GW Center for Healthcare Innovation & Policy Resea

Dr. Kris Lehnhardt is an Attending Physician and Assistant Professor at The George Washington University (GWU) School of Medicine and Health Sciences. He is board-certified in Emergency Medicine in both Canada and the U.S.A and he works clinically in the Emergency Department of GWU Hospital as well as the DC Veterans Affairs Medical Center. Dr. Lehnhardt is the Director of the Fellowship in Extreme Environmental Medicine (FEEM). In addition, he is a reservist in the Royal Canadian Air Force, an FAA Aviation Medical Examiner (AME), a private pilot, and a PADI advanced open water SCUBA diver.

Dr. David Diemert is an innovative research focused on developing an effective hookworm vaccine and characterizing hookworm biology. An Associate Professor of The Department of Microbiology, Immunology, and Tropical Medicine (MITM), Dr. Diemert co-hosts the clinical immunology laboratory and clinical trials unit of the Sabin Vaccine Institute Product Development Partnership (Sabin PDP), an Albert B. Sabin Vaccine Institute-funded partnership to develop new vaccines for neglected tropical diseases. In collaboration, both labs are currently running five phase 1 clinical trials for a hookworm vaccine: Two of these trials are carried out at the Children’s National Medical Center and the GW Medical Faculty Associates in Washington D.C., two in collaboration with the Oswaldo Cruz Foundation (FIOCRUZ) in Belo Horizonte and Americaninhas (Minas Gerais) in Brazil and one in Lambaréné in Gabon.

The ProvenExperience program at Geisinger Health System is a novel approach to population health and patient engagement. The program's new mobile app actually allows patients to request a refund when they are unhappy with their patient care experience.  Speaking with Dr. Jesse Pines, the Urgent Matters Director who is also a professor of emergency medicine, is Chanin Wendling, the Director of Geisinger in Motion in the Division of Applied Research and Clinical Informatics at Geisinger Health System. She is working to develop a variety of strategies that leverage mobile technology to improve patient engagement and enhance quality of care.

The Population Research in Identity and Disparities for Equality, or PRIDE, study is the first longitudinal health care study of LGBT people, aimed at better understanding factors relating to health and disease in this population. Currently in its community listening phase, the PRIDE study is utilizing technology, including a smartphone app, to engage LGBT individuals around the country. Learn more about the study at http://www.pridestudy.org/. Today's guests are the co-directors of the PRIDE Study, Dr. Juno Obedin-Maliver and Dr. Mitchell Lunn. Dr. Obedin-Maliver is a Fellow at SFVAMC Women's Health and a Clinical Instructor at UCSFMC. Dr. Lunn is an Assistant Professor of Medicine at the UCSF School of Medicine. Dr. Jesse Pines is the Director of the George Washington University Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy.

Healthy communication is an essential ingredient in any patient-provider relationship, but it is especially critical when delivering challenging or upsetting news. Today's guest, Dr. James Tulsky, understood the importance of healthy patient-provider communication and helped to develop OncoTalk, now VitalTalk, a series of courses that uses hands-on methods to teach advanced communications skills to providers.  Dr. James Tulsky is Chair of the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute. Dr. Jesse Pines is the Director of the George Washington University Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy.

The importance of physician-patient communication cannot be understated. But what happens when the interaction is less than ideal, when the provider struggles to connect, or empathize, with the patient? Empathy is important in medicine—it has been linked with patient experience, better outcomes and decreased physician burnout. It’s even part of the new MCAT. Dr. Helen Riess is the Director of the Empathy and Relational Science Program at Massachusetts General Hospital and the creator of “Empathetics,” a series of online courses for physicians on the issue. Dr. Jesse Pines is the Director of the George Washington University Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy. Visit our website for more information about OCPI.  Learn more about Empathetics here.

Continuity of care is important for provider-patient communication, trust and an understanding of patients outside of the moment they spend in the physicians office. However, primary care providers sometimes become overwhelmed and experience a burnout that leads to leaving clinical practice for a short while, or for good. And yet, little is known about the effect of primary care provider (PCP) turnover on patient experience and quality. In a recent JAMA Internal Medicine study, Dr. Ashok Reddy and his team investigated the effect of PCP turnover on patient experience using a sample of patients in the Veterans Health Administration. Dr. Jesse Pines is the Director of the George Washington Univeristy Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy. Visit our website for more information about GW's OCPI.

Health care spending is an enormous expense for individuals and America alike, yet many physicians remain unaware of the cost involved with tests, procedures and prescriptions. The ACA includes new care models aimed at containing health care costs and it is important that resident and attending physicians have an understanding of cost in this new system. To address this issue, Dr. Robert Fogerty created I-CARE, the Interactive Cost-Awareness Resident Exercise, to bring cost into discussions about care and treatment plans but in a manner that does not sacrifice clinical education. Dr. Jesse Pines is the Director of the George Washington Univeristy Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy. Visit our website for more information about GW's OCPI.

Donating and transplanting organs requires an alignment of many factors--first, a match, and then perhaps some inter-state travel or the ability of a living donor to take off time from work for the procedure and recovery. However, there are a limited number of organs available for a long list of deserving patients. State governments have tested a variety of strategies to increase the number of available organs for transplantation, including donor registries, population education programs, first person consent laws, and more. In a recent JAMA-Internal Medicine article, our guest, Dr. Atheen Venkataramani (and co-investigators) found that most state policies had no effect on the rate of organ donation and transplantation.  Dr. Jesse Pines is the Director of the George Washington Univeristy Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy. Visit our website for more information about GW's OCPI.

Hospitalized patients experiencing delirium often go unrecognized, due to clinical symptoms that include lethargy and immobility--two common side effects of hospitalization and age. In this episode, Dr. Sharon Inouye, the Director of the Aging Brain Center at the Institute for Aging Research in Boston and a Professor of Medicine at Harvard Medical School, discusses the importance of recognizing delirium in eldery hospitalized patients and a comprehensive patient-care program she developed to reduce the incidence of delirum in hospitals. The Hospital Elder Life Program (HELP) is designed to provide optimal care to elderly patients in a non-phamacologic manner.  Dr. Jesse Pines is the Director of The George Washington University Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy. Visit our website for more information about GW's OCPI.

Dr. Josh Landy, co-founder and Chief Medical Officer of Figure 1, talks about the medical imaging app often referred to as "instagram for doctors." 

Transitional medicine is emerging as an important new addition to the healthcare industry. Decades ago, patients with conditions such as severe congenital urologic abnormalities, or pediatric cancers usually died before reaching adulthood. These patients therefore always saw pediatric specialists. With the rapid advances in treatment options though, survival rates are making it common for patients to live well into adulthood. But where should they go for ongoing treatment? Adult urologists may not have seen pediatric conditions since they were in school, and pediatric urologists may not be as comfortable addressing the patient's sexual and reproductive needs (not to mention the challenges of treating adult sized patients in an office full of miniature sized equipment). Finding a new doctor can be challenging even for less complex patients.  Specialists such as Dr. Michael Hsieh are working to develop programs which will seamlessly transition pediatric patients into adult healthcare facilities. Dr. Hsieh is the Director of the Clinic for Adolescent and Adult Pediatric-Onset Urology (CAPITUL). CAPITUL works with patients to coordinate the transition of their pediatric urology patients at Children's National Medical Center, to The George Washington University Hospital as they approach adulthood.    Interviewing Dr. Hsieh, is Dr. Jesse Pines, Director of The George Washington University Office for Clinical Practice Innovation and a Professor of Health Policy and Emergency Medicine.    For more information about GW's OCPI, visit our website at: http://smhs.gwu.edu/clinicalinnovation/  and follow @Urgent_Matters on twitter and facebook

Did you know that nurses acquire musculoskeletal injuries at higher rates than construction workers? As the American nursing workforce ages, and patients grow heavier, moving patients continues to be a very dangerous activity for hospital staff. Hospitals and staff should all be concerned about the implications of serious muslculoskeletal injuries which can be painful, financially costly for everyone involved, cause staffing issues, and even end careers. In this episode, Dr. Pamela Cipriano, President of the American Nurses Association, calls in to talk to Jesse about the issue of nursing injuries.    Dr. Jesse Pines is the director of The George Washington University Office for Clinical Practice Innovation and a professor of Emergency Medicine and Health Policy.    For more information about GW's OCPI, visit our website: http://smhs.gwu.edu/clinicalinnovation/  and for additional podcast interviews, check out the "Urgent Matters" Podcast for the latest interviews with innovators in emergency care www.urgentmatters.org 

Mistakes happen frequently in the incredibly complex healthcare environment. But patients often don't know something went wrong. They also may have a difficult time finding details and information even when they do know something has occurred. Hospitals across the country have been realizing that a culture of hiding incidents from patients out of fear the patient will file lawsuits is misguided. Patients deserve honest and accurate communication from their medical providers, and programs that support mistake communication end up benefitting both the patients and their providers.    In order to facilitate and encourage the adoption of communication policies throughout the state, Massachusetts established the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI). Here today to talk about it is Dr. Alan Woodward, the Past President and Chair of the Committee on Professional Liability of the Massachusetts Medical Society, and Dr. Kenneth Sands, Chief Quality Officer at Beth Israel Deaconess Medical Center. For more information, visit their website: http://www.macrmi.info/   The Clinical Practice Innovations Podcast Series is produced by the Office for Clinical Practice Innovation at The George Washington University. OCPI is directed by Dr. Jesse Pines, a professor of emergency medicine and health policy and practicing emergency physician. Our goal is to spread the news about exciting ideas changing the delivery of healthcare in the United States. For more information, visit our website: http://smhs.gwu.edu/clinicalinnovation/  and for the latest innovations in emergency care delivery, check out our other podcast series: "Urgent Matters" and follow them on twitter @Urgent_Matters

Jan Walker (RN, MBA,) is talking to Dr. Jesse Pines this week about OpenNotes. Jan is the Co-Director of Open Notes and a member of the research faculty at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. OpenNotes is an initiative that promotes giving patients electronic access to their visit notes. Their studies have shown very positive effects from giving patients access, and surprisingly few of the common clinician fears came true. Patients weren't panicking about reading things they didn't understand, and patients weren't reacting negatively to notes about sensitive topics such as weight. Patients turned out to be more resourceful and reasonable than many clinicians expected. Having access to the more detailed narratives in physician notes actually improves patient experience and empowers patients and their caregivers.    The Clinical Practice Innovations interviewer is Jesse Pines, MD, MBA, MSCE. He is the director of The George Washington University Office for Clinical Practice Innovation, a professor of health policy and emergency medicine, and a practicing emergency physician.    For more information about Open Notes, visit their website: www.myopennotes.org To learn more about GW's Office for Clinical Practice Innovation, visit their website: https://smhs.gwu.edu/clinicalinnovation/  Don't forget to subscribe on iTunes so that you never miss an episode, and follow @Urgent_Matters on twitter and facebook for exciting emergency department innovation news, webinars, and other free products. 

Dr Peter Ubel is interviewed by Dr Jesse Pines about his paper (written along with Dr David Asch) in the 2015 issue of HealthAffairs "Creating Value in Health by Understanding and Overcoming Resistance to De-Innovation".  Innovation is a hot topic in healthcare. Everyone wants to come up with the latest and greatest tool for providing better care or more efficient care... but what if the way to create more value was actually through unadopting widespread practices? As challenging as it can be for new medical practices to become widely adopted, psychological biases can actually make it even harder for clinicians to give up old habits, even when new evidence reveals those practices to be of little value.    Dr Ubel is a professor of business, public policy, and medicine at Duke University, and Dr Pines is a professor of health policy, and emergency medicine at The George Washington University, as well as the Director of the Office for Clinical Practice Innovation. 

Manmeet Kaur of City Health Works talks to Dr. Jesse Pines of The George Washington University Office for Clinical Practice Innovation about the difference that incorporating health coaches into the healthcare system can make.    The GW Office for Clinical Practice Innovation Podcast Series is dedicated to promoting novel methods to organize and deliver medical care. For more information, please visit http://smhs.gwu.edu/clinicalinnovation/    More information about City Health Works can be found at http://cityhealthworks.com/      If you enjoy Clinical Practice Innovation Podcasts, check out Urgent Matters as well! 

Dr. Elizabeth Cobbs is here this week to talk with Dr. Jesse Pines of the GW Office for Clinical Practice Innovation about her goals for the future of advanced care planning. Every patient has a different idea of how they would prefer to spend the end of their life and what medical treatments they are willing to endure. Yet providers are too often left guessing about what should be done. The ubiquitous DNR (Do Not Resuscitate order) barely scratches the surface of understanding a patient’s goals and wishes. As the healthcare industry grows into the modern era of electronic health records and continuity of care, we should be considering how and where the patient’s wishes are being documented so that we can truly deliver the best care for that individual.  Dr. Cobbs is a professor of medicine, specializing in geriatrics and palliative care, at The George Washington University Hospital and the Washington DC Veterans Affairs Medical Center. She is Program Director for the GW Geriatric Medicine Fellowship and Associate Program Director and Founder of the GW Hospice and Palliative Medicine Fellowship, training physician leaders to care for persons living with serious illness or advanced age. Dr. Pines is the Director of GW's Office for Clinical Practice Innovation and a Professor of Emergency Medicine and Health Policy at The George Washington University. He is also a board-certified emergency physician practicing in Washington, DC with extensive experience in quality improvement, patient safety, operations research, and clinical epidemiology.   If you enjoy the Clinical Practice Innovations Podcast series, then also check out our partner podcast "Urgent Matters" for interviews with all the latest leaders in emergency department improvement.   

Dr. Jesse Pines and Dr. Shantanu Agrawal discuss CMS Open Payments. Open Payments is intended to shine light on the relationships between clinicians and industry. Listen to their discussion of why this started, what it means for the healthcare industry, how physicians can get involved, and what patients should know.   The Office for Clinical Practice Innovation (OCPI) at The George Washington University is dedicated to promoting new health-related research initiatives, dissemination, and implementation of novel methods to organize and deliver medical care. These include research initiatives (i.e. testing and evaluating clinical delivery strategies to improve the quality and value of medical care), clinical practice innovation (i.e. facilitating the development of new innovative practice models and products to improve care delivery), and other initiatives that leverage GW’s research and clinical infrastructure (i.e. international research, partnerships, or contracting with private or public entities).  

Dr Rebecca Smith-Bindman of UCSF talks to Dr Jesse Pines about the overuse of diagnostic imaging in current practice, how that is negatively impacting patients, and what hospitals can do about it.    The GW Office for Clinical Practice Innovation podcast series, seeks to highlight the work of innovative leaders throughout healthcare. For more information, check out our other interviews, or visit our website: smhs.gwu.edu/clinicalinnovation/