Healthcare Delivery Worldwide

It's been a while since I've last posted and I really don't have any good excuses. I'm currently traveling in Asia discussing how Salus programs can help to expand the health science professions in countries such as Singapore, China and Korea. It's been extremely educational for me to see, first hand, how some of the professions we train and really take for granted in the U.S. are practiced and regulated in Asia. Optometry, as we know it, is a fledgling profession in all of these locations with many variations of the profession practiced, often without any regulation or quality measures. What was extremely gratifying to me was that those providers who had successfully completed Salus courses and programs designed for non-U.S. based clinicians were enabling those providers to practice with significantly enhanced clinical competence that has led to an increased scope of practice in their countries. Clearly, as we have done in Europe over the past 20+ years, Salus (previously PCO) is changing the way optometry and potentially other professions are practiced throughout the world.  While we won't change things overnight, I firmly believe our efforts, combined with the development of requirements from the host nation's professional organizations we're partnering with, will improve the quality and efficiency of healthcare delivery worldwide. What makes this even more gratifying are that these efforts and subsequent successes are very much in concert with our ethos and mission to protect and enhance health and well-being through education, research, patient care and community services worldwide. We're doing that now!

When I travel and see how healthcare is delivered in Asia I feel extremely grateful for the system we have in the United States. While not perfect, by any means, our philosophy of leveraging professions such as optometry, audiology, physician assistants, occupational therapy, speech and language pathology as primary care entry points into our healthcare system provides a relatively efficient and effective method of assuring access to quality care for most patients.  While still not perfect there are significant advantages to the way we practice these professions in the U.S.  

This week we'll explore even more ways we can help others leverage Salus programs to improve their healthcare systems and provide quality care where necessary.  It's extremely exciting to be part of a team that can do so much!

Dr. Robert Morrison

It's not often one gets to meet an individual who has significantly influenced the way a profession is practiced, let alone help to invent a device that literally has changed millions of lives, but I had that very honor yesterday when I had to pleasure to spend time with Dr. Robert Morrison.  Dr. Morrison is a 1948 graduate of the Pennsylvania College of Optometry.  During the course of his very unique and successful career, Dr. Morrison helped to shape the way optometry and ophthalmology are practiced globally. You may ask what were his accomplishments and why haven't I ever heard of him?  I'll address the what first.  Dr. Morrison, working with scientists in Czechoslovakia helped to develop what is today's modern soft contact lens. As a young provider, Dr. Morrison had a keen interest in corneal physiology and contact lenses.  He was a pioneer in the fitting of PMMA lenses and did early research in orthokeratology that helped inform today's body of knowledge.  He also was a leader in the visual treatment of keratoconus, using toric contact lenses to help improve vision.  When he learned of a new polymer (HEMA gel) that was developed in Europe, he worked closely with chemists to perfect the optical quality of the material so it could later be employed as soft contact lenses.  

Always innovative and creative, Dr. Morrison didn't stop there, but he worked to develop toric soft lens designs and was the first to use what we call a "piggyback" lens, a soft contact lens with a rigid lens over it, to correct keratoconic patients.    Bausch and Lomb ultimately purchased the patent for the soft lens and as they say, the rest is history.  Throughout his very illustrious career, Dr. Morrison was called upon by royalty in Europe, movie stars, politicians and others to address their unique visual needs.  An avid tennis player, he managed to weave his love of tennis and eye care together often forging lasting friendships that have served both optometry and ophthalmology well.  He is very humble about all of his accomplishments, thus the reason many have not heard of him.

We've got a copy of his biography in our library and I would encourage our students to read it.  It's not often one person leaves a legacy of innovation, creativity and professional achievement.  Dr. Robert Morrison has done the optometric and ophthalmological professions and the patients we serve a great service and we all owe him a debt of gratitude.

Ice Storm Hits Philadelphia

We've been without power at our Elkins Park campus since the monster ice storm hit the greater Philadelphia area Tuesday night. Many of us are still without power at home as well, including me. The local electric supplier is telling us we should expect to see electricity restored at Elkins Park by late tonight, but that is still just an estimate. We're keeping our fingers crossed that they are correct. In the meantime, I want to take the opportunity to thank our students, faculty, consultants and staff for their perseverance during this weather emergency. I especially want to thank those folks who have kept the clinical operations going smoothly at The Eye Institute and our satellites. As a health science teaching institution,Salus has a dual mission; as an educator of professionals-in-training and as a health care resource to the community. When making decisions on how to operationalize our dual mission student education and safety are always at the core of the decision making process.  We understand that many of our students, faculty and staff are still without electricity, internet, etc. and that creates a major inconvenience for those effected.  We also realize that exam and class schedules are effected as well. We will make it through all this just fine but it's going to take some additional patience and perseverance. As we move into next week, we all need to remain flexible and keep smiling. Academic and clinic schedules will be adjusted accordingly and we'll get the job done. These types of experiences tend to be bonding experiences for those who work through them collectively. Thankfully, we purchased a notification system a couple of months ago that enabled us to put out text, email and cell messages to everyone that signed up.  While not perfect, due to the nature of the emergency we've been able to keep folks informed based on the information we have. 


That's just the nature of the beast. So, thank you ALL for being understanding, professional and flexible. We all learn from these experiences so next time something like this happens our response can be even better. Hoping everyone is safe, warm and ready to hit it hard next week.

The Eye Institute - Oak Lane

Great event at The Eye Institute last night. We had over 100 of our very generous donors, faculty, students and staff participate in the re-dedication of our Flagship clinical facility in the Oak Lane section of Philadelphia. It was great to show off the facility as well as meet and talk with many of our distinguished guests. Nice way to start off the week!

The Eye Institute Renovation & Re-Dedication

This Sunday we are celebrating the re-dedication and renovation of The Eye Institute in Oak Lane. This has a very special meaning to me as it was my class that was the very first one to see patients on a regular basis there. In 1978, when the building was first opened, it was considered a state-of-the-art facility, winning all sorts of architectural awards for innovation and design. From my recollection, it looked like the inside of a ship, with exposed HVAC ducts (bright green and blue), the exam rooms which were located in modules on the second floor had walls that extended only 3/4 of the way up and there were no places for student-faculty consultations other than small offices and hallways. One could walk up and down the halls and hear every interaction between students, patients and instructors. Not exactly HIPPA compliant! Visual field testing was done at the end of a hallway or on a tangent screen in the rear of each exam room. Fast forward to today, where, thanks to the vision and hard work of my predecessor, Dr. Tom Lewis and others including Dr. Sue Oleszewski, Mr. Pat Sweeney, Mr. Don Kates, the Salus Board of Trustees and a host of very generous private and corporate donors, this 35+ year old facility has once again been transformed into the state-of-the-art vision care facility that is second to none.  

I want to pass along my heartfelt thanks to all those who had a hand in transforming our flagship clinical facility into what it is today - Philadelphia's leading eye care facility.  This extensive undertaking is totally aligned with our long-standing commitment to our mission to provide competent, comprehensive and patient-centered vision care to all who seek services, while at the same time, providing the highest quality clinical education to optometric trainees and the community it serves. The excellent quality of care patients experience is now enhanced by a beautifully designed modern clinical space.

This newly designed facility also provides us with a wonderful opportunity to integrate a Patient Centered Medical Home into our practice sometime in the future.  As we continue to mature as one of the nation's leading Health Science Professions Universities we have the responsibility to continue to evolve our healthcare delivery model to meet the demands of a very fluid healthcare delivery environment. This must include weaving primary care directly into our current delivery model.  As I've stated in previous blogs, I believe a Patient Centered Medical Home model provides a cost-effective way to deliver high quality, essential care to the community we service directly in Oak Lane but also an opportunity to model this for other locations.  Have a great weekend!

Improved Healthcare for 2014

As we begin 2014 I want to have frank discussion and have Salus play a key role in helping to craft a transformation in the American healthcare system that results in better health outcomes, a more effective and efficient delivery model and improved access for undeserved populations, specifically those living in urban environments. This must include a dialog about changing behaviors both of how people access the healthcare system as well as how they act individually. In a recent OP-ED that was published in the Philadelphia Inquirer I discussed the attributes of a Patient Centered Medical Home (PCMH) and how this model was being effectively deployed in the Military Health System. I mentioned how people enrolled in such a model tended to use the Emergency Room less frequently (in locations where a PCMH was established, ER visits decreased by approximately 30%) and health outcomes appeared to be better. I firmly believe that this model, where primary care providers to include physicians, physician assistants, nurse practitioners, optometrists, podiatrists, nutritionists, mental health specialists, etc. serve as the primary conduit into the care system should become a centerpiece for our national healthcare system. But even as we craft an improved delivery system, we need to take a very frank and candid look at ourselves as a society and address our expectations of the healthcare system, how we utilize and access healthcare and some of the underlying behaviors that are the subsequent causes of disease that cost us all so much.

First and foremost we need to change the culture of healthcare from one of being reactive to proactive. Prevention and the preservation of wellness must be front-lined and in order to do that, must be incentive-based. Stronger policies combined with new, innovative behavioral health programs that integrate specialties such as clinical psychology, nutrition, social work and specially trained counselors are needed to help people change lifestyles that contribute to poor health such as alcohol consumption, smoking and obesity. While many states are making efforts to reduce smoking, there are fewer policies to tackle the harmful use of alcohol in the U.S. than you would find in other OECD countries, such as higher taxes on alcohol or minimum prices. 

The most commonly used measure of weight status today is the body mass index, or BMI.  BMI uses a simple calculation based on the ratio of an individual’s height and weight.  Research has shown that BMI provides a good estimate of being overweight and also correlates well with important health outcomes like heart disease, diabetes, cancer, and overall mortality.  Healthy BMI for adult men and women is between 18.5 and 24.9. Overweight has been defined as a BMI between 25.0 and 29.9; and obesity, has a BMI of 30 or higher. Unfortunately, obesity rates have, for the most part, stayed constant since 2003, they have more than doubled since 1980. They remain the highest among all of the high-income countries in the world.  Literature suggests that about two out of three U.S. adults are overweight or obese (69 percent) and one out of three are obese (36 percent). The American Medical Association has recognized obesity as a national epidemic and has declared it a disease to help change the way the medical community addresses the issue.     This is also recognized by the American Public Health Association. While appropriate medical intervention is imperative, I believe we also need to incentive those stricken with the disease to be proactive in managing it. People need to have “skin in the game” if they’re going to change behaviors. Those who have the lowest risk factors would pay less while those with higher risk factors would pay more for health and other types of services.  Since obesity is associated with so many chronic and acute diseases that cost society a fortune to manage, this requires attention now.  My belief is that people who are obese must be both cognizant and accountable for the associated health ramifications and costs in order for many of them to change behaviors and lifestyles.  Since more fuel is required to move more weight in airplanes, trains, cars, buses, etc., I’ve often thought that when one purchases tickets to fly on an airline or on another form of mass transportation, fares could could be adjusted based on a sliding scale of Body Mass Index (BMI). Only after people change their own personal behaviors will be begin to realize substantive changes in the overall health our the population; this, combined with appropriate medical and behavioral health supervision is one way to help move us in that direction. 

Concurrently, we need to be working on how a PCMH model can be rolled out nationally.  It's my sincere hope that we can help to validate this model at Salus, working with local partners and integrating our clinical programs in the Oak Lane section of Philadelphia.  The opportunity to develop a Medical Home in an urban, undeserved area of Philadelphia will reap benefits from a broad health perspective as well as economically. As I mentioned earlier, data shows that when populations are enrolled in medical homes, emergency room and urgent care visits drop dramatically, thus saving valuable healthcare resources as well as improving the overall quality and continuity of care patients ultimately receive. We've got all the right players to model this and prove it’s efficacy at Salus working closely with our academic partners in Philadelphia.  

So, that's my long-winded pitch for today. 2014 needs to bring about change in the healthcare delivery paradigm, by changing behaviors, making people accountable for their own health, and making primary care the centerpiece of our access model through a Patient Centered Medical Home. 

On the Horizon for 2014

It's been about a month since I last posted on my blog....sorry for the delay! First, happy holidays to all!  As we get ready to enter a new year I can't help but to be extremely excited about what's in store for all of us at Salus. Our students are will be preparing for a new semester - some the last semester in their professional school journey, and others, a continuation of their academic and professional journey. No matter where they are in their journey, each of our young professionals will have an opportunity to make their mark on the American healthcare system as it changes to meet the needs of  a growing aging population in an economically challenging healthcare delivery environment. I firmly believe our students and graduates will be well prepared to actively engage and positively affect the national healthcare debate, whether it be concerning scope of practice issues or healthcare policy. Salus professionals are poised to have a positive impact on the way healthcare is delivered and practiced in the U.S. as well as internationally, as we enter this new year.

Also on the horizon for 2014 I'm hoping to realize several partnerships with some of our Philadelphia academic neighbors that will result in a changed landscape for healthcare delivery and education in the city to include a Patient Centered Medical Home and some related academic programs. You will also see an improved website that should be more interactive and easier to navigate. So, as you all sit and sip your hot chocolate, or whatever you might be sipping on this Christmas morning, think about what we at Salus will bring to the healthcare table in the upcoming year.....it's an exciting thought!  Wishing everyone a very happy and healthy New Year!