November 25, 2011
MEDICAL UNIVERSITY of SOUTH CAROLINA
Vol. 30, No. 15
Holiday Hearts Employee adds warmth to season in labor of love If there’s one thing Glenda Behrens knows how to do well, it’s crochet a hat. Fifty-one perfect pink ones to be exact, one for each year of her life. Behrens, administrative assistant in transportation, said she decided for her birthday this year that she didn’t want it to be just about her. She wanted to give back in some way. She got the idea that she wanted to make hats for Hollings Cancer Center (HCC) patients, a spot of cheer for cold days during the winter season. People would see the hats and request one for a relative or friend who had cancer, so she kept having to make more. That even happened on the day she came to deliver the hats, so Behrens frantically crocheted another one during her lunch to get the total back up to 51. Behrens said she enjoyed the
Glenda Behrens, above, had fun making 51 hats for HCC cancer patients. She presented them to Barbara Busby, HCC concierge, Nov. 16.
project, crocheting relaxes her, and even pulled in her friend Veronica Champion, a bus driver in transportation, who contributed 12 of the hats. Barbara Busby, HCC concierge, was on hand to receive the donation. They piled up the hats on a table in HCC’s serenity garden to take a look. Behrens said she was determined that they all be the vibrant “perfect pink” color. When Walmart sold out of the yarn, probably because of her, she waited for the next batch. Busby smiled at her determination, thanking her for the contribution. Some patients who have to have chemotherapy get the chills, and they really need the hats and blankets to stay warm. “They are very caring to even think of doing this for the patients. They are so grateful for these types of things.”
Pharmacy students gobble up chance for a good cause
Honestly, Andy Curtis, a South Carolina College of Pharmacy, MUSC campus third-year student, is a bit burned out. It’s not something a little turkey fry and Thanksgiving break can’t cure, though. “We’re guys. We’re not the best cooks, but we try,” he said, smiling as people pile in behind him to sample the goods. Curtis and some of his fellow Kappa Psi fraternity mates rose at
6:30 a.m. to fry up 11 turkeys for the annual Turkey Fry. The fry raises about a 1,000 pounds in canned goods that goes to the Lowcountry Food Bank, and it gives students a chance to socialize before the break. “We’re all burned out. It’s nice to do this and get a break before exams.” Even better, in this economy, they can meet a community need. “We like to fill up their shelves before the holiday season.”
Andy Curtis, far left, watches his friends feast at the annual Turkey Fry. To view the video, visit http://bit.ly/MUSC_Turkey_Fry.
2 The CaTalysT, November 25, 2011
Patients, families with lupus receive support
From left: MUSC nurses Deborah Browning, Marilyn Schaffner, Katherine Chase, Sarah Gayle McConnell, Tara Lowry and Leonora Horton. McConnell and Lowry were responsible for the video. View the video at https://www.musc.edu/medcenter/news/LeavingOnAJetPlane.htm.
NNICU video wins award As part of an ongoing commitment to help alleviate the nursing shortage in South Carolina, the Johnson & Johnson Campaign for Nursing’s Future hosted a gala to help ease the shortage throughout the region. On Nov. 4, 40 MUHA nurses attended the Johnson & Johnson Promise of Nursing gala. One hundred percent of the $300,000 proceeds from the event will support S.C. nursing school grants, faculty fellowships and student scholarships. This was the first time the
event has been held in the state. Marilyn J. Schaffener, Ph.D., R.N., chief nursing executive, said she was proud that MUSC’s Neonatal Intensive Care Unit (NNICU) video, “Leaving on a Jet Plane,” won first place in a video contest that had several entries from multiple organizations. MUHA had two of the four final videos, including one from GI Endoscopy called “I Promise.” “This gala was a wonderful tribute to our extraordinary nurses,” said Schaffner.
MUSC Holistic Wellness Fair 11 a.m. - 1 p.m., Nov. 29 MUSC Horseshoe Come interact with local businesses and practitioners who offer natural approaches to health and specialize in a wide array of complementary health and wellness disciplines. Services scheduled to participate include hypnosis, healing touch, acupuncture, reiki, herbs, therapeutic massage, chiropractic, rolfing transformational breath work, organic foods and juices, Community Supported Agriculture and qigong demonstrations.
Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425. 843-792-4107; Fax: 843-792-6723 Editor: Kim Draughn catalyst@musc.edu Catalyst staff: Cindy Abole, aboleca@musc.edu Dawn Brazell, brazell@musc.edu
The Catalyst is published once a week. Paid adver tisements, which do not represent an endorsement by MUSC or the State of South Carolina, are handled by Island Publications Inc., Moultrie News, 134 Columbus St., Charleston, S.C., 843-849-1778 or 843-958-7490. E-mail: sales@moultrienews.com.
More than 120 patients and their guests attended MUSC’s inaugural Annual Lupus Patient Education Seminar Oct. 15. The MUSC Lupus Erythematosus Research Group and its partners organized the educational event, that was sponsored by the Division of Rheumatology & Immunology. The brainchild of Rheumatology Fellow Melissa Cunningham, M.D., Ph.D., the patient education seminar helped to give patients the latest information about lupus to help them have the best quality of life possible. The seminar, “Everything You Need to Know About Lupus,” focused on systemic lupus erythematosus (SLE), commonly referred to as lupus, an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissues and organs. The underlying cause of lupus is not fully understood but it is known to occur 10 times more frequently among females than males and presents most often in individuals between the ages of 10 and 50. In South Carolina, between 1996 and 2003, there were 6,521 systemic lupus patients hospitalized. Lupus can affect people of any race or ethnicity, although higher incidences of the disease are seen in African Americans, with no known cure for the disease. The seminar’s lead speaker, Gary Gilkeson, M.D., vice chairman for research, Department of Medicine, said awareness, early diagnosis and treatment remain the best weapons in controlling and battling lupus. Lupus may affect many different parts of the body such as the skin, heart, lungs, brain and nervous system. Symptoms vary by individual; some of the most common include a skin rash — a “butterfly” rash over the cheeks and bridge of the nose, fatigue, mouth sores, skin sensitivity to sunlight, hair loss, joint swelling, and other more severe symptoms depending on which part of the body is affected. “If you or anyone you know are experiencing symptoms, seek medical
“As a medical and academic community, we acknowledge the importance of engaging patients and their families in all aspects of their health and medical care.” Sharon Wolf advice from your health care provider immediately,” he said. Information disseminated at the seminar included the latest knowledge in pathology, familial and genetic disposition, medical treatment options, the importance of diet and exercise, female reproductive health, clinical research trials and possible environmental influences on the disease. The event also provided a forum where patients and family members could ask questions in a supportive environment and have the opportunity to network with other patients and their families. Diane Kamen, M.D., who was instrumental in organizing the event, shared information on clinical research trials with participants. After the seminar, she received an email from Shandora Drayton, an attendee who thanked her, adding that the experience helped her not to feel so isolated. Sharon Wolf, program coordinator with S.C. Clinical & Translational Research Institute Center for Community Health Partnerships, said the seminar was organized as a community engagement and outreach event. “As a medical and academic community, we acknowledge the importance of engaging patients and their families in all aspects of their health and medical care. As health is not static, we aim to empower patients by reaching beyond their average clinic or the traditional model of health care,” she said. For information, visit http://www. musc.edu/lupus, call 792-8997 or email lupusresearch@musc.edu.
The CaTalysT, November 25, 2011 3
Courage award James S. Krause J
ames S. Krause, Ph.D., has had a few months of looking at his sleek 2011 Medtronic National Courage Award to adjust to what it feels like to join the ranks of former recipients such as Stephen Hawking and Christopher Reeve. Krause, who suffered a paralyzing spinal cord injury while diving when he was 16, now is a professor and associate dean for research in the College of Health Professions and a leading national expert and researcher who specializes in health and longevity following a spinal cord injury. He said the award has increased his resolve to continue efforts in those areas. The award is especially meaningful to Krause, since he was a patient from 1976-79 at Minneapolis’ Courage Center’s Transitional Rehabilitation Program, known then as Courage Residence. A three-year inpatient stay at Courage Center was common in the 1970s and 1980s. Today, the average length of stay for someone with a spinal cord injury is 99 days. “I am honored beyond anything that can easily be put into words,” said Krause of his award. “I was a Courage Center inpatient for more than three years and certainly would not have been able to accomplish nearly as much as I have without the benefit of the services I received there. It gave me a foundation from which to build. The
friendships I developed there have lasted. Receiving this award will help me continue my work and to positively impact the lives of people with disabilities.” Ironically, in many respects, life is much more challenging 40 years later. “There has been some visible change in terms of accessibility, but there are other barriers that continue. Traveling has become more complicated. When I was at Courage Center, things were simpler. People had the opportunity to use facilities for a much longer period of time and the benefits are likely proportional to the time allocated for preparing for life after disability. The time I spent at Courage Center has had an immeasurable positive effect on my life. Whereas I was there for over three years while I was going to school, people now are there for perhaps three months, just enough time to get some rehabilitative services. It would be much more difficult under those circumstances.” Krause said barriers often prevent people with disabilities to be able to work, even for those who have the intelligence and motivation. “I believe that creating employment opportunities and facilitating education and socioeconomic status are the keys to improving quality of life for people with disabling conditions.” After leaving Courage Center, Krause received his
bachelor’s degree in 1980 and his Ph.D. in 1990 from the Department of Psychology at the University of Minnesota. He worked at the Shepherd Center in Atlanta, a nationally-known rehabilitation facility, for 13 years. His career includes numerous published articles in professional journals, as well as numerous awards. In 2008, Krause was inducted into the Spinal Cord Injury Hall of Fame by the National Association for his research in quality of life. Krause said the awards ceremony Sept. 24 at Earle Brown Heritage Center in Minnesota was wonderful, and he was able to share the moment with his wife, Laura, friends and colleagues. It also is an opportunity to get out a message of hope, he said. “People often focus on recovery and place their hope for a good life on the extent of their physical recovery. I want people to know that, under any circumstance, disability or otherwise, there is hope. It’s important to develop goals and live with whatever circumstance you have. Focus on the things that are within your control. Be concerned about the present and the future, not about the past or lost opportunities. I truly believe that when one door closes, another opens. You have to look for, and sometimes make, those opportunities.”
4 The CaTalysT, November 25, 2011
Help less fortunate, get involved
By MiChelle MCGinley Dietetic Intern
Hot turkey, mashed potatoes with gravy, cranberries and pumpkin pie with whipped cream. Many of us can already taste the delicious holiday fare. However, for the 48.8 million Americans who live in food-insecure households, the vision of home-cooked meals during the holidays is more of a wish than a reality. According to the U.S. Department of Agriculture, food insecurity is defined as, “limited or uncertain availability of nutritionally adequate and safe foods.” Of these 48.8 million Americans, one third of them are children. While hunger is a serious issue no matter the age of those affected, the long-term consequences of malnourished children are even more severe than in adults. According to a study at Tufts University, malnourished children have significantly delayed brain development and cognitive function and perform lower on standardized tests.
Children who are food insecure have to eat what is available out of necessity, with that often being a high-calorie, lownutrient-dense diet that is a major cause of obesity and can cause intellectual impairment. These less expensive foods are frequently the default option for those shopping on a limited budget. A survey by the University of Washington found that per 1,000 calories, high energy, low-nutrient-dense foods cost $1.76 whereas nutrient-dense foods, such as fruits and vegetables, cost $18.16. This means that a typical “junk-food” diet for one day would cost $3.52, which is more manageable for a financially-limited household than spending $36.32 on healthier foods. Fortunately, many agencies like Crisis Ministries, Helping Hands of Goose Creek, East Cooper Community Outreach and the Lowcountry Food Bank help decrease the amount of hunger in the community. With the economic recession, more families are relying on these programs.
WORKERS’ COMPENSATION SOCIAL SECURITY CLAIMS PERSONAL INJURY
Employees still have time to help Angel Tree
From 2006 to 2010, the estimated number of people served by the Lowcountry Food Bank alone increased 25 percent, and now serves more than 190,000 people annually. According to the Hunger in America 2010 report, agencies that distribute food to patrons “who ‘sometimes or always’ had to reduce distribution due to lack of food” doubled from 11 percent in 2006 to 22 percent in 2010. This increase in the need for food translates into a need for more people to donate to relief organizations. Helping out these causes is simple. You can volunteer on your own or gather your family, friends, and co-workers to donate money or food, coordinate food drives or attend events that raise money for hunger programs. For information on how to get involved, visit http://www. Crisisministries.org, http://www. Helpinghandsofgoosecreek.net, http:// www.ECCOcharleston.org or http:// www.Lowcountryfoodbank.org.
MUSC Angel Tree organizers are still looking for participants to dance in a Flash Mob sequence at the MUSC Annual Holiday Lighting Event from 4 to 5 p.m., Nov. 30 at the Horseshoe. There’s still time to join in a final dance practice starting at noon, Nov. 28 at the Children’s Hospital Atrium (seventh floor). Participants are asked to contribute a $5 gift to benefit the Angel Tree campaign. The MUSC Angel Tree Toy Parade and Toy Drop off event will start at 11:45 a.m., Dec. 9 at Ashley River Tower and ending at the Horseshoe. Featured will be vehicles filled with toys, bikes donated by employees, fire trucks, a horse and Cinderella carriage, the Burke Highsteppers Marching Band, parade marshall Jesse Dasinger and Santa Claus. For information, visit http:// www.musc.edu/catalyst/angel.html, call 792-8382 or email nistal@musc. edu.
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6 The CaTalysT, November 25, 2011
MUSC, STEM collaboration brings stroke awareness
By Dawn Brazell Public Relations
Little did Fort Dorchester High School senior Michael Sweet realize that he would be asked to hyperventilate on a school visit to MUSC. Obeying the odd request, Sweet listens for the next instructions from Robert Adams, M.D., who is interpreting the results of the transcranial doppler ultrasound that’s being done. He lets Sweet know he’s in good shape with nice young elastic blood vessels. Given that Adams holds a SmartState Endowed Chair in Stroke and directs the South Carolina REACH (Remote Evaluation of Acute Ischemic Stroke) Network, this is good news indeed. Sweet was one of 27 students from Fort Dorchester High School who visited MUSC’s Bioengineering Building and Center for Rehabilitation Research in Neurological Conditions on Nov. 2 to learn more about stroke as part of their term project for the biotechnology class. This event followed up on their teacher Ben Bertolet’s summer experience at MUSC as part of the STEM (Science, Technology, Engineering, and Mathematics) Program for high school science teachers. Bertolet was hosted for his summer visit by the Clemson-MUSC Bioengineering Program. Bertolet said the day was amazing. Many of the students have family members who have suffered or died from a stroke. “Any time you can establish connections between what is learned in the classroom and the outside world, students derive significant meaning and understanding. The field trip provided my students with a relevant learning experience and shed insight into how engineers help to better mankind through the use of technology.” Students learned about the biomedical basis and risk factors for stroke and the latest in treatment and rehabilitation for victims. “Knowledge is power. Experiences like these also provide students with a spark for a future career in engineering. They might have a ‘I could do this’ or ‘I want to do this’ epiphany.” Bertolet praised The Education Foundation, an initiative of the Charleston Metro Chamber of Commerce, which received funding from Boeing to write a curriculum for a “STEM in the Workplace” class. The class exposed around 100 math and science teachers to local industries and businesses that offer STEM jobs. It emphasized project-based learning and the benefits that educational style has for students. Bertolet’s particular project was on stroke awareness. “Programs like ‘Project Lead The Way’ are trying to carve the path for the innovation generation. We are in a STEM crisis in this country, and the need for bright young minds in these fields is higher than ever before.”
Fort Dorchester High School student Michael Sweet, left, volunteers to help demonstrate a transcranial doppler ultrasound. Judy Luden performs the procedure as Dr. Robert Adams, right, explains the procedure. Also pictured is Dr. Lidia Yamada.
Fort Dorchester High School students broke into three groups to tour the Center for Rehabilitation Research in Neurological Conditions. MUSC medical leaders agree. The day began with Adams and Lidia Yamada, M.D., describing medical aspects of stroke and its prevention. Adams and Judy Luden, the Neuroscience research program coordinator, then demonstrated some of the latest technologies for stroke diagnosis. After an overview of stroke rehabilitation research by Steven Kautz, Ph.D., director of research for the College of Health Professions, the students had interactive visits at three laboratories in MUSC’s Center for Rehabilitation Research in Neurological Conditions including Locomotor Energetics and Assessment (Jesse Dean, Ph.D., and Cameron Nott, Ph.D.), Locomotor Rehabilitation (Mark Bowden, Ph.D.), and Upper
Extremity Function (Michelle Woodbury, Ph.D.). Richard Swaja, Ph.D., director of the ClemsonMUSC Bioengineering Program and coordinator for this event, said the visit was successful by all measures. “The students learned about stroke from clinicians at MUSC’s nationally-recognized Stroke Center and about state-of-the-art rehabilitation research being conducted in the College of Health Professions. The MUSC staff presentations and demonstrations were absolutely great and maintained the students’ attention and enthusiasm throughout the day. The MUSC clinicians and scientists also enjoyed interacting with the students.” Having a facility like the bioengineering building for such functions helped immensely with regard to audiovisual and interactive meeting capabilities,” he said. “It is fitting that much of the event was conducted in the new facility since stroke research is such a multidisciplinary endeavor just like bioengineering.” Swaja said this type of outreach is valuable in that it reflects the commitment and involvement of MUSC in community development and education at all levels. “It provides students at a critical stage in their development – high school juniors and seniors who are thinking about college and careers – with real world experience and exposure to opportunities in biomedicine. Activities where high school students can meet and interact with nationally-recognized scientists and graduate students and experience vibrant and relevant research and clinical environments can have dramatic impacts on career choices and directions.”
The Catalyst, November 25, 2011 7
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Student reSearCh day 2011 First place winners for poster presentations Undergraduate I: Meghnin J. Gilstrap Undergraduate II: Kimberly Arnold Clinical Prof/Masters I: Lisa M. Johnson Clinical Prof/Masters II: Chelsey Baldwin Clinical Prof/Masters III: Christa Barrett Clinical Prof/Masters IV: Kristina Andrijauskaite PhD I: Krystal L. Dole PhD II: Kayla R. Hill PhD III: Daniel Grass PhD IV: Lindsay McDonald – Kinard/Gadsden Award Postdocs/Residents/Fellows I: Charles M. Butler Postdocs/Residents/Fellows II: R. Parrish Waters First place winners for oral presentations Undergraduates III: Kyle T. Brown Undergraduate IV: Aaron M. Blackshaw
Congratulations Perry V. Halushka MUSC Student Research Day winners. Clinical Prof/Masters V: Jason B. Wheeler Clinical Prof/Masters VI: Peter H. Tang PhD V: Ludivine Renaud PhD VI: Aram Parsegian — Eric James Award PhD VII: Haley B. Lindner — William & Betty Peterson Award Postdocs/Residents/Fellows III: J. Matthew Rhett Interprofessional Awards First prize: Kathleen B. Cartmell Second prize: Caroline G. Tuttle
Health Disparities Awards First prize poster: Sybil L. Prince Nelson Second prize poster: Jenny S. West First prize oral: Kathleen B. Cartmell Second prize poster: Jason B. Wheeler Sigma Xi Awards First place oral: Kyle Strickland First place poster: Brittney M. Cox For a list of the Student Research Day winners visit http:// tinyurl.com/6vlytnh.
Teddy Bear Gift Tag tree to help children at development center
MUSC’s Annual Holiday Lighting Event 4 – 5 p.m., Nov. 30 MUSC Horseshoe All MUSC students, faculty and alumni are invited to the annual Holiday Lighting Ceremony. In addition to the tree lighting, candles will be lit to recognize those who celebrate Christmas, Hanukkah and Kwanzaa. There will be story telling, carol singing, and an appearance by a special visitor in a horse-drawn carriage. This event is presented by the MUSC Gives Back Student Volunteer Program. For more information, call 792-4094 or 792-5138.
The Teddy Bear Gift Tag trees, located at the Colbert Education Center & Library Building, Basic Science Building, College of Health Professions lobby and the Harper Student Center, contain the names of children who could use a little holiday cheer. The trees will be decorated with the tags through Dec. 1. Carolina Youth Development Center (CYDC), an umbrella organization that supervises shelters for children, provided
a list of names and gift requests. CYDC also included some needs for its shelters, such as socks, underwear, and sheet sets. Choose a gift tag from one of the trees and purchase the child’s gift request. Gifts need to be returned (in gift bags only) to the MUSC Gives Back office, Room 213, Harper Student Center, by noon, Dec. 2. The Teddy Bear Gift Tag needs to be tied around the bag handle. For information, call 792-4094.
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10 The CaTalysT, November 25, 2011
TTC helps prepare certified coders for new upgrade
By CinDy aBole Public Relations
There’s a change in the air in the world of health care and medical coding. The United Kingdom did it. So did France, Australia, Germany and most recently, Canada in 2001. What’s happened in each of these countries, and soon in the United States, is a change in the way hospitals, physician practices and health systems assign codes to report medical diagnoses and inpatient procedures. It also will impact and improve the way these entities measure health care processes and outcomes. The new system goes into effect Oct. 1, 2013. The World Health Organization initiated this change, replacing the older International Classification of Diseases, 9th Edition (ICD-9) coding structure to a newer, more expanded ICD-10-Clinical Modification code sets. For the U.S., the Centers for Medicare & Medicaid Services is guiding this change. The new coding system supports diagnosis coding in most health care settings (ICD-10-CM) and within inpatient hospital settings (ICD-10-Proceedure Coding System). To help MUHA and UMA’s team of coding professionals prepare for this change, MUSC teamed up with Trident Technical College (TTC) this past fall to conduct a mandatory study course and review of related materials that would prepare certified coders for the ICD-10 upgrades. The new system will expand available codes from 13,000 to 140,000 defined by seven alpha-numeric characters in length. It will feature updates to medical terminology and disease classifications and allows for the expansion of existing code sets, including the ability to collect more data and clinical information. It also manages statistics and provides a better overall expanded reimbursement system, according to Machelle Morningstar, Health Information Services ICD-10 educator and trainer. For eight weeks, MUHA’s Health Information Services’ 43 code specialists spent Tuesday afternoons reviewing medical terminology and learning about human anatomy, physiology and pathology. The course featured interactive learning and practice tests and ended with a final exam. Students were able to take an online or hard copy exam, which consisted of 40 multiple choice questions. They received a certificate of completion and earned 16 continuing education units toward the renewal of their professional re-certifications with either of the profession’s accrediting bodies, the American Health Information Management or the American Academy of Professional Coders. Morningstar was recruited to manage the transition and guide MUHA coding team’s training and readiness plans. She also serves on the hospital’s ICD-10 steering committee, which is leading the change in her departments and with other users. “Establishing this new certificate program gives our
Health Information Services coder Veronica Rivers, left, reviews study material with Trident Tech instructor Cathy Lowe, center, and fellow medical coder and classmate Dawn Stewart. They joined more than 40 MUHA and UMA medical coders in an eight-week review course in preparation for the new coding system changes set for October 2013. medical coders the knowledge they need to prepare for the detailed changes associated with the ICD-10 transition. Offering this course like we did helped our coding team to step outside their everyday jobs and activities each week to concentrate on new information and actions that will help them maintain their skills and proficiencies. They all worked hard individually and as a team to achieve this.” For convenience, the two-hour class was taught on MUSC's campus by Cathy Lowe, R.N., health care training manager and instructor, TTC’s Division of Continuing Education and Economic Development. Lowe is part of a team that teaches medical coding through TTC’s online training program. “MUSC coders already possess a good knowledge base of medical terminology and anatomy. What this course did was provide an opportunity to expand their knowledge with new terms instead of outdated ones and align that with the institution’s current medical practice.” Veronica Rivers, a 20-plus year medical coding veteran who codes Ambulatory Surgery cases, admitted she was slightly nervous about returning to the classroom. “Like others, I thought I knew enough, but I soon realized that I really didn’t. Completing this class has already made a big difference in my coding work
and what I need to know for my job.” Dawn Stewart began her coding career with MUSC in 2008. She was excited to learn she was returning to the classroom as part of this training. She felt the class was well organized and the course directors were positive and supportive. Both Lowe and Morningstar agree that what made the classes work was the already established relationship between MUSC and TTC through the school’s internship program, which places its medical record coding students at MUSC to gain work experience. Lowe said the existing partnership made it easy for MUSC to move forward in this direction. “Trident Tech is already offering this training with other practices and organizations impacted by this coding system change. The early preparation and planning is a win for everyone,” she said. Starting in January, the coding team will return to the classroom to continue with the next step in their training. The class, which will be led by Morningstar, will focus on coding rules and classifications that pertain to procedures and diagnoses. Meanwhile, the committee is collaborating with other hospital specialists involved in billing, electronic medical records, software development and other departments involved in the transition.
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