Sara Cox had her “aha moment” in 2018.
A registered neuroscience nurse at Maine Medical Center, Cox had a patient who struggled with impulse control. He kept pulling at his feeding tube, which meant he needed to wear “mitts” to keep him from doing so. But many transitional care facilities do not accept patients wearing mitts, which then delays discharge.
It was the gown that was the issue, Cox realized.
The hospital gown, which provides little coverage for patients, is not particularly well-loved – studies have shown that the garment, essentially a sheet with armholes and two ties in the back, makes patients feel powerless and vulnerable.
But more than that, Cox, who supervises the hospital’s neuroscience patient navigator team, found that the gown allowed neurologically impaired patients to easily access their medical lines and tubes.
She needed something that wouldn’t pull up as easily – something more like a piece of clothing than a sheet – that still allowed clinicians quick access they needed to the tubes.
Enter the NewGown, a romper-like covering that snaps down the shoulder, down the side and between the legs, with a drawstring in the middle that both creates shape and acts as something for neurological patients to fiddle with.
The gown is one of more than 30 inventions to come out of MaineHealth’s new innovation division in the two years since it was formed.
Maine’s largest health care system established the new division in 2020 with the intent to help foster new ideas that will solve problems within the organization and beyond. It focuses on education, funding and connection, or networking.
An idea incubator of sorts, MaineHealth Innovation helps staff turn concepts into products by connecting in-house inventors with experienced entrepreneurs and technical experts.
The organization has partnered with Northeastern University’s Roux Institute in Portland, the University of Maine, the University of Southern Maine and the Maine Technology Institute.
MaineHealth Vice President of Innovation Susan Ahern said medical staff, the boots on the ground, are the true experts and their ideas are valuable. MaineHealth Innovation can help guide them through the process of bringing those ideas to fruition, she said.
“It’s not what they went to medical school for,” Ahern said. “(But) everyone has the insights and ideas to solve our unmet needs.”
11 PATENTS AND COUNTING
In the past two years, the division has worked with 49 inventors and innovators on 34 projects, invested over $337,000 in those projects and filed 11 patents.
Projects have ranged from low-tech to cutting-edge.
Some ideas use simple technology to make big changes, such as Cox’s NewGown. Others have relied on more advanced technology, such as using augmented reality to help train doctors in rural hospitals in neonatal resuscitation.
Some have created new products, such as a specialized tentlike device that creates a negative pressure enclosure for respiratory patients. Others have taken existing technology for use in Maine, such as a new diabetic retinopathy screening system to improve access to preventative eye care in rural areas.
The budding companies and products can be funded privately, or through the organization’s two funds. One provides up to $20,000 to help flesh out the idea or build a prototype and the other offers up to $100,000 to help commercialize a product.
Cox first started working with MaineHealth Innovation to develop the prototype for the NewGown in fall 2020.
Through the new division, Cox connected with the hospital’s director of linen services, who then introduced her to Standard Textile Co., an international textile manufacturer and vendor for MaineHealth. Standard Textile worked with Cox to develop more gowns in various sizes and fabrics.
She introduced the gown in June 2021 and expanded the pilot program with another batch of gowns in December.
So far, feedback has been positive, Cox said, and nurses beyond the neurological department have expressed interest.
“There’s a sort of ‘less-than’ feeling” that comes with wearing a traditional hospital johnny,” she said.
Some patients don’t want to get out of bed for physical therapy because they feel embarrassed and exposed. For years, doctors wanted surgical patients to stay in bed as much as possible, so it didn’t matter if the gown gaped in the back. Today, though, that has become an antiquated idea.
“It’s not good for patients, and it’s not good for people providing care,” Cox said.
The inventor hopes to finalize her prototype soon. Once it’s ready, she’ll present the idea to MaineHealth for wider adoption.
It’s unclear whether Cox has any specific plans to expand the NewGown beyond the health care organization, but she said Standard Textile has a strong global presence. If the gowns are a hit, she said, expansion is possible.
USING AI TO PREVENT BLINDNESS
An internal medicine physician at Western Maine Primary Care in Norway, Dr. Brian Nolan’s practice serves roughly 1,300 diabetic patients – all of whom are at risk of diabetic retinopathy, the leading cause of blindness in U.S. adults.
Of those patients, only about 60 percent receive the recommended retinopathy screenings, something Nolan said his practice has been trying to correct for years.
There aren’t enough eye care specialists in the area, he said. Between the lack of access to services, the high cost of care and limited patient education around the importance of screenings, hundreds of patients weren’t getting the necessary preventative care. He wanted to bring those screenings into the primary care setting.
Then Nolan discovered EyeArt, a new autonomous artificial intelligence system for diabetic retinopathy screening developed by California-based Eyenuk Inc. It uses a retinal camera that connects with a cloud-based artificial intelligence system to analyze retinal images within seconds.
EyeArt, which received clearance from the U.S. Food and Drug Administration in August 2020, aims to make diabetic retinopathy screening more accessible for primary care doctors – exactly what Nolan was trying to do.
In fall 2020, Nolan and his team received money from MaineHealth Innovation’s “Ignite Fund” to purchase the $16,000 retinal camera and cover the cost of the first 100 AI image interpretations, according to MaineHealth.
“I had been hearing about (the technology), but being able to put it into practice in a rural setting was exciting,” Nolan said.
The idea of using a camera for retinopathy screening isn’t new, he noted, but using the computer to interpret the information instead of sending images to an eye doctor is a relatively recent change.
The office screens between 10 and 20 patients each week in a quick, five-minute process at the end of their standing primary care appointments or during retinopathy screening clinics the practice now offers.
It’s already making a difference. Nolan said the provider has detected vision-threatening retinopathy in a few patients who were then sent for follow-up with a specialist and started treatment.
So far, Western Maine Health has screened about 200 of the 500 patients who were missing out on preventative care.
“We still have a gap,” he said, so further increased screening is the next step.
Then, Nolan said his team will do research to correlate their findings with eye doctors’ research to see how well the technology performs in real-world settings. They are also studying and preparing a publication analyzing the patient and provider experience.
Ultimately, he hopes to expand the technology across the health care system.
“To be in rural western Maine and feel like we’re doing cutting-edge things is encouraging,” he said.
MIXED REALITY HELPS RURAL INFANTS
Two pediatric doctors are working to develop an augmented reality system for training doctors in neonatal resuscitation – an invention they say will help change health inequity in rural communities.
In rural Maine areas, babies born in distress are six times more likely to have significant neurological complications, according to Dr. Mary Ottolini, chair of pediatrics at the Barbara Bush Children’s Hospital.
While there are measures out there to help, in rural hospitals where they may only see one birth per day and one or two cases of neonatal distress per year, health care workers don’t always have the practical experience they need in an emergency.
Ottolini teamed up with Dr. Michael Ferguson, a pediatric intensivist at Barbara Bush, to find a more mobile, affordable and accessible option.
Through MaineHealth Innovation, Ottolini and Ferguson partnered with Case Western Reserve University, a leader in augmented reality, to develop software that would simulate a real-time neonatal distress scenario.
Shortly after, the Augmented Technology for Medical Simulation, or ARTforMS, received money from the Ignite Fund, according to MaineHealth.
ARTforMS uses Microsoft Hololens mixed-reality goggles, Empatica biosensing wristwatches and Case Western augmented reality software.
Initially, Ottolini said she envisioned something more like virtual reality, but the innovation center introduced the idea of augmented reality, which was “critical” to its success.
Instead of operating in an entirely virtual world, mixed or augmented reality allows the person to see and touch real objects such as a mannequin while also viewing a software-driven virtual overlay. It allows them to practice skills they would need to use in a real situation, such as opening up an airway, doing CPR or inserting intravenous lines.
Ottolini and Ferguson are working to form a company to eventually manufacture and distribute the technology, hopefully reaching as many rural communities as possible.
The innovation center helped the duo move from concept to product. Without it, he said, the idea would probably still be sitting in Ottolini’s office.
“We are not businesspeople,” Ferguson said.
Ferguson estimated it could cost up to $20,000 for the headset and all the hardware plus some annual investment. He believes ARTforMS can help change the outcomes for children around the world.
“It’s outrageous that a kid can be born in a different ZIP code and have a six-times-more-likely chance of neurological injury,” he said.
If the risks are that high in Maine, a relatively wealthy state, he said, they’re likely even higher in other states.
Having the system as a training module for anyone in the world at any time would allow them to reach areas that ordinarily wouldn’t have access to that kind of training.
“There’s an urgency for this,” Ferguson said.
NEGATIVE PRESSURE TENT TRAPS COVID-19
In the early days of the coronavirus pandemic, as uncertainty swirled and hospitals grappled with how to contain the virus, a team of doctors invented a tentlike negative pressure system that attaches to a stretcher and can be used anywhere.
Negative pressure means there’s less air pressure inside the tent than outside, thus preventing any virus inside the tent from escaping.
In March 2020, Dr. Liz Hamilton and Dr. Katie Main, chief residents at Maine Medical Center’s emergency department, approached Dr. Samir Haydar, attending emergency physician, with their idea for a makeshift tent that could help contain the virus while patients waited to be transferred to the hospital’s popup negative pressure rooms.
They grabbed some PVC pipe and plastic covering from Home Depot, and within 24 hours had constructed an early prototype of what would eventually become the Collapsible Aerosolized Particle Enclosure, or CAPE.
Just draping a tent over the stretcher wouldn’t do quite what they wanted and wouldn’t have been comfortable for extended periods, Haydar said, so they started talking about adding in negative pressure.
“You don’t want to put someone in a plastic bag,” he said.
MaineHealth Innovation connected the group with Baker, a leader in biocontainment, and Thermoformed Plastics of New England, an expert in high-performance plastics.
Together, they developed the CAPE as it is today: a mobile device that attaches to a patient’s stretcher, turning most care settings into a safe negative pressure environment, according to MaineHealth.
The CAPE is designed to be reusable and easy to operate. It can be set up in 10 minutes, Haydar said.
Aside from protecting clinical staff and other patients by mitigating the spread of the virus, the CAPE is designed to be relatively comfortable. So far, they’ve had patients sitting in the CAPE for more than 11 hours without complaining or feeling claustrophobic, Haydar said.
The hospital now has five CAPE devices. Haydar said the team is ready to make more but is doing some minor optimizations on the design, such as adding a custom-made fan system from Baker. Once done, the CAPE will cost between $5,000 and $10,000, which Haydar said is much less expensive than some of the competing devices on the market.
Haydar hopes to see the CAPE scaled throughout MaineHealth and beyond.
He hopes to see it become standard issue in the event of a crisis such as the coronavirus pandemic, but he also sees uses for the device beyond coronavirus containment for hospitals. It could be used for any patient with a respiratory illness, Haydar said. And outside the hospital setting, it could serve as a way for, say, cruise ships to contain a small number of patients for a short period of time in the event of an onboard outbreak.
Haydar and his team are using money from MaineHealth’s “Bonfire Fund” to help obtain emergency use authorization from the Food and Drug Administration and conduct a clinical trial.
The device was recently featured in the American College of Emergency Physicians’ 2021 “Innovation of the Year” competition, according to MaineHealth.