Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Advancing Fetal Cardiology and Access to Care with Dr. Lisa Howley of Children’s Minnesota

Transcript

Advancing Fetal Cardiology and Access to Care with Dr. Lisa Howley of Children’s Minnesota · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:02
  At athenahealth,
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  we know your ambulatory practice wants healthier,
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  a healthier business, healthier care teams, and healthier
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  patients.
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  See how simpler is healthier@athenahealth.com.
• 0:44
  Hello, and welcome to the Becker's Healthcare Podcast.
• 0:47
  I'm Elizabeth Gregersen, a reporter here at Becker's,
• 0:50
  and I'm thrilled to interview doctor Lisa Howley,
• 0:53
  director of the fetal cardiology program at Children's
• 0:57
  Minnesota on the podcast today.
• 0:59
  Doctor Holly, thank you so much for joining
• 1:02
  me. I'm excited to chat
• 1:04
  to hear your insights on the field of
• 1:07
  pediatric cardiology.
• 1:09
  I think it'll be very valuable to our
• 1:11
  podcast audience, and I'm grateful
• 1:13
  to you for sharing your time. Before I
• 1:16
  dive into all my questions, could you introduce
• 1:19
  yourself and just tell us a bit about
• 1:20
  your background?
• 1:22
  Sure. So, thank you first, Elizabeth, for inviting
• 1:26
  me to be here. I'm delighted to join
• 1:27
  you this morning.
• 1:29
  As you said, my name is doctor Lisa
• 1:31
  Howley,
• 1:32
  and I am a pediatric and fetal cardiologist.
• 1:37
  My background is, a little varied. I am
• 1:40
  here in Minnesota now, but I actually grew
• 1:42
  up in a small town in New Hampshire.
• 1:45
  I did my college and medical school training
• 1:48
  in the state of Virginia, and then I
• 1:51
  moved to,
• 1:52
  the great state of Colorado where I did
• 1:55
  my pediatric and pediatric cardiology
• 1:57
  fellowship,
• 1:59
  training at the University of Colorado.
• 2:02
  Not wanting to be done with my training
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  at that point, I decided I wanted to
• 2:05
  pursue a little bit further, and so I
• 2:07
  went up to the Great White North. I
• 2:10
  went up to University of Alberta in Edmonton
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  to train in fetal cardiology, and that's where
• 2:15
  I had my fetal cardiology training.
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  And then I returned back to The States
• 2:20
  to begin my, pediatric and fetal cardiology
• 2:23
  job,
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  at University of Colorado.
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  So in from 2010
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  to 02/2019,
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  I worked at the Children's,
• 2:32
  Colorado
• 2:33
  Hospital,
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  in Denver, Colorado,
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  where I served as the co director of
• 2:38
  the fetal cardiology program, and then I was
• 2:41
  recruited out to Children's Minnesota
• 2:43
  in the Midwest Fetal Care Center, in 02/2019.
• 2:47
  So I've been
• 2:48
  in the great state of Minnesota now for
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  about six years,
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  where as you mentioned, I practice as the
• 2:54
  director of fetal cardiology
• 2:56
  at Children's Minnesota.
• 2:58
  Perfect. Thank you for laying that all out
• 3:00
  for for us. I I was going to
• 3:02
  say, oh, you've been all over the country
• 3:04
  training, but, really, you went to another country
• 3:07
  as well.
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  I sure did.
• 3:10
  That's really cool to hear.
• 3:12
  You know, given your experience
• 3:14
  and, you know, our listeners
• 3:15
  are gonna have varied degrees
• 3:17
  varying degrees of, you know, a connection to
• 3:20
  the field of cardiology.
• 3:21
  I'd love to tap you to hear, you
• 3:23
  know, what are the top three biggest issues
• 3:26
  in pediatric or fetal cardiology
• 3:29
  today that you think health care hospital system
• 3:31
  leaders should know about?
• 3:33
  Yeah. So that's a really great question. I
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  mean, clearly, I have a bit of a
• 3:37
  niche job really living on the prenatal side.
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  So, you know, I,
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  spend my days screening
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  for fetal heart conditions even before birth.
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  So I would say, you know, from my
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  vantage point, you know, there are three issues.
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  There's actually probably more than that, but the
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  number
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  one that I wanna highlight,
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  and I think is really important is really
• 3:59
  disparities and access to care and really,
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  differences in prenatal detection of congenital heart disease,
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  in different parts of the country. So, you
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  know, according to the American Heart Association, about
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  forty thousand children every year are born in
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  The United States with congenital heart disease,
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  and about a quarter of them are going
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  to have a critical form of congenital heart
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  disease, meaning they're gonna need some sort of
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  intervention, either surgery or a calf procedure to
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  be able to survive long term after birth.
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  And so trying to identify these babies prior
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  to birth is really
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  important so that we are able to counsel
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  and have these moms deliver it at cardiac
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  centers so we're able to take care of
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  these babies after birth.
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  One of the challenges that we have is
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  that,
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  you know, people in our country live in
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  lots of different
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  places, and there is significant geographic variation in
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  the detection rate of,
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  prenatal heart disease between different parts of the
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  country.
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  A publication that I highlight a lot, came
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  out in the journal of pediatrics in 2015
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  that really,
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  stated the point that in this paper, prenatal
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  detection rates for congenital heart disease were thirty
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  four percent.
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  And so there is a lot of babies
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  in this country that are born without that
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  recognition, and unfortunately, they may deliver in centers
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  that are not able to take care of
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  them,
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  at the level that they need.
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  So, you know, some of that limitation in
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  prenatal
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  detection
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  really might be just a result of, you
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  know,
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  access to ultrasound or to medical providers that
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  are skilled in,
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  detecting
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  these sorts of conditions,
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  as well as just some, you know, challenges
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  with social determinants of health for those families.
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  So, you know, limits to transportation
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  or inability to get
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  to larger medical
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  centers, which are often in urban areas. Right?
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  So, you know, I think that that's the
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  first one and I think just an important
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  thing to highlight that's really been,
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  a drumbeat for me is really working on
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  Sonaga for Education
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  in recognition of congenital heart disease. So even
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  those,
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  working in more rural and remote areas,
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  have that skill set to pick those
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  babies up and to be able to get
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  them to higher levels of care.
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  So I can hit on that later with
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  some of the things I'm excited about.
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  But,
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  I this is one that I is really
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  true to my heart is trying to make
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  sure that we are equally reaching,
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  patients both in urban areas as well as
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  in remote and rural areas,
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  in trying to take optimal care of,
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  these pregnant mothers.
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  So that's the first one, and that's probably
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  the one that I think is really important
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  to highlight.
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  The second
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  that I think is another area that is
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  a challenge at this point is,
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  you know, now with our advances in
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  medical and surgical treatments, we have a growing
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  population of children with congenital heart disease and
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  really those with complex forms of heart disease
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  that now we are, you know, not only
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  having them survive,
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  but trying to help them thrive through all
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  of childhood and into adulthood.
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  And so this ranges raises a lot of
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  challenges,
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  you know, managing long term complications that these
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  kids will have.
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  And that could be, you know, complications regarding
• 7:33
  their heart itself such as, you know, heart
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  failure or heart rhythm problems, but also
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  we have found that a lot of these
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  kids that have had early heart
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  procedures and interventions later will have neurodevelopmental
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  challenges.
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  So,
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  you know, what a lot of the research
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  that's coming out now is on neurodevelopmental
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  and psychosocial issues that are coming up in
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  children that have congenital heart disease that were
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  treated,
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  early on.
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  And so now we're finding that they are
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  having higher rates of learning difficulties
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  and attention disorders and mental health challenges.
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  And so that's just a lot of areas
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  that perhaps might not be a cardiologist
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  special specialty, but we need to be able
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  to try and provide wrap around services for
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  these kids and make sure that we are
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  diagnosing kind
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  of moving
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  through adolescence and into early adulthood with some
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  of these,
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  neurodevelopmental
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  and psychosocial challenges.
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  So I'd say that's number two.
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  And then the last one, kind of stems
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  off of that is then, you know, transitioning
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  these kids into adult care. So a lot
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  of children, even if you go back a
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  couple decades ago, like, a lot of these
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  kids didn't survive to adulthood because they had
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  heart disease that we weren't
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  very good at, taking care of, but now
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  our our advances in medicines
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  and surgical treatments, now we're affording
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  these kids to have very
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  exciting and and long lives,
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  that they previously
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  couldn't have. So now we have created, you
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  know, a very large adult population that have
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  congenital heart disease.
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  And so now there's more adults living with
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  congenital heart disease in The United States than
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  children,
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  which, you know, now we're talking about we
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  need to improve transitioning
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  those that are cared for in the pediatric
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  system,
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  to get them into adult congenital programs, which
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  are is now kind of a burgeoning field
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  with, specialists in the adult field taking care
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  of these kids. And this is an area
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  where we're not very good, and I would
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  say that we,
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  find that some of these kids in that
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  transition period are kind of lost,
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  in the gap, and we need to kinda
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  be better about a nice smooth transition.
• 9:53
  Perfect. Yeah. And and correct me if I'm
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  wrong. I think I wrote an article that,
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  adult congenital heart disease is a specialty that,
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  you know, is one of the rarest specialties
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  for a cardiologist to have. So it's it's
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  a growing field, but not many cardiologists
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  currently practicing are, you know,
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  treating it. Is that correct? Yeah. Well, I
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  think that you're hitting it on the head
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  that in in the course of my time
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  since training to now where I've really seen
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  the biggest growth,
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  in the field of pediatric cardiology is one
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  is going earlier, so fetal cardiology. So now
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  we're aiming for,
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  you know, as many kids as we can
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  to have prenatal diagnoses because we know that
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  that allows families times to be educated, to
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  make decisions for their family, to deliver
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  at, you know, cardiac centers of excellence and
• 10:46
  to transition them into, you know, pediatric cardiac
• 10:50
  programs
• 10:51
  without,
• 10:52
  having any, hopefully, any issues,
• 10:55
  in that newborn period. So one area is
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  really the growth of the fetal program. The
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  other is the other end of the spectrum,
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  which is that of adult congenital heart disease.
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  So now as as these kids are surviving
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  into adulthood,
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  you know, they have complex forms of congenital
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  heart disease, which often is gonna be malformations
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  of the heart from the time that the
• 11:18
  heart was ever created,
• 11:20
  that previously, you know, adult cardiologists were very
• 11:23
  good at taking care of kind of normal
• 11:26
  heart structure with just the wear and wear
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  and tear
• 11:30
  of, you know, life that has affected its
• 11:33
  its function.
• 11:35
  But now we are taking malformed hearts that
• 11:37
  we surgically modify,
• 11:39
  and then these children are living to adulthood.
• 11:42
  So it's requiring
• 11:44
  a new type of cardiologist.
• 11:46
  So these, you know, adult congenital
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  heart,
• 11:50
  specialists
• 11:51
  that are really specialized in these unique surgical
• 11:54
  procedures and malformations
• 11:56
  of the heart that are now surviving to
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  adulthood. So, you know, there is a, increasing
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  need for more adult congenital heart,
• 12:05
  doctors because we now have a large population
• 12:08
  of adults with congenital heart disease.
• 12:11
  Hopefully, that makes sense.
• 12:13
  No. It does. And I really appreciate you,
• 12:15
  you know, sharing that insight,
• 12:17
  to just give that perspective to our listeners.
• 12:20
  Shifting gears a little bit here, how do
• 12:22
  you see the field evolving over the next,
• 12:24
  you know, twelve to eighteen months?
• 12:28
  That is a great question, and I think
• 12:31
  that one that the first answer is going
• 12:33
  to have to be, you know, the discussion
• 12:36
  about artificial intelligence,
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  because, you know, I recently was just at
• 12:40
  the American Society of ECHO conference,
• 12:43
  in Nashville this year, and we had a
• 12:45
  whole session just on artificial
• 12:48
  intelligence and how that that is really coming,
• 12:51
  quickly into our field. So I think adoption
• 12:54
  of artificial intelligence and finding ways to utilize
• 12:57
  that,
• 12:59
  to help us in our field,
• 13:01
  is really where I think, you know, we're
• 13:03
  gonna see some big changes happening in the
• 13:05
  next twelve to eighteen months.
• 13:07
  Specifically, with what I do with prenatal diagnosis
• 13:10
  and with pediatric,
• 13:12
  cardiac imaging, I think it's gonna be, you
• 13:14
  know, thinking about imaging
• 13:16
  automation,
• 13:18
  and really trying to improve prenatal and pediatric
• 13:20
  cardiac screening. So trying to help us look
• 13:23
  at images faster,
• 13:25
  you know, pick up and detect abnormalities
• 13:28
  and bring them to our attention,
• 13:30
  and probably are, you know, increasing efficiency.
• 13:34
  I think that this can be really helpful,
• 13:36
  especially for reducing physician and stenographer
• 13:39
  kind of,
• 13:41
  interpretation fatigue.
• 13:43
  And so I think that artificial intelligence is
• 13:45
  probably the biggest one. You know, the other,
• 13:47
  I think, you know, trying to get into
• 13:50
  more rural areas, especially when we have a
• 13:52
  limited number of subspecialists makes me think about,
• 13:56
  creation of more telehealth
• 13:58
  options or kind of hub and spoke networks,
• 14:02
  especially for fetal consults and and those things
• 14:05
  that are more specialty access so that we're
• 14:07
  able to get into communities that aren't in
• 14:10
  the urban areas.
• 14:12
  I know, you know, when I was back
• 14:14
  in Colorado, I was part of a fetal
• 14:16
  telecardiology
• 14:18
  clinic, that I would run with my old
• 14:20
  partner, doctor Bettina Cuneo out
• 14:22
  there. And we ran a fetal
• 14:25
  telehealth clinic that was across the Rockies. So
• 14:28
  we would read the images in Denver, but
• 14:30
  the clinic was out in Grand Junction on
• 14:32
  the other side of the Rockies near Utah.
• 14:35
  And that was very successful, and it helped
• 14:37
  families get the, you know, specialty access without
• 14:40
  having to do a four hour drive.
• 14:43
  So I think that those things are are
• 14:45
  ones that are coming and hopefully will will
• 14:47
  be,
• 14:48
  on the forefront here in the next eighteen
• 14:50
  months.
• 14:52
  Perfect. Thank you. Yeah. I I
• 14:54
  I'm always amazed at all the different ways
• 14:56
  that, you know, technology and AI is is
• 14:59
  touching
• 15:00
  basically every single aspect of health care. So
• 15:02
  I'm I'm grateful that you can share, you
• 15:04
  know, how it's touching your field.
• 15:07
  Yeah. For my very last question, you know,
• 15:10
  feel free
• 15:11
  to take this either way, but
• 15:13
  what are you excited about when it comes
• 15:14
  to, you know, fetal pediatric cardiology right now,
• 15:17
  and maybe what makes you nervous?
• 15:21
  So things that I am excited about,
• 15:25
  you know, one is
• 15:27
  trying to continue to increase sonographer education, and
• 15:30
  I'm gonna put in a little plug that
• 15:32
  we,
• 15:33
  did our first fetal cardiology
• 15:36
  symposium
• 15:37
  out here,
• 15:38
  in the Upper Midwest,
• 15:40
  and I called it the best of the
• 15:42
  Midwest,
• 15:43
  the twenty twenty five fetal cardiology symposium, and
• 15:46
  we had,
• 15:48
  excellent speakers that represented from Children's Minnesota, from
• 15:52
  Midwest Fetal Care Center where I work,
• 15:55
  from the Mayo Clinic, and from University of
• 15:58
  Minnesota, and we all came together. We had
• 16:00
  a amazing showing
• 16:02
  with about 200
• 16:03
  attendees from 11 different states,
• 16:06
  really highlighting, you know, all the different aspects
• 16:09
  of fetal cardiac diagnosis, recognition, and treatment. We
• 16:12
  just had a really,
• 16:14
  robust,
• 16:15
  response and a lot of enthusiasm about education
• 16:19
  and so trying to continue taking that forward,
• 16:22
  to make sure those touching patients out in
• 16:25
  all the the aspects of the Upper Midwest,
• 16:27
  are able to recognize and and take care
• 16:29
  of good fam of families.
• 16:31
  So that is one. I would also say,
• 16:34
  you know, I'm excited about the early adoption
• 16:36
  of artificial intelligence. I think there's really opportunity
• 16:39
  there, especially if we're able to load,
• 16:42
  some of these algorithms onto the ultrasound machines
• 16:45
  themselves,
• 16:46
  really to
• 16:47
  you know, if they're able to get a
• 16:49
  couple sentinel views of the fetal heart, you
• 16:51
  know,
• 16:52
  maybe the AI would be able to say,
• 16:53
  you know, this looks like a normal screening
• 16:56
  views versus abnormal and kind of flag,
• 16:59
  just based on the images,
• 17:01
  really to try and help that physician or
• 17:03
  sonographer that's, in those more rural communities knowing
• 17:07
  which patients to refer and which ones look
• 17:09
  good.
• 17:11
  And so I think that those are probably,
• 17:13
  you know, two areas where I'm most excited.
• 17:15
  I think in terms of nervousness, I don't
• 17:18
  have,
• 17:19
  a whole lot of concern. I know that
• 17:20
  there are some out there that are really
• 17:22
  nervous about, hey, how AI is going to
• 17:24
  impact, you know, health care, how are we
• 17:26
  going to use it to partner with us
• 17:29
  and not, you know, impact our health care
• 17:32
  jobs.
• 17:33
  Right. But, you know, at this point, I
• 17:35
  think that that's more of a question, but
• 17:36
  I'm not one that has a lot of
• 17:38
  nervousness about that.
• 17:40
  Well, great.
• 17:42
  Yeah. I that's always nice to hear
• 17:45
  of an a leader who's, you know, more
• 17:47
  excited than nervous. So thank you for giving
• 17:50
  us a peek into your field
• 17:53
  today, and thank you for taking the time
• 17:55
  to join me on the podcast. It's been
• 17:57
  a really amazing and informative discussion.
• 18:00
  I invite our listeners to tune into more
• 18:02
  podcasts from Becker's Healthcare by visiting our podcast
• 18:06
  page at beckers hospital review dot com. Thank
• 18:09
  you again, doctor Howley, and I hope you
• 18:10
  have a wonderful rest of your day. Thank
• 18:12
  you very much.
• 18:15
  At athenahealth,
• 18:17
  we know your ambulatory practice wants healthier,
• 18:20
  a healthier business, healthier care teams, and healthier
• 18:22
  patients.
• 18:23
  But the complexities of modern health care tech
• 18:26
  make it hard for you and your care
• 18:28
  teams to focus on what matters
• 18:30
  most? That's where athenahealth can help. Our AI
• 18:33
  native all in one solutions reduce administrative burdens,
• 18:36
  streamline billing and payments, and deliver critical insights
• 18:39
  when clinicians need it most.
• 18:41
  That means fewer clicks, more time for patients,
• 18:44
  and stronger bottom
• 18:45
  lines. Practicing medicine is complex, but running a
• 18:49
  practice can be that much simpler with athenahealth.
• 18:52
  See how simpler is healthier at athenahealth.com.