More specifically, give minorities and the underserved in rural populations the ability to see physicians, get the medical exams they need, and receive treatment for their conditions to prevent worsening of health, which leads to higher costs.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Charles D’Amato.
Charles D’Amato is the chief product officer and managing partner at ANiGENT. He directs product development and innovation for use in the clinical setting. As the original designer of MAAP Analytics®, D’Amato applied his clinical expertise to create a comprehensive solution to drug diversion. A pharmacist by trade, D’Amato understood that great products applied in healthcare should begin in the clinical setting. During his 20+ year tenure at Mayo Clinic in Arizona, he was instrumental in leading, managing, and supervising drug diversion programs.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
I’ve been a Clinical Pharmacist for almost 30 years, and I’ve worked at Mayo Clinic for 20 years.
I became interested in drug diversion prevention about 9 years ago after experiencing a diversion event that could have potentially affected patients. While working in a different clinical role, I was asked to help review fentanyl vials that appeared to have been tampered. After testing the contents of the vials, we discovered the vials contained saline. Had the medications been given to patients, it could have had a devastating impact. The patients this nurse was caring for could have received contaminated blood pathogens. I realized how easy it was to divert medication and how difficult it was to detect. The experience affected me significantly. And it inspired me to find a solution. I knew that technology was the answer for this complex problem so I set about creating a software platform utilizing artificial intelligence and machine learning algorithms.
Can you share the most interesting story that happened to you since you began your career?
I’ve seen many sad drug diversion events. These are not “interesting,” but heart breaking. However, these diversion events did influence my most interesting story, which is the creation of the MAAP Analytics. The solution was designed initially for Mayo Clinic and is now being marketed nationally by ANiGENT, a software solution provider. Moving from clinical pharmacy care to developing an urgent solution that helps protect patients — during an opioid epidemic — by proactively identifying diversion risk has been an amazing journey. I have experienced many obstacles in developing this solution and I have an immense sense of fulfillment that we’ve come up with a proactive way to protect patients and my colleagues.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
In hindsight, the funniest mistake I’ve made was when I initially believed people would welcome a completely different model to detect drug diversion. I was wrong. I worked for years trying to demonstrate the power of intelligent analytics. But most laughed or brushed me off and they went back to the traditional models, which weren’t effective, were time-consuming, and didn’t catch diversion from occurring. Today, it’s different. Mayo Clinic is now implementing the drug diversion prevention platform across all of its affiliates. No one’s laughing now. Machine learning is providing incredible innovative opportunities that are making a difference. I believe perseverance was the greatest lesson learned.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Learn from yesterday, live for today, hope for tomorrow,” by Albert Einstein. The important thing is to not stop questioning. I have always felt there is so much to learn from the past, both the good and the bad, and I use this knowledge to promote good and avoid the pitfalls. My appreciation for today is related to being a healthcare worker. I have witnessed many individuals with difficult medical situations and that has made me appreciate every day and how blessed I am. I am always hopeful for tomorrow and strive to make it better than today. Most importantly, I feel we should never stop questioning things, because it is how we learn, how we improve, and how we innovate.
Are you working on any exciting new projects now? How do you think that will help people?
Yes, I am currently working on the next generation of a drug diversion prevention solution. MAAP Analytics is the only platform in the market capable of tracking, monitoring and predicting drug diversion from occurring. MAAP was based on my experience as a clinical pharmacist. My current work expands on the success of this product at identifying diversion by false documentation. Here’s an example. A physician or nurse writes down that he/she is administering medication to a patient, but in real life, he/she is actually stealing the medication. This type of diversion is very difficult to detect, but with advanced analytics, we not only can stop drug diverters, but also predict potential diversion from occurring. We believe this solution will set a new standard, virtually eliminating diversion opportunities from occurring in a healthcare setting.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is an individual who is passionate about providing the best care he or she can deliver. He/she must be knowledgeable and open to new ideas. Show compassion beyond compare. Treat every patient as though the patient is a loved one. It is the credence I learned at Mayo Clinic and is the primary value of the founders of Mayo Clinic… “The Needs of the Patient Come First.” Healthcare is advancing and the best healthcare provider evolves with it.
The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
Covid-19 presented many challenges to healthcare. Healthcare providers struggled with the “unknown:” a new virus with unknown origins, unknown transmission, and no standard treatment guidelines. At the hospital level, administrators were confronted with facility saturation and decimated staffing. Bedside care expanded beyond the designated COVID-19 floor.
Overwhelmed hospitals began converting chapels, cafeterias, waiting rooms, and even parking lots into treatment areas. These specialized units were not optimally equipped to manage bedside care so nursing staff improvised new approaches to treating patients and administering medication. With a short supply of staff, hospitals turned to contract healthcare providers, volunteers, and retired healthcare workers for help — in addition to current staff working long hours to save patient lives. The hospital supply chain was devastated.
Medication and personal protective equipment (PPEs) shortages led to healthcare workers creating makeshift PPEs, compromising their own health and the care of their patients. The supply of PPE couldn’t keep up with a global pandemic, a sudden rise in demand, and reduced production. When they were able to get supplies through other sources, the pricing for these products were extremely high. Panic and anxiety were widespread. The unfortunate, “Perfect Storm” created an incredibly difficult environment for healthcare workers to provide the best care. This perfect storm also became a ripe environment for drug diversion. It’ll take years before many of us know the full extent of diversion at hospitals and the cost to society. The media captured some of the stories, such as the healthcare workers who stole hydroxychloroquine and PPEs to sell online. The stress of the pandemic for many accelerated the opioid crisis.
I believe the pandemic exposed the weak link in our healthcare infrastructure. Recognizing the fragility, there is a great need for multiple actions, such as standardized protocols to manage the “next” virus. Minimum PPE supplies at hospitals should be mandatory. Incentivization of production of medication and healthcare supplies in the U.S. will help address future supply chain disruptions. Mental health support needs to be in place to help overwhelmed healthcare workers. To reduce the potential for at-risk employees to pilfer drugs, more facilities need to establish a solution — whatever that may be — to prevent diversion from occurring. More importantly, I believe healthcare has learned that despite all our medical advances, we will always be vulnerable. Honesty and transparency in the early days of the next outbreak will provide healthcare a better opportunity to handle the next crisis.
Of course, the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
Our healthcare professionals were outstanding and were true heroes. At immense personal risk, these providers cared for the many sick that entered their facilities. Many healthcare providers got sick as well. Sadly, as many people passed from the virus, there were also many who recovered. New treatment protocols were developed and decreased the severity of cases with increases in patient recovery. Supply chain eventually caught up with demand and our healthcare providers had the necessary meds and PPE to care for patients and protect themselves. My wife is a nurse that worked throughout the pandemic on a COVID unit. Every day she put her life on the line to care for patients. To keep us and our daughters safe, she followed the protocols that Mayo had installed, which meant there were times that we could not see her or be with her. I could not be prouder of her commitment to the care of these patients in a very difficult and scary time.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
As a pharmacist by training, it pains me to see the impact of the opioid and oxycontin epidemic on everyday people, individuals who became addicted to medications that were supposed to help them. Those who have found themselves suddenly addicted should be able to access mental health services without shame, guilt or risk of losing their jobs or homes. Today, more than any other time in our history, mental healthcare is a necessity. Our society needs to invest in people and leverage technology to improve the work that we do for communities. That starts with acknowledging our human weaknesses and find solutions to make them better.
Additionally, despite being one of the richest countries in the world, the US ranks below 10 other countries in healthcare performance. We spend more on healthcare per person than any other industrialized country, yet we have one of the worst health outcomes and one of the highest premature death rates. While my recommendations to improve the healthcare system may just focus on a narrow path, I believe that if we could change this part, it could positively benefit the overall healthcare problems that we’re experiencing.
- Give people more access. More specifically, give minorities and the underserved in rural populations the ability to see physicians, get the medical exams they need, and receive treatment for their conditions to prevent worsening of health, which leads to higher costs.
- Give rural facilities the ability to better serve their communities. Currently, most rural communities lack specialty services, requiring patients to seek care outside of their region or to not seek care at all. Advances in technology are now possible that would enable patients to come in for regular screenings and exams. With cloud-based solutions and telehealth services, rural communities will be able to care for their residents, reducing worsening of conditions.
- Use artificial intelligence to improve efficiencies at hospitals. Hospitals are one of the slowest adopters of new technologies. Most are afraid to invest in technologies if they’re uncertain of the outcomes. The end result are facilities utilizing old systems that have difficulty “talking” with each other (problem of interoperability) or making do without. An example is in drug diversion prevention, where there are facilities that still use excel sheets to track and record medications coming in and out of the hospitals.
- Learn how to best use big data in hospitals to predict: behavior, therapeutic outcomes, business intelligence decisions, and potential lost revenues. Let’s use machine learning to uncover the hidden issues that are costing hospitals significantly. Let’s learn from the data to improve our efficiencies, and our ability to care for patients. Let’s encourage hospitals to invest in artificial intelligence and secured data.
- Make mental healthcare as easy as making an appointment for a regular checkup. This requires getting managed care and employers to stop dictating prior authorization, how much of the medications are covered, and what the out-of-pocket costs might be.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
We need to incentivize schools to decrease cost of a medical education. Medical school education costs could be capped and subsidized with guaranteed enrollment numbers. Incentivize individuals to become physicians by providing educational grants with more money offered in the areas of medical need. Once they’ve completed their medical school, physicians need additional support. Reduce their malpractice insurance, which remains one of the highest in the industrialized countries. Eliminate the pressure to keep long medical resident hours, which currently is between 100 -120 hours per week.
How do you think we can address the issue of physician diversity?
As we know, racial and ethnic minority populations have poorer access to care and worse outcomes than their white counterparts. They may also have limited access to elementary and/or higher education. To improve diversity in healthcare is to provide the same or similar opportunities to people in underserved populations. Give them the opportunity learn and they will learn. Give them mentors to aspire to and they will aspire. If we address the problem of physician shortages as discussed above — provide incentives to decrease costs, cap medical school education, and offer educational grants to incentivize individuals to enter and stay in medical schools — we can improve the pool of diverse physicians. Naturally, this also improves patient outcomes among minority populations.
How do you think we can address the issue of physician burnout?
One way to address this issue is to look at what’s causing the burnout. Multiple studies are showing that physicians are overwhelmed with increased demand for documentation, prior authorization pressures from managed care companies, and challenges of working with older, clunkier systems that slow them down. Add to this pressure the demand for shorter hospital stays and better patient outcomes in a value-based environment.
Artificial intelligence and cloud technology can help reduce burnout through automation and improving workflow efficiencies. In radiology, physicians can now access, review, and analyze multiple records that once took hours into minutes and seconds in facilities that employ machine learning. Automation and chain of custody process have improved hospital pharmacy in how we track and dispense controlled substances.
But there are some things that artificial intelligence can’t fix that we as a society will need to take care of, and that is supporting healthcare workers who display symptoms of mental health breakdown. During the pandemic, the number of healthcare workers who reported suffering from mental health, rose significantly. As a pharmacist and drug diversion specialist, I worry that our healthcare workers would turn to taking medications to ease their mental anguish.
What concrete steps would have to be done to actually manifest all of the changes you mentioned?
What can a) individuals, b) corporations, c) communities and d) leaders do to help? I believe it will take an incredibly strong, problem-solving, energetic leader to create a task force from broad sectors of healthcare and society. The problem is incredibly complex and unfortunately there are many forces with political and financial interests that will make every attempt to influence. I think the first step and the hardest step would be the creation of a bipartisan body of medical, social, insurance, and financial experts from all levels of society protected from influence and conflict. The goal would be recommendations for a complete overhaul of healthcare in this country that is financially sustainable, fair, private, competitive and provides even better care to more individuals than our current system… everything needs to be considered. I believe competitiveness of care will lead to innovation, quality, and cost containment. Freedom to choose your healthcare needs will increase public acceptance. The recommendation of the committee could then be brought to the people for endorsement via proposition. It is an incredible challenge, but this country has been very successful when there is a true united front to solve an issue.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
If I could inspire a movement to help others, it would surely be a complete overhaul of healthcare in this country. Many have tried and many have failed mostly due to politics and financial influence. Our current healthcare trajectory is unsustainable with increasing costs and greater governmental subsidization, waste, fraud, increasing lengths of time for care, and increases in individuals without access to care. A movement to honestly create a sustainable healthcare structure for this complex problem that affects every single person in this country in many ways would be inspirational.
On a less grander scale, I would focus on getting more hospitals to accept new technologies as opportunities to improve the care that we provide, rather than a cost on a P&L or the fear that the technology is too new and therefore shouldn’t be tackled.
How can our readers further follow your work online?
I’m a humble man with a laser-focused vision on how we could improve healthcare through technology. As more stories come out on the news about healthcare workers caught taking medications from patients, the more hospitals will focus on the need to consider using AI to protect patients and healthcare workers from diversion. But for every hospital that takes the step to do this, I will be there to support them.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.