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4 JAN / FEB 2015 I HealtHcare Journal of lIttle rocK

Chief editor

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Philip Gatto [email protected]

Contributors

Valerie BeshearsPhyllis Ermer A.D. Lively

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2015 healthCare Journal of little roCk advisory board

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M. corey LittleChief Executive Officer, Arkansas Mutual

Henri Roca, MDChief, Integrative Medicine, Central Arkansas Veterans Healthcare SystemAssistant Professor, University of Arkansas Medical School

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Roxane A. Townsend, MDVice Chancellor of Clinical Programs and CEO, University Medical CenterUniversity of Arkansas for Medical Sciences

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January / February 2015 I Vol. 2, No. 2

MEMS: More Than Just A Ride pAgE 10

On ThE COvER

Departments

Editor’s Desk ............................. 8Healthcare Briefs ...................37 Hospital Rounds ....................55Books .........................................65

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President and CEO, Baptist Health

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editor’s desk

With rising health insurance premiums the choice of high deductible plans is increasing. as i’ve heard before, many people aren’t insuring their doctor visits and medi-cine, they are insuring their homes. We all want protection from the most costly hospital visits, and many choose to handle the office visits as consumers.

For physicians this means looking at alternative ways to attract patients. The expense component to an increasing population of patients is becoming more of a market-based decision. providers need to be increasingly aware both with attracting new patients and servicing existing patients. This means having a solid ability to have a real discussion with patients about risks and benefits of tests and treatment as they relate to patient cost. some

patients will begin shopping providers based on their ability to “get the job done” while minimizing costs.Theoretically, the patient’s involvement with the cost component is an important factor in overall management

of healthcare costs. But now patient involvement is increasing and providers should be equipped to meet those needs. This latest healthcare model encourages providers to seek and understand treatment options on a cost basis vis-a-vis health outcomes. treatment options will be more challenging because each patient has their own individual tolerance for expense.

For this system to work, providers have got to be willing to accept that some patients will refuse care based on expense. patients may refuse certain tests or treatment plans because the risk or possible outcome doesn’t sub-stantiate the cost to the patient. to continue to maintain good health, providers must have some good ideas that offer some medical and health solutions that work with the patient’s finances. patients will be demanding solu-tions.

i suspect we will see providers of the future lead with their fee schedule. pricing for office visits and tests will become more transparent. solutions-based providers will be in demand. providers who don’t want to compete on price simply won’t do it. patient volume and fee schedule pricing will be based on reputation and an adequate panel of satisfied patients.

This does not mean patients are subjected to substandard care. What this does mean is patients will have choices. patients will be able to make better consumer price decisions relative to their means and understanding of options. But, the process will take time. The education will take time. Developing a standard viable inventory of health options based on cost will take time.

Will this make life better? Who knows? it’s the next idea.

smith hartley chief [email protected]

profit in business comes from repeat customers, customers that boast about your project or service,

and that bring friends with them. — W. EdWards dEming

mems

By A.D. LiveLy

e

In the back of a training classroom at the Metropolitan

Emergency Medical Services (MEMS) headquarters in

Little Rock, an old business sign is propped against the

wall. The block lettering, still legible through the flaking

paint and rust, reads: Ruffin & Jarrett Funeral Home, Burial

Association, Ambulance Day or Night, Phone 1570

mems

Jon Swanson, MEMS Executive Director, identifies the sign as a relic of a not-too-distant era in which hearses often doubled as ambu-lances, providing patient trans-port but little else in terms of care and support. (And as the sign for a traditionally African-American funeral home, it also harkens back to the days of segregation, in which callers were screened by telephone operators for race so they could be connected to the “appropriate” service.)

“That’s headed to the archives,” says Swanson, indicating a glass

case in the hallway filled with mem-orabilia documenting the evolution of emergency services and trans-port. “This is an important part of history, and that history is part of why people still have misconcep-tions about what we do.”

Swanson recalls having to call for emergency transport himself as a boy when his mother fell down the stairs, and remembers how sinis-ter it seemed when the hearse-cum-ambulance finally arrived. “I was only seven years old, and I’m trying to process, why is my mom leaving in a hearse?”

Jon Swanson

12 JAN / FEB 2015 I HealtHcare Journal of little rock

mems

“An emergency Room on Wheels”According to Janelle Johnson, MEMS Train-ing Supervisor, the idea persists that ambu-lance rides are solely about transportation to the hospital, particularly among peo-ple old enough to remember seeing those hearses pull away with their loved ones,

“usually with only one driver and nobody to attend.” What they don’t realize, she says, is that thanks to better equipment and train-ing, the 21st century ambulance is “just like an emergency room on wheels.”

Johnson, who served “for many years” as a paramedic herself before supervising the certification and continuing education pro-grams at MEMS, has experienced firsthand

she concludes, the treatment that patient is receiving in the ambulance can actually reduce the overall amount of wait time in getting that patient from their home to hos-pital definitive care. “In a true life-threaten-ing emergency,” she says, “We can do every-thing short of surgery in the back of that truck.”

According to Mack Hutchison, Qual-ity Assurance Manager, each MEMS truck responding to an emergency call within their 2300 square mile service area in cen-tral Arkansas is an Advanced Life Support (ALS) unit staffed with at least one para-medic and one EMT. While MEMS also pro-vides Basic Life Support (BLS) units staffed with two EMTs for transportation of stable patients—from, for example, a hospital to a nursing home—those units are always pre-arranged after it has been determined that the patient is truly stable. “Safety is a recur-ring theme here,” says Hutchison.

Most MEMS EMTs and paramedics are trained through MEMS’ rigorous and com-petitive programs, which not only provide students with tuition, books, and testing fees but also pay them an EMT salary during their training and guarantee them employ-ment with MEMS upon completion.

The EMT certificate program, which takes about twelve intensive weeks to complete, usually has about 250 applicants for 15 available spots in each rookie class; and the seven-month paramedic program, which is populated entirely from MEMS’

how this lack of understanding can actually impede patient care:

“More than once, I’ve been in the ambu-lance with a patient in somebody’s driveway while I’m on the floor starting an IV, and my partner’s putting on oxygen, and we’re get-ting an EKG on, when somebody from the injured person’s household starts pounding on the door and screaming, ‘Let’s go, let’s go! Why aren’t you going to the hospital?’”

What they don’t realize, she continues, is that the paramedic and EMT team that staffs every MEMS emergency ambulance is providing that patient with the same assessment and care they’re going to get in the emergency room, “but they’re getting it quicker because we’re doing it now.”

She also notes the constantly improv-ing equipment and technical innovations that allow better advance coordination with destination hospitals, citing the abil-ity to run a twelve-lead EKG and transmit the results electronically as one of the most transformative EMS developments of the last decade.

“If we get a patient that’s having chest pain and the twelve-lead confirms they’re having a heart attack, those results are transmitted immediately to the hospital so they can have their cardiac catheter lab ready to open up the blocked vessel in the patient’s heart. And in the meantime we have already started the patient’s IV and medication,” says Johnson.

So while it might take a few extra seconds for the ambulance to leave the driveway,

“Safety is a recurring theme here.”—Mack Hutchison

Janelle Johnson

Mack Hutchison

‘‘“We can do everything short of surgery in the back of that truck.”

—Janelle Johnson

HealtHcare Journal of little rock I JAN / FEB 2015 13

existing EMT pool, is similarly competitive and immersive, with students going to class three days a week and doing hospital and field clinicals two days a week.

“Our paramedic students complete 44 col-lege credits from South Arkansas Commu-nity College (the academic sponsor for the program) in seven months,” says Johnson, noting that selection is “very much a privi-lege to go, not a right. You don’t get to go just because of seniority.”

By the time they complete their training, EMTs are equipped to provide basic care in just about any type of situation, while paramedics build on their EMT experience to become adept at many of the same skills as an emergency nurse. “They get the phar-macology, the electrical therapy, they can

defibrillate or pace your heart,” says John-son. “And they can do invasive skills as well, intubation and IVs and IOs (delivering fluid directly into bone marrow).”

By offering their students a free educa-tion, salary support, and a guaranteed career, MEMS training programs provide oppor-tunities for people who normally might not have been able to go to school because of the financial or time commitments. “It’s hard for nontraditional students like single par-ents to go to school and still bring home a paycheck,” says Johnson. “These programs have given them the opportunity to build a career, and they have made us a much more diverse company in the process.”

No Special Driving PrivilegesAnother thing that might come as a surprise to most people is that medics do not get any special privileges as drivers, and in fact are held to even higher standards than the aver-age person, according to Quality Coordina-tor Allen Buford.

A large part of Buford’s job is to ensure that crews maintain safe driving habits, which are monitored through cameras and through a safety system on each ambulance that tracks seat belt usage, whether or not lights and sirens are being used properly,

“What these callers don’t realize is that the EMD they are talking to is being supported by another dispatcher who is using a CAD (Computer Aided Dispatch) console to locate and send the nearest available ambulance to their location.”

“We have to be safe, just like everybody else does, and we fall under the same laws. The lights and sirens just give us a little bit of warning to our fellow drivers on the road.” —Allen Buford

Allen Buford


mems

and whether or not the drivers are speed-ing. If a driver is taking a curve too fast, for example, or braking too hard, the system indicates this through an escalating series of ticking noises and warning tones. This information also downloads into a data-base for review.

“Driving safety is of utmost importance to us,” says Buford. “We can do the patient no good if we are lying in a ditch ourselves, or if we injure somebody on the way to a call, because of a reckless habit. We have to be safe, just like everyone else does, and we fall

under the same laws. The lights and sirens just give us a little bit of warning to our fel-low drivers on the road.”

The First First RespondersThe persistent notion that the sole purpose of an ambulance is to provide transporta-tion to the hospital, combined with a limited understanding of EMS capabilities, can even put patients’ lives at risk during the initial call to dispatch.

“I would say a big misconception is that the person who is answering the phone is delaying the ambulance by keeping the caller on the line, or that help is not going to come as quickly if the caller stays on the line and answers questions,” says Captain Angela Bain, a former field paramedic and 20-year MEMS veteran who currently serves as Communications Quality Coordinator.

“We train our Emergency Medical Dis-patchers (EMDs) to tell people, ‘The para-medics are already on the way, and I’m just here to help you until they arrive.’ For some people, that resonates. But once in a while you get a caller who doesn’t seem to believe that anything is going to happen until the dispatcher hangs up the phone, goes to get an ambulance, and drives there themselves.”

What these callers don’t realize is that the EMD they are talking to is being sup-ported by another dispatcher who is using

a CAD (Computer Aided Dispatch) console to locate and send the nearest available ambulance to their location. CAD, which uses a color-based coding system to track each ambulance and its status, coordinates landline or cell phone information obtained from the initial 911 call with an extensive system of maps to facilitate the absolute fastest response. “The ambulance is usu-ally on the way even before the call taker has even confirmed and entered the caller’s phone number,” says Bain.

When the caller resists answering the EMD’s questions, it creates two problems. First of all, dispatch is unable to prepare the ambulance crew with all of the information they might need to begin the most appropriate care for the situation immediately upon their arrival. More importantly, however, it impedes the caller’s own ability to receive potentially lifesaving instructions from the dispatcher.

“We call our EMDs ‘the First First Responders,’” says Bain, “because they’re the first people at MEMS who touch that patient in a kind of patient care kind of way.”

MEMS, like many EMS providers through-out the U.S. and around the world, trains each of its dispatchers in the use of the Medical Priority Dispatch System (MPDS), an exten-sive set of research-based informational cards designed to enable a trained dispatcher to ask questions in a standardized way and

“Geography is the most challenging part of what we do.”

—Jeff Tabor

Angela Bain

Jeff Tabor

‘‘“We call our EMDs ‘the First First Responders

because they’re the first people at MEMS who touch that patient in a kind of patient care kind of way.”

—Angela Bain


then talk a caller through just about any type of medical situation until help arrives.

MPDS is also designed to accommodate differences in dialect and caller compre-hension levels, allowing the dispatcher to

“enhance the protocol” by asking questions in a different way (substituting “belly but-ton” for “navel,” for example), and offering options on how to work with child callers.

“It’s very stringent,” says Bain, “and for the most part, they want you to use this word-for-word, universally, because they have found in their research that these are the particular words that work with the great-est number of people.”

Facing the Geographical ChallengeMEMS continues to expand their capabilities in order to provide faster, better care in emer-gency situations to people within their dis-trict and beyond, often in unexpected ways.

The Trauma Communications Center Program (Trauma Comm), which is part of a larger statewide initiative that coordinates all trauma patient movement in the state, is another significant part of MEMS expanded capabilities.

Trauma Comm, implemented in 2011, not

only saves lives but can also radically improve the quality of life for patients, par-ticularly rural patients, by increas-ing their chances of good outcomes. In fact, it is home to a unique hand trauma telemed-icine program that has improved patient limb and digit retention by connecting peo-ple with hand injuries to surgeons for imme-diate assessment in real time.

“We coordinate 650 ambulances and heli-copters throughout Arkansas,” says Pro-gram Director Jeff Tabor, “with the goal of helping patients get rapidly admitted to a hospital that can provide the level of care they need” instead of spending precious time waiting in a facility that is not equipped to handle their injury.

“Geography is the most challenging part of what we do,” says Tabor, who grew up in Clar-endon farming country. “No matter the best intentions of the paramedics, that is often the limiting factor for ultimate trauma care.”

Beyond AmbulancesIn addition to its traditional ambulance ser-vice, MEMS equips and maintains a group of Special Operations Teams that can be

deployed in response to unconventional emergency situations.

These teams include the STAR (Spe-cial Tactics Advanced Response)

team, which provides tactical medical support to Arkan-

sas Law Enforcement in potentially hostile situa-tions; the SORT (Special Operations Response Team), whose members are trained to respond to

high-risk situations like chemical spills, mass casu-

alty incidents, swift water res-cues, and natural disasters; and the

Bike Team, which enhances MEMS response capabilities in any type of crowded or con-gested situation that would be inaccessible to a regular ambulance.

“People die because medical help can’t reach them quickly enough in a hostile envi-ronment,” says Swanson, “so we are con-stantly evolving our ability to reach and treat people more effectively, more safely, and more quickly, without exposing our per-sonnel to undue hazards.

“Our motto here is, we get better at what we do every day,” Swanson continues. “It’s always constant reinforcement, constant training, constant evaluation, and constant practice, based on lessons learned from real world experiences.”

“We have made promises to the commu-nity, that we are going to give them the best care we possibly can,” concurs Bain. “And that community happens to include our families. So you’d better believe we are going to do everything within our power to make those promises come true.” n

our motto here is, we get better at what

we do every day.

school nurses

More Than Meets

the EyeThe LiTTLe-Known worLd

of SchooL nurSeS

When school nursing began in 1902 in New York with Lina Rogers, it was an experiment to see if having a nurse in a school could decrease absenteeism. They found that by treating children with injuries and illnesses that were not contagious at school, students were able to stay in class. The school nurse was also able to identify children with disabilities that made learning difficult, such as poor vision and hearing. School nurses did send kids home when they had a

contagious illness, but they followed up with the family to teach prevention and

hygiene. The experiment turned out to be an extreme success. Within six

months the absentee rate had decreased by 90 percent. School

nurses are still doing the things that Lina Rogers began so long

ago, but our job has changed so much that if she were to visit our

schools today she might not recognize the specialty she helped to create (Elizabeth Hanink, 2013).

By Valerie Beshears, MSN, RN, NCSN, ASNA – Past President and Phyllis Ermer, BSN, RN, ASNA – President

It’s not all just about Band-Aids and liceMany people and nurses mistakenly believe that all school nurses do is to check for lice and put Band-Aids on paper cuts, but that is just not reality. While lice and Band-Aids are a part of our practice, there are many other health concerns that occupy most of our day. As a professional nurse, the knowl-edge we have gained about a wide variety of chronic health conditions allows stu-dents with complex medical conditions to attend school with their peers. Our assess-ment skills allow us to manage chronic con-ditions such as diabetes, asthma, seizures, obesity, and severe allergic reactions that may be life threatening. We plan care for students with complex medical conditions that require tube feedings, catheterization, and tracheostomy care and management. The school nurse provides support for our students that have a variety of mental health needs (NASN, 2013). The nurse is always on call for playground emergencies and acute illnesses that present during the school day.

It’s about challenges facing school nursing todayThe school population today is more medi-cally diverse, posing increasingly complex challenges for school nurses. Federal laws require that schools provide a safe learning environment for all students regardless of disability. With the help of school nurses, stu-dents who once would have remained home-bound or institutionalized are now educated alongside their peers (Robert Wood Johnson Foundation, 2010). With 98% of school-age children in the United States spending their days at school, the role of the school nurse is critical to the implementation of quality school health services. For many students, contact with a school nurse is often the only consistent access to the healthcare profes-sional (NASN, 2012).

‘‘18 JAN / FEB 2015 I HealtHcare Journal of little rock

school nurses

diagnosed each year (NASN, 2013). These students can sometimes be managed with oral medications or with a Vagal Nerve Stimulator, but some students require rec-tal medication or nasal Versed to control their seizures. The nurse can safely pro-vide all of these treatments so that the stu-dent can remain at school. The school nurse will develop a written plan of care for staff to follow until the nurse can administer the required medications.

The fastest rising chronic condition affect-ing our youth today is obesity. The obesity rate has tripled among children 6 to 11 years old and more than tripled for children 12 to 19 years old (NASN, 2013). Long-term health problems associated with obesity cost the healthcare system $120 billion each year (ACHI, 2013). Physical problems are not the only side effect of obesity; it has also been linked to behavioral and psychological

Statistics show that in a classroom of 25 students at least 4 of those students will have a health condition that can impact their abil-ity to be successful in the classroom (NASN, 2013). These conditions are chronic and can impact the student’s ability to learn. Manag-ing these conditions at school takes nursing knowledge and assessment skills.

The school nurse provides skilled nurs-ing care for students with chronic condi-tions. One of these conditions is diabetes. New cases of diabetes have almost doubled in the past ten years (NASN, 2013). Approxi-mately one in every 400 children under the age of 20 is diagnosed with diabetes (ADA, 2013). Diabetic students require frequent blood sugar monitoring, help with counting carbs, and insulin injections. Nurses provide continuing education for these students to help them learn to manage their condition which will allow them to become self-suffi-cient and productive adults.

Ten million children and youth have asthma in the United States, which amounts to 10% of students nationwide (NASN, 2013). Children with asthma miss more than 14 mil-lion days of school each year (ALA, 2013). These students can require nursing assess-ment, medication, and treatments at school to allow them to attend. The school nurse can help the student understand the importance of compliance with their prescribed medi-cations thus helping to decrease the num-ber of days missed due to asthma. Some of these students are able to safely manage their care on their own by carrying their inhalers with them during the day, however, there are many other students that cannot safely care for their asthma on their own. The school nurse provides their care by utilizing peak flow monitoring, nebulizer treatments, inhal-ers, and other treatments as prescribed by the student’s doctor.

The prevalence of food allergies in children under 18 has increased approximately 18% over the last few years (NASN, 2013). Food is the most common cause of a severe allergic reaction which can cause difficulty breathing or death. The foods most commonly asso-ciated with these types of allergies are pea-nuts, tree nuts, shellfish, cow’s milk, and eggs. These foods account for about half of all the

Diabetic students require frequent blood sugar monitoring, help with counting carbs, and insulin injections.

problems (ACHI, 2013). School nurses screen students in selected grades for elevated Body Mass Index. In 2012, Arkansas school nurses screened 214,809 students (ACHI, 2013). Our results showed that 21% of our students were obese, 17% were overweight, 59.8% were healthy, and 2.2% were considered under-weight (ACHI, 2012). Many school nurses work with their students to help them iden-tify more healthy food choices and challenge students to increase their physical activity. Nurses serve as valued members of their schools Nutrition and Activity Committees.

Some of our students are medically fragile and have complex, chronic medical condi-tions. These medically fragile students may require ventilators, tube feedings, and cath-eterization to participate in the school day.

cases of severe allergic reactions and approx-imately 100 deaths in the United States each year (ACAAI, 2010). This has caused many changes in our schools nationwide. Schools have begun to assess the foods served in the school cafeteria. The days of the peanut butter and jelly sandwich for lunch are over. Nurses coordinate care for students with food or other allergies by writing emergency care plans, training staff to administer emergency medications, and educating staff about pos-sible allergy triggers. School nurses educate students with allergies on self-administration of their medication and teach them to avoid their allergy triggers.

Seizures have one of the most dramatic presentations of the chronic conditions that are seen in the school setting. About 300,000 children under age 14 have some form of a seizure disorder (Epilepsy Foun-dation, 2012) and 45,000 students are newly

‘‘ HealtHcare Journal of little rock I JAN / FEB 2015 19

These students will have a written plan of care that is designed by the school nurse. In the school nurses survey for the school year 2013-2014, school nurses from nearly 96% of school districts and charter schools reported the number of chronic conditions in Arkan-sas’ schools. The key findings from the sur-vey reports there are 119,118 children identi-fied with chronic conditions such as asthma, ADHD, life-threatening allergies, obesity, cancer, psychiatric disorders, and diabetes. Medical procedures were required by 11,918 students. These procedures included blad-der catheterizations, gastrostomy tube feed-ings, blood glucose checks, injections, and occasionally peritoneal dialysis during the school day (Arkansas Public Schools Health Services Advisory Committee, 2014).

Mental health issues affect one in five students in our schools today (NASN, 2013). School nurses often provide referrals to appropriate mental health professionals. The nurse will provide medication admin-istration for these students while at school. It has been shown that school nurses spend on average 32% of their time providing men-tal health services to their students (NASN,

2013). Results from the 2012 School Nurse survey which was completed by only 25% of the school nurses in Arkansas, showed that there were 898 students counseled for risk of suicide and 50,348 students provided counseling for some form of mental or health issue (Smith, 2012).

School nurses work to prevent disease. Each year they assess the immunization records of their students. It has been shown that schools with nurses have a higher immunization rate than those without school nurses (NASN, 2013). Nurses assess their students for communicable disease with each visit to the nurse’s office. Trends in illness can be identified and reported to decrease the spread of contagious illnesses. The H1N1 flu epidemic was first identified by a school nurse because of the increased vis-its to her school clinic (NASN, 2013). In 2012 school nurses in Arkansas, along with health department staff, provided 178,646 flu shots that were given at vaccine clinics across the state (Smith, 2012). School districts across Arkansas continue to offer flu clinics annu-ally providing flu vaccine for faculty, staff and students.

School nurses in Arkansas provided 251,156 vision and hearing screenings during the 2012 school year. In addition to the rou-tine screenings, 23,252 students were referred for a vision exam, 11,309 students received an exam by a vision specialist. Thanks to the work of school nurses 9,926 students have improved vision during the school year (Smith, 2012).

It’s also about staff wellnessA staff wellness program can decrease employee absenteeism, increase productiv-ity, increase motivation to practice healthy behaviors, provide healthy role models for students and peers, and potentially decrease the cost of healthcare and insurance (Direc-tors of Health Promotion and Education, 2008). School nurses help promote staff wellness in the educational setting by pro-viding preventative services such as health screenings, physicals, and flu vaccine clinics. The nurse can coordinate health fairs that offer information on stress management, physical fitness, nutrition, smoking cessa-tion, and offer a variety of health related pamphlets and articles that promote opti-mum health.

Staff members utilize the nurse to help manage chronic conditions. The nurse pro-vides blood pressure monitoring, informa-tion on healthy food choices, medical self-care, and health promotion (Directors of Health Promotion and Education, 2008). As a member of the healthcare team, school nurses educate staff members on a variety of health concerns. These include physical conditions, emotional and mental health issues, stress related complaints, and acute illnesses. School nurses will recommend fur-ther evaluation by other healthcare provid-ers when appropriate.

Our assessment skills allow us to manage chronic conditions such as diabetes, asthma, seizures, obesity, and severe allergic reactions that may be life threatening.


It’s about who we areIn Arkansas school nurses are LPNs, RNs (Diploma, Associate’s Degree, or Bachelor’s Degree), APNs, nurses with advanced degrees, and nurses with national certifications. We work in relative isolation because we do not work in a traditional healthcare setting; we work in an educational setting. Our scope of practice is very broad. We can be generalists serving all students in the general educational setting or specialists that serve children in a special education setting with multiple nurs-ing needs. Any condition that affects a school-aged child will be seen in the school setting. The school nurse will be called on to manage all of these conditions whether it is a common condition like asthma or an obscure condi-tion that affects very few children nationwide.

School nurses are required to stay up to date on emerging technological advances because our students will be bringing these advances to school. Continuing education is vital for the school nurse. One way for our nurses to obtain this vital continuing educa-tion is to be a member of the Arkansas School Nurses Association (ASNA). The mission of ASNA is: to improve, promote, and advance the profession of school nursing through organizational unity and professional devel-opment among all school nurses and to pro-vide leadership in the delivery of quality health programs for the school community (ASNA, 2011). ASNA provides a yearly summer conference with continuing education oppor-tunities to allow our school nurses to keep up to date on new and emerging treatment modalities in order to provide better care for the school children of Arkansas. ASNA is a unified affiliate of the National Association of School Nurses (NASN). As such, members of NASN have access to a wide variety of online continuing education offerings.

It’s about school nurses speaking with one voiceASNA is a group of school nurses that are actively involved in advocating for the rights of our students and the needs of school nurses statewide. Although not affili-ated with either political party, ASNA seeks to help legislators pass laws that will pro-vide for quality healthcare for our students

while they are attending school.ASNA members, school nurses, and others

interested in the well-being of our students have been corresponding with the American Diabetes Association regarding training vol-unteer staff to administer insulin to students with diabetes. It is the position of ASNA that allowing trained volunteers to administer insulin is a dangerous practice that would put students at risk. We believe that because insulin can be dangerous if given in the wrong amount, allowing it to be given by unlicensed volunteers could have dire consequences. Our current Nurse Practice Act will not allow for the delegation of insulin and any bill that might be drafted to allow for this training will be in direct conflict with the School Nurse Guidelines as written by the Arkansas State Board of Nursing (ARSBN, 2007) and with the Nurse Practice Act (Arkansas Code 17-87-705, 2011), and the Rules and Regulations Chapter Five on Delegation (ARSBN, 2008).

ASNA was pleased with the passage of ACT 414 during the last legislative session and looks forward to legislation that may come from the work the Arkansas Public Schools Health Services Advisory Committee has completed to date. This committee has been collecting data about school health services such as who is providing the health services in our schools, who should be providing these services, what equipment is needed to pro-vide school health services, and where these services are to be provided. This committee was charged with assimilating the informa-tion collected and making recommendations to the Department of Education in an attempt to fix disparities in the level of health services provided in different districts across the state (ARKLEG, 2013). A report was presented to the Arkansas House and Senate Committee on Education in September 2014. Within the report were the guidelines for best practices as identified by the committee and recom-mendations for continuing the work of the committee to address other areas of concern that were identified during the first years data collection (Arkansas Public Schools Health Services Advisory Committee, 2014).

ASNA believes that School nurses save lives and help children learn and that every student deserves a nurse all day, every day. n

Works CitedACAAI. (2010). American College of Allergy, Asthma,

and Immunology. Retrieved 03 23, 2013, from http://

www.acaai.org/allergist/allergies/Anaphylaxis/Pages/

default.aspx

ACHI. (2013). Arkansas Center for Health Improvement.

Retrieved 03 23, 2013, from http://www.achi.net/Chil-

dObDocs/Fact%20Sheet%20on%20Childhood%20

and%20Adolescent.pdf

ADA. (2013). American Diabetes Association.

Retrieved 03 23, 2013, from http://www.diabetes.org/

diabetes-basics/diabetes-statistics/

ALA. (2013). American Lung Association. Retrieved

03 23, 2013, from http://www.lung.org/lung-disease/

asthma/creating-asthma-friendly-environments/

asthma-in-schools/

Arkansas Code 17-87-705. (2011, 12). Arkansas State

Board of Nursing. Retrieved 03 24, 2013, from http://

www.arsbn.arkansas.gov/forms/Documents/NursePrac-

ticeAct2.2013.pdf

Arkansas Public Schools Health Services Advisory Com-

mittee. (2014). Report to the Arkansas House and Senate

Committees on Education. Little Rock, Arkansas.

ARKLEG. (2013, 03 15). Arkansas State Legislature.

Retrieved 03 24, 2013, from http://www.arkleg.state.

ar.us/assembly/2013/2013R/Acts/Act414.pdf

ARSBN. (2007, 09). Arkansas State Board of Nursing.

Retrieved 03 24, 2013, from http://www.arsbn.arkansas.

gov/lawsRules/Documents/schoolnurseguidelines.pdf

ARSBN. (2008, 12 1). Arkansas State Board of Nursing.

Retrieved 03 24, 2013, from Rules - Chapter 5: http://

www.arsbn.arkansas.gov/lawsRules/Documents/Rules_

Chapter5_Dec_2008.pdf

ASNA. (2012). Arkansas School Nurses Association.

Directors of Health Promotion and Education. (2008).

Mississippi Office of Health Schools. Retrieved 03 24,

2013, from http://www.healthyschoolsms.org/staff_

health/documents/EntireGuide.pdf

Elizabeth Hanink, R. B. (2013). Working Nurse. Retrieved

03 23, 2013, from http://www.workingnurse.com/

articles/lina-rogers-the-first-school-nurse

Epilepsy Foundation. (2012). Epilepsy Foundation.

Retrieved 03 23, 2013, from http://www.epilepsyfoun-

dation.org/livingwithepilepsy/youth/index.cfm

NASN. (2012). National Association of School

Nurses. Retrieved 03 23, 2013, from www.nasn.org/

policyAdvocacy/RatioImprovementBills

NASN. (2013). National Association of School Nurses.

Retrieved 03 23, 2013, from http://www.nasn.org/

MemberCenter/SchoolNurseAdvocacyToolkit

Robert Wood Johnson Foundation. (2010). Unlocking

Potential of School Nursing: Keeping Children Healthy,

In School, and Ready to Learn.

Charting Nursing’s Future. Smith, P. (2012). Arkansas

School Nurse Consultant.

school nurses

ebola response

By A.D. Lively

Ebola Crisis

Connecting and Communicating: Arkansas’s Response to the

While EVD (Ebola Virus Disease) poses an extremely low risk to Arkansas and our healthcare system, the frequency of international travel demonstrates that everyone should be prepared to respond to the task of treating potential EVD patients. (Arkansas Department of Health Advisory, August 8, 2014)

ebola response

THE lEADing public HEAlTH authority and support system for all public health-related issues in Arkansas, including the state’s response to the Ebola epidemic, is the Arkansas Department of Health (ADH). One of ADH’s highest priorities is to ensure that all healthcare providers and emergency systems in the state are fully coordinated, trained, and equipped.

“it’s conceivable that a patient could land at any hospital,” says State Epidemiologist and Medical Director for communicable Dis-ease Dirk Haselow, MD, phD. “So every hos-pital in Arkansas has been informed about how to identify and isolate a patient, and equipped with enough ppE (personal pro-tective Equipment) to care for that patient for a brief period of time while we help them determine the next steps.”

“next steps” might include calling in help from the centers for Disease control (cDc), obtaining supplies from the strate-gic national stockpile, or moving the patient to another facility that can meet his or her needs, says Haselow, who is also an assistant professor of epidemiology at the university of Arkansas for Medical Sciences (uAMS).

The need for this level of readiness extends beyond hospitals to all manner of healthcare providers. personnel at any given physician’s office, emergency medical ser-vice, laboratory, community health center, or coroner’s office, for example, might be called upon to play an important role in an Ebola-related scenario, which is why ADH’s goal is to make sure that everyone at every level of healthcare delivery is prepared.

“Preparing for Ebola has definitely high-

lighted the need for ongoing collaboration

and communication with stakeholders

around the state. This is not an issue that any one group can

manage independently. You have to work as a

great big team.”—Dirk Haselow, MD, PhD

Ebola Crisis


ebola response

Building and Strengthening RelationshipsA large part of ADH’s efforts have focused on disseminating reliable, up-to-date informa-tion and instructions, not only to the health-care community but also to the many and varied other groups that might play a role in reporting or preventing the spread of Ebola, including:

•Schools, colleges, and institutions of higher education, both directly and through the Departments of Education and Higher Education

•Day cares and nursing homes•State and local government offices,

including the governor’s office, county Judges, county Emergency Managers, and local Health Departments

•Waste and wastewater management facilities

•Charitable and faith-based organizations with global outreach, like Heifer interna-tional and Faith First, and

•Businesses, both through State and local chambers of commerce and directly,

with particular attention to companies like Walmart that do a large amount of interna-tional business.

•The media and the general public.“ADH has always worked with partners

throughout the state and region to prepare for a variety of events that could impact the health of the citizens of Arkansas, including natural disasters, pandemic flu, a bioterror-ist event, or a radiological event,” says cathy Flanagin, ADH Director of communications, noting that one positive aspect of the flurry of Ebola-related activity has been the oppor-tunity to strengthen existing partnerships and encourage new ones.

“preparing for Ebola has definitely high-lighted the need for ongoing collabora-tion and communication with stakeholders around the state,” concurs Haselow. “This is not an issue that any one group can manage independently. You have to work as a great big team.”

Communicating Change“i want to stress that this has been and con-tinues to be a dynamic and changing situa-tion, so as cDc guidance and other efforts evolved, so have the ADH materials and response.” says Flanagin.

ADH has informed its partners of these frequent changes through a staggering array of letters, media alerts, audience-spe-cific guidance documents, conference calls, seminars and webinars, signage, and expert visits to local and regional meetings. These communications efforts are crucial, since policies and protocols are changing con-stantly as observation and research reveal

more information about Ebola’s behavior.One of the primary tools the ADH uses

to disseminate this rapidly-changing infor-mation is the Arkansas Health Alert network (HAn), which connects ADH directly and securely to the centers for Disease control’s nationwide emergency preparedness and response system. The HAN system, which was already in place before the Ebola epi-demic, allows ADH to instantly relay the lat-est available, vetted information to its thou-sands of subscribers via email, voice mail, or text. Anyone interested in receiving these notifications, which are classified according to levels of importance and urgency, can register on the ADH website, www.healthy.arkansas.gov.

in recognition of the need to be accessible and responsive for advice and guidance on a case-by-case basis, ADH has also estab-lished an Ebola-specific emergency commu-nications center (commonly known as “the hotline”), a 24-7 phone triage system con-necting everyone in Arkansas to its experts in real time. Anyone with questions, con-cerns, or reports of a possible Ebola case is encouraged to call 501-661-2136 for imme-diate assistance from ADH.

Focusing on FactsWhen the cDc issued a HAn advisory on October 2, 2014, confirming the first case of Ebola diagnosed in the united States had been identified in Dallas, the nearly contin-uous, and often alarmist, media coverage of the Ebola epidemic reached a fever pitch.

“nearly 30 percent of all media coverage in October 2014 was spent on Ebola,” says J.

J. Gary Wheeler, MD, MPS

Dirk Haselow, MD, PhD

‘‘“Nearly 30 percent of all media

coverage in October 2014 was spent on Ebola, although I am very proud

of the local media in Arkansas because, unlike our national media,

they remained very factual.”—J. Gary Wheeler, MD, MPS


gary Wheeler, MD, MpS, Medical Director of ADH’s infectious Disease branch, “although i am very proud of the local media in Arkan-sas because, unlike our national media, they remained very factual.”

The actual risk of contracting Ebola in the united States is miniscule, notes Haselow, with the chances of even encountering an actual Ebola patient in Arkansas less than 1 in 100 million. people are far more likely to die of the flu or another infectious disease. He goes on to cite misconceptions triggered by nonfactual books and movies, particularly those depicting Ebola as a potential bioter-rorist tool, as contributing to the sensation-alism and fear.

“What we’re seeing here, though, is natu-rally occurring Ebola that has evolved slowly from the animal reservoirs in West Africa, and it’s only transmitted by direct contact with an infected person or their bodily fluids, or with a decedent. Or in Africa potentially with bush meat, but that’s not an issue here.”

“We know how to contain the virus. it’s not that hard to do, with the right equipment and protocols,” Wheeler says. “but we also

make a real mistake if we don’t acknowledge the panic and confusion that exists out there, and give it some credibility.”

The Prevention Pipeline Ends in Arkansasin the face of the ongoing epidemic, the Department of Homeland Security coordi-nated with the cDc and the national Security council to develop and implement a number of protocols designed to prevent the arrival and spread of Ebola into the u.S. through international travel.

As of October 21, international travelers coming from countries with active Ebola outbreaks are now routed exclusively through five airports around the country. Enhanced passenger screening begins with u.S. customs and border protection (cbp) personnel visually reviewing all travelers entering the united States for overt signs of illnesses. Enhanced screening continues with active monitoring at the traveler’s destina-tion, meaning they are checked on at least once a day by public health officials for 21 days (the longest period of time the virus is

known to incubate) after their arrival. “if their final destination is Arkansas, then

that information is shared with ADH immedi-ately, before they even arrive,” says Haselow. “We call the passenger upon arrival, and then we check in with them at least daily for 21 days to report any symptoms and take their temperature on the phone with us.”

He points out that, while all state health departments are following the cDc’s rec-ommendations, Arkansas is adding an extra layer of protection by applying some degree of quarantine to everyone being actively monitored. The degree to which this is imple-mented is based on the cDc risk evaluation algorithm, which sorts travelers from Ebola-affected countries into categories of high, low, or no known exposure risk.

“We have chosen to be very conserva-tive. So if someone was a low-risk category person, we would ask them to avoid public spaces, for example, but they could travel by car,” says Haselow. “While if someone is in a high-risk category, of course we apply a higher degree of quarantine. it is really on a case-by-case basis.”

‘‘Part of the Ebola

response was increased and updated training on the

use of personal protective gear, as demonstrated

here by MEMS Executive Director,

Jon Swanson.


ebola response

Care Provider-Patient Communication: The Last Line of DefenseAs a final layer of “on-the-ground” screen-ing and security, ADH has asked all health-care providers in Arkansas to supplement federal and state efforts by implementing the cDc’s “identify, isolate, and inform” policy in their facilities by displaying provided sig-nage at their entrances asking patients who have recently travelled from Ebola-affected countries to self-identify upon arrival.

ADH has also requested that all providers add a single question to their triage: “Have you traveled anywhere outside the united States?” if the answer is no, then it is highly unlikely that the patient has Ebola, while a “yes” would require additional questioning about whether or not the patient had been to any of the Ebola-affected countries. if the answer to that question is “yes,” then provid-ers should consider that patient a person of concern and follow the latest cDc guidelines for patient isolation.

“if you identify someone who is at risk,” says Haselow, “you should get them out of your waiting area, put them in a room, shut the door, and inform us here at ADH by call-ing our 24-hour hotline at 501-661-2136. At that point we can help manage the situation

and provide some guidance.”While the ADH should be informed imme-

diately—and in fact all Arkansas healthcare providers are required by law to report per-sons suspected of Ebola and a variety of other virulent infectious diseases as soon as possible—there is no reason to panic, cau-tions Haselow.

“people are not usually highly infectious in the early stages of the disease. So what’s going on is urgent, but maybe not emergent. Once the patient has been identified and iso-lated and ADH has been informed, we can all take a deep breath and think through the best strategy for minimizing potential exposure on a case-by-case basis.”

not only will the rapid identification of an at-risk patient protect the general popula-tion from the spread of the virus, but it will also provide the best outcome for the patient, since early intervention is directly correlated to the increased likelihood of survival.

“These protocols we’ve put in place, screening people and isolating them when they are symptomatic, are going to work,” says Haselow. “While we may experience a few more isolated cases in the united States, we are prepared to handle them.”

“The real epidemic is still in W. Africa,” says Wheeler. “To keep truly safe in Arkansas, we have to focus on controlling the epidemic there. And we are nowhere near that yet.” n

‘‘“I want to stress that this has

been and continues to be a dynamic and changing situation,

so as CDC guidance and other efforts evolved, so have the ADH

materials and response.”—Cathy Flanagin, ADH Director of Communications

dialogue

One on One with Troy Wells

President & CeO

BaPtist HealtH

Troy Wells is the president and chief

executive officer of Baptist Health,

which is the largest healthcare system in

Arkansas. Wells has been in this position

since June, 2014 when he was selected

by Baptist Health’s board of trustees to

succeed longtime president and CEO

Russ Harrington upon his retirement.

“The spirit in the state is we’ve got an opportunity

to really do something unique. And I really think at the end of the day the

leaders of our state are going to embrace that and will want to continue to be a part of that opportunity.”


dialogue

Prior to being promoted to lead Baptist Health as its CEO, Wells served as senior vice president of administrative services for the Baptist Health system. Wells also previously served as chief executive offi-cer of Arkansas Health Group and vice president of Practice Plus, which are divisions of Baptist Health that specialize in physician staffing within the system and the management of affiliated physician clinics.

Wells joined Baptist Health in 2006 as the vice president of clinical services with system responsibility for pharmaceutical services, respiratory care, emergency services and MedFlight, and a pharmacy and gift shop as well as oversight of Baptist Health Medical Center-Arkadelphia, Baptist Health Medical Center-Heber Springs, and Baptist Health Medical Center-Stuttgart.

Before joining Baptist Health, Wells was the chief operating officer of Newport Hospital & Clinic providing strategic and operational direction for the hospital, retail pharmacy, two medi-cal-equipment companies, physician practices, recruitment, medical-staff relations, and a home health agency.

Wells earned a master’s degree in health services administration from the University of Arkan-sas at Little Rock and received a bachelor’s degree in microbiology from the University of Arkan-sas in Fayetteville.

Wells is an associate of the American College of Healthcare Executives, serves on the University of Arkansas at Little Rock alumni board of directors, and is a member of Calvary Baptist Church in Little Rock.


Chief Editor Smith Hartley In June, 2014 you replaced Russ Harrington. Describe for us the transition and what he meant to Bap-tist Health.

Troy Wells The transition really started a long time before people realized, I think. Our board began working with Russ about two years ago on a transition plan. I wasn’t aware of that, obviously, but they were very purposefully evaluating me and others internally and trying to decide if after 40 years of having the same CEO if an internal candidate was going to be appropriate and capable, or if they needed to recruit from the outside. Fortunately for me, and I think for all of us, they felt comfortable that there was an internal person that could replace Russ and that person ended up being me. But the point of that is the transition started way before it was visible. There were things happening behind the scenes for a while that I think prepared me to be here. So, I think that helped. Looking back there were some very purposeful things that he did and that I was involved in that made the transition pretty seamless.

But I think the most important part has to do with the group of people that I work with. That consistency and stability of our senior management team made this almost a non-event from an operating the com-pany standpoint. Somebody asked, “What was your biggest surprise since the transi-tion?” I said, “There haven’t been any.” Now there could be. Tomorrow I may wake up to something crazy, but between myself and the rest of the senior team it has just been a real smooth transition. And I give them credit for that.

Editor Can you explain the Baptist Health vision and how that meets the current healthcare delivery environment?

Troy Wells Let’s talk about the environment first. Most people associate the environ-ment with the Affordable Care Act and the reform that comes along with that. I’m not at all going to minimize that. It’s significant.

That’s the industry. But there was movement in healthcare prior to that, that I think in some ways made the Affordable Care Act, at least some of its concepts, make sense to people and put things in perspective. But healthcare was changing long before the ACA came into play. It was really a drive towards a couple of things. Transparency in the system around quality and around cost. It was a lot about the increasing costs year after year in healthcare. And I think univer-sally in our country, chronic disease and the cost to the healthcare system that’s kind of been left unchecked for many, many years, and not really understood, has created this environment of, “Look, we’ve got to do some things differently in healthcare for us all to survive and to continue to have a health-care system that we can be proud of and can afford.”

So with all of those things going on, along comes the Affordable Care Act, which just really accelerated the need to change and adapt to the environment that we’re in. So with all that in mind, we did craft a new vision for Baptist Health. A couple of years ago we were going through our plan-ning process and decided we needed a very understandable, short vision statement that

reflects what we are trying to accomplish in this changing environment that we find ourselves in.

So our vision is that Baptist Health will improve the health of Arkansans by chang-ing the way healthcare is delivered. That’s our vision statement and what that means is that we understand we can’t do things the same way we have been if we really want to improve health of people in Arkansas. It also reflects the fact that, and we talked about this a lot when we did it, sixteen years ago our name changed. It went from Managed Medical System to Baptist Health and I think the spirit of that, even back then was, we’re more than just hospitals and clinics taking care of acute needs. The spirit is really heal-ing, but it is also creating health. I think it took all those years for us now to realize what does that mean and how do we actu-ally go and do that so we can make Arkan-sas a healthier community and also provide healthcare that’s affordable to people in our state?

Editor What’s the importance of sustaining the Private Option and how has it helped Arkansas become a national leader in reducing the number of uninsured?


dialogue

‘‘Troy Wells Well there’s over 200,000 people in my mind that makes it very important to sustain. We’re able to care for people today better because they have a way to pay for care. We’ve always provided charity care. We provided $50 million dollars of it last year. We’ll continue to always have charity care, but to have people who don’t run from the system because they can’t afford it is dif-ferent. They come to us now where we can help them better, because they are willing to come and see us. It will take time I think, for people’s behavior to slowly change. People don’t overnight stop going to the ER when

they have a need. Because they’ve always done that. That was their sole resource for health. So that doesn’t change overnight, but you see hope that now it’s possible because they have other options that they haven’t had up to this point. So it’s really important for the people of Arkansas. Obviously the healthcare system in Arkansas, the provid-ers, doctors, and hospitals, benefit from that because it does help with that $50 million that Baptist Health provided – it helps off-set some of that. And that’s going to be the case throughout our state, so it’s important from that perspective.

The other thing that’s important for peo-ple to understand is that the cost of this was not done by itself. Providers in Arkan-sas have had and will continue to have over the next 8-10 years, Medicare cuts. They paid for this by taking money from the Medicare program and giving it back to the states to help with the uninsured. So we’ve already taken that hit from Medicare and are going to continue to have that year after year. It wasn’t like we just added new dollars into the healthcare system. We shifted it from one place to the other.

We are kind of leading the country in this effort. I don’t know that we have done all we can do to wave that flag, mainly because you never know if it’s going to continue, but it’s significant for the obvious reasons we talked about, but also it gets back to the environment we talked about. What’s hap-pened between the Centers for Medicare and Medicaid Services (CMS) at a federal level and then the state of Arkansas, you’ve cre-ated this opportunity for innovation in how we take care of people and improve qual-ity. There’s a CMS Innovation Center that has all these experimental efforts that the

“We had a group of thirty physicians who said, “We want to build a hospital in Conway. We want another option in our community and we want to work with Baptist Health.”


government has invested in, creating pilot programs across the country, and we are participating in one of them. But there have been multiple of these projects saying, “Look if you come up with a great idea, we’ll help you fund that and let’s see if you can actu-ally change the way you are delivering care. If it works, we’ll keep putting money into it and replicate it somewhere else.” So you’ve got all that going on then you’ve got the Pri-vate Option in Arkansas and we’ve now got money to help folks who are worst in the country in terms of chronic disease. I think out of that has come a whole lot of innova-tion and we are going to continue to see that. The spirit in the state is we’ve got an oppor-tunity to really do something unique. And I really think at the end of the day the leaders of our state are going to embrace that and will want to continue to be a part of that opportunity. I really do. So I am encouraged that when the dust settles from the elections, given some time, our state leaders will figure out a way to make this work for Arkansas.

Editor Why did Baptist Health decide to build a hospital in Conway? And what is the status of that project?

Troy Wells The hospi-tal is under construc-tion right now. We expect to open it in the Spring of 2016. The reason we decided to build a hospital in Conway has several factors. One, Baptist Health has always gotten involved in communities when we are asked to. And we’ve not gotten involved in communities when we weren’t asked to. So we are always invited. Whether it’s the Stuttgart facility that came in 2009, we were asked to come to Stuttgart. Hot Spring County joined our system earlier this year and we were asked to come to Malvern, Hot Spring County. And Conway was no different. We had a group of thirty physicians who said, “We want to build a hospital in Conway. We want another option in our community and we want to work with Baptist Health.” You don’t take that lightly. It wasn’t an automatic yes, but a, “Let’s talk.” It required a lot of work on our part to make sure we felt comfortable that there was a need for an additional hospital in Conway, which we believe there is.

The other thing that’s important to know is that we didn’t make the decision solely

about Conway, it’s sort of about that region of the state, there are four or five counties that make up that community, and we think that Baptist Health can create more growth in the healthcare market in that commu-nity and we think having another option for people is good and that’s what they are going to get. We’ve had resounding sup-port from the community everywhere we go. People are happy that we are going to build another hospital in Conway. It’s going to be a great location on the interstate. It’s going to improve access up along that cor-ridor. It’s really a unique relationship; very

different from anything else in Arkansas. The doctors don’t own part of the

hospital, but they are going to co-manage it with us. So

we’ve created a manage-ment structure that is inclusive of physicians, so decisions made about how we oper-

ate the facility, what we invest in, what we don’t

invest in, they have a seat at the table and they will also

be accountable for some of those decisions. So it’s really a unique model.

Editor What is Baptist Health’s philosophy and approach to collaboration with public hospitals and health entities?

Troy Wells It’s part of our strategic plan. It’s specifically outlined in our strategic plan that we understand partnerships and collab-oration are important for us to achieve our goals and our vision. We have active conver-sations going on with multiple health sys-tems and other non-health systems in the state to explore various partnerships and collaborative efforts. I can’t disclose what those are right now, but it’s very active and I was in a meeting for two and a half hours yesterday in one of those sessions and we think there are a lot of opportunities for all of us to get better and to improve the health system in Arkansas, make it more affordable and improve quality.

...Our visiOn is tHat BaPtist

HealtH will imPrOve tHe HealtH

Of arkansans By CHanging tHe way

HealtHCare is delivered.


dialogue

Editor Part of the mission is to not so much be a business, but a ministry. How does Bap-tist bring the “Baptist” to its health services?

Troy Wells It’s our people. It’s all about our people. It’s culture. People make culture and the culture at Baptist Health has been cre-ated over the last 95 years, almost, and it’s very much faith-based. I will give you an example of what I mean. I’ve spent the last three or four months going around the sys-tem and talking to employees and I always ask two questions. I ask, “What are you most proud of at Baptist Health and where do we need to improve?” I want to hear from peo-ple what their responses are and collect all those, compile them to see what people are saying.

The resounding number one response is, “I’m proud of the fact that we are a faith-based system and I’m proud of the fact that we pray before meetings and that I can pray with my patients and they want me to do that. It’s part of who I am and I get to express that in my work.” That’s what makes us different.

Editor Other than Conway are there other capital projects that you are working on?

Troy Wells That’s the biggest one. $150 mil-lion. There’s a lot of routine stuff that we’re doing, but that’s the big one right now.

Editor How’s technology changing the hos-pital business?

Troy Wells It’s changing quite a bit. I think there’s this promise of what electronic health records are going to deliver and some peo-ple thought when you turn them on that the promise was going to be fulfilled. Clearly it’s going to take time for the technology to integrate with the clinical practice and really continue to refine that. One of the big prom-ises is that everybody will have everybody’s information and wherever a patient is that information will be there. It’s not that simple, but I think it’s going to happen. It will hap-pen—it’s just going to take time and probably more investment than we ever imagined. But at the end of the day, we do think the technol-ogy can enable providers to have access to

information they need to take care of patients wherever the patient shows up, whether it’s here, or you’ve been here and then you end up in Northwest Arkansas, that provider is going to have access to clinical information that’s going to help him take care of you when you are in their facility or doctor’s office.

So the technology clearly has had an impact from that perspective. I think the other thing we see more and more innova-tion on and more and more entrepreneurs trying to figure out is how to use digital technology and integrate that into health-care, whether it’s Smartphone apps or the Fitbits. It’s fun to have a Fitbit, because you can see how many steps you took today, but how do you take that same concept and now use that information in a way that’s going to help a physician or nurse somewhere fol-low what’s happening with you. So they can intervene when appropriate because they have information about your health sta-tus. I think there are all kinds of interesting things with technology that are happening and people will innovate and find ways to improve healthcare with that technology.

“...we continue to invest in our people,

because as I said earlier that’s what makes us different. So we continue to

focus on our people that deliver care, the people that

make a difference in the lives of so

many others.”


Editor Have hospitals become more focused on their infectious disease protocols since recent events with Ebola?

Troy Wells I think most of the work is around training and preparation—it’s the “what if” scenario. I don’t think we’ve changed any-thing we’ve done in terms of infection practice, but there is heightened aware-ness. There’s enough out there already that, whether it’s personal protective equipment or protocols or how you deal with infectious waste or whatever, there are so many things that are out there today that are dangerous to healthcare workers, that they are on high alert. Certainly there are different precau-tions you have to take with Ebola, but it’s not been any kind of panic. It’s more about let’s go over this again, let’s train, let’s pre-pare, make sure we have the people we need and the equipment they need to take good care of patients should we get in that type of situation.

Editor How does Baptist Health competi-tively set itself apart in this market?

Troy Wells I think in a couple of ways. One, we continue to invest in our people, because as I said earlier that’s what makes us differ-ent. So we continue to focus on our people that deliver care, the people that make a dif-ference in the lives of so many others. I think the other way we make ourselves com-petitive is that we work well with doctors, whether it’s through our company where we employ physicians or whether it’s working with independent doctors and staff our hos-pitals. How we go about that I think is really significant and important and we’ve done a lot of work in the last two or three years to improve how we work with physicians, how we find common things that we both can agree we are going to work on and fix and improve for the sake of our patients, and engaging them differently around clinical issues has been real important for us.

I think the partnerships and collabora-tive efforts that we undertake will be signifi-cant in terms of competitive advantage. How

we relate to payers so employers know that when we are involved in a health plan that patient is going to get taken care of and the costs are going to be what they should be and the quality is going to be what it should be. So focus on those things is what I think gives us the competitive edge.

Editor I understand that you are pretty innovative with your physician alignment strategies. Can you explain a little bit the kinds of things you are doing?

Troy Wells Sure. Back in 2012 is when it offi-cially started. We had been working on it for a couple years prior to that, but we created an organization called Baptist Health Phy-sician Partners and it was really a way to associate or affiliate a group of physicians

that had no other formal affiliation with one another and put them in this organization, which they managed. The whole organiza-tion was created to get physicians aligned around improving quality. The whole key to it is can you create financial incentives that help physicians to pay for their time and their effort and their energy to change what they are doing in clinical practice and then reward them for being successful when they do it? That’s why the organization was built. It’s managed by physicians. I think there are 24 members and 14 are doctors, then there are four or five of us executives from Baptist that sit on that board, but they run it. It’s a separate organization. We have a separate executive director who manages that company. They’ve been successful this year in generating improvements in quality


dialogue

and reducing some costs. So we are starting to see the fruits of their labor and it’s start-ing to pay off. It’s exciting and encourag-ing. But that’s probably the biggest differ-ent thing we’ve done with doctors over the past few years.

It was really a long term strategy. We went into it saying it was a ten year deal for us to really make this work.

Editor Finally, as a new CEO can you describe your management style? What does the current environment and culture require of you as a leader?

Troy Wells This may answer both questions. One thing that is extremely important to me is that people continue to invest in them-selves and get better. So part of my job is to facilitate that, to make that part of the expectation I have for people who work for me—everybody’s got to get better. That’s probably my broken record, “Everybody’s got to get better today.” That’s kind of my theme. If you ever stop working on your-self you’ve kind of come to the end of the road, so I think it’s important that people continue to try to learn and develop them-selves as leaders. My job is to help people

do that, to create an environment where it’s easy for an employee to know, “Hey Troy wants me to get better, he’s going to pro-vide the resources for me to get better, and he’s going to hold me accountable to make sure I’m getting better.” That’s my style and I think that others who work for me have to do that as well.

Editor As far as that charge to others, what are some of the things you are doing to make yourself better?

Troy Wells Just like the people that work for me, I have a development plan that I put together, and it gets freshened up each year, but it’s not rocket science. It’s what am I good at that I can do more of, where do I need to improve as a leader, and what are some things I can do in the next 12 months to affect those things? I have a written plan that I share with my board that says, “Here’s how Troy’s going to get better.” n

‘‘“One thing that is extremely

important to me is that people

continue to invest in themselves and get better. So part

of my job is to facilitate that.”


briefshealthcare N e ws I P eo P l e I I N fo r m at I o N

From left: Lt. Cmdr Jaqueline Jung, Lt. Cmdr Mike Austin, UAMS Chancellor Dan Rahn, MD, state Sen. Jane English and Brig. Gen. Keith Klemmer, Deputy Adjutant General, Arkansas National Guard.

Dozens of veterans in attendance and hundreds more

employed by UAMS were honored at an appreciation breakfast, at

which the university itself was presented with the state’s highest

honor for an employer’s service to its veterans. The Pro Patria

Award, given by the Arkansas Employer Support of the Guard

and Reserve (ESGR), was presented by state Sen. Jane English,

chair of the ESGR, and accepted by UAMS Chancellor Dan Rahn,

MD. The Pro Patria Award is given to three employers statewide

— one small, one large and one public sector — for leadership and

policies that ease participation in the National Guard or Reserves.

UaMS receives Pro Patria award


the arkansas medical society, “sVmIC has a

local presence to support us including 3 local

representatives living in arkansas, as well as

a fully staffed office in nearby memphis. fur-

ther, we feel as though arkansas physicians

are well represented in the leadership of the

sVmIC Board of Directors and are proud that

an arkansas physician, Dr. John lytle of Pine

Bluff, has been elected as the next Vice-Chair

of sVmIC’s Board. this structure gives me great

confidence that sVmIC will continue to be in

close touch with the issues faced by arkansas

physicians.”

sVmIC was founded by physicians in 1976 and

provides mPl coverage in tennessee, arkansas,

Virginia, Kentucky, Georgia, alabama, and mis-

sissippi. sVmIC has maintained an “a” (excel-

lent) or better rating from a.m. Best Company

for more than 30 years.

aDh receives Grant for Blood Pressure control Projectthe arkansas Department of Health (aDH)

recently received an association of state

and territorial Health officers (astHo) mil-

lion Hearts learning Collaborative grant for

high blood pressure (hypertension) control.

arkansas is one of six states that received this

grant. the grant, totaling nearly $127,000, was

awarded for innovative approaches in high

blood pressure control and management.

aDH will implement “Community team-based

Care for Uncontrolled Hypertension” by part-

nering with Dr. Charles Vermont, a community

physician in Prescott. the partnership will also

include aDH, the Nevada County local Health

Unit, all Care Pharmacy, Nevada County Hos-

pital, and insurance providers.

Beebe Names OhIt Interim Director Governor Beebe has appointed shirley a. tyson

as Interim Director of the arkansas office of

Health Information technology (oHIt). tyson

took the position on December 1, 2014, follow-

ing the retirement of current Director ray scott.

tyson has served as the Chief technology offi-

cer for oHIt since its creation in 2010. a native

arkansas Medical Society endorses SVMIcthe arkansas medical society has selected

state Volunteer mutual Insurance Company

(sVmIC) as their exclusively endorsed carrier

for medical Professional liability/malpractice

(mPl) coverage effective January 2015. sVmIC

has been insuring physicians in arkansas for 25

years, making it the largest and longest contin-

ual writer of mPl coverage in the state.

sVmIC’s arkansas advisory Committee is com-

posed of 9 physicians from various specialties

throughout arkansas. In fact, says Dr. Dennis

Yelvington, Chair of the Board of trustees of

State

South central telehealth Forum to be held in March the third annual telehealth conference for the arkansas, mississippi,

and tennessee region promoting the use of telecommunications

technologies to support distance healthcare will take place on march

2nd at the Hilton Jackson Hotel in downtown Jackson, mississippi.

the south Central telehealth forum is organized by the University

of arkansas for medical sciences (Uams) Center for Distance Health

and the south Central telehealth resource Center, which serves

arkansas, mississippi, and tennessee. experts from the region will

give presentations, lead discussions and network about telehealth.

Nationally recognized reimbursement expert Nina m. antoniotti, rN,

mBa, PhD, will be the keynote speaker. she is the program director

of the marshfield, wisconsin-based marshfield Clinic teleHealth Net-

work. the conference also will feature nationally recognized speakers

and panelists from the south Central region of arkansas, mississippi,

and tennessee. Discussion panels will focus on clinical, education,

administrative, and technical aspects of developing telehealth pro-

grams and will demonstrate regional programs.

several technology vendors and other businesses and organizations

also will have booths and exhibitions at the conference. Continuing

education credits will be offered.

the cost for the conference is $160 per person. an early bird rate

of $135 is available through feb. 1. for more information and to reg-

ister, go to learntelehealth.org/sctf2015 and click on “Conference

registration,” or call (855) 664-3450.

go online for eNews updatesHealtHcareJournallr.com


•Smoking history of at least 30 pack years (an

average of a pack a day for 30 years; to deter-

mine pack years, multiply the number of ciga-

rettes smoked a day by the number of years

smoked.)

•Generally in good health with no history of

lung cancer

“with the low-dose Ct, we can see things as

small as a millimeter,” said thomas Koonce, mD,

a diagnostic radiologist at CartI. “the clear pic-

ture provided to us through these scans also

allows us to track any growth and change in

character of suspected abnormalities. this

tool also gives us the potential to identify other

non-cancerous health problems that may exist

for patients who have smoked for a long time,

like emphysema.”

James Named arkansas research alliance Fellowthe University of arkansas for medical sciences’

(Uams) laura James, mD, was announced as

an inaugural fellow of the arkansas research

alliance (ara) during a news conference at the

state Capitol.

the ara fellows program recognizes distin-

guished university research leaders who are

already working in the state. ara fellows are

nominated by their chancellor and receive a

$75,000 grant paid over three years. James is

a pediatrician, researcher, and director of the

Uams translational research Institute.

among James’ 96 peer-reviewed publications

are papers that range from describing cellular

and molecular mechanisms of acetaminophen

toxicity in liver cells to evaluation of acetamino-

phen-associated hepatic injury in children. Her

team’s work has led to the development of a

new diagnostic test for measuring a biomarker

of liver injury secondary to acetaminophen. as

an entrepreneur, James and her research team

at the arkansas Children’s Hospital research

Institute (aCHrI) have developed a rapid and

sensitive test for detecting acetaminophen

protein adducts in blood. working with Uams

BioVentures, she formed a start-up company,

acetaminophen toxicity Diagnostics, llC, to

develop and market the diagnostic kit.

Hamilton, lantana Consulting Group, the lewin

Group, telligen, and the Joint Commission.

starling has become a fellow in the ameri-

can College of medical Practice executives

(aCmPe). aCmPe is the certification entity of

the medical Group management association.

fellowship in aCmPe’s industry-leading pro-

gram demonstrates mastery and expertise in

the profession of medical practice management.

lOcal cartI Introduces low-Dose Screening In arkansas, lung cancer is the leading cause of

cancer death for both men and women. Nation-

ally, lung cancer accounts for more deaths than

breast, colon, and prostate cancers combined,

primarily because screening for an early diag-

nosis of lung cancer has not been an option,

until recently.

CartI has an effective screening method to

catch lung cancer at an earlier stage with a new

low-dose computed tomography (Ct) scanner.

this type of low-dose screening has now been

been endorsed by the american Cancer soci-

ety, the american lung association, and the

National Cancer Institute, as well as other major

medical societies.

the screening criteria are as follows:

•Current or former smokers (aged 55 to 74

years old)

of Pine Bluff, tyson previously worked in health

information technology at the arkansas Center

for Health Improvement.

scott retired on November 30, after serv-

ing in the administrations of seven arkansas

governors in a variety of leadership positions

over a forty year career, including seven years

as Director of the Department of Human ser-

vices. Beebe chose scott to serve as Director

after creating oHIt by executive order in 2010.

aFMc Medical Director, VP earn National recognitionthe arkansas foundation for medical Care

(afmC) announced the recent achievements of

Beth milligan, mD, faafP, CPe, CHCQm, afmC

medical director, and Peggy starling, faCmPe,

vice president of medicaid services and Pro-

vider strategies.

milligan was selected to serve on the techni-

cal expert panel of the electronic Clinical Qual-

ity measures Development and maintenance

for eligible Professionals project. funded by

the Centers for medicare & medicaid services

(Cms), the project’s goal is to develop elec-

tronic health record-based clinical quality mea-

sures for use in Cms quality reporting programs

for ambulatory care providers. the project team

is led by mathematica and includes individuals

from the National Committee for Quality assur-

ance, the american medical association’s Physi-

cian Consortium for Performance Improvement,

the american Nurses association, Booz allen

Beth Milligan, MD, FAAFP, CPE, CHCQM, AFMC

Peggy Starling, FACMPE


arkansas medicaid program of $284, a Class

C felony, for fraudulently billing medicaid for

reimbursement for at-home personal care

services he didn’t provide while a patient was

hospitalized.

Charges are merely accusations and a defen-

dant is presumed innocent unless and until

proven guilty.

to report medicaid fraud or abuse or neglect

in nursing homes, call the attorney General’s

medicaid fraud hotline, (866) 810-0016.

thomason receives Gerontological Nursing awardayasha Patel thomason, mNsc, aPrN, an assis-

tant professor in the University of arkansas for

medical sciences (Uams) College of Nursing,

was named a Patricia G. archbold scholar for

2014-2016 by the National Hartford Centers of

Gerontological Nursing excellence.

thomason, one of six to receive the honor, is

also director of the college’s women’s Health

Nurse Practitioner Program and is a board-

certified women’s health nurse practitioner.

Her mentors are leanne lefler, PhD, aPrN an

associate professor in the College of Nursing,

and Gloria richard-Davis, mD, a professor in the

Uams College of medicine.

she will receive a grant of $100,000 to sup-

port her doctoral education and begin a career

in academic gerontological nursing.

arNa Offers Online cNe coursesarNa has initiated online CNe courses for con-

tact hours. available now online are:

1) the Personal Values and How Values relate

to ethics/ethical Behavior. the purpose of this

continuing nursing education activity is to give

nurses the opportunity to examine their own

values and compare them with the values of

their profession. the connection between val-

ues, ethics, and ethical behavior is emphasized

through case studies.

2) legal Issues related to Nursing. the pur-

pose of this continuing nursing education activ-

ity is to help nurses understand the legal issues

related to nursing practice. Case studies and

examples accompany this thorough exploration

of nursing practice.

3) Children with sickle Cell Disease: man-

agement & treatment. the purpose of this

Continues to build upon his internationally

recognized electronics research program. the

team’s designs have flown on the International

space station. latest achievements include

developing an electronic charger for toyota’s

new plug-in electric vehicles.

•Trace Peterson, PhD, DVM, UAPB

assistant Professor, regulatory science Cen-

ter of excellence.

examines transgenic humanized zebrafish

used to study human cancers and kidney dis-

eases. also researching drug delivery systems

and patentable vaccine technology for previ-

ously non-preventable food fish diseases, which

will enhance worldwide food security.

healthcare Workers arrested For Medicaid Fraud attorney General Dustin mcDaniel announced

that healthcare workers from Poinsett and

Pulaski counties have been arrested following

two separate investigations by the attorney

General’s medicaid fraud Control Unit.

Kellye Gregg, 42, of trumann turned herself

in to the Pulaski County sheriff’s office and

is accused of defrauding the arkansas medic-

aid program of $3,557, which is a Class B fel-

ony. Investigators found that Gregg submitted

claims to medicaid for payment for personal

care services that were not provided between

January 2013 and march 2014.

In another case, robert myles, 41, of little

rock was arrested by the little rock Police

Department and is accused of defrauding the

the ara fellows program is a companion to the

well-established ara scholars program, which

recruits research talent to arkansas. Uams has

three ara scholars: Peter Crooks, PhD, Gareth

morgan, mD, and Daohong Zhou, mD.

James was among five inaugural ara fellows

welcomed by Gov. mike Beebe.

In addition to Uams, the ara fellows rep-

resent arkansas’ other research universities:

arkansas state University (asU), University

of arkansas, fayetteville (Uaf), University of

arkansas at little rock (Ualr), and University

of arkansas at Pine Bluff (UaPB). other inau-

gural ara fellows are:

•Alexandru Biris, PhD, UALR

Director and Chief scientist, Center for Inte-

grative Nanotechnology sciences (CINs)

explores the science of nanostructures that

can be used to alter properties of substances

at the atomic level.

•Argelia Lorence, PhD, ASU

Co-lead Plant Imaging Consortium (PIC)

leads research for the potential development

of crop plants with enhanced nutritional con-

tent, better growth, and improved tolerance to

multiple environmental stresses.

•Alan Mantooth, PhD, PE, FIEEE, UAF

executive Director, National Center for reli-

able electric Power transmission

executive Director, National science founda-

tion Center for Grid-connected advanced Power

electronic systems

21st Century endowed Chair, mixed-signal IC

Design and CaD

Laura James, MD Ayasha Patel Thomason, MNSc, APRN



seton Hall University.

Dr. allen is board-certified in hospice and pal-

liative medicine and geriatric medicine. she is

also certified with the american Board of family

medicine and is an american academy of family

Physicians fellow.

community Groups honored as research Partnerstwenty-four groups from across arkansas were

honored at the 2nd annual Community Part-

ners Celebration for their work in support of

research at the University of arkansas for medi-

cal sciences (Uams).

the translational research Institute’s mission

includes helping Uams researchers establish

and sustain community partnerships that will

help Uams better address the state’s many

health issues, particularly where health dispari-

ties exist in communities at high risk for poor

health outcomes.

the groups honored were:

Community Organizations

•Arkansas Coalition of Marshallese

•Arkansas Disability Coalition/Arkansas

family-2-family Health Information Center

•Arkansas Epilepsy Association

•Boys, Girls, Adults Community Development

Center

•CARE Coalition

•East Arkansas Enterprise Community Inc.

•Feed Communities

•Gaps in Services to the Marshallese Taskforce

•Greater Macedonia Baptist Church

•Holman Community Development Center

•Mid Delta Community Consortium

•Mississippi County Economic Opportunity

Commission Inc.

•Neighbors that Love

•Promise Neighborhood Advisory Board

mission and goals; dedication to the nurs-

ing profession, with current knowledge of the

professional, societal, political, and economic

issues affecting the profession and the associa-

tion’s mission; and ability to work independently

and as a team member, with a willingness to

learn from others.

arkansas hospice Names New VP, cMODr. andrea m. allen has joined arkansas Hospice

in the role of vice president and chief medical

officer. she earned her medical degree from

George washington University as well as a mas-

ter’s degree in healthcare administration from

continuing nursing education acitivity is to help

nurses understand sickle cell disease in children

and review the evidence-based approaches to

management of this disease.

4) sickle Cell Disease Crisis In adults. the

purpose of this continuing nursing education

acitivity is to help nurses understand sickle cell

disease in adults and review the evidence-based

approaches to management of this disease.

the arkansas Nurses association is accred-

ited as a provider of continuing nursing educa-

tion by the american Nurses Credential Cen-

ter’s Coa.

Please visit www.educationcenterarna.org for

more details.

Kinder elected to National Nurses Boardsarah rhoads Kinder, PhD, DNP, University of

arkansas for medical sciences (Uams) Cen-

ter for Distance Health education Director, has

been elected to serve a two-year term on the

association for women’s Health, obstetric and

Neonatal Nurses Board of Directors.

as one of 12 board members, Kinder, assis-

tant professor in the Uams College of medi-

cine’s Department of obstetrics and Gynecol-

ogy, will represent region II of the organization,

which consists of 11 states and two provinces

in Canada.

Kinder was chosen for her ability to lead and

inspire others in pursuit of the association’s

Community groups honored as research partnersChancellor Dan Rahn, MD, (back), posed with celebration attendees including representatives of the Arkansas Coalition of Marshallese and Gaps in Services to the Marshallese Taskforce (l-r): Grace Donoho, Melisa Laelan, Mindy Ritok, Rubon-Chutaro, Sandy Hainline and Wanna Bing.

Andrea M. Allen, MD


the paper, “Inequities in Health Care Needs

for Children with medical Complexity” was pre-

sented at the National Press Club in washing-

ton, D.C. It appears in Health Affairs’ December

issue focusing on children’s health.

Based on a secondary analysis of data from

the 2005–06 and 2009–10 National survey

of Children with special Health Care Needs,

the inequities the paper examined were those

based on race or ethnicity, primary language

in the household, insurance type and poverty

status. the paper compares inequities of chil-

dren with special needs to those of children with

special needs who also have medical complex-

ity. the results indicate children with medical

complexity are more than twice as likely to have

at least one unmet need compared to children

with special needs without medical complexity.

Marion Woman Pleads Guilty to Medicaid Frauda Crittenden County woman accused of

improperly billing the state’s medicaid program

has pleaded guilty to felony medicaid fraud,

attorney General Dustin mcDaniel announced.

elaina Brewer, 34, of marion entered a guilty

plea in Pulaski County Circuit Court before

Judge Barry sims. the conviction for medicaid

fraud, a Class C felony, came after an investiga-

tion by the attorney General’s medicaid fraud

Control Unit.

Department of Health.

after a career in academic medicine, Bates

joined the Health Department as director of the

tuberculosis Control Program in 1998 and has

served as deputy state health officer and chief

science officer since 2005. He played a key role

in the establishment of the College of Public

Health at Uams and since 2005 has served as

a member of its faculty and administration. He

has also been a vocal supporter for state legis-

lation affecting health and an advocate for the

needs of the underserved.

Medical complexity leads to Unmet Needsspecial needs children with medical complex-

ity, who see multiple specialists for more than

one chronic condition, are more likely to have

a healthcare need go unmet, according to a

paper by Dennis Kuo, mD, an associate profes-

sor of pediatrics at the University of arkansas

for medical sciences (Uams) and the arkan-

sas Children’s Hospital research Institute, pub-

lished in Health Affairs.

“among the children with medical complexity,

unmet need was not associated with primary lan-

guage, income level, or having medicaid,” wrote

Kuo and second author anthony Goudie, PhD, an

assistant professor of pediatrics at Uams. “we

concluded that medical complexity itself can be

a primary determinant of unmet needs.”

•Tri County Rural Health Network

Community advisory Boards (CaBs)

•12th Street Health and Wellness Center CAB

•Arkansas Center for Health Disparities

Community engagement Core CaB

•Community Advisory Committee to the

texarkana regional Center on aging

•Cord Blood Bank of Arkansas Advisory Board

•Faith Task Force

•Jefferson County Faith Task Force

•Patient-Centered Outcomes Research

Institute (PCorI) CaB

•Prevention Research Center CAB

•Translational Research Institute CAB

the Uams translational research Institute’s

mission is to help accelerate research that will

improve the health and healthcare of people in

arkansas and across the country. trI is one of

62 recipients of a National Institutes of Health

(NIH) National Center for advancing transla-

tional sciences (NCats) Clinical and transla-

tional science award (Ctsa).

New Procedure relieves enlarged Prostate Symptomsmore than 500 million men in the world have

a condition called benign prostatic hyperpla-

sia (BPH) that causes the prostate to enlarge.

Nearly half of the men in the U.s. with BPH have

symptoms so severe that it disrupts their lives

and requires treatment.

Baptist Health and the team of physicians at

arkansas Urology now offer a new minimally

invasive procedure to help those suffering from

the uncomfortable symptoms of BPH. the pro-

cedure, which is called Urolift, has a minimal

downtime, typically doesn’t require a catheter

or overnight stay, and preserves sexual function.

Bates honored as Public health heroJoseph Bates, mD, was named the 2014 recip-

ient of the state excellence in Public Health

award at the recent annual meeting of the asso-

ciation of state and territorial Health officials

in recognition of his outstanding service in pub-

lic health. Bates is a professor of epidemiology

and associate dean for public health practice

at the Uams fay w. Boozman College of Public

Health as well as the deputy state health offi-

cer and chief science officer for the arkansas

Bates honored as public health hero

Joseph Bates, MD, was named the

2014 recipient of the State Excellence in

Public Health Award



completed within five semesters. Part-time

options and post-graduate certifications are

available for students.

the program’s application cycle is oct. 15,

2014-march 15, 2015. for details on application

and admission requirements, visit www.hard-

ing.edu/nursing or contact the Harding Univer-

sity Carr College of Nursing at 501-279-4475.

UaMS earns Grant to Improve Drug Safety testingthe food and Drug administration (fDa) has

awarded a three-year $1.2 million contract to

the University of arkansas for medical sciences

(Uams) to study new approaches for testing

drug safety by accounting for gene mutations

that can cause adverse reactions.

alison Harrill, PhD, assistant professor in the

Department of environmental and occupational

Health in the fay w. Boozman College of Public

Health at Uams, leads a project entitled “the

Diversity outbred: a tool to improve preclinical

safety testing and pharmacogenomics analysis.”

this study will help predict which drugs carry

a safety risk early in development before they

reach the market. Harrill hopes that through this

Brewer was sentenced to two years of proba-

tion, fined $5,530, and ordered to pay $1,843

in restitution. she must undergo random drug

tests.

Brewer was arrested in october 2013 after

investigators found she billed the arkansas

medicaid Program for attendant-care services

that she did not provide.

harding University launches MSN Program Harding University’s master of science in Nurs-

ing degree program has begun accepting appli-

cations for fall 2015. the new master’s degree

prepares students for a career as a family nurse

practitioner.

the family nurse practitioner program offers

advanced training for registered nurses in assess-

ment, diagnosis, and treatment of patients in

primary care settings such as clinics. advanced

practice registered nurses work collaboratively

with physicians and other health care team mem-

bers to provide comprehensive treatment plans

and prescribe medications.

the full-time sequence of the predominantly

online distance education program can be

research drugs can move more quickly to mar-

ket so people can get needed medication sooner.

By identifying a drug’s reaction with specific

gene mutations, the research can improve the

understanding and prediction of adverse drug

and chemical reactions in humans. It will allow

medicine to be personalized to know what

works with a person’s specific DNa.

Medicaid Fraud arrests announcedattorney General Dustin mcDaniel announced

that the executive director and case manager

for a now-closed faulkner County facility for

the developmentally disabled were arrested

for medicaid fraud and exploitation following an

investigation by the attorney General’s medic-

aid fraud Control Unit.

Kathy Koone Hall, 48, and her daughter, mel-

anie ray Koone mcCarty, 28, both of Conway,

were arrested on multiple counts of medicaid

fraud and exploitation. District Judge susan

weaver set Hall’s bond at $15,000 and mcCar-

ty’s bond at $10,000.

Hall faces six counts of Class B felony med-

icaid fraud, nine counts of Class B felony

Barlogie Named Distinguished Professor In recognition of his contributions to groundbreaking translational research and his care of thousands of patients with multiple myeloma, Bart Barlogie, mD, PhD, has been named distinguished professor of medicine and pathology in the College of medicine of the University of arkansas for medical sciences (Uams) by resolution of the University of arkansas Board of trustees.

this rank is reserved for a very small number of faculty members who have made nationally recognized advances in the medical sciences and who have given exemplary service to Uams over many years. of the thousands of Uams faculty over the years, only nine have ever been promoted to this rank.

In addition, Barlogie has been awarded the title of distinguished clini-cal scholar in residence in further recognition of his key role in clinical research that has resulted in a doubling of the expected survival rate for newly diagnosed patients with multiple myeloma, a plasma cell can-cer of the bone marrow. He is the first Uams faculty member to be so designated by the Ua board.


been arrested following three separate inves-

tigations by the attorney General’s medicaid

fraud Control Unit.

Jennifer reid Casey, 33, of rogers was arrested

and accused of defrauding the arkansas med-

icaid program of more than $27,473, which is a

Class B felony. Investigators found that Casey

submitted claims to medicaid for payment for

adult day care services that were not provided

between January 2014 and april 2, 2014.

In another case, Jonathan Chandler, 26, of

Blytheville was arrested for medicaid fraud, a

Class C felony, for fraudulently billing medicaid

for reimbursement for attendant care services

he didn’t provide.

In the third case, martha renshaw, 50, of lake

City was arrested for medicaid fraud, a Class B

felony. renshaw is accused of billing the arkan-

sas medicaid Program $4,210 for in-home ser-

vices that she did not provide.

Professors Pledge Gift to college of Public healthJim raczynski, PhD, dean of the fay w. Booz-

man College of Public Health, and his wife, mar-

tha Phillips, PhD, associate professor of epide-

miology, have pledged a planned estate gift

of $1 million to the University of arkansas for

medical sciences (Uams) to establish the rac-

zynski Phillips Bruce Chair in social Determi-

nants of Health.

the gift is in honor of the college’s inaugural

exploitation, three counts of Class C felony

exploitation and one count of failure to main-

tain records, a Class D felony. mcCarty faces six

counts of Class C felony medicaid fraud and two

counts of Class C felony exploitation.

Hall was the executive director of my House,

Inc., a facility located in mayflower that served

mentally and physically disabled individuals.

my House, which closed in may 2013, con-

tracted with the arkansas Department of

Human services to provide services to indi-

viduals as an alternative to confining them in

state facilities.

Hall is accused of fraudulently billing the

arkansas medicaid Program for $90,566 dur-

ing 2012 and 2013. according to investigators,

Hall “pre-billed” medicaid for services that were

never rendered after the facility closed. Pre-bill-

ing was specifically prohibited in my House’s

contract with the arkansas Department of

Human services.

additionally, Hall is accused of using debit

cards to fraudulently withdraw $65,866.80

from multiple trust accounts established for

my House beneficiaries.

mcCarty, who served as case manager for

my House, is accused of fraudulently billing

the medicaid Program a total of $4,119.50 by

falsifying case management notes. according

to investigators, mcCarty falsified case manage-

ment notes to indicate she routinely visited mul-

tiple beneficiaries when she actually did not.

mcCarty is also accused of using debit cards

to fraudulently withdraw $800 from multiple

trust accounts established for my House ben-

eficiaries. additionally, investigators say mcCarty

never received the required training to meet

minimum requirements to be a case manager.

my House is in no way affiliated with the little

rock-based organization with a similar name.

researcher explores early Diagnosis with Nanoparticles University of arkansas for medical sciences

(Uams) researcher Vladimir Zharov, PhD, Dsc,

recently was awarded a $1.5 million r01 grant

by the National Institutes of Health to investi-

gate his diagnostic concept — “In vivo reading

written in blood” — with new stimuli-responsive

nanoparticles circulating in blood.

Zharov is director of the arkansas

Nanomedicine Center at Uams and a professor

in the Uams College of medicine Department of

otolarynology-Head and Neck surgery.

“many years ago we introduced new nonin-

vasive blood tests for early diagnosis and pre-

vention of cancer, infection, stroke, and heart

attack,” Zharov said. “recently using a hand-

worn photoacoustic clinical device, we proved

this concept by a 100-fold increase in diagnostic

sensitivity for melanoma patients. Now we plan

to develop a new generation of our technology

using innovative nanoparticles.

“we will synthesize photoswitchable nanopar-

ticles which can change a color under laser

light and /or change blood biochemistry and

test them in different biological environments.

we also want to see how these nanoparticles

interact with circulating tumor cells in blood.

when these nanoparticles conjugated with

drugs called nanodrugs are inside cells, and we

apply laser radiation, the resulting nanobubbles

around nanoparticles dramatically enhance

drug action to kill cancer cells.”

the NIH panel that reviewed Zharov’s grant

application gave it the best score (10) and per-

centile (1) from among all the grant applications

it reviewed in its most recent funding cycle.

three More caught In Fraudattorney General Dustin mcDaniel announced

that healthcare workers in Benton County,

Craighead County, and mississippi County have

researcher explores early diagnosis with

nanoparticles Vladimir Zharov, PhD,

DSc, demonstrates the use of the hand-worn

photoacoustic clinical device he uses in his research with photo-

switchable nanoparticles.



dean, thomas a. Bruce, mD, and his late wife,

Dolores.

Bruce was the college’s inaugural dean from

2001 to 2002 and the dean of the Uams Col-

lege of medicine from 1974 to 1985. at an earlier

point in his career, he served at the w.K. Kellogg

foundation in michigan, helping start new initia-

tives in rural development, health, and interna-

tional leadership.

Pulaski county Woman Sentenced to 10 Years For Medicaid Frauda Pulaski County woman accused of improperly

billing the state’s medicaid program pleaded

no contest to felony medicaid fraud and failure

to maintain records, attorney General Dustin

mcDaniel announced in December. frenchelle

Chapple, 62, of little rock was sentenced to 10

years in prison, ordered to pay $92,606 in resti-

tution and fined $277,820.

Chapple was arrested in December 2013 after

investigators found she filed 1,063 fraudulent

claims for speech pathology services allegedly

provided to medicaid beneficiaries under age

21. Chapple, also known as frenchelle Conley,

operated Great expectations Developmental

Center in little rock. money received from the

false claims was deposited into a bank account

controlled by Chapple and used for purchases of

gas, groceries, fast food, and clothing, according

to investigators.

UaMS awarded Grants to train teachers the University of arkansas for medical sciences

(Uams) Partners in Health sciences Program

has been awarded $135,000 in grants to give

arkansas pre-K-12th grade teachers tools to

teach health science topics.

of the total, $100,000 is the third installment

of a six-year $600,000 grant from the arkan-

sas Department of Human services’ Division

of Child Care and early Childhood education

to train pre-K teachers in “Healthy Hearts &

lungs” curriculum.

the remaining $35,000 is from the arkansas

Department of Health’s Comprehensive Can-

cer Control section and the tobacco Prevention

Cessation Program to train 6-12th-grade teach-

ers and school nurses in the “Healthy lungs &

Gums” and “Biology of Cancer” curriculums.

the Partners in Health sciences program

conducts professional development work-

shops across arkansas to equip teachers

with activities to use with their students. the

workshops are led by program founder and

director robert Burns, PhD, professor in the

Uams College of medicine’s Department of

Neurobiology & Developmental sciences.

college of health Professions Dedicates legacy GardenNearly 200 laser-engraved bricks spread across

a 2,000-square-foot courtyard were the center-

piece of the legacy Garden dedicated recently

by the Uams College of Health Professions. as

part of the dedication, four new bricks were

placed in the garden:

•A brick honoring Tip Nelms, DDS, MEd, the

college’s founding dean, who was leading the

Uams dental hygiene program when it was

decided to organize the handful of Uams allied

health programs into what is now the College of

Health Professions.

•A brick honoring Dean Emeritus Ronald

winters, PhD, who succeeded Nelms and led

the college from 1982-2011. He oversaw an

“amazing expansion of this college both in pro-

grams and in funding as well as its move to this

location.”

•A brick honoring Betty Jo Ward, widow of for-

mer Uams chancellor, the late Harry ward, mD,

who was memorialized with a brick earlier this

year. “for all that Dr. ward did for Uams, he and

Betty Jo were a team. they worked together,”

said Dean emeritus ronald winters, PhD, who

credited her for expanding the amount of art-

work on campus and greatly expanding the hos-

pital gift shop.

•A brick honoring Winters’ wife, Marsha, who

supported the college through the years with

her gracious presence at numerous receptions,

events and even welcoming candidates for fac-

ulty positions, the former dean said of his wife.

the courtyard sits among the buildings

that house the college’s academic programs.

Inscriptions on the bricks are in memory or in

honor of friends, family or colleagues or pro-

grams in the college. Proceeds from brick sales

support scholarships in the college. n

Legacy Garden College of Health Professions Dean Douglas Murphy, PhD,

right, invites Dean Emeritus Ronald Winters, PhD, to pick a place for his

engraved brick in the Legacy Garden.


(CDC’s) 2012 Breastfeeding Report Card, 62.4 percent of Arkansas women initiate breast-feeding, but only 23.8 percent are exclusively breastfeeding at three months and only 16.3 percent at six months. Arkansas’s rank on the CDC’s Maternity Practices in Infant Nu-trition and Care (mPINC) scale is 52 out of 53, the second lowest in the country.

There are many factors contributing to Arkansas’s low breastfeeding rate, includ-ing poverty, inadequate social support for breastfeeding, and hospital maternity prac-tices. We know that in Arkansas, breastfeed-ing rates are lower for low income women, who are also more likely to mix formula in-correctly, sterilize bottles inadequately, and to have difficulty being able to take time off from a job for a sick baby.

Maternal hospital practices strongly in-fluence breastfeeding behaviors during the critical time immediately after birth. There is abundant evidence in the literature that changing maternity care practices can re-markably improve breastfeeding practic-es. These changes can either be a part of a comprehensive set of modifications such as those implemented in pursuit of Baby

ChIlDReN Who ARe Not BReAstfeD are at a higher risk for many diseases throughout their lives, including higher rates of respira-tory and gastrointestinal infections, necro-tizing enterocolitis, sIDs and infant mortal-ity, allergies, celiac disease, inflammatory bowel disease, obesity, diabetes, childhood leukemia, lymphoma, and neuro-develop-mental problems. In addition, breastfeeding helps a mother’s health, including healing and weight normalization following child-birth. Breastfeeding also lowers the risk of many diseases for the mother, including diabetes, breast cancer, ovarian cancer, and osteoporosis.

Arkansas has one of the lowest rates of breastfeeding in the U.s. According to the Centers for Disease Control and Prevention’s

Breastfeeding should be the biologically preferred choice for

human infant feeding. According to the World health organization

(Who), in terms of preference of infant food sources, artificial

milk formula ranks 4th after breastfeeding, mother’s own milk

given to the child in a bottle, and milk of another human mother.

Together We Can Increase the Number of

Arkansas Mothers Who Breastfeed


formula to new mothers during the hospi-tal stay has been shown to negatively affect breastfeeding, particularly among vulner-able groups, such as those who are primipa-rous, less educated, nonwhite or ill during the postpartum period. The Who/UNICef International Code of Marketing Breast Milk substitutes, which is also ratified by the U.s., bans all promotion of formula feeding and sets out requirements for labeling and in-formation on baby feeding products. Any activity which undermines breastfeeding violates the Code. The Code’s main emphasis is on no promotional efforts to consumers, health care professionals or hospitals, such as the practice of distributing free gifts or food from commercial formula companies to patients.

Nathaniel Smith, MD, MPHDirector and State Health Officer,

Arkansas Department of Health

friendly hospital Initiative designation (a global program to encourage and recognize hospitals that offer an optimal level of care for infant feeding and mother/baby bond-ing—see details at www.babyfriendlyusa.org), or they can be incremental interventions such as increasing rooming in, training staff in helping mothers initiate breastfeeding right after delivery, or not giving infants formula unless medically indicated. Cur-rently Arkansas has no Baby friendly des-ignated hospitals, but several hospitals have expressed interest. The UAMs hospital has submitted the required letter of intent to begin the designation process.

supplemental formula given to breast-fed newborns negatively impacts the baby’s overall health, and distributing samples of

The Arkansas Department of health (ADh) has a goal of increasing the rate of exclusive breastfeeding in the state by 10 percent within the next three years. This requires concerted effort in many sectors, including hospitals, insurers, healthcare providers, employers, and the public health community. There are also laws in Arkansas aimed at encouraging women to breastfeed. The first Arkansas breastfeeding law, passed in April of 2007, allows a mother the right to breastfeed her child in any public place. The second law, effective July 1, 2009, requires employers to provide reasonable unpaid break time to an employee who needs to express/pump breast milk.

In addition, the ADh Women, Infants and Children (WIC) program encourages breast-feeding among all eligible participants by providing education and support. Although the program does provide infant formula to women who need it, the WIC Breastfeeding Peer Counselor Program also helps women initiate and maintain breastfeeding for as long as possible. Through breastfeeding support group meetings, Breastfeeding Peer Counselors provide information, mentor on breastfeeding practices, listen to concerns and help mothers plan how to continue breastfeeding when they return to work or school. ADh local health Units are also tak-ing steps to more strongly support breast-feeding as the normal and expected feeding method by implementing the National WIC Association’s six steps to a Breastfeeding friendly Clinic Program.

In summary, breastfeeding is an impor-tant life decision for any new mother and should be a priority for all sectors of the health care system. With your help, the Ar-kansas Department of health can meet our goal of increasing the number of women who breastfeed, and in doing so, improve the health of mothers and their babies. n

Arkansas has one of the lowest rates of breastfeeding in the U.S.


urrently, health care transpar-ency in Arkansas is limited. In 2013, Catalyst for Payment of uninsured Arkansans, moving from a state

with one of the highest rates of uninsured citizens in the nation to a state with the largest percentage decrease in its number of uninsured. As a result, more individuals are receiving preventive care and are able to better manage their chronic conditions. Our hospitals have reported significant de-creases in uninsured admissions along with a decrease in uncompensated care losses. Insurance premiums through the Health Insurance Marketplace average 2 percent lower in the second year of operation than in the first. More information on the Arkansas Health System Transformation Initiative and its components is available at www.achi.net.

As our health care system is transformed to better meet consumer needs, demand is growing for greater transparency so that the effectiveness of these efforts can be appro-priately assessed. In addition, patients are increasingly asked to make wiser choices. They have greater exposure to costs at point of service through deductibles, coinsurance, and copayments. Yet the information they need to evaluate quality and cost is often unavailable.

Concerns about exposure of personal health information, poor data quality, ad-ministrative burden, and untested metrics

Most of us want to compare

cost, quality, and features

before making a major pur-

chase. These days the Inter-

net makes it easier than ever

to find out just about any-

thing we want to know about

the goods and services we

plan to buy. The exception

is the health care industry

where information on quality,

price, and individuals’ expe-

riences is hard to come by.

Health care consumers are

left unable to find answers

to the most basic questions

about one of their most im-

portant purchases.

The Case for Health Care Data Transparency

in Arkansas

CReform (CPR) and the Health Care Incen-tives Improvement Institute (HCI3) worked together to release a report card evaluat-ing each state’s transparency laws. In this first report card, Arkansas was given a “D” grade for having only one statute in place concerning cost transparency. The newest report card, released in March 2014, expand-ed its scope to look at state regulations and public accessibility of price information. Un-fortunately, Arkansas received an “F” in the nationwide comparison. Many surrounding states received equally poor grades.

We are making progress in transforming Arkansas’s health care system through an interactive set of initiatives designed to: stra-tegically plan for the health care workforce we need; accelerate use of health informa-tion technology; increase access to health care coverage; and provide incentives for improved quality of health care and health care cost containment. Nearly half of our primary care physicians are now transform-ing their practices into team-based patient-centered medical homes, and 80 percent of Medicaid beneficiaries are now served by providers in a new value-based payment strategy.

We have significantly reduced the number


for quality measurement have shrouded the avail-ability of information. Too

often, the systematic barriers that serve to protect from these risks—con-tractually restrictive clauses between car-riers and providers, statutory protections from disclosure of data for proprietary interests, and privacy protections for pa-tients—eliminate pathways to greater trans-parency and make less attainable the goals of freeing information that would support individuals, families, and businesses in mak-ing informed choices. These barriers must be overcome to improve quality of care, contain costs, and make consumers more informed and active in managing their own health care. Even opponents of health care reform agree that the business of health care delivery must improve, and increased trans-parency is necessary to make that a reality.

Enhanced ability to identify high qual-ity clinical performers is key to health care consumers and referring providers being able to choose more wisely. Informed clini-cians could use quality and outcomes data to better determine where to refer their patients or drive hospital improvements where quality gaps exist. Likewise, private businesses could identify opportunities to improve their employees’ health and tailor the health plans they offer to best fit their employees’ needs. In addition, insurance companies could identify the best provid-ers available to their members, thus improv-ing outcomes and patient experiences and reducing inefficiencies.

While there is evidence of the positive impact of transparency on quality, there is

Joseph W. Thompson, MD, MPHDirector, Arkansas Center

for Health Improvement

on payment amounts for both practitioners and facilities.

Measures have been taken to improve health data transparency in Arkansas. Re-cently, the Arkansas Insurance Department-Health Insurance Rate Review Division (HIRRD) awarded a contract to the Arkansas Center for Health Improvement (ACHI) to build an APCD to support health insurance rate review and increase transparency in health care pricing. ACHI is in the first stages of the project, which includes stakeholder engagement, database design and build, es-tablishment of data submission guides and data use agreements, and the development of a sustainability plan. In addition to pro-viding HIRRD with information needed for their assessments, ACHI hopes to eventu-ally provide consumers with web-accessible tools and resources to aid in quality and cost determinations.

Health care is a major industry in the United States—one that consumes more of our gross domestic product per citizen than in any other nation. Yet, unlike most other major industries, information on the price of services and the quality consumers can expect in the delivery of those services is highly limited. It is time to overcome this lack of transparency. How can consumers make wise decisions for improving their health when the information they need to do so is hidden? We have a strong tradi-tion in Arkansas of working together for the betterment of our citizens. We need to employ that tradition now. Providers, insur-ance companies, and policymakers in both the public and private sectors must work together to remove barriers to data access and enable the creation of meaningful con-sumer information to ensure that Arkansans are empowered and informed to improve their health. n

limited research showing a direct link be-tween health care price transparency and cost reduction. This is mainly due to the lim-ited scope of available price information, including only cost averages and medians. However, increasing the availability of price information for specific services and fre-quently combined therapies will highlight the price variations between various provid-ers, and enable consumers to identify their best options.

It is important to note that price transpar-ency alone, although important, is limited in helping consumers identify high value products and providers. Price information must be linked with quality indicators to enable informed consumer choice. Making available price data in isolation can lead to the false assumption that a higher price tag will result in a higher quality product. A good example of this can be found in the pharmaceutical industry. Studies show that a better-advertised and more recognizable brand-named drug is perceived by consum-ers as being a better product than a clinically equal but lower-priced alternative. Because consumers do not readily see the quality information between the two products, they often presume a quality difference exists and choose the brand-named drug based on this faulty assumption.

A vehicle being used to increase trans-parency in the health care system is a web-accessible all-payer claims database (APCD) that provides for the examination of price and quality among health care ser-vices and assessment of the impact of state programs. Currently, eleven states have an operational APCD. Some states have accom-plished increased transparency via legisla-tive initiatives. For example, Colorado has a statutorily authorized APCD with a publicly available website that features information


Electronic Health Records

Building the Foundation for Patient-Centered Care

patient is entitled to receive at the conclu-sion of an office visit, makes it possible for patients to understand exactly what diag-nosis the clinician has made and the course of treatment. Meaningful use is evolving to ensure that patients have the ability to com-municate more effectively with their care providers. EHRs now include or incorporate a patient portal. The portal allows the pa-tient to send secure questions to their clini-cians, request refills, schedule appointments and view lab results. Patients are more em-powered than ever to be actively involved in their health care, and health care profession-als have the ability to ensure their patients have access to information in a timely and cost effective manner.

The use of EHRs has also proved to be a valuable tool to help physicians manage the health of their patient population. Through queries and reports, clinicians can monitor a patient’s chronic conditions, such as dia-betes; and they can easily produce a list of patients who need routine wellness exams, such as colonoscopies and mammograms.

EHRs have enabled more proactive patient engagement and empowered the

Technology has profoundly transformed our lives. Smart phones, tablets, and other web-enabled devices have changed our daily lives, and the way we communicate, shop, pay bills, and conduct research.

TEcHnological cHangES HavE also been made in our health care delivery mod-el, as physicians adopt and utilize electronic health records (EHRs). The migration away from paper charts to the more structured electronic medical record gives providers immediate access to patient information, in real time, from almost any location.

The EHR incentive program was created when the HiTEcH act was signed into law in 2009. This program will pay an incentive to eligible professionals who meaningfully use their EHR system. Meaningful Use is a set of objectives and standards designed to ensure that every EHR can produce infor-mation understandable by another clinician. These standards establish specific criteria clinicians should use to facilitate clear com-munication to any provider involved in a patient’s care. Every certified EHR is capable of producing standardized reports, such as:

• Summary of care documents• Medication lists• Quality measures and public health

results• Structured lab resultsa summary of care document, which each


Ray HanleyPresident and CEO,

Arkansas Foundation for Medical Care

patient to become proactively involved in his or her care. Patient engagement is al-lowing physicians to focus more on what matters to the patient, such as better com-munication or a more personal relationship. The relationship between the patient and physician can strongly influence treatment outcomes and a patient’s satisfaction with his or her care. a strong physician-patient relationship leads to a feeling of partner-ship that can result in better outcomes, more satisfied patients, better compliance, fewer hospitalizations, and lower health care costs.

Patient-centered care is becoming the new standard for care delivery. With EHR systems in place, clinicians can more eas-ily monitor a patient’s care, the patient’s compliance to prescribed treatments, and facilitate ongoing communication by using the patient portal. achieving meaningful use of an EHR system positions practices and

physicians at the forefront of the changing health care landscape, which is transition-ing to a more patient-centered approach to health care.

Examples of newer patient-centered care delivery models include the development of initiatives such as the patient centered medical home (PcMH) and accountable care organizations (acos). Both initiatives are physician-led, primary care centered, and patient-centric systems of care. EHRs play an important role in the continuity and quality of patient care, and allow provid-ers to share more comprehensive patient information.

The PcMH focuses on the patient as an individual and includes multiple personal and family factors in treatment consider-ations. The PcMH is entirely focused on delivering high-quality, team-based care, keeping the primary care physician as the

first point of contact, and coordinating pa-tient care across multiple specialties and settings to improve outcomes.

There is considerable overlap between the meaningful use of an EHR and the establish-ment of a PcMH. Providers can improve access to care by implementing an EHR and utilizing this technology for schedul-ing, evaluating patients, and communicating with patients and other care providers. in addition, health information technology (iT) can improve the ability to report on metrics related to the principles of a medical home.

acos are groups of doctors, hospitals and other health care providers, who vol-untarily come together to provide coordi-nated and high-quality care to the patients they serve. coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time. The goal of coordinated care is to avoid unnecessary duplication of services and prevent medi-cal errors. like PcMHs, acos rely heavily on health iT and the use of EHRs to share patient data, eliminate waste and provide better health care.

The arkansas Foundation for Medical care (aFMc) has been a leader in helping practices build their health iT foundation, migrating from paper-based charts to digital health care. a strong health iT foundation is a critical component for moving forward our health care delivery and payment reform initiatives. aFMc assists arkansas provid-ers with EHR implementation and achieving meaningful use, and provide guidance for establishing and participating in a PcMH. We are now working with arkansas pro-viders, in both rural and urban settings, to become active participants in an aco. our experienced staff understands the tremen-dous opportunities that lie ahead for health care in arkansas, and we are well positioned to help take your health care practice or hospital into the new world of health care efficiency and improved quality of care. n


A RetuRn to Rational thinking

Reminders to report travel outside the U.S. are everywhere, including hospitals and clinics. Travel busi-nesses, such as cruise lines and airlines, are asking passengers to report travel history, specifically any travel in Liberia, Sierra Leone, and Guinea, in the previous three weeks as well as any flu-like symp-toms or fevers. Although the Ebola virus initially appeared in central Africa, the current outbreak in west Africa, first reported in March 2014, is the largest and most complex, causing more cases and deaths than all other outbreaks since its discovery in 1976. In the past sev-eral months, the Ebola virus has emerged as a major topic in the U.S. after Dr. Kent Brantly and Nancy Writebol contracted the virus while working in Liberia. The transfer of

Dr. Brantly and Ms. Writebol along with several others back to the U.S. for treatment sparked debate among policy makers, healthcare workers, and the public at large. Fears escalated when Thomas Duncan, arriving from Liberia, was seen in the Emergency Department at Texas Health Presbyterian Hos-pital in Dallas in September and was discharged home with a pre-scription for an antibiotic. He was readmitted and diagnosed with Ebola three days later and two of his nurses, Amber Vinson and Nina Pham, contracted the virus in October after he had succumbed to his illness. Dr. Craig Spencer had just returned from Guinea and had resumed his normal activities before finding that he was infected with the virus on September 23.


the information most recently to the Little Rock chapter of the Arkansas Nurses Asso-ciation. The ADH has more information on its website at http://www.healthy.arkansas.gov/programsServices/communications/features/Pages/Ebola.aspx. The CDC, aided by professional associations and healthcare organizations, has widely disseminated cur-rent guidelines and practices. Email updates from healthcare related apps, such as Med-scape, have also published daily updates for clinicians.

As the intensity of the media saturation on this subject dies down, nurses must still be prepared for this and any number of other infectious diseases. A joint statement from American Nurses Association Presi-dent Pam Cipriano and American Asso-ciation of Nurse Executives CEO Pamela Thompson called for a return to a rational approach to a novel disease in this coun-try, “Now is the time to return to rational thinking, and trust in the evidence-based approaches to containing and treating this disease…we know what we need to do to detect, diagnose, and treat this disease. And as we have done before with so many other emerging infectious diseases, we are learn-ing from others’ experiences and adapting faster than the disease. We can successfully manage this disease in the U.S. and protect the health of the broader public” (Cipriano & Thompson, 2014). n

SOURCECipriano, P., & Thompson, P. (2014). Joint statement on how the health care sector is responding to Ebola. Retrieved from http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/Joint-Statement-on-How-the-health-Care-Sector-is-Responding-to-Ebola.html

Rhonda FinnieDNP, APRN, AGACNP-BC, RNFAPresident, Arkansas Nurses Association

Kaci Hickcox had also just returned from Sierra Leone on September 24 and was asymptomatic, but was transferred to an isolation tent at University Hospital in New-ark, New Jersey under a mandatory quar-antine before she was allowed to go home to Maine to finish the 21 day home quaran-tine. The police guarded her home until a

judge determined that she was comply-ing with her voluntary daily tem-

perature monitoring and overturned her travel restrictions. Her response to the forced quar-

antine was divisive and determined. Her

insistence that practices and policies should be based on

science, not fear, was central to her argument that a home quar-

antine was not necessary as long as she was asymptomatic. However, the fact that there were well publicized sys-tem failures provoked public anxiety at a time when there were conflicting reports about the origin of those failures, specifi-cally the transmission to healthcare work-ers and the risk to the public. This was com-

pounded by questions in the variations in protocols advanced by the Centers for Dis-ease Control, the World Health Organiza-tion, and Doctors without Borders and the

sense that healthcare workers were not ade-quately prepared.

In response, much has been done over the past several months to educate nurses, physicians, and other healthcare workers on the subject, particularly those who are most likely to be a point of first contact. The Arkansas Department of Health pro-vided a statewide webinar in October and has given presentations in smaller groups as requested. Dr. Gary Wheeler presented

This informative resource reaches healthcare leaders as they keep abreast of important industry issues.

HJLR pulls the Little Rock healthcare community together, so you can reach this powerful niche professionally, consistently, and cost-effectively.

For additional information regarding sponsorship please email to [email protected]

of Little Rock

Healthcare Journal of Little Rock

It’s not neuroscience...It’s just the smartest way to reach the Central Arkansas healthcare market.


Roundshospitalh o s p i ta l n e w s & i n f o r m at i o n

Community outreach Combats premature Birth Rate

According to the MArch of diMes annual Premature Birth report card, Arkansas received low marks (d) because of the state’s 13.3 percent preterm birth rate. A majority of those early births are among the uninsured and underserved population. however, one of the most significant ways to lower the chances of having a premature baby is to understand the impor-tance of prenatal care and to be diligent in seeing an obstetrician throughout the pregnancy.

through Baptist health community outreach’s free prenatal classes, expect-ing moms, who could use a helping hand, have access to important educa-tion and life-changing resources for themselves and their babies. some of the topics and services from the classes include nutrition and physical fitness, childbirth education/breastfeeding, newborn care, parenting, weight checks, assistance with Medicaid waiver and Wic enrollment, baby supplies, car seat checkups, and more.

the prenatal classes are held at the Baptist health community Wellness center located at st. John Missionary Baptist church in Little rock the sec-ond Wednesday of each month throughout the year. Moms-to-be and new moms with infants can drop by anytime from 3 to 6 p.m. for one-on-one class instruction from community health nurses.

For more information about the free prenatal classes, call Baptist Health HealthLine at 1-888-BAPTIST.

It’s not neuroscience...It’s just the smartest way to reach the Central Arkansas healthcare market.


UaMs supports Chicot Memorial with ER telemedicine

the University of arkansas for medical

sciences (Uams) emergency Department

recently began providing emergency medical

support via a telemedicine connection to the

Chicot memorial medical Center in lake Village.

as part of the pilot project, er-DoCs, Uams

emergency Department faculty and resident

physicians will be available 24 hours a day to

provide real-time, high-speed video telemedi-

cine consultations to Chicot memorial physi-

cians about their emergency room patients.

the pilot will also utilize the Uams Center for

Distance health’s Call Center to help facilitate

the calls and provide video support during the

interactive consult to ensure connectivity.

“er-DoCs will help improve decision making

about the need for patient transfers,” said rawle

seupaul, mD, chairman of the Uams College of

medicine Department of emergency medicine.

“Unnecessary transfers to other facilities can

be avoided and keep patients closer to home.

through access to Uams specialists, er-DoCs

can work with Chicot memorials’ physicians and

staff to enhance the quality of patient care and

ensure best practices are applied on a consis-

tent basis.”

a central goal of er-DoCs also is to provide a

cost-effective method for improving access to

quality emergency care in rural arkansas.

arkansas heart hospital offers New hF Monitorarkansas heart hospital announced that it is the

first facility in arkansas to implant a new, minia-

turized, wireless monitoring sensor to manage

heart failure (hf). the Cardiomems hf system

is the first and only fDa-approved heart failure

monitoring device proven to significantly reduce

hospital admissions.

the Cardiomems system features a sensor

that is implanted in the pulmonary artery dur-

ing a non-surgical procedure and can directly

measure pa pressure. increased pa pressures

appear before weight and blood pressure

changes, which are often used as indirect mea-

sures of worsening heart failure. the new system

hematology/oncology Earns National Certificationthe hematology/oncology Division at the University of arkansas for medical sciences (Uams) has received a national certification for its high standard of care.

the division is the only program in central arkansas to be recognized by the Quality oncology practice initiative (Qopi®) Certification program, an affiliate of the american society of Clinical oncology (asCo). the Qopi® Certification program certifies oncology practices that meet the highest quality standards for cancer care. the Uams Division of hematology/oncology provides care for patients in the Uams winthrop p. rockefeller Cancer institute.

Qopi® is a voluntary self-assessment and improvement program launched by asCo in 2006 to help hematology/oncology and medical oncology practices assess the quality of the care they provide to patients. the Qopi® Certification program (QCp™) was launched in January 2010. out of the 4,350 oncology practices in the United states only 248 practices are certified, and certifications last for three years.

the QCp seal designates those practices that not only scored high on the key Qopi quality measures, but meet rigorous chemotherapy safety standards established by asCo and the oncology nursing society (ons).

to become certified, practices have to submit to an evaluation of their entire practice and documentation standards. the QCp staff and steering group members then verify through on-site inspection that the evaluation and documents are correct and that the practices met core standards in areas of treatment, including:

•treatment planning•staff training and education•chemotherapy orders and drug preparation•patient consent and education•safe chemotherapy administration•monitoring and assessment of patient well-beingthe Qopi Certification program is a project of asCo’s institute

for Quality, an asCo affiliate dedicated to innovative quality improvement programs. for information, visit http://qopi.asco.org/certification.html.



allows patients to transmit daily sensor readings

from their homes to their healthcare providers,

allowing for personalized and proactive manage-

ment to reduce the likelihood of hospitalization.

the device is designed to last the lifetime

of the patient and does not require batteries.

there is no pain or sensation for the patient

when the Cardiomems takes and transmits

pressure readings.

a clinical trial studied the effectiveness of the

system in new York heart association func-

tional Classification system class iii heart fail-

ure patients who had been hospitalized for heart

failure in the previous 12 months. the Cham-

pion trial demonstrated a statistically signifi-

cant 28 percent reduction in the rate of heart

failure hospitalizations at six months and a 37

percent reduction during an average follow-up

duration of 15 months.

the Cardiomems hf system, from global

medical device manufacturer st Jude medical,

is approved by the fDa for commercial use in

the U.s. for more information, please visit www.

heartfailureanswers.com/.

Baptist health Expands eiCU® to ashley County ashley County medical Center is partnering with

Baptist health eiCUcare to give their patients an

additional team of critical care specialists who

will watch over them 24/7. the Crossett hospi-

tal went live with their eiCU care in December.

a ribbon cutting-ceremony took place at the

go-live time to celebrate this new high tech mon-

itoring system for patients in Crossett and the

surrounding communities who need intensive

care.

with a simple press of a button by the phy-

sicians or nurses at ashley County medical

Center, the staff will be instantly joined at their

patient’s bedside by Baptist health’s experi-

enced critical care team in little rock. the eiCU-

care team includes physicians and nurses who

are specialized in critical care and trained to exe-

cute predefined plans or intervene in emergen-

cies when a patient’s attending physician can-

not be immediately present.

each critical-care room with eiCU technology

is equipped with a camera, microphone, and

speaker that enable staff in the control center

to communicate with caregivers and the patient

in real time. the two-way video and “cockpit-like

sensors” of this advanced telemedicine technol-

ogy enables the eiCUcare staff to detect even

the slightest change in the patient’s condition

and communicate more effectively with the bed-

side team to reduce the time between problem

identification and intervention.

staffed round-the-clock, every day of the year,

the Baptist health eiCUcare command center

and its staff helps rural hospitals like ashley

County medical Center provide state-of-the-

art intensive care to its sickest patients.

typically, eiCUtechnology is used in emer-

gency departments, surgical iCUs (including

kidney transplants), trauma iCUs, cardiac sur-

gery (including heart transplants and artificial

hearts), medical iCUs, coronary care units,

surgical step-downs, extended care hospitals,

and progressive care units. hospitals across the

country using eiCU technology with critical care

specialists have seen reductions in complica-

tions, reductions in mortality, and better out-

comes for patients. at ashley County medical

Center, the hospital has three rooms with the

eiCU care technology and three mobile carts.

arkansas heart hospital Earns ‘top performer’ Recognitionarkansas heart hospital has been recognized as

a 2013 top performer on Key Quality measures®

for the 3rd consecutive year by the Joint Com-

mission, the leading accreditor of healthcare

organizations in the United states. arkansas

heart hospital was recognized as part of the

Joint Commission’s 2014 annual report “ameri-

ca’s hospitals: improving Quality and safety,” for

attaining and sustaining excellence in account-

ability measure performance for heart attack,

heart failure, surgical Care, and pneumonia.

arkansas heart hospital is one of 1,224 hospi-

tals in the United states to achieve the 2013 top

performer distinction.

the top performer program recognizes hos-

pitals for improving performance on evidence-

based interventions that increase the chances

of healthy outcomes for patients with certain

conditions, including heart attack, heart failure,

pneumonia, surgical care, children’s asthma,

stroke, venous thromboembolism, and perina-

tal care, as well as for inpatient psychiatric ser-

vices and immunizations.

this is the third year arkansas heart hospital

has been recognized as a top performer. arkan-

sas heart hospital was recognized in 2011 &

Chi st. Vincent opens New Multispecialty Clinic the Chi st. Vincent multispecialty Clinic at Chi st. Vincent north

in sherwood is now accepting patients. physicians’ specialties at

the clinic include gastroenterology, breast surgery, colorectal and

general surgery, as well as geriatrics. minor procedures will be per-

formed at the clinic. outpatient procedures will be performed at Chi

st. Vincent north.

physicians practicing at the clinic are as follows:

•Sanford Benjamin, MD, Gastroenterologist

•Neelima Rao, MD, Gastroenterologist

•Tonya Martin-Dunlap, MD, Breast Surgeon

•Patrick Szeto, MD, Colorectal Surgeon

•James Walker, MD, General Surgeon

•Thirumal Dubbaka, MD, Geriatrician

the clinic is open monday through friday 8 a.m. – 5 p.m.

physicians will alternate clinic days.


2012 for its performance on accountability mea-

sure data for heart attack, heart failure, surgi-

cal Care, and pneumonia.

arkansas heart hospital is one of only 314

hospitals to achieve the top performer distinc-

tion for the past three consecutive years.

to be a 2013 top performer, hospitals had to

meet three performance criteria based on 2013

accountability measure data, including:

•Achieving cumulative performance of 95 per-

cent or above across all reported accountabil-

ity measures;

•Achieving performance of 95 percent or

above on each and every reported account-

ability measure where there were at least 30

denominator cases; and

•Having at least one core measure set that had

a composite rate of 95 percent or above, and

(within that measure set) all applicable individ-

ual accountability measures had a performance

rate of 95 percent or above.

for more information about the top performer

program, visit http://www.jointcommission.org/

accreditation/top_performers.aspx.

Chi st. Vincent Neurosurgeon Receives awardemad t. aboud, mD, a neurosurgeon and the

director of the microneurosurgery laboratory

at the arkansas neuroscience institute (ani)

at Chi st. Vincent infirmary in little rock, was

awarded third place oral abstract for his presen-

tation of the aboud training model at the 28th

annual association of Vascular access (aVa)

scientific meeting. the model uses human

cadavers connected to a pump to provide life-

like pulsating pressure transmitted to blood

vessels containing liquid using 3D technology.

the micro neurosurgery laboratory at Chi st.

Vincent is the only location in the world where

the model is used to provide laboratory training

for developing and refining surgical skills, espe-

cially for microsurgery. this method provides a

condition that simulates live surgery in terms of

bleeding, pulsation, and fluid filling of the vascu-

lar tree. it can be applied to the whole cadaver

or to a particular part such as the head, arm or

leg or to an isolated organ like the heart, liver

or kidney to teach surgical techniques and the

management of traumatic injuries, particularly

combat and war injuries.

the method can also be applied to ethically

sourced animal cadaver specimens for veteri-

nary surgical training—eliminating the use of

live healthy animals.

this study is part of the whole project, pre-

senting the aboud training model to the medical

and surgical community as valuable for surgical

training that can be added to available training

models for teaching young surgeons, surgery

residents, medical school students, nurses, and

paramedics.

aboud, ali Krisht, mD, neurosurgeon & medical

Director of the arkansas neuroscience institute

(ani), and other ani faculty are teaching these

courses as well. in addition several publications

in peer reviewed journals cover the subject.

Erdem Joins Baptist health & Neurosurgery arkansasDr. eren erdem, a neurointerventional radiolo-

gist, is the newest member of the Baptist health

family of specialists since recently joining neu-

rosurgery arkansas on the Baptist health medi-

cal Center-little rock campus.

Before joining neurosurgery arkansas, erdem

was serving as associate professor of radiology

at the University of arkansas for medical sci-

ences. he now shares his expertise in carotid

and intra cranial stents; cerebral aneurysm coil-

ing; aVm and head and neck tumor emboliza-

tion; kyphoplasty, vertebraplasty and sacro-

plasty; acute stroke intervention; spine tumor

ablation; si joint fusion; minimally invasive spine

decompression and disc herniation treatment;

and any type of spine pain management; with

the patients at neurosurgery arkansas.

erdem practices at the clinic along with Drs.

tim Burson, David e. Connor, and David reding.

some of the other services offered at neurosur-

gery arkansas include surgery for carpal tunnel

syndrome, trigeminal neuralgia, brain tumors,

cervical and lumbar spine disorders, cranio-

synostosis, Chiari malformation, and carotid

endarterectomy.

erdem, who received his doctor of medicine

from istanbul University in turkey, continued

on to earn specialty degrees in the area of diag-

nostic radiology, neuroradiology, and neuroin-

terventional radiology at long island College

hospital in new York, Children’s hospital of

philadelphia, and lahey Clinic in Boston.

NpMC Recognized by aCsnational park medical Center was recognized

by the american Cancer society for its dedica-

tion to the fight for a cure at both the local and

state levels. npmC’s relay for life team raised

more than $21,000 over the year-long fundrais-

ing period for last year’s event, making them the

top ACS fundraiser in Garland County and in the

Central arkansas region. they were also recog-

nized as the runner up for the “Best tent” at the

relay for life event held in June, as well as 3rd

place for most money raised on-site at the relay.

“our team works very hard every year to raise

money and awareness for the american Cancer

society—but this year was a particularly moti-

vating one for us here at npmC,” said npmC’s

team captain, pat herrin. national park medi-

cal Center lost 39-year employee, and Human

resources director, sandra Culliver to cancer

in July of 2013. “this was the first year of relay

since having lost sandra. she was—and still

is—a major motivation for our team’s exemplary

efforts for the aCs,” said herrin. “her strength,

will to live, and refusal to let cancer take over her

life gave us a constant reminder of why we are

fighting for a cure, and the daily research, advo-

cacy and programming that the aCs provides is

a very worthy cause of our time and our efforts.”

national park medical Center’s fundraising

efforts are more than just hospital-wide—they

are more of a community undertaking. last

year marked the 26th annual Daffodil Days,

where npmC staff sold and delivered daffodil

orders all around town—and sold daffodils at

Eren Erdem



oaklawn park for race-goers. it was also the

12th annual npmC easter Basket silent auction,

where community businesses, individuals and

organizations, as well as npmC employees and

vendors, donate items for a day-long silent auc-

tion which benefits the american Cancer soci-

ety. the team also hosted two large yard sales,

multiple bake sales, a jeans day at the hospital,

a 31-gifts fundraiser, and spring flowers sales

all to benefit the aCs. a portion of their team

t-shirt sales went to the cause, and they donated

silent auction items to the ACS Gala in August

to further benefit the society.

New Chi st. Vincent ED holds Ribbon Cutting, Blessinga ribbon cutting and a blessing were held at

Chi st. Vincent morrilton to commemorate the

opening of the newly renovated and expanded

emergency department. following the ceremo-

nies invited guests and members of the media

toured the new facility.

the event was attended by patty shipp, Chair-

man of the Board, Chi st. Vincent morrilton;

Jimmy hart, Judge, Conway County; stewart

nelson, mayor, morrilton and Jerry smith pres-

ident, morrilton Chamber of Commerce. each

had the opportunity to speak about the opening

of the new facility with the aid of a $1.25 million

funding ordinance provided by Conway County.

leslie ‘Bubba’ arnold, president, Chi st. Vin-

cent morrilton, presided over the ceremony.

“when we broke ground here on may 14 of this

year we told you that we were grateful to Judge

hart, treasurer wayne De salvo, and the Conway

County Quorum Court for the work and guidance

they provided in moving this project forward as

we imagined better health with a larger and

improved emergency department. now what we

imagined is real. we are bringing better health

to the people of morrilton, Conway County and

the surrounding area with the scheduled open-

ing of this completed emergency department in

the coming days,” arnold said.

emergency department physicians and

nurses will treat patients in the space that has

more than doubled the number of emergency

exam rooms with nine all-private rooms. and

the square footage of the emergency depart-

ment has increased from 2,800 to 7,000 square

feet. “the expansion and renovation will allow

our dedicated team of physicians and nurses

to more efficiently treat patients,” said arnold.

total cost of the project is $1.5 million. in addi-

tion to the $1.25 million funding ordinance, Chi

st. Vincent auxiliary provided $60,000 for the

renovation and expansion. auxiliary members

raised the money with fundraisers through-

out the last two years with bake sales, silent

auctions, raffles, drawings, and the sales of

breakfast and lunch at the hospital Grill – the

employee cafeteria.

UaMs provides Maternal Fetal Medicine support the University of arkansas for medical sci-

ences (Uams) has started providing support

via telemedicine to high-risk pregnant mothers

and physicians at the oklahoma state Univer-

sity Center for health sciences Department of

Obstetrics and Gynecology who treat them at

osU medical Center in tulsa, oklahoma.

the osU/ Uams collaboration will allow con-

sultations in real time between medical special-

ists, pregnant mothers, and their physicians so

they can receive needed healthcare near their

homes. medical professionals at osU will be able

to collaborate with Uams medical specialists

to co-manage patient care so they don’t have

to refer patients to distant hospitals or clinics.

The support follows the ANGELS telemedicine

model developed and administered by Uams

Center for Distance health, though it is not an

extension of the ANGELS network. ANGELS (the

Antenatal and Neonatal Guidelines, Education

and learning system) is an innovative consulta-

tive service for a wide range of physicians includ-

ing family practitioners, obstetricians, neonatol-

ogists, and pediatricians in arkansas.

through telemedicine and distance health

tools, UAMS and ANGELS for more than a

decade have delivered subspecialty care ser-

vices to high-risk arkansas mothers and their

fragile infants.

osU obstetricians and gynecologists for sev-

eral years have taken part in regular interactive

video teleconferences and webinars as part of

professional distance learning and collaboration

with Uams physicians. the additional maternal-

fetal medicine support promises even further

to deepen the existing professional relationship

between the universities.

Baptist health introduces 3D surgeryBaptist health medical Center-little rock

reports that it is the only hospital in the state

to acquire the world’s only articulating, high-def-

inition, 3D surgical video system from olympus.

surgical video systems, through the collabora-

tive use of a video processor, light source, lapa-

roscope and monitor, enable surgeons to peer

inside the human body to diagnose, detect and

treat a range of diseases and conditions using a

minimally invasive approach.

laparoscopy is performed through small inci-

sions made in the abdomen or pelvis. a video-

scope (laparoscope with a miniature camera

built into its tip) allows the surgeon to view the

surgery site during an operation.

laparoscopy has become increasingly com-

mon in hospitals with about 2.8 million proce-

dures (laparoscopic, single site and robotic-

assisted surgeries) performed in the United

states in 2013. Compared to open surgery, a

laparoscopic approach offers reduced pain, less

hemorrhaging, shorter recovery times and bet-

ter cosmetic results all due to the smaller inci-

sion sites. however, surgeons lose some of the

natural depth perception and precision when

migrating from open surgery to laparoscopic

surgery. the 3D videoscope provides three-

dimensional, high-definition images that help

restore the surgeon’s natural 3D vision and

depth perception. its articulating-tip design

makes it possible to view the desired organs

and see areas not previously accessible with

standard rigid laparoscopes. the result for the

surgeon is better sight lines and the ability to

peer around anatomical structures and perform

more precise grasping, dissection and sutur-

ing—something that is lacking in the flat images

provided by 2D imaging systems.

this new 3D system will enable Baptist health

surgeons to perform laparoscopic surgery on a

universal platform that supports more than 100

different rigid, flexible, and articulating endo-

scopes used in a broad range of specialties.

the general benefits of 3D endoscopy are as

follows:

•Precise hand-eye coordination through the

three-dimensional image of the operating-room

environment

•Realistic presentation of tissue structures in


Comprehensive Rehab Clinic opens at UaMs Northwestthe University of arkansas for medical sciences (Uams) recently celebrated the opening of a comprehensive rehabilitation clinic on its northwest arkansas regional campus in fayetteville, improving access to physical, occupational and speech rehabilitation services.

the Uams northwest outpatient therapy Clinic hosted an open house in its 2,735-square-foot clinic that features a staff of experienced therapists and top-of-line therapeutic devices. the equipment includes an experimental assisted movement with enhanced sensation (ames) Device — one of only five such devices in the nation — for helping patients regain mobility or use of a paralyzed limb by enhancing sensory or motor connections.

now accepting appointments, the clinic can treat older patients, veterans, athletes, those with chronic conditions or patients recovering from injuries affecting mobility or speech. the clinic’s goal is to provide effective, evidence-based outpatient therapy for patients with a variety of diagnoses, including functional deficits due to neurological disease, neck and back pain, injury or amputations.

the clinic also will serve as an educational host for the coming Uams physical therapy doctoral degree program, which will welcome its first students in fall 2015. at the rehab clinic, the students will gain therapy experience with patients while under supervision of the clinic staff.

the experienced clinic staff includes: •John Jefferson, PhD, chair and associate professor for the

Department of physical therapy in the Uams College of health professions

•Nathan Jowers, MPT, clinic director•Angel Holland, MPT, director of physical therapy clinical

education•Kandy Salter, MS, an occupational therapist •Jamie Pulliza, MA, a speech-language pathologistClinic patients will have access to a range of therapeutic

devices, including the:•Alter G Anti-Gravity Treadmill — Allows patients to practice

walking and running with fully weight bearing•Balance Master System — Allows detailed assessment of

balance and posture control in patients•Assisted Movement with Enhanced Sensation (AMES) Device

— enhances sensory output and motor output connections in the brain for patients recovering from stroke or other neurological impairments

top The AMES Device, one of only five such devices in the nation.above A staff member demonstrates the anti-gravity treadmill.



their actual spatial position

•The shorter learning curve facilitates a safe

learning curve for more complex interventions

•More precise operation and therefore more

comfort for patients

•Time-saving because precise operation (e.g.

when positioning a suture) enhances efficiency.

otolaryngologist alissa Kanaan Joins UaMs alissa Kanaan, mD, an otolaryngologist, has

joined the University of arkansas for medical

sciences (Uams) and will see patients at the

ear, nose, and throat Clinic in the Jackson t.

stephens spine & neurosciences institute.

Kanaan, an instructor in the Department of

otolaryngology – head and neck surgery in

the Uams College of medicine, offers endo-

scopic nasal and sinus surgery and treatment

for chronic sinusitis, nasal obstruction, and fun-

gal sinusitis.

Kanaan received her medical degree at the

american University of Beirut in Beirut in 2007,

where she also did an internship in general sur-

gery in 2008 and residency in otolaryngology-

head and neck surgery in 2012. she completed

a fellowship in pediatric otolaryngology-head

and neck surgery at McGill University Montreal

in Quebec, Canada in 2013 and one in rhinology

and allergy at the University of pittsburgh medi-

cal Center in 2014.

she is a member of the american rhino-

logic society and american academy of

otolaryngology.

Chi st. Vincent Named accredited Chest pain Centerthe Jack stephens heart institute at Chi st. Vin-

cent infirmary in little rock has received Chest

pain Center accreditation from the society of

Cardiovascular patient Care (sCpC), an interna-

tional not-for-profit organization that focuses on

transforming cardiovascular care by assisting

facilities in their effort to create communities

of excellence that bring together quality, cost

and patient satisfaction.

sCpC accreditation is confirmation that hos-

pitals have achieved a higher level of expertise in

treating patients who arrive with symptoms of

a heart attack. the accreditation means these

hospitals emphasize the importance of stan-

dardized diagnostic and treatment programs

that provide more efficient and effective evalua-

tion as well as more appropriate and rapid treat-

ment of patients with chest pain and other heart

attack symptoms. they also serve as a point of

entry into the healthcare system to evaluate and

treat other medical problems; and they help to

promote a healthier lifestyle in an attempt to

reduce the risk factors for heart attack.

New president of Chi st. Vincent hot springs Namedin December, anthony houston took over as the

new president of Chi st. Vincent hot springs.

houston was previously the executive Vice-

president and Chief operating officer at ssm

st. mary’s hospital in Jefferson City, mo., spon-

sored by ssm health, the first healthcare winner

of the malcolm Balridge national Quality award.

houston’s experience with ssm health

includes serving as Corporate Director of opera-

tional finance where he served as project man-

ager for revenue Cycle transformation. prior to

that, he was senior Director for public finance

for fitch ratings from 2006 - 2010. from 2004

to 2006, houston was a senior associate at

pricewaterhouseCoopers where he served as a

consultant in their healthcare provider planning

practice. at the University of Chicago hospitals,

from 2000-2004, houston managed service line

and faculty physician practices for Cardiac &

thoracic surgery, heart transplant services,

and pediatric neurology and epilepsy services.

houston is a graduate of the University of Cin-

cinnati where he earned a Bachelor of science.

he also earned a master’s degree in health ser-

vices administration from Xavier University.

houston replaces thomas fitz who served as

interim president of Chi st. Vincent hot springs

when the system was acquired by Chi st. Vin-

cent in april 2014.

Baptist health offers New technology for Early Diagnosis each year more people die of lung cancer than

of colon, breast, pancreatic, and prostate can-

cers combined. and according to the american

Cancer society, arkansas will have an estimated

2,660 new cases of lung cancer diagnosed in

2014 resulting in 2,200 deaths.

early stage lung cancer that is detected,

diagnosed and immediately treated has sur-

vival rates up to 88 percent compared to the

current 15 percent for late stage lung cancer

patients. Baptist health is now offering a new

minimally invasive procedure that will aid with

earlier diagnosis for patients with lung lesions

(spots that appear on Ct scans that may indi-

cate cancer). this allows patients who turn out

to have cancer to get treatment as soon as pos-

sible and those with benign conditions to hope-

fully avoid surgery.

finding a spot on your lung is scary, but if

found while the spot is still small is extremely

beneficial, explained Dr. Jason holder, a pul-

monologist with pulmonary associates, pa, in

little rock.

Alissa Kanaan, MD Anthony Houston


research shows that most small lung spots

turn out not to be cancer and could be an

infection or scar tissue from a previous infec-

tion. however, physicians must take a tissue

sample or biopsy in order to make an accurate

diagnosis.

with the new electromagnetic navigation

Bronchoscopy™ (enB) procedures, which are

performed with a device known as the super-

Dimension™ navigation system with lung-

GPS™ technology, physicians can navigate

and access difficult-to-reach areas of the lung

from the inside.

“the superDimension navigation system, with

GPS-like technology, is a significant advance-

ment for aiding in the diagnosis of lung cancer

and overcomes limitations of traditional diag-

nostic approaches,” said holder. “By guiding us

through the complicated web of pathways inside

the lungs, we’re able to access and sample target

tissue throughout the entire lung without surgery

or a needle biopsy. this technology can aid with

earlier diagnoses which may allow for less inva-

sive treatments for patients with lung cancer.”

with the superDimension system, the Ct scan

images are used to create a roadmap of the

thousands of tiny pathways inside the lungs. the

LungGPS™ technology then provides a road-

map that allows physicians to guide tiny tools

through the lung pathways so they can take tis-

sue samples of the lesion and place markers.

this technology prevents patients from under-

going multiple procedures.

Mynatt Joins NpMC Medical staff Dr. richard mynatt, a board certified urologist,

has joined the medical staff at national park

medical Center.

Dr. mynatt is experienced with laser treat-

ments for enlarged prostate, which may be per-

formed in the outpatient setting. he provides

some of the latest treatments for kidney stones,

and works with patients for the prevention of

stones as well. additional conditions treated by

Dr. mynatt include urinary tract infections, uri-

nary incontinence, overactive bladder, prostati-

tis, interstitial cystitis, and urinary tract (kidney,

bladder, prostate, testicular) cancers.

Dr. mynatt received his medical degree from

the University of tennessee school of medicine.

he completed his general surgery internship at

the University of California Davis medical Cen-

ter, and his urology residency at Duke Univer-

sity. he has spent the past 30 years practicing

Urology, and comes to hot springs from wash-

ington state.

NpMC Breaks Ground on Expansion project national park medical Center has broken

ground on a 67,000-square-foot expansion

project that will create a standalone heart and

vascular center of excellence and renovate and

provide additional space for the existing emer-

gency department.

the new facility will be built immediately west

of the current hospital on about 9 acres of land

situated between hollywood avenue and the hot

springs Country Club golf course.

Jerry mabry, president of Capella healthcare’s

arkansas market, said prior to the groundbreak-

ing that plans for the expansion have been in the

works for about two years and the groundbreak-

ing is a “notable occasion for us.”

the initial expansion will cost $25-26 million,

mabry said, but adjunct plans that include

annual capital investments will push the invest-

ment to $30-35 million over a three-year period.

while the expansion won’t increase the num-

ber of beds from the present 166, it will special-

ize those beds, especially in the area of cardiol-

ogy, mabry said.

Mandy Golleher, director of marketing and

volunteer services, said the project will double

the capacity of the existing emergency depart-

ment and add a stand-alone cardiology center

of excellence featuring the latest heart care

technology in one location for all the hospital’s

advanced heart care services.

UaMs performs heart-stopping surgery ashley Bell’s heart stopped beating while

she was on the operating table. But that was

exactly what her doctors intended. she is the

first patient at Uams and likely the entire state

to undergo adenosine induced asystole in aneu-

rysm surgery, a method that stops the heart and

blood flow to an aneurysm, making it easier to

close it off.

Bell had bilateral carotid artery aneurysms,

called mirror aneurysms. they were pressing

on the optic nerves behind both her eyes. she

first noticed a significant change in her vision

in July.

“i couldn’t see as clearly out of one eye, then

the other. then my right arm went numb,”

Bell said. “at work one day, i was talking to a

coworker and could hardly get my words out.”

Bell visited her primary care physician in

Jonesboro and was initially diagnosed with

complex migraines (a migraine with neurologic

symptoms). when medication did not alleviate

her symptoms, Bell talked to a neurologist who

ordered a computed tomography (Ct) angio-

gram. the images showed two brain aneurysms.

“i was in shock,” Bell said. “they told me to

go to Uams immediately. i came in through the

emergency room.”

adib abla, mD is director of cerebrovascu-

lar surgery and neurovascular research in the

Uams College of medicine Department of neu-

rosurgery. he talked to Bell about her treatment

options and the risks involved.

“there was concern i could lose my vision,”

Bell said. “i told him i did not care. Just do what-

ever you can to keep me alive for my babies.”

“Based on the pressure the aneurysms were

putting on her optic nerves, she decided to have

surgery,” abla said. “we started on her left side

the next morning. she recovered very nicely

after the first surgery.”

Bell’s first surgery lasted four hours in the

operating room and in october, two months

later, Bell had another four-hour surgery, this

time on her right side. that’s the side where

abla needed to stop her heart to effectively

clip the aneurysm. since it was so close to her

optic nerve, the risk of blindness in the proce-

dure was estimated to be 5 percent.

“too much manipulation would have

increased her chances of going blind.” abla said.

“Deflating the aneurysm made it easier to clip

with less manipulation of the optic nerve.”

stopping and starting the heart successfully

would not be possible without a neuroanesthe-

siologist keeping a close eye on the patient’s

vital signs while under temporary cardiac

arrest.

“our colleagues in neuroanesthesiology are



ACHRI build on the work of their Arkansas Grow

healthy study, directed by Dr. Judith weber, pro-

fessor of pediatrics at the University of arkan-

sas for medical sciences (Uams), by convening

local farmers, child nutrition staff, city adminis-

trators, health professionals, education profes-

sionals, and community members. the arkansas

Grow Healthy Study is a five-year farm to school

feasibility pilot program, aimed at assessing and

building capacity for farm to school in arkansas.

the study is culminating in a year-long farm to

school pilot during the 2014-2015 academic year.

Lessons learned during the Arkansas Grow

healthy study will inform the planning process

for the 2015 farm to school summits. the sum-

mits will be held in the fall of 2015 in multiple

regions of the state. at each event, research

staff plan to:

•Train child nutrition staff in knowledge and

skills to create menus, as well as procure, mar-

ket, and prepare local foods in schools;

•Educate farmers about the Arkansas Mar-

ket maker program, school food safety require-

ments, and how to conduct business with

schools; and

•Create new connections between commu-

nity partners who support farm to school and

child nutrition staff who need help finding farm-

ers, planning events, and building a program

around local procurement efforts.

make a second incision in the neck, as is done

sometimes for carotid artery aneurysms. this

is still commonly done.

the other way, as was the case for basilar

artery aneurysms, put the patient under hypo-

thermic circulatory arrest, bringing the body

temperature to less than 85 degrees fahrenheit

and stopping the heart for 45 to 60 minutes.

that procedure is no longer practiced for cere-

bral aneurysms because of the risks involved,

abla said.

“i was really impressed with the care i received

from my doctors and staff,” Bell said. “i was ner-

vous and scared. when i think of aneurysms, i

don’t hear about those who live through it. i’m

grateful to still be here for my family.”

aChRi plans Regional Farm to school summitsthe arkansas Children’s hospital research

institute (aChri) will host several farm to

school summits in the new year that

will help schools create health-

ier meals using local pro-

duce thanks to nearly

$50,000 in grants

from the U.s. Depart-

ment of agriculture

(UsDa).

the funds will help

pivotal in doing this type of procedure,” abla

said. “They watch the EKG closely and bring her

heart back to beating normally if the medica-

tion doesn’t wear off the way it should. But in

ashley’s case, it wore off nicely.”

Using adenosine, a building block of Dna,

indranil Chakraborty, mD, associate professor

in the Division of neuroanesthesiology in the

College of medicine would stop the patient’s

heart for 20 seconds at a time.

that time frame, abla said, was enough for

him to put a clip on the aneurysm itself. Clos-

ing the blood vessel that supplies the aneurysm

is another option but in this case would have

required making another incision lower down

in the neck region.

“the aneurysm and the vessel that feeds it

are both at the base of the skull,” abla said. “we

would have had to make another incision and

opening in her neck

to clip the blood

vessel supplying

the aneurysm.”

Before using adenos-

ine to stop the heart for

aneurysm clipping, there

were two other ways doc-

tors used to treat aneu-

rysms that were difficult

to deflate. one way was to

Ashley Bell, a patient who had mirror aneurysms poses with UAMS neurosurgeon Adib Abla, MD

adib abla, mD examines patient ashley Bell during a checkup

weeks after her brain surgery.


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advertiser index

the dates and locations of the summits will

be announced in each community as they are

scheduled.

agriculture secretary tom Vilsack announced

support for the events as part of a grant pack-

age funding 82 projects across 42 states and

the U.s. Virgin islands. each of the projects high-

lights the UsDa’s efforts to connect school caf-

eterias with local farmers and ranchers through

its farm to school program. of the 82 awards,

eight awards are being given in the south west

region valued at $446,372.

“Community partners are coming together to

ensure a bright and healthy future for students,

and local farmers and ranchers,” said Vilsack.

“these inspiring collaborations create long-

term benefits for students, as they develop a

meaningful understanding of where food comes

from, and support our farmers and ranchers by

expanding market opportunities for local and

regional foods.”

selected projects will serve school districts in

arkansas, louisiana, new mexico, oklahoma,

and texas.

Dr. weber’s research program is supported,

in part, by funding from the arkansas Biosci-

ences institute, which was created as the major

research component of the tobacco settle-

ments proceeds act of 2000. the arkansas

Grow Healthy Study is supported by the Agri-

culture and food research initiative Competi-

tive Grant No. 2011-68001-30014 from the USDA

national institute of food and agriculture.

aChri provides a research environment on the

aCh campus to meet the needs of the Uams

faculty. research scientists at aChri conduct

clinical, basic science, and health services

research for the purpose of treating illnesses,

preventing disease, and improving the health of

children everywhere. n


You’ve got a big job. You took it on the moment your child

was born, knowing that protecting him was a lifetime assignment. And now, as part of that job, you’re questioning the viability of a rite that children have un-dergone for decades: vaccinate or not?

You’ve read the pros and the cons, and your mind swims. But once you read “On Immunity: An Inoculation” by Eula Biss, you’ll understand a little more.

While modern medicine is surely that, vaccination has been around for quite awhile: in the mid-1700s, many noticed that milkmaids exposed to cowpox were immune to smallpox, and they acted accordingly. Even before that, though, parents in Chi-na and India practiced a form of vaccination called variola-tion. And before that, birth was “the original inoculation.”

As the daughter of a doctor, Eula Biss got the full round of vaccines that most babies of her genera-tion received. She debated, however, about vacci-nating her own son from a strain of flu that was going around when he was an infant, which led to the greater question: which vaccines – if any - are necessary?

The complication, she learned, is that we can’t see vaccine “just in terms of how it affects a single body, but also in terms of how it affects the collective body of… commu-nity.” Total world-wide immunization against disease is nearly impossible, but statistics show that if the right percentage of a population is immunized, it can halt an epidemic. The majority effectively protects the minority.

So is it better to receive natural immunity from a disease by contracting it?

Not necessarily, says Biss. While it’s true that we wouldn’t be a species without viruses (a “surprising amount” of our genomes consist of “debris from ancient viral infections”), allowing your children to catch certain childhood diseases now can be detri-mental to them later in their lives.

Hand sanitizers aren’t the answer, either, since they kill “in-discriminately,” promote antibiotic resistance, and leave behind traces of unsavory chemicals. And part of the vaccine-or-not issue is that misinformation can, well, go viral.

by Eula Bissc.2014, Graywolf Press

And yet, “uncomfortable with both sides” of the argument, and “overwhelmed by in-

formation,” Biss went ahead with the schedule of inoculations for her son. “I still believe,” she says, “there are reasons to vaccinate that transcend medicine.”

When you see something these days about vaccinations, it’s easy to conclude that it might fiercely be for or against. Not so with “On Immunity.”

With cautious deliberation and careful reflection, author Eula Biss offers readers a good balance in this debate, which is de-lightfully welcome. As a mother, she’s obviously had to ponder the issue and her conclusions are based in fact and personal anecdote, although she also includes the perfect amount of his-tory and literature for entertainment.

I’m not sure this book will change any minds, but it does of-fer a fair mix to consider if you’re a parent facing the decision. For you, or for anyone who’s interested in a hidden history of medicine, “On Immunity” is worth a shot. n

R e v i e w s b y t h e b o o k w o R m

Author eulA biss

offers reAders A good bAlAnce in this debAte,

which is delightfully

welcome


Last night’s dessert was spectacular. As with many finales, that perfect end-

ing to a perfect meal left you satisfied for the rest of the evening. It was, like some conclusions - a little nightcap, a final chapter, a last dance, the lingering notes of a favorite song - a thing to savor.

Can the end of life be so sweet? Perhaps; there are steps to make it so, as you’ll see in the new book “Being Mortal” by Atul Gawande.

For about the last century, the average lifespan for North Americans has been increasing. Modern medicine has taught doctors how to save lives but, until relatively recently, it didn’t teach them how to deal with life’s end.

That, says Gawande, is unfortunate. In many cases, doc-tors feel extremely uncomfortable discussing the end of life with their patients. That often leads to proto-col that precludes quality of life when there isn’t much life left to have.

We’ve come to this point, this reluctance to face death, because we’re no longer familiar with it. A century ago, people died at home, often after self-treating their ailments. Hospitals were not places to get better, says Gawande; medicine back then usually had little impact on life or death. When penicillin, sulfa, and other drugs became available, however, hospitals became places for cure. Nursing homes, he says, were for people who needed additional care before going home.

But medicine isn’t the only thing that’s changed: aging has, too. We live longer, we expect our parts to last longer, and we’re surprised when health fails. But does that make aging a medi-cal problem?

To a geriatrician, it might be – but Gawande says there aren’t enough doctors of geriatrics and, without them, we have a less-ened chance to sidestep problems that could diminish the qual-ity of life in later years. He says, in fact, that the elderly don’t dread death, so much as they dread the losses leading up to it: loss of independence, of thought, of friends.

But long before that happens, Gawande says, there are con-versations that need having; namely, what treatments should,

or should not, be done? How far would you want your physician to go?

Let me tell you how much I loved this book: I can usually whip through 300 pages in a night. “Being Mortal” took me three.

Part of the reason is that author Atul Gawande offers lingering food for thought in practically every paragraph – whether he writes about the history of aging and dying, one of his patients, or someone in his own family. I just couldn’t stop thinking about the points he made with his anecdotes and with this informa-tion, how it could radicalize our lives, and how it fits for just about everybody.

We are, after all, not getting any younger.I think if you’re a caretaker for an elderly relative or if you

ever plan on growing old yourself and want to maintain qual-ity of life, this book is an absolute must-read. For you, “Being Mortal” is informative to the end. n

by Atul Gawandec.2014, Henry Holt

we live longer, we expect our

pArts to lAst longer, And

we’re surprised when heAlth

fAils

R e v i e w s b y t h e b o o k w o R m

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