Orlando Medical News July 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Todd Maugans, MD ON ROUNDS

Central Florida Breathes Easier

Sunshine State Cities Improve Standings on List of 2015 Asthma Capitals ... 8

Measuring the Impact of Interprofessional Education Do Lessons Learned Translate from the Classroom to the Clinical Setting? ... 11

To Roger Oxendale, Retirement Means ‘Pick Up the Pace’ In Three Years, Nemours CEO Brought Children’s Hospital from ‘Nothing’ to ‘One of the Nation’s Best’

By JULIE PARKER

Trekking to Illinois with his wife of 40 years, Diane, to see their first grandchild, Charlie; hopscotching across South Florida in their fifth-wheel RV; and spending time at the family’s lake house in the mountains of Western North Carolina are just a few items at the top of Nemours’ departing CEO’s post-retirement agenda. And that’s just the first two months!

Roger A. Oxendale, MBA, president of Nemours Children’s Hospital at Lake Nona Medical City in Orlando and a senior vice president with Nemours, will officially retire on Jan. 1, 2016. Not shabby for the hospital executive who arrived in Central Florida in

April 2010, soon after the foundation was poured for the new $400 million integrated pediatric health campus.

“Within less than three years, we’ve brought this hospital from nothing to clearly on our way to being one of the nation’s top children’s hospitals,” said Oxendale, who opened Nemours on Oct. 22, 2012. “We’re very proud of being considered a major pediatric provider and referral for children throughout the world.”

Since opening, Nemours has treated children and their families from every state in the union, every continent except Antarctica, and almost every county in Florida.

Last December, Leapfrog Group named (CONTINUED ON PAGE 4)

Florida Lags Behind Nation on Telemedicine Policy Despite lawmaker and FMA support, legislative action not taken to advance state’s telehealth practice medicine advancement, indicated the conservative approach – neither bill addressed parity for telemedicine reimbursement – would likely pass the 2015 session, making it easier to address monetary issues in subsequent sessions.

Telemedicine lobbyists agreed the proposed legislation in 2014 was

By JULIE PARKER

It looked like a shoo-in. And then it didn’t.

Overshadowed by Medicaid expansion, a pair of promising telemedicine bills perished in the closing days of the 2015 regular session.

State Sen. Aaron Bean (R-Fernandino Beach), chairman of the Senate Health Policy committee and a staunch supporter of tele-

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(CONTINUED ON PAGE 6)

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PhysicianSpotlight

Pediatric Neurosurgeon Pushes the Limits Blazing the Adrenaline Highway

By JEFF WEBB

ORLANDO - Meld the fictional characters from the television show Doogie Howser, MD and the movie Top Gun and you’ll have a peek into the non-fiction narrative of Todd Maugans’ life.

Maugans, chief of pediatric neurosurgery at Nemours Children’s Hospital at Lake Nona, grew up in Marysville, Pa., the third of three brothers born to parents who owned a furniture-making and upholstery business. As a youngster, he thought he would become a pastor. “Then I had a dream that I had done that, died and went to heaven and I tended sheep … forever.

I gave up that thought the morning after,” he said. Not long after his nocturnal epiphany, Maugans “became fascinated with the human body and decided to pursue a career in medicine,” he said. “I was strongly influenced by the family doctor … and I also had a close teacher friend who shaped my academic path and helped me get into college — when I was 15!”

The gifted teenager matriculated at Simon’s Rock College in Barrington, Mass., after 10th grade, becoming the first in his family to attend college. But when he started applying to medical schools, the 19-year-old had trouble getting interviews because of his age. “But when I did interview, my uniqueness was seen as an advantage,” said Maugans, who eventually was accepted and earned his MD at Temple University in Philadelphia.

But Maugans was undecided about his specialty. “I was pulled between family medicine and pediatric neurosurgery,” he said, so he decided to do both. A residency in general surgery in New Hampshire was followed by a residency in neurological surgery in Virginia, and then a residency in family practice in Vermont. After alternating between specialties for a total of seven years, he coupled his passions and accepted a clinical fellowship in pediatric neurosurgery at Los Angeles Children’s Hospital in 1997. Since then, his career has taken him from California, back to Vermont and then to Ohio, which was his last stop before arriving at Nemours in 2012.

Having been board certified as a practitioner and teacher in both specialties has given Maugans a rare perspective, he said. “It is fascinating to have delivered babies and also to have performed brain surgery on babies. The family practice was special preparation for what I’m doing now. It differentiates me from most, if not all, pediatric neurosurgeons that I have this extensive experience in primary care. The two greatest advantages of that are that one, I know what a difficult job primary care doctors have in sorting out difficult patients and referring patients appropriately,” said Maugans, 54. “The orlandomedicalnews

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second is the whole patient experience.

In pediatric neurosurgery we mostly take care of kids with chronic problems who will need years of care and follow-up. You need to have an appreciation for the complexities of their lives and you have to have a heart for it. I think my family practice experience prepared me well to do good things in this regard,” he said.

Maugans said he was attracted to Nemours because it was “an opportunity to build something exactly as I would love to see it built, and to be involved with an organization that has such an incredible philosophy and credo. It’s not just lip service here; Nemours truly does place patients and families above all in everything we do,” he said.

Maugans said he is in surgery a couple of days a week and sees patients in clinic for most of the other three, with administrative work here and there. “I came here to build new relationships and create new opportunities for patients and for providers. I really try to reach out to the broad medical community, whether they work for Orlando Health, Florida Hospital or someone else,” he said.

That collaboration is evident in Maugans’ creation and oversight of the Nemours Comprehensive Concussion Care Center. Other hospitals have concussion care centers, he said, but his is the

only one that is pediatrics specific.

Maugans also has an extensive background in craniofacial surgery, helping children with skull deformities. “I work hand-in-hand with Dr. Ramon Ruiz (MD and DMD) at Arnold Palmer Children’s Hospital. We make a fantastic team,” he said, adding that he dreams of creating “a national, if not an international, center for doing that work. We could do it in Orlando.

There’s only one really robust craniofacial program and it’s in Dallas.” Maugans said, “The concept of medical tourism would be very applicable. We easily could attract people from Central America, South

America and Europe. We could do worldclass work right here,” he said.

As busy as Maugans is, he has always found inventive ways (pay attention fans of “Maverick” in Top Guns!) to feed … a need … for speed.

When he was practicing in Vermont, Maugans spent a decade as the senior flight surgeon for a squadron of F-16 fighter pilots in the Air Force Reserve.

Having less-than-perfect vision prevented him from being a pilot, but Maugans said by the time he retired as a lieutenant colonel he had logged many hours in the two-seater training jets and availed himself of every opportunity to take the controls while soaring above the mountainous New England landscape. His call sign while flying? Doogie.

Maugans still has his private pilot license, but hasn’t flown since his wife Karen, a professional photographer he met in Vermont, gave birth to their daughter Ayla, now 15. But Maugans’ appetite for seeking thrills returned about a year ago when a physician assistant at Nemours invited him to the Daytona 200 motorcycle race. “I had never seen motorcycles perform like that. Two days later I got my motorcycle endorsement. One week later I bought my first motorcycle.

Two months later I bought my second (CONTINUED ON PAGE 6)

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To Roger Oxendale, Retirement Means ‘Pick Up the Pace’, continued from page 1 Nemours among nine children’s hospitals in the country as Top Hospitals. Nemours represented the only children’s hospital in the South to earn the elite recognition.

“This great award is so important because it features a focus on the demonstration of excellence in safety and quality,” said Oxendale. “Safety and quality is so very important as we treat our children, along with their families.”

In 2013, Nemours achieved LEED Gold Certification, the only hospital in Central Florida and only one of three children’s hospitals in the nation to do so.

“As hospital and community leaders, we need to be focused on how our buildings are impacting our environment,” he said. “As importantly is taking advantage of the natural light and healing gardens as we seek to provide the best healing environment for our patients.”

Oxendale’s road to Orlando began at Clarion University, where he earned an MBA and is a distinguished alumnus.

He served as a senior financial executive with the Allegheny Health Education and Research Foundation, and a senior audit manager with Coopers and Lybrand. In 1995, he joined the University of Pittsburgh Medical Center’s (UPMC) Children’s Hospital of Pittsburgh as CFO. Five years later, he moved to the COO post, where he helped establish Children’s Community Pediatrics, the largest pediatric and adolescent primary care network in western Pennsylvania. In 2005, he was named CEO of the children’s hospital, which U.S. World & News Report has consistently named among the nation’s 10 best children’s hospitals. In 2008, he was

‘‘

Safety and quality is so very important as we treat our children, along with their families.

’’

– Roger A. Oxendale, MBA, president of Nemours Children’s Hospital at Lake Nona Medical City in Orlando appointed president of the UPMC Foundation concurrently with his CEO post to more effectively align the hospital’s funding needs with foundation initiatives.

Oxendale, oversaw the construction of a new and technologically advanced 10-acre pediatric hospital campus in Pittsburgh’s Lawrenceville neighborhood that opened in May 2009. That hospital also received LEED certification and with its implementation of the Computerized Physician Order Entry System (CPOE) and other technological advances was named KLAS’ top digital children’s hospital in the nation. He also garnered international healthcare experience with his involvement in UPMC via projects in Qatar, Dubai, Ireland, Ukraine and China, and has become a nationally recognized healthcare executive as a board member of the National Association of Children’s Hospitals and Related Institutions (NACHRI).

Oxendale’s milestone achievements laid the groundwork for him to successfully recruit world-class talent to Central Florida. Famously, there’s the story of Board Chair John Lord tossing a blank legal pad to prime candidates to design their own dream departments, such as Stephen Frick, MD, now surgeon-in-chief and chair of the Department of Surgery for Nemours Children’s Hospital; Terri Fin-

Create Health for your Patients and Practice JOE PECORARO, MD Lost over 100 pounds over 9 years ago and has kept it off

kel, MD, now pediatrician-in-chief, chair of the Department of Pediatrics and chief scientific officer for Nemours Children’s Hospital; and her husband, Richard Finkel, MD, now division chief of neurology at Nemours Children’s Hospital, who in 2013 conducted the first targeted drug trial for Spinal Muscular Atrophy (SMA).

“I remember when Dr. Cartland Burns talked to the board about being convinced someone would develop a really great bowel and intestinal failure program in Central Florida and he said: ‘I want that to be me.’” said Oxendale. Burns was named division chief of general and thoracic surgery at Nemours Children’s Hospital.

“One of the most attractive recruiting tools is that a position here is truly a once-in-a-lifetime opportunity to impact the pediatric healthcare of Central Florida and beyond,” said Oxendale. “That’s been a very common theme. Most leaders we recruited, especially physician leaders, have come from very well-established children’s hospitals throughout the country. Dr. Burns’ kind of enthusiasm and focus is indicative of what brought physicians here from many parts of the country.”

Beyond his dedication to pediatric healthcare, Oxendale consistently supports the communities in which he serves, a practice he plans to continue from his

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“My future plans are still developing, but I have a specific interest in leadership development, particularly with young and upcoming individuals not only in healthcare, but also in the business world overall,” said Oxendale, a longtime volunteer leader for the Boy Scouts of America in Pittsburgh, Pa., and Central Florida. “I do a fair amount of informal mentoring at Nemours and through other connections, but I also have a strong interest in the youth of our country. As we continue to move forward as a country, it’s really important to have business and community leaders focusing on how we can continue to rethink and rebuild programs. For example, I believe we can better support our local schools and youth organizations. I’m passionate about it, and believe as a society, we have an obligation to not rely on the traditional way programs have worked and been funded.”

Oxendale is winding down his time at Nemours by staying busier than ever. He’s transitioning position of president to Dana Nicholson Bledsoe in late summer, while also overseeing a dozen pediatric primary care clinics, four pediatric specialty clinics, and six pediatric urgent care clinics and continuing to serve as senior vice president.

The father of three grown daughters, Oxendale stays fit by camping, backpacking and running. He’s looking ahead at RV trips to the west coast, with stops in the Rockies.

“Starting a hospital from scratch was challenging,” Oxendale admitted. “It required bringing together everyone’s best thinking as we built teams among people who haven’t historically worked together, and making sure we had all our policies and procedures in place. As we continue to grow, the challenging is keeping on top of having the right resources here at the right time to serve children and their families, both in terms of clinical expertise with our great physician leaders, and also with our nurse and staff at the bedside working directly with our patients.”

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Sniffling & Wheezing Across the U.S. Memphis Tops List of 2015 Asthma Capitals; Southern Cities Swap Rankings

By JULIE PARKER

After jockeying for position in the top five most challenging cities to live in the United States with asthma, Memphis holds the leading spot for 2015, according to the newly released annual Asthma Capitals report by the Asthma and Allergy Foundation of America (AAFA).

Poor air quality, inadequate public smoking bans, high reliance on asthma medications and voluminous emergency room visits for asthma were among the significant factors why the Bluff City – alternately known as Home of the Blues and Birthplace of Rock ‘n’ Roll, and perhaps more tellingly of health issues, the Barbecued Pork Capital of the World – climbed to the uncoveted spot atop the annual list, after moving from No. 3 in 2013 and No. 2 in 2014.

Rounding out the top five Asthma Capitals for 2015: Richmond, Va., which held the top perch last year; Philadelphia, Pa.; Detroit, Mich.; and Oklahoma City, Okla.

“Each year for our report, we look at the largest cities across the country and measure the things that people with asthma care about the most,” said Mike Tringale, senior vice president of external affairs and principal investigator for the report. “Obviously, we look at pollen, pollution, and ozone because nature affects adults and kids with asthma. But we also look at poverty, uninsured rates and city smoking bans because public policies matter, too.”

allergy patients experience their worst seasonal allergy symptoms, and patients report that they’re not fully satisfied with over-the-counter (OTC) options they find on drug store shelves.”

Rounding out the top five spring allergy capitals for 2015, respectively: Louisville, Ky.; Oklahoma City, Okla.; Memphis, Tenn.; and Knoxville, Tenn.

Congressional Response With an estimated $50 billion national price tag for treating asthma annually, Congress is considering important legislation to reduce America’s asthma burden.

The Family Asthma Act of 2015 (S 1064), introduced again this year by Sen. Kirsten Gillibrand (D-NY), would strengthen research, promote public education and develop improved recommendations for asthma treatment and management. If enacted, the Centers for Disease Control and Prevention (CDC) would expand asthma tracking to provide researchers with muchneeded data on disease prevalence, severity and treatment in the United States. The CDC could also develop recommendations regarding the federal government’s role in response to asthma by providing steps for reducing asthma’s prevalence, cost and mortality rates; and ideas for further research, treatments and intervention.

Gillibrand also introduced legislation to enable schools to enact better asthma management plans. The School Asthma

Overall Medical News market rankings in the 2015 Asthma Capitals report, with major markets highlighted in bold, are: NO. 1: MEMPHIS, TENN.

NO. 60: GREENSBORO, N. C.

NO. 7: KNOXVILLE, TENN

NO. 61: MIAMI, FLA.

NO. 8: CHATTANOOGA, TENN.

NO. 64: ORLANDO, FLA.

NO. 9: NEW ORLEANS, LA.

NO. 67: WINSTON-SALEM, N.C.

NO. 21: LOUISVILLE, KY. NO. 25: JACKSONVILLE, FLA. NO. 26: ST. LOUIS, MO. NO. 28: LITTLE ROCK, ARK. NO. 29: NASHVILLE, TENN.

NO. 68: CHARLOTTE, N. C. NO. 71: BATON ROUGE, LA. NO. 72: KANSAS CITY, MO. NO. 77: DAYTONA BEACH, FLA.

NO. 30: JACKSON, MISS.

NO. 92: RALEIGH, N. C.

NO. 44: BIRMINGHAM, ALA.

NO. 93: SARASOTA, FLA.

NO. 54: TAMPA, FLA.

NO. 94: CAPE CORAL, FLA.

NO. 58: LAKELAND, FLA.

NO. 95: PALM BAY, FLA.

Management Plans Act (S 1065) could greatly improve the way schools provide care and treatment for students with asthma. In the U.S., an estimated 7 million children under the age of 18 have asthma, a leading cause for school absenteeism.

The act directs grant-receiving schools to develop asthma management plans that identify all students with an asthma diag-

nosis, provide asthma education for all school staff, and develop protocols and training to support symptom management.

Schools could also use grant funds to acquire asthma inhalers, spacers, air purifiers, and related supplies.

Community Blueprint The annual report, Tringale pointed out, provides communities with a blueprint for change, along with data on 13 critical factors relating to asthma prevalence, environmental conditions and healthcare usage.

Teva Respiratory (TEVA) and QVAR Inhalation Aerosol sponsored the report, an independent AAFA research project.

“Communities can work to make progress of many of these factors,” said Tringale.

The most noticeable ranking change for Medical News markets: Knoxville, Tenn., which tumbled from No. 41 to No. 7, after making progress from the 2013 list (No. 10).

“The Allergy Capitals can help to inform a pollen sufferer about geographical areas that may provide and worsen their seasonal symptoms, which impacts their quality of life,” said allergist Cliff Bassett, MD, AAFA ambassador and medical director of Allergy & Asthma Care of NY. Similarly, the information holds true for families traveling to Asthma Capitals, perhaps altering the time of year to visit for the least impact on asthma sufferers.

Spring Allergy Capitals’ Impact Bassett also pointed to AAFA’s spring allergy capitals. The worst metro area: Jackson, Miss., based on higher-than-average pollen and medication use.

“It’s important that allergy sufferers take heed,” he said. “A new study by AAFA revealed that spring is when most orlandomedicalnews

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Florida Lags Behind Nation on Telemedicine Policy, continued from page 1 too complex for bipartisan support and believed the more succinct drafts of SB 478, sponsored by Bean’s committee, and HB 545, sponsored by the House Health Quality Subcommittee, seemed poised for success. As the session wore on, it became evident the Senate version had the most potential, only after amendments were added to pacify the opposition.

A summary of the final version of SB 478 filed on April 16, defined telehealth, telehealth provider, prescription boundaries, practice standards and record-keeping, limiting telehealth to exclude “audio-only transmissions, email messages, facsimile transmissions and consultations.” HB 545’s final version summary was similar, but had a specific exclusion of teleheath products from the definition of “discount medical plan.”

“House Bill 545 wasn’t heard in its last committee of reference prior to cessation of House committee meetings, and no additional movement occurred after mid-March,” noted Tamara Demko, JD, MH, telehealth consultant for Florida TaxWatch. “Senate Bill 478, while making it to the full Senate Appropriations Committee – its last committee of reference – remained unheard and wasn’t revived in the tumultuous last week of the 2015 legislative session.”

To improve the odds of producing

passable healthcare legislation, including a significant focus on telemedicine policy in 2016, Bean called last month for the creation of a Joint House and Senate Task Force on Health Care Policy Innovation.

“Our committee held a workshop (in early June) where we reviewed and discussed several pieces of legislation designed to expand access, increase competition and lower the cost of healthcare services in our state,” said Bean. “In one form or another, some of these policy ideas have previously earned support in the Senate, while others are new and haven’t yet been fully explored.”

Bean said legislators’ consensus view of which 2015 healthcare bills should move forward and when “is that a 20-day special session focused primarily on our constitutional responsibility to pass a balanced budget doesn’t lend itself to a thorough and proper vetting of foundational changes to our healthcare delivery system.”

“With the legislature scheduled to reconvene for committee meetings as early as September,” he continued, “I believe we have time to continue to work on these and other policy ideas in the interim. President Gardiner is open to the creation of a Joint Task Force on Health Care Policy Innovation. I believe this approach will provide the opportunity for the House and Senate to debate, discuss and take public testimony

on comprehensive short and long term solutions to Florida’s healthcare challenges.”

Despite the lack of passage of telemedicine legislation, Medicaid and some insurers are reimbursing Florida healthcare providers for telemedicine appointments via video-conferencing. The Department of Veterans Affairs benefits from frequent use of telehealth for specialties using secure video links.

“Beyond the great work of the VA, there are health care providers and health systems across Florida who are actively engaged in telehealth. Because of telehealth technology, Floridians are accessing care that has not been available to them in the past. One of the best and simplest ways for Florida to positively impact health outcomes is for policy makers to define and incentivize the proper use of telehealth by Florida’s providers,” said Rena Brewer, RN, MA, director of the Southeastern TeleHealth Resource Center (SETRC).

In the meantime, Florida – the nation’s third most populous state, where 1 in 4 Floridians is estimated to be 65 years and older by 2030 – lags behind the rest of the nation in telemedicine advancement. As of May, the American Telemedicine Association reported that 35 states scored higher than Florida concerning telehealth coverage and reimbursement.

PhysicianSpotlight

Todd Maugans, MD, continued from page 3 motorcycle. One for the road and one for the track,” said Maugans.

“I’m very new to the sport, but I’ve experienced a kind of exponential rise in terms of interest. I’ve tried to become very skilled very quickly. It all comes from the perspective of safety. They are incredibly fun vehicles, but obviously there is a lot of inherent danger,” he said.

“It’s almost an oxymoron to say you’re a brain surgeon who rides a motorcycle. I have taken care of a lot of patients who have not ridden safely on their bikes,” said Maugans. That’s why he invests in the most modern safety gear for riding his BMW to the hospital, and while racing his Kawasaki on professional tracks where he sometimes clocks straightaway speeds of 160 mph.

Maugans understands the correlation between his professional and personal pursuits. “That’s one of the things I really like about riding. It is very much like surgery. You are just hyper-focused. It’s like there is nothing in the world around you other than what you are doing,” he said.

“I think I’m not too atypical for a lot of doctors, especially surgeons. We’re addicted to adrenalin in the operating room and the things we do in our personal lives.

It’s just very exciting. I think life should be full of contrasts. Play it safe, but have awesome fun,” he said.

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We are dedicated solely to insurance coverage placement for Florida’s doctors and healthcare providers, including medical malpractice, medical facilities’workers’compensation coverage, and physician and employee benefits. Since 2001, we have become well known in Florida as strong advocates for healthcare providers, as well as creators of numerous society and network insurance purchasing programs.

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Central Florida Breathes Easier

Sunshine State Cities Improve Standings on List of 2015 Asthma Capitals

By JONATHAN SCOTT

Residents of Orlando can breathe a little easier these days, according to the latest compilation of asthma capitals in the United States.

Last year, Orlando was ranked as one of the top 50 cities in the nation considered to be among the most challenging to live in with asthma. However, the central Floridian city has Dr. Jordan improved its standing, Smallwood falling from No. 49 in 2014 to No. 64 in the 2015 report, Asthma Capitals, recently released by the Asthma and Allergy Foundation of America (AAFA).

In fact, every city in Florida improved its position on this annual list that most communities would prefer not to find themselves on, especially being ranked near the top. Here’s how the other cities in Florida changed their positions from last year to this year: • Jacksonville was No. 20 in 2014, now No. 25 • Tampa was No. 50, now No. 54 • Lakeland was No. 55, now No. 58 • Miami was No. 58, now No. 61 • Daytona Beach was No. 64, now No. 77 • Sarasota was No. 75, now No. 93 • Cape Coral was No. 82, now No. 94 • Palm Bay was No. 76, now No. 95 This year’s list, like most of the previous annual rankings, tends to be crowded with cities located in the South. The compilation contains six southern cities in the top 10, including Memphis, Tenn., and Richmond, Va., which claimed the unwanted No. 1 and No. 2 spots, respectively, on the list.

Florida, like so many other states in the Deep South, faces some unique challenges, noted Jordan Smallwood, MD, who practices in the Division of Rheumatology/Allergy/Immunology in the

Department of Pediatrics at Nemours Children’s Hospital in Orlando.

“The big risk factors for worsening asthma include tobacco smoke exposure, obesity, and air quality,” Smallwood said.

“Studies have also shown that individuals living below the poverty line have an increased risk of developing asthma. As Florida continues to work to reduce these risk factors, we continue to see improvements in asthma control, as evidenced by the recent AAFA polls.”

The weather can also impact the lives of some of those with asthma or allergies, especially in the South, he added.

“Some patients feel that the heat and humidity of Florida play a role in their asthma - some for better and others for worse,” Smallwood said.

Asthma efforts working The latest numbers appear to provide some encouraging evidence that the steps Florida’s healthcare community has taken recently to improve medical services for those who suffer with asthma and allergies are working.

Until recently, Florida was moving in the wrong direction.

From 2000 to 2010, lifetime asthma prevalence among adults in Florida increased by 52 percent, and asthma-related hospitalizations statewide rose by more than 32 percent. Between 2006 and 2012, the lifetime asthma prevalence among middle and high school students in the state increased by 21 percent.

But then Florida became one of 36 states selected to receive funding and technical support from the Centers for Disease Control and Prevention’s (CDC) National Asthma Control Program, and the state established the Florida Asthma Program in 2009. Prior to this, the state had no systematic approach to state and local

asthma surveillance, yet 15 percent of county health departments listed asthma as a priority health issue.

Now with the CDC’s support, the program has developed a comprehensive system for asthma data-gathering that provides easy, round-the-clock access to the latest county-specific asthma data, providing communities with information to better develop local Asthma Action Plans.

Medical community responds Additional efforts to combat asthma are also being made by the state of Florida and the medical community in the Sunshine State.

“Eliminating or reducing smoke exposure is important in asthma control and Florida has improved in their attempts to help control this statewide,” Smallwood said. “Depending on your source, the current adult smoking rate in Florida is 15-20 percent. The Florida Department of Health reported that in 2014, the rate of smoking of adolescents, ages 11-17, was down to 4.3 percent. Obviously we’d love to get that number down to zero, but Florida has taken some strong steps.”

He also noted that the medical profession is actively supporting these initiatives.

“I think the smoking bans and efforts to reduce smoking have always had the support and approval of doctors and hospitals behind them,” Smallwood added. “Hospitals are also always trying to battle obesity as well. If you look at the measures going on to reduce obesity and encourage exercise, almost of every one of them has the backing of some medical organization or a local hospital.

“You will also see the medical community holding a lot of events at which they talk to families about what asthma symptoms might look like, and what they can do to better treat their asthma. All these things go a long way to improve patient education and patient health.”

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How Telecom Keeps the Heart of Your Business Beating

By SCOTT WILLIAMS

It’s beyond dispute that the playing field of the healthcare industry has changed significantly due to laws such as the Patient Protection and Affordable Care Act (PPACA) and the Health Insurance Portability and Accountability Act (HIPAA).

With rising costs and a shortage of skilled workers this $2.6 trillion-dollar industry has no shortage of challenges. Despite all of this, they still must provide the best patient care possible.

This massive ecosystem of hospitals, physicians, pharmaceutical companies and insurance providers has been forced to change how business is conducted, adopt a pay-for-performance care mindset, maintain a compliant organization and reduce overhead costs.

So what strategies and tactics can be implemented to help ease the above challenges? Here’s the answer…A modern telecom infrastructure that boasts reliability, scalability, dependable access to data

coupled with an IT platform. All of this allows healthcare providers to deliver better patient-care while ensuring regulatory compliance and keeping costs down.

There is no doubt that recent government regulations have changed the old way of doing things. Gone are the days of filling hospital beds or feeding into the pay-for-service mindset. Instead, healthcare providers must focus on patient care and outcomes. A key piece in shifting the patient-care model and supporting advancing medical technologies is the right telecommunication solution.

Imagine for a moment that you are rushed to the nearest hospital. Unfortunately, the hospital you are admitted to cannot offer you the proper care. But luckily, the ER has videoconferencing equipment connecting it to doctors based in larger hospitals in other cities. These doctors can not only upload your medical records but can also provide the proper treatment – all from a distance. Courtesy of the right telecommunication solution.

The industry has to be on alert 24/7/365, and your infrastructure should be too. With the emergence of telemedicine, providers can reach remote patients who live in rural areas or who are homebound and provide expanded access to pri-

mary care, specialists, education, research resources and technology. Through better quality communications, providers can increase their quality of care to patients no matter what time of day and/or distance.

Like it or not, government regulations also demand that healthcare professionals enable their organization to operate under compliance set forth by PPACA and HIPAA. Implementing secure networks is critical in today’s healthcare environment and determines how patient information is managed and shared. Administrative staff should have the ability to maximize the company’s infrastructure. Whether “maximizing” includes properly uploading and transferring electronic medical records (EMR) or simply viewing them, staff should conduct their day-to-day responsibilities with confidence and not under a cloud of uncertainty. Should an organization mismanage information or be vulnerable to being hacked, penalties under the current government policies can be hefty.

Hosted VoIP has become more mainstream and is considered to be the future of telecommunications; however, not all hosted VoIP companies are created equal.

Some companies provide Quality of Service (Qos) and some do not.

What exactly is QoS? When band-

width is low in comparison to the traffic it must handle, some applications need higher priority to avoid impacting their users. Think of VoIP as one of these such applications. If voice traffic on a network is not prioritized (the target of QoS), noticeable quality issues may occur. Data packets being delayed or dropped and resent may result in voice dropouts, static, and dropped calls, which can all impact business productivity.

QoS may also aid in HIPAA compliance. While medical facilities may spend money on protecting their network to protect patient information, Hosted VoIP without proper QoS leaves the network wide open and unprotected. A suitable telecommunication solution will ensure a compliant environment and help safeguard sensitive information.

Another major role that telecommunications can play is lowering operating costs. A bona-fide telecommunications vendor should be able to seamlessly implement a telecom solution that offers a variety of products and services tailored to the specific needs of each unique healthcare provider, as well as phase out antiquated equipment and duplicative services. With the right products and services your work(CONTINUED ON PAGE 12)

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Measuring the Impact of Interprofessional Education

Do Lessons Learned Translate from the Classroom to the Clinical Setting?

By CINDY SANDERS

IPE … or interprofessional education … has become a popular buzzword among educators preparing the next generation of providers.

An interprofessional, team-based curriculum Dr. Malcolm has been lauded as the Cox best way to prepare healthcare professionals to work collaboratively in a value-based system where efficiency and quality are rewarded.

But does it work? Do the lessons learned in the classroom effectively translate into the clinical setting? And does this model of delivery actually have an impact on patient outcomes and the healthcare system itself?

Those were some of the questions posed by the Institute of Medicine’s Global Forum on Innovation in Health Professions Education. In late April, a six-member committee, chaired by Malcolm Cox, MD, published their findings in the IOM report “Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.”

The short answer to a long list of questions is that while the empirical evidence suggests this is a desirable way to train future providers, there simply isn’t enough scientific research to validate that opinion.

Asking the Question Cox, who is an adjunct professor of Medicine at the University of Pennsylvania Perelman School of Medicine and the former Chief Academic Affiliations Officer of the U.S. Department of Veterans Affairs, noted IPE became a common topic of discussion and debate among members of the Global Forum.

“One of the things that came up early on was that health professions education was ‘faith-based’ when it came to outcomes … that is we believed, without much data, that interprofessional education would be helpful, if not essential, to producing the kind of clinical workforce that the U.S. and world need in the future,” he said.

Cox noted a common sentiment among many educators is ‘the era of the Lone Ranger’ is over. He added, “I think that’s true … no one doubts that. Moreover, no one doubts that the U.S. health system is rapidly moving in that direction.”

And in fact, Cox pointed out, data exists showing teams can provide safer, more effective, efficient care … but that isn’t the same as proving the best route to get there.

“How do we prepare health professionals to hit the ground running when they reach the clinical workforce so they are ready to work in teams rather than as individuals?” he asked. “What we discovered is that while teams are known to be effective, how to create great teams is unclear,” Cox continued.

No ‘I’ in Team “The leaders of healthcare systems are not pleased with the graduates we are sending them,” Cox stated. While these new professionals might be well versed in disease recognition and the medical sciences, they aren’t well trained in working together, noted the physician-educator, who previously served as dean for Medical Education at Harvard Medical School Even when professionals from multiple disciplines are grouped together, Cox said it’s often more a matter proximity than actual teamwork. “Team leadership should be expertise- and situation-based rather than hierarchically based,” he pointed out. “Physicians are still giving orders and

nurses are taking orders, which is fine if the physician has the most knowledge on a subject, but there are times when the nurse or physical therapist or pharmacist should lead. The most effective team is where the expertise of professionals overlap so that the whole is greater than the sum of the parts.”

While a lot of emphasis is placed on leadership, Cox said the concept of ‘followership’ is equally important. “Physicians are great leaders but poor followers … I’m allowed to say this because I’m one of them,” he added with a chuckle.

In his experience, he added, “The only way you can really learn to work together as a team … is to work together as a team.”

IPE & Outcomes Cox said the committee studied the available research and literature for both the intermediate and final outcomes of IPE. The intermediate outcomes side of the equation is tied to learning outcomes and whether or not students understood, gained knowledge and developed new skills. “There’s pretty good information that interprofessional education begins to promote collaborative behavior within students,” he said.

(CONTINUED ON PAGE 12)

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How Telecom Keeps the Heart, continued from page 9 force will be more productive and streamlined, cutting costs exponentially.

The healthcare industry must effectively address a growing range of challenges, while focusing on the overriding goal of saving lives. Implementing a reliable telecommunications solution can give you the freedom to focus on what really matters.

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Measuring the Impact of Interprofessional Education, continued from page 11 “But,” he continued, “we haven’t taken it to the final endpoint, which is do those learning outcomes lead to enhanced patient health and health system outcomes?” Cox said, “The conclusion was there is no data that links the learning outcomes to health and system outcomes … that’s where the gap is.”

While this committee was focused specifically on measuring IPE, Cox said he personally believes that all health education innovations should be held to the same evidence-based standard. “We keep changing the way we educate, and there’s little solid data that any of these changes lead to measurable changes in health or system outcomes,” he said. “Belief is one thing, but data is another.”

Filling the Gap Cox pointed out IOM studies are not geared to go beyond the question at hand … in this case, a question of measurement.

However, the report included recommendations on how to move forward to produce more data to assess the real world outcomes of IPE on patients, populations and healthcare systems.

The committee highlighted four areas that should be addressed in order to truly evaluate the impact of IPE on collaborative practice – 1) more closely align the education and healthcare delivery systems, 2) develop a conceptual framework for measuring the impact of IPE (see graphic), 3) strengthen the evidence base for linking IPE to health and system outcomes, and 4) better link IPE with changes in collaborative behavior. Furthermore, the committee made two recommendations: Interprofessional stakeholders, funders and policymakers should commit resources to a coordinated series of well-designed studies of the association between interprofessional education and collaborative behavior, including teamwork and performance in practice. These studies should be focused on developing broad consensus on how to measure interprofessional collaboration effectively across a range of learn-

ing environments, patient populations and practice settings.

Health professions educators and academic and health system leaders should adopt a mixed-methods research approach for evaluating the impact of IPE on health and system outcomes. When possible, such studies should include an economic analysis and be carried out by teams of experts that include educational evaluators, health services researchers, and economists, along with educators and others engaged in IPE. Cox said the first recommendation is focused on collaborative learning outcomes.

The second, which he said is “the real crème de la crème” of the report, looks at linking IPE to health and system outcomes by using ‘mixed methods’ … incorporating both qualitative and quantitative research designs. “We need to know the how and why, as well as the what,” he stated, adding that without the qualitative piece, it’s difficult to generalize the quantitative results and apply findings to the larger population.

The IPE Study Team Not surprisingly, Cox pointed out the report on interprofessional education took teamwork and was a collaborative effort of the six-member committee. In addition to Cox, the team consisted of Barbara Brandt, EdM, PhD, director, National Center for Interprofessional Practice and Education at the University of Minnesota; Janice Palaganas, PhDc, RN, MSN, director of Educational Innovation and Development, Center for Medical Simulation, Massachusetts General Hospital, Harvard Medical School; Scott Reeves, PhD, MSc, professor of Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St. George’s, University of London; Albert Wu, MD, professor and director, Center for Health Services and Outcomes Research at John Hopkins Bloomberg School of Public Health; and Brenda Zierler, PhD, RN, FAAN, codirector of the Center for Health Sciences Interprofessional Education, Practice and Research at the University of Washington.

For More Info To access the full report, go online to iom.edu/Reports/2015/Impact-of-IPE.aspx.

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GrandRounds Danna-Gracey Introduces New Lead Agent in Orlando

Hunter’s Creek ER Celebrates First Anniversary The Hunter’s Creek freestanding Emergency Department on John Young Parkway is celebrating its first year of service.

The Hunter’s Creek ER, a department of Osceola Regional Medical Center, opened its doors on June 16, 2014. The freestanding ER serves more than 300,000 residents and visitors in northern Osceola and southern Orlando counties. Residents of Hunter’s Creek and the surrounding area have more convenient access to additional emergency care and other specialized services provided by Osceola Regional’s physicians. The experienced healthcare professionals at the Hunter’s Creek ER have spent the past year working to become South Orlando’s top choice for caring and convenient emergency medical services.

The one-story facility cost $10 million to build and covers 10,600 square feet. It has 11 private patient care beds, a separate ambulance entrance, a diagnostic laboratory, and imaging services (including CT scan, ultrasound and X-ray). The Hunter’s Creek ER is staffed by some 45 healthcare professionals, including ER physicians. The ER is fully equipped at the same high level of medical technology as the Emergency Department at Osceola Regional in Kissimmee. Emergency transportation to Osceola Regional is also available for patients requiring inpatient hospital care, or who need treatment at the new Trauma Center Provisional Level II at the main hospital.

The Hunter’s Creek ER is located at 12100 John Young Parkway, a few blocks from the JW Marriott and the Ritz Carlton.

The Seminole County Medical Society Foundation created the Dr. Willie Newman Scholarship Fund in recognition of Dr. Newman’s 25 years of service to the women of Seminole County. In addition, The Dr. Luis Perez Scholarship is awarded every year to a high school senior who reflects scholarship, integrity, and a strong interest in science. Dr. Perez was passionate about education, making sure that anyone wanting to go to college could get there.

The SCMS Foundation was honored to present the 2015 Dr. Willie Newman Scholarship Award to Loren Breen (Left photo) of Lake Mary High School at the recent Physician Membership Dinner and the 2015 Dr. Luis Perez Scholarship to Viraj Shah of Seminole High School.

Florida Radiological Society Receives Overall Excellence Award The Florida Radiological Society – of which all of Florida Hospital’s radiologists are members – was honored with the Overall Excellence State Chapter Award at the Annual American College of Radiology Meeting in Washington, D.C. The Overall Excellence Award honors chapters that have met standards across all categories of excellence established by the American College of Radiology, which include Quality & Safety, Membership, Meetings & Education, and Government Relations. Dr. Laura Bancroft of Florida Hospital (fifth from left middle row) serves as Chapter President for the Florida Radiological Society.

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One of the premiere independent malpractice insurance agencies in Florida, Danna-Gracey, has announced the hiring of Angela McCloskey, its new lead agent to head up its Orlando, FL location. Angela brings more than 11 years of experience working in the commercial insurance industry. A wife and mother of two children, Angela attended Edgewater High School and graduated with a degree in Business / Finance from the University of Central Florida.

McCloskey explained that she is pleased to join Danna-Gracey because the firm is an established group of specialists, people who focus only on specific areas of insurance for doctors, people who Angela McCloskey are truly experts.

Based in Delray Beach, Florida, with additional offices in Orlando, Jacksonville, Miami, Pensacola and Panama City, FL, the firm serves physicians throughout Florida by providing medical malpractice, workers’ compensation coverage, life & health insurance, and physician and employee benefits.

Digestive and Liver Center of Florida Announces a New Pediatric Gastroenterologist Dr. Walia is Board Certified in Pediatrics and specializes in Pediatric Gastroenterology. She completed her fellowship at the Cleveland Clinic Foundation.

Her interests include Acid Reflux, Inflammatory Bowel Disease (IBD), Abdominal Pain, Chronic Constipation/ Impaction, Motility Disorders and Irritable Bowel Syndrome (IBS). She also specializes in Fecal transplants for the Treatment of Recurrent C.difficile Infections Dr. Ritu Walia in Children.

Please Join us in welcoming Dr. Ritu Walia to our community.

Florida Hospital First in State to Offer More Accurate Prostate Cancer Screening Tool The Global Robotics Institute and Center for Urologic Cancer at Florida Hospital Celebration Health is the first in Florida to offer a blood test, the Prostate Health Index, which offers promise in reducing the number of unnecessary prostate biopsies.

The Prostate Health Index (commonly known as phi) offers an additional level of diagnostic information before a patient undergoes prostate biopsy. One clinical study showed a 31 percent reduction in unnecessary biopsies due to false positives when the phi test was used.

The phi test — which is FDA-approved — combines three prostate-specific antigen (PSA) markers, improving the accuracy of the information doctors use to determine if a biopsy is needed. The screening is designed for men over 50 years old who have negative results from a standard exam, but receive results between 4 and

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GrandRounds 10 on a PSA screening.

The prostate-specific antigen (PSA) test is currently the most widely used screening test for prostate cancer, but many patients undergo prostate biopsy unnecessarily. Among men with PSA levels in the 4 to 10 range – often considered a gray area – 75 percent of them undergo a prostate biopsy that uncovers no cancer.

JDL HealthTech Introduces HIPAA Security Essentials JDL HealthTech, a division of JDL Technologies and an industry leader in HIPAAcompliant IT services, today introduced its newest HIPAA compliance service, HIPAA Security Essentials. Designed specifically to help the 1-3 provider practice, HIPAA Security Essentials revolutionizes HIPAA compliance and ePHI security for the smaller healthcare provider in terms of both range of services and affordability.

The foundation of HIPAA Security Essentials is a HIPAA Security Risk Assessment, required on a regular basis by the federal Health Insurance Portability and Accountability Act of 1996. HIPAA Security Essentials provides holistic systems management as an overlay to an enhanced client network protected by commercialgrade firewall, domain controller and wireless access point, enabling robust security not found in the residential products typically used by 1-3 provider practices.

This configuration ensures that the practice’s network, workstations and Internet access are finally secure and HIPAA compliant. HIPAA Security Essentials includes intrusion detection and prevention, web content filtering and full-disk encryption.

The new compliance service also provides an upgrade to commercial-class email service, replacing the less secure residentialgrade email systems used by most 1-3 provider practices.

HIPAA Security Essentials is delivered as a service that JDL manages for the healthcare practice, including 24/7 user support and related engineering services provided through the JDL TechWatch Managed Services Operations Center. JDL Technologies is a leading Managed Services Provider, and was recently named to the 2015 Elite 150 Managed Service Providers in North America.

True Health Names a New Chief Executive Officer to Lead the Organization True Health, Inc. announced that its Board of Directors has named Latrice Stewart as the company’s Chief Executive Officer. Stewart has been in healthcare for more than 20 years and leads this organization with experience in a variety of medical practices. Joining the organization five years ago, she proficiently managed the overall operations of the organization and enhanced the effectiveness of its mission.

Stewart most recently served as the Chief Operations Officer of True Health where she significantly increased revenue with more efficient billing controls; she opened two of Central Florida’s first school based health centers, and expanded the accessibility of secondary services for underserved populations. Stewart orlandomedicalnews

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represents a positive image to community partners, provides practical operational solutions, and maintains fiscal responsibility. Prior to True Health, she was responsible for a portfolio that included medical offices for pediatrics, pulmonology, cardiology, neurology, pain management, and hospice care. Leading a variety of medical practices gives her a vast knowledge base that will contribute to her ability to ensure True Health’s success of providing the best care for the community.

Jamal Hakim, MD, named COO, and Bernadette M. Spong named CFO, Orlando Health David Strong, president and CEO, Orlando Health, has named Jamal Hakim, MD, chief operating officer (COO) and Bernadette M. Spong, CPA, chief financial officer (CFO) of the organization. Dr. Hakim assumes his position immediately. Ms. Spong will assume her position later this summer.

Dr. Hakim has served Orlando Health in various capacities since 1991, most recently as interim president and CEO from 2013 to 2015. In 2011, he was appointed the organization’s first chief of quality and clinical transformation overseeing the development and implementation of a system-wide quality plan that has since resulted in numerous quality awards and recognitions for Orlando Health hospitals and services. In this newly created COO position, he will oversee the daily operation management of multiple areas within the organization. Dr. Hakim is board certified in anesthesia, is an active member of the Society of Obstetric Anesthesia and Perinatology, and is a practicing anesthesiologist at Winnie Palmer Hospital for Women & Babies. He earned his bachelor’s degree in chemistry, graduating from Duke University, completed medical school at Indiana University and completed his anesthesia residency at the University of Florida.

Ms. Spong currently serves as senior vice president of finance/chief financial officer of network hospitals for the $3.4 billion University of North Carolina (UNC) Health Care system based in Chapel Hill, North Carolina. She holds the same position for the 665-bed Rex Healthcare System, one of UNC Health Care’s member systems.

Ms. Spong is responsible for financial operations for the system’s eight hospitals, a

medical school, research centers, approximately 2,200 physicians and multiple joint venture organizations throughout North Carolina. She is a licensed CPA who holds a bachelor’s degree in accounting from the University of North Carolina-Greensboro and an MBA from Elon University. She has received numerous honors and awards including the Becker’s Hospital Review 2014 130 Women Hospital and Health System Leaders to Know.

Conrad Prebys Donates $100 Million to Sanford-Burnham Sanford-Burnham Medical Research Institute (Sanford-Burnham) announced that it has received a gift of $100 million from prominent San Diego developer, philanthropist, and Sanford-Burnham honorary trustee Conrad Prebys. This is the largest donation ever made by Prebys and will be used to further implement the Institute’s 10-year strategic vision to accelerate the delivery of innovative new treatments that will have a tangible impact on improving human health.

In recognition of Prebys’ contribution, Sanford-Burnham Medical Research Institute will now bear his name, along with the other Institute namesakes T. Denny Sanford and Malin Burnham. Effective June 24, the new name will be Sanford Burnham Prebys Medical Discovery Institute.

Sanford-Burnham’s plan to form more pharma and clinical partnerships in order to advance translational research discov-

eries that will have a tangible impact on human health is critical to philanthropists like Prebys as they consider which organizations to fund. Prebys previously donated $11 million to the Institute, including $10 million in 2009 to support the Conrad Prebys Center for Chemical Genomics.

His investment in the ultra-high-throughput chemical screening center helped establish the drug discovery platform that is critical to Sanford-Burnham’s new emphasis on advancing laboratory discoveries to clinical study and gaining commercial interest in Institute assets.

Last year, Sanford-Burnham received a transformative $275 million gift from an anonymous donor. Including the Prebys gift, the Institute has received more than $375 million toward a $500 million, 10-year fundraising goal. Since 2014, Sanford-Burnham has received two of the five largest philanthropic donations to medical research in California. Prebys’ latest gift will help build sustainability for research and development, and further the Institute’s work in its focus disease areas of cancer, neuroscience, immunity, and metabolic disorders.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section.

Content and accuracy of the releases is the sole responsibility of the issuer.

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Front row (L to R): Patrice Muse, ARNP, Maria Soto, ARNP, and Deborah Tedesco, ARNP. Back row (L to R): Dr. Ricardo Ogando, Dr. Walter Conlan, and Dr. Barry Cook.

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