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>View discussions about this entry Country: United States
Organization: Henry Ford Hospital
Focus of activity - Technology
Year the initiative began (yyyy) - 2004
Positioning in the Mosaic of solutions
Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? Remote expert guidance of portable ultrasound examinations has significantly improved medical care capabilities in the Space Program by allowing the diagnosis of over 300 common medical conditions by non-physicians on the International Space Station. This model was recently exported for use in professional and amateur sporting injuries in the Winter Olympic Games in Turino where the technique was used over 250 times for injured athletes. We currently have 3 portable ultrasound units in the Olympic training facilities which are used to help diagnose a variety of injures in athletes across the country. We have recently provided these capabilities to the professional sporting teams of Hockey (Detroit Red Wings), Football (Detroit Lions), and Baseball (Detroit Tigers) where the technique is used during practice and game situations in professional athletes by their trainers. We have been asked to help export these techniques to Northern Ontario, via satellite support, to help extend care to underserved populations in these remote areas. These techniques are readily scalable to almost unlimited areas via internet, cell, or satellite coverage in during routine or disaster care.
Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. The primary focus of this innovation is the expansion of health care capabilities, developed by NASA, for use on Earth to increase diagnostic capabilities in under-served populations. The innovation involves rapid training and remote expert guidance of non-expert users in dispersed centers to perform targeted ultrasound examinations using in-expensive, portable ultrasound devices which are coupled to centers of excellence through the internet, cell, or telephone networks. The target populations of this innovation are remote, rural, or underserved populations where immediate and accurate diagnostic information concerning numerous health conditions including obstetrics, child care, musculoskeletal disease, trauma, kidney, liver, gallbladder disease, and cardiovascular health could be assessed. Currently, there is a long waiting period for a patient to obtain a radiologic test such as a CT, MRI, or ultrasound scan which are extremely expensive and site limited. The portable ultrasound devices are 1/6th the cost of previous devices, and can be placed in non-hospital, community settings, staffed by remote physicians for a fraction of the cost of a similar examination under standard conditions. Recent NASA investigations have demonstrated that ultrasound can provide similar diagnostic images to these expensive interventions and that the ultrasound examinations can be performed by non-physicians with high accuracy: this proposal will modify these techniques used successfully on the International Space Station and Winter Olympic Games to expanded health care on the Earth.
Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? This medical care innovation reaches its target population by selecting community sites which are convenient access points (schools, community centers, existing health clinics) can be quickly adapted. The access locations are readily available as the requirements are modest (comfortable, private location for scanning protocols, connectivity to a designated remote expert site via internet, cell network, or phone line). Target populations can be demographically screened (well obstetrics checks, vascular check ups in elderly, abdominal scans for pain, musculoskeletal examinations for pain or injury) or the technique can be on an as needed.
Currently, we support remote medical care on the International Space Station, 3 United States Olympic Committee Training Facilities in the US, the professional sporting teams in Detroit, and are in process of developing programs for Northern Ontario and the Summer Olympic Games in China. The utilization of these services is dependent of the activity of the participants in these locations and varies from almost continuous use for the National Football League during practices, to sporadic for the baseball team. The distribution of remote expert guidance is not limited by the system and can be a dispersed skill set and asset. We currently serve as the primary center of excellence for this activity, however, we have trained additional support sites in Dallas, Texas, Houston, Texas, and Pensacola Florida with the technique. Additional sites could be added without significant monitary or time cost. Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. NASA: Remote expert guidance was originally developed by NASA scientists to expand medical care capabilities on the Shuttle and International Space Station. Training programs and algorithms for the non-traditional uses of ultrasound were supported by 2 research grants and the technology was developed for terrestrial use. This original partnership was crucial to the success of the program and continual cooperation is ensured by a 5 year extension of this research effort with collaboration with the Russian Space Agency. This partnership is not central to this proposal, however, it provides additional resources for expansion.
GE: General Electric has state of the art portable ultrasound devices which have been provided to the Olympic effort which have aided the initial trials used in this proposal. Continued corporate support with innovation of technology, and advantageous pricing is crucial to this proposal. Mediphan: This company is an essential partner in the terrestrial expansion of this technique through proprietary video compression and streaming to remote locations. Continued cooperation is ensured through a shared business vision of expansion of remote medical technology. Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? The financial model for this innovation is variable based on the intended patient population. Provision of care to underserved populations can be inexpensively provided by using existing funds to purchase the ultrasound units and connectivity options. Partnering with local/regional centers of excellence will allow the parent center to provide expert services as an intact mechanism for patients where pathology is found or as a community outreach mechanism. Funding mechanisms through community health initiatives will also allow outfitting of these diagnostic centers in designated regions.
Currently, we are developing a funding model to extend these techniques to established medical facilities where these additional capabilities are required (e.g. Advanced musculoskeletal ultrasound for the Andrews Orthopedic Institute in Pensacola Fl). Earned income on this venture will be used to expand this technique (appx 15% of operating costs) to develop additional training modules for expanded ultrasound indications
Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? This innovation has exponentially increased medical care capabilities for the space program and International Space Station; Astronaut Mike Fincke "this is the biggest scientific achievement we have had in the space program during my time" Over 250 Olympic athletes were treated during the Winter Olympic Games with these techniques. Numerous professional athletes were benefitted during practice and competition as well. The National Football League is in the process of adopting this innovation for care of football players across the league.
Scaling up Strategy - What is your priority for the next 3 years and please describe why. The scaling up strategy is divided into educational, technologic, and economic.
Educational: The education of non-expert providers for trauma, abdominal, cardiovascular, and musculoskeletal uses of remote ultrasound are mature programs. Additional educational components for obstetrical care, and disaster management will need to be developed in the first year. Technologic: Current use of this innovation is based on broadband internet connectivity. Alpha testing of video compression/transmission algorithms for cellular network configurations is ongoing and will be expanded to encompass routine telephone lines within the first 2 years. Economic: Partnering with local, regional, and national funding authorities for community health and disaster managment will be explored throughout the first three years to provide funding for staffing, tech development, and equipment purchase/upkeep.
Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. Providing medical care for astronauts in deep space and patients in many areas of the world is more similar than you might think. There isnt a doctor on the Space Station, we have no X-ray or cat scan, and health problems occur despite precautions. We do have an ultrasound machine, so we developed a way to use it for things which would require a doctor and X ray capabilities on Earth. We've been very surprised (and pleased) that non-physicans can learn to use ultrasound very rapidly following a specialized training program, coupled with remote guidance by an expert using satellite or internet communication. Ultrasound proved to be better than X ray in many uses. We've migrated this technique to the Olympics; a few months ago a speed skater went off the track and injured his shoulder. An athletic trainer called me; i opened my laptop in Starbucks, and diagnosed his injury in 5 minutes.
Contact Information:
Scott Dulchavsky
Chairman of Surgery Henry Ford Hospital (non profit hospital) sdulcha1@hfhs.org Dept of Surgery, CFP-1 2799 W Grand Boulevard Detroit, MI 48202 United States Tel: 313 916 9903 Fax: 313 916 9445 Website: www.henryfordimagineering.com Discussions about this entry
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Space age medical care for use on Earth
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Christine S. Zambricki, CRNA, MS, FAAN
Chief Operating Officer & Chief Nursing Officer
Henry Ford West Bloomfield Hospital
Corporate Administration
One Ford Place, 4A
Detroit, MI 48202-3450
(313) 876-8719 Office
(313) 876-9893 Fax
(248) 885-15
This is a powerful innovation that has the potential to be transformational in challenging the complex, high cost, institutional approach that typifies health care delivery systems today. The health care industry desperately needs ideas that offer lower costs, higher quality and greater convenience and accessibility. While dominant players are focused on preserving business models of expensive care and technology arsenals, this innovation offers cheaper and simpler access to a qualified physician expert thus meeting the needs of the vast majority of patients who may otherwise suffer. Taking a world view, it is a relatively small population of people that has access to major medical centers and teaching hospitals. The benficiaries of this innovation could live in US cities or in vast desert communities or in outer space.
The long-term solution to affordable health care is making the system more efficient. I think we are headed for a new era of health care reform where health care delivery is digitized. Already many are touting electronic health records and doctors are reviewing their patients medical symptoms online. Once the electronic infrastructure has been built (most likely through private-public partnerships), we will see real health care reform take place.
Have you thought how this might work in a remote clinic site -- working on the Navajo reservation in rural western New Mexico we are far from ultrasound and even x-ray technicians -- can limited trained people use these portable units and send the info over plain old telephone lines??
Dear Dr. Dulchavsky:
This appears to be telemedicine done right! One question that arised was that because regulation still mandates that doctors have the final read of the ultrasounds, how much further could we push this capacity down the chain? Often radiologists are more capable of making the final read, are there any policy implications for the work you are doing or plans to push for this to be reformed to scale your innovation?
Thank you in advance for your response!
Changemakers Team
Scott A. Dulchavsky MD PhD
Chair of Surgery
Henry Ford Hospital
Thanks for your question. We are developing a network of physicans and radiologists with advanced reading capabilities thru networking which will provide a skilled interpreter for the examinations. Some exams, eg broken bones, etc are easily diagnosed on the video stream with high accuracy. others require greater resolution imaging with store and forward to the appropriate interpreter. We do feel that providing this worldwide network of experts, probably thru Skype, will allow a level of service and accuracy which exceeds most countries..
SD