South Asian Heart Center opens

| EL CAMINO HOSPITAL | NEWS FOR PHYSICIANS |
Synergy
APRIL 2006
Inside
Corporate
compliance 101
Magnet award
ECHO update
Health library
physician service
Bariatric
surgery center
Stroke center
accreditation
Construction
update
2500 Grant Road
Mountain View, CA 94040
(800) 216-5556
www.elcaminohospital.org
South Asian Heart Center opens
EL CAMINO HOSPITAL’S SOUTH ASIAN HEART
CENTER, the first such center in the world
established to address and aggressively manage
the increased incidence of coronary artery
disease among South Asians, has begun seeing
its first clients. After more than two years in
development, the center, located in the Park
Pavilion, opened in March, thanks to ongoing
efforts by volunteers and staff, as well as
significant donations from the community.
The center will educate patients and
physicians about cardiovascular risk factors
unique to the South Asian population. South
Asians — individuals from India, Pakistan,
Bangladesh, Nepal, and Sri Lanka — have a
fourfold higher risk for coronary artery disease
than the general population. The center will
offer advanced clinical and metabolic screening
to identify individuals at high risk. The
center will provide counseling and lifestyle
recommendations, and will follow the participants
as they return to their physicians with
their assessment and recommendation.
The center will maintain a dual focus, according
to Nivisha Mehta, development director. “First, of
course, we want participants coming in to be evaluated,”
she explains. “But the role of community physicians
will be very significant as well. We will conduct
half-day seminars for continuing medical education
credit so they can hear world-renowned researchers
on South Asians and heart disease. We want them to
take that information back to their practices and adapt
their testing and treatment methods to this population.”
Researchers have only recently begun to understand
why people from these areas experience such elevated
risk levels, according to Cesar Molina, MD, the center’s
medical director. Surprisingly, traditional risk factors
do not seem to account for the problem. South Asians
don’t have higher rates of tobacco use, obesity, hypercholesterolemia,
or hypertension; moreover, nearly
half are vegetarians who exercise
regularly. Theoretically they should be
the picture of health, but 50 percent
of heart attacks in this group occur
before age 50, and 25 percent before
age 40. Prevalence of coronary artery
disease (CAD) is 10–12 percent,
versus 2.5 percent in Caucasians and
roughly over one percent in other
Asian populations such as the Chinese.
“We now think the increased risk
is due to genetic factors related to the
production of lipoprotein (a), which
tends to magnify the risks for cardiovascular
disease,” Molina explains.
“El Camino Hospital is taking the first step in bringing
in individuals to screen them for these emerging risk
factors, which may be missed with a standard lipid
panel such as that for cholesterol and triglycerides.”
Research suggests that such risk factors may also
include glucose intolerance, lower HDL cholesterol,
and higher levels of LDL cholesterol, homocysteine,
and fibrinogen. Molina notes that the problem doesn’t
exist just in the United States or in other areas where
South Asian emigrants have settled; there is a CAD
epidemic in South Asia too. “The risk doubles as
Physicians interested in being
involved with the South Asian
Heart Center, or being part
of the referral network, should
contact Ashish Mathur at
(650) 988-7414 or via email at
amathur@southasianheartcenter.org
or visit the Web site at
www.southasianheartcenter.org.
Ashish Mathur,
executive director,
and Dr. Cesar Molina,
medical director
individuals move from the country
to the city because they become
more sedentary and start eating a
richer diet,” he says.
To address these concerns, the
center will emphasize evidence-based therapeutic
approaches — including dietary programs, exercise
regimens, lifestyle counseling, and stress-reduction
techniques such as yoga and meditation — that have
been shown to decrease incidence of cardiovascular
disease, atherosclerosis, and cardiac mortality.
“The center has a full approach,” Molina says. “We
have a physician, a nurse practitioner, and a nutritionist.
We will provide, for free, the medical interview, the
physical examination, and the counseling. Laboratory
testing will be handled through insurance and will also
be free for indigent patients. We will then encourage
patients to get pharmacologic and other interventions
from their physicians.”
Ashish Mathur, executive director,
has a personal stake in the center’s
success: he himself had a myocardial
infarction at age 44, and he has
tried ever since to make the knowledge
he gained available to anyone
who might benefit.
“I changed my life after the
heart attack,” he says. “People were
coming to me for advice, but I am
not a physician, so I felt that the
center offered a good opportunity
for me to apply everything I’d been
reading about.”
One of Mathur’s first steps was to lose 50 pounds
of extra weight. He did so with the Ornish diet, but
found that after six months his blood chemistry still
hadn’t corrected itself. He then adjusted his diet to
include certain types of fats. “Within three to four
months my blood chemistry changed dramatically —
every number was in line and has been since,” he
says. “It’s an iterative process for each individual to
find what works.”
Mathur also began exercising regularly and reducing
his stress levels. “People don’t believe it when they see
| continued page 4 |

| SYNERGY | APRIL 2006 | P AGE 2 |
Compliance 101:
What every physician
Some resources for
physicians and
medical office staff:
| The Council of
Ethical Organizations
| www.complianceprograms.com
| The Health Care Compliance
Company
| www.hcpro.com
should know
This will be part of a regular column sharing important
information with physicians about compliance.
DON BRIONES, COMPLIANCE OFFICER AT EL CAMINO
Hospital, would like to caution physicians that the
compliance environment has shifted to one in which
issues are initiated sometimes beyond a physician’s
control.
“Most physicians feel they are in full compliance
with all rules and regulations, “Mr. Briones says.
“However, there have been some highly publicized
cases in identity theft, quality of care, billing, and
privacy breaches in Northern California that should
serve as cautionary tales for physician offices.”
The essential ingredients in ensuring an effective
compliance program, according to the Health Care
Compliance Association, are:
• Set standards of conduct: written standards
provide clear guidelines for your staff and demonstrate
a commitment that everyone should follow.
• Identify a point person for compliance: smaller
practices might not practically have a dedicated
compliance officer. However, it is important to
appoint someone to be in charge of monitoring
updates and current events and for enforcing
compliance standards.
• Educate yourself and your staff: this is possibly
the most important line of defense. The Office of
Inspector General suggests one to two training
sessions per year.
• Monitor and audit your practice: Prioritize
monitoring and auditing to high risk areas or
high profile subjects in the media.
• Encourage reporting and investigating: ensure
an environment in which an employee can feel
safe in openly discussing any potential problem.
• Provide fair and consistent enforcement:
this relates directly back to written standards.
Emphasize that “sins of omission” as well as
“sins of commission” are subject to discipline.
• Learn from your mistakes: if you are aware of a
problem, it is critical to respond swiftly. Failure
to respond could seriously endanger your practice.
While there are many nuances to compliance,
these key steps can greatly diminish your risk of
problems in your practice.
El Camino Hospital
named Magnet Hospital
EL CAMINO HOSPITAL IS THE FIRST AND ONLY HOSPITAL
in the Bay Area and one of only seven in California
to have been awarded Magnet designation by the
American Nurses Credentialing Center (ANCC), the
credentialing arm of the American Nurses Association.
The hospital is among an elite group, representing
less than three percent of hospitals nationwide, to be
so recognized for the quality of its nursing care. The
announcement was made in December.
“This designation offers independent validation
of what many of our patients and physicians already
know: that El Camino Hospital and its nurses provide
outstanding patient care,” says Diana Russell, vice
president of patient care services. “El Camino Hospital
empowers and supports our nurses with strong
policies, technology and practices that allow them to
spend more time with patients. As a Magnet hospital,
it will be even easier to attract and retain the top
nursing talent that remains critical to providing the
best health care.”
The ANCC awarded El Camino Hospital Magnet
designation after a vigorous, multi-faceted evaluation
that included an extensive on-site visit. The Magnet
Recognition Program ® was developed by the ANCC
to recognize health care organizations that provide
the best in nursing care.
ECHO launches
EL CAMINO HOSPITAL ONLINE (ECHO), THE NEW
medical information system, launched on March 26.
The Web-based system offers an easier interface,
decision support tools, standard order sets and the
ability for physicians to create their own order sets
easily, and the ability to see any critical alerts about
patients in a single screen.
A team of testers — made up of IT staff, nurses and
physicians — have been carefully reviewing the system
over the last several months. A formal process helps
to coordinate and prioritize issues so they are properly
addressed. Each issue is categorized and a resolution
or action is assigned. The process will continue even
post-launch to ensure all concerns are addressed.
“For the requests we receive regarding the order
sets, we have set up an interdisciplinary clinical review
infrastructure,” says Mark Zielazinski, chief information
officer. “This structured process supports the use of
templates and standard formats for order set creation
and maintenance.”
Other requests, such as order enhancements, are
generally training issues. That is, the team develops
additional training materials to highlight those alreadyexisting
features in the current system.
Some issues have fallen into a category called
“workflow.” That is, they impact the way a clinical
unit processes orders or information. One example
is for admissions, discharges or transfers (ADT). In
response to an issue, a process in which the emergency
department nurse will review, complete, and/or
inactivate ED orders that are not in process prior
to patient transfer.
“We have taken every issue and request seriously,”
says Mr. Zielazinski. “The formal review process has
helped us enormously.”
End users will have access to feedback on issues
captured by Help Desk and Super Users during
activation. However, in many cases they will be asked
to complete enhancement requests or change request
forms to clarify their concerns or issues.
Health library adds
“Awareness Service”
for physicians
THE EL CAMINO HOSPITAL HEALTH LIBRARY &
Resource Center has added a current awareness service
to help physicians stay abreast of the latest research and
clinical information. Physicians who sign up for the free
service can select from hundreds of medical journals
and receive the table of contents as they become available.
If a physician is interested in a particular article,
the librarians will send the full article.
“Physicians who don’t have time or the resources to
subscribe to dozens of medical journals will find this
useful,” says librarian Karen Halverson. “They receive
a weekly or monthly table of contents by email, postal
mail or fax. This way they can remain aware of what
is happening in their areas of interest.”
Another new service is the availability of continuing
medical education programs on CD-ROM. Physicians
can check these out from the library and listen to
them at their leisure, complete a test form and submit
it for CME credit.
The library, accessible 24 hours a day with an
El Camino Hospital badge, has nearly one thousand
medical journal and magazine titles in its database.
Physicians who become members of the library can
access the database from their homes or offices at any
time and receive full article citations.
Contact the Health Library:
(650) 940-7210
Fax (650) 940-7174
healthlib@elcaminohospital.org
Visit online at www.elcaminohospital.org/library
or in person on the first floor of the hospital, down
the hall from Emergency Services.

| SYNERGY | APRIL 2006 | P AGE 3 |
Service updates
Bariatric surgery center
offers hope to morbidly
obese patients
OBESITY IS ASSOCIATED WITH A HIGHER RISK OF SEVERAL
conditions including hypertension, diabetes, sleep
apnea, and cardiovascular disease. Weight loss is critical
for obese people, but many are unable to achieve it
through lifestyle interventions such as diet and exercise.
Bariatric surgery provides hope to such patients —
both for weight reduction and its collateral benefits.
El Camino Hospital has offered bariatric surgery for
more than two years in collaboration with Peninsula
Surgical Specialists Medical Group (PSSMG). According
to Pamela Foster, MD, the program’s medical director,
patients are evaluated and treated in an individualized,
comprehensive, and integrative program that helps
assess procedures’ appropriateness and provides the
best possible care.
“We start with NIH guidelines, which consider the
patient’s body-mass index and weight-related health
problems, to help us decide whether someone is an
appropriate candidate,” Foster explains. “My job is
making sure they are mentally and physically prepared,
and we try to be judicious by having other specialists
help in the decision process when it’s appropriate.”
Bariatric surgery at El Camino Hospital is typically
performed laparoscopically, which involves less pain and
a quicker recovery than open surgery. In consultation
with Dr. Foster or her colleagues, patients choose either
gastric bypass — in which the size of the stomach is
dramatically reduced — or gastric banding, which
entails placement of an adjustable silicon band around
the top portion of the stomach to create the sensation
of fullness after little food intake. Clinical considerations
and patient preference affect the decision about
which approach to take; currently about 80 percent
of patients elect the bypass procedure.
“We are putting bands on our patients who feel
that the bypass isn’t right for them, who may have less
weight to lose, and who want to be involved in the
adjustment process,” Foster says. “Banding is also a
better choice for patients at higher risk—those who’ve
had a heart attack or stroke, for example.” Foster says
that maximum weight loss is achieved more quickly in
bypass patients—at about one year, versus two years
for those who receive the gastric band.
The surgical team includes Dr. Foster and her
PSSMG colleagues Albert Wetter, MD, and Barry
Sanchez, MD, and Prithi Legha, MD, recently hired
by Camino Medical Group as laparoscopic surgeon.
According to Foster and bariatric nursing specialist
Trude Hennessy, RN, the program’s excellence derives
from both the surgery team and outstanding perioperative
care and postoperative follow-up.
“Our dietician, Jodi Bjurman, and I have extensive
consultations with patients to discuss their medical
history and options,” Hennessy says. “There is a
weight-loss requirement prior to surgery, which has
health benefits of its own. While patients are in the
hospital, Jodi and I follow them closely, make sure
that everything is going well, and answer any questions
they have. We also maintain a monthly support
group for those who’ve had the surgery and those
who are considering it.”
The program has been designated a Center of
Expertise by several insurers including Blue Cross,
Aetna, and Health Net. This means, in most cases, that
Bay Area patients insured through those companies
must have their bariatric surgery at El Camino. The
designations are a vote of confidence from those who
evaluate such programs professionally, explains Foster.
“We’re delighted because we provide really great
care for our patients,” she says. “Having partners
like El Camino, and individuals like Trude, makes a
tremendous difference for our practice and our patients
in having the great results we do.”
Stroke center receives
JCAHO designation
EL CAMINO HOSPITAL ANNOUNCED IN FEBRUARY THAT
its Stroke Center received the Gold Seal of Approval
from the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO). To achieve this
designation, El Camino Hospital had to demonstrate
that its stroke program meets national standards and
guidelines that can significantly improve outcomes
for stroke, the nation’s third
leading cause of death.
El Camino Hospital joins the
elite ranks of less than 200
primary stroke centers in the
United States to earn the
designation.
“We’re pleased to provide
this definitive care to
patients in our community,”
says neurologist Ronald
Hess, MD, who led the effort
toward the JCAHO recognition.
“The data is clear that
the faster the treatment, the
better. If you treat a patient
within 90 minutes of onset
you can double the probability
of a good outcome.
Patients in our community
can receive that care right
here.”
Dr. Hess and his team —
Ruby Garma, RN, Audrey
Prairo, RN, and CNS
educator Janet Piltz —
worked with medical staff
and department managers
throughout the hospital to
gather data and improve
the “door-to-CT” time.
“The national standard
set by the Brain Attack
Coalition is 25 minutes from
the time a patient enters the emergency department to
the time they get their CT, and 20 minutes from the
scan to receiving results,” says Hess.
The Stroke Unit, staffed by nurses specially trained
in stroke care, is on the fourth floor of the hospital.
Additionally, the Stroke Center has an in-house team
of specialists — including a panel of on-call neurologists
— available 24 hours a day, seven days a week.
“The recognition by JCAHO reinforces our team
effort,” says Dr. Hess.
The team’s commitment extends beyond treating
stroke, however. According to Dr. Hess, 90 percent
of strokes can be prevented. The American Stroke
Association recently issued national stroke prevention
guidelines, including:
• Control blood pressure to a systolic of 120.
(According to Dr. Hess, his advice to patients
is, “Take your blood pressure medication. Take
your blood pressure medication. Take more
blood pressure medication.”)
• Control cholesterol, including the use of statins.
• Control blood sugar for diabetic patients.
• Strongly advise patients to stop smoking. (El
Camino Hospital has smoking cessation classes.)
• If a patient is a heavy drinker, recommend
limited or no drinking. Light drinking may
provide a protective effect.
• At least 30 minutes of moderate exercise most
days is desirable.
• Control weight, use balance of calorie intake,
physical activity, behavioral counseling.
| continued page 4 |
Dr. Ronald Hess and
Ruby Garma, RN
SYNERGY is a
quarterly publication
of El Camino Hospital
for its medical staff.

| SYNERGY | APRIL 2006 | P AGE 4 |
Construction update
EL CAMINO HOSPITAL CELEBRATED TWO MAJOR
milestones in March — the opening of the new Oak
Pavilion and the new parking structure.
Oak Pavilion, located at the corner of Hospital
Drive and South Drive, will house finance, payroll,
patient accounts and the dialysis center.
The parking structure has over 850 parking spaces
for patients, visitors and employees. It is located at the
corner of Hospital Drive and North Drive near the new
medical office building, still under construction. New
stop signs will increase pedestrian safety.
El Camino Hospital, along with many other
California hospitals planning or under construction,
are feeling the pinch of unpredictable market forces
on their construction costs, according to a presentation
to the El Camino Hospital Board in January.
The budget for the overall project, based on results
of the bidding process, stands at $450 to $480 million
and includes construction, contingencies, and other
costs. The primary cost driver has been construction,
which accounts for an unanticipated increase of nearly
$80 million from the original estimates two years ago.
Several factors have gone into the cost estimates,
some controllable and some not controllable. “On the
controllable factors, like scope and making modifications
to the design, we have managed to keep the cost
estimates close to our original estimates prior to the
detailing,” says Ken King, vice president of facilities.
“The hard part is mitigating the uncontrollable issues.”
El Camino Hospital finds itself in a similar
situation to other hospitals in California and
many construction projects nationally. A
recent San Francisco Chronicle story about
hospital construction said hospitals should
expect to pay at least one million dollars per
bed in the construction of their facilities.
“The cost of hospital construction in
California is exploding, due to the demands
placed on hospitals by the seismic requirements
adopted after the Northridge earthquake,”
says Duane Dauner, president and
CEO of the California Healthcare Association.
“There is a severe shortage of qualified
hospital architects, engineers and designers.
In addition, the cost of concrete, steel,
dry wall and other building products and
supplies has risen dramatically. The cost of
nearly every hospital construction or retrofit
project is exceeding cost estimates because of these
factors. Combined with all of the other forces facing
hospitals, these external cost increases are placing
many hospital projects in jeopardy.”
California hospitals are in a unique situation
with the mandate for seismic retrofitting. This also
influences cost. With so many projects underway,
manpower is at a premium. Also, the new building
codes have made hospital construction more
expensive.
The hospital board is evaluating a variety of
options ranging from the scope of the project
to the financing of it.
Light fills the
new Oak Pavilion,
which opened
in March.
| South Asian Heart Center | continued from page 1 |
me now,” he says. “I feel better than I did before the
incident, and I attribute that to the changes I’ve made.
I was fortunate to live through it, but there are many
who don’t. I’m hoping that other people can change
and prevent this from happening.”
Results are already starting to come in. In a test
screening conducted among 71 South Asian patients
last fall, the center found significant risk factors in
80% (57) of those tested — 44% (31) more than
would have been identified with a standard lipid test.
In addition, 13 were found to be at “high risk” of
cardiovascular disease — up to 20 times the rate of
Caucasian patients.
Community members, businesses, and
foundations have recognized the center’s
potential and given generously. Los Altos Hills
resident Malini Alles, founder of Stree: Global
Investments for Women Foundation, donated
$1 million. Other gifts total about $150,000,
and the center hopes to raise $1 million a year
over four years.
“The response from donors and from the
physician community has been phenomenal,”
says development director Mehta. “We’re
changing the standards of health care. We’re
creating a spark and hoping it will spread.”
| Stroke Center | continued from page 3 |
El Camino Hospital sees approximately 500 ischemic
and hemorrhagic strokes and TIA (transient ischemic
attack) patients each year. “In addition to our rapid
treatment of strokes, in recent years we’ve become much
more aggressive in treating TIAs. The community
really has access to a world class treatment at
our Stroke Center,” says Dr. Hess. “In fact,
some of the data suggests that we are getting
better outcomes than any other stroke center
in the area.”
The quicker t-pa is
given from the onset of
stroke symptoms the
better the outcome.
Even though you have
the 3-hour window
for treatment, it has
been shown that
patients have a better
outcome 3 months
post stroke if given
t-pa within 90 minutes
of symptom onset
compared to giving it
closer to 3 hours after
symptom onset.
Odds Ratio for Favorable Outcome at 3 Months
9
8
7
6
5
4
3
2
0
Benefit for rt-PA
No Benefit for rt-PA
60 70 80 90 100 110 120 130 140 150 160 170 180
Celebrity chefs from premier
restaurants will prepare
hors d’oeuvres followed by a
gourmet dinner and dancing.
For tickets, call the
El Camino Hospital Foundation,
(650) 940-7154.
Minutes from Stroke Onset to Start of Treatment