From #DOCSF17:
Dr. Thomas Vail, Chairman, Department of Orthopaedics UCSF; Former President, AAHKS & Knee Society, talks to Breanna about what the process is like for academic centers to adopt digital health solutions in their organizations, his favorite digital health app, and where he goes to discover new technologies.

Transcription to follow.

Breanna Cunningham: Live with the Doctor Thomas Vail from UCSF. He’s the Chair of Orthopedic Surgery there, also, the past President of AAHKS. We’re honored to be able to speak with him today.

Vail: Great to be here.

Cunningham: Today’s very fascinating topic on digital health and how that plays in medicine.

Vail: Yes.

Cunningham: As a surgeon that’s worked at two large academic centers, he was previously at Duke. What’s the process for evaluating technology in your department?

Vail: Well, we ve actually made a commitment to not only evaluating it, but trying to incorporate this into the department. I think it got started for a very simple reason. I guess, being in the Bay Area, we encountered a lot of vendors and startups and creative people with new ideas in digital health. Some of which was orthopedic specific, but honestly, not too much orthopedic specific, but healthy related. We started to ask ourselves, “Well, how are we going to take advantage of this tremendous opportunity being in this place, in this time, with this opportunity to look at the technology, evaluate the technology, decide what we want to adopt, and do it in an efficient way. We’re not wasting time, we’re getting the most out of it. Then maybe, best case scenario, partnering with some of these providers and creative people to create new things. That’s one point I would make to you.

I guess the second one, quickly, is that we see electronic health, digital health being promoted. In so many ways, the promise is huge of efficiency, but in so many ways it’s falling short. It’s not there. It’s impediment. It takes more time. If you talk to physicians about using the electronic health record, I don’t think you’ll get too many smiles or real happy faces about how that works. The question is why, because I think we all believe that, “Well, this has the potential to be great,” but it’s not. We really want to help drive this for orthopedic surgery to a place where it really does work and get the best out of it.

Cunningham: That’s fantastic. Yeah, I would agree that a lot of times in our personal life, the technology that we use helps us be more efficient. Yet it’s interesting that in healthcare, sometimes it can slow us down. I agree with you that there’s definitely room for improvement there. What is an example of an innovated or new technology that you’ve implemented in your practice, that is one of those pieces that’s like your mobile phone these days. That you can’t imagine what you did before you had it?

Vail: Right. Well, there is one that actually takes advantage of the mobile phone, and that is obviously … Somebody said today in the conference, “Well, the iPhone’s only been around for nine years.” Well, can you imagine that? It’s ubiquitous now, these smart phones. Everybody’s using a smart phone. Why not take advantage of that? In the best case scenario with digital technology, we would constantly be in touch with our patients. It would enhance this feeling of high touch. It would enhance this feeling and hopefully too, the reality of the patients, that they’re in contact with their physician. That they’re getting the information that they need. It improves their satisfaction, and ultimately improves the quality of care.

Well, one of these that we’ve adopted is a tool for patients having joint replacement. The patient would download an app once they signed up for a joint replacement. Embedded in that add is the information about that person, of course with their permission, that says they’re having a total knee replacement on X date. With that knowledge, that simple knowledge, the app begins to communicate with the patient ahead of surgery and say, “You have surgery coming up in two weeks. Have you thought about where you’re going to go after surgery?” Do you have somebody that’s going to stay with you? As you get closer to surgery, “Have you taken your shower?” Tomorrow is surgery. “Don’t forget not to eat after midnight.” You get the idea.

Then it continues afterwards, and it solicits information from the patient and says, “How are you feeling? Are you having a lot of pain or not? Is your pain well-controlled? Are you concerned about how the wound is? Are you having pain in the calf? If so, what is that like?” Then it triggers further communication to the care providers, to the physician, surgeon, or one of our physician’s assistants or nurse practitioners. When there is an alarm, when there is something that requires a response, so there’s- This platform, we envision it- It’s just the infancy, okay?

Cunningham: Okay.

Vail: Just getting started using some of the limitations of that technology that I’ve described to you. Within that, because it’s a secure network, you can have a patient send you a picture. If they’re concerned about a wound, they can send you a picture. You can attach tools to assess their level of satisfaction. It becomes not only a clinical tool, but a research tool. Any creative person listening, could begin to think about, “Well, what else could you attach to that platform that might be useful?” Like motion sensors, tells you how well they’re actually recovering. We adopted that one because we see it as a platform upon which we might be able to attach a lot of things. It’s a patient [satisfier 00:05:49]. It puts information collection in alignment, real-time with patient care, so it’s not extra. We’ve found that it decreases phone calls. That’s one example of a successful adoption of a technology.

Cunningham: Now how did you get that? Naturally, there’s an expense associated with these technologies, right? Nobody wants to pay for it. Was this something that was a grant-funded-type situation? Or was this something that was pushed up through administration and budgeted for? If so, either way, can you describe that process?

Vail: Right. That’s a really good question because it was part of the motivation. You asked me, “How did we get into this?” Well, my department, like most other departments or practices, has a limited budget for doing things. You have to decide where’s your best value, if you’re going to invest. Maybe even better, be a partner with, and decrease the cost by helping somebody who’s creative starting a company, develop something. We’ve done a little bit of both in this instance where we’ve committed some money to this, to be a subscriber. We’re also a partner in developing the interaction that I’ve described on this iPhone. How do we want it to look? What do we think is important? What questions do we want to ask our patients? We’re doing that. We’re part of this development process.

Cunningham: Almost like a sophisticated beta?

Vail: It is. It is in fact something like that. I don’t want to give the impression it’s not some huge money maker. It’s a way to mitigate the cost a little bit. To say, “Well, if we’re going to invest some of our money, which is a limited resource, is it a useful investment? Can we demonstrate that it provides patient satisfaction and quality?” This is one where, because we’re actually taking metrics right off of it, we can do some of that measurement to get some positive reinforcement that this is in fact the right thing to be doing for our practice.

Cunningham: Okay. I have one final question for you. That is, where do you go to find these new technologies? It’s at conferences like this, right? This is an amazing land here in San Francisco, we have all of these great startups. Do they come to you? Do you see them at conferences? Are you just constantly being pitched these ideas or these new products? Tell me where you go for your info?

Vail: Right. Well, it’s a little bit of all of those things. We are actively looking for things, okay? That’s part of it. There’s a group of people in my department from various disciplines who are really interested in this, who are innovators themselves, helping develop some of these ideas themselves, which is also helpful. You are correct in pointing out that because we are where we are geographically in the United States, we do have these things landing in our lap to some extent sometimes. So many people outside of my institution that are doing this work are in this area. Then, we asked ourselves the same question, which is exactly why this Digital Orthopedic Conference got started.

We recognized that there’s a community of providers, a community of innovators, a community of companies, large, small, startup, established that are in this field. We want to bring them together to help A, make it accessible, B, facilitate the further development. That’s why we’re here today in year one of the Digital Orthopedic Conference. We hope that it will do what we hope what it would do in terms of conceptually. Then grow into something generically as the ideas and the conversation that occurs with the people that are here. So far so good.

Cunningham: Yeah. I would guess that this is year one of many to come.

Vail: I hope so.

Cunningham: Dr. Vail, it’s been a pleasure talking with you. Thank you so much for your time and your great thoughts and information.

Dr. Vail: My pleasure.

About the Author

Ellen Laux

Ellen Laux

Ellen is a design and marketing veteran and lives on the marketing team at CODE. She's focusing on helping surgeons and hospitals understand and LOVE PROs.

ellen@codetechnology.com