Housecalls: Back to the future

by Keeley Wray on October 15, 2010

This week I attended an Innovator’s Forum, part of a new Innovation Acceleration Program at Children’s Hospital Boston. The program, spearheaded by the hospital’s new Chief Innovation Officer, Naomi Fried, PhD, seeks to empower clinical innovators in developing and testing their novel ideas by providing resources and support. The monthly Forum allows innovators to meet, tell their stories, form a community and support one another through the challenges of translating new ideas from the cocktail napkin to hospital operating procedure.

Presenters can have ideas at all stages of developmental maturity. Our first presenter, Robert Graham, MD, associate in Critical Care Medicine, set the bar high. Graham, an ICU physician, works with ventilator-dependent patients. The crux of his innovation was, as he humbly quipped, not innovation at all but rather re-innovation: He has returned the focus of his care to the home setting, reminiscent of house calls made by physicians prior to the 1960’s.

Graham started out by articulating the value of traveling to patient’s homes. Home visits ease the transition from the critical care setting to the patient’s bedroom. They can also prevent unintended or unforeseen problems like improper equipment set-up — such as placing it too close to a humidifier or heat source — or intolerance by the patient, which might have significant consequence for a child’s health. Home visits also allow Graham to reinforce the training that parents receive in the hospital and relieve families of the complicated logistics and stress of travel to and from the hospital for checkups.

Graham currently provides home care services to almost 200 patients, and the results have convinced him that home care really is the best way to ensure positive outcomes. He also suspects there will be significant cost savings to the overall health care delivery system.

Now he has to convince the insurance companies. He’s started negotiations but does not yet have the manpower to collect the cost saving and efficacy metrics that insurance companies need to to justify reimbursement. There’s much else to be done before the innovation enjoys wide adoption or is extended to patients with other types of technology dependence. One hurdle is finding resources to fund this type of care. Graham would like to hire a social worker and physician’s assistant to help expand the scope of the program and collect data to justify further support.

Graham also finds himself limited by travel time and geography, and hopes to introduce telemedicine technology to increase the efficiency of his local work and extend care to patients outside of Massachusetts. Also, improved EMR technology is needed so that information can be exchanged between institutions if patients visit other hospitals.

After listening to his talk, I was inspired by Graham’s grassroots energy. I’m amazed by the creativity of his approach and especially his ability to work with limited resources. Hopefully the hospital’s new tools — such as the new clinical innovation fund announced at the Forum — will provide clinicians like Graham the support they need to fully integrate their visions throughout the hospital.

I imagine that the ability to be an agent of change in healthcare is largely dependent on organizational culture and support. Graham’s efforts, among the many others I see at Children’s, are evidence that we’re on the right course. James Mandell, CEO of Children’s Hospital Boston, recently articulated the importance of innovating to improve patient care in a Q&A with MassBio. Given that our innovation culture is promulgated from the top down and bottom up, I expect Children’s to retain our position at the vanguard of patient care in a way that benefits all healthcare stakeholders, especially the littlest!

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