Friday, September 20, 2024 | New York Academy of Medicine (NYAM)
1216 5th Ave, New York, NY 10029
Dr. Robert Headrick, MD, MBA, discussed the challenges and successes of implementing mobile lung screening over the past eight years. He highlighted the evolution of the mobile units, from initial design flaws to achieving a robust, efficient system that screens thousands of patients annually. Dr. Headrick emphasized the importance of addressing logistical issues, such as HVAC systems and data transmission, and shared insights on future improvements, including the potential use of Tesla cabs and AI tools.
Watch Dr. Robert Headrick's Presentation Below:
See Dr. Robert Headrick's Slides Below:
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Transcript of Dr. Robert Headrick's Presentation:
[David Maron] [0.24s] Okay.
[David Maron] [1.04s] So session five, practical challenges in implementation.
[David Maron] [9.28s] And our first speaker today is is doctor Rob Headrick, who will talk about mobile lung screening challenges.
[David Maron] [16.30s] Doctor Headrick.
[Robert Headrick] [20.13s] Thank you, and it's great to be here.
[Robert Headrick] [22.77s] I was given eight minutes to talk about a journey that's taken eight years so far to speak about the challenges that we've incurred.
[Robert Headrick] [31.12s] There's a lot more than what's been in this slide, but there's a lot of positive things too.
[Robert Headrick] [36.64s] So if you look at where we are in the current state, we now have probably two dozen medical centers either with the bus delivered or in the process of implementing lung screening.
[Robert Headrick] [48.95s] We have the VA Medical Center now adopting it.
[Robert Headrick] [51.67s] We had Alberta, Canada, looking at a a province wide process.
[Robert Headrick] [57.09s] They were just down our site.
[Robert Headrick] [58.29s] We're getting calls weekly to come down and start the process of initiating.
[Robert Headrick] [64.05s] We also have the first, mini fellowship approved by our thoracic surgery, foundation where we got a physician from Ochsner Clinic who's gonna be coming up and spending two weeks with us in the mobile program, and then we're gonna help them set that back up in the rural, Southern New Orleans area.
[Robert Headrick] [82.23s] This month, we hit our ten thousandth patient we screened through a mobile process, and we've got about a seventy percent compliance rate.
[Robert Headrick] [91.27s] It sounds easy, but here's the the the backstory.
[Robert Headrick] [96.15s] You You have a thoracic surgeon building a mobile bus that doesn't exist with funding that's questionable and a lot of people, not necessarily supporters, but a lot of naysayers.
[Robert Headrick] [111.30s] There was no one who had built one.
[Robert Headrick] [112.90s] There was no data driving it, and you've gotta build something that is literally from scratch with willing to make lots of mistakes.
[Robert Headrick] [122.26s] So the beauty of it is we've all survived.
[Robert Headrick] [125.87s] We've had great partners.
[Robert Headrick] [127.31s] Go to Foundation has been incredibly patient and supportive of our second bus.
[Robert Headrick] [132.82s] It's getting getting ready to be, delivered again on end of this month.
[Robert Headrick] [137.75s] We went through a pandemic.
[Robert Headrick] [138.87s] We went through sales of ownership of building the buses.
[Robert Headrick] [142.15s] We went through supply chain shortages, but I think we're on the better side of that curve with a lot more knowledge.
[Robert Headrick] [149.35s] So why did I why did a thoracic surgeon do this?
[Robert Headrick] [153.32s] So I was frustrated 02/2015 with the lack of adoption of lung screening.
[Robert Headrick] [157.81s] And just like everybody else from the original, meetings we had all surrounding it, the with the American Cancer Society.
[Robert Headrick] [168.13s] I just go, I can't keep getting mad at the people or the process if I'm not understanding what the issue was.
[Robert Headrick] [173.41s] I narrowed it down till we had two issues.
[Robert Headrick] [175.33s] We had a messaging problem, meaning nobody outside of my circle knew anything about lung screening, and we had a listening problem.
[Robert Headrick] [182.25s] We weren't listening to the patients.
[Robert Headrick] [184.41s] They're not willing to spend a whole day getting a screening test that they don't really want for a process where they're currently asymptomatic.
[Robert Headrick] [194.00s] How much time were they willing to give us?
[Robert Headrick] [196.14s] Turns out the same time as this talk.
[Robert Headrick] [199.42s] It equates to the same amount of time a human will wait for a meal you need, but you don't really want.
[Robert Headrick] [205.82s] And that's what will equate in the South to a McDonald's.
[Robert Headrick] [208.78s] You may wait slightly longer for a Chick fil A or something you perceive as higher quality, but it's not ours.
[Robert Headrick] [215.04s] So I felt like we gotta get the message out.
[Robert Headrick] [217.53s] We have to execute a screening study in five to seven minutes, and there's no way I can do it in the brick and mortar buildings we have.
[Robert Headrick] [223.86s] So that's what led to the as we are putting lung cancer screening together, a mobile one piece of the puzzle was I felt had to be a mobile.
[Robert Headrick] [233.78s] We had to go to the patients and make it that simple, but also create something that allowed for the messaging to take place in the education.
[Robert Headrick] [241.33s] I'll tell you eight years into this process is way different than year one.
[Robert Headrick] [245.41s] Our current bus is at max capacity.
[Robert Headrick] [248.85s] Over 3,000 people scanned on it per year.
[Robert Headrick] [251.50s] It's booked a year in advance.
[Robert Headrick] [254.06s] We used to have to go out and not beg, but we had to spend a lot of time getting somebody to allow us to come in and screen patients or show up in a community and have people come on board.
[Robert Headrick] [263.90s] We go to communities now.
[Robert Headrick] [265.02s] They sign themselves up.
[Robert Headrick] [266.74s] So it is an eight year journey.
[Robert Headrick] [268.25s] It's been painful, but we're certainly way further along.
[Robert Headrick] [272.18s] So I'm a go through some of the issues that when people come for a site visit, they ask us what were our challenges, the same challenges they may be talking about.
[Robert Headrick] [279.45s] And first is what type of bus.
[Robert Headrick] [282.40s] Second is the most critical component of the bus turned out to be the HVAC unit, which we weren't aware of when we started the process, how we operate the bus, how we would get the results reported, and how do we get default compliance.
[Robert Headrick] [295.44s] So you can build a box truck, which is what we currently have.
[Robert Headrick] [298.08s] You can have an RV, which is what we start out with.
[Robert Headrick] [300.49s] You can have a tractor trailer.
[Robert Headrick] [302.16s] They all have different build, issues, and they also have different limitations.
[Robert Headrick] [308.72s] So we started out with the quickest thing I could do.
[Robert Headrick] [311.75s] Once I had funding from some local donors to do this, I went to Cedar, Falls Iowa where, Winnebago is.
[Robert Headrick] [319.11s] We purchased the largest chassis, which is 27,000 pounds, took an old 16 slice CT scanner that Siemens help us helped us make it a little bit more robust.
[Robert Headrick] [328.93s] They were concerned it wasn't gonna stand the vibrations and all the road challenges.
[Robert Headrick] [332.93s] And I built it exactly like an imaging center we see in the hospital, and everything about that was wrong.
[Robert Headrick] [338.25s] A recreational vehicle could not carry the weight and sustain it.
[Robert Headrick] [342.01s] So at year three, it was taken off the road for safety reasons.
[Robert Headrick] [345.05s] The chassis was fractured.
[Robert Headrick] [346.81s] The throughput was restrictive of coming in and out of how we go into radiology departments.
[Robert Headrick] [352.54s] But also the HVAC system, you have to maintain a certain temperature and humidity control for that CT scanner to be happy with the environment.
[Robert Headrick] [360.23s] It'll shut down if you're not in that range.
[Robert Headrick] [362.79s] When Tennessee gets to be a hundred degrees and humidity is stifling, And you're opening the door, letting people in and out, as my dad used to yell at us, shut the door.
[Robert Headrick] [372.39s] We're losing factory air.
[Robert Headrick] [373.83s] It was something you can't control with normal recreational HVAC units.
[Robert Headrick] [378.23s] So we went through probably 25 different HVAC units.
[Robert Headrick] [381.51s] And we have learned that the concept worked, but the design build was completely wrong.
[Robert Headrick] [387.25s] So we went back to it and said it needs to have a ten year lifespan.
[Robert Headrick] [390.44s] We need to double the chassis weight, make sure that the transmission engine components are gonna last, But we need to create something that can be repaired locally wherever that bus is.
[Robert Headrick] [399.88s] So if I'm building one that exists in the country, not 10, and that builder's five hours away and we have a problem, how do we fix it?
[Robert Headrick] [406.52s] How do you not shut down the program?
[Robert Headrick] [408.04s] How do you get back and forth?
[Robert Headrick] [409.65s] So we went with diesel.
[Robert Headrick] [410.77s] We went with something that a local diesel mechanic could get through and fix for us.
[Robert Headrick] [415.25s] We want to minimize the cost to build it just to ensure the success of the, project.
[Robert Headrick] [421.18s] Had to navigate all of our rural trains, and we wanna hit that 3,000 goal that we achieved this past year.
[Robert Headrick] [427.04s] So that's the current bus.
[Robert Headrick] [428.40s] Three years into it has done beautiful, except now we had a diesel generator failure.
[Robert Headrick] [434.74s] Seems simple, except supply chain issues still exist, shut the bus down for three weeks.
[Robert Headrick] [438.81s] We lost 300 patients in our screening process.
[Robert Headrick] [441.94s] Some of those are annuals, so we have to now work back into the system.
[Robert Headrick] [445.13s] So mechanical failures of it are are real.
[Robert Headrick] [449.45s] In doing so, we then take that information on the future buses, have tried to modify things that would, improve that performance.
[Robert Headrick] [460.10s] From a where are we at with this kind of a build?
[Robert Headrick] [463.38s] You have to buy chassis from Freightliner or Kenworth, gotta wait for it to be built, deliver to the company, and then you're building the box piece on it.
[Robert Headrick] [472.33s] There's a better solution.
[Robert Headrick] [475.44s] The the Tesla cabs are fascinating from an engineering standpoint.
[Robert Headrick] [480.00s] You can buy a cab, hook it up to a trailer.
[Robert Headrick] [482.08s] It doesn't have to be the same length as an 18 wheeler.
[Robert Headrick] [484.40s] And you can have one cab and multiple trailers, and you can build them simultaneously.
[Robert Headrick] [488.33s] So we'll go from a year or two or three build time to short few months.
[Robert Headrick] [493.77s] And you can also operate at a lower cost by doing it.
[Robert Headrick] [496.65s] What's the big elephant in the room?
[Robert Headrick] [498.33s] This is one of the examples that you've seen this week.
[Robert Headrick] [500.89s] The battery.
[Robert Headrick] [502.16s] 10,000 pounds lithium battery.
[Robert Headrick] [504.64s] Fire risk are not high, but certainly realistic.
[Robert Headrick] [508.24s] So one of the Tesla cabs driver probably fell asleep, hit a tree, caught on fire.
[Robert Headrick] [514.96s] You've got 63,000 lithium ion cells in it.
[Robert Headrick] [518.65s] Each has six liters of gas.
[Robert Headrick] [520.58s] You're emitting almost 400,000 liters of a toxic gas that's now a biohazard.
[Robert Headrick] [525.54s] You have to have hazmat suits, and water will not put out a lithium fire.
[Robert Headrick] [529.86s] It just cools the temperature down.
[Robert Headrick] [531.62s] So sixteen hours shut down the freeway.
[Robert Headrick] [534.18s] The trailer was engulfed in the fire.
[Robert Headrick] [536.26s] So whatever we have attached to that to that cab is gonna be ruined also.
[Robert Headrick] [540.74s] There's ways of mitigating it, and I think these are problems that are easily solvable.
[Robert Headrick] [544.49s] But what I think this might do is shorten our build time, get more on the road quicker, and actually make it simpler to to manage.
[Robert Headrick] [553.61s] Temperature issues, if you're in Alberta, Canada and you're 20 below zero, how's the battery work?
[Robert Headrick] [558.55s] Diesel fuel doesn't work there well there either.
[Robert Headrick] [560.95s] There's a lack of infrastructure for them, but you can go 300 to 500 miles, so it's not really necessary.
[Robert Headrick] [565.75s] You're not driving it as you're doing a cross country.
[Robert Headrick] [568.79s] I can tell you from a golf cart, I I had the first experience of a lithium battery that said 17% charged, and then thirty seconds later, it was zero wheels locked.
[Robert Headrick] [577.13s] I was stranded in the middle of our neighborhood on the street.
[Robert Headrick] [579.53s] Everybody came out and laughed at me.
[Robert Headrick] [581.13s] You cannot push an electric motor that is has zero battery charge.
[Robert Headrick] [585.93s] I had to talk my my pride, but, basically, you've gotta manage that all those things, but easily done.
[Robert Headrick] [594.33s] From a operating the bus, we just feel like a CDL driver needs to be there.
[Robert Headrick] [598.25s] We've gone through different models.
[Robert Headrick] [599.68s] We use a simple registrar using EPIC and communicating back to the hospital, then a CT tech, but that CT tech in the future is not gonna need to be there.
[Robert Headrick] [607.68s] Started with cell towers, unreliable actually started with dumping data at the end of the day.
[Robert Headrick] [611.68s] Radiologists hated it.
[Robert Headrick] [613.43s] Cell towers unreliable.
[Robert Headrick] [614.55s] We went to two cell towers.
[Robert Headrick] [616.79s] Still works, but not the best.
[Robert Headrick] [618.63s] Starlink is gonna solve that issue.
[Robert Headrick] [620.71s] Cheaper, more, HIPAA compliant, safer, faster.
[Robert Headrick] [625.54s] You have to have an AI tool to process the data.
[Robert Headrick] [627.77s] You now start talking about 10,000 people you're following in repetitive scans and in this database and how the radiologists handle it.
[Robert Headrick] [634.17s] It gets complex.
[Robert Headrick] [636.01s] We currently report coronary calcium scoring with the LODO CT from the bus.
[Robert Headrick] [641.69s] And then getting the results of the patients, you can't call them or mail them.
[Robert Headrick] [644.97s] It it just doesn't work.
[Robert Headrick] [646.65s] So we went to text messaging, HIPAA compliant, incredibly inexpensive, jumped from a 30% annual compliance rate to 70% where we currently are.
[Robert Headrick] [656.38s] What's coming?
[Robert Headrick] [657.18s] Apps.
[Robert Headrick] [658.07s] More as Appy shown me, how well patients adopt to it?
[Robert Headrick] [661.99s] Is it a whole lot better?
[Robert Headrick] [663.18s] It certainly functionally has a lot more promise, But these are things where we're going with testing these ideas, and all these things can be modified.
[Robert Headrick] [670.70s] We're now past the failure point to where it's more perfecting it.
[Robert Headrick] [676.62s] Compliance really came back to getting results same day, getting scheduled for the annual scan, text reminders, communication throughout other means in humans to, keep the process going.
[Robert Headrick] [688.88s] So there's way more than this that occurred.
[Robert Headrick] [691.27s] I'm happy if I have no financial stake in building the buses, partly because I didn't think it was gonna succeed.
[Robert Headrick] [697.33s] But second was also to be objective so that we can really solve this problem together.
[Robert Headrick] [702.21s] It's gonna continue.
[Robert Headrick] [703.09s] It won't be the same eight years from now.
[Robert Headrick] [704.85s] It'll have a different role, a different mission, different look.
[Robert Headrick] [707.74s] But anybody interested, I'm happy to sit down with you, help build business plans, see if it fits, but go through that process or entertain you.
[Robert Headrick] [715.42s] At our site, this is how to get in touch with me.
[Robert Headrick] [717.25s] Thank you.
The presentations were hosted by I-ELCAP – The International Early Lung Cancer Action Program.
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