MUSC Catalyst 3-20-2015

March 20, 2015

MEDICAL UNIVERSITY of SOUTH CAROLINA

Vol. 33, No. 29

mUsC leaders thrilled about legislative support The South Carolina House approved a $7 billion spending plan March 12, $25 million of which will be directed to MUSC’s latest building project, the Children’s Hospital and Women’s Pavilion and another $19 million for telehealth.

Inside Women’s History montH

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Clinical resource manager makes process her own. order of Palmetto

tHe

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The proposed design of the new Children’s Hospital and Women’s Pavilion.

Staff Report Leaders at MUSC are thanking state lawmakers for including funding for the new MUSC children’s hospital and telehealth in the state budget proposal that passed the S.C. House March 12.

MUSC President David Cole, M.D., FACS, said the funds outlined in the capital reserve bill would allow MUSC to move forward with a critical project.

“Our state legislators want pediatric health care to be the best it can be for South Carolina’s children. We are thrilled and thankful that they have recognized the value MUSC brings to pediatric care for patients throughout the state. We remain committed to our part of this public-private partnership by raising at least $50 million of the $350 million needed to build and support the new Children’s Hospital and Women’s Pavilion.”

The budget proposal includes $25 million for the new children’s hospital. That is half of the $50 million originally proposed in a $500 million bond bill that failed to pass March 12 after criticism from the governor for its reliance on borrowing. The new proposal now goes to the state Senate.

The $25 million in state funding would greatly boost fundraising efforts for the $350 million Children’s Hospital and Women’s Pavilion, which is expected to open in 2019 on Courtenay Drive. The

new hospital will replace the 28–year–old Children’s Hospital currently located on Ashley Avenue. The hospital will have a family-centered approach and will provide space for additional patients, expanded services and more spacious, family-centered amenities.

Mark Sweatman, MUSC legislative liaison, said the proposed funding is great news. “The House budget plan ensures that the MUSC Children’s Hospital will continue to be a crown jewel for every county of our state and beyond for decades to come.”

Matt Wain, chief operating officer of MUSC’s medical center and chairman of the steering committee for the new children’s hospital, agreed, adding that the MUSC Children’s Hospital Board appreciates the support from the House capital reserve bill. “The $25 million dollars, as the number one priority, demonstrates statewide support to ensure the best healthcare for the children and families of South Carolina.”

Wain said support from the state is critical to be able to move forward in building a new, state–of–the–art, patient and family– centered hospital that can provide the best care for the children of South Carolina.

See Funding on page 9

Beloved professor is honored with special award.

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Recognition

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Meet Layne

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Big Data

t H e C ata ly s t online http://www. musc.edu/ catalyst

2 The CaTalysT, March 20, 2015

Medical Center

‘Making a difference every day’ Employees of the Month Award Angela Ford Volunteer & Guest Services

“I took care of a patient that was sent here from out of town. He and his wife had valet parked at Hollings Cancer Center. After his appointment he came to Endo in ART via family shuttle, unfortunately his exam was more extensive and he became an inpatient.

His wife became fearful because she could not find their car and also afraid she would not be able to get back to ART. I tried explaining but she again expressed she knew she would not find it and began to cry. I called Justin to ask for his assistance, and he too tried explaining the directions but she was overwhelmed and scared. Justin then took charge and told her he would go get the car and not to worry. He got her keys and the valet ticket; a little while later he was back with her keys. He walked her to the handicap garage near ART so she would know exactly where her car was. The couple was so grateful they could not stop talking about how wonderful Justin was and how the care they were receiving was exceptional, and I totally agree. He helped me provide safety for the couple. Justin signs his email as a “Southern gentlemen” and that he is. He greets everyone with a smile, he takes on others problems and makes them his own, he works hard to find solutions. His hard work keeps our unit running smoothly. We are a very busy unit, and he works to keep the flow moving. The patients adore him, and you will hear most of the nurses in our department talk about how awesome he is and how much he helps us.

Nominated by Christine Ferguson

Editorial of fice MUSC Office of Public Relations 135 Cannon Street, Suite 403C, Charleston, SC 29425.

843-792-4107 Fax: 843-792-6723

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.

“Angela noticed a teenager walking through the RT 2nd floor lobby in the evenings in this cold weather without a coat. She has not worn a coat since it turned cold. She told Angela that her mother did not have money for a coat. Angela purchased a coat for her.”

Nominated by Theodosia Cockrum Justin Ravenel Volunteer & Guest Services

Editor: Cindy Abole

catalyst@musc.edu Catalyst staff: Mikie Hayes, hayesmi@musc.edu Dawn Brazell, brazell@musc.edu J. Ryne Danielson, daniejer@musc.edu Helen Adams, adamshel@musc.edu Sarah Pack, packsa@musc.edu Jeff Watkins, watkinsj@musc.edu

Colleen Sacknievich Endocrinology, Diabetes & Medical Genetics “My daughter is autistic and can sometimes get nervous to try new things. Last week we had an appointment at MUSC to see a new provider, but on the morning of the scheduled appointment she would not go. I told her fine, I would reschedule it for another time, and I did. Later that afternoon she came to me and said, “appointment.” She wanted to go very badly. I could tell she was very disappointed in herself that she was uncooperative that morning which resulted in the missed appointment.

This obsession progressed so much in the last week, that I knew there was no way we were going to make it until the appointment in two weeks. She would cry and couldn’t think of anything else.

So I took her to the Developmental Peds clinic and had her sit in the waiting room while I went to the nurse’s intake room where both Colleen and Tonya Svensson were. I introduced myself, and

explained why I was there, and what Chrissy needed was an opportunity to ‘right’ what she thinks she ‘wronged.’ I told her that her next ‘real’ appointment was in two weeks, but I needed her to find some sense of closure today, and was wondering if they could give her a mock appointment. They went to the waiting room, called her name, brought us both back. They asked her typical questions of an appointment and pretended to write it down. They weighed and measured her and attempted to take her blood pressure. (No one has ever been successful with that!) She got a sticker, and was told she did a great job. Chrissy left with a big smile and gave me a high five on the elevator. It may not seem heroic to anyone else, but it was to me.

These wonderful ladies understood my need and jumped at the chance to help me and my daughter. They made one special girl feel complete, relieved and successful, and there are no words to describe the peace that brings me. ” Nominated by Katy Kuder Jie Zhang Neuroscience, Clinical Neurophysiology “A 9 year old Chinese girl (recently adopted from China by an American

See Awards on page 10

The CaTalysT, March 20, 2015 3

Spread the word: language can create more inclusive world Dr. Michael Kern, right, Regenerative Medicine & Cell Biology, watches as colleague Dr. Jeremy Barth signs the Ban the “R” word banner sponsored by students of MUSC’s Chapter of the American Academy of Developmental Medicine and Dentistry students.

Public Relations

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he term “mentally retarded,” and the variations on it, were originally used in a clinical, neutral sense. They were meant to replace other derogatory terms, like “moron” or “imbecile,” which had been used purely as diagnostic labels by health care professionals to indicate a certain condition or set of symptoms. However, after migrating from medical to popular usage, the words mental retardation, or retarded for short, are evolved to carry a social stigma and is now often used to bully, ridicule and exclude. In 2008, Special Olympics International began a campaign called “Spread the Word to End the Word,” an advocacy and awareness-building social movement to eliminate usage of the “R-word.”

This movement has achieved recognition in a federal and legal sense as well. In 2010, President Barack Obama signed into effect “Rosa’s Law,” which strikes instances of the term “mental retardation” from federal policy and law and replaces them with “intellectual disability.” This piece of legislation was named after a girl named Rosa Marcellino with Down’s Syndrome, who was 9 years old at the time. She and her family worked to pass a law that removed this hurtful language from official documents. When signing the law, Obama quoted Rosa’s older brother Nick: “What you call people is how you treat them,” he said. “If we change the words, maybe it will be the start of a new attitude toward people with disabilities.”

This sentiment is at the heart of the movement. While Rosa’s Law gave the movement federal recognition, it is still mainly a social campaign, with the most important advancements being made on the individual level.

Members of MUSC’s chapter of the American Academy of Developmental Medicine and Dentistry (an interprofessional national society whose members on campus are currently limited to the College of Dental Medicine) led the charge to raise awareness. They’ve taken the pledge

photo provided to stop using the “R-word” and have promised to help others do the same.

On March 6 and 7, MUSC members set up a table in the Horseshoe and collected signatures on a banner from students, faculty and staff who took the pledge to help remove the “R-word” from personal use, and passed out promotional materials for the national campaign. Approximately 200 signatures were collected. They also presented an honorary T–shirt to Brad Neville, D.D.S, Distinguished University Professor and director of the Division of Oral Pathology. Neville was inspired by their email campaign and replaced 41 references to mental retardation with intellectual disability in the latest edition of his textbook titled “Oral and Maxillofacial Pathology.” Laura Kuhne, dental student and president of AADMD, described the response to their campaign as “incredible.

She continued, “So many people we’ve reached have mentioned having family members and loved ones with intellectual and developmental disabilities adding that this was a campaign that was very special to them… they were very glad to support the cause.”

“It’s all about getting the word out there,” said Michelle Ziegler, D.D.S, Advanced Education in General Dentistry program director. “People are aware of the stigma associated with the word, but aren’t always sure what

a better alternative is. Just last week, a nurse asked me if the diagnosis of my patient was “mental retardation?” When I corrected her and talked about the campaign, she apologized and said that she knew the words were wrong as they were coming out, but wasn’t sure of the

proper terminology.”

Raising awareness for this issue is especially important for health care professionals. That’s why the AADMD has publicly stated in no uncertain terms its support for this campaign, “The AADMD Board strongly encourages all AADMD members to take the pledge as well as all health care organizations and their members to support and respect people with Intellectual and Developmental Disabilities (I/DD).The AADMD further encourages health professionals to advocate in their local community to spread awareness of these efforts.”

Replacing derogatory names with language that focuses on the individual in medical settings is said to foster a community of respect and strengthen the bond of trust between health care providers and their patients. It could be as simple as changing a word or asking someone else to do the same.

For information, visit www.r-word.org and take the pledge.

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4 The CaTalysT, March 20, 2015

New approach may help prevent chronic back pain By helen adaMs Public Relations

M

USC gardener Daryl Bonnette’s back pain didn’t spring into full bloom overnight. Like the flowers she tends, it grew gradually. The seeds of her pain were planted in late October or early November.

“That’s when my plants come in for the fall,” Bonnette said before one of her twice–weekly physical therapy sessions at MUSC. “I did a lot of planting, and I moved some heavy pots. I started having back spasms.”

Bonnette joined the ranks of the estimated 26 million Americans between the ages of 20 and 64 suffering from frequent back pain.

A new approach to treating that pain may be on the way. A team at MUSC’s College of Health Professions is preparing to study interventions for people who suffer from acute lower back pain to see what works and what doesn’t when it comes to preventing the problem from becoming chronic.

It’s part of a national, multi–site study that also includes researchers at the University of Pittsburgh, Johns Hopkins Hospital and Health System and Boston Medical Center. It was approved for a $14 million funding award from the Patient–Centered Outcomes Research Institute. PCORI was created through the Patient Protection and Affordable Care Act of 2010 to study the effectiveness of medical treatments and give doctors, rehabilitation specialists and patients the best information possible.

David Morrisette, Ph.D., College of Health Professions professor and Physical Therapy program director, will serve as the lead principal investigator for the MUSC site. “There has been a ton of research on back pain,” he said. “The problem is, it hasn’t changed practice or outcomes to any great degree.”

Co–principal investigator Kit Simpson, DrPH, agreed. “I think some doctors, therapists and patients don’t realize that acute back pain can easily turn into chronic back pain unless they do something to prevent this from happening.” Simpson is a population health sciences researcher and professor at MUSC. She said according to a large database she studied, only 8.5 percent of people with back pain were referred to a physical therapist. Within that 8.5 percent, the average time to referral was 123 days. In other words, they were treated in a primary care setting for about four months before being sent to a specialist.

“I think some physicians just don’t realize that early referral to physical therapy for a subgroup of ‘at risk’ patients may keep acute back pain from becoming chronic,” Simpson said.

When back pain does become an ongoing problem, she said, many doctors try medicine and then surgery if that doesn’t work.

photo by Sarah Pack, Public Relations

MUSC physical therapist Stephanie McGowan works on gardener Daryl Bonnette’s lower back.

“Instead of treating a diagnosis, the intervention will be aimed at impairments, getting the patient to move correctly and without fear.”

Dr. David Morrisette That might not be the best plan. Morrisette said they should try non–invasive treatments when possible.

“If you look at previous research, you’ll see the outcomes for what is termed as ‘nonspecific low back pain,’ which represents the majority of people with low back pain, are as good or better without surgery.”

So how should doctors help people with acute lower back pain to give them the best possible outcome?

That’s what the MUSC team, which includes internist Howard Evert, M.D., will investigate. It will receive $2.6 million to study targeted interventions to prevent chronic lower back pain in high–risk patients.

It’s one of the first studies selected for funding through PCORI’s Pragmatic Clinical Studies Initiative, an effort to produce results that are broadly applicable to a variety of patients and care situations and can be more quickly taken up in routine clinical practice.

“We’ll test interventions that evidence shows

are effective but underutilized and match them to individual patients’ impairments,” Morrisette said. “A major emphasis will be that clinics testing our treatment ideas will be trained in cognitive behavioral therapy.

Instead of treating a diagnosis, the intervention will be aimed at impairments, getting the patient to move correctly and without fear.”

Simpson said there’s a good reason for that behavioral training. “There’s a strong psychosocial component to back pain,” she said. “Mostly in how someone deals with it. If you have back pain, you tend to lie down flat and be careful not to move much. That can actually make it worse.”

The experiment will also focus on making sure the patient feels like part of the treatment team, Morrisette said. “Once the patient takes ownership of the process and gets more involved, it steers us to better outcomes.”

But patient involvement in decision-making isn’t the only key to this experiment. Technology plays an important role as well. Thanks to MUSC’s electronic medical records, when doctors look up patient information, they’ll see a prompt to make it easy for them to screen patients for chronic back pain risk and refer patients for the treatment ideas being tested. This type of study would not be possible without such EMR support.

PCORI Executive Director Joe Selby, M.D., said it’s a promising approach. “This project was selected for

See Pain on page 11

The CaTalysT, March 20, 2015 5

Meet Layne

Layne Madden College College of Medicine

How long at MUSC 4 years Family and pets Father, David Madden; wife, Katie Madden (nurse at IOP); brother, Brent Madden; a black lab, Babe; and cat, Sophie Future medical specialty Emergency medicine What is your dream job Using my skills to get paid to do something that I enjoy and find valuable. Expedition medicine might be the closest thing that I know of right now.

Best thing about living in Charleston Happy people everywhere Favorite quote Je pense, donc je suis. (I think, therefore I am.) — René Descartes

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6 The CaTalysT, March 20, 2015

Supply chain leader brings down costs, elevates quality Women’s History Month at MUSC honors women leaders with vision, commitment and heart

By J. Ryne danielson Public Relations

I

n an ever-changing health care market, new products are introduced all the time. Sorting them all, weighing their costs and benefits, can be difficult. At MUSC, every time a new product comes into the hospital, whether it’s a device, a drug or a piece of equipment, it has to come through Mary Santanna. In her role as clinical resource manager in the Division of Supply Chain Management, she is responsible for value analysis, making sure new products are both necessary and cost–effective.

“We ensure that new products are FDA-approved and clinically acceptable,” she said. “Then we make sure we’re paying an acceptable price.”

March is Women’s History Month, and MUSC is celebrating by recognizing an extraordinary woman each week.

Santanna’s dedication and leadership made her an ideal choice.

Jacquetta Ancrum, who nominated Santanna for recognition, is value analysis coordinator in Santanna’s division. “Mary Santanna reflects the pillars of an exceptional leader,” she said.

“Her leadership skills and experience have resulted in approximately $1.3 million in savings for the Medical University this fiscal year alone.”

“That’s nothing, really,” Santanna said, explaining how such financial decisions are made. “On our high–dollar items, we form a committee with members consisting of doctors or nurses from the appropriate departments, then provide them data on the particular product. We always make sure we include physicians in the decision-making process. Then we take their input and conduct a bidding process with vendors.”

Santanna recalled that when she started the hospital was paying whatever the vendors asked. Now, they are much savvier consumers.

“I just had a knack for working with vendors, coordinating with clinical staff and pulling that all together,” she said.

Santanna acknowledged that playing hardball with vendors can be difficult, but she makes sure she knows the best price going in and eliminates vendors that don’t meet it. “We submit the price to the vendors and say ‘you must agree to this pricing and, if not, you’re out.’

Generally, if you say ‘this is it,’ they’ll agree to it.”

Santanna has lived in Charleston since she moved with her husband from Philadelphia 24 years ago. “We vacationed in Charleston for several years and thought it would be a great place to raise our children,” she said.

Santanna got her start in health care as an X–ray technician, then decided to go back to school for nursing. “I won a scholarship through the 1199 health care workers’ union,” she said. “They ended up paying for my education and my salary while I went to school.”

Santanna worked as a nurse in the operating room at MUSC prior to moving into her current position.

“When I was in the OR, I worked as a staff nurse in the cardiothoracic area. I was promoted to a coordinator. Then my nurse manager was promoted to director and asked me to cover the nurse manager role. I did that for three years.”

She said she enjoyed the business and management aspects of the role, so when a position in supply chain management became available, she decided to try it as a change of pace.

Santanna misses nursing, she said, but understands her current role requires a nurse, and she feels the hospital benefits with her in the position.

Santanna greatly expanded the role and responsibilities of the clinical resource manager.

“When I came down to the department, it was a very small role,”

photo provided MUHA Supply Chain Management’s Mary Santanna, right, joined Dan Altman, Support Services Operations officer and Regine Villain, Chief Supply Chain officer, after the medical center was presented with the ECRI Institute’s 2014 Healthcare Supply Chain Achievement Award. she said. “We belonged to UHC (the University Health System Consortium, which provides data–driven cost comparisons across a wide range of academic medical centers), but accessed very little. We were only participating in about $8 million of their portfolio. In about five years, when I started utilizing their portfolio, we went from 8 million to 24 million and now we’re accessing $130 million in their portfolio.”

When Santanna started, she was the only one working in value analysis. Now, there are six staff members working with her. She was also the only female manager at that time, she said, but was used to taking initiative and working hard to get ahead.

Roni Burk, chief supply chain officer in the Division of Supply Chain Management, has worked with Santanna since 2011. “She’s absolutely amazing,” she said. “She’s brilliant, she makes me smile, and I know, without a doubt, she is totally dedicated to our organization, especially our patients.”

Santanna said her focus is trying to be a good leader for her staff. “We have some difficult goals to meet, but I always

try to be supportive and nurturing. And, I try to think strategically, to teach them what they need to know to move ahead and meet their future goals.”

A great leader, Santanna stressed, should try to create leaders by giving people the skills necessary for their success. “You have to pick the right person for the right job. You have to train them and give them the opportunity to do the job. But you also have to give them room to grow. I push my staff out there to give them the skills they are lacking. For example, if one of my staff is afraid to do public speaking, I try to send them somewhere to practice that skill.”

When she’s not working, Santanna said she enjoys gardening, swimming and trying new restaurants. So far Cypress and The Grocery are her favorites. She also enjoys traveling. “At least once a month, my husband and I plan to go away somewhere,” she said. They hope soon to have visited all 50 states.

Editor’s note: Throughout March, The Catalyst will feature women who make a difference at MUSC as part of Women’s History Month.

The CaTalysT, March 20, 2015 7

Medical admissions dean given state’s highest honor

By Mikie hayes Public Relations

S

poiler alert: In case you hadn’t already heard, ABC’s “Bachelor” Chris Soules is officially engaged to Whitney Bischoff. While that headline will surely grace the cover of many gossip magazines this week, to Paul Underwood, M.D., assistant dean of admissions and chair of the College of Medicine Admissions Committee, it’s old news.

“The Bachelor” is his favorite television show, and to say he’s a devotee would be an understatement. Not only can he tell you the name of the contestants, which women seemed like nice people and which ones made fools of themselves throughout the season, he knew weeks ahead of time that Whitney had already won the hand and heart of Chris.

“I have the inside scoop,” Underwood said nonchalantly, long before the long–awaited final rose ceremony was televised on ABC March 9. “She’s wearing the Neil Lane ring around the office.” He knew because the winner works for a fertility practice, and Underwood knows people who know people.

But when it comes right down to it, how this season of “The Bachelor” ended is not the real news. What is big news at MUSC is that in February, Underwood, a favorite faculty member of students and colleagues alike, was surprised by the MUSC Board of Trustees when he was presented with the state’s top civilian honor — the prestigious Order of the Palmetto.

The important honor was protected under the guise of his being invited to present the latest enrollment statistics to the board. It wasn’t until he noticed that his wife, daughter, grandson and fiancée were also there did he begin to suspect something fishy. Even then he couldn’t imagine what was in store for him.

Medicine’s Dr. Paul Underwood, center, is joined by his family including daughter, Mary Muller, from left, wife, Peggy, grandson’s fiance, Morgan Milano, and grandson, Ben Muller.

photos by Anne Thompson, Digital Imaging

Dr. Paul Underwood was was surprised and elated to be honored with South Carolina’s Order of the Palmetto Award.

When called on, he stood up to present his wellprepared and detailed talk, but instead, he was the recipient of a very special presentation.

Underwood was nominated by South Carolina Rep. Murrell Smith, Jr., who on behalf of Gov. Nikki Haley, did the honors, bestowing upon him the Order of the Palmetto.

The planning committee and his family did a good job of keeping the closely-held secret. “I was totally taken by surprise,” Underwood said. “I had no hint whatsoever. They really got me,” he said laughing. “That Wanda Taylor was in on it. I thought they wanted me to talk about the admissions committee. I had slides ready and everything. I truly got caught blindsided. I knew something was up when I saw my family — I thought, this is weird, something’s wrong.”

Wanda Taylor, assistant dean for admissions for the College of Medicine, said it was very special being a part of the surprise presentation for him. “I had the difficult task of getting him over to the President’s Office for the presentation without his knowledge. He thought the board of trustees wanted him to give a brief overview of the admissions process for medical school. He was speechless and truly surprised when he received the award. Dr. Underwood is beloved and well respected by everyone who knows him. His teaching, patient care and kindness have positively impacted thousands of people in the state of South Carolina. I am blessed to

work with him on a daily basis and can think of no one more deserving of such a prestigious award.”

The Order of the Palmetto is awarded to outstanding persons who make contributions of statewide significance, and Underwood was honored for a lifetime spent sharing generously of his time, expertise and wisdom to generations of patients, students and colleagues.

Rep. Smith’s father, Murrell Smith Sr., M.D., longtime friend and member of MUSC’s board, shared a personal experience that exemplifies Underwood’s national reputation as an acclaimed gynecologist.

“When I began my practice of OB-GYN, I was required to face a panel of renowned physicians in an oral examination to become board-certified. I flew to Chicago, and with much trepidation, entered the examination room to begin answering questions from those who literally had written the books that I had studied. After a time of nervously sharing my knowledge, one of the examiners noted the list of my attending physicians. He interrupted the process by stating that there would be no need for further questions. I will never forget his statement: ‘We know that you are well trained because you have had the privilege of serving under Dr. Paul Underwood.’”

Although Underwood served as president of nearly every prestigious OB–GYN society and has won numerous prominent awards, including the South Atlantic Lifetime Achievement Award in 2013, he was exceptionally humbled by this particular honor. “I was, of course, aware of such an award. This one is special.

This is ‘THE’ award. Life has been good to me, I’ve had lots of awards, but the Order of the Palmetto is the cream of the crop. I didn’t know what to say.”

Colleagues are amazed by his stamina and the schedule he keeps. By 80 years of age, it’s common for people to be 10 years into retirement, enjoying rest and relaxation, golf, travel. But that is not the case for Underwood. Monday through Friday, he wakes up early and heads into the Medical University to see patients, perform surgeries and run the admissions committee.

Having completed his medical education, internship, and residency at MUSC, as well as a fellowship at M.D. Anderson in Houston, Texas, Underwood joined the medical staff at MUSC in 1967. He served in multiple leadership positions, including director of the Division of Gyn-Oncology until 1979, when he accepted the position of chair of the Department of Obstetrics and Gynecology at the University of Virginia. When he retired in 1999, he and his wife made plans to move back to Charleston. MUSC leadership saw that as an opportunity to conscript him back into service.

One such person was Layton McCurdy, M.D.,

See Honor on page 9

8 The CaTalysT, March 20, 2015

Big Data System provides big results: study uncovers patterns The Hadoop Distributed File System, built around Google’s “Big Table” technology, can scale to internet size analysis problems. Clinical 3PO interacts with the HDFS in three ways: 1) the Relevant Feature Selection Module, which identifies features that improve clinical predictive models, 2) the Cohort Selection Module, which identifies similar patients based on treatment data and medical event trajectories, and 3) the Predictive Analytics Module, which constructs and validates predictive models based on patient data. Ultimately, that will produce more personalized medical care.

By J. Ryne danielson Public Relations “How are patients treated?” asks Lewis Frey, Ph.D., associate professor in the College of Medicine. “And what were their outcomes?”

In an effort to answer just those types of questions, MUSC is partnering with Christiana Care, a network of private, non–profit hospitals based in Delaware, to launch a big data pilot study.

Big data is a catchall term used to describe very large datasets that hold useful information, but are unwieldy to store and analyze.

Frey previously worked with Leslie Lenert, M.D., Chief Research Information Officer at MUSC, to develop a big data system for the Department of Veterans Affairs and has seen its potential firsthand.

That system, called Clinical Personal Pragmatic Predictions of Outcomes, or C-3PO, uses the VA Informatics and Computing Infrastructure database to apply past experiences of patients, stored in large-scale medical records systems, in order to predict outcomes and personalize care.

“This pilot,” he said, “is aimed at deploying that existing C-3PO system into a typical health care

environment, such as the Medical University of South Carolina.”

The clinical focus of the pilot study is identifying patients at high risk for readmission and unnecessary acute care due to cardiovascular disease and stroke. “We want to be able to identify these patients early,” Frey said, “so that we can give them the proper interventions early don’t have to ship their data off–site. They become

By using cluster analysis, a statistical technique that takes scattered data and organizes it into meaningful groups, Frey said he can predict fairly well which patients are high–risk and which are low–risk. The specific analysis he uses was developed by Patrick Mauldin, Ph.D., a professor in MUSC’s College of Medicine.

Cluster analysis is a powerful tool, capable of

See Big Data on page 11

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Funding

investments the state already has made to support telehealth are paying off.

“South Carolina telemedicine initiatives have already demonstrated a significant improvement to health care access including maximizing telestroke coverage so that greater than 96 percent of the state’s population is within 60

Continued from Page One

“This is a great start, but we will continue to move forward in our public and private campaign to raise the $350 million needed to complete this project.

We cannot do this alone and need the continued rallying of our state to give our children and their families what they deserve.”

The other positive news is $19 million in proposed funding for telehealth.

Cole said state legislators, once again, have sent a strong supportive message regarding MUSC’s and the South Carolina Telehealth Alliance’s goals of bringing world-class care to the rural areas of our state. “With the funds outlined in both the general appropriations and capital reserve fund bills, we will be able to expand and continue using the latest telehealth technologies to connect patients and providers across South Carolina with our expert health care team.”

minutes of time-sensitive expert stroke care,” he said.

“The strategic foresight of our state’s health care and government leaders has provided South Carolina an opportunity to become a national leader in telehealth and effectively transform the delivery of health care in our state.”

Nominees sought for faculty service award Telehealth uses technology to link doctors with patients in rural S.C. Sweatman said the continued support guarantees that specialized care will be delivered to every rural area of our state.

“These investments are going to make our state a national leader in telehealth and make health care delivery more efficient and effective, while saving more lives.”

Shawn Valenta, program director for MUSC’s Center for Telehealth, said

honoR Continued from Page Seven Distinguished University Professor and dean emeritus of the College of Medicine, who counts Underwood among his dear friends and colleagues. “Paul Underwood has made several remarkable contributions in his career. He provided superior leadership at the University of Virginia in his obstetrics and gynecology department as well as a leader in the medical school.

We were fortunate when he moved to Charleston as he was approaching retirement. I claim some credit for recruiting him to our admissions process. He has modernized and streamlined that process in very effective ways. Perhaps most importantly is the fact that we were friends and neighbors while we were both medical students. Although he tried, he never got me into much trouble."

Jerry Reves, M.D., Distinguished University Professor and dean emeritus of the College of Medicine, also worked closely with Underwood and holds him in the highest regard. “Paul Underwood is most deserving of the Order of the Palmetto because few people at MUSC have done so much, for so long, for so many aspiring physicians and for gynecologic patients. In heading the admissions for our medical college he has helped select and recruit the brightest and best to matriculate here and somehow has done this without the usual fuss that comes from rejecting applicants at most other state schools. He has made four deans look mighty good!”

Of all the things he feels privileged to do on a daily basis, chairing the admissions committee tops the list of Underwood’s favorite duties.

“The Medical University has been great to me.

Nominations for the MUSC Foundation’s Distinguished Faculty Service Award are being accepted.

This annual award was enacted by MUSC’s board of trustees to recognize and honor faculty members of the institution who, over a substantial portion of their careers, have provided exceptional and sustained service and contributions in teaching, research, health care or public service to the university and the citizens of South Carolina.

To nominate someone, a written

I think it’s a fantastic medical school. It’s been my foundation,” he said. “And, we’ve gotten very popular,” he added proudly. “In 2007, we had right around 2,000 applicants. This year we had 4,396 applicants. U.S. News and World Report ranked us in the top 10 of the most popular medical schools in the U.S., and numbers have skyrocketed.”

He interviews three to five prospective medical students a week, “I love it,” he said. “It’s the best part of my day, and it keeps me young.”

Of the nearly 4,400 applications they receive, they narrow the pool down to between 400 and 425 students who will get interviews. Ultimately, they will take 160 new students. “That’s about one in 2 1/2. If someone gets an interview, they’ve really made a cut. By that stage, theoretically, they would make a good medical student,” he said.

He is proud of the integrity of the committee and the fact that politics plays no role in the selection of applicants. “We treat everyone fair. We play fair. While naturally we receive letters of recommendation, no one ever says, ‘you have to take someone.’ That allows us to accept only the most qualified students which is how it should be.”

He said the worst part for him is turning people down. “They are so well-qualified. I read every single letter. The quality of the applicants is unbelievable — the number of things they have done is almost unbelievable. We could accept 250 to 300 easily; the applicants are really that good. Cutting the list down is the hardest part. It’s kind of like ‘The Bachelor,’” he said coming full circle. “Poor Chris got to the point he had to cut some really great girls — it really does just get

justification to include a typed or printed narrative of no more than two single-spaced pages directly addressing the contributions made by the nominee to MUSC and those the institution serves must be included. A copy of the nominee’s curriculum vitae or professional resumé also should be enclosed. This deadline is April 24.

Nominations should be submitted to the attention of Mark S. Sothmann, Ph.D., vice president for academic affairs and provost, 179 Ashley Avenue, Colcock Hall, MSC 002, MUSC.

harder and harder.”

But what he does after a prospective student is cut is what distinguishes MUSC’s admissions process from other schools and sets him apart as a person people admire and respect. He or Taylor meets with every single student who wasn’t admitted and provide constructive criticism and things they can do to improve their chances if they choose to reapply.

“If they don’t get in, I call it like it is — I tell them, ‘This is constructive criticism.’ The students understand I have their best interests at heart, and I’m trying to help them. They trust me.”

Students don’t just trust him, they adore him. In 2005, when the Gold Humanism Honor Society started a chapter at MUSC, it was named in Underwood’s honor. Most medical schools choose to name their chapter after a clinician the students believe to be particularly worthy. His name immediately came to mind as the person who possessed all the qualities the society values. The mission of the GHHS is to recognize physicians who are examples of compassionate leadership and patient care who serve as role models, mentors and leaders in medicine.

But it’s just that type of special relationship with the students that keeps Underwood young and working at age 80 and one of the many reasons he was awarded the Order of the Palmetto.

“I love working with the students. I’m past retirement age, but I love what I do, so I keep on working. I love the students. I love the admission committee. It’s fun.

I still see patients. Yesterday I did a hysterectomy and today, I did pelvic surgery — I just enjoy doing it and keep on doing it.”

10 The CaTalysT, March 20, 2015

Mindful winner living healthy As is often the case, it took a q A Taste of African drastic diagnosis to change the Heritage — Free cooking way Roni Burk, an administrative series starting April 18 coordinator with Supply Chain to May 16, 10 to 11:30 Management, led her life. a.m., ART Auditorium “I recently discovered I have and cafeteria. Open to cirrhosis of the liver, while anyone age 15 and older. undergoing surgery in September Class begins with a lesson, to repair my esophagus. The the heritage of African– positive side of this news was that American cuisine, followed I can stop or definitely slow the by hands–on cooking and scarring or even stop it by making tasting. Participants must even more healthy choices!” She commit to all five classes.

Susan Johnson had already quit smoking in Space is limited. Contact 2012 and lost 76 pounds. due Debbie Petitpain, 792-to spinal issues 9644. and surgery but hadn’t yet q Quit Smoking in 2015 — MUSC reached her is conducting a research study to see personal goal. if magnetic stimulation can reduce “In reading about nicotine cravings and make it easier to the February stop smoking. Payment for participation Monthly Mindful is provided and free parking is available.

Challenge For information, contact Scott [Elevate Your Henderson, 792-5560.

Heart Rate], it q Chair massages — Free massages brought home are offered to employees midday on Burk the point that no Wednesdays. Check broadcast messages one can do this for locations and times. but ‘Me.’ And ‘Me’ is ready!!” So, she q Farmers Markets — Fresh fruits and added more exercise into her schedule, vegetables are available from local including Zumba exercise DVDs; walking farmers on Fridays from 7 a.m. to 3:30 to and from the CARTA Express buses p.m. at the Horseshoe. daily; and trying to include “extra” walking evening and weekends. “My MUSC Wellness Center motivation for exercise and healthier q Piloxing Barre — This well-rounded, eating is to live longer to be with my low impact fusion of ballet, Pilates and family, which includes two precious boxing, which uses the ballet barre for granddaughters.” Roni found that after support and resistance, is an excellent losing another 15 pounds, she’s less overall endurance and improves stressed and happier to have more energy flexibility, balance and stablization. as a result of her routine.

Mondays at 5 p.m., Thursdays at 6 p.m.

There’s a new Mindful Challenge and Saturdays at noon. monthly. To begin the March Monthly Mindful Challenge: bite into better MUSC Urban Farm snacks — opt for 100 calories (or less) of q Midday Work and Learn — 12:15 to satisfying foods (nutrient–rich choices 12:45 p.m., Tuesdays preferred), take the March Monthly q Early Bird Maintenance — 7:30 to 8:30 Mindful Challenge first survey at http:// a.m., Wednesdays tinyurl.com/oy3kq75. A link to the final q Sunset Work and Learn — 4 to 5 p.m., survey will be sent at month’s end to Thursdays those who take the first one. q Third Saturday Family-friendly Work and Learn — 9 to 11 a.m., March 21 Wellness Events q Lunch and Learns — 12:15 to 12:45 q Wellness Wednesdays — 11 a.m. to p.m., Thursday, March 19: Verde 1 p.m. March 25, Children’s Hospital Restaurant; Come out and learn about lobby: GigaBite (technology and the advantages of fresh and delicious nutrition) wholesome products.

Health at work

awaRds

Continued from Page Two

family) came into our lab for an EEG. This little girl was scared and did not understand the procedure, let alone her surroundings.

Her adoptive mom was visibly struggling to communicate with the child. The child only knew her native language and very little English. Jie (also from China) saw this little girl in the lab and offered to help. Jie was able to open up communication between the girl and her adoptive mom. She helped the little girl understand the procedure.

Not only did she help translate for the mom, but she gave the mom her personal contact info so the mom could contact her if she was ever in a bind needing to communicate with the little girl. She also gave the mom information on Chinese groups and activities in the Charleston area that the mom and girl could participate in together.

Jie offered advice to the little girl and a familiarity which meant more than words to this girl. While the EEG was being performed, the little girl told Jie she wanted to be a princess, like Sofia the First. That same day, Jie ordered the ‘Sofia the First’ costume dress from the Disney Store and later delivered it to her.

She also took her measurements and has since made her a dress. The little girl recently came back to the lab to visit Jie, and she looked like a whole new person.

What Jie did for this little girl and for her adoptive mom far exceeds MUSC Excellence. This is just one of the many examples of the heart Jie has. Jie has been given the nickname “Mama Jie” in our department. She takes people under her wings and offers us guidance and wisdom.”

Nominated by Malory Pagliaro Physicians of the Month Award John Bean, M.D. Oral Surgery “On Feb. 4, the STICU transferred a patient to ART. Due to multiple factors this patient has a tenuous airway with increased work of breathing, delirium and a very anxious family. This patient

was admitted under the Surgical Critical Care Services then transferred to the MICU service then to Cardiology Heart Failure service.

When the time came to make the transfer I was concerned that the patient might get so tired and his ability to breathe on his own became compromised although it is only a short two block ride from main hospital to ART. I asked Dr. Bean, our SCCS attending at the moment, if a physician would accompany this patient with an intubation box on the ride. Dr. Bean, who is a resident, stepped up.

We were lucky to have an airway expert on our team even though this patient really was not on the SCCS service any longer, our SCCS team was here. He graciously agreed to care for this patient and came to the patient’s bedside; assessed and helped calm the patient; obtained specific equipment for the trip; helped move the patient to the EMS stretcher; and rode with the paramedics to and from ART. Dr. Bean went out of his way to provide superior care. The collaboration with the STICU team was excellent.”

Nominated by Cindy Little Elizabeth Wallis, M.D. Department of Pediatrics “We recently had a patient who had been scheduled in the wrong clinic. The family was upset with the wait, they had missed work to drive a long way and they were not going to see the provider they really needed to see.

Although Dr. Wallis was not scheduled to be in clinic, I called her to check her availability. She demonstrated her adaptability. Not only did she come see the patient, she provided a thorough visit to address all of the patient’s needs.

The family left smiling and thanking all the staff with whom they were frustrated at the beginning of the visit. Dr. Wallis has worked with the nursing staff in Rutledge Tower and demonstrated her care and concern for patients, as well as her adaptability, on a number of occasions.”

Nominated by Amy Richburg

The CaTalysT, March 20, 2015 11

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revealing hidden patterns in very large datasets.

However, the challenge, he said, is the data itself.

“We have to have a system able to scale to arbitrarily large amounts of data,” Frey said. “The VINCI system includes approximately 20 million patients, but that number is multiplied by all those patients’ events over time: medical records, procedures, medications, lab values.”

Those events make it possible to follow a patient through a trajectory of care. Frey said this is extremely important to precision medicine and much more useful than just looking at snapshots in time. Though, with so many disparate records, he added, “the difficult part is making sure the data are consistent.”

Moving to a standardized storage format is the first step toward overcoming that challenge. The Observational Medical Outcomes Partnership is a project driven by the health care community that provides a common model and vocabulary so that disparate data systems can communicate with each other.

“Everybody is talking about big data, but nobody knows how to do it,” Frey said. “Well, Google knows how to do it. They’re already using these technologies, and they’ve open sourced them so that anybody can download them and build additional technology around them.”

The system Frey is using at the VA, and that he hopes to soon deploy at MUSC, is built around Google’s Big Table data storage system and uses a software framework called Hadoop to ensure the robustness and scalability of the system.

“Hadoop is a technology for parallelizing analysis of large volumes of data across multiple machines,” he said. “The more data that you get, if your system can’t process that amount of data, you just add additional machines. The system has triple redundancy, so if a node goes down, you just pull that node, replace it, and no data is lost. The network self-heals. The information flows into the new node and the computation keeps going.”

C–3PO uses Hadoop as its core infrastructure, Frey said. “Once we’ve encoded MUSC’s data for cardiovascular disease and stroke patients into the OMOP format, we’ll be able to load it into C–3PO to conduct our initial analysis.”

Part of the pilot entails building readiness at Christiana Care in Delaware so that the C–3PO system can eventually interface with other medical institutions across the country.

“This pilot will demonstrate the clinical utility of the system,” Frey said. “The goal is to pursue a Big Data to Knowledge grant from NIH, which will enable us to deploy this at multiple institutions.”

“This is a federated system,” he said. “Hospitals

photo by J. Ryne Danielson, Public Relations Drs. Lewis Frey, right, and Les Lenart meet with colleagues from MUSC and Christiana Care to discuss Big Data pilot. the stewards of their data. But, using this system, any hospital could set up an ad-hoc network at any time and compare apples to apples across institutions. It would make collaboration easier.”

Long term, Frey would like to see this system used to improve patient care nationwide. “Multiple institutions are already using the OMOP format and our software is open source, so other hospital systems could incorporate it into their workflow.”

The reception has been encouraging, Frey said.

“MUSC has a tremendous strength in big data systems that people are very hungry for. I have an incredible set of co-investigators, and I could not do this project without them: William Weintraub, M.D., from Christiania Care and Patrick Mauldin, Ph.D., Jihad Obeid, M.D., and William Moran, M.D., from MUSC.”

Pain

Continued from Page Four

A

PCORI funding not only for its scientific merit and commitment to engaging patients and other health care stakeholders in a major study conducted in realworld settings, but also for its potential to answer an important question about lower back pain and fill a crucial evidence gap,” Selby said. “We look forward to following the study’s progress and working with the research team to share its results.”

Those results can’t come soon enough for patients such as Bonnette. “Right now, my back pain is better.

Off and on,” she said.

She’s now in her third month of treatment, trying to make sure that, as she heals, she doesn’t do something to make her lower back pain worse as she gets ready to plant spring flowers.

12 The CaTalysT, March 20, 2015

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