5 minute read
The highs and lows of clinical innovation
Elizabeth Brown | Senior Communications Advisor
When it comes to reducing the cost burden of cardiovascular medicine on our health system and improving equity, Auckland cardiologist Dr Patrick Gladding is all about finding solutions.
An estimated 170,000 New Zealanders are living with cardiovascular disease, and it is responsible for about one in three deaths.
Dr Gladding works for Waitemata - DHB, which serves a growing but ageing population on Auckland’s North Shore and a more disadvantaged and highneeds population in the city’s west. It adds up to a lot of people needing to be seen.
The key tools in any cardiologist’s toolkit are ECG, echo-cardiography or cardiac ultrasound, and Holter monitoring to detect arrhythmia. “In most hospitals the waiting list for an echocardiogram is anywhere between nine months to a year unless there is an urgent problem. We are not meeting the needs of tomorrow at all, we are just getting by today, but the wait list is long,” Dr Gladding says. He explains that under current standards of care, a patient gets referred by a GP, then most likely waits months to see a specialist. When they finally see the specialist, they get a blood test and an ECG on the day, then get referred on later for an echocardiogram or Holter. Once that’s done the specialist sees the result and the patients gets rebooked to a clinic, which can also be months away. “It just seemed daft to have someone come back time and time again, disrupting their employment, making them travel repeatedly and adding stress,” Dr Gladding says.
AI technology
Using AI technology, he has introduced the Rapid Cardiac Screening Clinic, which he is piloting out of Waitakere Hospital. The aim is to speed up the patient management process, make treatment more accessible and improve outcomes. Dr Gladding says patients can get things done “in one hit”. When they turn up, they have their height and blood pressure taken, have an ECG and a short echocardiogram, and then see the specialist. The AI tool analyses the data using a probability-based system.
“Ultimately, I’m still the one who makes the call on the need for any further investigation or treatment because I look at the disease probability after looking at the patient and talking to them. The machine learning probabilities either get disregarded or acted on based on augmented decision making – so I still do all the same things. “We’ve shortened the whole experience for patients down to about 75 minutes as opposed to hours of to and fro and waiting – or sometimes days or months waiting for these things.” Six pilot clinics have been run in the past year involving around 60 patients. In that time the number of cardiac ultrasounds has been reduced by 25%, twice the number of patients have been discharged, and feedback has been very positive. “One of the cool things about this is you can introduce a technology and run it side by side against your current system and compare it. If it’s as good, you can say I’m going to go with that now. The clinic also has modularity so you can just plug in or out different things depending on their value add.”
Frustrations and challenges
A self-confessed early adapter, Dr Gladding is driven by a desire to do things differently. “It’s frustrating to be a doctor in this era when it’s the same as when you were at medical school. Things are printed out for you on paper, we just got rid of fax machines last year. There’s a gap where we are still doing the same things, yet we could be introducing some new ideas.” There is also frustration over what he sees as the lack of investment in clinical innovation from a Ministerial level and the fact he gets pretty much ‘zero nonclinical time’, despite the requirement of the MECA.
“When I have my admin time, I fill that with trying to get this clinic off the ground along with my usual paperwork.
Dr Patrick Gladding in a clinic room at Waitakere Hospital
This isn’t the fault of our hospital management, which has been very supportive. DHBs are only given so much to work with, and it’s all focused on service delivery. The problem is higher up at a governmental level." “Investment doesn’t necessarily have to be monetary – it can be time and being able to remove yourself from clinical commitments,” he adds. Other staff have also given their time, support, and commitment to getting the clinic going. “It’s the people in the hospital who are crying out for FTE who are helping this clinic. Everyone is crying out for more FTEs to cut down these wait lists.”
Another challenge to clinical innovation that Dr Gladding points to is that the DHB has no budget for research and development, and New Zealand’s R&D healthcare budget is tiny compared to other similar countries. He says fostering clinical concept in New Zealand is important but clinicians face difficulties getting funding through the Health Research Council because it tends to fund incremental academic and scientific research rather than projects at the delivery end of health or transformational change projects.
In saying that, he is grateful for the support he has had from Waitakere Hospital’s own internal innovation group – i3 – and its focus on digital infrastructure. Engagement with local Ma -ori and bringing in Ma -ori advisors has been key. They have raised particular concerns around data privacy and sovereignty in relation to AI technology. “We have really valued that input because we know AI is starting to be used in multiple areas like radiology and ophthalmology. How you govern data and establishing social contracts for its use needs to be discussed with the public.” Once a few hundred people have been through the clinic, Dr Gladding is hoping they will be at a point where the clinic can be a sustainable tool that can be rolled out in other hospitals. “In two years, I would want recognition of the clinic and the idea, and for the Ministry of Health and people higher up to actually see that instead of expecting it to work on some laughable budget, to actually fund it properly.”
