Orlando Medical News January 2017

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Now What for Future Physicians?

UCF medical students discuss concerns about ‘repealing and replacing’ and their future with former AMA president, Dr. Cecil B. Wilson By pL JETEr

At a recent policy forum on campus, students at the University of Central Florida College of Medicine (UCF-COM) peppered former American Medical Asso-

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PHYSICIAN SPOTLIGHT PAGE 3

Jamin Brahmbhatt, MD

HEALTHCARE LEADER PAGE 4

Banji Awosika, MD MEDICAL MARKETING You are so busy trying to keep your emails under control in your inbox, you may think you just don’t have time for social media ... 6

HEALTH INNOVATORS

ciation (AMA) president Cecil B. Wilson, MD, with questions about the nation’s healthcare policy and proposed changes expected under Republican Presidentelect Donald J. Trump.

“Several students expressed some fear

of the unknown … about what they’re getting into as physicians,” said Jessica Walsh O’Sullivan, a second-year medical student and AMA delegate for the UCF AMA chapter. “They want to know what’s to come with healthcare delivery changes

in general, and proposed adjustments to Obamacare.”

Wilson, an internist in Winter Park, presided over the AMA when Congress passed the highly controversial, AMA-sup(CONTINUED ON PAGE 7)

A Year of Uncertainty … and Opportunity Last month, PwC Health Research Institute released its annual report highlighting the forces anticipated to have the greatest impact on healthcare in the coming year. “Top Health Industry Issues of 2017” outlined 10 areas ranging from healthcare plans under a new administration and the move to ramp up value-based payments … to public health concerns over infectious disease and a public outcry for more transparency in drug pricing.

“The report enumerates 10 items, but I think there are some themes,” said Nick Walker, a partner with PwC’s Health In-

10 Medical Entrepreneurial Pearls for 2017 and Best of Health Innovators in 2016 ... 9

dustry Practice. “The fate of the Affordable Care Act dominates the day, and uncertainty is the theme of the day.”

He added, “Until the fate of the ACA comes into focus, there is a sense of unrest.”

However, Walker continued, “The driving force in healthcare hasn’t really changed, and that’s the move towards value.”

Moving to a value-based system is a bipartisan priority … although the path to get there could look very different once President-elect Donald Trump takes office.

Walker noted that as a candidate, Trump’s (CONTINUED ON PAGE 10)

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PHYSICIANSPOTLIGHT PHYSICIAN

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Jamin Brahmbhatt, MD Board-Certified Urologic Surgeon, South Lake Hospital, Orlando Health; Co-director, The PUR Clinic

By pL JETEr

The dentist dad of Jamin Brahmbhatt, MD, emigrated to the United States from India in 1979 with only $8 in his pocket. His incentive: to live the American Dream and provide otherwise improbable opportunities for his family.

“Everything my dad did centered on my education,” said Brahmbhatt. “He never cut corners to make sure I always had the best educational opportunities possible for a very strong base foundation.”

As a high school junior in New Jersey who had excelled academically and on his SATs, Brahmbhatt was taken aback when he wasn’t approved for early acceptance into a prestigious pre-med program. “That was an eye opener,” he admitted. “It motivated me to work even harder because by then, I knew medicine was what I wanted to pursue.”

Brahmbhatt, whose extended family includes doctors and nurses, graduated

from Boston College magna cum laude in 2003, and earned his MD from Boston University School of Medicine in 2007.

An internship and subsequent residency at the University of Tennessee Health Science Center Department of Surgery confirmed his interest in urology. “Urologists are usually the earliest adopters of technology; urology provides a great mix of medicine and surgery,” he explained.

Four years ago, he completed a fellowship in robotic microsurgery focusing on male infertility through the University of Florida and Winter Haven Hospital and immediately joined The PUR (Personalized Urology & Robotics) Clinic, affiliated with South Lake Hospital and Orlando Health, as co-director.

The PUR Clinic has been recognized as the nation’s highest volume practice of its kind in the management of chronic groin and testicular pain. “At last count, we’ve helped more than 5,000 men from all over the world,” he said, adding that first-visit patients usually share similar experiences, of “going from doctor to doctor, winding up on chronic narcotics or some kind of (dependent) opiate that temporizes or masks the pain. We’ve

been able to give them more permanent solutions, surgical solutions.”

Brahmbhatt credits his partner, Sijo Parekattil, MD, with taking the reins on the movement toward urological microsurgery solutions. Tracked data confirms their success via published research projects. “We essentially utilize the robot to do more efficiently what doctors have been doing for years when it comes to the management of conditions for infertility and management for conditions for chronic testicular pain,” he explained.

To encourage men to live healthier lifestyles and engage in preventive medical screenings, Brahmbhatt and Parekattil hit the road in a Tesla for the Drive 4 Men’s Health, a 10-day, 6,000-mile road trip every June that includes hospital and health clinic stops on the cross-country trek. “We do it because we’re really passionate about helping people,” said the father of three daughters – 3-year-old twins and a 4-year-old who turns 5 in February.

“Because we really care about helping people, we’ve also been able to utilize the robot in microsurgery to improve patients’ fertility. That’s perhaps our most important and lasting work.”

Brahmbhatt expands his reach via TV as a national on-air health expert with a robust social media presence. “In the office, I can maybe see 20 patients in a half-day clinic, or 40 patients in a full-day clinic,” he said. “But in a 3-minute segment on TV, I can affect over 40 million lives.”

Through TEDx, Brahmbhatt gives talks internationally not only on urologic technology advances, but also discussions about problems all physicians face. “The lecture I’m most proud of was my TEDx talk in London last year, where I discussed physician burnout,” he said. “Because physicians have been overrun by the system and as a result may have become somewhat disgruntled, it’s important to remind them that sometimes, we have to return to what drew us to medicine in the first place: our passion to help others.

There are so many naysayers out there, you must surround yourself with people who believe in and share your passion.

Then you’re able to conquer anything.

‘Never give up’ is the motto in the talks I give, whether to students, doctors or my own family.”

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HEALTHCARELEADER

Nephrologist Relies on Lifestyle Change as Much as Medicine Banji Awosika, MD, West Orange Dialysis Services By pL JETEr

When Orlando Mayor Buddy Dyer proclaimed Dec. 10, 2016, as Dr. Banji Awosika Day for his contribution to nephrology, hypertension and kidney dialysis through preventive care, only a few folks knew his stellar medical career was almost sidelined in medical school.

The son of a diplomat born in Cairo, Egypt, Awosika moved with his family during childhood to Japan and the United Kingdom before relocating to Nigeria to study at the University of Lagos Teaching Hospital College of Medicine. There, he stumbled not because of academic difficulty, but as a casualty of academic politics. University staff strikes led to temporary closures of the medical school. During one closure, Awosika gave it up and worked as a cabbie in London.

“Things were tough financially, and I really didn’t want to go back to medical school,” admitted Awosika, who planned to stay in the U.K. with his brother for a couple of months and instead stayed a year. In his

spare time, he played the saxophone, practiced martial arts and participated in marathons. “I’d planned to leave medicine behind but then a funny thing happened. Conversations with my passengers almost always led to discussion about medicine and their problems. We’d delve into what could be done to improve their situation. They kept asking why I left medicine. It came so naturally to me.”

Spurred by their encouragement, Awosika completed medical school in Nigeria, and then worked as a physician in Trinidad and Tobago, and a psychiatrist in the U.K. He emigrated to the United States in 1994, completing residencies in internal medicine and nephrology at St. John Hospital & Medical Center in Detroit, Mich. In 1994, he relocated to Orlando with his wife, Tejumade St. Matthew-Daniel, DDS, and acquired a small practice that quickly grew in patient volume and good reputation. Last November, he opened his own kidney dialysis facility, West Orange Dialysis Services, part of West Orange Nephrology.

Awosika, who calls himself a nephrologist by trade, considers himself a wellness physician and a staunch supporter of pre-

ventive care.

“I tell patients they didn’t inherit a gene that caused them to have kidney disease; they inherited a behavior, one that was passed down from their parents and their parents’ parents,” said Awosika, a father of three – Olajire, Obatimilehin, and Obasindara. “This is why diseases run in families.”

Awosika introduced a wellness clinic component of his practice with an in-house nutritionist/dietician who helps patients modify their eating habits and lifestyle. His motto: “We become what we eat.” Recently, cooking classes were introduced to create a forum for families to learn to live healthier through food preparation. “It’s not complicated. Focus on what you’re eating,” he tells participants. “Don’t eat passively.

Don’t eat for comfort. Eat for health.”

He encourages family participation in local 5k and 10k runs, insists on smoking cessation, and sings the praises of proper rest. “Don’t get sedentary,” he tells patients.

“The body has been wired to be worked out. If you don’t, the body will short-circuit.

It’s really that simple.”

As importantly, Awosika points out

the value of good relationships. “Good relationships are crucial for a healthy lifestyle, whether it’s a spouse, children, good friends, a higher being …,” Awosika emphasized.

Awosika’s efforts have resulted in phenomenal reversals of disease. “Some patients take two or three visits to become compliant with lifestyle changes; others take eight or nine visits,” he said. “We’re constantly bombarding them with information to change their lifestyles. I’ve just written a second book detailing these facts. We try different ways to support our patients in alignment with our vision. Because of our persistence, repeated through social media, we’re getting some great results.”

It’s not uncommon for Awosika to bump into strangers at local farmer’s markets, who introduce themselves and share their success stories. “’One guy came up to me and told me that he embarked on lifestyle changes that I recommended to his cousin. He was proud to tell me, ‘now I’m down to one medication from five.’ The goal for me is to reach as many people as possible, through whatever means I can muster, with this message.”

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CAPI CONVERSATION

Compassionate, Caring & Compassionate, CaringCare & Sophisticated Medical Sophisticated Medical Care

CAPI 2017 President Installed at Winter Gala

Distinguished Guests Share Pulse Disaster Perspective and Tomorrow’s Biomedical Engineering Technology

By JUDY OTTO

Attendees at the December 3 Winter Gala event hosted by the Central Florida Association of Physicians from the Indian Subcontinent (CAPI) left with much to think about: Newly-installed CAPI president Vijay Patange, MD, a 15-year partner in the Medical Center Radiology Group, and Chief of Radiology at Clermont’s South Lake Hospital, assumed his role by reminding members of how much the organization needs to accomplish in the year ahead, and sharing an ambitious 2017 agenda rich in outreach, education and mentorship—strongly focused on service to the Central Florida community.

Keynote speakers from Orlando Regional Medical Center and the University of Central Florida delivered fascinating firsthand perspectives on events and discoveries with far-reaching impacts not only on our community, but society as a whole: Sandeep Mukerjee, M.D., Chief of Anesthesiology at Dr. Phillips Hospital and Quality Director of Anesthesiology at ORMC spoke with simple and moving eloquence of his experiences in serving the wounded in the wake of the Pulse Nightclub shooting, for which he received the 2016 Harold S. Strasberg, M.D. Humanitarian Award from the Florida Medical Association. Accustomed to daily surgeries dealing with trauma and major illnesses, Mukerjee was nonetheless shocked to find himself facing, in the early morning of Sunday, June 12th, the bloody results of the United States’ deadliest mass shooting, with 49 murdered and 53 injured.

“I had never dealt with anything of this scope or magnitude. The victims came up to the OR’s, mostly still in their street clothes,” Mukerjee recalled. “Most were in shock, in pain and confusion, some crying for their mothers. I rapidly triaged the patients, identifying the most critically injured.”

Five OR’s were in use, with five different trauma surgeons at work on 41 cases. Mukerjee moved from OR to OR to help resuscitating patients and administering CPR as needed.

“I will always remember one haunting aspect of that night – the urgent, persistent ringing of cell phones in the discarded clothing of these patients in the OR’s, as families and friends tried desperately to reach their loved ones to see if they were okay,” he said.

This testament to medicine under pressure had a profound impact on caregivers. “I have never been so focused, engaged, and energized in my life as I was orlandomedicalnews

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that night,” Mukerjee reflected. “Sadly, this was the apex of my professional career.”

Seetha Raghavan, PhD, an associate professor in the Department of Mechanical and Aerospace Engineering at the University of Central Florida (UCF), shared an inspiring glimpse of a future where groundbreaking partnerships between UCF’s College of Engineering and Computer Science and College of Medicine continue to explore exciting possibilities.

Raghavan cited UCF’s new Biomedical Engineering Degree program, which “has inspired some really unique research focus areas that pair up UCF faculty with physicians – for example, fluid flow models that simulate outcomes of surgical procedures; developing new materials for synthetic tissues; creating new robotic surgical techniques, and understanding the interaction of neuroscience and biomechanics for more effective gait rehabilitation therapies.”

She pointed with pride to Albert Manero, a graduate student she has mentored. Manero, who received his PhD in Aerospace Engineering in December, founded UCF-based Limbitless Solutions, a nonprofit devoted to bringing 3-D printed bionic arms and hands to children at no cost to their families.

The multidisciplinary team of engineering students he brought together not only created an affordable prosthetic solution; the Limbitless team has now developed new bionic arm designs for 20 children as far away as Brazil and New Zealand, and is pursuing a patent for its bionic wheelchair controlled by facial gestures – the first of its kind in the world. Here’s proof that collaboration between engineering and medicine can change lives – and the world impacted by their improved circumstances.

President Patange rounded out the program by defining his priorities for CAPI in 2017. In keeping with the organization’s stated mission, he emphasized the need to continue building stronger alliances with area hospitals and local physicians’ groups. He also stressed increasing membership recruitment efforts, especially among the younger generation of rising physicians, and creating a youth forum to provide mentorship for local high school and college students as they shadow CAPI physicians. Additional areas of focus include improving the web site and media awareness of the group and its mission of making a difference in the community it serves.

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MEDICAL MARKETING

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Social Media and Marketing Your Practice

By BETH rUDLOFF, MEDSpEAkS, HEALTHCArE EXECUTIvE IN rESIDENCE AND COO EMErITUS OF UF HEALTH CANCEr CENTEr - OrLANDO HEALTH

Editor’s note: For 2017, we are excited to introduce a new section to Orlando Medical News called Medical Marketing. This is an important topic for your practice because social marketing has proved its sustainability and value. In fact, today it is a necessary element to your overall growth strategy. What was previously regarded as hype or a passing fad has ultimately yielded a variety of social platforms, analytics, content, and emerging influencers. For this year, however, it’s time to dig into your marketing plan and understand the best, most effective, yet efficient means of incorporating personalized content that ultimately engages the hearts of consumers and builds a relationship with you, your brand. The benefits of having your expertise and wisdom being discoverable will tell the story of who you are amongst a crowd of many eager to grow their practice and reputation. This section is dedicated to cut through the clutter of information and get down to brass tacks with tips, trends, and practical examples you can understand and implement. If you have specific questions you’d like answered, please send your questions to editor@ orlandomedicalnews.com.

You are so busy trying to keep your emails under control in your inbox, you may think you just don’t have time for social media. But if one of your resolutions for the New Year is to grow your practice, you need to know how social media can help you achieve your goals.

Omar Khateeb, strategic director of

marketing at MedTech Momentum, is on the cutting edge of medical marketing and has these words of advice based on a 2013 Google study, “Not surprisingly, the conclusion was that prospective patients say digital (marketing) matters. This study was divided into three key areas that define the path: Search, Mobile and Video.” Khateeb explains “the market is forcing <medical marketing> to evolve. Physicians are seeing that competitors who are not nearly as experienced, talented, or even qualified are getting the business because they adopted marketing practices of 2016. With the internet and companies like Amazon, Google, Apple, everyone is conditioned to expect that same kind of marketing to engage with.”

Think about how you shop for services you are unfamiliar with – maybe contracting for home improvement, for example. Most likely you will start with asking your friends for referrals, but then you will go to the web to research them – how did they rate on Angie’s list? Do they have a website with examples of their work? What does the Better Business Bureau say about them?

Patients will do (and are doing) the same thing, or even bypass their friend’s referral and go straight to a web search.

They look you up on rating websites like HealthGrades, look for your website, compare you with other physicians in your specialty, and ultimately form an opinion of you before they call your office for an appointment. Omar explains, “The internet has now eliminated borders to your

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business, so you’re not just competing with physicians domestically but internationally. Patients need to understand why they should see you.”

How do you begin to develop your social media marketing strategy or evaluate the one you already have?

• First, Google yourself. You might be surprised at what comes up. I was surprised to find that a quote I made in 1994 for the LA Times was still on the web. Your reputation is on the line, so also try searching by your specialty to see who you are competing against. You may even want to ask your new patients how they found you and what they searched for if they used the web.

• Secondly, determine what you want people to see when they search for you.

As Omar states, “Many things have changed over the past thousands of years, but our brains still function the same way. Data doesn’t resonate with us,

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stories do. Stories are what communicate ‘people like us when we do things like this’. When you tell the right story to the right person, something happens and it is told again to others. Helping patients find the story that resonates with them is what ultimately drives the actions that turn into a conversion, a client.”

Is what you are seeing when you search for yourself consistent with what you want to portray? Or, is your message different than how you really are because you have used a generic, pre-packaged marketing tool or website developer? Or, are there negative reviews on ratings sites that are concerning? When determining what story you want to have on the web, Omar suggests you look back into why you went into medicine in the first place, and what made your decision to choose your specialty. Perhaps, ask yourself who were your favorite patients and why?

• Thirdly, if you find that you need to develop a social media strategy, or revise the way you are currently portrayed online, here are the main areas to focus on for success according to Omar: • emotionally compelling offline media • search engine optimization (SEO) blogs and websites • engaging social media and referral marketing • cost-effective paid advertising • mobile marketing for doctors • video marketing What should you avoid with your social media strategy? Looking at short-term gains but not the long-term consequences. Developing your online story is a strategy that will take work and needs to be consistent across all platforms. As Omar says, “Experimenting is one thing, but selfish, sloppy tactics will often fail and tarnish your brand.”

Also, “don’t do it by yourself,” advises Omar. “It’s worth the investment to have someone either advise you, manage marketing for you, or be involved in some capacity. The greatest people in the world, high achieving people, all had a coach. I’m a marketer, and even I utilize other marketers. Take a true entrepreneur’s approach and hire people to help you in places where you’re not focused. Focus on being the greatest physician you can be, not a good one who’s also good at business.”

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Now What for Future Physicians? continued from page 3

Powering Medical City ported Affordable Care Act (ACA) in 2010 that he called “the most significant legislation since the Medicare Act in the 1960s.”

“When I talk to medical students, the first question I’m usually asked is whether I would go into medicine again. And of course, the answer is yes,” he said. “The second question typically is: how are we going to reorganize ourselves as a country to provide adequate medical care for everyone?

Obviously at this point, it’s an iffy question.

That said, I’m not pessimistic at all.”

Aaron Pollock, recipient of the prestigious UCF Order of Pegasus 2015 who anticipates graduating from medical school in 2020, admitted his primary concern postgraduation is dealing with “being overwhelmed.”

“I was attracted to medicine through a sense of moral obligation to help those struggling with their health and wellness,” he explained. “With the current physician/ patient ratio, I predict I’ll be seeing more patients than I’ll have time to provide quality patient care.”

Wilson, also a UCF-COM instructor, emphasized the national push for proportionate pay for primary care physicians, and fielded questions about “perhaps too much specialization.”

“Do you think we’ll still have job security if we pursue a specialty and several fellowships and find ourselves in a small niche?” asked one student. “If you’re good at your job and choose a small subspecialty, you’ll still have work,” Wilson assured him.

Jacob Henderson, a first-year medical student, who plans to pursue a career in pediatric cardiology, said he’s concerned about being able to make a difference in preventive patient care in an environment

shrouded by heavy regulation, voluminous documentation, and other time-consuming technicalities.

“The plague of cardiovascular disease is largely self-imposed,” he said, adding that, as a result, “we must become excellent educators to help our patients make the best decisions for their health. But will there be adequate time for that?”

Henderson is also concerned about the health of emerging patient populations, such as the LGBTQ community.

“These problems are far too big to be solved in isolation,” he observed. “I hope my generation of physicians breaks free from the medical profession’s history of lackluster political engagement.”

Born in Ireland and raised in North Carolina, O’Sullivan, who is considering emergency medicine as a specialty, was keenly interested in Wilson’s assessment of healthcare policy in various countries, particularly his anecdote about touring Nepal as president of the World Medical Association before the April 25, 2015 earthquake that killed 9,000 citizens and injured nearly 22,000. “No country has a perfect system, but there’s a lot to learn about different ways countries take care of their people,” she said.

By the end of the policy forum, O’Sullivan said she could sense a cloud of concern had lifted from the students. “Dr. Wilson was very encouraging to students,” she said. “He was really humble, very positive and politically neutral. When asked how they could make a difference, whether through advocacy or patient care, it was really cool for them to hear him say that sometimes, ‘the number one thing you can do is show up.’”

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100% of Med School’s First Residents Match Into Fellowships The first graduates of the University of Central Florida College of Medicine’s young internal medicine residency program matched into fellowships December 7 – with a 100 percent match rate for three third-year residents and two chief residents who joined highly competitive programs across the country.

After completing medical school, physicians must enter a graduate medical education program of between three and seven years depending on their specialty. Physicians, particularly in internal medicine, often go on to fellowship training in a subspecialty such as cardiology.

These UCF residents will begin their fellowship training in July 2017: • Dr. Gerard Chaaya– Tulane University School of Medicine: Hematology and Oncology • Dr. Bruna Pellini Ferreira – Washington University School of Medicine, St Louis: Hematology and Oncology

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• Dr. Arnaldo Reyes Esteves – University of Florida College of Medicine: Sleep Medicine The residents were in the first cohort of a partnership residency program that began in 2014 between the medical school, Osceola Regional Medical Center and the Orlando VA Medical Center. Since then, the College of Medicine has joined Hospital Corporation of America, owner of Osceola Regional, in creating other residency programs across Central and North Central Florida. By 2020, the UCF-HCA consortium is expected to add 580-plus residency slots to the state to help ease the physician shortage.

In addition to the 100 percent match rate for residents seeking fellowships, both of UCF’s chief residents who were seeking fellowship training matched. They are: • Dr. Noelle Rolle — University of New Mexico: Rheumatology • Dr. Kashif Shaikh – Baylor College of Medicine: Rheu-

matology Dr. Abdo Asmar, program director of the UCF-HCA Consortium Internal Medicine Residency Program in Orlando, applauded the new fellows as pioneers. The three matched residents took a chance on a new program and helped build it from scratch, he said, while the chiefs – who did their residency training elsewhere – developed as leaders and educators through their work with UCF and its partners. He noted that all five matched into highly competitive programs in locations and specialties that were their top choices. “I am so proud of them,” he said. “These are skilled, compassionate physicians who are tomorrow’s health leaders. Through their hard work and that of their faculty members and mentors, they have taken the next step in achieving their dreams. They have been important partners in our journey to improve the health of all.”

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When I was a medical student, I had long hair, a beard, and a collection tiedyed scrub shirts. Each day I would put on my tie-dyed scrub shirt, hop on my bicycle, and race to the hospital for my clinical rotations. My hair would stream out behind me, barely kept in check by a leather headband. When I arrived at the hospital, I would change into a dress shirt, tie my hair back in a ponytail and would put on ... my white coat. Donning the mantle. My super-hero costume. My own little White Coat Ceremony. For when I was wearing that white coat, I was part of a longstanding tradition, going back hundreds if not thousands of years. I could feel the transformation from Hippie to Hippocrates as I slipped on that coat. It gave me a code I could live by.

When I was a medical student, I worked at WBRU, which, at the time, was the number one radio station in the Providence market. “You’re listening to 95.5 ... just a little left of center on your radio dial ...” At the end of the day at the hospital, my personal White Coat Ceremony would reverse. The white coat was carefully stowed away in the saddle bag, the dress shirt was exchanged for the tie-dyed scrub shirt, and I let my hair down, both literally and figuratively. Then I hopped on the bike and raced to the WBRU studio, where I had an evening shift playing “progressive rock” or “album rock.”

Over the years, this mini-ceremony was repeated often, and gained many different variations.

For the longest time, I considered my white coat as transformative, covering up and disguising the hippie and turning me into something decidedly more medical.

Until one day... I was on the Intensive Care Unit caring for an elderly woman who was at the end of her life. Her organ systems were shutting down one at a time.

It was like standing outside of a house at night, watching the lights being turned off one at a time. I was at her bedside with her daughter, Judy. Judy, with tears streaming down her face, and me in my white coat.

I was terribly saddened by the unfolding events. It would be death with dignity, but it was death nonetheless. Old wounds that I harbored were being torn open, and I knew I was going to start crying, too.

But people in white coats don’t cry.

So I turned to walk out of the room so Judy wouldn’t see me crying. To this day, I don’t know why, but I stopped in the doorway instead, turned, and went back to the bedside. I decided it was okay to cry.

Okay to be seen crying. Perhaps people in white coats should cry.

A few weeks after her mother died, Judy sent me a note which I have kept to this day: Dear Dr. Elion, It has taken me this long to write to you because I have been searching for the words to express my profound gratitude for your kindness as my mother was dying. Your intuition is remarkable; you knew what I needed to hear even before I asked the questions. I don’t think anyone could have guided me as gently, as thoughtfully, or as wisely as you did through the waiting, the decisions, and the end of my mother’s life.

I hope you are involved in teaching new, young doctors. They will be privileged to learn more than cardiology from you.

Please accept my thanks from the depths of my heart. I will never forget your kindness.

I am convinced that this unfolded as it did because I did not let the white coat transform who I am, but rather, let it augment and enhance who I am. That longhaired hippie in the tie-dyed scrub shirt.

The computer geek. The guy with a weird sense of humor, and with his own set of experiences, wounds and pains.

Be sure that the white coat adds to who you are, enhances who you are; and does not in any way cover who you are. In the words of Oscar Wilde, “Be yourself... everyone else is already taken.”

Jonathan Elion, MD, FACC, is a practicing board-certified cardiologist and an Associate Professor of Medicine at Brown University with more than 25 years of experience in medical computing and information standards. Jon is the founder of ChartWise Medical Systems, Inc. Visit www.chartwisemed.com

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HEALTH INNOVATORS

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10 Pearls for Medical Start-ups

By KELLI MURRAY, Founder, MedSpeaks

The final year-end ‘Health Innovators’ meeting was paneled by three distinguished leaders within our Florida community: Bill Fair, director of Life Sciences Business Development at Tavistock Development, responsible for researching and curating innovating companies moving to the Lake Nona area, Christian Caballero, director of Public Affairs at Foley & Lardner, LLP and president of the TeleHealth Association of Florida, which advocates on behalf of the healthcare and business communities, and Phil Fibiger, VP of Engineering at Voalte, an Orlandobased company that develops smartphone alternatives that simplify caregiver communication.

We asked these local experts a series of questions centered on how to overcome hurdles when it comes to pragmatically deploying a start-up in the healthcare space.

Here are the top 10 pearls that came from the discussion: 1. Test your hypothesis with end users from Day 1. Have as many ‘back-ofthe-napkin’ conversations as you can to validate the problem and potential solution.

2. Understand what end user requirements are before you build a technology solution.

3. Identify your champion in the health organization and don’t ignore RNs, techs and therapists who understand back-end systems.

4. Think small – regional hospitals and clinics often have ambitious visions and seek ways to solve challenges as quickly and as cost effectively as possible. Local clinics and pharmacy groups can also offer great options to obtain customer proof points and references.

5. Be persistent with large health systems – “you may hear ‘no’ fifty-five times before

you talk to the right person.”

6. Recognize that healthcare remains a conservative industry that is at the forefront of being setup with innovation opportunities.

7. Do not ignore patient advocacy and disease associations because these groups generally have money for venture philanthropy and influence in the space.

8. Network as much as possible at industry events, both local and regional to raise awareness about your value and brand.

9. Be acutely aware that decisions are made based upon VALUE. For example, a telehealth visit costs $50 as compared to an ER visit that costs upwards of $500. For insurance payers, there is high value in keeping their costs low.

For parents of young children, averting the ER lessens the inconvenience of commuting a sick child, eliminates unwanted disease exposure and wait times, and for hospitals, it reduces non-

With the New Year upon us, Health Innovators is reflecting on 2016 and all of the incredible growth we’ve seen in the Central Florida healthcare ecosystem. This year we hosted 13 events in two cities, featuring over 30 expert speakers, showcasing an amazing variety of innovative health tech solutions, as well as the clinician leaders championing to bring these innovations to their patients. Here’s a recap: Predicting the Future: Genetics, Cancer, & You

March 22, 2016 - Orlando Health Cancer Center

We were joined by Dr. Rebecca Moroose, a medical oncologist specializing in breast cancer, and Board Certified Genetic Counselor Ryan Bisson, who discussed their groundbreaking work at The Cancer Genetics Center at UF Health Cancer Center — Orlando Health. Their talk covered almost every aspect of their work at the Cancer Genetics Center, from genetics and cancer risk, to genomics and its impact on Precision Medicine and the future of cancer care. They also discussed the technology they employ for pedigree drawing, analysis, and risk prediction.

Emerging Techniques in TBI & Concussion: An Expert Panel

April 28, 2016 - GuideWell Innovation Center

We were so honored to host this incredible panel, comprised of Dr. Todd Maugans, the head of Neurosurgery at Nemours and the only physician in the country conducting research into the difference between pediatric and adult concussion; Dr. Linda Papa, who alongside a team of researchers at Orlando Health is pioneering a blood test for concussion biomarkers; Dr. Kim Manwaring, director of orlandomedicalnews

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Neurosurgical Research at Nemours and inventor of some of the most widely used neurosurgical tools in the country; and Dr. Jackson Streeter, the Chief Medical Officer at Banyan Biomarkers, a company working to bring biomarker concussion testing to the market in 2017.

Accessibility of Healthcare Series

August 2, 2016 - Nemours Children’s Hospital September 22, 2016 - Orlando Veteran’s Affairs Medical Center October 25, 2016 - ‘WHIT’ Intelligent Home

This series of events was inspired by several conversations with healthcare administrators who were seeking new ways to increase access to patients, but were frustrated by the lack of constructive dialogue

centered around the actual problems they faced. Each of these three events featured a variety of experts including (but not limited to), Dr. Shayan Vyas the Medical Director of Telehealth at Nemours; Lisa Martel the Women’s Veteran Program manager at the Orlando VA; Marni Stahlman the president & CEO of the largest free clinic in the state, Shepherd’s Hope; and Dr. David Metcalf the director of the Mixed Emerging Technology Integration Lab (METIL) at UCF’s Institute for Simulation and Training.

In summary, 2016 was a year of many exciting changes, Health Innovators nearly doubled in size from 800 to

SERVING ALL OF EAST ORLANDO & LAKE NONA AREA To learn about becoming a Member contact the East Orlando Chamber

For more information on medical entrepreneurialism and to get involved with the Health Innovators community, please send an inquiry to info@medspeaks.com.

FEATURED EVENTS JANUARY 21 UCF Global Health Conference JANUARY 25 BioFL & Health Innovators Meeting HealthInnovators.info JANUARY 31 SEMDA PitchRounds Road Show FEBRUARY 1-2 Florida Venture Forum

Best of Health Innovators in 2016

By NINA TALLEY, Creative Director, MedSpeaks

urgent cases from clogging the ER.

10. Be able to really prove ROI (return on investment) and/or identify an existing budget. For example, Voalte replaced wired/corded phones, which were already a budgeted capital expense. Seek out opportunities to “displace by replacing” existing spend.

MedSpeaksTM showcases the most exciting experts, events and innovations in Central Florida by bringing together the state’s largest community network of Health Innovators. We have converged over 1,400 healthcare professionals including clinicians, entrepreneurs, and technologists to discuss and promote the problems facing healthcare today and the innovations reshaping the future. www.medspeaks.com

1,400 members, and we launched our first events outside the Central Florida area.

In 2017 we are eager to continue shining a spotlight on the people, technologies, community organizations, and healthcare systems that are making innovative strides towards the Triple Aim. Stay tuned at Orlando Medical News for more Health Innovators content in 2017!

• COFFEE CLUB EAST & NONA • TECH CF LUNCHEON • CHAMBER SPOTLIGHT • MONTHLY LUNCHEON • TOASTMASTERS JANUARY 2017

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A Year of Uncertainty, Opportunity, continued from page 1 healthcare policy raised more questions than answers with a lack of specificity.

Since the election, Trump has moderated his stance, moving from ‘repeal’ to ‘repeal and replace’ to ‘repeal, replace a lot, but keep some.’

Walker noted, “I think the new administration is beginning to understand how disruptive a full repeal of the ACA might be.” He pointed out to simply repeal the law would mean 20 million Americans would lose insurance coverage … and the health systems that serve them would lose reimbursement. “You would see massive uncompensated care in the system, and that’s a big problem.

Frankly, it’s almost impossible to do a full repeal,” Walker said.

“Also,” he continued, “the Trump Administration thinks there are some attractive parts of the law,” Walker said Trump has notably supported guaranteed issue so that those with pre-existing conditions could still have access to coverage and keeping adult children on a parent’s policy until the age of 26. “There’s a recognition that some parts of the program are useful.”

While providers, health systems, and industry suppliers wait for direction on how to proceed, Walker said there are measures that could … and should … be undertaken including scenario planning, investing in education and advocacy, and rethinking historic M&A agreements to create new collaborative arrangements.

Scenario Planning Walker stressed the importance of scenario planning, particularly in uncer-

tain times. Health systems, he noted, particularly need to think about what might happen, how that could impact business, and what the response should be.

What if 20 million lose coverage?

What if they don’t, but premiums are higher? What does that do to your system and how does it impact non-urgent procedures? Walker said thinking through various scenarios and possible reactions helps providers remain nimble in the face of uncertainty.

“You feel comfortable with health systems who say they don’t know what will happen, but they know how they might pivot depending on how things play out,” Walker noted.

Education & Advocacy “High performance organizations will invest in education and advocacy,” Walker said.

This is particularly important in light of a new president with a strong business foundation but little healthcare or policy background. Walker pointed out it isn’t necessarily intuitive to recognize there is an interplay between guaranteed issue and premiums. Instead, a crash course in healthcare requires the disparate parts of the industry to explain the complex intertwining that causes a ripple effect with each decision. “Sharp organizations are pushing the envelope here,” he said.

Innovative Collaborations “Historically, you’ve seen mega mergers. I think what you’re going to see in this new economy is more partnership strategies,” Walker said. He added those

strategies might be in the form of joint ventures or other collaborations. Already, the industry is seeing more partnerships between for-profit companies and notfor-profit health systems and collaborations based on specialized expertise or geographic reach where partners work together but maintain autonomy.

Opportunity from Adversity Walker said a question that should be on the mind of every innovator is: “When the dust settles, what’s going to be up for grabs and how can I take a shot at it?”

Nationally, he noted, several big payers pulled out of exchanges. “That left 1.6 million folks, which translates into $8 billion in premiums, up for grabs,” he said. Walker was quick to add there was a reason those large insurers opted out of specific markets, but he said it still leaves an opportunity to look at technology, collaborations, and other innovations to transform that void into a value proposition.

As America enters this new era in healthcare reform, Walker said, “Those who will do best are organizations that have demonstrated the ability to adapt … organizations that have demonstrated the ability to innovate … and organizations that know how to build for value.”

For additional insights and information, go online to pwc.com, click on industries and then select health industries.

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Iron Absorption

By HARINATH SHEELA, MD, with IVANA OKOR

Iron is a key element for survival; it is essential for oxygen transport, infection resistance and generation of energy via enzyme-catalyzed reactions. It is strictly conserved and recycled in humans such that minor changes in iron content can lead to disease states. Iron exists in two stable oxidation states, as ferrous iron Fe2+and ferric iron Fe3+, which makes its use in the body very versatile. Iron is found in the body mainly in the form of hemoglobin and myoglobin (80%), iron containing proteins, plasma transferrinbound iron and stored iron (20)(ferritin or hemosiderin).

Iron homeostasis involves the interaction of different proteins and hormones on both systemic and cellular levels. The body doesn’t have an effective physiologic mechanism of iron excretion hence it relies solely on absorption mechanism for iron homeostasis.

The normal iron content in an adult male is 3-4g and the body can function effectively by absorbing 1-2mg of iron daily. Approximately 1mg of iron is lost daily via sweat, urine, sloughing of gastrointestinal cells and shedding of skin cells. Premenopausal women may lose up to 2mg of iron daily during menstruation, without increased iron absorption they predisposed to iron deficiency anemia.

Iron absorption is a specialized process that actively involves the gastrointestinal tract. A daily diet contains approximately 15mg of iron; this exists in form of heme and non-Heme (inorganic) iron. Approximately 30 percent of Heme iron and only about 10 percent of the non-heme iron is absorbed. The mechanism and pathway for absorption of Heme iron and Non Heme iron differ; heme iron is believed to be absorbed directly via a heme carrier protein located on apical membrane of duodenal enterocytes, while non-heme iron absorption is more influenced by dietary factors. Dietary heme iron is derived from hemoglobin and myoglobin from animal sources such as meat, poultry and fish; non-heme iron is derived from both meat and plant products.

The rate of iron absorption depends on the physiological state of the body; decreased iron stores, ineffective erythropoiesis, and hypoxia all lead to an increased rate of iron absorption. Dietary iron absorption is enhanced by Ascorbic acid (Vitamin C), citrate and gastric acids; it is inhibited by phytates found in cereals, polyphenols in teas, dietary calcium, soy protein, tannins, soil clay and casein in milk. The use of proton pump inhibitors also decreases non-heme iron absorption.

In addition, iron absorption may also be reduced due to pathological conditions.

Diseases that lead to a reduced absorptive surface area such as celiac disease and inflammatory bowel disease lead decreased iron absorption. Impaired iron absorption may also be seen in patients with chronic liver disease, anemia of chronic disease and iron-loading anemia.

Mechanism of Iron Absorption Non-heme iron exists primarily in the oxidized Fe3+ (ferric) but Fe2+ (ferrous) iron is more easily transported across the basolateral membrane. Gastric acid in the stomach recreates the acidic environment needed by duodenal enzymes to reduce Fe3+ to Fe2+. In the duodenum, Cytochrome b as well as ferric reductase enzyme reduces Fe3+ to Fe2+, which can then be taken up by the duodenal iron transporter.

The duodenal iron transporter is a divalent metal transporter protein (DMT1), which takes up iron from the intestinal lumen. Mutations in the SLC11A2 gene coding for DMT1 have been shown to cause severe iron deficiency. This transporter also takes up other divalent metals such as lead, zinc, cobalt, manganese and copper; therefore, they serve as potential competitive inhibitors for the iron uptake. After luminal uptake, iron is either stored in ferritin or transported out of the cell.

An iron exporter known as Ferroportin transports iron across the basolateral membrane of the duodenal enterocyte, it facilitates the transfer of iron from enterocytes to circulation. It can also be found on macrophages and hepatocytes where it plays an important role in iron circulation.

Figure 1: Iron absorption at low and high levels

Ferroportin is under the physiologic control of the peptide hormone hepcidin. Hepcidin is produced by liver hepatocytes in response to increased iron stores and acute inflammation; its main role is to decrease iron absorption and transfer to plasma by down regulating and internalizing ferroportin. Hepcindin also regulates the release of iron from macrophages. Production of hepcidin is inhibited by iron deficiency, hypoxia, and ineffective erythropoiesis. Due to the role hepcindin plays in iron absorption, certain iron over load disorders especially hemochromatosis have now been linked to low hepcidin production.

After iron leaves the enterocyte, it

is reoxidized to Fe3+ by a ferroxidase known as hephaestin. The ferric iron is then bound to transferrin, a carrier protein that transports iron to tissues.

Dr. Harinath Sheela finished his fellowship in Gastroenterology at Yale University School of Medicine. His interests include (IBD), (IBS), Hepatitis B, Hepatitis C, Metabolic and other liver disorders. He is board certified in both Internal Medicine and Gastroenterology. He is the chairman at Florida Hospital’s Department of Gastroenterology and an active member of the Orange County Medical Society. In addition to being an Assistant Professor at the University of Central Florida School of Medicine, he is a teaching attending physician at both the Florida Hospital Internal Medicine Residency and Family Practice Residence (MD and DO) programs.

Ivana Okor is a 3rd year medical student at NSUCOM. She has an MPH in Epidemiology and a dual Bachelors in Chemistry and Psychology. She intends to be an internal medicine physician.

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The strength of a team with a single focus – you.

In today’s busy world, your financial needs can be complex and ever-changing.

It takes more than an individual to meet those needs. It takes a team. At Synovus Bank, we have a team of professionals with the expertise and resources you need.

407.839.6278

We work together with a single focus – helping you reach your financial goals.

Pictured left to right: Don Gaudette, CEO; Marc Powell, Commercial Banker; Bobby Cooper, Commercial Banker; Bobby Roehrig, Commercial Banker; Ken Eller, Private Wealth Manager

Banking products are provided by Synovus Bank, Member FDIC. Divisions of Synovus Bank operate under multiple trade names across the Southeast.

Investment products and services provided by Synovus are offered through Synovus Securities, Inc (“SSI”), Synovus Trust Company, N.A. (“STC”), GLOBALT, a separately identifiable division of STC and Creative Financial Group, a division of SSI. Trust services for Synovus are provided by Synovus Trust Company, N.A. The registered broker-dealer offering brokerage products for Synovus is Synovus Securities, Inc., member FINRA/SIPC. Investment products and services are not FDIC insured, are not deposits of or other obligations of Synovus Bank, are not guaranteed by Synovus Bank and involve investment risk, including possible loss of principal amount invested.

Synovus Securities, Inc. is a subsidiary of Synovus Financial Corp and an affiliate of Synovus Bank and Synovus Trust. Synovus Trust Company, N.A. is a subsidiary of Synovus Bank.