Westchester Medical Center Health Network's CMO says staff members ''understand the forces behind decisions if they are a part of the process.''
Renee Garrick, MD, executive vice president and chief medical officer of Westchester Medical Center Health Network (WMCHealth), says managing the health system's quaternary care hospital and balancing resources are her top challenges.
Garrick is the clinical leader for the Valhalla, New York–based health system, which features 1,700 inpatient beds at nine hospitals in the Hudson Valley. She recently talked with HealthLeaders about a range of topics, including leadership, physician burnout, clinical challenges now that the crisis phase of the coronavirus pandemic has passed, and workforce shortages. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: What are the main challenges of serving as CMO of WMCHealth?
Renee Garrick: There are two major issues in being the CMO of our network.
First, we are the only quaternary care hospital for this region, which spans several thousand square miles. As the major quaternary care hospital, it means we accept patients at the main hub who need high-end care that cannot be offered at the other facilities in the Hudson Valley. We are a referral hospital not just for our patients but also all hospitals in the region.
From the CMO perspective, that means there is a lot of juggling in terms of having our staff at the ready to accept patients and to be able to juggle inpatients and transfers 24/7. We must be able to do that while taking great care of the patients in our hospitals and the patients who transfer to our medical center. I spend a fair amount of my time making sure we have the best possible staff on the medical side, the nursing side, housekeeping, social work, and dietary to be able to care for a broad range of patients. I also need to make sure that the staff has the time to take care of themselves as well as patients, so their lives are balanced, and they can give the best care possible.
The other challenge is we have a lot of busy practitioners, and they have valid and important resource needs. It takes a lot to balance those needs and know that people understand that you are doing everything you can for everyone to the extent possible. That means there is some sharing that must go on. So, if surgery needs A and B, and neurosurgery needs C and D, and medicine needs E and F, they all must understand everyone's needs as a group. I expend a lot of energy making sure that people understand we are balancing resources and making sure that everyone has access to the best that is available. There's nobody who gets more than another. In the end, it all balances out.
Sometimes, people want to have an enormous amount of add-on resources, and you cannot do that if it is going to hurt a smaller department with equal need. I spend a lot of time speaking to the physicians, the medical staff, and the graduate medical staff so they can all understand how it works. Transferring patients and allocating care—and recruiting and retaining the medical staff—is a big part of what I do. It can be a challenge getting everyone to understand the greater good and the goals of the organization. It takes a lot of listening to make sure you do that well.
HL: How do you persuade colleagues to share resources?
Garrick: I try to be transparent about it. People understand the forces behind decisions if they are a part of the process. You must be aware of the staff you are working with—the medical staff, the nursing staff, and the administrative staff. You must explain your position and how you came to a decision—that is an effective way of building a coalition and having people come to an understanding of why things are being decided the way they are.
I graduated medical school in 1978. My experience has been as long as people are treated respectfully and you are honest about what can and cannot be done, the process resonates with people. A problem is created when facts are not shared, then people make up their own facts. They fill the vacuum with what they might think is the truth. It's hard to rescue the process under those circumstances.
Renee Garrick, MD, executive vice president and chief medical officer of Westchester Medical Center Health Network. Photo courtesy of Westchester Medical Center Health Network.
HL: What is the status of physician burnout at WMCHealth?
Garrick: Over the past year, we have recruited hundreds of providers. In the past three months, we have recruited 100 new nurses. So, we are a resilient organization. Part of that is we are the tertiary care referral center, and we are proud of that.
We are still dealing with COVID. But we have also been dealing with monkeypox—we have given 1,800 monkeypox vaccinations. We are thinking about polio because we are in the Northeast, where polio has had a resurgence. We also are dealing with RSV. So, our staff takes enormous pride in being at the ready and being resilient. We get so much joy out of helping patients on the nursing side and the physician side that our burnout has been less than other organizations.
A big key to physician burnout is the happiness and unanimity of purpose that we share with our nursing colleagues. Our nursing staff just ratified a new five-year contract, with overwhelming support. The core of the contract is to make it clear to our nursing staff that we have an enormous amount of respect for their skill and expertise, and we want to be able to recruit, retain, and reward the best nurses in the country. For doctors to be at their best, they work best when they have nurses who are happy by the bedside. A big part of our resiliency is we partner with an extraordinary nursing staff. That helps with how physicians cope with burnout—having a great nursing staff.
HL: What are your primary clinical challenges now that the crisis phase of the pandemic has passed?
Garrick: For us, the clinical challenges are always being ready for the next stress for the organization. Our staff had to be resilient because in the middle of COVID we had monkeypox, and we were asked by the state to be a referral center for monkeypox. We are also dealing with RSV. So, the clinical challenges are keeping the engine humming while gearing up for the next level because as a quaternary care hospital you must be able to provide basic care and get to the next level.
Right now, we are looking at high-end new radiation oncology equipment and thinking about how to move that part of our service for the region forward. That means recruitment, that means building, and that means growth and development. We are looking at building a new critical care area for the medical center to be able to serve the Hudson Valley with the highest level of care.
The clinical initiatives and clinical challenges are looking ahead to the next things we need to do to always be on the cutting edge. We are asking our people to have their feet in two worlds—the current and the future, where we are thinking about artificial intelligence and outfitting the ICU with bedside ultrasound. It's a big clinical challenge to do the day-to-day care while also planning simultaneously for the next several years to come.
HL: What are the primary efforts you have in place to address workforce shortages?
Garrick: On the medical side, we can attract some of the best physicians in the country because we provide a range of care including quaternary care. We have a good organ transplant program—we do heart, kidney, and liver. We have amazing neurosurgery and pediatric care. We have high-end care, but we are also a large network. So, at our institution, we are lucky because physicians can come to the medical center and ply their trade in complicated cases, then they can go to another hospital and be satisfied taking care of community-level conditions.
One of the advantages that we have in terms of addressing workforce shortages is there is a lot of variation in the kinds of patients that we treat, and physicians like to have the opportunity to see more than one type of patient and tackle more than one type of challenge. Over the past two years, we have credentialled more than 1,000 practitioners in our network, and the wide spectrum of the kind of patients that we see is attractive to young physicians.
We also have a lot of mentoring. When you finish your training, you still want to have somebody near your elbow as a mentor; so, if you have a question or have a complicated case, you have someone to help you. We are proud of the fact that we have a staff here that is stable—the medical staff has little turnover, and we have a lot of opportunities for mentorship. This is important for young physicians, especially the ones who trained during COVID. Our ability to provide mentors makes this network an attractive place to work.
Being an academic medical center also helps us recruit and retain physicians. Having a medical school at our main campus and being able to engage in research is a big part of recruitment and retention. The residents and fellows participate in the research as do the medical students. We love the fact that medical students stay here as residents, and some of them stay on as attending physicians.
Southern California Kidney Consultants is collaborating with Strive Health to improve outcomes and chronic care management for Medicare patients living with kidney disease.
Higher quality, cost-effective kidney care is the goal of a joint entity formed between the largest nephrology group in Orange County, California, and a Denver-based technology company.
The joint venture between Southern California Kidney Consultants (SCKC) and Strive Health is targeted at Medicare beneficiaries in Southern California, whereby each partner shares in the financial benefits, management, and governance of risk contracts with Medicare and Medicare Advantage plans and Independent Physician Associations (IPAs), aimed at improving outcomes and reducing costs.
The partnership includes 21 providers, based mostly in Orange County, who serve 5,000 patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Leveraging Strive's platform, SCKC aims to prevent the progression of kidney disease.
Centers for Disease Control and Prevention (CDC) estimates show that kidney disease impacts 37 million adults, or 15% of the US adult population, including more than 38% of those over 65 years old. Kidney disease is responsible for $410 billion of unmanaged annual medical spend, demonstrating the need for payment models that are based on outcomes.
"We know that our dedication to value-based models will make our practice a leader in the community," says nephrologist Nirav Gandhi MD, one of SCKC's partner/owners. "We evaluated several partners to help us on our journey and are confident that Strive offers the strongest vision, capabilities and team in value-based kidney care.”
The new SCKC/Strive entity contracts with Medicare, Medicare Advantage plans, and IPAs to take risk on the outcomes and costs of their kidney patient populations. Strive will supply SCKC with access to data and technology resources, administrative support, management expertise, and an interdisciplinary clinical care team including nurse practitioners, dietitians, pharmacists, care coordinators, and licensed clinical social workers. These team members act as an extension of the nephrologist’s office and help manage comorbidities, such as diabetes, that can impact a patient’s overall health.
"For so long, the investments in this space have been really focused on treating people with kidney failure once their kidneys fail," says Ben Kuhn, senior vice president of partnerships and growth at Strive Health. "A big focus of Strive and this partnership is on getting upstream, intervening with patients who have chronic kidney disease, helping to prevent and delay the progression of their kidney disease to avoid kidney failure. That's obviously in the interest of the patients, the providers, and also in the interest of the payers."
For SCKC, the partnership is intended to break a vicious cycle of patients failing to follow-up with their care providers or keep in touch in a timely fashion, which can lead to adverse health outcomes and even death.
"We get referrals of patients who have anywhere from mild to moderate to severe kidney disease that are sent to us in the office," Gandhi says. "What happens is sometimes these patients, whether it's insurance-related or they get lost to follow-up, or they just have a hard time for socioeconomic reasons, or various other reasons, they are not able to follow up or necessarily adhere to the treatments and everything that's necessary to try to delay progression of their kidney disease. They may end up suddenly crashing into the hospital ER, where they present and they're in advanced kidney failure."
In deliberating whether to partner with Strive, SCKC's partner/owners did due diligence, Gandhi says.
"Anytime you have a bunch of doctors who have a little bit of intelligence and ego, we're all going to have some opinions," he says. "We've been working on something like this for over 18 months and Strive is not the only company we spoke to. We had presentations with other companies. We even spoke to some of the large dialysis organizations, to figure out who we think would partner best with us to do what we wanted to do."
Competitive approaches varied from technology companies trying to do healthcare to healthcare companies trying to do analytics.
"We thought Strive was kind of both," Gandhi says.
SCKC will use Strive’s technology platform, which gathers data from hundreds of sources, to gain a holistic view of the patient’s experience. That information can help paint a picture about the risk of hospitalization or progression of disease, helping nephrologists better tailor care to a patient's specific needs.
"We’re giving leading nephrology groups the ability to intervene earlier based on data, which enhances the patient experience and makes expensive treatments less necessary," Kuhn says. "SCKC has leaned into these innovations, and the group and their patients are well-positioned to succeed in the future of kidney care."
The SCKC/Strive partnership also fits in with the Comprehensive Kidney Care Contracting Program launched in 2021 by the Centers for Medicare & Medicare Services' (CMS) Innovation Center, whereby nephrologists can take on value-based care incentives for Medicare patients they are already seeing.
"We were not going to join somebody where we're not heavily involved in decision-making, because we still think we know what we're doing better than anybody else when it comes to taking care of these patients," Gandhi says.
Strive manages more than 56,000 patients with CKD and ESKD through partnerships with nephrologists and other care arrangements with payers and providers. Earlier in 2022, the company signed a nephrologist-led partnership with the nation’s largest nephrology group, Nephrology Associates of Northern Illinois and Indiana (NANI).
HealthLeaders Innovation and Technology Editor Eric Wicklund chats with Joanna White, chief nursing executive for Infor, about using technology to engage and improve a health system's workforce culture, reduce stress and burnout, and adapt to new concepts like digital health.
A survey of CHIME executives by digital health company symplr, unveiled during the HLTH conference, indicates executives have adopted new technology at a fast pace, but those new tools and software solutions aren't always compatible.
Health system leaders say they're being swamped by technology solutions that don't integrate with other solutions, and it's costing them a lot of money and stress.
This, in turn, puts more pressure on the enterprise, increasing clinician burnout, complicating patient care, and slowing the pace of healthcare innovation.
Those takeaways can be found in a survey of 132 members of the College of Healthcare Information Management Executives (CHIME), conducted by Michigan-based digital health company symplr and unveiled during the recent HLTH conference in Las Vegas. It paints a picture of an industry that has been embracing new technology at a rapid pace, but hasn't been making sure those new tools and software solutions play well together.
According to the 2022 symplr Compass Survey, about 60% of respondents are using between 50 and 500 point solutions to manage healthcare operations, including roughly a quarter who are using at least 151 point solutions. Meanwhile, 88% say that working with all these IT systems and applications complicates their job.
And that's causing a lot of problems, including lost revenues, workforce stress and burnout and an inability to truly take advantage of innovative technologies to advance clinical care and improve workloads.
The problem has been compounded by the pandemic, which saw healthcare organizations adopt new technologies—particularly digital health and telehealth—at a dizzying pace. Many of these new point solutions were not integrated, leading to siloed platforms and, according to the symplr report "resulting in a decrease in management's confidence in the integrity of their operational infrastructure."
According to the survey, technology integration and interoperability could address a number of pain points for a health system. Almost 41% of those surveyed cited financial pressure as their biggest concern, while another 31% cited staffing challenges and clinician burnout and 22% listed patient privacy and cybersecurity.
Aside from finding cost savings in reduced IT expenses through better integration, executives say a more fluid and integrated technology platform would reduce stress on clinicians, including nurses, who often have to jump from one station or solution to another. Almost a quarter of executives surveyed say enabling their clinician workforce is their top priority when it comes to managing operations, and 84% say a streamlined IT infrastructure is an extremely or moderately important factor in their ability to keep clinicians.
“There’s a lot of concern about the danger of alarm and alert fatigue for nurses, and health systems are under increasing pressure to streamline and simplify clinical communications and processes,” Donna Summers, MSN, RN-BC, the Henry Ford Health System's chief nursing informatics officer, said in the report.
“Clinical collaboration among multidisciplinary teams is essential to improving care quality and creating efficient care delivery with very tight resources, and it is achievable by using the right technologies,” added Michele Strickland, MBA, BSN, RN, Asante's director of informatics and applications.
The symplr survey cited the 2022 Bain & Company KLAS Research report on the state of healthcare IT spending, which noted that healthcare organizations are rethinking their IT strategies and looking to streamline their IT stacks. According to that report, about a quarter of providers say their existing IT infrastructures are keeping them too busy to stay current on new offerings in the market, while a lack of cross-solution interoperability and poor EHR integration are hindering growth.
"Almost 80% of providers say labor shortages, inflation concerns, or specific organizational situations (like M&A or leadership changes) are top catalysts sparking new investments, and 95% of provider organizations expect to make new software investments in the next year despite economic uncertainty," the Bain/KLAS report noted.
All of this boils down to a four-pronged strategy for improving IT operations. According to the symplr report, healthcare organizations should use technology that unifies siloed systems and streamlines administrative tasks, offering efficiencies in:
Financial health, through enterprise tools that identify cost-containment strategies and value and savings opportunities;
Clinical communications, with automated provider processes and improved collaboration tools that enable staff to focus on patient care;
Technology consolidation, through standardized, scalable enterprise solutions that enable health systems to avoid data risks and regulatory penalties while curbing costs; and
Patient-centric care, with new digital health and telehealth platforms that cater to patient preferences and improve the patient-provider dynamic.
“To reduce costs without compromising service, we analyzed spending at the cost center level, discovering that we were inefficient across the system and uncovering huge savings opportunities," Kevin Smith, Luminis Health's chief financial officer, said in the report. "By adopting new operating measures, the health system has saved millions of dollars.”
A newly launched venture collaborative in Chicago aims to bring together health systems, corporate partners, innovative startups, and community resources to tackle health inequity.
A lot of the conversation in healthcare innovation these days centers around new partnerships to address health equity. In Chicago, a unique venture collaborative is forging those partnerships between health systems and community organizations, while closing gaps in care that contribute to wasteful healthcare spending.
Chicago ARC (Accelerate, Redesign, Collaborate) was launched in June 2022 on a model designed by Israel's Sheba Medical Center, a global leader in transforming healthcare delivery through innovation. Chicago ARC's goal is to create programs that bring together health systems and the communities they serve and take on barriers to accessing healthcare.
"These challenges have always been going on," says Kate Merton, PhD, Chicago ARC's executive director. "There's no one I know who doesn't want to solve that. It's getting down to the devil in the details … that takes time and effort."
Chicago ARC's healthcare partners are the University of Chicago Medical Center (UChicago Medicine) and the Sinai Chicago health system. The two health systems signed memorandums of understanding in June with the new organization, agreeing to support innovation that addresses such issues as maternal and child health, chronic disease management, rural and urban healthcare disparities, senior services, home-based healthcare, and behavioral health.
Kate Merton, PhD, executive director of Chicago ARC. Photo courtesy Chicago ARC.
"The south side of Chicago has experienced shrinking healthcare resources for many years," Kenneth Polonsky, MD, UChicago Medicine's executive vice president for medical affairs and dean of the biological sciences division, said in a press release announcing the collaboration. "Partnering with the Chicago ARC creates the dual benefit of identifying and integrating global technologies that meet the needs of our patients and healthcare professionals while enabling the University of Chicago to bring its research and innovation expertise to a local and global community seeking to address health inequities."
Armed with a $100 million investment fund, Chicago ARC will connect those health systems with local community organizations, venture capital funding, corporate partners, and startups to design programs that might include affordable housing, food resources, childcare, social services, transportation, and schools.
"Our job is to understand what keeps [healthcare executives] awake at night," says Merton, referencing the surge of attention being paid to social determinants of health and barriers to care that keep people and communities from accessing the care they need.
Much of that attention was brought on by the pandemic, which highlighted the plight of underserved populations and communities and turned the spotlight on digital health and telehealth as a means of addressing those inequities.
"COVID has incentivized innovation," Merton says. "People are more willing to take that leap now and try new things."
Chicago ARC may be an ideal example of healthcare innovation strategies discussed at the recent HLTH 2022 conference in Las Vegas, which included companies, startups, and ideas not usually associated with healthcare delivery. The conference helped to spotlight the benefits and challenges of partnerships, and the growing idea that innovation needs to expand its sights and adopt some unconventional concepts to tackle the biggest pain points in healthcare today.
These ideas also point out that healthcare—especially primary care—is getting crowded. New players like Amazon and Google are entering the market, alongside telehealth companies, payers, and retail giants like Walgreens, CVS and Walmart. All are offering unique access points to healthcare and their own banks of providers that compete with the local health system, clinic, or private practice.
Merton says collaborations like Chicago ARC give health systems an opportunity to get in front of those competitors.
"Industries outside healthcare will certainly have an impact on healthcare," she says. "But it's very easy to get distracted by the shiny ball."
The key to innovation, she says, is financial sustainability. A new program may look good and address a pain point in care access or delivery, but it won’t go anywhere if it can't support itself and find the right path to continued use. That's where payers, corporate partners, and even financial institutions play a role. They can highlight the processes needed to maintain sustainability.
Merton notes that payers are influencing healthcare innovation and have some pretty good ideas themselves—especially in health plans that support health and wellness—but they have their own business models.
A more important partner, she says, might be the Centers for Medicare & Medicaid Services (CMS), which covers a significant percentage of the population that would benefit from the programs and partnerships that Chicago ARC would be developing. CMS is conservative in embracing innovation, often calling for a good deal of research and data to support new technologies like telehealth and digital health for considering reimbursement, but the CMS Center for Medicare & Medicaid Innovation has been showing interest in new programs that address health inequity.
Merton says the goal now is to develop "a shopping list" of innovative ideas, then match the resources with programs aimed at addressing those ideas. With more people and organizations at the table, more opportunities will result.
"Imaginative thinking can truly make a difference when it's executed properly," she says.
Voice-enabled technology supports residents' independence and connects them with caregivers.
A senior care facility owned by one of the largest health systems in the country is deploying voice-activated "digital concierges" to bring together residents, their care teams, and loved ones to improve their quality of life and health.
The Gardens at St. Elizabeth, a Denver, Colorado-based CHI Living Community and division of CommonSpirit Health, is using Serenity, a network platform based in part on Amazon Echo Show devices, to reduce the burden on staff and empower residents to receive timelier updates on their health and living situation.
Overseeing this effort is Jane Woloson, executive director of The Gardens at St. Elizabeth.
"Serenity is an essential part of our communication by helping support independence for our residents, connecting our internal and extended care teams, and giving families more peace of mind that their loved ones are receiving the excellent care we are known for," she says. "Each day, we see the powerful impact this solution has on our residents and our community."
With her professional roots in the hospitality industry, Woloson sees similarities between running hotels and senior living communities. Since 2008, these communities have been more focused on the clinical aspects of the business, she notes.
Jane Woloson, executive director of The Gardens at St. Elizabeth, part of the CommonSpirit Health network. Photo courtesy The Gardens at St. Elizabeth.
The Gardens at St. Elizabeth features 132 independent living apartments and 57 assisted living apartments, with another 12 assisted living apartments and 36 memory care apartments opening within a month. The building has a long history, containing a 125-year-old chapel, and serving originally as a tuberculosis sanitorium and, later, an orphanage. It became an assisted living facility 40 years ago.
"One of my personal philosophies is to support independence," Woloson says. "If we can set residents up or give them the tools to be as independent as possible, I think we're moving in a successful direction."
Each participating room is equipped with an Alexa smart device. Residents can ask and receive voice-enabled answers to common questions, such as the day's lunch menu, or activities, and they can summon staff. Front desk personnel can communicate via the device to let residents know when a package is waiting for them. Residents will also be able to sign up for activities such as beauty appointments and transportation.
On the clinical side, Woloson says, these devices can help implement care plans for residents. Rounding physicians, hospice, home care, pharmacy, home health, and other providers are able to participate on the platform with patients.
"It saves a lot of phone calls to the front desk," she says. "Patients are not relying on someone else. Maybe they have failing eyesight, and they can't see the daily menu themselves."
The Serenity Connect platform and accompanying app, and its secure messaging, are HIPAA compliant, and also allow authorized family members to keep tabs on the resident's communications via the Alexa devices. These family members also have a direct line to key staff at the facility.
"Our nursing staff are getting instantaneous information," Woloson says. "Nurses can look at the app and have a great pulse on exactly what's happening with each individual resident's care."
A corporate leadership group at The Gardens at St. Elizabeth worked with corporate attorneys and the IT department to select and deploy the technology, initially as a pilot project. If residents ask the Alexa device something that would go against HIPAA guidelines, the device responds that it cannot answer that question, Woloson says.
"There's a false perception that senior citizens have no interest or bandwidth to work with such devices," she says. "That's not the case. The feedback from residents has been extremely positive. The data says they're using it, on average, four times a day. I think that's fantastic."
A study performed by Serenity and The Gardens at St. Elizabeth found that the platform saves five to 10 hours per week per key staff member at the facility. In addition, the platform reduces resident isolation and loneliness.
The Gardens at St. Elizabeth deployed the platform during the pandemic.
"It was a great time to do it, because of the importance of communication," Woloson says.
The platform has also become a selling point for the facility, as prospective residents and their families shop around for assisted living. So far, the platform has led to three new waitlist sign-ups and two new move-ins, she says.
Prospective residents who may be on a waitlist will soon be able to begin participating in the Serenity platform before moving in, providing a new kind of onboarding, Woloson says.
"At the time that Serenity Connect was introduced to us, I jumped all over it as something I wanted to participate in," she says.
The CIO of Phoenix Children's Hospital is an active participant in the hospital's efforts to improve care for both patients and their families.
Innovation for pediatric care is critical—and complex. Some of the best new ideas for clinical care are coming out of the nation's 46 free-standing children's hospitals, where providers are tasked with treating some of the smallest and most fragile patients and supporting their families.
"There are a lot of audiences to satisfy," says David Higginson, executive vice president and chief innovation officer at Phoenix Children's Hospital. "The enthusiasm and the acceptance of change," he says, are energizing, as is "the impact you see on family members' faces."
A veteran of some 25 years in children's healthcare, Higginson joined Phoenix Children's in 2011 as its chief information officer, after stints as the chief information technology officer for Arkansas Children's Hospital and CEO of Bluefish Systems, an innovative healthcare software company that he had launched. As CIO (information), he helped Phoenix Children's integrate its electronic medical record platform with billing and ancillary clinical systems and was named "CHIME Innovator of the Year" in 2016 and AZ Top Tech's "CIO of the Year" in 2017.
All that technology stuff is fun, but innovation really gets the brain working. Higginson became chief operating officer in 2018, then CIO (innovation) in 2020. Under his leadership, Phoenix Children's has become one of the nation's top children's hospitals.
Higginson's leadership strategy involves being in the trenches rather than the office behind a desk. He wants to be a part of the process.
David Higginson, executive vice president and chief innovation officer of Phoenix Children's Hospital. Photo courtesy Phoenix Children's Hospital.
"It's not sitting in a box by myself dreaming up what's going to happen in 10 years, but being in the hospital," he says. "You need to be there and to take part."
That's why Higginson says he spends a lot of time in waiting rooms, the cafeteria, and out by the hospital's entrance, unannounced and unobtrusive, watching how patients, visitors, and caregivers interact. He's looking for clues on how to make those interactions better, and ideas that can help shape how care is delivered.
"We are driven by outcomes and need, but we are also fundamentally trying to treat all the patients we have with limited resources," he says, hinting at the challenges facing healthcare after a pandemic and in the midst of economic turmoil. "We're not going to go out there and buy the biggest product, and we are also not afraid to build things ourselves."
A unique challenge to children's hospitals is the audience. Patient-facing technologies like patient portals "are incredibly complicated for children," Higginson points out, and their value has to be figured not only for kids but for the parents and caregivers who use them to access resources and coordinate care.
As an example, in 2014 Phoenix Children's decided to put an iPad in every room. The reasoning for this project was that children in a hospital are isolated from their friends, and need a platform to connect, play games, and access other entertainment. Higginson says the hospital had to build out a process where those iPads had the apps that children would want and use, while also creating channels that their parents would appreciate.
"It was really a quality of life issue," he says, "but there was a lot more that we had to take into account and build for."
That's how he's approaching an ongoing project to equip every hospital room with Amazon's Alexa virtual assistant technology, synchronized with a video platform like Zoom. Higginson says the platform needs to be configured for multiple parties so that providers can link in family members and specialists for meetings with the patient and his/her family, as well as interpreters. But it can also be used by care teams to check in on and communicate with patients when needed, and it can be used by patients and family members to access resources.
Higginson is also bullish on the use of AI in clinical care, particularly in helping clinicians identify health concerns. A project that sifted through some 20 years of data to spot early indicators of malnutrition, he says, has helped identify, on average, eight patients a week whose symptoms were so slight that they would have been missed.
"There's a lot of potential there," he says.
What he's not a big believer in is wearables and remote patient monitoring. They're not a good fit for children, he says, who aren't likely to wear something every day or hold to a certain schedule. Those platforms aren't sustainable for pediatric care, he says, often because of connectivity issues.
In fact, Higginson sees a future in healthcare innovation that focuses less and less on the technology and more and more on the connections.
The technology will get more sophisticated, he says, so that it stays in the background while giving care teams, patients, and families more and better opportunities to interact. Through these platforms, care teams will not only be able to improve clinical care, they will also be able to fine-tune their own workloads and offer more help to families who quietly deal with a lot of responsibilities and stress.
That's what makes children's hospitals so unique.
"We don’t treat little adults—we treat children," Higginson says. "They have different sets of needs." And they have families, also with different sets of needs. It's a complex environment that needs the right type of clinician—and chief innovation officer—to work well.
The Indiana-based health system's new program supports recovering patients at home through personalized engagement and remote patient monitoring.
Parkview Health, a not-for-profit, Indiana-based network of 10 hospitals and more than 100 clinics, will be offering virtual care programs designed to support patient recovery and self-management at home.
The program, featuring patient engagement, device-based monitoring, and telehealth tools to manage patients who are at risk of readmission, is being deployed in partnership with Veta Health, a provider of remote patient monitoring services.
"A strong virtual care offering is essential to how we best serve our post-acute and chronically-ill patients who are most at risk," Maximilian Maile, senior vice president of digital health at Parkview, said in a press release.
Parkview selected Veta Health to replace its existing telehealth platform, with plans to support more services soon. The multi-year partnership, which encompasses integration with the Epic EHR, will enable the health system to move patients more seamlessly through its care settings and reinforce the clinician-patient relationship.
Once they are enrolled, patients receive biometric monitoring devices to record their vital signs and a digitized care plan to report their symptoms, with communication via cellular data networks to Veta and Parkview. Patients can also view educational content and communicate with their care team via video conferencing. Digital care plans are uniquely tailored to each patient.
The RPM platform is designed to alert care teams about risk factors and disease exacerbation, permitting proactive, early intervention. By leveraging remote monitoring devices and telehealth capabilities to support the care journey, the program will offer connected layers of interaction and support from care teams to optimize recovery and outcomes.
Parkview Health is a not-for-profit, community-based health system, which serves northeast Indiana and northwest Ohio, covering a population of more than 850,000 people.
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A New York company has received a federal grant to test a digital health platform that captures brainwaves from a healthy sleeper and transplants them into someone with a sleeping disorder.
Imagine using someone else's thoughts to combat sleep deprivation and get a good night's sleep. One digital health company is looking to make that possible.
NeuroLight, a New York-based company focused on neuromodulation, is using a grant from the National Science Foundation (NSF) to, basically, transplant the brainwaves of a healthy sleeper into someone who is struggling to fall asleep.
The science behind this concept was described by Alexander Poltorak, the company's founder and president and a researcher at City College of New York (CUNY), in a September 2021 article in Frontiers in Human Neuroscience.
"Brain states, which correlate with specific motor, cognitive, and emotional states, may be monitored with noninvasive techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) that measure macroscopic cortical activity manifested as oscillatory network dynamics," Poltorak wrote. "These rhythmic cortical signatures provide insight into the neuronal activity used to identify pathological cortical function in numerous neurological and psychiatric conditions. Sensory and transcranial stimulation, entraining the brain with specific brain rhythms, can effectively induce desired brain states (such as state of sleep or state of attention) correlated with such cortical rhythms. Because brain states have distinct neural correlates, it may be possible to induce a desired brain state by replicating these neural correlates through stimulation."
According to a press release issued this week, Neurolight will use the $255,851 NSF Small Business Innovation Research grant to create a platform that records the cortical signatures, or brainwaves, of a healthy sleeping person and, through a mobile digital health device, transmit them into the brain of someone dealing with a sleeping issue like insomnia to train them to sleep.
"We propose that brain states may thus be transferred between people by acquiring an associated cortical signature from a donor, which, following processing, may be applied to a recipient through sensory or transcranial stimulation," Poltorak said in the journal article. "This technique may provide a novel and effective neuromodulation approach to the noninvasive, non-pharmacological treatment of a variety of psychiatric and neurological disorders for which current treatments are mostly limited to pharmacotherapeutic interventions."
Company officials said the research may help millions of people dealing with sleep issues, and note that seven of the 15 leading causes of death in the US have been linked to sleep deprivation.
The science of neuromodulation, or harvesting the power of electrical impulses for therapeutic benefit, dates back to 1967, when neurosurgeon C. Norman Shealy developed an implantable dives to use deep brain stimulation (DBS) to treat chronic and intractable pain. Early efforts ran into problems, mainly due to the technology of that era, but in 1974 physicians developed less invasive electrodes that could do the job without damaging the spinal cord.
Today's technology has evolved significantly since 1974, with digital health devices and platforms that can capture and transmit without damaging the human body. Neurotech Reports estimates that the worldwide neuromodulation industry will see $13.3 billion in business in 2022, addressing issues ranging from pain to chronic conditions like epilepsy, migraines and urinary incontinence.
NeuroLight officials say they're the first company to develop the technology for "transplanting mental states from one person to another," and early, small trials have been positive. Should this NSF-backed project see positive results, the company could be eligible for as much as $17 million in additional funding to continue the work.
"We are honored and gratified to have been awarded this highly competitive grant by the NSF," Poltorak said in the press release. "This grant will support R&D efforts to develop a prototype for the proof-of-concept study."
Renee Garrick, MD, executive vice president and chief medical officer of Westchester Medical Center Health Network. Photo courtesy of Westchester Medical Center Health Network.
