How We’re Powering Up Innovation in the Digestive Disease & Surgery Institute

Nurturing innovation and accelerating its impact on patient care are top priorities for Matthew Kroh, MD, the recently appointed Vice Chair of Innovation and Technology in Cleveland Clinic’s Digestive Disease & Surgery Institute.

In this newly created position, Dr. Kroh connects with the institute’s clinicians and researchers to develop novel devices and clinical services, and to identify promising external innovations that can be tested and deployed at Cleveland Clinic. He also aims to apply advanced technologies such as robotics and artificial intelligence to improve patient access, experience and treatment, enhance research and augment caregiver training.

Dr. Kroh works closely with D. Geoffrey Vince, PhD, Executive Director of Cleveland Clinic Innovations, Cleveland Clinic’s technology commercialization arm.

“In the Digestive Disease and Surgery Institute, we’re engaged in research that will change the way we care for patients, whether it’s a new robotic operation that allows people to recover more quickly or a complex endoscopic procedure that requires no incisions,” Dr. Kroh says. “Device development and new clinical service lines are critically important to our mission, but I also want to extend tech and innovation to areas that aren’t traditionally thought of, like patient experience, telehealth, education and global connectivity. I aim to be a facilitator. I want to be liaison to our faculty, to make sure we lead.”

Consult QD spoke with Dr. Kroh about his plans.

Q: The Digestive Disease & Surgery Institute is the first of Cleveland Clinic’s institutes to create a leadership position focused on technology and innovation. What prompted that?

A: It was the product of a conversation with institute Chair Dr. Miguel Regueiro and myself as he was looking at needs for the institute. There is a lot of innovation taking place, but not necessarily in the most organized and strategic way.

Q: What qualified you for the job?

A: Most recently, I was Chair of the Digestive Disease Institute at Cleveland Clinic Abu Dhabi. Prior to that, I was Section Head of Advanced Laparoscopic Surgery and Surgical Endoscopy in the Department of General Surgery on main campus. My research and professional interests have been in device development. Our team performed the first single-site robotic operation in the world at Cleveland Clinic. We brought several new technologies here for minimally invasive surgery. One of our biggest successes was the Developmental Endoscopy Lab. It was a collaboration between general surgery, colorectal surgery and gastroenterology where we taught ourselves, with external proctors and the appropriate oversight, how to do new endoluminal procedures that are now clinical service lines here, like endoscopic submucosal dissection for removal of early cancers and peroral endoscopic myotomy, or POEM, for treatment of achalasia, a swallowing disorder. It was a unique opportunity to explore beyond the confines of a clinical practice and then to improve patient care.

Q: Is the staff’s attitude a factor in ramping up innovation? Is there an open-mindedness within the Digestive Disease & Surgical Institute about introducing new technologies and methodologies?

A: We have a culture of innovation here already. Cleveland Clinic historically attracts top physicians, endoscopists and surgeons. They’re here because they’re good at what they do and they’re innovative by nature. I think one problem is the process you go through to develop an idea or a device can be cumbersome to a busy clinician. My goal is to identify physicians that have great ideas and help them go through the process of either commercialization or intellectual property protection.

Q: It all starts with a good idea?

A: Yes. I really want to promote a culture of innovation, so that when people have an idea, there’s a mechanism by which it can be vetted. Whether that results in anything meaningful is relatively unimportant at first. But if we create an environment where people are always thinking about how to do something better, that changes the culture.

Q: How are you encouraging innovation? With individual hallway conversations or something more formal?

A: We’re having a series of meetings and forums for key stakeholders — institute leadership, departmental leadership, section heads. Then we’ll have interactions and a mechanism by which any caregiver can say, ‘I’ve got this idea. Help me get it off the ground.’ Our team will also have dedicated “Innovation Office Hours” so that staff can drop in and discuss ideas.

Q: What infrastructure will support this effort?

A: I want to build an innovation council made up of people from within the Digestive Disease & Surgery Institute who not only want to develop their own designs but want to be a liaison to their departmental groups. When ideas come in, council members would vet them and provide a review. I want to make sure that when someone has an idea, the threshold for it to be heard and evaluated is incredibly low. And if the feedback is that it’s not a viable product because of existing intellectual property or lack of significant impact on patients, we still encourage you to come back with other ideas. We have a strong administrative team in place currently, and we will interact with our colleagues in research, education and operations.

Q: You mentioned wanting to apply technology and innovation to improve patient experience. Can you give an example?

A: One project we’re working on involves post-bariatric surgery monitoring. After surgery, there are specific attributes that need to be checked that are critically important for a successful outcome. A lot of that data isn’t captured very well in the hospital, let alone after the patient is discharged. Bariatric surgery patients are educated and actively engaged. We are working on a patient-centered app that allows patients to enter their own data and improve outcomes after surgery. The app idea came from one of our General Surgery residents, Dr. Thomas Shin. We want to create a nascent app, get a pilot study going. If patients like it, then we can build it out into something that could include long-term use.

Q: In addition to exporting innovative ideas and products from the Digestive Disease & Surgery Institute, you want to import new technology that could benefit patients. How would that work?

A: We want to make sure that the environment is such that we can bring innovative ideas here. Many of us already have external connections. We can give input in terms of device development or unmet needs. We can review early prototypes, get them into the lab and try them out. As a trusted organization with world-class researchers, we can design and conduct clinical trials that utilize our large, diverse patient base. That’s where Cleveland Clinic’s global connectivity is an advantage. We have campuses across Northeast Ohio, in Florida, Nevada, Toronto, Abu Dhabi and London. If a company doesn’t want to, or can’t run a clinical trial in the United States, maybe they do in Abu Dhabi, where they still have access to Cleveland Clinic-quality researchers and clinicians to run the study. Those sorts of opportunities are what I want to explore.

Q: How might artificial intelligence and machine learning be beneficial in the Digestive Disease & Surgery Institute?

A: Those are big catch phrases that can be hard to pin down, but I’ll give you two concrete examples. One opportunity for AI is an algorithm for detecting pre-malignant lesions during colonoscopy. There are computer programs that can look at digital images and identify what the computer thinks is a polyp. It’s an adjunct to the clinical decision. The endoscopist makes the final judgment and resects the lesion if appropriate. That’s a real application for AI in our field that is not far from being applied clinically. Deep learning is another opportunity we’re seeing when combined with robotics. Robotic surgical platforms allow us to do operations in a minimally invasive way, potentially with more precision than with the human hand. With deep learning, we can extrapolate, analyze and optimize data points across the course of an operation — the time the robot docks, the time when the trocars are inserted, the time of dissection of an artery, then the way in which it’s divided. Over time, this data will be accumulated into billions of points. And the future opportunity might be that if I’m doing a stomach removal and the robot is going through all the permutations of what should be my next step, when I’m outside of the 95th percentile, there might be an alert to say, ‘Is this really what you want to do?’ There’s still a lot of judgment in surgery and this might help surgeons in their decision-making during the course of an operation. That will have significant implications for training and safety in the future.

Q: What metrics will you use to judge your success in elevating technology and innovation within the institute?

A: We’re building a scorecard. We’re going to have short-term goals and long-term aspirations. Part of it will be simply measuring the number of novel ideas generated across these broad areas; the percentage of our staff that have an idea they try to move along; the number of new clinical service lines impacted; the number of competitive research grants awarded, internal and external, that are based on innovation. All of this can contribute to a perpetuating environment of innovation.

Q: Any final thoughts?

A: It’s a great time for this initiative. Innovation is central to medicine. The technology in our digestive disease and surgery practices is changing so quickly. We need to be on top of that. And Cleveland Clinic is poised to be a leader in this area. It’s a tremendous opportunity.