Tahoe Institute for Rural Health Research
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 to rural, remote and underserved communities. TIRHR is particularly interested in innovations that reduce health care costs or reform healthcare delivery in rural 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. The innovations developed by TIRHR will reduce the cost of care and /or improve 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 rural 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.
Lawrence Livermore National Laboratory
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/
Staff of the Institute
The President and Chief Executive Officer of the Institute is Thomas Hobday, an active community volunteer and retired Assistant Dean of UC Davis for Health Sciences Advancement. Prior to joining UC Davis, he had over 30 years in the industrial insurance industry, and since has had 17 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.
The Chief Operating Officer and the Chair of the Scientific Advisory Committee (SAC) is James Hood, PhD. 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.
The Chief Scientific Officer is Dennis Matthews, PhD. 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.
Senior Scientists of the Institute
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 MD, PhD, 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. Dr. Tatsukawa is an experienced clinical researcher and the lead investigator of the traumatic brain injury project.
Dr. Stephen Lane 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.
Division of Clinical Informatics
Lynn Barr, Mph. An energetic entrepreneur with thirty years of experience in health care, Ms. Barr has shepherded twelve medical inventions and five start-ups through research, the FDA and to worldwide markets. While earning her Master’s Degree in Public Health at UC Berkeley, she led the California Health IT and Exchange Strategic Planning Team under California HHS HIT Deputy Secretary Jonah Frohlich, formed the Rural Health Information Technology Consortium and assessed HIT status of California Rural and Critical Access Hospitals. She developed a $20 million rural hospital loan program with United Health Group and is the Executive Director of the CAReHIN network which is HRSA-funded to assist hospitals in technology adoption. Ms. Barr is a member of the National Rural Health Association Government Affairs Council, a 2013 NRHA Fellow, an ORHP Advisor on Health Care Reform, Chair of the National Rural Hospital Innovators Group and policy advocate on behalf of all rural providers. She is currently leading unaffiliated rural hospitals in the formation of an ACO as the Chief Innovation Officer of Tahoe Forest Health System, one of the top 100 rural hospitals in the country.
Ms. Barr spent 8 years in the military as a medical technologist in clinical and research settings. She holds patents in drug-delivery, interventional cardiology and informatics.
Margaret Leonard MSPH, Director of Program Development for CAReHIN. Prior to her position at CAReHIN, Margaret worked for three years as a Project Manager with community physician providers to implement electronic health records in a rural setting. As Director Quality Improvement for a four-county coalition of safety net community (FQHCs), she worked for three years developing quality improvement programs and clinic readiness for electronic health record implementation. She has an additional 20 years of experience in quality improvement, data analysis and strategic planning in multiple hospital settings.
Board of Directors
The TIRHR Board of Directors 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
Lars Berglund, MD, PhD, UCD School of Medicine
Rick Ganong MD, TTMG
Tom Dwelle, General Partner, Flyer's Energy
Chris Ryman, Chair, Tahoe Forest Hospital Foundation
Thomas Hobday, CEO, TIRHR
Current TIRHR Projects
I. Critical Care Product:
The Critical Care Product ("CCP") 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 Provisional Patent Application for this product.
II. Home Blood Monitoring:
A blood count monitoring device is being designed that will accurately monitor a patient’s 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 doctor’s 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 patient’s 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, 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.
IV. Auto-Diagnostic Acoustic Device:
This project is currently being submitted to the UC Davis Graduate School of Management for a preliminary marketing study.
The ADAD will provide the user with an instrument to automatically identify and diagnose abnormalities in body sounds indicating disease. The ADAD is a paradigm shift over existing digital stethoscopes in its form factor and diagnostic capabilities utilizing advanced digital signal processing and sound gathering technology. The device will be used to automatically diagnose heart, lung, blood flow, and other organ’s sounds using their Acoustic Signatures. The instrument will be used in a clinical, office, or field/home environment.
V. Home Vital Signs Monitor:
This project is currently being submitted to the UC Davis Graduate School of Management for a preliminary marketing study.
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
Division of Clinical Informatics
In addition to the programs described above, the Institute has recently opened a Division of Clinical Informatics under the direction of Lynn Barr, MPH. This division provides a home for the California Rural eHealth Information Network (CAReHIN), which provides a rural-focused approach to gather, exchange and use population health information to improve the quality, efficiency and patient-centeredness of care in rural communities. Resources are developed and shared among network members to facilitate the adoption and meaningful use of electronic health records, health information exchange and to promote accountable care. Examples of successful programs by the network include facilitating hospitals through vendor selection, provision of low-cost deferred payment loans for EHR adoption, development of a Rural California Health Information Exchange (HIE) Strategic Plan, and the Rural Incumbent Worker Training program. On August 1, 2011, the Institute received a $900,000 grant from HRSA to fund these programs for three years.
In 2013, TIRHR launched the National Rural Healthcare Transformation Project (NRHTP). This program designed by and for rural providers, revolutionizes rural health care by taking a proactive approach to population health and managing high risk and frail patients. It provides a system of care, including contracts, policies, procedures, management tools, outcome data and quality reports that enable rural communities to participate in Federal and Commercial Shared Savings Programs, Care Coordination Management Programs and Value Based Purchasing Programs with minimal investment. TIRHR is currently recruiting 100 Rural and Critical Access Hospitals and their primary care Physicians to participate in this program, forming a National Multi-Payer Rural Accountable Care Organization.
The Institute has had several additional promising medical needs presented to them by local physicians, and there are more yet to be provided by other front line providers. The Institute is uniquely positioned to fill a significant void in the identification and solution of problems found in rural and remote medical situations, as well as to analyze opportunities for the effective use of resources.