Friday, January 27, 2012

Arab Health Leaders in Healthcare: The Patient Experience

Our final speaker at Arab Health was Children’s National President and CEO Kurt D. Newman, MD. Dr. Newman was joined on this panel discussion by Stuart Leatherby, MD, MEA, Aetna International, and Marc Harrison, MD, CEO, Cleveland Clinic Abu Dhabi. The session was moderated by James Merlino, MD, Chief Experience Officer, Cleveland Clinic. The dynamic panel offered interesting perspectives because it not only captured how and why innovative hospital leaders are emphasizing patient experience improvements, but also the value that medical payers (like insurance companies) are beginning to place on systems that create inviting and supportive environments for people requiring care.

Dr. Newman shared how Children’s National is focused on four integrated initiatives that improve how our patients and families experience our hospital: quality, safety, service excellence/customer service, and access to care. By uniting these efforts to improve, we can keep one thing at the core of our efforts: doing what’s best for children and their families. Prior to the conference, Dr. Newman provided a summary of his talk via a short video message to potential attendees.

There was much discussion on this panel about the tangible financial benefits of improving the patient experience. In general, though, the participants agreed on two specific points:  
  1. The patients must always come first. As Dr. Newman put it, if you maintain your team’s focus on improving the quality of the care and service that families receive, the benefits of that, including financial ones, naturally follow.
  2. Any successful system to improve service must come with a commitment from leaders at the very top. Without leadership buy-in and dedication to improving outcomes in quality and service, nothing will change.

Thursday, January 26, 2012

The promise of genetic diagnosis for children at Arab Health

Our delegation to the Arab Health Congress also included Marshall Summar, MD, Division Chief of Genetics and Metabolism at Children’s National. Both Dr. Summar and Dr. Kim were featured at the 5th Middle East Paediatrics Congress.

Dr. Summar discussed how the development of new technologies in biochemistry, DNA microarrays, and genetic sequencing have greatly expanded the diagnostic reach and scope of genetics. He also noted, however, that while these analyses have come a long way, they still have a long way to go to live up to their full promise: the idea that drilling down into the genetic causes of disease will allow us to immediately “personalize” treatments based on each person’s unique genetic makeup.

For Dr. Summar, a world renowned geneticist, there is much to be excited about in the world of analyzing and understanding how genetics plays a role in disease. At the same time, though, he cautioned pediatricians about perceiving that genetic analysis, in its current state, will be a one size fits all solution for families who must live with disorders caused by their genetics.

While we may be able to drill deeper than ever before and generate more information about a specific disorder based on new genetic technologies, he said, “identifying the underlying disease or cause does not mean we already have a cure or treatment for it.”

Wednesday, January 25, 2012

Innovative pediatric health system design at Arab Health

A delegation from Children’s National is in the UAE this week to participate in the Arab Health Congress in Dubai. We have three doctors presenting at different sessions of this Congress.

Peter Kim, Vice President of The Sheikh Zayed Institute, presented at the 5th Middle East Paediatrics Conference which is a subset of Arab Health. He took the opportunity to reiterate the importance of integrating research and education into the design of a healthcare system to improve clinical treatment and patient care in a sustainable way.

He believes that governments of the Gulf/MENA region have a unique opportunity to build a new healthcare “ecosystem” for pediatric care that, from the very beginning, integrates translational and applied research as well as education into the system design. He often uses the translational research model of the Sheikh Zayed Institute as an example of a system that combines and focuses these components together to impact children’s surgery.

“These collaborative approaches are yielding ideas and product development efforts more quickly than we’ve ever seen before,” he said. “In this brief period of time, through creating an environment that allows doctors to work with engineers and scientists to address medical challenges together from the start, we have seen some tremendous work that will revolutionize how we care for children who need surgery.”

He cited the Institute’s ongoing work to develop a device to measure pain, as well as the development of a  robotic controlled ureteroscope, both of which are entering prototype phases, as examples of how this model accelerates the movement of ideas to reality.

Wednesday, January 18, 2012

Innovating health care delivery

As Denice Cora-Bramble, MD, MPH, Acting Executive Vice President, Ambulatory Services, Senior Vice President of the Goldberg Center for Community Pediatric Health at Children's National, told attendees at the recent SEHA Research Conference Abu Dhabi, we know from our work in Washington, DC, how important it is to establish a two-way conversation with the communities we seek to help through community-based research. We know that health disparities exist, and we know that research in a vacuum will not lead to discoveries that improve health care where it is needed most.

The Clinical and Translational Science Institute at Children’s National recently announced a partnership with Georgetown and Howard Universities that will create a first of its kind online tool. The tool is designed to actively engage our communities in research aimed at delivering better care to all people, regardless of where they live.

The online portal, known as the DC Healthy Communities Network (DC-HCN), will be a bilingual, community-driven, interactive web-based portal that will enhance community-based organizations’ ability to identify information, share and seek expertise and research, and access tools to impact health in local communities.

The most innovative concept to this portal is the way that it will build two-way communications between researchers, the community-based organizations seeking to help people, and the people of the community who are seeking better information and treatments for their families. Not only will people be able to participate in groundbreaking research, they will be able to influence it and learn from its findings.

Even better, by joining the research power of two NIH-funded Clinical and Translational Science Award recipients (Children’s National/George Washington University and Georgetown/Howard Universities) the teams can combine their regional expertise with community feedback to build a tool to address disparities in both children and adults.

Joseph Wright, MD, MPH, Senior Vice President of Children’s National’s Child Health Advocacy Institute, summed it up from the Children’s point of view: “This NIH funding enables us to pursue a community-driven model of research. This work is a vital part of the Children’s National commitment to improving the health of the children and families in our community through creative connections, innovative solutions, and modeling best practices.”

Read the press release here, and stay tuned for the launch of the portal, which is currently planned for fall 2012.

Monday, January 9, 2012

Cardiology collaborations

We often talk about how the Sheikh Zayed Institute's location on the top floors of Children's National Medical Center's main building in Washington, DC, is an unprecedented opportunity for doctors, researchers, and engineers to collaborate. Frequently, subspecialty clinicians, from otolaryngologists to neurologists, come upstairs to present their individual field's challenges.

We were recently visited by Charles Berul, MD, Division Chief of Cardiology at Children's National. Children's National Heart Institute is one of the premiere programs in the world when it comes to treating congenital heart disease. Dr. Berul shared with the bioengineering team some of his own research into developing better treatments for his unique pediatric population as well as the areas of opportunity for developing innovative new treatments for pediatric cardiology.

One of the common themes we hear is that current devices aren't developed specifically for children. There is little incentive for companies to undertake all the rigorous efforts of device development for children, no matter the surgical or clinical need, because very few children are sick enough to need these treatments compared with the adult population who require such solutions. In cardiology, this can mean devices and surgical tools that are far too large for a baby's tiny heart, or it can mean a wire or lead that wears out too quickly due to the daily activities of a typical toddler.

Dr. Berul discussed a catheter-based approach to normalizing heart arrythmias (irregular heartbeats) that employs an ablation technique. It has been quite successful in patients who have arrythmias due to scar tissue from previous heart surgeries. This is a huge problem for children who were treated for congenital heart disorders (CHD) at a young age and are now adults. Now that techniques have improved to surgically correct such anomalies for many children born with CHD, more people than ever before are living long into adulthood for the first time.

He noted that about 50 percent of people living with congenital heart disease suffer arrythmias about 10 years after surgery. The catheter ablation technique may resolve the arrythmia through a minimally invasive correction that prevents these people from needing additional open heart surgeries. Cardiac experts have been using some three dimensional imaging techniques to be as precise as possible when targeting a site in the heart for ablation in these delicate procedures, but Dr. Berul noted that some of the image fusion and HIFU projects at the Institute could break new ground and really help the cardiac team perform this procedure even more precisely. It is likely that the numbers of people who might require treatment for a CHD-related arrythmia will only increase in the coming years.

Additionally, Dr. Berul has worked for a long time to develop better ways to place pacemaker leads to accommodate children who can't have the pacemaker installed in the same way an adult would. He showed how his team developed a subcutaneous placement of the pacemaker leads, a placement that transfers the electrical current of the pacemaker just as well in little children as it would if the leads were implanted in the typical location, in close proximity to the heart. This could be used in children whose anomalies don't allow for traditional placement, or in children who are too small for that approach. He noted that today's pacemaker leads have a tendency to break or malfunction, and there is a need for a new design that can hold up better over the long term to avoid repeat procedures, especially in children.

These discussions are fascinating, both in terms of learning more about the current best practices in these subspecialty fields, and hearing the Institute team and the Children's National doctors thinking bigger, together, about how future collaborations could really improve care for children who need it.