Research aimed at finding a cure for dreaded diseases often commands the public’s attention. But Massachusetts General Hospital is also pursuing research with a different focus. Seeking innovation that will make medicine as a whole run more efficiently and effectively, this research is also shaping the future of health care.
Such research is varied and widespread at Mass General. For example:
- A new iPhone app created here lets diabetes patients and researchers track diet, exercise, medication use and other critical health behaviors.
- Mass General pathologists have developed a computer algorithm that recognizes troublesome patterns in patient data that might indicate problems such as acute kidney injury or a diabetic emergency.
- A search tool developed here allows caregivers to quickly extract a patient’s medical information from a variety of databases and organize it in a way that can enhance decision-making and help avoid unnecessary tests.
Transforming the Field
Mass General researchers have always pursued innovations aimed at transforming the field of medicine. But in recent years, such efforts have taken on added urgency, says Joseph Kvedar, MD, vice president of Partners HealthCare Connected Health. Partners HealthCare is the not-for-profit healthcare system that includes Mass General and other Harvard Medical School teaching hospitals. Connected Health focuses on helping Partners providers and patients use technology to better manage chronic conditions, maintain health and wellness, and improve clinical outcomes.
The United States spends more, per capita, on health care than other industrialized nations, Dr. Kvedar notes, adding that the one-to-one care model (in which a provider sees a patient in the office) contributes to these high costs. Furthermore, the healthcare system is struggling to care for the growing number of patients with chronic illnesses, such as hypertension, diabetes and obesity. Such conditions require a continuous and daily focus on lifestyle management, which the one-to-one care model isn’t equipped to handle.
“To address these challenges, we must employ new care models,” Dr. Kvedar says. “Of course, our nature in health care is to be conservative, so we must first do the research to test these models, analyze the outcomes and prove their economic value.”
Cancer Diagnosis via Smartphone
Supporting, promoting and guiding research that could spawn broad, systemic change is part of the reason Mass General launched its Research Institute in 2015. “Research isn’t just about looking down into a microscope,” explains Susan Slaugenhaupt, PhD, the institute’s scientific director and a researcher with the Mass General Center for Human Genetic Research. “Ultimately, we’re trying to make medicine better in many different ways.”
Case in point: the work of Ralph Weissleder, MD, PhD, director of the Mass General Center for Systems Biology. In South Africa several years ago, Dr. Weissleder noticed that while access to electricity and other forms of technology was spotty, everyone seemed to have a cellphone. It got him thinking about possible applications for smartphones in the medical field.
He and his team went on to develop a device called the D3 system, short for “digital diffraction diagnosis.” It allows doctors to take a sample of cells, slide it into a compartment on a smartphone and determine if the patient has cancer. The whole process takes just 20 minutes, which is currently unthinkable in places with few pathologists (like in many African countries). It even represents an improvement in the United States, where biopsy results can take a week to come back.
The D3 system fared well in Mass General pilot studies of cervical cancer screening and lymphoma diagnostics. Another pilot study involving lymphoma diagnostics is under way at Mass General, and Dr. Weissleder recently received funding for a 300-patient lymphoma study in Botswana, Africa, that is scheduled to begin early next year. He hopes to test the D3 with other cancers soon.
With the D3, a surgeon, interventional radiologist or oncologist can get a diagnosis on the spot within 20 minutes, Dr. Weissleder says. “It will allow doctors to be much more efficient and spare patients the anxiety of having to go home and wait for results. It will also allow patients to be much better connected to their primary health care centers.”
Guidance in Diagnosing Allergic Reactions
As a fellow at Mass General, allergist Kim Blumenthal, MD, saw how caregivers struggled to distinguish between different types of allergic reactions to medications. Pinpointing the correct type (allergy, intolerance or toxicity) and the severity thereof is critical for identifying the appropriate treatment and future viability of drugs in the same or similar class.
“Understanding allergic reactions is a significant issue at every hospital—after all, one in five patients is recorded as having some kind of drug allergy,” she says. “However, most doctors aren’t taught how to enter allergy information correctly into the electronic health record.”
In 2013, Dr. Blumenthal set out to create a decision-support tool to help doctors diagnose allergic reactions. She began with penicillin, as 12 percent of patients at Partners HealthCare institutions report they have a penicillin allergy—the highest figure for any drug. In reality, though, many patients are basing this belief on outdated or inaccurate information.
“Let’s say you had an anaphylactic reaction to penicillin 10 years ago,” Dr. Blumenthal says. “Today, you would be more likely to tolerate penicillin than have a reaction to it. But that reported allergy might force your doctor to unnecessarily prescribe a class of medications that is less effective or more toxic. Getting the right allergy diagnosis is a real patient safety issue.”
Plans for Expanded Use
Using Dr. Blumenthal’s tool—the Allergy Pathway App—on their smartphones or iPads, doctors can ask patients 10 “yes or no” questions. Based on the responses, the app classifies the allergic reaction so the right medication can be prescribed.
The process takes little time and saves the doctor from having to collect allergy-related information at ensuing visits. There’s a financial component, too. For instance, when treating patients with a reported penicillin allergy, doctors sometimes also avoid a class of antibiotics called cephalosporins because of their similar chemical structure to penicillins. While penicillins and cephalosporins are inexpensive, alternatives can cost up to $500 a day. If the Allergy Pathway App determines cephalosporin is in fact safe and effective for that particular patient, the cost savings are significant.
The e-consults program is now in place in over half of Mass General specialties, and the hospital is rigorously measuring and reporting outcomes.
The penicillin version of the Allergy Pathway App is set to launch throughout Mass General, and Dr. Blumenthal plans for the tool eventually to cover more antibiotics, aspirins and other drugs.
Electronic Consultations in Cardiac Care
Enhancing health care quality without driving up costs was on the mind of cardiologist Jason Wasfy, MD, M.Phil., when he began exploring electronic consultations. The premise? It’s not always necessary for specialists to see patients in the office. In some instances, it may be preferable to have the specialist consult the patient’s primary care physician via email. Then, the PCP can discuss the recommendations with the patient and integrate them into the care plan.
In January 2014, Dr. Wasfy launched a pilot program to study the use of “e-consults” in cardiology care. Three cardiologists and 67 patients took part. All three parties—specialist, PCP, patient—had to give their approval in order for an e-consult to proceed. Detailed surveys showed patient satisfaction exceeded 90 percent, with many participants lauding the convenience of avoiding office visits.
The e-consults program is now in place in over half of Mass General specialties, and the hospital is rigorously measuring and reporting outcomes. “When we deliver care innovations at Mass General,” Dr. Wasfy says, “it’s very important for us to share results with other hospitals because we want to be part of the solution to address the challenges facing American health care.”
Dr. Wasfy emphasizes that there are cases where a face-to-face meeting with a specialist is appropriate. “But for the patient who wants discrete input on a specific problem, the e-consult allows him or her access to specialized expertise without having to see the specialist in the office,” he says. “We have no intention of making care cheaper by withholding care; we’ll make it cheaper by making it more patient-focused, patient-oriented and efficient.”
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