December
2013
Vol. 4 No. 8
a year in review An Aberdeen Provider Copes with Family Illness
Sponsorship
Marketing that Works
Avera Surgeons Innovate with Magnets
South Dakota and the Upper Midwest’s Magazine f or Physicians & H ealthcare Professionals
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Scott Pham, MD
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Midwest Medical Edition
Contents Volume 4, No. 8 ■ December 2013
Regular Features
By Alex Strauss
2 | From Us to You 3 | MED on the Web
What’s new exclusively on the MED website this month
6 | Meet a MED Contributor
Heather Taylor Boysen, Good Spirits Fine Wine & Liquor
8 | News & Notes News and announcements from around the region 22 | Case by Case
The case of a toddler who swallowed magnets inspires Avera surgeons to improvise a new technique
26 | The Nurses’ Station Local awards, SDNA Conference 28 | Grape Expectations
page
11
Chocolate and Wine . . . a Match Made in Heaven ■ By Heather Taylor Boysen
A year in
In This Issue 4 | 2013: A Building Year for 2014
■ By Dave Hewett
6 | Sponsorship Marketing That Works
■ By Tana Phelps Before you invest more dollars in sponsorship of community events, make sure you’re investing wisely and effectively
10 | SD Celebrates Improvement in Preterm Birthrate The state maintains a solid “B” on the national report card
18 | Celebrity Doctors: Doing No Harm? 19 | Bumps on the Road to Meaningful Use One Doctor’s Experience
20 | Too Close to Home An Aberdeen PA learns about oncology the hard way while dealing with the illness of her granddaughter
24 | Consumer Choice Awards for Area Hospitals 24 | Pearce Receives National Recognition Researcher honored for “moving the bar” in rare disease research
REVIEW
2013
We wrap up our publication year with a look back at the people, places, and issues making headlines this year, including notable cases, a new specialty, the area’s longest-running residency program, healthcare missions, medical homes, ergonomics, and the progress of EHRs. Got a suggestion for 2014? Let us know!
From Us to You
Staying in Touch with MED
E
very time we wrap up another year of
MED with our annual Year-in-Review issue, we are astounded by how quickly the year has gone by. Before we jump headlong into the next fastmoving year, we like to slow down for a moment and reflect on the issues and accomplishments of our medical community in the past year. Did you miss a mid-summer issue of MED while on vacation? Did the office staff swipe a copy before you’d read it? Here’s your chance to catch up. We hope that this wrap-up inspires you to make some suggestions for articles and topics you would like to see in these pages in 2014. Our door is always open. We welcome your suggestions, comments, letters, and article submissions. Finally, if you enjoy this publication, keep in mind that is it being brought to you – as it has always been – through the support of local businesses who value what you do. If you find yourself in need of their services or products this holiday season, please support their businesses in return, and thank them for being a part of MED. Thanks for your continued readership. Happy Holidays! —Alex and Steff
Publisher
MED Magazine, LLC Sioux Falls, South Dakota
VP Sales & Marketing Steffanie Liston-Holtrop Editor in Chief Alex Strauss Design/Art Direction Corbo Design Photographer Kristi Shanks Web Design Locable Contributing Editor Darrel Fickbohm Copy Editor Hannah Steck
Steffanie Liston-Holtrop
Contributing Writers
Staff Writers
Alex Strauss
Heather Boysen Dave Hewett Sarah McQuade Tana Phelps Liz Boyd Caroline Chenault John Knies
Contact Information Steffanie Liston-Holtrop, VP Sales & Marketing 605-366-1479 Steff@MidwestMedicalEdition.com Alex Strauss, Editor in Chief 605-759-3295 Alex@MidwestMedicalEdition.com Fax 605-271-5486 Mailing Address PO Box 90646 Sioux Falls, SD 57109 Website MidwestMedicalEdition.com
2014 Advertising / Editorial Deadlines Jan/Feb Issue December 5
June Issue May 5
Sep/Oct Issue August 5
March Issue February 5
July/ August Issue June 5
November Issue October 5
April/May Issue March 5
December Issue November 5
Reproduction or use of the contents of this magazine is prohibited.
MED is committed to focusing on pioneering physicians, institutions, programs, and technologies that are paving the way for the future of healthcare on the Great Plains. We are accepting suggestions for feature articles for 2014. If you know of a person or program that deserves a closer looks, we would love to hear from you. Send your ideas and submissions to Alex@MidwestMedicalEdition.com.
©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition.com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to steff@midwestmedicaledition.com. MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.
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Midwest Medical Edition
on the
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Now More than a Magazine, A Medical Community Hub
Enhance your MED experience! MED now offers continually updated news and calendar events on our website, as well as an expanding free directory of area practices and businesses. Below is some of what you’ll find exclusively online this month.
Log on Now! Online Directory
EXCLUSIVELY on the Web Is Your Practice Ready for Higher Deductibles?
Your Guide to Wine & Chocolate Pairings
The passage of the Affordable Care Act is expected to trigger higher deductibles for many patients. The practice management experts at Aqreva share insights on the problem of these higher deductibles and what your practice may need to do to avoid more bad debt.
Read the Interviews Read our interviews with PA Theresa Cameron and Dr. Jeffrey Johnson (Too Close to Home and Meaningful Use: One Doctor’s Experience).
If you enjoy MED Contributor Heather Taylor Boysen’s thoughts on chocolate and wine pairings and are curious to try some for yourself, find and print a PDF of her recommendations that will make this holiday shopping trip a whole lot easier.
Plus, Comment on articles you’ve read and suggest some you’d like to read. We welcome your suggestions on anything you see in the pages of MED or on our website.
Using MED’s online Directory, powered by Locable, you can find and connect with area businesses that cater to healthcare providers. It’s easy and free for businesses and providers to be included in the Directory. With ongoing updates to our business identity solution tools, we make it simple to get the most out of the constantly-changing online environment. Being a part of MED online allows you to engage the online community in new ways and put the web to work for your practice.
Online Calendar Our online Calendar feature makes it easy to find and share local events specifically for heathcare professionals, so you will never miss a meeting or course you wanted to attend. You can even list your own upcoming event – such as an office open house or a presentation for colleagues – for free.
Find links to these articles and more under the “In Print” category.
December 2013
MidwestMedicalEdition.com
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2013
A Building Year for 2014 By Dave Hewett, SDAHO
I
don’t spend a lot of time
ruminating about the past. It takes away from the precious time we have trying to anticipate the future. That said, I wasn’t a big fan of 2013 as not much got done in healthcare at least from a public policy perspective. It really was a building year for what is to come beginning January 1, 2014. The much publicized insurance reforms that take effect this coming January are transformational. The individual mandate, elimination of medical underwriting, and premium subsidies offered through the public health insurance exchange (a.k.a. the Marketplace) will redefine our concept of how and why people have health insurance coverage. Two important concepts will come to the forefront. First, there will be growing intolerance toward those who do not purchase insurance as the insured population develops a keener sense that their premium dollars are paying not only for their own healthcare, but those who dodge the insurance marketplace. Second, the concept of community rating will become the norm. That is rather than segmenting off different parts of the population by age, gender, health status, etc., everyone will be in the same experience pool. So for the many years I’m healthy, I will likely pay in more than I spend. But in the year when I have that freak fall or develop that complex disease my community will
MED Quotes “ Illness is the doctor to whom we pay most heed; to kindness, to knowledge, we make promise only; pain we obey.” — Marcel Proust
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ensure that the resources are there to take care of me. After all, one of the things that is not changing about healthcare is the 80/20 rule, i.e., where 20% of the patients account for 80% of the costs. The much less noticed but more substantive aspect of healthcare reform happened on the delivery side in 2013. Pronouncements from politicians and media pundits that “not enough was being done reform the healthcare system” were heard more than a few times this year. You and I know that just isn’t true. The development of medical homes, substantive strides toward attaining “meaningful use”
for EMR’s, reductions in readmissions, improvements in patient safety and quality and a decline in the rate of increase in health care expenditures were all part of 2013. That occurred because physicians took a leadership position to make it so. So while the general media worries about when coverage websites will work, the provider community can take a few minutes to celebrate its quiet victories achieved in 2013. But then its on to 2014 where the concepts of keeping people well and making health care safer, more efficient and more affordable, will once again guide our little-noticed efforts at true delivery reform. ■
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Midwest Medical Edition
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Sponsorship Marketing that Works
A talk with MED Contributer
Heather Taylor Boysen
MED: You took a winding path into the wine world. How did you come to be selling fine wine? HTB: Our company started as a gas station business in 1932. My dad was actually the first person to open convenience stores in the city of Sioux Falls. After he passed away, my mom and I started running the company. We recognized that the Taylor’s Pantry spot (at 41st and Minnesota in Sioux Falls) was a really good corner and we felt that one thing that Sioux Falls could use was a fine wine shop. We all enjoyed drinking wine and the options here were pretty limited. MED: So it wasn’t your original ambition to become a sommelier? HTB: No. I was working at Lawrence & Schiller as a junior account executive when I left to work for my mom. At the time, the company had five convenience stores in Sioux Falls and they did not have the staff to run them all. We decided to remodel the store here at 41st and Minnesota and to start selling wine. So I had a lot to learn. MED: You are clearly very knowledgeable now, as a certified sommelier, first level. How did you educate yourself? HTB: I had some friends in the wine industry who taught me a great deal. I read a lot and spent a lot of time on the Internet. I took classes. I spent four days immersed in Oregon Pinot country. And I’m not ashamed to say that I drank a lot. I continue to travel at least every other year to wine regions and I stay in regular touch with my many contacts in the industry. MED: What are you drinking these days? HTB: I really love some of the strange Italian white varietals, what I call the ‘V-wines’… Vernaccia, Verdicchio, Vermentino. I like to think beyond Cabernet and Chardonnay and find unusual things people might like to try. I have learned to trust my palette along the way.
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By Tana Phelps
I
t might seem like everyone wants your sponsorship support, from an employee’s youth sports team to a charity group’s upcoming event. When done well, sponsorships can be a low-cost, distinctive way to activate your message in the community and increase media exposure. By supporting local initiatives, sponsorships can also help improve loyalty with current and future patients and employees. Sponsorships can be a sticky subject though, especially if your CEO is questioning the PR value, yet you feel obligated to say yes. Fortunately, sponsorship marketing can be a worthwhile investment. All it takes is a competitive approach and a well-defined process.
Here are five tips to make sponsorships work Start with a plan. Develop an organizational policy on sponsorships – such as requiring that sponsorships have a health message or benefit – and use a scoring tool to make the process objective. For example, you might give more points to a speaking engagement and fewer points to commemorative advertising. Assign an owner. For logistical reasons and to secure return on investment, designate one person or department to own sponsorships. Marketing and public relations should be well equipped to do so. They can manage the message, leverage the sponsorship
across other marketing initiatives and communication channels, and ensure that those dollars are equally distributed and tracked. Stick to a budget. Work with administration and finance to carve out dollars dedicated to sponsorships. Set the budget for contractual commitments and reserve discretionary dollars for special events. Consider splitting your budget between new and repeat sponsorships to expand your local reach year-after-year. Define the target market. A sponsorship marketing strategy will only be successful if it is targeted appropriately. To define your audience, identify your current customers and their common factors. If you serve a farming community, for instance, promote your expertise by supporting local FFA groups. If there’s a large football following in your town, sponsor the local stadium with ads featuring your orthopedic services. Get creative. When an organization asks you to sponsor an event, ask them for unique opportunities. For example, instead of featuring your logo on a banner at a baseball field, negotiate for one of your physicians to become the team doctor. By promoting your support as the “Official HealthCare Provider of Team X,” you’ll create a memorable partnership that showcases your organization’s true value. ■ Tana Phelps is a marketing specialist at Cassling, a Midwest health-care company that provides local imaging equipment sales and service, and marketing and professional services.
Midwest Medical Edition
Sioux Falls VA Extends Office Hours The Sioux Falls VA Health Care System now offers extended hours for Veterans for primary care and mental health appointments.
• Nurse Call Systems • Synchronized Clock Systems • Low Voltage Specialists
Primary Care Extended Hours Information During The Week • A primary care team now works until 6:30 PM each Tuesday. • The team working will see patients assigned to them as scheduled appointments. There will be no walk-in appointments.
Weekends • A primary care team now works every Saturday. • The team working will see patients assigned to them as scheduled appointments. There will be no walk-in appointments. • Walk-in patients will go to the Emergency Department during extended hours. • Extended hours are for scheduled appointments. • Extended hours will not be available on holiday weekends, e.g., Veterans Day weekend. • Lab and imaging services are available.
Mental Health Extended Hours Information • A mental health provider works every Saturday from 8:00 AM – 12:00 PM. • Mental health providers have extended hours for scheduled mental health patients until 6:30 PM. Please make your veteran patients aware of these changes.
December 2013
■
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Happenings around the region
South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska
News & Notes Avera
Black Hills Regional Health’s Community Jeans Day Program raised $1,326.83 in October for the Front Porch Coalition. The local
Dr. Benjamin C. Aaker has joined the Avera Sacred Heart Hospital Medical Staff and Emergency Department. Dr.
Aaker graduated from the University of Nebraska Medical Center in Omaha in 2005 and completed his Emergency Medicine residency from the University of Texas, Southwestern Medical Center in Dallas in 2008. Board-certified in Emergency Medicine, Dr. Aaker comes to Yankton from Brandon where he was employed by Sanford Medical Center in Sioux Falls. Avera Heart Hospital was recognized by Healthgrades as one of America’s 100 best hospitals for cardiac surgery care. The achievement is part of
findings in American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation, which demonstrates how clinical performance differs dramatically between hospitals and the impact that this variation may have on health outcomes. This year’s Simply D’Vine wine tasting and silent auction event on October 25 raised $107,000 to benefit the Avera Sacred Heart Cancer Center.
The silent auction featured convenient text bidding by cell phone. Proceeds raised at the annual fundraiser will help assist patients with transportation to and from treatment, housing while in treatment, Charity Care, and ongoing wellness and education classes.
Sanford
Team leaders Lacey Burrell, Clinical Dietitian, left, and Emily Brick, Academic Affairs Liaison, represented Rapid City Regional Hospital Family Medicine Residency which earned Best of the Best and Best of Service honors during the 2013 Regional Health Quality Expo.
Rapid City Regional Hospital Family Medicine Residency earned top honors at the 2013 Regional Health Quality Expo with its Service Category winner, “LACE—Tying Up Loose Ends”, a project aimed
at enhancing patient care by focusing on seamless transitions from the hospital to the next point of care. The Best of Community, Best of Patient Safety/Quality and Best of People awards went to Rapid City Regional Hospital (RCRH), the Best of Financial Health award went to Regional Health, and the Best of Growth award went to Spearfish Regional Hospital. Also announced at the 2013 Quality Expo were the Quality & Safety Advocates of the Year. This year’s honoree is the Influenza Education Team.
organization’s mission is to help people who have lost a loved one to suicide. It also works to reduce the incidence of suicide within the community through education, awareness and prevention services. Since November 2011, Regional Health employees have donated a total of $28,086.60 through the Jeans Day Program, with monthly proceeds going to a different local charity in each community. Rapid City Regional Hospital (RCRH) Infection Control and Occupational Health employees dressed in costume to “treat” hospital physicians, employees, medical students, and volunteers to free influenza vaccinations in a Halloween setting on October 31. In September, South Dakota’s
three largest healthcare systems – Avera, Regional Health, and Sanford Health, jointly announced they were requiring annual influenza vaccinations for all employees, healthcare providers and volunteers effective with the 2013-2014 influenza season. Last year in South Dakota, 37 people died from influenza, which is the highest number of influenza-related deaths since 2004.
The Edith Sanford Breast Cancer Foundation will become the official charity partner for the 2014 Women’s Running Series. The Women’s
Running Series encompasses four half marathon and 5K events uniquely catered to women. The 2014 series starts with Women’s Running San Diego Half Marathon on February 22. Women’s Running Series participants will be eligible for exclusive benefits and discounts when they register for a Women’s Running event as members of TeamEdith, the charity’s new participant engagement platform. Sanford Aberdeen has expanded its patient services into urology with the addition of urologist Melissa Brown, MD. Brown,
who is board-certified and began seeing patients in October, specializes in diagnosing and treating disorders and conditions of the urinary tract, including the kidneys, ladder, ureters and urethra. Dr. Brown received her undergraduate and medical degrees from The University of Iowa. She completed a residency in urology at the University of Utah and comes to Aberdeen from Kingman, Arizona.
Stay up-to-date with new medical community news between issues.
Log on! 8
Midwest Medical Edition
Wilson Asfora, MD, a neurosurgeon at Sanford Health, appeared on Becker’s Spine Review’s “90 Spinal Surgeon Device Inventors and Innovators to Know” list. This list compiles
spine surgeons and specialists who developed innovative implants and devices to advance the field. Many members of this list hold multiple patents and continue to work toward improving their technology.
Jackie Bleil, activity coordinator at Elmwood Care Center, vowed to shave her head if a fundraiser in October raised more than $1,000. Staff,
family and friends of the cancer center doubled their goal by raising over $2,000 through a bake sale and silent auction. Bleil made good on the bet and shaved her head on October 30. All of the proceeds stayed in Sioux City to benefit local cancer patients with needs such as financial assistance, transportation, utilities, housing, food, clothing, and other necessities.
Siouxland Mercy Urgent Care in Sioux City moved down the street to Mercy Singing Hills Family Medicine. The new location
Other April Ahrendt, RDLN, VA dietitian, and David Maddox, PhD, who recently retired from Research & Development with the Sioux Falls VA Health Care System co-authored an article with Drs. Kendra Kattelmann and Dr. Thomas S. Recor titled, “The Effectiveness of Telemedicine for Weight Management in the MOVE! Program.” The article was
published in The Journal of Rural Health on September 24.
encourages patients to become established with a primary care physician.
Jason Petersen, PhD, researcher at the Sioux Falls VA Health Care System, received a grant from the South Dakota Veterans of Foreign Wars Dept. of SD Auxiliary to continue his research related to skin cancer. He received a
grant for $5,483 from the Auxiliary on October 6. Victor Waters, MD, JD, Chief of Staff at the Sioux Falls VA Health Care System, recently passed the Boards in Legal Medicine that requires holding dual degrees in both medicine and law through the American College of Legal Medicine.
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December 2013
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South Dakota
Celebrates Improvement in
Preterm Birth Rate South Dakota lowered its preterm birth rate, giving more babies a healthy start in life and contributing to the national six-year improving trend. Although the preterm birth-
rate now stands at 10.7 percent, it was not enough to change the state’s “B” grade on the 2013 March of Dimes Premature Birth Report Card. South Dakota is part of a national trend toward improved preterm birth rates. On the 2013 Report Card, 31 states, Puerto Rico and the District of Columbia, saw improvement in their preterm birth rates between 2011 and 2012. Nationwide, the largest declines in premature birth occurred among babies born at 34 to 36 weeks of pregnancy. Every racial and ethnic group benefitted, and the preterm birth rates for babies born at all stages of pregnancy improved. Almost every state saw its preterm birth rate decline since 2006, the national peak. In South Dakota, the
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rate of late preterm births is 7.5%, the rate of women smoking is 24.9% and the rate of uninsured women is 19.4%. South Dakota earned a star on the report card for lowering the late preterm birth rate and reducing the percentage of women of childbearing age who smoke. These improvements mean not just healthier babies, but also a potential savings in healthcare and economic costs to society. The March of Dimes attributed the improved rates to an expansion of successful programs and interventions, including actions by state health officials here and in all other state. Although the numbers are moving in the right direction, the U.S. as a whole again received a “C” on the March of Dimes Report Card. Grades are based on comparing each
state’s and the nation’s 2012 preliminary preterm birth rates with the March of Dimes 2020 goal of 9.6 percent of all live births. The U.S. preterm birth rate is 11.5 percent, a decline of 10 percent from the peak of 12.8 percent in 2006. Birth before 37 completed weeks of pregnancy is a serious health problem that costs the United States more than $26 billion annually, according to the Institute of Medicine. It is the leading cause of newborn death, and babies who survive an early birth often face the risk of lifetime health challenges, such as breathing problems, cerebral palsy, intellectual disabilities and others. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants. ■
Midwest Medical Edition
It has been an extraordinary year of change in healthcare, both nationally and locally, and not all of it has been comfortable. As Washington struggled with the Affordable Care Act, doctors in our region were working to implement or optimize EHR systems, gear up for ICD-10, and continue to make a living in an increasingly competitive environment. We here at MED have been working to follow these trends and issues, while managing our own move into digital technology, as we shine a spotlight on extraordinary people, programs and institutions on the Great Plains. Following are excerpts and top stories from the pages of MED in . . .
a year in review
ƒ MED Jan 2013.indd 1
12/19/12 3:47 PM
January February
“Once I had this case…” The Stories We Could Tell It is said that everyone has a story to tell and it may be even truer for those in the medical field. By its very nature, the unique role of physicians brings them into close and sometimes intense contact with a wide swath of humanity. We invited several area physicians to share some of their most memorable practice experiences and notable cases and brought them to readers in their own words.
Jeff Murray, MD, Gastroenterologist, Sanford: “I remember a patient with a bleeding ulcer. I did an emergency endoscopy to treat it. When we were finally able to bring
him back in, even though this looked great, we decided to do a biopsy anyway. I’m not really sure why we did, but it turned out to be a signet ring cell cancer, which is uniformly lethal. Here is a guy who just about didn’t even come back. And even though it looked healed, we still took a biopsy. This patient had two thirds of his stomach removed and he’s doing great. Was it luck? Could have been. But you just know that there was more to it. Something intangible. If your eyes are open wide enough, you recognize that. And then you recognize that this is a pretty cool field to be in.”
Kelly McCaul, MD, Transplant Hematologist, Avera: “One patient that stands out for me had a high grade myelodysplastic syndrome (MDS). No one really had a lot to offer at the time. So she developed acute myeloid leukemia (AML) and eventually was referred back to me. At the time, the median survival with what she had would have been 3 or 4 months. So we really scrambled to get her into an NCI trial that could offer her something. She became the first person in the state to get on this new drug, called Vidaza. Now, ten years later, she has a perfectly normal blood count.” ■
This story launched MED’s “Case By Case” column, a forum for discussing notable or unusual cases.
Dr. Jeff Murray
News Flash Rapid City Regional Hospital unveils $2.8 million renovation of its Medical Imaging Department
News Flash Mercy Medical Center dedicates new state-of-theart robotic operating suite
News Flash Sanford becomes first in the region to use the world’s smallest microscope during endoscopies.
March Neurocritical Care at Sanford Health
ƒ MED MARCH 2013.indd 1
2/25/13 8:01 PM
Rare Subspecialty Provides Critical Interventions that Save Lives and Promote Recovery
N
eurocritical Care is the critical care of patients with injuries or acute conditions of the brain or spinal cord. Brain trauma as well as stroke, subarachnoid hemorrhage, intracranial hemorrhage, subdural hematomas, seizures, spinal cord trauma, status epilepticus, and encephalitis all fall under the auspices of Neurocritical Care. It has evolved in recent years from a segment of Intensive Care to its own subspecialty, with its own society, journal, research studies, and growing number of practitioners. “If it is something in your head, we will take care of it,” says Larry Burris, DO, who, along with his partner Charles Miller, MD, is now one of the 400 or so board certified Neurocritical Intensivists in the country. Vital to Neurocritical Care’s emergence as its own specialty area is the improved ability to monitor certain parameters such as intracranial swelling, brain blood pressure, and neurooxygenation. One of the lifesaving interventions made possible by improved monitoring is decompressive craniectomy during which a portion of the skull – sometimes as large as a hand – is removed and carefully preserved at -60° C while the patient’s potentially brain-damaging inf lammation diminishes. “Novel application of acceptable techniques allows us to go beyond standard therapies and give our patients a better fighting chance when it comes to these really terrible injuries,” says Dr. Miller. Another one of those acceptable but not highly-publicized techniques is therapeutic Spearfish Regional hypothermia, a method of lowering a patient’s Hospital is verified as a body to a therapeutic temperature of 91° F in Level III Trauma Center an effort to prevent ischemic injury to by the American College already-damaged tissues. of Surgeons. In addition to Drs. Miller and Burris, Sanford’s Neurocritical Care tem includes a vascular neurologist and the state’s only interBrookings Health System ventional neurologist. ■
Internist/Nephrologist Larry Burris, MD (on phone), and Neurosurgeon Charles Miller, MD (at computer),are the region’s only two board-certified Neurocritical Intensivists and two of only 400 or so, nationwide.
News Flash
News Flash
becomes the third in South Dakota to use robotic technology in its OR.
MidwestMedicalEdition.com
Jenna Neilsen, RN, sets up a therapeutic hypothermia treatment. Using an external or internal cooling device, a patient’s body can safely be cooled to 91° F to protect delicate brain and spinal tissues from ischemic damage.
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Vol. 4, No. 3
2013 April May
Putting Training Into Practice
South Dakota and the Upper Midwest’s Magazine for Physicians & Healthcare Professionals
April May
Jun ƒ MED June 2013.indd 1
Going the Distance 5/21/13 6:57 PM
Local Physicians Travel to Serve Resident Dr. Ben Liscano and Dr. David Brechtelsbauer, Geriatrician and Associate Director of the Residency Program.
The Center for Family Medicine Putting Training into Practice
T
he Center for Family Medi-
cine’s 16 faculty providers include 12 family physicians, a clinical psychologist, a licensed nutritionist, a PharmD and a geriatric nurse practitioner. The CFMbased Sioux Falls Family Medicine residency program, which has graduated nearly 300 residents and provides care for thousands of local patients, is jointly sponsored by Avera McKennan and Sanford Health Hospitals and is affiliated with the University of South Dakota Sanford School of Medicine. Be cau se residents play such an integral role in Avera McKennan the practice, Hospital & University Health Center is named CFM incora Top 100 Hospital by porates their Truven Health Analytics. cutting-edge new knowledge into its patient care Sanford Gynecologic model while Oncologist Maria Bell, the graduates MD, completes her t he m selve s 1000th robotic surgery
News Flash
News Flash
at Sanford Health.
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are learning the practical application of that knowledge. “Our mission is to train family physicians for South Dakota and other areas in the upper Midwest, which has a lot of rural and frontier areas, so they have to be pretty broadly trained,” explains David Brechtelsbauer, MD, a board-certified family physician and geriatrician who has worked and taught at the Center for Family Medicine since 1985. Accredited in 1973, the Sioux Falls Family Medicine Program is one of the oldest of its kind in the country. The program size has recently expanded to 9 with the result that, at any given time, about 27 residents are working in the practice. The diverse patient makeup at CFM means that the clinics doctors are more likely to encounter patients with rare or unusual conditions. “For instance, it would be unusual to see elephantiasis in a town the size of Sioux Falls, but we have seen it,” says Dr. B. “This is why it is a culturally and intellectually stimulating environment for teaching and learning.” ■
Every year, teams of American doctors, dentists and other healthcare professionals clear their schedules and pack their bags for some of the world’s poorest and most remote places. Their mission: to improve the lives and futures of underserved and vulnerable people around the globe by providing medical, dental, and surgical care, medicines, equipment, instruction and support. While their ranks are not large, their service-driven hearts invariably are. For this month’s Cover Story, we spoke with area physicians who have embraced the joys and considerable challenges of medical mission work. Craig Hedges, MD, Ear, Nose & Throat Although he has served in Honduras, Russia, Africa, Mexico and Cuba since 1994, teaching and training and bringing equipment, Dr. Craig Hedges’ first love is Vietnam, where he has served on 18 mission trips in 19 years. “When I first went, they were taking safety razors and breaking them into two pieces and holding the broken piece with a hemostat in order to make an incision,” says Hedges. “The things that we do and see
News Flash Heart specialists at both Sioux Falls Heart Hospitals begin offering a minimally invasive treatment for chronic total occlusion.
News Flash Sioux Falls Infectious Disease specialist Wendell Hoffman, MD, receives the CDC’s annual Childhood Immunization Champion award.
News Flash Iowa Health System changes its name to UnityPoint Health.
ne
July August Vol. 4, No. 5
2013 July August
Medical Homes
South Dakota and the Upper Midwest’s Magazine for Physicians & Healthcare Professionals
on a day-to-day basis in Sioux Falls – cancers and nasal polyps and perforated ear drums and chronic infections – were the exact things they wanted to learn.” Paul Amundson, MD, Family Medicine Working through the South Dakota Synod of the ELCA, Dr. Paul Amundson has travelled to Nicaragua 10 of the last 12 years. “We drive through dried out creek beds to get to villages of 10 to 15 families where we set up a clinic in whatever structure is available. For some, we are the first physicians they have ever seen,” he says. Parasites, malnutrition, and the increasing availability of cheap packaged foods and soft drinks are major health problems in the country. Greg Schultz, MD, Vascular Surgery Two years ago, Dr. Greg Schultz travelled to Gracias, Honduras, one of more than 50 sites around the world where the Luke Society provides support to indigenous mission-minded physicians. “On our first day, we probably saw 50 to 60 cases and they all came in with obvious medical problems… gallbladders, hernias, cancer,” say Dr. Schultz. “These people travel for 6 to 10 hours on bumpy roads, have major operations, and get up and leave the next day. And they are so gracious and so happy about it.” ■ Log on to find a list of organizations that provide service opportunities for medical professionals.
Dr. Paul Amundson in 2011 with his Nicaraguan host family
Medical Homes on the Prairie A New Structure for Care Delivery
A
ccording to the NCQA ,
the national certifying body for what they term Patient-Centered Medical Homes, a Medical Home is a primary care setting that “facilitates partnerships” between patients and providers and one in which “care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.” Or as Laurie Jensen, Director of Clinic operations at Sanford Luverne Clinic, itself a certified Medical Home for more than a year, explains it, “It is about achieving a team, including the patient, the doctor, the RN health coach, the family, etc., that works together to optimize care.” “This is not a program, but a philosophy of how we manage care.” Chad Markham, VP for Clinic and Network Development at UnityPoint St. Luke’s in Sioux City, puts it even more succinctly: “It’s about setting up a network of people to make sure that no one falls through the cracks.” UnityPoint St. Luke’s new Sunnybrook Medical Plaza in Morningside includes
a primary care clinic designed – both physically and logistically – entirely around the Medical Home model of care coordination. Under the Medical Home model, the sickest and most timeconsuming patients are funneled into a system to connect them with needed support services without clogging up the works or throwing off the schedule. “We know that a healthy population uses less of the more costly healthcare things,” says Amy Slevin, RN, Director of Clinical Program Development at Mercy Medical Center in Sioux City. “So you want to keep your healthy patients as healthy as you can, and your chronically ill patients in the management category so that they don’t progress into the more expensive category.” ■
News Flash Avera Heart Hospital is first in the region to offer the PEVAR procedure for repairing abdominal aortic aneurysm (AAA).
News Flash UnityPoint Health-St. Luke’s unveils new Siemens Definition AS 64 CT scanner, which can reduce radiation exposure.
15
Vol. 5, No. 6
2013 September October
Midwest Medical Edition
Gain
without pain Ergonomics in the Medical Workplace •
Warning for SD Doctors: Time for a Software Upgrade?
•
Stress-busting Treadmill Desks
•
Black Hills Company Keeps Provider IT Healthy
South Dakota and the Upper Midwest’s Magazine for Physicians & Healthcare Professionals ƒ MED Sept Oct 2013.indd 1
8/27/13 5:54 PM
September October
Dr. Maria Bell’s shoulder problems resolved after she began using the da Vinci robot for gynecologic oncology procedures.
By allowing him to work without a lead apron, Interventional Cardiologist Dr. Adam Stys says robotics are saving his back.
Gain Without Pain Ergonomics in the Medical Workplace
M
edicine can be a risky profession. According to the CDC’s National Institute for Occupational Safety and Health, healthcare workers experience musculoskeletal disorders at a rate exceeding that of working in construction, mining and manufacturing. In addition to lifting and positioning increasingly heavy patients, many of these injuries occur as a result of being forced to spend many hours working in awkward positions.1 “We do our procedures standing, often in non-ergonomic positions, trying to focus 1 “Preventing Back Injuries in Health Care Settings”, September 22nd, 2008, NIOSH Science Blog
16
on small movements of our fingertips while the rest of the body is frozen,” says Sanford Interventional Cardiologist Adam Stys. The awkward stance is exacerbated by the fact that international cardiology procedures are performed while wearing a heavy lead apron to protect against radiation exposure. So it’s no surprise that Dr. Stys and his colleagues at Sanford have gladly embraced the advantages of robotic technology. With robotic assistance, the surgeon can manipulate wires and catheters from a seated position behind a radiation-safe console. “Once I switched to robotics, my injuries went away,” agrees gynecologic
oncologist Maria Bell, MD, who developed upper back and shoulder issues after she began performing laparoscopic procedures more than 8 years ago. “Ergonomically, that was not a great transition. I absolutely believe that I will be able to operate longer because of robotics than I would have been able to otherwise.” Installing robotic systems is not the only way area hospitals are attempting to make life easier and more comfortable for physicians. Hospital administrators say even lower-tech improvements, like ergonomic stools and adjustable computer monitors, can make a big difference over the long haul. ■
Vol. 6, No. 7
2013 November
Midwest Medical Edition
Managing the maze
Navigating Meaningful Use on the Great Plains
TexT MessagIng and hipaa compliance
Job interview skills for doctors
November
ICD-10 and your cash flow South Dakota and the Upper Midwest’s Magazine for Physicians & Healthcare Professionals ƒ MED NOV 2013.indd 1
10/22/13 6:40 PM
Meaningful Use Managing the Maze
B
Most MED articles come from the suggestions of area healthcare professionals. If you know of a physician, program, or institution that you think is worthy of coverage in MED, write to us at Alex@MidwestMedicalEdition.com.
News Flash
y now it is a term with which every American healthcare provider is intimately familiar. Some would say all too familiar. But when the words “meaningful use” first entered our vocabulary as part of the American Recovery Reinvestment Act of 2009 as a way to bring medical care into the digital information age, they were, for many providers, a source of anxiety, confusion, and even fear. “We fully anticipated that there would be fear, challenges, blockades and barriers with meaningful use,” says Holly Arends, Clinical Program Manager with HealthPOINT. “You’re talking about a change in workflow and a major disruption in business.” “This has been a tremendous amount of work for everyone – providers, security teams, clinical informatics, nurses, IT departments – everyone,” agrees Hailey Schepp, Sanford Health’s Director of Meaningful Use. “It is so easy to get overwhelmed with the details of meaningful use, but we have Holly Arends to remember that this initiative really is about the patient and improving the patient care experience.” Arends says South Dakota is in the top 10 states nationwide in adoption of electronic health records, with more than 53 percent of the state’s providers having a ‘live’ EHR system. Providers who have not attested to at least one year of the twoyear Stage I meaningful use process by September 30, 2014 (which means they had to have started the process this September) will see a 1% reduction in reimbursements beginning in 2015, and an additional 1/% reduction every year thereafter until they “catch up”. ■ Hailey Schepp
St. Luke’s Sunnybrook Medical Plaza Opens in Sioux City
News Flash
News Flash
Sioux Falls Specialty Hospital joins a Johns Hopkins research study on best hospital practices.
Avera McKennan Hospital announces plans to open an outpatient dialysis center on its Sioux Falls campus.
News Flash Sanford Aberdeen cardiologist Puneet Sharma, MD, completes record 68-minute ‘door to balloon’ heart attack treatment using vascular robot.
News Flash Mercy Medical Center in Sioux City starts construction on a $16.8 million ICU renovation and MRI project.
17
MED Editorial
Celebrity Doctors: Doing
No Harm?
By Alex Strauss
Y
ou know their names. . . .
Andrew Weil, Sanjay Gupta, Dr. Oz, Dr. Phil. They are physicians who have built reputations and devoted followings by not only talking regularly to the press, but by writing books and blogging, maintaining popular websites, making liberal use of social media, appearing on or hosting their own TV shows, and, in some cases, even endorsing products with their names on them. But is what they are offering really improving the health picture for Americans who follow them? In addition to keeping their names and messages in the spotlight through the liberal use of social media as well as every other kind of media, these doctors have achieved celebrity, in part, by concentrating their efforts on subjects that are more or less universally appealing. These include topics such as ways to look younger, live longer, boost energy, sleep better and improve one’s love
18
life. Just writing the list makes my own ears perk up. Who doesn’t want these things? But here is the problem: While these celebrity doctors (many of whom have legitimate and even impressive credentials to go with their charismatic personalities) may have worthwhile contributions to make in these limited subject areas, their approach is too often exactly that – limited. Sure, smooth skin and more flexible joints can be lifeenhancing. But by focusing the bulk of their efforts and air time on headline-grabbing health topics and pointedly ignoring a host of less “sexy” but equally important subjects, many physician celebrities are failing to make the best use of their hard-won platforms. We all want to look sharp and feel peppy. But, inasmuch as the advertising industry and certain celebrity doctors might seem to suggest otherwise, good health is about more than good looks and good sex. The fact is, to understand what it takes
and be motivated to safeguard their health and that of their families, the public needs to be continually reminded of such ‘mundane’ health topics as the value of flu shots, the importance of immunizations and sunscreen, the power of hand-washing, the deceptively subtle signs of stroke and heart attack, and where and when to have cancer screening tests that may save their lives. And that is where non-celebrity doctors can make a world of difference. They may never have a Twitter following in the tens of thousands, but physicians who are willing to publically address, or even suggest to their local media outlets, a broader range of healthrelated news topics, will ultimately have a more positive, far-reaching, and long-term impact on public health. ■ MED Editor Alex Strauss is a former health news reporter and author of the new book, Physicians and the Press, available through Amazon and other booksellers this winter.
Midwest Medical Edition
Bumps on the Road to Meaningful Use
One Doctor’s Experience
Y
ankton Family Physician Jeff Johnson, MD, had just moved his practice from Watertown
to Yankton in 2009 as electronic health records were beginning to gain real momentum. The ruling that mandated EHR implementation came out a year later. Seeing “the writing on the wall”, as he says, Dr. Johnson and his partners, who later sold the practice to become Lewis & Clark Family Medicine, started from the ground up to choose and implement an EHR system. As many other providers have discovered, the road was not a smooth one. Now, with a vendor switch in the works, Dr. Johnson and his partners are gearing up for more bumps ahead. Editor Alex Strauss spoke with him recently.
MED: You started working with electronic
MED: Do you think that an optimized EHR
health records earlier than a lot of practices
system can ever enhance revenue?
in the region. What was it like to be using this new tool that not everyone was using?
Dr. J: When we started, we had no patients so no patient charts to transfer over. So, in some ways, we had it easier than clinics that had all paper records. The downside is that, although we did our best to pick a vendor that we thought would work for us, there are now better options out there, especially for family practice. Right now, I’m spending an hour-and-a-half to two hours every night doing charts when I get home. There are too many clicks. Too much typing. And I didn’t even know how to type before 2009!
MED:
Dr. J: Yes, but it takes time. Before we chose our new system, we did a site visit to a physician in Kentucky who was using it. His volume also dropped for a short period of time, but once he got going, he increased his revenue by 40 percent. One way a good system can help do that is through automated alerts. Before, we might not have known that that 65-year-old patient hadn’t had his pneumovax vaccine. That’s captured revenue for us. Alerts for screening tests also come in automatically. So do appointment reminders for patients who need to be seen regularly, such as those with diabetes. So it can help keep us from losing that potential revenue.
Are you worried about the cost of
changing EHR vendors after so much time?
Dr. J: There is a cost to not changing. Our system has hindered our ability to handle the volume. In Watertown, I would see anywhere from 25 to 30 people a day. My max was 37. But, working with EHR, we’re down to 22 to 24 patients a day. Everything is template driven, so in an exam situation, I actually have to go back through and click the parts that are irregular. I have to either type in answers to questions or click boxes. We decided to switch to the system recommended by the AAFP and we are hoping that it will save time and equate to higher volume.
December 2013
MED: Will the transition to EHRs be good for medicine in the long run?
Dr. J: I think that, ultimately, it is a good thing. The ‘First, Do No Harm’ study found that many people die every year from medical errors. I do believe that EHR has the potential to improve patient care and patient safety. While it does increase doctor frustration, I think it is appropriate for us to be held accountable. But there are still challenges. Patient privacy is a big concern. And with Stage II, as we implement our patient portal, we want to make sure that the access to all
MidwestMedicalEdition.com
of that information doesn’t generate excess worry for patients. Sometimes, if they see unusual lab values, that can prompt extra calls, which can require time.
MED:
What advice would you give to
anyone still trying to choose, implement, or switch an EHR system?
Dr. J: We worked with HealthPOINT to get our system going and I would definitely recommend having someone come alongside you early in the process. I would also recommend a site visit. This is a huge investment, so you also want to make sure that your vendor is going to be there to help you fully utilize all the bells and whistles in your system so you’re getting the most value out of it. And make sure they are up front about what everything costs. For instance, is your vendor going to charge you more to implement ICD-10?
MED:
Overall, you seem pretty upbeat
about a process that has caused you a lot of frustration. How do you manage that?
Dr. J: I know several doctors who opted for early retirement rather than trying to do this and others who just don’t see the value. Those who are close to the end of their career may not want to invest the time or money. Because it is very expensive and time-consuming. But I am 50 years old. If I only have a few more years to live, I feel like I would rather embrace it than fight it. ■ Lewis & Clark Family Medicine is in the process of building a database with its new EHR system and hopes to launch in January. They have attested to Stage I Meaningful Use.
MED Quotes “We learn the ropes of life by untying its knots.” —Jean Toomer
19
By Alex Strauss
T oo C l ose to H ome
Cameron and Big Sister Kassie
T
o say that 2013 has been a difficult year
for Theresa Cameron would be an understatement. While her colleagues were following the healthcare debates and grappling with digital medicine, rising patient loads, and reimbursements, the Aberdeen PA’s head and heart were with her extended family, as they faced one health crisis after another. It started when her 18-month-old granddaughter, Cameron, was diagnosed with Stage III T-cell lymphoblastic lymphoma in June. “My daughter, who is a PT in Vermillion, just thought it was strep throat so she asked to get a strep done,” recalls grandmother, Theresa, who works at Sanford Aberdeen Medical Center. “The doctor felt like something just didn’t look right. So they looked further and they found it.” Little Cameron was hospitalized at Sanford Children’s Hospital
in Sioux Falls, where she began the first round of a chemotherapy regimen that will last three years. Around the same time, Theresa’s other daughter developed problems during her second pregnancy and delivered her son, Bronsen, a month early in Sioux Falls in September. The baby was admitted to the NICU with heart problems. “At that point, I felt like I wasn’t so much a provider anymore as a mother and grandmother,” says Theresa, who regularly made the 3-hour trip to the Sanford campus in Sioux Falls, spending time in both the NICU and The Castle. “Sometimes it is really heart-wrenching. When Cameron first went in, they couldn’t intubate her because the mass was too large. When they put a tube in her, I thought, ‘I can handle this.’ But when they were actually doing the procedure, draining more than 750 cc’s from her lungs, she was looking right at me with a look like ‘Why are you letting them do this to me?’ and I almost passed out.” Although Bronsen is now home in Aberdeen, Cameron’s chemotherapy continues. Because Theresa’s work schedule is more flexible than her daughter’s, she is often ‘on call’ to help with her granddaughter in Sioux Falls. “Being a provider for 20 years, you have your family of patients, but in a crisis like this, your own family has to take priority,” says Theresa. “Sometimes, it can be hard to break away from the loyalty you feel to your patients.” Another challenge, as a provider supporting her own family in a health crisis, has been coping with and expressing what she knows – and doesn’t know – about their medical situation. “I’m in medicine but I don’t do pediatric oncology or pediatric cardiology, so it’s not always easy even for me to decipher exactly what’s being said,” says Theresa. “Family members ask me, what does this mean? What does that mean? And it can be frustrating if I can’t explain. On the other hand, sometimes, you know too much. People will say ‘Oh, I know someone who had that. That’s curable.’ But I know that it is much about the T-cells and the B-cells. I think it can actually be worse knowing and understanding the deeper parts.” When speaking with Cameron’s oncologist, for instance, Theresa says she often has very specific medical questions that an ordinary patient might not ask. “I don’t want to annoy them. But
“ I think I have always been compassionate, but now my understanding is deeper and I can relate more to the fear and the overwhelm.”
20
Midwest Medical Edition
Theresa Cameron, PA-C
Theresa and Cameron, age 2 ½ at Sanford Children’s
Cameron and her mom. “It can be heart-wrenching,” says Theresa.
I have done a lot of research and I have a lot of legitimate questions,” says Theresa. “I have found that it can be hard knowing where to draw the line.” Bronsen and Cameron weren’t Theresa’s only worries this year. While her grandchildren were sick, her nephew was killed in a serious accident. Rather than making her bitter, though, Theresa says this year’s personal challenges have helped to make her a better provider. “I think I have less tolerance for whining in my patients, for one thing,” she says. “When a patient comes in – again – with a
December 2013
relatively minor complaint, it’s tempting to say, ‘You think YOU have it bad…’ I don’t, of course. But I do think I am better able to be firm with the people who need it and encourage them to buck up and make changes, if they need to. I no longer enable them.” At the same time, Theresa says her level of compassion and empathy for patients and their families dealing with serious illness – especially cancer – has grown by leaps and bounds. “For one thing, when they talk to me about oncology terminology, I understand what it means. I think I have always been
MidwestMedicalEdition.com
compassionate, but now my understanding is deeper and I can relate more to the fear and the overwhelm. In the past, it was natural to just say, ‘It’s going to be OK.’ But now I can truthfully say to the family, ‘I really know how you feel.’” Today, as she awaits the birth of more grandchildren – a set of twins due in April – Theresa looks on 2013 as a opportunity to learn things that couldn’t have been learned any other way. “It’s not like you can just Google ‘How to deal with a relative with cancer’,” she reflects.” You have to live it.” ■
21
Case by Case
Avera Team Wins National Video Prize for Novel Technique
T
candy. In actuality, they caused the powerful magnetic beads were anything but harmless. When ingested, surgery major for need the in resulted have significant gastrointestinal distress that could – if not for the innovation of an Avera medical team. Avera Medical Group The expert care of Dr. Stephen Nanton, pediatric gastroenterologist with Institute of South Pediatric Specialists Sioux Falls; Dr. David Strand, surgeon with Surgical American College the in place first Dakota; and Joelle Roskens, RN, pediatric GI nurse, garnered for Removal of ue of Gastroenterolog y’s endoscopy video forum. The video, “Novel Techniq October annual meeting Ingested Neodymium Magnets in Pediatrics,” was awarded at the ACG in San Diego, Calif. th history of When presented to Dr. Nanton, this case involved a toddler with a one-mon child’s GI the in bracelet abdominal pain and vomiting. An X-ray revealed what appeared to be a an endoscopic procedure. tract. Hoping to remove the object non-invasively, Dr. Nanton scheduled numerous fuchsiaSoon after the procedure began, Dr. Nanton realized the “bracelet” was actually . colored beads, which reunited within the child’s stomach Nanton said. “When “These beads are 10 to 20 times more powerful than regular magnets,” Dr. imbedded in the wall children ingest them, they attract each other, and can perforate or become of abdominal organs,” Dr. Nanton said. and the attraction of Dr. Nanton noted that some beads were imbedded in the stomach wall, opic or even laparosc the beads had caused the stomach to become misshapen. Because he knew he called for Dr. Strand, open abdominal surgery might be required to remove the imbedded beads, an Hospital & University who immediately joined him in the endoscopy suite at Avera McKenn an object of this size and remove to Health Center. “Endoscopic forceps do not grasp well enough shape,” Dr. Nanton said. the beads endoscopiDrs. Nanton and Strand knew it was in the child’s best interest to remove use the cally if possible. It was truly a case of thinking on their feet, as to how to or papers no were “There beads. the equipment at hand to effectively remove literature to consult,” Dr. Nanton said. they Because the beads were so powerfully magnetic, the team realized that Net® could use the beads to attract one another. They placed a bead in a Roth proved foreign body retriever, which resembles a tiny fishing net. It immediately swalhad child the that effective, and they went on to remove all 25 magnets damage lowed. They could then clip the fistulas that had formed, repairing the o a 2-year-old child, the colorful spheres probably looked like
Dr Nanton
Dr. Strand
beads Twenty-five magnetic toddler’s were retrieved from a nth-long mo a sing cau t, trac GI and g history of vomitin taken abdominal pain. Photos cedure pro opy during an endosc of the nce eara app the w sho GI trac t. beads inside the child’s ra Ave y rtes Cou
22
so that the child would suffer no further effects. Neodymium-iron-boron magnets, also known as “supermagnets,” became U.S. available in the early 2000s in toys, jewelry and other items. In 2012, the of recall a Consumer Production Safety Commission banned sales and issued bowel supermagnet desk toys, after several magnet ingestions that resulted in longer no are toys agnet Superm child. one perforation, sepsis and the death of and marketed to young children in the U.S., yet they remain available online, can still be found in product s purchased before the recall. l situation which was Dr. Nanton said he believes this video won because it was a practica the need for surgical ng preventi hand, at resolved innovatively through the use of equipment can use in the case sts intervention, with a good outcome. “It’s somethi ng that gastroenterologi out the nation.” ■ of these types of ingestions, which do happen several times each year through
Midwest Medical Edition
Introducing Dan Duley, Clinical Equipment Specialist Dan Duley, BS-BioE, ATP, RET, has joined the staff of Rehabilitation Medical Supply, a subsidiary of Children’s Care, as Clinical Equipment Specialist. He serves patients in clinic and outreach settings, working closely with the seating teams and rehab technicians in Sioux Falls and Rapid City. Bachelor of Science degree in bioengineering from the University of Illinois ■ Over twenty years experience in rehabilitation equipment evaluation and fitting ■
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RESNA-Certified (Rehabilitation Engineering and Assistive Technology Society of North America) Assistive Technology Professional and Rehabilitation Engineering Technologist
For more information or to schedule an appointment, call (605) 444-9700.
December 2013
MidwestMedicalEdition.com
Sioux Falls & Rapid City www.rehabmedsupply.com
23
Pearce Receives
National Recognition
courtesy Sanford
Research’s David Pearce, PhD, was recently honored as a 2013 RARE Champion of Hope by Global Genes and the R.A.R.E. Project. The RARE Champion of Hope Award recognizes an individual who is moving the bar in rare disease research and science at the national level. Whether from academia, industry, the clinic or an advocacy group, this Dr David Pearce (left) person works to advance research for a spereceives the RARE cific rare disease or is a key agent in the Champion of Hope provision of tools and approaches to developAward in California. He is pictured with ing and/or delivering more effective Dr. John C. Carey, treatments for the rare community. Professor and Vice Dr. Pearce serves as vice president and Chair, University of Utah Health Sciences Center chief operating officer of Sanford Research and School of Medicine. and director of Sanford Children’s Health Research Center. He is one of the world’s leading researchers of Batten disease and also established the Coordination of Rare Diseases at Sanford (CoRDS) program. CoRDS is a global rare disease registry designed to accelerate research and encourage research collaboration into these unexplained conditions. The Sanford program collects and stores basic contact and clinical information on individuals of all ages who have been diagnosed with a rare disease (undiagnosed individuals are also eligible for enrollment). Pearce accepted the award last month at the RARE Tribute to Champions of Hope ceremony in Newport Beach, CA. ■
Read Pearce’s acceptance speech on the MED website.
24
courtesy Sanford
Researcher honored for “moving the bar” in rare disease research
Sanford USD Medical Center, Sioux Falls
Consumer Choice Awards for Area Hospitals National Research Corporation recently recognized the nation’s top hospitals with its 2013/2014 Consumer Choice Award winner list. Sanford Medical Centers in Fargo and Sioux Falls have won the award for the 8th consecutive year and UnityPoint Health-St. Luke’s has been named Siouxland’s preferred hospital for the 5th consecutive year. Consumer Choice Award winners are determined by consumer perceptions in four areas including best overall physicians, nurses, quality and image and reputation, based on the nationally syndicated Market Insights study. Information is gathered through surveys of more than 270,000 U.S. households. From the households surveyed, roughly 3,000 hospitals named by consumers are analyzed and ranked based on their Core Based Statistical Areas (CBSAs) as defined by the U.S. Census Bureau, with the winning facilities being ranked the highest. “The Consumer Choice Award is especially unique because it is based on feedback by patients and families who walk through our doors each and every day,” says Peter Thoreen, President and CEO of UnityPoint Health – St. Luke’s. “This award recognizes facilities that are meeting or exceeding patients’ expectations.” The Consumer Choice Award provides important insight into what patients expect from their healthcare provider adds Thoreen. St. Luke’s is one of four UnityPoint Health affiliate hospitals receiving this honor. Sanford has the only facilities listed in the Dakotas. The complete list was published in the print edition of Modern Healthcare Magazine on Oct. 21. ■
Midwest Medical Edition
The CSM clinic sees aproximately 1300 patients each month.
Residency Program
Celebrates 40 Years
The Sioux Fall Family Medicine Residency Program held
its official 40-year anniversary celebration in October. Dr. Ted Epperly, author of Fractured: America’s Broken Health Care System and What We Must Do to Heal It, addressed guests at a dinner reception on October 26. Dr. Epperly is director of the residency program in Boise, Idaho and former President of the American Academy of Family Physicians who has spoken at the White House on healthcare Dr. Earl Kemp is the longtime director of the Sioux Falls Family Medicine Residency Program. reform. The Center for Family Medicine (CFM) is a non-program corporation originally formed in 1973 as Family Practice Center. A joint effort of Avera McKennan and Sanford Hospitals since its inception, the program 30 Years of Equipment Service. Supplemental has graduated more than 300 family physiCassling customers, Services. Dedication. cians, over 80% of whom have stayed to on average, receive Our marketing/ We’ve been a trusted practice in South Dakota or an adjacent state. support on a critical consulting services and partner to Midwest down system in just educational events health-care organizations In addition to providing a rich educational 52 minutes. help you achieve your since 1984. environment for future doctors, the Sioux organizational goals. Falls Family Medicine program has greatly improved access to healthcare in the region. Graduates provide services in over 50 South Dakota communities through primary and satellite clinics. Thirty-eight percent of all YEARS board certified family physicians in South Dakota graduated from this program, including a third of physicians in communities smaller than 5,000. Visit www.cassling.com for case studies on Cassling’s services. The program was featured earlier this 880-228-5462 | 13808 F St., Omaha NE year on the cover of MED Magazine (See A Year in Review, pg. 14) ■
Work smarter and faster
with service and support from Cassling.
December 2013
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25
The Nurses’ Station
New eCourses Available for Nurses
Nursing News from Around the Region
Wolters Kluwer Health, a leading global provider of information and point-ofcare solutions for the healthcare industry, has released a new series of professional development eCourses for nurses that were developed in collaboration with Joint Commission Resources (JCR), official publisher and educator of The Joint Commission. This first set of 30 courses focuses on Compliance, Patient Safety and Heart Failure care. All of the new courses are included in Lippincott’s Professional Development Programs, an
Sanford College of Nursing discusses partnership with NDSU The Sanford College of Nursing Board of Directors and the
eLearning library available to hospitals
Board of Directors for Sanford Bismarck have signed a memorandum of understanding with
ment Programs are part of Lippincott’s
North Dakota State University to discuss a partnership for nursing education. Sanford and NDSU
Nursing Solutions, a series of evidence-
will work together to define the partnership and complete a definitive (final) agreement which
based software applications designed to
could occur in time for an effective date of fall 2014.
improve patient outcomes, enhance
and other health institutions. Lippincott’s Professional Develop-
nurse competency, standardize care, save
Recently, the Higher
why we are pursuing a part-
“Instruction in Bismarck allows
Learning Commission (HLC)
nership with NDSU,” said
NDSU to better serve the
The new eCourses are the first to be
changed its bylaws to require
Craig Lambrecht, MD, San-
needs of North Dakota, par-
released as a result of the collaboration
all colleges to become sepa-
ford Bismarck president. “The
ticularly
announced in July between JCR and
rately incorporated in order to
potential benefits for both
Dakota.”
retain their accreditation. The
organizations are exciting.”
western
North
All currently enrolled stu-
time and promote clinical excellence.
Wolters Kluwer Health. Designed to help hospitals meet Joint Commission
HLC recommended that the
“North Dakota faces a
dents would continue their
certification and accreditation require-
Sanford College of Nursing
growing challenge in meeting
education at the college and
ments, all of the new courses have been
explore possible partnerships
the demand across the spec-
be transitioned to the new
as an option to keep accredi-
trum for healthcare in the
program. Seniors will gradu-
tation and funding support.
western areas of the state,”
ate this spring from the
“The opportunities this
said Dean L. Bresciani, NDSU
Sanford College of Nursing.
partnership could create for
president. “Traditional sources
All faculty and staff will con-
our students as well as the
of credentialed healthcare
tinue to be employed. Faculty
organizations’ shared com-
professionals and the delivery
would transition to positions
mitment to help meet the
methods are inadequate in
within the new partnership in
need for nurses in central and
terms of meeting current,
Bismarck, honoring their years
western North Dakota are
much less future, demands.
of service. ■
MED Quotes “ Life is a succession of lessons, which must be lived to be understood.” — Ralph Waldo Emerson
reviewed and certified by The Joint Commission experts. ■
7.3% Rate of injury and illness in nursing homes last year – The highest in the nation. — Bureau of Labor Statistic
Jenifer Reitsma, MSN, RN, CPNP was elected to the American Pediatric Surgical Nurse’s Association (APSNA) Board of Directors; this is a two year term. APSNA is an international association that includes over 600 pediatric nursing colleagues (registered nurses and advance practice nurses) who provide care for pediatric surgery and trauma patients in variety of healthcare settings. ■
26
Midwest Medical Edition
SD’s Stroke Certified RNs Stroke Certified Registered Nurse is a new nursing certification that
started in the spring of 2013. Currently there are 440 stroke certified nurses in the US, and South Dakota has 4 of them – all employed at Sanford Medical Center. The Stroke Certified Registered Nurse (SCRN) credential formally recognizes a unique body of knowledge necessary for the practice of stroke nursing. South Dakota’s strokecertified nurses include:
s Michelle VanDemark, MSN, RN,ANPBS,CNRN,CCSN,SCRN: VanDemark started her career at Sanford in 1995 as a Neuro Clinical Nurse Specialist (CNS). Michelle became a clinical instructor in 2007 and completed her nurse practitioner certification in 2009. She works with the Neurocritical Care team and is a member of the Sanford Stroke Team.
s V alerie Folkens, MSN, CNP, SCRN: Folkens has worked at Sanford since July 2008. She worked in critical care and now is a CNP for neurology clinic, inpatients and a member of the Sanford Stroke Team.
s Emily Hutchinson, MSN, CNP, SCRN: Hutchinson has worked at Sanford since September of 2004. She has worked on ortho/neuro, neuro acute and in the emergency department. She is now a CNP for neurology clinic, inpatients and a member of the Sanford Stroke Team
s Jessie Wolf, RN, CNRN, SCRN: Wolf has worked at SMC since August 2002. She has worked on ortho/neuro and neuro acute and is the Stroke Program Nursing Coordinator. ■
Jamie Cessna received the September DAISY Award for Extraordinary Nurses at Rapid City Regional Hospital (RCRH). She has been a Registered Nurse in the Labor and Delivery Department for three years. Cessna was nominated for the award by a patient who said Cessna took the time to ask the family questions to get to know them and patiently answered questions the expecting parents asked. Cessna was described as “connecting with the family on a human level, surpassing a mere passion for nursing.” The nomination went on to say Cessna is very knowledgeable, professional, relatable, and has a good sense of humor. She gave
Ask ur tO Abou dge Lo e! g Packa
“tremendous care and compassion” and helped the family through a “beautiful experience” ■
December 2013
MidwestMedicalEdition.com
27
Grape Expectations
Chocolate and Wine
A Heavenly Combination By Heather Taylor Boysen
W
e all have our food and wine traditions for Christmas. For some it may be prime rib and a really beautiful Cabernet Sauvignon, or a spiral cut ham with Pinot Noir or roasted turkey with Rosé. In our family we have the standard homemade pumpkin, pecan, and apple pies for dessert as well as cheesecake, but this year I really want to shake it up with something decadently chocolate. Chocolate and wine pairings can be dicey. Getting the wrong percentage of cacao in the chocolate with the wrong wine and the pairing can cause severe palate distress! I chose a wide variety of chocolate including Ghirardelli, Vosges, Rausch and Lake Champlain. To my surprise, many of their websites actually had suggestions for beverage pairings. As with any wine/food pairing I conduct, I started with the lightest chocolate first and then went to the darkest for the finish. My first pairing started with the Rausch Amacado 60% chocolate bar. The cacao comes from an old avocado plantation in Peru even though the chocolate family hails from Germany. Because this cacao percentage is close to milk chocolate, which is really difficult to pair with wine, I chose a Gerard
Bertrand Banyuls from France. This fortified dessert wine has huge aromas of very ripe and black fruit with jammy flavors of blackberries. With the low percentage of cocoa in the chocolate it worked perfectly as it was like pouring blackberries over the chocolate when you tasted them together. My next chocolate experience was the Ghirardelli Twilight Delight. You want to be careful to make sure that your wine doesn’t have too much of a tannic or intense structure or the bitterness of both the wine and chocolate will make the experience less than palatable. The Beau Vigne Juliet Cabernet Sauvignon is a really elegant rich Cabernet without too much fruit, but a really easy tannic structure. Undercurrents of toffee and caramel as well as brambly raspberry made it a great pairing with this chocolate bar. There was just enough fruit in the Cabernet to mellow the 72% cacao in this bar and compliment the dark chocolate. The Lake Champlain 80% cacao, the daddy of chocolate in this lineup, was next. My challenge was to find a wine not obliterated by the percentage of cacao but with enough fruit flavors and tannic presence to compliment this bittersweet chocolate. I chose the Locations F, a French blend from Dave Phinney. The blend consists predominantly of Grenache and Syrah. The wine has intense aromas of wild berry, plum and kirsch with rich ripe deep fruit flavors particularly blueberry and has just the right amount of tannins to keep up with the chocolate.
I love toffee and chocolate so I couldn’t pass up trying to pair the Ghirardelli Intense Dark Toffee Interlude with the Fred Peterson Home Ranch Muscat Blanc. This is a fortified Muscat using spirits made from a portion of the previous vintage Muscat. The high alcohol is balanced by sweet honey tones in the wine with aromas of stone fruit. It was a really great counterbalance to the toffee and chocolate and a wonderful way to finish my chocolate experiment! Everyone’s palate is different and my experience with the aforementioned pairings might be different than yours if you try this. I will share this experience with friends and family, but I have it scheduled before New Year’s so resolutions won’t get in the way! ■ For a list of Heather’s wine and chocolate pairings, including five additional ones not mentioned here, log on to the website.
28
Midwest Medical Edition
Case by Case
uld (The Stories We Co
D, David Elson, M Avera Medical
Group Onco
What do YOU have to say?
Tell)
gy, Sioux Falls
grandmother. She involved my wife’s oning, uniquE CAsEs was high functi nE OF My MOst west Iowa. She she had and lived in North ies, etc. In 1989, was born in 1900 her own grocer d home, bought age, we decide lived in her own . Because of her tumor n ovaria up in her rade a growth show surger y for a high-g was 90, she had e she becom when just 5 marker had nt therapy and, nodes. The CA-12 not to do any adjuva lymph ed also had enlarg right groin. She gist, but I to be her oncolo was elevated, too. she wanted me available and that high doses of when she said been atious have trepid she had would I was a little risk for nausea of care for what time, standard there was a high agreed. At that 3 to 4 weeks, but count up. keep her white tin, one day every ating factors to Cytoxan and cispla no colony stimul s. There were latin and side effect combining carbop Taxol. where they were on this This was before going drug. So we did was an NCI pilot y from any single Fortunately, there toxicit be more much too would it order not to get Ifosfamide so carand cisplatin in a lower dose of with , used month also a I infusion. a few days once along with a 5FU the hospital over antiemetics. in with ent along treatm her two and three, tolerable. We gave her arthritic cisplatin on days ssion. Some of one and low dose had no myelosuppre boplatin on day got nausea and never she n, With that regime back to normal. went away. s, her CA-125 was 2003 symptoms even After about 2 month She lived until s of treatment. we took it out. We did six round 100th but after 3 years, to have a great ath put in place, We were able She had a portac ovarian cancer. a relapse of her until she died. qualit y of life without ever having high a d also because But enjoye for her and she the patient was. ned birthday party because of who cautio partly being me are to We rable with right now: This case is memo situare all struggling ize that there are an issue that we we have to recogn r I think it raises ine. But I think al for ovarian cance ce-based medic median surviv to practice eviden response to guide us. The is no evidence survivors, so this ar just there five-ye ng ations where gh we do see some ed to say that anythi 3 to 4 years, althou we really prepar patients is about nt standpoint, are vise many times a reimburseme I have had to impro years, the was unusual. From ctive? Over proven is ineffe t. trials that hasn’t been a particular patien times, clinical would work for pment. A lot of to find things that er than of drug develo 15 years young this raises is that ts that are 10 to The other issue thought done on patien t this underlying r centers are being there was almos in the major cance ’t being treated see. For a while weren lly they norma them sick, the ones we would h medicine to make and lymphoma, like leukemia ’t getting enoug that if they weren tumors have a talking about things common solid Do you case or h. When you are with the most aggressively enoug rable them. In my reasonable. But memo to share with le dose may be permanently cure e arily going to the highest tolerab D? but the lowest we aren’t necess experienc gues in ME t they can stand, in the elderly, highes find the lea we not lower that is col at look your ts do better with us at: dosing we should d, some patien showe r Write toedicalEdition.com view, the drug mothe grand As my wife’s idwestM that will work. Alex@M g ce less toxicit y.” doses that produ region to
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20
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FACP
logy & Hematolo
Off Hours
Passionate Pursuits
Outside the Office
Allison Wierda Su ttle,
yo g a
MD, Ob /Gyn
Instructor
o
Case by Case to share your most By Darrel Fickb
uTSIDER S MAY ASSuME
notable, challenging or memorable cases with your colleagues
ohm
order to benefit fro m it f ully? In the book, says it Yoga as Medic would not be possib ine: The Yogic that life moves Prescription le without a g reat for Health deal of support. and Healing, with a softer author Timot hy McCall, MD, agree rhythm here “I thin k I’m able to s with many other in the heartteach because I ha yoga great s practitioners that, land. But events ve uppor t from my hu even if a student d can still sband and also my oes not partne fully understand th crash in on any of u rs. They are alway e depth of it all, he s with an can st s will or she ing to trade calls,” says D ill enjoy the full b all-too-familiar patt r. Wierda Suttle. “Y ern. When simply enefits of the art, ou do need by doing it. the pressures of m a lot of support for odern life this, but you make “Stepping out threaten to overw time for wh at’s important to yo of the crazy, fast-p helm, the world followers of yoga u and yoga gives aced you en to pay close attenti are adamant that ergy; it doesn’t take it. In on to what’s happen their ing rig practice is the fact, some ht then and there pu key to keeping of my best yoga cl mind, body ts me in touch with asses have been pos and spirit from coll a calm place deep i Instead of ta t-call. apsing under the st nside me—deep insi king a nap, I’ll go t rain. Allison Wierd de all minut o yoga for 45 of us,” writes Dr. M a Suttle, MD, es and I’m comple cCall in his forward is one of book. those followers. In tely revitalized. It to the defini “It’s like the stillne addition to being a tely gives energy.” ss on the ocean floo busy that re Sioux Falls Ob/Gy r mains n with Sanford He undisturbed, no ma Yoga instructors co tter how franalth, tically Dr. Wierd a Suttle me from all walks o waves crash on the life, from part-time also regula rly f surface.” fitness instr uctors teaches power Vinyasa Yog In other words, resu to college students a at Santosha Hot Y lts precede the unde and business in Sioux Falls. He oga standing, to people. As a rphysician-instruct r practical approa give practitioners or, Dr. Wierda Suttl ch to a of attain the possibility subject that may e says the opportunity to ing true calm. seem mystical the Accor to subtly some sheds around ding incor to Dr. medic light on what yoga Wierd a Suttle porate her invites physicians ences. al knowledge into , when peopl really is. g series, MED practice experi e who have her teaching has “I lear ned about the In this ongoin attained that calm rable cases and made the experien spirit ual and phil get together, they their most memo ce that much more sophical par ts of y share some of o often able a form strong bonds enjoyoga, too, and all t nd meaningful fo . hat is interesting,” says r both her and he “There’s an imme students. Edition Dr. Wierda Suttle r diate bond when Midwest Medical . “But, meet w for me, it is very m you ith people that do yo uch a physical thin “I thin k the m ga,” says Dr. Wierd ost exiting thing i g and Suttle. a tool for stress red a a little bit of s to take “You want to talk ab uction that impacts my medical backgro out the experience. your When overall health. Tha und, in the you spend so muc way of anatomy a t’s what I went into h of your life under nd physiology, in it for, stress, and it’s how I’ve st classes,” she always looking to t to the ayed. Of course, it’s a explains. “W hen th he future or looking lmost back to an extension of my at happens, the past, it is a relie there are some medical practice, n real ‘ah-ha’ mome f that, when you’re ow. I on you never set out to tea nts for r yoga mat, you jus some students. ch it, but what I foun I’ve had peopl t have to be present d was and re that since I was alre e from my lax. We don’t do th classes come up a ady teaching my pa at enough and when nd say, ‘Wow, tha tients, you ge it was a natu ral ext really great t the chance to do t was ension of that.” when that that w you ta with ith som lked about the thy But does But someo eone else, it else, does aa yoga ne it can be quite yoga practitioner roid fu roid functi quite meaningful.” nction on and h and ow that parti need need to embrace the ce the vast cular yoga How does an on-ca vast philosophies pose can pose can impactt it.’ on-calll phy of yoga in l physic sician When my medic ian mana managge to find the time to do e degree applie al applies to th do this? D this? Dr. s to e yoga mat li r. Wie Wierd rda Su a Suttle ttle very ke that, it’s very ssatisfy atisfying.” ing.” ■
In Review shines a light on what you’re reading, watching and writing. Don’t keep it to yourself – share your recommendations – or critiques – with fellow readers. Medicine & the Arts gives recognition to the vast undercurrent of artistic talent in our local medical community. Tell us about the art you love.
24
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ally finishe while I was d read ing at the Nat it ional Con Suppor tive gress of the Care Coa lition, an that promot organizatio es palliativ n e care. Thi a lot to say s book has about mee ting people are in thei where they r lives and meeting thei and I end ed up telli r needs ng a lot of it at the con people abo ference. ut
Med: Wh at did you
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July / Aug
find par ticu about the book?
‘heart of medicine’, acc Do you agr ording to Dr. Swe et? ee?
dr. P: The heart
of medicin talking abo e that she ut is the con is nection that with you r you have patients that can only com taking the time to liste e from n and underst stor y. Giv and their ing people time is key and time to , tim e to talk heal. This is somethi to lose sigh ng we tend t of, but yes , I agree this true heart. But the boo is the k is really much mor about so e. So man y things are intertwined
Write to us! Do you have a media review? A book, film, or article? How about an opinion on a current event? Write to us at: Alex@MidwestMedicalEdition.com
ust 2013 MidwestMe
dicalEdition. com
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pursuits – from mountain climbing and hang gliding to gourmet cooking and wine making – that fill your time outside the office
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