By Lisa Fratt
Boston Children’s Hospital convened the National Pediatric Innovation Summit + Awards 2013 with an ambitious goal: to bring together thought leaders to address the toughest challenges in pediatric health care. During the two-day summit, a series of panels and town hall discussions sparked dynamic dialogue.
While the summit was designed as a forum for ongoing discussion and relationship building, five key takeaways have emerged.
1. Communication and collaboration are in, competition not so much.
Systems, particularly communication systems, direly need innovation. "We have emerged from the century of the molecule to the century of the system," said keynote speaker Atul Gawande, MD, surgeon, author and professor at Harvard Medical School.
Medicine, charged Gawande, has focused on components, and often neglects strategies to fit complex components together. Focused communication processes, such as checklists, are essential to high-quality health care systems.
He cited Boston Children’s Hospital’s Community Asthma Initiative, which realized an 80 percent drop in asthma hospitalizations one year after implementing a systematic checklist.
Collaboration – among providers, patient advocacy organizations, industry and other stakeholders – can fuel innovation. During his opening keynote, Jeffrey Leiden, MD, PhD, CEO of Vertex Pharmaceuticals, described such a partnership between the Cystic Fibrosis Foundation, academic investigators and industry, formed in the 1980s.
The philanthropic organization funneled capital into research and development, including genotyping all children with cystic fibrosis. That model accelerated progress, leading to approved and pipeline treatments that could help 90 percent of children with cystic fibrosis.
Pediatric hospitals, too, are starting to collaborate with each other. While some competition between them is healthy, outgoing Boston Children’s Hospital CEO James Mandell, MD, asserted, "It’s part of a CEO’s job to collaborate with CEOs from children’s hospitals from around the world."
However, Mandell and other children’s hospitals’ CEOs suggested they need to approach competition with care. Data, they said, should not be used to compete against each other, nor should children’s hospitals be drawn into local arms races with other providers.
2. Capital is king, and MDs need to learn the language.
Innovation hinges on investment, but connecting the dots between basic science, funding and profitability represents a tall order.
"You have to create a model that would be attractive to industry through showing some type of commercial viability and sustainability," said Alan Crane, general partner at venture capital (VC) firm Polaris Partners, during an innovation acceleration panel. "It’s a practical reality that this business model is a requirement in today’s setting, but this can be challenging with early-stage innovations."
As National Institutes of Health and other traditional funding sources dry up, the imperative to tap other funding sources enters the equation. New players, including industry, are tiptoeing in.
Johnson & Johnson (J&J), for instance, has opened innovation centers in Boston, London and California.
"The economic reality and what health care will be expecting of products in the not-so-distant future was part of the driver in our formation of these centers," said Robert Urban, PhD, head of the J&J Innovation Center in Boston. "In the past, it was reasonably sufficient for larger companies to sit back and wait to see where the next part of the health care food chain would lead. There are drastically fewer dollars available for entrepreneurs, so it’s no longer appropriate for large companies to sit on the sidelines and wait for the trickle down of innovations."
Yet, there appears to be a language barrier between physicians and investors; most physicians don’t understand balance sheets and bottom lines. Presenters and audience members suggested multiple ways to bridge the gap, including joint MD/MBA programs, business fellowships and mentorship for physician innovators.
3. Measurement matters.
That’s because patient engagement hinges on data – about patients’ health, about which treatments work and which don’t and about outcomes. After all, as patient engagement panelist Kathleen Carberry, who directs Texas Children’s Hospital’s Outcomes & Impact Service, said, "You manage what you measure."
Patient engagement has been dubbed the blockbuster drug of the 21st century. Yet, building effective patient engagement may be just as challenging as sequencing the genome once was.
But most existing tools measure patient satisfaction, not patient engagement. That’s a problem. A physician can provide a recommendation that a patient needs to hear, but if the patient does not want to hear it, he or she may opt to shop for a new doctor. This can crash physician satisfaction scores and doesn’t address the question of patient engagement.
Carberry seized on a common source of discontent among clinicians, noting that EMRs have not been designed by their end users. Developing a clinician-driven EMR may be an opportunity to innovate, she said.
4. Preventive medicine may be the next big innovation.
The era of preventive medicine is dawning. "In two to three years, children will be sequenced in one day at birth at a cost of $200 to $300," predicted Leiden. "We’ll know their risk for disease and will be able to treat children and cure or prevent [adult diseases like diabetes]."
Preventive medicine will leverage phenotyping and predictive analytics, and could produce high-resolution decision support tailored to individual patients, according to Joseph Frassica, MD, chief medical information officer and chief technology officer of Philips Healthcare.
- Children highly likely to have a condition with a genetic basis. In such children, he said, exome sequencing returns a specific genetic diagnosis about 25 to 30 percent of the time.
- Children with developmental or intellectual disabilities. "There, the rate of diagnosis is likely to be somewhat lower, maybe 5 to 15 percent, but the potential impact might affect a broader array of kids."
5. Just say yes.
At the close of National Pediatric Innovation Summit + Awards, moderator Bruce Zetter, PhD, who runs a lab in Boston Children’s Vascular Biology Program, wed words of wisdom from keynote speaker Robert Langer and Nancy Reagan. He called on the audience, when presented with a promising innovation, to "Just say yes."