Features, Medicine

Curing rather than treating hearts?


UofL teams led by Dr. Roberto Bolli are involved in multiple clinical trials investigating the use of stem cells to repair heart disease damage.

University of Louisville researcher Dr. Roberto Bolli’s findings about how a patient’s heart stem cells can be turned into a treatment that regenerates dead heart muscle continue to gain favorable recognition around the world.

This past July, Bolli travelled to Bordeaux, France, where the International Society for Heart Research bestowed on him its Peter Harris Distinguished Scientist Award, which recognizes a senior investigator for lifetime contributions of major discoveries in cardiovascular science. At home meanwhile, increased federal funding and new clinical trials will allow him to continue to build upon his promising research.

His work in cardiac regenerative medicine regarding stem cells and the heart, and related clinical studies, is one of the hottest areas of regenerative science research. Cardiovascular disease remains the leading cause of death worldwide, and one of the greatest needs is treatment methods for severe cardiac failure where traditional treatment or surgery is not an answer.

Dr. Bolli has been at the University of Louisville for 21 years, since December 1994, and serves as chief of UofL’s Division of Cardiovascular Medicine, director of the Institute of Molecular Cardiology and scientific director of the Cardiovascular Innovation Institute. He is vice chair for research in the Department of Medicine.

At his University of Louisville office you will find cherished framed copies of Circulation Research, a peer-review journal for which he is editor-in-chief. An American Heart Association committee selected Bolli in 2009 for a 10-year term overseeing the professional journal.

“We hope to contribute to moving the needle in cardiac treatment with stem cells here at UofL,” Bolli said. “These studies are totally new and we look to revolutionize medicine through this research.”

This regenerative therapy approach is qualitatively different than other treatments, he said, because “we are curing the disease, and removing the cause of heart failure. This is not a drug therapy approach.”

Bolli and groups he is leading at UofL are involved in several significant research projects.

The PACE Trial – UofL is part of an advanced research trial using new adult stem-cell therapy for patients with peri-pheral arterial disease in their legs and who face eventual amputation. The Phase I and Phase II trial is conducted under a National Institutes of Health grant as a member of the elite Cardiovascular Cell Therapy Research Network.

Only seven of 40 institutions that sought to be members of the Cardiovascular Cell Therapy Research Network were selected. In addition to UofL’s Bolli-led team, the others are: Stanford University; Texas Heart Institute; University of Florida; University of Miami; Minneapolis Heart Institute Foundation; and Indiana University.

UofL is one of the top two enrolling centers for the study, which Dr. Bolli said will continue accepting participant patients age 40 and over for a few more months.

Because conventional surgery is not an option, patients in this study are expected to eventually lose the use of their legs as the disease progresses and require amputation, Bolli explained.

Research under the seven-year grant was initiated after NIH awarded it in 2012. No preliminary research data is available yet.

Fixed and covered costs are approximately $3.5 million and each patient enrolled in the clinical research means additional dollars for the patient care. Protocols have been developed for approximately $10M in total and used in these studies primarily at Kentucky One’s Jewish Hospital Heart & Lung Institute.

The clinical trial is known as PACE and is a randomized, placebo-controlled study in which patients are followed for one-year. Patients with intermittent claudication – leg muscle pain, numbness, cramping or heaviness caused by obstructed arteries – will be injected with aldehyde dehydrogenase bright (ALDHbr) cells harvested from their bone marrow.

Intermittent claudication is a symptom 1 to 3 million Americans with peripheral arterial disease experience.

Manufacture of Stem Cells – UofL’s Cardiovascular Innovation Institute hopes to “manufacture” stem cells to combat peripheral arterial disease in a project Bolli will oversee. The principal investigators are at Indiana University in Indianapolis with UofL’s site slated to conduct the cell reproduction needed for this new research.

RENEW trial – UofL’s Institute for Molecular Cardiology is the only Kentucky site among the 50 U.S. sites participating in a nationwide Phase III clinical trial known as RENEW. It uses stem cells harvest from patients to see if they can lessen the debilitating effects of angina.

Originally planned for up to 2,000 patients, Baxter Pharmaceuticals decided to close clinical trial participation in early 2014. The several hundred patients already treated are being studied, according to Bolli.

2016: CONCERT-HF Trial – Another Bolli clinical trial expected to open for recruitment in early 2016 will look to validate the ability of replacing heart scar tissue with new muscle using stem cells. The new study will build on work Bolli completed several years ago.

In the previous SCIPIO trial, patients suffering heart failure due to a previous heart attack showed an average 12 percent improvement one year after being infused with their own stem cells, which tripled the anticipated improvement.

This new clinical work may require endomyocardial and bone marrow biopsies, cell cultures of both samples, and intramyocardial delivery of the cells. This is a randomized, placebo-controlled clinical trial for patients aged 21 to 79 who have a diagnosis of chronic ischemic left ventricular dysfunction secondary to myocardial infarction.

2016: SENECA Trial – This project investigates the value of giving stem-cell injections to cancer survivors who had taken medications for their cancer treatment that contributed to later heart failure. This Bolli trial will employ a one-year “treat and follow” approach and is seen as promising research, as there are no other real options for these patients.

(Detailed information on clinical trials is available at

The use of adult stem cells in clinical research has become more accepted, and Bolli said he expects to see nationwide studies of a larger scale in Phase III research using larger data sets within two to three years. For example, TEVA Pharmeuticals is sponsoring several trials in cardiology circles, and participating in this step to widespread commercialization.

The use of living organisms for treatment with cell therapy promises to see a surge in patents as well.

Meanwhile, Bolli has already applied for his first patent of a stem-cell type, separate from the trial cells.

Departments, Economic Development, Features, Features, Healthcare, Healthcare, March 2015, Medicine

Better Outcomes Via Partnerships


In 2012, Baptist Health announced two new additions to its Kentucky healthcare system – Trover Health in Madisonville and Pattie A. Clay Hospital in Richmond. They merged into the Louisville-based system and today are Baptist Health Madisonville and Baptist Health Richmond.

“Larger systems have a better opportunity at surviving in the reform of the industry that is coming,” Andy Sears, chief planning and marketing officer for Baptist Health, said then about the move to acquire those facilities.

And he was not alone in this view. Many Kentucky health system and individual hospital leaders have been saying that some form of shared risk via larger networks was necessary to meet needs, move healthcare forward and be financially stable. A question remained, however: Should systems grow market share through acquisition of other hospitals or were there more preferable partnership models?

Two-plus years later, there is less talk about consolidating regional hospitals into a handful of competing systems and more about developing strategic affiliations, which is less expensive and more in keeping with the goals of ongoing healthcare reform.

In February, Baptist Health Corbin finalized a joint agreement with Community Health Corp. of Plano, Texas, to provide clinical support to 54-bed Jellico Community Hospital on the Kentucky-Tennessee border and its CarePlus Center 14 miles away in Williamsburg, Ky.

The circumstances and care needs at those facilities are, indeed, substantially different from those of Baptist Health Madisonville and Baptist Health Richmond hospitals. However, Sears now describes healthcare industry strategies in a manner that provides an interesting contrast to his 2012 comments.

“Many rural hospitals will have to … see if something besides traditional ‘acute care’ would serve the community better,” Sears said. “The solution is not necessarily consolidation with a larger health system, although it might be.”

UK HealthCare a partnership pioneer

As the trend toward affiliations continues to evolve, the models industry leaders are implementing now avoid direct acquisition. There seems to be a growing preference for building relationships that emphasize appropriate systemic delivery of medical services across the commonwealth.

UK HealthCare has been a pioneer in strategic affiliation development. In the past several years, it has developed a network of mutually beneficial alliances with regional hospitals and health systems in central and eastern Kentucky. Its cancer treatment network associated with the Markey Cancer Center is familiar to many, but UK HealthCare is also building successful network affiliations in advanced heart care with its Gill Heart Institute and in stroke care via the UKHealthCare-Norton Healthcare Stroke Care Network.

Meanwhile, both the Saint Elizabeth Healthcare system in northern Kentucky and Pikeville Medical Center recently entered into formal affiliations with the Mayo Clinic Care Network based in Minnesota. It mirrors UK’s affiliation model.

Common themes emerge in interviews with the program directors and leaders about their strategic affiliations. The phrase “care close to home” is common in the marketing signatures of community hospitals.

Among the business benefits of affiliation relationships is that they don’t require the capital that an acquisition demands. They are easier to organize.

Dr. Michael Dobbs

Dr. Michael Dobbs

But the most significant benefit, according to Dr. Michael Dobbs, director of the UK Healthcare-Norton Healthcare Stroke Care Network; Dr. Susan Smyth, director of the UK Gill Heart Institute; and Tony Hyott, a planning director at Saint Elizabeth, is that it allows patients to receive appropriate treatment closer to home while allowing tertiary-care hospitals to deliver the advanced treatments best suited to them.

UK-Norton Stroke Care Network

Dobbs talked about the success of UK HealthCare-Norton Healthcare Stroke Care Network, an example of the affiliation strategy, which he said began at UK in 2008 when he was “tapped on the shoulder” by Dr. Michael Karpf, UK executive vice president for health affairs, to build a “value-based” stroke care network.
“At the time, I didn’t know what that meant,” Dobbs said. He now knows “value-based care” as an increasingly common term to describe a multihospital network that raises care standards across a broad population base with better quality, efficiency and less cost to patients and society.

Fortunately for Dobbs and his new mission, three hospitals with established relationships with UK HealthCare were looking for a stroke care partner: Georgetown Community Hospital, Rockcastle County Hospital and Harrison Memorial Hospital.

UK HealthCare medical centerInitially, the idea was to create a telemedicine system, but the communication technology required was beyond the partner hospitals’ means. Had the network pursued that strategy, it risked creating an alliance of “elites” – including only hospital systems with money for advanced technology.

“Our goal was to give patients across Kentucky better access to stroke care,” he said. “We wanted to narrow the disparities and improve access – in essence to ‘level the playing field’ for patients needing quality stroke care.”

They decided on an inexpensive, low-tech method in order to reach many more hospitals and allow them to affiliate. “Our approach was to go into network hospitals and teach their nurses and staff how to deliver better stroke care,” Dobbs said.

Meanwhile, somewhat uniquely, neither UK nor Norton is positioned as leader of the affiliation network. “The stroke care network has evolved into a self-learning institution. The member hospitals learn from us, but we also learn from them,” he said.

The network acts as a communication medium for every hospital to share ideas. It enabled Harrison Memorial and Rockcastle to talk about what worked for them, he said.

More importantly, the network established an effective assessment protocol to determine what type of stroke patient care is best retained at the home community hospital and what should be passed up the line to a larger system.

UK HealthCare-Norton Healthcare Stroke Care Network “has really taken off,” Dobbs said, and involves nearly 30 hospitals in three states. Of the roughly 16,000 stroke patients a year discharged from Kentucky hospitals, Dobbs said, around 6,000 of those discharges are from UK-Norton network hospitals. They’ve also done more than 13,000 public screenings for stroke risk.

The affiliation model that UK Healthcare and Norton are exploring in their relationships with regional hospital systems in Kentucky and in neighboring states is also being mirrored on a much larger scale involving some of the most respected names in the healthcare industry.

Establishing national-level affiliations also

Pikeville-Medical-CenterKing’s Daughters Medical Center in Ashland, for example, announced its affiliation with Cleveland (Ohio) Clinic’s globally recognized Heart and Vascular Institute in September 2014.

Saint Elizabeth Healthcare, whose hospitals dominate the Northern Kentucky-Greater Cincinnati region, was the first healthcare system in Kentucky to be accepted into the Mayo Clinic Care Network (MCCN). It was the 10th health system to join the network.

Pikeville Medical Center was accepted into the MCCN a year later.

Today, there are about 32 health systems affiliated with the Mayo Clinic. Tony Hyott, director of system orthopedics and neurology as well as planning and program development, was on staff as director of planning when Saint Elizabeth entered into a discussion with Mayo about joining the MCCN network.

Saint Elizabeth determined that a national affiliation made strategic sense, Hyott said. It was just finishing the details of its merger with Saint Luke, was managing its finances well by itself and not interested in further acquisitions.

Dr. Tony Hyott

Dr. Tony Hyott

St Elizabeth considered Cleveland Clinic, but at the time of their discussion, Cleveland’s affiliation model was focused on its niche in cardiovascular services. The Mayo Clinic model was much broader in scope, Hyott said. “The Mayo Clinic model was not service-line specific,” Hyott said. Actually, a key feature of the network is that it gives Saint Elizabeth’s medical staff access to e-consults with the Mayo Clinic across specialties.

While the medical staff is very good, there are situations when Saint Elizabeth patients present sets of symptoms that are unique and unusual, he said. Mayo’s resources are available to allow second and third opinions at no additional cost to the patient. “This is just an added layer of reassurance to patients about the quality of service at Saint Elizabeth,” he said.

Formerly when someone presented a serious illness or disease that required specialized treatments, families would pack up and head for Mayo’s location in Rochester, Minn. But healthcare has changed. Similarly to how UK Healthcare specialists talked about their new affiliations are “leveling the field” in access to a standard of care in Kentucky, Hyott echoes that point in relation to Saint Elizabeth’s participation in MCCN.

St. Elizabeth Hospital

St. Elizabeth Hospital

“Mayo recognized that they needed a model to expand their outreach. Instead of adopting a strategy of acquisition, it has instead sought to establish affiliations,” Hyott said. “These affiliations should have the net benefit of leveling access to quality care.”

In very rare circumstances would a patient present a case that would demand admission to a Mayo Clinic hospital. The affiliation network is designed to reduce those cases to only those that are right for Mayo’s brand of specialized care, he said. For many patients, even those seriously ill, this means being able to receive highly advanced care in a setting close to home where family and friends can stay in contact.

Other advantages include getting medical staff training on new methods of treatment and minimally invasive surgical procedures. In the last year, cardiothoracic surgeons from Saint Elizabeth were able to travel to a Mayo Clinic hospital to observe and assist in a trans-aortic valve replacement (TAVR) procedure – minimally disruptive heart surgery performed via a catheter inserted through an artery in the groin or a small incision rather than by a large chest incision and spreading the patient’s ribcage.


Owensboro Health remains independent but has entered into cooperative relationships with multiple professional medical education programs around Kentucky whose students rotate into its $385 million medical center that opened in 2013.

Attaining MCCN affiliation was also an endorsement of Saint Elizabeth’s quality of care, Hyott said. Health systems engage in a lengthy application process, and members are specifically selected by the Mayo Clinic to be included in the network.

“They liked what they saw in the Saint Elizabeth system, and it’s been an honor to be able to be a part of it. Certainly, it is a boon to be able to use the Mayo Clinic Network logo in our marketing efforts. But the network has a lot more meat on it than just a promotional tool,” he said.

Independent Owensboro creating affiliations

At first glance, it appears that Owensboro Health is unique because it has maintained an independent identity while its peers have either joined a hospital system or sought an affiliation with a recognized national provider like Mayo or Cleveland Clinic.

While Owensboro prides itself on being an independent tertiary-care system serving its portion of west-central Kentucky, it is interested in developing collaborative partnerships, said Dr. Chris Toler, chief medical officer of Owensboro Health.
“We are always interested in building affiliations with the hospitals in our service area,” Toler said. “We have a mark of quality ourselves and serve an important role in our region as a full-service health system.”

Owensboro Health opened a new $395 million medical center in 2013, and the significant patient growth it has experienced in the past five years has made it possible to imagine it forming a Western Kentucky system with which other hospitals would benefit from a connection. It has extended management support to an embattled Muhlenburg Community Hospital in Greenville, Toler said.

“Hospitals of a particular size and location in this area of Kentucky are being challenged in the current state of the industry,” he said. “We would always be glad to lend our support.”

Aside from service affiliations though, Owensboro Health has actively cultivated relationships with the state’s medical colleges to serve a different purpose. UK College of Pharmacy students rotate through the new facility. The University of Louisville’s School of Nursing has a branch that works directly with Owensboro. The medical system has made arrangements also for Pikeville University College of Osteopathic Medicine’s students to complete their third- and fourth-year rotations in Owensboro.

Just as service affiliations with larger provider systems help level the playing field in terms of accessing higher standards of care, these relationships to the state’s medical programs enable Owensboro to upgrade the healthcare quality of their area by recruiting young providers to practice in Western Kentucky.

Dr. Chris Toler

Dr. Chris Toler

Toler, a native of Owensboro, said he loved returning to his community, and one of the most satisfying aspects of his practice is the independence of the healthcare system.

“There is a lot of flexibility that comes from being independent,” Toler said. “Though we’re a large hospital and a major employer, there is still this sense that we have a voice in the changes and direction of the health system here.” Until the hospital began outreach programs with Kentucky’s colleges and universities, it was a challenge to recruit providers to this area. Those unfamiliar with Owensboro perceived it as remote, he said.

Because of its location, Owensboro Health has thrived despite the previously prevailing theories about the way in which healthcare systems should grow. At this point, Owensboro is not feeling the same pressures as its peers to seek out a business partner, Toler said.

Individuals and institutions, however, should never say never, Toler said. There is always that possibility down the road considering how frequently the healthcare climate changes. ■

Josh Shepherd is a correspondent for The Lane Report. He can be reached at

Banking and Financial Services, Departments, Economic Commentary, Features, Features, Healthcare, Legal Affairs, March 2015, Medicine, Technology

Rising Cyber Insecurity


Tumb chain 1st graphic

Potential dire effects vary by business, the type of computer-reliant operations it has and the nature of its data, and these effects can range from mere irritation to significant financial loss all the way up to a closing of the company doors.

Information technology security issues grow more important and urgent for business and industry week by week. Commerce-critical data today is made with intention at work stations as well as streamed by always-connected apps and devices into the cloud – streams that simultaneously make operations more efficient and more vulnerable.
Managers, accountants, healthcare providers, lawyers, retailers, bankers, public officials and more all are joining IT professionals in spending more of their time and energy on cybersecurity matters.

Anti-virus expert Eugene Kaspersky said at an IT security conference in October 2013 that the cost of data system disruption to business is “many times more than $100 billion.” Since then, data breaches have occurred at Target, Neiman Marcus, JP Morgan Chase, Home Depot, Sony Pictures, Anthem and others. However, while these large events attract news coverage, much of the overall cost of data breaches actually occurs at small- and medium-sized businesses because they are often easy targets.

John Askew

John Askew

“You have to assume that you have already been breached to some extent and determine how to continue running your business with that assumption,” according to John Askew, consulting manager and security team lead for SDGblue, a Lexington-based IT services firm.

“Hacking” into computer systems started three decades ago, largely among young men wanting to impress friends with their technical savvy. Nearly all data breaches today are by criminals looking to make money using an array of methods and powerful tools. The realities of computer security are much different than even just five years ago.

One result is that no one is too small to be a target. Thieves formerly tended to individually target the high-dollar score, like fishing with a large pole for that “big one.” Computer-powered automation today, however, enables thieves to fish with a net – which because of volume targeting creates large cumulative results.

Security experts all estimate the likelihood that a specific business’ computer systems will crash or be compromised at 100 percent – a matter not of if but of when. They also agree that most incidents are either preventable or can be cleaned up quickly with proper preparation. Money-sapping downtime can be averted or recovery expedited, reducing costs across the board. This security has a price, but prevention and planning tend to be far cheaper than curing a system shutdown for which a business is unprepared.

Most businesses today can’t run without computers, which are service platforms for credit card processing, tax filing, business websites and interacting with suppliers and customers.

Another recent computer security issue is that Kentucky and 47 other states along with Puerto Rico, the District of Columbia and the Virgin Islands have laws that punish companies found negligent in handling customer data, or that do not notify customers of a breach in a timely fashion.

Barbarians at the gate – and inside

Think of data security, experts say, in terms similar to doors to your business: The more data connection doors you have, the more security you need since doors are generally the most vulnerable points for unauthorized entry – or exit. Every email account is a potential door.

Further data vulnerability exists because businesses have to go through lot of other people’s “doors,” too. Cyber criminals watch that activity with programs designed to sniff out your and their weaknesses.

Many business people are shocked to learn that various studies find from 45 percent to 80 percent of data security issues originate inside the company. Not all are malicious; sometimes an employee password is easily hacked, like the word “password” or “1234567890” or their password is pasted on their desk for anyone passing by to see.

Data security becomes compromised because employees often aren’t trained, or no security guidelines exist and they innocently do something inappropriate. It can be a disgruntled employee or one paid to steal company data. “Drive-by downloads” into business networks can occur when an employee visits a web page with a malware delivery mechanism that is disguised as an ad. Sometimes network anti-virus programs are inadequate (such as free versions) or are not installed at all.

Phishing is most common attack mode

Internal breaches commonly come from “social engineering” attacks, which prey on human behavioral weaknesses. “Phishing,” a common social engineering method, is the most commonly used data assault process seen by those interviewed for this article. And it achieves the most success against users.

Phishing2Phishing criminals, usually using stolen email addresses, “bait” users at a target business with what appears to be an urgent email from a familiar company, such as a bank or retail chain they use. Problems begin if a recipient clicks a link or opens an attached file promising f urther details. The 2013 Target stores holiday shopping season breach that led to 110 million customer credit card records being stolen started with a phishing attack against employees of a subcontractor; Home Depot’s 100-million-customer-records breach in 2014 was a phishing attack.

Phishing messages whose official-looking logos, headquarters information or other content succeed in prompting a click for details instead initiate a download of malware onto the recipient’s device that propagates across the network. The many variations of this trick have worked worldwide millions of times.

“Phishing is the No. 1 problem for us on campus, and that is across faculty, staff and students,” said Brian Purcell, Murray State University’s information security officer and the school’s interim chief information officer. “If we see a phishing attack on campus, we proactively look to see who has responded to it by examining data traffic leading to the offending site. We then change their password and user identification and notify them that we have done so … because data breaches are very expensive to correct.”

A sophisticated variation is “spear phishing” in which attackers research individuals at a company and target them with sometimes surprisingly personal appeals. This technique increases the odds of success so much that spear phishing accounts for 91 percent of attacks. At financial institutions specifically, reported individual losses average $55,000 and some have exceeded $800,000, according to the Washington-based Internet Crime Complaint Center.

Phishing is one of the most common consumer complaints the Kentucky Attorney General’s Office gets, said Daniel Kemp, deputy communication director.

“Many of the calls lately extended from attempts to dupe consumers affected by the recent Anthem (Blue Cross Blue Shied) data breach,” Kemp said. “Getting trained in spotting these threats is one of the most effective defenses a business or consumer has. We have staff who go around the state training consumers in our Scam Jam classes. Face-to-face training is always effective, and every business should consider it for their employees.”

Who are the phishers? They come from around the world. The Chinese and North Korean governments have often been accused (e.g., the Sony Pictures Entertainment hack), as have criminals in former communist bloc countries, South America and in the United States. A town in Romania’s Transylvanian Alps, Râmnicu Vâlcea, population 120,000, is called the cyber-crime capital of the world, but it has only two government agents assigned to combat digital law-breaking. Regardless of their origin or motivation, the criminals are after your system, your data, your customers and your money.

Those illegally harvesting customer data often bundle their stolen info and sell it to others to avoid being caught using it – they let others do the phishing or scamming. It makes arrests and prosecutions difficult, and even if they are caught, restitution for victims’ losses is rare.

Assessing costs, value, safety and savings

Brian Purcell, Information Security Officer, Murray State University

Brian Purcell, Information Security Officer, Murray State University

The good news is that with appropriate measures, a business network can be kept reasonably-to-very safe. Although the due diligence of installing, maintaining and securing computer systems can be costly, security breach costs can be far, far more.
“PCs and computing resources are now a utility, not a luxury. IT security is often regarded as a discretionary cost, but it’s not – it should be fixed in the budget of every business,” Purcell said.

The term “disaster recovery” refers to being able to restore a computer system to the state it was in a short time before a failure. Only very rarely is this the result of a fire, flood, lightning strike or tornado, although those are considerations. Much more commonly it means a single computer’s hard drive fails and ruins all its data, which a business must recover to get back to work; or a server dies, corrupts a wider swath of data and shuts down daily operations.
Business IT disaster recovery plans often mean having off-site backup in case equipment is

tolen or offices are too damaged to use. With off-site data storage, operations can be restored in a temporary location and to continue to serve customers and avoid losing revenue also.

 Dave Sevigny, President, DMD Data Systems

Dave Sevigny, President, DMD Data Systems

“A company with six PCs that has no regular service vendor for support, and that hasn’t been getting regular system evaluations, is usually down two or three days,” according to Dave Sevigny, president of Frankfort-based DMD Data Systems, a regional IT services provider. “A company that has an established relationship is usually down about a half day. There is no substitute for qualified help.”

Sevigny and others advise considering the question: How would being without computers for two or three days affect your company?

“Today’s technology is more robust, more resilient and has more ‘call home’ properties that alert us, often before the customer knows they have a problem,” he said. Clients “have fewer problems if they make an effort to keep up their systems and allow us to help them. That’s what IT professionals do.”

An office technology policy can avert some of the latest threats to business. Sevigny advises caution regarding “the bring-your-own-device (BYOD) trend of letting employees bring smart phones and tablets into the office with no supervision, and even letting them do (company) work with them.

“While an employer might think he’s saving money by having employees use their own equipment to perform tasks for which the business formerly provided the equipment,” he said, “they are also opening themselves up to some real security problems. Giving someone open access to a business network when you can’t control what happens with that device after work is a very risky proposition.”

Lack of knowledge, lack of preparation
Investing in IT security and disaster recovery is less costly than restoring data from bits and pieces, or going back to printed records. Data breaches mean lost customers and tarnished business reputations, especially when customers must be contacted to inform them sensitive personal data is now “in the wild” and in the hands of criminals.

In calculating a budget for IT security and disaster recovery, managers are advised to consider their company’s average revenue or profit per hour or per customer, then assess the potential cost of lost operating hours or customers. At what point would losses become critical? At what point would the business be fatally crippled?

Many businesses lack security and data recovery plans.

Russ Hensley, CEO,  Hensley Elam Associates

Russ Hensley, CEO,
Hensley Elam Associates

“Kentucky lags the national averages for a variety of reasons,” said Russ Hensley, CEO of Hensley Elam Associates, a regional data services firm with headquarters in Lexington. “Despite the routinely quoted (estimate that there are only) 30 percent of businesses with adequate protection, we may be as low as 10 percent for companies with appropriate backup and disaster recovery plans.”

Lack of knowledge is thought to be the main reason why. “Most of them simply don’t know the risks, or they think it won’t happen to them because it hasn’t happened yet,” Hensley said. “They don’t realize their employees are usually their biggest threat. They often see the backups and IT security as something being sold to them versus being a real asset. Since they have never had an incident – despite some of them already being infected with malware and they don’t know it – they either balk at the cost or don’t see the need.”

Studies estimate the cost of repairing a data breach at $185-$195 per customer. That’s $18,500 for 100 customers or $185,000 in losses for 1,000 customers. Repairs can take months as little issues continue to present themselves. It’s fairly common for some data to be lost forever, complicating making financial books whole again. Damage to reputation and trust can mean a loss of current customers and future business.

Studies show preventive measures do reduce per-customer losses for data breaches: $14 less for companies with comprehensive security policies and procedures; $13 less when the company has an incident response or disaster recovery plan; another $7 less if a well-trained staff person serves as the chief information security officer. Those steps lower average losses to $151 per customer.

Mitigation but no 100% guarantee
Locks“There’s a saying in our industry that computer security always seems to cost too much, but still is never enough,” said Jerry Bell, a computer security consultant and founder of the website and blog in Atlanta. “Computer security is something like what they say about those who fight terrorism: We have to be right all the time, but they only have to be right once.

“There is no 100 percent guarantee against hacks or data loss,” Bell said. “Everyone is a target, too. There are breaches and attacks going on at all levels – from giant financial firms all the way down to parking garages. Statistics don’t tell the whole story because many breaches are not reported to authorities. The fear of damage to a company’s reputation is pretty powerful.”

One product that can mitigate the cost of data breaches, he said, is cyber-security insurance, which many companies now offer. Data breach coverage can mitigate costs in any case, and especially when the policyholder is not to blame.
“When a breach happens and a claim is paid, the insurance companies are looking for those responsible for the breach,” said Bell. “If (the insurance company) pays a claim, then someone else is likely to wind up paying the insurance company.

“Take some of the big, well-known, national companies whose data breaches made headlines in 2014. There are lawsuits against some of them by their vendors, like credit card processing companies, and those vendors’ insurers to cover the costs of cleaning up the mess,” he said. “They lay the blame at the feet of the big company, and that mess includes new cards, reimbursements, credit monitoring and many other charges.”

All the experts in this article concur that, on average, only about 30 percent of businesses today have adequate security and a disaster recovery plans – not elaborate security, but decent protection and enough to help with recovery.

“The one thing that keeps me awake the most at night is how our data is handled,” said Purcell at Murray State. “We’ve been collecting people’s personal data since the late ’80s, and the standards for security were different then. We’re like any other business in that regard. That legacy data is very valuable, and we have the responsibility for protecting it.” Most businesses are in the same boat.

The most common lament among the IT security professionals interviewed is that customers reel when told the cost to adequately protect their systems but don’t understand the value of that investment.

For example, initiating recommended system security measures might cost a small to medium-sized business $10,000 up front and another $300 in costs per month to monitor the system security, perform maintenance and pay for regular professional services ($3,600 per year). Under this scenario, first year expenses are $13,600; subsequent years might total $5,000 when software upgrades, checkups, equipment replacements, etc., are included. This is a five-year cost of $33,600, or $6,720 per year. It’s a considerable budget line.

If this business has 300 customers, however, using the $185-per-customer cost for a breach that studies found, a data system problem could cost $55,500. That’s about $22,000 more than the cost of IT system security.

Compliance does not mean security

Michael Gilliam, Security Team Lead, SDGblue

Michael Gilliam, Security Team Lead, SDGblue

In managing costs, businesses generally opt for meeting legal or regulatory obligations as an expense baseline.
“Compliance does not equal security,” warns Michael Gilliam, consulting manager and security team lead for SDGblue. “Security is a very complex issue to tackle (and) it becomes harder to defend the individual information systems and the organization as a whole as it grows.”

A lack of dedicated resources to implement an effective security program is the biggest issue SDGblue sees, Gilliam said.
“Security (is) often viewed as a cost center that needs to be minimized,” he said.

That anemic approach is further weakened when “combined with a confusion with regulatory compliance,” The word Compliance in blue 3d letters surrounded by related terGilliam said. A managerial view that data security resources are “dedicated to avoiding fines stemming from violations makes security often nothing more than an afterthought, prioritized only when it is too late.”

State and federal government requirements to notify customers of a breach are considered burdensome and complicating factors. However, the cost of doing so is small compared to the fines and penalties for not doing it in a timely fashion, and far less than criminal or civil charges, or lawsuits by customers.

There are major additional compliance issues in the medical field, which also must comply with complicated federal HIPAA and HITECH regulations.

The Health Insurance Portability and Accountability Act of 1996 mandates the confidentiality and security of healthcare information. Health Information Technology for Economic and Clinical Health Act of 2009 anticipates a massive expansion in the exchange of electronic protected health information.

“The cost of a breach to medical clinics can be staggering,” Hensley said. “One doctor had a laptop stolen with 2,000 patient records, and none of the data was encrypted (to make it unreadable to the thieves). They were fined $150,000 by the government for non-compliance – un-encrypted laptops are the No. 1 cause of fines. It used to be that large clinics were the ones fined, but now smaller offices are seeing fines, and they are never cheap. For the largest companies, there have been fines of $12-14 million. It’s quite serious.”

Breaches trigger legal obligations
Hensley holds the advanced Certified Information Systems Security Professional credential, which in addition to technical expertise requires knowledge of IT’s legal and financial issues. The CISSP credential is valued especially in the healthcare sector and other operations with high-stakes compliance obligations. Hensley said it improves his ability to advise clients about avoiding potentially expensive situations.

“For instance, I’ve seen cases where attorneys took a patient’s medical records into their office for a case. This puts the lawyers at tremendous risk because they think the attorney-client privilege protects them, but that’s not entirely true,” he said. “By assuming responsibility for those records, they are now under HIPAA laws and subject to penalties.”

Meanwhile, state legislatures are enacting new cybersecurity laws and reporting requirements, creating legal obligations sometimes to notify customers and staff about a data breach – or to not notify them because the breach is under a criminal investigation.

In Kentucky, HB5 and HB232 cybersecurity laws passed in the General Assembly in 2014 are now in effect. They changed the way the commonwealth’s businesses are required to store customer data and protect confidentiality. Depending on who is potentially affected, businesses and other entities that experience a data breach must contact the Kentucky State Police, state auditor of public accounts, state attorney general, Kentucky Department of Education or the Council on Postsecondary Education.

HB 232 defines what businesses must know about an electronic security breach, sets deadlines for informing customers and staff and whether to notify law enforcement.

Frank Goad is digital editor of The Lane Report. He can be reached at

Cover Story, Features, Features, February 2015, Medicine

Cover story: High Resolution Healthcare Investment

Kentucky providers pouring millions into imaging for better diagnoses and more precise treatment with better outcomes

Dr. Duane Densler, chief of neurosurgery at Pikeville Medical Center, brought advanced German imaging devices to PMC after having trained with them during his University of Louisville Hospital residency. Real time imaging allows for more precise, less invasive brain and spine surgery.

Dr. Duane Densler, chief of neurosurgery at Pikeville Medical Center, brought advanced German imaging devices to PMC after having trained with them during his University of Louisville Hospital residency. Real time imaging allows for more precise, less invasive brain and spine surgery.

By Josh Shepherd

Kentucky’s major healthcare systems and hospitals are investing hundreds of millions of dollars in advanced imaging technology to achieve earlier diagnoses, make treatments more precise and less invasive, and improve outcomes for patients.
As they’ve undertaken various new construction projects over the past five years, Kentucky’s health systems have invested to keep pace with technology in highly sophisticated 3D medical imaging along with hybrid operating suites for cardiovascular and neurosurgical procedures.

For example, as part of the continuing battle against cancer, 3D breast imaging called tomosynthesis is taking mammography to a new level of clarity for earlier detection of smaller lesions.

For oncological treatment, medical manufacturers have developed specialized machines that combine high-resolution computed tomography, or CT-scans, with external radiation therapy to more precisely attack malignant tumors with less damage to healthy tissues, meaning treatments cause fewer side effects and complications.

Dr. Pat Alagia, Chief Medical Officer, KentuckyOne Health

Dr. Pat Alagia, Chief Medical Officer, KentuckyOne Health

“This is where we are going,” declared Pat Alagia, M.D., KentuckyOne Health’s chief medical officer. “We are investing millions in equipment and high-tech surgical suites, but we’re doing it because it’s consistent with our strategy of providing the best level of care possible to our patients.”

Through The Lane Report’s interviews with physicians, administrators and trustees about the tens of millions being spent on medical technology, several common themes surface:
• It allows providers to make real-time diagnoses.
• It allows minimally invasive treatments that reduce damage to healthy tissues.
• It speeds recovery times, reduces incidence of infection and complications, reduces inpatient stays and promotes better outcomes.

Dr. Alex Poulos, Radiologist, Pikeville Medical Center

Dr. Alex Poulos, Radiologist, Pikeville Medical Center

Yet machines, however advanced their science, Alagia said, are merely enhancements and continue to rely on the skills of physicians and other providers. Alex Poulos, M.D., a practicing radiologist for 38 years with Pikeville Medical Center and a member of that hospital’s board of trustees, agrees.

And while the evolution of healthcare technology over the course of four decades is nothing less than astonishing, Poulos said, so, too, is the price tag for that equipment.

The price of medical technology is the price of providing care, according to one common view. But such investments, Alagia added, are also emblematic of the commitment Kentucky’s healthcare systems have toward providing patients the best possible care from the best medical professionals using the state-of-the-art that’s available.

Imaging: 320-slice CT scans and Tesla MRI

Like many Kentucky hospitals, Pikeville Medical has invested in a broad range of new technology across medical specialties, Poulos said, but in his opinion the most significant advances in the healthcare industry are within the field of medical imaging.
One could argue convincingly, he said, that advances in imaging technology are at the core of nearly every recent capital equipment purchase in tertiary care – highly specialized treatment in advanced facilities, where patients are referred by primary and secondary providers. PMC has invested more than $10 million in the past five years in CT scanning and Siemens Tesla MRI devices, Poulos estimates.

The only investment that might outpace Pikeville’s imaging spending in the past few years are costs for expanding and renovating the hospital itself, he said. However, these imaging device expenditures enable PCM to continue to improve the availability of advanced healthcare procedures for residents of Eastern Kentucky, West Virginia and western Virginia.
Among the most impressive of its major purchases are two 320-slice CT scanner systems, which are 4,400-pound machines that generate high-resolution internal images resolving down to 1.5 millimeters in size – less than one-sixteenth of an inch.
“This is the current standard for CT imaging in tertiary care,” Poulos said.

One of the systems was installed in Pikeville’s Emergency Room for rapid response to trauma cases, and the other serves the hospital’s regular patient population. Meanwhile, the high-resolution CT scanners have patient tables designed to handle a weight of over 660 pounds.

The German-made BrainLab imaging device at Pikeville Medical Center provides neurosurgeons data to navigate the least-invasive path to a tumor with smaller incisions and smaller craniotomies.

The German-made BrainLab imaging device at Pikeville Medical Center provides neurosurgeons data to navigate the least-invasive path to a tumor with smaller incisions and smaller craniotomies.

“The older CT scanner, which is still in use, could only support persons of up to 400 pounds,” Poulos said. “We needed machines that could handle the increasing girth of a segment our population.”
The gantry or bore of the machine is 78 centimeters, about 31 inches, which allows a patient’s whole body to be scanned “in one breath-hold.”

“In most cases, a single scan is all we need. The information is read by the radiologist and the images shared with the appropriate physician, depending on the patient’s needs,” Poulos said. “If we have an elderly patient or someone severely injured in a motor vehicle accident, for example, it is vital that we get that person scanned as soon as possible so that the information is read by the radiologist and information forwarded to a surgeon or ER physician – whatever the emergency calls for.”

The machines can be used for vascular imaging, cardiac imaging and many other applications.

Advanced imaging enables providers to map a patient’s internal anatomy in three dimensions, which is impressive in itself. But it reduces a patient’s exposure to X-rays while doing so, which is a more welcome aspect of the investment, Poulos said.
The complexity of 3D imaging is pushing diagnostic medicine in many profound ways. In mammography, 3D imaging has resulted in better breast cancer detection and prevention.

Tomosynthesis: 3D mammography technology

Norton Healthcare is among the latest major Kentucky health systems to invest in the 3D mammography technology known as tomosynthesis.

Tomosynthesis machinery costs less than some other current medical tech but is still a big dollar investment – hundreds of thousands rather than millions. The advanced breast imaging service Norton installed at Norton Women’s and Kosair Children’s Hospital in St. Matthews as well as at Norton Hospital Pavilion was “valued at more than $400,000,” according to a news release.

varian deviceTomosynthesis imaging technology has been implemented also at UK HealthCare’s Markey Cancer Center in Lexington, the Baptist Health system locations, the James Graham Brown Cancer Center in Louisville that is part of KentuckyOne Health, and numerous women’s health and specialized imaging clincs throughout the commonwealth.

Approved by the federal Food and Drug Administration in 2011, tomosynthesis “allows a more robust imaging of the breast tissue as opposed to the traditional 2D mammography,” said Dr. An Church, a Norton Healthcare radiologist with fellowship training in breast imaging.

Both technologies use X-rays to image the breast and require compression of the breast for imaging, Church said, but while mammography acquires images from two angles, tomosynthesis acquires images from multiple angles.

Dr. An Church, Radiologist, Norton Suburban Hospital

Dr. An Church, Radiologist, Norton Suburban Hospital

“The difference allows the radiologist to ‘look through’ the breast, similar to a CT scan of the body,” she said. “Traditional 2D mammography continues to be a proven method for the early detection of breast cancer. However, both national and international studies have shown that tomosynthesis increases the detection of breast cancer and decreases recall rates over 2D mammography alone.”

Doctors sometimes must ask a woman to return for additional imaging – a recall – after 2D mammogram screening, but further diagnostic exams determine the suspicious site to merely be overlapping tissue rather than a lesion. Tomosynthesis decreases such incidences, Church said, averting the physically stressful patient anxiety that usually accompanies additional imaging.

“We believe tomosynthesis has added value for the patient, and we are excited to offer this technology,” Church said.

Radiation oncology targeting is improving

The word “precise” is becoming inadequate to describe the highly technological world of radiation oncology, which focuses beams of high energy onto cancers to destroy malignancies. Specialists in this field talk about the “conformality” of treatment to attack and destroy irregularly shaped malignant tumors, which often are in the body’s most vital and sensitive organs and tissues.

The Siemens 3.0 Tesla magnetic resonance imaging unit performs patient scans faster and in finer detail than older MRI devices.

The Siemens 3.0 Tesla magnetic resonance imaging unit performs patient scans faster and in finer detail than older MRI devices.

Just as neurosurgeons strive to limit the invasiveness of their procedures to minimize damage to healthy brain tissues during their procedures, radiation oncologists rely on specialized equipment that uses advanced imaging to define and target the erratic three-dimensional shapes of tumors. That information enables physicians to exercise greater control over the intensity and shape of the radiation beam necessary to reduce and, hopefully, destroy all traces of the tumor.

Dr. Ryan Faught, Medical Director of Radiation Oncology, Owensboro Health

Dr. Ryan Faught, Medical Director of Radiation Oncology, Owensboro Health

Radiation oncologists Ruth Lavigne, M.D., co-director of the Leonard Lawson Cancer Center in Pikeville, and Ryan Faught, M.D, medical director of radiation oncology at Owensboro Health, frequently mention “conformity” when talking about interventional procedures to eradicate tumors from a patient. New technology systems they use are more effective than ever in cancer treatment, and accomplish this with fewer side effects and complications because healthy tissues receive less of the collateral damage traditionally associated with radiation.

Less damage to healthy tissues correlates to faster recovery times for their patients.

Lavigne discussed the two RapidArc Linear Accelerators that she and her husband, Brad Collett, use in external-beam radiation therapy. The machines, purchased for an estimated $10 million at Pikeville Medical, are bringing state-of-the-art cancer care to Eastern Kentucky, Lavigne said.

Dr. Ruth Lavigne,  Co-Director, Leonard Lawson Cancer Center

Dr. Ruth Lavigne,
Co-Director, Leonard Lawson Cancer Center

External-beam therapy has been a mainstay of cancer treatment for decades, but Lavigne said the technology has evolved to an astonishing level.

“When I started in this field, the state of the technology was such that we would add roughly two centimeters radially around a tumor (to the target treatment area) that would likely be affected by radiation,” Lavigne said. “That (added “margin”) was healthy tissue, and it was one of the reasons this therapy made people sick. We were getting at the cancer but had to be accepting of this margin. But not anymore.”

Workers unload a magnetic resonance imaging unit that was installed at Baptist Health Louisville hospital in August 2014.

Workers unload a magnetic resonance imaging unit that was installed at Baptist Health Louisville hospital in August 2014.

Using original 3D CT scan images fused with a mini-CT scan of the affected area for guidance, Lavigne said, RapidArc machines deliver an intensity-modulated beam therapy that alters its shape to conform to the tumor.

“The machine allows for precise adjustments in relation to the tumor – at the sub-millimeter level,” Lavigne said. “It is also set up to do the more elegant high-dose, non-invasive radiation techniques that we call ‘sabre’ or stereotactic ablation.”
Such equipment today is standard for tertiary-care hospitals across Kentucky, including the oncology wing of Owensboro Health where Faught practices, but he prefers to talk about the radiation therapy success he and colleagues have had treating breast cancer patients with the BioZorb Tissue Marker.

Owensboro Health is the first Kentucky hospital to use this surgical device, Faught said. In terms similar to those expressed by Lavigne, he stresses the importance of exactness in treating malignant masses. He is excited about how the BioZorb device can be implanted during a breast lumpectomy in the area where a tumor is removed.

It is made of a bioabsorbable material and titanium clips that hold the device then continue to mark the exact site of the original tumor, which allows Faught to precisely target follow-up radiation treatments to this location.

“The site of the original tumor is the most likely place where it could start again,” he said. “The BioZorb allows me to perform radiation treatments at that specific site. Research has shown that more-targeted treatments stand a better chance of eliminating the whole tumor.”

Overall radiation exposure areas are reduced, and patients benefit from a better standard of recovery, additional healthy tissue can flourish and create a fuller recovery from the cancer treatments.

Better precision, better brain surgery, better healthcare
Dr. Duane Densler,  Chief of Neurosurgery, Pikeville Medical Center

Dr. Duane Densler, Neurosurgery Chief, Pikeville Medical Center

Duane Densler, M.D., chief of neurosurgery at Pikeville Medical, describes Brainlab equipment as the standard of neurosurgical care. He trained in the use of the system while completing his neurosurgical residency at the University of Louisville and helped bring the technology to Pikeville when he began practicing seven years ago.

The technology manufactured in Germany has multiple capabilities and applications, Densler said, but its primary function is to help neurosurgical teams navigate the most direct route to a developing tumor or an aneurysm repair.

“In the operating room, Brainlab provides us data to navigate the least-invasive path around the brain to get to a tumor, which we can then resect or remove,” he said. “It allows us to make smaller incisions and smaller craniotomies.”

The result, in addition to the removal of a life-threatening tumor, is shortened time in the operating room, reduced hospital stays and quicker recovery times, Densler said.

PMC neurosurgery has a Brainlab add-on that allows more precise spine surgery, permitting surgeons to use real-time imaging rather than referencing previously made scans.

“You get an image of the spine while you are working on it, including the precise position of surgical tools,” Densler said.
Densler and Norman Mayer, M.D. have been aggressive in building the neurosurgery department in Pikeville. An initial Brainlab System investment estimated at $300,000 was upgraded for an additional $300,000, Densler said, and that doesn’t count the more important investment in human capital.

Dr Narenda Nathoo

Dr. Narendra Nathoo, Neurosurgeon, The Medical Center

The investment has been worth every dime, he said.

In Bowling Green, the neurosurgical department at The Medical Center has been using the Medtronic Stealth Navigation System for several years. When the most recent software upgrades in October 2014 are included, The Medical Center has invested over $1 million in state-of-the-art neurosurgical technology for southcentral Kentucky.

Narendra Nathoo, M.D., a staff neurosurgeon, said the stealth navigation system uses a powerful wide-angle camera to assist the surgeon in real-time brain and spine surgery. It also makes use of enhanced tracking technology with both wired and wireless instruments.

As with the BrainLab system, Nathoo said the department purchased the system to facilitate less invasive and more precise surgical procedures using “keyhole” incisions to reduce impact on healthy tissues.

“Also acquired,” he said, “was Fluro Navigation, a special adapter to an X-ray machine, so that surgeons can fixate the spine through smaller skin incisions” that require only a few sutures to close.

The Medical Center in Bowling Green has invested more than $1 million into neurosurgery technology such as this Medtronic Stealth Navigation System. Its real-time imaging allows surgeons to make “keyhole” incisions that reduce the impact on healthy tissues for better overall medical outcomes.

The Medical Center in Bowling Green has invested more than $1 million into neurosurgery technology such as this Medtronic Stealth Navigation System. Its real-time imaging allows surgeons to make “keyhole” incisions that reduce the impact on healthy tissues for better overall medical outcomes.

Stealth Navigation provides high-resolution images for image-guided surgery, and as with other forms of surgeries, CT and MRI imaging are reducing the invasiveness of surgeries, even in the most complex and delicate of procedures, Nathoo said. The results are consistently better outcomes and significantly improved patient recovery.

At KentuckyOne Health, one of the single largest capital equipment investments that 200-location, 15,000-employee system has made is into a NeuroCT system.

According to Alagia, the neuroCT system allows neurosurgeons to do evaluations in real time “without having to close the patient and then do a post-operative assessment about the location of tumor margins and whether the placement of interoperative devices were done right.”

There is a big advantage, he said, to using CT imaging to make adjustments and mid-course corrections during one procedure so that a patient does not have to undergo the additional trauma of follow-up procedures.

Hybrid ORs allow sophisticated team surgery

Cardiovascular surgery is another realm merging real-time imaging with minimally invasive procedures.
KentuckyOne Health is known for its pioneering history in Kentucky cardiac care, Alagia said, and recently the healthcare system has invested to develop two hybrid operating rooms in its flagship hospitals: Jewish Hospital with support from nearby University of Louisville Hospital, and at Saint Joseph Hospital in Lexington.

Nearly double the size of an average OR, the cost of one hybrid operating room is about $5 million, Alagia estimates, “if you’re going to do it right.”

Hybrid operating rooms combine a full traditional operating room with a full cath-lab and high-end imaging systems that allow for ultrasound as well as 2D and 3D imaging to support endovascular procedures.

“These are areas of real distinction for us because it allows us to perform highly complex treatments for vascular disease using minimally invasive techniques,” he said.

“The medical team operates in a coordinated way to perform highly sophisticated types of cardiovascular procedures.”
For example, he said, the new hybrid ORs are good for use in performing Transcatheter Aortic Valve Replacements (TAVR) without having to open up a patient’s chest.

“These types of ORs are not for every type of surgical procedure,” Alagia said. “But for certain select patients who have vulnerabilities that put them at risk, minimally invasive surgeries that these ORs make possible decrease mortality, reduce infection and have fewer complications. I get excited about their potential down the road.”

The new medical technology in this article is just a fraction of the resources available at Kentucky’s hospitals. For example, millions of dollars are being invested in electrophysiology laboratories in Baptist Health Paducah and in KentuckyOne Health.
But it is clear that significant investments are being made to ensure that Kentucky patients have ready access to the state of the art in healthcare technology. ■

Josh Shepherd is a correspondent for The Lane Report.  He can be reached at