symposium on enhancing patient- and family-centered care … · 2016-09-12 · enhancing patient-...

The Henry Hood Center for Health ResearchGeisinger Medical Center campus

Tue., June 14, and Wed., June 15, 2016

This conference is supported through a Eugene Washington Engagement Patient-Centered Outcomes Research Initiative (PCORI) Award (EAIN-3012) and the Geisinger Scientific Research Committee (SRC-S-52).

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Symposium on

Enhancing patient- and family-centered care through learning, engagement and discovery

Symposium on Enhancing patient- and family-centered care through learning, engagement and discovery

All across the United States, healthcare professionals are tackling the challenges of enhancing the quality of patient- and family- centered care. To meet those challenges, they have to form true partnerships with their colleagues, their patients and family caregivers.

At Geisinger, we’re embracing these challenges. We’re working with our healthcare professionals to help them partner with their colleagues, patients and patient families, all with the aim of improving the quality and the experience of care. And we’re asking patients and their families to collaborate with Geisinger as co-improvers, co-investigators and co-innovators in our drive to realize this overarching aim.

Today, we are excited to welcome you to this symposium: Enhancing Patient- and Family-Centered Care through Learning, Discovery, and Engagement. Over the next two days, we invite you to join us in exploring effective strategies for fulfilling Geisinger’s commitment to putting — and keeping — patients at the center of all we do.

Our goal is to make this symposium a stunning success, and without your participation, we will not be able to attain this goal. Please accept our sincere thanks for your participation and for your past, present and future contributions to making Geisinger the best.

Sincerely,

F. Daniel (Dan) Davis, PhD Rebecca A. Stametz, DEd

Tue., June 14, and Wed., June 15, 2016 • The Henry Hood Center for Health Research • Geisinger Medical Center campus

Geisinger is proud to announce that the June 14 – 15 symposium, Enhancing Patient- and Family Centered Care through Learning, Discovery, and Engagement, is officially “Patients Included” accredited.

This accreditation means that Geisinger partnered with patients or caregivers with experience relevant to our conference’s central theme to actively participate in the event’s design and planning, including the selection of themes, topics and speakers. To display the self-assessed accreditation,

the symposium must meet all five of the charter’s clauses. The format includes plenaries, workshops, engagement forums and a community open house, scheduled over the course of two full days.

Patients or caregivers

We have enlisted the help of three patient consultants who participated on the symposium planning committee and assisted with the symposium’s development and communication. Each patient partner also has a speaking role at the symposium.

• Mary Louise Schweikert, Geisinger patient and conference patient consultant

• Raven Rudnitsky, Geisinger patient and member of the MyCode® External Ethics Advisory Council

• Sara Kirkland, Geisinger patient and member of the MyCode® External Ethics Advisory Council

Patients or caregivers with experience of the issues addressed by the event participate in its delivery and appear in its physical audience.• We have a targeted community-based communication strategy that includes the following efforts: invita-

tions to members of patient and family advisory councils within the health system, targeted mailing to local patients and local newspaper and Chamber of Commerce advertisements.

• Patients will co-moderate or co-present at symposium sessions and will participate on panel discussions.

Travel and accommodation expenses for patients or caregivers participating in the advertised program are fully paid in advance. Scholarships are provided by the conference organizers to allow patients or caregivers affected by the relevant issues to attend as delegates.• The registration fee was waived for patient and community attendees.

• Travel and accommodation costs of all patient speakers were fully paid in advance.

The disability requirements of participants are met. All applicable sessions, breakouts, ancillary meetings and other program elements are open to patient delegates.• The symposium is being held at the Henry Hood Center for Health Research in Danville, Pa. This venue is

equipped to handle all disability requirements.

Access for virtual participants is facilitated, with free streaming video provided online wherever possible.• Symposium plenaries and keynote presentations will be recorded. These recordings will be available to all

Geisinger employees and community members (following the symposium). Videos will be accessible via the Geisinger website.

• The Twitter hashtag #GeisingerPX16 will be promoted during the symposium so that participants can join the conversation and discuss the symposium.

• Immediately after the conference, our planning committee will develop a symposium publication that will be circulated to attendees and beyond. This publication will feature symposium accomplishments and provide actionable next steps to engage in future activities.

Agenda

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Enhancing Patient- and Family-Centered Care through Learning, Discovery and Engagement: A Symposium

June 14 – 15Henry Hood Center for Health Research

Time Session Location

7:30 – 8:00 a.m. Registration w/continental breakfast Main Lobby

8:00 – 8:15 a.m. The Symposium: A Preview Auditorium

• F. Daniel (Dan) Davis, PhD Systemwide Director, Bioethics

• Rebecca Stametz, DEd Sr. Director, Clinical Innovation Institute for Advanced Application

8:15 – 8:30 a.m. Welcome & The Geisinger Vision Auditorium

• David T. Feinberg, MD President and Chief Executive Officer Geisinger Health System

8:30 – 9:30 a.m. Plenary: Keynote Address Auditorium

• Suzanne Schrandt, JD Deputy Director of Patient Engagement Patient-Centered Outcomes Research Institute (PCORI)

9:30 – 10:30 a.m. Plenary: “Enhancing the Patient’s Experience of Care” Auditorium

• Greg Burke, MD Chief Patient Experience Officer

• Susan Robel, RN Executive Vice President System Chief Nursing Officer and Patient Experience Officer

10:30 – 10:45 a.m. Break Main Lobby

10:45 – 11:45 a.m. Plenary: “Engaging Patients in Research Improvement and Innovation” Auditorium

• David Ledbetter, PhD Executive Vice President Chief Scientific Officer

• Gregory J. Moore, MD Interim Co-Chair Radiology Chief Emerging Technology and Informatics Officer Director, Geisinger Institute Advanced Application Diagnostic Neuroradiology

11:45 a.m. – 1:00 p.m. Lunch: Working lunch in facilitated small groups Auditorium

1:00 – 1:30 p.m. Reports from small work groups Auditorium

Tue., June 14, 2016



1:30 – 2:30 p.m. Plenary: “Implementing the Learning Health Care System at Geisinger” Auditorium


• Alistair Erskine, MD Chief Strategic Information Officer

• Gloria Gerrity, MBA Vice President, Pediatric Service Line Interim Vice President, System Radiology

• Rebecca Stametz, DEd Sr. Director, Clinical Innovation Institute Advanced Application

2:30 – 3:30 p.m. Plenary: “Engaging Patients in Quality Improvement” Auditorium

• Albert Bothe Jr., MD Executive Vice President, Chief Quality Officer

• George Godlewski, PhD Vice President, Division of Quality & Safety

3:30 – 3:45 p.m. Break Main Lobby

3:45 – 5:15 p.m. Panel Presentation: “Engaging Patients in Learning Health Initiatives” Auditorium

Moderators: • David Ledbetter, PhD

Executive Vice President Chief Scientific Officer

“Center for Pharmacy Innovation and OR” • Eric Wright, PharmD

Senior Investigator Co-Director, Center for Pharmacy Innovation and Outcomes

“The Obesity Institute” • Christopher Still, DO

Medical Director, Nutrition & Weight Management Director, Obesity Institute Medical Director, Employee Wellness

• Lisa Bailey-Davis, DEd Investigator I (Assistant Professor) Associate Director, Maternal and Pediatric Obesity Research

“Geisinger’s Digital Front Door” • Sarah Sommer

System Director, Social Media

“Institute for Advanced Application” • Rebecca Stametz, DEd

Sr. Director, Clinical Innovation Institute for Advanced Application

Tue., June 14, 2016



3:45 – 5:15 p.m. “Geisinger in Motion” Auditorium • Chanin Wendling, MBA

Director, Geisinger in Motion

“Population Health/Rheumatology” • Eric Newman, MD

Chief, Specialty Care Innovation and Integration, Population Health Vice Chair, Clinical Innovations, Division of Medicine

“The MyCode Community Health Initiative” • Carroll Flansburg, CPH

Research Coordinator

“Autism and Development Medicine Institute” • Christa Martin, PhD

Director and Senior Investigator Autism & Development Medicine Institute

5:15 – 5:30 p.m. Plenary Auditorium


5:30 – 7:00 p.m. Open House: “Becoming Engaged: Demonstrations of Main Lobby/ New Ways to Become Optimally Involved in Your Own Care” Multipurpose Rooms 1 – 3 Heavy hors d’ oeuvres will be served. Opening Remarks • Alistair Erskine, MD

Chief Strategic Information Officer

ProvenExperience™ Application • Jonathan Slotkin, MD

Director of Spinal Surgery, Neurosurgery Director of Spinal Cord Injury Research Associate Residency Program, Director, Neurosurgery Medical Director, Geisinger in Motion Division of Applied Research and Clinical Informatics

Poster Session

Book Purchase and Signing Session • Brian Boyle

Patient Experience Advocate

Tue., June 14, 2016



7:30 – 8:00 a.m. Registration w/continental breakfast Main Lobby

8:00 – 9:00 a.m. Plenary: Keynote Address Auditorium

• Brian Boyle Patient Experience Advocate

9:00 – 9:15 a.m. Plenary: “Overview of Today’s Agenda” Auditorium

• Gloria J. Gerrity, MBA Vice President, Pediatric Service Line Interim Vice President, System Radiology

9:15 – 10:15 a.m. Plenary: “The Communication Challenge” Auditorium

• Charlotte Collins, PhD Director, Behavioral Medicine and Adult Psychology Division of Psychiatry

• Nicole Woll, PhD Vice President, Faculty & Curriculum Development, Academic Affairs

10:15 – 10:30 a.m. Break Main Lobby

10:30 – 11:30 a.m. Plenary: “The Methodological Challenge” Auditorium

• Sharon L. Larson, PhD Director, Behavioral Research Research Director, Psychiatry Senior Investigator

11:30 a.m. – 12:30 p.m. Plenary: “The Challenge of Organizational Culture” Auditorium

• Lynn Miller, MBA Executive Vice President Chief Administrative Officer Clinical Enterprise

• Linda Famiglio, MD Chief Academic Officer

12:30 – 1:30 p.m. Lunch: Working lunch in facilitated small groups Location TBA

1:30 – 2:00 p.m. Reports from small work groups Auditorium

2:00 – 3:30 p.m. Workshops Location TBA

Workshop 1: “Learning from Caring: Embedding Rigorous Inquiry in Routine Processes of Care” • Rebecca Stametz, DEd

Sr. Director, Clinical Innovation Institute Advanced Application

• Matthew Hackenberg, RN Director, Innovation Implementation

Wed., June 15, 2016


Wed., June 15, 2016



Workshop 2: “Designing, Conducting, and Evaluating Patient-Engaged Research” • Lisa Bailey-Davis, DEd

Investigator I (Assistant Professor) Associate Director, Maternal and Pediatric Obesity Research

• Adam H. Buchanan, LGC Investigator I (Assistant Professor) Genomic Medicine Institute

• Sharon Larson, PhD Director, Behavioral Research Research Director, Psychiatry Senior Investigator

Workshop 3: “From Patient to Partner” • Jennifer Wagner, PhD

Associate Director, Bioethics Research • Alanna L. Kulchak Rahm, PhD

Clinical Investigator I (Assistant Professor) Genomic Medicine Institute

• Mary Louise Schweikert Patient Advocate/Consultant

• Raven Rudnitsky Patient Advocate/Consultant

• Sara Kirkland Patient Advocate/Consultant

Workshop 4: “Navigating the Regulatory and Oversight Pathways in a Learning Healthcare System” • Debra Henninger, RN

Associate Director, Research Compliance and Training • F. Daniel (Dan) Davis, PhD

Systemwide Director, Bioethics • Bethanny Smith Packard, MS

Genetic Counselor

Workshop 5: “Designing and Implementing a Successful Effort to Enhance the Patient’s Experience” • Randy Hutchinson, MBA

Director, Patient Experience • Megan King, MSN

Director, Patient Experience


Workshop 1: “Learning from Caring: Embedding Rigorous Inquiry in Routine Processes of Care” • Rebecca Stametz, DEd

Sr. Director, Clinical Innovation Institute Advanced Application

• Matthew Hackenberg, RN Director, Innovation Implementation




Workshop 2: “Designing, Conducting, and Evaluating Patient-Engaged Research” • Lisa Bailey-Davis, DEd

Investigator I (Assistant Professor) Associate Director, Maternal and Pediatric Obesity Research

• Adam H. Buchanan, LGC Investigator I (Assistant Professor) Genomic Medicine Institute

• Sharon Larson, PhD Director, Behavioral Research Research Director, Psychiatry Senior Investigator

Workshop 3: “From Patient to Partner” • Jennifer Wagner, PhD

Associate Director, Bioethics Research • Alanna L. Kulchak Rahm, PhD

Clinical Investigator I (Assistant Professor) Genomic Medicine Institute

• Mary Louise Schweikert Patient Advocate/Consultant

• Raven Rudnitsky Patient Advocate/Consultant

• Sara Kirkland Patient Advocate/Consultant

Workshop 4: “Navigating the Regulatory and Oversight Pathways in a Learning Healthcare System” • Debra Henninger, RN

Associate Director, Research Compliance and Training • F. Daniel (Dan) Davis, PhD

Systemwide Director, Bioethics • Bethanny Smith Packard, MS

Genetic Counselor

Workshop 5: “Designing and Implementing a Successful Effort to Enhance the Patient’s Experience” • Randy Hutchinson, MBA

Director, Patient Experience • Megan King, MSN

Director, Patient Experience

5:00 – 5:30 p.m. Closing Plenary Auditorium • F. Daniel (Dan) Davis, PhD

Systemwide Director, Bioethics

5:30 p.m. Adjournment

Wed., June 15, 2016

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Henry Hood Center for Health Research map

External speaker biographies

geisinger.org


Brian Boyle

It was a horrific car crash. On the way home from swim practice in 2004, 18-year-old Brian Boyle’s future changed in an instant when a dump truck plowed into his vehicle. He lost 60 percent of his blood and his organs and pelvis were pulverized. When Mr. Boyle emerged from a medically-induced coma two months later, he had no memory of the accident. He could see and hear, but not move or talk. Unable to communicate with his doctors, nurses or frantic parents, he heard words like “vegetable” and “nursing home.” If he lived, doctors predicted he might not be able to walk again, and certainly not swim. Then, miraculously, Mr. Boyle clawed his way back to the living. First blinking his eyelids, then squeezing a hand, then smiling, he gradually emerged from his locked-in state. The former swimmer and bodybuilder had lost 100 pounds.

In 2007, Mr. Boyle became a certified personal trainer through the American Council of Exercise to help do his part to inspire people to improve their health and fitness. In the same year, he staged what many consider to be one of the greatest comebacks in sports history when he crossed the finish line at the Hawaii Ironman just three years after leaving the Intensive Care Unit.

In 2008, he competed in the 2008 Foster Grant Ironman 70.3 World Championship in Clearwater, Fla., and Men’s Health magazine named Mr. Boyle one of its 20 heroes. In 2009, he published his first book, Iron Heart, and was presented the Spokesperson of the Year Award from the American Red Cross for his contributions. In 2010, he graduated cum laude from St. Mary’s College of Maryland, ran his first 50-mile ultramarathon, completed his third Ironman in 10:14, and also made his very first blood donation at the hospital that brought him back to life. In 2011, he was awarded the Presidential Award for Excellence from the president of the American Red Cross, Gail McGovern. He launched the Red Cross Iron Heart Campaign to help raise blood donation awareness on a national level, and was recognized by the President of the United States of America as a “Champion of Change” at the White House.

Mr. Boyle is studying for a master’s degree in Health Communications at Johns Hopkins University, and he has a column with The Huffington Post and The British Medical Journal. He recently published his second book, The Patient Experience: The Importance of Care, Communication, and Compassion in the Hospital Room, which is based on the experiences that he and his parents went through during his time in the hospital.

His story has been featured on the Ellen DeGeneres Show, NBC’s Today Show, ESPN, and several other programs throughout the country that have earned Emmy nominations and awards.

Mr. Boyle’s journey of courage and determination has touched the hearts of many and his story and the message it carries has been celebrated around the world.

Keynote/External speaker biographies


Suzanne Schrandt, JD

Attorney Schrandt is the deputy director of patient engagement at the Patient-Centered Outcomes Research Institute (PCORI). She is responsible for supporting the director of patient engagement in creating networks and engaging patients across the nation to provide broad-based input on the development and execution of PCORI’s research. Attorney Schrandt has been involved in patient education and advocacy since being diagnosed with a form of rheumatoid arthritis as a teenager.

For more than 15 years, she has advocated on behalf of children and adults with arthritis and has been engaged in numerous patient and provider education initiatives aimed at increasing early diagnosis and appropriate, patient-centered management of chronic disease. Before coming to PCORI, Attorney Schrandt served as the health reform strategy team leader for the Kansas Health Institute, where she educated the state’s policymakers, providers, and consumers on the implications of the Affordable Care Act. While there, she also led the Kansas Legislative Health Academy, an intensive educational experience for select Kansas legislators.

Attorney Schrandt also previously served as the coordinator of Public Health and Public Policy for the Arthritis Foundation in Kansas City and as a research associate for a Human Genome Research Institute ethical, legal and social issues project. She is a member of the Kansas Bar and the American Health Lawyers Association.

Keynote/External speaker biographies

Geisinger speaker biographies

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Lisa Bailey-Davis, DEd is an investigator and associate director of the Geisinger Obesity Institute where she focuses on maternal and pediatric research. She is also core faculty for the Geisinger Institute for Advanced Applications and an adjunct assistant professor of nutritional sciences at The Pennsylvania State University.

Her federally funded research focuses on testing mechanisms that build bridges between clinical and community settings to make it easier for families to adopt and maintain healthy lifestyles where they live, learn, work and play. Dr. Bailey-Davis is a registered dietitian and holds a doctorate of education in adult education from The Pennsylvania State University.

Albert Bothe Jr., MD is executive vice president and chief quality officer for the Geisinger Health System. He has oversight responsibility for a variety of quality initiatives that derive from Geisinger’s strategic focus on improving the quality of care provided throughout the organization. He also served as chief medical officer for Geisinger Medical Center, a 505-bed tertiary/quaternary medical center.

Dr. Bothe is past chair of the Association of American Medical College’s group on Faculty Practice and its subcommittee on Legislative and Regulatory Affairs, and serves on the board of advisors of the National Patient Safety Foundation. He is a member of the American Medical Association’s CPT Editorial Panel and the American College of Surgeon’s General Surgery Coding and Reimbursement Committee. He also serves on the board of directors of the Pennsylvania Health Care Improvement Foundation and is a member of the editorial advisory board of the Pennsylvania Patient Safety Advisory.

Dr. Bothe earned his bachelor’s degree from Johns Hopkins University and his medical degree from Harvard Medical School. After completing general surgery training, he was a member of the surgical faculty at Harvard Medical School for 19 years, followed by the University of Chicago Pritzker School of Medicine where he was also associate dean for clinical affairs. He subsequently earned a Master of Medical Management from the Tulane School of Public Health & Tropical Medicine.

Adam Buchanan, LGC is a licensed genetic counselor and a clinical investigator in the Geisinger Genomic Medicine Institute.

His research interests include access to genomic medicine and patient outcomes associated with returning genomic results to clinical care. He has a Master of Public Health in health behavior and health education from The University of North Carolina at Chapel Hill and a Master of Science in genetic counseling from The University of North Carolina at Greensboro.



Greg F. Burke, MD graduated summa cum laude from The University of Scranton and magna cum laude from Jefferson Medical College. He served as president of the Alpha Omega Alpha medical honor society at Jefferson. After training in internal medicine at Thomas Jefferson University Hospital, he completed a year as chief medical resident at the same institution. Dr. Burke joined the Geisinger Health System in the Department of General Internal Medicine in 1992. He continues an active practice in the field of internal medicine.

Dr. Burke serves as Geisinger’s chief patient experience officer, where he focuses on ensuring that patient receive compassionate and quality medical care. He is also medical director at both Geisinger HealthSouth Rehabilitation Hospital and Emmanuel Skilled Nursing Facility and is an active member of the Geisinger Bioethics Committee.

He lectures and publishes articles in the fields of medical ethics and physician spirituality. He has served on the editorial board of journals associated with bioethics. His awards include the Clinical Excellence Award for HealthSouth (2009), Best Doctors in America (2007-08, 2011-12), Victor Marks Service Excellence Award (2007 and 2013) and the Papal Medal “Benemerenti” award in 2007.

Charlotte Collins, PhD is a behavioral medicine psychologist. She works with patients throughout the Geisinger Health System who are dealing with medical issues, in particular chronic illness. Dr. Collins conducts a complete evaluation in order to identify ways that she might be helpful to patients as they work to take care of their health. She also helps with any behaviors (smoking, diet, exercise, stress management) that might impact a patient’s health.

Dr. Collins received her PhD from the University of Kansas. She completed her internship at the University of Illinois at Chicago Hospital and completed her postdoctoral fellowship at Harborview Medical Center at the University of Washington in Seattle, Wash. She previously worked at Brown Medical School and the Miriam Hospital in Providence, R.I.

F. Daniel (Dan) Davis, PhD is the director of bioethics for the Geisinger Health System. A native of West Virginia, Dr. Davis earned his PhD in the philosophy and ethics of medicine from Georgetown University and worked at Georgetown for more than 20 years, serving as director of strategic planning for the medical school and then as associate dean for educational planning and evaluation at the medical school. At Georgetown’s Center for Clinical Bioethics, he was a senior research scholar with varied responsibilities for teaching and research in bioethics; he also served as a senior ethicist on the ethics consultation service at Georgetown’s hospital and as chair of Georgetown’s institutional review board for psychosocial and behavioral research.

Dr. Davis served as executive director of the President’s Council on Bioethics and later as senior advisor for bioethics and policy in the Office of Science Policy in the Office of the Director at the National Institutes of Health in Bethesda, Md.

At Geisinger, he is working to build a vibrant, multi-faceted program in bioethics — establishing a small center for bioethics and establishing new and fortifying existing ethics committees at hospitals throughout the system.



Alistair Erskine, MD is chief strategic information officer at Geisinger Health System. He is responsible for sequencing innovative technologies, harmonizing data across the clinical care, research and health plan enterprise, and activating patients in a manner congruent with emerging patient consumerism. Dr. Erskine heads the Division of Applied Research and Clinical Informatics, which engages staff in the design and configuration of Geisinger’s clinical information systems and evolves Geisinger’s facilities to take advantage of ultramodern technologies. Dr. Erskine oversees Geisinger’s Unified Data Architecture, a hedged data management environment powered by Hadoop/Big Data and traditional relational database systems to ensure that data collected as a byproduct of clinical, and research investigation are accessible for new discovery and appropriate secondary use.

Dr. Erskine is the Program Director of Geisinger’s ACGME-accredited Clinical Informatics Fellowship program and participates on several clinical informatics research grants (e.g., PCORI, NIH).

Linda M. Famiglio, MD is the chief academic officer and associate chief medical officer at Geisinger Health System with system leadership responsibility for more than 425 residents/fellows, maintaining accreditation for over 40 programs for physicians, dentists, podiatrists, physicists, psychologists and others across 40 counties and 3 teaching hospitals in mostly rural Pennsylvania. Dr. Famiglio created the Geisinger Clinical Campus in 2006 for 50 full-time third- and fourth-year medical students and serves as an associate dean and professor of neurology at Temple University School of Medicine. Dr. Famiglio leads the Center for Continuing Professional Development, which holds joint accreditation from the ANCC, ACCME and ACPE for team-based continuing education and develops more than 30,000 hours of accredited courses each year. She advises the Advanced Practice Council, which focuses on education of physician assistants, nurse practitioners and CRNAs, and the Interprofessional Council, which promotes a culture of respect and team-based learning and care.

Dr. Famiglio is a practicing child neurologist who has trained at Johns Hopkins, Duke and the University of Washington. Dr. Famiglio has served as chair of the AAMC’s Group on Resident Affairs and the ACGME’s Institutional Review Committee. She serves on the Pennsylvania Medical Society’s Council for CME, chairs the ACCME’s Accreditation Review Committee and actively teaches students, residents and interprofessional teams. She has designed and implemented the Geisinger integrated curriculum, local and national curricula for leadership, faculty development, GME funding, and the AAMC’s Te4Q, focusing on interprofessional groups across the continuum of medical education, wellness, integrating quality and transforming systems of care.



William A. (Andy) Faucett, LGC is the director of policy and education for the Office of the Chief Scientific Officer for Geisinger Health System and a senior investigator for the Genomic Medicine Institute.

Mr. Faucett directs community engagement and public education for Geisinger’s biobank, the MyCode® Community Health Initiative. His research focuses on oversight of genetic testing, ethical and consent issues for genetic research, healthcare provider education, genetic counseling, rare disease test translation, and patient registries. He serves on the Geisinger IRB and the IRB leadership team. He leads the National Institutes of Health (NIH)-funded registry for the ClinGen project, GenomeConnect, and the ethical, legal and social issues aspect of the NIH-funded Clinically Relevant Variant Resource section of ClinGen.

Mr. Faucett holds a bachelor’s degree from the Baptist College at Charleston, a master’s degree in human genetics from Sarah Lawrence College, board certification from the American Board of Genetic Counseling (ABGC) and is licensed as a genetic counselor in Pennsylvania. He serves as chair of the Public Policy Committee for the National Society of Genetic Counselors (NSGC). He has previously served on the NSGC, ABGC and National Coalition for Health Professional Education in Genetics boards of directors, and the American Society of Human Genetics Information and Education Committee. He held positions at Emory University School of Medicine; Baylor College of Medicine; Memorial Medical Center, Savannah, Ga.; and the Centers for Disease Control and Prevention (CDC) prior to coming to Geisinger. While at the CDC, Mr. Faucett worked in the division responsible for the oversight of genetic testing under CLIA.

David T. Feinberg, MD is president and chief executive officer of Geisinger Health System, one of the nation’s largest health services organizations, known for reinventing medical care.

A longtime champion of the patient experience, Dr. Feinberg has caught the industry’s attention by introducing Geisinger’s latest evolution of its renowned ProvenCare® portfolio — ProvenExperience™ — that allows patients to request a refund based on the outcome of their experiences at Geisinger.

Triply board certified by the American Board of Psychiatry and Neurology in child, adolescent and addiction psychiatry, Dr. Feinberg earned his undergraduate degree at the University of California, Berkeley, and graduated with distinction from the University of Health Sciences/Chicago Medical School. He earned a Master of Business Administration from Pepperdine University.

Named to Modern Healthcare’s 100 Most Influential People in Healthcare as well as the Top Ten of the 50 Most Influential Physician Executives and Leaders, Dr. Feinberg has earned numerous awards and recognitions. He is also a well-known author and national speaker, especially on the subject of patient experience.

Prior to joining Geisinger, Dr. Feinberg served as CEO of UCLA’s hospitals and associate vice chancellor of UCLA Health Sciences, as well as president of UCLA Health System.



Carroll N. Flansburg, CPH is the project manager for the MyCode Community Health Initiative. MyCode is Geisinger’s genetic biobank.

Ms. Flansburg holds a Master of Public Health and a Master of Applied Anthropology, both from the University of South Florida.

Gloria J. Gerrity, MBA is the vice president of pediatrics for Geisinger Health System.

Ms. Gerrity holds a bachelor’s degree in business management from University of Maryland University College in College Park, Md., and a Master of Business Administration from Bloomsburg University of Pennsylvania.

Experientially, most of her practical experience is in leading and innovation. Her professional experience includes leading group practices, managing hospital programs and developing new programs. One of her greatest strengths is in developing the vision and making it real. Ms. Gerrity presents both nationally and locally on various healthcare-related business topics.

George A. Godlewski, PhD is vice president of the Division of Quality and Safety & Spiritual Care. Following positions in clinical and supervisory mental health work, Dr. Godlewski moved to system-level leadership roles at Geisinger. Current responsibilities include leadership for all spiritual care services, patient safety and risk management, infection prevention and control, patient experience, regulatory performance improvement, medical health physics, process improvement and quality metrics. He has experience in women’s health, hospital care management and specialty care development and is versed in group practice management as well hospital operations. Dr. Godlewski has led Geisinger’s initiative to improve care for patients with serious advanced illnesses. A major focus is patient-centered care.

Dr. Godlewski’s research experience is in qualitative methods, focused on work related to shared medical appointments.

Matthew Hackenberg, RN is a registered nurse and director of innovation implementation for the Center for Clinical Innovation in the Institute for Advanced Application. Matthew completed a fellowship in biomedical informatics with the National Library of Medicine and earned his certificate in Nursing Informatics through Eastern University.

Mr. Hackenberg is director of innovation implementation for Geisinger Health System. He is responsible for deployment of innovation and best practices including technology and operational solutions in both primary care and specialty service lines. Mr. Hackenberg has implemented programs for virtual visits, patient-reported data collection, optimized clinical notes and other solutions to support operational needs and primary care innovation. He has been a collaborator and consultant for the chief health information officer on the development of Geisinger clinical information systems. In addition to completing a fellowship in biomedical informatics with the National Library of Medicine, he earned his certificate in nursing informatics through Eastern University.



Debra L. Henninger, RN is the associate director of the Office of Research Compliance & Training (ORC) for Geisinger Health System. The ORC ensures that Geisinger follows rigorous standards for ethics, quality and protections for human research. Ms. Henninger is actively involved in the leadership of ORC’s programs, including research conflict of interest, noncompliance reporting and research auditing. She serves as a member of the Geisinger Institutional Review Board (IRB) and oversees IRB operations and management of relationships with external IRBs.

Prior to joining the ORC, Ms. Henninger spent 20 years in clinical research operations, including clinical trial coordination; management of core clinical, regulatory and administrative research staff; expansion of clinical research services; and training and dissemination of clinical research best practices through Geisinger Health System.

She also has 30 years of clinical experience, with much of her nursing career focused in care management and rehabilitation of patients with chronic lung disease.

Ms. Henninger earned a bachelor’s degree in nursing from The Pennsylvania State University and a master’s degree in health services administration from Marywood University. She is certified as a clinical research coordinator through the Association of Clinical Research Professionals.

Randy Hutchison, MBA is the director of patient experience for the Geisinger Health System. He is also an adjunct faculty member of the Department of Management at Bloomsburg University of Pennsylvania since 1986, teaching operations management and quality management. He has participated in several publications, including The Physician Executive and the American Journal of Medical Quality. He has been a program presenter at over 15 healthcare conferences.

Mr. Hutchinson earned his Master of Business Administration from Youngstown State University in 1985 and his bachelor’s degree in management engineering from Grove City College in 1980.

Megan West King, MSN is the director of patient experience for Geisinger Medical Center, Geisinger Bloomsburg Hospital and Geisinger Shamokin Community Area Hospital.

She began her nursing career as a graduate of the Geisinger School of Nursing, and holds a Master of Nursing Education from Drexel University.

Alanna Kulchak Rahm, PhD is a certified and licensed genetic counselor with a doctorate in health and behavioral science. Dr. Rahm joined Geisinger Health System as an investigator in the Genomic Medicine Institute after 12 years at Kaiser Permanente Colorado.

Dr. Rahm’s research focuses on implementing genomic technologies, such as universal tumor screening for Lynch syndrome, and new clinical models of risk assessment for hereditary breast cancer into clinical care. She is also exploring parent needs around learning genomic information about their children and family communication after genetic test results.



Sharon Larson, PhD is the director of behavioral health research for Geisinger Health System and is the director of research for the division of psychiatry at Geisinger Medical Center. Dr. Larson is also the director of survey research core. In these roles, she focuses on research related to the social and behavioral determinants of health and health behavior, as well as health outcomes and psychiatric and substance abuse epidemiology and health services.

Dr. Larson is a site co-principal investigator for the Patient-Centered Outcomes Research Institute (PCORI) clinical data research network (CDRN) project called PaTH. This CDRN is one of 13 funded by PCORI across the nation. PaTH’s mission is to address questions and concerns that matter most to the communities we serve in order to make more informed health decisions. Using patient-engaged research strategies and electronic health records, as well as other data resources, important health issues are examined and findings of the research are used to improve healthcare delivery. Dr. Larson is also working on a project to improve our understanding about medication adherence. Her team is interested in learning more about why patients may decide not to take their medication and in identifying strategies that support patients in making informed health decisions. She is also working on projects to improve behavioral healthcare access in primary care settings.

Dr. Larson holds a doctorate in sociology from the University of Nebraska and a postdoctoral certificate in psychiatric epidemiology from Johns Hopkins University Bloomberg School of Public Health.

David H. Ledbetter, PhD is executive vice president and chief scientific officer at Geisinger Health System. Dr. Ledbetter previously held academic and leadership positions at Emory University, the University of Chicago, the National Center for Human Genome Research (now NHGRI) at the National Institutes of Health, and Baylor College of Medicine. He is a graduate of Tulane University and earned his PhD at the University of Texas–Austin. After his early discovery of the genetic causes of Prader-Willi syndrome in 1981 and Miller-Dieker syndrome in 1983, Dr. Ledbetter has focused his research efforts on discovering the underlying etiology of childhood neurodevelopmental disorders such as autism, and the translation of new genomics technologies into clinically useful genetic tests for early diagnosis and intervention. His current research interest includes leveraging longitudinal electronic health information with large-scale DNA sequencing to determine the clinical utility and cost-effectiveness of precision medicine approaches in a real-world health system setting.



Christa Lese Martin, PhD is a professor and the director of the Autism & Developmental Medicine Institute (ADMI) at Geisinger Health System. ADMI is a systemwide initiative focused on clinical care and cutting-edge research to help individuals with developmental disorders. As director, Dr. Martin’s vision for ADMI is to create a seamless integration of clinical care and innovative research through a talented multidisciplinary team that will lead to improved outcomes for patients.

Dr. Martin’s research interests include the identification and characterization of genomic variation as it relates to human health and disease in prenatal and postnatal settings. Her main area of research is in developmental brain disorders, where she is involved in several initiatives that work to engage patients in research through online registries, support groups and specialty clinics at ADMI.

Dr. Martin earned her Bachelor of Science degree from The Pennsylvania State University and completed her doctorate in human genetics at the University of Pittsburgh. She did her postdoctoral training at the University of Chicago in the Department of Human Genetics, after which she achieved board certification in Clinical Cytogenetics by the American Board of Medical Genetics. Before joining Geisinger, Dr. Martin was an assistant professor in the Department of Human Genetics at the University of Chicago and then an associate professor in the Department of Human Genetics at Emory University. She also directed clinical genetics laboratories while at the University of Chicago and Emory University.

Lynn Miller, MBA is executive vice president for clinical operations for Geisinger. She has been with Geisinger since 1989. In her current role, Ms. Miller is responsible for the operations of the health system’s clinical enterprise that includes the hospitals; a multispecialty group practice including physicians, researchers and advanced practitioners; primary and specialty care clinic sites; outpatient surgery centers; home and hospice services; residents and fellows; and medical students.

Ms. Miller previously served as chief administrative officer of Geisinger Medical Center, the system’s tertiary/quaternary care hospital in Danville, Pa. During her tenure, she directed the planning and construction of a $100 million addition, incorporating a new acuity adaptable mode of care; implemented a hospital inpatient electronic medical record; and achieved Magnet status.

In addition to hospital operations, Ms. Miller has experience in hospital-based human resources, finance, business office management, and information technology, as well as home health and long-term care environments.

Ms. Miller serves on the boards of the Danville Child Development Center and the Pennsylvania State System of Higher Education. She is chair of the Governance Committee for the Geisinger/HealthSouth Joint Venture.

Ms. Miller holds a Master of Business Administration degree from Loyola College and a Bachelor of Science in psychology from Elizabethtown College.



Gregory J. Moore, MD serves as chief emerging technology and informatics officer (CETIO) for Geisinger Health System and as director of Geisinger’s Institute for Advanced Application (IAA). In his role as IAA director, Dr. Moore oversees the Institute’s three Centers (Center for Healthcare Systems Re-Engineering, Center for Clinical Innovation, Center for Emerging Technology and Informatics), negotiates external institute collaborations and partnerships through the Geisinger Informatics and Technology Trials Office, and manages core institute facilities and personnel. In his role as Geisinger’s CETIO, Dr. Moore leads strategic future-focused disruptive technology and informatics initiatives to shape and transform the future of healthcare at Geisinger, nationally and globally. In addition to his executive leadership roles, Dr. Moore continues to practice as a diagnostic neuroradiologist and maintains an active research program as an Abigail Geisinger Clinician Investigator. Prior to assuming his present positions, Dr. Moore served as vice chair of Radiology for Geisinger Health System with responsibilities including informatics and research. In that role, he led Radiology through transformational changes in their informatics systems, resulting in significant improvement in performance and quality metrics and contributing to marked growth of the department. Prior to his arrival at Geisinger, Dr. Moore held appointments at Los Alamos National Laboratory, Wayne State University School of Medicine and most recently at The Pennsylvania State University, where he was a tenured professor in the College of Medicine.

An engineer, magnetic resonance physicist, neuroscientist and neuroradiologist, Dr. Moore earned his PhD from Massachusetts Institute of Technology (MIT) and subsequently his MD at Wayne State University School of Medicine, followed by residency training in diagnostic radiology and subsequent fellowship training in neuroradiology, both at Penn State University College of Medicine. Dr. Moore is a prolific author with a substantial track record as a funded research investigator from the NIH and other federal agencies, as well as from industry sponsors and private foundations. He is a frequently sought-after speaker at national and international scientific and medical meetings, and has served on numerous expert advisory committees, advisory boards and study sections as a subject matter expert in the areas of emerging neuroscience, imaging technology, radiological sciences, informatics and health/science technology policy. Dr. Moore is a diplomate of the American Board of Radiology in Diagnostic Radiology and Neuroradiology and has special clinical expertise and interest in pediatric neuroradiology, areas of advanced imaging, informatics, technology and radiological sciences.



Eric D. Newman, MD is a member of the Department of Rheumatology, vice chair of Clinical Innovations for the Division of Medicine, and chief of Specialty Care Innovation and Integration for the Division of Population Health at Geisinger Health System.

Dr. Newman earned his bachelor’s degree in biology from Johns Hopkins University and his medical degree from The Pennsylvania State University College of Medicine. He completed an internal medicine residency at The University of North Carolina at Chapel Hill and a rheumatology fellowship at Geisinger Medical Center. He has been on staff at Geisinger since 1988 and director of Rheumatology from 1997 to 2015. In 2002 he was appointed vice chairman of the Division of Medicine, and in 2014, chief of Specialty Innovation and Integration for the Division of Population Health.

Among his awards and honors, Dr. Newman has been named to Best Doctors in America yearly since 2001, and received the ACP Clinical Practice Management Award from the American College of Physicians in 2007, the Paulding Phelps Award from the American College of Rheumatology in 2008, and the inaugural Henry Hood Medal for Clinical Excellence from the Geisinger Health System Board of Directors in 2012. He has published over 50 peer-reviewed manuscripts and book chapters, and is the co-author of Great Health Care: Making It Happen (Springer Publishing, 2012)

In addition to his administrative, research and clinical work, Dr. Newman is very active in quality improvement and process redesign, especially as it relates to the use of health information technology. He has led multiple projects designed to improve the quality of care for patients, including the development of specialized visual display software to improve quality and efficiency of healthcare delivery. His latest work surrounds integration of specialty and primary care physicians, improving communication and care handoffs, and developing novel value-based care models.

Marylyn Ritchie, PhD is a senior investigator and director of the Biomedical & Translational Informatics Program. Ritchie holds a dual appointment at Geisinger and at The Pennsylvania State University, where she is Paul Berg Professor of biochemistry and molecular biology and director of the Center for Systems Genomics.

Dr. Ritchie has a lab at Geisinger where, as part of a large integrated health system, she can pursue her research interests, and she will have the ability to maintain a link to an academic appointment and continue to mentor and train graduate students. Being at Geisinger has provided Dr. Ritchie with the perfect opportunity to conduct her research at a faster pace and in a more integrated way. Utilizing the rich longitudinal phenotype data available in Geisinger’s EHR combined with the large amount of genomic data available through MyCode, Dr. Ritchie and her group are conducting phenotypic mining or clustering of subgroups of patients. She is interested in examining phenotypically similar subgroups and looking at specific genes within that subgroup. For example, not all cases of Type 2 diabetes present with the same symptoms. Type 2 diabetes in people with high body mass index (BMI) might be very different from Type 2 diabetes in people with low BMI.

Another interest of Dr. Ritchie’s is to examine polygenetic models and genetic and drug interactions.



Susan M. Robel, RN is executive vice president, system chief nursing and patient experience officer for Geisinger Health System. As an executive nursing leader, Ms. Robel’s leadership has fostered the advancement of patient care in rural Pennsylvania and throughout the state.

Ms. Robel is directly responsible for nursing operations at Geisinger Medical Center (including Geisinger Shamokin Area Community Hospital), Geisinger Wyoming Valley Medical Center, Geisinger South Wilkes-Barre, Geisinger Community Medical Center, Geisinger Bloomsburg Hospital, Geisinger Lewistown Hospital, Holy Spirit Health System–A Geisinger Affiliate and nursing practice in the Community Practice Service Line hospital-based clinics throughout the system. She functions in collaboration with the executive vice president, the chief medical officer and entity chief medical officer, chief nursing officers, and chief administrative officers to lead, direct and coordinate fiscal and operational accountability. She is responsible for integration of system goals, objectives and vision, and is directly responsible for the fiscal and operational for the overall System Nursing Clinical Service Line. Her duties involve ensuring hospital operations and activities support organizational strategies. Ms. Robel partners with campus leaders, nurse leaders and others to outperform patient experience benchmarks and develop/enhance the patient experience culture. Under her leadership, Geisinger Medical Center achieved Magnet designation in October 2008 by the American Nurse Credentialing Center with redesignation achieved in July 2013.

She actively participates in networking and events through the Pennsylvania Organization of Nurse Leaders, the Hospital and Healthcare Association of PA and the Nightingales of PA. All of these support and encourage the growth of nursing across Geisinger Health System.

Jonathan R. Slotkin, MD is the medical director of Geisinger in Motion, Division of Applied Research and Clinical Informatics at Geisinger Health System. Dr. Slotkin has developed key strategies and solutions to drive digital provider and patient engagement, including the use of mobile device and bring your own device (BYOD) technology around lumbar spine surgery. He has a particular interest in digital methods for both the measurement of clinical patient outcomes and the improvement of global patient experience. He has been a clinical co-leader in the design and implementation of several of Geisinger’s care delivery reengineering initiatives, including ProvenCare®. He was a physician lead of Geisinger’s ProvenExperience™ patient refund app program, and helps lead efforts surrounding customer relationship management. Dr. Slotkin has clinical expertise in complex spinal surgery and active translational research in the areas of tissue engineering and regenerative medicine. He completed residency training and was chief resident of neurological surgery at The Brigham and Women’s Hospital, Harvard Medical School.



Sarah Sommer, MBA leads Geisinger’s Corporate Communications Digital Marketing team. The team partners across the health system to advance Geisinger’s digital strategy and capabilities (e.g., websites, social media) to serve as valuable resources that make it easy for consumers to research and access Geisinger care, programs and services.

Prior to joining Geisinger in 2012, she led digital marketing teams for a medical technology company, where she was responsible for developing and executing digital strategies in support of the company’s Endoscopy, Cardiac Rhythm Management, Urology, Women’s Health, Pain Management and Cochlear Implant business units. Sarah holds a Master of Business Administration from Harvard Business School.

Rebecca A. Stametz, DEd is the senior director of clinical innovation for the Center for Clinical Innovation (CCI) in the Geisinger Institute for Advanced Application. CCI is a physician-led think tank, analytic and evaluation team, and software development group that seeks to deliver greater healthcare value through clinical care process redesign, patient-family engagement and health information technology. As senior director, Dr. Stametz focuses on driving innovation and research throughout Geisinger Health System. She oversees the development, implementation, evaluation and dissemination of a robust clinical innovation and research portfolio.

Dr. Stametz is actively involved in the leadership of the CCI’s interrelated laboratories, including the Clinical Analytics and Application Laboratory, which focuses on areas of applied analytics and web application development; the Patient and Family Engagement Laboratory, which pursues the development of technologies and appropriate evaluation methodologies for engaging patient and families through the use of health information technology, and the Learning Health System Technologies Laboratory, which seeks to develop applications, methodologies and infrastructure to support widespread learning initiatives across the health system. From a scientific perspective, her interests include exploring patient and family engagement strategies, transparency in medicine and the evaluation of new health information technologies.

Rebecca holds a Master of Public Health from East Stroudsburg University and a doctorate in adult education from The Pennsylvania State University.



Christopher Still, DO has been studying developments in nutrition, metabolic syndrome and obesity for nearly three decades. His work has included research into genetic markers for obesity, NASH and diabetes; the metabolic differences among obese, formerly obese and normal-weight men; surgical options for severely obese persons; and leptin level determination among elderly obese women. He serves as principal investigator on a rural elderly nutrition and aging study of some 22,000 individuals.

He has recently edited CRC Press’s 2014 Nutrition and Bariatric Surgery as well as the 2014 ASMBS Textbook of Bariatric Surgery, Volume 1. He is the author of the book chapter on obesity in Conn’s Current Therapy 1999, 2007 and 2008 editions and the co-author of several other textbook chapters. He has also published in several journals, including Obesity, PNAS, Annals of Surgery, Current Gastroenterology Reports, Journal of Clinical Gastroenterology, and Surgery for Obesity and Related Disorders, among others. He has lectured on such subjects as vitamin and mineral metabolism; diet, nutrition, and exercise; obesity through the life cycle; and peri-operative medical and nutritional management of the bariatric surgery patient.

Dr. Still is certified by the American Board of Internal Medicine, the American Board of Obesity Medicine, the American Board of Physician Nutrition Specialists and the American College of Nutrition. He belongs to several professional societies, including The Obesity Society, the American Society of Metabolic and Bariatric Surgery and the American Society of Parenteral and Enteral Nutrition. He is a fellow of the American College of Physicians and the American College of Nutrition. He served on the board of directors for The Obesity Action Coalition and is the president of the American Board of Physician Nutrition Specialists, as well as other editorial boards. He and his program have been featured on CNN, National Public Radio, ABC News, The Discovery Health Channel and several local affiliates. He was awarded the 2011 ASMBS’ Integrated Health Circle of Excellence Award.

Dr. Still received his Master of Science from Columbia University Institute of Human Nutrition and his osteopathic medical degree from the Philadelphia College of Osteopathic Medicine. He completed his internship at the University of Buffalo at Sisters of Charity Hospital, followed by a residency in internal medicine and a subsequent fellowship in clinical nutrition and obesity treatment at Geisinger Medical Center in Danville, Pa.


Jennifer K. Wagner, PhD is the associate director of Bioethics Research for Geisinger Health System. She is part of the Integrating Bioethics @ Geisinger initiative. Since joining Geisinger in September 2015, Dr. Wagner has joined the patient engagement working group, the informed consent accessibility working group, the working group on learning healthcare systems, the social media in research working group, the genomics council, the GenomeFirst oversight committee and the genomics return of results clinical oversight committee.

Dr. Wagner’s main focus is to lead and conduct empirical bioethics research to inform Geisinger health, technology, engagement and research. Her personal scholarly focus is on the intersections of anthropology, genetics and law, with particular attention to human diversity, biocultural constructions of race and disparities in health and justice contexts. She earned a K99/R00 NIH Pathway to Independence Award from the National Human Genome Research Institute for her Multidisciplinary Study of Race, Appearance, Ancestry, Discrimination & Prejudice. Her research has also addressed a wide array of emerging issues, such as DNA fingerprinting, molecular photofitting, genetic discrimination, genetic privacy, DNA ancestry testing, direct-to-consumer personal genomics and the implications and applications of personal genomics in sports. Dr. Wagner has been engaged on the Genetics and Genealogy Curriculum Working Group, led by Dr. Henry Louis Gates Jr. and Dr. Nina Jablonski since 2008 to advance genetics and evolution education in middle school, high school and college.

Dr. Wagner earned her JD at The University of North Carolina and her PhD in anthropology at The Pennsylvania State University before completing postdoctoral research appointments at Duke University’s Institute for Genome Sciences & Policy and the University of Pennsylvania’s Center for the Integration of Genetic Healthcare Technologies. Prior to joining Geisinger, Dr. Wagner served in a U.S. senator’s office as a 2014–2015 AAAS Science & Technology Policy Congressional Fellow, where she managed the judiciary portfolio and assisted with privacy, health, consumer protection and environmental policy. In addition to her role in bioethics research, Dr. Wagner is a licensed, practicing attorney. She is a contributing editor to the Genomics Law Report, an academic editor for PeerJ (an open-access scientific journal), co-chair of the Ethics Committee for the American Association of Physical Anthropologists and member of the Ethics Committee for the American Association of Anthropological Genetics. She is a member of several professional organizations, including the American Association for the Advancement of Science, the American Society of Human Genetics, the American Association of Physical Anthropologists, the American Association of Anthropological Genetics, the American Bar Association, the Pennsylvania Bar Association and the Centre County Bar Association.



Chanin Wendling, MBA is the director of Geisinger in Motion, Division of Applied Research and Clinical Informatics.

Ms. Wendling has developed key strategies that leverage mobile and portal technologies to drive digital patient engagement and facilitate the provider’s ability to deliver quality patient care. Her mobile technology projects include smartphones for providers for secure text messaging and EMR access, text message appointment reminders, iPads to collect patient data and drive patient engagement, mobile apps for colonoscopy and lumbar spine surgery and eBooks. Her portal projects have included expanding patient access to clinical data; using the portal as a conduit to gather important patient data for areas such as medication reconciliation, depression screening and asthma management; using the portal to help patients prep for a visit so that exam room time can be focused; and providing a portal for referring providers to stay connected to their patients’ care at Geisinger.

Nicole Woll, PhD is the vice president for faculty and curriculum development in Academic Affairs across Geisinger Health System and is an assistant professor at Temple University School of Medicine. Academic Affairs oversees the education of more than 425 residents/fellows maintaining accreditation for over 40 programs, 50 full-time third- and fourth-year medical students as well as the Center for Continuing Professional Development with Joint Accreditation from the ANCC, ACCME, and ACPE. Dr. Woll is actively engaged in the Geisinger integrated curriculum for medical students, residents and fellows, as well as the faculty development efforts to continue to support our clinical learning environments. She is co-director of the standardized patient program that serves the health system in continuing to develop clinical, communication and professionalism skills through the Geisinger Education and Medical Simulation (GEMS) program.

Dr. Woll earned a bachelor’s degree from Bucknell University and came to Geisinger after completing her PhD at The Pennsylvania State University College of Medicine. She has also earned her Master of Education with an emphasis in health professions education from the University of Illinois. She has a focus on communication competencies, educational research and providing research training opportunities to the clinician investigator, with her own research interests in emotional intelligence.


Eric Wright, PharmD is a senior investigator and co-director of the Center for Pharmacy Innovation and Outcomes (CPIO) at Geisinger and adjunct professor of pharmacy practice at Wilkes University. Through the application of sound, systematic, pragmatic methodologies, the CPIO’s mission is to facilitate the dissemination of innovative approaches to pharmaceutical care within real-world healthcare. The CPIO’s focus areas include population health, pharmacoeconomics, medication safety, medication adherence, applied pharmacogenomics, pain, addiction and specialty pharmaceuticals.

Dr. Wright is involved in a number of system initiatives driven to improve medication use, engage patients and evaluate relevant outcomes. His research focuses mainly on medication use behaviors and medication adherence. He is an advocate for transparency of medical information to patients and disparate health providers and leads a study evaluating the impact of sharing hospital discharge information to community pharmacists on medication adherence and re-hospitalization. He is also principal investigator on an initiative designed to improve adherence and enhance the accuracy of the electronic health record medication list through innovative use of health information technology and patient input. He is the author of many publications, including a recent paper evaluating the impact of “OpenNotes” (an initiative of sharing primary care progress notes with patients through an electronic portal) on medication adherence to chronic medications.

Dr. Wright holds a Master of Public Health from Johns Hopkins University and a PharmD from the University of Pittsburgh.


Geisinger poster abstracts

geisinger.org


Authors: Rebecca A. Stametz, DEd, MPH1; Craig Wood, MS2; Christopher Still, DO,2,3

1Division of Clinical Innovation, Geisinger Health System, Danville, PA; 2Geisinger Obesity Institute, Geisinger Health System, Danville, PA; 3Center for Nutrition and Weight Management Clinic, Geisinger Health System, Danville, PA.

Background: Little is known about the lived experience of individuals who have maintained weight loss in light of the multi-dimensional viewpoints of obesity. Therefore, the purpose of this study is twofold: (a) to explore the experience and meaning-making processes of individuals who have maintained weight loss and (b) to explore how this learning manifested in successful weight maintenance and improved self-identity despite cultural stressors. This study is grounded in three intersecting theories, including Transtheoretical Model, Transformative Learning and informed by critical media literacy and critical public pedagogy.

Methods: Narrative inquiry was chosen to study the stories that bring meaning to the weight loss maintenance experience. Unstructured interviews elicited stories from 9 adult participants who successfully maintained a weight loss of 10–20% for at least one year and who were enrolled in a medical weight management program.

Results: Collective analysis resulted in four main themes; motivation to lose weight, learning processes, identity and hegemony, and obesity positionality. Integrating circumstances, disorienting dilemmas, and good learning triggered all individuals to want to lose weight. Changes in cognition and learning processes were evident and largely centered on non-formal, self-directed learning. There was little variation in self-identity, as weight loss was seen primarily as a physical transformation motivated by health and vanity. Challenges still surfaced in the areas of critical reflection on cultural/social factors, which is a pivotal aspect to a perspective transformation. Majority of participant’s continue to engage in the dominant discourse, have little acknowledgement to the role of advertising and have an obesity positionality with overtones of personal responsibility.

Conclusion: This study offers theoretical implications for adult learning and practical implications for strengthening subsequent intervention design.

Conversations with Adult Weight Loss Maintainers: A Narrative Analysis

Poster 1


Authors: Alanna Kulchak Rahm1, Janet L. Williams1, Michael Segal2, Lynn Feldman2, Audrey Fan1, Heather Stuckey3, Michele Bonhag, Doris Zallen4, Marc S. Williams1

1Geisinger Health System; 2SimulConsult; 3Penn State Hershey College; 4Virginia Tech University

Topic area: Clinical Genetics

Introduction: Most rare genetic disorders affect the lives of patients and their family on an ongoing basis. Current genetic laboratory results reports are designed for the provider; not for the patients and their families. Detailed information about disease prognosis is useful to clinicians for making the diagnosis and discussing with families, but the level of detail of this information is often more than can be practically conveyed by a provider in the typical patient encounter, or remembered by the family after the appointment. As part of a larger study of a patient-facing genetic testing report to facilitate patient and provider understanding of genetic results and improve patient involvement in care management, we tested whether tailored, detailed prognostic information about future health and development issues would be valued by parents if included in such a patient-facing report. We wanted to determine if such detailed information could be presented in a way that could be appreciated and used by families, or if it would be regarded as overwhelming or confusing.

Methods: Parents of children with intellectual disability without a causal diagnosis, who are undergoing whole genome sequencing as part of the larger study, were invited to participate in one of two focus groups. A total of 5 parents participated in the focus groups, one father/mother dyad and 3 additional mothers. Focus groups were led by an experienced moderator, recorded, and transcribed verbatim. Four sample presentations of detailed prognostic and temporal information for Mowat-Wilson disease were created using by exporting disease profile data from SimulConsult diagnostic software: one single page summary of findings with detail whether “few,” “some,” or “most” children would have that finding by multiple ages (birth to 15 years); one single page summary of findings with a column for how many children (“few,” “some,” “most,” or “all”) would show the finding by age 5, with another column of additional information about the finding; a single-page presentation with bulleted lists for treatment options, support, monitoring, and other guidance; and a multi-page comprehensive list of every finding related to the disease and by what age that finding would typically appear. The moderator presented the parents with each sample one at a time for discussion.

Results: Each of the four samples presented data in a way that was useful and important to parents, resulting in a unanimous request for a combination of three of the four different samples. All parents wanted the information from a single page summary table, but also appreciated the specific guidance offered in the one-page sample distilling the information into bulleted guidance for monitoring, support services, and additional medical specialists. All parents desired the temporal information as both a check list and for anticipatory guidance. Parents also wanted actual percent of children exhibiting findings instead of qualitative terms like “some” and “most.” Finally, parents wanting the comprehensive list of findings as a checklist they could revisit over time. Importantly, all parents discussed how they would utilize the information in each sample differently to engage in their child’s care, to help procure needed services, and to facilitate communication with doctors, family members, other caregivers, and schools.

Conclusions: We conclude that for reports of genetic results parents value multiple presentations of detailed disease prognosis with temporal information. This information can be generated automatically from an existing curated database. Parents desired this information as a personal resource, as a communication tool to engage in their child’s care, and as a resource to share with others. In the larger study, we will further assess whether the desire for this information continues and whether parents truly use these reports as a communication tool.

Parents Value Prognostic Information in a Patient-facing Genetic Test Report

Poster 2


Type: Original Research

Authors: Bailey-Davis L, Morris G, Cochran W, Hess LB*, Marini M*, Mowery JW, Lutcher S, Savage JS*

*Pennsylvania State University

Purpose: More than half of the infants in the United States participate in the Women, Infants and Children (WIC) program. WIC nutritionists and pediatricians deliver preventative care that is uncoordinated and even conflicting. The perspectives of pediatricians and WIC we evaluated to identify the opportunities and challenges of coordinating care to prevent infant rapid weight gain.

Methods: We used a semi-structured interview guide to gather the perspectives of pediatricians (N= 13) and WIC nutritionists (N= 35) in a Mid-Atlantic state. Investigators used a grounded theory approach to independently code-transcripts. Emergent and cross-cutting themes between groups are reported.

Results: Key themes regarding opportunities from both pediatricians and WIC nutritionists include: 1) Data sharing between clinical and community settings would improve quality of communication about care in either setting by removing mom as the messenger; 2) Care coordination would allow clinical and community partners to provide a unified front to deliver patient-centered messages for a higher dose of evidence-based prevention messaging; and 3) Open lines of communication between clinical and community partners should utilize health information technology strategies as well as informal educational sessions to enable relationship building. Both parties struggle with engaging mothers during preventive care due to parental preoccupation with electronic media and would benefit from an understanding of guidelines, policies, practices, strengths and capabilities of one another to foster care coordination.

Conclusion: Clinical and community sectors are optimistic about the potential to coordinate preventative care to promote more productive interactions between professionals and with parents to optimize engagement, learning, and healthy infant growth.

Cross-cutting themes about care coordination between pediatricians and community nutritionists for early childhood obesity prevention

Poster 3


First Author:

Carroll N Flansburg, MA, MPH, CPH, Geisinger Health System, Danville, PA

Co-Authors:

Monica A Giovanni, MS, LGC, Geisinger Health SystemW Andrew Faucett, MS, LGC, Geisinger Health SystemAdam H Buchanan, MS, MPH, LGC, Geisinger Health SystemMarci L Barr, ScM, LGC, Geisinger Health SystemMichael F Murray, MD, FACMG, FACP, Geisinger Health System

Background: The Geisinger MyCode Community Health Initiative biobank has completed whole exome sequencing on 50,000 participants for the primary purpose of discovery research. The associated GenomeFIRST return of results program represents an opportunity to study how to use secondary genomic findings to guide targeted patient care. The results of these interactions could help provide a model for returning results to other population studies including the 1 million people in the Precision Medicine Initiative cohort. Secondary results from our program enter the healthcare arena as unexpected test results. Central to a patient’s experience in managing these genomic results is the initial contact and subsequent flow of communication with their medical providers. The GenomeFIRST team has designed a communication plan for patients and providers in conjunction with an internal clinical oversight committee, an external ethics advisory council, and our institutional review board.

Methods: When a pathogenic or likely pathogenic variant is identified in one of 76 genes, the GenomeFIRST team notifies the provider via the electronic health record. Approximately 5 business days after this contact, the team sends the initial contact notification to the patient via certified mail or a secure electronic patient portal. This contact has four key aspects: (1) a thank you for participating in research, (2) a reminder of the purpose of the genomic research, (3) the identification of an actionable genomic result through their research participation, and (4) follow-up recommendations, including an appointment to discuss their result with either the GenomeFIRST team or their provider of record. Two additional contact attempts are made; if there continues to be no response from the patient, a fourth contact is made in the form of a certified letter. This letter notifies the patient that they have a result, that we have tried to contact them to discuss the result, provides contact information should they have any questions, and includes a copy of their genomic test result. A final notification is sent to the physician of record stating that multiple attempts to contact the patient were unsuccessful and that the patient is considered lost to follow up, however we remain available for information if the patient or physician contacts us.

Results: In a 6-month period (June to November 2015) the first 14 patients were notified of a secondary genomic finding through the GenomeFIRST program. Twelve of those patients received their initial contact letters through secure patient portal; patients read 11 of those messages. The remaining 2 patients were mailed a letter. Four patients responded to their initial contact to ask questions. Six patients were reached through subsequent phone calls. One patient is pending further contact attempts. Three patients did not respond to any contact attempts and were mailed a final contact letter containing a copy of their results; 2 of these patients responded to the final contact letter. Four patients have been seen by genomic specialists, 5 preferred to follow up with their primary care provider, 3 chose not to follow up, and 2 are pending further discussion.

Discussion: Identifying and employing appropriate patient contact methods to return of genomic findings identified through participation in research involves a complex interplay between providing accurate and appropriate information in a manner that is supportive of the patient and their physician while not causing undue anxiety. Early results have shown that multiple contact attempts using different methods may be required before the patient responds. As we continue to return results we will be able to develop methods to assess the patient’s preferred method of condition-association risk management and potentially expedite the process. Through the GenomeFIRST program we hope to establish a model for effective engagement, results delivery, and initiation of clinical management. Data on patient preferences and the overall efficacy of varied approaches could potentially inform procedures for returning actionable results to participants in large cohorts such as the Precision Medicine Initiative cohort.

Key Words: clinical genomics, contact, results, secondary findings, biobank, GenomeFIRST, screening

Patient and Provider Notification of Secondary Genomic Findings in Geisinger’s GenomeFIRST Program

Poster 4


Authors:

Randall Hutchison, MBA, Director, Patient Experience, Geisinger Health System, Danville, PA

Peter Berger, MD, Chairman of Cardiology, Geisinger Health System, Danville, PA

Jeffrey Tiesi, System VP Cardiovascular Service Line, Geisinger Health System, Danville, PA

Robert Spahr, MD, Senior VP, Service Quality, Geisinger Health System, Danville, PA

John Gerdes, PhD, Adult Psychology Program, Geisinger Health System, Danville, PA

John Bulger, MD, Chief Quality Officer, Geisinger Health System, Danville, PA

Geisinger Health System is a large integrated healthcare system located in central Pennsylvania. Geisinger’s Cardiovascular service line (CVSL) employs more than 50 cardiologists and more than 20 cardiology extenders (Physician Assistants and Nurse Practitioners), and has a fellowship program. Overall, the Cardiology service line has a history of very high patient satisfaction scores in aggregate, but as in almost all large departments, the individual physician patient satisfaction scores vary widely. Using data from Press Ganey, some of the cardiologists at Geisinger Health System score near the very top of cardiologists with consistent scores greater than the 90th percentile, some score in the middle of the comparator group, and some score in the bottom third.

Cardiology service line leadership identified individuals who were chronically scoring in the bottom third in terms of patient satisfaction and felt it important to help those physicians improve their scores. Instead of singling out one or two providers at the very bottom of the list to target, the service line wanted to provide direct help for all 14 cardiologists who were individually scoring below the 30th percentile.

A Geisinger Health System initiative within the department of cardiology had its highest success rate to-date, with 11 of 14 physicians who had chronically low patient satisfaction scores demonstrating improvement following an intervention involving experts in physician-patient relationships and communication, and the direct involvement of the physician leader. The active involvement of a physician leader makes a huge difference in the success of such interventions, and accounted for much of the success of this specific initiative.

Improving Individual Provider Patient Satisfaction Scores in Cardiology“Actions Lead Louder Than Words”

Poster 5


Authors: D. Clarke1, A. Berger2, J. Green1, R. Stametz1, J. Wolff3, J. Darer1

Affiliations: 1Center for Clinical Innovation, Geisinger Health System; 2Biostatistics Core, Geisinger Health System; 3Johns Hopkins University

Background: OpenNotes is an initiative granting patients access to provider notes through the patient portal (MyGeisinger). This has potential to be a tool in engaging family caregivers, but few caregivers have registered for portal access. Geisinger recently provided access to open notes for patients and family caregivers with shared access to the patient’s online health portal. Our study aims to understand the relationship of these patients to their caregivers, reasons for shared access, and opportunities for engaging this dyad through OpenNotes.

Methods: A survey was administered to 856 Geisinger patients and 735 caregivers who have caregiver access to these patients’ online health portal account. A multi-modal approach was used to administer the survey: electronically, via postal mail and over the phone.

Results: Three hundred and twenty-three patients (38%) and 389* caregivers (53%) responded to the survey (Table 1). The patients who responded were mostly 65 and older (41%) or under 25 years old (33%). Patients had granted MyGeisinger caregiver access to a spouse (26%), adult child (29%) or parent (39%). In contrast, caregivers were mostly age 25-64 (85%) and predominantly female. The majority of patients received help with at least one health-related task (75%). Patients were much more likely to have low health literacy (55%) compared to their caregivers (9%) (Table 2). Use of technology, including the internet, was less among patients than caregivers (55% daily vs. 88%)(Table 3).

*Note: 389 caregivers responded, but had 462 responses as some responded for multiple patients under their care.

Discussion: Understanding the heterogeneity of the patients and family caregiver who have access through the patient portal will help us to better engage and support the family network. A follow-up survey is planned in April 2015 to understand the impact of OpenNotes on the population.

Funding for this work was provided by a grant from the Robert Wood Johnson Foundation.

For more information on all OpenNotes initiatives please visit myopennotes.org.

OpenNotes and Family Caregivers: Understanding MyGeisinger Caregiver Access as a Means of Transparency and Patient-Family Engagement

Poster 6


Authors: Rahm AK, Buchanan AH, Davis FD, Fan A, Bailey L, Fultz K, Williams JL, Murray MF.

Geisinger Health System, Genomic Medicine Institute

Introduction: The American College of Medical Genetics and Genomics (ACMG) and the American Academy of Pediatrics (AAP) recommend that decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. However, parental attitudes about notification of adult-onset conditions in healthy children who undergo genetic screening without a clinical indication (e.g., through a biobank) remain relatively unexplored. The goal of this study is to elicit the perspectives of parents of children who are enrolled in Geisinger’s MyCode Community Health Initiative biobank — children whose biospecimens may undergo whole exome sequencing (WES) and the possible return of genomic results in the form of pathogenic variants in 76 genes, including the 56 genes listed by ACMG.

Methods: Three focus groups were conducted to elicit parental attitudes toward learning about adult-onset conditions in the ACMG list without childhood medical management guidelines in their children. Additional focus groups are planned. Participants (N=14) were adult MyCode participants whose minor children were also enrolled in MyCode, but had not yet undergone WES. Parents were recruited into the groups based on the age of their children — each group included parents of either 0-8 year olds or parents of 9–17 year olds. Focus groups used a deliberative engagement format, with education via media-based scenarios followed by discussion. Education included the ACMG and AAP recommendations and the risks, benefits, and ethical principles considered in those recommendations. Thematic analysis was conducted on verbatim transcripts of each focus group.

Results: All parents identified the desire to contribute to research as a main reason for consenting to have their children participate in MyCode. All parents were also interested in learning about the information to be gained from WES and about results important to their child’s health now as well as into adulthood. One parent focus group suggested researchers return results only for conditions with established medical interventions. Another group asserted that, even if results from WES would not impact their children’s medical care until adulthood, they would use results to encourage their children to adopt a healthier lifestyle that involved a change to diet and exercise. Most of the parents argued that the importance of this information to their children’s future health was in the best interest of the children and outweighed the right of children to make their own decisions about testing once they reach the age of majority. Parents also expressed a strong preference for hearing the results without their children present and for controlling how and when their children are informed. Opinions about how to inform children were dependent upon a child’s age. One parent expressed some reservation about learning children’s results for adult-onset conditions, but was adamant that WES should include results for adult-onset conditions that are placed in children’s medical records, and used to guide their medical care. Of note, parents in all groups also expressed the desire to know negative results as well as pathogenic variants for adult-onset conditions.

Conclusions: With few exceptions, parents of healthy children in our study want their children’s specimens to undergo genetic screening and want to receive results about adult-onset conditions, primarily because this information could be beneficial to future health as well as for prevention now. Parents wanted to hear the results first and control when and how they tell their children. Some parents also felt the information was important because they could encourage healthy behaviors in children, despite the lack of medical management guidelines. Specific conditions, such as Lynch syndrome and Hereditary Breast and Ovarian Cancer syndrome, for which there is no preventive strategy in childhood and which are unstudied regarding potential psychosocial harms in healthy children, will be explored further by our group.

Parental attitudes towards receiving genomic results for adult-onset conditions in healthy children

Poster 7


Authors: Janet Williams, Alanna Kulchak Rahm, and Daniel Davis

Background: Patient engagement and patient centeredness have become catch phrases used as core principles in reference to the Affordable Care Act, Learning Healthcare Systems, value-driven care and the Patient Centered Outcomes Institute, PCORI. Patient engagement is not a new concept; in 2001, the IOM defined patient and family centered care as care based on continuous healing relationships, customized according to patient needs and values, patient control, information equipoise, transparency, and anticipation of patient needs. Increased attention is also being paid to include patient defined outcomes, demonstrated shared decision making and patient assessed value in their care as benchmarks for reimbursement.

Methods: At Geisinger Health System, we have developed a framework to guide patient engagement across the continuum of care and in research and discovery to meet the strategic aim of enhancing the experience and quality of care for patients and their families. We have launched several initiatives and working groups to improve engagement of patients, families, and clinical stakeholders to continue evolving as a learning healthcare system. Initiatives include assessment of existing expertise to assist in engagement across the research continuum, multiple advisory boards, and developing purposeful community engagement activities. Workgroups developed include project-specific patient advisory committees, a patient engagement workgroup comprised of stakeholders across research and healthcare operations, and workgroups to design specific engagement tasks such as symposia and knowledge assessments regarding the learning healthcare system environment.

Results: We will present the overarching framework and strategies developed by the Geisinger patient engagement workgroup and share materials and strategies employed to encourage meaningful patient engagement in study design, measures, analysis and conclusions. Strategies include pre-engagement activities, identifying patient research partners, supporting patient partners, and the role of patient partners in dissemination and implementation.

Conclusions: Effective patient and family engagement in research depends upon adequate technical, programmatic and human resources that collectively constitute an integral infrastructure.

Formalizing and Optimizing Patient Engagement in a Large Healthcare System

Poster 8


Authors: Melody L. Danko Holsomback, Georgia F. Kornblatt

For the last several years, small groups within the Geisinger Health System have been working to increase the frequency of Advance Care Planning conversations and the completion of Advance Care Plans among patients with life-limiting illnesses and a life expectancy of one to two years or less. Between 2014 and the present, several different pilots have been run in order to attempt to make inroads with advancing Advance Care Planning. Some of these pilots have proven more successful than others, but all of them have provided insights into the barriers facing the initiation of end of life conversations, the continuation of those conversations through the completion of and Advance Care Plans, ongoing review of Advance Care Plans, and follow through with Advance Care Plans at the end of life. This poster will seek to provide insight into what inhibits improvement in Advance Care Planning and potential strategies for mitigation.

Advance Care Planning Pilots: Barriers to Improvement

Poster 9


Authors: Jennifer L. Wolff, Jonathan Darer, Andrea Berger, Deserae Clarke, Jamie A. Green, Rebecca Stametz, Christina Yule, Jan Walker, Tom DelBanco

Research Objectives: The provider-sponsored patient portal is instrumental to engaging patients and families in care. In a previous study of OpenNotes nearly 9,000 Geisinger Health System (GHS) patients were invited to read their primary care doctors’ visit notes through the patient portal. Many patients informally shared visit notes with family members; however, patients and care partners who explicitly shared access to a patient portal account were excluded from participating. This study sought to examine the acceptability and effects of OpenNotes on patient and care partner experiences in managing aspects of patients’ care.

Study Design: Survey at baseline and after 12 months exposure to OpenNotes.

Population Studied: Adult patients and care partners who share access to the patient portal account at GHS.

Principal Findings: Of 856 patients and 736 care partners who were eligible, 323 patients and 389 care partners completed a baseline survey, and 184 patients and 252 care partners responded at follow-up (57.0% and 64.8% response, respectively). Most patients (63.9%) and care partners (87.5%) viewed one or more available doctor visit notes at follow-up, stating a desire to learn about the patient’s health, to remember or better understand what was said by the provider during the visit, or to verify the accuracy of the doctor notes. More than one in three (35.5%) care partners viewed visit notes because they were unable to attend the doctor visit and wanted to know what was discussed. A large majority of patients and care partners perceived benefits and few reported downsides from reading doctor’s notes. At follow-up, patients and care partners responded that “because of care partner’s access to OpenNotes” they were more likely to agree about the patient’s treatment plan (84.6% and 78.6%, respectively) had more productive discussions about the patient’s care (85.6% and 75.8%), and were better able to formulate questions for the doctor (88.3% and 75.8%). Care partners were generally well prepared to manage aspects of patients’ care at baseline and few differences were observed at follow-up, although they were more likely to report improved communication with patients’ health care providers at follow-up than at baseline (OR=1.74; 95% CI: 1.36, 2.23). At follow-up, patients were significantly more confident in their ability to manage their health information (OR=2.13; 95% CI: 1.58, 1.90), to manage their care (OR=1.50; 95% CI: 1.15, 1.95) to prepare for office visits (OR=1.40; 95% CI: 1.04, 1.90), and to understand their plan of care (OR=1.38; 95% CI: 1.04, 1.84) than at baseline.

Conclusion: Making doctors’ visit notes available to patients and care partners who share access to a patient portal account was acceptable and resulted in improved communication between care partners and providers and increased patient confidence in managing aspects of their care.

Implications for Policy, Practice or Delivery: Many patients rely on or choose to involve family or friends in managing their care. Leveraging health information technology to purposefully involve family members as desired by patients could help bridge the digital divide and facilitate more appropriate and efficacious consumer engagement strategies and patient care.

Keywords: Health information technology, patient portal, care partner, consumer engagement

Inviting Patients and Care Partners to Read Their Doctors’ Notes: OpenNotes and Shared Access to the Patient Portal

Poster 10


Authors: D’Andra Lindbuchler, MSN, CRNP, Marci Barr, ScM, LGC, Kandamurugu Manickam, MD, Michael Murray, MD

Background: Over 100,000 Geisinger patients have joined Geisinger’s biobank called the MyCode Community Health Initiative. MyCode participants allow researchers to sequence their DNA, combined with medical record information for analysis. MyCode research data is also being used for clinical care through a genomic return of results (ROR) program, GenomeFIRST™. GenomeFIRST™ ROR screens MyCode DNA data for a subset of genetic results to give back to participants. This program will help find people at risk for disease so that they can get appropriate preventative care and disease management. This is different from the traditional care model where most people seek DNA testing to address a health problem. We would like to prevent the disease from occurring if possible.

Methods: When a result that suggests an increased risk for disease is found in one of 76 genes, the GenomeFIRST™ team first notifies the participant’s healthcare provider. The patient receives a letter or MyGeisinger message notifying them a MyCode result is available. Patients can opt to meet with a genomics provider or other appropriate healthcare provider to follow-up on their result. In-person, telemedicine, or genetic counseling sessions via telephone are available options for patients.

Results: To date, 106 participants in MyCode have received a result. The majority of results are of three conditions; most patients have chosen to be seen by the GenomeFIRST™ team. Many of these patients have not had a personal history indicating disease risk. Ultimately we expect that 2000 to 4000 MyCode participants will have a returnable result.

Conclusion: Geisinger is implementing a 21st century medicine approach with the goal of integrating personalized medicine into everyday healthcare to improve outcomes based on early diagnosis and disease prevention.

“ What You Might Get Out of MyCode – A GenomeFIRSTTM Approach to Care”

Poster 11


Authors: Michael J. Smith, MHS, MS; Amanda L. Jones, MBA; Chanin Wendling, MBA; Alistair Erskine, MD; Jonathan R. Slotkin, MD; Kyle Brewer, MBA

Patient satisfaction is a key measurement in healthcare today. Patient satisfaction scores are helpful for providers to gauge their effectiveness. The Department of Health and Human Services bases their reimbursement on HCAHPS scores and many hospitals are left looking for ways to increase patient satisfaction. Geisinger Health System has developed an innovative new way to help increase patient satisfaction, ProvenExperienceTM.

ProvenExperienceTM is a promise of providing the best patient experience for every patient, every time. The program offers refunds to patients whose expectations were not met. This new program moves the practice of providing great patient experience forward.

A pilot of the program was introduced at Geisinger Medical Center in Danville, Pa., in November 2015. A key component of the program is a patient mobile app, developed by Geisinger, which allowed certain surgery patients enrolled in the pilot to provide their feedback about their experience and if unhappy, determine the amount of the refund they want based on their co-pay. If a patient paid a $1,000 co-pay and they’re not pleased with how they were treated, they can use the ProvenExperience app and select the refund they desire. The refund will be processed within 7 to 10 business days. The app is now available for any Geisinger patient as a method to provide feedback and request a refund.

Geisinger’s reputation has been built on transforming the way health care is delivered. ProvenExperienceTM, an evolution of Geisinger’s renowned ProvenCare portfolio, elevating patient experience to the same level as quality and safety.

Patient Satisfaction Through A ProvenExperienceTM

Poster 12


Authors: Nancy Kass, Ruth Faden, Rachel E. Fabi, Stephanie Morain, Kristina Hallez, Danielle Whicher, Sean Tunis, Rachael Moloney, Donna Messner & James M Pitcavage

Background: Informed consent requirements generally require a lengthy process and signed documentation for patients to participate in clinical research. With growing interest in comparative effectiveness research (CER), whereby patients receive approved (nonexperimental) medicines for their medical condition, questions have been raised whether the same consent requirements should apply. Little input from patients has been part of these debates.

Methods: We conducted two “deliberative engagement sessions” with patients from Johns Hopkins Community Physicians (JHCP) and Geisinger Health System (GHS). Full-day sessions introduced participants to two different CER designs (observational vs. randomized) comparing two antihypertensive medications and three disclosure or consent approaches: Opt-In, Opt-Out, and “General Approval.” Sessions consisted of presentations and extensive discussion at small group tables. Pre- and posttest surveys were completed by participants before and after all-day discussions measuring attitudes about research and about each of the three disclosure/consent options.

Results: One hundred thirty-seven adults over age 40 years participated. Attitudes were similar between JHCP and GHS. Participants strongly preferred Opt-In or Opt-Out consent options to General Approval for both observational and randomized designs. For the randomized CER study, 70% liked Opt-In, 65% liked Opt-Out, and 40% liked General Approval. In discussing disclosure/consent options, patients cared most about choice, information, privacy and confidentiality, quality of the research, trust, respect, and impact of the study on patient care.

Conclusions: The majority of participants from two different types of health systems liked both Opt-In and Opt-Out approaches for observational and randomized designs for low-risk CER. There were no posttest differences in the proportion liking Opt-In versus Opt-Out. Patients in this study wanted to be told about research and have a choice, but were very open to such disclosures being streamlined. Policymakers may find patients’ views about what matters to them in the context of consent and CER relevant.

Alternative consent models for comparative effectiveness studies: Views of patients from two institutions

Poster 13


Authors: Rahm, A.K.; Kip, N.K.; Guha, S.; Fan, A.; Kaspar, H.G.; Williams J.L.; Gogoi, R.; Chen, Z; Davis, D.; Williams, M.S.

Background: Universal Lynch syndrome screening (ULS) has top-tier evidence for reducing cancer morbidity and mortality and is an objective of Healthy People 2020. ULS evaluates all colorectal tumors for mismatch repair gene deficiency and offers genetic counseling and confirmatory genetic sequencing to individuals based on the screening results. Additional guidelines recommend similar assessment of all endometrial tumors. Integration of ULS into clinical practice has been limited by lack of uptake and inconsistent implementation within systems. Geisinger Health System instituted ULS of all colorectal tumors in 2009 and added endometrial tumor screening in 2012.

Methods: One molecular pathologist and two genetic counselors evaluated immunohistochemical screening results of all colorectal and endometrial cancers tested since 2009. Program data were reviewed at multiple intervals. Presentations to various stakeholder and leadership groups facilitated program implementation and improvement.

Findings: 916 colon tumor results were evaluated from 2009 – 6/2015 and 161 endometrial tumor results were evaluated from 2012 – 6/2015. Review of colorectal cancer data in early 2014 identified gaps in the existing algorithm. Reflex BRAF and MLH1 promoter hypermethylation (PHM) were inconsistently performed. Presentation to pathologists in 5/2014 of this gap and rationale for the process resulted in an updated protocol. A collaborative tracking system was created to identify and facilitate communication about patients requiring confirmatory genetic testing. In 10/2014, endometrial cancer screening was reviewed. Presentations to multiple stakeholder groups, including pathology, ethics, genomic medicine, and gynecologic oncology were instrumental in removing barriers to incorporate endometrial screening. Concerns and barriers discussed included the need for informed consent, potential patient-related costs, health system costs and responsibility for follow-up of positive results. In June, 2015 system leadership supported full universal screening of endometrial cancers including the addition of reflex MLH1 PHM testing. Continual review and evaluation led to improvements in the ULS program resulting in optimal use of resources and improved identification of individuals at risk for Lynch syndrome.

Implications for D&I: Implementing ULS at Geisinger has yielded lessons potentially applicable to subsequent efforts to launch other genomics-informed public health practices and begin to realize the promise of precision medicine.

Implementing genomic medicine in an integrated health system: evaluation and improvement of a universal lynch syndrome screening program

Poster 14


Authors: Alex R. Chang, MD, MS, Christina Yule, Elisabeth Graboski, Anna Ziegler, RD, Vonda Hetherington, RD, Jacob Mowery, Lori Shah, DO, Charlotte Collins, PhD, Lisa Bailey-Davis DEd, RD

Background: Sodium intake and dietary acid load are important dietary factors that can influence the rate of progression of chronic kidney disease (CKD). An important, underutilized strategy to reduce progression is dietary counseling or medical nutrition therapy (MNT). Patients consulted in the formative phase indicated enthusiasm for strategies that reduced barriers to accessing MNT.

Objectives: The objective of our study is to test the usability of a smartphone application in conjunction with motivational interviewing and MNT to decrease sodium intake and dietary acid load in patients with early CKD.

Methods: Geisinger patients with stage 1-2 CKD and smartphones are being invited to participate in a pilot study testing the feasibility and acceptability of a smartphone app counseling program designed to reduce sodium intake and dietary acid load. Participants receive 8 weeks of intensive MNT by registered dietitians trained in motivational interviewing by telephone, educational materials on an internet website employing theoretically-based principles of behavioral change (fitkidney.com), and a smartphone app program using a HIPAA-compliant, FDA-approved mobile health platform (Vibrent Inc.). The smartphone app includes meal logging, daily reminders and tips, and direct communication with the dietician and study team. In addition to app analytics and participant surveys, semi-structured interviews will be conducted after completion of the study to attain feedback on the program. Baseline and post measures include 24-hour urine collections and dietary recalls that will be used to evaluate change in eating behaviors and biological outcomes.

Results/Conclusion: Thus far, 3 individuals have started the program with a total of 15 planned over the next 3-4 months.

Facilitating Improvements in KIDNEY Health Using a Smartphone App Counseling Program (FITKIDNEY): a Pilot Study

Poster 15


Authors: Snyder, Susan R., Leeming, Rosemary, Hao, Jing, Rahm, Alanna, Geng, Zhi

Background: There is considerable variation in adherence to available evidence-based recommendations for risk assessment, screening, genetic counseling and testing, surveillance and preventive care for women at risk for breast cancer. To improve adherence, patient outcomes, and facilitate appropriate referral to genetic testing, Geisinger implemented a new care model in February 2015 to systematically and efficiently deliver appropriate risk assessment and management services using mid-level providers. This “High Risk Breast Clinic” (HRBC) provides any interested woman with a personal risk assessment and care plan. Validated risk assessment approaches are used to stratify women into differing risk levels. This new approach focuses on the large moderate risk (5-year risk ≥ 1.7 percent and/or lifetime risk ≥ 20 percent) and average risk (5-year risk ≤ 1.7 percent) populations, who comprise the majority of women and who are typically underserved with usual care. It provides them with evidence-based counseling, surveillance and chemoprevention care services. This clinic also serves women with dense breasts (density greater than 50% which includes about half of all women) who are also known to be at increased risk for breast cancer.

Methods: The hypothesis is the HRBC care model with specially trained mid-level providers to assess, stratify and manage women in different risk levels improves delivery of appropriate care, patient experience and health outcomes with a favorable impact on cost compared to usual care for the targeted population of women at moderate risk of developing breast cancer. A decision analysis model will compare care, outcomes and costs for the HRBC’s approach to usual care. Information sources for model assumptions and parameter values will be based on Geisinger patient data, literature and expert opinion to develop estimates for clinical and economic outcomes.

Results: A decision analysis model comparing Geisinger’s HRBC to usual care will be used for a budget impact analysis to show the effect of differences in patient care on outcomes and costs, including benefits of delivering risk-based prevention and treatment at earlier stages to moderate risk patients. This analysis will be used to make a business case for an integrated health system.

Conclusion: A new targeted care model providing evidence-based risk assessment and screening services to women at moderate risk for developing breast cancer offers the potential to improve delivery of appropriate care, patient experience and health outcomes with a favorable impact on cost.

High Risk Breast Clinic –A New Evidence-Based Model for Cancer Risk Assessment and Screening

Poster 16


Authors: R. M. Martinez1, H. E. Kay2, L. M. Scicchitano1, and D. M. Wolk1,2

1Geisinger Health System, Department of Laboratory Medicine, Danville, PA, 2Wilkes Univ., Wilkes-Barre, PA

Background: Nucleic acid amplification and detection of respiratory virus (RV) pathogens is rapid and sensitive, but multiplex methods can be costly. Implementation of molecular methods promotes improvement in turnaround time (TAT) and increased laboratory workflow efficiency; however, few studies assess the impact of rapid results on downstream patient outcomes. The purpose of this study was to assess the impact of rapid multiplex RV testing for an ICU patient population.

Methods: Geisinger Medical Center is a 560-bed quaternary care hospital within an integrated health service organization of 8 hospitals, which serves >2.6 million residents throughout 45 counties in Pennsylvania and performs multiplex RV testing prior for all admissions. Between Nov. 1, 2010, and March 19, 2012, batch molecular RV testing (pre-intervention) was performed once per day for all inpatients. Between March 19, 2012, and April 30, 2014, RV testing (BioFire Diagnostics) was performed on a first-in first-out (FIFO), random access basis (post-implementation) with priority to ICU and ED locations. A quasi-experimental design was used to compare retrospective categorical and continuous data from pre-and post- intervention cohorts. The following data variables were analyzed using descriptive and comparative statistics in JMP ver. 12.0.1: collect to report time (CTR), 28 day mortality, length of stay (LOS), ICU days, ventilator days, anti-microbial (including viral and bacterial) utilization, laboratory test utilization, and total cost.

Results: Pre- (n=278) and post-intervention (n=462) groups showed similar data distributions for age, gender, diagnosis-related group, percent positive results, and treatable viruses detected. The following data variables showed statistical post-implementation improvement (by chi-squared analysis): 28-day survival, LOS, ICU days, ventilator days, anti-microbial utilization, laboratory test utilization, and total cost. The mean CTR was reduced by 30.5 hours for the post-implementation period and was associated with significantly improved mortality when results were reported in < 7 hr. Patients with positive RV results displayed a significant reduction in mortality. A 50% decrease in mortality was observed for Flu A-positive patients; however, due to the small sample size the difference was not statistically significant. For patients with negative RV results, mean ICU stay, mean overall LOS, and mean total cost decreased by 3.3 days, 1.9 days, and $8,082.60, respectively.

Discussion: Rapid molecular results can improve downstream patient and operational outcomes. Although random access molecular methods tend to be more costly than batch molecular assays, improved outcomes in certain populations, such as ICU, may warrant their use. A plan for action, driven by the test result, and attention to monitoring and improving CTR as a quality indicator appears to be an important strategy. Additionally, this study demonstrated that 28-day mortality significantly increased when results were reported in > 7 hours. Although a FIFO workflow may not be feasible for some laboratories, it may be possible to implement batch testing to achieve similar CTR. Lastly, the increased sensitivity and rapid result can promote antimicrobial stewardship and minimize overall healthcare costs per visit. Population-specific analysis is warranted for different medical practices and patient populations.

Implementation of Non-Batched Respiratory Virus Assay Significantly Impacts Patient Outcomes in the ICU

Poster 17

symposium on enhancing patient- and family-centered care … · 2016-09-12 · enhancing patient-...

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