Leveling Up: Munson’s four latest health-tech investments improve outcomes, aid recruiting and enhance safety
In the past year, MMC has made multiple major investments in new tech infrastructure that is not only improving outcomes for patients, but also enhancing safety for doctors, drawing top-tier medical talent to northern Michigan, and making it easier for surgeons to learn from past procedures and improve their skills.
Below, the TCBN takes a closer look at four recent technology upgrades that are changing the game at MMC, including a surgical addition, a cath lab upgrade, a virtual urgent care system and a new surgical robot for total knee replacements.
The Surgical Expansion
In the fall of 2019, Munson broke ground on a new surgical services expansion, aiming to bring four new operating rooms, an upgrade of two existing rooms, and brand-new equipment to the MMC campus. That expansion officially opened last fall, and according to John Cox, executive director for surgical services at MMC, it is already making a big difference for Munson’s surgical capabilities.
The addition is three floors, though Cox said only one of those floors – the second – is currently in use for expanded surgical applications. The basement is mostly being used for support – from storage to linens – while the first floor is “shelled for the future” and will eventually include two operating rooms intended mostly for “quick turnaround cases” and other “outpatient-oriented functions.”
The second floor, meanwhile, houses two large general surgery rooms at MMC – a feature Cox said offers numerous advantages above and beyond the robotic surgeries they are already being used for.
“We also have other cases that involve a lot of equipment, such as our neurosurgery cases and some of our urology cases, where it’s useful to have a bigger room where we can move equipment around the center of it,” he said.
In addition to those two large operating rooms, the second floor of the new surgical expansion includes a pair of what Cox calls “vascular procedure suites.” Only one of those suites is in use right now, but that room is equipped with a robotic system from Siemens – called a “pheno lab” – that Cox said offers vital advanced imaging capabilities.
“It looks a lot like a robot you’d see in an automotive plant,” Cox said of the Siemens robot, which has an imaging arm that comes in from the corner of the room and does the imaging.
The physician guides the arm, which scans from head to foot, moving along the table. The scan provides the imaging the surgeons need for any type of procedure, such as a trauma, where the patient has had vascular injuries or arterial blockages.
“The surgeons can use that advanced imaging to see what’s wrong to start the case and then when they’re done with their repair, they can check the imaging again to make sure blood flow has been reestablished and make sure they’re happy with the outcome before they close,” said Cox.
In addition to improving patient outcomes, Cox said the new surgical addition has significantly increased Munson’s surgical bandwidth, which is in turn making it easier for MMC to recruit new surgeons to the area. In the next three months alone, five new surgeons will be moving to the community and joining the Munson staff, including new surgeons in cardiac, urology, orthopedic, colorectal, and neurosurgery specialties.
“When a surgeon comes in, they need time in the OR,” Cox explained. “Typically, for a surgeon, at least two days of their schedule each week is OR time.”
Before the addition, the scheduling staff were having difficulty finding time in the existing ORs for new surgeons coming into the market.
“This addition really kind of opened that up,” he said, adding that it’s a big attractor of top-level talent.
“They see these new facilities, the kind of equipment we have, and they can pick their day,” he said. “A lot of times, the new guy doesn’t get choice times in the OR. This way, they’re able to kind of get their pick, and that helps them build their practices quicker.”
Cox added that, should Munson recruit a new vascular surgeon to the team (a process he said is currently in the works), the hospital will likely purchase a second Siemens pheno machine and bring a second vascular procedure suite online. That suite is currently built out but is not in use yet.
The Cath Lab Upgrade
Per Cox, one of the advantages of the new Siemens pheno machines is that they give off anywhere from a quarter to a third of the radiation that MMC’s old vascular imaging equipment emitted. The result is a safer surgery environment for all parties.
Similarly, Dino Deponio pointed to radiation reductions as one of the big reasons that Munson recently invested in upgrading one of its cardiac catheterization labs. Deponio is MMC’s director of nursing and of the cardiac cath labs. In January, he and his team opened the upgraded cath lab after trading that lab’s 12-year-old X-ray machine for a state-of-the-art replacement. In the six months since, that particular lab has gone from MMC’s least utilized cath lab to its most preferred.
One reason for new lab’s popularity is the radiation factor. In recent years, manufacturers of medical imaging technology have gone to great lengths to cut down on the radiation that their machines emit, in part because doctors and surgeons are demanding the change.
“It’s becoming a much more closely watched thing in the industry,” Deponio said of radiation. “People are really looking at radiation dosage, and dosage over lifetime.
Munson’s new system was quoted to be a 50% reduction in radiation for procedures, something Deponio says is anecdotally a little north of 50%.
“It’s better for the staff, the providers, and the patients, all (who) have a significantly lower dose of radiation,” he said.
There’s another big advantage to the new cath lab system, too: It is ceiling mounted, which is easier for surgeons to use than the floor-mounted units that used to be standard.
“The ceiling-mounted design really allows us to work throughout the entire body,” Deponio said. “When people think of cardiology, they always think of the heart for obvious reasons. But we actually do interventions from neck to feet. And this new machine really allows us to work on any patient from head to toe.”
The Virtual Urgent Care
According to Chelsea Szafranski, almost all of Munson’s practices have been offering scheduled video visits since the start of the pandemic. Szafranski, who came on board as Munson Healthcare’s first-ever system director of digital health in February 2021, has been playing a key role in developing that side of Munson’s patient service offerings. The latest development? A new program that takes the advantages of telehealth and applies them to the urgent care model.
“We realized that there was an opportunity to provide quick, on-demand access to video visits, similar to an urgent care visit,” Szafranski said. “So, the patient has that urgent care option of being able to just ‘walk in,’ but they’re doing it via video.”
Launched in March, Munson’s new virtual urgent care program starts patients off with an “ask a nurse” hotline. A patient who feels they might need urgent medical attention can call the hotline and speak to a Munson nurse, who in turn asks a series of clinical questions to understand that patient’s needs and make sure that they’re a good fit for a video visit. The nurses then triage the patients, decide who needs medical attention, who would be best served by virtual versus in-person visits, who can wait a day or two for a scheduled visit with their primary care physician, and so on.
Patients deemed to be good candidates for virtual urgent care are connected, via video chat, to one of the roughly 20 Munson Healthcare doctors who have agreed to pick up shifts for the program. While Munson, like many other local employers, has faced staffing challenges recently, the appealing nature of work-from-home hours has helped the healthcare system staff the virtual urgent care program without much difficulty.
“The idea of working from home is very new for people in healthcare,” Szafranski explained. “We’re finding a lot of providers are interested in that.”
Some national companies right now, like Amwell (a major telemedicine company), are offering the option for doctors to work from home. So, more and more providers can pick up video visits outside of their current hours.
“All the providers who work for Munson’s virtual urgent care already work in one of our emergency departments or our primary care clinics,” she said. “But on their days off, they’ve offered to pick up these shifts.
“It’s almost like a second job for them.”
After a slow rollout with minimal marketing, the virtual urgent care program is starting to pick up steam. Szafranski said that, as of early June, the program had seen about 250 patients and is growing every month. While Munson is marketing the program more now with billboards and other high-visibility collateral, Szafranski thinks the biggest driver of new interest is word of mouth.
“We’ll often have a lot of patients in the waiting rooms at our urgent cares or walk-in clinics,” she said. “When they arrive, they’ll learn that there’s a couple-hour wait (for in-person urgent care). But they’ll also find out that they’re able to be seen right away via the virtual urgent care program.”
The virtual urgent care is just one improvement that Szafranski is bringing to the table as part of a system-wide digital health overhaul. Also on the way is an enhancement to Munson’s “Find a Doctor” tool, which will soon incorporate bios, videos and ratings for all providers, as well as a sophisticated online scheduling feature that allows patients to lock in appointment times, fill out forms, file consent documents, pay their copays, and more, all electronically.
Similarly, Munson Healthcare is launching a new patient texting tool that will make it easier for providers to send appointment reminders and otherwise communicate with patients via text message.
The ROSA Surgical Robot
“We’ve been doing robotic-assisted partial knee replacement surgery for a good decade in the United States,” explained Dr. Michael VanWagner, an orthopedic surgery specialist at MMC. “Then, over the last five years or so, robotics has found its way into the total knee replacement world and even the total hip replacement world. The beautiful thing about robotics, anytime robotics is introduced to medicine, is that we are learning a lot more about the human body because of the robot. And we’re seeing a lot greater accuracy and precision from the robot, as it relates to doing total knees.”
Munson’s total knee robot is called the ROSA, and it comes from an Indiana-based medical device company called Zimmer Bionet. Munson acquired the technology last August – one robot for MMC and another for Grayling Hospital – and has done several hundred total knee replacement surgeries with it since. VanWagner said the Munson team is already hearing about positive outcomes from patients, including faster recovery times and more natural-feeling knees.
“Those benefits are because the knee is being put on based on somebody’s actual anatomy,” said VanWagner, who trained on how to perform robotic total knee procedures during a fellowship at Mayo Clinic.
Without a robot, surgeons would just basically apply a bunch of averages to somebody’s knee, Van Wagner says.
“Based on those averages, we would put the implants on and say, ‘Ok, we hope this works out for you,’” he said. “Now, we’re actually customizing it to the somebody’s anatomy, and that’s thanks to this technology.”
There are other advantages too. According to Spencer Derenzy, Munson Healthcare’s service line executive director for surgical subspecialties and orthopedics, the ROSA systems at MMC and Grayling are two of the first robotic total knee systems in northern Michigan, period. Previously, locals seeking out this type of surgery would have had to travel – usually to Grand Rapids or Saginaw – to find it.
“By investing in these technologies, we really want our community members to not have to travel downstate to receive expert care,” Derenzy said.
Additionally, Derenzy notes that the ROSA provides big opportunities to track data on each procedure and each patient. That data provides opportunities for surgeons to improve the knee replacement process over time.
“We really want to leverage the technology to educate ourselves on outcomes,” Derenzy explained. “Are we doing a good job? Or can we do better and learn from it?”
Nation-wide, about 15% of patients are not happy with the outcome of their total knee replacement, “for whatever reason,” Derenzy said.
“For a long time, we’ve wondered why,” he said. “Now, we are capturing a lot of data on the ROSA – pre-operatively, inter-operatively and post-operatively – and we have a partnership with Apple where patients can have an Apple Watch and it collects their data.”
The patient enters in their pain scores, plus the watch captures the number of steps a day and tracks their range of motion.
“We collect that data, and now that we have done hundreds of these cases, we’re studying it, and we can look back and say, ‘Ok, on this case, we did something a little different and that patient seemed to have a great outcome,’” he said. “Or ‘This person did not report as good of an outcome, and we didn’t do this step.’”