Episode Transcript
Interviewer: As a patient, you may have an idea for making your healthcare experiences better. Health care providers have them all the time. The trick is testing your idea and making it happen. That's the job of my guest Dr. Rachel Hess, director of a new entity at the University of Utah, called health systems innovation and research.
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Interviewer: I am here today with Rachel Hess, the director of Health systems innovation and research at University of Utah health sciences. Welcome.
Dr. Hess: Thank you, it's nice to be here.
Interviewer: I am very happy to have you. So, how do you define health systems innovation and research?
Dr. Hess: I think health system innovation and research is really quite broad. It's an idea about changing the way that we think about our health system and making it part of the continuous learning process. So we take data from patients and data from the care that we provide and think about how we could be providing it better, and then try and implement those changes. One of the things that HSIR is really striving to do is service that bridge between traditional health services research and hospital operations.
Interviewer: So what are the primary goals of HSIR? I should mention to our listeners that health systems innovation research, of course, the acronym is HSIR.
Dr. Hess: Yes, it's much easier to say. The goals that we have set for HSIR are to let data define our questions, to test the questions, to test the ideas that allow us to answer the questions, to take those ideas that we are promising and generalize them to larger work and to allow the University of Utah to lead in stakeholder and data driven intervention. When we talk about stakeholders, we mean patients the community clinicians, payers and the whole health system and how do we take those who are involved in health care and allow them to help define what it is that we need to be thinking about.
Practically, we see what HSIR does as serve as a safe place for people who are both, traditional researchers and non-traditional researchers but just have a good idea to come and allow their idea to grow and incubate. People who can help you develop your idea, people who can help you around the regulatory issues of your idea, people who can help you implement your idea and people who can help you analyze the data.
Interviewer: This definition of an incubator, I think, is something that really resonates with a lot of people. Would you say that's a fair analogy for what you do?
Dr. Hess: Yeah. What we really want to be able to nurture is the person in the trenches who asks a question.
Interviewer: Can you give me an example of study that you are working on?
Dr. Hess: We know that only about 10% of people are quitting smoking at any one time and as a doctor, if you are counseling all of your patients who smoke to quit smoking, it can be kind of demoralizing and so what are the studies that we have done is we have tried to get patients to talk to their doctors about smoking. So you have taken a computerized version of a patient intake form, the piece of paper that you fill out when you go to the doctor, and allowed that to give patients feedback. The feedback said something along the lines of, "Smoking is not good for you, your doctor is really interested in helping you figure out if this is the right time to stop smoking and partnering with you to help you stop smoking." And we look to see whether or not, that made patients more likely to initiate discussions around smoking.
We did the same thing with physical activity and mental health and what we found in our small pilot study that is now going to a larger randomized control trial is that, patients who are given that feedback were more likely to initiate conversations with their doctors, both about smoking and about mental health related issues, which are two topics that are hard for patients to bring up and hard for doctors to bring up. And then, the doctors are able to use all of the great counseling tools that they have learned in medical school and through their residencies, to help the patients through those times.
Interviewer: You work with, you mentioned earlier, clinician investigator. Would you say they are your primary clients?
Dr. Hess: Our primary outreach client is clinicians who may not think of themselves as investigators and patients who may not think of themselves as investigators, who may come in with really great ideas on how to change health care as well.
Interviewer: Just a line those up, if I'm somebody who has a great idea, I could be a patient, a payer, anyone and I need some help and this is [inaudible 00:4:41] is that would like sort of a turnkey.
Dr. Hess: Yeah, that sort of where we want to be. We really envision ourselves as a place where somebody can bring an idea and we can help them develop that idea and help them figure out how to best implement and test that idea. So what resources do they need, in terms of data gathering, data analytics, regulatory oversights etcetera, and can we take that idea and move it from the idea stage to the small pilot stage to a larger pilot stage and then to a stage that may become a funded research project where they need help applying for the grant to get the proposal funded to do the larger study.
How do we help them take the data they have gathered and analyze it and put it together in a way that's shared, not only in the institution, but also nationally. So how can we be in that place where it's safe to come at any stage and get the help that you need. For some of our researchers that may be helped connecting with Clinicians and operational people who can help them implement. For some of our clinicians, it maybe connecting them with the research skills and teams that they need to help develop and test their ideas but we really view HSIR as a place that bridges those two groups and brings them together.
Interviewer: So Rachel, why do you think HSIR is needed and what motivates you to take this on?
Dr. Hess: There have been so many amazing interventions and ideas developed and tested that never make it into the clinical practice. We always talk about the diffusion of aspirin and it took how many years for the aspirin to diffuse in patients with heart disease, and that was a pill. When you talk about other interventions like behavioral interventions, diffusion of things like weight-loss to prevent diabetes, weight-loss and physical activity to prevent diabetes, still have not really been implemented in practice.
So there are a lot of things that we know from research that may be helpful, that we never get into practice. So that's a part of how do we diffuse those things in but beyond that, there are amazing things that are happening at singular institutions and that singular clinicians are doing. They are trying to deliver better care to their patients and those ideas rarely go beyond the individual clinician or the individual hospital, if we are luck. And part of what HSIR will do is create a space where those ideas can be expressed and validated and translated. So, to take us really to the space that is continuously learning health system.
Interviewer: And do you see publishing the results of a study as a fundamental component of that?
Dr. Hess: I think that publishing is a component of that. I would change the word publishing to dissemination and I think dissemination is a fundamental component of that. I think that how we disseminate knowledge right now in the traditional biomedical or the traditional academic environment through journal publications is probably not the most effective way to impact change.
Interviewer: We often hear in the news, a new study was published in the journal Lancet and so now, we are going to be doing something with managing blood pressure but it sounds like there are other ways that patients can benefit from new ideas and technologies without necessarily publishing being a part of it.
Dr. Hess: There is a lot of good work that doesn't make it into Lancet, New England journal, JAMA, Annals, etcetera and that doesn't get picked up by the news outlets. Once the news outlets pick it up, it's almost that the journal was the conduit to get the news outlets to pay attention to it. But the news outlets are almost more important than disseminating the work to the general public and in a lot of cases, to the clinicians out there also because we can read everything that's coming out and we hear about it on the news sometimes too and then go learn more. But we are going to need to find new creative ways to disseminate this information and I think some of those are through non-traditional media or social media like Twitter and blogs and things like The Scope radio program that may be places that people can hear about things and then go read more.
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