Fall 2010 Issue

From the President
Gary R. Katz, MD, MBA, FACEP

@Ohioacep Are You Linked In?
Physicians and Social Media

The Social Network is a 2010 drama film about the founding of the Internet social networking website Facebook. The extent to which a college student, even a Harvard college student, was able to find and link personal information, should astound you. Websites dedicated to social networking represent a growing phenomenon. With the explosion of sites such as Facebook and Twitter, unforeseen opportunity and risk abound. This may be an example of how technology can advance faster than society’s ability to react to it. Currently, Facebook is one of the largest social networking sites with more than 500 million active users. Facebook reports people spend over 700 billion minutes per month on Facebook. Seventy-five percent of Facebook users admit to checking their Facebook at work, on company time and company-owned equipment.  Recently three educators from city public high schools in New York made the news when they were fired for having inappropriate dealings with students on Facebook. School districts in states such as Wisconsin, New Hampshire and Ohio have ordered or urged teachers not to "friend" students on social-networking sites.

Department of Education officials noted that "Socializing on Facebook can cross over into areas that are potentially dangerous." Similarly, colleges and universities have acknowledged that Facebook is just one of many sources that prospective students can and will use in forming their impressions of a college. Companies and organizations have embraced social media to market products and services, and the healthcare field is no exception. Hospitals such as Kaiser Permanente® and the Mayo Clinic® are utilizing social media platforms for the benefit of patients, employees and practitioners. What does this mean to physicians?

The Mayo Clinic calls the social media revolution the most far-reaching communications development since Gutenberg’s printing press. The Mayo Clinic Center for Social Media, a first-of-its-kind social media center focused on health care, builds on Mayo Clinic’s leadership among health care providers in adopting social media tools, which began with podcasting in 2005. Mayo Clinic has the most popular medical provider channel on YouTube and more than 80,000 “followers” on Twitter, as well as an active Facebook page with well over 25,000 connections. With its News Blog, Podcast Blog and Sharing Mayo Clinic, a blog that enables patients and employees to tell their Mayo Clinic stories, Mayo has been a pioneer in hospital blogging. This is branding by social media.

ACEP Immediate Past-President, Angela Gardner, blogs on Gardner’s Gate, tweets @ACEPheadliner and the Scientific Assembly in Las Vegas in October had an EMRA iPhone® App to guide attendees. I have a personal Facebook page and have friends that cross personal and professional life. Like many today, I delight in sharing the joys of friends and family, sharing wedding and baby photos, observations on life, and on occasion, a reference to a long night in the ED or an article on healthcare that frustrates or inspires me. “The expansion of social networking websites, like Facebook and Twitter, has forever changed the way everyone communicates in our personal and professional lives,” said Richard R. Ellison, MD, president of the Ohio State Medical Association (OSMA). “However, as a physician, social media use can also pose many potential concerns.” The OSMA took the next step recently and created a toolkit to provide resources to help physicians utilize social media while remaining within the legal and ethical bounds of the profession.

Social media participation is also becoming an essential tool in networking with professional contacts, making new contacts, recruiting employees, and keeping in touch with the world. You may feel that if you’re not participating in the top social media and networking sites, the world is leaving you behind. You can sign up for Twitter feeds, follow colleagues on Facebook and keep up with the news and newsworthy (e.g. the NYTimes "social network"). Seeing what interests others adds to our understanding and appreciation and for some, enlivens our day.

There are certainly employer policies to be aware of. A local university medical center notes that: 
Personal Use of social media using university electronic resources, like the use of personal cell phones and e-mail, should happen only during non-work time and in strict compliance with all other university policies. Use Of Resources: You may not use a university.edu-issued-email address as a credential for personal use social networking sites. Additional examples of employer policies may be found on the link provided.  

Recent articles from NEJM and JAMA on med students and social media review the experience of US medical schools with online posting of unprofessional content by students and existing medical school policies to address online posting. Taken a step further, some employers surf the Internet to vet job applicants. As reported in the Sacramento Business Journal, “How soon will it be before the pictures you posted on Facebook of your skydiving adventure result in cancellation of your life insurance policy? Or will that Twitter message about your drunken stupor be considered by your auto or health insurer when pricing your policy or determining if you even get coverage?”

Yet, today patients routinely search the Internet for answers to their health care questions, and social media is playing an even bigger role. Patients are taking advantage of the creative ways health care providers use social media. Emergency departments are displaying wait times and keeping family members updated on their loved-ones' progress. The CDC uses Facebook to keep people informed about public health events such as H1N1. KevinMD.com is even tagged as social media’s leading physician voice.

Organizations use social media. The Society for Academic Emergency Medicine (SAEM) has a social media committee with goals to recruit followers, post noteworthy developments from any other committees, task forces, the Board and the office; recruit fans on Facebook; interact with SAEM's followers / fans to provide social media coverage of Annual Meetings; post member submitted conference photos, and perceptions from session highlights; and disseminate breaking news to Twitter and Facebook accounts. But they also have as a committee focus the exploration of language or elements that need to be incorporated into a security and/or professional integrity policy for use of social networking sites in the context of being an SAEM member. 

Physicians might benefit from using Facebook as a communication tool in their medical practice, including:

• strengthening the physician/patient relationship;
• keeping patients informed/engaging in dialogue;
• increasing the physician's referral base; and
• securing job opportunities through social networking with colleagues.

Challenges to physicians include:

•  maintaining boundaries;
• accuracy of information;
• time required to keep pages current;
• security of information; and
• loss of nonverbal cues.

More information can be found at this site. 

Follow me, Friend me, Find me. What I do know is that physicians cannot ignore this social phenomenon. For now, I think I will simply have a personal Facebook page for family and friends, and interaction with colleagues.

November 2010 General Election Results

O’Connor and Lanzinger win; Governor-Elect Kasich; Portman to the U.S. Senate; Statewide Republican Sweep

John Kasich Elected Next Ohio Governor
John Kasich has been elected the 69th Governor for the State of Ohio. Governor-elect Kasich and Mary Taylor, the Lieutenant Governor, will be sworn-in in January 2011. Governor-Elect Kasich will take office on Monday, January 10, 2011.

Governor - Elect Kasich has announced that Tim Keen will be appointed Director of the Office of Budget and Management; Beth Hansen will be his Chief of Staff; and Wayne Struble will be the Director of Policy in the Governor’s Office.

O’Connor will become first female Supreme Court Chief Justice
Current Supreme Court Justice Maureen O’Connor will become the Chief Justice of the Court. Justice O’Connor beat Governor Strickland’s appointee Eric Brown in the election. Also winning their elections were Justice Judith Lanzinger and Justice Paul Pfeiffer.

Statewide Office Republican Sweep
The election brought a sweep of Republicans into office. The Republican candidates in all the Statewide races won: State Senator Jon Husted defeated Maryellen O’Shaughnessy for Secretary of State; former Senator Mike DeWine defeated incumbent Richard Cordray in the Attorney General race; State Representative Josh Mandel beat incumbent Treasurer Kevin Boyce; and Dave Yost defeated David Pepper for the Auditor of State’s set. All Statewide officials will take office on January 10, 2011.

Click here for MORE General Election Results.

This is Just a Drill
William P. Saunders, III, MD, MHA
EM Resident Board Member of Ohio ACEP

As an emergency medicine resident, exposure to disaster training is essential. As a discipline, we will play an integral role in any hospital setting in the event of an emergency. Within the hospital setting we will play a role as topic advisors, care givers, and leaders. Hospital administration will look to us for help with disaster planning, training, and execution. If your residency program does not actively promote disaster training I recommend that you pursue some level of disaster training exposure. At a minimum, every emergency medicine resident should observe and participate in a disaster drill at their facility. Until you have tried to move a non-ambulatory 300 pound patient down three flights of stairs, you can never appreciate the difficulty of a hospital wide evacuation in the chaos of a disaster. Please click here for the full article.

Preparing Ohio ACEP’s Next Generation of Leaders

On behalf of the Ohio ACEP Board of Directors and the Leadership Development Committee Ohio ACEP is currently recruiting the third class for our Leadership Development Academy. The next group of up-and-coming physicians selected to participate will:

• Discover the importance of state and national advocacy for their profession
• Develop a Emergency Medicine peer network and connect with mentors
• Enhance their interpersonal effectiveness, management and strategic decision-making skills
• Assess how they can most effectively contribute to the state or national organization

Ohio ACEP Leadership Development Past Academy Graduates: 

If you are interested in advocacy, administration, research, or education, this program will help you to develop a skill set to promote your career as well as gain valuable experience with Ohio ACEP. Please visit the Ohio ACEP website to download the application/ nomination form. THE NOMINATION/APPLICATION DEADLINE IS NOV. 30, 2010. Please contact Ohio ACEP Executive Director, Laura Tiberi or Staff Liaison, Kelley Shively with any questions. 

Ohio ACEP at Scientific Assembly 2010

The ACEP Scientific Assembly was held at the Mandalay Bay in Las Vegas September 26-27, 2010. Councillors from all states and sections deliberated over 34 resolutions. At the end of the two day meeting, Dr. Sandra Schhneider was installed as the President of ACEP. The Council elected David Seaberg MD, CPE, FACEP President-Elect; incumbent Board candidates Andrew I. Bern, MD, FACEP (Florida) and Andrew E. Sama, MD, FACEP (New York) were re-elected to the Board of Directors and were joined by two newly elected members of the Board, Robert E. O’Connor, MD, FACEP (Tennessee) and Paul Kivela, MD,MBA,FACEP (California).

Ohio Chapter President-Elect Tom Lukens, MD, FACEP greets visitors                  to the Ohio ACEP and Carol S. Rivers MD EM Board Review booth at                 Scientific Assembly with chapter staff Stephanie Posey and Holly Dorr.		Drs. Ellen Taliaferro, Pamela Bensen, and Marsha Ford share   memories of their colleague, Dr. Carol Rivers, at a reception   celebrating her contributions to emergency medicine.
Ohio Councillors Mike Smith, MD, FACEP [H] and Jason Cheatham, DO,        FACEP [O] with Alternate Councillors (left) Michael McCrea, MD [O] and       Joe Bushek, DO [I] show off the O-H-I-O at the Council meeting.		Ohio Chapter Leaders Mike Smith, MD, FACEP (Secretary);     Gary Katz, MD, FACEP (President); Tom Lukens, MD, FACEP     (President-Elect); and Eileen Baker, MD, FACEP (Immediate     Past President) break from business at the Council meeting.
Ohio Council Delegation at the Council meeting at Mandalay Bay in Las Vegas.		Dr. Katz, President of the Ohio Chapter                      and leader of the Ohio Council delegation.

Ohio ACEP Hosts Two Successful EMR Courses

Ohio ACEP held two highly-attended Emergency Medicine Review courses in August and October. The August course at the Renaissance Columbus Hotel featured both the 5-day Long Track course and the 3-day Fast Facts and Fundamentals course. In total nearly 350 people attended the course. The October course at the Doubletree in Worthington, Ohio was equally successful attended by almost 300 people. The purpose of the course is to provide an academic review of information critical for the emergency medicine board exam. Many physicians attend the course for general review and continuing medical education credits as well.

Exhibitors at the courses included:
 - 4M Emergency Systems, Inc.
 - Challenger Corporation
 - Cleveland Clinic
 - Dr. Carol Rivers’ EM Board Review
 - Elsevier, Inc.
 - The Exigence Group
 - Flexible Footwear Company
 - Hospital Physician Partners
 - Locum Medical Group
 - Practice Management Associates
 - Premier Health Care Services, Inc.
 - Schumacher Group
 - TeamHealth
 - University Hospital Case Medical Center

The courses were so successful Ohio ACEP has decided to hold two courses next year to meet the needs of our attendees. The Long Track 5-day course will be held September 19-23 and the Fast Facts and Fundamentals course will be held September 24-26. A second course will be scheduled soon, but the date has not been finalized. Once the date of the course has been determined it will be posted on the Ohio ACEP web site.

Ohio ACEP is your resource for Emergency Medicine Review!

Ohio Prescription Drug Abuse Task Force

The Ohio Prescription Drug Abuse Task Force's final report was issued Friday, October 1st. The report is also posted on the ODH Web site. This report outlines significant steps toward addressing the issue of prescription drug abuse on a statewide level, including 20 recommendations to the Governor and leaders of the General Assembly. Over the past six months, the Task Force convened 10 full meetings and 15 Work Group meetings. Members from a diverse group of professional backgrounds and perspectives worked together to develop a report of recommendations to address Ohio's complex prescription drug abuse epidemic. These recommendations reflect hours of discussion and debate and represent the consensus of the members of the Task Force. Among the regulatory recommendations is a “Redesign of the Medicaid Lock-In Program,” which notes that ODJFS should partner with Medicaid managed care plans, pharmacies, healthcare provider organizations, the state’s pharmacy benefit manager, the Executive Medicaid Management Agency (EMMA), emergency room physicians, hospitals and other advocates to identify common language to ensure a uniform set of rules for all consumers. The report also suggests authorizing the Pharmacy Board and respective prescriber licensing boards to create rules specifying when pharmacists and prescribers should register and use OARRS prior to prescribing controlled substances. Allowing each professional healthcare regulatory board to establish their own specific rules should mitigate stated opposition to blanket registration/use rules. These recommendations would allow the boards to establish their own rules and specify the circumstances under which a prescriber should check the patient’s OARRS history prior to prescribing controlled substances. Current law states that prescribers and pharmacists are not required to obtain information about a patient from OARRS.

Change in Ohio Law Will Affect ALL Active Ohio Certified EMTs/Paramedics

The Division of EMS has been given the ability through legislation, (H.B. 1), to begin issuing certifications for all levels both Fire and EMS, to expire on a common date. This date as established through the implementation of H.B. 401 will be the certification holder’s date of birth. This will give both the certificate holder and the division the ability to more easily track multiple certifications and the continuing education requirements that must be met for each one.

The Board of EMS, The Fire Training Committee and the staff of the Division of EMS are in the process of writing and approving rules, policies and procedures that will be utilized in implementing this new law and regulating it in the years to come. It is our goal to have this completed and implemented by 1/1/2011. This means that the expiration date of all EMS certifications will be changed to the card holder’s date of birth on that date.

ALL ACTIVE OHIO CERTIFIED FIRST RESPONDERS/ EMT’S/PARAMEDICS WILL BE AFFECTED BY THIS CHANGE IN THE LAW

ALL active Ohio certified First Responders/ EMT’s/Paramedics will be affected by this change in the law. For those who are dual certified through the division for both EMS and Fire, their EMS certification will be moved to the same expiration date as their current active Ohio Firefighter certification. For those who are certified for EMS only, their expiration date will be moved to their date of birth in the same year that their current Ohio EMS certification now expires.

Since all certification periods will be changed from the 3-year cycle that was in place at the time the affected certifications were issued, continuing education(CEU) requirements will also be changed. For all EMS certification holders whose Ohio certification period is lengthened, the continuing education required will not be changed. These certification holders will simply have more time to complete the educational requirements that are now in place in rule for renewal. For those certification holders whose Ohio EMS certification period is shortened, the continuing education required will be prorated to a lesser amount. These lesser amounts will be detailed on a chart that will be made available on our website when the rules are approved. Please visit the website often for this update. The Division of EMS has a newsletter with more information.

Member Kudos

Robert Broida, MD, FACEP, received a Service to College Award at this years Scientific Assembly for his work with the QIPS Section.

Catherine A. Marco, MD, FACEP was recently elected to the Board of Directors of the American Board of Emergency Medicine. Her term began July 2010.

Air Force class of 1970 graduate John Russ salutes the nine classmates who died in the Vietnam War during the dedication of the Southeast Asia Memorial Pavilion at the U.S. Air Force Academy, Octpber 1, 2010. The plaques on the wall honored the classmates from 1959 to 1972 who were killed during the war. (The Gazette, Christian Murdock)




Congratulations to Jeffrey A. Nielson, MD, MS for being published in the October 2010 issue of Annals of Emergency Medicine.

Clinical News

CME Article on Sore Throats Now Available
Originally printed in ACEP News, the “Focus On” series of articles brings the latest literature and best practices to help the busy emergency physician. This issue’s topic, “Sore Throats -- What Really Works?,” will help the emergency physician review the incidence of strep pharyngitis in different populations, understand present guidelines regarding the diagnosis of strep pharyngitis, and develop a plan of care for treating your next patient with a "sore throat." 
Read the article online and then take the CME quiz.

The Effective Physician: Chest Pain in the Emergency Department
Over 8 million people seek emergency department (ED) attention every year for assessment of chest pain. The American Heart Association recently issued a scientific statement to give guidance on rapid, effective approaches to the assessment of such patients. Conclusions: Most patients who present with chest pain to ED settings do not have acute ischemia: Less than 5% have an ST segment elevation myocardial infarction, and up to 25% can have a non–ST segment elevation event. Up to 7% of patients with chest pain after cocaine exposure have infarctions. At the same time, up to 2% of patients with acute coronary syndromes (ACS) are inadvertently discharged from EDs with potentially twice the risk-adjusted mortality of patients admitted for management of acute ischemia.
Read the Entire Article

Combination of Two Oral Drugs Shows Promise for HCV in Small Study
A combination of two oral drugs for reducing viral load in hepatitis C patients had good safety and tolerability in a small, phase I study. The finding, published online October 15 in the Lancet, points the way toward an alternative to the current standard of care – subcutaneous pegylated interferon-alfa plus oral ribavirin – which has limited tolerability and efficacy. The novel therapies that were tested in this study are RG7128, a nucleoside polymerase inhibitor, and danoprevir, a protease inhibitor, wrote Dr. Edward J. Gane of Auckland (New Zealand) Clinical Studies Ltd., an early-phase clinical pharmacology unit, and his colleagues.
Read the Entire Article

Nominations Accepted for ED Director of the Year

The Emergency Medicine Foundation (EMF) is now accepting nominations for the 2011 Blue Jay Consulting/EMF Award for Emergency Department Director of the Year. 

The award was created to identify and recognize an individual who has made significant strides in developing collaborative relationships with nursing to implement and improve operational and clinical standards in five specific areas -- quality patient care, operational effectiveness, education, community service, and a synergistic approach to leadership within the hospital or hospital system. 

Because successful emergency departments have strong collegial relationships between physicians and nurses, these collaborations can make lasting improvements in quality care and patient satisfaction. 

For a nomination form, visit www.emfoundation.org/directoraward. Nominations are due by February 18, 2011, and the 2011 award will be presented at the Emergency Department Directors Academy (EDDA) on May 2, 2011 in Dallas, Texas.

Emergency Medicine Foundation Expands its Funding Priorities

The Emergency Medicine Foundation (EMF) is pleased to announce an area of special emphasis for its fully funded grant categories in the 2011-2012 grant cycle. To better improve emergency patient care, illustrate value in emergency medicine research, and assist the practice of emergency physicians in a changing health care environment, the EMF Board of Trustees is emphasizing innovative health services and health policy research. 

EMF has been committed to supporting emergency medicine research by helping young investigators. Grants currently fully funded by EMF are the EMF Health Policy Grant ($50,000), the EMF Fellowship ($150,000 over two years), and the EMF Career Development Grant ($50,000). For this grant cycle, EMF encourages applications with a focus on health services research, including but not limited to, health policy, practice, medical liability, regionalization, patient safety, and hospital utilization. However, it is important to note that EMF welcomes all applications, including research that is not health services-based.

“The Emergency Medicine Foundation has committed to supporting actionable research that directly impacts the care of our patients,” said EMF Board Chair Alexander Rosenau, DO, FACEP. “EMF will continue to underwrite a wide variety of research. The EMF Board of Trustees believes that this new era in health care reform is not only momentous, but pivotal. It demands serious investigation by the best that emergency medicine researchers have to offer in health services and health policy research.”

The Emergency Medicine Foundation also offers several co-sponsored grants, including:  
EMF/SAEM Medical Student ($2,400 each, two available), due January 5, 2011

EMF/EMRA Resident Research ($5,000 each, three available), due January 5, 2011

2011EMF/ENAF Team Grant ($50,000,one available), due January 5, 2011 

EMF is pleased to announce two new co-sponsored partnerships: 
EMF/Medical Toxicology Foundation Resident Research ($5,000, one available), due January 5, 2011 

2011EMF/Emergency Medicine Patient Safety Foundation ($10,000, one available), due January 5, 2011

Also new this year will be two directed research grants. The first is underwritten by Baxter in sub-cutaneous infusion ($50,000, one available) (due January 5, 2011) and the other is underwritten by Genentech in regionalization and stroke care ($100,000, one available) (due February 1, 2011).

Go to our website to upload your application and instructions. Grant deadline is January 5, 2011 for all grant categories except for the EMF/Genentech grant, which has been extended until February 1, 2011.

NEMPAC Receives Record Support

NEMPAC, ACEP’s Political Action Committee, reported record fundraising efforts during the Scientific Assembly in Las Vegas, spurred by upcoming November elections that could change the political landscape in Washington, DC.

Members of the ACEP Board of Directors and Council donated more than $155,000 at the meeting. An additional $5,000 was donated at the NEMPAC Booth in the Exhibit Hall. Coupled with the $681,000 raised from ACEP’s general membership prior to the meeting and the collective contributions from individuals in physician group campaigns, NEMPAC is well on its way to exceeding our record of $1,167,342 set in 2009.

Outstanding EM group efforts during Scientific Assembly included CEP America’s contribution of $100,000 through its advocacy fund; EMP’s collection of $106,000 from its individual ACEP members; TeamHealth’s donations of $50,000 from its ACEP members and goal of $100,000 by year’s end; and EMA’s NEMPAC campaign among its eligible ACEP member physicians with a target of $60,000 by year’s end.

NEMPAC also is conducting an ongoing campaign with the general ACEP membership to reach this year’s goal of $1.25 million. A member-wide survey and solicitation from NEMPAC will be mailed in the next week. NEMPAC is currently the 4th largest physician specialty PAC behind the anesthesiologists, orthopedic surgeons and radiologists – with a goal to become number one.
In November’s mid-term elections both House and Senate seats will be at stake, with the possibility of dramatic change in party alignment in one or both houses of Congress. With the ongoing health care reform implementation process, it is more important than ever that emergency medicine has a strong PAC that gives the specialty an important voice and an influence in DC.

New Fellows Honored in 2010

Congratulations to the following Ohio ACEP members who recently achieved fellow status and were recognized at the 2010 Scientific Assembly:

Welcome New Members