Competition Shines Spotlight on Global Digital Health Care Solutions ACC, Israel Innovation Institute Co-Host Vital Next Challenge How would you improve care and outcomes of patients in the year following a hospitalization for a cardiac condition? This was the challenge that the ACC and the Israel Innovation Institute posed to digital innovation companies interested in taking part in the Vital Next Challenge, which took place Oct. 3 in Tel Aviv. Ten companies answered the call for innovation by submitting software, hardware or service solutions that would enable better patient engagement and/or reinvent health care in a way that supports more effective and efficient care management. Participating companies had opportunities to meet with ACC leaders and staff, including ACC Chief Innovation Officer John Rumsfeld, MD, PhD, FACC, and Harlan Krumholz, MD, SM, FACC, as well as Israel Innovation Institute Founder and President Leonid Bakman and other health care leaders from hospitals and health services providers in Israel about their products. They then competed against each other in a pitch event that resulted in four winners – each of which will now go on to implement “proof of concept” projects in clinical settings. Among the winning solutions: a medical-grade wearable sensor from BioBeat Technologies that can measure and report up to 20 medical parameters in real time and could lead to the development of a comprehensive rehabilitation program; automated tools for imaging analysis based on advance pattern recognition and machine-learning algorithms from Dia Imaging Analysis that can be integrated into ultrasound devices or health information technology systems; a unique, non-invasive diagnostic device from CardioSet that can assess the lung fluid status of heart failure patients both at home and at the hospital; and technology developed by Beyond Verbal that can leverage voice-driven emotion to alert patients and their caregivers when severe changes occur in a patients emotional or physical state. “The digital revolution made the world better than before, everything became more efficient, and we would like to bring the same change and improvements to the health care system,” notes Rumsfeld. “We were excited about collaborating with the Israel Innovation Institute on this challenge because we believe that combining our knowledge and their innovation and technology will create something bigger that can have a global impact on health care now and in the future.” A panel discussion prior to the challenge event underscored the importance of companies, hospitals, health systems and organizations like the ACC and Israel Innovation Institute working together to find and implement innovative global health solutions. Rumsfeld, Rafael Beyar, CEO of Rambam Health Care Campus, Krumholz, a member of ACC’s Innovation Workgroup, and Moshe Flugelman, MD, head of Cardiology at Carmel Medical Center in Israel, shared their thoughts on how treatment methods and current practice could be redefined to implement digital health solutions in the U.S. and globally. “Technology holds the promise of pushing medicine toward producing better care and outcomes and reducing wasteful, and even harmful, practices,” said Krumholz. “The ACC has emerged as a leader in supporting innovative approaches to improving health care and accelerating the progress of companies with novel solutions to challenges faced every day by patients, health care professionals and health systems.” John Rumsfeld, MD, PhD, FACC, Harlan Krumholz, MD, SM, FACC, Rafael Beyar, CEO of Rambam Health Care Campus, and Moshe Flugelman, MD, head of Cardiology at Carmel Medical Center in Israel, share their thoughts on how treatment methods and current practice could be redefined to implement digital health solutions in the U.S. and globally. Yael Ophir, BeWell.Haifa and a collaborator. Harlan Krumholz, MD, SM, FACC, a member of ACC’s Innovation Workgroup, answers questions at the Vital Next Challenge. Scan the QR code to watch the panel discussion on Facebook. Stay tuned to ACC.org for the latest news on ACC’s Innovation initiatives. Simulation-Based Education: Practice Makes Perfect Practice makes perfect. The newer version of this age-old axiom is practice until you can’t get it wrong. Simulation is one approach that can make this happen. As simulation technology becomes increasingly sophisticated and numerous, the ACC’s Simulation Work Group is exploring how to maximize the value and quality of simulation-based education that could be provided by the College. Established by the Lifelong Learning Oversight Committee (LLOC), the Work Group is working with staff in ACC’s Education Division as it examines program models and curriculum development to serve the membership. The Simulation Center at the ACC’s Annual Scientific Session has received positive feedback from members about their experience and has set the stage for extending this education. “This effort is grounded in the principles of education and the College’s high-quality content,” says Matthew Martinez, MD, FACC, co-chair of the Work Group. A key mission of the ACC has always been ensuring that its membership is highly educated and state-of-the-art and “simulation is another facet of how this could be achieved,” adds Martinez. Simulation can provide opportunities to practice clinical reasoning and judgement, communication and team work and technical skills, as well as build mental muscles and models. “A learner can be immersed in a case and learn from the decisions that are made, without a negative consequence for a real patient,” says Michael T. Spooner, MD, FACC, co-chair of the Work Group. In this controlled environment, learners receive feedback “that allows them to build a framework for understanding the information that’s most clinically relevant,” Spooner adds. Distinguishing the most relevant information is a challenge within the daily stream of information pouring in to every physician, he notes. Competency-based learning also can be provided through simulation, which could prove to be an important avenue because of the requirement of the American Board of Internal Medicine for physicians to demonstrate proficiency in technical skills starting in 2020. ACC guideline-directed simulation-based education is one vision being explored by the Work Group. This approach capitalizes on the recognized high-quality content from the College. And it serves the new learner such as trainees, fellows and early career professionals transitioning from education to actual practice, as well as experienced professionals seeking to maintain high skill levels and gain new knowledge. This summer, during a meeting at Heart House, the Work Group demonstrated its first pilot initiative, which employs the heart failure guidelines in virtual cases of patients with heart failure, to the LLOC. “Heart failure is a good model to showcase all the potential tools in simulation,” says Martinez. Heart failure is a very common part of everyone’s practice in cardiovascular medicine, whether in academic or private practice, and regardless of discipline, including clinicians and proceduralists. “We can disseminate stateof- the-art information across the spectrum from the physical exam to medical therapy, to advanced oral and intravenous therapies in the acute and chronic setting, and in complex advanced heart failure, including device therapy and transplantation,” he adds. Representatives from four companies in the simulation space looking to partner with a professional society with evidence-based content were on hand at the meeting to demonstrate how their respective products could help improve heart failure-related skills or enhance scenario training. Task trainers were demonstrated by 3D Systems and a virtual reality approach to skills training was demonstrated by Arch Virtual. These task training products also can be incorporated into scenario training, such as the full-body mannequin from Laerdal or virtual patients from Body Interact. Well-known to ACC members through the Simulation Center at the annual meeting, Body Interact is a clinical virtual simulator that provides a realistic interactive experience with 3-dimensional virtual patients. The dynamic scenarios mimic real-life with the patient’s symptoms evolving over time, requiring action, and each of the learner’s actions affecting the next step. A learner can access scenarios for solo learning on their computer or tablet. The large tabletop interface allows for a content expert to provide feedback during the experience and for team interaction that promotes and reinforces cooperation, coordination and communication. “The goal is to improve performance for delivering guideline-based treatment,” says Pedro Pinto, chief executive officer of Take the Wind, the developer of Body Interact. Similarly, problem solving and clinical reasoning in an interdisciplinary, learner-centered environment is gained through training with SimMan 3G, the high-fidelity mannequin from Laerdal Medical Corp. The SimMan 3G heart failure scenario also included cardiac catheterization by incorporating the Mentice endovascular training module. “Such training provides experiential memory to draw on when treating a real patient,” says Robert Rupert, program manager, Business Development, Laerdal. A subject matter expert engages with the learner and provides feedback during and after the scenario, while an operator runs the console for the mannequin. Task trainers, such as the Ultrasound (U/S) Mentor and the ANGIO Mentor from 3D Systems/ Simbionix, provide learners the opportunity to develop psychomotor skills, and to refine cognitive skills through guideline-based procedural practice. The U/S Mentor, which has a transesophageal echocardiography module, and the ANGIO Mentor can be used separately or together and they can be integrated within a full-body mannequin with various cardiac catheterization options. Team training is possible with the ANGIO Mentor and this simultaneous involvement “can help the team members to refine processes and roles, along with refining knowledge and skill,” says Gilat Noiman, senior product manager, Healthcare at 3D Systems. The simulators from 3D Systems include a customizable learning management system – MentorLearn – that collects performance data for each learner to track outcomes and proficiency. “The society can set the proficiency standards and benchmarks for each aspect of the training, and the learner receives metrics reports for their benchmarks and learning curve against those standards. Thus, the individual progress towards proficiency can be demonstrated and objectively assessed,” says Noiman. Virtual reality and its potential for teaching procedures and surgery was demonstrated by Arch Virtual. “Clinical reasoning and decision-making that meets guideline-directed recommendations is also taught through our system,” says Jon Brouchoud, founder of Arch Virtual, which is already collaborating with partners in the medical space, like GE Healthcare. Using the Oculus Rift technology, a learner enters an immersive, holistic experience of being in an operating room and performing the procedure, including picking up instruments in the same manner as in a real operating room. A content expert can interact with the learner during the scenario they developed for Envision EMI. Overall, “simulation-based education is an opportunity to engage each member at their level of need,” says Martinez. This could be initial learning of the material, returning to the material to ensure understanding and gaining mastery over time through repetition. Spooner adds that “active learning has greater stickiness, with a longer duration of knowledge retention.” Additionally, it can be available whenever and wherever the learner has time to engage, even if that’s just thirty minutes using a smartphone or laptop. In addition to providing guideline-based education for individual ACC members and for interprofessional team training, the Simulation Work Group envisions working with existing platforms. This could include existing brick-andmortar simulation centers and formal academic programs such as for Fellows in Training, residents or schools of nursing. ACC, Premier Inc. Collaborate to Bring Clinicians and Health Systems Together to Transform CV Care By John Rumsfeld, MD, PhD, FACC, and Kelly Rakowski, MHA Health care is in flux. Hospitals, health systems and clinical practices are rethinking care delivery amidst the push toward value-based care. Patient expectations for health care are evolving. And clinicians face changes in payment models as pressure to be more efficient continues to rise. As value-based care takes hold, better care coordination and collaboration among health care providers is essential. More specifically, there is a great need for cardiovascular clinicians and health systems to come together in the midst of building value-based care models to understand trends and opportunities in clinical outcomes, cost and quality performance, and care delivery usage patterns. This information will be central to clinical practice going forward – necessary both to survive and to thrive in the future of health care. This is the impetus for a new strategic collaboration between the ACC, the professional home for more than 52,000 members spanning the breadth and scope of the cardiovascular care team, and Premier Inc., a leading health care improvement company with an alliance of 3,9000 hospitals and 150,000 other provider organizations, including non-acute health care facilities, as well as thousands of clinicians. Together, ACC and Premier Inc. plan to explore ways to develop comprehensive and relevant solutions focused on assessment, implementation and sustainability. Our combined tools and resources, including ACC’s NCDR clinical data registries and Premier’s population health management expertise and services, can help support clinicians, practices, hospitals and health systems in their efforts to develop the capabilities needed to succeed in value-based care models. By combining resources, we can better understand care delivery opportunities in cardiology and seamlessly address clinical transformations to support alternative care delivery and payment models. The evolving health care environment presents challenges, but also opportunities. Clinicians, hospitals and health systems must harness these opportunities to overcome the challenges and ultimately help the industry transform. We think cardiovascular care is a prime opportunity area of focus and look forward to improving care coordination, enhancing efficiencies, lowering costs and improving patient outcomes, together. Rumsfeld is ACC’s chief innovation officer and Rakowski is senior vice president at Premier Performance Partners.
Published by American College of Cardiology. View All Articles.
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