JULY/AUGUST2011

Volume 41, No. 4

ESCAMBIA COUNTY MEDICAL SOCIETY

President’s MessageWhac-A-Mole! More Than aKids Gameby Michelle Brandhorst, MD

Dr. Michelle Brandhorst

UpcomingEvents

Tuesday, August 9, 2011General Membership

Meeting

Location: The Angus Resturant

5:30 pm

Sponsored by: Baptist Hosptial

RSVP: 478-0706ECMSinfo@bellsouth.net

Founded in 1873

Continued on page 3

If your work day is like mine there are many

things that happen that remind me of how great it is

to be a doc. The time spent developing caring rela-

tionships with our patients as well as the challenge

of keeping up to date with the science of medicine

provide satisfaction that I cannot imagine obtainable

in any other profession.

And then...well there are those other things that

I read about and encounter that drive me nuts. I be-

lieve it was in the seventies, when I took my daughter

to an amusement park that I found the game Whac-

a-Mole where the furry headed critters would pop

up through various holes and one would hit it with a

mallet. Whoever invented this game must have had

a keen insight into life as there seem to be count-

less real live analogies. How many ways can the

trial bar raise their head to make more money? How

many scope of practice challenges are there? How

many ways can Government and private payers try

to avoid or delay paying for services? Each situation

requires a game of legislative Whac-a-Mole.

Through the efforts of the Florida Medical Asso-

ciation (FMA) and legislators supported by the FMA

these “moles” have been pretty much kept at bay.

It is however becoming more evident that the joy

of being a physician is threatened by a much more

formidable creature, our own government. Because

CMS controls much of the reimbursement to physi-

cians and other healthcare entities, CMS can make

the receipt of the payment contingent on adherence

to whatever it feels makes sense. But too often what

CMS feels makes sense robs the patients of physi-

cian time. Instead physicians spend time making

sure we get enough bullet points in our notes.

Forcing us into EMR systems that may be great

for sharing data but are onerous at creating it. It forc-

es me to spend three times longer to typing an elec-

tronic prescription than writing one, and review four

a four medication reconciliation form for nine medi-

cations, and spending private time that could be

spent keeping current

on science but instead

spending it electroni-

cally sign off telephone

orders when I have

already reviewed and

verified the order with

the nurse when it was given. Are there any studies

that show that any of this serves to enhance patient

care? No! Physicians practice medicine based on

best available evidence, but CMS seems to practice

by well intentioned whims. We should not be made

to be a slave to technology. As always, technology

should be used to make work more efficient, consis-

tent and safer.

So it is time for physicians to start playing

Whac-a-Mole with regulations and requirements

that are at best non-beneficial to patient care and

at worse rob patients of our time. As long as CMS

incentives these requirements, health care entities

are reluctant to push back. It is up to physicians to

take the lead and I am proud to announce that the

Escambia County Medical society is taking a first

“Whac.” The ECMS has introduced a resolution ask-

ing the FMA to work in conjunction with the Florida

Hospital Association to pursue a Florida regulatory

change that would extend the length of time physi-

cians have to sign off verbal order from 48 hours to

30 days.

As a follow up the last news letter article on pa-

tient safety, I would like to acknowledge steps taken

by our local hospitals. If you missed Dr. Tim McDon-

alds lecture on patient safety, it was said by several

attendees to be one of the best the ECMS has pre-

sented. Fortunately you may get a second chance

as there plans be made to try to get Dr. McDonald

down for follow up lecture this fall.

Have a safe hurricane season as we continue

to preserve the patient-physician relationship.

ECMS BulletinThe Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/ Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.

EditorsNorman Vickers, MD

Holly Strickland, Executive Director

AD PLACEMENTContact Holly Strickland 478-0706

Ad RatesFull page: $600 • ½ page: $300 • ¼ page: $150

2011 ECMS OfficersPresident

Michelle Brandhorst, MDPresident-Elect

George Smith, MDVice President

Wendy Wozniak, MDSecretary /Treasurer

Susan Laenger, MD

Page 4 Dewey At Large

Page 7 Health Information Exchanges (HIEs)

Page 8 Michael Redmond, A Doctors Doctor

Pages 10-12 Vendors of Choice

Vision for the Bulletin:-Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond.- Collaborate with the Alliance to bring together Escambia and Santa Rosa County medical families. To know the needs of the community and promote the healthcare needs.- A powerful instrument to attract and induct members to organized medicine. Views and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the directors, staff or advertisers.

For more information, contact Shelly Hakes, Director of Society Relations at (800) 741-3742, Ext. 3294.

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Membership

Welcome New Members!James Jimenez, MDVascular/Interventional Radiology

Medical School: New York Medical College, Valhalla, NY

Residency: LIJ Medical Center, New Hyde Park, NY

Board Certified: American Board of Radiology

Board Certified: American Board of Phlebology

210 B East Government Street

Pensacola, FL 32502

Phone: (850) 607-7570 Fax: (850) 607-7571

Pablo Concepcion, MDPain Management/ Anesthesia

Medical School: Pontifcia University

Residency: SUNY Upstate New York

Board Certified: American Board of Anesthesiology

4624 North Davis Hwy

Pensacola, FL 32503

Phone: (850) 494-0000 Fax: (850) 494-0001

Issa Ephtimios, MDThe Center for Infectious Disease

Medical School: AIN SHAMS Medical School, Cairo, Egypt

Residency: RWJMS New Jersey

Board Certified: American Board of Internal Medicine – Infectious

Disease

8333 North Davis Hwy

Pensacola, FL 32514

Phone: (850) 474-8187 Fax: (850) 474-8684

ResidentsGail Joseph, MDFSU Sacred Heart OB/GYN Residency

Cecily Collins, MDFSU Sacred Heart OB/GYN Residency

Jessica Jayeson, MDFSU Sacred Heart OB/GYN Residency

Corrections to DirectoryCraig Broome, MD11809 Chanticleer Dr

Pensacola, FL 32507

Phone: 492-3426

Karanbir Gill, MD5149 North 9th Ave, Ste 246

Pensacola, FL 32504

Phone: 416-6159

Fax: 416-7198

Moved Lornette Epps, MD1717 North E Street, Ste 401

Pensacola, FL 32501

Phone: (850) 912-6550

Fax: (850) 912-6554

President’s Message, continued from page 1

Patient Safety Initiatives at Sacred Heart Health SystemBy Deanie Lancaster, CNO, Sacred Heart Hospital Pensacola

Sacred Heart Health System has been working in earnest for several

years to make healthcare safer. In 2002, Ascension Health, the parent

company of Sacred Heart, set the goal for all its ministries to eliminate

preventable injuries and deaths. Ascension Health facilities throughout

the United States set a goal of preventing 900 patient deaths in five years

by focusing on specific adverse events that occur in healthcare settings.

They exceeded the goal by three times, and an estimated 3,200 deaths

were prevented at Ascension Health facilities during a five-year period.

In December of 2007 Sacred Heart leaders and physicians decided

to build upon this success by initiating a system-wide focus on preventing

specific, preventable adverse events, such as patient falls, pressure ul-

cers, healthcare-associated infections and adverse drug-related events.

Since early 2008, all physicians and associates have been trained to

use specific error-prevention techniques that are modeled after those used

in the nuclear power and aviation industries. Pre-procedure checklists,

read-back of orders, time-outs before invasive procedures, and double

checks, along with technologies like bed alarms and computer alerts, are

used consistently to prevent patient injuries. Additionally, the use of unsafe

abbreviations in medical records is prohibited. Nurses perform bedside

shift report at the change of every shift to include the patient in his or her

care. These techniques have resulted in more than a 50 percent reduction

in serious safety events throughout the Sacred Heart Health System.

Working to prevent harm to patients continues to be top-of-mind for

clinical staff at Sacred Heart. Medication safety in an essential area of

focus due to many patients taking multiple medications for chronic condi-

tions. More and more commonly, we encounter patients taking more than

ten drugs, some of which can counteract each other. To prevent poten-

continued on page 9

Membership

Dewey at Large

By Dr. Charles MooreShort Introduction: This article comes to ECMS courtesy of the Capital Med-

ical Society. Dr. Charles Moore is a long time friend of Dr. Donald Dewey’s.

Dr Moore is the Editor of the Capital Medical Society’s newsletter Cap Scan.

I confess to some misgivings as I contemplated “Dewey”…that is Don-

ald “Dewbonz” Dewey, M.D….in an airplane. To cram that larger-than-life

character into an economy seat in the tail end of even a Jumbo Jet for a

ten hour flight seemed asking too much of modern technology. What if he

got restless? What if, overcome by some form of ennui, he reverted to his

“Elvis” persona? What if he started rockin’ and rollin’ and the tail section

began bounding up and down to the “Rhythm of Dewey?” What if we lost

the “Bernoulli effect,” or if the tail fell off?

As is well known to my acquaintances, I am, of course, rather re-

strained…except on rare occasions for which I apologize…a quiet sort of

guy, Professor Higgins-like. I am inclined, particularly in airplanes on long

flights, to simply hunker down, read a book, and eat whatever bit of plastic

I am served. Least of all do I want to do anything that might result in the

plane losing a wing or two. But Dewey, I thought, did not trouble himself

about such details.

He drove over from Pensacola to spend the night with us prior to our

early departure the next morning for Istanbul, where we were to spend 24

hours looking at various minarets before flying onwards to Simferopol, the

capital city of Crimea. There Dewey was to participate in ten or twelve

rather complicated surgeries, bad club feet and so on, afflicting a gathering

of orphans age two to ten, and who otherwise would be deprived, given the

anomalies of health care in the Ukraine, of such services. Good of him to

take the time out to come do this; and of his wife Cathy, too, who, given her

vaguely morbid fear of flying, fretted.

But let me tell you, we had no problems at all. Once in his seat, I

was astonished to discover Dewey-the-gentle-lamb. He and the plane

appeared to get along wonderfully well, and the wings never fell off, even

once. In due course we landed in Istanbul.

As Dewey looked about, I could tell that he perceived, and took a

highly intelligent interest in, the fact that there was a considerable difference

between Istanbul and Pensacola/Tallahassee.

Never minding “jet lag,” we toured the “Grand Bazaar” and the “Spice

Market,” haggled over the purchase of trifles, and took a cruise on the Bos-

porus. I demonstrated to him how my fake joints, that he put in so many

years ago, were wonderfully holding up, hopping along in fine fettle. In front

of the “Blue Mosque,” I bought us each a delicious looking corn on the cob

being sold by a vendor; but, just to warn you when you are next in Istanbul,

despite the delectable appearance, it was tough and not so sweet as our

own cobs. We learned to say “thank you” in Turkish, which is something like

Tashecure Aderim, or maybe not.

And the next morning we met the rest of our group, and flew off to

Simferopol.

Dewey, without even the ghost of Elvis at his side, captivated the Ukrai-

nians. They had never seen anything like him, ever; and unlike some of us,

every word he spoke was not only sensitively said, and perceptively con-

sidered, and very jolly, but perfectly translatable into Russian. The Ukrai-

nians, who actually speak Russian even though they also speak Ukrainian,

a language that Muscovites would

consider “Red-Neck,” but which

made Dewey easy to translate.

By our standards, the children’s

hospital where the surgeries are

performed may be here and there

somewhat down-at-heel, although they possess the welcoming advantage

of a lot of friendly cats, who perch themselves about the front door. Kids and

Dewey like this. The nurses and staff, of course, are more than welcoming,

pleased more than my words can describe by the opportunity to have this

sharing experience. Lack of funds forbids that they go forth into the world

for seminars and learning on their own; so Dewey et al represent a real op-

portunity.

In the office of Dr. Alexander Astakov, the CEO of the hospital, formal

introductions were made, and Dr. Alexander made very gracious welcom-

ing remarks. Dewey, I think, thought the remarks went on a bit too long, and

then even longer, for he was hankering after some bones to get at.

They had plenty for him. Dewey was summery looking in his white

rather than bile green scrubs, and enjoyed the rigorously enforced dis-

cipline of dipping his hands into some unknown solution prior to entering

the OR proper. On the other hand, the OR suite, one where a number of

surgeries may be performed at the same time in an elongated room, is

by no means without distinction. The entire, long wall is nothing but a big

window, the room flooded with natural light and a prospect overlooking Sim-

feropol that was simply lovely, with spring just coming and the first blush of

green everywhere seen. Dewey operated with Dr. Svetlana, their own very

excellent orthopedic surgeon of many years and much experience, the one

assisting the other in sequence. Ahh, with what modesty and discretion

did “Dewbonz” assert his own opinions while, justice be done, admiring the

expertise of Dr. Svetlana. Who would have ever guessed that “diplomacy”

in a foreign setting is yet another of his gifts. Amiability reigned, and those

little orphans were all made as straight as the very word “ortho-pedics”

says they should be made. And everyone learned quite a great deal from

everyone.

And then, of course, on the last evening there was a banquet in a Tatar

restaurant, the table groaning with exotic foods, wine and vodka flowing

by the bottle. Everyone gave toasts and made speeches, although I think

I was restrained for various reasons lest I place a foot in my mouth, and so

the next morning we flew home.

As teachers so often say about their profession, they learn as much

from their students as they

teach. So with us. Beyond

which, and all the more gratify-

ing, are these remarkably sweet

little orphans, these “least spar-

rows,” who because of the

generosity of physicians like

Dewey, Michael Erhard, Rich

Bosco, Kevin Neale and Ashok

Manocha, DDS are given such

a better chance at life.Dewey about to embrace a foot

Dewey-the-gentle-lamb-in-a-jumbo-jet

Practice Management

Giving Medical Receptionists Their DueBy Pauline W. Chen, M.D.

Not long ago, the receptionist on the hospital floor where I work went

on a family leave. Calm and with a wisecracking wit that she attributes to

her New Jersey roots, she had worked at the hospital for years and knew

better than anyone how to make things happen in the system.

What doctors and nurses missed most when she was gone, though,

was her ability to soothe emotional family members, intuit medical emer-

gencies on the phone and cut off rude doctors — then tirelessly repeat

that good work dozens of times over the course of a day.

When she got back from her leave, I told her how much all of us had

missed her. “There are some doctors and nurses who don’t think much of

what people like me do,” she laughed. “But we are the first ones to see

and take care of everything.”

While much has been written about the role of doctors, nurses and

other clinicians in the care of patients and their families, little attention has

been paid to those individuals who make up the very front lines of health

care. In almost every clinical practice, office receptionists and the profes-

sionals who do comparable work in hospitals, the ward clerks and unit

secretaries, are the first people patients see. But serious research on their

interactions with patients has been sparse at best.

Now the journal Social Science and Medicine has published a new

study on the work of this group of professionals. Despite the stereotype

that many receptionists bear as mere “gatekeepers” or even “the dragon

behind the desk,” the study found that their responsibilities extend far

beyond administrative duties. Ward clerks and office receptionists are a

vital part of patient care.

Over the course of three years, Jenna Ward, lead author of the study

and a lecturer in organization studies at the York Management School of

the University of York in England, embedded herself in general practice

offices and observed and interviewed nearly 30 office receptionists. She

found that in addition to their administrative work, receptionists had to

deal directly with as many as 70 people during a single day. Their emo-

tionally challenging work ranged from confirming a prescription with an

angry patient, to congratulating a new mother, to consoling a man whose

wife had just died, to helping a mentally ill patient make an appointment.

The demands changed from minute to minute and were often unpredict-

able. But one thing was certain: A significant portion of their work involved

managing the emotions and care of patients and families.

“Receptionists are a key part of the relationship between patients

and doctors,” Dr. Ward said. “We should be thinking of the relationship not

as a two-way one between doctor and patient or nurse and patient, but as

a three-way relationship among clinician, patient and receptionist.”

Dr. Ward observed that the most experienced and successful re-

ceptionists could rapidly change emotions to meet the patient’s needs.

For example, seconds after one of the receptionists confided to another

how sad she was about the accidental death of a young patient, the of-

fice telephone rang. The receptionist immediately collected herself, then

answered the phone in a warm and cheery way. During a mix-up over

appointment times, another receptionist responded calmly to an elderly

patient who had begun shouting racial epithets, helping to defuse the

situation.

“It’s not that the receptionists don’t feel anything; it’s just that they

may be mirroring the kind of ‘objective’ behavior that doctors are taught in

order to protect themselves,” Dr. Ward said.

But this detachment can also backfire. In an effort to protect doc-

tors from being inundated with patient visits and requests, many of the

receptionists relied on emotional distancing to deal with upset patients, a

strategy that sometimes only angered patients further. “In a lot of people’s

minds, the receptionist is barring access to primary care,” Dr. Ward said.

“But the receptionists see themselves in the very difficult position of hav-

ing to deal with all the emotions of the patients while remaining respon-

sible for the practice and protecting their practitioners.”

Dr. Ward believes that with more recognition and support for the

emotional work receptionists do, such misunderstandings and antago-

nistic interactions could be avoided. Practices, for example, could make

more explicit the fact that any requests to see a clinician would be fulfilled

within 72 hours rather than 24. Moreover, those who become receptionists

could receive training on handling not only the administrative but also the

emotional aspects of their work.

“Right now, when you employ people as receptionists, it’s kind of a

Russian roulette as to how much emphasis they place on the emotional

work,” Dr. Ward said. “If it were more integrated into the culture — health

care as being doctors, nurses and administrative staff — we might en-

courage people to perform these emotional tasks well.”

“Patient care is a holistic social process,” Dr. Ward added. “And

those on the front line can be a crucial part of that holistic treatment.”

Call Susan Prescott Today!Phone: (850) 484-5154Susan_Prescott@doh.state.fl.us

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Medical/Legal

Understanding the Types of Professional LiabilityBy the Risk Management Experts at First Professionals Insurance Company

In this age of expanding theories of tort liability, physicians may find

themselves responsible for more than their own acts. Most physicians re-

alize they have responsibility for the actions of their office staff or those

who are directly employed by them. However, they give little thought to

the fact they may also be responsible for the acts of their partners, office

staff, or others that act under their control or supervision. Liability can be

divided into two broad categories – direct and vicarious.

Direct Liability

Direct liability is defined simply as being responsible for your own

acts. If you deviate from the acceptable standard of care in the manner in

which you practice medicine, then you are negligent and directly respon-

sible.

Vicarious Liability

Vicarious liability encompasses those situa¬tions where you may

have acted appropriately but find yourself responsible for the failure of

another individual. The most obvious type of vicarious liability exists for

partners. Some physicians have organized themselves into professional

associations to avoid this situation. A partner is liable to the full extent of

their own assets for the acts of their partner, which were conducted in the

furtherance of the business of the partnership. This occurs even though

one partner may have never seen the patient nor participated in the care.

Physicians organize into corporate entities, such as professional associa-

tions, to avoid this scenario. Once the corporation is established, the phy-

sicians become employees rather than partners. Employees are generally

not responsible for one another’s acts. Therefore, unlike in a partnership,

the physician-employees of the professional association are effectively

shielded from the vicarious liability for another physician-employee’s acts

or omissions.

However, a corporate entity does create another category of respon-

sibility. The corporation employs physicians, physician extenders, and

others to accomplish the work of rendering medical care. Consequently,

the corporation (professional association) becomes the master and each

of the employees becomes a servant. As a result, a theory of law called

“respondent superior” comes into play. Under this theory, the corporation

is responsible for the acts of each of its employees. A common example

occurs when an office assistant renders medical advice on behalf of the

physician by telephone. If, in doing so, the physician has fallen below the

acceptable standard of care, this physician/employer or corporate em-

ployer can be held responsible.

Captain of the Ship

In addition to the categories of partners and employees are situa-

tions entailing a division of responsibility and thus, liability. State laws vary

significantly in this regard. One of the most common examples is the op-

erating suite. As the “captain of the ship”, the surgeon is generally thought

to be in control of all activities occurring in the operating suite and, there-

fore, responsible for all treatment during the operation. The captain of the

ship legal principle has evolved over the years. It is now recognized that

there are other specialists in the operating room who perform indepen-

dently of the direct supervision of the surgeon. The most obvious example

is the anesthesiologist. Although surgeons have ultimate control over the

operation, they do not have the technical skill or knowledge to control the

details of the anesthesiologist’s activities, although the law is less clear

with regard to non-physicians, such as a nurse anesthetist. Liability ex-

posure under a captain of the ship legal principle may exist despite the

absence of a statutory provision.

Surgical assistants generally have been held to be the responsibil-

ity of the surgeon. Although an operating assistant may have the same

degree of skill as their operating surgeon, the surgeon actually directs the

activities. The nurses may not fall under the responsibility of the operating

room surgeon. It generally has been held that when they are perform-

ing acts that require professional judgment, they are under the surgeon’s

supervision and control and, therefore, the surgeon’s responsibility. How-

ever, when they perform ministerial acts, such as sponge counting, they

are under the responsibility of the hospital that employs them.

Borrowed Servant

The same rules that apply in the operating suite can be utilized to

judge responsibility in other circumstances. If the physician exercises di-

rect supervision and control over the acts of another, then they may have

assumed responsibility for those acts. A good example is that of interns or

residents in a hospital. If the physician is employed by the hospital, then

the hospital becomes the master. Generally, the hospital will be respon-

sible for their negligent acts. However, if the individual temporarily comes

under the physician’s exclusive control and direction, the intern may have

become the physician’s “borrowed” servant and the physician therefore

may have assumed responsibility for the intern’s acts. Assessing liability

generally is driven by the degree of control the master exercises over the

servant.

The question of the consulting physician can be most closely analo-

gous to that of the surgeon and anesthesiolo¬gist. If a physician finds it

necessary to call in a specialist for a consulting opinion, one generally

selects an individual with greater knowledge in that particular area. One

does not exercise direct supervision and control over the consulting phy-

sician’s acts. As a result, the physician is not the master and not respon-

sible for that individual. However, this does not mean that the physician

calling in the consultant will always escape liability if the consultant per-

forms incorrectly. Once a physician has taken on the obligation and duty

of rendering medical care and attention, the physician cannot escape that

duty by delegating the responsibility to others. If the physician fails to use

reasonable judgment in selecting a consultant or in ensuring that the con-

sultant has performed the task, direct liability for selecting the consultant

arises as well as liability for the consultant’s negligent act or omissions.

Apparent Agency

There are situations where one can assume responsibility for another

even though one did not intend for the other to perform tasks on one’s

behalf. This theory of law is called “apparent agency.” A real agency is

created when one party confides to the other the management of some

business to be transacted in the former’s name or on their behalf. An ex-

ample of this is the office assistant or employee who passes along medi-

cal advice by telephone at the physician’s request.

However, what if the physician had instructed the assistant not to

act in such a fashion? In spite of the doctor’s instruction, the assistant

Continued on next page

Technology

gives advice, which is erroneous and results in an injury. Generally, an

employer is not liable for or bound by the acts or contracts of an agent,

which are not within the scope of the actual or apparent authority of the

agent. However, if a physician has conducted the affair in such a way as

to lead patients to reasonably conclude that the agent, or assistant in this

circumstance, is acting within his or her authority, the physician may be

responsible.

The most common examples of “apparent agency” occur in hospi-

tals. In most hospitals, the emergency room and department of radiology

are staffed by independent staff physicians. However case law has held

the hospitals liable for the acts of the staff physician on a theory of “ap-

parent agency.” The courts applied the general reasoning set out above.

They noted a reasonable person would have assumed the staff physician

was either the employee or agent of the hospital. If that person relied

upon that representation in seeking care, then both the hospital and the

individual rendering the care would be held liable.

Note: The preceeding information does not establish a standard of care, nor is it a substitute for legal advice. The information and suggestions contained here are gen-eralized and may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a reference guide only.

Types of Professional Liability, continued from page 6

Health Information Exchanges (HIEs) Nearly 21,000 healthcare providers have applied to the Centers for

Medicare and Medicaid Services (CMS) for Meaningful Use (MU) Stage

1 incentive payment since the program was launched in January 2011.

Under tight deadlines to receive maximum ARRA monies, hospitals and

physicians are focusing on meeting CMSs initial requirements of imple-

menting electronic health records (EHRs) and recording basic patient

data.

But racing to that goal must not give hospitals and physicians tunnel

vision. While the Federal Health Information Technology Strategic Plan

2011-2015, issued by David Blumenthal, MD, prior to his departure from

the Office of the National Coordinator for Healthcare Technology (ON-

CHIT), keyed in on getting healthcare providers to install and adopt EHRs,

it also created standards for exchange of that digital information. The

Strategic Plan underscores the need for local, regional, state-wide, and

national Health Information Exchanges (HIEs) to support this data transfer.

One can think of HIEs as the plumbing that will allow advanced uses

of healthcare data. ONCHIT believes that HIEs will track patient data and

improve clinical outcomes by allowing physicians and hospitals to share

EHRs with peers, follow patients when they receive care in different plac-

es, and exchange patient population data with public agencies like the

Centers of Disease Control (CDC). In addition, ONCHIT envisions HIEs as

the infrastructure for accountable care organizations (ACOs), the medical

home, and the bundled payments initiative.

Exchange networks are not yet mandatory. As stated in the Strategic

Plan, “Information exchange, which is central to realizing the benefits of

EHRs, is not fully possible today- there is no interoperable infrastructure

to securely exchange health information nationwide among providers, be-

tween providers and patients, and between providers and public health

agencies.” On the other hand, there are many examples of mature HIEs

across the country.

Today, HIEs are concerned with sustainability (finding the right fund-

ing model after initial grant funding dries up), governance, and security.

The number of working HIE networks (i.e., ones that actually transmit data)

has grown from just nine in 2004 to 73 in 2010. Each state has at least one

HIE, but only 44 states have working HIEs, according to an e-Health Initia-

tive survey last summer.

Other challenges exist for nascent HIEs such as connecting provid-

ers in different regions or states, misalignment of incentives for public and

private stakeholders, existing opt in/ opt out regulations which block ef-

fective use of HIEs, and the lack of an effective business model. We must

overcome these hurdles before David Blumenthal’s implementation of

nationwide HIEs can be realized. Perhaps more fundamentally, hospitals

and physicians view their peers as competitors and, consequently, they

are not motivated to share patient data.

Blumenthal and his successor, Farzad Mostashari, have pledged to

remove barriers to effective use of HIEs,in part, by offering about one-half

billion dollars for healthcare IT. These monies represent direct ARRA pay-

ments to hospitals and providers, direct grants to states for HIE develop-

ment, Beacon Grants to existing HIEs to underwrite the cost of spread of

concept, and support for Regional Extension Centers to help rural physi-

cians select and use EHRs. Also central to this effort is the development

of a National Health Information Network (NHIN). The NIHN program was

launched in 2004, but it has achieved little traction. Starting connectivity

within the federal government including the VA and Department of De-

fense, the NHIN is intended to coordinate a national, secure health infor-

mation exchange.

Pensacola is fortunate to have a local HIE. Sponsored by the

Pensacola Bay Area Chamber of Commerce, it is called Strategic Health

Intelligence, LLC or SHI. Chartered in 2008, it currently connects Naval

Hospital, Pensacola, Baptist Health Care, and Sacred Heart Health Sys-

tem. Its technology partner is Cogon Systems, and it has qualified for

the military’s highest standard for data integrity. Funding comes from the

hospitals, an ACHA grant from the State of Florida, and a federal earmark

shared with the University of West Florida. SHI is NIHN certified.

Soon on SHIs agenda is individual physician and physician group con-

nectivity. This will qualify practitioners for the ARRA federal fund reim-

bursement. This summer, look for the hospitals’ CMIOs to begin demon-

strating the exchange of data across our community hopefully ushering in

a new era of ready access to patient data that will improve our patients’

clinical outcomes.

In Memoriam

Michael Redmond, A Doctors DoctorBy Coy Irvin, MD

The family of Medicine lost one of it’s best advocates when Dr. Mi-

chael Redmond passed away recently. He lost his battle with pancreatic

cancer, but just as he lived his life he fought his illness calmly and was in

control right to the end. We all feel a loss in our world today.

Dr. Redmond has always been a strong advocate for the practice of

medicine and independence of physicians as they take care of their pa-

tients. He also was a healer dedicated to helping young patients preserve

their vision and thereby helping the quality of life. He was a scientist, an

entrepreneur, and an astute businessman, a friend and a loving husband

to his wife Janie. His ability to see a situation quickly and understand both

sides of an issue and then bring all parties together was a skill which was

always an amazing thing to behold. Dr. Redmond believed passionately in

the power of physicians to heal their patients and to be the leaders in mak-

ing healthcare available to the patient’s of Florida. He worked tirelessly

with the AMA, the FMA and the American Ophthalmologist Association

to be sure the voice of the practicing physician was heard in Washington

DC and Tallahassee. When he felt strongly about an issue you knew it and

you knew how he felt, but he could also bring you over to his side with his

reasoned debating skills. Long after he had finished his terms in the many

jobs at the Escambia County Medical Society (including being the presi-

dent), he continued to come to meetings to help make sure the past was

not forgotten and to be a supportive and knowledgeable source for the

many leaders of the Society who followed him. He was readily available

for advice or to answer a question to help the leaders of the Medical Soci-

ety do the right thing for our physicians and our patients. Over the years,

because of his strong beliefs, there were times when he took a stand that

some would not agree with. However invariably it would turn out to be the

right stand for the right reason.

I watched him many times at the American Medical Association as

well as at the Florida Medical Association stand up in a meeting and turn

the debate with his quick wit and his ability to express very complicated

issues in a very simple way. He was a master of debate and a diplomat in

the highest order, he was also a friend to many who have been active in

the medical arena. Pensacola will miss him as will the State of Florida and

the US. He had a commanding personality in a quiet and reserved way

which will not be forgotten. We have all been blessed to have known Mike

and I believe we are better off for all the things he did to advocate for our

profession of medicine and for our patients. Mike leaves behind a wonder-

ful family, his loving wife Janie, and a Legacy of a caring dedicated spirit

which we do not often see in this world.

In The Community

Hospital NewsSacred Heart NewsCritical-Care Capacity Expanded Sacred Heart Hospital in Pensacola has completed a $4.7-million renovation project to expand its capacity to care for critically ill patients. A new 12-room Surgical Intensive Care Unit (SICU) recently was opened on the third floor of the main hospital. Sacred Heart has recruited highly trained critical-care nurses to staff the unit, which is adjacent to the hospital’s oper-ating rooms and will be used primarily for surgical patients. “Our critical-care patient volume has increased so much that the need often exceeds our capacity,” says Deanie Lancaster, SHHP Chief Nursing Officer. The 12 new rooms expand the hospital’s critical-care capacity to 40 intensive care beds. Major Expansion Announced Sacred Heart Hospital in Pensacola has announced plans for a major expansion that will include a new five-story tower containing 112 private patient rooms. The tower will be constructed on top of the hospital’s existing Heart and Vascular Institute building. Construction will begin spring of next year, with the first 68 beds becoming operational in 2014. Another 44 beds will be added by 2016. “We have pressing needs right now for additional beds, especially for critically-ill patients and other adult patients with acute-care needs,” said Laura S. Kaiser, President and CEO of Sacred Heart Health System. “This expansion will provide the additional private-room capacity we need to ac-

commodate the demand for healthcare services in the decade ahead.”

West Florida HospitalWest Florida Hospital Awarded Accreditation West Florida Hospital has been designated as the area’s only Ac-credited Breast Imaging Center of Excellence by the American College of Radiology. This accreditation has only been given to 52 organizations in the state of Florida and is a testament to the level of quality care that our physicians and staff provide to our patients. The American College of Radiology recognized breast imaging cen-ters that have earned accreditation in: •DigitalMammography

tially harmful interactions of multiple medications, physicians at Sacred

Heart reconcile patient medications from admission through every level of

care and ensure the patient is taking appropriate medications in appropri-

ate dosages at time of discharge.

Safe outcomes and quality care will always be a major focus for the

health system and are now important to payers and regulators as well.

Evolving technology such as the electronic medical record (EMR) will be

a valuable patient safety tool in the future. Currently, Sacred Heart Health

System, Baptist Health Care and Navy Hospital are part of the Pensacola

Health Information Exchange, which soon will allow physicians at each

facility to access pertinent data on patients who are seen at any of the

three hospitals. This will enable physicians to determine what happened

to patients during previous admissions, as well as their existing chronic

conditions, to assist with prompt diagnosis and treatment.

With rapid improvements in technology and more and more complex

care, Sacred Heart physicians and staff remain focused on the goal of

producing safe and reliable patient outcomes.

Patient Safety Initiatives at Baptist Hospital Baptist Hospital has initiated innovative practices to prevent patients

from falling and sustaining hospital acquired injuries.

The first initiative is called “Code Fall.” Similar to a rapid response

team or code team, a fall team of dedicated professionals responds to

any fall that occurs in our facilities. If a patient fall occurs, personnel ask

switchboard operators to announce “Code Fall” over the hospital inter-

com. This signals the falls team to respond. In addition to assisting the

patient, the falls team captures real time events leading to the fall and

analyzes each fall for opportunities for improvement.

The second innovative initiative is modification of order sets. Phar-

macy, nursing, and medical staff leadership teamed up to change order

•StereotacticBreastBiopsy •BreastUltrasound •Ultrasound-guidedBreastBiopsy As an Accredited Breast Imaging Center of Excellence, West Florida Hospital ensures that our patients will be given the highest level of at-tention and treatment that can be offered. This prestigious designation is confirmation that our physicians and staff are committed to maintaining the highest level of image quality and patient safety standards available.

And, our facility is the only hospital in the area that offers all-private rooms.

Baptist HealthcareBaptist Hospital & Gulf Breeze Hospital earn The Joint Commission’s Gold Seal of Approval™ & are Unconditionally Accredited: Baptist and Gulf Breeze hospitals have earned The Joint Commis-sion’s Gold Seal of Approval™ for accreditation by demonstrating compli-ance with The Joint Commission’s national standards for health care qual-ity and safety in hospitals. The accreditation award recognizes Baptist & Gulf Breeze hospitals’ dedication to continuous compliance with The Joint Commission’s state-of-the-art standards at each of their facilities. Baptist and Gulf Breeze hospitals’ staff underwent a rigorous unan-nounced on-site four-day survey in June 2011 and May 2011, respective-ly. A team of Joint Commission expert surveyors evaluated each hospital for compliance with standards of care specific to the needs of patients, including infection prevention and control, leadership and medication management. President of Baptist Hospital David Wildebrant said “During the exit conference The Joint Commission surveyors shared that we were uncon-ditionally accredited and continue to maintain our Gold Seal of Approval. It was particularly gratifying when surveyors shared with our team that they have never met a more dedicated and caring staff. Achieving Joint Commission accreditation, for our organization, is a major step in our jour-ney to excellence and continually improving the care we provide.” “Gulf Breeze Hospital is proud of the success of our Joint Commis-sion Survey,” Bob Harriman, Administrator, Gulf Breeze Hospital & An-drews Institute said. “We are extremely proud of the diligent preparation by our staff and the collaboration with physicians, and we sincerely ap-preciate the support of our auxiliary, board members and peers at Baptist

Hospital who have assisted in our preparations.”

President’s Message, continued from page 3

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sets regarding the administration of diuretics to prevent administration in

the evening and night time hours. Another order set modification is the au-

tomatic ordering of the sleeping pill Ambien. Both diuretics administered

in the evening and night and the administration of Ambien have been

associated with a rise in fall rates for inpatients. The modification of order

sets allows physicians to order these medications when deemed appro-

priate, but the medications are no longer ordered automatically.

As a result, Baptist Hospital has seen decreases in falls on the ortho-

pedic unit, critical care unit, and progressive care unit.

The Joint Commission, who recently visited Gulf Breeze Hospital and

Baptist Hospital, stated that these innovations are best practices in pre-

venting hospital related falls. Both hospitals were praised by surveyors for

their progressive approach to falls prevention and their partnership with

medical staff to ensure world class outcomes.

President’s Message, continued from page 9

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View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.

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