TAG: "Innovation"

UCSF 2.0: Creating new partnerships


Collaborations on brain diseases point to promising possibilities.

UC San Francisco's Adam Gazzaley and colleagues are reporting in the journal Nature that they have found a way to reverse some of the negative effects of aging on the brain, using a video game designed to improve cognitive control.

No single institution can address the next decade’s health, research and education challenges on its own. As players from a wide range of industries continue to venture into health and health care, it will be imperative for UC San Francisco to form new partnerships to address familiar health challenges in creative, novel ways.

UCSF has actively increased its portfolio of partnerships in the past few years, announcing several major projects this year alone.

Most recently, UCSF formed a new collaboration between the Institute for Neurodegenerative Diseases and the Japan-based global pharmaceutical company Daiichi Sankyo Co. Ltd. This joint venture, capitalizing on the Nobel Prize-winning research of Stanely Prusiner, M.D., is focusing on developing therapeutics and molecular diagnostics for multiple neurodegenerative diseases.

The collective feedback from faculty and staff who participated in the planning initiative known as UCSF 2.0 calls on the University to “amplify its network of collaborators.” One big idea is for UCSF to lead the creation of a Bio Silicon Valley, taking advantage of its close proximity to the Bay Area’s innovation milieu by bridging biological, social, and technological sciences to revolutionize biomedical research.

Making the right connections

Neuroscientist Adam Gazzaley, M.D., Ph.D., director of the UCSF Neuroscience Imaging Center and a faculty member since 2004, is among a group of innovators who are doing just that. He partnered with Swartz Center at UC San Diego and Nvidia, which makes high-end computational computer chips, to create a new imaging technology called GlassBrain. The technology allows him to view the brain without using a big imaging machine or wiring the patient to a computer with the ultimate aim to find treatments for a variety of brain diseases, including Alzheimer’s and multiple sclerosis.

Gazzaley, an associate professor of neurology, physiology and psychiatry, says UCSF can help faculty make the right connections with partners across sectors.

“We need to know what companies are looking for and how to align our goals,” he said. “We just have to point in same direction and appeal to their public interests. What I found in my experience doing this is that we have to demonstrate our value as a real partner and not just be a charity case.”

UCSF also can help by embracing the entrepreneurial spirit by providing opportunities for faculty and students to share ideas and tools.

“I want us to have a platform that enables us to be more creative and aggressive in thinking how software and hardware can be a new medicine to improve brain health,” Gazzaley said. “Often, high-tech innovations take a decade to move beyond the entertainment industry and reach science and medicine. That needs to change.”

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Big Ideas@Berkeley launches new generations of social innovators


Winning entries demonstrate strategic blend of technology, social innovation.

Berkeley Ph.D. student Pablo Rosado, part of a team that developed ReMaterials to bring roofing systems to impoverished communities, explains the project at last week’s awards celebration.

Every year, thousands of students come to Berkeley with vague ambitions to change the world. The annual Big Ideas@Berkeley competition is inspiring some of them to do just that — by launching globally life-changing innovations even before they graduate. Last week, the program honored this year’s winning projects with an awards celebration at the Blum Center for Developing Economies.

From building Africa’s first wind- and solar-powered radio station to promoting yogurt for improved child nutrition in Nepal to creating an app to show the safest nighttime routes on the Berkeley campus, the competition’s winning entries all demonstrated a strategic blend of technology and social innovation.

“We’re teaching our students to face a challenge, take a risk and use their educations for real-world impact and social good,” said Phillip Denny, Big Ideas program manager and chief administrative officer at the Blum Center. “We’re helping them to get ideas out of their heads and to put actionable plans on paper.”

In contrast to most other business-plan competitions, Big Ideas@Berkeley is focused on social change. The yearlong program, started in 2006, offers training and mentoring for teams of undergraduate and grad students. They learn critical thinking, market analysis and presentation skills to develop real-world projects that are both feasible and scalable.

The competition is supported by several Berkeley centers and institutes, as well as key sponsors such as the Andrew and Virginia Rudd Family Foundation, the Charles Schwab Foundation and the Center for Information Technology Research in the Interest of Society, or CITRIS. This year, the program also formed a new partnership with the crowdfunding site Indiegogo to better promote and fund the projects.

“It’s a very Berkeley-esque idea,” said sponsor and judge Andrew Rudd, who earned his MBA at the Haas School of Business. “These students are doing something positive with what they’ve learned, to bring the 21st century to parts of the world that don’t share our good fortune.”

The competition drew proposals from 187 teams of more than 600 students from 75 different majors, five UC campuses and four other universities nationwide. Judges recognized a total of 40 projects with awards from $1,000 to $10,000 across nine categories including open data, human rights, clean and sustainable energy alternatives, social justice and information technology.

“The diversity, quality and overall execution were really extraordinary this year,” said Denny. “The winning entries were chosen based on the combination of personal passion and a commitment to improving the world.”

Advancing the lives of those in poverty

First place in the “global-poverty alleviation” category went to ElectroSan, a system that improves public health and the environment by converting human waste into income-producing by-products. The process applies electrochemical cells to recover nitrogen from human urine and to disinfect feces, bringing affordable sanitation to poverty-stricken communities.

Inspired by a visit to the urban slums of Nairobi in 2013, Ph.D. student William Tarpeh seeks to introduce waste treatment to the 4.6 billion people in the developing world who currently can’t afford adequate sanitation facilities. The project is in the technology- development phase to ensure maximum nitrogen recovery.

“Connecting technology and international development was a great part of this experience,” explained Tarpeh, who’s working toward a doctorate in environmental engineering. “Big Ideas helped me to think at both the molecular level and the business-model scale to bring this to fruition.”

Rami Ariss, a junior in chemical and biomolecular engineering, and Othmane Benkirane, a junior in energy engineering and structural engineering, won first place in the “clean and sustainable-energy alternatives” category. Their project, Solidge, is a solar-powered refrigeration system that doesn’t rely on an electricity grid. Refrigerators are the most sought-after appliance in low-income communities; by integrating energy generation, storage and use into the same appliance, Solidge enables users to store food, unsold crops or vaccines for longer periods. The project will initially launch in Benkirane’s native Morocco, but will ultimately be deployed in developing countries globally.

Benkirane credits the Big Ideas competition with changing his career focus from new technologies to pressing energy needs in developing countries. “The Solidge project taught us to really listen to the end user,” he said. “Whether they’re graduates of prestigious universities, blue-collar workers or rural farmers in eastern Morocco, all of these people have equal insights, and Solidge taught me to look for the hidden ones.”

Scaling up

“Scaling up Big Ideas” was the category for previous contest winners who are further along in implementing their projects. First place went to a team led by Charles Salmen, a recent graduate of UC San Francisco’s medical school, for a wind- and solar-powered radio station that reaches 200,000 listeners across Kenya, Uganda and Tanzania. An all-Berkeley team of Pablo Rosado and Hasit Ganatra, both Ph.D. students in mechanical engineering, and Caitlin Touchberry, a master’s student in development practice, took second place for ReMaterials, which provides roofing systems for communities in poverty.

More than a billion people currently live in slums worldwide, and adequate roofing is a critical issue for public health and comfort. The team has already developed a natural, recycled material mix and manufacturing process at the prototype level, and is now working on scaling up the manufacturing process, improving the supply chain and developing a sales and marketing strategy to attract investors and key partners.

“Last year we were focused on the engineering side, developing the materials and building small-scale roofs,” explained Rosado. “Now we’re looking for a mentor in law and finance to help us get the product to market. We’re going to India this summer to do a first round with our target audience.”

Participants uniformly credited mentorship as a critical component of the Big Ideas ecosystem. Tony Stayner, an angel investor and nonprofit board member, served as a Big Ideas judge and as a mentor to the ReMaterials project. He credited the program with increasing his own body of experience and his interest in social entrepreneurship.

“If you ever get depressed about the future of the world, go spend some time with the Big Ideas students,” he said. “They’re bright, creative, big-hearted and very passionate about making the world a better place.”

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UC Irvine to integrate Google Glass in med school curriculum


Wearable computing technology will transform training of future doctors.

Dr. Warren Wiechmann, assistant clinical professor of emergency medicine and associate dean of instructional technologies, will oversee implementation of the Google Glass four-year program at UC Irvine.

As physicians and surgeons explore how to use Google Glass, the UC Irvine School of Medicine is taking steps to become the first in the nation to integrate the wearable computer into its four-year curriculum – from first- and second-year anatomy courses and clinical skills training to third- and fourth-year hospital rotations.

Leaders of the medical school have confidence that faculty and students will benefit from Glass’s unique ability to display information in a smartphone-like, hands-free format; being able to communicate with the Internet via voice commands; and being able to securely broadcast and record patient care and student training activities using proprietary software compliant with the 1996 federal Health Insurance Portability & Accountability Act.

“I believe digital technology will let us bring a more impactful and relevant clinical learning experience to our students,” said Dr. Ralph V. Clayman, dean of medicine. “Our use of Google Glass is in keeping with our pioneering efforts to enhance student education with digital technologies – such as our iPad-based iMedEd Initiative, point-of-care ultrasound training and medical simulation. Enabling our students to become adept at a variety of digital technologies fits perfectly into the ongoing evolution of health care into a more personalized, participatory, home-based and digitally driven endeavor.”

While other medical schools have been experimenting with Glass in medical practice and education, UC Irvine’s comprehensive employment of the device will elevate the student experience unlike anything ever before, added Dr. Warren Wiechmann, assistant clinical professor of emergency medicine and associate dean of instructional technologies, who will oversee implementation of the Google Glass four-year program.

The effort will start this month – as the academic year begins for third- and fourth-year students – with 10 pairs of Glass. Preliminary plans are to utilize them in the operating room and emergency department. Integrating the devices into medical education complements the ongoing clinical use of Glass at UC Irvine Medical Center, where the technology has already been piloted in operating rooms, intensive care units and the emergency department in order to assess its impact on physician efficiency and patient safety.

An additional 20 to 30 pairs of Google Glass will be acquired and deployed in August, when first- and second-year students begin course work. They will be incorporated into anatomy labs, the medical simulation center, the ultrasound institute, the Clinical Skills Center and even the basic science lecture hall. Here, Glass will be used to transmit real-time patient-physician encounters in specific disease areas to augment the basic science lecture; the transmission will occur over the 16 miles between the medical center’s Orange campus and a lecture hall in Irvine.

“Medical education has always been very visual and very demonstrative, and Glass has enormous potential to positively impact the way we can educate physicians in real time,” Wiechmann said. “Indeed, all of medicine is based on ‘seeing,’ not ‘reading,’ the patient.”

When faculty wear Google Glass for instruction, he added, it gives students an unprecedented first-person perspective. Conversely, when students are wearing Glass, they can take advantage of pertinent information delivered directly into their line of sight by faculty members, who can see exactly what a student sees and thus better guide a dissection or simulation exercise.

“The most promising part is having patients wear Glass so that our students can view themselves through the patients’ eyes, experience patient care from the patients’ perspective, and learn from that information to become more empathic and engaging physicians,” Wiechmann said.

Google Glass joins other technologies at the core of the iMedEd Initiative in the School of Medicine. Launched in August 2010, the initiative involves an iPad-based education platform – every medical student is equipped with an iPad filled with electronic medical texts, podcasts, reference materials and notes for all course work and clinical experiences – along with training on point-of-care ultrasound devices and state-of-the-art medical simulation. UC Irvine’s medical school was the first to employ tablet computing in the curriculum and the second to include point-of-care ultrasound training.

Clayman said that the iMedEd Initiative appears to have enhanced student learning. He pointed to scores on Step 1 of the U.S. Medical Licensing Examination – taken at the end of the second year of medical school – as an example. The first two classes participating in the iMedEd Initiative scored an average of 23 percent higher than previous classes, despite having similar incoming GPAs and scores on the Medical College Admission Test.

The iMedEd Initiative is fully supported by philanthropic contributions.

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UC inventions on display at Tech Commercialization Forum


Breakthrough technologies creating public benefit, improving health.

A system for removing arsenic from groundwater, developed at Berkeley Lab, is helping to provide safe drinking water for people in India and Bangladesh.

By Carolyn McMillan

Lawrence Berkeley Laboratory scientist Ashok Gadgil has developed an inexpensive and easily maintained system for removing arsenic from groundwater.

It’s a breakthrough technology that could protect millions of people around the world from arsenic poisoning, a silent killer that is especially prevalent in the rural villages of India and Bangladesh.

Across the bay, a UC San Francisco orthopedic surgeon has tackled a different sort of epidemic — the thousands of young athletes who tear knee ligaments every year while playing soccer.

Dr. Jeffrey Lotz has developed a faster, better and cheaper way to assess whether an athlete is at risk for lower extremity injuries. His 3-D movement analysis system lets physical therapists and trainers assess an athlete’s body mechanics in order to prescribe the right exercises to avoid injury.

The products of research

These two innovations are just a fraction of the commercially viable discoveries and inventions to emerge recently from the University of California — and part of what makes UC such a powerhouse of economic growth for the state.

UC researchers reported more than 1,700 new inventions last year, according to the recently released Technology Commercialization Report. UC inventions led to 71 new start-up companies and produced roughly $106 million royalty and fee income for the university.

UC President Janet Napolitano, speaking at the university’s annual Technology Commercialization Forum on May 8, said that UC is committed to doing even more to help faculty, researchers and students bring their discoveries to the marketplace.

“Steering UC’s cutting-edge discoveries through our labs and into the world economy is central to our mission as a public university,” Napolitano said. “We are committed to supporting our faculty and students with a strong, nimble infrastructure that will help them pursue patents and develop start-up companies, and we will continue to develop partnerships with industry and investors.”

Gadgil and Lotz were among 20 UC inventors to showcase their innovative research at the forum. The work spanned a huge array of fields and came from eight UC campuses and Lawrence Berkeley National Laboratory.

Improving life and environment

At UC San Diego, a clinical trial is under way to test an oxygen delivery system for people with chronic pulmonary obstructive disorder (COPD), a respiratory ailment. The system automatically responds in real time to a patient’s changing oxygen needs, delivering the right amount of oxygen with each breath.

“Our goal is to increase the autonomy and mobility for people with COPD,” said Dr. Xaxier Soler, associate director of UC San Diego’s pulmonary rehabilitation program. “We want to extend their quality of life.”

The technology was developed  by  co-inventors Stephen Roberts and David Lischer — the latter a COPD patient who was frustrated that current oxygen devices limited his activity levels. Lischer has tested a prototype of the new device since 2010, and it works well enough that he now goes skiing, Soler said.

At UC Davis, Basam Younis has developed the next generation of water disinfection systems using UV light, rather than chlorine, to eliminate pathogens. Younis’ system achieves a higher level of water purification than earlier UV systems — and does it at a lower cost.

Better yet: His system has proven to be particularly effective at eliminating what Younis referred to as “emerging contaminants” — things like pharmaceuticals, flame retardants, human hormones and care products — which increasingly are found in water supplies.

Public benefit

Steven Beckwith, UC’s vice president for research and graduate studies, said that the breadth and depth of innovation is a reflection that UC has created an “ecosystem of discovery” across its campuses and labs.

“This is the largest, and without a doubt, the most prestigious university in the world,” Beckwith said. “Our researchers tackle complex issues and look to answer some of the biggest questions that society has. And ultimately, we are looking to create a benefit for the public.”

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Bioprinting a 3-D liver-like device to detoxify the blood


Device uses nanoparticles to trap pore-forming toxins.

Shaochen Chen, UC San Diego

Nanoengineers at UC San Diego have developed a 3-D-printed device inspired by the liver to remove dangerous toxins from the blood. The device, which is designed to be used outside the body — much like dialysis – uses nanoparticles to trap pore-forming toxins that can damage cellular membranes and are a key factor in illnesses that result from animal bites and stings, and bacterial infections. Their findings were published May 8 in the journal Nature Communications.

Nanoparticles have already been shown to be effective at neutralizing pore-forming toxins in the blood, but if those nanoparticles cannot be effectively digested, they can accumulate in the liver creating a risk of secondary poisoning, especially among patients who are already at risk of liver failure. To solve this problem, a research team led by nanoengineering professor Shaochen Chen created a 3-D-printed hydrogel matrix to house nanoparticles, forming a device that mimics the function of the liver by sensing, attracting and capturing toxins routed from the blood. The device, which is in the proof-of-concept stage, mimics the structure of the liver but has a larger surface area designed to efficiently attract and trap toxins within the device. In an in vitro study, the device completely neutralized pore-forming toxins.

“One unique feature of this device is that it turns red when the toxins are captured,” said the co-first author, Xin Qu, who is a postdoctoral researcher working in Chen’s laboratory. “The concept of using 3-D printing to encapsulate functional nanoparticles in a biocompatible hydrogel is novel,” said Chen. “This will inspire many new designs for detoxification techniques since 3-D printing allows user-specific or site-specific manufacturing of highly functional products,” Chen said.

Chen’s lab has already demonstrated the ability to print complex 3-D microstructures, such as blood vessels, in mere seconds out of soft biocompatible hydrogels that contain living cells.

Chen’s biofabrication technology, called dynamic optical projection stereolithography (DOPsL), can produce the micro- and nanoscale resolution required to print tissues that mimic nature’s fine-grained details, including blood vessels, which are essential for distributing nutrients and oxygen throughout the body. The biofabrication technique uses a computer projection system and precisely controlled micromirrors to shine light on a selected area of a solution containing photo-sensitive biopolymers and cells. This photo-induced solidification process forms one layer of solid structure at a time, but in a continuous fashion. The technology is part of a new biofabrication technology that Chen is developing under a four-year,$1.5 million grant from the National Institutes of Health (R01EB012597). The project is also supported in part by a grant (CMMI-1120795) from the National Science Foundation.

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Innovation propels UC Health


Colloquium highlights UC’s efforts to increase quality and decrease costs systemwide.

UC San Francisco's Dr. Rebecca Smith-Bindman leads a project to optimize and standardize computed tomography radiation doses for patients across UC medical centers.

>>Related: Moving toward one UC Health

By Alec Rosenberg

The University of California has taken great strides toward increasing quality and decreasing costs across its medical centers, from reducing blood clots to preventing falls to decreasing hospital readmissions.

To thrive as a system in this dynamic environment, UC Health will need to ramp up such collaborations, speakers said at the UC Center for Health Quality and Innovation’s third annual colloquium, May 2 at the Oakland Marriott City Center.

About 320 people attended the colloquium, whose talks can be viewed on UCTV. Speakers included innovation center leaders, grant recipients and collaborators as well as the head of a leading health care software company and the chair of the state Senate Health Committee. More UC innovators will be participating May 28-29 at the New York Times Health for Tomorrow conference at UCSF Mission Bay Conference Center (view the webcast live at www.nythealthfortomorrow.com).

The colloquium highlighted UC efforts to expand innovations across the system, build partnerships and break down silos amid trends that reinforce the urgency of working together to transform health care.

With 17 professional schools and five academic medical centers (Davis, Irvine, UCLA, San Diego and San Francisco) that have combined revenue of $7.5 billion a year, UC has significant scale as a health system. To leverage that scale, UC’s medical centers have increasingly been working together as a system, from contracting to reducing expenses to improving clinical performance, said Dr. John Stobo, UC Health senior vice president.

UC Health wants to “do the right thing for the patients we serve” and build on the strengths of its nationally ranked medical centers to be known for providing more affordable, more accessible, safe, quality health care, Stobo said.

Tackling the ‘triple aim’

UC’s innovation center, launched in 2010, has funded about 50 grant and fellow projects from throughout UC Health and convened systemwide collaborations from fetal treatment to heart surgery. The center supports innovations at UC medical center campuses and hospitals that seek to achieve the “triple aim” of better patient care and better population health while better controlling costs of care.

“UC Health is leading efforts to reduce variations, reduce costs and produce better outcomes,” said Karyn DiGiorgio, interim director of the innovation center.

Take, for example, the UC Cardiac Surgery Consortium, which has focused on four major areas, compared data and worked to develop evidence-based best practices.

“We were already providing very good care, and we’ve been able to improve upon that,” said Dr. Michael Madani, UC San Diego chief of cardiovascular and thoracic surgery.

“Coming together has made a real difference,” added Dr. Jeffrey Milliken, UC Irvine chief of cardiothoracic surgery. “Each of us got better.”

Overcoming obstacles

Working together can be challenging. UC campuses have different priorities, different structures and serve different populations.

“Change is never easy,” said Terry Leach, the innovation center’s past executive director. “But you can learn from the innovators before you, and they’re eager to share what they’ve learned.”

Indeed, obstacles can be overcome, grantees said. Keys include building relationships, forming multidisciplinary teams and gaining leadership support.

“The leadership has to buy in,” said Catherine Walsh of UCLA, who leads an innovation center-funded project that has reduced hospital falls at UCLA and is working to expand it to other UC medical centers.

UC San Francisco’s Dr. Rebecca Smith-Bindman leads the UC DOSE project to optimize and standardize computed tomography radiation doses for patients across UC medical centers. She organized a two-day retreat last month to bring together radiology decision-makers from each of the five UC medical centers. The retreat helped build trust, as participants could see the data showing variation in radiation doses and discuss low-dose protocols, she said.

“My concern is quality,” Smith-Bindman said. “The issue is very important to our patients.”

Tapping technology

UC Davis’ Dr. Elisa Tong leads the UC Tobacco Cessation Network, an innovation center-funded project that targets tobacco use and exposure — the No. 1 cause of preventable death. UC medical centers see about 125,000 smokers a year, and the network aims to reduce that number by using electronic medical records to address tobacco use and exposure at every clinical encounter, she said.

“This is something that can improve efficiency, patient care, quality, outcomes and it will improve return on investment,” Tong said.

Speaker Carl Dvorak, president of electronic health records vendor Epic Systems Corp., said the next frontier of health care innovation is mobile phones. It’s important for health providers to make things as convenient as possible for patients, such as offering mobile billing, payments, appointment scheduling and prescription refills, he said.

“Patients will wonder what’s wrong with you if you don’t offer these in five years,” Dvorak said. “It’s going to be the price of admission.”

Containing costs

Another key issue is implementation of the Affordable Care Act. As of April 17, nearly 1.4 million Californians had signed up for health plans through the Covered California exchange while 1.9 million people newly enrolled in Medi-Cal. UC Health has partnered with Anthem Blue Cross to offer Californians access to UC’s medical centers and physicians for in-network health care on the exchange.

“California has done an incredible job with health care reform implementation,” said state Sen. Ed Hernandez, an optometrist who chairs the Senate Health Committee. “But if we are going to be successful, we have to ensure there is cost control.”

Hernandez said he plans to hold hearings on how to contain health care costs.

UC Health has been focusing on ways to reduce costs. In March, UC announced that its five medical centers will collaborate as a system to save in the range of $100 million to $150 million a year. The “Leveraging Scale for Value” project will focus initially on three areas: supply chain, revenue cycle and clinical laboratories, Stobo said.

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Moving toward one UC Health


UC’s medical centers are at an inflection point, UCSF’s Sam Hawgood says.

Dr. Sam Hawgood, UC San Francisco's interim chancellor, urges UC's five academic medical centers to work as a unified force to transform health care.

>>Related: Innovation propels UC Health

By Alec Rosenberg

The University of California’s five academic medical centers are at an inflection point, according to Dr. Sam Hawgood, UC San Francisco interim chancellor and medical school dean.

If they act separately, they can survive but will be marginalized in isolation, Hawgood said. If they work together, they can transform and grow.

Hawgood outlined his case for the latter option during his talk, “UC Health and the Future of Health Care,” at the UC Center for Health Quality and Innovation’s third annual colloquium May 2 in Oakland.

“If we truly acted as a system, we would be quite a force,” Hawgood said.

Change necessitates action

Health care is changing rapidly in the United States, Hawgood said. While people are living longer, health spending is rising, with increasing pressure to meet the “triple aim” of better patient care, better population health and lower costs.

Health providers need to remain connected to the past but prepared to swing in new directions at this “hinge of history,” Hawgood said, borrowing a half-century-old phrase from former UC President Clark Kerr.

In other words, business as usual can’t continue. Academic medical centers can expect significant consolidation in the next decade as they struggle to meet their “triple threat” of clinical care, research and education, Hawgood said, citing futurist Ian Morrison.

What does this mean for UC Health and its five academic medical centers and 17 professional schools?

UC’s academic medical centers — Davis, Irvine, UCLA, San Diego and San Francisco — have been known for providing the most complex care, such as burn care and transplants, as well as conducting research and educating health professionals. That traditional model worked well in what Morrison characterizes as the volume-based first curve, where academic medical centers could be autonomous and focused on the short term. But the value-based second curve is coming, where the future will be focused on new technologies, new consumers and new markets.

As academic medical centers shift from the first curve to the second curve, they must transform their business and health care delivery models to balance quality, cost and patient preferences to achieve real value and outcomes while staying true to their three-part mission, Hawgood said.

A singular system

For UC, that means moving beyond efforts to coordinate regionally, said Hawgood, who praised broader efforts such as the innovation center and “Leveraging Scale for Value” project to reduce costs at UC hospitals.

To thrive in the future, UC must do even more to act as a health system and move toward one UC Health, he said.

“We have tremendous opportunities,” said Hawgood, such as building a statewide strategy, making clinical and educational innovations, collaborating on translational research, branding and marketing, training the workforce, and impacting policy.

Dr. John Stobo, UC Health senior vice president, agrees with Hawgood.

“The ‘second curve’ for UC is to take advantage of its leverage and power when acting as a system,” Stobo said. “In this new paradigm, UC Health and the UC system can truly be a national leader in clinical care, education and research to improve the health of society.”

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New patient care model reduces readmission rates


Early results are promising.

Medical specialists within integrated care teams are helping to lower hospital re-admission rates for patients who are HIV positive. (Photo by Elena Zhukova)

>>Related: Pilot program reduces hospital readmissions for people with HIV and AIDS

By Kate Rix

A demonstration project aimed at improving patient care for people with HIV and AIDS has reduced the number of hospital readmissions at one Bay Area hospital by 44 percent.

The new approach — jointly funded by the California HIV/AIDS Research Program (CHRP) at the University of California, the Alameda County Health Care Services Agency, the Gordon and Betty Moore Foundation and Alameda Health System  — puts primary care physicians at the helm of an integrated care team that includes social workers, psychologists and medical specialists.

These collaborative teams form virtual “patient-centered medical homes” that work together to ensure that patients come to appointments, take their medications and get the care they need.

“The HIV epidemic has had a history of clients being advocates for their own care,” said John Mortimer, CHRP health policy and health services research program officer. “Our goal is to make medical care even more client-centered to help improve patient outcomes.”

Promising results

Early results are promising. Highland Hospital in Oakland looked at how many patients were readmitted to the hospital in 2010 before the demonstration project started and compared it to rehospitalizations during the pilot program.

As a result of patient-centered medical home care strategies, which included support for care transitions from hospital to outpatient care, the number of readmissions fell significantly. Of 89 patients admitted in 2010 for HIV-related treatment, 35 were readmitted within a month. From October 2012 to September 2013, 63 patients were admitted, and only 14 of them were readmitted within 30 days.

“This shows that our system is working,” says Dr. Kathleen Clanon, medical director of the Health Program of Alameda County. “The supports are successfully in place outside the hospital.”

In addition to Oakland’s Highland Hospital, four other community clinics are participating: the Tri-City Health Center in Fremont, Lifelong Medical Care in Berkeley, and La Clínica and Asian Health Services, both in Oakland.

“UC is happy to have supported this innovative and effective pilot research program,” said Dr. George Lemp, director of CHRP.

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Athena is first network to adopt electronic data sharing standard for cancer


Guide will help UC network improve patient care.

The five University of California medical centers and their affiliates participating in the Athena Breast Health Network are using a new guide for sharing electronic data for breast cancer treatment. Developed by the American Society of Clinical Oncology (ASCO) and approved through ASCO’s Health Level Seven International committee (HL7), the guide will become a national data exchange standard. With the guide, Athena can utilize structured data capture tools for coordination of care, registry submission and research.

“ASCO applauds the leadership of both Athena and the Institute for Population Health Improvement in adopting this data sharing treatment plan and guide,” said ASCO President Clifford A. Hudis.“Their use of these standards will help physicians and practices move towards secure sharing of electronic information, so that they can improve patient care.” through the Athena Breast Health Network.

Electronic health records often contain data that cannot easily be shared among physicians or contributed to quality improvement, public health reporting or analytics. In addition, the current exchange standards did not include disease-specific templates needed for continuity of cancer care. To fill this void, ASCO hosted a Data Interoperability Standards Summit in February 2013 to encourage collaboration in developing standards that will overcome these barriers. The society selected adjuvant treatment for breast cancer as the focus for the first oncology standard. The draft standard was approved by open ballot through HL7, an accredited Standards Developing Organization (SDO) and the leading global SDO focused solely on health care, in May 2013.

Athena’s Breast Health Network participated in the larger Interoperability to Support Practice Improvement (INSPIRE) project, sponsored by the UC Davis Institute for Population Health Improvement (IPHI) and the California Office of Health Information Integrity (CalOHII). INSPIRE will produce breast cancer treatment plans and summaries for the Health Information Home, a patient-centered repository supporting care coordination. Integrated into the patient history, the information can support clinical care, registry reporting, and ultimately streamline clinical trials and quality improvement. In adopting this guide, Athena can now use a standardized format to transmit data across the systems supporting the project. The project is sending test data and expects to initiate transmission of patient data starting in the summer of 2014.

“It was critical to understand clinician work flow and to simplify data collection at the point of care,” said Michael Hogarth, professor of medicine at UC Davis. “We investigated clinician workflows and systems that would identify opportunities for structured data capture. We selected the widely implemented CDA standard as a foundation for the data exchange piece of our demonstration project. This is a strong step toward our goal of continuous improvement.”

ASCO is now expanding the guide for electronic data sharing with data relevant to the treatment of colon cancer and plans to submit the expanded guide to HL7 for review and approval in the fall 2014.

Project INSPIRE is funded as part of the Department of Health and Human Services Grant #90HT0029/01-02 (ARRA) to California Health and Human Services Agency in collaboration with UC Davis Institute for Population Health Improvement (IPHI) and California Health eQuality (CHeQ).

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UC innovation center colloquium will be May 2


Talks will air on UCTV beginning May 16.

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The University of California Center for Health Quality and Innovation will host its third spring colloquium, “Overcoming Obstacles to Spread,” May 2 at the Oakland Marriott City Center, 1001 Broadway, Oakland.

Carl Dvorak, president of electronic health records vendor Epic Systems Corp., will give the keynote speech, “How Technology is Facilitating the Transformation of Health Care Delivery.” State Sen. Ed Hernandez will discuss health care innovation. UC San Francisco interim Chancellor and School of Medicine Dean Sam Hawgood will discuss UC Health and the future of health care. Also, there will be poster presentations, remarks by UC Health and innovation center leaders, including John Stobo, UC senior vice president for health sciences and services, and panel discussions with innovation center fellows and with the UC Cardiac Surgery Consortium.

Talks from the colloquium will air on UCTV beginning May 16. For more information about UCTV, including videos from previous colloquiums, visit www.uctv.tv/chqi.

For any questions about the event, please contact the CHQI event planning team at brcevents@ucop.edu.

About the UC Center for Health Quality and Innovation

The UC Center for Health Quality and Innovation, launched in 2010, is charged with identifying best practices, convening key stakeholders to facilitate the exchange of knowledge, and funding innovative projects that demonstrate improved value in the health care delivery system. The center is governed by a board composed of the six UC medical school deans, five UC medical center CEOs and chaired by the UC Health Sciences and Services senior vice president. For more information, visit http://health.universityofcalifornia.edu/innovation-center.

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Sen. Boxer praises UC efforts to prevent medical errors


She tours UCLA, notes its safety measures.

Sen. Barbara Boxer observes two nurses demonstrating a bar code scanning safety procedure at Ronald Reagan UCLA Medical Center.

Every year, 325,000 patients die in the United States due to medical errors, a number that would fill the Rose Bowl nearly four times, according to a special report released today (April 25) at a UCLA news conference by U.S. Sen. Barbara Boxer (D-Calif.).

Boxer presented the findings of her report at Ronald Reagan UCLA Medical Center and noted steps UCLA already takes to prevent medical errors and that could serve as models for other hospitals around the country. Boxer’s report also highlighted efforts by UC Davis to reduce ventilator-associated pneumonia and by UC San Diego to reduce blood clots and central line bloodstream infections.

“These deaths are all the more heartbreaking because they’re preventable,” Boxer said after she toured the medical center with Dr. David Feinberg, president and chief executive officer of the UCLA Health System, so she could see for herself two systems being used to prevent medical errors. “This is not the time to sit back and do nothing. I will not turn away from this challenge when I have the opportunity to pull back 325,000 people from disaster every year simply by preventing medical errors.”

The third leading cause of death in the country, medical errors can be avoided by something as simple as washing your hands. These errors commonly result in hospital-acquired infections, bedsores, patient falls, adverse drug reactions, sepsis, blood clots, catheter-related urinary tract infections, ventilator-related pneumonias and surgical site infections. In addition to saving lives, preventing medical errors could save up to $19.5 billion annually, Boxer said.

While touring the seventh floor, Boxer was first was shown the bar code technology and electronic medical records system used at UCLA to ensure patients receive the right medications in the right doses at the correct times. The process begins with a medication dispenser that operates much like a vending machine, providing one dose of drug at a time. A nurse logs in to the patient’s medical record to determine what medications are due and accesses them from the dispenser.

Once in the patient’s room, a nurse logs into a bedside computer and scans a bar code on the patient’s armband that automatically opens up his or her electronic medical record. The nurse then scans the medication, which is individually wrapped and bar-coded for that specific patient. If the medication’s bar code isn’t recognized as belonging to the patient’s medication profile, a warning will flash on the computer screen. After giving the patient the medication, the nurse selects the “administer” button, which instantly updates the medical record that the medication has been administered.

UCLA nurses were heavily involved the development of the bar code system, said Renee Appleby, director for the seven west cardiothoracic telemetry unit. The nurses first studied the errors to determine what was going wrong, and then participated in the creation of a safer system.

Boxer called the bar code and electronic medical record system “exciting, an enormous change for the better,” and said it must give the UCLA medical team more peace of mind.

“As a nurse, it makes me feel safe,” nurse Megan Kelly told Boxer.

Prior to the installation of the bar code system, the medical center was making two to four medication errors a month. Since the new system has been in place, no medical errors have been made, Appleby said.

That’s an impressive accomplishment, since the medical center dispenses five million doses of medication a year, said Cathy Ward, UCLA’s chief nursing officer.

“You’re really doing everything you can to save lives,” Boxer said. “Congratulations.”

Boxer then went to the seventh floor ICU to see the medical center’s ultraviolet disinfection system in action. The medical center has two Xenex machines, which can disinfect a hospital room in five minutes. The Star Wars-like robots use a Xenon bulb, a powerful form of UV light, combined with technology that generates high intensity pulses of light that are effective against 22 pathogens, including MRSA.

“The light kills micro-organisms by breaking down the cell walls of bacteria and fungus,” said Dr. Daniel Uslan, assistant clinical professor of medicine in the division of infectious disease.

“This is amazing technology that will help save lives,” Boxer said.

Feinberg said he is proud of UCLA’s commitment to patient safety and he looks forward to partnering with Boxer to find new and effective ways to ensure patients remain safe.

The report was compiled after Boxer wrote to 283 California acute care hospitals asking them to respond with the actions they are taking to reduce medical errors. Of those, 149 hospitals responded.

All of hospitals that responded reported taking at least some steps to address the most common medical errors, Boxer said. The report includes some common approaches to combating medical errors, such as using bar code technology and electronic health records to ensure patients receive proper medications to avoid adverse drug events. This technology is currently in use at Ronald Reagan UCLA Medical Center.

Other common approaches to preventing medical errors in the report included maintaining hand hygiene, using central line anti-microbial port covers, assessing all patients for bedsores prior to and upon admission, assessing patients for blood clot risks preoperatively and elevating the heads of patients on ventilators from 30 to 45 degrees.

Boxer’s report, which will be sent to the 283 hospitals initially queried, made six recommendations to improve patient safety, including:

  • Requiring all federal programs designed to reduce medical errors to work off a single list where appropriate, specifically the Partnership for Prevention’s list of the nine most common medical errors.
  • Having the Department of Health and Human Services report to Congress the time it takes for quality measures to be developed, endorsed and implemented in programs related to medical error reduction.
  • Creating a standard way of reporting medical errors, allowing hospitals and researchers to better collect data on errors, their frequency and where they are occurring.
  • Evaluation of information collected by hospitals when assessing whether medical centers are meeting the requirement to track and report adverse events as a condition of participation in Medicare.
  • Have Congress review the adequacy of whistleblower protections to ensure health care providers are able to report errors.
  • Have the Office of the Inspector General examine the Hospital Patient Safety Initiative’s new surveyor tools and analyze their impact on increasing staff reporting of medical errors.

“If we work together, we can prevent these needless tragedies,” the report states. “If we ensure that doctors, nurses, hospital administrators, medical technology leaders, federal officials and patient advocates are all focused on this common goal, we can make great progress in preventing avoidable deaths and ending the epidemic of medical errors in this country.”

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Private partnerships for public benefit


Nobel laureate’s research into neurodegenerative diseases gets boost from Japanese firm.

Nobel laureate Stanley Prusiner (left), director of the UCSF Institute of Neurodegenerative Diseases, recently launched a partnership with pharmaceutical company Daiichi Sankyo that will accelerate his research into prion diseases. He credits the partnership largely to groundwork laid by IND’s associate director, David Ramsay (right).

Stanley Prusiner, M.D., is used to overcoming challenges in his career.

In 1982, as a UC San Francisco junior faculty member in the Department of Neurology, Prusiner published an article describing his discovery of an unprecedented class of pathogens that he named “prions.” These infectious proteins are now understood to be involved in numerous neurodegenerative diseases in humans and animals, including Alzheimer’s, Parkinson’s, frontotemporal dementia and Creutzfeldt-Jakob disease (CJD).

The article sparked a firestorm at the time.

Prusiner’s contention that a protein alone could be infectious flew in the face of the commonly held scientific belief that infections could only be transmitted by viruses, bacteria, fungi and parasites – all of which have genomes composed of either DNA or RNA. Proteins, however, are composed of amino acids.

Despite what he described as a “torrent of criticism” from the scientific community, the media and even funders of his research, Prusiner remained undeterred. He took comfort in the unwavering support of close colleagues, and mounting scientific evidence – much of it stemming his UCSF lab – that backed his claims.

The groundbreaking work led to Prusiner’s 1997 Nobel Prize in Physiology or Medicine.

“People often ask me why I persisted in doing research on a subject that was so controversial,” Prusiner said in his Nobel acceptance speech. “I frequently respond by telling them that only a few scientists are granted the great fortune to pursue topics that are so new and different that only a small number of people can grasp [their] meaning initially.”

In the decades since his discovery, Prusiner – now director of the Institute for Neurodegenerative Diseases (IND) at UCSF – has been committed to getting answers about prion diseases, and ultimately treatments and cures.

Even with a Nobel Prize under his belt, the road continues to pose challenges.

Federal funding from the National Institutes of Health (NIH) has been crucial to his research, but the recent recession – and resulting sequestration – highlighted the need to strengthen relationships with private industry. In 2013, the NIH awarded a total of $22.5 billion in funding to U.S. institutions, the lowest amount since 2003.

But this month, Prusiner’s work got a huge boost from an exciting new collaboration between the IND and the Japan-based global pharmaceutical company Daiichi Sankyo Co. Ltd. It will focus on developing therapeutics and molecular diagnostics for multiple neurodegenerative diseases.

“Alzheimer’s alone kills as many people every year as cancer does, but it only receives one-tenth of the funding that we dedicate to cancer research. This collaboration won’t fill that funding gap, but it will offer the tremendous value of Daiichi Sankyo’s scientific expertise to make progress on these diseases,” he said.

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