Innovation in

JUNE 2012

HEALTH CARE

ILLUSTRATION BY PAMELA J. SIRIANNI | CORVALLIS GAZETTE-TIMES

rom the Cascade Mountains to theCoast Range, innovation continuesto be a driving force in the mid-val-ley’s health care.

And it’s innovation that’s engag-ing consumers and providers alike.

It includes the medical students justwrapping up their first year at WesternUniversity’s College of Osteopathic Medi-cine of the Pacific-Northwest as well aslongtime veterans of the health care field,working to help create a Coordinated CareOrganization to serve the mid-valley’s Ore-gon Health Care patients — an effort whichcould point the way to far-reaching reformof our entire health care system.

It’s innovation that includes researchers

and students working to find ways to en-courage more physical activity among ele-mentary school students. It’s innovationthat could help to open new vistas forvideoconferencing, with plenty of oppor-tunities to expand doctor training and pa-tient care. It’s innovation that has madehandwritten prescriptions a thing of thepast.

In this section, you’ll also read about in-dividual innovators: The medical studentswho are thinking about ways to improvecommunity health, both locally and glob-ally. The medical director who’s beenworking on electronic medical records sys-tems for two decades and now can see whata revolution these systems could ignite.

The researcher who thinks he and his col-leagues might have found a way to stopwisdom teeth from becoming such a literalpain. And the artist who’s finding ways toconnect the dots between the arts andhealing, a bridge between body and soul.

It’s all innovation that’s going on righthere, in the mid-valley – and this section(a sequel to a similar section we did lastyear) barely scratches the surface of what’sgoing on. It’s an explosion of new thinking,new concepts, new processes.

Turn the page to begin reading aboutthese innovators, people determined toleave their mark on our health care systemby finding new ways to help us lead healthierlives.

Your healthy future starts hereF

Innovation in Health CareJune 2012Mid-Valley Newspapers2

ANDY CRIPE

Kelley Kaiser, left, and Mitchell Anderson are working to get to the mid-valley’s first Coordinated Care Organization up and running by Aug. 1

ou can forgive MitchellAnderson and KelleyKaiser these days if they

seem to be more in a hurrythan usual.

Anderson, the director ofthe Benton County Health De-partment, and Kaiser, chiefexecutive officer of SamaritanHealth Plans, are workingovertime these days: They’reamong the key players work-ing to get to the mid-valley’sfirst Coordinated Care Orga-nization up and running byAug. 1.

Coordinated Care Organi-zations — everyone calls themby their acronym, CCOs — arethe centerpiece of Oregon’sbillion-dollar bet that it cansave money and provide betterhealth care to patients (initial-ly, the state’s Oregon HealthPlan or Medicaid patients)through a coordinated effortthat involves care providers,hospitals, health care plansand other stakeholders.

The benefits offered by theOregon Health Plan will notchange. But the idea is that theCCOs will use patient-cen-tered and team-focused mod-els of delivering health careservices, with an emphasis onprevention, chronic illnessmanagement and person-cen-tered care. State officials hopethat through greater coordi-nation between providers, theCCOs will get not just betterresults in terms of care butmore efficient results as well,resulting in a savings.

In an interview conductedon Friday, June 1 at the Corval-lis Gazette-Times, Andersonand Kaiser talked about theirwork, their hopes for the localCCO (which encompassesBenton, Linn and Lincolncounties), and the fast-pacedtimetable which they and theircolleagues are working againstas they try to pull the piecestogether. (This is just a smallportion of the interview; forthe full version, refer to theonline version of this story atthe newspapers’ websites.)

Because the Benton CountyHealth Department has beenexperimenting with the so-called “medical home” ap-proach that will be used in theCCOs, that provided the start-ing point for the interview:

Mid-Valley Media: In the medicalhome approach, a patient gets towork with a team of providerswho are focused on the patient’swellness. That idea is part of thephilosophy behind the CCO, butit’s a mistake to think that themedical home and the CCO arethe same things, right?

Mitchell Anderson: (The medicalhome is) not a CCO. ... The CCO isdifferent than that; it’s more like anorganizing entity that is supposedto be the catalyst to create more

person-centered care homes. ... It’sthe framework, as it’s supposed toprovide an innovative fundingmechanism that promotes changein the health care system and acoordinating function that getswhat have been independentpractices and services across thewhole spectrum of health andsocial services to work together. ...(The idea) is to look at a muchbroader range of conditions andissues faced by the person who’scoming in for care, and seeing thatmany things other than whatthey’re in there for affect theirhealth. .... How can we provide carethat promotes health and doesn’tjust fix what they came in for thatday?

Mid-Valley: But if the HealthDepartment and other providersare working with that model, whyis the CCO needed?

Kelley Kaiser: (The CCOprogram) is really focused onMedicaid (patients) right now ,the Oregon Health Planpopulation. ... Right now, in theOregon Health Plan, your mentalhealth, physical health and dentalhealth are provided by threedifferent plans. So theoverarching goal of the CCO is tosay that (instead of those threeplans), you’re going to have onefunding and coordinating streamthat takes care of that person. Sothe goal would be bettercoordination, better integrationand then, innovation. ... We needto do things better and differentlyand more around the patient.

Mid-Valley: Are there otheradvantages for a patient in thisapproach?

Kaiser: Hopefully ... what you getis one-stop shopping. So not onlyis it more coordinated, which isone really important thing, buteventually, hopefully, you go in andthere’s a mental health worker, abehaviorist, there’s a navigator,there’s a pharmacist. So you get (achance to say to a patient), “Kelley,I saw you today and I noticed thatyou’re having trouble coping whenthis happens. We have behavioristsdown the hall, maybe you canspend a few minutes with themjust so in case that issue comes up,they can give you some tools onhow to cope with that next time.”So instead of saying, “Here’s acard, go call Joe Smith and see ifyou can get an appointment,” it’s awarm handoff, and you’re rightthen hopefully taking care ofthings that will make a differenceright away.

Mid-Valley: And in theory, thatwarm handoff helps take care ofthese issues before they becomemore serious, which leads to someof the efficiencies that you have togain in order for this to work.

Kaiser: Right.

Anderson: And ultimately whatyou’re looking at is having a systemthat’s monitoring somebody’shealth, over time. ... A systemthat’s proactively intervening withthat person, teaching them self-management, helping them to stayhealthy, so what you avoid is, “Ineed to go to the emergency room.I let this go too long.” (The goal isto have fewer) of those incidents,which are some of the most costlyin the system. ... The other piece is,I think, if you were to fast-forwarda number of years ahead ... publichealth will play a stronger role ...(and we’re doing) bettermonitoring of the wholepopulation in terms of the overalllevel of health. We can expand howpublic health can work in terms ofpolicy and health promotionactivities to help raise the bar interms of the overall health of acommunity.

Mid-Valley: To increase wellnessinstead of just dealing withsickness.

Anderson: Right. And thatultimately comes back in terms ofsavings to the CCO.

Kaiser: The key is populationhealth. So that so-called “tripleaim” (better health, better careand lower costs) is one of the keyelements of federal reform andstate reform. ... If you can do allof those pieces together, you havea healthier population.

Mid-Valley: Before we get off thisarea, from your perspective,Mitch, as someone who’s workedin public health, has that notionof wellness or community healthtended to get short shrift in ourhealth care system?

Anderson: Overall, I think it has.It garners very little statesupport. It’s a very small piece ofthe overall health care system. ...And so I don’t think it’s beenvalued for what it can do,

especially in terms of the health-promotion aspects. ... (But) ifyou’re going to reduce the cost ofhealth care, you’ve got to improvewellness, and you’ve got to havethe mechanisms to do that on apopulation basis, because ifpeople can only get wellness bygoing to the doctor, it’s anexpensive system.

Mid-Valley: This whole process ofcreating the CCO is really comingdown in a hurry, isn’t it? You’reworking with a timetable that ismeasured now in weeks –

Kaiser: Days. ... It’s moving veryfast and everybody’s working tomake it work.

Mid-Valley: And part of the reasonwhy everyone’s moving soquickly is that you have theseassumed savings –

Kaiser: That are (included) in thecurrent state budget.

Mid-Valley: So, overall, this is ahuge opportunity to reshape thehealth-care system.

Kaiser: Yes.

Mid-Valley: Are we trying to takeit too fast? Do we run a risk ofbotching the experiment bytrying to push it as quickly as weare?

Kaiser: Well, I think it certainlyadds some challenges.

Mid-Valley: So, on Aug. 1, if you’rean Oregon Health Authoritypatient, what changes do yousee?

Kaiser: Our goal is, you don’t seetoo many. So part of our planningcommittee has (adopted) really a“keep the lights on” approach.Because our biggest concern wasthat on Aug. 1, members fallthrough the cracks.

Anderson: I think what we saidwas that, maybe initially, the firstthing they’ll see is some

simplification. Instead of gettingmailings from their dental plan,mailings from their mental healthplan, mailings from their medicalplan and cards for each one ofthem, they’ll get one card, onemailing.

Kaiser: And one phone number.Now, we should be clear. Dental isincluded in this, but the law saysdental (doesn’t) need to beincluded (until) January of 2014,so we are not including dental onAug. 1. Not because we didn’twant to; we just wanted to focuson what we had in front of us andas soon as we get that going, we’llthen start (with dental).

Mid-Valley: Well, this has to beexhilarating and terrifying,considering the amount of workand the speed with which it hasto be implemented. Is that a fairway to describe this, exhilarationand terror in equal measure?

Anderson: I kind of think so. (But)when I look at the alternatives, Ithink this is still the best one.Probably the worst thing thatcould have happened was (havingsomeone at the state level) saying,“This is the way the system isgoing to work” (for every CCO).And then we’re reeling, trying toadjust to something that we’re notsure we have buy-in for, and it’snot going to fit our region, thingslike that. So the ability to controlour destiny to some degree interms of how we’re going to createthis in a region, it’s great.

Kaiser: It’s exciting.

Anderson: It’s fun to be on thefront edge and be able to takewhat you know and what you’velearned and try to move it into asystem that’s going to workdifferently and work better. But,yeah, it’s scary at the same time,because there’s nothing to fallback on.

Kaiser: It’s “Where’s yourbusiness plan?” and it’s a littlevague. Because you’re really atthe mercy, at this point, of thestate. Once we get the (budgetnumbers from the state), then thestate has empowered us to takeour pot and as a CCO, withincertain guidelines, be creativeand innovative and make sure wetake care of everybody. But wehaven’t quite got to that part yet.We’re still trying to figure outwhat our foundation is so thenwe can figure out the best way tobuild it, so to speak, and thatshould be fun.

Mid-Valley: And the idea is thatyou take the amount of moneyallocated to you by the state in alump sum and you provide thoseservices for that amount ofmoney.

AT A GLANCEConfused about some of these fundamental changes in Oregon health

care? Here’s a glossary of some of the key phrases and words you’ll wantto know:

Coordinated Care Organizations (CCOs) are networks of all types ofhealth care providers who have agreed to work together in their local com-munities for people who receive health care coverage under the OregonHealth Plan (Medicaid).

Oregon Health Plan: The Oregon Health Plan is Oregon’s state Medicaidprogram.

Medicaid: Medicaid is the U.S. health program for certain people andfamilies with low incomes and resources. It is a means-tested programthat is jointly funded by the state and federal governments, and is man-aged by the states.

CMS: An acronym for the Center for Medicare and Medicaid Services,the federal administrator of both programs.

Collaborators in the local CCO include: Samaritan Health Plans,Samaritan Health Services, InterCommunity Health Plans, Benton Countypublic health, mental health and addiction services, Lincoln County publichealth, mental health and addiction services, Linn County public health,mental health and addiction services, Accountable Behavioral Health Al-liance, Mid Valley Behavioral Care Network, Oregon Cascades West Councilof Governments, Capitol Dental Care, The Corvallis Clinic, Quality Care As-sociates, Samaritan Mental Health and Federally Qualified Health Centersof Benton, Lincoln and Linn counties.

Spotlight on Coordinated Care Organizations: System overhaul brings team approach to services

Health care collaboration

SEE CCO | 3

Y

Kaiser: And if we spend more, weas the CCO find that (extramoney). And if by some miraclewe spend less, we as the CCOretain that, so it truly is a budget.

Mid-Valley: But if you spendless, if you deliver theseservices more efficiently, thatgives you one of the incentivesto look for collaborations, andlook for those partnerships.

Kaiser: (And that would giveus) some dollars to beinnovative and creative and toreach out.

Mid-Valley: Do you have anyidea how many patients aregoing to be affected in the threecounties who are going to beinitially affected on Aug. 1?

Kaiser: Probably about 35,000,the bulk of whom are in LinnCounty.

Mid-Valley: Are there otherchanges that those 35,000people will notice in themonths after August?

Kaiser: Well, hopefully, theywould notice the beginnings ofsome better coordination,right? I mean, hopefully, evenas we try to maintain and notlet them fall through, just in thecollaboration and coordinationthat we have already created inthe last 15 months of meetingand talking and somecommittees that we’ve alreadygot going, I would hope thatthey’re even maybe right nowseeing some bettercoordination, maybe moreperipherally at the beginning.

Anderson: I agree. I think theother thing that they willprobably see more and willcontinue to see is moreinvolvement. We’ve had anumber of community forumsand they’ll just continue tohave more more opportunitiesfor input, on what this lookslike. We’ve just completed thefirst leg of the race, which wasjust getting the application inand getting a contract. We nowhave to get the budget amount,which then starts the secondleg ... and then we have todesign what this is going tolook like. It’s interesting,because the greatest fears Ihear expressed by people,some even (from) staff at the

Health Department, is, oh mygosh, the system is going tochange Aug. 1 and there’s thisidea that somebody has thisgrand plan and it’s all going togo into effect on Aug. 1.

Mid-Valley: And the grand planbecomes apparent to everyonewhen they walk in on Aug. 1.

Anderson: And, no.

Kaiser: No.

Anderson: This is really goingto be a developmental year.Once we have the budgetamount, then we can beginshaping what it looks like.

Kaiser: I think a reallyimportant piece that wehaven’t talked about much isthe community advisorycommittee, and maybe Mitchcan talk about that, becausethat’s really an importantpiece. ... And, really, part ofthe whole reform ortransformation ... is that themember is engaged and is partof it and the community isengaged and is part of it.

Anderson: There will be 19members on the committeeand it will be a regionalcommittee across the threecounties. But what we’vedecided is that each county(also) will have a homecommittee. Part of the reasonfor that is so we have moredepth in terms of fingers outinto the local communities.What we didn’t want to seewas a regional committee thatjust kind of boiled local issuesdown into a master regionallist of issues. We want to keepthe flavors of the local issuesbecause these health issues aredifferent in each of thecommunities.

Mid-Valley: Well, gosh. A lot ofwork, and not much time to pullit off, but the potential is huge.

Anderson: It’s a bigexperiment.

Kaiser: It is very exciting. It’svery exciting. It’s veryoverwhelming, but it is veryexciting. Because thepossibilities and the outcomescould really be impactful topeoples’ lives and ourcommunities. And that part isvery exciting.

Plan puts physicalactivity in the

classroomBY MIKE MCINALLY

Even as budget woesand other constraintsforce Oregon schools tocut back on their physicaleducation classes, SimoneFrei is working on a plan toget physical activity backinto the classroom — a fewminutes at a time.

Frei directs the HealthyYouth Program at OregonState University’s LinusPauling Institute. She andher students are workingon a trial program to de-velop a DVD that class-room teachers could use toget their students up andmoving right there in theclassroom.

The idea is to giveteachers a convenient andeasy way to work somephysical activity into theschool day — potentially aboon for school districtsthat find it increasinglyhard to find the time andmoney for PE classes.

“There is such an em-phasis” on traditional aca-demic work in schools to-day, she said. “Teachersare really stressed out.Even if there might bemoney to offer more PEclasses, I’m not sure theywould do that.”

At the same time,though, school districts arefacing a mandate from thestate to add 30 minutes ofPE activities to the schoolday by 2017 — despite ashortage of not just moneybut gym space as well.

All the more reason,Frei figured, to develop aDVD that could helpteachers put structured

physical activities backinto the classroom. TheDVD, created with the helpof OSU media and exercisestudents, includes five- toeight-minute segmentsthat can be used at anytime in the classroom.

It’s a project that’s rightin line with the goals of theHealthy Youth Programand the Linus Pauling In-stitute, says Balz Frei, theinstitute’s director, eventhough the institute likelyis better-known for itswork on micronutrientsand nutrition. (Balz Frei ismarried to Simone, but hedoes not supervise her.)

“The shift in focus awayfrom PE and nutrition iscompletely the wrong di-rection,” Balz Frei said.“It’s devastating.“

Especially, he said,when you consider thegrowing problem of youthobesity — a problem thatcould result in huge healthproblems in terms of heartdisease, diabetes and oth-er ailments in 25 or 50years as today’s chubbychildren grow into sicklyadults.

“That’s what we’re try-ing to counteract,” BalzFrei said. “Diet andlifestyle and exercise areabsolutely key to a healthylife and disease preven-tion. It’s hard to change

that later on” — all themore reason, he said, to tryto build strong habits inchildren.

Finding the barriersSimone Frei said she

and her students surveyedteachers to see what theyperceived as the barriersstopping them from in-cluding more physical ed-ucation activities duringthe day. The common hur-dles came as no surprise:Time and money.

But, she said, her workconvinced her that teach-ers were looking for alter-natives. “Teachers are re-ally interested,” she said.“They really do care, themajority of them.”

And the survey sug-gested that teachers wouldbe interested in a productlike the DVD — somethingthat would be free and

wouldn’t take up too muchclass time. Encouraged,she and her colleaguesmoved ahead with theproject.

Students went intoclassrooms to see whatsort of activities were hitswith students and whichones flopped.

The idea behind thevideo, Simone Frei said, isto make it easy for teachersto integrate the segmentsnaturally into a class peri-od. All the activities can bedone inside a classroom.

Eventually, the DVDwas shot in the studios atKBVR, the student-runtelevision station at OSU.

“This isn’t like a Holly-wood production,” shesaid. “But it’s going to bewell-done.”

And it does includesome appearances byBeavers athletes — usuallya good draw for the ele-mentary students who arethe DVD’s target audience.

Now, Frei is looking forclassroom teachers whoare willing to give thevideo a tryout.

“We just want to see,does it work?”

Mike McInally is the editor of theCorvallis Gazette-Times and thedirector of content for Mid-ValleyMedia. Reach him at 541-758-9502 or mike.mcinally@gazettetimes.com.

Innovation in Health Care 3June 2012

Mid-Valley Newspapers

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CORVALLIS CLINIC MAR

DVDaims to boostexercise

ANDY CRIPE

Simone Frei, who directs the Healthy Youth Program at Oregon State University’s Linus Pauling Institute,is working on a trial program teachers could use in the classrooms to get their students more active.

FOR MOREINFORMATION

Teachers and school offi-cials who are interested inlearning more about theHealthy Youth Program’s ex-ercise DVD can contact Si-mone Frei at Oregon StateUniversity’s Linus Pauling In-stitute. The phone number is541-737-9377 and the emailaddress is simone.frei@oregonstate.edu.

CCO: PartnershipsContinued from front page

Getting wisdom teeth re-moved is so common in theUnited States that it’s be-come almost a rite of pas-sage to adulthood.

An estimated 10 millionthird molar tooth extractionseach year account for morethan 92 percent of all teethremoved from patients underthe age of 40, according to a2007 article in the AmericanJournal of Public Health. Thisamounts to surgery on about5 million people annually andmore than $2.5 billion in coststo patients, not counting theadditional costs of sedation,X-rays and post-operationexpenses.

Surgery might be a mustfor patients who suffer fromimpacted molars, but manyteenagers and early adultssimply undergo the surgeryto remove teeth on the advicethat it will “eliminate moreserious problems in laterlife,” a practice that drawsmixed reviews from doctors.

“It’s a pretty involvedsurgery and it’s not withoutrisks,” said medical re-searcher John Mata in an in-terview at his office at Col-lege of Osteopathic Medi-cine of the Pacific-North-west in Lebanon on a recentafternoon. Mata has a verypersonal example: His owndentist broke a small chunkfrom Mata’s jaw when heunderwent the surgery as ayoung man in Omaha, Neb.

But, what if the need forall those surgeries could beprevented in the first place?

The third molars, knownpopularly as a set of “wis-dom teeth” are notable inthat they are the only set ofteeth that start their growthafter birth, and don’t emergefrom under the gums untillater in life. In fact, throughabout age 12 in humans, thetooth bud is not protected bya hard bony shell like theother teeth.

Mata and a team are test-ing out a process calledcomputed tomographyguided microwave ablation.In the process, a CT-scan isused to create a three-di-mensional map of the jawarea. Using this guide, aprobe about the size of adentist’s water pick is

touched to the gum justabove the targeted toothbud. The probe delivers asmall dose of microwave ra-diation – less than a cell-phone emits. The idea is tocook the tooth bud enoughto halt any further growth.

The possible benefits?The process, when fully de-veloped, is likely to be fast,relatively painless and lessexpensive compared to thetraditional approach, Matasaid. The hope is to somedayuse the procedure in chil-dren ages 6 to 12 to preventthe growth of wisdom teeth.

The study is still in themidst of animal trials usingpigs, but the initial resultsare exciting, Mata said. Sofar, the small microwaveburn has done just what re-searchers had hoped – halttooth development with nonoticeable side effects inswine at age 10 months (eachmonth in a pig’s early devel-opment is roughly equiva-lent to a year of developmentin humans). The next step ofthe study is to continuework with a large animal in-ternist. a dentist and a radi-ologist to perform the sur-geries and monitor the pigsfor long-term recovery.

Mata’s partners in theproject include Leigh Colbyfrom Oregon Dental Care inEugene, who initially ap-proached COMP-NW withthe idea for the study; JohnSchlipf and SusanneStieger-Vanegas, assistantprofessors at the College ofVeterinary Medicine at Ore-gon State University; andVickie Patel, an OSU pre-dental student.

The first year of researchwas funded by a $20,000grant from the ErkkilaFoundation for HumanHealth and Performanceand matching funds fromOregon Dental Care.

— Nancy Raskauskas

Innovation in Health CareJune 2012Mid-Valley Newspapers4

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CORVALLISFAMILY MED

Corvallis startup rolls outa software solution thatlets patients and doctors

connect in new waysBY BENNETT HALL

In a private room at Samari-tan Mental Health in Corvallis,third-year psychiatry residentMandi Hudson is working witha patient while Dr. MichaelMay, the medical director of theregional mental health system,scrutinizes her every move.

But May’s presence is not adistraction for Hudson or herpatient — in fact, he’s not evenin the same room.

Using a new software pro-gram called Aptius, he’s ob-serving the session on thedesktop computer in his officedown the hall. Twin video cam-eras and a microphone on Hud-son’s laptop let May see andhear the interaction betweenpsychiatrist and patient.

That’s not all. Using a livechat feature, he can send notesto Hudson about her perform-ance in midsession. He can alsotag portions of the live videofeed — which is automaticallyrecorded — so the resident canreview them later.

“I can say things like ‘Goodshow of empathy’ or ‘This wasan opportunity to go deeperinto this issue,’” May said.

Is this the future of Ameri-can medicine? May thinks itcould be.

“As a tool for teaching, thisgoes way beyond anything elsethat’s out there.”

But Aptius, the brainchild ofa Corvallis tech startup calledVisionary Mobile, goes way be-yond training residents. By

combining videoconferencingwith additional informationmanagement tools, it allowspatients and health careproviders to connect in newways that enable a host of po-tential applications.

Visonary Mobile has formeda joint venture with SamaritanHealth Services to test and re-fine its new medical communi-cations platform under realworld conditions, and the part-ners say they’re discoveringnew uses for the technologyeverywhere they look.

“We’re actually building asystem that really works in ahealth care setting, and we canoptimize it” for a variety ofspecialized needs, VisionaryMobile CEO Krishna Rao said.

“This isn’t just a video con-nection,” Rao added. “This is astep above that.”

‘Unlimited’ applicationsIn addition to streaming

voice and video, the technologyallows health care providers toview a patient’s medicalrecords, lab results, medicationlists, X-rays and other diagnos-tic images. Authorized userscan modify records as appro-priate and interact with otherparts of the health care net-work, ordering tests, adjustingdrug dosages, making referralsand so forth.

Samaritan Mental Health hasbeen using Aptius for severalmonths, and the technology isnow being rolled out in otherparts of the Samaritan system,including some hospital emer-gency rooms, primary careclinics, and the hospice andhome health departments.

“It’s going to have a lot ofapplications,” said SamaritanHealth Services CEO Larry

Mullins said. “It’s kind of un-limited, in my mind.”

The web-based product re-quires no dedicated servers (it’shosted on multiple cloudservers for redundancy) and isintended to operate with anyexisting hardware, softwareand operating system, Rao said.

It’s encrypted to federal privacystandards for medical informa-tion, and operators can controlaccess levels for multiple users onthe same conference.

One of the most important as-

pects of the technology, inMullins’ view, is the financial sav-ings it can bring to bear across theentire health care system. Thatwill be crucial, he believes, to thesuccess of reform measures beingrolled out at the state and nation-al levels, which call for extendingcoverage to more people whilereducing costs at the same time.

“I think it’s going to providefor a much more optimal assess-ment of the patient, but it’s alsogoing to be a more cost-effectiveway to provide care,” Mullins

said.“As we move into a reform

model, which is really a popula-tion health-based model, thesekinds of innovations are going tobe really important.”

Visionary Mobile has beencourting other health careproviders besides Samaritan, in-cluding Oregon Health & ScienceUniversity Hospital in Portlandand the University of Washing-ton Medical Center in Seattle,and a pair of Army medical offi-cers recently visited Corvallis tosee the system in action.

“There’s plenty of interestright now,” Mullins said.

Other potential customers in-clude rural clinics, ambulancecrews, nursing homes, inde-pendent medical practices andthe regional accountable care or-ganizations being rolled out un-der federal health care legisla-tion.

“We’re doing something thatis directly at the heart of healthcare reform,” Rao said. “We’re notgoing to just build something bigfor the community. We’re going tohave an impact on health care na-tionally.”

Bennett Hall is the special projects editorfor Mid-Valley Media. He can be contact-ed at bennett.hall@gazettetimes.com or541-758-9529.

AMANDA COWAN

Dr. Michael May uses the Aptius platform to observe Dr. Mandi Hudson during a psychotherapy session with a patient Fridaymorning at Samaritan Regional Mental Health Center. A blue paper sticks to the computer monitor to protect the privacy ofthe patient.

Medicine for the future

JOHN MATA, PH.D.Age: 51Occupa-

tion: Asso-ciate profes-sor at Col-lege of Os-teopathicMedicine ofthe Pacific-Northwestand phar-macologist by training.

Why he’s an innovator:Mata’s research has focusedon a wide variety of health is-sues ranging from cancertreatment (using peptides tofind and target cancerousgrowths), to nutrition and com-munity health. Currently, he isinvestigating a novel idea tohalt the growth of wisdomteeth in children that, if suc-cessful, could lead to a new andless invasive treatment optionfor children at risk for third mo-lar impaction and reduce theneed for oral surgeries.

Why he’s innovating here:Mata says that the WillametteValley is a great place to livefor someone interested in nu-tritional research. A past jobwith AVI BioPharma in Corval-lis was what initially broughthim to Oregon from his homein the Midwest, where he at-tended the University of Ne-braska Medical Center for hisdoctorate in medical sci-ences. He later did postdoc-torate work in pharmaceuticalscience at Oregon State Uni-versity mentored by Dr. RositaProteau. He lives in Corvallisand commutes to Lebanonwhere he teaches classes infundamentals of pharmacolo-gy, anti-microbial therapy andanti-arthritic drugs.

Mata

Visionary Mobile CEO Krishna Rao, left, and Samaritan Health Services presi-dent and CEO Larry Mullins talk about Visionary Mobile on May 23 at GoodSamaritan Regional Medical Center.

Stopping wisdom teethin their tracks

You get a postcard fromthe auto shop remindingyou that your car is due foran oil change.

Now, imagine this: Nes-tled among the postcard inthat day’s mail is a letterfrom your medical providerreminding you that you’rein need of maintenancework as well. You’re overduefor a colonoscopy.

It’s not at all inconceiv-able, said Dr. Dennis Regan,the new medical director atThe Corvallis Clinic, andsomeone with decades ofexperience in trying to de-velop the kinds of electronicmedical records system thateventually could make thatletter possible.

“We know that saveslives,” he said about themedical procedure. “There’sno question about it.”

Electronic medicalrecords have not yet ad-vanced to the point whereit’s easy to generate that kindof potentially lifesaving re-minder letter. But we’reconsiderably closer than wewere some two decades ago,when Regan first startedworking with electronicmedical records during hisprevious job at The BillingsClinic in Montana.

He offers this example: Ittook the financial servicesindustry decades to movefrom ATMs to the pointwhere online banking waseasy and secure.

“And banking is easycompared to health care,”he said.

But, he added, his senseis that the The CorvallisClinic and other health in-stitutions are nearing a tip-ping point where health careprofessionals and patientsalike are going to really un-derstand the potential ofelectronic medical records.

In terms of moving aheadwith electronic records, hesaid, “The Corvallis Clinichas come in the space of thelast 12 months what took me

15 years at The Billings Clin-ic.”

And the prospect of so-called patient portals thatallow consumers access totheir own health records,could be hugely empower-ing for patients — and alsocould set the stage for awave of disruptive tech-nologies that will overhaulthe health care landscape.One quick example: aniPhone app that monitorsblood-glucose levels.

Functioning electronicmedical records systemswill allow providers and pa-tients to share informationin a meaningful and timelyfashion, Regan said.

And the data gathered bythe systems should lead toimprovements in the entirehealth care system: “Whatwe do in medicine is handledata,” he said. “Taking careof somebody is a very data-driven enterprise.”

“I’m excited,” he said.“Now we get to do the realwork. Now we get to im-prove care rather than justput systems in place.”

— Mike McInally, Mid-Valley Media

Meghan Aabo and Kather-ine Peters, students at themedical school in Lebanon,have a fresh twist on the oldslogan about thinking global-ly and acting locally.

The students, leaders ofCOMP-Northwest’s GlobalHealth Club, are thinkingand acting — and they’redoing both on a local andglobal scale.

The mission of the club isto promote global healthawareness and activitiesthrough an emphasis on theinterdependence betweenthe health of the globe andthe health of people.

To accomplish this, Pe-ters and Aabo have teamedup with a variety of com-munity partners to connectmedical students and thegreater community.

“Community health is abig focus of ours, both lo-cally and globally,” Aabosaid. “Together with someoutstanding members ofour faculty, we are workingon an assessment and inter-vention model to improvecommunity health.”

The students will studycommunity health inLebanon, and in sites be-yond the borders of theUnited States.

“This summer, a smallteam will begin investiga-tion in a small coastal com-munity in northern Peru todetermine if it will be a goodstudy site,” Aabo said.

All of the club’s activitiesare intended to increasehealth and nutrition aware-ness and community health.

For example, Peters and

Aabo organized two addi-tional nights of care at theEast Linn Community Clin-ic for uninsured people inneed of health care. Stu-dents and clinical facultyoperate the clinic on thefirst and third Wednesday ofeach month.

The students haveworked with Planting Seedsof Change in the teachinggardens throughout theLebanon Community SchoolDistrict, providing addition-

al nutrition education.The pair can be seen

every other week at theDowntown Farmers Marketin Lebanon serving upfreshly prepared meals fromseasonal locally grown pro-duce, in an effort to encour-age seasonal eating, supportof local farmers, and health-ful eating.

Peters and Aabo are de-veloping a series of healthscreenings with theLebanon Soup Kitchen, tooffer basic health exams topatrons of the kitchen.

“Good health is notsomething that someoneelse can do for you,” Peterssaid. “You won’t find it inthe perfect combination ofpills or medications, or in amagic new product. Youfind it in the way you liveyour daily life.”

To be innovators of yourown health you must find abalance, she added.

“Eat a lot of fruits andveggies, get a little bit moreexercise, watch a little bitless TV, and get involvedwith activities that youlove,” Peters said.

Aabo added that knowl-edge is power.

“Our societal focus needsto shift to highlight well-ness,” she said. “I hope thatmy colleagues and I can pro-vide momentum toward thatchange where we practice.”

Communities and indi-viduals should be able tolook to health care providersfor information that willhelp them lead more health-ful lives, Aabo said.

– Emily Mentzer, Mid-Valley Media

KATHERINEPETERS AND

MEGHAN AABOAges: Aabo is 31; Peters, 27Occupation:Medical students

at the College of OsteopathicMedicine of the Pacific-North-west,a campus of Western Uni-versity of Health Sciences.

Why they’re innovators: Pe-ters and Aabo are leaders ofCOMP-Northwest’s GlobalHealth Club.They don’t per-ceive themselves as innovators– but their advisors and othersat the medical school disagree.

Why they’re innovatinghere: Their studies at themedical school, of course,brought them to Lebanon –but they’re interested in im-proving community health notjust in the mid-valley butthroughout the world.

Dialysis and cancertreatments are miserable,but in the mid-valley, TheArts Center in Corvallis cre-ated a program to bringbeauty and healing to anuncomfortable necessity.

Mary Van Denend,ArtsCare coordinator for TheArts Center, has run theArtsCare program for abouteight years; the programbrings artists and arts proj-ects to Samaritan Health Ser-vices to work with patients.

ArtsCare is at Samari-tan’s hospitals in Corvallisand Lebanon with a smallerversion at Pacific Commu-nities Hospital in Newport.The program is just begin-ning at North Lincoln Hos-pital. The program provides17 artists, includingpainters, poets, printmak-ers, potters, quilters and avariety of musicians, whodo what Van Denend calleda “delicate dance” to keepout of the way of nurses andtechnicians while providingopportunities to create art.

“Patients often arehooked up to dialysis ma-chines,” Van Denend said,“so they do things like one-handed painting or collage.”

What happens, Van De-nend said, is a total diver-

sion for a couple of hourswhile patients are there.

The art program also is of-fered to patients in oncologyand mental health settings.

“They think of themselvesin a different way for thattime,” Van Denend said.“They become artists andshare stories about their lives.”

Visiting artists are able tobe present in the hospitals ina way that nurses and techni-cians cannot and they oper-ate at a slower pace, offeringa calm and a different focus.

Van Denend said it is notuncommon for patients tobe resistant at first to par-ticipating. Their situation isuncomfortable; it’s difficultfor some of them to be hap-

py. But she has plenty ofstories about patients whoturn around completely intheir demeanor and thor-oughly enjoy the exercise.

“It is satisfying to makesuch a big impact,” Van De-nend said.

In addition, musiciansvisit the hospitals and playinstruments that entertainas well as soothe patientsand staff.

“It’s all about buildingteamwork,” Van Denendsaid.

The art/hospital rela-tionship began in 2004when The Arts Center re-ceived a small grant fromJohnson & Johnson to dosome site beautification atGood Samaritan RegionalMedical Center. Ceramicmurals were created and apainting was done outsidethe cafeteria. Around thesame time, Van Denendsaid, a group of localharpists in training neededto find opportunities to playto satisfy a requirement foran internship. It wasarranged that they wouldplay at the hospital.

“That was really the ini-tiation of the program,” VanDenend said. In 2007, an of-ficial partnership was

formed between The ArtsCenter and the hospital,which provides the primaryfunding.

After branching out fromits start in the medical cen-ter’s dialysis unit, ArtsCaretoday also operates inSamaritan’s cancer, mentalhealth and heart and vascu-lar units as well as at theMario Pastega House. InNorth Albany, the programoffers arts workshops in thecancer center and music inthe lobby. Lebanon Com-munity Hospital’s dialysisand infusion center also hasarts workshops.

ArtsCare is not therapyand the artists are not ther-apists, although the work istherapeutic.

The Arts Center activelyis seeking donors to supportthe ArtsCare program and isexpanding into additionalcare facilities such as assist-ed living, senior centers andyouth shelters.

– Maria Kirkpatrick

Innovation in Health Care 5June 2012

Mid-Valley Newspapers

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COUNTYHEALTH

AMANDA COWAN

Mary Van Denend, arts care coordinator for the Arts Center, stands among a mosaic mural recently at the Good Samaritan Regional Med-ical Center rehabilitation center. The mosaic, which was a community art project, was created by arts care patients, members of the pub-lic and medical staff.

Program melds art and medicine

Electronic records:Small steps, butmoving forward

Peters Aabo

COMP-Northwest students promote global health awareness

Student club focuseson global community

MARY VANDENEND

Age: Old enough (to be atThe Arts Center for 13 years)

Occupation: ArtsCare coor-dinator

Why she’s an innovator:Van Denend brings arts topeople in medical settings.

Why she’s innovating here:“It is satisfying and unique tobe able to do this program in asmall hospital and make sucha big impact,”Van Denendsaid.

DENNIS REGAN,M.D.Age: 55.Occupa-

tion: Medicaldirector, TheCorvallisClinic.

Why he’san innova-tor: Beforetaking hisnew job atThe Corvallis Clinic, Reganspent 20 years at The BillingsClinic in Montana, where hehelped lead the clinic’s trans-formation to electronic med-ical records.

Why he’s innovating here:“There’s just a lot of visionary,farsighted folks here whowant to see things change.”And his job at the clinic giveshim the opportunity to evan-gelize for electronic medicalrecords.

Regan

BYJENNIFER ROUSE

It used to be one of themost common aspects ofgoing to the doctor’s office– when you walked out thedoor, chances are you held alittle slip of paper in yourhand with mysterious nota-tions scribbled upon it andthe all-important physi-cian’s signature scrawled atthe bottom.

But with the rise of e-prescribing in the last fiveyears, handwritten pre-scriptions have all but dis-appeared—and that’s a goodthing, say both doctors andpharmacists.

“E-prescribing is saferthan scribbling illegibly,” saidRod Aust, chief operationsofficer of The Corvallis Clin-ic. “There have been docu-mented cases of errors causedby misread prescriptions.This all but eliminates that.”

Here’s how it works:when your doctor sees you,she uses a computer to se-lect the right medicationand dosing information,then asks you where you’dlike to pick up your pre-scription. That informationis sent through an e-pre-scribing network — Sure-Scripts is one commonlyused by doctors in the mid-valley. If you’ve been a pa-tient before and your insur-ance and prescription his-tory is on file with your doc-tor or pharmacy, the net-work will automaticallycheck your prescriptionbenefits and send up analert if there are any poten-tial interactions with med-ications you’re already tak-ing. The prescription showsup in the pharmacy’s inbox,just like an email, and staffcan begin working on fillingit immediately.

T.J. Sinn, lead pharma-cist at Elm Street Pharmacy,a Samaritan Health phar-macy in Albany, said the riseof e-prescriptions has re-duced the amount of his dayspent on the phone withclinics, double-checking onprescriptions he was unsureabout.

“Now you just have nice,clear, e-mailed prescrip-tions,” he said. “It’s a lotcleaner, and there’s a lot lesschance of error.”

In fact, Dr. Brian Curtis,an internal medicine doctorwith The Corvallis Clinic,pointed out that for mostdoctors, 100 percent of theirprescriptions are now writ-ten electronically. Prescrip-tions for controlled sub-stances are still required tohave a physical signature.And sometimes a patientmay not be sure whichpharmacy they want to takeit to, and will request aprinted prescription. Buteven in those situations, themedication information isstill typed on the computer,then printed out.

“We don’t write on a pad,

ever,” Curtis said.Aust said that while The

Corvallis Clinic still hassupplies of prescriptionpads in case of a major com-puter crash or power outage,doctor’s offices have gener-ators and back-up systemsin place. In the four yearssince the clinic has switchedto e-prescribing, it’s neverhad to return to hand-writ-ing prescriptions, he said.

Period of adjustmentIt’s been an adjustment

for some doctors and pa-tients alike.

“The biggest thing wasgetting physicians to trustthat when they push thebutton, it will go,” Aust said.“There’s a comfort levelwith having that prescrip-tion pad in the pocket. Andfor patients, it can be weirdto leave without somethingin their hand.”

But for the most part, theswitch has been widely ac-cepted. Sinn said that themajority of prescriptionspharmacies receive are nowelectronic, and Curtis saidmost of his patients love it.

The biggest trick fordoctors, he said, is to bal-ance personal contact with

their patients while simul-taneously entering infor-mation into their comput-ers.

“You want to keep thateye contact. You have to becareful you’re not looking atthe screen the whole time,”he said. “For the most part,it’s been a very positivething.”

Sinn said that the onlyproblem for pharmacists isthat physicians and patientsare sometimes, in fact, tooenthusiastic about thepowers of the system. Pa-tients sometimes expectthat their medication will beready for them when theyget to the pharmacy, andthat’s not always the case.

Sinn said that dependingon traffic on the e-prescrib-ing network, it could take15-30 minutes from thetime your doctor hits“send” before the prescrip-tion shows up in the phar-macy’s inbox. Then there’sthe time required to dis-pense and label the drugs.

“It’s fast, but it’s not im-mediate,” he said. “We try totrain both the doctors andthe patients to understandthat it’s not an instantthing.”

Behind the scenesMany of the advantages

to using electronic pre-scriptions are behind-the-scenes ones that patientsdon’t directly see — theprocess has improvedrecord security and patientprivacy, Aust said, becausethere are no longer reams ofpaper charts to track. Now,any time someone logs in tocheck patient information,it leaves a digital finger-print. It’s easy to see whohas been accessing data,and prevents unauthorizedaccess, he said.

It’s also easier for doctorsto track certain aspects ofpatient care over time, or tomanage groups of patients.

“If there’s a recommen-dation that diabetic patientsshould be using a certainmedication, I can do a searchand see which of my patientsare on it,” Curtis said. “Ifsome are not, we can correctthat more easily.”

Another way that the riseof e-prescribing hasstreamlined the process ofreceiving drugs is happen-ing at local emergencyrooms, where one prescrip-tion vending machine is al-ready in use and others are

on their way.The InstyMed machines,

as they are called, are avail-able for certain common an-tibiotics and painkillers.They are not meant to re-place human pharmacists,but simply to fill in the gapsduring the hours when regu-lar pharmacies are not open.If you visit the emergencyroom late at night, the In-styMed machine allows youto get started on your med-ication that night instead ofwaiting until morning.

“This helps patientscomplete their ER experi-ence,” said Penny Reher,chief pharmacy officer forSamaritan Health Services.

Prescriptions can only beordered by an ER doctor,and patients receive theirdrugs with a nurse assistingthem. Currently, the GoodSamaritan Regional MedicalCenter is the only mid-val-ley location with the pre-scription vending machine,but the plan is to implementthem at all Samaritan emer-gency rooms by the end ofthe year, Reher said.

Jennifer Rouse is a freelancewriter who lives in Albany anda frequent contributor toMid-Valley Media.

Innovation in Health CareJune 2012Mid-Valley Newspapers6

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SAMARITAN HEALTH MAR

DAVID PATTON

Pharmacist TJ Sinn works on the electronic prescription system recently at Elm Street Pharmacy in Albany.

Embracing e-prescriptions

AT A GLANCE• In 2001, the first e-pre-

scribing networks were found-ed.

• By 2004, 4 percent of U.S.doctors used e-prescribing.

• By 2007, e-prescribingwas legal in all 50 states andthe District of Columbia.

• By 2009, the stimulus actpassed by Congress provided$19 billion toward the adop-tion of health informationtechnology such as e-pre-scribing.

• By 2011, 58 percent of of-fice-based physicians were e-prescribing.

• The number of e-pre-scribers in Oregon is 6,063.

• As of 2010, 91 percent ofOregon pharmacies used e-prescribing. Oregon pharma-cies are near the limit of thenumber that are likely toadopt e-prescribing, due tothe specialized nature of theremaining holdouts; com-pounding pharmacies andveterinary pharmacies, for ex-ample.

• In 2008: 693,112 Oregonprescriptions were routedelectronically.

• By 2010: 4,266,385 Ore-gon prescriptions were routedelectronically.

Sources: Oregon HealthAuthority report, SureScriptsNational Progress Report on

e-prescribing.