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Saul Marquez:
Hey, everybody! Saul Marquez with the Outcomes Rocket. I want to welcome you back to the podcast. On this special series recorded at ViVE event here in Nashville, Tennessee, I’m accompanied by Dr. Peter Rasmussen. He’s the Chief Clinical Officer for The Clinic by Cleveland Clinic and professor of Neurosurgery, Department of Neurosurgery, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University. He maintains a busy practice offering patients either open microsurgery or endovascular minimally invasive treatment options. Such a pleasure to have you here, Dr. Rasmussen. Great to see you.
Peter Rasmussen:
Thanks. Pleasure to be here,
Saul Marquez:
Peter, so glad that we’re here. And one of the things that I like to ask all of our guests is, what is it that inspires the work that you do in healthcare?
Peter Rasmussen:
Well, I’m really very highly motivated individually by trying to come up with new and innovative creative solutions to solving clinical care problems. I really found that I had a passion for this, probably about 18, 19 years ago when I was running the multidisciplinary Stroke Center at Cleveland Clinic. And one of the ways that we recognized that we could drive business for us to help improve our top line was to increase the amount of transfers we would get from surrounding community emergency rooms. It was one of the very few things we would have control over at our level in the organization. And in order to do that, we recognized that this emerging technology or care paradigm of telestroke was going to be a strong solution for this. So I worked with our administration to implement a telestroke program. For those of you who are not familiar with this is putting high-quality audio-visual camera systems in place in local or remote emergency rooms that do not have stroke experts staffing their hospitals, or even if they do, they’re not able to respond very quickly. And it would allow that local emergency room to access Cleveland Clinic stroke experts within about 30 to 90 seconds. And because of that, we would increase the strength of our relationship with those hospitals, and when those patients did need transfer to a higher level of care frequently, then they would come to Cleveland Clinic. So that was a strong way to prove our patient flow as well as providing patients the best possible care. So that really whet my appetite for this. There were a couple of other things along the way that came out of that, and then about ten years ago, the CEO of Cleveland Clinic at that time, Toby Cosgrove, was looking for an internal champion to energize digital health at Cleveland Clinic. Since I was the physician, mainly doing most of the digital work at that time, primarily around Telestroke, it was sort of a natural for hit to ask me to do that, yeah. So from there it kind of launched and spent 6 or 7 years doing Digital Health inside Cleveland Clinic before moving over to The Clinic by Cleveland Clinic.
Saul Marquez:
Fantastic. Well, congratulations on finding those ways to add value to the health system and to the patients you serve. Today, your ViVE session covers specialty care deserts. Can you tell me a little bit more about what specialty care deserts are and how the healthcare community is addressing them?
Peter Rasmussen:
Well, there’s really a variety of different ways you can look at a specialty care desert. The obvious thing is to take a look at a rural state or a rural community where there’s not a strong attraction for a specialty physicians to base themselves there, maybe a paucity of patients that might be there, or might have to do with the payer opportunities in that area or other factors that are unknown. But as an example, we can talk about the state of Wyoming. I think several hundred thousand patients people live in Wyoming. There are no rheumatologists in the entire state of Wyoming. Another example would be state of Michigan. Last time I looked into this, there are no pediatric rheumatologists in the entire state of Michigan. This is 20 million people, maybe something like this. Even in a large state, heavily populous Michigan don’t have potential specialty care. But even beyond that, in a more nuanced way, there’s going to be a specialty care desert and those areas where there may be high-quality specialists, but there aren’t enough to meet the prevalence of disease. So I think a great example of this is stroke as an example, not enough stroke physicians being trained, huge number of strokes every year, some 800, 900,000 strokes. And the only way you can meet that patient need is by bringing physicians remotely into this. Same thing is true with congestive heart failure. 5 million, 6 million Americans are afflicted by heart failure, but a million die each year, only a very small fraction of those patients ever see a cardiologist or a heart failure specialty cardiologist, vast majority are managed by primary care and internal medicine physicians who may be fantastic, but more likely than not, are not up on the latest advances of heart failure care, and they’re not able then to offer their patients that digital health by whatever means that you can think about what that means, gives an opportunity to bring those specialists to those patients who may not be able to access that specialty care for the reasons we talked about.
Saul Marquez:
That’s great, Peter. And it started with your what you did with stroke in the emergency room at these community hospitals. And you saw an opportunity that there was an opportunity to really address those gaps across the board with other specialties.
Peter Rasmussen:
Yeah, exactly. And it didn’t take very long for us to recognize that the same equipment that we were putting in emergency rooms to do acute stroke work worked equally well for acute psychiatric work or acute cardiac care that needed to be done there, or projected pediatric intensivist into a pediatric ED. It was all the same thing, it was the same technologies, needed a different provider there. So it really became a paradigm and model for any of that kind of work for the inpatient. Started in the ED, went to inpatient services while we were doing remote neurology for a number of years as an example. And then it just became natural to extend that same concept to the outpatient arena initially with things like on-demand, urgent care online, on-demand urgent care, and then ultimately virtual visits for routine outpatient clinics in all specialties, and would frequently encounter some naysayers in the Cleveland Clinic who would say, I can’t do cardiac surgery by virtual visit. Yeah, that’s true, I can’t do neurosurgery by virtual visit either, but I can do a pre-surgical evaluation or follow-up evaluation of these patients by virtual visits, and that’s good for patients. And then you begin to add additional layers of technology to this. Things like imaging acquired locally, transferred to my office or the Cleveland Clinic through cloud imaging sharing solutions, you begin to layer on these technologies, and as you build into significant program to deliver a large amount of care that normally is done in the outpatient environment virtually and digitally.
Saul Marquez:
Yeah, and that could even scale globally.
Peter Rasmussen:
Yeah, exactly. And then really we come into the barriers of really around regulation. What are the regulators allow you to do, the bureaucrats allow you to do? What are the laws allow you to do? What was the medical licensure that’s needed in various states or these countries? And that really becomes the big barrier to this, unfortunately.
Saul Marquez:
Yeah, for sure. Another move towards digital health is the use of devices like wearables for scaling care to the home remote patient management. Can you speak to that?
Peter Rasmussen:
Yeah, real strong interest of mine right now. When I was working inside Cleveland Clinic, we put together the technology that was required to allow patients to have their data flow. One of the things that we identified very early on that, it didn’t necessarily help to give the patient the Bluetooth or Wi-Fi connected blood pressure cuff, as an example, if that data just sort of dead-ended into PDF or maybe an email message, to me, that doesn’t really help. So we really needed to have that data integrate electronically and automatically into our electronic health record. That was a significant lift at that time. Epic did not allow for an easy way of doing that. Fortunately, we were able to find a vendor partner to help us with this and we had really some highly skilled IT folks inside our organization that were able to create API links between the different platforms to get that done. And now that it’s in place, it’s very easy for your patients to do things like measure blood pressure at home, weight activity, heart rate, respiratory rate, etc, etc., and have that data flow into electronic health record that we have and incorporate it into their overall health picture that resides inside that EHR just as if that data was acquired in the clinic. There’s no reason that a home blood pressure monitoring device isn’t as accurate as one that’s done in the office.
Saul Marquez:
Yeah, that’s great. Thanks for sharing that. And what are the benefits to getting a second opinion virtually?
Peter Rasmussen:
Yeah. Well, unfortunately, as we talked about, there is a difficulty accessing specialty care generally, and so this is one opportunity to address that. But even if you have the opportunity to see a high-quality physician locally, he or she may not offer all the different treatment options that may exist. Perhaps there’s some diagnostic testing that should be done as part of your condition that they hadn’t done or didn’t think was valuable. If you’re really faced with a life-changing diagnosis like cancer or cardiac disease, significant neurologic disease, you really owe it to yourself to get a second opinion around this because you may or may not with a high-quality physician, your first go around. And it’s very simple now that most medical information is digital, that the medical records can be shared electronically, imaging can be shared electronically. And because that can happen and the regulatory environment allows for a remote second opinion across state lines that you can access an expert at the Cleveland Clinic who may be the world’s best physician for that condition, to opine on your particular circumstance and give you the treatment options that are certainly going to be up to date. What we’re finding is that about a quarter of the time we’re changing diagnosis. So this may be something dramatic like telling you you don’t have cancer when the local doctor said you did, or we might be changing the staging of the cancer that you have. And then about three-quarters of the time we’re finding different treatment recommendations, so that might be something as dramatic as saying you don’t need surgery when you’re told you need surgery locally, or we might be adding additional medication regimen to your cancer chemotherapeutic regimen or offering you some additional options where maybe locally or told you didn’t have any options.
Saul Marquez:
It’s all about the consumer experience now, and we’re taking big strides in healthcare around being able to provide consumers the healthcare experience that they need and want. And so what you’re sharing is you’re giving people options and you’re giving people transparency around what could be and what options they may not be aware of.
Peter Rasmussen:
Yeah, I still prefer to call the consumers patients, and the patient experience is something we take very seriously within our second opinion program. So it is a premium offering, it is a concierge-level service. People want expedited access to experts. If you’ve been told you need surgery and maybe you’ve got that booked within 2 to 3 weeks, obviously you need a fast turnaround for that second opinion. So we really work very hard to match the patient to the best possible physicians. You’ve got access to all of the technologies that are available now for medical record interoperability. As I mentioned, we’ve got cloud-based image-sharing solutions, and we’ve got a very highly-skilled nursing team that interfaces with each of the patient to provide a high level of touch and to really work with that patient as they move through the second opinion journey.
Saul Marquez:
That’s fantastic. If somebody wanted to access that, can they access the second opinion platform?
Peter Rasmussen:
Very simple. You can do an internet search. Cleveland Clinic Second Opinion should get you all of the appropriate links.
Saul Marquez:
Love it. There you go. There you have it, folks. We’ll leave that in the show notes. I personally think it’s a fantastic option to gut-check any assessment, diagnosis, or treatment plan that you have. Why not? If you’re going to need this type of treatment, why not gut-check it? What are some of the hang-ups that people have when it comes to getting a second opinion?
Peter Rasmussen:
Unfortunately, I think a lot of patients are a little bit of fearful about offending their local doctor. Maybe I’m second-guessing that for the most part, that’s not really a concern. As a surgeon myself, if I make a recommendation for a patient to have surgery or not have surgery, I want to be part of that patient’s care team. We’re working through this problem on this journey together. If they’re not entirely comfortable with my recommendation …, it makes sense for that patient to find a second opinion around that because I’d like that patient to be comfortable with what I’m doing. If they’re not comfortable with me, then they should get a second opinion or they should change physicians. So I’m not concerned about that whatsoever as a physician, doesn’t offend me. I think most physicians feel the same way. Some do, unfortunately, but at the same time, it’s your life, it’s your health. If you’re facing a major surgery or a major life-changing medical event, you know, you shouldn’t let the other person’s feelings get in your way. You got to put your own interests forward.
Saul Marquez:
Amen to that. And Peter, as you look at the future of healthcare, we’re here at ViVE ideating and also sharing the plans that are in place. What do you think is the biggest promise for us in 2023?
Peter Rasmussen:
Yeah, I think obviously a lot of stuff I alluded to already is that there’s a tremendous amount of excellent technology that’s out there and software solutions. Healthcare is still very human. People who are faced with significant chronic diseases want to know that they’ve got a care team that cares about them. So it’s a human-to-human interaction. That doesn’t mean that human interaction can’t be supplemented, augmented, or made better by leveraging the technologies that are available. So when I come to ViVE and I look around and I see the companies and devices and technology that’s out there, I don’t think about how I’m going to use that as a lone stand-alone solution to a problem. I think about how can I piece these solutions together to create a new and different way to deliver care, particularly in things like in chronic disease, like we talked about. No reason whatsoever we shouldn’t be putting together multiple technologies that can operate around things like congestive heart failure to create a new way of delivering care to these patients. I think that’s the kind of thing that’s going to be coming forward more and more frequently in 2023 and 2024.
Saul Marquez:
Love it. Thank you for that, Peter. And so folks, open your mind up. Don’t think single solution, think big picture. How can you piece these solutions together? Oftentimes, the solutions can’t provide the full answer. So you got to figure out how to put together the entire solution overall that will help your health system and your company succeed. Peter, this has been great. I’d love to ask you just for a closing thought that you want to leave our listeners with.
Peter Rasmussen:
Yeah, like I mentioned, don’t hesitate to think about that second opinion for yourself. If you’re not using digital health, virtual visits, etc, in your own personal care journey, I ask you to open up your mind and incorporate that into it because it can improve the quality of life. It’ll reduce the amount of time away from work or away from home, reduce your overall cost to do that. So folks, digital health, virtual visits, these kinds of things aren’t going away. Figure out ways to incorporate it into your life.
Saul Marquez:
Thank you, Peter.
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