Tahoe Institute for Rural Health Research

October 2013

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The Institute (TIRHR) was created in August 2009 as a subsidiary of the Tahoe Forest Hospital District. The mission of TIRHR is to develop innovative technological or programmatic products and practices, which improve the affordability and delivery of high quality healthcare. TIRHR is particularly interested in innovations that reduce health care costs or reform healthcare delivery in hospitals, clinics, and remote or home settings.

Project ideas for TIRHR typically originate from health care professionals, primarily from remote or rural environments, who work with more limited resources and are looking to solve an unmet need. Practitioners from these areas are more sensitive to opportunities for improvement than their peers from urban environments because of the need for solutions to problems that are not readily at hand. The innovations developed by TIRHR will reduce the cost of care and /or improve the quality of care and will therefore be applicable to a wide variety of health care settings both rural and urban. The scientists and engineers working as management or staff of TIRHR have significant experience in conducting revolutionary research and bringing important new technologies to market.

The TIRHR includes the expertise of physicians, nurses, scientists, engineers, researchers, educators, and other related fields through its current collaborative partners.

TIRHR is well positioned to conduct high quality community-based research focusing on the unique barriers to optimal healthcare delivery in a geographically remote, mountainous region. This is based on the involvement of the community, the resources invested in TFHS in tele-education (currently>$400,000 per year for 5 years), the expertise of the leadership of TIRHR, and the track record of successful collaboration with UC Davis. The Scientific Advisory Committee (SAC) of the Institute has requested that interested community members and medical professionals provide innovative ideas to the TIRHR that can be translated into solutions for providing better healthcare delivery services. This effort resulted in numerous ideas from front line providers in the community. The institute is currently pursuing or developing four projects that were approved by the SAC.

Collaborative Relationships:

Lawrence Livermore National Laboratory

University of California, Davis ("UC Davis") Schools of Medicine and Nursing, http://www.ucdmc.ucdavis.edu/medschool/ http://www.ucdmc.ucdavis.edu/nursing/

Center for Biophotonics Science and Technology ("CBEST") at UC Davis, (CBST advances research, development, and application of new optical/photonic tools and technology in medicine and the life sciences) http://cbst.ucdavis.edu

UC Davis Center for Healthcare Policy and Research, http://www.ucdmc.ucdavis.edu/chpr/

UC Davis Innovations Center, http://www.ucdmc.ucdavis.edu/cht/research/innovation/index.html (A state of the art research laboratory with a focus on changing the future of healthcare delivery in both rural and urban settings)

UC Davis Clinical and Transitional Science Center ("CTSC"), http://www.ucdmc.ucdavis.edu/ctsc/ A two-time recipient of the NIH Clinical and Translational Science Award, CTSC provides UC Davis researchers with connections, assistance, training and tools to help translate ideas into products to improve health and healthcare delivery.

UC Davis Graduate School of Management, http://gsm.ucdavis.edu/

The TIRHR Board of Directors:

The board of the Institute consists of 11 members that are affiliated with Tahoe Forest Health System (TFHS), UCD Clinical & Translational Science Center, NSF Center for Biophotonics UC Davis, UCD Graduate School of Management, and Truckee/Tahoe community business leaders:

Art Chapman, JMA Ventures, LLC
Betsy Cole, EVP, TIRHR
Bob Schapper, CEO, TFHS
Dennis Matthews, PhD, CBST, & CSO, TIRHR
James Stevens, Assistant Dean, UCD, Graduate School of Management
James Hood, PhD, COO, TIRHR
Karen Sessler, MD, TFHS Board of Directors
Tod Stoltz, MBA, UCD School of Medicine
Rick Ganong MD, TTMG
Tom Dwelle, General Partner, Flyer's Energy
Thomas Hobday, CEO, TIRHR

Staff of the Institute:

The President and Chief Executive Officer of the Institute is Thomas Hobday, an active community volunteer and retired Assistant Dean for Health Sciences Advancement at the UC Davis Medical School. Prior to joining UC Davis, he had over 30 years in the industrial insurance industry, and since has had 18 years in health system administration. Mr. Hobday is a very competent administrator, team leader, and fund raiser. He also served for three years as the National Chairman of Fund Raising and the only lay member on the National Research Grant Review Committee of the American Cancer Society. In 2013 he served on a grant development advisory committee with the National Science Foundation, and also as a grant reviewer for that institution.

The Chief Operating Officer and the Chair of the Scientific Advisory Committee (SAC) is James Hood, Ph.D., He has over 40 years of experience in the development, manufacture and sales of high technology electronic equipment and systems with twenty years of general management responsibilities. Dr. Hood was the Vice President of Engineering of the company that developed DSL. The existence of this Scientific Advisory Committee, and its distinguished membership, allows the Institute to review projects from a broad and critical perspective, not usually found in organizations of its kind.

The Executive Vice President is Elizabeth Johnston Cole, she has over 30 years of experience in investment banking, strategic planning and finance. From 1998 until 2010, Ms. Cole was Executive Vice President and Chief Financial Officer of Booth Creek Ski Holdings, Inc. ("BCSH"), the owner and/or operator of multiple Ski Resorts including Northstar at Tahoe. She was a partner in BCRP, LLC., the owner of BCSH. Previous positions held by Ms. Cole include Vice President of Business Development for Vail Resorts, Inc., Chief Financial Officer of Petrowax PA Inc., Vice President of Aurora Capital Partners, and First Vice President, Financial Institutions/Corporate Finance of Drexel Burnham Lambert, Inc.

Vice President Buddy Tucker has over 35 years of experience in the healthcare market, and has been instrumental in pioneering many new medical technologies that are now considered standard of care. As a former executive and pioneer of conceptual medical device technologies, he has successfully contributed to many breakthrough technologies within the healthcare environment. He has been instrumental in taking products from their conceptual stage by developing a long-term market strategy, identifying key physicians for beta testing, and implementing a full-scale sales strategy for product launch. Innovative medical devices Buddy has helped develop include dry heparin blood gas collection devices, pulse oximetry, harmonic scalpel, abdominal aortic aneurysm endograft, and surgical and remote presence robotics. By providing guidance, consultation, and direct contact with the many physician relationships established over the years, his expertise combined with his extensive knowledge of corporate strategy and development has contributed to healthcare startups emerging as an acquisition or IPO sustainable company. TIRHR welcomes his extensive knowledge and expertise within the healthcare arena.

The Chief Scientific Officer is Dennis Matthews, Ph.D., He joined the Institute on July 1, 2012 after his retirement from UC Davis where he had been the Associate Director for Biomedical Technology of the Comprehensive Cancer Center and where he remains as the Director of the NSF Center for Biophotonics Science and Technology. Dr. Matthews is now a Professor Emeritus in the UC Davis Department of Neurological Surgery and a member of the Biomedical Engineering, Applied Sciences and Clinical Sciences Graduate Groups. He is also a previous Program Leader and Division Leader at Lawrence Livermore National Laboratory and is currently in charge of developing new biotechnology program opportunities there. Dr. Matthews has more than 35 years of experience in building and leading large scientific research and development programs that focus on optical and x-ray imaging technologies, medical device creation and translation, as well as forming public-private partnerships for commercialization.

The Vice President of Business Development is Mark Peshoff, As a former executive within the Office of the CEO and COO at Cisco Systems, Mark Peshoff led the companywide restructuring efforts to fundamentally make the shifts in the Cisco business and strategic plan to align resources to the top priorities, simplify the operating model, enhance the supply chain, restructure engineering and align the go to market strategy with the company 5 year plan. With more that 32+ years in the High Tech industry, Mark's experience includes corporate strategy and development, sales management, consulting, product marketing, field marketing, product management, channels and acquisitions assessment/integration. Prior to Cisco, Mark spent 14 years with Hewlett-Packard, building the company's first Network Consulting Organization within both Cisco and Hewlett-Packard, he has held key leadership positions in Europe and Asia Pacific.

Applied Clinical Specialist, Maureen Ludwig, RN, MSN has a diverse background in health care with clinical, management, technical, training and medical-legal skills. She hasexperience in occupational health within corporate and field environments, as well as independent consultation. Her nursing career includes orthopedic sports medicine nurse practitioner with operating room privileges, as well as eight years as an operating room nurse at Stanford Hospital in Palo Alto, California. She received her education at the University of California, San Francisco where she also worked as a clinical professor.

Senior Scientists of the Institute include:

Richard Johnson, who has more than 40 years of engineering and senior management experience in the design, development and manufacture of electronic products/systems and was responsible for the start-up of several successful companies. The products included word processors, disk drives and media, printers, and satellite communications systems. Most recently he was a founder and key technical leader of Dish Network as Vice President of Advanced Development through the first 10 years of the company's rapid growth.

Keith Tatsukawa, spent his entire career conducting brain research at UCLA, and subsequently worked with Pfizer and Amgen. He is experienced with animal models for Parkinson's disease, Alzheimer's disease, stroke, epilepsy, oncology, developmental disorders and other neurodegenerative diseases. Mr. Tatsukawa is an experienced clinical researcher and the lead investigator of the traumatic brain injury project.

Dr. Stephen Lane Ph.D., was a researcher and scientific manager at Lawrence Livermore National Laboratory for 30 years where he worked on projects related to nuclear physics, laser fusion, biosecurity, semiconductor manufacturing, and medical technology. At UC Davis in 2002, he co-founded and became the Chief Scientific Officer of the NSF Center for Biophotonics where light based technologies were used to solve important problems in medicine and biology. He currently is an independent consultant and is an Adjunct Professor Emeritus in the UCD Dept. of Neurological Surgery and continues to work on the technology development and commercialization of medical devices and sensors.

Dr. Windy McNerney Ph.D., is a researcher at Lawrence Livermore National Laboratory where she primarily works on projects related to neuroscience. At the University of Notre Dame she conducted research projects on the neural basis of memory formation as well as EEG/ERP waveforms related to memory processing. She is currently on the investigation team for the traumatic brain injury project.

Dr. Nina Winans, MD, board certified in Sports Medicine, is one of the clinical investigators involved with the TTUSD/TIRHR collaborative program development and the implementation of Play it Safe Concussion Care. Dr. Winans received her medical degree at the University of Pennsylvania Medical School. She continued her education at the UC Davis Medical Center and completed her internship, residency and fellowship there. Dr. Winans research experience during her Sports Medicine Fellowship at UC Davis included exercise and hypertension, tension night splints for plantar fasciitis, and elbow dislocations. She currently practices Sports Medicine with the Tahoe Forest Health System MultiSpecialty Clinics and is the Medical Director at the Tahoe Center for Health and Sports Performance.

Division of Clinical Informatics:

TIRHR has contracted with the California Critical Access Hospital Network (CCAHN) to manage the third year of a grant the Institute received from HRSA to provide services to eighteen California Rural e Health (CAReHIN) member hospitals http://www.carehin.org/ to prepare for changes being mandated by the Affordable Care Act.

Tom Northey who is the Director of IT Collaboration for (CCAHN) has come onboard as CAReHIN's new Executive Director. CAReHIN will now be more closely aligned with CCAHN yet remain as the technical infrastructure and Meaningful Use driver for Critical Access Hospitals (CAHs) in California (a continuation of the CAReHIN Work Plan). CAReHIN's continued focus will be to assist those remaining hospitals still needing to successfully attest for Meaningful use Stage 1 and to assist all those hospitals preparing to attest for Meaningful Use Stage 2. Part and parcel to this effort will be the ongoing development and deployment of a Strategic Roadmap for California's CAHs to assist them in the planning and acquisition of key technologies that will move them along the path to HIMSS Level 7 achievement. This Strategic Roadmap (including MU2, HIE connectivity and HIMSS Level 7) will prepare and position CAHs for participation in whatever Population Health/Payment models emerge. Together with CAReHIN members, we will be refining this roadmap in the coming months. CCAHN through CAReHIN brings a number of key technology partners and an incredible set of resources (both technologically and strategically) together to propel CAReHIN and its members to greater economies of scale (cost savings), toward the achievement of critical initiatives and for the imperative of rural, hospital sustainability." Tom Northey can be reached at tom.northey@wha1.org, Direct phone: 866-986-3657, Cell phone: 303-919-2992.

Current TIRHR Projects

I. Critical Care Product:
The Critical Care Product ("CCPÓ) will meet an urgent need in operating and emergency rooms of smaller hospitals. The CCP will provide rapid access to the precise Critical Care Algorithms needed to stabilize a patient during a medical emergency. The product will guide the medical staff step by step through the prescribed protocols, while recording critical information. Improved outcomes are expected, particularly in smaller hospitals where patient symptoms, requiring use of these algorithms, is infrequent. TIRHR has filed a Patent Application for this product.

II. Home Blood Monitoring:
A blood count monitoring device is being designed that will accurately monitor a patientÕs blood count at home. The system is designed for home use by patients who require ongoing blood count monitoring such as those who have undergone chemotherapy or major surgery, or those fighting a significant infection. The device will report the results to the doctorÕs office, allowing the condition of the patient to be assessed daily. It will also be a meaningful tool in clinics or other medical settings that do not have more sophisticated blood-monitoring devices on site. The ability to monitor a patientÕs blood count inexpensively, without utilizing a hospital lab, will reduce health care costs and will allow for more frequent monitoring, thereby improving quality of care. In its initial stages partial funding for this project has been provided by the National Science Foundation. A Provisional Patent Application has been filed for this product.

III. Mild Traumatic Brain Injury Diagnosis (mTBI):
This project is attempting to develop a simple device to diagnose mTBI. The device would signal when participants should be sidelined and would determine when they were healthy to return to play. The goal is to prevent athletes from suffering successive head impacts when the brain is already injured resulting in more severe brain trauma. This research is being conducted with the cooperation of the Tahoe Truckee Unified School District, the Tahoe Forest Hospital Emergency Room, Incline Village Community Hospital Emergency Room and the emergency clinics at local ski resorts. Representatives of TFHS and TIRHR are working, within the Tahoe region, to test athletes and to educate parents, coaches, athletic trainers and athletes about concussion treatment and prevention. Particular emphasis has been placed on the danger of successive impacts to a brain already mildly injured. TIRHR is sponsoring the Play It Safe Concussion Care Program for all student athletes in contact sports within the Tahoe Truckee Unified School District which provides excess insurance for proper treatment of concussion injuries.

IV. Home Vital Signs Monitor:
The UC Davis Graduate School of Management has completed a very positive preliminary marketing study, and the Institute has begun working with UC Davis Health System and LLNL Scientists to develop the initial concepts for this product.

The Institute projects that the funding for these efforts will come from a variety of sources including members and affiliates, federal, state, and private grant funding, private investors, and philanthropy. The TIRHR Board is actively reviewing and applying for grant monies as well as soliciting support from community members.

For more information, please contact Tom Hobday at thobday@suddenlink.net or Sarah Jackson at sarah.jackson@tfhd.com.

Tahoe Institute for Rural Health Research Organization Design

Links

Tahoe Forest Hospital District, 10121 Pine Avenue, PO Box 759, Truckee, CA 96160, (530) 587-6011, information@tfhd.com

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