RamaOnHealthcare April 15, 2022
Today, RamaOnHealthcare talks with Dr. Vijay Shah, Carol M Gatton Chairman of Medicine, Mayo Clinic on the Transformation of Healthcare.
RamaOnHealthcare (ROH): Please summarize how “A 2030 Vision for the Mayo Clinic Department of Medicine” came about and the typical role of Academic Medical Centers in the transformation of healthcare.
Vijay Shah (VS): The traditional role of academic medical centers has been to educate the next generation and perform research that broadly advances the healthcare mission. This has defined academic medicine for many years and generally has been performed in the context of clinical care in a “teaching hospital.” Mayo Clinic is not an academic medical center in the purest definition of the term. We have pursued an academic mission but always in the primary context of our patients. This has served us well. We took our patient-based values to reimagine the role of the academic medical center in 2030. Simply stated, we see academic medical centers as having the mission of transforming healthcare to improve outcomes for patients, improve patient care processes, innovate the clinical practice, bring joy to healthcare providers, and develop leaders who understand how they can disrupt medicine for the better.
We took our patient-based values to reimagine the role of the academic medical center in 2030.
ROH: Mayo Clinic approach is a change from the traditional pipeline model to a platform model using multimodal data to manage the health of distinct populations holistically and cohesively. Please provide an example how this data is used within Healthcare Transformation.
VS: The traditional pipeline model of healthcare envisions patients coming to the academic medical center for their care and management at interval times. This is an outdated model. With the advent of consumerism, patients want care on their terms, and they want care 24/7. Of course, this is not scalable for the health system to provide people-only solutions that can give this level of service. At Mayo Clinic, we have been looking at our data and our knowledge as assets that can, in combination with expanding technologies, allow us to meet patients where they are, rather than having patients meet us where we are. An example of this approach has been a remote monitoring project in the Department of Medicine in collaboration with our center for digital health that we call REMODI. This remote monitoring system allows us to discharge patients earlier from the hospital than they might previously have been able to be discharged, by continuously monitoring them through wearables and app-based communication. Data streams come in, not only to allow us to manage that specific patient, but also to allow us to build a compendium of data that informs our algorithms in management for subsequent patients. This model has been shown to reduce healthcare cost as well as reduce re-hospitalization in a number of use cases, including liver disease, alcohol use disorder, and COVID-19. We are in the test and iterate stages for this project with each version improving and moving toward scale. This is an example of an internal platform process whereby data and knowledge can mediate value for patients and providers. There are a number of platform projects ongoing as well with external partners who, in some cases, may provide the interface with patients and/or third parties who can use our data and knowledge to advance patient care and science.
ROH: Please share your concept and some examples supporting inclusive patient-centered care models.
VS: An example of inclusive patient-centered care models that focuses on data, knowledge, and technologies is our ASSIST modules. We recognize that one of the greatest healthcare burdens is chronic pain and, within the context of internal medical care, this often relates to syndromes of visceral hypersensitivity. At Mayo Clinic, we’re not in a position to see every patient referred to us for conditions of visceral hypersensitivity, which may include irritable bowel syndrome, fibromyalgia and many others. However, we have developed content whereby we can provide interactive and soon-to-be immersive experiences to triage as well as educate and help patients manage these conditions. The scale we can achieve through this technology far surpasses what we can provide on a one-to-one individual patient-provider basis and thus allow us to help more patients globally.
The scale we can achieve through this technology far surpasses what we can provide on a one-to-one individual patient-provider basis and thus allow us to help more patients globally.
ROH: Your intention is to meet the needs of People (including those of Providers) where and when they are is an ambitious and challenging goal. What are some your ideas to accomplish this?
VS: Our digital transformation activities are expansive, as we look for ways to touch more people globally. Our external digital transformation that allows us to touch more people builds around our partnership with the Mayo Clinic Platform led by Dr. John Halamka. We also have a large number of external commercial partners and start-up companies that we interface with to provide new solutions for patients using a combination of digital start-up company assets along with our expertise, knowledge, and data. Many of our projects are focused on major unmet needs, such as rural and employee health. Given the focus of Mayo Clinic is on multidisciplinary management of serious and complex disease, our ability to partner for population health allows us to help many more patients while remaining focused on our core value proposition.
ROH: Broadening access for patients will likely result in providing care for more patients. How do you accommodate the time Providers spend on cognitive and clerical tasks within a comprehensive electronic health record (EHR)?
VS: We know that the electronic health record has been transformational in both positive and negative ways. Clearly, as someone who practiced medicine before the era of the electronic health record, I recognize the advantages we now have in reliably having patient information in front of us on a consistent basis. This would not be possible without the electronic health record. On the other hand, I recognize the levels of healthcare provider burnout are stratospheric, and this is in correlation with the growth of the electronic health record. This is because many of the current electronic health records are built around a revenue cycle lens, rather than a lens that is most useful for a provider in their patient workflow. We have a now-near-far framework as we think about the electronic health record. Right now, we have a major focus on reducing the clerical and cognitive burden that providers are feeling as they manage their patients through the electronic health record. A number of artificial intelligence tools will help us very soon, including voice recognition, natural language processing search functions, and algorithms that can be implemented into the electronic health record in a workflow that fits for providers. Farther out, it’s hard to know what the role of commercial electronic health records will be. As large institutions move more and more towards cloud-based data storage and knowledge expertise can be recognized as an asset, the cloud-based patient information and data may drive patient care and management independent of a third-party vendor. Of course, there will always be needs for compliance, billing, and documentation but we remain committed to providing outstanding care for our patients as our northstar.
ROH: We live in the digital, data age transforming ourselves as humans. Today, healthcare transformation is also about health, digital, data, and consumerism. Is it time to expand the concept of medical education? Do you foresee creating a four-year undergraduate major in Digital Health – and perhaps some of being taught at the high school level?
VS: At Mayo Clinic, we have introduced artificial intelligence and digital medicine into our residency curriculum. We now have master’s degree options for postgraduate training within our subspecialty medical fellowships. Much of the research endeavors of our trainees and junior faculty now focus around tracks of digital medicine. We are also introducing digital clinics, which are essentially virtual clinics that have healthcare delivery managed through data flow and asynchronous communication rather than traditional brick and mortar. Of course, the future will be a hybrid whereby patients come to the academic medical center for issues that are best served face-to-face, usually focusing around implementation of solutions for serious and complex disease, such as highly innovative surgeries and procedures. Much else can be managed around patients’ preferences. While we have thought deeply about a division of digital medicine, at the present time, we really see a digital transformation as requiring “everybody in,” rather than one dedicated division. We need digital solutions that truly disrupt the system to provide value by reducing human workload, rather than digital band-aids, whereby electronic processes are introduced but end up in a queue for traditional workflows. We have been thinking a lot about a model of digitization leading to automation, which in turn leads to smart process solutions as our paradigm.
Much of the research endeavors of our trainees and junior faculty now focus around tracks of digital medicine.
ROH: The mantra for decades of healthcare crisis is: “There is a fix for Healthcare. The status quo isn’t an option. Disruption is the answer.” We will be seeing altogether new players led by private sector innovation promoting community and consumer health with the support of caregivers and digital infrastructure. How do you visualize this transition occurring in the coming years?
VS: Of course, we have talked about healthcare disruption for decades. Compared to many other industries and sectors, healthcare has been impenetrant to many external disruptive forces and, for the most part, healthcare has not pursued internal disruption because the status quo has benefited many in the current system. However, COVID-19 and other factors have led to a tipping point. The wobbliness has been from several years now of efforts for value-based care, which has gone rather slowly. In parallel though, there has been an expansive progress in computer engineering, robotic automation, and an explosion in biomedical science discovery that is allowing us to bring new types of cures that previously were only imagined in preclinical models, such as CRISPR Cas gene editing and gene therapy. Therefore, I see change is occurring much more rapidly now over the next five years than we saw over the last 25 years. This will be driven by internal disruption from players such as Mayo Clinic as well as the external disruption of big tech into healthcare and the unprecedented amount of venture capital that is supporting digital medicine start-ups. I am very excited about the future and the innovation it will bring for better patient care and more satisfying careers for healthcare providers.
I am very excited about the future and the innovation it will bring for better patient care and more satisfying careers for healthcare providers.
ROH: What is or should be role of Academic Medical Centers in the transformation of healthcare now and going forward?
VS: Academic medical centers must lead the transformation of healthcare. While there is something to be said for tradition, we really want to keep only our values and some of our cultures from our past, but we have to discard the rest. We have to execute remarkably in our current mission of how we care for patients, but then really pivot to the future. We have to define that future. That future has to be global. The future has to recognize the health inequities in our system that exist from economic, racial, and cultural disparities and respond to the biomedical, computational and conceptual advances that are happening so rapidly. An example of this is the concept of decentralized clinical trials. Academic medical centers can try to maintain a status quo of how clinical trials are conducted, but we know that the current model is inconvenient for patients, highly bureaucratic, and generally unsuccessful as measured by numbers of completed clinical trials and many other metrics. Reimagining clinical trials from the vantage point of the patient, rather than from the vantage point of the academic medical center, can allow us to truly rethink how clinical trials are conducted. This is one example of how academic medical centers can be leading the transformation of healthcare. I am enthusiastic about the future, and I’m very excited to lead Mayo Clinic forward as we transform medicine.
Academic medical centers must lead the transformation of healthcare.
About Dr. Vijay Shah
Dr. Shah received his undergraduate, medical, and clinical medicine training at Northwestern University. He obtained advanced clinical and research postdoctoral fellowship training in hepatology and liver disease at Yale University. He has maintained an NIH-funded program at Mayo Clinic for almost 25 years which focuses broadly on alcohol related liver disease, cirrhosis, portal hypertension and its complications with over 250 peer review publications in prestigious journals such as Journal of Clinical Investigation, Nature, Proceedings of National Academy of Science, New England Journal of Medicine and others. The basic, translational, and clinical work leans heavily on Big Data analytics. Dr. Shah is a member of the prestigious American Society of Clinical Investigation (ASCI) and Association of American Physicians (AAP). Presently, Dr. Shah serves as the Carol M Gatton and Mayo Distinguished Investigator and Chair of Department of Medicine at Mayo Clinic, where he is overseeing a Digital Transformation of the Department. In his leisure time, Dr. Shah likes to ski, play guitar, kayak, exercise, and spend time with his wife, two daughters, and his Labrador retriever.