Healthcare Quality and Innovation 2014

Quality&

INNOVATION

LATE SUMMER 2014

body PARTS

Smart parts create fully functioning replacements Microprocessors are being used to replace and renew body parts thus creating bionic limbs, functions and systems.

• The use of microprocessors in prosthesis has created appendages that can “literally” perform all functions except sensation, says Russell De Palma, head of prosthetics at the COPE Center for Prosthetic Excellence in Munster. • “And that’s now being worked on, and that’s starting to happen,” he says.

D ANDREA HOLECEK Times Correspondent

ePalma, who returned to COPE recently after spending two years working with patients at Walter Reed Army Medical Center. The patients have one or more missing limbs.

Funded by the government, scientists working with the medical center have developed a myriad of advanced prosthesis using biometrics. “Without question, microprocessors have made a big difference,” DePalma says. “It’s bizarre, but the greatest advances in our nation’s history with respect to this technology have come out of wars beginning with World War II.” A spokesman for AdvaMed, an association that advocates in behalf of medical tech companies, says there is a constant stream of new bionic innovations: Bionic artificial limbs and joints, pacemakers for the heart, intraocular lenses for the blind, cochlear implants for those with hearing loss.

“It’s an incredible diverse and innovation industry” he says. “On average, there’s a new innovation every 24 months. There are always upgrades happening and new advances practically every 18 to 24 months.”

The U.S. Food and Drug Administration clears 4,000 new devices yearly, not counting 30 to 50 breakthrough devices it approves

PROVIDED

Albert DeRubertis, DO, new medical director of the Rehabilitation Institute of Chicago (RIC) at Franciscan St. Anthony Health-Michigan City, offers a long history of providing inpatient rehabilitation and outpatient care. He is shown working with patient Aaron Gustafson.

It’s an incredible diverse and innovation industry. On average, there’s a new innovation every 24 months. There are always upgrades happening and new advances practically every 18 to 24 months. RUSSELL DE PALMA annually, says AdvaMed’s spokesman, who asked not to be identified. “Innovation is constant in our industry,” he says.

Wanda Moebius, senior vice president, public affairs for the association, says the industry is an “American success story.” It creates life-saving and life-enhancing innovations every day while providing high-quality jobs in communities both large and small, she says adding that Warsaw, Indiana has even been called the “Orthopedics capital of the world.”

“The industry employs more than 420,000 people in the U.S. and approximately 20.000 in Indiana,” Moebius says. “It generates an

additional four jobs in suppliers, component manufacturers, and other companies providing services to the industry and its employees, for every direct job—for a total of more than two million jobs nationwide. The products created by the medical technology industry are an essential part of modern medical practice, and development of new medical technology has been one of the main engines of medical progress, she says.

“In large part because of the diagnostics and treatment option developed by the medical CONTINUED ON PAGE 2

PAGE 2 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

NEW ADVANCES IN

BRING ARTHRITIS RELIEF

T

JULIE DEAN KESSLER

here it is—that pain, the one that seems to holler, “inflammation!”

It comes and goes, but each time it’s just as hard to endure. Or maybe it’s the nagging pain that’s a constant reminder of another chronic condition.

If it’s a musculoskeletal condition like ankylosing spondylitis (can cause vertebrae in the spine to fuse), or a disorder of the autoimmune system, like lupus (can attack almost any area of the body, Dr. Keith Reich from the skin to of Franciscan internal organs), Alliance a rheumatology Rheumatology THINKSTOCK department may be the best have been commonly used, Reich says. bet for diagnosing and treating the “The side effects of some medicines condition. Rheumatology is a subspecialty of internal medicine, and the were so great that they were not helpful.” biggest rheumatology department in “Genetically engineered proteins the Region is at Franciscan Medical Specialists in Munster, where Dr. Keith are designed to inhibit specific components of the immune system Reich is chair of the department and medical director of the infusion center. that play important roles in inflammation, such as in rheumatoid “We offer services many other places don’t. That’s important perhaps arthritis. They’re different form earlier medicines that just suppress especially now, when people are inflammation overall; those medicines aging so more of them are using helped the symptoms but didn’t slow rheumatology services,” Reich says. the progress of the disease; they could With age can often come arthritis, put people at risk for other problems, which is one of the most prevalent of rheumatologic disorders. In November and weren’t as effective (as biologics).

“Biologics give better control 2013 the Centers for Disease Control over side effects like infection.

(CDC) released data estimating that More importantly, unlike the other 52.5 million U.S. adults suffer from medicines used, biologics have been arthritis—about 23 percent of the shown to slow the progression of the population. disease.” Side effects from biologics Other conditions diagnosed are generally less severe; the most and treated at the Franciscan common side effect of an injectable rheumatology department include psoriatic arthritis, lupus, osteoporosis, biologic is a rash, Reich says.

Reich says symptoms include inflammatory muscle diseases, gout, swelling and redness of the joint, and rheumatoid arthritis and more. Reich someone experiencing significant specializes in rheumatoid arthritis. stiffness in the hands for more than Reich says a key element in 45 minutes after diagnosis is arising in the morning ultrasound. “We’re should probably see a one of the only doctor. centers to use A major risk ultrasound for factor, Reich says, is diagnosis. For smoking, especially example, in treating if someone has a a shoulder injury, we Rheumatic strong history of take an ultrasound to see if there’s any disorders account arthritis in the family.

Smoking causes tear or fluid, then for a significant bone loss as well, also use ultrasound so osteoporosis can for guidance of the amount of develop. Poor dental injections and IV disability, so health is another infusions. For damage risk factor. Good to joints, ultrasound is early diagnosis nutrition is important a complementary test and treatment for joint health, with to other imaging such moderation the key, as X-rays. It can be are essential including for alcohol. done in the office, it’s for every one “Rheumatic relatively quick and disorders account painless, and it gives so they can for a significant a real-time view of be functioning amount of disability, the area and motion so early diagnosis (within the area).” members of and treatment are The infusion society. essential for every center for biologic one so they can be treatments offers functioning members different medications DR. KEITH REICH of society,” Reich says. from the ones that

CONTINUED FROM PAGE 1

technology industry, health advances in recent years have been astounding,” her statement says. “Between 1980 and 2010, medical advancements helped add five years to U.S. life expectancy.”

Kevin Gahan, director of therapy services at Munster’s Community Hospital, says bionics have improved prosthetic devices, giving them lifelike abilities.

“There are microchips in a more advanced prosthesis that add a lot more dimension,” he says. “When you add bionics, you’re taking sophisticated computerization to give more function to prosthesis.”

Using microprocessors in prosthesis provides joint control and allow joints to function, Gahan says.

“Computers add a level of safety and function to them (prosthesis),” he says. “They just keep getting more sophisticated every year improving the ability to function and be more mobile.”

One of the most recently use of bionics in prosthesis is the Biom foot, Gahan says.

“It’s an electronic device to give patients push-off,” he says. “It takes the place of calf muscles. It different

from the type of prosthesis used for running, those are low-tech blade style with spring.”

The Biom foot, which has five microprocessors controlled by gyroscope within the ankle allows its user to get up stairs, climb a hill, and an incline, perform any motion that

THINKSTOCK

Clinic delves into the locus painful gout attacks

J

JULIE DEAN KESSLER

ust try nudging the big toe of someone who’s enduring a gout attack in that joint and you’ll probably hear an agonized yelp.

In fact, “A bad gout attack can make a grown man cry,” says Dr. Kevin Joyce, rheumatologist in gout at Franciscan Medical Specialists in Munster. He lists the sudden and severe pain of gout at number 3 on an informal worst-pain list: “There’s childbirth, a kidney stone and gout.”

And although many people have some understanding of what it is, how to tell if it’s gout, what foods can trigger an attack, and how to treat it—it’s just not as simple as it appears to be.

Joyce, at the only gout clinic in Northwest Indiana, says the first thing is to Dr. Kevin Joyce be sure that it’s a genuine gout attack.

Diagnosing gout can be a delicate process. Many patients come to him with a diagnosis of gout from a primary physician, but about half of those patients turn out not to have it. There are also different kinds of gout, including pseudo-gout, a separate disease that calls for different treatment. A form of rheumatoid arthritis as well as degenerative arthritis mimics gout. The gout condition most people know is crystal arthritis, so-called because crystals of uric acid get deposited in the joint—big toe, knee, elbow, other joints—and cause pain.

Joyce says many people who have joint pain with swelling and/or a blood test showing a high level of uric acid assume it’s gout. “There’s only one definitive way to diagnose it, and that’s aspirating the joint and looking at the fluid under a microscope to see if there are crystals in the fluid. I try to catch people in a flare-up and take a joint aspiration then,” says Joyce. “You can’t go with, ‘My big toe gets red and swollen so it must be gout.’”

Joyce says not very many physicians without a lot of training know how to do a joint aspiration to determine the presence of crystals.

“If they do one, it’s usually only the large joints like the knee. But the most common joint is the base of the big toe joint, and a very good expertise is needed to work in that small, specific space.”

CAUSES AND TREATMENTS There are multiple causes for the development of gout. Most people hear about dietary influences, says Joyce, “and that is true, consuming rich foods and beverages. But more people have other issues. Some medications can put people at risk for developing gout, as well as a genetic history for it. Kidney dysfunction can allow uric acid to build up, then precipitate as crystals in the joint. An injury can cause gout; a lot of athletes get it. It’s often a perfect storm of factors.”

Joyce says most people do need medical treatment and it needs to be tailored to the individual. We usually start with tried-and-true medicines. If those don’t work, we go to the newer ones, and step those up as needed. The FDA (Food and Drug Administration) has approved Uloric as a prescription treatment for lowering levels of uric acid, and allopurinol can help. There is an IV infusion for really tough cases.” At home, a cold compress or ice pack on an inflamed joint can ease pain.

A gout attack will resolve on its own in one or two weeks, says Joyce, but too many gout attacks at a time in the same joint can start to develop irreversible bone deformity in the joint—unsightly but also destructive to the bone. If it goes unchecked, nodules of soft tissues can build up, as big as a plum or golf ball, and may need to be removed.

WHAT YOU CAN DO What about those food culprits? In the gout clinic a registered dietician goes over the patient’s diet and patients get a comprehensive list of foods that can trigger a gout attack, in categories from not so bad to really risky.

“Bad” foods are high in purines, which go through a cycle in the body that converts into uric acids, especially if the kidneys are not filtering as well as they should.

Found in meats, for example, particularly red meats but worst in organ meats such as liver; seafood in general, but shellfish especially; most alcohol, with beer as the worst; and some vegetables, like spinach, some beans, asparagus.

Joyce recommends drinking 64 ounces of water per day if tolerated, to help flush uric acid from the kidneys, and cherry juice and cherry juice concentrate, which have a chemical compound that helps kidneys excrete uric acid.

High uric acid can lead to heart problems, kidney dysfunction and kidney stones, and there’s a link with uric and metabolic syndrome, obesity and early diabetes.

“The main advantage of a gout clinic is getting comprehensive diagnosis, treatment, and follow-up,” says Joyce, for relief and to prevent more problems from developing.

and legs, which currently are being tested in a research mode. RIC has an alliance with local Franciscan hospitals including St. Margaret—Hammond and St. Margaret Mercy in Dyer.

The science of bionics will help the more than one million Americans with leg amputations take a giant step forward, according to the RIC. Levi Hargrove, PhD, the lead scientist of this research at RIC’s Center for Bionic Medicine, developed a system to use neural signals to safely improve limb control of a bionic leg.

“This new bionic leg features incredibly intelligent engineering,” says Hargrove in the release. “It learns and performs activities unprecedented for any leg amputee, including seamless transitions between sitting, walking, ascending and descending stairs and ramps and re-positioning THINKSTOCK the leg while seated.”

This method improves upon prosthetic legs that only use robotic requires push off. sensors and remote controls and do “It gives people new movements, not allow for intuitive thought control movements that are more natural,” of the prosthetic.”

Gahan says.

“As the technology advances and Cari Dinneen, director of marketing there is further funding a mindat Rehabilitation Institute of Chicago, controlled bionic leg will become says her institution was the first generally available,” Dinneen says. to develop mind-controlled arms

A Special Publication of the Times Media Co.

August 31, 2014 : Health care & quality Innovation : Page 3

PAGE 4 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

Community Healthcare forms a clinical integration model for patient care

C

JULIE DEAN KESSLER

ommunity Healthcare System will soon be implementing an integrated approach to its patient care. Community Healthcare Partners, a clinical integration organization, is designed to develop ongoing clinical initiatives to provide a higher quality, more efficient, less costly care for its patients.

It’s a model similar to an Accountable Care Organization, but it’s not tied to the Affordable Care Act or Medicare.

“We’re in the early stages of creating a clinical integration organization that will make Community a better healthcare system, with the goal of improving quality and reducing costs,” says Kevin Mybeck, vice president of managed care for Community Healthcare System.

At present Community is looking to formalize the corporation that will be the clinical integration organization.

“We’ll begin talking about quality issues we want to pursue and what requirements physicians must have to participate in the organization.”

Mybeck says. He explains that this will be a physician-led group. They will decide the quality initiatives that will be pursued by the organization.

independent physicians to participate alongside Community Healthcare System employed physicians.

ROLLING IT OUT For about a year Community has been forming the corporation and anticipates that the board of directors will be seated in the next month.

“We’ll start with our employees. It’s a way for us to go ahead and implement the program dealing with a relatively small population while we are building the infrastructure. The hospital already employs case managers and so we plan to use already existing resources to get the program started.

“One of the things we will want to manage is chronic diseases, such as appropriate care for a diabetic patient, for example. All three sites of the Community Healthcare System— Community Hospital in Munster, St. Catherine’s Hospital in East Chicago, and St. Mary Medical Center in Hobart— have programs in place to help our diabetic population, as we do with other chronic illnesses,” says Mybeck.

Clinically-integrated organization will help coordinate the tools and provide additional resources to help with the care of these patients.

INVESTING IN TECHNOLOGY Once the quality standards are in place and the program has developed sufficient data to demonstrate that it ‘MUTUALLY BENEFICIAL PARTNERSHIP’ works, Community Healthcare Partners can begin to approach health plans and Affiliated independent physicians local employers about the effectiveness will join together with Community of the program, Mybeck explains.

Healthcare System hospitals and A big part of establishing a clinical employed physician network to form integration organization is investing a mutually beneficial partnership. “We in technology. “Most people have a want to be sure physicians are driving primary care doctor; however, the the organization,” says Mybeck. doctor’s records may not be integrated “After the quality initiatives have with the hospital. Part of what we want been set, the clinical integration to do is to close that gap, whether it’s organization will be the primary data from a lab company or information network for our own employees,” he from a primary care physician. We plan says. to invest in information technology Clinical integration started in that will allow us to provide a complete the 1990s when the Federal Trade patient record at the point of care. By Commission determined that compiling all the data in one location, independent providers could legally we can use that data more effectively come together with the goal of to improve quality for better overall reducing costs and providing better patient care.” quality. Mybeck explains that the Mybeck says patients will still have clinically-integrated approach allows

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Community Healthcare System will soon be implementing an integrated approach to its patient care. Called a clinical integration organization, it is designed to encompass the entire scope of treatment of an individual. control, though, over how much and with whom their medical records are shared. The privacy controls that are currently in place will remain and the same protections that are in place

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August 31, 2014 : HEALTH CARE & QUALITY INNOVATION : PAGE 5

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO. ADVERTISING FEATURE

Putting an end to GERD now see the value of TIF over conventional surgery or taking chronic medications,” Dr. Mavrelis said.

Non-surgical TIF procedure stops acid reflux

SEEKING RELIEF Just as Cathy’s reflux progressed to the point of being unbearable, she remembered attending a TIF seminar athy Reed was suffering presented by Dr. Mavrelis and scheduled from acid reflux, also an appointment. known as GERD, when Because Cathy also had a hiatal she read about the hernia, Dr. Mavrelis employed a team transoral incisionless approach to address her problems. fundoplication (TIF) Dr. Tom Galouzis, a general surgeon, procedure in the repaired the hernia endoscopically, and newspaper. Rather than then Dr. Mavrelis performed the TIF treating the symptoms of acid reflux procedure. as medications do, a TIF procedure “Performing the two procedures addresses the cause…without making a in immediate succession is a relatively single incision. new concept. In doing so, we achieve “The TIF procedure really interested the same good results without any me because it’s incisionless and can be fixed if it doesn’t work right the first TONY V. MARTIN of the comorbidities associated with traditional surgeries,” said time,” Cathy said.

Gastroenterologist, Dr. Peter Mavrelis (left) with his patient, Cathy Reed.

Dr. Mavrelis.

Just six weeks after her TIF depending upon the approach used, a the defect that causes GERD,” said TREATMENTS procedure, Dr. Mavrelis told Cathy that two- to six-week recovery period.

Dr. Peter Mavrelis, a board certified GERD occurs when the valve between her procedure was a success.

In contrast, the TIF procedure is gastroenterologist and internal medicine the esophagus and the stomach no “I like being a success – it’s great,” completely incisionless. Performed physician. longer functions, allowing acid to she said. through the mouth under general The most common conventional escape into the esophagus. While “Cathy is an excellent example of a anesthetic, the surgeon sends a scope surgical treatment for acid reflux, medication can be effective for satisfied patient,” Dr. Mavrelis said. down the esophagus and stomach to laparoscopic nissen fundoplication, is the short-term, it doesn’t treat its “I’m really glad that Methodist offers recreate the barrier between them and often performed when a patient also underlying cause. With long-term the TIF procedure,” Cathy said. “It’s nice prevent reflux. Patients experience has a hiatal hernia. Unlike medication, use, those same medications can lose less discomfort and a shorter recovery to have that local expertise so you don’t this procedure addresses the GERD effectiveness or have adverse effects. have to drive back and forth to Chicago period than with an invasive surgery. cause. However, it involves surgical “In contrast, surgical correction “More and more insurance companies or deal with traffic.” intervention, a hospital stay and, of the esophageal valve corrects

C

IMA Physicians Perform 250th TIF Procedure recognized nationally as leaders who have embraced new and innovative methods to care for the GERD patients they serve.”

IMA Endoscopy SurgiCenter, PC, entered into a co-management agreement with Methodist Hospitals last year in which the hospital acquired IMA’s Endoscopy SurgiCenter. The co-management arrangement enables Methodist Hospitals to increase the number of endoscopic procedures it performs by more than 2,500 annually.

“Methodist Hospitals congratulates the IMA physicians for this outstanding achievement,” said Methodist Hospitals president and interim CEO, Dr. Michael Davenport. “Our partnership has provided us the opportunity to work with an outstanding group of physicians to continue to deliver excellent care to Northwest Indiana.”

Physicians affiliated with Internal Medicine Associates (IMA) were recognized by EndoGastric Solutions Inc. for outstanding achievement for their ongoing contributions to treating and improving the quality of life for patients with Gastroesophageal Reflux Disease (GERD), also known as acid reflux.

Gastroenterologists Daniel B. Hurwich, MD; Peter Mavrelis, MD; Ahmad B. Shughoury, MD; and Kumar Venkat, MD, have performed more than 250 Transoral Incisionless Fundoplication (TIF) procedures, a highly successful, incisionless procedure that treats GERD. “We believe the TIF procedure fills a therapy gap that exists for GERD patients who take daily therapy and who remain unsatisfied because of incomplete symptom control,” said EndoGastric Solutions CEO, Skip Baldino. “The IMA physician team is

Internal Medicine Associates (IMA) physicians are recognized by representatives of EndoGastric Solutions, developers of the TIF procedure to treat GERD. Pictured (left to right) are Dr. Kumar Venkat; Mary Ann Leodoro, Methodist Hospitals surgical services director; Dr. Peter Mavrelis; Kathleen Korman, Methodist Hospitals GERD Center nurse navigator; Skip Baldino, EndoGastric Solutions CEO; Jason Kangas, EndoGastric Solutions program development manager; Dr. Daniel Hurwich; and Amanda Breitweiser, Methodist Hospitals surgical services manager.

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PAGE 6 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

NEONATAL CARE Special technology dedicated to

I

Prior to delivery, a baby receives his oxygen from his mother through the umbilical cord. Once a baby is born, t takes a certain type of medical however, a baby’s lungs take over and professional to work in the blood carrying the oxygen begins to hospital unit that treats the flow to that area of the body. However, most fragile patients. in babies with Persistent Pulmonary “The nurses and doctors Hypertension, this switch doesn’t who work in the NICU (neonatal occur—keeping oxygen from moving intensive care unit) are extremely from the lungs to the rest of the body. dedicated to the little ones Another issue NICU units across the they care for,” says Kathryn Podorsek, country face is treating newborns who director of OB/NICU at Franciscan St. experienced interrupted oxygen flow Anthony Health in Crown Point. “It to the brain. Studies show as many takes a very special kind of nurse to as three of every 1,000 infants born work with such small, delicate babies.” in the United States will experience Whether it’s learning new, specialized this, but a piece of technology at equipment or assisting families during Franciscan St. Anthony Health works their time of need, NICU medical staff to reduce the risk of death or disability often have their hands full. as a result.

“Not only do the nurses work with The hospital is the only one in the high technology in the unit, they the region to use Cool Cap therapy, give motherly care to the babies which temporarily lowers the brain’s and work with the parents, siblings, PHOTO PROVIDED BY FRANCISCAN ST. ANTHONY HEALTH temperature and then slowly re-warms grandparents, aunts, uncles and friends Kathy Podorsek, left, clinical director of The Birth Place; Dr. Sudhish Chandra, the patient. Studies have shown who are often stressed and emotional right, Neonatal Intensive Care Unit medical director; and Lori Kemp, a unit infants experiencing hypoxic-ischemic over an unexpected admission of their nurse, tend to a patient in the NICU at Franciscan St. Anthony Health in encephalopathy, or perinatal asphyxia, newborn to the NICU,” Podorsek says.

Crown Point. can benefit from this technology in With significant advances in caring both the short- and long-term. for the extremely premature, however, Advanced “Many facilities have cooling more medical staff are seeing happy monitoring blankets, which cool the whole body,” endings—babies born very early going equipment and Podorsek says. “The machine we have home with their parents and leading technology just cools the head. This is used for healthy lives. is used in babies with an acute insult to the “When I started, the lower end of Community neurological system to prevent longviability was 25-to-26 weeks, and now we term deficiencies.” are saving babies as young as 23-to-24 Hospital’s Level In Neonatal Intensive Care units at weeks,” Podorsek says. “Not only are we III Neonatal Franciscan, Methodist and Community, able to deliver and care for these little Intensive Care physicians remain in-house 24 hours ones, but the long-term complications nursery and a day, seven days a week so that any for these babies has decreased.” the staff has time an emergency arises, they are Babies born prematurely can face completed available to the nurses, babies and a host of complications, including special training short-term problems such as breathing to care for high- family.

“Community Hospital also has difficulties and temperature control risk newborns. around-the-clock coverage to transfer issues. Long-term problems can include premature or critically ill babies in impaired cognitive skills, chronic health PROVIDED the area requiring a higher level of issues and vision, hearing and dental care to Community Hospital,” Dr. problems.

Masayoshi Uemura, a neonatologist on But as Neonatologist Ursula Colareta staff there, says. “Our transport team Ugarte, a physician at Methodist consists of neonatologists, neonatal Hospitals Level 3 NICU explains, “If we nurse practitioners, neonatal physician take appropriate measures during the assistants, neonatal nurses and first few hours, days, weeks of these respiratory therapists.” babies’ lives, their quality of life will be Methodist Neonatal specialists better in the long term.” have a strong belief that working with Physicians and nursing staff have mothers at risk can help bring down seen an improvement of both survival the incidence of premature births. and long-term outcomes in babies born “If a doctor thinks a baby may be at prematurely in the last 10 years due to risk, I am called in case I am needed advancements in technology, Dr. Carla during delivery,” Dr. Ugarte says. issues with Persistent Pulmonary Meyer, director of Patient Care Services the region is the use of Nitric Oxide “The assistance we provide to these Hypertension, and inhaled Nitric Oxide in the NICU,” says Michelle Cherry, at Community Hospital agrees. newborns helps not only the child, but helps relax the smooth muscles in Neonatal Intensive Care unit manager Community’s NICU has introduced their entire family and, ultimately, the the vasculature of the lungs without several new devices that care for these at Community Hospital in Munster. community in which we live.” affecting the rest of the body.”

“After delivery, some babies have fragile babies. “A newer technology to CHRISTINE BRYANT

Combined therapies: New tools for addiction and illness for mental health professionals

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well-documented benefits that derive from social connectedness.”

With ever-expanding technology, t Confidential Care Bradley notes, many clinical in Munster, which interventions are done outside of the provides services for traditional setting of a therapist’s office. mental health and “Rather than calling it new, I think substance use issues, of the changes as an evolution,” Drs. Vijay and Sanker says Shirley Morris, RN BSN, Clinical Jayachandran, both Manager, Behavioral Health Department, board certified in Franciscan Saint Anthony Healthpsychiatry and addiction psychiatry, rely Michigan City which offers medical, upon customary and emerging therapies psychopharmacological, behavioral and innovations to help patients live and social system approaches to treat fuller lives. psychiatric illnesses in adults. “Now “We just acquired a Transcranial there are longer lasting medicines which Magnetic Stimulation (TMS), a new help move people from psychiatric state-of-the-art machine that was inpatient to outpatient with the recently approved by the FDA for psychiatrist working with the primary treating mental and addiction disorders,” care doctor in taking care of the client. says Vijay, who recently was honored as It’s a great opportunity for change. a Distinguished Fellow of the American Doctors of different medical specialties Psychiatric Association—the professional didn’t use to always interface. organization’s highest honor. The TMS At Confidential Care, the machine is a non-invasive treatment Jayachandrans designed an outwhich stimulates specific areas of THINKSTOCK patient detoxification program to avoid the brain in order to alleviate a wide the disruption of in-patient care for spectrum of neuropsychiatric conditions. addiction treatment. As Dr. Sanker symptoms and improved functioning as “Though traditional psychotherapy Jayachandran, who is board certified result of meditation.” is still proven to be effective in treating in Addiction Psychiatry explains, by Bradley points out that advances in mental health issues, typically consisting offering a combination of both old technology have brought about major of individual therapy coupled with a improvements in overcoming significant and new methods, Confidential Care pharmacological intervention, there can individualize effective treatment barriers to patients having access to also is a growing trend in mental plans for each patient in an Intensive treatment. health to add meditation, yoga and Outpatient (IOP) setting so as to avoid “There are web-based interventions support groups to traditional therapy,” missing work or school, being away from that can be accessed through chat says Peter Bradley, MA, LPC, CRADC, support family members. rooms, email and video chats via PCGC, Corporate Services Clinician With a staff of more than 30 nurse webcams,” he says. “Smart phones and for Unity Point Health which partners practitioners, addiction counselors, apps allow patients to use the methods with Ingalls Health System to provide social workers, psychologists and mental found in such efficacious therapies as addiction services. “And it’s effective. A health specialists, Confidential Care can Cognitive Behavioral Therapy. Made comprehensive study published in 2012 also offer multiple levels of treatment in the Scientific Review of Mental Health simpler and user friendly and allowing including individual therapy, medical immediate access is huge in the mental Practices examined over 250 published tests, support groups and medication studies on meditation and reported that health field. This has not only improved management for other mental health were notable benefits including reduced access to care but has tapped into the JANE AMMESON

issues such as depression, anxiety, anger management, peer pressure and bullying using IOP. Ironically, technology, so good in the advancement of treatment, has also created a new area of concern which Confidential Care addresses in an IOP setting—misuse of social media.

Connecting to the community is an important aspect of their work says Morris who has been manager of behavioral health units for 29 years.

“We have a collaborative relationship with our community mental health department and primary doctors,” she says. “Last year we did a week-long suicide forum. We also include families of the patients who are in treatment to get their input and support. Psychiatry has been taboo for so long but when you reach out to the community and they respond, it makes for a great working relationship and also helps gain acceptance.”

One concern that Morris has had for a long time is the availability of psychiatric medicines for her patients after they leave the inpatient unit. But with the Affordable Health Care Act she is hopeful that is changing.

“You need to be able to afford treatment and medicines,” she says.

“Otherwise it doesn’t work.”

In determining the effectiveness of their programs, Morris says that among the metrics they use is to look at the number of Emergency Room visits postdischarge as well as readmission rates.

Sometimes the old is the new.

“The proven benefits of nutrition and exercise are timeless,” says Bradley.

“There has seemingly always been a correlation between mental health and positive physical activities and nutritional practices.”

August 31, 2014 : HEALTH CARE & QUALITY INNOVATION : PAGE 7

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO. ADVERTISING FEATURE

Franciscan St. Anthony Health–Crown Point receives national kudos for emergency care

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he Women’s Choice Award as one of America’s Best Hospitals in Emergency Care has been awarded to Franciscan St. Anthony Health-Crown Point.

The award is the only distinction that identifies the nation’s best health care institutions and signifies Franciscan St. Anthony Health’s commitment and passion for creating an extraordinary healthcare experience for women and all patients.

It is the lone recognition program that measures against the needs and preferences of women.

Of seven core measures reported by emergency departments to the Centers for Medicare and Medicaid Services, women rate “door-to-diagnostic-time” or, “door-to-doctor,” as the most important criteria when selecting an emergency room. The least important reported measure is the total time before leaving the emergency room.

“The award is based on robust criteria that consider patient satisfaction, clinical excellence and what women really want when it comes to treatment and a quality hospital experience,” said Delia Passi, CEO and founder of WomenCertified, which

presents the award. “Franciscan St. Anthony Health–Crown Point not only performed well clinically with regard to emergency care measures, but they also have a high recommendation rating, which is very important to women when it comes to health related decisions.”

Hospitals earning the Emergency Care Award consistently rank in the top 25 percent of the 3,600 hospitals reporting on their emergency department’s performance to the Centers for Medicare and Medicaid Services. The seven measures CMS publicly reports relate primarily to the amount of time taken in the ER, such as time for diagnosis, medication, and admission to the hospital, and are weighted, according to the priorities of women surveyed.

David Ruskowski, Franciscan St. Anthony Health president, was pleased to accept the honor.

“This award exemplifies our commitment to women and their unique health care needs. For years, Franciscan St. Anthony Health has created programs specifically for women and their families, including a first- rate Breast Care Center, a birthing center that offers numerous options and amenities, and an Emergency Department that offers compassion and

Franciscan St. Margaret Health campuses receive top marks from Healthgrades

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ranciscan St. Margaret Health-Hammond received 5-Stars for the quality of its treatment of heart failure for the seventh consecutive year from Healthgrades, the leading online resource that helps consumers search, compare and connect with physicians and hospitals; while Franciscan St. Margaret HealthDyer received 5-Stars for the quality of its total hip replacement.

Healthgrades is the leading online resource that helps consumers search, compare and connect with physicians and hospitals. The achievements are part of new findings released in American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation, which evaluates hospital performance at more than 4,500 hospitals nationwide for 31 of the most common inpatient procedures and conditions.

The new report demonstrates how clinical performance differs dramatically between hospitals. For the 2014 Report to the Nation, Healthgrades compared hospitals with statistically better than expected performance (5-Stars), as a group, to those with statistically worse than expected performance (1-Star), as a group, and found: • From 2010-2012, patients treated for heart failure in hospitals with 5-Star ratings for in-hospital mortality, had, on average a 63.2 percent lower risk of dying than if they were treated in hospitals with 1-Star for in-hospital mortality.

• From 2010-2012, patients treated for heart failure in hospitals with 1-Star ratings for in-hospital mortality were, on average, 2.7 times more likely to die than if they were treated in hospitals with 5-Stars for in-hospital mortality.

• From 2010-2012, patients having hip replacement surgery in hospitals with

We’re pleased that the strenuous efforts of our physicians and employees have been recognized in the context of the latest Healthgrades report.

GENE DIAMOND, CEO OF FRANCISCAN ALLIANCE’S NORTHERN INDIANA REGION

5-Star ratings had, on average, a 69.2 percent lower risk of experiencing a complication while in the hospital than if they were treated by hospitals with 1-Star ratings.

Statistics are based on Healthgrades analysis of MedPAR data for years 2010 through 2012 and represent 3-year estimates for Medicare patients only.

“We’re pleased that the strenuous efforts of our physicians and employees have been recognized in the context of the latest Healthgrades report,” said Gene Diamond, CEO of Franciscan Alliance’s Northern Indiana Region.

Franciscan St. Margaret Health– Hammond also was named a 5-Star recipient for treatment of hip fracture and esophageal/stomach surgeries in 2014.

Franciscan St. Margaret Health–Dyer was named a 5-Star recipient for treatment of hip fracture for two consecutive years and named a 5-Star Recipient for colorectal surgeries in 2014.

More information on the American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation, including the complete methodology, can be found at www.healthgrades.com/ quality.

PHOTOS PROVIDED

David Ruskowski, Franciscan St. Anthony Health president, accepted the Women’s Choice Award as one of America’s Best Hospitals in Emergency Care.

services, such as the Center of Hope program for victims of sexual assault.

Our mission is simple — to provide the very best in quality health care and treat every patient as if they were family.”

As the collective voice of female consumers, the Women’s Choice Award provides women with recommendations they can trust, from other women.

The Women’s Choice Award as one of America’s Best Hospitals in Emergency Care has been recently awarded to Franciscan St. Anthony Health-Crown Point.

Franciscan Healthcare-Munster, Franciscan St. Anthony Health, earn highest distinction in hospital safety scores

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ranciscan HealthcareMunster and Franciscan St. Anthony Health-Michigan City recently received A grades, the highest given, as a reflection of superior hospital safety.

The Leapfrog Group, a national leader and advocate in hospital transparency, reviewed more than 2,500 hospitals in the United States and assigned grades based on their ability to prevent errors, injuries and infections.

Of thousands of facilities that received a Hospital Safety Score, fewer than 32 percent earned the top grade.

“Our 2014 Hospital Safety Score demonstrates the work our physicians and staff have undertaken to improve patient safety in our facility,” said Barb Greene, Franciscan HealthcareMunster president. “This is part of what Franciscan Alliance is all about.

I am so proud that the hard work of our physicians and staff has been recognized.”

Added Trish Weber, Franciscan St. Anthony Health-Michigan City vice president of operations and chief nursing officer, “We are very proud of our team and their ongoing commitment to safe, quality health care. This recognition serves to shine the light on the great work of our dedicated physicians, nurses and health care professionals. We are proud to serve the residents of LaPorte County and surrounding areas and strive to remain the hospital of choice.”

Leah Binder, The Leapfrog Group president and CEO, applauded the hospitals’ efforts. “Safety should come first for our families when we pick a hospital, because errors and infections are common and deadly,” she said. “No hospital is perfect, but we congratulate the board, clinicians, administration and staff of Franciscan Alliance’s hospitals for achieving an A rating and showing us that you made the wellbeing of your patients your top priority.”

Barb Greene, Franciscan HealthcareMunster president

Our 2014 Hospital Safety Score demonstrates the work our physicians and staff have undertaken to improve patient safety in our facility. This is part of what Franciscan Alliance is all about. I am so proud that the hard work of our physicians and staff has been recognized.

BARB GREENE, FRANCISCAN HEALTHCARE-MUNSTER PRESIDENT

Q&A: Gene Diamond, CEO Franciscan Alliance’s Northern Indiana Region Q. What are the great strengths of your health care system?

A. The greatest single strength of Franciscan Alliance is the Mission of our sponsors, the Sisters of Saint Francis. Their unwavering commitment to continuing Christ’s ministry in our Franciscan tradition sets the tone for everything we do.

innovations you are making in your business right now that will pay off in the future?

A. We’re making strategic investments in people, technology and businesses, which will enable us to succeed in population health management. The challenges inherent in learning how to manage the health of a population drive the strategy of innovation throughout the organization.

has been retooling our system to engage the evolving dynamic. They’ve encouraged us to embrace change at all levels of the organization, so we can thrive, despite the many wrenching disruptions in health care delivery we’ve witnessed recently.

Q. What is the biggest challenge/ opportunity coming up in 2015?

A. The biggest challenge we face is Q. Where is the growth of your to perform a delicate balancing act in business going to come from in the an environment where the traditional near-term?

Q. What do you consider your most health care delivery system we all know A. We’re moving in to the population well persists, even as a new population health management business. It’s where important achievement in the past health management system rapidly much of our future projected growth is three years? develops and just as quickly evolves.

A. Simply this: The leaders of expected to come from, at least for the In other words, we’ve got one foot in Franciscan Alliance anticipated rapidly foreseeable future. each of two canoes, sailing in opposite evolving change in the health care directions. It’s an adventure not for the delivery system several years ago.

Q. What are the most important faint of heart!

They’ve led us through a process that strategic investments and

Gene Diamond

PAGE 8 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

TONY V. MARTIN PHOTOS

Doctor of Audiology Michele Watts (center) and Audiologist Jillian Smith (right) demonstrate how a patient with a Cochlear Implant is tested for progress. At Porter Health Physicians group in Valparaiso.

now available in NW Indiana Surgeon brings skill to hearing impaired

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JULIE DEAN KESSLER

Another important aspect is picking the right patient for the surgery. It needs to be someone with minimal or acceptable risk and a really good chance for a good outcome.

ochlear implants have been provided for decades, but often only at large, often university-affiliated hospitals. Now, Dr. Matthew Provenzano has brought his training and expertise to Porter Physicians Group in Valparaiso, where he is performing cochlear implants to help patients hear again.

The Physicians Group, an affiliate of Porter Regional Hospital, includes a team that coordinates diagnosis, treatment, and post-surgical support for hearing impaired patients who are candidates for a cochlear implant.

One part of a cochlear implant, placed outside the ear, is a microphone/ receiver, antenna, and speech processor; it analyzes sound and converts it to an electrical signal to the second part of the implant. The second part of the implant is a receiver/stimulator surgically implanted in the bone around the ear. It receives the electrical signal and sends it to the brain.

Provenzano, who is the only surgeon performing cochlear implants in Northwest Indiana, is board certified and fellowship trained in pediatric otolaryngology. He says people wanting to know if they might be a good candidate for a cochlear implant can simply call the Porter Physicians Group office. “The process doesn’t take a long time and involves a relatively inexpensive hearing test.”

CAREFUL EVALUATION The evaluation is more complex. The person needs to be completely or almost completely deaf in both ears, getting very little help from hearing aids. Yet someone who is an adult and completely deaf in both ears, or someone who has been deaf for a few years probably won’t be a good candidate because a good outcome is unlikely.

“That’s mostly because if the nerve that carries the signal isn’t used for years, it will naturally atrophy (waste away); it’s a case of use it or lose it.

The implant replaces portions of the inner ear, but it still needs the nerve to be in place.

“If it’s a child, before the child has learned to talk and develop language, there is higher probability of a good result.”

Patients need to be highly motivated, Provenzano says, because they will have to learn how to use the device, and most patients have speech and hearing rehabilitation.

DR. MATTHEW PROVENZANO

Cochlear implants are available from Dr. Provenzano of Porter Physicians group.

The Cochlear device has two sections, the implant on the left is put under the skin behind the ear and the processor that is worn over the ear on the outside.

The two connect through the skin with a magnetic hook up.

REALISTIC EXPECTATIONS “One of the many important things is making sure the patient has a realistic expectation going into the surgery, because the hearing from an implant is very different from natural hearing; the replacement is never as good as the original.

“Another important aspect is picking the right patient for the surgery. It needs to be someone with minimal or acceptable risk and a really good chance for a good outcome.

Evaluating the patient takes a team approach, with audiologists; a speech therapist to make sure the patient uses hearing to develop speech and see how they’re doing with the speech they have; social workers to be sure the patient’s family has the right resources; and sometimes a psychologist to evaluate the patient’s readiness — and the family’s readiness — for the surgery. And we need to know that the patient’s medical situation is good for the procedure.”

A cochlear implant is not FDAapproved for a child under 1 year old, because there needs to be enough development of the ear. For children a year old and older, you start with an audiology screening, possibly try hearing aids, and try to determine the cause for failure to hear.

Surgical skill is essential because the surgeon is working in a very small, enclosed area, around the obstructions in the way, putting small wires in right place.

Recovery from the surgery is “not too bad,” says Provenzano; sometimes it’s done as an outpatient procedure.

The device is meant to last a lifetime, though it is a piece of electronics and there have been some “reported cases of failure, but most people have it the rest of their lives.”

Provenzano says the team at Porter Physicians Group has done an “absolutely fabulous job educating patients. It’s really a testament to our concern for the patient.”

August 31, 2014 : HEALTH CARE & QUALITY INNOVATION : PAGE 9

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO. ADVERTISING FEATURE

CENTER FOR OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY Dr. Bethany Cataldi’s individual approach tailored to patients’ unique beauty needs

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n addition to being one of Northwest Indiana’s most accomplished ear, nose, and throat surgeons, Dr. Bethany Cataldi is also one of the area’s premier facial plastic surgeons. As the only female facial plastic surgeon in the region, Dr. Cataldi is especially in tune with the issues of beauty enhancement facing her patients.

AN HONEST ‘ONE-TO-ONE’ APPROACH Evaluating each patient’s own expectations is something Dr. Cataldi takes very seriously.

“When considering any mini facelift or wrinkle reduction procedures, I evaluate what each individual needs in a private and open conversation to address each patient’s specific and unique concerns,” says Dr. Cataldi. “I always look at the process as a journey that a patient and I will take together, so we need to be on the same page as far as what is and what isn’t achievable. Consequently, I will spend as much time as necessary to evaluate the patient’s condition and to answer the patient’s questions and offer my professional insights. Every one of my patients’ cosmetic needs are uniquely their own, and an honest “one-to-one” approach with patients is best when it comes to cosmetic procedures, and it’s clearly evident in the beautiful results.”

However, Dr. Cataldi adds, “It’s just as important for patients considering cosmetic procedures to understand that there may be any number of issues they face that might NOT necessarily be best resolved through medical procedures.

There have been times where I have recommended to a patient that they NOT undergo a cosmetic procedure.

As a female surgeon, I understand a woman’s self-image about beauty. There are many beautiful people- regardless of their age- who simply should reconsider undergoing any cosmetic procedure, and I feel that it’s my responsibility as their surgeon to advise them. It’s important

COURTESY OF CENTER FOR OTOLARYNGOLOGY

Established by Otolaryngology and Facial Plastic surgeon Bethany Cataldi, D.O., the Center for Otolaryngology and Facial Plastic Surgery, located in Highland, has provided Dr. Cataldi with the opportunity to treat prospective facial cosmetic surgery patients with a distinctly unique level of surgical care and skill. that a facial plastic surgeon be as forthcoming and honest as possible with their patients. A surgeon should be able to say, ‘No’ to a patient if he or she might not need cosmetic enhancement.”

Dr. Cataldi is especially noted for her wonderfully natural-looking mini facelifts, full face-lifts, and neck-lifts that go far in tightening the musculature of the face.

“I’m still always amazed by the years that a mini-lift can take away.

The recovery time is minimal following the procedure and the results can be breathtaking,” says Dr. Cataldi.

She also frequently performs blepharoplasty, a surgical procedure that entails the tightening the upper or lower eyelid skin, as well as rhinoplasty, otoplasty (a cosmetic surgery procedure

to change the external appearance of patients’ ears), and skin cancer and skin lesion surgery.

She also regularly performs noninvasive cosmetic enhancement procedures such as the applications of chemical peels, as well as Restylane®, JuvedermTM, and Botox® that help reduce the visible effects of aging.

Due to the growth of her practice, Dr. Cataldi has recently expanded her main office to a much larger and more comfortable suite in Highland, Indiana.

Says Dr. Cataldi, “My new office is twice as large as my old space to provide my patients with an overall more comfortable and relaxing experience. In fact, the new office has an exclusive Facial Plastic Surgery and Cosmetic Rejuvenation Suite with many first-class amenities.”

“The impact of cosmetic surgery and cosmetic enhancements on a patient is great,” says Dr. Cataldi. “Overall it helps improve one’s self confidence, one’s self esteem, and gives one a better quality of life. Sometimes it may take a person a long time to come in to see a physician for a cosmetic consultation, and I try to put all of my patients at ease. We’re on a journey together, and I want my patients to be happy at the end of it.”

FOR MORE INFORMATION: Dr. Bethany Cataldi- Center For Otolaryngology and Facial Plastic Surgery, LLC 2203 45th Street Suite B Highland, Ind. 219.836.4820

PAGE 10 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

HealthLinc expands a holistic approach to underprivileged

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JULIE DEAN KESSLER

alt and Loie Reiner’s vision 45 years ago of helping lowincome mothers with housing and child care, partnering with Project Neighbors, has since expanded into a forward-thinking enterprise.

HealthLinc now takes a holistic approach to meeting the healthcare needs of the uninsured and the underinsured.

Offering affordable housing for the disabled, the elderly, and those who meet income guidelines, by 1996 HealthLinc had opened its first free clinic with childcare services for lowincome mothers and their children.

Today HealthLinc’s services include a wide range of medical care and follow-up attention for residents in need, in nine Northwest Indiana counties.

The innovative aspect of the business is its holistic approach, explains HealthLinc CEO Beth Wrobel.

“HealthLinc treats the whole body.

When we started in ’96, it was primary medical care for episodic illnesses such as strep throat. We began adding services for chronic illnesses like diabetes and high blood pressure. We realized people can’t have physical health unless they have oral health, too, so we added dental care.” The March of Dimes cites studies that indicate a link between gum disease and premature births and low birth weight. HealthLinc also has optometry services for eye care, and behavioral health support for issues such as weight loss.

All six HealthLinc sites — East Chicago, Michigan City, Knox, Mishawaka, and two in Valparaiso — are accredited by the National Committee for Quality Assurance as a patient center of medical care. All physicians, nurse practitioners, dentists, are board-certified.

HealthLinc strives to help families attain and maintain health, and that helps lower the cost of health care overall. “If you have a sick child, a doctor will treat the child — but we will also know when we last saw you, what tests you’ve had so we can ask how you are now, and ask if you’ve had important annual checkups. It is an integrated health care, with compassionate team members who really put the patient in the center.”

JONATHAN MIANO PHOTOS

HealthLinc CEO Beth Wrobel, left, U.S. Rep. Pete Visclosky, D-Ind., center, and East Chicago Mayor Anthony Copeland talk after a ribbon-cutting ceremony for the new HealthLinc health center in East Chicago.

Longtime HealthLinc Board Member Dr. Patrick Bankston, Dean of the College of Health and Human Services — IU Northwest and Associate Dean, IU School of Medicine — Northwest, says, “As a person who teaches future generations of health care providers, I am keenly aware of the needs that Federally Qualified Health Centers meet in our communities. HealthLinc is among the best at providing excellent, low-cost care to our citizens with the least resources.

“I am a patient myself, which is a testament to the esteem I hold for the health care providers at HealthLinc. It doesn’t take a university health center to provide the best in primary care; it only takes the good health care teams found at HealthLinc who care about all patients as if they were family members.”

HealthLinc staff, background, and guests attend a ribbon-cutting ceremony for the HealthLinc health center in East Chicago.

New Age of E-Health

Providing care online and at home sparks an industry

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homes and it gives them information on their disease, they’ll be more likely to know when their having problems and elehealth, in all its ward off returns to hospital.” Goodall forms, has become an says. important tool for both Geriatric specialist Dr. Raji Majety at medical professionals Northpoint Internal Medicine Center, in and their patients.

Crown Point, agrees home healthcare The U.S. Department has been aided by telehealth. of Health and Human “The devices monitor blood pressure Services defines and other vital signs, shows any telehealth as the use of electronic changes and brings it to our attention,” information and telecommunications she explains. “Patients are being technologies to support longmonitored more closely, especially distance clinical health care, patient geriatric patients, who are on so many and professional health-related medications. It is a way to keep them education, public health and health out of the hospital.” administration. The technologies Telehealth is widely used for patients include videoconferencing, the internet, with diabetes, coronary heart disease, store-and-forward imaging, streaming hypertension and congestive heart media, and terrestrial and wireless failure. Goodall’s home health network communications. uses Health Buddy, made by Bosch, Therefore, telehealth may be as simple as a phone call, or as complicated to monitor patients. For example, Health Buddy base unit tells a patient as having an electronic devise sending signals between a patient’s heart and his with congestive heart failure to weigh himself. The patient will then enter the physician’s monitors. weight into an interface site, which also “Through telehealth, we can reach asks the patient about 25 questions more people by keeping up with their concerning his health, vital signs and healthcare without us being there,” symptoms. says Carolyn A. Goodall, Director Home “We can see the responses and if the Care for Franciscan St. Margaret and St. Margaret Mercy hospitals. “Through the weight is in the doctor’s perameters, it information we receive remotely, we can will show in green on the screen,” she says. “If it’s slightly above or below, monitor the patient and immediately it will show yellow and if in a warning report to the doctor when something’s area—like more than a weight gain of going on.” two pounds, it shows in red.”

Goodall, and her staff of 30 RNs “If the patient wasn’t on telehealth, and six therapists, began using he would end up in the emergency telehealth in 2008 when it became room,” Goodall says. widely accepted by the home Another telehealth method is healthcare industry. Since that time, provided by PT/INR Home Self-Testing, the use of telehealth technology which allows patients on Coumadin or has been a boon to the industry, its warfarin to check their anticoagulation providers and, most importantly, the levels at home. patients it serves, she says.

“Patients can check their own levels,” “The premise is that if you can put Dr. Majety says. “It prevents them from monitoring equipment in a patients’

ANDREA HOLECEK

heart and the goal is for patients to manage that and not be in hospital.”

The hospital also uses a loop recorder to monitor patients.

“After a pacemaker or other device is implanted, it’s a way for us to get information and that reduces the patient’s chances of getting into trouble.”

It there is an episode of arrhythmia, the monitor will send a message to the patient’s physician. The physician can get information from the monitor and contact the patient.

“The (telehealth) programs have evolved around heart failure,” Gingerich says. ”We’re starting to translate them into other conditions and situations.”

Many local home health care agencies also use telehealth to monitor their patients. Karen Brock, the administrator and director of Community Home Health THINKSTOCK Services, all the bigger agencies are using it, however some of the smaller ones find the cost of the equipment too having to go somewhere to have it expensive. checked every week.”

“Since we bought ours, more and Terri Gingerich, cardiovascular service line director at Porter Regional Hospital, more companies are leasing it and that makes it more affordable for agencies explains the hospital uses several to get into it.” However, the expense is types of telehealth and more will be mitigated by the saving achieved when developed. telehealth keeps patients out of the “We want to look for more hospital, says Goodall, whose company opportunities to care for our patients paid $25,000 for its equipment. post hospitalization, and manage their “It pays off if they can keep 10 conditions in an outpatient setting.” patients out of hospital. It’s a win-win In a program for heart failure for the hospital because it’s not costing patients, a nurse will phone a patient Medicare, Medicaid and insurance to after the patient is released from the hospital, The nurse can then determine treat patients that could be treated at if the patient understands his condition home.”

It also saves on home care because and his post-operative instructions. it reduces the number of home visits “And it gives patients a place to call made by health care workers, she says. in addition to their physician if they “Plus, it gives the patient a sense of have questions about heart failure,” security because they know someone is Gingerich says. “It gives patients an looking at them every day. It decreases improved quality of life in their natural patient and family anxiety.” setting. It’s a chronic condition of the

A Special Publication of the Times Media Co.

August 31, 2014 : Health care & quality Innovation : Page 11

PAGE 12 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

KYLE TELECHAN

Westville resident Flavia Cheng has her blood pressure taken by Porter Regional Hospital wellness educator Steve Beach at the annual health fair in May.

Something That Works Corporate partnerships with healthcare centers are a win-win for employees

M JANE AMMESON

ore and more employers are realizing that fitness is good business.

“When you have a healthy work site, you have healthier employees who come to work more often and are more productive,” says Laurie Wehner-Evans RN MSN, Director of Community and Corporate Wellness at Porter Health Care System. “It decreases absenteeism and increases presenteeism which by that we mean not only are employees at work but they work more efficiently.

We are less productive at work when we don’t feel well.”

According to a Society for Human Resource Management Foundation Executive Briefing titled “Wellness Strategies to Improve Employee Health, Performance and the Bottom Line” research shows that the health status of a company’s employees benefits work behavior, attendance and on-the-job performance. Research also indicated that presenteeism costs far exceed the costs of absenteeism as well as other health-related losses incurred by organizations.

Effective wellness strategies not only help reduce both absenteeism and presenteeism, it also impacts the bottom line.

“There are numerous companies reporting anywhere from 3-to-1 return and up meaning for every $1 spent on wellness initiatives, there is a $3 return in cost savings,” says Sharon Sporman, Regional Executive Director Wellness/ NIR at Franciscan Omni Health & Fitness.

But for these initiatives to work, wellness must be part of the company culture she says noting that Franciscan Alliance’s “Fitness is Good Business” for organizations and companies is customized to the wants and needs of the company and can include fitness assessments, fitness programming, group exercise, weight loss, weight management and encompasses accountability coaching, aquatic exercise including arthritis classes and recreational sports.

“Effective leadership and wellness committees set the stage for communication and provide a healthful environment with options such as: smoke free, healthful nutritional selections, engage in movement activities and stress reduction opportunities,” continues Sporman who also stresses the importance of accountability by using measures and outcomes of the employee population health status to provide services that educate as well as also offer resources like health coaching and other wellness programs for guiding employees towards healthier lifestyles and personal responsibility.

NewHealthyMe, a web-based wellness program provides individuals with their own wellness page so they can track their health profile, submit verification of their activities and earn NewHealthyMe (NHE) points and rewards is a tool to positively impact the rising cost of

KYLE TELECHAN

Pamela Ward, supervisor of food service at Methodist Hospital, hands out healthy food during a cooking demonstration at Family Heart Health Day at the Valparaiso Family YMCA. unhealthy lifestyle habits says Roger D. Vogie, M.A., Director of New Healthy Me Services and Director of Fitness Pointe for Community Health Systems.

Tools include a Personal Wellness Profile (PWP), biometric measurements such as Body Mass Index, cholesterol and glucose levels, blood pressure and nicotine usage as well as a customized web portal, health presentations, health challenges, lab screenings and health screenings.

“NHM is designed to help the patient achieve their goals and earn rewards based on the employer wants,” says Vogie about their incentive systems which offers participants the ability to earn points over a 12-month period for rewards preset incentives such as entries into quarterly drawings, gift cards, cash rewards and reductions in healthcare premiums Vogie says they are seeing great improvements in the voluntary program.

“People are keeping track of their weight, their blood sugar levels, their activity levels,” he says. “For every dollar invested we’re seeing a $4 return. And the folks who are participating spend less on health care than those who aren’t.”

A key part to the program’s success is engaging people to stay with the NHM. “What we’re doing,” Vogie says, “is we’re giving people the initial procedures and platform they need. We can monitor if they’re not doing it and remind them and help them get back on track.”

By offering different levels of services, Porter County Health Systems can create programs that best fit both the company and the employees.

“We can focus on prevention and early identification which can alert employees early-on about their health, such as diabetes so they can work at

Valparaiso YMCA members for multiple services from consultations with Methodist professional healthcare providers, along with free health fairs and screening services.

According to Pamela Johnson, BS, HHP- AADP, Wellness Supervisor and Wellness Champion for Working Well, the Franciscan Alliance staff at Working Well’s Healthy U @ Work offers three corporate wellness packages created to provide different levels of support based on the needs of their clients. Each package provides an effective, easy and balanced wellness program that is affordable and focusses on reducing health risks by increasing fitness activity, improving nutrition, promoting a healthy lifestyle and encouraging preventive care. Tools include a wellness portal, wellness screenings and assessments, JOHN J. WATKINS as well as educational offerings that Franciscan Alliance Omni’s Marci suggest tracing root cause for disease Crozier addresses a Promote by identifying nutrient deficiencies, toxicities and food sensitivities.

Wellness luncheon at Valparaiso “It’s innovative education offerings University. that include a holistic approach reducing the prevalence of the disease,” to lifestyle change and produces measurable results,” says Johnson says Wehner-Evans. noting that Working Well is the Depending on the levels, their world’s first ISO 9001:2008 Certified wellness programs can offer resources Occupational Healthcare Provider such as health fairs, educational as well as the state’s only Certified programs presented by physicians and dietitians and physical exams. They also Occupational Health Program.

The programs may include incentives can help set up a wellness committee to for participation and/or results. determine what strategies and goals to Rewarding employees for leading set. It’s important says Wehner-Evans a healthy lifestyle and engaging in for the committee to include both activities that promote that lifestyle. employers and employees.

“The big key is the payback in Methodist Hospitals last year benefited in the work environment,” created a healthcare engagement partnership with the Valparaiso Family says Wehner-Evans. “It decreases health care cost and makes for a YMCA, which will give access to the healthy work place.” general public as well as the 15,000

August 31, 2014 : HEALTH CARE & QUALITY INNOVATION : PAGE 13

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO. ADVERTISING FEATURE

Preventive Mastectomy Reduces Breast Cancer Risk to Less than 1%

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aureen Carlson of Homewood never imagined she’d be mentioned in the same sentence as movie star Angelina Jolie— much less share anything in common with her. Their paths have never crossed, and they probably never will.

But earlier this year, when both women came face to face with the very real possibility of developing breast cancer, each made a courageous decision to stack the odds in her favor: undergo a preventative double mastectomy and lower the lifetime risk from more than 50 percent to less than one percent!

Carlson’s story begins in December of 2012, when the first mammogram she’d had in nearly 10 years revealed a suspicious mass. A surgical excision showed the presence of lobular carcinoma in situ (LCIS).

“When abnormal cells grow inside the lobules of the breast, but have not spread to the nearby tissue or beyond, the condition is called LCIS,” explains Mark Kozloff, M.D., medical director of Ingalls Cancer Care. “Compared to women without LCIS, those with LCIS are up to 12 times more likely to develop invasive cancer in either breast.”

For most women, the average lifetime risk of developing breast cancer is roughly one in eight or 12%.

For women with LCIS, that number jumps to more than 50%.

Carlson did some research then met with Dr. Kozloff and general surgeon Michael Romberg, M.D. One option involved taking the anti-breast cancer drug tamoxifen to prevent the development of invasive breast cancer, along with regular mammograms every six to 12 months.

But Carlson had a complicating factor: fibrocystic breast disease.

Thick, dense, lumpy breasts can be difficult to image. Finding cancerous cells hiding in dense breast tissue is even trickier.

They began discussing the second option: preventative mastectomy, in which one or both breasts are

surgically removed to reduce or prevent the risk of cancer, followed up by immediate reconstruction.

EXAMINING THE ODDS “For women with LCIS, the odds are not in their favor,” Dr. Romberg added.

“I felt she would greatly benefit from the double mastectomy. With the availability of genetic testing and the medical knowledge we’ve gained over the last 10 to 15 years, more and more women are asking about preventive mastectomy as an option.”

Carlson was already heading in that direction. Then she presented Dr. Romberg with a question.

“I asked, and he told me, ‘If this were my wife, I would recommend the surgery,’” Carlson said.

That was all she needed to hear.

With her insurance company willing to cover the cost of surgery and reconstruction, the energetic wife and mother of four scheduled the procedure in April of 2013 at Ingalls Memorial Hospital.

swallowing or eating.

After her preventative double mastectomy, Carlson was one of the first to experience STAR services at Ingalls.

“We did a lot of movement of the tissue,” Carlson explained. “She worked on the back, chest and arms.

I’m a retired occupational therapist, so I know a good physical therapist when I see one, and Elisabeth is the best!”

“When Maureen first came in for therapy, she was in quite a bit of pain,” Posnik said. “She couldn’t sleep well, she couldn’t move well, which is to be expected after this type of surgery.

We worked on soft-tissue mobilization, stretching and strengthening.”

Within weeks, Carlson was comfortably wearing a bra and moving freely.

“By the time she finished therapy, she could mow the lawn,” Posnik added—perfect for a woman who spends her free time involved with nature activities, such as Audubon prairie restoration in Flossmoor, birding and hiking.

“The best part was I had everything done so close to home,” Carlson adds.

“When friends ask, ‘Where did you have it done,’ they’re surprised when Dr. Romberg performed the double I say, ‘Ingalls.’ And I respond, ‘Oh my mastectomy; plastic surgeon Sami Bittar, M.D., joined him in the operating gosh, yes, Ingalls!’ The fact that I can make it there in 12 minutes from my room and did the reconstruction home is great. Everything I needed was immediately afterwards. there. The experience was so much nicer than having to go downtown UNIQUE CANCER REHAB and deal with traffic and expensive Following a four-day hospital stay, parking. When those kind of services Carlson went home and began are available in my backyard, heck yes outpatient physical therapy with that’s where I’m going!”

Ingalls oncology specialist Elisabeth Fully recovered and back to her Posnik, P.T. Posnik and a multidisciplinary team active lifestyle, Carlson’s worries about breast cancer are gone. of Ingalls healthcare professionals “I’m so grateful,” she concluded. “As comprise the hospital’s nationally far I’m concerned, 30 more years, here certified cancer Survivorship Training I come!” and Rehabilitation (STAR®) Program.

The STAR program available The first of its kind in the area, the through Ingalls is being utilized at program is designed to help patients some of the best cancer centers in the heal from the debilitating side country, including Johns Hopkins. Most effects of cancer and its treatments.

STAR Program cancer survivorship It addresses the unique needs that services are reimbursable by health affect cancer survivors such as lymphedema, fatigue, musculoskeletal insurance providers.

For more information about Ingalls pain, joint stiffness, weakness, cognitive problems, balance problems cancer survivorship services, call 708.915.STAR (7827). and issues with communication,

Taking the next step after cancer.

Survive and thrive.

If you’ve fought with cancer, you know it can be exhausting. In fact, radiation, chemotherapy, and surgery can affect energy, endurance, balance, and strength.

The Ingalls Survivorship program is helping cancer survivors achieve a happy, healthy, energetic life following their cancer treatment.

The Ingalls Survivorship program provides personalized guidelines, activities, and exercises documented to improve endurance, strength, and balance – and is staffed by 25 experienced clinicians, all certified in Survivorship Training and Rehabilitation (STAR) including nurses, nutritionists, physical therapists, psychologists, and others who can help you take the next step.

We treat one kind of cancer. Yours.

SM

Ingalls is committed to helping you enjoy a rich, fulfilling life. So regardless of which hospital treated you for cancer, please contact the only hospital in the Chicago southland area to be certified in survivorship – Ingalls. Take the next step after cancer and truly thrive.

Call us at 708.915.STAR (7827) www.Ingalls.org/CancerCare

PAGE 14 : HEALTH CARE QUALITY & INNOVATION : August 31, 2014

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

Modern Midwifery

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CHRISTINE BRYANT

hough the vast majority of expectant mothers in Europe employ the assistance of midwives, it’s a different story on this side of the Atlantic.

“Here in the United States, it’s only 10 percent, so we have a lot of work to do to bring the profession into the health care system,” says Mary Lawlor, executive director of the National Association of Certified Professional Midwives.

Though several hospitals in the region like Porter Regional Hospital and Advocate South Suburban Hospital regularly support midwives who assist their patients during labor and delivery, most hospitals do not have actual midwife programs.

That’s something Lawlor is working toward changing. Her goal is to raise awareness about the benefits of midwives among both patients and medical professionals.

“There’s a national effort to improve relationships between providers and to increase access to various birth settings,” she says.

Kathryn Podorsek, director of OB/NICU at Franciscan St. Anthony Health in Crown Point, says the hospital currently has two midwives on staff — one employed by the hospital and the other employed by a private practice.

“Both of our midwives are certified nurse-midwives,” she says. “They were both labor nurses before they went back to school to become a midwife.”

Midwives are trained to offer expert care, education, counseling and support to women who are pregnant, many of whom want natural, unmedicated deliveries. Many also practice as autonomous health professionals working within a network of relationships with other maternity care providers, Lawlor says.

“There is a growing group of women who believe and understand the less

intervention you have in birth, the more likely it will go the way you want it to go,” she says.

While midwives typically fall into three categories — certified nursemidwives such as the two at St. Anthony Health, certified professional midwives and certified midwives — only about 70 are classified as the latter of the three.

“The two major groups are the

certified nurse-midwives and certified professional midwives,” Lawlor says.

“Certified nurse-midwives work mostly in hospitals, with about 14,000 who have credentials.”

Certified nurse-midwives are licensed in both nursing and midwifery, and at least possess a bachelor’s degree from an accredited institution of higher education, according to the American Pregnancy Association (APA).

Certified professional midwives, on the other hand, are specifically trained to assist patients who give birth outside the hospital, including those who have chosen to give birth at home or in birth centers. There about close to 3,000 licensed certified professional midwives in the United States, Lawlor says.

These midwives are trained in midwifery and meet practice standards of the North American Registry of Midwives.

Certified midwives are certified in midwifery and possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives, according to the APA. “Countries who use midwives for the majority of birth have better outcomes than the United States,” Lawlor says.

“The U.S. spends a lot of money because OBs are trained as surgeons.

We need them in the system, but we have a very high rate of intervention.”

When first measured in 1965, the national U.S. cesarean section rate was 4.5 percent. Since then, the cesarean rate has steeply increased — now at about 32.8 percent, according to the Centers for Disease Control.

At Lawlor’s practice, midwives work with patients throughout the pregnancy — only seeing a doctor if something is wrong.

“We order all the same lab tests and ultrasounds if the client chooses,” she says. “We meet on the same schedule as an OBGYN, and we check the mother’s blood pressure and estimate the growth of the baby.”

Out of hospital midwives also will

spend as much as an hour with their clients at these visits, Lawlor says.

“So there’s a lot of time for health enhancing to go on between the mother and midwife, lots of attention to nutrition and preparing for birth,” she says.

While the certified nurse-midwives at St. Anthony Medical work with patients who choose to give birth in the hospital setting, Podorsek says staff members work with the expectant mothers to give them the experience they desire.

Each room features a large tub moms can use for pain relief, and the hospital gives patients the choice of using intermittent or wireless monitoring, birthing balls and the use of volunteer doulas to help moms through labor.

“Our nurses love to help moms who want a low-risk, non-medicated delivery,” she says. “They are very knowledgeable in positioning patients for comfort and to help the baby get into the best position for delivery.”

Though the midwives have their own patients and manage them throughout the pregnancy, they have physician back up should something go awry.

“OB emergencies can happen unexpectedly and they can be severe,” Podorsek says. “When things go well with a home delivery, they do very well, but when they don’t go well, it can be life threatening to mom or baby.”

Currently less than 1 percent of babies are born at home, but Lawlor says that number has seen a sharp increase in recent years.

“What we’re looking for is to reclaim normal physiologic birth,” she says.

One of the goals of the National Association of Certified Professional Midwives is to develop better working relationships with hospitals and health providers so patients have all resources available to them during birth.

There’s also a push through federal policy work to enforce insurance companies to cover midwifery care.

“If states are licensing midwives and make this kind of care available to women, it should be available to anyone who wants to choose it and not just people who can pay out of pocket,” Lawlor says.

THINKSTOCK

Infraredx Technology A global study to see heart attacks before they happen

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how much cholesterol is in the wall of the artery which we believe is more important than knowing how much Nobel Prize winner cholesterol is in the blood.” and a leader in the The new technology is Infraredx’s research on the intravascular imaging technology, the causes of heart TVC Imaging System™, which will be attacks is excited used to detect LRP in study participants. about a new, largeOriginally from Indianapolis, Muller scale study aimed has lived in Boston for 30 years and at preventing served as professor of medicine at heart attacks. He’s also delighted Harvard Medical School. As a prethat Methodist Hospitals in Gary and medical student he started work at Merrillville are vigorously joining in the University of Notre Dame, learned effort.

Russian, and became an exchange Dr. James Muller is a cardiologist student to Moscow in medical studies. and Chief Medical Officer of Infraredx, As tensions ran high in the Cold War, he a medical device company sponsoring was one of the founders of International the international study that will include Physicians for Prevention of Nuclear War, 100 hospitals in 10 countries and 9,000 PROVIDED the organization awarded the 1985 Nobel study participants. A press release from Dr. James Muller with Dr. Andre Artis Peace Prize.

Methodist Hospital said the research, Today Muller credits the efforts of Dr. called the Lipid-Rich Plaque (LRP) Study, at Methodist Hospitals. The two doctors Andre Artis, interventional cardiologist is aimed at discovering whether there is are working on the global health study, at Methodist Hospitals in Gary and a link between the presence of LRP — a which will be looking at data from type of fatty coronary artery plaque Methodist patients, searching for a way Merrillville, for his role in getting the study started with participants.

— and an increased occurrence of a to prevent heart attacks.

“Dr. Artis has been leading the way,” cardiac event such as a heart attack. says Muller, enrolling more patients in “Methodist Hospital in Gary is one of this international study than any other the world’s leading centers in this large facility with the exception of one large, international study we’re doing,” Muller university hospital. “It’s because of his says. Methodist is one of 12 hospitals leadership that the trial is going so well.” that have begun enrolling patients in Artis, with expertise in placing stents in the study; 168 are already enrolled, As one of the nation’s cardiac patients, seeks permission from with a goal of 1,000 for the first part of the study. leaders in cardiovascular his patients for them to be part of the Lipid-Rich Study, explaining its purpose, “With the first part of this study, medicine, Methodist value, and process. we’re trying to predict heart attacks; Hospitals is proud to be “As one of the nation’s leaders in once prediction is successful, we will try new treatments to prevent these involved in a cutting-edge cardiovascular medicine, Methodist coronary events. Right now, (catheter) research effort that could Hospitals is proud to be involved in a cutting-edge research effort that labs are treating heart attacks after they have occurred, but in the future we hope advance our understanding could advance our understanding and management of coronary artery that cath labs will be able to prevent and management of disease,” says Artis, who is also them,” Muller says. coronary artery disease. co-director of the Heart and Vascular What causes heart attacks is Institute at Methodist Hospitals. “The understood: It’s the cholesterol DR. ANDRE ARTIS findings from the LRP Study could show accumulating in the arteries. This leads that patients with LRP are more prone to plaques, which rupture and cause a to experiencing a major adverse cardiac clot that blocks arteries, Muller says. “We is indicted but not yet fully convicted.” event. That knowledge could help inform Using the terms “lipid-rich plaques” need to find cholesterol in the arteries our decision of how and when to use and assess its size. We know we can find and “cholesterol-rich plaques” drugs and/or interventional treatments interchangeably, Muller says most the cholesterol-rich plaques; they show patients know their cholesterol level, but like angioplasty to improve patient up as a big yellow spot (on the imaging outcomes.” doctors haven’t been able to tell them device). What we believe, but is not yet ‘I love what I do’ how much cholesterol is in the wall of proven, is that the lipid-rich plaque is Kimberly Armstrong, coordinator the plaque that ruptures and causes the the coronary artery. “That’s what our heart attack. The cholesterol-rich plaque new technology provides: It can tell you of the study, works with Artis at

JULIE KESSLER

Methodist’s Northlake campus at Gary, operating the Infraredx imaging device. “Our device, the TVC Insight™ Catheter. which detects cholesterol in the coronary arteries, is used in 120 hospitals,” The device uses both light and sound to examine the artery. Muller says. “It’s like eyes and ears for the doctor inside the heart, producing a picture like a fetus ultrasound picture.

Without it, a patient can’t know how much and where the cholesterol is. The FDA says the device is the first device that detects lipid-rich plaques, which are of particular interest.”

After the imaging and when Artis has identified patients for the study, Armstrong enters patient data and obtains consenting and screening information. She explains to patients they need to be committed to participating for the two years the study is expected to last — but their only job is to respond to her follow-up calls, which determine whether the patient has had any adverse cardiac events during the study.

“I love what I do,” Armstrong says.

“It’s very exciting to be a part of something that may be able to change how things are done to treat patients with heart disease.”

“I’ve led many scientific studies over the decades,” Muller says, “and the key to a successful study is a talented research coordinator, someone who’s dedicated to the study. (Armstrong) is such a skilled research nurse.”

Dr. Ron Waksman at Washington Hospital in Washington, D.C., is the principal investigator — independent of Infraredx — who led the development of the protocol for the study.

Muller says patients are enrolling in this study because they already have heart disease and “they want what we want: to prevent a second heart attack.”

“Right now we’re working to prevent a second heart attack. Once we succeed, we hope to become part of a strategy to prevent the first heart attack.”

Results of the two-year study are expected to be published in about two years, Muller says. For more information on the LRP Study visit http:// clinicaltrials.gov/ct2/show/NCT02033694 or contact 884-9180.

A SPECIAL PUBLICATION OF THE TIMES MEDIA CO.

August 31, 2014 : HEALTH CARE & QUALITY INNOVATION : PAGE 15

Innovation in imaging MRI technology experiences rapid advances

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VANESSA RENDERMAN

he days of patients being fed into a horizontal tube with expectations to stay there for sometimes half an hour while a machine snaps detailed images are fading, as MRI technology makes way for wider, sturdier machines.

MRI stands for magnetic resonance imaging. The machines use a magnetic field and radio waves to form detailed pictures of the inside of people’s bodies.

Some of the newest technology is coming to Munster in September.

Stand Up Open MRI of Indiana will offer a U-shaped MRI that allows patients to sit, stand or lie down. It is ideal for people who are claustrophobic, as well as obese patients and children, says Meryl Mioni, administrator for Stand Up Open MRI of Indiana.

Aside from being more comfortable, it can capture images differently than a traditional MRI, because patients’ bodies are positioned differently.

Many area hospitals already expanded their equipment options, offering open MRI and wide bore MRI, along with imaging in a traditional machine.

Porter Health Care System recently installed a new wide bore MRI at its Valparaiso Medical Center, in addition to the two traditional machines in the health system.

The wide bore was chosen over an open MRI because it provides a clearer picture resolution, says Angie Hamilton, lead MRI technologist for Porter Health Care System and radiology supervisor at the Portage campus.

“The wide bore is still geared toward claustrophobia and has a heavier weight limit,” she says. “We can still accommodate that part of our patients’ needs and have the quality, so we’re not sacrificing.”

All three machines offer music.

“It helps the time go by faster,” she says. “It takes their mind off the test.”

Methodist Hospitals has three MRI units across its campuses, two of which will be replaced by wide bore machines early next year, says Bhupendra Dave, supervisor of MRI & nuclear medicine at Methodist Hospitals.

“Nowadays, the patient population is getting larger,” he says.

The wide bores will be able to support up to 550 pounds. The Southlake campus in Merrillville will be first to receive the upgraded MRI, and then one will be installed at the Northlake campus in Gary.

The newer technology on the machines will allow imaging of patients who cannot tolerate a contrast injection, such as patients with kidney problems, Dave says.

“We can do certain exams without

TONY V. MARTIN

Newest generation of MRI technology in Northwest Indiana. Wide bore MRI at Porter Health Care System Valparaiso Medical Center.

PROVIDED

Newest generation of MRI technology in Northwest Indiana at Franciscan Point, which is under the auspices of Franciscan St. Anthony Health-Crown Point. the use of a contrast injection,” he says. “We will be able to do exams on patients who are on dialysis.”

The advancements are continuous, Dave explains.

“Every six months, the technology advances and something new comes up,” he says.

Michael Budimir, administrative director of imaging services for the Northern Indiana Region of Franciscan Alliance, says MRI technology is always changing and improving.

“We do our best to be state of the art when we’re purchasing new equipment and forecast the needs of our patient population and where the market trends are heading,” Budimir says.

Franciscan uses traditional and open MRI machines.

“The open one accommodates patients who are claustrophobic or a little heavier,” he says.

Hospitals are more in tune with patients who are claustrophobic, and an open MRI eliminates the need for

TONY V. MARTIN

Stand Up Open MRI of Indiana under construction at Community in Munster. anxiety pills or mild anesthesia. In an open MRI, patients can look from side to side, he says.

“We are trying to accommodate everyone,” he says.

At the same time, the hospitals want to keep up with technology.

“We are continuing to work with our vendors to upgrade products as much as possible,” Budimir says. “We have to make sure that what we’re upgrading with is in the interest of our patients,” he says.

A modern method for treating a painful scourge JULIE KESSLER Times Correspondent‌

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aser surgery is a longaccepted procedure to correct many conditions, from cataracts to plantars warts. Yet new uses for laser are still being discovered for alleviating conditions ranging from aggravating to lifethreatening.

Dr. David Wilks, urologist at St. Mary Medical Center in Hobart, explains that treatment of painful kidney stones still often involves lithotripsy, but now there are different types of lithotripsy.

“Starting back in 1985, the patient with a kidney stone used to be put in a tub of water and have multiple, non-electrical shock waves broke up the stone(s) into small fragments that the patient would have to pass (during urination).

“Now we have the ability to treat kidney stones in a much less invasive way.

With laser lithotripsy, a scope is inserted into the ureter so we can see accurately where the stone is and its size. Then a tiny fiber is put onto the stone, touching it and breaking it up to be passed spontaneously or brought out through the same scope.”

Generally used in the lower half of the ureter and for smaller stones, laser lithotripsy is less invasive, requiring

no incisions, yet still relieves the patient from what Wilks calls, “the stone burden.” It is a burden: The pain associated with kidney stones is often compared to childbirth or gout.

A large stone in the kidney is typically treated with extracorporeal (from outside the body) shock wave lithotripsy (on a water-filled pad rather than in a tub of water), Wilks says. For very large stones — two and a half or three centimeters — a percutaneous nephrolithotomy (PNL) can be performed to avoid the patient having to pass all the larger fragments.

The PNL procedure involves threading a needle with a wire in it into the kidney, then dilating (stretching) surrounding tissue to allow putting a tube into the kidney. “We use ultrasonic lithotripsy to break up the stone and suction the fragments out of the kidney so the patient won’t have to pass them.”

There is a little higher risk of bleeding and a hospital stay of a day and a half or two is required. The tube, or stent, is usually removed before the patient is discharged, though it’s not unusual to leave it in and take it out a few days later, after which the opening closes up on its own.

Laser surgery can be used to vaporize scar tissue in the urethra sometimes caused by trauma, especially common in males who sit on a portion of it on hard surfaces such as bicycle seats. Scar tissue

Chandana Surgery Center in Valparaiso, says, “Laser is huge now,” as standard procedure for cataract removal for better vision. An incision is made in the lens and the laser moves up and down and sideways, breaking up the cataract.

“That’s what’s wonderful about laser surgery: It goes right to the area. For this one, no anesthesia is necessary and there is minimal pain. Usually the doctor will check the pressure in the eye that night and patients can do whatever they normally do. It’s really fascinating when the patient comes back and says, “My gosh, I can see so much better!’”

McCrammer says laser surgery works well for patients who are challenged with anesthesia, including special needs patients, including nonverbal and/or mentally handicapped children and adults. “An example is someone unable to sit in a dental chair and understand what’s going on, such THINKSTOCK as a dental restoration for a child with Downs syndrome.”

Different kinds of lasers include a interferes with the flow of urine carbon dioxide laser that sends out and can develop into a potentially beams to vaporize plantars warts of very serious condition. Laser is also the feet. A pulsed dye laser sends a useful for vaporizing the tissue in a burst of light to lighten or remove benign enlargement of the prostate. birthmarks, tattoos, and other benign It develops over a long period of time, marks by breaking up the discoloration and like scar tissue from trauma, that is then naturally absorbed into the causes symptoms but “a lot of men body. assume it’s just a matter of getting “With laser surgery there are older, but it can get very serious,” definitely faster recovery times because says Wilks. it’s less invasive,” McCrammer says.

Darlene McCrammer, director of

Page 16 : Health Care Quality & Innovation : August 31, 2014 A Special Publication of the times media co.