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PHYSICIAN SPOTLIGHT PAGE 2
SHARE allows care teams to coordinate patient care with other providers
By BECKY GILLETTE
Nanotechnology Showing Promise for Multiple Diseases UAMS laser-based device has wide ranging implications for cancer research, diagnosis and treatment Rarely does a new medical device show promise across broad areas of disease diagnosis and treatment ranging from cancer to cardiovascular disease, stroke and infections ... 4
Family Doctors Urged To Encourage Women To Remember Pap Smears Is cervical cancer a victim of successful treatment? In the past an abnormal Pap smear was a frightening diagnosis that often led to treatments in cases where the abnormalities might have cleared up naturally. Now that doctors have more tools at their disposal ... 5
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SHARE: Progress Connecting Multiple Providers with EHRs One of the more frustrating aspects for some healthcare providers in adopting Health Information Technology (HIT) is that in some cases the adoption of HIT has resulted in more paperwork than in the past. Even providers in the same town using the same vendor end up having to fax Electronic Health Record (EHR) information if their systems are not set up to share information electronically. Fortunately, there is a solution. Allowing easy sharing of health information between different hospitals, clinics and physicians is the mission of the State Health Alliance for Records Exchange (SHARE), which has been working to coordinate HIT activities throughout Arkansas and in neighboring states. SHARE allows care teams to coordinate patient care with other providers to share critical information about patients to the entire care coordination team across all stages of care. (CONTINUED ON PAGE 8)
HealthcareLeader Bradley Jefferson Walsh, MD Ashley County Medical Center Chief of Staff By BECKY GILLETTE
CROSSETT – One of the best strategies for helping fill critical shortages of physicians in rural areas of the state is to “grow your own.” Bradley Jefferson Walsh, MD, chief of staff at the Ashley County Medical Center (ACMC), is a perfect example of that. He grew up in Crossett hunting, fishing, and enjoying the great outdoors living in a county with two National Wildlife Refuges.
After graduation from the University of Arkansas for Medical Sciences (UAMS) School of Medicine in 2006 and completion of a family practice residency at the Area Health Education Center in Pine Bluff in 2009, it was a natural fit for this Natural State native to come back home. Walsh grew up in medicine as the son of family practitioner Benjamin Walsh, MD. Today the two practice across the hall from each other (CONTINUED ON PAGE 8)
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Alan Wilson, MD
Immediate Past President of the Arkansas Medical Society By BECKY GILLETTE
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CROSSETT – Alan Wilson, MD, has plenty of demands on his time being a general surgeon practicing in rural Arkansas where all types of doctors, including surgeons, are scarce. He is also married with five children. But Wilson has found time to take on volunteer responsibilities as president of the Arkansas Medical Society (AMS), a group established in 1875 that represents 4,300 physicians in the state. Wilson’s goals during his term as president include helping physicians come together to navigate the rapid changes in healthcare with the reforms brought about by the Affordable Care Act (ACA). No one is completely satisfied with the ACA, but the AMS strongly advocated the extension of private health insurance coverage to working families earning below 138 percent of the federal poverty level. “Here in Crossett and Ashley County, the Medicaid expansion has really helped because we previously had a significant number of uninsured patients, and now we don’t see nearly as many,” Wilson said. “Before, patients without healthcare coverage delayed seeing physicians for health problems. If we can see patients earlier on in the progression of their disease, and prevent serious complications later, we are improving health overall. There is less of a drain on the medical system in general because costs are lower. For employers, they have healthier employees with increased productivity, and less sick time.” Wilson said in the past his surgery schedule used to be slower in January and February. But this year, thanks to more insured patients, the clinic stays busy even in the dead of winter. There are concerns about people who abuse the system, and visit the doctor too often. But Wilson, who has 22 years of experience as a surgeon, said that can happen regardless of the patient’s insurance status. Other priorities during his term as president include advocating for responsible and practical reforms such as patientcentered medical homes and establishing a prescription drug monitoring program to combat abuse and diversion of prescription drugs. AMS members have also been successful advocating the establishment of a statewide trauma system and passage of the Clean Indoor Air Act. Wilson grew up in Houston, Texas, and knew from an early age that he wanted to be not just a physician, but a surgeon. That inspiration came to him in sixth grade when his school nurse took his class to the Texas Medical Center to watch open heart surgery.
“I can still remember them lifting the lungs up so we could see, and I knew then I wanted to be a surgeon,” Wilson said. “I was enjoying myself so much. It was fascinating. From that age on, becoming a surgeon was my goal. I made sure I took the right classes, and got good grades.” Wilson attended medical school at the University of Texas Branch at Galveston, Texas, and did his surgical residency in Detroit, Mich. For a couple of years he worked for a group practice in Corsicana, Texas, which is near Houston. His goal was to be in private practice, and he wanted to live in a small town. So when the opportunity came up to go into practice in Crossett, he didn’t hesitate. “I’ve been working my way down to smaller places,” Wilson said. “They were building a new hospital, they needed a surgeon, and I jumped at the opportunity. We have been here 17 years.” Many physicians prefer living in big cities, but Wilson said they are only a sixhour drive from Houston, and the Internet means you don’t have to be isolated from the world living in a small town. Wilson has been married to Stephanie Wilson for 32 years. They have daughters who are 25 and 26, sons who are nine, ten and 11, and a four-year-old granddaughter. His hobbies include computers, being a ham radio operator and a private pilot. He also is a deer and squirrel hunter. “I find that quite enjoyable,” he said. “Sitting out in woods where it is quiet and no one is bothering you is very nice.” arkansasmedicalnews
ARKANSAS on the MEND
BY BECKY GILLETTE
Give Me A Chance Equine Rescue Provides Loving Care for Abused, Neglected Horses Couple funded the rescue effort the first year before finding others to help
The horses had taken a dip in the pond and were taking off in a trot. Black Jack is bringing up the rear still shaking water out of his big ears.
By BECKY GILLETTE
MANCHESTER – Polly Cates was horse crazy when she was a little girl, and really wanted a horse of her very own. That dream wasn’t realized growing up in Vermont because the winters are so brutally cold. But now Cates cares not just for one horse, but 31 horses and a few donkeys as part of the operation Give Me A Chance Equine Rescue that she and her husband, Tom Cates, took over in 2010. The couple got started with horse rescue on Valentine’s Day 2010 when they decided their gift to each other would be to donate $100 worth of feed to an existing horse rescue operation. When they arrived, they found the owner of the operation struggling to take care of the horses. They drove back home very distraught, and decided to do all they could to help. Later, after seeing how committed the Cates were, the woman running the rescue operation turned it over to the Cates. “My husband is a disabled Vietnam veteran, and at first he footed the bill for caring for the horses from his veteran income,” Polly said. “He is the one who primarily carried the load financially.” “The first year it was pretty tough,” Tom said. “It took a lot of money to feed the animals, about $800 per month.” After they got the horses in good shape, the couple bought a piece of property in Manchester community about ten miles from where they live in Arkadelphia. That is where the rescue is located now.
How can you help? • Make a tax-deductible donation to the 501(c)(3) organization either on their Facebook page www.facebook.com/ GiveMeAChanceEquineRescue or website www.givemeachancee quinerescue.org/ • Donate good quality hay, feed, dewormers, salt blocks or other supplies.
“We have a successful rescue running now,” Tom said. “We are not buying everything ourselves. It is supporting itself. We do fundraisers, and get grants from organizations. We have a lot of people pulling for us. My wife does the evening feedings and care, and we have a good bunch of volunteers who do morning feedings and other labor things needed on the ranch. People like coming and seeing how good the horses look, how calm and friendly.” Tom stays busy, too, doing all the driving with hauling horses and hay and doing farm checks and investigations to meet their mission to take in starved and abused horses. Often law enforcement is involved initially, and Tom Cates with Simon, one of the rescued horses. then the horses are placed with the Cates. At times they take in owner surrender in freezing weather wading knee deep in horses when the owner has fallen on hard mud, I say, ‘Why am I doing this?’” she said. times. “I’m needed. That is why I’m there. I’m the The work with horses is physically mama to feed these horses every evening. strenuous. Wouldn’t Polly rather go home They get fed before us. It is very hard work, and relax after a day of painting? but thankfully the construction work put me “Some days when out I am out there in shape to do physical work moving 55-gal-
lon plastic barrels of feed every day. It is stressful some days. We just had to euthanize one. She was in pain. That is the hard part of rescue.” One of the highlights of their work is adoptions. “It is magical to see an owner connect with a horse, and see the chemistry and partnership,” Polly said. “Most of our horses were starved or abused, so we are very careful with adoptions. We have a three-page adoption application that requires references, and information about their property and their veterinarian. We drive to their property, ask lots of questions, and only let them adopt if everything checks out.” In addition to the horses, they have several donkeys who serve as greeters for guests—and as guards. Donkeys are very territorial, and are good at running off coyotes, dogs or other predators. That is particularly important for handicapped horses. “Plus, the donkeys are pets,” Polly said. (CONTINUED ON PAGE 7)
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Nanotechnology Showing Promise for Multiple Diseases UAMS laser-based device has wide ranging implications for cancer research, diagnosis and treatment By BECKY GILLETTE
Rarely does a new medical device show promise across broad areas of disease diagnosis and treatment ranging from cancer to cardiovascular disease, stroke and infections. But that is the case with translational research being conducted at the University of Arkansas for Medical Sciences (UAMS) by a team led by Vladimir Zharov, PhD, DSc, director of the Arkansas Nanomedicine Center at UAMS. Zharov and his team of researchers inject a cocktail of magnetic and gold nanoparticles with a special biological coating into the bloodstream to target circulating tumor cells (CTCs). A magnet attached to the skin above peripheral blood vessels can then capture the cells. “By magnetically collecting most of the tumor cells from blood circulating in vessels throughout the whole body, this new method can potentially increase specificity and sensitivity up to 1,000 times compared to existing technology,” Zharov said. “Once the tumor cells are targeted and captured by the magnet, they can either be microsurgically removed from vessels for further
Dr. Vladimir Zharov
genetic analysis or can be noninvasively eradicated directly in blood vessels by laser irradiation through the skin that is still safe for normal blood cells.” The clinical prototype device was used in trials involving melanoma and breast cancer. Zharov said indications are that the device will represent a huge step forward because cancer is most easily and effectively
treated if it’s found at a very early stage. Zharov’s team demonstrated that periodic laser irradiation of blood vessels decreases the level of metastatic CTCs more than 10 times and eventually led to an interruption of metastasis development in distant organs. “Further study could determine whether these new cancer treatments are effective enough to be used alone or if they should be used in conjunction with conventional cancer therapy,” Zharov said. The potential for cancer alone is huge considering the fact that most cancer deaths are the result of metastasis due to the spread of tumor cells from the primary tumor through the blood. But there are also other very promising applications. “The nanomedicine-based approach to read and treat whole blood in the body with nanotechnology seems to be universal, with further development holding the promise for the diagnosis and treatment of many diseases, including infections or cardiovascular disorders to prevent stroke and heart attack,” said James Suen, MD, chairman of the UAMS Winthrop P. Rockefeller Cancer Institute’s Department of Otolaryngology, Head and Neck Surgery. The prototype that uses “in vivo flow cytometry” has demonstrated in a pilot clinical trial that it can safely and noninvasively detect melanoma CTCs directly in patients’ blood vessels at sensitivity rates up to 300 times greater than conventional tests of blood drawn from the body. The patient trial was run by Laura Hutchins, MD, a UAMS hematologist and medical oncologist. A breakthrough using the technology was made by a member of Zharov’s team, Ekaterina Galanzha, MD, PhD, DSc, who demonstrated its ability to label and track individual CTCs as they circulate in the bloodstream. This discovery, using “photoswitchable flow cytometry,” could help shed important new light on the behavior of CTCs. Galanzha said the research should help fill the gaps in understanding by researchers of the basic mechanisms of CTCs, such as where they’re likely to go, which cell’s behavior contributes to metastasis, and how rapidly cancer cells shed from primary tumors into the bloodstream. Conducted in collaboration with Albert Einstein College of Medicine in New York and published in Chemistry & Biology, Galanzha’s study focused on CTCs with photoswitchable proteins. This approach was chosen because unique proteins within the individual CTCs reveal themselves when exposed to laser light. When a CTC passes through the laser beam, it changes from green to red. The red color becomes the CTC’s
permanent “label,” enabling researchers to track it as it moves through the body’s blood vessels using the principle of in vivo photoswitchable flow cytometry. “The cell proteins are genetically encoded, so when the labeled cells invade organs and divide, they get their green color back again,” Galanzha said. “This allows us to distinguish dividing and potentially metastatic cells from dormant cells, which keep their red color. It’s amazing.” Having the ability to track individual CTCs over time should capture the imaginations of scientists looking to unravel the mysteries of metastatically aggressive cells, Galanzha said. “Photoswitchable flow cytometry opens the door for a new bio-technical platform for basic research and possible clinical applications,” she said. For cancers that lack the photoswitchable proteins, Zharov invented artificial photoswitchable nanoparticles to detect and label their CTCs. The final destinations of labeled cells can be tracked and controlled by photoacoustic imaging in Zharov’s laboratory. Zharov hopes that someday the same device he is using to identify and label CTCs in humans can be recalibrated to kill the cells, making his device a “theranostic” instrument. “Theranostics” refers to procedure with combined diagnostic and therapeutic capabilities. “That’s our next ultimate goal, to treat patients using our technology,” Zharov said. “It is a single technology that can be used for treatment and for guiding treatment. The same laser can be used to kill the cancer cells. We’ve already demonstrated that in animal models.” Other members of the team include Dmitry Nedosekin, PhD, a biochemical engineer; Yulian Menyaev, PhD, a biomedical engineer; and Mustafa Sarimollaoglu, PhD, a software specialist. Zharov’s team collaborates productively with other UAMS scientists and departments including Mark Smelters, PhD, Dept. of Microbiology and Immunology; Robert Griffin, PhD, Dept. of Radiation Oncology, and Nancy Rusch, PhD, Dept. of Pharmacology and Toxicology. Currently several patents are pending on Zharov’s technology, which his team is refining for a more portable device that will offer real-time analysis. Zharov has an agreement with Cyto Wave Technologies, a company that has preliminary plans to bring the commercialized technology specifically for melanoma diagnosis. Research is currently supported by grants from the National Institutes of Health totaling about $3 million, and the UAMS Translational Research Institute, $50,000.
Go online to http://cancer.uams.edu/news/?sid=2&nid=10375 4
Family Doctors Urged To Encourage Women To Remember Pap Smears Is cervical cancer a victim of successful treatment? By BECKY GILLETTE
In the past an abnormal Pap smear was a frightening diagnosis that often led to treatments in cases where the abnormalities might have cleared up naturally. Now that doctors have more tools at their disposal such as testing for high-risk Human Papillomavirus (HPV), women are often advised to take a “wait and see” approach by having repeat testing to see if dysplasia has resolved. While it is positive that women aren’t risking scarring, infertility, stress, the expense, and the need to take time off work for a medical procedure that isn’t necessary, the flip side is that some women are so unconcerned that they fail to make follow-up Pap smear appointments. The problem is also visibility. While most women know multiple other women with breast cancer, it is rare to know a woman with cervical cancer – particularly someone who has died from it. “In the early 1900s, cervical cancer was the number one cause of cancer deaths of women,” said Kristin Zorn, MD, director of the Division of Gynecologic Oncology at the University of Arkansas for Medical Sciences (UAMS). “Because of advancements in treatment, it is much less common to have a woman die of cervix can- Dr. Kristin Zorn cer than in the past. The issue has fallen off the radar screen because people don’t know many women who have died of cervical cancer. It is not as visible to people. It is not hitting them where they live. That is why we need to raise awareness of the people who are still being affected by it.” Doctors are less likely to issue stern warnings to a woman regarding the need for follow-up appointments. “In a way, better knowledge of detection and treatment of cervical cancer has been a victim of its own success,” Zorn said. “I think there is confusion, and some of this is the fault of us in the medical community. A big part of the success with Pap smears was for them to be repeated over time so we could see if it was clearing up or getting worse. To encourage patients to keep follow-up appointments, doctors might put the fear of God in them. Now doctors are less likely to do that. And it can backfire.” Doctors explain to patients that they have low grade dysplasia, and not cervical cancer and pre-cervical cancer. Women are told not to worry too much, that is might clear up on its own. “We know a lot more about HPV now,” Zorn said. “We know many people infected with HPV will recover and they arkansasmedicalnews
won’t have to be treated. The woman’s immune system will kick in, and get control. Before, we jumped in and treated a lot of women who, now in retrospect, could have waited and their body would have healed on its own. Now if we do a HPV test at the same time and find the
worrisome types of HPV are not present, a patient can be followed rather than having biopsies or other treatment of the cervix. When there are abnormal cells and high risk HPV present, women are more at risk for severe dysplasia or true cervical cancer.”
At times procedures such as biopsies or cervix cryosurgery can lead to two issues: scarring that impairs fertility because sperm can’t travel up to the uterus, or the cervix is weakened so that it dilates too early in pregnancy, which can result in (CONTINUED ON PAGE 10)
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Population Health Advances Physicians are buzzing about the new healthcare paradigm By JULIE PARKER
America’s independent physicians met mid-March in San Antonio, Texas, for the 20th annual national meeting of TIPAAA – The IPA Association of America, the largest trade association serving independent and integrated physicians in the United States. The focal point: population health, a relatively new front burner issue unfamiliar to many practitioners. Congress included the model as a component of mandates in the Patient Protection and Affordable Care Act (ACA) (See box). “We covered a lot of ground at our annual meeting to educate independent physicians about population health,” said Al Holloway, founder and president of TIPAAA. “Once we fully understand what it is, then we’ll find tools, products and services that can assist independent physicians in their daily practice.” One question that repeatedly popped up: What’s the difference between population health and public health? “Some view population health as a more modern version of public health, which itself – improving the health of the public – may be a goal, a measurement system, and a conceptual framework that undergirds a profession and a scientific field,” wrote Michael A. Stoto, PhD, in
“Population Health in the Affordable Care Act Era,” published by Academy Health (Feb. 21, 2013). “Population health differs from public health, at least perceptually, in at least two respects,” Stoto explained. “First, it’s less directly tied to governmental health departments. Second, it explicitly includes the healthcare delivery system, which is sometimes seen as separate from or even in opposition to governmental public health.” David B. Nash, MD, MBA, founding dean of the Thomas Jefferson University School of Population Health, pointed out that population health “builds on public health founda- David Nash tions.” Among the building blocks, according to Nash: • Connecting prevention, wellness and behavioral health science with healthcare delivery, quality and safety, disease prevention/management and economic issues of value and risk – all in the service of a specific population. Examples: a city, provider’s practice, employee group, hospital’s primary service area or pre-school children.
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• Identifying socioeconomic and cultural factors that determine the health of populations, and developing policies that address the impact of these determinants. • Applying epidemiology and biostatistics in new ways to model disease states, map their incidence and predict their impact. • Using data analysis to design social and community interventions and new models of healthcare delivery that emphasize care coordination and ease of accessibility. “When applied to healthcare delivery, population health differs from conventional healthcare by emphasizing value rather than volume of services rendered,” said Nash. How will population health affect physicians? Monumentally, said Kathy Jordan, president of Jordan Search Consultants. “The primary care practice of the future will look much different than it does today,” she said. “Instead of one-on-one encounters between the patient and their provider, the patient interaction process will include phone visits, email consultations, group visits, education programs and encounters with a variety of care team members. Out-of-office contact will become the new norm as patient health improves. Additionally, primary care physicians of the future must exhibit leadership and interpersonal skills, as well as a passion for top-tier service delivery. How well they manage the team will directly translate to how well the health of their patient population is being managed, which will directly impact future compensation models.” Important financially: To be eligible for incentivized government funding, organizations must prove their commitment to, and implementation of, population health, said Jordan. “They’ll be required to improve the patient care experience, the overall health of populations, and lower per capita costs of case,” she said. “As a more comprehensively integrated system focused on
population health begins to dominate, the healthcare industry, healthcare experience and provider recruitment initiatives must also evolve.” Enter population health management. Regina Levison, vice president of client development for Jordan Search Consultants, said that “while population health is defined as the health outcomes of a group of individuals comprising a specific demographic population, population health management is a Regina business model centered Levison on the delivery of comprehensive care and management of total risk.” The foundational shift in the healthcare experience will morph from an industry driven by reactivity to an industry driven by proactive measures, said Levison. “The goal of population health is to keep a patient population as healthy as possible and minimize the need for costly interventions, procedures, emergency room visits, and hospitalizations,” she said. As an increasing number of healthcare organizations move to models of accountable care, the overall healthcare experience will be reconstructed, said Jordan. “Within this transformation, we’ll see an altered patient and physician experience,” she said. “With an emphasis on proactive preventative care, evidencebased protocols, managed care teams, care coordination, and multidisciplinary teams, population health management will reward value in care, versus volume of patients seen. “Although the results of these initiatives won’t manifest for a decade or more, population health management will almost certainly improve the quality of lives for millions of individuals throughout the country.”
The ACA and Population Health The Patient Protection and Affordable Care Act (ACA) addresses population health in four significant ways: •
Provisions to expand insurance coverage target the advancement of population health by improving access to the healthcare delivery system.
Other provisions seek to enhance the quality of care delivered.
Lesser known provisions aim to improve prevention and health promotion measures within the healthcare delivery system.
The final set promotes community- and population-health based activities, including the establishment of the National Prevention, Health Promotion and Public Health Council, which has already produced the mandated National Prevention Strategy and Prevention and Public Health Fund for monetizing Community Transformation Grants.
Arkansas Medical Society: 2015 Annual Meeting Physicians from across the state met on April 17th-18th in Fayetteville to discuss advocacy efforts, elect new physician leaders, participate in educational opportunities and plan for the future of healthcare in our state. At the forefront of each activity was the overarching concern for the patients of Arkansas, as highlighted in the inaugural address given by incoming president G. Edward Bryant, MD, an ophthalmologist from West Memphis. “By helping direct the legislative process in the 2015 legislative session, we have protected the quality of care for patients in Arkansas,” said Dr. Bryant. “All we have accomplished was made possible by the time and effort given by the staff and physician members of the Arkansas Medical Society… Our members continually promote and provide the highest quality of care for the patients of the state of Arkansas.” The inaugural gala, held Friday night, featured keynote speaker Marvin Caston, associate director of the Razorback Foundation. The former Arkansas fullback played for the 1998 Razorbacks team that shared the SEC Western Division title. The group’s Saturday events kicked off with a meeting of the Board of Trustees, followed by two educational programs; “Emerging Diseases Update” by Dirk Haselow, MD, PhD, State Epidemiologist, Medical Director, Communicable Diseases, UAMS, and a comprehensive report of the Legislative session provided by H. Scott Smith, JD, the society’s director of governmental affairs.
Smith’s presentation pointed to the 25O bills that were tracked during the session and focused on the 11 that were actively supported by the society, eight of which were passed into law. Smith also noted the 14 bills actively opposed by the society, none of which were passed. Bills that were supported by the society and were passed included: Prior Authorization for Terminally Ill (SB 316/Act 992), Graduate Registered Physician Act (HB 1162/ Act 929), APRN and PA Hydrocodone Combination Products (HB 1136/Act 529), Credentialing (SB 934/Act 1232), Combating Prescription Drug Abuse Act (SB 717/ Act 1208), Limiting Physicians’ Financial Penalties (SB 701/Act 902), Prior Authorization (SB 318/Act 1106), Telemedicine Act (SB 133/Act 887). Smith especially thanked Senator Cecile Bledsoe, Representative Deborah Ferguson, DDS, Representative Ken Hen-
Give Me A Chance, continued from page 3
“You can hear them bray. They all have different personalities.” The rescue operation had a major setback Oct. 13, 2014 when it was hit by an F-1 tornado that destroyed horse shelters, the hay shed, and the hay in it. Fences were damaged, they lost most of their trees, and had a tree go through the roof of their house. A blind mare was trapped under a tree that fell on top of the shed she took shelter in. “She stood patiently as we sawed limbs with bow saws to free her,” Polly said. “We feel very blessed that no volunteers or horses were seriously hurt or killed. The ASPCA gave the rescue a grant to replace the lost shelters for the horses. They now have cozy carports for shelters.” The Cates enjoy working with a network of people who have the same goals. “Unfortunately, there are lot of horses out there needing help for different rea-
sons,” Polly said. “Horses are like children. They thrive on routine and knowing they are loved. That is when they do the best physically and mentally. Knowing when going to get fed at a regular time is good. That is what takes most of my evenings. I custom feed; we have special needs horses that eat slower. They need to be in their own stall to take time to eat. Then all get different amounts, and some get additives. We have a grant from Purina so we get Purina feed that is excellent for older horses or rehabbing starved ones.” In addition to feeding, the horses have to be dewormed, and wounds doctored. They are bills for farrier work and the vet, including gelding of stallions. “We work to stop the flow of unwanted horses,” Polly said. “We have no studs. We don’t breed. If a horse come in as a stud, he will get gelded.”
derson, Senator Missy Irvin and Representative Steve Magie, MD for their work towards improving healthcare throughout the session. The annual awards luncheon followed and honored 31 physicians who have been practicing medicine for 50 years. Also honored was Dr. Kent C. Westbrook of UAMS who was presented the society’s Asklepion Award for his ongoing contributions to the art and science
of medicine and the betterment of public health. The weekend concluded with the annual meeting of the Arkansas Medical Society’s House of Delegates. The group is composed of physician leaders from every corner of the state and is AMS’ legislative and policy making body. During the meeting, new officers were elected including Dr. Scott Cooper of Rogers, who was announced as the society’s presidentelect. Dr. Cooper will take office at the society’s 2016 annual meeting. The Arkansas Medical Society is a voluntary professional association, established in 1875, comprised of over 4,300 Arkansas physicians, residents and medical students dedicated to protecting the interests of their patients and improving the health of all Arkansans. For over 140 years, the Society has served the physicians and patients of Arkansas; most recently, working together to support the extension of private health insurance coverage to working families earning below 138% of the federal poverty level, advocating for responsible and practical reforms such as patient-centered medical homes and establishing a prescription drug monitoring program to combat abuse and diversion of prescription drugs.
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SHARE: Progress Connecting Multiple Providers with EHRs, continued from page 1 “Providers may have the same EHR system, but not the same components or models,” said Shirley Tyson, interim director of SHARE. “SHARE takes that out of the equation. Seventeen hospitals are now live and pushing patient inShirley Tyson formation to SHARE with eight more in the implementation phase. In addition, there are currently 365 practices that have joined SHARE. Some examples of the larger hospitals connected to SHARE include the University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Conway Regional, Jefferson Regional Medical Center in Pine Bluff,
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and White River Medical Center, just to name a few.” SHARE gathers patients’ clinical data from all participating healthcare providers to instantly give doctors a holistic view of their patients’ health history, treatment and progress. Tyson said that is powerful information that can transform the way that a facility plans, delivers, and coordinates health care. “In a nutshell, SHARE provides access to patient’s info at the point of care in a real time manner,” Tyson said. “Healthcare providers don’t have to chase the data. SHARE is vendor agnostic. It doesn’t matter who the vendor is or whose system is being used. SHARE is designed to connect to those system so information can be accessed.” In addition, SHARE is also able to help providers meet their Meaningful Use incentive requirements for EHRs. The use of SHARE can help avoid duplicate testing and procedures, and make it easier to make referrals. “Joining SHARE will allow your facility to be part of the more than 1,210,990 secure patient records accessible to Arkansas’ health care providers through SHARE,” Tyson said. “In addition to improved quality of care and efficient cost savings, SHARE provides a secure and private way to exchange health data. Because state and federal law require that health information be kept secure both while it is being sent through a computer, and while it is at a provider’s office, providers who join SHARE can be assured
that all electronic health information exchanged in SHARE is protected and safeguarded by security protocols that provide a higher level of privacy and accountability than paper health records. Paper records do not provide this level of security. With SHARE, only those individuals with a need to know see the patient’s record.” There can be economic barriers for some hospitals adopting SHARE. Jan Bartlett, SHARE policy director, said that some large hospital systems that have invested considerable resources with a HIS vendor might not yet recognize the value of using SHARE to connect with other healthcare providers in the state. “They have spent a fortune on their HIS and they want to get as much value as possible from the purchased system,” Bartlett said. “Paying an additional fee for SHARE may seem unnecessary. But, unfortunately, patients don’t stay within hospital systems. Hospitals won’t have information about patients who have received care from other providers such as nursing homes, rehab facilities and nonowned clinics. SHARE can provide access to health information outside their HIS.” Hospitals joining SHARE are able to send and receive health information using Secure Messaging (SM) that allows some patient information to be shared securely and electronically from sender to receiver.
While not allowing access to an entire patient’s record across multiple healthcare providers, SM is more secure and faster than using faxes. Baptist Health uses SM to communicate with other healthcare providers using SHARE. SM uses DirectTrust protocol, which creates a trusted relationship between systems and users. Another example of SM is Simple Share, which allows a hospital to send secure messages to SHARE users. Another low technical option is SHARE’s Virtual Health Record (VHR) which permits hospitals and clinics view only access to the patient’s health record using a web-based portal. Tyson said in the long run, there will be efficiency cost savings by eliminating all of the faxing of documents back and forth, and courier services. Personnel costs for facilities that have people dedicated to monitoring a secure fax line will be reduced. “Manning fax machines, dealing with paper records, the need for that will go away,” Tyson said. Cost of participating in SHARE depends on what the provider wants, ranging from SM to a fully integrated health information exchange. The cost of joining SHARE depends on the services wanted from SM to the VHR or to a fully integrated health information exchange. Costs are as low as $50 per month.
For more information, call (501) 410-1999 or visit www.SHAREarkansas. com or www.OHIT.arkansas.
Healthcare Leader: Bradley Jefferson Walsh, continued from page 1 along with partners E. A. Gresham, MD, also a family practitioner, and Mark Malloy, MD, an internal medicine specialist. “When I was growing up, I could see from watching my father that practicing medicine was a worthwhile endeavor,” Walsh said. “My dad is well respected, and very involved in the community. I aspired to have a similar situation for myself and my family. I was always attracted to science and enjoyed the logical way of thinking through things, almost like detective work. Medicine was a good fit for me.” Since January 2014 Walsh has been chief of staff at the ACMC, which is owned by the county. He presides over the monthly medical staff meeting, participates in hospital policy-making decisions, and serves on the hospital board of directors. While the position doesn’t come with a salary, Walsh finds the work interesting because he is juggling several different areas of need at the same time. “Generally, when I am asked to weigh in on hospital policy or other decisions, the first need I try to meet is that of the patients,” Walsh said. “I try to make decisions that will benefit them, even if it is not in the best interest of the hospital or physicians. Beyond that, there is a balancing act of meeting the needs of the medical staff and the hospital for their respective abilities to take care of patients.” Ashley County built a new hospital in
1998 after the critical access hospital program was initiated. Some might be surprised at how modern and state-of-art the hospital is for a county with a population of about 22,000 located in south Arkansas near the Louisiana state line. The 25-bed hospital has a general surgeon, an OB\ GYN department, a nursery, an ICU with six beds, a full-service emergency room, advanced imaging (CT, MRI, Nuclear departments), and telemedicine services. ACMC also hosts a variety of outreach specialty clinics allowing for patients to avoid lengthy travel times to visit their orthopedist, cardiologist, or even oncologist. Telemedicine partners include Baptist Health, which assists with e-ICU services; the University of Arkansas for Medical Sciences (UAMS) AR SAVES stroke program; and Arkansas Children’s Hospital, which provides timely assistance for pediatric patients. Walsh said telemedicine consulting provides exceptional care, and allows patients to remain hospitalized locally when they would otherwise be transferred. Walsh is also chair of the hospital’s physician recruitment committee. At the age of 61, his father is the second youngest family practice physician in Ashley County. Many small private practices don’t have the considerable resources needed to attract a new family doctor. “It is incredibly expensive to recruit a
physician,” Walsh said. “Recruiting is really done at hospital level out of an urban environment. It is hard to draw highly trained and educated physicians to rural areas. That is a local, state, and national issue, but it is something we have got to figure out and fix. In ten to 15 years, if we haven’t recruited anyone, there will be an access crisis. I certainly can’t do it by myself, so we have to get some help.” They were successful recruiting a young new pediatrician to town, but there is still a need for more family practice doctors. Recruitment to rural areas is a major focus of the Arkansas Academy of Family Practice, and is a hot topic in the medical community at large. Walsh and his wife, Lori, have a daughter, Mallory, 7, and a son, Barrett, 4. Walsh is a big outdoorsman with a particular passion for fly fishing and fly tying. He travels widely to fly fish in both saltwater and freshwater. “I probably spend too much time thinking about fly fishing – I know my wife would agree,” Walsh said. “Growing up in Crossett, duck hunting was a favorite pastime for my family. Since I’ve moved back, I continue to duck hunt with my dad and brother, which is always an event.” The Walsh family are diehard Arkansas Razorback fans as well, having all attended the University of Arkansas at Fayetteville. arkansasmedicalnews
Arkansas-Based Company Provides Innovative Healthcare Solutions No practice, large or small, is immune from ICD-10 concerns ICD-10 is a cause for concern among everyone in the healthcare industry. No practice, large or small, is immune from ICD-10 concerns. The ICD-10 transition can seem overwhelming and intimidating, but it doesn’t have to be. Taking where you are now and learning how to take a practical path forward can help significantly reduce the concerns surrounding ICD-10 transitioning. First, it is important to realize that with SOAPware’s unique approach you don’t have to start with ICD-10 from scratch. We have designed our tools so that you simply use the diagnoses you now enter into your usual clinical documentation which already have billable ICD-10 codes attached. With a single click or two, more specific ICD-10 codes can be selected and/or added when preferred.
SOAPware is dedicated to making the transition as seamless as possible for you and your practice It is our intent for the degree of inconvenience, as well as expense, of transitioning from ICD-9 to ICD-10 to be far less for SOAPware clients than what is becoming the norm in the industry. We are happy to conference with your ICD-10 Implementation Planning Committees. This is especially true for sites not yet using SOAPware who are facing unacceptable, added burdens for both clinicians and coders in order to achieve ICD-10 compliance. Consider that it may likely be far less costly to switch to SOAPware,
than purchase and implement the ICD-10 upgrade paths offered by many other systems. Also, if you are an enterprise challenged with transitioning your outlying medical practices, we can discuss the options to bring in their ICD-10 codes from SOAPware into the enterprise billing system. This will likely save significant time, expense and frustration. This is likely to be far more practical than attempting to force use of the enterprise EHR system into them.
Resources available to help in implementing ICD-10 Numerous resources are available to help in implementing ICD-10; the key is to take advantage of them. The official website resource, Centers for Medicare & Medicaid Services (CMS) ICD-10, provides all the official codes as well as, timelines, checklists and implementation guides. In fact, most of the information available at other sites is derived from the CMS site. Communicate and collaborate with others in your area to share lessons and help with the transition. You can do this through organization newsletters and social media as well as at conferences, workshops, and other educational events.
ICD-10 support is already built into current versions of SOAPware Enough ICD-10 support is already built into current versions of SOAPware that we are advising our clients to consecutively proceed with initiatives to both begin as well as plan the transition process from ICD-9 to ICD-10. You can proceed now rather than waiting and hoping that something useful and practical will be forthcoming.
There are no plans for SOAPware users to upload a lengthy upgrade (from the current version) or engage a third party coding tool, in order to achieve ICD-10 and SNOMED-CT capabilities. For those SOAPware clients who haven’t moved to the SOAPware Cloud Services, there will not be a need to upgrade servers to accommodate ICD-10, and the only downtime to plan for is the time it takes to download and install updates. What are you waiting for? Find out more about SOAPware today and let us ease your ICD-10 concerns! Visit http://www.soapware. com/icd-10! • Experience You Can Trust Our products and services are derived from more than 20 years of experience. “With SOAPware, I am so efficient that the record is completed before the patient leaves the office!” — A. Herbert A., MD Orthopaedics, SOAPware User since 2002 At SOAPware, we make it easy to get in touch with our staff. Contact us today! Call: 1-800-455-7627 7a-7p M-F | 10a-4p Sat. (CST) Chat: Visit www.soapware. com/contact to start a live chat with a SOAPware EHR Specialist Email: Marketing@soapware. com Social Media: Twitter: twitter.com/ soapware Facebook: facebook.com/ soapware Blog: soapware.com/blog
GrandRounds New Administrator For Baptist Health Medical CenterConway CONWAY – Jamie Carter, who was most recently the chief operating officer of the 617-bed Methodist University Hospital in Memphis, has been named as the vice president and administrator of the soon-to-be-opened Baptist Health Medical Center-Conway. A Tennessee native, Jamie Carter Carter comes to Baptist Health with a wealth of experience in the health-care field including a stint as president and chief executive officer at Crittenden Regional Hospital in West Memphis. Carter completed his Bachelor of Science degree in commerce, business administration, and health-care administration at the University of Alabama and earned a Master of Business Administration degree from the University of Mississippi.
Hershey Garner, J.D., M.D., Named Interim Chair of UAMS Department of Radiation Oncology
LITTLE ROCK – Hershey Garner, J.D., M.D., has been named interim chair of the Department of Radiation Oncology in the College of Medicine at the University of Arkansas for Medical Sciences (UAMS). He succeeds Vaneerat Ratanatharathorn, M.D., M.B.A., who has led the department since it was estabDr. Hershey lished in 2000. Garner Garner is board certified in radiation oncology from the American Board of Radiology and practices at Highlands Oncology Group in northwest Arkansas. He previously served as clinical assistant professor in the UAMS Department of Radiation Oncology. A native of Little Rock, Garner received a law degree from the University of Arkansas at Little Rock William H. Bowen School of Law prior to earning his medical degree from the UAMS College of Medicine. He serves on several regional ethics committees and is active in many community organizations.
Family Doctors Urged, continued from page 5 pre-term birth or even miscarriage. “It is smart to prevent unnecessary treatments in terms of decreasing healthcare costs and sparing women time, expense, and possible side effects,” Zorn said. “But now we are seeing more women who fail to get follow-up appointments. The women who tend to get in trouble are those who haven’t seen a gynecologist in ten to 15 years. They had their children, and once that was done, they had their tubes tied. So they don’t go to the OB\GYN to get birth control pills. That is usually how we get women in for Pap smears.” Zorn said even if you are a healthcare provider who doesn’t do Pap smears yourself, in addition to asking patients if they are current with mammograms and colonoscopy, ask her about the last time she has had a Pap smear. “Remind them of this importance even if you are not going to be the one to do the test,” Zorn said. “Sometimes women are going to their primary care doctor, but they don’t get back to a gynecologist until they already have a cancer.” Doctors can also provide advice about how to enhance the immune system to help clear up mild dysplasia. “The number one risk factor impacting the immune system in cervical disease is smoking,” Zorn said. “It is hard to clear up dysplasia when you are smoking or even exposed to secondhand smoke. That is the number one piece of advice I give. That is getting easier with so many places not allowing smoking, but Arkansas still has higher rates of smoking than the national average.” Second is good nutrition: lots of fruits, vegetables and whole grains. Limit fatty 10
foods, and limit alcohol consumption. “That is the same diet recommended by diabetes and heart doctors,” Zorn said. “But that is hard for Americans to hear, because it is not the lifestyle we want to lead.” Providers may get a lot of questions about vitamin supplements, but said there is no clear evidence that makes much difference in this arena. “We as human beings are designed to get nutrition from the foods we eat, digesting foods and gradually absorbing the contents,” she said. “Supplements as pills and powders are probably never going to be the same as eating a healthy diet. I can’t recommend any particular supplement as being proven to improve overall health or cancer risk. Avoiding cigarettes and focusing on a generally healthy lifestyle is the best advice I can give.” Zorn is known for her research in ovarian cancer with numerous publications on ovarian cancer on topics ranging from prevention strategies to patients’ responses to chemotherapy. She is a recipient of the National Institutes of Health Women’s Reproductive Health Research Award. She is also a member of a Centers for Disease Control program that is working to improve HPV vaccination rates in adolescents and young adults. For more go online to: www.cancer.gov/ cancertopics/types/cervical/ pap-hpv-testing-fact-sheet www.sgo.org/hpv/
Dr. Beyga Joins Surgical Associates Of Fort Smith FORT SMITH – Zbigniew T. Beyga, MD, has joined Surgical Associates of Fort Smith, located at 923 Lexington Avenue. Dr. Beyga will work alongside C. Michael Gooden, MD, and Laurence Lo, MD. Dr. Beyga previously practiced at Arkansas Surgical Group. He has practiced medicine in the Fort Smith region for almost a decade and is certified by the American Board of Surgery. Dr. Beyga’s services include all general surgery procedures, breast surgery, diagnostic laparoscopy and exploratory laparotomy, hernia repair, excision of skin lesions and cancers, and laparoscopic surgeries involving the colon, spleen, appendix and gall bladder.
Sparks New APN Joins Gastro Center FORT SMITH – Chasidy McAllister, APN, has joined Sparks Gastroenterology Center located inside Sparks Regional Medical Center on Towson Avenue. McAllister, a Lavaca native, earned her Masters of Science in Nursing from the University of Alabama Chasidy McAllister at Birmingham in December. McAllister has nearly 20 years nursing experience and has worked closely with geriatric patients during her career at longterm acute care facilities and rehabilitation centers.
Pope Moseley, MD, Named Dean of UAMS College of Medicine LITTLE ROCK – Pope L. Moseley, MD, has been named dean of the College of Medicine and executive vice chancellor at the University of Arkansas for Medical Sciences (UAMS), effective July 15. Moseley succeeds G. Richard Smith, MD, who Dr. Pope L. Moseley has served as College of Medicine dean and vice chancellor of UAMS for the last two years. Since 2001, Moseley has been professor and chair of the Department of Internal Medicine at the University of New Mexico (UNM) School of Medicine in Albuquerque and, since 2013, a UNM School of Medicine Distinguished Professor. In 1976, Moseley earned his bachelor’s degree in chemistry from Davidson College in Davidson, North Carolina; in 1980, his medical degree from the University of Illinois College of Medicine in Chicago; and in 1983, his master’s degree in preventive medicine from the University of Iowa. He joined the University of Iowa faculty in 1985 after completing a combined residency in internal medicine and occupational medicine and a fellowship in pulmonary medicine.
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center stage in cancer research, finding new treatments that save lives
Faith Davies, M.D. UAMS Myeloma Institute UAMS Winthrop P. Rockefeller Cancer Institute
We’re on a mission to create a better state of health — for you and all of Arkansas. Thanks to our world-class research, patients from all over the globe travel to UAMS for treatment. At UAMS you have access to the best care, right here close to home. With a staff of the best and brightest, personalized medicine and convenient access to clinics, you can feel confident knowing the state of your health is in exceptional hands.
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