MED- Midwest Medical Edition December 2017

DECEMBER

2017

Vol. 8 No. 8

2017

A YEAR IN REVIEW with A FOCUS ON YOU

THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

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MIDWEST MEDICAL EDITION

2017

DECEMBER

Contents VOLUME 8, NO. 8 ■ DECEM B ER 2017

REGULAR FEATURES 4 | From Us to You 5 | MED on the Web Big changes and a NEW LOOK for MED - Everything you need to know

14 | News & Notes Your regular roundup of what’s happening around the region

Vol. 8 No. 8

2017

A YEAR IN REVIEW with A FOCUS ON YOU

IN THIS ISSUE THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

6 | Tips for Communicating with an Injured or Ill Employee How you react can set the tone for the entire situation. ■ Tonia Swan

7 | Information Management in the CIO-less Office No CIO? No problem. As long as you heed this advice from Golden West’s James Van Loan. ■ By Alex Strauss

8 | Opioids in South Dakota

Sanford Health to Study Alternatives to Opioids Avera Supports Efforts to Curb Opioid Dangers Tracking Opioids Has an Impact

10 | Talking So That Cancer Patients Can Hear A discussion of new ASCO communication guidelines with Sanford oncologist John Bleeker, MD ■ By Alex Strauss

14 | Rare Disease Registry is One-of-a-Kind Dr. Jill Weimer explains how CoRDS makes more rare disease research possible.

■ By Alex Strauss

22 | B lack Hills Cardiologists Reducing Stroke Risk with Blood Thinner Alternative This tiny device may be safer and less expensive in the long run for certain patients ■ By Alex Strauss

23 | Suicide Prevention Initiative Yields Encouraging Results 24 | National Recognition for Sioux Falls Researchers 24 |

Regional Health Rapid City Hospital Adds Advanced CT Scanner

A Year in

REVIEW with a Focus on You

In this month’s cover feature, MED continues its longstanding tradition of recapping the year’s top stories, including more growth and expansion, and how it is being managed for maximum quality and efficiency.

(Take a good look because our look and our focus is about to change. See page 5 for details.)

On the cover: Some of the people who have appeared in the pages of MED in 2017. Will you be here next year?

25 | Palliative Care Focuses on Family, Quality of Life Omaha Children’s brings palliative care to more young patients and their families.

page

16

From Us to You Staying in Touch with MED

H

ERE AT MED MAGAZINE, this is traditionally the time of year when we look back over the previous year and revisit the stories that made headlines. But this year, in addition to recapping the past year, we are excited to also be able to give you a glimpse of the upcoming year, which will include some big changes to both the look and focus of the print and digital magazines and our interactive website. These changes will make it possible for us to better serve the needs of both readers and sponsors and will further MED’s mission to be the premier source of medical community news and information for the entire region. (See more on page 5) In this issue you’ll also find a device that takes the place of

PUBLISHER

MED Magazine, LLC Sioux Falls, South Dakota VICE PRESIDENT SALES & MARKETING

Steffanie Liston-Holtrop 605-366-1479 Steff@MidwestMedicalEdition.com EDITOR IN CHIEF

Alex Strauss 605-759-3295 Alex@MidwestMedicalEdition.com

Alex Strauss and Steffanie Liston-Holtrop

blood thinners, new guidelines for talking to patients about cancer,

GRAPHIC DESIGN Corbo Design

how some area health systems are addressing the opioid problem,

and why a local rare disease registry is unlike any other. As always,

PHOTOGRAPHER studiofotografie

we also have all the latest news in our popular News & Notes

column. Don’t forget to send us your additions!

WEB DESIGN Locable DIGITAL MEDIA

We’ll be back next month with a new look and more resources

DIRECTOR Jaclyn Small

to support and enhance your business and your life. Until then,

MARKETING DIRECTOR Erika Tufton

Happy Holidays!

DEVELOPMENT DIRECTOR Kyra Torgerson

—Alex and Steff

CONTRIBUTING WRITER Tonia Swan

NEWS AND NOTES

EDITOR Virginia Olson STAFF WRITERS Virginia Olson

Liz Boyd Caroline Chenault John Knies

MAILING ADDRESS PO Box 90646 Sioux Falls, SD 57109 WEBSITE MidwestMedicalEdition.com

Steff gets a tour of the Sanford cath lab with cardiologists (and spouses) Adam and Maria Stys at a recent Circle of Red event in Sioux Falls.

Reproduction or use of the contents of this magazine is prohibited. ©2017 Midwest Medical Edition, LLC

NEXT ISSUE: January/February

2018

Next Contribution deadline December 1 Next Advertising deadline December 5 4

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.

MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.

We are excited to announce some big changes on the way here at

For the last several months, we have been working closely with our healthcare partners, digital media strategists, print and website designers, and other experts to expand our reach both in print and online, tailor our message, and serve the needs of our readers and sponsors even better.

Beginning with the upcoming January/February 2018 issue, MED Magazine will get a new look and a renewed focus on profiles, features and interviews – the “people-focused” content you have told us you want more of. By popular demand, will also expand our News & Notes section, the go-to source for a round-up of local healthcare happenings.

MED’s interactive website* (MidwestMedicalEdition.com) will become a hub for fresh health news in the region, giving you more ways to stay connected to “who’s doing what” in our large and diverse medical community.

Finally, our monthly emailed Digital Issue Announcement will also get a facelift and will become part of our weekly emailed News Updates, designed to keep you up-to-date between issues, right in your Inbox. Visit the website to get on the list (You’ll also get early notification when a new digital issue of MED goes live!)

Now, we want to hear from you. Send your article ideas, feedback, news, and calendar events to Info@MidwestMedicalEdition.com and be a part of the evolution of health news in the South Dakota region!

■ Are you cons

A new look for MED. Watch for your issue next month.

* NOTE: We will be offering a limited number of discounted Site Sponsorship opportunities to kick off these changes, including wide exposure for sponsor logos and exclusive content opportunities.

ContactSteff@MidwestMedicalEdition.com to find out more.

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VOL . 9 NO. 1

Tips for Communicating with an Injured or Ill Employee

By Tonia Swan

A

RE YOU CONFIDENT THAT YOU KNOW HOW TO BEST

communicate during the unplanned event of an employee’s injury or illness?

Here are some tips based on what has worked best for thousands of employers. They will help you get the process on the right track early and keep it there – which will help your employee recover quickly, get your workplace back to normal, and keep your costs down.

1. Immediately and visibly take charge.

Time is of the essence! As soon as you hear of an injury or illness, make a quick assessment followed by taking prompt action to respond. Those who wonder if you will stand by them when they’re hurt will be reassured. Those who might be tempted to “abuse the system” may lose their nerve when you make it clear you are going to be engaged.

2. D emonstrate concern for the employee’s well-being.

The employee may appreciate your help seeking medical care.

Also, offer to contact family or friends of the employee should they want additional support. Be certain someone from your management team is designated to follow-up with the employee during their absence from work and upon their return.

prompt them to contact a lawyer. Your personal feelings about this employee or the event are irrelevant. Stick to the facts, follow company policy, and maintain close communication with your carrier.

4. Practice the golden rule from the start.

Respond to the employee the same way you would want someone to respond to you – kind and helpful. Convey empathy and concern on behalf of your company. Ask if they have any questions, concerns, or requests. If so, how can you, as a supportive employer, assist?

5. Show your loyalty to strengthen theirs.

Why not rally around this person the same way you do when co-workers have a car accident, surgery, or trauma in the family? Consider sending a card. Have someone offer assistance with tasks the employee may not be able to do, such as yard work, snow removal, or a ride to work. The generosity of the business may generate a sense of desire to repay you – by coming back to work. ■ Tonia Swan, COTA/L, is an occupational therapy assistant and a member of the South Dakota Occupational Therapy Association. She is a Stay at Work/Return to Work Coordinator with RAS.

3. Realize you are setting the tone.

The way you physically and verbally respond to the employee may persuade their reaction to the situation. It may strengthen their loyalty, making them eager to return, or make them uncomfortable causing them to stall as long as possible. In some cases, it may

Go online to read all 9 tips!

Welcome to the

Each year, thousands choose to give the gifts of Sight and Health This season, register to be an Organ, Eye, and Tissue donor at www.dakotasight.org/register

6

Midwest Medical Edition

DISCOVER. INSPIRE. GROW.

Edith Sanford Breast Center Symposium Friday, April 20, 2018 SAVE THE DATE Edith Sanford Breast Center Symposium | Friday, April 20, 2018 Sanford Center, Dakota Room 2301 East 60th Street North | Sioux Falls, SD

Please join us to learn from local and national breast cancer experts.

011004-00548 9/17

Physicians, nurses, advance practice providers, scientists, genetic counselors, residents, students and other professionals interested in topics related to breast health are encouraged to attend.

For more information, email edithsymposium@sanfordhealth.org

Information Management in the CIO-less Office

By Alex Strauss

Chief Information Officer (CIO) - A job title commonly given to the most senior executive in an enterprise responsible for the information technology and computer systems that support enterprise goals. — Wikipedia

A

T A TIME WHEN INFORMATION

technology is playing an increasingly important role in healthcare, the job of CIO is also becoming more critical. But what about organizations that are too small to justify the expense of a dedicated CIO position? We spoke with Golden West Sales Manager James Van Loan about the challenges and the opportunity.

ED: What do you see as one challenge for M organizations that don’t have a CIO? JVL: What we find is that some organizations think their network admin can take on that role. But normally they don’t have that person as a top-level part of the team. So there is often a gap between the C-level and the IT

December 2017

group. The IT person may not understand the top goals of the organization. They are a steward of the IT infrastructure, but they may not fully understand where the organization is trying to get to.

MED: Are there things that should not be turned over to a non-C-level IT person?

JVL: Most of the C-level people that we work with don’t have an understanding of things like compliance and other things that they see as the IT manager’s responsibility.

At the same time, we find that the IT person may have a list of 20 to 30 priorities, but when we ask them what are the primary goals of the organization, they struggle to answer. So it is really critical to the success

MidwestMedicalEdition.com

James Van Loan

of an organization that these two groups find a way to work together.

MED: How should an organization start to make that happen?

JVL: They need to be asking what information across all areas of the organization – financial, operational, clinical, etc. – is most important to them. Anything they are inputting data into, they should be asking, what kind of data can we get that will help us to make strategic decisions? What does all of this data we are gathering actually mean?

This will have the most payback for the organization. ■

7

OPIOIDS in South Dakota Opioid addiction continues to be a crisis in the United States, with nearly 100 Americans dying every day from overdoses, according to the Centers for Disease Control and Prevention. More than half of all drug overdoses are related to opioids, and prescriptions for them have nearly quadrupled since 1999.

Sanford Health to Study Alternatives to Opioids Double-blind study seeks to better manage pain while lowering prescriptions SANFORD HEALTH IS ONE OF THREE SITES IN THE

US to launch a study to determine if non-opioid medications are as effective in managing pain after carpaltunnel surgery, one of the most common surgical procedures in the US. This double-blind study will evaluate the effectiveness of two pain management courses: hydrocodone and acetaminophen or ibuprofen and acetaminophen.

Opioid addiction continues to be a crisis in the United States, with nearly 100 Americans dying every day from overdoses, according to the Centers for Disease Control and Prevention. More than half of all drug overdoses are

8

related to opioids, and prescriptions for them have nearly quadrupled since 1999.

The study, which began in October, is based on work from a researcher in Canada. Health systems in Roanoke, Virginia, and Philadelphia, Pennsylvania, are also enrolling patients.

To be eligible for the study, enrollees must be 18 or older, not be on a pain management or ibuprofen or acetaminophen regimen, have no history of addiction or substance abuse, and not have cardiovascular or liver diseases. Participants will be followed for two weeks post-operation and be asked to keep a pain journal. â–

Tracking Opioids Proves Successful SANFORD’S OWN IN-HOUSE EFFORTS

already appear to be having an impact on the problem. By tracking opioid prescriptions through the EMR system and providing education around best practices, the health system has cut the number of pills and prescriptions by nearly 25% in the last two years.

Dan Heinemann, MD, is one of the people working on the opioid issue at Sanford as the VP and Medical Officer for Sanford Health Network and Clinic and described to MED some of the changes he’s seen.

“Our surgical clinicians were prescribing 30 to 60 days of meds postoperatively,” says Heinemann. “But some patients may only need five or ten, especially if the surgery corrected the issue that was causing the pain. With that data and knowing that best practice is to prescribe less, many surgeons are now prescirinb five to seven days and parntering with physicians to take care of additional needs.”

Heinemann says this practice, which has now been implemented system-wide, helps keep uneeded medications out of patients’ medicine cabinets. In addition, a controlled substance stewardship group developed short education modules around opioid use, which every clinician is required to complete.

As clinicians change their practices, Heinemann says Sanford will be ready to back them up by providing resources like drug use “contracts” for patients and enhancing areas like physical therapy, psychiatric services, and behavioral health services to help patients with issues that go beyond physical pain.

“You can’t ask someone to change the way they practice without providing them with the tools,” he says. “The bottom line is that we don’t want anyone to suffer . . . whether that suffering comes from chronic pain or from dependence on opioids, which may result in addictive behaviors or even overdose.” ■

Avera Supports Efforts to Curb Opioid Dangers AVERA HEALTH is also taking a multi-level

approach to combating the opioid abuse and overdose problem in our region.

Avera began its Responsible Prescribing Program in 2016, and more than 1,700 controlled substance abuse agreements have been signed between patients and providers since then.

Avera is also continuing to review its approaches to pain management and has also taken steps to make it easier for physicians to prescribe electronically to reduce the risk of fraudulent prescriptions.

The health system’s pharmacy joined with Hy-Vee pharmacy locations to offer over-thecounter access to naloxone, an anti-overdose drug that can save lives. In addition, AveraNow can help people in need of naloxone access a prescription through their smartphone, tablet or laptop. This service may be especially useful for individuals and families in rural areas.

In addition, Avera recently partnered with the US Attorney’s Office to host a conference focused on efforts to curb the impact of opioid abuse. That October 18 event included noted speakers from across the country and the state of South Dakota who shared insights with a crowd of more than 400, including people in law enforcement, government, healthcare, education and social services and many others. ■

9

TALKING SO THAT CANCER PATIENTS CAN HEAR

to more specific (eg, “Should clinicians discuss cost of care with patients?”). presents challenges even in the best situa“The first and most obvious challenge tions. When the patient is a cancer patient, is that a cancer diagnosis is often frightentrying to cope with the stress and coming,” Sioux Falls medical oncologist John plexity of their disease and their treatment Bleeker tells MED. “There is going to be options, communication can be especially more fear there than with, say, hypertension tough.

The American Society of Clinical or diabetes, which makes communicating Oncology (ASCO) recently published a set about it more difficult.” of guidelines and best practices designed In addition, says Dr. Bleeker, patients to help clinicians often come to the oncoloimprove how they “We always strive to ensure gist with preconceived communicate with notions of what a cancer that patients have an patients and families diagnosis means. Often, understanding of what we receiving cancer their situation and their just said. One way to do options are more complex therapy. Published this is to say ‘ Does that than they realize. as a special article make sense to you?’ . . .” in the Journal of “If you see a physician Clinical Oncology, for another type of probthe guidelines address nine questions around lem, he or she may recommend surgery or a communication in the oncology setting. treatment and that is all that is needed,” says These questions range from broad (eg, “What Bleeker. “But cancer care is extraordinarily core communication skills and tasks apply complex. You are often trying to coordinate at every visit, across the cancer continuum?”) a lot of different people and that can make DOCTOR-PATIENT COMMUNICATION

10

the whole course of treatment more difficult.”

But Dr. Bleeker says the skill needed to clearly communicate these complexities even to fearful or confused patients can be learned and mastered–with practice. “The old idea that you just have to be a good person to be able to communicate well is going away,” he says.

“We now know that there are specific skills that can be learned and that we can train oncologists to use.”

To compile the new guidelines, ASCO reviewed the medical literature for best communication practices. While the resulting tips and suggestions may not be groundbreaking for many practicing physicians, even Bleeker, who has practiced oncology at both Mayo Clinic and Sanford, says there are some “pearls” within the recommendations.

“For instance, we always strive to ensure that patients have an understanding of what we just said. One way to do this is to say ‘Does that make sense to you?’ or to ask the patient to describe in his or her own words what I just said.”

Another tip is to “ask first, then tell”, inviting the patient to lay out her questions or concerns first to ensure that they are addressed. “It can be valuable to ask the patient how much they’d like to know,” says Dr. Bleeker. “People process data in many different ways.” ■

Check out the website for a link to the ASCO research and guidelines.

Midwest Medical Edition

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December 2017

MidwestMedicalEdition.com

11

Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes

AVERA

Avera Health supported Drug Take-Back Day Saturday, October 28, by accepting unused or expired prescription medications including opioids in

its ongoing effort to help combat a national opioid abuse and overdose epidemic. Medications were accepted with no questions asked.

Avera Now is now a member of the American Well Exchange, an award-winning online healthcare marketplace run by

the telehealth company. Through the Exchange, Avera’s providers can help patients living in the Dakotas, Nebraska, Iowa and Minnesota. Patients will now be able to access telehealth visits on Amwell, the most downloaded video telehealth app.

BLACK HILLS Sabina Kadariya, RN, with Regional Health Rapid City Hospital has been recognized with a DAISY award for exceptional nursing. The

patient who nominated her said Kadariya cared for her “physically, emotionally, and spiritually” and brought her a feeling of “wellbeing, peace, and encouragement.”

Barbara J. Merriman, DO, has joined the staff of Regional Health Neurology and Rehabilitation in Rapid City.

Dr. Merriman earned her medical degree at the Des Moines University College of Osteopathic Medicine and completed her residency at the University of Pittsburgh Medical Center-Hamot Hospital in Erie, Pennsylvania.

She specializes in cerebrovascular medicine, posterior-circulation stroke, headaches, seizure disorders, neurodegenerative diseases and peripheral nervous system disorders and has extended training in nerve conduction studies and electromyography.

SANFORD Sanford Health’s German subsidiary has acquired stake in ISAR Klinik II AG, which includes Isar Klinikum, a hospital located in Munich, Germany. This

represents Sanford Health System’s first investment in an international hospital. Since 2015, Sanford Health has arranged for U.S. patients to travel to ISAR Klinikum to gain access to stem cell therapies allowed in Germany.

Sanford has also sent 11 physicians to the hospital to better understand the application and impact of these therapies.

Sanford Health launched an FDA-approved clinical trial that tests stem cells to heal leg wounds. The Phase I trial, which

opened in September, is the second adipose-derived stem cell clinical

12

trial at Sanford. It is open to participants 18 and older who have non-healing leg wounds (present for at least three months) of 1 to 9 inches and have an A1C of less than nine. The first adipose-derived stem cell trial at Sanford focused on rotator cuff injuries. The new trial will accept 36 participants.

Sanford Health recently recognized Mariah Hofer, RN, with the Medical Oncology unit and Carol Linder, RN, from Cardiology as winners of the DAISY award for exceptional nursing.

SIOUXLAND UnityPoint Health–St. Luke’s has named Kristen Beal, RN, BSN, as Infection Preventionist and Patient Safety Officer. Beal will

Askar Qalbani, MD, and Fahima Qalbani, MD,

received the Dr. George G Spellman Annual Service Award. The married physicians have served the Siouxland community’s medical needs for a combined 80 years. The award was given at the 2017 Mercy Foundation Gala November 4. Cathleen and Chris McGowan chaired the event.

Proceeds benefited Mercy’s Child Advocacy Center.

Hospice of Siouxland offered educational sessions to the public on hospice care in November in recognition of National Hospital & Palliative Care Month.

Mercy Medical Center–Sioux City recently opened its Mercy Express Care at the HyVee store located at 2827 Hamilton Boulevard. The clinic is staffed

oversee and implement new tactics and programs to enhance patient safety. Beal received her BSN from Briar Cliff University in Sioux City. She was previously a postpartum a labor and delivery nurse for seven years at St. Luke’s.

She was nominated as a March of Dimes Nurse of the Year this year.

by advanced practice providers who see patients 18 months and older on a walk-in basis.

Express Care providers can diagnose and treat illnesses such as influenza, strep/sore throat, sinus infections and urinary tract infections as well as provide basic health screenings.

UnityPoint Family Medicine–

OTHER

Sunnybrook has been recognized as a Level 3 Patient Centered Medical Home (PCMH) by the National Committee for Quality Assurance. To achieve this recognition, the clinic had to demonstrate excellence in, among other things, managing patient care, setting patient goals, identifying barriers, and properly preparing charts.

Lazaderm & Physicians Vein Clinic in Sioux Falls moved to a new location at 3401 S. Kelley Avenue in June.

Midwest Medical Edition

(l to r) Beth Graff, MRHS director of clinic & community services; Tammy Miller, MRHS CEO; Charlotte Charles, director of acute care services; Corolla Lauck, SD EMS for Children program director; and Jeremiah Schneider, MRHS ambulance services supervisor.

(l to r) Amy Klinkhammer, David Merhib, Ricki Boyle, Michael Bartley, Ed Wenniger, Dr. Andrew Ellsworth, Justin Sell, Jason Merkley, Walt Wosje, Keith Corbett, Mary Kidwiler, Ope Niemeyer, Tracy Renkly, Jim Booher and Joni Frolek.

Madison Regional Health System has received the South Dakota Heroes award from South Dakota EMS for Children.

Brookings Health System held a ribbon cutting at the West Entrance Grand Lobby on Friday, November 3, with the Brookings Area Chamber of Commerce, marking completion of the organization’s hospital expansion and renovation project.

The award was given to MRHS for their dedication to providing education aimed at reducing injuries in children. Specifically highlighted by the organization were Madison’s bike safety and care seat safety programs.

Homecare Services of South Dakota recently opened a new office in Aberdeen. Homecare Services is a private agency that

provides expert advice and specialized care to those who want to remain living independently at home. They offer a full range of in-home support services throughout South Dakota and Minnesota.

The West Entrance grants easy access to the Medical Plaza physician office building, outreach clinic, and cardiopulmonary rehabilitation area.Started in 2015, the project added 86,500 new square feet of hospital and clinic space and renovated another 17,550 square feet of existing hospital space.

Sioux Falls-based 724 Med, a healthcare and medical marketing business, has changed its name to Patient X Agency. The company

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Rare Disease Registry is One-of-a-Kind

By Alex Strauss

QUESTION: How do

you conduct research on a disease so rare, it may affect only a few thousand people worldwide?

ANSWER: Utilize data from a rare disease registry like CoRDS – Coordination of Rare Diseases at Sanford.

C

ORDS CAME OUT OF THE

Sanford’s Children’s Health Research Center which was launched in 2009 to lay the groundwork for Sanford researchers to conduct more studies on rare diseases. Although there are other national rare disease databases, CoRDS is the only one that is free and the only one that is associated with a health system. CoRDS has now registered about

4,000 people, some 800 of whom have “one in a million” type diseases.

a person full time to do it, it can be a burden on that person. It is also an added expense “We are the only rare disease registry that the foundation may not need to be that can enroll all burdened with.” rare diseases, includ- “ We knew that one of the CoRDS can big hurdles to working with take some of the ing those that are not rare disease patients is just burden off of attached to an advoknowing where those cacy group,” says these volunteer patients are,” —Jill Weimer, PhD foundations by Jill Weimer, PhD, who has been a managing the neuroscientist at Sanford since the beginning data for them at no cost, while still allowing of CoRDS. them to access it. CoRDS can even customize There are more than 7,000 rare diseases, the way the data is collected and managed about ⅔ of which affect children. Weimer to suit each foundation’s particular needs. says many patients with one of these diseases The organization can then share a link to a first get connected to a registry through a customized survey with newly identified grassroots patient advocacy organization. patients. Patients can also register themselves “They are the ones that collect the in the CoRDS database, independent of any information and they are often the keepers group, on the advice of a physician or genetic of that knowledge,” says Weimer. “But it can counselor. become time-consuming and costly to collate “We knew that one of the big hurdles to and manage all of that data. Even if you pay working with rare disease patients is just

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Midwest Medical Edition

Merry Christmas & Happy New Year

knowing where those patients are,” says Weimer. “Alzheimer’s disease is easy to identify a cohort because everyone knows someone who has it. But when you study a disease that impacts 1 in 200,000 people, it is not as easy to find those people.”

Weimer knows this challenge first hand.

Her research is focused on an especially rare form of Batten disease, a fatal childhood illness that affects fewer than 1 in 100,000 children worldwide. Weimer has used CoRDS data to develop a new gene therapy for the CLN6 form of Batten disease. Six children have received the treatment which is now in the Phase I clinical trial phase.

“To go on to the next step, the FDA requires you to show that the treatment has efficacy–that it is delaying the onset of disease,” says Weimer. But since there are only 19 children in the US with this form of Batten disease, most of whom are too far advanced to participate in a trial, Weimer says accessing patients to gather natural history is vital.

“We don’t have enough patients to do sham injections, but we still need data to show how the patients who receive the treatment are progressing in comparison to the typical child with Batten disease,” she says.

“Even parents of children who are now deceased can still participate in a natural history study.”

In addition, blood samples collected from registry participants may be used to develop biomarkers to gauge treatment response.

“We do not have good biomarkers for Batten disease, so we are trying to collect blood from patients so that we can see if we can come up with biomarkers that we can use to track during the treatment,” says Weimer. ■

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2017 16

JANUARY / FEBRUARY NEWS FLASH MERCY MEDICAL CENTER IMPLEMENTS PA

A YEAR IN REVIEW with

A FOCUS ON YOU

I

N KEEPING WITH OUR ANNUAL TRADITION, we have dedicated the next few pages to some of the year’s top stories. Many of this year’s MED cover stories have been all about growth and expansion. Sanford opened a new breast

center, Avera expanded its transplant program, LifeScape introduced new options

for autism, and Brookings welcomed patients to its renovated hospital. We also looked at the ways in which institutions across the region are working to manage their growth safely, efficiently, and cost effectively with help from telemedicine, hospitalists, and foreign-born providers. Is there someone or something you would like to see on the cover of MED in 2018? Send your ideas to Alex@ MidwestMedicalEdition.com.

2017

JANUARY FEBRUARY

7

Vol. 8 No. 1

Meeting the Need on the Prairie

Do Your Security Systems

International Medical Graduates Meeting the Need on the Prairie

INTERNATIONAL MEDICAL GRADUATES

Need a Checkup?

JANUARY/FEBRUARY

Estate Planning and Your 529

Recognizing Signs of an

EATING DISORDER

THE SOUTH DAKOTA REGION’S PREMIER PUBLICATION FOR HEALTHCARE PROFESSIONALS

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ITH THE SUPPLY OF US -born primary care providers and generalists dwindling

and the healthcare needs of baby boomers on the rise, the contributions of these international medical graduates (IMGs) are more vital than ever, especially in underserved and rural areas like ours.

One of those interviewees was Sanford Cardiologist Marian Petrasko, MD, PhD, a native of Czechoslovakia (from the part of the country that is now Slovakia). Dr. Petrasko applied to a US residency program shortly after the fall of the Berlin Wall and moved to Sioux Falls in 2004.

“We liked the Midwest and Sioux Falls was close to the size of the town where I grew up,” says Petrasko. After 12 years here, he retains his rich Slovak accent but says it has rarely been a problem.

“For most of the time, nobody minds it. It’s more like curiosity. People always ask you where you are from. But it is good the way everybody melds together here and works together.”

IMGs like Petrasko make up about a quarter of doctors practicing in the US. ■

LM SCANNING TO ENHANCE PATIENT SECURITY

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NEWLY EXPANDED BROOKINGS HOSPITAL OPENS

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MARCH NEWS FLASH FIRST FELLOW CHOSEN FOR INTERVENTIONAL CARDIOLOGY FELLOWSHIP AT SANFOR MARCH

Antimicrobial Stewardship in the Digital Age Avera Health’s Extensive Telemedicine System Helps Keep “Superbugs” at Bay 2017

MARCH

Vol. 8 No. 2

Midwest Medical Edition

ANTIMICROBIAL

STEWARDSHIP "Magic Words"

IN THE DIGITAL

AGE

and your invoices

Helping Patients with

ANXIETY

BROOKINGS

Opens Expanded Hospital

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ESP I T E Y E A R S O F WA R N I N GS about

the dangers of antibiotic overuse, and despite ongoing research and development of ever- more-powerful antimicrobial agents, the bugs appear to be winning, Those on the front line of the fight against so-called “superbugs” say it may be a harbinger of things to come if we stay on the current course.

Avera is utilizing its extensive existing telemedicine system to provide the expertise that smaller institutions need to get a handle on antibiotic use and comply with new antimicrobial stewardship standards established by the Joint Commission in January.

“What we have done is develop a model for implementing this in small, rural hospitals using technology and the resources we have,” says Infectious Disease specialist Jawad Nazir, MD. Pharmacists at nine Avera facilities have been trained to watch for red flags such as patients on two or more antibiotics for more than 48 hours, those who may be on the wrong antibiotic, any patient with a C. diff infection, and others. After review, Dr. Nazir or one of his four infectious disease partners may recommend deescalating the antibiotic dose, changing medicines, or even stopping a particular antibiotic. ■

APRIL / MAY

The Edith Sanford Breast Center Integration and Collaboration for World Class Care Area Hospital Leadership Changes

2017

Health Data in the Cloud

APRIL /MAY

Interview: Opioid Addiction and the ER

Vol. 8 No. 3

The Edith Sanford Breast Center Integration and Collaboration for World Class Care

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T

H I S S P R I N G , with an eye-catching new

space and integrated approach to breast health, including screening and diagnostics, genetic testing and counseling, cutting edge treatments, navigators, an extensive biobank, and clinical research associates in one setting, the new 48,000 square foot Edith Sanford Breast Center was poised to turn some heads. And turn them it did.

In February, Cancer Breakthroughs 2020 selected Sanford Health as one of three sites nationwide to launch the program’s first clinical trial, an immunotherapy vaccine for patients with unresectable or metastatic HER2-expressing breast cancer.

The trial is just one of a dozen breast cancer trials underway at Sanford. Some are focused on new therapies while others are exploring symptom control, nausea prevention, risk factors, etc.

“We have a reputation for getting these types of trials

up and running quickly because we are an integrated health system,” says David Pearce, PhD, executive vice president for Sanford Research.

In addition to providing a campus home for breast cancer treatment, the Center also offers stereotactic biopsy for both prone and upright 3D imaging, contrast enhanced mammography, and whole breast ultrasound. ■

JUNE NEWS FLASH REGIONAL HEALTH BREAKS GROUND ON ORTHOPEDIC AND SPORTS MEDI ■ AVERA ANNOUNCES PLANS FOR NEW SURGICAL HOSPITAL JULY / Midwest AUGUST NEWS F Medical Edition

D HEART APRIL / MAY NEWS FLASH SIOUXLAND DOCTORS RUSH TO AID AFRICAN BUS CRASH VICTIMS

Inside Regional Health's Automated Laboratory

Make Your Airline Miles Go Further

JUNE 2017

Does Your Patient Need Hand Therapy?

Vol. 8 No. 4

Midwest Medical Edition

JUNE

Forward Momentum Brookings Health System Steps Into It’s Future with Bold New Expansion

S

forward

MOMENTUM

INCE THE FIRST

Brookings Hospital opened its doors in 1964, the community has grown by 60 percent. With that growth have come changes in the community’s healthcare needs. More than 70 percent of Brookings' patients now come to the hospital on an outpatient basis, in contrast to just 20 percent in 1964. Today’s patients are also sicker and have higher expectations.

The 62,000+ square foot expansion and renovation project, which opened for business in February, took a little over a year-and-a-half but put Brookings decades ahead of where it had been

BROOKINGS HEALTH SYSTEM STEPS INTO ITS FUTURE WITH BOLD NEW EXPANSION

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2017

JULY / AUGUST

Vol. 8 No. 5

Examining Your CYBER ATTACK STRATEGY BETTER COSMETIC RESULTS

After Breast Surgery

OPIOID ADDICTION

Among Medical Professionals

ASD New Early Intervention Options at LifeScape

A

in its ability to efficiently care for patients.

Larger patient rooms maximize patient-caregiver interaction and improve efficiency and larger ORs are fully-integrated with high-tech lighting and video capabilities.

The five LDRP suites (up from 3) and redesigned entrance and public spaces are visible reminders of the hospital’s forward momentum while other upgrades, including the new HVAC system, private transport corridors, and new pharmacy, are less visible but just as vital to the hospital’s long-term success.

“I’m a big proponent of providing the highest quality of care we can possible provide,” says CEO Jason Merkley. ■

JULY / AUGUST

Early Intervention for Autism Spectrum Disorder LifeScape Offers New Options for the Youngest Patients

THE SOUTH DAKOTA REGION’S PRE M IER PUBLICATION FOR HEALTHCARE PROFESSIONALS

ƒ MED JulyAug 2017.indd 1

6/19/17 3:19 PM

CCORDING TO THE CDC, ONE IN 68 CHILDREN is diagnosed with Autism

Spectrum Disorder (ASD) – up from 150 in 2002. LifeScape is offering innovative and evidence-based new options for earlier ASD intervention. A child who has been diagnosed with ASD as early as 12 months can now receive multidisciplinary therapy through Early and Intensive Behavioral Intervention (EIBI) or through a new approach called the Early Start Denver Model (ESDM). Both models utilize principles of Applied Behavior Analysis (ABA). Under a new law, children with autism in South Dakota will be eligible to receive ABA services through the age of 18.

Delivered under the direction of Board Certified Behavior Analysts (BCBAs), the EIBI approach consists of identifying which skills the young child lacks, breaking these skills into component parts, and working on these separately, until the child has mastered a sequence and can perform the task independently.

ESDM utilizes a curriculum that includes ABA principles and addresses skills across all domains of development–fine and gross motor, communication, joint attention, activities of daily living, etc.–to provide a multidisciplinary approach for very young children and their families. ■

CINE INSTITUTE ■ USD SANFORD SCHOOL OF MEDICINE RELOCATES RAPID CITY CAMPUS DOWNTOWN LASH HELMSLEY CHARITABLE TRUST PASSES $300 MILLION MILESTONE FOR RURAL HEALTHCARE

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SEPTEMBER/OCTOBER NEWS FLASH SANFORD OPENS IMAGENETICS BUILDING

■

MERCY

2017

SEPTEMBER OCTOBER

Vol. 8 No. 6

SEPTEMBER / OCTOBER

Hospitalists and the Changing Face of Rural Healthcare CONSIDERING long-term care insurance

Avera offers BREAST CANCER BLOOD TEST

Why Fall is prime time for

Black Hills travel

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Did you miss an issue? Want to read a story again? We’ve compiled the full articles for you on our website.

Hospitalists and the Changing Face of Rural Healthcare

H

OSPITAL MEDICINE IS THE FASTEST GROWING MEDICAL SPECIALTY in the

history of American medicine.

Today, with the profession now 20 years old, hospitalists, who come from many different specialities including family medicine, internal medicine, pediatrics, even Ob/Gyn and cardiology, are being defined in terms of their own pivotal role in the medical system. While the largest health systems in South Dakota have had hospitalist programs in place for some time, a growing number of rural facilities and smaller hospitals are also now coming on board.

Prairie Lakes Hospital in Watertown has six hospitalists (some of whom are locum tenens) and one nurse practitioner providing care 24/7 and benefitting both the hospital and community in multiple ways.

“Hospitalists are proving to be very valuable in terms of saving money,” says Mian Javaid, MD, who holds hospitalist positions in Watertown and Bismarck, ND. “It reduces the number of tests that get done because we can order what we need right when we need it. Smaller hospitals are also recognizing the benefits of always having one or two doctors in the hospital providing continuity.” ■

NOVEMBER NEWS FLASH RAPID CITY MEDICAL CENTER BRINGS 3D MAMMOGRAPHY TO 20

MEDICAL CENTER USES NEW DRUG ELUTING STENT

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AVERA OFFERS NEW BLOOD TEST FOR BREAST CANCER

NOVEMBER

A Good Match Liver Transplantation Fits Seamlessly Into Avera’s Transplant Program

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T HAS BEEN A YEAR SINCE SOUTH DAKOTA MEDICINE reached a major milestone

when Avera Transplant Institute performed the region’s first-ever liver transplant in Sioux Falls. It was the culmination of an evolution that began in 1993 with the region’s first kidney transplant.

“Just as with kidney’s, we were always aware that there were patients in our area who could benefit from liver transplant,” says transplant surgeon, Jeffrey Steers, MD, who joined Avera in 2012 and helped to build the liver transplant team. “Historically, many of these patients were never referred for transplant at all.”

Over time, Avera developed an extensive hepatology program. As the number of patients with cirrhosis and end-stage liver disease grew, so did the number of physicians and allied health professionals needed to support them. The program’s integrated team now includes nurses, surgeons, anesthesia and critical care specialists, pathologists, nephrologists, and others–all with expertise in the special care of liver patients. Liver transplantation was the natural next step.

“We now have the capacity to provide anything a patient with liver disease would need,” says Dr. Steers. ■

THE BLACK HILLS

■

REGIONAL HEALTH BEGINS TRANSFORMATION OF RAPID CITY HOSPITAL CAMPUS 21

Black Hills Cardiologists Reducing Stroke Risk with Blood Thinner Alternative Watchman device may be safer and less expensive in the long run for certain patients

By Alex Strauss

A

LIFETIME OF BLOOD thinners–

and the risks associated with them–is no longer the only option for Black Hills area patients diagnosed with non-valvular atrial fibrillation.

Rapid City cardiologists Joseph Tuma, MD, and José Teixeira, MD, have begun offering an implantable device called Watchman to qualified patients who want or need an alternative to long-term blood thinner use.

The tiny device covers the mouth of the left atrial appendage which, according to Dr. Tuma, is the source of blood clots in 90 percent of patients who suffer from cardioembolic complications of atrial fibrillation.

22

Using a combination of fluoroscopy/ angiography and transesophageal echo for guidance, the device is implanted percutaneously through a small puncture in the right femoral vein followed by a puncture through the interatrial septum. It takes about 45 days for the area to be sealed completely off from the rest of the left atrium.

“By plugging the left atrial appendage, the Watchman device prevents ejection of clots into the circulating bloodstream, thereby reducing the risk of stroke,” Dr. Tuma tells MED. “The prevention of strokes is the same as if the patient of continuously on a blood thinner like coumadin,” adds Dr. Teixeira.

“But unlike the anticoagulants which only work in the patients take them, the Watchman device, once implanted, is good for the long run with no other maintenance required.”

While the device is not an option for people who have already had clots inside the left atrial appendage or those who are unable to take a blood thinner for at least the 45 days needed for the seal to form, it may be ideal for those at higher risk of bleeding or who have already bled.

According to Dr. Tuma, “The ideal patient for the Watchman device is someone with nonvalvular atrial fibrillation with a CHADS2Vasc score of 3 or greater, placing them at increased risk of stroke, who has experienced difficulty with anticoagulation either because of bleeding episodes, intolerance, or inconsistent therapeutic anticoagulation.”

Five year data on Watchman presented at the TCT Conference in Denver last month suggests that patients with implants not only have a stroke risk comparable to those on warfarin, but showed a 55 percent lower risk of hemorrhagic stroke.

Watchman is typically covered by insurance for patients who meet the criteria. A budget impact study also presented at the TCT conference showed that, at ten years, left atrial appendage closure with Watchman was less costly than with warfarin or non-warfarin anticoagulants.

“The long-term cost is favorable because there are no tests or other maintenance required once the device is deployed,” says Dr. Teixeira. ■

See our website for more on Watchman from Drs. Tuma and Teixeira.

Midwest Medical Edition

Suicide Prevention Initiative Yields Encouraging Results ONE YEAR AFTER IMPLEMENTING a suicide prevention initiative,

Avera Health is reporting significant reductions in suicidal behavior among current and past behavioral health inpatients.

Over the past year, Avera has been integrating behavioral healthcare into more aspects of overall care, using a quality improvement framework modeled on the National Action Alliance for Suicide Prevention’s 2012 key concept, Zero Suicide.

That program, which Avera initially implemented in its behavioral health inpatient units, seeks to engage more healthcare systems to enhance commitments to patient safety and to the safety and support of clinical staff that treat those patients.

According to Matthew Stanley, DO, Vice President for Avera’s Behavioral Health Clinical Service Line, Avera has seen a 97 percent system-wide decrease in suicide attempts among behavioral health inpatients and a 98 percent reduction in ER visits by previous behavioral health inpatients in Sioux Falls, Aberdeen and Marshall, Minnesota.

There has also been a 92 percent system-wide decrease in repeat behavioral health assessments of previous behavioral health inpatients.

Among other things, Avera is working to better coordinate behavioral health-related support for all providers using telemedicine resources like Avera eCare and the AveraNow app. Psychiatric medication consults, genetic testing, and triage therapy are additional approaches that Avera is applying to stave the “silent epidemic” of suicide in the United States.

“Avera’s focus is multi-faceted and much of our effort revolves around better screening to identify patients who might be at risk, as well as early intervention and enhanced access to treatment services,” says Stanley. “We are meeting patients where they are since many people who complete suicide see a health provider in the month before their death.” ■

December 2017

MidwestMedicalEdition.com

Ask ur tO Abou dge Lo e! g Packa

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Photo courtesy Regional Health

National Recognition for Sioux Falls Researchers

By Alex Strauss

S

ANFORD HEALTH’S CLINICAL Research Team has been

recognized by the Association of Community Cancer Centers (ACCC) with the David King Community Clinical Scientist Award. The award, which was presented at the ACCC 34th National Oncology Conference in Nashville, recognizes researchers who are leading the development of new clinical studies or are actively developing new screening, treatment, or support tools for cancer patients.

“We are a bit of an anomaly in the country and that has to do with our integration,” said Lora Black, RN, MPH, Senior Director of Clinical Research in an interview with MED. “It really is one big team effort between researchers and the clinical side. We are able to fill gaps because we understand where clinical trials are needed.”

Recognizing the need for trials focused on genomics and personalized medicine, Sanford researchers developed and launched the GEMMA trial in 2014. GEMMA utilized nextgeneration gene sequencing technology to identify cancer patients with genetic mutations that could impact their treatment.

Sanford is one of only 34 National Cancer Institute community research programs, meaning research programs that are not directly linked to an educational institution. Dr. Black says Sanford’s goal is to not only participate in ongoing national trials, but to develop more studies like GEMMA, that are initiated from within.

“We have developed quite a few physician investigators who are practicing oncologists,” says Black. “We anticipate growing our portfolio and developing trials that can be applied to other community cancer sites around the country.”

“We want every patient within Sanford to have the ability to participate in a clinical trial, if they choose to.” ■

MED QUOTES

“ 24

In the depth of winter I finally learned that there was in me an invincible summer. —―Albert Camus

”

Regional Health Rapid City Hospital celebrates the addition of a third CT scanner, an advanced a Siemens Somatom CT, during a ribbon-cutting ceremony Thursday. From left: Wendy Meadows-Anderson, Jamie Madden, Jimmy Seward and Chris Hargens.

Regional Health Rapid City Hospital Adds Advanced CT Scanner REGIONAL HEALTH RAPID CITY HOSPITAL has installed a new

advanced CT scanner, bringing the number of CT scanners to three in the hospital’s diagnostic arsenal. The addition of the new unit means better medical images, less radiation, and quicker turnaround times for patients awaiting results.

“Demand for CT imaging has grown exponentially over the past five years. Lower radiation has increased the safety, and better technology has expanded its uses,” said Senior Director of Medical Imaging Services, Jamie Madden.

The addition of the third device, a Siemens Somatom CT, will reduce the turnaround time to complete CT-guided biopsies for suspected cancers in the lungs, liver and kidneys. Madden says the hospital’s goal is to deliver biopsy results in less than three days.

Invented 45 years ago as an improvement on conventional X-rays, the CT has seen technology advances that mirror those of digital photography. The improved clarity means less time spent manipulating images to make an accurate diagnosis. “It’s like moving from a Kodak Instamatic 110 to a 35mm camera, to digital photography,” Madden said. “Physicians love it.”

The Siemens Somatom CT’s software and hardware combine to produce superior images with a much-lower dose of radiation.

“This is a state-of-the-art CT scanner. It’s a tremendous investment in our community. It gives us an opportunity to see disease in ways that we were never able to do,” says radiologist David White, MD. The third CT unit was scheduled to be part of the expansion of the Emergency Department, which is underway. Given the current CT demand, however, Regional Health Leadership decided to put the new device to work right away. The CT will be moved to the new ED when construction is completed. ■

Midwest Medical Edition

Palliative Care Focuses on Family, Quality of Life THE ADDITION OF A FULL-TIME physician dedicated to the Hand in Hand palliative care program at Omaha’s Children’s Hospital & Medical Center is bringing the multidisciplinary, team-driven service to more area patients and their families.

In the first three months after the arrival of Meaghann Weaver, MD, MPH, Children’s Specialty Physicians, Hematology/Oncology & Palliative Care last fall, the number of palliative care consultations at Children’s rose from an average of three per month to a total of 110. The number of patients in the program has now risen from 10 per day to approximately 25 per day.

“We are seeing a definite and growing need for these services,” says Dr. Weaver, who describes palliative care as “whole

December 2017

person care” for children with life-limiting or life-threatening illnesses.

Pediatric palliative care focuses on the prevention and relief of suffering through early identification, attentive assessment and compassionate treatment of pain and other symptoms. Not limited to terminal conditions, the Hand in Hand palliative care program at Children’s begins with the diagnosis of a serious or chronic illness and continues regardless of whether or not a child receives treatment directed at the disease.

“It is a misconception that we are called in only when the situation is hopeless,” says Andrew MacFadyen, MD, medical director of Children’s Palliative Care team. “In reality, the earlier we become involved, the more good we can do for the patient and the family.”

The Hand in Hand team offers a variety of inpatient consultative services including, but not limited to, plan of care creation; integrative therapies such as Healing

MidwestMedicalEdition.com

Touch, massage therapy, and aromatherapy; emotional, spiritual and decision-making support; advanced care planning; attentiveness to caregiver resilience; hospice and bereavement support; pain and symptom management and the longitudinal coordination of healthcare and community resources.

Weaver says the team partners with patients, families, and primary care physicians to coordinate services aimed at supporting quality of life.

“We don’t just ask the parents’ opinion.

We include the patient’s voice,” Dr. Weaver says. “We can have a much greater impact on symptom management if we know not only how the child feels but also what is important to them.” The team also involves siblings and grandparents in its caregiving approach.

“Our goal is not to add to the family’s burden, but to lighten the load as much as we can.” says Dr. MacFadyen. ■

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Photo courtesy Mercy Medical Center

Ugly Sweaters Make Life Safer for Home Care Patients

Mercy's Revathi Truong and Wendy Beavers show off some of the sweaters that were available at the Ugly Sweater event to benefit Mercy Home Care patients who need additional medical equipment.

MERCY HOME CARE HOSTED AN UGLY SWEATER sales event in November to raise funds for safety equipment in the homes of needy patients.

Bath benches, grab bars, hand railings and other safety equipment can often make the difference between a patient being able to stay in her home safely and independently or having to move.

“We often have patients who need safety devices/equipment but have no way of paying for them,” says event organizer Wendy Beavers. “Sometimes there is no family or no insurance coverage or the patient has very minimal income. Mercy Home Care does not want these barriers to prevent our patients from remaining safe in their home environment.”

Several different area groups helped provide and/or design more than 170 “ugly” sweaters for the sale, including the Siouxland Crafters Club, the Siouxland Center for Active Generations, Struck, Sioux City Fence, Casey Greer and others.

The sale will run again December 4-5 in Mercy’s South Lobby. ■

Learning Opportunities 26

Check out MED’s online calendar for upcoming events and CME opportunities Midwest Medical Edition

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