As executive director of the Penn Medicine Center for Health Care Innovation, David Asch, MD, MBA, PhD, enjoys an up-close view of an abundance of ideas for improving health care delivery and accessibility. The ideas usually have two things in common. First, they represent a significant opportunity to improve health care as currently delivered. Second, they need a little “lift and push” from innovation experts to reach fruition. That’s where the Center for Health Care Innovation comes in.
The Center, inspired by Kevin Mahoney, UPHS’s chief administrative officer, comprises more than two dozen staff members with backgrounds ranging from medicine to behavioral economics and operations management. Its mission is to promote “the rapid, disciplined development, testing, and implementation of new strategies to reimagine health care delivery.”
Since launching in 2012, the Center has spawned many attention-grabbing ideas and experiments, such as whether it is effective to pay people to quit smoking. Also garnering wide notice is its concept of automated hovering, a concepts which includes strategies such as “smart” pill-bottle tops that alert caregivers if patients are skipping their medication.
The Center also supports intrapreneurship -- employee engagement in entrepreneurial activity within a large organization such as Penn Medicine. For example, the Innovation Accelerator Program provides training and financial and technical support to promising start-up projects.
“The Innovation Accelerator Program offers Penn Medicine staff members the opportunity to put their ideas into action on a small scale at first,” Asch said. “It supports a culture of experimentation. Quick, rapid learning about what is working, paired with ongoing adjustments and tweaking, ensure that the entrepreneurial mindset remains strong.”
“We receive an array of interesting, original ideas,” said Center co-director Kevin Volpp, MD, PhD. “We home in on those that lend themselves to early testing, with a capacity to quickly adapt to the findings, refine, and iterate. This is an important complement to standard randomized control studies, which are of longer duration and which tend to use fairly static designs. We’re approaching things from a different angle, one often used in the business world and until recently, not much in evidence in health care.”
“All of us at the Center wish we could formally support many more projects than we can now,” said Roy Rosin, MBA, chief innovation officer. “But we do our best to help even when a project hasn’t been officially selected.” For example, a team of physicians submitted a proposal to link an endoscopy machine to a Smartphone. This would enable sharing of endoscopy images with consultative colleagues and for teaching purposes, neither of which is currently practical. Though the Center couldn’t provide funding, staff members directed the physicians to a design team who are helping convert the idea into reality.
The program’s first two rounds saw an average of 75 applications, eight of which were chosen as winners. One would develop software and a mobile app to encourage appropriate antibiotic use by providing real-time data directly to providers, minimizing the risk of dangerous pathogens developing resistance to life-saving antibiotics. “In an era of increasing antibiotic resistance, the iAntibiogram software has been transformative in how we think about using more personalized susceptibility data to inform antibiotic prescribing,”said Keith Hamilton, MD, HUP’s director of Antimicrobacterial Stewardship. The iAntibiogram has an average of 3,087 searches per month, whereas the prior website on which the data was displayed got an average of 29 pages views per month.
Making An IMPaCT
IMPaCT (Individualized Management for Patient-Centered Targets), trains neighborhood residents as community health workers who then help patients set and reach health goals. The workers do everything from exercising with their clients at the local YMCA to helping coordinate doctor's appointments. IMPaCT has been adopted throughout the Health System as part of routine care for over 3,000 patients.
IMPaCT’s developer, Shreya Kangovi, MD, MS, of General Internal Medicine, and her colleagues worked with Rosin, Damien Leri, and Kate Clayton of the Center, worked with them to design a business plan that includes guidelines for hiring, training, and supporting the workers, a website, and a consultation service through which Kangovi’s team helps other organizations adapt the model. More than 400 institutions across the country -- including Massachusetts General Hospital and the Pennsylvania Department of Health -- have accessed IMPaCT’s online toolkit.
“There is a clear path for bringing new medications into focus,” Kangovi said. “But until I discovered the Center, I was not aware of anything comparable for converting approaches such as IMPaCT from an idea into action.”
Hypertension is the leading cause of readmissions for postpartum mothers in the first week after discharge. And up to a quarter of pregnancies are affected by symptoms of maternal depression, which can increase women’s risk behaviors during pregnancy, such as poor nutrition and substance and alcohol use, leading to premature birth, low birth weight, and development problems.
Staff at HUP’s Helen O. Dickens Center for Women's Health often had difficulty reaching patients on the phone to ensure timely screening. Noticing that patients were avid texters, they turned to the Center for Health Care Innovation staff to develop text-based interventions for both conditions.
The first, a mobile screening application for prenatal depression, uses text-based mood monitoring. Participants are asked questions that assess their frame of mind; caregivers are then alerted to potential red flags. Following several adaptations to the prototype, the rate of standardized screening for prenatal depression increased from virtually 0 to more than 85 percent of Dickens Center patients.
In the second initiative, patients were discharged with electronic blood pressure monitors and sent daily text reminders to check their pressure. Patients texted their readings in, which physicians reviewed and assessed. The percentage of patients reporting at least one blood pressure reading in the first week post-discharge increased from 15 percent pre-intervention to 84 percent post-intervention.
Designer Matt Van Der Tuyn, who helped devise and implement TIPS-Connect, enjoys working at the Center because it emphasizes partnering with users, rather than imposing solutions. “We learned a lot by listening to the Dickens Center staff and their patients. While we offered some technical insights, ultimately TIPS-Connect is about meeting their needs. It’s been a privilege to be part of such a meaningful project.”
Learn more about the Center’s efforts online and @PM Innovation on Twitter.
Innovation Accelerator Program Kick Starts Eight Projects
Penn Medicine’s Innovation Accelerator Program, now in its third year, announced funding for eight new projects aimed at improving health care delivery and patient outcomes The newly funded teams were selected from a record pool of more than 85 proposals:
• Automated lab monitoring for patients on high risk medications.
• Increasing completion of and compliance with advance directives.
• Implementing a teleretinal imaging program to increase screening of diabetic patients.
• Increasing compliance with perioperative instructions to decrease complications and improve outcomes.
• Reimagining preoperative evaluation processes to reduce cancellations and improve outcomes
• Redesigning follow-up scheduling to reduce cancellations and improve patient experience.
• PEACE - optimizing care models for women with signs of miscarriage
• Managing superutilizers.
(Top two photos): Shooting hoops is on way IMPaCT worker Orson Brown helps keep Patricia Quick active.
(Middle) Illustration of a potential "conversation" between patient and care provider using the TIPS-Connect mobile screening application.
(Bottom) Roy Rosin (second from left) meets with members of a team that is eimagining preoperative evaluation processes.