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CPGH grows with advances

Turning technology into better health care

Posted: Thursday, March 01, 2001

The pulse Doug Davis began hearing in his ear could have been the sign of a tumor.

To rule out the frightening possibility, health workers sliced into his groin and snaked a wire up the blood vessels to his brain. Davis, director of diagnostic imaging for Central Peninsula General Hospital, said they slid a tube up the wire, then injected dye through that to X-ray the vessels in his brain.

Soon, though, high-tech methods for imaging people's insides may save many CPGH patients from such unpleasant procedures.

"It's the wave of the future," said Davis, whose problem turned out to be a malformed blood vessel that posed no hazard to his health. "Noninvasive techniques are taking over most of the invasive techniques we've done in the past."

One such improvement is the $1.38-million magnetic resonance imaging machine CPGH installed in 1999. The MRI uses magnetic energy and radio waves to make detailed images of the body -- with no need to thread wires and tubes up blood vessels. Unlike X-rays, Davis said, the MRI can distinguish between water, fat and muscle. The hospital already uses it to find tumors, muscle damage and torn tendons.

This year, Davis plans a $150,000 upgrade to enable MRI imaging of breasts and the blood vessels in people's necks and brains. He said the breast scans could eliminate the need for many biopsies and aid in the difficult task of diagnosing tumors in women who have had breast augmentation surgery. The blood vessel scans will be especially useful for tasks such as determining the extent of strokes and detecting plaque and the narrowing of major blood vessels in the neck.

The MRI complements the hospital's CT scanner, which uses computers to combine multiple X-ray images into detailed cross-sections of the body.

CT scans can reveal tumors, blood clots, fractures and abnormalities of the bone. Davis said they are especially useful for diagnosing injuries in accident victims. CT scans are much faster than MRIs, he said. Meanwhile, the strong magnetic fields generated by the MRI can turn steel equipment that comes with emergency patients -- oxygen tanks, IV pumps and more -- into missiles.

CT scanners have improved since the hospital bought its machine a decade ago. Davis has proposed spending $1.2 million this year for a new CT scanner that will cut imaging time by three-quarters and also will be able to image coronary arteries, revealing the extent of plaque and obstructions.

"We can't do that now," he said. "Now, we send patients to Anchorage for heart catheterization with dye."

Next year, he hopes to spend $480,000 to replace two existing ultrasound machines with newer models, adding the ability to use ultrasound imaging for obese patients and the sensitivity to measure blood flow through an artery.

Diana Zirul, president of the nonprofit corporation that runs the publicly owned hospital, said prudent management and community support have allowed the hospital to keep abreast of community needs.

"We're trying to look at the services that realistically can be provided here in a cost-effective, quality manner so that people don't have to go outside the community," she said.

Mike Gutsch, chief financial officer, said hospital operating costs should be about $30 million this year, with margins -- much like profits in a for-profit business -- of about $1.8 million. Property taxes from the Kenai Peninsula Borough's Central Kenai Peninsula Hospital Service Area should total about $1.3 million. The corporation typically spends margins and property taxes for capital improvements, he said. Large expenditures and expenditures of service area taxes require borough approval.

Zirul said new technology, the addition of expertise and changes in the way medicine is delivered have fueled hospital expansion. As the hospital adds services, more patients find treatment here, rather than in Anchorage or Seattle.

While the hospital opened in 1971 primarily as an in-patient facility, today, more than half of its revenue comes from outpatient services.

Rebecca Byerley, manager of physical medicine, said physical therapy used to be an inpatient service geared mainly to orthopedic patients. Now, she said, 90 percent of the hospital's physical therapy patients come as outpatients.

The department has added services for head-injury and stroke patients, for women suffering urinary leakage, muscle pain and osteoporosis and for people with balance problems. It treats hand, wrist and elbow problems that stem from the growing use of computers. It sees five times as many patients now as it did four years ago, and its staff has grown from three full-time equivalents to 14.

She and Marty Richman, hospital chief executive, also attribute some of the growth to the convenience of a physical therapy clinic the hospital opened in Kenai in 1999. The patients there nearly all come from Kenai, Richman said, and there has been no effect on the hospital's Soldotna physical therapy business.

"We believe that serving patients in their local communities is something they require of us," he said.

This summer, the hospital plans to open a clinic in Kenai where patients can have laboratory tests and X-rays. The Kenai clinic will offer general X-ray exams, mammography and X-rays to determine bone density and detect osteoporosis, a weakening of bones that can cause fractures in the elderly. While women are four times more likely than men to develop the disease, men also suffer from osteoporosis. Equipment to measure bone density is not available at the hospital in Soldotna.

Richman said he hopes opening the Kenai clinic will lead more women to have mammograms, X-rays that can detect breast cancer early. Now, he said, Kenai women are only 80 percent as likely to have mammograms as Soldotna women.

"I think it may be a convenience issue," he said.

Zirul said more satellite facilities could figure in the corporation's new strategic plan, which she hopes the planning committee will bring to the board by March. The committee is looking particularly at space needs and expansion of radiological, laboratory, physical medicine and surgical services, she said.

Recently, the hospital opened Serenity House, a drug and alcohol treatment center on Kalifornsky Beach Road. The board also recognizes the need for psychiatric services, Zirul said, and those likely will be addressed in the plan.

Other improvements already are under way. Zirul said the hospital plans an $894,000 project in April to centralize computerized records, replacing separate systems for laboratory, billing and other departments. The new system will improve efficiency, she said, and it may someday allow doctors to access lab reports and other information electronically from their offices, instead of waiting for paper reports.

The hospital is considering whether to add 4,000 square feet of laboratory space this summer.

Meanwhile, the administration has budgeted $500,000 this year and next to replace aging X-ray and fluoroscope machines with digital models. If the corporation and borough approve, doctors will view images instantly on video screens instead of waiting for films to develop. The digital system will allow computerized adjustments to image density, eliminating the need to retake X-rays that come out too light or too dark. The system also will print paper copies.

Doctors could potentially view CT scan and MRI images side-by-side or even overlay them, Davis said.

He also hopes to buy digital image archiving and communications. He said $400,000 would buy computerized storage plus remote monitors to display images from the radiology department in the emergency room and at the nurse's station.

The hospital is exploring costs of a second phase of adding equipment so that doctors could access stored images over the Internet. That technology also could allow doctors here to consult experts across the county without waiting for films to travel in the mail. It also could allow the hospital here to receive films from hospitals in Anchorage.

The digital system could eliminate 75 to 80 percent of the hospital's film budget, he said. Computerized archives would eliminate the labor required to retrieve X-ray films from tens of thousands stored in the hospital basement and reduce the need for space.

Richman said the hospital, which employs about 300 people, provides a remarkable economic asset.

"Each time the hospital adds a service, we do something for the community. People don't have to travel to Anchorage," he said.



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