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Vol. 6 No. 2



Leading Innovation at the Bench and the Bedside Cybersecurity Alert:

Assume a Breach

Leadership Changes

at Area Health Systems

New Cancer Center for

Marshall, MN

South Dakota and the Upper Midwest’s Magazine f or Physicians & Healthcare Professionals

Compassionate, state-of-the-art care for a unique, complex and growing population.

The Adult Congenital Heart Disease Program AT CHILDREN’S HOSPITAL & MEDICAL CENTER in partnership with the University of Nebraska Medical Center

The region’s only clinical service devoted to Adult Congenital Heart Disease (ACHD) featuring a team of cardiologists trained in the care and treatment of adults with congenital heart disease.

Our Team of ACHD-Trained Specialists •

Shane Tsai, M.D.,

ACHD Medical Director

Jonathan Cramer, M.D. • Anji Yetman, M.D. •

Our Team of Interventional, Electrophysiologic and Surgical Support Specialists Three Board Certified Adult and Congenital Cardiothoracic Surgeons:

James M. Hammel, M.D. • Kim F. Duncan, M.D. • Ibrahim Abdullah, M.D. •

For physician-to-physician consults, referrals, admissions and transport service call:

Jeffrey W. Delaney, M.D. • Christopher Erickson, M.D. • Scott Fletcher, M.D. • John Kugler, M.D. •

Children’s Hospital & Medical Center 8200 Dodge Street | Omaha, Nebraska 68114-4113

Physicians’ Priority Line


Midwest Medical Edition




Volume 6, No. 2 ■ M arch 2015

Regular Features

By Alex Strauss 2015


4 | From Us to You

This month’s MED cover story features clinicians who are also researchers. Why would a person choose this dual track? And what does it mean for their day-to-day lives, to be solving problems at the bench and the bedside? We talk with three Sanford doctors to find out.

Vol. 6 No. 2

5 | MED on the Web Articles and Information available exclusively on the MED Website

8 | News & Notes New doctors, certifications, clinics, and more

30 |  Wine Marketplace Red Wine’s Other Health Benefit… plus, a Sponsorship Opportunity

31 |  Learning Opportunities A Spring full of Conferences, Events, and CME Courses

In This Issue


6 |  Smartphone Apps: A Growing Trend in Medicine


dside h and the Be n at the Benc tio va ter for no CeN In Cer New CAN Leading N Changes Marshall, M Leadership rt: s ity Ale CyberseCur

eAch Assume A Br

■ By Lizabeth Brott, JD How can you make sure you’re maximizing efficiency while keeping critical healthcare data secure?

at Area Health



17 |  Potential Planning Opportunities with a Decedent’s Trust ■ By Kevin Eggebraaten, CPA

Cutting-edge Care


20 | Grant will Enhance Heart Attack Care in Rural Iowa Iowa receives $4.5 million Mission: Lifeline grant from the Helmsley Trust

24 |  Sanford Imagenetics Celebrates One Year Anniversary A discussion of the program’s first year with Sanford’s new Chief of Genomic Medicine

27 | Med School’s Rural Medicine Program Expands 28 | What is Physician Healthcare Credentialing? ■ By Lavonne McKee

29 |  Beef and Heart health

■ By Holly Swee, RD, LN More new research supports lean beef as part of a heart-healthy diet

 vera Cancer Institute A Marshall Celebrates Grand Opening

Assuming a Breach:

Security Architecture ■ By Eric Buzz Hillestad

20 | Nylen Cancer Center Acquires Siouxland Hematology-Oncology


hanges at the 23 CTop at Regional

19 |  Adult Congenital Heart Disease: New Clinic Offers Comprehensive,


e S Ma ga zin MiD we St’ th e up per ar e pro feS Sio na lS ko ta and Sou th Da cia nS & he alt hc f or ph ySi

Experts warn healthcare professionals to prepare for a security breach by assuming it will eventually happen.

On the


COVER PHOTO In his 20 years as a physician scientist, cancer surgeon and ENT John Lee, MD, has distinguished himself for his research on the relationship between the HPV virus and tonsillar cancer.

From Us to You Staying in Touch with MED


ny clinician knows that research is critical for advancing medical knowledge. And researchers know how important it is to validate their findings by applying them in a clinical setting. Clinicians who are also deeply involved in ongoing laboratory research, often called physician scientists, work at the nexus of these two fields, uniquely positioned to make some of the biggest strides in medicine. And yet, as we learned in preparing this month’s cover story, their numbers are dwindling. Find out why three local physician scientists are bucking that trend and how they are managing the challenges of their dual lives. Also in this issue. . . . New tools, new facilities, new services, and new leaders at the top in two of South Dakota’s largest healthcare systems. We also have advice from area experts on the safe use of smartphone apps and how to prepare for a security breach by assuming that you’ll have one. As we plan for upcoming issues, we encourage you to share your news, stories and opinions with MED’s 5,000+ regional readers. Call, go online, or reach us by email at All the best, —Steff and Alex Meet the MED team! (left to right) Angela Corbo Gier, Graphic Designer/Art Director, Steffanie Liston-Holtrop, VP of Sales and Marketing, Alex Strauss, Editor, Jillian Lemons, Director of Digital Media.

Publisher MED Magazine, LLC Sioux Falls, South Dakota

Vice president

Sales & Marketing Steffanie

Liston-Holtrop Editor in Chief Alex Strauss

graphic design Corbo Design

PhotographY studiofotografie

Web Design Locable

digital media director Jillian Lemons Contributing Writers Lizabeth Brott

Kevin Eggebraaten Eric Buzz Hillestad Lavonne McKee Holly Swee Staff Writers Liz Boyd Caroline Chenault John Knies

Reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical Edition, LLC Midwest Medical Edition (MED Magazine) is committed to bringing our readership of 5000 South Dakota area physicians and healthcare professionals the very latest in regional medical news and information to enhance their lives and practices. MED is published 8 times a year by MED Magazine, LLC and strives to publish only accurate information, however Midwest Medical Edition, LLC cannot be held responsible for consequences resulting from errors or omissions. All material in this magazine is the property of MED Magazine, LLC and cannot be reproduced without permission of the publisher. We welcome article proposals, story suggestions and unsolicited articles and will consider all submissions for publication. Please send your thoughts, ideas and submissions to alex@midwestmedicaledition. com. Magazine feedback and advertising and marketing inquiries, subscription requests and address changes can be sent to MED is produced eight times a year by MED Magazine, LLC which owns the rights to all content.


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Biomedical Innovation at USDSM Members of the USDSM’s faculty are involved in a wide range of basic biomedical research. We have a rundown of some of the most innovative work going on right here at home.

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Smartphone Apps —a growing trend in medicine By Lizabeth Brott, JD


smartphone isn’t just a phone; it’s a miniature

computer. We surf the web, email, play games, and use smartphones and other wireless devices as tools for work. This explosive growth in use has been aided by mobile applications (“apps”). Today physicians can monitor a patient’s vital signs, download patient schedules, access medical records, dictate office notes, and consult with other physicians without entering a clinical setting.

Greater Access, New Risks As with any new medical device, there are risks to consider. Mobile devices “are considered one of the most vulnerable areas for [privacy] breaches.”1 This is in part due to security assessments that failed to address the use of mobile devices.2 The Health Information Technology for Economic and Clinical Health (HITECH) Act requires notification whenever a breach of unsecured protected health information (PHI) occurs.3 Additionally, the Department of Health and Human Services requires security of PHI on storage devices (hard drives), transmission media (cyberspace), and portable electronic media (e.g., smartphones).4 Reference guides, such as Epocrates, should not be a HIPAA risk. However, apps that transmit PHI could be intercepted by hackers or corrupted by a virus. Regardless of whether a physician’s mobile device is used to access, transmit, or store PHI, consider all HIPAA and HITECH requirements. HIPAA requires data security and proper destruction, and retention of PHI, when appropriate. ■ Lizabeth Brott, JD, is Regional Vice President, Risk Resource with ProAssurance, a national provider of medical professional liability insurance and risk resource services. This article is not intended to provide legal advice.

1 Dolan, P. “Large settlement for data breach sends message to lock up laptops and smartphones.”

American Medical News, September 28, 2012, article/20120928/ business/309289995/8/ (accessed August 27, 2013). “Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act.

2, 3, 4


What Can You Do? ◆ ◆ R eview potential wireless apps to ensure security of PHI at all levels;

◆ ◆ Limit the type of app that can be used based upon the individual app’s level of security;

◆ ◆ U  se encryption software that makes data unusable by intercepting parties;

◆ ◆ Develop a security policy addressing mobile devices and the types of apps that can be used, along with the appropriate use and destruction of PHI data;

◆ ◆ D  evelop an eDiscovery policy for retaining PHI in the event of litigation; seek assistane from your attorney or your medical professional liability carrier’s risk management staff; and

◆ ◆ W  ork closely with IT personnel to address all security issues.

The Health Information  Technology for Economic and Clinical Health (HITECH) Act requires notification whenever a breach of unsecured protected health information (PHI) occurs.3

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March 2015


Happenings around the region

South Dakota Southwest Minnesota Northwest Iowa Northeast Nebraska

News & Notes Avera

Avera Health has named Kimberlee McKay, MD, FACOG, as Vice President for the OB/GYN Clinical Service Line across the Avera system.

Dr. McKay holds a medical degree from The University of South Dakota School of Medicine in Vermillion. She completed a residency at University of Kansas School of Medicine in Wichita, and is certified by the American Board of Obstetrics and Gynecology. Becker’s Hospital Review has named Avera McKennan Hospital & University Health Center in the 2014 edition of its annual list, “100 hospitals with great women’s health programs.” Hospitals were

selected for this list based on clinical accolades and recognition for women’s health excellence from various healthcare groups and agencies. Those agencies include U.S. News & World Report, Healthgrades, CareChex and UNICEF’s Baby-Friendly Hospital. Community members are preventing type 2 diabetes together with the Avera Sacred Heart Hospital lifestyle change intervention program offered through its Dakota Diabetes Center.At the 12-month reporting

interval, Avera Sacred Heart Hospital was notified by the CDC that it is meeting all of the standards for CDC recognition detailed in its Diabetes Prevention Recognition Program Standards and Operating Procedures.


The Avera Heart Hospital’s AED program is offering a $100 rebate for replacing aging automatic external defibrillators. As AEDs age,

the internal battery wears out, so a machine’s useful life is approximately 10-11 years. Through a partnership with Physio-Control, new AEDs can be purchased at a discounted price through the rebate program – at a cost of $899 rather than the regular cost of $999. Rebates are available now through April. The following physicians have been elected to serve on the Avera Queen of Peace Medical Executive Committee for the 2015 Medical Staff year that started February 1: Martin

Christensen, MD, (pictured) President; Jennifer Tegethoff, MD, President Elect/Vice President; Brian Kampmann, MD, Secretary; Alan Walton, MD, and Aaron Baas, MD, Members at Large; Scott VanKeulen, MD, Hospital Based; and William Graham, DO, Immediate Past President.

The Community Blood Bank of Sioux Falls, a non-profit cooperative program of Avera and Sanford Health has donated its former bloodmobile to the Los Cabos Children’s Foundation.

Tom Walsh, owner of local Burger King restaurants, is founder of the Los Cabos Children’s Foundation which provides medical treatment for children of the Los Cabos area. This is the second bloodmobile the Community Blood Bank has donated to the Los Cabos Children’s Foundation. The Molecular and Experimental Medicine Program at Avera Cancer Institute, Avera McKennan Hospital & University Health Center in Sioux Falls has formed a strategic partnership in cancer genomics with Foundation Medicine, based in Cambridge, Massachusetts.

Avera is conducting studies with Foundation Medicine that focus on individualized patient care, matching genomic profiles with investigational therapeutics, and fundamental cancer biology in preclinical models. Areas of potential collaboration between Avera and Foundation Medicine will include oncology personalized medicine, joint research, data sharing and database development, education and patient support programs.

Avera Health was recognized for excellence in the 2014 Cancer Awareness Advertising Awards for advertising and marketing that scored among the best in the nation. The CAA

Awards program is the nation’s most elite competition dedicated specifically to the promotion of all cancer products and services. Avera received a Gold Award for the Avera Cancer Institute Annual Report in the healthcare system group and annual report category and a Bronze Award for its “Cancer Care Done Differently” 60-second TV commercial in the healthcare system group, and TV/Video single advertisement category.

Regional Regional Health recently announced the Regional Way Leadership Awards for outstanding leadership.

Management level winners include Scott Brinker, Assistant Director/Chef, Rapid City Regional Hospital Food & Nutrition Services and Stephen Hoelzen, Coordinator, Sturgis Regional Hospital Respiratory Therapy. Physical therapist Betina Basso (Custer), Performance Improvement Coordinator Lindsay Bouman (Spearfish), Cardiovascular radiology tech Jeremy Johnson (Rapid City) and RN Connie Mather (Rapid City) were also honored.

Midwest Medical Edition

Larry Veitz, Chief Executive Officer (CEO) of Spearfish Regional Hospital, was

recently named in Becker’s Hospital Review as one of 50 Rural Hospital CEOs to Know in 2015. Veitz has served as Spearfish Regional Hospital CEO since 2002.

Sanford Sanford Health has selected David Pearce, PhD as the new president of Sanford Research.

Pearce replaces Gene Hoyme, MD, who has transitioned to be Sanford’s new chief of genetics and genomic medicine. Hoyme will also retain his positions as medical director of Sanford Imagenetics and chief academic officer for Sanford. Edith Sanford Breast Center is one of 23 recipients to receive a $45,000 grant from the Avon-Pfizer Metastatic Breast Cancer Grants Program.

The project granted a total of $1 million to organizations nationwide to support and educate more than 5,000 metastatic breast cancer patients, their caregivers and their communities.

March 2015

Dr. Tim Ridgway, of Brandon, SD, Dean of Clinical Faculty and Associate Professor in the Department of Internal Medicine at the University of South Dakota Sanford School of Medicine, has been named that

school of medicine’s inaugural Dr. Charley F. and Elizabeth Gutch Chair in Medicine. The three-year appointment recognizes Ridgway’s skillful leadership and commitment to the school of medicine, including students, faculty and staff. The force of head impacts in youth football can be similar to high school and college but may not necessarily affect short-term neurological function in children, according

to a study authored by Sanford Health’s Thayne Munce, PhD, and colleagues and published by Medicine & Science in Sports & Exercise. Munce and the Sanford Sports Science Institute team in Sioux Falls monitored 22 local youth football players 11 to 13 years of age during a single season of 27 practices and nine games. More than 6,000 head impacts were recorded and found to be similar in magnitude and location to those in high school and college football but less frequent. There’s one more opportunity to cook with Aberdeen’s cardiologists. Sanford Aberdeen is

hosting a four-night cooking series on preparing heart-healthy dishes with interventional cardiologist Puneet Sharma, MD and registered dietician Lisa Kopecky. On March 10, the South Dakota Beef Council will prepare breakfast, lunch and dinner recipes using lean beef. Classes are held from 6-7 pm at Cash-Wa’s test kitchen and classroom.

Siouxland Mercy Medical Center installed Reverend Anna Rudberg Speiser as Chaplain on February 9th.

Chaplain Speiser received a Master of Divinity Degree from Harvard Seminary in 2008 and was ordained in November. She completed a residency in Clinical Pastoral Education at Brigham and Women’s Hospital in Boston and completed an international internship in Bratislava, Slovakia. Her ministry involves routine visits as well as on-call and crisis ministry. Mercy Medical Center–Sioux City announces the appointment of Kaitlyn Henderson

to the position of Manager, Patient Access Services. Henderson is actively pursuing her Bachelor’s degree in Health Services Administration. In her new position, Kaitlyn will be responsible for providing oversight and day to day management for Central Registration, Emergency Department Registration, the Dunes Medical Laboratory Registration, Pre-Service Patient Processing and Financial Counseling. UnityPoint Health–St. Luke’s celebrated a new birth record of 2,104 babies in 2014. This

new record consists of 1,093 boys, 1,011 girls and 39 sets of twins – 8 of which were born in December. Eighty-nine percent of the market share of babies from Sioux City and the surrounding areas are born at St. Luke’s.

Dr. Kevin Hamburger, a long-time community physician practicing as an obstetrician and gynecologist with Siouxland Women’s Health Care, has

become the new president of the medical staff at Mercy Medical Center—Sioux City. Dr. Steven Joyce, an internist and pediatrician, practicing with Mercy Internal Medicine & Pediatrics clinic at Mercy Medical Center, will serve as president elect for Mercy’s medical staff. Dr. William Andrews, a neurologist at the Center for Neurosciences, Orthopaedics & Spine, PC in Dakota Dunes, will hold the post of secretary/treasurer on the medical staff executive committee. Peter Thoreen will retire as CEO of UnityPoint Health– St. Luke’s at the end of 2015. Under

Thoreen’s leadership, Luke’s opened its Same Day Surgery and Physician Center buildings on the hospital’s campus and completed multi-million dollar projects in St. Luke’s Birth Center and surgical services areas. In 2013, St. Luke’s also celebrated the opening of Sunnybrook Medical Plaza, an outpatient facility created around the philosophy of coordinated care offering specialty services in one of community’s fastest growing neighborhoods. Thoreen first joined St. Luke’s in 2002 as Chief Operating Officer before assuming the duties of CEO in 2003. He will continue assisting UnityPoint Health with development and other projects through the end of the year.


News & Notes Other LifeScape welcomes Sanford Children’s physician assistant Charlie Broberg, PA-C to its

team, providing rehabilitative medical care for children and adults through outpatient and residential programs. Broberg will assist Julie Johnson, MD, in her practice of physical medicine and rehabilitation at LifeScape. Broberg provides services for LifeScape through the pediatric specialist practice at Sanford Children’s Specialty Clinic. Prior to completing his medical training at the University of North Dakota, Broberg practiced chiropractic for 16 years, most recently in Britton, South Dakota.   LifeScape Rehabilitation Medical Supply (RMS) of Rapid City, SD welcomes

Certified Orthotist, Erin Rice, CO, ATC to its team, providing orthotic treatment for children and adults through outpatient services. Rice joined the RMS staff in Sioux Falls in 2011, where she primarily practiced in pediatric orthotics, and was a part of the CARE Clinic team, providing cranial remolding helmets for infants with qualifying cranial asymmetries. She is also skilled in adult and adolescent spinal bracing, lower extremity devices and orthotic treatment for the pathological or diabetic foot. 


Brookings Health System Chief Nursing Officer Tamera J. Hillestad

recently became a fellow of the American College of Healthcare Executives (ACHE), the nation’s leading professional society for healthcare leaders. Only 9,200 healthcare executives hold this distinction. Keith M. Baumgarten, MD, an orthopedic surgeon at Orthopedic Institute in Sioux Falls, SD has

been elected to the American Shoulder and Elbow Surgeons (ASES). Membership in American Shoulder and Elbow Surgeons, which has only 423 members, is by invitation only. Dr. Baumgarten has been in practice at Orthopedic Institute for ten years and is the current Head Team Physician for the Sioux Falls Stampede, the Sioux Falls Canaries and Dakota State University. He is the first and only orthopaedic surgeon in South Dakota to be elected to the ASES. Lornell E. Hansen II, MD and the LazaDerm Skincare Centre in Sioux Falls has achieved Suneva Medical’s Bella Diamond status. Suneva

medical is a medical aesthetic company and manufacturer of the dermal filler, Bellafill. The designation places the practice among the top 1% of Bellafill providers in the US.


Dr. John Wempe is the new Assistant Dean of Medical Student Affairs at the University of South Dakota School of Medicine. Wempe, a

native of Parkston, SD, received his MD from the University of South Dakota School of Medicine and earned a Master of Public Health degree from Johns Hopkins University. He comes to USDSM from Colorado Springs where he served as CEO of the Department of Defense Medical Examination Review Board at the United States Air Force Academy. The Management Committee at the Sioux Falls Specialty Hospital, LLP recently named R. Blake Curd, MD as its new CEO. Specializing in congenital

hand reconstruction, hand surgery, microvascular surgery and upper extremity surgery/ tissue transfer, Dr. Curd has practiced medicine at Orthopedic Institute for 13 years. Dr. Curd attended the University of Missouri – Kansas City School of Medicine, completed his orthopedic surgery residency at Wilford Hall Medical Center, and did his fellowship at the Indiana Hand Center. He served in the United States Air Force for 10 years. The new CEO follows in the footsteps of Dr. Schellpfeffer, an original founder of the Specialty Hospital with more than 30 years in the ambulatory surgery center environment.

Scott A. Duke of Billings, Montana, has been named the South Dakota Association of Healthcare Organizations’ new President and Chief Executive Officer. Duke brings

28 years of senior leadership experience in healthcare including CEO of a Critical Access Hospital and as a regional system executive. Most recently, Duke served as Vice President of Regional Operations with the Billings Clinic, Billings, Montana. Duke holds a Masters and Bachelor degree from Minot State University, Minot, ND, and is also a licensed nursing home administrator.

Stay up-to-date with new medical community news between issues.

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Formerly Children’s Care Hospital & School Sioux Falls & Rapid City •

Directed by Julie Johnson, MD, Physical Medicine & Rehabilitation, since 1998.

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March 2015


Look for more on the problem of physician burnout, its causes and cures, in the April/May issue of MED.


Burnout Hits All Time High The annual Physician Lifestyle Report put out by Medscape shows physician frustration, dissatisfaction, and burnout at an all-time high. While 39.8% of physician reported feeling burned out in 2013, this year the number jumped to 49%. Much of it is blamed on the ongoing difficulties of EHR implementation. Log on! for a link to the complete Medscape survey.

Top 4

Report highlights Specialty with the highest burnout rate:

Critical Care


Specialty with the lowest burnout rate:


37% 66+ 46-55


Age group with the lowest burnout rate:

Age group with the highest burnout rate:

causes of physician burnout Bureaucracy • Long hours • Low income • Increased computerization


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One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.


Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

Orthopedics Pulmonology Gastroenterology & GI Surgery Cardiology & Heart Surgery

MEDAd, Feb. 2015.indd 1

1/29/15 1:17 PM


By Alex Strauss


Leading Innovation at the Bench and the Bedside


esearch the phrase “physician scientist” and one word comes

up again and again: endangered. These individuals work at the intersection of clinical practice

and scientific inquiry, uniquely poised to bring clinical insights into the lab and vice versa. And yet, the gist of nearly every

article written about physician scientists in the 21st century is that, although their work is critical to medical advancement, their numbers are steadily declining. In 1999, Princeton microbiologist Leon Rosenberg wrote in Science, “If the country’s medical research enterprise is to make the contributions it is poised to deliver, the progressive, dangerous decline in the number of physician-scientists must be reversed.”

But the problem has only gotten worse. A 2014 article in Evaluation and the Health Professions called the continued downward trend “alarming”. A year earlier, an article in the Journal of the Federation of American Societies for Experimental Biology found, among other things, that physicians now represent a smaller percentage of grant recipients and are less likely to take a major role in biomedical research than they were in the past. These are just a few of the reasons why the three local physician scientists we spoke with for this story are so passionate about what they do. Despite long hours, erratic schedules and fragmented professional duties, these Sanford doctors all say they would not trade their rich professional lives of patient care and scientific inquiry.


Midwest Medical Edition

Dr. Michael Kruer

Dr. John Lee

Dr. Michelle Baack March 2015

Dr. Michael Kruer is an Associate Scientist in the Children’s Health Research Center at Sanford Research and a pediatric neurologist at Sanford Children’s Hospital. But neither role was in his sites when he started college at Arizona State. “I didn’t really know what I wanted to do but I was studying psychology and started doing some work with kids with autism,” says Dr. Kruer. “As I became closer with these kids and their families, I realized that if there was going to be a breakthrough for autism, it would have to be a medical breakthrough. That got me interested in brain science and how it could be translated into better care for people with neurological diseases, particularly children.” After graduation, as Kruer was struggling with whether to enter graduate school or medical school, a biochemist for whom he was working had some sage words. “He said ‘I’ll make it easy for you . . . Just do both!’” he recalls. In medical school at Arizona, Dr. Kruer found his niche working with children with rare movement disorders and neurodegenerative diseases and later did post-doctoral work in a neurogenomics lab. “Some other people advised me against going into such a difficult field. They said there’s not much you can do for these people,” says Dr. Kruer. “But I was struck by how much these patients needed someone to walk with them on this difficult path and also by how grateful they are. I became very passionate very quickly.” Today, Dr. Kruer spends two days a week in general pediatric neurology and specialty movement disorder clinics at Sanford Children’s. The other three days are spent studying the molecular mechanisms of inherited and acquired diseases of the central nervous system

– specifically dystonia and juvenile parkinsonism – in his lab. “I feel so blessed to be able to do both,” says Kruer. “My work in the clinic makes me realize how much we still don’t know and how important it is to continue with the research. My work in the lab is so much richer because I see the human faces behind what we’re doing.” That’s not say it’s an easy life. Like most physician scientists, Dr. Kruer is often torn between these two worlds. “It’s a juggling act and it can be incredibly difficult. There are days when I am supposed to be over in the lab but things are happening with my patients and my pager is going off. There are also times when I have presentations that take me out if town and it’s tough to keep in touch with my patients. On a bad day, it makes me a little crazy. But on a good day, it’s the best career I could ever imagine.”

Dr. John Lee Head and neck cancer surgeon and researcher John Lee, MD, spends three days a week seeing patients and performing surgery at Sanford USD Medical Center and two days a week studying the causes and treatments of tonsillar cancers that are triggered by the HPV virus. These cancers have increased by 300 percent in the last 3 to 5 years and are now the most common head and neck cancers that Dr. Lee treats. “The great thing is that I do research on the things that I treat,” says Dr. Lee. “We have a lab that looks at how the virus changes cells, how it causes them to become cancerous. My role is to not only see the patients but to translate new information from our lab and from labs around the world into better treatments.” After more than 20 years as both a clinician and a researcher (15 at the University of Iowa and 6 at Sanford), Dr. Lee calls himself the “old man”


photos courtesy Sanford

Dr. Michael Kruer

Dr. Michael Kruer

of the physician scientist bunch at Sanford. The Minnesota native took a job in a research lab to pay his way through Stanford and later through medical school at the University of Minnesota. His lab has produced four different cancer trials focused on tonsillar cancer and the HPV virus. When asked what attracted him to a career in both research and clinical work, he uses a music metaphor. “You have people who can compose the music and people who perform it,” says Dr. Lee. “The problem is that surgery is like playing an instrument. It’s

leave if something comes up. That is what makes it hard, that lack of continued focus.” But Lee says the rewards of continued learning and seeing his research translated into real clinical benefits are worth the challenges. “Based on our research on how the virus changes the way cancer eats sugar, we developed a therapy and have found that people respond 20 to 40 percent better with this therapy. That was very exciting,” he says. Dr. Lee worries about the future of research as fewer people choose the complexities

Michelle Baack, MD, spent ten years as the only full-time pediatrician in Pierre before deciding to pursue neonatology at the University of Iowa. It was there that she was “bitten by the research bug.” “During a pediatric fellowship, you do two years of research and then your clinical work,” says Dr. Baack. “As a pediatrician, I had seen the longer term effects of nutrition and I was thinking of ways that we could improve the outcomes of premature infants. So I started looking at the role of fatty acids and that is what I still do in my research.” As a neonatologist, Dr. Baack manages the sickest of newborns during one week on call each month, as well as one overnight each week. On the weeks when she is not on call, she is studying the importance of fatty acids in the promotion of normal growth, brain development and vascular health in early development. “Expectant mothers with diabetes can have very high circulating fat levels, which can actually turn genes on or off in the fetus,” explains Dr. Baack. “Our hope is to be able to fix these kinds of problems even in utero in order to prevent things like heart disease.” Like other physician scientists, Dr Baack believes that both sides of her dual career inform and enhance each other. “Sometimes I see new medical students

On a bad day, it makes me a little crazy. But on a good day, it’s the best career I could ever imagine. — Dr Kruer

very technical and you’re doing the same thing over and over, hitting the keys. Doing the research is like also having the opportunity to write the music. You’re designing new ways to present things. I think that is really what keeps me interested.” As for the challenges of time management, Dr. Lee has a simple solution – be available to everyone all the time. “You try to compartmentalize as best you can, but the bottom line is that you really have to be able to


of the physician scientist track and has this advice for medical students: “There is a point in your practice – often in your 40s – when you can start to get bored. Being a researcher, as well as a clinician, is a great way to assure that you don’t.”

Dr. Michelle Baack Not all physician scientists pursue both tracks from the beginning. Pierre, South Dakota native and neonatologist

say ‘This is the algorithm I learned in medical school and this applies to everyone.’ But being a researcher makes me think about patients and their medical care in more innovative ways.” “When I take the information gained from new research and apply it, it makes me a better physician. And when I take what I am learning from my patients and apply it in the lab, it makes me a better scientist.” Although her dual career causes some colleagues to see her as a ‘half time’ physician or scientist, Dr. Baack says the reality is that physician scientists must be more than full time – and fully-committed – in both areas. “When other doctors get done doing a night shift, they go home. When I get done, I go to the lab,” she says. “When I am not in the NICU, I am in the lab. When I am not in the lab, I am in the NICU or home writing grants and papers. So my ‘work/ life balance’ is mostly work.” Like her colleagues, Dr. Baack worries about the future of medical innovation as fewer students choose the difficulties of a dual career. She herself says she has never regretted her decision to pursue both medicine and scientific inquiry and is proud to be on the leading edge of advancement. “New physicians are learning algorithms. And who makes those algorithms? It is the leaders in their fields. In this line of work, you are really on the cusp of everything.” ■

Midwest Medical Edition

Potential Planning Opportunities with a Decedent’s Trust

For more of this article, including an example of the potential pitfalls of inadequate planning,

Log on!

By Kevin Eggebraaten, CPA


ver the years, one of the

tools of estate planning was to establish a decedent’s trust (DT) along with a survivor’s trust (ST) upon the 1st to die. In part, the planning was to carve out the DT assets that would not be part of the estate of the survivor and therefore not be taxed when the 2nd to die happens. This strategy worked well for many clients, but with only .15% of the estates owing estate tax, (1) the planning in 2015 and forward for some estate plans has shifted to dealing with low basis assets that are held in a DT. Income tax planning has become much more of the focus with the increase in the unified credit to $5,430,000 in 2015. This planning opportunity will not be for everyone. Consider whether the ability to make a principal distribution (if the trust document allows) from the DT into the ST could make a difference in the overall tax paid to the Department of the Treasury.

Let’s look at a real life example. ■ 1  st to die established DT with appraised land that went into the trust upon death valued at $185/ acre on 2,000 acres for a current value in 2002 of $370,000. ■ C  urrent Value (2015) of the 2,000 acres is roughly $1,750/acre for a total of $3,500,000. ■ T  he survivor is worth an estimated $3,000,000. ■ I f survivor died in 2015 this would leave appreciated asset value of $3,130,000 in the DT and the beneficiaries would pay an estimated $745,000 in federal taxes if they sold the 2,000 acres (2).

The survivor in my example has an ability to draw out 5% of the principal each year from the DT that would be around $175,000 without any discounts applied in the valuation process. This would save the beneficiaries an estimated $41,650/year in federal taxes that wouldn’t have to be paid upon the death of the survivor. There are many other planning opportunities that potentially need to be discussed with your attorney and tax advisor to assure compliance and see if there are any tax savings strategies. Remember it is “not how much you make, it is what you or your beneficiaries/charities get to keep”. ■ Kevin Egggebraaten specializes in healthcare tax and consulting and is a member of Casey Peterson & Associates Ltd. healthcare industry expert team.

Sources: 1 According to the Urban-Brookings Tax Policy Center January 9, 2015 2 This does not include potential state income tax considerations and their other income being taxed at a higher rate


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March 2015


Assuming a Breach –

Security Architecture By Eric Buzz Hillestad

Define Your Security Objectives The first question any security architect should ask themselves is: What are we trying to protect? If the answer is the entire network, then it is just a matter of time before you have failed your objective. If the answer is patient data and demographics, then you have come to a reasonable proposition. This does not make the problem easier to solve by any means. Rather, it opens up a can of worms. You’ll need to define a data-flow diagram to start. The data-flow diagram is easiest to construct if you use a logical diagram approach.

Detailing Your Objectives In order to come up with a proper flow of data, you’ll want to consider ‘where’ and in ‘what states’ the patient data and demographics exists. A concept I like to use when teaching layered security is the McCumber Cube. The McCumber Cube can be used in



Use the cube to ask yourself these questions: What people legitimately use the data? How is the data transmitted to them? Is it stored anywhere along the way or at the destination? Is it processed at the destination or somewhere else? Once you answer these questions, you can continue to the back of the cube and ask yourself similar questions for Process and Technology such as: What processes legitimately use the data? Do those processes transmit the data and if so where? Is the data stored at any point during the process chain? Which technologies legitimately use the data? And so on… As you move through this process, hopefully you are formulating a nice data-flow diagram. The next steps for layered security architecture are deciding how the attackers can possibly compromise the endpoints once the data flows and is stored and processed. Again, using the cube, we can decide what threats exist to the confidentiality of the data as it flows through the endpoints. How about the integrity? …and to the availability? Your risk assessment can help you prioritize the threats to these endpoints. Lastly, working your way back to the right side of the cube: What controls are in place to help mitigate the risk of a confidentiality



ity y ial t ilit ity r n b e a eg ail fid nt v I n A Co


of yore assumed that invading forces would breach some or most of their physical security controls, so in preparation they built castles with layers of defenses and hid their most valuable possessions and people deep within the center of these controls. This was called layered security. In the days of modern virtual environments, the mode of access has changed drastically. However, the methodology of defense has not. We need to assume a breach will happen or has already happened and design our security controls from the inside out with a layered approach. This is very different and more complex than a perimeter defense approach like that of the City of Troy.

many ways in information assurance but I’m going to flip it on its ear for this exercise. We will step from one side of the cube through the other and then back out again.



astle designers in the days

McCumber Cube


threat to the data on the endpoints while in transmission? How about to the integrity while stored on an endpoint? Your risk assessment can again help you decide which controls will mitigate the most risk for each threat at each endpoint. There is one final step in the layered security approach–use cases, or in this example, compromise cases. What if one of your users with access to patient data clicks on a phishing email and the workstation becomes infected with malware that allows the attacker to access the workstation as if they were the user? Can that endpoint be compromised without compromising the confidentiality, integrity, and availability of the data? ■ Eric Buzz Hillestad is Partner at SHS, LLC and Principal Consultant.

To see how a security architect can help plan for layered security in such a situation, see Hillestad’s complete article online.

Log on!

Midwest Medical Edition

Adult Congenital Heart Disease New Clinic Offers Comprehensive, Cutting-edge Care Sixty years ago, about 90 percent of babies born with serious congenital heart disease died in childhood. Now, 90 percent live to age 18 and beyond. In fact, there are now more adults than children living with congenital heart disease, the leading birth defect in the United States. “The growing adult congenital heart disease (ACHD) population ref lects our tremendous success – in Omaha and nationally – in the medical and surgical care of congenital heart disease patients,” says Jon Cramer, MD, a pediatric and adult congenital cardiologist, Children’s Specialty Physicians and assistant professor of Pediatrics-Internal Medicine at UNMC College of Medicine. “Simply surviving these complex lesions is no longer the goal, it’s the expectation.” To meet the medical and surgical needs of this challenging and rapidly growing population, Children’s Hospital & Medical Center, in partnership with the University of Nebraska Medical Center, created the region’s only focused clinical service devoted to adults with congenital heart disease. “As these patients have aged up, they require care by a cardiologist who is experienced in congenital heart disease, which is very different than adult onset heart disease. We offer those services at Children’s and

identical services at the University hospital,” says Anji Yetman, MD, Children’s Specialty Physicians, director of Vascular Medicine at Children’s, and professor of Pediatrics & Internal Medicine, UNMC College of Medicine.

Simply surviving these complex lesions is no longer the goal, it’s the expectation.

Directed by Shane Tsai, MD, the ACHD multidisciplinary program offers advanced, non-invasive monitoring and imaging techniques, interventional catheterization, cardiac surgery–including heart transplantation, ACHD in pregnancy services, including maternal and fetal care, as well as transition support to adult healthcare for adolescents and young adults. Dr. Tsai is assistant professor of Internal Medicine & Pediatrics, Division of Cardiology at UNMC College of Medicine. “We have different interventions and surgeries we can perform, and we work together as a group to decide what is best for each patient,” says Dr. Tsai.

Now, this unique regional service is preparing to add even more distinction – through accreditation. Starting this year, the American Board of Pediatrics and the American Board of Internal Medicine jointly will begin offering formal board certification for providers whose primary mission is caring for ACHD patients. Over the next five years, the certification focus will expand beyond the physicians. A governing body will begin certifying both ACHD clinics and regional programs of expertise. “Our goal is to be the highest certified ACHD center in the region,” says Dr. Tsai. “Not only do you have to have the ACHD physicians and surgeons, but you have to demonstrate a certain quality of care for the ACHD patients – and that’s what we’re doing here in Omaha.” The collaboration between the two institutions draws its success from the delivery of superior – and, one day, accredited – care. “Building something this complex isn’t always going to be smooth,” Dr. Cramer says. “But regardless of the challenges, everyone has the same core goals in mind – providing the patient with the best care in the right setting.” ■

South Dakota Medical Group Management Association Spring Conference

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March 2015


Nylen Cancer Center Acquires Siouxland Hematology-Oncology The June E. Nylen Cancer Center has acquired the medical practice of Siouxland Hematology–Oncology Associates, LLP in Photos courtesy Siouxland Paramedics

Sioux City. Since the opening of the cancer center in March of 1995, the physicians and staff of Siouxland Hematology-Oncology Associates have provided comprehensive medical oncology services in the Nylen facility as well as at 14 satellite clinics throughout Siouxland while the physicians and staff of the June E. Nylen

Grant will Enhance Heart Attack Care in Rural Iowa The American Heart Association,

Midwest Affiliate, has received a $4.6 million grant award from the Leona M. and Harry B. Helmsley Charitable Trust to enhance systems of care, save lives, and improve outcomes for heart attack patients in rural Iowa through a program called Mission: Lifeline. “This initiative represents a significant investment in Iowa’s healthcare system, especially in our rural areas,” said Dr. Patricia Quinlisk, Medical Director for Iowa Department of Public Health. Mission: Lifeline is designed to help identify the gaps that lead to slower and less effective patient care and closes those gaps through change in protocols, processes and equipment. It will be implemented over three years in collaboration with Iowa’s health systems, hospital networks, EMS providers, and the State of Iowa’s Department of Public Health, including the Division of Acute Disease Prevention, Emergency Response, and Environmental Health and the Bureau of Emergency and Trauma Services and other funders. “This program provides the roadmap for enhanced cardiac care in rural Iowa with training, equipment and by providing a standard of care previously offered only in


urban areas,” said Brian Jacobsen, Siouxland Paramedics Operation Director. “Evidence has shown that when EMS partners with hospitals to reduce door to device times, lives are saved.” In collaboration with stakeholders representing hospitals, individual ambulance services and the state of Iowa, the project will enhance many critical elements of an optimal STEMI system of care: a system-wide data tool for quality measurement and improvement; ongoing medical provider training and STEMI education; coordination of protocols for rural EMS and hospital personnel; regional plans for rapid transport and/or transfer of patients; and a public education campaign on heart attack signs and symptoms and the need to activate the 9-1-1 system. Targeted funding will be provided to assist hospitals and ambulance services in acquiring essential ECG equipment and training. According to statistics provided by the Iowa Department of Health, cardiovascular diseases (including stroke) are the leading cause of death in Iowa. The Helmsley Charitable Trust and the AHA launched Mission: Lifeline in South Dakota in 2010. Since then five other states have implemented the program including North Dakota, Wyoming, Minnesota, Nebraska and Montana. ■

Cancer Center have provided radiation therapy and support services. The medical oncology providers joining the June E. Nylen Cancer Center include Donald Wender, MD, Medical Director; Stephen Kahanic, MD; Radha Rao, MD; Kamalesh Bala, MD; and Shari Black, ARNP. Patients will continue to receive services from their established providers at the June E. Nylen Cancer Center and in the 14 satellite clinics thoughout Iowa and Nebraska. Appointments and treatments that are scheduled for 2015 will not change due to this transition. The physicians of Siouxland HematologyOncology Associates have been providing medical care in the area since 1980. They partner with the National Cancer Institute’s Clinical Community Oncology Program including Mayo Clinic to offer state-of-the-art treatment which might otherwise be unavailable for several years. The June E. Nylen Cancer Center is the only facility within a 75-mile radius of Sioux City that has some of the latest cancer-fighting technology like SBRT (Stereotactic Body Radiotherapy). Patient visits to the Nylen Cancer Center exceed 35,000 a year with an average of 175 visits per day. With the addition of the medical oncology physicians and staff, the Cancer Center will employ 101 colleagues and continue to serve 33 counties in northwest Iowa, eastern Nebraska and southeastern South Dakota. ■

Midwest Medical Edition

Avera Cancer Institute Marshall

Celebrates Grand Opening Avera Marshall Regional Medical Center recently celebrated the grand opening of Avera Cancer Institute Marshall. The 16,500-square-foot addition is attached to the front and side of the hospital. In addition to space for state-of-the-art cancer care, it provides a new front entrance to the hospital, a second hospital chapel, and an expanded gift shop. Avera Marshall has been offering chemotherapy for a number of years. The new Avera Cancer Institute Marshall building enhances space for chemotherapy and adds radiation therapy as a vital cancer care service. “Because this care is available in Marshall, patients can go home and sleep in their own bed every night. They can continue to be with their families, and even work if they feel up to it,” said Barbara Schlager, MD, Radiation Oncologist at Avera Cancer Institute Marshall.

A large atrium space at the entry way feaMarshall Regional Medical Center. “Under tures a donor and history wall, fireplace, and the Avera name, the healthcare consumer comfortable waiting space. The new ACI also can have immediate confidence in this features an Elekta Infinity linear accelerator, cancer center.” two changing rooms, four exam Because this care is available in rooms, six semi-private chemotherapy bays and two private bays, Marshall, patients can go home and as well as a family waiting room. sleep in their own bed every night. Like other Avera buildings, Avera Cancer Institute Marshall is home to Plans for a new cancer center offering radiation therapy have been in the works for its own original art collection of 30 pieces by 16 artists. Mediums include paintings, a number of years. When the city of Marshall mosaic tile, pastel drawings, tapestry and sold the hospital to Avera in 2009, $7 million photography. The chapel is adorned with six was set aside for cancer care. custom stained glass windows and two door With that seed money plus interest, the panels. community of Marshall provided financial support to see the project through to comple“This center is branded as Avera Cancer Institute not only in name, but in look and tion. To date, nearly $5 million has been feel, and the sophistication of expertise and raised to complete the $12.95 million project. technology offered,” said Mary Maertens, More than 1,700 donors have given toward Regional President and CEO of Avera the goal. ■

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March 2015


Photo courtesy Avera

Avera Queen of Peace Opens New Outpatient Dialysis Center Avera Queen of Peace Hospital in Mitchell has opened a new outpatient dialysis center on the third floor of the hospital. The newly remodeled and enhanced space offers:

◆  More dialysis stations to accommodate patients’ schedules ◆ State-of-the-art dialysis machines featuring Crit-Line technology ◆ Specially designed chairs with heat and massage for maximum comfort ◆ Blanket warmers ◆ Plenty of electrical outlets for personal computers and devices ◆ Comfortable lounge and waiting area ◆ Convenient parking ◆ Same-day lab results, and other diagnostic tests available on campus ◆ Experienced, caring staff ◆ Spiritual care ◆ Insurance patient advocates available for questions and assistance ◆ All the amenities of the Avera Queen of Peace campus, including the cafeteria and medical services on site

Primary care and multi-specialty physicians on staff at Avera Queen of Peace work hand in hand with nephrologists who oversee dialysis care. Avera nephrologists offer routine consultations and telemedicine technology is available to connect Avera Dialysis to nephrologists and the full range of specialty providers. In the past, Avera Queen of Peace contracted with an independent company to provide outpatient dialysis on its campus. Avera has operated numerous dialysis centers throughout the region for a number of years. By offering its own dialysis center, Avera is able to provide a complete continuum of care and more scheduling options. Insurance coverage also will be more seamless for those patients whose carriers prefer a comprehensive approach to kidney disease care. In 2016, Avera Dialysis Mitchell will relocate to the Grassland Health Campus, featuring a patient-friendly design for optimal dialysis care. ■


Avera Scientist is Co-author in Leading Science Journal Gareth Davies, PhD,

Chief Scientific Officer and Scientific Director at the Avera Institute for Human Genetics was among of group of scientists who contributed to the article titled “Common Genetic Variants Influence Human Subcortical Brain Structures” in the January 21 edition of Nature. This study focuses on the ways in which genetic variations influence the structure and development of the brain, and also possible dysfunction of the brain seen in the form of behavioral health conditions, such as schizophrenia. “Genetics, and its interplay with the development of disease, is a rapidly growing field of research, and one we’re involved with locally at the Avera Institute for Human Genetics,” said Dr. Davies. “The results of this study were only possible through extensive collaboration.” Researchers focused on seven subcortical regions of the brain, which are associated with memory, movement, learning and motivation. Alterations in these regions can lead to abnormal behavior and disease, so identifying these genetic variants may help to determine why such dysfunction occurs. ■

Midwest Medical Edition

Photo courtesy Avera

Inside the new dialysis center at Avera Queen of Peace.

Mercy Medical Center “Redefining Surgery” with New Robot Mercy Medical Center-Sioux City will now be able to offer more minimally invasive options to its surgical patients with the highly Michael “Mick” Gibbs

Kyle Richards

Tim Sughrue

advanced da Vinci Xi Surgical System, a

Changes at the Top at Regional

technological leap forward in replacing large-

After more than 28, years Tim

are associated with less trauma to the body,

Sughrue, Chief Operating Officer for Regional Health and CEO for Rapid City Regional Hospital and Regional Health Network, is retiring from Regional Health at the end of March. Michael “Mick” Gibbs has been named President of Rapid City Regional Hospital and Kyle Richards is President of Regional Health Network. Since 2013, Gibbs has served as Chief Operating Officer of RCRH upon his return from Sanford Health in Fargo, ND, where he served as the Vice President for Heart, Vascular, Surgery and Radiology programs. Prior to that, Gibbs was with Regional Health for eight years beginning his career as an Administrative Fellow and serving in roles as CEO of Gordon Memorial Hospital

in Nebraska, and Director of Customer Service and Vice President of Professional Services at RCRH. Richards has served as Chief Operating Officer for RHN since spring 2014, providing leadership for Custer, Lead-Deadwood, Spearfish and Sturgis hospitals, Regional Health nursing homes, assisted living facilities and home medical equipment stores serving South Dakota and Wyoming. RHN also manages hospitals and nursing homes in Philip, SD, and in Sundance and Newcastle, Wyoming. Prior to coming to Regional Health, Richards served as CEO at Waverly Health Center, in Waverly, Iowa. He is a licensed Long-Term Care Administrator and a Certified Professional in Healthcare Quality. ■ 

incision surgeries. “Surgeries performed with the da Vinci Xi faster recovery, less scarring, and lower postoperative pain,“ said Dr. Andrew Bourne, urologist and the chair of Mercy’s robotics steering committee. “This advanced technology makes possible minimally invasive surgery for complex diseases and conditions in gynecology, urology, thoracic surgery, cardiac and general surgery.” The new da Vinci Xi System replaces Mercy’s da Vinci S system purchased in 2008. It has broader capabilities than any prior generation of the da Vinci System and has been optimized for complex, multi-quadrant surgeries. The da Vinci Xi System features include wristed instruments, immersive 3D-HD visualization, intuitive motion, and an ergonomic design. Other key features include:

State of the Art MRI Technology Now Available in Watertown

■ A new overhead instrument arm architec-

Prairie Lakes Healthcare System has upgraded the MRI machine in radiology.

creates a simpler, more compact design

The upgrade brings state of the art technology to the Watertown area, without having to replace the MRI’s magnet. The upgrade to a Signa HDxt 1.5T from GE Healthcare makes the MRI machine engineered for enhanced image contrast, reduced blurring, and reduced artifacts so doctors can see more. This system also incorporates motion correction to help reduce the need for rescans. Prairie Lakes’ radiology staff A CartiGram of a knee now can scan rapid high resolution imagining acquiring crisp 3D gradient images, even while the patient breathes. Beyond crisper images, the upgrade has made available new scans for urology, nephrology, and orthopedic patients in Watertown. For example color coded CartiGrams are offered to detect osteoarthritis (a common joint disorder due to wear and tear on a joint) early and can be used to determine the best course of treatment. ■

with improved visual definition and clarity.

March 2015

ture designed to facilitate anatomical access from virtually any position.

■ A new endoscope digital architecture that

■ An ability to attach the endoscope to any arm, providing flexibility for visualizing the surgical site.

■ Smaller, thinner arms with newly designed joints that offer a greater range of motion than ever before.

■ Longer instrument shafts designed to give surgeons greater operative reach.

■ The da Vinci Xi System is expandable, designed to accommodate and seamlessly integrate a range of current technologies, as well as future innovations, in the areas such as imaging, advanced instruments and anatomical access. ■


Sanford Imagenetics

Celebrates a Year of Education, Clinical Innovation, and Research

January marked the one-year anniversary of Sanford’s sweeping genomics initiative called Imagenetics. Last year, Imagenetics became the first program in the nation to fully integrate genetics and genomic medicine into primary care for all adults. We asked Dr. Gene Hoyme, former president of Sanford Research and now it’s Chief of Genetics and Genomics, for an update on the three primary components of Imagenetics: Education, Clinical Innovation and Research.

MED: How has Imagenetics advanced education this past year? Dr. H: There are two components to education. The first is educating adult primary care providers about genomic medicine and how to incorporate it into their practices. We designed a 21 hour course called “Essentials of Genomic Medicine” which each of our general internists took and felt was valuable. The second thing is that in order to train the future workforce in genomic medicine, we had two programs that we felt we needed to create. The first is a Master’s program in


genetic counseling, which we have developed jointly with Augustana. That program has progressed very quickly. We have also identified at least one remote teaching site. We are very close to signing an agreement with a huge West Coast university. You need a certain clinical volume in order to study genetics and genomics. We can train about 5 genetic counselors a year between Fargo and Sioux Falls. If we want to have a class of ten or 12, we need a second site. We’ve probably had two hundred inquiries about this program.

MED: How have you innovated on

the clinical side? Dr. H: We have rolled out testing for drugs based on the genomic background of the individual. We plan to have pharmacogenetics testing available for twenty medications over the next year. There are published guidelines which have been vetted nationally and those are the medications we are going to start with. As the science grows, we’ll add more medications to that list. We have also hired genetic counselors to be imbedded within our general medicine

clinics and we are almost complete with our recruitment of those people. Combined with the pharmacogenetics and the increased knowledge of the internists, people who receive their primary care at one of these clinics will find that there is ready availability of genetic counseling within the clinic.

MED: And what about research? Dr. H: In terms of the research, I think that one of the questions that people have is what is the evidence that this approach to medicine really changes outcomes and at what cost? We have done a preliminary survey of our patients. One result was that two thirds of patients with no education about genetics, when asked if they would want to get genetic testing done if it would improve their healthcare, said yes. For cancer, it was 100 percent. So I think there is great acceptance of this idea.

MED: Imagenetics will soon get its own building near the med school building in Sioux Falls. What will this mean for the program?

Midwest Medical Edition

Dr. H: That facility will bring together all the players. Diagnostic laboratories in genetics, adult internal medicine practices, genetic counselors, and the genetics Master’s program will be housed there. It’s meant to be an educational, clinical, and research building. There is nothing like this in the whole country where we have brought this into primary care. We hope there will be synergy there which will lead to innovation in research. ■

Note: Groundbreaking for the new building is expected this summer.

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Sanford ENT specialists utilize high-resolution view for diagnosis Ear, nose and throat specialists at Sanford Health in Sioux Falls are the first in the nation to use the ENT-7000 Video Laryngoscope from Vision Sciences. The device allows pediatric physicians to easily gain an improved view with maximized patient comfort during diagnostic procedures. “When we’re working with children, especially in areas like the throat, ears or nose, it can be very difficult to see in those tight spaces,” said Patrick Munson, MD, Sanford pediatric ear, nose and throat specialist. “For example, this gives me a chance to examine a child’s throat to find the source of an issue without surgery and without additional discomfort from a larger or more rigid scope.” The ENT-7000 video flexible laryngoscope is just 2.4 millimeters in size, currently the smallest on the market, to ensure the patient is comfortable during the examination. On the other end, the video output is highresolution imaging to give physicians a vivid view. During a laryngoscopy, the flexible scope is inserted through a nostril or the mouth, allowing the doctor to examine the throat area using the display. Laryngoscopes are used to diagnose and treat a series of head and neck disorders including acid reflux, swallowing conditions, sinusitis, hoarseness, chronic cough, sleep apnea and head and neck cancer. Vision Sciences unveiled the ENT7000 in late September 2014. ■

March 2015

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2/10/2015 9:03:23 AM


Sanford Health announces leadership changes Sanford’s corporate leadership team will shift with the retirement of four longtime executives this summer: Dave Link, senior executive vice president and chief strategy officer, will retire after more than 30 years with Sanford Health. John Paulson, vice president for corporate administration, will retire after 4o years of experience in healthcare administration. Jacquie Kluck, chief clinical officer, will retire after a 40-year healthcare career. Rick Giesel, president of the Sanford Health Network, will retire in July. He began his career 40 years ago as a healthcare consultant. Giesel joined Sanford in 2010.

Planned transitions in corporate and operating functions have also begun across the organization: Rich Adcock was recently promoted to executive vice president for Sanford Health. Meghan Goldammer, current vice president of clinical operations, will assume the role of chief clinical officer this summer. Gene Hoyme, MD, recently transitioned from president of Sanford Research to Sanford’s new chief of genetics and genomic medicine. Jeff Sandene has been promoted to chief integration officer for Sanford Health’s Development and Research Division. Allison Suttle, MD, has been promoted to chief medical officer for the Sanford Health system. Heidi Twedt, MD, has been promoted to chief medical information officer for the Sanford Health system. Dave Pearce, Ph.D., a nationally renowned researcher, recently assumed the role of president of Sanford Research. Jesse Tischer will succeed Rick Giesel as president of the Sanford Health Network this summer. Bryan Nermoe has been promoted to enterprise vice president of population health and enterprise services. Kurt Brost has been promoted to chief of staff for the Health Services Division. Jennifer Grennan, current general counsel for Sioux Falls, will expand her role to become general counsel for Sanford Health’s Health Services Division.  Andy Wentzy is the new chief of staff for Sanford Health’s Development and Research Division.  Annette White, currently corporate counsel, will become general counsel for Sanford Health’s Development and Research Division.


For photos and more complete profiles of these employees,

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Midwest Medical Edition

Med School’s Rural Medicine Program Expands New communities will host FARM program students The University of South Dakota

Sanford School of Medicine has announced its third group of students to participate in the school’s Frontier and Rural Medicine (FARM) program. The school also announced new FARM communities – Vermillion, Pierre and Spearfish – joining other hosting communities across the state. Each student selected for the FARM program will receive nine months of intense and hands-on clinical training in a single, rural location that will help them understand the opportunities and rewards of practicing

The FARM program’s first class. Left to right: Susan Anderson, MD, FARM program director and students Josh Doorn, Erin Rasmussen, George Ceremuga, David Kapperman, Heather Walker and Nicholas Kohles

medicine in a small-town setting. Selected students are in their third year of medical training. Dr. Susan Anderson, MD, director of the FARM program, said the program introduces students to rural healthcare, and encourages students to practice in South Dakota’s non-urban locations. “Providing South Dakota with physicians who will practice medicine in in our smaller communities is an important mission of the medical school,” said Anderson. “The FARM program is a useful tool to help us accomplish that.” FARM students are supervised by practicing physicians in clinical, hospital

and other healthcare environments in host communities. The first group of FARM students launched the program in the Fall of 2014. That group included six students and five hospitals in five rural South Dakota communities. The third group includes seven students and hospitals in six locations. The program’s original host communities were Milbank, Mobridge, Parkston, Platte and Winner. Those communities will continue to host FARM students. New FARM communities hosting FARM students in the future are Vermillion, starting in February 2016, and Pierre and Spearfish, beginning in February 2017. ■

Learn how to be an Eye, Tissue, and Organ donor at March 2015


What is Physician Healthcare Credentialing? By Lavonne McKee


ealthcare credentialing has evolved over the years and plays an important role in protecting and providing healthcare services today. Physician healthcare credentialing is a process where a healthcare professional proves that he/she is educated and capable of practicing his/her healthcare specialty. The credentialing process is a lengthy process. Every healthcare physician practicing in the United States will in some way be credentialed to practice. Credentialing may be done on many different levels including but not limited to the following:

♦ ◆  State medical license, residency and/or professional in every state practicing

♦ ◆ Drug dispensing licenses on both national and in some states ♦ ◆ Malpractice insurance ♦ ◆ Health insurance companies ♦ ◆ H  ealthcare facilities where practicing or holding privileges ♦ ◆ Specialty committees in which participating ♦ ◆ Federation of State Medical Boards ♦ ◆ Federation Credentialing Verification Services ♦ ◆ Medicare ♦ ◆ Medicaid and others The credentialing process varies for each healthcare professional. Some of the variances are: type of professional, services provided and state where the service is provided. The best way to find the requirements for a specific state is to refer to that specific state’s medical licensing board. A link to each state medical board may be found through the American Medical Association website at: becoming-physician/medical-licensure/ Some of the common variances include but are not limited to: state drug license, continuing medical education hours, required residency licenses, foreign medical graduate requirements and others. ■ LaVonne McKee is President and Credentialing Specialist at Credentialing USA in Sioux Falls. To read the complete article, including details and advantages of thorough credentialing processes, Log on!


Ask ur tO Abou dge Lo e! g Packa

Midwest Medical Edition

Beef and Heart Health By Holly Swee, RD, LN


ou may have heard that a DASH (Dietary Approaches to Stop Hypertension) dietary pattern that includes fruits, vegetables, low-fat dairy and protein, predominately from plant sources, is a commonly prescribed cardiovascular diet and is typically associated with decreases in blood pressure. However, there is a growing body of evidence that shows lean beef can be part of a heart-healthy diet, too. New research published in the Journal of Human Hypertension titled “Effects of a DASH-like Diet Containing Lean Beef on Vascular Health” demonstrates that eating predominately lean beef as a protein source, as part of a dietary pattern rich in fruits, vegetables and low-fat dairy, can significantly help reduce blood pressure. This study’s authors had previously concluded that lean beef can be included in a DASH-like diet to reduce levels of total and LDL “bad” cholesterol. Note that this evidence suggests that it is the total protein intake —not the type of protein— that is instrumental in reducing blood pressure as part of a DASH-like dietary pattern. ■

Some of the latest research on red meat and heart disease presents a new way of thinking: Lean beef can be part of a solution to one of America’s greatest health challenges . . .

– eating for a healthy heart.

Holly Swee, RD, LN is Director of Nutrition & Consumer Information for the South Dakota Beef Industry Council Sources: Roussell MA, et al, “Effects of a DASH-like diet containing lean beef on vascular health”, J Hum Hypertens 2014 Jun 19. Roussell MA, et al, “Beef in an Optimal Lean Diet study: Effects on lipids, lipoproteins, and apolipoproteins”, Am J Clin Nutr 2012; 95:9-16.

Celebrating 20 Years of Serving Siouxland! Kamalesh Bala, M.D. Shari Black, C.N.P.

Stephen P. Kahanic, M.D. Charles Murphy, M.D.

Greg Naden, M.D. Donald Wender, Ph.D., M.D. Radha M. Rao, M.D.



Wine ine

Wine Marketplace Som m elier’s cor n er

It’s Not Just for Heart Health Anymore…

The heart benefits of red wine are well-documented, but new research suggests that a compound found in red wine could also be beneficial to the liver. The compound, called ellagic acid, apparently helps to prevent fatty liver disease. In studies conducted in Oregon, Florida and Nebraska, researchers triggered significant reductions in metabolic problems by supplementing the high-fat diets of lab mice with grape phytochemicals including resveratrol, quercetin and ellagic acid. After six weeks, blood glucose levels of mice on the high-fat diet who also consumed ellagic acid were equivalent to mice on the low-fat diet. Although ellagic acid did not help the high-fat-diet mice lose weight, even small amounts of the compound did trigger reductions in liver fat accumulation. Source: Oregon State University

Wine Fact The darkest-colored wines, including darkest reds and yellow white, come from warm climates. Light colors come from cooler climates.

South Dakota Wine Shipping Bill Last month, South Dakotans moved a step closer to being able to order their favorite wines by mail. A bill legalizing direct-to-consumer wine shipping is awaiting the governor’s signature at the time of this printing. The bill would allow South Dakotans to buy up to 12 cases of wine per year directly from wineries in or out of state. Many state wine retailers and wholesalers opposed the bill when it first came up last year. The new version seeks to make the law more equitable by requiring out-of-state companies to pay the same taxes that in-state companies have to pay, in addition to shipping.

Wine to Watch

Ruffino Orvieto Classico 2013


Tasting Notes: This top-rated value wine has a fruity and floral bouquet is reminiscent of green apples and meadow flowers. This wine’s smooth, refreshing flavors balance beautifully with its structure and acidity. Orvieto also offers a unique mineral character that comes from the chalky limestone soil called tufa. The finish is long and fragrant, with hints of almond. Grapes: Grechetto, Verdelho, Procanico, Canaiolo Blanco Region: Umbria, Central Italy Food pairings: Crostini with olive oil, squash soup, grilled fish, mild cheeses

Want to sponsor this popular page? Have a favorite wine source that might? Great rates and cross promotional opportunities available! For information:

Sponsorship Opportunity Midwest Medical Edition

Learning Opportunities March — May March 11

SDHIMSS Spring Conference

8:00 am – 4:30 pm

Location: Sanford Research Center, Sioux Falls Information & Registration:

March 13

8th Annual Brain & Spine Institute Conference

8:00 am – 4:00 pm

Location: Hilton Garden Inn Downtown, Sioux Falls Information & Registration:

March 14

June E. Nylen Cancer Center Winter Benefit

5:30 pm – 8:30 pm

Location: Marina Inn Conference Center, South Sioux City Featuring comedian Dave Coulier Information and tickets:

March 26

Perinatal, Neonatal & Women’s Health Conference

7:30 am – 4:30 pm

Location: Sanford USD Medical Center, Schroeder Auditorium Information:

March 26

Avera Transplant Symposium

8:15 am – 5:00 pm

Location: Prairie Center, Avera McKennan

March 30 – April 1

USD Center for Disabilities 2015 Spring Symposium Information: Registration:

April 8

Avera Trauma Symposium

7:30 am – 4:00 pm

Location: Sioux Falls Convention Center Information: 605-322-8987, Registration:

April 17

Mercy Medical Center – Protecting Families Spring Conference

8:15 am – 4:30 pm

Location: Bev’s On The River, Sioux City Information: 712-279-2507,

April 24

14th Annual Pediatric Symposium

8:00 am – 5:00 pm

Location: Sr. Colman Room, Prairie Center, Avera McKennan Information:, 605-322-8987 Registration:

April 30

Sanford Kidney Symposium

8:00 am – 4:00 pm

Location: Sanford USD Medical Center, Schroeder Auditorium Information:, 605-328-9290

April 29 — May 1

SDMGMA Spring Conference

8:30 am – 3:30 pm

Location: The Lodge, Deadwood, SD Information & Registration:

May 1

North Center Heart 2015 Vascular Symposium

8:00 am – 5:00 pm

Location: Sioux Falls Convention Center Information: 605-322-8987 Registration:

Do you or your organization have an event for the MED Calendar? Post it online for free through the calendar link on our home page.

MED reaches more than 5000 doctors and other healthcare professionals across our region 8 times a year. If you know of an upcoming class, seminar, webinar, or other educational event in the region in which these clinicians may want to participate, help us share it in MED. Send your submissions for the Learning Opportunities calendar to the editor at

Edith EdithSanford SanfordBreast BreastCenter Center


SEE THE DIFFERENCE SEE THE DIFFERENCE 2D Mammography 2D Mammography 3D mammography 3D mammography captures multiple captures multiple images at different images at different angles, providing angles, providing doctors withwith doctors exceptionally sharp exceptionally sharp views of the views of breast. the breast. 3D Mammography 3D Mammography

3D image increases 3D image increases cancer detection not not cancer detection seen in 2D seen in image. 2D image.

MAMMOGRAPHY MAMMOGRAPHY IMPROVES IMPROVESEARLY EARLYDETECTION DETECTION OF OFBREAST BREASTCANCER CANCER Edith Sanford Breast Center joined together with Edith Sanford Breast Center joined together with 12 other sites across thethe country to participate in in 12 other sites across country to participate thethe largest study focusing on on thethe benefits of 3D largest study focusing benefits of 3D mammography. Throughout thethe course of the study, mammography. Throughout course of the study, more than 450,000 mammograms were performed more than 450,000 mammograms were performed - 30,000 of which came from Edith Sanford Breast - 30,000 of which came from Edith Sanford Breast Center in the Sioux Falls area. Center in the Sioux Falls area.

Thomas Cink, MD:MD: Co-author Thomas Cink, Co-author

The study hashas been published in the Journal The study been published in the Journal of American Medical Association, and with ourour help, found that 3D3D of American Medical Association, and with help, found that mammography ledled to:to: mammography • 41• 41 percent increase in invasive cancers detected percent increase in invasive cancers detected 2D Mammography 2D Mammography In this image, whatwhat In this image, would havehave beenbeen would flagged as anasarea flagged an area of concern in a in a of concern 2D mammogram 2D mammogram is shown in a 3D is shown in a 3D mammogram to beto be mammogram normal overlapping normal overlapping breast tissue. breast tissue. 3D Mammography 3D Mammography

• 15• 15 percent decrease in false alarms percent decrease in false alarms • 29• 29 percent increase in the detection of all breast cancers percent increase in the detection of all breast cancers Edith Sanford Breast Center hashas been offering 3D3D mammograms since 2012 andand Edith Sanford Breast Center been offering mammograms since 2012 is the only place in Sioux Falls where it isitavailable. Through thisthis technology, is the only place in Sioux Falls where is available. Through technology, ourour three fellowship-trained breast radiologists areare ableable to give women better three fellowship-trained breast radiologists to give women better visualization of their breast, earlier detection of potential issues andand fewer visualization of their breast, earlier detection of potential issues fewer additional tests, which cancan make all all thethe difference in their breast health. additional tests, which make difference in their breast health.

Call (605) 328-5244 to schedule your lowlow dose 3D3D mammogram at at Call (605) 328-5244 to schedule your dose mammogram thethe Sanford Women’s Health Plaza or or Edith Sanford Breast Center. Sanford Women’s Health Plaza Edith Sanford Breast Center. Questionable lesion Questionable lesion seen in 2D on on seen in cleared 2D cleared 3D image. 3D image.

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MED-Midwest Medical Edition-March 2015