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Health Care

P ROU D TO S ERV E TH E A R IZONA TEC H NOLO GY COMMU N IT Y

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What’s Inside A R I Z O N A’ S

TECHNOLOGY MAGAZINE

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SONOrA QuEST

Company already working to counter shortage of trained lab staff.

HuMANA

Web-based system helps patients get the most for their dollars.

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Dr. DANIEL VON HOFF

Physician leads ‘dream team’ in ﬁght against pancreatic cancer.

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SPEED-DIALING DATA

TGen quickly finds usual flu fighters still work against H1N1.

The Focus

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COLLEGE OF MEDICINEPHOENIX

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UofA and ASU put aside rivalry to make shared campus work.

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The Network

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ArIZONA TELEMEDICINE PrOGrAM

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Center will help the region in conversion to electronic records.

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On the Cover :: The Health Care Issue

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Feature

Great Debate

Politics aside, the move to electronic medical records is the bigger issue in health care.

In Every Issue 006 Letter To Our Readers 028 Science Foundation Arizona 030 Arizona State University 032 The University of Arizona 034 Northern Arizona University 036 Capitol Watch

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Letter

Heart of the Matter

PuBLISHEr Steven G. Zylstra EDITOr Don Rodriguez ASSOCIATE EDITOr Tina May ArT DIrECTOr Jim Nissen, Switch Studio DESIGNErS Chaidi Lobato Erin Loukili Kris Olmon

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t was Aug. 29, 1985, in Tucson. While one man was getting a second chance at life, Arizona was about to get a new life as a center for medical 006 innovation. As the temperature was climbing to a routine summer high of 106 degrees, this particular Thursday became unlike any other at the University of Arizona Medical Center. Michael Drummond had been admitted three days earlier for an evaluation of his cardiomyopathy, a progressive deterioration of the heart muscle. The 25-year-old Youngtown resident’s condition was deteriorating quickly. Just 13 days earlier Dr. Jack G. Copeland, director of the hospital’s transplant program, received Food and Drug Administration approval to use the Jarvik-7, an artificial heart, as a temporary life-sustaining measure until it could be replaced with a human heart. Before that Copeland had been dealing with a different kind of heat: About five months earlier he implanted another model artificial heart, the Phoenix heart, into another man without federal approval. That man eventually had three hearts implanted in 46 hours. By the time Copeland met Drummond, the decision was made: He needed another heart. Despite finding himself earlier at the center of an ethics debate, the surgeon didn’t delay; he had work to do. A little after 8 that morning Copeland with the help of his team became the first to implant an artificial heart as a bridge to a transplant. About a half past noon the youngest human to receive an artificial heart was taken to recovery. The next day, the news appeared in The New York Times, the Los Angeles Times and other media throughout the nation. Drummond eventually received two artificial hearts and one human heart before dying about five years later at the same hospital. And his Jarvik-7? It joined other

items of historical significance at the Smithsonian Institute’s National Museum of American History. If Copeland hadn’t persevered to do what he felt was right, this chain of events never would have occurred. He didn’t do it for the fame. Now a co-director of the Sarver Heart Center at the university, none of the details mentioned above are even in his official biography on the center’s Web site. Like many of the people who become pioneers in healthcare technology, his real rewards have come from helping others. This edition of TechConnect, The Healthcare Issue, is dedicated to Copeland and those Arizonans who preceded and followed him in the quest to make life better for others. You’ll meet some of them in these pages and hear about the issues they now face. Despite the debate over the future of the nation’s healthcare system, we still feel confident that innovation will continue to make dramatic differences in our lives. For some, it will even deliver a second chance.

STEVEN G. ZYLSTRA

President & CEO, Arizona Technology Council

DON RODRIGUEZ Editor, TechConnect Magazine

CONTrIBuTING WrITErS Gremlyn Bradley-Waddell Al Bravo Amy Cotton Christopher Di Virgilio Kara Fort Jessica Franken Terry Koch Joe Kullman Alaina G. Levine (Southern Arizona) Donna Mason Kate Nolan Diane Rechel Bruce Wright Steve Yozwiak TrADEMArK // GENErAL COuNSEL Quinn Williams DISTrIBuTION PArTNErS Tucson Chamber of Commerce E-MAIL editor@techconnectmag.com For queries or customer service, call 602-343-8324 TechConnect is published by the Arizona Technology Council, One Renaissance Square, 2 N. Central Ave., Suite 750, Phoenix, AZ 85004. Entire contents copyright 2009, Arizona Technology Council. Reproduction in whole or in part without permission is prohibited. Products named in these pages are trade names or trademarks of their respective companies. TechConnect is a trademark of the Arizona Technology Council. All rights reserved. Publication of TechConnect is supported by private-sector businesses, and is not financed by state-appropriated funds.

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“I would love to change the world, but they won’t give me the source code.”

2009 Governor’s Celebration of Innovation

The state’s technology community will gather to honor its achievements Nov. 19 at the annual Governor’s Celebration of Innovation. Hosted by the Arizona Technology Council and the Arizona Department of Commerce, this year’s event will be held 4 to 10 p.m. at the Orpheum Theatre, 200 W. Washington St., Phoenix. Winners will receive Arizona’s highest honors for technology innovation. Craig R. Barrett, former Intel CEO and board chairman, will receive the OneNeck IT Services People’s Choice Lifetime Achievement Award in recognition for his efforts to educate others on the value technology can provide in raising social and economic standards globally. Other individual award winners will be: +W illiam F. McWhortor Community Service Leader of the Year: Ronald E. Shoopman, president, Southern Arizona Leadership Council +E d Denison Business Leader of the Year: Chuck Vermillion, CEO, OneNeck IT Services Categories for other awards and their finalists are: +P ioneering Innovation: Redflex Traffic Systems Inc., Universal Avionics Systems Corp. and GlobalMedia Group LLC. +G reen Innovator of the Year: MicroBlend Technologies Inc., American Solar Electric and Yulex Corp. + I nnovator of the Year/Start-Up Company: Ubidyne Inc., Digital Consumer Solutions and TUV Rheinland PTL + I nnovator of the Year/Small Company: General Plasma Inc., CellTrust Corp. and OneNeck IT Services + I nnovator of the Year/Large Company: Universal Avionics Systems Corp, IBM and Henkel/The Dial Corp. + I nnovator of the Year/Academia: School of Life Sciences/Arizona State University, ASU Polytechnic and The University of Arizona/Dr. Leslie Boyer

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Future Innovators of the Year Award winners to be honored will be Ebaa Al-Obeidi of Canyon Del Oro High School, Tucson; Scott Boisvert of Basha High School, Chandler; Rahul Mitra of Corona Del Sol High School, Tempe; and Michael Wallace, Tucson High Magnet School. Teacher of the Year is Michael Frank of Empire High School, Tucson. Arizona legislators who have supported the technology industry in their action also will be recognized. Sen. Barbara Leff will receive the Council’s Senator of the Year Award for the second consecutive year. Rep. Bill Konopnick will get the Representative of the Year award. The “Tech Ten” Legislator Award recipients will be Sens. Manny Alvarez, Al Melvin, and Richard Miranda, and Reps. Frank Antenori, Tom Boone, Chad Campbell, Lauren Hendrix, Lucy Mason, Michele Reagan, and David Stevens. ickets for the prestigious awards gala include a pre-award show cocktail reception, T awards ceremony and strolling dinner. Separate tickets will be needed for the VIP backstage after party. All can be purchased at www.aztechcouncil.org.

AZBio Awards

The Arizona BioIndustry Association named its winners during its annual awards event Sept. 24 at the Arizona Grand Resort in Phoenix. The awards and their winners were: Bioscience Company of the Year Award: Ventana Medical Systems, a member of the Roche Group, Oro Valley Fast Start Award: Applied Microarrays, Inc., Tempe Advancing Computer Science > Artificial Life Programming > Digital Media Digital Video > Game Art & Animation > Game Design > Game Programming Network Engineering > Network Security > Robotics & Embedded Systems Technology Forensics > Technology Management > Virtual Modeling & Design Web & Social Media Technologies

Jon W. McGarity Leadership Award: Martin L. Shultz, vice president, government affairs, Pinnacle West Capital Corp. Public Service Award: Rep. Nancy K. Barto, District 7, Arizona House of Representatives

local. G R O W national. THINK

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Close+up :A Collection of Brieﬁngs Focusing on Signiﬁcant Topics Affecting Technology.

THE NOVALIS-TX LINEAR ACCELERATOR

Banner Good Samaritan’s linear accelerator gets right to the point

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WRITING BY :: CHRISTOPHER DI VIRGILIO

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or many cancer patients, the treatment of a tumor had been limited to chemo-therapy or risky, invasive surgery that offered questionable results, higher risk for complications, and possible damage to neighboring tissues. But for most of this year, Banner Good Samaritan in Phoenix has been using a state-of-the-art weapon to help eradicate cancerous tumors without the invasiveness of a scalpel. In the lower-level of Banner Good Samaritan’s West Tower, Dr. John Kresl, director of oncology, and his team have trained the powerful beam of the Novalis-Tx linear accelerator (LINAC) on tumors with superior success. “Good Samaritan is one of two facilities in Arizona currently using the Novalis equipment,” says Kresl. There is another machine in Tucson, as well as treatment facilities in Los Angeles, Denver and Dallas. Linear accelerator technology has been around since the late ‘60s and uses microwave technology similar to that used for radar to accelerate electrons in a part of the accelerator referred to as “wave guide”, then allows these electrons to collide with a metal target. The resulting collisions are high-energy X-rays produced from the target that can be directed to the patient and shaped as they exit the machine to conform to the shape of the tumor. “The

beam may be shaped through the use of a multi-leaf collimator that is incorporated into the head of the machine,” says Kresl. “This allows for pinpoint precision with no encroachment into healthy tissue.” The LINAC resides in a specifically designed room of concrete and lead walls that shields the high-energy X-rays and is operated from a control panel that resembles a scaled-down mission control. The patient lies on a movable treatment table or “couch” where lasers are used for proper position and continuous adjustment during treatment. The beam comes out of a part of the accelerator called a gantry that resembles a large microscope base that rotates around the patient. “The accelerator has the ability to move 6-dimensionally around the axis x, y, and z as well as pitch, roll, and yaw,” says Kresl. “Radiation can then be delivered to the tumor with accuracy.” During treatment the radiation therapist continuously monitors the patient through a closed-circuit television and a series of computer screens that maintain the treatment parameters. “There is also a microphone in the treatment room so that the patient can speak to the therapist if needed,” says Kresl. “There are systems built into the accelerator to inhibit overradiation.” LINAC is also used for intensitymodulated radiation therapy, image guided radiation therapy, stereotactic radiosurgery

This allows for pinpoint precision with no encroachment into healthy tissue. - Dr. John Kresl and stereotactic body radio therapy. The Novalis-Tx is part of a $16.1 million commitment by Banner Health to radiation and oncology and radiosurgery. New linear accelerators are slatted for installation at Banner Desert Medical Center in Mesa and at Banner Thunderbird Medical Center in Glendale to support sterotactice radiosurgery. Banner Good Samaritan treated its first patient with the Novalis-Tx in early January 2009.

MEDICAL PHYSICIST STEPHEN SAPARETO WITH LINAC

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ON TrACK WRITING BY :: AL AINA G. LEVINE

Scientiﬁc Technologies’ innovative solutions keep tabs on nation’s health

EARLY WARNING

In the realm of disease prevention, the company created an early warning system that employs non-traditional data sources. Its analysts utilized information + GET CONNECTED www.stchome.com

Alaina G. Levine, TechConnect’s Southern Arizona correspondent, is the president of Quantum Success Solutions, a leadership and professional development public speaking and consulting company. She can be reached through her Web site www.alainalevine.com.

GOOD BOY WRITING BY :: KATE NOLAN

Scientists apply ‘tumor-snifﬁng dog’ technology to detect cancer

rizona nanobiologist Frederic Zenhausern is developing a new way to detect cancer. Using technology that parallels a dog’s super-sniffi ng capability, Zenhausern’s discoveries may lead to a simple noninvasive test for cancer. Scientists have known for decades dogs can smell the presence of a tumor in body emissions. Zenhausern’s team of researchers has created methodology that analyzes a gas made from a blood sample and detects metabolic changes caused by cancer, the way a dog’s nose does. “What we’re trying to do requires a close collaboration with clinicians,” said Zenhausern of The University of Arizona in Phoenix. TGen Clinical Research Services at Scottsdale Healthcare is conducting the clinical end of the research. In an earlier test there, the method correctly distinguished which 10 patients out of 20 had pancreatic tumors. Zenhausern has been probing the idea since the 1990s when he invented his first “artificial nose,” an electronic device that mimicked a dog’s olfactory sensitivity to chemicals. The

latest version, called the “Volatile Biomarker Discovery,” uses sophisticated chemical technology that converts a blood specimen from a liquid phase to a gaseous phase and then analyzes it. As more biomarkers are established, specific tumor types can be identified. Some kinks remain. “We need to be sure the biomarkers are not being inﬂuenced by exposure to the environment— like the French fries the individual may have had for lunch,” said Zenhausern. He expects within five years to understand metabolic patterns well enough to identify specific cancer molecules. The goal is to use the method to screen individuals for cancer in the population at large.

What we’re trying to do requires a close collaboration with clinicians. - Nanobiologist Frederic Zenhausern

THE HEALTH CArE ISSuE

from over-the-counter drug sales, school absentee data, and unusual symptoms reported in emergency rooms to design a system to identify and track diseases before a major outbreak occurs. They tested it in New Hampshire and plan to expand it to other states. Another innovation Watkins’s team devised involved shortening “the window of time to when the lab identifies positive results to where the public health officials can see it and then track it across geographic boundary,” he explained. Again this solution entailed a combination of technical expertise and public health know-how, something that makes STC unique. According to Watkins, his company was the first to integrate the private provider community into the immunization management and registry systems in many states. So “when you take your child to the doctor and they get a vaccination, they record that information in their information system and our (system) will send it to the states’ registry. …We’re really the only company in the market that has a true, commercial off-the-shelf solution for both immunization and disease surveillance.” The firm, which has done international work in Hong Kong, Bermuda, and Africa, is now turning its attention to H1N1 vaccination management. “We already have a product in use by 10 states that tracks mass vaccinations,” says Watkins. “We have submitted an unsolicited proposal to (the U.S. Department of) Health and Human Services to nationalize our mass immunization solution. In the meantime, we have made changes to our solution specific to H1N1 requirements that each of our states can utilize.” If approved, their system will allow first responders to know who is vaccinated early on, the status of the vaccine inventory, and other important information to lessen the chance of outbreaks. This information will be communicated to the Centers for Disease Control and Prevention in real time.

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ucson-based public health technology company is playing a leading role in disease surveillance, immunization management and outbreak management across the nation. Scientific Technologies Corp. monitors the nation’s health against tiny pathogens, but their innovative solutions in technology and public health reporting carry big consequences. As such, the company has emerged as a powerful force in helping public health agencies track and vaccinate against diseases. Its premise is unique, says Chief Administrative Officer Todd Watkins. “We started off as a technology company that helped systems talk to each other.” They got involved in public health in the early 1990s and decided to become a niche leader in the market. Clients are state public health agencies and large municipalities. The company has approximately 50 employees and had $8 million in revenue for 2008. Scientific Technologies changed their business model to “look at outcomes,” Watkins says. “We build systems that collect data and then we don’t just leave it at that; we look at the outcomes.” For example, on the immunization side, he says, the company helps clients identify pockets of need among at-risk populations. Then the client, say a certain state, for example, “can create very targeted (public service announcements) campaigns to help increase vaccination rates in certain demographics.” The company employs programmers to build web-based reporting and surveillance tools for its clients, as well as public health experts who serve as consultants and are integral in project management. For a project in Houston, it examined marketing campaigns for immunization programs and analyzed which demographics are underserved and why, Watkins says.

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Sonora Quest tries to head off impact of ASU Clinical Laboratory Sciences program’s closure WRITING BY :: DON RODRIGUEZ

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ho hasn’t lived this scenario?: Your doctor orders lab work to confirm a diagnosis. After providing a sample, the waiting starts. Healthy or not, it seems like forever before the results are back so you know which direction to take in life. Sonora Quest Laboratories knows this all too well. With 5.9 million patients expected in 2009 in just its commercial unit and 45 million tests conducted annually, that’s a lot of potential anxiety. That’s why in most cases its results are available the next day (regardless of what your doctor may say after making you wait for that phone call). But what if you had to wait? And wait. While that’s not part of Sonora Quest’s plan, it will still have to fight off such a possibility as the only four-year Clinical Laboratory Sciences program supported by state funds is closing. The Arizona Board of Regents in June supported Arizona State University’s recommendation to disestablish its program because enrollment was considered too small to justify the operating expenses. Six students will graduate in December and the last 24 will follow in May. Any visitor to Sonora Quest’s labs would be impressed by the abundance of multimillion-dollar equipment that can quickly handle the workloads that come with a growing population. But it all would come to a grinding halt without one element: knowledgeable staff. While the company can train

workers to operate the equipment, “they still need to understand why the machine works,” says Joyce B. Santis, the company’s chief operating officer. “There’s a great deal of science behind it.” The ASU program is part of a growing trend that finds schools taking drastic measures to deal with tighter budgets. The impact is layered. A Mississippi laboratory program survey concluded 80 to 90 percent of laboratory technologists who train in a state end up working in that state. Without ASU’s program, there would be none of its graduates to retain. Two-year programs offered by community colleges help somewhat but they graduate technicians, not scientists.

Short-sighted Decision “I think that the university’s decision to close the program was short-sighted,” Associate Clinical Professor Lauren Roberts said of the last program in the state accredited by the National Accrediting Agency for Clinical Laboratory Sciences. The agency estimates the vacancy rate in the clinical laboratory sciences profession is 13 percent. The rate is 12 percent in Arizona, Roberts said. Add to that 13 percent of U.S. lab scientists are expected to retire in the next five years and 25 percent during the next 10 years. In Arizona, the program’s closure and workers retiring mean labs will face a tough shortage in as soon as three years, says David

Dexter, Sonora Quest’s president & CEO. “We’re shortchanging the future by cutting the medical technology program,” he says. Dexter’s company is known for providing a great deal of specialty training for it staff so an added pressure is “everyone else in labs and biotechnology wants to have our employees.” To stay ahead of the curve, Sonora Quest has ongoing initiatives. For some openings, applicants who are phlebotomists or have lab training are hired. The 200 managers and supervisors are trained in applicant screening so they “know what to look for in candidates so they can articulate the job,” says Peter Michaelson, the chief people officer. “So there’s no disconnect on what the actual job is.” There is additional investment in the management ranks. “In this industry, you have people who are technically sufficient but maybe they’re not as good a supervisor,” Santis says. To help, the company created a leadership program with 12 modules. While it has given the managers and supervisors the chance to become better performers as leaders, employees also get a glimpse of future leadership opportunities, Michaelson says. This is all part of the company’s concerted effort to keep its employees. Although the turnover rate has dropped to 10.3 percent, “we want to get to single digit,” Michaelson says. Adds Dexter: “You have to be resourceful to face challenges.”

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WRITING BY :: AL AINA G. LEVINE

hen you go to your doctor for a blood test, how certain are you your sample doesn’t get mixed up with someone else’s? How can you be sure you get the right diagnosis or that something doesn’t happen to compromise it? This scenario was the premise of a classic “Seinfeld” episode, but there’s no humor in laboratory mishaps and mistakes. In real life, thanks to Sunquest Information Systems, the potential for laboratory blunders is significantly decreased. Founded in 1979, the privately held Tucson

Since patient safety is a core value, the company created what it calls “The Five Rights of Laboratory Testing.” All its products work in concert to ensure the right medication is given to the right patient in the right dosage via the right route at the right time, says Post. “We push this very hard in the marketplace and it has been very well-received.” In fact, “The Five Rights” were acknowledged as “an important addition to the Patient’s Bill of Rights” and among the industry’s “most important contributions to patient safety” in the July issue of LabMedicine. Sunquest does business with 1,300 U.S. hospitals and commercial laboratories, and more than 160 customers in Canada, the United Kingdom and other parts of western Europe, and the Middle East. Within Arizona, it is used by nine clients, including Tucson Medical Center and Phoenix Children’s Hospital. And of the 25 top-ranked medical schools in the nation, nine are clients, according to Post. + GET CONNECTED www.sunquestinfo.com

THE HEALTH CArE ISSuE

Sunquest Information Systems ensures no mix-up from test to results

‘The Five Rights’

TECHCONNECTMAG.COM

Shining Example

company develops and implements information systems solutions that “enable the day-today operations of a laboratory—both within the four walls and in the value chain of the lab,” says David Post, Sunquest vice president of customer operations and strategic programs. From simple pregnancy tests to more complicated analyses for pathogens, the company’s software and information technology make it possible to track samples from the moment they are taken by the doctor or phlebotomist to the lab where they are tested and back to the physician as the right test results. As blood is removed from a patient, a scanner using Sunquest software prints a barcode that is immediately attached to the sample and serves as the main beacon to track it. Overall lab efficiency is the name of the game, so not only does it produce information technology to track tissue samples, but it also has compatible products relating to billing, customer service and even physician outreach. Sunquest’s technical and business innovations focus on improving four areas: diagnostic workﬂow excellence in laboratories, patient safety, physician and patient affinity, and predictive medicine, which involves genetic testing, notes Post. Overall, it strives “to enable labs to operate as efficiently and profitably as possible,” he says.

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USING THE HEALTH ECONOMY SIMULATOR ARE (FROM LEFT): NICK HOLT, CONSULTANT, BTS; (SITTING) DAVID VEILLETTE, CEO, CANCER TREATMENT CENTERS OF AMERICA AT WESTERN REGIONAL MEDICAL CENTER; (STANDING) MARK EL-TAWIL, PRESIDENT, HUMANA OF ARIZONA; CRAIG HAY, PRESIDENT, INTEGRITY BENEFITS GROUP; SAL RIVERA, CEO, ARIZONA ECONOMIC RESOURCES ORGANIZATION; DR. MARGIE BALDWIN, DEAN, ARIZONA STATE UNIVERSITY SCHOOL OF HEALTH MANAGEMENT AND POLICY IN THE W.P. CAREY SCHOOL OF BUSINESS; JENNIFER WILLIS, PRACTICE LEADER, HUMANA OF ARIZONA.

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Humana’s patient-aid technology investment starts to pay off

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rue, you can’t—not yet, at least—turn on your computer and call the doctor in the morning. But Mark El-Tawil says technology has proven to be quite a shot in the arm, making new strides in and vastly improving the health care system. And, as president of Humana of Arizona and a 15year veteran of the industry, he should know. In fact, he says one of the things that attracted him to his new post at Humana was the company’s significant investment in IT, “both in dollars and in time” several years ago. “We’re not the only company (investing in information technology), but clearly we’re a leading company going back six or seven years,” he says. “Now, the marketplace is seeing the benefits.” El-Tawil is referring to a fairly recent trio of projects, which have either been created or backed by Humana. One of them is a “transparency tool” that’s available to Humana members on the company’s Web site. The goal is to help Humana members make better informed decisions about the doctors, hospitals and care they choose— even where their dollar will go farther while they’re still getting top-notch care. Numerous sources, comparison charts and printable reports all help patients determine what’s best for them.

On The Record Another customer-friendly program that Humana customers may not even be aware of is Availity, named for the fi rm that developed the application. El-Tawil says Availity is essentially a claims processing and capturing tool that can gather all the information from a patient’s “health encounters,” from doctor’s visits to prescription orders. In this way, when a Humana member walks into his doctor’s exam room, medical staff have a full record of the treatments that particular patient has received. “That’s one of the beauties of Availity,” El-Tawil says. “No one has to do anything differently. It takes advantage of all the electronic interchanges already going on.”

Now, the marketplace is seeing the beneﬁts. - Mark El-Tawil, Humana of Arizona’s president

Humana has rolled out Availity in Florida, in partnership with Blue Cross Blue Shield of Florida, and has also debuted the program by itself in several other states, including Wisconsin and Texas. Then, there’s another kind of fun, yet rather serious way that Humana is using technology to better people’s lives and improve health care. The Health Economy Simulator is what it sounds like: a simulation-type exercise that mirrors the country’s health care system and health care economy. It’s structured so that teams play against each other over a (simulated, of course) three-year period. “It shows leaders that any change, anywhere in the system, will have implications and ramifications to the whole system,” El-Tawil says, “and it helps them see in real time how to get the best outcomes.” Although the simulation exercise is not available to Humana customers, local leaders in health care and economic development recently came together at a two-day seminar to give it a whirl. The upshot? A fairly simple thing is needed before the health care system can be healed, El-Tawil adds. “We all need to start working together,” he says. + GET CONNECTED www.humana.com, www.availity.com

UPCOMING COUNCIL

EVENTS 11.03.09 Lunch and Learn: Improving Operational Performance

in Troubled Times, presented by Sustaining Edge Solutions, Inc. 11.04.09 Data Management and Security: Employee Emails –

What Every Employer Should Know 11.11.09 Tax Savings Strategies for 2009 11.17.09 Lunch and Learn: Presented by Clifton Gunderson 11.19.09 Governor’s Celebration of Innovation 12.01.09 Lunch and Learn: Presented by BDO Seidman 12.02.09 Keynote Speaker Series: Michael M. Crow, President,

Arizona State University 12.09.09 Council Connect: Leveraging LinkedIn – A Hands-on

Approach to Getting the Most out of This Powerful Platform 12.15.09 Lunch and Learn: Presented by Symantec Corporation

For more information or to register for a Council event, visit events.aztechcouncil.org

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IRA A. FULTON SCHOOLS OF ENGINEERING

The University of Arizona’s College of Engineering The college reported 444 students earned their bachelor of science degrees in 2008. Those getting their master of science or master of engineering degree totaled 146. The number of doctoral students was 48. There is a restructuring underway at the school. Ultimately, the goal is to have 600 bachelor’s degrees issued annually. While the segment of the student body who are women is already an impressive 19 percent, school officials want it to reach 25 percent.

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Management Information Systems Program at The University of Arizona’s Eller College of Management

BY THE NUMBERS UofA and ASU report totals of their students prepared to join technology workforce

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rizona for some time has dealt with the excuse from technology companies that they would relocate or at least set up branches in the state if they could fi nd the professional-level talent they need. The state’s universities are putting them on notice that the excuse no longer works. Some colleges at The University of Arizona and Arizona State University have shared their graduation levels with TechConnect. If you’re an alumnus of any one of the schools, you likely won’t be surprised. Or will you?

Arizona State University’s Ira A. Fulton Schools of Engineering The collective of schools awarded 718 undergraduate degrees in the 2008-2009 school year. Among the master’s students, there were 547 diplomas issued. For the doctorial students, the graduating class had 125. ASU also surveyed students who graduated in 2008 to check their work experience before they completed their degree requirements. Of all graduate students who earned their degrees, 24 percent reported they had completed an internship or practicum before getting hired by the same employer. Among all undergraduates, 73 percent had completed an internship, co-operative or field experience.

There were 45 students earning their bachelor’s degrees in May 2009. The total of those earning their master’s in December 2008 was 40. The graduating class of PhD students earlier this year totaled three, but it’s worth noting that an increasing demand for the program has pushed the number of students in the program to 41. School officials also reported the proportion of their recent graduates who were placed in jobs despite the tight economy. For bachelor’s recipients, 80 percent had jobs by the time they graduated. For master’s, all had jobs waiting for them. Two-thirds of those with a PhD went into academia.

The University of Arizona’s College of Optical Sciences The college, which was started in 1964, took an overall approach to its numbers. Since 1968, the school has issued 328 degrees for bachelor of science, 959 for master of science and 596 for a PhD. In addition, the school has issued 68 professional certificates. An interesting note is the number of students who stay in Arizona after graduation. In 1999, 15 percent of the graduates remained in the state. Ten years later 35 percent were reported as staying here.

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Boeing turns to Council to help ﬁnd innovation

GOVERNMENT GREEN WRITING BY :: DONNA MASON

ederal, state, and local governments offer an array of lucrative tax incentives for one purpose: to stimulate economic growth. Government incentives have become a widespread means for economic developers to lure businesses to their state. In turn, companies regardless of size have an opportunity to draw from the billions of dollars available annually from government agencies to reduce their operating costs. Arizona offers a low-cost, pro-business environment with its array of targeted business incentives including enterprise, foreign trade, empowerment and military reuse zones; and job training grants. Additionally, there are incentive programs for small business, research and development, motion picture production, and solar energy. Their benefits are immense. They can reduce a company’s capital costs and operating expenses, reduce its federal and state tax liability, and, most importantly, be captured retroactively as well as going forward. For example, Arizona’s Training Grant Program offers a “Net New Hire” incentive for businesses to apply for grants that return up to 75 percent of the costs of training those employees in jobs that meet wage criteria. Additionally, the incumbent worker portion of the

program allows training that upgrades the skills of existing employees with a reimbursement of up to 50 percent of allowable training costs. Another offering that contributes to a company’s bottom line is the Arizona’s Enterprise Zone Program, which was established to improve areas with high poverty or unemployment rates. It offers two types of benefits: income or premium tax credits and property tax reductions. In addition, Arizona businesses can take advantage of the federal Work Opportunity Tax Credit program for employers hiring individuals from one or more targeted groups before September 2011. The tax credit is a percentage of qualifying wages from $2,400 to $9,000, depending on the targeted group and length of employment. Business incentives can be a key component in remaining competitive in a rapidly changing global economy. Companies that fail to properly address this issue will be at a marked disadvantage. Clearly, government incentives will drive the course of our economic climate for many years to come.

Donna Mason of Walton Management Services has 15 years’ experience marketing tax credits and economic incentives nationwide. For more information, contact pernickmara@waltonmanagement.com.

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Enhance your company’s bottom line with variety of incentives

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he Arizona Technology Council has partnered with Boeing to identify innovative mid- to late-stage technology from adjacent industries that can help the company improve its products while creating new opportunities for technology creators in the state. The Council has recently become a member of the Boeing Technology Alliance, an international network of technology referral agents that help screen technology innovations coming out of adjacent and non-traditional markets. In an effort to continually improve its products and services, Boeing is constantly looking for external technologies that meet its growing needs while allowing it to remain competitive in the aerospace industry. Because of the challenges related to tracking technology developments around the globe, Boeing interacts with the alliance to help screen and identify those developments. While there are no guarantees Boeing will act on any lead, the company is reaching out to the Council to make recommendations. The Council will help fill Boeing’s technology needs by soliciting and evaluating referrals that are not already being marketed for aircraft or military products. The Council will be briefed regularly on information regarding high-priority technology needs from across Boeing business units. These technology needs are in areas such as materials, thermal management, electrical power, manufacturing, and systems. Anyone who knows an individual or company that can potentially help meet Boeing’s technical challenges can contact the Council for additional details.

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DR. DANIEL VON HOFF

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‘Dream team’ appointment, conﬁrmation of ﬁndings put TGen doctor on the road to breakthroughs

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WRITING BY :: STEVE YOZWIAK

r. Daniel Von Hoff, physicianin-chief of the Translational Genomics Research Institute (TGen), is a world-renowned physician-scientist whose pioneering research in pancreatic cancer has resulted in significant improvements in patient care. Von Hoff has been a guiding light at TGen since 2003, just a year after TGen began its cutting-edge genomic research— discovering genes within our 3 billion-base DNA that either cause or prevent cancer and other debilitating diseases. TGen’s pursuit of personalized medicine enables physicians to use laboratory discoveries to design targeted, individualized therapies for patients. Von Hoff’s efforts to advance new treatment agents based on high-quality clinical research has significantly advanced the field of medical oncology and highlighted the

value of translational cancer research, allowing patients access to new drugs, and speeding up the process of drug development. He also is chief scientific officer of TGen Clinical Research Services (TCRS) at Scottsdale Healthcare, which is a primary clinical drug trials site for TGen. Through

TCRS is conducting nearly 30 ongoing studies involving the treatment of patients with advanced cancer. The alliance works to identify new anti-cancer agents, and strives to bring diagnostic and treatment options to patients as fast as possible. Because of his stellar reputation, leadership abilities and devotion to helping patients, Von Hoff and TGen were joined in May by the University of Pennsylvania (Penn) in receiving an $18 million grant to research pancreatic cancer from Stand Up to Cancer (SU2C). Von Hoff and Dr. Craig B. Thompson, director of the Abramson Cancer Center at Penn, are co-leaders of the SU2C pancreatic cancer “dream team.” It will conduct a three-year investigation into new approaches to treat pancreatic cancer, which is the fourth leading cause of cancer death in the United States. “We want to do something dramatic. It is going to take a tremendous amount of real thinking power to make that difference, so it is a dream come true to be able to put this team together to work towards this goal,” Von Hoff says. The $18 million to TGen and Penn was the largest single grant among five awards totaling $74 million announced by SU2C, a philanthropic group created last year by cancer scientists and members of the entertainment industry to quickly turn scientific discoveries into ways to care for cancer patients. The goal of the pancreatic cancer dream team research project “Cutting Off the Fuel Supply” is to develop tests, using advanced imaging techniques, to determine what nutrients pancreatic cancer cells require to fuel their growth and survival. Understanding the cell’s fuel supply will help scientists develop more individualized treatments with fewer side effects. TGen and its clinical partners at TCRS will launch a series of innovative clinical drug trials for patients with advanced pancreatic cancer. These clinical trials will be designed

It is a dream come true to be able to put this team together to work towards this goal. - Dr. Daniel Von Hoff, on the potential treatment of pancreatic cancer the partnership between TGen and Scottsdale Healthcare, Von Hoff leads a 40-member staff at TCRS in the research and treatment of cancer.

to deprive pancreatic tumors of crucial nutrients, thereby cutting off the fuel supply. TCRS will be the primary clinical research site for the SU2C grant. It is located at

InnerView the Virginia G. Piper Cancer Center at Scottsdale Healthcare Shea Medical Center in Scottsdale. Other clinical sites in the SU2C study are at Penn in Philadelphia and at Johns Hopkins University in Baltimore. Earlier this year, Von Hoff was at the forefront of progress in another groundbreaking cancer study. In April, he was invited to be one of the key speakers at the plenary session of the 100th annual meeting of the American Association for Cancer Research. At the meeting in Denver, he explained the results of an 18-month study, which showed that some cancer patients can experience longer periods when their tumors do not progress after they received treatments based on their individual genetic profi les. Significantly, the study showed that molecular profiling of patients can identify specific treatments for individuals, helping keep their cancer in check for significantly longer periods, and in some cases even shrinking tumors. “This clinical trial was unique because patients acted as their own control,” Von Hoff says. “We compared each patient’s progression-free periods, following treatment based on molecular profi ling, to how their tumors progressed under their prior treatment

regimens, before molecular profi ling.” Last November, Von Hoff was named Arizona’s Community Service Leader of the Year at the 2008 Governor’s Celebration of Innovation, presented annually for contributions to Arizona’s technology industry through relentless community involvement, leadership, visibility and excellence in economic development activity. For more than 30 years, Von Hoff has dedicated his time and experience to the study of cancer and treatment methods. Among his significant activities: + International leadership in bringing to patients new anti-cancer agents, many of which have been shown to increase patient survival. + Study of pancreatic and other forms of cancer. + Dedication to teaching. + Entrepreneurial research efforts, which have led to 12 patents.

Steve Yozwiak is the senior science writer for TGen.

+ GET CONNECTED www.tgen.org

Pedal to the metal

About TGen The Translational Genomics Research Institute (TGen) is a Phoenix, Ariz.-based non-profit organization dedicated to conducting groundbreaking research with life-changing results. Research at TGen is focused on helping patients with diseases such as cancer, neurological disorders and diabetes. TGen is on the cutting edge of translational research where investigators are able to unravel the genetic components of common and complex diseases. Working with collaborators in the scientific and medical communities, TGen believes it can make a substantial contribution to the efficiency and effectiveness of the translational process. TGen is affiliated with the Van Andel Research Institute in Grand Rapids, Mich.

BIO | VON HOFF Von hoff earned his medical degree from Columbia College of Physicians and Surgeons. He held an internship and residency at the University of California, San Francisco; conducted four years of cancer research at the National Cancer Institute; and was a faculty member at the University of Texas. In Arizona, he has worked as director of the Arizona Cancer Center in Tucson, and he remains a clinical professor at the University of Arizona College of Medicine. He also holds a presidential appointment to the National Cancer Advisory Board, is widely published and has been a keynote speaker at numerous national and international medical and scientific conferences.

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great debate WRITING BY :: JESSICA FRANKEN AND AMY COTTON

Electronic medical records are integral (if now quiet) elements of health care dialogue

Arizona’s Health-e Connection Starting with an executive order from then-Governor Napolitano, the non-profit Arizona Health-e Connection was created in 2007 to provide strategic leadership to the state’s health care sector. A major goal:

to connect every doctor’s office, hospital and health care facility in the state into a seamless electronic network to exchange medical records. Early in 2008, Google unveiled a health initiative that would work with physicians’ groups, hospitals and pharmacies to provide a free outlet to enable patients to gain control of and store their medical records. (Note: If Google has become this serious about e-records, we probably should, too). Last November, Arizona was one of two states selected by the Centers for Medicare and Medicaid Services for a program that encourages seniors to store their medical histories with one of four Internet providers including Google. So far, the response has been slow but growing.

the health care issue

part of the health care industry. Should we even care about e-records? If so, when should we go electronic: now or later? What will it cost? What impact will it have? Based on ongoing efforts initiated and funded by the state of Arizona as well as recent federal rules expanding the number of entities now subject to federal privacy and security regulations, we believe it is time for you to get ready and to identify your specific needs and the resources available to you.

TECHCONNECTmag.COM

hinking the 2009 national health care debate will never end? You have lots of company. Interestingly, the political squabbling has pushed a major element into relative hiding yet it is one that will soon impact Arizona businesses. Technology may have carried us into the New Millennium but, ironically, that’s what is now on the back burner— specifically, the advances in the use of electronic medical records and the Internet that eventually will impact everyone. Change is coming for patients, doctors, pharmacies, hospitals, insurers and the workplace. As an Arizona tech company owner or HR executive, you may be asking: We’re not

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Nationally, the White House recently announced a rollout of the fi rst two in a series of Health Information Technology Extension Program (HITECH) priority grant programs designed to help states and qualified state entities develop policies, procedures and network systems to assist e-health information exchange within and across states. The envisioned results of these efforts are cost savings, reduction in medical errors, higher-quality patient care and increased communication between patient and provider. Officials estimate an Arizona e-network could save up to $2.6 million in health costs annually.

Yes…But There Are Issues The benefits from e-records should be significant but the road there will have some speed bumps not only for medical and biotech companies within the health care sector but for other technology firms simply wanting to set up an employee health plan. The core issue is finding a solution that will integrate today’s technology advances into a web of confusing, and often inconsistent, federal and state regulations, many of which were enacted long before the Internet age. For example, each state has its own patient privacy laws, not all of which conform to federal HIPAA (Health Insurance Portability and Accountability Act) standards. Today, no two states treat e-records the same. In addition, a variety of financial, technical, intellectual property and ethical issues need to be addressed including the high start-up costs for doctors’ groups, uncertainty over how one company’s software interfaces another company’s software into the overall system, ensuring patient privacy, disclosure requirements when sending

e-records to outside entities, and federal anti-kickback rules. There are some practical issues that need to be considered. For example, if a patient enters medical data into an e-record, who – the patient, doctor, hospital, ER – is responsible for updates? Is anyone liable when prescriptions that have been cancelled or modified continue to be refi lled because the original Rx refi ll information stays in a pharmacy’s automated system? What constitutes proper encryption? What is to prevent a third-party vendor such as Google from making unauthorized use of its e-records? And these issues are the tip of the iceberg.

Going Forward—Be Proactive The health care focus eventually will return to electronic records and the IP/Technology issues surrounding them will begin to get addressed. What should you be doing in the interim? We recommend a proactive approach; planning now will reduce the risk of being left behind when the next “e-push” begins. Non-health care sector companies may have more time to get ready but there is an overriding incentive for all tech companies to move forward now: the ability to dramatically lower health costs and make your operations more efficient. So, this is a good time to identify your specific needs and technology resources and to create your own e-records plan that will properly meet your technology licensing and support needs and satisfy applicable federal and state health care regulations. Coming up with that plan, including researching new e-record technology systems, is easier said than done. We suggest not trying to do everything on your own but looking to help from consultants or law firms with expertise in both IP, licensing and health care—to help you develop your plan. One way or another, electronic medical records are going to impact your company. You might as well get ready now. Jessica Franken is Phoenix Office Chair of the Quarles & Brady law firm’s Intellectual Property Practice and can be reached at jessica.franken@ quarles.com. Amy Cotton is a member of the firm’s Phoenix Health Law Practice and can be reached at amy.cotton@quarles.com.

Beat the Clock STAKEHOLDERS HAVE WORK CUT OUT TO GET ARIZONA’S HEALTH INFORMATION EXCHANGE READY WRITING BY :: DON RODRIGUEZ

Robert Dowd, CIO of Tempebased Sonora Quest Laboratories, has seen it happen before. He remembers when automatic teller machines were first rolled out and their first users were apprehensive about giving up any personal information. Decades later the advent of personal health records has people squirming again because “they don’t want the possibility their health records will be shared with insurers or employers” who could deny coverage or eliminate jobs of those workers whose healthcare needs are considered costly, Dowd says. This is the challenge for Arizona Health-e Connection (AzHeC), a nonprofit privatepublic partnership created to guide the state’s creation of a health information exchange and adoption of health information technology. Dowd heads its technical committee whose charge is to develop a standard for technical records. A sign of what still lies ahead already has been witnessed with one critical user group: seniors. A pilot launched in January allows Medicare Parts A and B beneficiaries’ data to be transferred to their own personal health record made available from several providers, including Google. While the exact number of participants has not been released, the regional administrator for the federal agency with oversight of government insurance programs that cover seniors told one publication, “We’d like to see more involvement.” But there’s a lot more at stake than just seeing seniors become more tech-savvy. The pilot is part of efforts to get more users for a health information exchange. In turn, the Health Information Technology for Economic and Clinical Health (HITECH) Act will make federal funds available directly to healthcare providers who participate in exchanges or to provide services or infrastructure for such providers as small primary-care practices or facilities in rural or underserved areas. To get the money, the state must have an exchange operating by 2011, Dowd says.

A piece of the system is in place. Arizona’s first functional exchange called the Arizona Medical Information Exchange already has worked to provide Medicaid providers instant access to patients’ health information at the point of care.

Catching up

Although Arizona is in the Top 5 of states preparing to qualify for the funds, there is still much to do. A New England Journal of Medicine study in 2008 revealed only 4 percent of U.S. doctors have a comprehensive digital records system and 13 percent have a basic system. “But it doesn’t mean they’re using the full function” says David Dexter, Sonora Quest’s president & CEO, who is on AzHeC’s executive committee and is the clinical laboratory representative on its board. For example, only 3 percent of physicians use the ePrescribe application to order prescriptions, he says. There are efforts underway to keep the momentum going. In April, AzHeC will partner with the Arizona Chapter of the Healthcare Information and Management Systems Society and Arizona Health Information Management Association to host the Western States Healthe Connection Summit & Trade Show at the Phoenix Convention Center. Previously known as AzHeC’s Annual Summit, the event is expected to draw health information technology and health information exchange stakeholders together to share developments. At the grassroots level, doctors and their patients also will be busy. Dowd forecasts a 400 percent increase in electronic medical records in 2010. Still, there is “fear by doctors of connecting, especially if sure he is going to retire,” he notes. Also, there are questions over what to do with existing records while switching to electronic systems as well as the “feeding frenzy” by vendors who may excel at marketing but be weaker at systems deployment, especially in practices with multiple physicians, Dexter says. Still, “Everyone is expected to move forward in good faith,” he says.

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TGen Speed-dials H1N1 Flu Data Research nonproﬁt’s Flagstaff lab ﬁnds new way to ID virus in record time WRITING BY :: KATE NOLAN

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most advanced disease testing methods, among other genomics related work. Earlier this year TGen’s Pathogen Genomics Division (TGen North) in Flagstaff began testing specimens from suspected cases of the new H1N1 virus after Arizona health authorities identified the state’s first case. TGen scientists used a recent technology called “Real Time PCR,” or polymerase chain reaction, a technique that rapidly replicates copies of a DNA sequence. Researchers were soon able to conclude that the new virus was not resistant to Tamiflu, a flu treatment for at risk individuals. The brand name for Oseltamivir, Tamiflu is a widely used antiviral that impedes the virus’s spread from cell to cell.

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he doctor in charge of protecting Phoenix Children’s Hospital’s at-risk patients from the novel H1N1 (or swine flu) virus believes last year’s flu defenses will work again this year, if used vigilantly. “All current indications are that routine application of the same measures is successful in containing H1N1 influenza,” said Dr. Scott Ostdiek, Phoenix Children’s medical director, whose thoughts parallel those of other area hospital physicians. Ostdiek’s patients are definitely more at risk than other demographic groups for the so-called swine-flu virus, officially called the “novel H1N1 2009 influenza A virus.” In September, 70 percent of the new cases of H1N1 reported in Arizona were children, according to the Arizona Department of Health Services. So parents may justifiably wonder: How can doctors be so sure that standard preventive and treatment measures will work with the new flu strain? At least part of the answer comes from new tests developed by a branch of the Translational Genomics Research Institute, a Phoenix-based nonprofit research organization that is developing some of the world’s

All current indications are that routine application of the same measures is successful in containing H1N1 inﬂuenza - Dr. Scott Ostdiek, Phoenix Children’s Hospital’s medical director

Testing In Real Time During the initial spring 2009 outbreak in Arizona, TGen developed the new rapid test while using viral samples submitted by the state. The new assay produces results within a few hours rather than days or weeks, generates vast data about the virus and may revolutionize viral detection. Known as the “anti-viral resistance detection assay,” it can identify a virus and discern whether it is Tamiﬂu-resistant and more. An assay is an analysis done to determine the presence, amount or characteristics of a particular substance. The state had been sending H1N1 specimens to the U.S. Centers for Disease Control and Prevention for subtyping. “The turnaround time for results reporting was increasing as the outbreak developed and spread across the U.S.,” said Victor Waddell, the state Department of Health Services’ laboratory director. “We were able to submit samples to TGen North so we could get results back more rapidly for surveillance,” he said, noting TGen’s ability to report rapidly on antiviral resistance. The new assay is up for “emergency” approval by the U.S. Food and Drug Administration that could possibly allow TGen to license it for use in other states during this year’s ﬂu season.

Tamiflu Works But … TGen North, which has been performing the H1N1 assays for the state health department without a fee, discovered early on that the virus had begun to produce mutations. Since May, TGen’s work has concentrated on testing whether those mutations are resistant to Tamiflu. Because all samples tested so far have proven nonresistant to Tamiflu, medical experts are optimistic they can rely on the drug to control the virus among at-risk patients as they have in most years since 2000. One bugaboo lurks on the horizon: a variant of the normal seasonal flu has produced a mutation that is antiviral resistant, although it has not yet been reported in significant numbers. “We’ve been working on influenza the last couple of years, developing new tools and assays because influenza is one of the greatest public health threats. And we’ve used real time PCR technology before, helping public health authorities study other disease outbreaks, such as Valley fever,” said David Engelthaler, director of programs and operations for TGen North. With 30,000 to 40,000 fatalities a year, influenza is the most deadly infectious disease in the United States. The roots of TGen’s new detection approach originated in recent biodefense techniques, rather than public health sources. “A lot of money went into developing accurate tests for anthrax and other toxins,” said Engelthaler, the former state epidemiologist and Arizona biodefense coordinator who had researched plague and other highly infectious diseases while a biologist at the Centers for Disease Control and Prevention. The biodefense detection technology works off of a molecular platform, examining toxins at the cellular or genomic level.

tests, but none has established a similar type of assay for virus typing, according to Engelthaler. So far, the results for identifying viruses have been 100 percent accurate, according to a TGen source.

Double Duty The molecular disease detection model may also help produce better tools for handling diseases. A by-product of duplicating DNA chunks by the millions is an abundance of data, which scientists speculate may help them create better anti-viral drugs. TGen North is already working with a small pharmaceutical company on developing ways to track and prevent anti-viral drug resistance. That way, anti-viral drugs wouldn’t become obsolete as viruses mutated. TGen researchers hope to use similar techniques to defeat some of the top biothreat agents, including anthrax and Ebola virus, hospital-related MRSA infections and community-acquired bacterial diseases such as streptococcus pneumonia and plague. But because inﬂuenza is such a big public health and clinical challenge, said Engelthaler, continuing advances there may have the largest impact. If the new viral assay wins approval by the FDA, it could soon be in use at the clinical level in any doctor’s office.

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SWINE INFLUENZA A ARE GROWN IN CELL CULTURES FOR FURTHER ANALYSIS.

In many medical clinics, the technology for detecting diseases, even recently, comes right out of the 1950s: a swab collects a specimen that is smeared on a slide and then the technician waits, sometimes weeks, for the thing to grow and provide a fairly limited scope of information on the attacking virus. But with PCR, which is also used by the state health lab, researchers can generate millions of copies of a DNA sequences from a viral specimen. The advantage of the increased mass of genetic material is that it becomes much easier to see whether a gene or mutation is present. The “real time” designation refers to techniques that speed the process. With real time PCR technology, TGen researchers found unique ways to tease out information, including the identity of a viral strain, its quantity in the sample and whether it was resistant to anti-viral treatments. Fluorescence and lasers make it possible to “read” specific molecular structures that are disease markers. But in order to identify a marker, an assay for that disease or mutation must first be created. “Until you get more information about the virus, you can’t build an assay around it. There is a little science and a little art to it,” said Engelthaler. “You have to make it very sensitive and very specific,” he said. Many different entities are working on

LABELING OF THE TRANSPORT TUBES IS CRITICAL.

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A New Level

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The Doctor Is In Rivalries set aside as UofA and ASU play on same team at biomedical campus W RITING BY :: A L BR AVO

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026 he future of health care delivery in Arizona seems to center on the Phoenix Biomedical Campus. In 2004, the Arizona Board of Regents approved a historic agreement to expand The University of Arizona medical school to Phoenix, in partnership with Arizona State University. In short order, the universities, with extraordinary cooperation from the city of Phoenix and the state of Arizona, developed a full, fouryear program in Phoenix. The first class of medical students began studies in 2007, ushering in a new era of growth, discovery and possibility for Arizona. But thatâ&#x20AC;&#x2122;s not all. The cooperation extended to include the College of Pharmacy, the nearby ASU College of Nursing and Health Innovation, and healthrelated programs from Northern Arizona University. Plans were put in place to expand the campus beyond the three historic

buildings and research facility already renovated at the corner of Seventh and Van Buren streets in downtown Phoenix to bring those areas onto campus. Its neighbor, the Translational Genomics Research Institute, has been making groundbreaking discoveries for several years now. The medical education effort hit its stride in the last year, setting a standard with a third class of students and poised to grow with the planned expansion of facilities. The initial expansion of class size was achieved with assistance from ASU, which provided classroom space for the students. It was just one of many relationships developed over the last year that show the impact of the College of Medicine-Phoenix in the community. The college drew hundreds of people to its special lectures, events and classes and reached out in many ways to inform and engage the community surrounding our campus. That outreach was developed

through one-on-one meetings with community leaders; through special events organized by community relations and external relations; and in public relations, garnering media attention in traditional and electronic avenues to tell our story. The college is holding several events, including a regular Breakfast Series lecture/discussion, CafĂŠ Science discussion; Buffmire Lecture and Mini-Medical School. Those events drew hundreds of citizens to the campus and nearby venues to learn about the medical school and some of the issues tackled by students in their studies.

Community Outreach Further, the Office of Outreach and Multicultural Affairs has used its programs to further relay the story of the downtown Phoenix campus. The office continues to hold its successful Med-Start program in Phoenix and Tucson, exposing high school juniors to the health field and the resources available

A CLASS OF MEDICAL STUDENTS AT THE PHOENIX CAMPUS.

Home For research In addition to the medical education space, the Arizona Biomedical Collaborative building was built to house the basic scientists educating medical students as well as ASU researchers in biomedical informatics. A third class of first-year students on the Phoenix campus—numbering 48—has

opportunity to create a biomedical campus for the 21st century in the nation’s fi fthlargest city with the collaborative spirit fostered among universities, clinical faculty, hospitals, business leaders and government. Challenges include the changing face of health-care delivery, the need for interprofessional education and patient care, meteoric advances in biomedical science, the aging of our population and the scourge of obesity, AIDS, diabetes, and other critical health issues in our society. Biomedical informatics, the marriage of medicine and technology, will serve as a key element for advancement. The College of Medicine-Phoenix is ideally positioned to address these challenges, drawing on more than 40 years of experience and guidance of its established and accomplished sister campus in Tucson. Al Bravo is associate director for public affairs at The University of Arizona. + GET CONNECTED www.medicine.arizona.edu/phoenix

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begun and represents the current capacity of the campus. Plans are in place to admit 120 students per class with additional facilities. Students are prepared for lifelong learning and critical thinking skills by undertaking independent scholarly projects and are exposed to four thematic areas in the medical curriculum: behavioral science; biomedical informatics; medicine and society; and public health, population medicine, policy and prevention. Add pharmacy, public health and other health-related students to the mix and that number reaches into the thousands on the campus. Funding for such expansion was approved by the governor and state Legislature in 2008 and restructured in 2009 and calls for a Health Sciences Education Building and a second research facility. The education building will provide space for the medical and nursing schools as well as the College of Pharmacy and the College of Health and Human Services from NAU. The building are slated to be completed in 20XX. In this challenging environment, the leaders of Arizona have the enviable

STUDENTS PERFORM A TEST IN A LAB.

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to be successful in the industry. Further, the office holds programs to help applicants in the process of getting into medical school and has begun to make connections with more schools to bring more information on the health field to all citizens. The Arizona Telemedicine Program has reached out to youth as well, with the Junior Osler program in its second year of bringing medical school curriculum to high school students in research to see if younger students could complete physician training earlier. The Telemedicine program is using amazing technology to change the face of health care delivery and education in Arizona. Even the medical students themselves reach the community. A group of students now staff a clinic in an underserved area near downtown Phoenix, seeing patients— with an attending physician—two nights a week when the clinic normally would be closed. Students even traveled to Mexico during spring break last year—to help perform physicals on children at an orphanage. In historic buildings owned by the city, the College of Medicine-Phoenix has drawn nationally renowned faculty; developed innovative curriculum and expansion plans; incorporated the emerging field of biomedical informatics into the curriculum; and received a $5 million gift from the Virginia G. Piper Trust, among other achievements. This follows more than 15 years of clinical education at Phoenix-area hospitals for third- and fourth-year UA medical students. Along the way, the number of affi liated clinical faculty has grown from 250 in 1992 to more than 600 in 2009.

FROM LEFT, THE RESEARCH TEAM OF DRS. TOM BEACH, ALEX ROHER, DOUGLAS WALKER AND LIH-FEN LUE

Slower Goodbye Team’s research could lead to Alzheimer’s prevention

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ith seniors being an important segment of Arizona’s population and economy, it’s fitting that Science Foundation Arizona awarded $680,000 to a group of researchers who are investigating the relationship between atherosclerosis (commonly referred to as “hardening of the arteries”) and Alzheimer’s disease. The group headed by Dr. Tom Beach includes Drs. Alex Roher, Douglas Walker and Lih-Fen Lue, all at Sun Health Research Institute in Sun City. This critical investment is focused on giving the team much-needed support for their bid to secure a five-year National Institutes of Health Program Project grant. The research involves the more than 800 Arizona seniors who have volunteered for the Institute’s Brain and Body Donation Program and agree to the imaging of their hearts and arteries and tests of their mental abilities. Autopsies done on deceased donors will reveal the circulatory system in even more explicit detail. The goal of the work is to discover new preventative or curative therapies. Earlier research indicates that Alzheimer’s patients have more atherosclerosis of their brain arteries. As atherosclerosis causes plugging of blood vessels, it is obvious that

this cannot be good for seniors’ thinking abilities. Beyond this simple plugging effect it also appears that atherosclerosis accelerates the Alzheimer’s process at a molecular level. Roher’s work uses ultrasound to examine the hearts of living seniors with and without Alzheimer’s. Atherosclerosis damages the heart, affecting its ability to supply blood to the brain. The connection between Alzheimer’s and atherosclerosis suggests that drugs now used to lower cholesterol and blood pressure may also help prevent Alzheimer’s disease. If treatment could be extended to all those who should receive it, heart disease, stroke and Alzheimer’s might be prevented in many more seniors. Walker and Lue take living brain blood vessel cells from donor’s brains after death and recreate functional blood vessels in a culture dish. Their work has thus far shown that Alzheimer’s blood vessel cells lack the ability to regenerate in response to injury or remodel in response to metabolic demands, and that the interface between blood and brain, so important to maintaining normal brain function, may be impaired in Alzheimer’s patients due to inﬂammation. Beach is further using a rabbit model of atherosclerosis, in which rabbits are fed a high cholesterol diet, to test his

Earlier research indicates that Alzheimer’s patients have more atherosclerosis of their brain arteries. As atherosclerosis causes plugging of blood vessels, it is obvious that this cannot be good for seniors’ thinking abilities. hypothesis that atherosclerosis results in brain accumulation of a toxic molecule called amyloid beta. Brain deposition of this molecule as “senile plaques” is widely considered to be the ultimate cause of Alzheimer’s, but nobody really knows why it accumulates. As the brain normally gets rid of amyloid beta by dumping it into the bloodstream, it is possible that blood vessels adversely affected by atherosclerosis may be obstructing this. Clearly this research in partnership with Science Foundation Arizona is important to discovering breakthroughs for Alzheimer’s and ways in which our golden years can indeed stay golden.

BRAIN ARTERIES FROM ALZHEIMER’S PATIENTS (BOTTOM) SHOW MORE PLUGGING FROM ATHEROSCLEROSIS THAN THOSE OF NORMAL OLDER PEOPLE (TOP).

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Program developed at ASU helps stroke and other patients with their physical therapy.

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movement performance, as well as direction eople who suffer strokes, or to improve it. They engage with audiovisual other debilitating diseases scenes, enabling them to practice physical or injuries, must undergo movements to speed their recovery. extensive physical therapy Here is how it works: Patients are posito relearn use of their limbs. tioned in front of a video screen and a set of To help them with their physical therapy, researchers in the Arts, Media and Engineer- sound speakers. Sensory equipment tracks their movements ing (AME) program at in real time and Arizona State Univerconnects them to sity have used cuttinginteractive imedge research to ages and sounds. For develop a computerized instance, patients Mixed Reality Rehabililearn to move their tation system. arms efficiently to After four years of make puzzle-like academic research images converge and implementation on the screen. The in a laboratory setting, image convergence AME installed a scaled is accompanied by version of the Mixed interactive music Reality Rehabilitation that helps patients system at the Rhodes improve the timing Rehabilitation Institute at Banner Baywood - AME Director Thanassis Rikakis of their movement. The system’s digital Medical Center’s Mesa and physical aspects facility. This past April, are algorithmically adapted to each patient’s the Banner Baywood-AME partnership needs and progress. started an ongoing program allowing 30 The system was developed to complement stroke patients to take part in a study using the work of physical therapists, and to the system. enhance therapy in the clinical setting, as Using the rehabilitation system, patients well as to allow continuous rehabilitation receive immediate feedback on their

Our system encourages patients to be actively involved in their rehabilitation in the clinical setting and the home and helps them in everyday life.

A MIXED REALITY REHABILITATION SYSTEM ASSISTS A STROKE PATIENT WITH PHYSICAL THERAPY.

{ UPDATE::ASU }

training at home. The goal is to get the Mixed Reality Rehabilitation system into an adaptable, portable low-cost platform that patients can use in their homes. Some of the Banner Baywood patients involved in the study will have the opportunity to take home a prototype home-training system, which is still in development. The home system is expected to be ready early next year, and plans are for patients to have them as soon as March. This will give the patients freedom to continue their daily rehabilitation training on their own, between sessions with trained medical professionals. Trained professionals also will be able to remotely monitor a patient’s progress. The home-training system will be a boon to patients who don’t have easy access or transportation to rehabilitation facilities at hospitals, clinics and medical centers. “Our system encourages patients to be actively involved in their rehabilitation in the clinical setting and the home and helps them in everyday life,” says Thanassis Rikakis, AME director. “The collaboration among researchers puts the project at the leading edge of today’s trend of employing virtualreality technology in medical rehabilitation.” The Mixed Reality Rehabilitation system was developed by AME researchers across several academic disciplines, including bioengineering, computer science and engineering, electrical engineering, media arts, music and psychology. Joe Kullman is a media relations officer at ASU’s Ira A. Fulton Schools of Engineering.

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UNIVERSITY PHYSICIANS HEALTHCARE’S CARDIAC CATHETERIZATION LAB

{ UPDATE::UOFA } sk Dr. William Crist about what’s happening at the Arizona Health Sciences Center at The University of Arizona, and his passion for both medicine and education shines through. Crist is vice president for health affairs at the UofA. A pediatric hematologist, he has been at the helm of the university’s health care enterprise for seven months. He most recently served as dean of the University of Missouri School of Medicine. “Our goal is to educate the workforce across all health disciplines: medicine, pharmacy, nursing and public health,” he says. “At the same time, we do biomedical research that is developing treatments for people with diseases that are inadequately understood.” That dual goal provides a robust framework for the diverse activities that take place each day on the campuses of the Arizona Health Sciences Center. The center is a thriving academic enterprise encompassing a growing network of health-related organizations and activities. Its components include four colleges and numerous centers affi liated with them, three hospitals, a physicians’ group, and the statewide Arizona Cancer Center (see sidebar). One special component of sciences center’s activities is southern Arizona’s newest aca-

demic medical facility, University Physicians Hospital. The university assumed responsibility for the 197-bed facility, formerly known as Kino Community Hospital, in June 2004 under an agreement with Pima County. “One of the remarkable aspects of the Kino campus is that half the patient population is there to receive psychiatric care,” says Crist. “That’s rare—and it meets a critical need for behavioral health services in southern Arizona.”

Other industries may come and go, but you’ll always need medicine - Dr. William Crist The hospital also is working toward addressing another vital need: development of southern Arizona’s first comprehensive diabetes care center. “Diabetes is especially prevalent in the Hispanic and Native American populations,” Crist says, “and it’s epidemic in Arizona. It’s a lifelong illness that requires a great deal of patient care and management to

avoid vascular problems leading to ulcers, amputations and other issues.” To enhance diabetes care, the university recently added Dr. Horatio Rilo to its faculty. Rilo is a pioneer in pancreatic islet cell transplantation. Transplanted pancreatic islet cells produce insulin, helping diabetic patients to regulate blood glucose levels. The Kino campus also is home to a stateof-the-art cardiac catheterization laboratory to diagnose and treat heart disease, and southern Arizona’s only da Vinci® robotic surgical system, which allows minimally invasive surgery for delicate procedures such as radical prostatectomies and hysterectomies. The Kino campus joins the ﬂagship of the sciences center’s patient-care activities, University Medical Center (UMC), which has served the region since 1971. Among its many distinctions, UMC houses southern Arizona’s only Level 1 trauma center. An expansion completed this past June is expected to greatly enhance the care UofA provides each year for more than 5,000 trauma patients and 55,000 emergency patients. UMC also has garnered national and international attention for its groundbreaking work in the areas of heart disease (including Arizona’s first heart transplant), cancer research and treatment, respiratory disorders and pediatric care, among other disciplines.

COURTESY ARIZONA HEALTH SCIENCES CENTER

Research and education are the dual goals of UofA’s Arizona Health Sciences Center

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Bruce Wright is associate vice president for University Research Parks at the University of Arizona.

UofA Health Care at a Glance THE ARIZONA HEALTH SCIENCES CENTER INCLUDES: UNIVERSITY OF ARIZONA COLLEGES College of Medicine – Tucson College of Medicine – Phoenix in partnership with Arizona State University College of Nursing College of Pharmacy Mel and Enid Zuckerman College of Public Health

Excellence UofA College of Pharmacy: Arizona Poison and Drug Information Center Center for Health Outcomes and PharmacoEconomic Research Center for Toxicology Medication Management Center UofA Zuckerman College of Public Health: CENTERS Canyon Ranch Center for Prevention and Health Arizona Cancer Center Promotion Centers associated with the colleges Arizona Center for Public Uof A College of Medicine: Health Preparedness Center for Health Equality Arizona Arthritis Center – Project EXPORT Arizona Center on Aging Arizona Center for HOSPITALS Integrative Medicine University Medical Center Arizona Emergency Medicine Research Center University Physicians Arizona Hispanic Center of Hospital Excellence Carl T. Hayden VA Medical Arizona Respiratory Center Center Steele Children’s Research Center PHYSICIANS’ GROUP UofA Sarver Heart Center University Physicians Valley Fever Center for Healthcare

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This collaborative approach “amounts to a real culture change in medicine,” he says. “It’s a shift that’s better for the patient, because it facilitates a real team approach. The doctor may lead the team, but the patient is at the center.” The University of Arizona Tucson medical campus trains 115 first-year students, while the Phoenix campus trains an additional 48. The Phoenix program is expected to grow to accommodate 120 first-year students. In addition to addressing the state’s shortage of doctors, Crist believes the UofA health-care enterprise helps the state in a number of important ways, including being a significant economic development engine. “Other industries may come and go,” he says, “but you’ll always need medicine. In addition to alleviating human suffering, we’re seeing the increase in innovation and discovery and the creation of spin-off companies – which will create an economic impact of multiple billions of dollars for the state. It will be a new day for Arizona when that happens.”

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“We’re particularly excited about the creation of the Diamond Children’s Medical Center,” Crist notes. “We already have a top-ranked pediatric department, but this center will help us serve children in a more family-friendly atmosphere. It will have a separate ER, designed especially for children, as well as private rooms to help children and families feel safe while they receive the care they need.” The center is scheduled to open next year. Arizona Health Sciences Center is reaching beyond its Tucson roots with another important endeavor – development of the state’s second medical school campus. The University of Arizona College of Medicine – Phoenix, in partnership with Arizona State University, is located on the downtown Phoenix Biomedical Campus. The college of medicine, which opened with its first class of medical students in 2007, offers a full, four-year program. Its inaugural class of 24 students began its clinical experience this summer. “One of the exciting aspects of the Phoenix campus is its multidisciplinary approach,” Crist says. “Our plan is to train doctors, qbi + E ^ i c % E & + F p p r b 0 � _ + m a c � � � 6 nurses and pharmacists together as much as possible, so they have an understanding of, and respect for, what each discipline does.”

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he prescription for curing the nation’s ailing health-care system is to take reform one step at a time, says a health policy expert at Northern Arizona University. Paul Dutton believes successful reforms will take years to implement, “but the politics of the matter aren’t permitting a parsing of reforms into sequential steps.” Dutton is a professor of history and executive director of the university’s Interdisciplinary Health Policy Institute. He is working to educate the public about health-care issues so informed decisions-and progress--can be made. “I believe that U.S. competitiveness in world markets and our standard of living will suffer irreparably if we don’t meet the health-care challenge, and quickly,” Dutton says. “We can’t afford another 15 years of dithering.” Author of the recent book, Differential Diagnoses, A Comparative History of Health Care Problems and Solutions in the United States and France, Dutton’s knowledge about health-care issues is sought worldwide. He’s a regular on the radio talk-show circuit, gave the commencement address at Brenau University in Gainesville, Ga., last spring, and is the keynote speaker for the European Studies conference at Duke University in November.

insurance. A very large proportion of the U.S. workforce will not leave current employment because the worker, or his or her dependant, has a pre-existing medical condition, and is fearful that the condition would be excluded from coverage under a new plan,” Dutton notes. “A would-be Bill Gates might at this very moment be saying to herself, ‘I can’t afford the risk of starting my own company. I’ve got a kid with diabetes’. I wonder how many more Microsofts this country would have had by now—all the jobs, wealth creation, spinoff industries and innovation if it weren’t for this crazy health care system we have.” Dutton suggests that to be successful, U.S. health care must address coverage, cost and quality, but the fact that they are interconnected make the politics of reform complex. His book points out what is working well with health care in France. It highlights the similarities between the United States and France, including their “distaste for socialized medicine” that restricts patient choice. “I am struck by how many ideals the French and American people share about health care, how similar their health-care systems were a hundred years ago, but how different they are today,” Dutton says. “By writing a comparative history that brings the reader right up to the present day, I hope to make a contribution to the U.S. health-care reform debate.” He says the United States needs to figure out what works and what doesn’t in all countries and create one that works for it. “The French insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as socialized medicine. In contrast to Canada and Britain, there are no waiting lists for elective procedures and patients need not seek pre-authorizations in France,” he says. Nor do doctors in France face the high expenses of non-medical personnel because a standardized electronic system is set up for physician reimbursement. “Their doctors’ freedoms are protected in ways that would make their managedcare-repressed U.S. counterparts envious,” Dutton says.

BIO | PAUL DUTTON

He says the Germans and French are coming out of the recession faster than the United States in part because their taxpayers and employers spend only two-thirds as much as the United States on health care. “Meanwhile, we have a system in which between 25 and 45 percent of workers are ‘ job locked’ for reasons related to health

As executive director of the Interdisciplinary Health Policy Institute, Paul Dutton is working to improve rural and urban health care in Arizona by addressing disparities in health related to race, ethnicity, poverty and socioeconomic status, with a special emphasis on Native American health issues. Diane Rechel is public affairs coordinator in the Office of Public Affairs at Northern Arizona University.

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Quarles & Bradyâ&#x20AC;&#x2122;s Bioscience Practice For over two decades, Quarles & Brady has represented biotechnology companies, universities, educational institutions, medical device companies and others in the life science industry. We provide a full range of counseling to our clients in this industryâ&#x20AC;&#x201D;from the protection, commercialization and enforcement of intellectual property rights to public and private financings and providing support for mergers and acquisitions. For more information, please contact Jessica Franken, Phoenix Intellectual Property Group Chair, at 602-230-5520 or jfranken@quarles.com

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Awards give Arizonans their moment in the spotlight WRITING BY :: GOV. JAN BREWER

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oday’s increasingly global economy means our businesses, universities and graduates no longer simply compete with other Arizonans or Americans—they are competing with others from around the world. As the current economic crisis impacts nations across the globe, it has never been more important to remain competitive. This is happening here by being innovative, developing new ideas and products, and advancing education methods so that Arizona remains ahead of the curve. On Nov. 19 I look forward to recognizing the exceptional innovative work taking shape in our great state on a daily basis.

Join me in celebrating some of the remarkable contributions to the world as we highlight Arizona’s education, science and technology innovators and companies...

The Governor’s Celebration of Innovation will honor Arizona’s technology leaders and innovators. The event attracts more than 1,000 attendees made up of technologists, corporate executives, entrepreneurs, investors, students and policymakers. These are Arizonans responsible for turning great ideas into reality, and ensuring discoveries made here can be brought to market—securing a strong, prosperous future for our state in the 21st century economy. Whether it is advancements in solar photovoltaic technology, improved lenses from Arizona’s world-renowned “Optics Valley” in Tucson, new medical devices improving patient care and made in Flagstaff, or breakthrough genetic discoveries from TGen, Arizona’s economic success is and will be very closely tied to our ability to foster innovation. This is about Arizona’s future and its role in the world economy. We must focus and grow the jobs essential to the success of our state and its people. I strongly believe our technology community is leading the way in building a stronger, more ﬂourishing future for all of Arizona. Join me in celebrating some of the remarkable contributions to the world as we highlight Arizona’s education, science and technology innovators and companies—this year’s Celebration of Innovation winners. + GET CONNECTED www.azgoverner.org

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he Arizona Telemedicine Program at The University of Arizona College of Medicine in Tucson has reached thousands of people across the state and around the world and is taking the next step 040 in bringing technology to health care. The program has just received a $1.1 million federal grant to create the Southwest Regional Telehealth Resource Center in a nationwide effort to support the transition to digital health records and implementation of telehealth services. The Southwest Center, covering Arizona, Colorado, Nevada, New Mexico and Utah, will be an integral part of a national network of seven regional resource centers and one national resource center, the Center for Telehealth and E-Health Law in

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Washington, D.C. The funds were granted by the Human Resources and Services Administration of U.S. Department of Health and Human Services. The Tucson-based center will provide resources, including assistance with electronic health record system selection, implementation and management and “help desk” technical support in its region. Users include independent health-care organizations and practicing physicians who are or plan to be telehealth service providers or users. The center also will support clinical applications needs assessments, facility design, assistance with legal, regulatory and reimbursement issues, business plan development and grant writing. The Arizona Telemedicine Program has served as a resource center for its 55-member organization for more than a decade. Now, the Southwest Center will leverage the program’s resources, expand services and offer them to many more health-care organizations and physician practitioners in the region. The Arizona Telemedicine Program is one of only two organizations in the United States with American Telemedicine Associationcertified training programs. “Timing for the awarding of the SWTRC grant by the U.S. Department of Health and Human Services is excellent for Arizona,” said Dr. Ronald S. Weinstein, founding director of the Arizona Telemedicine Program. “The federal government has made educating physicians about electronic health records and encouraging them to embrace the technology a high national priority.”

A New Model Having reached nearly 1 million encounters of patients, doctors and others in its 13 years of existence, the program has torn down the walls of classrooms, labs and clinics. Today’s medical students are learning medicine throughout Arizona and beyond, while they remain on campus—and health-care professionals are continuing their medical education without leaving their home towns—thanks to the program. The “nerve center” of this new direction in health-care education is the T-Health Institute based in downtown Phoenix at The University of Arizona College of MedicinePhoenix in partnership with Arizona State University. As an educational institution, T-Health incorporates both telemedicine and telehealth—distance learning and health-care delivery—using a wide range of technologies, including real-time videoconferencing, electronic transmission of digital medical images and data, and the Internet. Video walls, private teleconference rooms and individual computers bring together medical students, faculty, health care professionals and patients who are hundreds of miles apart, allowing individual and group interactions that bring to mind episodes of “Star Trek.” The program even has begun looking to even younger students to teach. A group of nine high school students in Phoenix and Tucson took part in the second Junior Osler Summer Fellowship Program. The students are part of an effort to see younger people can handle medical school curriculum, the ultimate goal being combining undergrad and medical school into a shorter course of study. That would allow the school to produce physicians quicker and save students thousands of dollars in tuition. The future is definitely now in the Arizona Telemedicine Program. Al Bravo is associate director for public affairs at The University of Arizona.