Earlier this month, the U.S. Department of Health and Human Services announced that electronic health records must now include the option to designate patients’ sexual orientation and gender identity (SO/GI). Though care providers will not be required to ask patients about SO/GI, this important addition to electronic medical records has the ability to improve patient care, facilitate better research and reduce the health inequities faced by LGBT patients.

At BWHC, Harry Reyes Nieva and Kerstin Palm, MA, OTR/L, CHT, co-chairs of the LGBT & Allies Employee Resource Group, have been working to make this change a reality since May 2014, when BWHC and Partners leadership made a significant commitment to support the work necessary for the ability to document SO/GI demographics in Epic for Partners eCare implementation.

The multidisciplinary SO/GI eCare Working Group was then formed—comprised of clinical content experts, admitting and registration personnel, social workers and many others—to develop a framework for collection of SO/GI demographics in Partners eCare across all Partners institutions. The group created the Epic fields, developed the specific language that would be used in the system, held training sessions for clinicians and shared best practices to improve clinicians’ knowledge about how to accurately and compassionately gather SO/GI information.

Through the Employee Resource Group’s efforts, leaders at BWHC, Partners and MGH also co-signed a letter with several non-Partners institutions to advocate for inclusion of SO/GI demographics in Meaningful Use 3, further demonstrating the system’s commitment to LGBT health equity on a national scale. Meaningful Use is a Medicare and Medicaid program that awards incentives for using certified electronic health records to improve patient care.

“Collecting this information allows us to better understand LGBT health, including inequities in insurance coverage, access to care, diagnosis and treatment,” said Reyes Nieva, a research manager in General Medicine and Primary Care. “From a clinical perspective, understanding our patients as individuals is imperative to tailoring their health care to ensure a positive experience and the best possible outcome. By capturing SO/GI information, clinicians can be sure appropriate preventive care and screenings are conducted.”

Some of the health inequities experienced by LGBT patients include high rates of behavioral health issues, such as thoughts of suicide and suicide attempts, a higher prevalence of sexually transmitted infections and HIV, and a greater likelihood of being overweight or obese, lipid abnormalities, glucose intolerance, inactivity and cardiovascular disease.

Reyes Nieva, Palm and Tanya Zucconi, MBA, formerly of BWH, recently presented a workshop at this year’s Gay and Lesbian Medical Association (GLMA) annual meeting about the work they and colleagues across BWHC and Partners did to ensure the collection of SO/GI data from BWHC patients. The inclusion of SO/GI demographics in Partners eCare has positioned BWHC and Partners as leaders in the field of LGBT health care equality.

“Providers who may not have asked these questions in the past are now more aware of its importance and the support that exists for them institutionally,” said Palm, Outpatient Rehab Services manager at BWFH. “This is a systematized way that providers will be cued to get to know their patients in the areas of sexual orientation and gender—a way for patients to be known by their providers and have their health care tailored to them as individuals. This is best practice for patient care and continues our long tradition of high-quality health care centered on patients. I’m glad we’re doing it here.”

The BWHC LGBT & Allies Employee Resource Group meets the fourth Tuesday of every month. To learn more, email bwhlgbt@partners.org.

From left: C4HDS team members Danielle Isaman, Niteesh Choudhry, Namita Mohta, Kyle Morawski, Roya Ghazinouri, Julianne McDonough, Julie Lauffenburger and Alexis Krumme

Many highly effective health interventions are never widely adopted into routine care—sometimes because patients do not follow through on what has been recommended or because providers do not practice as the evidence would indicate they should.

For example, only about 40 percent of adults receive a flu vaccine and only half of patients who have had a heart attack continue to take their cardiac medications over the long term. Overcoming these gaps in health care implementation requires patients and providers to be more actively involved in health care delivery.

The Center for Healthcare Delivery Sciences (C4HDS), a newly created research center within the Department of Medicine, is working to address this problem by design, implementation and rigorous evaluation of novel ways to engage patients and providers in care delivery.

Under the leadership of hospitalist Niteesh Choudhry, MD, PhD, of the Division of Pharmacoepidemiology and Pharmacoeconomics, the C4HDS team focuses on interventions that have the potential to be scaled across settings and could help address engagement problems, including medication adherence, smoking cessation and narcotic misuse.

Studies currently underway at the center include randomized evaluations of the impact of text messaging to increase medication adherence; written commitment devices and “nudges” to increase influenza vaccination rates among Medicare beneficiaries; electronic medical record-based tools to prevent opioid over-prescribing; and others.

Choudhry said C4HDS wants the studies to be undertaken in the same conditions—with the same distractions, impediments and pitfalls—as physicians and patients would experience.

“The ultimate goal for the studies initiated by C4HDS is to create effective, simple and easily scalable interventions,” said Choudhry. “In addition, wherever possible, we want those interventions to address vital challenges: behaviors that can simultaneously address related problems, such as extended disability and hospital readmission.”

Additionally, the center’s two-year fellowship program in implementation research trains the next generation of delivery science academics and researchers.

“The center is a unique place for those interested in improving health care quality to gain the expertise and knowledge to conduct pragmatic clinical trials and evaluate novel strategies in a rigorous manner,” said Roya Ghazinouri, DPT, a physical therapist with extensive expertise in quality improvement, who directs operations at the center.

To learn more about C4HDS and ways to collaborate with the center, email rghazinouri@bwh.harvard.edu.

Ann DeBord Smith

Kicking off the innovation track at Discover Brigham were four presenters who have been able to leverage digital health care to solve common patient issues. The session, moderated by Jeff Greenberg, MD, MBA, associate medical director of the BWPO and medical director of the BWH Innovation Hub, gave each presenter seven minutes to present a compelling pitch for their project.

First to the podium was Alexander Lin, PhD, director of the BWH Center for Clinical Spectroscopy, who walked the audience through his cloud-based system that allows radiologists to detect brain tumors in MRI scans in as few as 30 seconds by keying in on a chemical by-product known as 2-HG (2-hydroxygulatarate). This technology, he believes, has the potential to expedite the diagnosis of brain cancer and ultimately improve surgical outcomes.

Benjamin Raby, MD, MPH, of the BWH Channing Division of Network Medicine and the Division of Pulmonary and Critical Care, followed with a presentation of his smartphone application programmed to interpret a user’s breathing pattern in speech to detect the onset of an asthma attack. Raby is currently working with Cogito, a local tech company that specializes in voice analytic software, to optimize his program. His hope is that this same technology can be used to detect potential heart failure and chronic obstructive pulmonary disease (COPD) as well.

The third presenter of the morning, Ann DeBord Smith, MD, MPH, a BWH General Surgery resident, detailed her own smartphone application, VISION, that can detect peripheral arterial disease (PAD) in as few as two minutes by simply analyzing a photo of one foot or hand and comparing it to the other. DeBord Smith’s application seeks to improve upon more commonly used tests, like a segmental doppler, and make identifying this very common disease easier for clinicians.

Wrapping up the session was Mark Zhang, DO, a Palliative Care consultant at Dana-Farber Cancer Institute, whose project focused on end-of-life care planning. His online tool, called CAKE, allows people to answer questions that shed light on their end-of-life preferences, breaking the ice for difficult conversations.

Zhang calls it a “handbook for the end of life” that can make a potentially very difficult conversation a little easier.

Charles Czeisler

BWH researchers discussed recent novel findings in sleep medicine during this afternoon session. Frank Scheer, PhD, MSc, neuroscientist and director of BWH’s Medical Chronobiology Program, shared information about circadian rhythms and the timing of meals, which may help prevent physiological changes that put overnight workers more at risk for the development of diabetes, obesity and cardiovascular disease. Susan Redline, MD, MPH, program director in the BWH Division of Sleep and Cardiovascular Medicine, spoke about the high prevalence of sleep apnea, treatment options available to patients today and opportunities to improve screening, diagnosis and treatment with use of patient-centered research. Charles Czeisler, MD, PhD, chief of the Division of Sleep and Circadian Disorders, discussed our country’s sleep deficiency epidemic and why sleep is so crucial to good health. Czeisler said while we are all facing increased pressures to meet the demands of everyday life, we must ensure that we get adequate sleep (seven to nine hours per night for adults) in order for our bodies and our brains to perform at their best. New Yorker writer Maria Konnikova served as moderator.

The session, like many others of the day, drew a large crowd.

As our ability to monitor almost everything we do increases with wearables like FitBits and Apple Watches, technology companies and health care leaders alike are considering how the tremendous amount of data collected by these devices could be leveraged to improve health care delivery. During a panel discussion, BWHC Chief Medical Information Officer for Health Information, Innovation & Integration Adam Landman, MD, MS, MIS, MHS, noted that a great deal of analysis is still required. “We need real clinical trials to validate that these sensors measure what they say they are measuring, and we need to determine if they are of value in a clinical setting. That will require FDA approval and time.” He also emphasized that how the data is displayed to providers will be a key factor in whether it is useful to them. “We need ways to summarize the data and highlight what’s important, so that clinicians can quickly see and share this information with a patient during an appointment,” he said, noting that clinicians cannot comb through weeks’ worth of data to find the important points. Proper interface and display “will help make or break these tools for providers.” Boston Business Journal health care reporter Jessica Bartlett moderated.

Terrie Inder (left) and moderator Mallika Marshall

BWH has a long history of transforming health care for mothers and babies, from the 1832 founding of BWH predecessor hospital Boston Lying-In—one of America’s first maternity hospitals—up through the fascinating neurodevelopment research being explored by BWH’s Department of Pediatric Newborn Medicine (PNM) today. During an informative session on newborn health, PNM Chair Terrie Inder, MD, MBChB, shared how BWH is helping to build a better brain beginning with babies in utero, by focusing on different types of risks to the developing brain. From maternal obesity to infant congenital heart disease to the effects of pharmacological agents given to babies experiencing pain, BWH’s Sarbattama Sen, MD, Cynthia Ortinau, MD, and Christopher McPherson, PharmD, respectively, took attendees through the many factors that can impact a baby’s brain development before and after birth and later in life. Physician and WBZ-TV medical reporter Mallika Marshall, MD, moderated the session.

Jackie Somerville (left) and Susan Gennaro

The sixth annual BWH Haley Nursing Forum celebrated innovative nursing research taking place at BWH. Jackie Somerville, PhD, RN, chief nursing officer and senior vice president of Patient Care Services, and Susan Gennaro, PhD, RN, FAAN, dean and professor of the William F. Connell School of Nursing at Boston College, talked about the Haley Nurse Scientist program, a collaboration between the two institutions that is designed to advance nursing science through research. Three Haley Nurse Scientists gave overviews of their work. Katherine Gregory, PhD, RN, spoke about her investigation of the gut microbiome and its impact on newborn health; Patricia Dykes, PhD, RN, detailed her work enhancing patient engagement and communication around safety measures, such as fall prevention; and Lichuan Ye, PhD, RN, spoke about her research on sleep promotion in the hospital setting.

Oren Levy

From contact lenses to dental fillings to sutures, bioengineering materials are everywhere. The discovery and improvement of biomaterials have the potential to offer major advances in the treatment of patients. Following an engaging history of the field of bioengineering, Jeff Karp, PhD, introduced speakers who are advancing approaches with industry to usher in new therapies for patients. Natalie Artzi, PhD, presented her work on developing disease-responsive and disease-selective biomaterials that can be delivered locally to treat cancer. Aaron Goldman, PhD, spoke about computational approaches that can improve treatment regimens for breast cancer, and Oren Levy, PhD, discussed designing therapeutic stem cell “ninjas” that can zoom in on the right place at the right time to treat diseases like multiple sclerosis and prostate cancer. Health and science reporter Megan Scudellari later led a lively discussion about how bioengineering is perceived as a hot topic in the media and one that captures the public’s imagination.

Laura Medina Martell (at right) meets Pharmacy student Oluwafeyisikemi Obatusin at the readiness fair.

Between now and February 2016, surveyors from The Joint Commission (TJC) are expected to arrive at BWH to conduct a hospital-wide accreditation survey, which occurs every three years. TJC, which accredits and certifies more than 20,000 health care organizations and programs in the U.S., is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

To be sure staff are ready for the visit, BWH’s Clinical Compliance team held a readiness fair in Cabot Atrium last month with informational tables where employees could ask questions and gather tips. The different tables included Billing Compliance, Emergency Management, Interpreter Services, Biomedical Engineering, Ambulatory Services, Nursing, Pharmacy, Patient Safety, Influenza Vaccine, Infection Control and Security.

“TJC standards are about patient safety and quality, and its mission is to help organizations be their best,” said Kelly Doorley, director of Clinical Compliance. “Our upcoming survey is an opportunity to demonstrate to TJC the excellent care we provide to patients every day. If TJC identifies opportunities for improvement, we will work hard to implement the necessary changes, as we are an organization that strives to continually improve.”

Doorley said that staff need to remain focused on the basics, including asking patients to confirm their name and date of birth or medical record number; labeling specimens in front of patients; following precaution signs outside of patient rooms; cleaning shared patient equipment with sanitizing wipes; and cleaning hands before entering and exiting a patient’s room.

According to TJC, the survey is data-driven, patient-centered and focused on evaluating actual care processes. The objective of the survey is not only to evaluate the organization, but to provide education and best practice guidance that will help to improve performance. The on-site survey focuses on continuous operational improvement in support of safe, high-quality care, treatment and services.

Laura Medina Martell, a medical assistant in Thoracic Surgery, appreciated the opportunity to test her TJC knowledge at the recent fair and prepare for the survey.

“It’s important to be ready,” Martell said. “The Joint Commission makes sure we are doing everything in our power to improve patient care and safety. I want to give patients the best care, so why would I not want to be ready for that? I’m thankful that TJC keeps us on our toes.”

Test your TJC knowledge with a crossword puzzle and brush up on ways to prepare at BWHPikeNotes.org.

BWH nurses Chantal Cayo (at left) and Katie Labella go through an Epic tutorial with Sam Sanni, of health care solutions company HCTec.

This is the first in a series of stories that BWH Bulletin will feature in the coming months about Partners eCare implementation.

Since Partners eCare went live just over four months ago, staff across BWH, BWFH and Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) have been diligently learning and adapting to the new system, adjusting their workflows and troubleshooting issues with colleagues. During the next five years, the new system will integrate all clinical, administrative and revenue systems across Partners into one comprehensive system, improving the way BWHC delivers care to patients across the hospitals and distributed campus.

BWH Bulletin talked to several BWHers about improvements, growing pains and overall impressions of the new system so far. Here is what a few of them had to say:

Rob Boxer, MD, PhD, Hospitalist, Director of BWH’s General Medicine Service

“Given the amount of change providers have absorbed, things overall have gone really well. People are getting used to the new system and becoming more efficient with it. Some areas already recognize Partners eCare as a clear improvement from old systems, especially the ability to access and receive information in a timely fashion.

“I’ve been hearing about the place where providers are most struggling with the transition, which has been medication reconciliation on admission and discharge. Orders are now written with a particular phase of a patient’s care in mind and reviewed and ordered at different stages. Providers didn’t have to do this prior to Epic implementation and are getting used to it; there have been fewer concerns over time.

“There are also pockets of concern related to certain workflows. Some of the homegrown systems that were custom-fit to our needs and adapted over the years are certainly missed, but Epic is working to fix our issues and has been open to where the gaps are. Additional tip sheets are being developed on how to best use the new system, and sessions with frontline providers are identifying root causes related to workflow issues. Committees are working to understand how much of our challenges are due to people getting used to a new system, which is natural, as opposed to areas where Epic needs to update or change the system.

“Providers recognizing areas of concern in their workflows can submit tickets to the Help Desk to alert the Partners eCare team of the issue. If the issue relates to patient care, it will be resolved right away. Larger system-build issues go to a committee to review the root cause of the problem and determine options for changes to the system. Shelly Anderson [vice president of Strategy Implementation] is organizing different workgroups to focus on key areas—lab orders, radiology, IP workflows, ambulatory workflows—to identify and prioritize the work that needs to be done.

“Overall, this has been a hard period of transition, as we’ve identified the gaps and problems with initial implementation, but we are adapting and can see that there is great opportunity to make our workflows more efficient and to be able to provide the highest-quality care for our patients using the new tool. Anytime I talk to someone about Partners eCare, he or she says, ‘I miss this aspect [of an old system], but overall, I think the new system will be better.”

Theresa Stone, Research Billing Compliance Manager

“The Epic research functionality allows for increased transparency and the ability to provide better and more streamlined care, both in terms of patients’ usual clinical care and their research-related care as subjects in clinical trials. With the ability to enroll patients as subjects and link their research-related ordered or scheduled services, all clinical staff are able to see these different layers of care. In addition, we have a more robust method of ensuring research billing compliance.

“Study coordinators and department administrators have told me that they feel they can track things better. For example, after working out some of the kinks, Epic has been hugely beneficial to them in placing lab orders because they are getting the lab results more quickly. For patients in that area, it’s a huge improvement.

“It’s been challenging for many folks with varying degrees of frustrations; there have been some issues to work out that we didn’t anticipate with regard to weaving research activity into clinical activity. But truly, there has been much success and support for this functionality within our research community.”

Diane Miller, RN, Emergency Department Clinical Nurse Educator

“There are 144 nurses in the ED, and they have all really stepped up to the plate. The morning we went live, a major trauma patient came in, and nurses jumped right onto the Trauma Navigator and documented the case in real-time; that was a huge accomplishment. There was a big crowd huddled around one computer; everyone wanted to learn the process. We had lots of help with super-users and our Partners eCare partners to help us in documenting trauma right off the bat.

“Now, we’re problem-solving when nurses have trouble with their workflows. We’re looking at revising tip sheets and connecting with Epic to resolve some of the issues. There are parts of Epic that fit really well with our workflows and parts where we stumble a bit, and that’s when we hear from staff.

“Our department has embraced Epic and done well with it. There have been challenges, such as being slowed down at triage. We are still working through those processes, and Janet Gorman, RN, BSN, MM [Emergency Medicine nurse director] has been instrumental in helping us work through that.

“In the ED, nurses and all staff have put their best foot forward.”

Stephen J. Elledge

Stephen J. Elledge, PhD, of BWH’s Division of Genetics, has been selected as a co-recipient of this year’s Albert Lasker Basic Medical Research Award.

The Albert Lasker Basic Medical Research Award honors researchers whose investigations have “provided techniques, information or concepts contributing to the elimination of major causes of disability and death.” Widely considered to be among the most prestigious awards in biomedicine, the Lasker Awards are popularly known as “America’s Nobels” due to the fact that so many Lasker recipients have gone on to win a Nobel Prize (including 44 within the last three decades).

Elledge will share the award with Evelyn Witkin, PhD, of Rutgers University, for discoveries that have illuminated the DNA damage response (DDR)—a cellular pathway that senses when DNA is altered and triggers a series of responses to protect the cell and repair damage.

I have always wanted to make an impact on the world, to have my life on earth count for something. I hope my work can accelerate discoveries to improve people’s health and lives.”

– Stephen Elledge

This year’s Lasker Awards will be presented to Witkin and Elledge at a ceremony on Sept. 18. Their work has laid a foundation for understanding how cells detect and repair DNA damage. Witkin discovered how bacteria resist the damaging effects of ultraviolet light, while Elledge detailed the molecular pathway by which cells in more complex organisms, including humans, detect and respond to DNA damage. DNA damage repair processes are crucial for maintaining health and preventing cancer and other diseases related to cell growth.

Over the years, Elledge and his colleagues have continued to uncover the components of a signaling network that informs a cell when DNA sustains damage. The DDR network senses the problem and sends a signal to the rest of the cell so it can begin to repair itself. As a result, the pathway helps keep the genome stable and suppresses adverse events such as tumor development. When individuals are born with mutations in this pathway, they often have severe developmental defects. If the pathway is interfered with later in life, cancer can result.

In addition to his groundbreaking contributions to understanding DDR and to many other fields of research, including cancer biology, host-pathogen investigations and technology development, Elledge is also known for his dedication to mentoring the research community’s next generation of investigators.

“Courageous and insatiably inquisitive, Dr. Elledge represents the best of BWH and our mission of transforming the future of medicine to improve health,” said BWHC President Betsy Nabel, MD. “The Lasker Awards are a reflection of the caliber of scientific discovery that takes place here. This distinguished honor for Dr. Elledge brings immense pride to our entire institution.”

Elledge hopes that his research contributions will lead to a better understanding of cancer and other conditions, and provide therapeutic opportunities for many diseases.

“I have always wanted to make an impact on the world, to have my life on earth count for something,” he said. “By contributing to basic research, I hope my work can accelerate discoveries to improve people’s health and lives.”

The Heart Health 4 Moms team, including Janet Rich-Edwards (far left) and Ellen Seely (third from right), wearing red to support heart health

Five out of every 100 pregnant women are diagnosed with preeclampsia during the second half of their pregnancy. Characterized by high blood pressure and signs of kidney damage, preeclampsia can lead to serious complications if left untreated. Currently, the only cure is delivery of the baby.

Additionally, although women generally return to good health after delivery, preeclampsia is a predictor of future hypertension and cardiovascular disease. According to the American Heart Association, preeclampsia doubles the risk of heart disease and stroke and triples the risk for high blood pressure later in life.

In order to help new mothers who recently experienced preeclampsia improve their long-term health and well-being, BWH’s Ellen W. Seely, MD, and Janet Rich-Edwards, ScD, joined forces with the Preeclampsia Foundation to launch an online study called “Heart Health 4 Moms” (HH4M). The online study is currently open to women living in the U.S. or its territories, who have given birth in the past five months and who had preeclampsia. The study is being funded in part by the national Patient-Centered Outcomes Research Institute.

“Our study is the first attempt to identify the group of women who have experienced preeclampsia and help them take charge of their health after pregnancy, while raising awareness about the condition,” said Rich-Edwards, director of Developmental Epidemiology in the Connors Center for Women’s Health and Gender Biology.

The study, which began recruiting in July, tests a lifestyle intervention program that encourages participants to make healthy changes, such as getting consistent exercise and making nutritious food choices, in order to lower their blood pressure, weight and risk factors for cardiovascular disease. In addition to empowering participants to improve their health, the study also seeks to help them return to their pre-pregnancy weight since weight retained six and 12 months after childbirth is a predictor of being overweight or obese in the future—a major risk factor for hypertension and type 2 diabetes.

Participants are divided into two groups: an enhanced control group, which receives a variety of online resources, such as access to patient information on smoking cessation and healthy eating; and an intervention group, which receives information about behavioral changes, as well as support to make these changes. The second group also has email and phone access to a lifestyle coach who is a registered dietician, and participants can view online educational PowerPoint modules. These participants create a personalized action plan each week with goals for the week, which the lifestyle coach reviews and advises on.

Both groups receive a scale and a blood pressure device that uploads the gathered information to the site. Data on blood pressure and weight are collected at the beginning of the study, three months after the start date and then at nine months after childbirth.

“This study is so important because we are taking a step to enable women with prior preeclampsia to reduce their risk for hypertension and heart disease,” said Seely, director of Clinical Research in the Endocrinology, Diabetes and Hypertension Division. “A web-based program accessible by PC or cell phone allows new mothers to access the program at any hour, day or night, when they can fit it into an already demanding schedule.”

Learn more at http://www.hh4m.org.

AMIGO suite

The National Institutes of Health (NIH) has renewed funding for the National Center for Image Guided Therapy (NCIGT) at BWH. The five-year $12 million grant will allow the center to continue its work focused on the multidisciplinary development of innovative image-guided intervention technologies to enable effective, less invasive clinical treatments that improve outcomes and value for patients.

Under the leadership of Clare Tempany, MD, the NCIGT is helping to implement this vision with support from the National Institute of Biomedical Imaging and Bioengineering (NIBIB), by serving as a proving ground for some of the next generation of image-guided therapies.

Since its inception in 2005, NCIGT has provided local, regional, national and international researchers with access to these capabilities. Recent groundbreaking scientific achievements of NCIGT include the use of focused ultrasound energy to disrupt the blood brain barrier and deliver targeted drugs to the central nervous system, and the use of intraoperative mass spectrometry to guide brain tumor surgery. These and other innovations have resulted in more than 400 peer-reviewed publications, some of which have been translated into the treatment of more than 900 patients in the Advanced Multimodality Image-Guided Operating (AMIGO) suite at BWH.

“Having performed hundreds of cases in AMIGO, the NCIGT team has a deep understanding of the current limitations of image-guided cancer treatments,” said Tempany, director of the NCIGT. “This renewed funding will allow us to develop novel innovative technologies for ideal precision cancer surgery.”

In addition to technology development, NCIGT will conduct trials to validate and translate the technologies, primarily involving prostate and brain cancer patients. These cases span a broad range of diseases and technological applications, from cancer diagnosis and characterization to its subsequent complete removal. Specifically, researchers at the NCIGT will develop, test and investigate novel techniques to define the tumor with precision to ensure precise biopsy sampling and complete treatment.

In addition to Tempany, who is the principal investigator (PI) of the Prostate Core, the NCIGT leadership team consists of Tina Kapur, PhD, executive director and Outreach PI; Ron Kikinis, MD, Collaborations director; Alexandra Golby, MD, Neurosurgery Core PI; William Wells, PhD, Computation Core PI; and Noby Hata, PhD, Guidance Core PI.

Carolyn Mary Kaelin
Photo Credit: Steve Marsel

BWH and the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) mourn the loss of Carolyn Kaelin, MD, MPH, FACS, who died surrounded by loved ones on July 28. She was 54.

Dr. Kaelin, of Boston, was a breast cancer surgeon at DF/BWCC and the founding director of the Comprehensive Breast Health Center at BWH. Known for her empathy and skill, Dr. Kaelin was active in the research field, focusing on quality of life issues for breast cancer survivors and how doctors and patients make medical decisions.

“Our hearts go out to Dr. Kaelin’s family in this time of profound loss and sadness,” said Michael Zinner, MD, BWH Surgery chair. “As we grieve for our dear colleague and friend, let us find some comfort in the remarkable legacy she leaves behind. In her life, she made an everlasting difference to each patient who came to her for care and to every colleague she mentored. Let us be inspired by her example of grace and fortitude.”

Born in Syracuse, New York, Dr. Kaelin graduated from Smith College and Johns Hopkins School of Medicine. She earned her master’s degree from Harvard School of Public Health.

In 2003, Dr. Kaelin was diagnosed with breast cancer and had a mastectomy. A rare complication of breast cancer therapy prevented her from returning to clinical practice. She decided to redouble her patient education and survivorship efforts, with a particular emphasis on the underserved population. In 2010, she was diagnosed with brain cancer, which was unrelated to her previous cancer.

Over the years, Dr. Kaelin worked to improve the lives of women facing breast cancer. She established the Quality of Life Fund at BWH to support breast cancer survivorship projects and launched the “Knowledge, Strength and Grace” conference series for breast cancer patients and their families. She also cofounded the Quality of Life Cancer Fund in Aspen, Colorado, to support indigent cancer patients.

Dr. Kaelin coauthored two award-winning books, “Living Through Breast Cancer” and “The Breast Cancer Survivor’s Fitness Plan,” and helped to create an innovative, exercise-centered breast cancer recovery program at the YMCA. She was extremely physically active throughout her life and cycled in Dana-Farber Cancer Institute’s (DFCI) Pan-Mass Challenge to support cancer research and treatment.

In 2001, Newsweek featured her as one of “15 Women of the New Century.” She received many honors, including an Exceptional Women Award and the Mary Horrigan Connors Award at BWH, which recognized her outstanding commitment to women’s health.

Dr. Kaelin is survived by her husband, William G. Kaelin, Jr., MD, Howard Hughes Medical Institute investigator at DFCI and Harvard Medical School professor; children, Kathryn Grace and William (Tripp); parents, Mary and Richard Scerbo; brother, Richard Scerbo, and his wife, Ellen; and additional family and friends.

On Friday, Aug. 28, at 4 p.m., a memorial service will be held at St. Ignatius Church, 28 Commonwealth Ave., in Chestnut Hill. Guests are welcome to wear a touch of pink.

In lieu of flowers, memorial donations can be made in Dr. Kaelin’s honor to Spaulding Rehabilitation Hospital or DFCI to support brain tumor research under the supervision of Patrick Wen, MD, chief of BWH’s Division of Neuro-Oncology. Read an obituary written by Dr. Kaelin’s family.

The Rad Onc Wait Time App allows patients to check waiting times from a web browser or smartphone.

It seemed like a simple request. Back in 2005, Joseph Killoran, PhD, a medical physicist in the Department of Radiation Oncology, created a popular application that informed patients of current treatment wait times. But it had one problem: patients, many of whom needed daily treatment, could only view the wait times once they were at the hospital.

One day, a patient asked Jay Harris, MD, former department chair, if it would be possible to view this information online before leaving home. And if the wait times could be displayed on a website, could they also be displayed on a smartphone app so that patients could check them on the fly?

As the wait time app bloomed into something more than an internal tool, Killoran found himself wading into uncharted territory. He wanted to go through proper channels to expand the reach of the app, without compromising security or privacy. He knew that information systems resources could make this possible but didn’t know how to navigate them. The process of connecting with the right people was made easier when Killoran’s colleague, Neil Martin, MD, MPH, contacted Adam Landman, MD, MS, MIS, MHS.

That’s how Killoran learned of the BWHC Information Systems (IS) Digital Health Innovation Group (DHIG). Led by Landman and Donna Fraser, senior project specialist, DHIG supports BWH researchers, clinicians and staff who seek to use digital health technologies in their practice or research.

“One of the challenges of being an innovator is that you are doing things for the first time, and it’s not easy to find out how to get the assistance that you need,” said Fraser. “We’re trying to be a point of contact within IS that can help get innovators to the right services and the right contacts and follow up if they’re having any issues.”

“Adam and Donna were my advocates,” said Killoran. “The overall process was challenging—it took five months and involved assistance from many different groups—but in the end, we were able to connect with the right people and meet our goal of developing an accessible site that meets Partners standards.”

DHIG offers this assistance to all innovators and works closely with the Brigham Innovation Hub. In addition to Landman and Fraser, DHIG also includes representatives from research, Partners IS Information Security, Partners eCare and Materials Management. “We can help throughout the entire lifecycle of an idea,” said Fraser.

DHIG has supported several other groups and researchers around the hospital, including Katherine Rose, MD, who began a pilot project with Twine Health, a software platform for chronic-disease management, to empower patients to manage hypertension and other conditions. It has also supported Stephanie Shine, BSN, RN, who adapted Google Glass technology to allow new mothers to see their baby in the NICU.

Landman and Fraser want the entire clinical and research community to know that DHIG is here to help BWHers develop new applications to address important hospital challenges.

“This group was formed to help BWHC leverage digital health technologies safely and efficiently to improve health care delivery and facilitate research discoveries,” said Landman.

To learn more, email BWHCDigitalHealthSupport@partners.org.

Bohdan Pomahac, MD, Division of Plastic Surgery

What is your research project about?

Following traumatic amputation, detached extremities can only survive for four to six hours. We have developed a portable machine that may be able to keep detached limbs—arms, legs, hands and feet—alive for half a day, and possibly even longer.

The machine will also allow us to test how to:

• Extend the time available for transportation of donated extremities for transplantation
• Manipulate detached extremities prior to replantation—in other words, make the detached extremities “better” before reattaching them on the body
• Treat patients who suffer certain types of cancer of the extremities with targeted high doses of chemotherapy, without affecting the rest of their body

What is a compelling aspect of your research project?

Think about all of the brave warriors who lost their limbs in the wars in Iraq and Afghanistan. Our device could provide sustainment of severed limbs by supplying them with oxygen and important nutrients. It could keep these body parts alive outside of the body for more than three times longer than what is currently possible. This extended time would allow for the transfer of wounded warriors and their limbs from the battlefield to hospitals in the U.S. or Europe, where surgeons could then attempt reattachment. We hope our device will buy precious time, allowing us to provide the best possible care to those who experience a traumatic injury.

How will your research project benefit future patients who suffer from trauma-related injuries?

More than 1 million Americans are living with missing limbs, many of them due to traumatic amputation. Likewise, more than 1,200 of our brave servicemen and servicewomen lost one or more limbs in recent wars. Our machine will enable the saving of amputated extremities for up to three times longer than what is currently possible. Moreover, it will provide amputees with a better chance of receiving an extremity transplant years after their initial trauma by facilitating the transportation of donated limbs over longer distances and greater time.

The machine can also treat detached limbs with drugs that cannot be introduced into the entire body’s circulation for safety or other reasons. While the limb is attached to the machine, drugs and compounds can be introduced to treat various conditions, such as cancer or infections.

CAST YOUR VOTE
or read more about the other Stepping Strong Innovator Awards finalists:

Healing Bones with Nanodrones: Next Frontier in Orthopedic Surgery

Healing Muscle Trauma Using 3-D Bioprinting

Su-Ryon Shin, PhD, Division of Medicine

What is your research project about?

Tissue engineering has emerged as a promising way to create 3-D tissue for patients who have lost muscle through traumatic, athletic, military and disease-related injuries. However, developing muscle tissue that functions as real muscle—allowing the proper flow and penetration of nutrients like blood and oxygen—remains a challenge.

Our project addresses this obstacle by introducing an entirely new approach: bioprinting. Through bioprinting, we can create 3-D muscle tissue that contains blood vessels and mimics living cells. This advanced technology also has the potential to create significant financial savings by treating muscle trauma without requiring muscle organ donors—a surgical process that imposes staggering costs on our health care system.

What is a compelling aspect of your research project?

The use of bioprinting as an alternative way to treat muscle trauma is a revolutionary scientific concept. Our project uses a perfusable, breathable tissue construct. This is a distinct improvement over earlier models because it allows the flow of a patient’s own blood through the muscle tissue to prevent tissue death. We accomplish this by inserting a hollow tube within the thick muscle tissue construct that enables the proper flow and penetration of nutrients. We also use bioink fibers—biodegradable materials that mimic the elasticity and mechanical properties of living muscle tissues. We believe this novel bioprinting approach will not only help heal muscle trauma but also advance the field of large-scale muscle tissue engineering. Best of all, this process can be readily applied to other areas of regenerative medicine, such as generating new organs.

How will your research benefit future patients who suffer from trauma-related injuries?

Damage and loss of skeletal muscles are common for survivors of trauma-related injuries. When large amounts of muscle tissue are lost, the body is unable to replace it. The trauma site often forms scar tissue that lacks the functionality of the lost muscle. Current treatment options are limited, and many trauma patients must undergo multiple surgeries, which often aggravate the damage. Tissue engineering using 3-D bioprinting holds great promise as an alternative therapy because of its ability to re-establish the structure and function of the injured muscle tissue without potentially harmful surgeries or costly transplants.

CAST YOUR VOTE
or read more about the other Stepping Strong Innovator Awards finalists:

From Battlefield to Bedside: A Portable Device for Rescuing Limbs

Healing Bones with Nanodrones: Next Frontier in Orthopedic Surgery

Omid Farokhzad, MD, Department of Anesthesiology

What is your research project about?

Our project aims to address the problem of bacterial infections and lack of new bone growth in patients who undergo orthopedic trauma surgery. Injuries from accidents and severe trauma can cause large open bone fractures and, in more extreme cases, large bone defects. Such injuries are frequently prone to poor bone healing and high rates of infection. As a result, orthopedic trauma surgeons are often challenged to both stabilize and repair bone injuries, while also promoting an optimal environment to prevent infection and aid bone healing.

Currently, the standard of care is rudimentary. A cement paste containing antibiotics to kill infecting bacteria is molded into the open fracture and the wound is closed up. At best, only about 25 percent of the antibiotic is released from the cement, and since the cement is not biodegradable, patients require further operations for removal. The cement can also cause bacterial biofilms to grow, leading to more infection.

This project addresses these challenges by developing very small biodegradable robots called nanomedicines that can deliver antibiotics and other drugs to promote bone growth and wound healing in a much more efficient way. These nanorobots can stick to a biodegradable moldable material that is placed in the bone defect, target bacteria and deliver drugs to kill them, and can also deliver drugs that will help the bone heal faster and better.

What is a compelling aspect of your research project?

We are harnessing the power of nanotechnology to treat infections, heal bone fractures, minimize the need for patients to have follow-up surgeries after injury or trauma, and prevent amputations. Our team is highly multidisciplinary in that a nanomedicine scientist and an orthopedic trauma surgeon are working closely together to achieve these goals.

How will your research project benefit future patients who suffer from trauma-related injuries?

In the short term, bacterial infections are minimized or eradicated, and natural bone growth is accelerated. In the long term, the patient may not need follow-up surgery, as the moldable matrix can biodegrade in the body, leaving new bone in its place. We aim to improve the quality of life for trauma patients and to lower health care costs by minimizing the need for further surgeries.

CAST YOUR VOTE
or read more about the other Stepping Strong Innovator Awards finalists:

From Battlefield to Bedside: A Portable Device for Rescuing Limbs

Healing Muscle Trauma Using 3-D Bioprinting

William Savage, MD, PhD, Department of Pathology

What is your research project about?

Thousands of patients with cancer, sickle cell disease or autoimmune disease, as well as organ transplant recipients require specialized blood treatments, called apheresis. During apheresis, blood is taken out of the body using large, specialized medical devices, and the part of the blood that is causing disease is selectively removed. The rest of the healthy blood is returned to the patient. The current process, which uses a large, complicated centrifuge-based machine, can require donor blood transfusions and a big catheter placed into a large vein near the patient’s heart. Our project will make apheresis easier for both patients and the people who operate the devices.

What is a compelling aspect of your research project?

In collaboration with engineers at the Charles Stark Draper Laboratory, our team has invented a technology that uses ultrasound waves to separate blood into its components for apheresis. We call this “acoustic apheresis,” and it represents a completely new way to perform the procedure.

Also, we use materials that make the technology scalable for pediatric to adult-sized patients.

How will your research project benefit people?

First, our device is smaller, simpler, mounted on an IV pole, and will require less training to use and maintain, reducing health care costs.

Second, because it is a small device, acoustic apheresis reduces the need for large catheters and eliminates the need for donor blood to fill up the large volume of current devices, a huge improvement for people who may receive up to 100 treatments annually. Moreover, for critically ill patients, removing less blood means a safer procedure.

Third, because of its simplicity, our device can be used continuously for days, like an IV infusion. Many apheresis treatments for hospitalized patients are staggered three times a week because of the staffing complexity and large blood volumes involved. With a smaller, simpler device that can be operated continuously, patients won’t have to wait between treatments, and we can remove more disease-causing antibodies and blood cells than is currently feasible.

CAST YOUR VOTE
or read more about the other BRIght Futures finalists:

Tiny Drones to Target Cancer

AIMSpire: Outsmarting Asthma

Wilfred Ngwa, PhD, Department of Radiation Oncology

What is your research project about?

Cancer is a leading cause of death worldwide, accounting for more than 8.2 million deaths per year. About 90 percent of cancer deaths are caused by the spread of the cancer to other parts of a patient’s body, making it more difficult to treat effectively.

We have developed a powerful new technology designed to kill cancer cells that have spread to other parts of the body. The technology combines microscopic nanoparticles with medicine—all packed into a tiny drone the size of a grain of rice. Currently in the clinic, similar rice-size materials are routinely implanted in patients to guide radiotherapy treatment of cancers such as pancreatic, lung or prostate cancer. We want to upgrade the technology that is currently used with our “smart” technology, which can be employed at no additional inconvenience to patients. Once in place, our technology will proficiently release the microscopic particles/medicine to enhance local tumor cell death during radiotherapy and act as a beacon to call in the patient’s white blood cells. The white blood cells are then trained to kill cancer cells and can patrol the entire body, fighting cancer that has spread with greater effectiveness.

What is a compelling aspect of your research project?

Our team brings a new approach to an old problem. Our unique combination of state-of-the-art radiotherapy with nanotechnology and immunotherapy in one device will pack a pretty impressive punch.

When patients are treated with radiotherapy and/or drugs delivered via injections, the treatment can often harm healthy cells and tissue, in addition to cancer cells. Our tiny drones will enable highly targeted tumor cell death, with minimal damage to healthy tissue. In addition, the trained white blood cells will have the potential to kill off any cancer that may arise or come back in the future.

How will your research project benefit people?

Our technology is designed to substantially boost cancer cure rates, with minimal harm to healthy tissue, including for patients whose cancer has spread. One of the greatest fears of patients who are receiving treatment for cancer or are in remission is that their cancer will come back. Our technology is also designed to help prevent that from happening. Overall, our transformative new technology could drastically increase the survival rate and quality of life for cancer patients, particularly those with pancreatic cancer, for whom current treatments are limited.

CAST YOUR VOTE
or read more about the other BRIght Futures finalists:

Making Blood Treatments Better

AIMSpire: Outsmarting Asthma

Metabolic Test Kitchen staff

BWH’s Metabolic Test Kitchen on Tower 9A is equipped with precision balances, industrial refrigerators and other specialized equipment. Walk into the test kitchen on any given day and you’ll find team members designing menus and preparing meals for BWH research studies and meeting with study participants about nutrition.

As part of the Center for Clinical Investigation (CCI), the test kitchen provides nutrition resources and expertise to investigators whose studies involve a nutrition component. Depending on study protocol, the team’s dietitians and nutrition research assistants calculate and create individual menus according to study participants’ food preferences and the study’s nutrient targets. Diet technicians weigh each food and prepare it for outpatient pick-up or inpatient trays.

“Nutrition plays a big role in treatment and prevention in many realms of medicine,” said Karen Yee, MS, RD, senior dietitian for BWH Nutrition. “It’s an integral part of health and wellness, which shows in the variety of studies we’re involved in.”

The nutrition team is deeply involved in several ongoing studies. For example, staff are working on a weight loss study that assists participants in losing 10 percent of their total body weight. Subjects participate for three to six months, consuming meals that are carefully designed and prepared by test kitchen staff. In addition to meals and snacks, nutrition staff provide weight loss counseling to help participants reach the study goals and continue a healthy lifestyle after the study ends.

“The kitchen is an integral resource in the discovery of how food affects metabolism and other processes and the translation of these findings to benefit patients,” said research dietitian Leigh Keating, MS, RD.

Learn more at brighamandwomens.org/research/cci/dietary.aspx. View a recipe designed by the team below:

James Kang

James D. Kang, MD, has been appointed chair of the Department of Orthopedic Surgery, effective Sept. 1.

A nationally recognized orthopedic spine surgeon, Kang joins BWHC from the University of Pittsburgh Medical Center (UPMC), where he is the executive vice chair for the Department of Orthopedic Surgery, the endowed chair in Orthopedic Spinal Surgery and the director of the Ferguson Laboratory Musculoskeletal Research Center for Spine Research.

Kang is an internationally renowned leader in the basic science and clinical treatment of intervertebral disc degeneration—osteoarthritis of the spine—with a research team that focuses on the biochemistry of disc degeneration and the biomechanics of the spine. Kang has been leading the development of novel therapies for disc degeneration based on the latest gene transfer and stem cell technologies. He has also been an invaluable teacher to residents and fellows, as well as graduate students and post-doctoral research fellows at the University of Pittsburgh.

“A collaborative leader, Dr. Kang brings a depth of experience in patient care, research and teaching that will surely enrich our orthopedic services and benefit our patients for years to come,” said BWHC President Betsy Nabel, MD. “Additionally, his boundless energy and enormous contributions to excellent clinical care and cutting-edge scientific work have been recognized by several leading spine societies, including the International Society for the Study of the Lumbar Spine, where he was just installed as president, the Cervical Spine Research Society and the North American Spine Society.”

Kang received his MD from the University of Oklahoma College of Medicine. He completed his orthopedic surgery residency at the University of Pittsburgh School of Medicine and a spine surgery fellowship at Case Western Reserve University in Cleveland.

Kang will succeed Thomas S. Thornhill, MD, who announced his intention to step down last year after 20 years of extraordinary leadership in the department.

“We are so grateful to Dr. Thornhill for his unwavering commitment to the department and his dedication to innovation, his passion for training and education and his commitment to providing exceptional care to our patients and their families, setting a standard that other institutions seek to emulate,” said Nabel.

Thornhill will remain part of the Brigham family as a clinician, surgeon, investigator and mentor, in addition to continuing to lead Operation Walk Boston, which he founded in 2007.