Digital Transformation in Healthcare: Abbott’s Philip B. Adamson On How Medical Practices Can Use Digital Transformation To Provide Better Care

An Interview With Dan Rodrigues

Access — Many worries and anxieties patients experience can lead to costly emergency department visits or hospitalizations. A highly effective medical practice provides access for patients to appropriately triage questions and concerns.

As part of our series about “How Medical Practices Can Use Digital Transformation To Provide Better Care,” I had the pleasure of interviewing Philip B. Adamson, M.D., MSc, FACC.

Philip B. Adamson, M.D., MSc, FACC is chief medical officer of Abbott’s heart failure business. He is responsible for global development of Abbott’s heart failure programs, including cardiac resynchronization therapy, the CardioMEMS HF™ system and Mechanical Circulatory Support portfolio, including the HeartMate 3™ heart pump. Dr. Adamson joined Abbott (formerly St. Jude Medical) in 2015. His clinical interests focus on development of more efficient and effective disease management systems for patients with chronic heart failure, specifically focusing on remote monitoring of physiologic signals from implanted devices.

Thank you so much for your time! I know that you are a very busy person. Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a story about what brought you to this specific career path?

Thank you for the opportunity!

I’ve always been fascinated by discovering useful information from physiologic signals like heart rate, its variability, arrhythmia burdens and frequent measurement of pulmonary artery pressure. It is an amazing adventure trying to understand what the body and brain “sees,” how the brain and nervous system process information and how the body attempts to control life and survival. This passion was amplified by the opportunity to apply these concepts to monitor and help people deal with chronic heart failure. I had the rare opportunity to expand my research from the basic science “bench research” to the bedside of people who suffer with heart failure.

After leading several remote monitoring trials, the CHAMPION Clinical Trial discovered CardioMEMS HF System, a remote heart failure management technology, kept people stable, reduced hospitalizations and improved quality of life. I was given the opportunity to join the industry and help further guide development of this concept, which I viewed as an opportunity to help millions of people. It was and remains an extremely exciting learning experience.

Can you share the most interesting or most exciting story that has happened to you since you began at your company?

Understanding how medicine is funded, regulated, and practiced in other countries has been an amazing learning experience. I also find it incredibly rewarding to meet the patients whose lives were changed by the innovations we provide.

It has been said that our mistakes can be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Then, can you tell us what lesson you learned from that?

It is true that good judgment comes from experience and experience comes from bad judgment. I have always underestimated how complex it is to fundamentally change how medicine is practiced. After all, the fundamental methods of patient evaluation with history and physical examination are a ritual enshrined by thousands of years of tradition. I was a bit naïve thinking that evidence and reason would rule the day to help improve peoples’ lives, especially when dealing with heart failure. I have learned that persistence, focus, and integrity are required to make slow, but steady progress in the job of helping implement novel tools to improve medical practice.

You are a successful leader. Which three-character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Over the years, I’ve learned to appreciate how humility opens so much opportunity to learn from others. It is really fun to discover very important ideas and perspectives when one allows others to share openly in a healthy environment. Everyone can contribute if given the chance. Humility requires daily practice since it can quickly disappear in our stressful and busy lives.

Persistence is required for ultimate success. Winston Churchill’s advice of “Never, ever give up” is so important. Nothing is easy…except losing focus. Important leaders in my life have been able to provide perspective in the “weeds” to tell the story of the ultimate goal. My daily life requires a quick review of how individual effort fits into the ultimate goal and overall strategy.

Passion funds persistence. A successful career is seldom just a job or opportunity to make a living. Most successful people I admire are passionate about why they do what they do. While I’ve had the luxury of learning from and being influenced by many great people, my grandfather was the most important person in my early life. As a young man, I watched him deal with chronic heart failure that arose after he had several heart attacks. He was amazing, but I saw him feel hopeless as his condition worsened and his activity levels progressively declined. I am reminded of him every time I look into the eyes of a patient with heart failure which fuels my passion to bring meaningful and effective innovations to improve both the quality and quantity of life for this population and their loved ones.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I feel truly fortunate to work at Abbott as we are committed to uncovering new innovations that will profoundly improve patient lives. Our innovations surround the entire experience with heart failure, from nutrition, diagnostics and medications coupled with interventions to correct heart valve disease, remotely monitor patient status with implantable devices, treat electrical abnormalities that arise in heart failure and provide heart pump assistance to prolong the lives of people in shock or with advanced heart failure. The most exciting part of my day is understanding how all these innovations can work together to improve heart failure outcomes. We have recently discovered that less symptomatic patients benefit from the insight provided by CardioMEMS (remote) guided care. Amazingly. we continue to learn new things about heart failure — a disease that was first described over 2,000 years ago — that directly impacts how people can be successfully treated.

Let’s now shift to the main focus of our interview about Digital Transformation in Health care. For the benefit of our readers, can you help explain what exactly Digital Transformation means? On a practical level what does it look like for a medical practice to engage in a digital transformation?

Think about the last time you went to the doctor. You made an appointment, showed up at the clinic, met with your doctor, and received a few instructions to follow. Would it surprise you to know that this is exactly the way it has been done for thousands of years? The problem is: today’s system is incredibly inefficient because it relies on human judgment and experience and cannot be scalable as we look forward to meeting the changing and growing needs of our health system. Furthermore, our system tends to be quite paternalistic which can make the patient a dependent nonparticipant who simply follows directions.

For health care, and specifically for people with heart failure, digital transformation means changing the script from a reactive mode of waiting for people to get worse to the point that they have to be treated in the hospital. Worsening heart failure that requires rescue therapy in the hospital has about a 4% overall risk of dying in the hospital and each episode further weakens the heart and blood vessels. We now can prevent many episodes of worsening heart failure by using implantable sensors and remote digital analytics. These tools are now available to provide insight to the doctor and nurses caring for people with heart failure by delivering precise, personalized care that improves outcomes. The digital data provided by implantable monitoring devices are a great input to advanced analytics and promises to “see” aspects of care that go unnoticed with management based on centuries-old methods. Finally, digital transformation of health care empowers the most important health care worker — the patient. Giving patients insights about their condition creates a motivated, knowledgeable and impassioned person who can focus more time on improving their care and experiencing the fulfilment of their lives.

What are the specific pain points that digital transformation can help address in a medical practice?

For centuries, patients and providers required hands-on, face-to-face encounters to diagnose and treat acute and chronic illnesses. While face-to-face encounters will never be replaced completely, the era of digital medicine promises to significantly change routine encounters. It is also important to realize how traditional office visit models can contribute to health inequities. Many economically challenged patients cannot afford the travel logistics or co-payment required to see their physicians, which many times forces the patients to wait until their condition worsens to the point that they require hospitalization. Virtual visits and frequent physiologic assessment from implanted sensors provide a safe and effective means to overcome the need for frequent in-office visits. This type of digital technology has revolutionized diabetes care in the advent of continuous glucose monitoring with Abbott’s FreeStyle Libre and is transforming heart failure care with CardioMEMS. Patients seem to embrace the convenience of virtual visits and physicians can now have key data from the patient’s home to inform their assessment. This approach also creates an opportunity to discover meaningful changes in patient status even before patients develop worsening symptoms.

People with heart failure are almost always treated with medications called diuretics to control the amount of fluid they have in their bodies. Heart failure stimulates the body to retain fluid inappropriately which can lead to worsening stress on the heart and blood vessels. Also, too much fluid in the blood vessels causes people to feel short of breath, sometimes even at rest. Until CardioMEMS, there has been no clear guidance about how to provide the appropriate dose of diuretics required for patients since most of the time the dose depends on the individual patient status. There is no one-size-fits-all strategy for diuretics.

What are the obstacles that prevent a medical practice from engaging in a digital transformation?

When the COVID-19 pandemic reached the U.S. in the spring of 2020, people were thrown into the deep end of the virtual medicine pool and told to swim. That immediate shift posed significant challenges, and it limited one of the most traditional ways we assess patients — through a physical exam. The shift toward remote virtual care was coming before the pandemic, though very slowly. The pandemic changed this behavior seemingly overnight.

To make sense of this change, it is important to understand the goals of physical examination coupled with understanding how patients feel. For thousands of years, we’ve peered mystically at the outside of the body to imagine what might be happening on the inside using the physical examination

Even in the best of hands, physical examination is not very accurate in trying to predict the heart’s pressures…and this was the most important way to decide about changes in very important, but potentially harmful, medications such as diuretics. Now, with the CardioMEMS HF System, we can directly measure pressures that previously was guess-work in routine face-to-face encounters. If you couple that with the fact that face-to-face encounters represent a ridiculously small amount of time patients live with heart failure, it becomes clear that traditional methodology is severely limited.

Maybe it shouldn’t be surprising, but patients have embraced remote care. They save time and money; they don’t need a loved one or friend to drive them to visits that, in rural communities can be hours away, and they avoid sitting in a waiting room where they risk exposure to COVID. They see clear benefits.

If we want to adopt more digital and remote technologies, the infrastructure and reimbursement policies need to be stable to ensure usability and efficiency.

There are already positive steps underway: Earlier this year, Cigna revised its medical policy to include coverage for CardioMEMS which is the remote monitoring system proven to improve outcomes, reduce rehospitalization and bring new quality-of-life benefits for people living with heart failure.

Cigna’s coverage of the Abbott CardioMEMS HF System took effect March 15, 2022, expanding access to 14+ million Cigna beneficiaries who meet key criteria. This expansion is a significant industry move, and one that will expand access to convenient and effective remote management for millions of people. It is refreshing to see the community embrace twenty-first century technology for the betterment of people who otherwise hopelessly suffer with chronic heart failure.

Managing a health care facility is more challenging than it has ever been. Based on your experience or research, can you please share with our readers a few examples of how digital transformation can help a medical practice provide better care? If you can, please share a story or example for each.

We have talked about CardioMEMS. In my clinical practice, I was able to manage patients with heart failure who lived in rural Oklahoma without making them travel several hours to see me. I still checked up on them, but in a way that was far superior than if they were in front of me in the office. I was able to make heart failure something they managed, not their full-time job. This made my clinic able to accommodate more new patients that were assimilated into my system’s practice, freed time for consultation with community doctors and provided reimbursement for a remote management service that we previously were providing for free. I employed two full-time nurses to answer the telephone when patients called with problems. They almost always got a “live voice” on the line when they called. While this was effective, it was not as effective in keeping people stable by watching CardioMEMS pressures. Why? Telephone calls almost always were generated by people recognizing problems or worsening symptoms. The digital revolution CardioMEMS represents allowed my team the opportunity to see when things were worsening, but long before people recognized worsening symptoms. This made it easier to adjust medications to maintain patient’s well-being. Also, the insight CardioMEMS provided allowed my crew to figure out quickly if symptoms were due to heart failure or due to other things. We found in clinical trials that people monitored with CardioMEMS not only had reduced heart failure hospitalizations, but also had reduced respiratory hospitalizations. When two problems cause the same symptoms — like heart failure and bronchitis, emphysema or early pneumonia — it is VERY important to have information to guide early intervention that accurately treats the real problem.

This technology is incredible. The CardioMEMS HF System has a tiny sensor that is permanently implanted in the pulmonary artery using a common procedure called a right heart catheterization. The sensor does not need a wire or battery since it is empowered by external radio-frequency interrogation using microelectromechanical processes. The sensor measures pressure in the pulmonary artery. This is the pressure that goes up when people with heart failure start to worsen. Patients can transmit this data from the comfort of their homes to a secured website that health care providers can securely access. We have found that the implant of the sensor is very safe — with very low (less than 1%) risk of complications. Therefore, the benefit of reducing life-threatening hospitalizations and improved quality of life is clearly greater than the implantation risks.

Can you share a few examples of how digital interactions or digital intake processes can help create a frictionless patient experience and increase access for patients?

Remote monitoring technology is an excellent example of digital transformation, but there are several other opportunities. The electronic medical record (EMR) promised to digitally revolutionize medical care. However, downsides for clinicians and patients became apparent early on. For example, doctors had to enter data into the EMR during the patient-physician interaction, which was very distracting and inhibited the process. It was also apparent that the immense amounts of data included in EMRs were not easy to summarize or really use to improve outcomes. For example, health care systems found it difficult to find out simple things like how many patients were getting recommended therapies since it was hard to get discrete data in a populational way. Abbott addressed this issue with a solution called “In-View” which summarizes objective data in the EMR and filters them through societal guidelines and physician preferences to discover patients who may be eligible for treatment pathways. One system in the U.S. recently received one of three global awards for medical transformation using the In-View process in their EMR. They were surprised to find over 40,000 people with heart failure in their system! This process inadvertently addressed a particularly important problem of health equity as the objective data did not include race or gender. This eliminated any unconscious bias that may influence referrals or evaluations by demographics. Advanced analyses of existing databases represent the “new normal” when providing life changing innovations for many people with several chronic medical problems.

Based on your opinion and experience, what are your “5 Things You Need To Create A Highly Effective Medical Practice” and why.

1. Teamwork — Defining the health care team should include everyone that plays an important role in helping people get better. This including receptionists, schedulers, assistants, nurses, advanced practice providers, specialist physicians along with community physicians. But most importantly, the next years MUST include the patient as an active team member.
2. Innovation — Medical innovation is developed to meet a care-gap and after extensive clinical research demonstrates benefits outweigh the risks and costs. A highly effective medical practice embraces and uses approved innovations in medications, devices, and management techniques. The U.S. FDA continues to find ways of accelerating innovation without sacrificing the scientific evidence supporting clinical breakthroughs. For example, 21 years after the first cardiac resynchronization pacemaker was FDA approved, less than 40% of people with the highest recommendation to receive this innovation actually get it. After 30 years of developing very effective heart failure medications that save lives, only less than 5% of people get to benefit.
3. Access — Many worries and anxieties patients experience can lead to costly emergency department visits or hospitalizations. A highly effective medical practice provides access for patients to appropriately triage questions and concerns.
4. Thoughtful inclusion — Reaching out to those who may not otherwise be able to receive care is very important. A shining example is in Louisville, Kentucky with the Norton Health care investment of a new hospital system in the middle of one of the poorest sections of Kentucky. Led by Dr. Kelly McCants, the program will meet people where they are and bring highly effective and advanced medical care to those who otherwise would die early.
5. Kindness — I’m not sure anything “goes without saying”, but surely kindness in health care enhances patient outcomes. Empathetic care characterizes a highly effective medical practice.

Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good to the most people, what would that be? You never know what your ideas can trigger.

There seems to be a significant disconnect between medical innovation development and clinical application for people with chronic cardiovascular illness. Repeatedly, studies find a huge difference in the number of people who benefit from life-saving medications, devices and management are only a small portion of those who qualify. I think everyone wants the best care for their medical problems…but only a few receive the most effective, innovative breakthroughs. Patients should know, from reliable sources, all the tools available to help them recover and survive with improved quality of life. They should be making informed choices about their care…empowering them to fight and survive.

This problem is amplified when considering underserved populations of color or economic challenge. It is hard to believe that in 2022, survival can differ as much as 10 years between two zip codes that are less than 50 miles apart. Health equity and inclusion starts at the clinical trial stage of development with appropriate representation and should be on the forefront of providers’ minds when delivering modern health care. As part of a research group called the Heart Failure Collaboratory, I recently co-authored a study published in the Journal of the American Medical Association that underscores the disparities between those who carry a greater burden of heart failure (particularly Black and Hispanic patients) and the under-representation of those groups in heart failure clinical trials. The research also found that despite cardiovascular disease being the leading killer of women worldwide, only 38% of research participants are women.

While some progress has been made on this front, successfully engaging underrepresented communities in clinical trials is paramount to developing effective therapies for all populations.

As a medical community, there is more we must do: provide training to investigational site personnel to ensure adequate representation of these demographic subgroups; regularly review enrollment data to investigate whether there is under-representation of these demographic subgroups; and frequently review withdrawal rates for under-represented subgroups and compare these rates with that in the overall clinical trial population.

Abbott has been leading efforts to engage under-represented populations in heart clinical trials, most recently through its Champion Study (2015) and GUIDE-HF Study (2021). By tackling the disparities that currently exist in our clinical research, we can increase access to potentially
life-saving treatments and drastically improve patient outcomes for more of the population.

How can our readers further follow your work online?

Readers can follow me on LinkedIn at @Philip Adamson, MD, MSc, FACC, FESC, FRCP (Ed).
I also host a cardiology podcast called Between Two Ventricles where I meet with other leading cardiologists to discuss the most up-to-date innovations, products and clinical advancements for managing and treating heart failure. People can listen and subscribe to the podcast on Spotify.

This was truly meaningful! Thank you so much for your time and for sharing your expertise!

About The Interviewer: Dan Rodrigues is the Co-Founder and CEO of Tebra, a leader in practice growth technology and cloud-based clinical and financial software for independent practices. With an all-in-one, purpose-built platform to drive practice success and modernize every step of the patient journey, Tebra provides digital tools and support to attract new patients, deliver modern care, get paid quickly, and operate efficiently.