Advances at Southeast Michigan Health Systems put patients first
By Ilene Wolff
Southeast Michigan is among a handful of regions nationwide that has a wealth of medical facilities able to treat even the rarest conditions. These hospitals employ the highest of high tech to treat people from around the world. Patients also benefit from hospital- and university-based research that uncovers the most innovative treatment alternatives available.
X-OLOGY surveyed medical facilities in the region to discover new healthcare technologies, including integrated wireless tech that makes being in the hospital safer and more comfortable; a new way to diagnose stroke via telemedicine; medical technology that improves diagnosis of aggressive prostate cancer; and partnerships that make it possible for children and adolescents with acquired or congenital hand and arm deficiencies to live more productive lives.
Intelligent Care System covers all the bases
Practices like hand washing, preventing patients from falling, establishing an atmosphere for healing and having the necessary medical equipment nearby are basic measures in a hospital providing quality care, but in the hustle and bustle of a busy inpatient unit, steps can be overlooked. As a result, patients may be exposed to infections, healing delayed and staff time wasted.
St. Joseph Mercy Oakland hospital in Pontiac, MI, has taken action to eliminate such risks.
St. Joseph built an Intelligent Care System — an integrated network of wireless, computer-based technology — into its new $145 million South Patient Tower, which opened in 2014. The system includes real-time location badges that record whether staff members clean their hands. The hand-cleaning data is compiled and sent to hospital leaders to remind staff that washing hands is one of the most basic infection control measures.
“Right now, not only are we tracking staff, we’re tracking equipment,” says Robert Jones, information services director for Trinity Health, the hospital’s parent company.
Step inside a patient room and you’ll see a bed that records patient weight and monitors critical safety measures including bed height and whether side rails are up and wheels are locked. If a patient tries to get out of bed and shouldn’t, an alert is sent to every staff member on the floor and a light flashes outside the room.
High-tech beds aren’t the only technology in evidence. Patients wear wrist devices that track blood pressure, heart rate, level of blood oxygen, breathing and temperature. Data is sent to patient medical records and nursing staff, eliminating the need to wake sleeping patients in order to take vital signs.
Rooms are also equipped with telespeakers that enable patients to communicate with staff. Pressing the “pain” button summons a nurse. Pushing the “bathroom” button sends a call to a patient care assistant.
Four years in the planning, Jones and Dr. Fabian Fregoli, vice president of quality and safety for the hospital, started the project by asking staff, “If you could build the best system, what would it do?”
“We really wanted to push the limits on this,” says Fregoli. “These are the things that our caregivers said would help workflow.”
Jones and Fregoli assembled a group of eight vendors, making it clear from the start that every technological component had to work as part of an integrated whole.
“Vendors had some initial trepidation in working with their competitors,” says Jones. “But they eventually came around once they understood the vision and goals of the hospital.”
Tuning in to treat stroke
During his interview for this story, McLaren Health Interventional Neurologist Dr. Aniel Majjhoo was on his way from Mt. Clemens, MI, to treat a stroke patient in Flint, MI, whom he had diagnosed just minutes earlier.
Majjhoo, who is based at McLaren Macomb, hasn’t mastered teleportation. He used TeleStroke from InTouch Health (Santa Barbara, CA), a telemedicine system new to McLaren that enables doctors to examine patients remotely, view their lab results and images, make decisions about using clot-busting medication and talk to patients, family and staff at another hospital, in this case McLaren Flint.
Majjhoo doesn’t even need to be near a wireless router for the cloud-based system; he uses an app on his smartphone or laptop that has a 4G LTE Network connection to control a telemedicine robot at the Flint hospital.
“It’s almost as good as being at the bedside yourself,” says Majjhoo. “The picture quality is so good that you can actually examine patients’ pupils.”
While Majjhoo drove northbound on Interstate 75, a physician assistant in Flint was making the necessary arrangements to take the patient to a catheterization lab where the neurologist would remove the clot when he arrived.
“Every minute you leave a brain with a clot about two million brain cells die,” Majjhoo says.
Majjhoo, who used telemedicine for treating strokes at another health system before McLaren, explains there’s a three-hour window to administer clot-dissolving medication, and about twice as long to do a clot removal procedure using a catheter inserted through an incision in the groin.
The interventional neurologist is one of two currently on staff for 10 hospitals in McLaren Health Care Corporation. Plans are to add two more of the specialists, says Majjhoo.
“We’re starting with stroke, but we’re planning to extend to neuro-critical care as well as other neurology consults,” says Majjhoo. “After that there is a lot of potential in other fields such as dermatology, psychiatry, infectious diseases or any underserved area.”
Majjhoo is enthusiastic about using new telemedicine technology for a condition that can be debilitating when treatment lags.
“I think McLaren is at the frontier of stroke care with this telemedicine network and the new guidelines in stroke that just came out,” he says.
Progress in detecting prostate cancer
While Majjhoo was on his way to Flint, Dr. Jeffrey Montgomery was seeing urology patients in Ann Arbor, MI, where University of Michigan specialists have combined techniques for more refined prostate cancer diagnosis in order to detect aggressive disease that’s likely to grow quickly and spread.
Many of the 239,000 men diagnosed each year will die with the disease, not from it, because most prostate cancer grows slowly. However, some men develop aggressive prostate cancer that requires immediate and aggressive treatment. The challenge for doctors is to accurately identify the type. U-M urologists like Montgomery, an associate professor, use the UroNav system, which fuses magnetic resonance imaging, or MRI, and ultrasound images, marking suspicious areas to help guide a biopsy needle. The system is designed to make sure all suspicious tissue is sampled.
One U-M doctor compares traditional prostate biopsies to being blindfolded while shooting fish in a barrel. The new technology removes the blindfold.
MRI is primarily used to identify potential prostate cancer when the standard exam doesn’t clearly identify disease type; for example, a negative biopsy but a rising prostate-specific antigen (PSA). MRI is very effective at detecting moderate- to high-risk cancer while ignoring low-risk disease, says Montgomery.
U-M urologists have developed a new test, the Mi-Prostate Score, or MiPS, to more accurately diagnose aggressive cancer. MiPS combines PSA with a marker and genetic anomaly present in half of all prostate cancers discovered at U-M. The marker, PCA3, and the genetic flaw are detectable in urine.
“PCA3 is a biomarker that we generally use for men in cases where we want more information to assess their risk for a positive prostate biopsy,” explains Montgomery. Such patients might have an elevated PSA and a previous negative prostate biopsy. Doctors try to figure out if the biopsy should be repeated, Montgomery says.
“In combining those three factors, we have an algorithm that generates a score indicating what percent chance the man has of a diagnosis of any prostate cancer on a repeat biopsy and what chance that it would be high-risk prostate cancer.”
Neither MiPS nor the urine tests replace PSA and a digital exam for prostate cancer screening, says Montgomery. “It’s a very nuanced test,” he says. “It’s not currently appropriate for the general public.”
Giving kids a hand
While U-M is making strides in diagnosing aggressive prostate cancer, Beaumont Children’s Hospital is changing the lives of children and adolescents who have had a hand amputated or were born without a fully developed upper limb. The hospital’s Variety Myoelectric Center at Beaumont Children’s Hospital, in Royal Oak, MI, led by Medical Director Edward Dabrowski, M.D., has fitted eight children with high-tech prostheses since opening in 2014. Children control movements in a myoelectric limb using their own muscles, which are attached to sensors.
Myoelectric prosthetics are attached to a limb with suction; once attached, the prosthetic’s electronic sensors detect minute muscle, nerve and electrical activity. Muscle activity is translated into signals that the prosthetic’s electric motors use to control the artificial limb. Children can control the strength and speed of the prosthetic movements and grip by controlling their own muscle intensity.
With a myoelectric prosthesis and occupational therapy training, children can function more like their peers with two biologic hands.
“It’s amazing what the kids can do,” says Dabrowski. “From zipping a zipper, to buttoning clothing, to tying their shoes.”
The center, sponsored by Variety the Children’s Charity-Detroit, has existed since the early 1980s, but was located in different downtown Detroit sites before moving to Beaumont, Dabrowski says. The Beaumont patients join more than 300 other children who have benefitted from the expertise of the center’s staff and Variety’s funding.
“Without Variety, this program would not be viable,” Dabrowski says. “The funding makes a huge difference.”
The charity’s funding is critical because insurance companies have balked at paying for the prostheses, which can range from $12,000 to $30,000. Beaumont is a Children’s Miracle Network hospital, and that organization has contributed additional funding.
Also filling the gap is the center’s limb bank, which consists largely of prostheses children outgrow as their bodies develop. Each child requires multiple prostheses over many years to accommodate growth. The bank has become even more critical as manufacturers stop producing the myoelectric arms because of insurers’ hesitance to pay for them, says Dabrowski.
Talk About Personalized Medicine
The medical community in Southeast Michigan is turning to 3D printing to make patient-specific guides for knee replacement surgery and splints for babies whose airways haven’t developed, in addition to planning complex surgeries.
Also called additive manufacturing, 3D printing makes items by layering raw materials. The technique can manufacture intricate items, with complex geometries that would currently be impossible to make any other way. 3D printing has been used in the automotive industry for decades. In medicine, design can be based on imaging of individual patients, such as the patient-specific cranial patch used to fill skull defects, which was the first FDA-cleared, 3D-manufactured polymer implant.
Materialise, a Belgian company with a location in Plymouth, MI, has applied for clearance from the U.S. Food and Drug Administration to employ a different imaging technique to make guides for surgeons to use while performing knee replacements. Currently, the FDA mandates that guides are based on either computed tomography or MRI scans.
Since few people have the sophisticated, higher-cost, imaging done, Materialise wants to make patient-specific guides based on X-rays. Almost every knee replacement patient has had a knee X-ray, and many orthopedic surgeons have imaging machines in their offices.
The company submitted an application in March to the FDA for clearance to base the guides on X-rays, and their request is under review. Materialise has been testing guides based on X-rays in surgeries in the European Union for more than a year.
At Henry Ford Hospital in Detroit, a cardiologist is using a 3D printer in the hospital’s Innovation Institute to make models of patients’ hearts so he can properly size aortic valve replacements.
Cardiologist Dr. William O’Neill says the 3D printed models have finally given him and other heart specialists an adequate sizing tool. Properly sized valves are critical because valves that are too small can result in heart failure. In addition, the heart models allow him to plan correct placement of the replacement valve based on a patient’s unique anatomy and decrease the time needed for a patient to be anesthetized.
At Beaumont Hospital in Royal Oak, MI, plastic surgeon Dr. Kongkrit Chaiyasate uses 3D printed models of patients’ skulls to plan complex microsurgeries to correct deformities and enable proper brain development. He also shows the models to patients and parents to explain what will happen in the operating room.
Children treated at the University of Michigan in Ann Arbor also benefit from 3D printing, including dissolvable splints for babies whose airways haven’t developed properly before birth and have collapsed. U-M’s Dr. Glenn Green, a complex airway reconstruction specialist, has implanted several of the splints, which support the airway until the trachea cartilage can develop and stay open on its own.
Green has collaborated with a colleague, Dr. Scott Hollister, to make the dissolvable splints. The pair has also collaborated on a permanent trachea splint for adults with a life-threatening autoimmune disorder that weakens airway cartilage.