Posts made in June, 2010

PAMF is No. 1 Large Non-Profit in Bay Area Top Work Places 2010

Bay Area News Group’s Survey Reflects Employee Satisfaction

The Palo Alto Medical Foundation (PAMF) was ranked in the top ten of the Top Work Places in the Bay Area, in the first employee-based survey of Bay Area companies. PAMF placed first as the top non-profit workplace and sixth in the Top 10 large companies to work for.

“Every day, our employees care for thousands of people and put our organizational values into action: compassion, honesty, integrity and teamwork. We are proud of the excellent job they do and are gratified that they feel that they are appreciated and supported in their efforts,” said David Druker, M.D., PAMF president and CEO.

The employee survey was conducted by Workplace Dynamics, an independent company, which announced its results in the June 20 edition of the Bay Area News Group, which includes the San Jose Mercury News, Contra Costa Times, Oakland Tribune and San Mateo County Times. More than 1,200 companies in the Bay Area were invited to participate in this survey. The results of the entire survey can be found online at the Bay Area News Group website.

Lung Cancer Treatment Extends Life, Improves Quality of Life

In the United States, lung cancer causes more deaths than any other cancer and is second only to heart disease in overall mortality. Because pulmonary tumors (a form of lung cancer) are difficult to detect and biopsy, the disease is often diagnosed late—at stage III or IV. At those stages, five-year survival of lung cancer is only about 15 percent.

Ganesh Krishna, M.D., a pulmonologist at the Palo Alto Medical Foundation’s (PAMF) Mountain View Center, is one of few physicians in the United States trained to perform inReach electromagnetic navigation bronchoscopy. Using this revolutionary technology he has taken lung cancer treatment to a whole new level.

Two-minute video demonstration of the inReach System 

The inReach electromagnetic navigation bronchoscopy system allows clinicians to non-invasively biopsy small lesions in the periphery of the lung for the first time. Using traditional methods, doctors can only direct a typical bronchoscope down two or three airway branches, however, there may be 17 to 25 branches before they get to a small nodule in the periphery of the lung. In the past, pulmonologists would either follow these nodules over time or insert a needle through the chest and into the lung, which can sometimes collapse this delicate organ. The new navigation system allows Dr. Krishna and other pulmonologists to biopsy tissue they wouldn’t have been able to reach otherwise.

In 2005, Carol Thorington was diagnosed with stage IV lung cancer—the most serious classification of cancer. With hundreds of tumors in both lungs, she was given two, at most six, months to live. Although doctors told her that it was inoperable, Carol wasn’t ready to give up. She went to see Dr. Krishna, even though she knew conventional wisdom said her cancer was incurable. Read More

Cardiovascular Disease the Leading Cause of Death for California’s South Asians

Doctors at the Palo Alto Medical Foundation Research Institute (PAMFRI) today released a new study that quantifies that cardiovascular heart disease (a category of illnesses of the heart or blood vessels) is the leading cause of death for South Asians in California. More than 1.6 million South Asians live in the United States, more than one quarter of them in California.


Latha Palaniappan, M.D., M.S., is the lead PAMFRI researcher on this study. She collaborated with investigators at the University of California, School of Public Health to study California mortality records from 1990 to 2000. All of the study details are available in today’s complete press release, with the stunning conclusion: four out of every 10 South Asians in California dies of cardiovascular disease. Read More

Volunteers Pilot EMR Use in Haiti using iPhones


In this post, Dr. Steven Lane describes ongoing volunteer medical relief efforts in Haiti following the earthquake in January 2010. He is part of a volunteer group of doctors, nurses and medical staff who are caring for patients and helping to establish an international standard for health IT in disaster situations by piloting the iChart mobile EHR program on the iPhone. The group sends a new team of volunteers to Haiti every month for a week of service. The fifth group returned to Haiti in May 2010. More than 82 team members have traveled so far. The volunteer teams are organized by Dr. Enoch Choi, of the Palo Alto Medical Foundation’s Urgent Care Department, and  include members from other medical organizations.

Dr. Lane is a Family Medicine Physician at the Palo Alto Medical Foundation, EHR Ambulatory Physician Director at Sutter Health, Clinical Associate Professor of Medicine at Stanford University School of Medicine, and Associate Clinical Professor of Family & Community Medicine at the University of California, San Francisco.

Piloting Mobile EMRs for use in Disaster Situations

In planning for our initial trip to Haiti to provide post-earthquake disaster medical relief we felt that some sort of electronic medical record (EMR) capability would be beneficial to support our team of doctors and nurses. An EMR would provide a simple record keeping system regarding the patients seen and the care provided and could potentially allow us to make this information available to other providers who might assume ongoing responsibility for follow-up care of the same population.

We reached out to friends and colleagues who worked in medical informatics and received a number of offers of help including donated hardware, software and custom development to provide an application that would meet our needs. At the same time we learned of the work of the Harvard Operational Medicine Institute (OMI) that was working with the United Nations to pilot a number of mobile EMR applications in hopes of establishing an international standard for the use of health information technology in disaster relief situations. The Harvard group had determined that the most ubiquitous technology amongst health care workers providing disaster relief in Haiti was the Apple iPhone and that standard mobile phone technology would provide the most reliable connectivity between providers. They quickly reviewed the available applications and decided to try to use one called iChart,  developed initially by an internist in Los Angeles. The volunteer medical team working at an impromptu field hospital near the Haiti-Dominican Republic border had begun using the iChart application with some success. Due to the nature of disaster relief they were not using the EMR application in the way it had been designed, but rather were redefining existing data fields to allow for the rapid entry of key demographic and clinical information.

The Harvard team was also in discussion with the developers of Open MRS, an open source EMR that has been used extensively in the third world, particularly to support HIV care. As we made contact with Harvard they were hoping to finalize a handheld front end for the Open MRS application that our team might be able to pilot to provide a comparison with the early field experience with iChart. As our departure date approached we did not know which application or what sort of mobile devices we would be using in Haiti. Four days before our departure we learned that the Open MRS application would not be ready in time and we were invited to join the iChart pilot. As our team would be working in tent cities providing primary and urgent care this would provide a very different use case than the experience thus far in the field hospital where they were caring for post-op patients and managing children who had lost their families.


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