OUTCOMES REPORT 2020

Forward Together

Greetings from UTHealth Neurosciences and best wishes for a healthy 2021. In spite of COVID-19, 2020 was a year of growth for us. We brought together two departments at McGovern Medical School at UTHealth, both of which have rich histories of accomplishment in clinical care, teaching, and research: the Department of Neurology and the Vivian L. Smith Department of Neurosurgery. In the process, we streamlined operations and improved efficiency to better serve our patients.

UTHealth Neurosciences now has 141 clinical providers at 15 locations across Greater Houston, 41 research faculty based primarily at the Texas Medical Center, and robust residency and fellowship programs training 113 physicians and physicianscientists. We continue to deliver excellent outcomes for our patients, as evidenced by the mortality and length of stay data you’ll see in this report.

In 2019, the Department of Neurosurgery was ranked No. 8 nationally in research funding awarded by the National Institutes of Health to neurosurgery departments, based on data compiled from the NIH Research Portfolio Online Reporting Tools by the Blue Ridge Institute for Medical Research. The Department of Neurology was also ranked No. 22 nationally, and our combined departments have an annual budget of $31 million. Our congratulations to Claudio Soto, PhD, professor and director of the George and Cynthia W. Mitchell Center for Alzheimer’s Disease and Other Brain-Related Illnesses, and to Georgene Hergenroeder, PhD, associate professor in the Department of Neurosurgery and director of the Innovation and Quality (IQ) Program at UTHealth Neurosciences, both of whom ranked high in NIH research funding. Soto is No. 6 among principal investigators of NIH-funded clinical science research studies in neurology, and Hergenroeder is ranked No. 7 in NIH funding for all neurosurgery research funding.

This year’s outcomes report gives perspective on the strength, depth, and breadth of UTHealth Neurosciences. GQ Zhang, PhD, Samden Lhatoo, MD, and Nitin Tandon, MD, are using big data to expand our patient care footprint, creating a new clinical care and research paradigm for our group. We have redefined fast treatment for acute stroke by creating a citywide network of accessibility for patients. Along with the downside of COVID-19, the pandemic has given us an opportunity to communicate with our patients in new and more convenient ways, thanks to robust technological support from UTHealth.

Our team of clinicians and scientists at UTHealth Neurosciences has taken us well down the road to our destination: to be the premier provider of neurosciences services in the nation. We are grateful to our providers, researchers, staff, and patients for pulling together during the pandemic to make all this possible.

With best wishes,

World-Class Neuroscience with Exceptional Patient Experiences

UTHEALTH NEUROSCIENCES has a long-standing reputation for innovation, high-quality outcomes, and the best possible health care experiences, which draws patients from around the world. Our clinicians, researchers, and educators are nationally recognized as leaders in medicine and consistently ranked by quality benchmarking organizations as leaders in clinical quality and patient safety. Their insights, technological innovations, and success at bringing research findings to the bedside quickly are helping to transform neuroscience.

Our clinician team is part of McGovern Medical School at UTHealth. We are Houston’s undisputed leader in neuroscience care and the foremost neuroscience provider in the southern half of Texas. We have extended our continuum of care by creating a citywide network of neurologists, neurosurgeons, neurointerventionalists, neuro oncologists, radiation oncologists, interventional pain management specialists, neurocritical care physicians, neuropsychologists, and advanced practitioners. By building a new structure for the practice of neurology in the community, we have reduced referral wait times.

Our clinicians in Houston’s suburbs analyze quality data and track outcomes as a group using the same standards employed by their counterparts at UTHealth Neurosciences locations in the Texas Medical Center. We continually modify our clinical practice to ensure exceptional patient experiences. For 13 years, our physicians have reported mortality rates well below the national expected benchmark, with a 50 percent reduction in length of stay, despite the increased acuity of our patients. Through the Innovation and Quality (IQ) Program, the Texas Institute for Restorative Neurotechnologies, and other initiatives, our leaders are organizing data to improve physician and service performance. We’re also measuring quality and tracking long-term outcomes through clinical trials, and using big data – the enormous amount of information available in the medical datasphere – to advance patient care.

At a Glance

PHYSICIAN TEAM
Staff Physicians 104
Clinical Residents and Fellows 113
Medical Students on Rotation 315
Research Fellows 41
Advanced Practice Providers 37

RESEARCH
Research Projects in Progress More than 200
Grants Awarded Over $50 million
(Neurology and Neurosurgery)

SPECIALTY EQUIPMENT INCLUDES:

• Leksell Gamma Knife® Perfexion™ and Icon™
• Varian Trilogy™ and Edge™ Linear Accelerator
• Siemens Artis zee (intra-operative angiography suite)
• Robotic SEEG (ROSA®)
• RP-7™ Remote Presence System
• 3D C-Arm
• Philips Healthcare endovascular temperature
  modulation system
• Simultaneous electroencephalography
  and polysomnography
• Continuous EEG monitoring
• Magnetoencephalography imaging
  (Magnes Elekta Neuromag® TRIUX)
• MRI capable of advanced spectroscopic
  and diffusion tensor imaging with tractotomy
• Portable CT machine
• Nihon Kohden EEG 1200 machine with
  NeuroWorkbench® data management software
• Viking Nicolet EMG machines (2 freestanding)
  & Viking NicVue EMG machine (1 portable)
• Phillips CX50 sonography machine (4)
• LivaNova VNS Therapy® devices
• Allergan BOTOX Injection Amplifier®
• Medtronic DBS programmer – Samsung tablet

FELLOWSHIPS
McGovern Medical School at UTHealth offers multiple postgraduate fellowships in neurology and neurosurgery.

Department of Neurology

• Clinical Neurophysiology Fellowship
• Epilepsy Fellowship Movement Disorders Fellowship
• Multiple Sclerosis Clinical/Research Fellowship
• Neurocognitive Disorders Fellowship
• Neurohospitalist Fellowship
• Neuropsychology Postdoctoral Fellowship
• Vascular Neurology Fellowship

Vivian L. Smith Department of Neurosurgery

• Cerebrovascular/Skull Base Fellowship
• Neurocritical Care Fellowship
• Neuroendovascular Surgery Fellowship
• Pediatric Neurosurgery Fellowship
• Spinal Neurosurgery and Peripheral Nerve Surgery

Expanding the Patient Footprint: Big Data Creates a New Clinical Care and Research Paradigm at UTHealth Neurosciences

EVERY TWO DAYS humans generate as much data as were generated from the dawn of civilization through the year 2003. With hospitals gaining a greater footprint in the collection of biomedical and health data, the repository of clinical information is now growing at a rate of about 50 percent annually.

The enormous amount of information available in the medical datasphere has the potential to advance patient care dramatically, if clinicians can access the knowledge it generates. How to organize data and derive value from it is the area of expertise of GQ Zhang, PhD, professor of medicine, biomedical informatics, and public health, and vice president and chief data scientist at The University of Texas Health Science Center at Houston (UTHealth).

“Big data is changing the entire way we practice medicine,” says Zhang, who also is co-director of the Texas Institute for Restorative Neurotechnologies (TIRN) at UTHealth Neurosciences, which integrates efforts across specialties and schools at UTHealth to advance clinical research and patient care for epilepsy and other functional neurological disorders. “A couple of decades ago, the digital footprint for patient care was virtually nonexistent, and how a physician treated his or her next patient was based solely on education, training, personal experience, and the medical literature, or on the experience of other physicians via consultation. This type of empirical knowledge cannot be shared quickly and widely. Health information technology, artificial intelligence (AI), and big data have the potential to empower caregivers with very precise knowledge at their fingertips to help them make the right intervention decisions in the right context. And this is just the beginning. The possibilities are limitless.”

What Zhang is developing with neurologist Samden Lhatoo, MD, FRCP (Lon), neurosurgeon Nitin Tandon, MD, and others at UTHealth Neurosciences, leverages their prior experience with epilepsy at TIRN and applies it to other areas such as cerebrovascular disease and stroke. “In the current paradigm, physicians see patients in the traditional office setting and enter data into the electronic health record (EHR). We extract it, clean it up, and load it into a registry database to be used in research. This is an expensive, time-consuming process with a long lag time and less value,” says Lhatoo, who is professor and John P. and Kathrine G. McGovern Distinguished Chair in the Department of Neurology at McGovern Medical School at UTHealth, director of the Texas Comprehensive Epilepsy Program (TCEP), and codirector of TIRN. “Instead, we’re leveraging data and providing innovative interfaces around those data so that they can be captured more efficiently and used to drive clinical care. Our interfaces are developed based on physician input and physician experience, so they save physicians time. With the current EHR system, physicians struggle with all kinds of issues. We’re making that process more efficient so that clinicians can spend more time caring for patients and physician scientists have more time for research.”

Most of us are familiar with gigabytes, and some may have heard of terabytes, petabytes, and exabytes. In 2015, the scale of the entire datasphere – all the digital information available – was four zettabytes. By 2025, the datasphere is projected to exceed 75 zettabytes, according to Lhatoo.

“That kind of exponential growth in digital information is a huge boon to the way we provide patient care,” he says. “For cerebrovascular disease and stroke, there are big questions we’ll eventually be able to answer, for instance, how best to respond to stroke with a precise diagnosis that can save people’s lives. We’re deriving data from the care we provide to help us understand disease outcomes and the efficiency and effectiveness of care delivery systems, from the time a stroke patient arrives at the hospital all the way through rehabilitation.”

Zhang describes the system they are developing as a spectrum of specialty-specific vertical systems. “To generate high-quality data in the context of patient care and make that data immediately available to researchers, we use a custom-tailored EHR approach specific to each specialty,” he says. “We can quickly customize our general architecture design to disease areas to fill gaps in our database system that prevent us from capturing and integrating valuable real-time information. Our goal is to break down traditional barriers and better leverage information holistically across our entire academic medical system for greater patient benefit. Our system is patient centric and improves the quality, velocity, and experience of the patient journey, taking physician needs into consideration.” Big data is about more than the traditional three Vs: volume, veracity, and velocity. Zhang adds “value” as the fourth V.

“We’re talking about a frame of mind,” he says. “It’s about being open minded, having a bigger vision, thinking globally, and asking a bigger question. This bigger vision will allow us to perceive the health care
landscape on a grander information scale and gain more collective value. Data can be replicated an infinite number of times. It can be transported at the speed of light. The value of big data can be much more than the sum of its parts. We’re making data findable, accessible, interoperable, reusable, and more importantly interactable. Data is a commodity that should be carefully
curated for the common good.”

There also is the concept of the Internet of Things – the network of physical objects embedded with sensors, software, and other technologies for the purpose of connecting and exchanging data with other devices and systems through the Internet. “Everything is connected, whether it’s your electronic health record, the data from your smart watch, or data in the cloud,” Lhatoo says. “These things will eventually all connect with each other. It’s a mindboggling concept to grasp but it isn’t inconceivable that one day the computer in your car will be able to monitor some aspect of your physical health, like how long you’ve had to sit in traffic and how that relates to your stress level. There is every reason to believe that these platforms eventually will interact with the platforms your doctor uses. The concept has been with us for some time. We’re now getting the processing power to create what previously has been a science-fiction scenario.

“We have a world-class informatics team,” Lhatoo adds. “We have world-class researchers who understand how to leverage biomedical informatics expertise for research and health care delivery. What is
unique about UTHealth, TIRN, and the School of Biomedical Informatics is that we already are using this expertise in the everyday delivery of patient care. A good understanding of disease processes is what informs preventive health care. In the U.S. today, we are very good at disease care, but we’re not necessarily where we need to be with preventive care, which is the real ‘health’ care. But big data is helping us get much closer.”