Seth Martin, Associate Professor of Medicine (Cardiology) at Johns Hopkins Hospital

Enabling Application Interoperability to Scale Population Health with Seth Martin, Associate Professor of Medicine (Cardiology) at Johns Hopkins Hospital transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the podcast. And in today’s Population Health series brought to you by HP Population Health I.T. Solutions, I have the privilege of hosting Dr. Seth Martin. He’s a preventative cardiologist and clinical lipidologist at Johns Hopkins Hospital in Baltimore, Maryland. He is a core faculty member in the Ciccaroni Center for the Prevention of Cardiovascular Disease, where he directs the lipid clinic and leads mobile health innovations. Dr. Martin also serves as the associate faculty member in the Welch Center for Prevention, Epidemiology and Clinical Research and an affiliate factory for the Malone Center for Engineering in Health Care. He’s a dedicated clinician and clinical educator. Dr. Martin’s a member of the Hopkins Bedside Medicine Faculty. He serves as a firm faculty, clinical coach and educator with the Janeway firm on the Osela Medical Residency. As a prolific researcher and innovator, Dr. Martin led the development of a more precise system for estimating LDL cholesterol. He works with many students, residents and fellows with whom he’s published more than 200 articles in leading cardiology and medical journals. He serves as associate editor for the American College of Cardiology’s Dyslipidemia clinical community as an associate editor for the Journal of Clinical Lipid Allergy as well. He’s an NIH mobile health scholar and leads a mobile health interest group focused on examining cutting edge techniques and facilitating interdisciplinary synergy. He’s a founder of Corrie Health, which we’re going to dive into this podcast on a patient centered digital health platform that really helps cardiovascular prevention in celebration of the 125th Johns Hopkins Medicine anniversary. Dr. Martin was selected as one of the one hundred twenty five individuals who personify Johns Hopkins medicine’s mission to improve the health of community and the world by setting the standard of excellence in medical education, research and clinical care. In today’s podcast with Dr. Martin, we discuss interoperability, building and scaling a digital health solution and the work that he and the team at Corrie Health has done to bring cardiovascular care and prevention in to communities that more than likely would not have this care, and also scaling in such a way to allow people to get that type of care during an era of covid-19 and beyond. And so with that. Glad to have a Dr. Seth Martin here with us. And today we’ll be super focused around his thoughts on health care, but also around interoperability and the idea of of building and scaling a digital health solution, but also the execution of that. So, such a privilege to have you here, Dr. Martin. So glad you could join us.

Seth Martin:
My pleasure to join you. Thank you for having me.

Saul Marquez:
So, Dr. Martin, what inspires your work in health care?

Seth Martin:
Yes, I have been inspired for a long time, I come from a medical family and knew for a long time that I was probably heading towards a career in health care. And so I’m on the frontlines now of clinical care as a cardiologist at Johns Hopkins Hospital. And so the being able to help my patients solve the problems that they’re facing and lead healthier lives, spend more time with family, stay out of the hospital, that inspires me. It’s really from that that inspiration. But also seeing that there’s still room for improvement in the way that our healthcare system serves patients inspired me to become part of the Corrie health team and really work on building the future of health care. And so think I’d love to sort of shares some of that story and how Corrie started. It’s basically been at this point about five years in the in the making. And then I was fortunate to meet a really incredible physician. France was marvel back at that time when she was at the beginning of her internal medicine residency. And this came at a time that I started getting interested in health technology and had recently returned from a training in mobile health technology at the NIH. And really, it was becoming ingrained in me the importance of working on a multidisciplinary team with more than physicians but engineers and nurses and having patients as partners in research. And so around that time that I was starting to think, you know, what could be some next steps to really help the cardiovascular patients that I was seeing in the inpatient setting of the hospital in an outpatient setting. And I’d done some work around promoting physical activity that I knew that there was more to it then than that. One thing that we the patients really need a full package and not one thing. And so France was Marvel was starting to work in this accelerator program at Johns Hopkins around technology and thinking about building a smartphone app for patients and connecting with some great engineers. And early on, we connected with the amazing engineer Meatiest Lee, who was in the teach program at Hopkins. And really the we wanted to work on something that was addressing a problem our patients were facing. And the problem that we honed in on was this transition from the hospital to home.

We are seeing that our patients with who came in suddenly clenching their chest with a heart attack in the hospital. We have all these great interventions, putting stents in arteries, really proven medications that help after that. And we do all that really well in the hospital. But then the transition happens home and that transition happens quickly. And it’s not really a paper based process where patients get given those instructions that are really lifesaving instructions at the tail end of that hospitalization. And and there there’s really this, we thought opportunity to improve the implementation of everything we know by better engaging patients in their care around that time and using that time, they’re in the hospital to start introducing two to a tool, not to papers, but a tool on the devices that folks are having their hands on the smartphone to guide them through that recovery. And so we started working with that. We got connected around that time through our tech innovation center with a team at Apple Health, and they were incredible partners as we began to build a smartphone based solution for patients. And it’s just been an incredible journey of working with patients, working with engineers, working with other physicians like Dr Marvel, working with nurses like Aaron Spaulding, building something from scratch, bringing this vision to life of moving beyond just the paper-based process to something that’s really serving our patients to help them engage better and in guideline therapies.

And so it’s been a journey over time of building the smartphone app, which is paired with smart watch and a blood pressure cuff and getting that in the hands of patients and their families and then to study this, to see the impact that we’re having. And we’re still working on the final study results. But we just published a paper in partnership with one of our patients in BMJ case reports, and her words are so powerful about the impact that this type approaches is having on her. And that’s what inspires me to work in health care, is to have a positive impact on the lives of our patients. And there’s just so much I can do by. You know, delivering everything that we we know how to do. But I. That I’ve come to realize that my impact is it’s one thing to see a patient in the hospital and have that brief moment of time with them. It’s one thing to see my patients in outpatient clinic every now and then, every few months for six months or a year. But I can really extend my reach and the impact I can have as a clinician if I can work with other folks and build technologies that can empower the patient every second of the day. And really the extending that reach, I think, is going to be a future of the master clinician understanding how to empower patients with technology, because ultimately it’s about what the patient understands and recognizes as important and has access to what they need to take care of themselves because they’re ultimately the person who’s responsible and them and their family.

I think I’ve also learned throughout this process the importance of the caregiver, whether that’s about the caregiver helping them engage with technology or helping engage with getting the aspects of their care that that they need to engage with. So this is really what I think we have incredible tools to help patients in cardiovascular disease and in medicine. And I am inspired to bring those to my patients every day. But I’m also inspired to drive forward the future of health care that I think is going to be more digital, more patient centered. It’s going to be it’s going to engage families better. It’s it’s really we’re entering now into a new decade, the twenty twenties. This is an exciting, exciting time to be innovating in health care and figuring out how we can bring these new technologies into the workflow of our health system and into the daily lives of our patients to better make us better clinicians and help patients achieve better outcomes. And again, you know, stay healthy and out of the hospital.

Yeah, that’s super, super interesting, appreciate the story and how things came to be. For those of you listening, you may want to check out the Web site. It’s Corie Health dot com that c0 our eye health dot com. You’ll see what the app does in the cardiology space. It’s about the last mile. And getting a patient used to taking care of themselves with the help of their clinician, with the help of technology, as Seth mentioned, interoperability. How do you make that happen? And building and scaling digital health solutions. Not easy. And what what Dr. Martin and his team have done is is very impressive. And so I want to dive a little bit deeper into it. And so so tell us a little bit more, Dr. Martin, about how you believe the solution is is making things better and for the health care ecosystem and for four patients.

Yes, my absolutely it’s a great question. I think we’re adding value by having a strong emphasis on the end user on that, on the patient. A lot of solutions are being built. They’re directed at the clinician and is as much as I want more tools to help me. It’s been a interesting if we talk about, you know, value and interoperability, it’s a pretty touchy subject around electronic medical records and clinicians and how clinicians really, you know, have accepted the electronical medical records which were built as as billing systems rather than really to to extend the impact to the patient and make our lives easier. And then there’s a whole national debate going on around interoperability of different medical record vendors. And I think that the that’s a tough subject there on the clinician side of things. And that that needs to be sorted out on the that ultimately it’s the patients who were serving.

And there needs to be more emphasis on proven patient oriented solutions or using credible sensors, credible information, and really have evidence behind their ability to help patients a lot. There’s hundreds of thousands of apps out there, and many of them are directed at patients or the consumer, but unfortunately really lacking credibility in terms of whether they’re providing the measurement that they claim to provide, whether they are providing the value that they claim to to deliver for the patient. And so what we’re really doing here, I think, is is working on a credible patient orien solution where the patients were involved in the development itself, where we have an intense focus on the end user.

That’s something we’ve been taught by companies like Apple that have such a strong emphasis on end users or or my colleagues at HP and and others that this is something that we need to bring throughout the technology development process. How is the end user going to do this? And is this going to be intuitive, how they interact with this technology? But going beyond that, once it’s shown to do a clinical study like we’re doing with our my core study to show that it actually is something that adds value in terms of clinical outcomes, in terms of saving money for the health care system, really the promise of digital technologies to both improve outcomes while saving money, which helped my health economics colleagues would say is a dominant strategy. That’s really what we need to do. So I think that’s where we’re adding value by putting more emphasis on the patient and on proven solutions and also thinking about something that’s more comprehensive, as I’m sort of mentioned earlier. Patients don’t need just one thing. My early focus was on physical activity, but my patients need physical activity. They need help with diet. They need help with the medications. They need help getting to appointments and just high quality educational content and so on. And so are we’re adding value to by bringing things together in a comprehensive way so the patients have a one stop shop rather than having to have 10 or 20 different apps to do what they want to do.

Yeah, you know, and that’s really neat. I had a chance to to dive deep into the into the Tacon. And you guys really do take a look at the whole patient perspective then and capture all those things, making the the solution for them a one stop shop, which which is critical, keeps things all integrated as you as you think about what makes Corie different and what you guys are doing there, whether it be from a business model side or a technology or even outcomes perspective. What makes what makes what you guys do different than all the other apps out there?

Yeah. Yeah, I think I started touching on some of those things already in terms of the comprehensive approach and the credible content and our intense focus on end users. But, you know, beyond that, you know, something is pretty interesting. This is this idea of the digital divide that technology has a risk of serving only the rich and wealthy.

And and and and people that are already healthy to begin with and not Hurby, those that are sick and in need and don’t necessarily have direct access to these technologies that are folks. I’m thinking of folks from places like Baltimore where we work, where we have and serve a lot of patients who don’t have tons of resources initially familiar with technology. And our partners of the American Association Heart Association have this strategic initiative called the Health Equity Initiative, where they’re really like the MIT. Yeah. Committed to this idea that that that really there should be we need to be working on a way that this can provide equal access to technologies that we’re really committed to promoting the health of everyone, not just those that can afford this or have.

Resources. And so that’s an approach we’ve taken on, Corie, the way that we did in our initial work is we actually loaned devices to talking about iPhones and Apple watches to patients that didn’t already have them. So that we could serve everyone, not just the select few that came into the hospital with these devices already. I see. That makes us different. We have thought a lot about how to turn that into a business model. And, you know, for that particular solution, since we were focused on the hospital recovery, we it was a defined time period.

And so patients actually sent these devices back to us in prepaid mailers. And the vast majority was somewhere around 70 percent of devices came back to us. So we’re able to do pretty successfully get these devices and developed a recycler program. And we’ve even published paper in JMI are describing that process to help others who want to develop this program that can really serve all patients. And the case report that I mentioned earlier with our patients in BMJ case report she was fits this bill of someone who was underserved. She was actually previously incarcerated, had very low income and was not someone who has had access to an iPhone or her Apple Watch. And we provided to her as part of the study, and she was she found it, in her own words, extremely useful. And so I think that that makes us different. The fact that we’re we’re actively trying to make this available to everybody. We’re not just sort of putting it out there for anyone to use who already had, you know, has the resources and access. I think that really sets us apart.

Yeah, I would I would agree. That’s a big differentiator. And and in tackling it from a provider perspective, Right. and and and even kind of a public health perspective, you know, for everybody listening, you’re probably like, well, yeah, there’s there’s a lot of savings, but also a lot of wellness that comes with doing the things that Dr. Martin and his team are doing. And so has there been any interest from the payer community that that you guys work with, to partner with you on this?

Yeah, I think, you know, the wellness standards, a lot of interests in that area, and we really, you know. You know, we’re starting with sick patients in the hospital with with our first kind of use case of heart attack patients in the hospital in a CCU. And it’s something that’s quite unique that we’re doing that. But that’s typically how how kind of cardiovascular innovations come to be. They sort of start in the sickest people. And if we can show that they’re helpful there, then we kind of start working our way back from what in in the cardiology community calls, you know, those patients who’ve already had an event, secondary prevention. We start working our way back to primary prevention people who have risk factors but have not had and then and we want to get further upstream and prevent one from happening. And so that that area of primary prevention or wellness, there is a lot of interest around there. I think the challenge. And we do want to tackle this is longer term engagement. So we’ve we’ve shown our ability to do this over a short time. But it’s well known that technologies can be used for a month or so. And then people kind of put them on the on the desk and don’t pick them up again. And so one thing that we’re thinking a lot about and preparing for is how can we keep people engaged over the long term so that we can because it’s not about delivering value only in that first month, but value over the long term. That’s going to be key to to wellness. And part of the trick, we think, is the social piece of it, that it’s making this part of someone’s world, not just something for them, but the way that they connect with family and friends to promote each other’s wellness. And so that’s something where we’re there’s definitely quite a lot of interest in it. It’s a next frontier.

Yeah, that’s that’s super interesting.

And so, you know, I think about the before and after and you guys are doing a really great job of of of building evidence for the tool. What have you seen? I mean, what what has improved with the implementation of of of the of the device and of the program?

It’s a great question. I mean, it’s one thing to have to kind of sit in a room and talk about how it may look when you when you get in the hands of patients. But it’s another thing to actually start, you know, going into a patient’s room in the CCU and introducing this type of technology. So through this process, we’ve learned a lot about workflow. The what’s the most effective, efficient workflow to actually introduce the technology to patients? We’ve certainly gotten feedback on the app itself, the features, how people would know that that was feedback early on as we were first developing it and then, you know, as people, as patients used it, feedback on the technology itself. But one thing I would emphasize that it’s not the tech not. And by the way, some of that feedback was around simple things like size of certain font or certain buttons and so on, which can be important when serving patients who are of older age or vision may not be as good or earth or things like that. So some of it was around the app design, but other pieces are beyond the app. It’s just the process by which this is is introduced to patients. And that that that I think those are both really key ingredients to success.

Yeah, that’s interesting. And, you know, as as you guys have done the work, what’s been one of the biggest setbacks that you’ve had? And what’s the key learning? And is there anything around interoperability that you guys ran into that that was that issue.

Yeah, absolutely, I think anyone who’s tried to integrate with EPIC will will know what I’m speaking of and it’s just not easy. So our medical system uses epic and we. I I think had we had a sense that it was not going to be easy, but I think the all the all the kind of hoops that are put there when it comes to epic integration, something as simple as, you know, just having an order that kind of communicates to your to your app to sort of deploy it. You know, there’s it’s not so much the difficulties, I think, on the technology side, but more of the all the administrative structure that’s built around doing anything in EPIC.

So for I know this is the case at any large institution to do anything in EPIC, it’s kind of requires going from committee to committee to committee. And you kind of find yourself going in circles through committees, trying to to an end. That’s been although I think we had a sense of it.

It’s been surprisingly difficult to try to have anything interoperable with ethics. So at this point, what we’ve done is been outside of of epic. This is and it works because it’s a patient oriented solution.

And we still can have some data come directly from EPIC through Appel’s health records tool. So that was quite, you know, an important step forward when they introduced that. But the ability to be interoperable with EPIK has turned out to be even more difficult than than than we envision now. Is it a huge setback? You know, I don’t know. I think there’s advantages of curating the user experience entirely out of epic and building the best user experience for patients. And and so we’ve really been laser focused on on doing that. And we’ve been able to build a workflow where we can still get to the patients we serve without that interoperability. But I wish it was easier to work with EPIC.

Yeah, no, that’s that’s a good call out. And, you know, something that is on the minds of a lot of people. And, you know, that’s a get into politics.

But they’re looking at this and figuring out how we could more easily work with patient data from EPIC for apps like Corie Health that you guys are building to make it even better. But ultimately, we’re, you know, looking at these procedures, looking at, you know, a lot of procedures that fall under the bomb, bundled payments for readmissions. You know, effectiveness at the home is is critical. And I guess you don’t really need it right now. What are your thoughts on that?

Mm hmm. Yeah, I think, you know, once we have patients, you know, at their home, it’s it’s really it’s really about, you know, connecting with them and their families and and making it a human experience for them to engage in in the positive health behaviors that we want. I think it really doesn’t have to depend on electronics, medical record, but we do.

We want you know, we’re in a time and I’m really happy about this, where it’s more about shared decision making in a partnership between clinicians and patients. And so we’re in this time that they’re really me as a clinician. I would hope that it’d be easier for me when my patient comes into clinic to kind of review their data together, make decisions together, make things easy in that way. And so that’s kind of my notes in the electronic record line up with their notes. And we we’re making plans together. And it’s. And so I hope for a world where where it is easier. But the reality is that greater than ninety nine percent of the time is going to be the patient in their home, in their community. And really what matters is the way that we inspire them, empower them, connect them with resources.

And I think technologies can can do that well with with or without, you know, interoperability and integration all the time. In fact, I just wanted to point out, I wrote an interesting editorial with one of my colleagues at at at Hopkins named Adam Cohen. It’s a nature, digital medicine. And we were invited to to comment on a review article that was was published on integration of technologies with the electronic medical record in this new age of digital health. And they had a fantastic paper that talks about all the ways that there will be kind of deep integration with existing medical structure, you know, down the line, you know, to you know, for, you know, digital health pharmacies where we’re prescribing apps like we prescribe a drug and having infrastructure built to support patients using digital health technologies. And it was it was a fantastic article. And what Adam Cohen, I pointed out was that that kind of deep integration may be very important for certain contexts and for other contexts. Technologies may be most impactful if they actually bypass the existing clunky medical infrastructure and actually just go right to the end users, to the patients and serve them, you know, in an easier way.

And that and that the more we move towards those wellness prevention efforts, the more there may be less need for integration. And the most disruptive technologies will be those that just get right to it and and go go in this direct path to people and really disrupt the model. So we were kind of actually forced me to think a lot working on this article with Adam. And, you know, we describe kind of a number we give an example of sort of Edison’s light bulb and how that it really, when that was first introduced, required a whole new infrastructure even to allow the electric Leipold to do this. I it was a fun article to work on. I think it forced me to think about the different models for integration. And I think it’s not going to be a one size fits all approach. But ultimately, we just need to have the right model that for each type of technology that that helps patients.

Yeah, that’s a that’s a really great point, Sath. And as we as we hit these brick walls, because if you’re working on a solution, you’re going to hit brick walls in health care and really in any in an area. But especially health care. And this point that Dr. Martin is bringing up is so great. Be be flexible and think outside of the EMR. It may it may be that you don’t need that EMR to deliver the care that you’re looking to. And. And so that’s inspiring in itself. And a great lesson that that you’re sharing with us today, Seth. Well, what are you most excited about today?

I’m excited that we have amazing technology. I’m excited that there’s a lot of energy and funding go into this area and that I think the fields maturing so that we’re going to really see a lot of innovation in this area that helps helps patients. There’s endless opportunities. It is amazing of the healthcare system as we have. There’s still endless opportunities to sort of challenge the status quo and figure out something that works even better for patients. So, Max, I’m really excited about this this time that we’re entering into this very patient centered, family centered and and starting to embrace technology. And now we just really need the high quality solutions and the the evidence so that this will start getting written into our medicine guidelines and our cardiovascular HHC guidelines. It’ll start getting paid for even better. But we’re already seeing positive signals from CNS around pain for, you know, remote technologies. And so I think we’re in a very exciting time here. And I’m excited about it because it’s going to help me do a better job as a clinician. It’s going to help my patients.

That’s that’s fantastic. That reimbursement pieces is critical. And then I think we are on that tipping point right now and it’s truly exciting. And if you had to recommend any book to us. Dr. Martin, what would it be?

Interesting. Interesting years ago, read Eric Topol’s The Creative Destruction of Medicine, How the Digital Revolution will create Better Health Care. So I was very inspired by the book. Would recommend it.

That was that was years ago, I guess, in almost a decade ago that I read that these days I’m reading a lot of kind of online articles and journal articles. But I did just yesterday add to my reading list. I saw an article that Elon Musk, who who definitely inspires me, had eight books on that he kind of credits with shaping his revolutionary kind of approaches. And so there’s there’s an article out there, I guess I could quickly go through them structures or why things don’t fall down by G. Gordon Benjamin Franklins, American Life, Einstein, His Life and Universe. Superintelligent Path. Dangerous Strategies. Merchants of Doubt. Lord of the Flies. Zero to one. And the Foundation. So Mattie means to my reading list.

I’m not sure how quickly I’m going to get to them, but it’s pretty. Seems pretty, pretty cool.

Now that is cool. A great list. Appreciate you recommending those folks. As you all know, we will find links to all the things we’ve discussed on the podcast. Full transcript. The short notes. All outcomes. Rocket that health. If you go to that and type in Corie health or type in Dr. Martin or even, you know, population health, you’ll see the podcasts come up and you’ll be able to get that list and our discussion before we conclude. Dr. Martin, I love if you could just share closing thoughts and where the listeners could get in touch with you to continue the conversation.

Absolutely. I guess as a closing thought, I mean, we’re as I mentioned earlier, we’re now in year 2020 where any this new decade. So this this is really, I think, a decade where we’re going to see a transformation of of healthcare from digital technology side of things. And I really think it needs to be a decade of prevention where we start moving upstream to prevent problems before they occur. And as a preventive cardiologist, that means a lot to me.

And I really feel our health care system is heading in that direction. But I thank the listeners for for taking the time in terms of getting in touch with me. I’m on Twitter at Seth Shay Martin. I’m also available by email. I guess you could I could give you my emails. You could post those is as well. Smart. One hundred HHI. My daddy to you. So know. Thanks again. It’s been a pleasure to join you on on Outcomes Rocket.

Hey, it’s been a it’s been a true pleasure for us as well. Dr. Martin. And wishing you the best and looking forward to staying in touch.

Thank you.

Hpd Population Health I.T. solutions are creating convenience and choice for providers and patients. Building on over 50 years in health and life sciences, HP is delivering end to end solutions for remote care and in-home monitoring.

Supporting the transition to home chronic disease management. Medication adherence. Health, education and remote clinical trial monitoring. HP Fit Solutions. Your single source for cost effective technology enabled remote care solutions and financing services.

Visit w w w dot hp dot com slash go slash healthcare. Thats w w w dot hp dot com slash. Go slash health care for more details.

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