Read HL, 2008, spring final text version

HMGHealth Line

Summer 2008, Volume 26 Kingsport, Tennessee

Spring and summer allergies in the Tri-Cities are nothing to sneeze at.

Inside this edition...

PAGE 4 Region's First Virtual Colonoscopy PAGE 5 HMG Welcomes New Providers PAGE 6 myHMG ­ Introducing Patient Online Services PAGE 8 Arthur Agatston, MD Applauds HMG PAGE 10 Medication Regimen Assessment

Watery eyes, a scratchy throat, coughing and, of course--sneezing. If you're among the more than 50 million in the United States who suffer from allergies, you'll agree, allergies are certainly nothing to sneeze at. They can be quite serious. The Tri-Cities region ranks near the top in spring allergy prevalence, ranking 21st out of 100 cities throughout the United States. Knoxville ranks 6th. (The Asthma and Allergy Foundation of America's allergy report compares cities based on key environmental and medical factors.) HMG's David Cowden, MD, says he is not surprised by this ranking. "The incidence of allergies in the Tri-Cities is extremely high," says Dr. Cowden, an ear, nose & throat specialist with more than three decades of advanced allergy testing and immunotherapy experience. "As the report indicates, our region is home to a tremendous number of offending allergens." Allergies are characterized by an overreaction of the human immune system to a foreign protein substance (allergen) that is eaten, breathed into the lungs, injected or touched. For the person with allergies, their immune system overreacts, resulting in symptoms such as: coughing; sneezing; itchy eyes; a clear, runny nose; or a scratchy throat. More severe

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Message from the President

It can be said that physicians of yesterday characterized themselves as, "doctors who have patients." Yet, today, it is, "patients who have doctors." Times have changed. As medical champions of the 21st Century, I'm pleased that we embrace this patient-centric move. Providing the very best care for those we're privileged to serve is at the very heart of all that we do within Holston Medical Group. Indeed, to provide the care our patients desire, we must work smarter, desiring increasingly compassionate interaction and yet ever-mindful of the need for robust efficiency. We serve a very deserving patient population-- patients who are, no doubt, consumers with choices. Today, facing challenging issues confronting our delivery system and with the rising number of individuals with chronic illnesses, I'm grateful that our HMG patient-centric focus continually propels us to the leading-edge of modern healthcare. It is because of our dedication, that, within this Health Line, you'll learn of the remarkable technologies and advanced services that we are committed to bring our patients. Whether it is the provision of the region's first virtual colonoscopy or our determination to expand convenient patient access through our new myHMG online service, you'll learn more about the voracious commitment of the region's leading provider group. In closing, I'd like to directly address you, our "patients who have doctors." It is my sincere hope that your Holston Medical Group providers stand head and shoulders above the rest, endearing you to our care and us to your service. cases can result in rashes, hives, lower blood pressure, difficulty breathing, asthma attacks and even death. There are no cures for allergies--only prevention and treatment. "Surprisingly to some, allergies are the fifth leading chronic disease in the United States," explains HMG's Hal Loveless, MD, an ear, nose & throat specialist with advanced allergy training. Dr. Loveless has been providing allergy testing and treatment since 1986. Drs. Cowden and Loveless, along with HMG ear, nose & throat specialist Jeff Hunt, MD, offer both skin and blood testing for specific allergens known to be associated with allergic rhinitis, sinusitis, asthma, and insect anaphylaxis. "If allergy testing is positive, it confirms the validity of using allergy medications and/or allergy shots to control a patient's symptoms," explains Dr. Loveless. "If allergy testing is negative, the patient doesn't need to spend their time or money on allergy treatment." One in five Americans suffer from all types of allergies including indoor/outdoor, food and drug, latex, insect, skin and eye allergies. Among physicians in the U.S., there is wide latitude of belief in respect to allergy testing and treatment. Some advocate skin testing for allergies while others only blood testing. Some will treat food allergies with immunotherapy, others will not. Likewise, some will provide allergy injections for insect venoms, others will not. As for Drs. Cowden, Hunt and Loveless, they do not agree with immunotherapy for food allergies. "We feel that is unsafe and of unproven efficacy," explains Dr. Cowden. Yet, for those who allergy testing has revealed specific allergens and who are good candidates for allergy immunotherapy, both allergy specialists agree that their outcomes with allergy injections have been quite successful. "Our experience has been that relief from allergy symptoms can be expected for between 70 to 90 percent of the patients who are treated," says Dr. Cowden.


Jerry L. Miller, MD HMG Founder & President

Hal Loveless, MD

Jeff Hunt, MD

David Cowden, MD

Allergy shots, or immunotherapy, are custom-mixed for each individual patient within HMG Ear, Nose & Throat by trained medical professionals. Each mixture contains the allergens to which an individual patient is allergic. "The beginning concentration of each allergen in the mixture is determined by the relative allergenicity of each antigen," explains Dr. Loveless. "Only with accurate allergy test results can you create the specific allergy mixture for each patient." In addition to allergy treatment, HMG Ear, Nose & Throat also provides specific counseling regarding possible food allergies and environmental modifications. Such counseling can greatly reduce a patient's exposure to offending antigens. For more information concerning allergy testing and immunotherapy, talk with your HMG primary care provider or contact HMG Ear, Nose & Throat at 423-990-2494 (Bristol) or 423-392-6299 (Kingsport).

OnePartner ATAC certified as nation's first and only commercial tier III facility

OnePartner, LLC, is pleased to announce its Advanced Technology & Application Center (ATAC), Duffield, Va., has achieved certification as the nation's first and only commercial Tier III facility. As such, the ATAC promises to be the region's premier commercial data center for collocation, hosting and disaster recovery services. "This is a tremendous feat," says Tom Deaderick, director of OnePartner. "There is an enormous amount of work and planning that goes into designing a building system in which any one component can be removed for replacement or repair without interrupting service. From the beginning, concurrent maintainability with a Tier III Certification was our goal." Julian Kudritzki, certification manager of the Uptime Institute and ComputerSite Engineering, affirms the accomplishment. "The OnePartner Advanced Technology & Application Center (ATAC) in Duffield, Virginia, is currently the sole US company providing outsourced commercial data center services (including collocation and disaster recovery) that has been awarded a Tier III Design Certification by the Uptime Institute," says Kudritzki. The Uptime Institute ( created the Tier classification system as a benchmark for reliable data center infrastructure design.


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traditional colonoscopy," explains Samantha Sizemore, HMG radiology manager. "We're hoping the ease of this procedure will save lives." Virtual colonoscopy relies on advances in CT scanning to produce high quality, 3D images of the colon, able to detect tumors and precancerous lesions (polyps) in the colon. "With virtual colonoscopy, we're visualizing both the interior and exterior of the colon, whereas conventional colonoscopy is limited to visualizing only the interior of the colon," explains Dr. Shone. The virtual scan also allows for the examination of the other organs of the abdomen and pelvis. "Abnormalities can be found outside the colon that would not be seen with conventional colonoscopy," adds Dr. Shone. An October 2007 finding published in the New England Journal of Medicine, compared conventional optical colonoscopy to virtual colonoscopy. Researchers discovered that virtual colonoscopy was as effective as optical colonoscopy in detecting polyps larger than 5mm. "This much less invasive procedure is most excellent for patients on blood thinning medications," says Dr. Shone. "Because there is minimal risk of puncturing the colon, patients do not have to stop their medications. It's also excellent for patients who have breathing difficulties and are at increased risk when undergoing anesthesia." Preparation for a virtual colonoscopy is much like preparation for a conventional colonoscopy in that the colon must be emptied using laxatives. Yet, in contrast to the conventional optical colonoscopy, the virtual screening only requires the slight insertion of a small rubber tip designed to fill the colon with carbon dioxide. The CT scan takes images of the colon in a matter of minutes. "Fortunately, more than 95% of patients will have a clean bill of health," says Dr. Shone. "For those who are found to have significant polyps, we then perform a follow-up optical colonoscopy to remove the growth." Those who are over 50 are encouraged to talk with their primary care provider about recommended colon screening measures, including the new virtual colonoscopy. At this time, not all insurance plans provide coverage for a virtual colonoscopy. Patients are encouraged to verify coverage with their insurance provider.


HMG introduces region's first virtual colonoscopy: no sedation, discomfort or downtime

Thanks to leading-edge technology like the new "virtual colonoscopy" introduced at HMG's Outpatient Diagnostic Center at MeadowView Lane, patient screening measures for one of the most preventable types of cancer--colon cancer-- just got an incredible boost. HMG is currently the first and only provider of virtual colonoscopies in the Tri-Cities. "The images produced are most incredible," says HMG gastroenterologist Dallas Shone, MD. "Virtual colonoscopy is even able to detect polyps `hiding' behind folds that can be difficult to see by optical colonoscopy." For the patient, the best part is that the scan takes only 10 minutes, does not require sedation, and involves only minimal discomfort. Patients can literally return to their normal activities immediately. Though colon cancer is one of the most preventable types of cancer, still yet, an estimated 52,000 people will die from it this year. The reason? Only about half of those over 50 (the recommended age of when screenings should begin) get tested. "Many patients put off this very important test because they don't want to undergo the unpleasant experience of a

HMG welcomes new providers

Amirah H. Daher, MD

Pediatrics, Pediatric Intensivist

He and his wife, a pediatrician, Gayle Bates, MD, make their home in Kingsport with their two children.

Holston Medical Group welcomes pediatric intensivist, Amirah H. Daher, MD. Dr. Daher comes to HMG with more than 15 years of pediatric critical care experience and will serve to expand the care provided by HMG's pediatric hospital team at Holston Valley Medical Center. Board certified by the American Board of Pediatrics in pediatric critical care, Dr. Daher received her doctorate of medicine from the Jordan University School of Medicine, Amman. She completed both a residency in general pediatrics and a fellowship in pediatric critical care at Emory University, Atlanta, Ga. She also holds a master's in public health from the Rollins School of Public Health, Emory University, Atlanta, Ga. Dr. Daher's extensive experience includes serving as assistant professor in pediatrics at the Jordan University of Science and Technology's School of Medicine, Irbid. She is a member of the American Academy of Pediatrics, the American Board of Pediatrics, and the Society of Critical Care Medicine. Additionally, she has served as a consulting pediatrician in the development of education curriculum for UNICEF.

Tabitha Davidson, NP

Gastroenterology, Indian Path Medical Office Building

HMG is pleased to announce the addition of Tabitha Davidson, NP. Davidson joins the HMG gastroenterology team of Manoj Srinath, MD, and Dallas Shone, MD. Following the receipt of her bachelor of science in nursing from East Tennessee State University, Davidson received her master of science in nursing from Old Dominion University, Norfolk, Va. A native of Northeast Tennessee, Davidson is the recipient of numerous awards and honors. She and her husband reside in Bristol, Tenn.

Sherif Z. Yacoub-Wasef, MD


Chad E. Bates, MD

Family Medicine, MeadowView Lane

HMG welcomes family physician Chad E. Bates, MD. Dr. Bates comes to HMG from the Medical Associates of Big Stone Gap and Lonesome Pine Hospital. Board certified by the American Board of Family Medicine, Dr. Bates graduated summa cum laude from The College of William and Mary prior to receiving his doctorate of medicine from the Eastern Virginia Medical School, Norfolk, Va. He completed residency training through the Spartanburg Family Medicine Residency Program, Spartanburg, SC. The recipient of numerous academic and professional awards, patient satisfaction surveys recognize Dr. Bates' provision of outstanding service.


HMG is pleased to welcome endocrinologist Sherif Z. YacoubWasef, MD. Dr. Yacoub comes to HMG from the Medical University of South Carolina, Charleston, where he activitely participated in the design and implementation of a diabetes management in-patient program. Board certified by the American Board of Internal Medicine, Dr. Yacoub received his doctorate of medicine from the Ain Shams University, Cairo, Egypt. He completed his internal medicine residency training at the New York Medical College, New York, NY. Additionally, he completed an endocrinology fellowship at the Medical University of South Carolina, Charleston.


Dr. Yacoub and his wife, Elena Yacoub, MD, enjoy time with their daughter, Sophia.

The author of multiple medical publications, Dr. Yacoub is also the recipient of numerous honors and awards. He is a member of the American Medical Association, the American Diabetes Association, and the American Association of Clinical Endocrinologists.

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"We're continuing to fine-tune the features and add new areas of functionality," says Childress, who has been behind the new online service since its inception. "Like everything we do at HMG, we want to make sure this service is at its best before we open it up to everyone. So far, we've received great feedback from both our patients and our provider teams." myHMG is securely linked with a patient's individual electronic health record. Future expansion of myHMG will give guardians the ability to manage the medical affairs of their entire family via myHMG. "Once someone has gone through the appropriate security measures, privacy guidelines, and enrollment steps, they'll have the ability to review the myHMG online information of their children* or even their adult parents," says Childress. One of the features the patients enjoy most is the ability to send their provider team a secure message via myHMG. Upon the provider response, the patient receives an email instructing them to log-in to their password-protected, fullyencrypted myHMG site. The response from their provider will be waiting for them in the secure message center. "In today's world, we're busy. It's not uncommon to miss phone calls or play phone tag for days," explains Childress. "Now, with myHMG, a patient can contact their provider at their convenience and have the confidence of knowing that they will receive a timely response, without the hassle of missed return telephone calls." Childress cautions that myHMG is not for critical events or immediate appointment needs. At this time, during the initial pilot stage of myHMG, enrollment is limited to a select group of patients. A phased-enrollment process, opening up access to myHMG for all patients, is expected in the summer of 2008.


It's 2 a.m. and you decide that now is the perfect time to ask your provider for a medication refill. While you're at it, you might even review your lab results. The good news is your provider won't mind. In fact, she won't be bothered a bit. Why? Because you're enrolled in HMG's new myHMG patient online service--affording you confidential and secure online access to your personal health information--any time you want. "This is really patient convenience at its best," says HMG's Chip Childress, director of information systems. "myHMG gives the patient the access and control they want, when they want it."

"If a patient has an acute need that needs attention right away, they should continue to call their provider's office as usual," explains Childress. "This

service is meant for convenience and increased access, not needs or questions that are a matter of urgency or patient safety." In an effort to protect patient privacy, a face-to-face enrollment within your provider's office is a required prerequisite for registration. A phased plan is currently underway to extend enrollment to all patients within HMG.

*Due to HMG's legal requirement to comply with the State of Tennessee laws regarding the sexual health privacy of minors, some restrictions may apply to children ages 12 to 18.

With myHMG you can:

· · · · · · Review allergies & immunizations Request an appointment Request medication refills Review routine lab results Send a message to your provider team View new announcements

Coming myHMG features:

· On-line bill pay · Automatic appointment reminder · Manage the medical affairs of your family

HMG News Briefs....

Dr. Gonce: Certified Medical Director in Long Term Care

HMG's Joel Gonce, MD, CMD, has been granted the title of Certified Medical Director in Long Term Care by the Board of Directors of the American Medical Director's Certification Program. Dr. Gonce is one of more than 2,300 physicians nationwide who have received the CMMD designation since the program's inception. Dr. Gonce, who has been with HMG almost since it's inception, is also board certified by the American Board of Family Medicine. He received his doctorate of medicine from the University of Tennessee, Memphis.

Nuclear medicine services receive ACR Accreditation

The MeadowView Lane Outpatient Diagnostic Center has been awarded a three-year term of accreditation in nuclear medicine services as the result of a recent survey by the American College of Radiology. The ACR, headquarted in Reston, Va., awards accreditation to facilities for the achievement of high practice standards after a peer-review evaluation of the practice. Accreditation by the ACR demonstrates a commitment to quality care and patient safety.

Dr. Miller receives "Algernon Sydney Sullivan Award"

Delivering the fall commencement address at King College, Bristol, Tennessee, Jerry L. Miller, MD, founder & president of Holston Medical Group, was presented with the nationally-acclaimed Algernon Sydney Sullivan Award. Colleges nationwide present this prestigious award to honor members of the community for their application of spiritual qualities to daily living. The award highlights the importance of service to others and service to the community. "Dr. Jerry Miller's integrity, combined with his faithful dedication and generosity of service to mankind, has dubbed him a leader in this regard," writes Dr. Randall Blevins, associate professor of business at King College, in his letter of nomination. Since 1934, the Algernon Sydney Sullivan Foundation has taken as its primary mission the inspiring of young people to lead lives of integrity, characterized by service above self and service to the community.


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Nationally-acclaimed preventive cardiologist, Dr. Arthur Agatston, applauds HMG

Today, individuals don't have to die of a heart attack...

That's the message nationally-acclaimed preventive cardiologist pioneer Arthur Agatston, MD, FACC, impressed upon a captive audience of more than 90 HMG physicians and mid-level providers at Holston Medical Group's annual provider retreat held at the Grove Park Inn Resort, Asheville, NC. "As we like to say, heart disease is the number one killer," explains Dr. Agatston. "But it doesn't have to kill you." According to Dr. Agatston, today--not tomorrow--today, we have the medical knowledge and ability to prevent the great majority of heart attacks and strokes. "Right now we have the noninvasive-- no cutting, no pain, no recovery required--diagnostic techniques that can identify people who are at high risk for developing coronary artery disease, so that they can be treated early," explains Dr. Agatston, referring to advanced lipid testing and revolutionary diagnostic imaging technology like the 64-slice CT scan of the heart. Along with his reputation as a researcher, lecturer, and pioneer in clinical and preventive cardiology, Agatston is well known as the author of the best-selling The South Beach Diet. He is also an associate professor of medicine at the University of Miami Miller School of Medicine. With the recent launch of the new HMG Center for Vascular Medicine, Holston Medical Group and its expansive base of nearly 100 primary care providers are taking an aggressive approach to combating heart disease. "I applaud you," complimented Dr. Agatston, speaking of Holston Medical Group. "It's not often that you see a group that has take taken the bull by the horns and is really being so


creative in addressing heart disease. I think your story should be told." HMG's life-saving preventive cardiology approach is nearly identical to the aggressive measures of Dr. Agatston. The measures, aimed at detecting, preventing and even reversing heart disease, include: heart-healthy eating, exercise, advanced diagnostic and lipid testing, and the latest "heart-protective medications." HMG Founder & President Jerry L. Miller, MD, says his wholehearted endorsement of Agatston's research is evidenced by HMG's purchase of more than 250 copies of The South Beach Heart Program. "I think your dedication to the overall profession is just exemplary," begins Dr. Miller. "I must say, HMG is going to be on your doorstep because we want to learn from you and be able to implement your research and findings. This is going to save lives." Dr. Agatston's findings reveal the fallacy of today's current reactionary approach to cardiac disease--after the disease is already advanced. Instead, the best preventive measure is an aggressive approach aimed at early identification of patients who are at high risk for a heart attack, many who are seemingly healthy and yet are headed for a massive coronary event.

"The Calcium Score is the best single predictor of who is destined for a heart attack in the future," affirms Dr. Agatston.

"I like to think of the heart scan as the `mammogram of the heart' and believe that if it is widely used as a screening tool, like the mammogram, it will save many lives."

Step 3 of Agatston's 4-step plan is Holston Medical Group was the first that of "getting the right diagnostic "I like to think of the heart scan as in the region to introduce the tests." The South Beach Heart the `mammogram of the heart' calcium score heart scan, utilizing its Program recommends patients and believe that if it is widely used as a 64-slice CT with cardiac capabilities. undergo a coronary calcium scan to determine their "Calcium Score," screening tool, like the mammogram, Dr. Agatston emboldened HMG known also as the "Agatston it will save many lives." providers to continue their course of Score." This advanced CT scan, promoting prevention, encouraging performed in minutes, provides an heart-healthy wellness initiatives and advanced lipid and incredible view of the amount of hard, calcified plaque a diagnostic testing. patient has accumulated in his arteries. The greater the amount of plaque, the higher the Calcium Score and the higher the risk.

A n n i versary Milestones

The following individuals celebrated anniversary milestones of employment with Holston Medical Group d u ring the 1st quarter of 2008. We're thankful for your faithful service within the HMG "Family of Care"!

1 Year

Collins, Robin D. Hubble, Benjamin Pierce, Catherine J. Riffe, Robin Smith, Jacqueline E. Davenport, Rachel A. Coleman, Karen E. McCord, Melissa K. Bestermann, William, MD Williams, Ronald L., MD LaForce, Carla Phillips, Melissa K. Coffman, Teresa P. Hale, Melissa D. McQueen, Kelly, MD Monty, Susan D. Tyndall, Gregory E. Taylor, Darlene A. Earl, Peter C., MD Dean, Pam L. Hensley, Susan M. Wallen, Heather N. Arbogast, Delores A. Smith, Dena J., DO Smith, Gary S., DO Salaita, Cheryl H. Barb, Tasha M. Burke, Wanda L. Williams, Sharon K. Cole, April M. Arnette, Bryan T., MD Howe, Elizabeth M. Luehrs, Tamatha L. Woodall, Amanda Duffield HV Surgery HV Surgery HV Surgery Indian Path Med Ofc Insurance Clinical Research ODC at Sapling Grove Vascular Medicine UC at Sapling Grove Peds at Stone Plaza Oral & Maxillofacial Vascular Medicine Colonial Heights Indian Path Med Ofc HV Surgery Housekeeping Church Hill Seasons of Abingdon Disease Management Insurance Department UC at Stone Plaza Gastroenterology Hospital Team Hospital Team Seasons of Kingsport Sapling Grove Surgery ODC at Sapling Grove MV Lane at Peds ODC at Sapling Grove Weber City Accounting Insurance Scan Department Jan. 1, 2007 Jan. 1, 2007 Jan. 1, 2007 Jan. 1, 2007 Jan. 1, 2007 Jan. 3, 2007 Jan. 8, 2007 Jan. 8, 2007 Jan. 15, 2007 Jan. 15, 2007 Jan. 18, 2007 Jan. 19, 2007 Jan. 22, 2007 Jan. 22, 2007 Jan. 22, 2007 Jan. 22, 2007 Jan. 22, 2007 Jan. 23, 2007 Feb. 5, 2007 Feb. 12, 2007 Feb. 12, 2007 Feb. 12, 2007 Feb. 26, 2007 Feb. 26, 2007 Feb. 26, 2007 March 1, 2007 March 5, 2007 March 5, 2007 March 5, 2007 March 12, 2007 March 19, 2007 March 19, 2007 March 19, 2007 March 26, 2007

20 Years

Theobald, George L. Voorhees, Earlene F. Dowell, Bonnie L. Housekeeping Housekeeping Business Office Float Sapling Grove Family Behavioral Health HV Surgery Duffield Administration Nurse Manager Peds at Stone Plaza MV Lane ODC UC at Stone Plaza Sapling Grove Family Seasons of Kingsport Orthopaedics Occupational Med. Colonial Heights MV Lane ODC Transcription Peds at Stone Plaza Gastroenterology Weber City UC Feb. 1, 1988 Feb. 1, 1988 March 28, 1988 Feb. 1, 1993 March 9, 1993 March 15, 1993 March 22, 1993 Feb. 9, 1998 Feb. 18, 1998 Feb. 23, 1998 March 3, 1998 Jan. 1, 2003 Jan. 13, 2003 Jan. 13, 2003 Jan. 13, 2003 Jan. 31, 2003 Feb. 19, 2003 Feb. 20, 2003 Feb. 27, 2003 Feb. 27, 2003 March 24, 2003 March 25, 2003

15 Years

Deckard, Melva A. Castle, Barbara A. Lawrence, Mark L. Bogan, Mary F.

10 Years

Knight, William R. Grant, Barsha I. Hubbard, Teresa R. Polinski, Melissa A.

5 Years

Geer, Robert M., MD Moore, Sarah L. Richardson, Linda C. Shelton, Rebecca A. Gibson, Deanna L. McConnell, Jennifer L. Bronstetter, Steven D. Barrett, Angela L. Dobbs, Emilee F. Chandler, Ginger N. Harrod, Donna K.


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Getting it just right

"Medication regimen assessment" helps HMG patients and providers, alike.

There are a few things in life that you can't afford to have, "almost right." Medications are one of them. They've got to be just right. Variance, even slight, can be detrimental-- if not deadly. Yet, pharmaceutical advances, marketed directly to the consumer, are shot from the barrel at a bewildering speed. "When I graduated from med school, I had a wonderful mentor who told me, `Jerry, I want you to know six drugs. Six basic drugs are all you need to treat patients," quips HMG Founder & President Jerry L. Miller, MD. "Today, there are 26 that begin with the letter `Z'. There are 720 new drugs in the pipeline." According to Dr. Miller, pharmacists are one of the "most under-utilized resources for focused patient and provider education as well as collaborative management of some chronic diseases." "They're highly-knowledgeable of the efficiencies, efficacies, interactions and reactions of drugs," begins Dr. Miller. "And, they're an integral component of a multi-disciplinary approach to education and chronic care management." Through HMG's collaborative relationship with the University of Tennessee College of Pharmacy, HMG co-funds three academic pharmacy clinicians (L. Brian Cross, Pharm.D., CDE; Benjamin Gross, Pharm.D.; and Joni Foard, Pharm.D., CDE). Together, they not only help to manage multiple HMG specialty clinics (anticoagulation, lipids, diabetes management, etc.), they also provide a service called "medication regimen assessment." HMG's L. Brian Cross, Pharm.D., CDE, says the medication regimen assessment service emphasizes the Pharm.D.s' role within HMG as that of a "physician advocate." "Our goal is to support our HMG providers by working directly with them and their most difficult-to-manage patients," begins Dr. Cross. "We're a part of the physician's team. When

Partnering with the UT College of Pharmacy

HMG's collaborative relationship with the University of Tennessee College of Pharmacy began in 1999. The three cofunded clinical pharmacists within HMG also teach and lecture at the University's Knoxville campus. Additionally, they provide oversight for a one-year post-doctoral pharmacy residency program funded by the College. "Most people see us as pharmacists," explains Dr. Cross. "They might not be aware of all of the different levels of education that are in collaboration with our function as clinicians at HMG." HMG serves as the host site for the one-year residency program as well as for a monthly rotation of UT clinical pharmacy students.

they have a patient with a really difficult medication regimen, we're a great resource to put another set of eyes on a regimen and look at it from a patient-specific therapeutic perspective." Here's how the service works. Say an HMG physician has a patient who sees multiple specialists and is on more than a dozen different medications. The HMG primary care provider can refer the patient for limited visits with an HMG Pharm.D. for medication regimen assessment. "We basically offer a `tune up' and then promptly send the patient back to their PCP for continued care. Our focus is solely on that of working with the provider to improve a patient's medication regimen," says Dr. Cross. The first visit typically involves an hour of counseling and medication review. Patients are instructed to bring in every single product they take--over-the-counter medications, prescriptions products, vitamins, natural medicines, herbal products and homeopathic items--containers and all. "More often than not, we'll have a patient bring in a bag of 20 to 40 different products--quite a stock pile, many of them of their own choosing," explains Dr. Cross. "To make matters worse, we find that most are not even taking their prescribed medications according to their doctor's orders." Recent studies suggest that as many as 1/3 of all hospital admissions and/or ER visits are secondary to medicationrelated issues. In addition, it has been shown that adherence to certain chronic medications for things such as hypertension and hyperlipidemia is a direct predictor of improved clinical outcomes such as heart attacks and strokes. HMG's Dr. Warren Jones calls the services of the HMG Pharm.D.s' a "very good resource," applauding their patient education efforts. "They've been an incredible help to me, streamlining medications and providing great patient education and information," says Dr. Jones. For the patient, a return visit to the Pharm.D. may involve medication counseling and education regarding the importance of adhering to prescribed medication instructions. "We're a medication-advocate, pharmaceutical-consultant and physician-extender all wrapped up in one," says Dr. Cross. "We're therapeutic managers, not diagnosticians. When we identify a medication regimen that could be improved, we first consult with the patient's HMG provider for approval." "This service has been a great resource for me," says HMG primary care provider Emily Morawski, MD. "Often, I don't have time to sit down with the patient and go through each


medicine with them and look at the different interactions and side effects." Dr. Morawski says she most often utilizes the medication regimen assessment service for her patients who are on multiple medications (generally more than ten), most often related to diabetes. Both Drs. Jones and Morawski agree that the Pharm.D. resource provides great reassurance. "This is a true team approach to patient care," concludes Dr. Jones. "It's great for the patient and the provider." For more information concerning HMG's medication regimen assessment service, contact Dr. Brian Cross at 423-578-1586.

Portion of Heart Card proceeds benefit the American Heart Association

Holston Medical Group and Cardiovascular Associates donate $10 from the sale of every "Healthy Heart" gift card to the American Heart Association. A recent donation was presented by HMG's Jerry L. Miller, MD, and CVA's Herb Ladley, MD, to Amanda Henley, regional director for the American Heart Association. "Healthy Heart" gift cards are designed to give individuals access to leading-edge technology successful in detecting coronary artery disease at an early stage. Gift card recipients are entitled to a Cardiac CT for Calcium Scoring diagnostic imaging -- a screening that is ten times a more powerful predictor of coronary artery disease than cholesterol screenings. Healthy Heart gift cards ($149 value) may be purchased by calling the HMG's Outpatient Diagnostic Imaging Center at MeadowView Lane at 423-857-2800.

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Healthy U Update

Bank of Tennessee joins Fit for Living

The Bank of Tennessee has recently adopted HMG's Fit for Living employee wellness initiative. In addition to offering bank employees and spouses an opportunity for a comprehensive Health Risk Assessment, Fit for Living also provides quarterly measurements (BMI, weight) and semi annual labs. "It's going very well," says HMG Healthy U Manager Candice Alder. "We talk weekly and we've established a great rapport. Our goal is to work closely with the bank to improve the health and wellness of those they employ." According to Alder, based on the outcome of the Bank's HRA results, Fit for Living will cater health services, including talks by HMG physicians, to meet the HRA-identified areas of needed improvement. "As leaders in health care, it's important that we aggressively monitor and improve our own health," explains HMG Executive Director Craig Kilgore. "The HRA was a great opportunity for us to have a candid snapshot of exactly how we're doing. Now that we know, we can make plans to improve areas of identified need." With the greatest areas of identified need being improved fitness and nutrition, HMG's Fit for Living is currently making plans to provide weekly fitness classes for HMG employees and providers. According to Alder, HMG employee wellness participation is increasing. Most recently, as of January, 450 employees are actively enrolled in Fit for Living.

Lose it 4Good's Healthy Habits sets summer session

Though school may be out, health and wellness are still in! HMG's Lose it 4Good for Kids & Teens provider team is set to kick-off the third quarter of its new "Healthy Habits" June 2. Healthy Habits, offered every other Monday for 12 weeks, targets children 8 to 14. Each session includes parent and child interaction with Lose it 4Good physician coaches, dietitians and exercise activity consultants. These free, evening sessions are currently open for enrollment. For more information, call Emily Dobbs at 423-230-2432.

HMG's HRA results are in!

Thanks to the 294 who participated in HMG's recent Health Risk Assessment, Holston Medical Group has been able to identify the top five health risks within the Group: · 85% need improved fitness · 82% need better nutrition · 72% need to reduce their cancer risk · 69% are above their recommended weight range · 25% have increased coronary risk

HMG Health Line

Jerry L. Miller, M.D. Robert C. Lee, M.D.

President and Founder Medical Director

A quarterly publication for the employees and friends of:

Holston Medical Group

2323 N. John B. Dennis Hwy. Kingsport, Tennessee 37660 (423) 857-2000

Craig M. Kilgore

Kellie Crowe

Consultants, Edito

Myra Windle Danehy

Layout and Design

Executive Director Communication



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