From leveraging machine learning techniques to map abnormalities in functional brain networks to developing personalized vaccines for ovarian cancer patients and moving the needle on rare disease research and treatments, Penn Medicine continues to be at the forefront of science and medicine at a time when advances are happening in the lab and the clinic almost every day.
Here’s a look at what some of Penn Medicine’s top researchers and clinical care providers expect will have significant impact in the coming year.
Subtypes of Suicide
Advances in research on suicide behavior will lead to better treatments
In 2018, the CDC announced that suicide rates continued to rise dramatically for adults in the United States. Most people think of suicide as a catastrophic reaction to a stressful event—whether it is a marital, financial, legal, or academic problem, the lore goes, the person cannot deal with it and takes their own life. But that is far from accurate. Suicide is the result of abnormalities in the brain. Interventions to address suicide risk and the psychiatric illness can help prevent more serious outcomes.
New research being led by Maria A. Oquendo, MD, PhD, chair of Psychiatry, aims to identify two new subtypes of
suicidal behavior with different biological underpinnings. “Subtypes are extremely important to identify as they can be used to predict a person’s future level of risk and help with treatment,” Oquendo explains. “There are different risk groups within the illness and each needs their own strategy. When it comes to preventing and treating people for suicidality, a one-treatment-fits-all approach is simply inadequate.”
The Future of Telemedicine
The doctor is always within reach, with expanding telemedicine programs
With the help of advances in technology, telemedicine has ushered in a new era of improved care. Penn Medicine provides a growing array of telemedical specialty services through Penn Medicine’s Center for Connected Care
in fields such as transplant, dermatology, ophthalmology, radiology, adolescent and young adult medicine, sleep medicine, and complex neurological conditions. Other telemedical specialty services include post-operative surgical visits in various specialties and a new second opinion program for brain tumor patients. The Steven A. Cohen Military Family Clinic currently offers telemedicine appointments as an option to help military members, veterans, and their families access care—with a goal to expand telemedicine support in 2019—to more veterans, and in more regions.
“Expanding our telemedicine services allows us to better serve our patients, making it easier for them to get the care they need, where they need it,” said Leah Blain, PhD, clinic director of the Steven A. Cohen Military Family Clinic at Penn. “A variety of mental health issues including depression, anxiety, post-traumatic stress, and family issues, can be addressed via telehealth. By creating accessibility for veterans with telehealth, we can breakdown more barriers to care and expand our services to those who might not be able to make it into Philadelphia for weekly appointments.”
Improving Care at Home
A friendly chatbot will help more patients with chemo adherence and symptom management
After a small pilot that spanned the entirety of 2018 drew rave reviews from the patients who used it, a Penn Medicine “chatbot” called “Penny” will reach a much wider base of patients as it undergoes new trials in 2019. Developed through a collaboration between a Penn Medicine Oncology team, the Center for Health Care Innovation and a New York-based startup named Patient.ly, the AI program uses text-messaging to remind patients of their doses and guide them through their at-home oral chemotherapy regimen, which can be extremely complicated. The interactive texting will also help answer questions about how to manage any associated side effects patients may experience, as well as immediately notify doctors if the need arises.
“This use of artificial intelligence and the chatbot is not intended to replace our skilled clinicians, but is rather an enhancement of their work, increasing both efficiency and patient support in this critical area,” said Lawrence Shulman, MD, the deputy director for Clinical Services at the Abramson Cancer Center.
With Penny’s second trial going out to more than 100 patients in 2019, it’s a big step toward keeping patients safe and supporting their compliance at home, given out-of-hospital treatments have become the norm for many cancer treatments.
FirstCall Extending to New Employees at Princeton Health
This month, Penn Medicine’s employee tele-clinic FirstCall will become available to employees at Princeton Health, boosting those eligible to use it – all Penn Medicine hospital- and outpatient practice-affiliated employees and their dependents –to 60,000.
“Patients who already used it have enjoyed the convenient times and ease of having a virtual appointment. More than 95 percent of patients say they would recommend it to others,” said Krisda Chaiyachati, MD, medical director of FirstCall. “We’re excited to grow and improve this service as we move into the second full year of offering it.”
This expansion is also likely to significantly boost the roughly 300 calls that come in per month, which is already well above competitors’ averages. Over the last year, roughly seven out of 10 Penn Medicine employees who utilized it avoided a visit to the emergency department or an urgent care center.
Entwining Obstetric and Pediatric Care Teams to Get New Mothers Back Home Sooner
Many mothers who give birth in the hospital stay for two or three days, but often wish they could head home sooner to recover. In her own bed and without the bustle of a hospital, the idea is that a new mom will have less stress and can get a jump on quality bonding with her baby. A team in the Center for Health Care Innovation’s 2018 Innovation Accelerator class is piloting a concierge program for mothers that offers expedited discharge, in-home private nursing, and daily text message check-ins. The texting platform gives mothers a direct line of communication with pediatricians, obstetricians, and lactation specialists to receive timely answers to their questions.
“I would like for mom and baby to be considered one patient because their health is so inter-connected immediately after birth and it makes sense for health concerns like mental health and lactation,” said Jessica Gaulton, the lead of the HealingAtHome program, a clinical innovation fellow in the Center for Health Care Innovation, and a fellow in Neonatology at the Hospital of the University of Pennsylvania and the Children’s Hospital of Philadelphia.
Curbing Distracted Driving
Behavioral and technological approaches for preventing cellphone use while driving
Despite over 50 years of progress in reducing motor vehicle crash deaths, motor vehicle crash deaths have been on the rise again since 2014. Beyond the human tragedy, in the same time period, the auto-insurance industry has reported a 20 percent increase in claims, resulting in significant economic losses. New insurance programs that incentivize customers to download smartphone apps are now available track driving behaviors such as hard breaking and accelerations, as well as handheld phone use while driving, using the sensors in the phone and artificial intelligence.
A research project underway and led by M. Kit Delgado, MD, an assistant professor of Emergency Medicine, aims to identify ways to re-design smartphone usage-based auto insurance programs to reduce handheld cellphone use while driving. Through an innovative partnership with Progressive Insurance and their Snapshot Mobile program, Delgado’s team will conduct a randomized trial of financial and non-financial strategies that leverage insights from behavioral economics to “nudge” drivers to keep their hands off their phones. The study will examine strategies such as the use of phone settings that automatically limit notifications while driving, and new insurance discount incentives.
“I’m optimistic we can find ways to reduce distracted driving on broad scale given the buy-in auto-insurance companies, the available technology to nip the temptation in bud and provide real-time feedback on phone use, and the previous success of behavioral economic interventions for addressing similar impulsive behaviors.”
The Neurology of Addiction
Advances in Understanding the Reward Center of the Brain Will Lead to New Drugs to Battle Addiction
Helping people combat addiction to opioids, alcohol, and nicotine is a persistent public health challenge. John Dani’s lab takes an original tack to this crisis, seeking to find out what determines the likelihood of becoming addicted. “How do you become addicted, what does addiction do to the brain, and what therapies can we create to prevent, stop, or cure addiction?” he asks.
A person’s genetics is one factor that defines risk, but so is their environment, in this case their lifetime exposure to a certain drug. Dani takes the approach that once the brain has changed from a drug-free “naïve” state to an “addicted” state after long-term use, it is difficult to change it all the way back to its perfectly naive state. “However, we don’t have to put the brain back exactly as it was, we just have to help a person stop taking drugs,” he said.
Dani and others at Penn Medicine have identified crucial circuits and molecular targets in the reward center of the brain. They are now testing several drugs in animal models to decrease drug use and relapse. “This next year is poised to show us how these therapies are helping the ‘addicted’ brain to heal,” Dani said.
New Clues to Treating Castleman Disease
Building off a landmark year in 2018, 2019 will see more progress in the effort to understand Castleman disease
In the coming year, researchers at Penn, led by David C. Fajgenbaum, MD, MBA, MSc, an assistant professor of Medicine in the division of Translational Medicine & Human Genetics, will launch a clinical trial of a promising new therapy for patients who fail the only drug currently approved by the FDA to treat Castleman disease.
“Currently, these patients have few therapeutic options and typically receive chemotherapy, but they often relapse,” Fajgenbaum said.
The trial is funded by a five-year grant from the National Institutes of Health, the first of its kind ever awarded for research into this group of Castleman patients.
Transforming the Electronic Health Record
Molding the EHR into a More Agile, Useful Medical Tool
Due to a federal law incentivizing the proliferation of electronic health records (EHRs), they have become ubiquitous in health systems. But concerns have been raised about the usability of EHRs and their contribution to physician burnout.
Through 2019, a task force—which was set up following the October 2018 launch of a new initiative to streamline and boost overall value of the EHR—will work across the health system to address pain points raised by clinicians with an eye toward finding more time to care for their patients, and spending less of their time clicking through the EHR. Changes will be also developed through “sprint” pilot sessions focused in four different specialties: Family Medicine, Renal, Consultative Cardiology, and Otolaryngology. On top of that, the EHR task force also aims to make the EHR more personalized for teams that work with certain diseases, such as those within the Abramson Cancer Center. This effort will work to make data that those teams interact with regularly more prominent and easier to access, prompting more efficiency in administering care to patients. Read more about Penn's efforts to transform EHRs in the latest issue of Penn Medicine magazine.
Combating a Crisis
Despite national attention and an increasing focus on efforts to combat what is now considered a public health epidemic, the statistics are staggering; on average, every day 115 Americans die from an opioid overdose.
For the past two years, Penn Medicine’s opioid task force – a multidisciplinary team from throughout the Health System – has been putting strategies in place to fight this epidemic on many fronts including changes to electronic medical record default settings for prescription opioids, and encouraging alternative approaches to managing pain. In the year ahead, new grants and research will show what peer language in Reddit threads and Twitter posts reveal about weaning strategies and other information about Suboxone use. Other initiatives currently underway will build and study medication assisted treatment (MAT) training programs and assess statewide engagement in MAT and patient outcomes.
“We are continuously improving our efforts to engage patients into treatment from the emergency department,” said Jeanmarie Perrone, MD, director of Medical Toxicology and a professor of Emergency Medicine. “Overall, our robust response and other health systems engaging in ED treatment should help mitigate some of the rising death rates in PA from fatal overdoses.”