Expanding Access

Project Connects Clinics Serving Most Vulnerable with Health Systems, Specialists

Posted on Sep 16, 2020 in Community Benefit, Expanding Access, Health Equity, Scroll Images, Uncategorized

Pandemic underscores value of seamless connection. More than 2 million patient records shared with participating providers.

Coordination between health care providers can be crucial for patients’ health – and it’s even more important while caring for them during the COVID-19 pandemic.

A newly completed electronic health record system is enabling primary care providers from Community Health Center Network (CHCN) health centers to better coordinate patient care, improve health equity, and manage population health for the vulnerable groups they care for in the East Bay. The project electronically connects the eight community health centers of the CHCN with local health systems and specialists.

The new system – powered by OCHIN Epic Electronic Health Record (EHR) and funded through generous grants from Sutter Health and Kaiser Permanente– allows CHCN health centers to reliably and confidentially share patients’ electronic health records (EHR) with participating providers.

With more seamless collaboration between health centers, primary care providers, hospitals, and specialists in Alameda County, more than 270,000 patient records are now digitally accessible. Through this state-of-the-art EHR technology this is helping provide high-quality health care for the area’s most vulnerable residents.

“This new integrated system ensures that patients will have a seamless experience, while receiving the best possible coordination of their care,” said Ralph Silber, CEO of CHCN. “We’re already seeing the positive impact and transformative potential of the OCHIN Epic EHR, as it’s deployed across our network.”

First implemented at Axis Community Health, OCHIN Epic EHR is now available at all eight of CHCN’s community health centers with the last health center, La Clínica, launched in April.

“We were really pleased to be able to complete this deployment for CHCN, despite the pandemic, by offering full support for a virtual go-live at La Clínica,” said OCHIN CEO Abby Sears. “Now more than ever, we need to ensure frontline providers and public health authorities are able to exchange real-time health information and can respond quickly to the needs of their communities.”

When the COVID-19 pandemic began, health centers had to quickly adapt to caring for patients virtually. OCHIN Epic allowed CHCN health centers to quickly begin telehealth and video appointments so patients could continue receiving high-quality health care.

“OCHIN Epic is a powerful system,” said Sue Compton, CEO of Axis Community Health in Pleasanton, Calif. “We’re just beginning to explore its full capabilities, but the portal already offers more engaging features for our patients and more robust charting features for our providers, including both medical and Integrated Behavioral Health providers. It has strengthened our capacity to meet the complex needs of the patients we serve.”

The OCHIN Epic EHR also provides CHCN health centers with tools for data reporting and population health management, and offers a patient portal called My Chart, which facilitates patient communication.

To date, over 2 million patient records have been shared between CHCN health centers’ OCHIN Epic EHR and hospital/specialist EHRs. With full implementation, the system supports over 500 primary care, dental, and behavioral care providers who serve over 270,000 patients across CHCN’s network of care.

“Sutter Health is a longstanding partner of CHCN and its member clinics. We are delighted to expand our partnership through this vital initiative to improve care coordination between health care providers and to deliver comprehensive, quality health care for underserved communities of the East Bay,” said Emily Webb, vice president Bay Area External Affairs for Sutter Health. “Being connected through technology will support improvements in care for vulnerable patients at an especially critical time when the need is so great in our communities.”

“As a nonprofit organization with a mission to improve community health, Kaiser Permanente is pleased to support this important work,” said Kevin Hart, senior vice president, Strategic Development and Technology, Kaiser Permanente Northern California. “We are investing and partnering in our communities to improve health care quality and access; helping build out the EHR among our safety net partners is key to this.”

The OCHIN Epic EHR is available at CHCN’s community health centers including: Asian Health Services, Axis Community Health, Bay Area Community Health, La Clínica, LifeLong Medical Care, Native American Health Center, Tiburcio Vasquez Health Center, and West Oakland Health.

“Tell me your life story, I’m listening, I see you.”

Posted on Sep 3, 2020 in California Pacific Medical Center, Community Benefit, Expanding Access, Health Equity, Innovation, Mental Health, People, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento

Faculty and residents in Sutter’s Family Medicine Residency Program

We are a mosaic of our experiences, lifestyle, social and family connections, education, successes and struggles. Apply those factors to our health, and a complex formula arises that clinicians commonly call the patient experience.

Learning the skills to assess these factors and deliver compassionate care to patients is what Sutter’s family medicine resident physicians aim to enhance. The newly enhanced Human Behavior & Mental Health curriculum is helping lead the way.

“We encourage faculty and residents to think about context, systems and dynamics within population health to address social determinants of health,” says Samantha Kettle, Psy.D., a faculty member in Sutter’s Family Medicine Residency Program.

She and colleague, Andy Brothers, M.D., a family medicine physician in Sacramento and faculty member in the residency program, are bringing health equity to the patient experience and training family medicine residents in Sacramento and Davis.

Family medicine faculty and residents at Sutter Medical Center, Sacramento

Seven residents each year learn to screen patients for social determinants of health (such as financial challenges, environmental and physical conditions, transportation needs, access to care and social factors) that may impact patients’ risk of depression and anxiety, substance use disorder and suicide.

This year’s residents may train in addiction medicine, psychotherapy, chronic pain, spirituality in medicine, well-being and the field of medicine that supports those who are incarcerated.

And in a community as diverse as the Sacramento Valley Area, statistics suggest these factors may significantly impact the health of its residents:
• 15.9% of California adults have a mental health challenge(1)
• Nearly 2 million Californians live with a serious mental challenge
• Substance misuse impacts 8.8% of Californians
• The prevalence of mental health challenges varies by economic status and by race/ethnicity: adults living 200% below the federal poverty level are 150% more likely to experience mental health challenges; 20% of Native Americans and Latinos are likely to have mental health struggles, followed by Blacks (19%), Whites (14%) and Asians (10%).

“Taking care of our local population’s health is a moral imperative,” says Dr. Kettle. “Many residents have entered our program to continue their quest in helping people in underserved communities.”

For instance, third-year Sutter family medicine resident Mehwish Farooqi, M.D., is studying ways to screen for post-partum depression using an approach developed through the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program.

“Women are most vulnerable to mental health concerns during the post-partum period: as many as one in seven women experience PPD. ROSE is a group educational intervention to help prevent the diagnosis, delivered during pregnancy. It has been found to reduce PPD in community prenatal settings serving low-income pregnant women,” says Dr. Farooqi.

“Sutter has clearly demonstrated a commitment to health equity and social justice that has propelled our residency program toward a future vision of health care in which all patients are cared for as individuals with unique life stories, struggles and successes,” says Dr. Brothers.

Advancing Social Determinants of Health through Graduate Medical Education at Sutter:
Other family medicine programs across Sutter’s integrated network incorporate health equity into ambulatory training for residents. The family medicine faculty at California Pacific Medical Center include a social worker who teaches residents to address concerns like financial and food insecurity, as well as social isolation. Residents learn how to care for people with depression and anxiety, and lecture series are offered on topics like addiction medicine and chronic pain/narcotic management.

Sutter Santa Rosa Regional Hospital’s Family Medicine Residency Program incorporates social justice through a Community Engagement and a Diversity Action Work Group—a committee comprised of faculty and residents who help tackle issues around inequity and structural racism.

“We are committed to strengthening a relationship between the residency program and the diverse communities we serve, guided with cultural mindfulness and compassion in our pursuit of overall wellness for all,” says Tara Scott, M.D., Program Director of the Family Medicine Residency Program in Santa Rosa.

Learn more about Sutter’s Family Medicine Residency Program.
• Find out how Sutter is advancing health equity.

Reference:

  1. California Department of Health Care Services.

Video Visits by Flashlight: Telehealth Keeps the Doctor ‘In’ Even When the Power is Out

Posted on Aug 25, 2020 in Carousel, Expanding Access, Quality, Safety, Scroll Images, Transformation, Uncategorized

When the next heat wave causes power outages or the next round of wildfires prompt evacuations throughout Northern California, chances are the global COVID-19 pandemic will still be unfolding. Under any or all of these conditions, we want to remind patients how and when to seek care, even during displacement or power loss.  

First: Make Your Smart Phone Smarter with the My Health Online App.

There is no question that mobile phones have become essential to our lives, and that reality has been underscored during the current emergency. Your phone may already receive alerts, including air quality reports, evacuation announcements or planned power shutoff notices, but is your phone optimized for your personal health needs?

If you haven’t already, we encourage Sutter patients to download the My Health Online smart phone app from the Apple App Store or Google Play. The My Health Online smartphone app helps connect you with your care team – even if you lose power or are displaced – provided you have wireless or mobile internet access and a charged phone battery.

“When we created the My Health Online patient portal we knew we would need a mobile phone option, but I don’t think we realized how important it would be in the context of natural disasters,” said Albert Chan, M.D., chief of digital patient experience at Sutter Health. Within the app you can send a message to your care team, view lab and most test results, securely access health records and schedule and complete a video visit.

“While we previously saw the app as a convenience, we now know that it’s a necessity; in fact we have a dedicated support team at (866) 978-8837 to troubleshoot any issues that patients have activating the app,” said Dr. Chan.

Second: Know that Severe Weather Can Cause Symptoms to Worsen, Quickly.

The smoke from wildfires, the heat in late summer and the stress of evacuation or a power outage can compromise your immune system and put stress on your body. “People who already have heart or lung-related illness, and some who don’t, may need personalized medical care to manage through this period,” said Chan. Video visits can often help doctors determine the severity of symptoms, provide medical advice and guide someone to in-person care as needed; providing reassurance in a very uncertain time.

“Bottom line, if you experience new or worsening symptoms we encourage you to schedule a same-day video visit with your doctor or another provider in the Sutter network – don’t ignore your body’s signals.”

You can also use the “symptom checker” that is integrated into Sutter Health’s website and My Health Online patient portal. Originally launched in February 2019, the self-led symptom checker is a kind of online survey that helps patients decide whether to engage in self-care or to seek care, if they need an in-person appointment or a video visit, and if they need to be seen now or soon.

As always, call 911 or go directly to the nearest hospital emergency department if you are experiencing chest pain or having difficulty breathing.   

Third: Don’t Let an Evacuation Erode Your Health.

“Often, when people are ordered to evaluate they are in such a great rush that they leave medications, medical equipment, or medical instructions behind,” said Chan. “We recommend preparing a ‘go bag’ for each member of the family with medications and any needed medical supplies, just in case.”

But if you have to evacuate without medications, remember an often- overlooked value of video visits is their role in enabling physicians to authorize new prescriptions or call in short-term refills of existing medications to pharmacies near a patient’s temporary relocation spot. “We will do everything in our power to assist with your medication or medical device needs, so please remember to reach out as soon as you are somewhere safe.”

Virtual ‘Topping Out’ Ceremony Caps Sutter Santa Rosa Expansion Milestone

Posted on Jul 30, 2020 in Expanding Access, Scroll Images, Sutter Santa Rosa Regional Hospital

SANTA ROSA, Calif. – With a few clicks of a mouse, the community logged on to witness the “topping out” of Sutter Santa Rosa Regional Hospital’s new three-story expansion. The medical facility reached its latest construction milestone on July 30 and marked the occasion with a virtual gathering, where viewers watched as the final structural steel beam was secured into place. Hospital staff; elected officials, including Congressman Mike Thompson and Susan Gorin, chair of the Sonoma County Board of Supervisors; HerreroBOLDT crewmembers; and the public, all tuned in.

Hospital CEO Dan Peterson kicked off the program and acknowledged the unusual online ceremony made necessary by the pandemic. “This is no traditional ‘topping out.’ We’re using technology to keep everyone safe, and we’re making history with one of the country’s first virtual topping out celebrations.”

Watch the full program below.

Healthcare, Always in Demand

The healthcare industry continues to be one of the largest and fastest growing in the U.S. The country’s aging Baby Boomer population, plus the addition of the COVID-19 crisis, has only made healthcare more taxed and in demand than ever.

“Today healthcare is on all our minds as we face the continued threat of coronavirus pandemic. This facility will expand our ability to deliver quality care no matter the crisis we face—a pandemic, wildfires or earthquakes,” said Congressman Thompson. “I can’t wait to celebrate, hopefully in person, when we cut the ribbon to open the space.”

Supervisor Gorin added, “Sutter has been a vital partner to Sonoma County for almost three decades, and this expansion is the embodiment of its continued commitment to the community. This hospital will provide high-quality care to residents in a state-of-the-art, seismically safe and environmentally conscious setting.”

Expansion Will Add Hospital Bed Capacity

Sutter Health has invested $158 million to expand the hospital to increase capacity, adding 40 all-private patient rooms, 13 outpatient care unit beds, an 11-bed post-acute care unit bay, and 21 emergency department bays. The first phase of the three-story tower will add 67,000 square feet of space and is scheduled for completion in spring 2022. It will be followed by a phase II renovation to expand the hospital’s emergency department and support services in fall 2022.

“Today’s ceremony is a celebration of a momentous achievement for our hospital that will help us serve our patients and our community for generations to come. Everyone at Sutter Santa Rosa knows the hard work it’s taken to reach this milestone, and I want to offer a heartfelt ‘thank you’ to our team, which has continually served this community with integrity and compassion,” said Peterson.

Out with The Shovels and in with The Sharpies

Ahead of the event, hospital staff, physicians and construction crewmembers were invited to sign their names on the final beam. Former hospital CEO, Mike Purvis, was even on hand to add his name to history.

“It warms my heart to know that this beam was personally signed by our hospital’s doctors, nurses, staff and construction crew—all important players in our hospital’s future,” said Peterson. “Once the beam is bolted into place, it will signify that we’re ready for the next chapter in our 2022 hospital expansion.”

Construction in the Time of COVID

From first learning of the pandemic, the HerreroBOLDT team made worker safety its number one priority, ensuring proper social distancing and masking.

“Our biggest accomplishment thus far has been that we have not had a single case of COVID-19 spread on our project,” said Tom Guardino, HerreroBOLDT project superintendent. “Our entire team has been committed to early proactive behaviors.”

Crunching the Numbers of Hauling Dirt & Erecting Steel

• During the preparation of the project site, crews hauled off 3,300 yards of dirt—enough to fill 1.5 Olympic-size swimming pools.

• During the foundations phase, teams poured 1,987 yards of concrete. It was delivered in 223 concrete trucks and represents 8 million 47 thousand pounds of concrete.

• Roughly 196 thousand pounds of reinforcing was used to strengthen the building’s foundations. If stretched out in a continuous line, it would span more than 7 miles.

• The expansion consists of 441 tons of structural steel, weighing about 882,000 pounds. To put that into perspective, an average blue whale weighs about 110 tons. That means the building’s steel weighs about four blue whales.

“We are excited about the opportunity to build such an important project in the North Bay. A lot of our construction works are from this area. We’ve enjoyed a long and successful history with Sutter, and we are proud to be part of a project that will give back to the community for years to come,” Guardino said.

About Sutter Santa Rosa Regional Hospital

Sutter Santa Rosa Regional Hospital, part of Sutter Health’s not-for-profit integrated network of care, is an 84-bed acute care hospital that offers an extensive array of inpatient and outpatient services. The facility opened in 2014 and has a long, proud history of providing high quality care in Sonoma County and beyond. Because of an unwavering focus on health and healing the hospital is consistently ranked as one of the top hospitals in the region.

How a Rural Hospital Treated a COVID-19 Patient 120 Miles Away

Posted on Jul 2, 2020 in Expanding Access, Innovation, Memorial Hospital, Los Banos, Quality, Safety, Scroll Images, Uncategorized

When Sutter Health’s Memorial Hospital Los Banos had a critically ill patient test positive for COVID-19, there wasn’t an ICU room for her. The small community hospital’s four ICU beds are located in the same large room separated by curtains, and this patient needed to be isolated.

A private room was made available, but there was a problem: It was not equipped with the Sutter eICU telehealth system that allows 24/7 critical-care physician coverage from a central hub 120 miles north in Sacramento. But, as part of its preparations for a COVID-19 patient surge, Sutter Health had just deployed a new system that allowed its eICUs to more than double its capabilities. The patient in Los Banos was the first to be cared for using the new system.

Sutter, a national pioneer in electronic ICU (eICU), has for years ensured critically ill patients in both large cities and small towns have 24/7 access to an expert team of doctors specially trained in their care. From central hubs in Sacramento and San Francisco, these doctors monitor patients in ICUs many miles away using live interactive video and remote diagnostic tools to instantly assess critical changes in a patient’s condition and provide expert critical-care physician support and supervision for the hospitalists, specialists and nurses who provide the hands-on care.

Sutter Health has more than 300 ICU patient rooms at 18 hospitals, each one outfitted with interactive video cameras, but in a matter of a month, Sutter designed and deployed specialized units that enable the eICU’s critical-care physicians to care for upward of 1,000 coronavirus patients without having to travel from hospital to hospital and using in-demand PPE. As part of its COVID-19 surge planning, each hospital set aside other patient rooms that don’t have the eICU video technology installed, and Sutter’s eICU team created and deployed 82 iPad stands across its network to bring these specialized critical care teams to those patients, too. Including the patient in Los Banos.

“The challenge was to come up with a plan for our eICU to provide care for a surge in patients across Northern California,” said Dr. Tom Shaughnessy, medical director of Sutter Health Bay Area eICU. “We are now able to meet the need of a patient surge by giving the same comprehensive, quality care whether a patient is in one of our ICU beds or a converted room.”

With the assistance of the eICU team through the mobile units, the patient in Los Banos recovered from the novel coronavirus. Now rural hospitals throughout the Sutter network are prepared for patients who need to be isolated and still have 24/7 critical-care physician coverage, and Sutter’s larger hospitals are prepared for a future patient surge of any type that requires all-hours critical-care coverage.

“We have nurses and physicians providing some of the best bedside care in the country, and the eICU allows us to come in and provide advanced specialized support as they care for patients,” said Dr. Vanessa Walker, medical director of the Sutter Health Valley Area eICU. “This is critical in the care for those suffering from compromised lung function due to a virus such as COVID-19. Now with these additional mobile units, we are well prepared to meet a surge of patients from this current crisis or any other that may come in the future.”

Vanessa Walker, D.O., cares for a patient through the eICU system in Sacramento

A Conversation Guide: COVID-19 Medical Research Terms Defined

Posted on Jun 22, 2020 in Affiliates, Community Benefit, Expanding Access, Innovation, Quality, Research, Safety, Scroll Images

Investigational Treatments
Researchers conduct clinical trials to study investigational or experimental treatments to determine if potential new treatments, such as drugs and medical devices, can safely and effectively prevent or treat disease or other health concerns. Clinical trials of potential new drugs can also provide information on how much of a drug is needed, what benefits and side effects may occur, and how drugs or other interventions impact individuals differently based on age, gender, and race/ethnicity.

Drug and medical device development is most commonly conducted in several phases:
Preclinical tests: Before clinical trials involving humans are conducted, potential treatments are first assessed in preclinical research. Such preclinical research assesses the features of a test or treatment. For example, the research may aim to learn if a device is harmful to humans. Another aim may be to learn more about the chemical composition of a drug. In preclinical studies of vaccines, researchers give the vaccine to animals to see if it produces an immune response.

Phase 0: These studies are the first clinical trials conducted in humans. They aim to learn how a drug is processed in the body and how it affects humans. In these trials, a very small dose of a drug is given to about 10 to 15 people.

Phase 1: These studies assess the safety of a drug or device. This phase of testing, which can take several months to complete, usually includes a small number of healthy study participants (20 to 100 people). Phase 1 studies aim to better understand the effects of the drug or device on humans. For drug studies, this may include how the drug is absorbed, metabolized or excreted in humans, and what side effects may occur as dosing increases. In Phase 1 studies of vaccines, researchers give the vaccine to a small number of people to test safety and dosage, and confirm that it stimulates the immune system.

Phase 2: Phase 2 studies test the effectiveness of a drug or device over several months to two years, and involve up to several hundred patients. Most Phase 2 drug studies are randomized trials where one group of patients receives an experimental drug, while a second “control” group receives a standard treatment or placebo. Often these studies are “blinded,” meaning neither the study participants nor the researchers know who has received the experimental drug or other intervention. With such an approach, comparative information can be generated about the relative safety and effectiveness of the new drug, device or other intervention.

In Phase 2 studies of vaccines, researchers give the proposed vaccine to hundreds of people split into groups to see if the vaccine acts differently among the various groups of study participants. These trials seek to further test the proposed vaccine’s safety and ability to stimulate the immune system.

Phase 3: These studies involve randomized and blind testing in several hundred to several thousand study participants. This large-scale testing, which can last several years, seek to provide the manufacturer of a proposed treatment with a thorough understanding of the effectiveness of the drug or device, as well as the benefits and the possible adverse reactions or side effects. Once Phase 3 is complete, a pharmaceutical company or medical device company may use the data generated and collected from the performance of the Phase 3 study in order to request FDA approval to market the drug or medical device.

In Phase 3 studies of vaccines, researchers give the vaccine to thousands of people and wait to see how many become infected, compared with study volunteers who received a placebo. These trials can determine if the vaccine protects against COVID-19, for example.

Phase 4: These studies, often called Post Marketing Surveillance Trials, are conducted after a drug or device has been approved for consumer use. Pharmaceutical and medical device companies have several objectives at this stage: to compare a treatment with other similar treatments already in the market; monitor the treatment’s long-term effectiveness and impact on a patient’s quality of life, and; to determine the cost-effectiveness of a particular approved treatment relative to other traditional and new therapies.

In Phase 4 studies of vaccines, regulators in each country review the trial results and decide whether or not to approve the vaccine. During a pandemic, a vaccine may receive emergency use authorization before formal approval.

Expanded Access
Sometimes called “compassionate use,” expanded access is a potential route for patients with a serious or life-threatening disease to gain access to an investigational drug or device where there is no comparable, alternative therapy, but the patient’s clinician, in coordination with the pharmaceutical or medical device company, believes that the particular treatment may be beneficial to the patient if applied. Expanded access use of a drug or device is done outside of the clinical trial context, but, as with clinical trials, also involves regulatory and reporting obligations to the FDA.

As of June 2020, expanded access is one pathway advancing the use of convalescent plasma for patients with serious COVID-19, who are not otherwise eligible for or who are unable to participate in clinical trials.

Emergency Use Authorization
An Emergency Use Authorization (EUA) is one way the FDA makes certain medical products (drugs, tests, vaccines) available quickly during a pandemic. The FDA may issue an EUA to provide access to these products when there are no adequate, approved options.

Under an EUA, in an emergency, the FDA provides access to the public based on the best available evidence, without having all the evidence that would normally be needed for full FDA approval. The FDA balances the potential risks and benefits of the medical products based on the data currently available.

EUAs can be revised or revoked by the FDA at any time as the agency continues to evaluate the available data and patient needs during a public health crisis like a pandemic.

“Off-Label” Use of an Approved Drug
After the FDA approves a drug for a certain disease or health condition, doctors may prescribe the drug in clinical care for an use not specifically listed in the approved labeling (i.e., “off-label”) based on the physician’s medical judgment, but recognizing that the FDA has not assessed the safety or effectiveness of such use.

For example, in April 2020 the FDA acknowledged that certain off-label use of the antimalarial drugs hydroxychloroquine and chloroquine had been prescribed by physicians for the treatment of COVID-19. These drugs have been FDA approved for use in treating malaria, but not for widespread use in treating COVID-19 since no formal clinical trials had been previously conducted to examine the efficacy of the drugs for this purpose. The FDA thus did not have data necessary to support an approved use of hydroxychloroquine or chloroquine.

“FDA Approved”
The FDA is the national regulatory agency that among its various duties, approves drugs, medical devices, and vaccines based on clinical data and other information showing that the treatment is safe and effective for its intended use and in compliance with federal quality standards. The “stamp of approval” is provided when the FDA determines that the benefits of a drug, device of other medical product outweigh its risks.

Learn more about clinical research and the phases of clinical trials.