Legislature(2009 - 2010)BUTROVICH 205
04/09/2009 04:00 PM Senate WORLD TRADE, TECH, INNOVATIONS
| Audio | Topic |
|---|---|
| Start | |
| Overview: Advances in Neurosurgery | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE SPECIAL COMMITTEE ON WORLD TRADE, TECHNOLOGY AND
INNOVATION
April 9, 2009
4:16 p.m.
MEMBERS PRESENT
Senator Lesil McGuire, Chair
Senator Hollis French
Senator Gary Stevens
Senator Bill Wielechowski
MEMBERS ABSENT
Senator Lyman Hoffman
COMMITTEE CALENDAR
OVERVIEW: ADVANCES IN NEUROSURGERY
HEARD
PREVIOUS COMMITTEE ACTION
No Previous Action to Report
WITNESS REGISTER
CHRISTIE ARTUSO, Director
Neuroscience Services
Providence Alaska Medical Center
Anchorage, AK
POSITION STATEMENT: Delivered a presentation on the advances in
neuroscience.
ACTION NARRATIVE
4:16:54 PM
CHAIR LESIL MCGUIRE called the Senate Special Committee on World
Trade, Technology and Innovation meeting to order at 4:16 p.m.
Present at the call to order were Senators Stevens, Wielechowski
and McGuire. Senator French arrived soon thereafter.
^Overview: Advances in Neurosurgery
Overview: Advances in Neurosurgery
CHAIR MCGUIRE announced the business before the committee is to
hear an overview on the advances in neurosurgery by Christie
Artuso.
4:17:30 PM
CHRISTIE ARTUSO, Director, Neuroscience Services, Providence
Alaska Medical Center, explained that neuroscience services was
created a little over a year ago to look at needs of Alaskans
who have specific neurologic disorders. At that time she began
to look at the use of technology to deliver specific aspects of
care. She is here today to share some of the innovations they've
begun to implement that will make a difference to access to care
and survivability.
Technology continues to advance and facilitate improved quality
in the delivery of healthcare. This technology impacts the
healthcare system
· Through the use of electronic medical records to provide
global accessibility for the patient
· Through the use of computer-chip-based clinical monitoring
devices
· Through advanced web-based applications using wireless
connectivity to see or evaluate a patient, share
information or provide a service that couldn't otherwise be
provided
· Through the use of clinical decision software including the
ImPACT program and the electronic ICU (eICU), which allows
high-level decisions to be made more rapidly and improves
the quality of patient delivery by recognizing patient
problems earlier than is possible in a traditional model
4:20:26 PM
Hospitals with multimillion dollar information systems and
hospitals without computer systems are moving toward common
technology goals, which include implementing technology and
software systems to maximize a clinician's time. This technology
is user friendly, increases patient safety, produces more
positive outcomes, and meets the goals of an organization's
strategic and business plans. Clinical alarms that are built
into these programs will warn caregivers of immediate or
potential adverse patient conditions. For example, caregivers
might be able to see the trend of a patient's brain pressure is
increasing.
4:25:39 PM
Programs that are in use here in Alaska include:
· The ImPACT program, which is used for patients with
traumatic brain injury from an accident or a stroke.
· The Telestroke program is scheduled for launch in the next
two weeks. One cart is installed in Juneau and will
connect patients here to Anchorage so that a higher level
of care can be provided.
· An eICU was launched on January 27, 2008. This is a
computerized intensive care unit that uses clinical
software decision support to monitor all patients in an
intensive care unit by a nurse and intensivist. Those
individuals can use the software to recognize potential
problems with a patient before they would be clinically
apparent. The practitioner at the bedside could then be
alerted to take early action to minimize complications.
MS. ARTUSO related that the annual incidence of sports related
concussion is over 300,000, which is equivalent to roughly half
the number of people that have strokes each year. Estimates are
that 20 percent, or one in five, of all athletes will sustain a
concussion during a given sports season.
Post-concussion syndrome happens over a longer period of time;
some patients have deficits that will last up to ten years
following the initial injury yet they may not have been
diagnosed with a brain injury at the time of their accident.
These patients suffer from things like chronic headaches;
fatigue; sleep disturbances; personality changes; sensitivity to
light /noise; dizziness when standing; or deficits in short term
memory, problem solving, and academic functions. Suffering a
second concussion before repair from a first can be
catastrophic. In several states there have been deaths when a
second or third concussion follows before the first has had time
to heal. Sadly, this is diagnosed on autopsy. She said we are
working diligently to raise awareness of the significance to
traumatic brain injury to make sure that doesn't happen here in
Alaska. The ImPACT program is used to help diagnose and guide
treatment. Legislative support is needed to help with the
awareness, Ms. Artuso said.
4:28:21 PM
The post-concussion recommendations are that
1. No adolescent should continue to play or return to a game
after sustaining a concussion.
2. An individual sustaining a concussion should cease doing
any activity that causes the symptoms of a concussion to
increase (headaches, dizziness, nausea, etc) because that
could delay recovery. She related that her son sustained a
concussion playing hockey. He underwent ImPACT screening
and scored in less than the first percentile on three of
four categories. Among other things, the neuropsychologist
recommended that he limit video gaming to one hour per day
for two weeks. He followed all the instructions but the
video game part. When he was reevaluated with ImPACT
testing two weeks later he got A's on everything but verbal
and visual memory. On those he scored worse than on the
initial screening. The next week he followed all the
instructions and scored in the 80th and 90th percentile on
everything.
3. School attendance and activities may need to be modified.
4. Neuro-cognitive testing is an important component for the
management of concussions. It is used in assessing recovery
and has been shown to be a most effective tool. It is a
computer-based test that can be done on a laptop.
5. No athlete should return to contact competitive sports
until he or she is symptom free. Neuro-cognitive tests
should be normal both at rest and with exercise.
4:32:17 PM
ImPACT is a user-friendly, Windows-based computer program that
can be administered by a team coach, an athletic trainer or
physician with a minimum of training. She noted that at
Providence they are using a neuropsychologist to administer this
ten-module test that allows assessment of an individual as they
exercise and fatigue. The test takes about 20 minutes and is
relatively inexpensive. The test measures attention span,
working memory, sustained and selective attention time, response
variability, non-verbal problem solving, and reaction time. The
accuracy has been validated nationwide on various age groups and
various types of individuals.
4:33:20 PM
The different test modules look at
1. Word discrimination, which measures attention.
2. Design memory, which entails displaying a picture and
asking the participant to describe what they remember
seeing.
3. X's and O's measures visual working memory as well as
visual processing.
4. Symbol matching
5. Color matching
6. Three letters, which measures working memory and visual-
motor response speed.
The test data is put together by the computer program and can
help physicians, athletic trainers and schools all of which make
difficult decisions about whether or not an individual should
return to play.
4:35:13 PM
The current users include: the National Football League; Major
League Baseball; Professional Automobile Racing; the National
Basketball Association, Olympic organizations; the National
Hockey League; Junior Hockey, but none in Alaska; the Alaska
Aces, but not the junior teams or school systems; rugby; Junior
Soccer, colleges and universities, but none in Alaska; high
schools throughout the nation, but none in Alaska; the Alyeska
Ski and Snowboard Club. An entire team can be given a baseline
screening in half a day so that if a member suffers an injury it
shows how severe the injury is. If there is no baseline, the
test is scored against the approximate norms in the country.
This isn't quite as definitive and these decisions are typically
made on the conservative side.
4:36:27 PM
MS. ARTUSO displayed a picture of an air traffic control unit at
work and explained that the electronic intensive care unit
(eICU) is a system-wide critical-care program that is built on
technology that is very similar to an air traffic control unit.
This patented program provides technology infrastructure that
improves quality, operating efficiency, and economic
performance. The eICU program is staffed with an intensivist and
critical care nurses at a computerized monitoring station that
allows them to monitor hundreds of patients like air traffic
controllers monitor hundreds of planes. An intensivist is a
physician who is board certified as an intensive care physician.
The critical nurses have years of experience and are certified
as experts. An eICU facility actually keeps patients safe. Each
critical care nurse and intensivist is able to comfortably
monitor up to 50 patients. She displayed a pictorial to
demonstrate how an eICU interacts with big city hospitals,
community hospitals, and rural hospitals to deliver a higher
level of care by providing guidance and decision-making.
MS. ARTUSO displayed a picture of the eICU computer support
technology. One screen lists the patients. Red and yellow bars
alongside each name indicate various alerts. Another screen
shows a selected patient's vital signs and electronic medical
records. Yet another screen allows the intensivist or nurse to
access imaging studies. This information is combined to get a
full picture of the patient. Additionally, there is a camera in
every patient's room so it's possible to see the patient and
talk to the nurse or physician who is live in the room. Lab
tests are automatically fed into the system so all the reports
from diagnostic studies are in one location.
MS. ARTUSO said health care has safety and quality problems
because it relies on outmoded systems of work. We want safer and
higher quality care and we will therefore need to redesign the
systems that are used.
4:40:58 PM
SENATOR MCGUIRE apologized that the members are pressed for time
and asked if she would summarize what the technology is, where
it is being used in Alaska, where use should be expanded.
MS. ARTUSO said the eICU at Providence in Anchorage currently
monitors 30 ICU beds. It has not been introduced to other
facilities because of the cost to lease the patented eICU
program. She noted that there is a potential for Medicare to
require the presence of an intensivist in every ICU and if that
occurs, this program would bridge that gap. This is important
because there aren't enough intensivists in Alaska to staff all
the ICUs in the state.
She said the biggest problem with stroke care is the lack of
stroke neurologic expertise in rural hospitals. The first stroke
neurologist came to Alaska in September 2008. He is located in
Anchorage and is the director of this program. Basically, they
use a webcam, a computer on wheels, and a laptop for the stroke
neurologist. It's possible to log in and do a patient consult
anyplace that has wireless Internet. The interactive cart makes
it possible to see and talk to the patient, evaluate the
severity of their stroke, look at their CAT Scan and diagnostic
tests, and make a decision about treatment. This is important
because strokes can only be treated effectively within three
hours within onset of the symptoms. In Anchorage they have the
capability for two additional procedures. One is to use intra-
arterial medication to dissolve a clot in the brain and the
other is to insert a clot retrieval device into the vascular
system of the brain and pull the clot out. That can be done
within six hours of onset of symptoms.
Currently Juneau, Kodiak, Seward and a second location in
Anchorage have a telemedicine cart and there are plans to put
them in a number of other areas across the state. We're
confident that this is going to be successful here in Alaska,
she said. The decisions to bring this technology to the state
were based on the patients in Alaska, their needs and the
outcomes. This state has one of the worst stroke death rates in
the U.S. but that will be improved through the use of this
program. They are trying to develop strategic partnerships with
hospitals and corporations statewide to deliver this level of
care to the people of the state because they deserve that
access. This addresses one of the major national healthcare
goals, which is access to quality healthcare. That access can be
bridged through an electronic ICU, through a telestroke or
telemedicine system, and through ImPACT screening.
4:47:04 PM
SENATOR FRENCH thanked Ms. Artuso for an excellent presentation.
SENATOR MCGUIRE said the members of this committee will pass
this information along.
SENATOR FRENCH added that it's another argument for webcams; the
presentation could be streamed to the public at the same time
that the committee is hearing it.
MS. ARTUSO related that in the near future the stroke
neurologist will give a presentation that will be streamed live
to five different hospitals.
4:48:50 PM
There being no further business to come before the committee,
Chair McGuire adjourned the meeting of the World Trade and
Technology Special Committee at 4:48 pm.
| Document Name | Date/Time | Subjects |
|---|---|---|
| NEUROSURGERY ADVANCES.pptx |
SWTI 4/9/2009 4:00:00 PM |