AMDIS: Leaders on what’s trending in healthcare innovation

BOSTON—Three rising stars in healthcare shared their experiences on how to transform the industry through innovation at the AMDIS Fall Symposium.

“We genuinely want to change and disrupt healthcare and we need an interdisciplinary group to do it,” said Adam Landman, MD, MS, MIS, MHS, CMIO, health information innovation and integration, Brigham and Women's Hospital (BWH).

Hackathons—events in which computer programmers, graphic designers, interface designers, project manager and others collaborate intensely on software projects—may provide that burst of innovation yielding new solutions to effectively improve care, he said.

The BWH Hackathon, which took place on Sept. 20-22, attracted “remarkable” interest, with 233 applicants vying for 120 spots, he said. Hackathon participants, all volunteers, were 30 percent clinicians, 30 percent engineers/developers and 30 percent business experts. “We’re trying to get industry, academia and startups to change medicine.”

Hackathons are easy to organize. The only essential ingredients are space, power and good Wi-Fi, he said. On the day of the hackathon, participants come up with solutions to common problems and groups are assembled. After the teams create their product, they present their innovations and then judges award the best solutions.  

At the BWH Hackathon, a group from MIT created a three-dimensional ring that could measure heart rate, with software that could analyze the heart rate and activity of a person, he said. This would alleviate the need for stress tests. “You could recommend it to someone after a heart attack.”

In other comments, Landman said the future of healthcare must involve better care coordination and he also predicted that wearable computing devices like Google Glass will remove the need for physician documentation. “This is only going to the next level.”

Fixing inadequate problem lists is an area ripe for innovation, said Adam Wright, PhD, assistant professor of medicine, Harvard Medical School; and senior scientist in the Division of General Medicine at Brigham and Women’s Hospital.

He said 63 percent of patients with diabetes show up on a list, but the rest fail to appear in the quality report. “This is not good."

The answer: engage in association rule mining, a method of discovering relations between variables in large datasets. “You quickly see patterns,” he said of variables associated with patients with diabetes.

Thus Wright conducted a six-month randomized trial with two groups of physicians on an innovation to insert alerts in a problem list when data suggest that a patient has a certain condition.

“We didn’t show alerts until we were sure a patient has the condition,” he said.

The intervention spurred “a sudden and fairly dramatic increase in the use of problem lists,” he said, adding that he is actively seeking partners to participate in the intervention.

Narath Carlile, MD, MPH, CMIO, ACT.md, a past Global Health and Social Equity resident, and soon to join the Division of General Internal Medicine at the Brigham, shared the systems thinking philosophy he had learned from Paul Farmer, called the “hermeneutics of generosity."

“It’s clever sounding, it’s kind, it’s opaque… It’s the interpretation of generosity in the action of others. Even in these systems, people are trying their best,” he said. “Without a bad guy, making things better together is more likely.”

While working at a hospital based in Tanzania, Carlile was alarmed by the fatalities. “In two weeks, I saw more death than I’ve seen in four years.”

Thus with feedback from a quality improvement committee, he developed an open-source paging system for physicians and implemented strong hand washing and hygiene rules. Although the new paging system had a great clinical champion, he said adoption faced many barriers in physician use due to their competing priorities.

On the topic of innovation, Carlile advocates for the Agile approach, which stresses collaboration, test-driven development, continuous integration and open source for health IT development, clinicians and healthcare teams and governance. For innovation to succeed, these elements need to be there, he said.

Carlile sees information systems and medicine overlapping to a great degree. “The reality is medicine is information heavy.”

“Patients and caregivers need to be connected in a secure environment and need their information to be protected. We are struggling to find the right way to share,” but with greater collaboration, “I think we’ll find a lot of innovation out there.”