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NYT article on Nursing Shortage

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"It's gone from the human touch to 'get it done and get it billed,'" one nurse said.

Credit... Jaime Jacob

A shortage of nurses elevated the misery of a woman in my support group during a recent health crisis, she informed us. Because I participate in a clinical trial, in which I am vigilantly monitored in both Bloomington and Indianapolis hospitals, I was surprised. But I quickly began to realize that her ordeal could not possibly be unusual and then to fear that our current health care system is becoming more unfriendly, inhospitable to patients and to nurses as well.

My friend Dana arrived at Bloomington Hospital's emergency department with a problem that many people confront after below-the-belt surgery or radiation: a bowel blockage. Dana ended up spending the entire night in the emergency department. When she asked why, she was told that administrators at the short-staffed hospital had closed an entire floor.

Once in a room, Dana discovered that it took 45 minutes for the overworked nurses to answer her call button. The young woman who inserted her NG tube was supposed to care for four patients, but had been assigned to six and to the infusion center. While Dana was kept awake the second night by the audio of her roommate's TV, she found herself shivering and wondered if she had a fever. Before being discharged the next afternoon, she discovered that the thermostat had been set at 60 degrees. Understandably, the following week Dana became exasperated during an automated phone survey from the hospital: "On a scale of 1 to 4, did we make it easy for you?"

Dana emerged unscathed from her wretched hospitalization, but her experience reminded me that something similar had happened to me a few years ago, although back then I did not know why. Also undergoing a blockage, I too had spent an entire night in the local hospital's emergency room, parked in a sort of closet. After being moved to a room the next morning, I needed to consult a stoma nurse about my nonfunctioning ileostomy. However, another 24 hours crept in their petty pace before one appeared. At that point, I was in no state to profit from her expert advice.

By calling our health care system unfriendly, then, I mean to underscore not hostile or antagonistic but tardy, hurried or distant responses from clinicians - careless care generally related less to their personal failures and more to the constraints within which they operate.

No wonder, since it turns out that there is a shortage of nurses in Indiana and even more so in California, Texas, New Jersey, South Carolina, Alaska, Georgia and South Dakota. According to the American Association of Colleges of Nursing, the shortage is expected to intensify. Especially in the context of an aging population, the retirements of a generation of baby boomers - one million of the 3.8 million registered nurses in the United States will leave the work force between now and 2030 - have created and will continue to create staffing crunches. Hospitals are not the only sites affected. Many public schools do not currently have full-time nurses in their employ.

As I was learning about this, I went to the hospital for a periodic blood draw. The nurse about to access my port paused to tell me that the receptionist in the infusion center had resigned, but would not be replaced. The nurses were expected to take up the slack. "It's gone from the human touch to 'get it done and get it billed,'" she said. Then she explained that her department would soon be given a new computer system to learn so I should phone before my next appointment. Finally, she assured me that having gotten her complaints off her chest, she would be as gentle as possible, and so she was.

During the following weeks, I continued to mull over nursing scarcities since, paradoxically, poor supply has nothing to do with poor demand, not only from people who need nurses but also from those who seek to become nurses. Many candidates want to enlist in nurse training, despite the long hours and the taxing physical and emotional demands of the job. But baccalaureate nursing programs are not enrolling a sufficient number of undergraduates. Nursing schools turned down 75,000 qualified applicants in 2018 because they didn't have enough people to teach required courses and because of budget constraints.

Apparently there is an aging and depleted nursing professoriate partly because highly trained nurse educators - who must have advanced degrees - often make less money in academia than they would if they worked in a clinical capacity for a hospital, a corporation or the military.

As a humanities professor, I was surprised to discover this: I had assumed that only humanities professors were undervalued and underpaid. Dedicating oneself to a pedagogic role, choosing to instruct future generations of nurses, entails investing in expensive graduate work and also in taking a pay cut.

New Developments in Cancer Research

Card 1 of 6

There is something wrong with this picture, I was brooding when I found myself back in Indianapolis for a meeting with my oncologist and a blood draw by a nurse who has been accessing my port for so many years that I know all about her children and she knows all about mine. I was therefore shocked when she confessed - after she removed the needle and affixed a plaster - that she was leaving.

At a loss for words and clearly troubled, she stammered as she hugged me. Eventually, she resorted to quoting another nurse who had also just decided to quit: "I'd rather be a greeter at Walmart than work under these conditions." The comment jarred me into a new awareness. Nursing shortages will strain overburdened nurses, which will surely increase shortages in the days to come.
Susan Gubar, who has been dealing with ovarian cancer since 2008, is distinguished emerita professor of English at Indiana University. Her latest book is "Late-Life Love."

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The Nursing Shortage Is Threatening Our Care (Published 2020)

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"It's gone from the human touch to 'get it done and get it billed,'" one nurse said. A shortage of nurses elevated the misery of a woman in my support group during a recent health crisis, she informed us. Because I participate in a clinical trial, in which I am vigilantly monitored in both Bloomington and Indianapolis hospitals, I was surprised.

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This contact lens could someday measure blood glucose and other signs of disease

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This contact lens could someday measure blood glucose and other signs of disease

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https://www.kurzweilai.net/this-contact-lens-could-someday-measure-blood-glucose-and-other-signs-of-disease

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The new subsidiary of nonprofit generic drug maker Civica Rx and backed by Blue Cross and Blue ... [+]
Getty

The new subsidiary of nonprofit generic drug maker Civica Rx and backed by Blue Cross and Blue Shield plans is poised to make cheaper copies of prescriptions like insulin that have little competition and high prices.

Insulin is a life-saving drug for people with diabetes that has been around for decades but has soared in price by more than 250% in some cases over the last decade and drawn the attention of members of Congress and state governments. One insulin maker, Eli Lilly, announced last March it was introducing a lower priced generic version of its brand insulin Humalog. Lilly had no comment about the new Civic Rx venture when reached Thursday.

But some observers think a nonprofit drug maker could bring an even lower priced insulin to the market.

The new subsidiary of Civica Rx, backed by 18 Blue Cross and Blue Shield companies, announced plans this week to "acquire and develop abbreviated new drug applications (ANDAs) for select generic drugs." Those involved aren't saying the drugs they are targeting for development yet as they research expensive generics driving up premiums for Blue Cross plans across the country.

But analysts see insulin as a good start for the Blue Cross-Civica venture because they could shield health plan members from price hikes and potentially reduce prices given the nonprofit drug maker's pledge to produce no margin or financial return beyond the cost of running the company's operations.

"It does have the potential to tackle the ongoing insulin cost issue, which desperately needs to come down in price," Matthew Gibbs, national pharmacy solutions leader for Aon, the global risk, healthcare consulting and professional services firm said of the Blue Cross-Civica venture. "Despite insulin being available for decades, current market pricing makes insulin difficult to afford for many patients right now."

The key will be whether the Civica Rx-Blue Cross venture can indeed bring drugs to market at a lower price given manufacturing costs involved for a drug like insulin that includes an injection and vial. Any drugs produced and manufactured by Civica Rx and any contract manufacturing partners it has will have to have large volume to get a lower price, analysts say.

"The biggest question overall is can this new venture manufacture these products at a reduced market price, thus likely driving down other 'equivalent generics,' which could benefit the entire market at some point," Aon's Gibbs said. "And in doing so, can this venture - and the health plans that back it - drive market behavior and effectively force any given retailer, mail order or PBM to exclusively dispense their generic version? It is likely the retailers might not sign up for it if there is not enough supply to cover all the patient flow from these health plans."

Maureen Sullivan, chief strategy and innovation officer for the Blue Cross and Blue Shield Association, said a board of the new company is being created to identify medications that the new company could develop at lower costs and those involved expect the first new cheaper versions of high cost medicines to be available to health plan customers this year. Sullivan and Civica executives says those involved are currently researching potential generics to develop. Decisions on what drugs to produce would be left up to the Blue Cross plans.

Analysts say the effort could have a limited impact but it shows health plans and the pharmacy benefit managers (PBMs) they operate are trying new things, especially with legislative action from policy makers in Washington and state capitals slow to get anything done.

"We should note that this effort, like many others in the market, reflect growing frustration with the status quo and slow pace of change within health care broadly, and the pharmacy world specifically," Aon's Gibbs said. "As a firm, we believe in the need for a more efficient and effective health care system and applaud efforts to drive change."

Follow me on Twitter or LinkedIn. Check out my website or some of my other work here.

... Read More

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High Insulin Prices May Be First Remedy For New Blue Cross Drug Maker

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The new subsidiary of nonprofit generic drug maker Civica Rx and backed by Blue Cross and Blue Shield plans is poised to make cheaper copies of prescriptions like insulin that have little competition and high prices.

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Google Health recently announced the results of a study it says indicates artificial intelligence could be more effective in spotting breast cancer than human oncologists.

WHY IT MATTERS
The findings, published in Nature, indicate that Google's AI model spotted breast cancer in de-identified screening mammograms with greater accuracy, with fewer false positives and false negatives than experts.

Google's London-based AI subsidiary DeepMind worked with Cancer Research UK Imperial Centre, Northwestern University and Royal Surrey County Hospital to train and deploy the AI model, which scanned data from more than 76,000 women in the U.K. and more than 15,000 women in the U.S.

The AI model was also able to more effectively screen for breast cancer using less information than human doctors, relying solely on X-ray images, while doctors had access to patient histories and prior mammograms.

THE LARGER TREND
The use of machine learning technologies in breast cancer screening could have huge implications, as spotting and diagnosing breast cancer early remains a challenge, with radiologists overloaded and the disease affecting millions of women across the globe.

The latest research builds on Google's work with deep learning algorithms, which it developed to help doctors spot breast cancer more quickly and accurately in pathology slides.

This isn't the first time artificial intelligence has shown big promise for better mammography detection. In 2016, researchers at Houston Methodist developed an AI software they said could improve readings to 99 percent accuracy by analyzing values from X-ray images and the text of clinical reports

The opportunities for clinical improvements using AI are broad and diverse, and the technology stands to continue making big advances across healthcare in 2020, experts say.

For instance, AI technology based on a deep learning model has also shown promise of helping cardiologists predict irregular heart rhythm, atrial fibrillation, before it develops. That was the conclusion drawn from two studies presented at the American Heart Association Scientific Sessions 2019 and conducted by Geisinger researchers.

ON THE RECORD
"Looking forward to future applications, there are some promising signs that the model could potentially increase the accuracy and efficiency of screening programs, as well as reduce wait times and stress for patients," said Shravya Shetty, technical lead at Google Health, in a blog post describing the mammography findings.

"But getting there will require continued research, prospective clinical studies and regulatory approval to understand and prove how software systems inspired by this research could improve patient care," he said.
Nathan Eddy is a healthcare and technology freelancer based in Berlin.
Email the writer: nathaneddy@gmail.com
Twitter: @dropdeaded209

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Google AI platform aids oncologists in breast cancer screenings

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Google Health recently announced the results of a study it says indicates artificial intelligence could be more effective in spotting breast cancer than human oncologists. WHY IT MATTERS The findings, published in Nature, indicate that Google's AI model spotted breast cancer in de-identified screening mammograms with greater accuracy, with fewer false positives and false negatives than experts.

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Robert Golden, dean of the UW-Madison's School of Medicine and Public Health for the past dozen years, leaned into the question as if he wanted no doubt to exist on where he stood. We were in his office in a campus building located a stone's throw away from University Hospital.

I had asked him why it was important that the medical school do a better job of accommodating clinical trials for new drugs and techniques sponsored by for-profit corporations.

Golden swings for the fences.

"This gets to our very core. It is fundamental to the Wisconsin Idea," he says, citing the university's historic role as a vessel of knowledge to the state and beyond. "We should not be insular. We should not have ivy-covered walls keeping us from people, keeping us from promulgating advanced health and economic development."

Richard Moss, a senior associate dean for basic research, seconds the point. "We look at clinical trials as the frontline of bringing therapeutics into the future."

This is surprising talk coming from an organization that, as we reported two weeks ago, has been accused of being next to impossible to work with, including by Kevin Conroy, CEO of high-flying Exact Sciences, the cancer-testing innovator.

Yes, UW-Madison is one of the great universities in the world, spending more than $1 billion in research funding a year. But increasingly there are complaints of sclerotic bureaucracy hampering research, indifference or hostility to business-supported projects, and an undistinguished record of launching tech startups from that bounty of research.

(For one such flash point, see a story at isthmus.com on how UW's Waisman Center declined to participate in developing a new blood test to detect autism.)

Golden put his finger on why change is imperative: The Wisconsin Idea requires it. That lodestone of the university mission was memorably captured by UW President Charles Van Hise in 1905 when he said, "I shall never be content until the beneficent influence of the university reaches every family of the state."

More than empty rhetoric, the Wisconsin Idea has deep roots in this state. They begin in 1862 with President Abraham Lincoln signing the Morrill Act, which established a national network of land-grant universities funded by the sale of federal land. UW-Madison was a charter member.

The land-grant mission was not the classical education fostered by the elite Harvards and Yales but a more practical education demanded by the times for farming and technical training. The UW's experimental agricultural stations and county farm agents got their start here. Add in the civic idealism promoted by Milwaukee's socialists and La Follette's Progressives, and you have the DNA of the expansive Wisconsin Idea that Van Hise put forward in 1905.

The med school, in facing up to its problems, is pushing hard to reconnect to this old promise.

But where the hell is the parking lot?

I was driving around lost, looking for the Wisconsin Institutes for Medical Research when I spotted Paul DeLuca, the retired UW-Madison provost, waving at me to pull into a spot that is nominally reserved for pregnant women involved in a WIMR study. Fine by me!

The only thing less known than this lot is probably WIMR itself - two massive complexes connected to the University Hospital. They are teeming with next-generation medical researchers, who are a few minutes walk from what U.S. News & World Report ranks the #1 hospital in Wisconsin.

Nearby in seeming helter-skelter placement are the American Family Children's Hospital, the hulking medical school classroom building (where Golden's office is) and the Ebling medical library. A few blocks away is the Waisman Center, famed for its study of developmental disabilities. In short, we're talking about an extraordinary cluster of medical researchers, patients, physicians and students concentrated on the west end of campus.

Thousands of people crossing paths each day, all caught up in the intricate web of health care. When I talk to Golden about it, I ask if all this had been planned when University Hospital moved from its old University Avenue haunts to Highland Avenue in 1978. He laughs. Nope, not at all.

The health care hub was put together piece by piece in the decades that followed. Opportunity and happenstance were in the mix as well as smart planning, which are often the recipe when successful economic clusters transform a community. Think of fields as diverse as computer chip development in Silicon Valley, clothing design in New York, and country music in Nashville.

"We wanted to capitalize on the geography and culture," Golden says. The research labs are connected to the hospital and to the classrooms of UW's School of Medicine and Public Health. "The scientists coming in each day will literally share elevators with the doctors and nurses caring for patients," he explains. "They'll go to the cafeteria where the patients and families eat. They will get a true organic sense of what they're working on."

The same spirit guides the structure of WIMR. It broke away from the centuries-old tradition of siloing disciplines and departments. So biochemistry is not walled off from pharmacology. Instead there is a lung cancer floor where a public health expert might be studying cancer occurrences working next to a researcher investigating the molecular structure of cancer. Nor is there the usual hierarchal separation of professors from students from post-doctoral fellows.

"This is science without walls," Golden says. "It encourages a communal integrative approach. It's worked out real well."

The first thing DeLuca gives me when we stop at his modest emeritus office - he was a professor and later chair of medical physics and a med school vice dean before becoming provost - is a thick sheath of 266 patents dating from the 1970s that attorneys from the Wisconsin Alumni Research Foundation had secured for UW's all-star medical imaging faculty.

It's not an exaggeration to say that these patents help save the lives of Wisconsinites and people all over the world. They are - drum roll, please - the manifestation of the Wisconsin Idea in action. But who really knows about it?

UW's muscular health care hub is overshadowed by more publicized research centers on campus. Namely, the Wisconsin Institute for Discovery and the Morgridge Institute for Research, which share the Discovery Building, and the three "BioStar" laboratory buildings of the nearby Biochemical Sciences Complex. But it's the overlooked med school complex that seems to excel best at translating basic lab-coat research into breakthrough commercial techniques and products.

"I don't think many other people on campus are aware of the magnitude of the whole research structure here," DeLuca confides. Indeed, the two WIMR buildings, which cost $315 million and opened in 2008 and 2014, house about 1,000 people, including 127 faculty researchers.

The place got energy. Staffers move briskly through the halls as if on a mission. First up is Jonathan Engle, an assistant professor in the departments of medical physics and radiology, who I'm surprised to learn got his bachelor's degree in Islamic political science at Colorado College before flipping to the hard sciences at the University of Utah.

Engle works in the dizzying world of medical imaging - long a wheelhouse of UW research might and tech spinoffs. Think of veteran UW researchers like Rock Mackie, Charles Mistretta and Scott Reeder. Think of next-generation researcher-entrepreneurs like Robert Jeraj and Bryan Bednarz. Think of TomoTherapy, Mackie's celebrated research spinoff that uses imaging to guide radiation treatment of cancer. (The Middleton firm sold to Accuray for $277 million in 2011.)

My poor reporter's noggin spins at seeing the elaborate gadgetry for computerized tomography (CT) and Positron Emission Tomography (PET) scanners. DeLuca helpfully explains that the CT scan will pinpoint where the tumor is in your brain, but won't distinguish if you happen to be dead or alive. The PET scan, on the other hand, documents the pulsing physiology of the tumor. "It's different dead versus alive," says DeLuca.

Overlap the two images and you get - voila! - a truer and more complex picture of a brain lesion than either scanner provides alone.

Somewhere President Van Hise is smiling.

Engle is jazzed by his research. "The whole future of nuclear medicine is probably headed to therapeutics," he tells me. In other words, from traditional uses in diagnoses to new uses in actual treatment. He's "already seeing little breakthroughs," Engle says (as if a cancer disappearing is a small thing) in the treatment of stage four glioblastoma, the most malignant form of brain cancer. That's what killed U.S. Sen. John McCain.

Engle and his colleagues work closely with med-tech giants like GE Healthcare and Siemens Medical Solutions. And with clinicians on the front lines at the hospital. Their WIMR labs are roughly 500 feet from the University Hospital's Carbone Cancer Center.

That proximity is critical because the labs make their advanced imaging devices available to clinical patients in the mornings. It would be crazy expensive for the hospital to duplicate this array of equipment, says DeLuca.

Frank Korosec, a medical physicist who runs the UW's Imaging Science Section, says the clinic connection is invaluable to researchers. "We get lots of leads from radiologists on what they need," he says. "That helps us figure out better ways of imaging. If we operated in a vacuum, we'd probably be headed in the wrong direction."

Korosec helped negotiate the university's current 10-year, $34 million research contract with GE Healthcare in 2012. Their partnership dates back a quarter-century and stands as a high point in UW-Madison's undistinguished record with business-sponsored research and technology transfer.

"Because we collaborate, it doesn't mean we give the technology away," says Korosec. In a nutshell, GE patents what its researchers create and WARF patents what UW researchers create, with GE having the first right to license the UW discoveries.

Among those profitable WARF licenses was a Korosec discovery for vascular imaging called 3D TRICKS (for Time Resolved Imaging of Contrast Kinetics), which tracks blood flow during body scans. He says it's GE Healthcare's best-selling application for its magnetic resonance scanners and was licensed by Toshiba and Siemens as well.

The GE Healthcare partnership is bragworthy for the campus.

The company is one of the state's high-tech stars and among the largest private employers in Wisconsin. Its 46,000 worldwide employees include almost 6,000 in Wisconsin at sites in Madison, Waukesha and Milwaukee. Company revenue topped $19 billion in 2017. And, yes, GE Healthcare is a major recruiter of UW-Madison graduates.

GE also gives UW-Madison first dibs on its newest technology, including placement of its "state-of-the-art" magnetic resonance imaging units. "They want us to kick the tires and check it out," says Korosec. "Because we have experienced scientists and radiologists, they ask us to evaluate their latest and greatest software. They provide us with a lot of tools that other institutions don't see until much later."

That's the good news.

The bad news is how business relationships continue to vex the campus. More typical is UW's failure to reach a research agreement with the Ford Motor Co.

The auto giant had wanted a "master agreement" with UW-Madison that set the terms for joint research projects not just for a particular department or center - as is the Madison custom - but across the full campus, which has upwards of 200 separate research entities.

Ford's interest is potentially huge for UW. The auto industry is facing an existential crisis as Silicon Valley disrupters - including Google's Waymo, Uber, Lyft, Tesla, and others - try to push their way into the car industry's driver's seat. Led by a TED-talk kind of innovative leader named James Hackett, Ford continues to look for more strategic/holistic relationships with top-tier universities for research.

As Business Insider observes, cars aren't just made of engines and steel these days: "They're rolling computers that are learning to drive themselves, talk to each other, and generate enormous amounts of lucrative data that's shared with the cloud. In fact, Ford thinks the data business could generate double the profit margins the company has historically seen on vehicles, potentially as high as 20 percent."

In late 2017, Susan LaBelle, then head of the UW's Office of Corporate Relations, cited the failed Ford contract in a candid memo to her boss, Charles Hoslet, in explaining the "stagnant corporate sponsored research at UW-Madison."

The problem? Well, there were at least two. The breakdown - and backlog - in UW's contract-negotiating office, and the campus' strong preference against master contracts.

"Ford wanted a campus-wide master agreement for simplicity," LaBelle wrote. "We eventually proposed to Ford that we limit the agreement to Engineering to get started, but after three years, we still do not have an agreement..." Make that four years now, according to Hoslet, who is vice chancellor for university relations, though he adds that "conversations" have restarted between Ford and Engineering.

Hoslet makes the point that UW has forged ahead with 25 other master agreements in fiscal year 2018. But this statement is a head-scratcher. He admits that most all of these master pacts pertain only to specific UW research units and are not campus-wide in application.

That's a big problem for Ford. "Almost all top-tier research universities are now willing to negotiate cross-campus master agreements," says Ed Krause, Ford's global manager for external alliances. He describes negotiating with the campus as "uniquely difficult."

Madison tech veteran Allen Dines says UW's stubbornness on master contracts is costly: "One of the Ford executives said they figure all great universities are about equal when it comes to getting innovative thinkers. They go to where it's easiest to get a deal put in place." That wasn't UW-Madison.

Instead, Ford partners with top-tier universities like Purdue, Michigan, MIT, Georgia Tech, Stanford and several European centers. At the University of Michigan, Stephen Forrest, a former vice president for research, successfully pushed for the campus to adopt campus-wide master agreements. From the corporate perspective, he explains, master contracts simplify intellectual property issues and project management, while recognizing how surprisingly wide their research needs can be.

"Transportation has huge implications from the social to the economic to the technical, so Ford wants to go to a university with breadth," Forrest says.

The stakes are huge for UW's reputation.

While the campus ranks sixth nationally in overall research funding, the National Science Foundation scores it as only 48th for business-sponsored research. The Milken Institute's calculation for university tech transfer, meanwhile, puts the Madison campus at an unimpressive 40th in the nation based on patents, licensing income and startups.

Still, the med school's pledge to work better with business stands out on campus. A Milwaukee executive calls it "a bit of a rogue operation." The diplomatic Rock Mackie dials it back to say "a little bit rebellious." What isn't in dispute is the school's goal to move its research from "bench to bedside." That is, to apply the insights learned in the laboratory to new ways of treating patients.

For example, the med school launched its own nonprofit in 2014, known as Wi2 (for the Wisconsin Technology Innovation Initiative), to support medical product development by faculty and students. This included creation of a state-supported $1 million seed fund to help Wi2 commercialize medical school research. Among the first recipients: the UW's Wisconsin Alzheimer's Institute for its efforts to identify disease markers and treatments.

In 2016, Wi2 also agreed to a strategic collaboration with Orion, a Finnish pharmaceutical and diagnostics company, to develop new cancer treatments - any income generated will be split according to each side's percentage of investment.

Engle, meanwhile, points out "a significant amount" of the funding for his Cyclotron Research Group comes from the production of radionuclides - unstable atoms that emanate radiation - that are the subject of the group's research. Through a UW "charge-back" account, the radionuclides are sold at cost to a national network of investigators. Engle credits that revenue for allowing his group to pivot quickly to investigate new topics. (Quickness is not usually a word associated with launching new university research endeavors.)

Finally, the complaints of Exact Sciences' Kevin Conroy and others have prompted a major internal review by consultant Mary Westrick of med school policies that could better accommodate business-sponsored clinical trials. The problem: While the med school accounts for almost a third of UW's $1.58 billion research expenditures, just $10 million is spent on clinical trials.

Judging from subterranean rumblings on campus, the med school's initiatives sometimes face administrative resistance. Campus managers, for good reason or bad, seem to take a harder line on potential conflict-of-interest issues than other universities do, which has complicated launching campus-based startups led by faculty and students.

But fear of public resources being used for personal gain is not unreasonable. The recent tumult at New York's Memorial Sloan Kettering Cancer Center - a nonprofit hospital executive overseeing for-profit ventures benefited handsomely from stock options in one such startup - is a case in point.

Even a steadfast defender of UW engagement with business like DeLuca recognizes the challenge of faculty startups on campus. "You're standing on the edge of the abyss," he says. "We have to be careful here." For DeLuca, the question comes down to what degree campus leadership "is comfortable hanging toes over the board."

Hanging toes? It's surfing lingo for attempting "a difficult maneuver that takes both grace and balance," according to Google. That's the perfect metaphor for UW's challenge to bring the Wisconsin Idea into the 21st century.
Part III in the series will look at the UW's conflicted commitment to building an entrepreneurial culture on campus. All the stories in this series on UW-Madison research can be found at isthmus.com/topics/uws-challenge/

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Robert Golden, dean of the UW-Madison's School of Medicine and Public Health for the past dozen years, leaned into the question as if he wanted no doubt to exist on where he stood. We were in his office in a campus building located a stone's throw away from University Hospital.

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Executive Summary

Ambient Clinical Intelligence systems in hospital beta testing is bringing AI into exam room with an inconspicuous array of microphones to capture the patient interaction accurately regardless of speakers' movements or positions, with all computing and data entry into the electronic health record taking place behind the scenes in back-end and cloud-based systems. The goal is to reduce doctors' documentation burden and allow them to spend more time interacting with patients. This could reduce burnout and costs, and improve patients' and doctors' experience.

Larry Washburn/Getty Images

A surge of new healthcare products from wearable consumer health trackers to diagnostic algorithms promising to improve medical outcomes and costs with artificial intelligence (AI) is prompting physicians and hospital executives to ask a fundamental question: "Are these technologies solving the right problems?"

Two ongoing developments add scale and urgency to this important question. The first is a virtual gold rush of technology vendors looking to stake a claim in the healthcare IT market, which is projected to top $390 billion by 2024 according to research firm MarketsandMarkets. The second is what the World Medical Association is calling a "pandemic of physician burnout," caused by a staggering workload of electronic paperwork to document patient care and which is required for insurance coverage, financial reimbursement, and medicolegal liability protection. More than half of clinicians report feeling burned out from the hamster wheel of documentation and reporting tasks that often require spending two hours at a computer for every hour spent in patient care. A 2019 study published in the Annals of Internal Medicine conservatively estimated the resulting annual costs of higher physician turnover and lower revenue from reduced clinical hours at $4.6 billion.

It is essential to develop technology that empowers doctors so that they can get back to doing what they trained for and love. It is equally important that we return to patients their doctors' undivided attention.

Accordingly, healthcare IT development should begin with a deep understanding of how clinicians need and want to work, then implement AI capabilities with the explicit goal of adapting to and supporting how they deliver care. Ambient clinical intelligence (ACI) is one promising approach.

Reconnecting doctors and patients

As the name indicates, ACI is less a device than a set of capabilities as unobtrusively present and available as the light and sound in the exam room. The best way to picture ACI is to think of a typical exam room with a flat-screen display on the wall showing requested information. An inconspicuous array of microphones captures the patient interaction accurately regardless of speakers' movements or positions. A computer isn't needed in the exam room, because the computing and data entry takes place behind the scenes in back-end and cloud-based systems.

ACI builds on the familiar speech recognition technology that doctors have used for the past 20 years. It also uses voice biometrics - in short, a way to identify individuals by voice - to authenticate clinical users, and other technologies to distinguish between the clinician, patient, and anyone else in the exam room. It also integrates conversational AI, machine learning, speech synthesis, natural language understanding, and cloud computing to provide diagnostic guidance and clinical intelligence. That includes highlighting potentially overlooked diagnoses based on patient history and symptoms, as well as possible drug interactions and recommended alternative medications. The system responds in real-time when the doctor asks to view patient histories or test results, prescribes medications, orders tests, and schedules follow-up appointments. Once the patient visit is over, the system creates a summary for the patient, updates the patient's record, and enters appropriate billing codes for the physician to review, edit, and submit in the electronic health record (EHR).

Patient privacy is necessarily integral to ACI for HIPAA compliance, system functionality, and user acceptance. The patient data collected in ACI must be closely guarded, stored with the patient's consent, and only repurposed in anonymized form for clearly defined clinical purposes.

Pilots under way

Today, an array of providers, including Nuance (where co-author Petro is CTO), Microsoft (which has partnered with Nuance to accelerate ACI development and deployment), Google, Amazon, and Apple are developing versions of the technology.

Two of us (Drs. Ash and Rab) began pilots of Nuance systems at our institutions earlier this year. We started by providing ACI to a minimum of five physicians each in specialties that tend to have structured visits and predictable issues, including: orthopedics; ear, nose and throat; surgery; gastroenterology; and cardiology. This measured approach allows us and our clinicians to refine the technology and to adapt to a workflow that is at once different - in how we have used technology - and familiar, in how we naturally deliver patient care.

To measure ACI performance we are capturing metrics related to the quadruple aim of enhancing patient experiences, improving population health, reducing costs, and improving the work lives of healthcare providers. Those include independent patient satisfaction surveys, EHR data indicating documentation of time per visit and after-hours documentation, average visit counts per provider, and qualitative assessments from physicians comparing ACI to the use of remote virtual and in-person scribes, and when no scribe is used.

It's too early to report definitive quantitative conclusions about clinical or financial outcomes. However early data and personal reports from physicians using ACI have been encouraging. For example, 95 percent of patients whose doctors used ACI during a visit have consented to being recorded, and turnaround time for ACI to complete reports in the EHR is 50 percent lower than what we had anticipated.

The clearest results to date are qualitative, especially in physician satisfaction reported directly to us and spread by word of mouth from physicians using ACI to others who have not experienced it. One physician reported that, "I would probably spend six to eight hours a week documenting. I bet that my time has been cut in half, if not by two-thirds. Spending an extra five minutes on every patient, if you've got 30, 35 patients, that's a lot of time, and you can find a lot of things to do with an extra two hours every day."

More generally, one commented that ACI "allows the patient visit to work the way it should." One of the most striking comments came from a physician initially skeptical of ACI, because past technologies failed to deliver on promises of reduced administrative burdens. He is now an ACI supporter "because it allows me to go back to being a physician versus a data-entry clerk and allows us to do what we wanted to do in a way that doesn't fracture the patient-physician relationship."

ACI and other new AI technologies can transform healthcare. But technical advancements alone cannot achieve the improvements we need in costs, quality, and outcomes. That can only happen by designing technology in support of clinicians who make the healthcare system work and care for us and our families.

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How AI in the Exam Room Could Reduce Physician Burnout

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Executive Summary Ambient Clinical Intelligence systems in hospital beta testing is bringing AI into exam room with an inconspicuous array of microphones to capture the patient interaction accurately regardless of speakers' movements or positions, with all computing and data entry into the electronic health record taking place behind the scenes in back-end and cloud-based systems. The goal is to reduce doctors' documentation burden and allow them to spend more time interacting with patients.

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Socially Determined Closes Series A Round, Raises Over $11M

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Socially Determined Closes Series A Round, Raises Over $11M

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https://www.prnewswire.com/news-releases/socially-determined-closes-series-a-round-raises-over-11m-300990703.html

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AI, design thinking, robotics and big data have made a splash across all industries, but perhaps their greatest impact is in healthcare. As technology and innovation have grown in the healthcare field, hospitals and startups have found amazing ways to improve their offerings and revolutionize the industry. The result is amazing applications of new technology and thinking that can forever change how patients are treated.

Here are 10 examples of explosive innovative in healthcare.
1. Pennsylvania Hospital Changes Traditional Design
Pennsylvania Hospital is steeped in history, but a new facility will bring in new thinking and technology. Instead of being organized by department like most hospitals, the facility will have a more cohesive feel. The goal is for every department to have ownership over every patient in an environment that feels more like a hotel than a sterile hospital. The Pavilion isn't set to open until 2021. Throughout the design and construction phases, the hospital has involved patients and staff to provide feedback and recommendations for the best healthcare technology.
2. Boston Children's Hospital Uses 3D Models To Shorten Surgeries
Detailed operations can dangerous and long. The more time a patient is in surgery, the bigger the risk. A growing number of hospitals, including Boston Children's Hospital, are using 3D operating models that allow surgeons to practice complex operations before they walk into the operating room. Practicing beforehand not only helps the surgeries go more quickly but also allows surgeons to test innovative practices to be more confident of their success. 3D printing allows hospitals to create exact models of a patient's organs for detailed practice.
3. Startup Uses Big Data To Treat Rare Diseases
One of the biggest challenges to creating new drugs and treatments for rare diseases is simply getting enough information to find the right treatment. Healthcare startup RDMD is trying to solve that problem by using AI to analyze data from medical records to find commonalities in rare disease cases. The company then sells that data to pharmaceutical companies so they can create cutting-edge treatments. RDMD's approach shows that harnessing the power of data can help find better treatments, faster.
4. University Of Chicago Medical Center Solves OR Bottlenecks With Predictive Analytics
A common problem for many hospitals is bottlenecks and slowdowns in the operating room, which is expensive and frustrating for patients and doctors. The University of Chicago Medical Center uses predictive analytics to streamline the movements in and out of the OR. By combining real-time data and an AI-powered algorithm, the hospital has decreased turnover by 20%, or four minutes per room. The new system improves communication and workflows from all the moving parts in the operating room and is expected to save the hospital $600,000 a year, plus lead to more satisfied patients and staff.
5. AI Robot Helps With Heart Treatments
Advanced robotics opens doors for surgeries and treatments that were previously more dangerous and invasive. Researchers at Carnegie Mellon University developed HeartLander, a miniature robot that can perform heart therapy treatments. A doctor makes a small incision and then navigates the robot to particular parts of the heart, where the robots sticks to the organ and performs therapy. HeartLander is a huge improvement over traditional heart therapy procedures because it is more precise, safer and less invasive.
6. Children's Hospital Connects Newborns And Parents With NICU App
Premature babies or newborns with health problems often have to stay in the NICU, even after their parents leave the hospital. To help ease a stressful situation and provide clear updates, researchers at the University of Chicago and the Ann & Robert H. Lurie Children's Hospital of Chicago use the PreeMe+You app to keep parents in constant contact with their babies and their care teams. Parents can track their baby's progress in real time and know what their baby is doing at every moment. It's a comfort for parents who can't be at their baby's side and helps parents and the care team stay on the same page.
7. Seattle Children's Uses Data For Better Diagnoses
Doctors at Seattle Children's Hospital have started using big data analytics to provide faster and more accurate diagnoses for its patients. The new system can comb through thousands of data points about each patient to diagnose the condition and find treatment options nearly instantly. Previous systems could take days or weeks and weren't as accurate. Taking advantage of big data allows doctors and nurses to provide personalized treatment options that are backed by statistics and current research.
8. VR Helps Patients In Difficult Situations
Certain situations can be difficult for patients, such as going through childbirth or facing anxiety about an upcoming surgery. Startup has partnered with healthcare providers to bring virtual reality to patients. The innovative concept is rather simple: patients are given VR glasses during painful or difficult procedures to minimize the stress. The technology makes for a more pleasant patient experience while also creating a better environment for providers to safely perform the procedure. VR technology also helps clinics gather new patient information and share treatment instructions for after the patient goes home.
9. Chatbot Provides 24/7 Personalized Health Advice
Innovative technology puts patients in control. Chatbot Florence is an AI-powered chatbot that gives answers and advice whenever patients need. Instead of waiting to talk to their doctor, patients can simply ask Florence a question about symptoms or medication, and she'll provide personalized responses. She can also remind users to take medication and track healthy habits. Florence is constantly learning new information to stay ahead of health trends and changing disease patterns.
10. Cloud-Based Systems Streamline Data Access
Instead of keeping separate charts and systems for each department and patient, innovative healthcare systems are moving towards cloud-based data management systems. These programs combine patient data into a single system that can be accessed instantly and from anywhere. Instead of having to sort through multiple systems, healthcare providers can get all the information they need about a patient in one place and easily share it with other members of the care team. Companies like allow providers to access protected data in real time.

These 10 examples show the power of innovation in healthcare and how new ideas and technology can completely change the experience for patients and providers. As technology develops, we'll see even more innovation and healthcare growth.
Blake Morgan is a keynote speaker, futurist and author of "More Is More." Sign up for her weekly customer experience newsletterhere.

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Healthcare Innovation - 10 Recent Examples Of Powerful Innovation In Healthcare

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AI, design thinking, robotics and big data have made a splash across all industries, but perhaps their greatest impact is in healthcare. As technology and innovation have grown in the healthcare field, hospitals and startups have found amazing ways to improve their offerings and revolutionize the industry.

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https://www.healthcareitnews.com/news/epic-debut-ambient-voice-technology-assistant-himss20

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Google Health - Tools to help healthcare providers deliver better care

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Google Health - Tools to help healthcare providers deliver better care

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https://www.youtube.com/watch?v=P3SYqcPXqNk

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https://medcitynews.com/2018/04/consumer-data-not-clinical-data-will-fix-healthcare/

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How Healthcare is Using Big Data and AI to Cure Diseases

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How Healthcare is Using Big Data and AI to Cure Diseases

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https://www.forbes.com/sites/nicolemartin1/2019/08/30/how-healthcare-is-using-big-data-and-ai-to-cure-disease/#c321f2b45cfc

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https://www.ama-assn.org/delivering-care/population-care/what-meant-population-health-and-why-it-matters

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https://www.vox.com/policy-and-politics/2020/1/22/21055118/maryland-health-care-global-hospital-budget

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Pocket-size ultrasound devices that cost 50 times less than the machines in hospitals (and connect to your phone). Virtual reality that speeds healing in rehab. Artificial intelligence that's better than medical experts at spotting lung tumors. These are just some of the innovations now transforming medicine at a remarkable pace.

No one can predict the future, but it can at least be glimpsed in the dozen inventions and concepts below. Like the people behind them, they stand at the vanguard of health care. Neither exhaustive nor exclusive, the list is, rather, representative of the recasting of public health and medical science likely to come in the 2020s.

David Abney: Drone-delivered medical supplies

Since March, UPS has been conducting a trial program called Flight Forward, using autonomous drone deliveries of critical medical samples including blood or tissue between two branches of a hospital in Raleigh, N.C., located 150 yards apart. A fleet-footed runner could cover the distance almost as fast as the drones, but as a proof-of-concept program, it succeeded, and in October the FAA granted the company approval to expand to 20 hospitals around the U.S. over the next two years. "We expect UPS Flight Forward to one day be a very significant part of our company," says UPS CEO David Abney of the service, which will deliver urine, blood and tissue samples, and medical essentials like drugs and transfusable blood. UPS is not alone in pioneering air deliveries. Wing, a division of Google's parent company Alphabet, received similar, but more limited, FAA approval to make deliveries for both Walgreens and FedEx. And in Ghana and Rwanda, drones operated by Silicon Valley startup Zipline are already delivering medical supplies to rural villages. -Jeffrey Kluger

Christine Lemke: The biggest Big Data

There are 7.5 billion humans, and tens of millions of us track our health with wearables like smart watches, as well as with more traditional devices like blood-pressure monitors. If there were a way to aggregate all that data from even a few million of us and make it all anonymous but searchable, medical researchers would have a powerful tool for drug development, lifestyle studies and more. California-based Big Data firm Evidation has developed just such a tool, with information from 3 million volunteers providing trillions of data points. Evidation partners with drug manufacturers like Sanofi and Eli Lilly to parse that data; that work has led to dozens of peer-reviewed studies already, on subjects ranging from sleep and diet to cognitive-health patterns. For founder Christine Lemke, one of Evidation's ongoing projects, to see if new technologies can effectively measure chronic pain, is personal: Lemke has a rare genetic disease that causes frequent back pain. Evidation is partnering with Brigham and Women's Hospital on the project. -Jeffrey Kluger

Doug Melton: A stem-cell cure for diabetes

Type 1 diabetes affects 1.25 million Americans, but two in particular got Harvard biologist Doug Melton's attention: his daughter Emma and son Sam. Treatment can involve a lifetime of careful eating, insulin injections and multiple daily blood-glucose tests. Melton has a different approach: using stem cells to create replacement beta cells that produce insulin. He started the work over 10 years ago, when stem-cell research was raising hopes and controversy. In 2014 he co-founded Semma Therapeutics-the name is derived from Sam and Emma-to develop the technology, and this summer it was acquired by Vertex Pharmaceuticals for $950 million. The company has created a small, implantable device that holds millions of replacement beta cells, letting glucose and insulin through but keeping immune cells out. "If it works in people as well as it does in animals, it's possible that people will not be diabetic," Melton says. "They will eat and drink and play like those of us who are not." -Don Steinberg

Abasi Ene-Obong: A more diverse global bio bank

A major limitation threatens to hamper the era of personalized medicine: people of Caucasian descent are a minority in the global population yet make up nearly 80% of the subjects in human-genome research, creating blind spots in drug research. Dr. Abasi Ene-Obong, 34, founded 54gene to change that. Named for Africa's 54 countries, the Nigeria-based startup is sourcing genetic material from volunteers across the continent, to make drug research and development more equitable. 54gene is conscious of the ugly history of colonial exploitation in Africa. If companies are going to profit by developing marketable drugs based on the DNA of African people, Africa should benefit: so, when partnering with companies, 54gene prioritizes those that commit to including African countries in marketing plans for any resulting drugs. "If we are part of the pathway for drug creation, then maybe we can also become part of the pathway to get these drugs into Africa," Ene-Obong says. -Corinne Purtill

Sean Parker: A disruptive approach to cancer research

One of the original disrupters of the new economy is bringing his approach to medical research. The Parker Institute for Cancer Immunotherapy, established by Napster co-founder and former Facebook president Sean Parker, is a network of top institutions including Memorial Sloan Kettering, Stanford, the MD Anderson Cancer Center and more. Its goal is to identify and remove obstacles to innovation in traditional research. For example, all of the participating institutes have agreed to accept an approval decision by any of their respective Institutional Review Boards, which "allows us to get major clinical trials off the ground in weeks rather than years," says Parker, and at lower costs. Perhaps most important, Parker wants to infuse the project with his market sensibility: "We follow the discoveries coming from our researchers and then put our money behind commercializing them," he says, either by licensing a product or spinning it out into a company. Since its founding in 2016, the institute has brought 11 projects to clinical trials and supported some 2,000 research papers.

Thomas Reardon: A wristband that can read your mind

A man wearing what looks like a chunky black wristwatch stares at a tiny digital dinosaur leaping over obstacles on a computer screen before him. The man's hands are motionless, but he's controlling the dinosaur-with his brain. The device on his wrist is the CTRL-kit, which detects the electrical impulses that travel from the motor neurons down the arm muscles and to the hand almost as soon as a person thinks about a particular movement. "I want machines to do what we want them to do, and I want us to not be enslaved by the machines," says Thomas Reardon, CEO and co-founder of CTRL-Labs, the device maker. The hunched-over posture and fumbling keystrokes of the smartphone era represent "a step backward for humanity," says Reardon, a neuroscientist who, in a past life, led the development of Microsoft's Internet Explorer. The technology could open up new forms of rehabilitation and access for patients recovering from a stroke or amputation, as well as those with Parkinson's disease, multiple sclerosis and other neurodegenerative conditions, Reardon says. -Corinne Purtill

Jonathan Rothberg: An ultrasound in your pocket

There are more than 4 billion people globally who don't have access to medical imaging-and could benefit from Butterfly iQ, a handheld ultrasound device. Jonathan Rothberg, a Yale genetics researcher and serial entrepreneur, figured out how to put ultrasound technology on a chip, so instead of a $100,000 machine in a hospital, it's a $2,000 go-anywhere gadget that connects to an iPhone app. It went on sale last year to medical professionals. "Our goal is to sell to 150 countries that can pay for it. And [the Gates Foundation] is distributing it in 53 countries that can't," Rothberg says. The device isn't as good as the big machines are and won't replace them in prosperous parts of the world. But it could make scanning more routine. "There was a time when the thermometer was only used in a medical setting, when a blood-pressure cuff was only used in a medical center," Rothberg says. "Democratizing [health] happens on multiple dimensions." -Don Steinberg

Shravya Shetty: Cancer-diagnosing artificial intelligence

Symptoms of lung cancer usually don't appear until its later stages, when it's difficult to treat. Early screening of high-risk populations with CT scans can reduce the risk of dying, but it comes with risks of its own. The U.S. National Institutes of Health found that 2.5% of patients who received CT scans later endured needlessly invasive treatments--sometimes with fatal results-after radiologists erroneously diagnosed false positives. Shravya Shetty believes artificial intelligence may be the solution. Shetty is the research lead of a Google Health team that in the past two years built an AI system that outperforms human radiologists in diagnosing lung cancer. After being trained on more than 45,000 patient CT scans, Google's algorithm detected 5% more cancer cases and had 11% fewer false positives than a control group of six human radiologists. The early results are promising, but "there's a pretty big gap between where things are and where they could be," says Shetty. "It's that potential impact that keeps me going." -Corinne Purtill

Joanna Shields: AI to read every science paper

Every year, more than 2 million peer-reviewed research papers are published-far too many for any individual scientist to digest. Machines, however, don't share this human limitation. BenevolentAI has created algorithms that scour research papers, clinical trial results and other sources of biomedical information in search of previously overlooked relationships between genes, drugs and disease. BenevolentAI CEO Joanna Shields was an executive at companies such as Google and Facebook, and then the U.K.'s Minister for Internet Safety and Security, before joining BenevolentAI. A frequent critic of the tech industry's lapses in protecting young people from exploitation and abuse online, Shields sees BenevolentAI as an opportunity to harness technology's power for good. "All of us have family members, friends who are diagnosed with diseases that have no treatment," she says. "Unless we apply the scaling and the principles of the technology revolution to drug discovery and development, we're not going to see a change in that outcome anytime soon." -Corinne Purtill

Sean Slovenski: Walmart-ification of health care

Whenever the world's biggest retailer aims its gigantic footprint at a new market, the ground shakes. In September, Walmart opened its first Health Center, a medical mall where customers can get primary care, vision tests, dental exams and root canals; lab work, X-rays and EKGs; counseling; even fitness and diet classes. The prices are affordable without insurance ($30 for an annual physical; $45 for a counseling session), and the potential is huge. In any given week, the equivalent of half of America passes through a Walmart. "When I first started here ... [I] thought, That can't be true," says Sean Slovenski, a former Humana exec who joined Walmart last year to lead its health care push. If the concept spreads, repercussions await in every direction. Like Walmart's merchandise suppliers, doctors and other medical pros may need to adjust to the retailer's everyday low prices. Still, cautions Moody's analyst Charles O'Shea: "Health care is multiple times harder than selling food." -Don Steinberg

Charles Taylor: 3-D digital hearts

For too many people with suspected heart problems, invasive catheterization is necessary to diagnose blocked or narrowed arteries. Doctors must then choose the best method for improving blood flow from a handful of options, including balloon angioplasty and stenting. Charles Taylor, a former Stanford professor, started HeartFlow to help patients avoid invasive diagnostic procedures and improve treatment outcomes. The company's system creates personalized 3-D models that can be rotated and zoomed into, so doctors can simulate various approaches on screens. In some cases, it can help avoid invasive procedures entirely. "By adding the HeartFlow ... to our available resources for diagnosing stable coronary disease, we are able to provide patients with better care as we evaluate risk," said Duke University cardiologist Manesh Patel, at the American College of Cardiology's annual meeting in March. -Jeffrey Kluger

Isabel Van de Keere: Rehab in virtual reality

Isabel Van de Keere was at work one day in 2010 when a steel light fixture pulled loose from the ceiling and fell on her. The accident left Van de Keere, a Belgian-born Ph.D. in biomedical engineering, with a cervical spine injury and severe vertigo that required three years of intense neurological rehabilitation. She practiced the same tedious exercises dozens of times in a row, with progress so slow it seemed undetectable. Now 38, she's the founder and CEO of Immersive Rehab, a London-based startup whose goal is to change the neurological-rehab experience using virtual reality. By expanding the range and type of exercises patients can try, VR creates more opportunities to harness the brain's plasticity and repair neural pathways; increases the amount of data caregivers can use to measure progress and adapt programs; and improves the monotonous, frustrating experience of rehab. Feedback from volunteer patients and therapists has been promising; the company is now preparing to run clinical trials in the U.S. and Europe. -Corinne Purtill

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12 Innovations That Will Change Health Care and Medicine in the 2020s

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Pocket-size ultrasound devices that cost 50 times less than the machines in hospitals (and connect to your phone). Virtual reality that speeds healing in rehab. Artificial intelligence that’s better than medical experts at spotting lung tumors. These are just some of the innovations now transforming medicine at a remarkable pace.