Cutting-Edge Care

By Held, Shari

TECHNOLOGY CHANGES so rapidly that it is often difficult to know who is doing what and where. Here is our annual look at cutting- edge technology and techniques that help keep our Indiana hospitals among the leaders in health care.

Indiana University Melvin and Bren Simon Cancer Center, Indianapolis. The new $150 million patient care building at the Indiana University Melvin and Bren Simon Cancer Center (IUSCC) is slated to open this August.

“The actual demographics of the state of Indiana and the fact that the incidence of cancer was rising . . . was the impetus for us to build this facility,” says Debra Uhl, COO for Indiana University Hospital. “It represents a combined commitment between Clarian Health and IU School of Medicine to deliver top-notch, integrated, state-of-the-art care and to bring different practitioners together so we can assess patients and provide prompter service than we can today.”

The Center is the only National Cancer Institute-designated cancer center in the state that treats patients. There are only 63 centers nationwide. It is one of the nation’s leading hospitals when it comes to two procedures: minimally invasive hepatopancreaticobiliary (HPB) surgery for pancreatic cancer and transanal endoscopic microsurgery (TEM) for rectal cancer.

Minimally invasive HPB surgery techniques involve much smaller incisions, so recovery time is much improved. IU is one of the top three hospitals in the nation in terms of volume for pancreatic tumors and pancreatic surgery. IUSCC has been performing TEM for less than a year – often on an outpatient basis. It spares patients from having an incision and a colostomy.

Lutheran Health Network, Fort Wayne Recent studies have shown a direct correlation between decreased kidney function and higher risk for other medical problems. The more kidney tissue saved, the better for the patient. Radical nephrectomy (removal of the entire kidney and surrounding area) is only performed when absolutely necessary. But until recently many patients had to choose between open surgery with a partial nephrectomy (in which as much kidney tissue is spared as possible) or less invasive laparoscopic radical surgery which removed the entire kidney.

“To try to combine those two benefits, we, one, try to take only the tumor out and, two, we try to do this laparoscopically,” says Dr. Erik Weise, urologist and medical director of robotic surgery at Lutheran Hospital. “That is the best of both worlds.”

Weise, who has been with Lutheran Health Network for two years, has taken partial laparoscopic nephrectomy to another level by using the da Vinci Surgical System. The benchmark for a center of excellence for this procedure is that it is used on one out of every five patients with a kidney mass. The first year Weise performed the surgery, he hit that benchmark. Since then he has surpassed it – in the subsequent six months, his numbers increased to 32 percent; the next six months they reached 49 percent and in the most recent six- month block they reached 67 percent.

“What that means, is that out of all patients that walk through our door with a kidney mass, two-thirds will have laparoscopic nephrectomy and keep most of their kidney,” Weise says. “This is huge given the fact that we are saving heat attacks, strokes, hospital admissions and lives. The [da Vinci] robot has taken me from [the benchmark] one-in-five to two-out-of-three.”

It’s also made Lutheran Hospital Fort Wayne the world leader in the number of robotic partial nephrectomies performed.

Deaconess Health

System, Evansville. In November 2007, Deaconess began offering patients a state-of-the-art procedure for treating inter-cranial aneurysms. Aneurysms develop when a weakened or diseased area of a blood vessel bulges or “balloons” out. Most people don’t realize they have an aneurysm until it ruptures, when it can cause life- threatening bleeding. In the past, open cranial surgery was the mode of treatment. In the new technique, brought to Deaconess by Dr. Neil Troffkin, a catheter is threaded from a vessel in the groin to the aneurysm. A thin wire coil, typically made of platinum, is placed in the aneurysm, causing it to clot. The coil remains in place to protect patients from re-hemorrhaging.

It’s a great technique,” says Dr. Emil Weber, the neurosurgeon who was instrumental in putting the program together, and who now serves as a consultant for Deaconess. “It is minimally invasive – all done from inside the blood vessel. That’s the beauty of it.”

To provide the new procedure, Deaconess invested in the latest biplane imaging system, which plots the progress of the catheter and the coil in real-time to ensure they stay contained in the blood vessel. It is the first system of its kind that can cover the lateral and frontal anatomy simultaneously.

Other new endovascular procedures offered by Deaconess include the use of the Merci catheter for embolic stroke (when a clot in the heart embolizes to the brain) and for arteriovenous malformations which cause seizures and bleeding.

“Previously we had to send seriously ill people nearly 170 miles away [to get treatment],” Weber says. “Now we can treat them right here, and do it promptly.”

Methodist Hospitals, Northwest Indiana.

Methodist Hospitals recently invested in the latest 3D/4D ultrasound equipment and other advanced technologies for its Maternal-Fetal Medicine program. 3D/4D ultrasound allows physicians to look at a fetal heart or other structure in 3D and provides picture-like quality (4D ultrasound adds movement). That means defects, such as cleft lip, and complications, such as prematurity and fetuses that are not growing properly, can be recognized and treated earlier.

“Complicated pregnancies are fairly common,” says Dr. Howard Grundy, maternal-fetal medicine sub-specialist. “We follow twins and triplets closely because they have more complications, birth defects and slower growth than single babies.”

Other services offered by the program include testing for Downs Syndrome, monitoring of fetuses, and consulting with and creating management plans for patients with complicated pregnancies, such as women with diabetes, high blood pressure or heart disease. Methodist has stepped up to the plate to provide this needed service across the board to area women of all economic strata.

“No one [in the area] had made a major investment in technology and providing maternal-fetal specialists on a regular basis to help manage these patients,” Grundy says, “but Methodist decided they would be the leader in this and made a huge commitment.”

This summer Methodists’ Southlake Campus is installing a biplane imaging system that will diagnose and treat strokes, aneurysms and vascular disease faster and more efficiently than other systems. Procedures also require fewer x-ray images and contrast injections, resulting in less radiation exposure for patients. Earlier this spring, Dr. May Oka, a neuron-interventional radiologist at Methodist Hospitals, performed the first minimally invasive endovascular coiling technique in northwest Indiana. The new biplane imaging technology will allow the hospital to provide this highly specialized care to more people locally.

Goshen Center for Cancer Care, Goshen. This May the Goshen Center for Cancer Care (CCC) became a HOPE award winner for its model of integrated care, named by Hematology & Oncology News & Issues Magazine. It was cited as the “best example of integration of care among medium-sized community-based oncology practices.”

Included alongside medical, surgical and radiation oncologists are naturopathic physicians, dietitians, social workers and pastoral support.

“Having that added strength really complements our whole program of care,” says Dr. Doug Schwartzentruber, CCC’s medical director. “When you talk about cancer in broad terms, I would say we cure about 60 percent of cancer. But our goal is to heal everybody. Even though we may not cure the physical component, we can provide healing in terms of emotional and spiritual needs that for that particular person is extremely important and very meaningful.”

Patient satisfaction at the CCC consistently runs in the 95th to 98th percentile compared to the rest of the cancer centers nationwide.

Schwartzentruber credits the hospital’s strong mission statement, its board and administrative leadership “for making choices that are patient-centered” and allowing the CCC to “think outside the box a bit and invest where we think it is going to be best for the patient.”

The not-for-profit, comprehensive adult cancer center was the first to bring Intensity Modulated Radiation Therapy (IMRT) to the state of Indiana several years ago. The CCC is also actively involved in clinical research so it can bring new treatments and options to cancer patients. Its radiation department has two patents to its credit – one for mobile radiation therapy and the second, an improvement on a method of delivering high doses of radiation therapy to breast cancer patients.

Schwartzentruber calls that “pretty exciting” for a small community hospital. “Our premise has been to incorporate in this model, the best people and the latest technology in an integrative fashion to create a delivery of healthcare model at its best.”

Cancer Care Services, St. Francis Hospital Health Centers, Indianapolis. This April,

St. Francis Hospital & Health

Centers became the first hospital in central Indiana to deliver radiation treatments via TomoTherapy technology. Used to treat areas of the body that require a high degree of precision, TomoTherapy employs a helical mode of delivery (360 degrees of continuous treatment) with thousands of radiation beams – other technology may deliver only 180 degrees of treatment. TomoTherapy treatments are painless and are most often used for prostate, head and neck, central nervous system and cranial tumors.

“It’s unlike any other,” says Kent Brumbaugh, executive director of St. Francis Cancer Care Services. “TomoTherapy is a complete system. The treatment machine and the treatment planning system are integrated and incorporated into one, helping us make changes on the fly.”

Each time a patient comes for treatment, a scan is performed to catch any changes so the treatment is more precise and targeted. That precision allows the treatments to spare healthy tissue and promotes better outcome with fewer side effects.

Brumbaugh says St. Francis’ next step for utilizing TomoTherapy technology is stereotactic radiosurgery, a method of targeting radiation beams in a very precise manner so higher-dose levels can be administered. The stereotactic radiosurgery technology will be used primarily for targeting intercranial brain lesions.

Center for Advanced Medicine, St. Mary Medical Center, Evansville. When St. Mary’s Center for Advanced Medicine opened in December 2006, it featured $10 million of world-class imaging technology, including a 64-slice CT, 1.5 Tesla Open MRI and PET CT. The center remains a technology leader in its area.

Julie Wolowitz, director of imaging services, says the high- profile technology is probably the Center’s biggest selling point, but there are other technologies that are also important to providing quality health care.

The center’s rooms are equipped with digital x-ray and fluoroscopy, which delivers results approximately two-and-a-half times faster than traditional analog systems. Besides speed, the digital system allows minor adjustments to be made to images for optimal quality.

The Powerscribe digital dictation and transcription system provides faster reporting to physicians. “We are averaging a little over an hour to get reports to referring physicians,” Wolowitz says. “And that’s the final interpretation in their office, printed on their fax machine.”

The gold standard in centers of excellence in imaging is 24 hours. When fast-growing, aggressive cancers are involved, that one- hour turnaround can make a significant difference in patient outcomes.

Another new technology that St. Mary’s Medical Center offers patients is radiofrequency ablation (RFA). RFA is a minimally invasive treatment in which alternate currents are delivered to a targeted tumor to dissolve it, sparing the patient from major surgery.

Center for Wound Healing, Community Health Network, Indianapolis. Diabetes is on the rise. That means an increased demand for centers dedicated to healing the ulcers associated with that disease, as well as other wounds that are difficult to heal. Community Health Network responded to that need with the Center for Wound Healing at Community East, which opened this March. The center features four wound-treatment rooms that utilize the latest therapeutic methods. Patient progress is recorded via digital camera during every treatment. The center is managed by National Healing Corp., which has a heal rate of 85 percent within 16 weeks.

Approximately 10 percent of the center’s patients are candidates for its two state-of-the-art hyperbaric oxygen (HBO) chambers. The chamber surrounds patients with pressurized oxygen, which stimulates the red blood cells to heal the wounds.

“The Wound Center takes a big burden off family-care physicians, because, one, wound care is very time-consuming, and, two, the products used can be very expensive,” says Amy Propst, director of the Center for Wound Healing. “Physicians can refer patients to a wound center that specializes in that care and they don’t have to carry that high overhead. We supply referring physician monthly progress reports on their patients all the way through until they are healed.”

Memorial Hospital and Health System, South Bend. Memorial Hospital, one of the leaders in stroke prevention and treatment in northern Indiana, has been offering patients an alternative to carotid endarterectomy for years. That alternative is minimally invasive angioplasty in which a catheter is advanced from a blood vessel in the groin and the blood vessel reopened with a balloon. This is followed by the insertion of a stent to keep the vessel open.

“There was a need in our community,” says Dr. Gerard Duprat, medical director of interventional radiology for Memorial, “so we have refined the technique over the last decade and can offer this as a very safe alternative to surgery when surgery is not feasible.”

One refinement was the modification of Doppler ultrasound to monitor patients during the procedure initiated at Memorial. The resulting trans-cranial device gives physicians critical input about blood flow in real-time. Memorial has also begun using a “wind sock” filter to rapture any resulting debris from the stenting process to prevent it from reaching the brain and causing a stroke.

Another cutting-edge therapy offered for stroke patients is catheter-directed thrombolysis. TPA, a drug that dissolves blood clots, can be administered intravenously within three hours of the onset of symptoms, but now the medication can be administered directly to the clot in the brain via a catheter from the groin area from three to six hours after the onset of symptoms.

“It can prevent the patient from going into full neurological deficit following a stroke,” Duprat says. “We can now help more patients recover more quickly from stroke.”

Porter Health Systems, Valparaiso. Porter leads the region in diagnosing and curing complex heart ailments. This March, the hospital became one of the first five hospitals in the nation to implant a Livian heart device into a heart-failure patient. The devise, implanted in conjunction with the traditional defibrillator and a pacemaker, auto-synchronizes all the chambers of the heart. Average life expectancy of patients with the Livian heart device is improved three-fold-from three years to nine years.

Porter was the first hospital in northwest Indiana to perform minimally invasive hip surgery with the OSI PROfx Table. The table provides optimal positioning patients so muscle and nerve tissue can be spared during surgery. Patients recover more quickly, getting out of bed within 24 hours versus one week.

Porter is currently in the process of constructing a larger 261- bed, private room hospital situated on a wooded property overlooking a lake. The new facility in Porter County is slated for completion in 2011. It will feature a Cardiac and Vascular Institute; a 65,000- square-foot Mother/ Baby unit for labor and delivery, pediatrics and neonatal intensive care unit; and an expanded emergency department “within steps” of the hospital’s diagnostic and imaging services.

“We love the fact that we are building the hospital, but we are continuing to invest in technology and equipment that aids our staff and our doctors today, so we continue to be a leader in the region,” says Jonathan Nalli, CEO of Porter Health Systems.

Women’s & Children’s Hospital, Parkview Hospital, Fort Wayne. When Parkview Hospital began the design process of its $20 million Women’s & Children’s Hospital, the main focus was to make it feel like home.

Despite the activity, it is quiet and soothing with soft lighting and a central courtyard, where patients and families can find a few minutes of peace. The artwork is created by the children and grandchildren of hospital staff.

The hospital, which opened this February, features 24 post- partum rooms, 10 labor/delivery/recovery/ rooms, two labor/deliver/ recovery/ post-partum rooms with laboring tubs, four pre-term rooms, six private triage rooms, two operating suites and 20 private neonatal intensive care rooms with sleeping quarters for parents. Sue Ehinger, COO of Parkview Hospital, says patient satisfaction is very high.Women’s Diagnostic Center, Community Healthcare System, Munster. MRI detection of breast cancer has long been available, and is especially useful in detecting cancer in high-risk women that may have small, elusive breast cancers. MRI-guided breast biopsy, a new technology, just became available at Community in April. Already the technology has made a huge difference in treatment and planning for women with breast cancer. MRI biopsy is a minimally invasive breast biopsy, performed under local anesthetic, which requires only a tiny three-millimeter incision. The procedure provides information that cannot be obtained by other means.

It also can be performed in less than an hour, and there are no dietary restrictions and no need for a driver to and from the facility At Community, same-day results are available.

Traditional methods often require an open biopsy, a 20- millimeter incision, stitches, and a follow-up to get results. It may take a week or more.

“Happily, we have been able to condense everything and do it faster, with less pain and less breast tissue removal than the open method,” says Dr. Mary Nicholson, the only fellowship-trained breast radiologist in Northwest Indiana, and medical director of breast imaging services for Community Healthcare System. “Statistically 70- to 80-percent of breast biopsies are benign. But if it is cancer, you have the opportunity to take your cancer diagnosis and meet with your surgeon and plan your treatment with potentially just one visit to the operating room.”

Copyright Curtis Magazine Group, Inc. Jul 2008

(c) 2008 Indiana Business Magazine. Provided by ProQuest Information and Learning. All rights Reserved.