Switch to electronic records improves patients' health

July 01, 2011

By Cori Ast

As Jennifer Brull, MD, enters an exam room, her hands are free to greet her patient with a warm handshake. That's because, unlike many doctors, Brull isn't holding a clipboard with the patient's chart. Paper charts are a thing of the past at Plainville Medical Clinic, which documents patient visits with electronic health records (EHRs) that Brull can call up on a password-protected, networked computer in the exam room.

Brull, a family physician, can enter her diagnosis, treatment and other health information into the computer during the visit. Then she can print up a summary -- for the patient, not for her files.

"Each patient encounter is much more comprehensive. I no longer have to remember things about visits that might have been six months ago or more -- the computer remembers for me," Brull says.

The EHR system at Plainville Medical Clinic improves patient care and physician efficiency, but it also qualifies Brull for up to $63,750 in Medicare incentive payments. The payments are given to registered physicians and hospitals who engage in ""meaningful use"" of EHRs, which requires physicians to use the technology to improve patient care in a measurable manner. Some of these measurements include tracking preventive health screenings and behavioral information, such as tobacco use, that often influence patient health.

As of mid-May, only 1,026 providers in the nation had registered for the payments, out of a possible 56,599 that have demonstrated ""meaningful use."" Brull was one of the earliest adopters -- and the first certified ""meaningful use"" physician in Kansas.

"It's cool to be the first doctor in Kansas, but the best part of meaningful use is that, in the process, I improved the way I take care of my patients," Brull says. "And that's what''s key -- my patients get better care."

That better care has saved lives, too, according to Brull, who graduated from the KU School of Medicine in 1998.

For example, Brull thought she was doing a great job of talking to her patients about colon cancer prevention. However, when Plainville Medical Clinic implemented an EHR system, Brull realized her baseline measures for colon cancer screening were a paltry 43 percent.

"Anecdotally, I thought I was doing a great job of screening my patients for colon cancer. In reality, I wasn't," Brull says. In the two years she has been using EHRs, the percentage of her patients who are screened regularly for colon cancer has jumped to 85 percent. Brull has also caught three cases of colon cancer so early that the patients did not need chemotherapy. Those cases, she says, might have been missed if she was still screening fewer than half of her patients.

In fact, improved quality of care is why Brull and the physicians at Plainville Medical Clinic paid the hefty start-up costs to implement their EHR system, which went live in 2008. Despite the substantial investment, the EHR system at Plainville Medical Center has already paid for itself in increased physician productivity.
"It's just easier to see patients in the electronic world," Brull explains.

The financial incentives for EHRs extend beyond increased productivity. Brull has already received her first $18,000 Medicare incentive payment. The payments, which are authorized under the American Recovery and Reinvestment Act of 2009, will continue through 2016 for Medicare-based payments and through 2021 for Medicaid-based payments.

In 2015, however, punitive measures will go into effect for physicians and hospitals choosing not to comply with "meaningful use" of EHRs. Those providers will receive less money from Medicare reimbursement for providing the same services as certified "meaningful use" providers.

Karl Koob, chair of health information management at the University of Kansas School of Allied Health, says that the Center for Medicare and Medicaid Service''s carrot-and-stick approach is necessary because collecting the data on a national scale is critical for improving the U.S. health care system.

Although physicians benefit from the government''s push to adopt EHRs, many practices still haven't switched to electronic records. Anna Johnson, MET, clinical assistant professor of health information management at KU School of Allied Health, believes the hesitation, particularly among rural physicians, is due to in large part to the high start-up costs and the drastic changes EHRs can have on a physician's work day.

"Small physician practices don''t have as many resources," Johnson says. Because implementing an electronic health record system is resource-intensive, the uncertainty of success can leave doctors waiting on the sidelines.

Brull believes that cost isn't the largest barrier. Instead, she says, it's a lack of support.

"I think when doctors say they're not financially able to implement an EHR, it has to do a lot more with the culture that is in place in the office. If you have people who believe it won't work, then it won''t," Brull says.
Brull and the physicians at Plainville Medical Clinic believed an EHR system could work for their practice -- and it does. Today, Plainville's patients can access their health records online, email their physicians with questions and receive overall better care thanks to the EHR system. Brull and the other physicians spend less time on paperwork and more with patients. The EHR system has also reduced the number of late nights in the office, leaving more time for family. A meaningful change indeed.

To view this article visit:  http://www.kumc.edu/news-listing-page/electronic-records-improve-patients-health.html

New Salina med school campus unique in U.S.

By Dave Ranney
KHI News Service
July 5, 2011

 

SALINA — Next month, the University of Kansas School of Medicine will open a four-year, fully accredited school – officials prefer to call it a campus – next door to the Salina Regional Health Center.

“This will be the smallest medical school campus in the country and Salina will be the smallest city in the country - outside of a few major suburbs - to have a medical school campus,” said Dr. Heidi Chumley, senior associate dean for medical education at KU Medical Center.

The first class will have eight students, seven of whom are from Kansas.

KU Medical Center officials said they plan to add eight students a year at the campus in each of the next four years.

More primary-care docs

“The goal is to develop more primary care doctors for rural Kansas,” Chumley said. “We’re shooting for 75 percent (of the new school’s eventual graduates) choosing primary care, and 75 percent rural.”

Much of the new school’s curriculum will be tied to the classroom offerings at the KU Medical Center’s campuses in Kansas City and Wichita.

“We completely redid our curriculum about six years ago. It’s very computerized now,” said KU Medical Center Executive Vice Chancellor Barbara Atkinson. “All the lectures are podcasts. They’re all going to be teleconferenced (in Salina), though some will be generated on-site.”

The cost of remodeling the three-story building has been picked up by Salina Regional Health Center. And the hospital’s foundation and several private donors are covering many of the operational costs and scholarship offers.

“So far, we’ve not asked the state for any money for this because we understand the financial situation the state is in,” Atkinson said. “But we have asked donors to support it and they’ve been very, very generous. Incredibly generous.”

Salina-area benefactors, she said, hope to raise $2.5 million over the next four years. They’ve already raised $1.5 million with $1 million coming from the salina hospital.

Salina Regional Health Center has hosted a residency program for KU Medical School graduates for about 30 years.

Most of its residents went on to start or join rural practices.

Model for other states

“What the University of Kansas is doing, I think, will be a template for having a positive impact on the number of medical practitioners in rural communities,” said Brock Slabach, senior vice president at the National Rural Health Association. “Other universities will be watching because, really, for a major medical school to commit itself to meeting rural-community needs like this is truly novel. It shouldn’t be, but it is.”

Slabach said he’s long been baffled by the fact that medical school officials in many rural states’ fail to see the connection between their states' shortages of health care providers and their students leaving for big cities in other states.

“I wouldn’t include Kansas in that group,” he said.

Last year, a national survey of how well medical schools were fulfilling their “social mission to train doctors…” ranked KU School of Medicine fifth in the nation.

The school was ranked eighth for its percentage of graduates (44 percent) practicing in underserved areas.
Earlier this year, a Kansas Department of Health and Environment survey found that 51 of the state’s 105 counties had less than one physician per 2,695 residents and were considered medically underserved.

Looming retirements

“The shortage of health care professionals has been a critical issue for a long time,” said Dr. William Cathcart-Rake, a Salina oncologist and director at the KU-Salina campus. “It’s not new, but what is new is that now we have a number of physicians who are nearing retirement age, and a good number of them are practicing in the rural communities.”

Generating enough new doctors to replace those who are retiring – especially in rural areas - will be difficult, he said.

“We have to do something,” Cathcart-Rake said. “We can’t keep doing what we’ve always done. It’s not enough.”

The Salina campus, he said, will be geared toward allowing students from small towns to complete their studies and residencies in a small-town environment.

“There is evidence that shows that if someone is trained in a rural area they are more likely to stay in a rural area,” he said. “So the idea is that from day one we’ll be training our students in in non-metropolitan settings and exposing them to all the good and the bad that comes with life in rural Kansas. After that, we’ll hope for the best.”

Cathcart-Rake, who grew up in small town in Orange County, Calif. (“…back when there was still a small town in Orange County”), has been practicing medicine in Salina for 32 years.

“The perception is that if you go to a small town you’ll work yourself to death, you’ll never get a vacation and you won’t get to spend time with your family,” he said. “The way to get around that is to be with a group of physicians so you can cover for each other so you don’t have to do everything for yourself.

“The days of there being a doc in every little town are gone. That’s not the model anymore,” Cathcart-Rake said, noting that in Clay Center, for example, the local clinic has eight physicians and four mid-level practitioners serving a large catchment area.

Similar models are in place in Tribune, Quinter, and Beloit.

Enjoying small-town life

Earlier this year, Aneisa Slack, 25, completed her second year of study at KU Medical School in Kansas City. She’s starting her third year on the school’s Wichita campus.

“I’ll be here for six months,” she said. “Then, in January I’ll go to Salina. I’ll be there for 18 months.”
Slack, who grew up on the family farm south of Oxford in Sumner County, said she wants to be a primary-care physician in a small town.

“I like the small-town lifestyle,” she said. “I know that a lot of people don’t. But that, I think, is because they’re not from a small town. I’ve had some classes with students from Wichita and Kansas City who’ve never been to a small town. They’ve driven through them, but they’ve never spent any time in one.”

Slack last year was president of the KU Rural Medicine Interest Group, which is a student organization. She said she was leaning toward joining an existing practice or going to work for a small-town hospital.

Most of her fellow students, she said, are not interested in opening their own practices.

“The ones I know aren’t really interested in starting a business,” she said. “They don’t want to have to put up with all the paperwork. They just want to be a doctor.”

Article courtesy of Kansas Health Institute.  View article at:  http://www.khi.org/news/2011/jul/05/salina-medical-school-campus-be-no-other/#

Wichita-area health care leaders sign pact to create training site

BY RON SYLVESTER
The Wichita Eagle

Every year, 180,000 people die because of accidents in their medical treatments.

"That's the equivalent of a huge plane crash once a day," said Wichita physician Robert McKay, program chair of anesthesia at the University of Kansas Medical Center-Wichita. He was citing a survey last year of medical deaths by the inspector general of the Department of Health and Human Services.

"If a plane crashed every day, people would stop flying. But they can't stop going to the hospital," McKay said Tuesday.

This week, McKay learned, a simulation training program similar to one he's trying to help bring to Wichita had all but eliminated what the health care profession calls "adverse events" at one large Midwest hospital.

Cincinnati Children's Hospital recorded about one such event every six months 10 years ago, before they started training with medical simulators. Now, the hospital has gone 3 1/2 years without a serious safety event, according to Tom LeMaster, program director for the Cincinnati Children's Center Simulation and Research Center.

Simulators allow medical professionals to practice real-world scenarios on high-tech mannequins under the same types of circumstances they face in hospitals or ambulances.

"I can't say simulation fixed everything, because there are other changes we made, but I can say it was a huge part of it," LeMaster said.

Such success helped bring together leaders from Wichita's hospitals, medical clinics, military installations, emergency services and health care schools to sign a joint operations agreement for the Mid-Continent Regional Center for Health Care Simulation.

About a dozen health care leaders and educators signed the agreement for the proposed $14 million training center during a lunch at the Wichita Art Museum.

The agreement represents a formal backing of the project from the city's health care organizations and schools. It may open as early as next year if enough money can be raised, organizers said.

"It worked in Cincinnati; it can work anywhere," said McKay, who serves on a steering committee for the new center.

LeMaster said the Cincinnati program started training hospital staff in the emergency room and now is integrated throughout the hospital. LeMaster said his crew now can bring a simulated emergency test into the hospital, unannounced, and teams must react as if it's a real emergency.

"We run about two codes per month throughout the hospital," LeMaster said.

LeMaster cited the cardiopulmonary bypass machine, which pumps blood and oxygen to a patient during heart surgery. It effectively takes over for the heart and lungs. When it works. But it's a machine, built by humans, and has its limitations and failures.

"And when a heart-lung bypass stops, you're in trouble," LeMaster said.

But since doctors and nurses have been training in simulation of such emergencies, they now handle them better.

"With something happens now, it barely bothers them, and they can fix it quickly without stress to the patient," LeMaster said.

That's the kind of training, and patient safety results, those hoping to bring to Wichita's health care community.

Paul Uhlig, a heart surgeon and associate professor of preventive medicine and public health at the KU medical school, is chair of the steering committee. He said the center is organizing itself as a nonprofit. The Wichita Community Foundation is taking donations for the project until the group gets its tax-exempt status.

Uhlig said the group hopes to raise $8 million of its startup costs through community donations, another $5 million through a one-time investment of local and state funds and $1 million in support from the local health care industry.

Tuesday's signing was a symbol of the community commitment to raise the funds.

"It's a statement of sincere interest in working together to create this center," Uhlig said.

The group is scouting several locations for the center, Uhlig said, which would be centrally located and easily accessible by all the health care centers and educational programs in the area.

The goal, Uhlig said, is to become a regional medical training center.

Read more: http://www.kansas.com/2011/06/30/1914670/health-care-leaders-sign-pact.html#ixzz1Qmm33Lc6

From Rural Health to the JayDoc Clinic: A Pre-Med’s Journey

Part 3

Part 2 (You can view Part 1 from the March 24 post)

Part 1 (You can view Part 1 from the February 11 post)

Why I Volunteer
I am not the kind of girl who likes to set an alarm for Saturday morning.  I am not the kind of girl who likes to set an alarm really any day of the week, but that is another story.  On the Saturdays I volunteer at the JayDoc Community Clinic (JCC) my alarm goes off at 7:00am.  I have come to affectionately call the Saturdays that I volunteer at the clinic my “JayDoc Saturdays.” Typically, the piercing noise coming from my alarm clock ranks right up there with nails on a chalkboard, but on JayDoc Saturdays things are different.  They’re different because on JayDoc Saturdays I am up before the alarm even has the chance to go off.  I am merrily bouncing all around my house getting ready for my day at the clinic.  I am excited about what my day potentially holds for me.  Questions race through my mind as I prepare for a day at the clinic.  What kind of patients will I have today?  What am I going to learn?  Will I be able to work the blood pressure cuff correctly?  Is someone bringing breakfast?  At this point, I need some answers and most likely some breakfast too.

On JayDoc Saturdays, I simply cannot wait to get to the clinic!  I just completed the spring semester at JCC and was given the opportunity to join the clinic for the fall semester as well.  Something about the JayDoc Clinic just keeps me coming back for more.  Why am I continuing to volunteer at JCC when I could clearly be sleeping in?  I have attempted to provide a few reasons for my choice to continue volunteering below.

Reason #1
You know the game shows where your prize is based on which door you choose?  You can choose door #1 and you know what that prize is, it’s a sure thing, done deal, no risk.  Then there is door #2 and you have no clue what is behind that door.  If you are feeling lucky, you can choose door #2 and hope for the best.  Well, I found that patients are always like choosing door #2.  As I bring back each patient to the exam room, I have no idea what is in store for me once I close the door. This could be a quick open and shut case or I could spend all day trying to assist this patient.  Once I get the patients in the exam room they have been known to laugh, cry, cough, gag, and/or watch me fall off my rolling chair (true story).  Do I feel completely prepared to handle the patients’ diverse needs?  – Not really.  I think this feeling of preparation is something that comes from experience and I will feel more prepared as time goes on.  For right now, when that exam room door closes what happens next is always a surprise, and I am going to be honest – it gives me an adrenaline rush.

Reason #2
I am a part of the patient care team on JayDoc Saturdays.  What I do and how I do it matters to these patients and to the success of the team.   The vitals I record and the information I obtain from the patient helps prepare the medical student to formulate a game plan and minimize “door #2 syndrome.”  

Being an active member of this team requires a lot of learning on my part and a lot of teaching on the part of the medical students, residents, and physicians.  During my most recent JayDoc Saturday, I learned the what and the how behind SOAP notes (subjective, objective, assessment, plan) and even got to deliver ¾ of a SOAP note to the attending resident physician.  I received a crash course on the different stages of hypertension and learned all about the devastating effects of high blood pressure on the human body.  This all occurred over the course of an hour.  I am so appreciative of the people I volunteer with at JCC.  They are incredibly supportive and always willing (and excited) to answer any question I may have.   My time at JCC has provided me with an invaluable learning opportunity.  I am very fortunate to have learned so much from the JCC volunteers and I look forward to what I will learn in the future. 

Reason #3  
Volunteering at the JayDoc Community Clinic is a truly humbling experience.  When my life gets stressful, school gets tough, and work is overwhelming, I come to JayDoc and I am immediately reminded of why I want to be a physician.  Suddenly, the path I have chosen for myself feels easier.  I feel energized and ready to continue my journey to becoming a physician.

Is that Flat Jaydoc?

Conclusion
Why sleep in when I could be volunteering at the JayDoc Community Clinic?  My enthusiasm for being a part of JayDoc Saturdays keeps me from having to hear the awful noise that emanates from my alarm clock in the morning.  I also save money because the adrenaline rush I get from being at the clinic allows me to work all day without caffeine.  From where I stand, my time at the clinic is truly a win-win situation.

-Auburn Weber, Rural Health Education and Services, University of Kansas Medical Center
 

Like KU School of Medicine–Wichita on Facebook

Wednesday, June 15, marked the launch of the KU School of Medicine–Wichita Facebook page! The page will keep everyone in the know about the exciting news taking place on the Wichita Campus and within our community. However, we promise not to be a “Facebook Minutiaest”.

Oh, the places he’ll go
With the launch of Facebook, there will be a new “Doc” on campus, and he will be photographed everywhere students, residents, and faculty members can be found. His name is Flat JayDoc and, even
though he is flat, he will fit right into experiencing the intriguing and rewarding things those on the Wichita Campus get to do. Flat JayDoc is similar to the Flat Stanley project for children, which  ncourages students to make connections with other schools through photos and letters. On our campus, students, residents, and faculty members will host Flat JayDoc for up to five days and assist him (after all, when you are flat, you have issues with manipulation) with getting his photos on the KU School of Medicine–Wichita Facebook page. He will be passed on to other hosts for his adventures to continue and his photos will be posted on the KU School of Medicine–Wichita Facebook page.

“Likes” for Wichita
First-Years The new 1styear medical students aren’t coming with a skeleton in the closet, but they will get one as soon as we get 1,000 “Likes”! To welcome the 1st-year class, the 4-Wichita Advancement Board will donate up to $1,000 to purchase a skeleton and a protective cabinet, a bonus and exciting instructional aid for the 1st-year students to enhance their Wichita experience. For every person who “Likes” our page, the board will donate $1 toward the purchase. We’re hoping to welcome the skeleton by Halloween. Take a minute to show your support for the 1st-year students on the Wichita Campus by simply “Like”-ing our page and then spreading the word.

White House announces the establishment of a White House Rural Council

The White House - http://1.usa.gov/kPeVr2
Office of the Press Secretary
June 09, 2011

WASHINGTON, D.C. – The White House today announced the establishment of the first White House Rural Council.  While rural communities face challenges, they also present economic potential.  To address these challenges, build on the Administration’s rural economic strategy, and improve the implementation of that strategy, the President signed an Executive Order establishing the White House Rural Council.

“Strong rural communities are key to a stronger America,” said President Barack Obama.  “That’s why I’ve established the White House Rural Council to make sure we’re working across government to strengthen rural communities and promote economic growth.”

The White House Rural Council will coordinate programs across government to encourage public-private partnerships to promote further economic prosperity and quality of life in rural communities nationwide.  Chaired by Secretary of Agriculture Tom Vilsack, the Council will be responsible for providing recommendations for investment in rural areas and will coordinate Federal engagement with a variety of rural stakeholders, including agricultural organizations, small businesses, and state, local, and tribal governments.

“Rural America makes significant contributions to the security, prosperity, and economic strength of our country,” said Agriculture Secretary Tom Vilsack.  “The Rural Council announced by President Obama shows his continued focus on promoting economic opportunity, creating jobs, and enhancing the quality of life for those who live in rural America.  Together with the rest of the Obama administration, USDA has worked to support families and businesses in rural communities so that their success will pay dividends for all Americans.”

In the coming months, the White House Rural Council will focus on job creation and economic development by increasing the flow of capital to rural areas, promoting innovation, expanding digital and physical networks, and celebrating opportunity through America’s natural resources. The Council will begin discussing key factors for growth, including:

• Jobs: Improve job training and workforce development in rural America
• Agriculture: Expand markets for agriculture, including regional food systems and exports
• Access to Credit: Increase opportunity by expanding access to capital in rural communities and fostering local investment
• Innovation: Promote the expansion of biofuels production capacity and community based renewable energy projects
• Networks: Develop high-growth regional economies by capitalizing on inherent regional strengths
• Health Care: Improve access to quality health care through expansion of health technology systems
• Education: Increase post-secondary enrollment rates and completion for rural students
• Broadband: Support the President’s plan to increase broadband opportunities in rural America
• Infrastructure: Coordinate investment in critical infrastructure
• Ecosystem markets: Expanding opportunities for conservation, outdoor opportunities  and economic growth on working lands and public lands

Since taking office, President Obama’s Administration has taken significant steps to improve the lives of rural Americans and has provided broad support for rural communities.  The Obama Administration has set goals of modernizing infrastructure by providing broadband access to 10 million Americans, expanding educational opportunities for students in rural areas, and providing affordable health care.  In the long term, these unparalleled rural investments will help ensure that America’s rural communities are repopulating, self-sustaining, and thriving economically.

Dr. Eve-Lynn Nelson uses telemedicine to help Kansas children cope with mental illness

June 02, 2011

By Cori Ast

By age 18, one in five American children will have a diagnosable mental health condition and millions more will have be in situations where they could have benefitted from mental health counseling. With 99 of 105 Kansas counties designated as mental health professional shortage areas, only a handful of these children might receive necessary treatment.

School of Medicine researchers such as Eve-Lynn Nelson, PhD, are finding ways to change that. Dr. Nelson, an associate professor of pediatrics, is one of three School of Medicine psychologists providing regular pediatric mental health services via video conference to Kansas children, a practice known as telemedicine.

"Without telemedicine, many Kansas kids might not receive necessary mental health treatment, and an untreated mental health condition affects every aspect of a child's life." Nelson explained.

Due to a shortage of licensed child psychologists, a Kansas child could wait six months for an in-person visit. However, a child seen through telemedicine could begin treatment within a month. In addition to quicker access, other benefits of pediatric behavioral telepsychology include the ability to get additional information from school officials and reduced travel time for the patient.

With appropriate technology and training, a telemedicine visit is no different from a face-to-face visit. "Successful treatment depends on relationship building, which is no more challenging in telemedicine than in person," said Dr. Nelson. "We are still able to forge close doctor-patient relationships even though we are often communicating over long distances."

Dr. Nelson and Susan Sharp, DO, a clinical assistant professor of psychiatry and behavioral sciences, are studying the use of a team-based approach in treating youth who have signs of depression. Their research also includes a provision for training providers in telemental health.