Excerpts from other publications

Newly renovated medical center in Immokalee

ready for physicians from FSU and CHS

By Liz Freeman, posted on naplesnews.com Aug. 5, 2009

IMMOKALEE — Dr. Javier Rosado spent a few cold winters in New Haven, Conn., for a predoctoral internship in clinical and community psychology at Yale University. Last September, he relocated to Immokalee for a postdoctoral fellowship with Florida State University, where he will complete 2,000 clinical hours with families, mostly children, who need therapy.

... The 28-year-old psychologist says the best part of his practice in Immokalee is learning about the cultural differences with the mostly immigrant families and helping them.

“I love it,” he says of his time so far in Immokalee. “The family system is totally different than the American family.”

On Monday, Rosado and other colleagues with FSU’s rural medicine program in Immokalee and its affiliated pediatric clinic run by Collier Health Services will occupy what used to be empty space in the FSU Isabel Collier Read Medical Center. Until now, they used other space in the building that wasn’t suitable for their purposes on a permanent basis.

The NCH Healthcare System donated the 29,000-square-foot building to FSU in December 2007 after protracted negotiations that enabled the university to bring its rural medicine training program to Immokalee for medical school students.

About $4 million has been spent to transform what had been 11,000 square feet of unused shell space in the building into a medical clinic. Half of the cost came from the Naples Children and Education Foundation, sponsors of the Naples Winter Wine Festival. Another 2,000 square feet of space will be renovated in the next stage of the project.

All told, there are 17 examination rooms for the pediatrics clinic operated by Collier Health Services, a private, nonprofit organization, in a partnership with FSU where the university provides the educational component of the program for the medical students and CHS handles the clinical operations.

“It’s been a wonderful relationship,” said Steve Weinman, chief operating officer of CHS. “I think there is a huge benefit being affiliated with a university.”

Patients are more receptive to a university affiliation but it could also be a draw to get more physicians to come to the community, even from Naples, for the experience of teaching and to acquire courtesy privileges with the university, he said.

“We are hoping to get specialists out here at some point,” said Lesa Peterson, spokeswoman for CHS.

Even an old patient transport bus was replaced with a new bus, with CHS and FSU splitting the cost, she said.

The rural medicine training program in Immokalee, which got started in January 2008, has become popular with third- and fourth-year medical students at FSU for rotations, said Dr. Karimu Smith-Barron, FSU’s faculty director for pediatrics and adolescent medicine in Immokalee.

“We usually have two to three students,” she said. “This winter between October and January, we will have 10 students. Immokalee is a hot spot. They want the experience in internal medicine.”

She even has a second-year medical student in Immokalee this summer who is going around the community assessing perceptions about health care and shadowing doctors. As a second-year medical student, it’s too early for clinical rotations for him, she said.

Today, the rural medicine program has about 10 elective options in Immokalee in terms of specialties, which include pediatrics, family medicine, women’s health, internal medicine and behavioral health.

“So there’s quite a few options,” Smith-Barron said. “And we have students coming as far as Pensacola.”

Housing has been a hindrance in attracting more students than six at a time. The students must be willing to share a room with another student in a three-bedroom, two-bath home that CHS acquired near the facility.

The hope for CHS and the Immokalee community at large is that some of the medical students would return after they complete their education to set up practices in Immokalee. The program hasn’t been operating long enough in the community for that to have happened.

But Rosado, the psychologist who began a fellowship in Immokalee last fall with FSU, said he is enjoying the experience and working with the families and the issues they face. There may be undocumented family members who face deportation, and he deals with the impact to the children or other issues that migrant children face, he said.

“It’s a very unique population,” he said. “I really enjoy the community.”

HIT and Medical Education: The Innovators

Excerpt from: EHR Bloggers/ Physician insight on EHR and healthcare IT topics

Friday, September 4, 2009

… [F]inding space to teach HIT in a densely packed medical school curriculum means subtracting time from something else.

Still, it is argued here that the HIT Deluge presents unprecedented challenges to time-honored communication channels involving patients and physicians, and that it blurs boundaries between all stakeholders in the care process in ways that generate new ethical challenges and legal risks of a magnitude that simply cannot be ignored.

Many medical schools including Harvard, Stanford, Vanderbilt, UCSF and Ohio State have chosen to approach the conundrum by offering elective courses in HIT, often in conjunction with other graduate programs at the university….

The Florida State University College of Medicine has taken a more aggressive approach. It is one of the newest medical schools in the US, so its curriculum developers were not constrained by prior commitments and teaching methods. They chose to leapfrog ad hoc approaches to HIT education and design an Internet-age curriculum that has medical informatics woven into its fabric.

Nancy Clark, who directs the Medical Informatics program there, told me recently that FSU students receive laptops upon arrival at the school. Their textbooks are on line. During orientation and first semester, they learn to access library resources on line and gain early exposure to decision support tools.

In the second semester, she said, FSU medical students receive PDAs and learn how to use them. They also learn how to carry out literature reviews and manage bibliographies on line.

In their fourth semester, the students meet in specially designed classrooms where they learn how to use SOAPware, a laptop-supportable EHR. During their third year, students use SOAPware during supervised patient encounters and receive feedback from attending physicians regarding their work.

Alas, the hide-bound curriculums of most medical schools are unlikely to undergo full-scale renovations of this sort in order to accommodate the HIT Deluge. Even if they did, medical schools are not properly positioned to meet the immediate learning needs created by it.

After all, most practicing physicians graduated long before even the innovators had HIT courses, and health care professionals other than physicians need HIT education as well.

This has prompted the American Medical Informatics Association to initiate its so-called 10x10 program, whose goal is to train 10,000 health care professionals in applied health and medical informatics by the year 2010….

SPEAKING OF INNOVATION…

Dennis Saver , M.D., family medicine clerkship faculty in Fort Pierce, was featured prominently in a Los Angeles Times story earlier this year about the use of information technology in health care. Here’s the beginning of the article by Noam N. Levey:

A stethoscope with three tiny koalas dangling from his neck and eyeglasses perched on his nose, Dennis Saver looks every bit the family doctor as he steps into the examining room of his small practice on Florida's Treasure Coast. When Saver begins to examine his patient, however, the 56-year-old physician does something that four out of five doctors in America do not: He pulls out a computer.

The little black Toshiba, its edges worn to the bare metal, gets more use than the stethoscope and has become key to the care Saver gives his patients -- organizing medical histories, test results, prescriptions and other data that were once a jumble of paper records. Saver's laptop, and the system behind it, put him on the cutting edge of what President Obama and many experts say is a critical step to improving the nation's healthcare system while also reining in costs.

It is known as “Health IT,” an idea that promises to use information technology to cut medical errors, avoid unnecessary tests and procedures and identify better treatments. The Obama administration is betting that $19 billion of the economic stimulus package will spread the concept from coast to coast. Saver and the nine other physicians in his practice decided to take the plunge 3 1/2 years ago. Gone are tens of thousands of manila files that filled a big room in their office. Doing away with those has allowed the practice to cut its record-keeping staff from seven to three. The office eliminated 2 1/2 more positions in the billing department because clerks no longer have to struggle over doctors' handwritten notes.

In the examining room, Jim Culleton -- an 84-year old retiree who cheerfully explained that Saver had saved his life three times -- teased the doctor about his incessant tapping on the laptop. “I liked it better when he talked into his tape recorder. Now, I don't know what he's saying about me,” Culleton said. “Well, I don't lose your chart anymore,” Saver countered. “And I don't throw my back out hauling around your file.”

The laptop also allows Saver to quickly check lab results -- in Culleton's case alleviating concerns about a possible infection, something that could be deadly for the recent heart attack victim. And costly tests aren't repeated because a lab result is lost or an image is misplaced, Saver said. Thanks to warnings embedded in the electronic health record, or EHR, Saver can monitor his patients' prescriptions to avoid harmful interactions. In case of a recall, he can check the database in minutes to find out whom to notify….