Hospital IT Team uses Technology to Improve Lives and Save Money, Time

By Dan Barber

Public Affairs Officer

Robert E. Bush Naval Hospital

             Naval Hospital Twentynine Palms, Calif., has set a goal to significantly decrease overall command operations cost and increase productivity with the latest technology.

            “Our goal is to leverage technology in different areas making peoples jobs easier and faster,” said Craig Palmer, Chief Information Officer of the Naval Hospital.

            One example of this technology innovation is with the addition of virtual computer log-on for Medical Home (Med Home) providers. “In the case of the Med Home providers, the IMD staff has been very sensitive to their needs,” Palmer said. “It used to be that the patient was moved around to our staff, now our staff is moved to the patients,” Palmer said. “We figured that it was conceivable that there would be about three people trying to log into a computer in a 20-minute exam in the same exam room. Normally, the log in time on each computer takes roughly 3-minutes. We tried to figure out what we could do to help. We basically did a technology insertion for our Med Home staff, which has worked out so well that it is being incorporated in other parts of our hospital and clinics,” Palmer added.

            “We were able to get the log in time on Exam Room computers, down from about 3-minutes to approximately 18-seconds… our ultimate goal is to get that time down to 3-seconds. Based on feedback we have received there are two other sites that are conducting virtual log-on trials.”

            Palmer added, “If a provider logs on 14 times a day (which is typical) and they are saving two and a half minutes per log on, the time saved can add up pretty quickly.  A real big bonus is before, because of computer log-on times, they weren’t always able to enter their clinic notes in CHSC and AHLTA records while in the exam room. This technology now empowers the providers to be able to enter their notes while in with the patients.”

            Palmer pointed out that providers report that they are now able to get out of the hospital in the an hour or more earlier then they did before. “This technology not only allows for better patient care, but it is adding to the quality of life for our providers,” said Palmer.

            Commander Raul Carrillo, NC, Medical Services Deputy Director and Department Head, Emergency Medicine Department was the key clinical contact for the project. Carrillo reports, “Virtual log-on for providers has increased productivity, it also gives the staff the ability to pull out their CAC [Common Access Card] from one station and move to the next. The clinic staff calls it ‘follow me CAC’ allowing staff to move from exam room to exam room.”

            “The time saved with virtual log-on will also allow our people to be able to work on Relay Health, a secure web-based program to provide better communications with our patients, and to allow the providers more time to complete their charts,” said Carrillo.

            The bottom line is, with the technological advances taking place at the hospital, it will improve patient care, decrease overall costs, work-hours and add to the quality of life for staff, which will lend itself to making this command a health care facility of choice, and a work place of choice for staff.

Summer Heat and Your Meds -- What's The Link?

Summer Heat and Your Meds – What’s The Link?
Martha Hunt, MA CAMF

      According to the Substance Abuse and Mental Health Services Administration (SAMHSA) certain medications such as psychotropic medications, antidepressants, or alcohol can change how your body responds to heat and how well you recognize that you are in danger of overheating. Heatstroke occurs when the body unable to cool itself and internal body temperatures rise to levels that may cause irreversible brain damage and death.
      Psychotropic medications are medications used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder, anxiety disorders, and attention deficit-hyperactivity disorder (ADHD). These medications can interfere both with your ability to regulate your body temperature and your awareness that you are overheating.
      According to the Centers for Disease Control and Prevention (CDC) the risk for heat-related illness and death may also increase among people who use medications for Parkinson’s disease (because they can inhibit perspiration), those who use tranquilizers and users of diuretic medications or "water pills" that affect fluid balance in the body. Certain antihistamines can also lead to heat stroke
      Also watch out for nutrition supplements that boost your metabolism or advertise that you will lose weight or build muscle. These supplements increase the risk of heat stroke by revving up metabolism. This can produce extreme amounts of body heat and can lead to death or brain injury.
      For more information on heat injury, visit the CDC's “Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety” (http://www.bt.cdc.gov/disasters/extremeheat/) for information on how to prevent, recognize, and treat heat-related illnesses.

Change of Command at Robert E. Bush Naval Hospital

A traditional Navy Change of Command and retirement ceremony will take place at 9 a.m. June 28, at the Robert E. Bush Naval Hospital, Marine Corps Air Ground Combat Center, Twentynine Palms, Calif., where Commanding Officer, Capt. Ann Bobeck, Medical Service Corps, United States Navy will be relieved by Capt. Jay Sourbeer, Medical Corps, United States Navy.

Bobeck took command in May 2010, and will be retiring after serving 29 years in the United States Navy.

Bobeck was born in Sugar Notch, Pennsylvania, the youngest of seven children.  Following graduation from Pennsylvania State University with a Bachelor of Science Degree in Healthcare Administration and Planning in 1981.  Her initial assignment in 1983 was at Naval Medical Command, North West Region, Oakland, California where she served as the Assistant to the Associate Director of Plans and Operations, as well as the Flag Aide to the Commander, Navy Medical Command North West Region.

After her assignment at Oakland, Bobeck transferred to Naval Hospital Philadelphia in 1986 and was assigned as the Head, Outpatient Records followed by a promotion to Head, Patient Administration.  During this two year tour, her Patient Administration Department earned Naval Hospital Philadelphia the "Certified Pipeline Mover" Award, the first time Navy Medicine was awarded this distinction.  After Duty under Instruction at The George Washington University, Bobeck was awarded a Masters Degree in Healthcare Administration in 1990.  Upon graduation, she was assigned as the Head, Patient Administration Department, Naval Hospital Yokosuka, Japan until December 1992.

Subsequent assignments from 1993-1998 included Director for Administration and Resources, Naval School of Dental Assisting and Technology, San Diego, California., and Senior Analyst, Bureau of Medicine and Surgery, where she wrote the Navy’s contact lens policy to support operational requirements. 

In October of 1998, she assumed responsibility as the Director, TRICARE Western Pacific, implementing the Navy’s first contract to provide healthcare services in remote countries, which now provides services world-wide.  From 2001-2007, Bobeck served as Associate Director, Healthcare Operations and Planning, National Naval Medical Center Bethesda, Maryland., Director, Healthcare Operations and Planning, Naval Medical Center, San Diego, as well as the Director, Multi-Service Market Office, San Diego.

Bobeck’s previous assignment before reporting to Naval Hospital Twentynine Palms was as Executive Officer, Naval Health Clinic Annapolis, Maryland. 

She is a Certified Healthcare Administrator, American Academy of Medical Administrators.  Her awards include the Defense Meritorious Service Medal, the Meritorious Service Medal (four awards), the Navy Commendation Medal (two awards), the Navy Achievement Medal as well as numerous unit and service awards. 

Bobeck is married to a fellow Navy Medical Department Officer, Captain Scott Colburn, Dental Corps, United States Navy.

Bobeck and her husband will be retiring to Southport, North Carolina, after a combined 52 years of U.S. Naval Service.

Prospective Commanding Officer, Captain Jay Sourbeer was born in 1959 in Clearwater, Florida.  After graduating Largo High School in June 1977, he attended Duke University, graduating with honors, completing bachelor degrees in chemistry and economics in 1981.  Sourbeer joined the Navy in 1981 via the Armed Forces Health Professions Scholarship Program.  He completed his Medical Doctorate in June 1985 at Jefferson Medical College in Philadelphia, and was elected to the Alpha Omega Alpha Honor Medical Society.

In 2009 Sourbeer was selected to attend the Naval War College, serving as the Class President and earning his Masters Degree in National Security and Strategic Studies.

He is dual boarded in Family Practice and Occupational Medicine, Diving and Hyperbaric Medicine.  He is a Flight Surgeon, Undersea Medical Officer, Surface Warfare Medical Officer, Submarine Warfare Medical Officer, and he also has earned the Presidential Service Badge and the Deep Submergence Dolphins.

Sourbeer served as the Executive Officer, Naval Hospital Oak Harbor prior to reporting to the Robert E. Bush Naval Hospital.

Sourbeer’s wife Shelly and sons, Jeffrey and Jay will accompany him on this tour in Twentynine Palms.

Top Seven Health Screenings for Men

By Shari Lopatin

TriWest Healthcare Alliance

Prostate cancer is the most common cancer in men, regardless of their age or ethnicity, according to the Centers for Disease Control and Prevention.

So for Father’s Day this year—which is June 17—why not encourage the men in your life to get tested?

“Prostate cancer screening means looking for cancer before it causes symptoms. This helps to find cancer at an early stage when it may be easier to treat,” the CDC says on its website.

One such test is called the PSA test. And it’s as simple as drawing some blood. TRICARE covers prostate screening tests for men who are:

·         older than 50

·         older than 40 and had a vasectomy

·         ages 40-49 with a family history of prostate cancer

In addition to prostate cancer screenings, men should receive these remaining top six tests to stay at optimal health:

1)      Cholesterol, every five years, and yearly starting at age 35

2)      Blood sugar levels, every three years

3)      Colon cancer screening, starting at age 50; colonoscopies are recommended only once every 10 years

4)      Blood pressure, every year

5)      Digital rectal exam, starting at age 50

6)      Skin cancer screening, every 3 years age 20-40, and every year for anyone older than 40

For more tips on screening recommendations, visit TriWest.com/Healthy Living and visit the Screening Guide under “Health and Wellness.”

Hospital Provides Premium Care and Communications

By Dan Barber
Public Affairs Officer
Robert E. Bush Naval Hospital

Patients of the Robert E. Bush Naval Hospital have now been cared for in its clinics using the Medical Home Team model for more than a year now.

The patient-centered method of delivering health care has been instituted in most military medical care treatment facilities and many civilian medical practices over the past couple of years.

This hospital’s model, which was begun last year, assigned primary care staff to Blue Team, Gold Team and Pediatrics, and enrolled TRICARE Prime patients to each team. This allows patients to see the same team each time they come in for an appointment. This replaced the prior concept of having patients assigned to a single Primary Care Manager.  Patients at the Naval Hospital now have an entire team of health care professionals made up of physicians, physician assistants, Certified Nurse Practitioners, Registered Nurses, Licensed Vocational Nurses and Corpsman who are dedicated to providing their assigned patients with the best possible health care management.

Specialty care by one of the hospital’s network health care providers has and will remain unchanged in the near future, but, work is underway at the hospital to try to bring more specialty services ‘in-house’ with additional staff, training or “circuit rider” specialists from San Diego or Camp Pendleton seeing patients here instead of making patients travel some distance for care.

Also, the hospital disestablished “Central Appointments” last year to allow the staff of the Medical Home Teams to speak directly to patients calling in to request appointments. In many cases with this change, patients have been able to book a same day appointment, or to speak with a team member to receive an answer to a simple health care question. The phone number has remained unchanged, patients can still call 760-830-2752 and they will be directed to their assigned team.

Another patient pleaser the hospital has just initiated is posting the available open appointments each work day on the hospital’s Facebook page. Normally this posting will be listed by 7:15 a.m., to allow the patients to see what is available. “If the caller misses the opportunity to book one of these appointments, they still will be able to talk to a team member who will do their best to help them ,” said Commander Lisa Morris, Director of Medical Services of the hospital. “We want our patients to be satisfied with their care, but we also want to deliver that care safely. With that in mind we will always strive to say ‘yes’ to our patients when we can,” she added.  To check out the hospital’s Facebook page visit:
http://www.facebook.com/pages/Naval-Hospital-Twentynine-Palms/83701100741#
In addition, the hospital signed up for a secure computer based communications tool last year called Relay Health where patients can access their medical team from home…to email their provider,  request an appointment, cancel an appointment , request a prescription renewal or find out the results of lab tests. To sign up visit: https://app.relayhealth.com/Registration.aspx and follow registration directions.

 “We have found that  the Medical Home Team method of patient-centered care provides our customers with more access to primary care and it allows longer appointments so our providers are able to meet most if not all of our patients health care needs during one visit,” said Morris.

The purpose of the Robert E. Bush Naval hospital is to care for the Marines, Sailors, and families of the Marine Corps Air Ground Combat Center and to keep its promise of care to the military retirees and families in the surrounding communities of the Morongo Basin. “The reason we are here is to care for our patients,”  said Morris.

The Hospital Emergency Medicine Department is a Busy Place

By Dan Barber

Public Affairs Officer

Robert E. Bush Naval Hospital

One of the important benefits of serving in the U.S. Military is the health care provided to active duty service members and their families as well as eligible military retirees and their families.

Here at the Marine Corps Air Ground Combat Center the Robert E. Bush Naval Hospital provides an Emergency Medicine Department staffed with highly trained individuals. “The Emergency Medicine Department employs a mix of both military and civilian staff,” said Commander Raul Carrillo, a Nurse Corps Officer and Department Head for the Emergency Medicine Department. “All are highly trained, with all the physicians being board certified in Emergency Medicine. Both the civilian and military nurses are registered nurses and are also trained in Emergency Medicine. The corpsmen also receive specialized training to work in the department,” he added.

A typical 12 hour shift in the hospital’s Emergency Medicine Department (EMD) is staffed with one certified emergency medicine physician, two registered nurses and two corpsmen. Others can be called in as needed.

To operate the Emergency Medicine Department twenty-four hours a day, 365 day a year takes a staff of 14 emergency medicine physicians, 12 registered nurses, 10 corpsmen and 2 clerks. The physicians and nurses are a mix of both military and civilian personnel.

The definition of emergent care is the threat to life, limb or eyesight… that could be a threat to your life, a fractured bone or an injury to your eye.

The hospital’s EMD should never be treated as a walk-in clinic; however, no one is ever turned away from receiving care.

 “I would highly encourage patients get seen by their Primary Care Manager (PCM), if possible. Here at the hospital we have established a Patient Centered Medical Home with the philosophy that the PCM who is assigned to the patient is responsible for providing their medical care needs. The Patient Centered Medical Home has been established in Pediatrics, Gold Team, and Blue Teams only. If their provider is on leave, TAD or ill, then their Medical Home Team, regardless of who they see for care can see any other provider on their team,” said Carrillo.  “There are times when patients cannot come in during clinic hours for care then yes, they will be seen in the Emergency Medicine Department,” he added.  But Carrillo pointed out that patients need to keep in mind “we are an Emergency Medicine Department and we always take the sickest first, and everyone else will be prioritized for care.”  Sometimes patients may have a wait between 2 to 4 hours… depending on multiple factors to include patient acuity, patient census, ambulance arrivals, and critical care transport coordination to higher levels of care.

According to Carrillo patients arriving at the EMD by ambulance are always seen first. “I would highly encourage patients to keep in mind that if they are calling for an ambulance to make sure it is a life threatening emergency. The use of Emergency Services shouldn’t be used at the whim of making a trip to the ER… if you have shortness of breath, if you have chest pain and you perceive it as a life threatening illness, then yes I would encourage you to call 911,” said Carrillo.  “If a patient comes in by ambulance and it isn’t a life threatening illness or injury you will essentially have taken one ambulance out of service,” said Carrillo.  “There are only two ambulances on base, and if one is responding then that ambulance is off line when it could be responding to a true emergency on base,” Carrillo added.

According to Carrillo the best times to be seen in the ER, if needed, are pretty much anytime of the day on Tuesdays through Thursdays. He pointed out that off payday weekends, the day prior and after a holiday and military special liberties are busy times in the EMD.

Patients coming into the Emergency Medicine Department need to check in at the window in the Emergency Medicine Department Waiting area. If there is no one at the window because they are busy in the back, then there is a button that can be pushed and someone will respond.

Once a patient is checked in, they will be called for triage by a Registered Nurse. The patient will be assessed and assigned an appropriate triage category of 1 through 5, known as the Emergency Severity Index. The number assignment is based on age, chief complaint, history of present illness, and vital signs upon presentation.

Number one category is a life threatening injury or illness, in most cases a one is assigned when a person has stopped breathing or their heart has stopped. A number one can also be assigned for mental illness for a patient who is actively suicidal or homicidal with altered mental status. A level 2 or 3 patient may be someone with shortness of breath or chest pain. “In the cases of one through 3 we would provide immediate care,” said Carrillo. According to Carrillo a level four patient is someone who may have a sprained ankle or sustained some orthopedic injury but is not a life or limb threatening injury. A level five category would be someone with an upper respiratory infection with no fever and they have had these symptoms greater than 48 hours. “This system allows us to prioritize patients in the order that they will be taken care of,” said Carrillo.

“Sometimes there are delays in the Emergency Department because our staff is working on a critical patient that requires a more comprehensive evaluation and they need to be stabilized so they can be transported by ambulance or flown out by air transportation. Our role in the Emergency Medicine Department is to stabilize patients, and we do have a mix of different patients with different triage categories and based on the number of staff, we do the best we can to expedite care so we can get patients feeling better and discharged, transported or admitted as soon a possible,” said Carrillo. The EMD has the capacity to call in a back-up provider if there is greater than 4 hour wait, a level one category patient that results in  greater than 4 hour wait in the EMD, and patient surges from a single incident (e.g. vehicle roll-over) that overburdens resources and staffing.

 The typical time a patient will spend in the Emergency Room here at the hospital for a non urgent problem is around 2-hours. “We are a nine-bed emergency department with patients suffering from various illnesses or injuries. Some patients require more care than others and keep in mind that we have one provider on duty with two registered nurses and two corpsmen. When patients come in the ED during busy times they can expect a longer wait to be seen and possibly a longer disposition time before they can be discharged,” said Carrillo.

 Patients requiring medical advice can call TRICARE Online at 1-800- or Military One Source at 1-800-342-9647.  A consultant is available 24/7.  The National Suicide Prevention Hotline is at 1-800-273-TALK (8255). Another option is to contact the Naval Hospital Quarterdeck at (760)830-2190. A physician or Nurse Practitioner is available from 1600-0700 to answer any questions. Emergency Medicine Providers can treat most acute illnesses or injuries, but the Emergency Medicine Department is not a patient’s Primary Care Manager. If the Emergency Medicine Provider recommends a patient to have a follow-up appointment within 24-48 hours, the department will have a copy of the Emergency Treatment Record available for clinic staff to pick-up the following morning. The clinic will contact the patient to schedule a date and time for an appointment. If the Emergency Medicine Department recommends follow-up as needed, the patient is required to call the clinic or use Relay Health in contacting the clinic for a requested appointment. “There seems to be some confusion for the patient when told to follow up with their primary care provider and they show up without making an appointment,” said Carrillo.  The Naval Hospital is a small community-type hospital where most specialty care is referred out. “We have a small Emergency Medicine Department,” said Carrillo. The Department has a small waiting room. When people come in with an upper respiratory infection, everything is done to prevent the spread of illnesses.  “We do provide masks to prevent the spread of illness and we advise patients with chicken pox or any skin infection to inform our check-in staff so they can isolate them from other patients in the waiting area to minimize exposure,” said Carrillo.

The Emergency waiting area of any hospital is not a very comfortable place for someone with a cold or flu to be waiting for care, and it can prove hazardous for someone with a reduced immune system, or a newborn waiting to see an Emergency Medicine provider. All efforts are made to triage and deliver care to patients in a timely fashion.

Routine or acute appointments can be made at the Robert E. Bush Naval Hospital, and even in many cases a same day appointment can be scheduled with your Primary Care Manager by calling 760-830-2752.  Patients enrolled to the Naval Hospital Twentynine Palms Patient Centered Medical Home Pediatrics, Gold Team, or Blue Teams can sign up for Relay Health at www.relayhealth.com.

Deny Mosquitoes a Breeding Pool

By Lt. Shelley Griffith, MPH, RS
Robert E. Bush Naval Hospital

Summer is fast approaching and with it come the mosquitoes that accompany our outdoor activities.

There are ways you can prevent these bugs from flying away with your outdoor barbeque happiness. Simple things in the yard can have standing water. Mosquitoes need water to make more little mosquitoes.

Take a look around the outside of your home and notice what has water sitting in it. Think of ways to provide drainage to those items to get the water out. Properly dispose of old tires so they don’t become a hatchery for new mosquitoes. Potted plants need to have proper drainage to maintain a healthy plant and to prevent standing water. These are just a couple of simple tips that may help to make your summer more enjoyable.

Another way to plan outdoor activities is to understand that mosquitoes like to come out at dawn and dusk, just when it is warming up or cooling down here in the desert. Try to plan activities to end before the sun starts to go down. Protection from mosquitoes also can be accomplished by wearing long sleeves and jeans with covered shoes. This will prevent being bitten by a mosquito. Bug spray, zappers, and insecticide are also a choice, but it may be a smelly one.

If you would like to find more simple tips for enjoying summer activities just look at cdc.gov and epa.gov for more fun ways to stay healthy this summer.