Recently in Mia Iverson Category

Patient A is admitted into the ER. As she lays in the taut, paper-lined bed, she watches her assigned nurse punch numbers into a computer screen, not turning around to offer a quick smile or explanation of test results. Hours later, as Patient A is wheeled into an elevator on her way to her new room in the orthopedic wing, she lifts her good arm to notice a barcode on her identification wrist band. The next day, she pretends to understand the medical jargon her doctor is throwing at her and is discharged a day later after surgery. Curious, she has a desire to look at her EKG readings and X-Ray the medical staff took of her now casted arm. Instead of taking the trip back to the hospital and dealing with the administrative staff in the medical records department, she can now sit at her own computer in the comfort of her home and access her medically documented journey through the hospital - so can her nurse, doctor, and radiology techs.

     Gone is the day of charting at the end of shifts, frantic physician phone calls to overworked nurses, and working the maze of accessing the tree-killing closet of medical records. Now, with a simple log in, medical records are now at patients, nurses, and doctors' fingertips.

     EMR, Electronic Medical Records, are revolutionizing the way medicine is practiced, and locally, it has already made a huge impact on how Lawrence Memorial Hospital operates on a daily basis.

"We started this about 10 years ago," said Belinda Rehmer, Communications Coordinator at Lawrence Memorial Hospital. She reported that LMH is no longer in the beginning stages and is currently up and running on an EMR system throughout the hospital and in conjunction with practices that they own including Eudora Family Practice and Mt. Oread Family Practice. "We've been up and running for over a year now - at least a year".

     But it wasn't an easy process. Cost was one of the major roadblocks in jump-starting this process. "Implementing the software is not cost neutral because the physicians would have to buy the software out of their own expenses," said Rehmer.

     Dr. Stephen Myrick, general surgery, at LMH has yet to take advantage of the EMR system 10 years after the idea reached LMH. "I don't use EMR because I don't have the software or no-how to do it. I am, however, in the process of converting over. I'm the research phase and I need to know which way is most cost effective".

     Clinical Informatics Liaison and Nurse Administrator Jessica Wright believes that the end users are most affected by the new EMR system. The end users include physicians, nurses, and patients alike. Wright emphasized her frustration with the common misconception of the EMR. "We have to recognize that this is neither time saving or time neutral".  In the long run, using EMR is fast when pulling up these files, but now, Wright says, the end user has to log on, and sometimes transcribe what a machine reads.

     Down in the medical records department, Director of Health Information Management Nancy Knaggs gave another perspective. "We started the actual process in 2004," Knaggs said. "We are still building hybrid plans right now; we still have paper". At first, the department tried to compromise with unwilling-to-change physicians' requests by fulfilling both paper and electronic records, but after a year in 2005 the department stopped. "They've adapted fairly well and this is a huge change for physicians and some aren't very happy," Knaggs said.

     The main part of the challenge for the medical records department is that some things are still paper while another part of the record is electronic. "I still think we're moving the same amount of records, just less paper in each," Knaggs said.

Knaggs agrees with the step-by-step process it has taken LMH to get everyone on the EMR system. "It's too hard to change everything at once - especially for a community hospital like us. Our step by step process is better in the long run".

"It has also turned the nurses world upside down," Wright said. Rehmer noted that at first the nursing staff was 50% for the EMR conversion, but now it's about 98%. Before, nurses would go about their day, taking notes in their notebooks and charting at the end of the shift. Now, because of EMR, they must now chart in real time. Because of the mobility factor that comes with the EMR, physicians can log on at home and see their patients' updated statuses based on what the nurses are putting into the electronic chart. An EKG taken five minutes ago is now available to a doctor who may be on the opposite end of the hospital or at home and he or she no longer needs track down the paper chart and read the paper slip attached to the record.

     Likewise, reorientation of bedside manner is underway. "We have to teach the nurses not to be so focused on the computer in the patients' rooms. They have to learn how to both transcribe updates into the computer system and stay focused on the patients' needs and trust," Wright said.

     Elsewhere, Family Physician Dr. David Doran at the Heartland Clinic expresses his enthusiasm in going digital. "I never really liked the paper records. It would only be available to one person at a time. EMR has certainly changed our workflow and how we interact with each other in the office and with our patients. More than 75 percent [of our patients] are online and can log into the EMR to view their own records, communicate with us, schedule visits, etc".  Voran went on to explain that he didn't like in the past how only ten percent of his records couldn't be found because of misfiling and accidental shredding. "Those who don't change their workflows aren't seeing some of the same benefits we're seeing," Voran said.

     "I like the switch," Wright said. "Improving our overall charting decreases the likelihood of human error".

     Voran said that patients usually love the implementation of the EMR. "Having the same access to the same system that I do is key. Being able to see their records being created, managed and also to see digital X-rays and communicate electronically with us has been a huge satisfier."

     Wright, who has worked in the ICU as a nurse and has now focused her clinical skills into improving the healthcare system via technology, contemplates on the future. "My goal would to make everything automatic," Wright said. "Not to minimize nurse responsibility, but to eliminate human error. Imagine if the EKG could tell the computer what it was reading. Yes the nurse would have to verify the results, but the step of reading the monitor and entering that data into the computer by hand has now been erased."

     The EMR system and LMH is not perfect, and many of its users are still converting and making it better. But because LMH remains one step ahead of the game in the healthcare industry, they are now offering more efficient healthcare through the implementation of EMR

Becky Swearingen isn't a name you hear very often. If asked who she was, students probably shrug their shoulders and talk about maybe going to the Jaybowl later. Incidentally, they probably see her every day, especially if the Kansas Union is part of their daily campus routine.
Without fail, Becky sits ready and poised for whatever may come her way. As Business Manager of Union Programs, it is her job to be on the ready for anything from a fresh coat of paint at the Jaybowl to a superstar's hotel booking for an upcoming SUA event.
"She knows everything, she's a jack of all trades and very needed in our offices," said J.J. O'Toole-Curran, Director of Union Programs. "Her business office title does not do her justice".

Becky's coworkers' faces brighten at the mention of her name and are ready to pour the praises on her behalf, but seldom can say who she was before she came to level 4 of the Kansas Union.
"I grew up on a farm that has been in my family for over 100 years," said Swearingen. "I've lived in Lawrence my entire life".
After graduating high school, Swearingen decided to follow her life long dream of becoming a police officer. She doesn't know why, but for some reason she wanted to be a police officer her entire life. "I went to Johnson County Community College because I knew they had that degree there," said Swearingen. She studied criminal law and worked throughout college. In the end, she did not finish her degree and wound up in accounting. "I don't even know how I got there".

Swearingen has worked for the Union going on 17 years. She began her service to KU in the banking office, handling all the money for the Hawk Shops, dining services, and catering. From there, she went to work in Accounts Receivable handling money for room rentals and Union services. But she was dissatisfied. "I was dealing with numbers everyday; it just became monotonous".
Becky came into her current position five years ago as business manager. "Has it really been that long?" she asked, diving back behind her desk to check a saved email confirming her position. "It doesn't seem like that long at all".

Now, she admits, nothing is the same. Swearingen admires the amount and diversity of students running in and out of the office everyday. She is responsible for KJHK, Jaybowl, some aspects of SUA, and runs the Box Office. "I also see ourselves as an information booth, but my main job is to keep track of bills, payments and budget for Union programs.". She shared a frightful thought of handing a SUA student a credit card, but then quickly shuddered at the thought. "We would have double bookings, miscommunication, unpaid statements...no, I'm in charge of that".

Swearingen also oversees the display cases, updates the Memorial Unions' KU website, and has the opportunity to meet "pretty cool" people.
"I loved meeting Anderson Cooper, Lisa Ling was really nice, and I was totally impressed with Michelle Branch. But George Stephanopoulos was my favorite".

She remembers when Common came to KU and found it amazing how he took a student aside during his show and had them tell him about Lawrence. "Five minutes later he rapped an entire song about Lawrence and KU - just amazing".

Swearingen is proud of her students when the talent they bring in stays with them after the show. "The students put on these major events, so they should get a chance to meet the artist. Gabriel Inglesias did this, and Fluffy too!"

At work, Swearingen hangs with students and meets rock stars, at home is a different story. "I live in what you would call a hobby farm - it's my passion". She grows zucchini, cucumbers, tomatoes, squash, green beans, cantaloupe, sweet potatoes and onions to name a few. Swearingen also has an 11-year-old daughter at home. "It would be great if she comes to KU, but she can be a die hard KU fan and get her education elsewhere". Swearingen hopes her daughter will finish college and study abroad as well. "I'll push for that [study abroad] and maybe for my own benefit, but I'd love to go to Alaska, Antarctica, the German countryside, Paris".

Down in the level 1 Jaybowl, Tim Fields, Recreational Coordinator, pauses for a comment on Swearingen. "Beside her being my direct supervisor, she is a tremendous source of motivation and support, and is always coming up with great ideas". Later he adds, "I like to poke fun at how organized she is; everything is color coordinated!"

"I love my job," said Swearingen, "There's nothing I dislike about it." The most fun she has is when she doesn't know what students are talking about. Swearingen enjoys popping her head over and saying, "What?" and quickly going to look it up on YouTube.

"Ten years ago, I would have gone back to school, but not now. There's no way. I'd miss seeing all the students and meeting all the interesting people".

Swearingen would definitely be missed if she decided to leave. "Our mission is to provide quality programs for the campus and Lawrence community," O'Toole-Curran said, "I hope she never leaves; it would be a personal loss".

At her desk, talking casually with Fields about Jaybowl's future prospects, Becky Swearingen does not seem the power-force her co-workers paint her to be. Instead, humble, she smiles and strikes up a conversation with those who enter her domain. You want to talk to her; how could you not?

"I'm not an unsung hero. I'm here to do my job the best I can and hopefully help someone along the way".
But where does she see her future self?
"In 10 years, I hope I'm still here in the union and that I'm not too old to enjoy SUA functions".

Like many other uninsured Lawrencians, Spencer comes to Health Care Access, a community-based primary care clinic. Here they only treat the uninsured and rely heavily on outside help.

"Back when I was unemployed I came here. Way back. But now, for the past two years, this is where I come. I work with my hands and I injured one. Now, I don't have insurance." Spencer said.

Health Care Access strives to care for the uninsured. But this gallant effort offers little monetary gain. Always understaffed and overworked, this Lawrence based clinic survives off of outside help. This June however, they received a surprise: $20,000 more than anticipated from KDHE, the Kansas Department of Health and Environment. With this money brings many prospects for the future.

Overworked and Understaffed

Lixel Barnhill sits in a cramped exam room. Her blue scrubs stretch comfortably around her broad frame and she changes the air with a quick smile. "You want to know my position here?" she teases innocently. "I'll tell you. I'm a certified medical assistant, a front desk assistant, a clinical nurse, a medications coordinator, and a translator. Need I go on?"

She explained that the clinic was an appointment only clinic and that they next available appoint is in September. Usually, before people began losing their jobs and their insurance coverage, a patient could get an appointment about three to four weeks out. Now, it's six to nine. "It's because we're understaffed." Barhill said. "And we don't have enough providers."

Providers for the clinic include two nurses, a certified nursing assistant, and 12 to 15 physicians that rotate through and take referrals.


A Friendly Surprise

"We've been planning to move into a new building." Director Nikki King said. "And with this new money means doubling our capacity."

Every year without fail, King applies for outside grants to fund the much used clinic. So do two other community-based primary care clinics. But this year, King was exstatic to receive $160,000, $20,000 more than usual.

"This means with the new building we can double the exam rooms and have more volunteers. An increase in funds makes a huge difference in hiring more part time staff and allows for more available appointments."

Within the recent past Health Care Access turned away 10 to 15 patients a day. The clinic does offer same day appointments, but they fill in less than 10 minutes of opening. "We tell them to call back tomorrow. You can only make same day appointments over the phone. No walk-ins."

The Road Ahead

Health Care Access plans to open its new doors mid September. The new site sits two doors down from the Douglas County Dental Clinic and across the street form Lawrence Memorial Hospital's ER.

"We have a handyman putting up the numbers on the building." King shared. "How could we forget the numbers?"

The old site will remain open. "We will offer wellness education at the old site. More on site classes and resources to ensure a more physically fit and healthier lifestyle." Another goal includes tapping all chronic diagnosis such as diabetes and high cholesterol.



Individual Concern

Stated by the Community Based Primary Care Clinic Grants Program Review Overview, "Grant funds are intended to make primary medical and dental care, prescription drugs, and preventative heal care services accessible and affordable to underserved and vulnerable Kansas residents.."

Sarah Wise of Lecompton sits in a tattered brown leather chair. She bites at her nails and runs her hands through her cropped hair. Her baggy pants and loose shirt feel out of place encircled by the pale grey walls. Wise fidgets as she waits for her free inhaler refill.

"I came in about four months ago with a sinus infection." said Wise. "They gave me an inhaler for no cost. They solve problems, medical problems."

A tired Barnhill emerges from behind a wooden door. "Wise?" she says, scanning the room. Wise stands, slouched with hands in pocket, and accepts the brown paper bag. She sits back down and examines her bitten nails.

"I think they should move to the east side of Lawrence. More people need this over there." Wise said. She quickly added, "Not that the East side is bad or anything."

Stats

This year, KDHE gave out $5,515,840 in grant money to support Kansas' community-based primary care clinics. $291,704 went to Douglas County. $51,704 went to Douglas County Dental Clinic, $80,000 to Heartland Medical Clinic, and $160,000 to Health Care Access. Wyandotte County received $834,000 in grant funds and Johnson County received $280,000.



King and Barnhill hope for the best now with their surplus money in tow. They look forward to opening the new clinic and believe that the extra $20,000 will serve the growing number of the poor in health and uninsured.

Sandy-haired and bright-eyed, 12-year-old Kardal Hart walked into locally owned Kwality Comics. He shifted his red backpack and brushed his hair out of his face as he navigated his way through the rows of comic books held in dusty cardboard boxes.  At the front of the store, Hart gave the owner a friendly wave, and continued on his search. He had no trouble walking up and down the two narrow aisles. He was the only customer. But it was Wednesday - the day new comic books are released.

When Hart walked into the comic book store, he had no clue of the economy's influence over his favorite afternoon past time.

"I come in about once day." Hart said when asked about how often he pops into the locally owned Lawrence shop. "But I buy about three times a week."

 
As consumers spend less on print media, and newspapers cross over into the digital domain, comic book sales defy national trends on a local level. Furthermore, comic books are keeping up with online media via motion comics and movie enterprises.  DC Comics, however, has a different plan. Instead of accepting the digital move, the company has decided to return to newsprint.

JUSTICE LEAGUE V. AMERICA'S ECONOMY

"Sales have gone down," reported Craig Dye, owner of Kwality Comics, "but it's pretty good here."

In June, ICv2, an independent news source on the comic universe, posted the following national sales trends.

Comic sales dropped a staggering 19% in May versus May 2008...The paucity of big event titles and strong #1s, the continuing deep recession, and the financial drag of higher cover prices, all worked together to help produce a steep decline..."

Dye admits that the current economy is a factor in his overall sales, but he also takes into account the loss of university students over the summer months.

Dye noticed the increase of cover prices that Marvel and DC Comics have put on their books. "It's outrageous," he said in regard to the two companies raising the price on books by a full dollar amount. "If quality follows the price increase, then there is no issue, but that's not the case here."

The same story could apply just a few blocks down at Astrokitty Comics, another locally owned comic book shop.

"With summer break and a lot of students leaving, it's hard to look at sales when it compares to the current economy." said Joe Noh, Astrokitty employee. "Compared to last year, we're pretty much doing the same. No change."

Nationally, there is a different story. From April 2009 to May 2009, the top selling comic went from selling 104,107 copies to 94, 367. In May 2006, the top comic sold 260,000 copies at $3.99 each. May 2007's top comic sold 170,027, and May 2008's top comic sold 182,443 copies.
Jeff Litterio, director of sales at DC Comics, failed to give information regarding their national sales trends from 2006 to May of 2009. "Our numbers are our own." he said.

Milton Griepp, publisher at ICv2, said that comic book sales (including graphic novels and toys) went down 3% from 2007 to 2008. "The interesting thing is that sales were up 4% in the fourth quarter in 2008."

Noh said that in some ways the comic book market is a niche market. Those who read this medium are usually dedicated. He knows a few customers who have lost jobs. Some have continued to shop at Astrokitty while some have stopped all together.

"For the most part," Noh admits, "it seems we're unaffected. What probably is happening is that we'll stay at the level that we are at. We won't lose business but there isn't room for growth either."

Back at Kwality Comics, customer Dylan Riley of Lawrence had a similar opinion. He said that the current economy does not affect his buying habits.

In order to keep up with the faltering economy, Riley has noticed the increase of titles that Marvel and DC are coming out with. Furthermore, he has seen his favorite comics go through a "reboot" with titles starting over with a new first issue. "A first in a series always sells more."

NEW WORLD

Like newspapers and other trade publications, comic books are shifting towards the digital side of media.

"I know Archie Comics are now a dollar to download and some are free at Marvel, but some prefer the physical copy." said Dye. He also mentioned the emergence of motion comics. Motion comics are not quite a cartoon but not a comic either. "It is a new way of applying old material to reach new audiences. Movies also help to keep the characters in mind."

Owner Joel Pfannenstiel of Astrokitty Comics expressed his views on the future of the comic universe. He noted the development of a "comic reader" applicable to smart phones and that Marvel is now offering subscriptions to read comics online. Pfannenstiel also mentioned a revolutionary new tool that was announced at this years' Heroes Convention: Longbox.

"It's basically iTunes, but for comics." said Pfannenstiel.

                                                                                                                                                     

BUCKING THE TREND

With comic sales down on an annual trend and the push for the medium to digitize, DC Comics decided to go against the grain. Beginning July 8, DC Comics will release a 12-week run of their 'Wednesday Comics'.

"It's a huge deal!" Dye said. "Because of the format and talent, it's unlike anything we've ever seen in comics frankly ever."




Dye shared that the comic will be printed on traditional newsprint to give it a nice retro feel.

"The main thrust of Wednesday Comics is the return to the excitement of tabloid comics on Sundays, but Wednesday." Dye excitedly added, "Art has never been attempted on this scale!"

Both Kwality Comics and Astrokitty do not plan on taking extra measures in promoting this event.

"The only thing we may do differently is order extra copies to meet demands due to the press coverage." Noh said.

Down the way, Dye added, "We let regulars know about it. DC [Comics] has been running [promotions] in the back of their books. Nationwide, people seem really excited about it, but it may be a tough sell because of the name - it's wacky."

Dye speculated DC's move also had to do with their sales. Figures indicate that they hold the #2 spot against Marvel. He discussed how he believes Marvel is selling more books because of their hand in recent political events; their involvement in real life.

"One thing that can sell a comic book is Obama."

DC's "Wednesday Comics" hit comic book stores July 8. Spiderman will also be featured in the Wednesday edition of USA Today.