May 2012

official publication of the san diego county medical society May 2012

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S A N D I E G O P HY S I CI A N .or g O c tob e r 2011

Octo ber 2011 SAN DIEGO P HY SIC I A N. o rg

1

this month Volume 99, Number 5

Managing Editor Kyle Lewis

features HEALTHCARE TECHNOLOGY 10 The Data Is Coming! The Data Is Coming!

by Royan Kamyar, MD, MBA

14 The San Diego Beacon Health Information Exchange

by Anupam Goel, MD, MBA, Theodore (Ted) Chan, MD, and Deborah Taheri, MBA

16 From Paper Charts to EHR/EMR: Two Common Problems and Useful Strategies for a Successful Transition

by Ron Anderson, CPEHR, CPHIT

20 How ‘Value-based Payment’ Impacts Housecall Medicine

Editorial Board Van L. Cheng, MD, Adam F. Dorin, MD, Kimberly M. Lovett, MD, Theodore M. Mazer, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Art Director Lisa Williams Copy Editor Adam Elder

SDCMS Board of Directors Officers President Robert E. Wailes, MD (CMA Trustee) President-elect Sherry L. Franklin, MD (CMA Trustee) Treasurer Robert E. Peters, PhD, MD Secretary J. Steven Poceta, MD Immediate Past President Susan Kaweski, MD geographic and geographic alternate Directors East County William T-C Tseng, MD, Heywood “Woody” Zeidman,

MD, Kimberly M. Lovett, MD (A:Venu Prabaker, MD) Hillcrest Theodore S. Thomas, MD, Steven A. Ornish, MD, Jason P. Lujan, MD (A:Gregory M. Balourdas, MD) Kearny Mesa John G. Lane, MD (A:Marvalyn E. DeCambre, MD, Sergio R. Flores, MD) La Jolla Gregory I. Ostrow, MD, Wynnshang “Wayne” Sun, MD (A: Matt H. Hom, MD) North County James H. Schultz, MD, Douglas Fenton, MD, Niren Angle, MD (A: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD, Mike H. Verdolin, MD (A: Andres Smith, MD)

by C. Gresham Bayne, MD

22 San Diego Blood Bank ‘Moves to the Future’ at New Headquarters

by Rosemarie Marshall Johnson, MD

26 Leveraging Technology to Continually Improve Quality of Care: UC San Diego Health System

by Angela L. Scioscia, MD, and Joshua Lee, MD

At-large and At-large alternate Directors Jeffrey O. Leach, MD, Bing S. Pao, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD, Peter O. Raudaskoski, MD, Mihir Y. Parikh, MD, Suman Sinha, MD (A: Carol L. Young, MD, Thomas V. McAfee, MD, Ben Medina, MD, James E. Bush, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO, Theresa L. Currier, MD) other voting members Communications Chair Theodore M. Mazer, MD (CMA Vice Speaker)

28 Healthcare Apps: A Handful of Those Used by Your SDCMS Colleagues

Young Physician Director Van L. Cheng, MD

30 Information Services: Scripps Health

Medical Student Director Beth P. Griffiths

by Patric R. Thomas

Resident Physician Director Steve H. Koh, MD Retired Physician Director Rosemarie M. Johnson, MD

OTHER NONVOTING MEMBERS Young Physician Alternate Director Renjit A. Sundharadas, MD Resident Physician Alternate Director Christina Pagano, MD Retired Physician Alternate Director Mitsuo Tomita, MD CMA President James T. Hay, MD CMA Past Presidents Robert E. Hertzka, MD (Legislative Committee Chair), Ralph R. Ocampo, MD CMA Trustee Albert Ray, MD CMA Trustee (OTHER) Catherine D. Moore, MD CMA SSGPF Delegates James W. Ochi, MD, Ritvik Prakash Mehta, MD CMA SSGPF Alternate Delegates Dan I. Giurgiu MD, Ashish K. Wadhwa, MD

departments 4 Briefly Noted

Calendar • Featured Member • Get in Touch • Medical Student Advocacy • Legislator Birthdays • And More …

8 Diagnostic Errors: What, Me Worry?

by The Doctors Company

34 Physician Marketplace

Classifieds

2 SAN DIEGO PHYSICIAN .org May 2012

8

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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brieflynoted calendar SDCMS Seminars, Webinars & Events SDCMS.org/event

For further information or to register for any of the following SDCMS seminars, webinars, and events, visit SDCMS.org/event or contact Serena Sauerheber at (858) 300-2779 or Serena.

Sauerheber@SDCMS.org.

Cal-OSHA Certification Training (seminar/webinar) MAY 24 • 11:30am–2:00pm HIPAA / Meaningful Use (webinar only) MAY 30 • 11:30am–1:00pm SDCMS White Coat Gala (event) JUN 2 • 6:00pm–11:00pm Social Media Basics for the Medical Practice (seminar/ webinar) JUNE 7 • 11:30am–1:00pm Are Your Contracts Healthy? (seminar/webinar) JUNE 14 • 11:30am–1:00pm Business Law 101 for New Physicians (seminar/webinar) JUNE 20 • 11:30am–1:00pm

Cma Webinars

CMAnet.org/events

Strategic Planning for Solo, Small, and Medium Group Practices MAY 23 • 12:15pm–1:15pm Workers’ Compensation: E-billing Implementation Requirements MAY 24 • 12:15pm–1:45pm California’s Changing Insurance Marketplace MAY 30 • 12:15pm–1:15pm Workers’ Compensation: Understanding E-billing Remittance Advice Codes MAY 31 • 12:15pm–1:45pm A Manager’s Guide to Lowering Practice Costs JUN 6 • 12:15pm–1:15pm

CMA and the Courts: Accessing CMA’s Legal Library JUN 13 • 12:15pm–1:15pm Writing Effective Appeals JUN 20 • 12:15pm–1:15pm Preparing for a Medicare and/ or Medi-Cal Audit JUL 18 • 12:15pm–1:15pm Coding for Medical Necessity AUG 1 • 12:15pm–1:15pm Program Integrity in Medicare and Medi-Cal: The Physician’s Role AUG 15 • 12:15pm–1:15pm A Guide to Reviewing Payor Contracts SEP 5 • 12:15pm–1:15pm Creating and Implementing Financial and Office Policies SEP 19 • 12:15pm–1:15pm Protect Your Practice From Payor Abuse OCT 3 • 12:15pm–1:15pm

featured SDCMS SEMINAR On May 24 (11:30am–2:00pm), SDCMS will conduct an “OSHA Certification: Regulatory Compliance for the Medical Practice” seminar and webinar. Topics covered will include Cal-OSHA standards, Department of Health requirements, Environmental Protection Agency requirements, Medical Board of California requirements, Department of Toxic Substances Control requirements, Fire Department requirements, and more. This seminar is presented by Julian Goduci, president and CEO of EnviroMerica, Inc., specialists in regulatory compliance consulting and medical waste management and transport. SDCMS members receive 35% on all EnviroMerica products and services.

For further information or to register, contact SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

Establishing Expectations for High Performance from Medical Staff OCT 17 • 12:15pm–1:15pm Understanding ARC and CARC Revenue Codes NOV 7 • 12:15pm–1:15pm

Community Healthcare Calendar To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. Events should be physician-focused and should take place in or near San Diego County.

California Society of Industrial Medicine and Surgery’s Midsummer Seminar: Are You on the Right Track?

JUN 14–16 • www.csims.net 55th Annual San Diego Academy of Family Physicians’ Family Medicine Update: 2012 JUN 22–24 • Paradise Point Hotel, Mission Bay • www.sandiegoafp.org 13th Annual Science and Clinical Application of Integrative Holistic Medicine NOV 2 • Hilton San Diego Resort

4 SAN DIEGO PHYSICIAN.org May 2012

featured member

Russell W. Engevik, MD

Russell W. Engevik, MD, SDCMS-CMA member since 2003, is a senior partner at California Emergency Physicians, practicing emergency medicine at PPH. He has lived in San Diego County since 1969. After medical school (George Washington University, 1983) and military service, he returned home in 1990. Dr. Engevik has been affiliated with Sharp (Cabrillo, Grossmont, Chula Vista, and Coronado), but over the past 13 years, he has been almost exclusively at Palomar/Pomerado Health, where he was named the Palomar Physician of the Year in 2011. Additionally, Dr. Engevik is currently doing an emergency medicine ultrasound fellowship at UCSD in order to gain skills unavailable during his residency in the 1980s. Dr. Engevik has been named “Top Doctor” for the past eight years (2004–11).

If you would like to be considered for our next “Featured Member” spotlight, email Editor@SDCMS.org. Thank you for your membership with SDCMS-CMA!

you take care of the san diego communit y ’s health. we take care of san diego’s

healthcare communit y.

get in touch

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SDCMS Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO • EXECUTIVE DIRECTOR Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO • CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org DIRECTOR OF ENGAGEMENT Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org DATABASE ADMINISTRATOR Janet Lockett at (858) 300-2778 or Janet.Lockett@SDCMS.org DIRECTOR OF MEMBERSHIP SUPPORT • PHYSICIAN ADVOCATE Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org DIRECTOR OF BUSINESS DEVELOPMENT Naeiry Vartevan at (858) 300-2782 or at Vartevan@SDCMS.org DIRECTOR OF COMMUNICATIONS AND MARKETING • MANAGING EDITOR Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org OFFICE MANAGER • DIRECTOR OF FIRST IMPRESSIONS Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org MEMBERSHIP ADMINISTRATIVE ASSISTANT Rhonda Weckback at (858) 300-2779 or Rhonda.Weckback@SDCMS.org LETTERS TO THE EDITOR Editor@SDCMS.org GENERAL SUGGESTIONS SuggestionBox@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 300-2777 F (858) 560-0179 (general) W SDCMSF.org EXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or Barbara.Mandel@SDCMS.org project access PROGRAM DIRECTOR Tanya Rovira at (858) 565-8161 or Tanya.Rovira@SDCMS.org RESOURCE DEVELOPMENT DIRECTOR Lauren Banfe at (858) 565-7930 or Lauren.Banfe@SDCMS.org Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or Rebecca.Valenzuela@SDCMS.org Patient Care Manager Elizabeth Terrazas at (858) 565-8156 or Elizabeth.Terrazas@SDCMS.org IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org

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brieflynoted medical student advocacy

UCSD Medical Students Visit the California Senate

As part of the SDCMS Foundation’s mission to expose medical students to the world of advocacy, future physicians visited the California Senate in March 2012 and met with, among others, Senator Christine Kehoe.

FDA

The Patient’s Lament

by Melvyn L. Sterling, MD, Clinical Professor of Medicine at the University of California, Irvine Yes, we’ve lots of Tylenol, But we have no Adderall.

Fentanyl’s in short supply, There is no more for us to buy.

Taxols used for chemotherapy, Now in very short supply, Liquid morphine, a hospice staple, Became “unapproved” by those not capable, Of understanding patient sufferin, Said to use more Bufferin.

FDA created a crisis by summarily curtailing, Access for those severely ailing, Until the impact of their regulatory intrusion, Created a crisis of epic proportion, For those that were dying in pain unrelieved, Due to decisions too stupid to be believed.

The morphine debacle is now just a memory But the bureaucracy remains and retains its authority The patient’s access to the drugs they need,

L–R: Tom Gehring (SDCMS CEO), Sherry Franklin, MD (SDCMS president-elect), Greg Bernstein, Lucy Cheng / Dustin Wailes, Senator Christine Kehoe, Karen Levy, Jefferey Cui, Tina Lu

legislator birthdays

Should not be foolishly decreed.

One way to let your legislators know that you’re paying attention and that you vote is by wishing them a happy birthday!

BIRTHDAY: JUNE 20

BIRTHDAY: JUNE 22

BIRTHDAY: JUNE 28

State Assemblywoman Diane Harkey (District 73) E: (via website) arc.asm.ca.gov/member/73 E: assemblymember.harkey@assembly.ca.gov Sacramento Office: State Assembly, Sacramento, CA 95814 T: (916) 319-2073 • F: (916) 319-2173 Oceanside Office: 300 N. Coast Highway, Oceanside, CA 92054 T: (760) 757-8084 • F: (760) 757-8087

U.S. Senator Dianne Feinstein E: (via website) feinstein.senate.gov Washington, DC, Office: T: (202) 224-3841 • F: (202) 228-3954 San Diego Office: 750 B St., Ste. 1030, San Diego, CA 92101 T: (619) 231-9712 • F: (619) 231-1108

State Assemblyman Marty Block (District 78) E: (via website) asmdc.org/members/a78 E: assemblymember.block@assembly.ca.gov Sacramento Office: State Assembly, PO Box 942849, Sacramento, CA 94249-0078 T: (916) 319-2078 • F: (916) 319-2178 Lemon Grove Office: Lemon Grove Plaza, 7144 Broadway, 2nd Floor, Lemon Grove, CA 91945 T: (619) 462-7878 • F: (619) 462-0078

6 SAN DIEGO PHYSICIAN.org May 2012

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Risk Management

Diagnostic Errors What, Me Worry?

Contributed by SDCMS-endorsed The Doctors Company. For more information on diagnostic errors, visit www.thedoctors.com.

Despite dramatic advances in the quality and availability of diagnostic tests, diagnostic errors remain a leading cause of preventable morbidity and mortality.

There is growing recognition that physician factors like fatigue and resource or time constraints contribute to these poor but avoidable outcomes.

A study of consecutive malpractice claims at The Doctors Company from 2000 to 2007 revealed that more than 50% of claims were related to diagnosis. Of that amount, more than 75% were due to failure to diagnose.

Overall, diagnostic errors account for nearly half of all malpractice claims in 8 SAN DIEGO PHYSICIAN.org May 2012

nonsurgical specialties. One of the most frequently cited process errors is management of test results. Most breakdowns in the diagnostic process occur because of failure to order an appropriate diagnostic test, create a proper follow-up plan, or obtain an adequate history or perform an adequate physical examination. Breakdowns also include incorrect interpretation of diagnostic tests.

Review the following tips to refresh your diagnostic process.

1. Practice by standards: Organize yourself with routines and checklists: • Document all encounters.

• Develop and document a plan of care for each patient.

• Ensure an adequate history and physical are completed and recorded.

• Maintain a medication list for each patient, and update the list at each visit.

2. Involve the patient and family when appropriate: • Give clear, written follow-up instructions.

• Include the patient and family in the “redundancy process.” Tell them: “We will call you with your lab results. If you don’t hear from me or my office staff within 10 business days about your lab report, call the office at [number].”

• Communicate! The more open and transparent the communication, the better.

• Develop a plan or process to overcome communication or language barriers, hearing impairment, and health illiteracy.

3. Determine who is coordinating the care: • If you are the primary care physician, make sure all tests and consultations are tracked back to you.

• If you are the consultant, know who ordered the consultation, who should receive the report, and who will provide treatment.

• If you are the hospitalist, know when and how to transition the care back to the admitting physician.

4. Communicate effectively, using the teach back or Ask Me 3™ method.

The Doctors Company and the National Patient Safety Foundation (NPSF) have formed a partnership to bring the “Reducing Diagnostic Errors” program to physicians. This module uses a case-based approach to identify strategies for error reduction. Sign up for the course on the NPSF website at www.npsf.org (there may be a cost to participate). CME for this course is provided by The Doctors Company.

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Healthcare Technology

10 SAN DIEGO PHYSICIAN.org May 2012

The Data Is Coming!

The Data Is Coming!

Guiding the Future of Our Profession By Royan Kamyar, MD, MBA

Traditional medical education incorporates four years of medical school, three to seven years of residency training, and, for some, up to three more years of fellowship or further specialization. Our classroom training is diverse, ranging from biochemistry and gross anatomy to pharmacology and ethics. Ultimately, students move into the clinical setting where they interact with patients in psychiatric departments, cardiology units, family clinics, and operating rooms. Computer science, remarkably, has never been part of the curriculum, even at top schools. Indeed, “bioinformatics” and “data analytics” are terms I only became acquainted with at UC San Diego’s Rady School of Management. To many physicians, labels like “Bluetooth” and “Zigbee” sound more like Saturday morning cartoon characters than technologies that promise to transform healthcare.

With undergraduate degrees in biochemistry and business, I expected to encounter and potentially develop, upon completion of an MD/MBA, innovations that were hybrids of technologies relating to genetics, pharmacology, and immunology. After four years of medical school, a year of internal medicine residency, and two years of business school, I thought I would be well equipped for the challenge. Little did I know that a revolution was on the horizon, that disruptive industries were colliding with the ancient art of healing.

Health IT Revolution and Its Implications Policymakers and industry leaders, capitalizing on the promise of an innovationdriven marketplace and opportunity, have taken momentous steps to address the

integration of technology and medicine.

The Health Information Technology for Economic and Clinical Health Act, signed into law as part of the American Recovery and Reinvestment Act of 2009, injects more than $20 billion directly into health IT. The presidential effort to promote the adoption and use of electronic health record (EHR) technologies is being compared to Lincoln’s transcontinental railroad and Eisenhower’s Interstate Highway System, in terms of size, scale, and potential level of impact.

Health IT and wireless health technologies promise to improve healthcare. In December 2010, the president’s Council of Advisors on Science and Technology, cochaired by representatives from Harvard, MIT, and Memorial Sloan-Kettering Cancer Center, summarized the potential benefits: • Integrate technology into the flow of clinical practice as an asset, while minimizing unproductive data-entry work.

• Give clinicians real-time access to complete patient data, and provide them with information support to make the best decisions.

• Help patients become more involved in their own care.

• Enable a range of population-level public health monitoring and real-time research.

• Improve clinical trials, leading to more rapid advances in personalized medicine.

• Streamline processes, increase transparency, and reduce administrative overhead.

• Create new high-technology markets and jobs.

• Support a range of economic reforms

in the healthcare system in an effort to address our nation’s long-term fiscal challenges.

There is little doubt that with the widespread implementation of EHRs and accompanying technologies, reams of previously unavailable information will become readily accessible. Operational and quality improvements have been seen after moving onto IT platforms in other industries, such as banking and manufacturing.

To turn these positive outcomes into a reality in the healthcare space, however, a major evolution in physician education needs to take place.

Doctors and Health IT Along the lines of Hamlet’s claim that “nothing is either good or bad, but thinking makes it so,” it would be difficult to argue that the availability of information enabled by EHRs, in itself, is either a good or bad thing. Data is simply that: data. But how that information gets used may tip the scales one way or another. Curated data can be shaped into a sword. But who will be carrying the sword after the healthcare IT revolution?

Many of my closest friends from medical school have gone on to residency programs at prestigious schools, including Harvard, Stanford, and UC San Diego. Yet none of them knows IT or high-tech very well.

These smart, courageous, energetic people have found themselves unarmed with proficiency in technologies actively disrupting their industry. In fact, I would estimate that less than 10% have the IT, engineering, management, leadership, or policy backgrounds required to be an integral part May 2012 SAN DIEGO PHYSICIAN.org 11

of the health IT revolution.

This generation of physicians may be left in the dark, serving as a backstop to the doors of innovation. And they will likely get trampled in the process.

The Data Is Coming

A physician’s day is already filled with patient visits, operations, night calls, and barely enough time for sleep.

Currently, the only people with adequate time, focus, and resources to use these types of data are pharmaceutical companies, insurance companies, and malpractice lawyers.

12 SAN DIEGO PHYSICIAN.org May 2012

The first thing that will happen as soon as EHRs fully set in — especially after medical device integration is complete (expected by 2017) — will be an influx of data, not to mention the data already being collected on paper that will now go electronic. Basic lab results tied with patient demographics will open new fields of retrospective and prospective analyses, and a scale of datamining and research that has not been possible before.

This is great news for the future. But right now, it has the potential to be catastrophic.

A physician’s day is already filled with patient visits, operations, night calls, and barely enough time for sleep. Currently, the only people with adequate time, focus, and resources to use these types of data are pharmaceutical companies, insurance companies, and malpractice lawyers.

Pharmaceutical companies are facing a steep patent cliff, a drowning rate of research and development productivity, strong generic competition, and cashstrapped governments. They are looking for new industries in which to invest their buckets of cash, and health IT is it. Expect to see health IT-enabled data improving their marketing power in the very near future.

Insurance companies traditionally have some of the best access to patient data and will undoubtedly take a lead role in ensuring their bottom line by selecting the bits of data that support their cause — whether it be denying claims to patients or reducing reimbursement levels to physicians.

The potential scope for malpractice claims, already a primary concern of many physicians, is augmented by the data allowed for by health IT. A recent article published in The New England Journal of Medicine by the NYU Department of Medicine and Harvard School of Public Health, “Medical Malpractice Liability in the Age of Electronic Health Records,” framed the situation in the following passage: This prospect reflects a deeper concern about health information technology: Will the practice environment evolve along with the information environment to allow

physicians to make use of the available information resources? The time constraints of typical office visits, for example, may hinder a thorough examination of voluminous EHRs. Under such constraints, key information may be missed in a sea of new electronic data, much of which is of dubious clinical significance. The legal standard of care in malpractice cases is meant to reflect reasonable care, but what appears to be reasonable may differ from the perspective of a layperson, who is convinced of the easy accessibility of electronic information, and the physician, who has the challenge of examining both the patient and his electronic dossier in a 15-minute visit.

Solution: Physician Education In the short term, only savvy, motivated physicians with relevant backgrounds such as IT, engineering, management, leadership, or policy will have a seat at healthcare’s decision-making table. Meanwhile, those who will be making the decisions that guide the future of healthcare will be those with the access and ability to actively utilize the streams of incoming data.

Unfortunately, these parties often have somewhat antagonistic relationships with physicians (not to mention patients), as they have completely different incentives within the healthcare field. As the pharmaceutical companies, insurance companies, and malpractice firms continue to hire fulltime IT graduates from top universities to harness and curate electronic data, via deep pockets and strong, immediate incentive, they will grow the ability to use the new information to their own advantage.

Unless today’s doctors take active steps to educate themselves in new ways and advance synchronously with the evolution of their industry, they will cease to guide the future of the profession to which they have dedicated their lives. Universities must step up in concert to provide our physicians the interdisciplinary training they need to thrive in tomorrow’s environment.

Dr. Kamyar, SDCMS-CMA member since 2012, is an entrepreneur-in-residence at the Rady School of Management working to define and develop the new health sciences program, which addresses the challenges of integrating the complex, evolving field of health sciences with the rapidly changing world of technology, business, and public policy.

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Leadership and Innovation in Health Sciences Today’s physcians - whether in practice, discovery or administration - face the challenge of integrating the complex, evolving field of medicine with the rapidly changing world of business and public policy.

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Brad M. Pruitt, M.D., Rady MBA ‘11

www.rady.ucsd.edu/mba May 2012 SAN DIEGO PHYSICIAN.org 13

Healthcare Technology

The San Diego Beacon Health Information Exchange Delivering Higher Quality Care, Reducing Unnecessary Repeat Tests and Procedures, Lowering the Risk of Potential Medical Errors

by Anupam Goel, MD, MBA, Theodore (Ted) Chan, MD, and Deborah Taheri, MBA

14 SAN DIEGO PHYSICIAN.org May 2012

The San Diego Beacon Community (SDBC) is one of 17 communities nationwide chosen by the Office of the National Coordinator for Health Information Technology (ONC) to demonstrate how information technology could measurably improve the health of a population. The ONC awarded SDBC $15.3 million to be spent over three years to achieve three specific aims: 1. build and strengthen health information technology (HIT) infrastructure and information exchange capabilities to pursue sustainable healthcare quality and efficiency; 2. translate health IT investments into measurable improvements in quality, population health, and cost; 3. test innovative approaches to improve healthcare delivery, technology integration, and performance measurement.

SDBC’s major HIT investment is a community health information exchange (Exchange), which will link healthcare providers electronically. Once connected, authorized providers will be able to access a patient’s health records from other participating providers and organizations.

The shared records will include diagnoses, medications, allergies, lab test results, radiology results, and provider notes. In addition, SDBC will have the capability to notify primary care providers about their patients who have been seen in an emergency room or discharged from a participating inpatient facility. In essence, the patient’s medical record will follow them regardless of where they received care in San Diego. With access to more patient information, providers will be able to deliver higher quality care, reduce unnecessary repeat tests and procedures, and lower the risk of potential medical errors.

It is important to note that the SDBC Exchange is built on a federated model where no clinical information will be stored outside a provider organization’s record. Instead, when outside providers are caring for a patient, they will be able to access records from other organizations at that time via a query-retrieval exchange model. Moreover, electronic data will be exchanged only with the highest standards for security and privacy. In fact, the SDBC Exchange has been certified as meeting the requirements for the federal Nationwide Health Information Network, and has also been sanctioned

by the state’s California Office of Health Information Integrity.

Medical centers, community clinics, medical groups, and independent providers have been engaged to connect at various levels ranging from full patient data exchange to view-only access. As of March 2012, the UC San Diego Health System and the VA San Diego Healthcare System are sharing information on the Exchange.

Kaiser Permanente Southern California and Rady Children’s Hospital San Diego are testing their connections with the Exchange and anticipate joining the exchange later this spring. Other providers and organizations are planning to join throughout 2012.

By the summer of 2012, SDBC expects to have more than 1.4 million patient records in San Diego County that could be accessed through the Exchange.

Other SDBC HIT investments include public health, emergency medical services, and monitoring cardiac devices. SDBC is connected to the County of San Diego’s Public Health Department to help providers and hospitals qualify for meaningful use.

SDBC is also connected to the San Diego Immunization Registry, both for meaningful use and to evaluate a texting intervention to new parents about their child’s upcoming immunizations. SDBC has helped coordinate the electronic transfer of electrocardiograms from ambulances to emergency rooms for more rapid and appropriate activation cardiac catheterization teams to treat suspected myocardial infarction. Finally, SDBC has been working with the implantable cardiac device companies to have patient device information shared through a provider-accessible interface on the Exchange.

For more information about the San Diego Beacon Community, please visit www.SanDiegoBeacon.org. If you would like the San Diego Beacon project team to come out to your medical group or provider organization to discuss the project in more detail, please email Jami Young at jjy018@ sandiegobeacon.org.

Dr. Goel, SDCMS-CMA member since 2011, is a board-certified internist with the UC San Diego Health System. Dr. Chan, SDCMSCMA member since 2005, is a board-certified emergency medicine physician with the UC San Diego Health System. Ms. Taheri is project manager at San Diego Beacon.

Provider Benefits of Participating in the San Diego Beacon Community: • Ability to access a patient’s electronic health information and medical record from other providers at the time of care to improve quality and reduce risk for errors.

• Notification about a patient’s discharge from an emergency room or inpatient facility.

• Connection to Public Health for Syndromic Surveillance reporting (meaningful use).

• Connection to the San Diego Immunization Registry for immunizations reporting (meaningful use).

• Connection to emergency medical services.

• Access to cardiac device information in the near future.

Organizations Participating in the San Diego Beacon Project: • American Medical Response • Children’s Primary Care Medical Group • Council of Community Clinics • County of San Diego Health and Human Services Agency • Hospital Association of San Diego and Imperial Counties • Kaiser Permanente • Naval Medical Center San Diego • Palomar Pomerado Health System • Rady Children’s Hospital San Diego • Rural/Metro Ambulance • San Diego County Medical Society • San Diego Fire-Rescue Department • San Diego Immunization Registry • Scripps Health • Sharp Community Medical Group • Sharp Healthcare • Tri-City Medical Center • UC San Diego Health System • VA San Diego Healthcare System

May 2012 SAN DIEGO PHYSICIAN.org 15

Healthcare Technology

16 SAN DIEGO PHYSICIAN.org May 2012

From Paper Charts to EHR/EMR

Two Common Problems and Useful Strategies for a Successful Transition By Ron Anderson, CPEHR, CPHIT “I’d never want to go through that again, but I never want to go back to paper charts.”

This comment is commonly heard about the transition to electronic health record/ electronic medical record systems. If you have already decided to make the transition, the process was (or currently is) very challenging at best, and an absolute disaster at worst. That said, there are ways to prepare and have a successful transition. In the past four years, we have implemented EHRs for more than 300 physicians in about 60 practices of various sizes and specialties.

Working side-by-side with the physicians, management, and staff, we’ve learned quite a bit and would like to share some lessons and tips with you.

Realizing the Importance of Change Management Mark Twain once said, “It’s not the progress I mind, it’s the change I don’t like.” In other words, “I don’t mind change, as long as it doesn’t include me.” Change management is often overlooked or underplayed as a key concern. There will be resistance — more with some than others — but it’s always a factor. Staff and physicians who are comfortable with how they go about their daily responsibilities and tasks are going to feel pressure about developing new skills, look-

ing incompetent in new skill sets, and, in some cases, losing status among peers, management, and physicians/leadership. There is pressure connected to new workflows, expectation of fewer errors, and for some the fear of losing their job due to an inability to adapt to or adopt new technology.

While there is no one-size-fits-all solution to dealing with change management, all practices must have strong management and leadership; all practices must be honest and fair in assessing their staff’s and physicians’ strengths and weaknesses so they know who will be able to lead and help others and the practice through the transition, and who will need more training and support along the way; and all practices must be open to leveraging younger or less experienced staff, since they are usually more comfortable with using technology in their daily lives while being less tied to established workflows. You might be surprised at who rises to the occasion and can work effectively with more experienced staff to design and create efficient processes.

Designing and Developing New Workflows Having worked with large and small offices in a wide range of specialties, I’ve found that one reality every practice should accept is that workflows will necessarily change.

Paper-chart-based workflows are inherently manual- and labor-intensive. Individual tasks such as completing chart notes or writing a sticky memo may be faster than entering or typing information into a computer screen or note form, but understand that optimum efficiencies and office productivity as a whole can only be realized if everyone accepts and utilizes the same basic workflows.

Include and expect participation and recommendations from your EHR/EMR software vendor or support organization because they should be familiar with optimizing use of the system. Depending on the size of your practice and staff, encourage — if not mandate — that all staff and providers participate, or at least be represented, in this transition. By including your entire staff, they will feel like part of the process instead of feeling dictated to or having this forced upon them. It’s vital that at least one physician be intimately involved in both the workflow and note form/template design.

The physician(s) must represent the needs of all the physicians. Without physician participation and buy-in in the long-term viability of the EHR/EMR implementation, usage will most surely fail or certainly be less successful.

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almost every person in the practice, including patients. This is the perfect time to think outside the box in creating new workflows. One valid concern with physicians is that they have to spend more time in the charting process. Beyond dealing with frustration, this can negatively affect productivity and, therefore, cashflow. It’s important to plan for this in advance and try to minimize it. One way to do this is to design the workflows so that as much data entry as possible is pushed down to the lowest-cost entity. The physician is at the top of the “time=money” pyramid; the bottom would be the patient. Think about ways physicians can do less and the nurses do more; the nurses do less and the front office does more; the front office does less and the patients do more.

Patients doing more means utilizing online forms, patient portals, or input devices in your practice so that patients complete demographic, medical history, chief complaint, and other information prior to the actual encounter, and then import the information instead of its being transcribed or entered by doctors, nurses, and/or staff. The technology is there, and most vendors have various ways to accomplish this.

Another suggestion is to implement EHR/EMR in phases, with the last phase being what happens in the exam room. This allows physicians and staff to become more familiar with using the software, devices, and technology in general in their daily tasks as opposed to wholesale changes throughout the practice overnight.

Another key factor in building

good workflows is to create lists of every document in the practice, those created and those coming into the practice from external sources. Create workflow maps that include the people and processes through which these documents flow. Include faxes, phone calls, emails, and all other communication in the practice. Using this visual tool, you can design efficient practice workflows.

There are many important aspects and considerations to take into account when approaching a significant transition such as from paper charts to EHR/EMR in a medical practice. These are just a few key aspects to think about if and when you make the leap.

We’ve learned a lot over the past four years implementing EHR/EMR for our clients, and we’re still learning every day as we work with different groups and as the technology continues to change. Be prepared, have strong management, expect participation from all stakeholders, and know you can succeed.

Mr. Anderson is a certified professional in electronic healthcare record and healthcare information technology (CPEHR, CPHIT), and has been involved in providing technology services and solutions to healthcare practices for more than 22 years. SDCMS-endorsed CHMB provides business and technology services for more than 3,500 physicians nationwide and is based in Escondido. CHMB has recently been selected by Scripps Health, Inc., to deploy and provide support for the Scripps Electronic Health Record Subsidy Program for its affiliated community physicians.

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Healthcare Technology

20 SAN DIEGO PHYSICIAN.org May 2012

How ‘Value-based Payment’ Impacts Housecall Medicine Part II of ‘An Overview of HIT in the Mobile Practice Venue’

By C. Gresham Bayne, MD Note: To read the complete article by Dr. Bayne, visit www.SDCMS.org.

At first blush, it would appear the new ACO movement is a boon for mobile providers, who solve the cost riddle for the high-cost patients. However, to paraphrase Einstein, “We should not look for solutions from those who caused the problems.” For years, CMS has refused to say it interferes with the practice of medicine while it created the episodic caps for home health, leading to a steady increase in readmission rates of 28% during the benefit period; the organization forced the HMO movement and made it unaccountable by passing ERISA in 1976, leading to cost shifting, no savings in population-based studies, and horrific stories of gatekeeping sick patients and cherrypicking of healthy patients. The net result: For the past decade, Medicare Advantage Plans have tripled the rate of inflation as compared to fee-for-service Medicare.

Why should the ACO movement be any different? One of the big claims, or hopes, is that the EMR movement will provide data integration at the point of care, allowing physicians to make better (meaning more cost-effective) decisions. Presently, little data supports this outside of staff-model HMOs like Kaiser, or Integrated Delivery Networks like Geisenger or Intermountain Health plans. The recent CBO report cataloging the failure of all 15 major demonstrations to show savings despite significant upfront costs must give pause.

It is especially troublesome since little government attention has been paid to the unique bandwidth/connectivity problems faced by those of us treating the sickest patients in the low-cost environment of the home. The AAHCP was able to get an exemption from the eRX penalty for those

practicing in areas with limited Internet access (like everyone outside of wifi range for the most part). It would appear this applies to house-call practices; a typical day in the life of our call doctor physicians in San Diego (the so-called “Digital City”) involves 32 abrupt disconnects from the web without notice. More than half of our housecalls are made when bandwidth measured dynamically (www.speedtest.net) is less than 500k/sec.

Through our experiences with Janus Health, which provides noncertified (you can’t perform eRx when offline) EMR and all communications and charting activities, we have learned that house-call practices can average up to 10MB/house-call in data creation. It is important to note that most of the data creation in house-call practices is uploaded to the web to get to an officebased server or the cloud. The Internet was designed primarily to DOWNload information (think games and movies) for entertainment. With three media companies accounting for 67% of web traffic, and one (Netflix) responsible for two-thirds of that, it is easy to see why mobile clinicians taking care of the highest-cost, most complex patients are having problems with their software. To compound the problem, the ARRA bonuses for meaningful use are still restricted to EMRs that cannot provide safe functionality without a fiber-optic cable.

The future for mobile care is clear: dramatic increases in services for the home or workplace to reduce costs, promote wellness, and increase access to care for the complex, homebound elderly and disabled.

This means we must address immediately the issues of bandwidth we face going forward. If you think you are having “connectile dysfunction” now, just wait until next year when the standard of care becomes

DNA-based treatment decisions. We must begin assessing metrics to report on our house-call practices that answer questions that have never been asked before, for example: 1. How long after a doctor orders a portable X-ray is it being looked at by someone with the authority to make quality and cost-effective decisions?

2. When a clinician orders oxygen, how long is it before a patient takes a breath with it? Where did the delay occur and how do we measure it?

3. Why send a clinician out on a house call to assess oxygenation? Shouldn’t the %sat be streaming online to any qualified observer as soon as that breath is taken?

4. When urgent patient calls come in, how do we find the closest appropriate mobile provider and know they are available to be dispatched to evaluate the urgent condition (as has been done for two decades in France through the SAMU system, analogous to our 911 system, but with doctors in the ambulances when necessary).

Clearly, a new day is dawning, but my biggest concern is that few people are aware of how fast this will happen, due to the national fiscal crisis and clear-cut CMS financial requirements. As HHS’ chief technology officer, Todd Park, has said, “There is no money to do this … we have to find growth capital out of savings in better systems using technology.”

Dr. Bayne, SDCMS-CMA member since 2003, is founder of Call Doctor Medical Group (1984), chief medical officer of NantHealth, senior medical advisor to Inspiris, a division of Optum Health, and chief medical officer of SIMNSA International.

May 2012 SAN DIEGO PHYSICIAN.org 21

Healthcare Technology

San Diego Blood Bank ‘Moves to the Future’ at New Headquarters To Support Expansion As Blood Services and Technology Evolve Over Next Several Decades

By Rosemarie Marshall Johnson, MD Lives depend on donated blood. Lives like 5-year-old Brianna Johnson’s of Rancho Peñasquitos, who has sickle cell anemia, 7-year-old Aidan Good’s of Imperial Beach, who needed a heart transplant, and 3-yearold Angel Caloca’s of Encanto, who has leukemia. Recently, when I donated blood at the San Diego Blood Bank’s new headquarters, I learned about these young patients and the hundreds of other area residents who rely on blood transfusions to survive.

My donation process was simple, involving four steps and only an hour of my time: 1. Registration: Valid identification such as a driver’s license or student picture ID is needed. You will also be asked for your name, address, phone number, and the last four digits of your Social Security number (optional).

2. Medical History and Mini-physical: A medical interviewer will ask you a series of confidential medical questions to determine your eligibility to donate. Then, your temperature, pulse, blood pressure, and iron level will be checked. Low iron is the most common cause of blood donor deferral.

3. The Blood Donation: A nurse will cleanse and sterilize your arm before inserting a needle that will cause a slight, momentary sting. The needle is sterile, used only for your donation, then disposed. After five to

seven minutes, you will have given a lifesaving pint of blood for a patient in need.

4. Rest and Refreshments: Relax and enjoy fruit juice and assorted snacks for 15 minutes.

I learned that processing my blood after donation was when things became both complex and fascinating, especially in the new state-of-the-art building. With more than double the space of the previous facility, the staff is able to employ optimum lean principles and streamline complex processes to make various blood components, filter out white blood cells, and freeze plasma and cryoprecipitate.

The Blood Bank, which used to be located in a four-story building in Hillcrest, urgently needed a new headquarters to more efficiently manage its operations and to be prepared for the future of life-sustaining blood and tissue donations from and for our diverse community.

Over the past 30 years, the Blood Bank has experienced incredible growth due to the increased need to be self-sufficient in providing blood for a variety of lifesaving medical procedures. When the previous headquarters opened in 1972, the Blood Bank had only one bloodmobile and collected fewer than 50,000 pints of blood per year. Today, the bank has 12 bloodmobiles and six donor centers that collect more than 120,000 donations each year.

The new building fulfills all of the needs

of today’s Blood Bank, including: • A large-scale, single site where blood is organized, processed, and distributed in an efficient, single-level assembly line.

Every other aspect of the safeguards involved in delivering vital blood products to the patient is benefitting from modern space planning, updated laboratories, and consolidation (including same-site bloodmobile, delivery vehicle, and supply storage).

• Expanded laboratory space to facilitate new pharmaceutical processes required for today’s transfusion medicine. In the past few years, blood processing has changed from simple testing to complex technological analysis*, thereby requiring more stringently controlled laboratory settings.

• An expanded cord blood facility to allow efficient processing of newly donated cord blood units as this program is re-launched in 2012 as the only nonprofit cord blood program in Southern California. This will allow the Blood Bank to provide more units for transplant and to utilize these stem cells for new breakthrough technologies. Having greater capacity to accommodate an active cord blood donor program will allow the 140 cord blood units transplanted to grow exponentially.

• Extensive space to accommodate future technologies, such as pathogen inactivation to guard against emergMay 2012 SAN DIEGO PHYSICIAN.org 23

Tests Done on Every Pint of Donated Blood:

• Blood Type: Blood is tested to determine the donor’s ABO group (A, B, O, AB) and Rh type (positive or negative). This is critical in selecting compatible blood for a patient in need of a transfusion.

• Hepatitis B Surface Antigen (HBsAg) and Core Antibody (anti-HBc): The hepatitis B virus has an inner core and an outer envelope (the surface). The HBsAg test detects the outer envelope or surface of the virus. The anti-HBc tests for the presence of antibodies to the inner core of the hepatitis B virus. In the absence of any other positive test for hepatitis B, the presence of antibodies to HBc suggests the individual may have had past exposure to the hepatitis B virus and it is unlikely he/ she is infectious.

• Hepatitis C Virus Antibody (anti-HCV) and Nucleic Acid Test (NAT): Two tests are done to detect hepatitis C infection. The anti-HCV test detects antibodies to the hepatitis C virus. A positive result suggests the donor has been exposed to the hepatitis C virus and may be infectious. The second test detects RNA, the genetic material, of the hepatitis C virus.

• Human T-Lymphotrophic Virus Type I and Type II (HTLV I/II) Antibody: HTLV I/ II testing detects antibody to the HTLV-I and HTLV-II viruses. These viruses are uncommon in the United States. HTLV-I has been associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-I is associated with myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-II has not been clearly associated with any diseases, but may lead to subtle abnormalities of the immune system.

• Syphilis Antibody: Syphilis tests detect the presence of an antibody to the organism Treponema pallidum that causes syphilis. This test has been performed on blood donors since shortly after World War II, when the rate of infection was much higher.

The risk of transmitting syphilis through a blood transfusion today is very small, since the rate of infection is low in blood donors and the organism causing syphilis is very fragile and unlikely to survive blood storage.

• Human Immunodeficiency Virus 2 (HIV-1/2) Combo Antibody and Nucleic Acid Amplification Testing (NAT): HIV-1 and/or HIV-2 virus cause acquired immunodeficiency syndrome, or AIDS. HIV-1 is more common in the United States, while HIV-2 is prevalent in Western Africa. Two tests are done for detecting HIV. One screens for antibodies to both HIV-1 and HIV-2 viruses. The other detects RNA, the genetic material, of the HIV-1 virus.

24 SAN DIEGO PHYSICIAN.org may May 2012

ing diseases and regenerative medicine associated with stem cell technologies.

The Blood Bank is poised to provide these techniques at the local level as they become available. Also, additional easily convertible space will accommodate future opportunities for collaborative and revenue-generating operations with other blood banking organizations and researchers/educators.

• Blood storage in more than one refrigeration unit, rather than the single refrigerator that held the entire community’s back-up supply in the old building.

• A welcoming, modern blood donation facility allowing the Blood Bank to improve the blood supply with easy access to and from all parts of its service area, and ample parking for donors, bloodmobiles, and blood delivery vehicles and employees.

All of this, of course, is costly. And, in today’s managed-care environment, the Blood Bank must operate on a very thin margin. For those reasons, a major gifts campaign is under way, in addition to a brick-and-tile campaign for the main entry of the new headquarters building. To find out more about contributing to our community’s blood bank, call (800) 469-7322 or log on to sandiegobloodbank.org.

On a final note, I was pleasantly surprised to learn that the San Diego Blood Bank, a nonprofit organization, was established through the support of the San Diego County Medical Society in 1950. It has never been cited with a consent decree from the FDA and has an excellent safety record. It is also locally governed and is the largest blood collection agency in San Diego County.* Dr. Johnson, retired SDCMS-CMA member and former SDCMS president, is the medical community liaison for the SDCMS Foundation’s Project Access San Diego. *In addition to the San Diego Blood Bank, there are a few other blood centers operating in San Diego County, including the American Red Cross Blood Services in Escondido, Naval Medical Center in Balboa Park, and Kaiser Permanente Blood Center in Allied Gardens.

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Healthcare Technology

26 SAN DIEGO PHYSICIAN.org May 2012

Leveraging Technology to Continually Improve Quality of Care UC San Diego Health System

By Angela L. Scioscia, MD and Joshua Lee, MD Adopting new health information technologies (IT) to advance operational, clinical, and research capabilities is a strategic priority for UC San Diego Health System. We are one of only 65 hospitals in the United States that has achieved Stage 7 of electronic medical record (EMR) adoption — a ranking devised by the Healthcare Information and Management Systems Society analytics group. Having reached this pinnacle not only allows us to operate in a paperless environment, but to measure, report, and continually improve our quality of care.

Our EMR system by EPIC gives physicians instant access to patient health information, regardless of whether the individual is being seen on an in- or outpatient basis. One component of our EMR is computerized physician order entry (CPOE). Through our integrated provider ordering and pharmacy system, physicians can securely enter a medication order online from any computer, and it is immediately sent to the pharmacy. In turn, orders generated in the pharmacy’s information system are populated in the orders, medication administration, and work list sections to facilitate the accurate delivery of medications to patients by nurses. What used to take hours before we adopted CPOE — more than a decade ago — now happens in just minutes.

CPOE is designed to reduce, if not eliminate, the possibility of medication errors due to illegible handwriting, transfer delays, and lost orders. When used effectively, it can improve quality of care, patient safety and efficiency, and result in more predictable therapeutic outcomes.

This summer, the proposed Stage 2 meaningful-use rules of the Electronic Health Record Incentive Program set forth

by the Centers for Medicare and Medicaid Services will raise the bar for healthcare providers on the use of CPOE. If approved, Stage 2 core objectives will require the use of CPOE for more than 60% of medication, lab, and radiology orders — compared to only 30% in the past. The focus of Stage 2 is quality improvement, whereas Stage 1 centered on adoption and implementation.

At UC San Diego Health System, 100% of all orders — medication, radiology, and lab — are now entered through CPOE. This allows us to have a reproducible track record of order management and clinical decision support that we can use to drive quality targets. Early on, through the use of thrombosis orders in CPOE, we demonstrated that greater than 90% of our inpatients had the appropriate clot prevention measures in place. One of our principles is to first understand how we can measure whether we have made a difference before we put forward orders or clinical decision support tools.

Our commitment to quality and patient safety was recently recognized as we were named one of the Leapfrog Group’s “Top Hospitals” partly for our CPOE efforts. As a Top Hospital, UC San Diego Health System fully met the standards for implementing CPOE. As part of this standard, physicians had to enter at least 75% of medication orders through a CPOE system, and demonstrate, via a test, that their inpatient CPOE system could alert them to at least 50% of common, serious prescribing errors.

On a broader scale, we use the EMR for its many other tools besides just order entry to improve the quality of care we deliver. We can pull aggregate clinical data and look at our performance to help guide our performance improvement efforts and initiatives.

This is increasingly important as organizations that evaluate us, such as University HealthSystem Consortium, The Joint Commission, and Hospital Compare will require electronic extracts for quality reporting.

We’ve built provider alerts about best practices into the care paths so that we can see which patients are due for health maintenance events, such as immunizations and mammograms. We can provide immediate feedback to our providers about the care they are delivering. With more than half a million visits per year in just our ambulatory setting, the EMR is essential to our preventive care efforts.

Using our EMR system, we can also conduct research that is part of our true mission as an academic health system: translational medicine at the bedside. Recently, we were engaged in a study to show the efficacy of giving smokers free packs of nicotine patches. Our EMR allowed us to integrate clinical research right into the workflow; it was seamless to the providers, fully compliant with research regulations, and immediately measured results.

Our EMR system provides a complete record and meets all of the regulatory standards of care, but, most importantly, it allows us to provide better care. As a datadriven organization at the forefront of IT, our goal has been to leverage IT, not just for the sake of technology, but to improve the quality of patient care, as well as the safety and efficiency of healthcare delivery.

Dr. Scioscia, SDCMS-CMA member since 2005, is chief medical officer at UC San Diego Health System. Dr. Lee, SDCMS-CMA member since 2010, is chief medical information officer and an associate professor of medicine at UC San Diego Health System.

May 2012 SAN DIEGO PHYSICIAN.org 27

Healthcare Technology

Healthcare Apps A Handful of Those Used

by Your SDCMS Colleagues

DocBookMD “Free communication tool for SDCMS member physicians. DocBookMD allows physicians to send X-rays, EKGs, and other patient information directly to their colleagues for quick consultations. Completely HIPAAcompliant, DocBookMD allows fast, secure, multimedia messaging between physicians to enhance patient care.”

Free to SDCMS members — available for download from iTunes and the Android Market.

To register your DocBookMD app once you’ve downloaded it, all you need is your SDCMS DocBookMD number. To get your number, contact Marisol Gonzalez, your SDCMS physician advocate, at MGonzalez@SDCMS.org or at (858) 300-2783.

heartsmart iglobal Designed by SDCMSCMA member Purushotham Kotha, MD, who specializes in internal medicine and cardiology, heartsmart is a unique global risk indicator app that calculates your risk of developing diabetes, heart disease, and stroke by using simple measures, your gender, and ethnicity.

Heartsmart iglobal includes three components: 1. The first discusses health risk factors and provides statistics about how often heart disease, stroke, and diabetes affect people around the world.

2. The second part is a risk calculator that has the user input data about themselves, including ethnicity, gender, waist size, blood pressure, age, smoking status, and family history of heart disease.

3. The third part offers information on what the user can do to improve his or her health, such as quitting smoking, exercising more, and losing weight. $0.99 — available for download from iTunes and the Android Market 28 SAN DIEGO PHYSICIAN.org May 2012

Epocrates “Get quick access to reliable drug, disease, and diagnostic information at the point of care.

Epocrates is the No. 1 mobile drug reference among U.S. physicians. Trusted for accurate content and innovative offerings, 50% of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency.” Free — available for download from iTunes and the Android Market

NEJM This Week “The latest medical research findings, review articles, and editorial opinion on a wide variety of topics of importance to biomedical science and clinical practice, from the most trusted name in medicine — The New England Journal of Medicine.”

Free — available for download from iTunes

mobilePDR for Prescribers “mobilePDR provides the most accurate FDAregulated information on more than 2,400 prescription drugs, and is free to all U.S.-based MDs, DOs, residents, NPs, and PAs. This latest update is based on the 2012 edition with additional features, enhanced functionality, and ongoing updates. mobilePDR contains full-label information on the most commonly prescribed drugs, hundreds of full-size and full-color photographs, and more.” Free — available for download from iTunes and the Android Market

PubMed On Tap (iTunes) / PubMed Mobile Pro (Android Market) “PubMed On Tap searches PubMed to find and display reference information.” $2.99 — available for download from iTunes and the Android Market

Accent “OvernightScribe.com is an online medical transcription service catering to U.S. healthcare providers.” Free — available for download from iTunes

Pocket Lab Values “The perfect companion for health professionals with access to more than 320 common and uncommon lab values.” $2.99 — available for download from iTunes and the Android Market

AO Surgery Reference “An online repository for surgical knowledge.

It describes the complete surgical management process from diagnosis to aftercare for all fractures of a given anatomical region, and also assembles relevant material that the AO has published before.” Free — available for download from iTunes and the Android Market

ORTHOSuperSite “From the publisher of Orthopedics Today, Orthopedics Today Europe, and Athletic Training and Sports Health Care, the ORTHOSuperSite mobile application puts news and perspective for the musculoskeletal health and disease specialist at your fingertips. Access daily breaking news articles, blog posts, and meeting highlights from around the world. Sort the news by most recent or most popular and share content with your colleagues.” Free — available for download from iTunes

Monster Anatomy — Lower Limb “An interactive lower limb radiology atlas presented at the 2009 Radiological Society of North America annual meeting.

The application was developed in the Medical Imaging Department of the University Hospital Center of Nancy, France, under the supervision of Professor Alain Blum.” $8.99 — Available for download from iTunes

CathSource “An up-to-date medical reference devoted to cardiac catheterization and angiography. Developed by practicing interventional cardiologists for both specialists and trainees in the field of cardiovascular disease.” $3.99 — available for download from iTunes

Acta Orthopedica Journal “Presents original articles of basic research interest, as well as clinical studies in the field of orthopaedics and related subdisciplines.”

Free — available for download from iTunes

Tarascon Pharmacopoeia “The most popular and most trusted portable drug reference. This musthave resource contains vital drug information on thousands of drugs to help clinicians make better decisions at the point of care.” $39.99 — available for download from iTunes and the Android Market

Psych Dx “Developed by a psychiatrist for mental health providers, from seasoned clinicians to students.

Psych Dx aims to be the reference of choice, a learning tool regularly updated with new features.” $5.99 — available for download from iTunes

Medscape “Medscape from WebMD is the leading medical resource most used by physicians, medical students, nurses, and other healthcare professionals for clinical information.” Free — available for download from iTunes and the Android Market

Vlingo — Voice App “In addition to search, messaging, voice dialing, and directions, Vlingo integrates with your Facebook and Twitter accounts, making it the most social assistant available.” Free — available for download from iTunes and the [ continued on page 36 ] Android Market May 2012 SAN DIEGO PHYSICIAN.org 29

Healthcare Technology

Information Services Scripps Health

By Patric R. Thomas, Corporate Vice President and Chief Information Officer, Scripps Health Information Services

30 SAN DIEGO PHYSICIAN.org May 2012

Scripps is committed to supporting physicians across the spectrum of practice styles, from large integrated groups to solo practices, hospital-based physicians to office-based primary care doctors. The 2,600 physicians who practice at Scripps represent every practice environment. To meet everyone’s needs, Scripps is investing in information technology that will connect physicians across the care continuum.

An ambulatory electronic health record is available to physicians in both the Scripps Medical Foundation and private practitioners, who can receive a subsidy from Scripps to help cover installation costs. At the same time, inpatient care is supported by an acute electronic medical record (EMR). These systems provide secure access to Scripps lab, images, dictations, EKG, and more to physicians from anywhere.

A health information exchange (HIE) will tie together information from all Scripps clinical data repositories to present a unified, easy-to-read patient summary and eventually connect to other HIEs in the community and nationwide. For practitioners without an EMR, the HIE will provide a simple, web-based location for a summary of all the information available on a patient in the Scripps environment. For those with an EMR, information can be downloaded and incorporated into their own EMR. Patient safety, quality, and population analyses are supported via barcode medication charting and electronic prescribing and an enterprise data warehouse.

Finally, in response to physician requests, Scripps is developing a clinical web portal to allow doctors to access information securely from anywhere, while also offering online collaboration tools. The new portal will extend current system access to mobile devices and allow for wireless patient monitoring.

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Looking for a way to give back to the community?

The San Diego County Medical Society Foundation’s (SDCMSF) mission is to address the unmet San Diego healthcare needs of all patients and physicians through innovation, education, and service. SDCMSF is proud to partner with volunteer specialty physicians and nearly 100 community clinics in the county who provide primary care services for the medically uninsured and underserved. These clinics have little to no access to specialty care for their patients and need your help!

Opportunities for Physicians 1

Volunteer for Project Access San Diego:

If you are a specialist in private practice in San Diego, please consider joining more than 180 specialists in the county by seeing a limited number of uninsured adult community clinic patients in your office for free. Project Access coordinates all aspects of care so your volunteerism is hassle-free for you and your office staff.

2

Volunteer for eConsultSD:

eConsultSD allows primary care physicians from the community clinics in San Diego to articulate a clinical question to a specialist and receive a timely response in a HIPAA-compliant, web-based portal. eConsultSD is an easy way for busy specialist physicians to give back to the community who are not able to provide direct patient care.

3

Obtain a Volunteer or Paid Position at a Local Community Clinic: SDCMSF is happy to connect specialist physicians with a community clinic that needs your services on site. This opportunity involves traveling to a clinic within San Diego County as your schedule permits.

4

Make a Contribution:

SDCMSF needs your support to care for the medically underserved in our community. Please consider making a contribution of any size to support the Foundation’s efforts.

Contributions can be made online at SDCMSF.org or sent to the San Diego County Medical Society Foundation at 5575 Ruffin Road, Suite 250, San Diego, CA 92123.

Thank you for your support!

Thank you for your dedication to the medically underserved. If you are interested in any of the opportunities above, please contact Lauren Banfe, resource development director, at (858) 565-7930 or at Lauren.Banfe@SDCMS.org.

The San Diego County Medical Society Foundation is a 501(c)3 organization (Tax ID # 95-2568714).

Please visit SDCMSF.org for more information. Telephone: (858) 300-2777 or Fax: (858) 569-1334

SDCMSF was formed as a separate 501(c)3 in 2004 by the San Diego County Medical Society.

32 S AN D I E G O P HY S I CI A N. or g 2012 A u gu st 2011 32 SAN DIEGO PHYSICIAN.org May

apri l 2012 SAN DIEGO PHYSICIAN.org 32

May 2012 SAN DIEGO PHYSICIAN.org 33

classifieds PRACTICE ANNOUNCEMENTS JENNIFER EASTLACK, MD, JOINS DEL MAR MED: Dr. Jennifer Eastlack, a board-certified dermatologist specializing in medical, surgical, and cosmetic disorders of the skin, hair, and nails, has joined a new practice. She is now seeing pediatric and adult patients with partners Dina Massry, MD, and Jeffrey Eaton, MD, at Del Mar MED in Carmel Valley. Her address is 12395 El Camino Real, #200, San Diego, CA 92130. (858) 481-3376. [020] PHYSICIAN POSITIONS AVAILABLE PSYCHIATRIST: San Ysidro Health Center, a Federally Qualified Health Center with nine medical clinics serving southern San Diego, is recruiting for a psychiatrist. Performs psychiatric assessments, medication management, and diagnostic evaluations of assigned mental health patients as ongoing patients or walk-ins. Qualifications: MD degree in medicine. Valid/current/unrestricted California license to practice for at least two years; board eligible/ board certified for adult psychiatry. Minimum one year internship in hospital. Extensive knowledge of local resources, community organizations, and entitlement programs.

Bilingual (Spanish/English) preferred but not required.

Send resume to euclidjobs@syhc.org. [033] PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR PART-TIME MEDICAL DOCTOR: Established and busy pain management practice in Mission Valley is looking for a physician assistant, nurse practitioner, or part-time medical doctor, preferably experienced in pain management or family practice. Knowledge of controlled substance prescriptions and regulations is required. Interpretation of diagnostic tests and the ability to apply skills involved in interdisciplinary pain management is necessary. We offer a competitive salary and benefit package that provides malpractice coverage, CME allowance, as well as an excellent professional growth potential. Please email your curriculum vitae/resume to sdpainclinic@yahoo.com. [39a] PRIMARY CARE/PSYCHIATRY JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com ) is a fastgrowing group of house-call doctors. Great pay ($140– $220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 279-1212 or email CV to hpmg11@ yahoo.com. [037] PHYSICIANS WANTED: Vista Community Clinic, a private, nonprofit clinic serving the communities of North San Diego County, has openings for part-time and per-diem positions. Five locations in Vista and Oceanside. Family medicine, OB/GYN medicine, pediatric medicine. Requirements: California license, DEA license, CPR, board certified, one (1) year post-graduate clinic experience. Bilingual English / Spanish preferred. Benefits: malpractice coverage. Email resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit website at www.vistacommunityclinic.org.

EOE/M/F/D/V [035] CLINICAL RESEARCH PHYSICIAN: Profil Institute for Clinical Research needs a clinical research physician.

Requirements: Three years MD experience in clinical research, hospital, family practice, or other related clinical environment in adult medicine. Unrestricted California MD license. Responsibilities: Serve as sub-investigator or principal investigator on studies. Perform medical histories, physical exams, admit, discharge, and monitor subjects, including reviewing labs results, EKGs, and telemetry as part of clinical research trials. Assess and manage adverse events and medical emergencies. Interested parties please apply online at profilinstitute. com under “News and Career Opportunities.” If you have further questions, please contact Robyn Nielsen, recruitment manager, at (619) 419-2048. [034] BOARD-CERTIFIED FAMILY PRACTICE PHYSICIAN NEEDED: To cover hours at busy urgent care/family practice office in Carlsbad. Nights and weekend coverage needed. Please Fax CV to (760) 603-7719 or email CV to gcwakeman@sbcglobal.net. [031]

PHYSICIAN WANTED: Physician wanted to assume a parttime practice by Paradise Valley Hospital from retiring physician who has been in the area for 35 years. Please email me at bpmedina@msn.com if you are interested. [029] GENERAL SURGEONS NEEDED IN SAN DIEGO: Sharp Rees-Stealy Medical Group, a 400+ physician multi-specialty group in San Diego, is seeking two well-rounded general surgeons to join our group. Competitive firstyear compensation guarantee, excellent benefits and shareholder eligibility after two years. Please send CV and letter of interest to: Lori Miller, 2001 4th Ave., San Diego, CA 92101. Fax: (619) 233-4730. Email: lori.miller@ sharp.com. [023]

idays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at venk@gpeds.sdcoxmail.com. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778] PRACTICE WANTED WE BUY URGENT CARE OR READY MED-CLINIC: We are interested in purchasing a preexisting urgent care or ready med-clinic anywhere in San Diego County. Please contact Lyda at (619) 417-9766. [008] OFFICE SPACE / REAL ESTATE

MEDICAL DIRECTOR — SUNNY SAN DIEGO: County Psychiatric Hospital needs a full-time medical director.

This is a key leadership role in our very physician-friendly, dynamic behavioral health system. Facility includes an inpatient unit and a very busy psychiatric emergency unit. County has partnered with UCSD to develop a community psychiatry fellowship, and teaching opportunities will be available, though the facility does not do research. Medical director does limited direct clinical care.

Required: Proven administrative, leadership, and supervisory skills, and a “big-picture” orientation to help us evolve our entire system. Salary competitive and excellent County employee benefit package. San Diego combines the lifestyle of a resort community and the amenities of a big city. Hospital centrally located, minutes from many recreational opportunities and great residential communities. Wonderful year-round weather, of course!

CV and letter of interest can be submitted online at www. sdcounty.ca.gov/hr. For questions, please contact Gloria Brown, human resources analyst, at (858) 505-6525 or at gloria.brown@sdcounty.ca.gov, or Darah Frondarina, human resources specialist, at (858) 505-6534 or at darah.frondarina@sdcounty.ca.gov. Questions and interest can also be directed to Marshall Lewis, MD, Behavioral Health Clinical Director, Health & Human Services Agency, at marshall.lewis@sdcounty.ca.gov. [021]

ENCINITAS OFFICE SPACE TO SUB-LEASE: North Coast Health Center, 477 El Camino Real, Encinitas.

Newly remodeled and beautiful office space available at the 477/D Bldg. Occupied by seasoned vascular and general surgeons. Great window views and location with all new equipment and furniture. New hardwood floors and exam tables. Full ultrasound lab and tech on site for extra convenience. Will sublease partial suite for two exam rooms and office work area or will consider subleasing the entire suite, totally furnished, if there is a larger group. Plenty of free parking. For More information, call Irene at (619) 840-2400 or (858) 452-0306. [041]

MEDICAL CONSULTANT — COUNTY OF SAN DIEGO: BC/BE internist/family practice physician sought for full-time employment with the County of San Diego, Edgemoor in long-term care at the 192-bed Santee facility. Compensation includes salary, bonuses for certifications, and on-call reimbursement, as well as medical, dental, vision, and retirement benefits. Seeking physician with superior interpersonal and clinical skills, attention to detail, comfortable working in teams to serve patients ages 18 and up with mental and physical disabilities. CV can be submitted online at www.sdcounty. ca.gov/hr. [015]

SCRIPPS HM POOLE BUILDING OFFICE SPACE AVAILABLE FOR SUBLEASE: One doctor’s office and use of three exam rooms, as well as the use of our conference room, are available for sublease in a newly updated and beautifully designed office in the HM Poole Building. A few feet away from Scripps Memorial Hospital. Terms are flexible, perfect for someone looking for a part-time presence on campus. Please contact Olga at (858) 909-9033 for more information. [040]

CHIEF MEDICAL OFFICER: San Ysidro Health Center, a Federally Qualified Health Center with nine medical clinics serving southern San Diego, is recruiting for a chief medical officer. Reports to the president/CEO. Partners with the board of directors, senior leadership, and all healthcare providers to ensure the highest quality of healthcare for patients. Provides clinical supervision of provider staff. Provides some direct patient care (80% administrative / 20% direct patient care). Qualifications: MD valid / current / unrestricted California medical license and BC; minimum 10 years professional experience in primary care setting; 10 years administrative and patient care management. Send resume to jobs@ syhc.org. [012] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides attentive support allowing you to focus on direct, quality patient care.

Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO delivery standby or rushing out in the night.

Benefits include tail-covered liability insurance, paid hol-

SCRIPPS ENCINITAS CONSULTATION ROOM/EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas.

Will be available a total of 10 half days per week. Located next to the Surgery Center.

Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703]

SCRIPPS / XIMED BUILDING, LA JOLLA OFFICE SPACE TO SUBLEASE: Currently occupied by one fulltime and three part-time physicians. One office available plus one exam room. Receptionist space available for your employee. For more information, contact Mary at (858) 457-3270. [975] LA JOLLA OFFICE SPACE: Share reception, waiting area, and exam/consultations rooms in brand new office. Four exam rooms. Office is close to Scripps Memorial Hospital. In Golden Triangle between 805 and 5 freeways. Terms negotiable. Please contact Kathy Koppinger at (858) 678-0455. [025] 1450 SQ. FT. OFFICE SPACE FOR LEASE IN LA MESA, NEW BUILDING, NEAR GROSSMONT HOSPITAL: Beautiful building recently completed at 5980 Severin Dr. in La Mesa. Off highways 8 and 125. Space includes handicap bathroom, new HVAC, upgraded electrical panel, tall ceilings, plenty of parking, very functional design and layout. Price is $1.50 per sq. ft., a very good rate for new construction. Call Nathan at (619) 787-3422 or email at hythams@att.net for further information or a private showing. [022] SPACE AVAILABLE FOR SUBLEASE IN A 1,850 SQFT FAMILY PRACTICE OFFICE IN ENCINITAS: Two furnished exam rooms. One doctor’s office furnished with computer — EMR available. One lab/procedure room to share. Please contact Jaleh Brunst at (858) 756-2340 or at jalehbrunst@mac.com. [019]

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

34 SAN DIEGO PHYSICIAN.org May 2012

2,142 SQ-FT OFFICE AVAILABLE FOR SHARING/ SUBLEASE: Currently occupied by cardiothoracic and vascular surgeons. Share partially furnished reception and waiting area. Three exam rooms furnished. One doctor office available. Terms negotiable. Please call Sonia at (619) 287-6003. [018] POWAY OFFICE SPACE AVAILABLE IN GATEWAY MEDICAL BUILDING, NEXT TO POMERADO HOSPITAL: Close to the 15 and 56. Large (18 ft. x 10.5 ft.) consult room with large windows, lots of natural light. Ample free parking. Rooms are soundproofed. Separate exit. Secure waiting room with large, comfortable seating. Kitchen with refrigerator, microwave, coffee maker, and toaster. Bathroom in suite. Utilities, high-speed internet included. Suite has new carpet, paint, and waiting room furniture upholstery. Days, evenings, and weekends available. Please email lisa@thinnertimes.com with inquiries. [013] LUXURIOUS / BEAUTIFULLY DECORATED DOCTOR’S OFFICE NEXT TO SHARP HOSPITAL FOR SUB-LEASE OR FULL LEASE: The office is conveniently located just at the opening of Highway 163 and Genesee Avenue. Lease price if very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc. Please contact Mia at (858) 279-8111 or at (619) 823-8111. Thank you. [836] NEW — EXTREMELY LOW RENTAL RATE INCENTIVE — EASTLAKE / RANCHO DEL REY: Two office/medical spaces for lease. From 1,004 to 1,381 SF available.

(Adjacent to shared X-ray room.) This building’s rental rate is marketed at $1.70/SF + NNN; however, landlord now offering first-year incentive of $0.50/SF + NNN for qualified tenants and five-year term. $2.00/SF tenant improvement allowance available. Well parked and well kept garden courtyard professional building with lush landscaping. Desirable location near major thoroughfares and walkable retail amenities. Please contact listing agents Joshua Smith, ECP Commercial, at (619) 442-9200, ext. 102. [006] POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467 sqft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease/satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at mzarei@cox.net. [873] TWO MONTHS FREE RENT: 1,215 SQ FT MEDICAL OFFICE NEXT TO POMERADO HOSPITAL: Office has furnished waiting area, front and back stations for four staff members, two exam rooms, a break room, private bathroom, and doctors’ office. Office is updated and ready for move in. Located in a great medical/dental complex in Poway, close to Pomerado Hospital, on the border with Rancho Bernardo. Second floor. Elevator/ stair access. Large, free patient parking area. Ideal for medical, complementary/alternative medicine, physical therapy, chiropractic, acupuncture, massage/body work, etc. Patients from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Rent is $1,300/month + NNN. Please contact Olga at (858) 485-8022. [980] OFFICE SPACE TO SHARE: Currently occupied by orthopedic surgeon. Great location close to Scripps/Mercy and UCSD Hospital. Looking to share with part-time or fulltime physician. Fully furnished, fully equipped with fluoro machine and four exam rooms, and staff. (NEGOTIABLE) Please contact Rowena at (619) 299-3950. [804] FULL-AND PART-TIME OFFICE SPACE IN UTC: with 8th floor view in suite with established psychologists and psychiatrists in Class A office building. Features include private entrance, staff room with kitchen facilities, active professional collegiality and informal consultation, private restroom, spacious penthouse exercise gym, storage closet with private lock in each office, soundproofing, common waiting room, and abundant parking.

Contact Christine Saroian, MD, at (619) 682-6912. [862]

trian walkway connected to parking lot of hospital, and ground floor access. Lease price: $1.75 +NNN. Tenant improvement allowance. For further information, please contact Lucia Shamshoian at (760) 931-1134 or at shamshoian@coveycommercial.com. [965] SHARE OFFICE SPACE IN LA MESA: Available immediately. 1,400 square feet available to an additional doctor on Grossmont Hospital Campus. Separate receptionist area, physician’s own private office, three exam rooms, and administrative area. Ideal for a practice compatible with OB/GYN. Call (619) 463-7775 or fax letter of interest to La Mesa OB/GYN at (619) 463-4181. [648] BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa/East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services. Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign. Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable.

Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building.

Medicare certified ambulatory surgery center next door.

Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@SDCMS.org for more information. [867] NONPHYSICIAN POSITIONS AVAILABLE PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR PART-TIME MEDICAL DOCTOR [39b] — See ad #39a under “Physician Positions Available.”

PHYSICIAN ASSISTANT: Physician assistant needed for house-call physician in Coachella Valley (Palm Springs / Palm Desert). Part time, flexible days/hours.

Competitive compensation. Call (619) 992-5330. [038] NURSE PRACTITIONER, FLOAT — SAN DIEGO NORTH COUNTY COASTAL: North County Health Services (NCHS) is looking for highly competent family practice nurse practitioners. Job Qualifications / Skills: Highly effective communication skills; desire and ability to work autonomously; enjoys the variety of working at NCHS’ multiple health centers; flexible (must be available to work during peak periods of the year); ability to relate to and work with people of all ages; ability to work independently and as a part of a team; comfortable treating patients of all ages. Experience: Minimum 3–5 years clinical experience preferred. Contact Araceli Mercado at fax (760) 736-8740 or at araceli.mercado@ nchs-health.org. [032] MEDICAL EQUIPMENT ALMOST NEW X-RAY PROCESSOR: The Hope Micro-Max processor is value-priced to ideally serve the moderate film developing needs of the private practice market, including medical clinics and diagnostic and chiropractic care centers, as well as mobile diagnostic applications. The back-to-basics features of the Hope Micro-Max processor are designed to deliver high output for its compact size. 110V, 60Hz, 14amp. Includes stand, hoses, and refill tanks. Works great and 1/3 the price of a new processor. Processing Capacity: 135 seconds equals 68 (10” x 12”) films/hour; 45 (14” x 17”) films/hour; 113 seconds equals 89 (10” x 12”) films/hour; 57 (14” x 17”) films/hour; 90 seconds equals 110 (10” x 12”) films/hour; 70 (14” x 17”) films/hour. Contact kathy.koppinger@ bonebuilders.com or (858) 354-5549. [016]

Increase Your Referral Business San Diego Physician is the only publication that is distributed to all 8,500 practicing physicians in San Diego County. Advertising is a cost-effective and profitable way to increase your referral business.

Contact Dari Pebdani at 858-231-1231 or at DPebdani@sdcms.org

3998 VISTA WAY, IN OCEANSIDE: Two medical office spaces approximately 2,000 sq. ft. available for lease. Close proximity to Tri-City Hospital with pedes-

May 2012 SAN DIEGO PHYSICIAN.org 35

Healthcare Technology

Healthcare Apps

A Handful of Those Used by Your SDCMS Colleagues [ continued from page 29 ]

DG Apps “Brings the best of the world of medical apps to the physician or healthcare professional. Focused 100% on professional practice (rather than apps for the general public), it saves time and keeps users up-to-date with apps of most interest to their particular specialty area(s).” Free — available for download from iTunes

Scoligauge “An accelerometerbased ‘Scoliomoter.’

Scoliogauge brings this important screening tool to the iPhone.” $0.99 — available for download from iTunes

Monthly Prescribing Reference (MPR) “MPR provides concise prescription and OTC drug information, side effects, and interactions for medical professionals.” Free — available for download from iTunes and the Android Market

DSM Search “Enables psychiatrists to quickly look up DSM codes.” $2.99 — available for download from iTunes

36 SAN DIEGO PHYSICIAN.org May 2012

NeuroMind “One of the highest ranked neurosurgical apps in the world, twice mentioned on iMedicalApps’ ‘Top Apps’ and more than …”

Free — available for download from iTunes and the Android Market

MedPage Today Mobile “Puts breaking medical news, comprehensive drug information, and CME/CE credits at your fingertips ….” Free — available for download from iTunes and the Android Market

Dragon Medical Mobile Recorder “For clinicians authorized to use Dragon Medical Mobile Recorder with Nuance Healthcare’s background speech solutions.” Free — available for download from iTunes

STAT ICD-9 LITE “What is the code for hypertensive heart disease with CHF?” Free — available for download from iTunes

Pocket Eye Exam AAOS Now “Monthly news magazine of the American Academy of Orthopedic Surgeons, ….” Free — available for download from iTunes and the Android Market

AAOS Orthopaedic CodeX X-Lite 2012 “Built-in companion for immediate, onto-go coding.” Free — available for download from iTunes and the Android Market

HandFeed “RSS-based abstract collection from peerreviewed journals and other web-based media sources regarding hand surgery and affiliated professions.” $0.99 — available for download from iTunes and the Android Market

“Mobile tool for neuroophthalmalogists, neurologists, optometrists, medical students and residents, and anyone interested in brain-eye interaction. Developed and tested by biomedical engineering undergraduates and neurologists (among them, Amy Guzik, MD, SDCMS-CMA member since 2011) at the University of Virginia, this application includes an OKN strip, pupil chart, Snellen (visual acuity) chart, red desaturation test, and Ishihara plates, as well as extensive educational material for these tests, the ophthalmoscope and the Maddox Rod.” $1.99 — available for download from iTunes and the Android Market

We Celebrate Excellence – James Strebig, MD CAP member, internal medicine physician, and former President of the Orange County Medical Association.

800-252-7706 www.CAPphysicians.com San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For 35 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like Irvine internal medicine specialist James Strebig, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best.

We invite you to join the more than 11,500 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

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mayapri 2011 SAN DIEGO P HY SICIA N. o rg 37 l 2012 SAN DIEGO PHYSICIAN.org

$5.95 | www.SANDIEGOPHYSICIAN.org PRSRT STD U.S. POSTAGE PAID DENVER, CO PERMIT NO. 5377

San diego County Medical Society 5575 RUFFIN ROAD, SUITE 250 SAN DIEGO, CA 92123 [ RETURN SERVICE REQUESTED ]

How did

we make a great partnership even greater?

With savings of up to

22

%.

The Doctors Company and the San Diego County Medical Society have a long history together. Now we’ve teamed up through an exclusive endorsement to offer SDCMS members savings of up to 22 percent on workers’ compensation insurance and 5 percent on medical malpractice insurance. Call the experts at The Doctors Company Insurance Services today to see how many hundreds—even thousands—of dollars SDCMS members can save on coverage tailored to cover the unique risks of each medical practice.

Call (800) 852-8872 for a SDCMS member customized quote.

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Medical Malpractice Workers Compensation Health and Disability Property and General Liability

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Employment Practices Liability Directors and Officers/Management Liability Errors and Omissions Liability Billing Errors and Omissions Liability

Exclusively Endorsed by

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License#: 0677182