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Today on Town Hall

people with paralysis or need to use a wheelchair, or they have vision loss and they have cognitive deficits.

They can't go into just any old gym and exercise on that equipment. There's so many variables there to consider, so we're trying to figure out what does that all look like in our performance lab?

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. .

Alright, let's jump right into today's episode.

Welcome to another This Week Health Town Hall. I'm excited to have Debbie Backus here from Shepherd Center. Today we get to feature the importance of innovation and technology and rehabilitation. Welcome, Debbie. Thank you. Thank you. I'm excited to have you here.

First question I have for you as we jump right into this.

Can you share a little bit of a background about Shepherd Center, its mission, and how innovation and technology play into the role of driving the organization's goals forward?

Oh, that's a big one altogether. Yes, I know,

right?

So, well, Shepherd Center you mentioned we are a not for profit organization, hospital in Atlanta, Georgia.

And our mission is to provide world class clinical care to, patients and their families. And to conduct research to accelerate recovery, to advance discoveries, not only to improve the care that we provide at Shepherd Center, but also in the field and promote lifelong health in people with these very complex conditions.

In order to do that, not only do we have to provide that care as it is today, what best practices are, but we're creating the next generation Through conducting our innovative research and developing other innovative programs that provide new opportunities to develop solutions and technologies for our patients.

That is a huge mission, very meaningful. What kind of assistive technologies for like daily living and mobility are leveraged by Shepherd Center as you guys are driving that mission forward?

Yeah, so, so when we think about assistive technologies we definitely address mobility needs for people with paralysis or very weak extremities or other challenges that keep them from being able to walk around in their home or their community.

working with, it's obvious, wheelchairs, manual wheelchairs, but there's also power wheelchairs. Well, not everybody can utilize the wheelchairs. If they don't have function of their hands, they may not be able to drive a power wheelchair, let alone push a manual wheelchair. Right? So we have.

Both in house and with working with industry partners helped to identify ways that those wheelchairs can be modified to be accessible to more people. So we've partnered with industry partners who have created tongue drives with a switch on the tongue. They can control the, yeah, they can control the device with that switch.

Things called a sip and puff. They can use it can sit through like a straw like mechanism that controls the switches to drive the wheelchair. We even have worked with 1 partner who works with eye gaze to be able to control the. switch is on the wheelchairs. Similarly, those mechanisms can be used to control the environment.

How can we help? Use the technologies we have, or can we create new ones if they don't exist that allows people right away to have access to their environment to have them have as many ways of being independent as much as possible. So as soon as they came into Shepherd, even way back when they would be set up.

with some way of controlling the switch in the room so they could call a nurse. Because imagine laying on your back, not being able to use your arms and not being able to roll or move and needing somebody to come and give you a sip of water or something that simple or scratch an itch on your nose. If you're in pain, or whatever the reason might be, you need somebody to come, you need a mechanism to do that.

Well, Shepard quickly stood up a way to use that sip and puff mechanism or to use a head switch by moving their head on the pillow to do the nurse call light to turn the TV on and off those various things.

Yeah, that is incredible. And I love the approach of meeting people with where they're at with their current capabilities to enable their freedom, right?

Like you said, the self sufficiency is so important to the individual and Shepard Center really does so much to go all the way to make sure that they're meeting people where they're at, right? And as we talk about different populations I know you mentioned earlier on when we spoke a lot about robotics and exoskeletons and some of the really cool technology coming out.

Right. But it's expensive, right? How does Shepherd Center really focus on meeting people where they're at in terms of capabilities for demographics, equity and things like that?

Well, so that's an interesting question because we can do some of that now and we do our very best to really understand and do assessments and understand who the person is, where they're going to be going back to, and what are the resources they have.

And that dictates what we offer. In our research, we don't just think about the coolest new technologies that cost a lot of money but What do those technologies afford us that once we demonstrate, for instance, that the robotic upper arm, the arm training device, that's a robot can accomplish certain things.

We look at what are those features and what can we make available at a lower cost for other settings where they may not have the funds to do that or the patient that may not have that. The other part of what we're trying to do is develop our precision rehab. So we have. Almost 50 years of data.

Not all of it's all totally accessible, but we have a lot of data on patients that we can leverage and look at to learn what worked to get those people to their outcomes. And then we can use that predictive and then we can look at the data and we can look at the analytics for patients coming in, and we can say, Okay, let's collect this data from you compare that to these thousands of patients like you and see what worked best for them.

See what are the things that you will need. It might mean we can try it here or it might mean that we can figure out how to get that to you when you're in your home environment. are building an innovation institute in which we will have a fully outfitted cutting edge technology for movement analysis for behavior analysis so that we can collect data about each individual, what their functional abilities are, understand better what they need so that we can even more quickly get them to in the right direction for what they need. And figure that out.

And so. And what we will do with that is we'll take into consideration where are you going? What are your social demographic variables? Who are you as a person? Because all of us come with us ourselves as a person. All of our patients come as people. And you have to consider all of those things. So we want to get as much of that information as possible.

So that we can start again comparing to what we've already learned. Our experts are involved in figuring out what this person might need and then come up with the best solution for that individual person.

As they're working through the plans for the individual, are they starting to use any AI technologies?

Either in terms of building out the assessment, how to provide them the best possible rehabilitation solutions, or just for data mining or predictive analytics?

Yeah, so well, so we are building a remote monitoring program where we're using remote sensors in the home in the community as well as here at Sheppard, but you know, we know that sometimes in our controlled environment, somebody might do okay, then they go home to their busy environment, non accessible environment, no resource environment, and all of a sudden, they're very challenged.

So, We have investigators that are working with remote technologies and collecting data from people, whether it's with MS or spinal cord injury or brain injury, pulling that data in and combining it with our EMR data and developing dashboards that will then bring that data back to that person, to the patient that might facilitate the discussion with their clinicians.

They're physical therapists, occupational therapists, it might go directly to a clinician. So the clinician can see what's going on with that patient in the community. And that might facilitate discussions with the patient and it may allow the clinician to say, I see that you've decreased your activity.

Why is that? And that can help us to identify problems sooner. Or really get to the heart of the problems, so that we can come up with the best solution. And then in another line of work working with partners and other academic and clinical facilities to take that information and drive a chat bot.

So that a chatbot that can interact with, a person can interact with that could be for mental health type issues, identifying symptoms, or promoting that whatever it is that they need to be working on.

Yeah, absolutely. That's wonderful. And it kind of ties into the innovation mindset, right? And you mentioned the Shepherd Center has been working on an innovation institute.

Can you tell us a little bit about the approach that the institute is taking towards innovation?

So, I wish you could see my board back here. So, essentially, we're taking that data driven approach, taking data that we have, figuring out what data we still need that would help us do better, bringing that in, combining it so we understand the whole person and the whole population.

To drive the development of new solutions, rehab, health and wellness solutions to advance that lifelong health and wellness and fully living after a traumatic injury or in the case of a disease like MS, or helping to develop new platforms and new technologies actually, and We're doing things like standing up the, what we're doing with burn along through burn along.

when somebody has a condition like spinal cord injury or MS or brain injury, and they have physical and cognitive challenges. It's difficult to find the tools and the experts across the country. There's not a shepherd center in every community or. And I'm not sure if I should name a small name rehab or I'm not.

Oh, I shouldn't even name any others because I might leave somebody out. But there's just a, a small group of us who have the expertise. So by using burn along, we're providing live and on demand classes. Provided by experts to push out exercise and wellness and education and training so that people can get that in their communities.

We're also combining that with coaching. Which we can do virtually we're combining it with remote monitoring. So as somebody's doing a class, we could be collecting information about how they're performing the class, how many repetitions. We can see , how they're doing in between classes with that remote monitoring.

We're using that information to then inform what's going on. So we're coming up with a solution that's not just for our patients here, but that can serve people elsewhere as well. And all those tools. They're all, tools that we've either developed in house or we're working with partners to come up with, let's fill this gap in a new way, so we have a new model of care, a new solution that can reach more people.

Sure. That's fantastic. Now I forget to ask you the

question. No, that's fantastic. So by leveraging the Burnalong platform, you're able to create content and share it more broadly. Do you share it beyond Shepherd Center patients? Like, can other rehab centers leverage it as well, or other people just like, individuals who have access to the Burnalong platform access the programs that you create?

Yes, they can join burn along and they can access the content. So our patients get the content. They have access to it when they're inpatients. We offer live classes and we offer on demand classes when we get to our innovation Institute, we're going to be able to provide even more classes in our best health suite, which is a fully instrumented Studio that allow us to bring people in, do the classes and then somebody can join the burn along platform and they can search for whatever they need.

So they might say they need classes because they're paralyzed or they're very weak or they have MS or spinal cord. They can search for that kind of content. And it will pull up the content that we're providing and it can be something that's as simple as resistance activities and how to safely do exercise.

If you have Ms and you don't want to get too fatigued. It could be. Modifying exercises so that because they may have balance challenges, how do you modify those and do things in sitting that will address what you need in your core? Or it might be education and training about nutrition for if you have MS or you need to be healthier, or lose weight even though you have paralysis, that sort of thing.

And you can't maybe exercise at the same level as you did before your injury.

Yeah, I think that's great. And then there's also the performance lab, in addition to the best health suite where you're leveraging burn along. But tell me more about the performance lab and how you're going through movement assessments and helping to meet patients where they're at.

I continue to that mission and goal of just meeting patients where they're at is so important, especially in the rehab, I imagine. And to tell me a little bit about how you guys are approaching the performance lab side of the Innovation Institute.

So the performance lab is primarily an assessment lab.

It will have force plates and a walkway to collect how people walk. It'll also, it's 3D cameras everywhere to look at what's happening in their body when they're doing, when they're walking or when they're using their arms or performing other activities of daily living. There will be a VR treadmill that we can assess how people do in very busy environments so that we can start to tailor the treatment to help them be successful in their environment.

And we will also be doing behavioral assessments, trying to understand what motivates you. What are your goals? Because telling them you have to come in here to exercise three days a week. There's so many people. In general, who don't do that, or they do different things on different days, depending on their moods, but people with paralysis or have need to use a wheelchair, or they have vision loss and they have cognitive deficits.

They can't go into just any old gym and exercise on that equipment. There's so many variables there to consider, so we're trying to figure out what does that all look like in our performance lab? That data will feed back into our data hub and be combined with other meaningful data about each person as well.

We'll also be collecting the data from the. Remote sensors. We have a brilliant team of data scientists, very small, but mighty where they are bringing in the data from things like Fitbits and different sensors, different monitoring devices.

So not everybody's going to have a Fitbit. Not everybody's going to have a Whoop. If somebody doesn't have anything, can we provide them with something that we can pull in that information? We want to meet them where they are, so we're building the infrastructure to be able to do that. Working with a company That puts sensors in clothing and socks, that we can provide

Wow.

Yeah, it's really fun.

Yeah, that's fine. I imagine the data is just growing by leaps and bounds. Your data analytics teams. Are they leveraging data governance at all? Oh, yeah, help kind of manage and organize the enterprise around what data you have is a quality canopy trusted, especially since you're using it to draft some strategic decision making.

Yes, so we are definitely We partner with and integrate with our IS governance team.

Okay, great.

And

So we are very integrated and work very closely with IS. They work very closely with us. They support us as much as they can. Of course, we do have to. Think about and focus on the keep the lights on, we are a clinical facility. We're always cognizant of that. So we communicate, we collaborate with the other leaders to figure out the best way to do this and to prioritize our asks are keep the lights on in research and innovation is, well, we have to be able to do the research, that we get funding for.

If we don't do it, we don't get the funding. So there's that. And we can only be able to assess the data and do the things we do with that support. So, in order to keep our lights on, that's what we have to do. But. It starts at our leadership. Shepard's leadership values research and innovation.

And if they don't see it, we have to make the case that, if we don't do this, we're not serving our patients. So it is a give and take constant communication.

Yeah, I love that. And it's definitely fostering that collaborative environment, especially between a technology team driving innovation and working with other business units across the country.

I imagine the entirety of Shepherd Center. How do you make sure that you guys are aware of each other and priorities and making sure that when there's competing priorities, you guys are micro focus on the things they're going to move the meter for your patients.

So that's a lot of that's my job is,

I am part of operations teams. So I hear what the problems are. I bring it back. I bring to them that some of the solutions that we're working on. I share that. And it's a process. It is an iterative process that has been going on for a while, establishing the communication, establishing the trust.

Demonstration. Everything's a pilot. We have to demonstrate it. We can't just say it and expect that they believe it. So we do a lot of pilots. And we report back. And it's really exciting to watch as it takes off. Like, in the beginning, talking about the data science and what's possible. We did one project to demonstrate and there's like a little bit more enthusiasm.

And then we did something else. And now the brain injury. Director program director is all in. I don't have to say a word. I mentioned what we've done with her and she takes off and she's the one telling everybody. Just how great the program is. And that's kind of how it's that's been what it's been like for me for 30 years here, is that so

that is fantastic.

You have people out there evangelizing. The research that you guys are doing with your data scientists, that is huge in terms of bringing the business to the table to get that buy in and then go be able to commit to beyond the proof of concept, right? And deliver on a broader scale.

The same thing happened with Burnalong.

When we first started talking about it we had one person, she's leading the effort, she's doing an amazing job and we started talking about it and I honestly thought. That one program was going to be better at better prepared to take off with it. We started having regular meetings. They weren't the ones.

It was another program that jumped on and now, all of the programs are interested at different levels and we don't push it. We just say, this is a resource. We want to work with you. We need your expertise. But if you're not ready right now, we'll work over here. But then all of a sudden, it's like knocking on the door.

We're ready, and so yeah, then really, it's been really fun to watch it grow.

That's fantastic. I have one last question for you. And this is a future question. So what trends or developments do you see shaping the future of Shepherd Center's approach over the next 3 to 5 years?

Definitely AI and LLMs, the large language models for precision rehab, being able to figure out what each individual needs, because just because somebody has the same level of spinal cord injury doesn't mean they have the same needs as the person right next to them.

So it's what they each need. The data and analytics we need deeper insights to really drive. actionable decisions and the development of new tools and new strategies. And not just at the facility at the home. I just heard today for people who've had severe strokes where both sides of their body are affected in the last year and a half, two years, length of stay has decreased by 23 days, 23.

Wow. What the heck? So that means that's going to happen. It's unfortunate. What can we do for them when they go home? What are the tools we can provide? What can we do with burn along to make sure they still get exercise and training and all of that? What can we do with the mobility tools? What can we do with remote monitoring so we figure out when they're having problems?

How can we help transition them? Really important. And we've all as a community rehab Medicine, we've gotten a little bit better at this, but engaging all of the stakeholders in the process. So it's not just the clinicians, but it's our industry partners. It's policy makers. It's other leaders in the field, bringing them all together.

And I think you and I have talked about this is thinking about the caregiver strategy. We have a peer support program. We engage them in these discussions. Now we use them as a tool to disseminate information as well, but we also bring them in early to help us identify the most meaningful problems to pursue solutions for.

We have an advisory council of care partners. That meets regularly and we can go to them and say, this is our idea. What do you think? We're going to be standing up burn along in our best health suite in the new building. We need to charge. What do you think is reasonable? You see, this is the, what do you think would be meaningful to offer to our patients?

Yeah, so, with burn along, people can invite, they can invite other family members to participate. So they're building a community or friends or other people with MS, whatever it takes. To make them feel comfortable, and we do that in our other programs as well. Try to figure out how can we leverage and bring in, we have family dinners once on, I think it's once a week.

Yeah, and different people come together, different family members, our community partners, our board members. So really building that community of support, not just for when they're here, but for when they leave as well.

And that's really addressing it, like, digitally and in person. So again, meeting people where they're at and just the, like, I love the idea of the weekly dinner because just the conversation around a meal can be so different.

It's so much more open because it's very casual and everybody has to eat, right? So it creates, that's a part now where it has to be amazing that gets created in that in person as well as the digital experience, and being able to educate your loved ones. Right. Carrie Devereux.

These are the videos, these are the things I have to do to get better or to improve some function or, whatever it is and being able to share that and educate along the way is so important so somebody can be on the journey with you and you're, again, you're not alone in that journey. So,

very good.

Well, thank you so much, Debbie, for your time today. I truly appreciate it. I love hearing about But in a way, innovative way, you're thinking about just rehabilitation at Shepherd Center and helping drive forward the mission and the goals that you guys have. It's just outstanding. I just really appreciate your time today and talking with me.

Thank you so much for asking me. I've had fun. I appreciate it. Good. Excellent. Thank you so much, Debbie. Take care. All right.

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