Thursday, January 29, 2015

Grounded

I am sure this happens to you too.  You are at a party and a friend introduces you to others you are meeting for the first time.  At some point, they ask 'So what do you  do?'

'So what do you do?'    

When someone asks this question, we often start talking about work and our professional activities. Some may avoid 'talking about work' and go on to talk about what they do with their family.  However, what I learned from Bob Rosen, author of the  New York Times bestselling book Grounded is that both the question and answer are misplaced.

Who you are is not defined by what you do.  For example, my position as president of MHRI or as an academic cardiologist is not who I am.  These are things I do (with passion!) because of who I am.  The things I choose to do (and the manner in which I do it) is a product of who I am.  Yes, the truth is that what you do is driven by who you are and not the other way around.

So who are you? That is what the person at the party meeting you for the first time really wants to know.  

What we learned at our  MHRI Managers' retreat today is that  who you are (the roots of the tree), the part of  you that makes up the components of 'you' (that make you grounded) and allow you to grow (the tree to grow) and become what you have become are based on different domains of health.  These domains include: physical health, emotional health, intellectual health, social health, vocational health and spiritual health. Think about it - if you  don't have physical health, your ability to 'do things' will be impaired.  Same for emotional health and all the others. Knowing yourself in each of these domains helps you become grounded and working on improving these different healths makes your roots stronger so your 'tree' can grow stronger and weather the winds of change. 

These concepts will form the bases for the professional development program called 'MedStar Leader of the Future.'  Over the next few months, I hope to share more information on my perspective on each health domain and the launch of MedStar Leader of the Future program.

Monday, January 26, 2015

MedStar Set To Open Ambulatory Care Campus in Downtown DC

Earlier this month MedStar announced plans to develop a 112,000 sq. ft. ambulatory care campus at Lafayette Centre, between 20th and 21st streets in northwest Washington, D.C. 
MedStar will occupy 92,000 sq. ft. of the Lafayette Centre’s Building 2, which will be renamed the MedStar Health building. We will have clinical treatment areas and offices on six floors and a dedicated lobby off 21st Street. In addition, MedStar will lease 20,000 sq. ft. of Building 1 on 20th Street where space will be redeveloped as a sports medicine center that will serve all levels of athletes and weekend warriors in the District and surrounding communities.
The MedStar Surgery Center, which has served the community for more than 35 years at its 19th Street location, will also be relocated to the MedStar Health building, with state-of-the-art surgical capabilities. Primary care and specialty physicians currently practicing nearby will relocate their offices to the center.
Services at MedStar Health at Lafayette Centre will include:
  • Men’s health
  • Women’s health
  • Primary and preventive care
  • Heart and vascular care
  • Orthopaedics and sports medicine
  • Rehabilitation (physical, occupational, and speech therapy)
  • Same-day surgery
  • Full-service medical imaging
  • Laboratory services
  • Other specialty services
The center is expected to be operational in mid-2016.

To see the full press release, visit:  

https://www.medstarhealth.org/Pages/News%20Articles/MedStar-Health-Set-to-Start-Construction-Project-in-Downtown-DC.aspx

Wednesday, January 14, 2015

Regulatory Science at Georgetown



Regulatory what?

Earlier this week I participate in a leadership meeting for the Georgetown University Program for Regulatory Science & Medicine (or PRSM) where we discussed the growing potential for ‘regulatory science.’ While regulatory science is not new, the term is not well known so I thought it would be a good topic to share and show another example of the strength of our academic partnership with Georgetown. 

Regulatory science is often confused for regulatory affairs. As you know, regulatory affairs comes into play at specific points in time during research (such as the IRB approval, reporting adverse events or when an IND or NDA are filed with the FDA); regulatory affairs deals with compliance, quality, and ensuring the ethical conduct of research and human subject protection.  As such, it is a vitally important component of any research enterprise.



However, regulatory science is a form of translational science conducted throughout the entire clinical research lifecycle and potentially across multiple studies. It is the science of the regulator process. What is the best way to regulate a study - well, that can be turned into research questions for which a study is designed to answer. Regulatory science looks at innovative approaches or new tools that can be used in the regulatory process of research to improve efficiency, efficacy or quality of the process. For example, does one method of oversight or access to data or consent process produce a better outcome than another?

Another way to distinguish between regulatory affairs and regulatory science is through these questions:
-          Do you want to do research the right way today? If yes, your answer is regulatory affairs.
-          Do you want to do an innovative approach to research to improve the way we do research tomorrow? Then what you need is regulatory science.

The FDA has driven an effort to elevate regulatory science and demonstrate its significance, in part by awarding academic Centers of Excellence – Georgetown PRSM is home to one such Center – and by writing strategic plans or documents that explain the science.

I’m very excited to be part of this team at Georgetown University that aims to catalyze clinical research through regulatory science. It is a very forward-thinking group of individuals who are interested in a wide range of topics relevant to regulatory science, from bioinformatics to patient-reported outcomes research, direct-to-consumer genetic testing, and the transformation of clinical trials.  This group also fits nicely with our other foreward looking clinical research activities such as CTTI (Clinical Trial Transformation Initiative) and UIDP (University Industry Demonstration Project) .

The Georgetown Program for Regulatory Science & Medicine offers research opportunities as well as education and training to FDA, Georgetown, and MedStar employees. As such, it means we at MedStar have a unique opportunity to interact with FDA – and I highly encourage you to take part.

If you would like to learn more about regulatory science or if you would like to participate in seminars, training, or other opportunities, contact Erin Wilhelm (eew6@georgetown.edu), who directs the program at Georgetown. Erin will be happy to talk with you or connect you to your areas of interest.

Sunday, January 11, 2015

Smartphone Medicine 2015

Once again, the new year is full of predictions. In the Wall Street Journal's Saturday Essay, Eric Topol (a cardiologist by the way!) shares his vision of how smartphones will change medicine.  Two things struck me:  1) 'Wow' - this is really going to change everything we currently do today and how the emphasis will move to 'health' (early detection and prevention of disease) that is driven by people rather than doctors and 2) a sense of Déjà vu - you see, it was this time last year that I posted on this blog about SmartPhone Medicine.

Nonetheless, this article is very provocative.  Here are a few excerpts:

Over the past decade, smartphones have radically changed many aspects of our everyday lives, from banking to shopping to entertainment. Medicine is next. 

With the smartphone revolution, an increasingly powerful new set of tools—from attachments that can diagnose an ear infection or track heart rhythms to an app that can monitor mental health—can reduce our use of doctors, cut costs, speed up the pace of care and give more power to patients.

Let’s say you have a rash that you need examined. Today, you can snap a picture of it with your smartphone and download an app to process the image. Within minutes, a dedicated computer algorithm can text you your diagnosis. That message could include next steps, such as recommending a topical ointment or a visit to a dermatologist for further assessment.

Even bigger changes are in the works. Using wearable wireless sensors, you can use your smartphone to generate your own medical data, including measuring your blood-oxygen and glucose levels, blood pressure and heart rhythm. And if you’re worried that your child may have an ear infection, a smartphone attachment will let you perform an easy eardrum exam that can rapidly diagnose the problem without a trip to the pediatrician. 

Even bigger changes are in the works. Using wearable wireless sensors, you can use your smartphone to generate your own medical data, including measuring your blood-oxygen and glucose levels, blood pressure and heart rhythm.


Other wearable sensor tools now being developed include necklaces that can monitor your heart function and check the amount of fluid in your lungs, contact lenses that can track your glucose levels or your eye pressure (to help manage glaucoma), and head bands that can capture your brain waves. Someday, socks and shoes might analyze the human gait to, for instance, tell a Parkinson’s patient whether his or her medications are working or tell a caregiver whether an elderly family member is unsteady and at risk of falling.

Take asthma attacks. A teenager who’s prone to wheezing in gym class could get comprehensive data on environmental exposures such as air quality and pollen count, along with data on physical activity, oxygen concentration in the blood, vital signs and chest motion; their lung function can be assessed through their smartphone microphone, and their nitric-oxide levels can be sampled via their breath. Then that information could be combined with the data from every other tracked asthma patient—and trigger a warning, delivered by text or voice message on the teenager’s phone, that an attack is imminent and tell the teenager which inhaler would prevent it.

As I said, very thought provoking!

Wednesday, January 7, 2015

Healthy Working for the New Year

So let me guess...your new year's resolution this year involved healthier living. Whether through exercise or diet, or what you will or will not do this year as compared to last - right?

Since we all spend a substantial amount of time at work, I ask you to start the year by thinking about healthier living while at work. This fits nicely with our HRO (high reliability organization) goal to have a safer environment for us, our associates and our patients. It also fits nicely with our goal to improve wellness (such as healthy choices through benefit selection and the wellness committee activities). 

Let me tell you about one of my initiatives - through our new relationship with 1776 I learned about a healthier desk that helps get you up and moving! The body is just not made to be in a sitting position for a prolonged period so this "treadmill desk" allows you to stand and slowly walk (0.5 to 2.0 MPH) as you work.  We placed one of these in the cardiovascular core laboratory to try it out.  In the attached pictures, you can see me reading echocardiograms (cardiac ultrasounds) and filling out the electronic case report form, as part of a multi-center trail on new heart valves.  

It's great!  This afternoon, I walked 7000 steps (3.5 miles based on my fitbit) as I got my work done!

So what will make your workplace safer and healthier?  Discuss this with your supervisor and management team. We want to hear your ideas.  I am committed to our MHRI associates to make this as healthy a work environment as possible and will look at any reasonable idea that is feasible. Remember, improving health, including our health, is part of our overall vision of "advancing health" at MedStar so lets start the new year out on the right foot!

Monday, December 29, 2014

Holiday Award Season!

It’s been another successful proposal season at MHRI with several new federal and foundation awards as well as commercial contracts all within the last quarter of the year. I would like to extend a BIG congratulation to the investigators below for their recent accomplishments. It’s wonderful to see how their science will extend from the bench to the bedside to the community and ultimately make healthcare safer, better and more accessible. From a new PCORI contact to a high profile CDC study to a prestigious Robert Wood Johnson Foundation award to an impressive AHRQ R01, the studies below all represent truly innovative and transformative research at the most elite level. To all investigators – thank you for your hard work and contributions to research across MedStar!





Suzanne Groah, MD, MPH,  director of Spinal Cord Injury Research at MedStar National Rehabilitation Network was recently awarded a prestigious research contract from the Patient-Centered Outcomes Research Institute (PCORI), titled “The Impact of Self-Management with Probiotics on Urinary Symptoms and the Urine Microbiome in Individuals with Spinal Cord Injury and Spina Bifida.” As part of the three year study, with a projected budget of $1,785,883, Dr. Groah’s team will conduct a prospective study in which they will develop and assess a patient-initiated Self-Management Protocol using Probiotics (SMP-UTI) instilled directly into the bladder for UTI symptom relief, early UTI management, and urinary health.  The team will also develop a urinary symptom questionnaire for individuals with neurogenic bladder which will facilitate future research endeavors.




  Kathryn A. Walker, PharmD, will be leading a project with Abt Associates to develop a coordinated care plan for safe opioid prescribing for U.S. health systems. As part of the contract, awarded to Abt Associates by the CDC, MedStar will become the first healthcare system in the nation to develop, pilot and test a safe opioid prescribing plan which will then be available as a guide for any health care provider or system to implement in their practice.  MedStar’s subcontract is for an 18 month period.









Sarah E. Henrickson Parker, PhD, Research Scientist at the National Center for Human Factors Engineering in Healthcare was recently awarded an 18 month grant titled “Leveraging the informal social networks that exist in health care settings to improve patient safety” from the Robert Wood Johnson Foundation. More information about the grant can be found here: http://www.rwjf.org/en/grants/grant-records/2014/07/leveraging-the-informal-social-networks-that-exist-in-health-car.html 
  





Rollin J. "Terry" Fairbanks, MD, MS, director of the National Center for Human Factors in Healthcare and director of the Simulation Training & Education Laboratory (MedStar SiTEL), emergency physician at MWHC, and associate professor of emergency medicine at Georgetown University received an AHRQ R01 award for “Cognitive Engineering for Complex Decision Making & Problem Solving in Acute Care.” This five year, $2.5 million award is being lead by Dr. Fairbanks and his co-PI Zach Hettinger, MD MS, Medical Director of the National Center for Human Factors in Healthcare, emergency physician at Union Memorial, and assistant professor of emergency medicine at Georgetown University, and continues a productive collaboration with the department of industrial systems engineering at the University at Buffalo. This grant is a follow-on to work the team completed as part of Dr. Fairbanks' NIH K08 career development award from the NIBIB which ended recently.