TAG: "Innovation"

Brain Innovation Group funded for brain tumor tool


National Cancer Institute grant boosts development of optical wand technology.

Laura Marcu, UC Davis

The UC Davis Comprehensive Cancer Center’s Brain Innovation Group has received a grant from the National Cancer Institute (NCI) to improve brain cancer surgery and treatment using UC Davis-developed biophotonic technology.

The $400,000 grant is the first for the cancer center’s eight cancer research innovation groups, which link scientists, oncologists, surgeons, engineers and other experts in discussions about patient care needs and potential innovations.

“The groups were started to fulfill a big part of our mission as a comprehensive cancer center by enhancing clinical and translational cancer research,” said cancer center director Ralph de Vere White. “This grant is a clear example of the success of this endeavor.”

UC Davis researchers will use the funding to adapt state-of-the-art optical biopsy technology, the Multispectral Scanning-Time Resolved Fluorescence Spectroscopy, to help neurosurgeons distinguish between radiation necrosis and cancer recurrence during brain cancer surgery. The technology was developed by Laura Marcu, professor of biomedical engineering and neurological surgery and principal investigator on the project.

The collaborative Brain Innovation Group includes specialists from adult and pediatric oncology, neurology, neurosurgery, neuroradiology, radiation oncology, biomedical engineering and biophotonics, hematology and biochemistry. They meet once a month in an open forum to present their projects and look for ways to combine and translate their work into high-impact clinical trials.

“This NCI grant demonstrates the benefit of having experts with different backgrounds work together to find new ways to better diagnose and treat cancer,” said Marcu, adding that the idea to apply the novel photonic technology in distinguishing between brain tumor recurrence and radiation necrosis was sparked during an innovation meeting.

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UCLA Health System, Anthem join others to launch Vivity


Unique product created by insurer and seven health systems aligns care for SoCal members.

The UCLA Health System and six other top hospital systems in Los Angeles and Orange counties have partnered with Anthem Blue Cross to offer Anthem Blue Cross Vivity, an integrated health system. This partnership — the first in the nation between an insurer and competing hospital systems — will help the medical centers enhance the health of all Anthem Blue Cross Vivity members and enable them to share financial risk and gain.

The six other hospital systems — all of which have hospitals ranked among Los Angeles County’s top 30 by U.S. News and World Report — are Cedars-Sinai, Good Samaritan Hospital, Huntington Memorial Hospital, MemorialCare Health System, PIH Health and Torrance Memorial Medical Center.

“Vivity will create economies of scale, allowing us to provide the highest quality and affordable health care to thousands of Californians,” said Dr. David Feinberg, president of the UCLA Health System and CEO of the UCLA Hospital System. “UCLA is proud to join Anthem Blue Cross and its hospital partners at the vanguard of health care delivery in the U.S.”

Vivity continues the move away from traditional fee-for-service reimbursements that may create incentive for providers to increase the volume of medical procedures they perform, and it continues the trend toward a structure that financially rewards activities that keep patients healthy.

“This is an exciting and historic time,” said Pam Kehaly, west region president for Anthem Blue Cross. “This innovative venture will create a foundation to significantly advance the medical delivery system, simplifying the care experience and creating a structure with aligned incentives to eliminate waste and redundancy and improve overall health.”

This is just the first step in aligning the delivery system. Longer term, value will come from future improvements in efficiency and effectiveness enabled by such things as a common electronic medical records system, shared care management systems, joint wellness resources and other enhancements.

Anthem Blue Cross Vivity will provide members with more predictable costs, a simpler experience and convenient access to some of the best primary care doctors, specialists and hospitals in the region. For doctor visits, medical procedures or prescriptions, Vivity members only pay a co-pay; they don’t have to worry about meeting deductibles or deciphering complicated medical bills. The seven hospital systems and their affiliated medical groups have built a network of doctors that provides both quality care and affordable prices to Vivity members in Los Angeles and Orange counties.

CalPERS, the nation’s second largest purchaser of health benefits and an early adopter of health care system innovations, has already agreed to use Vivity network doctors and hospitals within its Select HMO network in Los Angeles and Orange counties. Large group brokers can start requesting proposals on Oct. 1, with coverage beginning on Jan. 1, 2015.

The name Vivity captures a fresh perspective on health care. Coined from vivify, meaning “to enliven or animate,” the name speaks to the energized team of providers coming together to deliver a uniquely people-centric offering.

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UC innovation grants produce healthy returns


Report finds return on investment of more than 5 to 1.

UC San Diego Dr. Greg Maynard leads a five-campus UC project to reduce dangerous blood clots (venous thromboembolism, or VTE), which prevented an estimated 140 VTE occurrences in 2013 for an annual savings of $1.45 million.

By Alec Rosenberg

A University of California center that fosters health care innovation at UC’s five medical centers is proving to be a boon to both patient health and the bottom line.

A report assessing the impact of grants made by the Center for Health Quality and Innovation (CHQI) found that UC’s investment is paying off with improvements such as fewer blood clots and improved post-surgery care at UC hospitals. Based on current cost savings, revenues and additional funds received, the projected net financial gain in 2016 of the center’s grants will be about $40 million from a $7.3 million allocation from UC medical centers — a return on investment of more than 5 to 1.

“The investment has been a good one,” said Dr. John Stobo, UC Health senior vice president and CHQI chairman. “The innovation center has done a lot of good in terms of improving quality and saving costs.”

CHQI was established in 2010 to foster innovations developed at UC medical center campuses and hospitals in order to improve quality, access and value in the delivery of health care. To date, the center has issued a total of 50 grants. In addition to funding from UC’s five medical centers, CHQI also has awarded $7.7 million it received from the UC Office of Risk Services for grants designed to reduce the risk of clinical harm to UC patients.

“We’ve been able to support innovative projects that produce better outcomes for patients, reduce costs and are being expanded across the UC Health system,” said CHQI Executive Director Karyn DiGiorgio. “This report helps quantify our impact.”

Examples include:

  • A five-campus project led by UC San Diego’s Greg Maynard to reduce dangerous blood clots (venous thromboembolism, or VTE) prevented an estimated 140 VTE occurrences in 2013 for an annual savings of $1.45 million.
  • A project at UC Irvine reduced the median length of stay for high-risk abdominal surgery patients by two days, resulting in fewer complications and projected annual savings of $816,000 (Maxime Cannesson).
  • The 2012 UC San Diego colorectal postoperative program reduced length of stay by 4.5 days for high-risk surgical patients and 0.9 days for moderate-risk patients, resulting in projected annual savings of $553,000 (Elisabeth McLemore).
  • A 2012 UCSF palliative care intervention resulted in 45 additional palliative care consults in the intensive care unit, generating $167,000 in annual savings from reduced ICU bed-days (Wendy Anderson).
  • A 2012 UC Davis specialty pharmacy initiative led to contracts that generated $18,000 in revenue at UC Davis and $1.36 million in revenue at UCSF during a CHQI fellowship (John Grubbs).
  • The 2012 UCLA elective surgery discharge program increased net revenues through a discharge pharmacy program for surgical services by $639,000 during a CHQI fellowship (Michael Yeh).

The report projects at least $25 million in grant-generated cost savings and revenues by the end of 2016. Also, seven project teams have received an additional $16 million in external funding based on their CHQI work, including a UCSF-led radiation safety project (Rebecca Smith-Bindman), a UC Davis pediatric telehealth project (James Marcin) and a UCSF-led eConsult project (Nathaniel Gleason).

In addition, 16 papers in national journals have been published based on work funded by CHQI.

The report did not assess the center’s other activities, such as hosting three systemwide colloquiums and convening multicampus collaboratives to develop and implement evidence-based practices.

The report was prepared by the center’s Innovation Evaluation Committee, which includes Michael Ong of UCLA, Patrick Romano of UC Davis, Andrew Auerbach of UCSF, Sheldon Greenfield of UC Irvine, Theodore Ganiats of UC San Diego and Stephen Shortell of UC Berkeley, and Karyn DiGiorgio, executive director of the center. CHQI plans to issue a yearly update, and by 2016 expects to present an in-depth review of the overall impact of the programs funded by the center.

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Diaper detective


Students develop inexpensive, versatile pad to detect medical problems in infants.

A team of UC Riverside Bourns College of Engineering students created an inexpensive pad that can be inserted into diapers to detect dehydration and bacterial infections in infants.

The product, which recently won an award that included a $10,000 prize at a national engineering design contest, operates much like a home pregnancy test or urine test strip. Chemical indicators change color when they come in contact with urine from an infant who is suffering from dehydration or a bacterial infection.

The pad, which is 2.5 inches by 5 inches and called “The Diaper Detective,” is attractive for numerous reasons. It costs 34 cents to make. It doesn’t require electricity, cold storage or an advanced education to interpret. It’s customizable so that other chemical indicators can be added to test for other medical conditions. And it could be adapted to be used in adult diapers.

“We created this to fulfill a need for a versatile, inexpensive, non-invasive method of urine collection in developing countries and elsewhere,” said Veronica Boulos, one of the team members. “The beauty of this is that it solves a huge problem with simplicity.”

Strike against infant mortality

The Diaper Detective addresses the worldwide problem of infant mortality in developing nations. Of the estimated 3.9 million annual neonatal deaths, 98 percent occur in developing countries and could be prevented with access to low cost, point-of-care diagnostics.

In developing countries, the students hope the Diaper Detective will be distributed via relief organizations. In the United States, the students believe the pad would qualify for reimbursement through medical insurance, making it an inexpensive option for low-income users.

The uniqueness of the diaper insert comes from the use of lateral flow channels that guide the user’s urine to the reactive regions where the color change takes place. The lateral flow channels were originally created using Crayola crayons and are now created by paraffin wax and a laser printer.

The students won a third place award at the National Institute of Biomedical Imaging and Engineering Design by Biomedical Undergraduate Teams Challenge. They have also submitted the product to the National Collegiate Inventors and Innovators Alliance BMEStart competition.

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Five wearable health gadgets on the horizon


UCSF collaborations helping develop next generation of digital health devices.

We’ve all seen ads for Fitbits, Jawbones, Gearfits – perhaps even tracked our own health with a specialized home glucometer or blood pressure cuff.

These devices can help collect data that can help motivate an individual and track progress, but they don’t tell us much beyond that. The next wave of wearable health technology has far more advanced biosensors that can collect new data, teach us what data is most valuable – and maybe even change the way we practice medicine.

Wearable health devices are just one niche in the rapidly growing field of digital health. Future wearable biosensors may be as small as a patch worn on the skin or an ear bud or even a tiny fiber sewn into clothing – and these tools can gather new data in real-time with patients in the real world, tracking things we couldn’t accurately measure outside a hospital until now.

This data not only will provide useful information for the patient and his or her doctor, but could also lead to huge gains in precision medicine, an emerging field that aims to integrate data from molecular, clinical, population and other research to create treatments that are more predictive, preventive and precise.

“We need to get to a world where individuals are using digital health devices to collect accurate, detailed data about themselves and that data is available for clinical trials as well as to their clinicians for helping them maintain wellness or managing disease,” says Michael Blum, M.D., director of UCSF’s Center for Digital Health Innovation, which collaborates across health care and industry to create, implement and validate digital health technologies. One of its biggest collaborations is with Samsung, a partnership that’s launched the UCSF-Samsung Digital Health Innovation Lab at Mission Bay.

Blum, who also serves as chief medical information officer of the UCSF Medical Center, says the goal is for wearables being developed now to someday be able to seamlessly “provide patient data into larger databases that can be accessed for clinical care and that multiple researchers can have access to in order to create new understandings.

“When we have access to these large, rich data sources, we will likely see new patterns and relationships that will lead to the development of new, non-traditional ‘vital signs.’”

For all of the wearable health devices being developed, Blum says, it’s vital that they are validated: Do the sensors accurately measure the things they’re designed to measure? Does wearing the device and knowing this information lead to changes in treatment or behavior?  Does it generate better outcomes for the patients? Did we uncover new health data points that could be more important to measure for a certain disease?

For example, Aenor Sawyer, M.D., an orthopedic surgeon and associate director of CDHI, says one key area where monitoring could really help inform doctors – and patients – is when a patient is released from the ICU or after a serious surgery.

“Imagine a patient who’s been closely monitored, then when he’s discharged, we don’t have any oversight, and we don’t have any vital signs being taken. These patients might benefit from some closer scrutiny. We know that certain things can happen in those windows that would be nice to have some way to track it,” says Sawyer.

A number of wearable health devices being developed now could help close that critical loophole. And the data that future wearables gather will teach us new key indicators for health we haven’t even thought of yet, Sawyer says.

Here are five exciting new wearable health gadgets on the horizon:

Track what gets you stressed

The next generation of wristbands will have far more accurate biosensors that can measure specific health indicators such as blood pressure, heart rate, oxygen saturation and body temperature. The devices will be able to send data to your doctor, and could help researchers measure how different medicines or behavior changes are affecting patient health. For example, Samsung has partnered with UCSF to develop the Simband, which will measure heart rate, blood pressure, temperature, oxygen level and even signs of stress. Simband is also a reference platform that allows other companies to develop sensors that will integrate into it, allowing for a community of developers to create the ecosystem of sensors and products that will be critical to this nascent market.

Take part in a sleep study – in the comfort of your own bed

In the sleep lab, researchers hook patients up to complex machines and sensors to measure motion, heart rate and rhythm, respiratory rate and rhythm, and oxygen and carbon dioxide saturation.

Soon tiny, non-invasive biosensors could gather this data while you sleep in your own bed and transmit the information to a central database.

Know how your elderly mother is doing from hundreds of miles away

A combination of biosensors can measure movement and heart and respiration rates. They could be calibrated to an individual’s patterns to alert caretakers when something is amiss. Knowing that an elderly relative is not going to the refrigerator, leaving the house, or calling friends and family could provide early clues to a brewing illness that could be easily managed with early intervention, but might be devastating if left unchecked.

Let the doctor monitor your heart in real time 

For anyone who has worn a holter monitor to check for irregular heart rhythms, a Vital Connect patch is a big upgrade. Instead of having to go in to the doctor’s office to pick up a cumbersome device, wear it for weeks, then go back to the doctor’s office to return it and wait for it to be analyzed, the data from the patch is uploaded to the cloud-based system via the Internet, and the doctor can be alerted if there are any signs of danger.

Measure your vitals while listening to music

The ear is an excellent spot on the body to measure physical signals such as motion, heart rate and blood pressure.  Several companies are exploring making a new high-tech ear bud that can measure heart rate, temperature and respiration rate using photoplethysmography, or PPG, which measures changes in blood flow by shining a light on the skin and measuring how it scatters off blood vessels (this is often done in hospitals with a device that fits over your fingertip).

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Monitoring a new vital sign


Biosensor may help doctors determine which patients should be fed following surgery.

AbStats, developed by a team at UCLA, is a non-invasive acoustic gastrointestinal surveillance biosensor that monitors gut sounds.

A disposable plastic listening device that attaches to the abdomen may help doctors definitively determine which post-operative patients should be fed and which should not, an invention that may improve outcomes, decrease health care costs and shorten hospital stays, according to a UCLA study.

Some patients who undergo surgery develop a condition called post-operative ileus, a malfunction of the intestines. The condition causes patients to become ill if they eat too soon, which can lengthen an affected patient’s hospital stay by two to three days. Until now, there was no way to monitor for post-operative ileus other than listening to the belly for short periods with a stethoscope, said study first author Dr. Brennan Spiegel, a professor of medicine at the David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health.

If proven successful, the device, a non-invasive acoustic gastrointestinal surveillance biosensor called AbStats, could also be used to help diagnose irritable bowel syndrome and inflammatory bowel disease as well as helping obese people learn by the sounds from their gut when they should or shouldn’t eat, which could help them lose weight.

Spiegel and his team worked with researchers at the UCLA Wireless Health Institute at the Henry Samueli School of Engineering and Applied Science to develop the sensor, which resembles a small plastic cap and has a tiny microphone inside to monitor digestion.

“We think what we’ve invented is a way to monitor a new vital sign, one to go along with heart rate, blood pressure and respiration. This new vital sign, intestinal rate, could prove to be important in diagnosing and treating patients,” Spiegel said. “The role of wearable sensors in healthcare has reached mainstream consciousness and has the capacity to transform how we monitor and deliver care.

“Yet, there are very few biosensors that are supported by any peer-reviewed evidence,” Spiegel continued. “This study represents peer-reviewed evidence supporting use of a biosensor, a device born and bred out of UCLA multidisciplinary research.”

The study appears in the early online edition of the peer-reviewed Journal of Gastrointestinal Surgery.

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Innovation center names executive director


Karyn DiGiorgio to lead systemwide center.

Karyn DiGiorgio

Karyn DiGiorgio, M.S.N., R.N., has been appointed executive director of the UC Center for Health Quality and Innovation (CHQI).

The center, based at the UC Office of the President, is a systemwide effort launched in 2010 to support innovative grants and spread best practices that aim to improve quality, increase efficiencies and reduce costs at UC medical centers.

DiGiorgio joined UCOP in 2013 as the associate director of CHQI, after working for the Gordon and Betty Moore Foundation, where she was a program officer in the Betty Irene Moore Nursing Initiative.

“Karyn brings a wealth of experience to this position, having served as associate director since 2013,” said Dr. John Stobo, UC Health senior vice president. “Karyn also served as interim director since March of 2014 following the retirement of Terry Leach, and has helped to enhance the scope of the center’s mission, collaborating with UCOP and medical center leadership to develop and implement a variety of patient care and revenue models as well as systemwide reimbursement models that will support UC Health’s Leveraging Scale for Value initiative.”

UC Health launched its Leveraging Scale for Value initiative in March to collaborate as a system to reduce costs and enhance revenue at UC medical centers.

At the Moore Foundation, DiGiorgio developed and managed multiple systemwide health care grants in the Bay Area and greater Sacramento regions — many of which resulted in significant reductions in patient morbidity and mortality and led to improvements in patient care. Previously, she worked as the R.N. discharge coordinator and a staff/charge nurse in the emergency department at UCSF Medical Center. She is a graduate of Georgetown University and holds an M.S.N. in health policy from UC San Francisco and an M.S. from Drexel University in Philadelphia.

The Center for Health Quality and Innovation is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and chaired by the UC Health senior vice president.

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Providing a medical home for HIV patients


UC San Diego transforms HIV care as part of DSRIP pay-for-performance initiative.

UC San Diego Dr. Amy Sitapati (left) directs the Owen Clinic, which has become a model medical home for HIV patients.

By Rebecca Vesely, Special to UC Newsroom

Though incurable, HIV today is a manageable, chronic condition. With advances in drug therapy, those infected with HIV in North America can expect to live into their early 70s — almost as long as the general population.

However, HIV is a chronic illness that typically requires a complex treatment regimen and has the added layer of social stigma.

At UC San Diego Health System, providers have implemented a novel multidisciplinary approach to HIV care management that is improving outcomes for patients. This approach could be a model for chronic care management in other populations.

UC San Diego’s HIV care delivery transformation began under the California HIV/AIDS Research Program and was implemented as a special Delivery System Reform Incentive Program (DSRIP). DSRIP is a novel, pay-for-performance initiative in which California’s 21 designated public hospitals receive Medicaid dollars in exchange for meeting pre-set milestones.

California’s public hospitals had the option of participating in a fifth DSRIP category focused on HIV care. UC San Diego is one of the state’s 10 public hospitals working in this category.

UC San Diego, through DSRIP Category 5, was able to overhaul its outpatient care delivery for HIV/AIDS patients into a medical home model.

‘Truly transformative’

“This is what the ‘triple aim’ is all about,” said Dr. Angela Scioscia, chief medical officer at UC San Diego Health System. “This project has been truly transformative. We took a clinic that had lost its way in terms of structure and turned it into a model for care delivery.”

Also known as the Owen Clinic, the UC San Diego HIV/AIDS outpatient center is located on the third floor of a medical office building across the street from UC San Diego Medical Center at Hillcrest. The clinic treats about 3,500 patients annually. Last year, 500 new patients joined, with the demand for services growing by approximately 40 percent in the past five years, said Dr. Amy Sitapati, Owen Clinic director.

About 70 percent of patients served at the clinic are in Medi-Cal managed care plans. DSRIP support enabled the clinic to hire more staff, with a total of 60 personnel, both full- and part-time.

Team-based approach

The clinic uses a team-based approach, with four teams, each led by a primary care physician. Two of the teams have Spanish-language fluency.

Each morning, the teams meet in “huddles” and review the patient panel for that day. A computer printout shows patient names, ages and reasons for the visit, status on preventative screenings and viral loads. The printouts also show each patient’s Veterans Aging Cohort Study (VACS) score, an evidence-based score that assesses HIV patient risk of mortality. The Owen Clinic may be the only outpatient clinic in the country using patient VACS scores in daily huddles.

Knowing a patient’s risk of mortality helps to frame the office visit because providers understand before the patient walks through the door his or her need for additional support services, Sitapati said. A patient with a high VACS score might need more time in the clinic to meet with a staff pharmacist or psychiatrist or social worker, for instance.

Comprehensive, coordinated services are available to all patients. Because of the complexity of many of these patients’ treatment regimens (patients take on average seven medications each day), the staff aims to make each visit as productive as possible. For instance, staff pharmacists on site work together with physicians to educate patients about their prescriptions, help them find affordable options, get adequate reimbursement from payers and avoid adverse reactions to drugs.

Eight to 10 drugs are commonly used in HIV treatment, meaning there are between 30 and 50 total drug combinations. Finding the right balance for patients can be a challenge, especially with myriad side effects, co-payments and insurance pre-authorization requirements to fill a prescription.

“There are a lot of barriers to patients taking the right medications,” Sitapati said.

Incorporating health information technology

Access to health information technology resources has been crucial to the clinic’s transformation. UC San Diego assigned a four-person team of health IT specialists — including a physician informaticist, a data analyst, a programmer analyst and a Master of Public Health team member — to work on the clinic’s patient-centered medical home innovation projects. Having a clinical informatics team that understands the patient population, is invested in the clinic’s success and is aligned with the project’s vision and goals has been absolutely critical, Sitapati said.

Ongoing communication with patients is an important component to care. Patients at the clinic are avid adopters of MyUCSDChart, a Web portal that sends reminders for appointments and preventative screenings.

In 2013, there were an average of 1,003 MyUCSDChart patient encounters per month, up from 288 MyUCSDChart encounters in 2012. These patient portal interactions are on par with in-person and phone visits in 2013, which averaged 1,135 office visits and 1,455 average phone calls per month in 2013.

Perhaps one of the most valuable clinic informatics tools is SmartSet — an electronic medical record tool that allows clinicians to order lab tests in batches for patients who haven’t received recent laboratory screenings. The Centers for Disease Control and Prevention recommends annual screening for sexually transmitted diseases (STDs) in HIV-positive individuals. The SmartSet allows clinicians to quickly identify patients due for screenings and then order tests without manually ordering each lab for each patient, increasing clinic efficiencies and productivity.

Focusing on care transitions

The Owen Clinic focuses on care transitions for its patients. The clinic has a dedicated “nurse transition specialist” skilled in HIV/AIDS care to assist patients moving between inpatient care and the Owen Clinic. The nurse transition specialist program is part of another DSRIP project at UC San Diego.

These proactive, integrated approaches are garnering results. Viral load monitoring rose from a baseline of 63 percent in 2011 to 81.9 percent for the period of January through December 2013. Screening for both chlamydia and gonorrhea increased from 57.4 percent in 2011 to 84.2 percent for the period of January 2013 through December 2013. Wrap-around services for HIV care — including nutrition, substance abuse counseling, pharmacy, psychiatry and case management — increased 34 percent.

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Hall of Fame inventor cooks up projects to serve the neediest


Berkeley Lab’s Ashok Gadgil puts engineering to work for humanity.

Ashok Gadgil demonstrates use of the Darfur stove to Mary Robinson, former president of Ireland and former UN High Commissioner for Human Rights. (Photo by Roy Kaltschmidt, Berkeley Lab)

By Kate Rix

When Ashok Gadgil arrived in Washington this spring to be inducted into the National Inventors Hall of Fame, a quote on the back of the event program spoke directly to his own personal philosophy.

It was from Abraham Lincoln: “The patent system added the fuel of interest to the fire of genius.”

“This is the first time the body made a decision not just to recognize patents which have led to improvements in the developed world, but also began to say, what do invention and patent do for the bottom 3 billion people?” Gadgil says of his induction, seated in his office above the UC Berkeley campus. “It signals to those of us who work on problems not because they’ll lead to corporate profit or a better weapons system, that this is another important role of creativity.”

Gadgil was one of 15 inventors admitted into the Hall of Fame this year. He was inducted specifically for UV Waterworks, a disinfecting device that uses ultra violet light to generate the electricity needed to kill pathogens in water. The technology provides safe drinking water for 5 million people every day in deep rural communities of India, the Philippines and Ghana.

Gadgil (pronounced GOD-gill) directs the Energy and Environmental Technologies Division at Lawrence Berkeley National Laboratory. His other inventions include a fuel-efficient cookstove and a method to remove arsenic from groundwater. Overall, his body of work has helped millions of others, in the spirit of what Lincoln called “the fuel of interest” combined with humanitarianism.

Safe water for mere pennies

UV Waterworks systems provide safe drinking water a cost of about 2 cents for 12 liters.

“My goal was to see what people could pay if they make $1 or $2 a day,” Gadgil says. “We are asking for 2 cents for 10 liters, so they can avoid getting diarrhea several times a year.”

UV Waterworks has saved an estimated 1,000 children’s lives, Gadgil said. “That’s not too bad, though the number could be 10 or 50 times larger.”

While Gadgil invented the system, the UC Regents hold the patent and the publicly traded corporation WaterHealth International lined up investors, including Johnson & Johnson and Dow Chemical.

Fuel-efficient stove lessens women’s risks

Also making an impact is the Berkeley Darfur Stove, which replaces the traditional “three stone” cooking fire for Darfuri refugees in western Sudan. The old method of cooking required women to walk — for up to seven hours, five times a week — outside the safety of the camps to collect wood. Encounters with armed militia during those treks almost certainly result in rape.

In 2005 Gadgil led a fact-finding mission to Darfur, interviewing women and observing how they cook. He realized he could design a stove that uses 75 percent less fuel to cook the same amount of food in the same pot, reducing the number of firewood collection trips.

The stoves were designed at Lawrence Berkeley Lab but are manufactured in a factory in Darfur and sold for $20 each, generating income for factory workers. Some 15,000 cookstoves are in use in Darfuri camps, plus additional stoves modified for use in Ethiopia.

Gadgil’s team continues to refine the cookstove technology, in pursuit of even cleaner ways to use biomass fuel. Another project, however, hearkens back to clean drinking water. Gadgil and his lab developed a method to remove naturally occurring arsenic from groundwater in Bangladesh and India, binding iron to microscopic arsenic molecules so they become large enough to be captured by a filter. The technology recently was licensed to an Indian business with a plan to install filtration plants in villages where the water will be sold.

The existence of a business model is core to Gadgil’s guiding principles as an inventor. While some of his colleagues in science turn their nose at the idea of making a profit from research, Gadgil — who applied to business school before engineering graduate studies — sees sustainability and potential in financial gain.

‘A model where everybody prospers’

“You cannot go to scale and help a billion or 2 billion people without everybody along the way making a dime,” he says. “Charity is critical to filling cracks in the system, but there is not enough charity to go around. If you want to lift people from an existence we consider beneath human dignity, you have to have a model where everybody prospers.”

Gadgil was not always so focused on using his skills to help people in the developing world. As a student at the Indian Institute of Technology Kanpur he worked hard, did well in school and that was enough.

In 1971 Gadgil had an acceptance letter from every university to which he had applied, except Berkeley. He was about to start courses at CalTech when the letter came from Berkeley to say that they had secured funding to offer him a spot in the graduate civil engineering program.

“A friend of mine told me that Berkeley is a deep and vast ocean and that I would not experience the intellectual depth anywhere else,” he recalls. “He was right. I took courses in everything under the sun. I could sit in the back of the room and take classes in political economy of development.”

He recalls a lesson from one of his professor, former Cal physicist Arthur Rosenfeld: A good scientist takes in the bigger picture of how the real world works.

“I was just very, very good at physics,” he says. “Being here doing my Ph.D. changed my thinking. I credit that to the Berkeley experience.”

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Sen. Boxer highlights efforts to prevent medical errors


She visits UCSF Medical Center.

U.S. Sen. Barbara Boxer (second from right) tours UCSF Medical Center on July 2 to learn how it is working to reduce preventable deaths. Susan Barbour (left), R.N., talks about pressure ulcer prevention. (Photo by Cindy Chew)

Every year, between 210,000 and 440,000 Americans die as a result of preventable errors in hospitals, according to a special report released at UC San Francisco by Democratic Sen. Barbara Boxer.

She presented the updated report detailing the most common and harmful errors at our nation’s hospitals and highlighted what UCSF Medical Center is doing to prevent them.

“We have the opportunity to save not just one life, but to save hundreds of thousands of lives,” Senator Boxer said during her visit to UCSF Medical Center on July 2. “Many people will be shocked to hear this, but medical errors are one of the leading causes of death in America today. These deaths are all the more heartbreaking for families because they are preventable.”

Boxer said she is grateful to UCSF for the steps it has taken to save patients’ lives.

“If we all work together – doctors, nurses, hospital administrators, patients, patient advocates, medical technology pioneers, public health experts and federal officials – we can prevent so much heartbreak for families and stop these tragedies before they occur,” said Boxer at a press conference following a tour of UCSF Medical Center.

Preventable errors in hospitals, such as hospital-acquired infections, adverse drug reactions, patient falls and bedsores, total $19.5 billion annually and that the economic costs of medical errors, including lost productivity, could be as much as $1 trillion a year, according to Boxer’s report.

“We’re one of the nation’s top hospitals,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “But that is meaningful only as it relates to every single patient who walks through our doors, and how we administer their care, follow up and safety. We’re proud of the great strides we’ve made as a leader in patient safety and to partner with Senator Boxer to help all hospitals become places where safe care is offered to every patient, every day.”

While touring UCSF Medical Center, Senator Boxer was shown the interdisciplinary approach UCSF takes to address major hospital issues such as sepsis, ulcer prevention, medication errors and hand hygiene.

As part of its interdisciplinary approach, UCSF creates teams comprised of nurses, pharmacists, doctors and medical center leaders, in addition to staff in medical records and environmental services. Those teams focus on understanding the underlying causes that may have allowed an error to occur and on collaborative problem solving. An open discussion ends with a clear action plan, which might involve implementing a new system, purchasing a piece of equipment, or training doctors and nurses in communication strategies.

UCSF processes and results for sepsis prevention

Sepsis is a potentially fatal, full-body inflammation caused by infection, and one of the main sources of sepsis is hospitals themselves.

“At UCSF we now treat sepsis as a true emergency with a focus on immediate interventions proven to help patients,” said Joshua Adler, M.D., chief medical officer at UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. “This approach has involved innovations in our electronic health record systems, use of rapid response personnel, novel nursing protocols, and continuous evaluation of our performance.”

UCSF’s electronic sepsis surveillance system continuously searches for warning signs, alerts clinicians to the potential presence of sepsis, and provides a means to activate “Code Sepsis”. The Code Sepsis team – a rapid response team, critical care nurse practitioner, and pharmacist – has helped UCSF to treat sepsis as an emergent situation requiring immediate attention and action. “With this approach we have reduced the mortality rate for sepsis by nearly 25 percent since 2012,” Adler said.

Processes and results for ulcer prevention

Ulcers resulting from being bedridden, and thus immobile for a lengthy time, are an ongoing challenge for hospitals. In addition, to training all patient care providers in pressure ulcer prevention, UCSF conducts quarterly pressure-ulcer prevalence study days. On these days, every patient in the hospital is examined for evidence of a pressure ulcer. The total number of pressure ulcers counted is divided by the total number of patients examined to obtain a percentage of patients with pressure ulcers.

UCSF has reduced the rate of hospital acquired pressure ulcers among adult and pediatric patients by 79 percent, from 4.98 percent in fiscal year 2008 to 1.03 percent in fiscal year 2014.

Preventing inpatient medication errors

In 2011, UCSF launched what is believed to be the nation’s most comprehensive automated hospital robotic pharmacy that is designed to prepare and track medications, with the goal of improving patient safety. The pharmacy operation is now linked to the electronic health record system, creating an end-to-end electronic system in which a nurse at the bedside scans the barcode on the patient’s wristband, scans the medication and then scans the bar code on his/her own ID badge. Only after confirming all the information matches is the medication administered. UCSF administers over 10,000 doses of medication daily.

“The barcoding system is a way to minimize the potential for an error at every step of the medication delivery process,” said Laret.

Hand hygiene training and surveillance

Hand hygiene is considered one of the most effective approaches for reducing hospital-related infections. In July 2010, UCSF implemented a hand hygiene education and surveillance program. Since then the rate of hand hygiene has improved from 75 percent to about 92 percent each month. The data are collected and monitored by cameras in some hospital areas, and a daily report is distributed. Some floors even feature real-time monitoring that displays hand hygiene compliance rates.

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Rapid surgical innovation puts patients at risk for medical errors


UC San Diego surgeons call for national safety measures to protect patients.

Kellogg Parsons, UC San Diego

Researchers at the UC San Diego School of Medicine have found that the risk of patient harm increased twofold in 2006 – the peak year that teaching hospitals nationwide embraced the pursuit of minimally invasive robotic surgery for prostate cancer. Results of the study are published in the July 2 online issue of JAMA Surgery.

“This study looked at the stages of innovation and how the rapid adoption of a new surgical technology—in this case, a surgical robotic system — can lead to adverse events for patients,” said Kellogg Parsons, M.D., M.H.S., surgical oncologist, UC San Diego Health System and first author of the paper. “There is a real need for standardized training programs, rules governing surgeon competence and credentialing, and guidelines for hospital privileging when novel technologies reach the operating rooms of teaching and community hospitals.”

In 2003, there were an estimated 617 minimally invasive robotic prostatectomies (MIRPs) performed in the United States. By 2009, this number increased to 37,753 procedures. In 2005, patients were twice as likely to experience an adverse event if they were undergoing MIRPs compared to a traditional open surgical procedure. The following year – 2006 – was considered the tipping point for the adoption of MIRP when it equaled or exceeded 10 percent of all cases.

“The trend observed here is not new to robotic surgery. The same phenomena occurred with the move to minimally invasive approaches to gallbladder and kidney surgeries, both surgeries that are now well documented to improve safety and outcomes,” said Christopher Kane, M.D., professor of surgery and interim chair of the Department of Surgery, UC San Diego School of Medicine, who was not involved with the study. “Whenever a new technology is adopted, there is a temporary period where there may be an increased risk to the patient. This can be reduced by extensive surgical training, vigorous credentialing standards and extended mentorship by experienced surgeons.  This report should encourage the adoption of more rigorous credentialing standards proposed by professional organizations rather than by individual hospitals.”

Kane added that robotic prostatectomy by experienced surgeons has proven to be beneficial to the patient with less blood loss, reduced infections and shorter hospital stays.

“A responsibility of deploying a surgical technology should include the responsibility to monitor it as it diffuses throughout the real world to ensure safety,” said David C. Chang, Ph.D., M.P.H., M.B.A., director of outcomes research at UC San Diego School of Medicine and the paper’s senior author.  “Surveillance of surgical safety should be ongoing, much like the Centers for Disease Control monitor changes in trends of infectious diseases across the country.”

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$10M grant to bring online respite to dementia caregivers


UCSF, UNMC to offer education, support and care.

Katherine Possin, UC San Francisco

UC San Francisco and the University of Nebraska Medical Center have been awarded a $10 million grant from the Centers for Medicare & Medicaid Innovation to create a new Web-based model of dementia care. It will provide around-the-clock consultations for patients and their families, online education and, for a subset of patients, remote monitoring with smart phones and home sensors.

The Dementia Care Ecosystem will not replace clinicians, but rather bring educational resources developed over the last decade by the UCSF Memory and Aging Center (MAC) to patients and their families, while enabling clinicians to monitor their patients from afar.

“Our hope is this is going to radically improve the way dementia patients are cared for,” said Katherine Possin, Ph.D., who is an assistant professor of neuropsychology at UCSF. “We hope we’ll show this works, and that it can be adopted nationwide.”

Each patient will have a navigator, who will check in by telephone or with a personal visit, as well as by monitoring communication with patients and their families through an Internet dashboard, created with the help of Salesforce. Navigators will be people without a formal medical degree and will be supervised closely by nurses, social workers and pharmacists with expertise in dementia care.

These navigators will triage calls, making sure that patients see nurses and doctors when necessary and helping with other things that don’t require medical expertise, such as a hazardous situation in the home that could cause the patient to fall. Meanwhile, patients and their families will be able to get training online to help make financial plans and work through tough medical decisions before their loved ones have reached a crisis stage.

Researchers hope to create a virtual care system that is supportive enough to protect the mental and physical health of caregivers, who tend to neglect their own needs. If caregivers learn to cope better, patients may be able to remain at home longer before moving into assisted living. Last year, according to the Alzheimer’s Association, about 15.5 million people in the United States were caring for friends and family members with dementia. Nearly 60 percent said the work was highly stressful and more than a third reported symptoms of depression.

Bruce Miller, UC San Francisco

“Our ecosystem will have wisdom and experience continuously piped in every day to caregivers who are overwhelmed,” said Bruce Miller, M.D., director of the MAC, who holds the A.W. and Mary Margaret Clausen Distinguished Professorship in Neurology at UCSF. “Typically, these people have a hard time getting through to anyone in the medical system.”

Some patients in the study will have an added level of technology-based care. They will use smart phones and electronic wristbands to record their activity levels, count the number of steps they take and measure how far they range from home. And a small number will have sensors placed inside their homes to detect behavior changes that could signal the onset of a health problem, like being up all night, staying in bed all day or going to the bathroom more times than usual.

“If someone, instead of getting up two times a night, is getting up four or five times a night, we might send a nurse the next morning to their home to get a urine sample, and if it’s bad start the patient on antibiotics,” said Steve Bonasera, M.D., Ph.D., an associate professor of geriatrics at UNMC, who did his fellowship at UCSF. “We’re going to be monitoring people who are a seven- or eight-hour drive from my office in Omaha.”

The system will also monitor the drugs that patients take and flag high risk and inappropriate medications, such as antipsychotics and benzodiazepines that can send patients with certain forms of dementia to the emergency room. It will also flag medications that should not be combined.

Initial projections are that the improved caregiver support, more continuous access to medical help and medication management will reduce emergency room visits by a half, cut hospitalizations by almost a third and delay the move into a nursing home for six months. This is projected to save $4.3 million over the three years of the grant.

The MAC already has a well developed website that attracts traffic from around the world. Some of the center’s recorded lectures on caring for people with dementia have been viewed hundreds of thousands of times. Researchers said that once families have easy access to educational resources, office visits will become less pressured and patients and their families will be able to take more time to absorb information and make important decisions.

“The idea of 24/7 telephone access to clinicians with expertise in dementia has really resonated with caregivers,” said Jennifer Merrilees, R.N., Ph.D., a clinical nurse specialist at the MAC who will oversee the care that is dispensed online. “That’s what’s really made their faces light up when I’ve described it to them.”

Beginning this fall, 2,100 patients, all diagnosed with varying stages of dementia, will be enrolled through San Francisco General Hospital and Trauma Center, UCSF Medical Center and the UCSF MAC clinics and Chinatown Clinics, as well as UNMC and other service organizations in Nebraska serving the elderly.

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