Podcast Summary

Podcast: Becker’s Healthcare Podcast
Episode: Advancing Fetal Cardiology and Access to Care with Dr. Lisa Howley of Children’s Minnesota
Host: Elizabeth Gregerson
Guest: Dr. Lisa Howley, Director of the Fetal Cardiology Program, Children’s Minnesota
Date: October 10, 2025

Episode Overview

In this episode, Elizabeth Gregerson interviews Dr. Lisa Howley, a leading pediatric and fetal cardiologist and Director of the Fetal Cardiology Program at Children’s Minnesota. The conversation centers on the evolving landscape of fetal and pediatric cardiology, with Dr. Howley sharing insights on disparities in care access, the growing needs of children and adults with congenital heart disease, technological advances in diagnosis, and the positive impact of artificial intelligence. Dr. Howley emphasizes both the urgent challenges facing the field and her excitement for advancements that promise to improve care for families across urban and rural regions.

Introduction & Dr. Howley's Background

[00:44–02:58]

• Dr. Howley introduces her academic journey and career, having trained in New Hampshire, Virginia, Colorado, and Canada.
• She explains her current role as Director of Fetal Cardiology at Children’s Minnesota and outlines her experience from fellowship to leadership roles in Colorado and Minnesota.

Memorable Quote:
"I spend my days screening for fetal heart conditions even before birth."
— Dr. Lisa Howley [03:33]

Key Issues in Fetal & Pediatric Cardiology

[03:33–09:52]

Dr. Howley identifies three pressing issues:

1. Disparities in Access to Care & Prenatal Detection

• Significant geographic variation exists in prenatal detection rates for congenital heart disease; some regions have considerably lower detection.
• The 2015 Journal of Pediatrics study identifies a 34% prenatal detection rate nationally, highlighting a critical gap.
• Factors include access to ultrasound technology, provider expertise, transportation, and social determinants.
• Dr. Howley’s main passion is improving equity through sonographer education and outreach.

Quote:
"There's significant geographic variation in the detection rate of prenatal heart disease."
— Dr. Lisa Howley [04:57]

2. Long-term Outcomes for Children with Congenital Heart Disease

• Advances in treatment mean more children survive, leading to new challenges: heart failure, arrhythmias, and especially neurodevelopmental and psychosocial issues.
• There's now greater need for wraparound care—supporting learning, mental health, and well-being throughout childhood and adolescence.

Quote:
"Now we're finding that they are having higher rates of learning difficulties and attention disorders and mental health challenges."
— Dr. Lisa Howley [07:30]

3. Transitioning Patients to Adult Care

• With improved survival, many patients are now living well into adulthood.
• Transitioning pediatric patients to adult congenital heart disease programs is complex and underdeveloped; many are "lost in the gap."
• There's urgent need for more adult congenital heart disease specialists.

Quote:
"Now there's more adults living with congenital heart disease in the United States than children."
— Dr. Lisa Howley [09:15]

Growth of the Field: Adult Congenital Heart Disease as a Specialty

[09:52–12:13]

• Adult congenital heart disease is now among the rarest and fastest-growing cardiology specialties.
• The field has expanded in two directions: earlier diagnosis via fetal cardiology and ongoing care into adulthood for those with complex heart defects.

Quote:
"It's requiring a new type of cardiologist... adult congenital heart specialists that are really specialized in these unique surgical procedures and malformations." — Dr. Lisa Howley [11:18]

Near-Future Developments: Field Evolution in 12–18 Months

[12:13–14:51]

Dr. Howley predicts two major trends:

Artificial Intelligence in Cardiac Imaging

• Rapid adoption of AI is aiding image interpretation and speeding up prenatal and pediatric cardiac screening.
• AI tools can highlight abnormalities, reduce interpretation fatigue, and improve detection in both urban and rural settings.

Quote:
"Adoption of artificial intelligence and finding ways to utilize that to help us in our field is really where I think we’re going to see some big changes happening in the next 12 to 18 months."
— Dr. Lisa Howley [12:35]

Telehealth & Expansion of Specialty Access

• Expansion of telehealth and hub-and-spoke models can bring specialized fetal cardiology care to remote areas.
• Successful models, like the fetal telecardiology clinic across the Rockies, demonstrate significant impact in reducing care disparities.

Quote:
“It helped families get the specialty access without having to do a four hour drive.”
— Dr. Lisa Howley [14:14]

Excitements & Concerns for the Future

[15:21–17:40]

What Excites Dr. Howley:

• Expansion of sonographer education, as exemplified by the inaugural Upper Midwest Fetal Cardiology Symposium with 200+ attendees from 11 states.
• Early adoption of AI—particularly if algorithms can be loaded directly onto ultrasound machines to provide real-time feedback in rural settings.

What Makes Her Nervous:

• While others express concern about AI’s impact on clinical jobs, Dr. Howley remains optimistic, seeing more opportunities than risks.

Quote:
"I think that those are probably, you know, two areas where I'm most excited."
— Dr. Lisa Howley [16:41]

“I don't have a whole lot of concern... at this point, I think that's more of a question, but I'm not one that has a lot of nervousness about that.”
— Dr. Lisa Howley [17:13]

Notable Quotes & Memorable Moments

• On Disparities:
  "Trying to make sure that we are equally reaching patients, both in urban areas as well as in remote and rural areas." — Dr. Lisa Howley [06:05]

• On the Evolving Patient Population:
  "We need to improve transitioning those that are cared for in the pediatric system to get them into adult congenital programs." — Dr. Lisa Howley [09:40]

• On the Promise of AI:
  "I think artificial intelligence is probably the biggest one" [12:33]

Key Timestamps

• Dr. Howley’s Background: [01:22–02:58]
• Top 3 Issues in the Field: [03:33–09:52]
• Specialty Growth & Adult Care: [09:52–12:13]
• Field Evolution (AI & Telehealth): [12:28–14:51]
• Excitements and Concerns: [15:21–17:40]

Conclusion

Dr. Howley leaves listeners with a message of both urgency and optimism. She highlights the critical need to bridge gaps in care, harness emerging technologies, and continue professional education—especially to serve families in underserved regions. Most importantly, she expresses hope that with continued innovation and collaboration, the future of fetal and pediatric cardiology will be both equitable and bright.