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Practicing medicine is complex, but running a practice can be that much simpler with athenahealth. See how simpler is healthier@athenahealth.com.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: I sure did.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: Right.

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: Thank you very much.

Speaker 0: 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.