The Needs of Innovation: Reflection and Collaboration

Realizing a need is the first step in the innovation process¹, and it is also the most important. It has been said that “a well-characterized need is the DNA of great invention”². But what is a need? And what does it take to realize a need?

The electronic medical record (EMR), artificial pancreas, and ultraviolet (UV) sterilization reveal the multifaceted nature of healthcare needs and the ability of technology to address these needs. Radiologists are ideally positioned to help teams identify needs given their role in the healthcare system and the influence of technology in their approaches to patient care.

The EMR was first developed in 1972³. At the time, reports from the Institute of Medicine stated that one in seven hospitalizations was a result of missing clinical information. Errors related to handwriting and untimely access to patient records also fueled a practice environment conducive to medical errors. There was a need for physicians to communicate effectively and efficiently between each other.

The need to communicate better was realized by the various stakeholders in this process: physicians, pharmacists, and hospital administrators. This big problem led to a big solution: the EMR market size value was $26.8 billion in 2020 and has a $33.41 billion revenue forecast in 2025⁴.

According to the Center for Disease Control and Prevention’s 2020 National Diabetes Statistics Report, 1.6 million Americans live with Type 1 diabetes. Of this population, 187,000 are children younger than 20 years⁵. A 1983 randomized control trial indicated the benefits of intensive glycemic control, citing a reduction in the risk of renal disease by 50 percent, a reduction of retinopathy by 76 percent, and a reduction of neuropathy by 60 percent.

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However, these benefits were associated with a three-fold increase in severe hypoglycemia⁶. Blood glucose monitoring is critical, though difficult. A “need” to maintain euglycemia existed for 1.6 million Americans. Artificial pancreas devices (closed-loop glucose control systems) were subsequently developed and wildly successful. A randomized control trial showed that patients with an artificial pancreas had blood glucose levels between 70 and 180 mg/dL for an additional 2.6 hours, compared to patients treated with a sensor-augmented insulin pump⁷. There are currently three commercially available hybrid-closed loop insulin delivery devices: Cambridge CamAPS Fx; Medtronic 670G; Tandem/Dexcom Control-IQ⁸.

Healthcare-associated infections (HAIs) arise in 1 out of 25 patients⁹. This amounts to more than 1 million annual HAIs in the United States and a multi-billion dollar impact to the healthcare system⁹. In 2018, a study showed that UV light can reduce active microbial burden more effectively than manual-chemical disinfection (92 percent-to-97.7 percent reduction vs 52.8 percent-to-90.9 percent reduction)¹⁰. Devices to sterilize hospital fomites have since skyrocketed, and many hospitals now utilize UV rays in the cleaning of patient rooms. Pulsed Xenon UV devices and Mercury UV-C are additional technologies being investigated as ways to clean hospital equipment with even higher efficacy¹¹.

Healthcare is all about the patient. But, we need to remember that the care of the patient happens through the EMR on computer screens, at home through patient self-monitoring, and in the hospital through clean hospital equipment.

Imagine the position of the radiologist: a physician who “sees” hundreds of patients each day, corresponds with dozens of departments, and works with computers. The radiology reading room is a front where innovation opportunities abound. The objective is simple for the radiologist: to be as efficient and as accurate as possible. Despite these simple objectives, the specific “need” for innovation in radiology is hard to assess for someone not in the field. I am not a radiologist, but I imagine the answers to these questions hold the key to innovation for improvements in patient care on the radiology front. What do I need to become more efficient? What do I need to become more accurate? What bothers me? What is my source of mistakes? What is easy? What is hard?

Through communicating these needs to computer programmers, engineers, and data scientists, radiologists can catalyze healthcare innovation in a way that is most helpful to them and, therefore, most helpful to the patient.

With a creative mind and the drive to run with an idea, a radiologist can contribute to healthcare innovations. Although radiologists may love PACS more than the EMR, Gray measurements more than glucose measurements, and darkness more than UV light, the innovations of the past show that there is immense potential to help more patients than simply the ones who present on the Barco screen.

And I believe the way to best capitalize on this potential is to let the needs be known: let’s get radiologists on multidisciplinary innovation teams to catalyze healthcare improvements.

Jack Cerne, M.D., is a clinical research associate in cardiovascular MRI at Northwestern University.

References

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2. Tj B, Cq K, Db C, et al. Outcomes from a postgraduate biomedical technology innovation training program: the first 12 years of Stanford Biodesign. Annals of biomedical engineering. doi:10.1007/s10439-013-0761-2

3. wiley_admin. EMR: The Progress to 100% Electronic Medical Records. The University of Scranton Online. Published September 17, 2013. Accessed December 1, 2020. https://elearning.scranton.edu/resource/health-human-services/emr_the-progress-to-100-percent-electronic-medical-records

4. Electronic Health Records Market Size | EHR Industry Report 2018-2025. Accessed December 2, 2020. https://www.grandviewresearch.com/industry-analysis/electronic-health-records-ehr-market

5. More People Being Diagnosed with Type 1 Diabetes. JDRF. Published February 18, 2020. Accessed December 2, 2020. https://www.jdrf.org/blog/2020/02/18/more-people-being-diagnosed-type-1-diabetes/

6. Cowie CC. Diabetes Diagnosis and Control: Missed Opportunities to Improve Health: The 2018 Kelly West Award Lecture. Diabetes Care. 2019;42(6):994-1004. doi:10.2337/dci18-0047

7. Brown SA, Kovatchev BP, Raghinaru D, et al. Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med. 2019;381(18):1707-1717. doi:10.1056/NEJMoa1907863

8. Automated Insulin Delivery. diaTribe. Published December 2, 2014. Accessed December 2, 2020. https://diatribe.org/automated-insulin-delivery

9. UV light could reduce hospital-acquired infections. Published February 3, 2019. Accessed December 2, 2020. https://www.medicalnewstoday.com/articles/324284

10. Armellino D, Walsh TJ, Petraitis V, Kowalski W. Assessment of focused multivector ultraviolet disinfection withshadowless delivery using 5-point multisided sampling ofpatientcare equipment without manual-chemical disinfection. Am J Infect Control. 2019;47(4):409-414. doi:10.1016/j.ajic.2018.09.019

11. Portable Ultraviolet Light Surface-Disinfecting Devices for Prevention of Hospital-Acquired Infections: A Health Technology Assessment. Ont Health Technol Assess Ser. 2018;18(1):1-73.