Moving Forward


Going paperless at Emory Healthcare
2002 General Assembly good for health care
Dry run at Emory Crawford Long Hospital
Closing the gap
Interest in nursing soars
Gates opens new doors for international health
Nurses and research
EUH tops in 5 areas
Grady research center is win-win
Did you know . . . ?
Still testing after all these years
Yerkes gets new name

 

The joke is that the patient can never read what a doctor scribbles on her prescription pad.

What's not so funny is that sometimes the pharmacist can't read it either.

If the pharmacist can't make out the prescription, which can be rendered more illegible by a fax machine, the doctor has to be paged. That interrupts a visit with another patient -- briefly if the doctor remembers what she wrote, longer if she doesn't. Meanwhile, the patient may be waiting for the medicine.

"There's one wriggly line on the top, and another for the signature. The doctor's done, but someone else has to read it," says Bill Bornstein, chief medical officer and chief quality officer for Emory hospitals. "It ends up taking more time than if it was done right originally."

That's why Bornstein is spearheading an effort to make sure it's done right the first time every time. As part of the Emory electronic medical records (EEMR) project, a 10-year undertaking to completely eliminate paper records, doctors at Emory University Hospital, Emory Crawford Long, and Wesley Woods will soon enter data as they see a patient. Proponents hope it will end the miscommunications and delays inherent in writing information on a chart to be transcribed later.

The improvements in efficiency are clear: Entering patient information, diagnoses, prescriptions, and other instructions immediately eliminates the need for someone else to type it into the computer system separately. But quality of care and patient safety should also improve, as provider entry means instant access to the information already in the system.

So when a doctor considers prescribing a certain drug, the system can immediately tell her if the patient is allergic to a similar medicine. Or it can remind the doctor that a diabetes patient is due for a regular vision test. And instead of sending those hastily scribbled prescriptions down to the pharmacy by fax or pneumatic tube, they can pop up completely legible in the pharmacy computer, allowing the druggist to fill the orders that much faster.

"It's that immediacy that's crucial," Bornstein says. "That's why these paperless medical records are important in their own right."

Many of the specific details remain to be worked out and will be based on input from doctors, nurses, and other care providers, but Bornstein says he envisions terminals in examination rooms and at nurse's stations. Planning and infrastructure work will probably take about two years, he says. The first physicians should be using components of EEMR by the end of 2003.

Transferring the entire hospital record system from paper files to databases will take considerable effort and cost an estimated $27 million. The key is making all the components work together, so the network can recognize that a person who was once hospitalized at Emory Crawford Long is the same person who now is looking for outpatient care at The Emory Clinic.

EEMR is expected to cost $27 million over 10 years, but Bornstein says it will pay for itself in savings. "And it will increase quality of care and job satisfaction," he says. "Things that that are hard to attach numbers to."

Going paperless at Emory Healthcare

EEMR will cost $27 million over 10 years, but will pay for itself in savings.


Issues important to Emory Healthcare were being considered by the House and Senate just minutes before final adjournment in April after the longest (89 days) session in almost a century. In addition to the state budget, Emory took a position on bills that concerned such issues as bioterrorism, health care workforce shortages, and payment of physician and hospital claims by insurance companies, says Linda Womack, director of state affairs for Emory's Office of Governmental and Community Affairs.

Because of Georgia's declining revenues since summer 2001, last fall Governor Roy Barnes ordered 2.5% in cuts in the state's fiscal year 2002 budget. While fund availability was even tighter in the fiscal year 2003 budget, the General Assembly supported the governor's proposal for a much-needed increase in Medicaid provider reimbursement rates, effective July 1. Georgia hospitals will be reimbursed based on 2000 calendar year cost data plus a 2.7% inflation factor, resulting in an additional $18.1 million of state funds and with the federal match, a total increase of $44.6 million.

Reimbursement rates for physicians and related providers were increased by using 90% of Medicare's 2000 Resource Base Relative Value Scale, resulting in enhanced state funds of $13,377,880 and total funds of $33,023,648 with the federal match. Providers in the PeachCare program, which provides health insurance for Georgia children 18 and under, are in line for a $10 million increase. Nursing home providers will receive an additional $29 million of state and federal dollars.

The legislature also restored funding for the Emory Autism Resource Center in both fiscal year 2002 and 2003 budgets. The center has existed for 10 years and has served some 3,000 children, adults, and their families in 156 of Georgia's 159 counties.

Additionally, $587,000 in the 2003 budget will address health care workforce shortage issues. More than $1.6 million will go for bioterrorism preparedness and response, including $744,000 for hospital data collection to support development of a statewide trauma system. The General Assembly also appropriated $24 million for the Georgia Research Alliance and $30 million for the Georgia Cancer Coalition. The 2002 amended budget also includes an additional $24 million for the cancer initiative.

The Consumer's Health Insurance Protection Act, part of the governor's legislative package, addresses ongoing problems with payment of claims encountered by hospitals and physicians. This bill includes a number of provisions:

Insurer must pay for services precertified for the enrollee. Insurer must provide sufficient staff 24 hours a day, seven days a week to precertify by phone all procedures except nonemergency or elective care scheduled at least 24 hours in advance. The insurer is required to advise the enrollee if the procedure is approved and the reason if rejected. Enrollees must be informed about scope of the plan network and be provided a list of providers in the plan.

Like many other states, Georgia has a shortage of nursing, allied health, and behavioral health care professionals. Under the new Health Care Work Force Shortage Act, health care licensing boards must survey licensees upon application or renewal. Data must be collected and analyzed under secure conditions and be limited to information on workplace and practice settings, current practice specialty, location, and future practice plans. The State's Health Care Work Force Advisory Committee will have access to the confidential data in order to analyze and trend the supply and demand for health professionals in Georgia. This will help the state identify areas with the most need and provide accurate data to support future workforce shortage initiatives.

Also important to Emory Healthcare was the passage of the governor's legislation that clarifies existing laws relating to public health and emergency powers of the governor. Under this new law, should there be a bioterrorism incident, the governor has the authority to declare a public health emergency. The Department of Human Resources is required to develop a bioterrorism plan, and the department's Division of Public Health is in charge of handling bioterrorist emergencies. Provisions also empower the state to compel a hospital to provide services or use of its facilities in the event of an emergency.

In addition to these and other bills that have been signed into law by the governor, several resolutions created committees to study health care related issues. One Senate committee will study and develop possible solutions to the shortage of registered professional nurses. Another important committee is studying the future of health care in Georgia, examining among other things, accessibility to affordable and quality health care; delivery of health care; the availability, quality, and equality of trauma care throughout the state; and the cost of malpractice insurance for hospitals and other health care providers. Both committees will be abolished December 31 and may report findings and recommend legislation. The Senate Future of Health Care Study Committee recently heard testimony from Emory physicians Mahlon DeLong, who addressed issues surrounding complementary and alternative medicine, and Jeff Lesesne, who presented information on prevention and aging.

The 2002 session was very positive for Emory Healthcare and through these two study committees and standing legislative committees, state agencies, and other avenues, Emory's position on major issues will continue to be presented.

For more about the 2002 General Assembly, see www.emory.edu/GCA/.

2002 General Assembly good for health care



Linda Womack is director of state affairs
for Emory's Office of Governmental
and Community Affairs.


What would a "day in the life" be like in the six-story, 500,000-square-foot Diagnostic and Treatment Center that opened this summer at Emory Crawford Long Hospital? To find out, more than 300 physicians, staff, and community volunteers tested out several scenarios, new processes, equipment, and wayfinding in the new facility in June.

"Opening a new hospital is a huge undertaking and the transition must be seamless," says COO Al Blackwelder. "Our staff must react to situations quickly and effectively regardless of the new surroundings." Pre-opening receptions and behind-the-scenes tours for the community and faculty and staff also heralded the opening as did signs that officially put Emory up front in the hospital's name.

Over the last weekend in July, staff from each department moved into their new spaces. By the end of the month, Midtown's premier medical landmark had opened its doors to the public.

Dry run at Emory Crawford Long Hospital




African Americans in Georgia are often up to three times more likely to die of prostate cancer than Caucasians and twice as likely to die of breast or colon cancer.

There's a lot of speculation about why, not the least of which is a lingering mistrust between the African American community and the medical establishment, where care is often based on sterotypical assumptions rather than patients as individuals, says Don Speaks, director of community affairs for Emory Healthcare. "On the other hand, many patients don't do what they're told," he adds. "They don't stop using salt, they don't lose weight, and they don't stop smoking. Or they may not have access to care -- there are still 40 medically underserved counties in this state."

Speaks, who orchestrated the recent health disparities conference, "Cancer -- It can happen to you," says the conference was a first step in changing those outcomes. "It was important that the conference agenda reflect a sound commitment to changing access to cancer treatment in disproportionately affected areas, that it foster the development of community prevention and intervention programs, and that we left the conference with a better understanding of the barriers to improving health outcomes," Speaks says.

Conference speakers included Gov. Roy Barnes, Winship Cancer Institute Director Jonathan Simons, and Otis Brawley, the WCI's associate director for cancer detection, control and intervention. They provoked dialogue about people's fears about cancer, the second leading cause of death in Georgia. Georgia ranks among the top five states in the number of new cancer cases each year.

The conference agenda was developed by health care professionals and other key leaders in communities of color with a goal of addressing cancer disparity issues beyond the close of the May 2002 conference. The cancer disparities committee will now take on the role of adviser to developing cancer programs in research and clinical care at Emory Healthcare, the Winship Cancer Institute, and the Georgia Cancer Coalition.

As an outcome of the conference, the advisory group already has some recommendations in hand:

  • Provide more primary care in communities.
  • Retool provision of health care to include lay health workers who promote healthy lifestyles and help people understand the implications of their behavior.
  • Create incentives to market healthy foods and provide good health care for employees in the work place.
  • Work with health systems to make navigating health centers more user friendly from the time a patient parks his car all the way through the medical encounter, including follow-up care.
  • Provide ongoing education in the community so people can understand disease, symptoms, and what they can do to prevent it.

The coalition plans to bring its message to other Georgians throughout the state through similar conferences and will recommend that disparity advisory committees be involved in all research and clinical efforts.

"We're trying to create a culture that accepts nothing less than excellence in the way we identify, treat, and ultimately cure all Georgians with cancer," he says, "so that five to 10 years from now there will be no glaring differences between men and women, rich and poor, minority or majority."

Closing the gap



An effective prescription for America's ailing health system would provide coverage for the uninsured by building on programs that already work -- employer coverage, Medicare, Medicaid, CHIP, and PeachCare. They could be expanded to reduce the number of uninsured and to increase stability and continuity of coverage, resulting in better access to needed health care services and a healthier, more productive workforce.  --Karen Davis, Economist and health policy expert, President, The Commonwealth Fund, Future Makers speaker


A combination of factors may be spurring new interest in pursuing nursing as a career. This spring, the Nell Hodgson Woodruff School of Nursing experienced a 47% increase in the number of undergraduate applications. Additionally, the school received 69% more inquiries from prospective students and a nearly 53% increase in deposits compared with last year.

"I think September 11 is a very important factor," says Dean Marla Salmon of the increases. "People are really thinking about their lives differently, and some people who may have made career decisions based on finances may be looking at careers differently." Salmon also believes that recent layoffs resulting from the slowed economy have prompted people to seek new careers.

Whatever the reason, the increase in applications is great news for the nursing school and a profession plagued by a critical shortage of nurses nationally and globally. Come fall, the school is looking to enroll 75 new undergraduates, which falls within the school's 72- to 78-maximum range of admitted students. In recent years, the average class size for entering nursing students has been 65.

As for graduate students, the number of applicants remains steady. The school expects to enroll 60 to 65 advanced-degree students, which is comparable with recent years.

The news is good at other nursing schools as well, says the American Association of Colleges of Nursing (AACN) in Washington, DC, which conducts an annual survey of entry-level baccalaureate programs in nursing. Results of its fall 2001 survey showed that enrollment was up by 3.7%, based on responses from 80.8% of the nation's nursing schools with bachelors and masters degree programs. The increase ended a six-year decline in enrollment. AACN members attribute the 2001 enrollment increase to stronger recruitment efforts as schools seek to fill the professional void caused by the nursing shortage. Most schools attribute application and enrollment increases this spring to September 11, more media attention on the nursing shortage, and the massive "Nurses for a Healthier Tomorrow" media campaign by Johnson & Johnson.

Interest in nursing soars

Since Sept. 11, people are really thinking about their lives differently.


Four mid-career public health professionals from developing countries will study international health at the Rollins School of Public Health (RSPH) starting next year, thanks to a $5 million gift from the Bill & Melinda Gates Foundation to establish the William H. Foege Fellowships in Global Health.

While at Emory, they will be encouraged to develop partnerships with mentors at the Centers for Disease Control and Prevention (CDC), the Carter Center, and Care USA. Fellows will be issued a laptop computer when they begin the program and will be encouraged to take their laptops when they return to their home countries so they can maintain the relationships they have developed in the United States via the Internet.

Foege, the former director of the CDC, is now senior medical adviser to the foundation, and presidential distinguished professor at Emory. "He has devoted his life to ensuring that others can enjoy full and healthy lives," says Bill Gates, co-chair of the foundation. "His achievements remind us that investing in health is a critical first step to improving the social and economic well-being of millions of people around the world."

Foege's career has been defined by unwavering optimism that global diseases can be conquered. He played a pivotal role in eradicating smallpox and preventing river blindness. He was executive director of The Carter Center and founded the Task Force for Child Survival and Development, which increased childhood vaccination rates worldwide.

Gates opens new doors for international health




The Nell Hodgson Woodruff School of Nursing now ranks fifth in National Institutes of Health (NIH) research funding among comparable private schools of nursing in academic health centers. The ranking is based on the $1.4 million awarded by NIH to the School of Nursing in fiscal year 2001. While the School of Nursing ranks 24th among US nursing schools in NIH research funding for 2001, the field narrows considerably when comparing private US nursing schools that offer bachelor's, graduate, and doctoral degrees. The top five schools in this category are as follows:
  1. University of Pennsylvania
  2. Johns Hopkins University
  3. Case Western Reserve
  4. New York University
  5. Emory

The ranking puts the School of Nursing two years ahead of schedule in reaching this goal for research. "One of our vision statements three years ago was to reach the top five in schools of nursing within five years," explains Salmon. "So, with respect to this measure, we have reached the top five two years ahead of time."

Nurses and research


Emory University Hospital is one of the best in the nation in five medical specialties: heart, eye, kidney, psychiatry, and urology, says U.S. News and World Report.

For the 12th time since the magazine began ranking programs in 1990, Emory's heart/heart surgery programs were included in the nation's top ten -- this year number 8. No other Georgia hospitals were included in the top 50 rankings.

Ophthalmology came in at 13th this year, and psychiatry was 17th based on professional reputation. That means its reputation is beginning to catch up with the reality at Emory, something several other specialties at Emory are eagerly waiting to happen as well.

Kidney disease ranked 21st, and urology moved up six notches to 35th.

EUH tops in 5 areas


From fighting kidney disease caused by sickle cell anemia to looking for new ways to treat victims of traumatic injury or to study new vaccines for HIV/AIDS, a new General Clinical Research Center (GCRC) at Grady Hospital will allow physicians to study many diseases and conditions prevalent in underserved patients.

Created by a National Institutes of Health $4.2 million grant to the Emory School of Medicine, the new center promises innovative treatments for Grady patients, new educational and training opportunities for Emory and Morehouse School of Medicine students and staff, and a large infusion of revenue for Grady's bottom line.

The center opened this spring in a remodeled eighth floor unit at Grady and has six inpatient beds, one outpatient bed, and five infusion bays where patients can receive intravenous medications, says Juha Kokko, associate dean for clinical research.

Physicians, residents, medical students, and nurses will rotate through the center, which has a permanent core staff of nine nurses and many participating physicians. A research subject advocate will provide health education and a patient care advocate (a clinical nurse specialist) will serve as a liaison between doctors, research oversight committees, staff, and patients. Both advocates will be voting members of an advisory committee that will review all projects, including consent forms, safety monitoring, and nursing care plans.

"A General Clinical Research Center is a well-defined area in a hospital which is completely funded by the NIH," says Kokko. "It's very unusual to find a GCRC in a non-university-owned hospital. All patients will be completely paid for by an outside payer, the NIH, or in some cases by a pharmaceutical company or another sponsor of a clinical study in the GCRC. Thus, the hospital as well as the patients benefit. In addition, Emory and Morehouse students and residents will have an unprecedented opportunity to learn from faculty how to conduct clinical research."

From an administrative standpoint, the Grady GCRC will function as a satellite to a long-established GCRC at Emory University Hospital. The program director of the Grady GCRC is Lawrence Phillips, professor of medicine at Emory.

The new center deepens a decades-long partnership between Emory School of Medicine and Grady. Grady's medical staff is composed primarily of Emory medical school faculty and residents; the remainder are faculty and residents from Morehouse. Grady is the primary clinical training site for both Emory and Morehouse.

Grady research center is win-win




Many visitors come to www.emoryhealthcare.org to research health conditions or browse through Emory's departments and services. In the past if they wanted an appointment, they could hang up and call (404) 778-7777 or submit an e-mail request, then wait for a call back from a HealthConnection nurse. Now a new feature called "Full Contact" lets the 35,000 monthly visitors to Emory Healthcare's web site call HealthConnection directly from their computers while they are still online. HealthConnection connects prospective patients with health information and doctors in appropriate specialties.
Did you know . . . ?


It's been around for nearly 45 years, but the Anthrax Vaccine Adsorbed (AVA) is still being tested. Now the Emory Vaccine Research Center (VRC) has begun a five-year study of AVA, the only human vaccine approved for the bacterium, Bacillus anthracis.

Sponsored by a $4.2 million grant from the Centers for Disease Control and Prevention (CDC) and under the direction of immunologist Robert Mittler, the study compares the efficacy of three different vaccine regimens in rhesus macaque monkeys. Researchers also hope to determine the strength of protective immunity against anthrax after inoculation.

The Yerkes portion of the study uses harmless proteins derived from anthrax toxins to assess the immune response promoted by AVA in 33 monkeys. After Mittler tests blood samples for cellular immunity at Yerkes, the monkeys will be sent to a lab in Ohio, where they will be exposed to the anthrax bacteria and re-evaluated. This animal study is associated with a larger study of AVA vaccine regimens in humans. The Emory arm of the human study is directed by Harry Keyserling, professor of pediatric infectious diseases. (See cover story in Spring 2002 Momentum.)

Since 1970, when the Food and Drug Administration licensed AVA for human use, more than 2 million doses of the vaccine have been administered, mostly to members of the military and laboratory workers. Like most vaccines, AVA has side effects such as redness and swelling at the injection site.

While this controversial vaccine has already proven safe and effective, concerns that it also may have systemic effects were raised in the mid-1990s, after some asserted that Gulf War Syndrome might be related to the vaccine. Pressure to study the malady prompted Congress to mandate new research on AVA. The CDC's AVA research program emerged from this initiative.

AVA has also drawn criticism for the large number of shots associated with the regimen (eight) and the amount of time needed to raise protective immunity (18 months). No other human vaccine requires as many shots as AVA, notes Mittler.

"I would take the vaccine in a minute if I were not an investigator," says Mittler. "I think it has no merit to say that Gulf War Syndrome is associated with the anthrax vaccine. Without a doubt, some people will have adverse reactions to any vaccine, but only about 60 out of several hundred thousand veterans have claimed to have problems with AVA. And these people were in the Gulf at a time when oil fields were being burned, and they could have been exposed to gases and other noxious agents. There's no way to tease out the effects of the vaccine."

Indeed, the vaccine has been extensively tested for safety among lab workers and military personnel for about 45 years. The only clinical trial among civilians was successfully conducted in the 1950s by Emory professor Philip Brachman, while he was an epidemiologist at CDC.

Mittler's co-investigators at VRC are researcher Chris Ibegbu, VRC Director Rafi Ahmed, and veterinarian Denyse Levesque.

Still testing after all these years



Immunologist Robert Mittler is directing a
five-year study in rhesus macaque monkeys
of three different regimens for the only
human vaccine approved for anthrax.


The National Institutes of Health has designated Yerkes as a National Primate Research Center (NPRC) to recognize its role in and impact on research throughout the world.
Yerkes gets new name

One of eight federally funded NPRCs, Yerkes receives an NIH base grant awarded at five-year intervals via a competitive renewal process. The base grant now represents a fraction of Yerkes' $36 million research funding for 2001, which has tripled since 1998 and ranks second behind the School of Medicine in terms of research income at Emory. In return for the federal dollars it receives, Yerkes provides optimal research environments for School of Medicine faculty and serves as a resource for collaborators from other institutions. It has nearly 85 affiliate and collaborative faculty from Emory and scientists from 65 research institutions in and outside of the United States.

"The change from regional to National Primate Research Center underscores the point that all of us involved in every aspect of research, whether it is basic research or applied clinical research, serve not just our local community but the entire nation with regard to our health priorities," says Yerkes Director Stuart Zola.

In this Issue


From the Director  /  Letters

Banking on benevolence

Healing the bottom line

Moving forward  /  Noteworthy

On point: Tell Congress what's at stake

Stopping the AIDS cycle

 


Copyright © Emory University, 2002. All Rights Reserved.
Send comments to the Editors.
Web version by Jaime Henriquez.