UC Davis doctoral student Katherine Kim honored by HIMSS.

Katherine Kim, UC Davis

Katherine Kim, a Betty Irene Moore School of Nursing at UC Davis doctoral student, was awarded the Healthcare Information and Management Systems Society 2011 Northern California Chapter scholarship for academic excellence. The society annually awards eight scholarships at its national conference to student members who possess the potential to be future leaders in the health-care information and management-systems industry.

“I am so honored and excited to receive this scholarship,” Kim said. “As part of the award I had the opportunity to go to the national conference and be introduced to leaders in the field. This is the type of invaluable experience that can help open doors at a national level.”

The Healthcare Information and Management Systems Society is focused on providing global leadership for the optimal use of information technology and management systems for the improvement of health care.

Kim, one of the 33 inaugural-class students at the School of Nursing, juggles a full-time class schedule, teaches at San Francisco State University and leads the Interprofessional Health Informatics Special Interest Group. The student group, which she co-founded, was created to provide professional development opportunities. The group’s goal is to stay on the cutting edge of informatics — the use of electronic resources, devices and methods to enhance the acquisition, storage, retrieval and use of information in health — and to be aware of ever-changing new technologies that can be used to improve health care and systems.

She is excited about the future of nurses as leaders in health informatics. Nurses, as the primary health care providers who acquire and manage health information, are in the best position to think of new ways technology can solve problems in health care, Kim said. Education in human-computer interaction and how technology may be better applied prepares the future workforce, she continued.

Kim plans to use the scholarship award to prepare her dissertation, which focuses on the development of a tool to assess how technology can be matched to individuals to improve their health. Kim says she hopes to increase people’s capacity for self-management and enhance their interactions with health care providers.

“As a researcher and university faculty member, I will be able to conduct applied research that leverages the field of health informatics to design, develop, implement and evaluate interventions that place consumers in control of their health and support a partnership among people and their health care providers,” Kim said.

Kim was the only Californian awarded a scholarship at the Healthcare Information and Management Systems Society award banquet Feb. 23 during its annual conference in Las Vegas. More than 35,000 members attended the four-day conference. To learn more about the Healthcare Information and Management Systems Society visit www.himss.org.

About the Betty Irene Moore School of Nursing at UC Davis: For 100 years, UC Davis has engaged in teaching, research and public service that matters to California and to transform the world. The Betty Irene Moore School of Nursing at UC Davis was established in March 2009, UC Davis’ first major initiative to address society’s most pressing health-care problems in its second century of service. The school was launched through a $100 million commitment from the Gordon and Betty Moore Foundation, the nation’s largest grant for nursing education. The vision of the Betty Irene Moore School of Nursing is to transform health care through nursing education and research. Through nursing leadership, the school will discover knowledge to advance health, improve quality of care and health outcomes, and inform health policy. The school’s first programs, a doctoral and a master’s degree program, opened in fall 2010. Additional students and programs will be phased in over the next decade. The Betty Irene Moore School of Nursing is part of the UC Davis Health System, an integrated, academic health system encompassing UC Davis School of Medicine, the 645-bed-acute-care hospital and clinical services of UC Davis Medical Center and the 800-member physician group known as the UC Davis Medical Group. For more information, visit nursing.ucdavis.edu.

School of Medicine retreat focuses on applications in research, patient care and education.

(From left) Joseph DeRisi, Clay Johnston, Sam Hawgood, UC San Francisco

In the world of bioinformatics, the rush is on to extract gold from a data mine.

The amount of data that health care providers and scientists collect from patients and research participants is growing explosively. This information ranges from the genetic to laboratory tests and imaging exams, to medical histories and information about treatment and outcomes — and in some cases to survey data on large populations.

This deluge of data and the bioinformatics capabilities necessary to take advantage of it were the focus of this year’s daylong UC San Francisco School of Medicine leadership retreat on Jan. 20. In his welcome address, Dean Sam Hawgood, M.B.B.S., outlined his goal for the day — to engage campus leaders in the question of how to optimally develop, organize and integrate clinical-outcome data, research data, business intelligence, and population data so that information is accessible and usable to empower research and improve medical practice.

Making greater use of available data to improve care

Some have compared efforts to take advantage of the data to trying to drink from a fire hose. Consider DNA as an example. Our genetic variations contain clues to disease risk, disease prognosis and treatment response. The identification of such clues by scientists and their translation into medical practice is a major enterprise. Soon, expense will no longer be a major limitation to obtaining a readout of an individual’s entire genetic makeup. “A complete human genome assay will be an assay like any other, at least in terms of cost and time,” Hawgood said.

However, as vivid as the water hose analogy may be, it might be more apt to say that in many organizations data of many types dwells in various unconnected dammed reservoirs, with little of it flowing to potential users.

Much of the day’s discussions centered not only on identifying data to collect and on ways to use this data, but also on how best to “unlock the data” that already exists.

In introducing the day’s theme, Hawgood said that in his view, UCSF, despite the depth and range of clinical and research data being collected, must develop ways to make much greater use of available data in the day-to-day workflow to improve research and patient care.

UCSF’s leaders in informatics can learn from what others have already done. “We want to take enough time to make sure that we’re not repeating other people’s mistakes,” Hawgood said.

Already this year UCSF is completing implementation of a new electronic medical records system, called APeX, tailored to UCSF by EPIC Systems Corp. of Madison, Wis. The system features a single, comprehensive record for each patient.

Apart from being a boon to physicians and other care providers, information within the new clinical record can be “de-identified” to protect privacy and then made available to researchers.

The experience gained from the implementation and the system itself may be a good jumping off point for using data to advance research and education. But the true potential of APeX as a platform to support collaborative research is still being investigated. Taking full advantage of UCSF medical records for research — and enabling ways for new research findings to be used to better guide patient care — will require new innovations.

UCSF already has convened a task force, soliciting input from an external team of international leaders in the field, to explore strategies to bolster bioinformatics on campus, including the establishment of new academic programs and infrastructure through which computer sciences faculty and other bioinformatics experts could be recruited, new experts trained, and novel research collaborations launched. In addition, Hawgood noted, thanks to UCSF’s proximity to Silicon Valley, “We are in a spectacular region for partnerships.”

UCSF is exploring how to accomplish its bioinformatics goals within UCSF and its affiliates, as well as ways in which to access and use data in research networks that span institutions. In addition, there is a need to share information with other providers to provide the best care to patients who also obtain health care outside of UCSF, a theme discussed at last year’s School of Medicine retreat as well.

Using hospital systems as living laboratories

In his keynote address at this year’s retreat, “Aligning the Academic Health Care Enterprise for Acceleration of Precision Medicine,” Isaac Kohane, M.D., Ph.D., a renowned bioinformatics expert and a professor of pediatrics and health sciences and technology at Harvard Medical School, said that the expense of working with data from clinical records has historically been much more expensive than working with genetic and molecular laboratory data.

Kohane, who co-directs the Harvard Medical School Center for Biomedical Informatics, has led efforts to develop computer systems to allow cheaper use of clinical records data from multiple hospital data systems in the study of genes and disease, while maintaining privacy.

Kohane talked about the potential for “apps” to capture useful information related to health outside of the hospital or clinic — for instance a tool that tallies nutritional information on purchases from the cash register.

In his own research Kohane now combines clinical and genomic data to learn more about cancer and autism, but he also presented research showing that such systems — had they been in place earlier — could have called attention to serious side effects of Vioxx and other drugs much sooner.

Kohane’s described workflows and systems that can better “unlock” clinical data to speed research discovery and its application in medical practice, while lowering the costs of using clinical data.

Imagining UCSF’s future in the Digital Age

Speakers at a morning panel titled “Imagining UCSF’s Future in the Age of Information Technology,” included Opinder Bawa, chief technology officer for the School of Medicine; Michael Blum, M.D., medical director of information technology for the UCSF Medical Center; Catherine Lucey, M.D., vice dean for education; Joe DeRisi, Ph.D., co-chair of the Department of Biochemistry and Biophysics; and moderator Clay Johnston, M.D., Ph.D., director of the Clinical and Translational Science Institute at UCSF and vice chancellor for research.

Not all bioinformatics applications are orchestrated institution-wide from the top down. Panelists and commenters from the audience highlighted a role for applications developed by smaller groups. For instance, as an educational tool, UCSF faculty from the Department of Emergency Medicine have spearheaded implementation of software used by physicians-in-training to respond to simulated clinical scenarios unfolding in real time.

The data collected during these exercises can be used to better understand how long it is likely to take for emergency room physicians to take critical actions — in the management of chest pain or in the ordering of pain medication, for example. In essence, the data can be used to learn more about how we learn, knowledge that can be incorporated into successive generations of teaching tools.

In the coming years, physicians will be trained to become increasingly comfortable using improved, data-driven, decision-making software tools, according to Lucey. “We will be able to teach students how to learn for themselves for 30 to 40 years, and we will free faculty up to teach in person what needs to be taught in person.”

DeRisi described how information on UCSF graduate school applicants is being used to identify factors associated with future success. In addition, he described how extensive data collection is being used to log graduate students’ progress and decision-making throughout their careers —  another way of identifying early career paths that bode well for future success. DeRisi also talked about an information-technology partnership that allows lab notebook entries made on pad devices to be immediately incorporated into a computerized database.

Developing more innovative research, clinical protocols

An afternoon panel — “The Future Is Now” — moderated by Robert Hiatt, M.D., Ph.D., co-chair of the Department of Epidemiology and Biostatistics and deputy director of the UCSF Helen Diller Family Comprehensive Cancer Center, focused on two large-scale collaborative research programs co-led by UCSF researchers in which molecular, clinical and demographic data already are being put to work to develop more innovative research and clinical protocols.

Laura van’t Veer, Ph.D., leader, and Laura Esserman, M.D., co-leader of the cancer center’s breast oncology program, described the ATHENA Breast Health Project, which unites UC academic medical centers in a state-wide collaboration. The project will initially involve 150,000 women throughout California who will be screened for breast cancer and followed for decades.

ATHENA project leaders aim to create common systems to integrate clinical research and care across the UC campuses to advance the science of prevention, screening, diagnosis, and treatment of breast cancer. The collaborators are creating a biospecimen repository that has broad racial and ethnic representation. A major goal is to marshal molecular and clinical data to better personalize breast care, tailoring treatment to the patient and avoiding overtreatment, and to use the information gained to drive innovation in prevention, diagnosis and treatment.

Neil Risch, Ph.D., co-chair of the Department of Epidemiology and Biostatistics at UCSF and director of the UCSF Institute for Human Genetics, along with Catherine Schaefer, Ph.D., director of the Kaiser Permanente Research Program on Genes Environment and Health, described progress to date in building the largest data base of its kind to focus on genetic variation and environmental exposures in an older population.

The average age of the hundreds of thousands of individuals whose genetic information will be genotyped for the project is 65. The project’s foundation is Kaiser’s electronic health record, which for many Kaiser Permanente members has information spanning decades — including information on clinical diagnosis and treatment as well as lab-test results and prescription information. UCSF expertise has allowed extraordinarily fast genotyping, as well as uniquely large-scale analysis of telomeres to quickly grow the molecular component of the data resource.

The afternoon panel provided a useful point of reference for break-out groups that met afterward, charged with identifying institutional priorities, problems and potential solutions in advancing the use of bioinformatics in research, clinical care and education.

For instance, the ATHENA collaborators have standardized protocols used at the different medical centers, including protocols for mammography screening. To make clinical data more useful for research, some breakout session panelists advocated more extensive standardization of clinical imaging and clinical lab protocols and reporting throughout UCSF clinical practices.

The Kaiser-UCSF collaboration highlights ways to combine strengths across organizations. While Kaiser is famous as a health maintenance organization, UCSF is perhaps best known as a tertiary care center. Some breakout session panelists raised the question — also raised at last year’s retreat — of whether or not the focus of UCSF research should more closely reflect the patient population seen at UCSF and its affiliated medical centers. UCSF specialists routinely gather extensive information on large numbers of patients with serious acute and chronic conditions, including many of the most difficult–to-treat cases. This extensive data is a potential gold mine for research aimed at identifying factors related to disease risk, prognosis and treatment outcomes.

Moving toward a new taxonomy of disease

The retreat followed on the heels of a similarly themed report by the National Academy of Sciences (NAS), “Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease” [PDF] by a committee co-led by UCSF Chancellor Susan Desmond-Hellmann, M.D., M.P.H. The NAS committee advocated the creation of a “knowledge network” that could link researchers in collaborations that span the nation and globe.

The NAS panel envisioned a future in which there is much greater use of genomic and other molecular data to improve and refine the classification of diseases, but also recognized an opportunity to improve research by more extensively taking into account information about how patients fare in the clinic or hospital.

Instead of the current state of affairs, through which biological, pre-clinical and clinical research eventually lead to advances in medical practice, the new paradigm will be a virtuous cycle through which — with appropriate privacy protections — patient data also will feed back into research. In patient care increasing amounts of laboratory information will become available and interpretable more quickly to help teams of caregivers make more accurate and effective decisions and choices in diagnosis, prognosis and treatment for each individual patient.

New website puts prognostic indices in one central location.

Alexander Smith

A team led by researchers from the San Francisco VA Medical Center and the University of California, San Francisco, has completed the first systematic review of prognostic indices used to calculate a patient’s life expectancy, and created a website that puts these indices in one central location.

The review concludes that the most accurate and usable indices might have value when used in conjunction with other clinical information.

The review appears in the Jan. 11 issue of the Journal of the American Medical Association. The prognostic indices are collected at www.eprognosis.org.

Many medical interventions have guidelines recommending that doctors take a patient’s life expectancy into account, said senior investigator Alexander K. Smith, M.D., M.P.H., a palliative medicine doctor at the UCSF-affiliated SFVAMC.

Given this goal, he said, “It would be ideal if there were one index that would allow you to plug in your patient’s information – age, diseases, functional impairments – and get an accurate long-term prognosis,” Smith said. “Unfortunately, there is not. In the absence of that, we have this systematic review and corresponding online compendium, which we hope physicians will find a useful adjunct, along with patient preferences and their own professional judgments, in making clinical decisions that involve life expectancy.”

The authors note that the 16 indices need further independent testing for accuracy in different settings, and that further studies are needed to show whether use of the indices improves clinical outcomes. In the meantime, they have made the indices more accessible to clinicians and patients who are interested in the information they provide.

“We often don’t talk about prognosis with our patients, and, as clinicians, we are, frankly, not trained to think about it,” said lead author Lindsey Yourman, M.D., a medical student at UCSF at the time of the study. “This can lead to unnecessary suffering when we order invasive interventions for patients who may not live long enough to benefit from them.”

At the same time, she noted, prognostic indexes are not intended to limit care for elders. “In some instances,” she said, “they may lead to more interventions. For example, some older patients may not be offered cancer screening due to their age, but a prognostic index may suggest they are healthy and likely to benefit from cancer screening because of long life expectancy.”

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Expanded UC San Diego study uses text messaging to encourage dieters.

Cell phones aren’t just for talking any more. Surfing the web, storing music and posting to Facebook have all contributed to the near-mandatory use of a cell phone. How about using that cell phone to lose weight? Researchers with Calit2′s Center for Wireless and Population Health Systems (CWPHS) and the Department of Family and Preventive Medicine, at University of California, San Diego, are expanding a previous study aimed at finding out if cell phone technology can help with weight loss.

For one year, researchers with the “ConTxt” study will evaluate the use of cell phone text messages to remind participants to make wise nutritional choices throughout the day. Participants randomized to the intervention conditions will also be given tailored messages for weight loss and lifestyle changes as well as a pedometer to monitor their daily activity.

“ConTxt is an innovative, yet straightforward approach to getting people to monitor their diet and physical activity,” says CWPHS project principal investigator Kevin Patrick, M.D., M.S., professor of family and preventive medicine, UC San Diego School of Medicine. “We are trying to make this as pain free as possible. People won’t stick to something that’s too difficult and they’re all multitasking anyway. We’re doing this study to increase what we know about using the cell phone to get messages to busy people on the go.”

Who can participate?

ConTxt is recruiting more than 300 participants who meet these criteria:

• Men and women
• 21 to 60 years of age
• Overweight or moderately obese with Body Mass Index (BMI) of 27-39.9
• Own a cell phone capable of sending and receiving picture and text messages
• English- and Spanish-speaking participants who reside in San Diego County

Strategy

As a part of tailoring of the program, surveys completed during baseline visit will help assess the participant’s lifestyle, for example, assessing nearby grocery stores, finding opportunities for physical activity and possibly enlisting the support of friends or family.

The intervention is designed to send “prompts,” text or picture messages, with specific suggestions or tips regarding diet and improving lifestyle habits. “It seems like everybody has a cell phone. Those who do usually carry it with them at all times,” explained ConTxt study coordinator Lindsay W. Dillon, M.P.H., CHES. “We want to see if we can use that same technology to get people to think differently.”

About CWPHS

CWPHS research focuses on how the health of individuals, families, communities, social networks, and populations can be improved through the creative use of wireless and networked technologies. CWPHS is housed within the UC San Diego division of Calit2: the California Institute for Telecommunications and Information Technology.

Collaborators include physicians and scientists with backgrounds in clinical and preventive medicine, computer science and engineering, social networks, political science, clinical and experimental psychology, electrical engineering, health behavior, behavioral exercise and nutrition science and public health. Center research is supported through public and private sources, including the National Institutes of Health, the U.S. Centers for Disease Control and Prevention, the National Science Foundation, the Robert Wood Johnson Foundation, the American Cancer Society and Nokia Research.

To learn more about enrolling in the ConTxt study, call (858) 534-8412 or email contxtcoach@ucsd.edu.

Future UCSF Medical Center at Mission Bay to showcase advances.

A mock up of an acute pediatrics room at the future UCSF Benioff Children's Hospital at Mission Bay shows a multimedia wall.

A man with a rare form of cancer sits in his longtime doctor’s office, where the two of them discuss the latest innovations in treatment with a UCSF cancer specialist located hundreds of miles away.

A diabetic woman uploads data from her blood sugar monitor into UCSF’s secure online patient portal and then participates in a personalized quality-of-life survey – all from the comfort of her kitchen.

A child hospitalized with cystic fibrosis interacts with fellow patients and friends back home through a large video screen on the wall of his room at the UCSF Benioff Children’s Hospital.

These are a few of the many scenarios expected to unfold in the coming years as UCSF implements ever-more-advanced technologies designed to make life easier for patients and care providers, and help break the cycle of treating individuals only after they’re sick. Some of the changes will coincide with the planned opening in 2015 of the new UCSF Medical Center at Mission Bay, a state-of-the-art hospital complex designed to accommodate the best current technologies and evolve over time as new innovations arise.

“Technology is the lynchpin for all of us to engage in keeping patients well,” said Seth Bokser, M.D., medical director of information technology at the UCSF Benioff Children’s Hospital and co-chair of the Mission Bay IT executive steering committee. “We need to move from a system of sick care to a system of health care.”

Certain tools, such as the increased use of telemedicine, are already in the pipeline. UCSF recently launched a pilot program deploying telemedicine interaction with some of its referring pediatric hospitals so that local health care providers can interact in real time with both a patient in the community and a UCSF expert participating remotely. Alternatively, a provider whose patient is being treated at UCSF’s children’s hospital can stay apprised of his or her condition from afar.

By the time the new UCSF Benioff Children’s Hospital opens at Mission Bay, that program is expected to extend to all pediatric referring hospitals, Bokser said. The medical center at Mission Bay also will offer technology-based educational and entertainment options to patients that aren’t available at the current medical center at Parnassus Heights.

“We have many patients who are too sick to get up and get around or be around other children because of their infectious issues,” said Michael Towne, manager of Child Life Services at UCSF Benioff Children’s Hospital. “We see kids with cystic fibrosis having conversations with each other out in the hallway, standing 12 feet apart, doing anything they can to connect with another human being.”

Towne says the display screens on the walls of each patient room in the 289-bed medical center now under construction at Mission Bay could prove transformative for such patients.

“Imagine if you could Skype from room to room, or to family members who are back at home. Or if you could upload photos from your favorite vacation and cover the screen with them, like wallpaper,” he said. “We currently have a teen lounge where patients can share their war stories, but imagine if we were able to have a virtual teen lounge that every patient could take part in. We look forward to exploring those possibilities.”

The benefits of such technologies will extend to the new specialty hospitals for women and cancer patients as well, said Elena Gates, M.D., chief of the UCSF Division of General Gynecology, who has been closely involved in the medical center planning process.

“It will be like bringing people to a virtual meeting,” she said of the media walls. “Currently, in our birthing center, people bring in laptops and we see family members all over the world gathering to watch a birth remotely. In the future, we would make it easier for them to experience that special moment or, if someone comes into the cancer hospital for chemotherapy and has a support network back at home, they would be able have a group visit them remotely.”

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Parents, physicians recall different advice on children’s weight management counseling.

Ulfat Shaikh, UC Davis

Parents of overweight children and their pediatricians agree that doctors routinely provide weight-management counseling — but they disagree on just what the doctor actually ordered, a study by researchers at UC Davis has found.

The rigorous study, which involved the use of parent questionnaires, audiotapes of well-child visits during which the weight-management counseling was delivered and examination of electronic health records, found that parents tend to overreport and doctors underreport the counseling delivered on weight, nutrition and physical activity.

The study on the “Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling,” is published online today (Jan. 3) in the journal Academic Pediatrics.

“It’s important to find ways to accurately understand what occurs during medical care,” said Ulfat Shaikh, director of Healthcare Quality Integration at the UC Davis Schools of Health and the study’s lead author. “Reviews of medical records and patient surveys are commonly used as proxies for actually being inside an examination room and observing the visit. But before we use these methods to figure out what happens during a patient visit, we first need to make sure that what we measure reflects what actually happened.”

Nearly one-third of the estimated 75 million children in the United States between the ages of 2 and 19 are overweight or obese — 17 percent are obese and 15 percent are overweight. Overweight and obesity are risk factors for the development of multiple health conditions in children and adults, such as diabetes and heart disease.

Modifying children’s food intake and increasing their levels of physical activity are cornerstones of weight management and obesity prevention, and a key source of advice on weight management and weight loss is physician counseling on nutrition and physical activity.

In fact, doctors are required to provide such counseling to address this serious health concern. Counseling for nutrition and physical activity for children and adolescents is a quality measure in the Healthcare Effectiveness Data and Information Set, a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). The counseling also is a criterion for “meaningful use” of electronic health records under the American Recovery and Reinvestment Act of 2009.

To assess how frequently physicians provided weight-management counseling, Shaikh and her colleagues at UC Davis enrolled 198 diverse children between 2 and 12 years of age who were seen for well-child visits in the general pediatrics outpatient clinic at UC Davis Children’s Hospital. The children averaged 5½ years of age, roughly divided evenly between boys and girls.

The children’s parents were informed that the study would assess their perspectives about the well-child visit. The 38 treating physicians in the clinic were informed that parent education would be assessed for these patients, but the topics that would be evaluated were not specified.

With parents’ and physicians’ full knowledge, audiotape recorders were placed in the examination rooms in inconspicuous locations. The researchers audiotaped each complete visit for study participants. After the well-child visits a research assistant entered the examination room and provided parents with a questionnaire to complete before they departed the clinic.

The researchers then compared the parental reports of counseling on the questionnaires, the audiotaped records, and what information was included in the electronic health record by the physician after the conclusion of the well-child visit. The study found significant differences between what the parents reported, what was recorded on the audiotapes, and what appeared in the electronic health record.

Parents, in general, tended to remember and report discussing a wide variety of topics with greater frequency than was recorded in the audiotapes, indicating a high level of “false positive” reports.

For example, 90 percent of parents reported receiving counseling on weight management on the questionnaires; the audiotaped assessments indicated that the topics were discussed 87 percent of the time; the medical record documented these discussions at only 39 percent. Parents indicated that their pediatricians discussed consumption of fruits and vegetables 80 percent of the time; the audiotaped assessments recorded these discussions at 77 percent; but the medical record documentation indicated these discussions took place only 44 percent of the time.

Documentation of counseling in medical records is important because it serves as a memory aid to physicians when they talk to families at future visits, said Shaikh, who also is an associate professor of pediatrics. Knowing what lifestyle goals were set during the last visit helps physicians follow-up on these goals and provide support to patients and their families to help them make lifestyle changes and maintain a healthy weight. Detailed documentation in the health record also helps to improve communication between clinicians and patients, thereby improving clinical care.

Documentation in medical records of counseling on weight, nutrition and physical activity also is now used by insurers as a measurement of whether counseling has been provided and is tied to physician payment.

The study suggests that for health-care professionals, electronic health record documentation may significantly underestimate the counseling that patients receive. The study also suggests that what goes into electronic medical records may vary depending upon nuances in electronic health record tools and templates used by physicians.

“Parental report via the use of a questionnaire administered immediately following the patient visit is a more valid method of assessing physician counseling on weight, nutrition and physical activity in pediatric primary care, compared to medical record documentation,” Shaikh said.

Additional study authors include Jasmine Nettiksimmons, Robert Bell, Daniel Tancredi and Patrick Romano, all of UC Davis.

The study was funded by a grant from the UC Davis Center for Healthcare Policy and Research and the Center for Clinical and Translational Research. Shaikh also is supported by a career development award from the Agency for Healthcare Research and Quality.

The UC Davis School of Medicine is among the nation’s leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master’s degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit UC Davis School of Medicine at www.ucdmc.ucdavis.edu/medschool.

Devices to track heart-ventricle and pulmonary artery pressure may be particularly promising.

Gregg Fonarow, UCLA

FINDINGS:
Heart failure affects 5.8 million people in the U.S. alone and is responsible for nearly 1 million hospitalizations each year, most resulting from a build-up of body fluid in the lungs and other organs due to the heart’s inability to pump effectively. The disease needs to be closely tracked in order to avoid such hospitalizations, and home-monitoring interventions may be especially useful, UCLA researchers say.

Leapfrog Group names nation’s top 65 hospitals for patient safety and quality.

The Leapfrog Group’s annual class of top hospitals — 65 from a field of nearly 1,200 — was announced today (Dec. 6) in Washington, D.C., and included UC San Diego Health System for the first time. The 2011 list includes university and other teaching hospitals, children’s hospitals and community hospitals in rural, suburban and urban settings. The selection is based on the results of the Leapfrog Group’s national survey that measures hospitals’ performance in crucial areas of patient safety and quality.

“UC San Diego Health System’s faculty and staff are the heroes whose commitment to quality and patient safety has lead to this recognition,” said Tom McAfee, M.D., interim chief executive officer and dean of clinical affairs for UC San Diego Health Sciences.

The survey, which launched in 2001, focuses on four critical areas of patient safety: the use of computer physician order entry (CPOE) to prevent medication errors; standards for doing high-risk procedures; protocols and policies to reduce medical errors and other safe practices recommended by the National Quality Forum; and adequate nurse and physician staffing. In addition, hospitals are measured on their progress in preventing infections and other hospital-acquired conditions and adopting policies on the handling of serious medical errors, among other things.

“All hospitals that voluntarily participate in the Leapfrog Group’s annual survey deserve recognition for their willingness to publicly report critical patient safety and quality information to their communities,” said Leah Binder, CEO of the Leapfrog Group. “However, only a handful of these hospitals achieve excellence by meeting these national standards and earning Leapfrog’s highest distinction — Top Hospital.”

As a 2011 Top Hospital, UC San Diego Health System fully met the standards for implementing CPOE and for carefully testing their system with Leapfrog’s CPOE Evaluation Tool. As part of this standard, physicians must enter at least 75 percent of medication orders through a CPOE system, and demonstrate, via a test, that their inpatient CPOE system can alert physicians to at least 50 percent of common, serious prescribing errors.

“The commitment of UC San Diego Health System’s physicians to embrace electronic health records (EHR) and CPOE was instrumental to achieving Top Hospital,” stated McAfee. “When our faculty leadership voted to fund the implementation of an EHR in 2004, it started a revolution in how information is communicated and medicine is practiced at UC San Diego Health System. The real leadership though, has come from the physicians who embraced information technology very early on.”

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UCSF’s robotic pharmacy system has assembled more than 1.5M pill packages of patient medications without an error.

UC San Francisco’s automated pharmacy has won a 2011 Best of What’s New award from Popular Science. The awards recognize 100 innovations that indicate where technology is headed in the future.

Each year, the publication reviews thousands of new products and innovations and chooses the top 100 winners across 11 categories for inclusion in its annual Best of What’s New issue. Winners represent products or technology that are significant steps forward.

UCSF’s automated hospital pharmacy, built at the end of 2010, uses robotic technology and electronics to prepare and track medications with the goals of improving patient safety and increasing efficiency. Believed to be the nation’s most comprehensive automated hospital pharmacy, it is the hub of UCSF’s integrated medication management system, which combines state-of the-art technology with personalized care.

To date, the automated system has assembled more than 1.5 million pill packages of patient medications without an error.

“For 24 years, Popular Science has honored the innovations that surprise and amaze us — those that make a positive impact on our world today and challenge our views of what’s possible in the future.” said Mark Jannot, editor-in-chief of Popular Science. “The Best of What’s New Award is the magazine’s top honor, and the 100 winners — chosen from among thousands of entrants — represent the highest level of achievement in their fields.”

Once computers at the new pharmacy electronically receive medication orders from UCSF physicians and pharmacists, the robots pick, package and dispense individual doses of pills. Machines assemble doses onto a plastic ring, each of which contains all the medications for a patient for a 12-hour period.

Registered nurses at the hospital receive each of their patients’ scheduled medications on the rings, which are barcoded and include the patient’s name, list of the medications and administration times.

“By leveraging technology, we have reduced inefficiencies which allows nurses to spend more time with their patients and makes for a safer medication administration process at UCSF Medical Center,” said Sheila Antrum, RN, UCSF Medical Center chief nursing officer and executive director of patient care services.

Antrum oversees pharmaceutical services for UCSF Medical Center, including the UCSF Benioff Children’s Hospital.

“The automation also has resulted in increased satisfaction for the nurses,” she said.

By using robots instead of people for previous manual tasks, pharmacists and nurses have more time to work with physicians to determine the best drug therapy for a patient, and to monitor patients for clinical response and adverse drug reactions. The pharmacy also will enable UCSF to study new ways of medication delivery with the goal of sharing that knowledge with other hospitals across the country.

The automated systems also prepare oral and injectable medicines, including toxic chemotherapy drugs, in a tightly secured, sterile environment which creates a safer environment for pharmacy employees. An automated inventory management system keeps track of all the products, and one refrigerated and two non-refrigerated automated pharmacy warehouses provide storage and retrieval of medications and supplies.

Studies have shown that technology, including barcoding and computerized provider order entry, as well as changes in hospital processes for medication management, can help reduce errors. In addition, the new pharmacy offers a rich training ground for pharmacy students in the drug distribution systems of the future.

“While these robotics clearly increase the safety of dispensing medications to patients, they have also been proven to increase the pharmacist’s key oversight of the safe and effective use of medications in patients,” said Joseph Guglielmo, Pharm.D., chair of the Department of Clinical Pharmacy in the UCSF School of Pharmacy and  assistant director of pharmaceutical services for the UCSF Medical Center.

Next spring, nurses at UCSF Medical Center will begin to use barcode readers to scan medication at patients’ bedsides, verifying it is the correct patient, drug and dose. As the phase-in continues, additional steps in the process will be eliminated as doctors begin inputting prescriptions directly into computers in 2012.

The facility, located at Mission Bay south of downtown San Francisco, has been awarded LEED-CI Gold certification for its sustainable building practices. The new pharmacy currently serves UCSF hospitals at Parnassus and Mount Zion and has the capacity to dispense medications for the new UCSF Medical Center at Mission Bay, scheduled to open in 2015.

All of the winners will be featured in the December special issue of Popular Science, on newsstands Nov. 15.

About UCSF and UCSF Medical Center

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

UCSF Medical Center and UCSF Benioff Children’s Hospital are world leaders in health care, known for innovative medicine, advanced technology and compassionate care. Our expertise covers virtually all specialties, including cancer, heart disease, infertility, neurological disorders, organ transplantation and orthopedics as well as special services for women and children. UCSF Medical Center has been ranked by U.S. News & World Report among the nation’s top 10 premier hospitals for 10 consecutive years.

Mission Bay hospital complex to integrate new media, social media.

UCSF Benioff Children’s Hospital at Mission Bay will incorporate the latest innovations in information technology when it opens in 2015.

When Michael Blum, M.D., imagines the new UCSF Medical Center being constructed at Mission Bay, he thinks of a beloved TV show.

No, it’s not “E.R.” or “General Hospital.” It’s “The Jetsons.”

Blum, chief medical information officer at the current UCSF Medical Center, sees the emerging 289-bed hospital complex as a thrilling chance for UCSF to implement the health information technology equivalent of flying cars and robot maids.

“The new hospital gives us the opportunity to really integrate new media, social media, the work flows of care providers and the experiences of the patients and their families,” he said. “It’s a platform where we can start with a blank sheet of paper.”

That sheet began filling up about five years ago, when UCSF set out to refresh some of the existing hotel-style amenities in its facilities, a process guided by the suggestions of patients and care providers, Blum said.

“Everyone gave input into what these spaces need to look like,” he said.

The resulting plan for the new medical center, which features separate specialty hospitals serving women, children and cancer patients, is highly ambitious from a technology standpoint. Features will include a large display screen — perhaps covering an entire wall — in every room that offers an array of entertainment and communication options as well as education tools tailored to each patient.

Michael Blum, UC San Francisco

“Patients these days are all about social media; they spend huge amounts of time online both communicating with peers and looking for information,” Blum said. “We’re really going to look at that very aggressively, so that the experience of patients and their families in the hospital will center around social media.”

In addition, Blum and his colleagues are working to launch a pilot project within the next year using Chatter, an internal social network for businesses created by Salesforce.com, whose CEO, Mark Benioff, and his wife, Lynne, are major supporters of UCSF. The couple donated $100 million to help build the new UCSF Benioff Children’s Hospital and the current children’s hospital also bears the Benioff name.

“Every member of the care team would be able to see what everyone else is saying about a patient,” Blum said of Chatter, adding that the tool would be integrated with UCSF’s existing electronic health record system. To ensure patient privacy, it would not be accessible to anyone outside the patient’s care team.

With the medical center at Mission Bay still several years from completion, UCSF already has begun implementing leading-edge technology. In the spring, for example, the university launched its new patient portal, UCSF MyChart, which allows patients to access their electronic medical records and communicate with doctors and clinic staff from home.

[Related: UC med centers going digital]

That commitment to innovation stood out to Hayden Pheif and his family during the 11-year-old’s four-month stay in the Pediatric Intensive Care Unit at the children’s hospital earlier this year.

Hayden suffers from fibrodysplasia ossificans progressive, or FOP, an extremely rare condition in which soft tissue such as muscle and tendons turn into bone. The disorder can immobilize patients and even shorten their lives. There is no cure.

As a team of UCSF specialists helped Hayden regain strength and transition off of a full-time ventilator,the Mill Valley boy was able to participate in his fifth grade graduation from his hospital bed, using Apple’s video calling application FaceTime. He also logged many hours playing interactive games on a Nintendo Wii in the hospital’s All Stars Technology Room and keeping up with his beloved San Francisco Giants on TV, said his mother, Megan Pheif.

“When you’re sick and have limited ability to get around, it’s nice to be able to connect to your friends,” Megan Pheif said of the hospital’s social media access. “That was a big part of helping Hayden get better.”

Pheif said the family was excited to hear about some of the high-tech features planned for the new medical center. Hayden offered his own suggestions, such as on-demand movies that patients could order without leaving their room. On-demand movies, games and education content will indeed be available in each patient room, Blum confirmed.

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MediSens Wireless, after receiving investor funding, will expand to Silicon Valley.

UCLA's Majid Sarrafzdeh and a "smart" shoe

MediSens Wireless, which in 2009 was one of the first startup companies selected for the UCLA on-campus technology incubator at the California NanoSystems Institute (CNSI), has received funding from a strategic investor in the greater Los Angeles area. The young company, the first to “graduate” from the incubator, will now set up its own base of operations in Northern California.

The technology incubator was established two years ago to nurture early-stage research and to help speed the commercial translation of technologies developed at UCLA. It was inspired by the success of Nano H2O, a California startup that licensed water purification technology developed by UCLA researchers and conducted proof-of-concept research at CNSI.

MediSens, which focuses on the development and manufacture of personal body-monitoring systems for medical and health applications, moved into the incubator to begin commercializing technology invented by Majid Sarrafzadeh, a professor of computer science and engineering at UCLA’s Henry Samueli School of Engineering and Applied Science and co-director of the Wireless Health Institute at UCLA.

Sarrafzadeh and his team formed the startup when they created a “smart shoe” — a shoe equipped with a device allowing it to be monitored remotely, enabling health care professionals to keep track of patients with balance problems, such as those with diabetes or those starting a new medication regime. This technology will be used to develop body-monitoring systems with specific applications for diabetics with peripheral neuropathy — the loss of sensation in the foot — and those with health issues that affect their balance.

MediSens began clinical trials in 2010 on its novel Clinical Movement Assessment System (CMAS), a wireless monitoring technology for assessing muscle and neuromotor functions in the upper extremities. CMAS is designed for a wide variety of medical applications and could potentially benefit health care professionals and facilities specializing in the areas of physical medicine and rehabilitation, neurology, orthopedics, and physical and occupational therapy, among others.

It is anticipated that the system will provide clinical assessments of fine motor movement, muscle strength, hand-eye coordination and patient responses to treatment. Repeat assessments could lead to early warning and detection of deteriorating conditions.

Additionally, MediSens-patented technology is being implemented on a “smart bedsheet” to monitor patients in bed in real-time, with quantifiably preventative objectives in mind.

According to Behrooz Yadegar, the CEO of MediSens, the company will move to Santa Clara in the Silicon Valley area, where it plans to double its staff — currently at five employees — within a year. At its new base of operations, the company plans to further product hardware and software development and begin marketing and development for its wireless technologies.

MediSens Wireless was the first spinoff from the Wireless Health Institute, which Sarrafzadeh helped create. UCLA’s Wireless Health Community is made up of experts from many disciplines across campus, including engineering; law; management; medicine; nursing; public health; and theater, film and television.

The California NanoSystems Institute is an integrated research facility located at UCLA and UC Santa Barbara. Its mission is to foster interdisciplinary collaborations in nanoscience and nanotechnology; to train a new generation of scientists, educators and technology leaders; to generate partnerships with industry; and to contribute to the economic development and the social well-being of California, the United States and the world. The CNSI was established in 2000 with $100 million from the state of California. An additional $850 million of support has come from federal research grants and industry funding. UCLA CNSI members are drawn from UCLA’s College of Letters and Science, the David Geffen School of Medicine, the School of Dentistry, the School of Public Health and the Henry Samueli School of Engineering and Applied Science. They are engaged in measuring, modifying and manipulating atoms and molecules – the building blocks of our world. Their work is carried out in an integrated laboratory environment. This dynamic research setting has enhanced understanding of phenomena at the nanoscale and promises to produce important discoveries in health, energy, the environment and information technology.

Winners receive up to $100K to commercialize innovations.

Michael Miyamoto, UC Irvine

Five teams of scientists from multiple campuses of the University of California and a Southern California hospital have been awarded up to $100,000 each to commercialize their ideas for new, lower cost health care technologies that will address a long-standing need for more affordable and efficient chronic disease management and preventive health care, particularly in underserved communities. The commercialization grant program is led by the von Liebig Entrepreneurism Center at UC San Diego Jacobs School of Engineering.

Chosen from a field of 64 applicants from 10 different institutions in Southern California, the projects range from smart phone-based disease diagnostics and weight-loss management tools to a device that turns cell phones into microscopes. Selected university-based engineers, physicians and entrepreneurs will now work with von Liebig technology and business advisors on prototype development and testing, proof-of-concept studies. MBA students from the UC San Diego Rady School of Management will provide support to the innovator teams in the form of market research and competitive analysis.

The awards are part of the von Liebig Center’s Southern California Healthcare Technology Acceleration Program, which nurtures and accelerates the commercialization of novel healthcare inventions developed within research institutes and universities in Southern California.

The program is sponsored by the California HealthCare Foundation, Booz Allen Hamilton, and the Pioneer Portfolio of the Robert Wood Johnson Foundation. A project’s success will be determined by the ability to secure follow-on funding for further development after the initial grant period.

“The California HealthCare Foundation is eager to spark innovations that can reduce the costs of health care and expand access to services for the underserved,” said Veenu Aulakh, a senior program officer at the Oakland-based foundation. “Sometimes great concepts need nurturing at the early stages, allowing them to prove their effectiveness and garner sustained support.”

About the winners:

Steve Jiang, PhD and Yuanyuan Zhou, Ph.D., UC San Diego, Departments of Radiation Oncology and Computer Science and Engineering: GPU and Cloud-based Next Generation Cancer Radiotherapy Treatment Planning

Approximately two-thirds of U.S. cancer patients are treated with radiotherapy because it has proven a particularly effective treatment for many cancer types. The main objective of radiotherapy is to deliver a lethal dose of radiation to the tumor to kill cancerous cells while sparing surrounding healthy organs and normal tissues. The treatment is complex and very patient-specific and must be carefully inspected and approved by the attending physician. Unfortunately, until now, this has meant using a dedicated computer and software system for treatment planning that is expensive and lengthy, often taking as long as one to two weeks to develop and approve. Treatment data may also be stored in individual institutions and different formats, which is costly to maintain and difficult to share among institutions.

This UC San Diego research team is developing a next-generation, Web-based treatment planning system that promises to reduce the cost of treatment planning, make better use of physician time, encourage treatment data sharing and improve the effectiveness of radiotherapy devices. Jiang is a professor and executive director of the Center for Advanced Radiotherapy Technologies in the Department of Radiation Oncology at the UC San Diego Moores Cancer Center. Zhou is a professor in the Department of Computer Science and Engineering and Qualcomm Chair in Mobile Computing at the UC San Diego Jacobs School of Engineering. Their system combines graphics processing unit (GPU) technology, which was developed for high-resolution graphics in video games and has become popular for high-performance scientific computing, with cloud computing, through which computation and data storage are provided through a third-party Internet service. Hospitals would simply pay a fee for processing each plan, eliminating any need to maintain their own in-house treatment planning systems. In the proposed system, GPU would be used to design optimal treatment plans through cloud computing. The resulting treatment plan would be delivered to the physician via any small mobile device such as a smart phone. Their research partnership combines Zhou’s expertise in cloud computing with Jiang’s expertise in medicine, and, in particular the role of GPU in medicine, bringing the latest advances in computer science to bear on a significant medical problem.

Aydogan Ozcan, Ph.D., UCLA, Departments of Electrical Engineering and Bioengineering: Microscopy on a Cell-phone as a Diagnostic Tool (LUCAS)

This UCLA group has pioneered a lens-free, on-chip imaging modality termed LUCAS, which enables converting conventional cell phones into microscopes and diagnostic tools, providing an important solution to various rural and inner city medicine needs. The first application for LUCAS is the Complete Blood Count (CBC), a broad diagnostic blood test that alerts doctors to a wide range of disorders including anemia, infection and poor nutrition, major problems affecting young children in poor communities. CBC is a critical laboratory test for aid in diagnosis and management of these conditions, and one of the most widely ordered laboratory tests in medicine.

Morbidity and mortality are disproportionally high in children from resource poor settings and disenfranchised populations particularly those living in rural or inner city areas of the United States. Poverty, limited access to health care, poor nutrition, and low level of parental education all contribute to these troubling statistics.

With instant availability of CBC results, physicians, physician assistants or nurse practitioners will be in a better position to make a diagnosis and prescribe the right drugs during an initial patient contact that can take place practically anywhere. Being able to diagnose and prescribe medicine in one visit also reduces the need for follow-up appointments, which patients in poor communities frequently miss. The platform can also be used, through telemedicine, to guide referral to other medical services. And, by doing tests in-house rather than sending the blood specimens to outside labs, the provider can capture significant additional value for themselves or their institution. This is of particular importance for many organizations that are chronically underfunded and dependent upon government or philanthropic agencies.

Chi On Chui, Ph.D., UCLA, Department of Electrical Engineering: Low-Cost Semiconductor Test Strips for Accurate In Vitro Diagnostics

This project seeks to exploit a low-cost, nanoengineered sensor technology for rapid, point-of-care diagnosis of acute diseases in critical settings such as emergency rooms, intensive care, ambulances and even your doctor’s office. For example, evidence of long-term cardiac injury appears early in blood samples, but often in very low concentrations immediately following a heart attack. The researcher has completed a proof-of-concept study of the sensor technology showing that it is 10 times more sensitive than the leading nanoelectronic sensors and provides results in minutes, making it easier for health care providers to recognize and treat cardiac injury. This platform technology will be packaged in a simple hand-held reader interfaced with a disposable test strip, and will ultimately be applied to other disease diagnostics in point-of-care  scenarios where ease of use, fast results and low cost are critical for adoption, especially in areas where healthcare resources are inadequate.

Michael Miyamoto, M.D., UC Irvine and Mission Hospital: Integrated Heart Failure Disease Management

Heart disease patients require long-term, outpatient monitoring to maintain their health and prevent problems that can land them back in the hospital. Unfortunately, current chronic disease monitoring systems for heart failure (HF) aren’t achieving this goal. According to hospital admission data, HF patients have a 25 to 30 percent readmission rate in the first 30 days following discharge. Miyamoto has developed a disease management system that combines necessary clinical monitoring with a user-friendly device that allows doctors to receive regular, wireless updates about the condition of their patients such as whether they are accumulating fluid in their chest, a common indicator that the heart is deteriorating. While the entire potential market for the technology is made up of all patients discharged after a HF hospitalization, implementation of the technology could be focused on patients doctors believe are most at risk for readmission. The economic burden of HF care upon the health care system exceeds $40 billion annually with impatient care comprising the bulk of this cost at just under $30 billion, according to recent data from the American Heart Association. Given the mounting fiscal challenges faced by Medicare and other payers, there is significant opportunity to address the unmet needs inherent in the existing systems of management of chronic disease. Effective monitoring of HF patients will reduce the number of hospital readmissions and expenses to Medicare and other payers.

Michael Leon, Ph.D., UC Irvine, Department of Neurobiology & Behavior: Mobile Mandometer for At-Home Weight Normalization

“Obesity is the century’s greatest public health threat,” according to the 2010 Dietary Guidelines for Americans report released by the U.S. departments of Agriculture and Health and Human Services. Indeed, Americans spent about $60 billion last year in largely unsuccessful attempts to lose weight and they also lost an estimated $73 billion in productivity to obesity. Obesity also raises the risk for diabetes, glaucoma, kidney damage, cardiovascular and other diseases, which add additional billions of dollars each year to U.S. medical costs.

The Mando Group has demonstrated the effectiveness of a treatment that trains obese patients (including children and teens) to normalize their food intake by providing real-time feedback about eating behavior during and between meals through a device called a Mandometer (mando means “I eat” in Latin). The Mandometer consists of a small scale that sits under a dinner plate that sends information about their eating behavior to a small monitor, which also shows the eating behavior of a normal-weight person to allow patients to model it. Such training allows them to normalize their eating pattern and thereby eat less without feeling hungry.

Having shown the device’s effectiveness, the Mando Group is working to move it out of a clinical setting by developing a more affordable, portable device that can communicate wirelessly with smart phones. They will use the power of the iPhone and Android operating systems to develop a portable scale and three smart phone applications that will help patients recognize fullness during a meal, hunger between meals and provide a virtual therapist for additional practical support needed for an effective weight-loss program away from the clinic.

About the program

“This program is an effective way to inspire our scientists and engineers in our great universities to focus on developing solutions to real world problems. That, in turn will lead to the creation of great products and companies that will set the foundation for job creation,” said Rosibel Ochoa, executive director of the von Liebig Entrepreneurism Center at UC San Diego Jacobs School of Engineering. “We are excited to provide technology acceleration programs that meet the needs of our partners, students and society.”

The current competition was aimed at supporting the development of early-stage innovations toward commercially viable products or services involving non-pharmaceutical therapies, medical diagnostics and devices. To be considered, the candidate projects were required to have a focus on lowering health care system costs with technologies or services that:

• are significantly less expensive than the current approach, or
• provide care in a lower-cost setting, such as an outpatient clinic, or
• make more efficient use of skilled healthcare professionals

“Booz Allen Hamilton understands the power of new, innovative ideas to create change in the healthcare industry,” said Timi Leslie, vice president, Booz Allen Hamilton. “Programs like this provide the needed platform to identify and nurture the solutions of the future. Booz Allen Hamilton is proud to be a sponsor and participate in selecting the winning ideas.”

For more information, visit the website: www.healthcaretechnologyacceleration.com