maryland physician magazine may/june 2012 issue

CELEBRATING MARYLANDWOMEN IN MEDICINEFour InspirationalWomen Physicians

MEANINGFUL USE PHASE TWOIncrease Productivity withPatient Portals

THE REVOLUTION OFCHILDREN'S HOSPITAL CARE

CELEBRATING MARYLANDWOMEN IN MEDICINEFour InspirationalWomen Physicians

MEANINGFUL USE PHASE TWOIncrease Productivity withPatient Portals

THE REVOLUTION OFCHILDREN'S HOSPITAL CARE

VOLUME 2: ISSUE 1 MAY/JUNE 2012

PhysicianPhysician

www.mdphysicianmag.com

YOUR PRACTICE. YOUR LIFE.YOUR PRACTICE. YOUR LIFE.

MARYLAND

VOLUME 2: ISSUE 1 MAY/JUNE 2012

LOVE THE SERVICE. APPRECIATE THE CONVENIENCE. TRUST THE NAME.

call 1-888-972-9700 or visit our website at www.advancedradiology.com

Find us on

MAY/JUNE 2012 | 3

10 Simply InspirationalWomen Physicians Who Go Beyond the Norm

14 Thyroid and Lung Cancer on the Rise

16 The Revolution of Children’s Hospital CareFrom Facilities to Care Delivery, Pediatric Hospitals Have Taken a Great Leap Forward

20 Patient PortalsPath to Increased Productivity and Happier Patients

F E A T U R E S

D E P A R T M E N T S

ContentsMay/June 2012 Volume 2: Issue 1

1610 24

Cases | 7 | Tics: Screen for Neuropsychiatric Comorbidities

Solutions | 13 | EMRs:Worth the Pain?

Living | 24 | Harper’s Ferry: A GetawayWorth Exploring

Policy | 26 | Recap: Physicians Gain Ground in 2012 Maryland General Assembly Session

Compliance | 29 | Six Ideas to Help Improve Internal Control Processes withinYour Practice

Good Deeds | 30 | Lending Much-Needed Helping Hands to the People of Africa

On the Cover: Briana Walton, M.D., director, Female Pelvic Medicine and Reconstructive Surgery, Anne Arundel Health System.

HAPPY 1ST BIRTHDAY to MarylandPhysician Magazine! This issue launches our sec-ond year of production and as we did in ourMay/June 2011 inaugural issue, we’re celebratingMaryland women in medicine.

After the first issue was out, I received somecongratulatory messages from readers. One, a retired physician, wrote to me that he sentthe issue on to his granddaughters who were planning careers in medicine for someinspiration. There is no better compliment than to hear that I’m doing just what I setout to do when I launched of Maryland Physician: inspire and connect Marylandphysicians with a commitment to achieving the highest standards of quality patient care.

In this issue, we’re showcasing just a few of many, many inspirational femaleMaryland physicians (page 10). The story of one of the docs, AAMC’s Briana Walton,M.D., led us to this issue’s Good Deeds focus (page 30), a spotlight on the InternationalOrganization for Women and Development (IOWD). While we chatted during thecover photo session, Dr. Walton shared her experiences in treating Rwandan girls andwomen with fistulas with heart wrenching stories of young girls and women who havesurvived genocide, malnutrition and now are societal outcasts, suffering fromhumiliating and debilitating gynecologic conditions.

Back home here in Maryland, pediatric patients and their families are blessed tohave four pioneering pediatric hospitals, two of which opened new centers earlier thisspring. The adaptability for care, growth and research each center provides allows formuch needed flexibility in treating pediatric patients and often leads to innovativetreatments benefitting adult patients (page 17).

In 1960, John Steinbeck took a 10,000-mile trip around the United States ina pickup with a retrofitted camper on its back, and a large Standard Poodle namedCharley. He wrote about what he saw and did along the way in Travels with Charley.Steinbeck’s literary style, stories of a simple America and his four-legged travelcompanion have forever inspired me to write and experience America from the roadwith an easy going travel companion of my own. Travels with Eli is the first ina series of my Steinbeck-inspired travels across and around Maryland with my ownStandard, Eli. The first travel stop: Harper’s Ferry – the destination in this issue’sLiving department (page 24).

Many of you are planning your own summer trips which very well may includea good deed trip of your own. We’d love to hear from you and share your experienceswith your fellow Maryland Physician readers. Throughout this issue and online atwww.mdphysicianmag.com, you’ll find a number of ways to connect with us online andvia social media. Please do and safe travels!

To life!

Jacquie RothPublisher/Executive [email protected]

4 | WWW.MDPHYSICIANMAG.COM

JACQUIE ROTH, PUBLISHER/EXECUTIVE [email protected]

LINDA HARDER, MANAGING [email protected]

CONTRIBUTING WRITERSTracy FitzgeraldJackie Kinsella

CONTRIBUTING PHOTOGRAPHYTracey Brown, Papercamera Photography

www.papercamera.comMark Molesky, Moleskey Photographywww.moleskyphotography.com

ADMINISTRATIONGinger Jenkins

EXECUTIVE ASSISTANT/WEBMASTERJackie Kinsella

Maryland Physician Magazine™ is published bimonthly byMojo Media, LLC. a certified Minority Business Enterprise (MBE).

Mojo Media, LLCPO Box 1663Millersville, MD 21108443-837-6948www.mojomedia.biz

Subscription information: Maryland Physician Magazineis mailed free to Maryland licensed and practicing physiciansand a select audience of Maryland healthcare executivesand stakeholders. Subscriptions are available for the annualcost of $52.00. To be added to the circulation list, call443-837-6948.

Reprints: Reproduction of any contact is strictly prohibitedand protected by copyright laws. To order reprints of articlesor back issues, please call 443-837-6948 or email [email protected].

Maryland Physician Magazine Advisory Board: Anadvisory board comprised of medical practitioners and businessleaders in diverse practice, business and geographic scopesprovides editorial counsel to Maryland Physician. Advisoryboard members include:

KAREN COUSINS-BROWN, D.O.Maryland General Hospital

PATRICIA CZAPP, M.D.Anne Arundel Medical Center

HOLLY DAHLMAN, M.D.Greenspring Valley Internal Medicine, LLC

PAUL W. DAVIES, M.D., FACSKURE Pain Management

GAUROV DAYAL, M.D.Adventist HealthCare

MICHAEL EPSTEIN, M.D.Digestive Disorders Associates

STACY D. FISHER, M.D.University of Maryland Medical Center

REGINA HAMPTON, M.D. FACSSignature Breast Care

DANILO ESPINOLA, M.D.Advanced Radiology

GENE RANSOM, J.D., CEOMedChi

Although every precaution is taken to ensure accuracy ofpublished materials, Maryland Physician and Mojo Media, LLCcannot be held responsible for opinions expressed or factssupplied by authors and resources.

Green logo here

Call it transformation. A renovation. Or an extreme hospital makeover. But for those who haven’t

experienced the hotel-like comfort of the newly redesigned Herman & Walter Samuelson Breast

Care Center at Northwest Hospital, you will be pleasantly surprised. Led by Dr. Dawn Leonard,

fellowship-trained breast surgeon, you’ll find a relaxing spa-like atmosphere, the latest in digital

mammography and a staff of leading oncologists and surgeons. There is no finer setting in

Baltimore for comprehensive breast care. To learn more, go to lifebridgehealth.org.

YES, WE’VE REDESIGNED OUR BREAST CARE CENTER TO FEEL MORE LIKE A FOUR-STAR HOTEL.

NO, YOUR IN-LAWS CAN’T STAY HERE WHEN THEY’RE IN TOWN.

Northwest Hospital is locatedat the corner of Old Court and Liberty Roads.

SATURDAY, JUNE 16, 20125:00 – 10:30 P.M.

PHILIP MERRILL ENVIRONMENTAL CENTER (CBF HEADQUARTERS),

ANNAPOLIS, MARYLAND

BANDS: S.T.O.R.M., MAD PLANET, AND MISSPENT YOUTH

PLEASE JOIN US FOR A PART Y LIKE NONE OTHER, ON THE BEACH, STEPS AWAY FROM THE BAY. ENJOY A DAZZLING EVENING WITH

COOL DRINKS, DELICIOUS FOOD, JAMMIN’ L IVE MUSIC, AND DANCING— ALL TO BENEFIT THE CHESAPEAKE BAY FOUNDATION.

EVENT TICKETS: $100 PER PERSONFOR MORE INFORMATION: CBF.ORG/BANDSINTHESAND OR 410/268-8816

GREAT BLUE HERON SPONSORS

MEDIA SPONSORS

FOUNDING SPONSOR

PRESENTINGS P O N S O R

OSPREY SPONSORS

BB&T, G&M INVESTMENT GROUP, CAMPBELL & CO.

DISCUSSIONMovement disorders arecommon in children and often provokeparental anxiety. Tic disorders, seen in20 to 30% of children, are the mostcommon pediatric movement phenomenon.Tourette syndrome, defined by vocali-zations as well as motor tics occurring formore than one year, is also common, affectingup to 4% of the population. Tics can besimple (cough, sniff, eye blinking) orcomplex (touching in patterns, coprolalia).

Named for Gilles de la Tourette, a

French neurologist in the late 1800’s,Tourette syndrome was characterized asa neuropsychiatric condition severaldecades ago. More recently, it hasbecome better understood as an organicneurologic disorder with a number ofpsychiatric comorbidities.

Although it has gained mediarecognition, Tourette remainsinfrequently recognized by primary careproviders and parents. Physicians mayattribute eye rolling to absence seizures,eye blinking and “irritation” to allergy,and cough, sniffing and throat clearing tosinus disease. While reasonable toinitially attribute these symptoms tomedical problems, chronic conditionsshould prompt consideration of ticdisorder to minimize unnecessaryevaluation and treatment.

Why is the early identification of ticso important? Aside from the worry itcauses parents, it is crucial to screenthese children and adolescents forcomorbid neuropsychiatric conditions.More than 50% of children withTourette have attention deficit disorder;approximately 40% have a learningdisability and a significant proportionhave anxiety, obsessive-compulsivedisorder or depression.

Our patient is typical of many whohave undergone a number of previousevaluations by non-neurologicsubspecialists prior to a final diagnosisand management. Siblings often manifestsimilar comorbidities and haveunrecognized tic disorder. Parents can beaffected by anxiety, attention deficit orobsessive-compulsive behaviors. Touretteis clearly genetically mediated; however,a specific gene or gene product has notyet been identified.

There is no consistent evidence thatall tic disorders have infectious triggerssuch as group A streptococcus, despiteefforts to establish this hypothesis. At thesame time, some series appear todemonstrate an infectious trigger of tic,

possibly accompanied by obsessive-compulsive disorder or anxiety.

Research in this area is fraught withpossible confounders. Tic disorders arehighly prevalent, often wax and wane andcan be precipitated by stressors. Group AStrep can have an asymptomatic carriagerate of 15% in school age children. Ticswill often flare up upon return to school,coincident with re-exposure to infectiousagents. At present, there is not aconsistent test that proves causation.

Pediatric Acute NeurologicDisorders Associated with Strep or otherinfectious agents (PANDAS) should beestablished by a pediatric neurologist orspecialist with expertise in movementdisorders in children. Testing or empiricantibiotics for all children with tics arenot presently indicated. Surveillance andintervention for psychiatric comorbiditiesis requisite, however. Medicaltreatments where warranted can helptreat the tic and the psychiatriccomorbidity. Education from physiciansand support groups such as the TouretteSyndrome Association is always helpful.

While disabling in its severe form, ticsmay convey a selective advantage forpeople who tend to be compulsive ordetail-oriented. In fact, some of the mostsuccessful people in history probably hadTourette. Samuel Johnson, Mozart andmany others appear to have been affected.

Our patient did not warranttreatment, as her current tic was mildand not disabling. Parental reassurancewas sufficient in this case. Our patientand family left reassured, and happy toavoid medication.Mark DiFazio, M.D. is director of Pediatric

Neurosciences at Shady Grove Adventist

Hospital and assistant professor of Neurology

at the Uniformed Services University of the

Health Sciences, [email protected]

MAY/JUNE 2012 | 7

Cases

Tics: Screen for NeuropsychiatricComorbidities

CASE: An 8-year-oldpresents with a chiefcomplaint of chronic coughand previous treatment forsinusitis, allergy andpossible mild asthma. Herpediatrician, an allergist anda pulmonologist haveperformed a number oftests and prescribed severalinhaled medications forpresumed reactive airwaydisease. She is otherwisehealthy, a good student andan avid dancer. Familyhistory is notable for abrother with ADHD and amother with anxiety andobsessive-compulsivebehaviors. Two years agothe patient was seen by aneurologist for possibleseizure secondary torepeated eye-rollingmovements. The patienthad a negative electro-encephalogram and normalphysical examination.

Mark DiFazio, M.D.

N THE PAST DECADE, BARIATRICsurgery has become the safest, mosteffective treatment for severely obesepatients. In contrast to non-surgicaltreatments that produce a 95% recidivismrate and long-term Excess Body WeightLoss (EBWL) of only 20%, surgicaltreatments yield low recidivism (under35%) and an EBWL of over 50%.

“Today, bariatric surgery’s morbidityand mortality rates are on a par with simplesurgeries like laparoscopic appendectomy,”says Andrew Averbach, M.D., FACS,FASMBS, director, Bariatric Surgery, SaintAgnes Hospital. “It’s the only workabletreatment for morbid obesity. At Centers ofExcellence like ours, mortality rates are 0to 0.1%. As a result, close to half of thepatients now come to us after theirphysician talks to them. The fact is thatbariatric surgery works.”

The Bariatric Program, designated aCenter of Excellence by the AmericanSociety for Metabolic and BariatricSurgery (ASMBS) and multiple insurers,recently celebrated its 10-yearanniversary and has performed morebariatric surgeries than any other hospitalin Maryland. It now has four skilledsurgeons – Dr. Andrew Averbach, Dr.Isam N. Hamdallah, Dr. Kuldeep Singhand Dr. David von Rueden – who haveperformed more than 4,000 surgeries.

The Saint Agnes program is one ofonly two in Maryland to offer surgeryusing the state-of-the-art da Vinci robot,which provides surgeons with enhancedvisualization and greater precisioncompared to standard laparoscopy. TheBariatric Center of Excellence hasevolved into the cornerstone of theMaryland Metabolic Institute, which also

encompasses the Diabetes Center andwell4life, an innovative non-surgicalweight loss and healthy lifestyle program.

The center’s success can be attributedto the expertise of its physicians, thededication of the support team (includingnurse coordinator Cathy Carr-Dardin,R.N., C.B.N. – a patient herself) and thecommitment to furthering minimallyinvasive techniques. Kim Fabian,director, Maryland Metabolic Institute,comments, “In addition to our excellentsurgeons, our team of dietitians,behaviorists, nurses and otherprofessionals supports patients before,during and after their bariatric procedure.This team approach ensures that we aremeeting all aspects of the patients’ needsto foster their success.”

The surgery has health benefits farbeyond the weight loss, addressing key


Profile SPONSORED CONTENT

Saint Agnes Bariatric Program offerssafest, most effective treatment for obesity

10Years, 4000 patients,350,000 lbs. lost

I

Dr. Isam N. Hamdallah,Dr. Andrew Averbach,Dr. Kuldeep Singh(not pictured Dr. Davidvon Rueden)

comorbidities such as heart disease,diabetes, hyperlipidemia, arthritis andpsychological wellbeing. “Surgery is onlyone part of a whole program,” adds Dr.Averbach.“Obesity is a chronic diseaseand patients need to stay with theprogram for life, including annual visitsto the surgeon.”

He concludes, “The surgerydramatically enhances a patient’s qualityof life and ability to perform simple taskssuch as buckle a seatbelt, fit in a booth ata restaurant and take care of personalhygiene – things that most people takefor granted.”

BARIATRIC SURGERY INDICATIONSUsing National Institutes of Healthguidelines, appropriate candidatesmust have:� Evidence of previous non-surgical

weight loss attempts� Body Mass Index (BMI) of 40 or

higher, or a BMI of 35 or higher withdefined co-morbidities

� Absence of psychiatric conditions andaddiction that could prevent adequatepreoperative teaching and compliance

PROCEDURE OPTIONSThe most widely performed laparoscopicprocedures are:� Roux-en-Y gastric bypass – the gold

standard. Patients typically lose 70%of EBWL in the first three years.

� Vertical sleeve gastrectomy – patientslose up to 70% of EBWL. Newer andgrowing in popularity.

� Laparoscopic adjustable gastric band

(‘Lap Band’ & ‘Realize Band’) –patients typically lose about 40%of EBWL.

Choosing the right procedure is basedon body mass index, co-morbidities andpatient preference. “I recommend toprimary care physicians that, rather thanadvising patients to undergo a specificprocedure, they leave that decision to thesurgeon and patient,” Dr. Averbach advises.

Gastric bypass and sleeve gastrectomyproduce a substantially higher percentageof EBWL in the first three yearscompared to banding (70% vs. 40%). Theresolution rate of co-morbidities also ishigher after bypass and sleevegastrectomy. However, successful bandpatients continue to lose weight overtime, while up to 35% of bypass andsleeve gastrectomy patients experienceweight regain. Patients are advised that,in 25% of cases, the band requiresmaintenance and is removed after 10years. These patients eventually undergobypass or sleeve surgery.

BARIATRIC SUPPORT GROUPSAND SEMINARSTwice a month, Saint Agnes offers freebariatric support groups for patients,family members and friends to gainsupport from others who have had surgeryor are considering bariatric surgery.

Free, informative seminars on surgicalweight-loss options, including laparo-scopic gastric banding, gastric bypass andsleeve gastrectomy, are also offered threetimes a month. These seminars are open

to the public but require reservations.Call 1-866-690-9355.

WELL4LIFE PROGRAMNow Offers Options for Bariatric PatientsThe first program of its kind in Maryland,well4life is a multidisciplinary, non-surgical weight loss and healthy lifestyleprogram. In addition to the basic well4lifeprogram, a Pre-Operative Bariatric Trackis offered to provide patients thedocumented weight loss, dietaryeducation and behavioral consultationrequired for approval of bariatric surgery.In addition, pre- and post-operativebariatric patients can benefit from weeklyexercise classes.

The eight-month basic well4lifeprogram also can help bariatric patientswho are one or more years beyond theirsurgery and wish to maintain their weight,or for those who have gained weight backand would like to lose more. Participantsreceive a health assessment, biometricscreenings, educational classes, healthcoaching, fitness classes, support groups,a web companion, and medical oversight.Call 410-368-3228.

For more information on bariatricsurgery, view videos of Saint Agnesbariatric surgeons discussing weight losssurgery on the Live Well channel atwww.stagnes.org. To sign up for a bariatricsurgery seminar, call 1-866-690-9355.Saint Agnes was awarded Center of Excellence

designation for bariatric surgery by: • CIGNA

• United/Optum • Aetna • CareFirst Blue

Distinction • American Society for Metabolic

and Bariatric Surgery (ASMBS)

MAY/JUNE 2012 | 9

TYPE

PROCEDURE

MORTALITY

30 DAY/LONG TERMRISK OF MORBIDITIES

INDICATIONS

EXPECTED EBWL

LAPAROSCOPIC ROUX-EN-Y BYPASS

Restrictive/malabsorptive procedure creatingsmall proximal pouch with bypass of distalmain stomach, duodenum and proximaljejunum with variable length intestinal shunt(Roux limb)

0 – 0.2%

30 Day: 10- 15%LT: 5-10%Ulcers, intestinal obstruction, hypoglycemia,nutritional deficiencies

Procedure of choice for all BMI, especiallypatients with diabetes and multiple disablingco-morbidities

1 yr: 65-70%5 yr: 55%

Resection of 80% of lateral stomach withconstruction of sleeve-like tubular stomach

0 – 0.2%

30 Day: 10%LT: 5-10%Gastric leaks, strictures, GERD

Any BMI range; can be an alternative whengastric bypass contraindicated

1 yr: 65-70%5 yr: 55%

LAPAROSCOPIC ADJUSTABLE BAND

Restrictive procedure placing inflatablesilastic band around subcardia of stomachwith minimal gastric pouch above band

0 – 0.1%

30 Day: 4%LT: 25-30%Erosion, GERD, esophageal ectasia,insufficient wgt. loss

Preferred BMI <45; young/teenage patientswith minimal or no co-morbidities; first-linetreatment for BMI 30-35

1 yr: 35%5 yr: 50%

LAPAROSCOPIC VERTICAL SLEEVEGASTRECTOMY


WOMEN PHYSICIANSWHO GO BEYONDTHE NORM

Simply Inspirational

BY LINDA HARDER

PHOTOGRAPHY BY TRACEY BROWN

Cynthia Plate, M.D., chief of surgery and president-electof the medical staff, Washington Adventist.

EEven on a good day, being a womanphysician presents its share of challenges,especially when a spouse and children arepart of the picture. Yet some femalephysicians rise above the expected,inspiring others to achieve morethemselves. Maryland Physician celebratesour annual Women in Medicine issue byspeaking to four such physicians. Wediscuss why these women chose theircareer path and how they leave the worlda better place.

Male Influences for Medical PursuitsPerhaps surprisingly, all four physicianswere chiefly influenced by one or moremen in their lives to go into medicine.Judy Destouet, M.D., FACR, chief ofmammography at Advanced Radiology,recalls, “After leaving a job as a researchassistant at USC, I was going to be amedical technologist. I loved being in thehospital but wanted to be with people.My boyfriend (now husband) told me Iwas smart and should go to medicalschool. I took his advice. At BaylorCollege of Medicine, not only werewomen only about 10% of the class, but Iwas one of the older students.”

Cynthia Plate, M.D., chief of surgeryand president elect of the medical staff,Washington Adventist Hospital, wanted tobe a nurse since she began putting band-aids on her dolls. Her father argued that,“If you study a little bit longer, you can bethe one making the decisions.” His advicehelped launch her medical career,although she frequently had to ignorewell-intentioned advice from wives offamily friends who told her she ‘couldn’thave it all’ if she became a surgeon. Shesays, “During my surgical rotation, I wasthe first one to arrive each morning and Iloved the almost militaristic chain ofcommand of the assured surgeons atHoward University Hospital.”

Like Dr. Plate, Briana Walton, M.D.,director, Female Pelvic Medicine andReconstructive Surgery, Anne ArundelHealth System, subjected her Barbie dollsto medical treatment at a young age, andwas persuaded to seek a professionalcareer by her father. In college, shediscovered she was good at math andscience, and the next logical step seemedto be medical school.

Similarly, a psychiatrist father helpedlaunch the medical career of Rosa Mateo,M.D., infectious disease specialist and

medical director of infection control atShore Health System. “My siblings and Iused to be angry that my father was latepicking us up from school because hedidn’t want to cut short his time with apatient, but he taught me how doctorsshould address patients and that gainingtheir trust is what’s important. Inever forgot those lessons.”

Choosing a SpecialtyDr. Destouet says, “I lovedsurgery but wanted to have afamily, so I fell in love withradiology – it was like being adetective. In the 70s, when I wasdoing my residency, it was anexciting time. It was the dawn ofthe CT scan – radiology was reallycoming into its own after years ofrelying on X-rays and primitiveultrasound.”

“Once in medical school,”reminisces Dr. Walton, “OBpicked me, not vice versa. I likedcutting, but I kept being pulled back toOB. I enjoy taking care of women, andurogynecology provides a great blend ofsurgery and taking care of people.”

“In Peru, where I spent my first 12years, the most common problem isinfection. The smartest person was alwaysthe infectious disease specialist becausethe specialty is so broad. And ID usuallysees the sickest patients in the hospital,”comments Dr. Mateo. Like Dr. Destouet,she was attracted to the ‘detective-like’aspects of infectious disease. “I love thechallenge. And being bilingual helps meexplain what’s happening to patients intheir native Spanish.”

Screening Mammography Pioneer;Breast Cancer SurvivorWhen Dr. Destouet began performingmammography, a physician could onlyperform about five film-basedmammograms a day in women who hadsigns and symptoms of breast cancer, as allmammograms were “diagnostic”mammograms. She recalls, “In the early80s, Swedish radiologists beganperforming screening mammograms onasymptomatic patients. I became the headof mammography at MallinckrodtInstitute of Radiology in St. Louis and weembarked on a screening mammogramprogram where we eventually performedmore than 100 mammograms a day. The

insurers realized that you could savedollars by catching breast cancer early, sothey supported it. But when my chairmanpromoted a male to a full professorshipover me, I decided to accept an offer inprivate practice in Maryland, where Ibrought this model with me.”

Dr. Destouet had been lecturingaround the country to help othersimplement the new model. “I was alsotired of traveling all the time andwelcomed the opportunity to do some-thing different,” she adds. The East Coastwas slower to adopt the new practice, andDr. Destouet encountered increasingregulation from the FDA and others. Yetshe persevered, to excellent results.

“I never doubted for a moment thatscreening mammograms were the rightthing to do,” Dr. Destouet continues.“The data supported what we were doing.It’s been especially heartwarming to seedisadvantaged women get screening,especially since breast cancer is oftenmore aggressive in the African Americanpopulation.”

Ironically, Dr. Destouet is now abreast cancer survivor herself. “I wasdiagnosed in 2008. It adds to my ability torelate to patients. I believe very stronglyin mammography on both a professionaland a personal level.”

Giving RwandanWomen a Second ChanceIn sharp contrast to her focus on roboticsurgery with its highly technicalequipment and specialized ORs in theU.S., Dr. Walton has been extensivelyinvolved in women’s health care indeveloping countries, specializing infistula repairs in Ghana, Niger and

MAY/JUNE 2012 | 11

Briana Walton, M.D., director, Female Pelvic Medicine andReconstructive Surgery, Anne Arundel Health System.

Rwanda as a member of the InternationalOrganization for Women andDevelopment (IOWD). “Part of the reasonI got involved with fistula care is that Ihave Crohn’s Disease and had problemswith fistulas myself. I sympathized withothers who had this type of problem,which can be devastating.”

During her fellowship at Harvard,Dr. Walton made her first trip overseas –to Ghana – alone. “Providing care for apopulation of women who were outcastfrom their villages and families moved meto partake in international care. It was partof my calling as a physician. Furthermore,the indirect message of being a role modelas a woman and a woman of color inspiredme to continue my work. However, Irealized that I needed to be part of agroup. I first went to Niger with IOWD in2006, and since 2009, I’ve gone with themto Rwanda. The presentation of fistulas inRwanda is different and the health caresystem is more established. And althoughfemale genital mutilation from traditionalcircumcision does not occur, women havebeen subjected to horrific acts of violenceduring Genocide.“

Her IOWD group goes to Rwanda

three times a year for two weeks each.This April 2012, she had her firstexperience as Team Leader of a group ofeight physicians. Because many older,more experienced physicians were killedduring the genocide in Rwanda, one ofthe team’s critical roles was teachingyoung, inexperienced providers to safelydeliver care to women.

Hospital Leader, Honduran HealerLike Dr. Walton, Dr. Plate is lendingher surgical skills to developingcountries. In March 2012, she returned

from the first of what shehopes will be many tripsto Honduras. There, shewas part of a team of fourvolunteer surgeons whoperformed gallbladderand hernia surgeries onmore than 100 patients.She reflects, “Thepatients wereunbelievably grateful.And since I am fluent inSpanish, I could helpinterpret.” These visitsextend her tradition ofservice here in the U.S.,where she participates inbreast cancer and otherscreenings.

Dr. Plate’s servicealso extends to being a medical leaderwithin the hospital. Partially through herthree-year term as Chief of Surgery, shebegan serving as the President-Elect ofthe medical staff in January 2012. She’sthe first female to serve in either role.“I thought about this long and hard,”she reflects. “My partners and theadministration were very supportive.It gave me confidence to know thateveryone felt I was ready.”

Saving Lives In Community andHospital Settings“Saving a life gives me satisfaction,” notesDr. Mateo. “I feel that someone is guidingmy hands and that there’s something morepowerful than us. Sometimes patients getwell against all odds – like a 90-year-oldpatient on DNR who was so sickovernight that we thought he would dieby morning; yet miraculously, herecovered. But sometimes the badoutcomes teach us the most. I hadestablished a good relationship with onepatient who knew he was dying of lungdisease secondary to HIV. I told him itwas time to be in peace. I couldn’t changehis outcome, but I made his last hours the

best they could be, which is as importantas curing someone. My oncology rotationgave me good training in how to approachdying patients.”

Dr. Mateo works closely with theTalbot Health Department to controlinfections in the community as well as thehospital. She recounts, “My phone ringsall day long when I’m on call. If they havequestions about an outbreak, they call me.Several years ago, when we had the H1N1outbreak, we determined who shouldreceive treatment with antivirals. We’vehad gastroenteritis, measles, a few cases ofTB, and HIV, especially since manyyoung people come back here from thecity to be with their families oncediagnosed. We’re now faced with apopulation that will live many years withHIV but they’ll suffer medication sideeffects – we can help them manage.”

Unique AttributesDr. Walton says, “I’m proud that I stayedmarried for 20 years because you evolve alot during that time. I’m true to myselfand my job hasn’t changed who I am orwhat I want to be. Most women have goodemotional intelligence so it makes it easierfor us to remain faithful to our core.”

“As a woman, my leadership style is tolisten to everyone, then wrap it up withoutbelaboring a point,” notes Dr. Plate. “ Assurgical chief, I gained a deeper under-standing of how the system works and Ilearned to tie things together better. Ibelieve in providing clear explanations sothat people understand why we dosomething a certain way. I strive to be agood leader and role model to our residents,while taking great care of my patients.”

“My advice for women doctors is towork harder than their malecounterparts,” concludes Dr. Destouet.“We do ourselves a disservice if our malecounterparts consider us just ‘part time.’A woman’s work ethic is not different thana man’s and many of us have to multi-taskby raising a family.”


Rosa Mateo, M.D., infectious disease

specialist and medical director of infection

control at Shore Health System.

Judy Destouet, M.D., FACR, chief of

mammography, Advanced Radiology.

Cynthia Plate, M.D., chief of surgery and

president elect of the medical staff,

Washington Adventist Hospital.

Briana Walton, M.D., director, Female

Pelvic Medicine and Reconstructive

Surgery, Anne Arundel Health System.

Rosa Mateo, M.D., infectious disease specialist and medical direc-tor of infection control at Shore Health System and Judy Destouet,M.D., FACR, chief of mammography at Advanced Radiology.

MAY/JUNE 2012 | 13

Solutions

EMRs:Worth the Pain?

MBy Seth R. Eaton, M.D.

ARYLAND PROVIDERSare faced with the difficult task ofselecting and implementing electronicmedical records (EMRs) to improve andengage patients in their overall care. Alarge percentage of providers continue tooperate with paper charts, which areneither efficient nor safe. With thevarious government incentives availableto encourage adoption of electronicrecords, medical professionals understandthe advantages and care improvementsthat EMRs supply, although most areunequipped to adjust to the inevitablehurdle of a significant practice workflowtransformation. Implementation of anEMR can be a challenge at first; howeverit is well worth the investment in the end.A practice’s return on investment (ROI)depends upon choosing a solution that isa fit for the practice. To ease the difficultselection process, Maryland’s HealthInformation Exchange (HIE) providessupport and recommendations for a selectnumber of EMR vendors.

Support from CRISP and HIE networksChosen as Maryland’s RegionalExtension Center by the Office of theNational Coordinator of HealthInformation Technology, ChesapeakeRegional Information System for OurPatients (CRISP) helps achieve improvedoutcomes and practice efficiencies. Theprogram helps healthcare providers inMaryland implement and use EHRsefficiently and share clinical data acrossthe state.

EMR SelectionDeveloping a plan and asking the toughquestions is a vital first step in selectingan EMR vendor. First, identify yourpractice’s goals and objectives. Next,speak to fellow colleagues and othermedical professionals for recommen-dations on EMR vendors. Selecting anEMR system that associates are using willassist in the initial learning curve and

implementation process. Certainplatforms will be easier to implement, socheck before purchasing to see whichsystem has the serviceability needed.Additionally, EMRs will provide the toolsto integrate with health informationexchange networks. After evaluatingvarious systems, conclude which solutionbest fits your practice’s goals.

The path to fully implementingEMRs can be a bumpy one. Manypractices face difficulties for at least sixmonths while everyone from providers tothe front office staff adjust to the change.However, after climbing over the initialspeed bump you will see a return on yourinvestment, quality improvementsthroughout your practice and improvedcare between primary, specialty andhospital systems.

Quality Improvements afterImplementationDifferent EMR systems and differentoffices experience varied adoption rates.Hopefully your practice will experience arapid adoption by providers and deployafter only a short period. Once it iscomplete, the clinical quality of care willimprove immediately; patients will havethe tools to communicate with specialistsand physicians will have moreinformation to coordinate and improvecare. Records will be readily available andbetter communication with specialistswill enhance care.

Other advantages experienced withrobust EMR systems are:

� Legible, thorough and accurateprogress notes

� Fast receipts of and easy location oftest results to improve communicationwith patients

� Letter generation and mailings, callsand electronic messages for moreefficient follow-up care

� Patient records available over a secure

network, improving coordination ofcare during after-hours on-call, hospitalrounding, and other times when theprovider is not at the practice site butneeds to render medical judgment

� Easy and secure access to lab results,medication refill requests and referralmanagement when patients access thepatient portal

Patient EngagementThe key goal of an advanced EMRsystem is to improve the patient’sexperience. The patient portal allowspatients to communicate with their doctorand access important information over theInternet. It facilitates preventive care,providing patients 24/7 access to medicalinformation from the comfort and privacyof their home or office. It gives patientsthe tools to better manage their health by:

� Requesting and creating appointments� Request prescription refills� Pay bills online� Receive health maintenance reminders

National RecognitionMedPeds, LLC, selected eClinicalWorksin 2004 because it was the most user-friendly and intuitive EMR with thefastest learning curve. eClinicalWorksprovides the tools to further enhance thepractice’s ability to engage patients andfamilies and support the medical homemodel of healthcare delivery. InDecember 2010, MedPeds wasrecognized by the National Committeefor Quality Assurance (NCQA) forachieving Level 3 Physician PracticeConnections®-Patient-Centered MedicalHome™ (PCMH) status. PCMH is amodel of delivering primary care that isaccessible, continuous, comprehensive,family –centered, coordinated,compassionate and culturally effective.Seth R. Eaton, M.D., is board certified in both

Internal Medicine and Pediatrics. He started

the MedPeds, LLC practice in Laurel in 1982.

Thyroid &Lung Cancer

Increase in Thyroid CancersIn the past 30 years, the incidence ofthyroid cancers has more than doubledand now represents the fastest growingcancer for women. Endocrinologistssuspect that the increased iodineconsumption in developing countries isassociated with chronic inflammation,sometimes leading to cancer. Otherssuggest that radiation from dental X-raysand mammograms are possible culprits,and encourage women to use thyroidshields during such procedures.

While women are three times as likelyto develop thyroid cancer as men, the mostcommon thyroid cancers - papillary (80%)and follicular (15%) - have a good prognosis.Nicholas Argento, M.D., endocrinologist,observes, “Thankfully, the majority ofcancers, often detected on MRI or CT of

the neck or chest, or during carotid ultra-sound, are indolent. The more aggressivecancers are typically found in older patients.”

More Active Lymph Node SurveillanceFollowing thyroid surgery, with moreadvanced ultrasound testing available inplace of repeat nuclear scans, surveillanceof lymph nodes has improved. “We usedto have to withdraw people from thyroidmedication for a month to do the test, andhad to perform recurrent tests,” Dr.Argento states. “Now, we often onlyperform one nuclear scan and prepare thepatient using an injection of syntheticTSH. Neck ultrasound is then used forfurther follow up. The ultrasound ispainless, more specific and cost effective.Using fine needle aspiration, patients canget a biopsy at the same time.”

Decreasing Use of Radioactive IodineWhen lymph nodes are cancerous,doctors are increasingly likely to performa second surgical procedure in lieu ofradioactive iodine treatment. Dr. Argentonotes, “There’s been a big shift in theemphasis on radioactive iodine, as werealize that it entails more risk and is lesseffective for most patients than oncebelieved.” When prescribed, radioactiveiodine is more frequently given at a lowerdose and on an outpatient basis forpatients who meet the criteria.

Hypothyroidism during PregnancyThe evidence is mounting that untreatedor undertreated hypothyroidism mayincrease the risk of miscarriage anddecrease fetal IQ. Women with knownhypothyroidism should be retested early in

Both thyroid and lung diseases are on the increase in the U.S.,especially in women. Maryland experts weigh in on the latest

advancements in detecting and treating these diseases.


On the Rise

BY LINDA HARDER • PHOTOGRAPHY BY TRACEY BROWN

pregnancy, with monthly testing for thefirst 20 weeks. Even women withoutknown problems should be considered atpotential risk, but whether they should getroutine thyroid screening is still controversial.Dr. Argento says, “Women with certainconditions, such as a history of goiter, type1 diabetes or family history of thyroiddisease, should definitely be screened.”

The most recent recommendationfrom the American Thyroid Association isthat women with known hypothyroidismshould receive a 30% to 50% increase inthyroxine early in their pregnancy. SaysDr. Argento, “Physicians should seek tokeep the thyroid stimulating hormone(TSH) level below 2.5 in the firsttrimester and below 3.0 in the remainingtrimesters.”

“The patient guides at the websitewww.hormone.org are a great resource,”concludes Dr. Argento.

Lung Disease in WomenWhile breast cancer receives most of themedia attention, lung cancer is on the risefor women and has become their leadingcause of mortality since 1987. Further,more than twice as many women as menare diagnosed today with chronicbronchitis and more women have diedfrom COPD than men every year since2000. Advances in imaging have led toearlier detection of lung disease, but lungscreening is not yet reaching sufficientnumbers of those at risk.

Lung Cancer Not Just aSmokers’ DiseaseSurprisingly, 20 to 30% of lung cancersoccur in former smokers age 55 and olderwho have not smoked for 15 or moreyears. Riny Karras, M.D., thoracicsurgeon at Saint Agnes Hospital, notes,

“The National Lung Screening Trialdemonstrated that lung cancer screeningsare critical for this population. It alsodetermined that CT was superior to chestX-ray for detecting cancers and that lowdose CT scans were effective in detectingsmall masses, enabling patients to reduceradiation exposure.”

Dr. Karras adds, “Another 10 to 15%of lung cancers occur in those who havenever smoked. Detecting lung cancer asearly as possible dramatically affectssurvival rates. When caught at Stage 1, the5-year survival rates are 90 to 95%, whileStage 4 survival rates are only 10 to 15%.”

Precise Localization with PleuralDye MarkingLocalizing and treating tiny peripheralnodules used to be challenging andinvolved large incisions. Pleural dyemarking, a newer approach developed atFranklin Square employs navigationalbronchoscopy and CT in real time todetect these nodules.

“The dye allows physicians to markthe pleural surface adjacent to the lesion,and can detect even the more elusive“ground-glass” lesions. A bronchoscopicbiopsy can be performed during the sameprocedure,” says Sy Sarkar, M.D.,interventional pulmonologist at MedstarFranklin Square.

VATS (Video-Assisted Thoracic Surgery)While some 60 to 70% of lobectomies inthe U.S. are still performed using an openincision, specialists in Maryland aremoving to videoscopic-assisted thoracicsurgery (VATS) and robotic-assistedlobectomies.

“If the bronchoscopic biopsy isunrevealing, a surgical biopsy can beperformed within 24 hours using thepleural dye as a localization technique,”Dr. Sarkar notes. “This speeds theprocess from detection to treatment.”

A woman with uterine cancer whodeveloped sub-centimeter pulmonarynodules illustrates the advantages of thisapproach. Her oncologist wanted toverify that the nodules were metastaticand referred her for the bronchoscopicbiopsy and pleural dye marking forlocalization. The procedure did not revealanything; however, the dye allowed thethoracic surgeon to readily locate thenodule, determine that it was metastaticand remove it using the VATS procedurethe next day. The patient couldimmediately start chemotherapy.

Robotic-Assisted LobectomiesSaint Agnes Hospital is one of a smallpercentage of hospitals offering robotic-assisted lobectomies. “We can do thingswe could do with VATs but lessinvasively,” says Gavin Henry, M.D.,thoracic surgeon at Saint Agnes. “Therobotic-assisted procedure is appropriatechiefly for Stage 1 and 2 lung cancers. Ittypically involves less pain because therobot allows us to use ¼ to ½ inchincisions. It also provides better angles toreach the tumor and affords surgeonsbetter depth perception – more of a 3Dview, compared to a 2D view with VATs.Patients leave the hospital as early as oneto two days post-op.”

Seamless CareMany hospitals now have nursenavigators to provide easy access toservices and a 24/7 resource for patients.Ruth Evans, R.N., thoracic coordinator atMedstar Franklin Square, says, “Patientsjust call me and I can access ourphysicians on their behalf. We help tokeep costs down by preventing repeattesting, such as a pre-op blood draw. Wealso facilitate a patient’s treatment,typically involving surgery, medicaloncology and radiation.”

Riny Karras, M.D., on the left and GavinHenry, M.D. on the right – both fromFranklin Square.

Sy Sarkar, M.D., interventional pulmonologistand Ruth Evans, R.N., thoracic coordinator,Medstar Franklin Square

Nicholas Argento, M.D., endocrinologist,

Maryland Endocrine, PA.

Sy Sarkar, M.D., interventional

pulmonologist, and Ruth Evans, R.N.,

thoracic coordinator, MedStar Franklin

Square Hospital

Gavin Henry, M.D., and Riny Karras, M.D.,

thoracic surgeons, Saint Agnes Hospital

MAY/JUNE 2012 | 15

From facilities to care delivery, pedatric hospitalshave taken a great leap forward

The (R)evolutionof Children’s Hospital Care

Giant puffer fish are suspended from the ceiling at the new Johns Hopkins Children's Center.

MAY/JUNE 2012 | 17

Giant yellow puffer fish suspended from asoaring ceiling. Abstract rhino sculptures in the courtyard.Marine motifs and live broadcasts from the NationalAquarium. Pediatric ICUs where both parents can stayovernight. Many of today’s spacious pediatric facilities onlyvaguely resemble hospitals of the past, with family-friendly,private rooms that are stuffed with electronic amenities likevideo games and flat screen TVs.

Why are pediatric facilities enhancing services whenvaccines and treatment advances result in fewer and shorterhospitalizations? In part, the ability to treat formerly life-threatening conditions, such as congenital heart disease andfetal neurology deficits, has increased the need for intensivepediatric care.

“Across the country, community hospitals arequestioning whether they should partner with a tertiaryhospital or get out of the pediatric business,” says David L.Wessel, M.D., senior VP, The Center for Hospital-basedSpecialties, Children’s National Medical Center. “There’sa focus on inpatient service being tertiary and quaternary.”

Flexible, Innovative FacilitiesWith the help of private donations, all four of Maryland’slocal children’s hospitals are investing multiple millions intheir facilities, staff and technology to dramatically alter caredelivery. Sinai Hospital opened its new 23,000 sq. ft.Herman & Walter Samuelson Children’s Hospital in midMarch, Hopkins opened the new 205-bed, 560,000 sq. ft.Charlotte R. Bloomberg Children’s Center on May 1st, andUMCH and Children’s National have added new facilitiesand completed major overhauls of existing ones.

Todays’ rooms are large, private and replete with hightech features. One or both parents can sleep overnightwith their child, even in the ICU. Teens enjoy high-techoptions in separate lounges so they don’t have to mix withyounger children.

Flexibility is key. Medical/surgical rooms can beconverted to ICUs simply by increasing the nurse staffingratios. Joseph M. Wiley, M.D., FAAP, chief, Department ofPediatrics, the Herman and Walter Samuelson Children’sHospital at Sinai, says, “In our new children’s hospital, wedesigned the flex unit to have three pods, each with tworooms; the rooms can be used as an ICU so we don’t haveto move sicker patients.”

“The strength of our new facilities is that we can adapt tochange quickly so that we can still take care of patients in 20years,” notes George J. Dover, M.D., director, Johns HopkinsChildren's Center. “We’ve also designed the new hospital sothat new technology can be available to both children andadults. Further, we’ve grouped related pediatric services onthe same floor. For example, we’ve grouped our new NICU,delivery suites, ORs devoted to C-sections, and a nursery onthe same floor. On another floor, we have a large PICUadjacent to a suite of pediatric ORs that can handle both

LINDA HARDER • PHOTOGRAPHY BY TRACEY BROWN

To learn how inpatient pediatric care is evolving,Maryland Physician spoke with the heads

of pediatrics at Johns Hopkins, University ofMaryland, Sinai and Children’s National

George J. Dover, M.D., director, Johns HopkinsChildren's Center

same-day and complex procedures, a huge recovery area andpediatric radiology.”

Sinai’s solution to the confining isolation rooms of the past is tocreate a wing where four isolation rooms have glass on three sidesand anterooms. The entire facility is also HEPA-filtered to reduceinfectious transmission. “We now have a physical facility thatmatches the way we want to practice medicine,” remarks Dr. Wiley.

“Our approach is to invest our dollars to get the maximumreturn,” says Steven J. Czinn, M.D., professor and chairman,Department of Pediatrics, University of Maryland MedicalCenter. “We’ve built a new pediatric hybrid cardiac catheterizationlab and are finalizing plans for a new state-of-the-art NICU. Wehave often retooled existing space to use the dollars efficiently.For example, we converted existing space to mostly privaterooms and separate teen, toddler and family lounges.”

Growth in Pediatric Subspecialized CareHospital pediatrics has become highly intensive andsubspecialized, encompassing more than 20 subspecialties,including pediatric emergency physicians, pediatricgastroenterologists, neuro-surgeons, oncologists, cardiologists andanesthesiologists.

“One of the biggest transformations is in pediatric ICUcare,” Dr. Wessel observes. “In the near future, nearly 50% ofour beds will be ICU beds. In addition to a 54-bed NICU and39-bed PICU, we opened a new cardiac ICU with 26 beds inearly 2012. Even though we built the unit for growth, wealready are nearly full.”

Children’s National has had success with a hypothermiaprogram to cool newborn body temperatures to 32 to 34 degreesCelsius following cardiac arrest. They also are expanding fetaland transitional medicine, with specialized services in utero that

extend to advanced post-delivery care. In the brain, doctors cannow determine brain development by measuring brain foldingand metabolism. “It’s a very exciting area and we rebuilt a wholesuite for fetal medicine,” enthuses Dr. Wessel.

“We have the only pediatric hybrid cardiac catheterizationlab in the state, or perhaps the region,” says Dr. Czinn. “Wespent $3 million to provide both cardiothoracic andinterventional cardiology services in the same lab.” Another areaof strength at UMCH is its pediatric GI program that includespediatric anesthesia, a GI infusion center, and wireless capsuleendoscopy to evaluate the small bowel.

Dr. Wessel notes, “Our whole east tower inpatient unit isonly two years old. We have the only dedicated cardiac PICU inthe area. We can open an aortic valve in a preemie weighing lessthan two pounds in that ICU, a procedure that would have beenimpossible eight to 10 years ago.”

The survival of infants and children with serious conditionshas led to the need for new services to treat them as they growup. UMCH offers a Pediatric Oncology Survivorship Program toexamine and monitor the most common side effects that developin children who have undergone radiation and chemotherapytreatments. Dr. Czinn comments, “If we see them at regularintervals, we can prevent problems.”

Dr. Dover says, “Hopkins has the largest cystic fibrosisprogram in the region. Those children have now grown up andwe’ve had to train internal medicine providers to deliver cardiac,pulmonary and other care to them as they’ve become adults.”

Pioneering and Rapid Adoption of AdvancesWhether pioneering new technology in infants, or more quicklyadopting adult advances to children’s care, these facilities drivechange. Dr. Dover comments, “At Hopkins, we don’t wait forthings to be developed in adults first. From the operation torepair the congenital heart condition, Tetralogy of Fallot, in 1944to today, advances often start in pediatrics.”

Dr. Wessel notes that the first reported use of Viagra wastreating pulmonary hypertension in a 6-week old girl in the late90s. He also cites the heart/lung machine as an example oftechnology that was adopted for use in adults only after it wasdeveloped for children.


The strength of our new facilitiesis that we can adapt to changequickly so that we can still takecare of patients in 20 years.

– George Dover, M.D.

Left to right: Steven J. Czinn, M.D., professor and chairman, Department of Pediatrics, University of Maryland Medical Center. David L.Wessel, M.D.,senior VP, The Center for Hospital-based Specialties, Children’s National Medical Center. Joseph M. Wiley, M.D., FAAP, chief, Department ofPediatrics, the Herman and Walter Samuelson Children’s Hospital at Sinai.

MAY/JUNE 2012 | 19

Adds Dr. Czinn, “Because there is a larger market for adultadvances, technological advances tend to occur first in the adultworld and trickle down to children. We’re committed to speedingthe adoption of those advances to pediatric care.”

Community Hospitals AdaptDr. Dover says, “There’s a new model of community pediatrichospitals that was started at Howard County General, is now atGBMC and Franklin Square, and is spreading to UpperChesapeake and Bayview. In this model, pediatric ER,observation and inpatient services are all staffed by a shared setof pediatric nurses and hospitalists. We’ve developed protocolsthat guide when to transfer children needing more specializedcare to us, to keep as many patients at the community hospitalsas we can.”

IT Transforms Care DeliveryTelemedicine is facilitating the communication betweencommunity hospital pediatric staff and tertiary centers.Children’s National has developed telemedicine technologyto network area community hospitals with its emergencyand inpatient specialists, Hopkins is launching telemedicinein its new hospital, and UMCH has telemedicine pilotsunderway.

Dr. Wessel says, “We have media rooms that connect to othercenters across the country. A community hospital can do a cardiacultrasound and feed it to us. We can make the diagnosis andtransport the child when necessary. We transport more than 6500patients a year.”

“With telemedicine,” Dr. Czinn remarks, “we can speak tothe referring physicians, look at the child’s lab and imagingresults in real time and make a decision to transfer them here ortreat them there. It will dramatically influence the value of thehealthcare dollar.”

Both Hopkins and Sinai have advanced electronic medicationordering systems in which medications are delivered directly to alocked cabinet in each patient’s room. Dr. Wiley notes, “Nursesno longer have to retrieve medications from a med room, wherethey risk being interrupted. They can check the dose and scanthe bar codes to match the medication to the child.” Dr. Doveradds, “Hopkins will soon assign a pharmacist to each floor towork with the providers there as a team.”

Family Centered CareMaking pediatric care more family-centered is not just a nice touch, it’s goodmedicine. In most facilities, both parentscan be accommodated for overnight stays,and bathrooms are designed with adultneeds in mind, as well as the child’s.

At Children’s National and Sinai, theirfamily-centered rounds intimately involvethe family. “Research has demonstratedthat this approach increases informationaccuracy, reconciles medication dosingwith the child’s condition and lets thefamily know what diagnoses we’reconsidering so there are no surprises,”Dr. Wiley states.

Adds Dr. Wessel, “We invite parentsto join us every morning, even in theICU.” Parents are even allowed to stay

during cardiac resuscitation of their children if they wish, andunder certain conditions.

Child Life specialists add a critical dimension of care.According to Dr. Dover, Hopkins has one of country’s oldestchild life programs. These specialists have a strong backgroundin child development and family systems so they can provideemotional support to the entire family as well as the hospitalizedchild’s development. “Normal play can be the best therapy,”observes Dr. Wiley.

Easy Single-Point AccessTertiary hospitals used to be infamous for their lack of access.While they have worked on improving access for years, thesehospitals are striving to make additional enhancements. Sinai hasPediatric One Call and has developed a reputation for being wellconnected to its referral base. Dr. Wiley claims, “As long as a bedis available, we can get the patient in. The ED can be bypassedas appropriate.”

At Children’s National, Kurt Newman, M.D., the newpresident and CEO, has set ambitious goals to have a singleperson and number to call for each service. “His single greatestfocus is to increase access,” says Dr. Wessel. In addition toUMCH’s One Call system, Dr. Czinn says, “Pediatricians cankeep one phone number on speed dial – mine. My commitmentis that doctors can call me directly at 410-328-6777.”

Dr. Dover concludes by commenting, “Pediatrics is the jewelin the crown for Hopkins.” With new facilities and careparadigms, it’s clear that pediatric care is a shining jewel for allfour of these specialty hospitals.

Joseph M. Wiley, M.D., FAAP, chief, Department of Pediatrics, the

Herman and Walter Samuelson Children’s Hospital at Sinai.

George J. Dover, M.D., director, Johns Hopkins Children's Center,

professor of Pediatrics, professor of Oncology, Given Professor

and director, Department of Pediatrics

David L. Wessel, M.D., senior VP, The Center for Hospital-based

Specialties and division chief, Critical Care Medicine, Children’s Na-

tional Medical Center

Steven J. Czinn, M.D., professor and chairman, Department of Pe-

diatrics, University of Maryland School of Medicine, and Physician-

in-Chief, University of Maryland Children’s Hospital

PATIENTPORTALS

Healthcare IT

A Path to Increased Productivity and Happier Patients

BY LINDA HARDER • PHOTOGRAPHY BY TRACEY BROWN


MEANINGFUL USE STAGE 2:

Patient portals are not new. David Rowe,global director of Product Marketing atGE Healthcare IT, remarks, “We’ve hada patient portal for more than 10 years,but it was dormant until MeaningfulUse reawakened that marketplace. It’sa way for physicians to provide patientinformation easily and quickly.”

Portals Aid Two Measures in Stage 2Patient portals help physicians meet twocore measures of Stage 2. The firstmeasure requires providing a clinical visitsummary to at least half of your patientswithin three business days. The secondmeasure requires physicians toelectronically provide lab results,medication lists and the like to patientsupon request.

Most portals provide a range of functionsthat may include:� Prescription renewals� List of medications� Lab and other test results� Clinical summaries� Personal medical history� Secure SMS messaging� General health reminders

� Appointment requests� New patient registration

Not Just Another IT HeadachePatient portals may seem like just onemore IT headache. Yet the earlyexperience of doctors who haveimplemented portals in their office –sometimes under protest – suggests thatonce the hurdles of implementation andtraining have been crossed, the officewill be more productive, with happierpatients and providers alike.

Take the experience of AndrewMcGlone, M.D., a family practitionerwith Annapolis Primary Care. Earlyadopters of EHRs, they switched from anearlier EHR system to Epic in May of2009. In 2010, they added Epic’s patientportal, called MyChart, which can bebranded to the health system.

“At first,” confesses Dr. McGlone,“I was leery of yet another responsibilitythat I wouldn’t be reimbursed for. Now,my biggest complaint is that not enoughof my patients are using the portal.”Noting that about 20-30% of his patientshave signed on, he adds, “I was amazedby the amount of time the entire office

Physician offices barelybegan to pass Stage 1of Meaningful Userequirements before itwas time to gear up forStage 2, where a keyrequirement is toincrease the electronicinformation shared withpatients. MarylandPhysician spoke withtwo area primary carephysicians who haveexperienced patientportals first hand.

could save while also providing moreimmediate and better patient care.

“Before the portal,” Dr. McGlonecontinues, “if a lab result showed apatient’s thyroid needed adjustment, I’dcompare a piece of paper with the chart,then call the patient, often having to leavea message, then eventually having aconversation to confirm the dose and thepharmacy. In the patient portal, everythingis right there. In a few keystrokes, I canrelay the result and new dose adjustment,electronically prescribe the new medication,and order follow-up lab testing.”

Dr. McGlone enthuses, “You canrespond on your time and patients canreply back at their convenience. There isno need for additional documentation, as

the correspondence takes place in themedical record. If a patient’s lab or imagingresults are normal, you provide themreassurance in seconds. Another aspect thatmade me a convert is that patients cansend a message directly to me in their ownwords, not translated through the staff. Theportal removes a lot of barriers to care. Itallows us to engage in a productivedialogue with our patients, and we havethe system set up to protect us fromirrelevant or emergency requests.”

Types of Portals and CostsEssentially, patient portals come in three“flavors.” Some are integrated with thevendor’s EHR, including portalsprovided by Epic, NextGen, andeClinicalWorks. In a second model,vendors such as GE and Allscripts haveinterfaced third-party portals (Kryptiq

and Intuit Health, respectively) withtheir EHRs. A third model involves arelationship between the EHR vendorand an independent portal vendor, whichcould entail additional work for staff ifthey have to re-enter information.

Costs for the portals vary. With theEpic and GE Centricity systems, the flatfee paid for the EHR also covers thepatient portal module, but some vendorscharge an additional monthly fee.

Mark Lamos, M.D., president of

Greater Baltimore Medical Associates(GBMA), believes that portals havevalue, but is somewhat reserved abouttheir cost-to-benefit ratio. GBMA, apractice that encompasses 69 primarycare providers and other providers, usesthe fully integrated portal fromeClinicalWorks. Only a few months afterthe portal launched in January 2012,more than 9000 patients had signed up.

“The biggest advantage is that theportal is an alternative to another phonecall,” states Dr. Lamos. “The portalworks well if the question is succinct,and providers can select from recordedmessages to save time. At worst, it’s abreakeven and it probably saves time.”

Patient Participationand SatisfactionHe continues, “Patients ofall age groups are using itand overwhelmingly, they’rehappy. We used to have tomail their records to themand now we can quicklypost them online. However,we still send a letter ifsomething is questionable.A portal is not an excuseto avoid communicatingwith a patient.”

Perhaps surprisingly, even olderpatients welcome the portal if they arecomfortable with technology and

MAY/JUNE 2012 | 21

Andrew McGlone, M.D., a family practitionerwith Annapolis Primary Care. Right: MarkLamos, M.D., internist, president of GreaterBaltimore Medical Associates, and staff.

Patients of all age groups are using it andoverwhelmingly, they’re happy. – Mark Lamos, M.D.

DDRR.. LLAAMMOOSS AADDVVIISSEESS PPHHYYSSIICCIIAANNSS::� First convert your records from

paper to electronic.

� Select a software vendor with a proven functional portal.

� Before you promote the portal toall of your patients, test it on asmall number of patients andmake sure employees can handletheir questions.

� Don’t delay implementation;future pay-for-performance basedplans will require them

computers. Dr. Lamos notes, “The tool is simple enough that patients canuse it easily.”

“To encourage participation, we havecomputers in our front lobby and seniorswho volunteer to serve as tutors,” addsDr. Lamos. “The front desk staff askspatients if they want to sign up, we havesigns in the waiting rooms, and I andother staff wear buttons that say ‘Ask MeAbout the Portal.’”

GBMC also developed aninstructional video for patients. *Otherpractices report that sending postcardreminders to patients and havingtechnologists and other extenders discussthe advantages of the portal beforepatients leave the office can be effectivetools to increase participation.

“Compared to the challenge of thePatient Centered Medical Home, this is apiece of cake,” comments Dr. Lamos.However, he cautions, “It’s not aweekend process. It takes days to weeksof effort to implement.”

Mobile, Rapid ResultsPatients can use the web-based Epicportal from most laptops or android oriPhone platforms. “We often have sameday turn around on laboratory andimaging results which patients receivewith our interpretation and instructionson their mobile devices. The efficiencyof electronic correspondence for routinemedical care allows more time in the day for phone conversation to addressurgent or concerning results,” Dr.McGlone exclaims.

“One of my favorite things isproviding reassurance and follow-upthrough the portal,” he concludes. “Wecan send quick messages to stay in closecontact with sick patients and trackchanges from medications in real time.Patients are more active participants intheir own health. We can even set thesystem to remind them of flu shots,mammograms or other screening testswhen they are due.”


*The myGBMC portal is located at gbmc.org/myGBMC; the video is available at video: http://vimeo.com/35900413

A NEW KURE FOR YOUR PATIENT’S NECK AND BACK PAIN

Call 800-997-2460kurepain.comNine locations throughout Maryland & DC

Our multi-disciplinary approach means our physicians are highly experienced in a variety of procedures that precisely deal with your patient’s back and neck pain. We often have same day appointments and accept most insurance plans. Before you consider medication, discover the best way to “Kure” your patient’s pain.

• Back pain• Neck pain• Arthritis• Work injuries• Degenerative disc disease

Formerly

Outpatient Procedures• Incision-free treatments• No general anesthesia• No lengthy recovery time• No fusions or hardware

USE YOUR QR READER TO DOWNLOAD OUR APP

MARYLAND PHYSICIAN

GOES MOBILENow your go-to source for the news that matters most to Maryland physicians is available on-the-go on your mobile devices.

matters most to Maryland physicians is

Now your go-to source for the news that

GOES MOBILEYLAND PHYSICIANMAR

matters most to Maryland physicians is

Now your go-to source for the news that

GOES MOBILEYLAND PHYSICIAN

available on-the-go on your mobile devices.matters most to Maryland physicians is

available on-the-go on your mobile devices.matters most to Maryland physicians is Andrew McGlone, M.D., family practi-

tioner, Annapolis Primary Care.

Mark Lamos, M.D., internist, president

of Greater Baltimore Medical Associates

(GBMA), the GBMC HealthCare-owned

group of more than 40 multi-specialty

physician practices.

MAY/JUNE 2012 | 23

Good Medicine Has ItsRewards: $228 Million

We have returned $228 million to our members through our dividend program.The 2012 dividend is made possible by the excellent claims experience of our members

in Maryland. As a leading carrier in the state for more than two decades, The Doctors

Company is strong. This strength allows us to deliver on our promise to defend, protect,

and reward the practice of good medicine.

7.5% dividend for

Maryland members in 2012

To learn more about The Doctors Company’s medical

professional liability insurance program in Maryland,

including the member dividend, call (866) 990-3001 or

visit www.thedoctors.com.

www.thedoctors.com

Clinical FeaturesMaryland Physician focuses on the latest cancer

developments. We talk with top Maryland specialists to

get their take on the effectiveness of the latest treatments

for prostate, breast and blood cancers.

Healthcare ITIn every issue, Maryland Physician explores a different

facet of the race to implement EHRs to meet Meaningful

Use and other e-health government incentives. Don’t be

left behind – read what Maryland physicians and health-

care IT experts have to say that eases the pain of transition

to an electronic world.

In Every Issue and OnlineCases � Solutions � Compliance � Medical Beat � Policy

Jacquie Roth � Publisher/Executive Editor443-837-6948 � [email protected]

www.mdphysicianmag.com

Mobile App + Email =

MORE APPOINTMENTS

MedMarketer.com Book More Appointments. Guaranteed.

MedMarketer

com.erte

MORE APPOINT


kMedMar

MarkMede AppoinBook MorBook More Appoin

MORE APPOINT


eterMarkteed.ants. Guarts. Guarantmene Appoin

SENTMMORE APPOINT


T’S THE TYPE OF PLACE THATis sought out by people of all interestsand likes. Some come to relax. Others

come to explore, enjoy nature, seekadventure or learn. Those who havevisited, be it for a fun family weekend, aromantic getaway or for a few simple andquiet days of solitude, would say thatthere is something for just abouteveryone in Harper’s Ferry, the littletown that is perched where Maryland,Virginia and West Virginia, as well as theShenandoah and Potomac rivers, meet.

A History Lover’s ParadiseHistory buffs will have more than enoughsites to see and stories to hear while visitingHarper’s Ferry. The town became a favorite

retreat hot spot for U.S. presidents in the late nineteenth and early twentiethcenturies; in fact, Thomas Jeffersonhimself was once quoted, referencingHarper’s Ferry as “a beautiful spot that isworth a trip across the Atlantic.” Perhapsmost notable in history books read todaywas the 1859 raid against the federalarmory at Harper’s Ferry, orchestrated inan attempt to end the institution ofslavery in Maryland and Virginia. The act,led by abolitionist John Brown, who wascaptured during the raid and later hungfor his conviction, is commonly cited as apivotal movement in history that spurredthe start of the Civil War. Today, thetown’s “John Brown Wax Museum”showcases 87 life-sized wax figurines to

show and tell the complete story.And that’s not all. The first steel

structural bridge in the world wasconstructed in Harper’s Ferry, and marksthe spot where the first railroad crossedthe Potomac River. American manuf-acturing was forever changed when in the industrial district of town, it wasproven that interchangeable parts couldand should be used to develop goods.And, in 1865, Storer College opened itsdoors in Harper’s Ferry, becoming thefirst institution to offer educationalopportunities to freed slaves who aspiredto read, write and develop new skills.Well before its time, the school helpedencourage African Americans to pursueentrepreneurial paths.


Living

Harper’s Ferry: A Getaway Worth Exploring Tracy M. Fitzgerald

COURTE

SY O

F HARPE

RS FE

RRY TOURISM

History lovers, adventure seekers and romantics at heart easily find common ground in Harper's Ferry,where there is much to see, do and explore. Many who visit find themselves returning time and timeagain, to enjoy a getaway that can be reached easily and relatively quickly, from just about every pointin the State of Maryland.

I

A fter an early spring visit to Fort Sumter in Charleston, the battle site which launched the

Civil War, I was inspired to visit another pivotal Civil War site, Harper’s Ferry. With thanks

to Fitzgerald Auto-Mall Annapolis and homage to John Steinbeck, my Standard Poodle

Eli and I set off to Harper’s Ferry in a 2012 Volkswagen Passat V6. VW is legendary for its German

engineering and premium standard features in an automotive class ripe for comparison. Does it

deserve those impressive accolades as “2012 Car of the Year”?

Having experienced German engineering and VW’s – including a Super Beetle that needed

to be jump started, heading downhill to pop the clutch and one spanking new BMW traded in after

my first baby was born for a VW Jetta with 116,000 miles – the Passat didn’t disappoint. We had a gorgeous spring day to test the

Passat’s drivability and fun factor. Always eager for a ride, Eli wasn’t shy about jumping right into a very roomy rear seat and I was

excited to see if the Passat was as much fun to drive as my ‘80s VW GTI. Living up to its family’s reputation, it was.

The V6 engine and relatively low weight added spunk and easy maneuverability as we navigated our way to Harper’s Ferry. Lots

of modern technology with user-friendly controls and navigation system made me feel snug, safe and secure in my driver’s space.

The iPod doc, impressive Fender sound system and large sunroof added to the trip’s enjoyment factor.

So, do Eli and I believe that the 2012 deserves to be named best in class? The photo of Eli’s fuzzy head poking out of the Passat

along the Shenandoah’s riverbank says it all with his Poodle grin – yes!

Touring the TownSelf-guided historical tours of the townhave proven to be a popular way to takein all that’s there to see. Those who areeager to learn some new things duringtheir stay may opt to participate in achartered or group tour. O’ Be JoyfullHistorical Tours and Entertainment gives Harper’s Ferry tourists a chance to experience the town’s most notablehistorical spots, with entertainmentinspired from the Civil War days. Thosewho crave a bit of “spooking” will want totake American’s oldest ghost tour, whichincludes a one-hour walking expeditionaround Harper’s Ferry’s “lower town,”where a number of ghostly phenomenonshave been reported.

Exploration and Outdoor Adventure Those who visit Harper’s Ferry tonavigate the great outdoors may find theNational Historic Park to be a good placeto start, with over 2,300 acres stretchingacross three states, giving site see-errsplenty to explore. In fact, the parkcontributes to the many reasons why arthistory experts have described Harper’sFerry as “the most painted town inAmerica because of its beautiful scenery.”Some choose to spend their timemeandering along the miles upon miles ofhiking and biking trails, perhaps stoppingoff to toss out a fishing line or snap a fewphotos along the way. Others takeadvantage of the chance to saddle up andgo for a horseback ride through the BlueRidge Mountains or along the outskirts of the Potomac River. Those seeking

excitement and adventure have plenty ofoptions too, with whitewater rafting trips,tubing, canoeing and zip line canopytours all available.

Wine and Dine with a Local FlairThere is no shortage of dining options to be found in town. Those wishing to continue their historical-themedexperience may want to dine at TheTown’s Inn Restaurant and Pub, knownfor its cuisine from the Civil War era. Iflocally grown food and wine are priorities,be sure to put the Canal House Café andthe Grandale Farm Restaurant on the go-to list. Additionally, a number of deli’s,café’s and taverns are open year-round inthe heart of town, and serve everythingfrom pizzas, burgers, subs and salads, to hearty soups, barbeque and seafoodentrees. Homemade ice cream and candyshops are also plentiful, for a mid-daysnack or after-dinner sweet treat.

Call it a NightBecause there is so much to see and do,staying overnight in Harper’s Ferry maybe a good idea. Armory Quarters,neighboring the National Park and withinwalking distance of many restaurants,shops and battlefields, is a good option forthose who want to see and do it all. As aspecial bonus, Hollywood Casino andCharles Town Races are only about fivemiles away. For those seeking morequaint and quite accommodations,perhaps for a special weekend away, adozen-or-so bed and breakfasts are openfor business. And for the true nature and

outdoor enthusiasts? Book a site at one ofHarper’s Ferry’s campgrounds, eachlending themselves to beautiful riverviews and sun-up to sun-down access tohiking trails, watersports and otheroutdoor activities.Resources and tips for planning a visit

to Harper’s Ferry, as well as a listing of

upcoming events, can be found at

www.historicharpersferry.com.

MAY/JUNE 2012 | 25

Local Harper’s FerryDoc Gets YoungstersMovingSome people who live in or near

Harper’s Ferry know Dr. Mark

Cucuzzella because of his work as a

family medicine physician in the

community. Others know him

because of the active role he plays

in encouraging young people to get

out, get active and be healthy,

through his leadership in developing

the “Tiger on the Trail” hiking

program, a partnership between

Harpers Ferry Family Medicine, the

middle schools in Jefferson County

and Harpers Ferry National Historic

Park. Dr. Cucuzzella can often be

found leading groups of students on

hikes throughout the park,

promoting the importance of

physical and activity and healthy

living, along the way.

Travels with Eli

JACQUIE ROTH


DESPITE THE FACT THATlegislators did not approve the statebudget in time, on the whole, it was ahighly successful legislative session forMaryland physicians, with the MedChiLegislative Committee reviewing a totalof 222 bills and proposals. At press time,it was anticipated that a Special Sessionwill be called to pass a budget.

Mr. Ransom observes, “From theperspective of physicians, we had anincredible legislative session. It wouldhave been a home run if Medicaid hadpassed, and I’m cautiously optimistic that it will pass in a Special Session.”

MEDICAID REIMBURSEMENT“The Senate version of the bill, whichwould have increased E&M (evaluationand management) codes for all specialtiesby nearly $70 million, won out over theHouse version,” notes Mr. Ransom. “But because the budget was not passed,the legislation is currently in limbo. An increase in these codes couldpositively affect the existing deterrentsfor accepting Medicaid patients, whichwill be even more critical when healthcare reform creates a larger Medicaidpopulation.”

The fee increases will not occurunless there is a Special Session thatenacts the related revenue measuresnecessary to fully fund the Budget.

LEGISLATION THAT PASSEDThe following bills were passed by bothChambers and await Governor MartinO’Malley’s signature.

Prior Authorization Reform Bill (SB 540/HB470) Both Chambers passed identical versions ofthis Bill, which was MedChi’s top priority

for 2012. It calls for insurance interme-diaries to adopt a single electronic methodfor submitting prior authorization requests.It will allow a physician to access insurancewebsites to determine preauthorizationrequirements and then request itelectronically, using unique trackingnumbers. Most drugs will be eligible forreal-time preauthorization by July 2013.

Mr. Ransom comments, “Physiciansare currently spending inordinateamounts of time contacting insurancecompanies for authorization. TheMaryland Health Care Commission haslaid out a plan to move to a standardized,electronic system for filing and processingrequests, and this legislation willempower them to hold insurersaccountable. This bill provides a gameplan for the next three years.”

Health Disparities/Enterprise Zones (HB 439/SB 234)The Administration’s legislation ondisparities provides $4 million in newmoney for physicians in certainunderserved zones, the location of whichis yet to be determined. This bill was a top priority of the MedChi DisparityCommittee for 2012, which arose fromthe disparity report completed byUniversity of Maryland Medical SystemDean Albert Reece, M.D., in 2011.

Mr. Ransom comments, “We testifiedin favor of the bill, which takes effect July2012. We’re polling our members to seewho is interested in applying for the fundsto better serve areas with health disparities.”

Coverage for Telemedicine Services (SB 781/HB 1149)This legislation requires covered insurersto reimburse providers when medicalservices are delivered via telemedicine.

However, two other telemedicine billsthat deal with credentialing and licensurewere not acted on favorably. Says Mr.Ransom, “The other bills raised a varietyof complex issues and will best beaddressed next year after discussion byvarious stakeholders.”

Health Benefit Exchange (SB 238/HB 443)The Maryland Health Benefit ExchangeAct of 2012, as it is called, creates anoption for individuals and smallbusinesses seeking to purchase healthand dental insurance under the federalAffordable Care Act. The exchange mustbe operational by fall 2013 and beginoffering coverage Jan. 1, 2014.

Truth in Advertising (SB 395/HB 957)This complex legislation, which dealtwith advertising, badges and informationregarding how healthcare practitionersdescribe their services, was scaled backbut moves the issue forward.

HIPPA /Privacy (SB 954)With the help of Attorney GeneralDouglas Gansler, MedChi supportedamendments to this bill, which wasintroduced by CareFirst. “Thelegislation, which initially lessenedprivacy restrictions, became a very goodbill that protects patient privacy, whileallowing for positive data sharing withinPatient Centered Medical Homes andACO programs,” says Mr. Ransom.

KILL(ED) BILL(S)Physicians successfully defeated severalpieces of legislation, including multiplebills dealing with scope of practice. “We were especially concerned about abill that would have created a licensingboard for naturopaths, which was tabled,”notes Mr. Ransom. “We stopped theencroachment from other groups wherethey don’t have the level of training orexpertise to practice.” Visit medchi.org for a more complete review.

Policy

Recap: Physicians Gain Ground in 2012Maryland General Assembly Session

Maryland Physician interviewed Gene M. Ransom,III, Esq., CEO of MedChi, to discuss highlights ofthe 430th General Assembly session.

LINDA HARDER • PHOTOGRAPHY BY TRACEY BROWN

MAY/JUNE 2012 | 27

130 Admiral Cochrane Drive, Suite 102 l Annapolis, MD 21401 l www.SHRAssociatesinc.com l 410.897.9888

Building Healthy Practicesin today’s dynamic healthcare environment

As a leader in the field of medical practice

management, SHR Associates, Inc. delivers

consulting and practice management services to

physicians and healthcare organizations. We

provide the business resources and tools to help

physicians prosper in today’s dynamic healthcare

environment. We offer both short-term consulting

and ongoing management services to help

healthcare organizations maximize revenue,

reduce overhead, promote growth, manage risk

and develop dynamic teams.

Proudly servingthe physician communityfor over 30 years!

Hospice of theChesapeake’s

Chesapeake KidsWhen home is whereyou want to be . . .

There are limited options forMaryland families with pediatrichospice needs. In response to

community outcry from both healthcareprofessionals and families in need,Hospice of the Chesapeake has addedto its child focused programs with thelaunch of two programs. Both areholistically centered under theumbrella of Chesapeake Kids.

The Perinatal and Infant LossSupport program is designed tosupport families who have receivedthe devastating news that their unbornchild has a condition which may resultin stillbirth or early death. The programis designed to support families throughall aspects of the journey they are aboutto take, from planning through pregnancy,birth and death. While honoring thefamily’s wishes, Hospice of theChesapeake facilitates lasting memoriesof the family’s pregnancy and baby.

The challenges of caring for a childwith a life-limiting illness can be over-whelming and can take a toll on the entirefamily. As part of its commitment to careand support families, the second pediatricprogram was launched and created tocare for children living with advancedillness. Hospice of the Chesapeakeprovides support and care in the home,surrounded by family members andmemories providing much needed comfort.

An interdisciplinary team of health-care professionals, chaplains and trainedvolunteers provide the care, comfortand support for infants through youngadults living with advanced illness andthe associated treatments while providingeducation and support for the caringfamily. The support continues as thefamily works through its needs when facedwith the grief from the loss of their child.

Chesapeake Kids also includesHospice of the Chesapeake’s griefcamps for children, Camp Nabi andPhoenix Rising as well as its ongoinggrief counseling support programs forchildren hosted through The LifeCenter. For more information please call, 1-877-462-1103 or visitwww.hospicechesapeake.org.


Advertiser IndexAdvanced Radiology ....................................................2

www.advancedradiology.com

Lifebridge Health ...........................................................5

www.lifebridgehealth.org

Chesapeake Bay Foundation....................................6

www.cbf.org

Saint Agnes .......................................................................8

www.stagnes.org

KURE Pain Management ..........................................22

www.kurepain.com

The Doctors Company ...............................................23

www.thedoctors.com

MedMarketer .................................................................23

www.medmarketer.com

MetroMedia Power.....................................................27

www.mmenergy.com

SHR Associates ..............................................................27

www.SHRAssociatesinc.com

Papercamera...................................................................28

www.papercamera.com

MEDENT EMR .................................................................28

www.medent.com

Maryland Wound Healing Center .......................31

www.marylandgeneral.org

Washington Adventist Hospital...........................32

www.TrustedHeartCare.com

MPM online: more content, more answers and more often!

Increase the power of your marketing to Maryland physicians, healthcare executivesand Maryland healthcare stakeholders via advertising on mdphysicianmag.com

Jacquie Roth - Publisher/Executive Editor443-837-6948

[email protected]

ONLINEwww.mdphysicianmag.com

Medent Version 19.5Medent Version 19.5

Medent Version 19.5CC-1112-119223-1

http://www.medent.com/onc-atcb.html

MEDENT EMR/EHRWith the Top rated MEDENT EMR many doctors have received their Meaningful Use money!

The MEDENT Patient Portal, which is an option for the EMR has practices seeing productivity gains of 30%!

Request a demo of the ICD-10!

Call 1.315.255.1751today or visit us atmedent.com

HILE OPERATING Apractice, a physician is forced to delegateduties to trustworthy employees.Sometimes, this trust is not warranted andthe temptation to take something knocksdown the protective walls of honesty. Agood adage to keep in mind is that fraud istypically committed by someone we trust.Understanding how and why fraud occurscan help you prevent it.

There are three major reasons thatindividuals commit fraud:

� Pressure – pressures from anemployee’s personal life, such asfinancial need, debt, lifestyle orgambling addictions, can be the drivingforce behind these acts

� Opportunity – the employee works inan environment where his or her workgoes unchecked due to the stress of the day, time constraints or negligence.Exceptions are frequently made byvarious employees for a variety ofreasons and often go unnoticed. Theorganization lacks proper segregation of duties and adequate checks andbalances, so that errors in accountingare often undetected

� Rationalization – employees believethat their actions are warranted in someway. They may say to themselves, “I’llpay it back,” “They won’t miss it,”“I’m underpaid” or “I didn’t get a raisefrom my last review.”

Medical practices in today’s economyare constantly facing reductions inreimbursement and other outside factorsthat affect revenue generation. The last thing a practice needs is to sufferadditional losses due to internal fraud. A practice can reduce the potential for fraud by recognizing the reasons why employees may commit fraud and by immediately establishing andmaintaining an environment where

all employees from the top downare in compliance.

The most common ways thatemployee dishonesty or fraudoccurs is paying fictitious invoicesor absconding with receipts of the business and markingaccounts paid. To prevent thesetypes of fraud, we recommend the following steps:

1. The bank statements should bereceived unopened each month by atrustworthy employee, or preferablythe physician. This individual shouldnot have any responsibility formaintaining the accounting records,paying bills, billing, etc. When thestatement is received, the physician ordesignated employee should carefullyreview the signatures on the checks for any improprieties or forgeries.Physicians should also look at thepayees to ensure these are vendorswith whom your business is dealing.Another precaution you should take is to watch for double endorsements on canceled checks, which could be a sign that funds have been divertedfrom the original intended payee. A reputable business is not going to co-endorse their checks.

2. All incoming mail, especially thepayments on account, should beopened and received by an individualwho has no accounting, billing orbookkeeping duties. All posting toaccounts receivable records should bedone by reports generated from thedeposit slips or the actual deposit slipsthemselves. If someone is going toabscond with cash, they will mark anopen account as paid and divert thepayment. Do not make the mistake ofthinking that, because the customer isissuing a check to your business, thesefunds cannot be diverted. Horrorstories abound about individuals who

have opened up corporate accountswith falsified documents. Banks willopen up an account with a board ofdirector’s resolution and financialpaperwork. Both of these can befalsified.

3. Spot-check any voids or credits to youraccounts receivable records and ensurethat these were properly authorizedand warranted. In the medicalprofession, there are substantial write-downs. You should receive a report ofthese on a monthly basis.

4. Pay careful attention to sales returnsand voids of the medical supply sales.This is a common way that a dishonestemployee can pocket supplies.

5. On a monthly basis, review reports that show accounts receivable aging,services by procedure, checks made to cash, and miscellaneous and voidedchecks.

6. Carefully inspect what you sign or pay. “Rubber stamping” or signingdocuments without thought creates a temptation for your staff.

The above suggestions can be easilyimplemented to improve your practice’sinternal control processes – and yourbottom line!

MAY/JUNE 2012 | 29

Compliance

W

Six Ideas to Help Improve Internal ControlProcesses within Your Practice

By Bob Galiszewski, CPA and Cory Chaney, Senior Accountant

Bob Galiszewski, CPA, Shareholder,

[email protected].

Cory Chaney, Senior Accountant and

chair of KatzAbosch’s Medical Practice

Services Group, [email protected]


Lending Much-Needed Helping Hands to the People of Africa

HILE VISITING AFRICAin support of the U.S. State Department’sInternational Information Program in theearly 2000’s, Barbara Margolies had theunique opportunity to meet with MadamAicha Foumakoye, the then Minister ofSocial Development in Niger. Throughher conversations with him, she learnedabout a complex and debilitating healthcondition called vesico vaginal fistula,impacting thousands of Nigerianwomen. And right away, she knew shehad to do something about it.

“What I learned and what I sawliterally brought me to tears,” Margoliessaid. “These women, some as young as 13 years old, were suffering andneeded help.”

In 2003, she led the establishment ofthe International Organization for Womenand Development (IOWD), with a goal to rally surgeons and nurses together toprovide volunteer medical assistance forwomen in Africa who required surgery.Vesico vaginal fistula is a result ofprolonged, obstructed labor withoutmedical assistance, causing the formationof a hole in the wall between a woman’sbladder and vagina, and leadingultimately of the leakage of urine. Withextremely limited access to doctors,medical facilities and medications, morethan 200,000 African women havebecome outcasts in their own society as a consequence of this extremelyhumiliating and uncomfortable condition.

With Margolies’ leadership, IOWD’sfirst medical mission took place inOctober 2003, and since then, more than1,000 African women have been treatedby U.S. doctors and nurses, who havevolunteered their time and talent to notonly performing surgeries and providing

medical care, but also serving as teachersfor African physicians, originally inNiger, and more recently in Rwanda.IOWD has organized teams of 25 to 30 obstetricians, gynecologists,anesthesiologists, urologists and nurses,and has returned to Africa nearly 30times, making strides with each visittoward the establishment of a sustainableprogram for the repair of fistulas.

“The key is to go back again andagain,” Margolies said, who has workedto develop partnerships with King FaisalHospital and Kibagabaga RegionalHospital, both in Rwanda. “Over time,this is what has helped us earn the trustand respect of the people there. Theyknow we care and want to help them,and they welcome us whole heartedlywhen we arrive each time.”

Four physicians from Maryland havetaken part in IOWD’s mission efforts,three of which represent Anne ArundelMedical Center: Dr. Briana Walton, apelvic medicine and reconstructivesurgeon; Dr. David McDermott, aurological surgeon; and Dr. ClaudiaHays, OB/GYN. Dr. Joan Blomquist,

a urogynecologist from GBMC, has alsovolunteered. Margolies believes that thephysicians who get involved are peoplewith special gifts and hearts.

“The doctors come and see what theneeds are, and most importantly theimpact they can have … and then theycome back,” she said. “Coming on thesemission trips gives our doctors a chanceto use their skills in a new way, and theylike that.”

Mission trip planning is a constantpriority for Margolies, and she is activelyseeking new volunteers for upcomingvisits to Rwanda. Her most significantneed is for physicians and nurses whospecialize in obstetrics, gynecology andurology. Those interested in learningmore about how to get involved cancontact Margolies directly by sending anemail to [email protected].

Good Deeds

Maryland Physician would like to hear about your “Good Deeds.” Please share your ideas with us at [email protected].

WBy Tracy M. Fitzgerald

INTE

RNATIONAL ORGANIZATION FOR W

OMEN

AND DEV

ELOPM

ENT

Left to right: On a recent mission trip, GBMC’s Dr. Joan Blomquist (pictured right, in blue), workedwith Rwandan doctor Victor Mivumbi, to surgically repair a fistula. Teaching the Rwandans physi-cians is a key priority for IOWD. Dr. David McDermott from Anne Arundel Medical Center recentlyperformed a six-hour surgical procedure for young Eric. Today, he is no longer incontinent.

Any patient with a wound that has not begun to heal in two to three weeks will most likely require advanced wound care. The new Maryland Wound Healing Center at Maryland General Hospital extends your expertise and provides you with an effective resource for problem wound management.

Our coordinated, multidisciplinary approach to healing complex wounds utilizes clinically proven treatment options that are highly effective in expediting the healing process, including:

• advanced dressings and wraps• debridement• hyperbaric oxygen therapy• bio-engineered tissue substitutes• negative pressure wound therapy• growth factor therapies

Healing wounds is our specialty. To refer patients, call 1-855-866-HEAL

You care for your patients. We care for their wounds.

in woundYour partners

in dYour partners

healing.

827 Linden Avenue Baltimore, MD 21201 • 1.855.866.HEAL or 410.225.8600marylandgeneral.org/woundhealing/htm

Chris Barritt's 5,000 Mile Journey Began atWashington Adventist Hospital

Chris Barritt, 57, Mount Airy, Heart Tumor Surgery

The Cardiac team at Washington Adventist Hospital o�ers themost advanced treatments in heart care, including:

To refer a patient for acardiac surgery consult,

call 301-891-6101.

For priority transfer of yourcardiac admissions, callCardiac One-Call at866-684-8460.

The Ride of His Life

maryland physician magazine may/june 2012 issue

Documents