2015: The Year in Review
As is our long-standing tradition here at MED, we wrap up our year with a look back at the top stories and news headlines of 2015. Once again, technology has often taken center stage in our publication, but MED has also tackled the problem of physician stress, shined a spotlight on the dual roles of physician scientists, highlighted sight saving services at the SD Lions Eye Bank, explored the Black Hills/Nepal connection in the wake of an earthquake, and provided a platform for area healthcare leaders to discuss the future of their industry. As you read this year’s Review article, please keep in mind that we are always on the lookout for new ideas. Let us know what stories and issues you want to read about in these pages in 2016.
High-Tech Sight Saver
The South Dakota Lions Eye and Tissue Bank Offers Rare Tissue Prep Technique to Restore Vision
The South Dakota Lions Eye and Tissue Bank is one of 9 eye banks in the U.S. (out of 79) with the training and experience to prepare DMEK transplants for corneal surgery. The transplants are used to treat rare conditions such as Fuch’s dystrophy, bullous keratopathy, and other cause of poor endothelial function..
Unlike previous generation partial thickness corneal grafts, the ultra-thinness of DMEK grafts means they can only be prepared manually. Under microscopic guidance, a specially-trained tissue preparation expert must carefully isolate and remove this miniscule layer of cells from the underside of a donor cornea.
“The average cornea is about 500 to 600 microns thick and the endothelium (the innermost layer) is absolutely the tiniest portion,” says Marie Bowden, CEBT, CTBS, Clinical Recovery Manager at the SDLETB in Sioux Falls. Bowden uses delicate instruments and a surgical microscopy to prepare circular grafts that are approximately 8.25 to 8.5 millimeters in diameter, a mere 10 to 12 microns thick, and the consistency of wet tissue paper.
Not every patient is a candidate for DMEK and many surgeons are still not trained to perform the delicate procedure. While the demand for DMEK tissue is growing, DSAEK remains the graft of choice for most surgeons. The SDLETB stays busy delivering both.
“More surgeons want to be as minimally invasive as possible to restore sight,” says Bowden. “Our job is to get the grafts to surgeons that they desire and that their patient needs.”
News Flash! Brent Phillips becomes the new CEO of Regional Health
News Flash! Prairie Lakes is one of only 19% of eligible hospitals to attest to Stage Two Meaningful Use
Leading Innovation at the Bench and the Bedside
Physician scientists work at the intersection of clinical practice and scientific inquiry, uniquely poised to bring clinical insights into the lab and vice versa. This is just one of the reasons that the three local physician scientists we spoke with for this story are so passionate about what they do.
Dr. Michael Kruer is an Associate Scientist in the Children’s Health Research Center at Sanford Research and a pediatric neurologist at Sanford Children’s Hospital. In medical school at Arizona, Dr. Kruer found his niche working with children with rare movement disorders and neurodegenerative diseases and later did post-doctoral work in a neurogenomics lab.
“I was struck by how much these patients needed someone to walk with them on this difficult path and also by how grateful they are,” says Dr. Kruer.
Head and neck cancer surgeon and researcher John Lee, MD, spends three days a week seeing patients and performing surgery at Sanford USD Medical Center and two days a week studying the causes and treatments of tonsillar cancers that are triggered by the HPV virus. T
“My role is to not only see the patients but to translate new information from our lab and from labs around the world into better treatments,” says Dr. Lee.
Pierre, South Dakota native and neonatologist Michelle Baack, MD, spent ten years as the only full-time pediatrician in Pierre before deciding to pursue neonatology at the University of Iowa. It was there than she was “bitten by the research bug.”
Being a researcher makes me think about patients and their medical care in more innovative ways,” she says.
News Flash! Mercy Medical Center unveils the da Vinci Xi Surgical System
News Flash! USD Sanford School of Medicine expands its FARM rural medicine program
The Other “Healthcare Crisis”
Most discussions of the “healthcare crisis” in the United States include the fact that the numbers of physicians, particularly those on the front line of care such as critical care, emergency medicine and primary care, are in shorter and shorter supply.
And yet, according to several nationwide surveys in recent years, these physicians and many of their specialty colleagues are burning out at an alarming rate, impacting not only their own lives but the institutions in which they work and the patients they serve.
In a 2011 physician survey, 87 percent of respondents named paperwork and administrative tasks as the primary causes of work-related stress and burnout. Sixty-three percent said their stress was rising.
In 2013, an editorial in the Journal of General Internal Medicine reported burnout rates between 30 and 65 percent across all specialties.
In a 2014 survey, 68 percent of family physicians and 73 percent of internists said they would choose a different specialty if they could start over.
And in this year’s annual Medscape survey, half of all family physicians, internists and general surgeons surveyed reported feeling burned out. Bureaucracy, administrative tasks, and too much time spent at work were cited as the more frequent causes.
“We are never taught how to take care of ourselves during medical training or residency. In fact, the workaholic ‘never need help, go it alone’ mentality is praised,” says Jill Kruse, DO, Family Medicine, Avera Medical Group, Brookings, South Dakota. “So when we do have issues, many students, residents, and even seasoned doctors don't feel comfortable asking for help.”
News Flash! June E. Nylen Cancer Center marks 20th Anniversary in Sioux City
From Nepal to Rapid City...and Back
The Black Hills of South Dakota are a long way from the mountains of Nepal. But for 12 Nepali doctors who work at Rapid City Regional Hospital, Rapid City has come to feel almost like home. Now, in the wake of Nepal’s devastating earthquake on April 25th, some of them are making the long journey back again to help their homeland recover.
RCRH Hospitalist Binod Dhungana, MD, is one of ten hospitalists and two specialists who have settled in Rapid City in the last five years. Within days of the earthquake, he became the first of the doctors to book his ticket home.
“My mom and dad live in Kathmandu. I have three sisters and a brother, too. They are all doing alright physically but, of course, they are very scared,” says Dr. Dhungana.
Ironically, this was the first year since moving to the US that the young doctor had decided not to use his summer vacation time to go home to Nepal. He had hoped to introduce his extended family to the Black Hills, where he has lived for the past two years.
By the time Dr. Dhungana left for Nepal, the American Nepal Medical Foundation had already collected more than $250,000 dollars to support the relief effort in Nepal. Some of that money came from group members, but some was directed to the foundation from other organizations, looking for a way to contribute. One of the biggest contributors was Rapid City Regional Hospital.
“It really means a lot to be part of such a great organization that is willing to help,” says Dr. Dhungana. “The support of the community has been great, too.”
News Flash! The Sioux Falls VA Medical Center introduces new integrative therapies for vets
News Flash! Sanford partners with IBM for genomic initiative
South Dakota Gets a Physical
Groundbreaking public health report provides comprehensive look at the state of healthcare in South Dakota
By Peter Carrels
In the executive summary of the report titled “Focus on South Dakota, A Picture of Health” the following statement summarizes the scale and importance of this newly-released statewide analysis.
“South Dakota and other largely rural states face many challenges in meeting the healthcare needs of rural and underserved communities, in part because data to guide improvement is often limited or unavailable. The South Dakota Health Survey provides unprecedented statewide survey data on regional patterns of behavioral health prevalence and access to care.”
Unprecedented is an ambitious word, but it is indeed likely that South Dakotans have never before been the beneficiaries of such a comprehensive analysis of their health and their access to healthcare. To conduct this health needs assessment, 7,675 randomly-selected households from across the state were surveyed by phone, mail and in-person.
The report identifies several “key” findings of special interest, including:
● South Dakota may have rates of alcohol misuse, anxiety, and post-traumatic stress disorder that are higher than national rates.
● Hospitalization use for mental health issues is high.
● Individuals utilizing hospital emergency rooms present high rates of mental health concerns.
● There are pockets of high rates of depression, heavy alcohol misuse, unmet medical needs, and adverse childhood experiences.
Survey results indicate that Buffalo, Lake, Lyman, Union and Yankton counties are the healthiest counties in the state. At the same time, surveys suggest that McPherson, Potter, Harding, Clay, and Fall River counties are among the state’s least healthy counties.
News Flash! Sanford introduces enterprise-wide pharmacogenetics service
News Flash! Avera begins using telehealth app “AveraNow”
The Future of Healthcare
Challenges for Hospitals, Health Systems and Physicians
As we talked with regional CEOs from both large and small health systems for our new series on The Future of Healthcare, we started by asking them to discuss what they see as the biggest challenges facing healthcare in the next five to ten years.
Jill Fuller, Prairie Lakes Healthcare System: Our biggest challenge will be the continued transformations in our business including the shift from inpatient to outpatient care settings and the transition from fee-for-service to reimbursement based on value.
Paul Hanson, Sanford USD Medical Center: One of the biggest challenges will be organizations developing a sustainable business model that balances clinical, financial and operational initiatives. Access to and management of capital, both human and financial, has never been more critical in ensuring an organization’s success.
Jason Merkley, Brookings Health System: The biggest challenge for healthcare organizations in the next five years is the shift from volume-based to value-based medicine and how we in rural America find ways to succeed under this reformed model and payment transition.
Brent Phillips, Regional Health: Recruiting and retaining a quality healthcare labor force could be a significant challenge well into the future. We have a huge shortage of several hundred thousand doctors across the United States today, and that shortage is only going to manifest itself more in the face of an aging workforce and an aging population.
Fred Slunecka, Avera McKennan Hospital and University Health Center: Regulatory [i.e. MACRA} and technology disruption will be a challenge. From evolutions of patient medical records to advancements in genetics and the study of microbiomes, we will understand care at completely different levels.
News Flash! Sioux Falls VA Medical Center opens its first women’s clinic
News Flash! UnityPoint Health, Avera, and Sanford again make CHIME’s “Most Wired” list
The Rise of Interprofessional Care
South Dakota Leads the Nation in a Team Approach to Medicine
By Peter Carrels
The campaign to propel the interprofessional healthcare movement in South Dakota got a big boost and elevated levels of responsibility and opportunity last June when the University of South Dakota, representing South Dakota’s Interprofessional Practice and Education Collaborative (SD-IPEC), signed a Memorandum of Agreement (MOA) with the National Center for Interprofessional Practice and Education. SD-IPEC is the statewide group working to advance interprofessionalism in South Dakota.
Dr. Carla Dieter, chair of the Nursing Department in the School of Health Sciences at the University of South Dakota, also serves as chair of SD-IPEC.
“We are now part of a national effort to contribute to the measurement of the interprofessional education and practice through affiliation with the National Center,” says Dieter. “By working with the national center we can tap into resources that will help propel our work forward on a broader scale as well as contribute to the National Center's Data Repository. It is exciting to be part of this important national effort.”
South Dakota is one of only 11 states to have formalized a relationship with the national organization, and South Dakota’s level of statewide organization is a rarity among states. Out of the 11 member states, only South Dakota’s and Arizona’s initiatives involve multiple educational institutions, and South Dakota is the only member state involving practice partners in their membership.
“The ultimate goal is to educate students interprofessionally so that it becomes so ingrained in their nature to work together that when they enter practice it will translate into sound interprofessional practices and produce positive patient outcomes,” says Dr. Dieter.
News Flash! South Dakota ranks above national average in key measures of happiness
News Flash! Avera opens new NICU