UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES • FALL 2011 JO RN L

Closing the Distance Better health through COMMUNICATIONS TECHNOLOGY MESSAGE from the Chancellor Dear Readers, It’s my pleasure to welcome you to our inaugural issue of UAMS Journal, a publication that will show how the University of Arkansas for Medical Sciences is working to improve health in Arkansas and beyond. Our purpose at UAMS is to engage in activities that result in better health — through patient care, education of health professionals, discovery of new knowledge through research, and translation of that knowledge into improvements in health and economic development. Over time, this magazine will present a profile of As Arkansas’ only the scope of what we do at UAMS. In this issue, we comprehensive look at how UAMS uses communication technology to increase our impact on health by expanding academic health our educational reach and research, and removing sciences center, geography as a barrier to treatment. our focus on You will read about our innovative ANGELS program that helps high-risk pregnant women health unifies and their newborns get medical care and our Arkansas SAVES program that makes livesaving all we do. stroke treatment available throughout the state. Telemedicine brings education to our students and continuing education to rural physicians. We are expanding broadband to 474 health care and education sites in Arkansas, and working with India, China and other regions of the world to bring an exchange of students and faculty for education and research. As Arkansas’ only comprehensive academic health sciences center, our focus on health unifies all we do. The vast array of resources under our watch not only includes a state-of-the-art medical center, but also Colleges of Medicine, Nursing, Pharmacy, Health Related Professions, Public Health and a Graduate School. Further exploration is underway within our Institutes on translational research, cancer, aging, psychiatry, the eye and the spine, as well as a statewide approach through our Area Health Education Centers. All of these efforts help us pave the way toward a healthier future.

So enjoy our story!

Dan Rahn, M.D. Chancellor, University of Arkansas for Medical Sciences

2 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Journal CONTENTS FAll 2011 EDUCATION In the Beginning ...... 6 EDitoR AHECS Provide One Platform for Expanding Distance Health ...... 10 Elizabeth Caldwell Interactive Video Crucial to Northwest Campus ...... 12 Nuclear Pharmacy Training Delivers Online...... 14 CREAtivE DiRECtoR Laurie Shell PATIENT CARE

WRitERS A Lifeline for Newborns ...... 16 Nate Hinkel UAMS Angel Eye Drawing National Attention ...... 18 Jon Parham Spreading Its Wings ...... 19 David Robinson Seeing Is Believing ...... 20 Susan Van Dusen Back in the Pulpit ...... 23

PhotogRAPhER UAMS Leads Arkansas’ First Trauma System Center...... 24 Johnpaul Jones TECHNOLOGY Making a Connection with Arkansas e-Link ...... 28 ------A United Front ...... 31 Hitting the caBig Time ...... 32 ChAnCElloR Technology Promotes Collaboration in lab, Classroom, at Bedside ...... 35 Dan Rahn, M.D. RESOURCES viCE ChAnCElloR FoR CoMMUniCAtionS Speeding Bench to Bedside ...... 36 & MARkEting UAMS BioVentures ...... 39 Pat Torvestad UAMS Establishes Tri-state Telehealth Training Center ...... 40

ASSoCiAtE Going Global with Interactive Videoconferencing ...... 42 viCE ChAnCElloR FoR CoMMUniCAtionS BRIEFS & MARkEting Child Mental Health Turns to Telemedicine ...... 44 Leslie Taylor Distance Education Allows Dental Hygiene Partnership ...... 44 ASSiStAnt Practicing Telecardiology ...... 45 viCE ChAnCElloR FoR CoMMUniCAtionS UAMS Electronic Records Systems Pay Off ...... 45 & MARkEting Public Health Data Available Online ...... 46 Tim Irby Portal Gives Patients Access ...... 46

TheUAMS Journal is published Where You Live Shouldn’t Matter ...... 47 twice a year by the Office of Communications & Marketing, University of Arkansas for Medical Sciences, 4301 W. Markham St. #890, 24 35 47 Little Rock, AR 72205.

Phone: (501) 686-5686 Fax: (501) 686-6020

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 3 Communication Technology Delivers

THE POWER OF TECHNOLOgY is and patient to communicate in real time over nowhere as breathtaking and life changing as it is interactive video — was born with the creation when applied to improving the health of millions of a high-risk pregnancy program that worked to of people. decrease the number of babies born throughout In Arkansas, parents can turn on their home the state with severe health problems. computer to talk to their preemies and watch Since then, UAMS’ use of communication At the them sleep in the hospital’s neonatal intensive care technology has expanded to include: unit. Stroke patients brought to their community University of hospital can be quickly and accurately diagnosed A Center for Distance Health in the College of Arkansas for Medicine that works to decrease disparities in and treated by stroke neurologists located in health care Medical Sciences metropolitan areas. (UAMS), Pharmacy, medical and nursing students A national virtual information network for researchers and physicians to more easily the use of attending class in one part of the state can hear, share data and knowledge for cancer research see and ask questions of a professor teaching in and treatment communication a classroom hundreds of miles away. Medical technology to A patient portal for access to medical tests professionals can take continuing education and online bill payment deliver health classes without driving great distances that would A research data repository care and cost them greater time away from their jobs and continuing health families. A statewide trauma system Medical records and images can be transported education as A second campus for educating health in seconds between physicians consulting on a professionals well as improve hard-to-diagnose-case. Researchers can hasten research results from their labs to become life-saving A regional telehealth resource center to provide technical assistance and training in capabilities has treatments by pooling statistics online with establishing telehealth programs in a three- grown in leaps researchers across the country. state area At the University of Arkansas for Medical and bounds since Opportunities for marketing telemedicine tools Sciences (UAMS), the use of communication created at UAMS its beginnings in technology to deliver health care and continuing the 1990s. International partnerships with medical health education as well as improve research schools and hospitals capabilities has grown in leaps and bounds since its beginnings in the 1990s. In 2010, UAMS received a $102 million Arkansas’ rural nature was a driving force in federal grant to establish or upgrade broadband finding ways to meet the health care needs of its connections and equipment at 474 health care and population. Early video technology was used to education sites across the state. When the three- deliver continuing education to rural hospitals year project is complete, Arkansas will be one of and to make advanced nursing degrees available the best-connected states in the country, bringing in rural areas. health care and health education within reach of Then in 2003, UAMS took another huge every Arkansan. ❖ step, and telemedicine — allowing doctor

4 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Center for Distance Health CaBig

myUAMS health.com Global Interactive Video Conference

Trauma System

BioVentures

UAMS Northwest Telehealth Campus Translational Resource Research Center Institute

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 5 EDUCATION

In the Beginning Rural hospital needs and College of nursing Spark telehealth By David Robinson

IN THE MID 1990s, UAMS’ Ann Bynum, assistant vice chancellor for UAMS Regional Ed.D., was challenged by a mandate to share Programs and director of the Center for UAMS resources with rural hospitals, many of Rural Health. which were closing their doors. About the same time, then-College of Nursing “We wanted to help them by exporting Dean Linda Hodges, Ed.D., R.N., was leading an UAMS services,” said Bynum, who at the time effort to make advanced nursing degrees available “That seemed directed the UAMS Rural Hospital Program in rural Arkansas using interactive video, and and was director of program development for later, the Internet. like the perfect the UAMS Area Health Education Centers Not only did the communications technology answer for us (AHEC) Program. arrive at the right time for Bynum and Hodges, to export our The focus was on sharing the medical grant funds were available too. In 1994, Hodges programs.” knowledge that was concentrated on the UAMS had received $407,240 in state grants to link campus. Initially, faculty were asked to drive UAMS to its AHECs in Fayetteville, Fort Smith, to distant communities to deliver continuing Texarkana, El Dorado and Jonesboro. education programs, but time and costs made The same year, Bynum received a $500,000 that impractical on a regular basis. grant that enabled interactive video links between A light bulb went on for Bynum one day UAMS and hospitals in Helena-West Helena and when she read about the emergence of interactive Warren. video communications. Working in collaboration with nursing “That seemed like the perfect answer for us to schools at the University of Central Arkansas and export our programs,” said Bynum, who now is Arkansas State University, Hodges led the

6 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 7 establishment of the R.N.-to-B.S.N. program fetal medicine and neonatal medicine expertise that was taught using interactive video. available in distant hospitals. In 1999, Hodges received a $1 million ANgELS is the brainchild of UAMS’ Curtis federal grant to begin the state’s first online Lowery, M.D., who is director of the UAMS higher education degree program. The Internet Center for Distance Health, director of the was used for the bachelor’s program as well as Translational Research Institute and chair of the graduate courses. College of Medicine’s Department of Obstetrics “Before our distance education program, there and gynecology. was no way nurses who lived out in the state could “Dr. Lowery just took to it like a duck to get an advanced degree without driving all the way water and started building the clinical portion to Little Rock,” Hodges said. “I am very proud of our interactive video program,” Bynum said. In the mid 1990s, of UAMS, the AHEC program and the nursing “That’s what it needed, a physician champion to an interactive schools in the state since we were major leaders get that part of it going, and he’s just taken off.” video unit cost nationally in the area of telecommunication and Today, UAMS has 130 distant sites in its online education.” interactive video network, including all 86 rural $80,000 compared As Hodges had hoped, more than 50 percent hospitals connected to the UAMS campus. with $13,000 to of nurses who received their bachelor’s degree Within the last year, the Center for Rural Health $30,000 today. through the distance education program went on recorded more than 6,000 participants in its to even higher levels of nursing. Some got their continuing education programs provided via master’s degrees and became instructors while telehealth to rural hospitals and the AHECs. The others became nurse practitioners. Both helped center also broadcasted 425 continuing education fill critical voids in Arkansas’ health care system. programs for physicians, nurses, pharmacists and grant funding for UAMS’ telehealth all the allied health professions. outreach program with rural hospitals continued Bynum said there’s no doubt that interactive to flow, and by 2006, more than $6 million in video is improving health care in Arkansas. grants had been acquired by the UAMS Rural Participants evaluate every continuing education Hospital Program. program on the benefit to their practice and While the emphasis was on education, patient care, and they nearly always receive the UAMS faculty sometimes used interactive video highest score of five, she said. to provide patient consults, but there was no “There’s so much knowledge here at UAMS, mechanism for reimbursement. and there is such a need in rural Arkansas That began to change in 2002, when the newly for a connection to knowledge,” she said. proposed UAMS ANgELS program was included “Communications technology has made it in a grant application. ANgELS, (Antenatal and possible for us to share our knowledge across the Neonatal guidelines and Education Learning state and beyond.” ❖ System) uses telemedicine to make its maternal-

8 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 9 AHECs Provide One Platform for Expanding Distance Health By David Robinson

EDUCATION, clinical subspecialty care and — coming soon — research are on the menu of outreach services provided via interactive video at UAMS Area Health Education Centers (AHECs). Located strategically across the state in the 1970s, the Telemedicine AHECs have expanded their allows seamless education and patient care live two-way roles thanks to high-speed communications links with communication the UAMS campus. Interactive and the use of video at the AHECs offers a instruments and platform for more subspecialty monitors, such follow-up care from the main as ultrasound campus, and it enables the AHECs to become Patient and fetal Centered Medical Homes, a echocardiogram designation by the National equipment, Committee for Quality designed Assurance. for distance The use of distance health education at the AHECs began medicine. when the UAMS College of Nursing was awarded a series of state higher education grants beginning in 1992 to establish a Bachelor of Science in Nursing degree program to registered nurses around the state. The use of interactive video for patient care in the AHEC clinics was pioneered by UAMS’ Curtis

10 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Lowery, M.D., a maternal- conferences to family medicine to offer follow-up care at fetal medicine specialist residents and faculty at the AHECs through telemedicine. who in 2002 established the AHECs as well as other primary ANgELS is performing ANgELS (Antenatal, Neonatal care physicians around the state. community needs assessments guidelines Education Learning All 86 rural Arkansas hospitals to determine subspecialty care System) program. Throughalso have interactive video links needs in each AHEC region. ANgELS, UAMS has used with UAMS. “We want to offer our telemedicine to help manage “It’s extremely important subspecialty care where it is and improve outcomes of that our family medicine needed,” Benton said. “We high-risk pregnancies in rural residents and private practice don’t want to duplicate services Arkansas, including OB patients physicians know the guidelines that may already exist in a at the AHEC clinics. for OB patients,” said Tina community.” Telemedicine allows seamless Benton, director of the The AHECs also will have live two-way communication ANgELS program. “Not only an important role in future and the use of instruments and do we present cases, but the research projects, especially as monitors, such as ultrasound AHECs can present cases, so it’s UAMS continues rolling out and fetal echocardiogram a real sharing of information.” translational research projects equipment, designed for In more recent years, as part of a $20 million 2009 distance medicine. Clinical and Translational the ANgELS program has “We want From a management included the management of Science Award. Using to offer our perspective, interactive video neonates, ensuring the highest telemedicine, the AHECs could has brought all the AHECs level of care for very-low-birth- become a conduit for additional subspecialty and UAMS together like never weight babies at 22 hospital clinical trials subjects. In one care where it before, said Ann Bynum, Ed.D., nurseries across the state. upcoming study, UAMS will is needed.” assistant vice chancellor for Today, each of the eight test the benefits of telemedicine UAMS Regional Programs and AHECs has at least three on weekly follow-up care of director of the Center for Rural interactive video units that patients with hyperfunctional Health. Nearly all directors’ can link with any of the 114 speech disorder. meetings involve interactive units on the UAMS campus Follow-up care typically has a video, with all participants in Little Rock. In addition, the no-show rate of 30 to 40 percent visible on their conference room UAMS Center for Distance on the UAMS campus, Benton screens. Health — established in 2006 said, compared to less than 15 “Interactive video has been — has expanded telemedicine’s percent for clinical telemedicine fantastic for our team of AHEC capacity to allow nearly 300 patients. directors,” Bynum said. “They simultaneous connections. “Patients who live far away get to stay in their communities Such capacity has opened the simply can’t travel every week and their offices and save travel door to additional subspecialty due to issues such as work dollars.” care offerings. For example, obligations, finances and The ANgELS programBenton said, the Department transportation,” Benton said. ❖ regularly uses telehealth for of Neurology in the UAMS lectures and weekly OB case College of Medicine is planning

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 11 Interactive Video Crucial

to Northwest Campus By Jon Parham

College of Pharmacy students at UAMS northwest

12 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES WHEN A STUDENT at the UAMS Northwest and a camera automatically zooms in so that the campus walks into a classroom in Fayetteville, he lecturer can see who is asking a question and or she may as well be entering a class on the main respond directly. UAMS campus in Little Rock. Tests can be simultaneously administered to Through interactive video and distancestudents at the regional campus via a computer education tools, the 200 miles between central lab adjacent to the regional campus’ library. Arkansas and northwest Arkansas are virtually The third and fourth years of medical school bridged. Medical and pharmacy students in mainly involve rotations in various medical Fayetteville hear the same lectures at the same specialties at local hospitals or clinics. The distance time from the same faculty members and can ask technology connects students for lectures, questions right then, just as their fellow students in grand Rounds events on the main campus with Little Rock. visiting lecturers, and interactive conferences on UAMS established the regional campus as a obstetrics, pediatrics or other specialties. way to address growing shortages of health care “The beauty of this campus is that students professionals in Arkansas at a time when demand here can connect with peers and instructors for health care is increasing. Technology has been a and connect with their training. Through the key ingredient in the campus, which welcomed its technology our students here have everything first students in 2009. that students on the main campus have,” said “While our regional campus allows us to expand Chris Smith, M.D., regional associate dean for enrollment, our technology infrastructure ensures the UAMS College of Medicine at UAMS that our academic programs remain seamless Northwest. between the two campuses,” said Peter Kohler, The 27 family medicine resident M.D., vice chancellor for UAMS Northwest. physicians who were already in the region The first six medical students to complete their at the UAMS Area Health Education UAMS third and fourth years at the regional campus Center (AHEC) Northwest — which graduated in May 2011. By fall 2011 the campus relocated to the regional campus established the included the first group of 21 third-year pharmacy facility when it opened — also regional campus students who joined 19 medical students. Eventual take advantage of the technology. as a way to enrollment will total more than 300 medical, They can connect with the main address growing pharmacy, nursing and allied health professions campus for their monthly shortages of students, along with resident physicians. resident meetings, saving them The fledgling campus got a boost from a a trip to Little Rock. health care $650,000 grant from the Walmart Foundation In addition, the AHEC professionals in 2010 that funded the learning technology. uses the technology for in Arkansas at Four classrooms and a conference center are now educational lectures and a time when equipped with audio-video linkups with plans administrative meetings demand for to expand the technology into conference rooms with colleagues in for student and faculty meetings, continuing Little Rock. health care is education and other needs. “It has been a increasing. The classrooms feature a hookup with dual godsend,” said screens, allowing students to see the lecturer Robert gullett, on one screen and then any presentation, video M.D., AHEC or computer screen on the other. Classroom Northwest microphones are activated when a student speaks director. ❖

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 13 Nuclear Pharmacy Training

Delivers Online By Nate Hinkel

AS ONE OF ONLY a handful of universities in the country to offer nuclear education and training for traditional student pharmacists, the UAMS College of Pharmacy also leads the way training students all over the world with its innovative online program. While it was the UAMS College of Health Related Professions (CHRP) that began offering a Nuclear Medicine Technology online program in 1998, it was the vision of Nicki Hilliard, Pharm. The program D., a 1983/1996 graduate of the UAMS College trains nuclear of Pharmacy, that transformed it. Hilliard, who pharmacists, began the nuclear pharmacy program at UAMS, nuclear recognized an early opportunity to merge UAMS cardiologists, efforts with the University of New Mexico (UNM), which had established the nation’s first pharmacy commercial radiopharmacy in the early 1970s. technicians and “The three of us came together in 1999 general radiation to launch an educational consortium to help workers. expand specialty education and training beyond the walls of the universities and meet the growing workforce demand,” Hilliard said. The program trains nuclear pharmacists, nuclear cardiologists, pharmacy technicians and general radiation workers. A $440,000 grant the Nuclear Education Online program received technicians, Positron Emission Tomography (PET) from the U.S. Department of Education Fund for cyclotron operators and shippers and transporters the Improvement of Post-Secondary Education of radiopharmaceutical supplies. (FIPSE) allowed recent expansion of online The program has graduated more than 1,200 educational programs to train nuclear cardiologists, nuclear professionals and hundreds of trained radiologists, oncologists, nuclear pharmacy general radiation workers from all over the world

14 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Dao le, Pharm.D.,(left) and nicki hilliard, Pharm.D., have nurtured the nuclear pharmacy program into one of the most respected in the country.

and ensures online graduates meet the education as a nuclear pharmacist within a few months,” and training requirement necessary to be an Hilliard said. “We get inquiries from all over authorized nuclear pharmacist by the federal the world from pharmacists looking for a career Nuclear Regulatory Commission. change or additional training.” ❖ “Through our online program, an existing pharmacist can be up and running with a job

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 15 PATIENT CARE

A Lifeline for Newborns telemedicine connections prove their worth to nurseries By David Robinson

THE NEWBORN BOY at Washington fetal ultrasonography, in cardiology to perform Regional Medical Center in Fayetteville had just echocardiography, and to provide education and arrived in the neonatal intensive care unit when family support. nurses noticed he was struggling to breathe. UAMS neonatologist Whit Hall, M.D., Matthew Cheadle, M.D., a neonatologist at leads a telemedicine program that partners the hospital, suspected reverse differential cyanosis, UAMS, a Level III perinatal center, with a rare heart defect that only reveals itself after birth. 22 outlying hospital nurseries. Through live He set up the NICU’s echocardiogram and video conferencing, Hall meets with the called Arkansas Children’s Hospital (ACH) in nursery physicians at all 22 sites each Monday, Little Rock, where he talked to Thomas H.H. Wednesday and Friday, focusing on the care of Best, M.D., a University of Arkansas for Medical very-low-birth-weight neonates (less than 1,500 “We actually Sciences (UAMS) pediatric cardiologist based at grams). decrease the ACH. Very-low-birth-weight neonates are among number of Using the latest communications technology the most critically ill and fragile patients. transports a linking ACH with Washington Regional, Best was Mortality rates range from 15 percent to 25 able to confirm Cheadle’s diagnosis by viewing percent, and those who survive often have little bit by using live, high-resolution video of the heart. Cheadle serious, chronic health conditions. telemedicine.” put the baby on a ventilator and arranged for “Telemedicine offers a novel solution for immediate air transport to ACH, the only hospital getting these high-risk newborns the tertiary in Arkansas with the ability to provide the required care resources they need,” Hall said. “We know surgery. that they have lower mortality rates when they’re “He got to his surgery in as good a condition born in perinatal centers.” and as fast as he could under any circumstances,” Consultation and collaboration through Cheadle said. “It was almost as if he had been born telemedicine is making regionalization of at Children’s.” neonatal care a reality with fewer very-low-birth- Not all telemedicine consults are so dramatic, weight deliveries in hospitals without neonatal but telemedicine is an exciting advance in the care intensive care units. of many Arkansas newborns as part of UAMS Hall recently put the practice to the test as the ANgELS (Antenatal and Neonatal guidelines, principal investigator in a nine-month study of Education and Learning System). UAMS’ telemedicine partnership with nine hospital Telemedicine is being used in NICUs to assess nursery sites around the state. for retinopathy of prematurity in very-low-birth- Called TOUCH — Telemedicine Outreach weight neonates, in obstetrical units to provide Utilizing Collaborative Healthcare, the program led

16 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Matthew Cheadle, M.D., a Fayetteville neonatologist to trends in improved regionalization of neonatal In addition, TOUCH has improved evidence- care and fewer very-low-birth-weight deliveries in based clinical practice compliance; provided hospitals without neonatal intensive care units. better coordination when managing discharges The study found that the proportion of very- of very-low-birth-weight neonates and high-risk low-birth-weight neonates delivered in telemedicine OB patients, and made fetal echocardiography hospitals without NICUs decreased from 13.1 available to identify congenital heart conditions percent to 7 percent. in more high-risk obstetrical (OB) patients in the “About 10-20 percent of the time we see things partnering hospitals. on video that help us make better decisions as Although the study revealed positive effects opposed to using only the telephone,” Hall said. on the care of neonates, Hall said telenursery “What we’ve found is that we actually decrease programs need to be studied on a larger scale to the number of transports a little bit by using reach more definitive conclusions.❖ telemedicine.”

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 17 Angel Eye program came from the gertrude E. Skelly Charitable Foundation, which donated $31,750 in 2010 and $31,500 in 2011. The redesigned camera is mounted in a protective casing on an arm that swings above the Isolette. When a nurse positions Rebecca Smith, R.n., adjusts the Angel Eye camera over a baby in the UAMS neonatal the camera above the baby, it intensive care unit. provides a wide view, ensuring that the baby is seen by family back home or wherever they UAMS Angel Eye Drawing have computer access. The new National Attention By David Robinson cameras, available 24 hours a day, have better picture quality and are capable of showing the baby RENOWNED for its use who spearheaded the camera in total darkness. of communications technology, innovation. The new audio feature UAMS has reached another “We have 30 other institutions regulates sound levels no matter Developed high-water mark with a camera interested in using the Angel how loud it is coming through in 2010 and system that allows distant family Eye cameras right now,” said the Isolette speaker from a integrated with members to see and talk to Rhoads, an assistant professor parent’s microphone. Whether equipment that’s their newborns in the UAMS in the Department of Obstetrics it’s a barking dog or a loud part of each neonatal intensive care unit via and gynecology in the UAMS sibling, the audio system limits the Internet. College of Medicine. “It’s really the sound in the Isolette to 65 Isolette, the web Developed in 2010 and exciting.” decibels. camera system integrated with equipment that’s Rhoads is working with UAMS ANgELS and NICU is believed to part of each Isolette, the web UAMS BioVentures, which leaders believe the camera system be unique in the camera system is believed to be helps commercialize discoveries will have long-term benefits for United States. unique in the United States. at UAMS, and UAMS’ IT the physical and emotional health Families and NICU nurses Department to begin marketing of both the baby and the parents. have embraced the technology, the Isolettes. A recent survey and a qualitative and hospitals around the country UAMS now has 21 Angel Eye study by Rhoads have confirmed are inquiring about them, said cameras for its 58 private NICU benefits of the program.❖ Sarah Rhoads, D.N.P., A.P.N., patient rooms. Funding for the

18 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Spreading Its Wings By David Robinson

HAVINg ESTABLISHED to health care providers who continuing education hours, itself in Arkansas, the UAMS treat high-risk pregnancies and Rhoads said. ANgELS program is now using newborns. The U.S. Department of In its first year, the communications technology to “We expect this number Health and Human Services program delivered provide continuing education to to triple in year two with the (HHS) grant was announced doctors and nurses in eight states implementation of our new learn- last year by U.S. Sen. Mark more than 278 of the Delta region. on-demand website: http://cdh. Pryor and then-U.S. Sen. continuing ANgELS, (Antenatal & uams.edu/LearnOnDemand,” Blanche Lincoln and-U.S. Rep. education hours Neonatal guidelines, Education said Sarah Rhoads, D.N.P., Mike Ross and then-U.S. Reps. to health care and Learning System) is A.P.N., assistant professor and Marion Berry and Vic Snyder. providers who preparing nurses and doctors to the principal investigator on “This funding will enable respond to non-routine, high- the $300,000, three-year federal UAMS to reach more rural treat high-risk risk health factors for pregnant grant. health care professionals and pregnancies and mothers, infants and children. As a result of the grant, for provide them with training that newborns. In its first year, the program the first time, UAMS is able is central to the evidence-based delivered more than 278 to live-stream its events and practice of medicine,” Rhoads Renee Bornemeier, M.D, continuing education hours access archived presentations for said. ❖ points to an ultrasound image.

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 19 Seeing Is Believing telemedicine delivers dramatic results for Arkansas stroke patients By David Robinson

ONE AFTER ANOTHER, members of Arkansas will end its reign as the nation’s leader the UAMS stroke team who had worked to save in stroke death rates. In 2007, the latest year for David Bullock came by his hospital room. which state-specific statistics are available from “They couldn’t believe it; they said they had to the national Centers for Disease Control and see for themselves,” Bullock, 52, said. “One of the Prevention, stroke-related deaths in Arkansas doctors said it was a miracle.” totaled 1,873. Despite having a severe stroke in DeWitt that So far, AR SAVES has 28 community hospital was later complicated by four subsequent seizures, partners. Arkansas hospitals become part of Bullock went home from UAMS two days later the program after extensive training by the with no discernable, lingering effects. UAMS Center for Distance Health and stroke For Julie Hall-Barrow, Ed.D., program certification by the National Institutes of Health. director for AR SAVES and education director for the UAMS Center for Distance Health, the case Overcoming Barriers illustrates the life-saving power of telemedicine, Prospects for a full recovery from stroke even for patients who ultimately must be improve significantly when patients transported for subspecialty care that is available receive tissue plasminogen activator Since the in Arkansas only at UAMS. (t-PA), the powerful clot-dissolving program began, “We know from many, many studies that drug. AR SAVES was established more than 700 the earlier you intervene the better the chances to overcome the major patients have are for somebody to come out of a stroke with obstacles to t-PA’s availability: received stroke no disability or far less disability,” Hall-Barrow limited time, challenging said. “Mr. Bullock is the ultimate example where geography and a lack consults through communications technology made successful of public awareness AR SAVES, and treatment possible.” about stroke. more than 130 Intravenous patients have AR SAVES t-PA must be received t-PA. Bullock was the beneficiary of AR SAVES given within 4.5 (Arkansas Stroke Assistance through Virtual hours of the first Emergency Support), a UAMS-led telemedicine signs of a stroke. Many program to improve stroke outcomes statewide. patients have been ineligible for the drug Established in November 2008, the program because they weren’t aware when their symptoms removes the barriers to timely care thanks to began or didn’t interpret their symptoms as an partnerships that involve the UAMS Center emergency. A public awareness campaign is a big for Distance Health, Arkansas Department of part of AR SAVES, with staff working to educate Human Services, Arkansas Department of Health communities about stroke. and Sparks Regional Health System in Fort Smith. The telemedicine component helps overcome Through AR SAVES, health officials hope that the issues of geography and time. The high-speed

20 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 21 connections link patients who UAMS’ “stroke pathway,” which ensures that arrive at their local hospitals to UAMS subspecialists and staff, imaging devices one of the five stroke neurologists and procedure room are ready when the patient who are part of the AR SAVES arrives. team. The stroke neurologist “The minute he hit the door, all the doctor can then advise whether had to do was lay an eye on him to know if the patient should receive he was better or not,” Hall-Barrow said. “We t-PA. Making the correct weren’t starting from scratch, so there was no stroke diagnosis is critical when time wasted, and that’s tremendously helpful.” deciding whether to use t-PA. If the patient has Bullock, who arrived at UAMS within about a hemorrhagic stroke rather than an ischemic two hours of his stroke, needed aggressive, stroke, the drug will cause further brain damage. acute endovascular therapy that could be provided only by one of UAMS’ interventional Timely Connection neuroradiologists — in this case, Eren Erdem, Bullock’s stroke occurred on a hot June day M.D., who is internationally known for his as he climbed the steps to his family’s crop- advanced catheter-based treatments. dusting business. His wife, Shannon, an EMT II, witnessed the fall, rushed to his aid and called 911. Subspecialty Care An ambulance arrived in less than 10 minutes, Erdem used the Penumbra device, one of and the DeWitt Hospital, about 1.5 hours from the latest devices for retrieving blood clots UAMS, was linked to a UAMS stroke neurologist that works by fragmenting and sucking the through AR SAVES in about an hour. clot. Bullock’s clot was affecting two-thirds With live two-way audio/video, and with of his left hemisphere, but Erdem was able to assistance from DeWitt Hospital staff, the stroke open the vessel and restore blood flow before neurologist could see Bullock’s right-side weakness, extensive damage occurred. loss of peripheral vision on the right, and inability “The device was very important to the to speak, understand spoken language, and feel outcome, but just as important was the ability touch or a pinprick on that side. to make the right decision and act very fast, The live connection allowed the stroke which couldn’t have been done without a team neurologist to determine that Bullock’s stroke of highly experienced doctors, the stroke team was large and severe, something that wouldn’t and the AR SAVES program,” Erdem said. have been evident if just relying on a telephone Following his emergency treatment, conversation. Bullock was taken to the neurointensive care unit where his care was overseen by one of Stroke Pathway just two neurointensivists in Arkansas, both at For a stroke as large as Bullock’s, t-PA isn’t enough, UAMS. so the stroke neurologist urged his immediate air “Everything went perfectly,” Hall-Barrow transport to UAMS and simultaneously activated said. “You can’t hope for a better outcome.” ❖

22 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Back in the Pulpit By David Robinson

PARALYzED ON HIS LEFT SIDE and in diet, began a regular exercise program and lost the UAMS intensive care unit, the Rev. William 20 pounds. Eight months after the stroke, he was L. Robinson of North Little Rock said he was on able to jump rope. the verge of depression. “I want people to know there is life after He had seen people crippled for life by stroke, stroke,” he said. “Every chance I get, I tell them and he didn’t want to become another casualty. about knowing the warning signs of stroke and “I was sad, and I was asking god to just the miracle of t-PA. Without it, I would probably have mercy on me,” said Robinson, 50, still be in a wheelchair.” ❖ who speaks to congregations all over the United States. He discovered later that the groundwork for his miraculous recovery was laid just in time. On that Aug. 9, 2010, Robinson felt an explosion of pain in the back of his head and fell as he was concluding a sermon in West Memphis. He was rushed to nearby Crittenden Regional Hospital, which only recently had joined the AR SAVES (Arkansas Stroke Assistance Through Virtual Emergency Support) network, enabling a stroke neurologist at a distant location to evaluate Robinson via telemedicine. The pastor of the First Baptist Church in North Little Rock was the hospital’s first AR SAVES patient. On the advice of a stroke neurologist, Robinson received the powerful clot-dissolving drug t-PA. Although he initially feared he would never walk again, Robinson began to notice improvement the following day. north little Rock pastor William l. Robinson recovered from a stroke thanks to telemedicine. In addition to rigorous physical therapy, Robinson improved his

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES 23 UAMS Leads Arkansas’ First Trauma System Center By Jon Parham

AS A STATEWIDE trauma system began the risk of death by 25 percent for patients with operation in Arkansas in 2011, UAMS took a severe injuries. lead role. The new Arkansas trauma system, expected to UAMS Medical Center is the only adult cost about $28 million annually, is being funded trauma center designated in the state for providing by a nearly $86 million tobacco tax increase the highest level of trauma services. Also, UAMS that took effect in 2010. The increase includes a physicians, nurses and administrators served in 56-cents-a-pack hike in state cigarette tax and an advisory roles to state officials and continued to increase in the tax on smokeless tobacco. guide the creation of a coordinated referral system for trauma patients. Coordinated Care “What is happening is the most important From an accident scene, emergency responders change to emergency care in Arkansas in a long will classify injuries and then coordinate care with time,” said James graham, M.D., a pediatric the call center. The call center will be able to direct UAMS Medical emergency medicine specialist at UAMS now the ambulance to the closest trauma center with Center is the serving as chairman of the 26-member Arkansas the services needed for a particular patient. Trauma Advisory Council. “UAMS has really Previously, patients may have been sent only adult taken a leadership role in the planning and to the closest facility regardless of the type trauma center implementation for the statewide trauma system.” of injuries sustained. Now, depending on designated in Before it was established by the state Legislature condition and the extent of injuries, the the state for in 2009, Arkansas was one of only three states trauma system may route a patient past other providing the without a fully functioning trauma system. Now facilities that could treat some — but not all the state is using a statewide trauma call center, — of the injuries. highest level a tiered designation for trauma centers based on “It’s about getting the right patient to the of trauma the services they can provide trauma patients, right facility at the right time,” said John services. improved communications and telemedicine Cone, M.D., a UAMS trauma surgeon and a technology to save lives. member of the trauma council. Traumatic injuries have been the leading cause Immediate routing to the nearest of death in Arkansas for adults and children ages appropriate hospital became increasingly 1 to 44. A 2008 report by the American College faster for emergency responders anywhere in of Surgeons said the overall injury fatality rate Arkansas with the implementation of the new in Arkansas is nearly 50 percent higher than the statewide trauma system. At 8 a.m. on Jan. national average, and the injury fatality rate for 3, the Arkansas Trauma Communications motor vehicle crashes (the second most common Center began taking calls from hospitals across injury mechanism in the state) is 60 percent higher the state. Based at Metropolitan Emergency than the national average. In 2005, Arkansas Medical Services (MEMS) in Little Rock, ranked 50th in the nation for timely trauma center the trauma system call center — staffed by a accessibility. paramedic or registered nurse — streamlines The U.S. Centers for Disease Control has the process for directing trauma patients to said getting to a Level 1 trauma center can lower hospitals within the system.

24 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 25 “In the past, there could be six- to eight- implemented by the end of 2011, all designated hour delays in getting trauma patients referred trauma centers will be able to electronically to the appropriate hospital,” said Jeff Tabor, transmit radiography imaging of patients to program director for the trauma call center, other centers. citing logistics and other problems that could In addition to allowing more detailed slow a transfer. “Now the average time is about consultation with specialists, the image In the first 10 minutes. The new system has already made repository will allow physicians to see computed that much of an impact.” tomography (CT) scans or X-rays for trauma seven months By the end of 2011, graham said, all of the patients being referred to them before the of operation, about 600 ambulances operating in Arkansas ambulance arrives. the call center will be linked up by satellite radios. This will “This will have a huge impact,” said Ron has handled further improve efficiency and coordination Robertson, M.D., a UAMS trauma surgeon. 2,674 trauma with the trauma call center. “Treatment can be started before the patient In the first seven months of operation, arrives. Personnel can be called in and appropriate transfer calls. the call center handled 2,674 trauma transfer preparations made before the patient arrives.” calls. Of those, 471 patients have been If a patient arrives at a smaller hospital routed to UAMS. In that period, UAMS and with a head injury, CT images can be sent to Arkansas Children’s Hospital, where UAMS a neurosurgeon at UAMS or another higher physicians provide medical care, received the level trauma center. Through that consultation, most trauma transfers. a quicker decision can be made about care and preparations can be made at the hospital that Telemedicine in Trauma Care would receive a referred patient. Another new tool in the trauma system is a The repository also addresses issues of statewide trauma image repository. When fully incompatible technology between hospitals that

26 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UAMS Medical Center was the first and only hospital in the state to be designated Level 1 by providing the highest level of adult trauma care with specialized surgeons on duty at all times for treating the most serious and urgent cases. Arkansas Children’s Hospital was the first pediatric Level 1 trauma center in the state. graham said he and other members of the trauma committee are continuing to make site visits to hospitals around the state working through the designation process. By the end of 2012, it is expected that more than 70 hospitals will be a part of the system, he said. UAMS trauma services got a boost with the January 2009 opening of a hospital expansion that included a larger, more comprehensive Emergency Department featuring a general X-ray room and a CT scanner, eliminating the need to transport trauma patients for imaging. The designation is not solely based on medical had sometimes hampered efforts to share images. services either. Terry Collins, UAMS director In addition, the system will prevent duplication of trauma services and another member of the of imaging procedures once a patient arrives at state’s trauma advisory council, noted UAMS the hospital, Robertson said. had to demonstrate to the trauma system survey “This is one of the first image repositories, team from the Arkansas Department of Health if not the first in terms of its statewide reach,” that UAMS had injury prevention education graham said. and outreach programs as well as a program of The UAMS Center for Distance Health, trauma research. an already recognized national leader in “This is truly an institutionwide commitment telemedicine, is establishing and operating the to trauma care,” Collins said. image repository for the Arkansas Department UAMS education programs include hosting of Health, which is overseeing the trauma regular symposiums for health care professionals system. across the state on new emergency medicine The initial hospitals online with the trauma techniques or refresher courses on trauma repository were already part of a Center for practices. A patient referral call center and Distance Health telemedicine-based stroke care extensive telemedicine network with rural program, Arkansas SAVES. hospitals are among UAMS trauma outreach efforts. It’s Not Just Care But Also Prevention UAMS leads or participates in numerous Hospitals participating in the trauma system injury prevention programs, including youth are designated by the Department of Health at accident prevention programs, the anti-drunk one of four levels depending on the capability driving program Prom Promise, driver safety of treating traumatic injuries and resources programs for older drivers and car seat safety available for trauma education and research. education. ❖

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 27 TECHNOLOGY

Making a Connection with Arkansas e-Link Arkansas is on its way to becoming one of the nation’s most well-connected states By Nate Hinkel

AS A LARgELY RURAL STATE, Arkansas’s need for establishing and upgrading broadband to all corners of the state was a barrier withholding life-changing technology from taking root. That all changed in the summer of 2010 when federal and state government officials, alongside leaders at the University of Arkansas for Medical Sciences (UAMS) and various integral state agencies, announced a $102 million federal grant to establish or upgrade broadband connections “This effort and equipment at 474 health care and education will pay sites across the state. dividends for “In short, receiving this grant was a game- changing event that put Arkansas on the path generations.” toward becoming one of the most well-connected states in the country,” said Curtis Lowery, M.D., director of the UAMS Center for Distance Health and chairman of the College of Medicine Department of Obstetrics and gynecology. “This effort will pay dividends for generations. There’s no way to figure how many lives can be saved, the number of new educational opportunities and the overall quality-of-life benefits this will bring to Arkansans.” A force of veteran and newly hired specialists along with a handful of statewide partners is in the throes of implementing the three-year project that will be completed by August 2013. Once the network, named Arkansas e-Link, is in place, it will be one of the most sophisticated broadband networks in the country and will not discriminate between the health care and educational opportunities available in rural and urban areas.

28 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link e-Link

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 29 Bottom to the Top for telecommunications networks for the education The $102,131,393 federal grant received by and research communities. Lowery and managed by the UAMS Center for green said a major hurdle was cleared in June Distance Health, was one of the largest ever received as the project received federal clearance on an by an Arkansas institution. In addition to the $102 environmental assessment, meaning no public or million grant, UAMS and its partners also pledged a private land or historical markers stand in the way 20.6 percent match of $26,450,427. of laying the network. The broadband grant, funded by the American “That freed us up to move forward with taking Recovery and Reinvestment Act, is the second- bids and procuring the necessary equipment and largest federal grant for an infrastructure project. contractors we’ll need heading into the final two Only West Virginia, with a $126 million grant, years of implementation,” green said. “We’ve has received a larger federal grant for broadband reached a very exciting point of actually being able infrastructure. to start seeing this come together.” “What makes this grant so critical to Arkansas is that our state ranks 50th in the percentage of Highway to the Future households with a computer, 50th in percentage Every resident in the state will potentially of households with Internet access and 46th in benefit from new services as a result of the extended percentage of households with broadband access,” broadband Internet access in hospitals, community Once the said Debbie green, project director of Arkansas clinics, universities, colleges and other participating network is e-Link. “Arkansas also ranks third worst in the sites. completed, it country for early deaths. So the need is obvious, and Once the network is completed, it will have the we’ll be able to vastly improve upon those statistics.” potential for expansion to nearly 4,000 additional will have the community institutions. Those include 1,072 potential for Getting Connected K-12 public schools, 29 charter schools, 305 expansion to Work has begun to install fiber connections private schools, 412 long-term care facilities, 758 nearly 4,000 and upgrade bandwidth in all 75 counties and in provider clinics, 231 public libraries, 203 licensed additional 135 Arkansas communities, including 81 Arkansas ambulance services, 264 police departments, 575 hospitals, all two-year colleges, eight public libraries, fire departments and 77 offices of emergency community all state human development centers, the state’s management. institutions. trauma network, the majority of community health “With broadband Internet connecting virtually centers, many mental health clinics and some home all of the state’s health care institutions, it will give health agencies. Arkansas the unique ability to use specialists to Arkansas e-Link’s team is now working alongside improve efficiency and improve medical outcomes several partners to map the network by leasing for patients,” Lowery said. existing broadband lines and laying new fiber It also will benefit research, education and public throughout the state. safety and have a profound effect on the state’s The two existing networks the project is expanding economy, with nearly 60,000 two-year college are the Arkansas Telehealth Network, managed by students and 50,000 workforce trainees reaping Arkansas Telehealth Oversight & Management added efficiency and technological advances. (ATOM), and the Arkansas Research and Education “Lives will be saved and new educational Optical Network (ARE-ON) network. opportunities will be added,” Lowery said. “A better ATOM is a coalition of health and information prepared workforce and more stable economy technology organizations funded by the FCC will be grown. But most of all, Arkansans can be Universal Service Fund to consolidate and expand proud to live in one of the nation’s most connected telehealth services in Arkansas. ARE-ON was states.” ❖ established with state funding to create infrastructure

30 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Curtis lowery, M.D., says the Atn laid the groundwork for a statewide telehealth system.

director of the UAMS Center for Distance Health. Work quickly began on consolidating the state’s existing telehealth networks, which encompassed 174 existing sites; updating and expanding the statewide network to improve rural access, connecting to Internet2 and nearly 200 miles of dark fiber; and scheduling and managing the needs of the network through a centralized system. The ATN naturally was boosted and has successfully integrated efforts when the $102-million federal broadband grant was announced in summer 2010. LearnTelehealth.org “The goal all along was to is a grant-funded have better and more efficient connectivity throughout the website managed state to better treat Arkansans,” by UAMS that Lowery said. “We would not provides training in A United Front have been able to get the big telemedicine. By Nate Hinkel grant or be organized enough to implement it had we not laid WHEN THE ARKANSAS statewide telehealth system. the groundwork with the ATN Telehealth Network (ATN) The united front included state in 2007.” was awarded $4.2 million in agencies, nonprofit hospitals, In early stages of completion, FCC support in late 2007, private hospitals, rural clinics, the ATN has successfully it allowed the state’s health community and mental health revolutionized the state’s care organizations to begin agencies and a number of trauma network and is working planning for the future. others interested in delivering toward facilitating geriatrician ATN, overseen by Arkansas telemedicine services to their support directly into nursing Telehealth Oversight & rural patient population. homes, where seniors can Management (ATOM), united “That effort leveraged the seek the ongoing care they Arkansas’s major health state’s current telemedicine need, reducing unnecessary care service organizations resources to create a network transports for geriatric care and stakeholders to build that benefits everyone inthat can be provided through the framework for a fully Arkansas seeking medical care interactive video. ❖ connected, tactically expanded, or desiring medical education,” and efficiently managedsaid Curtis Lowery, M.D., e-Link UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 31 Hitting the caBIG Time UAMS is a national leader in cancer research data system By Susan Van Dusen WOULD IMPROVINg communication initiative. Early proponents of the program between scientists and physicians around the included Cheryl Lane, director of research and world lead to quicker advances in cancer research? development systems for UAMS Information That’s what developers of the cancer Technology, and Shirley gray, Cancer Institute Biomedical Informatics grid (caBIg) are administrator. banking on. Since that time, the university has been Deemed the “World Wide Web of cancer recognized as a pioneer in the effort, forging research,” caBIg (pronounced c-a-big) was the way nationally in many of the initiative’s created by the National Cancer Institute (NCI) areas. The caBIg effort at UAMS is led by in 2004 as a virtual information network Umit Topaloglu, Ph.D., assistant professor of enabling researchers and physicians to more biomedical informatics and assistant director of easily share data and knowledge. Its primary goal information technology research. is to accelerate progress in cancer research and “It’s an honor to be recognized for what we’ve treatment. achieved at UAMS, but it’s more important to “We’ve seen the benefits of caBIg since its understand that the software we are developing very beginning. Our ability to manage and share can be used by other organizations to progress data has greatly improved with the addition this effort across the country and around the of caBIg components,” said Laura Hutchins, world,” Topaloglu said. M.D., director of clinical research at the UAMS All of caBIg’s software is open source and Winthrop P. Rockefeller Cancer Institute. available free of charge to organizations engaged Hutchins also is a professor and division director in cancer research, enabling widespread access to in the Division of Hematology/Oncology in the tools, data and infrastructure for the cancer and UAMS College of Medicine. biomedical research communities. In 2007, Hutchins received an NCI The UAMS Cancer Institute became the first grant of more than $120,000 allowing the cancer center in the country to implement a Cancer Institute to participate in its caBIg suite of eight software components — including

32 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES five caBIg components and three developed at Among the institutions UAMS is consulting UAMS — designed to handle data for clinical with are the University of Rochester, Indiana trials in an efficient format. University, Lehigh Valley Health Network and The UAMS Information Technology Research the Louisiana Cancer Research Consortium. Team also has partnered with the Cancer Leaders at UAMS also are spearheading the use Institute and the UAMS Tissue Procurement of caBIg tools in the National Children’s Study, Facility to develop and implement numerous a large research project studying children’s health open-source clinical research and biospecimen and development. tools to support clinical research studies. National recognition for UAMS’ caBIg The teams have migrated the UAMS Tissue efforts includes the NCI’s 2009 Delivering Procurement Facility to the caBIg caTISSUE Results Award designated for a project that software, a biospecimen identification and addresses specific research questions using caBIg tracking software, and have customized and applications, cagrid and data available for implemented participant registration software, sharing. a patient study calendar and study management The university also received a Top 10 ranking “Our success software, among other programs. in the 2010 Healthcare Informatics Innovator with the initiative “Our success with the initiative has led to us Awards presented by the Health Care Information being contacted by several institutions in the and Management Systems Society (HIMSS) for has led to us United States, Pakistan and the Netherlands.,” its caBIg efforts and was ranked No. 23 in the being contacted Topaloglu said. 2009 InformationWeek 500 list. ❖ by several institutions in the United States, Pakistan and the Netherlands.”

UAMS’ gail Douglas; laura hutchins, M.D.; Cheryl lane; and Umit topaloglu, Ph.D., accepted the Delivering Results Award from the national Cancer institute for development and use of caBig technologies.

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 33 34 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Technology Promotes Collaboration in Lab, Classroom, at Bedside By Jon Parham

INFORMATION is a tool just as valuable TurningPoint, an audience response system, is to a researcher, physician or instructor as a lab, used in many classes for real time student polling. stethoscope or classroom. In campus research labs, UAMS is working Technology that allows seamless sharing of toward an enterprise data warehouse to give its information and resources is not only efficient scientists access to HIPAA-compliant clinical data but aids UAMS in accomplishing its health from electronic medical records. A key initiative care mission, said David Miller, UAMS chief of the UAMS Translational Research Institute, information officer. This can range from students the data warehouse will provide another tool for Almost all accessing the Blackboard application for lecture researchers striving to turn basic science discoveries classes offered notes or test taking to physicians getting the latest into new medical treatments. in all five UAMS information in an electronic medical record on an An enterprise data warehouse provides outpatient now being admitted to the hospital. clinicians and researchers a convenient data colleges and the “We want to create a technology infrastructure resource. Cheryl Lane, assistant vice chancellor Graduate School to enable communications across our academic, for academic, research and enterprise systems, said use Blackboard patient care and research operations in a meaningful the data warehouse offers UAMS clinicians a tool as a repository way,” Miller said. “The point is to consolidate the unlike any they have had before with an ability for class syllabi, information and make it easily accessible for those to provide trending information and track illness- who need it regardless of the setting: research lab, specific data. schedules, grade patient bedside or classroom.” UAMS began shifting its patient medical distribution, Blackboard Learn is a Web-based classroom records from paper to an electronic record in curriculum learning management system. Almost all classes the late 1990s. As much as 90 percent of patient information, offered in all five UAMS colleges and the graduate information is handled electronically now, said handouts, School use Blackboard as a repository for class Jeri garland, director of electronic medical records syllabi, schedules, grade distribution, curriculum services. That percentage goes up to 100 percent videos and information, handouts, videos and presentations. for patient order entry and inpatient nursing presentations. Resident physicians use the system to access documentation. education resources at their convenience. garland said the focus now is to continue Tests also are administered using Blackboard at improving record systems used by UAMS inpatient four testing labs on campus, said Steve Boone, Ph.D., and outpatient operations to minimize redundancy UAMS director of educational development. This – whether it is getting patient information or patient allows up to 200 students to take a test at the same testing – and improve workflow. From the clinics to time and these tests can be automatically graded the hospital, the electronic medical record provides Wimba Classroom, a virtual classroom application a mechanism to share needed patient information that includes a Web chat, an electronic whiteboard in a secure and convenient way. and real-time lecture recording functions, further The electronic records system offers a connects students taking courses off campus to patient report that follows that patient through their instructors. “Wimba Classroom works in shift changes, clinics and hospital units as well conjunction with Blackboard Learn as a complete as the various physicians, nurses and others on classroom resource for our students,” Boone said. the care team. ❖

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 35 RESOURCES Speeding Bench to Bedside the newest UAMS institute takes aim By David Robinson

MEDICAL RESEARCHERS have long dreamed of finding a shortcut through the “valley of death,” the decade-plus period between discovery and approval of new therapeutics. Academic medical centers such as the University of Arkansas for Medical Sciences (UAMS) are working to make this dream a reality. UAMS recently launched the Translational Research Institute, which developed from the Center for Clinical and Translational Research. As part of The Center for Clinical and Translational that grant, Research was established at UAMS in May 2008 the institute is and subsequently received a $20 million federal Clinical and Translational Science Award in 2009. collaborating As part of that grant, the institute is collaborating with other with other institutions and employing the latest institutions communications technology to help streamline and employing drug development. the latest The institute is directed by Curtis Lowery, M.D., chair of the College of Medicine’s communications Department of Obstetrics and gynecology and technology director of the Center for Distance Health, with to help the day-to-day operations overseen by Executive streamline drug Director Lisa Jackson, a lawyer and registered development. nurse. One of the biggest impediments to advanced drug development is the inability to recruit enough participants in clinical trials. Sufficient pools of demographically diverse clinical trial subjects are critical to approval from the Food and Drug Administration (FDA). “Clinical trials are the most time consuming and expensive part of the drug development processes,” Jackson said. “Patients are suffering while researchers try to navigate through the valley of death with their drug. One way we could

36 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 37 Shared Resources reduce the timeframe is by recruiting appropriate The institute is also streamlining research at numbers of research subjects into clinical trials.” UAMS by developing an enterprise data warehouse to facilitate the use of rich clinical data for research Satellite Clinics purposes. The Institute is helping researchers tap into While medical data and tissue samples will new populations of research participants by remain heavily guarded, the new system will allow utilizing the telemedicine systems at six UAMS researchers to quickly access data that has been satellite family medical clinics around Arkansas. stripped of patient identifiers. Nurses at the UAMS Clinical Research Center “The data warehouse and accompanying tissue will use interactive video connection to recruit bank will create a treasure trove of information for research volunteers who receive their medical potential studies that will be available to all UAMS care from one of the six UAMS satellite clinics. researchers,” Jackson said. “The mere development of these two items will remove major barriers to Research Partnerships/Collaborations research at UAMS. Our goal is to have shared The Institute also expects to increase clinical resources for researchers on campus, clinicians, and trial participation by breaking down barriers the community at large.” Jackson to forming collaborations with other research The Institute is committed to ensuring that said she is institutions. The institute is currently working UAMS gets the biggest bang for its institutional determined to overcome various legal and other hurdles so investments. Through its pilot funding program, to remedy that UAMS can partner with the University of the institute selectively awards grants to faculty California at San Francisco on a clinical trial researchers with the most promising ideas. The situations of an investigational breast cancer drug. Once institute also is working to put mechanisms in place in which a these challenges are overcome, the drug study to ensure that discoveries made at UAMS can easily scientist makes will benefit from the combined participant be transferred from the lab to the patient bedside. a discovery, population from Arkansas and California. Jackson said she is determined to remedy publishes a situations in which a scientist makes a discovery, NCTR Partnership publishes a paper, and then the discovery is put on paper, and then Jackson believes that clinical trials could also a shelf. the discovery is benefit from better design, which is why the “By having a central place like the Translational put on a shelf. institute partnered with the National Center Research Institute, we can bring disparate parties for Toxicological Research (NCTR), an FDA together to get the discovery out of our academic research facility near Redfield, Arkansas. “We are center and into the community where it can have putting things in place to develop a curriculum real impact,” she said. for regulatory science that focuses on the process The Translational Research Institute is UAMS’ of moving drugs and devices through the FDA seventh institute, and joins the Winthrop P. pipeline,” she said. “We want it to help us Rockefeller Cancer Institute, the Jackson T. improve our study designs in order to make Stephens Spine & Neurosciences Institute, the better and safer trials that produce solid results at Myeloma Institute for Research and Therapy, the end.” the Harvey & Bernice Jones Eye Institute, the The regulatory science degree will be offered Psychiatric Research Institute, and the Donald W. by the UAMS College of Public Health. Reynolds Institute on Aging. ❖

38 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UAMS BioVentures UAMS Business incubator Uses Distance technology By David Robinson

WHEN UAMS BIOVENTURES hosted its fifth Private Equity Roundtable this year, the venue wasn’t limited to a conference room in Little Rock. Though venture capitalists from seven states flew in for the event, those who couldn’t make the roundtable were not left out. They were able to take part as it was live-streamed over the Internet. The live streaming was a first for the conference, which seeks to connect investors with discoveries and innovations at UAMS. During the conference, 15-20 of UAMS’ most promising BioVentures startup companies and discoveries are presented to an invited group of venture capitalists. “This year those presentations were streamed live the skin cream omnibalm was marketed with help from UAMS Bioventures. to the rest of the world,” said Mike Douglas, Ph.D., director of UAMS BioVentures. into play for Balm Innovations LLC, a UAMS In addition, brief videos were made with each BioVentures startup company. UAMS presenter giving a condensed version of their ANgELS, (Antenatal and Neonatal guidelines presentations. The videos were placed on youtube. and Education Learning System) uses telemedicine BioVentures, com and linked to the UAMS BioVentures website extensively to make its maternal-fetal medicine and established in at www.uams.edu/bioventures. neonatal medicine expertise available in distant 1997, is one “The videos allowed investigators to explain hospitals. UAMS BioVentures recently worked with of only two their technology and attempt to persuade investors ANgELS to copyright Angel Eye, a new camera university-based why it’s a world beater,” Douglas said. system that allows distant family members to see The live-streaming and individual videos were their newborns in the UAMS neonatal intensive incubators in the funded by a federal grant and in partnership care unit (NICU) via the Internet. United States, with Arkansas Capital Corporation and Connect The camera system, which is built into the providing Arkansas. NICU Isolettes was designed by ANgELS staff. laboratory and “This is a case where communications More than 30 institutions across the country have office space technology gives our scientists much broader inquired about using the system, and ANgELS is exposure to the market and hopefully this will pay developing a plan for marketing it. to startup off for everyone,” Douglas said. Venture capital is Balm Innovations, which markets Omnibalm, companies essential for funding additional research needed to a tea tree oil-based skin cream, soon will begin created as refine discoveries for marketing. working with UAMS researchers to study a result of a Douglas noted that communications technology Omnibalm as a treatment for diabetic foot ulcers. discovery. also is a central component of UAMS ANgELS, a The study will involve telemedicine, with patients UAMS BioVentures client, and it will soon come in at least one distant location using the product. ❖

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 39 UAMS Establishes Tri-state Telehealth Training Center By Susan Van Dusen

FOR PEOPLE who live just been positively impacted,” said network with more than 500 a few miles from their health Curtis Lowery, M.D., chairman video conferencing units in clinics care provider, going to the of the Department of Obstetrics and hospitals. doctor doesn’t present much of and gynecology in the UAMS Other recipients of the award a challenge. College of Medicine and director are the georgia Partnership for But for those residing in of the center. Telehealth, the University of rural areas of the United States, A boost to this already Hawaii and the University of the very act of getting to a successful effort came inKansas. physician’s office or major health September 2010 when the The South Central Telehealth care facility is one of the biggest Center for Distance Health was Resource Center functions obstacles to receiving quality designated as one of four new primarily through a new website care. Regional Telehealth Resource that works in partnership To address the issue of access Centers in the United States, with the Center for Distance “We’re to health care, UAMS in 2006 serving Arkansas, Mississippi and Health’s Training Center based founded its Center for Distance Tennessee. excited at UAMS. The website, www. Health as a centralized location Called the South Central learntelehealth.org, targets health to play a to integrate the university’s Telehealth Resource Center, care and health education groups lead role in clinical and educational it is funded for three years that have an interest in using this effort.” telehealth services. Telehealth with $979,416 from the telehealth. (also called telemedicine) refers U.S. Department of Health “The website is free, and it to the use of high-speed, two- and Human Services Health offers easy-to-navigate tutorials, way interactive video that Resources and Services a social network and other connects doctors and patients Administration. interactive features for anyone from distant locations. “This funding has allowed us interested in learning how to “Telehealth has made it to establish and operate a regional incorporate telemedicine into possible for us to expand our resource center that provides their health practices,” said health care services in ways hands-on technical assistance Adam Rule, director of the South previously unheard of. By and interactive training in the Central Telehealth Resource allowing physicians in rural three-state region,” Lowery said. Center. communities to consult in real- UAMS was selected for the “We are grateful for this time with specialists at UAMS, funding due to its longstanding opportunity to serve as a resource the lives and health outcomes track record and expertise in center for our neighboring of countless Arkansans have providing technical assistance in states,” Lowery said. “Our the development of innovative, experience at UAMS has taught cost-effective telehealth programs us that telehealth is the most for rural and medically efficient way to get expert care to underserved areas in Arkansas. people in medically underserved The Center for Distance Health areas, and we’re excited to play a manages the statewide telehealth lead role in this effort.”❖

40 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES For a simple explanation of telehealth and the many ways in which it benefits patients, visit www.learntelehealth.org/media/video/jennifer.

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 41 UAMS Goes Global with Interactive Videoconferencing By David Robinson

IN RECENT YEARS, educational institutions dean for research in the College of Medicine and on every continent but Antarctica have established the UAMS vice chancellor for research, agrees interactive video connections with UAMS. that more robust collaborative relationships are Many institutions are connecting with UAMS always a positive development, whether at the to learn about the ANgELS (Antenatal and state, national or international level. Neonatal guidelines Education and Learning Earlier this year, UAMS signed a memorandum “We’re System) standards for treating high-risk obstetrics of understanding with the University of developing patients and very-low-birth-weight neonates. Hyderabad in India. Under the agreement, stronger Others are connecting with UAMS to learn how coordinated by UAMS’ Hari Eswaran, Ph.D., the to incorporate the video conferencing technology universities will develop a joint educational and collaborations at their institution. research program to encourage the advancement between UAMS In addition to its numerous interactive video of science and medical education systems and and these connections with institutions across the United specialty expertise at both institutions. international States, UAMS has linked with China, Australia, “Establishing international collaborations like schools.” New zealand, Russia, Iraq, germany, Costa Rica, the one with the University of Hyderabad will Argentina, Canada, Saudi Arabia and Ecuador. enable UAMS students and scientists to increase “Video conferencing allows UAMS to their competitiveness for grants from federal develop strong collaborations with international agencies that support collaborative international educational institutions,” Lowery said. “The science projects,” Cornett said. “Similarly, goal is to reach the point where we can share University of Hyderabad students and scientists advancements in education, research and clinical will have additional opportunities for awards service among all of our peers in every discipline.” from agencies in India that support joint India- Lawrence Cornett, Ph.D., executive associate U.S. projects.” ❖

42 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 43

coordinate BRIEFS Child Mental Health Turns to Telemedicine Concern about a shortage of mental health professionals to assist with children’s issues has led UAMS to turn to telemedicine. Psychiatric telehealth, liaison and Consults, or Psych tlC for short, began in August 2009 and Distance Education Allows is bringing hope to children with mental illness, their families, Dental Hygiene Partnership their physicians and their Five students became the first to communities. the program graduate the UAMS dental hygiene program is a partnership between the hosted at Arkansas State University UAMS Psychiatric Research Mountain home in May 2011. institute and the state the distant location for the dental Department of human hygiene program started in 2009 following Services. a regional needs assessment by the it provides physicians Department of Dental hygiene in the UAMS throughout Arkansas College of health Related Professions. the enhanced access classroom portion is hosted on the Arkansas to child and adolescent State University campus, where students mental health expertise by are taught via real-time interactive video by offering free telephone and/ dental hygiene faculty on the UAMS campus or tele-video consultation for three hours away in little Rock. psychopharmacologic and/ UAMS faculty members in Mountain or diagnostic consultation to home provide laboratory and clinical physicians caring for children instruction. the Mountain home Christian and adolescents experiencing Clinic allows use of their facility for the emotional and behavioral disorders clinical portion. and their families. Students in Mountain home receive the Physicians may call the Psych same classroom instruction from the same tlC Call Center toll free 24 faculty at the same time as the students hours a day, seven days on the little Rock campus, said Susan a week and receive long, Ed.D., professor and chairman of the consultation from a Department of Dental hygiene. child and adolescent “A lot of students probably wouldn’t have psychiatrist within 15 minutes. gone into the program without the location the program also oversees closer to home,” said nancy Smith, M.Ed., follow-up care for children ages 2 to 12 discharged from an assistant professor in the UAMS dental the Psychiatric Research institute’s child diagnostic unit. hygiene program who works at the Mountain in addition, the Psych tlC program provides primary care home facility. physicians with training and continuing medical education. Smith noted that students were not just Regional roundtables and interactive video teleconferences are coming from the Mountain home area but available to provide education on evidence-based treatment from across the mostly rural north Arkansas guidelines. region.

44 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES UAMS Electronic records Systems Pay off

Upgrades in electronic health record technology have improved quality and efficiency of patient care. Now meeting federal incentives for its records systems Cardiologist ibrahim Fahdi, M.D. could pay off literally for UAMS. the 2009 federal stimulus act included PrACTiCing TElECArDiology financial incentives through the Medicare and Medicaid programs for demonstrating A confluence of telemedicine, cardiology and “meaningful use” of electronic health high-risk pregnancy expertise is offering a new records. that allowed UAMS recently to way to provide care for pregnant women with upgrade its inpatient and outpatient records heart problems so they do not have to leave systems to versions certified for meeting their hometown. those standards. The ANGELS Heart Clinic took flight in UAMS could receive about $3 million early 2011 as a collaboration of physicians by meeting the first guidelines by 2012. in the Center for Distance health with the As much as $8 million could be earned by Division of Cardiovascular Medicine and high- achieving all three of the federal meaningful risk pregnancy program of the Department of use stages by 2015. obstetrics/gynocology, both in the College of the standards call for electronic records Medicine. the clinic allows pregnant women systems to be used in ways that show with heart disease or at high risk for it to be improvements in the quality of care. this can seen by cardiovascular specialists at UAMS via include allowing for electronic prescribing telemedicine. and ordering, automatic notifications for ibrahim Fahdi, M.D., director of cardiac patient drug allergies or interaction warnings telemedicine in the Division of Cardiovascular and ease of record access by caregivers in Medicine, who has used telemedicine to see any unit of the hospital. patients at distant locations in recent years, “the standards are more an operational believes “telecardiology” is cost effective and objective than merely having the efficient. technology,” said Jeri garland, UAMS “telemedicine allows us to consult on high- director of inpatient electronic records risk patients who will not have to leave their services. hometown to have access to specialty care,” he “it’s a true partnership between said. information technology and the clinician to telemedicine does not replace traditional provide the tools that support the workflow care for patients, but instead supplements it and of patient care.” offers hometown physicians options for getting the best care for their patients, Fahdi said.

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 45 Public Health Data Available online

the Fay W. Boozman College of Public health made key public health information specific to all 75 Arkansas counties easier to access with a website that holds a wealth of valuable statistics and research. the Public health in Arkansas Community Search (PhACS) site takes available public health-related information and presents it in an easy-to-use way to all Arkansans. it can be found at www.uams.edu/phacs. A Spanish version is at www. uams.edu/phacs/espanol. “the site is a one-stop source for Arkansans looking for community specific health data,” said Jim Raczynski, Portal gives Patients Access Ph.D., dean of the College of UAMS patients can now coordinate their health care needs Public health. “the website is at any time with a just a few keystrokes and clicks of the designed for community-based mouse using the patient care tools on the www.uamshealth. organizations and citizens com website. looking to take charge of the myUAMShealth portal of the UAMS website allows health outcomes and risks in patients to request appointments, refill prescriptions, see lab their communities.” results, send secure messages to their physician and pay Research categories their hospital bills online, 24 hours a day, 7 days a week. include demographics, social “Patients value convenience in addition to excellent environment, access to health care, behavior risks, preventive medical care, and myUAMShealth makes it easier than care and screenings, and ever to do business with UAMS,” said lannie Byrd, UAMS health outcomes and mortality Web director. “Using the patient portal, we provide care in rates. partnership with our patients and their families.” the website was developed The portal launched with prescription refills in July 2009, in partnership with the and there are now more than 9,000 registered users. the Arkansas Center for health most popular service is lab results, with an average of 2,200 Disparities, the Arkansas lab results viewed a month. Prevention Research Center, in order to protect the privacy of patient information, the Arkansas Minority health patients are required to register with a signed paper form Commission and the UAMS presented in person or faxed to their clinic for access to translational Research lab results. other features are available with a simple online institute. registration.

46 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES Curtis lowery, M.D., pioneered the use of telemedicine at UAMS.

Where You Live Shouldn’t Matter By Nate Hinkel

CURTIS LOWERY, M.D., has become the to ask for telemedicine advice and training. face of telemedicine efforts at UAMS and beyond. In addition to high-risk pregnancy His mantra, “Where you live shouldn’t patients, UAMS’ specialists today are determine whether you live or die,” is well known using telemedicine to serve patients with to anyone who has worked with him or heard him strokes, seizures, geriatric issues, trauma and speak. He has dedicated his career at UAMS to the newborns who need special medical attention. As a maternal- cause, and in return, rural Arkansans have reaped When “virtual” physician house calls become fetal medicine the benefits and lived more fruitful lives. routine in the years to come, UAMS is likely to be specialist, As a maternal-fetal medicine specialist, Lowery leading the way. Lowery in 2003 in 2003 put UAMS’ telemedicine program on the “This is evolving very rapidly, and doctors as national radar. He was the creator of ANgELS well as patients need to know how to use this put UAMS’ (Antenatal and Neonatal guidelines, Education technology,” Lowery said. “I would envision in the telemedicine and Learning System), which uses telemedicine not-too-distant future that many of these systems program on technology to connect UAMS’ maternal-fetal will be in many people’s homes. So you won’t go the national specialists with high-risk pregnancy patients and to the doctor, your doctor will virtually come see radar. their doctors in rural areas. you in your house. This is the way things are going The innovative program has won multiple to go; there’s no stopping it.” national awards and was the springboard for And so, thanks to Lowery, no matter where UAMS to become a model for telemedicine. As patients live, location is becoming a far less a result, hospitals and other health care providers important factor in determining whether they live from inside and outside Arkansas – even other or die. ❖ countries – have been contacting UAMS

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