Academic medical centers face shrinking profits - what to do?

Here are some suggestions from the official AMA newsletter for 5 recommendations to help academic medical centers evolve, with my comments:

1. Build a brand name by holding faculty accountable for cost and quality. Mayo Clinic has mastered that and they offer a "subscription service" allowing local hospitals to gain quick access to Mayo experts - and to advertise that in the local press.

2. Become part of a larger community network. This is part of the "spokes of a wheel" concept to generate referrals to the tertiary center from the peripheral clinics and hospitals.

3. Increase effectiveness by maximizing use of extenders such as telemedicine and simulation technology. Mayo Clinic has a TeleStroke unit. Cleveland Clinic offers an "all-electronic" second opinion for a base price of $600.

4. Become an information hub. MayoClinic.com, the online patient information portal of the Mayo organization, is a good example of that concept.

5. Align research efforts with clinical and business strategies.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:



References:

Academic medical centers may face shrinking profits. Amednews staff. Posted April 4, 2012.
Image source: openclipart.org, public domain.

Mayo Clinic uses smartphone images to evaluate stroke patients in remote locations through telemedicine

A new Mayo Clinic study confirms the use of smartphones medical images to evaluate stroke patients in remote locations through telemedicine. The study, the first to test the effectiveness of smartphone teleradiology applications in a real-world telestroke network, was recently published in Stroke, a journal of the American Heart Association.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:

Mayo Clinic latest computer toy: "YES" Board patient tracking system

From Mayo Clinic YouTube channel:

Vernon Smith, M.D., an emergency room physician at Mayo Clinic in Arizona, discusses the benefits of the computerized YES Board patient tracking system which he developed over the course of several years and input from hundreds of doctors, nurses and emergency room staff while he worked at Mayo Clinic in Rochester, Minn.



According to Mayo Clinic, "the YES board reduces the time required to translate data, allowing physicians to forecast the needs of their patients and track progress. It has the capacity to walk physicians through current and past information for each patient — in addition to all patients collectively. Additionally, the YES Board helps to secure usable space and resources and detect the most at-risk patients and also helps forecast the needs of the patients in the emergency department. Plus, the YES Board can be viewed through any approved computer with an internet connection."

Mayo Clinic CEO's one-hour presentation on how Mayo Clinic is transforming medicine

Mayo Clinic president and CEO John Noseworthy speaks at Karolinska Institute on how Mayo Clinic is transforming medicine, June 25, 2012:

Beyond a hearing aid - Cochlear implants - Mayo Clinic video

From Mayo Clinic YouTube channel: Imagine what life would be like if you lost your hearing. No music, no sounds of nature, no listening to the voices of your loved ones. But some people with profound hearing loss do have options. Cochlear implants, in the right patients, offer the chance to hear again.

New treatment for dry eyes: "LipiFlow" uses heat and pressure to open blocked eyelid oil glands

The Meibomian glands (or tarsal glands) are sebaceous glands at the rim of the eyelids, responsible for the supply of meibum, an oily substance that prevents evaporation of the eye's tear film. They prevent tear spillage onto the cheek, trapping tears between the oiled edge and eyeball, and make the closed lids airtight. There are approximately 50 glands on the upper eyelids and 25 glands on the lower eyelids. The glands are named after Heinrich Meibom (1638–1700), a German physician (source: Wikipedia).

The LipiFlow Thermal Pulsation System uses heat and pressure to open blockages of the eyelid (Meibomian) glands. The treatment was approved by the FDA in 2011. Here is more information: http://lipiflow.com

Here is a Mayo Clinic video about the procedure:

Social media FTW: Mayo Clinic offers preferred early access to journalists and bloggers to health news

The newly launched "Mayo Clinic News Network" is billed as the journalists' multimedia source for health, science and research information: http://newsnetwork.mayoclinic.org

The no cost, password-protected site for journalists offers the latest breaking medical news, videos, graphics, links for background, animation, experts and patient interviews. Journalists from TV, radio, newspaper, blogs, and mobile platforms are invited to visit our site http://newsnetwork.mayoclinic.org and register. Pending approval, you will have access to this rich source of multimedia content.



I feature high-quality videos from Mayo Clinic on CasesBlog 2-3 times per month, and after some brief consideration I registered and applied for access. I will let you know if a medical blog with 7 million page views qualifies for access to the Mayo Clinic News Network or not (update: the application was approved).

The flagship journal of ACP, Annals of Internal Medicine, already includes medical bloggers in their embargoed news release before each new issue.

The ACP Internist website took a step further and includes guest posts from hand-picked medical bloggers (disclaimer: I am one of the selected authors). Many of the posts are quite interesting and cover a wide variety of topics. You can see for yourself here: http://blog.acpinternist.org

Kudos to the ACP editor Ryan DuBosar who is leading the medical blog initiative there: http://blog.acpinternist.org/2012/05/qd-news-every-day-nearly-1-in-8-doctors.html

Mayo Clinic now offers Patient App: access to personal medical record, appointment schedule and more

The Mayo Clinic Patient app allows access to the latest news, publications, and health information from Mayo Clinic. Mayo Clinic patients also have access to their personal medical record, appointment schedule and other services using their Patient Online Services account.

The Mayo Clinic Patient app provides local community information, including directions to local restaurants, entertainment, and more. http://youtu.be/UAymmf5ZUNo

Dermatology Art Contest by Mayo Clinic shows that art can be seen in every aspect of life

A Mayo Clinic dermatology art contest shows beauty really is skin deep. From Mayo Clinic News blog:

A hair follicle or skin specimen that doesn’t look like much of anything to the naked eye can become a complex, colorful work of art under a microscope. The winner of the Mayo dermatologists’ first art contest in 2011 was “Hair Follicle Triplet”. Alexander Meves, M.D., used fluorescent dyes to highlight proteins. The inaugural winners of the art contest appeared in the May issue of the Journal of Cutaneous Pathology.

“Every single day, dermatopathologists get to see beautiful images under the microscope, and most people never have the opportunity to see that. So I thought it would be a nice way to show not only the science of dermatopathology, but also the art,” says the contest’s creator, Dr. Lehman, a Mayo Clinic dermatopathologist.



Dr. Lehman hopes medical societies will run with the idea and hold similar competitions to highlight aesthetics in their specialties. People in other lines of work can also celebrate the beauty of what they do each day, she says.

Editor's note: Allergists should do something similar. We already highlight beautiful pollen allergens on the monthly covers of the ACAAI journal.

“Art can be seen in every aspect of life,” Dr. Lehman says. “You just have to have an open mind and be looking for it.”

References

Dermatology Art Shows Beauty Really Is Skin Deep. Mayo Clinic News.

Mayo Clinic Offers Dietary Supplements, Stress Management, Massage and Acupuncture in the Mall of America

Cleveland Clinic has a Wellness Institute. In another push to the realm of wellness, Mayo Clinic now offers one-on-one consults with Complementary and Integrative Medicine physicians on campus and where the customers are - right in the Mall of the America. See this 3-part video series below:



Brent A. Bauer, M.D. Dr. Bauer is a physician in the Department of General Internal Medicine and supervisor of the Complementary and Integrative Medicine Research program at Mayo Clinic.



Nancy Drackley, a physical therapist, massage therapist, and supervisor of massage therapy at Mayo Clinic.



Tony Chon, M.D, a physician in the Department of General Internal Medicine and a member of the Complementary and Integrative Medicine team at Mayo Clinic, discusses acupuncture.

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."



Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

Blood Management Summit and App - Transfuse 2012

Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.

This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.

Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:



This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.

The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780

One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.

It should be a great conference. Go check it out.

What are Yips? (Mayo Clinic video)

Yips are involuntary wrist spasms that occur most commonly when golfers are trying to putt. However, the yips can also affect people who play other sports - such as cricket, darts and baseball.

It was once thought that the yips were always associated with performance anxiety. However, it now appears that some people have yips that are caused by a focal dystonia, which is a neurological dysfunction affecting specific muscles.



Charles H. Adler, M.D., neurologist at Mayo Clinic in Arizona, discusses study findings related to the yips, a condition affecting a significant number of already anxious golfers during putting or chipping.

References:

Yips. Mayo Clinic.

Running Marathons and Staying Injury Free - Mayo Clinic Video

Mayo Clinic Florida sports medicine physician Daniel Montero, M.D., provides tips on avoiding injuries while running in a marathon. He also addresses tips on:

- safely keeping up when running in large crowds
- staying hydrated
- dressing for weather conditions
- running the way you were trained to do

Why Mayo Clinic is a power user of social media: "Our patients are doing it, so this is where we need to be"

Mayo Clinic's first-ever Social Media Residency took place October 20-21, 2011. At the end of the first day, the attendees went out on a video interview assignment. Check out some of the videos they returned with.

The best interest of the patient is the only interest to be considered

The Mayo Clinic CEO, John Noseworthy, M.D., pointed out recently that Mayo intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.

Social Media and Medicine is a Good Marriage, says Mayo Clinic director for social media: We're judged more by how well we listen, than by what we say (http://goo.gl/0ECin).

If you work for Mayo Clinic, social media is not an option, it's a job requirement http://bit.ly/IHf3lM - Others will follow.

References:

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Risk of heart attack and stroke goes up during holidays - Mayo Clinic video

From the Mayo Clinic YouTube channel: Are you at an increased risk of heart attack and stroke? Studies show the incidents rise during December and January, but particularly on Christmas Day and New Year's Day. Stay safe.

Jon Lord (70), a Hammond organ player, and a founding member of Deep Purple, who is currently recovering from cancer, says it very well: "Party hearty but look after yourselves. I wish you success and happiness, and above all I wish you health."



Jon Lord - Child In Time, 4 March, 2009, Palace of Arts (MÜPA), Budapest, Hungary.

Happy New Year!

References:

Jon wishes you a Happy New Year

How to Stay Active With Osteoarthritis: "Motion is Lotion"

Dr. Daniel Montero, a sports-medicine physician within the Department of Orthopedics at Mayo Clinic in Florida discusses what kind of exercises are you should take part in if you suffer from joint pain. Remember, "motion is lotion", says Dr. Montero.

Exercises you may need to avoid if you have moderate or severe osteoarthritis of the knee or hip include:

- Running and jogging. The difference between how much force goes through your joints jogging or running, as opposed to with walking, is sometimes more than 10-fold your whole body weight

- Jumping rope

- High-impact aerobics

- Any activity where, at any time, you have both feet off the ground at once, however briefly (basketball, jumping)

Fortunately, that leaves a lot of activities that are OK for people with knee and hip osteoarthritis and that can help keep you mobile - see the list at WebMD.

References:

Knee and Hip Exercises for Osteoarthritis. WebMD.

Holiday time can be really stressful for patients with eating disorders - here is what to do

From Mayo Clinic YouTube channel:

For people with eating disorders such as binge eating disorder, bulimia nervosa and anorexia nervosa, the holiday season can be a nightmare.

People with eating disorders usually begin to worry about food consumption at holiday gatherings weeks sometimes even months - before the event, says Leslie Sim, Ph.D., clinical director of the Mayo Clinic Eating Disorders Program. "It's really a stressful time because there are large amounts of food around."

Dr. Sim suggests a few tips to navigate through holiday gatherings:

- Have a plan. People with eating disorders should eat like they would on a normal day and not skip any meals. Make sure to eat breakfast, lunch, and a light snack in addition to the meal. People who starve themselves are more likely to skip out on the meal entirely or engage in binge eating.

- If family or friends know someone is struggling with an eating disorder, it's not a good idea to comment on their weight during a holiday gathering. Even a compliment can be taken the wrong way.

- If you're hosting a holiday gathering with plenty of food, don't take offense if someone doesn't eat.

- People with eating disorders should have a coping strategy if they begin to feel stressed during a gathering. Such tactics include deep breathing, meditation and talking to a close friend of family member.

Clinical Pearls in Gastroenterology from Mayo Clinic (video)

The social media department of Mayo Clinic combines journal articles and videos by the lead authors. This is a useful approach that should be followed by other journals, in addition to Mayo's own journal, Clinic Proceedings.



Dr. Amy Oxentenko, Assistant Professor of Medicine at Mayo Clinic, discusses "Clinical Pearls in Gastroenterology" (article abstract). Here is the 2009 edition of the same project.

References:

Clinical Pearls in Gastroenterology 2011. Amy S. Oxentenko, MD, John B. Bundrick, MD, and Scott C. Litin, MD

Disease-Specific, Social Network-Initiated Study by Mayo Clinic and Dr. Tweet

Mayo Clinic is the clear leader in social media use by hospitals at this time. Mayo has published 1,500 YouTube videos, has a social media center with approximately 20 employees, and external advisory board with experts that span the globe. They have a social media "residency" program where (for a fee) they are ready to teach you how to blog, Twitter, Facebook and YouTube in 3.5 days. Unhappy with the Facebook use for healthcare, Mayo launched their own social network for patients. But why stop there? Mayo Clinic figured out that you can collect data from the clusters of patients with rare conditions that form spontaneously in social networks. This pilot study is a novel example of “patient-initiated research.” I think this is great and potentially very useful to patients and science. Let's hope more hospitals follow in the footsteps of these pioneers.

The two videos below illustrate the start of Disease-Specific, Social Networking Community-Initiated Study Focused on Spontaneous Coronary Artery Dissection (SCAD):



The chest pain experienced by the woman you're about to meet was much more than a difficult recovery. She had a heart attack when a rare and deadly condition stopped blood flow to her heart. The same thing happened to another woman. After sharing their stories on social networking sites they found more women with the same problem. That's when they contacted Mayo Clinic to convince cardiologists to use the information they gathered on the internet to research this condition.



Dr. Sharonne Hayes, Professor of Medicine in Cardiovascular Diseases at Mayo Clinic in Rochester, MN, discusses her article appearing in the September 2011 issue of Mayo Clinic Proceedings on using social media to research and treat spontaneous coronary artery dissection (SCAD).

After being approached by several members of an international disease-specific support group on a social networking site, the researchers used it to identify patients who had been diagnosed as having at least 1 episode of spontaneous coronary artery dissection and recruited them to participate in a clinical investigation of their condition. Medical records were collected and reviewed, the original diagnosis was independently confirmed by review of imaging studies, and health status (both interval and current) was assessed.

Recruitment of all 12 participants was complete within 1 week of institutional review board approval. All participants completed the study questionnaires and provided the required medical records and coronary angiograms and ancillary imaging data.

This study involving patients with spontaneous coronary artery dissection demonstrates the feasibility of and is a successful model for developing a “virtual” multicenter disease registry through disease-specific social media networks to better characterize an uncommon condition. This study is a prime example of patient-initiated research that could be used by other health care professionals and institutions.

A cute factoid? The lead author of this social network-initiated study is actually called Dr. Tweet (as in a message on Twitter).

References

Electronic Communication and Medical Research: Beyond the Record

Spontaneous Coronary Artery Dissection: A Disease-Specific, Social Networking Community–Initiated Study

Another related video:



Dr. Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic, Dr. Marysia Tweet and Lee Aase, director of the Mayo Clinic Center for Social Media, discuss findings of a pilot study of SCAD (spontaneous coronary artery dissection) published in September 2011 in Mayo Clinic Proceedings.