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Your Middle TN Source for Professional Healthcare News

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Pampee Young, MD, PhD ON ROUNDS

Before Stage Four

Identifying, Addressing Depression with Early Intervention By CINDY SANDERS

Last month, suicide dominated national news. The high profile deaths by suicide of Kate Spade and Anthony Bourdain came amid a new report from the Centers for Disease Control and Prevention that found suicide rates have increased dramatically over the last two decades in the United States.

Scope of the Issue

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The CDC’s Vital Signs: Trends in State Suicide Rates1 noted suicide rates in the United States have risen almost 30 percent since 1999. In 2016, there were nearly 45,000 suicides among those aged 10 and over, making it the 10th leading cause of death

and one of only three leading causes of death that is on the rise. From 1999-2015, the report cited increased suicide rates among both sexes, all geographic areas, across all racial/ethnic lines, and in all age groups under 75. The largest absolute rate increase was among adults aged 45-64. As a result, 44 states saw significant increases in suicide rates with 25 states experiencing increases greater than 30 percent over that time period. In addition, U.S. emergency departments witnessed the rate of nonfatal self-harm rise by 42 percent from 2001 to 2016.

Missing the Signs

While much of the country was in shock over the CDC news, mental health experts weren’t nearly as surprised. Most experts agree that suicide isn’t caused by a single factor and that interventions too often happen downstream. While the CDC report included 2015 data from 27 states that indicated 54 percent of suicide decedents were not known to have mental health conditions, Paul Gionfriddo, president and CEO of Mental Health America (MHA), pointed out ‘not known’ isn’t the same as ‘not having.’ (CONTINUED ON PAGE 2)

Nashville Fosters Innovation at Startup Day Event HHS CTO Says Nashville at ‘Top of Our List’ for Entrepreneurship By KATIE SCHLACTER

The Department of Health and Human Services (HHS) is looking to invest in innovative healthcare startups, according to an official who attended the Startup Day Nashville in June. The HHS official, Acting Chief Technology Officer Ed Simcox, spoke to local organizations about how healthcare leaders can engage with the federal government. Nashville was one of the first stops on HHS’ cross-country tour of 13 cities. “We’ve put Nashville at the top of our list because of the amazing entrepreneurial scene,” Simcox said. “We want to be the front door to HHS for entrepreneurs.” Simcox explained HHS wants to drive value in healthcare by promoting open data. He cited HHS’ partnership with the American Society of Nephrology to create a kidney innovation accelera(CONTINUED ON PAGE 12)

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MHAMT Leader Takes on National Role Tom Starling Inducted as MHA Board Chair Mental Health America of Middle Tennessee President and CEO Tom Starling, EdD, was sworn in as chairman of the national MHA Board of Directors at the organization’s annual meeting last month. Starling – who holds degrees in psychology, theology, ethics and education Tom Starling administration – has led MHAMT since 2009. “We’ve been around for 72 years, since 1946,” he noted of the local organization. “We were started by Dr. Frank Luton, who was the first chair of Psychiatry at Vanderbilt.” Starling added Luton and a $500 donation from the Junior League of Nashville launched the nonprofit that now provides professional and community education, advocacy, links to resources and an array of specialty programs. “A third of our staff includes the Tennessee Suicide Prevention Network, and they provide suicide prevention training and resources across the state,” said Starling. “For 34 years, we’ve had an Aging & Alzheimer’s program to train both lay caregivers and professionals in facilities,” he continued. “Our forte in the landscape of behavioral health is really education and advocacy.”

Starling noted MHAMT is among the largest affiliates in the South. In fact, the local branch has expanded to the point that the organization is rebranding this month to become MHA of the MidSouth as the service area expands to also include areas east to Chattanooga and west to Memphis. In his new national role, Starling said, “I would love to continue to emphasize the B4Stage4 mantra.” He continued, “We have to be better at prevention and early intervention and recognizing the signs. We need more integrated care. We should really be focusing more on the whole person.” Starling added engagement is critical to help prevent suicides and stressed the importance of making a connection … which might come from a support group but could also easily come from joining the church choir, an exercise class or hobby group. “One of the biggest protectors against suicide is connectedness,” he reiterated. “Our society is becoming so fragmented and isolating. I would encourage any community to look at how they can increase connectedness.” He also will advocate for increased screening for mental illness. Starling noted a child has to have a physical to enroll in school or play sports but no such mandate occurs for the evidence-based mental health screenings available. While he noted providers might hesitate to ‘label’ a child,

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the National Suicide Prevention Lifeline throughout the news reports. Additionally, having sports heroes including Olympian Michael Phelps and basketball star Kevin Love open up about their struggles has underscored mental illness can impact anyone at any time. “Getting help is not a weakness,” concluded Starling. “It takes real strength to get help.”

Before Stage Four, continued from page 1 He believes one issue is a lack of routine screening for early warning signs that could lead to interventions well before suicidal ideation is present. “Death by suicide is the ultimate Stage 4 Paul Gionfriddo event in the progression of many mental health conditions, whether or not they have ever been recognized and labeled,” said Gionfriddo. “People don’t just go from being perfectly healthy one day to having suicidal ideation the next, just as they don’t go from being perfectly healthy one day to having any other late stage chronic condition the next.” He continued, “Most suicide prevention activities over the last decade have tried to focus on breaking the connection between suicidal ideation and suicide. My response to that is that’s too late. It’s too late to start an intervention … we need to walk it back years.” Gionfriddo pointed out providers wouldn’t expect great outcomes if the first intervention was at Stage 4 of any other disease. “If you’re focusing on suicide or suicidal ideation, which is also a late-stage event, then we’ve really lost many opportunities to intervene early and look for early warning signs.”

Screening Opportunities

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the flip side is that screenings could save lives. Starling added that although the stigma of mental illness is still pervasive, recent events have begun a national dialogue. He said he appreciated the media’s handling of last month’s high profile suicides, which included reiterating that help is available and running the number for

Part of the frustration with catching the depression that can lead to suicide so late in the game is that an evidence-based tool is readily available to help identify warning signs at a much earlier point. “The most commonly used mental health screening is the PHQ-9,” said Gionfriddo. The patient questionnaire, which is available at no charge on the MHA website (screening.mentalhealthamerica. net), features nine questions about feelings and activities over the last two weeks with answers measured in terms of frequency (from ‘not at all’ to ‘nearly every day’). “This screening is recommended by the U.S. Preventative Services Task Force for everyone over the age of 11 on a regular basis, but relatively few clinical providers are using that tool,” he continued. Gionfriddo added it’s easy to administer and to score. He said about 3,000 people a day have come to the MHA screening site over the last four years with about half of those taking the PHQ-9 depression screen, which means

the organization has amassed de-identified data on approximately 3.25 million individuals with half focused on depression. Of the nine questions, he noted, suicidal ideation is eighth … near the bottom … in terms of frequency, which is significant because it points to being able to catch signs of depression in earlier stages. “The initial warning signs happen way earlier than suicidal thinking,” noted Gionfriddo. “That gives us the greatest chance for success.” Asked how providers might identify those at risk and intervene before patients get to Stage 4, Gionfriddo said adopting the PHQ-9 as a routine part of every visit is an easy first step. “They’ll find people who answer three, four, five questions positively often years before thinking about suicide and before they act on it,” he said. “That’s what clinicians could do and what clinicians should do … and oh, by the way, it’s reimbursable,” he stated.

Warning Signs, Now What?

One of the possible reasons the screen isn’t more widely adopted is a feeling of ‘now what?’ Many areas have a shortage of mental health professionals, and other providers often aren’t aware of what local resources exist to help a patient identified as having early warning signs for depression. “Not knowing is not helping,” stated Gionfriddo. He added people typically want one of four things once identified as being at risk for depression and suicide: • Referrals to care and treatment (often the only one considered by clinicians), • More information, • Do-it-yourself tools like stress-reducing activities including journaling, exercise and improved nutrition, and • Engagement or peer connections. “At least one of those four things is available in every community, and often two, three or all four of those things are available,” he said. “When people complete screens on our website, they’re given information on all four of those areas,” he continued, adding MHA is also happy to provide interested clinicians with information on area resources. “That’s the answer to ‘then what?’” Gionfriddo concluded. “It might not be perfect, but it’s better than not knowing.” Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates – United States, 1999-2016 and Circumstances Contributing to Suicide – 27 States, 2015. MMWR Morbidity and Mortality Weekly Report 2018; 67:617-624. 1

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The Opioid Crisis – Where Do We Go From Here? As discussed in last month’s edition of Nashville Medical News, the Tennessee General Assembly recently approved a significant portion of Governor Bill Haslam’s “TN Together” plan to combat the opioid crisis in Tennessee. That legislation, a result of discussion and compromise between legislators, By Jerry W. Taylor the administration, and healthcare providers, has since been signed into law by the governor as Public Chapter 1039, effective immediately for rulemaking and on July 1 for all other purposes. The main goal of the governor’s TN Together plan is to and Matthew Kroplin “attack the state’s opioid epidemic” through prevention, treatment, and law enforcement. According to the TN Together website: “Tennessee remains in the top 15 of all states in drug overdose deaths, and each year, more opioid prescriptions are written than there are people living in Tennessee, with more than 1 million prescriptions left over.”1

Some of the key components of the new law require providers to check the Controlled Substance Monitoring Database at certain points before and during opioid treatment and place limitations on the duration, frequency, and dosage of most opioid prescribing and dispensing. The new law specifically states that it does not apply to certain types of treatment, including inpatient treatment, active or palliative cancer treatment, hospice care, and prescriptions issued by certified pain management specialists. Tighter restrictions on access to opioids are intended to help curb the personal and economic devastation wrought by opioid abuse and addiction. But what cannot be ignored by the medical industry and society as a whole is the fact a significant portion of the population suffers from acute and/ or chronic pain. The alleviation of such pain is typically beyond the capabilities of over-the-counter analgesics and NSAIDs, and effective non-opioid painkillers are needed. Tennessee’s new law, for example, specifically requires a provider to document “consideration of non-opioid and nonpharmacologic pain management strategies and why the strategies failed or were not attempted” when treating certain patients with more than a three-day supply of an opioid. (See page 4 for TMA education offerings on the new law.) There has been promising research in developing drugs that seem to be effective in blocking pain but do not produce the pleasurable responses in the brain, which lead to abuse and addition. These drugs

act on nerve receptors at the site of the injury or infirmity, rather than those in the brain. However, while there is heightened awareness of the need for effective nonopioid painkillers, the research and development of such alternatives has been stymied by numerous factors. Most of these are interrelated, and the cumulative effect is that research and development of new painkilling drugs is moving at a snail’s pace. One obstacle is that pain, unlike almost any other disease or disease manifestation, is completely subjective. What may be a “9” on the pain scale to one, may be “6” on that scale to another. Other diseases have clear biomarkers that can determine the efficacy of drugs in clinical trials, but that is not the case with pain treatment. The implications are far-reaching in the areas of research and development, clinical trials, funding, and insurance coverage decisions. Payers and insurance companies are understandably reluctant to cover and pay for what could be more expensive and lessproven effective drug alternatives. Although opioids carry significant hazards in terms of the risk of addiction and abuse, they are proven to be very effective and efficient in their intended use – to alleviate pain. While this reluctance may be changing, it will take time to get the payers and insurers on board. Another problem is funding for research and development in this area. Venture capital investment in companies focused on developing opioid alternatives has been extremely low relative to companies focused on developing drugs

for other diseases. A report issued by the Biotechnology Innovation Organization’s opioid working group concludes that venture capital investment in companies focused on pain is 3.6 percent of total drug company funding and is 17 times less than the amount of venture investment for cancer companies in the past decade.2 The lack of strong financial incentives, in addition to the regulatory hurdles – which are always significant and are exacerbated in regard to opioid alternatives – are contributing factors to this lack of venture capital funding. Stemming the availability of opioids is one important step in helping resolve the opioid addiction crisis, but the other half of the effort is finding and developing alternatives to treat pain. The research and development of such drug alternatives is producing some initially promising results, but those efforts have been stymied by the unique characteristics of pain as a disease, a lack of private funding, and the ubiquitous regulatory hurdles. https://www.tn.gov/opioids/about-tn-together.html

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Drug Makers Developing Non-Opioid Pain Alternatives to Battle the Opioid Epidemic, http://wxpress.wuxiapptec.com/ drug-makers-deveoping-non-opioid-pain-alternatives-battle-opioidepidemic/ 2

Jerry Taylor and Matthew Kroplin are both partners in the Nashville office of Burr & Forman in the firm’s Health Care Practice Group. Taylor concentrates his practice in the areas of healthcare and administrative law. Kropin focuses on healthcare and business litigation and represents a wide range of healthcare providers, suppliers and companies. For more information, visit burr.com.

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Op-Ed: The Need for Effective Measures to Treat Mental Illness There is an urgent need for more dynamic and effective measures to care for the growing number of Americans with serious mental illness – in Middle Tennessee and across the nation. It is estimated that one in six adults, or more than 40 million Americans, suffer from a behavioral health disorder each year, and 75 percent of these individuals go without treatment. Those with serious by Tim Adams mental illness are vulnerable to chronic medical conditions, which can reduce their life expectancy by 25 years. Serious mental illness is estimated to cost the federal government more than $193 billion annually, and over the last 20 years, the rates of violence, suicide, homelessness victimization and incarceration among the mentally ill have continued to rise. Behavioral health needs in Middle Tennessee continue to increase in all sites of care … and while already extraordinary, projections for the future indicate demand will only increase. There are currently 19,900 behavioral health discharges annu-

ally in the Middle Tennessee region and the market size has grown by more than 25 percent since 2011. We cannot have a compassionate and just society if we are not striving to provide the best care possible to the mentally ill and those suffering from addiction. Saint Thomas Health and Ascension are committed to addressing behavioral health needs across the country as part of our strategic direction. Recognizing the impact of lacking behavioral health

resources in Middle Tennessee, Saint Thomas sought to develop a joint venture partnership with Acadia Healthcare – an international, leading behavioral health provider with almost 600 behavioral health facilities in the U.S., U.K. and Puerto Rico headquartered in Franklin. Saint Thomas Health will develop a freestanding 76-bed hospital at Metro Center. As part of this strategy, Saint Thomas Health has developed a plan to renovate and backfill the existing geriatric psychiat-

Acadia, Saint Thomas Partner on Psychiatric Hospital In May, Saint Thomas Health and Acadia Healthcare announced plans to open an inpatient psychiatric hospital in Nashville. The partnership will include the establishment of a new 76-bed psychiatric inpatient hospital at Metro Center in Nashville, encompassing 40 adult psychiatric beds and 36 geriatric psychiatric beds. “We are delighted to enter this joint venture partnership with Saint Thomas Health,” said Joey Jacobs, chairman and CEO of Acadia. “A central focus at Acadia has long been the consistent expansion of our capability to meet the growing behavioral health needs of our local communities. By becoming a part of Saint Thomas Health’s clinically integrated system of care through this joint venture, we are taking a significant step toward fulfilling this goal in Middle Tennessee.” Saint Thomas Health will relocate the existing 24 geriatric psychiatric beds at Saint Thomas West Hospital to develop the planned freestanding hospital and convert the existing geriatric psychiatric unit to a critical care unit. Pending certificate of need approvals, construction would begin in early 2019.

ric unit and convert to a critical care unit needed to support the rising acuity levels at Saint Thomas West. These efforts result in Saint Thomas Health’s $37 million investment into the behavioral health needs of the communities we are privileged to serve. Our initiative to expand behavioral health resources in our community is consistent with our mission and efforts to serve all – mind, body and spirit. These efforts will meet a tremendous community need by filling a care gap in our community and is part of our strategic direction. We recognize that the need for behavioral health solutions in our community and across the nation is urgent. This new facility will expand access to behavioral health services with a focus on both quality of care and providing patients with a distinct, personalized experience – all part of our mission. Saint Thomas Health and Ascension is excited to expand behavioral health access in Middle Tennessee because it is the right thing to do for the individuals we serve. Tim Adams is president and CEO of Saint Thomas Health and ministry market executive for Ascension Tennessee. He presides over Saint Thomas Health’s nine inpatient facilities in Middle Tennessee, in addition to a network of physician practices, joint ventures and community partnerships. For more information, go to sthealth.com.

Behavioral Health Rounds TMA Leads Physician Education on New Opioid Laws

The Tennessee Medical Association has launched an online resource center to give physicians and other healthcare providers tools to help fight the state’s opioid abuse epidemic, including detailed information on new state laws limiting opioid prescriptions after passage of one of the nation’s most comprehensive and restrictive laws regulating initial opioid supply. Effective July 1, physicians and other prescribers must adhere to new limits and specific requirements for opioid prescribing. TMA has developed proprietary tools at tnmed.org/opioids to educate doctors on the new law and help members stay compliant. The online resource center features guidelines, videos and a proprietary infographic that visually walks doctors through prescribing under different patient scenarios. “Our members are confused and anxious about how the new laws will affect their day-to-day practice and, most importantly, their patients, some of whom depend on these medications as part of pain management,” said TMA President Matthew L. Mancini, MD, FACS. “We want physicians to look to TMA for accurate, authoritative information on the new prescribing restrictions so they can stay compliant and hopefully still give patients effective pain therapies.” 4

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CleanSlate to Open 22 More Centers in 2018

Nashville-based CleanSlate, a national leader in outpatient pharmacological treatment for the chronic disease of addiction – primarily opioid and alcohol addiction – recently secured $25 million in financing. The round was led by HealthQuest Capital, which joins existing controlling investor Granite Growth Health Partners. The funding will be used to help CleanSlate continue to accelerate its growth – 45 centers currently operate across eight states, with another 22 centers slated to open this year. “In addition to new centers, we envision working with hospitals, health insurers, local government and community organizations to develop partnerships and creative ways to expand access and deliver treatment, beyond the traditional brick and mortar center,” said Gregory Marotta, president and CEO of CleanSlate Centers.

TSPN Responds to CDC Suicide Trends Report

In response to the recent release of a report by the Centers for Disease Control and Prevention on trends in state suicide rates (see page 1 for more information), the Tennessee Suicide Prevention Network released the following information: “In any given day, three people in Tennessee die by suicide. In 2016, the number of suicides increased in young people (ages

10-18) in Tennessee, with one person in this age group lost to suicide every week. We lose one person between the ages of 10-24 every four days, and every day we lose at least one person over the age of 45, with adults in midlife and older adults remaining at higher risk. While suicide rates in Tennessee went up only slightly in 2016 from 2015, the new figures are the highest recorded in Tennessee in more than 35 years of record-keeping. However, with all of this information, TSPN wishes to praise efforts happening in Tennessee toward suicide prevention.” TSPN Executive Director Scott Ridgeway, MS, added the number one risk factor for suicide is undiagnosed depression. “If we are really going to address the issue of suicide in Tennessee, we need additional funding in our state devoted specifically to suicide prevention efforts,” Ridgeway stated.

2018 Senior Report Shows Increase in Suicide

In mid-May, United Health Foundation released its annual 2018 America’s Health Rankings Senior Report. While Tennessee’s overall ranking (44th) didn’t change for seniors from last year, there were some notable strengths and challenges across a number of categories. Of particular interest was an increase in the suicide rate of 18 percent in the past four years among Tennessee seniors aged 65 and older.

AMA Adopts Policy to Improve Physician Access to Mental Healthcare

During the AMA’s annual meeting last month, the nation’s largest physician organization adopted a new policy to address the growing concern of physician and medical student depression, burnout, and suicide. “We are deeply concerned that physicians and physicians-in-training are oftentimes discouraged from seeking mental health services because they are afraid that publicly disclosing a mental health issue would unfairly stigmatize them and impede their ability to obtain a medical license,” said AMA President David O. Barbe, MD. “We must do everything we can to improve physician wellness and eliminate any barriers that stand in the way of physicians accessing needed mental healthcare services so they can have more meaningful and rewarding professional experiences and provide the best possible care to their patients.” The new policy aims to help alleviate concerns about the presence and phrasing of questions on medical licensing applications related to a physician’s past health impairment. Instead, the policy encourages state licensing boards to focus on disclosure of current physical or mental health conditions that would impair judgment or otherwise adversely affect the ability to practice medicine in a competent, ethical, and professional manner. nashvillemedicalnews

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HEALTHCARE ENTERPRISE

SAFE Clinic Opens to Victims of Sexual Violence New Clinic Available through Nashville’s Sexual Abuse Center By MELANIE KILGORE-HILL

man explained. The Tennessee Department of Health, the Tennessee Coalition to End Domestic and Sexual Violence, and the Sexual Assault Center developed the online training, which takes 20 minutes to complete.

Forty years ago, Nashville’s Sexual Assault Center (SAC) was founded as a crisis hotline for abuse victims. Today, more than 700 men, women and children visit the multi-faceted facility each year for long-term counseling and holistic therapy services designed around healing.

Educating Providers

By the Numbers

The stats are sobering: One in four girls and one in six boys will be victims of sexual abuse before age 18, and only one in 12 child sexual abuse victims will ever report it. Meanwhile, one in six women will experience rape or attempted rape in her lifetime. While the consequence of abuse is often life-long, SAC President Rachel Freeman, LCSW, hopes to improve outcomes for victims through the center’s new SAFE (Sexual Assault Forensic Exam) Clinic. “We’ve been working on providing more choices for rape survivors Rachel Freeman for a decade or more because until now, there’s only been one place to get a rape exam,” Freeman said. In Davidson County, that one place was Nashville General Hospital’s Emergency Department. And while rape victims need the support of medical professionals, 80 to 90 percent don’t need emergency care. “An ER is not the most trauma informed place or the most comfortable place to start recovering from rape,” Freeman said, noting the citywide desire to create a non-hospital clinic for rape survivors. That reality led to ongoing conversations with the Mayor’s office and leaders from the District Attorney’s office, Metro Police, Nashville General, the Office of Family Safety and Our Kids to discuss what the city could provide for survivors of rape. SAC was the logical choice for a non-hospital environment … and within nine months, $2.5 million was raised through a successful capital campaign to fund a secure, 1,100-square-foot clinic specifically for these victims. “The majority of people who contributed were most excited about the community-wide collective impact since we weren’t duplicating services but creating a safe, nurturing and peaceful environment that didn’t exist in Nashville,” Freeman said.

Advocates for Victims

The SAFE Clinic utilizes Nashville General’s sexual abuse experts, who have decades of experience working with vicnashvillemedicalnews

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Community stakeholders joined Nashville Sexual Abuse Center President Rachel Freeman to celebrate the opening of a unique facility to care for sexual assault victims.

tims, testifying in court and understanding the chain of custody. “We’re not reinventing the wheel but replicating what was already working well at Nashville General in a new space focused exclusively on the healing of survivors,” Freeman said. The highly secure unit with the Sexual Assault Center includes a small waiting room and reception area, consultation room, two exam rooms and a spa-like restroom with shower. The SAFE Clinic held a June ribbon cutting, and doors officially open in early July. “Nationally, it’s estimated that only one-third of all rapes are reported to law enforcement, and of those, only a small fraction lead to a conviction and incarceration,” said Freeman. “By making rape exams more accessible, we hope to make Nashville a safer community by collecting the evidence that will get offenders off the street, and therefore reducing the occurrences of rape and sexual violence. “Walking into this building is the hardest first step, which is why it’s so important to have this facility,” Freeman said. “Victims need to see they’re not alone, to feel validated and know they don’t have anything to be ashamed of.”

Addressing Behavioral Health

Freeman said the mental and emotional toll of sexual abuse is typically the most devastating. In fact, more than half of SAC patients are adult survivors of childhood abuse who kept their secret for decades. While no two survivors respond the same way, many experience years of depression, sleep disorders, anxiety, relationship issues, fear, embarrassment, guilt and shame. “Sexual assault doesn’t cause mental illness, but the body’s reactions to it can lead to bigger problems if the story is held inside for a long time,” Freeman said. That tension manifests itself through

headaches, GI problems, fibromyalgia and other physical ailments. “The best prognosis for healing is if you’re believed and supported, and that’s the message we try to promote so the potential for longterm negative impact is lessened,” Freeman noted.

Reaching Out

The center provides prevention and outreach programs for children, teens and college students, while their Safe Bar training program has been adopted by several Middle Tennessee establishments. “There’s a strong correlation between alcohol and sexual violence, and we want to make sure bar staff feel equipped to act if they see something suspicious,” Free-

SAC staff members also work with Middle Tennessee’s medical community to provide awareness, education and insight on how to talk to patients about sexual violence. “Primary care and OB/GYN providers need to know we’re here, not only to help survivors but to support other professionals in the community,” said Freeman. “A lot of survivors disclose multiple times before they’re finally heard or believed … and the sooner we help them disclose, the less longterm impact it will have on their lives and their overall physical and mental health.” She encourages providers to ask the tough questions – those not typically included on medical history forms. For example, many include questions related to domestic violence. “Are you safe at home?” is a common inquiry that fails to address sexual abuse. “We assume the domestic violence question will answer it, but most sexual abuse victims are currently safe, so we’re not asking the right questions to encourage people to disclose,” Freeman said. “If you look at the stats and the prevalence of sexual assault, it’s happening whether we ask questions or not. Survivors need to know it’s not their fault and that we believe them and are here to help.”

Lipscomb Launches Online RN-to-BSN Program Lipscomb University’s School of Nursing has launched an RN-to-BSN program, university officials recently announced. The new program, housed in Lipscomb’s School of Nursing within the College of Pharmacy & Health Sciences, is fully online and designed to help equip and empower Registered Nurses with an associate degree who desire to advance their Chelsia Harris career by completing a bachelor’s degree in as few as 18 months. “Research links improved patient outcomes, decreased medication errors and lower mortality rates to nurses educated at the baccalaureate level,” said

Chelsia Harris, associate director of nursing for degree development at Lipscomb. While Harris said nurses at the associate degree level are wonderful clinicians, she noted there is gap between those providers and their colleagues with a bachelor’s degree. “BSN nurses are trained to be critical thinkers, to lead, design, and manage patient care. They’re not just doers. They can think at the bedside and make sound clinical decisions that are best for patients and outcomes,” she said. Lipscomb’s RN-to-BSN program holds initial approval status from the Tennessee Board of Nursing and is pending accreditation by the Accreditation Commission for Education in Nursing (ACEN). The program is accepting applications for its first cohort of students to begin in August 2018. JULY 2018

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AAC Utilizing AI to Improve Outcomes EarlySense™ Technology Helps Monitor High-Risk Detox Patients By MELANIE KILGORE-HILL

Over the past decade, artificial intelligence has morphed from the big screen to the patient room, revolutionizing clinical care throughout the United States. In June, American Addiction Centers (AAC) became the industry’s first treatment provider to utilize EarlySense™ technology during detox. This potentially life-saving technology provides medical staff with real-time data to identify irregular vital signs, which is crucial for patient safety in the detox phase of treatment. Over the next few months, American Addiction Centers, which is headquartered in Brentwood and owns and operates more than 30 treatment facilities across the country, will implement this technology as a standard of care at all of its facilities with detox services.

Patients First

“This decision was all about patient safety, and we’ve been very focused on reducing risks as patients go through detox,” said Tom Doub, PhD, chief clinical and compliance officer for AAC. “Addiction killed 64,000 people last year, so by Dr. Tom Doub

the time they get to us they’re often very fragile and experiencing serious physical health, medical co-morbidities and psychiatric problems so you really have to watch them closely.” The FDA-cleared patient monitoring system uses a sensor placed beneath the mattress to continuously tracks the patient’s heart rate, breathing patterns and movements without attaching any wires to the patient. Concerning changes, such as irregular heartbeats or breathing patterns and sudden movements, will immediately distribute real-time alerts to a central nursing hub, tablets, and mobile devices, providing nurses with ample time to proactively respond.

Assisting Staff

Mark Calarco, MD, national medical director for AAC, stressed that EarlySense is intended to assist staff, not replace them. However, the highest risk of withdrawal is between midnight and 8 a.m., which is also when many facilities schedule fewer and newer staff. Dr. Mark Calarco “This supports the human component of nursing during the graveyard and third shifts, which are just hard on the human

body,” Calarco said. “EarlySense adds another layer of safety for both patients and staff.” An unexpected benefit includes the ability to monitor patients for falls. Additionally, the device is intelligent enough to set at an appropriate level for each patient – meaning fewer annoying false alarms.

Better Results

Last year, AAC saw good results when they piloted EarlySense in a California facility that serves medically compromised patients. “The technology is very simple and easy to use, but the ultimate test is always whether staff finds it a help or hindrance, since some technology just creates more work and doesn’t necessarily add to patient care,” Doub said. The result? Happier clinical staff and better outcomes. That’s because the device samples the heart rate twice a second giving staff an early warning if someone’s deteriorated or in distress rather than relying on hourly check-ins. For an organization with 1,200 patients at any given time, the potential is a game changer.

The future of AI at AAC

Calarco said EarlySense is just the start of artificial intelligence for AAC, which also utilizes biotech AI to provide personalized medicine for individualized recovery plans. The technology supports

their translational software, which allows physicians to collect a large database for research studies. Leaders are also looking at low-cost biometric devices to help track patients’ recovery progress and medical needs, including technology that detects if a patient is abstaining or relapsing on a particular drug. “The human brain is good at processing certain information but less so in other areas, and we don’t always make logical decisions based on highest probability,” he said. “That’s an area where AI could help us in making clinical decisions and diagnoses. Some patients have a lot of variables including multiple diagnoses and multiple meds, and that’s where AI will be especially useful.” AAC is also moving toward a common electronic medical record platform for their growing number of facilities. “Like other industries, healthcare produces a tremendous amount of data, and as we’ve brought in new facilities on different systems it’s increasingly difficult to compile data in a granular way,” Doub said. “As one of the larger providers of addiction services we have a tremendous opportunity to be more engaged and advance the state of knowledge. Those who use customer data wisely and responsibly will do so to provide a more effective and responsive product.”

Tech Talk Bridge Connector Attracts Investor, Grows Nashville Presence

Last month, Bridge Connector, a B2B tech startup company delivering streamlined integration solutions for healthcare organizations announced a seed investment of $4.5 million, led by Tampa-based emerging-technologies firm Axioma Ventures LLC, which is backed by Howard Jenkins, the former CEO of Publix Super Markets. The financing will be used to continue hiring developers and bolster its support, sales, and management teams. Headquartered in Palm Beach Gardens, Fla., the integration platform as a service (iPaaS) company is streamlining integration with a seamless, full-service solution that can be deployed regardless of the platform being used. The technology acts as a secure pipeline between endpoints, moving medical data between systems directly without the need to store sensitive electronic healthcare information in another database. With the new investment and continued growth, Bridge Connector has added two key hires to the company’s Nashville team. Joshua Douglas has joined the company as chief technology officer. He has more than 15 years experience in data and analytics strategy, integration, clini6

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cal workflow, process improvement, and product management. Most recently, he was principal at Nashvillebased D2 Health Inc. and before that served as director of Implementation at Sandlot Joshua Douglas Solutions. Andy Harlen has been named vice president of sales with oversight of new business development, vendor partnerships, enterprise clients and go-to-market strategy. He has significant Andy Harlen experience scaling SaaS-based startups and comes to Bridge Connector from Virsys12. Prior to that, he held positions at fast-growing SaaSbased startups, including PlayMarker CRM, Shareholder InSite (acquired was by Ipreo), and Bernard Health.

Virsys12 Receives Funding Round, Garners National Accolades

Founder and CEO Tammy Hawes recently announced Salesforce Consulting

Partner Virsys12 has been recognized in a list of “Cool Vendors” in a research note by Gartner, Inc., and the company is positioned as a “Contender” in a report by IDC. In addition, Virsys12 Tommy Hawes recently closed its first round of outside funding led by Salesforce Ventures’ SI Trailblazer’s Fund. Notably, Virsys12 was also recently the recipient of a 2017 Salesforce Partner Innovation Award for their implementation of Health Cloud. “We believe our customers’ success is our greatest reward,” explained Hawes, who has funded and owned Virsys12 since launch in 2011. “However, we also believe acknowledgement of our work by these two prestigious research firms is testimony to the expertise of our team and our ability to successfully customize Salesforce for the complexity of healthcare.” She added, “The investment from the SI Salesforce Trailblazer Fund will support company growth to meet the increasing demand in the market for Health Cloud implementations and to continue to provide our clients with transformational technology on the Salesforce platform.”

Middle Tennessee HIT Companies Recognized Among Top 100

The 2018 Healthcare Informatics 100 list was recently released, and Middle Tennessee was well represented among the companies recognized as being the top healthcare IT firms in the nation based on revenues from the most recent fiscal year. “More than just a list, the Healthcare Informatics 100 is an absolute indicator of which companies are solving issues in the U.S. healthcare industry – and doing it at scale,” said Rich Tomko, vice president and managing director of Healthcare Informatics. Middle Tennessee companies to make the 2018 list were Change Healthcare (#4), Experian Health (#41), M*Modal (#43), HealthStream (#50), MedHost (#67), HCTec (#72), Cumberland Consulting Group (#82), and emids (#88).

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What to Expect at Health:Further 2018 August Festival Highlights Innovation, New Partnerships By MELANIE KILGORE-HILL

From August 27-29, more than 2,000 healthcare entrepreneurs, investors and clinicians will gather for Health:Further’s fourth annual industry gathering at Nashville’s Music City Center. A sister company of healthcare innovation fund Jumpstart Foundry, the international event is based on the premise that health is a human right, which must be supported affordably and sustainably. “As Health:Further continues to grow, we continue to open a big tent to all healthcare communities and collaborators to foster an entrepreneurial spirit,” said Marcus Whitney, CEO of Health:Further and co-founder of Jumpstart Foundry. “We’ve grown by recognizing that healthcare innovation requires a diverse group of operators, and the purpose of this is to bring all these perspectives together in one event.”

Always Improving

Whitney said a lot of planning went into differentiating and improving 2018’s event. “We’ve spent the past six months defining who the Health:Further community really is,” said Whitney. “There are a lot of experience upgrades this year.” That includes an overdue focus on clini-

cians, and partnerships with the American Nurses Association and the Physician Entrepreneur Summit. Also on the roster is a daylong Clinician Innovator and Entrepreneur Track dedicated to exploring what happens when innovation sits in the hands that deliver it, discussing how to bring big ideas to market and lead innovative change as a clinician. Opening day will include several keynote speakers with more focused conversations and breakout sessions on the following days. For financial managers, Health:Further and the Tennessee Health-

Advising Nashville’s Growing Healthcare Companies and Investors

care Financial Management Association are offering a content track called “Growing the Margin: Innovation for Financial Sustainability.” The program is designed to provide education and insight to healthcare financial managers and expose them to the trends that will change their organizations in the future. Additional topics for 2018 include Healthcare Informatics, Telehealth, Care Team Enablement and Cybersecurity.

HCA Healthcare

Health:Further also recently announced a new partnership with HCA

June 2018

Healthcare. The Nashville-based global healthcare company will serve as presenting sponsor of the 2018 and 2019 Health:Further festivals. At this year’s festival, the collaboration will include an opening day event with HCA Healthcare CEO Milton Johnson and a pitch competition featuring HCA Healthcare CIO Marty Paslick as the head of an all-star panel of judges. Additionally, HCA Healthcare will host the festival’s international delegations, welcoming them to their headquarters as part of their Health:Further experience.

May 2018

(CONTINUED ON PAGE 8)

February 2018

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What to Expect at Health:Further 2018, continued from page 7 High-Tech Challenges

The August event also will explore blockchain innovation through the Tokenizing Health Summit, where attendees will learn from those building the latest blockchain solutions for healthcare, connect with a coalition of leading blockchain experts, and network with likeminded technology leaders. A serial entrepreneur, Whitney said a leading industry challenge surrounds interoperability and data sharing. “Today, a vast majority of records are in the cloud, but getting them from place to place and creating a shared experience continues to be a real issue,” he said. “We’ll continue to look at ways to improve outcomes and costs, because shared coordination across organizations is so important.” Whitney believes there’s a tremendous opportunity on a federal level for

promoting buyer interoperability, impacting care delivery models, improving workflow and innovation. “There are a lot of developments underway, and it’s important to get it right,” he said. “There are pressing issues that could be big victories.”

Summit of the Southeast

Another notable highlight for 2018 is the second annual partnership with Tennessee’s Health Information Management Systems Society, which will present the best in Healthcare IT thought leadership. August’s festival also will feature the tenth TN HIMSS Summit of the Southeast, which will deliver thought-provoking content for attendees. TN HIMSS president Tommy Lewis said the partnership is a win-win for both forward-thinking groups. “We’re aligned really well with Health:Further’s vision of having a

AMA Celebrates Five Years of VUSM Education Innovation On June 5, representatives from the American Medical Association’s Accelerating Change in Medical Education (ACE) leadership team visited Vanderbilt University School of Medicine (VUSM) to review accomplishments made during the past five years of VUSM’s particiby Bonnie Miller, MD pation in the ACE consortium. Led by Susan Skochelak, MD MPH, group vice president for Medical Education at the AMA, the team met with faculty members who oversaw VUSM’s transition to Curriculum 2.0, an innovative medical school curriculum that promotes the skills needed for self-directed lifelong learning, allows individualized curricular pathways, and employs a competency-based assessment system. VUSM began implementation of Curriculum 2.0 in 2013, and two classes have now graduated from the program. In 2013, VUSM was one of 11 medical schools awarded a $1 million grant over five years to support these transformative efforts. Last month’s visit marked the end of the initial funding period. In 2015, the AMA invited 21 additional schools to participate in the consortium’s efforts. Skochelak presented her reflections on the impact of the ACE consortium during a Medical Education Grand Rounds that was open to all of VUSM’s faculty and students. By encouraging the introduction of health systems sciences into medical school curricula, promoting competency-based progression through 8

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medical education, and supporting the technology and coaching processes that guide self-assessment, professional formation and individualization, the ACE consortium was tremendously successful and exceeded the AMA’s hopes for the project, she said. Even though this initiative is drawing to a close, the AMA will continue to support innovation in medical education with a new focus on graduate medical education and the transition from medical school to residency. At the start of the Grand Rounds program, Skochelak recognized Kim Lomis, MD, associate dean for Undergraduate Medical Education and principle investigator for VUSM’s ACE grant, for her role in Vanderbilt’s success and her contributions to the consortium’s collective efforts. As senior associate dean for Health Sciences Education at VUSM and executive vice president for Educational Affairs at Vanderbilt University Medical Center, I also had the opportunity to share perspectives during Medical Education Grand Rounds and told those gathered, “We are deeply grateful for the support the AMA has provided us over the past five years and have benefitted greatly from the collaborations built by the consortium. We now look forward to another five years of innovation, in order to address ongoing challenges in healthcare and medical training.” Vanderbilt will continue to serve as a leader in preparing the next generation of physicians. Bonnie Miller is senior associate dean for Health Sciences Education at Vanderbilt University School of Medicine and executive vice president for Educational Affairs at Vanderbilt University Medical Center. In those roles, she spearheaded the Curriculum 2.0 revision as part of the school’s AMA grant to innovate medical education.

health conference of this scale, and without high aspirations you won’t be able to achieve it,” Lewis said. “The main reason we joined was to focus on what we’re good at, which is delivering great content and Tommy Lewis thought leadership to our members and guests.” With an annual growth rate of 15-20 percent, Tennessee’s HIMSS chapter is the largest in the nation. Lewis said the festival helps attract new members previously unaware of the group’s unique structure. “Some might only associate our broader organization with health tech, but our membership includes a broad range of professionals from executives and clinicians to hardcore IT developers and leaders. Our membership is as diverse as Nashville is.”

Nashville Is

Health:Further is also a part of the Nashville Is event, which includes the Live

On The Green music series and 36|86, a conference event for Southeastern entrepreneurs. Discounted tickets are available online for those wishing to attend all events.

Bringing Innovation Home

“One of the things that makes Health:Further successful is that it’s created by Nashville leadership and industry,” said Whitney, noting the amount of healthcare innovation within Middle Tennessee. Globally, Nashville’s healthcare industry generates more than $84 billion in revenue and more than 500,000 jobs. “Nashville is not as well known as it should be for what its contributing to America’s healthcare economy, so we need to make sure the rest of the country knows how much innovation happens here. It’s really impressive when we all get in one big room, share what we’ve been working on and bring innovators from around the world into our own backyard,” he concluded.

Briovation Launches Tokenizing Health Health:Further Summit Offers Latest in Blockchain Innovation By MELANIE KILGORE-HILL Blockchain is the buzzword in healthcare innovation for 2018, and Nashville-based Briovation, the parent company of Jumpstart Foundry and Health:Further, is doing its share to promote the permissionless digital ledger model. The company recently unveiled Jumpstart Token, which invests in healthcarerelated blockchain companies. This latest effort is part of a larger initiative called Tokenizing Health, which analyzes, invents and invests in startups using the technology. The Role of Blockchain “Generally speaking, there are two ways to think about blockchain in healthcare,” said Marcus Whitney, president and co-founder of Briovation and Tokenizing Health. “The most common discussion is around blockchain as a technology being employed by enterprise organizations to share data between organizations in a secure, reliable manner without a central authority in place. This approach to blockchain is an Enterprise IT model.” Alternatively, Whitney said blockchain’s token concept creates vastly different business models built around connecting patients and Marcus Whitney providers. “The invention of digital tokens spurred by Bitcoin is an entirely different conversation. It is about how to create new models for value exchange and peer-to-peer markets that are powered by blockchain technology,” he said. Tokenizing Health After lengthy research, Briovation discovered more than 100 tokenized blockchain models in healthcare, many of which had received financing very quickly. The Briovation team became interested in tracking and understanding the process and in trying to help convey the blockchain concept to the larger healthcare industry. “We saw stories around enterprise information technology and industry leaders like Change Healthcare and Humana using blockchain but not as much about the new crop of innovators who were Tokenizing Health,” Whitney said. “We’re analyzing these new business models that utilize digital tokens and offer patient-centered alternatives to the current healthcare industry largely driven by insurance companies.” The Tokenizing Health team has been evaluating the crypto space as it applies to health and has published their first report, The Blockchain BrioView, as an industry chart that analyzes, catalogues and organizes innovation in healthcare. Since its publication, Tokenizing Health has conducted numerous briefing calls, gathering first-hand data from over 70 companies in the space. They’ve also launched their first company, Solaster, which will help public health blockchains interact with one another. Health:Further Summit On Aug. 29, Health:Further attendees can take part in The Tokenizing Health Summit, designed to explore public, permissionless blockchains in healthcare and convene the innovators creating the future of health through tokenized health platforms. Attendees will learn from the individuals and organizations building the latest blockchain solutions for healthcare and connect with industry blockchain experts. For more information visit healthfurther.com.

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Smarter Medicine through AI Artificial intelligence can reduce costs, prompt greater medical advancement, and improve patient outcomes, but it is not without risks. Integrating artificial intelligence (AI) into healthcare systems links the need for physician-inventors to protect their innovations, and for healthcare practitioners to minimize risk where unintended con- By ALEX HUFFSTUTTER sequences of AI decision-making can incur significant liability. Most healthcare-related AI patents focus on physician assistance and support rather than replacement, including diagnosis, treatment, prediction, record and ZACHARY GUREASKO management, and surgical assistance. AI-based systems enhance decisionsupport capabilities by providing quick, accurate diagnoses and eliminating costly repetitive or unnecessary diagnostic testing. AI-based medical image diagnostic systems have improved and expedited readings of CT scans and x-rays. Stanford University researchers created an algorithm for rapid skin cancer diagnoses, leading to earlier treatment and improved patient outcomes. Artificial intelligence has a growing role in the personalized medicine space as large-scale aggregation of patient data enables more accurate diagnoses and more effective treatments. Automated AI systems can analyze past medical history to predict the likelihood of developing a disease. AImanaged data analytics can identify classes of individuals more prone to a disease or more likely to respond to a treatment. Nevertheless, despite superior accuracy and decreased margin of error, physicians must remain alert. Liability will likely remain with the physician, suggesting that best practice will be to confirm test results and report errors to product developers. Patent protection incentivizes AI innovations by permitting inventors to exclude others from making, using, selling, offering to sell, or importing the protected invention into the United States for a limited time. Many companies already utilize patents to safeguard their healthcare innovations. GE Healthcare has filed applications covering computer-assisted image processing diagnostic systems, most notably in the field of oncology. Siemens has protected computerized systems and automated methods that distinguish between benign and malignant breast cancer lesions. Phillips has safeguarded diagnostic and treatment systems for cancer and various other neurological disorders, such as Alzheimer’s disease. Companies that traditionally provide nashvillemedicalnews

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services in the field of technology, including Samsung Electronics, IBM Corporation, and Google, seek to capitalize on this growing market and become major players in this area for the foreseeable future. Companies specializing in artificial intelligence for healthcare have already begun building patent portfolios around their products. One such company, IDx developed IDx-DR, an AI-based diagnostic system for the autonomous detection of diabetic retinopathy, a leading cause of blindness. This device will help over 30 million Americans suffering diabetes, half of which forgo annual eye examinations. Just last month, the FDA approved IDx to market the IDx-DR, marking a historic moment for our changing healthcare system. IDxDR is the first autonomous, AI-based diagnostic system to be granted such approval. It screens patients for diabetic retinopathy using deep learning algorithms. U.S. Patent No. 9,924,867 recently issued to IDX with claims directed to both diagnostic systems and imaging methods used therein. AI benefits physicians, allowing them to devote more resources to individual patient needs. With the greater precision and accuracy, medical malpractice laws should become a less viable means of policing diagnosis and treatment decisions, increasing physician confidence and decreasing the exposure of physicians to lawsuits. Physicians will no longer need to run batteries of tests to avoid misdiagnoses

Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website.

NEW IN JULY: Nancy Achuff, LCSW, director of Behavioral Health at the Center for Spine, Joint & Neuromuscular Rehabilitation, writes about the need for increased suicide awareness for veterans in chronic pain.

and shield themselves from liability. The goal is defensive medicine will disappear. Artificial intelligence also decreases healthcare costs. A recent report by Accenture indicates that clinical healthcare AI-based applications can create $150 billion in annual savings by 2026. This is significant, as healthcare is the fifth largest industry by GDP share in the United States with a GDP of over $1.2 trillion. AI-based applications could save money in such areas as robot-assisted surgery, fraud detection, and dosage error reduction. Greater accuracy and precision will in turn pass on the savings to the physician in the form of decreased malpractice insurance. As AI gains traction, its efficacy for advancing the current system must be proven. Inventors and healthcare professionals will play critical roles in transitioning AI from bench to bedside. Inventors will need to be vigilant in protecting the systems they have developed. Doctors and nurses must be prepared to validate system accuracy to obtain a true baseline of accuracy. Doctors and nurses will need to keep up with the ever-changing legal landscape to evaluate potential liability. Outside the healthcare context, autonomous vehicles exemplify these concerns. Uber recently ceased automated vehicle testing in Arizona when one of its cars killed a pedestrian, despite the presence of a human safety driver behind the wheel. Analogous risks exist in the healthcare

industry. For example, diagnosis failures or AI-based surgical robot malfunctions could lead to increased morbidity or mortality. The what-ifs implicated by use of AI to treat patients raise a myriad of concerns for legislators, regulatory bodies, practitioners, and patients. Who should ultimately shoulder liability if an AI system fails to diagnose a condition or disease or misdiagnoses a patient? What implications does artificial intelligence have on the role of members of the physician’s supporting staff? Should a line be drawn in terms of risk? Government agencies and industry organizations should assist in formulating approaches toward mitigating risk as the presence of artificial intelligence in healthcare increases. Diligent lobbying efforts, successful case studies, and meaningful statistical analyses will determine when the benefits outweigh the risks. The healthcare community must address the legal, regulatory, and ethical considerations that accompany these technological advances. Registered patent attorney Alex Huffstutter practices at Patterson Intellectual Property Law primarily in the areas of electronics and the mechanical arts, with particular expertise in recent technical innovations in electrical engineering including graphene synthesis. Zachary Gureasko is a civil litigator who predominantly defends claims on behalf of various individuals and entities in the areas of: general civil liability, personal injury, premises liability, products liability, and medical malpractice. For more information, go online to iplawgroup.com.

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Network & Cyber Security Coding/Compliance Audit HIPAA, HITECH & HITRUST IT Audit Internal Audit SOX Compliance SOC Examination

Don Baham, president of Kraft Technology Group, LLC, discusses the ways healthcare organizations are leveraging Office 365 to improve patient care. Chase Spurlock, PhD, CEO and co-founder of Nashville-based data science company IQuity, discusses how machine learning and advanced data analytics can help stakeholders across the healthcare continuum positively impact outcomes, reduce costs associated with chronic autoimmune diseases and, ultimately, provide true precision medicine from early diagnosis and optimal treatment to prevention.

Healthcare Services

Lucy Carter

Scott Mertie

Gina Pruitt

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PHYSICIAN SPOTLIGHT

Dr. Pampee Young: Nashville Physician Oversees National Red Cross Blood Supply By CINDY SANDERS

As chief medical officer for the American Red Cross Biomedical Services, Pampee Young, MD, PhD, has responsibility for ensuring about 40 percent of the nation has a safe, effective, and adequate supply of blood and blood products to meet everyday demand and increased need in times of crisis. It’s a job that’s never finished. “We’re always looking at ensuring we have safe and effective blood products. This is a constant effort. You can never collect a bunch of blood and say, ‘we’re done,’” she noted of the continual need. Young, who was named to her new role in January 2018 after spending 15 years at Vanderbilt, added red cells have about a 40-day shelf life and platelets about five days. “Platelets are almost always in very short supply,” she stated. In addition, Young said there is often a shortage of the rare O negative blood type. “The summer is a really tough season,” she continued. “Most people are busy and have a lot of other plans. Platelets can take

donate blood. From driving messaging to enhance donations to addressing policy issues on a federal level, Young is keenly aware of the critical nature of her position. “We provide blood to about 2,600 U.S. hospitals,” she explained. Despite the challenges, Young relishes her new role in a field that sparked her interest long before she joined the American Red Cross.

A Love of Science

one to two of hours to donate … that’s a pretty significant time commitment. A unit of whole blood only takes about 15 minutes to collect and about an hour for the whole process.” In addition to time, other barriers to donation include fear of the process and strict federal regulations that make some volunteers ineligible to

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Young immigrated to the United States as an eight-year-old from her native India. She grew up in the Houston area where she went to high school before earning her undergraduate degree in biochemistry from Rice University. “I was always very fascinated by the complex biochemistry of the human body,” Young recalled of her childhood. “That drew me to science and medicine. Once I got into medical school, I just loved the diagnostic process.” She earned her MD/PhD from U.T. Southwestern in Dallas before relocating to Washington University School of Medicine in St. Louis to pursue residency in clinical pathology followed by a fellowship in transfusion medicine. Young joined the faculty at Vanderbilt University School of Medicine in 2003. “While at Vanderbilt, I developed a program in regenerative medicine,” she explained of her lab’s focus on the WNT signaling pathway to foster regenerative rather than a scarring repair of complex soft tissue injuries. “My laboratory was interested in how to drive the repair toward restoring the injured tissue’s original function and architecture,” Young said, adding the team’s work resulted in several patents. She also served as medical director of Transfusion Medicine at Vanderbilt University Medical Center and was actively involved in translational research in the field of transfusion and cellular therapies, which combined her many scientific interests. “As transfusion medicine doctors, we partner with trauma surgeons, as well as other surgeons and hematologists, to understand difficult transfusion cases, what the best transfusion strategy is, and to understand hemolytic diseases and their best workup.”

Scaling Her Efforts

Young said her work at Vanderbilt helped her prepare for her new role as she scales her experience and knowledge to a national level. As CMO for the Red Cross, her key priorities are “working with national agencies to ensure a healthy blood supply, a safe blood supply, and to ensure we have the resources to develop innovative blood solutions.” She continued, “We have to talk

seriously about blood sustainability. Can we meet our nation’s blood demands in a time of crisis?” she questioned. Young added it’s more than a medical matter … the answer to that question also has national preparedness and security implications. A pandemic, for example, could quickly jeopardize the nation’s blood supply. To that end, she is helping lead the Red Cross advocacy for more flexibility and funding to develop new technologies for pathogen reduction, improve storage options to preserve blood and platelets longer and develop new blood products. While there are a number of regulatory hurdles, Young said the American Red Cross national lab does a great deal of research around identifying emerging threats. She added the Red Cross was the first to implement Zika testing in their blood centers. It was this opportunity for impact at a national level that drew her to the Red Cross when the opportunity presented. “We are the largest blood supplier/collector in the world so we have a seat at the table in making policy, a seat at the table in how to protect the safety and quality of our blood,” she said.

At Home in Nashville

While the American Red Cross is headquartered in the nation’s capital, it was important to Young to remain based in Tennessee’s capital city. Over the 15 years spent at Vanderbilt, Nashville had become home. “My husband, David Young, has a job here that he enjoys,” she said. Her children also have roots in Nashville. The mother of three girls, her youngest is a rising fourth-grader at USN. Her oldest just graduated from Vanderbilt, and her middle child will be a sophomore at Young’s alma mater Rice University. “We enjoy our friends and our community,” she added. “We love to hike and love to go to all the parks.” Young said kayaking and gardening are two other activities she particular enjoys in Middle Tennessee. So far, being based in Nashville has worked out well for her myriad duties with the Red Cross. “Having a nationallevel position, it’s actually advantageous to be located centrally in the country,” she noted of her frequent trips to D.C. and across the country to work with regional CMOs under her supervision. No matter where she lands, Young’s focus remains the same – directing awareness, resources and research to ensure the Red Cross blood supply is ready when needed.

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Betting on Blockchain By CINDY SANDERS

Blockchain has become a hot healthcare buzzword over the last couple of years. One of the key reasons so many in the healthcare industry are working to unlock the technology’s potential is the promise it holds to revolutionize the field by creating a safer, more cost efficient data sharing system with both clinical and back office application. Still in its infancy, there are numerous hurdles to clear to fully deploy blockchain throughout healthcare, but a number of companies have already begun utilizing the technology. “Three or four months of ‘blockchain time’ is like a year of regular time … so much is happening so fast,” said Kristen Johns, a partner at Waller in the firm’s Intellectual Property practice group. Considering the regulatory and legal hurdles that come with any transformative Kristen Johns change, it is perhaps not surprising that some of the earliest blockchain experts have come from the legal field. “It’s simple from our point of view,” noted Chris Sloan, a shareholder with Baker Donelson who is chair of the firm’s Emerging Companies group and also leads the Blockchain & Cryptocurrency team. “We believe blockchain is going to become a very widespread and widely Chris Sloan adopted technology across almost all industries. It makes sense for us to get on board early to be able to advise our clients on it.”

Blockchain Basics

Sloan likened blockchain technology to the Internet in the late 1990s. “You’ve got a disruptive technology that has significant and diverse applications across all industries, and it’s colliding with existing legal and regulatory schemes,” he pointed out. Like the Internet, he anticipates those issues ultimately will be addressed to make way for broad deployment of the technology. “Blockchain works really well anytime you have an intermediary that’s necessary to complete a transaction,” he added of the decentralized technology that lends itself to process automation. “The other area where blockchain works very well is where you need to preserve the integrity of the data.” Johns was immediately intrigued by the potential power of blockchain when she was first introduced to the concept a couple of years ago. There was a competition to write a white paper about blockchain for the National Institute of Standards and Technology (NIST) and nashvillemedicalnews

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the Office of the National Coordinator for Health Information Technology (ONC). “I flippantly said, ‘That’s a nobrainer,’ and then sat down and figured out how hard it was,” she said with a laugh. Although Johns didn’t win the competition, she did gain a great deal of insight into the new technology and now leads Waller’s Distributed Ledger/Blockchain practice. Recognizing the concept of blockchain can be difficult to grasp for experts and certainly for providers, Josh Ehrenfeld, Corporate and Tax partner at Burr & Forman and a member of the firm’s Blockchain, Cryptocurrency and Electronic Transactions group, suggested thinking of the technology as a baseline platform with Josh Ehrenfeld cryptocurrency and various other financial and clinical functions being related applications just as Excel and Word are programs under the Microsoft Office umbrella. “At the end of the day, it’s a databased platform,” he continued. “It allows for a more efficient and locked-in transfer of information. It takes the blocks and locks them up … they’re immutable.” Ehrenfeld added that once information is put into the system, it cannot be changed so if an error is initially made or circumstances shift, a new block must be added to update the original information.

Back Office Functions

One of the benefits of having a decentralized permanent record is that it allows everyone to see the same information without having to re-input the data for each user … thus minimizing transcription errors and making it nearly impossible to surreptitiously alter data once its entered. However, Sloan pointed out, that doesn’t necessarily mean blockchain will eliminate fraud. “Just like any system, it’s only as good as the data put into it. It won’t stop fraudulent data that was put in from the start but would be easily visible if manipulated once in.” All three legal experts agreed back office functions have seen the most blockchain activity thus far. “It’s a powerful tool to reduce transaction cost because most transactions can be replicated, and it allows you to replicate them in a more efficient and less costly manner,” said Ehrenfeld. Johns said some of the first functions utilizing blockchain technology are the ‘low hanging fruit’ applications that are easier to roll out with more complex uses to come as technology and legal hurdles are addressed. Still, she said, the movement is rapid. “The conversation is not so much about education now. It’s about use cases and where do we start and where do we go?” she noted of making the leap to the next level of deploying blockchain in healthcare.

Clinical Support

“The holy grail of blockchain is medical records,” stated Johns, who added a number of regulatory concerns must first be addressed. However, she said, the potential for improved communication … and, in turn, improved quality and safety … is too great to be ignored. “Is the promise of blockchain the ability to connect across the continuum of care? The answer is a resounding, ‘yes.’ How that happens, time will tell,” she said. Ehrenfeld noted one of the major upsides to using the technology with electronic health records is its decentralized nature, which allows participants across the chain to access information from different locations. Everyone from a patient’s internist to specialists to an urgent care provider seen while on vacation could potentially have access to the EHR and pertinent clinical information including medication allergies and co-occurring conditions. However, he noted, “Once you start putting someone’s health record on this chain, if someone hacks into it, you have a huge issue. Security becomes that much more critical.” Data is, of course, encrypted … and Ehrenfeld pointed out those using blockchain in a clinical setting face the same issues as an individual office with protected health information. In both cases, a strong cybersecurity plan should be in place that looks at processes, risk management and action plans in case of a breach. “The treatment you have from the protection and response side is similar to existing protocols but will ultimately have to be tailored and enhanced to account for blockchain technology.”

Barriers

Sloan said there are a number of barriers to broadly implementing blockchain ranging from regulatory concerns with existing laws to inertia. “Historically, the healthcare industry has been one of the slowest adopters of technology,” he pointed out. “Is it better now than 20 years ago? Exponentially so, but I still think it’s going to take a little bit longer than people think.” Sloan noted it isn’t the young, nimble companies that are the issue in deploying blockchain. “It’s that you have to get so many disparate groups on board – providers, payers, regulators – it’s a lot of mouths to feed.” Johns said scalability is an issue and noted many potential applications aren’t readily available, as the underlying technology doesn’t currently exist. “We can see what is possible, but we’re just not there, yet,” she said. Ehrenfeld reiterated the barriers are different on the clinical front where there are more variables than with back office functions. “You are taking the art of medicine and trying to marry that with an executable and replicable set of activities,” he pointed out. Working through

complicated medical scenarios and permissions are key reasons Ehrenfeld thinks it will take more thought and time before blockchain is widely deployed on the clinical front. “I have no doubt someone will figure it out, I just don’t know what that looks like, yet.”

Next Steps

While there are multiple hurdles to overcome, blockchain is increasingly being considered as a way to innovate business functions. Johns, Ehrenfeld and Sloan all three said it was easy to see the allure of the technology in the healthcare setting. “It adds efficiency and integrity to any system that involves data moving back and forth between multiple parties,” Sloan pointed out. “Anyone in healthcare can probably think of a dozen areas where a blockchain network could save time, save money, reduce errors and add transparency … and that’s powerful for healthcare.” Ehrenfeld echoed those thoughts, saying, “It’s a powerful tool to achieve these results, but the devil is going to be in the details.” Johns noted, “Some entities are calling what they’re building a blockchain when it isn’t at all … but that’s okay. It’s still innovative and offers more efficiency, greater transparency and improved security.” She continued, “Even if blockchain isn’t your answer – and often, it isn’t – that’s okay. It has still forced you to look at your infrastructure, existing procedures and even policies in a fresh way. Blockchain technology can inspire those conversations.” Johns added, “I think it would be a mistake to ignore this. Even if you are a skeptic, you should pay attention. It would be naïve to say this is a passing fad. It’s not a matter of if … it’s a matter of when … and that answer will depend on the use case.”

Mark Your Calendars Distributed:Health 2018 Nov. 5-6 • Nashville

Billed as the premier event for Healthcare X Blockchain and co-hosted by Nashville-based Hashed Health, the two-day global summit will take a deep dive into applications in blockchain technology for the healthcare industry. For more information or to register, go online to: health. distributed.com.

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Nashville Fosters Innovation at Startup Day Event, continued from page 1 DONN JONES PHOTOGRAPHY

tor, called KidneyX, as an example of the department’s plan to bring new treatment and therapies to market. “We want to lower the barriers to entry,” he said. “We want to lower the amount of red tape, and we want to give you access to your government so that you can innovate. That’s what we get excited about.”

Session One: Intro to Working with Government

Government agencies are excited to work with smart entrepreneurs across the country, but startup CEOs need to know how to approach the process. During the first session at Nashville Startup Day, two officials explained best practices for partnering with federal agencies. “To work with the NIH, for example, the first step is to meet with a program officer who can explain the application process and the type of funding that’s available,” said Anna E. Mazzucco, an analyst at the NIH. Similarly, CMS Health Insurance Administrator Sherard McKie gave an overview of his organization, including its Center for Medicare and Medicaid Innovation (CMMI). He discussed CMS’ “patients over paperwork” concept, explaining the importance of patient experience and the burden administrative tasks place on physicians today. “We know that regulations are necessary to ensure patient safety,” he said, “but we’re also finding that some regulations are not as effective. We’re working with the private sector to move toward patient-centered care and market-driven reform. And we’re currently conducting a national listening tour, for providers to tell us what regulations are causing them the most burden.”

Session Two: Demystifying Government Agencies

Despite great ideas and good intentions, smaller startups often get stuck in what Narus CEO Michael Burcham calls “pilot purgatory.” In the second Startup Day session, he asked Simcox, who shared the stage with TennCare Chief Information Officer Hugh Hale, how entrepreneurs could accelerate conversations with government.

Bonus Editorial Go online to NashvilleMedicalNews. com to read these online exclusives for July: • NMGMA 10 Minute Takeaway featuring effective communications tips from SVMIC’s Assistant Vice President of Medical Practice Services Stephen Dickens, JD, FACMPE. • ACHEMT Update with information on the organization’s inaugural early morning panel event “Making Sense of Performance Transformation Methodologies.”

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MannieBear CEO Amanda Waller shares information on her company at a pitch session.

“Knowledge is power,” Simcox said, adding that entrepreneurs who are minorities or veterans and those with disabilities are eligible for Small Business Administration carveouts. He noted smaller companies could also partner with other, larger organizations that have already completed the procurement process. “If they could be your customer, then they may be better positioned to sell to the federal government.” Organizations that support local entrepreneurs can also accelerate access, Hale said. “We have relationships with the Nashville Health Care Council, the Entrepreneur Center and other firms in the area that work with entrepreneurs closely,” he said. “One of the best things you can do is to align with those groups, because then you’re just one step away from an introduction.” Both Hale and Simcox said that their organizations were in constant need of people who were thinking about healthcare differently – and that Middle Tennessee continues to be a fertile source for those who will change the industry. “It’s our belief that TennCare needs innovation – particularly from the companies here in Nashville,” Hale said. “I’m a firm believer in the innovative community here and that the next thing to really turn the needle on cost and quality is already being built in a garage in Nashville somewhere.”

Session Three: “Shark Tank,” Nashville-style

To end the day, five local companies were put on the spot and pitched a panel of experts on stage. The panel included Microsoft’s Director of Sales for Healthcare Life Sciences Connie McGee; Perception Health CEO Tod Fetherling; and Paul Currie, the chief technologist at HCA’s Information Technology and Systems Department. Companies included: MannieBear: Leveraging her family’s powerful story of childhood traumas, founder Amanda Waller presented her company’s idea to use gamification, technology and data to help establish trust between children and therapists. Synchronous Health: After admitting that technology could be part of the country’s behavioral problem – and

acknowledging the App Store has 4,500 apps aimed at mental health – Guy Barnard introduced “Karla,” an Apple Watch bot that serves as a liaison to a licensed professional and can extend the therapy experience between visits. Utilize Health: Payers spend more than $240 billion annually to treat patients with mobility issues from strokes, brain and spinal cord injuries to neuromuscular diseases – all of which require different codes and present unique difficulties in care coordination. After a gymnastics injury paralyzed her from the waist down, CEO Jessica Harthcock launched Utilize Health to coordinate care and provide solutions for patients with neurological conditions. Belle: “Healthcare’s stepchild,” as Armand Lauzon described adequate foot care, is the focus of Belle, which aims at providing at-home, professional foot care for patients with diabetes and other conditions affecting their podiatric needs. The

company estimates it will save payers $7 million, and 38 lives, annually per every 1,000 members. MyHealthDirect: The three personas presented by Mary Tackbary and Richard Moore each rely on different payers for healthcare and live very different lives – from the active new mother to the elderly Medicare Advantage member. Yet, through its member engagement technology platform, MyHealthDirect helps automate appointment scheduling and has shown dramatically improved appointment attendance for all member segments. After presenters received feedback from the onstage mentors, Simcox asked questions and offered guidance on working with the government more closely. “The government plays a huge role in healthcare, and you have to work with them,” said Lauzon, with Belle. “That’s why I valued today, because now I know there are a lot of individuals in the government who want to make it work for startups like ours.”

Nashville at the Epicenter

“Nashville’s healthcare expertise is unmatched. In no other place in the country can you find this level of concentrated healthcare knowledge combined with the power to enact change at a large scale in care delivery,” said Hayley Hovious, president of the Nashville Health Care Council. “We are thrilled that HHS has identified Nashville as a center of innovation by coming here to interact with our community.” “Startup Day Nashville featuring HHS” was hosted by the Nashville Health Care Council, Nashville Entrepreneur Center, Nashville Technology Council, Nashville Area Chamber of Commerce, Tennessee HIMSS, Center for Medical Interoperability and Life Science Tennessee.

A Really Big Deal

Cressey & Co Raises Billion Dollar Fund In mid-June, Cressey & Company, a healthcare-focused private investment firm with offices in Chicago and Nashville, announced the closing of Fund VI on $995 million and a related co-investment vehicle on $105 million, bringing total new capital commitments to $1.1 billion. The new funds will continue Cressey & Company’s focus on investing in and building leading healthcare services and information technology businesses in North America. Similar to prior funds, Fund VI will implement the firm’s “Target, Partner and Build” strategy that focuses on providing capital and support to executives in high-potential sectors within healthcare. As part of this strategy, Fund VI will focus on investing in leading platform businesses and accelerating growth both organically and through acquisitions. Cressey generally seeks investments in companies with enterprise values at the time of investment of between  $50 million and $500 million. 

Former U.S. Senate Majority Leader Bill Frist, MD, has been a partner in the firm since 2008 and leads Cressey’s Distinguished Executives Council. “Ten years ago we opened our Dr. Bill Frist Nashville office specifically to be at the epicenter of health service activity,” Frist said, adding the firm has invested in numerous Nashville businesses including Compassus, QualDerm and Essent. Fund VI launched in March 2018 with a target of $750 million and had a single close on June 8, at its hard cap, raising a total of $995 million. The firm also offered and closed a co-investment vehicle totaling  $105 million. Including Cressey & Company’s Funds IV and V, the firm currently manages more than $2 billion in committed capital. nashvillemedicalnews

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Heart Monitor Cardiology News from Nashville It’s been an exciting few weeks for cardiac care in Middle Tennessee with major announcements coming from Saint Thomas Health and TriStar Centennial.

Saint Thomas Launches State’s First Total Artificial Heart Program

On May 30, officials with Saint Thomas Health recently announced they had become the first health system in Tennessee to offer Total Artificial Heart (TAH) as part of their cardiac treatment services. The technology was funded in part by the Speer Foundation and will be used by the cardiac experts of Saint Thomas Heart. Ashok N. Babu, MD, will serve as surgical director of the program, and Kyle Stribling, MD, will serve as medical director. The TAH is a life-saving treatment option provided to individuals eligible for heart transplant surgery who have endstage biventricular heart failure. The artificial heart replaces both lower chambers of the heart and the four heart valves and occupies the space of the removed heart. It is connected to an external driver, which pumps and monitors the TAH. For patients, the TAH increases chances of survival, allows an enhanced quality of life, including discharge home, and prepares those eligible for transplant by restoring blood flow and optimizing organ function. “We are honored to be the first in Tennessee to inte-

GRAND ROUNDS Business Briefs

June was a big month for big deals. New York-headquartered global investment firm KKR & Co. acquired Envision Healthcare and its AmSurg division in a deal valued at $9.9 billion. The allcash transaction is expected to close in the fourth quarter of 2018, pending customary closing conditions and regulatory approvals. Nashville-based Cumberland Emerging Technologies Inc. (CET) and LSU Health New Orleans have entered into a collaboration agreement to develop new biomedical products based on research from LSU. With the shared goal of translating research discoveries into commercial products, the parties have agreed to combine their strengths to identify opportunities to develop. The potential development pipeline includes therapeutics for cardiovascular diseases, cancer, antifungals, as well as those emerging from drug repurposing. CET will pursue new sources of funding for these LSU Health New Orleans projects through the Small nashvillemedicalnews

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grate Total Artificial Heart into the comprehensive cardiac services offered by our cardiologists and heart surgeons at Saint Thomas Health,” said Fahad Tahir, president and CEO of Saint Thomas Midtown and West Hospitals. “This technology continues a legacy of innovation, allowing us to save lives and improve the quality of life for individuals requiring highly specialized heart care. We are so appreciative of the Speer Foundation for supporting this important initiative.” Babu added, “The Total Artificial Heart technology gives individuals who are too ill to wait for a heart transplant a second chance at life. This device will allow patient mobility and a more active, higher quality of life for individuals waiting for a heart transplant who previously had no other options.” Saint Thomas Heart serves more than 5,000 advanced heart care patients each year in physician practices and hospitals throughout the region. The technology is provided through a partnership between

Saint Thomas Health and SynCardia, the manufacturer of the world’s only commercially approved Total Artificial Heart.

Business Technology Transfer and Small Business Innovation Research and other grant programs. Nashville-based NaviHealth has new owners after Cardinal Health sold a majority stake to New York-based private equity firm Clayton, Dubiler & Rice. Cardinal will maintain 45 percent ownership in the technology-based care transitions company, which is led by Clay Richards. Brentwood-based QualDerm Partners, which creates market-leading dermatology practice partnerships through affiliations and de novo development, recently announced Lebanon Dermatology has joined the company as an affiliate practice. This marks QualDerm’s nineteenth partnership with physicianowned practices. Community Health Systems continues divestitures. The Franklin-based hospital company, recently announced completion of the sale of three Tennessee hospitals - 225-bed Tennova - Dyersburg Regional in Dyersburg, 150-bed Tennova-Regional Jackson in Jackson, and 100-bed Tennova Volunteer Martin in Martin - and their associated assets to West Tennessee Healthcare. The com-

pany also completed the sale of 85-bed Tennova Healthcare - Jamestown to Rennova Health, Inc. and 60-bed Byrd Regional Hospital in Louisiana to subsidiaries of Allegiance Health Management. In late June, CHS announced a definitive agreement to sell the 291bed AllianceHealth Deaconess hospital in Oklahoma City and its related businesses to INTEGRIS Health. Last month, BerniePortal and Proliant announced a new integration between their respective benefit and payroll features. Proliant joins a growing network of payroll providers, insurance carriers and other software companies that integrate with BerniePortal’s benefits feature. Employers who use BerniePortal can provide Proliant with API access to the benefit deduction information necessary to run payroll, minimizing the risk of error by exchanging benefit deduction information in real time.

TriStar Centennial Heart & Vascular Implants First MEMO 4D, Launches LVAD Program,

On June 1, TriStar Centennial Heart & Vascular Center implanted the first MEMO 4D semi-rigid mitral annuloplasty ring in the world led by cardiovascular surgeon, Sreekumar Subramanian, MD. The implant now comes in larger ring sizes, allowing surgeons to treat a broader range of patients who suffer from mitral valve regurgitation, where the valve doesn’t close Dr. Sreekumar Subramanian properly causing the blood to flow backward within the heart. “MEMO 4D simplifies and standardizes complex mitral valve repair, facilitates minimally invasive surgical approaches and preserves the mobility of the mitral valve leaflets,” said Subramanian. “The new, larger sizes allow us to treat more patients and pathologies while providing the potential to further improve patient outcomes. With MEMO 4D, surgeons can optimize mitral repair procedures rather than replacing the entire mitral valve.” LivaNova, the medical

Berlin Named to New VICC Leadership Post

Jordan Berlin, MD, has been named associate director of Clinical Investigation Strategy and Shared Resources at

device company that produces the larger MEMO 4D, is the only company to offer larger ring sizes which helps in the treatment of severe mitral regurgitation like Barlow’s disease or enlarged annuli. Also in June, TriStar Centennial Heart and Vascular Center announced the expansion of its advanced, comprehensive cardiovascular surgical treatment program to now include Left Ventricular Assist Devices (LVAD), a life-saving surgical option for patients with severe heart failure who have exhausted all treatment options for their care. The LVAD, which is implanted during open-heart surgery with one end attached to the left ventricle and the other end attached to the aorta to take blood from the left ventricle and carry it to the aorta, can be placed temporarily as a “bridge” to a heart transplant. It can also be used as destination” therapy – a permanent solution for patients who don’t qualify or may not want a transplant. “Left Ventricular Assist Devices have dramatically changed how we are able to help treat patients with severe heart failure,” said Duc Nguyen, MD, who performed the first LVAD surgery at TriStar Centennial Heart and Vascular Center several weeks ago. “When a patient is facing a difficult diagnosis with few treatment Dr. Duc Nguyen options, we now have the ability to offer them a proven solution to assist their failing heart and a better quality of life.” the Vanderbilt-Ingram Cancer Center (VICC). In his new role, he will chair the Resource Allocation Committee and continue as chair of the Clinical Trials Shared Resource (CTSR) Steer- Dr. Jordan Berlin ing Committee. Berlin is an Ingram Professor of Cancer Research, and co-leader of the Gastrointestinal Cancer Research Program and director of the Phase 1 Clinical Trials Program at VICC. He received his medical degree from the University of Illinois, Chicago, and completed an internship and residency in Internal Medicine at the University of Cincinnati Hospital. He completed a fellowship in Medical Oncology at the University of Wisconsin Hospital and Clinics, in Madison and later became a faculty member. Berlin joined the faculty at Vanderbilt in 1999 and is co-director of the Administrative Core for Vanderbilt’s GI Specialized Program of Research Excellence (SPORE), a prestigious research grant program funded by the National Cancer Institute (NCI).

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GRAND ROUNDS Portacci Named Saint Thomas Health VP of Strategy Saint Thomas Health, part of Ascension, recently introduced Ruth Portacci as vice president of strategy. In her new role, she will provide support to the chief strategy officer and will oversee the system’s growth portfolio, including supporting enactment of Saint Ruth Portacci Thomas Health’s service line and continuity of care initiatives. She is also tasked with helping position the organization for future growth opportunities. Previously, Portacci served as principal of Healthcare Strategy Partners, a healthcare consulting firm based in Nashville. Prior to that role, she was a senior director of strategy and marketing at Community Health Systems. She has served on the American Hospital Association’s Society for Healthcare Strategy and Market Development (SHSMD) board for the past nine years and was board president in 2017. 

LBMC Promotes Burnette LBMC, one of the Southeast’s largest accounting and business consulting firms, announced Mark Burnette, CPA, CISSP, CISA, QSA as its new leader of the Risk Services practice. Burnette succeeded previous leader Thomas Lewis on June 1. As shareholder- Mark Burnette in-charge of LBMC’s Risk Services practice, Burnette will lead a nationally recognized team of cybersecurity and audit professionals located around the United States as they help clients navigate the complex maze of compliance regulations and seek to improve their security posture.

Promotion, New Faculty at Sarah Cannon

William Donnellan, MD, was recently promoted to director of Leukemia/Myelodysplastic Syndrome Research at Sarah Cannon. Donnellan original

joined Sarah Cannon in 2014 as an investigator of hematologic malignancies. After graduating from Auburn, he earned his medical degree at the University of Alabama Dr. William School of Medicine. He Donnellan then completed residency and a fellowship in hematology/oncology with a special focus on blood and marrow transplantation at UAB in nearby Birmingham. In addition to his role at Sarah Cannon, Donnellan is an associate with Tennessee Oncology, PLLC. In other news, three new research faculty members have been appointed to the drug development programs in Nashville and Denver. Saurin Chokshi, MD, from Yale University, and Meredith McKean, MD, from MD Anderson Cancer Center, will be joining Sarah Cannon Research Institute at Tennessee Oncology in Nashville this summer. Shiraj Sen, MD, from MD Anderson Cancer Center, will be a part of Sarah Cannon Research Institute at HealthONE in Denver. Locally, Chokshi will be focusing on GI cancers and early phase clinical trials under the leadership of Axel Grothey, MD, who was recently announced as the director of Sarah Cannon’s GI Cancer Research. McKean will focus her efforts on melanoma, and she will be taking on that cancer program while leading investigational therapy trials.

TwelveStone Adds Private Infusion Suites, Names Medical Director In June, TwelveStone Health Partners announced the addition of infusion therapy suites to the company’s Murfreesboro headquarters. While the company has offered home-based infusion therapy for several years, the leadership team recognized a need for outpatient services, as well. “We are pleased to offer URAC-certified private suites to infusion patients here in Murfreesboro. Until now, patients had to go all the way into Nashville to have treatments,” noted TwelveStone CEO Shane Reeves. A physician order is required for the infusion appointments, which are available Monday-Friday until

HCA’s TriStar Health Invests in Middle Tennessee TriStar Health recently announced plans to invest more than $500 million into its Middle Tennessee facilities. The capital investments include new construction, campus expansion projects and the addition of new technology and services to existing healthcare facilities. Almost half of the expenditure will be invested in TriStar Centennial Medical Center, the health system’s flagship campus. Major projects include the addition of four floors with a dedicated ‘hospital within a hospital’ joint replacement center, renovation and enhancement of existing patient care floors, and addition of an eight-level parking garage. Additionally, TriStar Skyline, TriStar Summit, and TriStar StoneCrest are all slated for expansion projects including two new floors at Skyline, an expanded patient tower at Summit, Emergency Department expansion at StoneCrest, free-standing ER in Hermitage, and a behavioral health hospital in partnership with Maury Regional Medical Center in Columbia that is expected to open in late 2019.

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7 pm and by arrangement on Saturday. Additionally, the company named family medicine practitioner Chris Beckman, MD, as medical director for the TwelveStone Infusion Center. Serving the area for more than 20 years, he opened Beckman Family Medical in 2004 and is also on staff at Saint Thomas Rutherford. Beckman will continue in his private practice while also overseeing clinical quality at the new center. Last month, TwelveStone also announced expansion into Ringgold, Ga., just over the state line in the Chattanooga area. Elizabeth Owen, PharmD, will lead operations at the new facility, which includes a pharmacy and infusion services.       

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements Lipscomb University College of Pharmacy student pharmacist Matthew Murphy is among a select group chosen to participate in the prestigious American Association of College of Pharmacy Walmart Scholars Program for 2018. Murphy, of Nashville, is a Matthew Murphy third-year student pharmacist on track to complete his Doctor of Pharmacy degree in May 2019. He is one of 85 students chosen from more than 14,000 student pharmacists and will attend the AACP Annual Meeting later this month in Boston. In late June, HCA presented the HCA Healthcare Awards of Distinction to recipients at a ceremony in Nashville. The Frist Humanitarian Award, which recognizes individuals who demonstrate an unrivaled commitment to caring and serve as an inspiration to colleagues, is annually presented to an employee, volunteer and physician. This year’s physician award was presented to Sami Ismail, MD, a neonatologist at TriStar Centennial Medical Center. Ismail, who has worked with TriStar Centennial for 29 years, founded a neonatal intensive care unit in Aleppo, Syria where he continues to assist with training and donation of medical equip-

ment and supplies. Locally, he provides support for NICU families through the March of Dimes and Parents Reaching Out, a support group for parents of hospitalized babies. In addition, two other local professionals were named HCA Innovators Award winners. Aaron Montlary, director of clinical development and innovation for HCA Healthcare IT&S, was recognized for service excellence; and Donna Harrell, RD, LDN, CNSC, division food and nutrition analyst and clinician nutrition lead for HealthTrust, was honored for her work in quality and patient safety. Last month, BlueCross BlueShield of Tennessee and MP&F Strategic Communications were awarded Best of Silver Anvil at the Public Relations Society of America’s annual awards ceremony in New York City for their efforts to combat Tennessee’s opioid epidemic through the “Don’t Be An Accidental Drug Dealer” public education campaign. The City of Franklin has made the list of “Top 10 Best Cities for STEM Workers” in 2018 by Livability.com. The Livability editors looked at more than 2,000 cities across the country and considered criteria including the percentage of STEM jobs and median income for those jobs in relation to the city as a whole. More than 15 percent of jobs in Franklin are in the STEM category and are among the best-paying careers in an already affluent community with a median income of $100,648 for STEM jobs. Saint Thomas Rutherford Hospital recently announced the medical center has been recertified with The Joint Commission’s Gold Seal of Approval® for Chest Pain, which combines a review of Acute Myocardial Infarction (AMI) and Acute Coronary Syndrome (ACS) programs into one certification award. Engineering News Record’s 2018 Top 400 Contractors list has been released and several companies with offices in Middle Tennessee made the list. Turner Construction came in at number 3 (the same as last year), Skanska ranked 6th (up from 7th) Brasfield & Gorrie was listed at 27 (up from 30), Hoar Construction at 96 (up from 126), DeAngelis Diamond at 225 (up from 288 in 2017), D.F. Chase at 262 (up from 362) and Bell & Associates Construction debuted at 364 this year.

Vanderbilt Opens New Unit Last month, Vanderbilt University Medical Center opened a new inpatient unit on the eighth floor of Medical Center East. The 37-bed unit is the first phase of a previously announced $118 million renovation and expansion project, converting two floors in the North Tower into adult hospital operations. The new cardiac step-down unit features 30 adult inpatient rooms and seven observation beds.

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PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Maggie Bond Pam Harris Jennifer Trsinar MANAGING EDITOR Cindy Sanders csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Tim Adams, Zachary Gureasko Alex Huffstutter, Melanie Kilgore-Hill, Matthew Kroplin, Dr. Bonnie Miller, Cindy Sanders, Katie Schlacter Jerry Taylor CIRCULATION subscribe@nashvillemedicalnews.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Nashville Medical News 105 Spring Ridge Lane Nashville, TN 37221 615.646.3916 • (FAX) 615.673.8819 or e-mailed to: subscribe@nashvillemedicalnews.com Nashville Medical News is published monthly by Graham | Sanders Publishing, LLC. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Nashville Medical News will assume no responsibilities for unsolicited materials.        All letters sent to Nashville Medical News will be considered the newspaper’s property and therefore unconditionally assigned to Nashville Medical News for publication and copyright purposes.

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YOUR

NEW DESTINATION FOR ADVAN C ED J O IN T R E P L AC EM ENT SURG ERY Patient Benefits:

Building upon a longstanding history of providing our patients with high-quality, outcome-driven orthopedic care, TriStar Centennial Medical Center is excited to introduce a new era in joint replacement surgery. Our new, state-of-theart TriStar Centennial Advanced Joint Replacement Institute is a “hospital within a hospital” and is uniquely designed to offer each individual patient a highly personalized treatment plan supported by the region’s top surgeons who specialize in the most advanced procedures and treatments options.

• Specialty-trained orthopedic physicians, nurses and therapists who are dedicated solely to the unique needs of the joint replacement patient • Hotel-like setting with a patient concierge, a large family waiting room with fireplace, private seating booths and a full-service coffee bar • Complimentary valet parking for patients and families

The TriStar Centennial Advanced Joint Replacement Institute will greatly enhance the patient and provider experience, ensuring our specialists are further positioned to meet the growing joint replacement needs of patients throughout the region and beyond.

Learn more at TriStarCentennial.com

O P E N I N G AU G U S T 2018

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July 2018 NMN  

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