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Letter from Medical Leadership
RHEUMATOLOGY
715

Letter from Medical Leadership

Hear from the Surgeon-in-Chief, Physician-in-Chief and Chief Scientific Officer

As has been the case for so many institutions, recent events sparked a sweeping, albeit temporary, transformation at HSS in 2020. For several months in the spring of 2020, our organization served a crucial role in the New York City community response to COVID-19, providing space for patient care, making available our supplies and personnel, and contributing to the knowledge base that would help to define treatment protocols for the disease.

We have since been able to return to our core mission of providing the best musculoskeletal care in the world, and there have been lasting changes for the better. One of those is the explosion of growth in areas that will support a healthy and dynamic organization for the future.

The primary example of this was the implementation of a robust telehealth program, HSS Virtual Care, which grew from 1,000 appointments in 2019 to more than 100,000 in 2020. This swift virtual shift enabled our patients to continue their care uninterrupted during a time in which continuity was both lacking and paramount.

hss virtual care grew from 1,000 appointments in 2019 to more than
100,000appointments in 2020

We expect to see this trend toward virtual care continue and are working to bring as many of our clinicians as possible into this new model, as well as to help musculoskeletal providers outside of HSS to overcome the challenges of care delivery through this means.

This swift virtual shift enabled our patients to continue their care uninterrupted

We also expanded our capacity to care for people with urgent musculoskeletal injuries and illnesses at our outpatient locations in New Jersey and New York State, essentially serving as the de facto orthopaedic trauma emergency room at the height of the crisis. Continued development of our geographic footprint through our satellite locations is a priority, as are our strategic initiatives to expand outpatient surgery regionally, with the aim to improve access and convenience for all patients.

The deep expertise of our rheumatologists is always invaluable in ensuring positive outcomes for our patients, but it was never more vital than during this crisis. Our researchers were a voice of authority during a chaotic time, publishing research that shed light on the efficacy of treatments for COVID-19 while continuing to meet the needs of our rheumatology patients.

Our researchers were a voice of authority during a chaotic time, publishing research that shed light on the efficacy of treatments for COVID-19

The strong interdisciplinary ties among our clinician-scientists, basic scientists and surgeon-investigators that have long been a trademark of HSS have been further strengthened by the effort to bring our expertise to bear on confronting this pandemic. Current basic science projects are studying the cell types responsible for COVID-related cytokine storm syndrome, dissecting the role of macrophages in COVID-induced acute respiratory distress syndrome, and seeking to identify biologic predictors of a favorable outcome in patients with severe cases of the disease. We are also evaluating the disease as it affects orthopaedic surgical outcomes. This includes research to evaluate the response to and recovery from total knee arthroplasty in people with antibodies to the virus that causes COVID-19, as well as to predict and prevent postsurgical blood clots in COVID-19 patients. The latter of these studies is a true collaboration, with investigators in orthopaedic surgery, rheumatology, pathology and anesthesiology, among others.

The latter of these studies is a true collaboration, with investigators in orthopaedic surgery, rheumatology, pathology and anesthesiology, among others.

The past year also made clear the imperative of a renewed emphasis on diversity and inclusion at HSS. While there is much to be proud of, including efforts to impact diversity within both our institution and our patient population, there remains significant work to be done. One of the most important ways we as clinicians can reshape the field is to broaden its accessibility to underrepresented groups through outreach and opportunity. The Perry Initiative and other programs with local students are just one example of the means by which this can and should be done. On the research side, HSS physician-scientists are shedding light on care disparities as the first step in rectifying them. This includes work by orthopaedic surgeon Michael Parks, MD, rheumatologist Susan Goodman, MD, and others to highlight outcomes disparities among arthroplasty patients. It is also vital to create as welcoming a space as possible for patients as well as staff. Among the many ongoing efforts in this regard, training for staff on the role of implicit bias in healthcare has become a priority under the leadership of Jillian A. Rose, EdD, MPH, LCSW, who leads Community Engagement, Diversity & Research at HSS and this year was selected to participate in the Diversity and Inclusion Task Force of the American College of Rheumatology.

Meanwhile, our efforts to advance the standard of musculoskeletal care have continued undiminished, in spite of these unusual times. Our clinicians are actively working to shed light on efforts to more effectively combat periprosthetic joint infection, create new and better options for spine surgery, optimize perioperative care in pediatric patients, and chart the future of care for patients with rheumatologic and musculoskeletal diseases such as rheumatoid arthritis, osteoarthritis, lupus, scleroderma and others.

The unparalleled collaboration of rheumatologists and orthopaedic surgeons at HSS provides a truly unique opportunity to transform care of patients with rheumatic and musculoskeletal diseases through discovery and rapid application of this new knowledge to healthcare.

Building on the substantial achievements in basic and translational research by investigators in the HSS Research Institute, we are actively expanding our world-renowned team of clinicians and researchers to facilitate the translation of discovery into improved patient care.

our big data initiative will build expertise and infrastructure to maximize the use of artificial intelligence and machine learning to address key clinical questions
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Our Big Data Initiative will build expertise and infrastructure to maximize the use of artificial intelligence and machine learning to address key clinical questions in rheumatic and musculoskeletal diseases. Data that will be used for these large-scale discovery efforts include biologic data from analysis of patient samples from our biobanks and repositories, as well as data from electronic health records, patient-reported data, large administrative databases such as Medicare, and others.

These efforts will help to identify subtypes of complex diseases, predict which patients may have a disease flare in the future, and allow rheumatologists to precisely tailor treatment plans for individual patients. Thus, these efforts will both enhance our understanding of rheumatic diseases and lead the field in innovative healthcare delivery.

It’s never been clearer that change is a constant. How we choose to handle it will define the legacy of this time for generations of medical professionals to come. It is our goal to continue to rise to the challenge, adapt to the circumstances, and use this adversity to fuel necessary evolution for the future.

Bryan t. Kelly, Md, MBA
Bryan t. Kelly, Md, MBA
Surgeon-in-Chief and Medical Director
Chief Emeritus, Sports Medicine Institute
Korein-Wilson Professor of Orthopaedic Surgery
s. Louis bridges, JR., MD, PHD
s. Louis bridges, JR., MD, PHD
Physician-in-Chief
Chair, Department of Medicine
Chief, Division of Rheumatology
Franchellie M. Cadwell Professor of Medicine
lionel b. ivashkiv, MD
lionel b. ivashkiv, MD
Chief Scientific Officer
Richard L. Menschel Research Chair
David H. Koch Chair in Arthritis and Tissue Degeneration
Professor of Medicine and Immunology
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