IT Update from the Chief Health Information Officer: Dr. William Feaster

As our current fiscal year comes to an end, I am pleased with all the progress we have made this year and look forward to new and exciting information technology (IT) projects on the horizon. Last February, we welcomed a new vice president and chief information officer, John Henderson, to our organization. He joined us from Texas Children’s Hospital and has been a huge addition to our leadership at CHOC Children’s. A seasoned IT leader, John has a successful track record of guiding cohesive teams in the design, deployment, administration and enhancement of enterprise IT applications and infrastructures. We are also excited to onboard our new chief technology officer, Adam Gold, who will also be a great addition to our team.  The CTO is a new position for CHOC and Adam will be responsible for all our infrastructure including computers, networks, data center, communications and other technologies.

Dr. William Feaster, chief health information officer at CHOC

Currently, our technical staff just finished the roll-out of tap-and-go access to our clinical computers in the inpatient areas, emergency department, surgery (outside of OR and procedure rooms) and Outpatient Infusion Center. Now, when you log-in to our systems from these clinical areas, you can tap-in with your badge.  This has been a huge win, especially for our nursing staff, saving them a lot of time during the day as they frequently log in and log out. We hope to continue to optimize the performance of this technology and implement it in our clinics and other outpatient service areas beginning in July.

Remote access to our systems is also changing with the addition of two-factor authentication (2FA), a security process in which the user provides authentication factors to verify they are who they say they are. This is just as essential for protecting patient medical records as it is your bank account.  While 2FA is not new, it has become more prevalent in the current digital age. Beginning in June, we will be cancelling access to remote.choc.org for those who have already registered for two-factor authentication and over the following months, we will be switching all remote users to secure.choc.org.  Stay tuned for more information coming soon.

We are currently implementing a new Dynamic Documentation build in our Children’s Medical Group (CMG), replacing their current PowerNotes documentation. Beginning in July, we will be implementing our Cerner EMR in our other primary care practices, along with Cerner Pro Fee billing, and a new version of Cerner’s registration and scheduling called Cerner Practice Management (CPM).  CMG and our specialty care clinics that are part of CHOC Children’s Network will also be going to the new Pro Fee billing and CPM over the next year.  These enhancements are a huge undertaking, which are currently consuming our IT resources and may delay some of the requests that are frequently submitted.  We ask for your patience over these next several months.

In addition, we are continuing to advance our work in population health, data science and analytics. We are also continuing to develop new technologies to improve the care of our patients with chronic diseases, advance home monitoring technologies, better support our care management staff both in and out of the hospital, and develop predictive models for readmission and patient deterioration, among other things.

Lastly, we are eagerly awaiting the final word on our capital budget for FY19 to determine what new projects are approved for next year. Our highest priority right now is to implement E-prescribing for controlled substances (EPCS), which we hope to do in the first half of FY19.

Should you have any questions about any of these developments, or other issues related to current information technology systems, please feel free to contact me at wfeaster@choc.org, or at 714-509-7637.

William Feaster, MD

CHOC Children’s Chief Health Information Officer

Mental Health Nurse Manager Shares How Nursing is the Art of Caring for People

CHOC Children’s wants its community providers to get to know its staff. In recognition of National Mental Health Awareness Month, meet Lisa Schneider, nurse manager in CHOC’s new Mental Health Inpatient Center.

Q: What is your education and training?
A: I have a degree in nursing from The Ohio State University, and I am in the last semester of completing my master’s degree with a focus on Nursing Administration. In addition, I am a board-certified psychiatric-mental health registered nurse.

Q: What are your special clinical interests?
A: I am very passionate about pediatric mental health. I have a strong interest in trauma-related diagnoses and crisis prevention, as well as serving as an advocate to de-stigmatize mental health.

Q: How long have you been on staff at CHOC?
A: I am new to the organization and so excited to be here! I have been with CHOC since January 2018.

Q: What diagnoses are most common among the patients you care for?
A: As the community is beginning to recognize mental health disorders sooner, children and adolescents can present with a wide range of diagnoses such as depression, anxiety, eating disorders, psychosis, autism, PTSD, and ADHD, among others.

Q: What myths about mental health would you like to dispel?

A: Many people believe that talking to kids about suicide can put the idea into their heads. However extensive research has shown that this is not the case. Suicide is currently the second leading cause of death in children and young adults ages 10-24. Start the conversation now and talk to your kids about suicide – it could save their life.

Q: What excites you most about the Mental Health Inpatient Center?

A: The opening of the Mental Health Inpatient Center is so exciting because we will be providing innovative care and services to children and their families. The unit will consist of private rooms, group activity rooms, an expansive outdoor play area, along with daily programming such as music therapy, art therapy, pet therapy, and classroom education. The Center is designed around aspects of nature to promote a holistic and healing environment.

In addition, every child will receive a comprehensive treatment plan which will include individual and family therapy sessions while inpatient, and care continuation at discharge. I am so excited for the positive impact this Center will have on the kids in our community, especially since we will be the first to offer inpatient mental health services to children under the age of 12 in Orange County.

Q: What inspires you most about the care being delivered here at CHOC?
A: I am inspired by the tremendous amount of dedication that CHOC has shown in our mission to provide quality healthcare to children. Specifically, we are taking a leadership role and setting a high standard through our commitment to de-stigmatizing mental health and expanding services. It is important to remember health does not solely rely on physical health, but strongly depends on mental health as well. In order to achieve overall health and well-being, mental health must be cared for with the same emphasis that is placed on physical health.

Q: Why did you decide to become a nurse?
A: I chose to become a nurse based on the philosophy of nursing. Nursing is known not only as a science, but also as an art in caring for people. I have a passion for creating strong nurse-patient relationships, which can promote the healing process. I chose pediatrics because I’m inspired by the resiliency I see in children, and mental health specifically because I strongly believe in the concepts of prevention and early intervention.

Q: If you weren’t a nurse, what would you be and why?
A: If I wasn’t a nurse, I think I would probably be a police officer. I enjoy serving others and building strong relationships within the community.

Q: What are your hobbies/interests outside of work?
A: Outside of work, I love spending time with my husband and 4-year-old son. We are new to California so we have been spending a lot of time exploring this beautiful state!

Learn more about CHOC’s mental health services at www.choc.org/mentalhealth.

Gluten-Free Diet: What Patients and their Families Should Know

By Dr. Bassam Younes, pediatric gastroenterologist at CHOC Children’s

In recent years, gluten-free diets have risen in popularity and gluten-free products become more readily available—but not everyone who puts themselves or their children on a gluten-free diet has a medical reason for doing so. Here’s what your patients and families should know about this widespread diet:

Shouldn’t everyone just go gluten free?

Many people assume that since gluten can have such strong negative effects on some of us, that it would be safer if we all just avoided gluten. Wrong.

Gluten-free foods may be safe to eat, but they’re not calorie-free. Many gluten-free foods and snacks are higher in fat and calories. Also, very few gluten-free products are enriched with essential vitamins and minerals that most gluten-containing products contain. This means if you’re on a gluten-free diet not managed by a registered dietitian, you could be missing out on essential nutrients your body needs. At CHOC, our team of pediatric gastroenterologists work in tandem with registered dietitians to care for children who require a gluten-free diet.

Dr. Bassam Younes, pediatric gastroenterologist at CHOC

What is gluten?

Gluten is a general name for the proteins found in wheat, rye, and barley and triticale (a cross between wheat and rye). It can be found in many types of foods, but is primarily made up of two different types of proteins:

  • Gliadin– gives bread the ability to rise
  • Glutenin– responsible for dough’s elasticity, acting as a glue to hold the food together, affecting the chewiness and maintaining the shape of baked products

Here’s a few cases where I would recommend a gluten-free diet to my patients:

Celiac disease

If you are diagnosed with celiac disease, it means you have an autoimmune reaction to gluten. Whenever you eat something containing gluten, your small intestine is hyper sensitive to that gluten, which leads to difficulty digesting food. Some common symptoms of celiac disease are diarrhea, decreased appetite, stomachache and bloating, poor growth, and weight loss.

Many kids are diagnosed with celiac disease when they’re between 6 months and 2 years old, which is when most kids get their first taste of gluten in foods. Girls are twice as likely to have this disorder than boys.

For some people, the problems start slowly and the symptoms may be terrible one week and not as bad the next. Because of this, some people aren’t diagnosed with celiac disease until they’re older. The problem is chronic, which means that although symptoms may come and go, people who have celiac disease will always have it.

If celiac disease is not treated, patients will develop weight loss and malabsorption (a condition that prevents the absorption of nutrients through the small intestine).

No one is sure why celiac disease happens, but it appears to run in families. You have a 5 percent to 10 percent chance of getting celiac disease if someone in your family has it. Others at higher risk for celiac disease include those with Type I diabetes, an autoimmune thyroid or liver disease, Trisomy 21 (Down syndrome), Williams syndrome, Turner syndrome, IGA deficiency or juvenile chronic arthritis. If your child falls into this at-risk group, they should be tested for celiac disease even if they don’t currently show symptoms. Celiac disease can harm the digestive system if no obvious symptoms are present.

Some children with celiac disease do not respond to the Hepatitis B vaccine. They will respond to the vaccine once they are on a gluten free diet. If your child was vaccinated for Hepatitis B prior to their celiac disease diagnosis and starting their gluten-free diet, they may need to be revaccinated for Hepatitis B. Consult your pediatrician about your child’s vaccination history.

In addition to a complete medical history and physical examination, diagnostic procedures for celiac disease may include blood work or a biopsy.

The only treatment for celiac disease is a lifelong adherence to a strict gluten-free diet.

Wheat allergy

You might be hypersensitive to wheat proteins without having celiac disease. People living with a wheat allergy have an immune reaction to the proteins found in wheat. A type of white blood cell attacks the wheat, alerting the body that there is a problem. Reactions can occur within a few minutes to a few hours, and can include nausea, abdominal pain, itching, swelling of the lips and tongue, trouble breathing or anaphylaxis. People with wheat allergies cannot ingest wheat, but they have no trouble ingesting gluten from non-wheat sources.

Children with a wheat allergy may eventually outgrow it, but the only treatment is eating a wheat-free diet.

Non-celiac gluten sensitivity

Non-celiac gluten sensitivity is not well-defined, but it is not an autoimmune response (like Celiac disease) or immune response (like a wheat allergy). There are no tests to diagnose a gluten sensitivity, but your doctor can do a biopsy or allergy test to rule out Celiac disease and wheat allergy. If a child’s symptoms improve by following a gluten-free diet, then gluten sensitivity may be diagnosed.

The only treatment for non-celiac gluten sensitivity is adhering to a gluten-free diet.

Learn more about pediatric gastroenterology at CHOC.

CHOC Researcher Recognized at International Molecular Medicine Conference

Jeffrey Huang, Ph.D., a research scientist at CHOC Children’s Research Institute whose scientific interests include applying innovative molecular biology techniques to the treatment of rare pediatric disorders, was recently honored at the Molecular Medicine Tri-Conference. Considered one of the world’s leading international events in the field of drug discovery, development and diagnostics, the conference attracts more than 3,000 innovative thinkers and thought leaders in biotech, pharma and academia from around the world.  In addition to serving as a guest speaker at the conference, Dr. Huang was honored with the “Best Poster” award for his presentation, “Engineering cellular and animal models of rare disease using CRISPR-Cas9 genome editing.” In this Q & A, he shares insight about his research and its promise for the future.

What inspires you to focus on rare pediatric disorders, such as Pompe disease?

As a translational research scientist, I am committed to bringing the best scientific research has to offer to the clinic. My decision to join CHOC Children’s Research Institute was fueled by a desire to address the lack of alternative treatment options for CHOC patients and families affected by rare pediatric disorders. Over 30 million Americans – nearly 1 in 10 people – suffer from one of the 7,000 conditions classified as a rare disease. Many rare disorders often lead to progressively debilitating and sometimes fatal outcomes in infants and children.  Unfortunately, there are no cures for most rare diseases; if existent, current therapy only attenuates or slows disease progression. My primary research focus is to evaluate and develop CRISPR genome editing therapeutics to address deficiencies of existing treatment for rare pediatric disorders such as Pompe disease.

Jeffrey Huang, Ph.D., research scientist at CHOC, after being honored with the “Best Poster” award for his presentation, “Engineering cellular and animal models of rare disease using CRISPR-Cas9 genome editing,” at the recent Molecular Medicine Tri-Conference.

What are you seeking to accomplish with your research?

Currently, I lead a project to develop personalized CRISPR genome editing therapeutics for Pompe disease – our proof-of-concept rare pediatric disorder. Pompe disease is a progressive cardiac and skeletal myopathy lysosomal storage disorder (LSD) which, despite intravenous doses of recombinant enzyme 40 times that of other LSD treatments, results in the deterioration of affected patients’ muscle strength.  With over 15 years of experience in advanced molecular, cellular, and developmental biology, I have outlined the following strategy to evaluate the therapeutic efficacy and safety of CRISPR genome editing for Pompe disease.

The specific aims of our project are:

1) To generate, via CRISPR-Cas9 technology, animal models of Pompe disease that bear mutations homologous to those that cause human Pompe disease

2) To fully evaluate and validate the animal models generated to ensure molecular, biochemical, histopathological and functional analogy to human Pompe disease

3) To develop specific CRISPR genome editing/delivery systems correcting mutations in validated models of Pompe disease

4) To assess molecular, biochemical, histopathological and functional efficacy as well as safety of CRISPR genome correction in our Pompe disease animal models

I am excited to report that within the past year we have successfully demonstrated that our Pompe disease-specific CRISPR genome editing strategy has produced the desired mutations in cultured cells. Following this pilot experiment, we microinjected our Pompe disease CRISPR reagents into fertilized mouse zygotes to produce the first CRISPR-generated animal model at CHOC Children’s (Specific Aim 1). We are currently expanding this new animal model of Pompe disease and will perform the appropriate tests on the expanded cohort to confirm analogy to human Pompe disease (Specific Aim 2).

Our newly generated Pompe animal models will form the basis for future studies that will test the efficacy and safety of CRISPR-mediated genome correction in an in vivo context.

What other projects are in the works?

Future work will focus on evaluating which CRISPR delivery strategy works best to correct Pompe disease mutations in affected tissue (Specific Aim 3) and assessing the efficacy and safety of genome correction in our animal model (Specific Aim 4). Our application of CRISPR technology to Pompe disease will form the basis for future personalized genome editing studies and model the appropriate safeguards that need to be taken prior to testing CRISPR genome editing therapies in a clinical setting.

Learn more about CHOC Children’s Research Institute.

In the Spotlight: Kelly Davis, M.D.

A board-certified physician in pediatrics and sports medicine has recently joined the CHOC Children’s Orthopaedic Institute. Dr. Kelly Davis specializes in sports injuries, injury prevention, concussion management and advanced musculoskeletal ultrasound medicine for children, adolescents and young adults. Among the most common diagnoses she sees include overuse injuries and knee pain in athletes of all ages who play a variety of sports.

Her passion for helping young athletes comes from her own experience growing up playing sports. She played tennis, soccer, basketball, and also swam and water skied. She continues to play competitive tennis today and thanks her mom, a huge tennis enthusiast, for getting her into the sport.

“My mom played in college and has been my coach my whole life. I think what I love about tennis so much is that no matter your age or skill level, there is always someone you can play with and it is a great way to meet new people,” she says.

Dr. Davis completed her undergraduate studies at the University of California, San Diego, followed by medical school at Temple University School of Medicine, in Philadelphia. After graduation, she completed a pediatric residency at CHOC, and stayed an additional year to serve as chief resident. She completed a fellowship in pediatric primary care sports medicine at Vanderbilt University in Tennessee.

During her time at Vanderbilt University, she served as a team physician for a high school and for several collegiate teams including football, baseball, cross country, track and field, tennis and soccer. Additionally, she was a team physician for the Nashville Sounds, a minor league baseball team.

Today, she continues to have the same commitment and enthusiasm for her patients.

“These kids have a certain drive. They’re really motivated and fun to work with,” she explains. “I also know what it’s like to sustain an injury, put in the rehab work and come back to the sport you love.”

Her patient care philosophy is straightforward: She treats each patient and their family as she would want one of her own family members to be treated. As a recent, first-time mom, she has gained an added appreciation for her patients’ parents and their questions or concerns, she says.

“I’m available as a resource for our community providers as well,” Dr. Davis adds. “If they have any concerns or questions, they can reach out to me or a member of my team anytime.”

In her spare time, Dr. Davis loves spending time with her husband and their baby boy. She also enjoys playing soccer and tennis, hiking, camping and exploring the outdoors.

To contact Dr. Davis, please call 714-633-2111.

Learn more about the CHOC Children’s Orthopaedic Institute.