In this episode we talk to Jeff Williamson, MD, MHS, Director of the Center for Healthcare innovation, about what is on the horizon for patient care and how it impacts value.
Can you talk to me about Center for Healthcare Innovation and the Center for Aging? What is the mission of each?
Yep. Well, the Center for Healthcare Innovation was really founded, uh, on the concept that we needed a vehicle for more rapid communication and translation of our discovery into the patient’s environment. Whether that's wellness or actually the delivery of care, for example, in the hospital. So, Wake Forest is known around the world for its research. It's a research institution. But many of the things we discover are implemented 20 years after the discovery or they're implemented in some health system halfway across the nation. So, that was really the purpose for the Center for Healthcare Innovations.
We've had for many years a sister center, so to speak, Wake Forest Innovations, which is about commercializing discovery. You know, a new kind of hip replacement or a new enzyme. But our Center is specifically tasked with taking a lot of that discovery that's not commercial allowable but has tremendous value to patients, their families, and to the health care system. And getting that more rapidly to the front lines.
You also asked me about geriatric medicine. Wake Forest really has a clinical entity, it’s called the Section on Geriatric Medicine and Gerontology, which I’m head of. Then there’s a Center for Healthy Aging and Alzheimer’s Prevention. I’m a clinical leader of that. The Center is actually led by doctors Stephen Kritchevsky and Suzanne Craft. They’re research faculty. But our mission of all of that together is to find more ways to help prevent disability with aging. So, when I mean disability, a simple way to put it is how can we prevent the two most common reasons that someone moves from their home and into an assisted living or nursing home facility. And either they have difficulty walking or difficulty remembering. So, our main thrust of our research is understanding how to delay or prevent loss of particularly leg strength and walking and loss of brain health. The most common form of which is Alzheimer's disease. That's really the purpose of Geriatrics in the Center for Health Care Innovation.
And even all of our clinical care, uh, when I take care of patients, I'm thinking of them holistically. How can I help you preserve your ability to walk and think? Even if you have 10 diseases at 90, the successful patient to me might have 10 diseases, but they're still interacting with their family, they're remembering those interactions, and they're still able to physically contribute to family life. You know, we all want to be that patient that at 95, just doesn't wake up one morning and the night before we were, you know, hugging our honey or reading to our grandchildren, tucking great grandchildren taking the bed. That's the goal. So, that's what we do, and we really try to marry those two goals between the Center for Healthcare Innovation, that I’ll talk about a little bit later, and Geriatric Medicine and the Sticht Center for Healthy Aging and Alzheimer's prevention.
Well you touched on this a moment ago, but I would like you to elaborate on how you see this work impacting patients’ quality of life?
Yes. Uh, I see a lot of patients, you know, journey through the health care system and at the end of that journey they're not really sure are they better off or not. Um, and has the healthcare system addressed what's the most important thing to them. And usually what I find is that patients, especially this Center for Healthcare Innovation, is unique in the nation, even in the world, there is no other one that's focused on wellness and health care delivery for the senior population. That's a major focus of ours. And for that population, we want to make it so that the people caring for them have the tools at their disposal to increase the joy that they have of working with older people. And we want to make it so that the patients, the citizens, the participants at the end of that experience say, “I know more about myself. This was a much easier experience than the complicated healthcare system that we've had to navigate before.” And finally, that “the care that I received was tailored to where I am in my functional health and not just my numeric health.”
CHESS has done a lot of work with social determinants around removing barriers in the home that impact the elderly population. Can you tell me about the work your team is doing in this space that exists beyond clinical care?
So, there's been, over the last decade and a half, a lot of talk about personalized medicine and a lot of that generated from genetic research. Can I match a person’s genes to their treatment plan? But for me, and for many of my colleagues in the Center for Health Care Innovation, personalized health is matching the care plan to where someone is in terms of their the social factors and social determinants headwinds that they might face. It might be factors related to where they are in terms of their functional help, their cognitive health, their family structure. And so, personalized medicine goes well beyond genes and that is in many ways the core of the mission of the Center for Healthcare Innovation. To help health care providers, doctors, nurses, therapists, and their patients to personalize the health care based on whether they're frail or not, whether they're highly functioning, are they playing tennis. And I have I have a lot of patients here in their late 80s and early 90s who play tennis 2 or 3 times a week. And I have some who the biggest challenge for them is getting out of bed and going to the mailbox every day. So, I want to personalize that care to each one of those.
As we’re talking about ideation, development, and innovation, I’d like to know what your recommendation would be for how we can all work together to expedite research from the bench to the bedside?
One of the, uh, both banes and blessings of the last decade or so has been the development of the electronic health record. And because of that, and the times that we live in, which are amazing, well there's tremendous computing power. We can combine those now to actually rapidly understand a person’s health status. We can understand their social determinants of health status. We can understand their cognitive and their physical health. And we can put all that into an equation that helps a doctor, or a nurse, or a therapist standing in front of them know exactly where this person is. So, they can start the therapy where the patient is and not just a generic start. So, the answer to your question is the way we can do that is to combine the electronic health record technology we have with the desires of the patient and that the health care system. Are we there? We are nowhere near there yet. We're still, in many cases, practicing as if it's as if it was 2000 or 1980. Uh, but slowly, we're beginning to make changes in that regard.
The electronic frailty index, which we haven't talked about in this interview, but you and I have talked about it personally, is an example of that. We can now start treatment based on how healthy or how frail a person is. Actually, we have someone working with us now who wants to rename that the electronic healthy index, um, because it actually measures all spectrums of people, not just frail, it measures health. And, so, um, but that's an example of how we begin to personalize health care. And that opens up a ton of innovation for personalizing healthcare. We're just on the very beginning of what I could see is a wonderful and beautiful journey to try and do that. You know, when you go to Walmart or you go to any department store or even you go fishing, you have a specific interaction in mind. Still the healthcare system is very generic. I mean, you don't, it doesn't match the consumer with the consumers desires with our services very well yet. And so, we want to help that. That's a very important piece of the innovation that we have.
What problems or pain points can the CHI team solve for Health systems, for providers, for patients, for family members?
Well, one of the important, um, events in the past 48 months or longer, has been the combination of healthcare systems into, you know, the Wake Forest for example healthcare system combining with Atrium. At least in parts. So, this then increases our ability to work with providers in many locations. Whether that's inner city or rural areas to bring some of the kind of care that we've been talking about, even in this podcast, to more people, in a more efficient way. Many people, for example, in this nation, maybe even the majority of people, live you know hundreds of miles or 100 miles from a geriatric specialist. But now, with our work in the Innovation Center, we can take their electronic health data, understand that they might need a geriatrician, and actually do at least a virtual visit. Which isn't as good as an in-person visit still with a geriatrician, but it's better than nothing. And so, we can begin to help people understand how can I prevent or preserve my cognitive function who live in far-flung places of the world or who just don't have, they might live very close to this microphone, but traveling to the physician to take their mom to the physician is too hard. But maybe they can do that from their living room or from a doctor's office in their neighborhood. So that's how we can begin to bring innovation into the neighborhoods and the communities where people are living without them having to come to some ivory tower. That's our goal.
And how do you see the role of the geriatric emergency department fitting into that
Yes. Uh, you and I just were talking about the, you know, concept of the fact that emergency rooms are packed around the country. And I think one of the one of the reasons for that is we have not begun to rethink, uh, emergency care. You know, we we're still practicing it as if it's like 1975 in some ways. Not technologically practicing it, but in terms of customer service. Practicing it that way. So, for many years we've had pediatric emergency rooms. But now the fastest growing part of our population, and really one of the largest parts, are older people. And emergency rooms, uh, are often not a friendly place for older people.
So, there is a movement in the country, there are some places already that are developing, just like we have pediatric emergency departments, that are developing geriatric emergency departments. Where we can then implement, um, electronic health record metrics that tell us already this person was frail before they ever got here. Or they had cognitive impairment or dementia before they ever got here. And we can then adjust our protocols according to that. So, I think this is going to be an increasing demand but also an increasing implementation of geriatric emergency rooms and geriatric protocols more for emergency rooms.
So, Doctor Williamson, tell me what are some of the cool ideas that your team is investigating now?
Well, what you and I've already talked about, the frailty index. Which again might be renamed the healthy aging index as well. But that has tremendous, um, applicability to many areas of medicine. For example, our cardiology teams or cardiovascular medicine teams are trying to identify people who are in that sort of middle ground. They're not frail, but they're not healthy. But those are the people who often get a procedure and it and they actually never recovered. Their function is worse rather than better. You know, they spend you know many days in intensive care unit or in a nursing home and actually don't ever return home. So, one of the projects that we're really working now is how can that electronic health index help refine, especially people in the middle. We're doing pretty good already with someone who's very frail. We don't we don't put them through chemotherapy or operations. But can we identify people in that middle group, who this means everything to restoring their function or it means actually the worst possible thing to reducing their function if we operate on them or replace their aortic valve etc.? That's a big project.
We're doing exactly the same thing; we're beginning to do this with cancer therapy. What people in that middle will chemotherapy actually help restore them like a younger person or give them a longer functional life. But what people, who if we give them chemotherapy, we're actually shortening their life by doing that. So, that's a big product project for us and that will use data. We'll begin to look and see what are the factors that we didn't really realize were factors, uh, in this. Such as, maybe, these people have what we call subclinical cognitive impairment. They're beginning to have an unhealthy brain and so the chemotherapy actually makes that even more unhealthy. Uh and so that's just one example. Or there's some people that their social determinants of health headwinds were so high that we need to address all that before we started replacing their heart valve. That kind of thing.
We have another very important project. One of the “holy grails” of dementia research, is can we begin to identify people early, much earlier, than what I often say is that the next-door neighbor can diagnose to that someone has Alzheimer's disease or not. That doesn't take a professional physician. But understanding very early in the course the disease when you could do something about it. Right now, there's not any tests that we do for that. But we believe there are signals in the electronic health record, in some of the billing and prescription refill records, that will begin to help us identify people who may be having some memory difficulty and we can start working with them when their families early.
We're also working a lot on remote patient monitoring. So, small devices that could be used in communities that are not very close to the hospital, but they could tell us a lot more about what's going with the patient. Are they walking more slowly today than they did last year? Just by testing them for a week; putting a little dot on them. Can we gather some of the information without them having to travel take a day off of work with their family member to get information? Can we start getting some of that information at home? That's a really big one. We just actually published a paper also working with Verily health, which is sort of, it's a division that's in the same company that Google is in, measuring people's temperature with a little patch about the size of quarter. That just where it tells the temperature or your day. But that's really important in retirement homes because temperature changes were often undetected and then COVID breaks out in the facility and infected a lot of people before they ever knew. So, those are the kind of things we're really working on now.
Wow. So much potential and opportunity! How can CHESS and CHI work together to change the world?
CHESS is in many ways the best laboratory for the CHI. All kinds of research need congenial and convenient laboratories to test new ideas, especially an Innovation Center. So, we've been partnering with CHESS, as you know, to implement the electronic frailty or the electronic healthy index so that we can help primary practitioners identify patients who are more prone to miss a visit, for example. Can identify people who they need to prioritize for vaccinations or can identify people who really maybe the last thing they need is a dermatologic surgery but instead they need advanced care planning or a colonoscopy. It might be less important for them to get a colonoscopy than advanced care plan.
So, CHESS is the laboratory in which we're looking for early adopters of, uh, of innovation to help them improve the personalized care they want to deliver to patients. CHESS has a group of clinicians, be they nurses, nurse practitioners, physicians, etc. who are willing to think about, you know, the old Wayne Gretzky thing about where the pucks going, not just where it is. They're willing to think about where the healthcare system going, where does it need to go to be a better citizen. You know, we're talking about corporate citizenship, well there's healthcare citizenship. And so, I think CHESS seems to attract people who are wanting to especially improve the citizenship of the health care system. And that's how we can really partner. What we also need in that partnership from CHESS are the frontline clinical providers coming to us through the CHESS leadership and saying, “Well here's something you could really help us with.” We may or may not be able to help, but until we know what the pain points for providing better care are, we might be working on something that has no relevance to the frontline. So, that's also part of this partnership.
What is the next frontier?
I like to use the analogy of Amazon, and probably others are using it now, but I always think I did it first. But people purchase consumer goods from their living room now, and I think there's a huge hunger to produce healthcare services from your living room. And to me, I think, that's part of the, uh, that's part of the mission, that's part of the frontier, that will expand better health. Actually, people want to purchase wellness from their living room. You can't purchase an ICU in your living room, but you can purchase wellness and information to help you age successfully like we talked about at the very beginning, to preserve physical and cognitive function for as long as possible. That's the frontier that I think is going to be really important over the next 5 to 10 years. Giving people from all walks of life, all socioeconomic status, access, equitable access to information that can help them live productive lives in their families and their communities.
Well, Doctor Jeff Williamson, thank you for joining us today on the Move to Value Podcast.
Tom, it's been a pleasure for me to do this and I just really enjoyed talking with you. And even as I'm talking and listening, I'm thinking about the exciting opportunities we have in the future.