TAG: "Patient care"

Building the future of health care


More than 1,000 donors give $131M in support of UC San Diego Jacobs Medical Center.

By Judy Piercey and Jade Griffin, UC San Diego

Committed to fostering the future of health care in San Diego, more than 1,000 donors have contributed $131 million to UC San Diego’s Jacobs Medical Center. Included in the total are gifts that matched a donation of $25 million, meeting the Challenge goal of the initiative.

Today (Nov. 20), the campus announced that the Challenge donation, originally anonymous, was made by Joan and Irwin Jacobs. They provided a $75 million lead gift for the new facility in 2010; with the Challenge gift, that brings their contributions to the Jacobs Medical Center to a total of $100 million. Continued private support will help fund the completion of the new medical center, which is the largest hospital project currently underway in Southern California.

Under construction and projected to open in 2016, Jacobs Medical Center is a $839 million, 10-story facility on the university’s La Jolla campus, which will include three new clinical care units in one location: The A. Vassiliadis Family Hospital for Advanced Surgery, The Pauline and Stanley Foster Hospital for Cancer Care and the Hospital for Women and Infants.

“We are deeply grateful to Joan and Irwin Jacobs for their generosity, including the recent $25 million match challenge,” said UC San Diego Chancellor Pradeep K. Khosla. “We also thank Carol Vassiliadis and Pauline Foster, who made leadership gifts, as well as all of the other donors who participated in meeting this challenge. These visionaries support UC San Diego’s commitment and vision to create a healthier world through new science, new medicine and new cures.”

“Jacobs Medical Center is part of a multibillion dollar university investment in the future of health care for the region,” said Dr. David A. Brenner, vice chancellor for Health Sciences and dean of the UC San Diego School of Medicine. “I want to thank all of the donors who have helped make this extraordinary medical center a reality.”

Irwin and Joan Jacobs

“When we came here in 1966, the medical school was just starting,” said Irwin Jacobs, co-founder, former chairman and CEO of Qualcomm Inc. and UC San Diego founding faculty member, who served as a professor in electrical and computer engineering from 1966 to 1972. “There was no hospital, just a school. So it’s very exciting to make Jacobs Medical Center possible. More and more, we’re learning how to bring results from basic research in biology and engineering to medicine, and to the clinic. I think this medical center is going to show how effective that can be. The innovations will spread out from San Diego, and go all around the world.”

The 509,500-square-foot facility will house 245 patient beds and be connected on multiple floors with the existing John M. and Sally B. Thornton Hospital on UC San Diego’s La Jolla campus, in the heart of the area’s nexus of biomedical research centers. Jacobs Medical Center has been designed with the patient in mind. From spacious private rooms to soothing color schemes and artwork, to next-generation medical equipment, the vision and needs of patients, doctors and nurses, all aspects of the Jacobs Medical Center have been fully integrated. Each floor will combine all the necessary healing elements while achieving optimal safety and efficient delivery of care.

“Soon we will have the largest, most technologically advanced hospital in the region, dedicated to offering specialized care for every kind of patient, in every phase of life,” said Paul Viviano, CEO of UC San Diego Health System.

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UCSF Mission Bay hospital complex to open Feb. 1


Three new hospitals for women, children and cancer patients.

UCSF Medical Center at Mission Bay will open Feb. 1, 2015. (Photo by Mark Citret)

After more than 10 years of planning and construction, UCSF Medical Center at Mission Bay will open Feb. 1, 2015 on UC San Francisco’s world-renowned biomedical research campus. UCSF Medical Center at Mission Bay comprises UCSF Benioff Children’s Hospital San Francisco, UCSF Betty Irene Moore Women’s Hospital and UCSF Bakar Cancer Hospital. The new facilities include a 289-bed hospital complex, with children’s emergency and outpatient services that will integrate research and medical advancements with patient-focused, compassionate care.​

UCSF Medical Center at Mission Bay will welcome its first patients the morning of Feb. 1, when teams of health care professionals and ambulances begin moving some inpatients from the UCSF Parnassus campus and Mount Zion campus into the new facilities.

The new medical center, strategically located on UCSF’s 60.2-acre Mission Bay research campus, will enhance UCSF’s ecosystem of innovation by putting physicians in close proximity to researchers and near biotechnology and pharmaceutical companies in Mission Bay and beyond. The new cancer hospital, for example, will sit near the UCSF Helen Diller Family Cancer Research Building, where every day leading scientists are seeking causes and cures for cancer.

UCSF Medical Center at Mission Bay also will feature the only operating hospital helipad in San Francisco to transport critically ill babies, children and pregnant women to the medical center from outlying hospitals.

“UCSF Medical Center at Mission Bay profoundly advances our ability to fulfill our mission as a public hospital, providing high-quality health care that meets the future needs of the entire Bay Area,” said Mark R. Laret, CEO, UCSF Medical Center and UCSF Benioff Children’s Hospitals. “By embedding clinical care within our research enterprise at Mission Bay, UCSF physicians and scientists in the forefront of cancer medicine, and women’s and children’s health will be able to more readily translate discoveries into next-generation therapies and cures.”

Each of the new hospitals’ designs reflects significant input from patients and families, as well as clinicians.

“UCSF Medical Center at Mission Bay sets a national benchmark for patient- and family-centered health care by offering an unparalleled healing environment that supports and connects patients and their families during hospital stays,” said Cindy Lima, executive director, UCSF Mission Bay Hospitals Project. “These new hospitals expand our capacity to provide the most advanced treatments in buildings that reflect input from the people who will use them.”

The hospitals feature state-of-the art technology, including the world’s largest hospital fleet of autonomous robotic couriers which will deliver linens, meals and medications. Interactive media walls in each private room will enable patients to communicate with their families and clinicians, and an imaging suite specially designed to eliminate anxiety during an MRI offers children the chance to virtually experience a San Francisco trolley ride, or to play with a cast of animated critters as they boat around the San Francisco Bay.

Distinctive features of UCSF Medical Center at Mission Bay include 4.3 acres of green space and 1.2 acres of rooftop gardens, soothing art- and light-filled interiors and a public plaza created in partnership with the City of San Francisco. In addition, UCSF Medical Center at Mission Bay is on target to be one of the first LEED Gold-certified hospital in California.

The Integrated Center for Design and Construction brought together more than 200 architects, engineers and contractors working side by side in a command center on the construction site. Construction of the hospitals began in December 2010.

“The healing power of UCSF Medical Center at Mission Bay extends beyond the hospitals’ walls, as clinicians and researchers work side by side to accelerate medical breakthroughs and transform the delivery of health care in this country,” said Sam Hawgood, M.B.B.S., chancellor of UC San Francisco. “It’s important to note that the hospital complex was built only through the generous philanthropic support of the Bay Area community, who share our vision of advancing health care across the world. We are greatly appreciative of their unwavering commitment to our mission over the past decade. ”

UCSF Benioff Children’s Hospital San Francisco

UCSF Benioff Children’s Hospital San Francisco, one of the nation’s leading children’s hospitals, provides treatment for virtually all pediatric conditions, as well as for critically ill newborns. The Neonatal Intensive Care Nursery at UCSF Benioff Children’s Hospital San Francisco was one of the first of its kind in the world. The hospital is the only California state-designated children’s medical center in San Francisco and is affiliated with UCSF Benioff Children’s Hospital Oakland.

The new 183-bed facility at Mission Bay creates an environment where children and their families find quality care at the forefront of scientific discovery. Private rooms in the intensive care nursery support the youngest patients, while the fully accredited classroom and teachers enable school-age patients to continue their education while focusing on their health. The hospital offers accommodations for families of pediatric patients and nearby lodging for those requiring longer stays.

UCSF Bakar Cancer Hospital

UCSF ranks consistently among the top cancer care centers in the nation, according to the “America’s Best Hospitals” survey from U.S. News & World Report. UCSF Bakar Cancer Hospital sets the standard in personalized care, delivering advanced cancer therapies tailored to individual patient needs. The hospital increases UCSF’s inpatient and outpatient capacity to meet growing demand, in a state-of-the-art facility. The new hospital will absorb many of the cancer surgery beds currently located at UCSF Medical Center at Mount Zion, offering cancer surgeries in specialties ranging from urology and orthopedics, to head and neck and gynecologic oncology. Specialists also serve the individual needs of cancer patients from the children’s and women’s hospitals. In the future, Mission Bay could house as many as 250 or more surgery beds, with a full complement of outpatient cancer care services.

UCSF Betty Irene Moore Women’s Hospital

As the region’s first dedicated women’s hospital, UCSF Betty Irene Moore Women’s Hospital will embody the philosophy of the UCSF National Center of Excellence in Women’s Health. The new hospital will deliver care that addresses health needs across a woman’s lifetime, including cancer treatment, specialty surgery, a 36-bed birth center, nine deluxe labor and delivery rooms, and select outpatient services. Customizing care to each patient, the hospital will provide the best available diagnostic tests and treatments in a caring, women- and family-focused environment that incorporates the latest technology. Spacious rooms allow loved ones to spend the day or night comfortably.

Each labor and delivery room is designed to be respectful to patients and families during the life-altering event of childbirth. Combining sophisticated technical capabilities with carefully considered design choices, each room emits a sense of calm for the birthing experience. At the same time, it is a highly functional space for clinicians to provide quality care.

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UC San Diego opens first angioedema treatment center


Nation’s first dedicated center for diagnosing, treating diverse forms of swelling.

Bruce Zuraw, UC San Diego

By Jackie Carr and Christina Johnson, UC San Diego

UC San Diego Health System in partnership with the U.S. Hereditary Angioedema Association (HAEA), a nonprofit patient advocacy organization, has opened the nation’s first dedicated center for diagnosing and treating diverse forms of swelling, known collectively as angioedema.

The U.S. HAEA Angioedema Center at UC San Diego Health System will serve as an international referral center for people with all types of angioedema and will work closely with basic science laboratories at UC San Diego School of Medicine to better understand the condition and develop new treatments.

“The opening of this center is an incredible step toward building a national center of excellence for the diagnosis and treatment of angioedema,” said Bruce Zuraw, M.D., professor of medicine, the center’s director and the inaugural recipient of the U.S. HAEA Endowed Chair at UC San Diego. “With our research and clinical expertise and partnership with the U.S. Hereditary Angioedema Association, we can improve patients’ lives, save lives and ultimately find a cure.”

Marc Riedl, UC San Diego

Physicians at the center will offer comprehensive, holistic approaches to angioedema, emphasizing the importance of educating patients, families and the medical community about the condition in all its forms. Using the latest therapeutic tools, physicians will ensure that patients are correctly diagnosed and will then use novel therapies to treat and prevent acute swelling events that occur sporadically, often without clearly identifiable triggers, which may be life threatening.

“The disease may be misdiagnosed as a food or medication allergy, a bowel disorder or a gynecological condition, leading to unnecessary surgeries or even death if a patient has a swelling attack in the throat,” said Marc Riedl, M.D., associate professor of medicine and the center’s clinical director.

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Grant will aid patients suffering from severe pulmonary hypertension


$7.6M grant helps launch a nationwide patient registry to improve CTEPH practices.

Imagine trying to take a deep breath, but feeling like you’re sucking air through a straw. That’s how some patients with chronic thromboembolic pulmonary hypertension (CTEPH) describe living with the condition, which is estimated to affect several thousand Americans yearly but is commonly misdiagnosed. UC San Diego Health System is a world leader in CTEPH, and now with a $7.6 million grant, has helped launch the first national CTEPH registry to improve best practices and patient care.

The United States CTEPH registry, funded by Bayer Healthcare Pharmaceuticals, is a centralized electronic database that will involve 30 sites across the nation. UC San Diego Health System will manage the registry with the goal of enrolling 750 newly diagnosed patients over the next six years. It will allow physicians to follow the short- and long-term outcomes of patients and learn more about CTEPH.

CTEPH is believed to be a complication of a common blood clot condition called pulmonary embolism. It has been reported that as much as 3.8 percent of individuals with first-time pulmonary embolism may develop CTEPH. This suggests there may be thousands of new cases of CTEPH in the United States annually.

“Currently, the number of patients in the United States with CTEPH is unknown. Because the symptom of shortness of breath is nonspecific, many CTEPH patients may be misdiagnosed as having more common diseases like asthma or COPD,” said Kim Kerr, M.D., principal investigator and pulmonologist at UC San Diego Health System. “Using data collected from the registry, we will identify barriers to patients receiving the correct diagnosis and treatment of their CTEPH. This registry will also allow us to assess the effectiveness of established and evolving therapies of this disease.”

UC San Diego Health System is the pioneer of pulmonary thromboendarterectomy (PTE) surgery, a life-saving procedure that removes the blood clots from the lungs’ arteries that rob patients of their ability to breathe.

“The registry will serve as an educational tool for physicians and centers to learn more about the disease and its prognosis and outcomes, especially as it relates to surgical techniques used for PTE and the benefits to the patient,” said Michael Madani, M.D., co-investigator and cardiac surgeon, chief of cardiothoracic surgery and director of UC San Diego Sulpizio Cardiovascular Center – Surgery. “People from around the US suffering from CTEPH are referred to UC San Diego Health System for PTE but usually after discharge we do not have the resources to follow up long-term. Another critical part of the registry is that it will give us a more thorough understanding of how PTE truly improves a patient’s overall quality of life, even if they live 2,000 miles away.”

Nick Kim, M.D., pulmonologist and director of pulmonary vascular medicine at UC San Diego Health System, adds that the registry will enrich physicians’ understanding of all aspects of CTEPH in the U.S., including the subset of patients deemed not operable and treated with medical therapy instead.

“Centers across the nation working as a team will not only help health providers improve their approach to CTEPH, it will ultimately give patients more options, knowledge and empowerment in how their disease is managed,” said Kim.

For more information on pulmonary vascular medicine at UC San Diego Health System, please visit heartcenter.ucsd.edu.

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UC Irvine Health announces affiliation with Corona Regional Medical Center


Priorities include enhancing cancer, stroke and perinatal-neonatal care.

UC Irvine Health and Corona Regional Medical Center announced a comprehensive affiliation that will enhance the depth and variety of specialty health care services available in Corona and nearby communities. A major hospital expansion project will accompany this affiliation.

“Our goal is to transform health care in west Riverside County,” said Mark Uffer, CEO and managing director of Corona Regional Medical Center. “The affiliation with UC Irvine Health complements our strengths, brings residents a variety of clinical services normally available only from an academic medical center and allows local patients to be treated closer to home.”

This transformation of Corona Regional Medical Center includes recently approved expansion plans that include an entirely new building. This new building will include a larger emergency room that more than doubles the size of the existing space and creates shelled space above that will be designed for future private patient rooms.

Corona Regional is a subsidiary of Universal Health Services Inc. The expansion and an affiliation with a prestigious university health system reflects the strong commitment UHS has toward meeting the needs of the growing communities along the Interstate 15 and Highway 91 corridors, Uffer said.

“We are pleased to provide the residents of the Inland Empire access to the clinical expertise we’re known for as an academic medical center,” said Terry A. Belmont, CEO of UC Irvine Medical Center. “The area is growing and it is a privilege to formalize the longstanding relationship we have with Corona Regional and the area’s residents.”

The agreement will initially focus on developing several key specialty services supported by UC Irvine’s clinical and research expertise:

  • Stroke telemedicine — Minutes count when treating a stroke. Backing up Corona Regional’s stroke program with the resources of UC Irvine Health and its Joint Commission-certified Comprehensive Stroke Center gives the community instant access to the region’s greatest concentration of fellowship-trained stroke neurologists and surgeons.
  • Cancer services — The two institutions will explore ways to bring the resources of UC Irvine Health’s National Cancer Institute-designated comprehensive cancer center to the Inland Empire. The UC Irvine Health Chao Family Comprehensive Cancer Center is one of only 41 in the United States and is dedicated to excellence in cancer treatment, prevention, research and education. Its specialists in medical and surgical oncology offer access to more than 150 ongoing clinical trials that reflect the latest cancer treatments.
  • Maternal-fetal medicine — The affiliation includes plans to create a perinatal services program in Corona, building on Corona Regional’s obstetrical and gynecological program and UC Irvine Health’s expertise in managing complex and high-risk pregnancies. This agreement formalizes a years-long relationship in which UC Irvine’s medical faculty assisted physicians at Corona Regional to manage difficult pregnancies and deliveries through the resources of the UC Irvine Health high-risk perinatal and regional neonatal intensive care services. The two organizations will also explore jointly developing a neonatal ICU at Corona Regional.

This affiliation is a natural extension of a longstanding connection between the greater Corona area and UC Irvine Medical Center. Many residents have roots in and commute to work in Orange County. UC Irvine Health has provided services to Corona-area residents for decades, including more than 525 last year who required tertiary care such as complex neurosurgery, high-risk perinatal, trauma and cancer services. This agreement strengthens the continuity of care for Corona Regional patients who need primary, specialty and tertiary services, as well as access to new health care resources.

Corona officials are enthusiastic about the announcement.

“I am elated that the expansion is finally coming to fruition, as the residents of Corona will benefit from more modern facilities and higher levels of care,” said Corona Mayor Karen Spiegel. A longtime supporter, Spiegel has worked closely with the Corona Regional administration for a decade on expansion plans. “We have worked hard to change the face of our city and to create a healthier community — one that we can all be proud of.”

Spiegel said the project will bring much needed health care services to the growing community and views the academic and clinical affiliation with UC Irvine Health as a major contribution to the quality of life for Inland Empire residents.

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Hundreds welcome UC Irvine Health Medical Group to Tustin, Orange


Opens two new primary care centers.

Dr. Sajee Lekawa, right, greets a visitor to the UC Irvine Health Medical Group open house on Nov. 15.

More than 500 people from Tustin, Orange, Santa Ana and Irvine visited Saturday’s grand opening celebration of two new, state-of-the-art UC Irvine Health Medical Group primary care offices in Tustin and Orange. The family-friendly event was held at the Tustin office, 1451 Irvine Blvd., and featured free flu shots, blood pressure screenings, tours of the new center, face painting, music, healthy snacks and a chance to enter a drawing to win an iPad mini.

A ribbon-cutting ceremony featured remarks by Terry A. Belmont, CEO of UC Irvine Medical Center. Tustin Mayor Al Murray, Orange County Supervisor Todd Spitzer and Assemblymember Don Wagner also delivered remarks and presented certificates and proclamations welcoming UC Irvine Health to the community. Representatives from Sen. Mimi Walters’ office were also in attendance to present a certificate on her behalf.

Physicians from both the Tustin and Orange locations were on hand to meet new patients, greet long-standing patients and answer questions.

“The opportunity to interact with so many members of the community outside of a traditional office visit is a very meaningful, personal way to let them know that we are here to better serve them and their families by bringing exceptional care close to home,” said Dr. Sajee Lekawa, medical director of UC Irvine Health Medical Group. “Our patients have access to world-class clinical services, and more than 500 specialists at UC Irvine Health.”

UC Irvine Health physicians, nurses and other health care experts hosted information stations, offering health screenings and providing a more detailed description about their specialty services.

Both the Tustin and Orange locations feature family and internal medicine plus laboratory services. The Tustin center also offers pediatrics, rheumatology, imaging services and urgent care. Office hours are from 8 a.m. to 5 p.m. Monday through Friday. Urgent care services are offered from 5 p.m. to 9 p.m. Monday through Friday, and from 9 a.m. to 5 p.m. on weekends and holidays.

The Orange office is located at 293 S. Main Street, Suite 200, and is open from 8 a.m. to 5 p.m. Monday through Friday.

In October 2013, UC Irvine Health and MemorialCare Health system created an affiliation to develop primary care centers across Orange County. The new centers complement existing UC Irvine Health primary care practices at UC Irvine Medical Center in Orange and the Gottschalk Medical Plaza on the UC campus in Irvine.

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L.A. leaders to celebrate UCLA Health/CTI lab in China


Advanced medical lab to open in Shanghai early next year.

Los Angeles Mayor Eric Garcetti will escort a delegation of Los Angeles leaders in tourism, business and medicine to China to attend a Nov. 19 ceremony celebrating UCLA Health’s partnership with Centre Testing International (CTI), a Chinese firm, to launch an advanced medical laboratory in the Zhabei district of Shanghai.

The new facility, to be named the UCLA Health/CTI Medical Laboratories, is expected to open in early 2015.

“Our laboratory will bring UCLA’s state-of-the-art clinical diagnostic testing and pathology expertise to China to support pharmaceutical companies’ local clinical trial programs, and offer advanced diagnostic services and companion testing at the highest international standards,” said Dr. Serge Alexanian, the facility’s chief medical officer.

The partnership advances UCLA Health’s international outreach efforts aimed at strengthening Sino-U.S. relationships in order to enhance patient care around the world. It also acts as a bridge between Chinese patients, research and development professionals and world-class pathologists from UCLA.

“Los Angeles is a hub for medical excellence and innovation, and the UCLA Department of Pathology is on the cutting edge of clinical testing,” said Garcetti.  “Through this partnership with CTI, UCLA can share its expertise with fellow scientists while improving health care and the quality of life for the people of China.”

The partnership is the first between a Chinese company and a U.S. academic medical center to create a specialized laboratory in China. The 25,000-square-foot facility will offer genetic and molecular diagnostics and other sophisticated tests that exceed the scope of the average lab in China. UCLA pathologists will train Chinese lab specialists to accurately interpret the tests with an information-technology platform that will generate reports in both Mandarin and English.

“This joint venture is founded on UCLA’s desire to build strong global relationships that improve the health of people and communities through education, research and service,” said Michael Burke, director of international development for UCLA Health. “UCLA has a genuine interest in elevating the level of medicine around the world.”

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Blood test predicts signs of acute rejection in kidney transplants


UCSF finding could lead to earlier detection, treatment and improved organ survival.

Researchers at UC San Francisco have developed a potential test for diagnosing and predicting acute rejection in kidney transplants, a finding that eventually could replace the need for biopsies and lead to earlier detection and treatment.

The study is in today’s (Nov. 11) issue of PLOS Medicine.

“We have found a set of genes in blood that pick up inflammation and acute rejection in different solid organ transplants and thus can replace the need for an invasive biopsy in the future,” said senior author Minnie Sarwal, M.D., Ph.D., professor of transplant surgery at UCSF. “This assay also predicts the onset of histological rejection by three to four months, meaning graft inflammation can be treated early and proactively, even reversed.”

“This is the first assay of its kind that can provide a sensitive readout of very early rejection and inflammation in the organ, which cannot be picked up by any other blood test on the market,” Sarwal continued. “The result is improved graft function and survival.”

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Bridging the gap in precision medicine


UCSF takes steps to solve the ‘last mile’ problem.

By Pete Farley, UC San Francisco

For entertainment giants such as Netflix and HBO, there’s an oft-cited concept known as “the last mile.”

It refers to the performance bottleneck that can arise in the short, final stretch of cable that links their vast, sophisticated server farms to the humble jack on a subscriber’s wall.

More than a decade after the immense promise unleashed by the completion of Human Genome Project, precision medicine has struggled with its own “last mile.” Despite major leaps in the field as a whole, the technical work needed to integrate a patient’s genomic information into the day-to-day practice of medicine has lagged far behind.

This month, UCSF is unveiling its bridge across that persistent gap.

Through its Genomic Medicine Initiative (GMI), UCSF has integrated data from a comprehensive cancer genetic testing program into the electronic medical records of patients at the Helen Diller Family Comprehensive Cancer Center. Not only does it allow for continuity of care with all testing and treatment results tied to the same electronic record, but it also allows physicians and researchers to identify larger patterns in the data that can lead to the development of better treatments.

“Many major medical institutions, including UCSF, have long had the science and the technology to generate genomic test results,” said Kristen McCaleb, Ph.D., program manager for the GMI. “The problem we’ve had is a lack of IT infrastructure to return those results to the clinicians who order the tests in a clearly actionable, doctor-friendly format.

This new project is a powerful new cloud-based software platform built in partnership with Palo Alto-based Syapse that seamlessly unites genomic testing and analysis, personalized treatment regimens, clinical data, and outcomes data, and –  crucially – integrates all of these features directly into APeX, UCSF Medical Center’s Epic-based electronic medical record (EMR) system.

“Genomics has the potential to dramatically improve patient care in oncology, but the full promise of precision medicine cannot be realized without a software platform to bring genomics to the point of care,” said Jonathan Hirsch, who founded Syapse six years ago as a 23-year-old Stanford University graduate student. “It is critical that genomic data be integrated with the patient’s medical history and presented to the clinician within the workflow of their EMR.”

One of the most comprehensive genetic tests for cancer

A major feature of the UCSF-Syapse partnership is that, beginning in the spring of 2015, UCSF oncologists will be able to order the “UCSF 500,” a panel of more than 500 gene mutations that have been implicated in a range of cancers. The test results will automatically feed into their adult and pediatric patients’ EMRs.

The assembly of the UCSF 500 wouldn’t have been possible without UCSF’s medical oncologists collaborating with Syapse to define which genomic alterations in which cancer types can be best treated with targeted therapies,” he said.

“The collaboration between the UCSF Helen Diller Family Comprehensive Cancer Center and Syapse is just one example of what the UCSF Genomic Medicine Initiative, launched two years ago, is doing to bring genomics to bear on clinical medicine,” said Robert Nussbaum, M.D., director of the GMI. “We are excited with the results and look forward to using it to improve the care of our patients here in the Cancer Center.”

When completed, test results from the UCSF 500 will automatically appear in a Syapse-powered window in the EMR, and from there, physicians can trigger consultation by a newly formed Molecular Tumor Board, a group of expert physicians and researchers that can recommend customized treatment plans for each patient.

These recommendations are recorded in Syapse alongside the physician’s decisions, and the patient’s clinical course will be continuously tracked. The resulting information is displayed to the physician in an easy-to-understand graphical format, and clinical notes and summaries are automatically populated in the EMR.

Learning from the data

Because the Syapse system is cloud-based, on Amazon Web Services (AWS), physicians and members of the Molecular Tumor Board can query a patient’s test results in real time against the latest entries in UCSF’s knowledge-base, which is also drawn from public genetics, oncology and clinical trial databases, as well as the current scientific literature. AWS was selected for its robust security, support for compliance with medical information privacy laws, scalability and redundancy, Hirsch said.

A de-identified version of each patient’s clinical history from APeX and information on how patients respond to treatments is simultaneously added to a dedicated clinical research knowledge-base within Syapse, so future recommendations of the Molecular Tumor Board for any patient’s case will always be informed by the latest clinical experience.

Because APeX is based on Epic, a widely used EMR system, the new platform is easily scalable, and could easily capture clinical data from many medical centers in a consistent, easily accessible form, said Hirsch.

“Our top priority is benefitting our patients today, but if we can begin to collect and leverage the knowledge we gain from each positive patient outcome, and combine our experience with that of others doing similar work worldwide, future patients may be able to sidestep conventional therapies and go directly to the best targeted therapy as a first-line treatment,” McCaleb said.

“And that would be truly powerful.”

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Software platform bridges gap in precision medicine for cancer


Cloud-based system seamlessly integrates ‘actionable’ genomic insights into EMR.

UC San Francisco has unveiled a new cloud-based software platform that significantly advances precision medicine for cancer. Built in partnership with Palo Alto-based company Syapse, the new platform seamlessly unites genomic testing and analysis, personalized treatment regimens, and clinical and outcomes data, crucially integrating all of these features directly into UCSF’s electronic medical record (EMR) system.

The project was a collaborative venture of UCSF’s Genomic Medicine Initiative (GMI) and the UCSF Helen Diller Family Comprehensive Cancer Center.

“Many major medical institutions, including UCSF, have long had the science and the technology to generate genomic test results,” said Kristen McCaleb, Ph.D., program manager for the GMI. “The problem we’ve had is a lack of IT infrastructure to return those results to the clinicians who order the tests in a clearly actionable format. This new platform creates a doctor-friendly report that physicians can use to put genomics into the context of a patient’s clinical history, to receive guidance based on our institution’s best practices, to query for additional information — including outcomes of prior UCSF patients — and, ultimately, to provide better care for their patients.”

Jonathan Hirsch, Syapse president and founder, said that tight integration with APeX, UCSF’s Epic-based EMR, makes the new platform uniquely powerful. “Genomics has the potential to dramatically improve patient care in oncology, but the full promise of precision medicine cannot be realized without a software platform that brings genomics to the point of care,” said Hirsch. “It is critical that genomic data be integrated with the patient’s medical history and presented to the clinician within the workflow of their EMR.”

Beginning in the spring of 2015, UCSF oncologists will be able to use the new system to order the “UCSF 500,” a panel of more than 500 gene mutations that have been implicated in a range of cancers, with tools built directly into their adult and pediatric patients’ EMRs. When UCSF 500 test results are available, they will automatically appear in a Syapse-powered window in the EMR, and from there, physicians will be able to trigger consultation by a newly formed Molecular Tumor Board, which can recommend customized treatment plans for each patient.

The Tumor Board’s recommendations are recorded in Syapse alongside the physician’s decisions, and the patient’s clinical course will be continuously tracked, with the resulting information, including clinical notes and summaries, displayed to the physician in an easy-to-understand graphical format in the EMR.

Hirsch said that the assembly of the UCSF 500 wouldn’t have been possible without the energetic involvement of UCSF’s medical oncologists. “The clinicians at UCSF have been highly involved in defining what ‘actionability’ truly is — knowing which genomic alterations in which cancer types can be best treated with targeted therapies. They’re sitting down and doing the hard work of creating a cancer genomics knowledge-base, which has allowed Syapse to design automated clinical decision support that reflects UCSF’s leading oncology care.”

Because the Syapse system is cloud-based, implemented on Amazon Web Services (AWS), physicians and members of the Molecular Tumor Board can query a patient’s test results in real time against the latest entries in UCSF’s knowledge-base, which also draws from public genetics, oncology and clinical trial databases, as well as the current scientific literature. Hirsch said AWS was selected for its robust security, support for medical privacy-law compliance, scalability and stability.

A de-identified version of each patient’s clinical history from APeX and information on how patients respond to treatments is simultaneously added to a dedicated clinical research knowledge-base within Syapse, so future recommendations of the Molecular Tumor Board for any patient’s case will always be informed by the latest clinical experience. Because APeX is based on Epic, a widely used EMR system, the new platform is easily scalable, and could easily capture clinical data from many medical centers in a consistent, easily accessible form, Hirsch said.

“Our top priority is benefiting our patients today, but if we can begin to collect and leverage the knowledge we gain from each positive patient outcome, and combine our experience with that of others doing similar work worldwide, future patients may be able to sidestep conventional therapies and go directly to the best targeted therapy as a first-line treatment,” McCaleb said. “And that would be truly powerful.”

Robert Nussbaum, M.D., the Holly Smith Distinguished Professor in Science and Medicine and GMI director, said, “This collaboration is just one example of what the GMI is doing to bring genomics to bear on clinical medicine. The partnership is the product of a large multidisciplinary team of oncologists, molecular pathologists, and IT specialists. We are excited with the results and look forward to using it to improve the care of our patients.”

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Pediatric cancer expert champions innovative treatment at new hospital


UCSF researcher has helped redefine the treatment of neuroblastoma.

The entrance to the new UCSF Benioff Children's Hospital San Francisco at Mission Bay, which will open Feb. 1, 2015.

It offers whimsical works of art by celebrated artists, interactive exhibits designed by the Exploratorium and acres of rooftop gardens. When UCSF Benioff Children’s Hospital San Francisco moves to its new home at Mission Bay, it will even feature a fleet of robots that glide silently across hospital hallways bearing food trays or linens.

For most young patients, visits will be brief and occasional. But physicians like Kate Matthay, M.D., who runs the pediatric malignancies program, recognize that for some patients visits may be lengthy and frequent.

“The hospital is child friendly and family friendly, and that’s important because sick kids need their families close by,” said Matthay, who has been working at UCSF Benioff Children’s Hospital San Francisco since her fellowship in 1979 and is herself the parent of three adults.

Kate Matthay, UC San Francisco

Matthay is uniquely attuned to the needs of very sick children, because her patients include those with neuroblastoma, one of the most challenging pediatric cancers. Neuroblastoma is a rare malignancy of the nerve cells that usually starts in the adrenal glands, abdomen or near the spine by the chest or neck, spreading rapidly and aggressively in some patients. About 50 percent of patients present with advanced disease and require a bone-marrow transplant, follow-up therapy and lifelong specialized medical surveillance. Only 45 to 50 percent of patients over the age of 18 months with metastatic disease survive five years after diagnosis.

Matthay’s mission is twofold: She is committed to researching strategies that boost survival of neuroblastoma as well as other pediatric cancers with low cure rates; and she wants to identify the hallmarks of lower-risk disease that enable physicians to pare down treatment regimens, reducing side effects like hair loss, nausea and compromised immunity. More significantly, it will lower the risk of late effects, such as stunted growth, developmental delays and secondary cancers.

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Perioperative surgical homes improving results for patients, hospitals


UC Irvine Health anesthesiologists spearhead effort.

UC Irvine Health physicians continue to be leaders for a model of surgical care that may drive down hospital costs and, more importantly for patients, results in better outcomes and fewer complications.

At the recent annual meeting of the American Society of Anesthesiologists, Dr. Zeev Kain discussed the perioperative surgical home concept and UC Irvine’s experience in front of more than 5,000 participants during the meeting’s opening session.

“The perioperative surgical home delivers better patient outcomes, enhances safety and reduces costs,” said Kain, M.D., M.B.A., chairman of the UC Irvine Department of Anesthesiology & Perioperative Care and Chancellor’s Professor of Anesthesiology, Pediatrics and Psychiatry. “That’s not wishful thinking, it’s hard data.”

“Readmission rates are between 8 and 12 percent for the U.S. Our readmission rate from the [perioperative surgical home] is 0.5 percent,” he said.

Noting that half of all hospital costs occur in the postoperative period, Kain said avoidable complications such as pneumonia, urinary tract infections or the delirium some patients experience as they emerge from anesthesia can add $10,000 to the cost of treatment.

In addition, UC Irvine Health anesthesiologists made more than two dozen presentations, including Minimizing Postoperative ICU Complications with Drs. Trung Q. Vu and William Wilson, Optimization of the High-Risk Surgery Patient in the Era of Enhanced Recovery After Surgery and Perioperative Surgical Home with Dr. Maxime Cannesson and Kain, and Total Joint Perioperative Surgical Home at UC Irvine Health: A Cost Analysis with Drs. Darren R. Raphael, Cannesson, Leslie M. Garson, Shermeen B. Vakharia, Kain, Ran Schwarzkopf and Ranjan Gupta.

This perioperative care model, which refers to the period before, during and after surgery, spans the patient’s entire surgical experience, starting with the decision to have surgery through 30 to 90 days after hospital discharge. The care pathway is a mapped out by a clinical team that includes surgeons, anesthesiologists, nurses and to the medical device specialists to the rehabilitation therapists, such that there is complete continuity of care as well as standardization of practices to enhance patient safety.

Kain and Cannesson summed up the reasons for their surgical home efforts in the May issue of the journal Anesthesia & Analgesia:

Interestingly, with the recent changes occurring in the health care system in the United States, the American Society of Anesthesiologists has endorsed the concept of the Perioperative Surgical Home (PSH) and has recommended including it as part of affordable care organizations and hospitals. It is widely recognized that our current perioperative system in the United States is costly, fragmented, and often driven by focus on hospital reimbursement as well as culture and tradition rather than on quality and service. …  Because it has been shown that most perioperative complications are related to a lack of coordination of care and a wide variability in the way care is delivered, a model such as the PSH is much needed.

UC Irvine Health physicians published several other articles about the perioperative surgical home in the May Anesthesia & Analgesia, including a review of the university’s experience with orthopaedic surgeon Schwarzkopf and the model’s implementation for total hip and total knee replacement surgeries.

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