Orlando Medical News June 2018 by Orlando Medical News

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Mitigating Florida’s Opioid Crisis

7 key items to know about the new controlled-substance law HB-21 By PL JETER

Florida lawmakers hope new rules governing controlled substances will mitigate the damaging effects of the opioid crisis. Because understanding the 160-ish page House Bill 21 (HB 21) is a daunting task, physicians should know its key components. “We’re a bit worried as an organization there’ll be a large number of physicians and other providers in the community who are unaware of the impact of this bill and may be noncompliant,” said Fraser Cobbe, executive director of Orange County Medical Society and Seminole County Medical Society and conference host of an educational webinar on the implementation of the bill. For example, in North Carolina, after

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similar controlled-substance legislation was implemented via the NC STOP ACT on Jan. 1, thousands of unaware physicians continued prescribing controlled substances in the same manner. “We want to make sure we don’t repeat that experience in Florida,” he said.

Mandatory Physician Education Perhaps the most urgent aspect of HB 21 revolves around mandatory physician education. Before Jan. 31, 2019, all DEA-registered medical providers must take a Board of Medicine-approved 2-hour CME course on prescribing controlled substances. This educational component must be repeated with every license renewal. “The best way physicians will understand

the implications of this bill is by taking the course ASAP,” emphasized Cobb. “It’ll provide a more official overview of the legislation and various components and penalties for noncompliance.” So far, Florida Medical Association, Florida Osteopathic Medical Association, Florida Association of Family Physicians and Florida College of Emergency Physicians are approved providers for the new mandatory course. Online courses will be available; some are free. The medical societies of Orange and Seminole counties will provide the course twice this summer: July 13 and Aug. 18. “Even if you no longer write for opioids or other scheduled drugs, every person registered with the DEA and authorized to

prescribe controlled substances must take this course,” he said. PAs and ARNPs are already mandated to take a 3-hour course to prescribe as required by legislation passed in 2016 allowing both groups the ability to prescribe controlled substances.

Mandatory Review of the Prescription Drug Monitoring Database (E-FORCSE) Effective July 1, prior to prescribing a controlled substance, every prescriber must consult the database to review the controlled substance dispensing history of patients 16 or older. The only exception: (CONTINUED ON PAGE 4)

HEALTHCARELEADER

Maggie Bonko Healthcare means everything for South Seminole Hospital COO Ask Maggie Bonko and she will tell you: Good quality health care is not just about treating patients when they are sick, “it means caring for all aspects of a person… it’s all encompassing.” The COO of South Seminole Hospital, part of the Orlando Health System, is putting that philosophy to work as she oversees the completion of a new $42 million, 30acre medical complex in Lake Mary. The complex is part of the new mixeduse community, New Century, in Lake Mary that will have offices, residences, hotel and retail elements. The goal for this community is to become a sustainable place to live, play and work, and the medical wellness town

center is a big part of that. As someone who grew up in eastern Kentucky, “surrounded by nurses,” Bonko said, “I like looking at health care as a wholelife-package.” The project will feature a free-standing emergency room with 24 exam rooms, an imaging department, ambulance bays and a helipad. In addition, a four-story, 90,000-square-foot medical pavilion will be home to a wider array of outpatient services that are geared to serve Lake Mary’s current needs while being able to anticipate and adapt to the community’s future needs. The health care site includes an acute care hospital, additional medical offices, a potential ambulatory

surgery center and other health and wellness concepts. The new medical complex is just one element in Orlando health’s presence in Seminole County. “We have 15 access-points for the community,” said Bonko, “including five urgent care facilities in which we partner with other healthcare providers.” These “access points” include the South Seminole Hospital, primary care and urgent care offices, imaging clinic, cancer center and the Lake Mary project. It’s a sprawling set of (CONTINUED ON PAGE 6)

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PHYSICIANSPOTLIGHT

Jamin Brahmbhatt, MD Extending mens’ lives one very quick mile at a time

It sounds like the makings of a buddy movie. Two friends set off on a 10-day road trip across America in an exotic sports car. Their mission is simple: Have a good time. Visit half a dozen cities. Eat good food. Hang out with friends and people whose heads spin around at the sight of this swoopy coupe, a rare BMW i8 – a 360-horsepower, highwaygobbling hybrid with gravity defying doors that rise into the air. And when the crowds gather – as they inevitably do, thanks to a savvy publicity team – the pair talk to them about the things men should be doing in order to live longer. This is the fifth year that Drs. Jamin Brahmbhatt and Sijo Parekattil have started summer with the epic road trip across the country they call the Drive for Men’s Health™ (www.driveformenshealth.com). Brahmbhatt and Parekattil are co-directors of The PUR Clinic (Personalized Urology & Robotics, at South Lake Hospital in Clermont), which is part of the Orlando Health system. During the road trip, they make stops in major cities to participate in educational lectures and activities to raise awareness for men’s health, conduct public events and do interviews with local news outlets. Lots of interviews. The car is a big part of what draws interest, said Brahmbhatt. “We used to do this with a Tesla,” he said. “But now those cars aren’t as unusual as they used to be. So Sijo – who is a real car enthusiast – changed to the BMW i8. We use the car as way to start the conversation. We tell men, ‘The car has a manual – but your body doesn’t. So, you really need to pay attention to the warning lights. If something doesn’t feel right, if there is blood in your urine, pain in your chest or you have a headache that doesn’t go away, you need

to get checked out.” The doctors became interested in increasing awareness about men’s health when they noticed a glaring statistic: the life expectancy for men is significantly less than for women. In fact, the average is about five years less. “We want to help close that gap by encouraging men to take better care of themselves and by becoming more aware of little warning signs they might be taking for granted.” This year the theme is about eating healthier while still eating well. After kicking off the trip with a fashion show-themed event in Orlando on June 1, the doctors will visit hot spots for local food and chefs in New York City, Philadelphia, Columbus, Ohio, Chicago and Houston before returning to Central Florida. “We will be talking about how to eat healthier and why this is such an important part of men’s overall health,” said Brahmbhatt. In past years, the Drive for Men’s Health (D4MH) trips have focused on exercise and fitness, nutrition and sexual health issues that are sometimes considered taboo. Since it was founded, the D4MH has reached millions of people with important messages surrounding men’s health issues. Beyond awareness, the D4MH raises funds in support of the latest research and development of best practices in urology care. Each year, the D4MH donates tens of thousands of dollars to help underwrite

research, educational, and awareness-generating efforts. Last year alone, the D4MH traveled more than 4,000 miles. Using the weeklong drive to garner publicity, the D4MH reached millions of people through digital social media platforms as well as traditional media channels. The doctors appeared on the CBS This Morning national television show, Delta’s Sky Magazine and scores of media outlets in between. “There is a lot of research that goes into deciding the theme of the D4MH and the cities we will visit,” said Brahmbhatt. It can be a grueling experience, he said, “We have to think about what is feasible in a week.” To accomplish this, the D4MH has an eight-person road team that follows them and supports them at each stop. In addition, there is an eight-person team that stays home and helps to coordinate publicity around each of the events and on all of the digital social media platforms. Although each city is special, this year, Brahmbhatt said, he is especially looking forward to the stop at New York’s Essex Street Market, where they have partnered with a local chef, and where the New Jersey native will have a chance to see friends and family. But what he really is looking forward to is the chance to make a difference in someone’s life. “When we started,” he said, “I just wanted to get one guy inspired to make

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some healthy improvements in his life. Now, I know for a fact that we have helped thousands.” A highpoint for the doctors is when “somebody’s mother tells us that because he saw us on TV, her son decided to visit his doctor, or some guys will come up to us to how they have gotten fit, lost weight and are feeling better.” “Guys get stressed out about their health,” said Brahmbhatt. “They don’t want to go to the doctor because they don’t think anything is wrong, or sometimes they are afraid of what might be found. We want them to find a physician – just like they might look for a mechanic for their car – who can serve as their guide. And we want them to understand that they need to take it one mile at a time.” The opportunity to work with a supportive healthcare system like Orlando Health has also been a factor in the D4MH’s success. “From the second we walked into South Lake Hospital five years ago, we loved it,” said Brahmbhatt. “They were willing to take on these two crazy doctors and their crazy ideas.” Even though the D4MH will wrap up back in Clermont, Fla., on June 9, Brahmbhatt and Parekattil’s work to increase awareness of men’s health issues will continue. “We don’t stop,” said Brahmbhatt. “The messaging continues all year.”

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Mitigating Florida’s Opioid Crisis, continued from page 1 scripting a nonopioid Schedule V. “If the database isn’t operational by fault of the database or your own technical difficulties, the bill requires you to document the reason why the database wasn’t consulted,” Cobbe said. “However, in that case, you cannot prescribe more than a 3-day supply of a controlled substance.” Because there’s no strict timeframe on when to check the database prior to writing the script, “use common sense and best practice,” suggested Cobbe.

EFFECTIVE DATES OF HB 21 ADDRESSING OPIOID ABUSE

Limitations on Prescribing Controlled Substances Limitations of this component of the bill only relates to acute pain, not chronic pain treatment. Acute pain doesn’t include pain related to cancer, a terminal condition, palliative care, or a traumatic injury with an Injury Severity Score of 9 or higher. Possibly the most controversial part of the bill involves the 3-day maximum for a prescription of Schedule II controlled substances (listed in the bill) for the treatment of acute pain. “However, there’s a pathway to write a script for up to seven days,” Cobbe pointed out. The conditions of prescribing up to a 7-day supply for any Schedule II controlled substance for acute pain, not just opioids, the practitioner must demonstrate that more than a 3-day supply is medically necessary to treat the patient’s pain as an acute medical condition. The magic script words: ACUTE PAIN EXCEPTION. The prescriber must also adequately document in the patient’s

RESOURCES FOR COMPLIANCE WITH HB 21 – CONTROLLED SUBSTANCES

July 1: Mandatory checking the PDMP; restrictions in opioid prescriptions commence. Jan. 1, 2019: Certificate of Exemption for Pain Management Clinics. Jan. 31, 2019: Two-hour CME course requirement for all DEA-licensed providers. TDB: Board of Medicine Standards for Treating Acute Pain.

Florida Department of Health FAQ: http://www.flhealthsource.gov/FloridaTakeControl/faqs DEA Registration for Electronic Prescribing Controlled Substances: https://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html E-FORCSE (Drug Monitoring Database) Home Page: http://www.floridahealth.gov/statistics-and-data/e-forcse/ Register for the Drug Monitoring Database: https://florida.pmpaware.net record the acute medical condition and lack of alternative treatment options to justify deviation from the 3-day supply limit. To treat chronic pain or use an exemption to go beyond seven days, the magic script words are NON-ACUTE PAIN. As a reminder, this requirement doesn’t apply when prescribing a nonopioid controlled substance listed in Schedule V. Because federal law prohibits refills of

controlled substances, additional scripts are considered new prescriptions, Cobbe said. “Legislation doesn’t say a patient is limited to three or seven days for the whole duration of their acute condition,” explained Cobbe. “It’s meant to be slow and low.” To alleviate physician concern about the impact of patient volume if in-person exams are mandated for subsequent prescriptions of these controlled substances, the Board of

Medicine is developing rules on the Standards of Practice for Treating Acute Pain to include how often providers must see patients and review treatment plans. Some states, but not yet Florida, are mandating e-prescribing. However, progress is being made to alter the Board of Medicine’s rules prohibiting the prescription of controlled substances using telemedicine. “Those (prescribers in states) that do, say it’s great,” Cobbe said. “The Board of Medicine attorney doesn’t believe an in-person evaluation will be required for ongoing treatment of a condition already diagnosed and performance of a treatment plan.”

Compliance & Penalties The most prominent front-line enforcer of monitor compliance will be the pharmacist, who will view the database prior to dispensing scripts to patients to see if the patient has three additional active scripts for opioids. In that scenario, the pharmacist will file a complaint with the Board of Medicine for physician failure to consult the patients’ drug history before writing a new script. “Pharmacist interpretation will be key to smooth – or rough – implementation,” said Cobbe. Because the Board of Medicine acknowledges the sharp learning curve necessary to implement the bill, the first instance will be a non-disciplinary citation and fine. Penalties and fines will increase for additional violations. “What do you (physicians) do if you see (CONTINUED ON PAGE 6)

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HEALTH INNOVATORS

INNOVATOR'S HEADLINES

Let’s Get Practical: Blockchain in Healthcare By NINA TALLEY, MedSpeaks

When it comes to blockchain in healthcare, Electronic Health Records (EHRs) dominate the conversation. The need to secure and move this highly sensitive data has long been a bottleneck in healthcare. Healthtech futurists are looking hungrily at burgeoning blockchain and related technologies as a part of the solution to this time-consuming problem. But are we truly there yet? “Dreams of interoperability and selfsovereign medical records are nothing new,” said John Bass, CEO of Hashed Health, a healthcare innovation firm focused on developing meaningful utilization of blockchain technologies and networks. “It’s understandable that the big, disruptive blockchain use cases have captured the world’s imagination. The blockchain certainly provides an exciting new framework for these solutions. But we have to figure out how to get from here to there.” There is likely an amazing blockchain solution for health records in our future. The blockchain can only be added to – it is like a series of append only notes – which is much like what health records are. No one should be able to be able to change the past of our health records, only to add to them, which is very much the pattern of

the blockchain, which is designed to store a series of records in successive blocks, never overwriting the past, just adding more facts to the list of successive facts represented by the specific chain. But EHRs are messy, legally complicated, and more importantly, critically important to a patient’s life. There’s also the question of who owns that data, with many patients uninterested in managing their own healthcare data. If you’re looking to strike while the metaphorical blockchain iron is hot, why would you choose a point of entry with a barrier that’s so high? Especially with a technology as versatile as blockchain that can solve so many existing pain points in healthcare. So, if now isn’t the time for blockchain to make a splash by tackling EHRs, how can it gain a foothold in an industry as slow to adapt as healthcare? “What we need in 2018 and 2019 are (blockchain) solutions that demonstrate value,” said Bass, “solutions that solve real problems for real businesses in today’s world. What we will find is that solving these problems sets the foundation for disruption and proves that we can use the blockchain to solve old problems in new ways.” “Blockchain has a lot of potential (in medical records) but it’s already good at

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some things that are way more ‘disrupt-able’ than EHR,” said Colin Forward, CEO of MobileCare and Blockchain Analyst. “The obvious one is payments, but blockchains can help operationalize all sorts of data for providers, insurers, and the patients themselves. Blockchains can support supply chain management within the hospital, or serve as a hub for data from wearables and other consumer health services. There are also plenty of use cases that are secondary to healthcare delivery, such as continuing medical education and clinician credentialing, which are ripe for blockchain.” We’re beginning to see a few companies seize on these practical applications, such as Hashed Health’s new Professional Credentials Exchange. They are taking on the issue of physician credentialing, which although not as flashy as EHRs, is just as critical. The government mandated credentialing process often takes several months to complete, largely impeded by a lack of reliable, verified information available to those doing the work tracking down the credentials. This hits hospital systems where it hurts, in their bottom line. Delays in physician credentialing can cost hospitals an estimated $7,500 per day. (CONTINUED ON PAGE 23)

Opportunity is Perishable By Ted DellaVecchia

For many of us who recall the frictionfree wheeling and dealing days of the late nineties and now look back on what was retrospectively labeled the “dot com bubble” it’s not hard to relate to the simple truth that opportunity is perishable. These are indisputably inspiring times in the domain of digital health and the associated prospects of a transformed healthcare industry. A number of amazing investment and brilliant entrepreneurial trends have emerged. The hype is seemingly unending and by many accounts, worthy of the excitement. There are however familiar elements that have prompted me to offer some balanced (and experienced) advice to many digital health innovation leaders who may be pumped up from the recent mega-round of funding or that Beta-client success. That being: Stay focused on the big picture, do not slow down to “wave to the crowd” and seek to avoid the pitfalls of basking in the glory you’ve achieved thus far. Otherwise all glory could be fleeting. I’ve been in this “movie” before and given how historical events have played out we should take a few moments to consider what we know works and what may 5

JUNE 2018

not - as we move forward. Two illuminating examples: In the mid-90’s I was the CIO of the $11 billion IBM division named the Personal Computer Company. Lou Gerstner just came on-board with a mission to save our much beleaguered icon from implosion and or worse. He immediately charged the PC Co. to not only spearhead IBM’s turnaround, but extend goals and have a transformative impact on the use of personal computers at the individual/ social level around the world. We excitedly centered our initiatives in the Research Triangle Park of North Carolina – rich with community assets and talent from notable educational institutions such as UNC, NC State, Duke, ECU, and Wake Forest among others. Our division also coalesced an amazing management team in the Triangle – manufacturing, logistics, electronics, marketing, service, unparalleled software and hardware engineers, etc. – no one could match our chances of realizing our goals. In less than 9 months we architected an amazing capability – the ability to generate demand for our PC offerings by reaching out directly to consumers (most PCs back then were sold to Corporations). Configuring personal needs, confirming the order, closing the

financial transaction – and then building and shipping the product to the consumer; all within 48 hours. Our IBM PC-Direct channel P&L went from zero-to-$500 million in less than 18 months. We were bowled over with glory related to successfully creating what no other computer company had done before. Then we were blindsided – by a guy in a dorm-room. Michael Dell had a sticky-message and once he got rolling with a legacy-free ecosystem (versus doing it all himself) took charge of the “build-to-order” PC world and you all know how this movie ends. Dell Wins – IBM not so much. Lesson 1: We lost sight of the big picture and got caught up in Company politics over marketing relationships with the global Value-Added Resellers whom we had just disintermediated as our sole channel for that $11B in annual revenues. Retrospectively, our laurels became the genesis of our loss in this opportunity. Lesson 1: Even with unlimited resources, polished brand equity, and momentum-fueled functional capabilities we watched our differentiating achievement become diminished to “us too.” In the late nineties, I joined Starbucks Coffee Company as their CIO with a mission to enable and drive unprecedented (CONTINUED ON PAGE 23)

ORLANDO, FL: Limbitless Solutions launches first clinical trial of its kind to study the effectiveness of its prosthetics and their impact on the children’s quality of life

ORLANDO, FL: Vestagen Protective Technologies active barrier apparel received clearance as a Class II medical device from the FDA months after raising $9.5M

TAMPA, FL: Employee Wellness company, PeerFit raised $14.2 million and hires former GuideWell/Florida Blue exec as new Chief Strategy Officer

SUNRISE, FL: MDLIVE Surpasses 1 Million Virtual Health Consultations and Offers Free Online Counseling Services to those affected by Santa Fe High School tragedy Disclosure: Readers, please take note that the companies featured in the Health Innovators section have not paid for or bartered for these acknowledgements. All companies are selected based on merit, intrigue, and their potential to move healthcare forward towards the Quadruple Aim. In a noisy and biased market, we believe this to be a valuable distinction.

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Mitigating Florida’s Opioid Crisis, continued from page 4

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the patient has active scripts? The law is silent on that. But the Board’s standards of care may address it, and care coordination involving other prescribers may be an answer,” said Cobbe.

every two years. “You shouldn’t have to continue to apply for this exception every two years, which is our major concern with this language,” Cobbe said.

Mandatory Emergency Opioid Antagonist Prescription For a prescription for a Schedule II opioid for the treatment of pain related to a traumatic injury with an Injury Severity Score of 9 or higher, the prescriber must concurrently prescribe an emergency opioid antagonist. “This applies even if you’re sticking to the 3- or 7-day limit,” said Cobbe. Mandatory Application for a Certificate of Exemption Starting Jan. 1, 2019, physician offices exempt from pain management clinic regulations must apply for a Certificate of Exemption via the Agency for Health Care Administration and must reapply

Board of Medicine to Adopt Standards of Practice for Treatment of Acute Pain The Board of Medicine plans to adopt rules establishing guidelines for prescribing controlled substances for acute pain, which may include evaluation of the patient, creation and maintenance of a treatment plan, obtaining informed consent and agreement for treatment, periodic review of the treatment plan, consultation, medical record review and compliance with controlled substance laws and regulations. “The Board is going to meet with other professional boards to create these standards, so they may take a while to complete,” Cobbe said.

HEALTHCARE LEADER Maggie Bonko, continued from page 1 facilities that serves the diverse county of a Overcoming challenges is a lot easier half-million people just north of Orlando. when you have good people around you, This is all part of a constantly evolving and Bonko is quick to lavish praise on her set of challenges for Bonko, who has been co-workers. the COO for South Seminole for the past “I am lucky to work with people who year and a half. “The challenges are just part are a lot smarter than me,” she said. “I am of the fun,” she said. surrounded by leaders who amaze me on a Running the operations of a such a daily basis. So, my role is to make sure they complex health system wasn’t an obvious have what they need to do their jobs, and goal when Bonko was starting her career. then to stand back and get out of the way.” She majored in biology at the University of Bonko makes it sound easy, but that Kentucky, and then took a turn into business clarity of purpose is a big part of the secret management for her masters. to her success. With more than a thousand Operations, the business of running employees, including more than 500 physicians, she knows how important it is to keep a business, is what brought Bonko to Orlando. She was working with Lexmark, the people working as part of a team. big printer and printer supply company that “Our teams are very entwined with was spun off from IBM in the early 1990s. each other,” she said. “Everyone has a role She was an executive working in the operain the quality of the patient experience.” tions area when a corporate transfer brought For example, minimizing the chance for a her to Orlando, and she knew right away she patient to develop an infection is everyone’s had found a new home. When the business job. From the person who cleans the room went through a big downsizing 13 years ago, or hallway to the nursing staff and physicians, everyone understands the importance the opportunity arose to combine her understanding of business with her love of people: of this and their role in achieving this goal. She became a nursing recruiter for Or“You don’t change an organization’s lando health. It was a perfect fit. culture, you create one until it becomes your Soon, Bonko was rising through the culture,” Bonko said. “Every decision we ranks, becoming the head of nursing recruitmake is tied back to the patients.” ment for South Seminole Hospital. Then This approach helps keep Bonko and her in 2013 she tapped back into her operations team focused on the mission of patient care. roots, helping to set up the department of “How do make sure every dollar we operations at another part of the Orlando spend goes back to care for our patients?” Health system, Dr. Phillips Hospital in OrThat’s the question that drives this lando, in 2013. chief operating officer. The goal that question helps her to reach is a lot simpler; A year and a half ago Orlando Health “The cool thing is that as much as I love gave her a choice to become chief operating officer for either Dr. Phillips Hospital or our patients, I love it more then they aren’t South Seminole Hospital. She wanted to here and are instead home with their loved stay in Seminole County. It was a good call. ones, enjoying life.” “It’s never the same day twice,” said Bonko. “My job is to be a problem solver and to remove barriers.”

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Patient Centered Care: Re-defining How Healthcare Interacts As healthcare continues to transition to sions. Regardless of healthcare industry an integrated, interoperable system, there and/or departmental segment, there is an are a multitude of currently fragmented inherent need to address all factors surrounding cost, quality, outcomes (CQO components throughout healthcare causing a negative effect. The fragmented initiatives), patient safety initiatives, and components create redundancies (wasteful location security objectives throughout the spending), operational variances (lack of patient’s continuum of care. standardization), and unnecessary interrupRe-defining how healthcare interacts: tions in service delivery causing gaps in PaAddressing the “common denominators” of tient Centered Care Objectives. healthcare and providing a complimentary Healthcare is taking a closer look into resource to any/all provider locations. the different components as we review both Healthcare is a heavily regulated industry. Regardless of healthcare industry sides; Health Care (Patient Perspective) and segment; federal requirements, accreditaHealthcare (IDN/HCO Perspective). tion guidelines, patient safety initiatives, and The traditional healthcare model has location security objectives are consistent. changed due to reimbursement, breakthroughs in technology, and insurance covEach healthcare organization and entity erage. Healthcare (IDNs and health systems) is required to perform the necessary due have traditionally placed the majority of diligence, ensuring the different requirements, guidelines, initiatives and objectives resources at the acute care (hospital) level, are achieved. As each organization and enhowever, there has been an industry shift as tity independently tries to obtain and verify 93–97 percent of total patient encounters vital information, it leads to redundancies, have navigated to continuum of care and alternate site locations. As more and more paoperational variances, and gaps that negatient encounters occur outside of the acute tively impact the overall performance of care setting, there is a higher demand placed healthcare. on the different provider segments that supBusiness Relationship Manageport alternate site locations throughout the ment (BRM) plays a vital role throughout Resources for Resources for patient’s continuum of care. healthcare. The healthcare delivery system The paradigm change as total patient mutually relies on providers (healthcare orencounters continues to navigate to alternate FL Department of Health FAQ: ganizations) and healthcare industry comDepartment of Health FAQ: panies (3rd party organizations including siteFLlocations places the patient’s continuum http://www.flhealthsource.gov/FloridaTakeControl/faqs business affiliates, business partners, outof http://www.flhealthsource.gov/FloridaTakeControl/faqs care at the forefront of industry discus-

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sourced contingent workforce, and vendors Healthcare impacts everyone and everyone’s loved ones. In order to truly achieve and supplier companies) to support the cost savings and cost containment there is a overall’s patient centered care. Each entity, need to address all segments of the healthregardless of industry segment, cannot function without the other. care delivery system that collaboratively Healthcare organizations and healthsupport the patient’s continuum of care and care industry companies need a simplified lowers costs for all organizations. system for data exchange that connects the Healthcare industry companies are utilized by multiple GPOs, IDNs, HCOs, and currently fragmented healthcare delivery continuum of care providers. Look for a system – a cutting edge, innovative technology, and business model that streamlines solution that creates a neutral environment the flow of vital information between orgato seamlessly share your global corporate nizations needed for federal requirements, profile with any/all healthcare provider accreditation guidelines, patient safety initialocations simultaneously with a “turn-key, tives, and location security objectives. This is plug and play” system that provides various done by addressing the “common denomiresources from an operational management, nators” throughout healthcare providing the direct marketing, and representative risk necessary tools, information, and resources management perspective. in a mutually beneficial environment. Randy Rowell is a seasoned healthcare industry professional Healthcare is navigating toward an inwith 25+ years of experience throughout the different tegrated, interoperable “community based” healthcare segments (provider and supplier). His previous experiences provide an all-inclusive reference to HB – data in a “community blended system.21 Accessing the different sides of healthcare. As the Founder and CEO HB based, 21 shared – services” environment lowers of One Pass Access, a new unique BRM Software connecting providers and healthcare industry companies that mutually costs while increasing compliance. support the healthcare delivery system. His passion is to meaningful use, mutually beneficial, and integrated Healthcare is expensive: E-FORCSE (Drug compliance, Monitoringprovide Database) Home Page: solutions that address Triple Aim & CQO Initiatives, Patient E-FORCSE (Drug Database) Home risk management, patient safety,Monitoring and secuSafety Guidelines, and Security ObjectivesPage: at the forefront of http://www.floridahealth.gov/statistics-and-data/eindustry discussions. To learn more visit www.opaccess.com rity shouldn’t be. http://www.floridahealth.gov/statistics-and-data/eor email Randy at rrowell@opaccess.com

forcse/ forcse/ DEA Registration for Electronic Prescribing Resources for HB 21 – DEA Registration for Electronic Prescribing HB 21 – Register for the Drug Monitoring Database: Controlled Substances:Resources for Register for the Drug Monitoring Database: Controlled Substances: FL Department of Health FAQ: https://florida.pmpaware.net E-FORCSE (Drug Monitoring Database) Home Page: https://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html FL Department of Health FAQ: https://florida.pmpaware.net E-FORCSE (Drug Monitoring Database) Home Page: https://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html http://www.flhealthsource.gov/FloridaTakeControl/faqs http://www.floridahealth.gov/statistics-and-data/ehttp://www.flhealthsource.gov/FloridaTakeControl/faqs

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EFFECTIVE DATES forcse/ EFFECTIVE DATES

DEA Registration for Electronic Prescribing DEA Registration for Electronic Prescribing Controlled Substances: July 1, 2018 Controlled Substances: https://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html July 1, 2018 https://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html Mandatory Checking the PDMP

Mandatory in Checking the PDMP Opioid Prescriptions Restrictions Restrictions in Opioid Prescriptions

1, 2018 January 1, July 2019 July 1, 2018 Mandatory Checking the PDMP January 1, 2019 Certificate of Exemption for Pain Management Clinic Mandatory Checking the PDMP Restrictions in Opioid Prescriptions Certificate of Exemption for Pain Management Clinic Restrictions in Opioid Prescriptions

Register for the Drug Monitoring Database: Register for the Drug Monitoring Database: https://florida.pmpaware.net January 31, 2019 https://florida.pmpaware.net January 31, 2019

2-Hour CME - All Providers with DEA license All Providers with DEA license

2-Hour CME EFFECTIVE DATES EFFECTIVE DATES

January 1, 2019 January 1, of 2019 Certificate Exemption for Pain Management Clinic Certificate of Exemption for Pain Management Clinic

To Be Determined:

January 31, 2019 To Be Determined: Standards for Treating Board of Medicine January 31, 2-Hour CME -2019 All Providers with DEA license Standards for Treating Board of Medicine 2-Hour CME All Providers with DEA license Pain

ToPain Be Determined: To Be Determined: Board of Medicine Standards for Treating Acute Board Pain of Medicine Standards for Treating Acute DATE: Pain

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THE LOWEDOWN ON HEALTH LAW

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y d a L R H By WENDY SELLERS, MHR, MHA, SHRM-SCP, SPHR

Q: The buzz on the street is that many companies are doing away with annual performance reviews. Why is this?

Q: Can I pay all of my employees on a salary basis versus an hourly basis? The answer actually is yes. Most people think that “salary” is only for exempt status employees however there is also a non-exempt salary status. In plain English this means yes you can pay them salary, but you still have to pay them overtime pay. If your staff does not qualify to be exempt (meaning that they are exempt from overtime pay even if they work over 40 hours in a work week) then that leaves them with the non-exempt status, therefore you must pay them any hours they work over 40 hours in a fixed 7 day work week period. Another requirement for non-exempt employees is that their employers must track all hours worked, therefore most employers simply pay them hourly since they cannot avoid the time-consuming task of tracking hours. With non-exempt hourly employees, if they work 35 hours, you pay them for 35 hour, yet if they work 42 hours, you pay them 40 hours of regular pay and 2 hours at 1.5 times their regular pay rate. If you change them to non-exempt salary, you will pay them the weekly pay (typically based off of 40 hours) even if they work less than 40 hours, yet you still have to pay them overtime pay at 1.5 times their regular pay rate for any hours worked over 40 hours in a work week. Clear as mud? The easiest option for employers is actually to just stick to an hourly pay basis for non-exempt employees. To learn more about exempt status, review to the Department of Labor’s Handy Reference Guide to the Fair Labor Standards Act

Thankfully, millennials are driving this long overdue change. They grew up with instant feedback through video games and social media. If there was not feedback, interaction or even a “like”, they got worried. Worry causes anxiety and a drop in performance as well as a foot out the door! Let’s face it, our outdated annual performance review system is dreaded by managers, employees and even HR. It is a year too late in providing feedback, the appraisal rating systems are often confusing and downright insulting and when a rare company actually connects the ratings to rewards, often the managers hands are tied in what those rewards even are. The reviews often end up pushing employees to start looking for a new job. So, what should we be doing instead? Managers should be having regular performance conversations. By regular, I mean at least weekly. Grab a piece of paper (or just use an index card), draw a “t” on it and mark the 4 areas as SWOT. Then grab a coffee with your employee and discuss their SWOT: Strengths, Weaknesses, Opportunities and Threats, followed by “What can I help you with this week”? While the first conversation may take longer (45-90 minutes), you can often boil these down to 10-minute weekly chats. The employee feels valued, you are in the loop on their needs and goals and kumbaya– employee engagement has increased by 100%, which means the employee is less likely to leave and more likely to work harder to achieve the company goals. (And you also have documentation that HR and lawyers suggest.) If you have to have a difficult perfor-

mance conversation, try my “sandwich approach”. Start with the good (you are a valued, talented employee), then get straight to the meat (what happened yesterday – insert specific details – violates our customer service policy and cannot ever happen again, this is your only warning), then end with the good (people make mistakes and I know you will come out of this a stronger member of our office).

Q: What is your key piece of advice for my small business? Communication, Communication, Communication! Relators say location is key while HR says communication is key. Clear, professional communication is vital to maintaining an engaged, high performing workforce. Why? In humans, osmosis just doesn’t work. Unfortunately, a lack of human interaction is what todays workforce has become. Email, text messages, social media and technology sources were meant to improve our results, reduce time spent in meetings, increase effi-

ciency and positively affect the bottom line– and while they have, they have also replaced human conversations which has resulted in miscommunication, lack of clarity and a heck of a lot of mistakes. When mistakes are not handled effectively by management, employees feel resentful and fear retribution. This makes them want to find another job while hiding their mistakes from you. Eventually the customer/ patient will find the mistakes and you will wish you knew about them sooner. How to you avoid this mess? Make time every single day to talk to your direct reports for just 10 minutes each. Yes, every-single-day! And consider that your communication may be part of the problem. “The HR Lady,” Wendy Sellers is a leadership coach, author, speaker and COO of BlackRain Partners, a business consulting company focused on coaching, training, development and HR. She has a master’s in healthcare administration, a master’s in human resources, SHRM-SCP and SPHR certifications. Wendy’s leadership book, “Suck It Up, Buttercup” will be released for sale on Amazon.com in June 2018. Visit www.blackrainpartners.com

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GrandRounds Nemours Children’s Hospital Receives Accreditation for Pediatric Residency Program

Nemours Children’s Hospital in Lake Nona has received accreditation from the Accreditation Council for Graduate Medical Education (ACGME) and will launch its first Pediatric Residency Program next summer. The Pediatric Residency Program leadership will begin recruiting residents this fall with the inaugural class beginning in July 2019. “We opened the doors to Nemours Children’s Hospital five and a half years ago with a distinct vision to create something new for Central Florida,” said Dana Bledsoe, president of Nemours Children’s Hospital. “Our mission was to build a world-class pediatric academic medical center, and this training program is an es-

sential piece that will benefit families struggling to access care.” Nemours Children’s Hospital has institutional accreditation and is sponsoring the program with the support of Nemours Children’s Health System. Florida ranks near the bottom in sponsoring GME residents and fellows, per capita (41 out of 50). Starting a pediatric residency program and subsequently building fellowship programs in a freestanding pediatric hospital, is a unique opportunity to make a difference. “At Nemours, we have a rapidly growing population of children with medical complexity and those with high acuity needs,” said Dr. Amber Hoffman, program director for Nemours Children’s Hospital

Pediatric Residency Program. “This paired with an expert faculty that has assembled from across the country is a combination that provides a perfect training ground to teach pediatric residents and subspecialists evidence-based, cutting edge medicine.” The new residency program will help relieve the statewide physician shortage crisis. The state anticipates an increase of children and a shortage of 7,000 medical specialists by the year 2025. The risk is that medical situations for sick children can become acutely worse with a delay in care, or lack of specialty expertise. In years to come, Nemours specialists will build a pipeline of high-level pediatric specialty care physicians in central Florida.

Families will have more access to specialty care and won’t be forced to travel out of the region in search of care. “Academic medicine is defined by a threefold mission. As a faculty physician you are expected to be an excellent clinician championing quality and safe care, a researcher to advance the field, and a medical educator to ensure high caliber training,” said Dr. Heather Fagan, vice chair of education at Nemours’ Department of Pediatrics. “Our doctors have been recruited from academic medical centers across the country, and are ready to help families in Florida by training the next generation of pediatricians and pediatric specialists.”

Oviedo Medical Center Brings Da Vinci Xi® Robotic Surgery To Growing Seminole County Community Orlando Gastroenterology Holds Annual "Get Your Rear in Gear" 5k Run/Walk In spite of rain, nearly 500 participants attended the annual Get Your Rear in Gear 5K Run/Walk in May, presented by Orlando Gastroenterology, PA. This event is organized annually to raise awareness and encourage screening for colorectal cancer, the nation's No. 2 cancer killer. The day included opportunities for celebration of the survivors, and support for caregivers and colon cancer community. Money raised supports local efforts for prevention and screening of colon cancer within the central Florida community!

JUNE 2018

The latest in minimally invasive surgical technology has arrived in Oviedo. Surgeons at Oviedo Medical Center, an HCA healthcare North Florida facility, performed the first da Vinci surgery at the hospital this week using the da Vinci Xi® Surgical System. This robotic surgical system is used for a wide range of procedures in urology, gynecology, gynecologic oncology, general surgery and colorectal surgery including hysterectomies, hernia repairs and radical prostatectomies. “The da Vinci Xi® Surgical System is an important addition to Oviedo Medical Center’s surgical program,” said Dr. Christopher Bryant, gynecologic oncologist at Oviedo Medical Center. “This system will allow our team to perform surgeries using 3-D and high-definition visualization while using minimally invasive procedures. For patients this means improved outcomes, smaller in-

cisions, less pain after surgery and shorter recovery times.” “We are proud to bring the da Vinci Xi® Surgical System to Oviedo,” said KC Donahey, CEO of Oviedo Medical Center. “With multiple surgeons trained in this highly specialized robotic surgery, we are providing our community with access to the latest in medical technology in a state-of-the-art facility, close to their home.” Called the “hospital of the future,” the 198,000-square-foot Oviedo Medical Center has been on the forefront of cutting-edge hospital technology since it opened in 2017. In addition to advanced surgical procedures, the facility includes a real-time location system, hand hygiene compliance monitoring and an advanced nurse call system to promote patient safety.

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GrandRounds Pediatric patients trade hospital gowns for tuxedos and dancing shoes Girls in glittering gowns and boys in sharp tuxedos strolled down a red carpet during the Hollywood-themed annual prom at Florida Hospital for Children. Teens diagnosed with a chronic illness or disease such as cancer have to make countless sacrifices, and hospital staff made sure prom wasn’t one of the milestones they’d have to miss. On Saturday, patients enjoyed hair and makeup sessions while they prepped for the festivities, which included food, entertainment, photo ops and party favors. Patients were also crowned prior to entering the event. "Many of our patients sadly miss mile-

stone moments, like their school prom, because of their treatments,” said Chantelle Bennett, Child Life manager at Florida Hospital for Children. “We’re dedicated to providing wholistic care for our patients, and tonight, that meant providing an experience that helped them forget about their challenges and just have fun.” While the teens enjoyed the event, parents were invited to watch a movie and received a “parent pass” to briefly join the prom for pictures with their children. For media inquiries only, call Florida Hospital Corporate Communications at 407-303-5950.

Orlando, Pittsburgh physicians save teen’s life with Central Florida’s first pediatric liver transplant A team of surgeons from Florida Hospital and Children’s Hospital of Pittsburgh of UPMC performed Central Florida’s first pediatric liver transplant, saving the life of a local teenager. The health care systems are pleased to announce the child was just released from the hospital and is continuing his recovery at home. The teen’s identity is not being disclosed to protect his privacy. Florida Hospital for Children and Children’s Hospital of Pittsburgh of UPMC launched a partnership in late 2017 to make lifesaving pediatric liver transplants available throughout north and Central Florida. Prior to the partnership, the only active pediatric liver transplant program in Florida was in Miami. “We knew there was a critical need for children across Florida to have access to a liver transplant program that is close to home. Our patient came to us in acute liver failure, and fortunately, we aren’t far from his house,” said Dr. Regino P. GonzalezPeralta, director of pediatric gastroenterology, hepatology and liver transplantation with Florida Hospital for Children. “We’re thrilled that the patient is doing well and back home with his family.” The teen was the first pediatric patient

JUNE 2018

placed on the OPTN/UNOS national transplant wait list by Florida Hospital, and his surgery was performed May 7 — just days after being listed. Four physicians (two surgeons, an anesthesiologist and a pediatric intensivist) as well as a team of operating room and intensive care nurses, traveled from Pittsburgh to Orlando to perform the surgery alongside counterparts from the Florida Hospital team — represented by both Florida Hospital for Children and the Florida Hospital Transplant Institute. “Children’s Hospital of Pittsburgh of UPMC has the benefit of 37 years of pediatric liver transplant experience, and we are proud of our role as a pioneer and innovator in the field of pediatric transplantation,” said George V. Mazariegos, M.D., chief of pediatric transplantation at Children’s. “We’re honored to be able to share our experience and expertise with our colleagues in Florida in order to make life-saving transplantation a more viable option for residents of Central Florida.” Physicians with the Hillman Center for Pediatric Transplantation at Children’s Hospital of Pittsburgh of UPMC have performed more than 1,800 pediatric liver transplants — more than any other center in the United

States, according to the United Network for Organ Sharing, with patient survival rates consistently higher than national averages. The Florida Hospital Transplant Institute is one of the busiest transplant centers in the state, offering kidney, liver, kidney/ pancreas, lung and heart transplants. The adult liver transplant program has one of the best outcomes in the U.S. “We are honored to partner with our esteemed colleagues at Children’s Hospital

of Pittsburgh of UPMC and hope to recreate their world-class pediatric liver transplant program in Central Florida,” said Dr. Thomas Chin, director of the Florida Hospital Transplant Institute’s liver transplant program. “There are no machines or procedures that can replicate the liver’s functions, and so when the organ fails, transplant is the only option. We’re privileged to bring this service to families in Florida and the Southeast.” orlandomedicalnews

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GrandRounds 3B Medical Plans Manufacturing Expansion into Central Florida by Year’s End

When the underdog wins, it makes a great story. It’s easy to think of times when the presumed loser prevailed. As Team USA laced up their skates and stepped onto that hockey rink in Lake Placid in 1980, they believed in themselves and skated an incredible game. When Erin Brockovich became an environmental activist, she spearheaded litigation against one of the largest utility systems in the United States. As JK Rowling sat in an English coffee shop with a story on a napkin, she continued trying to get published as the rejection letters kept coming. All these underdogs deeply believed in their causes and overcame many stigmas to win. Small businesses are much like underdogs. They embark on a journey in which they totally believe in their product. Because they have seemingly insurmountable odds against them, small businesses tend to look at problems and develop unique solutions that the big corporations ignore. Exactly how 3B Medical began in Winter Haven. Tom Thayer Sr. is a serial entrepreneur and third generation citrus farmer, and he saw a problem in respiratory care products as he cared for his wife, Anne, in her battle with pulmonary fibrosis. He saw an urgent need to bring new and better products to market. Thayer and Alex Lucio formed 3B Medical with innovative new solutions for the respiratory and sleep aid industry. As with most small businesses, there are many obstacles to hurdle, and this is where David

Sonda Eunus Named Associate Publisher of North Florida Medical News After a dozen years developing the highly successful B2B Orlando Medical News, publisher John Kelly is launching North Florida Medical News. Sonda Eunus has been named associate publisher of the new, demand-driven publication. “I’m excited to bring our publication to new markets and build on the value we’ve provided our readers all these years,” said Kelly. “Sonda is a terrific addition to our team.” Concurrently with her new role, Eunus, a certified medical practice executive, will continue her role as CEO with Leading Management Solutions, a healthcare management and marketing firm. Eunus and her consulting team at the company she established assists medical practices and other healthcare providers with administrative compliance and marketing strategy and implementation.

JUNE 2018

met Goliath. Within 90 days of launching 3B Medical, litigation was filed, and it continued into 16 lawsuits across three continents. At that time, Lucio, 3B Medical’s CEO, spent most of his time managing complex litigation and coordinating defenses with four different law firms representing the company. 3B Medical recently reached a confidential global settlement agreement, and they are now aggressively moving forward with new product plans and expanding manufacturing. Calling Central Florida home with headquarters located in Winter Haven, 3B Medical began as an underdog and dreamt big. With 40 percent year over year growth, the company is living through the adage about slow and steady wins the race. Their determination to fight through litigation so they could provide top notch products that consumers demand has driven the company from day one…starting with comfortable respiratory products. The respiratory industry is substantial as the American Academy of Sleep Medicine estimates that 29.4 million Americans are afflicted with obstructive sleep apnea. The most common problem expressed to physicians is equipment discomfort for treatment with reportedly more than 40 percent of patients stopping treatment because of the lack of a comfortable mask and other accessories. With Thayer’s personal experience and his entrepreneurial spirit, 3B Medical embarked on improving these products with patient comfort leading the effort. “Our goal is to make our mark in the respiratory product space through innovation and new product design,” said Lucio. “This year we are launching six

Our Favorite Intern Celebrates Graduation! Corrin Hardin, who has been interning for Orlando Medical News for a year, is celebrating her graduation from Florida State University. She earned a bachelor's in Marketing with a minor in Communication. She is graduating with a 3.5 GPA overall. Corrin is excited about turning to a new chapter in her life, and is going to work for https://www.tomjames.com as a "Clothier" and will represent a line of completely custom business attire; including suits, shirts, casual wear. Connect with Corrin on LinkedIn @ CorrinHardin. She enjoys hiking, biking and long walks in the beach. Just kidding!... more like scuba diving and sky diving!

major products, each very different and unique, and each changing and redefining the landscape of the product sector they are in.” Products have been so well received that production quantity for the newest introduction, the Lumin, a disinfectant machine for a CPAP mask, was expected to last the first quarter and was completely sold in two weeks. To help support the growing product demand, the company will be adding a manufacturing location in Central Florida by the end of the year expecting have around 50 employees. Branching into three distinct markets of sleep therapy, oxygen therapy and disinfection, 3B Medical has ambitious production introduction plans for

the next 18 months. The company has an extensive portfolio of patents and patent applications, and recently completed the acquisition of VBOX, a Minnesota research and development company with a broad offering in the portable oxygen product space. “VBOX provided 3B Medical with a very fast ramp into a second large product space, oxygen therapy, with leading edge proprietary technology,” explained Lucio. “One thing we learned from litigation was the importance of developing and owning our own intellectual property around our own technology. Very rapid new product development is the heart of this strategy, and 3B Medical has a new product pipeline that rivals that of (CONTINUED ON PAGE 14)

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GrandRounds companies 10 times our size.” After years of being dragged through the legal arena, the underdog emerges into the limelight of success. This Central Florida company fought Goliath and now boldly embarks on becoming one of the respiratory and sleep market leaders.

New Coalition Launches to Support Independent Physician Practices in Leading Value-Based Care Movement

Recognizing the importance of independent physician practices in bringing about the movement to value-based health care, a group of leading health care organizations have joined together to form the Partnership to Empower Physician-Led Care (PEPC). The founding members of PEPC are: Aledade, the American Academy of Family Physicians (AAFP), California Medical Association (CMA), Florida Medical Association, Medical Group Management Association (MGMA), and Texas Medical Association/ PracticeEdge. PEPC is dedicated to supporting value-based care to reduce costs, improve quality, empower patients and physicians, and increase access to care for millions of Americans through a competitive health care provider market. The organization will focus on education and advocacy to urge action on four policy priorities: advancing physician-led alternative payment models; ensuring an equitable policy framework that promotes choice and provider competition; creating new opportunities for physicians in commercial markets such as Medicare Advantage; and supporting consumer-directed care. “We believe it is impossible to achieve truly value-based care without a robust independent practice community,” said Kristen McGovern, PEPC’s Executive Director. “Our goal is to ensure that independent practices are recognized as a vital part of the health care system and are given a clear path to continue to contribute to this transformation.” Independent physicians make up almost half of the physician workforce. However, too often the significant role they play in leading the movement to value-based care is overlooked. Many stakeholders don’t realize that independent practices are able to take risk for their patients, or that independent practices can lead alternative payment models like accountable care organizations (ACOs), often providing higher quality care and generating more savings than other types of models. For example, a report on the Medicare Shared Savings Program found that nearly half (45 percent) of physician only ACOs earned savings, and that they were significantly more likely to do so than other types of ACOs. As we strive to transform our health care system, it is critically important for policymakers and stakeholders to hear the voices of independent practices on the front lines of care and to ensure that a range of practice arrangements – including independent practice – are allowed to flourish. “While our delivery system may have

JUNE 2018

changed in recent years, one thing continues to ring true – family physicians play a central role in improving health care for individuals, families, and communities across the country,” said Michael Munger, MD, President of the American Academy of Family Physicians. “Physicians and physician-led groups are leading the movement to value-based care.” “Value-based care models should be calibrated for physicians regardless of their mode of practice,” said Dustin Corcoran, CEO of CMA. “We look forward to providing physicians with the support and innovation needed to make a successful transition to value-based care and maximize healthy outcomes for their patients and communities.” “Independent doctors are often very tied into their communities, working with patients on the frontlines,” said Tim Stapleton, CEO of Florida Medical Association. “These are exactly the types of providers who should be the center of the health care system of the future.” “Independent practices play a critical role in the health care system, affording many physicians autonomy and flexibility to make decisions that are best for their patients,” said Halee Fischer-Wright, MD, MMM, FAAP, CMPE, President and CEO, Medical Group Management Association. “We look forward to working with PEPC to ensure that the independent practice is a viable option for those who seek it.” “Independent physicians in Texas are being increasingly squeezed by regulatory burdens and rapid provider consolidation,” said Lou Goodman, CEO of TMA PracticeEdge. “We are pleased to join PEPC to help relieve this pressure so our physicians can get back to caring for their patients.” (CONTINUED ON PAGE 15)

SCMS Awards Two Scholarships The Seminole County Medical Society President, Fernando Alvarado, MD, and our Scholarship Chair, Udita Jahagirdar, MD, have awarded scholarships to two deserving students for 2018.

Every year the SCMS Foundation awards two $1,000 scholarships to local high school students who demonstrate extraordinary scholarship, integrity, and a strong interest in science.

Victoria Orindas is the 2018 Dr. Willie Newman Scholarship Winner. The Dr. Willie Newman Scholarship was established by the SCMS Foundation as a perpetual scholarship to honor Dr. Willie Newman's 25 years of service to the women of Seminole County, to be given to a deserving high school student interested in the field of medicine. A 2007 article in Central Florida Doctor magazine said that Dr. Newman had practiced obstetrics and gynecology in Seminole County since the early 1980s and played key roles in shaping the community's obstetric services, establishing pivotal programs in high schools, clinics, and jails, and he had become a hero and a friend to thousands of women and their families. He delivered more than 10,000 babies, watching as they took their first breath, smiling as they entered the world.

Jessica Man is the 2018 Dr. Luis Perez Scholarship Winner. The Dr. Luis Perez Scholarship was established by SCMS in his honor and memory upon his death in 1988. Dr. Perez had many core beliefs. One of the main ones was his strong belief in community service, to which he dedicated his life. In 1976 he received national recognition when the American Medical Association presented him with the Dr. Benjamin Rush Award for community service as the most communityminded doctor in America. Dr. Rush was a signer of the Declaration of Independence, and left a small bequest in his will to be presented to the most communityactive doctor in America on the nation's 200th birthday - the bicentennial.

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GrandRounds The Partnership to Empower Physician-Led Care (PEPC) is a membership organization dedicated to supporting value-based care to reduce costs, improve quality, empower patients and physicians, and increase access to care for millions of Americans through a competitive health care provider market. We believe that it is impossible to achieve truly value-based care without a robust independent practice community. PEPC represents independent physician practices pursuing value-based care, and those organizations and associations that support them. Our current members include Aledade, American Academy of Family Physicians, California Medical Association, Florida Medical Association, Medical Group Management Association, and Texas Medical Association/ PracticeEdge. PEPC’s Executive Director is Kristen McGovern, a former HHS and OMB official and expert in federal health care policy. Visit PEPC at www.physiciansforvalue.org, and follow us at @PEPC_DC.

University of Central Florida Life Sciences Incubator Opens as the Only Wet-Lab Incubator in Central Florida

The wait is over for budding life science and biotech startups in Central Florida who have, until now, had limited options for accessible state-of-the-art equipment and business support in one place. Today, the University of Central Florida (UCF) opened the doors of its new Life Sciences Incubator, marking the introduction of the first and only wet-lab incubator in Central Florida. Tom O’Neal, Ph.D., UCF associate vice president of innovation & commercialization, led the opening ceremony alongside UCF Interim Provost Elizabeth Dooley, Ed.D., Orlando City Commissioner Jim Gray and State Senator Victor Torres. The celebration kicked off with a commemorative unveiling of the incubator, located on the second floor of the GuideWell Innovation Center in the heart of Lake Nona Medical City. “We are thrilled to open the doors of our Life Sciences Incubator, as we contribute to the exciting work happening in Lake Nona by helping our clients fill critical needs in the fields of life science, health care and biotechnology,” O’Neal said. “This can truly be a game-changer for researchers and the companies they are trying to grow to create new discoveries and high-wage, high value jobs. We look forward to offering an environment that allows them to learn critically important business processes and gives them access to UCF’s depth of scientific knowledge.” The 10,000-square-foot incubator is the first of its kind in Central Florida, offering private, Biosafety Level II wet labs, private offices, collaboration space, shared equipment and access to support services, including specialized expertise and community partnerships in and around Lake Nona. Incubator clients will have access to a suite of support services, plus additional specialized equipment and expertise from UCF core facilities, ranging from imaging to advanced microfabrication. “The introduction of the UCF Life Sciences Incubator further strengthens our university’s presence in Lake Nona and

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solidifies our commitment to promoting innovation, collaborative research and the growth of Central Florida’s burgeoning life sciences community,” said UCF Vice President for Research and Dean of the College of Graduate Studies Elizabeth Klonoff. “UCF believes in the power of partnerships and this facility exemplifies the value of working together to make things happen that simply would not be possible otherwise.” The UCF Business Incubation Program is an economic development partnership designed to help create and sustain jobs in the community and spur economic growth throughout the region. This goal is accomplished by helping new and struggling early-stage businesses grow to the point where they need to hire employees to continue operating and growing. Since 1999, we have assisted more than 350 early-stage companies, who’ve sustained nearly 3,700 jobs throughout Central Florida. These companies have also had a total impact on regional economic output (GDP) in the amount of $2.48 billion.

Brain Mapping That Seeks To Identify ‘Normal’ Could Aid Alzheimer’s Treatment

Inside Florida’s largest retirement community researchers using new brainmapping technology are trying to peel back the secrets of the brain. The goal: Make world-changing discoveries about how our minds work that could lead to earlier detection of Alzheimer’s and other brain diseases. The research’s success could allow physicians to start treatments earlier than ever and perhaps delay the onset of this memoryrobbing condition that haunts the older population. “As you look at people as they grow older, from a health perspective they are probably more afraid of losing their memory than they are of getting cancer,” says Dr. Jeffrey Lowenkron, who is chief medical officer of The Villages Health, a medical practice in The Villages, a Florida retirement community that’s home to more than 125,000 people. There is no cure for Alzheimer’s. Part of the problem in finding one: For all the world’s scientific and medical advances, there is still a lot we don’t know about the brain, Lowenkron says. “What happens with the electrical activity of the brain as it ages?” he says. “What’s normal and what’s abnormal? No one really knows.” With this trailblazing research in The Villages®, we may be drawing closer to finding out. About 1,000 residents of The Villages volunteered to participate in the brainhealth research that’s being conducted in partnership with faculty from the University of South Florida and an Israeli company called ElMindA that originally developed the sophisticated BNA™ (Brain Network Activation) technology for use in concussion treatment with young people. All of the partners believe that the technology holds the potential to revolutionize the diagnosis, monitoring and treatment of brain-related disorders. Here’s how it works: An electrode monitoring device that resembles a hair net is placed on the volunteer’s head. The volun(CONTINUED ON PAGE 16)

Florida Hospital Celebration Health receives The Beacon Award for Excellence Silver designation The American Association of Critical-Care Nurses awarded Florida Hospital Celebration Health’s Baby Place with the first Beacon Award for Excellence Silver designation for obstetrics in the nation. The award recognizes recipients for consistent growth, development and organization to achieve the best patient care. Seven teams across Florida Hospital have received a Beacon Award for Excellence, including Winter Park Memorial Hospital, and four of them are on the Celebration Health campus. "Florida Hospital is committed to consistently providing the best qual-

ity health care by treating the whole person," said Daryl Tol, president and CEO of Florida Hospital and Adventist Health System’s Central Florida Division. "Receiving this prestigious award recognizes the unwavering efforts of our nurses, and demonstrates our commitment to quality and efficient care in our hospitals." Units that earn this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

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GrandRounds teer is then given a series of computer tasks to perform during an EEG recording. From there, a 3-D representation can be created to show what the brain looked like when the volunteer was responding to the tasks. The goal is to develop a baseline of what a healthy brain looks like. ElMindA says the results can give physicians: Snapshot mapping of brain-network function in comparison to a healthy/normative group. The ability to compare multiple tests over time. Objective information to assist with better-informed medical decisions. “In the future, doctors could routinely test how well a patient’s brain is functioning, just like they routinely test for cholesterol levels, vitamin deficiencies or other health problems today,” says Carla Vandeweerd, the study’s Co-Principal Investigator who serves as Director of Research for The Villages Health and is a faculty member at the University of South Florida. The BNA technology also has been used in assessing brain damage caused by concussions, especially sports-related concussions, and it’s hoped it will be effective with other brain disorders, such as depression and dementia. For the Alzheimer’s study, there’s probably not a better place in the country than The Villages because no where else can you find a community this large that’s made up mostly of people the right age for the study. The community has a research board that gave the go-ahead and the project began in July 2017. The goal was to recruit 1,100 volunteers, and so far about 1,000 people between the ages of 55 and 84 signed on to help out. “We are recruiting enough people to get a sense of how normal looks in the brain based on age categories and gender,” Lowenkron says. The research participants will be monitored several times over the course of the study, which Lowenkron says will go on for about another year. Most likely, the residents of The Villages who volunteered to participate will never gain any personal benefit from the research results. But the generations who follow them might, which Lowenkron says is enough to make it worthwhile to them. “This is a very giving community from

Center for Advanced GI Relocates this perspective,” Lowenkron says. “If they can do things that will help others in the future, they are eager and willing.”

Florida Hospital invests $508 million in metro Orlando

Florida Hospital has released its annual Community Benefit Report, which details the contributions the organization made in Central Florida through charity care, health research and its support of local charitable organizations. In 2017, Florida Hospital provided $508 million in community benefit in Orange, Osceola and Seminole counties, $55 million more than in 2016. When faith-based care, capital investments and other benefits are also added, Florida Hospital’s total impact in Central Florida surpassed $830 million last year. Other items detailed in the 2017 annual report: • $166 million in charity care • $15 million in cash and in-kind contributions • $23 million in community health services • $251 million in unpaid costs absorbed by the hospital from Medicaid reimbursement shortfalls • 197,173 unique Medicaid and uninsured patients served “For more than 100 years, we’ve been committed to providing our patients and entire community with care that is focused on the whole person — mind, body and spirit,” said Daryl Tol, president and CEO of Florida Hospital and Central Florida Division – Adventist Health System. “Partnering with local organizations that share this commitment is key to bringing care and services to those who need it most, and to achieving our goal of making our community one of the healthiest in the nation.” Items in the Community Benefit Report also include projects funded by the Community Health Impact Council, also known as CHIC. CHIC’s primary goal is to address the needs of targeted populations, including the underserved and uninsured, while reducing preventable medical costs and increasing the overall health of the community. The CHIC board, comprised of local business and nonprofit executives,

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helps determines how and to whom Florida Hospital’s funding will be allocated in the community. (To learn more, visit floridahospitalcares.org) The nonprofit Community Health Centers, which provides health care to uninsured, under-insured and under-served Central Floridians, received a CHIC grant for a project that monitors and ensures continuity of care for high-risk patients. “It is an honor to partner with Florida Hospital on this initiative that connects patients directly in the hospital, identifying their medical needs and barriers to care, providing a seamless pathway into a primary care home,” said Margaret Brennan, president and CEO of Community Health Centers. “With locations throughout Central Florida, this project will make a significant impact in our communities, offering an array of comprehensive medical services including pediatric and adult primary care, dental care, obstetrics and gynecology, optometry, behavioral health, chronic care management, on-site laboratory and pharmacy services.” To view the full report, visit: https://goo.gl/9g9BdM

Florida Hospital and GE Healthcare Partners to build ‘command center’ to guide clinical operations

Florida Hospital and GE Healthcare Partners are working together to design and build a command center that will transform clinical operations at Florida Hospital locations across Central Florida. The hightech center, the first of its kind in the region, will use predictive analytics to help hospital staff working to deliver quality, safe, and optimized clinical operations. The command center will function like NASA’s mission control, but focused on constantly orchestrating patient care at nine Florida Hospital campuses in Orange, Seminole, and Osceola counties. Together, these hospitals handle more than 2,000,000 patient visits per year, making Florida Hospital one of the nation’s largest nonprofit health systems. The command center’s Wall of Analytics leverages existing IT systems. The platform takes data from multiple systems and applies artificial intelligence algorithms to spot the “needle in the haystack” so staff (CONTINUED ON PAGE 17)

Orlando Health expands skin cancer initiative in Lake County at the National Training Center Orlando Health UF Health Cancer Center is partnering with Orlando Health South Lake Hospital’s National Training Center (NTC) in Clermont, Fla., to expand their skin cancer prevention initiative to help protect residents and athletes from the harmful effects of prolonged exposure to sunlight. The Cancer Center, which has a location in Clermont, will work with the NTC to deploy sunscreen stations at all three outdoor facilities including the aquatic center, multipurpose fields and track and field complex for use during training and events. The seven dispensers at the NTC will contain water-resistant, 30 SPF sunscreen at no cost for athletes, fitness members, visitors and guests that use the facilities to help

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protect themselves from the cancer-causing ultraviolet rays of the Florida sun. “The NTC hosts tens of thousands of residents, athletes and visitors at its facilities each month and many are outside for several hours so sun protection is essential for good health,” says Brian Wetzel, chief operating officer for Orlando Health UF Health Cancer Center. “It was a natural fit for us to provide these to our partners at the NTC and we hope that the addition of the dispensers will allow those enjoying the outdoors to do so safely.” The Cancer Center has already partnered with Orange and Seminole County to deploy 33 sunscreen stations throughout their public parks. The locations are listed below:

Orange County: · Barnett Park · Cypress Grove Park · Downey Park · Dr. P. Phillips Community Park · Fort Gatlin Recreation Complex · George Bailey Park · Kelly Park (Rock Springs) · Killarney Station (West Orange Trail) · Moss Park Seminole County: · Boombah Soldiers Creek Park · Boombah Sports Complex · Red Bug Lake Park · Sanlando Park · Seminole County Softball Complex · Sylvan Lake Park

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GrandRounds can act to prioritize patient-care activities and discharges, make short-term staffing decisions, and mitigate potential bottlenecks before they occur. Command-center technology has also been shown to reduce wait times, expediting needed patient care. And by using near real-time data, providers can streamline their processes in time-sensitive clinical situations. Florida Hospital joins a growing ecosystem of such centers which includes The Johns Hopkins Hospital in Baltimore and Humber River Hospital in Toronto. Florida Hospital’s Command Center (FHCC) will achieve the distinction of being the largest health-care command center (square footage) supporting the largest number of beds and hospital campuses. Analytic “tiles” in the FHCC will leverage learning from the other centers and break new ground in using artificial intelligence to constantly help caregivers. “Florida Hospital prides itself on utilizing innovative technology to provide the best possible care for our patients. Our goal is to improve the patient experience, enabling caregivers to spend more time with their patients while making care decisions more easily and quickly,” said Daryl Tol, president & CEO of Florida Hospital and Adventist Health System’s Central Florida Division. “We are excited to partner with GE Healthcare Partners to bring this innovative concept to our care network.” “Command Center staff using advanced analytics in a purpose-built space will help caregivers help patients, all the time. The combination of human and artificial intelligence is what’s so powerful,” added Jeff Terry, CEO of Command Centers for GE Healthcare. “Florida Hospital is so advanced in many ways. We’re honored for them to join GE’s command center community.” The command center will be built in a centralized location to serve Florida Hospital operations across the region. It is expected to open in 2019.

AI to Save Healthcare Sector US$52 Billion in 2021

New Artificial Intelligence (AI) applications in healthcare will lead to billions in savings within the sector over the next four years announced ABI Research, a market-foresight advisory firm providing strategic guidance on the most compelling transformative technologies. In its recent report, ABI Research finds that while only a few AI applications have resulted in commercialized and scaled solutions so far, most do show promise in Proof of Concepts (PoCs). If successful, these applications could produce more effective drugs, save doctors’ time, and save lives. Hospitals in Israel and the United States have already started to adopt AIbased predictive analytics. The number of patient monitoring devices using the data to train AI models for predictive analytics will rise from 53,000 at the end of 2017 to 3.1 million in 2021 with a CAGR of 176%. This includes the use of AI for home-based preventive healthcare solutions. With more devices connected to AI-based predictive analytics models,

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hospitals will save US$52 billion in 2021, led by North America with US$21 billion in savings. “If AI vendors hope to fulfill the potential of their applications in hospitals and medical institutions, they must help implement the communications, network, and IT infrastructure necessary to deliver actionable analytics,” says Pierce Owen, Principal Analyst at ABI Research. “Unfortunately, clinicians in most hospitals often must work with pen and paper or pagers from twenty years ago and have limited access to secure, networked devices. These institutions need help to collect data in a secure manner and deliver actionable analytics while staying compliant with all regulations.” Applications that target hospitals and medical institutions include predictive analytics for patient monitoring, finding patients for clinical trials and transcribing notes for electronic health records (EHRs). EarlySense builds AI-based predictive analytics that use data from a contact-free sensor that goes underneath a mattress. The company has launched products for both hospitals and homes. Deep 6 AI finds and matches patients to clinical trials. It claims it shortens the process from ten months to seven minutes. It scans complete EMRs including the free text and reports using natural language processing (NLP) to find the best possible matches. Cedars-Sinai Medical Center in Los Angeles has used Deep 6 and already sees an ROI of US$10,500 per trial. LexiconAI has expanded its NLP voice-controlled transcription software to healthcare to save clinicians time in filling out EHRs. Its PoCs have resulted in US$5,000 per user per year in efficiency and savings, and it only takes early adopters one month to reach ROI. Of course, not all the applications examined within the report target hospitals. Pharmaceutical companies continue to invest in AI for drug discovery, and some AI vendors target patients for pre-primary care. AI has yet to generate a molecule design for a drug that has gone to market but some from BERG Health have made it into Phase I and Phase II trials with successful results so far. AI-based pre-primary care apps with NLP, such as Your.MD, have already gone to market. With human lives potentially at stake, AI vendors also need to establish a reputation of trust through PoCs and proper regulatory approval before attempting to scale. Once scaled, they may need to assist with data curation through managed services for clients that lack data scientists. “We as a society need AI to transform the healthcare sector across the board. Already, people without insurance cannot afford care, and the massive increases in costs and healthcare spending will become a drag and burden on the economy if they continue. Luckily, a couple of these AI applications have already proven they can save money and lives,” concludes Owen. These findings are from ABI Research’s Artificial Intelligence in Smart Healthcare report. This report is part of the company’s AI & Machine Learning research service which includes research, data, and Executive Foresights.

Winnie Palmer Hospital Launches Hello Baby! App for Expecting Parents Orlando Health Winnie Palmer Hospital for Women & Babies has launched a new pregnancy app, Hello Baby!, available for both Apple and Android devices. The app provides weekly updates on the growing baby, advice from medical experts and tools such as a kick counter and contraction timer. What makes the app unique are the elements specific to the experience at Winnie Palmer Hospital. • Instead of coming in person, users can pre-register for their birth directly through the app. • Parents can search for local OBGYNs and pediatricians. • Moms can develop their birth plan to provide to their medical team during delivery.

• The labor and delivery section details what parents can expect during their time at Winnie Palmer Hospital. • A virtual tour gives parents a behindthe-scenes look inside the hospital. • The discharge book given when parents leave the hospital is available digitally on the app. Local OB-GYNs are encouraging their patients to download the app to help them prepare for their upcoming delivery. With an average of 14,000 births a year, Hello Baby! will be a valuable resource to the many expectant mothers who choose Winnie Palmer Hospital. The next update to the app will include a Spanish version.

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GrandRounds Social Media Contest Offers Prize Packages Valued at More Than $10,000 Each to Medical Practices in Florida

Prize packages valued at more than 10 thousand dollars each are up for grabs this week in a recently launched social media contest for healthcare practices. The "Pay it Forward" contest, hosted by Leading Management Solutions, a healthcare management and marketing company, aims at engaging medical practices to share the greatest obstacles their offices face through a post on Facebook, Twitter, Instagram, or Youtube. They can also obtain bonus tickets from Eventbrite. Contestants earn one raffle ticket for each post, and one winner will be randomly selected from each 50 entries. The mega-stuffed prize package includes a variety of services and specialty items that promote quality, efficiency and profitability for medical practices. Leading Management Solutions will offer a practice efficiency and productivity assessment, as well as interview each practice winner on their new "Leading Healthcare" podcast. Every winning practice will also receive a Business Spotlight in the Orlando Medical News. A security and compliance assessment by Eukairos Tech, a financial analysis report by TSYS Health, a marketing consultation from Medkeen Solutions, and a gift package from WeLa Nutraceuticals are also among the prizes. Additionally, each winner will receive a new, regulation-compliant HIPAA Manual from MedMal, as well as free trials of various software platforms, such as MedAux, the ADAPT Platform, Panterra Networks, and Alltrust Insurance ThinkHR. In addition to the whopping prizes, each winner will have the opportunity to "pay it forward" by nominating the healthcare facility of their choice to receive a prize package. Sonda Eunus, Founder and CEO of Leading Management Solutions, says witnessing the challenges and stress her father faces running his medical practice inspired the idea for the contest. "I know first-hand how changes in the healthcare industry have led to increasing challenges for medical practices, and many physician owners struggle just to keep the doors open and pay employees," said Eunus. "We are blessed to have so many great partner companies who believe in and support our mission so that we can make a large impact and help as many medical practices as possible." The contest will run monthly. Managers, physicians, and owners of healthcare companies are eligible to participate. For additional information or to register, visit www.healthcarecontest.com. Leading Management Solutions is a healthcare management and marketing company that assists medical companies in achieving operational and financial success through a variety of services, including outsourcing process management, customized strategic and marketing plans, and indepth analysis of all business aspects such as workflow, compliance and finances. To learn how Leading Management Solutions can help your practice run more efficiently, attract more customers and increase revenue, visit www.lmshealthpro.com or call 407-674-1916.

Florida Hospital for Children patients and Princess Belle

Patients showing Belle his muscles

Princess Belle reading to pediatric patients

Stars from ‘Disney On Ice’ visit Florida Hospital for Children Princess Belle, along with other performers from “Disney On Ice presents Dare to Dream!” made a royal visit to Florida Hospital for Children in May, where they spent the morning reading books and playing with the children. “As parents we see our children go through very challenging moments, but

to see them engaged, smiling and being just a regular a kid makes us as parents feel a little lighter,” said Lacey Macedo, mother of Florida Hospital for Children patient. “Disney On Ice presents Dare To Dream!” features five Disney heroines, including Moana’s first ice appearance, as

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they embark on personal quests to realize their dreams and find their identities. "Feld Entertainment gives back to the communities it serves. As a performer, being able to bring the magic to children means the world to me,” said Tosha Hanford, who portrays the role of Anna in Disney On Ice presents Dare to Dream.

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What If We Could Predict When an Athlete is Going to Be Injured? New study quantifies individual risk of injury for athletes using Internet of Things From:The Society for Risk Analysis

Thousands of athletes showcased their abilities for the world in PyeongChang, South Korea, in pursuit of Olympic gold. But for every dazzling triple axel or stellar snowboarding run, athletes face the risk of career-ending injuries. Athletic performance isn’t the only casualty of sports injuries. These injuries pose economic burdens on athletes and their families and can have long-lasting effects on an athlete’s quality of life. To help reduce the risk of injury, researchers at the University of Tennessee Chattanooga have developed a framework that measures an athlete’s risk of injury using Internet of Things (IoT) technology. Published in the journal Risk Analysis, the study, “Mitigating sports injury risks using Internet of Things and analytic approaches,” outlines how injury risk screening procedures can be administered using wireless devices, such as smartphones, connected to a cloud server. This connection between phones, computers and other devices is what researchers refer to as the Internet of Things. This approach to categorizing injury risks combines the athlete’s previous injury history, data from phones and devices with injury surveillance data. Using cloudconnected smartphones and other devices, various screening tests may be combined from different sources to create a realtime “dashboard” of an athlete’s status. This data may then help identify athletes with higher injury risk, and reduce the economic, emotional and physical toll of sports injuries. Conventional sports injury management relies heavily on subjective assessment, such as the athlete’s verbal description of pain and discomfort. However, athletes may not always assess their own abilities and injuries accurately. They may start competing before they are ready, 19

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which can increase their risk of re-injury. Currently, the most widely used method for assessing injury risk is the Functional Movement Screen, which generates a subjective score based on observed ability to complete the movements. In contrast, researchers Gary B. Wilkerson and Marisa A. Colston used a smartphone to gather performance data on each individual in the study. To understand the factors influencing an athlete’s risk of injury, this data was integrated with self-reports of previous injuries and longitudinal tracking of exposure to game conditions. The researchers tracked 43 players from an NCAA Division I-Football Championship Subdivision (FCS) football team, starting one month prior to the start of preseason practice through the conclusion of the season. Information regarding their previous injuries was collected in a 10-item Sport Fitness Index (SFI) survey. Prior to the start of preseason, each player participated in the Unilateral Forefoot Squat (UFS) test. This test assessed their ability to synchronize muscle responses in the legs while maintaining an upright position, a knee angle of 135 degrees and a slight heel elevation for 10 seconds. The researchers measured postural sway jerkiness – an evaluation of postural control. The use of a smartphone to quantify postural jerkiness using accelerometer output during the UFS test was an inexpensive and efficient way to objectively measure of the athlete’s ability to maintain a postural position through coordinated muscle movements. This data was transferred to the athlete database and integrated with data from the SFI survey. Documentation of game participation and injuries sustained during the season were added to the database to develop the (CONTINUED ON PAGE 20)

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The Right Population Health Analytics to Transform the Patient Experience By ABHINAV SHASHANK

Consider a situation where healthcare is not just an industry term- a situation where EHRs are not an integral part of physicians’ schedule but just a support to providing care. All considered, imagine a situation where patient-centric care actually involves the patient, and patient engagement is not just a buzzword but a reality. Unfortunately, all these imaginations were supposed to be a reality, but still, healthcare managers and organizations are struggling with the problems such as the lack of patients’ adherence to medication, varying trends in the population health, and a lot more. Patient population, nowadays, expect the same on-demand delivery convenience from the healthcare organizations as they get from the other companies like Netflix.

Why is Patient Engagement the Core of Providing Patient-centric Care? To understand the value of the patient in the entire care continuum, let us take an example. Consider a patient, Marcus, who works at an IT firm and is affiliated to a Commercial ACO in his county. Marcus is a 65-year-old male suffering from comorbidities like Type 1 Diabetes, and diabetic retinopathy. He is at constant risk of sporadic elevated blood pressure. In the year 2016, Marcus visited the ED approximately five times. Considering the situation, the primary care physician of Marcus referred him to a specialist and prepared a schedule comprising at least two monthly visits. The year 2017 started with a lot of workload for him at his firm, and he was unable to keep up with the prescribed schedule. Due to improper communication between his PCP and him, his physician was not able to keep track of Marcus’s health. As a result, the ED utilization rate of Marcus increased from five times to nine times. Due to enhanced stress and improper quality of care, the sporadic episodes of elevated blood pressure turned into a constant problem of hypertension. Also, the overall cost of care for Marcus increased drastically. Challenges in Achieving True Patient Engagement Patient Engagement, in itself, is not as simple as ABC. It is not just bringing patients in the cycle of care continuum but enhancing the patient’s skills, ability, knowledge, and most importantly, willingness to participate in the task of managing his own care. The concept of providing care with ‘engaged patients’ sounds great theoretically, but it is not that smooth sailing. According to a survey, nearly 87 per20

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cent of the patient population believes that communication with their doctor apart from their scheduled appointments is really important. The major flaw is the lack of awareness among the patients regarding their care procedures. Many patients are ignorant of the clinical processes which a physician follows, and they might miss out on major health details. With no actual knowledge of the disease symptoms, patients might not report to their physicians which might lead to reduced patient engagement, not to mention the increased risk of developing a chronic disease. Care teams play a vital role in engaging the patients through regular followups. Irregular and fragmented workflows of care managers and lack of personalization might lead to the generation of ineffective care plans for the patients. Reduction in patient engagement could also be the result of underutilization of technologies to analyze the massive amount of patient data that care managers have at their disposal. Through building more personalized care plans, patients can be engaged at a more grass-roots level.

Driving Effective Engagements through Value-based Care Predictive population health analytics is the answer to nearly every problem linked with patient engagement. Advanced predictive analytics tools will help in dealing with the problems of disparate data systems and can pinpoint the exact area on which healthcare organizations can focus. Leveraging the insights obtained by data analytics, care teams can prepare the statistical models to prioritize each patient and can take necessary measures to engage patients in the process of decisionmaking. Understanding the patients’ habits by the care teams increases the chances of preparing personalized care plans for them and enhancing the level of patient satisfaction. With enhanced technologies, advanced tools, and constant patient engagement, individual care management can pave the path for systematic populationlevel solutions. Whether it may be population-level or individual-level intervention, it is essential to identify the root cause of the problem. With interactive analytics, the physicians can identify the episodic outcomes variations. Systematic analysis of patient population can not only help in stratifying population based on factors such as risk-scores but can also lead the way for holistic diagnosis and personalized care being delivered based on key health trends. When it comes to realizing smart healthcare choices, we always eliminate a major factor- social and behavioral deter-

minants of health. This data helps in identifying individual struggle with daily routine activities and can turn out to be a strong tool in eliminating the barriers which are outside the limits of healthcare. Care organizations can classify the area’s population based on various parameters like language, accessibility to vehicles, and others to manage their outreach programs. Including social determinants of health data for advancing patient engagement can be highly beneficial for healthcare. For instance, if the physician knows her patient to be someone who follows an unhealthy lifestyle, she can take preemptive steps to avoid the occurrence of any illness that the patient might have become prone to. Moreover, the patients can be made aware beforehand about any health risk they might be contracting due to their lifestyle, environment, neighbourhood, eating habits etc.

Advanced Approach to Bridge the Physician-Patient Gap Healthcare organizations are constantly trying to improve the patient experience of care and deliver quality at every step. And the immense amount of healthcare can serve as a significant avenue for innovation to enhance patient engagement. A patient can receive care from multiple facilities- even within a network. A comprehensive, accurate picture can be obtained only when the patient health data is obtained from all these facilities and brought together on a unified healthcare data platform. Such a healthcare data platform can integrate disparate sources into longitu-

dinal records, that detail every patient’s risk scores, medical history, admissions, and discharge events. These records can be further analyzed to understand the gaps in care, learn about the impacts of ongoing care programs, and plan timely interventions for the patients. With a close monitoring of care programs impact the patients, the care teams can address the specific blind spots, and even link community resources to assist patients with their varying needs. One such organization, with the use of an integrated, data-driven approach, was able to reduce SNF visits in their network by 12% and cut down their 30-day readmission rate by 7.14%!

The Road Ahead In the present healthcare scenario, patient engagement is like the medicine which is to be prescribed to every patient as well as provider. Changing the entire nation’s healthcare ideology to a single patient-centric approach is tough, but this transition is vital. It is nearly impossible to realize engaged patients without a strategic approach covering the overall domain of the healthcare. Being an integral part of healthcare, patients serve as one of the major drivers in the improvement of the overall picture. Properly engaging them not just to improve their individual health but for improving the entire population health is a must and cannot be neglected in the long run. Abhinav Shashank, Co-Founder & CEO at Innovaccer, is an expert in population health management and robust technologies. For the better part of the decade he has been working to revolutionize healthcare delivery with 25+ value-focused organization and making over 10 million lives better. Visit www.innovaccer.com

What If We Could Predict, continued from page 19

individual’s injury prediction model. In the analysis of the data, the researchers found that athletes who played at least eight games had more than three times greater odds of injury occurrence than those who played fewer than eight games. Among athletes who exhibited at least one risk factor, 42 percent sustained an injury. “Assigning all athletes to a single type of training program, without consideration of an individual’s unique risk profile, may fail to produce a substantial decrease in injury likelihood. The results also provide a useful estimation of the odds of injury occurrence for each athlete during the subsequent season,” states Wilkerson, lead author and professor in a graduate athletic training program. This study used only one test to assess physical ability, but there are many other types of screening tests that can be used to assess different aspects of an athlete’s

performance capabilities to create a more detailed picture of the individual’s injury risk. Other tests could be used to gauge neuromechanical and neurocognitive abilities and the extent of head injuries. As smartphones and other IoT devices become more prevalent, various screening tests may be combined from different sources to create a real-time “dashboard” of athlete status indicators. This data may then help to clearly identify athletes with elevated injury risk, thereby supporting efforts to reduce the economic, emotional and physical toll of sport injuries. The Society for Risk Analysis is a multidisciplinary, interdisciplinary, scholarly, international society that provides an open forum for all those interested in risk analysis. SRA was established in 1980 and has published Risk Analysis: An International Journal, the leading scholarly journal in the field, continuously since 1981. For more information, visit www.sra.org. orlandomedicalnews

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Who Becomes Addicted and Who Does Not? By ANTOINE KANAMUGIRE, MD

When we submit to the temptation of achieving pleasure and instant gratification, it comes at a personal cost. When we find ourselves compromising our morals, our principles, our careers, our future goals, our families’ well-being, and our health to achieve that ‘’feel good’’ moment—and find ourselves doing so over and over again—here we can start talking about addiction. Can anyone become addicted to cannabis? Who is more at risk of succumbing to cannabis addiction? Can some people use cannabis without becoming addicted? As you probably already know, it’s in human beings’ nature and design to seek out what’s most pleasurable, enjoyable, and least difficult; it is only when we are following a greater purpose to achieve our goals that we choose to take a more difficult path. We all long for pleasure and the faster and easier we can obtain it, the more we risk becoming addicted to the source of pleasure. The design of the human mind allows us to experience enjoyment, but also makes us vulnerable to becoming addicted to these pleasurable experiences… How do we biologically fall into addiction?

The Reward System or Dopamine reward pathways Our brain is intelligently designed; the circuitry of our brain is designed to help us enjoy pleasurable activities such as great meals, good company with friends, or a stimulating encounter with a new romantic interest. Thebrain circuitry system responsible for allowing us to enjoy such experiences is called the Reward System or the dopamine reward pathways. These pathways in the brain encourage us to seek out these awesome, exciting, and pleasurable experiences and reinforces these types of behaviors when we seek them out, making us more likely to do so over time. Let us underscore that there are survival reasons to this reward system, food is pleasurable to encourage us to eat and stay alive, sex is pleasurable to encourage us to mate and reproduce. You can skip the following paragraph if you’re not interested in scientific explanations, but if you are, let’s briefly discuss the structures of your brain which are involved in developing addictive behaviors. The reward system is first stimulated when an addictive substance or pleasurable experience is encountered; practically all addictive substances will directly or indirectly increase dopamine levels in your brain. Dopamine is a neurotransmitter or chemical in your brain that is involved in pleasure and motivation. Without going into detailed medical or scientific explanations of this circuitry, let us note that the reward 21

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system involves many parts of the brain such as the prefrontal cortex, the nucleus accumbens, the limbic system, the anterior cingulate, the ventral tegmental area, and the amygdala… When exposed to an addictive substance, the reward circuitry stimulates some people to seek more intense experiences to achieve the same pleasure over time. As someone repetitively uses the drug, dopamine is released and over time the brain becomes ‘used to’ the dopamine released by the brain, it then releases less dopamine for the same amount of stimulation-or same amount of substance-over time, and therefore requires ever larger amounts of stimulation to achieve the same pleasure as time progresses. Furthermore, the brain’s response is dependent on numerous other factors such as genetic predisposition, morals, self-control, life stressors, protective factors, etc., and so everyone’s vulnerability to addiction is based on a variety of different variables. In these cases, the need to achieve pleasure becomes an affliction; feeling good becomes the ultimate goal, and the person can become trapped by compulsive instant gratification seeking behavior. When we submit to the temptation of achieving pleasure and instant gratification, it comes at a personal cost. When we find ourselves compromising our morals, our principles, our careers, our future goals, our families’ well-being, and our health to achieve that ‘’feel good’’ moment—and find ourselves doing so over and over again—here we can start seeing the signs of addiction.

Our Brains might look similar, but each Brain is Unique! All brains are based on a shared basic design, but they are not identical. We see variations in sizes of different brains, in the sizes of different structures of the brain, variations in the connections between different parts of the brain, and functional differences which neuroscientists can’t yet fully explain or understand. Some brains are more vulnerable to addiction or mental health problems than others, for a variety of reasons. Two people from the same background, at the same age, and in comparable health could ingest the same drug, and while one will be fine, the other could experience a psychotic episode! We are all unique, and due to a host of genetic, emotional, and nurturing differences, we might all be affected in unique ways if we choose to use drugs. Who gets Addicted and Who does not? Stats Corner • Not all drugs or alcohol users become addicted • About 10% to 20% of all substance users will lose control and slide into addiction 17

• 50% of the risk of substance addiction can be attributed to genetic factors • Additional risk factors are involved in triggering the addiction, if the user is exposed to addictive substances. • Teenagers and Young Adults are at higher risk of becoming addicted to cannabis So the question is: can anyone become addicted to cannabis or other drugs? The tricky answer is both “yes” and “no”. Given the right circumstances, the right substances, the right experiences, and the right timing, I believe anyone can develop an addiction of some kind. Some might become addicted to cannabis, others to cocaine, alcohol, or amphetamines. Others still to pornography, internet usage, cell phones or social media, video games, or to watching sports. Those who are vulnerable, like the high sensation seekers or novelty-seekers, are at increased risk whenever they engage in thrill-seeking or pleasure-

seeking behaviors which expose them to the possibility of becoming addicted. Some studies suggest that about 10% to 20% percent of substance users will become addicted to the substances they consume. Genetics plays a major role in determining who will or won’t become addicted to substances, and researchers suggest up to 50% of this risk is determined by your genetic predisposition to addictive behaviors in the first place. Many other risk factors also play a role, such as life stressors, family history, brain developmental stage and age, and the type of drugs being consumed. Teenagers are far more vulnerable to developing an addiction when they try an addictive substance than adults are. Antoine Kanamugire, M.D. is a Canadian medical doctor, specializing in psychiatry. He pursued a bachelor’s degree in biology in Pittsburgh, USA, then went to Canada where he completed a medical degree at the University of Sherbrooke and then a specialty in psychiatry at the University of Montreal. He is a consultant psychiatrist in outpatient clinics, in the Emergency Department and for mental health first line teams in Montreal suburbs.

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