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