UNIVERSITY OF NEBRASKA MEDICAL CENTER
Two University of Nebraska students interact with a 3D anatomy training module of the human heart inside the iEXCEL Visualization Hub at the Davis Global Center.
Nebraska might not be top of mind when one thinks about the medtech industry. But the state has seen strong growth in the sector—especially in Omaha—driven in part by the opening of a large, state-of-the-art medical simulation facility. The five-story, 192,000-square-foot Davis Global Center opened in March 2020, just as the COVID-19 pandemic was ramping up. The iEXCEL program was designed to train students from the Nebraska public university system and clinicians from area hospitals—and eventually attract clinicians from around the country. But what was needed immediately after opening was training medical providers on how to properly perform procedures like a COVID-19 nasal swab. “There were incorrect procedures that were leading to some patient-safety issues, and teams had to be trained and taught very, very quickly,” said Pamela Boyers, associate vice chancellor for clinical simulation at the University of Nebraska Medical Center. The center is located on the school’s campus.
UNIVERSITY OF NEBRASKA MEDICAL CENTER
The five-story Davis Global Center, located on the campus of the University of Nebraska Medical Center, opened in March 2020.
“The testing results were only as good as the swabbing techniques, so we worked with nurses, physician assistants, physicians, medical students, the National Guard, all around on doing correct nasal pharyngeal swabbing in the early days of COVID-19, because there was a patient-safety concern.” It was seemingly simple, but the swab training was exactly what iEXCEL was designed for. And it’s part of larger growth in the medtech industry in Omaha, where business leaders see a bright future. Companies like drugmaker Merck, diagnostics companies Streck and BD, and nutraceuticals company Vireo Resources all have sizable operations in the greater Omaha area. Part of the draw has been from state incentives; in 2020, the Nebraska Legislature created a new refundable income tax credit for corporations and others. More than 3,000 people are employed in these industries in the region. Boyers and her colleagues led the charge on finding funding for the center, which has a $3.5 million annual budget. It was paid for in part by a $25 million initial investment from the state, the City of Omaha and private sources.
UNIVERSITY OF NEBRASKA MEDICAL CENTER
Residents practice their COVID-19 intubation technique on one of the simulation center’s mannequins.
Each floor depicts a different setting, from a nursing home to hospital room and even a home. The center also has a visualization wall, and simulations can be done on both models and cadaver tissue. “Patient safety has to be paramount, and yet, here we are, with unfavorable statistics still coming out about the number of avoidable deaths due to medical error … and those don’t even include the patients who have been hurt or suffered,” Boyers said. “(The problems) often result from systematic issues involving teams and handoffs.”
A new vertical Officials see so much potential for the center to draw clinicians from across the country—and even internationally—that the Greater Omaha Chamber of Commerce decided to more aggressively build out a new vertical industry in medical technology, and is actively recruiting more companies to choose the city. “(The Davis Global Center opening) was the biggest reason for us to jump into medical technology,” Chamber CEO David Brown said. “Now we’re trying to figure out how it ties in with all of our entrepreneurship work, our existing small business work and our business attraction work.” The Chamber last year formed a group to focus on growing the sector, looking at research and development, medical equipment manufacturing and supply chain companies. This year, they launched a digital marketing campaign—mostly on LinkedIn. Representatives from the state’s Department of Economic Development will attend the international trade show Medica in Germany later this year, one of the largest medtech conferences in the world. “Our central location really provides great opportunity from a medical supply chain position. We have low costs and we have great connectivity for transport goods,” said Mark Norman, senior director of business attraction and expansion at the Chamber. “Wages, for the most part are above average and that’s something that we want to attract our area.” The iEXCEL program also recently hired a director of business operations to focus on arrangements with medical supply and device companies that want to conduct clinical trials on products within the simulation scenarios. They’ve begun research and development work with about a dozen industry partners that pay the center to use and test their products. Norman said he’s hoping some of these companies might consider Omaha as a location for further development. Dr. Harry Greenspun, a partner and chief medical officer at consulting firm Guidehouse, said the Omaha center’s simulation capabilities offer an attractive environment because getting patients’ consent for device trials is a time-consuming and expensive proposition. “You could actually get proof of concept in a simulation center, and many of these large centers can charge pretty heavily, or get joint ventures with some of these companies using their products first in the simulation environment,” Greenspun said. That revenue, however, has to be balanced with the main goal of improving patient quality and safety. “We have to be very judicious and careful about how we keep those two things separate; we can’t be seen as a state institution to be promoting or selling anything,” Boyers said. “There’s a moral issue and an integrity issue that has to be carefully balanced.” The mission of improving safety was thrown into sharp relief by the summer of 2020, when it was apparent that medical students wouldn’t get the hands-on training in hospitals they normally would, because of the pandemic. The simulation center helped fill that void.A safe space to practice Madeline Cloonan, who just finished medical school at UNMC and is starting residency in general surgery at Nebraska Medicine soon, recently spent a week in a workshop participating in various simulations, from delivering bad news to an actor, to cadaver disections and practicing surgical procedures. “You don’t get that chance this early on in any other settings,” Cloonan said. “It’s getting an idea of what it’s like to be an attending surgeon in a very safe environment.” In April alone, the center had 4,700 people go through various training sessions at the center, most of whom were students. Other hospitals in the Omaha area are also looking at having their residents and doctors train at the simulation center. Children’s Hospital Medical Center has its own simulation capabilities, but on a much smaller scale and without the same budget as iEXCEL. “Some of the equipment is thousands of dollars, and some of the mannequins are tens of thousands of dollars, so it’s trying to not duplicate what is already there,” said Dr. TJ Lockhart, a pediatric anesthesiologist at Children’s, adding that they’ve hired consultants to figure out how to build out their own simulation space. “One of the biggest challenges is that we’re not next to each other. It’s a couple miles down the road. You can’t just easily have an hour of simulation in the afternoon for your fellows.” Lockhart and his team recently trained their hospitalists in anesthesia practices, which these doctors don’t usually perform. With an increase in diagnostic tests like MRIs for children at the hospital, more hospitalists need to be trained in lower-level anesthesia practices. “Sometimes it’s hard to get on to our pediatric anesthesia schedule, so we’ve come up with certain (procedures) that can be done without the need for an anesthesiologist to be involved, where standardized sedation protocols can be used for patients who fit certain criteria,” Lockhart said.
The business case Payers don’t reimburse for simulation training, but there’s money to be made in other ways. And as the Chamber hopes, the center will eventually open to outside hospital clinicians and other staff for training, though that largely hasn’t happened yet due safety concerns around the pandemic. But once that side of the business is up and running, it has the potential to drive quality improvement. Studies have shown simulation training can improve patient safety by decreasing medical errors. And with the simulation center’s range of settings, the iEXCEL program can work with hospital quality programs by bringing clinicians in to target procedures that are driving lower quality scores. “One client I know is using this (their simulation center) as entirely a revenue process where they are training other innovation-driven hospitals to build these types of programs; they’ve productized this exact thing as part of a larger innovative system,” said Robert Lowe, CEO of innovation software company Wellspring. “They’re recognizing that the expertise they’ve built over the years is now something that they can help other institutions with.” And this type of training is what Boyers says the Omaha center is all about, where clinicians can try new practices, hone their skills and make mistakes in a safe space. “There are different financial cultures in each institution, and some of them are more short term, where they look at the next six months, and others look at the longer-term benefit of simulation and the impact on liability, risk, better patient-safety outcomes,” Boyers said. “I’ve never met a healthcare professional who wasn’t afraid of hurting a patient, and I think having a safe place to practice, that’s well embedded into their training, is really, really important.”
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