The President’s Cancer Panel is a federal advisory committee that reports on barriers to progress in reducing the burden of cancer. This year, the panel is conducting a series of public meetings to discuss the current landscape of patient navigation.

Dr. Handler specializes in digital solutions to optimize care. Along with researchers from OSF HealthCare and the University of Illinois, Dr. Handler published research demonstrating a doubling of cancer screening rates after technology-assisted interventions were implemented for economically disadvantaged women who were late (often two years or more) in their breast cancer screening. Together with another set of researchers from those same institutions, Dr. Handler developed AI to better balance the workload of nurse navigators for cancer patients to avoid burnout and provide the best care.

Dr. Handler believes AI should be developed which can effectively, ethically and equitably support cancer care, regardless of a person’s race, ethnicity or where they live. OSF HealthCare recently joined a national collaborative to provide input on new AI guidelines. 

OSF HealthCare will soon expand cancer services across its Ministry when the OSF Cancer Institute opens on the campus of OSF Saint Francis Medical Center in Peoria in February 2024. It will offer the second proton-beam therapy location in Illinois as well as serve as a site for clinical trials, advanced treatment, therapy and a wide range of support services.  

In a rapidly evolving technological landscape, machine learning has emerged as a transformative force; it is reshaping countless industries, health care included. Machine learning and artificial intelligence increases productivity, reduces human errors and frees up time for other tasks that can have greater impact. In the case of converting medical scans into 3D or 4D images for a deeper view of organs, tissues and tumors, AI has the possibility of changing how surgeons prepare to operate on patients with complex issues.

Matthew Bramlet, MD, is a pediatric cardiologist at the University of Illinois College of Medicine at Peoria who specializes in congenital cardiac MRI for the Children’s Hospital of Illinois.  His Advanced Imaging and Modeling (AIM) lab at Jump Trading Simulation & Education Center is focused on translation of medical images into 3D and 4D interactive models (for 3D printing for virtual reality) to assist in pre-surgical planning of complex cardiac and cancer cases. 

According to Dr. Bramlet, the heart is a unique organ because it changes shape as it expands and contracts to pump blood through the body. This change in shape becomes a problem when the muscle of the heart grows abnormally and obstructs its own ability to pump blood out of the heart. This is a problem, because no current technology exists that allows a surgeon to view this 4D, dynamic obstruction. 

Rather than relying on years of trial and error of surgical expertise to determine the correct way to cut out muscle to relieve the obstruction, this project seeks to provide the surgeon with a VR view of their next patient’s beating heart in 4D.

The Innovation for Health (IFH) grant program with Bradley University in Peoria, Illinois is designed to inject funding ($50,000) to combine clinical problems with computer science expertise.  Assistant Professor Sam Hawkins, PhD, and graduate students at Bradley University plan to utilize machine learning to convert standard medical images into a sequence of 3D models, that when played sequentially create a 3D beating heart; the “4D heart”.  

This concept has been previously demonstrated by Dr. Bramlet’s AIM lab, but it took an entire summer to convert images of a 4D heart, showing both the expansion and contraction of the heart that could be viewed through a virtual reality headset. Dr. Bramlet says that’s not a sustainable approach.

“How do we put the CT data into a computer and slice by slice, say this is the myocardial tissue so we get an exact replica of the heart. But I don't need just one (3D replica of a heart); I need 20 to make each phase of that heart (he simulates the sound of repetitive beats) into a 4D heart.”

Assistant professor Hawkins believes machine learning can be leveraged to perform the labor-intensive process of converting images. Hawkins explains Computer Science graduate students at Bradley are part of the research effort.

“First, we need to figure out what part of the image is the heart and what part is not. And then we need to combine these tiny images into a 3D image. And then we need to do that many times to get the 4D.”

Improving pre-surgery planning

The solution should allow surgeons to virtually preview the beating heart of their patient, showing the obstruction in 4D, therefore providing a completely new pre-surgical analysis tool. The multidimensional view allows surgeons to zero in on structures of the heart, significantly enlarge elements and get a much better view of the anatomy. This machine learned 4D generation of a beating heart will be a first of its kind technology.

Researchers believe creating an automated solution can reduce the manual process of converting images from months, to hours, and eventually perhaps minutes. That option could eventually be applied to images for other types of complex medical cases in adults, children and the smallest infants.

Dr. Bramlet says new AI-supported software could provide a scaled solution for surgeons everywhere.

“The most immediate impact isn’t going to be the 4D heart. The impact at a grander scale will be the scalability of how any program will be able to create models for pre-surgical planning; 3D printed or for VR with this technology.”

Hawkins believes the technology will lead to other hospitals adopting the approach for pre-surgery planning.

“It has the potential to really remove the barrier of entry for institutions that don’t have the expertise or the time but do have images they wanted to view (more intricately).”

This entire machine learning project has been made possible by Jump Simulation’s long-term investment in sharing 3D insights. Since, 2014, Jump has contributed 3D models of congenital heart disease to Dr. Fauci’s 3D database at the NIH. This library of annotated 3D models provides the rich dataset of raw material needed for machine learned insights into automated segmentation of patient specific 3D models.  

Within a year, this project aims to automate, through machine learned algorithms, the conversion of cardiac CTs into virtual reality. The 4D view will enable surgeons to see the beating hearts specific to individual patients.

Imagine being a surgeon who can plan a surgery in VR by seeing the beating heart of your patient before you walk into the OR. This project seeks to transition this vision from science fiction to science fact.

Dr. Matthew Bramlet

Sam Hawkins, PhD

4D Hearts B-roll

Peoria, Illinois-based OSF HealthCare is partnering with the University of Illinois Chicago (UIC) to award six grants totally more than $460,000 to support projects funded through the Community Health Advocacy program, with a goal to improve outcomes and reduce health care disparities. The latest grants seek to generate solutions focused on new models of care that improve access and reduce barriers for individuals from all racial and ethnic backgrounds. The projects also explore prototypes that can transform care and community-based initiatives that address the social determinants of health. The CHA program is also aimed at improving outcomes and reducing health care disparities.

The CHA program is a partnership between OSF HealthCare and The University of Illinois Chicago (UIC).

The funding supports research involving clinicians, engineers and social scientists to rapidly develop technologies and devices that could revolutionize medical training and health care delivery. A requirement of the grant applications was for solutions that could be deployed quickly, within four to six weeks.

Spring 2023 CHA Grant Projects

Automated Seizure Detection in Ambulatory EEG

• Huan Huynh, MD, OSF HealthCare
• Biswajit Maharathi, PhD, University of Illinois Chicago

Ambulatory EEG is a powerful tool to evaluate seizure propensity in patients with epilepsy within natural community settings and residential environments. This goal of this pilot project is to build a semi-automated seizure screening system using modern machine learning-based computational approaches to significantly reduce the physician’s time evaluating these events by providing faster and more accurate screening methods and improving the patient care experience.

BRIDGeS (Building Resourceful Interactions Despite Grief and Stress)

• Eileen Knightly, MHA, RN, BSN, OSF HealthCare
• Carolyn Dickens, PhD, APRN, ACNP-BC, University of Illinois Chicago

This project addresses the growing issue of violence and incivility in the community and its impact on patient care in hospitals. It utilizes findings from a 2022 community health needs assessment to address cultural and communication barriers affecting nursing staff and patients. Nurse burnout, caused by prolonged stress, has worsened due to staffing shortages, documentation burden and increased violence.

Developing Tools to Empower Patient Understanding, Management and Communication of Condition

• Jonathan Handler, MD, OSF HealthCare
• Michael J. Scott, PhD, University of Illinois Chicago

This project will focus on social determinants of health (SDoH) and consider solutions that empower the patient to more accurately track and communicate their conditions before they reach the reactive state. The approach is to change the way patients engage with their health-related data and provide better tools to convey this information to their care provider.

Harnessing Mobile Technology to Diagnose Migraines in Rural Communities

• Hrachya Nersesyan, MD, PhD, OSF HealthCare
• Yelena Nersesyan, MD, PhD, University of Illinois Chicago

The goal of this project is to test and improve the MiGRO app that enables providers to quickly and accurately diagnose and treat migraines, resulting in better health outcomes and improved patient satisfaction. The app also streamlines the referral process, allowing providers to quickly refer patients to migraine specialists, reducing medical costs and improving access to care in rural areas.

Improving Cancer Screening in Underserved High-Risk Populations

• Lisa Barker, MD, FACEP, OSF HealthCare
• Elizabeth Papautsky, PhD, MS, University of Illinois Chicago

This project seeks to characterize the current barriers to completion of screening recommendations among patients at high risk for breast cancer, then use that data to create and pilot test an “intervention bundle” to optimize rates of breast MRI completion for eligible high-risk patients. With attention to the underserved communities within the OSF service population, this project will contribute to reduced health disparities by reducing barriers to care in the context of timely breast cancer diagnosis.

UI Health Pancreatic Cancer Screening Initiative

• Jason Bill, MD, OSF HealthCare
• Paul Grippo, PhD, University of Illinois Chicago

The project aims to develop an infrastructure of early community engagement with clinical trials for all types of cancer. The goal is to address the increasing technological development in screening modalities without simultaneously widening the gap in morbidity rates of cancer within underserved communities. With this health care protocol in place, the team hopes to increase accessibility of clinical trials using methods that are showing promising results in pancreatic cancer detection.

The latest round of grants will fund 10 projects, leveraging OSF Innovation expertise and faculty from 16 colleges and health sciences at UIC. Grant recipients are expected to create solutions that can be deployed quickly, within four to six weeks.

The projects will examine patient experience for at-risk individuals who use the emergency department at OSF HealthCare Little Company of Mary Medical Center in south suburban Evergreen Park, explore ways to build a pipeline for allied health and first-line health care providers, develop a plant-based diet that would appeal to Black men at risk for prostate cancer and expand communication tools for exploring social needs for patients, particularly for non-English-speaking individuals and those with special needs.

Other projects will launch a pilot in homeless shelters, use an artificial intelligence (AI) -based tool to check for diabetes-related vision problems and develop AI curriculum for medical students. Another will focus on creating the best strategies to communicate the risks of cannabis consumption on women of child-bearing age before, during and after pregnancy.

“Given the massive workforce shortages across the industry, our focus is on using technology and evidence-based approaches for strategies to serve our patients most effectively and solve some of the biggest challenges that prevent individuals from achieving better health and wellness,” says 
Dr. John Vozenilek, chief medical officer for Innovation & Digital Health at OSF HealthCare. “We’re also attempting to make sure we reach all populations that deserve a holistic approach to improving their health and their experience with health care.”

TJ Augustine, vice chancellor for Innovation at UIC says, “As Chicago's only public research university, we are uniquely positioned to address a wide range of community health challenges. Having OSF HealthCare as a partner is key to implementing solutions that make an impact. We’re proud that our partnership will yield best practices that help not only UIC and OSF, but that also support community medical providers who serve diverse populations.”

Here is a complete list and description of the projects receiving CHA grants.

Highlight Project: Prenatal Cannabis Exposure: Investigating Reasons and Messaging  
With cannabis laws changing at a rapid pace, traditional media and social media are saturated with positive messages about recreational or medicinal use of cannabis, and many people think it is safe because it’s marketed as being “natural.”  Dr. William Bond of OSF HealthCare is working with co-lead Erin Berenz, PhD, of the University of Illinois at Chicago on a Community Health Advocacy (CHA) grant to investigate women’s risk perceptions of using cannabis in pregnancy.  Read more.

Jump ARCHES research and development program awarded nearly $1.8 million in funding across 16 projects to address a variety of medical challenges. Many of the grant awards address issues dominating the news, including health care inequity, misinformation on social media, and the need for earlier detection of anxiety and viruses for improved treatment.

“These projects leverage the strengths of OSF HealthCare and our academic partners who are committed to practical solutions that can be deployed throughout health care to make a difference in early diagnosis, personalized treatment and disease prevention,” according to John Vozenilek, MD, vice president/chief medical officer, OSF Innovation & Digital Health. 

Elizabeth Hsiao-Wecksler, PhD, interim director of the UIUC Health Care Engineering Systems Center and professor of mechanical science and engineering, says some of the grants build on
past successful Jump ARCHES research that is driving innovative solutions.

“Those projects will advance efforts to show proof of concept and scalability as a go-to-market solution to benefit partners and many others in the health care industry,” says Hsiao-Weckler. “Other projects lay the foundation for novel initiatives that will take time to develop but that show promise for transforming approaches to prevention, diagnosis, treatment and health outcomes.”

The Jump ARCHES program is a collaboration between OSF HealthCare, the University of Illinois Urbana-Champaign, and the University of Illinois College of Medicine Peoria. The funding supports research across multiple disciplines including clinicians, engineers and social scientists focused on rapidly developing solutions to advance medical training and health care delivery.

SEE THE FULL LIST OF PROJECTS AWARDED GRANTS through the Jump ARCHES program.

Highlight Project: Creating an application for health care providers to counter misinformation on social media

Health experts worry Twitter owner Elon Musk’s decision to drop a ban on misinformation will exacerbate the growing problem of health misinformation circulating on social media. Health providers can’t keep up with the latest misinformation so they’re often left with few options to respond to patients’ assertions or questions. This project will develop and deploy a stream of cost-effective, real-time fact-checking services through an application that provides physicians and other health care professionals with early-warning information tied to a variety of diseases, treatments and remedies. READ THE STORY. 

Some experts have referred to trust as a social determinant of health – meaning a factor outside of a medical office that can influence as much as 80% of a person’s health and wellness. If someone doesn’t trust health information or their health care provider, they’re not likely to comply with what they need to do to be their best self.

Thus, the importance of Community Health Workers (CHWs). These  community health care workers are local, trusted members with a close understanding of the community they serve. This trusting relationship enables the CHW to facilitate access to services by serving as a link between health and social services and community organizations.

OSF HealthCare, through an innovative partnership with East Peoria-based Illinois Central College (ICC), has created new training for the next generation of digitally-enabled CHWs. Many of the CHWs will soon begin working with federally-qualified health centers (FQHCs), under a Medicaid Innovation Collaborative (MIC) contract with the state of Illinois. MIC is aimed at improving health and wellness by providing underserved individuals with a personalized approach to coordinated care that leverages CHWs and digital tools to provide the right care, at the right time, using the right method that works for the individual and their family or caregivers.

Karlen Sandall, manager of the OSF OnCall Digital Health Worker program, says the training makes it clear that trust is critically important and that connecting individuals with community resources is one way of providing help beyond the clinic or hospital.

“It shows we’re caring about not only what’s bringing them into our health care center, but also what’s going on outside of that; how we can bridge those gaps and keep them healthy all the way around, I think really shows we want to build trust with them, and we want to align them with the resources that are going to keep them safe and healthy.” 

Sandall says CHWs will be embedded in the communities they serve and will represent the diversity of those neighborhoods. Many in the first CHW class already served as Pandemic Health Workers which were developed during the early stages of the COVID-19 pandemic, helping to support individuals through digital tools to keep them connected to their care team and any resources they might need to keep them healthy and out of the hospital. Sandall says they’re passionate and most have already visited many community-based organizations (CBOs).

“To understand all of their offerings … to understand the funding because that changes a lot with CBOs. That’s something we learned with the pandemic and aligning individuals to resources so as they gather more expertise, they’re definitely going to be able to guide and support individuals from the community to the resources they need.” 

Maura Lansing is one of those passionate, newly-trained CHWs who also worked to support individuals during the height of the COVID-19 pandemic. She says the training through ICC went beyond what she already knew through first-hand experience.

“We talked about and learned about how we could become community advocates and we could actually plan community events based around a health care issue, and all the different ways we could reach out to the community at large, as well as helping individual patients.” 

Class uses specially-trained actors

Ann Willemsen-Dunlap of OSF Jump Simulation is a curriculum developer who designed the training to exceed core competencies identified but not yet finalized by the Illinois Board of Higher Education and the Illinois Department of Public Health. Willemsen-Dunlap incorporated the use of Jump’s standardized participants (SPs) – trained actors - a unique aspect of the curriculum.

“They’re trained to do both coaching and give feedback to our community health worker learners and help shape the way they go forward and interact with clients later. Not many programs have this,” Willemsen-Dunlap explains. 

The capstone project for the training included using an SP in a scenario with a man recently diagnosed with diabetes. Lansing used what she learned about motivational interviewing, which includes the OARS approach – open questions, affirmations, reflective listening and summary reflections. Lansing says every aspect helped build trust, and it was particularly impactful to acknowledge the recently-diagnosed man was trying to be the best grandparent by helping watch his grandchildren regularly.

“’I know that’s a lot of hard work. Can we possibly include a quick 10-minute walk each day with the grandchildren so that you don’t feel like you’re having to add exercise into your already busy schedule?’” Lansing says he felt heard and understood. “He seemed like, ‘Wow, she understands what I’m going through.’” 

Willemsen-Dunlap says the digitally-equipped and trained CHWs will not only coordinate care with FQHCs and their provider partners, they’ll help by serving as additional eyes and ears for medical providers.

“When it comes to interacting with the clients and seeing what’s happening in their home or living environment … they can take that back to the provider and help the provider understand what might need to be tailored in some specific way to maximize treatment effectiveness.” 

More advanced training will enable them to help individuals and families use digital tools that might be needed for education, remote monitoring, or even a virtual exam. They can also provide calming reassurance, especially at a stressful time during a pending or recent diagnosis.

“Having this neutral third party who’s able to manage the tech and be that intermediary and that calming, confident presence is going to be very important,” Willemsen-Dunlap stresses. 

The next training session for becoming a certified digitally-enabled CHW starts July 11 through ICC. It includes 12 sessions of online instruction (Monday and Wednesday evenings) over the first six weeks, followed by a two-week internship for participants who do not have previous CHW experience.

Here is more information and an option to register.

Video Clips with Karlen Sandall, manger Digital Health Worker program, OSF OnCall

Video clips with Ann Willemsen-Dunlap,  director of Educational Development, Jump Simulation and Education Center

Targeted text reminders and other interventions erased disparity in the rate of breast cancer screening between economically advantaged and disadvantaged patients, according to an OSF HealthCare study published in Population Health Management.

While screening has been shown to reduce breast cancer deaths, women who are economically disadvantaged are less likely to have breast cancer screening and more likely to die of the disease, often because the breast cancer isn’t detected until it reaches a more advanced stage. Mammography screening rates plummeted during the COVID-19 pandemic, which only increased the disparity between economically advantaged and disadvantaged patients.

OSF HealthCare researchers analyzed the effectiveness of interventions created and supported by the OSF OnCall digital health team to reduce that disparity, with: text messages that included a link to schedule a mammogram and information about the importance of breast cancer screening; calls from a digitally-enabled community health worker (CHW) to help schedule mammograms and solve challenges such as transportation; and an invitation to a health fair offering on-site mammograms. Breast cancer screening rates more than doubled among Medicaid patients who received interventions.

The National Comprehensive Cancer Network (NCCN) guidelines recommend annual mammography for most women beginning at 40 and earlier for women at higher risk for breast cancer.

 “Previous studies have found that similar interventions help increase the rate of breast cancer screening, but not whether they would reduce disparities among different populations,” said Jonathan A. Handler, MD, FACEP, FAMIA, senior author of the study and senior fellow, OSF Innovation at OSF HealthCare.

The study included more than 4,000 women in two groups: an economically disadvantaged group (those with Medicaid coverage), and an economically advantaged group (those with private commercial insurance). All were 41 or older, were aligned with an OSF primary care physician and appeared to be overdue for their mammogram – typically by two years or more. All with Medicaid were randomly assigned to one of three intervention arms and compared with a subset of commercially insured women randomized to receive no intervention

All in the Medicaid group received the first intervention (at least one text message reminder). The moderate intervention arm also received additional educational content, a reminder text after a mammogram was scheduled, and phone outreach by a CHW to answer questions, assist with scheduling a mammogram, and address other issues related to the screening. The third arm had all of those interventions, and also received an invitation to a health fair where attendees could participate in interactive educational activities, schedule a mammogram or receive a same-day mammogram at the health center after attending the event.

In the Medicaid group, the rate of mammogram screening more than doubled following the interventions, from 5.4% to 11% of eligible patients. Interventions targeted only to the Medicaid group reversed the disparity in screening rates. Before interventions, the Medicaid group had 2.6% lower breast cancer screening rate than those with private insurance. After the interventions, the Medicaid group’s screening rate was 3.7% higher than those with commercial insurance who had been randomly assigned to receive no intervention.

Medicaid covers mammograms

Researchers determined Medicaid participants who had moderate to maximum intervention had a significant improvement in screening rates. Many in this group were reluctant to get a mammogram because of the expense until learning from a CHW that appropriate screening is covered by Medicaid.

Screening rates also increased after intervention among privately-insured women who were assigned to intervention arms. Therefore, researchers said economically disadvantaged women might require more intense intervention than their economically advantaged counterparts, with private insurance, to close the disparity gap moving forward.

“The goal is equity in health outcomes, not always standardization of an intervention or what we think of as equality. So it’s vital to strategically implement interventions among patients who would most benefit,” said Sarah Stewart de Ramirez, MD, MPH, principal investigator of the study, medical director for Population Health Services at OSF HealthCare, and associate dean for Population Health Equity Innovation at the University of Illinois College of Medicine Peoria. “For example, we found that simply providing interventions such as a text message equally to the entire patient population might actually widen that disparity, because economically advantaged patients have fewer hurdles to access care and therefore are more likely to be able to act on those reminders.” 

Dr. de Ramirez added, “Ultimately, we hope to find an engagement approach that achieves equity while also improving screening rates for all women. It’s imperative that we continue to study new population based interventions so we can apply them with the same science as clinical interventions, and ensure our patient populations receive the highest level of care, wherever they are.”

The study was funded by the American Hospital Association’s Institute for Diversity and Health Equity and Blue Cross Blue Shield of Illinois.

Visit osfhealthcare/innovation to learn more about how OSF HealthCare is working to transform health care.

Sample of video message for education efforts