The Past, Present, and the Future...Imaging: MUSE (Levenson/Fereidouni) – Involved lots of faculty...

1Department or Presentation Title

Lydia Pleotis Howell MD

Professor and Chair

Pathology & Laboratory Medicine

The Past, Present, and the Future: Department of Pathology and Laboratory Medicine


My second five-year chair review

A valuable opportunity to:– Reflect – Shine a light – Advocate– Get feedback– Become better than ever


In this presentation, I will share:

- Vision and plans from 10 years ago.- Accomplishments today – a few examples among many!- How we have achieved these.- Future directions and plans


10 years ago:Chair Search and Vision Presentation


Vision is important to leadership

“Good business leaders: - create a vision, - articulate the vision, - passionately own the vision, - relentlessly drive it to completion.”

Jack Welch, former chairman & CEO, General Electric


The chair is the CEO of a major enterprise

Academic pathology is a $120+M business at UCD Health:

- $8M grants/contracts- $8.2M professional fees- $4.3M purchased services for medical directors- $100+M clin lab revenue- Priceless: Education and community service contributions


Vision then -- and now

To be acknowledged nationally as a department of the future

In other words: a department that:

Is at the cutting edge of its discipline, anticipates and leads the future thru its research and creative work,prepares others for the distant as well as the immediate future.


Being future-oriented is our inherent obligation:

As a land-grant university:- Discover and share knowledge to

improve the lives of the people

Fits the Chancellor’s vision to “boldly go”

Fits our role as a core department with a major role in every mission.

This Photo by Unknown Author is licensed under CC BY

https://www.flickr.com/photos/52030408@N05/33156393848

https://creativecommons.org/licenses/by/3.0/


If chosen as chair my duty is to be sure we meet this obligation by:

Facilitating research and discovery:- Future-oriented and multi-disciplinary.

Providing clinical care:- Efficient, high-quality, and cutting-edge- Brings innovations to the bedside to the benefit all members of our

community.

Educating trainees and practitioners: - Emerging methods and trends. - Critical thinking about the future.


Departmental activities/themes: Derived from major forces of change in medicine

• Tests for personalized risk assessment, prevention strategies, treatment, monitoring.Proteomics and other

Biomarkers

• Digital and in-vivo imaging on gross and sub-anatomic and cellular level

• Quantitative image analysis New imaging technologies

• Integration of clinical and research info• Data-mining• Availability across wide geographic areas

Informatics and AI

• High quality, innovative, efficient care• New delivery sites: POC, home• Diminishing workforce, growing needs

Healthcare economics & reform


The national context: NIH priorities

Example: NCI’s 2010 Professional Judgment Budget Request- Clinical proteomics & other resources: $75M- New imaging tools: $150M- Biomedical computation: $45M- Oncology tissue banks: $30M- CaBIG & BIG network: $100M


NCI Budget Proposal 2021

Many similar themes today Opportunities specifically noted in the report:

– Microbiome– Artificial intelligence – often combined with imaging– Implementation science


The national context, con’t

CAP’s 2010 Campaign to Transform Pathology includes:– Investigation in emerging technologies– Better integration across disciplines: laboratory, clinical & basic

science– New best practices & standards– Education not just for now, but for the future, too.

http://www.cap.org/apps/cap.portal


Fits my own experience

• My leadership in American Society of Cytopathology and their focus on the future:

• Vice president (at that time – later president)• Past-president, ASC Foundation• Executive Board member x 5 years in 2010 – 10 years total.• Discussion facilitator at ‘09 ASC Future Summit


Focus on innovation is especially important for today’s leaders


Have we achieved the vision?

Are we an innovative and future-oriented department?


Research accomplishments:Discovery of new knowledge drives innovation improve clinical care


NIH funding and rankings

0

10

20

30

40

50

60

70

80

$0.00

$1.00

$2.00

$3.00

$4.00

$5.00

$6.00

NIH Funding and Ranking, 2010-presentUCD Dept. of Pathology & Laboratory Medicine

NIH Funding, Dept. of Pathology & Lab Medicine

Ranking, Pathology & Laboratory Medicine

NIH funding:– $4.2M as of July 2019– Higher today

NIH rankings:– #68 in 2011 #42 in 2018– Mid-30s predicted for 2019


Areas of strength

Neuroscience group: $16+M in NIH grants over past 5 yrs.

Vice Chair of Research Yvonne Wan: – Top 15 funded PIs at UCD School of Medicine– $7.5M total awards in the past 5 yrs.,

Anticipate more growth– New research-intensive faculty recruitments in progress.– On-going work by our current faculty


Not all about rankings: We are acknowledged leaders of major multi-disciplinary programs

Multi-center personalized medicine studies: NIH-funded All of Us and WISDOM– Site PI: Sandy Borowsky MD

Neuropath Core, $13M NIH R01 “Oldest Old” Dementia study– Lee-Way Jin MD PhD

Microbiome Program, Cancer Center– Led by Yvonne Wan PhD– Recent collaborative seed grant program

Clinical trials, largest site for Roche Diagnostics– Nam Tran PhD


New technology: Cool new tools for pathologists

Imaging: MUSE (Levenson/Fereidouni)– Involved lots of faculty and students

Awards– Astellas C3 Technology award– Chancellor’s Innovation Award– Innovation of the Year, Optical Society– 2019 Power List, The Pathologist

Validation as a lab-developed test is underway


More cool tools – James Chan and colleagues


Even more cool new tools: Artificial intelligence

Artificial intelligence/Machine Learning– Rashidi– Graff– Dugger


Our research role is not just about us:- We support research across UCD Health


Leaders of inter-disciplinary seed grants

2015-2016

• Inter-dept seed grant program Pathology.• Expanded from 4 to 8 departments: $80,000

2016-2017

• Pathology leadership continued• Expanded from 8 16 departments: $160,000

2017-2018

• Collaborative for Dx Innovation: $370,000• Gift + 11 depts, 3 Centers, SVM, PMB, OOR• 9 Pathology faculty involved in 10/17 projects


Support research in the clinical lab

Clinical Research Oversight Committee Purpose:

– Create an effective “front door” to foster research in our clinical laboratory.– Ensure:

- Capacity (instrumentation and staff)- Workflows to protect turnaround time of clinical work- Appropriate pre-analytic specimen preparation - Compliance with CAP and other regulations- Payment for services rendered

– Minimize tension and conflict.

Outcomes (as of 12/2018)– 223 projects supported– Serves 108 principle investigators and 30 departments. – Improved satisfaction and attitude among clinical investigators and lab staff.


Education accomplishments


Undergrad programs

Medical Laboratory Technician

Clinical Lab

ScientistsCytotechs

Medical students

Residents Fellows

Continuing Education

for Practitioners

Educational breadth spanning the professions and level of learners


New in education over the past 5 years

2nd year med student course (PMD410):– #1 rating in pre-clinical curriculum:

New electives for med students: – 3rd yr elective– Acting internship in AP– Increased capacity for 4th electives

New lab professional training: – Med Lab Tech– Cytotech – award-winning grads!!!

Clinical Informatics Fellowship


Highlight: Two educational programs


Residency program

High ratings in ACGME annual survey

Above nat’l average in recent engagement survey

Thanks to hard work by many after an external review.


Award-winning residents

George Gao– Best poster, USCAP– Two leadership awards: ASCP, USCAP

Ying Liu – Certificate of Congressional

Recognition for volunteerism with ACS

Ananya Datta Mitra– UCDH High Value Care Competition


Outcomes, con’tInstituion Fellowship(s)

City of Hope Hemepath

Emory Molecular pathology

Johns Hopkins Gyn pathology

MD Anderson Cancer Center

Surg path

San Diego Coroner’s Office Forensic pathology

Stanford Transfusion

Univ, of Alabama Molecular pathology

Univ, of Massachusetts Dermpath

UC Davis Cytopath, Hemepath, Surg Path

UCLA GI path

UCSD Neuropath, Bone/soft tissue

Univ. of Washington GI path

Outstanding fellowship placement


Edmondson Summer Research Internship: ~35 yrs

Encourage careers in science, pathology, lab medicine

Develop diverse pipeline– Prep Medico partnership x 3 yrs.

Survey for 2002-17– 93% strongly agreed/agreed:

“Important to career development.”– 25%: Doctoral degree (PhD, MD, other)– 10%: Masters or other health

professional degree


Faculty: National leaders in education

Test Development Advisory Committee, American Board of Pathology – Hooman Rashidi (Hemepath)– Max Fung (Dermpath)

National Executive Board, Alpha Omega Alpha Honor Society– Regina Gandour-Edwards

Test Material Development Committee, United States Medical Licensing Examination (USMLE), National Board of Medical Examiners– Regina Gandour-Edwards

2015 Excellence in Advising Award (Faculty Advisor category), Region 9 of National Academic Advising Association– Hwai-Jong Cheng PhD


Education innovators

PMD 410A&B: – Techniques from humanities education:

Essay questions

Artificial intelligence applications– Histology education– For early identification of students

experiencing academic difficulties


Clinical Accomplishments


Our clinical role: Testing for our region

• We enable care for an underserved region.

• Sacramento County • Moderate access to health coverage

• San Joaquin County • Lowest access to health coverage• Life expectancy 69 years for poor vs. 90+ years for all others• Higher percentage (23.4%) of uninsured nonelderly adults ages 18-64

compared to state as a whole

• High incidence of cancer in the surrounding counties


Our clinical role: Make care available to all in our region

Cost-effective lab tests

More patients served• Including those who can’t pay

Healthier community and region


Points of Pride: Financial stewardship

$11M savings, 2015-16: Negotiated capital equipment expenditure for new automation line

$1.1M savings, 2015-16: Converted four reference labs to 3rd party billing.

$660K new revenue, 2018: Created new billing codes for opiate testing.

New Lab Utilization Committee, to be launched in 10/2019:– Chaired by non-pathologist physicians– Charter and P&P created by the department to get multi-disciplinary provider buy-in on

test menu and controlling use of expensive send-out tests


Points of Pride: New, better, faster tests in the Clinical Lab

Earlier treatment

Betterworkflow in Emer

Dept.

Early dx of fibrosis

and cardiotox

• Among 1st labs nationally to implement high-sensitivity troponin (hsT)

• 2 hrs faster!!• More sensitive

for myocardial damage


New better, faster, more efficient tests: mPOC for sepsis detection

mPOC for high-risk pts (burn unit)

Early dx (28.7 hrs) of meth-sensitive S.

aureus infections

Reduced unnecessary

empiric vancomycin tx

35% decrease: Vanco-induced acute kidney

injury

• UC Davis Health: 1st in the nation to implement molecular POC pathogen detection in this high-risk group.


Anatomic Pathology: Department’s biggest challenges

Non-automated testing -- dependent on human effort and subject to human variability.

Lack of automated quality monitors in LIS: – Manual data collection is required– Custom builds required

Critical shortages of lab professionals negatively impacting recruitment– 2 year vacancies for AP manager and pathologist assistants

Requires continual work on relationships


Anatomic Pathology: Points of Pride

In-sourced renal pathology: Kuang-yu Jen MD, Mingyu Cheng MD– Better service, education, clinician satisfaction– Grew volume

Digital pathology:– Implemented in 90% of all tumor boards in 2018– Telepathology for frozen section and consultations

Key to accreditation of the new Rectal Center of Excellence– Special commendation from site visitors

Frozen sections:– Low discrepancy rates: ~0.50% since 2014 (nat’l benchmark =1.10-3.25%) – Fast turnaround time


How have we achieved so much?- 2 strategic plans – but it takes more than just a plan


Advice that has resonated with me for many years

#1: Surround yourself with good people

Am J Med 2012; 125:315-319


So proud of our great people!

Lots of new recruits – 2/3rd of faculty are new in the past 10 years– 21 new faculty in the past 5 years!

- 13 replacements- 8 new positions

– Retention rate better than AAMC’s national average

New faculty section leaders in the past 5 years– Nam Tran PhD: Chem/POC/Tox– Anna Romanelli PhD: Microbiology – Grace Monis MD PhD: Apheresis– Sarah Barnhard MD: Transfusion– Dorina Gui MD PhD: Surgical Pathology– Kuang-yu Jen MD PhD: Renal Pathology

Lots of great new admin and clinical lab staff on our team


Celebrate our staff and faculty, and honor each other


Advice, con’t

#2: Serve the interests of the faculty

Am J Med 2012; 125:315-319

Faculty come here because UCD is a great university they expect to have great careers here.


Supporting faculty research

Seed grants– Department-initiated and leadership in collaborative grants– Department-only grants

Continual attention to our administrative services– Mandatory PI effort confirmation in Cayuse.– Improved monthly budget reports– Continued training of Business Office Staff in research admin.– More staff: Added part-time effort from Gabriela Lee MBA – Open houses to build relationships with Business Office.

Advocating for space: 2000 sq ft. deficit.


Faculty DevelopmentDevelopment Program Participants (Year)

ASCP Leadership Institute Barnhard, Jen, Tran, Romanelli (2018)

APC Pathology Leadership Academy

Vali Betts, Dugger (2019)Rashidi, Olson (2017)Wan, Gui (2016)

USCAP Course for Emerging Leaders

Barnhard (2017)

UC Women’s Initiative for Professional Development

Olson (2017)

UCD Health Mentored Clinical Research Training Program

Graff (2017-19)Grimsrud (2016-18)

AAMC Minority Leadership Program

Martinez-Cerdeno (2019)

~1/3rd of our faculty have participated in development programs

Almost all were Assistant or Associate Professors


Outcomes: Success in academic advancement

% of successful actions:– 90% promotions– 95% merits

% of actions with Step Plus or Accelerations– 30% promotions– 20% merits

Why so successful?– Strong mentoring– Good advice– Resources and opportunities0

5

10

15

20

25

30

35

1 1.5 2 Denied Accelerated

Faculty Academic Advancements by Step,

AY1516 - AY1819Pathology & Laboratory Medicine

Merit Promotion


Advice, con’t

#3: Perfect the art of compromise

Am J Med 2012; 125:315-319


Reflects our values– Collaborative

environment– Importance of

relationships

Compromise means:– Negotiation – Partnership

This Photo by Unknown Author is licensed under CC BY-NC

https://smbuick.wordpress.com/2015/09/15/kim-davis-update-free-for-now-country-remains-divided/

https://creativecommons.org/licenses/by-nc/3.0/


Compromise, negotiation and partnerships: Examples

Improvements to billing and collections– Dept billing central billing unit– Outcome: More $$ to the

department.

Partnerships with Radiology and Academic Affairs for shared services.

Off-loaded responsibility for core research services:– EM lab Anatomy & Cell Bio;

$300K savings– Flow cyto core lab Med

Microbio; $50+K savings


Advice, con’t

#4: Be transparent

Am J Med 2012; 125:315-319

(for all the things that aren’t confidential!!)


Transparency

Regular updates:– Financial – Council of Chairs– Association of Pathology Chairs

Finance Advisory Committee: – Rules-based compensation plan

“Lunch with Lydia”This Photo by Unknown Author is licensed under CC BY-SA-NC

http://corporateeurope.org/pressreleases/2015/01/eu-lobby-register-still-failing-deliver-real-transparency

https://creativecommons.org/licenses/by-nc-sa/3.0/


Advice, con’t

#5: Give others responsibility and authority

Am J Med 2012; 125:315-319


Divide the work and conquer -- get more done!!

Delegation of authority to lab directors:

Vice Chairs:– Modelled after Dean’s office structure– Requires formal reviews


Advice, con’t

#6: Never accept the status quo

– “If a day has gone by without a threat to the well-being of your department, you probably have not been paying attention.”

Am J Med 2012; 125:315-319


Avoiding threats Planning for the future


Future: Research

Keep our research programs growing!– Address areas of current scientific interest and need.

Opportunities:– Complete recruitments for 3 tenure-track research faculty:

- Stowell Chair in Experimental Pathology- Microbiome- Neuropathology

– Leverage new recruits to expand dept-based collaborative programs, especially immunology.


Future: Research, con’t

Be a leader re: new diagnostic technologies – Develop, evaluate, implement – AI, imaging, and more– Create new pertinent quality programs, too.

Support translational pathway establish a Center for Diagnostic Innovation (CDxI)– Organize, brand, and market our activities under a single umbrella– Refine our plan based on feedback from external reviewers.– Submit to Dean and Vice Chancellor for support– Seek funding: internal and external.


CDxI: Clinical Validation Laboratory

Clinical Implementation

(including provider education)

CLIA/FDA Regulated Validation

Method Development

Cost and Value Analysis

CAP Accredited Biobank CLIA and CAP accredited Lab

Feedback from clinical practice


Future: Education

Undergrad programs

Medical Laboratory Technician

Clinical Lab

Scientists Cytotechs

Medical students

Residents Fellows

Continuing Education

for Practitioners

Mature and sustain our many new programs.– Medical student electives– Clinical informatics program

New subspecialty focus for surg path fellowships. Curriculum reform for medical students


A few new things to think about

On-line continuing education for practitioners:– CME/CE, SAMs for our Lab Best Practice blog and Case of the Month

More use of educational technologies for training programs:– Less “sage on the stage”– More on-demand delivery at the learner’s convenience

Create educational programs within Center for Diagnostic Innovation– Grow cross-disciplinary literacy between medicine, computer science,

and engineers.


Future: Clinical Service

Partner with Radiology Path-Rad integration– Integrated reports and more– New opportunities with a new Chair of Radiology

Refine our AP subspecialty team model:– New and better teams?– Integrate clinical partners into teams?– Frozen section “hospitalist” role??

Quality programs– Leverage LIS– ?Cross-dept monitors– Client satisfaction


Future: New financial model

How will new funds flow model influence:– Faculty staffing in all subspecialty areas (AP and CP)?– Salaries and Z-payments?– Departmental funding for education and research programs


Lastly, to paraphrase the Presidents

Being a chair:

– “is a glorious burden”- George Washington

– “is a splendid misery”- Thomas Jefferson

– “has made every person who occupied it bigger than s/he was -- and no matter how big, not big enough for its demands.”

- Lyndon B. Johnson


But it’s the best job I’ve ever had!

Thank you all for a great 10 years You make our department what it needs to be I look forward to your feedback during my review

Date post:	13-Aug-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

The Past, Present, and the Future...Imaging: MUSE (Levenson/Fereidouni) – Involved lots of faculty...

Documents