Hello Friends 👋
This week we have a fantastic conversation with Dr. Myers. Eliza Myers, an academic neonatologist, shares her journey in neonatology and her passion for combining art and medicine. She discusses the importance of pursuing personal passions and making time for hobbies. Dr. Myers also highlights the role of visual arts in medicine and the impact it has on creativity and problem-solving. She then delves into her dedication to breastfeeding and lactation, including the development of the Track My Milk app. She explains the process of building the app and its integration into the electronic medical record system. Dr. Myers emphasizes the importance of parent compliance and engagement in using the app and the positive impact it has on the bedside experience. She also discusses the collaboration between physicians and lactation specialists and the support needed for trainees with unique ideas. Finally, Dr. Myers shares her thoughts on expanding the app to other electronic medical record systems and the challenges and rewards of the development process. In this conversation, Eliza Myers discusses her work on Track My Milk, a mobile app for tracking breast milk production. The conversation covers challenges of collaboration, the impact of technology on research in medicine, the importance of parent engagement and data collection, the potential of artificial intelligence in healthcare, and the exploration of brain microstructure in neonatology. The conversation concludes with a discussion on the future of Track My Milk and its potential dissemination.
Enjoy!
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Short Bio: Dr. Myers is an Academic Neonatologist in the Yale New Haven Children’s Hospital system NICUs, and Medical Director of the level 3 YNHCH NICU on the Bridgeport Campus. She is a graduate of Harvard College, where she majored in Visual and Environmental Studies, and the University of Rochester School of Medicine and Dentistry, from where she received her MD and completed pediatric residency. Her fellowship in Neonatal-Perinatal Medicine was at Yale. She remains active in the visual arts and completes a few very large-scale oil paintings a year and occasional medical illustrations. Her scholarship work dovetails neatly with her clinical work, where she focuses on family centered care and lactation medicine. She is aiming to become board certified in Breastfeeding and Lactation Medicine in the spring of 2025. She is also the recipient of a 2022 Yale New Haven Health System Innovation Award, for her work in creating a MyChart-imbedded breastmilk pumping log that allows parent entered expressed milk data to populate the Epic EMR. In her words, “Human milk saves lives. For babies, parent’s own milk is as critical as customized medicine, protecting against infection and providing gold standard nutrition. For parents, expressing milk yields lifelong metabolic benefits and protection against some cancers. This tool empowers parents to engage with the medical team and brings patient-entered data directly to clinicians for review and action. My vision is that TrackMyMilk changes the landscape of human milk use in our system NICUs, driving equitable and skilled lactation support across our system.”
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The transcript of today's episode can be found below 👇
Ben Courchia MD (00:00.692)
Hello everybody, welcome back to the Incubator Podcast. It is Sunday, we are back with another interview. Daphne, how are you this morning?
Daphna Yasova Barbeau, MD (she/her) (00:07.454)
I'm great. I love interview days. So, you know, it's way more fun to have people in here than just talking to you all the time.
Ben Courchia MD (00:15.884)
Fair enough. Thank you for saying that. No, today we have an amazing guest. I love guests that have a multifaceted approach to neonatology, and we are joined by Dr. Eliza Myers. Eliza, welcome to the show.
Eliza Myers (00:33.048)
Thank you.
Ben Courchia MD (00:34.7)
For people who are not familiar with who you are, you're an academic neonatologist in the Yale New Heaven Children's Hospital System, NICUs. You are the medical director of one of their level three NICU, the Bridgeport Unit, is that correct? And you have an extensive bio. You are a neonatologist. You are a lactation consultant. You are doing some innovative things with an app that we're going to talk about today called Track My Milk.
Eliza Myers (00:48.405)
Mm-hmm.
Ben Courchia MD (01:03.988)
So we're very excited to talk to you today and find out more about all the things that you do.
Eliza Myers (01:09.524)
Wonderful.
Ben Courchia MD (01:11.464)
So the question we start with, if you've listened to the show, you know it. Like, how did you find yourself in neonatology? What was the story behind that?
Eliza Myers (01:23.028)
Oh, the story behind that is I loved my pediatric residency program. I did my residency at the University of Rochester and it was a very gentle program, I think by design. And I felt like the place where I saw the most action, where I like did stuff where, where we had to make decisions without someone looking over our shoulder was in the NICU. So I loved the, like running to the, it was, it was.
Ben Courchia MD (01:46.304)
That's surprising to hear.
Eliza Myers (01:52.296)
It felt like a lot of the other, really? Like what? It was, well, I guess you had to go to the delivery room and you had to like do it right. And there was no one there, right. You just had to do it. And it was a busy NICU service as I, a big probably 70 bed-ish NICU. And it was just, you were just like do stuff all the time. And I just, I really liked that. I liked, you know, not waiting for someone to tell me what to do. I just had to do it.
Daphna Yasova Barbeau, MD (she/her) (01:52.494)
I feel like most of us have the opposite experience.
Daphna Yasova Barbeau, MD (she/her) (02:01.57)
Do it, Ram.
Ben Courchia MD (02:04.268)
Yeah.
Eliza Myers (02:20.584)
And obviously it was a wonderful, supportive academic neonatology service where the neonatologists watch us like hawks. I guess I mean in the delivery room, we had to just do it.
Ben Courchia MD (02:32.176)
And I guess I wanted to ask you a little bit about your background even before then, because I was reading through your bio and I was noticing that you majored, I guess, in college in visual and environmental studies. And I think that's such a fascinating aspect of this, especially when you tie things with the NICU. Can you tell us a little bit more about that interest of yours and how does that tie in with your current role as a neonatologist?
Eliza Myers (02:44.088)
Yeah, so just, just.
Eliza Myers (02:57.928)
Yeah, that visual and environmental studies is just a fancy way of saying studio art. So I really was a studio art major in college, which is fancy also. I went to Harvard, but it was a studio art major. And I feel like I've had this tension my whole life where I grew up wanting to be a doctor. My dad is a doctor and I grew up seeing him working so hard and seeing how much his patients loved him and just thinking, well, obviously that's exactly what I'm going to do with my life. But I'm not really a born scientist or mathematician. And so my
academic career, I was much more drawn to the liberal arts and studio arts in particular. And I think I just sort of got lucky. Like I figured out that I could, I could major in this thing that I really loved and was really good at. And I also sort of knew like that was going to be the end of it. Like I was going to do studio art in college and then never again, because I was going to go to medical school and be a doctor. But I did a post-baccalaureate degree after college. One of those...
Daphna Yasova Barbeau, MD (she/her) (03:47.31)
Hmm.
Eliza Myers (03:55.136)
sort of great one year programs where you do all of, all your pre-med stuff in one year. And then I went to the, that was at Bryn Mawr College, and then I went to the University of Rochester. But I have figured out a way to get back, get back into doing visual arts. I mean, partly just by being creative at work and partly by continuing my own studio work.
Daphna Yasova Barbeau, MD (she/her) (04:18.838)
Well, tell us, I'd like to hear more about that. I think that we have so many non quote unquote non-traditional applicants into the community. And that basically means like you did literally anything other than the routine pre-med track. But I find that there's like so much value to that. I think it adds such a richness to your life for one, but also how you think about problems in medicine.
Eliza Myers (04:21.665)
Thank you.
Eliza Myers (04:35.565)
Yeah.
Daphna Yasova Barbeau, MD (she/her) (04:45.398)
But it's kind of routinely discouraged, I think, in the underground, in the undergraduate world for people who are looking at med school and things like that. So, I mean, I'd love to hear more about how you've continued to keep that in your life and what you think what is your message for people who have a background that is a little bit multifaceted.
Eliza Myers (05:00.83)
Hahaha
Eliza Myers (05:04.256)
Well, my message is definitely do the thing you love. Don't flunk out of the science classes and look into these post-baccalaureate programs. They won't take you if you do poorly in the science classes, so better just not to take them in the first place, which luckily I figured out pretty early on. And then in my own life, I just kept painting really, sort of watercolors are easy to do anywhere, small scale oil paintings. And then when we're in the last eight years that we've lived in New Haven,
Daphna Yasova Barbeau, MD (she/her) (05:09.764)
That's right.
Daphna Yasova Barbeau, MD (she/her) (05:16.65)
Hehehehe
Eliza Myers (05:33.78)
a place where I can, I like painting big, large scale paintings. So I found a studio where I can keep a big canvas and I have a, I go on Thursday nights. And so it's sort of ingrained in my family. Also like that's what mom does on Thursdays is she, I think nobody at work knows this. So this might be exciting when people listen to it.
Daphna Yasova Barbeau, MD (she/her) (05:51.932)
you made it sound like maybe you're doing some crafting at home. This is like the real deal. You're really doing art here.
Eliza Myers (05:55.059)
Oh yeah!
Oh, I'm all big on the crafting at home too. Like I will custom knit you a sweater with your name across the front of it. No problem. But yes, I go to a art studio, a painting studio and paint large scale paintings. I try and be loose, but my internal drive is to be sort of like creepy and meticulous, but I try and loosen up. Like that's the one place where you just, it doesn't matter, right? The stakes are so low. Nobody's going to live or die. It's just making a painting.
Daphna Yasova Barbeau, MD (she/her) (06:28.174)
That's so interesting. And I love that you've scheduled it into your week, really, because I think that's where a lot of us lose sight of our hobbies and our other passions is we feel like there's not enough time. But you're an exceptionally busy person. So how do you make the time?
Eliza Myers (06:47.232)
Um, you just schedule it and then you just do it. I'm into rules, not decisions. Don't think about it.
Daphna Yasova Barbeau, MD (she/her) (06:49.539)
Mm-hmm.
Daphna Yasova Barbeau, MD (she/her) (06:53.186)
Mmm. Mmm-hmm.
Ben Courchia MD (06:54.268)
I like that. What is the importance of visual arts and arts in general in bringing you balance as a physician and maybe how you see this also as an outlet for your patients and your families?
Eliza Myers (07:12.46)
I think maybe just flexing a muscle of creativity, just thinking about things outside of the box. I mean, first of all, it's just very relaxing. You know, some people swim and some people meditate and some people go to their painting studio. So I think it's good to be good to have a relaxation practice, whatever it is. But I think thinking creatively and thinking outside of the box and thinking of, I think is incredibly helpful. It's certainly what's driven a lot of my projects at work.
Ben Courchia MD (07:41.504)
cool. I wanted to also then touch on, we've talked about you as a neonatologist, we've talked about art, but one of the aspects of your profession is that you are truly dedicated to breastfeeding and feeding human milk to critically ill newborns to the extent that you actually are a certified lactation consultant. And if I remember correctly, you said that you're hoping to take this brand new board exam.
Uh, that is coming out in 2025 for breastfeeding and lactation medicine. I've never heard anybody being excited about a potential of taking a board exam, but can you tell us a little bit about where did that come from?
Eliza Myers (08:16.802)
Hahaha!
Eliza Myers (08:22.808)
Oh, yeah, where did that come from? I think that there was sort of a natural intersection between my life. Well, I should step back. There was really not, I did not get a lot of lactation specific training in either breastfeeding medicine training in residency or in fellowship. I think I had an awareness that there was human milk use in the NICU when I was a fellow, but I really, I thought he's going to ask me this and I just couldn't.
come up with anything more than having an awareness of and a regard for the work that the lactation specialists were doing, but nothing specific. Like if you had asked me on any given day, what is that, you know, what does baby Smith consume? I don't think I would have been able to tell you. So that wasn't part of my daily rounds. That was not like something we dwelled on in detail during daily rounds. And then I think there was, I think over time, four kids, and so I think that there was a sort of
my personal life where sort of for a long time was either pregnant or breastfeeding somebody and then my professional life and becoming aware of the role that the neonatologist could play in promoting human milk.
Eliza Myers (09:34.784)
I think those paths kind of merged. And I had a new job at the time at Yale. So this new job in the Yale system where for the first time I had, it's a beautiful unit with a lot of resources, people who said yes to my ideas, people who said, yeah, you can spend money on that. And so I had opportunity and I saw that what we were missing was sort of specific NICU focused lactation. And I thought, well, I guess I'll...
Daphna Yasova Barbeau, MD (she/her) (09:53.876)
Hmm.
Eliza Myers (10:04.792)
do it myself then. So.
Daphna Yasova Barbeau, MD (she/her) (10:07.926)
I love that. In my experience, I feel like every unit has the one person in the unit, sometimes the nurse, sometimes it's a physician, sometimes it is a lactation consultant primarily, who says, this is important and I want to talk about it on rounds. But truthfully, in my experience, I think it is not uncommon that neonatologists say like, yeah, human milk is important, but if we don't get it, we've got this other stuff.
Eliza Myers (10:23.6)
Bye.
Daphna Yasova Barbeau, MD (she/her) (10:35.782)
And that's not really my job. It's the lactation people's job. It's the bedside nurse's job. But why do you think it's important that the neonatologist, the physician, the head of the team really takes a stake in the procurement of human milk?
Eliza Myers (10:53.12)
I, you first of all, you just like summed up the last six years of my life, but yes. Why is it, because it is so important. I think it's like one of the most important things we have in our toolbox to prevent neck, to improve neurodevelopmental outcomes, to enhance family centered care, to make the parents happy and why it's gotten pushed to the side or it's siloed in its own sort of like.
Daphna Yasova Barbeau, MD (she/her) (10:58.07)
Ha ha ha.
Eliza Myers (11:17.42)
arena, I don't really know. And I've read lots on the topic. Is it because it's a women's health thing? Is it because we're talking about breasts and some physicians don't have breasts? I just, I really don't know. But it seems so obvious to me that discussing human milk needs to be part of daily rounds in the same way I make this analogy, particularly when I'm talking to non-physicians. If I'm explaining this project to
to leadership people or tech people. And I make this analogy to the pancreas. And I say the pancreas is an exocrine gland, it excretes insulin. You know how it's doing its job by checking the patient's blood sugar, which is a number. The breast is an exocrine gland, it excretes milk. You know how well it's doing its job by checking how much milk it's excreting relative to the age of the baby that it's feeding. It's not complicated. And I get these like light bulb moments, particularly with non-physician people,
Right, so it's just a number. We're just talking about the number. So I've thought a lot about your question, why don't the neonatologists talk about it? But maybe that's changing.
Daphna Yasova Barbeau, MD (she/her) (12:30.103)
The tides, they are changing. So how do you have the time then to integrate all these other additional skills, because it is a specialized training, into your daily practice? What does that look like for you on rounds? What does that look like for you in the afternoons when you're doing your kind of bedside walking around? Tell us a little bit about that.
Eliza Myers (12:48.357)
Yeah.
Eliza Myers (12:52.544)
Well, I loved doing all the learning to become an IBCLC. I definitely do not do the bedside work that the bedside IBCLCs do and that they do so well. So I'm not the person who's spending 30 to 40 minutes at the bedside, like actually helping the baby latch. I've really allowed my focus and my area of expertise to be initiating and maintaining the milk supply of a parent who's separated from their baby. So I'm much more into the...
physiology of the milk supply, which can be discussed on rounds and does have, that's more time limited than the amount of time you could spend promoting all the best breastfeeding behaviors and putting babies to breast like that, that's infinite and I don't have the time for that. So I'm very grateful for the amazing lactation specialists who I do work with who do that on the ground work.
Daphna Yasova Barbeau, MD (she/her) (13:46.658)
Yeah, but I love that. And I think, I mean, what you're saying is something we can all do on rounds because it is not the extra 30, 40 minutes at each bedside. It is, I mean, you tell me what are the top three things? Is it asking mom how pumping is going? Is it documenting the supply? What are, if units are really starting to look at how can we get more milk at bedside, what are the top three things we can all be doing?
Eliza Myers (14:14.584)
Well, I can streamline it from three things to two things, because I say milk in two places. We talk about it as a data point. So it's a piece of data. I like it in the I's and O's. This is what the baby consumes. This is the way the baby peed and pooped. This is what the parent produced in express breast milk. And then again, in the feeding section of the plan. So this is when you're in the FEN section of your plan.
Daphna Yasova Barbeau, MD (she/her) (14:19.229)
Love it.
Eliza Myers (14:43.916)
Track my milk stuff is so cool because it feeds that data. Like the magic of track my milk, if I can just start talking about it, is that it feeds the data point of how much milk the parent pumped into the data section of the note. So it just, you're not asking the parent anything, you're not looking at a pumping log, you're not chasing them or tracking them down.
Daphna Yasova Barbeau, MD (she/her) (15:11.246)
Okay, well, I guess, I mean, now's a good time, I think, for us to really talk about Track My Milk since you brought it in. And just so people who aren't familiar with it, it's called Track My Milk. It's an EMR integrated mobile app allowing real-time clinician review of human milk production in order to support initiation and maintenance of human milk supply. You won a Yale New Haven Health Systems Innovation Awards for this app. So tell us if somebody's never heard of it before. Tell us what that...
Eliza Myers (15:16.856)
Hahaha! Yeah!
Eliza Myers (15:29.768)
Yes.
Daphna Yasova Barbeau, MD (she/her) (15:40.982)
what that app does and what it looks like.
Eliza Myers (15:43.044)
I will. So I always get in trouble when I talk about it as an app, even though that's how the parent perceives it as an app because it is like sitting on their phone, but it's truly an optimization to the MyChart app. So this is only going to make sense to people whose hospital systems use Epic. Epic is an electronic medical record company and their patient facing portal or their patient facing service is called MyChart.
And MyChart has a desktop version that can sit on your desktop, but it also has a mobile app that patients keep on their phone. And you can do tons of cool stuff with MyChart. You can look at your upcoming appointments and text your provider to ask a question, and you can request your medications. I mean, it's a nice app. But we built into MyChart a pumping log. So I described it as a very fancy pumping log, but in fact, it's an incredibly basic express milk pumping log.
But it lives in the MyChart app. And because it lives in the MyChart app, it can input data directly into the electronic medical record. So the parent enters data on a pump by pump basis, which is exactly how all, all the pumping logs that you can buy in Apple, um, in the Apple store and that, um, the, um, like the, I can't remember the other thing from app, the mobile app. Any, any sort of like, go ahead. But yes, the iOS store.
Ben Courchia MD (17:05.132)
No, I was going to say the iOS store or the Apple store.
Eliza Myers (17:09.524)
I panicked about how you're supposed to pronounce iOS, but yeah, the Apple Store or the iOS Store, you buy your pumping log. And it's, it's sort of a very basic version of one of those. But the magic is that when the parent enters on a pump by pump basis, so every time they pump, they put in how much milk they pumped, it goes into a data server and it gets put back into the electronic medical record, into the flow sheet lines that the nurses use to document feeding. So as the clinician, when you go into the NICU Eyes and Nose Flow Sheet, and you look and see,
how much the baby PO'd, how much the baby gavaged. There's also how much the parent pumped. And we have it tallied up. So the parent enters on a pump by pump basis, but what you see in the flow sheet is the 24 hour milk volume. Because the literature, all breastfeeding medicine literature describes 24 hour milk volumes. We can also see how many times the parent made an entry. And then because it's in a flow sheet line, like anything else that's in a flow sheet line, you can have it auto populate your notes. So every day when I open my note and I refresh it,
the new data of the last 24 hours of milk volume appears. I actually have a seven day tally, so I can look at a trend over seven days. I can see how many times the parent pumped. So you're not asking the questions anymore, now you know. So we know that best practice is to pump six to eight times in 24 hours. And if the patient is not meeting the milk volume targets that we...
want them to meet or that we hope that they meet to make, to be on a trajectory to achieve a full milk supply, because we know that the literature says 500 mls by day 14 predicts taking home your premature baby on a human milk diet. So if we're not seeing that trajectory, we make interventions. And that's that, I mean, that's it. And it's been extraordinarily gratifying. And I have definitely changed the trajectory of people's sort of milkmaking careers by identifying
either too much milk or more commonly not enough milk in making interventions.
Ben Courchia MD (19:01.964)
Lots of techie questions coming up. How did you build this? Was this a ton of coding and whatever, or was this something you had to delegate to a team of developers? Is this something you built yourself?
Eliza Myers (19:04.8)
Yeah.
Eliza Myers (19:14.24)
Yes. No, I did not build it myself. I got extraordinarily lucky. I had been, so I'd embarked on this big journey about breastfeeding education and I'd figured out all the best practices. Like I had all this expert knowledge and I had no expert know-how. So all the lactation luminaries say to best support a parent, a NICU parent in making milk, you have to keep a pumping log, you have to track initiation and maintenance of milk supply. And I was like, okay, but how, like...
But like how, what kind of pumping log? Nobody tells you exactly how. I made a paper pumping log, but nobody ever used it or looked at it or the parent would say, oh, I left it in the car. Or like, oh, I didn't really fill it out. I didn't add it up or I didn't have a pen. So the paper pumping log was a total bust. So I went through a lot of iterations of like how to like actually get this done. And I spent a long time actually vetting a...
You know, there are third party milk management systems that your hospital can buy and they do this really well. They're really fancy. They have all the bells and whistles, but they're also really expensive. And I was doing this right around COVID and the hospital said, no, you cannot spend money on that. They can't spend money on anything. What you can do is pitch to the Yale innovations team. So I'm just incredibly lucky to have a job in a place that has an actual innovations team.
So I made a pitch to the Yale innovations team for, I wasn't even sure what I was pitching. I mean, I hadn't even gotten as specific as like, I want it to be embedded in my chart, right? I was just like, I need a way. I just read for it. Yeah.
Daphna Yasova Barbeau, MD (she/her) (20:53.126)
But I love that. You just went for it, right? I think that's a message we really try to... What do you always say, Ben? You say... What are you saying about just... No. I don't know. Act and think, I guess, sort of thing when it comes to doing something new.
Ben Courchia MD (21:01.496)
I see a lot of crap.
Ben Courchia MD (21:13.332)
ambitious goals with a humble approach. Is that the one? That's another one.
Eliza Myers (21:14.115)
Yeah!
Yeah, sometimes...
Daphna Yasova Barbeau, MD (she/her) (21:17.562)
That's not what it is, but okay, it'll come to me. But I love that.
Eliza Myers (21:22.744)
So I pitched to Yale Innovations and I just got incredibly lucky because one of the IT sort of experts assigned to me was a former NICU nurse. So she just got it. She was like, oh yeah. And her husband was a MyChart expert. And she's like, it was really her. She said, we're going to make a pumping log and we're going to put it in MyChart and it's just going to populate the Epic flow sheets. And it was just like, done. After that, it took us a year.
Ben Courchia MD (21:48.929)
Wow.
Eliza Myers (21:52.1)
to build it. Remember, I'm the kid with the colored pencils. Like, I'm not, I'm in art class. I'm not coding anything. But I had, it was this terrific sort of serendipity of the right people in the right place and people saying, yes, let's do this. And I think I had probably a compelling pitch, probably with like pictures of babies in it or something, people love a baby. And so we just did it. It took a year. We started in the summer of 21.
And by the winter of 21 into 22, it was obvious that the thing was going to work. And we submitted, um, we, uh, applied to present at the Epic XGM conference in the spring, which is their sort of expert user conference. And Epic said yes. And then we had a deadline. Then it was like, oh my gosh, we got to get this. Like this has to work by May of 22. And, um, and it did. So by May of 22, we were alive collecting.
data from patients and putting it in the EMR and into the notes and into a data set and acting on it. And then since then, oh, go ahead. As I say, in the last, so that was the spring of 22 and now we're in the fall of 23. So since in that more than a year, we've made tons of amazing refinements, just making it better for the, for the parent experience basically. So they get messages back.
Ben Courchia MD (22:58.059)
Is this? Oh yeah, go ahead. No, no, go ahead.
Eliza Myers (23:20.536)
data back, they can see their own trends. I just recently, this I think is super cool and also not my idea, but I'm totally ran with it. We have a little message that parents get that say, if you are not making 500 mLs by day 10, please contact your lactation specialist. And we now have a little.
button and you can just tap it and it opens up the dialer on your phone and dials the Yale outpatient lactation specialty service. So it just takes all the friction out of it. And how cool would that be if you had that for like everything in your life? You don't even have to press the buttons. It just does it for you.
Daphna Yasova Barbeau, MD (she/her) (24:00.278)
That would be awesome. I mean, I'll let you ask your techie questions.
Ben Courchia MD (24:01.864)
And so now, now that this is built, no, I just want to know because I'm sure I'm sure we don't get to use Epic. So I'm, we're at this point, our level of concern is just jealousy. And we're just like, man, that'd be kind of nice. However, however, if you are using Epic and somebody says, oh man, I would love to implement this in my workflow. Um, is this something that they could just request from Epic or is this something that's going to stay internal at Yale? Or is this something that they could just roll out right away? How does that work?
Eliza Myers (24:06.212)
I'm sorry.
Daphna Yasova Barbeau, MD (she/her) (24:10.104)
Hmm.
That's right.
Eliza Myers (24:13.564)
Oh no, I'm sorry.
Eliza Myers (24:20.295)
Yeah.
Eliza Myers (24:30.764)
They can't request it from Epic yet, although that is definitely my goal in the next year. Right now, they just contact me, and I do a presentation at their institution, and then I share the build document with them, and then my IT people talk to their IT people, and it's sort of like an on-the-ground sharing kind of thing. In the future, I'm hoping that Epic takes it on.
Daphna Yasova Barbeau, MD (she/her) (24:58.794)
Yeah, we'll get there. But theoretically, anybody who has Epic could go through this process and get the network.
Eliza Myers (25:06.568)
Yeah, exactly. I have like a Lego analogy, if you will indulge my Lego analogy. It's as if, it's like, okay, Epic is Lego. And I have made like a super cool Lego set. Like I made, I thought that Baby Yoda was going to be behind me, but like I made the Baby Yoda Lego set. But the problem is I built a custom piece that's not a Lego. And so Lego is like, we're not going to sell your cool set.
Ben Courchia MD (25:13.044)
Love, love Lego analogies.
Daphna Yasova Barbeau, MD (she/her) (25:13.505)
Let's hear it.
Eliza Myers (25:32.908)
because it has a non-Lego piece in it. And so with Track My Milk, almost all of it is an Epic build, but we did hire a custom code writer to write one piece of custom code. And Epic is saying, we can't take on your project because it has this one piece of custom code in it. However, in the next year or two, they're going to rewrite that. The custom code is going to become incorporated into Epic, and then they will sell my Lego set at Epic. So in the next two years.
Ben Courchia MD (25:58.063)
Cut.
Daphna Yasova Barbeau, MD (she/her) (25:59.214)
That was both very easy to understand and also frustrating.
Eliza Myers (26:03.968)
Yes. But in the meantime, yeah, I share with anyone who's interested.
Ben Courchia MD (26:04.62)
So when, when-
Ben Courchia MD (26:09.192)
And so is there a concern that parents are going to be inconsistent? And right, I mean, in Epic, we document, the nurses document. And while we're always prone to mistakes, parents have no incentive. They could say, screw this. I'm not logging it in. So how do you make sure that it's compliant? Or maybe you don't need to make sure it's compliant because it's been adopted across the board by everyone who you've presented it to.
Eliza Myers (26:36.58)
I just don't worry about compliance. So that was a big question. In the very beginning phases of the project, there were people who were like from a safety perspective. They thought they were saying, but what if a parent doesn't do it right? And I just said, well, then like, what if? Right now we know nothing. So this is only knowing a little bit more than nothing. I would say that my parent feedback has been almost uniformly entirely positive. Parents are completely pleased to do something on the phone.
They see that my daily note includes their milk. And I put little, I can't remember what you call them, those little Easter eggs in my note that's like, the baby was like, we're in a Purple Wednesday this morning. They see that I'm reading, they see that I'm writing a note. They see that I'm looking at their milk data. They see that I'm commenting on it. So they're perfectly happy to participate. And some parents say, this is totally not for me. And I say, that's totally okay. What works, how can I help you? What works for you? So I don't worry about that inaccurate or missing.
Ben Courchia MD (27:29.743)
Mm-hmm.
Eliza Myers (27:33.132)
data.
Daphna Yasova Barbeau, MD (she/her) (27:35.182)
I mean, I would counter that by saying the parents have the biggest incentive to do the documentation correctly, more than any of us. That's their tiny human.
Ben Courchia MD (27:43.32)
I got to ask the question, Daphna. I got to ask the question.
Eliza Myers (27:46.793)
I'm sorry.
Daphna Yasova Barbeau, MD (she/her) (27:48.802)
Your question made me mad today.
Ben Courchia MD (27:53.016)
How has that transformed your approach at the bedside? When you, because I think to me, the reason I'm asking, because now I'm going to have to explain why I'm asking every question now, because that's not going to be on my case otherwise. But I think what you've done beyond providing a cool, useful tool to parents is that you've actively made the parents a partner in the care of their infant. How does that transform this experience at the bedside?
Eliza Myers (28:21.524)
Um, well, I think only for the better. I'm not, I'm not sure I can get more specific than that. I think it means, um, I skip a lot of the conversation about how much did you pump? How much are you pumping? I get to, I just could like skip past that to, um, let's talk about best practices or how can I help you or tell me about what pump you're using? And maybe I can make, um, make a more specific advice or
Ben Courchia MD (28:47.6)
So let me reframe that question then. Have you seen that parents feel are different because through the Track My Milk app, they feel like, hey, I'm an active participant in this and I'm not just a bystander watching other people care for my kid until my baby is ready to go home. Do you see that there's almost a halo effect of because I can take ownership of my milk production and track this, then I could also take ownership of other things that are happening to my child in the ICU.
Daphna Yasova Barbeau, MD (she/her) (29:17.686)
Yeah, some of those unmeasurable, you know, things you can't measure on your app that we.
Eliza Myers (29:22.316)
Yeah, I haven't, I can't say that I have, although I love the idea, and I will now maybe tailor some of my, sort of I do like a little exit interview about, like what was your experience with lactation and how did you like the app? That's how we've made a lot of changes based on feedback. I'll try and elicit that. I will say we've seen, or you alluded in the introduction to Yale has a system of NICUs. There's one giant.
NICU in New Haven and then multiple small community NICUs. I'm the medical director of one of the community NICUs. And in my community NICU where TrackMyMilk use is, nearly every patient uses it for nearly the entire duration of their hospitalization and me and my two colleagues act on the data very, you know, we act on it quite robustly. We use it robustly in the way that I intend for it to be used. We have seen truly significant.
measurable outcomes in the use of human milk at discharge, moving the needle in a way that I'm not even sure I thought was possible. I didn't set this up in a QI framework where I said, I'm going to change this from 60% to 80%, because maybe I wouldn't have even hoped that would happen, but we have changed our human milk at discharge rates from 60% to 80%, which is really major.
Ben Courchia MD (30:38.06)
That's huge.
Eliza Myers (30:41.012)
And of all, I've made many, many interventions. And now at this point, I do have control charts where I'm putting little arrows in and saying what intervention happened when. And it's the track my milk intervention that's making the difference, I think.
Ben Courchia MD (30:53.636)
When you're taking on a project like this, I think as a physician, I think there's always a concern of like, definitely I said in the beginning, we have very sometimes to a false siloed team in the units. We have our respiratory therapists, we have our occupational. Do you feel like as you're walking in, as a certified lactation consultant, do you feel like, oh man, are the lactation consultants going to accept me or are they going to say like, oh my God, this doctor's trying to tell us what to do? And how does that dynamic work?
Eliza Myers (31:22.144)
Oh, that's so interesting. I never even thought about it. I mean, part, one problem with the Yale system is we don't have a lot of lactation specialists. I think if you ask any lactation specialist, what is the biggest problem here? They would say, we are stretched too thin. There are not enough of us. So I...
I, no one has complained to me that I am getting on their turf, although maybe they wouldn't do that. So I'm not sure.
Ben Courchia MD (31:47.749)
Mm-hmm. Fair enough.
Daphna Yasova Barbeau, MD (she/her) (31:50.638)
I think what you describe is common for a lot of health systems, you know? I think a lot of health systems say, how few of these people can we get by with even though if we really had all the support we could hope for? It's like a lot of person power to get the time in. I had a kind of a similar question.
Eliza Myers (32:04.132)
Thank you.
Eliza Myers (32:08.909)
Yeah.
Daphna Yasova Barbeau, MD (she/her) (32:21.171)
our nurses are protective of their duties. And they say, well, you know, it's really like a nursing thing. So why are the doctors getting involved? And I wonder how you feel about overcoming that sentiment.
Eliza Myers (32:41.845)
I think that everything that the Track My Milk feature does takes away from the annoying stuff I used to ask the nurse. If I used to say, hey, when mom calls, find out how much milk she plans to bring in. And now I don't say that anymore. So I think I've only taken work away, I think.
Daphna Yasova Barbeau, MD (she/her) (32:51.948)
Mm-hmm.
Daphna Yasova Barbeau, MD (she/her) (33:02.894)
That makes sense. Yeah, that makes sense. And my other follow-up question is kind of related to that. I feel like a lot of times, let's say trainees may be interested in something that is not thought to be like, I don't know, maybe in the physician lane. And so how can we support trainees who have kind of these, you know, unique ideas that don't follow?
kind of the traditional model.
Eliza Myers (33:37.476)
Hmm, I think that goes back to, you know, just do it. Ask forgiveness, not permission. Like, you know, follow the thing you're super interested in. I, if the question is specifically to lactation and breastfeeding medicine, I think I am hoping that with the introduction of this new board examination for physicians, the North American Board of Breastfeeding and Lactation Medicine and...
I think a heightened awareness of the importance of physician level, a provider level education in breastfeeding and lactation medicine. That I hope that there are trainees who, who see this as not, as not a siloed thing for only lactation specialists or only the lactation nurses, but something at the, at the physician level too, at the neonatologist level.
Daphna Yasova Barbeau, MD (she/her) (34:27.09)
And then I had a borderline techie question about, like you said, you're artistic and the tech is, maybe you're not so comfortable with the tech language, but what guidance do you have for people who are interested in that sort of thing that is kind of maybe outside of their area of comfort, but they've identified a problem, they feel like they have a solution.
in getting these kind of new dynamic ways of integrating these ideas in technology.
Eliza Myers (35:07.108)
I think if you can't build it yourself, then you got to figure out the right people who can and then make a compelling pitch and jump in and do it. I only am familiar with the Epic world. So Ben, your hospital, Daphne, does your hospital system use Epic? Neither of you? Oh, man. I only know how to answer the question in the realm of Epic, which is that they offer lots and lots of classes for physicians and physician builders to take to become well-versed in the language.
but that's not a very helpful answer to you guys.
Daphna Yasova Barbeau, MD (she/her) (35:39.742)
No, but I was wondering if there was a thought about being able to have the coding transition to some of the other EMRs.
Eliza Myers (35:48.888)
Oh, oh, like track my milk. Yeah, I think it would be totally doable. As long as the EMR has a patient facing portal and as long as that patient facing portal communicates with the in-house EMR, it feels completely doable. And I think, so another analogy or like the place in my chart where we put track my milk is the place where a physician might order you to check your blood pressure at home and then your blood pressure data comes back into
Daphna Yasova Barbeau, MD (she/her) (35:50.885)
Mm.
Eliza Myers (36:18.444)
comes back into Epic or check your blood sugar at home and your blood sugar data comes back. Those data points come back in usually to a message box. And what's different about Track My Milk is that the data points come back into the flow sheets, which gets back to Ben's question about, well, what if parents do it wrong? Like the flow sheet is fact and the parents are entering numbers, maybe they're doing it wrong. Turns out, I said, it doesn't really matter if they do it wrong. It does not change the baby's clinical management if the numbers are wrong. So just, you know, go with it.
So as long as I think you're working with an EMR that has a patient facing portal that can communicate with the EMR, you could totally build a very analogous system. And you can call it something better than Track My Milk and I won't be offended.
Ben Courchia MD (37:02.224)
Have you, for some, we've built mobile apps, we're in the process of building a mobile app. It's a frustrating experience. So for some, it's energizing. So you build one and you're like, I'm going to build a hundred more. And for some, it's like, never again. Do you look at other aspects of your work in the NICU and be like, man, we could build something for this, we could build something for that. Or are you completely discouraged by the tedious process of developing a mobile application?
Eliza Myers (37:17.7)
I'm sorry.
Eliza Myers (37:31.124)
Well, it is so interesting that you asked that because I think one of the coolest, the most energizing and exciting and awesome things about the Track My Milk project was that I did it basically totally by myself with these incredible epic, this like very niche team of epic builders. Yes, exactly. A power couple. Me, me and Michelle, if you're listening, it was just us in it. And, and so, but I've, with this success.
Ben Courchia MD (37:46.688)
Power couple. This epic power couple.
Eliza Myers (38:00.624)
Now I have gotten roped into many other projects, many of which are big and bulky, and getting six people in one place at the same time is nearly impossible. And so there was a nimbleness to track my milk and like an excitement and enthusiasm and a nimbleness that made it possible. Now there's downsides to that too, and that now I have this like fleshed out project and I'm all by myself trying to now get my 30 odd colleagues, you know, 80 odd colleagues, if you
advanced practice providers to understand it and take it on. Where if we had been a giant committee all along, maybe we'd have more of that elusive, the buy-in. People talk about the buy, you have to have buy-in, the buy-in. But so I'm now engaged in projects where there's way more people and you got to meet and it's impossible. That I find exhausting. I do enjoy just like getting stuff done by myself.
Ben Courchia MD (38:40.908)
The buy-in. Mm-hmm. Ha ha.
Ben Courchia MD (38:56.212)
Yeah, yeah, there's, yeah, I think it's, this is something that's very hard because obviously as the project become more ambitious then they need a larger team. And then like you said, you said it's nearly impossible to get five people in the room, it is actually impossible. Like let's be frank, we've tried this as well and it's just, it doesn't work. So yeah, totally, totally resonates with that. Let me ask you a little bit about like how, I think Daphna touched on this, but like has this expended?
your view on how medicine is being done from a research standpoint, right? I mean, where it's not like, it's not the usual thing to just tweak Epic and get a new technological tool to help parents track something. Like it's very, very innovative. How has that morphed into how you conduct research and what you see the future of research to be for clinicians like you and us?
Eliza Myers (39:55.524)
I think, I think parent engagement, especially for neonatology where, you know, the patient is the baby, but the patient is also part of the structure that is the family, the parent engagement on the platforms that the parent uses is, um, is incredibly important, I think. So we're so mo whatever the getting away from paper and towards whatever platform the parent wants to be using QR codes, videos on YouTube.
mobile apps. And then I think this parent entered data or this parent provided data is also super interesting. We're good at measuring a lot of things in neonatology. We're very good at numbers, but having, I guess measuring the patient experience through what the parent provides is...
Eliza Myers (40:44.8)
I think that's also going to be very important for the future. I mean, if, when you think about, I have this massive data set on infant feeding that goes back a couple of years now across every baby born into the Yale health system, and a lot of that is, um, driven by track my milk data. It's pretty cool.
Ben Courchia MD (41:01.257)
Mm hmm. Yeah.
Daphna Yasova Barbeau, MD (she/her) (41:04.65)
Yeah, it seems like each new innovation then opens up a whole new possibility of, you know, research questions and ideas about where to go next. You know, you said that you didn't make it a QI project, but you actually have quite some experience in QI methodology. And so I wonder why you didn't do it in the QI format.
Eliza Myers (41:32.096)
I think all my, my formal QI training has sort of come after the fact. I had this wonderful colleague join me a couple of years ago. She was new from fellowship, totally understood QI, saw me, you know, I'm like, I'm like that machine that they pull the bingo balls out of. That's like, like the cage filled with bingo balls and the balls are like flying out and she was like, she's a guy. She said, I'm going to, I'm going to, I'm going to, I like your ideas. I'm going to structure your ideas. And so she, she has really helped me. Um,
understand how QI works in a way that super engaging, which is like, we're going to take this project and we're going to do it, we're doing it like this, we're going to make these charts, we're going to put these arrows, we're going to see how it works. So I could go backwards in time, I think, and do that to track my milk. I'm not sure there's like a ton of point to doing that after the fact, but I definitely see that as understand that going forwards.
Ben Courchia MD (42:17.732)
Um, you mentioned in the beginning of the interview about track my milk, how you can automate some of the support that can be provided to parents if certain milestones are not met. I am wondering if you're looking at new artificial intelligence tools and see the promise of what they could offer for even picking up trends and even catching parents even before they reached the point where their supply is below a certain threshold, like are you entertaining those, those possibilities?
Eliza Myers (42:28.566)
Mmm.
Eliza Myers (42:48.884)
I have not, but I have heard people talk about it. That is, yes, on the list of things to think about. Super cool, but frightening to imagine advice being given by a robot.
Ben Courchia MD (42:56.455)
I know. I mean.
Ben Courchia MD (43:00.164)
Yeah. And, and, and I think to me, the most frightening thing is just, um, artificial intelligence. I think to me that's the biggest and the most frightening thing about it, not in a negative way, but the fact that artificial intelligence can pick up on patterns that are, we're completely oblivious to telling you this, this mother's supply is going to go below the threshold in the next week. And you could have looked at it a hundred different ways and you would have have, would have never seen this. I'm not exactly sure.
And so I think to me that's where it's both scary but also very promising
Eliza Myers (43:33.668)
I'm sure you're right, it's too scary to think about.
Ben Courchia MD (43:33.847)
Yeah.
Daphna Yasova Barbeau, MD (she/her) (43:38.726)
We spent a good bit of time talking about your work in milk and I and the patient experience of course, but I actually had an interest in some of your other work. You've done some studies on functional connectivity and looking at the brain microstructure. I actually really feel this is a blossoming thing in neonatology. I think it was…
you know, a decade ago, it was like a hot topic and then it kind of settled down. And you've done some work in, you know, the outcomes of preterm infants and follow-up. I feel like we're missing something in the NICU, this time period where the baby brain is growing and developing. And while we try to change the way our NICUs...
look in terms of lighting and single family rooms and we try to control for noise. I feel like there's potentially some, not just removal of noxious things, but some interventions that we could do to assist in either the rehabilitation or this growing connectivity in the brain. And since you have kind of a little bit of a background in that, I was wondering if maybe you can speak to...
Why isn't this a big area of interest in neonatology?
Eliza Myers (45:04.84)
Gosh, well, that's such an amazing question that I have no articulate answer for. That was all my research from fellowship and my first job after fellowship was so different from my academic fellowship that I really, I didn't, I haven't stayed in touch with any of that literature or that work. But I'm with you. I mean, I know we designed, the NICU that I work in now is brand new, brand new built construction and
Ben Courchia MD (45:05.233)
Ha!
Eliza Myers (45:32.664)
We tried to do all the things that you're talking about, the single family, everything is dark, the blankets on the isolettes. We have a massive project in reducing blood draws and blood sticks, which has been hugely successful across the system. That's the work, not my work, but work that I'm totally in support of. But I, and I'm not sure. And we have a music therapist who comes and we have the OT and the PT, but I'm totally with you. I don't know.
Ben Courchia MD (46:02.024)
Eliza, my last question for you today really goes back to the work you're doing with Track My Milk and see if you do have any concrete next steps for what the future holds for Track My Milk. Is this something where you're looking at dissemination or is there something, is there a next level that you're considering in the near future that people can look forward to?
Eliza Myers (46:23.176)
Oh yes, locally I want the tool to be used in the same robust way across the whole health system at Yale as it is in my small NICU because that's where we're going to see, I'm a fraction of the babies in the Yale system. So I want this at the big hospital. And then I really think it's possible that Epic will take it on and make it part of their bill so that any hospital that purchases Epic and has the STORC platform, which is the parent-baby
we'll just be able to use TrackMyMilk. And then I think it'll be really exciting to see what other like add-ons and enhancements people do to it, cause that's what Epic is all about is user enhancements.
Ben Courchia MD (47:06.708)
Love it. I think definitely anything. Are you good, Daphna? Any other questions before I wrap up? No? All right. Eliza, thank you so much for making the time to be on with us. This was a fun conversation. Congratulations on Track My Milk. It sounds like a fantastic app. We wish we could have access to it. And we will put your contact information in the episode page. And again, thank you so much for making the time to be on with us this morning.
Daphna Yasova Barbeau, MD (she/her) (47:15.199)
No, thank you.
Daphna Yasova Barbeau, MD (she/her) (47:27.598)
Mm-hmm.
Eliza Myers (47:35.512)
Thank you so much, I appreciate it.
Ben Courchia MD (47:36.544)
Thank you.
Daphna Yasova Barbeau, MD (she/her) (47:38.306)
Bye, everybody.
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