development. The center is part virtual hospital, part hands-on clinical training facility working to push the bounds of healthcare training through technological innovation.

Pasadena, Calif.-based Huntington Memorial Hospital’s Institute for Nursing Excellence and Innovation was designed to further and enhance training and preparation for the hospital’s nursing workforce. The center drives clinical advances and research in nursing through innovative nursing practices, professional development and specialty nursing education programs.

Intermountain Healthcare opened its Transformation Lab in Murray, Utah,in 2013. Projects at the lab include developing the patient room of the future, 3D printing and sensors to boost hand hygiene compliance. Marc Probst, CIO of Intermountain Healthcare, oversees innovation at the lab.

Philadelphia-based Thomas Jefferson University Hospital opened its two-story, open floor plan Jefferson Accelerator Zone in January 2015 as the home base for innovation activities. JAZ hosts an innovation engagement speaker series — including a December appearance from Pennsylvania Gov. Tom Wolf — and hackathons. People can rent out space in JAZ by zone, floor or building for innovation-related activities.

At the Armstrong Institute for Patient Safety and Quality from Baltimore-based Johns Hopkins Medicine, researchers study the ways in which the physical care environment can improve patient safety and impact human performance. Through the study of macroergonomics and the application of human-centric engineering principles, the institute has been creating new models of care delivery that improve care quality and efficiency. Experts have developed tools and training programs that enable healthcare workers to realize radical, measurable advances in care delivery.

Baltimore-based Johns Hopkins Medicines’ Technology Innovation Center is a multidisciplinary hub for clinicians to create novel, technology-based solutions that span medical specialties and practice settings. A clinically embedded team of software engineers, data analysts, project managers and designers shepherd ideas from conceptual stages to product deployment. The center also includes an entrepreneurial accelerator as well as leadership training programs. The TIC often works in close affiliation with Hopkins’ Armstrong Institute.

In 2006, Kaiser Permanente opened the Sidney R. Garfield Health Care Innovation Center in San Leandro, Calif., named after the health system’s founding physician. Dr. Garfield was a pioneer in hospital designs that improved care delivery and enhanced the patient experience. Though closed to the public, Kaiser Permanente started offering virtual tours of the center in 2012. The center is modeled to look like a real hospital to allow providers to test products in as close-to-reality settings as possible.

Massachusetts General Hospital’s Stoeckle Center (Boston). Focused on primary care innovation, The Stoeckle Center offers several programs to test ideas through education, research and policy. The center is named after John Stoeckle, MD, who had a 50-year career as a primary care physician at Massachusetts General.

UCLA’s Children’s Discovery and Innovation Institute at Mattel Children’s Hospital in Los Angeles was founded to promote innovation and collaborative research spanning from molecular studies to community initiatives. The institute connects laboratory research to bedside practice and community outreach programs at a local and national level. The institute conducts research into the four following core areas: brain behavior and development; nutrition, metabolism and growth; cancer and regeneration; infection, inflammation and immunity.

Rochester, Minn.-based Mayo Clinic opened itsCenter for Innovation in 2008, making it the first to be integrated into a medical practice setting. The center includes an outpatient lab that allows researchers to observe patients while interacting with providers, as well as a Healthy Aging and Independent Living Lab. The center focuses on design in healthcare — such as patient exam rooms and delivery models — to improve the patient experience.

The Innovation Center linked to 802-bed Mercy Medical Center – Des Moines (Iowa) was established in 2014. Mercy Innovation Center provides observation opportunities, engineering services, simulation labs, project piloting, business plan development and process improvement for individuals engaged in the creative process. Samuel Schone serves as the director of Mercy Innovation Center.

Wyoming, Mich.-based Metro Health Innovation Center houses four departments: the physician hospital organization, IT, security and privacy, and professional billing and pre-arrival. The facility is a collaborative space, allowing for Metro Health employees to gather and work on projects.

Nationwide Children’s Hospital in Columbus, Ohio, has its Center for Innovation in Pediatric Practice, one of 13 research centers within the hospital. Researchers at the center seek to discover new methods for care delivery, both through information technology and communication techniques. The center has four key research focuses: depression or suicidal ideation, clotting disorders, drug use and routine preventive care services.

NewYork-Presbyterian Hospitallaunched its innovation center in 2014. NYP Innovation Center is based in Blueprint Health, an accelerator and coworking space for health tech startups. The center held New York City’s first hospital hackathon in March 2014.

The Center for Learning & Innovation at Great Neck, N.Y.-based Northwell Health aims to advance professional provider education through a variety of continuous learning programs, including patient safety, bio-skill development and leadership and nursing fellowships. The CLI works to improve patient care, develop future leaders and enhance healthcare business practices.

New Orleans-based Ochsner Health System launched its accelerator initiative called innovationOchsner in 2015. iO partners with technology developers and tech innovators both inside and outside of the healthcare industry to support the development of new clinical products in patient-centered care. Ochsner also embarked on a three-year health initiative in collaboration with GE Healthcare and The Idea Village to foster healthcare innovation through challenges that promote the marriage of technology and patient-centered care.

Fort Wayne, Ind.-based Parkview Health’s Mirro Center for Research and Innovation is among the newest innovation centers the country, having opened in late April. Folded into the Mirro Center is Parkview Research Center, a 25-year-old research hub, and the newly formed Center for Healthcare Innovation where scientists, entrepreneurs and organizations collaborate on new clinical solutions. The Mirro Center also features three simulation labs and classrooms for education and training personnel.

In Burlingame, Calif., is Mills-Peninsula Health Services, a Sutter Health-affiliated organization comprised of a medical center and health center. It operates the Center for Innovation & Research, a laboratory to develop new healthcare models, technologies, products, service and treatments. The center makes use of its proximity to Silicon Valley (25 miles) and San Francisco’s (17 miles) biotech industries to partner with entrepreneurs and innovators.

The Innovation Lab at Presbyterian Rust Medical Center in Rio Rancho, N.M., aims to bring healthcare workers and consumers together to develop better care approaches for improved patient outcomes. The lab occupies a designated space within the hospital set up for testing new ideas and care innovations. Since its conception, the lab has helped design and implement several leading-edge approaches at Rust, including acuity-adaptable patient rooms and a telemedicine-enabled ICU.

The Center for Medical Education and Innovation at Riverside Methodist in Columbus, Ohio, is a joint medical education facility and clinical training center. Through the use of human patient simulators and other advances in medical education technology, the center enables Riverside Medical Education to simulate the patient experience in a wide variety of clinical situations to establish improved training practices and better prepared medical staff.

In 2010, theUniversity of Californialaunched the Center for Health Quality and Innovation in Oakland, with representation from six UC medical school deans, five UC medical center CEOs and chaired by John Stobo, MD, the UC Health senior vice president. The center supports innovations in development across the UC health campuses through grants, fellowships and colloquiums.

The Center for Surgical Innovation is affiliated with Aurora-based University of Colorado Hospital and the university’s medical school. The CSI has been part of the medical school for about a decade, serving as a training facility for surgeons as well as a development hub for new surgical techniques and technologies. Clinicians from around the world come to Colorado to learn at the CSI alongside UC medical students.

The Connecticut Institute for Primary Care Innovation is a collaborative enterprise between Saint Francis Care in Hartfordand the University of Connecticut School of Medicine in Farmington. The center aims to advance primary care education and innovation by conducting research on primary care delivery models. CIPCI includes a collaborative theater for clinician learning sessions, a simulation studio with moveable walls for patient flow and office redesign research as well as an idea lab for brainstorming and process mapping.

The Innovation Accelerator Program from Philadelphia-based University of Pennsylvania Health System is a grant program designed to help thought leaders develop, test and implement new approaches in healthcare delivery. The accelerator program currently supports teams conducting research into: increasing compliance with preoperative instructions, automating lab monitoring for patients on high risk medications and redesigning follow-up scheduling practices to improve patient experience. 

In Chapel Hill, N.C., UNC Health Care and the UNC School of Medicine share Innovate Health Care @ Carolina. Within the center is an Innovation Council, which functions as a think tank that helps with ideation and selection of innovative opportunities. David Rubinow, MD, is the director of UNC Innovation and Health Care System Transformation. Through a partnership with Forecast Health, the center recently produced an analytical model that helps clinicians predict when patients are at high risk of readmission so care teams can proactively offer support to individual patients based on their risks and needs.

In Pittsburgh,UPMCEnterprises is the health system’s innovation arm. Formerly called the UPMC Technology Development Center, UPMC Enterprises features a team of more than 200 technology professionals offering clinical, technical, business and capital resources to develop, test and commercialize new healthcare products and services. Rasu Shrestha, MD, CIO of UPMC, also serves as executive vice president of UPMC Enterprises.

The commercialization and technology transfer arm of Winston-Salem, N.C.-based Wake Forest Baptist Medical Center, Wake Forest Innovations seeks to transform ideas and inventions into proprietary technologies and inventions to improve healthcare. The organization offers industry relations and business development, product innovation services, and contract research and development services. Eric Tomlinson, PhD, CIO of Wake Forest Baptist Medical Center, leads the Wake Forest Innovation Quarter, a hub for biomedical science and IT within Wake Forest Innovations.

WakeMed Center for Innovative Learning, part of WakeMed Health & Hospitals in Raleigh, N.C., is designed to facilitate realistic multidisciplinary clinical training and education using human patient simulators, educational gaming and other technologies. The center offers clinical and educational training to providers across the healthcare continuum, including physicians, nurses, respiratory therapists and first responders.

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What your father wants is your love and time

What would my father wants for father’s day

A trip to the beach with his loves, his children and partner

A good dinner with all his loves in one place

A son giving him a helping hand in his chores

A daughter dancing with him and cooking his favorite breakfast

A leisurely walk and chat in a beautiful nature setting

A massage from loving children

An honor to be proud of, children finishing college

A respectful profession chosen by their children

A loving and obedient grandchildren and children

An unconditional love from respectful, courageous and good hearted children.

Cancer cure from tests of lab-grown organs

test sis lab for cancer drug

Seven years after creating their first organoid – a three-dimensional organ-bud grown in a test tube – Dutch researchers say the technique has changes the lives of more than 1,500 sufferers of cystic fibrosis, and dozens more with cancer.

The technique takes a sample from an organ such as the stomach, then uses stem-cell technology to grow it in a lab to produce hundreds of tiny living clusters known as organoids.

These are then tested with different drugs or combinations of drugs to gauge which are the most effective.

“If we have a drug or a combination of drugs that show responsiveness in the organoid model, we are going to treat the patient with that drug or that combination of drugs,” Kors van der Ent, professor in paediatric pulmonology at the University Medical Center, Utrecht, told Al Jazeera.

“We use the organoid’s responses as a sort of predictor for drug therapy in the patient.”

Rather than relying on the results of generalised clinical trials or their own experience, doctors can use the results of the organoid experiments to choose the medication that will be the most effective for the individual patient.

For one young woman, Madelief Meijering, who was diagnosed with cystic fibrosis as a small child, this has resulted in a dramatic change in her condition and her life.

The genetic disorder, which mostly affects the lungs, is caused by a faulty gene that fails to regulate the movement of salt and water in cells.

It has no cure and normally gets worse with age, with many of those with the disease dying prematurely.

“It is the phlegm that sticks in your lungs and makes you feel short of breath or just generally off-colour,” said Meijering.

She recently experienced a remarkable turnaround after starting a new regime of medication her doctor chose as a result of the organoid technique.

“When I started taking this medicine, I had 70 percent lung capacity. Now I am at 106 percent so it is going really well with this medicine. It really shows it works, which is great.”

More than 1,500 cystic fibrosis patients in the Netherlands have been treated using the technique, but it is also being used to treat cancer where each drug has a different effect from one person to the next.

“We take material out of each cancer patient then we try every drug that is available on that material and see if it can predict which drug the patient needs,” Rob Vries, managing director of Hubrecht Organoid Technology, said.

Last year, researchers grew kidney organoids containing tubes and structures resembling the kidney of a human embryo.

Although not developed enough to be transplanted, they were able to used them to test new drugs and see how diseases affect the kidney.

Cancer personalize cure from tests of lab-grown immune system, gut bacteria and liver and their interactions

“Obviously a person is more than only their liver – they have an immune system, they have bacteria, they have an interaction between the intestine and liver,” said Vries.

“In our system, we put them together to try to see how it works together in disease modelling and disease treatment.”

The team in Utrecht has also discovered they can freeze the organoids and then bring them back to life.

They have tens of thousands of them in a bio-bank, including livers lungs and stomachs, an invaluable resource for drug developers and researchers.

“It’s a library of tissues from all sorts of diseases, from [different] people [and different] genetic backgrounds,” said Vires.

“If an academic or an industry wants to solve a particular issue, they can come to us, look in the catalogue and find cystic fibrosis, colon cancer, a specific genetic background. They can then take that organoid out and start developing drugs or start answering questions.”

For doctors, the advantage of being able to test new drugs on individual patients in the lab, rather than giving it to them, has tremendous benefits.

“For the patient, it is only one biopsy but he is helped for many years because the lab is always there,” said van der Ent.

“You don’t have to bother the patient with testing new drugs and looking at whether they work because you can pre-test on the genetically identical brother or sister that’s in the lab.”

Source: Al Jazeera

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