MD News

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2012:Looking Back,Moving Forward

Richmond/TRi-ciTies

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Lynchburg, VAPermit No. 425

| November/December 2012 |

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ContentsNOv/Dec 2012

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

12

8PAGE

on the cover


FEATURES2012: Looking Back, Moving Forward 8Pulled in all directions by a battle of many wills, the U.S. health care system has charted an uneven course over the past decade. The coming year promises further transformation as government officials and the health care community at large face a number of looming questions revolving around electronic health records, Affordable Insurance Exchanges, accountable care organizations and more. Read on as we take a look at recent developments in U.S. health care and examine the challenges it will face in the near future.

EMErging ownErship ModELs For physician practicEs 12As physician ownership of medical practices continues a steady decline that began more than 20 years ago, recent trends find independent practices becoming increasingly less profitable. With a number of factors continuing to push doctors away from solo practice, some experts predict the demise of the business model over the coming decade. In this feature, we explore the reasons behind evolving changes in ownership structure and examine alternatives to independent ownership.

DEPARTMENTSthat’s nEws 5Bariatrics 6cME activitiEs 7MEdicaL EquipMEnt and suppLiEs 10hospitaL rounds 14

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ello, and welcome to the September/October issue of MD News Richmond/Tri-Cities.

In our cover story, we examine the decades-in-development trend away from solo ownership of medical practices. While physician-owned practices are becoming less profitable and their numbers continue to decrease, some experts anticipate they’ll disappear altogether over the next five to 10 years. We explore the factors driving the trend — from accountable care organizations (ACOs) to medical record and patient management technology — and take a look at alterna-tive business models and strategies for success.

In another feature, we look back at the most impactful U.S. health care developments seen in recent years and contemplate the challenges leaders and lawmakers will face in the near future. While the past few years have brought dramatic shifts in health care, including the pas-sage of the Patient Protection and Affordable Care Act and swift movement toward the adoption of electronic health records (EHRs), the coming year promises still more transition. Over the next 12 months, decisions made regarding the implementation of EHRs, Affordable Insurance Exchanges and ACOs — just to name a few — will affect every American’s health care future.

As the landscape of the American health system rap-idly changes, so, too, are the operations and technologies that guide the practice of medicine. In this and all issues of MD News, we strive to provide content pertaining to these and other matters that impact you most. Feel free to contact me to learn how you can contribute to the conversation.

Thanks for reading,

Paul Darden

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4 | Richmond/Tri-Cities MD News n MdnEws.coM

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in JuLy 2012, the U.S. Food and

Drug Administration announced the

approval of the first over-the-counter

test kit for human immunodeficiency

virus (HIV). Developed by OraSure

Technologies and presented as a

screening option for people who

otherwise would not be tested, the

OraQuick In-Home HIV test allows

people to test for both HIV type 1

and HIV type 2 in the comfort of

their homes.

Using an oral swab, users take a

sample of skin cells from the inside of

their mouths, then place it in a special

vial containing a developing solution.

Within 20 to 40 minutes, they obtain

results indicating the presence (or

lack) of antibodies to HIV. Because

the test can produce false positive

results, the FDA strongly urges

consumers to follow up with a health

care provider. In addition, people

who have had the virus for fewer than

three months — or, in some cases,

longer periods of time — may not

exhibit the antibodies that would yield

a positive result, making follow-up

care paramount. n

a nEw cLass of drugs that reduce

inflammation in the brain could eventually

become a treatment option for chronic

conditions such as Alzheimer’s disease,

Parkinson’s disease and multiple sclerosis,

and speed healing for patients with

traumatic brain injuries.

Under development at Northwestern

University Feinberg School of Medicine,

FDA APProves hiv home TesT KiT

New Medication Promising for Alzheimer’s, Parkinson’s and Multiple Sclerosis

this class of medication would aim to pre-

vent the formation of beta amyloid plaques

in the brain, which are thought to lead to

Alzheimer’s disease. The drugs suppress

brain inflammation and keep the brain

from overproducing cytokine molecules.

Currently known as MW151 and MW189, the

drugs have already been put through the

first phase 1 clinical trial stage.

In a study conducted by Northwestern’s

Feinberg School and the University of

Kentucky, mice that were given MW151

experienced a delay in the progression of

Alzheimer’s disease. n

+++++++++++++++++++++++++++++++++++++++++++++++++++ +++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++ ++++++++++++++++++++++++++++++ +++++++++++++++++++++++++++++++++++++++++++++++++++ +++++++++++++++++++++++++++++++++++++++++++++++++++

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MdnEws.coM n MD News Richmond/Tri-Cities | 5

TWO NEW MEDICATIONS APPROVED FOR WEIGHT LOSS BY THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) GIVE PHYSICIANS MORE OPTIONS FOR TREATING OBESE PATIENTS BUT REINFORCE THE NEED FOR ONGOING PATIENT EDUCATION AND A TEAM APPROACH FOR LONG-TERM SUCCESS.

Rx

oBEsity is an epidemic in the United States, affect-ing more than one-third of the adult population. Two new drugs, Belviq (lorcaserin hydrochloride) and Qsymia (phentermine and topiramate), were

approved this past summer for chronic weight management when used as adjuvant therapy to a regimen that includes exercise and a reduced-calorie diet. The approvals marked the FDA’s fi rst for anti-obesity medications in more than a decade.

These new medications will join phentermine, recommended for short-term use, and orlistat — available over the counter as alli or in a prescription as Xenical — but they work differently. Belviq is a fi rst-in-class medication that binds to serotonin receptor 5HT2C to help patients feel full after consuming smaller portions of food. Qsymia, a combination of two already approved drugs — phentermine, an appetite suppressant, and topiramate, an anti-seizure medication — targets brain pathways to curb overeating.

defi nition of EffectivenessAccording to Quang Nguyen, D.O., FACP, FACE, endocri-

nologist at Carson Tahoe Physician Clinics in Carson City, NV, medication is deemed an effective weight loss agent by the FDA if, after one year of treatment, either:

+ The difference in mean weight loss for subjects using the active product compared with those using the placebo is at least 5%.

+ The proportion of subjects who lose a minimum of 5% of baseline body weight in an active product group is at least 35% and is at least double the proportion in the placebo group.

Measures of successThree randomized, placebo-controlled trials were used to

evaluate Belviq’s effectiveness. Nearly 8,000 overweight and obese patients — some with and some without type 2 diabetes — were treated for one to two years with a regimen including exercise counseling and a reduced-calorie diet.

Nearly half (47%) of patients without type 2 diabetes in the active group lost at least 5% of their body weight, compared with about 23% of those taking a placebo. Treatment with Belviq for up to one year resulted in an average weight loss of 3% to 3.7% of original body weight.

Belviq can disrupt memory and attention and should not be used during pregnancy. Patients who have not lost at least 5% of their body weight after 12 weeks of treatment should discontinue use.

Qsymia was evaluated during two one-year, placebo-controlled, randomized trials open to obese and overweight individuals without signifi cant weight-related conditions. Participants also fol-lowed a reduced-calorie diet and participated in regular exercise.

In this group, weight loss at one year showed patients taking the recommended and the highest dose had an average weight loss of 6.7% and 8.9%, respectively. More than half of patients (62% and 69%) in the active group lost at least 5% of body weight, compared with 20% of those taking a placebo. n

+++++++++++++++++++ ++++ +++++++++++++++++++++

BARiATRiCS

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Br E a s t c a n c E r c a n be a devastating diagnosis for many women, and the thought of being permanently disfigured

after a mastectomy only compounds that devastation. In the July issue of Plastic and Reconstructive Surgery: The Journal of the American Society of Plastic Surgeons, physi-cians with San Antonio, TX-based PRMA Plastic Surgery take on the controversial topic of breast reconstruction in obese women and say their research indicates that DIEP (deep inferior epigastric perforator) flap breast reconstruction is safe in obese populations and, in fact, may be the recommended method of abdomen-based breast reconstruction in patients with a body mass index (BMI) of less than 40.

Historically, women with a high BMI were discouraged from having breast reconstruction because of the prospective risk of complications. A higher BMI was associated with poor outcomes in breast reconstruction using traditional techniques.

PR M A s u rge on s conduc te d a retrospective analysis of 639 DIEP f laps in 418 patients, concluding that, “Increasing body mass index predisposes patients to delayed wound healing complications in both flap and donor-site locations, but given a similar flap complication profile and main-tenance of abdominal stability, DIEP f laps are recommended in patients with increased body mass index.”

Surgeons with PRMA have con-ducted more than 4,000 of these reconstruction surgeries, and this research confirms that the DIEP flap method of reconstruction in obese populations should be considered an option.

“The DIEP f lap, which is today’s gold standard in breast reconstruction, is one of the safer reconstructive procedures in patients with a BMI as high as 40,” says PRMA surgeon Minas Chrysopoulo, M.D.

He adds that, while complications can occur with any surgery, obese

Groundbreaking new research Says Breast reconstruction Surgery After Mastectomy May Be an option for obese Women

oncology News:

women may still be able to have breast reconstruction surgery and should consult a plastic surgeon specializing in advanced breast reconstruction tech-niques like the DIEP flap.

To learn more about the DIEP method and receive CME credit, please visit http://cme.dannemiller.com/mdnews/oct. This continuing education activity offers an interview with Dr. Chrysopoulo about the journal ar t icle “Abdominal Wall Stability and Flap Complications after Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Does Body Mass Index Make a Difference?”

This continuing medical education activity is brought to you by Dannemiller. For more than 28 years, Dannemiller has been an independent provider accredited by the Accreditation Council for Continuing Medical Education and holds the highest level of accreditation. Dannemiller provides accredited education online, in printed pub-lications and via live courses. Dannemiller is proud to present accredited education in partnership with MD News. n

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MdnEws.coM n MD News Richmond/Tri-Cities | 7

Ehrs and the Mystery of Meaningful useAs 2012 winds down, one of the biggest question marks hanging over the heads of

hospital CEOs involves the use of electronic health records (EHRs). Since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, health systems and practice groups have been vying for a piece of the $17.2 billion pie. Unfortunately, meaningful use stipulations seem to inherently favor large health systems with a lot of capital, as successful EHR implementation requires a hefty fi nancial investment up front. In addition to purchasing an EHR product and hiring outside consultants to explain the complex meaningful use clauses, hospitals must also invest the time to train physicians and staff members. They also need to unify and consolidate any disparate electronic fi ling systems. Financial penalties for failing to achieve meaningful use will be doled out starting in 2014. Hospitals and physician groups that haven’t yet started the process are quickly running out of time.

the Future of affordable coverageLooking forward, 2013 is shaping up to be a big year for new ideas. One of the most

promising of them involves the Affordable Insurance Exchange (AIE). The Center for Consumer Information and Insurance Oversight (CCIIO), a subset of the Centers for Medicare & Medicaid Services, has proposed the AIE as a way to promote a competitive private health insurance market. While specifi cs around AIEs are still forming, the general objective is to create a one-stop shop where small businesses — including physician practices — can compare insurance rates and enjoy the same purchasing power as a large entity. As the CCIIO notes, the provision of the PPACA prohibiting discrimination against people with pre-existing conditions will force the hand of insurance companies holding out on competitive prices. According to the Congressional Budget Offi ce, these state-based exchanges will reduce average premiums by as much as 10%. AIEs are due to be up and running by 2014.

The future of the country’s health care system may depend largely on executive branch activity in the coming year. Over the next 12 months, the major questions facing the Department of Health and Human Services and the health care community at large will be:

+ How will EHR implementation affect smaller entities?

+ Will initiatives such as AIEs be able to tackle the challenge of affordable health care coverage?

+ Will accountable care organizations be able to overturn the broken health maintenance organization system?

+ Will wide-scale initiatives to incentivize preventive care work?

W hat are your answers to these quest ions? Join the conversat ion at www.mdnews.com. n

A BattLE oF Many wills has been pulling the U.S. health care system in every direction. With the arrival of the Obama administration in 2008 and the passing of the Patient Protection and Affordable Care Act (PPACA) in 2010, the gears of the health care machine fi nally seemed to be moving. But an uncertain economy

continues to undermine progress, and voters have become increasingly jaded about the likelihood of a permanent health care solution being reached.

turning the Elusive cornerIn a 5-to-4 ruling this past June, the U.S. Supreme Court voted to uphold the

individual mandate requiring Americans to buy health insurance or pay a “penalty,” a central component of the PPACA. Other mandates of the act will continue to be upheld, such as:+ People younger than 26 can still be covered by their parents’ health insurance plans.

+The government will continue to back Medicare.

+ Insurance companies can’t deny anyone coverage because of a pre-existing condition.

While these provisions are designed to ensure every U.S. citizen has health insurance, the jury is still out on their effectiveness.

As a case in point, 50 million Americans are without health insurance. Pundits from both sides offer

differing explanations. Some say the PPACA is inherently flawed, while others argue the

lack of results comes down to delays in the implementation of the PPACA. With politi-cal standoffs slowing progress, the light at the end of the health care reform tunnel still looks dim.

HEALTH CARE IN AMERICA HAS

CHARTED AN UNEVEN COURSE DURING THE

LAST DECADE. AS 2013 LOOMS LARGE ON THE

HORIZON, LEADERS AND LAWMAKERS

ARE STRUGGLING TO BRING HEALTH CARE

DELIVERY UP TO PAR.


THE NEW ERA OF MODERN MEDICINEwhiLE hEaLth carE reform slowly comes to frui-tion, medical breakthroughs continue to advance at breakneck speeds. Here are a few highlights:

ROBOTIC SURGERYSince its debut in 1999, the da Vinci Surgical

System has raised the bar for nearly every

type of surgery. Recently, robotic technology

has been applied to spinal surgery through use

of the Mazor Renaissance guidance system,

which signifi cantly reduces the incidence of

permanent nerve damage.

Supplementary advances are also increas-

ing the noninvasiveness of robotic surgery.

Firefl y, a fl uorescent imaging dye, is now being

used to help robotic surgeons remove kidney

tumors with enhanced accuracy. Seen through

a fl uoroscopic camera, the dye helps surgeons

differentiate between healthy and cancerous

tissue, making it possible to spare more

healthy tissue and reduce surgical trauma.

LAPAROSCOPIC SURGERYThe push for minimally invasive surgery has

led to the recent development of single-port

laparoscopic surgery (SPlS). SPlS utilizes one

incision in the abdomen to access the procedural

area, thus minimizing scarring and postsurgical

pain. The single-port approach has been utilized

for a wide range of procedures, among them

bariatric surgery, appendectomy, colectomy,

hysterectomy and hernia repair.

TRANSCATHETER AORTIC VALVE REPLACEMENT

Heart disease remains the No. 1 cause of death

in the United States. As the nation’s elderly

population continues to grow, the need for

minimally invasive cardiac device implantation

is ever-present. Some of the fi rst successful

attempts at transcatheter aortic valve replace-

ment (TAVR), a minimally invasive procedure

to implant a new device called a transcatheter

heart valve, were seen in 2012. TAVR allows

surgeons to implant the valve without having

to cut through the chest wall or perform a

cardiopulmonary bypass.

Cover Feature

REVIEW ONLY


Ehrs and the Mystery of Meaningful useAs 2012 winds down, one of the biggest question marks hanging over the heads of

hospital CEOs involves the use of electronic health records (EHRs). Since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, health systems and practice groups have been vying for a piece of the $17.2 billion pie. Unfortunately, meaningful use stipulations seem to inherently favor large health systems with a lot of capital, as successful EHR implementation requires a hefty fi nancial investment up front. In addition to purchasing an EHR product and hiring outside consultants to explain the complex meaningful use clauses, hospitals must also invest the time to train physicians and staff members. They also need to unify and consolidate any disparate electronic fi ling systems. Financial penalties for failing to achieve meaningful use will be doled out starting in 2014. Hospitals and physician groups that haven’t yet started the process are quickly running out of time.

the Future of affordable coverageLooking forward, 2013 is shaping up to be a big year for new ideas. One of the most

promising of them involves the Affordable Insurance Exchange (AIE). The Center for Consumer Information and Insurance Oversight (CCIIO), a subset of the Centers for Medicare & Medicaid Services, has proposed the AIE as a way to promote a competitive private health insurance market. While specifi cs around AIEs are still forming, the general objective is to create a one-stop shop where small businesses — including physician practices — can compare insurance rates and enjoy the same purchasing power as a large entity. As the CCIIO notes, the provision of the PPACA prohibiting discrimination against people with pre-existing conditions will force the hand of insurance companies holding out on competitive prices. According to the Congressional Budget Offi ce, these state-based exchanges will reduce average premiums by as much as 10%. AIEs are due to be up and running by 2014.

The future of the country’s health care system may depend largely on executive branch activity in the coming year. Over the next 12 months, the major questions facing the Department of Health and Human Services and the health care community at large will be:

+ How will EHR implementation affect smaller entities?

+ Will initiatives such as AIEs be able to tackle the challenge of affordable health care coverage?

+ Will accountable care organizations be able to overturn the broken health maintenance organization system?

+ Will wide-scale initiatives to incentivize preventive care work?

W hat are your answers to these quest ions? Join the conversat ion at www.mdnews.com. n

A BattLE oF Many wills has been pulling the U.S. health care system in every direction. With the arrival of the Obama administration in 2008 and the passing of the Patient Protection and Affordable Care Act (PPACA) in 2010, the gears of the health care machine fi nally seemed to be moving. But an uncertain economy

continues to undermine progress, and voters have become increasingly jaded about the likelihood of a permanent health care solution being reached.

turning the Elusive cornerIn a 5-to-4 ruling this past June, the U.S. Supreme Court voted to uphold the

individual mandate requiring Americans to buy health insurance or pay a “penalty,” a central component of the PPACA. Other mandates of the act will continue to be upheld, such as:+ People younger than 26 can still be covered by their parents’ health insurance plans.

+The government will continue to back Medicare.

+ Insurance companies can’t deny anyone coverage because of a pre-existing condition.

While these provisions are designed to ensure every U.S. citizen has health insurance, the jury is still out on their effectiveness.

As a case in point, 50 million Americans are without health insurance. Pundits from both sides offer

differing explanations. Some say the PPACA is inherently flawed, while others argue the

lack of results comes down to delays in the implementation of the PPACA. With politi-cal standoffs slowing progress, the light at the end of the health care reform tunnel still looks dim.

HEALTH CARE IN AMERICA HAS

CHARTED AN UNEVEN COURSE DURING THE

LAST DECADE. AS 2013 LOOMS LARGE ON THE

HORIZON, LEADERS AND LAWMAKERS

ARE STRUGGLING TO BRING HEALTH CARE

DELIVERY UP TO PAR.


THE NEW ERA OF MODERN MEDICINEwhiLE hEaLth carE reform slowly comes to frui-tion, medical breakthroughs continue to advance at breakneck speeds. Here are a few highlights:

ROBOTIC SURGERYSince its debut in 1999, the da Vinci Surgical

System has raised the bar for nearly every

type of surgery. Recently, robotic technology

has been applied to spinal surgery through use

of the Mazor Renaissance guidance system,

which signifi cantly reduces the incidence of

permanent nerve damage.

Supplementary advances are also increas-

ing the noninvasiveness of robotic surgery.

Firefl y, a fl uorescent imaging dye, is now being

used to help robotic surgeons remove kidney

tumors with enhanced accuracy. Seen through

a fl uoroscopic camera, the dye helps surgeons

differentiate between healthy and cancerous

tissue, making it possible to spare more

healthy tissue and reduce surgical trauma.

LAPAROSCOPIC SURGERYThe push for minimally invasive surgery has

led to the recent development of single-port

laparoscopic surgery (SPlS). SPlS utilizes one

incision in the abdomen to access the procedural

area, thus minimizing scarring and postsurgical

pain. The single-port approach has been utilized

for a wide range of procedures, among them

bariatric surgery, appendectomy, colectomy,

hysterectomy and hernia repair.

TRANSCATHETER AORTIC VALVE REPLACEMENT

Heart disease remains the No. 1 cause of death

in the United States. As the nation’s elderly

population continues to grow, the need for

minimally invasive cardiac device implantation

is ever-present. Some of the fi rst successful

attempts at transcatheter aortic valve replace-

ment (TAVR), a minimally invasive procedure

to implant a new device called a transcatheter

heart valve, were seen in 2012. TAVR allows

surgeons to implant the valve without having

to cut through the chest wall or perform a

cardiopulmonary bypass.

REVIEW ONLY


For thE past four years, The Scientist: Magazine of the Life Sciences has published a list of the Top 10 Innovations in the life sciences fi eld that will have a major impact on our lives in the future. Read on for my brief summary

of and thoughts on the list of 2011’s top innovations, as chosen by the magazine’s panel of judges from more than 65 entries.

MicroscopE on thE MovE: The name’s self-explanatory, but it’s not just a shrunken version of the microscopes high school students use in biology class. This holographic instrument, developed by an electrical engineer at the University of California, Los Angeles, can be attached to a cellphone’s camera. The images can then be transmitted and re-created using an algorithm on a distant computer. The microscope, called LUCAS for “Lensless, Ultra-wide-fi eld Cell monitoring Array platform based on Shadow imaging,” weighs less than 50 grams. Since cellphone networks exist throughout the world, LUCAS can be carried into remote villages in the developing world, where it can help identify diseases in people with no access to hospitals.

in vivo opticaL iMaging: In vivo is Latin for “in the living,” and Bioscan’s BioFLECT device will, for the fi rst time, give

researchers a 360-degree look inside lab animals. The device reconstructs light emissions and provides an accurate optical look inside living tissue.

pcr siMpLiFiEd: PCR is the short form of “polymerase chain reaction,” the process used to develop enough DNA to be adequately tested. Among other things, the process is used in detecting disease-causing pathogens in humans. The FilmArray system, developed by Idaho Technology Inc., makes the pathogen identifi cation process so simple that virtually anyone can do it. Insert DNA from a nasal swab, for instance, in the FilmArray pouch, then insert the pouch into the machine. Before you know it, pathogens are identifi ed at half the price of traditional methods.

ZEroing in: Cytometry refers to the measurement of the physical characteristics of cells, and a mass spectrometer is a device that measures the masses of atoms and molecules. DVS Sciences has now developed CyTOF, a mass spectrometer that can zero in on molecules within and on the surface of cells. The exciting development will facilitate research that could lead to creation of “boutique” drugs to treat rare diseases.

Mighty MicroscopE: Optical microscopes have been around for more than four centuries, but the N-SIM Super Resolution Microscope marks an evolutionary leap in their development. The instrument, developed by Nikon, incorporates a technique fi rst developed more than a decade ago. It uses light from differ-ent angles and a computer algorithm that produces images with double the resolution available from standard microscopes. If you are an amateur biologist, however, you might think twice about buying one. Cost of the complete system is $600,000.

dna sEquEncing systEM: RainDance Technologies’ next-generation ThunderStorm System pushes DNA sequencing to the next level. DNA informs cells what proteins to produce, and these proteins dictate their function. DNA sequencing has opened up enormous possibilities for targeted therapies to treat illnesses. The system is fully automated and has enormous processing capabilities, making it ideal for large-scale scientifi c studies.

Mri MiniaturiZEd: Magnetic resonance imaging (MRI) machines have always been big and hugely expensive — until now. Aspect Imaging has developed a portable, mini MRI that can fi t on a tabletop. The $500,000 price tag for the M2 Compact MRI System doesn’t make it cheap, but the cost is a fraction of that for a full-size MRI system. The device is ideal for research centers working with lab animals. The machine doesn’t require shielding, so researchers don’t have to worry about it erasing information on their credit cards.

shEdding Light on circadian rhythMs: You can wear it as a pendant, attach it to your shirt or wear it like a tiny timepiece — although it won’t carry quite the cachet of a Cartier. Function, not form, is what’s important with the Dimesimeter. The instrument, about the size of a U.S. dime, is designed to measure the wearer’s activity and exposure to light. The information collected is transferred wirelessly to a computer

so the numbers can be analyzed. Developed by the Lighting Research Center at Rensselaer Polytechnic Institute, the device is giving researchers insight into the physiological impacts of light and how it affects circadian rhythm. This could prove to be very important in treating diseases.

singLE-stEp saMpLE prEp: Preparing research samples for mass spectrometry can take several days, but with Protea Biosciences’ LAESI (Laser Ablation Electrospray Ionization) system, the time frame can be cut to a matter of hours. Basically, a laser creates a mini explosion that vaporizes any samples containing water. The machine then converts the gaseous particles into a form that can be analyzed by a mass spectrometer. The effi ciency of the device should free up a lot of time and substantially improve researchers’ effi ciency.

supEr-rEsoLution Microscopy: Overlapping light waves limit standard fl uorescent microscopes, preventing them from resolving objects less than 200 nanometers (billionths of a meter) apart. Leica’s SR GSD Microscopy System solves this problem by illuminating and photographing just a few molecules at a time, but doing so thousands of times until a complete image is assembled. The Hubble Space Telescope has enabled us to peer farther and farther into space. Advances in microscopy are enabling us to look deeper and deeper into the microcosm.

The Scientist’s list of Top 10 Innovations isn’t science fi ction — it’s science fact. Technology is expanding exponentially, and it’s enabling us to expand our knowledge of the life sciences at the same pace. This bodes well for a better future.

Vito Di Bari is an acclaimed futurist, author and authority on innovation. He was chosen to be the Innovation Designer for the upcoming 2015 Universal EXPO to be held in Milan. He is recognized worldwide for his numerous innovative theories and multitude of published works. n

By Vito Di Bari

Top recent innovations in Life Sciences

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For thE past four years, The Scientist: Magazine of the Life Sciences has published a list of the Top 10 Innovations in the life sciences fi eld that will have a major impact on our lives in the future. Read on for my brief summary

of and thoughts on the list of 2011’s top innovations, as chosen by the magazine’s panel of judges from more than 65 entries.

MicroscopE on thE MovE: The name’s self-explanatory, but it’s not just a shrunken version of the microscopes high school students use in biology class. This holographic instrument, developed by an electrical engineer at the University of California, Los Angeles, can be attached to a cellphone’s camera. The images can then be transmitted and re-created using an algorithm on a distant computer. The microscope, called LUCAS for “Lensless, Ultra-wide-fi eld Cell monitoring Array platform based on Shadow imaging,” weighs less than 50 grams. Since cellphone networks exist throughout the world, LUCAS can be carried into remote villages in the developing world, where it can help identify diseases in people with no access to hospitals.

in vivo opticaL iMaging: In vivo is Latin for “in the living,” and Bioscan’s BioFLECT device will, for the fi rst time, give

researchers a 360-degree look inside lab animals. The device reconstructs light emissions and provides an accurate optical look inside living tissue.

pcr siMpLiFiEd: PCR is the short form of “polymerase chain reaction,” the process used to develop enough DNA to be adequately tested. Among other things, the process is used in detecting disease-causing pathogens in humans. The FilmArray system, developed by Idaho Technology Inc., makes the pathogen identifi cation process so simple that virtually anyone can do it. Insert DNA from a nasal swab, for instance, in the FilmArray pouch, then insert the pouch into the machine. Before you know it, pathogens are identifi ed at half the price of traditional methods.

ZEroing in: Cytometry refers to the measurement of the physical characteristics of cells, and a mass spectrometer is a device that measures the masses of atoms and molecules. DVS Sciences has now developed CyTOF, a mass spectrometer that can zero in on molecules within and on the surface of cells. The exciting development will facilitate research that could lead to creation of “boutique” drugs to treat rare diseases.

Mighty MicroscopE: Optical microscopes have been around for more than four centuries, but the N-SIM Super Resolution Microscope marks an evolutionary leap in their development. The instrument, developed by Nikon, incorporates a technique fi rst developed more than a decade ago. It uses light from differ-ent angles and a computer algorithm that produces images with double the resolution available from standard microscopes. If you are an amateur biologist, however, you might think twice about buying one. Cost of the complete system is $600,000.

dna sEquEncing systEM: RainDance Technologies’ next-generation ThunderStorm System pushes DNA sequencing to the next level. DNA informs cells what proteins to produce, and these proteins dictate their function. DNA sequencing has opened up enormous possibilities for targeted therapies to treat illnesses. The system is fully automated and has enormous processing capabilities, making it ideal for large-scale scientifi c studies.

Mri MiniaturiZEd: Magnetic resonance imaging (MRI) machines have always been big and hugely expensive — until now. Aspect Imaging has developed a portable, mini MRI that can fi t on a tabletop. The $500,000 price tag for the M2 Compact MRI System doesn’t make it cheap, but the cost is a fraction of that for a full-size MRI system. The device is ideal for research centers working with lab animals. The machine doesn’t require shielding, so researchers don’t have to worry about it erasing information on their credit cards.

shEdding Light on circadian rhythMs: You can wear it as a pendant, attach it to your shirt or wear it like a tiny timepiece — although it won’t carry quite the cachet of a Cartier. Function, not form, is what’s important with the Dimesimeter. The instrument, about the size of a U.S. dime, is designed to measure the wearer’s activity and exposure to light. The information collected is transferred wirelessly to a computer

so the numbers can be analyzed. Developed by the Lighting Research Center at Rensselaer Polytechnic Institute, the device is giving researchers insight into the physiological impacts of light and how it affects circadian rhythm. This could prove to be very important in treating diseases.

singLE-stEp saMpLE prEp: Preparing research samples for mass spectrometry can take several days, but with Protea Biosciences’ LAESI (Laser Ablation Electrospray Ionization) system, the time frame can be cut to a matter of hours. Basically, a laser creates a mini explosion that vaporizes any samples containing water. The machine then converts the gaseous particles into a form that can be analyzed by a mass spectrometer. The effi ciency of the device should free up a lot of time and substantially improve researchers’ effi ciency.

supEr-rEsoLution Microscopy: Overlapping light waves limit standard fl uorescent microscopes, preventing them from resolving objects less than 200 nanometers (billionths of a meter) apart. Leica’s SR GSD Microscopy System solves this problem by illuminating and photographing just a few molecules at a time, but doing so thousands of times until a complete image is assembled. The Hubble Space Telescope has enabled us to peer farther and farther into space. Advances in microscopy are enabling us to look deeper and deeper into the microcosm.

The Scientist’s list of Top 10 Innovations isn’t science fi ction — it’s science fact. Technology is expanding exponentially, and it’s enabling us to expand our knowledge of the life sciences at the same pace. This bodes well for a better future.

Vito Di Bari is an acclaimed futurist, author and authority on innovation. He was chosen to be the Innovation Designer for the upcoming 2015 Universal EXPO to be held in Milan. He is recognized worldwide for his numerous innovative theories and multitude of published works. n

By Vito Di Bari

Top recent innovations in Life Sciences REVIEW ONLY


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BON SeCOURS ST. MARy’S HOSPITAl ANNOUNCeS PARTNeRSHIP WITH RONAlD MCDONAlD HOUSe CHARITIeSBon Secours St. Mary’s Hospital and Ronald

McDonald House Charities (RMHC) of

Richmond are teaming up to bring world-

class comfort to the families of pediatric

patients at Bon Secours St. Mary’s Hospital.

Ronald McDonald House Charities of

Richmond, which has supported families of

children receiving medical treatment away

from home for decades, has committed a gift

of $75,000 to build two dedicated sleep-

ing rooms and a respite lounge on the fifth

floor at St. Mary’s. The rooms will allow the

families of patients to take a moment away

to rest and recharge before returning to their

children’s bedsides.

In addition, St. Mary’s is one step closer

to breaking ground on a new guest house

for patients’ families, thanks to a gift of

$175,000 from the Ronald McDonald

House Charities of Richmond. This gift will

establish a pediatrics wing at the St. Mary’s

Guest House. Focusing on the comfort of

young patients’ families, the gift will allow

St. Mary’s to create three sleeping rooms

and a playroom.

“We are profoundly grateful to Ronald

McDonald House Charities for these

generous gifts,” says Toni R. Ardabell,

CeO of Bon Secours St. Mary’s Hospital.

“It is invaluable not only to have financial

support from Ronald McDonald House

Charities, but also their expertise in

providing a home away from home for

patient families.”

“RMHC is honored to be part of the heroic

efforts of Bon Secours’ pediatric health care

providers,” says Derek W.H. Kung, President

of the Board of the Ronald McDonald House

Charities of Richmond, VA, Inc. “We are

proud to be teaming up with an organization

and be part of a Richmond community that

feels so passionately about the health and

well-being of sick children and their families.”

In addition to the financial gifts, Ronald

McDonald House Charities of Richmond will

provide expertise and additional volun-

teers for Bon Secours’ efforts to provide

comfort and care to families of St. Mary’s

pediatric patients.

VCU MeDICAl CeNTeR CHOSeN FOR NATIONAl PROGRAM TO TeST HOUSe CAllSVCU Medical Center has been selected as

one of 19 sites nationwide to participate in

the Independence at Home Demonstration

to test the advantages of house calls for

elderly patients too ill or disabled to visit

their physicians.

Peter Boling, M.D., professor of medicine

and Chair of the Division of Geriatric Medicine

at VCU Medical Center, along with his team of

physicians, nurse practitioners, social workers

and support staff, are operating the three-

year initiative, which began in September,

in collaboration with the University of

Pennsylvania and MedStar Washington

Hospital Center.

The Centers for Medicare and Medicaid

Services approved the program, known

as the Mid-Atlantic Consortium for the

Independence at Home Demonstration,

based on a model tested and promoted

by VCU House Calls, a program that has

provided in-home primary care for more than

5,000 home-bound patients over the past

25 years.

Similar programs are operated by the

other two consortium partners.

“By going to these patients, you make it

much easier for them to have the care they

need when they need it, both for chronic

illnesses and newly developing problems,”

Dr. Boling says. “This program can help keep

our patients from needlessly riding in ambu-

lances and going to emergency rooms when

their conditions can safely be managed at

home, which could also keep patients out of

harm’s way and save the Medicare program

billions of dollars each year.”

JOHN RANDOlPH MeDICAl CeNTeR ReCOGNIzeD AS A TOP PeRFORMeR By THe JOINT COMMISSIONJohn Randolph Medical Center has been

selected as a Top Performer on Key Quality

Measures for 2011 by The Joint Commission

— one of the nation’s leading accreditors of

health care organizations. This marks the sec-

ond consecutive year John Randolph Medical

Center has received this designation.

The program recognizes hospitals that

achieve excellence in accountability measure

performance and is based on data reported

about evidence-based clinical processes

that are shown to be the best treatments

for certain conditions. eleven hospitals in

Virginia received The Joint Commission’s

Top Performer designation; however, John

Randolph Medical Center was the only acute

care hospital in the Richmond area selected

for achieving and sustaining excellence in ac-

countability measures for heart attack, heart

failure, pneumonia and surgical care.

“This recognition is a firm testament to our

commitment to quality and unwavering ef-

forts to provide top-notch patient care,” says

Dia Nichols, CeO of John Randolph Medical

Center. “everyone on the patient care team at

John Randolph Medical Center has contrib-

uted to this milestone, and I thank all of them

for striving to keep our standards high.”

The Top Performers list includes 620

hospitals representing the top 18% of

Joint Commission hospitals reporting core

measure performance data for 2011. The

Top Performers on Key Quality Measures

program supports and provides an incentive

for organizations to continually improve. The

program also provides an opportunity for

top-performing hospitals to celebrate their

achievement of excellence in accountability

measure performance. n

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Children’s Hospital of Richmond at VCU ......... Back CoverHospice of Virginia ................................... 5

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5 Reasons Your Hospital Will Fail.

1 Your marketing and strategy is uninformed or underinformed. The IBM Global Chief Marketing Officer Study found that 80% of CMOs plan

to use customer analytics more extensively over the next three to five years.

2 Your marketing is not targeted. Top-performing companies are three times more likely to be leading

users of analytics, according to a report from the IBM Institute for Business Value and MIT Sloan Management Review (MIT SMR).

3 You lack competitive advantage. MIT SMR reports that 58% of organizations now apply analytics to

create a competitive advantage within their markets or industries, up from 37% just one year ago.

4 You don’t understand your individual customers. An IBM study found that 88 percent of business executives — and an

astounding 95 percent of those heading the most successful organizations — feel that getting closer to their customers was the top priority for success.

5 You don’t measure decisions. Nearly two-thirds of CMOs think return on marketing investment will be

the primary measure of their effectiveness by 2015.

EMR...Meaningful Use…EHR…ICD-10…Accountable Care…HIPAA 5010…HCAHPS…Telemedicine...RFID…Health Data Exchange…PACS… Cloud Computing…Virtualization…

The volume of healthcare data is exploding — and understanding the data you create is imperative. If you’re not leveraging analytics to inform and measure strategy, it’s a formula for failure.

Take the first step toward success. Visit irmhealth.com.

© 2012 True North Custom Media | All rights reserved. True North Custom Media, True North Custom Media logo, IRM, Intelligent Relationship Marketing, IRM logo, and other trademarks, service marks, and designs are registered and unregistered trademarks of True North Custom Media and its subsidiaries in the United States and foreign countries.

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