Transformation

A Higher IQ for Cancer Care at Sutter

Posted on Apr 20, 2020 in California Pacific Medical Center, Innovation, People, Quality, Research, Transformation

Machine learning for cancer research

To learn how Sutter cancer researchers are applying machine learning to cancer care, we interviewed John Chan, M.D., a gynecologic oncologist at Sutter’s California Pacific Medical Center (CPMC) and Palo Alto Medical Foundation, and the Denise & Prentis Cobb Hale Endowed Chair in Gynecologic Oncology Research.

John Chan, M.D.

How might artificial intelligence (AI) be used to improve cancer care?
AI builds smart machines capable of performing tasks that typically require human intelligence like learning, reasoning and problem-solving skills. We already see AI playing a key role in our daily routines and our interactions with media, transportation and communications.

With a surge of new knowledge in this area, researchers are applying AI and machine learning to innovate healthcare with improved diagnoses and treatment. As machine learning algorithms are exposed to more data—in some cases gleaned from the electronic heath record (EHR)—they can detect hidden patterns within data that can be used to perform a task without sophisticated programming.

Given the large number of Americans diagnosed with cancer and the huge volume of data generated during cancer treatment, there is a growing interest in using AI and machine learning to improve cancer care.

How are you applying AI and machine learning to your gynecologic oncology practice at Sutter?
Through a collaboration with the University of North Carolina and The Medical College of Georgia at Augusta University, we’re using machine learning to classify cancer patients into high- or low-risk groups, and to personalize sub-groups of uterine cancer patients who may or may not benefit from chemotherapy. Our research resulted in a clinical calculator that was described in Gynecologic Oncology.

The findings suggest a clinical calculator can help predict benefit and risk of chemotherapy treatment in patients with uterine cancer. And now we’re expanding the machine learning tool to study advanced-stage cancers and gynecologic diseases like ovarian cancer.

We plan to share the clinical calculator with providers across Sutter and with peer institutions that care for gynecologic cancer patients who live in more remote communities, or who are otherwise unable to travel to larger cancer centers. That way, more cancer patients may benefit from the research underlying this new AI-based tool. This could help increase access to safer and more effective cancer treatments, and reduce healthcare costs.

What are the potential benefits of using AI and machine learning to guide oncology treatment decisions?
Machine learning can “free think” creatively because it’s not confined by pre-existing human biases that may be present in routine clinical practice. This and other AI approaches like deep learning can help us determine levels of risk and benefit associated with various cancer treatments.

For example, an older patient with ovarian cancer may be at increased risk of treatment-related complications compared with younger patients. AI can identify risk profiles to help guide treatment decisions based on data from similar sub-groups of cancer patients.

In clinical oncology, AI has increasingly been applied to harness the power of the EHR. Specifically, AI-based natural language processing techniques may help predict the development of diseases across large healthcare systems.

At Sutter, our integrated network enables access to EHR and outcomes data from a highly diverse patient base. Machine learning can find associations and calculate risk scores to better predict treatments that will provide optimal benefit and reduced risk of treatment-related complications or adverse effects. This approach may become a new decision tool that we can add to our clinical toolkit and share with collaborators across Sutter.

Cancer care and research at Sutter: High “CQ” using machine learning:

Other Sutter physicians, researchers, and innovators across the system are applying AI to cancer care and elsewhere. Here’s how:

  • Earlier this year, Sutter partnered with Bay Area startup Ferrum Health to develop machine learning algorithms for early detection of lung cancer at radiology clinics in Sacramento. Ferrum’s AI platform read 10,000 CT scans and reports. Within 90 days, it flagged 83 cases in which it detected a mass of tissue on the scan that was not mentioned in the report.
  • Albert Chan, M.D., M.S., Sutter Health chief of digital patient experience, is leading digital transformation efforts across Sutter. He oversees a unified digital patient engagement and virtual care strategy, including leadership of Sutter’s patient portal My Health Online, telemedicine and artificial intelligence-powered solutions.
  • Through a collaboration with Stanford Medicine, Sutter Health systems researchers will launch the Oncoshare Project using a “big data” approach to improve breast cancer care. Oncoshare enables researchers to generate high-resolution maps of breast cancer treatment, and identify care pathways that yield the best outcomes for patients.

Learn more about Sutter research and clinical trials.

How a Pandemic Launched a NorCal Healthcare System

Posted on Apr 14, 2020 in Carousel, Community Benefit, Expanding Access, Innovation, People, Quality, Scroll Images, Sutter Medical Center, Sacramento, Transformation, Uncategorized

Spanish Flu
A nurse takes a patient’s pulse in the influenza ward at Walter Reed Hospital in Washington, D.C., on Nov. 1, 1918. Photo courtesy of Library of Congress.

The pandemic started slowly in Sacramento. For weeks, residents of the city believed what was going around was just the usual flu that arrived every fall. But in just two months, thousands in the city had been infected and about 500 Sacramentans were dead.

That happened a century ago. Because of the inadequacy of the existing Sacramento hospitals to care for the numerous victims of the Spanish flu in 1918, local doctors and civic leaders banded together to build a new, more modern hospital to meet the growing city’s needs.

Sutter Health was born.

Begun as a single Sutter Hospital kitty-corner to Sutter’s Fort, Sutter Health now has a presence in 22 counties across Northern California, featuring thousands of doctors and allied clinical providers and more than 50,000 employees. As an integrated health system, Sutter is uniquely qualified and capable to care for residents during a health crisis such as COVID-19.

“A group of hospitals and doctor’s offices are able to band together, share resources, skills and knowledge, and institute best practices to care more effectively and efficiently for our patients and the communities we serve,” said Dave Cheney, the interim president and CEO of Sutter Valley Area Hospitals and the CEO of Sutter Medical Center, Sacramento. “We have systems in place that we test all the time to ensure we are prepared for many crises, including a pandemic like COVID-19.”

Groudbreaking
Just a few years after the devastating Spanish flu, Sacramento physicians, nurses and civic leaders gathered to break ground in 1922 for the first Sutter Hospital.

Physicians Fill a Need in Sacramento

The deadly influenza commonly called Spanish flu killed about 50 million worldwide. From August 1918 to July 1919, 20 million Americans became sick and more than 500,000 died, 13,340 of them in California. In Sacramento, slow action by the city public health office delayed care and, within a couple of weeks, sick residents flooded the hospitals. The city library was even converted into a makeshift hospital. A Sutter Medical Center, Sacramento history recounts: 

“The influenza epidemic of 1918 gave convincing evidence to Sacramento doctors that the city’s two major hospitals were woefully inadequate to provide the health care services vital to the rapidly growing community. The flu epidemic had sorely taxed these facilities and highlighted the need for a modern, fireproof hospital. Recognizing the critical need for hospital care for their patients, 17 local physicians came together with civic leaders to create a new hospital.”

The group incorporated as Sutter Hospital Association in 1921, naming it after its neighbor, Sutter’s Fort, which cared for Gold Rush pioneers as Sacramento’s first hospital. The first Sutter Hospital was built two years later and opened in December 1923 as “the most modern hospital to be found in the state,” according to The Sacramento Bee. It was the first private, non-sectarian hospital in the city, and the first to offer private rooms.

The hospital became not-for-profit in 1935 and changed its name to Sutter General Hospital. It opened Sutter Maternity Hospital in 1937 two miles away and it soon expanded its services and was renamed Sutter Memorial Hospital. In the 1980s, the old Sutter General Hospital was replaced by a modern facility across the street from Sutter’s Fort, and in 2015 all adult and pediatric services were combined under one roof when the Anderson Lucchetti Women’s and Children’s Center opened essentially in the same location as the original Sutter Hospital.

First Sutter Hospital
The first Sutter Hospital opened in December 1923 as California’s “most modern hospital.” Now, Sutter Health is an integrated healthcare system that includes 24 hospitals in Northern California.

A Health Network Grows

The 1980s and 1990s saw tremendous growth for Sutter. Struggling community hospitals in Roseville, Auburn, Jackson, Davis, Modesto and other nearby cities merged with what was then known as Sutter Community Hospitals. Then came the deal that more than doubled the healthcare system. In 1996, Sutter Community Hospitals merged with a group of Bay Area hospitals and physician groups known as California Healthcare System. These included such large, well-respected, historic hospitals as California Pacific Medical Center in San Francisco and Alta Bates in the East Bay. This new system became, simply, Sutter Health.

Now as a model of healthcare integration, Sutter Health provides a user-friendly system centered around patient care — a system that offers greater access to quality healthcare while holding the line on costs. This connectivity allows Sutter teams to provide innovative, high-quality and life-saving care to more than 3 million Californians. Sutter’s integrated care model allows care teams and care locations to use the power of the network to share ideas, technologies and best practices, ultimately providing better care and a user-friendly experience, achieving healthier patient outcomes and reducing costs.

Our Heroes Wear Scrubs
Grateful community members are thanking Sutter Health front-line workers throughout Northern California.

An Integrated Network Fights COVID-19

Today, Sutter Health’s hospitals and physician groups don’t operate in a vacuum. Each hospital is supported by a larger system that can share knowledge and send materials, equipment and even manpower to where they are needed most. The system is called the Sutter Health Emergency Management System, which is organized after the federal government’s National Incident Command System.

Here’s how it works: Part of the Sutter Health Emergency Management System is a team throughout the network that works on gathering and purchasing the necessary supplies and equipment needed during this pandemic, including N95 masks and ventilators. Another team monitors bed space to ensure that each hospital can care for a COVID-19 patient surge. Clinical team members across the network are working together to address any issues that may unfold and to share best practices as they treat coronavirus patients.

That’s the power of a not-for-profit, integrated healthcare network.

“We are leveraging the strength of our united teams to increase our capacity and knowledge, and to provide the necessary equipment,” Cheney said. “We are preparing all of our network hospitals in the event we see a surge in patients due to COVID-19. Thanks to the integrated system that has been more than 100 years in the making, we are prepared for a pandemic of this magnitude now more than ever.”

The Cancer Treatment Within You

Posted on Nov 20, 2019 in Affiliates, California Pacific Medical Center, Expanding Access, People, Quality, Research, Scroll Images, Sutter Medical Center, Sacramento, Transformation

How blood, urine and gene mutations may unlock secrets to lung cancer treatment options.

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When Online Matchmaking and Cancer Treatment Collide

Posted on Nov 19, 2019 in Affiliates, Expanding Access, Innovation, Quality, Research, Scroll Images, Transformation

More than 600 types of drugs exist to treat cancer. A new tool will help doctors supercharge their searches for the ones that will work best for their patients.

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Quelling the Storms of Seizures in People with Epilepsy

Posted on Nov 1, 2019 in Affiliates, California Pacific Medical Center, Innovation, Neuroscience, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Transformation, Uncategorized

SAN FRANCISCO, Calif. – An electrical “storm” in the brain causes seizures in people with epilepsy, producing symptoms that may include lapses in consciousness, twitching or jerking movements, weakened or limp muscles, spasms, blurred vision, experiencing unusual smells or tastes, and changes in sensation or emotions.

Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide.1 Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures.2

Epileptic seizures are generally categorized into three main groups: generalized (affecting both sides of the brain), focal (seizures that start in one area of the brain), and those that could start anywhere.

The stormy weather of seizures can clear with medications called anti-epileptic drugs (AEDs). AEDs can to stop seizures from occurring, but they do not always lead to a remission or cure epilepsy. With the right AEDs, up to 70% of people with the illness may remain seizure-free, and sometimes may “outgrow” seizures or go into remission. For other people whose seizures are uncontrolled with conventional AEDs, other treatments including surgery may be an option. Surgery may involve removing part of the brain that causes the seizures.

Michael Chez, MD

“Knowing where seizures start in the brain provides us clues into what occurs during a seizure, what other conditions or symptoms may be seen, how they may affect someone and, most importantly, what treatment may be best for that seizure type,” says Michael Chez, M.D., a pediatric neurologist and epileptologist, and Sacramento regional director of pediatric epilepsy and research at the Sutter Neuroscience Institute.

“Life without seizures and improved quality of life is what specialists aim to provide epilepsy patients, through a treatment plan personalized to their particular type of epilepsy and seizures,” says Dr. Chez.

Two Sutter hospitals, California Pacific Medical Center and Sutter Medical Center, Sacramento are renowned for providing patients specialized epilepsy care guided by leading-edge research. Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.

Sutter examining new ways to ‘map’ and monitor brain activity

Epilepsy is usually diagnosed with magnetic resonance imaging (MRI) and electroencephalogram (EEG) testing. Those techniques are also used to regularly monitor brain activity in people with the illness. Sutter researchers are studying the use of novel neuroimaging techniques to visualize and track the brain’s electrical activity in people with epilepsy.

For patients with refractory epilepsy (in whom medications are not adequately controlling seizures), a new “high-density” EEG machine is being tested to locate precisely where a patient’s seizures originate in the brain.

“Use of these high-density or high-array EEG machines can help dramatically accelerate research and patient care by identifying the focal point of a seizure,” says Kenneth Laxer, M.D. a researcher in the Sutter Pacific Epilepsy Program at Sutter’s California Pacific Medical Center (CPMC).

With more than 40 years’ experience in epilepsy research, Dr. Laxer is renowned for studying neuroimaging techniques including magnetic resonance spectroscopy for the evaluation and management of the illness. With high-density EEGs, the patient wears a net over their head, and the brain’s electrical activity is recorded from 250-plus electrodes. The recordings are combined with the patient’s own high-resolution MRI scan to help localize the seizure focus. Surgeons use these precise images to remove the section of the brain that’s causing the seizures.

“If we pinpoint that abnormal area, we can remove a smaller portion of the abnormal brain tissue and therefore decrease the risk of serious complications from the surgery,” says Dr. Laxer. He notes that 50-70% of patients who undergo a focal resection may become seizure free. “Most of these patients remain on seizure medications, frequently at reduced dosages; however, the goal of surgery is to bring the epilepsy under control—not to stop epilepsy medication use. Patients who undergo such surgeries typically experience improved quality of life.” Stay tuned later this month for Part 2 of this series on Sutter epilepsy research, which will include information on neuromodulation and anti-epileptic medications.

Stay tuned later this month for Part 2 of this series describing epilepsy research at Sutter.

References: 1. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/fast-facts.htm 2. Epilepsy Foundation. https://www.epilepsy.com/learn/types-seizures/refractory-seizures SAN .

Sutter Research: Advancing Care for Patients with Breast Cancer

Posted on Oct 21, 2019 in Affiliates, Alta Bates Summit Medical Center, California Pacific Medical Center, Expanding Access, Innovation, Memorial Medical Center, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Quality, Research, Scroll Images, Sutter Medical Center, Sacramento, Transformation, Women's Services

SAN FRANCISCO, Calif. – Breast cancer research has the potential to improve cancer care for the 3.8 million American women living with the illness. Recognizing Breast Cancer Awareness Month, we’re highlighting the bold science and game-changing breast cancer research at Sutter. This work can help advance knowledge of how to detect and treat the illness.

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