Riding the Wave

By Marie Shields, Editor

EHM’s Marie Shields talks to Peter Slavin, President of Massachusetts General Hospital, about the challenges facing hospitals in an era of increased focus on holistic care, and MGH’s drive to push the boundaries of medical research.

The current trend in healthcare is to move away from event-driven, unconnected treatment and toward a more holistic, patient-centered, community-based system. This might present a challenge to some hospitals, but Massachusetts General Hospital, the largest and oldest hospital in New England, has been in on the first wave of these developments.

As long ago as 1994, MGH joined with Brigham and Women’s Hospital to form Partners Healthcare, a health system that leads the way in providing the best, most consistent care for a population of people, rather than one hospital visit or doctor visit at a time, and now serves more than 20 percent of the population of eastern Massachusetts. As Slavin explains, “There’s been a huge push to implement electronic medical records and to implement a series of disease management programs aimed at improving the health of the population we’re caring for.

“There’s no question that the use of home care services will grow, along with our ability to manage healthcare at home. At MGH, we are currently updating a computer system that we implemented over the last four years that enables our outpatients to get access to their medical records online, to request appointments online and to renew prescriptions online.”

Patient care

No small feat for a hospital that each year admits more than 46,000 inpatients and handling nearly 1.5 million outpatient visits. It makes sense then, that the hospital’s main priority is its patients: “Our future success as an organization will be determined by how well we take care of the more than 100 inpatients and 3000 outpatients we see every day. Our number one priority is to take great care of our patients – that’s why we’re there in the first place. Doing that well is the most important ingredient for success.”

Addressing important health-related issues is part of this focus on patient care. To this end, MGH has created a Disparities Solution Center, which looks at healthcare disparities within the hospital. “I’m convinced, based on national and local data, that healthcare disparities are an important public health issue,” Slavin says. “In the world of academic medicine, there has been a lot of good work done to document those disparities through good clinical research, but a couple years ago we became convinced that there was too little effort going into actually addressing and trying to remedy those disparities.

“We established a Disparities Committee at the hospital, and also set up the Disparities Solution Center and are busy looking within our own walls at where healthcare disparities exist. When we find them, we put in place programs aimed at eliminating them.

“For example, one of the areas in which we did find a disparity had to do with the diabetes care of our Spanish-speaking patients, who were getting tested for diabetes less frequently, and whose diabetic control was poorer than their English-speaking counterparts. We’ve instituted a program to improve the care of these patients, and some results I’ve seen recently showed that we’ve made significant progress.”

MGH is committed to providing its staff – including physicians, nurses and pharmacists – with ongoing opportunities for education, as well as improving the health of the communities it serves. It has created a number of community health programs above and beyond its clinical care and research and education.

Innovative research

MGH conducts the largest hospital-based research program in the US, with an annual research budget of approximately $500 million, and has recently created several innovative research centers focused on the themes in biomedical research with the most promise for making a difference in the lives of patients.

“We have a genetic center, and we have what’s called a Regenerative Medicine Center, which is largely focused on stem cell research,” Slavin explains. “We also have several other centers, with investigators from different clinical departments focused on making progress in a specific area of biomedical research.”

This focus on research has led to scientists at Massachusetts General being on the forefront of the move to push the boundaries of medical understanding. “One thing that is unique about teaching hospitals like Mass General is that we have an ability not only to bring great scientific ideas from the bench to the patients, but also to take astute clinical observations by our clinicians and to try to understand in the laboratory what underlies those.

“For example, a few years ago, one of our clinicians realized that certain patients with lung cancer responded dramatically to a particular new medication. Most patients didn’t respond at all, but the ones who did responded incredibly dramatically and that lead to a collaboration between the clinician and one of our geneticists, who together figured out that the patients who responded had a certain mutation in their lung cancer that made the tumor susceptible to this drug. Now that test is becoming standard of care not only at our hospital but around the world.”

Beating cancer

Another research project that Slavin is excited about is one that has just been published in the New England Journal of Medicine, involving a new technique for isolating tumor cells in human blood. Scientists have known for some time that there are circulating tumor cells, but they are so rare in the blood that it has been impossible to purify them and count and analyze them. Then one of the hospital’s cancer researchers, working with an expert who trained in engineering at MIT, developed a chip that can isolate these cancer cells to a level of purity and specificity that is much greater than had previously been achieved.

“This technology may ultimately become a screening tool for cancer,” Slavin enthuses. “It will enable doctors to monitor their treatment and fine-tune it over time, because it appears that when the cancer responds to treatment, the number of cells in the blood go down much quicker than with other clinical indications. When the tumor comes back, these cells start to appear in the blood much faster than with the usual mechanisms we use to follow cancer patients. You can then isolate the cells and see, genetically, what happened to them and what they may be most susceptible to.”

Stem cell research is another of the hospital’s focus areas. MGH scientists have shown that there are medications that have been used for other purposes that can have a significant impact on the environment in which stem cells operate. Slavin says that one of the most significant results of stem cell research may turn out to be the discovery of how to use medications that are available today for purposes that we would not have previously considered.

“For example, stem cells live mostly in bone marrow and are very susceptible to the amount of bone that surrounds them. It turns out that if you treat patients with Vitamin D, people’s stem cells are healthier and after bone marrow transplantation, they bounce back more quickly. This was a totally unexpected finding.”

Revolutionary medicine

Slavin is positive about the direction in which healthcare is moving. “We’re in the early stages of a revolution in medicine, which has been generated by the gradual unlocking of our understanding of the human genome and our ability to analyze genetics in a much more powerful way than ever before. Medicine 10 years from now is going to be more different from medicine now than the medicine now is from medicine 10 years ago. We’re at the early stages of a transformation in the way medicine is practiced that will be driven by genetics and stem cells and minimally invasive diagnostics.

“In addition to that, there’s no question that by using information technology, we can empower people to learn more and do more about their healthcare at home than ever before. There are all of these astounding things going on in every different direction that have huge implications for the medicine we’ll be practicing in the future.”