Forecast for the Future: A Conversation with Richard Azizkhan, M.D., Children’s President & CEO

“We are going to use technology to enhance what we do without replacing the human relationships that are always going to be critical.”

– Richard Azizkhan, M.D., Children’s President & CEO

Children’s Hospital & Medical Center will mark its 70th year of service in 2018—a journey that has taken the institution from a community hospital founded in the midst of a polio epidemic to a regional and national academic medical center with aspirations for global impact.

The near-future will bring even more evolution. (That is a guarantee—not a prediction.) Children’s has already broken ground on its 10-story Hubbard Center for Children. The state-of-the-art expansion, set to open in 2021, will allow Children’s to offer a broader menu of programs and services, add medical fellowships, support advanced research and incorporate the latest care-enhancing innovations and technologies.

As we peer deeper into tomorrow—2021 and beyond—what could those advancements look like and how will they impact the way Children’s operates on its young patients, cares for children with cancer and treats acutely ill babies before they are born?

“The pace of change is accelerating,” says Richard Azizkhan, M.D., Children’s president and CEO.

He recently shared his forecast for the future of pediatric health care – the themes and technological trends that he believes will disrupt the care paradigm and help to improve and save young lives.

Genomic Medicine

The rapidly advancing field of genomics is widely considered the frontier of a new era in medicine.

“I really think that’s one of the most important advances, because it affects every aspect of what we do,” Dr. Azizkhan says.

Genomic medicine involves the sequencing and analysis of a patient’s complete set of genetic material to treat, mitigate or prevent disease.

“Our goal is to really be one of the cutting-edge institutions when it comes to genetic medicine, which relates to personalized, predictive medicine,” says Dr. Azizkhan. “When you understand what makes a person’s genomic materials go in a certain order, you can then target risks to their health or potentially prevent a diagnosed disease from advancing.”

To advance the study of genomic medicine, Children’s has been named one of the designated sites for Illumina, a major gene sequencing company. Illumina researchers will perform gene sequencing on critically ill babies in Children’s Newborn Intensive Care Unit (NICU) “so we can identify diseases much earlier and intervene or even discover new diseases,” says Dr. Azizkhan.

Fetal Therapy & Treatment

Fetal ultrasound began revolutionizing prenatal care on a broad scale about 30 years ago. Imaging technology has been advancing ever since, allowing caregivers to see very detailed surface features of the embryo and readily recognize any abnormalities.

“Right now, 99 percent of fetuses that have abnormalities are best treated after birth because they can grow safely and be delivered,” Dr. Azizkhan says. “But one percent of these are opportunities to treat in utero.”

In the future, he sees fetal surgery developing into a tool that will have a much more prolific impact.

“Where you marry fetal surgery and gene therapy together, the opportunity arises to treat millions of unborn babies with genetic defects. If we can introduce the appropriate gene correction into the fetus then that baby will potentially be cured of his or her condition. That’s really the Holy Grail. That’s why we are developing a fetal treatment program at Children’s.”

He continues. “Developing our experience with that one percent will allow us, in the next 10 years, to treat babies in utero for a lot of different conditions and improve their quality of life—and their lives. We’re talking about lifetimes.”

Surgical Advances

While change is assured in the future, one thing will remain constant: children will require straightforward and complex surgical care for a variety of conditions, whether congenital anomalies, acquired conditions, trauma or cancer.

“One of the most important sets of innovations has been the addition of image guidance in surgery,” says Dr. Azizkhan. “As a surgeon, I spent 30 percent of my time in image-guided rooms—hybrid ORs that had a combination of interventional imaging capabilities for surgery. That is going to become more and more common. I would predict that about 50 percent of our surgical procedures will be image-guided to create smaller incisions, reduce pain and morbidity and shorten hospital stays.”

Cancer Care: Biologic Treatments & Genetic Modification

“Surgery will continue to play a role in cancer care but so will new biologic treatments,” Dr. Azizkhan predicts. (Biologics are produced from or contain components of living organisms.)

To underscore the potential, Dr. Azizkhan highlighted the FDA’s historic August 2017 approval of Chimeric Antigen Receptor (CAR)-T cell therapy for certain children with acute lymphoblastic leukemia (ALL). The groundbreaking treatment involves removing the patient’s own immune cells (T cells), genetically “reprogramming” them to attack cancer cells and then re-infusing them into the patient. The results are astounding: 83 percent of 63 pediatric and young adult patients in a multicenter clinical trial achieved remission within three months of treatment.

“With a lot of these biologics that are being developed—not just for cancer but for other diseases like Crohn’s disease or rheumatoid arthritis—researchers are understanding the genetics of intracellular pathways, and they’re developing drugs that will target one or more of these pathways that have become abnormal or create illness.

“These drugs literally change how the cell reacts with less morbidity compared to existing therapies, so you’re not getting the side effects that you get with standard pharmacological treatments. This is going to revolutionize how we treat certain complex and chronic diseases, including cancer, immunological diseases and metabolic pathway disorders.

“We have 7,000 known diseases in human beings and we currently have only about 500 that are adequately treated with drugs. This opens up an opportunity to treat many more diseases that are otherwise not adequately managed.”

Integrated Care Delivery

In the next 10 years, Dr. Azizkhan believes Children’s can and will develop an integrated clinical delivery system that “engages Children’s in improving the health status of children in every community in the areas that we touch – whether it’s in Nebraska or western Iowa or South Dakota.

“If you need a bone marrow transplant, you’ll come here. If you need your appendix removed or a hernia repaired, that could be done in your community by our providers or with our providers being part of the system to ensure standards of care are comparable.

“One of the biggest changes that will occur – and is already occurring – is the need for collaborative partnerships to reduce unnecessary duplication of critical assets because there are not enough resources to support excessively competing enterprises. We need to do it together.”


Developing NICUs of the Future

Right now, Children’s is working with technology company Philips to develop Newborn Intensive Care Units of the future.

“We’re looking at making all the relevant clinical data real-time, on a dashboard monitor in the patient’s room. Caregivers will have access to it and families will be able to see it,” Dr. Azizkhan explains. “Being able to do real-time analytics will allow us to look at early trends: Is this child deteriorating and what are those signals so that we can start to intervene? It’s basically integrating supportive technology into the care paradigm—but it will not replace the human touch.”

Telemedicine

Telemedicine is the use of technology to evaluate, diagnose and treat patients remotely.

“I see telemedicine becoming like the telephone is used today,” Dr. Azizkhan says. “Right now, a lot of telemedicine is informal and pro bono. Many of our physicians get emails from all over the world — how would you treat this? — and they informally give their feedback. I see telemedicine becoming much more organized and transactional, and certain standards, expectations and accountabilities will be put in place to manage that.” We have used this in our behavioral health program and it has been an enormous success for both our patients and clinicians.

Digital Engagement

“If you look at how we’re delivering care, many of our physicians are using their smartphones or tablets as their vehicle to interface with colleagues, other institutions, electronic medical records and data acquisition. The use of this technology is going to become even more robust in the next several years.

“We treat young families. They’re millennials — and they think very differently. They want services on demand and information at their fingertips. They expect us to communicate with them in a different way, and we have to be very mindful of that as we move forward.”

Single Patient Identifiers

“In the next 25 years, I see an opportunity to create a single patient identifier that can be used across all systems in this country so that your medical record is absolutely portable. Regardless of which institution you go to, it’s there. There are examples of where that’s working in smaller countries. They do it in the military; their records are completely portable. That will revolutionize how we think about medicine.”


Even as he looks to the future, Dr. Azizkhan says, in many respects, the future is here already.

“Intensive care units are becoming even more complicated environments. All of the pumps are computerized and have different kinds of fail-safes to make sure the doses are appropriate. Robotics are already being used in different areas – everything from dispensing medications in the pharmacy to bringing linens and supplies, sanitizing rooms and removing trash. All of these technologies are really enhancing how we care for our patients.”

He continues, “The fact that we are one of the first pediatric institutions to use Biovigil (an automated hand hygiene system) is a reflection of the direction that we are taking. We are going to use technology to enhance what we do without replacing the human relationships that are always going to be critical.”

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