The advancement of healthcare hinges upon leaders that are forward thinking, ambitious, and attuned to the needs of the populations they serve. Balancing the requests of providers with the needs of patients is no small task, which is why leading healthcare organizations rely on their Chief Innovation Officer to listen, evaluate, and guide them toward implementing the tools that will strengthen and advance their quality of care.
Often, innovation within healthcare is viewed as a concept or a movement, but it's important to consider just who is enacting change within our industry. At Redox, we see CIOs as the people driving the industry forward into a more unified and tech-enabled state. On the forefront of innovation, CIOs intimately understand the biggest problems facing healthcare, and also have invaluable insight on how to those problems could best be remedied.
In the interest of learning more about how CIOs think about changing healthcare, we reached out to a few CIOs to ask them about what their biggest accomplishment of the last year was, what technologies have made an impact at their organizations, and how they're approaching innovation in 2018.
Today, we feature Roy Rosin, CIO of Penn Medicine.
What was your team’s biggest accomplishment this year?
What I’m most proud of is how my team implemented rapid experimentation methods into an academic medical center setting while working closely with faculty and IS partners. High-performance organizations have recognized it’s essential to learn fast at low cost. But doing so is hard and requires more than just an understanding of new technologies and techniques required for validating novel interventions and care models quickly—it also relies on infrastructure, decision processes, resource allocation changes, and even an evolution in how you measure success.
It’s challenging to try new things in big organizations in general, and healthcare introduces some extra friction due to everything from the realities of keeping patients safe and the perception of risk, to clinicians with little bandwidth and the extraordinary complexity within technology systems that are not designed with experimentation in mind. Nonetheless, we have projects that ran nine or ten experiments in 90 days to validate or invalidate key assumptions related to reimagining care delivery. I’m excited to see measurable results that range from cutting readmission rates nearly in half for some of our most complex, vulnerable populations, to bringing down post-acute care costs, increasing patient compliance and engagement, reducing opioids left over in patients’ medicine cabinets, getting people with uncontrolled hypertension to normal blood pressure faster and at lower cost, and reducing length of stays in the hospital.
We do our work in partnership with many groups across Penn Medicine, so credit goes to our many clinical, operational, and research collaborators. We’re continuing to invest in building an environment supporting rampant, rapid experimentation that’s rigorous instead of chaotic, and continue to see more new ideas get developed and tested in areas meaningful to patients and providers.
That gets me excited, when we can accelerate better outcomes, value, and experiences for the people trying to get healthy or the clinicians trying to help them get healthy.
What's an example of a new tool or solution that made a meaningful impact on your organization, patients, or providers?
One tool developed by our team—but enabled by our IS organization making data available—is called Agent. The simplest way to describe Agent is a platform that allows care teams responsible for a defined population of patients to know what requires action at that moment and address those items in a coordinated manner. Agent comes in two basic forms, both with clinically-validated and defined notifications and team dashboards. The platform aspect is that it’s built in a way to add new applications efficiently, decreasing the marginal cost of that next new intervention.
Early on, the team started by working with our ICU leaders to ensure safe management of high-risk extubations. It quickly expanded to everything from catching medication expirations, identifying vulnerable patients who’re becoming super-utilizers and required attention, and helping an ID transition team reduce readmissions for patients discharged on IV antibiotics, to improving renal discharge care coordination and supporting implementation of a best practice pathway for GI bleeds. We’re really proud of the impact Agent has made, as it has truly helped all three of those stakeholders—patients who require better outcomes and care management, providers who need efficient systems to manage overwhelming amounts of data and workloads, and the system which benefits from higher value care.
Agent has now won both internal and external (from ECRI) awards for quality and safety. It was developed by David Do, Damien Leri, Eugene Gitelman, and Katherine Choi, four members of the Innovation Center with expertise both clinically and with application development.
If Agent is the enabling platform of the year, I’d pick Heart Safe Motherhood (HSM) as the example of a patient-facing application that made a big difference this year. HSM was developed by a collaboration between Katy Mahraj in our Center and Drs Sindhu Srinivas and Adi Hirshberg in OBGYN. The problem they attacked was preeclampsia, a condition of high blood pressure related to pregnancy, which has been a top driver of readmissions and morbidity for the maternal population.
The standard of care is to have two blood pressure values the first week post discharge for women at risk, and a care model that can effectively address pressures that are too high. Before HSM, several attempts had failed to successfully address this problem, from free walk in clinics to follow up phone calls. Sindhu, Adi, and Katy designed an intervention that made a dramatic difference, from identifying and engaging the at risk women, sending them home with blood pressure cuffs, developing a texting protocol that enabled us to know about elevated pressures, and a care model that was able to react quickly to this new information to change the course of the disease, preventing nearly all readmissions and adverse health outcomes.
HSM has now been recognized by others as a leading intervention and will soon be deployed at systems beyond Penn, so it’s great to see that kind of impact keeping women safe.
Is there an area you’ve specifically identified as the next target for innovation? Any pain points you're looking to address in 2018?
The need to improve healthcare delivery is pervasive, so it’s hard to point to a single area. Today, it’s all about designing high-value care—new interventions and care models that deliver better outcomes relative to cost. That requires looking across all kinds of issues and touch points.
Generally, our group will continue to focus on a couple of conceptual directions in 2018. First, connected health models where we figure out ways to see and know about issues evolving much earlier than ever before. That involves sensing and what we call “automated hovering”, which means staying connected to patients even when they’re outside our walls. Second, we are focusing on behavioral-science-based interventions. Most of the cost of healthcare relates to chronic disease, which is mostly about the choices people make and behaviors in everyday life. We have the first Nudge Unit in an academic medical center led by Dr. Mitesh Patel as a collaboration with CHIBE (Center for Health Incentives and Behavioral Economics), the leading institute for applying behavior change to health care. That group has had great success in their work to date influencing both patient and provider behavior in novel ways, so we’re excited to continue investing in that direction.
We’ll also simply keep paying attention to the great insights our clinicians have from being on the front line. They see better ways to do things all the time, but as I noted above, it’s not always easy to turn those insights into actions and outcomes. We try to stay plugged in and close to patient and provider experiences to help guide our focus.
Thank you to Roy Rosin for sharing his reflections and ambitions for innovating in the coming year. To learn more about Roy's role at Penn Medicine, please click here.
Next week, come back for the next installment featuring Chen Cao of Brigham and Women's.