Where Is Health Care Going in the Future?
Health care innovation requires thinking of new ways to help people live healthier lives. For decades, Washington University physicians at Barnes-Jewish Hospital have been at the forefront of medical innovation, pioneering new procedures and treatments to help patients with the most complicated health conditions. But as BJC HealthCare celebrates its 30th anniversary as one system, it’s time to look at where we’re going next, including in the areas of community health improvement, hospital design and artificial intelligence.
For much of the 20th century, heart surgery mostly included a footlong incision into the chest, a bone saw to cut through the sternum and heart-lung bypass machines to keep the patient alive during the procedure.
Today, due to advancements made by physicians such as Ralph Damiano Jr., MD, a Washington University cardiothoracic surgeon at Barnes-Jewish Hospital, many cardiac surgeries are performed using minimally invasive techniques. The result is improved outcomes, fewer complications and shorter recovery times.
One important advancement was Damiano’s refinement of the Cox-Maze procedure for the treatment of atrial fibrillation, or a-fib, the most common type of heart arrythmia. In Cox-Maze, which was developed by Washington University cardiothoracic surgeon James Cox, MD, and first performed in 1987 at then-Barnes Hospital, the surgeon creates a series of scars in the heart’s upper chambers. The mazelike pattern of scarring interrupts the heart’s electrical signals, so it no longer beats out of rhythm. Damiano worked with his colleagues to refine the technique, eventually using a clamp with embedded electrodes that could accomplish the scarring through a single 2-inch incision. The result was a reduction in surgical complications for the Cox-Maze procedure, from 10 percent to 2 percent. It is currently the only procedure approved by the FDA for the treatment of a-fib.
The final step, Damiano said, was teaching the procedure to other surgeons.
“That’s the responsibility of an innovator,” he said. “It’s the only way you make an impact.”
With the assistance of breakthrough operative technology, Washington University neurosurgeons at Barnes-Jewish Hospital can see more in the operating room with the ability to capture real-time MRI images that can be viewed in the OR.
In most ORs, neurosurgeons must make their best estimation when evaluating whether they’ve removed an entire tumor during surgery. It isn't until an MRI is completed after surgery — sometimes days or weeks later — that the true success of the surgery is known. With intraoperative MRI, surgeons can more completely remove tumors the first time. The technology also allows surgeons and health care providers to confer with other colleagues during the procedure with teleconferencing.
Immunotherapy is one of the most important developments in the fight against cancer. This breakthrough uses a variety of methods to coax the patient’s immune system to recognize and fight cancer cells. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine was among the first to recognize immunotherapy’s potential, particularly in chimeric antigen receptor, or CAR-T cell therapy. “Washington University’s Center for Gene and Cellular Immunotherapy (CGCI) focuses on this area of research, along with other cellular therapies for cancer," said Armin Ghobadi, MD, who serves as the clinical director for the center and is a medical oncologist at Washington University.
In CAR-T cell therapy, a patient's white blood cells are genetically modified with the CAR molecule, which enables them to identify and target cancer cells for destruction. Washington University researchers at Siteman played a crucial role in the pivotal study that ultimately led to FDA approval in 2017 of CAR-T cell therapy for certain types of lymphoma treatment.
Physicians and researchers are now collaborating on the development of on-site local manufacturing for CAR-T cell therapies. This innovation aims to significantly decrease the time previously needed for extracting, modifying, freezing and shipping CAR-T cells from centers to treating facilities. As a result, treatment initiation can potentially take place within days instead of weeks.
"We're only at the outset of our potential," Ghobadi emphasized. "We have the capacity to improve the speed of manufacturing, effectiveness and safety of these treatments, as well as broaden the applicability of the CAR-T platform to address various blood cancers and, hopefully in the near future, solid tumors."
In 2020, design was underway for the 660,000-square-foot patient tower at Barnes-Jewish Hospital. But when COVID-19 caused patient numbers to surge in the hospital, design was paused for the organization to focus on taking care of patients. When design ramped back up, BJC leadership challenged the design team to reimagine how the tower could better meet the challenges of a future pandemic.
“When we design any of our spaces, we’re always thinking about how we can plan for unknown future events,” said Donna Ware, executive director of BJC Planning and Design. “Being able to design in that moment when we were faced with a crisis was very powerful for us.”
The biggest shift, according to Ware, was where no patient would see it: the HVAC system. The HVAC system originally was designed to use recycled air, which is more efficient than ventilating it out of the building. However, recycled air can potentially carry airborne pathogens. The team modified the design to enable air to be HEPA filtered and mixed with outside air before recirculating, effectively eliminating the circulation of airborne pathogens. Additionally, all nursing units can be converted to negative pressure, which prevents microorganisms from escaping into hallways, allowing further isolation for highly infectious patients.
Even small changes can lead to huge benefits. All patient rooms in the new tower will now be equipped with a window in the door, as well as charting stations outside of rooms. This enables nurses and other health care practitioners to check on patients from outside their rooms. During COVID, providers were forced to constantly gown, mask and don face shields before entering patient rooms. A simple window can save valuable time during an emergency and help protect providers from infection.
Uncontrolled type 2 diabetes can lead to potentially deadly complications such as heart disease and kidney failure. But controlling it requires access to, among other things, healthy food to lower A1C levels. The presence of food deserts, the rising cost of food and lower incomes are all huge barriers to people being able to control their diabetes.
Christian Hospital serves a patient population with a high incidence of type 2 diabetes. Providers wanted to find ways to better help their patients control their diabetes at home and decrease the number of people admitted with diabetes complications. In 2021, they collaborated with North Sarah Food Hub, a local farm and food-processing service, to create a pilot program providing medically tailored meals to patients with uncontrolled type 2 diabetes. Qualifying patients and their families received 12 weeks of healthy, prepared and culturally desired meals, along with diabetes education and social supports.
The results from the first pilot were so promising, a second pilot was launched this fall building on lessons learned. Participants had a 10 percent difference in 30-day, all-cause hospitalization readmissions versus those who were in the control group. They also saw an average A1C decrease of 2.1 points from baseline to the end of the pilot.
Doneisha Bohannon, director of partnerships and collaboration with BJC’s Community Health Improvement team, said the project showed how access to healthy food is medicine. The program is planning for further scalability and sustainability, by working with area grocery stores to provide food deliveries and ongoing education to help patients beyond their time in the pilot.
“It's going to take collaborating with organizations that work well for people,” she said. “People need services to meet them where they are to have real success.”
The conversation in health care technology has turned to the potential of artificial intelligence and machine learning. AI sounds cold and impersonal, but Thomas M. Maddox, MD, vice president of Digital Products and Innovation at BJC HealthCare and Washington University, believes that harnessing the power of AI can lead to more compassionate patient-driven care.
Maddox and his teams — in conjunction with many partners across the health system — are leading several projects that use AI to improve both patient outcomes and operational efficiency while protecting private personal information. For example, they have developed a predictive model that can demonstrate the predicted trajectory of chronic illnesses among children. Care teams can then use that model to predict whether a patient might be headed for a health crisis that can be prevented. Another predictive model using AI works to provide better timelines for patients with terminal illnesses, which is critical in helping patients and their caregivers and loved ones plan and focus on spending the patient’s remaining time together or at home. A third predictive model has been deployed to use surgical schedules and OR data to help OR teams staff and schedule surgeries more accurately.
“One of the hardest things about practicing medicine now is the absolute onslaught of information,” Maddox said. “Patients are so sick and so complicated. The technology to support their care is wonderful, but it generates so much information. What AI can do is help clinicians sift through all of that information to focus on what’s really important.”
In the beginning of next year, the team at the Healthcare Innovation Lab — along with technology and clinical partners at both BJC and Washington University — will be launching a pilot to test using audio recordings and generative AI to create documentation of patient encounters. In addition, another pilot will use generative AI to assist care teams in drafting patient communication via the electronic medical record. Maddox said these basic administrative tasks encompass a huge portion of providers’ time, which could be spent working directly with patients.
“AI isn’t going to replace humanity in health care,” Maddox said. “Instead, it could free up providers to spend more time with patients. Done well, it could actually enable more humanity in health care.”
Learn more about how Barnes-Jewish Hospital and Washington University’s leading-edge health innovation impacts lives.