1998 Annual Report

Year in Review

A Quality Blend of Buildings, People, Technology

The rising of PAMF's new campus dominated the horizon for PAMF physicians and staff members during 1998 and early 1999, just as the campus buildings dominate the skyline along El Camino Real in northern Palo Alto--where thousands of motorists daily glimpse the construction progress as they drive past.

Planning for the big move, known simply as "The Move" within PAMF, occupied the thoughts of literally hundreds of persons at PAMF as they made detailed plans for a complex "five-day blitz" moving operation this fall. The Move is now targeted for late September.

Physicians and staff members who took preview tours have been impressed by the 305,000-square-foot, $120 million campus--a figure that includes fiber-optic wiring throughout and design refinements to meet specific departmental needs for patient care.

"My first reaction was, 'Wow!'" urologist Andrew Epstein, M.D., said after a tour in the fall of 1998. "It's unbelievably bigger and more complex than I thought it would be. The amount of work that goes into this is just amazing."

"It's readily apparent that the building has been designed to be both patient- and staff-friendly," allergist Robert Bocian, M.D., Ph.D., said of his tour. "I can't praise it highly enough. It has been designed in a way that is at once beautiful and efficient."

But the progress in 1998 didn't come easily--the El Niño rains hit hard in the first two months, with 54 out of 62 days having moderate to heavy rains, which in early February left three acre-feet of water standing in the construction site. Construction crews for general contractor Swinerton & Walberg and dozens of subcontractors struggled to recover the lost time, with significant but not complete succes--under the encouragement of PAMF's Project Team and PAMF Assistant Administrators David Jury and Jenifer Turnbull.

The new campus consists of three main components: (1) the patient care areas that will occupy the large southern wing and most of the central building, and (3) a health education center, with an auditorium that can be divided into six classrooms--located on the third floor of the central building along with PAMF administrative offices.

A future "Wellness Center"-- contingent on a successful fund-raising effort separate from the capital campaign for the main campus--is planned for the northeast corner of the site, adjacent to the CalTrain tracks. The center is still in the early stages of planning.

Funding for the new campus will come from three sources: (1) $35 million from Sutter Health, the non-profit health care network that serves Northern California, pledged when PAMF affiliated with Sutter Health at the end of 1992; (2) sale of the PAMF properties in downtown Palo Alto, expected to pay off existing bond-related debt so new non-profit revenue bonds can be issued; and (3) completion of the $40 million-plus Capital Campaign, now at more than $35 million-- thanks to the hundreds of donors listed in the back of this report.

"Our success thus far is proof that the philanthropic community spirit is not just alive but very robust in the Palo Alto area," Capital Campaign Director Anne Jigger said.

Building The 'Human Systems,' Too

But the new campus is only the first step in building for the future in the Palo Alto area, David Druker, M.D., Chief Operating Officer, pledged in 1998 as he announced a major "clinical redesign" effort and administrative reorganization.

The redesign is intended to improve how patient care is delivered throughout PAMF's Health Care Division.

"We want our human systems to match the quality of our magnificent new buildings," Dr. Druker declared.

The redesign effort is spearheaded by David Hooper, M.D., backed by Assistant Administrators Cheryl Kilsdonk, Cathy Mackin and Jenny Pagan, as well as by other administrative staff. All have a depth of experience and 10 to 15 years of "institutional memory" and knowledge of PAMF, Dr. Hooper noted.

"And all are driven by a mission--they all share with me the mission of focusing on the patient experience, and on the daily experience of physicians and staff," he said.

"We must continually improve the experience of patients, and at the same time create meaningful jobs and relationships for people in the workplace. Both are related, and you can't separate them. My underlying philosophy is--in addition to the delivery of Western medical technology-- that 'relationship heals,' the relationship between the providers and the patient," he said.

Technology Tools of the 21st Century

A stunning array of state-of-the-art technology will provide the health care tools of the 21st century for PAMF physicians and staff in the new campus.

The technology will range from the fiber-optic ("speed of light") communications wiring throughout the campus to the latest in diagnostic imaging and treatment devices--some of them costing millions.

Due in large part to PAMF's outstanding reputation for high quality of care, several manufacturers of such high-tech equipment have developed special relationships with PAMF, wherein they provide the latest equipment at low cost in return for using PAMF as a showcase for how the equipment should best be set up and utilized in a busy outpatient-clinic setting.

Health care providers from throughout the United States and from foreign nations visit PAMF to see the devices in use in what the manufacturers--firms such as GE, Acuson, Picker (formerly Elscint), Varian, 3-Com and others--call "luminary sites," "show sites" or "learning centers."

Satellites bring care 'closer to home'

Much of PAMF's continuing growth in staff and patients in recent years has occurred not at the Palo Alto clinic but at PAMF's satellite clinics: the Fremont Center (created in 1984) and the Los Altos Center (created in 1994).

The number of satellite clinics is about to double, first with PAMF's merger with the five-physician Women's Health Medical Group of Portola Valley (an obstetrics/gynecology clinic) in mid-1998 and next with the opening in the summer of 1999 of a new primary care satellite clinic in the Redwood Shores area of Redwood City.

The Portola Valley group is the first full merger with an existing group in PAMF's history. The Redwood Shores Health Center is the first to be jointly developed with another health care provider, Mills-Peninsula Health Services of Burlingame/San Mateo--also a Sutter Health affiliate.

The Fremont Center made regional news in the fall of 1998 when it opened a new building at its prime location in central Fremont, enabling the physicians and staff to work in a single building instead of two buildings across a parking lot. There is future-expansion space adjacent to the new 56,000-square-foot building for a connected building of equal size when needed.

The new Redwood Shores Health Center--announced in late 1998-- will occupy a custom-designed building on Redwood Shores Parkway, near the Nob Hill Market in "The Marketplace at Redwood Shores" shopping center. The 10,000-square-foot clinic will initially include three primary care physicians and several specialists, plus support staff, laboratory and x-ray services. For the convenience of patients in the area, the new clinic will have extended hours, 7 a.m. to 7 p.m. weekdays and 9 a.m. to 5 p.m. Saturdays, for both routine and urgent care. The new clinic will have 24-hour advice capability.

PAMF receives top 'quality' ratings

The grey El Niño skies of early 1998 were brightened for PAMF when it received news that it was rated highest in overall patient satisfaction of any medical group in California in a major independent statewide survey. The survey was commissioned by Health Net, the second largest health plan in the state, with 2.2 million members in 50 counties. Health Net said it was the first comprehensive rating of patient satisfaction in California.

PAMF received Health Net's top "Five-Heart" rating, based on a poll of more than 100,000 patients statewide. A later analysis of specific results showed PAMF leading the state with an overall satisfaction rating of 95.9 percent, while 96.1 percent of patients surveyed said they would recommend PAMF to family and friends. The state average for overall satisfaction was 83.9 percent, and the Bay Area average was 87.6 percent.

PAMF's strongest showing came in the friendliness and warmth of its staff and physicians, and in the confidence of patients in physicians' expertise.

Health Net followed up its Five-Heart rating in the fall with another award to PAMF, a crystal flame award for being the top-rated medical group in California--the second year in a row PAMF received a crystal flame award.

PAMF also received earlier recognition from Blue Cross California Care, which rated PAMF as one of the top three medical groups in the state.

In late 1998, PAMF received a special "Blue Ribbon Award" from the Pacific Business Group on Health (PBGH), which has placed major emphasis on assessing health care quality. The eight recipients of the first-time award were selected from 150 physician groups statewide, based on PBGH's four strategic initiatives: quality, cost, partnering and data management, according to Patricia E. Powers, PBGH Executive Director. She said the groups show a "commitment to participate in statewide quality-of-care projects and to pursue in-house quality-improvement activities."

Dr. Druker said such recognition is a tribute to all of our physicians and staff who have helped "deliver high-quality care and achieve high patient satisfaction in an era where managed care has cut reimbursements."

In early 1999, PAMF was presented the "Tall Tree Award" by the Palo Alto Chamber of Commerce. Awards Committee member Alan Henderson, a former mayor and City Council member, said the award "is for not only the health care services the Foundation provides but for all the other things it does relating to the community's health--the seminars, conferences, classes, information and educational resources it provides, and the basic research it conducts in its Research Institute," as well as for the "community services it has provided for many years," often in collaboration with other community-based organizations.

'Electronic Medical Record' Is Coming

A completely digital--and highly secure--electronic medical record, or EMR, is being refined for pilot testing at PAMF and several other Sutter Health affiliates for eventual use throughout the Sutter system. During 1998, a special team of physicians and staff members worked on defining the interfaces between the EMR and existing record-keeping systems, including the old paper-based medical charts.

The new record will "revolutionize" health care communications at all levels, and should strengthen significantly how patients and physicians are able to communicate, according to Steven Lane, M.D., MPH, a Family Practice physician who is leading the EMR project at PAMF. It also should help improve quality and consistency of care: "The EMR clearly is going to become a tool to allow us to follow guidelines for care and to study outcomes."

In the fall of 1998, Dr. Lane teamed up with Sandra Wilson, Ph.D., chair of the Department of Health Services Research at PAMF's Research Institute, to design a study that will monitor the EMR's impacts and help design improvements in the EMR system.

The EMR is "a system linked to all the clinical, pharmacy, radiology and lab databases, as well as financial databases," Dr. Wilson said. "It has the capacity to notify physicians about medication conflicts or allergies. It even produces a visit summary that goes home with the patient." But relatively little solid research has been done on how the EMR impacts patient outcomes, cost effectiveness, data collection for research, and physician and patient satisfaction, she said.

"No one else has thoroughly evaluated an outpatient EMR system before," she said. "We'll be the experts," Dr. Lane added. "We'll have intimate knowledge of both the clinical and data systems" involved in an EMR system. The EMR is a refinement of the Epicare EMR of Epic Systems Corporation, Madison, Wis.

Vastly Expanded Web Site is Popular

A redesigned and vastly expanded Internet Web site was created by PAMF during 1998, and by year's end was attracting more than 10,000 individual visitors per month--growing to 15,000 by the second quarter of 1999.

Ed Bierman, who joined PAMF in early January 1998 as full-time Internet/Intranet Manager, said the most popular features of the Web site include the physician directory, information about PAMF and locations of facilities, a job listings database, and an "Alphabet Soup of American Medicalese" glossary of terms.

A priority for 1999 is to continue to expand health-related information that will be of direct and immediate practical use to patients and others in the community, he said. PAMF created its first Web site in 1994--one of the first health care Web sites. PAMF also has played an active role in developing a Web site for the entire Sutter system.

The site also features a complete history of PAMF and a 360-degree digital photograph of the new PAMF campus under construction. The Web site's address is www.pamf.org.

The Growing Scope of Health Education

Health promotion and educational programs offered or cosponsored by PAMF continued to expand and diversify in 1998, while Education Division leaders began making even more ambitious plans for utilizing the extra space and facilities that will be part of the new campus when it opens. They also continued refining the concept of creating a "Wellness Center" as a future addition to the new campus--a hub of outreach programs for the community and region. A special collaboration with the Palo Alto Unified School District and the PTA Council resulted in bicycle-helmet and bike-safety programs and health lectures at schools.

The Women's Health Resource Center in Palo Alto passed its 10,000th visitor, and a new Family Health Resource Center opened in Fremont with the help of $10,000 for materials raised by staff and physicians there. The Women's Health Resource Center will become the Community Health Resource Center when the new campus opens.

Turning Point For Basic Research

"The next generation of research is now," Allen D. Cooper, M.D., Director of PAMF's Research Institute, declared in his message in a special report on research in late 1998.

Not only had construction begun on the research building of PAMF's new campus in early 1998, he noted, but federal funding for biomedical research has improved. Scientifically, the study of genetics has opened a "new world of understanding and possibilities for scientists," and this is the new focus of the Institute, coupled with continued administrative support for "clinical research" and a growing interest in health services and "outcomes" research.

The Institute's new Department of Health Services Research, created in late 1997, reflects the new understanding that "the goal of healthcare and health-related research is no longer just to prolong life but to improve health and the quality of medical outcomes," Dr. Cooper said. The department is working on two studies that may help prevent the spread of HIV in two high-risk populations--women with sexually transmitted diseases and Latino couples. It also will be assisting in the evaluation of PAMF's new electronic medical record.

Other highlights of 1998 include:

  • A five-year, $2.1 million federal grant was awarded to fund the cholesterol-related research of Dr. Cooper and his Department of Atherosclerosis and Cardiovascular Research. The scientific evaluation of the grant termed past progress "outstanding."

  • Jack Remington, M.D., Chair of the Department of Immunology and Infectious Diseases, was awarded the prestigious Osler Medal and invited to deliver the Osler Oration in London, England, by the Royal College of Physicians-- which also elected Dr. Remington a Fellow of the college.

  • The Institute completed a reorganization that included creation of: (1) a Research Committee of the PAMF Board of Trustees--to be chaired by Robert J. Glaser, M.D., a member of the PAMF Board of Trustees; (2) a "Friends of Research" group chaired by Mary Rudow, a longtime member of the former Research Institute Board; and, (3) a "Scientific Advisory Board" comprised of three distinguished medical/scientific leaders: Alan M. Fogelman, M.D., Stephen H. Friend, M.D., Ph.D., and Gordon N. Gill, M.D.

  • The Institute, in conjunction with the Health Care Division, launched 10 new clinical studies and hired two new clinical research nurse coordinators.