Quarterly. Wearable Technology. Are You Empathetic? MediGold Partnership Expands. On the forefront of. Create a therapeutic patient relationship

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1 Published by Kettering Health Network Q3/Q4 : 2014 PHYSICIAN Quarterly On the forefront of Wearable Technology Are You Empathetic? Create a therapeutic patient relationship MediGold Partnership Expands Kettering Grandview Sycamore Southview Greene Fort Hamilton Soin Physician Satisfaction Survey Results

2 Kettering Grandview Sycamore Southview Greene Fort Hamilton Soin Table of Contents Network Increase Patient Use of MyChart...4 MediGold Relationship Expands...5 MyChart by the Numbers...5 Is Weight Loss Surgery Safe?...6 Safety of Hormone Replacement Therapy for Menopause...7 Network Technology Update...8 Senior Leadership Restructures...9 Network Hospitals Honored by U.S. News Awards...9 Network Doctor Reviews Sleep Study Proposals for Astronauts...10 The Power of Empathetic Care...11 Network Expands Diabetes Centers and Offers Certification...12 VMware View Simplifies Clinician Experience with Epic...13 Physician Satisfaction Survey Results...14 Shout Outs...16 Medical Education Single Graduate Medical Education Accreditation Approved...17 Welcome New Residents...18 Grandview Residents Publish Articles on Psychopharmacological Research...19 Kettering/Sycamore New Interventional Procedures for Pulmonary Disease...20 HFAP Surveyors Comments Speak to Quality Care...21 Kettering & Sycamore Medical Staff Welcomes New Docs...21 On Our Cover Brent Bamberger, DO (left), and David Martineau, MD (right), who specialize in hand surgery at Southview Medical Center s Hand Center, are using Google Glass, a wearable technology device that integrates computer access during surgery and enhances surgical training (p. 23). Grandview/Southview The Future of Family Medicine...22 Surgeons Use Google Glass During Procedures...23 New EMS Room at Grandview...24 Grandview & Southview Medical Staff Welcomes New Docs...24 Soin/Greene Greene s HFAP Results Reflect Dedication to Mission...25 Network Partners with Greene County Health District...25 Soin Expands Call Schedule...26 Soin & Greene Medical Staff Welcomes New Docs...26 Fort Hamilton Sharing Stories: Compassion...27 Hospital Welcomes Surgeons to Support Patients...28 New Outpatient Wound and Diabetes Centers Meet Need...29 Fort Hamilton Medical Staff Welcomes New Docs...29 Kettering Physician Network Female Cardiologist Joins Network...30 KPN Website Offers Patient Services...31 KPN Welcomes New Docs...31 Service Lines Align Office Operations...32 Published by Kettering Health Network Q3/Q4 : 2014 PHYSICIAN On the forefront of Wearable Technology Are You Empathetic? Create a therapeutic patient relationship MediGold Partnership Expands Quarterly Physician Satisfaction Survey Results We need PHYSICIAN Experts! Are you willing to volunteer your expertise in any of the following areas? Author Physician Quarterly articles Contribute content ideas Serve as media spokesperson Speak at community events or call (937) Physician Quarterly is published by Kettering Health Network to support communications between physicians, residents, fellows, alumni, and hospital administration. Managing Editor: Emily Syvertson Design & Layout: James Bartosik Additional Writing: Mindy Cooper, Catie Drake, Karen Drury, Debbie Juniewicz, Tara Pettit, Alex Smith, Elyse Travis, Michelle Wesney, Leigh Wilkins Cover Photography: Colin Gatland Further examination shows that hormone replacement therapy can be used quite safely. William McCullough, MD, on how research supports a return to prescribing HRT for menopausal women (p. 7) The unified system will prepare future physicians of the highest quality with the broadest opportunities to serve the public while preserving the infrastructures within each profession. Paul Martin, DO, on the move to a single accreditation system for graduate medical education programs (p. 17) We now can offer a comprehensive array of interventions that provide diagnostic, therapeutic, and palliative benefit [for patients with pulmonary diseases]. Hemant Shah, MD, on the new interventional procedures Kettering Medical Center can perform with the addition of Ehab Hussein, DO, fellowship-trained interventional pulmonologist (p. 20) Medical care is the summation of a multitude of details working in concert equipment, medications, procedures, environment, and most of all, dedicated people. David Small, MD, on patient care and experience (p. 25) It was one of the most incredible acts of compassion, humanism, and empathy I ve seen. Dan Rauh, NP, describing an exchange he witnessed between Tom Vajen, MD, and a patient (p. 27) It brings everyone into the same room to share insight from different perspectives. David Doucette, MD, on Kettering Physician Network s new physician-led service line model (p. 32) 9 The number of Medicare Advantage Plans Kettering Health Network partners with (p. 5) 53 The age of the average MyChart user (p. 5) 0.13% The mortality rate for weight loss surgery in a study conducted (p. 6) One in five The number of people who meet criteria for a mental disorder diagnosis in the Dayton region (p. 19) 130% Increase in ED discharge diabetes diagnoses rates in Butler County (p. 29) 3

3 4 Increase Patient Engagement Through MyChart Moving toward meaningful, useful care and communication MyChart is an online patient access portal that provides opportunity for improved patient care and communication. It also helps providers meet Centers for Medicare & Medicaid Services Meaningful Use measures. How patients use MyChart depends on what s in it for them ; patients must go beyond simply activating their accounts to using them on a continual basis in a personally relevant way. Physicians and medical staff can greatly influence patients engagement with MyChart by telling them how MyChart enhances their care. With over 65% of her patients signed up on MyChart and 45% of them messaging her every month, Susan Stedje, MD, of Sycamore Family Medicine has experienced some success with encouraging patient use of MyChart. Her desire to deliver personal care drives MyChart activation tactics, such as signing patients up during their visit. Strategies to increase patient use of MyChart Talk with each patient about the advantages of using MyChart (e.g. receiving test results quicker, messaging about a minor inquiry, renewing prescriptions, managing appointments, paying medical bills). Get patients involved in the office to increase the likelihood that they will continue to use MyChart with ease. Sign them up right then and there, highlighting the messaging feature. Janice McGinnis-Bolser, LPN, does this on a regular basis. It takes less than 60 seconds of her time, which she simplifies by setting patients up with a username before having them enter a password. She will often show patients how to use a few basic features once they are logged in. Send a pre-appointment questionnaire for patients to fill out online prior to the office visit. This reduces time spent documenting in the office and encourages patient use of MyChart messaging. Encourage hospital patients to review summaries of their hospital stay, test results, and discharge instructions. Follow up using secure messaging to touch base and retain patients. Customize interactions with a personal touch, such as, Have a good weekend! or, Enjoy the holiday! Dr. Stedje s patients say they love this added level of personal connection. When patients manage their health care through MyChart, clinical staff experience a lighter work load. By providing test results to patients through MyChart, Dr. Stedje s staff rarely calls or mails test results to patients, saving money on postage and time on the phone. As patients turn to MyChart to manage their medical needs, offices see a decrease in overall phone calls, resulting in less phone-tag, fewer interruptions, and more time to complete work on busy clinical days. When patients pay their medical bills online, practices save money on printing and mailing statements, and achieve a quicker payment turnaround time. Addressing medical inquiries through MyChart messaging also leaves a helpful, paperless trail. There is less misunderstanding because my patients are reading exactly what I want them to know... and they can refer back to my message later for clarification, says Dr. Stedje. If you have questions or would like to learn more about MyChart, contact Charles Watson, DO, CMIO at khnetwork.org or Natalie Mescher at Stage 2 Meaningful Use MyChart Measures: 1. More than 50% of all unique patients seen during the Electronic Health Record reporting period are provided timely (available to the patient within four business days after the information is available to the provider) online access to their health information, with the ability to view, download, and transmit to a third party. 2. More than 5% of all unique patients seen during the EHR reporting period view, download, or transmit to a third party their health information. In addition, for providers-only: 3. A secure message was sent using the electronic messaging function of certified EHR technology by more than 5% of unique patients seen by the eligible provider during the EHR reporting period. Network Expands Partnership with MediGold In order to expand the community s access to our care, Kettering Health Network is strengthening its relationship with MediGold. As a result, Kettering Health Network will be MediGold s preferred provider in this region. MediGold is just one of many Medicare Advantage Plans that the network contracts with. MyChart by the Numbers 44,735 patients activated MyChart accounts as of September 1 The average MyChart patient is 53 years old 15% are 70 years or older Why are patients sending messages? (Q2) 4,851 Medical Advice 1,753 Rx Refill Requests 594 Appointment Requests Clinical staff responded to of these 86% messages in 1 business day or less Monthly average of patient logins 9,468 patients Q ,362 patients Q ,567 patients Q In June, 67,378 outpatient test results were released electronically to MyChart, potentially saving $202,134 Test results are the #1 item patients view in MyChart 63% of patients who logged in during June viewed test results Health Plans Kettering Health Network partners with the following Medicare Advantage Plans: Aetna Medicare Anthem Blue Cross and Blue Shield Buckeye Community Care CareSource Gateway Health (effective Jan. 1, 2015) Humana Health Plan of Ohio, Inc. MediGold UnitedHealthcare Molina Healthcare 3,478 activated patients use the MyChart mobile app as of September 1 (7% of all activated patients) Over half a million dollars was paid toward patient medical bills via MyChart in Q2 $500,000+ 5

4 How Safe Is Weight Loss Surgery? Strategies for the Menopausal Transition 6 High demand yet high skepticism As obesity rates grow, the number of bariatric surgery procedures continues to climb, increasing by an estimated 200,000 procedures annually 1. Around the year 2000, bariatric surgery came under attack, especially for the perceived risk of the procedures 2. At the time, there was little data to confirm or deny these perceptions. In 2006 the Centers for Medicare and Medicaid Services charged the Surgical Review Corporation and American College of Surgeons to collect and report on patient data. From June 2007 to May 2009, a total of 57,918 patients with bariatric procedures were included in a study that examined the outcomes from the newlydeveloped database. The overall mortality rate for patients in the sample was 0.13%. Mortality related to predictable risk factors According to a study 3, morbidity and mortality rates increase on a predicable trend with increasing age and body mass index. From a sample of 29,323 patients, this study found the important risk factors for developing postoperative complications to be age, diabetes, hypertension, shortness of breath, and chronic obstructive pulmonary disease. These studies were not the first to suggest a decline in bariatric surgery mortality. The Agency for Healthcare Research and Quality reported a 79% reduction in mortalities from This collection of data concludes mortality after bariatric surgery is a rare event. It is influenced by different risk factors, including type of surgery, open surgery, prolonged operative time, comorbidities, and volume of activity. Holistic treatment approach Carey Brown, MD, of Kettering Bariatrics, says bariatric surgeons evaluate each patient s risks on a case-by-case basis. We look at the whole picture of the patient s presentation in determining the most appropriate operation for the patient, says Dr. Brown. This includes medical conditions, BMI, body habitus, prior abdominal surgical history, and other social factors, such as family and occupational responsibilities. Our goal is to treat the whole patient and not just their obesity. 1 The 2008 Edward E. Mason Founders Lecture: interdisciplinary teams in the development of best practice obesity surgery 2 Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database 3 Postoperative complications in bariatric surgery using age and BMI stratifications: a study using ACS-NSQUIP Data, 2014 William McCullough, MD, Chief of Staff at Kettering and Sycamore Medical Centers Menopause may be a natural part of the aging process, but it certainly can be a miserable one. With symptoms that include hot flashes, sleep disturbances, anxiety, and diminished sex drive, menopause can wreak havoc on a woman s well-being, including her personal relationships at work and at home. Traditionally, the standard regimen for menopausal women was hormone replacement therapy estrogen only for women who no longer had a uterus, and a combined estrogen and progesterone product for those who did. However, that changed after results from the Women s Health Initiative Postmenopausal Hormone Therapy Trials were announced in The trials seemed to demonstrate that the estrogen in combined hormone replacement therapy Prempro slightly elevated a woman s risk of breast cancer. Many physicians went to the extreme of no longer recommending hormone replacement therapy even for their menopausal patients who were on estrogen only. Now the pendulum seems to be swinging back a bit toward a more pragmatic approach. Further examination of the WHI research findings, as well as additional studies, shows that hormone replacement therapy can be used quite safely. The key is to prescribe the lowest dose of estrogen possible for a limited amount of time instead of indefinite use of high doses. This is good news for menopausal women, many of whom benefit from hormone replacement therapy. In fact, a recent scientific study showed that FDA-approved prescription hormone replacement therapy usually reduces hot flashes significantly for as many as 80% of patients who use it. The rise of designer estrogens Within the past few years, selective estrogen-receptor modulators, or SERMs, have become more widely available. SERMs are designed with selective receptor agonists/ antagonists to provide targeted relief from specific menopause symptoms and have additional selective menopausal benefits, such as the prevention of osteoporosis. The SERM Osphena, for example, acts like estrogen to stimulate cells in the genital canal and help prevent pain associated with sexual intercourse. It doesn t significantly stimulate cells in the uterine lining or breast, thereby avoiding the possibility of associated cancer risk. Another drug option, Duavee, contains both estrogen and a SERM named bazedoxifene. This combination can provide effective treatment for hot flashes, avert genital atrophy, and prevent osteoporosis all without the side effect profile associated with progesterone in traditional combined hormone replacements. SERMs aren t for everyone. Some patients, especially those experiencing extreme night sweats and daily hot flashes, have benefited from taking non-hormonal drugs including clonidine, paxil, and even gabapentin. Alternatives to hormone replacement therapy Among the patients who come to my practice seeking relief from menopausal symptoms, I d say about two-thirds want to pursue alternative options to prescriptive therapy. These may involve some trial and error, but some patients do report success. A few strategies include: Striving to attain a healthy weight through nutrition and exercise Increasing consumption of phytoestrogens (soy, whole grains, and flax seed) Taking herbals or botanicals, such as black cohosh, dong quai, gingko biloba, and evening primrose oil Taking vitamin supplements, such as multivitamins, Vitamin D, and Vitamin E Further examination of the WHI research findings, as well as additional studies, shows that hormone replacement therapy can be used quite safely. The menopause transition is a journey to a new beginning, the gateway to the second half of a woman s adult life. As physicians, our job is to help patients experience a healthy, vibrant transition and assure them that one day soon, the challenging discomforts of menopause will come to a peaceful end. 7

5 8 Network Technology Update Technology advances at a quick pace, and at Kettering Health Network it is no exception. Here is a snapshot of how technology is evolving across the network. Charles Watson, DO, Chief Medical Information Officer of Kettering Health Network Epic update We will upgrade to Epic version 2014 on December 7. This update will include a search field function. ICD-10 The United States government confirmed that the country will move to ICD-10 coding, the latest diagnostic coding system implemented by the World Health Organization, on October 1, 2015 one year later than the original date. This will put us on par with international coding standards. Physicians may want to revisit HealthStream to review the ICD-10 training. If you need help accessing the site, please contact isupport. E-prescribing Shortly after the beginning of 2015, we will be able to offer inpatient E-prescribing through Epic. When we discharge a patient, we will be able to send the discharge prescriptions electronically to the patient s preferred pharmacy. E-prescribing has been available to Epic ambulatory sites for a while, and will now be available to the inpatient arena. This feature should help cut down on medication errors and patient wait times at the pharmacy. Meaningful use Five out of the seven network hospitals have achieved Meaningful Use stage 2 and attested to the government for reimbursement. This resulted in Kettering Health Network receiving $5.6 million in Centers for Medicare & Medicaid Services incentives. We anticipate that Grandview and Southview medical centers will be able to attest this October. Managed print services The network introduced managed print services in June 2013 to cut down on the amount of printing and track printing utilization. During the pilot of our new managed print services at Soin Medical Center, clinical workflow experienced interruptions caused by the tapto-print feature, which requires users to tap their badges on the printer to initiate printing. In response, the tap-to-print feature was removed for all Epic printing. This model will extend to all other sites as managed print services continue to roll out throughout the network. K-Connect and Mobile-Connect K-Connect, the physician secure WiFi, is rolling out at all sites. K-Connect allows physicians to connect to WiFi without having to select I Accept whenever they enter a new network environment. Mobile-Connect, the secure physician messaging application, is now live at all sites with wide utilization. Mobile-Connect enables physicians to send and receive HIPPA-compliant clinical messaging on their smart devices. If you are having any difficulty with either service, please contact isupport. Order sets require code status Physicians will notice a change in all order sets except the motherbaby and pre- and post-op sets. To avoid patient status errors, order sets now have a hard stop requiring the code status to be manually filled in. Best practice alert Physicians may have noticed a new best practice alert. If you have unsigned, verbal telephone orders that are 36 or more hours old, you will get a BPA alerting you to those orders when you sign into Epic with a hyperlink to the in-basket so you can sign them immediately. This will help with our HFAP and CMS compliance. Senior Leadership Restructures to Enhance Consistent Care Kettering Health Network recently updated its leadership roles to better reflect the changing landscape in health care and in the network. The executive team wants to ensure physician leaders have timely information about the network and strategic areas of focus. With this current leadership structure, the network continues toward One Best Practice and better supports the ongoing alignment within the organization. Here is a current list of the campus executive team leadership and new network roles. New Network Roles: Richard Haas Senior Vice President Bev Knapp Vice President of Health Reform Strategies Nancy Robie Vice President of Business Development Campus Executives: Roy Chew President of Kettering Medical Center Executive Vice President of Kettering Health Network Wally Sackett Senior Vice President of Sycamore Medical Center Terry Burns Senior Vice President of Soin Medical Center and Greene Memorial Hospital Russ Wetherell Senior Vice President of Grandview Medical Center Becky Lewis Senior Vice President of Southview Medical Center Mark Smith President of Fort Hamilton Hospital George Lewis President of Kettering Physician Network Network Hospitals Named Best by U.S. News & World Report Each year U.S. News & World Report examines and awards hospitals across the nation for their quality. This year they reviewed data for almost 5,000 hospitals and surveys from more than 9,500 physicians. After they analyzed multiple factors (including death rates, patient safety, and hospital reputation), they narrowed the hospitals down to 144 that ranked nationally. U.S. News & World Report recognized five Kettering Health Network hospitals as a best regional hospital in Kettering Medical Center ranked #17 among more than 150 hospitals in Ohio and within the top five in Dayton. Grandview Medical Center and Southview Medical Center ranked #27 in Ohio and within the top five of Dayton. Greene Memorial Hospital ranked #32 in Ohio and within the top five in Dayton. Kettering Grandview Greene Fort Kettering Hamilton Grandview Greene Fort Hamilton Fort Hamilton Hospital ranked #29 in Ohio and #8 in the Cincinnati metro area, which has 40 hospitals. 9 Kettering Grandview Greene Fort Kettering Hamilton Grandview Greene Fort Hamilton

6 Network Doctor Reviews Sleep Study Proposals for Astronauts Creating a Therapeutic Relationship Through Empathy 10 Donna Arand, PhD, clinical director of the Kettering Sleep Disorder Center, was asked by the National Space Biomedical Research Institute, a NASA-funded consortium of institutions studying the health risk related to long duration space travel, to participate in panel reviews of proposals related to sleep in space. The proposals describe experiments for studying and improving sleep for astronauts. Dr. Arand, who has a PhD in experimental psychology from the University of Cincinnati and is also a diplomate of the American Board of Sleep Medicine, has traveled to Washington, D.C., and participated in the review panel once a year for the past three years. After review, the panel scores the proposals and passes along the information to be considered for funding. Most recently, she served as a chair of one review panel. Most [astronauts] only sleep four to six hours a day, which results in significant performance impairment in less than a week, says Dr. Arand. Chronic sleep deprivation effects are cumulative, so a typical six months in space increases this risk. NASA is looking into why it is difficult for astronauts to sleep and possible solutions. In the space station, astronauts orbit the sun every 90 minutes, which means they experience 45 minutes of daylight followed by 45 minutes of dark. This affects circadian rhythm, which is controlled by the sun and directs the body s sleep-wake cycle. Taking an organism that is used to a 24-hour cycle and putting it in a 90-minute cycle, in terms of light exposure, is problematic, says Dr. Arand. It causes sleep deprivation, which leads to performance and memory decrement, as well as hand-eye coordination decline. In addition to the circadian rhythm issue, astronauts conditions inside the international space station are not conducive to getting quality sleep. Due to the lack of gravity, astronauts sleep in sleeping bags attached to the wall, ceiling, or floor to keep them in one place. There is constant noise and someone is always on duty, moving around. Sudden, unexpected work shifts during emergencies also contribute to irregular sleep periods. Applications for everyone Dr. Arand notes that people who stay on the earth s surface may experience similar challenges. Interrupted sleep, short amounts of sleep, and situations where an individual is suddenly awakened and must immediately react are common in many occupations, especially among shift workers who must respond to critical situations upon waking, such as medical professionals, emergency responders, and military personnel in the field. Twenty percent of the population does shift work. Not everyone adjusts easily to this type of schedule, says Dr. Arand. Anything found that works in space may also have huge applicability on earth with our various work schedules. Dr. Arand notes that research has shown circadian rhythm is very sensitive to blue light, which blocks the release of melatonin. Melatonin promotes sleep and is released in the brain as the sun goes down. The STS-112 crew members sleep on the middeck of the space shuttle Atlantis. People can use this information to influence their sleep-wake cycles. On the drive home from work, night shift workers can wear blueblocker sunglasses that trick their brains into thinking it is still night, making it easier to fall asleep once they arrive home. Daytime sleepers can also install blackout curtains in the bedroom, which block natural light. One of the most common sources of blue light at bedtime comes from electronic devices, such as TVs, laptops, and cellphones. In contrast, people can use blue lights to help maintain alertness during the day or night shifts at work. Using the blue light spectrum to adjust the sleep cycle is one of the areas that NASA is currently looking into, says Dr. Arand. Photo Credit: NASA By Sandy Johnson, Network Director of Patient and Family Experience Think about a time when you experienced a significant loss, crisis, or challenge. What did someone say or do that helped? What did someone say or do that was not helpful? What often comforts and strengthens us are words and actions that convey competence, compassion, non-judgmental presence, and empathy. If we asked any of our patients in our hospitals at this moment, they would have answers similar to ours about what helps them feel safe and cared for. As clinicians, it is also important to remember that being present with another person who is facing trauma, serious illness, loss, or grief requires an awareness and understanding of one s own emotional responses. Only then can we serve as a therapeutic tool in the care of others. A therapeutic relationship cultivates emotional safety and facilitates the person s capacity to heal and to participate in the recommendations for their recovery. Mary Koloroutis and Michael Trout in their book See Me as a Person, write: A therapeutic relationship exists when: People know that they are seen as unique persons, as evidenced by sustained eye contact, authentic communication, and the clinician remembering what is most important to them. People are given the opportunity to be partners in their care; they are given information and explanations that fully prepare them to make informed decisions about their treatment and care. I am your patient. I am a person with family, friends, faith, hope, longings, and plans for the future. Everything you do or say that helps me feel seen as a person, moves me one step closer to healing. When you do the things I d do for myself if I could, I feel like you ve got my back. Every time you help my family, you help me. Every time you hold my hand, I m comforted. Every time you are in my room and you see me not as a diagnosis or series of tasks but for who I really am I feel safe. Marcus Engel (as a patient, The Other End of the Stethoscope ) People perceive that they are being touched with care, kindness, and dignity. People can see by the actions taken that they are being listened to and heard. People perceive that the magnitude of their illness or injury is recognized and respected. Empathy Self-Check People are encouraged to feel a sense of hope and possibility by those who recognize and respect the magnitude of their illness or injury. People are supported to cope with and find meaning in their illness. People feel safe and know that they will not be abandoned. Do I make sure I connect with the patient as a person? Do I watch for non-verbal clues about what the patient is feeling? Do I invite the patient to share his or her experience and feelings? Do I check-in and acknowledge the patient s and family s feelings using words like You sound or You seem or Let me see if I have this right? Do I validate or confirm the legitimacy of the patient s feelings, showing my understanding? Do I express empathy to people different from myself as much as I do to people similar to me? Do I pursue or follow-up on a patient s or family s concerns and feelings? If family members are present, do I connect with them personally and involve them in the care of the patient? If family members are present, do I show empathy for their feelings, too? YES 11 Do I show empathy through my non-verbal presence skills?

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