FOCUS TOPICS GENOMICS • CARDIOLOGY • LEGISLATIVE AGENDAS
February 2020 >> $5 ON ROUNDS Cardiologist’s Skills, Assets Help Enhance Le Bonheur’s Program After first hesitating to take a position in Memphis, pediatric cardiologist Dr. Jeffrey Towbin has helped elevate Le Bonheur Children’s Hospital to a lofty level.
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TMA, THA Disclose List of Concerns As Legislature Debates As the Tennessee General Assembly reconvenes, two of the state’s major provider and facility organizations reveal plans to keep watch for bills impacting their memberships while also pursuing action on their own legislative priorities.
St. Jude’s Team Empowering Global Research Community Finding Cures Faster by Making Genomic Data Available By JUDY OTTO
Miracles seem to be commonplace at St. Jude Children’s Research Hospital, a belief widely accepted by most Mid-Southerners. The latest example may be St. Jude Cloud, introduced in April 2018 and continuing to dazzle as it evolves under the eye of Alex Gout, PhD, the project’s scientific lead. The Cloud’s nucleus began to coalesce ten years ago, when highlevel researchers at St. Jude teamed with Washington University in St. Louis to devise the Pediatric Cancer Genome Sequencing Project. Until that time, Gout explains, most cancer research, in the form of cancer genomic sequencing, was focused on adult cancers—which affected a larger number of individuals. The project sequenced about 700 pediatric cancers, which led to countless discoveries detailed in high profile publications and scientific journals. Published papers, Gout points out, require substantiating references, i.e. sequencing data or other data generated with that publication. Central repositories, however, “were cumbersome to access, cumbersome for us to upload our pediatric cancer genome sequencing data to, and cumbersome for users around the world to download this data to their own (CONTINUED ON PAGE 6)
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As CMO at UCH, Dr. Canada Enjoys Doing Double Duty
New Year Brings Important Merger In Women’s Health Memphis’ healthcare got off to a fast start in 2020 as two of the area’s largest private providers of women’s health merged. Elsewhere, Regional One Health opened a new facility and Campbell Clinic has a new affiliate.
By LAWRENCE BUSER
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Robert Bradley Canada
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Dr. Robert Bradley Canada doesn’t quite fit the image of the traditional chief medical officer of a multi-physician healthcare practice. Even though he’s held that title at University Clinical Health (UCH) for some 10 years now, he still looks like he’s just out of medical school. No gray hair or no senior-status demeanor, but a doctor who knows how to work both sides of the aisle.
“Some people call it the bridge between the white coats and the suit coats,” says Dr. Canada, 48, a nephrologist who has never stopped seeing patients. “I see myself as the liaison between the administrative and the physician sides of the practice. Continuing to see patients helps me because if you do have to put on the suit coat, that administrator role, it helps give you credibility with your colleagues. “You’ll see in hospitals the CMO is typically more full-time administrative, but I like (CONTINUED ON PAGE 5)
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Pediatric Cardiologist Helps Build Excellence Jeffrey Towbin Assists in Elevating Le Bonheur’s Program By LAWRENCE BUSER
Dr. Jeffrey Towbin has spent more than 30 years building pediatric cardiology programs in Houston, Cincinnati and, since 2015, at Le Bonheur Children’s Hospital in Memphis. To his way of thinking, just OK is not OK. Texas Children’s Hospital and Cincinnati Children’s Hospital Medical Center have long been ranked among the very top pediatric cardiology programs in the country, and since his arrival in Memphis, Le Bonheur has climbed into the top 10 from a place on no one’s radar. But Cincinnati, like Texas before it, he says, was beginning to lose its fervor for the cutting edge. “Frankly, I had never really heard of Le Bonheur before, but I was starting to get frustrated in Cincinnati and, at just the right time, Dr. Jon McCullers (pediatricianin-chief) called,” says Dr. Towbin, who initially passed on the offer before accepting. “I interviewed and accepted the offer because of Dr. McCullers and (former president and CEO) Meri Armour. They
had a great vision and were wanting to go from what was historically a community children’s hospital focus to a national, highimpact hospital with international name
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recognition like the hospitals where I had been previously. “I felt they were genuine, really wanted to support the vision that I was espousing and that I potentially could be helpful in building that kind of program in pediatric cardiology. So that was the intriguing thing to me. They were willing to trust me with the resources to build that sort of program. From a national perspective, people now know who we are and what we’re doing, and that’s kudos to all of my colleagues.” Dr. Towbin holds many overlapping titles, including co-director of the Heart Institute, chief of cardiology at both Le Bonheur and at St. Jude Children’s Research Hospital, vice chair of strategy advancement, and professor of pediatric cardiology at the University of Tennessee Health Science Center. Since coming to Memphis, he has recruited more than 20 new cardiologists and started a number of new programs, including the Cardiomyopathy/Heart Failure Program, the Mechanical Circulatory Support Program, and the Heart Transplant Program. When Dr. Towbin arrived, Le Bonheur had not performed a heart transplant in nearly 20 years. Since October 2016, the number stands at 34, placing the hospital’s yearly totals in the top 10 or 15 in the country, with excellent outcomes, he adds. In perhaps a bit of irony, having a high number of transplants has never been one of his goals. Earlier in his career, children with heart muscle disease or heart failure were likely to be heart transplant candidates because pediatric medicine at that time had little else to offer. “In Houston, I started the first pediatric cardiomyopathy/heart failure clinic and program, and I also was head of the transplant service, but my goal was always to avoid having to do a heart transplant if possible by optimizing medical therapy,” says Dr. Towbin. “For me, I thought there were patients I could take care of with medications in a way that they wouldn’t need a transplant in the near term, and potentially not ever. A lot of these were very young kids – infants 1, 2 and 3 years old in a lot of cases. I thought if you could avoid transplantation during that time frame, you could possibly give them a lot of years of not needing a heart transplant, if ever, and so that was really my goal-set at the beginning. “Now, cardiomyopathy/heart failure has become a field in pediatrics and I have trained many of the cardiologists in the field. You finish three years of cardiology training; you do an extra year or two in cardiomyopathy and heart failure, as well as transplantation, opposed to doing one in transplant only. The goal is not having to transplant the patient, as the heart failure doctor may
be able to optimize treatment in advance of that with our current therapies.” In the mid-1990s, Dr. Towbin was a research pioneer in what was called molecular cardiology in which he sought to identify the genes and viruses causing heart muscle disease and sudden cardiac arrest and arrhythmias. Today such pediatric genetic testing is common. “I like to do what’s called bedsideto-bench-to-bedside research, meaning I come across a patient with a problem that I don’t think is well understood (the bedside), then take information from specimens like blood or tissue over to the laboratory (the bench), and try to figure out the genes or viruses that are causing the problem and the mechanisms of the disease causing the problems,” he explains. “Then we try to bring that information back to the patient (the bedside) and develop a targeted therapy based on what we know the problem is. That’s the approach we try to take. Learn about the disease, identify its cause and mechanisms, and develop new treatments. That should lead to better outcomes. “So it’s advanced from being ‘We didn’t know anything’ to ‘We knew stuff, but it was research’ to it becoming a clinical test and now its part of everyday care. That’s happened over the past 30 years. The hope is that through molecular biology, genetics, et cetera, we’ll figure out through one of those pathways how to actually fix the problem instead of dealing with the symptoms of the problem.” When he was growing up in the projects of Brooklyn, an asthma condition led to Dr. Towbin’s early interest in medicine because of the kind-hearted general practitioner he frequently visited. His older brother, Richard, also went into medicine and recently retired as a nationally recognized pediatric radiologist. “We lived in the projects and though neither of my parents went to college, they were very interested in providing me and my brother with cultural opportunities,” said Dr. Towbin, who played the accordion, the clarinet and the violin until he went off to college. “I actually might have been pretty good because of my ability to differentiate sounds. I never recognized that when I was young. “One reason I went into cardiology is because I have good auditory memory and auditory skills. In medical school and residency, pediatric cardiology didn’t have a lot of technological, high-level things with which to make diagnoses. You had to use your stethoscope and your ears, and I could hear things other people couldn’t hear, and remember the sounds. It’s a skill I just happened to have. It’s a little bit of an unusual way to get into cardiology, but ultimately it worked out.” memphismedicalnews
THA, TMA Outline Legislative Priorities Telehealth, CON, Scope of Practice Lead Concerns By CINDY SANDERS
The Tennessee General Assembly reconvened in January for the second half of the 111th session. Hundreds of bills have been filed that intersect with the broad topic of healthcare. While many will never make it out of committee, two major provider and facility organizations – Tennessee Hospital Association (THA) and Tennessee Medical Association (TMA) – will keep watch for bills impacting their membership while also pursuing action on their own legislative priorities. From consensus items to ones causing consternation, the leadership of two organizations was surveyed to learn their 2020 priorities and key advocacy issues.
The THA has new leadership, but ongoing priority concerns. Wendy Long, MD, MPH, last fall was named president and CEO of the statewide organization, taking the reins from Craig Becker, who retired after more than 25 years at the helm. Among continuing concerns are maintenance of the state’s certificate of need program, the voluntary hospital assessment and support for rural hospitals. Additionally, THA is focused on measures to improve telehealth laws as usage contin-
ues to increase. CON: THA is a strong supporter of Tennessee’s certificate of need program, believing the regulations help level the playing field and dissuade “cherry pickWendy Long ing” the commercially insured patients that keep hospitals financially viable. “We do definitely believe the CON program is absolutely essential,” Dr Long said. “We think it helps in managing healthcare cost, workforce demands and making sure access to quality healthcare services is available throughout Tennessee.” She added the CON program was a hot topic last year and expects legislation to be introduced again this session. “We agree there are some improvements that could be made in the CON process or operation of the program, and we hope that is the focus.” She noted THA is happy to work with the Legislature to improve the efficiency and transparency of the program in a way that isn’t detrimental to the underlying reasons certificates of need were originally implemented. “We certainly worry about rural hospitals if there are changes to the
CON program,” she said. Hospital Assessment: Dr. Long said THA will again voluntarily bring the annual hospital assessment legislation to Tennessee lawmakers. The assessment at the state level draws down matching federal dollars for the TennCare program. She noted the idea of hospitals’ picking up what had traditionally been funded by the state first occurred in 2010 at the height of the recession. “We were looking at substantial changes to services and benefits in TennCare. As a result of that set of dire circumstances, hospitals came forward and voluntarily offered to put up the necessary funding. That assessment today generates $602 million in state funding, which draws down a federal grant for a total of $1.7 billion.” The rate of assessment will remain at the current rate of 4.87 percent of a hospital’s net patient revenue. The funding, Long explained, averts limits on certain benefits, including physical, speech and occupational therapy, for TennCare enrollees. It also avoids a 7 percent reduction in TennCare provider rates. Although hospitals have agreed to the assessment annually for the last decade, Dr. Long said it shouldn’t be considered an automatic conclusion. “It’s something
we discuss each and every year. I would not characterize it as an easy decision,” she noted. “Hospitals continue to hope at some point the state might begin to replace this money with other revenue sources, but that has not happened so each and every year, hospitals have to reassess the issue.” Rural Hospital Support: In 2018, the General Assembly created the Rural Hospital Transformation Program to support work between at-risk rural hospitals and consultants who would assess the facilities and formulate strategies to improve hospital viability and access to care. As a result of this program, Dr. Long said several hospitals have completed the work with consultants and now have a list of recommendations in hand. “Some good suggestions were made . . . but in many, if not all, cases, there was a need for funding resources,” she said. “This was a great first step to do the analysis to come up with these plans. Now we’d like to see funding be directed to help the hospitals be in a position to implement those plans.” Telehealth: THA is working in concert with a number of provider organizations to tweak Tennessee telehealth laws. Long, who previously served as director of (CONTINUED ON PAGE 4)
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THA, TMA Outline Legislative Priorities, continued from page 3 TennCare, noted she has been involved in telehealth for many years. Originally, technology was the big obstacle. As tech improved, the next question was whether or not patients would use it. “People really do like it,” she noted. “Now, I think our focus is on reimbursement.” Long continued, “We’re working the Tennessee Medical Association on legislation to try to make sure payment is there. The vast majority of insurers do pay on the originating end – but not all – so that’s one of the areas we’d like to clean up.” In addition to codifying facilities that host the patient encounter receive a site origination fee, other desired modifications include establishing infrastructure and payment parity for provider-based telehealth services to enable patients to receive ongoing care from their existing physicians via a telehealth encounter and ensuring coverage for remote patient monitoring in a manner consistent with current Centers for Medicare and Medicaid Services policy. TennCare: While not a legislative agenda item, Dr. Long said keeping hospitals in mind as TennCare begins the bid process for managed care contracts is definitely an advocacy issue for THA. “This is a ‘once-in-a-not-very-often’ bid,” said Long, adding the hope is appropriate language is included in the RFP and awarded contracts to ensure hospitals are fairly considered and compensated. Improving access to care is another key advocacy issue. “We would still love to see expansion of the number of people with access to insurance in the state, but we don’t see any kind of appetite for traditional Medicaid expansion,” Long explained. “But, we do perceive the block grant the state proposed as a step in the right direction and will continue to be very engaged as the proposal moves forward.”
The Tennessee Medical Association has a number of priorities on the table for 2020: Balance billing, telehealth and the state professional privilege tax are all on the organization’s radar. And, after a three-year moratorium, the contentious issue of scope-of-practice regulations has returned. TMA CEO Russ Miller, CAE, shared insights on his organization’s
stance on all four topics. Balance Billing: Although no related bills gained traction in the Tennessee General Assembly last year, Miller said the U.S. Congress is Russ Miller looking at the issue of “surprise medical bills.” He believes solutions ultimately will occur at both a federal and state level. “Whatever happens at the federal level, we’ll try to improve upon at the state level to best serve our physicians and their patients,” said Miller. “Nobody should be caught by a surprise bill and be stuck with tens of thousands of dollars. We’ve got to help the patients who get caught in that situation.” While everyone has an example of a patient caught in a situation usually out of their control, Miller said such surprises are still fairly rare in comparison to the normal delivery of care. However, he added, out-of-network surprise billings seem to be increasing in frequency and becoming more expensive for the patient responsible for payment. He cited a narrowing of insurance networks as a key contributing factor to the problem. “This is not about doctors or hospitals gouging patients, it’s about this insurance network wrinkle,” said Miller, adding that TMA is advocating for a solution that exonerates patients from the financial burden of these surprise out-of-network charges while ensuring physicians are paid appropriately for services provided. Miller thinks one solution is to create an average cost for services, but doesn’t believe insurers should be in charge of the benchmarking. “There needs to be a non-biased, third party benchmark set,” he explained. “There must also be some type of independent dispute resolution,” he continued. Citing New York as an example, Miller said disputes happen in less than 2 percent of cases. When a third party arbitrator has been called in to adjudicate, the decisions have been split almost dead-even in favor of payers or providers, he said. Telehealth: A bill supported by
G. Coble Caperton
TMA in 2019 to ensure telehealth services be reimbursed at the same rates as inoffice visits did not pass. However, Miller said it did advance the conversation about rules and reimbursement governing the technology that has become increasingly critical for access to care, particularly in rural and underserved areas or for specialties with a shortage of providers. “There are times you need emergent care, but we’re trying to afford convenience to established patients,” Miller said of using the technology to support medically appropriate encounters, including follow-up appointments. Telehealth interactions are typically defined as synchronous or asynchronous. The former utilizes audio and video technology, along with encryption, to facilitate real-time consults. The latter, also known as “store and forward” applications, have delayed communication and are used to transport images or in a messaging type of format. “Right now, you have a lot of services provided in one of those formats without a lot of regulation around it,” Miller said, adding the goal is to facilitate access to the technology while putting up some guardrails to ensure appropriate use. Tennessee Professional Privilege Tax: “It is a privilege to be a doctor, but we shouldn’t be taxed on that,” Miller stated. Prior to adjourning the 2019 session last May, the General Assembly exempted several professions from paying the state’s professional privilege tax, but physicians weren’t included in that group. TMA has advocated for a reduction or removal of the tax for years, and Miller said they would continue working with state lawmakers on the issue. Scope of Practice: After previous talks led nowhere, a three-year moratorium was instituted from 2017-2019 on any scope-of-practice legislation redefining supervisory parameters for advanced practice nurses. With the end of the moratorium, the issue is again at the forefront of discussions between TMA and TNA. “We were at great odds, and the debate was pretty raw,” Miller said of where things left off in the fall of 2016. Since last summer, the two groups have been working toward finding some resolution to the debate. Miller said he perceives some small progress has been made. “There are some things we agree on; some things we’re far apart on; and some things we need to get back to them on,” he said of the current status. While the statutory relationship between physicians and advanced prac-
tice nurses changed from being called ‘supervision’ rules to ‘collaborative’ rules in 2016, Miller said there was no real substantive change other than nomenclature. Now the goal of both organizations is to meaningfully modernize and enhance that collaborative arrangement, but there is still significant disagreement on how updated regulations ultimately look. Independent practice for nurses remains the sticking point. “There are situations when care can be delivered efficiently by advanced practice nurses, but we don’t think those instances mean that you can do everything, all the time independently,” Miller said of the physician viewpoint. However, he continued, physicians recognize some of the current rules need updating. Particularly in areas of shortage, it can be difficult for nurses to secure a collaborative agreement with a physician prepared to come onsite for chart reviews monthly. While TMA isn’t willing to abandon collaborative arrangements completely, Miller said there might be ways to build in some flexibility. “We’re trying to modify the relationship. For those APRNs with a lot of experience, reduce the amount of interaction and oversight for them, but those new to practice still need some hours of behind-thewheel mentoring,” he said. Although the level of oversight could be less for experienced nurses, the TMA stance is that it would never reduce to zero. “Having a physician in the arrangement serves as a vital backstop when there are conditions they (APRNs) are not able to take care of. It’s not good enough to say you’ll refer it,” Miller stated. “We have a hard time understanding why practicing alone will improve the environment when the entire industry is moving to teambased care.” While completely independent practice is a non-starter for physicians at this point, Miller said there are a number of areas TMA agrees should be addressed. “We need to do a better job of monitoring and regulating those who serve as collaborating physicians,” Miller noted of one frustration nurses have voiced. He added the bureaucracy governing collaborative agreements certainly could be improved, and the willingness to lower the level of oversight for demonstrably experienced APRNs is a shift from even a few years ago. “They (TNA) want to know if whatever we are working on now will lead to an independent pathway, but TMA physicians won’t accept that as a solution.”
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As CMO at UCH, Dr. Canada Enjoys Doing Double Duty, continued from page 1 the combination. I don’t want to leave patient care. I like my patients. That’s what I was ultimately trained for, but I do like the administrative side as well.” UCH is the practice arm of the University of Tennessee Health Science Center’s College of Medicine, with approximately 130 physicians and some 45 nurse practitioners and physicians’ assistants, 19 specialties and 120,000 patients per year. The not-for-profit, nottax-supported group practice has revenues of around $85 million per year. Before undergoing a major reorganization five years ago, UCH was called the UT Medical Group (UTMG), which had to evolve to remain a sustainable practice model. “Those were some rough times we came through,” says Dr. Canada. “Because of national market factors, doctors in certain specialties really needed to be employed by hospitals, but UT Medical Group basically contained all of the physicians of the UTHSC College of Medicine, with the exception of specialties like neurosurgery and orthopedics. “Because the group could not, over the long term, sustain these physicians without significant hospital support, some of them were moved to a group now called UT Regional One Physicians (UTROP) and part was moved to a group now called UT Methodist Physicians (UTMP). So now they are employed by both the university and a hospital system.” The specialists who remained with UTMG, now UCH, were those who did not traditionally work for hospitals, such as ophthalmologists, dermatologists, plastic surgeons, nephrologists and family medicine physicians, among others. Dr. Canada’s daily duties generally are divided evenly between practicing physician and CMO, though he says that can change daily. “For example, one day recently I saw patients from 8 to 11, then went to an 11 o’clock meeting and saw patients again from 12 to 1,” he says. “Then I had a 2 o’clock meeting and another at 3. Some days, though, it’s totally patient care, in the hospital or in my office, and then the next day it’s back and forth. It’s a challenge sometimes, but it keeps things interesting.” The CMO position is not one he sought, but he was drawn to it by the former CMO, Dr. Lacey Smith, who enlisted a young Dr. Canada to help him with a few projects for the organization. “I really looked up to Dr. Smith and learned a lot from him, so I was certainly glad to do whatever I could to help him,” says Dr. Canada, who always has plenty on his CMO plate. “We have a department that’s totally dedicated to quality, and I’m our main administrative leader of that department. The other major part of my job is sort of an ad hoc role of bridging that gap between the administrative leadMEMPHISMEDICALNEWS
ership of the group and the physicians of the group. I try to represent the physician view to the administrative personnel and interpret the administrative views and reasoning to the physicians. “Currently our organization is involved in two major quality programs. One is the Medicare quality initiative/ pay for performance program. It’s called MIPS—Merit-based Incentive Payment System. The second is a TennCare initiative that basically calls for a transformation of primary care for TennCare recipients. There’s a lot in this program geared toward women and children’s health care, opioid addiction, bringing patients that are out of care back into care, and trying to reduce hospitalizations. Tiffany Wright is our Director of Quality — she and her team take care of a lot of the details of these programs.” Dr. Canada, a native of Hernando, Miss., is the son of a pharmacist, so he’s been around medicine and health care his whole life. “So something in the medical field was always in my mind,” he recalls. “When I went to college at the University of Mississippi, I decided to take the premed requirements and see what happened. I then came to UT for medical school and stayed here for all my training in internal medicine and a fellowship in nephrology. “As a trainee, I worked with an excellent attending nephrologist, Dr. Jennifer Kinnard, who is now retired. I liked how she interacted with her patients and what she did every day. She had a large effect on the specialty I chose. There were a couple of others I looked up to as well, so then I thought ‘You know what? I think I’m going to do nephrology.’ I don’t think I realized it at the time, but mentors are very important in shaping your career.” Dr. Canada says he had no particular training in administration work, and that, to some degree, he has learned on the job. “I’m practicing at being an administrator, and certainly there are things you have to learn,” he says. “A physician makes decisions quickly. For example, if a physician is seeing a patient, he or she might quickly decide to prescribe this medicine or take a patient to surgery. Administrative decisions tend to have a much longer timeline. I certainly had to learn that.” When he’s not busy wearing a white coat or a suit coat, he likes to travel to enjoy the scenery and history of foreign countries and continents. Recent destinations include Vietnam and Cambodia on one trip and South Africa on another. There’s also an annual ski trip to Colorado with a group of longtime friends. “It’s the only athletic thing I can do. I can ski (difficult) one-diamond slopes, but I don’t do double diamonds,” he says. “I like the part of the trip where you return home in one piece.” FEBRUARY 2020
St. Jude’s Team Empowering Global Research Community, continued from page 1 computing environment—which might take hours or even days,” Gout noted. “It was a big mess.” The solution – St. Jude Cloud: a platform in the cloud, developed at St. Jude Alex Gout to share all of the rich genomic pediatric cancer data generated over the previous ten years. From its launch in the spring of 2018 through August 2019, more than 50,000 users from across the world had accessed the Cloud. Today, less than 6 months later, that figure has more than doubled, and now exceeds 100,000 users, including 61 institutions in 16 countries. St. Jude Cloud, a partnership with Microsoft and DNAnexus, offers three interactive data-sharing platforms where scientists can use an array of exceptional tools to manipulate data in the form of whole genomes, whole exomes, and RNAsequenced data derived from pediatric cancer patients—rare data now available to doctors and researchers anywhere in the world. “The driving force behind any scientific endeavor is discovery and advancement of knowledge,” Gout reminds us. “Anyone in the pediatric cancer space is trying to discover or make advances toward better understanding of the disease and developing treatment. Therefore we want as many people looking at this data as possible, because the more brains we have on the case, the quicker we’re going to come up with discoveries and solutions to treating childhood cancers.” The more that’s shared, the more that’s learned; increased genome sequencing and analysis are revealing more and more about the long-term negative health effects of cancer treatment. Over time, lesstoxic interventions are replacing treatments like radiation, which is being eliminated as less toxic treatments are developed. Gout’s fascination with pediatric cancer genomics was home-grown in Australia, where he studied genetics as an undergraduate, followed by a graduate degree in computer science, a PhD in medical biology/infectious disease, and additional post-doctorate studies in pediatric
Is the missing
oncology genomics before spending time at the Broad Institute at Harvard-MIT in Boston as part of his post-doctoral focus. He returned to the U.S. in 2017 as editor for Nature Communications’ Cancer Genomics, a prestigious scientific journal— until Jinghui Zhang, PhD and chair of the St. Jude Dept. of Computational Biology, invited him to join the fledgling St. Jude Cloud project, late in 2018, as the project’s Scientific Lead. “It’s been a fantastic experience; St. Jude is an absolutely amazing place,” he adds. “The St. Jude Cloud project is really paving the way for how we share genomic data with the world, and how we analyze genomic data, as well. I’m so happy that I came!” His efforts shepherded the project into its next phase in May 2019—making real-time clinical genomics available in the Cloud. Instead of waiting for the publication of related research (the traditional path, which can sometimes take years) before sharing the data, St. Jude now uploads unmined, de-identified patient data on a monthly basis. “We don’t want to delay other people’s access to this data—and potentially finding their own discoveries,” says Gout. “Instead, as soon as we sequence the data and generate it, we want to put it out into the world. Because pediatric cancer is such a rare disease, we need a lot of data to find associations and commonalities and correlations in order to make discoveries. The faster we share, the faster we allow this discovery process to happen.” The Survivorship Portal, a new feature of St. Jude Cloud, was introduced last fall, as part of a National Cancer Institute (NCI)-funded project. “This is a fascinating study,” Gout marvels. “They’ve accumulated between 3,000 and 5,000 patients who have, once upon a time, been treated at St. Jude for cancer. Many of these survivors return to St. Jude voluntarily every year, to have more than 100 different phenotypes measured: their blood pressure, heart characteristics, eye strength, mental agility, weight, height, BMI, etc. We study their DNA, if they agree; we look at these clinical phenotypes, the cancer they had in the past, the treatment used, and consider whether or not those things have affected their lives moving forward, in
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programs to analyze the data in multiple locations at the same time.” Other potential participants in the collaborative cloud project include Kids First, at the Children’s Hospital of Philadelphia; and NCI’s Target Study, housed inside NCI Data Commons. “Collaborating with these other repositories and performing federated data analysis would allow us to leverage all of the data that each collectively has,” he notes. This would allow researchers to view scattered and rare cases, comparing commonalities—or lack thereof—without knocking on multiple virtual doors in order to gather and analyze valuable research data. “The federated data analysis project is something very cool that we’ll embark on very soon,” Gout believes.
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5, 10, or 15 years. “Proper analysis of these data sets may enable us to serve preventative measures when we’re treating another child with cancer,” he suggests, “by comparing the results shown for patients with a similar genomic profile, who received different therapies, as recorded in the Survivorship Portal. “The Survivorship Project is a really beautiful retrospective study whereby we can leverage the accumulated knowledge that we can get from previously treated patients, and how we develop that treatment strategy for future patients.” The newest evolution -- Today, St. Jude Cloud anticipates its newest evolution: Federated data analysis of collaborating but currently incompatible genomic clouds. “Those who hold major pediatric databases use different clouds, and don’t allow simultaneous access between them,” says Gout. “We have over 10,000 whole genomes sequenced within St. Jude Cloud,” he reminds us. “With such a large number of samples, we need to think about new ways to house and analyze this data—new ways to develop processing and analysis software protocols that allow us to work with other large data repositories. “This is a big paradigm shift in doing genomics research in computational biology and other medical research,” he points out. “St. Jude Cloud is the largest genetic sequencing repository in the world, but there are other very large sequencing repositories being born around the world as well. Rather than finding one place where we could combine all of this data, we’re striving towards a federated data analysis approach, whereby we leave all the data in these other large pediatric cancer repositories and develop software analysis
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GrandRounds Campbell Clinic Affiliates with Titan Orthopedics Campbell Clinic Orthopaedics has announced it is affiliating with Titan Orthopedics and its owner, John Lochemes, MD. It is the first affiliation agreement for Campbell Clinic. Dr. Lochemes will maintain the Titan Orthopedics name and location at 795 Ridge Lake Blvd in Memphis, while operating within the Campbell Clinic network. As a board-certified orthopedic surgeon, Dr. Lochemes practices general orthopedic surgery with an emphasis on arthroscopic and minimally invasive procedures. He also provides workers’ compensation injury treatment. He earned his medical degree from the Medical College of Wisconsin in Milwaukee then went on to complete his residency in orthopedic surgery at the University of Tennessee-Campbell Clinic Department of Orthopedic Surgery. Dr. Lochemes is also a fellow of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot & Ankle Society. Titan Orthopedics will continue to operate independently, while providing patients with additional options, including the Campbell Clinic physical therapy departments, MRI services and ambulatory surgery centers, among others.
Kosten Foundation Announces $185,000 in Funding The Kosten Foundation, a Memphisbased nonprofit created to provide support for pancreatic cancer patients and their families, awareness for pancreatic cancer issues, and funding for research, announced it is providing $185,000 to be used for research associated with pancreatic cancer. The Kosten Foundation has donated more than $2,000,000 for pancreatic cancer research since its inception in 2003. Recipients of the funding are Baptist Clinical Research Institute, UT-Southwestern Medical Center, UT-Rio Grande Valley School of Medicine
Regional One Opens Facility in East Memphis Regional One Health has opened Kirby Primary Care, a new family medicine practice at 2725 Kirby Road, Suite 1, in East Memphis. It will be open Monday through Friday from 8 a.m. to 5 p.m. The new location, which opened early this month, offers primary care services for an entire family, including pediatrics and midwifery services. It is Regional One’s sixth primary care site and adds an eastern location to its current sites that span the city. Kirby Primary Care provides preventative medicine, physical exams, and treatment of acute and chronic conditions. The location also offers access to imaging, specialists and a full-service pharmacy nearby at the Regional One Health East Campus. Family medicine services for adults and pediatrics at Kirby Primary Care are provided by physician Cecilia Dowsingmemphismedicalnews
Adams, MD; and Certified Family Nurse Practitioners Amanda Best, Carol Simmons and Jeff Stricklin.
Women’s Health Specialists Merges with MOGA Memphis Obstetrics and Gynecological Association, PC (MOGA) one of the largest private providers of women’s healthcare in the Memphis area has merged with of Women’s Health Specialists (WHS) and this month will become a division of MOGA. The addition of WHS makes MOGA one of the largest OB/GYN provider groups in the southeast, bringing the total number of providers to 39. MOGA currently employs 150 other additional support full-time employees and now is in seven locations, including East Memphis, Germantown, and DeSoto County in Mississippi, plus this, its newest location in the Wolfchase area at 8110 N. Brother Blvd. Dr. Thomas Stovall, Managing Partner at WHS, said the merger, the third in the past decade, allows its groups to become “stronger and able to provide expanded services and more efficient care to our patients while maintaining quality obstetrical and gynecologic care.” Dr. Aric Giddens, MOGA President, will allow the practice to remain independent rather than owned by a larger system.
Dr. Gosain Wins University Surgeons Award Ankush Gosain, MD, PhD, FACS, FAAP, associate professor of Surgery and Pediatrics at the University of Tennessee Health Science Center UTHSC), was awarded the 20192020 Mid-Career Award from the Society of University Surgeons (SUS). Dr. GoAnkush Gosain sain is also the director of Pediatric Surgery Research in the Children’s Foundation Research Institute at Le Bonheur Children’s Hospital. The Mid-Career Award was created by the Society of University Surgeons to provide funding for principal investigators with a history of research on major independent grants or smaller pilot grants. The award provides Dr. Gosain and his lab with $40,000 for one year toward their current project, while requiring that a presentation of results be given at the 2021 Academic Surgical Congress in Houston. Dr. Gosain’s current project, “Neural Crest Cell and Extracellular Matrix Interactions in Hirschsprung Disease,” is looking at how the enteric nervous system, or the “brain of the gut,” fails to develop properly in children with Hirschsprung Disease. Hirschsprung Disease is a birth defect that sees the enteric nervous system fail to form correctly in children, thus resulting in missing nerve cells that are required to help the gut function.
Medical Society to Assist with Student Loans The Memphis Medical Society (MMS) will partner with Splash Financial, a student loan refinancing company, to assist its members. Reduced rates will be available to members in order to refinance current student loans. MMS president, Danielle Hassel, MD said the organization’s board of directors “has reviewed the proposal from Splash and believe it provides tremendous value to our members. We consistently hear that finance and student loan payback are a top concern for our members, and we decided we must act to provide a solution.” Dr. Hassel said members who have student loans and are not pursuing a loan forgiveness program, may be able to save money by refinancing with Splash Financial.
Dr. Murrmann Achieves New Fellowship Susan Murrmann, MD, FACOG, recently graduated from a two-year program at the American Academy of AntiAging Medicine (a partner with George Washington University School of Medicine and the Metabolic Medical Institute.) She is now a Fellow in AntiAging, Metabolic and Susan Murrmann Functional Medicine (FAAMFM) that will allow her to specialize in personalized, anti-aging, and functional medicine that emphasizes a holistic and preventative approach to health. The program focuses on the latest research and scientific evidence in endocrinology, cardiology, neurology, nutrition and cancer therapies. Murrmann is a founder, chief medical officer and medical director of the McDonald Murrmann Center for Wellness and Health and their Center for Aesthetics and Laser.
The 2019 CORNET Awards in Health Disparities Research winners and their project titles are: “Role of Extracellular Vesicles in HPV-Induced HIV Pathogenesis” by Santosh Kumar, PhD, (UTHSC); Wendy Likes, PhD, DNSc, APRN-Bc, FAANP, (UTHSC); Crystal Walker, PhD, DNP, FNP-C, (UTHSC); Carolann Risley, PhD, MSN, (UMMC); and William Robinson, MD, (Tulane). The project aims to investigate the biological interactions between HPV and HIV infected cells in an effort to address how and why HIV/AIDS disproportionately affects African Americans, especially in the southern Delta region. “Cardiometabolic Risk and Aggressive Prostate Cancer in African-American and White Men: The Delta Cancer Research Consortium” by Jay H. Fowke, PhD, MPH, MS, (UTHSC); Lydia A. Bazzano, MD, PhD, FACP, FACN, CIP, (Tulane); and Christian Gomez, PhD, (UMMC). This project aims to determine the link between cardiometabolic risk factors and the disproportionate rate of prostate cancer in African American men, and to develop methods to harmonize findings across studies.
Delta Medical Center Renamed Delta Medical Center has been renamed Delta Specialty Hospital. This name change reflects the strategic changes they have made to the services and programming options they provide. While Delta Specialty Hospital remains capable of providing subacute medical services, they have reduced the number of acute medical-based interventions that were previously offered. Instead, they have placed our focus on the delivery of clinically excellent mental health and addiction treatment.
Two Research Teams Win CORNET Awards Two multistate research teams – one investigating “Cardiometabolic Risk and Aggressive Prostate Cancer” and the other investigating “The Role of Extracellular Vesicles in HPV-Induced HIV Pathogenesis” have won the 2019 CORNET Awards. The winning teams were composed of researchers from the University of Tennessee Health Science Center (UTHSC), Tulane University, and the University of Mississippi Medical Center (UMMC). The CORNET Awards were created 2016 to foster collaborative partnerships between researchers in Memphis and various regional and global academic institutions, and industry partners. The purpose of the awards is to give seed funding, up to $75,000 per project, to collaborative research teams working to combat regional health inequities faced by those living in the Delta South. FEBRUARY 2020
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