The Connectors

The Information Age has been all about connectivity. The boom in transformational technologies—particularly from the world of computing—has allowed people to access and transmit information and communicate with others around the world with unprecedented ease.

At Carilion Clinic, the obsession with connectivity has become embedded in its philosophy on innovation. Whether it’s developing groundbreaking technologies that take advantage of connectivity to provide better care for patients, or putting researchers and clinicians in touch with the right business partners to bring new ideas and products to market, making connections is central to the process.

Perhaps nowhere is this spirit more evident than in Carilion’s recent partnership-building efforts—particularly its growing maturity in working with startups. Carilion has been keen to take advantage of this open, increasingly connected environment to find new opportunities to collaborate.

As Troy Keyser, director of Carilion Clinic Innovation, explains: “Our mission is to look at our research and operations, to see what we’re doing versus what nirvana might look like, then look across the marketplace to identify where we might be able to fill the gaps. We want to facilitate the development of solutions that can help not only our patients, but potentially patients across the country, if not the globe.”

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Carilion has bolstered and formalized its innovation efforts over the past decade to keep pace with and take advantage of technological advances, leading to the creation of Carilion Clinic Innovation.

“The R&D portfolio had grown, so there was a natural offshoot of translatable research that had the potential to have patient impact,” Keyser explains. “We needed to be able to bring those innovations to market more effectively so patients could benefit from our research.”

That effort is far from a solitary one. Carilion has benefited from a rich biomedical ecosystem that, along with enabling technology, has made it easier to connect, collaborate, and identify new opportunities. Significantly, Carilion’s affiliations with academic institutions such as Virginia Tech provide a pipeline of new scientific research and ideas ready to be tested in the clinic, as well as connections to entrepreneurial alumni and not an insignificant amount of funding.

Moreover, the extended network of hospitals within the Carilion system makes it easier to bring medical specialists together to collaborate and bring forward innovations of their own, along with the resources and opportunity to partner with patients to conduct proper testing of new treatments and processes.

In the arena of partnerships specifically, Middleland Capital’s VTC Ventures and the LINK + LICENSE + LAUNCH program at Virginia Tech have proven to be essential, like-minded partners. VTC Ventures, under the management of James Ramey, J.D., helps identify external partnership opportunities for Carilion Clinic Innovation and others, and provides seed investment in potential new technologies. Meanwhile, LINK + LICENSE + LAUNCH—a unique program at Virginia Tech that combines the patent and licensing services of a traditional tech transfer office with the external networking expertise of a strategic partnership office—connects university researchers with appropriate partners for development.

“Sometimes people think of Virginia Tech principally as an engineering school, but life sciences–related discoveries represent a significant and important part of our asset portfolio,” says Brandy Salmon, M.B.A., Ph.D., who leads LINK + LICENSE + LAUNCH as the university’s associate vice president of innovation and partnerships. “The health sector constitutes 20 percent of the nation’s economy and, of course, carries significant human and economic impact. Faculty and researchers across multiple colleges, institutes, and units at Virginia Tech are making discoveries and developing technologies with applications to the health sector. It’s exciting to think about the potential these discoveries could offer if they were translated to the marketplace.”

With the possibilities for investment continuing to grow across biomedicine, there needs to be a way to prioritize projects. For Carilion, that involves keeping patients top-of-mind.

 “First and foremost,” Keyser says, “the question we always ask ourselves is: Will this innovation help our patients or help our providers care for our patients?”

The benefits Carilion Clinic Innovation looks for include improved diagnostics and treatments, as well as a better patient experience from appointment scheduling, through office visits and follow-up. But benefits may also extend into patients’ communities.

“Part of Virginia Tech’s mission—as well as Carilion’s—is to promote economic prosperity and improve the human condition,” says
Dr. Salmon. “One way to do that is to create economic development opportunities, such as startups, that can scale, become regional employers, and create jobs. Carilion has done that in magical ways in the region, and we are looking forward to building on the momentum of both organizations to create ‘the next.’”

Running Diagnostics

To benefit the community, potential Carilion partners need to have a regional tie—an existing footprint in the Roanoke or Blacksburg area, for instance, or a willingness to bring part of their operation to the area. That can include opening a development office in the region, or working with Carilion-affiliated investigators to develop a product or run clinical trials.

Sometimes, the potential partners are connected by school ties.

Ontera was co-founded by a Virginia Tech alumnus, William Dunbar, Ph.D. In their roles connecting people and ideas, members of the LINK team helped Dr. Dunbar and his colleagues engage with a range of potential partners and collaborators. Ramey at VTC Ventures, for example, ultimately connected Ontera with Ralph Whatley, M.D., a pulmonologist who serves on the scientific advisory board for Carilion’s venture funds.

The funds took an interest in Ontera, and Carilion is now set to embark on clinical trials of a fast and easy-to-use diagnostic system Ontera is developing for COVID-19. It’s a novel use of Ontera’s existing system, which uses nanopore technology to detect the presence of a specified pathogen. The system consists of a cassette containing a special molecule designed to latch onto part of a pathogen of interest. A biological sample—the contents of a nasal swab, for instance—is put into the cassette, which is then inserted into a small, easily transportable machine. If the pathogen is present, it triggers a chemical reaction and an electrical signal that sets off the nanopore sensor.

The machine detects minuscule concentrations of a given pathogen, so a surface-level nasal swab should theoretically be enough to accurately detect the virus that causes COVID-19. The challenge lies in creating the right molecule to bind to the virus and trigger the sensor. Ontera developers believe they’ve done that hard work and now, with the help of Carilion, they’re set to test it in the clinic, where they will compare the accuracy of their diagnostic system head-to-head with that of the PCR-based tests that are the current gold standard.

If successful, this faster, simpler test could be a game-changer for patients. Results return in under 20 minutes, and the machines are easy to set up and use virtually anywhere.

“This could be deployed rapidly and used by almost anyone, so long as they’re trained to take a nasal swab and run the device. It’s not sent out to a lab,” Dr. Whatley explains. “From a Carilion perspective, that means it could be quickly and widely distributed to the more than 200 practice sites in our system—even in the most remote, mountainous, and rural parts of Virginia.”

And the utility of the device could extend beyond COVID-19. In fact, Dr. Whatley says, the technology first appealed to him because of its potential to detect other diseases—respiratory illnesses such as tuberculosis, for instance, or sexually transmitted infections.

“Ontera has already done proof-of-concept studies for other infectious diseases. COVID is certainly timely, but I might be more interested in the technology for other reasons,” Dr. Whatley says, noting that COVID-19 might be less of a concern by the time the study concludes.

Bringing this sort of innovation to patients across Virginia is one of the clearest benefits to working with external partners—and clinical trials remain the most common form of partnership. According to Andrea Bidanset, M.H.A., director of clinical trials at Carilion, the health system has more than 120 clinical trials open involving outside pharmaceutical and device companies, testing promising new drugs and biomedical devices.

“One of the biggest advantages to having a robust portfolio of clinical trials is the access it provides our patients,” Bidanset says. “It has the potential to improve quality of life for people living in our region because they don’t necessarily have to travel several hours to a larger, urban academic medical center to get cutting-edge treatments.”

In the case of the Ontera device, the benefit is in early diagnosis. As
Dr. Whatley puts it, “Imagine being able to walk into a primary care clinic, having a precise diagnosis in less than half an hour, and walking out the door with a plan or even a prescription. What more could a patient want?”

Optimizing Searches

Some health care innovations are more or less invisible to patients, affecting care behind the scenes. In recent decades, the Information Age’s data deluge increased demand for innovation in health care, and greater oversight of providers has translated into crushing administrative costs and strains on clinical manpower—both of which affect how patients are served and at what cost.

Carilion innovators who are looking for ways to offset these burdens are more frequently turning to health information technology to streamline administrative processes. Such machine-based solutions are now second only to medical devices in terms of investment in health care technologies.

Through VTC Ventures, one of Carilion’s investments in health information technology has been in MetiStream. According to Keyser, MetiStream’s natural language processing (NLP) technology came onto the radar of Carilion’s chief medical information officer, Stephen Morgan, M.D., several years ago. The company specializes in delivering NLP and analysis of unstructured clinical data for patient and population insights in health and life sciences.

“Dr. Morgan thought the off-the-shelf products available from MetiStream were more than enough to justify becoming a customer,” Keyser recalls. “But it was clear that there were other, unexplored applications for their platform. My office set out to find what needs at Carilion weren’t being addressed by the market already, and where MetiStream could potentially help.”

In addition to contracting for MetiStream’s existing module for annotating and analyzing pathology reports for colonoscopy screening, Carilion is partnering with the company to develop a new product that automates the chart review process for reporting surgical quality data. Such data are requested by a range of external entities, from the American College of Surgeons to U.S. News & World
Report to Medicaid.

 “MetiStream’s NLP technology essentially reads text and extracts meaning from it,” explains Jacob Gillen, M.D., a trauma surgeon and critical care provider who leads Carilion’s efforts with MetiStream. “We’re trying to use that technology to enhance and augment what our human readers do when we submit data to NSQIP, the main surgical quality database.”

Currently, human readers have to go through charts line by line to extract information—such as symptoms, treatment paths, and outcomes—to report into NSQIP (the National Surgical Quality Improvement Program). NSQIP then returns valuable data that benchmark Carilion’s care against that of other providers across the country. The results help Carilion surgeons recognize areas of weakness and make improvements.

While valuable, the collection of such data is labor-intensive and comes at a cost, limiting how much information Carilion can report. MetiStream’s NLP uses machine learning to make quick work of the text. The technology—dubbed the Surgical Clinical Reviewer module—is trained to identify specific variables; Dr. Gillen estimates that NSQIP considers more than 180 variables. The NLP then scans documents quickly for those variables, then quantifies and reports results.

Dr. Gillen likens the process to a highly sophisticated version of the “find” function on a PDF or the way Google rapidly returns results from search queries. Human reviewers can then check that work for accuracy instead of having to read every word of text. 

“The idea,” Dr. Gillen says, “is to increase the volume of patient charts that we can submit, to get more and better data on our outcomes—and then use that to drive better care for our patients.”

Carilion recently executed a collaboration and license agreement with MetiStream to co-develop the Surgical Clinical Reviewer module, which the partners believe has the potential to improve patient care nationally and internationally. Already the module is being used to detect adenoma rates for identification of patients at high risk for colon cancer.

 Minutes Instead of Months

While partners can bring technological elements and expertise to the table, there’s no shortage of innovation within Carilion’s walls.

ArchiveCore is a startup founded by two Carilion physicians, Keel Coleman, D.O., an emergency medicine provider, and Lennox McNeary, M.D., a physical medicine and rehabilitation specialist. The company evolved out of conversations they were having several years ago, when Dr. McNeary was voicing frustration about delays in the medical credentialing process. Dr. Coleman, who was studying business at the time, had become fascinated by the ability of distributed ledger technology (DLT) to verify and secure identity.

“It seemed obvious to both of us that DLT could be used to solve the medical credentialing problem,” says Dr. McNeary. “It was a solution looking for a problem, and we had a use case looking for a solution.”

Medical credentialing is an essential process required before any medical specialist is allowed to start work in a health care facility. It’s needed to ensure that those hired to provide care indeed have the proper training to do so.

When a new doctor is hired, his or her education and other medical credentials need to be verified. The process takes three to four months on average, during which the hiring clinic exchanges countless phone calls and faxes with offices at the various institutions where the doctor worked or studied. Since medical education spans several years and multiple locations—often in different states—the process is arduous.

“The grim side of that process is, if you’re hiring a new specialist, they’re needed in that place at that time, so the delay in credentialing becomes an access issue for patients,” Dr. McNeary says. “And on the health care revenue side, having that clinician sidelined costs the system about $7,000 a day in lost revenue, so the wait hurts health care institutions as well.”

ArchiveCore uses DLT to secure medical credential records and make them readily available for hiring institutions to speed up the credentialing process. A distributed ledger is essentially a secured spreadsheet of sorts that is available on the internet to anyone with access. Perhaps the most commonly known use of DLT is blockchain for securing cryptocurrency.

ArchiveCore’s DLT allows credentialing institutions to log a document, such as a diploma or license, which is then “hashed,” or turned into a single line of encrypted code. That entry is also marked in the ledger, or spreadsheet, which is also secured. Users can then see the record of the transaction and get a copy of the original, hashed document, which has been stored and encrypted, through a secured email service. As long as the verified and secured records are on file, the credentialing process could take minutes instead of months.

 “Part of the beauty of the system is that it’s institution agnostic, so no matter where in the world a clinician trained, the credentialing process would be accelerated,” says Dr. Colemen. “We are hoping this in-house innovation can be adopted more broadly to help health systems across the country.”

Here, too, Carilion’s commitment to fostering innovation has helped, by providing the resources needed to pilot ArchiveCore’s technology.

“That partnership has been critical to us having access to the world of graduate medical education, the credentialing verification office, and the health system so we can test the technology and make improvements,” Dr. Coleman says. “We are grateful for our partnership with Carilion.” 

Written by Veronica Meade-Kelly