Use Virtual Hospitals and Technology to Deliver Patient-Centric Care

Medically Home Group’s Chief Medical Officer Dr. Eliza, “Pippa”, Shulman at CES 2020 Digital Healthcare Summit

“My story does not begin in this lovely room, I hope none of your stories begins in a ballroom at the Venetian actually, I’m eight years old and I’m sitting on a gurney in a hospital emergency department. My arm is about to be set. Now I’m not crying. I’m looking around at this place, the lights, the beeping noises, there was an actual light box with an x-ray on it, people were moving all around, checking in on me, doing all kinds of wondrous things, kind of dancing almost with each other, and I’m not crying. I cried earlier when the sixth-grade boy pushed me off the top of the slide. But I’m not crying now. I am absolutely dazzled by what I see. And I think to myself and my little eight-year-old brain I think I’d really like to spend a lot of time here. And it was at that moment that I decided I wanted to become a doctor. It was also at that moment that I realized medicine is this interesting blend of the good and the terrible, of the comfort and pain and kindness and technology and people. And I tried to carry that forward in my career.

In medical training I was always the first one to try the new thing. I carried my Palm Pilot very carefully in my white coat, taking notes on it, it was terrible by the way, although I do kind of miss it and I have it in my drawer. I always wanted to try the newest thing and so when I was offered the opportunity to take part in a new pilot with my primary care patients using voice recognition to try to monitor patients for depression and isolation I jumped at the chance. And I knew exactly which patient I was gonna try this on. So, the next day one of my favorite and most complicated patients came in and I extolled the virtues of this technology. We were gonna help her avoid the hospital. Now, let me paint a picture of who this woman was. She was in her mid to late 60s, she’d been institutionalized for a large part of her life because severe mental illness. She had multiple chronic conditions including congestive heart failure, COPD, hypertension. She came to our emergency department almost every single day. She “Trick-or-Treated” in the emergency department. She sang Christmas carols. And here I was the young doctor who thought, “I have a great idea.” So, she was convinced, it was installed in her apartment, and a week later she was back in my office very angry at me. You see the first day the algorithm called her, and she was a little suspicious, and the second day the algorithm called her she ripped the phone out of the wall and threw it out the window. Now in retrospect you could’ve seen for the naïve doctor that this would have been a bit of a failure, but I had forgotten, in my zeal to try the new thing, to respond to this need to monitor her. I had forgotten the key point which was the patient. I had forgotten what kind of problem I was trying to solve.”

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“So fast forward. I become a family physician and then a geriatrician, hospice and palliative care.  I take over care of the department of geriatrics and palliative care, and I have the incredible opportunity to move into an innovation role at the new innovation center at Atrius Health where we are really focused on how can we provide the best possible care for our patients using the newest technology and the most amazing care model redesign?

We believe in human-centered designs We brought patients in and had them participate in our work at every step of the process and really talk to them and listen to them and heard what they had to say. And the number one thing our patients talked about was hospitalization. That they wanted to avoid the hospital. That they wanted to stay in their homes independent before, during, and after their illness. That was their safety net. And so, for the last three years I have been making that dream a reality. We have built a virtual hospital that allows us to bring the most high-tech, complex hospital care to someone’s living room. We can infuse medications. We can do x-rays. We can place central lines in their homes. And it’s incredible but the magic is in the compassion and the care and the trust that’s enabled by how we designed this system. The magic is that as a physician I am looking into their space and I’m seeing their clutter and I’m seeing how they walk and I’m seeing the foods they don’t want me to see them eat. And I’m seeing the reaction on their face when we talk about hard things. I’m hearing the anxiety in a daughter’s voice and I’m responding with my voice and my body language.

Our first patient was a gentleman by the name of Chuck. I’m allowed to say his name. And we treated him for, let’s see he had pneumonia, urinary retention, hypertension, a whole bunch of issues. And we treated his medical problems. But during his episode of care we learned that he was being financially exploited and in a living situation that he couldn’t escape and had been estranged from his family. So, in the course of his care, we brought him back to health, but we also enabled a new connection with his family and got him closer to them and got him in a new living situation. And I wish I could take credit for that, but I can’t. This was the combination of the most incredible technology, but the most incredible humans, making this person feel like they were safe and cared for and not alone and that’s the power.”

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“This whole show is filled with the most wondrous technology. You can go downstairs and play for hours with some of these great toys and we’re hoping to incorporate some of them into our program. However, very little of them have been shown to reduce the real problem; which is in the physician burnout, in clinicians burning out, in nurses burning out. Atul Gawande wrote this incredible piece in the New Yorker not too long ago where he described this idea of the tar pit that was engulfing all of us. That we spend our days in front of this computer focused on the constraints in doing our jobs, rather than in actually doing our jobs. And my belief, truly, is that by using these technologies by creating systems where the technology actually vanishes, where it takes a backseat to that empathy, and that human connection, that’s what will get us out of the tar pit. Artificial intelligence should make us more intelligent. We should use it cooperatively with physicians. It should not make the encounter feel artificial which in so many ways it does. It should look like the patients that I’ve recently cared for.

One, in particular, I want to tell you about is a gentleman who was diagnosed with pancreatic cancer and we take care of these patients for four months while they’re having their very intensive chemotherapy. We install a virtual hospital in their living rooms, but more than that we listen to them about their symptoms. We proactively respond to their symptoms. We prevent dehydration, monitor vital signs. This patient for the entire time he was with us was able to go to his cabin up in New Hampshire every single weekend. He would bring the monitoring equipment with him and he reported his vital signs in and then when I would do my video visit with him on Monday he would remind me, “You know Dr. Shulman my blood pressure is much lower by the lake.” And he was right. Everyone’s blood pressure is much lower by the lake. And that’s the opportunity here. That’s the power of all the new generation of technology. Some people come to healthcare from technology and some to technology from  healthcare, but we have to remember is that it’s about a human being, about making that technology vanish and disappear because we went into medicine, and I heard someone say this from the stage just a few moments ago, because of that intense caring and empathy and the desire for that human connection. And so how do our magical innovations here help us strengthen, help us provide the safety, and the necessary care that we have. That’s the way I see out of the tar pit. It’s allowing people to return to their lives. It’s allowing my 41-year-old type one diabetic with a complicated skin infection to stay home with his family when he needed hospitalization, to be with his kids, to return to work quickly, and to not feel like he was defined by his illness. I am so excited about the opportunity for us to transform care in this way but not just because it’s the shiny and new but, because we’re actually putting people at the center of what we do. That that is the problem we are solving. And that we are being the most authentic care, the most authentic innovation, to provide the most authentic advances in healthcare today. Thank you.”

– Dr. Eliza, “Pippa”, Shulman at CES 2020 Digital Healthcare Summit

Meet Dr. Shulman and the rest of the Medically Home Group team.

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