The Award-Winning Journal of the Michigan Osteopathic Association W I N T E R 2020
McLaren
PROTON THERAPY CENTER
Offers Newest Cancer-Fighting Technology
w w w. D O M O A . o r g
michiganosteopathic
MichiganDOs
m i c h i g a n - o s t e o p a t h i c- a s s o c i a t i o n
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CONTENTS
In Every Issue 05 President’s Page 20 Coverys 25 Healthcare Partners
of Michigan
27 Advertiser Index
FEATURES 07
House of Delegates: Call for Resolutions
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McLaren Proton Therapy Center Offers Newest Cancer- Fighting Technology: Precise Treatment Spares Healthy Tissue with Fewer Side Effects
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MOA 15th Annual Autumn Convention Recap
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Local doctor testing cancer-screening AI software
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Beaumont casts a wider net launching podcast for patients and families
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MOA mourns the passing of Augustine L. Perrotta, DO
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Component Connection
MICHIGAN MOA OSTEOPATHIC ASSOCIATION 3
MICHIGAN OSTEOPATHIC ASSOCIATION
121st Annual Spring
SCIENTIFIC CONVENTION Thursday, May 14 - Sunday, May 17, 2020 30+ AOA Category 1-A Credits Anticipated SESSION HIGHLIGHTS: • OMM • Business of Medicine • Cardiology • Womens Health • Psychiatry & Addiction • Genetic Determinants of Disease • Functional & Integrative Medicine • Neurology • Office Emergencies • Workplace Violence • Infectious Disease • HIV/AIDS • Domestic Violence • Risk Management Licensing Requirements • Pain & Symptom Management • Human Trafficking • Florida Requirements
SPONSORED IN PART BY:
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Includes education requirements for Michigan License Renewal.
REGISTRATION OPENS JANUARY 2020
WWW.D O M OA.O RG/S P R I N G
Login required for member discount. By default, your username is your AOA number. If you experience difficulty logging in, please call 800-657-1556.
PRESIDENT'S PAGE
GENERATIONS OF CHANGE B Y C RA I G G L I N E S, D O, M OA P R E S I D E N T
T Craig Glines, DO
“While my career was light years from Andrew Taylor Still’s time, I can only imagine how things will change for the DO’s of the next generation.”
his TRIAD has a theme of change. My thoughts went to Andrew Taylor Still, the founder of osteopathic medicine, and I wondered if he could imagine where his philosophy and ideas would lead. Currently, one fourth of all medical students in the U.S. are in DO schools.
I also began to think about my family, myself and our DO history. My fatherin-law graduated from CCOM in Chicago in 1960. There were no laser surgeries, ultrasounds, CT scans etc., all surgeries were still done “open.” Antibiotics were still new and limited to a few kinds. Primary Care physicians could go into practice after completing their internships. My own journey began in 1987 at MSUCOM and I graduated in 1991. I did not have a computer, laptop or cell phone when I was in med school. I studied from textbooks or lecture “pool notes.” For the most part, lectures in med school were still on “slide decks” and occasionally the lecturer had an overhead projector. I started my residency in OB/GYN in 1991 at Riverside Osteopathic Hospital and I was in the first class where we completed our training in four years not five. We were still doing Hysterectomies through open incisions although, Laparoscopies were being used for diagnosis and some smaller procedures. Laser surgery was in vogue. While my career was light years from Andrew Taylor Still’s time, I can only imagine how things will change for the DO’s of the next generation. My son is in his second year of ER residency. They wheel computers around with them and they are able to access more knowledge in their phones then we could on early computers the size of a building. They have far more medications with more coming out weekly basis. The amount of new information bombarding society every day is overwhelming. This is the era of electronics, robotics and computerized medicine. Telemedicine is still in its infancy, but it is quickly becoming an accepted tool. Health teams are connected by their cell phones to labs, radiology, and medical records. And while medicine is more instantaneous, are we losing the humanistic interaction osteopathic medicine was based on? How would Dr. Still look at the world today? He might be overwhelmed and maybe saddened at the loss of the doctor/patient relationship. Although he would probably remind all of us, Osteopathic Medicine, practices and techniques are still all done manually, one on one and doctor to Patient.
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n of health ators and etermine how e. Submitting nfluences the
WRITE POLICY, INF LUENCE CHANGE! MOA House of Delegates 9:00 am - 3:30 pm Thursday, May 14, 2020 Westin Southfield Detroit
CALL FOR RESOLUTIONS
The Michigan Osteopathic Association (MOA), is GATES the largest, most influential osteopathic medical
organization in Michigan, and serves as an support assertive advocate for physicians and patients. s members This success comes from member involvement to communicate the physician vision of health of policy care to the public, legislators, regulators and other health policy leaders who determine how never u have medicine is practiced in our state. Submitting MOA for action directly influences the te before, resolutions most agenda. thisadvocacy join atMOA
CALL FOR DELEGATES
standing s in good The MOA relies on the support and participation the entire of its members to attend in shaping the health policy of PMif are AM – 3:30 m 9:00tomorrow. Even you have never served as a delegate o apply. Each component before, MOA welcomes you to join at this most includes delegation important event.a and concerned dedicated MOA members in good standing to maintain ans, who whowish are able to attendathe entire meeting from 9:00 AM – 3:30 PM are among the state’s g position welcome to apply. Each component society’s delegation includes a societies. opathic group of dedicated and concerned physicians, who wish to maintain a strong position among the state’s osteopathic societies.
MORE INFORMATION AT WWW.DO MOA.ORG/HOD
or 517-347-1555 ext 103 if you are interested oa.orgWWW.DOMOA.ORG/HOD at vbernero@domAT Virginia Bernero Please contact MORE INFORMATION Please contact at vbernero@domoa.org or 517-347-1555 are 13, interested 2020. March submissionsextare103dueif you applications and resolution delegate serve. AllBernero toVirginia available and and available to serve. All delegate applications and resolution submissions are due March 13, 2020. T R I A D | W I N T E R 2020
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MCLAREN PROTON THERAPY CENTER OFFERS NEWEST CANCER-FIGHTING TECHNOLOGY McLaren Health Care is proud to introduce the newest weapon in its arsenal of cancer-fighting technology: Proton Therapy.
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he most powerful and precise radiation oncology treatment available to treat cancer is now provided at the McLaren Proton Therapy Center, located on the campus of the Karmanos Cancer Institute in Flint, Michigan.
As one of only 28 proton therapy centers in the United States, the McLaren Proton Therapy Center features leading treatment technology and expertise to deliver proton therapy with supreme precision. This advanced
technology delivers higher doses of radiation to cancer cells while sparing healthy tissue and organs, greatly lowering the risk of secondary cancer, reducing side effects, and resulting in strong cure rates.
Benefit of Proton Therapy: Radiation Stops at the Target Patients experience fewer side effects and complications when healthy tissues and organs are spared from unnecessary radiation. The goal of radiation therapy is to deliver the optimal amount of radiation to the target (the tumor), while minimizing the radiation to healthy parts of the body. That’s the power of proton
PRECISE TREATMENT SPARES HEALTHY TISSUE WITH FEWER SIDE EFFECTS
INSIDE OF THE GANTRY, OR TREATMENT ROOM AT THE MCLAREN PROTON THERAPY CENTER.
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therapy. It accurately and precisely targets the tumor while sparing healthy tissue more than any other form of radiation therapy. With proton therapy, the great majority of unnecessary radiation outside the target is avoided completely. Compared to traditional forms of radiation, proton therapy releases most of the radiation dose at an exact point inside the tumor and not along the path through which the beam exits the body. In fact, there is virtually no “exit dose” of radiation beyond the tumor volume, which means the protons stop at the tumor and do not continue on to harm healthy parts of the body.
DR. HESHAM GAYAR, MEDICAL DIRECTOR OF THE MCLAREN PROTON THERAPY
DAVID WOOD, PROSTATE CANCER PATIENT, RINGING THE CELEBRATORY BELL AT
CENTER, WITH DAVID WOOD, THE FIRST PATIENT TO RECEIVE TREATMENT.
THE CONCLUSION OF HIS TREATMENT AT THE PROTON THERAPY CENTER.
Leaders in Advanced, Next Generation Technology When it comes to proton therapy, McLaren Proton Therapy Center provides several major advances. Pencil-beam scanning and a stateof-the-art delivery system called Intensity Modulated Proton Therapy (IMPT) ensure that the distribution of radiation is very precise. With pencil-beam scanning, a focused set of proton beams (as small as a few millimeters in diameter) can target the tumor. This considerably reduces radiation exposure to healthy tissues. Isocentric gantries with 180-degree rotation and highly sophisticated robotic patient-positioning systems enable incredible flexibility of beam delivery, which allows the radiation beam to be directed with incredible accuracy—down to a millimeter. Coupled with a robotic couch, this technology allows for 360-degree rotation and unlimited treatment angles. The Radiance 330 synchrotron generates proton beams with energies up to 250 megaelectron volts (MeV. The Radiance 330 synchrotron produces less harmful radiation and less scatter radiation because it uses pencil-beam technology. Image Guidance allows for precise positioning of the target (tumor) for accurate delivery.
CANCERS TREATED BY PROTON THERAPY Proton therapy most often treats solid tumors and is particularly applicable to treating: • Bladder Cancer • Brain and Central Nervous System Cancer • Breast Cancer • Esophageal Cancer • Head, neck, and skull base Cancer • Kidney Cancer • Lymphoma • Liver Cancer • Lung and thorax Cancer • Pancreatic Cancer • Pediatric Tumors • Prostate Cancer • Sarcoma • Spine and Chest Wall Cancer • Select Gynecological and Gastrointestinal Cancer
Recurrent disease Our expert team of physicians, physicists and other proton specialists are highly trained in proton therapy and work collaboratively to provide an individualized treatment plan for each person’s unique cancer and situation. The physician team of board certified radiation oncologists include Medical Director Hesham Gayar, M.D., who serves as Vice President for the Particle Therapy Co-Operative Group (PTCOG), North American Chapter, and on the Steering Committee for PTCOG worldwide; Kiran Devisetty, M.D.; Jack Nettleton, M.D., and Omar Gayar, M.D.
Treatment Experience and Support Services Proton therapy is a noninvasive modality, and the actual beam of protons is only delivered for several minutes per session. Typically, the entire treatment experience, from entering the Proton Center to the completion of treatment, takes less than an hour. Depending on the specific case, patients typically receive these daily outpatient treatments for a number of weeks, with treatment plans varying based on tumor type, location and size. Because of proton therapy’s noninvasive nature, many patients report limited side effects, with most feeling well enough to continue on with their normal daily activities during the treatment period. Support services available for patients include: proton navigator, nutritional counseling, art therapy, wellness classes, and financial counseling. Additionally, the McLaren Hospitality House, located adjacent to the Proton Therapy Center, provides comfortable, extended-stay housing at minimal cost and offers a healing, caring and comfortable environment for patients and their caregivers who are traveling long distances for treatment. For more information about the McLaren Proton Therapy Center, please visit www.mclaren.org/protontherapy or call 855-697-7686 (855-MYPROTON)
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Fulford Legacy Conference ))
BAS I C PE RC US S I O N C OUR S E Thank you 2019 Attendees!
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The Michigan Osteopathic Association would like to thank the over 65 attendees from around the world for their enthusiastic participation at the recent Fulford Legacy Conference. The basic percussion course took place in Novi, Michigan from Friday, November 22 through Sunday. If you missed this event, but would like information on furture events focused on OMT techniques or Dr. Fulford’s philosophies, please contact Melissa at 517-347-1555.
Speakers: Richard W. Koss, DO, C-SPOMM, C-ACOFP
William H. Stager, DO, MS, MPH, FAAFP, FAAMA, FAAO, FACOFP dist.
Attendees earned 23 NMM-Specific AOA Category 1-A Credits
Michigan Osteopathic Association | 2445 Woodlake Circle, Okemos, MI 48864 | P 517-347-1555 | F 517-347-1566 | www.domoa.org
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MICHIGAN OSTEOPATHIC ASSOCIATION
15th Annual Autumn
SCIENTIFIC CONVENTION
CO N V E N T I O N R E CA P The MOA 15th Annual Autumn Scientific Convention attracted over 400 physicians, nurses, students and residents to Grand Rapids for the 3-day educational program that included an impressive lineup of presenters and topics. This years’ CME lectures began on Friday morning and offered 26 AOA Category 1-A credits. The MOA would like to thank the MOA Education Committee for their amazing efforts which contributed to the exciting growth of this young convention in Grand Rapids. Save the date to attend next year at the Amway Grand Plaza, November 6-8, 2020.
CRAIG GLINES, DO, WELCOMES ATTENDEES TO THE CONVENTION AS CURRENT MOA PRESIDENT.
TTRRIIAADD | W I N T E R 2019 2020
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MOAautumn.com
Congratulations SRE Winners! First Place: Towards Automated Structured Reporting of Thyroid Ultrasound to Reduce Fine Needle Aspirations in Thyroid Cancer
Evaluations and CME Information Evaluation website link:
Sydney Rubin, MSU; Joseph Adams, MSU; Joseph Cox, MSU; Carina Pereira, UW; Manjiri Dighe, UW; Bruce Wolf, MSU; Adam Alessio, Michigan State University College of Osteopathic Medicine
• Autumn Convention attendees
Second Place: Creating and Validating the Disordered Eating Screen for Athletes (DESA-6): A Proposed Screening Tool
data.express-evaluations.com/
Ryley Mancine OMS-II1 , Donald Gusfa OMS-II1 , Samantha Kennedy D.O.1; 1 - Department of Psychiatry, Michigan State University College of Osteopathic Medicine
Third Place: The Ureteral Calculi Urinary Culture (UCUC) Calculator: A Prospective Internal Validation Matthew Rohloff, DO; Elizabeth Lojewski, DO; Metro Health: University of Michigan HealthKenneth Shockley, DO; Metro Health: University of Michigan HealthThomas Maatman, DO; Metro Health: University of Michigan Health Mohammad Mustafa Ahmadzai, College of Osteopathic Medicine, Michigan State University; DO/PhD Program, Michigan State University; Roberto De Giorgio, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy; Brian Gulbransen, Neuroscience Program, Michigan State University
Miscellaneous: Polycythemia Vera: An Unusual Cause of Heart Failure Anila Rao D.O., McLaren Macomb Medical Center, Mt. Clemens, MI; Edward Chi D.O., McLaren Macomb Medical Center, Mt. Clemens, MI; Lakshmi Rao D.O., Beaumont Hospital, Farmington Hills, MI; Vasim Lala D.O., McLaren Macomb Medical Center, Mt. Clemens, MI; Dheeraj Thammineni, M.D. McLaren Macomb Medical Center, Mt. Clemens, MI
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website at this link: eval/38060/web/ Link to CME information: • www.domoa.org/cmeinfo
Speaker Presentations Some speakers have allowed us to share their presentations as PDF files via the following link: • www.domoa.org/
MSUCOM DO-PhD Award
THE SCIENTIFIC RESEARCH EXHIBIT (SRE) COMPETITION SAW ITS HIGHEST RATE OF PARTICIPATION YET AT AUTUMN CONVENTION. MEDICAL STUDENTS, INTERNS, RESIDENTS AND ATTENDING PHYSICIANS PRESENTED ON OVER 30 TOPICS.
can access the evaluation
autumnpresentations
Online Photo Album There were many friendly faces and great events at Autumn Convention! Check out our Facebook page to see if your photo is among them! • www.facebook.com/ michiganosteopathic
THE FOUR SUBMISSION CATEGORIES FOR THE SRE COMPETITION ARE: BASIC SCIENCE RESEARCH ABSTRACT FORMAT; CLINICAL VIGNETTE (CASE REPORT ) ABSTRACT FORMAT; CLINICAL MEDICINE (RESEARCH STUDY) ABSTRACT FORMAT; QUALITY IMPROVEMENT/ PATIENT SAFETY HIGH VALUE CARE ABSTRACT FORMAT.
Physician Wellness Center Grows with New Partners Six treatment tables and a room of yoga mats were occupied by attendees and guests at the Autumn Convention, thanks to additional resources in the Physician Wellness Center. The American Academy of Osteopathy (AAO) provided administrative assistance and recruited physicians to perform Osteopathic Manipulative Treatment (OMT). Amanda Wallace of Yoga Everywhere shared her passion and expertise for guided relaxation, meditation and yoga techniques.
THE PHYSICIAN WELLNESS CENTER SERVES AS A PLACE FOR RELAXATION AND REJUVENATION FOR PHYSICIANS AND GUESTS DURING THE CONVENTION. PHYSICIAN VOLUNTEERS ARE ABLE TO PRACTICE AND RECEIVE OSTEOPATHIC MANIPULATIVE TREATMENT (OMT ) IN THE CENTER FREE OF CHARGE AS PART OF THE EDUCATIONAL EXPERIENCE.
SCIENTIFIC CONVENTION
E AV
THE DAT
E!
November 6-8, 2020 Amway Grand Plaza Hotel Grand Rapids, MI
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Dr. Goldman led a hands-on learning OMT session during the convention, and also continued the learning experience in the Physician Wellness Center. The MOA is pleased to offer this unique opportunity to relax and rejuvenate for attendees and their guests during our conventions. While educating physicians is a main priority, being mindful to combat burnout and its symptoms also has its place and focus. Over 50 people participated and experienced these essential pain management and wellness practice.
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MICHIGAN OSTEOPATHIC ASSOCIATION
121st Annual Spring
SCIENTIFIC CONVENTION
Dynamic speakers, in depth and relevant topics at a nationally accredited program and 750+ physicians in your DO family.
SEE YOU IN SOUTHFIELD
Thursday, May 14 - Sunday, May 17, 2020 32+ AOA Category 1-A Credits Anticipated www.domoa.org/spring
SPONSORED IN PART BY:
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LOCAL DOCTOR TESTING CANCER-SCREENING AI SOFTWARE USING AN ALGORITHM, SOFTWARE SIGNIFICANTLY IMPROVES BREAST CANCER DETECTION By Justin Dawes (originally published in the Grand Rapids Business Journal)
Dr. Mark Traill, a radiologist at Metro Health - University of Michigan Health, is one of the first in the state to use FDA-approved ProFound AI, which uses technology he says will be “massively Dr. Mark Traill
disruptive” in the field.
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he software helps doctors spot breast cancer tumors more accurately, reducing false positives and unnecessary patient callbacks for additional testing. Using an algorithm, the software can analyze each 3D mammography image for a patient and detect malignant and nonmalignant tumors at a rate of about 7%-8% higher than humans can, Traill said. “The algorithm can look at a scan and put together patterns that you can't even see,” he said. Traill said it’s easy for even several doctors to completely overlook abnormalities in a screening. “Nobody finds them all,” he said. When New Hampshire-based medical technology company iCAD rolled out the technology last year, Forbes called it one of the 2018’s biggest moments in AI. Through Traill’s relationship with iCAD, the company donated the
technology to Metro Health a little over a month ago, which Traill alone is using on a research basis with the University of Michigan. He said Metro plans to expand the use of the technology throughout the entire system this month. At that time, the hospital will be one of three systems in the state using it. “I would expect that probably within a year or so, that number is going to be much, much higher,” Traill said. Traill said he remembers the excitement when MRI technology was introduced because of the changes it brought in diagnoses. “This is going to be a lot bigger than that,” he said.
“There's been a lot of hype, but I don't think it's overdone for this. I think this is something that is really going to have a huge impact on radiology and across the board in medicine.” He said there was some apprehension from radiologists when the technology was first being introduced because of the fear that it will automate what the doctors do. “That's not going to be the case,” he said. He argues that radiologists who use the technology no longer have to spend time reading mammograms but instead will be able to offer more valuable care. “AI is not going to replace radiologists, but radiologists who use it and embrace it are going to replace those that don't.” Traill said he has been attending conferences and following advances in this technology for about four years, and the progress has been “surprisingly fast” and seems to be somewhat outpacing its utilization for now. The technology still is in the early stages. In the next decade, he said he expects it may even be able to diagnose issues, not just find abnormalities.
“... the software can analyze each 3D mammography image for a patient and detect malignant and nonmalignant tumors at a rate of about 7%-8% higher than humans can,” Traill said. T R I A D | W I N T E R 2020
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BEAUMONT CASTS A WIDER NET LAUNCHING
PODCAST FOR PATIENTS & FAMILIES Technology has allowed the field of medicine to advance more than just in the hospital setting. There has been a general shift of information sharing to now include media like podcasts.
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till present on other channels, Beaumont decided to look at a podcast as an opportunity to take a deeper dive on subjects, feature experts from a variety of specialties and get them out into the community. Podcasting was determined to be the most nimble medium for sharing information to help people be smarter about their health care. There’s clearly an audience for health and wellness related podcasts – Health and Fitness being one of the top categories in Apple Podcasts. After determining that they could have a voice in the health and wellness category, Beaumont launched HouseCall in 2018. The length of each episode is approximately 20-30 minutes, which seems to be the right amount of time for a commute or a quick walk. It provides very digestible content for someone interested in maintaining or improving their health.
health medical director and a board-certified family medicine physician. “For medical questions, simple and complex, many people turn to Google, which doesn’t always result in the right answers or reliable advice,” Dr. Gilpin said. “We are creating podcasts that feature Beaumont doctors and experts having in-depth discussions about health trends with everyday life application.” According to Dr. Shajahan, many of the conversations in the podcast emphasize matters that prompt important conversations between patients and their primary care provider. “We just want to make listeners aware that support and health resources are available and accessible. Sometimes that’s through national support groups, hotlines or websites,” she added With topics beyond typical diseases or treatments, this podcast touches on things that are trending and topical. In fact, some of the most popular episodes include Ticks & Lyme Disease, Vaping, Fad Diets, Bullying and Embarrassing Symptoms. “We understand that each individual episode is very specific, so each one will not appeal to everyone,” Dr. Gilpin
explained. “But those who want to find out more about a topic will spend time learning more by downloading the episode.” Now wrapping up its fourth ‘season,’ and planning its fifth, the team has been able to assess the success of HouseCall. More than 20,000 downloads/streams have been recorded to date. In addition, HouseCall has won and been recognized multiple times in health care and podcast marketing awards, most recently winning the 2019 eHealthcare Leadership Award Best Healthcare Podcast–Platinum. The best feedback is from physicians and patients, though. Patients appreciate the honest discussion and conversational tone of the podcast. Physicians who have listened have shared topics with their patients, knowing the content is coming from a trusted source. HouseCall is available on Apple, Spotify, Stitcher, Google Play, YouTube, SoundCloud and more. To access the HouseCall podcast, visit https://www. beaumont.org/podcast or find it on these apps: iTunes, Google Play, Spotify, Stitcher and SoundCloud.
The next step was finding the talent. Who was knowledgeable, relatable and passionate about bringing patients the information needed to live a smarter, healthier life? The hosts who came to mind were Dr. Nicholas Gilpin and Dr. Asha Shajahan. Dr. Gilpin is Beaumont, Grosse Pointe’s chief medical officer and a board-certified infectious disease and internal medicine physician. Dr. Shajahan is Beaumont, Grosse Pointe’s community T R I A D | W I N T E R 2020
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REDUCE DIAGNOSTIC ERRORS WITH CLINICAL DECISION SUPPORT SYSTEMS By Jade Thompson, RN, MSN, CPHRM
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iagnostic errors are among the most common and costly of all medical mistakes. A National Practitioner Data Bank study of malpractice claims spanning 25 years found that
the occurrence of lethal and non-lethal errors associated with diagnostic error was roughly equal.
Clearly, diagnostic accuracy should be a major priority in healthcare, and some believe that use of a clinical decision support system (CDSS) can help. A CDSS is not a diagnostic application, but a tool that physicians can use to support their decision-making without losing control of their diagnosis or replacing hands-on care.
Role clarification – CDSS vs. doctor The CDSS, and the medical providers who use it, perform separate, complementary tasks. To be clear, no computer can replace the judgement and bedside manner of an experienced physician. Establishing a diagnosis is a multifactorial process that involves a wholepatient assessment supported by the interpretive judgement and personal interaction that physicians bring. Supercomputers are no replacement
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for that interaction. On the flip side, doctors are no replacement for supercomputers, either. The magnitude of data that computers store can't be contained by one human brain. Big data is here now, bringing both benefits and liabilities. On one hand, it's great to have access to an ocean of data. On the other, people can drown in the ocean. An excess of information can slow decisions down and sabotage their quality. When decision-makers are bombarded with so many details that they can't process and synthesize them intelligently and rapidly, diagnostic errors may occur. That's where a CDSS comes into play.
You get the map, I'll take the wheel In 2007, the Journal of the American Medical Informatics Association defined CDSS as a tool that "provides clinicians, staff, patients, or other
individuals with knowledge and person specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare.” Let's put the emphasis on those words, "intelligently filtered." In our tech-first, data-driven era, we've accumulated more raw information than at any other point in human history – and our minds are not adapted to store and use big data. We need computers to store it for us, and if we're to use it at all, we need computers to extract it for us too – presenting a curated selection of relevant data to support the human work of decision-making. A CDSS does not replace doctors’ decision-making. What it does, rather, is synthesize information quickly so that physicians can apply supercomputer-scale insights to human-scale contexts. The doctor is behind the wheel, navigating in real time. CDSS is the passenger who reads relevant information off a map so the driver can make the right split-second decisions when the moment comes.
Five tips to effective implementation and use of CDSS Get involved. Become an active player in the testing, rule-setting, and implementation for the CDSS, so you'll have a voice in making sure that data is up to date, usage is in sync with best practices, and any concerns you may have are addressed. Practice as a group. Teach your team to use the system constructively. Role-play diagnostic problem-solving using a CDSS, including scenarios in which you disagree with the recommended diagnosis. Develop a process in which the information provided is only one factor out of many, and ultimately, it's up to you to reach your own decision. Document decisions. Understand and acknowledge that deviations from CDSS may be appropriate in certain circumstances. Thorough documentation of medical decision-making promotes patient safety through conveying the rationale behind certain medical decisions. Documentation also assists the physician and defense in the event of a lawsuit. Emphasize bedside manner. If you navigate the system in front of a patient and you're still on the learning curve, don't express confusion or frustration. Equally, while the system may require some attention, don't forget that there's a patient in the room who needs you to remain emotionally present. Position the CDSS in a way that facilitates positive patient interaction. Monitor results. Apply the same quality standards to your CDSS as you do to your entire record-keeping system, and create systems to collect feedback from doctors and ensure quality control. Read more at https//www.coverys.com/ Knowledge-Center/Reduce-Diagnostic- Errors-With-Clinical-Decision-Su
FREE TO MOA MEMBERS: AOA ACCREDITED CME COURSES CGM 101: Strategies for Primary Care Providers and Ancillary Staff Join diabetes experts Alison Evert, MS, RD, CDE, and Anne Peters, MD, as they talk about how to start individuals with type 1 diabetes (T1D) on continuous glucose monitoring from the primary care perspective. Learn more about the different devices, their benefits and limitations, how to interpret the data, and billing and insurance coverage considerations. See course details (www.med-iq.com/a1273).
Curing HCV in Treatment-Naïve Patients With Early Stage Liver Disease: Considerations for Treatment Selection, Monitoring, and Follow-Up This activity provides an overview of available therapeutic regimens for treatment-naïve patients with HCV infection and stage F2 or lower liver disease. It also addresses recommended monitoring that should occur during and after treatment, as well as the opportunity for cure among people who use injection drugs. See course details.
HIV Prevention for Black/African American Women: The Use of PrEP in the Primary Care Setting This activity explores the behavioral, social, and structural risk factors that contribute to the disproportionate risk of HIV in black/African American heterosexual women. It also addresses ways to incorporate HIV prevention strategies, including pre-exposure prophylaxis (PrEP), into routine care. Additionally, expert faculty offer insight into the unique challenges that contribute to the increased HIV risk in black/African American women and explain how PrEP can be a powerful tool for HIV prevention in this population. See course details.
Insulin Pumps: What the Primary Care Clinician Needs to Know Join diabetes experts Anne Peters, MD, and Jay Shubrook, DO, to learn more about insulin pumps. Find out about the benefits and limitations of insulin pumps and how you can help interested patients with type 1 diabetes (T1D) get started on this type of therapy. See course details (www.med-iq.com/a1275).Compliments of Coverys and provided through Med-IQ®, a Coverys company
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IN MEMORIAM MOA MOURNS THE PASSING OF
AUGUSTINE L. PERROTTA, DO
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Augustine L. Perrotta, DO
t is with great sadness the Michigan Osteopathic Association (MOA) shares the news on the passing of Augustine L. Perrotta, DO, November 24, 2019. Dr. Perrotta was an accomplished physician, a vocal advocate of the osteopathic profession and a prolific author. His education and practice as a physician took him from Seattle to New York, settling in the Midwest. For over 30 years, he worked as a hematologist and medical oncologist at Detroit Osteopathic Hospital, and at Henry Ford Hospital-Warren, where he served as chairman of the Department of Medicine for the last 10 years of his career. He was an Emeritus Professor of Medicine at Michigan State University College of Osteopathic Medicine and served as a mentor to hundreds of medical students, interns, residents and physicians. "Dr. Perrotta was an iconic osteopathic physician, brilliant in his field, outstanding teacher, pioneer in his field, author of medical as well as a non medical book. He was devoted to his faith his family and his profession," said Peter Ajluni, DO, Past President of the MOA.
In his retirement, Dr. Perrotta published a non-fiction book comprised of 15 medically-oriented short-stories entitled “A View from the Inside.” The book chronicled his connection to public and private personalities describing his connection to them and the impact they had upon him.
Dr. Perrotta was a fixture at the MOA Spring convention, with his signature bow tie, goatee and smile. He could always be seen greeting colleagues and protégées who would share stories and relay the impact he had made on their lives and careers. The MOA encourages those who knew Dr. Perrotta to leave their recollections on the Guestbook using the link below. Local obituary and guestbook
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domoa.org/HCPM
I’M SUPPORTING HEALTHCARE INTEROPERABILITY.
HOW ABOUT YOU? By Ewa Matuszewski, CEO, MedNetOne
We know that “Fix the Damn Roads” was a critical campaign slogan for Michigan’s current governor while running for office. But is “fix the damn interoperability problem with electronic health records” another challenge?
T
he intersection of healthcare and politics is obviously not new. I would contend it’s more visible – and rancorous – than ever. Still, the focus tends to be on access to care and delivery of care, and I understand that. Interoperability of Electronic Health Records (HER) hardly pulls at the heartstrings or incites passionate conversation from either side of the aisle; accordingly, it doesn’t garner much attention from the consumer media either. That is why it is important for healthcare decision makers to individually and collectively raise awareness of the issue, not just in the healthcare community, but with our elected officials. To make sure we’re clear on the topic (and in case some politicians are reading this,) interoperability in this context refers to the ability to share and interpret patient data and information electronically across systems and devices among hospitals, insurers, clinics and private practice physicians.
I’ve said it before, and I’ll say it again: “There ought to be a law.” While I disdain the proliferation of excessive laws that seemingly aim to control our every move, legislation embraced by both parties to establish requirements for the interoperability of individual health care records is critical element of health reform. It empowers both patients and their providers to get sensible, timely care without excessive testing, over-testing and re-testing. It is patient-focused and cost conscious, while consistent with population health goals. If I’m hospitalized and then transferred to another hospital, the assumption is that my records will be immediately available electronically to the receiving hospital. Similarly, if I had an ultrasound done at hospital “X” last year, the ultrasound results should be available online, with my permission, at hospital “Y” this year, correct? The response to either scenario is, “Not necessarily,” especially if it was performed under a different insurance plan the year prior. Similarly, unless a physician practice uses a registry that “speaks” to another physician practice, the patient has to ask the provider for the information to be released, which can get needlessly complicated when the physician doesn’t use a registry at all. Why is this lack of patient data transfer still acceptable in 2019?
Surprising to many, interoperability also plays a role in chronic illness surveillance and treatment. Among our organization’s patient population, primary care physicians have dramatically increased compliance with diabetic patients for annual retinal eye exams, thanks to the affordability of a smartphone app that allows the scan to be taken in the Primary Care Physicians (PCPs) office using an iPhone. The scanned results are then immediately sent electronically to a retinal specialist for interpretation; a referral to a local retinal specialist is provided when merited. Despite multiple state-wide initiatives in recent years to make interoperability a reality, including those spearheaded by state agencies, none of our collective efforts have moved the needle far enough. Michigan is fortunate to have two key partners in the area of interoperability: Blue Cross and Blue Shield of Michigan through its Physician Group Incentive Program (PGIP) and the Michigan Health Information Network Shared Services (MiHIN). Both organizations along with Michigan’s Physician Organizations are supporting a healthcare environment that would be designed to power the future of interoperability through the integration, acceptance, and testing of technologies, with open standards within a collaborative digital platform. But then again maybe legislation could help us finally achieve the goal? T R I A D | W I N T E R 2020
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COMPONENT CONNECTION
UPCOMING EVENTS
The Women of Excellence award is given on an annual basis by the MOA to recognize a female osteopathic physician who has provided exemplary leadership in the field of medicine. The award recipient will be honored at the Women of Excellence Reception which will take place during the MOA Annual Spring Scientific Convention in May 2020 at The Westin Hotel in Southfield. For more information and to make a nomination visit the Women of Excellence webpage on the MOA website. https://www.domoa.org/women-of-excellence
Tri-County Events — 1 AOA 1-A credit anticipated. Tri-County Resolution Writing Event
Saturday, January 25, 2020
The Nuts and Bolts of Saturday, March 28, 2020
Primary Care
CME seminar hosted by OCOMA, MCOMA and WCOMA
Tri-County Resolution Discussion Breakfast
Thursday, May 14, 2020 Westin Southfield Detroit
Delegates to serve at the MOA House of Delegates meeting are invited to attend.
For more information on these upcoming events contact Cynthia Earles at (517) 512-4307Â or cearles@DOMOA.org
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IOA General Membership Meeting Wednesday, February 12, 2020 Kellogg Hotel & Conference Center 6 pm Networking 6:30 pm Meeting & CME Lecture For more information on IOA events and membership please contact Virginia Bernero at (517) 347-1555 ext 103.
ADVERTISERS TRIAD STAFF
Beaumont............................................................................16
Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Virginia Bernero, Executive Assistant & Marketing Coordinator Melissa Budd, CME Program Manager
Blue Cross Blue Shield of Michigan.......................................6
2019-2020 BOARD OF TRUSTEES
Kerr Russell.........................................................................19
Department of Business Affairs - Directors
McLaren Health Care...........................................................23
Craig Glines, DO, President Jeffrey Postlewaite, DO, President-Elect Lawrence Prokop, DO, Immediate Past President John Sealey, DO, Past President David Best, DO, Secretary/Treasurer
Department of Socio Economics - Directors Stephen Bell, DO Emily Hurst, DO
Department of Education - Directors Kevin Beyer, DO Adam Hunt, DO
Department of Membership - Directors Jasper Yung, DO Nathan Holmes, Student Trustee
Department of Healthcare Technology & Informatics - Directors Andrew Adair, DO Miles Medina, DO The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another. TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients. The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA.
COMMUNICATIONS DEPARTMENT Michigan Osteopathic Association Communications Department 2445 Woodlake Circle, Okemos, MI 48864 Phone: 517.347.1555 Fax: 517.347.1566 Website: www.domoa.org Email: moa@domoa.org Š2019 Michigan Osteopathic Association 27
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Coverys.................................................................................2 Healthcare Partners of Michigan..........................................24
Metro Health.......................................................................14 MOA...................................................................................28 MOA Spring Convention.................................................4, 14 MOCF.................................................................................18 MOPAC...............................................................................19
For advertising inquiries, please email Todd Ross at tross@domoa.org or call 800.657.1556.
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