Ensuring Healthcare’s Innovation Boom Benefits All Equally
Despite (and in part because of) all of the pain and suffering it has caused, this past year has been a groundbreaking one for medical innovation. From creative treatment protocols to telehealth to vaccine development, the pandemic has given the public a front row view into the value of healthcare research and technology.
We have literally seen some of these advances move from the drawing board to the field in record time and before our very eyes, including profound advances in therapeutics, delivery systems, consumer engagement, diagnostics, information systems and digital health. New gene-based therapies are on the cusp of treating and possibly curing hundreds of diseases. And Big Data and Artificial Intelligence (AI) are now shaping clinical care, hospital operations, drug discovery, population health management and physician empowerment like never before.
Dr. Anne Klibanski, the President and CEO of Mass General Brigham, rightly points out that many of this year’s advancements were based on nascent technologies or processes that have been accelerated because of the pandemic. Still, she believes their success has changed the rules around development and opened the door to more innovations finding purchase in the sector long after COVID has been defeated.
As a clinician, scientist, administrator, and now CEO, Dr. Klibanksi has a perspective earned by decades of service in academic medicine, a discipline that combines insights from research and clinical care to speed life-saving therapies to patients and clinicians worldwide. She now sits at the helm of the largest academic research organization in the nation - Mass General Brigham – an institution conducting nearly $2 billion in research annually that can trace its roots back to 1811 and whose academic faculty have paved the way for generations of breakthroughs in patient care, teaching strategies, and research.
She shared thoughts on three areas of innovation that have seen some of the biggest leaps in the past few years.
The Rise of Telehealth
Prior to COVID-19, Dr. Klibanski says Mass General was conducting roughly 1,000 virtual clinical visits per month. Since the outbreak of the pandemic, the health system has held over a million of these same visits.
While there might be a drop off in telehealth visits once the pandemic subsides, it has undoubtedly become a mainstay of medicine. The convenience and cost savings are simply too great to ignore. In fact, a January 2020 study by the American Journal of Emergency Medicine estimated savings to be as high as $121 per visit.
Beyond patient preference, Dr. Klibanski also says it’s a critical lifeline for some patients unable to regularly see their provider due to distance, mobility issues, childcare, or even illness. She says one of the keys to embed this as a standard of care will be the ability to connect to remote sensors and devices like blood press cuffs that can be used from home to inform physician decisions.
The use of data to improve treatments or even inform early interventions has also made a significant leap. That data has always existed, but health systems have only recently begun to improve their collection and analysis capabilities.
The potential is enormous, but Dr. Klibanski is adamant that data standards and the use of contextual data gathering to make more informed treatment decisions require big improvements. As an example, she says the use of ICD codes show how incomplete data can actually be harmful. Scientists and clinicians using only ICD coding – absent other information sources – to identify patient cohorts to look at disease predictors and outcomes could miss important factors.
Looking ahead, she wants to see healthcare systems look beyond their own walls for data. By bringing in data from insurers, foundations, pharmaceutical companies, and others she says providers can construct a more complete picture of a patient’s health and make more accurate medical decisions.
Growing Role for AI
This boon in data has opened the door for AI and machine learning. Dr. Klibanski says that while data can help show us the historical impact of a drug or treatment on a patient, AI can help us understand what that same drug or treatment could do for a patient in the years to come.
That use of AI or machine learning as a predictive model will be critical in understanding the path of a disease, outcomes of treatment, as well as understating the quality and accuracy of specific interventions. Early use cases like radiology have already proven this ability of AI to aid in treatment.
Of course, Dr. Klibanski points out we’re still in the early days of AI in medicine and there is still much room for growth. The challenge is that these algorithms are only good as the data upon which they’re based. And in many instances, she says that data is still lacking– highlighting the critical interplay of the development of data protocols alongside AI innovations.
Despite all of these advancements and the promise of even greater innovations to come, Dr. Klibanski is concerned they will be applied unevenly. “The industry is at a crossroads,” she observed. “It has never been more effective, as demonstrated by its response to the pandemic. At the same time, its historic shortcomings in caring for those most in need have exacerbated the effect of the coronavirus.”
Those shortcomings can be in how care is meted out by geography, between wealthy and poor patients, or even because of unequal capacity and capabilities of individual providers. AI in particular is vulnerable to the biases of developers who build algorithms.
In particular, she is an active proponent of having more diversity – people of color and women – in the field to counter a world of medical haves and have nots. Even in a year when women - from front line caregivers to Nobel Prize winners – were recognized for their contributions to medicine, they are still noticeably absent in research and development roles.
This is attributable to a wide range of issues, from a lack of support by institutions to lack of funding for women-led initiatives to poor workplace policies that lead to drop out by women because of childcare issues. According to a 2019 analysis by Erin Cech, a sociologist at the University of Michigan in Ann Arbor, nearly 50% of the women in the field of science leave the field after the birth of their first child.
Funding Women in Research
Dr. Klibanski has experienced much of this firsthand. As a junior faculty member at Mass General Hospital, she remembers there being very few women in leadership positions. She also noticed many of the female faculty members were leaving just as their careers were beginning to advance, most to have and raise children.
To help stem the tide at Mass General, she teamed with honorary trustee Jane Claflin to create the Claflin Award, a two year grant worth $50,000 per year to support female academics in medicine. Grant winners can use the funds to hire additional technicians in a laboratory, a study coordinator for clinical research, or for childcare.
The grant has been a tremendous success with more than 100 awardees to date and has spawned similar programs at other systems. Of note, 2002 Claflin award-winner Dr. Rochelle Walensky was recently nominated by President-Elect Biden to be the head of the CDC. Dr. Klibanski says that in addition to financially supporting winners, the program also sends a message that women are valued as faculty members and seen as future leaders.
Dr. Klibanski hopes to see more efforts like this in the recruitment, training, and nurturing of women in academic medicine and healthcare overall. She ardently believes the mission of medical research is to catalyze change for the benefit of all people — no matter where they live, their gender or race, or their economic and social status. The key to achieving that mission is to build a diverse workforce and leadership team that reflects those populations.
So, coming out of this pandemic, she is charging all of us – including caregivers and administrators – to make this an urgent priority. Profound change is happening in medicine, and we must ensure the transformation is for the benefit of every patient.