Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Jan. 30, 2015 | Archived Issues

Recognition for Chugh, Danovitch, McGovern

Physician News

Sumeet S. Chugh, MD, has received a grant to study how to better predict sudden cardiac arrest, a group led by Itai Danovitch, MD, has published a guide to insurance options for coverage of addiction treatment, and Dermot P.B. McGovern, MD, PhD, has been elected a member of the International Organization for the Study of Inflammatory Bowel Disease.

» Read more


Meetings and Events


Grand Rounds

Click here to view upcoming grand rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - January 2015


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue. Click here to email us your milestones and comments.

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Individual/Family Plan Contracts Signed With Health Net and Blue Shield

From Thomas M. Priselac, President and CEO

Our patients now have more options for individual and family plans that provide coverage for Cedars-Sinai. We recently signed a contract with Blue Shield that allows us to offer individual and family plans on and off the exchange and extended our contract for these plans with Health Net off of the exchange.

» Read more

New Portal Will Manage CME Activities

The Continuing Medical Education office has implemented a new portal to manage all CME activities at Cedars-Sinai. The barcode and badge system used to track attendance for more than two decades is being replaced. The new Web-based CME portal is called CloudCME.

» Read more

The Measles Outbreak: Answering Your Questions

The U.S. is experiencing a large, multistate measles outbreak that originated in Southern California. Measles should be considered in any patient with new onset fever and rash. Airborne isolation (negative pressure) should be used for any patient suspected of having measles. Do not wait for confirmatory testing before isolating the patient and notifying Epidemiology/Infection Control at ext. 3-5574.

» Read more

Service, Memorial Fund for Michael Davidson, MD

On behalf of our colleague, Robert M. Davidson, MD, and his family, thank you for your expression of sympathy on the tragic death of his son, Michael Davidson, MD, on Jan. 20. Your tremendous support in this time of personal tragedy is appreciated. A memorial service will take place Sunday, Feb. 8, from 10 a.m.-1 p.m. at Leo Baeck Temple, 1300 N. Sepulveda Blvd., 310-476-2861.

» Read more

CS-Link Tip: Adding Photos to a Patient's Chart

There are many clinical situations in which a photograph augments our documentation, conveying a complex situation in a single image. Now a photo can be added directly to a patient's chart from your smartphone by using the Haiku application in CS-Link™.

» Read more

Prominent Neuroscientist Joins Cedars-Sinai

Axel Rosengart, MD, PhD, a prominent neurologist and clinical researcher whose work fostered the creation of medical devices to treat brain-injured patients, has joined Cedars-Sinai in two key neurology posts. Rosengart will serve as director of Neurocritical Care and of Neurocritical Care Research. His research collaborations have focused on monitoring and helping patients with brain injuries.
 

» Read more

Hundreds From Cedars-Sinai Help at Health Fair

Nearly 500 physicians and other healthcare professionals from Cedars-Sinai participated in the 11th annual health fair presented by Telemundo 52-KVEA and the California Endowment on Jan. 25. More than 30,000 people attended the event, and Cedars-Sinai provided more than 9,800 screenings.

» Read more

Individual/Family Plan Contracts Signed With Health Net and Blue Shield

From Thomas M. Priselac, President and CEO

Our patients now have more options for individual and family plans that provide coverage for Cedars-Sinai. We recently signed a contract with Blue Shield that allows us to offer individual and family plans on and off the exchange and extended our contract for these plans with Health Net off of the exchange.

Open enrollment for individual and family health insurance runs through Feb. 15, 2015. During this time, people can enroll in coverage or change their plan. Please note that this open enrollment only affects people who purchase their own insurance policies for themselves and their families; it does not affect those who receive health insurance through their employer, such as Cedars-Sinai employees.

The following plans now provide coverage for care from Cedars-Sinai:

Through the Covered California health benefit exchange:

  • Anthem Blue Cross Exclusive Provider Organization (EPO) plans (all metal levels — e.g., Platinum, Gold, Silver, Bronze)
  • Blue Shield of California PPO plans (new option) (all metal levels, coverage for Cedars-Sinai takes effect March 1, 2015)

Through an insurance broker or insurance company directly (off the exchange):

  • Anthem Blue Cross EPO
    • Anthem Blue Cross EPO plans (all metal levels — e.g., Platinum, Gold, Silver, Bronze)
    • Cedars-Sinai Medical Center is a Tier 1 facility in EPO plans.
    • Patients can keep coverage under a grandfathered Anthem Blue Cross plan that offers their full network of providers as long as they continue to pay premiums under the plan.
  • Assurant Health PPO
    • Assurant Health offers a full range of Preferred Provider Organization (PPO) network plans — using the Aetna PPO physician and hospital network.
  • Blue Shield of California PPO (new option)
    • All metal levels (e.g., Platinum, Gold, Silver, Bronze) of Blue Shield of California PPO plans will provide full coverage for care from Cedars-Sinai Medical Center and many of our physicians beginning March 1, 2015.
    • Patients can keep coverage under a grandfathered Blue Shield plan that offers a full network of providers as long as they continue to pay premiums under the plan.
  • Health Net PPO (contract extended)
    • All metal levels (e.g., Platinum, Gold, Silver, Bronze) of Health Net PPO plans will provide full coverage for care from Cedars-Sinai Medical Center and many of our physicians.
    • Patients who currently have coverage through a Health Net PPO plan purchased off of the exchange will continue to be covered for care at Cedars-Sinai.

We also recognize that there are many people who want to come to Cedars-Sinai, but may be concerned about out-of-pocket costs such as deductibles and co-pays for hospital services. To make things easier for our patients, we offer a variety of financial assistance programs that can help people with some of these costs. These programs are available to a wide range of incomes and more information is available online or by calling Patient Financial Services at 323-866-8600.

For the most up-to-date information and guidance, please access the following resources:

New Portal Will Manage CME Activities

The new Web-based CME portal is called CloudCME.

The Continuing Medical Education office has implemented a new portal to manage all CME activities at Cedars-Sinai. The barcode and badge system used to track attendance for more than two decades is being replaced.

The new Web-based CME portal is called CloudCME. You will be able to access your credit history on this portal via a link on My CS-Link™, a direct link or the CME office Internet site. A link to the portal also is available from the Intranet home page.

How this affects you as a member of the medical staff:

  • You no longer will need your badge to obtain CME credit at activities.
  • You will simply sign in (as you are already doing) on the appropriate sign-in sheets for the activities you attend.
  • The departmental CME agent will then input your attendance into the CME portal. Departmental agents are already trained, and your information is already in the system.
  • Once credit is entered into the system, it will be immediately viewable on your transcript via the new CME portal (replacing the CME transcripts in WebVS).
  • The initial rollout was completed this week. Additional features of the system, including online program evaluations, will be implemented over the coming year.

All medical staff members should have accounts in the new system. Your user name is the email address that you have on file with the medical staff office. An email with your login information was sent to that address from the CME office (cme@cshs.org) on Jan. 20.

If you have questions or did not receive the email containing your login information, please contact the CME Office at cme@cshs.org or 310-423-5548.

The Measles Outbreak: Answering Your Questions

The U.S. is experiencing a large, multistate measles outbreak that originated in Southern California and has spread to six additional states and Mexico, according to the federal Centers for Disease Control and Prevention.

Key messages for healthcare providers:

  • Measles should be considered in any patient with new onset fever and rash.
  • Airborne isolation (negative pressure) should be used for any patient suspected of having measles.
  • Do not wait for confirmatory testing before isolating the patient and notifying Epidemiology/Infection Control at ext. 3-5574.

What are the symptoms of measles, and when are people contagious?

Measles symptoms usually begin 10-12 days (up to 21 days) after exposure with a prodrome of fever (up to 105 degrees F), malaise, cough, coryza and conjunctivitis. Two to four days later, a maculopapular rash develops around the hairline or ears and spreads downward to the face, trunk and extremities. Severe illness can occur, including pneumonia, encephalitis and death.

Measles is highly infectious and is transmitted by airborne spread of respiratory droplets. Typically, measles patients are contagious from four days before to four days after rash onset. Suspect measles cases should not be allowed in patient waiting areas. They should be masked and placed immediately in an examination room, with the door closed. Patients with suspect measles should be seen at the end of the day and use a separate entrance. The examination room should not be used for two hours.

Who should be vaccinated against measles?

With few exceptions, everyone should be vaccinated against measles. Routine vaccination with two doses of measles-containing vaccine is the safest and most effective way to prevent disease. It is routinely recommended for all children and is a requirement for school attendance. Most children receive their first measles vaccine at age 12 months, with a booster prior to kindergarten. Infants as young as 6 months of age may be eligible for vaccination in certain settings (such as international travel), though this may reduce vaccine efficacy.

The measles vaccine is a live virus vaccine and is contraindicated in patients who are pregnant, as well as those with severe immunodeficiency (including receipt of chemotherapy, long-term immunosuppressive therapy such as >=20mg prednisone daily for >=2 weeks, or advanced HIV with CD4+ T-lymphocyte count <=15%).

Do I need to get a measles booster shot?

Booster shots are not currently recommended for those with evidence of immunity to measles. Evidence of immunity includes any of the following:

  • Born in the U.S. before 1957
  • Written documentation of two or more doses of measles-containing vaccine in high-risk individuals, such as healthcare workers, international travelers and school-age children
  • Written documentation of at least one dose of measles-containing vaccine in individuals not at high risk
  • Documented serologic evidence of immunity (elevated measles IgG)

Note: Those who received killed measles vaccine (offered from 1963-67) should receive at least one additional dose of live measles vaccine.

Healthcare workers who do not meet one of the above criteria should receive vaccination.

How effective is the measles vaccine?

MMR vaccine is highly effective in preventing measles, with a one-dose vaccine effectiveness of 95 percent when administered on or after age 12 months and a 2-dose vaccine effectiveness of 99 percent.

What should I do if I suspect someone may have measles?

Patients suspected of having measles should immediately be isolated from others. In outpatient areas, patients should avoid waiting rooms and be placed in a single room. When possible, they should be masked and seen as the last case of the day and use a separate entrance from other patients. In inpatient settings, patients should immediately be placed in airborne isolation. Do not wait for laboratory confirmation before isolating a patient and notifying Epidemiology/Infection Control.

What tests are available for measles?

Serologic testing is available (IgM and IgG). In addition, nasopharyngeal swabs and/or urine samples may be used to test for the virus by PCR. All testing should be performed in consultation with Epidemiology/Infection Control and public health authorities.

What can I do if I have been exposed to measles?

It is rare for people with immunity to measles to contract the disease following exposure, but cases have occurred. Those with measles immunity who have been exposed should self-monitor for symptoms; no specific prophylaxis is indicated.

Nonimmune, immunocompromised persons, infants ≤ 12 months and others at high risk of complications from measles can be protected with immune globulin ≤ 6 days after exposure. Nonimmune, immunocompetent individuals can receive the MMR vaccine ≤72 hours after exposure.

Click on the following links for more information on the measles situation and vaccination:

U.S. Centers for Disease Control and Prevention

California Department of Public Health

Los Angeles County Department of Public Health

Service, Memorial Fund for Michael Davidson, MD

Michael Davidson, MD

On behalf of our colleague, Robert M. Davidson, MD, and his family, thank you for your expression of sympathy on the tragic death of his son, Michael Davidson, MD, on Jan. 20. Your tremendous support in this time of personal tragedy is appreciated.

A memorial service will take place Sunday, Feb. 8, from 10 a.m.-1 p.m. at Leo Baeck Temple, 1300 N. Sepulveda Blvd., 310-476-2861.

The Dr. Michael J. Davidson Family Fund has been established at RTN Federal Credit Union. If you wish to contribute, please visit www.rtn.org/davidsonfund/.

Announcement from Brigham and Women's Hospital: brighamandwomens.wordpress.com/2015/01/21/dr-michael-davidson/

CS-Link Tip: Adding Photos to a Patient's Chart

A picture is worth a thousand words. There are many clinical situations in which a photograph augments our documentation, conveying a complex situation in a single image.

Now a photo can be added directly to a patient's chart from your smartphone (iPhone or Android) by using the Haiku application in CS-Link™. As always, document that the patient has given you permission to take a photograph for the medical record.

In case you have not yet downloaded Haiku to your phone, it's a free application. For help, please refer to these detailed instructions in CS-Link Central:

Capturing Images Using the Haiku or Canto Applications (PDF)

Haiku: Physician Quick Start Guide (PDF)

You can learn more by visiting CS-Link Central or by scheduling a training session with Lisa Masson, MD, (lisa.masson@cshs.org) Shaun Miller, MD, (shaun.miller@cshs.org) or Alex Bram (alex.bram@cshs.org).

Click here for more CS-Link training updates for physicians.

Prominent Neuroscientist Joins Cedars-Sinai

Axel Rosengart, MD, PhD, a prominent neurologist and clinical researcher whose work fostered the creation of medical devices to treat brain-injured patients, has joined Cedars-Sinai in two key neurology posts.

Axel Rosengart, MD, PhD

Rosengart will serve as director of Neurocritical Care and of Neurocritical Care Research. His research collaborations have focused on monitoring and helping patients with brain injuries, resulting in experimental medical devices and techniques to cool the brain, deliver drugs — such as the clot-busting drug TPA — or remove toxins from the bloodstream, and detect critical changes in patients at the bedside.

Since 2008, Rosengart has served as medical director of Neuroscience Intensive Care and of the Neuroscience Physician Assistant Service at New York Presbyterian Hospital. He also served as associate professor of Neurology, Neuroscience and Neurosurgery and medical director of Critical Care and of Emergency Neurology and Neurosurgery at Weill Cornell Medical College.

Rosengart previously was an associate professor at the University of Chicago Medical Center, where he was director of Neurocritical Care Research.

"We are truly fortunate to have recruited a neurointensivist of Dr. Rosengart's stature," said Patrick D. Lyden, MD, chair of the Cedars-Sinai Department of Neurology, director of the Stroke Program and the Carmen and Louis Warschaw Chair in Neurology. "After a national search and interviews with several of the most widely respected thought leaders in the emerging field of neurocritical care, we have found the perfect leader for our unit."

Rosengart earned his medical degree and PhD in neuroscience at universities in Germany, where he also completed a residency in neurology and earned a master's degree in public health. He acquired additional postdoctoral training in neurology, stroke research, neuro-ophthalmology research, psychiatry and neuroscience critical care.

Cedars-Sinai's Neuroscience Critical Care Unit, with 24 beds, is one of the largest in the nation and has the lowest severity-adjusted mortality rate in California.

Hundreds From Cedars-Sinai Help at Health Fair

B. David Massaband, DPM, a Cedars-Sinai podiatric surgeon, (in blue scrubs) and a translator help a participant at the Telemundo health fair.

A team of nearly 500 healthcare professionals, including physicians, from Cedars-Sinai who participated in the 11th annual health fair presented by Telemundo 52-KVEA and the California Endowment on Jan. 25.

Ruchi Mathur, MD, director of the Diabetes Outpatient Treatment and Education Center in the Division of Endocrinology, Diabetes and Metabolism at Cedars-Sinai, noted that the Latino community is at higher risk for diabetes, obesity and related health problems that can be life threatening.

"Screening people and finding disease early is really important," said Mathur, who was overseeing data collection at the event for Cedars-Sinai researchers studying health issues in the Latino population. "Events like this that can reach a large number of community members are fantastic because they give people a chance to learn what their health issues are, and we can point them in the right direction for care."

More than 30,000 people attended the event, including several generations of some families. Parents and grandparents took turns watching the kids as they received free health screenings and information from Cedars-Sinai and other health fair participants, including the John Wesley Community Health Institute, the Watts Health Center and the American Heart Association.

This is the fifth year Cedars-Sinai has participated in the Telemundo health fair, and the team spread out over more than half of the exhibit hall was the largest yet. It included physicians, nurses, dietitians, pharmacists, podiatrists, educators, advanced practice nurses, clinical researchers and other healthcare professionals.

Many team members speak Spanish, and translators were available to assist. Cedars-Sinai provided a total of more than 9,800 screenings during the health fair, including blood pressure, cholesterol, glucose, podiatry, weight and body mass index. In addition, team members provided seasonal flu immunizations and pharmacy consultations.

Click the image below to see more photos from the Telemundo health fair.