There are several ways to think about healthcare innovation. There’s the influx of new tools meant to transform medical care, and then there’s the way in which providers care for patients.
Thomas Maddox, M.D., prefers the latter. As the inaugural director of the new Health Systems Innovation Lab, created out of a partnership between BJC HealthCare and Washington University School of Medicine in St. Louis, Maddox wants to dig deeper into ways technology and data can improve care by first understanding where the process of medical care can improve.
Earlier this month, BJC HealthCare announced it was investing $20 million into the innovation lab over the next 10 years. Health systems around the country are taking similar steps, some of which have taken the form of health IT incubators.
But rather than developing new apps or gadgets, BJC’s initiatives wants to take a more academic approach to healthcare innovation. Maddox joined BJC this month after serving as the national director of the VA Clinical Assessment, Reporting and Tracking Cardiac Quality Program, but he said the idea has been percolating within the system for some time.
“I think the conversation started three or four years ago with the idea that with all of the innovation, technology enhancements and thinking around care delivery redesign that there needed to be a more dedicated activity around source testing and implementing those kinds of innovations for BJC,” he told FierceHealthcare.
In the Q&A below, Maddox explains how the center plans to focus on advancing personalized care by giving more weight to community, social and behavioral data, and how home-based telehealth could be a commonplace model for care.
Editor’s note: The following has been lightly edited for length and clarity.
FierceHealthcare: What are your goals for this innovation lab? What do you hope to achieve? Do you want to build commercial products or do you plan to test new technology within the systems?
Thomas Maddox: The way I’ve kind of thought about of innovation right now—and there are a million ways to categorize it, of course—but one categorization that has been useful as I start to think about it is there’s product innovation and then process innovation. And I think the real desire here is process innovation. The way we deliver care is something that is a key focus.
There are three areas in particular that are of initial interest—these will evolve over time, of course. One is acute care delivery in the hospitalized setting and a way to more efficiently organize and deliver that.
Number two is community and population health. There is a strong desire to really take a look at the St. Louis community where we practice and a little beyond St. Louis too, and look at some of the health and social determinants of health issues that are going on. St. Louis has gotten some unfortunate publicity about some of those, so there is obviously a real need.
The nice thing is in addition to an interest from the health system and the school of medicine is there is a very strong community interest in that too. There have been a lot of initiatives out of the Ferguson mess and in the greater St. Louis philanthropic and business communities to pay attention to this.
The thought is with our resources and some of the things going on with the school of medicine and the broader Washington University community, are there things we can bring to bear to take a look at and ultimately improve the community in which we live?
The third one is capitalizing on Washington University's established reputation as a leader in genomic medicine and the idea of personalized medicine. The terms are messy sometimes, but I think if you accept that precision medicine is primarily interested in the genomic linking to healthcare, and personalized medicine is the broader definition of that—where it’s not just genomics, it’s environment, it’s behavioral, its all the factors that go into it—I think Washington University is interested in saying are there things we can start to do to put together what we know about genomics into the actual person and community which they live?
The term I’ve heard, which is an interesting one is “mass customization.” The concept is you provide standardized care—the best evidence-based care we have. Then you come to a point with that patient where you take into account all the induvial things they have going on.
You say, here are the basic building blocks of best science we have, let’s talk a little bit about what your preferences are, what your life is all about, where you want to be health-wise, and tailor it to your needs and desires.
The goal is to start to build a system that integrates all that information, meets the patient where they are and then delivers that tailored care. We’ll probably knock all this out in the next month (laughs).
FH: So, what I hear you saying is you guys are less interested in building specific technology or tools and more interested in focusing on care processes to better understand where technology can fill the gaps?
TM: Yes, exactly. I very much think that a lot of what I read and understand about healthcare technology is it’s a little bit of cart before the horse. And technology, I think, can be an incredibly useful tool, but it’s a tool. The focus that we can provide—both because I think it’s the right thing and it also because it harnesses our strengths—is how do we actually organize ourselves to deliver optimal care to get to the health outcome we want. And then can technology help? Can other types of information help?
It seems to me that if you start with what optimal care delivery will get you the best health outcome, the rest of the stuff will fall into line.
FH: Some would argue that’s where health IT has failed—failing to consider physician workflow or patient needs or any of that before diving ahead? Do you think that’s true?
TM: The few tech companies I’ve interacted with, their intentions are awesome. I think everyone gets motivated by the calling that medicine has—I know I certainly have been. It’s a great thing to be associated with. But coding is only part of the issue. We certainly need it, but it’s just part of it.
I think the other thing we’d like to think about bringing to bear is the intellectual rigor and academic rigor Washington University has. Obviously, in the traditional realm of medical research, we are very rigorous about how do you set up the trial, how do you do the basic science. I think we can provide that same methodical rigor to find out how does a care delivery intervention work? Does it actually do what it purports to do? Does it do it in an economical way? Are there unintended consequences we didn’t anticipate?
I think doing that really hard analysis is something we have the talent for. It’s tricky to do and it’s difficult, but I think we’re seeing through examples like Theranos that if you’re operating evidence-free, you’re going to stumble pretty quickly.
FH: I know you went over the overall focus of the innovation lab, but are there any specific innovations you’re looking at right away?
TM: I think there’s a real role of not shaking the hand of the patient on the way out the door and wishing them luck.
There’s been a lot of cool puzzle pieces I’ve seen on managing that transition and continuing the relationship with that patient as they move home. I was most recently at the VA and the VA has a high percentage of patients in rural locations. I was practicing in Colorado and some of my guys were in God knows where Wyoming and Montana, super far away from medical centers.
What the VA started doing, which I thought was quite innovative, was they would send them home with an iPad and an exercise machine. It made more sense financially to set them up at home. They would actually have a live video connection with a cardiac rehab specialist three times a week and they can go through all of the things cardiac rehab offers at the home. They never had to leave, even in the middle of a snowstorm.
There’s a lot of telehealth going on, but that whole idea of bringing care to the patient is something there is a lot of interest in here. And the trick will be to understand our population what their needs are, what their home life is like, and tailor the care intervention appropriately.
On the community side, there has been a lot of interest in public health to look into the gun violence that is, unfortunately, a pretty big part of the St. Louis scene. They have started some very early programs combining ER data from 15 or so ERs that are a part of BJC with St. Louis police department data to start to understand where there are hotspots of gun violence both in terms of location, dates and other factors.
Once you have a triangulation of that data, you can start to dig into source causes of that violence, you can start to think about staffing your police and ER staff appropriately. You start to become a little more anticipatory and ultimately preventative.
It’s trying to use pretty disparate data sources, but when put together they could be pretty inciteful.