Cedars-Sinai Medical Center

medical staff pulse newsletter

Text size: A A A
A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Dec. 2, 2016 | Archived Issues

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 - December 2016 (PDF)  


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.

Submit your milestones and comments.

Key Changes Coming to Medicare Payment Model

As part of a federal effort to streamline regulations and improve healthcare value and quality, the Medicare payment model will undergo significant change beginning Jan. 1. Under the new rules, eligible clinicians must participate in one of two payment tracks. More than 85 percent of physicians will work with the Merit-Based Incentive Payment System, while the remainder will use the Advanced Alternative Payment Model.

» Read more

$1.2 Million State Precision Medicine Grant

Cedars-Sinai health investigators will use a $1.2 million grant from a state precision medicine initiative to design a system using remote monitoring to predict heart attacks and other cardiovascular events. Among the data collected will be activity, sleep, heart rate and stress levels. The co-principal investigators are Brennan M. Spiegel, MD; C. Noel Bairey Merz, MD; and Jennifer Van Eyk, PhD.

» Read more

Pulmonary Fibrosis Linked to Stem Cell Failure

Cedars-Sinai investigators have pinpointed a major cause of pulmonary fibrosis, a mysterious and deadly disease that scars the lungs and obstructs breathing. The disease, which has no known cure, appears to result from the failure of special lung stem cells that help airways recover from injury, the investigators reported in the journal Nature Medicine. Paul W. Noble, MD, was the principal investigator, and Carol Liang, MD, was the first author for the study.

» Read more

New Director to Focus on Patient Experience

Alan Dubovsky

Alan Dubovsky has been appointed director of patient experience and chief patient experience officer at Cedars-Sinai, a new position to help coordinate service excellence initiatives. He assumed the post in late November.



» Read more

Daskivich Helps Lead Precision Medicine Study

Timothy Daskivich, MD, assistant professor and director of Health Services Research in the Cedars-Sinai Department of Surgery, has been named a co-investigator for a prostate cancer study funded by the California Initiative to Advance Precision Medicine. The study's goal is to create computer algorithms, using biomarker data, patient characteristics and tumor risk markers, to predict the effectiveness of various treatments for early-stage prostate cancer.

» Read more

Study Finds Few Share Fitness Data With Doctors

Personal fitness tracking, using devices such as Fitbit and the Apple Watch, may be all the rage, but getting users to share the data with their doctors is not easy, according to a new study by Cedars-Sinai investigators.

» Read more

Medical Staff Can Take Shot at Clippers Tickets

Medical staff can win tickets to an NBA game thanks to Cedars-Sinai's new partnership with the Los Angeles Clippers. Clippers tickets will be made available to Cedars-Sinai staff through a random drawing. Staff members may enter only once and can win only once this season.

» Read more

Core Labs to Switch to STAT Immunoassay Dec. 21

The Core laboratories in the Department of Pathology and Laboratory Medicine will switch from a standard PTH immunoassay to a STAT immunoassay beginning Wednesday, Dec. 21.

» Read more

CS-Link Tip: Access Available to CURES

cs-link logo

CS-Link™ now has access to the website of CURES (the Controlled Substance Utilization Review and Evaluation System).

» Read more

Core Labs Updating Reference Intervals Jan. 3

Beginning Jan. 3, the Core laboratories in the Department of Pathology and Laboratory Medicine will update cortisol and progesterone reference intervals to match new assay formulations and U.S. Food and Drug Administration-approved information provided by Roche Diagnostics.

» Read more

Key Changes Coming to Medicare Payment Model

As part of a federal effort to streamline regulations and improve healthcare value and quality, the Medicare payment model will undergo significant change beginning Jan. 1.

Under the new rules, eligible clinicians must participate in one of two payment tracks. More than 85 percent of physicians will work with the Merit-Based Incentive Payment System (MIPS), while the remainder will use the Advanced Alternative Payment Model.

Under MIPS, physicians will still be required to comply with many of the provisions of Meaningful Use, a 5-year-old federal program designed to enhance health outcomes and to encourage the adoption of electronic health records. The federal program's next phase is known as Advancing Care Information, which will score physicians on a revamped set of measures. Physicians who do not participate could face penalties.

For more information, see the Centers for Medicare & Medicaid Services website.

$1.2 Million State Precision Medicine Grant

Brennan M. Spiegel, MD
C. Noel Bairey Merz, MD
Jennifer Van Eyk, PhD

Cedars-Sinai health investigators will use a $1.2 million grant from a state precision medicine initiative to design a system using remote monitoring to predict heart attacks and other cardiovascular events.

In this study, the research team will look for the earliest signs of cardiovascular disease by monitoring patients remotely with a specialized watch that measures activity, sleep, heart rate and stress levels. Participants also will report their levels of anxiety, depression and quality of life using a smartphone or computer. Additionally, patients will send researchers finger-prick blood samples by mail, allowing doctors to assess a variety of biomarkers and measure more than 500 blood proteins.

By combining these data and integrating them into patients' medical records, the researchers will seek a signal that can predict who may be about to have a heart attack or stroke, empowering patients to better manage their conditions. The team also will measure the cost-effectiveness of this approach and whether it could be covered by insurance companies and other payers.

The Cedars-Sinai study aims to address a major national health issue: Cardiovascular disease is the leading cause of death for both men and women in the United States, disproportionately impacting younger women and ethnic minorities. Health experts say early signs of a heart attack or stroke can be missed because people typically have limited interaction with doctors or hospitals, making it challenging to monitor symptoms.

"The governor's precision medicine initiative creates an amazing opportunity to confront this leading health threat by leveraging team science and advanced data analytics in ways never before possible," said Brennan M. Spiegel, MD, professor of Medicine and director of Health Services Research at Cedars-Sinai, who will lead the study. "For us, that means trying to stay one step ahead of cardiovascular disease by predicting who may have a heart attack or stroke before it happens."

Funding for the study comes from the California Initiative to Advance Precision Medicine, launched by Gov. Jerry Brown in 2015 to expand the capabilities of precision medicine within California. Cedars-Sinai, one of six demonstration projects selected by the state precision medicine initiative, will receive the $1.2 million grant over two years.

The research reflects a broad national push to combine emerging technology and medicine to benefit patients. Precision medicine aims to use data-driven tools and analysis to develop new diagnostics, therapies and insights into disease. The teams in the California initiative will join forces to use data across research, clinical, environmental and population health settings to better diagnosis, treat, manage and prevent disease.

"Despite effective medical therapies and lifestyle interventions, many heart disease patients still progress due to undertreatment, poor adherence to treatment or failure to recognize clinical or biochemical clues that warn of heart attacks, strokes and heart failure," said C. Noel Bairey Merz, MD, professor of Medicine, director of the Barbra Streisand Women's Heart Center and a co-principal investigator in the study.

The key is identifying new predictive blood biomarkers earlier, said another co-principal investigator, Jennifer Van Eyk, PhD, director of the Advanced Clinical Biosystems Institute and of Basic Science Research in the Barbra Streisand Women's Heart Center. "Then impending cardiovascular death and disability may be prevented through treatment intensification and efforts to enhance compliance with lifesaving therapy," Van Eyk said.

The Cedars-Sinai team also includes researchers Corey Arnold, PhD, and Peipei Ping, PhD, from the David Geffen School of Medicine at UCLA. The team will partner with five California life science companies: HealthLoop, Neoteryx, Beckman Coulter, SCIEX and Thermo Fisher Scientific.

The study also has received funding from Cedars-Sinai Precision Health, a campaign to transform the institution's practice of medicine by harnessing advanced data on individuals' genes, proteins, microbiome (bacterial communities) and other body chemistry. The goal is to tailor therapies and medications for specific patients.

"This study, across medical disciplines and in partnership with industry, addressing a critical clinical question, is an example of the outstanding projects that Precision Health at Cedars-Sinai is brilliantly positioned to address," said Dermot McGovern, MD, PhD, professor of Medicine and Biomedical Sciences and director of the campaign. "Using big data and near-patient technologies together with outstanding clinical care to address a significant clinical problem is at the core of Cedars-Sinai Precision Health."

Pulmonary Fibrosis Linked to Stem Cell Failure

Images of mouse lungs show severe fibrosis (dark areas, right panel) after deletion of hyaluronan compared with control mice (left). Hyaluronan is a chemical substance that promotes tissue repair and renewal.

Paul W. Noble, MD

Carol Liang, MD

Cedars-Sinai investigators have pinpointed a major cause of pulmonary fibrosis, a mysterious and deadly disease that scars the lungs and obstructs breathing. The disease, which has no known cure, appears to result from the failure of special lung stem cells that help airways recover from injury, the investigators reported in the journal Nature Medicine.

The study is a major step toward understanding and one day treating pulmonary fibrosis, which affects about 100,000 people in the U.S. The disease often is called idiopathic pulmonary fibrosis because, in most cases, the cause cannot be found. While the prognosis is unpredictable, patients typically survive only three to five years after diagnosis, according to the U.S. National Library of Medicine.

"Pulmonary fibrosis slowly robs patients of breath and finally life," said Paul W. Noble, MD, professor and chair of the Department of Medicine and director of the Women's Guild Lung Institute at Cedars-Sinai. "In our study, we identified novel potential pathways to finding treatments for this relentless disease." Noble was the study's principal investigator.

The investigators focused on alveoli, the small air sacs at the ends of lung airways. In the alveoli, oxygen and carbon dioxide are exchanged with blood during respiration. Epithelial cells that line the alveoli also make a substance that helps keep the airspaces open. In pulmonary fibrosis, these epithelial cells become abnormal, and fibrous tissue builds up in the lungs, causing severe scarring. Researchers don’t know why this scarring process happens.

The Cedars-Sinai research team found an answer in special stem cells known as AEC2s that are found in adult lungs and are critical to repairing and regenerating epithelial cells. When viral infections, pollution or other injuries damage lung tissue, AEC2 cells come to the rescue.

In people with pulmonary fibrosis, something goes wrong with AEC2 cells, the study found. Compared with lung tissue of disease-free individuals, lung tissue from patients with pulmonary fibrosis had far fewer AEC2 cells, and those that remained were less able to renew themselves. Surfaces of these cells had lower concentrations of hyaluronan, a chemical substance that promotes tissue repair and renewal. Further, in laboratory mice, the team found that by deleting this substance, they could produce the type of scarring found in pulmonary fibrosis after lung injury.

"These findings are the first published evidence that idiopathic pulmonary fibrosis is primarily a disease of AEC2 stem cell failure," said Carol Liang, MD, assistant professor of Medicine at Cedars-Sinai and the study's first author. "In further studies, we will explore how the loss of hyaluronan promotes fibrosis and how it might be restored to cell surfaces. These endeavors could lead to new therapeutic approaches."

One promising approach may be to develop drugs that stimulate the reproduction of AEC2 cells in the lungs of patients who lack enough of these cells, Noble said. "The exciting aspect is that we have learned how to isolate these stem cells from diseased lungs. We can use these cells to create tiny 'lungs in a dish' as tools for drug development," he explained.

In an accompanying commentary in Nature Medicine, Paul F. Mercer, PhD, and Rachel C. Chambers, PhD, from the University College London in England noted another novel finding from this study. They said it identifies a new link between innate immune receptors, which help mobilize the immune system to fight bacterial invaders, and hyaluronan. This link, which promotes normal AEC2 renewal, is lost in pulmonary fibrosis, the study showed.

Research reported in this publication was supported by the National Institutes of Health under award numbers P01 HL108793, R01 HL060539, AI052201 and R01 HL122068; and by the California Institute for Regenerative Medicine under award number RB5- 07302.

The IRB number for human subjects in research referenced in this article is 35396.

New Director to Focus on Patient Experience


Alan Dubovsky

Alan Dubovsky has been appointed director of patient experience and chief patient experience officer at Cedars-Sinai, a new position to help coordinate service excellence initiatives. He assumed the post Nov. 28.

In this new role, Dubovsky will work closely with the Cedars-Sinai operations team, management, physicians and staff to build on existing efforts to advance the organization's commitment to patient- and family-centered care. The position was created in recognition of the increasingly important role the patient's view plays in improving quality and performance at Cedars-Sinai.

"We should take pride in the solid foundation we have built together over many years in providing exceptional customer service," said Mark R. Gavens, executive vice president of Hospital Operations and chief operating officer at Cedars-Sinai. "Working with all of us, Alan will help coordinate our many simultaneous patient satisfaction as well as experience initiatives, and facilitate their expansion and sustainment."

Dubovsky comes to Cedars-Sinai after more than five years at the Emory Clinic in Atlanta, where he served as director of customer and physician engagement, as well as director of operations. He oversaw the development of the Emory Clinic's service management and patient experience effort, which helped propel the organization to its highest-ever patient satisfaction scores.

Previously, Dubovsky held management positions at St. Joseph's Hospital, a 410-bed community medical center in Atlanta, and at The Advisory Board Company in Washington, D.C. He received his undergraduate degree in business administration from the University of Georgia and his master's in business administration from Emory University's Goizueta Business School.

Daskivich Helps Lead Precision Medicine Study

Timothy Daskivich, MD

Timothy Daskivich, MD, assistant professor and director of Health Services Research in the Cedars-Sinai Department of Surgery, has been named a co-investigator for a prostate cancer study funded by the California Initiative to Advance Precision Medicine. The study's goal is to create computer algorithms, using biomarker data, patient characteristics and tumor risk markers, to predict the effectiveness of various treatments for early-stage prostate cancer.

Daskivich is the Cedars-Sinai site director for the study, which is led by the University of California, Irvine, and funded by a $1.2 million grant. The other collaborators are UCLA, VA Long Beach Healthcare System and VA Greater Los Angeles Healthcare System. Up to 600 patients from the five sites are expected to enroll in the two-year clinical study.

The study is one of six precision medicine projects recently funded by the state institute. Cedars-Sinai leads one of those projects, to design a system using remote monitoring to predict heart attacks and other cardiovascular events. Brennan M. Spiegel, MD, professor of Medicine and director of Cedars-Sinai Health Services Research, heads that study.

Study Finds Few Share Fitness Data With Doctors

Joshua Pevnick, MD

Personal fitness tracking, using devices such as Fitbit and the Apple Watch, may be all the rage, but getting users to share the data with their doctors is not easy, according to a new study by Cedars-Sinai investigators.

Fitness data, including regular updates on activity levels, blood pressure, body weight and other metrics, potentially can help physicians monitor a patient's health status, progress and response to treatment.

Prior to the study, Cedars-Sinai's Enterprise Information Services took the innovative step of inviting registered users of My CS-Link™, a database for Cedars-Sinai patients, to sync their mobile fitness trackers with their medical records. Of 66,105 users who met the study criteria, only 499 uploaded their fitness data into My CS-Link during the initial 37-day study period.

"Our results demonstrate that, at least initially, patients had little intrinsic desire to share personal fitness tracker data with their providers," said Joshua Pevnick, MD, the study's first author and assistant professor of Medicine in the Cedars-Sinai Division of General Internal Medicine.

Furthermore, people who could benefit most from data sharing were least likely to do it. Compared with those who shared data, those who didn’t share data were significantly older, poorer and more likely to be nonwhite — all factors that predict poor health status in coming years. That's a problem, Pevnick said.

"For personal fitness data to help providers take better care of their patients, the data needs to be from the older and sicker patients most afflicted by illness, rather than the younger, healthier population that is leading the embrace of these devices," he explained.

The study had limitations, including a short time window. Researchers did not collect data on how many patients in the sample were using personal fitness trackers.

But the results are significant because "this is the largest study to date, to our knowledge, of connecting patients using wearable sensors to a health system," said Brennan Spiegel, MD, a study co-author, who is director of the Cedars-Sinai Center for Outcomes Research and Education and professor of Medicine.

The researchers concluded that more marketing, incentives and possibly cultural changes are needed to encourage patients to share mobile fitness data with providers. The study was published Nov. 15 in the online journal PLOS ONE.

To learn more about syncing a fitness device with a medical record, visit the My CS-Link™ home page. Click "What devices and apps sync with My CS-Link?" under Frequently Asked Questions.

The IRB number for human subjects in research referenced in this article is 40437.

Medical Staff Can Take Shot at Clippers Tickets

ClippersMedical staff can win tickets to an NBA game thanks to Cedars-Sinai's new partnership with the Los Angeles Clippers.

Clippers tickets will be made available to Cedars-Sinai staff through a random drawing. Staff members may enter only once and can win only once this season.

After submitting the proper information online, a staff member will automatically be entered to win tickets for the Clippers' game against the Miami Heat on Jan. 8. Winners will be notified by Dec. 9.

After notification, winners can pick up their tickets from Recreation Connection, located in the South Tower, Street Level, Room 1604. T-shirts will be distributed with each ticket as well.

"We are pleased to offer our staff this great opportunity," said Andy Ortiz, senior vice president of Human Resources and Organization Development. "Good luck, and let's go Clippers!"

During the NBA season, Cedars-Sinai will sponsor a half dozen "Heart of LA" games that will celebrate health, wellness and the partnership's community outreach, which will include educational materials, videos, cooking demonstrations and exercise techniques.

To participate in the drawing for the Clippers tickets, fill out a brief online form. (There will be additional drawings in 2017.)

Core Labs to Switch to STAT Immunoassay Dec. 21

The Core laboratories in the Department of Pathology and Laboratory Medicine will switch from a standard PTH immunoassay to a STAT immunoassay beginning Wednesday, Dec. 21.

The new STAT PTH assay from Roche Diagnostics will have an incubation time of about nine minutes, approximately half the current time. This shorter test will particularly benefit intraoperative PTH measurement, where patients are held in surgery under anesthesia to ensure sufficient parathyroid tissue has been removed during parathyroidectomy.

There is a large negative bias with the new Roche assay (compared to the existing Abbott assay) of 33 percent. Many immunoassays are not standardized to a reference method or to each other, so biases between manufacturers are to be expected.

Since the new STAT PTH assay will be used for routine PTH measurement, in addition to intraoperative assessment, it is important to note this difference once live. Reference intervals will also be adjusted in accordance with a validation of Roche expected values.

Please see below:

Abbott (current method) Roche (new method)
Bias -33% (lower)
Reference Interval 8.7 – 77.1 pg/mL 15.0 – 65.0 pg/mL

When new STAT PTH assay begins use, a comment will also be appended to all new results noting the bias. This comment will be present for 90 days.

If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org, or Holli Mason, MD, at holli.mason@cshs.org.

CS-Link Tip: Access Available to CURES

CS-Link™ now has access to the website of CURES (the Controlled Substance Utilization Review and Evaluation System).

All California licensed prescribers authorized to prescribe scheduled drugs, and all pharmacists, are required to register with CURES.

CURES contains the following information: patient name, patient date of birth, patient address, prescriber name, prescriber DEA number, pharmacy name, pharmacy license number, date prescription was dispensed, prescription number, drug name, drug quantity and strength, and number of refills remaining.

To access the website through CS-Link™, go to Web Activities>State Registries>CURES. User ID and password are required.

Learn to be more efficient by attending a Physician Efficiency Training session. The classes are held in Cafeteria Conference Room C. The schedule:

  • Thursday, Dec. 8, noon-1:30 p.m.
  • Tuesday, Dec. 13, 7:30 a.m.-9 a.m.

If you have questions, email groupeisphysicians@cshs.org.

Core Labs Updating Reference Intervals Jan. 3

Beginning Jan. 3, the Core laboratories in the Department of Pathology and Laboratory Medicine will update cortisol and progesterone reference intervals to match new assay formulations and U.S. Food and Drug Administration-approved information provided by Roche Diagnostics.

The current and new intervals are shown below for your reference.

If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org, or Holli Mason, MD, at holli.mason@cshs.org.

CURRENT NEW
Cortisol (mg/dL)
Morning: 6.0 – 19.0
Afternoon: 3.0 – 14.0
Cortisol II (mg/dL)
Morning: 6.02-18.4
Afternoon: 2.68-10.5
Progesterone II (ng/mL)
Men
0.2-1.5
Women
Follicular: 0.1-2.9
Luteal: 1.4-34.8
Postmenopausal: 0.1-0.8
Progesterone III (ng/mL)
Men
<0.5-0.149
Women
Follicular: 0.057-0.893
Ovulation: 0.121-12.0
Luteal: 1.83-23.9
Postmenopausal: <0.05-0.126
Pregnant women (trimester)
1st: 11.0-44.3
2nd: 25.4-83.3
3rd: 58.7-214