1 00:00:02,240 --> 00:00:02,899 At athenahealth, 2 00:00:03,279 --> 00:00:05,940 we know your ambulatory practice wants healthier, 3 00:00:06,319 --> 00:00:09,279 a healthier business, healthier care teams, and healthier 4 00:00:09,279 --> 00:00:09,779 patients. 5 00:00:10,160 --> 00:00:12,400 But the complexities of modern health care tech 6 00:00:12,400 --> 00:00:14,240 make it hard for you and your care 7 00:00:14,240 --> 00:00:15,974 teams to focus on what matters most. 8 00:00:16,614 --> 00:00:18,315 That's where athenahealth can help. 9 00:00:18,695 --> 00:00:21,495 Our AI native all in one solutions reduce 10 00:00:21,495 --> 00:00:22,635 administrative burdens, 11 00:00:23,015 --> 00:00:25,914 streamline billing and payments, and deliver critical insights 12 00:00:25,975 --> 00:00:27,515 when clinicians need it most. 13 00:00:27,894 --> 00:00:30,475 That means fewer clicks, more time for patients, 14 00:00:30,535 --> 00:00:34,710 and stronger bottom lines. Practicing medicine is complex, 15 00:00:34,929 --> 00:00:36,689 but running a practice can be that much 16 00:00:36,689 --> 00:00:37,829 simpler with athenahealth. 17 00:00:38,530 --> 00:00:42,229 See how simpler is healthier@athenahealth.com. 18 00:00:44,274 --> 00:00:46,935 Hello, and welcome to the Becker's Healthcare Podcast. 19 00:00:47,315 --> 00:00:50,454 I'm Elizabeth Gregersen, a reporter here at Becker's, 20 00:00:50,515 --> 00:00:53,414 and I'm thrilled to interview doctor Lisa Howley, 21 00:00:53,795 --> 00:00:57,175 director of the fetal cardiology program at Children's 22 00:00:57,315 --> 00:00:59,495 Minnesota on the podcast today. 23 00:00:59,859 --> 00:01:02,179 Doctor Holly, thank you so much for joining 24 00:01:02,179 --> 00:01:04,040 me. I'm excited to chat 25 00:01:04,739 --> 00:01:07,459 to hear your insights on the field of 26 00:01:07,459 --> 00:01:08,680 pediatric cardiology. 27 00:01:09,140 --> 00:01:11,379 I think it'll be very valuable to our 28 00:01:11,379 --> 00:01:13,400 podcast audience, and I'm grateful 29 00:01:13,715 --> 00:01:16,034 to you for sharing your time. Before I 30 00:01:16,034 --> 00:01:19,075 dive into all my questions, could you introduce 31 00:01:19,075 --> 00:01:20,995 yourself and just tell us a bit about 32 00:01:20,995 --> 00:01:21,655 your background? 33 00:01:22,674 --> 00:01:26,034 Sure. So, thank you first, Elizabeth, for inviting 34 00:01:26,034 --> 00:01:27,630 me to be here. I'm delighted to join 35 00:01:27,630 --> 00:01:28,609 you this morning. 36 00:01:29,150 --> 00:01:31,390 As you said, my name is doctor Lisa 37 00:01:31,390 --> 00:01:31,890 Howley, 38 00:01:32,349 --> 00:01:35,329 and I am a pediatric and fetal cardiologist. 39 00:01:37,230 --> 00:01:40,510 My background is, a little varied. I am 40 00:01:40,510 --> 00:01:42,750 here in Minnesota now, but I actually grew 41 00:01:42,750 --> 00:01:44,524 up in a small town in New Hampshire. 42 00:01:45,564 --> 00:01:48,864 I did my college and medical school training 43 00:01:48,924 --> 00:01:51,484 in the state of Virginia, and then I 44 00:01:51,484 --> 00:01:52,384 moved to, 45 00:01:52,844 --> 00:01:55,004 the great state of Colorado where I did 46 00:01:55,004 --> 00:01:57,024 my pediatric and pediatric cardiology 47 00:01:57,989 --> 00:01:58,489 fellowship, 48 00:01:59,030 --> 00:02:00,890 training at the University of Colorado. 49 00:02:02,150 --> 00:02:04,230 Not wanting to be done with my training 50 00:02:04,230 --> 00:02:05,989 at that point, I decided I wanted to 51 00:02:05,989 --> 00:02:07,909 pursue a little bit further, and so I 52 00:02:07,909 --> 00:02:10,229 went up to the Great White North. I 53 00:02:10,229 --> 00:02:12,889 went up to University of Alberta in Edmonton 54 00:02:13,189 --> 00:02:15,805 to train in fetal cardiology, and that's where 55 00:02:15,805 --> 00:02:17,825 I had my fetal cardiology training. 56 00:02:18,444 --> 00:02:20,205 And then I returned back to The States 57 00:02:20,205 --> 00:02:23,025 to begin my, pediatric and fetal cardiology 58 00:02:23,485 --> 00:02:23,985 job, 59 00:02:24,605 --> 00:02:26,064 at University of Colorado. 60 00:02:26,580 --> 00:02:29,379 So in from 2010 61 00:02:29,379 --> 00:02:30,580 to 02/2019, 62 00:02:30,580 --> 00:02:31,879 I worked at the Children's, 63 00:02:32,819 --> 00:02:33,319 Colorado 64 00:02:33,860 --> 00:02:34,360 Hospital, 65 00:02:34,900 --> 00:02:36,199 in Denver, Colorado, 66 00:02:36,659 --> 00:02:38,819 where I served as the co director of 67 00:02:38,819 --> 00:02:41,060 the fetal cardiology program, and then I was 68 00:02:41,060 --> 00:02:42,875 recruited out to Children's Minnesota 69 00:02:43,735 --> 00:02:47,194 in the Midwest Fetal Care Center, in 02/2019. 70 00:02:47,254 --> 00:02:48,235 So I've been 71 00:02:48,615 --> 00:02:50,775 in the great state of Minnesota now for 72 00:02:50,775 --> 00:02:51,754 about six years, 73 00:02:52,135 --> 00:02:54,534 where as you mentioned, I practice as the 74 00:02:54,534 --> 00:02:55,915 director of fetal cardiology 75 00:02:56,455 --> 00:02:57,675 at Children's Minnesota. 76 00:02:58,830 --> 00:03:00,750 Perfect. Thank you for laying that all out 77 00:03:00,750 --> 00:03:02,830 for for us. I I was going to 78 00:03:02,830 --> 00:03:04,669 say, oh, you've been all over the country 79 00:03:04,669 --> 00:03:07,150 training, but, really, you went to another country 80 00:03:07,150 --> 00:03:07,810 as well. 81 00:03:08,989 --> 00:03:09,810 I sure did. 82 00:03:10,189 --> 00:03:11,810 That's really cool to hear. 83 00:03:12,185 --> 00:03:13,724 You know, given your experience 84 00:03:14,025 --> 00:03:15,644 and, you know, our listeners 85 00:03:15,944 --> 00:03:17,324 are gonna have varied degrees 86 00:03:17,784 --> 00:03:20,025 varying degrees of, you know, a connection to 87 00:03:20,025 --> 00:03:21,164 the field of cardiology. 88 00:03:21,705 --> 00:03:23,305 I'd love to tap you to hear, you 89 00:03:23,305 --> 00:03:25,405 know, what are the top three biggest issues 90 00:03:26,199 --> 00:03:28,699 in pediatric or fetal cardiology 91 00:03:29,000 --> 00:03:31,719 today that you think health care hospital system 92 00:03:31,719 --> 00:03:33,099 leaders should know about? 93 00:03:33,879 --> 00:03:35,960 Yeah. So that's a really great question. I 94 00:03:35,960 --> 00:03:37,400 mean, clearly, I have a bit of a 95 00:03:37,400 --> 00:03:40,485 niche job really living on the prenatal side. 96 00:03:40,864 --> 00:03:41,925 So, you know, I, 97 00:03:42,625 --> 00:03:44,324 spend my days screening 98 00:03:45,344 --> 00:03:48,004 for fetal heart conditions even before birth. 99 00:03:48,544 --> 00:03:50,384 So I would say, you know, from my 100 00:03:50,384 --> 00:03:53,104 vantage point, you know, there are three issues. 101 00:03:53,104 --> 00:03:55,240 There's actually probably more than that, but the 102 00:03:55,240 --> 00:03:55,740 number 103 00:03:56,199 --> 00:03:57,659 one that I wanna highlight, 104 00:03:58,120 --> 00:03:59,879 and I think is really important is really 105 00:03:59,879 --> 00:04:02,460 disparities and access to care and really, 106 00:04:03,240 --> 00:04:06,699 differences in prenatal detection of congenital heart disease, 107 00:04:07,604 --> 00:04:10,164 in different parts of the country. So, you 108 00:04:10,164 --> 00:04:13,205 know, according to the American Heart Association, about 109 00:04:13,205 --> 00:04:15,604 forty thousand children every year are born in 110 00:04:15,604 --> 00:04:18,024 The United States with congenital heart disease, 111 00:04:18,404 --> 00:04:20,884 and about a quarter of them are going 112 00:04:20,884 --> 00:04:23,139 to have a critical form of congenital heart 113 00:04:23,139 --> 00:04:25,060 disease, meaning they're gonna need some sort of 114 00:04:25,060 --> 00:04:27,860 intervention, either surgery or a calf procedure to 115 00:04:27,860 --> 00:04:29,959 be able to survive long term after birth. 116 00:04:30,899 --> 00:04:34,339 And so trying to identify these babies prior 117 00:04:34,339 --> 00:04:35,639 to birth is really 118 00:04:36,485 --> 00:04:39,125 important so that we are able to counsel 119 00:04:39,125 --> 00:04:41,464 and have these moms deliver it at cardiac 120 00:04:41,604 --> 00:04:43,125 centers so we're able to take care of 121 00:04:43,125 --> 00:04:44,425 these babies after birth. 122 00:04:44,964 --> 00:04:46,884 One of the challenges that we have is 123 00:04:46,884 --> 00:04:47,384 that, 124 00:04:47,845 --> 00:04:49,845 you know, people in our country live in 125 00:04:49,845 --> 00:04:50,824 lots of different 126 00:04:51,199 --> 00:04:54,399 places, and there is significant geographic variation in 127 00:04:54,399 --> 00:04:55,939 the detection rate of, 128 00:04:56,480 --> 00:04:59,199 prenatal heart disease between different parts of the 129 00:04:59,199 --> 00:04:59,699 country. 130 00:05:00,639 --> 00:05:04,000 A publication that I highlight a lot, came 131 00:05:04,000 --> 00:05:06,415 out in the journal of pediatrics in 2015 132 00:05:06,415 --> 00:05:06,995 that really, 133 00:05:08,175 --> 00:05:11,074 stated the point that in this paper, prenatal 134 00:05:11,134 --> 00:05:13,535 detection rates for congenital heart disease were thirty 135 00:05:13,535 --> 00:05:14,275 four percent. 136 00:05:15,215 --> 00:05:17,775 And so there is a lot of babies 137 00:05:17,775 --> 00:05:20,009 in this country that are born without that 138 00:05:20,170 --> 00:05:23,290 recognition, and unfortunately, they may deliver in centers 139 00:05:23,290 --> 00:05:25,370 that are not able to take care of 140 00:05:25,370 --> 00:05:25,870 them, 141 00:05:26,330 --> 00:05:28,110 at the level that they need. 142 00:05:28,569 --> 00:05:30,889 So, you know, some of that limitation in 143 00:05:30,889 --> 00:05:31,389 prenatal 144 00:05:31,770 --> 00:05:32,270 detection 145 00:05:33,675 --> 00:05:35,754 really might be just a result of, you 146 00:05:35,754 --> 00:05:36,254 know, 147 00:05:36,634 --> 00:05:39,915 access to ultrasound or to medical providers that 148 00:05:39,915 --> 00:05:41,274 are skilled in, 149 00:05:41,675 --> 00:05:42,175 detecting 150 00:05:42,555 --> 00:05:44,014 these sorts of conditions, 151 00:05:44,634 --> 00:05:46,529 as well as just some, you know, challenges 152 00:05:46,529 --> 00:05:49,089 with social determinants of health for those families. 153 00:05:49,089 --> 00:05:50,789 So, you know, limits to transportation 154 00:05:51,089 --> 00:05:52,709 or inability to get 155 00:05:53,089 --> 00:05:54,310 to larger medical 156 00:05:54,930 --> 00:05:57,829 centers, which are often in urban areas. Right? 157 00:05:58,464 --> 00:05:59,985 So, you know, I think that that's the 158 00:05:59,985 --> 00:06:01,664 first one and I think just an important 159 00:06:01,664 --> 00:06:03,524 thing to highlight that's really been, 160 00:06:03,985 --> 00:06:06,064 a drumbeat for me is really working on 161 00:06:06,064 --> 00:06:07,204 Sonaga for Education 162 00:06:07,504 --> 00:06:10,544 in recognition of congenital heart disease. So even 163 00:06:10,544 --> 00:06:11,044 those, 164 00:06:11,680 --> 00:06:14,019 working in more rural and remote areas, 165 00:06:14,560 --> 00:06:16,579 have that skill set to pick those 166 00:06:17,360 --> 00:06:20,160 babies up and to be able to get 167 00:06:20,160 --> 00:06:22,180 them to higher levels of care. 168 00:06:22,720 --> 00:06:24,480 So I can hit on that later with 169 00:06:24,480 --> 00:06:26,259 some of the things I'm excited about. 170 00:06:27,545 --> 00:06:28,045 But, 171 00:06:28,665 --> 00:06:30,745 I this is one that I is really 172 00:06:30,745 --> 00:06:32,425 true to my heart is trying to make 173 00:06:32,425 --> 00:06:34,605 sure that we are equally reaching, 174 00:06:35,545 --> 00:06:37,545 patients both in urban areas as well as 175 00:06:37,545 --> 00:06:39,165 in remote and rural areas, 176 00:06:40,069 --> 00:06:42,949 in trying to take optimal care of, 177 00:06:43,350 --> 00:06:44,490 these pregnant mothers. 178 00:06:45,670 --> 00:06:48,150 So that's the first one, and that's probably 179 00:06:48,150 --> 00:06:49,990 the one that I think is really important 180 00:06:49,990 --> 00:06:50,650 to highlight. 181 00:06:51,589 --> 00:06:52,330 The second 182 00:06:52,895 --> 00:06:55,875 that I think is another area that is 183 00:06:56,014 --> 00:06:58,194 a challenge at this point is, 184 00:06:58,495 --> 00:07:00,915 you know, now with our advances in 185 00:07:01,215 --> 00:07:04,355 medical and surgical treatments, we have a growing 186 00:07:05,210 --> 00:07:08,990 population of children with congenital heart disease and 187 00:07:09,290 --> 00:07:12,750 really those with complex forms of heart disease 188 00:07:13,129 --> 00:07:15,610 that now we are, you know, not only 189 00:07:15,610 --> 00:07:16,990 having them survive, 190 00:07:17,665 --> 00:07:20,064 but trying to help them thrive through all 191 00:07:20,064 --> 00:07:21,845 of childhood and into adulthood. 192 00:07:23,024 --> 00:07:25,504 And so this ranges raises a lot of 193 00:07:25,504 --> 00:07:26,004 challenges, 194 00:07:26,625 --> 00:07:29,345 you know, managing long term complications that these 195 00:07:29,345 --> 00:07:30,324 kids will have. 196 00:07:31,399 --> 00:07:33,819 And that could be, you know, complications regarding 197 00:07:33,879 --> 00:07:36,199 their heart itself such as, you know, heart 198 00:07:36,199 --> 00:07:38,620 failure or heart rhythm problems, but also 199 00:07:39,000 --> 00:07:40,360 we have found that a lot of these 200 00:07:40,360 --> 00:07:42,939 kids that have had early heart 201 00:07:43,274 --> 00:07:46,095 procedures and interventions later will have neurodevelopmental 202 00:07:46,714 --> 00:07:47,214 challenges. 203 00:07:47,915 --> 00:07:48,415 So, 204 00:07:48,795 --> 00:07:50,475 you know, what a lot of the research 205 00:07:50,475 --> 00:07:52,735 that's coming out now is on neurodevelopmental 206 00:07:53,115 --> 00:07:55,694 and psychosocial issues that are coming up in 207 00:07:56,189 --> 00:07:58,590 children that have congenital heart disease that were 208 00:07:58,590 --> 00:07:59,090 treated, 209 00:07:59,629 --> 00:08:00,529 early on. 210 00:08:01,310 --> 00:08:03,150 And so now we're finding that they are 211 00:08:03,150 --> 00:08:05,810 having higher rates of learning difficulties 212 00:08:06,670 --> 00:08:09,650 and attention disorders and mental health challenges. 213 00:08:10,574 --> 00:08:12,975 And so that's just a lot of areas 214 00:08:12,975 --> 00:08:14,914 that perhaps might not be a cardiologist 215 00:08:15,615 --> 00:08:18,814 special specialty, but we need to be able 216 00:08:18,814 --> 00:08:21,615 to try and provide wrap around services for 217 00:08:21,615 --> 00:08:24,014 these kids and make sure that we are 218 00:08:24,014 --> 00:08:24,980 diagnosing kind 219 00:08:27,600 --> 00:08:28,180 of moving 220 00:08:28,560 --> 00:08:30,576 through adolescence and into early adulthood with some 221 00:08:30,576 --> 00:08:30,879 of these, 222 00:08:32,240 --> 00:08:32,740 neurodevelopmental 223 00:08:33,200 --> 00:08:34,580 and psychosocial challenges. 224 00:08:35,679 --> 00:08:37,460 So I'd say that's number two. 225 00:08:38,065 --> 00:08:40,304 And then the last one, kind of stems 226 00:08:40,304 --> 00:08:42,245 off of that is then, you know, transitioning 227 00:08:42,464 --> 00:08:44,384 these kids into adult care. So a lot 228 00:08:44,384 --> 00:08:46,065 of children, even if you go back a 229 00:08:46,065 --> 00:08:48,784 couple decades ago, like, a lot of these 230 00:08:48,784 --> 00:08:51,605 kids didn't survive to adulthood because they had 231 00:08:51,745 --> 00:08:53,129 heart disease that we weren't 232 00:08:54,009 --> 00:08:56,490 very good at, taking care of, but now 233 00:08:56,490 --> 00:08:58,750 our our advances in medicines 234 00:08:59,129 --> 00:09:01,470 and surgical treatments, now we're affording 235 00:09:01,929 --> 00:09:03,230 these kids to have very 236 00:09:03,929 --> 00:09:06,669 exciting and and long lives, 237 00:09:07,129 --> 00:09:08,054 that they previously 238 00:09:09,174 --> 00:09:11,108 couldn't have. So now we have created, you 239 00:09:11,108 --> 00:09:13,095 know, a very large adult population that have 240 00:09:13,095 --> 00:09:14,475 congenital heart disease. 241 00:09:15,014 --> 00:09:17,975 And so now there's more adults living with 242 00:09:17,975 --> 00:09:20,054 congenital heart disease in The United States than 243 00:09:20,054 --> 00:09:20,554 children, 244 00:09:21,870 --> 00:09:24,269 which, you know, now we're talking about we 245 00:09:24,269 --> 00:09:25,649 need to improve transitioning 246 00:09:26,190 --> 00:09:28,049 those that are cared for in the pediatric 247 00:09:28,190 --> 00:09:28,690 system, 248 00:09:29,230 --> 00:09:31,950 to get them into adult congenital programs, which 249 00:09:31,950 --> 00:09:34,370 are is now kind of a burgeoning field 250 00:09:34,815 --> 00:09:37,455 with, specialists in the adult field taking care 251 00:09:37,455 --> 00:09:39,054 of these kids. And this is an area 252 00:09:39,054 --> 00:09:40,735 where we're not very good, and I would 253 00:09:40,735 --> 00:09:41,634 say that we, 254 00:09:42,575 --> 00:09:44,495 find that some of these kids in that 255 00:09:44,495 --> 00:09:46,434 transition period are kind of lost, 256 00:09:47,330 --> 00:09:49,730 in the gap, and we need to kinda 257 00:09:49,730 --> 00:09:51,750 be better about a nice smooth transition. 258 00:09:53,090 --> 00:09:55,250 Perfect. Yeah. And and correct me if I'm 259 00:09:55,250 --> 00:09:57,970 wrong. I think I wrote an article that, 260 00:09:58,690 --> 00:10:01,845 adult congenital heart disease is a specialty that, 261 00:10:01,845 --> 00:10:03,524 you know, is one of the rarest specialties 262 00:10:03,524 --> 00:10:06,165 for a cardiologist to have. So it's it's 263 00:10:06,165 --> 00:10:08,825 a growing field, but not many cardiologists 264 00:10:09,365 --> 00:10:11,625 currently practicing are, you know, 265 00:10:12,069 --> 00:10:14,709 treating it. Is that correct? Yeah. Well, I 266 00:10:14,709 --> 00:10:16,709 think that you're hitting it on the head 267 00:10:16,709 --> 00:10:19,429 that in in the course of my time 268 00:10:19,429 --> 00:10:21,750 since training to now where I've really seen 269 00:10:21,750 --> 00:10:22,970 the biggest growth, 270 00:10:23,990 --> 00:10:26,785 in the field of pediatric cardiology is one 271 00:10:26,785 --> 00:10:30,384 is going earlier, so fetal cardiology. So now 272 00:10:30,384 --> 00:10:31,524 we're aiming for, 273 00:10:32,705 --> 00:10:34,544 you know, as many kids as we can 274 00:10:34,544 --> 00:10:37,504 to have prenatal diagnoses because we know that 275 00:10:37,504 --> 00:10:40,579 that allows families times to be educated, to 276 00:10:40,579 --> 00:10:43,319 make decisions for their family, to deliver 277 00:10:43,860 --> 00:10:46,500 at, you know, cardiac centers of excellence and 278 00:10:46,500 --> 00:10:50,179 to transition them into, you know, pediatric cardiac 279 00:10:50,179 --> 00:10:50,679 programs 280 00:10:51,434 --> 00:10:51,934 without, 281 00:10:52,875 --> 00:10:55,215 having any, hopefully, any issues, 282 00:10:55,835 --> 00:10:58,235 in that newborn period. So one area is 283 00:10:58,235 --> 00:11:01,115 really the growth of the fetal program. The 284 00:11:01,115 --> 00:11:03,054 other is the other end of the spectrum, 285 00:11:03,629 --> 00:11:06,429 which is that of adult congenital heart disease. 286 00:11:06,429 --> 00:11:08,690 So now as as these kids are surviving 287 00:11:08,830 --> 00:11:09,649 into adulthood, 288 00:11:10,190 --> 00:11:13,410 you know, they have complex forms of congenital 289 00:11:13,549 --> 00:11:15,970 heart disease, which often is gonna be malformations 290 00:11:16,350 --> 00:11:18,264 of the heart from the time that the 291 00:11:18,264 --> 00:11:19,565 heart was ever created, 292 00:11:20,504 --> 00:11:23,945 that previously, you know, adult cardiologists were very 293 00:11:23,945 --> 00:11:26,445 good at taking care of kind of normal 294 00:11:26,504 --> 00:11:29,144 heart structure with just the wear and wear 295 00:11:29,144 --> 00:11:29,884 and tear 296 00:11:30,504 --> 00:11:33,429 of, you know, life that has affected its 297 00:11:33,429 --> 00:11:34,250 its function. 298 00:11:35,190 --> 00:11:37,990 But now we are taking malformed hearts that 299 00:11:37,990 --> 00:11:39,370 we surgically modify, 300 00:11:39,829 --> 00:11:42,409 and then these children are living to adulthood. 301 00:11:42,549 --> 00:11:43,850 So it's requiring 302 00:11:44,964 --> 00:11:46,184 a new type of cardiologist. 303 00:11:46,565 --> 00:11:49,065 So these, you know, adult congenital 304 00:11:49,524 --> 00:11:50,024 heart, 305 00:11:50,804 --> 00:11:51,304 specialists 306 00:11:51,764 --> 00:11:54,585 that are really specialized in these unique surgical 307 00:11:54,644 --> 00:11:56,024 procedures and malformations 308 00:11:56,325 --> 00:11:58,404 of the heart that are now surviving to 309 00:11:58,404 --> 00:12:01,460 adulthood. So, you know, there is a, increasing 310 00:12:01,600 --> 00:12:04,580 need for more adult congenital heart, 311 00:12:05,519 --> 00:12:08,660 doctors because we now have a large population 312 00:12:08,879 --> 00:12:11,300 of adults with congenital heart disease. 313 00:12:11,804 --> 00:12:13,024 Hopefully, that makes sense. 314 00:12:13,404 --> 00:12:15,245 No. It does. And I really appreciate you, 315 00:12:15,245 --> 00:12:16,684 you know, sharing that insight, 316 00:12:17,164 --> 00:12:19,585 to just give that perspective to our listeners. 317 00:12:20,125 --> 00:12:22,284 Shifting gears a little bit here, how do 318 00:12:22,284 --> 00:12:24,524 you see the field evolving over the next, 319 00:12:24,524 --> 00:12:26,465 you know, twelve to eighteen months? 320 00:12:28,299 --> 00:12:31,120 That is a great question, and I think 321 00:12:31,179 --> 00:12:33,659 that one that the first answer is going 322 00:12:33,659 --> 00:12:36,299 to have to be, you know, the discussion 323 00:12:36,299 --> 00:12:37,679 about artificial intelligence, 324 00:12:38,860 --> 00:12:40,815 because, you know, I recently was just at 325 00:12:40,815 --> 00:12:42,914 the American Society of ECHO conference, 326 00:12:43,375 --> 00:12:45,774 in Nashville this year, and we had a 327 00:12:45,774 --> 00:12:47,634 whole session just on artificial 328 00:12:48,735 --> 00:12:51,235 intelligence and how that that is really coming, 329 00:12:51,934 --> 00:12:54,355 quickly into our field. So I think adoption 330 00:12:54,549 --> 00:12:57,610 of artificial intelligence and finding ways to utilize 331 00:12:57,670 --> 00:12:58,170 that, 332 00:12:59,029 --> 00:13:00,649 to help us in our field, 333 00:13:01,590 --> 00:13:03,830 is really where I think, you know, we're 334 00:13:03,830 --> 00:13:05,750 gonna see some big changes happening in the 335 00:13:05,750 --> 00:13:07,290 next twelve to eighteen months. 336 00:13:07,754 --> 00:13:10,415 Specifically, with what I do with prenatal diagnosis 337 00:13:10,634 --> 00:13:11,615 and with pediatric, 338 00:13:12,315 --> 00:13:14,554 cardiac imaging, I think it's gonna be, you 339 00:13:14,554 --> 00:13:15,934 know, thinking about imaging 340 00:13:16,715 --> 00:13:17,215 automation, 341 00:13:18,154 --> 00:13:20,815 and really trying to improve prenatal and pediatric 342 00:13:20,955 --> 00:13:23,769 cardiac screening. So trying to help us look 343 00:13:23,769 --> 00:13:24,990 at images faster, 344 00:13:25,529 --> 00:13:28,269 you know, pick up and detect abnormalities 345 00:13:28,730 --> 00:13:30,190 and bring them to our attention, 346 00:13:30,970 --> 00:13:33,470 and probably are, you know, increasing efficiency. 347 00:13:34,835 --> 00:13:36,274 I think that this can be really helpful, 348 00:13:36,274 --> 00:13:39,095 especially for reducing physician and stenographer 349 00:13:39,715 --> 00:13:40,274 kind of, 350 00:13:41,075 --> 00:13:42,375 interpretation fatigue. 351 00:13:43,315 --> 00:13:45,634 And so I think that artificial intelligence is 352 00:13:45,634 --> 00:13:47,955 probably the biggest one. You know, the other, 353 00:13:47,955 --> 00:13:50,429 I think, you know, trying to get into 354 00:13:50,429 --> 00:13:52,910 more rural areas, especially when we have a 355 00:13:52,910 --> 00:13:55,730 limited number of subspecialists makes me think about, 356 00:13:56,350 --> 00:13:57,889 creation of more telehealth 357 00:13:58,429 --> 00:14:01,009 options or kind of hub and spoke networks, 358 00:14:02,195 --> 00:14:05,315 especially for fetal consults and and those things 359 00:14:05,315 --> 00:14:07,875 that are more specialty access so that we're 360 00:14:07,875 --> 00:14:10,274 able to get into communities that aren't in 361 00:14:10,274 --> 00:14:11,495 the urban areas. 362 00:14:12,674 --> 00:14:14,674 I know, you know, when I was back 363 00:14:14,674 --> 00:14:16,570 in Colorado, I was part of a fetal 364 00:14:16,570 --> 00:14:17,070 telecardiology 365 00:14:18,090 --> 00:14:20,169 clinic, that I would run with my old 366 00:14:20,169 --> 00:14:22,269 partner, doctor Bettina Cuneo out 367 00:14:22,649 --> 00:14:24,750 there. And we ran a fetal 368 00:14:25,129 --> 00:14:28,409 telehealth clinic that was across the Rockies. So 369 00:14:28,409 --> 00:14:30,570 we would read the images in Denver, but 370 00:14:30,570 --> 00:14:32,985 the clinic was out in Grand Junction on 371 00:14:32,985 --> 00:14:34,924 the other side of the Rockies near Utah. 372 00:14:35,464 --> 00:14:37,304 And that was very successful, and it helped 373 00:14:37,304 --> 00:14:40,524 families get the, you know, specialty access without 374 00:14:40,584 --> 00:14:42,365 having to do a four hour drive. 375 00:14:43,065 --> 00:14:45,144 So I think that those things are are 376 00:14:45,144 --> 00:14:47,680 ones that are coming and hopefully will will 377 00:14:47,680 --> 00:14:48,180 be, 378 00:14:48,720 --> 00:14:50,480 on the forefront here in the next eighteen 379 00:14:50,480 --> 00:14:50,980 months. 380 00:14:52,000 --> 00:14:54,100 Perfect. Thank you. Yeah. I I 381 00:14:54,480 --> 00:14:56,320 I'm always amazed at all the different ways 382 00:14:56,320 --> 00:14:59,120 that, you know, technology and AI is is 383 00:14:59,120 --> 00:14:59,620 touching 384 00:15:00,044 --> 00:15:02,365 basically every single aspect of health care. So 385 00:15:02,365 --> 00:15:04,924 I'm I'm grateful that you can share, you 386 00:15:04,924 --> 00:15:06,544 know, how it's touching your field. 387 00:15:07,245 --> 00:15:09,904 Yeah. For my very last question, you know, 388 00:15:10,125 --> 00:15:10,784 feel free 389 00:15:11,085 --> 00:15:12,705 to take this either way, but 390 00:15:13,059 --> 00:15:14,980 what are you excited about when it comes 391 00:15:14,980 --> 00:15:17,940 to, you know, fetal pediatric cardiology right now, 392 00:15:17,940 --> 00:15:20,120 and maybe what makes you nervous? 393 00:15:21,460 --> 00:15:24,120 So things that I am excited about, 394 00:15:25,220 --> 00:15:26,759 you know, one is 395 00:15:27,315 --> 00:15:30,514 trying to continue to increase sonographer education, and 396 00:15:30,514 --> 00:15:32,195 I'm gonna put in a little plug that 397 00:15:32,195 --> 00:15:32,695 we, 398 00:15:33,554 --> 00:15:35,975 did our first fetal cardiology 399 00:15:36,514 --> 00:15:37,014 symposium 400 00:15:37,394 --> 00:15:38,134 out here, 401 00:15:38,754 --> 00:15:39,894 in the Upper Midwest, 402 00:15:40,920 --> 00:15:42,679 and I called it the best of the 403 00:15:42,679 --> 00:15:43,179 Midwest, 404 00:15:43,480 --> 00:15:46,440 the twenty twenty five fetal cardiology symposium, and 405 00:15:46,440 --> 00:15:47,100 we had, 406 00:15:48,040 --> 00:15:52,440 excellent speakers that represented from Children's Minnesota, from 407 00:15:52,440 --> 00:15:54,764 Midwest Fetal Care Center where I work, 408 00:15:55,644 --> 00:15:58,125 from the Mayo Clinic, and from University of 409 00:15:58,125 --> 00:16:00,365 Minnesota, and we all came together. We had 410 00:16:00,365 --> 00:16:01,745 a amazing showing 411 00:16:02,125 --> 00:16:03,424 with about 200 412 00:16:03,565 --> 00:16:05,825 attendees from 11 different states, 413 00:16:06,285 --> 00:16:09,100 really highlighting, you know, all the different aspects 414 00:16:09,100 --> 00:16:12,379 of fetal cardiac diagnosis, recognition, and treatment. We 415 00:16:12,379 --> 00:16:13,600 just had a really, 416 00:16:14,139 --> 00:16:14,639 robust, 417 00:16:15,820 --> 00:16:19,200 response and a lot of enthusiasm about education 418 00:16:19,259 --> 00:16:21,679 and so trying to continue taking that forward, 419 00:16:22,684 --> 00:16:25,085 to make sure those touching patients out in 420 00:16:25,085 --> 00:16:27,264 all the the aspects of the Upper Midwest, 421 00:16:27,965 --> 00:16:29,965 are able to recognize and and take care 422 00:16:29,965 --> 00:16:31,184 of good fam of families. 423 00:16:31,644 --> 00:16:33,985 So that is one. I would also say, 424 00:16:34,524 --> 00:16:36,389 you know, I'm excited about the early adoption 425 00:16:36,870 --> 00:16:39,529 of artificial intelligence. I think there's really opportunity 426 00:16:39,670 --> 00:16:41,610 there, especially if we're able to load, 427 00:16:42,389 --> 00:16:45,190 some of these algorithms onto the ultrasound machines 428 00:16:45,190 --> 00:16:45,690 themselves, 429 00:16:46,470 --> 00:16:47,370 really to 430 00:16:47,670 --> 00:16:49,029 you know, if they're able to get a 431 00:16:49,029 --> 00:16:51,590 couple sentinel views of the fetal heart, you 432 00:16:51,590 --> 00:16:52,090 know, 433 00:16:52,415 --> 00:16:53,855 maybe the AI would be able to say, 434 00:16:53,855 --> 00:16:56,175 you know, this looks like a normal screening 435 00:16:56,175 --> 00:16:58,595 views versus abnormal and kind of flag, 436 00:16:59,455 --> 00:17:00,754 just based on the images, 437 00:17:01,455 --> 00:17:03,855 really to try and help that physician or 438 00:17:03,855 --> 00:17:07,369 sonographer that's, in those more rural communities knowing 439 00:17:07,369 --> 00:17:09,450 which patients to refer and which ones look 440 00:17:09,450 --> 00:17:09,950 good. 441 00:17:11,049 --> 00:17:12,910 And so I think that those are probably, 442 00:17:13,049 --> 00:17:15,070 you know, two areas where I'm most excited. 443 00:17:15,609 --> 00:17:18,009 I think in terms of nervousness, I don't 444 00:17:18,009 --> 00:17:18,509 have, 445 00:17:19,075 --> 00:17:20,515 a whole lot of concern. I know that 446 00:17:20,515 --> 00:17:22,115 there are some out there that are really 447 00:17:22,115 --> 00:17:24,355 nervous about, hey, how AI is going to 448 00:17:24,355 --> 00:17:26,835 impact, you know, health care, how are we 449 00:17:26,835 --> 00:17:29,654 going to use it to partner with us 450 00:17:29,795 --> 00:17:32,275 and not, you know, impact our health care 451 00:17:32,275 --> 00:17:32,775 jobs. 452 00:17:33,394 --> 00:17:35,250 Right. But, you know, at this point, I 453 00:17:35,250 --> 00:17:36,769 think that that's more of a question, but 454 00:17:36,769 --> 00:17:38,769 I'm not one that has a lot of 455 00:17:38,769 --> 00:17:40,150 nervousness about that. 456 00:17:40,850 --> 00:17:41,750 Well, great. 457 00:17:42,049 --> 00:17:44,549 Yeah. I that's always nice to hear 458 00:17:45,570 --> 00:17:47,809 of an a leader who's, you know, more 459 00:17:47,809 --> 00:17:50,825 excited than nervous. So thank you for giving 460 00:17:50,825 --> 00:17:52,684 us a peek into your field 461 00:17:53,065 --> 00:17:55,304 today, and thank you for taking the time 462 00:17:55,304 --> 00:17:57,384 to join me on the podcast. It's been 463 00:17:57,384 --> 00:17:59,804 a really amazing and informative discussion. 464 00:18:00,904 --> 00:18:02,984 I invite our listeners to tune into more 465 00:18:02,984 --> 00:18:06,039 podcasts from Becker's Healthcare by visiting our podcast 466 00:18:06,100 --> 00:18:09,140 page at beckers hospital review dot com. Thank 467 00:18:09,140 --> 00:18:10,980 you again, doctor Howley, and I hope you 468 00:18:10,980 --> 00:18:12,740 have a wonderful rest of your day. Thank 469 00:18:12,740 --> 00:18:13,640 you very much. 470 00:18:15,955 --> 00:18:16,695 At athenahealth, 471 00:18:17,075 --> 00:18:19,735 we know your ambulatory practice wants healthier, 472 00:18:20,115 --> 00:18:22,994 a healthier business, healthier care teams, and healthier 473 00:18:22,994 --> 00:18:23,494 patients. 474 00:18:23,875 --> 00:18:26,195 But the complexities of modern health care tech 475 00:18:26,195 --> 00:18:28,035 make it hard for you and your care 476 00:18:28,035 --> 00:18:29,579 teams to focus on what matters 477 00:18:30,059 --> 00:18:33,099 most? That's where athenahealth can help. 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