Joey Wahler (Host): This is WakeMed Perspectives, a limited podcast series focused on the strategic combination of WakeMed and Atrium Health. Our guest is Dr. Charles Harr. He's a cardiovascular and thoracic surgeon, as well as chief medical officer of WakeMed Raleigh campus. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Harr. Welcome.

Dr. Charles Harr: Thank you for having me.

Host: Great to have you aboard. We appreciate the time. So, we'll get into some specifics in a moment. But first, Doc, generally speaking, what would you say the biggest advantages are of aligning with a system like Atrium Health?

Dr. Charles Harr: Oh, my goodness, they are so unlimited. And I have to start out a little bit by telling you my perspectives come—I went to school at Wake Forest School of Medicine on the Bowman Gray campus. I was there for 12 years by the time I did my medical school, and then my general surgery residency and CT surgery residency.

And then, I moved to Charlotte, North Carolina, where there was consolidation of systems. I worked in the Atrium system from 1991 to 2016. And then, I moved to Raleigh in 2016 and have worked in the WakeMed system. So, I have extensive knowledge of all three systems

Host: So, you have firsthand knowledge of Atrium then?

Dr. Charles Harr: That is correct. And I also had 24 years in the military looking at health systems across not only the country but across the world. So, I can bring that to bear on this discussion also.

Host: Yes, looking forward to that. And indeed, you led me beautifully into where I was going next, Doc, namely the fact that you do bring such a unique perspective to this chat, having been not just someone firsthand familiar with Atrium Health, but also having been a rear admiral in the U.S. Navy performing surgery both on and off the battlefield. Thank you for your service, of course. And how would you sum up that experience?

Dr. Charles Harr: It was the most enriching experience I ever had. When I joined the Navy, I thought, you know, "I'm a heart surgeon. I'm going to be the best thing that ever happened to the Navy." When I finished that service, the Navy was the best thing that ever happened to me. It kept my biases down. It kept my perspectives wider. It gave me a whole lot of insights I never would've had otherwise.

Host: Interesting. And so, it sounds like you got exactly from that experience what most everyone really ideally should, right?

Dr. Charles Harr: Yes. I mean, we should all be lifelong learners. None of us like change, but we should all be willing to change if that leads us in a better direction. And nobody knows in the beginning when they start their journey exactly where it's going to take them.

Host: So based on your experience both in the military as well as in large healthcare systems, including Atrium as we covered, what gives you so much confidence in this kind of a strategic alignment here?

Dr. Charles Harr: If you wanted to design an alignment that has more closely associated and affiliated individuals and ideas, you almost couldn't make this up. You could manufacture this if you want to. And I'll point you to the mission statements of each. And mission statements are oftentimes made in the absence of doing.

But the mission statement of Atrium Advocate is to improve health, elevate hope, and advance healing for all. And then, the mission statement for WakeMed is that WakeMed is committed to improving the health and well-being of our community by providing outstanding, compassionate care to all.

And then, the mission statement of Wake Forest is to improve health for all by preparing the next generation of healthcare leaders through cutting-edge education, advancing discovery and innovation, and delivering compassionate, patient-centered care. And having been associated with all three, we all walk the walk and we walk the talk associated with those mission statements.

Host: Let me ask you a little bit more about the all part, because you read all three of those. They all had the word all in there. In this context, what does the word all mean here?

Dr. Charles Harr: It means every individual in the community who has a need. At one time, I was very narrow-focused on cardiovascular disease. I knew that was a killer, and I really wanted to attach that to—I will tell you that as I have matured—I think it's probably mental health and behavioral health issues. I don't have a friend or an associate who's not affected by that. So, it's looking at behavioral health, mental health, obesity, diabetes, stroke, cancers. We have to be able to address the needs of all those patients. We also have to address the needs not only of those patients who have money and ability, but also those patients who don't.

Host: You're clearly a man, Doctor, who is all about learning as the years go on. So, speaking of which, what do you think about this proposed combination in terms of the opportunity for strengthening physician and clinical expertise?

Dr. Charles Harr: This is an opportunity. Again, if we had tried to design this going into it, we couldn't have, but the synergies that come from this. At WakeMed, we are a community healthcare system which has a tertiary bent. We do almost quaternary level care, not to the level of Wake Forest, but we do really advanced care. But we also do it with a focus on the execution of delivering healthcare rather than researching and finding the innovative ways to go.

If you look at Wake Forest and the things they've done there with aging, with their Sticht Center on Aging, with their focus on Alzheimer's, which obviously is a big concern for all of us, if you look at the cancer centers on both the Wake Forest and the, Atrium Campus, the advances that they've made in that and the resources they put to it. If you look at our community health mission, both at WakeMed, we've got a community center of excellence, that's run by an individual called Brian Klausner that reaches out to those underprivileged, unhoused, special needs. And both Wake Forest and Atrium have a similar experience.

Host: Naturally, Doctor, those joining us, if they're patients or potential patients, they're wondering, "How will this most affect me?"

Dr. Charles Harr: This is going to make the level of care we deliver on all three campuses rise. We will share information amongst each other. We will take our level of expertise at WakeMed, we'll share that with the physicians and nurses and physicians assistants, et cetera, with the administrators on all three campuses. The level of care you get will be better on all three campuses because of the sharing we can do.

And we do it a little bit anyways. We've been doing that in the field of cardiac imaging. we call oftentimes and ask questions. but this just makes it easier, and brings us all together in a way that we can more aggressively share information.

Host: Of course, Doc, as you know very well, advanced skills, techniques, and resources like minimally invasive approaches these days, clinical research trials, such an important part of the healthcare picture. So, how will this partnership affect that?

Dr. Charles Harr: So, Atrium Advocate has a center called the IRCAD Center, I-R-C-A-D Center. It is dedicated to marrying industry and the advances in industry up with the clinical expertise of our practitioners. It's focused on minimally invasive surgery. There's only four of them in the world, and this will be the only one in North America.

It will allow our physicians, as new techniques, as new best practices come into line to learn this early, to travel to Charlotte, to participate in that. It changes it both for cardiac surgeons, for general surgeons, for urologists, anybody who utilizes robotic for spine surgery. So as we go into the future, we'll have the best training tools we could have.

And then at Wake Forest, as we train new medical students to become residents and then physicians, they're going to have the ability of learning from people who do it every day and have done it every day for years. It's a massive opportunity.

Host: Couple other questions for you, Doctor. First, how can this combination help to expand WakeMed's capabilities while at the same time not compromising some of those personalized care approaches for all that, as you've discussed, have been such an important part of the culture for so long? How do you balance the two?

Dr. Charles Harr: It's by establishing a culture, which we have established. And the thing that makes me feel easier about this is I know what the cultures are in Charlotte, I know what the cultures are in Winston-Salem with Atrium Advocate and then Wake Forest. If you don't have to worry about the logistics, if all you have to worry about is keeping up with the medical advances, keeping up with the needs of your patients and making sure that not only the things that you do in the hospital setting, but also when you send them back to the community that you're addressing all of those, it makes us much better. We will be delivering individual care. We won't have to deliver it with the weight of handling so many of the other logistical pieces also. So, I think it will free up time for us to be even more patient-centered and more conducive getting the right care to the right patient in the the right manner.

Host: Gotcha. I would be remiss, of course, being that you are a heart surgeon, if I didn't ask you about cardiology in all this. In your department, for you and yours, what's the main benefit people can look forward to, do you think?

Dr. Charles Harr: Well, we've already been harvesting some of that benefit. In a changing method of diagnosis of cardiac disease, we're seeing where we used to have to do diagnostic heart catheterizations, we now can use CT imaging, CCTA. And then, there's fractional flow reserve that we can use. And now, there's even an entity called plaque analysis so that, without having to put catheters into the patient's heart, we can tell with high degree of certainty the level of heart disease you have. If it needs to be intervened on, then we can take people to the cath lab with a high expectation that we know what we're going to do when we're there. And if they're not at that level yet, we can design interventions based upon the severity of their disease, which slow down that progression.

And then, for those people who have advanced disease in the areas where we call structural heart, there are transcatheter interventions now. A lot of our listeners will have heard of TAVRs or transaortic valve replacements now. There are replacements and repairs of the mitral valve and replacements and repairs of the tricuspid valve. There are so many things that are complex that, with the medical school, at our side and with the expertise coming out of Atrium Advocate, we'll all learn those processes better, and we'll bring them to the bedside sooner.

Host: And, Doc, I've got to ask you, speaking of which, even for someone like you that performs heart procedures at the highest level there is, is it even for you sometimes kind of a let-me-take-a-step-back moment to really take in all of that great technology and advancement that you just discussed? Because some of those things you mentioned are pretty amazing to us in the layperson community. How about for an expert like you? Do you ever think to yourself, "This is pretty incredible stuff we're doing compared with not all that many years ago," right?

Dr. Charles Harr: Every day. But it also brings challenges, because I'll give you an example. When I was moving to doing da Vinci robotic surgery for lung cancer and other operations on the lungs, I knew how to approach the lungs and do lung surgery almost with my eyes closed through a thoracotomy, an open procedure. When you know things that, well, changing course and adopting new technology can be very difficult because you are comfortable with what you've gotten. And none of us want to ever do any harm. There's always some learning curve associated with that. So, moving to those procedures when you know you can do the open approach, it can be very hard. And having a support system that empowers you to get there quicker and with less risk enables you to step out and adopt it more aggressively.

Host: Absolutely. And then, in summary here, Doctor, you've done such a great job of breaking down all the practical details involved here in this partnership, how about from an emotional standpoint? You're obviously very passionate about what you do and about your organization and the one that you're partnering with here. What most excites you about all this? What's the number one thing that you think is going to get you up in the morning from here on in terms of bringing more cutting-edge technology and advanced care options to patients in the community?

Dr. Charles Harr: It's the professionalism of our enterprise. As physicians, as nurses, as advanced practice practitioners, as physical therapists, as all those people who support us in the hospital and take us together, we want to earn the trust of our patients. And we do that partly with our own abilities, partly with the capabilities of the facilities that we get to work in. And we want t have the very best and be able to tell passionately and with conviction every patient we see, "We can take as good a care of you as you can have anywhere." And I think this gives us the opportunity to say that.

Host: Well, folks, we trust you're indeed now more familiar with this combination between WakeMed and Atrium Health. Dr. Harr, again, thanks for your service. Really amazing to talk with a man like yourself who's had this unique dual career in both the medical and military professions. Congratulations on all of that. Best of luck with all that I'm sure you still have in front of you, to you and yours, and thanks so much again.

Dr. Charles Harr: Thank you. I have truly been blessed. And it's been a pleasure this morning.

Host: Same here. And to learn more about WakeMed, Atrium Health, and the future of healthcare in Wake County, please visit wakemed.org/wakemed-atrium-combination, or keep tuning in for this limited podcast series, WakeMed Perspectives. If you found this episode helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for being part of WakeMed Perspectives.