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Technology helps connect doctors fighting opioid abuse

Misuse of opioid painkillers such as Vicodin has reached epidemic proportions in rural Colorado

The places hit hardest by the opioid epidemic often have the fewest resources to fight it. Places like rural Colorado, where doctors in small towns are on the front lines and need reinforcements.

CU Anschutz fights the opioid epidemic

This is the fourth in a series of articles that examines how University of Colorado Anschutz Medical Campus faculty and students are finding ways to solve the opioid epidemic.

That is a problem Liliana Tenney, MPH, an instructor at the Colorado School of Public Health (ColoradoSPH) and deputy director of the Center for Health, Work & Environment, knows must be solved.

“There are a lot of primary care physicians in rural areas across the state who are facing significant challenges when it comes to the opioid epidemic,” Tenney said. “It’s the rural providers, the ones that have less time and access to resources, who need the most help.”

Tenney is one of many University of Colorado Anschutz Medical Campus researchers and faculty working on the epidemic. She believes using online training programs and telemedicine offer effective ways to reach rural doctors and help them fight the epidemic.

Taking opioid education online

Together with colleagues in the ColoradoSPH Center for Health, Work & Environment, Tenney developed one of the first internet-based classes teaching doctors about alternatives to prescribing opioid painkillers such as Vicodin and OxyContin to manage non-cancer chronic pain patients.

Liliana Tenney MPH
Liliana Tenney MPH

Tenney said the course, “The Opioid Crisis: Guidelines and Tools for Improving Chronic Pain Management,” was designed with rural doctors in mind.

“We decided early on that we wanted to develop an online training so that we could reach providers all across the state who didn’t have access to big conferences or the time to go,” she said.

After a few years of work, she sees signs of success. More than 3,000 doctors have taken the course since it debuted a few years ago. Follow-up surveys showed doctors were using the information in their practice, had begun checking the state’s database of prescription drugs, and had started discussing with patients how to safely use, store and dispose of opioids.

“It’s been really encouraging to see the results and what’s happening in terms of education,” Tenney said.

Telemedicine and treatment

Opioid abuse by the numbers

188 people died in Colorado from misusing opioids such as Vicodin and OxyContin in 2016

 

Colorado ranks 15th in the nation for opioid abuse—down from second in 2011

Tenney is now co-chair of the Colorado Consortium for Prescription Drug Abuse Prevention’s provider education work group. One of its missions is to find ways to reach and educate all prescribers in rural areas and mountain towns including doctors, dentists and even veterinarians. Now, they are working to use telemedicine to help doctors help their patients overcome addiction.

The consortium is considering expanding an initiative named Project ECHO (Extension for Community Health Outcomes in Colorado). It uses video conferencing to bring together small groups of doctors. Experts discuss best practices or the latest research, and doctors can present tough cases to their peers.

The meetings could replicate in-depth, interdisciplinary case conferences, which are common at medical schools and large hospitals but less common for rural physicians.

“In a lot of these communities, they don’t have these types of resources,” Tenney said.

Despite the challenges, doctors are committed to fighting the epidemic while making sure their patients have the medications they need to be well.

“The medical community knows they need to take action,” Tenney said. “I think we’re making a lot of progress in preventing opioid misuse and abuse. On both the prevention and treatment side, I think there’s still a lot to do.”

Providers interested in learning more about how to prevent opioid misuse can visit ucdenver.edu/chwe/preventingrxabuse to learn more about the Center for Health, Work & Environment’s online training.

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Fighting opioid misuse by linking electronic health records, databases

Emergency Department staff
A pilot project at the University of Colorado School of Medicine is linking its electronic medical records to state prescription drug database.

Doctors should be able to rely on new technology to fight opioid misuse, University of Colorado School of Medicine (SOM) Assistant Professor Jason Hoppe, DO, believes. But so far, existing systems such as online databases that track prescriptions have not lived up to their promise.

Dr. Hoppe, an emergency room physician and medical toxicologist, wants that to change, and he thinks a pilot project at the CU Anschutz Medical Campus might be a step in the right direction. Hoppe and a team of physicians and software developers have linked the state’s online opioid prescription database, the Colorado Prescription Drug Monitoring Program (PDMP), and University of Colorado Hospital’s electronic medical records system.

CU Anschutz fights the opioid epidemic

This is the third in a series of articles that examines how University of Colorado Anschutz Medical Campus faculty and students are finding ways to solve the opioid epidemic.

The new connection already saves doctors in the Emergency Department time. With a single click, physicians can see if a patient might be at risk for misuse, abuse or diversion of controlled medications, or if a patient might be going from provider to provider trying to get new prescriptions. It also could stop a doctor from prescribing medications that could be lethal when mixed with an opioid. So that single click could save a life or prevent or stop addiction, Hoppe said.

The federally funded project is an example of how CU Anschutz faculty and researchers could have a national impact on the opioid abuse epidemic. The project could lead to better software that helps doctors and hospitals across the country improve patient safety, identify people vulnerable to addiction, and stop prescription medication misuse.

Diagnosing a digital disconnect

Jason Hoppe
School of Medicine professor Jason Hoppe

Software that tracks prescription medications has been available for years. Since 2008, Colorado has had an online statewide database that records whenever a pharmacy dispenses a controlled substance. That includes opioids such as Vicodin and OxyContin, as well as other potentially addictive medications, such as stimulants like Adderall and benzodiazepines. Doctors and other health care providers can review a patient’s history before writing a prescription.

Hoppe said such databases could also be effective tools for identifying people who try to persuade multiple doctors to write prescriptions for opioids or addictive medications. Doctors could then refer them to treatment. Databases also can warn doctors if a patient takes a dangerous combination of medications, and in the future software could create risk profiles that could identify a patient susceptible to addiction.

“I think there are positives, and there is evidence that shows they improve patient safety,” Hoppe said. “But there are a lot of barriers to using it.”

Hoppe cited national statistics to support his view. Doctors only check the databases in their states 12 to 20 percent of the time before they write a prescription for a controlled substance.

“We would like to get that number a lot higher,” Hoppe said. He is in a position to help, as the co-chair of the Colorado Consortium for Prescription Drug Abuse Prevention’s working group focused on improving the database.

The critical element is time. Doctors need to quickly diagnose and treat patients while simultaneously reading and updating electronic medical records (EMR). Switching to a different software program to check the state database takes several steps and distracts both doctors and patients.

“If you’re in a busy primary care clinic or emergency department, and you’re seeing patients for only five minutes, and it takes you five minutes to load the system, you’re unlikely to use it,” Hoppe said. If doctors think a patient needs an opioid painkiller and do not see signs that raise concerns about possible misuse or abuse, they often write prescriptions without checking the state’s database. Then they have to move on to the next patient.

Testing the link

Opioid abuse by the numbers

 

329 people died in Colorado from misusing prescription opioids in 2015

 

224,000 Coloradans misuse prescription drugs each year

 

Colorado ranks 15th in the nation for opioid abuse—down from second in 2011

An obvious solution would be to integrate the state database and EMR systems. Hoppe said doing that took about a year. To overcome technical problems, the team worked with Epic, the software company that sells one of the most widely used EMR systems. UCHealth uses Epic’s software and is part of the project.

The initial rollout is small, Hoppe said, with doctors in the SOM’s Emergency Medicine Department and the University of Colorado Hospital being the first users.

“We have to see how it does, how people like it, and if we can make it solvent in terms of cost,” Hoppe said. The U.S. Department of Justice funded the pilot project, and the software will have to show results before receiving more financial support.

Users at CU Anschutz like the system so far, Hoppe said, and it already has made his job easier.

“I use it for 90 percent of patients now that it’s just one click,” he said.

Ultimately, Hoppe would like to see the system or a similar one used nationally, but it won’t happen overnight. He said it could take several years and millions of dollars before every hospital and doctor’s office has quick access to their state’s prescription drug database. Health care providers will need to find money for an expensive upgrade. They also will have to work with many software companies to overcome the challenges of connecting hundreds of systems.

But Hoppe remains optimistic. Doctors need a system that works better, and the severity of the opioid epidemic provides urgency. The software CU Anschutz helped develop and the lessons learned from the pilot program could cut the number of opioid addictions, save lives and help end a crisis.

“There’s a lot of pressure to integrate these systems,” he said. “This gives us a big tool to help.”

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CU Innovations, StartUp Health create program for health care innovators

Health care providers and researchers face a changing world, where technological advances ranging from ever-improving machine learning to simple smartphone apps are altering the $2.8 trillion industry. It’s a challenge that doctors, insurance providers and academic medical centers, including the University of Colorado Anschutz Medical Campus, are going to have to confront, Chancellor Donald Elliman said at the launch celebration for StartUp Health Colorado.

Carm Huntress speaks at the StartUp Health Colorado launch event. He is the CEO and cofounder of RxREVU, the first private company to be part of StartUp Health Colorado.
Carm Huntress speaks at the StartUp Health Colorado launch event. He is the CEO and cofounder of RxREVU, the first private company to be part of StartUp Health Colorado.

“We know technology is going to change our landscape,” Elliman said. “I don’t think we’re going to recognize health care five years from now.”

The recent event at Krugman Conference Hall announced the start of a new partnership that brings together CU Anschutz, UCHealth, Children’s Hospital Colorado and StartUp Health. The latter is an organization formed with the goal of encouraging entrepreneurs to build digital health companies. StartUp Health also helps clinicians and researchers interested in forming companies to commercialize their ideas and technology, as well as matching them with investors.

StartUp Health is helping the three entities create an “innovation hub” on the CU Anschutz Medical Campus. The hub is StartUp Health’s first in the U.S. and joins Finland as one of two in the world. StartUp Health Colorado will co-locate with CU Innovations on campus and have access to StartUp Health’s network of industry leaders, investors and entrepreneurs.

The goals of StartUp Health Colorado are to facilitate innovation and entrepreneurship at each of the partner institutions, and to build, validate and commercialize at least 30 health startups within three years.

Embracing the need to innovate

Health care innovation is a focus for Elliman. In his recent State of the Campus address, Elliman said encouraging CU Anschutz faculty and researchers to be bolder and less risk averse should be a priority.

Rethinking how doctors and researchers work with private companies is part of that change, Elliman said. “If we don’t do it, we’re going to get run over by somebody who does,” he said. “It’s that simple.”

“We’re very lucky that, collectively, we look at this world and say, ‘We know it’s going to change, and we embrace that concept,’” he continued. “We want to lead it.”

Call for Innovations

StartUp Health Colorado also released a “call for innovations.” The initial call is for entrepreneurs and startups that are developing novel solutions that impact three key areas of healthcare to apply to receive co-development, clinical validation and pilot opportunities at the CU Anschutz Medical Campus institutions. The goal is to identify and nurture companies that will improve clinical outcomes and performance; help create a seamless patient experience; or improve communication and accessibility.

Entrepreneurs and companies can apply online by Dec. 9. The selected companies will be announced next spring. StartUp Health already supports more than 175 companies in 16 countries around the world.

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Center for Surgical Innovation expands services and trainings

Dr. Samy Youssef of the CU School of Medicine
Samy Youssef, MD, PhD, professor of neurosurgery in the CU School of Medicine, (center) demonstrates a minimally invasive brain surgery procedure for two visiting neurosurgeons using live imaging technology in the Center for Surgical Innovation.

Efficiency in health care is a subject that gets a lot of attention these days. A combination of efficiency and positive outcomes sums up the astonishing amount of activity that takes place at the Center for Surgical Innovation (CSI) on the University of Colorado Anschutz Medical Campus.

Considering that CSI offered 263 training sessions to surgeons from around the world in fiscal 2016 – up 65 percent from 2015 – it’s safe to say that the facility’s innovations and education programs are rapidly improving health care across the globe.

CSI typically offers four to five trainings a week. It’s not unusual for surgical courses on skull base tumors to take place one day, aortic aneurysms the next and hernia repair the next. Partitions are often set up so different trainings – a spinal surgery here, a heart procedure there – can take place simultaneously. Surgical techniques on every quadrant of the body are taught in the facility by world-class experts from the CU School of Medicine (SOM) using state-of-the-art equipment.

‘Our mission is to educate’

“We try to be a one-stop shop for everyone who trains here. We handle logistics on everything from lodging and transportation to the specimen and equipment needs of each training,” said Sarah Massena, CSI executive director. “We just try to make it streamlined and easy for the trainees who come here, so they can go back home and enhance patient safety.

“Our main mission is to educate,” she said, “We want to enhance patient safety in the operating room.”

Surgical training at the CSI at CU Anschutz
Hundreds of surgical training sessions, such as this one, take place each year at the Center for Surgical Innovation at the CU Anschutz Medical Campus.

CSI, which operates 24/7 and is the only surgical training center at an academic institution in this region, moved to a new space inside Bioscience 1 in the Fitzsimons Redevelopment Authority (FRA) in early 2015 and has seen a dramatic increase in trainings since. Last year, 3,400 surgeons attended trainings in the 5,000-square-foot facility.

The high-volume facility, which launched in 2005, was previously located in a 1,700-square-foot space in the anatomy lab on the fifth floor of the Education 1 building.

“One of the major advantages of this facility is that it’s a custom build-out,” said Peter Mouser, CSI lab manager. “These suites were an empty shell, and we worked with our architects and building-design people to have the surgical training suite be built out the way it should be.”

Attractive to medical device industry

A challenge, however, is that the CSI loses the rent discount that came with being physically located on an academic medical campus. Being across the street – the FRA is located on the north side of Montview Boulevard – means that CSI’s rent increased. “We had to move here because, for our needs, it was the only space available,” Massena said. “We’re still right next door to an academic medical campus, so our trainees can drive in, park for free and come straight into our lab.” For physicians already on campus, including residents at the University of Colorado Hospital (UCH), CSI is an easy walk to and from the hospital.

The facility is multidisciplinary, so it has five founding surgical departments in the SOM that help fund its operations. The departments, representing 15 surgical divisions, are Surgery, Orthopedics, Obstetrics and Gynecology, Otolaryngology and Neurology. The many “outside” trainings offered by CSI – 70 percent of the courses are for surgeons from outside the CU Anschutz Medical Campus, compared to 30 percent for residents at the campus –  help subsidize the departmental-member trainings.

Surgical training at CSI at CU Anschutz
Medical residents from the University of Colorado Hospital Emergency Department receive surgical training on a cadaver at a recent CSI educational program.

CSI is attractive to industry representatives seeking to test medical technology. Medtronic, an international medical device company, collaborates with Omid Jazaeri, MD, an associate professor in the Department of Surgery, on its latest stent technology. Da Vinci Surgery regularly brings in its magnified, 3D high-definition vision technology for trainings. The state-of-the-art robotics system allows surgeons to operate with enhanced vision and precision. The system also allows a surgeon at another location, such as on the East Coast, to operate a remote console and perform procedures in CSI’s surgical suite.

CSI is expanding into bioengineering research and development as well as nursing programs and unique trainings that educate surgeons on how to perform procedures in low-resource environments without high-tech surgical tools.

‘Impressed by this facility’

Each spring, Samy Youssef, MD, PhD, professor of neurosurgery in the CU SOM, has trained over 60 surgeons from around the globe at a three-day cadaveric dissection-training course in skull base/endoscopic surgical techniques. The invitational course is in high demand and currently filled through the 2020 session.

“The surgeons we have coming from Germany, Japan and elsewhere are impressed when they see this facility,” Youssef said. “For example, it’s very convenient to have the lecture room next door to the surgical room where the senior residents get hands-on practice.”

In addition, CU’s Department of Neurosurgery offers a Skull Base Surgery year-long fellowship/resident program that uses the CSI Microsurgery Laboratory to give young neurosurgeons exposure to complex cranial cases and minimally invasive skull base approaches.

Besides the cadavers on the operating tables and the surgeons in scrubs surrounding them, the striking elements of CSI are the innovative pieces of equipment, flat-screen monitors all around, and the booms that house the equipment. Less obvious are ceiling cameras that can zoom in on proctor stations and livestream procedures across the globe. Procedures are also regularly recorded.

Robust AV technology

Trainees can watch a live feed of a surgery taking place at UCH and simultaneously practice the techniques on specimens at CSI. “The audio-visual (AV) technology is very robust in this facility,” Mouser said. “It really provides for an enhanced educational experience for our surgical trainees.”

The facility is so busy that it is already bursting at the seams to store its surgical equipment. Staffing is another area that had to be increased to deal with demand. CSI recently hired two lab support technicians to help stagger the hours of the small staff – the facility now has five employees, including Medical Director Thomas Robinson, MD – around the late-day, early-morning and weekend training sessions that best suit surgeons’ busy schedules.

The staff at CSI constantly has dialogues with surgeons about the latest techniques and equipment on which they’d like to have training. “Also,” Massena said, “we engage in a lot of continuing medical education for surgeons to learn the latest surgical techniques.

“What I always say is, ‘Wouldn’t you rather that your surgeon practices techniques in a lab than on your mother, father, brother or sister in the OR?’” she said.

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Vital conduit between campus research and private industry

The University of Colorado Anschutz Medical Campus brims with the best health care, technologies and research. Now the campus has taken a bold step forward to accelerate the transfer of world-class research and ideas to the marketplace.

CU Anschutz recently launched its own technology transfer office and rebranded the group to become CU Anschutz Innovations to align and leverage campus-specific expertise with key industry partnerships. Similarly, CU Boulder launched its own technology transfer office that’s focused on exploring innovation through its exceptional physics, biosciences, aerospace and engineering programs.

Previously, the CU Technology Transfer Office operated at the CU system level and quickly became an integral part of Colorado’s innovation ecosystem. But even more streamlined support and expertise is available now that the campuses, as of July 1, operate their own tech transfer offices. CU Anschutz Innovations will serve the transfer needs for CU Denver, while CU Boulder will handle requests for the University of Colorado Colorado Springs.

Richard Weir robotic hand research CU Anschutz
Doctoral student Jabob Segil and Richard Weir, PhD, associate research professor in the Department of Engineering work on a robotic hand in a lab on the CU Anschutz Medical Campus. Their research is illustrative of the kinds of patient-centered innovations that take place regularly on the campus.

Steve VanNurden, executive director of biotechnology relationships at CU Anschutz and CEO of the Fitzsimons Redevelopment Authority, said the change will result in more streamlined services to meet the needs of inventors that will hopefully lead to bringing more technologies to market for the betterment of patients worldwide. “What’s exciting about being at an academic medical center is you can play a role in these technologies getting to patients,” he said. “I’ve seen it in my career: certain technologies that I worked on ended up benefiting a family member or friends.”

Another key leader in CU Anschutz’s growing research and tech transfer capacity is CU Anschutz Innovations Director Kimberly Muller. Muller came to the campus in June 2015 from Yale University, where she served as deputy director of the Yale Entrepreneurial Institute and associate director of New Ventures.

Already, she has launched the Center for Innovation at Children’s Hospital Colorado, which is providing an opportunity for innovators to develop groundbreaking ideas that will enrich and save lives through better technology and health care.

“We really needed a different type of person to run CU Anschutz Innovations, not just someone from a licensing background,” VanNurden said of Muller. “Kim is also a patent attorney and has run startup companies, so she’s quite skilled in developing new approaches.”

In every approach, the CU Anschutz Innovations office will provide the vital conduit between the inventors and innovators on campus and the decision-makers in private enterprise.

“How do you best deliver technologies to patients? You match the business side to the science side,” VanNurden said. VanNurden came to CU Anschutz in 2012 from the Mayo Clinic, where he oversaw a patient-focused technology licensing and commercialization enterprise.

For instance, he said, physicians and other health care providers regularly come up with ideas that will advance care or fill an unmet need. “The goal is to make it easy for them to bring in an idea and then have a team evaluate it and get an early read from industry or key external groups,” VanNurden said. “As an academic medical center, there’s a lot of great science, research and health care that happens here. If we match that up with great business, then you really have something.”

Bioscience 2 Building at CU Anschutz
The 112,000-square-foot Bioscience 2 Building opened in 2015. A groundbreaking on Bioscience 3 is planned for next year.

The CU Anschutz Medical Campus has emerged in the past decade a major economic engine in Colorado, providing more than $5.6 billion total economic impact. Since 2002, over 1,900 patent applications and more than 50 startup companies have been formed based on intellectual property developed on the campus.

VanNurden said 65 companies already operate out of the two Bioscience buildings at the Fitzsimons Redevelopment, with a groundbreaking for Bioscience 3 planned for next year.

The CU Anschutz Medical Campus is renowned for its direct links between academia and industry. For example, bioengineering students can connect their classroom work to the real world by taking advantage of the existing companies on campus or maybe they even start their own company.

“Those are the kinds of things we can do on this campus when we start to connecting different groups together,” VanNurden said. “It’s pretty unique, because there’s nothing that’s related to life science and medicine that we can’t do on the CU Anschutz Medical Campus. To accomplish much of it, you don’t even have to move your car.”

Because CU Anschutz Innovations is focused on life sciences and medicine, it will refer any non-medical ideas from CU Denver researchers to the CU Boulder tech transfer office.

The opportunities for technology transfer are seemingly boundless, and VanNurden and Muller are excited to create collaborative, yet streamlined, pathways between the research bench and a patient’s bedside.

“In the future we want to look at new models and different ways of doing things,” VanNurden said. “So how can a tech transfer office add value to a campus? Let’s reimagine that.”

To reach the Technology Transfer Offices, email ttocontact@cu.edu.

Story was written by University Communications and the Office of University Relations.

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