The pediatric cardiologist team at Boston Children’s Hospital improved its understanding of flow balance and characteristics in postoperative planning by utilizing computational fluid dynamics software and additional modeling techniques for sophisticated congenital heart disease patients. This improved clinical decision-making and patient outcomes. When learning that your child’s soul does not function properly, you turn to the most talented surgeons you can find to repair and correct the flow pathways. While there are many different types of pediatric brain surgeries, most children require various therapies. Children can experience extra-heart-busting consequences due to the sizes and shapes of these areas and, occasionally, the metabolic benefits. Generally, it’s been hard to predict precisely how to work to get each growing individual long-term results. According to Dr. David Hoganson, chairman of the Boston Children’s Hospital’s Department of Cardiac Surgery,” It’s a matter of how do you get that piece excellent so the baby doesn’t have to come up for a correction of that patch, or has narrowing of that patch that causes more work for the heart over time, and that generally has been left to the surgeon’s judgment in the operating room.” Engineering initiatives that have traditionally been done outside of the field of medicine are helping to” significantly reduce the guesswork and intraoperative decision-making to dramatically increase the consistency of the outcomes, both from a physiologic standpoint and in the geometric perspective,” he told Healthcare IT News. Before deciding which approach was the best, Hoganson said,” I believe we had one patient for whom we conducted about 80 different flow simulations. When Boston Children’s first hired a computational fluid dynamics expert from the U.S. Department of Defense who was well-versed in the ANSYS software to set up a presurgical cardiac computer modeling program, the program decided to do what we would have guessed right away:” We would have been completely wrong, and the patient would have been returned for another operation.” Adding more engineers from various academics and industry backgrounds, the hospital now has a team of 12 – soon to be 14 – that perform the 3D modeling workflows for patients, Hoganson said. obtaining solutions before surgery Patients and parents will seek different viewpoints and viewpoints as they see fit. However, there are times when the engineers race against the clock, of course. ” It’s built into the challenge of this disease”, Hoganson said. ” Sometimes you have the luxury of time, and other times you don’t. He said it’s been exciting as a clinician to witness the CFD engineering analysis delivered on time and when the patients need it most.” Building a professional engineering team that can respond and do this as quickly as can be done has been completely transformational,” he said. The crucial component of the solution is the time constraint. ” It’s not just the math. It’s not just the science. The key factors are the service, the delivery, and the timely delivery,” Hoganson said of his team’s efforts to adopt their model and employ engineers. The program is working on getting data published, even though they do not currently have quality metrics to share. ” We now have 75 patients in a particular valve repair workflow, and, you know, the data is extraordinary”, he said. Pediatric patients, parents embrace CFDThough the math, science and engineering behind CFD modeling is extraordinary, Hoganson said it’s the three-dimensional pictures of a child’s heart that resonate with clinical families. Boston Children’s families are shown the models and flow simulation data for those options to engage in the results and” see what we see,” Hoganson said because doctors are frequently relying on patients to make complex decisions in pediatric cardiac surgery. He said,” My little line drawings and hand-waving and the things that are sort of the standard in the field are really short of ideal.” Because we’ve thought of everything, we’re putting literally the best technology on Earth to use to treat these patients and doing everything we can to reduce variability questions that might arise during the operation. We’ve tested all that, and we know that this is the best option”. ” We’ve had teenage patients say,’ Well, obviously you’re gonna do that, right”? ” They know we’re doing everything we can … but we want the families to feel like they truly understand what’s on the table “.Evolving practice, proposing billing codesCFD is also used in respiratory medicine, the development of medical devices like dialysis machines to improve their operation, pharmaceutical efficacy, patient education, treatment decisions, air quality systems and more. The technology can also be combined with artificial intelligence to create diagnostics and analyze complex datasets. Hoganson noted that using CFD to model congenital heart defects used to take two months with upwards of 19 software packages, but it now takes about three weeks. We wanted to submit in about four days. Or, what takes us now 12 hours, we should get to two hours, right” ?A lot of that is software and workflow development” that continues to be refined, he said. Hoganson said the team is working with other heart centers and the U.S. Food and Drug Administration to standardize the workflows and capitalize on the use of CFD in other practices, even though some of the program’s modeling workflows are not created using CFD software. We want to simulate a lot more things than we can right now, Hoganson said, and this can cause case complexity to challenge modeling assumptions. From an engineering standpoint, trust requires the simulating of cardiac flows in a way that the outcomes are reliable, and CFD cannot be used in all patient cases at this time. When there are complexities, particularly in arterial circulation, they require” a very careful assessment of’ Are the tools up to up to par to tackle this?’ And still, in a lot of those areas, the answer is no, “he said. Hoganson and his team are also working at the national level to provide payer support for CFD modeling.” We are currently pursuing those efforts,” he said. We’ve actually worked with the Society of Thoracic Surgeons, several other cardiology, radiology, and other organizations to submit billing codes to the CPT in an effort to get this approved, which has been really exciting. Andrea Fox is the company’s senior editor, Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.