From left: Judy De Leon, medical assistant, Ann-Marcia Tukpah, clinical fellow in Pulmonology, and Fotine Liakopoulos, medical assistant, converse outside a patient room in the COVID Recovery Center, located in the Lung Center.

There were so many things Monique Vaughan, 31, used to do without a second thought.

She worked full-time, sometimes up to 60 hours per week, at a busy mental health facility. To clear her head after work, she took her dog on a leisurely walk through her neighborhood for 30 to 45 minutes. In college, she had taken courses to sharpen her IT skills, making it a breeze for her to troubleshoot technology issues at home.

All of that changed after Vaughan tested positive for COVID-19 over one year ago. Long after recovering from the initial infection — which made her sick enough to require hospitalization for several days — she continues to live with a variety of lingering symptoms that have significantly affected her quality of life. Over the past year, she has been coping with extreme fatigue, intense migraines, severe muscle pain and ongoing cognitive struggles (or “brain fog”) and memory loss.

As a result, Vaughan says she had to scale back her hours at work to part-time. Walking more than a block feels like running a marathon. Focusing on a seemingly basic task can feel impossible at times.

“I was recently having trouble with my router at home. I’m a millennial, so internet stuff has never been hard for me to figure out. It was an issue I had fixed many times before, but this time I couldn’t remember how to do it,” she said. “I got so frustrated that I just sat in front of the router and cried.”

Among the many concerning aspects of COVID-19 has been its long-term effects on the body and mind — a mystery that scientists and health care experts are still just beginning to understand.

Seeking to address the complex medical and psychosocial needs of “long-hauler” patients like Vaughan, the Brigham recently launched the COVID Recovery Center, a new clinical and research center that brings together experts from a diverse range of disciplines. Each patient is assigned a patient navigator to help coordinate their care and facilitate follow-up appointments, referrals and testing.

While located in the Brigham’s Lung Center, pulmonology is just one of the many specialties the center offers. Depending on what a patient’s individual needs are, they can also be connected with cardiologists, hematologists, infectious disease specialists, nephrologists, neurologists, psychiatrists, dietitians, social workers or other health care providers.

“A new illness mandates a new approach,” said Bruce Levy, MD, chief of the Division of Pulmonary and Critical Care Medicine. “A lot of the symptoms these patients are experiencing are rather non-specific, so primary care providers are often challenged to figure out who is best suited to help their post-COVID patient when help is needed. For patients who may be going to multiple specialty clinics, finding those locations and navigating that system is not easy either. In the COVID Recovery Center, our goal is to ensure COVID ‘long-hauler’ patients get the best, most efficient care possible.”

Centered on Collaboration and Equity

Collaboration is at the heart of the center’s strategy. A multidisciplinary team conducts weekly case reviews to ensure all aspects of a patient’s care plan are thoroughly evaluated. Similar centers recently established at Massachusetts General Hospital and the Spaulding Rehabilitation Hospital for recovering COVID-19 patients offer additional systemwide collaboration opportunities.

The COVID Recovery Center team also works closely with primary care providers for referrals, serving as a centralized resource to patients and providers who are struggling with the management of long-term symptoms, also known as post-acute sequelae. In addition, the center plans to launch peer support groups to allow patients to connect with each other and share their experiences in a safe space.

An estimated 10 to 20 percent of people who had COVID-19 experience persistent symptoms long after their infection has resolved, Levy said. In addition to the symptoms that patients like Vaughan encounter, COVID-19 can also cause the immune system to have a long-term inflammatory response that may lead to serious consequences for the heart, lungs, kidneys and other organs.

“We’ve always known that surviving a critical illness isn’t the same as recovering,” said Daniela Lamas, MD, co-director of the COVID Recovery Center. “Our hope is that this isn’t a chronic condition but rather a lingering condition that improves over time. We are trying to not only respond to it but also find ways to help people improve.”

As part of a broader commitment to health equity, the COVID Recovery Center hopes to partner with community organizations to remove barriers that may prevent patients from disadvantaged communities from seeking care.

“The shared vision we all had was to ensure we were serving the patients who were acutely affected by this pandemic,” said Ann-Marcia Tukpah, MD, MPH, a clinical fellow in Pulmonology who was involved in drafting the proposal for the center last year. “We want to make sure that every element of how care is provided in the center confronts these inequities. It’s not enough to just have the center — we have to think about improving awareness, engaging patients in a thoughtful way, considering transportation costs, the prospect of multiple visits and so on. We have to first identify these barriers, then develop processes to eliminate them.”

In addition to providing clinical services, the center will also include a robust research component to advance our understanding of the long-term impact of COVID-19 from pulmonary, vascular, immunologic, neuropsychiatric, psychological and social perspectives. Patients will be invited to enroll in clinical trials and a clinical research registry.

“There’s a lot we don’t know about this disease,” said Elizabeth Gay, MD, director of the COVID Recovery Center. “Being able to see patients in a setting where other clinicians and providers are thinking about a similar set of issues can allow us to identify patterns and understand needs. And from a research perspective, that offers the ability to develop a cohort you can follow to try to answer some of these questions.”

For patients like Vaughan — who began receiving care at the Brigham prior to the center’s establishment — the prospect of getting answers, and hopefully relief from her symptoms, might be that much closer.

“My body is not the same as it was before,” she said. “It feels like I don’t know myself anymore. It is unsettling to have the body you’ve been in for 31 years feel like a complete stranger. And I don’t know if I’ll go back to normal or this is just the new normal — but I hope not.”

Peter Chai demonstrates “Spot,” a robot used in the Emergency Department to remotely triage COVID-19 patients. Photo credit: Susan Symonds/Mainframe Photographics

Physical distancing remains one of the most important and effective measures for preventing the spread of COVID-19, but it initially presented clinicians with a dilemma: How do you safely deliver care when face-to-face interactions suddenly pose so many challenges?

One compelling solution: digital technology.

The meteoric rise of virtual care and rapid adoption of new technologies across Brigham Health helped keep staff, patients and families healthy, safe and connected throughout the pandemic. From the booming expansion of existing programs to the swift implementation of new ones, multidisciplinary teams used mobile devices, video conferencing and even robots to continue delivering expert care with compassion.

“Before COVID, there was almost no virtual care happening in our acute care settings, and less than 1 percent of ambulatory visits were done virtually,” said Adam Licurse, MD, MHS, executive director of Virtual Care for Brigham Health. “That changed nearly overnight.”

 ‘A Game-Changer’

When the spread of COVID-19 prompted the Brigham to shutter most ambulatory clinics in mid-March, the Virtual Care team and Information Services (IS) staff came together to support hundreds of providers who were caring for patients remotely for the first time.

In February, prior to COVID-19’s widespread presence in the Northeast, Brigham outpatient providers collectively conducted 200 virtual visits. In May, they completed 80,000.

“Very quickly, we had to train nearly all outpatient providers on how to do visits over the phone and by video,” Licurse said. “It was a huge mobilization of resources and communication, including guidance around regulatory issues and reimbursement, in addition to procuring and distributing a lot of new equipment like webcams.”

Primary care physician Lilian Mahrokhian, MD, completed approximately 500 virtual visits between March and May, mostly from her home via video. In May alone, her appointment volume exceeded that of a typical October, historically the busiest month for primary care.

“It’s been a game-changer. Patients have loved the opportunity to see and talk with us, and it has been invaluable to check in with them while keeping all of us safe,” said Mahrokhian, who practices at the Fish Center for Women’s Heath. “I keep thinking, what if this pandemic had hit at a time when this technology wasn’t in place? We would not be able to deliver this type of care as effectively.”

Mahrokhian, an enthusiastic proponent of telehealth prior to the pandemic, said that while not every condition can be treated remotely, many aspects of primary care are well-suited to the model.

“There’s a lot of counseling we can do in primary care that translates well to virtual care,” she said. “An in-person exam is not as relevant for evaluating a patient’s response to an antidepressant or helping them manage weight loss.”

Mahrokhian said she was exceptionally grateful to Virtual Care and IS teams who worked behind the scenes to continually monitor the system, respond to providers’ needs and quickly implement improvements.

“As a provider, I felt really supported,” she said. “It seemed like they were working tirelessly to get this up and running for us, and there was always someone available to help if I ran into any issues.”

Keeping Everyone Safe

Inside the hospital, where care teams needed to maintain in-person contact with patients, the use of technology flourished in creative ways as staff sought to minimize exposure to COVID-19, conserve personal protective equipment (PPE) and help patients and families remain connected while most visitors were prohibited.

A video intercom system enabled hospitalized patients with COVID-19 and their providers to interact via secure video conferencing. Through a bedside iPad in the patient’s room, clinicians could initiate a video chat using a computer or mobile device — relieving providers from needing to enter patient rooms for every routine question or conversation.

Thanks to the innovative work of a multidisciplinary team — led by Cheng Zhang of Virtual Care, Greg Kane of Analytics, Planning, Strategy and Improvement, and Laura Carroll and Steve Penney of Brigham Health IS — the group deployed nearly 400 iPads in only a few weeks.

To help nurses wearing full PPE in patient rooms communicate more easily with colleagues on the other side of the door, Brigham Health IS staff also expanded the hospital’s use of Vocera, a system of lightweight, wearable badges that staff can clip to scrubs or a gown for hands-free, real-time voice communication.

Staff communicate through a video intercom system. Photo credit: Max Esposito

“A silver lining of the COVID-19 pandemic has been the rapid adoption of new technology. We have achieved years of digital transformation in just a few months,” said Adam Landman, MD, vice president and chief information and digital innovation officer at Brigham Health. I’m especially proud of the BH Information Systems, Virtual Care and Digital Innovation Hub (iHub) team members, who worked tirelessly to rapidly deploy these new tools to front-line clinicians.

Additionally, the pandemic transformed daily rounds, as several inpatient units used iPads to conduct virtual rounds to limit the number of providers who needed to enter a patient’s room.

Hospitalist Karen Jiang, MD, medical director for BWFH’s 7 North, normally conducts rounds on her own, but during the pandemic she found that conducting virtual rounds with a trainee was helpful in juggling the many tasks at hand.

“Even though we didn’t have as many patients, I spent much more time and energy planning each interaction,” Jiang said. “I had to think a lot about hand-washing, wiping things down, gowning and de-gowning each time, so to have another person helping with other needs, such as taking notes, allowed me to stay more focused on everything I needed to do in the room.”

In the Emergency Department (ED), a research team piloted the use of Boston Dynamics’ four-legged robot, known as “Spot,” which was equipped with a video conferencing-enabled tablet. By sending Spot to interact with patients in a triage tent outside the ED, providers could evaluate patients while conserving PPE.

Other uses of digital technology were more internally facing, such as the COVID Pass app, a mobile app and web-based portal staff used to attest to their wellness each day before reporting to work. The multidisciplinary project, which was deployed across the entire Mass General Brigham system, was led by Landman and Mark Zhang, DO, MMSc, medical director of the Brigham Digital Innovation Hub, with app development completed by the MGB IS Application Development team.

Staying Connected

Technology also became an essential means of maintaining human connection, such as when staff on Connors Center 7 donned party hats and used the video intercom system to sing “Happy Birthday” to their patient.

To support patients who didn’t have access to personal devices, a device loaner program enabled any hospitalized patient to borrow mobile devices and laptops to stay in touch with loved ones through apps like Zoom and FaceTime.

Additionally, a virtual family visit program also provided an opportunity for patients and their loved ones to connect through staff-facilitated video sessions at the bedside. Ngoc Vu, a medical assistant in the Neurosciences Center who was redeployed to support the program, coordinated and conducted eight to 10 video sessions each day throughout the pandemic.

While holding an iPad so that a patient and their loved one could see each other and speak, Vu often used her free hand to offer a comforting touch, such as holding the patient’s hand, during the session.

“Sometimes the conversations were very sad, but other times they were happy — the patient was doing well and getting extubated, and the family members were excited to see them,” she said. “It gave me a new appreciation for how precious life is and how important these connections are.”

Charles A. Morris, vice president and associate chief medical officer, responds to an audience question during the forum.

Editor’s note: Due to the rapidly evolving nature of the worldwide COVID-19 (Coronavirus Disease 2019) outbreak, faculty and staff are strongly encouraged to stay tuned to their work email for updates from Partners HealthCare and Brigham-specific guidance. Visit PikeNotes for additional resources and updates.

On March 3, clinical experts and hospital leaders on the front line of the Brigham’s COVID-19 (Coronavirus Disease 2019) response hosted an open forum to provide an update on preparation efforts and respond to questions from faculty and staff.

In a wide-ranging presentation before a full audience in Bornstein Amphitheater and more than 800 webcast viewers, speakers reviewed what is currently known about the disease, how caregivers should screen and care for potential COVID-19 patients, protocols for using personal protective equipment (PPE), other preventive measures and guidance around travel, furlough and sick time.

“You are all very important to us, to the organization and to the patients and families whom we serve and support. We want you to know, too, that we want to support all of you by making sure that you’re well-educated,” said Jean Jackson, SPHR, SHRM-SCP, RACR, vice president of Human Resources. “It’s really important to us that we keep the lines of communication open and continue to have opportunities to engage.”

Patient Screening

Worldwide, most COVID-19 patients have a mild form of the illness, with only 20 percent requiring hospitalization, explained Michael Klompas, MD, MPH, hospital epidemiologist. Of that 20 percent, one-quarter need to be treated in an intensive care unit (ICU). The U.S. Centers for Disease Control and Prevention (CDC) report that the disease has a 2 percent mortality rate as of March 5.

During the open forum, Brigham clinical leaders emphasized the importance of following the Identify, Isolate and Inform protocol (see related box below) for screening patients in inpatient settings, ambulatory areas and the Emergency Department (ED).

In the ED, patients are being screened at registration for fever, cough or respiratory symptoms and recent travel outside the U.S. In the ambulatory setting, teams are screening all patients proactively before their appointment and upon arrival at the clinic.

“What I would ask of everyone is to take a philosophy much like hand-washing,” said Karl Laskowski, MD, MBA, associate chief medical officer for Ambulatory Services. “We need to hold ourselves accountable. If you go into a clinic and see people aren’t asking these questions, politely remind each other we should be asking these patients about fever, cough and travel history.”

Preparations Continue

Since Jan. 29, a multidisciplinary team has met regularly to develop, update, drill and refine the Brigham’s preparation and response plan in coordination with colleagues across Partners HealthCare and its member institutions. This includes readying the hospital and distributed campus for a variety of potential scenarios, including patient surges, to ensure the Brigham has the supplies, staffing and protocols in place to safely deliver care no matter the circumstances.

For example, ED staff have been conducting ongoing drills in close coordination with the Medical ICU (MICU), where initial patients with a suspected or confirmed case of COVID-19 would receive care, said Janet Gorman, BSN, MHA, associate chief nursing officer for the ED.

An important part of the strategy for managing a potential patient surge will be helping clinicians determine which patients need acute care, which can be monitored at home and which require an intermediate approach, said Eric Goralnick, MD, MS, medical director of Emergency Preparedness.

Michael Klompas presents during the forum.

As drills continue and the first test cases emerge, Goralnick encouraged staff to share their feedback about opportunities for process improvement.

“We need your help to get this right — to ensure that we communicate with all of our teammates, understand where our gaps are and learn from every one of these engagements,” he said.

Jon Boyer, ScD, CIH, director of Environmental Affairs and hospital safety officer, reviewed when and how PPE — including N95 respirators and powered-air purifying respirators (PAPRs) — should be used. To protect critical supplies, N95 masks are being provided at high-risk locations, and PAPRs are available 24/7 from Central Transport.

Boyer also clarified the process for N95 fit-testing. Nearly 6,700 staff have been fit-tested, including those who would most likely assist or care for a COVID-19 patient, such as clinicians, Environmental Services staff and Brigham Police and Security personnel.

Protecting Each Other

To minimize the risk of infection, speakers at the forum advised employees to practice what they normally would do during flu season: frequent hand-washing, staying home if sick and avoiding touching one’s mouth, nose and eyes.

Responding to an audience question about the effectiveness of hand sanitizer versus hand-washing, Meghan Baker, MD, associate hospital epidemiologist, said that alcohol-based hand sanitizer effectively kills coronavirus. She noted that someone who has soiled hands, including direct exposure to blood or other bodily fluids, should wash them with soap and water for at least 20 seconds.

Speakers reiterated that all personnel should stay home if they are sick. Jackson noted that the Human Resources team is working with Partners to review sick-time and remote-work policies.

Staff who stay home because they do not feel well and who cannot perform their job duties remotely will be paid under the guidelines of their paid time-off policy. If an employee does not have enough paid time off available, Partners will advance them up to two weeks of their scheduled hours, as needed. Staff who do not accrue paid time off may use time off available to them per Massachusetts’ Earned Sick Time law. (Learn more.)

Brigham personnel who travel to areas with widespread local transmission of COVID-19 must complete Occupational Health Services’ Returning Traveler Activity Survey, and OHS will communicate when they are allowed to return to work. Employees who have traveled to these areas — regardless of whether or not they have symptoms — will be furloughed from work upon their return date for 14 days. Partners’ TravelSafe website contains the most up-to-date information about what qualifies as an area with widespread local transmission.

For more information, including FAQs and a webcast recording of the March 3 forum, visit BWHPikeNotes.org.

DO IT Challenge project team members, from left: Santosh Mohan, Callie Patel, Caroline Coy and Reed Goldberg

Through a new challenge called DO IT — Decreasing Operational Inefficiencies Together — the Brigham Digital Innovation Hub (iHub) is inviting faculty, staff and trainees to help uncover the most inefficient, cumbersome or redundant work-related tasks and technologies that they wrestle with daily.

But that’s just the beginning. The iHub team also wants to solve these day-to-day headaches and administrative burdens using digital technology.

“It’s the little things that amount to mountains — stacks of paperwork, confusing technology, long hours spent on bureaucratic tasks like documentation and billing, resulting in less and less time to deliver care,” said Santosh Mohan, MMCi, CPHIMS, FHIMSS, managing director of iHub. “These everyday inefficiencies clutter our workflows and lead to frustration among staff and patients.”

Now through March 18, the DO IT Challenge welcomes all Brigham employees, regardless of department or role, to participate by visiting bwhihub.org/doit. Using an online submission form, staff can describe an existing problem and share a digital solution, including ways to improve Partners eCare (Epic). Staff can vote and comment on their favorite ideas to give them a better chance at being selected.

The iHub team will begin evaluating the crowdsourced ideas and proposed solutions in late March. One or two submissions will be chosen and matched with resources and support from the iHub and other internal funding to bring them to life. The winning projects will be announced this summer.

“Maybe someone has an idea about moving an inefficient paper process into the digital age, or perhaps they’re interested in how to make any number of arduous and repetitive technology-based tasks in their workflow more efficient,” Mohan said. “Whatever their ‘Eureka!’ moment is, DO IT is all about enabling simple and nimble digital solutions to creatively solve cumbersome problems.”

Channeling a Community of ‘Doers’

In developing the program, the iHub team partnered with Healthbox, the innovation arm of the Healthcare Information and Management Systems Society (HIMSS), and drew inspiration from an unconventional source: Marie Kondo, the Japanese author and self-described tidying expert who became a global sensation for her philosophy of discarding possessions that fail to “spark joy.”

“We are on a quest for digital solutions that can help us get rid of things that don’t ‘spark joy’ for our staff and patients,” Mohan said.

Another large source of inspiration was a similar initiative at Hawaii Pacific Health, a health care system in Honolulu, whose “Getting Rid of Stupid Stuff” program aimed to reduce documentation burdens for clinicians using its electronic health record (EHR) system.

“The initiative struck a chord with us,” Mohan said. “We decided to leverage the crowdsourcing approach, expand the scope of our program to cover more than the EHR, and collect not just problems, but also solutions and votes from staff.”

DO IT’s grassroots approach is essential to ensuring that whatever solutions are implemented address true pain points and resonate with staff, Mohan said.

“Our team believes that those best suited to voice these frustrations and help solve them are the employees who deal with them firsthand,” he said. “We’re bringing together a community of creative, insightful thinkers and ‘doers’ who want to improve the Brigham Experience for all of us.”

To participate in the DO IT Challenge, visit bwhihub.org/doit. The submission deadline is Wednesday, March 18. For questions or assistance, email ihub@partners.org.

Beth Regan

There are five words that always make Beth Regan, MS, CCC-SLP, senior speech language pathologist in Rehabilitation Services, smile when she meets with patients at Brigham and Women’s/Mass General Health Care Center at Patriot Place in Foxborough: “I’m so relieved you’re here.”

That’s because, until recently, the Speech and Swallow Service at the Brigham had primarily functioned as an inpatient service. Upon recognizing the large and growing need for more comprehensive speech therapy services in an outpatient, community-based setting, the Rehabilitation Services team opened the ambulatory speech clinic in Foxborough last fall. The launch follows an expansion of outpatient services last summer on the main campus, where the team hosts a half-day clinic for patients with swallowing disorders.

The Foxborough clinic, which operates five days a week, cares for patients with a diverse range of needs around swallowing disorders, language disorders, speech difficulties and cognitive deficits. Patients may be referred to the service following a neurological event that affects their speech, such as a concussion or stroke, or if they experience difficulty swallowing food, liquids or medication.

Laura Kasparian, MS, CCC-SLP, a coordinator in the Speech and Swallow Service, said the team saw an opportunity to improve continuity of care for existing patients who were looking to access physical therapy, occupational therapy and speech therapy in one place. They were also watching the diminishing availability of speech services in the region with growing concern as more local rehabilitation centers closed their doors.

“After an acute neurological event, such as a stroke, patients usually make the most progress in speech rehabilitation within the first six months to a year. If a patient has trouble accessing services during that time, that is a precious window in which they could be making gains,” Kasparian said. “We’re really excited to help meet that need for patients in a convenient setting.”

Regan, who serves as the Foxborough clinic’s sole speech pathologist, said many patients have expressed appreciation for having access to these specialized services in the local community.

“Going into the city can be daunting for a lot of patients who live outside of Boston and are recovering from a stroke or traumatic brain injury,” Regan said. “Being able to access these services closer to home is a true relief for many of our patients.”

The clinic’s integration into the Brigham’s Foxborough site has also enabled Regan to work closely with colleagues in neurology, physical therapy, occupational therapy and other referring providers — ultimately enhancing care for their patients.

“We talk and collaborate often, sharing what we’re seeing in terms of a patient’s rehabilitation and what could be helpful moving forward,” she said. “It’s very much a team effort.”

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Thinking about enrolling in a training class or educational course to enhance your professional skills? Thanks to a recent expansion in benefits, doing so is more affordable for eligible employees.

At the start of the new fiscal year in October, the Brigham increased its tuition-reimbursement benefit — now providing up to $3,000 for full-time, benefits-eligible, weekly paid employees and research fellows in good standing.

Paula Squires, MBA, SHRM-SCP, SPHR, senior vice president of Human Resources, said the Brigham encourages staff to take advantage of educational opportunities that help them build their skills and competencies and advance their careers.

“We care deeply about our staff, and we’re always working hard to ensure that we are able to support those who seek out educational opportunities,” Squires said. “We are pleased that we’ve been able to increase our tuition reimbursement amount and hope many colleagues take advantage of the program.”

About the Program

Employees and research fellows who have at least six months of continual employment at the Brigham upon submitting the tuition reimbursement application are eligible to apply.

To qualify for reimbursement, staff must receive at least a C grade in a for-credit course, a pass in a pass/fail course or earn a program certification. The course or program must take place outside of the employee’s regular working hours.

J.F. Goldstyn, MBA, director of Organization Development and Learning in Human Resources, said the beauty of the program is its flexibility around what types of courses are eligible for reimbursement. To qualify for reimbursement, the course must provide knowledge or skills that the employee can directly apply to a current position or would assist in transitioning to a new role within the Brigham.

Employees can receive reimbursement for tuition and fees, the latter of which includes laboratory, registration, exams, books, technology and application fees. The Brigham will reimburse employees who are successful in completing non-degree, degree courses and/or programs, continuing education and certification programs. All courses or programs must be completed either in person or online through an accredited school, college or university.

Courses and programs that are ineligible for reimbursement include doctoral degrees, audited courses, conferences and seminars. Nurses who are part of the Massachusetts Nurses Association bargaining agreement are not eligible for reimbursement through this program. These nurses are eligible for a separately administered tuition reimbursement and professional development program within the Department of Nursing.

Goldstyn said a key component of the program is the opportunity it provides for employees to discuss their career goals with their supervisor. All managers are involved in the approval process for tuition reimbursement.

“We view learning as a lifelong activity,” Goldstyn said. “Not only do we encourage you to take the time to learn, but we also want to help pay for your course expenses and make investments in your education.”

To learn more about the tuition reimbursement program, including how to apply via PeopleSoft, visit hospitalpolicies.ellucid.com and search for policy HR-507.

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Natalie Artzi, left, receives the BRIght Futures Award from Jackie Slavik, of the Brigham Research Institute

Natalie Artzi, PhD, of the Division of Engineering in Medicine, and her team were hard at work on research related to delivering cancer treatment when tragedy struck close to home. Artzi found out that a family friend’s 13-year-old son had been diagnosed with brain cancer. As she began reading more about the disease, Artzi realized how little progress had been made in the last 20 years.

“Treatment hasn’t improved much for this deadly cancer. With all of the advancements in our understanding of immunology, we thought, maybe we can leverage what we’ve been working on to change this,” said Artzi.

Think Local Delivery

Artzi and her lab have been working on a new way to deliver effective cancer therapy where it is needed most. Their research on solid tumors, including breast cancer and colon cancer, has shown that local delivery — delivering a drug to the site of a tumor rather than infusing it into the bloodstream — is the best way to hit cancer hard while keeping side effects to a minimum.

“Less than 1 percent of the administered dose of drugs get to solid tumors. Now, imagine what’s happening when we have another biological barrier to cross, the blood-brain barrier, which is designed to keep molecules out,” said Artzi.

Artzi’s team specializes in nanotechnology and is developing particles no larger than 1,000th the diameter of a human hair that can deliver cancer drugs. They envision that during surgery to remove a tumor, an adhesive material containing the nanoparticles can be sprayed onto the brain, creating a hydrogel patch.

Artzi’s team is especially excited about the power of immunotherapy — a therapeutic approach that retrains the immune system to detect and destroy cancer cells.

“We think that combining the power of local delivery and immunotherapy will have a big impact,” said Artzi.

Raising Excitement and Hope

To build public support and funding for this new approach, Artzi submitted an application for the BRIght Futures Prize.

“I felt both excitement and fear,” said Artzi. “I have a lot of experience presenting at scientific conferences. But I had little experience in talking to the public. But as a scientist, we’re trained to dive into new areas.”

Artzi and her lab worked tirelessly to engage with as many people as possible to raise awareness about their research, especially on social media.

“We did as much as we could, as fast as we could, and just when I thought we’d done everything possible to get the word out, we accelerated even more.” said Artzi.

Lab members from Mexico, Spain, Portugal, Brazil, England, Ireland, India, China and Israel began sharing news about the competition with people from their home countries and word spread rapidly. News stations became interested, and Artzi was soon interviewed by broadcasters in Israel. As the project began to go viral, messages of encouragement poured in.

“We got messages from families of brain cancer patients encouraging us to keep pursuing this project. Some said they knew it was too late for the work to help their loved ones, but they hoped it would save the lives of other children someday,” said Artzi. “There were so many times when I was in tears.”

The project also generated buzz closer to home — faculty members from the Neurosurgery Department have reached out to Artzi about future collaborations.

Artzi says the competition has given her team opportunities they could not have predicted.

“I didn’t anticipate that level of support and touching responses from people all around the world,” Artzi said. “The recognition, the excitement, and the hope it gave people — that’s what we came here to do. Saving lives is our dream, and this competition gave me a glimpse into how it could be.”

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From left: Rintaro Sato, Mark Zhang and Aaron Pikcilingis display the BWH Maps app.

A new smartphone app called BWH Maps, released by the Brigham Digital Innovation Hub (iHub), makes finding your way around the hospital easier than ever with real-time indoor navigation to more than 300 destinations on the main campus.

With functionality similar to consumer apps like Google Maps, BWH Maps uses Apple and Android smartphones’ native capabilities — including Bluetooth and Wi-Fi — to pinpoint your exact location inside the hospital, track your movement on the map with a blue dot and deliver turn-by-turn walking directions to your chosen destination on the main campus. The mobile app is free and available for download by employees and the public.

“The Brigham is a big place, which can make it challenging to navigate. Whether you’re visiting a sick loved one in the hospital or you’re an employee trying to get to your next meeting in a hurry, the last thing you want to worry about is figuring out how to get there,” said Mark Zhang, DO, MMSc, iHub’s medical director. “Having an easy, reliable and fast tool in scenarios like these can be a godsend.”

With the release of BWH Maps, Brigham Health is the first organization in the Partners HealthCare system to support real-time indoor navigation on mobile devices. Earlier this year, iHub launched the BWFH Maps mobile app, which provides the same functionality for Brigham and Women’s Faulkner Hospital.

Aaron Pikcilingis, an innovation specialist at iHub and one of the project leads, said the value of the app was quickly proven whenever he and iHub colleague Rintaro Sato, an innovation and operations analyst, would walk around the main campus to test out and finetune the app.

“Pretty much every time Rin and I were out testing the app, we’d wind up using it to help five or six people who needed directions,” Pikcilingis said. “It’s amazing how the app makes it so easy to assist someone even if you don’t personally know where their destination is.”

A Game-Changer

Kelsey Craig, volunteer program and training coordinator in the Office for Sponsored Staff and Volunteer Services, sees tremendous potential for the app among her volunteer corps. For the past two years, all college volunteers enrolled in the Medical Career Exploration Program have been required to complete a rotation as wayfinders, a role in which they make themselves available in high-traffic areas of the main campus to proactively assist anyone who looks lost.

Until now, volunteers would direct patients and visitors using a printed map containing some general information about key areas of the hospital — such as the locations of entrances, bathrooms, amenities, elevators and some larger clinics — but it can’t compare to BWH Maps’ robust database of destinations, which include all patient-facing areas, most conference rooms and more.

Craig has begun training volunteers to use the app when providing directions. Volunteers will also show patients and visitors how to download the app themselves so that they can take advantage of the location-tracking feature and turn-by-turn directions on their own smartphones.

“Being able to pull up directions on their phone will be a game-changer for our volunteers,” Craig said. “They will be able to provide an answer more quickly and efficiently, leading to a better experience for our patients and families. In addition, I think the fact that volunteers are using a device they’re already comfortable with, rather than rustling through a packet of papers, will allow them to feel more confident helping someone — which in turn leads to better customer service.”

Building on Success

Since beta testing the BWH Maps app this spring, the iHub team has added more destinations to its database, improved the reliability of the location-tracking function and added an “offline mode” feature that enables the app to continue providing directions even if the device loses its internet connection.

The smartphone app builds on the success of a browser-based predecessor, maps.brighamandwomens.org — an effort previously led by Josie Elias, MBA, MPH, former iHub program manager for Digital Health Innovation. The website, which allows users to plot out directions in advance, remains available and will continue being updated by the team.

The most popular destinations accessed in the browser-based version have been clinics that use Medumo, a digital health tool that sends patients text messages with appointment reminders and other important information — including directions to the clinic via maps.brighamandwomens.org — in advance of their visit. The iHub team hopes to build a similar functionality with the BWH Maps mobile app and is beginning to explore opportunities for future integration with other Brigham apps and operations.

In addition to internal collaborations with departments such as Facilities and Patient Access Services, the iHub team worked with wayfinding technology vendor LogicJunction on both projects.

“Everyone who works here wants to be helpful, but sometimes you just don’t know the answer when a patient or colleague asks you how to get somewhere,” Zhang said. “This app is a great way to empower all of us to provide the best experience.”

Find BWH Maps in the Apple App Store or Google Play Store, or visit maps.brighamandwomens.org.

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Robert Chelsea, shown before and after undergoing a face transplant at the Brigham.

When Robert Chelsea noticed his car was overheating while driving on a California freeway six years ago, he never could have imagined the life-altering trauma that would occur just moments after he stopped his vehicle on the side of the road.

Chelsea, who had been on his way home from church, was sitting in his car when a drunk driver struck his disabled vehicle. It burst into flames — resulting in a fiery explosion that burned over 60 percent of Chelsea’s body and face. After being rescued by a bystander and rushed to a nearby hospital, Chelsea remained in a coma for six months and hospitalized for a year and a half. During that time, he underwent more than 30 surgeries. His injuries drastically altered his physical function and appearance. His lips, part of his nose and left ear were unable to be reconstructed, and his face was severely scarred.

After learning about face transplantation, Chelsea and his family pursued the option, in the hope that he could qualify for and receive a face transplant. In July, Chelsea, at age 68, became the first black patient, and the oldest, in the U.S. to receive a full face transplant in a procedure performed at the Brigham.

The 16-hour surgery, involving a team of over 45 physicians, nurses, anesthesiologists, residents and research fellows led by Bohdan Pomahac, MD, was the ninth face transplant procedure at the Brigham and the 15th nationwide.

“Despite being the oldest face transplant patient at 68, Robert is progressing and recovering remarkably fast,” said Pomahac, the Roberta and Stephen R. Weiner Distinguished Chair in Surgery and director of Plastic Surgery Transplantation at Brigham Health. “We are looking forward to seeing a significant improvement in Robert’s quality of life.”

Making History

The Brigham performed the nation’s first full face transplant in 2011 and has long been recognized as one of the world’s leaders in transplantation. The institution’s other transplant milestones include the first successful human organ donor transplant, a kidney, in 1954; the first heart transplant in New England in 1984; the first heart-lung transplant in Massachusetts in 1992; and the first bilateral hand transplant in New England in 2011.

From left: Robert Chelsea speaks with Bohdan Pomahac during a recent follow-up appointment.

After evaluation by Pomahac, and an extensive screening process, Chelsea became eligible for a face transplant in March 2018. His wait for a donor was longer than that of previous Brigham face transplant recipients due to the effort to find a match that would work for Chelsea’s skin tone. This was complicated by the fact that the number of black organ and tissue donors is disproportionately smaller — and range of skin tones much larger — compared to white donors. The gap is caused by several issues, but numerous studies have shown that chief among them is a broad mistrust of the U.S. medical system by many black Americans due to the racism that African-American patients experienced throughout the nation’s history.

Chelsea is the first-known black patient to receive a full face transplant; another black patient in Paris received a partial face transplant in 2007. The care that Chelsea received at the Brigham reflects the institution’s commitment to reversing the health disparities that patients of color nationwide continue to face today.

“It is vitally important for individuals of all races and ethnicities to consider organ donation, including the donation of external grafts, such as face and hands,” said Alexandra Glazier, president and CEO of New England Donor Services. “Unlike internal organs, the skin tone of the donor may be important to finding a match.”

A follow-up study of face transplant recipient outcomes, recently published in The New England Journal of Medicine, found the Brigham’s first face transplant patients had a robust return of motor and sensory function of their face, as well as functionality, allowing them to socially reintegrate in a way that would not have been possible pre-transplant. These data indicate Chelsea is likely to achieve near normal sensation and about 60 percent restoration of facial motor function within a year, including the ability to eat, smile and speak normally.

“Our previous experience has demonstrated that face transplantation is a viable option for patients with severe disfigurement and limited function who have no alternatives,” said Pomahac. “As we continue to expand this treatment to more patients, we are exploring the ways in which we can quantify how much benefit our patients receive as well as identifying opportunities to limit the risks of this transplant through new immunosuppression protocols.”

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Jennifer Beatty

Physician Assistant (PA) Week is held Oct. 6–12 to honor physician assistants’ substantial role in improving health. In celebration of Brigham PAs and their involvement in nearly every facet of the care across the institution, Brigham Bulletin is highlighting one of the many exceptional physician assistants to cap off PA Week this year.

Looking back on when she joined the Brigham a decade ago as a new physician assistant in the Department of Surgery, Jennifer Beatty, PA-C, still remembers how daunting it all felt at first. Having made a career jump from physical therapy to medicine, she was filled with excitement and anticipation for this next professional chapter.

“Starting off as a brand-new PA was overwhelming. Trying to figure out how to care for complex patients while learning the ins of outs of an academic medical center — it took me a good year to 18 months to feel comfortable rotating into difference services,” Beatty recalled.

Now as the department’s first director of Surgical PAs and Clinical Operations — leading more than 100 surgical PAs and championing multidisciplinary process-improvement efforts — she draws on her years of experience at the bedside and operational expertise.

Continuing to devote 30 percent of her time to clinical practice, Beatty emphasized that staying close to patient care is essential for obtaining an authentic perspective on challenges and opportunities for surgical PAs.

“It’s hard to really know what the problems are without seeing what is happening on the floor, so having someone who can be a link between more senior leaders and frontline clinicians is vital as we all come together to set objectives and improve care,” said Beatty, who has served as director since March.

Among several projects she’s working on is a multidisciplinary effort to streamline patient flow and discharge processes for the Extended Recovery Unit, which serves patients who require overnight observation after a procedure.

Joy Brettler, PA-C, chief physician assistant in the Department of Surgery, applauded Beatty as a tremendous advocate who excels at identifying operational barriers and implementing smart interventions.

“As a surgical PA with nearly a decade of experience as part of the inpatient teams that provide care in General Surgery and Burn/Trauma, Jen understands the logistical issues each department has with hiring, training and retaining PA staff,” Brettler said. “Having her represent our voice and opinions on how to properly integrate and maximally utilize our skills is a huge asset.”

Malcolm Robinson, MD, associate chair of Surgery for Clinical Operations for the Department of Surgery and director of the Nutrition Support Service for its Division of Gastrointestinal and General Surgery, agreed that Beatty was an ideal fit for this new role.

“Jen is an excellent clinician who has the respect of her colleagues. She is a great leader and problem-solver, and she is a hard worker who collaborates well with health care professionals at all levels of responsibility and authority,” said Robinson said. “We are fortunate to have her and look forward to working with her for years to come.”

Above all, Beatty noted she is proud to be part of such an extraordinary group of PAs at the Brigham and have the support of her colleagues as well as hospital leaders, the latter of which include not only Robinson but also Gerard Doherty, MD, chair of Surgery; Kevin Hart, MBA, senior director of Clinical Operations for Surgery; and Jessica Logsdon, MHS, MHA, PA-C, senior director of PA Services.

“PAs have been in the Department of Surgery for 30 years, and we historically haven’t had an administrative structure to support their growth. The hope is that other departments see what we’re doing and adopt a similar model,” Beatty said. “We’re trailblazing a new level of support that our PAs deserve.”

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Left: Karen Bruynell in 2016, before embarking on her weight-loss journey. Right: Bruynell in 2019, after completing a recent 5K.

When Karen Bruynell, administrative director of Brigham Education Institute (BEI), sets a goal, she doesn’t stop until it’s achieved. So, when she decided to compete in 5K races in all 50 states, she hit the ground running — literally.

The idea came to her as part of a two-year weight-loss journey. In March 2017, at age 53, Bruynell realized several health issues were hindering her day-to-day activities. She began to change her lifestyle and improve her health, including undergoing bariatric surgery that fall. In January 2018, Bruynell embarked on her personal challenge to run throughout the country.

Since starting her journey and losing a total of 140 pounds, Bruynell, now 55, has competed in Florida, New York, Tennessee, Texas, Virginia and every state in New England. She set a goal to run in at least 10 states each year to complete the map by age 60.

But maintaining a healthy weight is not the only thing that motivates Bruynell to keep going. With every step, she is reminded that each charity race she runs benefits people all over the country.

“It’s great to be indirectly connected to people through a cause. I like the idea of being able to help everyone through donations and raising awareness, even if I only play a small part,” said Bruynell.

Many of the causes have personal connections. Bruynell participated in a charity run for multiple sclerosis research in honor of a colleague living with the disease. She selected a 5K in Arlington, Va., that benefited the maintenance of Mount Vernon — a place Bruynell cherishes because of her love for history. She also completed a race benefiting people with brain injuries in honor of her stepmother, who recently experienced a stroke.

One of the most poignant and touching events was a race she didn’t select for herself.

This past May, Bruynell’s youngest son suggested she take part in “Tracy’s Run,” a race dedicated to supporting individuals with mental health issues, in Gilford, Conn. What he didn’t know then was that Bruynell had lost her best friend, who lived in Gilford, to suicide 14 years ago. She said completing that race was an experience she will always hold close to her heart.

Drawing Inspiration

In addition to competing in about four 5Ks a month around the U.S., Bruynell maintains her athletic prowess by remaining active in local running programs, including the Brigham’s, and has participated in the Boston Athletic Association (B.A.A.) 5K and 10K races while fundraising on behalf of the hospital.
“The Brigham Running Program is excellent. The leaders’ enthusiasm is so great and helpful. It makes me consider running a marathon,” said Bruynell.

Cheering her on from not only the sidelines but also, in some cases, alongside her are Bruynell’s BEI colleagues. Anna De Cristofaro, senior administrative coordinator at BEI, said Bruynell inspired her to get back into running after taking a hiatus due to a prior injury. De Cristofaro has completed three races with Bruynell by her side, including one in Florida.

“Karen has been a great encouragement for me to get out there and get active with running again, and she is the sole reason why I pushed myself to start competing in more 5Ks,” said De Cristofaro. “She’s excelled immensely and exudes confidence in every workout she does.”

Looking to the future, Bruynell strives to make additional progress each day. Since embarking on her unexpected running career, Bruynell has improved her per-mile pace by five minutes, and in a recent race placed first in her age category. She plans to push herself to compete in longer races, such as 10Ks and half-marathons, more frequently.

“I am constantly striving to become better, and running presents me with that challenge,” she said. “Since deciding to follow through with my running goal, I feel like my life has just started.”

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