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May 14, 2019

Congratulations to our graduates

Late last week, I crossed the Quad on my way to a meeting. As I walked past row after row of pristine white chairs, I was humbled to think of the gifted students and proud families who would occupy them in just a few days' time.

I was inspired by the thought of our graduates' passion and their promise, and I was excited to imagine the advances they'll pioneer, the help and hope they'll provide to people in need--all the good they'll do in the world. I was also moved to think of their families, whose deep love and support helped get them here. I reflected on the pride I felt when my own children graduated, and I smiled to think about these loved ones enjoying that unique and unrivaled happiness.

Yesterday I had the honor of being present at the fulfillment of that moment as we celebrated Emory's 174th commencement. I was thrilled to be part of such a momentous occasion and grateful to all who worked so hard--faculty, event planners, facilities and maintenance crews, volunteers, and others--to make it the outstanding day our students and their families deserve.

Congratulations to all our graduates across the health sciences and the entire university. I wish you happiness, health, and prosperity as you move forward in your journey. May the path you choose bring you joy and allow you to make a positive difference in the world.

Please direct questions and comments to evphafeedback@emory.edu.

Jonathan S. Lewin, MD, FACR
Executive Vice President for Health Affairs, Emory University
Executive Director, Woodruff Health Sciences Center
CEO, President, and Chairman of the Board, Emory Healthcare

Continuously improving patient care

Marybeth Sexton, Shailly Shah, Kim Cooley

"For Our Patients, For Our People" was the theme of the 2019 Emory Quality Conference held earlier this month. Gary Kaplan, chairman and CEO of Virginia Mason Health System, delivered the keynote speech. Virginia Mason was one of first health systems to adopt the Lean operating system, and Kaplan shared lessons learned. Attendees then adjourned to view the finalists in the quality innovation poster contest. Selecting this year's finalists, and then winners, was even harder than in years past. Submissions jumped to 180 from an average of 125, and the quality of the submissions continues to improve. "It was very hard to choose the winner with so many excellent posters," says Nate Spell, director of the EHC Quality Academy and associate dean for education and professional development at the medical school, who oversees the poster competition. "We finally identified our top two, but we just couldn't pick between them, so we had a tie for Best Overall Poster."

Infectious disease specialist Marybeth Sexton, director of antimicrobial stewardship for Emory University Hospital (EUH), presented work from a multidisciplinary team that claimed one of the top awards for an initiative to increase the use of cephalosporins for perioperative prophylaxis in penicillin-allergic patients. These antibiotics are the gold standard for preventing surgical site infections, but surgical and anesthesia teams were often reluctant to use them in patients who were allergic to penicillin.

Sexton's team included another infectious disease physician, two attending anesthesiologists, an anesthesia resident, a surgeon, and an allergist. Their research showed that perioperative use of cefazolin or cefuroxime was safe in the vast majority of patients with a penicillin allergy label, excepting a small subset with a history of a reaction involving skin blistering or organ damage.

To get this message out, the team conducted two educational presentations--one at an anesthesiology morning conference at EUH and the other at anesthesia grand rounds. The response was surprisingly strong. Use of cephalosporins in penicillin-allergic patients jumped from less than 10% before the intervention to almost 90% after.

"The literature shows that educational interventions aren't necessarily effective," says Sexton. "I think this one was so successful because the message was so simple and because it was presented by a multi-disciplinary team with members from medicine, surgery, and anesthesiology."

Shailly Shah, director of inpatient pharmacy at Emory University Hospital Midtown (EUHM), led the other team that tied for Best Overall Poster. This team, which included pharmacists, pharmacy leaders, clinic administrators, a point of service representative, registration and admissions staff, and the unit director for the inpatient infusion floor, tackled the problem of lengthy wait times for inpatient chemotherapy for patients who had planned admissions from the EUHM Hematology Oncology clinic.

"We were getting a lot of complaints from patients, so pharmacy was working on improving its practices. The unit was also working on improving its practices. But none of us were working together," says Shah.

Unit director Dushon Copper and Shah assembled the team to go through every process and department involved in admitting a patient for inpatient chemotherapy, and they found it was quite cumbersome. Patients had to go to the clinic to check in, get labs drawn, and see the physician. Then they went to admissions to check in, where they would often wait two to three hours before being sent to the unit for infusion.

Clinic staff were not aware they could schedule appointments by specific times for these patients, not just on a specific day. The team asked the clinic staff to use this scheduling feature so patients are now staggered throughout the day, streamlining the flow. And now patients go directly from the clinic to the infusion unit, where admissions staff come to them. Finally, the team standardized and streamlined the process from placing the order for the chemotherapy drugs to their delivery in the unit.

The changes shaved off an average of two hours from the whole process. "We were each trying to fix things within our separate departments, but we learned we could only make an impact when we worked together," says Shah.

Kim Cooley, clinical nurse specialist at EUHM, led the team that won the Outstanding Safety Results award. In response to an uptick in central line bloodstream infections (CLABSIs) in newborns, the team investigated the problem and initiated two interventions. They found that the hub, or the access point that connects to the central line, was not being cleaned long enough prior to introducing the medicine. So they reeducated staff on proper "scrub the hub" techniques. They also developed a CLABSI checklist that included asking two questions about each infant in the nursery--"Does the central line need to be in today?" and "If this baby did not have a central line, would we start one today?"

As a result of both interventions, the median number of central line days in the nursery dropped from 205 in 2015 to 125 currently, and the nursery went 568 days with no CLABSIs.

See a list of other winners in this year's competition. --Martha McKenzie

Haygood Drive entry view

HSRB-II construction slated to begin later this year

The new Health Sciences Research Building (HSRB)-II, funded by a gift made last year by the Woodruff Foundation, is scheduled to begin construction in December. Located adjacent to HSRB-I, the building will have eight floors, six above grade and two partially below, with 346,000 gross square feet of space.The building is slated to include the following:

  • Experimental Research
  • Computation Research (2.5:1 wet-to-dry lab ratio)
  • Division of Animal Resources
  • Center for Systems Imaging (relocation from Wesley Woods)
  • Shared core labs, including Integrated Cellular Imaging, Flow Cytometry and Cell Sorter, Mass Spectrometry, Biorepository, 3D Printing and Fabrication, Biostatistics, and ABSL3-BSL3 Containment

2019 Georgia legislative highlights

Kallarin Mackey, assistant VP, State Affairs

On April 2, just before midnight, the Georgia General Assembly completed the 2019 state legislative session, concluding the first year of the 2019-2020 biennial session. Georgia lawmakers gave final passage to the state's $27.5 billion budget for the 2020 fiscal year, which includes several provisions impacting Emory:
  • The legislature appropriated $1,047,540 for Emory to establish a telepsychiatry consult line for maternal mental health cases.
  • The legislature also allotted $828,000 for OB/GYN residency programs around the state, and $1.9 million for primary care medicine residency programs.

Several pieces of legislation that addressed health care received final passage. The Governor has signed the "Patients First Act," which allows the state to pursue a Section 1115 Medicaid waiver. The Governor's Office will hire a consultant to draft the details of the waiver, which may include an increase in the income threshold up to a maximum of 100% of the federal poverty level. The bill also allows the state to seek a 1332 waiver to modify insurance coverage for individual and small group markets.

Also affecting Medicaid, the state passed legislation that renews the hospital provider fee that reallocates revenue from hospitals into the state's Medicaid program. In the same legislation, the General Assembly passed transparency provisions that require nonprofit hospitals to publicly report a range of financial data. See a detailed summary of the new transparency requirements.

Much of the legislative debate around health policy this session centered on efforts to modernize state regulations of hospital expansion, governed by the Certificate of Need (CON) program. While the overall program remains in place, the following changes were made:

  • Cancer Treatment Centers of America will be allowed to convert to a general cancer hospital by going through the CON process.
  • Capital expenditure thresholds are raised to $10 million (from $3.4 million), and equipment expenditure thresholds are raised to $3 million (from $1.3 million).
  • Clarifies that freestanding emergency departments are required to obtain a CON regardless of project expenditures
  • Establishes the Office of Health Strategy and Coordination that will share resources across multiple state agencies to strengthen the state's health care infrastructure
  • Requires nonprofit hospital financial disclosures
See a full summary of the bill.

Other bills impacting the health care community that received final passage include the "heartbeat bill" that prohibits abortions if a fetal heartbeat is detected. The legislation includes exceptions for instances when the life of the mother is at risk, the pregnancy is medically futile, or is the result of incest or rape.

Policies around telehealth also receiving final passage will ease the practice of telehealth. Insurers will now be required to reimburse for care covered under the policy that is delivered using telehealth services after January 1, 2020, and the Georgia Composite Medical Board can now issue licenses to physicians outside Georgia to provide telemedicine services to patients locally.

On the issue of low THC oil, an agreement was reached in the final hour of the session on establishing in-state cultivation for medical marijuana, capping a five-year effort by the legislature to increase access to low THC oil for patients with certain medical conditions. The bill establishes a licensing process for the cultivation of low THC oil. UGA and Fort Valley State University, as Georgia's two land grant universities, will be allowed to seek a Class 1 production license. The bill also allows for four Class 2 production licenses for commercial entities. This process will be overseen by a newly created Georgia Access to Medical Cannabis Commission under the Secretary of State's Office. The oil will be distributed by pharmacies. Language was included in the bill to clarify that nothing in the bill will prohibit Emory from continuing to conduct research in accordance with federal law.

Another bill that received final passage creates a Preceptor Tax Incentive Program to address the state's medical workforce shortage. This is a new income tax credit for taxpayers who are licensed physicians, advanced practice registered nurses (RNs), or physician assistants (PAs) who provide uncompensated preceptorship training to medical students, advanced practice RN students, or PA students.

Finally, several bills that address access to care through interstate compacts passed this session, including the Interstate Medical Licensure Act, the Physical Therapy Licensure Act, the Psychology Interjurisdictional Compact, and updated language to the Nurse Licensure Compact.

An indication of the policy issues that the legislature will consider next session are the study committees they will engage in over the months leading up to the 2020 session. Legislators interested in a particular topic can pass legislation to create a study committee, to be comprised of several members who will meet three to four times with various experts and stakeholders on the issue. The study committee can then make legislative recommendations for the upcoming session. Leadership in both chambers has the discretion to appoint the study committee. House or Senate committees available for appointment this year include topics such as maternal mortality, heat-related injuries in youth sports, rural development, and toddler social and emotional health. See a complete list of committees.

View the complete 2019 Session Report.

Health innovation district envisioned for Executive Park

Emory University filed a rezoning permit on May 1 with the city of Brookhaven for Executive Park, to replace the current retail- and office-centric site plan with a revised plan that builds on programs in orthopedics, sports medicine, brain health, medical science education, and health information technology already located on site. Emory seeks to add more medical and office space, including a 140-bed, non-emergency hospital. Plans also call for more than 1.5 miles of new sidewalks and a half-mile, off-street multi-use trail that will provide additional pedestrian and bike connectivity. Read more. See website on plans for Executive Park.
Synergy II Nexus Awards
Recipients of the most recent Synergy II Nexus Awards have been announced, with four proposals selected out of 16 submitted for funding. These four awards support collaborative projects among faculty in health sciences and Emory College, with funding from WHSC, School of Medicine, Emory College, and the Provost. Since the Synergy Awards were initiated in 2016, more than $3.6 million in funds have been awarded to more than 110 researchers, supporting 38 proposals. Read names of those receiving awards (under Round 6).
Health Sciences at a glance

If you need facts and figures about the Woodruff Health Sciences Center and its components—the number of faculty, staff, students, patients, and buildings; locations of outpatient practices throughout Georgia; or the ways in which the WHSC affects the state and local community, consult the 2019 At-a-Glance brochure, now available online and in pdf format. To obtain print copies (supplies limited), please contact Carol Pinto.

University Impact Report
Did you know that Emory provided $558.8 million last year in community benefits? Read Emory’s new Impact Report for FY 18, detailing work in five areas: preparing tomorrow’s leaders, discovery, community, caring and healing, and economic impact on Atlanta.
New basic science chairs
Gari Clifford, DPhil, recently was appointed chair of Biomedical Informatics after serving as interim chair since 2016. Eric Sundberg, PhD, was recently recruited from the University of Maryland School of Medicine to head Biochemistry, effective September 1, 2019. Read more.
Safety of driverless cars?

Ric Martinez (emergency medicine and former administrator of National Highway Traffic Safety Administration) argues compellingly in Automative News (“What’s the acceptable death rate for autonomous cars?”) that makers of such vehicles need a zero-tolerance standard in making decisions affecting health and safety. Yes, such vehicles have potential to help reduce crashes overall, but that doesn’t compensate for failing to prevent preventable accidents in driverless cars.

Rollins leads hurricane response hub
Rollins School of Public Health has been chosen to serve as one of five regional technical assistance centers for the Hurricane Response Hub (HRH) initiative led by the National Network of Public Health Institutes. Funded by the CDC, this program is designed to enhance disaster-related surveillance and environmental and occupational health recovery efforts in areas impacted by Hurricanes Harvey, Irma, and Maria by building disaster-related public health workforce capacity. Read more.
EHC is official provider for Globetrotters
The Harlem Globetrotters, which moved to Atlanta in 2016, announced last month that they have named Emory Healthcare as their official sports medicine provider. Emory physicians also serve as team physicians for the Atlanta Hawks, Falcons, Braves, and Dream. Read more.
Hospital awards
Emory University Hospital (EUH) was named a Top 100 Global Hospital in Newsweek’s World’s Best Hospitals and as one of Becker's Healthcare "100 great hospitals in America" for 2018. The EUH Tower also recently earned LEED Silver designation. Emory Rehabilitation Hospital received the President’s Recognition Award at the 2019 Select Medical Inpatient Rehabilitation Conference.

Karen Andes (global health) was selected as a 2018-2019 Governor’s Teaching Fellow.

Mark Borodovsky (biomedical engineering) was inducted into the American Institute for Medical and Biological Engineering College of Fellows.

Deb Bruner received the Outstanding Alumni Award from Penn Nursing.

Jeong Hwan Kim received second place in the Young Investigator Awards in Clinical Investigations.

Mary Lynch received the Innovator Award from the American Glaucoma Society.

Manu Platt (biomedical engineering) was inducted into the American Institute for Medical and Biological Engineering College of Fellows.

David Stephens (VP for research in health sciences and chair of medicine) received the 2019 Charles R. Hatcher Award for Excellence in Public Health.

Robert Taylor (cardiology) was inducted into the American Institute for Medical and Biological Engineering College of Fellows. 

May 21: Dean's Distinguished Faculty Lecture and Award, 5:30, SOM 110. More info.
May 31-June 1: National LGBTQ Health Conference. Emory Conference Center. More info.

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