The center has everything --
it's one-stop shopping for bones and joints.

The new orthopaedics and spine center is like going from a Yugo to a Ferrari.

By Rebecca Rakoczy    

Outside the tree-lined avenues of South Executive Park, afternoon rush hour is building on Interstate 85. Some 270,000 commuters making their way past the North Druid Hills exit near the park can't miss seeing the big blue sign, looming large atop the five-story Emory Orthopaedics and Spine Center. But it's more than the sign that Emory Healthcare hopes will attract those drivers' attention. It's the facility itself, the expertise within, and location, location, location. The center, in fact, may be a glimpse into the future as Emory Healthcare revisits its 21st century master plan.

"Did you know that more people will see an orthopaedist in their lifetime than any other specialist?" For orthopaedic surgeon and center director Scott Boden, it's a rhetorical question. He knows. Last year, the orthopaedics and spine services logged 55,000 visits -- a number expected to increase substantially this year.

The center is certainly poised to be at the right place at the right time: It's the right time because musculoskeletal diseases and disorders represent one of the leading causes of disability worldwide, leading the World Health Organization to name 2000-2010 the Bone and Joint Decade.

And it's the right place: With I-85 at its front door, and I-75 and 400 close by, Boden and his colleagues see this facility as Emory's best opportunity for making bones the buzz word for this century -- and Emory the place to go to get them repaired.

The new center is more than just an outpatient clinic for patients with bone and spine ailments. At 95,000 square feet and five stories tall, it's a mini-city of integrated services. Forty-three physicians, plus more than 120 employees share space here, including sports medicine specialists, clinical researchers, physiatrists, radiologists, nurses, physical therapists, pharmacists, podiatrists, orthotics and prosthetics specialists, occupational therapists, and eventually a chiropractor and an acupuncturist. They came from the Emory Spine Center as well as Emory Crawford Long and Emory University hospitals.

Anything that has to do with the human musculoskeletal system is now under one roof. That's a plus for patients who are used to traveling one place for X-rays, another for exams, and yet another for physical therapy. Now everything can be done at one place, with one coordinated visit.

Even physical therapy, contracted to HealthSouth over the past decade, is back in-house under the Emory Healthcare name. Many HealthSouth physical therapists are now Emory employees, providing familiar faces for some patients.

Establishing a brand

"We are focused on the prospects of making life easier for our current and prospective patients," says John Fox, CEO of Emory Healthcare. "And along with the economies we can achieve by combining facilities from a number of different locations, we believe we have a dramatic opportunity to reposition and rebrand Emory orthopaedics."

The idea of putting related services under one roof already has been successfully road-tested at Emory. The Winship Cancer Institute provided the blueprint for both patient convenience and bringing together everything from clinical research to radiology.

Now Emory's attention has turned to orthopaedics. If the new center can attract attention from both the public and the academic medical community, the orthopaedics "model" at Emory will likely be copied nationwide, says Boden. "We are where MD Anderson or Sloan Kettering were when they started. Pulling together all these specialties, we can create a model for musculoskeletal centers of excellence."

But striving for excellence is a goal, not an immediate end product. Bringing formerly separate specialties under one roof has also meant merging office cultures and hierarchies. Anyone who didn't like the new arrangement (and there were a few, says Boden) were given the "suggestion" to look for employment elsewhere.

Overall, high expectations for the success of the facility have made the transition easier. "There has been a wave of enthusiasm from the staff, and we want to maintain that," says James Roberson, orthopaedics chair in the School of Medicine. "They are part of a new culture. It's unusual for people to get the opportunity in the middle of their careers to re-engineer the way they do things, to get a chance to start anew and even do it better." Roberson says that clinical research is much easier to manage now that the physicians and related services are under one roof. Previously, the clinical research team, managed by Shelby Lewis-Radeks, was spread among three different locations. "This is the ideal setup for orthopaedic clinical research to flourish," she says.

New outpatient surgery rooms are more convenient for physicians as well as patients. Surgeons can now book more patient visits between outpatient surgery cases, Roberson says, "because it's just a simple trip downstairs to see patients in the office."

That's an obvious bonus for employees like Kay Patterson, Roberson's administrative assistant. Trying to set up appointments for a patient who needed a variety of orthopaedics services in the past often meant a half-day of exchanging voice and e-mail messages. These days, she just walks down the hall or takes an elevator if she needs an immediate answer. "I like this much better. It's easier dealing with people face to face -- and it's better for customer service."

While staff convenience is important, the focus is on patients. Patricia Bennett of Tucker recently visited the new center for a follow-up on her October back surgery. Although a little intimidated by the size of the building and its location (the old facility was closer to her home), she gave the new center good marks. "Before, I had to go back and forth between the Emory Spine Center and the hospital for everything. Here I can schedule appointments together and do everything in one place. And really, there's nowhere else I'd rather go. People come here from all over the country -- this is the Johns Hopkins of the South."

For many people, accessibility to the new center won't be measured so much in miles as its proximity to the highway system. Recently, two Notre Dame University football players hopped a plane from South Bend, Indiana, to get treatment from sports medicine chief John Xerogeanes. From Hartsfield-Jackson International Airport, they jumped on the interstate and arrived at the center in less than 30 minutes. After consultation and an MRI, they both had surgery for anterior cruciate ligament tears and then physical therapy before they flew back home. In the past, the trip would have taken much longer. "The difference is it's easy to get here from anywhere in Atlanta," says Xerogeanes.

Creating an atmosphere that will attract high-profile researchers and physicians is also a key strategy for combining services in an expanded facility. Clinical trials and research are important parts of the orthopaedics department culture. So is developing a high-profile fellowship and residency program. "The move allows room for additional faculty, and the location itself drives patient volume increases necessary to recruit faculty," says Roberson.

All grown up

The new facility epitomizes more than a decade of thinking beyond the confines of Emory's main campus. In 1991, orthopaedics created the Emory Spine Center on North Decatur Road -- one of the first stand-alone facilities for Emory Healthcare. With its back door facing the Publix shopping center, the space was all about patient convenience, but not much on aesthetics. Sports medicine was a relatively new practice for the group. When Xerogeanes arrived in the mid-1990s, he hired another physician and began carving a niche for the specialty, drawing patients not only from the community, but also from sports programs at Emory, Georgia Tech, and Oglethorpe University.

The Spine Center soon became a victim of its own success. Doctors on the spine and sports medicine services jockeyed for room as the practice grew. There were signs of wear and tear throughout the heavily used building. "The walls were practically falling in," Xerogeanes says.

Those patients who didn't care about aesthetics still had to contend with visiting several different sites to get treatments. For example, a patient with a musculoskeletal tumor required imaging studies such as MRI and CT scans at multiple locations with different scheduling requirements. Elderly patients who needed bone densitometry scans after hip surgery had to set up separate appointments for follow-up, since a bone density scan was unavailable at the center.

It was clear that orthopaedics needed a more unified service as early as 1997. But instead of moving one office into a larger space, the idea of putting everything under one roof began to gel.

Location and accessibility for patients was key, and building 59 at Executive Park South was identified as the final site. But first the building had to be gutted down to its steel studs and elevator shafts, then rebuilt from the inside out. "Everything in this building is new," says Boden, from imaging equipment, such as the MRI on the fourth floor, to a full-service restaurant.

Boden and his colleagues focused not only on bundling services for orthopaedics in one location but on bringing new technology to the center. Starting from scratch made wireless technology a good fit. Cellular phones and PDAs communicate using constantly changing radio frequencies and pick up signals from a chip imbedded in hardware. The same wireless technology allows computers to have mobility. The building has the infrastructure on all floors for expanding wireless applications, a first for Emory Healthcare.

"We had detailed discussion about speed, connectivity with the main campus, and the wireless network," says Boden. How the network is received may be a determining factor for bringing wireless technology to the entire campus. And then there's PACS -- the Picture Archiving and Communications System for radiology that was installed at EUH, ECLH, and Wesley Woods a year ago. Boden argued for faster, upgraded imaging equipment to accommodate the increased volume of patients anticipated at the center. He got it.

Laughter is good medicine

The facility also offers a few new bells and whistles. An aquarium greets visitors coming off the elevator to the third floor waiting room; to the left is the Jerry Lewis Healing Theater with the image of the comedian etched in the glass. The idea for a laugh theater surfaced during a social gathering where Boden met the comedian, who suffers from chronic back pain. The result of the collaboration is an intimate space with theater seating and cubicles designed to help patients forget about their ailments for a while. Each cubicle is equipped with headphones where waiting patients can choose to watch vintage comedies and television shows on donated LCD plasma screens. It's all part of a strategy to calm and relax patients, says Boden. "We don't want to stress them out with news channels -- they can get that at home."

The building offers more open space for clinicians for consultations and chart review and a large classroom. And in a nod to the new technology in the building, Boden's patients register on electronic tablets, from which data can be downloaded to the main patient record system. Patient-entered information on the tablet is stored and updated automatically. The tablets can also store PACS images and physician notes and eventually will have video welcomes from physicians. The plan is for all center doctors to use the tablets in the near future.

And there is the new Center for Complementary Medicine. The introduction of complementary medicine to the facility this spring is practical. The National Institutes of Health reports that millions of people use more complementary medicine than traditional therapies. "This facility will assure quality providers," Boden says, including a chiropractor, an acupuncturist, and a massage therapist.

The building is a far cry from the former quarters, adds Xerogeanes. "It's like going from a Yugo to a Ferrari. The patients are going to love it."

Rebecca Rakoczy is a freelance writer.