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Archive for February, 2016

Medical Association of Atlanta Introduces Medical Student Scholarships

Sunday, February 28th, 2016

In an effort to increase the number of practicing physicians in the State of Georgia and increase Medical Student involvement in organized medicine, the Medical Association of Atlanta Board of Directors created four $5000 scholarships, two to be awarded to senior medical students at Emory University School of Medicine and two to be awarded to senior medical students at Morehouse School of Medicine.

To qualify for one of these scholarships a senior medical student must have matched and committed to a residency program located in Georgia. Preference will be given to those students who have joined the Medical Association of Atlanta and attended MAA events.

The MAA board of directors feels it is important for medical students to participate in organized medicine and to that end charges no dues to medical students who are members. The board of directors has committed to provide these scholarships for five years and then will reassess their effectiveness.

As a result of working with Emory and Morehouse leadership to establish these scholarships, MAA has a better relationship with both of these Medical Schools as we all work toward the goals of providing excellent care to all the citizens of Georgia and developing physicians who are leaders in medicine and their communities.

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Global Health in Our Own Backyard

Thursday, February 25th, 2016
Susan Reines

Susan Reines, M.D.

Providing Pediatric Care for Newly Resettled Refugee Children and Adolescents in DeKalb County

By Susan. S. Reines, M.D. and Tarissa Mitchell, M.D.

For the past five years, The Southeast Permanente Medical Group’s (TSPMG) Cares Program and DeKalb County Board of Health (DCBOH) have collaborated to provide pediatric services to newly resettled refugee children in DeKalb County.

Tarissa Mitchell

Tarissa Mitchell, M.D.

The Refugee Pediatric Clinic opened its doors on May 5, 2010, to help refugee kids with chronic medical conditions gain access to specialty care providers. Initially providing limited services only one day per week, we now provide comprehensive pediatric care four days per week, offering well child exams and acute and follow-up visits. Same-day and walk-in access are also available. In 2014, we completed more than 2,000 visits for approximately 800 children and teens.

The clinic is staffed by TSPMG physicians and nurse practitioners, and we are lucky to work with volunteer pediatricians from the Centers for Disease Control and Prevention (CDC) and pediatric residents from Emory University. DCBOH provides clinic staff, including an LPN, a public health tech, multilingual reception staff, laboratory staff and a cadre of dedicated and trained onsite medical interpreters who speak approximately eight different languages; language line services provide additional language support when needed.

The national Reach Out and Read program has generously worked with us to help immerse young refugees in the English language and the joys of reading. Collaborations with Emory University and CDC have encouraged ongoing clinical research, which has been presented at national American Academy of Pediatrics meetings.1,2

We were inspired to start this clinic when it appeared that refugee children in our community with significant health problems were having trouble accessing follow-up care after their initial health screening and were “falling through the cracks.” Although they had health insurance (Refugee Medical Assistance), they confronted new obstacles. Language and communication barriers, transportation barriers and a low level of health literacy were only compounded when they encountered our complex healthcare and insurance system.

Our goal was to deliver care in a setting that could effectively address some of these barriers and provide multiple services in one location. DCBOH had the necessary infrastructure for this program, including a well-developed refugee screening clinic with a multilingual staff that already evaluated new refugees. Numerous ancillary services were already in place, including Women, Infants, and Children (WIC); clinics for HIV, other sexually transmitted infections, tuberculosis (TB), latent TB infection and dental care; the Children’s First Program; and programs for mental health and environmental health. We succeeded in establishing a pediatric clinic built on the widely recognized core values of immigrant medicine.3

We strive to:

  • Recognize the continued health inequities faced by refugees after resettlement.
  • Show respect for our patients’ cultures, religions, experiences and resilience.
  • Promote trust by using bilingual staff and not rushing through encounters.
  • Demonstrate cultural humility by showing respect, interest and willingness to learn from others.
  • Approach newly arrived refugees with compassion.
  • Understand the unique health profiles of refugees based on their country of origin.

An understanding of these values helped our perceptive practitioners quickly determine the cause of this baby’s elevated lead level:

Baby S was a 3-month-old exclusively breastfed refugee from Afghanistan. Her labs were significant for a lead level of 22ug/dl (normal less than 5µg/dl). Development was appropriate for age and mothers lead level was undetectable. The pediatric provider immediately noticed that the infant was wearing eyeliner, or surma, brought from Afghanistan. These products are believed to help eyesight develop and ward off evil spirits, but can also expose children to lead. The Division of Environmental Health at DCBOH made a home visit and tested the surma for lead, finding an extremely high level. The family was counseled about the dangers of this product in children and immediately stopped using it. One month later, the lead level was 19 µg/dl and, thereafter, continued to fall.

Table 1 lists many of the unique medical problems we have treated in children and teens over the past 5 years.

In the next section, we will give an overview of refugee health, providing some global and local statistics, and a description of the refugee medical screening process.

Refugee Statistics

The United Nations High Commissioner for Refugees reported that in 2014 there were 59.5 million forcibly displaced persons worldwide, representing the largest refugee crisis since World War II. This number includes 19.5 million refugees, 38.2 million internally displaced people and 1.8 million asylum seekers.4 About one-third of the world’s refugees originate in Syria and Iraq, but large numbers also come from Afghanistan, Somalia, the Democratic Republic of the Congo (DRC) and Sudan.4

In 2014, 69,986 refugees resettled in the United States, of which 2,694 from 34 countries arrived in Georgia.3 The majority originated from Burma/Myanmar, Bhutan, Somalia, Iraq, DRC and Afghanistan (Table 2). Each year, Georgia receives approximately 3-5 percent of the U.S.-bound refugee population, primarily in DeKalb County, and ranks among the top 10 states (numerically) for refugee resettlement.

Depending on their countries of origin, refugees may have a high burden of infectious diseases, including hepatitis B, TB and parasitic infections. Many children have lived in refugee camps or other settings where malnutrition and micronutrient deficiencies are prevalent. Others have received little or no care for significant congenital anomalies and sequelae of difficult pregnancies and traumatic deliveries. Mental health problems such as post-traumatic stress disorder, depression and anxiety are frequent in those who have been traumatized by war, conflict, persecution and torture.

Refugee Medical Screening

The Overseas Medical Evaluation. Prior to resettlement in the United States, refugees undergo an overseas medical examination conducted by panel physicians selected by the Department of State, with regulatory oversight and technical instructions for the examination provided by the Centers for Disease Control and Prevention (CDC). The purpose of this exam is to identify and prevent (or delay until treatment is complete) travel in those with communicable diseases of public health significance (such as active tuberculosis, leprosy, untreated sexually transmitted infections) and mental health disorders associated with harmful behaviors and drug addiction. Conditions noted at the time of the exam that do not legally preclude travel are documented on the overseas medical record.

Additionally, most refugees bound for the United States are offered a number of Advisory Committee on Immunization Practices (ACIP)-recommended immunizations, as well as pre-departure presumptive treatment for parasitic infections that varies by country of origin. Immunizations and parasitic treatment are not legally required but are strongly recommended to refugees to improve health and prevent resettlement delays that arise during outbreaks of vaccine-preventable disease.

A completed overseas health assessment (DS-2053) form is given to families prior to travel, and they are instructed to bring this form to their domestic health evaluation. This health information is also available on a CDC database (Electronic Disease Notification System) and can be accessed by state and local health departments. CDC guidelines for pre-departure and post-arrival medical screening and treatment can be found on their website.

Domestic Medical Screening. Once refugee families arrive in Georgia, most undergo a comprehensive medical screening within 30 days at the DCBOH Refugee Screening Clinic.  Under the supervision and guidance of Drs. Sentayehu Bedane (Manager of Countywide Services) and Alawode Oladele (Lead Physician of Refugee and TB services), the DCBOH screened 2,574 (95 percent) of new refugee arrivals in Georgia in 2014. Table 3 provides a summary of the age-appropriate medical evaluation performed.

All new refugees receive Refugee Medical Assistance (RMA) for the first eight months after resettlement. Following the initial domestic health screen, adults are referred to their primary care provider, and children and adolescents are offered appointments in the Refugee Pediatric Clinic or can be seen by a primary care physician in the community. A family nurse practitioner is available to assist adults with their referrals.

Despite the challenges and sometimes frustrations of providing care to this unique group of patients, the clinic has been a valuable addition to the refugee resettlement process and a rewarding experience for providers and staff. We present a successful model for how multiple health partners (DCBOH, TSPMG, Emory University, CDC) can combine resources to improve healthcare for an often overlooked group in our community. We look forward to many more years of service to the refugees who have demonstrated tremendous courage, strength and resilience in the face of extreme adversity and hardship.

References

  1. Shah, A. Y., Suchdev, P. S., Mitchell, T., Shetty, S., Warner, C., Oladele, A., Reines, S. Nutritional Status of Refugee Children Entering DeKalb County, Georgia. Journal of Immigrant & Minority Health. 2014; 16(5):959-967.
  2. Calhoun, C. Reines, S., Suchdev, P. Oladele, Goodman, A. Adapting an Autism Screening Tool for Use in the DeKalb County Refugee Pediatric Clinic. Poster presentation, AAP National Conference 11/ 2014.
  3. Walker, P., Barnett, E. Immigrant Medicine. Philadelphia: Elsevier; 2007, p 6.
  4. UNHCR Global Trends 2014. Available: http://www.unhcr.org/pages/49c3646c4b8.html
  5. Fiscal Year 2014 arrivals. Available: http://www.acf.hhs.gov/programs/orr/resource/fiscal-year-2014-refugee-arrivals
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Understanding Autism

Thursday, February 25th, 2016

Mark MoncinoSimplified diagnostic criteria and more awareness are helping both parents and doctors identify autism at an earlier age

By Mark Moncino, M.D.

Autism Spectrum Disorder (ASD), previously termed autism, Asperger’s Syndrome, and PDD-NOS, is a common, heterogeneous, treatable – and potentially curable – cause of developmental disability. ASD is a spectrum of neurobehavioral disorders with manifested symptoms in an individual child that are quite unique, prompting the oft-quoted “If you have seen a child with ASD, you have seen ONE child with ASD.”

With the publication of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), the diagnostic criteria have been simplified. DSM-5 now emphasizes the two fundamental neurobehavioral problems common to all children with ASD:

1) Deficits in social-communication efforts, and

2) Dysfunctional behaviors that include:

a] Stereotypic and repetitive motor or verbal behaviors,

b] Rigid routines or ritualized patterns of behavior,

c] Restricted or fixed interest and

d] Widespread sensory sensitivities, acknowledged for the first time by DSM-5

Over the last 40 years, the number of children with an ASD diagnosis has exploded. Until the 1980s, ASD was thought to be rare, affecting approximately 1 in 2,000 children and only diagnosed in those with profound deficits. Now, the 2014 CDC data shows that 1 in 64 of Georgia’s children (1 in 39 boys and 1 in 181 girls) are diagnosed with ASD. Of note, CDC data shows the picture of ASD is changing, with almost half of all children identified with ASD having average or above average intelligence.

No etiologic agent has been identified as the cause of ASD, although genetics play a role, as do a host of other associations. One thing we know for certain is that vaccines do NOT cause ASD.

A significant factor is an increase in diagnostic substitution. Historically, many of these children were considered intellectually disabled or received no diagnosis. Incidentally, this increase has been associated with the establishment of access to school services, with the passage of The Education For All Handicapped Children Act (PL 94-142) in 1974; the forerunner to the Individuals With Disabilities Education Improvement Act of 2004.

ASD is four times more common in males than females but is not X-linked. We know the concordance rate in identical twins is high (36-95 percent) but not 100 percent. In fraternal twins the risk is elevated, as is the risk if parents have a previously affected child (2-18 percent risk). While research studies show there are 300 to 500 gene associations, thus the postulated reason for the wide variation in symptoms, no single gene has been associated with more than a tiny fraction of cases (< 1 percent). ASD tends to occur more often in people with certain genetic conditions, with about 10 percent of ASD children having Down syndrome, Fragile X syndrome or Tuberous Sclerosis.

The American Academy of Pediatrics recommends screening children for general development using standardized, validated tools at 9, 18 and 24 or 30 months; and for ASD at 18 and 24 months, or whenever a parent or clinician has a concern. Despite this, CDC data shows that the average age of diagnosis of ASD in Georgia’s children is 4 years 5 months of age, although children can be reliably diagnosed as early as age 24 months of age (and possibly younger).

The variation in symptoms can be profound. Some children are nonverbal with virtually absent social skills, self-injurious behaviors and severe sensory disorders. Others may have reasonably good expressive language but impaired social skills, weak perspective taking abilities, repetitive behaviors or interests, or sensory problems. Regardless of severity, all children with ASD demonstrate weakness in social skills, which are fundamentally interrelated to communication and essential for integration in the community.

Consider ASD as a social learning disability created by a lack of connectedness with other individuals. Children with ASD do not spontaneously learn that words have meaning, and thus their communication and language is delayed. They have severe deficits in non-verbal communication – pointing, waving and nodding – and they do not understand that gestures (such as waving) are a way of communicating. The delay in gesture use is one of the earliest signs of ASD that may bring the child to medical attention, even if parents miss the deficit in social connectedness.

A lack of symbolic gesture use extends to the child’s lack of pretend play.  A block is a block, and while a child with ASD may pound blocks together or stack them, he never uses the block as a creative tool – it never becomes a car or train or an airplane; it is always a block.

Some of the most difficult problems that parents face are the rigid, inflexible behaviors exhibited by their children with ASD. Relatively simple acts, like cleaning up toys, using a different cup or sitting in a different position at the dinner table, can lead to tantrums of monumental proportions. These tantrums can be triggered by minimal changes in routine, such as a change in the placement of food on a plate, or being required to wear a different colored shirt, as opposed to the child’s favorite striped shirt. As so many children with ASD are nonverbal, or of limited verbal ability, it leaves parents guessing as to what led to this most recent tantrum.

As children with ASD age, sensory issues related to touch, sound, lights, smells and tastes can be severe and life altering. Consider how difficult it is for a new mother to have their infant or toddler pull away crying from her, with the mother not realizing that the hug she was trying to give her child was distressful.

So what can parents do? The key is not accepting early delays in language because “he’s a boy” or “grandpa didn’t speak until he was 2.” Be aware of these seven red flags:

  1. By 6 months: No big smiles or other warm, joyful expressions
  2. By 9 months: No back-and-forth sharing of sounds, smiles or other facial expressions
  3. By 12 months: Lack of response to name
  4. By 12 months: No babbling or “baby talk”
  5. By 12 months: No back-and-forth gestures, such as pointing, showing, reaching or waving
  6. By 16 months: No spoken words
  7. By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating

Thanks to media attention and parental education about ASD, it is uncommon for parents to be unwilling to seek out a diagnosis. Once a child is identified as having any social or communication deficit, unusual behaviors or sensory oddities, parents need to talk with their pediatrician about the developmental concerns. Alternately, a parent can self-refer to Georgia’s Children First program (855-707-8277), which provides a single point of entry for any child at risk for developmental delays.

For children in Georgia with ASD who are 7 years old or less, Ava’s Law, or Insurance Reform Bill SB1, mandates coverage for up to $30,000 annually in ASD-related medical services. Passed in April 2015, it specifically covers Applied Behavior Analysis (ABA). Behavior Analysis (BA) is a validated approach to understanding the “why” of an individual’s behavior; ABA uses that understanding to affect meaningful and positive change in behavior.  The various ABA techniques are all designed to teach children with ASD who “lack the learning to learn skills.”

ABA is a small piece of the total care of a child with ASD. Specific treatment interventions include speech therapy, occupational therapy, physical therapy, feeding therapy for children with significant oral aversions and early access to preschool programs. Most importantly, and the key to successful overall care, is the central role parents play in learning their child’s unique strengths and weaknesses and incorporating taught techniques into learning activities throughout the day at home.

Because of the neuroplasticity of the infant brain, early interventions can potentially reverse, or at least minimize, social communication and behavioral deficits. We know that 10 to 15 percent of children who were diagnosed at 2 years of age, and who received interventions considered standard in the early 1990s, will no longer meet the criteria for ASD at 17 to 25 years of age. Earlier diagnosis, and more aggressive interventions, can only improve on these outcomes.In a 2013 Nature study, Atlanta’s Marcus Autism Center and Emory University’s Warren Jones, Ph.D., and Ami Klin, Ph.D., showed that eye-tracking technology can identify differences in eye fixation in those infants later diagnosed with ASD over the first 24 months of life. More remarkably, the apparent differences in gaze fixation are observable as early as two to six months of life.

While preliminary, this opens up an opportunity to objectively identify infants with ASD earlier, thus allowing intervention at younger ages when the infant’s brain shows more neuroplasticity.

While it may be a stretch to imply that we can “cure” ASD, these remarkable findings provide hope that early diagnosis and intervention may offer our youngest children – and their families – an opportunity for improved outcomes.

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Central EMS & Northside Hospital Collaboration

Thursday, February 25th, 2016

With emergency medicine, time is critical in diagnosing and treating every patient. One of the most time-dependent diagnoses is a STEMI, or ST elevation myocardial infarction.

During American Heart Month, Central EMS and the Northside Hospital-Forsyth Emergency Department are focused on coordinating efforts for a seamless STEMI response. Central EMS began providing emergency medical response to Forsyth County in January and since that time, the ambulance provider has conducted additional training with EMTs and paramedics on immediately recognizing the signs of STEMI and has integrated communication processes with the emergency department.

“EMTs and paramedics are often the first point of contact for a patient who is encountering a STEMI,” said Northside Hospital Director of Emergency Services Chris Munn. “Our partnership with Central EMS is incredibly important in allowing our hospital to continue its gold-level standard of STEMI care in Forsyth County.”

“In years past, the No. 1 measurement goal was to get a patient from the emergency department door to the catheterization lab in under 90 minutes. We’ve updated that standard to measure success as getting the patient from the first medical provider on the scene to the catheterization lab in under 90 minutes.”

As soon as a Central EMS emergency team arrives, EMTs and paramedics can begin lifesaving care. Every Central EMS ambulance in Forsyth County is outfitted with mobile electrocardiogram (EKG) patient monitors. These devices transmit vital data to area hospitals so Northside emergency department doctors are able to view the transmitted data and activate the heart catheterization lab prior to the patient’s arrival. The hospital is prepared to begin treatment immediately to clear blockage from the arteries and restore blood flow.

“Immediately calling 911 for an ambulance when you recognize the sign of a heart attack can save your life,” said Diahan Underwood, training coordinator for Central EMS. “The moment a patient calls 911, they activate a streamlined process between our ambulances and the emergency department to ensure that the STEMI intervention happens as soon as possible. Time saved means better patient outcomes.”

Central EMS is conducting additional training with its EMTs and paramedics to review the signs of a STEMI and the interpretation of EKG data on the scene. In the rare case of equipment malfunction or EKG transmission failure, EMTs and paramedics will have a failsafe in place to communicate with Northside emergency department physicians to activate the catheterization lab in anticipation of a patient with a suspected STEMI.

Cooperation between emergency medical teams and emergency departments, such as the partnership between Central EMS and Northside Hospital, has been effective at reducing the death rate from coronary heart disease across the country by 38 percent over the past decade.

 

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Gov. Deal Announces Additional Investment in Atlanta’s Medical Schools

Wednesday, February 24th, 2016

Gov. Nathan Deal announced the state will invest an additional $70 million in two medical schools as a result of a settlement agreement offer from the Centers for Medicare and Medicaid Services. The recipients, Morehouse School of Medicine and Mercer University, were selected based on their continued efforts to place graduates in rural and underserved areas throughout the state.

“The state should receive these funds as a result of a health care lawsuit settlement regarding Medicaid reimbursements,” said Deal. “It is only fitting that we in turn invest this money in health care education programs, particularly those that prioritize placing primary care physician graduates in high-demand areas throughout the state. Likewise, this funding fulfills a decades-old commitment made to Mercer University by the state. With this investment in its health care program, we are making good on that promise. Finally, we look forward to continue working with these two medical schools to advance their health care training and delivery efforts.”

“Morehouse School of Medicine is extremely pleased and honored that Gov. Deal continues to recognize the significant contributions that we are making to increase the number of primary care providers who practice in underserved urban and rural communities in the state of Georgia,” said President and Dean of Morehouse School of Medicine  Dr. Valerie Montgomery Rice. “This additional investment from our state lawmakers will allow us to continue to increase the enrollment of our medical school and residency programs, as well as ensure increased access to innovative and critical health services for the residents of our state.”

“We are grateful to Gov. Deal and members of the General Assembly for their ongoing and steadfast commitment to improving the delivery of healthcare to Georgians in rural and underserved areas of our State, including exploring new and innovative approaches to meeting rural health challenges, said Mercer University President William D. Underwood. Mercer University is committed to use these funds to make a profound difference in the education of future physicians from Georgia. These funds will directly support future physicians who demonstrate a commitment to providing primary care in areas of the greatest need.”

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2016 Emory Technology and Innovation Celebration Winners

Wednesday, February 24th, 2016

Emory University’s Office of Technology Transfer will celebrate its faculty entrepreneurs and their innovative discoveries at the 10th Annual Celebration of Technology and Innovation.

Start-up of 2015: Microbial Medical, Inc.

Mark Goodman, PhD (radiology), W. Robert Taylor, MD, PhD (cardiology), and Kiyoko Takemiya, MD, PhD (cardiology)

Microbial Medical develops imaging agents for the non-invasive detection of bacteria in humans. The diagnosis of infections related to implanted medical devices is a critical problem, with an estimated financial impact exceeding five billion dollars annually. Although numerous imaging strategies have been developed for diagnosing infections, none can accurately detect early stage infections or distinguish between infection and inflammation. The inventors developed a technology that uses maltodextrins – sugars that target the maltodextrin transporter, which is uniquely present in all bacteria but not in areas of inflammation. The company’s product pipeline includes novel imaging agents and drugs for diagnosing (using common medical scanners) and treating bacterial and fungal infections. In 2015, Emory executed a high net worth license with Microbial Medical for the technology.

Deal of 2015: Bristol-Myers Squibb – CXCR4 Antagonists
Dennis Liotta, PhD (chemistry), and Lawrence Wilson, PhD and Michael Natchus (Emory Institute for Drug Discovery)

CXCR4 protein expression is low or absent in many healthy tissues, but it was shown to be expressed in more than 20 types of cancer, including prostate, ovarian and breast cancer, and melanoma. Emory researchers have developed small molecules that act as antagonists to CXCR4 and may be orally administered. CXCR4 antagonists are known to block adhesion, replication and outgrowth of HIV and can mobilize white blood cells. In 2015 Emory executed a high net worth license for the technology and research collaboration with Bristol-Myers Squibb.

Innovation of 2015: Motion-based Detection by DNA Machines
Khalid Salaita, PhD (chemistry)

Single Nucleotide Polymorphism (SNP) genotyping is the screening and analysis of genetic variations of SNPs, which are common in all species including humans. SNP genotyping and analysis technology can analyze thousands of SNPs and has the potential for whole-genome genotyping. DNA-based machines have potential in several applications and industries, but DNA machines called “walkers” are challenging to work with due to their low fidelity and slow rates. Emory inventors have developed a DNA-based machine that converts chemical energy into controlled motion. Because this new class of DNA-based machines “roll” rather than “walk,” they are able to surpass the maximum speed of existing DNA motors by three orders of magnitude. This technology can serve as a new and powerful tool in SNP genotyping, as well as other applications in diagnostics, drug delivery and biomaterials.

Significant Event of 2015: EGL Genetic Diagnostics, LLC and Eurofins Scientific
Madhuri Hegde, PhD (human genetics)

Emory Genetics Laboratory (EGL) was founded at Emory University in 1970 as a component of the Department of Human Genetics. EGL provides high-complexity molecular, biochemical and cytogenetic testing for rare and common genetic diseases and disorders, serving more than 400 institutional clients, including hospitals and other commercial laboratories in the U.S. and globally. As the first academic laboratory to bring Next Generation Sequencing technologies to the commercial clinic market, EGL remains a leader in cutting-edge genetic tests, with “first-to-market” tests comprising more than 80 percent of its portfolio. EGL conducts more than 35,000 tests annually for genetic diseases, carrier screening, and prenatal testing and is leading the industry in gene panels including cancer testing and exome sequencing in the realm of personalized medicine. In 2015, Eurofins Scientific, the global leader in bio-analytical testing, and one of the world leaders in genomic services, acquired a 75 percent stake in EGL for approximately $40M. With the acquisition of EGL, Eurofins is expected to further strengthen its pharmaceutical and genomic service offerings and reinforce its development as a leader in specialty clinical testing services for hospitals, clinicians and pharmaceutical companies.

In 2015 Emory University’s Office of Technology Transfer celebrated 30 years of success in guiding scientific discoveries from the laboratory into the marketplace. Emory currently manages more than 1,000 technologies invented by its scientists and physicians. This has led to the formation of 72 new companies and the introduction of more than 39 new products into the marketplace, some of which, like the discovery of several HIV drugs, have had major health and societal impact.

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Gwinnett Medical Group Announces New VP and Chief Physician Executive

Wednesday, February 24th, 2016

Bedri YusufDr. Bedri Yusuf has been named to the newly created position of Vice President and Chief Physician Executive for Gwinnett Medical Group, an affiliate of Gwinnett Medical Center.

Dr. Yusuf’s appointment to the new position continues GMC’s commitment to combining medical and management competencies at leadership levels throughout the health system. Dr. Yusuf has previously served as vice president of the GMC medical staff and as co-director of the hospital’s hospitalist program, which he joined in 2006.

“Dr. Yusuf embodies the perspectives and abilities we want to deploy at leadership levels throughout GMC,” said Phil Wolfe president and CEO of GMC. “He is a proven leader with a passion for improving every aspect of the way we deliver healthcare.”

Gwinnett Medical Group is a wholly-owned subsidiary of Gwinnett Health System, Inc., and is made up of numerous medical practices, including family practitioners, pediatricians, OB/GYN practitioners, cardiovascular physicians, neurologists and others. In his new role with GMG, Dr. Yusuf will work with the group’s executive director, Steven A. Rubin, and will share responsibility for the group’s overall operations and performance.

Rubin said Dr. Yusuf will have primary responsibility for “quality, safety, standards of care, clinical resource utilization, provider behaviors, provider performance management, clinical transformation and provider alignment, among other duties.”

“Many of his responsibilities are based around clinical quality improvement and patient care efficiency as well as population health management initiatives, which impact the health outcomes of those patients who depend on GMG physicians for care,” Rubin added.

Dr. Yusuf earned his medical degree from Addis Ababa University in Gondor, Ethiopia. He has also graduated with an MBA from the Isenberg School of Management at the University of Massachusetts and had previously been awarded his Lean Six Sigma Black Belt from the Georgia Institute of Technology. He plays a critical role in GMC’s ongoing patient safety improvement program and has served as chairman of GMC’s Medical Performance Improvement and Patient Safety Committee since 2013. He will also continue to serve as a hospitalist on a limited basis.

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7 Thoughts on Healthcare Marketing

Tuesday, February 23rd, 2016

healthcare-marketing-seven

Lenz VP of Marketing Mike Killeen recently spoke to a healthcare marketing class at Valdosta State University. Here are the notes from Mike’s presentation.

1. Marketing healthcare is noble work

It connects doctors and patients who need them

Marketing often gets a bad rap. For some, it is the dark side of business, purely focused on making the cash register ring. But the purpose of marketing is to connect people with products and services they desire.

In turn, healthcare marketing exists to connect patients with healthcare providers and services that can help them stay healthy, get well, and live better lives.

Sure, marketing has been used to sell cigarettes to children. That’s bad. But more often it helps patients in need find a doctor that can care for them. That’s good.

2. Patients are people, too

They drink Coke and vote in elections

Effective healthcare marketing has more in common with consumer product marketing than most people realize. Why? Because patients are people, not some foreign species that exists only to receive medical treatment.

In other words, we’re all consumers, making choices everyday about what soda to drink, which political candidate to vote for, and where to take our sick kids for care.

Consumers arrive at buying decisions for different products in similar ways. They want value. They want to make choices with confidence. And, most of all, they want to associate with brands, organizations, and products that reinforce their views of themselves.

That’s true whether they are choosing a doctor or a can of sugar water.

3. Healthcare is jazz

Overnight shipping is the symphony

Patients may not be a foreign species, but doctors and healthcare executives often are!

That’s a joke of course, but the point is that the most singular aspect of healthcare marketing isn’t the patient audience, but working within the healthcare ecosystem, which presents a set of dynamics very different from other industries.

The healthcare industry is a constellation of loosely associated components striving to move together in a positive direction – kind of like a jazz band. Hospitals, physician practices, government, private insurance groups, pharmaceutical companies, and non-profit organizations all play a role. Sometimes they are well coordinated, and sometimes they are not. Overnight shipping, on the other hand, is more like the symphony: a well “orchestrated” set of activities arranged with a single goal in mind.

Today, the healthcare industry is experiencing a rapid transformation toward consumerism, where patients make independent choices about their care team instead of relying entirely on physician referrals. Most senior physicians and leadership entered the industry and built successful practices before the rise of the Internet and healthcare reform helped create this new reality.

So, understanding how patients make decisions is the easier part. Understanding how to effectively communicate the value of direct-to-patient marketing to a healthcare organization’s leadership requires a deeper understanding of the industry.

4. Nobody cares until they do

Then it’s all that matters

There is a segment of the population that is always in the market for a new guitar. If they had the money, the space, and their spouse’s approval, they would buy a guitar every day. But on a given day, relatively few people have an interest in or need for an orthopedic surgeon. Their backs, knees, and shoulders feel great. So, they probably wouldn’t even notice a TV commercial for an orthopedic group. But an ad about a holiday special at Guitar Center? That gets their hearts pounding every time.

There’s an old healthcare marketing joke about the guy who injures his knee and turns on the radio, waiting to hear the first ad for an orthopedic surgeon, so he knows where to go for help. The point is that that’s not how it works. By the time you injure your knee, the well marketed practice has probably already won your business, even if you didn’t consciously notice their TV ads until you were hurt.

Healthcare is a service that most people don’t think or care about until they need it. Once they do, it’s all that matters to them, and then they want to act fast. The lesson is that healthcare marketing requires branding—establishing a preference in the mind of the consumer before they have a need—and patience until the need arises. It’s an investment, but one that pays off.

5. All doctors are experts

And everybody cares

If you are a physician in America, there is some good news and some bad news. The good news is that the public recognizes you as an expert. The bad news is that they think the same of your colleagues and competition.

The message is that clinical expertise is rarely a differentiator. Word of mouth based on bedside manner and even wait times are more likely to separate a physician from the pack—as is an association with well-esteemed and well-branded institution.

Marketing works best when there is an appropriate balance between functional and emotional appeals. But the classic healthcare marketing mistake is saying, “we are experts” (functional appeal) and “we care” (emotional appeal).

Expertise and compassionate medicine are examples of the “price of entry” concept—where what is most important to the consumer is also expected by them, and therefore does not differentiate one product from another. A healthcare provider promoting expertise and compassion will be about as effective as a restaurant promoting its clean kitchen, or an airline promoting safety. In either case a stronger position, or differentiator, is required for success.

6. Big data is coming

But will patients accept it?

In some ways healthcare marketing is the ultimate branding platform. Historically, very little data has been published about patient outcomes, and treatment expenses are largely hidden from view.

So, what do patients compare? Their perceptions and the reputations of the healthcare providers they consider. In other words: their brands.

This may be changing. Soon, we will see more healthcare data than ever before. Healthcare reform and the advent of Accountable Care Organizations are tying payment models to patient outcomes. Medicare has begun releasing physician-payment records annually, providing public access to how billions of dollars are spent on healthcare each year. And high deductible insurance plans are helping accelerate the retail medicine movement.

Together, these changes further contribute to an increasingly consumer healthcare environment where patients will have the opportunity to consider the more functional components (like treatment results and pricing) rather than relying on physician referrals and quality perceptions when making healthcare decisions.

The questions are whether, and how fast, patients will embrace the opportunity.

7. Dear Doctor: It’s not about you

Tell your patients’ stories, not yours

For whatever reason, doctors really like promoting their backgrounds: the schools they attended (all four of them), their certifications, prior hospital leadership positions, the conferences they attended, and the papers they’ve published.

But their audience—the ones who make or break their businesses—are patients who want to hear about the things that affect them: the treatments they have to choose from, what they’ll experience on their first office visit, and whether their insurance is accepted.

If they do care to hear about their doctor, it’s not where they went for residency, but why they entered medicine, what they are passionate about, and which former patient had the greatest impact on their life – all things that will help discerning patients understand what they can expect from their doctor.

Mike Killeen is VP of Marketing for Lenz, Atlanta’s Healthcare Marketing Experts.

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MGMA 2106 Financial Management & Payer Contracting

Sunday, February 28th, 2016

February 28-March 1, 2016, Hyatt Regency Grand Cypress, Orlando, FL. For more information, visit Medical Group Management Association

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CME: Clinical Co-Management of the Oncology Patient for the Primary Care Provider

Saturday, February 27th, 2016

February 27, 2016, Georgia Tech Hotel and Conference Center, Atlanta, GA. For more information, visit Oncology CME Conference

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