BREVARD COUNTY, FLORIDA – As its name implies, Sushoo, the first independent healthcare information exchange in the United States, is very, very fast. The newly designed product from West Melbourne, Florida-based Doctors Partner is also quickly catching the attention of healthcare decision-makers around the country.

Technology entrepreneur Naveen Venkatachalam and his wife, physician Dr. Geetha Priyanka.

Idaho is the latest state to give its seal of approval to Sushoo, which was launched last fall by the award-winning Doctors Partner, the electronic medical records and medical practice management software company created by technology entrepreneur Naveen Venkatachalam and his wife, Melbourne physician Dr. Geetha Priyanka.

The Gem State, Idaho has a golden reputation for interest in affective healthcare data exchange. In 2006, the state formed the Idaho Health Data Exchange in order to raise the bar on residents’ healthcare outcomes by developing health information technology that will seamlessly network with all providers.

The Exchange was task was to develop an effective statewide health information exchange for patient medical data. Because both outpatient practices and emergency facilities are to be of this network, all healthcare facilities must install electronic medical records software approved by the state.

Perfect Combination

Doctors Partner, an electronic medical records and medical practice management software, together with offspring “Sushoo” proved the perfect combination for Idaho.

Beth McKenzie

“The full suite of services in the software creates a seamless transmission of Idaho’s health data,” said Beth McKenzie, Doctors Partner vice president of marketing.

“It not only meets the standards of the Exchange, but it has the capability to fill in missing links between providers.”

Sushoo allows providers to simply and securely share data over the internet with other physicians or healthcare organizations.

In preliminary research, Sushoo has been shown to save an average of $17,000 a year at a typical solo medical practice.

Doctors Partner is currently implementing the software throughout Idaho. Federal mandates require physicians to adopt health information exchanges to qualify for stimulus funding.

As more physicians move to implement HIEs, McKenzie expects Sushoo’s reputation to place it as the top choice.

“We have already been recognized as the missing link in healthcare informatics,” she said.

“This is such an amazing feat for such a young product.”

For more information on Doctors Partner and Sushoo, call 574-5356 or visit www.sushoo.com.

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DOCTORSPARTNER owners Naveen Venkatachalam and Dr. Geetha Priyanka are closely watching the federal government’s efforts to encourage physicians to adopt Electronic Medical Records.

BREVARD COUNTY, FLORIDA – A quiet office doesn’t usually signal a bustling business. But to the founders of DoctorsPartner, the absence of ringing phones at the company’s Melbourne, Florida call center means their product is successful.

DoctorsPartner provides software that helps doctors maintain electronic medical records and manage their practices. The product needs little support, boasts Naveen Venkatachalam, who created DoctorsPartner with his wife, Dr. Geetha Priyanka.

The idea for the software product was born of necessity. Priyanka, an internist, wanted to computerize medical records when she started her own practice. “The prices people wanted to charge were ridiculous,” she recalled, citing figures upwards of $120,000 for the service.

And yet, she was convinced of the need. Priyanka had worked for large groups before branching out on her own, and she’d seen the chaos that paper charts can cause. She remembers when Baycol, a cholesterol-lowering medication, was recalled. Individual paper charts had to be manually consulted so the practice could notify every affected patient of the recall. “It took hours and hours of work,” she said.

If the practice had used electronic medical records, also known as EMR, the same function could have been performed in less than a minute.

She didn’t need to look far for a computer expert to engineer a solution. A former IBM employee, Venkatachalam has a background in finance and worked in business software.

In fact, his computer expertise is somewhat responsible for bringing them together. The two were acquaintances when Priyanka was working in New Jersey and wanted to develop a web site for professional women. “I was the only computer guy she knew,” Venkatachalam said, so she contacted him about the idea. That web site didn’t end up coming to fruition, but they did create a site for pet owners based on their hobby of showing dogs. The couple married in 2002 and moved to Melbourne the following year.

Affordable and Functional

Priyanka wanted to build a top-notch product and make it available to doctors at an affordable cost. They launched the business in early 2003, offering three main product lines:
• Solo doctor and small office system. A small office can get started with the basic product, known as Daylite, which offers just the EMR feature. The company often provides the starter package at no charge, knowing that doctors will like the product, grow their business, and need a more powerful version.
• Mid-level product. The full-blown DoctorsPartner system includes the EMR function, as well as practice management features.
• Large group customization. “Some practices are so big or specialized that nothing fits them out of the box,” Venkatachalam said. They might have multiple offices that provide care for large companies and need customization for their particular business.

Versatile and Efficient

The software performs a variety of functions.  In addition to managing a database of electronic medical records, DoctorsPartner can provide automated calling to patients to remind them of upcoming appointments.

It’s also a single source for a variety of hospital and other forms that can be scanned in and signed on-screen. Lab work can be integrated into the system and electronically fed into the EMR. And at the end of the workday, bills are automatically generated.

DOCTORSPARTNER’S practice management solutions – part of its integrated EMR product – ranked Best in KLAS among small doctor offices in the company’s annual ratings in 2007. The Electronic Medical Records side also fared very well, coming in second place.

As a doctor, Priyanka knows that what works for her specialty won’t apply to someone else’s. So DoctorsPartner documents can be modified easily to accommodate an ear-nose-throat specialist or a cardiologist. Different specialties working at the same practice can customize their screens based on a different login.

And patients will appreciate the convenience of being able to fill out medical forms at home and have them imported into the system, instead of the “arrive-15-minutes-early” routine. A portal feature allows a patient who has an account with a doctor to plug into the doctor’s website and fill out forms, request an appointment or ask for a prescription refill.

DoctorsPartner installs a server in the doctor’s office, so that all data is in-house and is not relying on the Internet to be operational. But the system can be accessed by the doctors via the Internet when they’re away from the office, using the same security as Internet banking transactions. Priyanka recently used the feature during a trip to India. She was able to connect with the system and work from there.

“Naveen runs a tight ship. They’re very responsive to what people are looking for,” said Mark Wagner, director of ambulatory research for KLAS. The Orem, Utah-based company monitors healthcare technology products and firms to help healthcare providers make informed technology decisions. KLAS provides annual ratings of vendor performance based on research with thousands of healthcare organizations.

DoctorsPartner’s practice management solutions – part of its integrated EMR product – ranked Best in KLAS among small doctor offices in the company’s annual ratings in 2007. The EMR side fared very well, coming in second place.

Users particularly liked the company’s training support and responsiveness to requests for new features, Wagner said.

Scores slipped in the 2008 ratings, which came out in December. Wagner suspects that users are concerned about where the company fits in the future of healthcare. Its small size makes DoctorsPartner nimble, but also might mean limited resources to address challenges, he said.

DoctorsPartner’s business model counteracts those concerns, Venkatachalam said, by using a subscription system. He explains the benefit by contrasting the company to a system like Microsoft Word. Buy the software, and you’ll incur a one-time fee and get to use the software forever. When there’s an upgrade, you’ll need to invest more – or you can put it off. Many EMR companies operate the same way, charging very high upfront fees and basing their success on continued sales.

That hasn’t worked so well in the current recession, Venkatachalam noted. But DoctorsPartner continues to thrive because of its approach. The company charges much less upfront, but then continues to receive subscription fees. Clients receive frequent upgrades without having to make another big purchase. The result is more staying power. “Our revenue stream is guaranteed,” Venkatachalam said.

Customers particularly like the fact that DoctorsPartner requires little investment after the initial purchase, Priyanka said, and doesn’t nickel-and-dime the customer.

Conform Or Be Penalized

Like all companies, DoctorsPartner is closely watching the federal government’s efforts to encourage physicians to adopt EMR.

NAVEEN VENKATACHALAM created DoctorsPartner with his wife, Dr. Geetha Priyanka.

As part of this year’s stimulus package, doctors can get federal money by meeting meaningful use standards by 2011. If a practice hasn’t met the standard by 2015, they’ll be financially penalized.

The mechanism for the carrot and stick is Medicaid and Medicare reimbursements. Qualifying practices will get a higher percentage in reimbursements, and penalized practices will get a lower percentage. The goal is to improve patient care and reduce medical errors, both results that have been shown to accompany EMR utilization.

The sheer number of practices that have not yet adopted EMR – estimated at 75 percent of the half million practices nationwide – mean that vendors are likely to be overwhelmed once standards are clear and practices move to comply.

DoctorsPartner already anticipates certain requirements and is working those in now, Venkatachalam said.      More details about requirements for EMR systems are expected to emerge in the fall. “There’s a mad scramble to find out what the software has to do,” Venkatachalam said.

Beyond the federal standards, his personal vision for the future includes technology that would allow patients to check in and out by a hand-scan device, introducing a new level of privacy for the patient.

CLICK HER FOR RELATED STORY

Regardless of the politics involved in President Obama’s Economic Stimulus Plan, recent legislation tied to this plan begins a long and complex expansion of foundation principles required for increased adoption and usage of electronic medical records by physicians and patients.

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MRI SCANNERS, or Magnetic Resonance Imaging scanners, like X-rays and CT scanners, are machines doctors use to take pictures of the inside of the body so that they can figure out what’s ailing you.

PET SCAN is 90 percent or better sensitive in detecting most cancers, especially solid cancers including lung, breast, head and neck, ovarian etc. In recent months, Medicare has expanded its coverage for PET scans to improve the diagnosis and care of patients with suspected or known cancers.

MRI doesn’t involve ionizing radiation like X-rays and CT scans. Rather, MRI takes advantage of something you already have in your body – water. Another benefit to MRI is its ability to generate three dimensional images in any orientation and at any depth in the body.

While X-rays remain useful for looking at bones, MRI scans are the diagnostic tool of choice for soft tissue – the circulatory system, ligaments, organs  and the spinal column and cord. MRIs help physicians identify multiple sclerosis, tumors, tendonitis, strokes and many other conditions. For most applications, MRI is far superior to other imaging tools in providing non-invasive images (and even chemical information) at high resolution.

MAGNETIC FIELD STRENGTH
The strength of the MRI signal is influenced by the “magnetic field strength” of the MRI magnet. The magnetic field strength of an MRI magnet is measured in a unit called the “Tesla (T).” For example, a 1.5 T MRI scanner has a field strength of 1.5 Tesla

1.5T MR vs. 3T: To most physicians and hospitals, 1.5T MR is the most reliable field strength. With a wide variety of coil options, 1.5T has the potential for better image quality across a variety of imaging applications in comparison to 3T. Imaging departments and imaging centers, like Rockledge MRI & PET Center, recognize that 1.5T simply has a more proven track record than its higher field strength cousin, the 3T.

A challenge for higher strength magnets is the interaction with metal implants such as stents, aneurysm clips and even prosthetic devices. With the Siemans 1.5T, Rockledge MRI patients who have these safety concerns are not an issue and imaging can be done without an increase in metal artifact.

“1.5T has now struck upon the highest level upon which you can achieve good imaging for the array of imaging applications, such as abdominal, neuro, cardiac, chest, spine, peripheral, and joint imaging—without one of those groups falling off the map,” according to Alan R. Moody, radiologist in chief, department of diagnostic imaging, at Sunnybrook Health Sciences Centre in Toronto. “The reason 1.5T is so successful is that it works for all of those applications,”  he says.

“As you go to the higher field strengths, because of the physics, some of the artifacts that you get start to impact on the image quality that you don’t get at 1.5T and you have to work harder to get your images out at 3T,” adds Moody.

Another limitation of 3T, and thus a benefit of 1.5T, is related to its energy deposition. 3T might enable faster and higher resolution imaging, however, the restriction is in how much energy can be put back into the patient.

“With 3T you have to ease back on the throttle, and you potentially lose some of the advantages you had of ramping up to that field strength in the first place,” Moody says, who adds that there seems to be a slight plateauing of that linear progression of the low field strength. Instead of racing to the next level in magnet strength, the imaging community has hit a plateau, staying strong with 1.5T MRI for its applicability across imaging applications.

SHORT BORE MRI VS. OPEN MRI
Many existing open MRIs are originally designed to accommodate larger or claustrophobic patients. Conventional MR scanners are cylindrical in shape, while an open MRI is usually open on two or three sides. Most claustrophobic patients want to automatically gravitate toward “Open MRI’s” without even considering other options.

While, a patient could use an Open MRI, these systems bring with them a couple of compromises. Scan times are much longer. Additionally, the image resolution offered by these systems can be less than optimal when certain parts of the body (most notably, the brain, vascular, abdominal and spine) are being scrutinized.

Rockledge MRI & PET Center

“Open MRI” scanners generally have field strengths of 0.2-0.3 T, and are considered to be “low-field” systems. “Mid-field” systems have field strengths of 0.5-1.0 T. “High-field systems” are MRI scanners that operate at or above 1.5 T.

Rockledge MRI & PET Center addressed this issue, with the Siemans Short Bore MRI, and enabled all patients a comfortable solution. Short bore systems are 50 percent shorter and five percent wider than conventional MRI setups.

These altered dimensions make for a much less claustrophobic experience for our patients. Scanning time is the same as with conventional MRIs. Best of all, short bore MRIs offer first-rate image quality with superior resolution.

Now, claustrophobic patients need not compromise. Rockledge MRI also offers oral and IV sedation and a patient may bring their own choice of music-all for added comfort.

Dr. Wasim Niazi

ABOUT THE AUTHOR

Dr. Wasim Niazi is a neurologist who has practiced in Rockledge, Florida for the last 15 years. Board Certified in Neurology, Pain Medicine and Electro-diagnostic Medicine, Dr. Niazi also has special interests in epilepsy with video and ambulatory monitoring, PET scan of brain for diagnosis of dementia  and Sleep Medicine.  Dr. Niazi has privileges at Wuesthoff and Cape Canaveral Hospital. For more information call 321-636-6599 or log on to www.RockledgeMRI.com.

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BREVARD COUNTY, FLORIDA – Launched in October of this year, Sushoo health information exchange has already proven its value to physicians.

SUSHOO: “It’s been a great communications tool,” said Dr. Rengena Chan-Ting, medical director of Care Level Management in Melbourne. Dr. Chan-Ting, the Network Medical Director of Care Level Management, visits Melbourne patients Alfred and Clara Yentzer.

“It’s been a great communications tool,” said Dr. Rengena Chan-Ting, medical director of Care Level Management in Melbourne.

Because Care Level Management specializes in home visits to medically frail patients, Chan-Ting already had at her disposal sophisticated electronic medical records capabilities that allows her to stay in touch with the Care Level team while on the field.

Sushoo, however, takes connectivity a step further.

“It’s made it easier for us to share patient information with primary care physicians,” said Chan-Ting.  “Before it was more of a one-way street.”

The eclectic sounding Sushoo is the brainchild of Melbourne entrepreneur Naveen Venkatachalam, who developed the product with input from his wife, physician Dr. Geetha Priyanka.

Venkatachalam owns DoctorsPartner, a company that developed award-winning electronic medial records and medical practice management software.

Venkatachalam

“DoctorsPartner provided the seed for the idea,” said Venkatachalam.

Sushoo, the first independent health care exchange in the United States, arrives at a very opportune time.
Embedded deep in healthcare reform is healthcare waste. According to a report from Thomson Reuters, up yo $850 billion is the tab for waste in the United States healthcare system.

Reuters estimates that 18 percent of healthcare waste is due to administrative inefficiency and redundant paperwork, both issues that Sushoo addresses by keeping all medical parties completely up-to-date on patient status.

“The idea is so innovative, because it minimizes redundancy and possible mistakes,” said Chan-Ting.
To combat duplication of services, the federal government has mandated medical practices to meet technology standards by 2011, rewarding those that do with higher reimbursements, while penalizing those that do not adopt specific EMR standards.

Dr. Priyanka

Because of these looming requirements, interest has been intense in Sushoo. Since Sushoo’s Oct. 2 launch, Venkatachalam and his Melbourne team have been busy customizing Sushoo to fit any type of medical location. “People love it,” said Venkatachalam.

One of the first to try Sushoo is Cathy Jones, medical secretary in the busy practice of Dr. Anthony Mazo-Mayorquin.

“It has made it very easy for us to go and pick whatever records I need (from another physician),” said Jones. “Before, we would have to call over and ask them to fax over the records.”

By providing an easy way to exchange records, Sushoo keeps all healthcare partners current on patients’ lab work, medications and diagnosis.  With paper records, primary care practices must either fax the information to a specialist or vice versa or wait for a patient to bring the hard copy at the next appointment, delaying care and often inconveniencing patients by forcing them  redo expensive medical tests.

“You also run the risk of wrong choice of treatment,” said Priyanka.

Using Sushoo, which is encrypted so only appropriate healthcare providers can access the information, allows access to all medical charts for all physicians working with a patient.

The United States lead the world in per capita spending on healthcare than any other OECD country, yet we are an unhealthy population fraught with obesity, heart disease and diabetes. Sushoo could be the part of the prescription.

Share Charts, Lab Results With a Click

The network’s most salient feature is its flexibility. As long as a practice has an EMR that can integrate with Sushoo, all physicians need do is click once to share charts, lab results and other clinical data. If a practice relies totally on paper records, it can still benefit from Sushoo through a gateway.

Venkatachalam designed the network to attract first-time users wary of investing large amounts of cash. “We’re using a simple design that is very inexpensive to use,” he said.

Before Sushoo’s inception, health information exchanges have been the domain of large multi-physician practices, but Sushoo levels the playing field so that all practices, no matter the size, can participate.

Practices that want to test run the network can participate at no cost. “We make it extremely easy,” said Venkatachalam.

For more information, log on to www.Sushoo.com or call 574-5245; 1-800-779-1723.

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ORLAND FLORIDA – As the national debate on healthcare reform rages, the University of Central Florida launched a new program that will prepare students for jobs considered essential to streamlining and improving health care.

Twenty-seven very diverse students are enrolled in the UCF’s new health care informatics 20-month master’s degree program. “We had tremendous interest in the program and received 42 applications,” said Interim Program Director Kendall Ward. PHOTO COURTESY OF UCF

UCF’s new healthcare informatics 20-month master’s degree program will educate students on the use of electronic medical records (EMRs) and the electronic exchange of information between organizations.

EMRs are considered a hallmark of the Obama administration’s efforts to modernize health care, said Aaron Liberman, chair of the Department of Health Management and Informatics and a founder of the new program, which is the first of its kind in Florida.

EMR systems allow health care providers to review, update and share a patient’s medical record using a secure computer network. They provide a more timely and efficient way to order medications and laboratory tests, improving health care delivery, reducing the need for paper records and potentially lowering costs.

“They’ll be able to use the information to recommend standards of practice for disease and injury management in both hospital and medical practice settings,” Liberman explained.

The students also will gain a proficiency in the management and analysis of large databases of health information. Identifying trends within this data is key to improving the overall quality, safety and efficiency of health care delivery.

Twenty-seven very diverse students are enrolled in the online program, which hoped to attract between 15 and 20 students.

“We had tremendous interest in the program and received 42 applications,” said Interim Program Director Kendall Ward.

Abdul Hai enrolled in the program because he saw the robust growth of the health care industry at a time when the economy is crashing. He spent more than 14 years working in information technology. But he never has worked in health care. By merging both, he plans to transition into the health informatics industry.

“There are not enough properly trained and educated Americans to fill the employment demands,” Hai said.

Jeremy Martin, who earned his undergraduate degree in biomedical sciences in 2008 has always had an interest in computer technology. He called this career the “perfect intersection” of his interests and hopes to work as a health informatics specialist at a hospital when he graduates.

Tuition for the program is $29,000 and some employers are encouraging their staffs to enroll and are providing tuition assistance. Recognizing the importance of informatics and the role it will play in the future of health care, Altamonte Springs-based NCG Medical Systems Inc. has established a $10,000 scholarship available to those who get into the program. The first NCG Medical Scholarship in Health Care Informatics will be awarded this semester.

“Helping talented students pursue their dreams of implementing the next generation of health care technology is one of our most important pursuits,” said Antonio Arias, vice president of business development for NCG Medical.

The health care informatics program will admit one class per year and has already begun recruiting its class for August 2010. Click here for information or  email kcortely@mail.ucf.edu.

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John Hitt

ORLANDO, FLORIDA (Sept. 7, 2009) – The University of Central Florida College of Medicine hosted the grand opening of their Clinical Skills and Simulation Center last week as UCF President John Hitt, and Dr. Deborah German, founding dean of the new College of Medicine, welcomed over 100 attendees, including all 41 of the med school’s inaugural class.

In her opening remarks, Dr. German affirmed that UCF – in collaboration with private industry, government, the military, and other UCF departments who have an expertise in simulation – is harnessing 21st Century technologies and educational concepts to bring a state of the art medical curriculum to the College of Medicine.

Dr. Deborah German, Founding Dean of the UCF College of Medicine, with SpaceCoastMedicine.com Editor-In-Chief, Dr. Jim Palermo (right) and Publisher Tom Palermo.

This year the Clinical Skills and Simulation Center will be housed on the Orlando campus in the Orlando Tech Center where 2,400 square feet includes four exam rooms, and has been developed to provide an environment in which students experience a rich variety of medical situations in controlled situations and scenarios without exposing real patients to possible risk.

All rooms are equipped with an exam table, and tools and devices to check ears, eyes, blood pressure, EKG and respirations.  State-of-the-art automated mannequins, avatars, virtual reality and other futuristic simulations are also strategically located in the center to give students hands-on experience that will better prepare them for the real world of medicine.

'First See, Learn About, Practice Many'

Dr. Moshe Felman, left, and Dr. Lynn Crespo demonstrate the high tech capabilities of their "dummy," David, in the UCF Emergency Care Simulator.

Dr. German emphasized that the traditional medical educational concept related to experiential participation in skills practiced and procedures done on live patients of, “See one, do one, teach one,” has, with the emphasis on skill simulation at UCF, become, “First see, learn about and practice many in the Clinical Skills and Simulation Center in preparation for interaction with real patients.”

In her remarks to the attendees of the grand opening, Dr. Laura Cuty-Ruiz, Director of the Clinical Skills and Simulation Center, emphasized that, “The utilization of simulation in our curriculum is one of the essential features of our medical education program, and using experiential learning and simulation will help us develop our future physicians’ communication skills, deepen clinical knowledge, procedural skills and critical thinking while providing them repeated experience to practice in a safe controlled environment.”

UCF's Dr. Maria Cannarozzi shows the capabilities of this high-tech mannequin which provides the opportunity for medical students to develop technical skills under clinical supervision.

High fidelity simulators and numerous part task trainers model the physiology of humans and facilitate training on specific skills (e.g., ear and eye exam, pelvic, breast, prostate and other intimate exam trainers).

Just as important, the fake and virtual patients created by avatars, computer based serious games and animations, will help train students how to talk to and glean information from patients during examinations and other procedures.

Randy Shumaker

“It lets students experience a rich variety of medical situations without bringing harm to anyone. It’s sort of a take off from flight training,” said Randy Shumaker, director of the Institute for Simulation & Training.

“You want to practice as many takeoffs and landings and be able to make mistakes, which you wouldn’t want to do when you’re really flying a plane.”

“The mannequins, web-based and computer-based aids are not intended as a replacement for a real patient,” said Cuty-Ruiz, who also recruits community volunteers to work as standardized patients — people who are specially trained to portray medical conditions from broken bones to heart conditions.

“But the high-tech tools provide opportunities for practice and learning early on,” she added. “They’re learning good technical skills under clinical supervision. That’s our ultimate goal.”

Students will use the Clinical Skills and Simulation Center as a critical piece of the integrated curriculum during all four years of their education. They can also take advantage of individualized instruction in areas where there is a need for additional practice or remediation.

SFC Paul Ray Smith

Paul Ray Smith Simulation and Training Technology Center

UCF collaborated with the U.S. Army, which has a research facility on campus, in the design of the robotic mannequins which are used by the military for field-training exercises.

Col. Craig Langerhauser

In his address to the crowd at the Clinical Skills and Simulation Center grand opening, Colonel Craig G. Langerhauser, the Director of the U.S. Army Simulation and Training Technology Center, extolled the heroics of the center’s namesake, SFC Paul Ray Smith, the first soldier to receive the Congressional Medal of Honor – the nation’s highest award for battlefield valor – for actions in Iraq.

The new UCF Medical College complex in Lake Nona will open in May of 2010 and include a markedly expanded 10,700 square foot Clinical Skills and Simulation Center consisting of a 2800 square foot Simulation Center, a 1,400 square foot Simulation Research Center, and a 6,500 square foot Clinical Skills Center with 12 exam rooms and two large training rooms.

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Kelly McLendon

BREVARD COUNTY, FLORIDA – Regardless of the politics involved in President Obama’s Economic Stimulus Plan, recent legislation tied to this plan begins a long and complex expansion of foundation principles required for increased adoption and usage of electronic medical records by physicians and patients.

This new legislation is called ‘The American Recovery and Reinvestment Act’ or ‘ARRA,’ and, while it is a massive piece of legislation reaching across multiple industries, the healthcare components are substantial.

Development and Adoption
Many who have worked in the medical record industry have been waiting for decades to have an increased governmental push towards adoption of electronic record systems. To date, development and adoption of these systems (of which there are many kinds of electronic medical records) has been an industry led initiative that has proceeded with fits and starts. The Act calls for electronic medical records for all patients by 2014.

Although there was development of computer software applications for use by physicians and nurses in the 1980s, widespread efforts by more companies did not commence until after the publication of the Institute of Medicine’s 1991 landmark report in which it was recommended that, for patient safety reasons, all physicians, nurses and patients should utilize electronic medical records.

During the nearly two decades since this report was published there have been dramatic improvements in technology, some electronic record adoption and increased laws protecting health information privacy (called ‘HIPAA’) – but by no means a stampede towards fully electronic medical records with the capability for information exchange between hospitals and physician offices.

It has become obvious that left to the non-mandated path of development it would take decades more to get all healthcare providers utilizing electronic medical records in ways that are beneficial to patient care and that increase the efficiencies garnered by computerized automation over paper based records.

For many years, advocates of more rapid adoption of electronic medical record systems pushed for regulations and funding to provide incentives for the design, development and implementation of automated healthcare records.

By strengthening privacy laws and providing critical funding to physicians and hospitals that will allow them to pay for the expensive new technology, the ARRA has removed some of the barriers to more extensive electronic record adoption

Medical Record Privacy

CURRENTLY THE MOST common types of health information exchanges are typically paper copies of paper medical records.

One of the greatest impediments to widespread adoption of electronic medical records by both physicians and patients has been fears of information breaches and other privacy concerns.

Several years ago, laws called The Health Insurance Portability and Accountability Act (HIPAA) were created to begin to tighten privacy, and are widely used by all healthcare providers to protect patients’ confidential healthcare information. The ARRA broadens privacy protections so that companies like Google and Microsoft can manage and make various forms of medical information more accessible using personal health records (PHR) via the web.

The Act also strengthens patients’ rights by including civil monetary penalties for people who breach medical information and increasing enforcement provisions.  Under provisions of ARRA, patients have the ability to request all incidences where their health information was released, copied or exchanged. These new protections go far to establish a much higher degree of medical record information privacy and security.

Health Information Exchange
To date, there has been very limited automated data exchange between hospitals and physicians outside local hospitals and their medical staffs. In today’s world the most common types of health information exchanges are typically paper copies of paper medical records.

These are inefficient at best and cause needless duplication of services.  For example, one physician simply may not know of a test that was completed on a patient earlier by another provider or that a diagnosis for a particular condition had been made.

The specific systems that will foster and ultimately allow increasingly automated data interchange of electronic medical record information are still very much in their infancy.  However, the foundations of privacy, better defined system requirements and monetary incentives built into ARRA are expected to drive increasing electronic medical record development and medical record data interchange between providers of care over the next few years.

MANY WHO HAVE worked in the medical record industry have been waiting for decades to have an increased governmental push towards adoption of electronic record systems.

Incentives For Adoption of Electronic Medical Records
ARRA creates funding mechanisms for incentives to be paid directly to hospitals and physician practices that adopt and have “meaningful use” of electronic medical records by 2014.

Conversely, penalties will begin to be applied in 2015 for providers of care that do not move to these electronic records. The premise is that, over time, electronic records will reduce the cost of medical care and increase the efficiencies of the administrative processes that surround medical information generation and usage.

Because electronic medical record systems cost tens of thousands of dollars for physician practices and millions for hospitals, the funding opportunities and usage mandates in the ARRA complete the circle to induce providers to invest in electronic record systems.

Increased Educational Opportunities
A key part of ARRA is the expansion of grants and other monies that will enhance college level programs that teach Health Information Management  (HIM-management of medical records) and Information Technology – Healthcare Informatics, which covers healthcare computer systems and the data contained within them.

The provisions and mandates in ARRA require a markedly increased pool of trained professionals to design, develop and manage the projected proliferation of automated record systems.  Grants and expanded HIM and Healthcare Informatics educational programs and curriculum are expected to shore up a work force which currently is understaffed relative to the requirements projected for the expansion of future electronic records.

There are currently programs in Medical Records (HIM) and Healthcare Informatics that are for two (A.S.) and four year (B.S.) degrees at institutions like the University of Central Florida, Daytona Beach Community College and St Petersburg College, but there are few Masters degree level and shorter certificate courses. The new Act broadens the opportunities in all of these areas.

Anyone considering a career in healthcare information should investigate these programs.  There are already some scholarships and grants available, and many believe the amount of this education assistance will be dramatically increased with ARRA funding.

Stay tuned for more information on ARRA and its impact in the local community and amongst our healthcare providers as they move towards increasingly automated electronic records for their office and in the hospitals.

CLICK HERE FOR RELATED STORY

DR. GEETHA PRIYANKA, a Melbourne, Florida  internist, and her husband, Naveen Venkatachalam, are ahead of the curve in terms of innovative electronic management of patients’ healthcare information.  CLICK HERE to read the story in Space Coast Medicine & Healthy Living Magazine.

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“I check on my parents any time and all the time. They make daily entries about how their day is going, what they did, and how they feel. I keep them updated with family pictures, messages, and how my day is going. We are building our virtual network of support.” - Dr. Annie Becker, assistant dean of research at Florida Tech’s College of Business and president of the school’s Women’s Business Center

OurVNS.com promotes health and wellness for families with members who are scattered all across the world

AFTER AN elderly Viera, Florida resident heard of Dr. Annie Becker’s research on using technology to assist caregivers of older adults, the man, who had been caring for his wife, approached the Florida Tech professor for help.

“He asked for a way to connect him to his  daughter-in-law to help with distance caregiving,” said Dr. Becker, assistant dean of research at Florida Tech’s College of Business and president of the school’s Women’s Business Center.

Becker knew what the man was going through, for she herself was geographically distant from a family growing increasingly frailer with each passing year.

As a Baby Boomer, she also realized that her health would soon require more of her attention.  “We’re at an age when we need to be proactive about our own health,” she said.

Like most families, Dr. Becker’s has its share of health conditions. Her aging parents both have health issues, yet phone calls back home  didn’t address those concerns. “Phone calls and e-mails to family back home are mostly about the weather, kids or birthdays,” said Becker.

Based On Years of Research
Moved by the man’s plight, Becker developed OurVSN.com, a free virtual support network site where family members and friends can track each other’s health.

DR. MARY BETH MINSER combined forces and research with her sister, Dr. Annie Becker, to bridge the technical divide that still exists with older adults. “It was designed with an aging population in mind.”

Becker combined her research on bridging the technical divide that still exists with older adults with the hands-on experience of her sister, Minnesota chiropractor Dr. Mary Beth Minser. “We joined forces to see how technology could be used for aging caregivers,” said Becker. “The idea for OurVSN.com is based on my years of research regarding technology for older adults. My sister urged me to take my ideas and turn them into a social network site so others could benefit from them.”

Anyone with a computer and Internet access can connect with the site to track aspects of their health, post pictures, blog on health issues and join community forums. “The basic idea is to let the user privately track personal health and wellness,” said Minser. “He or she decides what to share with others in a virtual support network.”

Users can be part of multiple networks that include immediate family, extended family and friends, as well as other individuals experiencing similar health issues.
The result is a site similar to Facebook or My Space, but focusing on promoting health and wellness for families whose members may be scattered across the world. “It connects families for their health and wellness,” said Dr. Becker. “It was designed with an aging population in mind.”

Site users can be caregivers or persons struggling with a health condition. It’s particularly useful for individuals suffering from chronic conditions such as fibromyalgia. “If you have a chronic health problem, this site is for you because you have to track so many things,” said Becker. “You are able to build a network.”

To assure the site’s ease of use, Dr. Becker used her own parents as test cases, since her father, a farmer, and her mom, a factory worker, were decidedly not techno groupies. “If my parents can use it, anyone can use it,” she said.

TO ASSURE the site’s ease of use, Dr. Becker used her own parents as test cases, since her father, a farmer, and her mom, a factory worker, were decidedly not techno groupies. “If my parents can use it, anyone can use it,” she said.

Her father, who suffers from advanced heart disease, records his blood pressure and pulse daily. Her mom discusses the quality of her day.  “It’s an opportunity for me to check on them,” said Dr. Becker. “If my mom rates her day as only fair, I can try to find out why.”

For Dr. Minser, who is her parent’s primary caregiver, the site offers support from siblings many miles away. “I’m starting to share in the caregiving,” said Becker. “I’m starting to share the load.”

Although she primarily intended the site for adult children with aging parents, Becker has discovered that OurVSN.com is also useful for younger families.

Becker’s teenage daughter, a freshman at the University of South Florida, suffers from chronic asthma. Through her daughter’s comments in the site, Becker learns how her daughter is coping with the disease. “I get to see her entries and they become a way of staying connected at all levels,” said Dr. Becker.

“I think there are a lot of parents out there who could use this. This is a unique opportunity to get involved and stay connected anytime, anywhere and for free. It does bring families together.”

To visit the site, log onto OurVSN.com

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THE DIAMONDBACK 360 device is ideally suited to treat patients with peripheral arterial disease.

DOCTORS AT Parrish Medical Center in Titusville, Florida have a new weapon in their arsenal in the fight against vascular disease.

Blocked arteries in the legs, difficult to clear with previous devices, now can be treated with the Diamondback 360 Orbital Atherectomy System. The technology uses a diamond-coated crown that orbits when guided through an artery, a more effective technique for removing the hard, calcified plaque that tends to gather in the leg.

The instrument is at home in the hospital’s new $10 million cardiovascular studio, in use since August. The 11,000 square-foot expansion to the hospital includes two catheterization suites.

THE PARTICULATE generated from the Diamondback 360° is 10 times smaller than the pore size of the smallest distal protection device.

The device is ideally suited to treat patients with peripheral arterial disease (PAD), a condition that often manifests with calf or thigh pain and leg fatigue. Patients might notice a change in color or numbness in their feet. The condition can be confirmed through a simple screening test that checks blood pressure in the ankle.

PAD is not exclusive to the elderly but also can affect young people, especially if they smoke. The condition is characterized by a buildup of plaque on the interior walls of the arteries that causes the arteries to harden and narrow, reducing blood flow to the legs and feet. The condition is complicated by the fact that more than half the blockages in the lower legs contain difficult-to-re move calcium.

A magnified look at the diamond-coated crown that orbits when guided through an artery.

Joe Flynn, MD

“The nemesis of the legs, below the knee especially, is calcium,” said Dr. Ravi Rao, an interventional cardiologist at Parrish. He and Dr. Joseph Flynn, an interventional radiologist at Parrish, were among the first in Central Florida to offer the treatment option. The Diamondback 360 system, by Minneapolis firm Cardiovascular Systems Inc., won FDA approval in late August.

Dr. Rao explains that, “Other devices work well for removing plaque, but are not as effective against hardened calcium deposits and not necessarily well-suited to use in the leg.” Inserting a balloon to make room for a stent, for example, is an effective technique for treating arteries of the heart.  “A leg artery, however, would be compressed by muscles when the patient walked, and the stent would collapse,” Dr. Rao points out. Lasers offer less control over speed and direction, and other plaque-gathering devices either are less effective against calcium, pose greater risk of damaging the vessel wall, or don’t create a large enough opening in the artery.

To use the system, the doctor first inserts a wire through the artery, which serves as a guide for the device, and controls the instrument while monitoring a screen showing its progress. The Diamondback 360 moves through the artery, using the principle of centrifugal force to remove plaque layers. As the crown rotates in elliptical fashion at increasing speed, the force presses the diamond-coated surface against the clogged artery walls. The increasing crown orbit creates a larger opening than other techniques, and the gritty surface of the diamond coating pulverizes calcium so that it can be absorbed by the body’s cells and no longer block blood flow.

Before the device, a patient with extensive calcium blockages would be a candidate for surgery.  Now, doctors are able to use a much less invasive procedure to improve vascular health and possibly save the patient’s leg. “That’s huge in quality of life,” Rao said.

THE 411 ON PERIPHERAL ARTERIAL DISEASE (PAD)

Sometimes called a heart attack of the leg, PAD is a life-threatening condition in which a fatty material – plaque – builds up on the interior walls of the blood vessels that carry blood from the heart to the legs and arms. Lower extremity PAD can be an early warning sign of vascular disease elsewhere in the body.

• Between 8 million and 12 million Americans have PAD
• One in three diabetics over age 50 is likely to have PAD.
• PAD patients are at six to seven times greater risk of coronary artery disease, heart attack, stroke or transient ischemic attack -  also known as a mini stroke.
• For more information on PAD CLICK HERE.

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MRI BREAST COIL TECHNOLOGY, shown here at Wuesthoff Health System, is especially useful in detecting small tumors in women with dense breasts, which are composed of more connective and epithelial tissue and less fat than less dense breasts.

TWO NEW TECHNOLOGIES, the MRI Breast Coil and Ethicon Biopsy Probe are now available to women on the Space Coast.

THE MRI BREAST COIL and its accompanying software works in conjunction with MRI (magnetic resonance imaging) equipment  to spot small tumors that can be missed by mammogram and ultrasound tests.  If a suspect tumor is detected, the biopsy probe is used with a special viewing station and imaging for exact placement of the biopsy needle to determine if a small tumor is benign or malignant.

Wuestoff Health System recently installed this equipment which enhances the ability to diagnose difficult to detect breast tumors in high-risk patients. Catching cancerous tumors when they are small allows for less-burdensome treatment options and a better prognosis, says Dr. Paul Isenbarger, M.D., radiologist and chief of interventional radiation for Wuestoff Health System.

The MRI Breast Coil technology is especially useful in detecting small tumors in women with dense breasts, which are composed of more connective and epithelial tissue and less fat than less dense breasts.

“We used this technology to test my mother, who had had breast cancer four years ago, and found a small tumor that had been missed by both a mammogram and ultrasound,” Isenbarger says.

Isenbarger’s mother, Margot Jensen, now is undergoing hormonal treatment to keep the tumor in check. “A mammogram and ultrasound are both important tests that can’t be replaced by a MRI Breast Coil test, but the MRI Breast Coil is better for detecting smaller tumors in many cases,” Isenbarger says. “It’s important to use these tests in conjunction, especially for high-risk patients.”

Mammograms, unlike the MRI Breast Coil, for example, can detect calcifications, which are footprints for cancerous tumors. The American Cancer Society recommends women with a high-risk for breast cancer receive annual MRI tests as well as mammogram and ultrasound tests. High-risk women include those who have previously had breast cancer or have a mother or a sister with breast cancer.

Availability of the New Technology is Windfall

Dr. Isenbarger pushed for the new MRI Breast Coil technology after first learning about it at a conference several years ago. Some insurers will pay for the MRI Breast Coil test for high-risk patients. The cost for the test for those who self pay is approximately $1,500. Because the MRI Breast Coil test is more sensitive, there’s an increase in the number of biopsies that show the suspect tumor to be benign, Dr. Isenbarger says. “Anytime a test is more sensitive there will be more false positives,” he says.

The best time for a pre-menopausal woman to be tested is between the seventh and 14th day after their monthly cycle. Women who have a pacemaker or any other embedded electronic device are not candidates for the MRI Breast Coil test. A sedative can be prescribed for women who are concerned they may become claustrophobic during the enclosed MRI test.

“The local availability of the new technology is a great windfall for those who would otherwise have to travel for their MRI testing and biopsy,” said Gordon Hessie, Diagnostic Imaging Director for Wuesthoff Health System.

The addition of the new technology was made possible by the Wuesthoff Health System Foundation. For more information call  321-636-2211.

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A new and innovative radiosurgery system designed to treat tumors anywhere in the body with sub-millimeter accuracy.

An 80-year-old woman with cancer in both lungs had no chance of having surgery because of her poor health and medical condition. Typically, this diagnosis meant she would have to endure about six weeks of radiation to treat the tumors in her lungs, possibly worsening her condition and drastically changing her quality of life.

But the physicians at the Cancer Care Centers of Brevard (Florida) offered her an alternative - CyberKnife Robotic Radiosurgery, a revolutionary non-invasive procedure that delivers concentrated beams of radiation to targeted areas. “We recommended that she be treated with hypo-fractionated radiation treatment to both lung tumors simultaneously,” explained Dr. Ravi A. Shankar, a radiation oncologist with training in stereotactic radiotherapy and radiosurgery. He has been using the CyberKnife system since June.

The woman consented to the treatment, which was administered over a period of just three days. The results: “She is now three months post-treatment and recent radiological investigations show good response to the treatment,” Shankar said. “Plus, from a quality of life standpoint, the patient is able to get along with no changes to her previous lifestyle.”

Always at the forefront of innovative treatments and technologies when it comes to treating cancer, Cancer Care Centers of Brevard is accustomed to providing patients with top-notch, excellent care. But with the addition of the CyberKnife Robotic Radiosurgery System, the center now offers patients a targeted, painless alternative to surgery and opens up a treatment option for those whose tumors and lesions were diagnosed as “inoperable” or otherwise untreatable.

The system treats tumors and lesions on the skull, head, neck, lungs, pancreas, prostate, spine, kidney and liver as well as melanomas. “I think this is a great technology,” said Radiation Oncologist Todd V. Panarese, M.D. “With the CyberKnife, we can certainly treat more tumors in areas that were either not possible before or that we went into with great trepidation because of their location,” he said.

Dr. Silas Charles

Silas J. Charles, MD, founder of the Cancer Care Centers of Brevard was the mastermind in bringing the CyberKnife to Brevard and Indian River Counties, Florida.  The CyberKnife radiosurgery system was created by industry leader Accuray, Inc. and is approved by the FDA.

• Physicians on staff are highly trained in CyberKnife operations and the center treats patients in a state-of-the-art CyberKnife suite.
• During the treatment setup, patients undergo a pre-treatment CT scan and/or MRI to gather information on the size, shape and location of the tumor or lesion. Physicians then work with the surgeon to determine the correct dosage of radiation and where on the body the radiosurgery should be performed.
• The information is uploaded into the CyberKnife’s computer software, which then locates the position of the tumor within the body through the use of image guidance cameras similar to those used for cruise missile guidance.
• The CyberKnife then uses a miniature linear accelerator mounted on a robotic arm to deliver concentrated beams of radiation to the targeted tumor. The dose of radiation is high enough to control or kill the tumor cells while minimizing radiation exposure to surrounding healthy tissue.
• The system is highly accurate, down to a sub-millimeter, which is perfect for achieving surgical-like outcomes for lesions of the brain and spine. Because it is non-invasive - with no pain, blood loss or sedation during treatment - it has significantly fewer complications than traditional open surgery.

Plus, the CyberKnife system considerably shortens the duration of radiation treatment, Shankar said. “Even though we have no long-term data, we see that the side effects from this form of treatment are considerably of shorter duration. There is less recovery time so that patients tend to get back to their normal lifestyles quicker,” he said. “They are also happy that the radiation treatment is not such a prolonged course as it normally is with the standard forms of radiation treatment,” he added.

CYBERKNIFE’S computer software locates the position of the tumor within the body through the use of image guidance cameras similar to those used for cruise missile guidance.

Two added features to the CyberKnife system are its Synchrony Software and Xsight Lung Tracking System. Synchrony uses a complex system of cameras, motion-tracking software, fiber-optic sensing technology and infrared emitters to accurately deliver radiosurgery to soft-tissue tumors, such as lung, pancreas, kidney, and liver lesions. The Xsight Lung Tracking System uses sophisticated image processing and registration techniques to directly lock onto and track tumors throughout the treatment.

Panarese said the CyberKnife Robotic Radiosurgery System gives the Cancer Care Centers of Brevard a “new tool in our arsenal to treat cancer.”  Patients’ responses to the radiosurgery system have been overwhelmingly positive, he said. “I’m finding that patients are now requesting more information on the CyberKnife in anticipation of receiving treatment with it,” he said.

Shankar added that patients are informed beforehand that the CyberKnife treatment is a relatively new technique with no long-term data. “However, the short-term results from various centers show that it is equivalent to the standard forms of radiation treatment,” he said.

“With more and more people undergoing this form of treatment and the data continuing to be good, this may become the standard form of treatment for many cancers.”

The CyberKnife is located at the Cancer Care Center, 1430 South Pine Street in Melbourne, Florida.  For more information, please call  Mary Markisen at 321-951-9959 or log on to CancerCareBrevard.com

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