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Santa Barbara County in Vanguard as Health-Care Industry Adapts to Advances in Technology

Medical devices, electronic record-keeping among disruptors in local hospitals, with many of the high-tech solutions created right here at home

Dr. Bryant Wilson, an internal medicine resident, works on a computer for patient health records at a Santa Barbara County Health Care Center.
Dr. Bryant Wilson, an internal medicine resident, works on a computer for patient health records at a Santa Barbara County Health Care Center. (Lara Cooper / Noozhawk photo)

[Noozhawk’s note: This article is the first in a series on the impact of technology on medicine and health care in Santa Barbara County. Click here for a related article.]

A young mother goes about her busy day, still a bit disoriented by the arrival of her first child but stirred from the trance of routine by the ding of a text message.

“Your medical appointment is tomorrow morning,” she reads. “Will you be there?”

Yes or no is the reply, sent to organizers of the Women, Infants and Children (WIC) nutrition program for pregnant women and mothers with kids under age 5, a product of the Santa Barbara County Public Health Department.

The two-way texting program — catering to a generation that prefers typing to talking on the phone — has seen success since it was implemented locally two years ago, even getting picked up by other agencies throughout California, according to Susan Klein-Rothschild, the department’s deputy director.

Technology is transforming the ever-changing medical field, with texting and increased Internet access, a shift to electronic records, and innovations such as vaccines and devices affecting how — and how quickly — ailments are detected and treated.

Not to mention the cool robots allowing doctors to treat patients many miles away.

The benefits of digital technology for medicine are great and seemingly limitless, those in the health-care industry say, helping improve the quality and length of people’s lives.

Patients can learn more about medical conditions by searching online or by downloading mobile apps, including the one from the Centers for Disease Control and Prevention.

But, like anything else, there are limitations and hiccups for those thinking outside the box. It’s a matter of trial and error and adapting to a changing U.S. population that has an average life expectancy of 79 years.

Electronic Patient Records

There’s some extra space at the county Public Health Department offices off Calle Real in Santa Barbara, where administrators plan to convert old file record-keeping storage into new examination rooms.

The Santa Barbara County Public Health Department has replaced many of its paper records with an electronic system. Click to view larger
The Santa Barbara County Public Health Department has replaced many of its paper records with an electronic system. (Santa Barbara County Public Health Department photo)

Space was freed up four years ago as hospitals and medical centers nationwide began switching to electronic records from folders of paper records.

According to Dr. Takashi Wada, the county’s public health director and chief health officer, electronic records are more accessible and inexpensive, effectively improving overall care while reducing the number of staff errors and decreasing unnecessary duplication.

The state and federal governments offered financial incentives to those making the swap.

Wada said the department’s slow switch was probably its biggest technological advance to date, with a year of preparation and another for implementation and staff training.

“When you were on paper, if you wanted to ever look at your paper charts, which was time consuming, it certainly wasn’t an easy process,” he told Noozhawk.

“Certainly, by having everyone on the electronic system, it allows us to do better reports, data, (and) population health management.”

The long-term benefits will be great, Wada said, but — as in any job — some staff members were more proficient at using computers than others.

The Public Health Department is also working to convert its public health lab to an electronic system to scan and code different specimens for testing, Klein-Rothschild said.

“It is a challenge for all users and for all customers during the transition,” she said of records changes.

The department is experimenting with a disease control program, in which patients who need to take certain types of medication can call their health professionals via Skype on a web camera or cell phone, to prove they’re properly taking their medicine.

“This is particularly helpful on weekends,” Klein-Rothschild said, noting the benefits mostly for those with tuberculosis.

Having that direct line of communication via confidential video connection is important, but with advances also come questions.

“Similar to what’s happened with some other fields like banking and things like that, there are issues about privacy and security,” Wada said.

Wearable Sensors, Detailed Brain Imaging Technology 

Colleges with large hospitals like UCLA or Stanford University are better known for their medical research, but UC Santa Barbara has something they don’t: nationally renowned engineering and science programs.

Although lacking a hospital, UCSB boasts a think tank specifically designed to foster collaboration between experts in science, biology and engineering, taking a skeptical approach to biological medical research.

The Translational Medicine Research Laboratories (TMRL) partners with researchers at the UC San Francisco Medical Center and other hospitals to use technology — sensors or data or whatever else — to help doctors better diagnose and treat patients.

Founded five years ago, the program is among the best in the country in bio testing (detecting diseases) in real time, for example, and its predictive modeling for massive bleeding and how to manage blood transfusions is used on every Army battlefield, said Dr. Scott Hammond, TMRL executive director.

“We work on broad and deep medical problems that are huge in scope, with different definitions than what people think of as medical research,” he said.

“It’s all horizontal. That’s sort of what we accomplish — broad approaches to complex problems.”

Researchers from different disciplines collaborated to create a wearable sensor to more immediately monitor diabetes and other ailments, a brain imaging center with a map of neural networks, stem cells to reverse a chronic eye disease (dry macular degeneration) and other projects.

“A lot of ideas not traditionally in the medical field are becoming more and more interesting,” said Samir Mitragotri, a professor in UCSB’s Department of Chemical Engineering.

“I think medicine is a new area on campus. We would love to tackle problems for infectious disease.”

Mitragotri, a 16-year UCSB veteran, specializes in drug delivery research, most recently working to develop a diabetes pill that would deliver an insulin patch to the intestine.

Hammond, who’s also a physician at UCSF Medical Center, said the most exciting aspect has been the data available to track health issues and to get real-time testing results.

“Certainly, the message we had was the medical community just didn’t understand it until a year ago,” he explained.

“Medicine is probably 20 years behind the rest of the world in terms of technology. We were way ahead of the curve. Now medicine is starting to catch up.

“Ninety percent of medicine is delivered in community hospitals, but zero percent of research is done at that level.”

iMRI for In-Depth Neurological Images

Because so many patients are served at the community hospital level, local facilities hope new technology will keep residents in town.

At Santa Barbara Cottage Hospital, officials are about to install a new neurology-focused iMRI technology — one of only two in the state.

Dr. John Park has more than 20 years of experience working with an iMRI machine, which takes clearer images to ensure neurosurgeons remove all or nearly all of brain tumors. “It makes brain tumor surgery much safer and more effective,” he says. Click to view larger
Dr. John Park has more than 20 years of experience working with an iMRI machine, which takes clearer images to ensure neurosurgeons remove all or nearly all of brain tumors. “It makes brain tumor surgery much safer and more effective,” he says. (Cottage Health photo)

When an individual has a brain tumor, experts believe the chances of survival are greatest if all or nearly all of the tumor is surgically removed, which is where an intraoperative MRI comes in, said Dr. John Park of the Santa Barbara Neuroscience Institute at Cottage Health System.

Its images are sharper and the iMRI goes into an operating room as opposed to another area of the hospital, so neurosurgeons can monitor progress throughout surgery.

Cottage’s iMRI (a 3.0 Tesla) will boast the highest magnetic field of any in California.

It also will have one of the most experienced operators in Park, who happened to be working at Harvard Medical School when the technology was developed by General Electric and installed at Brigham and Women’s Hospital in Boston in 1994.

“It’ll make brain tumor surgery much safer and more effective,” Park said.

He said the iMRI should be up and running in January, when final licensing is expected and the machine will be in its special shielded room. Because the device is so magnetic, Park has been training staff on protocol and the proper titanium equipment to use.

In Santa Maria, meanwhile, Marian Regional Medical Center has invested in two radiology technologies that aim to improve breast cancer detection and treatment.

Faxitron Pathvision helps more precisely determine the spread of breast cancer by taking high-resolution images of a tumor after it’s been removed in surgery, a one-of-a-kind device on the Central Coast, according to Dr. Kevin Ferguson.

Normally, radiographs are taken of a tumor still inside the patient.

Vickie Berry, Marian’s director of imaging services, said two devices called breast tomosynthesis, which provide more accurate digital mammogram results, will be installed in the Santa Maria hospital in January.

GE SenoClaire 3D Breast Tomosynthesis provides 3-D images, in addition to the normal 2-D, during a breast exam, clarity that’s particularly helpful for younger women with denser breasts and for detecting smaller breast cancers earlier.

“This technology actually reduces the number of patients who need to return for additional imaging,” Berry said. “When you’re told, ‘Oh, we need for you to come back’ ... that woman has this huge anxiety.

“We live and die on technology. It really is pretty remarkable. For women, it’s the next best thing since sliced bread. I think it’s going to be the new standard, I really do.”

Making the Connection for Remote Doctoring

Sheldon, an InTouch iRobot, waits in the hallway outside exam rooms at Marian Regional Medical Center while a nurse or doctor explains to patients what will happen next.

Once reassured, stroke victims and their families are greeted by the robot, which beams a neurologist from a fellow Dignity Health hospital into the room to begin an assessment.

The neurologist on the screen is from Sacramento, but guides Sheldon into the room and through the regular rundown.

“With a nurse’s assistance, it can asses patients through visuals,” said Tauny Sexton, Marian’s senior director of emergency services.

“They can zoom in. They can look at pupils. They can ask questions. They can show visual cues; sentences they can read. Once they start the conversation with the neurologist, it really is as though the neurologist is standing right there.”

The telemedicine device industry has grown steadily over the years, with this particular robot manufactured by a pioneer in the field, Goleta-based InTouch Health.

Goleta boasts a thriving community of cutting-edge medical-device manufacturers, including Inogen, Karl Storz Veterinary Endoscopy America Inc. and TrueVision Systems.

In Santa Maria, where Marian has two neurologists on call in addition to a 24/7 robot, Sexton said patients have been assessed remotely at least a couple of times a week since Sheldon was introduced in April 2014.

A second robot named Dexter is located in the Critical Care Unit and has to be pushed around by a nurse or someone on staff.

“At first, the nurses thought, ‘Well, the patients aren’t going to like this,’” Sexton said. “It’s all been extremely positive. ER nurses and staff like it because it’s an immediate resource for us.

“That’s always better for patient. Patients understood this is actually advanced medicine right at our fingertips.”

Other facilities use a similar robot for psychiatric care because of a shortage in specialists, she said, which was a use Sheldon could eventually expand into.

There’s been talk of piloting a patient-to-provider telemedicine program in Lompoc via CenCal Health — specifically for those with heart issues — but the details haven’t been worked out yet, according to Dr. Polly Baldwin, the county Public Health medical director.

Fewer hospital admissions and emergency room visits would be better for everyone, but county health officials see potential issues surrounding privacy, security, billing and reimbursements.

Despite a cumbersome regulation process, telemedicine robots could make Marian more competitive in recruiting new doctors and specialists, said Sexton, who noted hospital growth and technology exploration as attractive to young physicians seeking a university setting.

Noozhawk staff writer Gina Potthoff can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

Telemedicine robots from Goleta-based InTouch Health allow neurologists to remotely assess and talk to patients at hospitals miles away. Click to view larger
Telemedicine robots from Goleta-based InTouch Health allow neurologists to remotely assess and talk to patients at hospitals miles away. (InTouch Health photo)
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