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Saving the lives of the future: Grand Rapids plays starring role in national health care

 Dr. John Deveau speaks with patients over video chat.

To say the healthcare industry is in flux is an understatement. As the field evolves, however, one thing is certain: by continuing to implement new and improve existing technologies, Grand Rapids is at the forefront of innovation in health care.
A distinct tone cuts through the sterile air of the emergency room floor as hospital hallway doors swing wide open.

A team of nurses briskly escort a motionless stroke victim on a wheeled gurney toward the operating room. A doctor assessing the situation rules out more than one life-saving option as vital seconds count down.

The patient is, at this point, likely not considering the possibility of a wormhole on the other end of the hallway, but the technology at work in today's health care facilities is perhaps the next best thing to turning back the clock.

From predictive care, and machine learning models (which use algorithms in order to identify patterns and make predictions in data) integrated with wearable devices, to the biological science of cancer research, technology and modern medicine are often one and the same. West Michigan's epicenter of health care and research, the Medical Mile, has been and will become even more of a driving force in this field in the coming years. There is no shortage of research going on down the road from Michigan Street, either.

The basis for technological improvement, health care providers like MetroMercy, Priority, and Spectrum are finding new ways to incorporate the research into their practice every day. By connecting the machines that many hospitals have been using for years through a data center, providers are finally starting to make the most of the information that’s being collected on both sides of the stethoscope.

The Metro Health Innovation Center, a partnership with the University of Michigan, has brought connectivity and digital communication into the hospital by providing staff with reliable and normalized records, allowing every physician the advantage of knowing crucial patient details the second the examining doctor logs them. Rehabilitation and recovery plans can be augmented by an algorithmic process to hasten the healing process.

At Spectrum, tools are developed completely in-house, from idea to iteration, under the guidance of Dr. Brent Mulder, senior director of Spectrum Health Innovations. New devices like the Pannus Support and Airway Innovations represent successes of their work, which has been licensed to other healthcare systems across the world. Even the Seamless Accelerator, a global technology incubator facilitated by several West Michigan corporations, as well as Priority and Spectrum, have interests in health care innovation. Data and machine learning are being used to improve the system on nearly every health care facility’s floor, but it all starts with humans.

Individuals like John Deveau, medical director for Emergency Care Specialists and Answer Health on Demand, are changing the way children, the elderly, and other patients in rural and underserved areas view healthcare with advances in telemedicine and mobile apps.

A West Michigan native, and graduate of the Michigan State University College of Osteopathic Medicine, Deveau’s work becomes even more relevant as our population grows. Access to health professionals 24 hours a day was once a distant dream for those living outside major metropolitan areas. In combining existing telecommunications technologies with medical knowledge and training, Deveau and Answer Health on Demand have made it possible for anyone with an iPhone or Android device to be checking in to a doctor’s “office” in minutes.

Innovation is driving healthcare forward, and it’s being generated by research, analysis, experimentation, and wonder.

Haley Kamp uses her iPad to speak to a doctor.

Dr. Norman J. Beauchamp, Dean of the Michigan State University College of Human Medicine, has been eagerly awaiting the opening of MSU’s new research facility in downtown Grand Rapids. The building will serve as a testament to the innovation cycle in health care, which, Beauchamp says, starts with a question practitioners need to ask: What can't I do for my patients? Connecting that answer to scientific research, solutions then emerge which can be introduced in clinical applications. With an industry partner, those solutions can be developed into a national and global distribution.


Beauchamp is no stranger to this cycle. Neither are the many he's been able to save through innovative monitoring and treatment methods in the moments after experiencing a stroke. While working with General Electric at Johns Hopkins University in Baltimore, Beauchamp and his team developed software that allows magnetic resonance scanners to track the movement of water molecules in the brain, allowing them to understand more about how and when treatment is most effective. Their work has essentially extended the treatment window for stroke victims around the world. All it took meaningful conversations with physiologists, engineers and scientists, as well as faith in the innovation cycle.

"I knew that if we could use that in MR imaging that's done in hospitals across the country, then we could better evaluate patients with stroke and extend the treatment window," Beauchamp says.

Dr. Norman BeauchampBeauchamp, who grew up north of Lansing in St. Johns, was awarded his undergraduate degree from Michigan State Medical School at Michigan State University, and later attended Johns Hopkins for residency and fellowship, where he trained in neuroradiology and interventional neuroradiology. Beauchamp spent his last two years of medical school in Grand Rapids and completed his surgical internship at Blodgett Hospital and Saint Mary’s Hospital. After achieving a Master's degree in public health at University of Washington, where Beauchamp served as professor of neurosurgery, radiology and industrial engineering, he returned to MSU in 2016 as the dean of the College of Human Medicine.

Beauchamp is overseeing the launch and initial work of MSU’s new research facility at Michigan Street and Monroe Avenue. From his room at the Rowe Hotel, he says, he can see some amazing hospitals practicing state-of-the-art work. While they may be separated by physical walls, the physicians and faculty face similar challenges in identifying gaps in care. But where these gaps can be identified and linked to the strengths of scientific research, either in-house or at centers like the Van Andel Institute, the innovation cycle will generate growth and improvement within the system.

"We will be able to be one of the leaders in connecting the things we can't do to our capabilities, and driving it back through," he says.

One of the biggest opportunities in medical research is that for both public and private partnerships, Beauchamp says. The health care industry, in using tremendous amounts of data in daily operations alone, literally has a lot to learn from the way others use that same information. Where there's a gap in knowledge, there's an opportunity for the innovation cycle, he says.

West Michigan is home to an impressive number of health care providers, and there are indeed some gaps to be identified. But strategic partnerships that facilitate the closing of those gaps are not more than a few blocks away.

Using data

In 2008, information on search queries collected by Google was linked to a flu epidemic in the country. As  search bars were filled with "headache" and "nasal congestion," a pattern started to emerge.

The results of "Google Flu Trends" didn't exactly replace the Centers for Disease Control and Prevention, but a valuable lesson was learned: There is much more information in the data that health care professionals acquire every day than they've been using.

At the University of Washington, Beauchamp worked with Philips, the Dutch technology company, to deploy computer scientists and mathematicians on a data project for a network of five hospitals. They noticed that the imaging equipment being used was all remotely monitored so technicians could make repairs efficiently. In aggregating that data, Beauchamp and his team were able to look at the entire system, and establish strategic improvements.

Six million patient interactions with hospital equipment provided the data. Beauchamp could tell how long a technologist who handled patient scanning and ultrasound held a probe, and when she sat it down. He could see a number of details about the way procedures were being handled, but more importantly, he could see where in the five hospitals patients were being seen efficiently, and where they weren't.

This approach also been applied to looking at how often physicians follow a recommendation from a referring physician. Beauchamp has found that only 40 percent of the time does the referring physician follow the recommendation. But after enough research with large data sets, he and his team, using natural language processing, a method of translating human language patterns into data that a computer can analyze and map, actually discovered it's dependent on how you make the recommendation, and not to whom.

"It turns out, about 20 percent of the cost  [of medical treatment] can be removed, and the effectiveness increased if you can find ways to get referring physicians to comply with recommendations by an expert," Beauchamp says. "By being able to look at large data sets, you can start to identify best practices, then you can systematize them, and sequentially make them better."

No small part of the MSU Research Center in Grand Rapids will be dedicated to data analysis. Beauchamp is personally overseeing the installation of the MSU research facility’s data science core, and expects the metrics derived once operations begin to provide even more insight into how to adjust and improve health care systems.

Machine learning

Initially applied to radiology and making it easier to detect where there is a hemorrhage in the brain, machine learning and smart machines that can continually improve their approach are giving hope to victims of stroke and serious disease.

Identifying a hemorrhage on a CT scan is incredibly challenging, even for trained professionals. This fact, and the resulting lack of confidence in doctors faced with such a search, leads to a large number of misdiagnoses and follow-up treatment plans, Beauchamp says. That's where the machines come in.

"What we've found with machine learning is that we're able to teach a computer how to go in and find where the hemorrhage is on the CT scan and identify it for the doctor," he says. "Then, the doctor is able to be confident in the detection of blood, and it goes him the confidence to give the right treatment to the patient. We're finding that we can also apply machine learning to detection of cancer, to improving stroke, and we believe a number of other areas will be possible."

A major reason for chemotherapy or surgery is a doctor's initial pathology or diagnosis. The decision a physician makes after looking at a biopsy will often dictate whether or not surgical procedures need to take place. Beauchamp quotes one study that found breast cancer diagnosis changed about 20 percent of the time after a second opinion.

"You can imagine, you go to a regional center, they do a biopsy and they say you have an aggressive breast cancer and start treatment," he says. "One time out of five they are misdiagnosing that biopsy."

What machine learning can do for this field is find the markers within a digitized slide and determine a likely diagnosis for the patient. That insight is scarred on to the next task, and the next, and the machine gets smarter and smarter.

"It won't replace physicians, but it will increase safety and decrease costs," Beauchamp says.

It also improves patient safety. The intensive care unit monitoring system, as ubiquitous as they may seem in hospital rooms, generate a huge amount of data. While it's not feasible for a human to analyze that data in real time, a computer can. Using predictive analytics, computer software can determine when a patient is going through shock, or headed toward sepsis. By being able to spot this otherwise aggressive and infectious condition early, doctors can intervene.

"By linking this informatics core to patient care delivery, we are going to be able to lead in creating the algorithms and software for monitoring, but we're also going to benefit health care by taking out costs in an important way, and improving safety for patients," Beauchamp says.

Non-invasive procedures

Some health care providers are warming up to the idea of providing care as gently as possible. From bariatric procedures at Spectrum and other hospitals, to spine realignment surgery, data mining and new imaging technologies are being used to eliminate the need for scalpel work.

A specialty of Beauchamp's is minimally invasive treatment for stroke and aneurysms. What used to require a five-day hospitalization, with surgery to remove a piece of the patient's skull, exposing the brain for doctors to treat from the outside, is now a small discomfort.

"We invented a way to actually treat that from a small needle puncture in the leg, going up into the brain, always staying on the inside of the artery," he says of a technique that’s been in practice at the University of Michigan since 2006. "What that allowed us to do is change something from a major surgery to something that can be done in a 23-hour stay."

An even more subtle approach would be not having to come to the hospital at all, which wearables and telemedicine have provided to patients in remote areas. A Bluetooth-enabled bracelet licensed by Spectrum as part of a National Institutes of Health program can track activity and keep patients on top of their sleep and exercise schedules, while Nintendo Wii games provide rehabilitative therapy. Smartphone applications have even been developed to measure asthma, and using the accelerometer, provide osteoporosis data. These innovations were once just exhibition at the TEDMED conference hosted by Steelcase’s health care brand, Nurture, in 2012. Today they’re integrated into mainstream use.

Telemedicine

Theresa Bacon-Baguley, associate dean for research at Grand Valley State University's College of Health Professions, leads the 12-year-old telemedicine initiative in the physician assistant curriculum. One of the missions of the the Physician Assisted program at Grand Valley is to provide rural and underserved populations with access to proper health care.

Theresa Bacon-Baguley

Updating the interactive television technology that's been available for at least 20 years, Bacon-Baguley, originally from Hart, Michigan has seen an improvement in the way both care providers and educators can help others. About five years ago, the program expanded from Kent and Ottawa County into the Traverse City area, providing education to health care professionals who would hopefully stay in the community, and provide care to the citizens they live with.


A telemedicine program has been operating at the University of Arizona for more than 20 years now, and in another two to three, Bacon-Baguley says, 80 percent of medicine will involve some sort of telemedicine technology.

"At the time we looked at incorporating telemedicine into our curriculum, there was no other physician assisted program in the country that was doing it," Bacon-Baguley sayd. "We did our background, went to the University of Arizona, and looked at what it takes to teach students about telemedicine and are in the process of developing a pretty intensive educational model for the usage of telemedicine."

Telemedicine practitioners study everything from dictation and presentation on the computer or phone, to operating ultrasounds and EKG equipment remotely. Otoscopic and ophthalmoscopic procedures are covered as well.

GVSU relies on Answer Health on Demand, a Grand-Rapids based company that provides instant face-to-face web conversations between patients and providers, as a telemedicine platform. Working with Exodus Place, Answer Health also provides telemedicine to transitional housing occupants in Grand Rapids. GVSU students have been "sitting in" on medical procedures being administered through telemedicine, with all the appropriate consent forms filed, and acting as physician in mock scenarios.

"It's a great step-wise approach for students to actually get used to the technology and see it in action," Bacon-Baguley says.

Spectrum Health operates its own telemedicine service as well. MedNow was launched in 2015 and has since provided parents of school children a welcome rest from unexpected sickness

Biologics

Perhaps some of the most technologically advanced work being done in health care happens within our own bodies.

Once thought to be our unalterable code, modern scientists are finding they can splice genes in and out of DNA, similar to editing the notes of an orchestral masterpiece, but producing far greater good for humankind. A clinical report published in Nature has shown that the HIV-1 genome can be effectively targeted and removed by an RNA-guided CRISPR editing system, a method that allows scientists the ability to remove, add, or alter segments of DNA. A December piece in New Scientist even reported that gene editing could take on leukemia, and has already been integrated into the Chinese health care system.

Clinical trials in cancer research may require more than a decade of research, costing billions of dollars. There's no doubt innovation and technology can benefit the field greatly. At the Van Andel Institute, along with work in genetic mapping, scientists are working on fighting metastatic colorectal cancer, Parkinson's, and other serious diseases through continuous research and private and public partnerships. Even as David Van Andel admits in the Grand Rapids Business Journal that it's often an uphill battle, new discoveries are made every day.

Stem cell therapy is yet a vastly opportunistic field for medicine, as are innovations in regrowth. Platelet rich plasma has been used to some success in helping the body to regenerate cartilage, as opposed to opting for an implant.

"Things like that you see fostering more rapid healing. Being able to look at the development of biologics, delaying significant surgery, will be a big part of what we'll be able to do, in terms of technology, in the future," Beauchamp says.

Not only delaying surgery, but helping doctors perform those procedures faster and more efficiently than ever is a possibility with 3D printed tissues and organs. As the cycle of innovation continues, the only limit to our future growth is our own research. All theories aside, the future has already brought a host of solutions to our own medical capability.

To say the health care industry is in flux is an understatement. Residents of West Michigan, at least, have the privilege of proximity to renown care providers and research facilities. But even as proximity loses its value, whether it’s the science of data analytics or biology that drives our discoveries in medicine, one thing is for sure: Grand Rapids will be playing a major role in saving the lives of the future.

This article is part of Rapid Growth's series highlighting the technological innovators and drivers in West Michigan. To see previous articles in this series, please go here. This series is funded by Open Systems Technologies(OST), a Grand Rapids-based information technology leader that is delivering enterprise level solutions around the globe.

Matthew Russell, the editor of this series, is a writer, baker, inventor and mapmaker living in Grand Rapids. He enjoys bicycling and playing with his daughter as much as possible. You can email him at m.s.russell@gmail.com, or follow him on Facebook and Twitter.

Photography by Adam Bird.
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