[MUSIC] Hello, thank you for joining me on this video, Case Study in Project Management. So I'm Seth Martin, a cardiologist here in Baltimore at Johns Hopkins Hospital. My interest is in health IT and informatics, and really based on desire to make scalable solutions that can help patients. I did my cardiology fellowship here at Hopkins, and have had specific interest in addition to informatics and health IT around lipidology, specifically the study of cholesterol. And cholesterol as it's carried on particles in the bloodstream and how that contributes to cardiovascular diseases. I've had statistical training here in the School of Public Health. And I really enjoy multi-disciplinary teams, being part of that team, interacting with engineers, bridging the divide between engineers and clinicians, and clinicians and statisticians. So I wanted to talk about Corrie. Corrie is a mobile digital health product, it's also a project and I wanted to tell you some of that journey and why it's been something that I have become very passionate about. So C-O-R, Cor, is Latin for heart and we added RIE to make it sound something like your buddy Siri. So Corrie is re-engineering heart attack discharge and recovery to help patients navigate that risky transition from hospital to home. This has been a transition that's really led to a lot of national attention and also local attention here at our hospital about how we can empower patients to better navigate that transition. And I have the good fortune of pairing up with Francoise Marvel, my colleague here at Hopkins who's a physician here. She started this project as a resident and then as a chief resident, and also has joined our cardiology fellowship. And Francoise Marvel was very forward thinking and joined the HEXCITE accelerator program here. Which really prepared her to launch a team in a startup company, Mobile Digital Solution around this problem of this risky transition. And really started by talking with patients about their experience after having a heart attack. And patients were saying things like, I don't know really what was next, I felt lonely, I didn't feel like I had all the information that I needed to succeed. I was watching a lot of TV in my hospital room, the doctors and nurses came by occasionally, they told me a lot of important information. But I needed more ways to reinforce that information and to guide me. So if we think about being a patient and coming into the hospital with a heart attack, this is how Corrie is used. So patients comes in, they're clenching their chest when they come to the hospital, it's determined that they have an heart attack. And the first thing that happens is that they're rushed to the cath lab, the most important thing is someone's having what's called an ST elevation in myostemy, is to open up that blocked vessel. So they'll go to the cath lab, the artery is opened, a stance put in to keep that blood vessel open. And it's a pretty quick procedure and then the patient rolls into their hospital room and they're wondering, what just happened? This came all of a sudden, I thought I was healthy, what is going on? And there is where Corrie comes in to complement the clinical team. Corrie has the answers about what happened, what lead to the heart attack, and what's next. Providing patient education, it really does that through really clear articles as well as through animated videos that helps reinforce that information, the concepts of what's going on, what needs to be done now. It serves as a self management tool related to tracking medication adherence, critical vital signs like heart rate, blood pressure, mood, organizing follow up appointments. And organizing all the medical information, your insurance, stent card, who your doctors are. Really it can become overwhelming when this is all happening all of the sudden and there's so much to do and Corrie serves as an organizer. So as you can see, I like working on patient facing solutions, interventions that go directly to patients, I want to have that direct clinical impact. Another example that I'm really proud of beyond the Corrie app is what I created, this LDL cholesterol calculation. LDL is known as bad cholesterol, it's something that's used everyday in clinical practice. It's on the lab report, if you've gone to your doctor and gotten your lipid profile, you'll see the LDL cholesterol there. We've developed through big data analysis a more accurate way to calculate LDL cholesterol. So this is something that's been adopted by our latest American College of Cardiology, American Heart Association. Clinical guidelines are now being used by millions of people around the world. And that's something I'm really proud of that we've been able to improve the accuracy of a measure that's used in daily clinical practice. What we had found is that the old equation was developed decades ago in a small data set and worked really well, except for certain clinical scenarios that we now encounter much more commonly. So we had been able to adapt the method to be more flexible to accommodate these new clinical scenarios. And therefore empower patients and clinicians with more precise information. And this falls in the realm of consumer health informatics. We had leveraged big data to generate this new algorithm, that's been incorporated back into the informatics infrastructure to provide an automated way. So thinking about wearables, the digital health boom, huge data sets like I was just discussing. This is a great time to be in the space and we can really make direct and rapid impact. So back to Corrie as an example project, once we develop this app/platform, we launched a study. In order for new techniques to be adopted in clinical practice, you need to have evidence for that. And so the next logical step was to do a study, we call this the MiCORE study. And it was being conducted at Hopkins along with our friends at Massachusetts General Hospital and Reading Hospital. In order to make this happen, we had to plan the designer to study and put that in the form of IRB protocol. And submit that IRB, get comments over the next couple of month back from the IRB, respond to those comments, and then eventually get approval. This is all, although it seems cumbersome, a very important process to make sure when we're going to start testing something in patients that we really thought through the details to make this a worthwhile endeavor and safe for patients. So we developed, in addition to the IRB protocol, which provides kind of the framework for how we're going to study this. We also developed standard operating procedures for those on the ground level, implementing the study to have everything very clear about how we roll this out to patients as well as then how we extract data. So we recruited the team to carry out the study, and one particular member of our team that's been very important is a nursing PhD student, Erin Spalding, who's really been on the front lines to point this to patients. And it was nice that this fit with her own interest around patient engagement as it relates to mobile technology. But we've had a really, really close working relationship along the way with our engineers whenever issues have come up with the tech as well as with our statistical team. And many of the undergraduates and medical students have contributed to aspects of our study and success. So we've been recruiting patients, giving them Corrie, and we are getting close after about one years time hitting our target of 200 patient study. We wanted to rather than just do a 10, 20 or 30 person study, we wanted to do something large, more impactful to really get more confidence in our results. So along the way to stay organized, we use certain project tools, you may have heard of Trello. It's one of the many tools that can be used for project management, allows you to have sort of posted notes in different categories. To assign deadlines to them, assign different members of the team to them, to stay organized. And we ended up finding out that our team calls could, sometimes it was helpful to organize them around what we needed to do on Trello. Also for more real-time messaging between team members, we have used Slack, and this provides different channels. The different folks on a team can be part of to go back and forth in real time. And we find that our engineering team really likes to use this even more than they like to use email for real time communication. And it's important to have weekly calls or meetings. I think face-to-face is great, but it often can be inconvenient for a lot of folks. Especially if you're on different campuses and have to drive to meet up with each other. And so maybe we you can do those every now and then. We've in fact sometimes used meetings more to sort of celebrate our successes and try to keep the weekly work calls to a phone or Zoom, Skype meetings have worked well for us as well. Just wanted to close by talking about, as you start to gain success with the project such as Corrie, then the next natural kind of progression can be scope creep. So when there's this initial enthusiasm around a solution like Corrie for heart attack recovery. Now we've generated all this interest with the solution, it is easy to see how something like this it's been useful for cardiac disorders, for heart attack patients. And now all of a sudden folks are wondering, can we use this for pneumonia, can we use it for COPD, can we use it for diabetes, for surgical disorders? There's clear overlap in the way that this would be approach and we're definitely interested in getting into those as well and helping more patients. But it does represent scope creep and we have to balance that interest in expanding the other types of patients. With the value of staying focused and really finishing what we started and building on our strengths in heart attack recovery, having the best refined solution that gets better and better. And figuring out the right balance for when we no go to another condition. So that's something our team has been wrestling with. I don't have the full answer or solution, I think it's going to depend on your own personal journey and story when it makes sense. But just realize this is something that, I think, naturally going to happen and something that you have to kind of figure out as you go along and see what feels right. But I think it is important not to dilute efforts too early. So I'm going to end there and on that note. And thank you, very much for joining me on this video.
