Innovation in Health Care 2012

Innovation in

HEALTH CARE JUNE 2012

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Your healthy future starts here

rom the Cascade Mountains to the Coast Range, innovation continues to be a driving force in the mid-valley’s health care.

And it’s innovation that’s engaging consumers and providers alike.

It includes the medical students just wrapping up their first year at Western University’s College of Osteopathic Medicine of the Pacific-Northwest as well as longtime veterans of the health care field, working to help create a Coordinated Care Organization to serve the mid-valley’s Oregon Health Care patients — an effort which could point the way to far-reaching reform of our entire health care system.

It’s innovation that includes researchers

and students working to find ways to encourage more physical activity among elementary school students. It’s innovation that could help to open new vistas for videoconferencing, with plenty of opportunities to expand doctor training and patient care. It’s innovation that has made handwritten prescriptions a thing of the past.

In this section, you’ll also read about individual innovators: The medical students who are thinking about ways to improve community health, both locally and globally. The medical director who’s been working on electronic medical records systems for two decades and now can see what a revolution these systems could ignite.

ILLUSTRATION BY PAMELA J. SIRIANNI | CORVALLIS GAZETTE-TIMES

The researcher who thinks he and his colleagues might have found a way to stop wisdom teeth from becoming such a literal pain. And the artist who’s finding ways to connect the dots between the arts and healing, a bridge between body and soul.

It’s all innovation that’s going on right here, in the mid-valley – and this section (a sequel to a similar section we did last year) barely scratches the surface of what’s going on. It’s an explosion of new thinking, new concepts, new processes.

Turn the page to begin reading about these innovators, people determined to leave their mark on our health care system by finding new ways to help us lead healthier lives.

Innovation in Health Care

June 2012 Mid-Valley Newspapers

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ANDY CRIPE

Kelley Kaiser, left, and Mitchell Anderson are working to get to the mid-valley’s first Coordinated Care Organization up and running by Aug. 1

Health care collaboration Spotlight on Coordinated Care Organizations: System overhaul brings team approach to services ou can forgive Mitchell Anderson and Kelley Kaiser these days if they seem to be more in a hurry than usual.

Anderson, the director of the Benton County Health Department, and Kaiser, chief executive officer of Samaritan Health Plans, are working overtime these days: They’re among the key players working to get to the mid-valley’s first Coordinated Care Organization up and running by Aug. 1.

Coordinated Care Organizations — everyone calls them by their acronym, CCOs — are the centerpiece of Oregon’s billion-dollar bet that it can save money and provide better health care to patients (initially, the state’s Oregon Health Plan or Medicaid patients) through a coordinated effort that involves care providers, hospitals, health care plans and other stakeholders.

The benefits offered by the Oregon Health Plan will not change. But the idea is that the CCOs will use patient-centered and team-focused models of delivering health care services, with an emphasis on prevention, chronic illness management and person-centered care. State officials hope that through greater coordination between providers, the CCOs will get not just better results in terms of care but more efficient results as well, resulting in a savings.

In an interview conducted on Friday, June 1 at the Corvallis Gazette-Times, Anderson and Kaiser talked about their work, their hopes for the local CCO (which encompasses Benton, Linn and Lincoln counties), and the fast-paced timetable which they and their colleagues are working against as they try to pull the pieces together. (This is just a small portion of the interview; for the full version, refer to the online version of this story at the newspapers’ websites.)

Because the Benton County Health Department has been experimenting with the socalled “medical home” approach that will be used in the CCOs, that provided the starting point for the interview:

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Mid-Valley Media: In the medical home approach, a patient gets to work with a team of providers who are focused on the patient’s wellness. That idea is part of the philosophy behind the CCO, but it’s a mistake to think that the medical home and the CCO are the same things, right?

Mitchell Anderson: (The medical home is) not a CCO. ... The CCO is different than that; it’s more like an organizing entity that is supposed to be the catalyst to create more

person-centered care homes. ... It’s the framework, as it’s supposed to provide an innovative funding mechanism that promotes change in the health care system and a coordinating function that gets what have been independent practices and services across the whole spectrum of health and social services to work together. ...

(The idea) is to look at a much broader range of conditions and issues faced by the person who’s coming in for care, and seeing that many things other than what they’re in there for affect their health. .... How can we provide care that promotes health and doesn’t just fix what they came in for that day?

Mid-Valley: But if the Health Department and other providers are working with that model, why is the CCO needed?

Kelley Kaiser: (The CCO program) is really focused on Medicaid (patients) right now , the Oregon Health Plan population. ... Right now, in the Oregon Health Plan, your mental health, physical health and dental health are provided by three different plans. So the overarching goal of the CCO is to say that (instead of those three plans), you’re going to have one funding and coordinating stream that takes care of that person. So the goal would be better coordination, better integration and then, innovation. ... We need to do things better and differently and more around the patient.

Mid-Valley: Are there other advantages for a patient in this approach?

Kaiser: Hopefully ... what you get is one-stop shopping. So not only is it more coordinated, which is one really important thing, but eventually, hopefully, you go in and there’s a mental health worker, a behaviorist, there’s a navigator, there’s a pharmacist. So you get (a chance to say to a patient), “Kelley, I saw you today and I noticed that you’re having trouble coping when this happens. We have behaviorists down the hall, maybe you can spend a few minutes with them just so in case that issue comes up, they can give you some tools on how to cope with that next time.”

So instead of saying, “Here’s a card, go call Joe Smith and see if you can get an appointment,” it’s a warm handoff, and you’re right then hopefully taking care of things that will make a difference right away.

Mid-Valley: And in theory, that warm handoff helps take care of these issues before they become more serious, which leads to some of the efficiencies that you have to gain in order for this to work.

Kaiser: Right.

AT A GLANCE Confused about some of these fundamental changes in Oregon health care? Here’s a glossary of some of the key phrases and words you’ll want to know: Coordinated Care Organizations (CCOs) are networks of all types of health care providers who have agreed to work together in their local communities for people who receive health care coverage under the Oregon Health Plan (Medicaid).

Oregon Health Plan: The Oregon Health Plan is Oregon’s state Medicaid program.

Medicaid: Medicaid is the U.S. health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states.

CMS: An acronym for the Center for Medicare and Medicaid Services, the federal administrator of both programs.

Collaborators in the local CCO include: Samaritan Health Plans, Samaritan Health Services, InterCommunity Health Plans, Benton County public health, mental health and addiction services, Lincoln County public health, mental health and addiction services, Linn County public health, mental health and addiction services, Accountable Behavioral Health Alliance, Mid Valley Behavioral Care Network, Oregon Cascades West Council of Governments, Capitol Dental Care, The Corvallis Clinic, Quality Care Associates, Samaritan Mental Health and Federally Qualified Health Centers of Benton, Lincoln and Linn counties.

Anderson: And ultimately what you’re looking at is having a system that’s monitoring somebody’s health, over time. ... A system that’s proactively intervening with that person, teaching them selfmanagement, helping them to stay healthy, so what you avoid is, “I need to go to the emergency room.

I let this go too long.” (The goal is to have fewer) of those incidents, which are some of the most costly in the system. ... The other piece is, I think, if you were to fast-forward a number of years ahead ... public health will play a stronger role ... (and we’re doing) better monitoring of the whole population in terms of the overall level of health. We can expand how public health can work in terms of policy and health promotion activities to help raise the bar in terms of the overall health of a community.

Mid-Valley: To increase wellness instead of just dealing with sickness.

Anderson: Right. And that ultimately comes back in terms of savings to the CCO. Kaiser: The key is population health. So that so-called “triple aim” (better health, better care and lower costs) is one of the key elements of federal reform and state reform. ... If you can do all of those pieces together, you have a healthier population.

Mid-Valley: Before we get off this area, from your perspective, Mitch, as someone who’s worked in public health, has that notion of wellness or community health tended to get short shrift in our health care system?

Anderson: Overall, I think it has.

It garners very little state support. It’s a very small piece of the overall health care system. ...

And so I don’t think it’s been valued for what it can do,

especially in terms of the healthpromotion aspects. ... (But) if you’re going to reduce the cost of health care, you’ve got to improve wellness, and you’ve got to have the mechanisms to do that on a population basis, because if people can only get wellness by going to the doctor, it’s an expensive system.

Mid-Valley: This whole process of creating the CCO is really coming down in a hurry, isn’t it? You’re working with a timetable that is measured now in weeks – Kaiser: Days. ... It’s moving very fast and everybody’s working to make it work.

Mid-Valley: And part of the reason why everyone’s moving so quickly is that you have these assumed savings – Kaiser: That are (included) in the current state budget.

Mid-Valley: So, overall, this is a huge opportunity to reshape the health-care system.

Kaiser: Yes. Mid-Valley: Are we trying to take it too fast? Do we run a risk of botching the experiment by trying to push it as quickly as we are?

Kaiser: Well, I think it certainly adds some challenges.

Mid-Valley: So, on Aug. 1, if you’re an Oregon Health Authority patient, what changes do you see?

Kaiser: Our goal is, you don’t see too many. So part of our planning committee has (adopted) really a “keep the lights on” approach.

Because our biggest concern was that on Aug. 1, members fall through the cracks.

Anderson: I think what we said was that, maybe initially, the first thing they’ll see is some

simplification. Instead of getting mailings from their dental plan, mailings from their mental health plan, mailings from their medical plan and cards for each one of them, they’ll get one card, one mailing.

Kaiser: And one phone number.

Now, we should be clear. Dental is included in this, but the law says dental (doesn’t) need to be included (until) January of 2014, so we are not including dental on Aug. 1. Not because we didn’t want to; we just wanted to focus on what we had in front of us and as soon as we get that going, we’ll then start (with dental).

Mid-Valley: Well, this has to be exhilarating and terrifying, considering the amount of work and the speed with which it has to be implemented. Is that a fair way to describe this, exhilaration and terror in equal measure?

Anderson: I kind of think so. (But) when I look at the alternatives, I think this is still the best one.

Probably the worst thing that could have happened was (having someone at the state level) saying, “This is the way the system is going to work” (for every CCO).

And then we’re reeling, trying to adjust to something that we’re not sure we have buy-in for, and it’s not going to fit our region, things like that. So the ability to control our destiny to some degree in terms of how we’re going to create this in a region, it’s great.

Kaiser: It’s exciting.

Anderson: It’s fun to be on the front edge and be able to take what you know and what you’ve learned and try to move it into a system that’s going to work differently and work better. But, yeah, it’s scary at the same time, because there’s nothing to fall back on.

Kaiser: It’s “Where’s your business plan?” and it’s a little vague. Because you’re really at the mercy, at this point, of the state. Once we get the (budget numbers from the state), then the state has empowered us to take our pot and as a CCO, within certain guidelines, be creative and innovative and make sure we take care of everybody. But we haven’t quite got to that part yet.

We’re still trying to figure out what our foundation is so then we can figure out the best way to build it, so to speak, and that should be fun.

Mid-Valley: And the idea is that you take the amount of money allocated to you by the state in a lump sum and you provide those services for that amount of money.

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Innovation in Health Care

June 2012 Mid-Valley Newspapers

DVD aims to boost exercise

CCO: Partnerships Continued from front page Kaiser: And if we spend more, we as the CCO find that (extra money). And if by some miracle we spend less, we as the CCO retain that, so it truly is a budget.

Mid-Valley: But if you spend less, if you deliver these services more efficiently, that gives you one of the incentives to look for collaborations, and look for those partnerships.

Plan puts physical activity in the classroom

Kaiser: (And that would give us) some dollars to be innovative and creative and to reach out.

BY MIKE MCINALLY

Even as budget woes and other constraints force Oregon schools to cut back on their physical education classes, Simone Frei is working on a plan to get physical activity back into the classroom — a few minutes at a time.

Frei directs the Healthy Youth Program at Oregon State University’s Linus Pauling Institute. She and her students are working on a trial program to develop a DVD that classroom teachers could use to get their students up and moving right there in the classroom.

The idea is to give teachers a convenient and easy way to work some physical activity into the school day — potentially a boon for school districts that find it increasingly hard to find the time and money for PE classes.

“There is such an emphasis” on traditional academic work in schools today, she said. “Teachers are really stressed out.

Even if there might be money to offer more PE classes, I’m not sure they would do that.”

At the same time, though, school districts are facing a mandate from the state to add 30 minutes of PE activities to the school day by 2017 — despite a shortage of not just money but gym space as well.

All the more reason, Frei figured, to develop a DVD that could help teachers put structured

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ANDY CRIPE

Mid-Valley: Do you have any idea how many patients are going to be affected in the three counties who are going to be initially affected on Aug. 1?

Simone Frei, who directs the Healthy Youth Program at Oregon State University’s Linus Pauling Institute, Kaiser: Probably about 35,000, is working on a trial program teachers could use in the classrooms to get their students more active. physical activities back into the classroom. The DVD, created with the help of OSU media and exercise students, includes five- to eight-minute segments that can be used at any time in the classroom.

It’s a project that’s right in line with the goals of the Healthy Youth Program and the Linus Pauling Institute, says Balz Frei, the institute’s director, even though the institute likely is better-known for its work on micronutrients and nutrition. (Balz Frei is married to Simone, but he does not supervise her.)

“The shift in focus away from PE and nutrition is completely the wrong direction,” Balz Frei said.

“It’s devastating.“ Especially, he said, when you consider the growing problem of youth obesity — a problem that could result in huge health problems in terms of heart disease, diabetes and other ailments in 25 or 50 years as today’s chubby children grow into sickly adults.

“That’s what we’re trying to counteract,” Balz Frei said. “Diet and lifestyle and exercise are absolutely key to a healthy life and disease prevention. It’s hard to change

FOR MORE INFORMATION Teachers and school officials who are interested in learning more about the Healthy Youth Program’s exercise DVD can contact Simone Frei at Oregon State University’s Linus Pauling Institute. The phone number is 541-737-9377 and the email address is simone.frei@ oregonstate.edu.

that later on” — all the more reason, he said, to try to build strong habits in children.

Finding the barriers Simone Frei said she and her students surveyed teachers to see what they perceived as the barriers stopping them from including more physical education activities during the day. The common hurdles came as no surprise: Time and money.

But, she said, her work convinced her that teachers were looking for alternatives. “Teachers are really interested,” she said.

“They really do care, the majority of them.”

And the survey suggested that teachers would be interested in a product like the DVD — something that would be free and

wouldn’t take up too much class time. Encouraged, she and her colleagues moved ahead with the project.

Students went into classrooms to see what sort of activities were hits with students and which ones flopped.

The idea behind the video, Simone Frei said, is to make it easy for teachers to integrate the segments naturally into a class period. All the activities can be done inside a classroom.

Eventually, the DVD was shot in the studios at KBVR, the student-run television station at OSU. “This isn’t like a Hollywood production,” she said. “But it’s going to be well-done.”

And it does include some appearances by Beavers athletes — usually a good draw for the elementary students who are the DVD’s target audience.

Now, Frei is looking for classroom teachers who are willing to give the video a tryout.

“We just want to see, does it work?”

Mike McInally is the editor of the Corvallis Gazette-Times and the director of content for Mid-Valley Media. Reach him at 541-7589502 or mike.mcinally@gazette times.com.

the bulk of whom are in Linn County.

Mid-Valley: Are there other changes that those 35,000 people will notice in the months after August?

Kaiser: Well, hopefully, they would notice the beginnings of some better coordination, right? I mean, hopefully, even as we try to maintain and not let them fall through, just in the collaboration and coordination that we have already created in the last 15 months of meeting and talking and some committees that we’ve already got going, I would hope that they’re even maybe right now seeing some better coordination, maybe more peripherally at the beginning.

Anderson: I agree. I think the other thing that they will probably see more and will continue to see is more involvement. We’ve had a number of community forums and they’ll just continue to have more more opportunities for input, on what this looks like. We’ve just completed the first leg of the race, which was just getting the application in and getting a contract. We now have to get the budget amount, which then starts the second leg ... and then we have to design what this is going to look like. It’s interesting, because the greatest fears I hear expressed by people, some even (from) staff at the

Health Department, is, oh my gosh, the system is going to change Aug. 1 and there’s this idea that somebody has this grand plan and it’s all going to go into effect on Aug. 1.

Mid-Valley: And the grand plan becomes apparent to everyone when they walk in on Aug. 1.

Anderson: And, no.

Kaiser: No. Anderson: This is really going to be a developmental year.

Once we have the budget amount, then we can begin shaping what it looks like.

Kaiser: I think a really important piece that we haven’t talked about much is the community advisory committee, and maybe Mitch can talk about that, because that’s really an important piece. ... And, really, part of the whole reform or transformation ... is that the member is engaged and is part of it and the community is engaged and is part of it.

Anderson: There will be 19 members on the committee and it will be a regional committee across the three counties. But what we’ve decided is that each county (also) will have a home committee. Part of the reason for that is so we have more depth in terms of fingers out into the local communities.

What we didn’t want to see was a regional committee that just kind of boiled local issues down into a master regional list of issues. We want to keep the flavors of the local issues because these health issues are different in each of the communities.

Mid-Valley: Well, gosh. A lot of work, and not much time to pull it off, but the potential is huge.

Anderson: It’s a big experiment.

Kaiser: It is very exciting. It’s very exciting. It’s very overwhelming, but it is very exciting. Because the possibilities and the outcomes could really be impactful to peoples’ lives and our communities. And that part is very exciting.

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June 2012 Mid-Valley Newspapers

Medicine for the future Corvallis startup rolls out a software solution that lets patients and doctors connect in new ways

BY BENNETT HALL

In a private room at Samaritan Mental Health in Corvallis, third-year psychiatry resident Mandi Hudson is working with a patient while Dr. Michael May, the medical director of the regional mental health system, scrutinizes her every move.

But May’s presence is not a distraction for Hudson or her patient — in fact, he’s not even in the same room.

Using a new software program called Aptius, he’s observing the session on the desktop computer in his office down the hall. Twin video cameras and a microphone on Hudson’s laptop let May see and hear the interaction between psychiatrist and patient.

That’s not all. Using a live chat feature, he can send notes to Hudson about her performance in midsession. He can also tag portions of the live video feed — which is automatically recorded — so the resident can review them later.

“I can say things like ‘Good show of empathy’ or ‘This was an opportunity to go deeper into this issue,’” May said.

Is this the future of American medicine? May thinks it could be.

“As a tool for teaching, this goes way beyond anything else that’s out there.”

But Aptius, the brainchild of a Corvallis tech startup called Visionary Mobile, goes way beyond training residents. By

combining videoconferencing with additional information management tools, it allows patients and health care providers to connect in new ways that enable a host of potential applications.

Visonary Mobile has formed AMANDA COWAN a joint venture with Samaritan Health Services to test and re- Dr. Michael May uses the Aptius platform to observe Dr. Mandi Hudson during a psychotherapy session with a patient Friday fine its new medical communi- morning at Samaritan Regional Mental Health Center. A blue paper sticks to the computer monitor to protect the privacy of cations platform under real the patient. world conditions, and the partners say they’re discovering said. new uses for the technology “As we move into a reform everywhere they look. model, which is really a popula“We’re actually building a tion health-based model, these system that really works in a kinds of innovations are going to health care setting, and we can be really important.” optimize it” for a variety of Visionary Mobile has been specialized needs, Visionary courting other health care Mobile CEO Krishna Rao said. providers besides Samaritan, in“This isn’t just a video concluding Oregon Health & Science nection,” Rao added. “This is a University Hospital in Portland step above that.” and the University of Washing‘Unlimited’ applications ton Medical Center in Seattle, and a pair of Army medical offiIn addition to streaming cers recently visited Corvallis to voice and video, the technology see the system in action. allows health care providers to “There’s plenty of interest view a patient’s medical right now,” Mullins said. records, lab results, medication Other potential customers inlists, X-rays and other diagnostic images. Authorized users Visionary Mobile CEO Krishna Rao, left, and Samaritan Health Services presi- clude rural clinics, ambulance can modify records as appro- dent and CEO Larry Mullins talk about Visionary Mobile on May 23 at Good crews, nursing homes, indepriate and interact with other Samaritan Regional Medical Center. pendent medical practices and parts of the health care netthe regional accountable care orwork, ordering tests, adjusting Mullins said. “It’s kind of un- pects of the technology, in ganizations being rolled out unMullins’ view, is the financial savdrug dosages, making referrals limited, in my mind.” der federal health care legislaThe web-based product re- ings it can bring to bear across the and so forth. tion.

Samaritan Mental Health has quires no dedicated servers (it’s entire health care system. That “We’re doing something that been using Aptius for several hosted on multiple cloud will be crucial, he believes, to the is directly at the heart of health months, and the technology is servers for redundancy) and is success of reform measures being care reform,” Rao said. “We’re not now being rolled out in other intended to operate with any rolled out at the state and nation- going to just build something big parts of the Samaritan system, existing hardware, software al levels, which call for extending for the community. We’re going to including some hospital emer- and operating system, Rao said. coverage to more people while have an impact on health care naIt’s encrypted to federal privacy reducing costs at the same time. gency rooms, primary care tionally.”

“I think it’s going to provide clinics, and the hospice and standards for medical information, and operators can control for a much more optimal assess- Bennett Hall is the special projects editor home health departments.

“It’s going to have a lot of access levels for multiple users on ment of the patient, but it’s also for Mid-Valley Media. He can be contactgoing to be a more cost-effective ed at bennett.hall@gazettetimes.com or applications,” said Samaritan the same conference.

Health Services CEO Larry One of the most important as- way to provide care,” Mullins 541-758-9529.

Stopping wisdom teeth in their tracks Getting wisdom teeth removed is so common in the United States that it’s become almost a rite of passage to adulthood.

An estimated 10 million third molar tooth extractions each year account for more than 92 percent of all teeth removed from patients under the age of 40, according to a 2007 article in the American Journal of Public Health. This amounts to surgery on about 5 million people annually and more than $2.5 billion in costs to patients, not counting the additional costs of sedation, X-rays and post-operation expenses.

Surgery might be a must for patients who suffer from impacted molars, but many teenagers and early adults simply undergo the surgery to remove teeth on the advice that it will “eliminate more serious problems in later life,” a practice that draws mixed reviews from doctors.

“It’s a pretty involved surgery and it’s not without risks,” said medical researcher John Mata in an interview at his office at College of Osteopathic Medicine of the Pacific-Northwest in Lebanon on a recent afternoon. Mata has a very personal example: His own dentist broke a small chunk from Mata’s jaw when he underwent the surgery as a young man in Omaha, Neb. But, what if the need for all those surgeries could be prevented in the first place?

The third molars, known popularly as a set of “wisdom teeth” are notable in that they are the only set of teeth that start their growth after birth, and don’t emerge from under the gums until later in life. In fact, through about age 12 in humans, the tooth bud is not protected by a hard bony shell like the other teeth.

JOHN MATA, PH.D. Age: 51 Occupation: Associate professor at College of Osteopathic Medicine of the PacificMata Northwest and pharmacologist by training.

Why he’s an innovator: Mata’s research has focused on a wide variety of health issues ranging from cancer treatment (using peptides to find and target cancerous growths), to nutrition and community health. Currently, he is investigating a novel idea to halt the growth of wisdom teeth in children that, if successful, could lead to a new and less invasive treatment option for children at risk for third molar impaction and reduce the need for oral surgeries.

Why he’s innovating here: Mata says that the Willamette Valley is a great place to live for someone interested in nutritional research. A past job with AVI BioPharma in Corvallis was what initially brought him to Oregon from his home in the Midwest, where he attended the University of Nebraska Medical Center for his doctorate in medical sciences. He later did postdoctorate work in pharmaceutical science at Oregon State University mentored by Dr. Rosita Proteau. He lives in Corvallis and commutes to Lebanon where he teaches classes in fundamentals of pharmacology, anti-microbial therapy and anti-arthritic drugs.

Mata and a team are testing out a process called computed tomography guided microwave ablation.

In the process, a CT-scan is used to create a three-dimensional map of the jaw area. Using this guide, a probe about the size of a dentist’s water pick is

touched to the gum just above the targeted tooth bud. The probe delivers a small dose of microwave radiation – less than a cellphone emits. The idea is to cook the tooth bud enough to halt any further growth.

The possible benefits?

The process, when fully developed, is likely to be fast, relatively painless and less expensive compared to the traditional approach, Mata said. The hope is to someday use the procedure in children ages 6 to 12 to prevent the growth of wisdom teeth.

The study is still in the midst of animal trials using pigs, but the initial results are exciting, Mata said. So far, the small microwave burn has done just what researchers had hoped – halt tooth development with no noticeable side effects in swine at age 10 months (each month in a pig’s early development is roughly equivalent to a year of development in humans). The next step of the study is to continue work with a large animal internist. a dentist and a radiologist to perform the surgeries and monitor the pigs for long-term recovery.

Mata’s partners in the project include Leigh Colby from Oregon Dental Care in Eugene, who initially approached COMP-NW with the idea for the study; John Schlipf and Susanne Stieger-Vanegas, assistant professors at the College of Veterinary Medicine at Oregon State University; and Vickie Patel, an OSU predental student.

The first year of research was funded by a $20,000 grant from the Erkkila Foundation for Human Health and Performance and matching funds from Oregon Dental Care.

— Nancy Raskauskas

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Electronic records: Small steps, but moving forward

AMANDA COWAN

Mary Van Denend, arts care coordinator for the Arts Center, stands among a mosaic mural recently at the Good Samaritan Regional Medical Center rehabilitation center. The mosaic, which was a community art project, was created by arts care patients, members of the public and medical staff.

Program melds art and medicine Dialysis and cancer treatments are miserable, but in the mid-valley, The Arts Center in Corvallis created a program to bring beauty and healing to an uncomfortable necessity.

Mary Van Denend, ArtsCare coordinator for The Arts Center, has run the ArtsCare program for about eight years; the program brings artists and arts projects to Samaritan Health Services to work with patients.

ArtsCare is at Samaritan’s hospitals in Corvallis and Lebanon with a smaller version at Pacific Communities Hospital in Newport.

The program is just beginning at North Lincoln Hospital. The program provides 17 artists, including painters, poets, printmakers, potters, quilters and a variety of musicians, who do what Van Denend called a “delicate dance” to keep out of the way of nurses and technicians while providing opportunities to create art.

“Patients often are hooked up to dialysis machines,” Van Denend said, “so they do things like onehanded painting or collage.”

What happens, Van Denend said, is a total diver-

MARY VAN DENEND Age: Old enough (to be at The Arts Center for 13 years) Occupation: ArtsCare coordinator Why she’s an innovator: Van Denend brings arts to people in medical settings.

Why she’s innovating here: “It is satisfying and unique to be able to do this program in a small hospital and make such a big impact,”Van Denend said.

sion for a couple of hours while patients are there.

The art program also is offered to patients in oncology and mental health settings.

“They think of themselves in a different way for that time,” Van Denend said.

“They become artists and share stories about their lives.”

Visiting artists are able to be present in the hospitals in a way that nurses and technicians cannot and they operate at a slower pace, offering a calm and a different focus.

Van Denend said it is not uncommon for patients to be resistant at first to participating. Their situation is uncomfortable; it’s difficult for some of them to be hap-

py. But she has plenty of stories about patients who turn around completely in their demeanor and thoroughly enjoy the exercise.

“It is satisfying to make such a big impact,” Van Denend said.

In addition, musicians visit the hospitals and play instruments that entertain as well as soothe patients and staff.

“It’s all about building teamwork,” Van Denend said.

The art/hospital relationship began in 2004 when The Arts Center received a small grant from Johnson & Johnson to do some site beautification at Good Samaritan Regional Medical Center. Ceramic murals were created and a painting was done outside the cafeteria. Around the same time, Van Denend said, a group of local harpists in training needed to find opportunities to play to satisfy a requirement for an internship. It was arranged that they would play at the hospital.

“That was really the initiation of the program,” Van Denend said. In 2007, an official partnership was

formed between The Arts Center and the hospital, which provides the primary funding.

After branching out from its start in the medical center’s dialysis unit, ArtsCare today also operates in Samaritan’s cancer, mental health and heart and vascular units as well as at the Mario Pastega House. In North Albany, the program offers arts workshops in the cancer center and music in the lobby. Lebanon Community Hospital’s dialysis and infusion center also has arts workshops.

ArtsCare is not therapy and the artists are not therapists, although the work is therapeutic.

The Arts Center actively is seeking donors to support the ArtsCare program and is expanding into additional care facilities such as assisted living, senior centers and youth shelters.

– Maria Kirkpatrick

You get a postcard from the auto shop reminding you that your car is due for an oil change.

Now, imagine this: Nestled among the postcard in that day’s mail is a letter from your medical provider reminding you that you’re in need of maintenance work as well. You’re overdue for a colonoscopy.

It’s not at all inconceivable, said Dr. Dennis Regan, the new medical director at The Corvallis Clinic, and someone with decades of experience in trying to develop the kinds of electronic medical records system that eventually could make that letter possible.

“We know that saves lives,” he said about the medical procedure. “There’s no question about it.”

Electronic medical records have not yet advanced to the point where it’s easy to generate that kind of potentially lifesaving reminder letter. But we’re considerably closer than we were some two decades ago, when Regan first started working with electronic medical records during his previous job at The Billings Clinic in Montana.

He offers this example: It took the financial services industry decades to move from ATMs to the point where online banking was easy and secure.

“And banking is easy compared to health care,” he said.

But, he added, his sense is that the The Corvallis Clinic and other health institutions are nearing a tipping point where health care professionals and patients alike are going to really understand the potential of electronic medical records.

In terms of moving ahead with electronic records, he said, “The Corvallis Clinic has come in the space of the last 12 months what took me

DENNIS REGAN,M.D. Age: 55.

Occupation: Medical director, The Corvallis Clinic.

Why he’s an innovator: Before Regan taking his new job at The Corvallis Clinic, Regan spent 20 years at The Billings Clinic in Montana, where he helped lead the clinic’s transformation to electronic medical records.

Why he’s innovating here: “There’s just a lot of visionary, farsighted folks here who want to see things change.”

And his job at the clinic gives him the opportunity to evangelize for electronic medical records.

15 years at The Billings Clinic.”

And the prospect of socalled patient portals that allow consumers access to their own health records, could be hugely empowering for patients — and also could set the stage for a wave of disruptive technologies that will overhaul the health care landscape.

One quick example: an iPhone app that monitors blood-glucose levels.

Functioning electronic medical records systems will allow providers and patients to share information in a meaningful and timely fashion, Regan said.

And the data gathered by the systems should lead to improvements in the entire health care system: “What we do in medicine is handle data,” he said. “Taking care of somebody is a very datadriven enterprise.”

“I’m excited,” he said.

“Now we get to do the real work. Now we get to improve care rather than just put systems in place.”

— Mike McInally, Mid-Valley Media

Student club focuses on global community COMP-Northwest students promote global health awareness Meghan Aabo and Katherine Peters, students at the medical school in Lebanon, have a fresh twist on the old slogan about thinking globally and acting locally.

The students, leaders of COMP-Northwest’s Global Health Club, are thinking and acting — and they’re doing both on a local and global scale.

The mission of the club is to promote global health awareness and activities through an emphasis on the interdependence between the health of the globe and the health of people.

To accomplish this, Peters and Aabo have teamed up with a variety of community partners to connect medical students and the greater community.

“Community health is a big focus of ours, both locally and globally,” Aabo said. “Together with some outstanding members of our faculty, we are working on an assessment and intervention model to improve community health.”

The students will study community health in Lebanon, and in sites beyond the borders of the United States.

“This summer, a small team will begin investigation in a small coastal community in northern Peru to determine if it will be a good study site,” Aabo said.

All of the club’s activities are intended to increase health and nutrition awareness and community health.

For example, Peters and

Peters

Aabo

KATHERINE PETERS AND MEGHAN AABO Ages: Aabo is 31; Peters, 27 Occupation:Medical students at the College of Osteopathic Medicine of the Pacific-Northwest,a campus of Western University of Health Sciences.

Why they’re innovators: Peters and Aabo are leaders of COMP-Northwest’s Global Health Club.They don’t perceive themselves as innovators – but their advisors and others at the medical school disagree.

Why they’re innovating here: Their studies at the medical school, of course, brought them to Lebanon – but they’re interested in improving community health not just in the mid-valley but throughout the world.

Aabo organized two additional nights of care at the East Linn Community Clinic for uninsured people in need of health care. Students and clinical faculty operate the clinic on the first and third Wednesday of each month.

The students have worked with Planting Seeds of Change in the teaching gardens throughout the Lebanon Community School District, providing addition-

al nutrition education.

The pair can be seen every other week at the Downtown Farmers Market in Lebanon serving up freshly prepared meals from seasonal locally grown produce, in an effort to encourage seasonal eating, support of local farmers, and healthful eating.

Peters and Aabo are developing a series of health screenings with the Lebanon Soup Kitchen, to offer basic health exams to patrons of the kitchen.

“Good health is not something that someone else can do for you,” Peters said. “You won’t find it in the perfect combination of pills or medications, or in a magic new product. You find it in the way you live your daily life.”

To be innovators of your own health you must find a balance, she added.

“Eat a lot of fruits and veggies, get a little bit more exercise, watch a little bit less TV, and get involved with activities that you love,” Peters said.

Aabo added that knowledge is power.

“Our societal focus needs to shift to highlight wellness,” she said. “I hope that my colleagues and I can provide momentum toward that change where we practice.”

Communities and individuals should be able to look to health care providers for information that will help them lead more healthful lives, Aabo said.

– Emily Mentzer, Mid-Valley Media

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6

Innovation in Health Care

June 2012 Mid-Valley Newspapers

Embracing e-prescriptions

BY JENNIFER ROUSE

It used to be one of the most common aspects of going to the doctor’s office – when you walked out the door, chances are you held a little slip of paper in your hand with mysterious notations scribbled upon it and the all-important physician’s signature scrawled at the bottom.

But with the rise of eprescribing in the last five years, handwritten prescriptions have all but disappeared—and that’s a good thing, say both doctors and pharmacists.

“E-prescribing is safer than scribbling illegibly,” said Rod Aust, chief operations officer of The Corvallis Clinic. “There have been documented cases of errors caused by misread prescriptions.

This all but eliminates that.”

Here’s how it works: when your doctor sees you, she uses a computer to select the right medication and dosing information, then asks you where you’d like to pick up your prescription. That information is sent through an e-prescribing network — SureScripts is one commonly used by doctors in the midvalley. If you’ve been a patient before and your insurance and prescription history is on file with your doctor or pharmacy, the network will automatically check your prescription benefits and send up an alert if there are any potential interactions with medications you’re already taking. The prescription shows up in the pharmacy’s inbox, just like an email, and staff can begin working on filling it immediately.

T.J. Sinn, lead pharmacist at Elm Street Pharmacy, a Samaritan Health pharmacy in Albany, said the rise of e-prescriptions has reduced the amount of his day spent on the phone with clinics, double-checking on prescriptions he was unsure about.

AT A GLANCE • In 2001, the first e-prescribing networks were founded.

• By 2004, 4 percent of U.S. doctors used e-prescribing.

• By 2007, e-prescribing was legal in all 50 states and the District of Columbia.

• By 2009, the stimulus act passed by Congress provided $19 billion toward the adoption of health information technology such as e-prescribing.

• By 2011, 58 percent of office-based physicians were eprescribing.

• The number of e-prescribers in Oregon is 6,063.

• As of 2010, 91 percent of Oregon pharmacies used eprescribing. Oregon pharmacies are near the limit of the number that are likely to adopt e-prescribing, due to the specialized nature of the remaining holdouts; compounding pharmacies and veterinary pharmacies, for example.

• In 2008: 693,112 Oregon prescriptions were routed electronically.

• By 2010: 4,266,385 Oregon prescriptions were routed electronically.

Sources: Oregon Health Authority report, SureScripts National Progress Report on e-prescribing.

“Now you just have nice, clear, e-mailed prescriptions,” he said. “It’s a lot cleaner, and there’s a lot less chance of error.”

In fact, Dr. Brian Curtis, an internal medicine doctor with The Corvallis Clinic, pointed out that for most doctors, 100 percent of their prescriptions are now written electronically. Prescriptions for controlled substances are still required to have a physical signature.

And sometimes a patient may not be sure which pharmacy they want to take it to, and will request a printed prescription. But even in those situations, the medication information is still typed on the computer, then printed out.

“We don’t write on a pad,

DAVID PATTON

Pharmacist TJ Sinn works on the electronic prescription system recently at Elm Street Pharmacy in Albany. ever,” Curtis said.

Aust said that while The Corvallis Clinic still has supplies of prescription pads in case of a major computer crash or power outage, doctor’s offices have generators and back-up systems in place. In the four years since the clinic has switched to e-prescribing, it’s never had to return to hand-writing prescriptions, he said.

Period of adjustment It’s been an adjustment for some doctors and patients alike.

“The biggest thing was getting physicians to trust that when they push the button, it will go,” Aust said.

“There’s a comfort level with having that prescription pad in the pocket. And for patients, it can be weird to leave without something in their hand.”

But for the most part, the switch has been widely accepted. Sinn said that the majority of prescriptions pharmacies receive are now electronic, and Curtis said most of his patients love it.

The biggest trick for doctors, he said, is to balance personal contact with

their patients while simultaneously entering information into their computers.

“You want to keep that eye contact. You have to be careful you’re not looking at the screen the whole time,” he said. “For the most part, it’s been a very positive thing.”

Sinn said that the only problem for pharmacists is that physicians and patients are sometimes, in fact, too enthusiastic about the powers of the system. Patients sometimes expect that their medication will be ready for them when they get to the pharmacy, and that’s not always the case.

Sinn said that depending on traffic on the e-prescribing network, it could take 15-30 minutes from the time your doctor hits “send” before the prescription shows up in the pharmacy’s inbox. Then there’s the time required to dispense and label the drugs.

“It’s fast, but it’s not immediate,” he said. “We try to train both the doctors and the patients to understand that it’s not an instant thing.”

Behind the scenes Many of the advantages to using electronic prescriptions are behind-thescenes ones that patients don’t directly see — the process has improved record security and patient privacy, Aust said, because there are no longer reams of paper charts to track. Now, any time someone logs in to check patient information, it leaves a digital fingerprint. It’s easy to see who has been accessing data, and prevents unauthorized access, he said.

It’s also easier for doctors to track certain aspects of patient care over time, or to manage groups of patients.

“If there’s a recommendation that diabetic patients should be using a certain medication, I can do a search and see which of my patients are on it,” Curtis said. “If some are not, we can correct that more easily.”

Another way that the rise of e-prescribing has streamlined the process of receiving drugs is happening at local emergency rooms, where one prescription vending machine is already in use and others are

on their way.

The InstyMed machines, as they are called, are available for certain common antibiotics and painkillers.

They are not meant to replace human pharmacists, but simply to fill in the gaps during the hours when regular pharmacies are not open.

If you visit the emergency room late at night, the InstyMed machine allows you to get started on your medication that night instead of waiting until morning.

“This helps patients complete their ER experience,” said Penny Reher, chief pharmacy officer for Samaritan Health Services.

Prescriptions can only be ordered by an ER doctor, and patients receive their drugs with a nurse assisting them. Currently, the Good Samaritan Regional Medical Center is the only mid-valley location with the prescription vending machine, but the plan is to implement them at all Samaritan emergency rooms by the end of the year, Reher said.

Jennifer Rouse is a freelance writer who lives in Albany and a frequent contributor to Mid-Valley Media.

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