UCSD’s Christopher Longhurst, M.D., on Innovation Led from a Dual Role
As Healthcare Innovation Senior Contributing Editor David Raths reported on Feb. 16, “UC San Diego Health is working on developing a patient-care ‘mission control center’ enhanced by artificial intelligence. In his report of last week, Raths noted that “UCSD Health describes the future mission control center as a hyper-connected hub to monitor patient health and safety through integration of data streams from cameras, sensors, electronic health records, bedside monitors, imaging, wearables, and multiple other sources. The goal is to develop AI algorithms and models that proactively improve personalized treatment, health equity, and patient experience, person by person.” His report followed up on a Feb. 8 press release announcing the development.
“The vision for a hospital-based, AI-enhanced mission control center will be one of the first in the U.S.,” Christopher Longhurst, M.D., chief medical officer and chief digital officer at UC San Diego Health, said in a statement contained in the press release. “Our goal is to be a leader in all digital health tools that can improve the delivery of health care across the continuum, from inpatient rooms to clinic spaces to home environments.”
Raths noted that “The work is made possible by a $22 million in gifts from Joan and Irwin Jacobs, who are also funding the Jacobs Chancellor’s Endowed Chair in Digital Health Innovation. These initiatives and other plans will be shared and celebrated on May 4-5 with the Innovation in Digital Health symposium for thought leaders across the nation. The Center for Health Innovation was founded in September 2021, with internal seed money from UC San Diego to develop and test technologies that make measurable differences in the lives of patients. After the center demonstrated multiple successes at scale, the Jacobs funded several initiatives that are scheduled over the next three to five years. The $22 million in gifts builds upon the $100 million to build Jacobs Medical Center, the 10-story, 245-bed academic medical center in La Jolla.”
The Feb. 8 press release also quoted UC San Diego Chancellor Pradeep K. Khosla, who stated that “The Center for Health Innovation represents a singular opportunity to redefine the way our clinicians and patients leverage the power of technology and data to improve health outcomes,” said UC San Diego Chancellor Pradeep K. Khosla, in a statement. “Once again, Joan and Irwin Jacobs are transforming healthcare in San Diego through their visionary generosity and kindness. We thank the Jacobs for their continued partnership in caring for our community, now and in the future.”
Last week, Editor-in-Chief Mark Hagland interviewed Dr. Longhurst, who in addition to his CMO and CDO roles, continues to practice as a pediatrician specializing in neonatal hospitalist care, regarding the recent developments, as well as, more broadly, his evolving role at UCSD Health and his perspectives as a senior patient care organization leader who has taken on several different key roles in different organizations at different times—CMIO, CIO, CMO, and now, CMO and chief digital officer at the same time. Below are excerpts from that interview.
The announcement of the funding was terrific. It also is supporting a somewhat unique set of activities aligned around your blend of roles, correct?
There are a lot of digital health teams and groups in patient care organizations; what makes our team different is key. In the summer 2021, I was appointed CMO and CDO, and that’s pretty unique that I serve in dual complementary roles. And part of the vision for all of this is that sits inside the health system; it’s not an academic role, even though we can leverage the strengths of an academic medical center. The goal of this dual role is to solve problems for our patient population. I was funded internally with about $1.5 million. And we have done a number of demonstration projects, including P1000, where we remotely monitored 1,000 patients. It changed the care paradigm for those patients. We started with our MSSP-attributed patients [patients attributed to the Medicare Shared Savings Program accountable care organization that UC San Diego operates], and now we’ve extended it to all primary care patients. So if you’re on a continuous glucose monitor, we’re monitoring you. And we’ve seen a drop in hemoglobin a1c for our diabetic patients, and a drop in blood pressure among our hypertensive patients.
That’s the genesis of this, and there are other things we’re handling through the center, including mobile AI algorithms. For example, Epic [the Verona, Wis.-based Epic Systems Corporation] was criticized by some in the industry for their sepsis algorithm [embedded into that vendor’s electronic health record]. And if you look at some of the data involved, for example around serum lactate testing to detect the possible emergence of sepsis, the reality is that by the time a doctor orders a lactate test, they’ve already considered sepsis, so lactate as a data point doesn’t change behaviors. What is more advanced is multi-modal AI, where you’re integrating multiple data sources, which can include bedside monitor-based data as well as EHR-based data. But it’s not easy to link disparate sources together, because the systems aren’t architected that way. You can predict no-shows based on historical data. But when you’re trying to predict something like sepsis, you need to know real-time status data that you can only get from patient monitors, as well as EHR data. In fact, we’ve published a paper that my team wrote around how to create a sepsis algorithm.
And this funding will allow a robust expansion of your team’s work, correct?
Yes; with this internal funding, we’ve done remote patient monitoring and the gift will allow us to scale up efforts. It’s about having real patient care impact at scale, not about having trials of five and ten patients or about algorithms that are useless and don’t make a difference in patient care. It’s about introducing elements that will impact the patients we serve, at scale.
How do you frame this work as a combined CMO and CDO?
As a CMO, I see all the challenges every day. One of the biggest is patient throughput and flow and capacity. So this grant will fund a NASA-style mission control that will allow us to make better decisions in an efficient manner about patient flow challenges, and that will require a lot of architecting of AI tools as well as physically co-locating the people who make these decisions. This gift will allow us to bring together some of the best minds and to solve real problems related to quality of care and patient safety, in a transformative way.
In that regard, another project that has been moving forward in the center has been our Virtual Transitions of Care (VToC) program, which is allowing hospitalists to do follow-up telehealth appointments with patients after discharge. It’s turned out to be a win-win, because our hospitalists like doing telehealth, as it gives them an opportunity to work remotely. And patients love it because it allows them to see the doctors who cared for them in the hospital. It began in the spring of 2022 as a pilot, and fall of 2022 as a full program.
How did you recruit the hospitalists into the program?
We started with a champion in hospital medicine and she looked for volunteers, and we identified the right types of patients most amenable to the intervention. It’s another example of innovation at scale. The UCSD Center for Health Innovation aims to innovate at scale. It’s a health system-owned center that is overseen by the CDO who is also the CMO, who is uniquely positioned to see problems in the health system, and so this will help us to make transformative changes in the way in which we deliver care.
For those in patient care organizations across the country who won’t receive a fair amount of funding to do this kind of work, how might they be able to replicate this?
That’s a fair question; and they should be open to innovative ideas. Innovation doesn’t have to be expensive. Here’s an example of another problem the Center will help to tackle: you have to produce your health insurance card at every doctor appointment, and it’s a paper card. We joined the VCI group, whose initials originally stood for “Vaccine Credential Initiative,” and now stand for “Verifying Clinical Information.” That group created a QR code with a digital copy of our vaccination card that was verifiable and trustworthy. We were the first health system in the country to do that. Because of our leadership in that area, we’re leading a new initiative looking at replacing paper health insurance codes with digital QR codes that can sit on phones. Ten percent of insurance denials come out of inaccurate information transcribed at the time of registration.
On your journey as a physician and informaticist, what stands out marrying the medical and informatics elements?
I have been in lots of different roles. As CMIOs, we like to say that we bridge that divide between IT and clinicians. The CIOs often focus just on running the department and keeping the lights on and the trains running on time. The CMO is often concerned with keeping clinical operations going. The key is how we use digital tools to drive clinical operational improvements. Ed Kopetsky was an excellent CIO, someone with a vision who did those important things.
I was CIO after being a CMIO, and then took on an associate CMO role. And a lot of what comes up in the CIO and CMIO roles is finding technological and other interventions to help solve clinical problems. And there are many people like me who are operationally active and looking for problems to solve and have a tool set. And in Patty Maysent, I’m very fortunate to have a very supportive CEO here at UC San Diego. Our mission is to innovate with impact at scale; it’s a team effort, we’ve got a lot of people involved. And the gift will help us focus on mission control, but we’re also focused on interventions. A multi-modal sepsis algorithm development will be very innovative.
