Introduction and Welcome

Welcome to the First Annual Innovation Day at Childrens Hospital Boston. Every day I marvel at the depth and breadth of our innovative past and present. In 2010, I joined Childrens as its first Chief Innovation Officer and formed the Innovation Acceleration Program with Pedro del Nido, MD, Childrens Chief of Cardiac Surgery. Our team has a unique mission: to accelerate innovation at Childrens by supporting and empowering innovators to develop and test their novel ideas, to collaborate on strategic institutional innovation initiatives, and to initiate cross-disciplinary projects to address unmet clinical needs. We launched two grant programs, the Innovestment Grant and the FastTrack Innovation in Technology (FIT) Award, to supercharge innovation and the entrepreneurial spirit among Childrens employees. At that time, I was actually worried about getting enough applications to justify either programs existence. What a difference a year makes! Weve now completed the third round of Innovestment Grants, supporting and stimulating early prototypes and pilots of short-duration projects. These projects are meant to be interdisciplinary solutions and paradigm-shifting innovations are encouraged. Youll be hearing about some of them today. In partnership with Daniel Nigrin, MD, MS, Childrens Chief Information Officer, we have had two rounds of FIT Awards. The FIT program provides software development resources, including time with a team of experienced developers, to build clinical software solutions. Committed to rapid cycle development, these prototypes are usually completed within a few months. Youll hear about some of these today, too. Between grant cycles, we keep the buzz about innovation at Childrens going with a monthly Innovators Forum. Open to all employeesand always packedthe forum features guest experts and innovators looking for feedback on their ideas. To keep the conversation going and help inventors connect to resources, we also launched a social networking platform called SPARC (the Social Platform for Accelerating Resources and Connections). We recently held the first of a series of Innovation Boot Camps, to help spot and develop innovation opportunities, and have been hosting an active Mobile Applications Working Group. We also formed a Telehealth task force, and expect to see Childrens break new ground this year in remote care delivery and virtual physician-to-physician consultation models. Today, families come to Childrens for care from all over the world; tomorrow, telehealth projects will make our specialists and their expertise available at any time, anywhere in the world. Making health care safer, better and less expensive is our goaland that means fostering an entrepreneurial culture and celebrating our innovations. I invite you to dive into the next few hours, to challenge all of us with tough questions, to connect with new colleagues and to share your innovative ideas. Thanks for coming. Im delighted youre here!

Naomi Fried, PhD Chief Innovation Officer

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Agenda Overview
Folkman Auditorium 1-5 p.m.
1:00 1:15 Welcome and History of Innovation Presentation Sandra Fenwick, President and Chief Operating Officer and Naomi Fried, PhD, Chief Innovation Officer 1:15 2:50 Healthcare IT & Process Innovation Moderated by Sandra Fenwick, President and Chief Operating Officer Eric Fleegler, MD, MPH, in collaboration with Eugenia Chan, MD, MPH Collecting Childrens Health Information from the Patient, Parents and Teachers Through a Web-Based System Between Doctors Visits: ICISS Lynn Darrah, MSPT, MHA, in collaboration with Courtney Cannon, MBA ALICE: A White Board for Hospital Floors that Works Joseph R. Madsen, MD Does My Baby Have a Flat Head? Using the Web and Digital Photos to Triage Visits to the Doctors Office Peter Laussen, MBBS Using Real-Time Data to Catch Critical Care Crises Before they Happen: T3 Kate Donovan, PhDc, BS, AGST, in collaboration with Dennis Gotto, BFAVC Collecting Data the Green Way: Gastroenterology Procedure Unit Efficiency Tracker Debra Weiner, MD, PhD BEAPPER: Mobile Communication for the Emergency Department Care Team John Brownstein, PhD Public Health Surveillance in Real Time: HealthMap Rahul Rathod, MD When the Going Gets Tough, the Tough Get Data: SCAMPs Jeff Burns, MD, MPH Cloud-Based Learning Platform to Help Sick Kids Around the World: Pediatrics Without Walls Moderated Questions & Answers 2:50 3:15 Coffee Break Enders lobby Poster & Demonstration Session 3:20 4:50 Healthcare Device Innovations Moderated by Pedro Del Nido, MD, Chief of Cardiac Surgery Pierre Dupont, PhD Robotic Surgery Inside the Beating Heart Karen Sakakeeny, RN, BSN, CNOR, CPN Its Just a Hat: A Head Wrap for Re-Warming Babies During Cardiac Surgery Kai Matthes, MD, PhD Two Scopes May Be Better Than One: A Solution for Navigating Difficult Airways David Hunter, MD, PhD Pediatric Vision Scanner: A Handheld Device that Diagnoses Vision Problems in Preschoolers Dan Kohane, MD, PhD New Directions in Drug Delivery: A Contact Lens that Dispenses Medication John Kheir, MD When a Patient Needs Air: Injectable Microbubbles that Release Oxygen into the Blood P Ellen Grant, MD . Bedside Assessment of Babies Brains with Innovative NIRS Approaches Hiep T. Nguyen, MD, FAAP Human Inspired Technology: An Implantable Kidney Dialysis Unit Moderated Questions & Answers 4:50 5:00 Closing remarks James Mandell, MD, Chief Executive Officer 5:00 Reception Enders lobby Poster & Demonstration Session

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Detailed Agenda
Presentation Summaries
1:00 1:15 Welcome & History of Innovation Presentation Sandra Fenwick, President and Chief Operating Officer and Naomi Fried, PhD, Chief Innovation Officer 1:15 2:50 Healthcare IT & Process Innovation Moderated by Sandra Fenwick, President & Chief Operating Officer Eric Fleegler, MD, MPH, in collaboration with Eugenia Chan, MD, MPH Collecting Childrens Health Information from the Patient, Parents and Teachers Through a Web-Based System Between Doctors Visits: ICISS Monitoring how a child with a chronic condition responds to medicationswhats making him better or worse can be complicated. The Integrated Clinical Information Sharing System (ICISS) is a web-based disease monitoring and management system that gathers information from patients, parents, teachers and others to monitor a patients health and functional outcomes. Instead of spending most of a patient visit trying to gather routine information about medications and symptoms, clinicians can collect it in advance through ICISS, allowing them to delve into more important issueslike helping a child with ADHD manage school, homework, peers and siblingsduring the visit. ICISS will be implemented and evaluated in the departments/divisions of Adolescent Medicine, Primary Care Center, Developmental Medicine, Neurology and Psychiatry. The goal is to improve care coordination, decrease unnecessary healthcare utilization, enhance clinical decision-making and identify variations in care for defined patient populations. Lynn Darrah, MHA, in collaboration with Courtney Cannon, MBA ALICE: A White Board for Hospital Floors that Works On each inpatient unit, there is a dry-erase whiteboard that is used to display patient assignments (beds, attending physician, nurse, etc.), contact information and clinical information. Its an essential communication tool for hospital staff, but its a challenge to manually keep the board up-to-date at all times as patients clinical statuses and caregiver assignments change. ALICE (Aggregated Local Information Collected Electronically) integrates Childrens many IT system applications and replaces the whiteboards with digital displays. The boards also display CHEWS (Childrens Hospital Early Warning Score), so staff can quickly see a patients condition without having to go into the medical record. Joseph R. Madsen, MD Does My Baby Have a Flat Head? Using the Web and Digital Photos to Triage Visits to the Doctors Office Thanks to the Back to Sleep campaign, babies are spending more time on their backs, causing their skulls to flatten, a condition known as plagiocephaly. A web-based program has been designed to triage plagiocephaly cases and potentially reduce the number of unneeded clinic consultation visits. Parents can use cell phones and digital cameras as diagnostic aids and send their photos to a website for a clinician to review. This telemedicine solution is enhancing efficiency in the clinic and saving parents time. Peter Laussen, MBBS Using Real-Time Data to Catch Critical Care Crises Before they Happen: T3 Intensive care units are busy and complicated environments. Staff work under high pressure to make critical decisions about patient management and resource utilization. To make those decisions, they must constantly gather, combine, and interpret the high volume of data coming from a variety of monitoring systems tracking the health of each patient under their care. While all this data can be lifesaving, its sheer volume and complexity can be overwhelming, and can itself contribute to errors and mistakes. Tracking, Trajectory and Triggering (T3) is a scalable, portable system for visualizing data and intelligently providing early warnings about the status of critically ill patients, allowing critical care doctors to make predictive, analytic decisions, rather than prescriptive and intuitive ones. This web-based software captures and displays integrated streams of patient data from bedside monitors at five-second intervals, and calculates and analyses data trends. Over time, we aim to analyze and model the data collected to develop patient, disease, or procedure specific management algorithms and indexes. These algorithms will allow clinicians to track a patients real-time clinical course, enhance patient safety and quality by triggering communication and interventions early, and support the most efficient use of resources.

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Kate Donovan, PhDc, BS, AGST, in collaboration with Dennis Gotto, BFAVC Collecting Data the Green Way: Gastroenterology Procedure Unit Efficiency Tracker The Gastroenterology Procedure Unit (GPU) Efficiency Tracker is an innovative electronic, greener replacement for current paper-based processes for measuring efficiency in the unit. Integrated with our electronic medical record, the GPU Tracker allows the nursing staff to quickly enter important data, information about procedure delays, and quality metrics. This data can be used to improved efficiency within the GPU, resulting in fewer delays and shorter wait times for patients and families. While it is currently being piloted in the GPU, the tracker could be of value to procedural units institution wide. Debra Weiner, MD, PhD BEAPPER: Mobile Communication for the Emergency Department Care Team Childrens emergency department wants to enhance communication between providers regarding shared patients, and to provide clinician support resources. Inspired by Twitter, we developed a mobile app known as BEAPPER (Bidirectional Electronic Alert Patient-Centered Provider Encounter Record). BEAPPER offers a provider-specific list of patients that includes demographics, provider team information (with picture) and clinician contact information. Free, pre-scripted text messages, referred to as beaps can be sent between providers and from hospital , systems to providers. Clinician-support resources guide practice and facilitate workflow. A proof-of-concept project is underway involving ED patients with abdominal pain. John Brownstein, PhD Public Health Surveillance in Real Time: HealthMap HealthMap is an online resource utilizing informal sources (e.g., newspaper articles, eyewitness reports, expertcurated discussions and validated official reports) for disease outbreak monitoring and real-time surveillance of emerging public health threats. Through a website (healthmap.org) and mobile app (Outbreaks Near Me), HealthMap delivers real-time information on a broad range of infectious disease outbreaks for a diverse audience including libraries, local health departments, governments and travelers worldwide. Through an automated processupdated 24/7 365 days-a-yearthe system monitors, organizes, integrates, filters, maps and , disseminates online information about emerging diseases in nine languages, providing a view of the current global state of infectious diseases and their effect on human and animal health and facilitating early detection of global public health threats (e.g. H1N1 influenza). Rahul Rathod, MD When the Going Gets Tough, the Tough Get Data: SCAMPs The United States healthcare system is struggling to control ballooning costs while continuing to provide high-quality care. Standardized Clinical Assessment and Management Plans (SCAMPs) are part of a novel quality improvement initiative designed to 1) improve clinical outcomes and health care decision-making by generating new clinical knowledge, 2) reduce variation in medical practice through standardized algorithms and management plans, and 3) identify ineffective or unnecessary resource utilization. For any medical condition or set of symptoms, doctors can create a SCAMPan algorithm with a decision tree guiding them on how to manage each patient. Clinical questions and plausible patient outcomes are identified in advance and built into the SCAMP allowing data collection to be focused around them. To date, 19 SCAMPs have been created for pediatric , cardiology conditions, involving approximately 8,000 patient encounters at Childrens Hospital Boston over the past three years, and more than 150 patients at other institutions around New England. All of Childrens Hospital Boston is embarking on the SCAMPs process.

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Jeff Burns, MD, MPH Cloud-Based Learning Platform to Help Sick Kids Around the World: Pediatrics Without Walls See one, do one, teach one goes global. Pediatrics without Walls is a web-based educational resource for clinicians around the world. By harnessing the global reach of the Internet, the latest knowledge about effective health care can be shared instantly so that clinicians can gain access to life-saving information anywhere at any time. Pediatrics without Walls is a comprehensive, continuously updated, and peer-reviewed knowledge exchange platform dedicated to providing multimedia and interactive teaching for physicians and nurses who are caring for critically ill children around the world. Developed in collaboration with IBM interactive, the 2012 beta launch will include 1,000 users in hospitals across six continents. 2:50 3:15 Coffee Break Enders lobby Poster & Demonstration Session 3:20 4:50 Healthcare Device Innovations Moderated by Pedro Del Nido, MD, Chief of Cardiac Surgery Pierre Dupont, PhD Robotic Surgery Inside the Beating Heart The use of catheters has substantially reduced the risk and trauma for heart patients in comparison to openheart surgery. But many intracardiac repairs require tissue to be manipulated in ways that cannot be achieved by catheters. This innovation consists of a robotic technology and surgical tool set enabling percutaneous, beatingheart interventions. The robot, consisting of concentric, pre-curved elastic tubes, provides dexterity similar to a catheter, but with substantially higher tip stiffness, allowing cardiac surgeons to pierce and pull tissue, press tissues together, and sew sutures in tight spacesthings catheters arent designed to do. The surgical tools are manufactured using a unique metal MEMS process that produces fully assembled, millimeter-scale devices with micron-scale features that cannot be achieved by any other manufacturing process. Both the robotic platform and the tool set are applicable to many other types of surgery including neurosurgery, urology and orthopedics. Karen Sakakeeny, RN, BSN, CNOR, CPN Its Just a Hat: A Head Wrap for Re-Warming Babies During Cardiac Surgery Infants undergoing open-heart surgery are cooled to protect their heart and brain from damage, and gently re-warmed once the surgery is complete. However, despite the host of methods at our disposal, it can be quite difficult to raise an infants body temperature sufficiently, leaving them at high risk for complications associated with hypothermia. Even though an infant can lose as much as 60 percent of their body heat through their scalp, the current standards of care for re-warming them after surgery do not include any particular type of head covering. To avoid hypothermic complications, we have developed a new Mylar-based Thermoregulation Head Wrap to help infants retain warmth while the care team re-warms them after surgery. Kai Matthes, MD, PhD Two Scopes May Be Better Than One: A Solution for Navigating Difficult Airways Placing a breathing tube in the throat of a child prior to surgery can be difficult for reasons of size and anatomy. To get around such difficulties, doctors need to be able to see both a childs vocal chords and the opening of his or her airway while placing a breathing tube, something that cannot be done with current techniques. We have developed a system for connecting two endoscopic tubes togethera large one for viewing the vocal chords, and a smaller one for viewing the tracheamaking it much easier to see what is going on in a childs throat and safely insert a breathing tube.

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David Hunter, MD, PhD Pediatric Vision Scanner: A Handheld Device that Diagnoses Vision Problems in Preschoolers Amblyopia (lazy eye) and strabismus (misaligned eyes) are the leading causes of preventable single-eye vision loss in children. These conditions are reversible if caught early, yet difficult to diagnose in the primary care setting. As a result, pediatricians unnecessarily refer millions of visually-normal children for specialist examinations every year, while referring half of all children with true amblyopia or strabismus too late for effective treatment. The Pediatric Vision Scanner (PVS) is a hand-held device that uses retinal birefringence scanning technology to precisely measure the eyes alignment, automatically detecting amblyopia, strabismus, or reduced vision of any cause. Initial tests suggest that the PVS can detect vision loss when it occurs with greater than 95 percent accuracy. If used routinely by primary care physicians at annual visits, the PVS could alter the practice of pediatrics, improve the efficiency of health care delivery, and eradicate severe vision loss caused by amblyopia and strabismus. Dan Kohane, MD, PhD New Directions in Drug Delivery: A Contact Lens that Dispenses Medication Eye drops often provide quick relief to patients suffering from minor eye problems such as redness, itching and dryness, but much of the dose isnt absorbed. Doctors have found that drops do not work very well for more serious chronic conditions such as glaucoma. Prototype multilayer lenses are a form of a contact lens that sandwiches medicine between two layers of polymer film and administers large doses of medication at constant rates over extended periods. John Kheir, MD When a Patient Needs Air: Injectable Microbubbles that Release Oxygen into the Blood Delivering much-needed oxygen to the bloodstream during critical circumstances, such as asphyxia, cardiac arrest and hemorrhagic shock can be very challenging. We have developed an oxygen micro-bubble foam that can be injected directly into the bloodstream, delivering lifesaving oxygen when and where it is most needed. This foam may help improve outcomes in a variety of critical illnesses, and could also provide new avenues for diagnostic testing. P Ellen Grant, MD . Bedside Assessment of Babies Brains with Innovative NIRS Approaches Few tools exist to evaluate the brains of fetuses and newborns, because their size and physiology are very different than the brains of older children and adults. The Fetal Neonatal Neuroimaging and Developmental Science Center is introducing advanced technology for tracking brain health and development. Near Infrared Spectroscopy (NIRS) has the potential to inexpensively assess newborns brain health at the bedside. Combining two technologies, we are able to estimate the rate of regional cerebral oxygen consumption and to assess infant brain development, to detect acute newborn brain injury, and also to more accurately determine the brains response to therapeutic hypothermia. Hiep T. Nguyen, MD, FAAP Human Inspired Technology: An Implantable Kidney Dialysis Unit Many patients with disorders of the kidney need dialysis. In peritoneal dialysiswhich can be done at home fluid is introduced into the abdomen through a permanent tube, which draws waste products from the blood via the membrane lining the abdominal cavity, and is flushed out of the body, either at night or at regular intervals. Because this method causes recurrent scarring and infection, many patients need to switch to hemodialysis, which requires them to go into the hospital three times a week for five to six hours per session, and have their blood extracted and filtered through a machine to remove waste products. We are creating an alternative: an implantable dialysis unit with the benefits of both hemodialysis and peritoneal dialysisbut without their disadvantages. The prototype, known as the Holly I, was inspired by a friend and colleague of Dr. Nguyen. 4:50 5:00 Closing remarks James Mandell, MD, Chief Executive Officer 5:00 Reception Enders lobby Poster & Demonstration Session

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Presenter Biographies
John Brownstein, PhD, is on the research faculty for Emergency Medicine and Informatics Departments and an Associate Professor of Pediatrics. Previously, Brownstein advised the Institute of Medicine, the US Department of Health and Human Services, the Department of Defense and the White House on real-time public health surveillance. His research has been reported on widely including pieces in Science, Nature, New York Times, The Wall Street Journal, CNN, National Public Radio and the BBC. He currently holds research grants from the National Institutes of Health, Canadian Institutes of Health Research, and Google.org. Brownstein completed his postdoctoral training at Childrens Hospital Boston and Harvard Medical School, and has a PhD in Epidemiology and Public Health from Yale University. Jeff Burns, MD, MPH, is the Chief of the Division of Critical Care Medicine, Director of Medical and Medical/ Surgical Intensive Care Unit, and the Edward & Barbara Shapiro Chair of Critical Care Medicine and Chair of the Pediatric Section of the Society of Critical Care Medicine. Burns was awarded the highest teaching award by the Department of Medicine and Anesthesia, and has an MPH from Harvard School of Public Health and an MD from Tufts University School of Medicine. Courtney Cannon, MBA, is the Director for System Operation. Cannons focus has been on strategic initiatives that improve performance and efficiency throughout the institution. Previously, Cannon served as the Director of Patient Flow and Emergency Medical Services at UMass Memorial Medical Center, and has an AB in Psychology from Harvard University and an MBA from Stanford. Eugenia Chan, MD, MPH, is the Director of the Quality and Performance Program for the Division of Developmental Medicine and Director of the ADHD Program in the Developmental Medicine Center. She was awarded the T. Berry Brazelton Award for Innovation and has written numerous publications on quality of care in ADHD and other childhood mental health disorders. Chan served a Fellowship in Developmental-Behavioral Pediatrics and in Pediatric Health Services Research. She has an AB in psychology from Harvard College, an MPH from Harvard School of Public Health and an MD from the University of Washington. Lynn Darrah, MSPT, MHA, is a Project Manager in Patient Care Operations. Her focus has been on improving patient throughput and efficiency throughout the institution. Previously, Darrah has served as a Quality Assurance Analyst in Radiology at Beth Israel Deaconess Medical Center. She has an MS in Physical Therapy from Ithaca College and an MHA from Simmons College. Pedro del Nido, MD, is the clinical founder of the Innovation Acceleration Program. He is currently the Chairman of the Department of Cardiac Surgery at Childrens Hospital Boston and the William E. Ladd Professor of Child Surgery at Harvard Medical School. Previously, del Nido served on the Surgical Faculties of the University of Illinois in Chicago and the University of Pittsburgh. He is a pioneer in the development of robotic tools used during cardiac surgery, and through his research, was awarded a United States patent for Process for Preserving An Organ and Organ Preservation Solution and has published over 258 peer reviewed articles. He has a BA in Biochemistry from the University of Wisconsin, Madison, and an MD from the University of Wisconsin Medical School. Kate Donovan, PhDc, BS, AGST, is the Educational Innovation Technology Coordinator for Medical Patient Services at Childrens Hospital Boston, and the Chief Motility Technologist for Center for Motility and Functional Gastrointestinal Disorders where she performs specialized testing for the pediatric patient population. She speaks on the subject of Pediatric Motility internationally and is a consultant for Medical Measurement Systems, Inc. Donovan also works at Apple Computer, Inc. and has been an SDK developer for over four years. She is creative consultant of Presentations Kreated, a company that provides technical support, education, guidance and creative presentation development for businesses across the country on multiple technological platforms. Donovan has a BS from Harvard University in Chemistry and Biology, and is completing her PhD from MIT Sloan School of Management.

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Pierre Dupont, PhD, is the Edward P Marram Chair of Pediatric Cardiac Bioengineering at Childrens Hospital . Boston and a Visiting Professor of Surgery at Harvard Medical School. His research group develops new technologies for minimally invasive surgery. He is an IEEE Fellow who has served in many capacities with the IEEE Robotics and Automation Society. After graduation, Dupont moved to Boston University, where, until recently, he was a Professor of Mechanical Engineering and Biomedical Engineering. Dupont was a Postdoctoral Fellow in the School of Engineering and Applied Sciences at Harvard University and has a BS, MS and PhD in Mechanical Engineering from Rensselaer Polytechnic Institute. Sandra Fenwick is President and Chief Operating Officer for Childrens Hospital Boston. She currently serves on the Board of Directors of Acusphere, Inc., the Medical, Academic and Scientific Community Organization (MASCO), A Better City, the Belmont Hill School, Simmons College Corporation and the Massachusetts Taxpayers Foundation, where she is the immediate past chairperson. Fenwick is also a member of the Massachusetts Womens Forum and Women Corporate Directors/Boston. She has a Bachelors degree from Simmons College, an MPH in Health Services Administration from the University of Texas, and a Doctor of Science from Pine Manor College. Eric Fleegler, MD, MPH, is an Assistant in Medicine in the Division of Emergency Medicine. He did his residency in pediatrics at the Boston Combined Residency Program and fellowships in pediatric emergency medicine and health services research at Childrens. Fleegler has numerous publications including Families health-related social problems and missed referral opportunities (Pediatrics. Jun 2007;119(6):e1332-1341) and Attempts to Silence Firearm Injury Prevention (American Journal of Preventive Medicine. 2012: 42(1):99-102). Fleegler received the Humanism in Medicine Award from National Beth Israel in 1999 and a special achievement award for the development of The Online Advocate by the American Academy of Pediatrics in 2005. He has a BA in Political Science from Brown University, an MPH from the Harvard School of Public Health and an MD from the University of Pennsylvania. Naomi Fried, PhD, is Childrens Hospital Bostons first Chief Innovation Officer. Previously, she was the Vice President of Innovation and Advanced Technology at Kaiser Permanente where she chaired the board of its internal Innovation Fund for Technology and helped run the Garfield Innovation Laboratory. She has a BS in Chemistry from the University of California, Berkeley and a PhD in Materials Science from MIT. Dennis Gotto, BFAVC, is an Application Development Specialist in the Information Services Department and was the multimedia and web developer for Childrens Genetics Department. Gotto was also an independent contractor for Boston Retinal Implant Project, Perkins School for the Blind, Massachusetts Eye and Ear Infirmary, the Department of Veteran Affairs and the sole proprietor of Blue Phoenix Media (Mobile Applications). He is certified by Section508. gov for Web and Multimedia Accessibility and has numerous publications including Boston Retinal Implant Project: An Accessible Web-Based Educational Resource Invest (Ophthalmol. Vis. Sci. 2007 48: April 1, 2007) and An Online Interactive Educational Resource to Assist the Development of Visually Impaired Students Through Online Resources (Invest. Ophthalmol. Vis. Sci. 2007 48: April 1, 2007). Gotto has also created a web-based system for clinical algorithms. He has a BFA in Visual Communications from Endicott College and a Java Certificate from University of Illinois OReilly School of Technology. P Ellen Grant, MD, is the founding Director of the Fetal-Neonatal Neuroimaging and Developmental Science . Center and the first incumbent of Childrens Chair in Neonatology. Previously, she headed the Division of Pediatric Radiology at Massachusetts General Hospital for five years. Grant is a co-author of two popular textbooks for clinical neuroradiology and has won a number of awards for her research efforts and clinical excellence. She did her radiology residency at Vancouver General Hospital in British Columbia, Canada, and her fellowship in adult and pediatric neuroradiology at the University of California, San Francisco. Grant has an MS in Physics and an MD from the University of Toronto.

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David Hunter, MD, PhD, is the Ophthalmologist-in-Chief at Childrens Hospital Boston. Previously, he served on the faculty at Johns Hopkins University, founded REBIScan, Inc, served as Editor-in-Chief of the Journal of the American Association for Pediatric Ophthalmology and Strabismus and Vice President for the Association for Research in Vision and Ophthalmology. The REBIScan was a finalist in the MassChallenge competition in 2011. Hunter has numerous publications including Automated detection of eye fixation by use of retinal birefringence scanning (Applied Optics 1999;38:1273-9), The Pediatric Vision Screener 1: Instrument design and operation (Journal of Biomedical Optics 2004;6:1363-8), The Pediatric Vision Screener 3: Detection of strabismus in children (Arch Ophthalmol 2006; 124:509-13) and Rapid, High-Accuracy Detection of Strabismus and Amblyopia Using the Pediatric Vision Scanner (Invest. Ophthalmol Vis Sci 2011;52:5043-8). Hunter served his Residency in Ophthalmology at Harvard Medical School and a Fellowship in Pediatric Ophthalmology at Johns Hopkins University. He has a BS in Electrical Engineering from Rice University, a PhD in Cell Biology from Baylor College of Medicine, and an MD from Baylor College of Medicine. John Kheir, MD, is a Staff Physician for the Cardiac Intensive Care Unit in the Department of Cardiology. He completed his residencies at Cincinnati Childrens Hospital Medical Center. Kheirs research focuses on intravenous oxygen delivery and he has several publications on the topic. He has a BS in Chemistry and an MD from University of Virginia. Dan Kohane, MD, PhD, is the Director of the Laboratory for Biomaterials and Drug Delivery, Senior Associate in Pediatric Critical Care and an Associate Professor of Anesthesiology at Harvard Medical School. His research focuses on a wide range of medical problems including pain, peritoneal and other adhesions, vaccine vehicles, intracranial drug delivery, patient-controlled drug delivery systems, antifungal surfaces, intracellular delivery of enzymes/inborn errors of metabolism, drug delivery to the eye and ear. Kohane has employed microparticles, nanoparticles, hydrogels, combination systems and others. He has a PhD in Physiology and an MD from Boston University. Peter Laussen, MBBS, is Chief of the Division of Cardiovascular Intensive Care in the Department of Cardiology, and the D.D. Hansen Chair of Pediatric Anesthesia and Senior Associate in Cardiology. He leads a large clinical research program focusing on the management of newborns, infants, children and adults with critical congenital and acquired heart disease. Laussen is a center site investigator for the NIH-NHLBI funded, multi-centered, prospective and randomized Trial of Right Ventricular Versus Modified Blalock Taussig Shunt in Infants with Single Ventricle Defects Undergoing Staged Reconstruction (Single Ventricle Reconstruction Trial) for the Pediatric Heart Disease Clinical Research Network. Laussen is also leading an innovative and novel project to capture, store and improve the visualization and analysis of real-time physiologic data in critical care, with the aim to develop predictive algorithms and dynamic learning to improve outcomes, quality of care and resource utilization. Laussen completed fellowships in anesthesia and pediatric critical care at the Austin Hospital and Royal Childrens Hospital, Melbourne. He is a native of Melbourne, Australia, and has an MD from the University of Melbourne Faculty of Medicine, Australia. James Mandell, MD, is the Chief Executive Officer and serves on the Board of Trustees. He is also a Professor of Surgery at Harvard Medical School. Previously, Mandell served as Dean of Albany Medical College and Professor of Surgery and Pediatrics. He was promoted from Chief of Urology to Dean of Albany Medical College in l996, and also served as Executive Vice President for Health Affairs at Albany Medical Center and Executive Medical Director of Albany Medical Center Hospital. Prior to his tenure at Albany Medical College, Mandell was a member of the medical staff at Childrens for nine years, advancing to an associate in Surgery with an associate professor appointment at Harvard Medical School. He has an MSN from Union College, New York and an MD from the University of Florida.

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Joseph R. Madsen, MD, is the Director of the Epilepsy Surgery Program in the Department of Neurosurgery and Director of the Neurodynamics Laboratory. Previously, Madsen was at Mass General Hospital, where he completed his neurosurgery training. His diverse research team studies alterations in dynamic attributes of the childs brain, both electrical and mechanical. Madsen is an internationally recognized expert on the surgical treatment of epilepsy and hydrocephalus, two of the most prevalent neurosurgical conditions of children. He is an inventor and medical device designer honored by the Boston Business Journal in 2007 as Healthcare Champion in Innovation. Kai Matthes, MD, PhD, is the Attending Physician in the Department of Anesthesia, Perioperative and Pain Medicine. He did his residency in anesthesia at Beth Israel Deaconess Medical Center, and his fellowships at Childrens and Massachusetts General Hospital. Matthes has received many honors including the Milton H. Alper Fellowship Award, Farley Fund Fellowship Award, Harvard Medical School Excellence in Teaching Award, Robert Smith Faculty Development Fellowship and serves as the Ambassador to the American Society for Gastrointestinal Endoscopy. He has a PhD and an MD from Friedrich-Alexander University, Erlangen-Nuremberg, Germany. Hiep T. Nguyen, MD, FAAP is a Director of Robotic Surgery, Research and Training Center at Childrens, and , Associate Professor in Surgery (Urology) at Harvard Medical School. Recently, Nguyen was named the Rose Zimmerman Mandell Chair in Innovative Urological Technology. His mission is to apply and develop existing technology for novel clinical use, and he divides his time between an active clinical practice and research in the basic sciences, animal and clinical research. Nguyens research is in the field of vesicoureteral reflux, prenatal hydronephrosis, molecular imaging and robotics, and he is designing hand-held robotic instruments for the U.S. Army and developing robotic organs. He has an MD from University of California, San Francisco. Rahul Rathod, MD, is an Assistant in Cardiology, and did his residencies at Rainbow Babies & Childrens Hospital in Cleveland, Ohio. He has several publications including Novel Approach to Gathering and Acting on Relevant A Clinical Information: SCAMPs (Congenit Heart Dis. 2010; 5(4):343-353), Deciding without Data (Congenit Heart Dis. 2010; 5(4):339-342) and Management of pediatric chest pain using a standardized assessment and management plan (Pediatrics. 2011; 128:239-245). Rathod has a BS from Duke University and an MD from Case Western Reserve University School of Medicine, Cleveland. Karen Sakakeeny, RN, BSN, CNOR, CPN, is a Staff Nurse III in the Main Operating Room where she has been a nurse for over 20 years. Previously, she was a staff nurse at Beth Israel Deaconess Medical Centers adult cardiac medical acute care unit. Sakakeeny is a Certified Nurse perioperative, Pediatric Nurse and Peripherally Inserted Central Catheter (PICC) Nurse. She was recently featured in Sigma Theta Tau International Honor Society of Nursings Real-life Success Stories and published Evidence-Based practice...A spirit of Inquiry in Implementing Evidence-Based Practice. Sakakeeny has a BSN in Nursing from Georgetown University School of Nursing. Debra Weiner, MD, PhD, is an Attending Physician in the Department of Medicine, Division Emergency Medicine. She is a member of the National Disaster Medical System, and her work focuses on creation, integration and use of technology for patient care and medical education. In addition to creation of BEAPPER, Weiners endeavors include a Pediatric Emergency Medicine Virtual Clerkship website to guide trainees through ED patient care in real time, Shared Digital Libraries to allow user-driven, on demand targeted access to multidisciplinary, multimedia educational resources, Handheld Simulation Haptic Training Device to allow trainees and clinicians to learn and practice procedures anywhere, anytime, a simulation course to prepare clinicians for disaster response in austere environments, and software to improve clinical trial patient recruitment. She did her residency at University of Colorado Health Sciences Center, has a PhD in Human Genetics from Medical College Virginia, and an MD from the University of Southern California, Los Angeles.

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About the Innovation Acceleration Program

childrenshospital.org/innovation | innovationacceleration@childrens.harvard.edu
The Innovation Acceleration Program is focused on enhancing the innovation culture and community within Childrens Hospital Boston. The program supports grass roots innovation, providing employees with a variety of formal and informal resources. The Innovation Acceleration Program also supports strategic institutional innovation initiatives and seeks to identify unmet innovation opportunities and catalyze solutions in those areas. Our programs include: Innovestment Grant The Innovestment Grant program provides seed funding to support clinical innovations in patient care. The goal of this program is to stimulate the development of early prototypes and pilots, focusing on rapid assessment of the feasibility of new ideas. FastTrack Innovation in Technology (FIT) Award The FIT award (sponsored by the Innovation Acceleration Program and the Information Services Department) offers software development resources dedicated to the development of promising innovative ideas in clinical care. A team of experienced software developers in partnership with innovators work to rapidly develop software solutions for use in clinical care. Innovators Forum The Innovators Forum is a monthly gathering of innovators and people interested in innovation that has developed into a vibrant innovation community. Both established guest speakers and innovators looking for input present ideas and solicit feedback at the forum. Telehealth Task Force A task force has been established to develop hospital-wide strategy for a telehealth program that includes both the remote delivery of care and physician-to-physician virtual consultations. Social Platform for Accelerating Resources and Connections (SPARC) SPARC is Childrens internal social networking website designed to foster communication and collaboration, supporting innovation across Childrens. Innovation Boot Camp Boot Camp is a two-hour crash course in innovation, designed to empower participants to create change in their clinical areas. Boot camp includes an introduction to the innovation lifecycle and resources available at Childrens to support innovation and lessons from experienced innovators. Participants take part in interactive exercises to develop innovative solutions to clinical and non-clinical problems.

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Innovation Acceleration Program Team

Naomi Fried, PhD Chief Innovation Officer Kristen Verdeaux Program Coordinator & Executive Assistant Elizabeth Phillips, MSHI Project Manager FIT Sarah Mahoney, MPH Community Manager SPARC Alex Pelletier, MBA Telehealth Program Specialist Pedro del Nido, MD Chief of Cardiac Surgery Paola Abello, MBA Program Manager Gajen Sunthara Lead Developer FIT Melinda Tang, MEng Developer FIT Shawn Farrell, MBA Telehealth Program Manager

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Grant Winners
2010 Innovestment Grant Winners
Dr. Michael Agus Dr. Henry Cheng Dr. Anne Hansen Dr. David Harrild Dr. Heung Bae Kim Dr. Joe Madsen Dr. Hiep Nguyen Karen Sakakeeny, RN Elastic Multi-Electrode ECG Strip Cardioscopy for Identification and Closure of Complex Ventricular Septal Defects in Children Can Esophageal Dilation Prevent Stricture Formation After Anastamosis of Esophageal Atresia? A Speckle Tracking-based Tool for 3D Visualization of Ventricular Contraction Using Cardiac Magnetic Resonance Images Is Ductus Venosus Closure the Triggering Event for Necrotizing Enterocolitis? Digital Photography for Web-Based Triage for Plagiocephaly Diagnosis of Pyelonephritis Using Fluorescence Imaging Thermo Regulation Head Wrap

2011 Innovestment Grant Winners

Dr. David Casavant Dr. Gulraiz Chaudry Dr. Jason Kahn Dr. Kai Matthes Dr. Nilesh Mehta Dr. Stephen Sanders Dr. Fred Wu Tele-CAPE: Remote Monitoring Program for Kids on Home Ventilators Novel Expansile Biodegradable Sclerosant for Vascular Anomalies Development of Technology Enhanced Toys for Severe Emotional Regulation Disorders Novel Coupling Mechanism to Combine Two Endoscopes for Endotracheal Intubation Prototype Development for Metabolic Monitoring During Noninvasive Ventilation Cardiovascular Imaging to Advance Autopsy Practices A Noninvasive Technique to Monitor the Hemodynamic and Liver Status of Fontan Patients

2012 Innovestment Grant Winners

Dr. Patrick Codd Dr. Camille Gomez Dr. Michael Manfredi Dr. David Mooney Concentric Tube Robotics for Neurosurgery Helping Sick Kids Breath Easy: Image-Guided Neuromuscular Ventilatory Assistance Trans-oral Gastric Volume Reduction for Weight Loss in Adolescents Repair of Esophageal Atresia without Thoracotomy

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FIT Awards
2010 Awards
Courtney Cannon, MBA Dennis Gotto, BFA Dr. Hiep Nguyen Dr. Debra Weiner Aggregated Local Information Collected Electronically (ALICE) GPU Occupancy Tracker Childrens Hospital Boston Patient Passport Bidirectional Electronic Alert Patient- centered Provider Encounter Record (BEAPPER)

2011 Awards
Dr. Vincent Chiang Dr. Timmy Ho Care Transition: Patient Follow up After Discharge Real Time Collaborative Task List for Residents

2011 Catalyst Consulting Award:

James Smith Wayfinding App for Mobile Devices

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Articles On Innovations at Childrens Hospital Boston

Top 10 science and clinical innovation trends: Looking forward to 2012
vectorblog.org/2012/01/top-10-science-and-clinical-innovation-trends-looking-forward-to-2012/ by Nancy Fliesler on January 4, 2012 Here once again is Vectors take on some exciting trends weve been watching in the pediatric health arena and what we expect to see more of this year. If youve got others to propose, scroll to the bottom and let us know! Whole-genome sequencing enters the clinic In 2000, with our genome deciphered, the Human Genome Project promised to transform medicine, predicting and preventing all that ails us. The project spawned next-generation technologies, accelerated the development of bioinformatics and shaped new perspectives on research. But if, say, a stroke patient was asked the question, Is your life any better than 10 years ago thanks to advent of genomics? the answer would have to be no. Hence the New York Timess assertion in 2010 that the project yielded few new cures. Now that paradigm seems to be shifting. Whole-genome sequencing has begun moving into the clinic, sleuthing out problems, offering hope for a medicine thats more effective and more personal. 2011 saw genomic information provide biochemical insights timely and actionable enough to improve the treatment of individuals with cancer and dystonia, and, in a case at Childrens, failure to thrive and severe kidney calcification. An increasing number of people are embracing genomic analysismany of them with rare diseases, but others simply to advance the science or just for fun. In 2012, as costs of genome sequencing fall further, well increasingly be able to find needles by analyzing entire haystacks. Expect more focus on how to handle and interpret the flood of information and how to communicate it to patients. Innovation meets healthcare reform Just as environmental threats stimulate organisms to change and adapt (like bugs evolving resistance to new antibiotics), the political and economic pressure to cut costs is leading the healthcare system to innovate. It may be partially a survival move, but the emerging innovations in payment models, care coordination and care delivery are turning out to be big wins for patients. Its hard to say what will happen in the legal and policy arena, with the Affordable Care Act going before the Supreme Court later this year, and what effect, if any, the new Occupy Healthcare movement may have. But experiments are rolling out anyway. Employers and empowered patients may be incentivized to vote with their feet and migrate toward care plans that offer innovations like virtual telehealth visits and medical homes. Global health: Medical missions give way to telemedicine Doctors frequently go on medical missions overseas; Childrens alone has recently sent medical relief teams to Haiti, urologic surgeons to Kenya, cardiac surgeons to Ghana, and plastic surgeons to Chechnya. But what if doctors could be trained in new procedures or receive live or nearly-live guidance via telemedicine? As critical care physician Jeff Burns put it during a talk at IBMs Impact 2011 Global Conference last April, Ten million children under 5 die each year around the world from preventable causes. Can we use web-based technology to save some of them? With web-based modules and mobile technology, sharing medical expertise with someone in Africa isnt much different from sending radiology images across town, and organizations such as Health eVillages are distributing technology to resource-poor areas. And that information exchange neednt be just one way. I know very little about malaria, and Ive never treated Chagas disease, yet they afflict many children in the world, Burns told the IBM audience. When these children become dehydrated, whats needed isnt me out of Boston. Its my colleagues in Bangalore who see 1,000 children a day. Timely diagnosis for behavioral disorders Early intervention is one of our best tools for helping children with behavioral and learning disorders: Neuroscience shows that these interventions can help rewire young childrens more changeable brain circuitry, perhaps sparing children with conditions like dyslexia and attention deficit hyperactivity disorder (ADHD) from frustration and social isolation once they start going to school. Unfortunately, these disorders are hard to spot early with behavioral criteria. Autism cant be reliably be diagnosed before 18 months of age, dyslexia generally doesnt become apparent until kindergarten or later, and behavioral criteria for ADHD are unreliable before age 8 or 9even as the American Academy of Pediatrics suggests considering drug treatment for ADHD as early as age 4. But what if there were an objective, unbiased test for these disorders? 2011 saw exciting steps in this direction.

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Functional MRI studies were shown to pick up structural brain differences in 5- and 6-year-olds with a family history of dyslexia (watch for more on this soon). EEGs coupled with machine learning algorithms distinguished infants at high risk for autism from controls with 80 percent accuracyat as young as 9 months of age. A study thats still recruiting is comparing EEG activity and metabolic activity on fMRI in two groups of 3- to 7-year-olds with and without ADHD. Even newborns with a known neurologic insult are starting to be tracked over time with advanced neuroimaging, so their outcomes and the effects of early treatments can be better understood. Digital health apps 2.0 The electronic revolution in healthcare continues, even as Google Health disbands. Mobile apps are growing exponentially, while the industry puzzles out which are worth investing in and waits for the FDA to weigh in. Techniques from gaming are motivating patients to take charge of their health. Medical records are starting to incorporate voice-to-text apps and user-generated content, helping physicians and patients track symptoms more easily and systematically, and incorporate this data into decision-making. Robotics and telehealth are allowing doctors to make virtual house calls to patients recovering from surgery. On the public health side, researchers are getting new insights into the populations health behaviors by tapping Google searches. For more on the fastmoving digital health industry, read the coverage of this years Health 2.0 meeting (samples here and here). And read this disturbing report: Will electronic records and devices lead to distracted doctoring? Repurposing medicines finding new uses through mass screens Getting a completely untested drug through FDA approval is a long, hard road. So researchers and pharmaceutical companies are increasingly repurposing medicines that have already been approved. Rapamycin is a great example of drug that is seemingly useful for just about everything, from immunosuppression to neurocognitive disorders to congenital heart defects. Using high-throughput assays, researchers are taking whole libraries of FDA-approved compounds, throwing them at new medical problems and finding new therapeutic hits. The FDA and private companies are lending a hand, and researchers at Stanford created a program that matches the gene activity caused by a disease with drugs inducing the opposite gene activity. At Childrens, the screening platform of choice is increasingly zebrafish fast-breeding creatures that are small enough to load into a 96-well plate, soaking up compounds through their skin. The transparent embryos provide a literal window into a drugs effects. The fish are so useful that Childrens has developed and licensed a love tank that optimizes their breeding. In 2011, zebrafish led the way to an arthritis drug that may help treat melanoma and an asthma medication that may help restore muscle in Duchenne muscular dystrophy, sparking a collaborative research agreement with Pfizer. One compoundoriginally developed to fight stomach ulcers but then abandonedis now helping boost stem cell engraftment in patients receiving cord blood after cancer chemotherapy. Rethinking clinical practice pays off Are we practicing too much defensive medicine and erring toward increased utilization, just to be on the safe side? If youre a doctor, how tempting is it to just get the CT scan or admit a child to the hospital if he has a complex chronic health condition youre not comfortable managing? Thoughtful clinicians are delving deeper into the question of why some patients are so frequently rehospitalized (one study last year found that patients readmitted four or more times in one year accounted for nearly 20 percent of all pediatric hospital admissions and one-quarter of inpatient expenditures). Many of these situations turn out to have actionable causes and can be turned around through simple preventive measures, as Atul Gawande compellingly detailed in the New Yorker. Studies reviewing patient outcomes of large numbers of cases, like those by the Pediatric Emergency Care Applied Research Network, fueled new guidelines and decision rules that can safely reduce the use of medical tests, such as CT scans for children with head or blunt abdominal trauma or chest X-rays for children with suspected pneumonia. The SCAMPS program, launched hospital-wide at Childrens in 2011, allows physicians to continuously update their care algorithms based on patient outcomes, safely reduced cardiac testing in children with chest pain.

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Making the flu less devastating Flu for most people is an uncomfortable inconvenience, but it can cause serious problems. Researchers are getting a glimpse at why some people are particularly susceptible to flu, such as children with asthma, who often land in the hospital gasping for air. One ominous finding in 2011 was that otherwise healthy children carrying MRSAwhich is becoming more prevalent in the communitywere eight times more likely to die with influenza during the 2009 H1N1 flu pandemic. Influenza immunization (especially of preschoolers) is the best defense, but the need to update the flu vaccine every year, particularly when dangerous new strains appear, is a major challenge; in the 2009 pandemic, vaccine distribution was delayed. Scientists made progress last year toward a universal flu vaccine that targets parts of the virus that dont mutate, a step in the right direction. But the year closed with the National Security Advisory Board asking the journals Science and Nature to omit certain details from pending flu research papers (describing creation of a highly transmissible form of avian flu) for fear of bioterrorism, sparking a debate about censorship of scientific communications. Taking tissue engineering to the next level Weve gotten good at building basic tissues and even simple organs in the lab. But making complex engineered tissues that can perform biological functions that the body does naturallysmart tissues if you willare only now emerging. Scientists are figuring out how to harness mechanical cues that induce cells to create multiple tissue types and three-dimensional organs on their own. Engineers are starting to incorporate nanotechnology to make heart patches that conduct electrical signals and beat as a unit, and fatty particles, filled with drugs, that can home to damaged tissue. Others are combining tissue engineering with gene therapy, creating tissues that can secrete desired compounds like protein drugs or factors that can kick-start regeneration within the body. New pharma R&D models empower academic medical centers Academic medical centers have always worked with the pharmaceutical industry, but never so closely as now. In the old model, industry drove therapeutic development. A company might fund an academic project or supply reagents, but the relationship generally ended with the project (and publication of a paper). Now, with drug pipelines drying up and R&D costs rising, big pharma is under pressure to change. New industry-academia collaborations have creative deal structures that are altering how both parties do business. Theyre allowing hospital researchers to do what theyve never done beforetake the lead in R&D. 2011 saw a plethora of new industry-academic collaborations, and more are coming. Why? Academic medical centers have deep expertise in disease and the biology that underlies it, and a long-term commitment to finding curesnot to mention access to human tissue samples and to patients for clinical trials. We know what our patients need, and pharma is listening. Nowhere is this more apparent than for orphan diseases, where the medical need is great and where many of the ingredients for clinical trials in place. The NIH just gave a great kickstart to therapeutic R&D with the National Center for Advancing Translational Sciences (NCATS) launched last month. When all parties interests are strategically and tactically aligned, its a beautiful thing.

Why I play with robots: The promise of telemedicine

vectorblog.org/2011/12/why-i-play-with-robots-the-promise-of-telemedicine/ by Hiep Nguyen on December 1, 2011 It cant be ignored that dramatic transformation in our healthcare system is imminent. The economy, market forces and increasing political demands will soon force physicians and healthcare professionals to change how we take care of our patients. Just as the days of housecalls are gone, so is our current system of delivering care. The rising cost of healthcare now has the government and insurance companies placing more emphasis on controlling costs, sometimes at the expense of quality. They demand that we become more efficient and manage an even greater number of patients. Advancements in medical technology are believed to be a principal cause of the rising cost of healthcare: While they have improved patient care, they often come with a high price tag. Does that mean we should abandon them? My answer is to play with robots. Technology can help us deliver care that is more efficient, cost-effective and, most importantly, of high quality. As a surgeon, for example, I see one aspect of our care that needs to evolve: post-operative care. Traditionally, we have patients recover in the hospital so they can be monitored for complications and cared for until they are able to manage for themselves at home. Some patients may only need low-level care and monitoring, but cannot be discharged to their homes without significant risks. Because hospital care is so expensive, insurance companies encourage us to discharge patients sooner, sometimes refusing to authorize care beyond a certain time period. While this reduces the immediate cost, there is a greater chance that patients will have complications and return to the hospital, negating the cost-saving effort. In addition, early discharge often leaves both patients and physicians feeling that their care was incomplete and of lesser quality.

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Thats why I play with robots. Recent developments in telecommunications and remote monitoring technology can provide a bridge between the hospital and the home. Through robotic systems that include video and audio capabilities, physicians, nurses and other healthcare professionals can go into the patients home to provide follow-up care. They can monitor and assess patients and even talk families through performing minor procedures such as wound care and removal of drains and Foley catheters. Not only is the home a less costly care setting, but being at home is often medically beneficial for the patient. There are many other applications for this method of healthcare delivery. Patients with chronic diseases, who traditionally must show up for frequent clinic visits, could have some of these visits replaced by virtual ones. Compact, mobile ultrasound devices, blood and urine analyzers and stethoscopes could provide vital information on their health remotely, minimizing the need for direct physical evaluations. See more robot ideas from patients and hospital staff in Vector tomorrow. In our preliminary studies, patients and their parents have found this virtual care to be very helpful in their transition home from the hospital. They report a sense of security and confidence that their physician is watching over themwithout having to surmount traffic, bad weather and physical distance to receive care. Physicians find they can be more time efficient, yet still have direct access to their patients. One might assume that the cost of this technology would negate the cost benefits of getting patients out of the hospital sooner. This is not the case. Most of this technology is already in wide use; sometimes all thats needed is a cell phone with video capabilities. Competition is making the technology ever more affordable, economical and effective. In fact, with novel technology, the days of a physician having the time and capacity to do house calls may not really be over. Housecalls can be reborn with a modern twist. Most importantly, we observed in our studies that the patients and families who utilized telemedicine technology were more engaged in their healthcare. They participated actively in their recovery, rather than having it spoon-fed to themsomething many physicians have been trying to encourage for years. Their care became an active partnership with us. Only with patient engagement can we take care of a greater number of patients without compromising on thoroughness or quality. Only with their active involvement can our healthcare system change from one thats primarily reactive to one thats proactive and collaborative. Obviously, we can never eliminate the need for hospitalization or in-person visits. Some patients will always need intense care, monitoring and direct physical evaluation. We can, however, be more efficient in using these resources. I therefore continue to play with robots, believing that technological advances can be a solution to rather than a cause of our current healthcare crisis.

Beating-heart surgery and the search for a killer app

vectorblog.org/2011/02/beating-heart-surgery-and-the-search-for-the-killer-app/ by Nancy Fliesler on February 16, 2011 Inventors and engineers tend to come up with ideas and technologies first, then say, This is cool, whats it good for? Clinicians tend to say, Heres my clinical problem, how can I solve it? This was roughly the thinking that brought together Boston University engineer Pierre Dupont and Pedro del Nido, chief of Cardiac Surgery at Childrens Hospital Boston. Dupont had a vision for a next-generation surgical robot. del Nido had a vision of doing complex cardiac repairs in children while their hearts are still beating. Could they create a viable technology? Currently, there are two alternatives for fixing hearts. One is open-heart surgery: stop the heart, put the child on cardiopulmonary bypass, open the chest, and make the surgical repair. But theres riskdisruption of heart rhythm, infection, dangerous air bubbles slipping into the bloodstream, and possible inflammatory responses when the blood contacts the heart-lung machine. Recovery takes weeks to months. Theres also catheterization, a technique Childrens cardiologists have helped perfect. A narrow, flexible catheter is guided through a blood vessel to the heart, where it can remove a blood clot, inflate a small balloon to prop open narrowed structures, open up umbrella-like devices to patch holes, apply heat or extreme cold to destroy abnormal tissue, and implant devices like stents and even artificial heart valves. But many of the things surgeons do require the application of forceto pierce and pull tissue, press tissues together, sew sutures in tight spaces things that a noodle-like catheter isnt designed to do. del Nido wanted to combine surgical dexterity with the minimally invasive nature of cardiac catheterization. He enlisted the help of Dupont, who moved his lab to Childrens to become chief of Pediatric Cardiac Bioengineering. Together, theyre reinventing how heart surgery is done. With funding from an NIH Bioengineering Partnership, theyre developing completely new, miniaturized tools to replace the surgeons scalpel, needle and suture, and a robotic system that could snake its way through the heart to operate these tools. Currently, robotic surgery involves taking existing clinical procedures and simply inserting a robot between the

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clinician and the patient, Dupont said this week at the monthly Innovators Forum hosted by Childrens Innovation Acceleration Program. The next generation of surgical robots should enable procedures that are currently impossible. The surgical robot, invented by Dupont and one of his graduate students, is small enough to use at the bedside. It has telescoping, curved, steerable arms, that can negotiate around delicate heart structures and approach tissue from a variety of angles. To develop the tools, Dupont and del Nido partnered with California startup Microfabrica, Inc., which specializes in a unique process for manufacturing millimeter-scale tools from metals. The technology allows them to fabricate simultaneously large numbers of tiny, fully-assembled devices with intricate working parts. At the time, Microfabrica was looking for new applications; now, medical devices are a major thrust of the company. The collaboration has designed and tested several new tools (best appreciated under magnification). One is a suture substitute, designed to close holes or join tissues. Resembling a tiny wall-anchor, its eight moving parts include adjustable wings and a ratcheting device for customized tightening. There are also tissue removal devicesa rotary razor-type device that shaves off a surface layer, and another that can mill a cavity in tissue (shown at TEDMED last fall on a grape tomato and chicken breast, respectively). But can this technology be commercialized? Although del Nido sees applications in pediatric beating-heart surgeryreconstructing defective heart valves, for examplethe market is relatively small. He and Dupont need a much larger market to entice industry to develop the technology and see it through clinical trials and FDA approval. Physicians in the audience discussed possible uses in neurosurgerycould the tools be made from something other than metal, so theyre MRI-compatible? They could. What about fetal surgery? Maybe the robot could help improve on the operation for spina bifida, reported last week in the New England Journal of Medicine. When you open the uterus, you create a risk of premature birth, said neurosurgeon Joe Madsen. If you could do this through an amniocentesis-type device, you could make surgery much faster and much less morbid. Thered be a market for every single case of spina bifida. del Nido thinks the uses could be very broad. This device provides a mechanism for doing what the surgeon does in an open procedure, he says. It could enable physicians to perform tissue reconstruction operations without having to open a cavity surgically, whether that be the chest, abdomen, or the brain. Ultimately, it may take high-volume applications in adult surgery to get investors to put their dollar down enabling del Nido to offer beating-heart surgery to infants with complex congenital heart defects. Any ideas? Vector is ready to forward them.

Reducing unnecessary care: The SCAMPs manifesto

vectorblog.org/2011/08/reducing-unnecessary-care-the-scamps-manifesto/ by Nancy Fliesler on August 22, 2011 We all know the problem: The cost of health care needs to come down. About five years ago, pediatric cardiologists at Childrens Hospital Boston realized it was critical to practice more cost-effectively. Most of the money that is going to be removed from the federal budget to reduce budgetary deficits is going to come from health care in one fashion or another, cardiologist-in-chief James Lock told an audience of senior Childrens physicians last month. Theres no question we were under a tremendous amount of pressure. Seeking to eliminate unnecessary care and testing, Locks team first turned to clinical practice guidelines, or CPGs, a tool meant to standardize best practices. But it soon became clear that CPGs were ineffective, giving no insight into how to improve care or how to deal with unexpected findings. Even worse, over time, many mandated CPGs have been shown to be wrong by subsequent data. There is no such thing as best practicetheres only sound practice that is constantly being refined. Randomized controlled trials (RCTs), the classic gold standard, arent fool-proof either. A group of Canadian researchers looked at 100 RCTs to see if they were still valid based on new information in the literature. Within 5.5 years, 50 percent of the trials conclusions needed updating, based on new data. And by their nature, RCTs provide answers to narrow questions in narrowly defined groups of patients. They dont capture the messy variability of actual patient populations. Lock and colleagues decided to take a look at the clinical decisions they themselves were making. They dispatched a cardiology fellow to record, over seven days, every decision the faculty cardiologists were making. He tallied 1,188 decisions, mostly based on training, prior experience, first principles, anecdote, instinct not data. What the cardiologists came up with in response is called SCAMPs, or Standardized Clinical Assessment and Management Plans. Now going hospital-wide, supported by Childrens Program for Patient Safety & Quality, SCAMPs has three maxims: Toprovidecost-effectivecare,youneedreliable,relevantclinicaldatayoucanacton. Progresscanbemadeevenifthedataarentbullet-proof. Changesincarebasedonthedataareneverfinal.

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There is no such thing as best practice, Lock told the audience. Theres only sound practice that is constantly being refined. For any medical condition or set of symptoms, doctors can create a SCAMP an algorithm with a decision tree guiding them on how to manage each patient, but one thats also designed to explore one or more clinical questions. These questions, and all plausible patient outcomes, are identified in advance and built into the SCAMP , allowing data collection to be focused around them, supported by nimble, dedicated software. The task of the people writing the algorithms is to define what needs to be captured, cardiologist Steven Colan, who oversees the information technology that underlies SCAMPs, told his colleagues. The reasons that doctors choose not to follow a SCAMP are extremely important information, and fuel improvement at a rapid clip. The ideal SCAMP topic is one where people arent sure what constitutes the best care, and where there arent enough data to go by, elaborated cardiologist Rahul Rathod in a session called How to Create a SCAMP . A SCAMP doesnt need the rigor of a prospective, hypothesis-driven study, but it should generate data to help answer a question. Deviations from whats prescribed by a SCAMP are not only OK, theyre expected. All are captured by the software and can potentially be used to adjust the SCAMP . If you want to do something different than what the SCAMP calls for, theres only one requirement, Lock said. You have to explain why youre doing it differently. The reasons that doctors choose not to follow a SCAMP are extremely important information, and fuel improvement at a rapid clip. As of July 20 of this year, more than 2,600 Childrens patients have been enrolled in 14 different pediatric cardiology SCAMPs. Five of these SCAMPs have already been modified based on findings in clinical practice. One SCAMP for example, addresses the management of children who present with chest pain a common , symptom generating parental anxiety, a lot of practice variation among doctors, and a lot of unnecessary testing. Based on a review of all patients seen for chest pain in 2009, cardiologist Kevin Friedman and colleagues projected that the SCAMP would have enabled a 20 percent reduction in the use of exercise stress tests, echocardiography and Holter monitoring. More recently, a historical comparison found a 20 percent actual decrease in hospital charges after the SCAMP was in place. More than 150 patients have now been enrolled in cardiac SCAMPs at other institutions around New England, and the Program for Patient Safety & Quality is asking every department and division throughout Childrens to embark on the SCAMPs process by June 30, 2012. A new era of rationalnot rationedcare is coming. Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, & Moher D (2007). How quickly do systematic reviews go out of date? A survival analysis. Annals of Internal Medicine, 147 (4), 224-33 PMID: 17638714 Rathod RH, Farias M, Friedman KG, Graham D, Fulton DR, Newburger JW, Colan S, Jenkins K, & Lock JE (2010). A novel approach to gathering and acting on relevant clinical information: SCAMPs. Congenital Heart Disease, 5 (4), 343-53 PMID: 20653701 Friedman KG, Kane DA, Rathod RH, Renaud A, Farias M, Geggel R, Fulton DR, Lock JE, & Saleeb SF (2011). Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics, 128 (2), 239-45 PMID: 21746719

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MRI-powered medical robots are coming

vectorblog.org/2011/10/mri-powered-medical-robots-are-coming/ by Nancy Fliesler on October 3, 2011 It began as a proof-of-principle demonstrated with LEGOsa surgical biopsy needle whose motor is driven solely by a clinical MRI scanner: The above demo shows that an MRI machines magnetic field can be programmed to produce enough force to control a robotic instrumentan accomplishment with broad potential in medicine. In the demo, the scanners magnetic field swings a rotating arm, and a set of gears convert that motion into the motion of a biopsy needle, strong enough to puncture the tough outer tissue of an animal heart and then withdraw. All parts exposed to the magnetic field are metal-free and MRI-compatible. While MRI-compatible robots have been built before, this was the first demo of a motor powered by MRI, says Pierre Dupont, chief of Pediatric Cardiac Bioengineering at Childrens Hospital Boston. His engineering team was one of five finalists for Best Paper Awardout of 790 papers presentedat last weeks International Conference on Intelligent Robots and Systems (IROS 2011). The system was tested in collaboration with Lei Qin of Brigham and Womens Hospital. But Duponts vision for the technology is much broader than simply doing biopsies. Our ultimate goal is to create magnetically powered robots that can either travel through the body to perform highly targeted therapies or reside inside the body as adjustable prosthetic devices, he says. That might include ball-bearing-sized robots that could be steered through the cerebrospinal fluid or the urinary system to deliver drugs or stem cells. Or implantable devices that could be adjusted to regulate blood flow in the heart. Or implants for children that could be gradually enlarged as they grow, preventing the need for repeat operations to place larger implants. A number of engineering challenges lie aheadsuch as how to get the MRI machine to image and drive a device at the same time. You need to use MRI to not only power the device, but also to monitor the device and its interaction with the body, says Dupont. Another challenge being tackled in the lab is to get magnetic fields to steer swarms of tiny, injectable robots to different destinations in the body. While magnetic control of a single swimming robot has been demonstrated in a blood vessel and inside the eye, no one has figured out how to use the same magnetic fields to control many robots at once. This is important, because it may be necessary to target many locations inside the body or simply to deliver a larger quantity of drug than one robot can hold, Dupont says. His team recently showed that an MRI magnetic field can independently control two robots at once, and just submitted another paper demonstrating its first results in multi-robot control, using differences in how each robot speeds up and slows down to tweak the robots individual swimming speeds. Right now, were telling the robots where to go, says Dupont. Ultimately, we want them to figure that out for themselves. Ed. note: Read about the robot and special tools Duponts team designed for beating-heart surgery.

Its just a hat: Simplicity in innovation

vectorblog.org/2011/07/its-just-a-hat/ by Tom Ulrich on July 13, 2011 When we think about innovation, especially in health care, our thoughts often turn to the highly complex: new surgical procedures, new drugs, new devices or machines, etc. But innovation in medicine and patient care doesnt have to be complex. Sometimes it can be very simple. Like a hat. Karen Sakakeeny has been a clinical nurse for more than 30 years, spending much of that time in the operating room. While doing a stint in cardiac surgery, she found herself thinking about ways to improve the rewarming process for infants undergoing open heart surgery. During surgery, infants on cardiac bypass are cooled down to about 82 Fahrenheit. This slows their metabolism and helps prevent damage to the heart muscle. After the surgical repair is complete, the OR team starts to rewarm the child, typically with a heated mattress, warmed fluids, adjustments to the bypass machine, and by turning up the thermostat in the operating room. Still, it can be difficult to achieve and maintain an optimal body temperature. And then there is the trip to the cardiac ICU. The hallways between the operating room and the ICU are cool, and the ICU itself is cool, says Sakakeeny. Its hard for us to bring the childs temperature up when we keep moving them from one cool space to another.

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While working on a project on evidence-based practice, Sakakeeny decided to study the rewarming problem. Her epiphany came when thinking about an opposite situation. If we need to cool an infant further, we often place ice packs around their head, she says. I suddenly said to myself, If we cool them down this way, can we also use the head to help warm them up? Sakakeenys epiphany was followed by a eureka moment. We always tell our own kids to put a hat on to stay warm, she says. Indeed, as much as 60 percent of an infants body heat can be lost through the scalp, and the clinical literature champions using hats to maintain infants body temperature. We often put hats on children in the hospital in other settings to help them stay warm. So maybe what we need is a hat. Putting the idea into practice While the idea may be simple, it can be a long road to putting it into practice, an experience Sakakeeny related at a recent Innovation Acceleration Program (IAP) Innovators Forum, monthly gathering of the Childrens innovation community where resources and ideas are shared. She started by trying a simple change in practice, using a regular knit hat in the OR. But that didnt work: To put a regular hat on an infant when its time to rewarm, we would have to move them, and that would disrupt the surgical field, she explains. Also, because infants are so small, IV lines are often placed in the scalp. A regular hat gets in the way. Sakakeeny went to the drawing board to come up with something new. I realized we needed something made of a material that helps regulate temperature. Something with flaps that could be spread out unfolded on the OR table before surgery. That way we could position the childs head on top of the hat when we bring them into the OR and, when it came time to rewarm them, we could just close the flaps. This still gives the anesthesiologist access to the scalp, says Sakakeeny. And if the child starts to get too warm, we can open up one of the flaps. The next hurdle: data. The Technology & Innovation Development Office (TIDO) helped me file a provisional patent application and found several companies potentially interested in producing the hat. But the companies wanted to see clinical data before moving forward, says Sakakeeny. Im a clinical nurse; I was out of my comfort zone. It all came together after Sakakeeny applied for and received an IAP Innovestment Grant. The grant was the last part of the puzzle. It gave me both credibility and financial support, and opened up all kinds of doors, including help from nurse scientists on the Cardiovascular Critical Care team with designing and submitting a study to the Institutional Review Board. The grant also gave her the support she needed to make a prototype. Ive gone to and been friends with a pair of seamstresses for years. I approached them with a sheet of Mylar and asked for their help in making a prototype. We spent hours brainstorming ideas and designs, using a doll to figure out the right shape and size. Together, they came up with a three-flap design in four sizes that uses Mylar with a cotton backing and Velcro to hold the flaps together. With her patent pending, and her protocol to test the effectiveness of the hat under IRB review, Sakakeeny has high hopes. In her eyes, the hat could have very broad use. I envision that we could use this in just about any situation where you need to keep a newborn or premature infant warm, she says. In the end, she concludes, what amazes me still is that its just a hat.

Disease management meets intelligent design

vectorblog.org/2011/04/disease-management-meets-intelligent-design/ by Eric Fleegler on April 14, 2011 At a conference in Texas a couple of years ago, I found myselfas at all good national conferencestalking to a colleague from my own institution. As we browsed the poster session, we talked about our respective work. Eugenia Chan works in the Developmental Medicine Center at Childrens Hospital Boston, where Im an emergency physician and health services researcher. I told Eugenia about The Online Advocate, a Web-based system Id been developing for the past eight years. It screens patients and families for health-related social problems, provides feedback and helps them find services in their area that can assist them. Eugenia was excited about bringing The Online Advocate to her patients. This is really great, and I want to use it, she said. But I have another idea that I would like to explore with you. The Developmental Medicine Center relied on childrens parents and teachers to complete extensive questionnaires to help providers understand their patients problems. Providers would give the parents paper questionnaires to fill out themselves and to pass on to teachers. But only 30 percent of parents and fewer than 10 percent of teachers were completing them.

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These results werent surprising. We all know how hard it can be to remember both to fill out a form and to send it in. Its not convenient, the forms are cumbersome and long, it takes additional energy to return the forms to the clinics, the parents have to get the forms to the teachersthe list goes on. As Eugenia and I talked about the challenges of collecting quality patient data and reviewing it in real time, I realized that we could use the skills my small team had developed in online questionnaire design. WIth funding from her department, I hired a second full-time software engineer, and Eugenia and I worked with my team of programmers to sketch out what became the electronic Developmental Medicine Center (eDMC). We knew that the interface needed to be as simple and user-friendly as possible, removing any barriers that would keep parents and teachers from using it. At the same time, it needed a sophisticated graphing and report mechanism to ensure that providers could extract as much value as possible from the system. We met every other week to review our design progress, brainstorm how users would best interact with the system and discuss how to make the software fit easily into Developmental Medicines operational flow. We asked parents and other providers to beta-test the system and provide us with feedback. All the while we refined the interface, expanded the providers view of the data collected and created ways to transfer it into patients medical records. The software launched last July, and currently we have over 1,000 patients enrolled. Questionnaire response rates have jumped to over 70 percent for parents and over 50 percent for teachers. And whenever I talk to Developmental Medicine providers, they tell me that eDMC has changed the way they practice medicine. When I talk to doctors in other clinics about eDMC, I hear a familiar refrain: This is really great, and I want to use it, but I have another idea that I would like to explore with you. Which of course has led to new opportunities. The Department of Neurology wants to track symptoms across a spectrum of diseases. The Department of Psychiatry is interested in tracking medication side effects to prevent adverse reactions. Our Adolescent Medicine clinics are trying to find ways to motivate adolescents to fill out questionnaires at all. Next on the agenda are mobile apps. And as my team develops these disease management systems, were integrating our work with The Online Advocatewith the firm belief that the best way to improve a patients health is by addressing the familys needs as a whole.

Innovation: Is it just lightning in a bottle?

vectorblog.org/2011/10/innovation-is-it-just-lightning-in-a-bottle/ by Naomi Fried on October 19, 2011 The word innovation gets thrown around a lot these days by people trying to set their products and ideas apart from everything else out there. But when everything is innovative, is anything really innovative? And if there really are innovative ideas out there, are they simply flashes of brilliance that cant be planned for or predicted? The answer to this last question is no, as I see every day as Chief Innovation Officer here at Childrens Hospital Boston. The real trick is creating an innovation culture that supports great ideasbut that also supports the not-so-great ideas that teach us almost as much. So what are the attributes of an innovation culture? First, people must feel safeto experiment, to take risks and, most importantly, to fail. Failure is a critical ingredient of innovation; progress rarely can be made without it. To make people feel safe to fail, there must be no significant penalties for failure. In fact, we need to look at failure as an opportunity to learn what went wrong so we can do better the next time. And we have to encourage our innovators to share what didnt work and what they learned, and then go back to the drawing board to try again. I knew we were well on our way to creating a safe innovation environment when, at a recent meeting, one of our well-respected clinical department heads volunteered that his great idea had been an abject failure. No one berated him or mocked him, but instead listened for the lessons learned and moved on. Second, an innovation culture is open. People are nonjudgmental and welcoming. All types of innovation are accepted. Just as its okay to fail, it is okay to have small-scale successes and improvements, not just the really big new ideas. Just as the perfect can be the enemy of the good, we need to make sure that our preoccupation with paradigm-shifting, disruptive innovation doesnt cause us to denigrate the value of incremental, small-scale innovation. In fact, small changes can often add up to something big. One great and recent example is work done by the parking and Commuter Services Office to streamline the return of valet-parked cars to our patients families leaving the Emergency Department. In five months, their hard work resulted in being able to return almost 90 percent of the cars in less than 15 minutes, a major improvement in throughput.

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Third, an innovation culture is one in which the innovator feels supported. That support can take many forms. For starters, people need the time to innovateto notice problems, brainstorm new ideas and test their theories. Its hard to create a culture conducive to innovation if people dont have time to reflect and think. To foster innovation, Google allows their engineers to spend 20 percent of their time away from their assigned projects, experimenting with new ideas. Half of Googles new innovations have come from ideas developed in this 20 percent time. To make an innovation a reality, people also need access to resources for testing and developing ideas including seed money, software expertise, space and, most importantly, advice. Guidance and support (especially when things are failing!) go a long way in creating an innovation culture. Mentors and innovation experts who can share their lessons are a valuable institutional resource. And learning the ropes from experienced innovators is a great way for novice innovators to get started. Just ask Karen Sakakeeny. Karen is a nurse who, after 33 years at Childrens, decided to try her hand at innovation with a hat for rewarming infants undergoing open-heart surgery. With an innovation grant and the support of a team of innovation and patient-care experts, Karen is now navigating the innovation process quite successfully. We are extremely fortunate here at Childrens to have leaders who understand that building an innovation culture requires resources. They supported the formation of the Innovation Acceleration Program team and have provided time, money and space for innovation. We have a seed fund for clinical innovation, the Innovestment Grant program, the FIT software development team (which focuses on developing innovative new technology solutions), and many institutionally supported opportunities to share ideas and learn from each other. But changing peoples attitude toward failure and creating a safe and open environment takes time, work and commitment across the organization. A year into our teams work, were well on our way to becoming a hospital culture that supports innovationand proving that its much easier to catch lightning in a bottle when youve created the atmosphere for brainstorms.

After surgery, a robot may be at your side: In quest for efficiency, savings, hospital is testing at-home mechanical monitors
bostonglobe.com/business/2011/12/12/after-surgery-robot-may-your-side/GFsv1KtHm9MjJAmaKyNikL/story.html by Jay Fitzgerald, Globe Correspondent on December 12, 2011 When Erin Tally took Aidan, her 2-year-old son, home from Childrens Hospital Boston on the day after his urinary surgery, she brought along a new friend: a 4-foot-6, 17-pound, two-wheeled robot that would help deliver care to her recovering child. Over about two weeks that included five video consultations, the robot, made by Vgo Communications Inc., of Nashua, eliminated the need for Tally to drive Aidan into Boston every three days for post-surgical checkups. With cameras, advanced audio gear, and a video screen on its face, the robot allowed Aidan and his parents to talk with nurses and doctors in Boston. They could see and communicate with Aidan and his parents, take close-up photos of his surgical scars for doctors to review, and help determine what type of medications he needed. It was kind of comforting to know it was there, said Tally, adding that Aidan was groggy after the surgery and needed the extra care. He was tired and couldnt run around like he usually does. The Vgo device, priced at about $6,000, is part of a five-robot pilot program at Childrens Hospital, testing whether the devices can help monitor patients after they leave the hospital. Such teleconference devices are increasingly being used in limited ways across the nation, but the Childrens program is being conducted on a larger scale and is considered a first in health care. Eventually, I see a whole fleet of these robots being sent home with patients, said Dr. Hiep T. Nguyen, an associate professor at Harvard Medical School and director of Childrens Hospitals Robotic Surgery Research and Training Center. With this technology, were going to be able to replace hospital monitoring with home-based monitoring. Including Aidan Tally, eight Childrens patients have been sent home with Vgo robots over the past few months. Childrens hopes to test the robots on about 40 at-home patients before taking the pilot program to the next level: sending patients home early, along with a robotic companion. Nguyen said he could only loosely define Vgo as a true robot, because its functions are limited. Communicating over Verizon Wirelesss high-speed 4G LTE network, Vgo robots conduct two-way video and audio consultations. A 5-inch screen, with a camera and microphone attached, serves as the head of Vgo. The robots movements and functions are controlled by computer by hospital staffers. They can remotely drive the robot around a house, with the Vgos camera looking up and down to avoid running into walls, people, or household items.

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Nguyen envisions robots that will be able to measure blood pressure, take a pulse, and conduct blood and urine tests, sending the information to hospital personnel for review. Robots could also be used to monitor homebound elderly patients who cant make it to hospitals for checkups. Were at a kind of tipping point in health care, said Jorge Sanchez de Lozada, assistant director of information technology at Massachusetts General Hospitals Institute of Health Professionals, who added that the hospital is considering doing its own tests of home-use robots. This technology is definitely where health care is going. Nguyen added that hospitals are under pressure to reduce health care costs, and robots could be used to cut expensive hospital stays. Physicians like me are constantly being asked to be more efficient with our time and money, Nguyen said. This is a technology that allows us to be very cautious, efficient, and innovative at the same time. After developing and testing prototypes of its robots, five-year-old Vgo Communications worked with Verizon Wirelesss Innovation Program center in Waltham, where the telecom company helps incubate new technologies, to embed Verizons cellular communications technology into the robots. Through its connection to the cellular network, a Vgo does not need to rely on Internet broadband connections. Vgo Communications has raised more than $12 million in venture capital since its founding and has 16 employees. It has sold about 200 of the robots, manufactured for it by a company in Spokane, Wash., since January. We think we have a lot of good traction in this niche, said Peter Vicars, the companys chief executive. Another potential use for the robots is as avatars for children too sick to attend school. The devices could go into classes, allowing a student to attend from home. The robots could also be sold for security monitoring tasks. But health care is the most intriguing field, industry officials say. A Bedford company, iRobot Corp., has teamed up with InTouch Health of Santa Barbara, Calif., to develop a remote presence robot nicknamed Ava, which the companies say could one day perform health care tasks at patients homes. Its a powerful idea, said Colin Angle, iRobots chief executive. IRobot produces the popular Roomba floor cleaner and robots used by the military in Iraq and Afghanistan, among other products. Last month, InTouch, which makes in-hospital robots, filed a patent-infringement lawsuit against Vgo Communications, claiming the New Hampshire company was improperly using two of its patented technologies dealing with remote controls and front-end cameras. Yulun Wang, chief executive of InTouch, said the lawsuit is based on the whole concept of remote-presence robots and called the at-home robotics market a potentially huge area of growth. Vicars denied the allegations of patent infringement and vowed that his company will defend itself aggressively against the lawsuit. Nguyen said he is glad companies are competing to develop health care robots. With competition, well see the prices getting much better, he said.

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