Data Science and Predictive Analytics in Cardiology

Transcription:

Dr Nicolas Madsen (Host): Welcome to Pediatric Insights, advances in innovation with Children's Health, where we explore the latest in pediatric care and research. I'm your host, Dr. Nicolas Madsen, Co-director of the Heart Center at Children's Health and Chief of Cardiology at UT Southwestern. Today, I'm speaking with my fellow colleague, Dr. Javi Lasa, Director of Innovation, Informatics, and Strategy for the Heart Center at Children's Health, and an Associate Professor at UT Southwestern. Dr. Lasa's clinical specialty is in pediatric cardiac critical care. Today, we'll be discussing his work in informatics and data science and how he employs these tools to improve patient outcomes.

Dr. Lasa, good morning. Is it okay if I call you Javi?

Dr Javier Lasa: Sure, sure. Is it okay if I'll call you Nicolas, Nicolas?

Dr Nicolas Madsen (Host): That sounds good to me. That sounds good to me. All right. Javi, good to be with you here this morning. Javi, I thought maybe you could tell us a little bit about your background and professional interests to start off. As I well know, you've trained at and been educated by some of the finest institutions and programs in the US and maybe we can start there.

Dr Javier Lasa: Sure. Sounds good. Thanks a lot for the opportunity. After pursuing an undergraduate education University of Florida, I moved on up to Hopkins for med school and there, was exposed to the beginning of what would become my career in pediatric cardiac space. I had some phenomenal mentorship there, rotating through both pediatric cardiology and intensive care rotations and that led me to the Children's Hospital of Philadelphia where I did my training in general pediatrics and subsequently followed that up with fellowships in cardiology as well as critical care. Subsequent to that, I took my first opportunity to join the faculty and left for Texas Children's Hospital, where I was welcomed by a growing group in a heart center that really became well-positioned and really was a fantastic place for me to sort of spread my wings as a junior faculty member.

Thanks to you, now I'm here at Children's Health, joining the faculty recently now in August of 2022, and really excited to be here.

Dr Nicolas Madsen (Host): Well, Javi, we're super excited to have you, both for your clinical skills and professional academic skills, but also just your great company. So, Javi, as we talk about some of the work that you do today, we'll get into the details of the work in the informatics and data analytics space, but I thought maybe you could start us off by sharing a little bit more about your clinical work in the cardiac critical care unit. Can you share a little bit more about that environment with our audience, both the patients and the medicine, and how you came to choose that as your specialty?

Dr Javier Lasa: Sure. Yes. It's a great segue, I think, into how I became interested in the world of informatics. But as I mentioned, my exposure to both critical care and cardiology happened as a medical student, and I never forgot those experiences and always figured there'd be a way to bring those two together and rotating as a resident in the general pediatric intensive care unit really felt like home, but I had already been exposed to the trajectory and the sort of full spectrum of care that you get to see as a cardiologist and really enjoyed the sort of fetal to adult spectrum and really felt that that was an important part of who I was in terms of the kind of doctor I wanted to be.

And so, after spending time in both cardiology and critical care rotations, I really spent a lot of time and thought long and hard about what was best for me. And it was really at that time that I made a tough decision, although now in retrospect, I think was by far the smartest decision of my career, which was to pursue dual fellowships both in cardiology and then followed by an abridged two-year fellowship in critical care, so the total of about five years of post-residency training, which I do not regret, and I feel really made me who I am today.

And so, how do I spend my time? Well, I think clinically I spend my time about 95% in the inpatient setting, in the cardiac intensive care unit. I'm blessed to work in an institution that has a dedicated cardiac ICU with capacity for about 30 patients, two teams rounding every day. And I'm joined by an impressive team of colleagues who help us manage some of the sickest kids in the hospital. I always felt called to take care of the sickest of the sick. And I never really looked back on that decision. The other 5% I did spend in my previous institution seeing outpatients. So, I still have some outpatient experience and sort of continuity with patients, but I do spend the majority of the time in the ICU.

So again, what is it about this role that I enjoy? Well, I enjoy the physiology, the beat-to-beat, minute-to-minute physiology. I feel like that's where I felt most alive, and that's really the trigger that was set as a medical student when I was working through the general pediatric intensive care unit as a sub-I. Feeling like I was making decisions and seeing the outcomes immediately was important and felt gratifying to me.

I also feel like my ability to interact with families, who are in sometimes quite dire straights kind of places some of my strengths in terms of being able to sort of relate to families, get down to their levels, communicate effectively and make sometimes tough decisions, both end-of-life decisions as well as important therapeutic decisions. And so for me, that interactions with family is quite gratifying. I also enjoy the outpatient experience. I enjoy that relationship I build with families. But in the heat of the moment, being able to calmly look into a parent's eyes and say, "I'm here for you. I'm here to help and I want to get through this really tough situation, and I hope you trust me because we're doing the best we can." That for me is what I come home with most gratified with clinically.

Dr Nicolas Madsen (Host): It's amazing work, Javi. And I know you know this already, but we in the Heart Center are indebted to the work that you do and the work of your colleagues in the cardiac ICU. And as you mentioned, it is the sickest of the sick patients in the hospital and the specialization of care and the remarkable accumulation of talent, both physician, nursing, advanced practice providers. It's an enormous part of who we are and we are indebted to you all for that work.

Javi, when you are not in the cardiac ICU and you are committed to some of your professional activities that advance the science of care, you do a lot of work in informatics and data analytics. Can we start a little bit with, just so the audience knows what we mean, the term informatics? What does that mean? And how does that exactly relate to heart care?

Dr Javier Lasa: In its broadest sense, biomedical informatics is a field of study, but also practice, in which you try to make use of the wealth of biomedical data and knowledge that we're gathering every single minute here in the hospital, in the outpatient setting, across our healthcare institutions, across the public healthcare sector. All that information you're really trying to make use of it for the purpose of advancing our science, scientific advancements, decision-making as well and problem-solving. And ultimately, this is all being done as efficiently as possible to make and improve human health.

It's obviously a hugely encompassing view. You know, people often ask me what exactly informatics is, and it's really trying to apply advanced data sciences as well as public health information, human computer interaction, and human factors theories, project management, clinical decision-making, our understanding of health information systems and how we transmit and receive information. You're trying to apply all of that towards improving human health. So, it's exciting to me because I feel like we're at the cusp of a data revolution here in healthcare, trying to make use of this wealth of information. How we do so is really the next question. And at any heart center level, I think informatics is a primarily clinical effort in trying to best understand how we store all the information, manage it, and then apply it to help us put a data-forward, evidence-based decision-making process to ultimately improve the care of our patients is what I'm excited about.

Heart centers are a great microcosm for the larger healthcare system because we have the full breadth of care experience for our patients. We have inpatient care, both acute and critical. We have diagnostic imaging, interventional suites, our laboratory system, but we also have a large outpatient presence. We have patients that span routine visits to those with chronic care, those requiring solid organ transplantation, and even those who require chronic mechanical circulatory supports through the use of ventricular assist device. So, we really see it all. And so because we're seeing so much, here, I think at Children's Health, we're uniquely positioned to lead in that space because of the maturity with which our heart center has developed over the past several years.

So, I'm excited to be here. I feel like informatics is a field that a lot of folks ask questions about, but hopefully we can share a little bit of information today. Let them know what we're trying to do.

Dr Nicolas Madsen (Host): It's outstanding work and I agree with the notion of its all-encompassing nature. It is something that we are passionate about as a heart center and certainly something that we are grateful to you for your leadership. As you think about informatics and data analytics, can you maybe ground that a little bit in a specific example or two of when informatics and data analytics has improved an outcome for a patient or a group of patients?

Dr Javier Lasa: Sure. And I think it comes down to understanding one of the basic foundational principles of effective informatics, which in some ways is access to information or access to data, but also transparency and sharing of outcomes. And so I think, and this is something right up many of our listeners' alley in understanding what we're doing at the national level. But thanks to your leadership with the Pediatric Acute Care Consortium or the PAC3, putting information out there that says, "Okay, well, what's going on with our patient and what's our goal?" And in particular, for example, the duration of chest tube, which is one of those things that our patients often require after heart surgery and often can delay their discharge to home. But that's a great example of us displaying and being transparent about where patients are at and what our goals are, translating that information that we're capturing from the computer and electronic medical record into a visualized format for our patients and even their families, to see that ultimately changed outcomes. It changed the practice of when we take these tubes out and when patients can go home.

I think that transparency is also related to our own internal efforts here to try and reduce one of the most complex, complicated, and most highly morbid complications for our patients, which is a cardiac arrest. And so, understanding where we're at, number one, understanding what may be causing the cardiac arrest, but more importantly, our rates in comparison to national benchmarks, trying to understand exactly what may be influencing the cardiac arrest through retrospective chart review, but then analyzing that, putting that information out to the right people at the right time has impacted our cardiac arrest rates in terms of reducing those rates. So those are two areas where I feel like just being transparent about capturing the information from the electronic medical record, translating that into a usable format for our providers and giving it to them at the right time for the right purpose can change outcomes.

Dr Nicolas Madsen (Host): Yeah, thanks very much, Javi. It is remarkable work and I think as you highlight, when that work is shared within a center such as ours or even between centers, the reach of the work and the benefit to our patients is really astronomical. And I think, as you mentioned, is our responsibility to be in pursuit of that.

And so I think as we wrap up our conversation and the introduction for our audience to informatics and data analytics and the work that we are doing here at the Heart Center at Children's Health, you joined Children's Health a few months ago, so it may be early, but can you reflect a little bit on, as you look to the future and as you look to the work that you do in the cardiac ICU and you look to combine that both within the ICU and at greater heart center level with your aspirations for next level or potential future interventions, where does your mind go and what does that look like to you, if you don't mind? A question that's asking you to speculate a little.

Dr Javier Lasa: Yeah. Let's speculate together here. I think it's important before I even do that though, to recognize the reason why I'm here. I think Children's Health attracted me because of how mature the heart center, in particular the outcomes team, is and how welcoming they were to someone with my skillset and with my background.

The team structure and the resource allocation here is way out ahead of many competitors, I think. And they're clearly thinking, and you guys were clearly thinking 10 years into the future. And for me, it's a dream scenario, one that I was blessed to walk into. And so, that in combination with the Children's robust IT service line and, more importantly, I think, is that all that's backed up by a hospital leadership that recognizes the future of healthcare is dependent on strong informatics and analytics.

So for me, I think, first, for a one-year vision plan, I think our heart center members deserve to know exactly how we're performing. And that internal transparent awareness is of not only the key outcomes for our patients, but also our process metrics is the first step towards, what I think is going to make us a heart center that is number one in the country, and one that, of course, is going to be based on a data-forward and evidence-based approach. And so sharing our outcomes with each other puts us all in the same page as you're fully aware and encourages a group think mentality towards improving those outcomes for our patients and ultimately the experience for them. So, I think that's first and foremost.

Secondly, the foundation for some of the more advanced data sciences, including predictive analytics, is robust and highly validated and clean data. And so, that's another key goal of mine, is to create a centralized, very efficiently aggregated, if you want to call it a data warehouse or data mart that's dedicated to the multitude of all our heart center data sources, that are being created every single day, beat to beat, every visit to visit. And that's another important goal for us because, once you create that centralized pool of data, I think querying that, putting it together, making it usable and visualizable, especially for important decisions is easy.

Dr Nicolas Madsen (Host): It is a journey I think we're excited to be on together, not just you and I obviously, but all of us at the Heart Center. I think we share in the joy of seeing it as a path forward, not just for us, but certainly for our patients and our families. And we thank you, Javi, for your leadership and expertise in this space. And thanks for your time today to discuss some of these complex but exciting topics in a little bit more detail. I really appreciate it.

Well, thanks to our audience for their time today. I want to thank Dr. Javi Lasa for his expertise. And thanks to all for listening to this episode of Pediatric Insights. You can find more information about the Heart Center at Children's Health by visiting childrens.com/heart. And if you found this podcast to be helpful, please share it and check out the entire podcast library for more topics that hopefully are of interest to you. So with that, thanks very much.