Driving Medical Progress

by | Feb 27, 2024 | 2023, Research 2023

Susan S. Jacobs, MS, RN

Susan S. Jacobs, MS, RN

Driving Medical Progress

Susan Jacobs’ 25-Year Journey in Clinical Research Leadership

Susan S. Jacobs, MS, RN

Susan S. Jacobs, MS, RN

Driving Medical Progress

Susan Jacobs’ 25-Year Journey in Clinical Research Leadership

When Susan Jacobs, RN, MS, nurse coordinator and research nurse manager, started in the division of pulmonary, allergy, and critical care medicine (PACCM), there was no clinical trial program. “Part of the purpose of my position was to start it,” she says. And over the past 25 years, under her dedicated and driven direction, the clinical research program has grown immensely, from one or two treatment trials for patients with chronic lung diseases to roughly 30 different research projects and protocols overseen by about 15 principal investigators.

“Susan is one of the most competent, diligent, hardworking, and dependable colleagues I’ve ever had,” says Rishi Raj, MD, clinical professor of medicine at Stanford.

The clinical trials that Jacobs coordinates now span a wide variety of treatments and diseases. Some of the pulmonary diseases that the program provides treatment options for are common, like asthma, and some are rarer, like pulmonary fibrosis, lymphangioleiomyomatosis (LAM), post-lung transplantation rejection, and chronic lung infections like non-tuberculous mycobacteria.

The types of trials vary widely: Some are treatment trials for an investigational drug for a particular lung disease. Others are observational studies that utilize registries, where patients are monitored over time, and data such as bloodwork and pulmonary function are collected to try to better understand a disease. 

For example, “we might try to identify some biomarkers that could predict how a disease will progress,” Jacobs says.

One theme that ties all the clinical trials together: Jacobs’ “power and initiative,” as well as her expansive knowledge of clinical trial management, says Stephen Ruoss, MD, professor of pulmonary and critical care medicine. 

“She was the architect of some annual meetings of clinicians and faculty between our institution and others,” he says. “She’s got great organizational initiative and focus.”

When Susan Jacobs, RN, MS, nurse coordinator and research nurse manager, started in the division of pulmonary, allergy, and critical care medicine (PACCM), there was no clinical trial program. “Part of the purpose of my position was to start it,” she says. And over the past 25 years, under her dedicated and driven direction, the clinical research program has grown immensely, from one or two treatment trials for patients with chronic lung diseases to roughly 30 different research projects and protocols overseen by about 15 principal investigators.

“Susan is one of the most competent, diligent, hardworking, and dependable colleagues I’ve ever had,” says Rishi Raj, MD, clinical professor of medicine at Stanford. The clinical trials that Jacobs coordinates now span a wide variety of treatments and diseases. Some of the pulmonary diseases that the program provides treatment options for are common, like asthma, and some are rarer, like pulmonary fibrosis, lymphangioleiomyomatosis (LAM), post-lung transplantation rejection, and chronic lung infections like non-tuberculous mycobacteria.

The types of trials vary widely: Some are treatment trials for an investigational drug for a particular lung disease. Others are observational studies that utilize registries, where patients are monitored over time, and data such as bloodwork and pulmonary function are collected to try to better understand a disease. 

For example, “we might try to identify some biomarkers that could predict how a disease will progress,” Jacobs says.

One theme that ties all the clinical trials together: Jacobs’ “power and initiative,” as well as her expansive knowledge of clinical trial management, says Stephen Ruoss, MD, professor of pulmonary and critical care medicine. 

“She was the architect of some annual meetings of clinicians and faculty between our institution and others,” he says. “She’s got great organizational initiative and focus.”

She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.

— Stephen Ruoss, MD, professor of pulmonary and critical care medicine

Juggling the coordination of multiple studies in different phases is not without its challenges. Jacobs shares that keeping track of many moving parts is one of her most difficult and critical tasks. “Susan possesses an extensive knowledge of clinical trial protocols, having worked on a diverse range of studies across different therapeutic areas,” says Hope Woodworth, the PACCM finance and grants management specialist. “This expertise enables her to execute study procedures with meticulous precision while adhering to rigorous ethical standards and regulatory guidelines.”

Jacobs’ expertise has been indispensable as the number of trials has grown significantly the past few years. “We’ve had immense growth in the number of principal investigators in our division, the number of trials that are being offered,” says Jacobs. “That’s good — we want to support the fact that we need better treatments. For example, in pulmonary fibrosis, over the past 20 years, despite numerous trials, we only have two drugs that are FDA approved. So with that challenge, we have to keep going.”

That dedication to her patients shines through everything Jacobs does. “The patients love her,” says Ruoss. “They see her as the linchpin of the program. She’s been a committed, enduring support for our patients.” To that end, Jacobs initiated and organized several patient support groups, for LAM and interstitial lung disease. “Many patients are incredibly hard-hit by these diseases, and the support that the groups provide is critical for them,” says Ruoss.

In all that Jacobs does, her dedication to her patients shines. “She’s known by patients as a kind of fairy godmother for these chronic diseases,” he says. Caring for patients feeds right back into supporting research, as far as Jacobs sees it. “Our patients see clinical trials as a great opportunity, especially those who have exhausted all their treatment options,” she says. “Our study participants are incredibly dedicated and committed, and we are so thankful for their participation. We couldn’t complete these trials and get these drugs to market without them.”

Another role Jacobs plays is to help support junior investigators, faculty who are just starting their research careers and writing their own protocols. With her decades of experience, she is able to help guide young researchers along the way as they learn to navigate the ins and outs of clinical trials. “Her strong leadership qualities inspire confidence, foster camaraderie, and contribute to a positive work environment,” says Woodworth.

“She’s always there,” says Ruoss. “She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.” Raj says, “She is the glue that holds the clinical research in the pulmonary division together.”

She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.

— Stephen Ruoss, MD, professor of pulmonary and critical care medicine

Juggling the coordination of multiple studies in different phases is not without its challenges. Jacobs shares that keeping track of many moving parts is one of her most difficult and critical tasks. “Susan possesses an extensive knowledge of clinical trial protocols, having worked on a diverse range of studies across different therapeutic areas,” says Hope Woodworth, the PACCM finance and grants management specialist. “This expertise enables her to execute study procedures with meticulous precision while adhering to rigorous ethical standards and regulatory guidelines.”

Jacobs’ expertise has been indispensable as the number of trials has grown significantly the past few years. “We’ve had immense growth in the number of principal investigators in our division, the number of trials that are being offered,” says Jacobs. “That’s good — we want to support the fact that we need better treatments. For example, in pulmonary fibrosis, over the past 20 years, despite numerous trials, we only have two drugs that are FDA approved. So with that challenge, we have to keep going.”

That dedication to her patients shines through everything Jacobs does. “The patients love her,” says Ruoss. “They see her as the linchpin of the program. She’s been a committed, enduring support for our patients.” To that end, Jacobs initiated and organized several patient support groups, for LAM and interstitial lung disease. “Many patients are incredibly hard-hit by these diseases, and the support that the groups provide is critical for them,” says Ruoss.

In all that Jacobs does, her dedication to her patients shines. “She’s known by patients as a kind of fairy godmother for these chronic diseases,” he says. Caring for patients feeds right back into supporting research, as far as Jacobs sees it. “Our patients see clinical trials as a great opportunity, especially those who have exhausted all their treatment options,” she says. “Our study participants are incredibly dedicated and committed, and we are so thankful for their participation. We couldn’t complete these trials and get these drugs to market without them.”

Another role Jacobs plays is to help support junior investigators, faculty who are just starting their research careers and writing their own protocols. With her decades of experience, she is able to help guide young researchers along the way as they learn to navigate the ins and outs of clinical trials. “Her strong leadership qualities inspire confidence, foster camaraderie, and contribute to a positive work environment,” says Woodworth.

“She’s always there,” says Ruoss. “She’s deeply engaged equally in patient care and in support of the research initiatives we have. Her resilience and endurance really set her apart.” Raj says, “She is the glue that holds the clinical research in the pulmonary division together.”

SCCR’s Quality and Compliance Team Shows Resilience Amid Pandemic Pivots
Teaching Tolerance to the Immune System

How to Endure in a Pandemic? Magic!

by | Feb 27, 2024 | 2023, Clinical Care 2023

Jonathan Chen, MD, PhD

Jonathan Chen, MD, PhD

How to Endure in a Pandemic? Magic!

Jonathan Chen, MD, PhD

Jonathan Chen, MD, PhD

How to Endure in a Pandemic? Magic!

While the darkest days of the COVID-19 pandemic were challenging for most people, the experience of Jonathan Chen, MD, PhD, was particularly trying. As he documented in a poignant thread on X (then Twitter), Chen, assistant professor of medicine, had to manage a two-career household with two kids who were largely homeschooled during the pandemic. During that time, his mother developed COVID, which required Chen to commute between Northern and Southern California frequently for several months as her condition deteriorated, other medical problems set in, and she ultimately died.

“It’s no exaggeration to objectively say that 2021 was the worst year of my life,” Chen admits.

In addition to his personal trials, he had a full work schedule to maintain.  

He provided clinical care as a hospitalist on the front lines treating COVID patients amid surging hospital volumes, while also leading a clinical informatics research lab as a member of the Stanford Center for Biomedical Informatics Research, the division of hospital medicine, and the Clinical Excellence Research Center.

Besides friends, family, and purposeful work, curiously a blend of magic and music offered him the creative outlet to pull through.

Simple magic tricks that Chen had dabbled in as a kid grew into a serious hobby during the height of the pandemic. Perhaps focusing on magic as a means of engaging and delighting others kept Chen sane while so much of life was anything but routine.  

As he toiled away writing grant proposals, Chen found it therapeutic to rekindle his skills at the piano, which he hadn’t played much since his youth. Slow but steady progress with both hobbies gave him much-needed satisfaction.

When the Stanford School of Medicine’s Medicine & the Muse program started a Stuck@Home concert series over Zoom, Chen chose to play piano for two of those concerts. But, acknowledging that there were many more talented musicians in the School of Medicine than himself, he focused on honing his magic skills and “actually got pretty good at it,” he says.

He has since performed magic for multiple Stuck@Home concerts. He also gave a magic display to open a big show at the Bing Auditorium on the Stanford campus later during the pandemic.

I wanted to show how presentation techniques can make the ordinary seem extraordinary.

— Jonathan Chen, MD, PhD, assistant professor of biomedical informatics

His burgeoning reputation as a magician led to invitations to perform at student recruitment and other events, including the 2021 Stanford School of Medicine MD Program Teaching Awards program (a portion of which can be seen here).

“Early on, I was doing close-up magic because it was just me and another person, but I began attracting larger crowds while performing for students at conferences — until I found myself facing a wall of over 30 pairs of eyes staring at me,” Chen says. “Because a little card trick doesn’t play that well to a larger audience, I’ve expanded my skills and interests to present ‘parlor magic,’ where I entertain with props that everyone can see, such as a newspaper, a rope, large rings, and Rubik’s Cubes.”

His enthusiasm as a performer extended to an April 2023 research colloquium that he led for his biomedical informatics research division. In “Delivering Compelling Talks: Why, What, and How?” he used magic to demonstrate how to manage people’s attention. “I wanted to show how presentation techniques can make the ordinary seem extraordinary,” he says.

For his exceptional abilities, the magician, musician, and bioinformatician was recently recognized with a Department Teaching Award and a competition award from IBM — not the multinational technology corporation, but the International Brotherhood of Magicians!

With the extraordinary challenges of 2021 behind him, Chen continues to balance clinical practice and research. He contributed to a Stanford-Lancet commission on opioids and published multiple perspective commentaries in the Journal of the American Medical Association on the present and future use of computers in medicine. He received funding from the National Institute of Drug Abuse Clinical Trials Network to lead a study on opioid treatment retention and is augmenting human assessments of diagnostic utility of next-generation sequencing tests with support from the Stanford University Institute for Human-Centered AI and the Stanford Center for Artificial Intelligence in Medicine & Imaging.

In July 2023, after several years of grinding, Chen was thrilled and relieved to be notified of his first National Institutes of Health Research Project R01 grant. He will receive $3.8 million from the National Institute of Allergy and Infectious Diseases to lead a multisite study to measure, predict, and recommend appropriate antibiotics in the face of increasing worldwide antibiotic resistance.

As Mark Musen, MD, PhD, chief of the Stanford Center for Biomedical Informatics Research, says, “Jonathan’s commitment to advancing medical knowledge alongside his creative endeavors paints a picture of a well-rounded individual who is an inspiration for others in our department to find their own paths to renewal.”

While the darkest days of the COVID-19 pandemic were challenging for most people, the experience of Jonathan Chen, MD, PhD, was particularly trying. As he documented in a poignant thread on X (then Twitter), Chen, assistant professor of medicine, had to manage a two-career household with two kids who were largely homeschooled during the pandemic. During that time, his mother developed COVID, which required Chen to commute between Northern and Southern California frequently for several months as her condition deteriorated, other medical problems set in, and she ultimately died.

“It’s no exaggeration to objectively say that 2021 was the worst year of my life,” Chen admits.

In addition to his personal trials, he had a full work schedule to maintain. He provided clinical care as a hospitalist on the front lines treating COVID patients amid surging hospital volumes, while also leading a clinical informatics research lab as a member of the Stanford Center for Biomedical Informatics Research, the division of hospital medicine, and the Clinical Excellence Research Center.

Besides friends, family, and purposeful work, curiously a blend of magic and music offered him the creative outlet to pull through.

Simple magic tricks that Chen had dabbled in as a kid grew into a serious hobby during the height of the pandemic. Perhaps focusing on magic as a means of engaging and delighting others kept Chen sane while so much of life was anything but routine. As he toiled away writing grant proposals, Chen found it therapeutic to rekindle his skills at the piano, which he hadn’t played much since his youth. Slow but steady progress with both hobbies gave him much-needed satisfaction.

When the Stanford School of Medicine’s Medicine & the Muse program started a Stuck@Home concert series over Zoom, Chen chose to play piano for two of those concerts. But, acknowledging that there were many more talented musicians in the School of Medicine than himself, he focused on honing his magic skills and “actually got pretty good at it,” he says.

He has since performed magic for multiple Stuck@Home concerts. He also gave a magic display to open a big show at the Bing Auditorium on the Stanford campus later during the pandemic.

His burgeoning reputation as a magician led to invitations to perform at student recruitment and other events, including the 2021 Stanford School of Medicine MD Program Teaching Awards program (a portion of which can be seen here).

I wanted to show how presentation techniques can make the ordinary seem extraordinary.

— Jonathan Chen, MD, PhD, assistant professor of biomedical informatics

“Early on, I was doing close-up magic because it was just me and another person, but I began attracting larger crowds while performing for students at conferences — until I found myself facing a wall of over 30 pairs of eyes staring at me,” Chen says. “Because a little card trick doesn’t play that well to a larger audience, I’ve expanded my skills and interests to present ‘parlor magic,’ where I entertain with props that everyone can see, such as a newspaper, a rope, large rings, and Rubik’s Cubes.”

His enthusiasm as a performer extended to an April 2023 research colloquium that he led for his biomedical informatics research division. In “Delivering Compelling Talks: Why, What, and How?” he used magic to demonstrate how to manage people’s attention. “I wanted to show how presentation techniques can make the ordinary seem extraordinary,” he says.

For his exceptional abilities, the magician, musician, and bioinformatician was recently recognized with a Department Teaching Award and a competition award from IBM — not the multinational technology corporation, but the International Brotherhood of Magicians!

With the extraordinary challenges of 2021 behind him, Chen continues to balance clinical practice and research. He contributed to a Stanford-Lancet commission on opioids and published multiple perspective commentaries in the Journal of the American Medical Association on the present and future use of computers in medicine. He received funding from the National Institute of Drug Abuse Clinical Trials Network to lead a study on opioid treatment retention and is augmenting human assessments of diagnostic utility of next-generation sequencing tests with support from the Stanford University Institute for Human-Centered AI and the Stanford Center for Artificial Intelligence in Medicine & Imaging.

In July 2023, after several years of grinding, Chen was thrilled and relieved to be notified of his first National Institutes of Health Research Project R01 grant. He will receive $3.8 million from the National Institute of Allergy and Infectious Diseases to lead a multisite study to measure, predict, and recommend appropriate antibiotics in the face of increasing worldwide antibiotic resistance.

As Mark Musen, MD, PhD, chief of the Stanford Center for Biomedical Informatics Research, says, “Jonathan’s commitment to advancing medical knowledge alongside his creative endeavors paints a picture of a well-rounded individual who is an inspiration for others in our department to find their own paths to renewal.”

CHIP: Where Artificial Intelligence and Cardiology Come Together
Hospital Medicine Rises to Meet the Needs of More Patients

Hospital Medicine and Oncology Rise to Meet the Needs of More Patients

by | Feb 27, 2024 | 2023, Clinical Care 2023

From left: Jason Chang, MD; Mingwei Yu, MD; Goar Egoryan, MD; Susanna Miao, MD; Margaret Shyu, MD; Koorush Kabiri, MD; and Megha Shalavadi, MD

From left: Jeffrey Chi, MD; Tyler Johnson, MD; Neera Ahuja, MD

Hospital Medicine and Oncology Rise to Meet the Needs of More Patients

From left: Jason Chang, MD; Mingwei Yu, MD; Goar Egoryan, MD; Susanna Miao, MD; Margaret Shyu, MD; Koorush Kabiri, MD; and Megha Shalavadi, MD

From left: Jeffrey Chi, MD; Tyler Johnson, MD; Neera Ahuja, MD

Hospital Medicine and Oncology Rise to Meet the Needs of More Patients

About two years ago, says Tyler Johnson, MD, clinical assistant professor of oncology, the hospital experienced a “perfect storm of events that happened over the course of about six months,” which led to unmanageable numbers of patients relative to the number of health care providers.

Often, in the past, the oncology units experienced occasional high volumes of patients, but internal medicine had always been able to flex up capacity to help in those rare situations. Unfortunately, the increase in patient volumes two years ago was not unique to oncology; internal medicine saw an influx of its own and lacked the capacity to help with patients from other departments. “It became impossible for all of us to provide care for the increasing number of patients, and from the oncology perspective, we no longer had the option of receiving help from other services,” says Johnson.

“There was no contingency in situations of high volume. There was no place for patients to go when the regular services were full,” Johnson recalls.

The excessive and unpredictable volume of new patients started before COVID-19, when Stanford Health Care opened the new hospital at 500 Pasteur Drive. Then, says Neera Ahuja, MD, division chief of hospital medicine, COVID exacerbated the situation.

“During peak portions of the pandemic, the hospital was intermittently filled with COVID patients, and nonemergent procedures and surgeries were canceled or postponed to ensure capacity and safety for patients needing urgent/emergent care. Plus, patients that didn’t have COVID were actually scared to come to the hospital,” she says. Those patients delayed care, which meant that by the time they did return to the hospital, their conditions had often progressed.

“They were a bit sicker, and primary care clinics or specialty clinics were often really full, so for some patients, coming to the ER/hospital was faster,” she adds.

Maintaining high-quality care for all of these patients took a series of Herculean efforts. The hospital needed to renew its strategies and grow its teams.

Click image below to expand

About two years ago, says Tyler Johnson, MD, clinical assistant professor of oncology, the hospital experienced a “perfect storm of events that happened over the course of about six months,” which led to unmanageable numbers of patients relative to the number of health care providers.

Often, in the past, the oncology units experienced occasional high volumes of patients, but internal medicine had always been able to flex up capacity to help in those rare situations. Unfortunately, the increase in patient volumes two years ago was not unique to oncology; internal medicine saw an influx of its own and lacked the capacity to help with patients from other departments. “It became impossible for all of us to provide care for the increasing number of patients, and from the oncology perspective, we no longer had the option of receiving help from other services,” says Johnson.

“There was no contingency in situations of high volume. There was no place for patients to go when the regular services were full,” Johnson recalls.

The excessive and unpredictable volume of new patients started before COVID-19, when Stanford Health Care opened the new hospital at 500 Pasteur Drive. Then, says Neera Ahuja, MD, division chief of hospital medicine, COVID exacerbated the situation.

“During peak portions of the pandemic, the hospital was intermittently filled with COVID patients, and nonemergent procedures and surgeries were canceled or postponed to ensure capacity and safety for patients needing urgent/emergent care. Plus, patients that didn’t have COVID were actually scared to come to the hospital,” she says. Those patients delayed care, which meant that by the time they did return to the hospital, their conditions had often progressed. “They were a bit sicker, and primary care clinics or specialty clinics were often really full, so for some patients, coming to the ER/hospital was faster,” she adds.

Maintaining high-quality care for all of these patients took a series of Herculean efforts. The hospital needed to renew its strategies and grow its teams.

Step 1: Surge Protection

At the start of the influx, “we really needed a solution, more or less right away,” says Johnson. “We created surge services.” Surge services were teams of physicians that were paid per diem to pick up extra shifts and help care for extra patients.

“The standing up of the surge services was a logistical miracle,” says Johnson. “The most challenging aspect of maintaining the surge teams centered around the daily logistics of ensuring constant staffing. Between the days and nights, Rita Pandya, MD, the nocturnist section chief, and myself were, at times, responsible for scheduling up to 16 faculty and trainees per day,” says Jeffrey Chi, MD, section chief of general medicine at hospital medicine, adding that “there was a significant range of experience, ranging from PGY1s to PGY6s, with backgrounds in many specialties.”

The surge teams helped manage the increase in patients while new services like Med12 and LOLA were set up, but since patient loads continued to climb, surge teams have had to continue operating. After two years, explains Chi, the teams have learned a lot about various staffing models. They’ve improved staffing, brought together multiple different specialties, and improved the educational experience for residents.

The standing up of the surge services was a logistical miracle.

— Tyler Johnson, MD, clinical assistant professor of oncology

Step 2: Med12

Between January and July 2022, Heather Wakelee, MD, professor and chief of oncology; Johnson; and their team “advertised, recruited, interviewed, hired, and then got licensed and credentialed, six attending physicians. The new team was developed in just six months, with capacity to care for up to 30 patients a day, which sometimes even went up to 35,” says Johnson.

But the influx of patients continued to grow. Staff had to find even more attending physicians. “We’ve had to increase the number of attendings working at a time from three attendings to five attendings,” says Johnson. “Now, we’re going to have a total of 10 attendings, five on at a time.”

Oncology patients frequently switch between inpatient and outpatient care. Having a dedicated team, dubbed Med12, managing the inpatient care makes communication with the outpatient team more effective, improving the quality of care for the patient.

From left: Jason Chang, MD; Mingwei Yu, MD; Goar Egoryan, MD; Susanna Miao, MD; Margaret Shyu, MD; Koorush Kabiri, MD; and Megha Shalavadi, MD

Med12 team members from left: Jason Chang, MD; Mingwei Yu, MD; Goar Egoryan, MD; Susanna Miao, MD; Margaret Shyu, MD; Koorush Kabiri, MD; and Megha Shalavadi, MD

Step 3: LOLA

As patient volumes continued to grow, the division of hospital medicine created the long length, low acuity (LOLA) service in November 2022. “The physicians were quite busy. And so we thought, ‘What if we take the less sick patients (i.e., low acuity) who still need to be in the hospital … we put them on a special team that just addressed their one need keeping them in the hospital?’ That way, it provided bandwidth for all the other teams to take care of sicker patients more efficiently,” says Ahuja.

Ahuja is extremely proud of the physicians on her team. She says that no matter how tired they were, patient care was “never compromised.” Still, the workload wasn’t sustainable long-term, and the new teams were introduced at just the right time.

“A proxy for a good division is how well you’re able to retain your physicians,” says Ahuja. “And we’ve had excellent retention. This has been successful, and we’ll continue to support our physicians and continue to evolve as times change.”

Step 1: Surge Protection

At the start of the influx, “we really needed a solution, more or less right away,” says Johnson. “We created surge services.” Surge services were teams of physicians that were paid per diem to pick up extra shifts and help care for extra patients.

“The standing up of the surge services was a logistical miracle,” says Johnson. “The most challenging aspect of maintaining the surge teams centered around the daily logistics of ensuring constant staffing. Between the days and nights, Rita Pandya, MD, the nocturnist section chief, and myself were, at times, responsible for scheduling up to 16 faculty and trainees per day,” says Jeffrey Chi, MD, section chief of general medicine at hospital medicine, adding that “there was a significant range of experience, ranging from PGY1s to PGY6s, with backgrounds in many specialties.”

The surge teams helped manage the increase in patients while new services like Med12 and LOLA were set up, but since patient loads continued to climb, surge teams have had to continue operating. After two years, explains Chi, the teams have learned a lot about various staffing models. They’ve improved staffing, brought together multiple different specialties, and improved the educational experience for residents.

The standing up of the surge services was a logistical miracle.

— Tyler Johnson, MD, clinical assistant professor of oncology

Step 2: Med12

Between January and July 2022, Heather Wakelee, MD, professor and chief of oncology; Johnson; and their team “advertised, recruited, interviewed, hired, and then got licensed and credentialed, six attending physicians. The new team was developed in just six months, with capacity to care for up to 30 patients a day, which sometimes even went up to 35,” says Johnson.

But the influx of patients continued to grow. Staff had to find even more attending physicians. “We’ve had to increase the number of attendings working at a time from three attendings to five attendings,” says Johnson. “Now, we’re going to have a total of 10 attendings, five on at a time.”

Oncology patients frequently switch between inpatient and outpatient care. Having a dedicated team, dubbed Med12, managing the inpatient care makes communication with the outpatient team more effective, improving the quality of care for the patient.

From left: Jason Chang, MD; Mingwei Yu, MD; Goar Egoryan, MD; Susanna Miao, MD; Margaret Shyu, MD; Koorush Kabiri, MD; and Megha Shalavadi, MD

Med12 team members from left: Jason Chang, MD; Mingwei Yu, MD; Goar Egoryan, MD; Susanna Miao, MD; Margaret Shyu, MD; Koorush Kabiri, MD; and Megha Shalavadi, MD

Step 3: LOLA

As patient volumes continued to grow, the division of hospital medicine created the long length, low acuity (LOLA) service in November 2022. “The physicians were quite busy. And so we thought, ‘What if we take the less sick patients (i.e., low acuity) who still need to be in the hospital … we put them on a special team that just addressed their one need keeping them in the hospital?’ That way, it provided bandwidth for all the other teams to take care of sicker patients more efficiently,” says Ahuja.

Ahuja is extremely proud of the physicians on her team. She says that no matter how tired they were, patient care was “never compromised.” Still, the workload wasn’t sustainable long-term, and the new teams were introduced at just the right time.

“A proxy for a good division is how well you’re able to retain your physicians,” says Ahuja. “And we’ve had excellent retention. This has been successful, and we’ll continue to support our physicians and continue to evolve as times change.”

How to Endure in a Pandemic? Magic!
Clinical Informatics Harnesses Information Technology to Revolutionize Patient Care

Clinical Informatics Harnesses Information Technology to Revolutionize Patient Care

by | Feb 27, 2024 | 2023, Clinical Care 2023

The clinical informatics group uses AI to improve how doctors and nurses identify and assess hospitalized patients at risk of deterioration

The Clinical Informatics Group uses AI to improve how doctors and nurses identify and assess hospitalized patients at risk of deterioration.

Clinical Informatics Harnesses Information Technology to Revolutionize Patient Care

The clinical informatics group uses AI to improve how doctors and nurses identify and assess hospitalized patients at risk of deterioration

The Clinical Informatics Group uses AI to improve how doctors and nurses identify and assess hospitalized patients at risk of deterioration.

Clinical Informatics Harnesses Information Technology to Revolutionize Patient Care

Controversies around artificial intelligence (AI) and ChatGPT seem to be everywhere these days — from students using these technologies to cheat on tests to chatbots threatening to take away people’s jobs. But Stanford physicians are balancing the scale by using these technologies to innovate ways to improve patient care — and nowhere is that passion greater than in the Clinical Informatics Group in the hospital medicine division of the Department of Medicine.

These physicians are hospitalists who not only treat patients but also use their interest in computer science to conduct research, fine-tune operational workflow, and design medical education around the latest technologies. While these physicians have a wide range of interests and expertise, ultimately they all want to improve the quality and safety of hospital stays, as well as the overall delivery of health care.

Hospitalists and Research Are a Natural Match

The Clinical Informatics Group includes a robust team of researchers who collaborate with divisions and departments across Stanford University and Stanford Health Care. Pilot projects showing positive outcomes have led to improved patient care practices systemwide.

“As academic clinicians, we as hospitalists have interests and passions outside of practicing medicine, and for many that’s research,” explains Ashwin Nayak, MD, clinical assistant professor of hospital medicine. “Within research, informatics is a broad foundation that can be applied to different specialties and problems.”

From left: William Collins, MD; Poonam Hosamani, MD; Thomas Savage, MD (on the screen); Ashwin Nayak, MD; Oluseyi Fayanju, MD; Jason Hom, MD

Adds Ron Li, MD, medical informatics director for digital health, “As hospitalists, we are system thinkers. We are not focused on one specific disease but about the entire care journey for a patient who may have many complex issues during a hospital stay.

Clinical informatics research projects are increasingly exploring the use of AI — specifically ChatGPT — in clinical practice.

Hospitalized patients with complex conditions are typically cared for by multiperson teams who assess large amounts of constantly changing data, making it challenging for the team to stay in sync. One recent research project, Clinical Deterioration Prediction & Prevention Using Artificial Intelligence, looked at how AI could be used to improve how doctors and nurses work together to identify patients whose condition could deteriorate in a hospital setting.

Controversies around artificial intelligence (AI) and ChatGPT seem to be everywhere these days — from students using these technologies to cheat on tests to chatbots threatening to take away people’s jobs. But Stanford physicians are balancing the scale by using these technologies to innovate ways to improve patient care — and nowhere is that passion greater than in the Clinical Informatics Group in the hospital medicine division of the Department of Medicine.

These physicians are hospitalists who not only treat patients but also use their interest in computer science to conduct research, fine-tune operational workflow, and design medical education around the latest technologies. While these physicians have a wide range of interests and expertise, ultimately they all want to improve the quality and safety of hospital stays, as well as the overall delivery of health care.

Hospitalists and Research Are a Natural Match

The Clinical Informatics Group includes a robust team of researchers who collaborate with divisions and departments across Stanford University and Stanford Health Care. Pilot projects showing positive outcomes have led to improved patient care practices systemwide.

“As academic clinicians, we as hospitalists have interests and passions outside of practicing medicine, and for many that’s research,” explains Ashwin Nayak, MD, clinical assistant professor of hospital medicine. “Within research, informatics is a broad foundation that can be applied to different specialties and problems.”

Adds Ron Li, MD, medical informatics director for digital health, “As hospitalists, we are system thinkers. We are not focused on one specific disease but about the entire care journey for a patient who may have many complex issues during a hospital stay.”

Clinical informatics research projects are increasingly exploring the use of AI — specifically ChatGPT — in clinical practice.

Hospitalized patients with complex conditions are typically cared for by multiperson teams who assess large amounts of constantly changing data, making it challenging for the team to stay in sync. One recent research project, Clinical Deterioration Prediction & Prevention Using Artificial Intelligence, looked at how AI could be used to improve how doctors and nurses work together to identify patients whose condition could deteriorate in a hospital setting.

Explains Li, who is a clinical assistant professor of hospital medicine and biomedical informatics research, “We used AI to develop a collaborative huddle and checklist process, allowing doctors and nurses to better assess at-risk patients and work together to intervene more quickly.” Not only did the pilot project reduce deterioration events at Stanford Hospital by 20%, but also it won the 2023 Healthcare Information and Management Systems Society (HIMSS) Nicholas E. Davies Award of Excellence for using health information technology to substantially improve patient outcomes.

Large language model chatbots such as ChatGPT are a particular area of interest for Clinical Informatics Group members. A recently published study comparing the clinical notes written by ChatGPT versus Internal Medicine residents found the quality to be comparable. “This study shows one of the many time-saving applications of large language models that could help free up clinicians so they can focus more on patient care,” comments Nayak, who was first author of the study.

As academic clinicians, we as hospitalists have interests and passions outside of practicing medicine, and for many that’s research.

— Ashwin Nayak, MD, clinical assistant professor of hospital medicine 

Information Technology Drives Hospital Efficiency and Safety

“Informatics is the glue that underlies the operation of the modern hospital. Every step in a hospital’s workflow requires a computer or cellphone app,” notes Weihan Chu, MD, clinical assistant professor of hospital medicine and associate chief medical officer of Stanford Health Care Tri-Valley and medical informatics director, Stanford Health Care.

Chu works extensively with the Stanford IT department to represent the physician perspective in developing and updating content used in nearly 200 hospital workflows, from auto-populated content for doctor notes for greater accuracy to checklists for hospital-admitted patients to improve consistency and efficiency.

Even basic hospital operations can have complex workflows involving many different areas. Explains Chu, “A blood transfusion for a patient’s cardiac surgery involves many behind-the-scenes steps, from routing the request to a blood bank and getting it filled and picked up to the operating room notifying the blood bank if they need more blood. IT tools make this process seamless.”

Before there were computers there was paper. “When we used paper to track patient care, there wasn’t one easily referenced source of truth,” he notes. “You can’t have multiple people looking at and updating the same piece of paper at the same time. Ultimately, these IT tools help us better coordinate care and improve patient safety.”

The Role of Informatics in Medical Education

AI technology is moving so quickly and integrating into so many areas within health care that Clinical Informatics Group members are exploring how to incorporate training into the Stanford School of Medicine’s basic curriculum for medical students and physician assistants obtaining an MSPA degree.

“It’s not a question of ‘if’ we’re going to integrate formal teaching about AI into the curriculum for students, but ‘how’ and ‘when,’” says Jason Hom, MD, clinical associate professor of hospital medicine. “We want to make sure our students are fully prepared for what they encounter in their clinical rotations. And since practicing clinicians were trained in a pre-AI world, we’re looking at continuing medical education courses as well,” adds Hom, who also serves as course director, Practice of Medicine Year 2, at the Stanford School of Medicine.

Educators around the world are intrigued by ChatGPT’s performance capabilities. In a study published in the Journal of the American Medical Association Internal Medicine, several Clinical Informatics Group members found that ChatGPT performed well on answering free-form questions from Stanford School of Medicine clinical reasoning exams. The study, Chatbot vs. Medical Student Performance on Free-Response Clinical Reasoning Examinations, was co-first authored by clinical associate professor of hospital medicine Eric Strong, MD, and School of Medicine Associate Director for Evaluation and Scholarship Alicia DiGiammarino, along with co-senior authors Jonathan Chen, MD, PhD, assistant professor of hospital medicine, and Hom. Yingjie Weng, Andre Kumar, MD, MEd, and Poonam Hosamani, MD were also co-authors. “We have to ensure new MD and MSPA students have a minimum level of unassisted competency before integrating AI into their studies. And we have to ensure that students have a basic understanding of how these emerging models work and can be used and what their limitations/biases are,” says Hom.

While the debate over how best to integrate AI into health care continues, the uniquely human aspects of medical training become even more important. “Teaching how to build rapport with patients, how to compassionately tell patients about a cancer diagnosis, how to listen to a patient’s heart — these are irreplaceable aspects of the patient-clinician relationship that we can focus on in training,” explains Hom.

Stanford and Technology Go Hand in Hand

Li cites Stanford leadership’s strong support for the use of informatics to solve problems as instrumental in the success of the group’s projects. “At Stanford, it’s in our DNA to use technology in service of innovation. There’s the rich ecosystem we’ve developed with Silicon Valley companies and cross-pollination with local industry. Plus, we tend to attract faculty who are skilled both as informaticians and as physicians,” he says. One such faculty member is Jonathan Chen, who is also assistant professor of biomedical informatics research and is featured in “How to Endure in a Pandemic? Magic!”

Explains Li, who is a clinical assistant professor of hospital medicine and biomedical informatics research, “We used AI to develop a collaborative huddle and checklist process, allowing doctors and nurses to better assess at-risk patients and work together to intervene more quickly.” Not only did the pilot project reduce deterioration events at Stanford Hospital by 20%, but also it won the 2023 Healthcare Information and Management Systems Society (HIMSS) Nicholas E. Davies Award of Excellence for using health information technology to substantially improve patient outcomes.

Large language model chatbots such as ChatGPT are a particular area of interest for Clinical Informatics Group members. A recently published study comparing the clinical notes written by ChatGPT versus Internal Medicine residents found the quality to be comparable. “This study shows one of the many time-saving applications of large language models that could help free up clinicians so they can focus more on patient care,” comments Nayak, who was first author of the study.

As academic clinicians, we as hospitalists have interests and passions outside of practicing medicine, and for many that’s research.

— Ashwin Nayak, MD, clinical assistant professor of hospital medicine

Information Technology Drives Hospital Efficiency and Safety

“Informatics is the glue that underlies the operation of the modern hospital. Every step in a hospital’s workflow requires a computer or cellphone app,” notes Weihan Chu, MD, clinical assistant professor of hospital medicine and associate chief medical officer of Stanford Health Care Tri-Valley and medical informatics director, Stanford Health Care.

Chu works extensively with the Stanford IT department to represent the physician perspective in developing and updating content used in nearly 200 hospital workflows, from auto-populated content for doctor notes for greater accuracy to checklists for hospital-admitted patients to improve consistency and efficiency.

Even basic hospital operations can have complex workflows involving many different areas. Explains Chu, “A blood transfusion for a patient’s cardiac surgery involves many behind-the-scenes steps, from routing the request to a blood bank and getting it filled and picked up to the operating room notifying the blood bank if they need more blood. IT tools make this process seamless.”

Before there were computers there was paper. “When we used paper to track patient care, there wasn’t one easily referenced source of truth,” he notes. “You can’t have multiple people looking at and updating the same piece of paper at the same time. Ultimately, these IT tools help us better coordinate care and improve patient safety.”

The Role of Informatics in Medical Education

AI technology is moving so quickly and integrating into so many areas within health care that Clinical Informatics Group members are exploring how to incorporate training into the Stanford School of Medicine’s basic curriculum for medical students and physician assistants obtaining an MSPA degree.

“It’s not a question of ‘if’ we’re going to integrate formal teaching about AI into the curriculum for students, but ‘how’ and ‘when,’” says Jason Hom, MD, clinical associate professor of hospital medicine. “We want to make sure our students are fully prepared for what they encounter in their clinical rotations. And since practicing clinicians were trained in a pre-AI world, we’re looking at continuing medical education courses as well,” adds Hom, who also serves as course director, Practice of Medicine Year 2, at the Stanford School of Medicine.

Educators around the world are intrigued by ChatGPT’s performance capabilities. In a study published in the Journal of the American Medical Association Internal Medicine, several Clinical Informatics Group members found that ChatGPT performed well on answering free-form questions from Stanford School of Medicine clinical reasoning exams. The study, Chatbot vs. Medical Student Performance on Free-Response Clinical Reasoning Examinations, was co-first authored by clinical associate professor of hospital medicine Eric Strong, MD, and School of Medicine Associate Director for Evaluation and Scholarship Alicia DiGiammarino, along with co-senior authors Jonathan Chen, MD, PhD, assistant professor of hospital medicine, and Hom. Yingjie Weng, Andre Kumar, MD, MEd, and Poonam Hosamani, MD were also co-authors. “We have to ensure new MD and MSPA students have a minimum level of unassisted competency before integrating AI into their studies. And we have to ensure that students have a basic understanding of how these emerging models work and can be used and what their limitations/biases are,” says Hom.

While the debate over how best to integrate AI into health care continues, the uniquely human aspects of medical training become even more important. “Teaching how to build rapport with patients, how to compassionately tell patients about a cancer diagnosis, how to listen to a patient’s heart — these are irreplaceable aspects of the patient-clinician relationship that we can focus on in training,” explains Hom.

Stanford and Technology Go Hand in Hand

Li cites Stanford leadership’s strong support for the use of informatics to solve problems as instrumental in the success of the group’s projects. “At Stanford, it’s in our DNA to use technology in service of innovation. There’s the rich ecosystem we’ve developed with Silicon Valley companies and cross-pollination with local industry. Plus, we tend to attract faculty who are skilled both as informaticians and as physicians,” he says. One such faculty member is Jonathan Chen, who is also assistant professor of biomedical informatics research and is featured in “How to Endure in a Pandemic? Magic!”

Hospital Medicine Rises to Meet the Needs of More Patients
Two Residents, United in Equality, Are Fighting Health Disparities

The Pre-Renal Initiative

by | Feb 27, 2024 | 2023, Education 2023

Pre-Renal Initiative participants. Front row, from left: Winnie Ellerman, manager; Alondra Camrena, UC Berkeley; Rodrigo Salinas, Emory University; Angelina Powers, UC Santa Cruz; Avanti Ramraj, Stanford; Alexandra Bibby, coordinator; Mallika Reddy, UC Berkeley; Jeffrey Doeve. Back row, from left: Brian Van Lee, Rice University; Brevyn Belfield, Hampton University; Maria Luiza Periera Ortiz, Mount Holyoke College; Arianna Mejia, University of Pennsylvania.

Pre-Renal Initiative participants. Front row, from left: Winnie Ellerman, manager; Alondra Camrena, UC Berkeley; Rodrigo Salinas, Emory University; Angelina Powers, UC Santa Cruz; Avanti Ramraj, Stanford; Alexandra Bibby, coordinator; Mallika Reddy, UC Berkeley; Jeffrey Doeve. Back row, from left: Brian Van Lee, Rice University; Brevyn Belfield, Hampton University; Maria Luiza Periera Ortiz, Mount Holyoke College; Arianna Mejia, University of Pennsylvania

The Pre-Renal Initiative

Recruiting Nephrologists Early

Pre-Renal Initiative participants. Front row, from left: Winnie Ellerman, manager; Alondra Camrena, UC Berkeley; Rodrigo Salinas, Emory University; Angelina Powers, UC Santa Cruz; Avanti Ramraj, Stanford; Alexandra Bibby, coordinator; Mallika Reddy, UC Berkeley; Jeffrey Doeve. Back row, from left: Brian Van Lee, Rice University; Brevyn Belfield, Hampton University; Maria Luiza Periera Ortiz, Mount Holyoke College; Arianna Mejia, University of Pennsylvania.

Pre-Renal Initiative participants. Front row, from left: Winnie Ellerman, manager; Alondra Camrena, UC Berkeley; Rodrigo Salinas, Emory University; Angelina Powers, UC Santa Cruz; Avanti Ramraj, Stanford; Alexandra Bibby, coordinator; Mallika Reddy, UC Berkeley; Jeffrey Doeve. Back row, from left: Brian Van Lee, Rice University; Brevyn Belfield, Hampton University; Maria Luiza Periera Ortiz, Mount Holyoke College; Arianna Mejia, University of Pennsylvania

The Pre-Renal Initiative

Recruiting Nephrologists Early

Despite the need for more nephrologists, the field of nephrology has suffered an image problem. The subspecialty has been perceived as somewhat stale and stodgy, with limited therapies available for chronic kidney disease (CKD) and a scant research pipeline.

“By the time they enter medical school, many students already know what area of study they intend to pursue, such as cardiology, oncology, or general surgery,” says Vivek Bhalla, MD, associate professor of nephrology and director of the Stanford Hypertension Center. “Early exposure to the field of nephrology is crucial to attract more practitioners and researchers to this dynamic subspecialty, and that is exactly what our initiative is designed to do,” says Bhalla, who is co-director of the Pre-Renal Initiative, a summer research program for undergraduate college students aimed at attracting trainees to the field of nephrology.

Enter the Pre-Renal Initiative

The Pre-Renal Initiative was founded in 2019 to develop an interest in nephrology by planting a seed at the undergraduate level, especially among the very minority and underrepresented populations most affected by CKD. Through this outreach and recruitment effort, Stanford is creating the potential for a clearer path to this subspecialty for those who may not have considered it previously.

Students are recruited through the initiative’s website and social media accounts, as well as with campus outreach at local universities and student groups using targeted emails and virtual talks.

The initiative includes the subspecialties of urology and benign hematology — related areas of study that also need to draw attention as potential career choices.

Bhalla says that in the past 10 years, an explosion of new therapies has emerged for CKD. Multiple new drugs for treating the disease are now available, and amazing insights are revealing how those drugs can manage or even cure CKD. These developments, combined with the current nationwide epidemics of diabetes and obesity, have triggered a need for more nephrologists who can treat the 37 million Americans who have CKD, many of whom are ethnic minorities. 

The 10-week program has three components: a research project, a lecture series, and professional development. Each summer includes twice-weekly lectures with nephrology, urology, and hematology faculty members, covering topics in clinical care and research. Additional activities include professional development seminars, social events, and a poster symposium at Stanford and at the National Institutes of Health (NIH), which provides funding for the program.

Glenn M. Chertow, MD, is proud of the initiative’s success in “fostering the interests of women and other underrepresented groups into medicine, nephrology, and urology.” Chertow is a former division chief of nephrology and is currently associate chair of fellowship programs in the Department of Medicine.

Emerging From the Pandemic

The year 2023 was only the second time the Pre-Renal Initiative took place fully in person, with a group of 11 undergraduate students from California, New York, South Carolina, and Texas. They were paired individually with a faculty member and in groups of three with a fellow or resident.

Maria Luiza Periera Ortiz (at easel) is benefiting from early exposure to the field of nephrology. 

“The faculty lectures are multidisciplinary and are a highlight of the Pre-Renal Initiative,” notes Winnie Ellerman, administrative manager for the division of nephrology. She adds that “the most thrilling part of the program has been seeing the students present their research at the end of the summer. They’d been able to establish a hypothesis and see it come to life in the lab.”

Stand By for Results

As for creating a pool of future nephrologists, the success of the program won’t be measurable for at least another 10 years. And, says Bhalla, “even if they don’t go to medical school or specialize in nephrology, they will have benefited from the experience.”

Ellerman adds, “I know the bonds that have formed here will follow these students into their future lives. That is very powerful.”

Brevyn Belfield makes a point during a presentation

I cannot thank you enough for this wonderful program! I feel so happy knowing there is a sphere of medicine that fascinates me as much as urology/nephrology does and that there is so much room for me to join and continue improving renal care!
— Pre-Renal Initiative participant

Despite the need for more nephrologists, the field of nephrology has suffered an image problem. The subspecialty has been perceived as somewhat stale and stodgy, with limited therapies available for chronic kidney disease (CKD) and a scant research pipeline.

“By the time they enter medical school, many students already know what area of study they intend to pursue, such as cardiology, oncology, or general surgery,” says Vivek Bhalla, MD, associate professor of nephrology and director of the Stanford Hypertension Center. “Early exposure to the field of nephrology is crucial to attract more practitioners and researchers to this dynamic subspecialty, and that is exactly what our initiative is designed to do,” says Bhalla, who is co-director of the Pre-Renal Initiative, a summer research program for undergraduate college students aimed at attracting trainees to the field of nephrology.

Maria Luiza Periera Ortiz (at easel) is benefiting from early exposure to the field of nephrology

Enter the Pre-Renal Initiative

The Pre-Renal Initiative was founded in 2019 to develop an interest in nephrology by planting a seed at the undergraduate level, especially among the very minority and underrepresented populations most affected by CKD. Through this outreach and recruitment effort, Stanford is creating the potential for a clearer path to this subspecialty for those who may not have considered it previously.

Students are recruited through the initiative’s website and social media accounts, as well as with campus outreach at local universities and student groups using targeted emails and virtual talks.

The initiative includes the subspecialties of urology and benign hematology — related areas of study that also need to draw attention as potential career choices.

Bhalla says that in the past 10 years, an explosion of new therapies has emerged for CKD. Multiple new drugs for treating the disease are now available, and amazing insights are revealing how those drugs can manage or even cure CKD. These developments, combined with the current nationwide epidemics of diabetes and obesity, have triggered a need for more nephrologists who can treat the 37 million Americans who have CKD, many of whom are ethnic minorities. 

The 10-week program has three components: a research project, a lecture series, and professional development. Each summer includes twice-weekly lectures with nephrology, urology, and hematology faculty members, covering topics in clinical care and research. Additional activities include professional development seminars, social events, and a poster symposium at Stanford and at the National Institutes of Health (NIH), which provides funding for the program.

Glenn M. Chertow, MD, is proud of the initiative’s success in “fostering the interests of women and other underrepresented groups into medicine, nephrology, and urology.” Dr. Chertow is a former division chief of nephrology and is currently associate chair of fellowship programs in the Department of Medicine.

I cannot thank you enough for this wonderful program! I feel so happy knowing there is a sphere of medicine that fascinates me as much as urology/nephrology does and that there is so much room for me to join and continue improving renal care!
— Pre-Renal Initiative participant

Brevyn Belfield makes a point during a presentation.

Emerging From the Pandemic

The year 2023 was only the second time the Pre-Renal Initiative took place fully in person, with a group of 11 undergraduate students from California, New York, South Carolina, and Texas. They were paired individually with a faculty member and in groups of three with a fellow or resident.

“The faculty lectures are multidisciplinary and are a highlight of the Pre-Renal Initiative,” notes Winnie Ellerman, administrative manager for the division of nephrology. She adds that “the most thrilling part of the program has been seeing the students present their research at the end of the summer. They’d been able to establish a hypothesis and see it come to life in the lab.”

Stand By for Results

As for creating a pool of future nephrologists, the success of the program won’t be measurable for at least another 10 years. And, says Bhalla, “even if they don’t go to medical school or specialize in nephrology, they will have benefited from the experience.”

Ellerman adds, “I know the bonds that have formed here will follow these students into their future lives. That is very powerful.”

Translational Investigators — the Future of Team Science
How to Secure Competitive R01 Research Grants? Check Out This Program!

Teaching Tolerance to the Immune System

by | Feb 27, 2024 | 2023, Research 2023

Everett Meyer, MD, PhD

Everett Meyer, MD, PhD

Teaching Tolerance to the Immune System

A Q&A with Everett Meyer

Everett Meyer, MD, PhD

Everett Meyer, MD, PhD

Teaching Tolerance to the Immune System

A Q&A with Everett Meyer

A healthy immune system is in a constant state of vigilance, patrolling the human body for invading pathogens and mounting a quick response against dangerous bacteria or viruses. But what happens when that immune response is unwanted? After a sick patient receives a lifesaving transplant, the immune system can attack the new organ, triggering transplant rejection. In people with autoimmune conditions like rheumatoid arthritis and lupus nephritis, the immune system attacks healthy cells, causing disease. In both cases, clinicians want to block the immune response — but without shutting off the entire immune system.

Researchers and clinicians in the bone and marrow transplantation and cellular therapy division are developing and testing new methods of cellular immune tolerance — techniques to reprogram the immune system to be more tolerant of healthy cells and transplanted organs. This kind of renewal of the healthy immune system offers hope for patients who have long had few options. Physician-scientist Everett Meyer, MD, PhD, who has been studying cellular immune tolerance for more than a decade, recently answered some questions about how these breakthroughs are impacting Stanford Medicine patients.

Doctors have been trying to prevent organ rejection and to treat autoimmune disease for a long time. What’s changed in recent years?

In the past decade, we’ve had an incredible amount of advancement in our basic understanding of the immune system. Scientists have developed extremely powerful new techniques that let us see at a very deep level how individual immune cells function. At the same time, we also have new ways to reprogram those immune cells using genetic tools. The success of cancer immunotherapy, which reprograms immune cells to attack cancer cells, has paved the way for us. Now, we’re expanding those same approaches used to prevent organ rejection and treat autoimmune disease in completely new ways.

How are clinicians at Stanford Medicine applying these breakthroughs to organ transplants?

Right now, by really pushing the frontiers of how we prevent organ rejection. We can reengineer immune cells and transplant them into patients at the same time they receive a new organ. This has the potential to allow patients to completely stop taking standard immunosuppression drugs that shut down the immune system. We have a large California Institute of Regenerative Medicine grant to study whether patients can be weaned completely off immunosuppressants if they receive a bone marrow transplant and cell cultured immune cells at the same time as a kidney transplant.

The success of cancer immunotherapy, which reprograms immune cells to attack cancer cells, has paved the way for us.

How are clinicians at Stanford Medicine applying these breakthroughs to organ transplants?

Right now, by really pushing the frontiers of how we prevent organ rejection. We can reengineer immune cells and transplant them into patients at the same time they receive a new organ. This has the potential to allow patients to completely stop taking standard immunosuppression drugs that shut down the immune system. We have a large California Institute of Regenerative Medicine grant to study whether patients can be weaned completely off immunosuppressants if they receive a bone marrow transplant and cell cultured immune cells at the same time as a kidney transplant.

What does this mean for patients in terms of their quality of life?

For most of history, patients who received organ transplants had to take immunosuppressant pills for the rest of their life. This leads to a lot of long-term side effects — not only are you more prone to getting sick, but you can get secondary cancers, diabetes, and hypertension. In some cases, the immunosuppression can actually end up damaging the new organ that you’re trying to protect. What’s more, even when immunosuppression is effective, the organ is often rejected after 15 or 20 years. Patients who get transplants when they’re young usually plan to get another one or two organs over their life span.

With the new cell therapies we’re testing, patients can get one organ transplant that lasts for life, and they won’t have to take immunosuppressants forever. This means far fewer long-term side effects, as well as not having the burden of daily pills.

Are you also expanding these therapies for autoimmune disease?

Yes, some of the same approaches that are being used to treat B cell cancers can be repurposed to treat autoimmune diseases, because in both cases, you have faulty B cells. Right now, we’re planning a trial that will test these therapies in lupus nephritis and multiple sclerosis. We’re also involved in a large, national trial that’s planning to treat multiple sclerosis with bone marrow transplants, and we are working with a company developing cell therapy for rheumatoid arthritis. In all these cases, we’re using molecular tools to reeducate the immune system to stop responding to things that it shouldn’t be responding to. For our patients, having access to these trials, which offer a completely new paradigm of treating autoimmune disease, is incredibly valuable.

Why is Stanford such an ideal place to be studying this?

Stanford has taken an innovative stand in terms of bringing together all the different players in cellular immune tolerance into one program. We are among the leading centers in the world when it comes to studying human immunology, and we have a rich history of being innovators in transplantation. In addition, we have this entrepreneurial culture and collaborative environment that fosters the development of these kinds of completely new approaches to medicine. All these things come together to make Stanford uniquely positioned to really advance the field of cellular immune tolerance.

Driving Medical Progress
Revealing Microbial Triggers of Autoimmune Disease