FOCUS TOPICS PEDIATRIC ONCOLOGY • DERMATOLOGY • INTEROPERABILITY • MEN’S HEALTH
June 2017 >> $5 ON ROUNDS
A Mind for Research with a Love for Patient Care Jackson Clinic Dermatologist Turned from the Microscope to the Satisfaction of the Clinic One look at the resume of Maria Mariencheck, MD, and you cannot help but be impressed. High school valedictorian, a generous scholarship to Washington University, acceptance Maria Mariencheck into a medical scientist program that included a full ride to medical school as well as a stipend that earned her an MD/PhD, and a dermatology residency followed by faculty appointment at Duke.
St. Jude Physician Leading Study to Test Avelumab
Drug Holds Promise for Pediatric Patients With Osteosarcoma By MADELINE PATTERSON
Pediatric patients with recurring osteosarcoma have not seen a successful new drug treatment in nearly 30 years. With a survival rate of less than 20 percent, these patients are now hoping the new drug avelumab will be an answer for children ages 12 and up with recurring or progressive osteosarcoma. Michael Bishop, MD, at St. Jude Children’s Research Hospital is leading a phase two study that began in January to test avelumab in adolescent and young adult patients 12 years of age and older. Avelumab is an immune checkpoint inhibitor that targets cancers by blocking PD-L1 (programmed death ligand-1). It’s an anti-PD-L1 monoclonal antibody, inhibiting interactions between PD-1 expressed on T cells and PD-L1 on cancer cells, allowing the T cells to activate and target tumor cells. Additionally, in contrast to other available PD-1/PD-L1 inhibitors, avelumab has the ability to induce antibody-dependent cellular cytotoxicity (ADCC). PD-L1 is a protein found on normal cells as well as some cancer cells that serves as a “lock” for the “key” of PD-1. When the protein PD-1 binds to PD-L1, it signals to the immune T cells that this cell is normal, so the immune system does not attack. (CONTINUED ON PAGE 4)
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Memphis VA’s New Director Makes a Return to His Roots
Plays Well with Others Healthcare Moves Closer, Continues Quest for Interoperability
By JAMES DOWD
During a 30-year Army career punctuated by service in Operation Desert Storm and a 15-month deployment to Baghdad, David K. Dunning developed a profound respect for his fellow military service members. That unwavering commitment to, and connection with, veterans has prepared Dunning well, he believes, for a new career challenge: overseeing the Memphis VA Medical Center. After more than a year of a succession of interim and acting directors, the Memphis VA Medical Center chose Dunning this year as permanent medical center director and CEO. His appointment came at a time when VA facilities across the country faced intense scrutiny over issues such as quality
The Healthcare Information and Management Systems Society is keenly focused on improving health and the business of healthcare through the application of information technology.
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A Mind for Research with a Love for Patient Care
Jackson Clinic Dermatologist Turned from the Microscope to the Satisfaction of the Clinic By SUZANNE BOYD
One look at the resume of Maria Mariencheck, MD, and you cannot help but be impressed. High school valedictorian, a generous scholarship to Washington University, acceptance into a medical scientist program that included a full ride to medical school as well as a stipend that earned her an MD/PhD, and a dermatology residency followed by faculty appointment at Duke. If you only looked at her on paper, you’d miss the best part of the story – her heart. The oldest of three girls, Mariencheck grew up in Glen Ellyn, Illinois, about an hour outside of Chicago. The importance of getting a good education was stressed in her home and not just because her mother was a school teacher. “My grandparents immigrated to America from Italy, they mined coal in Virginia and never learned to read. My parents were born in the United States and while my mom went to college, my father, who worked for the railroad, only completed high school. Education to them was the way out,” said Mariencheck. “We lived a simple lifestyle. I went to a public high school; we may have taken two vacations my whole life.” Even though she graduated at the top of her class, Mariencheck had not really looked at many colleges. In fact, she thought her only option, for financial rea-
For Dr. Maria Mariencheck and her husband Dr. Bill Mariencheck, visiting their daughters Marissa (left middle) and Claire (middle right) means going back to their Alma Mater, Washington University.
sons, would be the University of Illinois until a trip with a friend opened another door. “I tagged along with a friend and her parents to St. Louis and we toured Washington University. I got to talk to the people there and fortunately they took an interest in me,” said Mariencheck. “I only applied
to the University of Illinois and to Washington University. When I was offered a very generous scholarship to Wash U, it was an easy decision. While I wasn’t a fan of big cities, St. Louis was close enough that I could take the train home.” That train ride home would ultimately
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come to mean a great deal, not only to Mariencheck, but also to the career path she would choose. Late in her sophomore year, her father was diagnosed with stomach cancer. “I spent the summer after he was diagnosed at home helping my mother care for him. Then, went back to school in the fall, but came home on weekends until he died at the end of my junior year,” she said. “I had planned to go into research in cell biology but going through my dad’s cancer got me interested in medicine. My advisors encouraged me to apply to Washington University’s medical scientist training program, that would earn me a MD and a PhD in cell biology. The seven-year program included a full ride to medical school plus a stipend for living expenses and with my dad gone and two sisters for my mom to support on her own, that made the competitive program even more attractive as an option after I completed my undergraduate studies.” In the program, students spend the first two years in medical school followed by four years working on their PhD. The final year has them back in medical school doing rotations throughout different specialties. “During my PhD program, I did a lot of research on elastic tissue so there was quite a bit of dermatology related to it,” said Mariencheck. “I found that I really liked interacting with people which made me think that maybe research wasn’t the avenue I wanted to pursue after all. When I went back to finish up my last year of medical school, I knew dermatology was what I wanted to do.” In addition to completing her medical degree, Mariencheck also found love and married in her last year of medical school. “Bill and I met in my second year of medical school and dated for four years before we got married,” she said. “We graduated from medical school at the same time and we both matched at Duke University in North Carolina for our residency; mine was in dermatology and Bill went into pulmonology.” Residency for Mariencheck also meant becoming a mother. Her two daughters were born two years apart while she was in residency. When she and Bill completed their respective residencies, they both took faculty appointments at Duke. “With having the girls, we found we ourselves at the point of looking to what was next for us and knew we wanted to be closer to family,” said Mariencheck. “Bill’s family was in Memphis and when we found openings for both of us at the Jackson Clinic, it was the natural place to land and we moved here in 2000. Jackson has been the best place for us to raise our daughters and working for an organization that is so supportive of families has been great.” (CONTINUED ON PAGE 4)
Plays Well with Others
Healthcare Moves Closer, Continues Quest for Interoperability By CINDY SANDERS
The Healthcare Information and Management Systems Society is keenly focused on improving health and the business of healthcare through the application of information technology. To accomplish that, the global non-profit organization recognizes the very real need to improve interoperability, which is even more crucial as the United States moves to a value-based system that follows the patient across the continuum of care. Perhaps it shouldn’t be surprising that over the last few decades, the historically siloed healthcare industry has embraced numerous innovative programs and platforms designed to improve quality, outcomes and efficiency … without giving much forethought to how that technology might interact with other entities. In fact, it’s not even unusual to find multiple HIT applications that have trouble communicating under the same roof. Joyce Sensmeier, RN-BC, MS, CPHIMS, FHIMSS, FAAN, who serves as vice president of Informatics for HIMSS, said breaking down those barriers to effectively share and interpret data is a core … albeit complex … focus for HIMSS. “At the foundation of it is the need for stan-
dards and for everyone to be implementing those standards in the right way,” she noted.
Moving the Needle
The HIMSS Inno- Joyce Sensmeier vation Center, headquartered in Cleveland, Ohio, is the centerpiece of the organization’s interoperability efforts. ConCert by HIMSS™ comprehensively tests and certifies electronic health record (EHR) and health information exchange (HIE) vendors. Built off of the
findings of the EHR|HIE Workgroup and the IHE USA (Integrating the Healthcare Enterprise USA), the ConCert seal of approval means a product has been proven to be interoperable with other products. Noting HIMSS works closely with IHE, Sensmeier said the annual ‘Connectathon,” which is usually held each January in Cleveland, fosters collaboration among competitors with the mutual goal of improved interoperability. “It’s refreshing to see them working on that in a neutral environment,” she noted of the approximately 500 systems engineers representing 100 organizations who come together to collec-
tively improve data sharing. Sensmeier added yet another barometer of interoperability momentum was on display this past February in Orlando at the Interoperability Showcase. “We had the largest number of participants this past year,” she said, adding, “Vendors have to be able to show interoperability to even participate.” The showcases typically feature about 15 different use case scenarios to provide attendees the opportunity to witness how standards-based transactions could impact care across the continuum by decreasing duplicative entry and enhancing quality and safety. “It really brings a picture of what can be,” Sensmeier said, adding nearly 10,000 attendees came through the showcase in Orlando.
Sensmeier said progress also is visible in the work being done by Regional HIEs. In the San Diego area, where Sensmeier is based, the large hospitals have worked together to enable access to patient data no matter the facility where it originated through the deployment of business agreements. While technology standards have enabled cross-communication at the base, (CONTINUED ON PAGE 6)
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St. Jude Physician Leading Study, continued from page 1 Per the American Cancer Society, PD-1 inhibitors are being used to treat melanoma, non-small cell lung cancer, kidney cancer, bladder cancer, head and neck cancers, and Hodgkin lymphoma. Whereas PD-L1 inhibitors like avelumab, atezolizumab or durvalumab are currently being prescribed for treating bladder cancer, non-small cell lung cancer and Merkel cell skin cancer. The success of immune checkpoint inhibitors in adults with various cancers with high rates of mutations “provided some interest for us in treating our patients” said Bishop about the study at St. Jude, as osteosarcoma is one of the most highly mutated pediatric tumors. This new class of treatment has shown promise in adults especially when combined with other checkpoint inhibitors with different targets such as CTLA-4. The use of immune checkpoint inhibitors is relatively new in pediatric oncology said Bishop, and studies like the avelumab phase two
research study provide a window into the possibilities for children with recurring osteosarcoma. But, the immune checkpoint inhibitors can lead to the immune system attacking non-cancerous cells and serious side effects like nausea or issues with organs like the lungs. Even though the drug
is approved by the FDA for treating adults with certain cancers, there are less data on toxicity in children and quality of life concerns. Bishop is monitoring the quality of life and side effects of avelumab in the trial at St. Jude by having patients complete questionnaires about physical and emotional wellbeing throughout the study. The trial also includes several correlative biology studies developed in conjunction with St. Jude Immunology members. These include looking at expression of certain markers on tumor cells, as well as markers of “exhaustion” on T cells related to chronic antigen exposure and the likelihood of tumors to respond based on their presence. Bishop hopes that these studies will improve our understanding of the use of immune checkpoint inhibitors by making “novel insights on how the interplay between tumor and immune system impact the ability to generate a response to these types of therapies.” Physicians at St. Jude are studying the
response of the tumors and the length of time patients are receiving the drug without tumor growth. For the trial, St. Jude is studying patients ages 12 or older with measurable recurrent or progressive osteosarcoma. St. Jude is hoping to recruit 32 patients in total over the course of this three-year trial. Every two weeks, patients are treated with avelumab and evaluated by imaging at 8 weeks, 16 weeks and then every 12 weeks following. Currently, St. Jude is the only hospital testing avelumab in adolescents and young adults, but Texas Children’s Hospital, Memorial Sloan Kettering and Children’s Hospital of Los Angeles will be opening this trial soon. While it’s too early to tell if the immune checkpoint inhibitor avelumab will be useful for children with osteosarcoma and potentially other cancers, it is hopeful to have a potential treatment for the recurrence of the most common type of pediatric bone cancer.
Memphis VA’s New Director Makes a Return to His Roots, continued from page 1 of patient care, long wait times to see doctors and understaffed and aging campuses. But Dunning accepted the job fully aware of the criticisms and stresses faced in Memphis and elsewhere, and they have strengthened his resolve to improve the welfare of veterans. Dunning believes his military background provides an insider’s advantage that will aid in accomplishing the task. “I’m a veteran of 30 years, and while I can’t share all the experiences of every veteran who comes to the VA, I do have a valuable context to draw upon because I’ve been there,” he said. “I have three decades of military experience that help me understand where they’re coming from, and I understand their issues.” Those issues are complex and numerous. The Memphis VA serves nearly 200,000 veterans from Memphis and 53 counties in West Tennessee, North Mississippi and Northeast Arkansas. Dunning is determined to elevate the healthcare experience for all those served by the institution. “The Memphis VA is similar to places I’ve worked in the past, and I’m convinced that as good as I believe the care is here – and it is very good – we can get even better,” he said. “Memphis has true potential to be a national leader among VA centers, and we’re committed to realizing that vision.” Dunning leads a new executive team that he said initially will be focused on improving access and quality of care, increasing patient safety and meeting and exceeding veterans’ and employees’ expectations. Now that a permanent team is in place, he is confident that stability from leadership will generate better and standardized care across the board. “We have tremendous support from the VA central office and the Mid-South district to carry out this mission,” he said. “We’re short on people and we’re working to recruit highly qualified personnel and 4
make this a better place for healthcare professionals already in place. “I’m also making it a priority to walk around the campus and talk to veterans and employees to find out what they need. The best way to find out how we can improve is to speak directly to the patients receiving care and the people providing services.” In addition to services and experiences inside the VA, Dunning said plans are in place to address parking problems, which he admits aren’t unique to his facility. “Parking is a huge dissatisfier, but you can’t ignore it just because every other healthcare facility suffers from similar situations,” he said. “We’re working to eliminate some of those headaches. Our ER renovation should be complete soon, and that will open up several dozen spaces that have been blocked. When the north tower renovation is complete, that also will help overcrowded parking.” On the facility’s west side, construction on a new three-level parking garage will begin once funding has been awarded later this year. The two-year project likely will get under way in 2018. The garage will be built over an existing parking lot, resulting in 315 total spaces. Also in the works is a plan to reconfigure the interior spaces where veterans access patient services. The current diagram can be confusing and frustrating, Dunning said, but that will change. “Our goal is to re-create the VA as a state-of-the-art facility, and part of that strategic plan includes taking a hard look at the halls and walls,” he said. “We want to offer a seamless and easy experience for our veterans rather than requiring them to walk all over the building. I’d like to see a one-stop shop in the lobby that streamlines the process and makes it more efficient and less cumbersome for everyone.” Dunning is also excited about the VA’s partnership with the University of Tennessee Health Science Center, and he looks forward to working closely with UTHSC
officials to build the VA’s residency program and produce more medical professionals. “The VA does not stand alone in this community,” he said. “Our strength comes from collaborating with existing ties within our community.” When Dunning says “our community,” he indicates an investment in an area he has called home for his entire life. A Memphian by birth – his family lived in Somerville, but he was born at the old Baptist Hospital in the Downtown Memphis medical district – Dunning has two brothers who attended the former Memphis State University, and he still counts family members here. After spending his first three years in West Tennessee, Dunning moved with his parents to Columbia, Tennessee, and lived there several years before the family relocated to Syracuse, New York. He spent his teen years there before being awarded an ROTC scholarship that led him to Greenville, South Carolina, where he studied at Furman University, and earned a bache-
lor’s degree in political science. He earned a master’s degree in public administration from the University of Missouri at Kansas City and a master’s degree in strategic studies from the U.S. Army War College. His professional experience includes an internship at Walter Reed National Medical Center, a couple of years as a military consultant in Saudi Arabia and medical administrative posts in Germany, Hawaii, Kansas, Louisiana, North Carolina and Texas. And through 13 career moves in 19 years, Dunning always considered Memphis a part of him. After completing 30 years of military service, he looked for opportunities to continue serving, and the Memphis VA seemed to be a perfect fit. “Although this is the first time I’ve actually lived in Memphis, I’ve visited family here off and on my entire life and I’m very familiar with the city,” Dunning said. “My wife is so excited for us to move here that we call this our forever home. This is where we plan to stay.”
A Mind for Research, continued from page 2 During her residency, Mariencheck was exposed to both medical and cosmetic dermatology but her interest remained on the clinical side. While it has been over 20 years since she was a resident, she says skin cancer and skin diseases are still the predominant issues she treats in her practice. “We are a lot more aware of skin cancer and the risks of tanning bed use today than when I was a resident,” said Mariencheck. “Most of my skin cancer patients are getting younger. I now see basal cell carcinoma in patients under the age of 30, and almost all of them are those who have used tanning beds. Genetics can also play a role as well as sun exposure, but whether it runs in your family or not, you can control sun exposure and avoid tanning beds.” Advances in the treatment of skin
disease, such as psoriasis and eczema, has been one of the most significant changes Mariencheck has seen over the years. “Many skin diseases have been found to have an auto immune basis and using injections of biologic treatments has been found to be quite effective,” she said. While this accomplished dermatologist may have gotten her degrees in the big city, her heart remains a small-town girl’s who still enjoys the simple things. With both girls in college at Washington University, she and Bill enjoy running, cooking and hiking in the Appalachian Mountains in North Carolina. Family is also at the top of her list. Her mother makes her home with the Marienchecks during the summer months and they all love time at the beach whenever they can. westtnmedicalnews
New Technologies Pave the Way For Innovation in Men’s Health Regional One Health Finds Improved Ways to Treat Prostate Cancer By BETH SIMKANIN
Mid-South physicians are able to detect, diagnose and treat prostate cancer earlier and easier than ever before due to a recent explosion in technology and new therapies, according to several MidSouth physicians specializing in prostate cancer treatment. Advancements in the use magnetic resonance imaging, genomic testing and advanced therapies, in addition to the development of a comprehensive men’s clinic at Regional One Health, are revolutionizing how physicians identify and treat prostate cancer in the Mid-South. “We are on the verge of becoming a center for excellence in the detection and treatment of prostate cancer,” said Robert Wake, MD, urologist with UT Regional One Physicians and chairman of the Department of Urology at the University of Tennessee Health Robert Wake Science Center. “We are training medical residents in new procedures with new technology right here in Memphis.” The MRI fusion biopsy procedure with ultrasound guidance is a new, innovative treatment that has become available in the Mid-South to assist in the detection of prostate cancer within the last year. The procedure blends multi-parametric prostate MRI images with a transrectal ultrasound (TRUS), which allows urologists to locate suspicious areas on the prostate and perform targeted biopsies. Merging the MRI images of the prostate with a TRUS helps to diagnosis prostate tumors that were previously missed using the traditional prostate biopsy technique in which most tumors could not be seen with the TRUS alone. Previously, urologists sampled quadrants of the prostate hoping to identify prostate cancer. “This procedure has revolutionized early detection of prostate cancer,” Wake said. “Before MRI fusion, we performed more biopsies and there were sampling errors in some cases, or we would miss a tumor altogether because it was so small that we couldn’t see it. Now we can look at all areas of the prostate and get targeted samples. There’s no more random sampling because the MRI shows us the suspicious area so we know where to take the biopsy.” Wake and Mark Saslawsky, MD, chairman of urology at Baptist Memo-
rial Health Care and medical director at UroCenter, an outpatient urology surgery center, are two Mid-South urologists who advocate the MRI fusion biopsy procedure for the detection and diagnosis of prostate cancer. “This procedure has been available in Memphis for only a year, so it’s a recent development,” Saslawsky said. He said the MRI fusion biopsy procedure with ultrasound guidance is performed after Mark Saslawsky a patient has an initial traditional biopsy that produces a negative result, yet the patient has an elevated PSA level. A blood test measures the level of PSA in a man’s blood. An elevated PSA level indicates a patient may have prostate cancer and a biopsy may be recommended. “MRI fusion is not done on the first biopsy,” Saslawsky said. “Insurance coverage is an issue due to the expense, and it’s time-consuming to coordinate.” Wake affirms. “Not every hospital can afford MRI fusion technology,” Wake said. “It’s expensive and you must have an experienced radiologist on hand who knows what to look for. Two years ago, insurance companies wouldn’t pay for it. Now it’s standard because it’s so effective and patients are demanding it.” Research indicates the procedure produces results. Researchers with the National Institutes of Health performed the MRI fusion biopsy procedure with ultrasound guidance on 1,000 men with an elevated PSA level or suspicious digital rectal exam results over a seven-year period. The team published results from its study in the
Journal of the American Medical Association in 2015. The study found that 30 percent more high-risk prostate cancers were diagnosed with targeted MRI fusion biopsy with ultrasound guidance than with a standard biopsy. Prostate cancer is one of the most commonly diagnosed cancers among men in the United States. According to the American Cancer Society, 238,000 new cases are diagnosed each year. Wake has performed 45 MRI fusion biopsy procedures with ultrasound guidance since the procedure became available six months ago at Regional One Health’s East Campus. Additionally, an experienced radiologist is on site, which Wake says is rare. The fifth floor houses a full-service urology practice, which is designed to evolve into a comprehensive men’s healthcare clinic over the next three to five years. “With the framework set up at the East Campus, we are well on our way creating comprehensive men’s health services,” Wake said. He added that the next step is offering a new prostate cancer treatment called focal laser ablation at Regional One Health. Focal laser ablation is when a laser, assisted by real-time MRI guidance, is positioned within the prostate tumor and used to heat the area to a temperature that kills cancer cells. This procedure is performed on patients with localized prostate cancer. It can be performed as alternatives to surgery and radiation treatment, which can result in serious side effects such as erectile dysfunction and urinary incontinence. “Focal laser ablation is very new, and it’s something we could bring to Memphis,” Wake said. In addition to innovative treatments, local experts say there have been advance-
ments in genomic testing for patients with low-risk prostate cancer. Genomic testing looks at the activity of certain genes in the prostate tumor and assigns a Genomic Prostate Score to each case that is personalized to each patient. The test is performed on cancerous tissue taken from the prostate in order to provide information on how a patient’s prostate cancer might behave in the future. “Before we were just getting a negative or positive result,” Saslawsky said. “Now we can get more information in order to make a better evaluation on how aggressive a cancer is and how likely it is to cause future problems.” Wake said, “We can look at the genetic markers in the tissue to determine how it might advance in 10 to 15 years. The more data we have, the better we can decide on how to treat it.” According to Brad Somer, MD, an oncologist at West Cancer Brad Somer Center, there have been recent advancements in the treatment of metastatic prostate cancer that can prolong a patient’s survival. Metastatic prostate cancer is when the cancer has spread from the prostate to other parts of the patient’s body. “There has been a recent wave of advancements in immunotherapy, nuclear medicine agents and gene alternation,” Somer said. Immunotherapy is a treatment in which a patient’s blood cells are altered and then reinfused into the patient to attack cancer cells. An example of a nuclear medicine agent is targeted radionuclide therapy, which is when a radioactive drug is injected into a patient’s bloodstream and destroys cancer cells. Prostate cancer is a genetic disease that is characterized by multiple genomic alterations. Somer said there are medical trials underway in which gene alterations, combined with a class of medications, could prolong a patient’s survival. Wake agrees that advancements in the field give physicians more information and access to easier detection and better treatment. “MRI technology is getting better and is rapidly changing,” he said. “One day we may not have to perform a biopsy at all. There may be a better way.”
Plays Well with Others, continued from page 3 Sensmeier said those business agreements are an equally important part of the overall interoperability equation. The success among health systems has led to such agreements moving into other healthcare sectors including the prison systems, EMS, and VA, Sensmeier noted of the local uptake in her region. She added San Diego isn’t unique and that such collaboration is occurring in pockets across the country. “There’s now an understanding it’s the right thing to do and good business,” she pointed out.
Movement is also happening on a national level. Last month, after nearly two decades of work and advocacy by the HIT community, Congress included report language in the FY17 Omnibus spending bill to address a prohibition on the unique patient identifier (UPI). The ban, which was put into place in 1998, stemmed from concern over patient privacy. The result, however, has stymied efforts to accurately match patients to their data across different systems and settings of care on a national basis. In a blog post, Carla Smith, MA, FHIMSS, CNM, who serves as executive vice president for HIMSS, noted that over the last 19 years, the UPI language has prohibited the U.S. Department of Health and Human Services from engaging in any conversations with the private sector pertaining to the UPI. Over the past two
decades, she said, it has become clear that a consistent patient data matching strategy is required across the public and private sectors of healthcare. While the new Omnibus language does not allow HHS to use funds “to promulgate or adopt any final standard providing for the unique health identifier for an individual” without Congressional authorization, it does open the door for HHS to be able to study the issue through the following clarification: “Accordingly, the Committee encourages the Secretary, acting through the Office of the National Coordinator for Health Information Technology (ONC) and CMS, to provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.” ONC officials have also announced the launch this month of a Patient Matching Algorithm Challenge. The challenge, which includes up to $75,000 in prize money, has a goal of spurring the adoption of performance metrics, reducing duplicative entry, and improving the linkage of critical data. More information is available at PatientMatchingChallenge.com. Additionally, Sensmeier said, the ONC has been working to improve data exchange and usefulness through the Interoperability Standards Advisory (ISA). “ONC has raised the bar on identifying what standards are available in interoperability and what those
HIMSS Defines Interoperability
standards serve,” she explained. Through the website healthit.gov/isa, there is a single public list of the standards and implementation specifications, which are published and open for comment. “It’s a huge step forward,” she said.
In April 2013, the HIMSS Board of Directors approved a definition of HIT interoperability and outlined three functional levels: foundational, structural and semantic. At the highest level, semantic, two or more systems have the ability to not only exchange information but also to be able to interpret and use that data. As outlined in the definition, “Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of health-related financial data, patient-created wellness data, and patient summary information among caregivers and other authorized parties. This level of interoperability is possible via potentially disparate electronic health record systems, business-related information systems, medical devices, mobile technologies, and other systems to improve wellness, as well as the quality, safety, costeffectiveness, and access to healthcare delivery.” The board noted the creation of data exchange schema and standards should permit data to be shared across organizational settings and with patients regardless of the application or application vendor. Work to create and broadly implement such standards is ongoing.
“The nut to crack is that providers and hospitals need to be requiring interoperability in the systems they purchase,” Sensmeier stressed, adding interoperability should become a foundational part of the procurement process. “If the customers are asking for it, the vendors are more likely to make sure it’s there,” she noted. “I think the will is there,” Sensmeier continued of movement across public and private sectors to address interoperability. “We have the standards now, and we’re pointing people to them.” While the U.S. is still probably several years out from deploying a comprehensive national strategy, Sensmeier said it is encouraging to see more pieces and parts come online. She noted interoperability certification programs are now in place; there is increasing patient demand and expectation that health information travels with the individual; and new provider reimbursement methods require improved connectivity across the continuum of care. In meeting these demands, HIT products and systems should be well on the way to fulfilling the promise of enabling providers to deliver safer, more cost effective care.
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GrandRounds West Tennessee Healthcare Trustees Name Ross As President & Chief Executive Officer JACKSON - West Tennessee Healthcare is pleased to announce James Ross as its President & Chief Executive Officer. The West Tennessee Healthcare Board of Trustees voted to approve Ross during its May board meeting. Ross has been serving as Interim President & Chief Executive Officer James Ross since April 2016. James “JR” Ross joined West Tennessee Healthcare in 1985 as a registered nurse in the surgical intensive care unit. Throughout his career with the health system, he has held various positions including, Critical Care Coordinator, Cardiac Services Manager, Director of CCU, Administrator of the West Tennessee Surgery Center, Executive Director of Physician Services, Director of Case Management/Social Services as well as Vice President of Hospital Services. In 2009, Ross was named Chief Operating Officer for West Tennessee Healthcare. A native of Henderson, Tennessee, Ross is the son of the late Bradie and Mary Ann Ross. He has been active with numerous community and civic organizations. He serves on the Executive Board of the West Tennessee Council for Boy Scouts of America, Jackson Airport Authority, Union University Foundation and he is the Second Vice Chairman on the Jackson Chamber Board of Directors. In 2014, Governor Bill Haslam appointed Ross to the Emergency Medical Services Board of Directors for the State of Tennessee. He has formerly served as a member of the Union University Board of Directors and served on the search committee to hire President Dub Oliver. In 2015, Ross served as the NAACP’s 2015 Freedom Fund Honorary Co- Chair. James Ross is a member of the One Jackson Action Committee, Tennessee Hospital Association Diversity Council, 100 Black Men of West Tennessee, and Madison County Board of Health. He attends Englewood Baptist Church and serves as Chair of the Personnel Committee and has previously served on the Strategic Planning Committee. In 2016, the American Red Cross honored Ross with the Humanitarian of the Year Award. Ross is also active with many professional organizations including, the Tennessee Hospital Association, Tennessee Organization of Nurse Executives (TONE), American Nurses Association (ANA), American College of Healthcare Executives (ACHE) and Leadership Jackson Alumni Association. WESTTNMEDICALNEWS
Ross says he is honored with his new role. Ross has an Associate of Science degree from Jackson State Community College, a Bachelor of Science degree in Nursing from Union University, a Master of Science in Health Services Administration from the University of Alabama at Birmingham, and is a Licensed Registered Nurse and a Licensed Nursing Home Administrator as well as an Emergency Medical Technician by the State of Tennessee. JR and his wife Cindy have two children, Ashley and Kelsey and two grandchildren, Weston and Maddie Kate.
Cancer Care Center Founder Passes Away JACKSON – William D. Permenter, Jr. passed away in March at his home in Humboldt. William lived most of his life in Tennessee graduating from East Tennessee State University and Quillan-Dishner College of Medicine in Johnson City. He completed his residency in Radiation OnWilliam D. cology at Baylor College Permenter, Jr. of Medicine in Houston. He established his medical practice, Cancer Care Center in Jackson, Tenn. in 1989 and quickly expanded his practice to 3 more clinics in Dyersburg, Union City, & Paris. He was a member of The American College of Radiation Oncology and The American Board of Radiology. His patients loved and respected his compassion and his dedication to his profession. He first chose this field of medicine because his brother, Patrick lost his battle with leukemia in 1979. His other interests included farming & history. Memorials may be made to St. Jude Children’s Research Hospital in Memphis.
Henry County Medical Center Earns “A” Grade for Patient Safety in Spring 2017 Leapfrog Hospital Safety Grade PARIS – The Leapfrog Group, a nonprofit organization committed to driving quality, safety, and transparency in the U.S. health care system, today released new Leapfrog Hospital Safety Grades, which assign A, B, C, D and F letter grades to hospitals nationwide. Henry County Medical Center was one of 823 hospitals to receive an “A” for its commitment to reducing errors, infections, and accidents that can harm patients. Hospitals that earn top marks nationally in the Leapfrog Hospital Safety Grade, have achieved the highest safety standards in the country according to Leah Binder, president and CEO of The Leapfrog Group. Developed under the guidance of an Expert Panel, the Leapfrog Hospital Safety Grade uses 30 measures of publicly available hospital safety data to assign A, B, C, D and F grades to more than 2,600 U.S. hospitals twice per year. It is calculated by top patient safety experts,
peer-reviewed, fully transparent and free to the public. To see Henry County Medical Center’s full grade, and to access consumerfriendly patient tips for staying safe in the hospital, visit www.hospitalsafetygrade. org or follow the Leapfrog Hospital Safety Grade on Twitter or Facebook. Consumers can also download the free Leapfrog Hospital Safety Grade mobile app for Apple and Android devices.
Chattanooga Pediatrician New Tennessee Medical Association President Nita Shumaker, MD, has taken the reins as President of the Tennessee Medical Association, the state’s largest professional organization for doctors. Her one-year term officially began during last month’s annual meeting of the TMA House of Delegates Nita Shumaker in Nashville. Shumaker is the second female to hold the position. Dr. Phyllis Miller, also of Chattanooga, served as TMA President from 2005-2006. As President, Shumaker will serve as the public spokesperson and official representative for TMA’s more than 9,000 members. She will also hold a seat on the TMA Board of Trustees. Shumaker served as a pediatrician in the U.S. Air Force from 1990 to 1994 while she completed her residency training. She went on to serve two years as a pediatrician at March Air Force Base in Southern California and in 1994 was awarded an Air Force Commendation for Meritorious Service. She has been in private practice with Galen Medical Group, a large, multispecialty practice in Chattanooga, since 1997. Dr. Shumaker has held multiple leadership positions with Galen and currently is a member of the Board of Directors. She is a North Carolina native who earned a bachelor’s degree and completed medical school at East Carolina University. She completed both her internship and residency at the Medical College of Georgia.
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TMA to Partner with UT on Physician Executive MBA Program The Tennessee Medical Association, the state’s largest professional organization for doctors, has announced a new partnership with the University of Tennessee, Knoxville’s Haslam College of Business Physician Executive MBA program. The partnership reaffirms TMA’s commitment to providing leadership training opportunities for members and fostering a new generation of physician leaders to guide the future of healthcare in Tennessee. The University of Tennessee, Knoxville’s Haslam College of Business Physician Executive MBA program is a oneyear program exclusively for physicians. It emphasizes career impact and return on investment through leadership development and a curriculum that emphasizes applied assignments, innovation, and financial acumen. It has a robust and active alumni community with more than 650 graduates since the program’s inception in 1998.
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Pediatric Unit Rated 99% in Patient Satisfaction
Collaborating with Monroe Carell Jr. Childrenâ€™s Hospital at Vanderbilt Dedicated Pediatric Unit Child Life Services including Pet Therapy Neonatal Intensive Care Neonatal Follow-Up Clinic Pediatric Hospitalists Therapy & Learning Center -Provides pediatric therapy and educational services
Pediatric Specialty Clinic Nationally ranked Vanderbilt specialists provide care in: -Cardiology -General Surgery -Developmental Pediatrics -Nephrology -Diabetes Clinic -Neurology -Endocrinology -Pulmonology -Gastroenterology -Urology
Exceptional care provided by dedicated pediatric nurses & physicians at Jackson-Madison County General Hospital
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