MUSC leaders focus on change

Health care is in the midst of a massive transformation across the nation. Health care systems and hospitals are choosing different routes to navigate this transformation, ranging from combining forces to gain economies of scale to keeping their heads down and waiting to see what happens.

MUSC isn’t waiting. 

“We think we need control of our own destiny, and we’re betting big on partnerships and innovation,” said Patrick Cawley, M.D., CEO of MUSC Health and vice president of Health Affairs, University. 

Cawley spoke during the SCBIO 2018 conference in Charleston. The conference, a gathering of companies, universities and entrepreneurs in the life sciences, pharmaceutical and biotechnology spheres, featured several panels with leaders from MUSC, including the panel with Cawley and Patrick Springhart, M.D., of Greenville Health System and John Singerling of Palmetto Health. 

MUSC president David Cole, M.D., FACS, joined Dave Pacitti, president and head of the Americas for Siemens Healthineers, and spoke about their organizations’ recently announced partnership. 

Some of the proposed MUSC-Siemens Healthineers initiatives sound like sci-fi come to life: artificial intelligence, machine learning, predictive analytics and digital twins. But Cole emphasized that at the center of all that high-tech razzle dazzle is the patient. 

Cole highlighted the partnership’s joint focus on stroke care, in which the partners are seeking to reduce the time it takes to begin endovascular therapy, a way of physically removing clots, for stroke patients. Though MUSC is already well below the national average of 90 minutes, the partners want to streamline procedures to decrease the time to treatment even more. 

“We want to cut it from 90 to 25 minutes. Think of the implications of that,” Cole said. “The families that are not torn apart by somebody dying or being disabled for the rest of their life. The jobs that are not lost because of their disability and the rehab that’s required. How does that happen? Artificial intelligence. Predictive analytics. Integrated platforms that are emerging.” 

Further, he added, MUSC doesn’t want to hoard the expertise it gains through this partnership with Siemens Healthineers. 

“We don’t want to own that. We want to share it. We want to define the best practice internationally and share it. That’s what’s revolutionary about this partnership,” he said. 

Health care today is still delivered the way it was in the 1940s, Cawley said. It is very physician- and nurse-centric. And while physicians and nurses are crucial, they now face more data than ever. Scientists have discovered some 70,000 diseases –and treatments for those diseases –since the 1940s and developed some 4,000 new procedures, Cawley explained. In addition, providers are burned out, in large part because of the demands of electronic health records, he said. 

“We’ve buried our clinicians. We’re not using them in the right way. So there’s a whole area right there that is ripe for innovation,” he said. 

Thornton Kirby, CEO of the South Carolina Hospital Association, said the health care system is often described as broken, but noted that it’s not so much broken as disjointed. The modern American health care system started in the 1940s, he said, when companies faced a worker shortage but were banned from offering higher wages because of wartime wage controls. Instead, they began to offer employer-sponsored health insurance as a benefit. 

Medicare and Medicaid were introduced in the 1960s to cover people who couldn’t work, and in the 1980s, President Ronald Reagan signed into law a bill guaranteeing emergency access to health care. Under President George W. Bush, the drug benefit under Medicare was expanded, and then under President Barack Obama, the Affordable Care Act was passed. All in all, Kirby said, the system is doing what it was created to do: address acute illness regardless of cost. 

“It’s not broken at all. This health care system was built to recruit workers in the era of wage controls, cover retirees until the end of their lives, to cover uninsured people, and to treat people in the emergency room. That’s what it was built to do, and it’s doing that quite well,” he said. “It was not built to do the things we wish it would do, like encourage healthy behaviors, manage chronic disease and control cost.”

That disjointedness means many patients have what Cole calls a “yeah, but” experience: “‘Yeah, I liked my physician, but it took forever waiting in the ED. Or they messed up this, or they couldn’t do that.’ We have to put our patients in the middle of what we do and build systems around it.”

That’s what’s happening with the MUSC Shawn Jenkins Children’s Hospital under construction. Pacitti said Siemens Healthineers is creating a digital twin of the building, which allows the partners to run thousands of models showing variations of how people might enter the building, leave the building, move around the building and have procedures in the building – all with the idea of creating a better layout to ensure people’s visits are smooth. 

Getting patients to the right place at the right time sounds simple, but in reality, hospitals operate in isolated silos of organized chaos, Cole said. He cited real-world examples of patients waiting five hours to be discharged or having an elective surgery canceled – even though it was on the books for three months – because there aren’t any operating rooms available. The digital twinning of the children’s hospital is an opportunity to use technology to build in processes that get patients where they need to be more efficiently, he said. 

The speakers all agreed that change is hard. Singerling, vice president of innovation and economic development at Greenville Health System, said that with some 30,000 team members, change management is one of the greatest challenges he faces. Cawley noted that change in the health care sector usually takes about 17 years, but no one has 17 years to wait. Cole agreed. 

“Our greatest risk is to do nothing. We have to change how we do things,” Cole said.