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FOCUS TOPICS BEHAVIORAL HEALTH • WOMEN’S HEALTH

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Self-Care on the Front Lines of Coronavirus By CINDY SANDERS

With coronavirus dominating news cycles for weeks now, it seems difficult … if not impossible … to escape the mounting death toll, case load, unemployment figures and economic havoc that COVID-19 has left in its wake. For healthcare providers, first responders and other workers on the front lines, it’s far too easy to forget self-care when the focus is so strongly on caring for others. Yet, ignoring warning signals of the physical and emotional toll the pandemic has taken could have far-reaching consequences. Joshua Morganstein, MD, serves as chair of the American Psychiatric Association (APA) Committee on the Psychiatric Dimensions of Disaster. “The committee’s role is to provide education, consultation and resources to APA members, our state-level district branches and leadership,” he explained. Morganstein added the committee’s focus has primarily been in response to non-military disasters. However, he noted, some similarities have been drawn between the current global COVID-19 outbreak and the type of stressors and reactions seen in a prolonged (CONTINUED ON PAGE 4)

Delivering Care

Changes to Labor & Delivery during COVID-19 By MELANIE KILGORE-HILL

As providers scramble to keep patients safe amid the COVID-19 pandemic, hospitals are finding innovative ways to deliver quality obstetrical care – and a memorable birthing experience – during an otherwise uncertain time.

building guidelines around that,” she said. Price continued, “From the very early days, we decided it was important patients had support.” The hospital, which welcomes 3,400 babies a year, has continued to preserve partner support for women in labor, also allowing for the presence of a professional birth doula (both masked).

Making Changes Access to Care Amber Price, DNP, CNM, chief operating officer Nicole Heidemann, MD, medical director of at the Women’s and Children’s Hospital at Centenobstetrics/gynecology at Centennial and an obstetrinial Medical Center, said safety measures were implecian with Centennial Women’s Group, said access to Dr. Nicole Heidemann mented from day one of the virus’s onset. “As things care has remained a priority. “Down to essential OB developed and we understood the seriousness and potential impact visits, we’re still providing well above what standards should be,” she on pregnant women, we started working on visitation policies and (CONTINUED ON PAGE 7)

Stay Tuned for Details on the 2020 Women to Watch Breakfast Event CELEBRATING 15 YEARS

Coronavirus might have delayed our celebration a bit, but we are so looking forward to recognizing the Class of 2020 this summer at the annual breakfast event. Stay tuned for details and ticket information in our next issue.

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Behavioral Health in a Time of Social Isolation Health Care Council Hosts Second Virtual Panel By CINDY SANDERS

In late April, the Nashville Health Care Council hosted its second panel discussion via Zoom. “Virtual Models of Care: Behavioral Health in a Time of Social Isolation” addressed long-term effects of social isolation and loneliness, the potential fallout from the COVID-19 crisis, and innovations helping providers adapt to the ‘new normal’ and reach those in need through telehealth. The event was moderated by Susan Dentzer, senior policy fellow for the Duke-Margolis Center for Health Policy. She was joined by panelists Julianne Holt-Lunstad, PhD, professor of Psychology and Neurosciences at Brigham Young University; Patrick J. Kennedy, former congressman (D-RI) and cofounder of OneMind and Nashville-based Psych Hub (see page 5 for more information); and Rob Rebak, CEO of ForeFront Telecare and a graduate of the Nashville Health Care Council Fellows Program. Holt-Lunstad, who has spent her entire career researching how social relationships can influence physical health, noted, “In light of the current pandemic, it is critical that we have evidence-based information and actionable Dr. Julianne Holtsteps to help protect Lunstad the public.” She pointed to a National Academies of Science report released in February, prior to the pandemic, that underscored loneliness and social isolation as major public health concerns. “When it comes to long-term health effects, we have very robust evidence that social isolation and loneliness are independent risk factors for premature mortality and that social connection is a significant

protective factor,” she said. Referencing a metanalysis of 3.4 million participants that Holt-Lunstad and colleagues at BYU conducted, they found loneliness is associated with a 26 percent increased risk for earlier death, social isolation a 29 percent increased risk, and living alone a 32 percent increased risk for death from all causes. Conversely, a metanalysis of 148 studies found being socially connected increases the odds of survival by 50 percent. She noted the studies followed participants for an average of more than seven years with the outcomes being long-term effects. Holt-Lunstad stressed the risks outlined should not be seen as evidence to disregard COVID-19 social distancing recommendations. Nonetheless, she continued, many people are feeling significant distress and concerns due to the quarantine recommendations. “To a certain extent, these feelings of distress are normal. This is our body signaling a need to reconnect, just like hunger signals us to eat and thirst signals us to drink water,” explained Holt-Lunstad. “Loneliness is thought to be a biological drive that motivates us to reconnect. When we lack proximity to trusted others, our brain and body respond with a state of heightened alertness that can increase blood pressure, stress hormones and inflammatory processes which, if experienced on a chronic basis, can put us at increased risk for a variety of chronic illnesses. So, we need to be vigilant to mitigating these effects.” She added the healthcare system plays an important part. The National Academies report, she said, outlined five key goals for enhancing the role of the healthcare system in addressing the impacts of social isolation and loneliness: • Develop more robust evidencebased strategies for effective assessment, prevention and intervention,

• Translate current research into healthcare practices, • Improve awareness of health and medical impacts of loneliness and social isolation across both the healthcare workforce and the public, • Educate and train the healthcare workforce on best practices, and • Strengthen ties between the healthcare system and community-based networks. Turning to Kennedy, he said as someone living in long-term recovery, “I have spent my life focusing on mental health and addiction treatment.” While he has worked for decades advocating for mental health parity, he said it has largely been hard to gain a lot of traction. He noted the current crisis, while a tragedy, might help open some Patrick J. Kennedy minds to the fact that all of us are affected to some degree by mental health symptoms and issues. He described the current public health crisis as pouring gas on “the fire of disconnectedness.” Kennedy added, “I love that we can share remotely through new forms of technology, but I know firsthand there is no substitute for the personal connection of a 12-step meeting and being part of a recovery community in person.” In preparation for what comes next, Kennedy said, “We’ve been very active in trying to get mental health provisions in all of these stimulus bills so that we’re ready to deal with the tsunami of mental health crises that we’re expecting in the wake of COVID-19.” He added, “I’m convinced we’re going to lose more people to suicide and addiction than the coronavirus. We need to help both, but the double standard for

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lives lost to mental health is staggering, and this crisis highlights the disparity.” Kennedy said we should be pushing out certified community behavioral health providers, Medicaid funding and block grants to facilitate infrastructure of treatment. “We need to prepare now for the other half of COVID-19: The mental health crisis,” Kennedy stated. Rebak, whose company connects behavioral health providers to rural facilities, said he has been focused on safety, understanding changes and helping others during the pandemic. Trying to stay on top of the massive regulatory, reimbursement, technical and funding changes has been all-consuming for behavioral health Rob Rebak organizations. However, Rebak added he was encouraged and heartened by the number of people who were making it a priority to step up to help others during a difficult time. As phase three of his company’s “Rural Health Strong” program, ForeFront offered their network of behavioral health professionals to volunteer using the company’s platform for free to serve those on the frontlines. As a telehealth company, he said social distancing rules have put virtual care platforms front and center during the coronavirus outbreak. Rebak noted telehealth is part of the solution to Americans’ mental health needs and that a tremendous amount of progress has been made in the last two months. “The pandemic has been an accelerant to increase access, decrease cost and increase quality of care,” he said. “The numbers are staggering: Telehealth visits per year that are normally in the 2 percent to 3 percent range will triple or quadruple in a matter of months in response to the pandemic.” While the decreased restrictions around telehealth have been beneficial for behavioral healthcare during the pandemic, Rebak admitted they would need thorough review to ensure HIPAA compliance going forward. However, he said those issues could be addressed. He called what’s happened over the last few months “a dramatic accelerator” for utilizing telehealth and noted mental health services, which typically don’t require invasive procedures like drawing blood, are a natural fit for the medium. “I’m really happy to finally see more parity for mental health, finally see more parity for telehealth. It’s about time, so keep going,” said Rebak. Rebak said the crisis has somewhat forced the tech-enabling of providers. However, Kennedy said much more work remains to be done on the technology infrastructure side and pay parity pieces of the puzzle to truly “do this right” and have a robust lasting impact. nashvillemedicalnews

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COVID-19 & Mental Health

Providers Find New Ways to Reach Patients By MELANIE KILGORE-HILL

The mental health fallout of COVID19 is unprecedented, and few feel the sting quite like behavioral health practitioners on the front lines. Breanna Banks, PhD, director of clinical education at Centerstone Research Institute, said the virus is taking a toll on patients and Dr. Breanna Banks providers, alike. A Different Type of Crisis “I’ve been in training every day with clinicians in five states,” said Banks, who oversees instruction of 4,000-plus frontline providers treating 180,000 patients a year. “We’re seeing clients across the life band with full diagnostic criteria, from inpatient to outpatient, in-home care, foster care support and military support. It’s a full gamut of service provisions.” The virus has triggered a worldwide increase in suicide, post-traumatic stress disorder, addiction and depression, and it is worsening anxiety in children and adults – particularly those with autism or developmental disabilities. A recent survey by the Chinese Psychology Society found that of 18,000 people tested for anxiety related to the outbreak, 42.6 percent registered positive. Of 5,000 people evaluated for PTSD, 21.5 percent had obvious symptoms. In Italy, a psychological support centre run by the Red Cross is overwhelmed by calls from people struggling. Today’s patients are at an intersection of anxiety and grief, often worsened by loss of a job or loved one. Psychosocial barriers also exasperate mental health diagnoses. Lack of resources like bus transportation, or tending to childcare while working from home, are logistical issues affecting mental health, as well. In addition, a majority of Centerstone’s clients are already struggling financially and less likely to receive medical care or virus education accessed by many Americans. “The CDC has highlighted cross sections having the most complications, and there’s a higher incident rate with COVID in lower socioeconomic groups,” Banks said. Transition to Telehealth Within two weeks of the virus’s onset, Centerstone providers had transitioned to telehealth for the majority of patient visits. Banks oversees training on telehealth software, allowing providers to work from home. She also helps providers amend treatment protocols and engage clients, and she continues to develop curriculum ranging from telehealth suicide prevention to common patient concerns. Banks has also developed clinician reflective process groups – a “therapy for the therapist” model that’s proving successful. “It’s designed for those working with difficult clients and allows therapists NASHVILLEMEDICALNEWS

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to assist each other in problem solving, processing experiences and barriers, share with each other and just vent,” she said. According to Banks, lack of self-compassion is a constant challenge among providers, and even more so in today’s high-stress environment. “None of us are unaffected by COVID-19, and we have the same anxieties as our clients,” said Banks, noting universal challenges in trying to maintain productivity and connections surrounded by distractions of home. “It’s hard. Clinicians have a genuine desire to help and be of service, and we tend to sacrifice ourselves at the altar of helping others. We need to give ourselves permission to not get it right the first time around and understand that we’re all in this together.” Positive Changes As providers transition to a new normal, Banks said there have been bright spots, such as connecting to patients who otherwise might have fallen through the cracks. “Telehealth has helped connect patients when they need it,” she said. Prior to COVID-19, providers were limited to working in their own state. Now, a temporary grant has allowed niche providers (i.e. suicideologists) to work across state lines. “Because of telehealth abilities, we can now connect patients with very specific needs to clinical specialists in highly nuanced areas, which we’ve never been able to do,” Banks said. “We now have a wider range and enhanced knowledge to be able to place clients with specialists as we do with medical care. We’re working with policymakers and payer boards to maintain these rapid changes we’ve been able to embed.” Additionally, Banks said telehealth has helped bust misconceptions about virtual possibilities in counseling. “There tends to be a bias against telehealth to some degree, because so much of what we do as counselors and psychologists is to leverage that relationship, working with emotions and body language,” she said. “We have tools and evidence-based practices, but we use interpersonal dynamic as the secret sauce to make it work, and some assumed that couldn’t work as well by telehealth.” However, science has shown otherwise. Trials comparing telehealth to traditional therapy have proven virtual sessions equally effective, but Banks said it requires a level of competence and confidence on behalf of the clinician, and she has been coaching providers on that initial telehealth session. “There has to be a priming conversation to call out the elephant in the room,” she said. “To say, ‘I know this is really different, so tell me your concerns, and I’ll tell you mine so we can work together.’ It’s ok to admit it’s weird now. By creating the space to say, ‘I’m figuring this out too,’ we can strengthen that alliance.” Mental Health & Kids Younger, tech-savvy patients tend to have the smoothest transition to telehealth

– good news in the face of a generation with unparalleled rates of anxiety and depression. Meg Benningfield, MD, director of the Division of Child and Adolescent Psychiatry at Vanderbilt University Medical Center, said kids already struggling now face added uncertainty related to COVID-19. “Some of the biggest challenges for kids are wondering if it will end, when they’ll get to see Dr. Meg Benningfield their friends again and what the ‘new normal’ will look like after the pandemic,” she said. Kids also internalize financial hardship, often allowing job loss or economic strain to inflate fears. Benningfield said it’s important for parents to acknowledge challenges and not make up answers to ease minds. “It’s really important for families to be aware that kids are listening all the time,” she said. It’s best to be honest, but we don’t have to share all of the details. Sometimes the answer will be, ‘We’re taking care of that, and you don’t have to worry about it.’” Benningfield said it can be tough for physicians to distinguish between those

who’d benefit from treatment and those who are having a normal response to a very abnormal situation. Warning signs include sleep or appetite disruption for more than a few days, irritability and a sudden focus on morbid thinking. “In this situation where we’re all feeling more anxious, we still want to take it seriously,” she said.

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Self-Care on the Front Lines of Coronavirus, continued from page 1 conflict. “In a pandemic like this, it’s sort of an ongoing disaster,” he pointed out. This sense of being at war is particularly true for those fighting the coronavirus on the front lines, With an infec- Dr. Joshua Morganstein tious disease outbreak, he said adverse psychological and behavioral responses might include difficulty sleeping, feeling unsafe, irritability or anger, distractibility, and increased use of alcohol or other substances as a way of managing. Healthcare workers have additional challenges including increased concerns of exposure for themselves and their families, managing the distress of patients separated from family members, and shortages of staff and equipment.

Self-Care

The best defense, said Morganstein, is a good offense in the form of proactive self-care. He said eating regularly, getting sleep and taking a breather when needed allow people to make better decisions and strengthen the immune system. “I would really encourage healthcare workers in general to work on … and encourage each other … to take care of basic needs,” said Morganstein. “I would also encourage having a battle buddy,” he continued. Morganstein noted a battle buddy in the military has their

friend’s back and is more likely to notice early warning signs of struggle, such as increased irritability. “We need people looking out for each other. Battle buddies don’t let someone go off a cliff.” Some organizations assign battle buddies and others have team members choose their own support partner. Either option can be effective, Morganstein said. He added the responsibilities are pretty straightforward. Battle buddies check in on each other via text or in person, encourage one another during a tough day and remind one another to take a break. Morganstein said it’s also important to stay informed on current information regarding the pandemic from trusted sources, as accurate information plays an important role in controlling the spread of the disease and can also help alleviate uncertainty to a degree. The caveat, however, is to get the day’s information and then step away. “People want to be encouraged to use media wisely,” cautioned Morganstein. “There is a good body of evidence that increasing exposure to disaster-related media in particular increases stress, makes sleep worse, increases people’s use of alcohol and results in higher rates of post-traumatic stress and depressive symptoms.”

Organizational & Community Support

Organizations play an important role in supporting their workers, noted

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Morganstein. Citing a 2018 review of social and occupational factors impacting healthcare workers during an infectious disease outbreak (Journal of Occupational and Environmental Medicine, March 2018, S.K. Brooks, PhD, et al.), Morganstein said a number of measures were shown to improve outcomes. Ensuring people have adequate training in a timely manner and have equipment they understand how to use and that will protect them are the first steps in mitigating stress. Regular communication from the organization and leadership is also critical. Similarly, finding ways to foster collegiality and recognizing the seriousness of the situation but creating positives whenever possible both encourage a sense of camaraderie and help alleviate feelings of aloneness or separation from the larger group. Videos of healthcare workers praying, dancing or singing together that have appeared on social media and broadcast channels are good examples. Although it won’t replace organizational support, Morganstein said there is well documented evidence of the importance of community support, as well. “A feeling of strength among community members is protective,” he said, adding

the ‘community’ might be a city, zip code, neighborhood, faith group, military unit or sports team. “There is no small act of kindness and generosity … there are only acts of kindness and generosity,” he reminded. Whether it’s clapping for a healthcare worker, giving to a food bank or waving at a neighbor, receiving and giving kindness is important. “Those things will help our society emerge from this in the most positive way possible,” he noted.

The Long View

“Crisis experiences change us and create a new normal,” said Morganstein. For some there will be delayed reactions. He noted some people compartmentalize in order to cope and manage in the moment but then have to deal with issues down the road. “To the degree people are able to care for themselves and find support and be able to find outlets to release some of the stress, that can help to reduce the burden they carry forward with them even if it doesn’t eliminate it.” Fortunately, Morganstein said, “The vast majority of people, including those who have difficulty along the way, will ultimately do well.”

Reaching Out for Help The healthcare workforce is regularly subjected to high-pressure, highly stressful situations, even prior to the current pandemic. Mental health data shows a higher rate of suicide in physicians than in the general population … yet many providers do not seek help that is available. The Medscape National Physician Burnout & Depression Report 2019 found 44 percent of physicians surveyed described themselves as ‘burned out’ and another 15 percent as either colloquially or clinically depressed. Yet tellingly, 64 percent said they had not sought professional care to address these issues. In the updated 2020 report, which took a generational approach, 61 percent of millennials, 64 percent of generation X and 63 percent of baby boomers said they have not sought professional care for their burnout and/or depression. In the general U.S. population – where one in five Americans has a behavioral health disorder – the stigma attached to seeking help is beginning to give way under the weight of the sheer pervasiveness of mental health issues and increased acknowledgement of the powerful, effective resources available both to assist in times of acute need and to maintain emotional health. Although some career concerns linger among physicians over seeking help, there is a strong recognition among industry organizations that behavioral health issues must be addressed. Rather than being seen as a weakness to search out help, there is a growing understanding that recognizing a need and reaching out for assistance is actually a sign of strength. If you would encourage an individual in physical distress to seek help from a clinician, then heed your own advice if experiencing acute emotional distress or ongoing behavioral health issues that have become a cause for concern.

For Immediate Help:

Disaster Distress Helpline: Call 800-985-5990 or text TalkWithUs to 66746 National Suicide Prevention Lifeline: Call 800-273-8255 or suicidepreventionlifeline.org/chat Crisis Textline: Text TALK to 741741

For Connection to Assistance:

Many professional healthcare organizations, including the American Medical Association, have created resources for members experiencing behavioral health challenges. Check your specialty organization or go online to AMA-assn.org for additional information. While by no means an exhaustive list, other resources for seeking care, include: Anxiety and Depression Association of America: adaa.org Mental Health America: mhanational.org National Institute of Mental Health: nimh.nih.gov/health/find-help National Alliance on Mental Illness: nami.org Substance Abuse and Mental Health Services Administration: Online at samhsa.gov or FindTreatment.gov or call the SAMHSA Treatment Referral Helpline at 800-662-HELP (4357)

5/12/20 9:46 AM nashvillemedicalnews

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HEALTHCARE ENTERPRISE

Sharing Best Practices in Behavioral Health Psych Hub Generating Awareness, Education around Mental Health By MELANIE KILGORE-HILL

Understanding mental health is an ongoing challenge for providers and patients, alike. That’s where Nashville-based Psych Hub comes in. The world’s most comprehensive platform of digital education on mental health issues provides online education with certification courses that take the audience from ‘knowledge learned’ to ‘behavior change.’ Their free micro video library hosts over 150 consumer-facing, animated videos focused on improving mental health literacy and reducing stigma about seeking care, while a subscription service provides in-depth continuing education courses for clinicians.

Starting out

Marjorie Morrison, LMFT, LPC, president and CEO of Psych Hub, cofounded the company with mental health advocate and former U.S. Representative Patrick J. Kennedy in 2018. Prior to launching Psych Hub, Morrison was founder and CEO of PsychArmor Institute, a 501(c)3 nonprofit that designs free online courses for military service Marjorie Morrison members and their families. Morrison left California-based PsychArmor in 2019 to grow Psych Hub

in Nashville but remains on her former company’s board of directors. “I learned a lot about the power of online education with PsychArmor, including how you can make lasting changes,” Morrison said. “If students take what you’re teaching and relearn it or teach the core content to someone else, it doesn’t matter how many times it’s watched.” Morrison said the animated video model is more effective than outdated PowerPoints or webinars with few visuals. “Most people aren’t engaged by watching those,” she said. “We went after healthcare providers to educate them on using evidencebased practices and specific intervention. When you go to grad school, you learn more theory … but we wanted to provide tools to

treat symptoms for everything from insomnia or addiction to depression and anxiety.”

A New Model

After successfully launching and growing PsychArmor, Morrison knew the types of people and expertise she needed to start Psych Hub. The development process pulls together the latest research, clinical oversight, creative artists and instructional designers to create engaging content that is trauma-informed, clinically sound and nontriggering. She spent 2018 in the planning process and publicly launched Psych Hub’s free 150video micro library in 2019. The animated videos, each under four minutes, are spon(CONTINUED ON PAGE 9)

May is Mental Health Month There have been observances of Mental Health Month each May since 1949 in the United States. While educational events have been held for more than 70 years, perhaps there has never been a time when people have been more aware of mental health needs than now. Prior to the COVID-19 pandemic, one in five American adults experienced a mental health condition every year. The expectation by behavioral health experts is that the coronavirus will leave new or worsening cases of anxiety, depression,

Local Help Available MHA National Board Chair Tom Starling, EdD, hails from the Nashville area where he serves president and CEO of MHA of the MidSouth. With mounting isolation, depression and Tom Starling anxiety, he reminded providers and residents that help is available locally, as well. “Anyone can text ‘TN’ to 741741 in order to reach the Crisis Text Line. This will immediately connect you to a trained crisis counselor 24/7. Have you used the ‘My Healthcare Home’ website?  Go to myhchTN.org to navigate to your nearest charitable clinic for mental health, dental care, or primary care. It also provides guidance on prescription discounts. The Suicide Prevention Lifeline number is 800273-8255. By googling the Lifeline, you could also be connected with a helpful chat feature. The local Mental Health America affiliate also has online, anonymous, evidence-based screenings. At mhamidsouth.org, you can take a screening for depression, anxiety, additions, trauma, and more,” Starling said in a statement.

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post-traumatic stress disorder, substance abuse and other mental health diagnoses in its wake. On the plus side, mental health parity laws, which were passed in 1996 and 2008, have helped foster a growing awareness of the importance of an integrated health approach that encompasses mind, body and spirit … even if true parity between behavioral and physical health remains elusive in many cases. Still, much of the stigma associated with reaching out to attain and maintain optimal mental health through prevention, therapy and recovery has begun to recede. During May, a number of organizations offer toolkits and resources for both consumers and providers. A common theme in this time of social distancing is to focus on ways to create connections using digital tools and technology. Mental Health America (MHA) is cel-

ebrating its 71st Mental Health Month as the organization that launched the movement. In 2020, MHA’s “Tools 2 Thrive” provides a practical toolkit to improve mental health and increase resiliency. The toolkit is available for download at mhanational.org/may. The National Alliance on Mental Health (NAMI) has launched the “You Are Not Alone” campaign to share the experiences of people affected by mental illness. The goal is to fight stigma, feature stories of inspiration and educate the public. For more information, go to nami.org. The National Council for Behavioral Health serves as a unifying voice for America’s healthcare organizations that deliver mental health and substance abuse services. For May, the organization has developed materials for print and social media campaigns focused on mental health first aid, women’s mental health and warning signs of teen mental illness. Resources and down-

loads are available at thenationalcouncil.org/mental-health-month. There are numerous other national organizations – including the American Academy of Child & Adolescent Psychiatry, American Association of Suicidology, American Foundation for Suicide Prevention, American Psychiatric Association, Anxiety and Depression Association of America, National Association for Behavioral Healthcare, National Child Traumatic Stress Network, National Coalition for Mental Health Recovery, National Institute of Mental Health, Society for Adolescent Health and Medicine, and the Substance Abuse and Mental Health Services Administration, among many others – that offer advocacy, research, policy information, statistics, support and resources for either patients or providers. Additional links to resources are available on our website at NashvilleMedicalNews.com.

LBMC experts serving the healthcare industry

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Business Insights

Qualifacts Uses Data, Industry Position to Advocate for Behavioral Health Providers Editor’s Note: Business Insights is a new NMN series tapping into expertise in our community. As the COVID-19 threat became imminent and we realized our company would need to create a virtual workplace plan — and do so very quickly — back in March, we also

knew that our customers would be facing the same challenge. Behavioral health and human services providers are in the business of serving our communities’ most vulnerable populations and doing so through in-person visits is a key component of their success. How would this $200 billion industry transition to a virtual setBy DAVID KLEMENTS ting?

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lose any ground in their support activities. Our team worked tirelessly on many different fronts to make that happen, most notably the rapid implementation of an integrated telehealth solution to support agencies’ most pressing needs. As a dominant behavioral health EHR provider across the United States, including 10 customers in Tennessee, Qualifacts had the expertise to create solutions as well as the experience to speak out about what our customers would need in those early days, as well as going forward. We leveraged our expertise in producing timely webinars by partnering with OPEN MINDS and the National Council for Behavioral Health to discuss the actions executives would need to take to navigate the “new normal,” as well as with the team at McDermott + Consulting to analyze the flurry of aid packages coming out of Congress — and show how providers could tap into and leverage those funds. We also created two online resources for our clients and others in the behavioral health space to gain access to rapidly changing information around regulatory changes and funding sources. At the same time, providers told us they also needed help in making their case to state and federal regulators to loosen some restrictions around virtual services and reimbursement so that their businesses could survive the transition. To meet that challenge, we took a deep dive into the data generated by our proprietary CareLogic database, which utilizes information from more than 50 million mental health and addiction treatment services delivered to more than 1.5 million patients annually. This anonymized data was then offered to national media so that we could amplify the story being told by individual providers to local, state and national elected representatives.  The situation continues to be fluid, as a patchwork of regulations around reopening are being promulgated across the country. Behavioral health and human services providers have done a masterful job of pivoting quickly to a virtual world. They have protected their employees and maintained a lifeline to their clients. Our next step is a survey in partnership with the National Council for Behavioral Health, which was slated to come out the first week of May, to assess what the move to virtual care has meant for their business operations. That will allow Qualifacts to continue the necessary work on our end to make sure providers continue to get the services and support they need. David Klements is president and CEO of Qualifacts, a trusted strategic partner and technology provider of electronic health records (EHR) for behavioral health and human services organizations. Qualifacts’ EHR platform, CareLogic® and CareLogic Mobile helps organizations focus on client care by optimizing efficiency and productivity regardless of care environment or internet access. For more information, go to qualifacts.com.

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Celebrating 15 Years of Incredible Leaders Following are the 15 classes of Women to Watch. Some of these trailblazers have happily retired after a career of service. Others have moved to other positions and taken up new challenges since they were first recognized. Sadly, we’ve lost some of our shining stars over the years, as well. But all of these leaders have left their impact. During this anniversary year, we tip our hat to all the wonderful women who have made a difference in the healthcare industry. As we celebrate the legacy of these women, we also look forward to opening nominations next January to honor even more change agents who are transforming the way we deliver and consume healthcare in a compliant, efficient, evidence-based, patient-centric manner. If there’s one thing the coronavirus has made clear, it’s that everyone working in healthcare in any capacity is truly a hero to the patients, families and communities served. Patsy Powers Beth Price Karen Rhea, MD Anne Wilkins Laura Williams, MD Mary Ann WoodwardSmith Caroline Young

CELEBRATING 15 YEARS

2006 Nancy Chescheir, MD Staci Davis, MD Karen Duffy, MD Kathryn Edwards, MD Latonya Knott, MD Valerie MontgomeryRice, MD Sue Ross Jamie Waselenko, MD Cindy Wedel Debra Wollaber

2007 Shari Barkin, MD Susan Cooper, MSN, RN Martha Jo Edwards, EdD Maria de Fatima Lima, PhD Connie Graves, MD Wendy Long, MD Beth Malow, Beth, MD

Melissa Waddey Nancy West Denise Yardley, MD

2010

2008 Nancy Anness, MSN Mary Bufwack, PhD Stephanie Hatcher, MD Nancy Denning Martin Lynn Matrisian, PhD Anna-Gene O’Neal Jennifer Pietenpol, PhD Margaret Rush, MD Dee Anna Smith Debbie Cagle Wells

2009 Judy Aschner, MD Colleen Conway-Welch, PhD, FAAN Concepcion (Conchita) Martinez, MD

Kasey Anderson Jan Lewis Brandes, MD Donna Gilley Jan Goodson Jone Koford Bonnie Miller, MD Bonnie Pilon, PhD, FAAN Gloria Richard-Davis, MD Leigh Walton Elizabeth Williams, PhD

2011 Misty Sperry Chambers, RN Joann Ettien, RN Heidi Hamm, PhD Gwinnett Ladson, MD Jennifer McAnally Debbie Roberts, RN Rhonda Sides

Catherine Stallworth, MD Denise Warren Jeanne Yeatman, MOM, RN, EMT

2012 Nancy Brown, MD Monet Carnahan, RN Michelle Covington Jill Grandas, RN Susan Earl Hosbach Michele Johnson Laura Lawson, MD Kelly Miller, Kelly Dawn Rudolph Janet Southerland, DDS

2013 Patsy Brown Cherryl Carlson Molly Cate Marilyn Dubree, MSN, RN Janice Huckaby, MD Angela Humphreys Susan Newbold, PhD Nancy Peacock, MD Pam Womack Wendy Wright

2014 Anne Sumpter Arney Jennifer Elliott, RN Cherae Farmer-Dixon, DDS Heather Greene Beth Connor Guest Beth Hail Suzan Logan Linda Norman, DSN, RN, FAAN Susan Wente, PhD Andrea Wills, MD

2015 Christy Tosh Crider Lauren Hackett Christina Lohse, MD Lisa Nix Rosemary Plorin Heather Rohan Lynn Simon, MD Cathy Taylor, DrPH, MSN, RN Ellyn Wilbur

2016 Sharon Adkins, MSN Stephanie Bailey, MD Beth Chase

Kriste Goad Hayley Hovious Rita Johnson-Mills Amy Leopard Divya Shroff, MD Nancy Shultz Karen Springer

2017 Lucy Carter Jennifer Domm, MD Amy Johnston Little Lisa Kachnic, MD Linda Marzialo June Patterson Nita Shumaker, MD Amber Sims Corina Tracy Michele Williams, MD

2018 Karen Cassidy, MD Joanna Conley Yvette Doran Jana Dreyzehner, MD Claire Cowart Haltom Veronica Mallett, MD Mandi Ryan Katie Tarr

Robin Williams, MD Kinika Young

2019 Katina Beard Velinda Block, DNP, RN DeAnn Bullock, MD Chris Clarke Nicole Cottrill Lisa Davis Kristen Johns Rebecca Leslie Gina Pruitt Jeanne Wallace, DVM

2020 Tatum Hauck Allsep Jackie Cavnar Tina Gerardi, RN Julie Gray, DDS Pam Jones, DNP, RN, FAAN Nicole McCoin, MD Amber Price, DNP, RN Cindy Reisz Jodie Robison, PhD Melissa Scalise, MD

Delivering Care, continued from page 1 said. “We’re still a patient-centered institution and want to help alleviate fears of being in a hospital and of the virus itself.” Heidemann and her peers are continually educating patients regarding safety protocols so they can feel confident and safe. The practice also is utilizing phone and telemedicine visits when possible and now offers drive-up appointments – an especially popular alternative among patients with younger children in tow. “We’ve really tried to keep in touch and still provide safe, excellent care,” she said, noting the critical nature of personto-person contact in obstetrics. “The idea was born to have drive-up visits so patients stay in their cars, and providers can assess them in person. We can do so much with telemedicine, but the bottom line is that OB is a hands-on specialty and not just about medication adjustment. We’re listening and feeling and hearing, and it’s been a really great innovation to keep patients safe in a low-risk environment.” Patient Response Nicole Schlechter, MD, PhD, chief medical officer of Saint Thomas Midtown Hospital, said gradual changes in safety measures have elicited a myriad of responses from patients. “We’ve gone from having five guests in Labor and Delivery … to two … to one, and from unlimited visitors in the NICU to two to nashvillemedicalnews

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one,” she said. “It’s been a progressive evolution, but it seems like we’ve done it our whole lives, and we still have daily conversations about the next step.” But Schlechter said the sliding scale Dr. Nicole Schlechter of reactions from patients is no different than typical opinions in birthing choices. “You have deniers, who want their entire families in the room with no masks, and some so afraid they don’t want anyone in the room,” she said. “We see the entire spectrum of reactions, just as we do with staff and physicians and friends.” Heidemann said fear of contracting the virus has led some patients to request home birth transfers, but she stresses that often is the result of misinformation or a misunderstanding of how women’s hospitals are functioning. Birthing hospitals, some of which include ERs specifically for moms-to-be, provide a safer respite. “I would really reiterate to patients that we have a wonderful institution and that they’re safe here. I wouldn’t want a patient to choose a less safe environment because of fear,” she said. A New Normal Schlechter expects the ‘new normal’

to create lasting changes in Labor and Delivery, including more telehealth – particularly for childbirth classes and virtual tours, which have proven a hit among patients and providers, alike. She also expects long-term use of heavier personal protective equipment. “Many obstetricians don’t wear a mask or goggles during delivery because it’s such a personal, intimate experience,” she said. “I think many will continue to wear a mask and eye cover because those are issues we didn’t think much about before. People will also continue to wash hands a lot more for years to come. The new normal will be a different new normal, and hospitals won’t be rushing into going back to the way it was before as far as visitation and PPE. The last thing we want to do is be the cause of a second surge.” She said it’s a balancing act to give patients an incredible birth experience while keeping everyone safe. “We’re doing it slowly and thoughtfully, not just for OB but for surgery, ER and general medicine,” Schlechter added. Heidemann said drive-up care will continue to allow providers to gradually open up, while drive-up testing will help keep patients on track for planned admissions without an in-office visit. “Testing before admission will allow us to gradually open up to the entire community,

and as more people become immune and fall back into old patterns, the same basic behavior in the community will linger for a while,” she said. “People will social distance for comfort, and that will determine how we set up waiting rooms or stagger appointments until we all start feeling we can go back to a normal routine.” Preparing for the Future The pandemic also has helped hospital leaders better prepare for future epidemics. “We’re so much more prepared if it happens again,” said Schlechter, who helped create a hospital-wide, four-phase Surge Plan as the virus emerged. “We would go straight to social distancing and know the importance of early testing, not just at a local but a national level. We also know how many more beds we might need and how to staff them … and know how much we need of equipment, from IV poles to ventilators and trash cans. Our plan has been meticulously drawn out.” Schlechter also is grateful for the many positive moments since the pandemic’s onset, including unprecedented thoughtfulness toward healthcare workers. “I keep coming back to how kind and generous I’m finding people are,” she said. “The best in people is brought out in the worst of times, and I hope people will stay supportive and loving and maintain that balance.” MAY 2020

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New Study Looks at Cost Impact of OTC Birth Control By CINDY SANDERS

On May 9, ‘the pill’ celebrated 60 years of approval from the Food and Drug Administration. While no over-the-counter option is currently available, a growing chorus of women’s health providers, researchers and advocates is calling for improved access to oral contraceptives. In April, new findings on the impact of over-the-counter costs for birth control pills on both use and unintended pregnancy were released in Women’s Health Issues, a peer-reviewed, bimonthly journal of the Jacobs Institute of Women’s Health. “Modeling the Impacts of Price of an Over-the-Counter Progestin-Only Pill on Use and Unintended Pregnancy among U.S. Women” primarily looked at data from a nationally representative 2015 survey of more than 2,500 American women ages 15-44 to assess Alli Wollum interest in using an OTC progestin-only pill at different price points. The analysis also utilized the National Survey of Family Growth 2013-15, which was released from

the National Center for Health Statistics in 2016, as well as 2017 population data from the U.S. Census. According to the analytical study: “In a model assuming no out-of-pocket costs, more than 12.5 million adults and 1.75 million teens reported likely use of an OTC progestin-only pill if available. Among adults, this resulted in an estimated 8 percent decrease in unintended pregnancy in one year. Adult and teen women on average were willing to pay $15 and $10, respectively, resulting in 7.1 million adult and 1.3 million teen users and an estimated 5 percent decrease in unintended pregnancy among adults.” Lead author Alexandra Wollum, MPH, senior project manager with Ibis Reproductive Health, noted, “These results show that an over-the-counter, progestin-only birth control pill at a low or no out-of-pocket cost has the potential to decrease unintended pregnancy rates and expand access for people of all ages.” Improving affordable, equitable access to healthcare is a timely topic with experts at the International Monetary Fund projecting a nearly 6 percent contraction in the U.S. economy in 2020. In the wake of layoffs resulting from COVID19 business closures, more than 26 million

Congratulations Honorees!

Americans filed for unemployment over a five-week period between March and April, wiping out nearly a decade’s worth of job gains and decreasing access to employer-sponsored insurance coverage. “The findings of this study are particularly important in the middle of the public health crisis we’re facing now,” said Wollum. “As people struggle with mounting job losses and economic insecurity as a result of the COVID-19 pandemic, they must be able to obtain an affordable birth control pill over the counter to control their reproductive health. This study highlights the need for low or no out-of-pocket cost progestin-only birth control pills that are available over the counter to better meet people’s healthcare needs.” “This study shows that people are willing to pay something out-of-pocket for the convenience of getting progestin-only pills over the counter,” added co-author Dan Grossman, MD, professor in the Department of Obstetrics, Gynecology and Reproductive Science at the University of California San Francisco and director of Advancing New Standards in Reproductive Health (ANSRH) at UCSF. “But in order to best meet people’s needs and help them plan their fertility, overthe-counter pills should be fully covered by insurance without co-pays and available at a very low cost or no cost for those without insurance,” An earlier study published in February 2015 in the journal Contraception demonstrated affordability as a key factor for using OTC oral contraceptives among low-income populations. However, that study – led by Diana G. Foster, PhD, of ANSRH and co-authored by Grossman – did not use data that specifically looked at progestin-only pills (POP) in comparison to combined oral contraceptives (COC), which use both estrogen and progestin to

prevent unintended pregnancies. While there are a wider choice of prescription COC options compared to prescription POPs (also known as the minipill), both are effective forms of contraception if taken appropriately. The new study specifically looked at the POP option, which has garnered growing consensus among industry groups as the more likely version to gain FDA approval to become the first oral contraceptives available without prescription. The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion highlighting barriers to access as one of the key reasons women don’t use contraceptives consistently. Furthermore, the committee also found cost to be part of the larger access issue. “Pharmacist-provided contraception may be a necessary intermediate step to increase access to contraception, but over-the-counter access to hormonal contraception should be the ultimate goal,” the opinion states. In addition to OTC oral contraceptives, ACOG has also called for similar access to vaginal rings, the contraceptive patch and depot medroxyprogesterone acetate injections without age restrictions. The Jacobs Institute of Women’s Health was founded in 1990 and is part of the Milken Institute School of Public Health at George Washington University in Washington, D.C. Women’s Health Issues focuses on research related to women’s healthcare and related public health policy.

Blog Log The Nashville Medical News Blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website. NEW IN MAY:

Mark Your Calendars AJMC® Hosts Patient-Centered Oncology Care® 2020 Sept. 24-25 Omni Nashville Hotel

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The American Journal of Managed Care® will bring together renowned experts to deliver insights on the future of valuebased oncology care during a two-day conference in Nashville this fall. Featured speakers will engage in panel discussions on policy, precision health, chronic care management, biosimilars, the impact of technology and telehealth on value-based medicine, and more. For more information and to register, go to ajmc.com/meetings.

Michael Genovese, MD, JD, chief medical officer at Acadia Healthcare, warns behavioral health can’t be an afterthought amid a physical health crisis and urges the full healthcare system to prepare for a surge ahead in mental health and addiction needs. Chris Jones, MD, a cardiac electrophysiologist with Centennial Heart and president of the medical staff at TriStar Centennial Medical Center, and Craig Morrison, MD, an orthopaedic surgeon with Southern Joint Replacement Institute, each provide perspective on the decision to halt elective surgeries in Tennessee and the steps being taken to safely relaunch those procedures. Brian Moyer, president and CEO of the Nashville Technology Council, shares how Middle Tennessee healthtech companies stepped up to pioneer innovative solutions and provide assistance in response of COVID-19.

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Sharing, continued from page 5 sored by industry partners and disseminated to PsychHub’s full network of 500-plus – a growing list of corporations, non-profits, associations and educational institutions committed to sharing mental health information. Videos are formatted for the general public, as well as informal community supporters (teachers, healthcare workers), support professionals (school or addiction counselors), and mental health providers.

Training Providers

In 2020, the company launched subscription-based learning hubs for healthcare providers. The platform of evidence-based practices has proven to be a welcome alternative for continuing education credit and includes companion videos to share with patients to reinforce skills at home. “There’s no shortage of online education for healthcare providers – but not in the way we deliver it,” Morrison said. “We have a very engaging delivery model that uses all mediums, from providers talking to each other to fireside chats and animation. We change it up to include different types of mediums, so the learner goes through their own journey and chooses how they want to learn. We focus on the shift between knowledge learned and behavior changed and give them the tools they need.” Subscribers include large payers and healthcare systems, and subscription rates vary by client size. Psych Hub’s Nashville office includes 16 employees with more than 30 creative and clinical experts working remotely worldwide.

Addressing COVID-19

In April, the company added an additional free hub to address challenges associated with COVID-19, with more tools rolling out each week. Topics range from social isolation and working from home to alcohol addiction, PTSD and insomnia. “We’ve been working with major health insurance companies, larger nonprofits and the Department of Veterans Affairs to create a resource hub with lots of content around COVID-19 for mental health,” said Morrison. “Insurance companies don’t often work together, but I’m excited to see them come together for this.” Morrison credited collaboration efforts to Psych Hub’s reputable partner list, which recently grew to include Metro Nashville, HCA, Centerstone and TennCare. “Everyone’s asking for resources, and we, as an industry, only had so many,” she explained. “By partnering as a group, we can share resources and find answers without looking in a million places.”

Expanding horizons MagMutual isn’t just a malpractice insurer, we protect you from all the liability risks you face. Our visionary approach examines risk from all sides to offer you comprehensive insurance solutions for the practice, business and regulation of medicine. We see your whole picture – and that makes you even stronger.

Moving Ahead

Looking forward, Morrison said a longterm hope is to see all mental health providers using evidence-based practice for more precision therapy, along with informed consumers who will better know what to ask for. She also wants providers who aren’t licensed mental health practitioners to be better equipped to provide individualized support by having access to better training. “We want providers to know this service is available to them and how to access it themselves or talk to employers about subscribing so that they can better serve their patients,” she concluded. nashvillemedicalnews

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AHA Releases Scientific Statement on CAD with Type 2 Diabetes By CINDY SANDERS

Last month, the American Heart Association released a new scientific statement underscoring the impact of type 2 diabetes management on coronary artery disease. “Clinical Management of Stable Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus,” published April 13 in the journal Circulation, suggests a more aggressive approach might be required to balance the two chronic conditions. In light of emerging evidence, the statement calls for greater consideration when it comes to selecting medication options and interventional procedures. Walter Clair, MD, MPH, board member and past president of the American Heart Association (AHA) Dr. Walter Clair Middle Tennessee, discussed the significance of this new scientific statement. “Most of our focus as cardiologists has been on decreasing cardiovascular mortality,” he pointed out. In order to address the lagging indicator of decreased cardiovascular disease, there has to be focused attention on the leading indicators, which are the risk factors leading to CAD, he noted. “We know hypertension, diabetes and smoking increase the risk of cardiovascular disease … but the link between diabetes and cardiovascular disease has never been as important to us as the link between hypertension and cardiovascular disease,” said Clair, who serves as executive director and chief medical officer for the Vanderbilt Heart & Vascular Institute. This new statement is meant to focus a spotlight on the risks of type 2 diabetes (T2D), as well. “We’ve now come to appreciate the fact that diabetes is not just ambient … a coincidental ‘other disease,’” Clair said, adding T2D significantly complicates cardiologists’ efforts to decrease coronary artery disease (CAD). Over the last couple of decades, new classes of drugs beyond insulin have come online to treat diabetes. Clinical studies leading to Food and Drug Administration approval of thiazolidinediones (TZDs) found the drugs quite effective in lowering blood sugars, but meta analyses began to emerge a little more than a decade ago showing increased risk of cardiovascular morbidity and mortality with TZD usage. “That is what initially caught the attention of cardiologists,” said Clair. As a result, the FDA issued guidance in 2008 calling for new T2D therapy developers to conduct large cardiovascular outcomes trials to demonstrate safety. It should be noted, though, new draft guid10

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ance just released by the agency in March no longer includes that recommendation. However, the resulting focus on cardiovascular safety from 2008 has led to a much better understanding of the cardiac profile for both newer drugs and well established therapies. For example, metformin – the most frequently prescribed medication to lower glucose for initial treatment in T2D patients – sometimes leads to weight loss and is at least neutral in terms of cardiovascular effects. The AHA scientific statement noted there are newer classes of drugs where research indicates a bigger win/win in terms of diabetes and heart disease. “The wonderful, surprising finding in these new drugs is that not only do they not worsen the cardiovascular morbidity profile, they actually make it better,” said Clair. Sodium-glucose co-transporter inhibitors (SGLT2 inhibitors), which are taken orally, were the first to show weight loss, reduced risk of heart failure and less progression of chronic kidney disease. Glucagon-like peptide-1 agonists (GLP-1 receptor agonists), which are injectable medications, both lower blood glucose levels and can also help with weight reduction. While there has been some mixed results in terms of actually reducing cardiovascular diseases, the AHA statement said some “GLP-1 receptor agonists have been shown to reduce the risk of major cardiovascular events caused by cholesterol build-up in the arteries, such as heart attacks and strokes.” The statement also pointed out that although aspirin is often appropriate for people with heart disease, it might not be as effective in people with T2D and CAD. For those with both chronic conditions, using newer antiplatelet medications might be more effective. Similarly, T2D could also influence the type of interventional procedure deemed best to reopen an artery. The AHA statement reads, “Studies have found a greater reduction in the five-year risk of death, heart attack or recurrent angina/chest pain when patients with T2D and CAD undergo coronary artery bypass graft (CABG) surgery to widen a narrowed blood vessel instead of treating the narrowing with angioplasty and stenting.” Clair said having the new AHA statement in hand underscores the need to consider the bigger picture when caring for patients with T2D and CAD and serves as a reminder to cardiologists, endocrinologists and primary care providers to consider all options. He added the ‘big picture’ includes being good stewards of resources. “The newer drugs always cost more and might not be covered by insurers,” he pointed out. “But if you’re looking at the

morbidity of patients, they really do better on these newer drugs.” Clair added oral SGLT2 inhibitors are about half the cost of the more expensive injectable GLP-1 receptor agonists but said both cost considerably less than the expenditures of money, lower quality of life and lost productivity that are associated with a heart attack. “If patients are getting good control from standard medications and they don’t have known heart disease – fine,” said Clair. “But, if they do have cardiovascular disease, the risk/benefit ratio shifts.” As for lifestyle and nutritional changes, Clair said establishing good habits is the baseline for treatment of both T2D and CAD. He added most patients really want to try to address high blood pressure, high cholesterol, diabetes and other issues without medication. “I used to let them try lifestyle changes (first), but then they come back to see me and weigh six pounds more. Now I’ve shifted my view,” Clair said. “I tell them, ‘Let’s use the drugs to get your condition under control, then if your lifestyle changes work, we’ll look at backing off the medications.’” Clair added an improved understanding of the pathophysiology of both T2D and CAD has allowed newer diabetes medications to offer more benefits while reducing cardiovascular risks. In this new era, he concluded, “We’re moving more aggressively toward prevention.” The scientific statement was developed on behalf of the American Heart Association’s Council on Lifestyle and Cardiometabolic Health and Council on Clinical Cardiology. Suzanne V. Arnold, MD, MHA, associate professor of medicine at the University of Missouri Kansas City, served as chair of the writing committee. Access the full statement through the AHA website at Heart.org in the ‘Guidelines and Statements’ section under the ‘Professionals’ tab or through the link posted with this article on our website at NashvilleMedicalNews.com.

Mark Your Calendars Music City SCALE July 24-26 The premier meeting for cosmetic and medical dermatology is going virtual in 2020. SCALE is using technology to share the latest developments and technological breakthroughs in aesthetic medicine. CME credits available. For more information and to register, go to ScaleMusicCity.com.

Y O U R M I D D L E T N S O U R C E F O R P R O F E S S I O N A L H E A LT H C A R E N E W S

PUBLISHED BY: Graham | Sanders Publishing, LLC PUBLISHERS Susan Graham & Cindy Sanders SALES 615.397.2836 Cindy Sanders Maggie Bond Wade Elder Pam Harris MANAGING EDITOR Cindy Sanders csanders@nashvillemedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com CONTRIBUTING WRITERS Melanie Kilgore-Hill David Klements Cindy Sanders Nancy Wise 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

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Necessity … the Mother of Invention

VUSN Students Experience Virtual Clinical Care in an Age of Social Distancing What do you do with 154 nursing students who are suddenly unable to participate in the hands-on clinical care that makes up 60 percent of their education each week? That was the challenge facing Mary Ann Jessee, PhD, director of PreSpecialty education at Vanderbilt University School of Nursing (VUSN), and the 30-plus faculty who instruct those first-year (prelicensure) nursing students in patient care. With the spread of COVID-19, the students’ clinical education in hospitals, clinics and other facilities was suspended in midMarch. VUSN was unwilling to postpone clinical learning and possibly delay the students’ path to becoming advanced practice registered nurses – so faculty got creative. “For a couple of weeks, we had been determining what we would do if students weren’t able to be in the clinical setting,” Jessee said, adding she brainstormed with course coordinators, Erin Rodgers, DNP, and Heather Robbins, DNP, on what a virtual experience might look like for students and how that would translate to traditional clinical learning. “Could we use the Simulation Lab and have the students participate by telling someone in the lab what to do?” the trio wondered. VUSN Simulation Lab Director Jo Ellen Holt, DNP, responded enthusiastically with suggestions. The result was a virtual live-streamed learning experience with students using their instructors and Simulation Lab staff as avatars to interact with the school’s high-fidelity nursing mannequins to provide patient care.  “One instructor acted as the student’s eyes, ears and hands while another observed and coached, just as they would do with actual patients in the clinical setting,” Rodgers said. “Students instructed their avatar on what to do, step-by-step. The avatar reported the results, and then the students as a group evaluated whether that skill was implemented correctly and discussed the outcome.” The students joined the simulations via video conferencing, working in the same sixstudent cohorts as for their in-person clinical learning. Each student experienced directing the avatar and discussed the scenario with their group. “What we’re trying to mirror is the typical direct patient care experience and clinical conference, but in a virtual format,” Jessee said. “We had to determine how to recreate those patient interactions, and in those, ensure that students had the ability to conduct assessments, prioritize patient needs, make decisions about care, implement that care and evaluate the results.” Throughout the simulation, the instructor is observing and coaching, just as they would with actual patients. “In the virtual clinical experience, the faculty member can’t see the student doing the assessment or preparing for safe medication administration. The student needs to explain it before the avatar acts so the faculty can see that the student knows how to do it. This allows fac-

PHOTO CREDIT: VANDERBILT UNIVERSITY

By NANCY WISE

Pediatric Instructor Lesley Ann Owen waits for instructions from student Alec Bradbury before providing respiratory care to their pediatric patient. Instructor Jennifer Hicks observes and coaches, just as she does in a clinical setting.

ulty to assess the same competencies in the virtual simulation as in the clinical setting.” The School of Nursing’s PreSpecialty program is for students with undergraduate degrees in a field other than nursing. They spend 12 months in intense generalist nursing learning, then spend 12-18 months gaining specialty education. In addition to directing the PreSpecialty level, Jessee serves as assistant dean for academics, generalist nursing practice. The virtual clinical simulation is only one strategy the PreSpecialty faculty are using for clinical skills. The school also uses

the Virtual Healthcare Experience portal, developed by Canadian schools of nursing to engage students in highly complex scenarios using actors, as well as materials from the Institute for Healthcare Improvement, ReelDX videos and faculty-created case studies. VUSN PreSpecialty clinical faculty created multiple virtual clinical simulations to support pediatric, adult, obstetric and psychiatric-mental health care. Students whose clinical experiences did not require the simulation lab participated in similar virtual situations within a simulated home

or office setting. Before starting the virtual curriculum, VUSN consulted the Tennessee Board of Nursing and the Commission on Collegiate Nursing Education (CCNE) to determine how the simulations would relate to the students’ future licensing. “They sent us confirmation that simulation can be used one-to-one in place of direct patient care,” Jessee said. “Every hour that students are logging in these virtual activities counts toward their preparation for the national council licensure examination, NCLEX.” Student reaction has been positive. In addition to finding the simulations valuable, students have noted they feel supported in keeping their educational dreams on track thanks to the innovation. The faculty also judged the simulations successful. “We were able to develop meaningful, realistic virtual experiences that would provide students with opportunities to learn and demonstrate competency in essential clinical thinking skills,” Jessee said. Although she doesn’t know of other schools that have created similar virtual clinical simulations, Jessee said that nursing schools across the country are developing various creative learning experiences. “We’re all working to enable on-time graduation of nurses to fill vacancies in the nursing workforce,” she said. “Our students won’t miss a beat.”

LET’S GIVE THEM SOMETHING TO TALK ABOUT Awards, Honors, Achievements

Kathryn Edwards, MD, who holds the Sarah H. Sell and Cornelius Vanderbilt Endowed Chair in Pediatrics and is a professor of Pediatrics at Vanderbilt University School of Medicine, has been awarded the 2020  John Howland Award, the highest honor given by the American Dr. Kathryn Pediatric Society (APS). A Edwards member of the National Academy of Medicine, Edwards’ work focuses on the evaluation of vaccines for the prevention of infectious diseases in adults and children. She has led many of the pivotal clinical trials of vaccines licensed in the past several decades and has played a major role in their implementation. Edwards is the third Vanderbilt faculty member to receive the John Howland Award, which has been given annually since 1952.  The late Amos Christie, MD, was honored in 1979, and Mildred Stahlman,

MD, received the award in 1996. The Society for Vascular Surgery’s Vascular Quality Initiative (SVS VQI) has awarded Nashville Vascular and Vein Institute (NVAVI) the maximum of three stars in the Registry Participation Program. The mission of the SVS VQI is to improve patient safety and the quality of vascular care delivery by providing web-based collection, aggregation and analysis of clinical data submitted in registry format for all patients undergoing specific vascular treatments. Participating centers can earn up to three stars based on actions that lead to better patient care, including completeness of long-term, follow-up reporting and initiation of quality improvement activities, among other criteria. “The VQI database allows us to continually improve by utilizing the knowledge gained by all the practices that participate in VQI nationwide,” said Patrick Ryan, MD, FACS, founder Dr. Patrick Ryan of NVAVI.

Ascension Saint Thomas Proposes State’s First Neighborhood Hospital

Mental Health Cooperative of Nashville was recently honored with the “Mobile Crisis Award” by the American Association of Suicidology. MHC provides a comprehensive array of crisis services to the Middle Tennessee community for those experiencing behavioral health emergencies. MHC’s Emergency Psychiatric Services continuum includes a Crisis Treatment Center, a 15 bed Crisis Stabilization Unit, an 8 bed Crisis Respite Unit and a 10 bed 23-hour Observation Unit.

The Adult Congenital Heart Association (ACHA) recently announced the newest additions to the organization’s Medical Advisory Board (MAB), including Jonathan N. Menachem, MD, director of Advanced Congenital Cardiac Therapies (ACCT), Heart Failure and Transplantation Section, at Vanderbilt University Medical Center. ACHA MAB members play a crucial role in offering expert opinions on research and medical developments in ACHD to assure that organizational policies meet the highest standards of scientific need and accuracy.

Last month, Ascension Saint Thomas proposed construction of the state’s first neighborhood hospital, which would be located in Murfreesboro near the Westlawn community. If approved by HSDA, the new facility would serve as a satellite hospital of Ascension Saint Thomas Rutherford to serve one of the fastest growing zip codes in the state. Designed to complement services on the main campus, Ascension Saint Thomas Rutherford at Westlawn will include eight private inpatient medical beds, an Emergency Department with eight treatment rooms, diagnostic imaging and laboratory services. The hospital will have two levels, with the second floor used for clinical office space and additional clinical services. The Certificate of Need hearing on the project is scheduled for August. If approved, completion of the estimated $24.6 million project is anticipated for early 2022.

Profile for Medical News

May 2020 Nashville Medical News  

your primary source for professional healthcare news

May 2020 Nashville Medical News  

your primary source for professional healthcare news