Startupalooza NJ is a competition in which technology, digital health and medical device companies competed for the chance to present their products before a wider audience of private equity investors in New York next month.  This is one of a series of posts I’m publishing that includes elevator pitches from three of the companies I liked.

Epion Health is a digital health company focusing on improving health literacy in the one place it can be reasonably sure it will have the patient’s undivided attention — the physician’s waiting room.

The Lebanon, New Jersey-based company’s president and cofounder, Joe Hogan, was the head of commercial operations at Abraxis Oncology, part of Abraxis BioScience, which was acquired by Celgene (NYSE:CELG) for $2.9 billion in 2010. Its CEO, Joe Blewitt, previously worked on education products for the pharmaceutical industry. Content comes from the Mayo Clinic, among other sources.

It is finishing up a pilot program with one of the five largest pharmaceutical companies in the world focusing on hypertension and osteoporosis across six healthcare centers in five states, including New York. Although the information is disseminated through tablets, provided free to physicians, it is about to embark on a second pilot program that will expand the program to smartphones.

Epion Health CEO Joe Blewitt

Mayo Clinic beat Cleveland Clinic in the much-hyped and highly questionable U.S. News and World Report‘s list of America’s best hospitals.

But at least Cleveland Clinic can take solace in the fact that it’s the clear victor in a comparison of the two heavyweight hospital systems’ websites, according to a recent edition of Website Smackdown at Inc.com.

The author of the post, Jon Gelberg of New York-based web design firm Blue Fountain Media, said Cleveland Clinic’s site does a much better job of serving its users’ needs.

“The Cleveland Clinic website is clearly superior to the Mayo Clinic site,” Gelberg said in an email. “It is far more user-friendly than Mayo’s. Most importantly, it does a better job of providing visitors with information and steering visitors to the care they are seeking.”

Apparently Mayo’s status as King of Hospital Social Media doesn’t extend to such old-fashioned matters as its homepage. In the piece at Inc., Gelberg blasted Mayo’s homepage as offering “virtually nothing … that is designed to help patients, families of patients, or people looking for assistance from the hospital.”

Cleveland Clinic’s homepage, with its more straightforward navigation, makes finding directions or scheduling an appointment much easier, Gelberg said.

When it comes to finding a doctor, it’s a similar story. Mayo’s site, which allows users to search by doctors and department, and nothing else, is “clinical and unfriendly,” Gelberg said. It also features videos that in which Mayo doctors talk about what a wonderful place Mayo is.

Cleveland Clinic, in contrast, offers users five different searches and includes a video that walks users through the search process.”Rather than extol the virtues of the Cleveland Clinic, it provides a real service to site visitors,” according to Gelberg.

So, while there’s room for debate about whether a patient is better off seeking medical treatment at Cleveland Clinic or Mayo, it would appear that there’s little question about which hospital’s website provides the superior user experience.

“If the purpose of a hospital is to care for patients, then that should be the purpose of the hospital’s website,” Gelberg said. “That’s exactly what the Cleveland Clinic’s site does.”

“Merecido, Dr. Arguelles. Mi gratitud eterna.”

It happened again Wednesday. The 15th comment, this one by “Caridad,” was posted cheering on Mayo Clinic Dr. Guillermo Ruiz-Arguelles for his place as the 42nd greatest Mayo Clinic doctor of all time. Nearly half of the comments are in Spanish. The first appeared a day after the story appeared, and they haven’t stopped coming since.

“Congratulations to Dr. Guillermo Ruiz Argüelles and his family,” read a comment from Eduardo Garza de la Peña M.D. “I’m very proud to be part of the Clínica Ruiz alumni. I’m glad I had the opportunity to work with him, his father Dr. Guilllermo Ruiz Reyes, his brother Dr. Alejandro Ruiz Argüelles and his son Dr. Guillermo Ruiz Delgado. All of them excellent professors, prominent physicians and devoted researchers. A great example for many young Mexicans.”

A reader who signed his name Alfredo Ulloa-Aguirre M.D., D.Sc., commented: “Congratulations Guillermo. You deserve this honor for your efforts and breakthrough contributions to the treatment of hematologic malignancies. Incidentally, I am also sure that you will agree with me in that our late teacher and friend Donato Alarcón-Segovia should also be in this list.
Proud to be your friend!”

Ruiz-Arguelles, the current president of the International Society of Hematology, is noted for his contribution to how leukemia, lymphoma and aplastic anemia can be managed. He is also the director, hematology and internal medicine, and teaching division head, Clinica Ruiz in Puebla, Mexico.

Ruiz-Arguelles says, via e-mail, that he was unaware of being selected among such an elite group of physicians, and only found out when a friend who happens to be a physician at Mayo passed on the link to the story. He has personally thanked all who sent their congratulations to him.

[Photo from Flickr user SCA Svenska Cellulosa Aktiebolaget]

Mayo Clinic is possibly writing the primer on healthcare social media with its foray into Connect – Mayo’s twist on Facebook.

Roughly six months into operating it, Mayo Clinic Connect continues to be more popular than anyone conceived   boasting 13,000 plus users. But Mayo is learning that running its own healthcare-focused social network requires dedicated resources to react quickly to problems.

“On the one hand you have the opportunity to make changes, on the other hand you have the responsibility to make them (and need to) dedicate the resources to make those changes,” said Lee Aase, director for Mayo’s Center for Social Media in an interview last week.

For instance, since the launch last year in July, users brought it to Mayo’s attention that when people based outside the U.S. tried to register on the site, they still had to select a state to complete the registration process. That must have frustrated some and driven them off but others randomly picked a state and got registered any way.

The problem has been solved with the state box getting grayed out when a user is from abroad, Aase said.

But the fact that among its 13,000 users, about 850 are from outside U.S. borders, is “quite an accomplishment” given the technical glitch some of them encountered, Aase said.

And Aase said more improvements are coming down the pike. They include:

• A new landing page in Spanish. (no surprises there, given Mayo’s Spanish-language Twitter effort)
• Automatic flagging of some keywords (these could be four-letter words, but more importantly phrases like “kill myself,” “suicide” or “I don’t want to live”)
• A new profile view such that a user sees his or her profile the same way other Connect user sees it in order to help them to easily alter privacy settings

Those changes may help to expand the user base even further.

Currently, Connect has garnered about a 1,000 users from Florida, where it has a campus, and the same number from California. Texas, Illinois and New York provide 600 a piece. And home base Minnesota has brought in 900 users.

Aase said that he was “pleasantly surprised” that with the exception of Minnesota, Connect’s user base is roughly proportional to each state’s population.

More women than men fill up the user ranks and the most active discussion threads revolve around women’s health, brain and nerve diseases and mental health.

With Connect, Mayo is boldly going where no one has gone before. Mayo’s brand name and the fact that at least one patient from each of the 50 states comes to Mayo Clinic every year, undoubtedly helps the Connect initiative. But Aase’s description implies how such an effort could have only been initiated first at the Clinic with its home in far flung Rochester, Minnesota.

“For us this is a great way to connect because we are separated by geography from the great population centers,” Aase said.

Happtique‘s program would evaluate and certify healthcare apps. The program would articulate quality and performance standards for an app’s clinical relevance and technical functionality, developed by members of a blue ribbon panel in the next six months.

The voluntary program will be open to all app developers and will be funded by developer application fees.

“With more than 20,000 healthcare apps in the marketplace — and more coming out every day — healthcare organizations and professionals are expressing the need for a bona fide mhealth app certification program,” Happtique President Corey Ackerman said in a press statement.

The panel will be chaired by Dr. Howard J. Luks, an orthopedic surgeon and associate professor of orthopedic surgery at New York Medical College and chief of sports medicine and arthroscopy at University Orthopedics and Westchester Medical Center. He also serves on the advisory board at the Mayo Clinic’s Social Media Network.

Other members include Shuvo Roy, director of the Biomedical Microdevices Laboratory and associate professor in the bioengineering and therapeutic sciences department at the School of Pharmacy at the University of California, San Francisco. He previously served at the Cleveland Clinic as codirector of the BioMEMS Laboratory and on the faculty of the Spine Research Laboratory. Dave deBronkart is a patient engagement activist who is a blogger and cancer patient, and is also on the advisory board  of the Mayo Clinic Center for Social Media. Franklin Shaffer is the CEO of CGFNS International, the certification organization for graduates of foreign nursing schools.

Happtique is a subsidiary of the Greater New York Hospital Association‘s business arm, GNYHA Ventures. Through its business, hospitals, physician practices and continuing-care facilities can create individually branded, secure apps for employees and patients to use on their smartphones. Among the 11 healthcare facilities Beta testing Happtique’s custom app store are Mount Sinai Hospital, Mount Sinai School of Medicine and Beth Israel Medical Center. They developed or are developing their own mobile applications.

The U.S. Food and Drug Administration has been developing some type of mobile app certification itself, two years after approving its first mobile health app, Airstrip Technologies’ AirStrip RPM.

But now the Mayo Clinic has found that the procedure requires a lot of practice. And that raises the question of how widely the nascent technology will be adopted in the U.S. and whether doctors would need credentials to perform the procedure.

Heart.org reported that the Mayo study found that doctors may require as many as 30 procedures before they reach proficiency in using TAVI. The study was part of Edwards Lifesciences’ Partner Trial and was based on observing 44 patients who underwent transcatheter aortic valve replacement at the Mayo Clinic in Rochester, Minnesota between November 2008 and May 2011. Edwards Lifesciences is the first company in the U.S. to receive regulatory approval to market its transcatheter aortic valve replacement system called Sapien.

In an editorial published along with the study in the December issue of the Journal of the American College of Cardiology: Cardiovascular Interventions, editor Peter Block highlighted the complex learning curve and speculated about TAVI’s rollout.

“How all this will play out over the next year should concern every center and operator contemplating the addition of TAVI to their list of available therapies,” he wrote. “[I]t may take more than a full year for an operator to become procedure ‘proficient,’ [and] the question of maintenance of proficiency is totally unanswered at present.”

This conclusion, if widely held, may ultimately affect companies who have developed TAVI systems

While Edwards Lifesciences with its Sapien is the only company with an approved product in the U.S., Medtronic was the first to win regulatory approval for a TAVI system in Europe and other nations. Called CoreValve, the system has reported positive clinical outcomes in a study following patients in Europe and Canada. A clinical trial is currently under way in the U.S. to test the device.

On Tuesday, a Medtronic spokeswoman acknowledged that “we are aware of the learning curve and accommodate it through rigorous physician education. …”

That training includes “hands-on training featuring state of the art simulation … (and) proctored case support that is led by skilled physician proctors who have both depth and breadth of experience with the CoreValve System in countries where the CoreValve System is commercially available,” said Kathleen Janasz, a Medtronic spokeswoman.

Janasz’s comments were echoed by an Edwards spokeswoman.

“Edwards has designed a robust training program that is tailored to the needs of the Heart Teams performing TAVR [transcatheter aortic valve replacement], enabling teams to develop a high level of comfort with this new procedure,” said Sarah Huoh. “We believe the results from The Partner Trial, which include this experience from the Mayo Clinic, will drive adoption of TAVR  and [we] have confidence in the plans we have in place for the U.S. introduction of this new therapy.”

CoreValve and Sapien will vie for a target population of 100,000 Americans who suffer from severe aortic stenosis.

The problem with proton therapy is simple, according to the editorial: It’s very expensive, and it’s only proven to work better than conventional methods in treating a few rare types of pediatric cancer. But because proton facilities are so expensive, often costing close to $200 million, builders are motivated to use proton therapy to treat a wide variety of cancers.

The consequence is that proton therapy ends up costing the U.S. additional millions if not billions in spending each year to treat diseases that could possibly be better treated — and certainly could be more cheaply treated — with other types of therapy.

That is “crazy medicine and unsustainable public policy,” write the authors, oncologist and former White House adviser Ezekial Emanuel; and Steven Pearson, director Institute for Clinical and Economic Review at the Massachusetts General Hospital’s Institute for Technology Assessment.

Like more conventional cancer treatment methods, proton therapy uses radiation. The difference is that protons do the bulk of their work beneath the skin where a tumor is located, unlike X-rays, which tend to lose power and cause collateral damage as they penetrate the body’s tissues. In theory, that means proton therapy allows for the more precise targeting of tumors, reducing collateral damage.

But Emanuel and Pearson aren’t buying into proton therapy’s promise. “The higher price would be worth it if proton beam therapy cured more people or significantly reduced side effects,” they write. “But there is no evidence showing that this is true, except for a handful of rare pediatric cancers.”

Similarly, patient safety group the ECRI Institute last year concluded that no true analysis of the efficacy of proton therapy was possible given that the data available was insufficient. Until that changes, opponents of proton therapy — and there are plenty — will always have ammunition.

Mayo in 2010 announced plans for two $180 million proton centers in Arizona and Minnesota, touting the technology and characterizing the centers as a “bold move forward” for the health system.

Emanuel and Pearson see Mayo’s move fueled by slightly less-idealistic motivations: boosting profits and keeping up with the Joneses, noting that other premier national health systems like M. D. Anderson in Texas and the University of Pennsylvania already have proton centers. There are nine operating proton centers in the U.S., with plenty more on the drawing board.

Still, proton therapy has plenty of staunch advocates. Many who have undergone proton therapy swear by it, saying it provided the hope of a cure without the pain and side-effects associated with X-ray treatment. One support group of prostate cancer patients who’ve undergone proton therapy boasts about 6,000 members and is dedicated to spreading awareness of the treatment option.

So this isn’t an argument that will die anytime soon.

In the meantime, Emanuel and Pearson have a suggestion that could reduce the amount Medicare spends on proton therapy that they call “dynamic pricing.”

Medicare would pay more for proton beam therapy, but only for diseases that are proven to be treated more effectively by the therapy than by other forms of radiation. For cancers like prostate, it would pay only what it pays for the cheaper alternatives. But if studies were done showing that proton beam therapy was better than other treatments, the payment would go up. If no studies were done, or the new evidence demonstrated no advantages, then coverage would continue, but at the lower reimbursement.

Photo from flickr user habi

A review of life science current events reported by MedCity News this week:

Mayo Clinic helicopter crash: How often do these accidents happen? But there remains a consensus that, in general, helicopters used for medical purposes are not safe enough. The National Transportation Safety Board earlier this year said current helicopter EMS accident records are unacceptable. (See the follow-up story, Details, identities emerge in Mayo Clinic helicopter crash.)

Big pharma should hate these Hollywood blockbuster movies. Pharmas have figured prominently in many movies, more often than not coming off as the bad guy. Big Pharma has a thick skin. That’s needed in order to deal with the pressures from Wall Street, scrutiny from the U.S. Food and Drug Administration and criticism from dissatisfied patients. But some movies might cut a little too close to the bone for pharmas’ comfort.

UW chairman takes heat over royalties from Medtronic. The Milwaukee Journal Sentinel published a story Tuesday on Thomas Zdeblick, the chairman of the Department of Orthopedics & Rehabilitation at the University of Wisconsin-Madison, who has received more than $25 million in royalties from Medtronic since 2003. The article calls to question Zdeblick’s position as chairman of the department.

Cleveland Clinic’s ‘top medical tests’ list is viral (not in the Internet way). Cleveland Clinic did what all health systems do in mid-December: send out news-you-can-use, 2012 predictions about better health in the coming year. This one included top medical tests people should get in 2012. Unfortunately, one of the leading media watchdogs on health news treated the tips like a bad infection. And now the release — which I couldn’t find on the Cleveland Clinic’s website — has become a symbol for a hot-button topic among medical professionals and media types: poor and cheesy medical information.

The best LinkedIn groups for healthcare and life science innovation. LinkedIn’s groups are a great way to survey industry colleagues and discuss issues that are attracting attention in a specialized community. They can be a particularly important source for contacts and networking, too.

Because the crash started a fire that destroyed 85 percent to 90 percent of the aircraft, the National Transportation Safety Board says it could take six months to a year to complete the investigation to determine the cause and conditions of the accident, which also killed pilot E. Hoke Smith.

Although the men were part of a charter mission to procure an organ, as opposed to the emergency medical rescue of a patient, the Mayo Clinic crash brings to the forefront some important safety issues that surround air medical services in healthcare.

A 2010 article in Popular Mechanics pointed to the dangers in medical helicopter safety, following some high-profile helicopter EMS crashes and a transplant mission accident that killed six people in 2007. The number of fatal helicopter EMS accidents nearly doubled between the mid-1990s and mid-2000s, and the accident rate among HEMS missions is above the rate for all general aviation flights.

To put the Mayo crash in context, we talked to Tim Pickering, the president of the Association of Air Medical Services, a nonprofit trade organization that supports providers of air and surface medical transport systems. He explained some concerns from the AAMS’ perspective, including a lack of development and support in low-altitude aviation operation and a general lack of data about HEMS and charter flight accidents.

Q: What are the differences between “air ambulances” for EMS use and regular charter helicopters, like the Bell 206 involved in the Mayo crash?

Physically, they differ only in the fact that an AAMS helicopter would be specifically equipped to transport a patient. Otherwise, they could be identical aircraft and equipment, just purposed for different missions. They both operate under Federal Aviation Administration regulations part 135, which gives whoever operates the aircraft the requirement of having an air carrier certificate.

Q: Are there general requirements that pilots and medical helicopters must meet in order to contract with hospitals?

Other than the requirements under FAA’s regulations that anybody operating and renting or leasing an aircraft have an operating certificate under part 135, I don’t know of any federal or state requirements for medical pilots and medical helicopters to contract with a hospital.

Q: Do most hospitals contract with aviation companies for helicopter services?

Many hospitals that use helicopter EMS will contract with aviation companies to lease the required part 135 air carrier certificate, but there are some hospitals that have chosen to own an aircraft and establish and own their own air carrier certificate, and thus they inherently become an aviation company as well. A lot of it would vary around economics, but a lot of it also might vary on whether a hospital felt it wanted to have more ability to control the specifics of the aviation side.

Q: Why are things like flight data recorders and filing a flight plan not required for emergency air operations?

Helicopter EMS operations do file flight plans under part 135 requirement. They’re generally not flight plans with air traffic control centers; they’re local flight plans through their communications coordination or operational control centers. Flight data recorders are not required for certain types of aircraft based on operating weight and their use, so it’s not just HEMS aircraft that do not have them. They are heavy and weight is a concern.

The FAA considers operations in HEMS to be similar to general aviation operations, thus the FAA hasn’t invested in and hasn’t begun any real development in support of what’s called the low-altitude infrastructure — that is, the requirements for below the 5,000-foot area, which most HEMS operate in. AAMS has called for and lobbied for FAA investment in this area, including weather reporting, regulating meteorological powers and communications capabilities.

Q: What poses the biggest problem for EMS pilots? Lack of equipment? Flying and landing in hazardous conditions? Feeling rushed?

Many folks who operate HEMS aircraft in the last five to seven years have voluntarily made huge financial investments in improving equipment in the fleets. They’ve added things such as night-vision goggle systems, helicopter warning systems and improved their flight following and risk-assessment systems, and all of this has been developed generally without regulatory requirement.

Ultimately, the real problem comes down to human factors of decision-making and we believe that’s what contributes to the majority of today’s accidents. Why did a human make a decision at a particular point in time to do something that ultimately led to an incident or accident? The NTSB has added human factors into its accident investigation process, looking at fatigue issues. You may be aware of the well-publicized airline part 121 rules on pilot fatigue, and we believe those kinds of requirements will come down to our part 135 air carrier operations.

Q: Do doctors/surgeons typically go on the kind of trips like the Mayo one (to retrieve organs)?

AAMS doesn’t know what a typical medical crew component of a transplant service is. We know in the past, like in a recent accident with the University of Michigan, their transplant team had several physicians on that aircraft. We do know that some AAMS members use a helicopter simply as a means of expeditiously transporting the physical organ, not a team to get the organ.

Generally, it’s hard for us to know because there’s no data. That’s one of the big things that the FAA acknowledges and the NTSB has planned out — there’s a dearth of accurate data collection for helicopter EMS and the charter industry. Who’s doing what? Where? How? Under what conditions? We hope that FAA’s rule-making role will mandate more data collection.

Mayo Clinic identified the two employees killed as Dr. Luis Bonilla, 49, a thoracic and cardiovascular surgeon (at left), and David Hines, a procurement technician from Kentucky. Both were employed by the Mayo Clinic’s Jacksonville location. The Florida Times-Union reports that the third person killed was E. Hoke Smith, the pilot and president of SK Jets, the company that owned the helicopter.

The helicopter departed Mayo Clinic in Jacksonville at 5:45 a.m. to retrieve a donated heart at Shands at the University of Florida in Gainesville. Kathleen Bergen, a spokeswoman for the Federal Aviation Administration, said no flight plan was filed for the helicopter.

Just before 6 a.m., the helicopter crashed in a remote, dense pine forest southwest of Green Cove Springs — about midway between Gainesville and Jacksonville. Around noon, the wreckage was spotted by another helicopter. The crash started a fire that burned about 10 acres, the Times-Union reported.

There was light fog but no rain at the time of the crash, according to the National Weather Service in Jacksonville. Officials with the FAA and the National Transportation Safety Board are investigating the crash.

Owned and operated by SK Jets, the helicopter was a Bell 206, which MedCity readers noted is not a medical air ambulance but rather a routine, multipurpose charter helicopter. At a press conference this morning, NTSB investigator Jose Obergon said there were no indications of a problem before the crash and that the helicopter did not have a black box that recorded the flight’s activity.

SK Logistics Jets has been working with Mayo since 1997, the company’s Vice President Derrick Smith told First Coast News. He said that flight plans are typically filed by SK pilots, even though they are not required by law.

“As we mourn this tragic event, we will remember the selfless and intense dedication they brought to making a difference in the lives of our patients,” said Mayo President and CEO John Noseworthy in a prepared statement. “We recognize the commitment transplant teams make every day in helping patients at Mayo Clinic and beyond. Our thoughts and prayers are with the families.”

The viability of the heart that was being transported expired and it couldn’t be used in another transplant, a Mayo spokeswoman said.

First Coast News has photos from the scene.

Three people including two Mayo Clinic workers were killed in a Mayo Clinic helicopter crash in Florida on Monday. The cause of the crash and names of the victims are still unknown. But the accident will likely increase the already growing scrutiny on using helicopters for the transport of medical personnel.

The aircraft used in this flight was from a private service and is used for everything from emergency medical services to firefighting to corporate transportation. It’s been identified as a Bell 206. That’s  not unique to healthcare, but it’s also not the “air ambulances” the public associates with medical transport.

It’s been an intense 18 months for the practice of using helicopters for healthcare. Medical helicopter pilots were labeled as flying the “most dangerous missions in aviation” and the “most dangerous profession in America” in a July 2010 article in Popular Mechanics. Some states were using helicopters unnecessarily, the article found, and they have fewer equipment requirements and poorer protocols — around things as pedestrian as weather checks — than other kinds of flights.

Part of the reason for the dangers were from an early era as the practice grew. As of mid-2010, the fatal accident rate on medical helicopters was 1.18 per 100,000 hours. Meanwhile, the rate for all general aviation and air taxi flights is 1.13 per 100, 000 hours, according to the Federal Aviation Administration. For helicopters specifically, the rate can vary between 1 and 1.94 per 100,000 hours.

But there remains a consensus that, in general, helicopters used for medical purposes are not safe enough. The National Transportation Safety Board earlier this year said current helicopter EMS accident records are unacceptable.

More specifically, there’s a big difference in how safe one helicopter is to another. The NTSB pointed out that no matter the cost and makeup of the helicopter — a $800,000 single-engine model versus a $12 million twin-engine autopilot air ambulance — Medicare reimbursement is the same.

Monday’s Mayo Clinic organ transplant flight accident is different than many medical flights. But that won’t stop the safety debate from restarting. And even these flights aren’t without challenges. According to the Associated Press, a surgeon and an assistant flying to pick up a donor heart died in 1990 crash in New Mexico. In 2007, a twin-engine plane transporting a set of lungs crashed into Lake Michigan.

Key questions to be answered about any medical helicopter accident will involve:

• equipment for the pilots
• whether the pilots had scenario-based simulator training and if they had instrument proficiency training
• the kind of autopilot and navigation equipment on the helicopter

It’s unclear what’s happened at the FAA in the past year. The Popular Mechanics article and intensified scrutiny around air ambulances triggered both voluntary safety measures and federal rule proposals. More helicopters came with helmets equipped with night vision goggles, for example. A rule proposed by the FAA in 2010 received final comments in January of this year. It included requirements around pre-flight checks, minimum weather requirements and training — some of which a trade association had already required or implemented.

But the FAA regulation bogged down — due in part to partisan issues around the FAA — and the rule has not yet been implemented.

[Image from News4Jax.com]

A review of life science current events reported by MedCity News this week:

The 50 best Mayo Clinic, Cleveland Clinic doctors. Ever. The history of a hospital is written primarily by the actions of its doctors. Here are our choices for the 50 best doctors in the history of Mayo Clinic and Cleveland Clinic.

5 healthcare social media tips that break the mold for pharma, med tech. With Facebook’s recently implemented “wall policy” rules and minding the U.S. Food and Drug administration regulations on advertising, pharmaceutical companies are treading carefully.

Cleveland Clinic’s 5th-highest-paid employees in ’10 hasn’t worked for hospital since July ’09. Despite abruptly leaving the Clinic amidst cloudy circumstances and vague explanations in July 2009, former Chief Operating Officer David Strand was the Clinic’s fifth-highest paid employee in 2010 at $1.3 million. What’s more, he received the largest raise, 18 percent, of any of the Clinic’s employees who were paid more than $1 million last year. (And Cleveland Clinic Millionaire’s Club adds 2 in 2010, grows to 15 members.)

Fishchell stent development co. raises $17 million in series B round. Svelte Medical Systems, a medical device company started by serial entrepreneurs Robert Fischell and his sons David and Tim, has raised $17 million in a series B Round of financing — just under half of its $37 million target to develop its first- and second-generation stents for cardiac surgery.

A brief history of medical technology. A social media strategy firm has created a useful graphic that charts a brief history of medical technology, from the invention of the stethoscope in 1816 to the development of the commercial hybrid PET/MRI scanner to more recent advances.

The Mayo Clinic.

While it bears the name of its founders, Mayo’s worldwide reputation is not tied inextricably to them. Instead, it rests upon countless physicians who have worked there over time.

Yesterday, my colleague Brandon Glenn ran a list of the best Cleveland Clinic doctors in history. Below is a top 50 list from a slightly more storied healthcare institution. You’ll notice a bit of a contrast: Having been born in a country whose history dates back several centuries to 3300 B.C., I have particular respect and appreciation for history. That is why my top 10 contains only those long-departed who have become legends for their contributions to healthcare.

Beyond the top 10, luminaries still abound, but there are also some who you might not think of immediately. They are those whose contributions have been lasting because they have become entirely routine. There are educators who have imparted their skill and knowledge to thousands of students who practice all over the world. And then there are current physicians working tirelessly to solve the medical conundrums of today.

Of course, feel free to re-rank my list and add or subtract any way you please and send them to us @medcitynews on Twitter or comment below.

1. William James Mayo and Charles Horace Mayo (tie)

The Mayo Clinic might have never been established had the Mayo brothers not joined their father’s medical practice in the late 1880s after they each completed medical school.

The two, along with other partners who joined the Clinic in later years, pioneered the model for an integrated, multi-specialty group practice that has been amply copied but rarely matched. Both served their country during World War I and were honored for their distinguished service.

Both were excellent surgeons, with William specializing in surgery of the abdomen, pelvis and kidneys, while Charles was somewhat of a generalist. He was known to have pioneered procedures in several clinical areas that included thyroid, neurological, cataract and orthopedic surgery.

“Dr. Will” apparently also had a sense of humor. A story goes that an unsatisfied patient accosted him and asked whether he was the head doctor. He reportedly said, “I am the belly doctor. My brother Charlie is the head doctor.”

The two brothers died within months of each other in 1939.

3. John Kirklin

Kirklin developed the first commercial heart-lung bypass machine and refined the design of the original heart-lung machine invented by John Gibbon. In fact, Kirklin’s machine came to be known as the Gibbon-Mayo heart-lung machine.

The device represented a major accomplishment in open-heart surgery because it made it possible to use the bypass machine routinely.

For years, Kirklin was the chair of Mayo Clinic’s Department of Surgery before he left to assume a similar position at the University of Alabama School of Medicine.

4. Henry Plummer

Plummer, an internist and endocrinologist, and an early partner of the Mayo brothers, was equal parts physician and inventor.

He created the first medical record that contained the details of each patient’s history that could be easily accessed and shared by multiple doctors. It later became the model for patient records.

But Plummer’s contributions were not limited to the medical record alone. He designed several buildings and developed the pneumatic tube delivery system through which medical charts and other information could be physically transported within the Clinic.

5. Edward Kendall and Dr. Philip Hench (tie)

Plummer recognized the importance of diagnostic and research labs, but it was Drs. Edward Kendall (seated in the above photo) and Phillip Hench (far right) whose research activity won the duo, along with Swiss chemist Tadeus Rachstein, the prestigious Nobel Prize in Physiology or Medicine in 1950.

Decade of Discovery is an initiative of the Minnesota Partnership for Biotechnology and Medical Genomics, a collaboration between the university, the clinic and the state of Minnesota. It was formed last year and today announced three new grant recipients.

The first project targets obesity, the greatest risk factor for type 2 diabetes. University of Minnesota and Mayo Clinic researchers who want to develop an anti-obesity drug received $875,000 to explore new molecular targets for the drug. They’re currently working with the peptide TLQP-21, which was recently shown to prevent obesity in mice by increasing fat decomposition and decreasing the size of fat cells.

A second project using mice with human HLA alleles to test drug efficacy and safety before human trials won $486,368. Researchers are looking for ways to make insulin-specific T cells, which have been shown to cure type 1 diabetes in mice, more tolerant and keep them from destroying insulin-producing beta cells.

Researchers who received the final $500,000 award are developing a specialized electronic chip sensor that can transmit data wirelessly and function in more locations in the body, improve glucose monitoring as part of the artificial pancreas being developed by Mayo Clinic.

Minnesota is a likely target for diabetes-related research; in addition to the clinic and the university, it’s home to Medtronic, which is regarded as the leader in developing the artificial pancreas, and EnteroMedics, a company developing innovative devices for obesity, among others.

The Evangelical Lutheran Good Samaritan Society — the nation’s largest not-for-profit provider of senior care and services — has signed on to support Mayo’s Healthy Aging & Independent Living (HAIL) Lab. Established in September in collaboration with the clinic’s Robert and Arlene Kogod Center for Aging, the HAIL lab is located in the Charter House, a continuing care retirement community that’s connected to the clinic.

“The HAIL Lab will be a place for focus groups, as well as for designing, prototyping and piloting new services and technologies with voluntary participation from residents of Charter House and other community agencies,” Mayo said in a June news release.

It’s supported by member organizations, like the Good Samaritan Society, that share the clinic’s mission to create innovations for the growing elderly population. Best Buy was the first founding consortium member to sign on to the project in September.

It seems that now is as good a time as ever for the center. Census data from 2010 revealed the number of U.S. adults over the age of 90 is now at nearly 2 million; they comprise 4.7 percent of the population, compared to 2.8 percent just 30 years ago. And that number is predicted to quadruple by mid-century.

Mayo is just one of many big-name companies and institutions investing time and money in researching and developing healthcare technology for the elderly. For example, Pfizer and Humana committed to a five-year partnership in October to investigate pain, cardiovascular disease and Alzheimer’s in the elderly.

The convenience factor for the aging population coupled with cost effectiveness has resulted in a booming long-term care and home healthcare market. BCC Research estimated that the global market for elder-care technology products was worth $2.6 billion in 2010 and is expected to grow to $4 billion in 2015.

“We will not open at midnight on Friday with the rest of the mall,” said spokesman Bryan Anderson. “Instead, we will open at 6 a.m., which is a bit earlier than usual, and will have limited Black Friday offerings.”

The special offerings? They’ll give a free journal to anyone who buys the Mayo Clinic Diet book and offer some special discounts to Mayo employees.

The clinic is sticking to its healthy living guns — after all, the store’s mission is to entertain and educate guests on wellness topics like nutrition, exercise and, yes, sleep.

“We’re still trying to make connections to healthy living around the holidays, but also trying to do that in the retail environment,” James Yolch, the project’s administrator, told the Pioneer Press.

Mayo just announced some changes to the store resulting from guest feedback during its first 100 days, including a new name, expanded retail offerings, free wellness assessments and new gaming kiosks. It will also expand its clinical services offered in a smaller, separate space near the store.

Acting as a prototype for a possible permanent Mayo Clinic facility to be built as part of a proposed expansion to the mall, the store is a 2,500-square-foot space designed to be a cross between a high-tech Apple store and an interactive library of Mayo Clinic health information centered around wellness.

So it seems that Mall of America shoppers won’t encounter any fighting, exhaustion or long waits in line at the clinic’s store. But if they encounter it elsewhere, you can be sure the growing number of retail healthcare clinics nearby would welcome the extra business on Black Friday.

At least that’s what the healthcare social media gurus at Mayo Clinic think of their organization’s founders.

Since January, the hospital has been tweeting a quote a day from one of the Mayo men in memory of the elder Dr. William Mayo, who died 100 years ago, and in commemoration of the 100-year anniversary of a defining graduation speech given by his son, Dr. Will Mayo, at Rush Medical College in Chicago.

Referred to as Dr. Will and Dr. Charlie, the Mayo brothers — and their father William — were known for “the kind of pithy, incisive comments that would fit perfectly on Twitter,” Mayo Clinic Center for Social Media Director Lee Aase wrote in a blog post when the project launched in January. Plus, they had a passion for education and sharing within the medical community, traveling to medical centers all over the world to swap medical discoveries and knowledge with other doctors, so they would no doubt be avid social media users today.

Aase wrote that the idea behind tweeting bits of wisdom from the Mayo men was to renew appreciation for the wisdom that the clinic was founded on. But it’s also another fun way the clinic, a leader in healthcare social media, is embracing social media to reinforce its brand identity.

You can read the no-nonsense nuggets of knowledge straight from the mouths of the Mayos themselves daily on Twitter, or compiled at the Mayo Brother’s Wisdom page. Here are six of our favorite Tweets from this year:

Dr. Will Mayo: “Civilization and intellectual growth depend largely on preventive medicine.”

Dr. Charlie Mayo: “When you want support for public health measures, you have to educate the people. When you start to educate the people, you should begin with the women because they will fight for the health of their children.”

Dr. Will Mayo: “I think all of us who have worked years in the profession understand that many very skillful operators are not good surgeons.”

Dr. Charlie Mayo: “More good would come to our country through tongue control than birth control.”

Dr. Will Mayo: “The future of any country depends on the proper use of its most intelligent men.”

Dr. Will Mayo: “The glory of medicine is that it is constantly moving forward, that there is always more to learn.”

Screencap from Mayo Clinic's Discovery's Edge iPad app

Earlier this week, MedCity News reporter Brandon Glenn showed you five ways hospitals are using the iPad. Here’s an addendum to that list, courtesy of Mayo Clinic: to publish.

Mayo has launched a free iPad app to distribute an interactive version of its research magazine, Discovery’s Edge. Published biannually, the app edition of the magazine includes video stories, animations, quizzes and slide shows.

“The goal of Discovery’s Edge from the start was to make research come alive, and this new app edition really makes that possible,” said medical editor Dr. Stephen Russell in a news release.

This is just the first of several Mayo publications that will eventually have iPad editions, according to the hospital. Others include Mayo Alumni Magazine, Mayo Magazine and the cancer center’s Forefront magazine.

But Mayo isn’t the first hospital to release an interactive research magazine app — Inova Health System in Falls Church, Virginia launched one earlier this year.

Hypoparathyroidism is a rare endocrine disorder in which the body produces insufficient levels of parathyroid hormone, the principal regulator of calcium and phosphorus, and for which there is no FDA-approved replacement therapy, according to a release from the company.

Although the symptoms of the disorder are typically managed with large doses of oral calcium supplementation and active vitamin D therapy to reduce the severity of symptoms, the prolonged use of oral calcium supplementation and active vitamin D therapy may result in serious long-term health complications, according to the release.

Bart Clark, a professor of medicine at the Mayo Clinic and an investigator for the REPLACE study, cheered the results: “Considering hypoparathyroidism is the only endocrine disorder for which we do not have an approved replacement hormone to treat the underlying condition, these data indicate that Natpara may offer a valuable option to achieve a physiological treatment and outcome by delivering the missing hormone.”

Francois Nader MD, CEO of NPS Pharmaceuticals, said: “These positive results from our Phase 3 REPLACE study are an important milestone and bring us one step closer to our goal of providing hypoparathyroidism patients with a much-needed replacement therapy.” He added the company expected to file for FDA approval next year. It’s orphan drug status is expected to fast-track Natpara for approval in 12-18 months.

The company’s shareprice fell 33 percent last week after announcing new data on their drug Gattex for the treatment of short bowel syndrome in which three participants developed cancer and two of them died.

Seeking Alpha analyst Bryce Istvan said at the time that the selloff was premature, pointing out that according to a press release from NPS about the study, each of the participants in question  had pre-existing conditions or precursors to cancer.

Following the announcement about the breakthrough earlier in the day its share price rose about 11 percent to $6.05 before ending the day at $5.42.

John Lynch, who leads the Penn team, is an assistant professor of medicine in the division of gastroenterology, and one of six principal investigators in the group.

The networks will investigate the impact of chronic inflammation and bile acids in molecular pathways and stem/progenitor cells. They will explore how to target these cells for developing preventive and therapeutic treatments.

The Penn project members will contribute a a large patient population and Barrett’s inflammatory animal models to the network.

Lynch said:  “Our understanding of the pathogenesis of Barrett’s esophagus and esophageal adenocarcinoma has lagged behind that of other cancers because we have not yet developed physiologically relevant laboratory models and an integrated research network, both of which are supported by this award.”

The tweets are a mix of camaraderie, live coverage, advice, best practices and emoting about the state of healthcare and social media. Plus, they include links to blogs and other coverage (and these are your best bet for feeling like you were at the summit live even if you didn’t attend).

You can browse all of those tweets through the transcript of the conference hashtag, #mayoragan. But below are a handful of some of the best.

Send or post your nominees in the comments section and we’ll add them to the slide show.

That’s because more healthcare organizations are taking notice of what others are doing with social media and seeing the need to collaborate on new ways to implement social media throughout the healthcare system, according to the director of the Mayo Clinic Center for Social Media, Lee Aase.

Aase is part of the team that has helped Mayo Clinic establish itself as the poster child for healthcare social media. In the past year, Mayo has launched its own social networking site that has attracted more than 7,000 users, created Spanish-language Facebook and Twitter accounts, and encouraged its doctors to get on board with social media. Today, he took some time after giving his keynote address at the conference to answer some questions about what’s new and important in healthcare social media.

What is the biggest challenge facing healthcare marketers in using social media?

“If people are only thinking of these as marketing tools, they’re missing opportunities,” Aase said. “That’s probably part of the reason for the growth this year.”

Social media is no longer used just for marketing purposes — it now has a place in medical education and medical research. “These tools aren’t just about building market shares, but they’re about helping patients and connecting providers,” he said.

Part of the challenge for organizations is developing a careful social media strategy that actually supports what they want to accomplish, rather than just going all out on every social media platform available. Organizations should look at what they want to accomplish through non-social media means and then spend some time thinking about which social media tools could help them reach those goals, Aase suggested.

What is the biggest strength when it comes to using social media in healthcare?

Social media has made it possible for in-depth communication to happen among parties who have similar medical interests. “The thing about healthcare is that no one cares about it until they get sick, and then they get interested in it deeply,” Aase said.

Patient-initiated research, a panel topic at the conference, was previously unthinkable without social media. But now, Dr. Sharonne Hayes, a cardiologist at Mayo, is leading a study on a rare heart condition that was initiated by a woman in Virginia who turned to social media for help in understanding her condition. She organized a group of 12 patients with spontaneous coronary artery dissection (SCAD) in four different countries, and Dr. Hayes compiled their data for a pilot study. Now Mayo is collecting information from 200 more patients and conducting two bigger studies on SCAD.

What’s the next big thing Mayo will do with social media?

In the next few weeks, Mayo will roll out another mobile app to connect patients with its online community. But its priority from now until February, according to Aase, will be promoting heart health through a social media campaign called “Know Your Numbers,” launched this morning at the conference. It combines a YouTube video, a Facebook app and a contest to raise awareness leading up to American Heart Month.

What does Mayo get out of hosting this conference?

“It’s keeping with our organization’s DNA,” Aase said. “For over 100 years we know we’ve been in a not-so-easy-to-get-to location, and yet our founders said, we’re not going to let that be a barrier to having an impact.” Having a reason for lots of people to physically come to Mayo Clinic is a great opportunity, he said, but it’s also about helping others learn about how to take advantage of the social media tools available and to create connections that will ultimately help patients.

What’s the coolest application you’ve seen of healthcare social media not done by Mayo?

Aase cited a few popular YouTube videos, including one of a dog running a half-marathon for cancer research and another of the da Vinci surgery robot folding a paper airplane the size of a penny, that he thought were interesting. Although you can never predict when a video will go viral, if it does, it can have a real impact (Envoy, anyone?).

“Mayo Clinic begins any of its partnerships or relationships in research by mutual interest; talking to each other and the relationship building that way from the ground up. That is what happened here and that’s how many of our other [partnerships] have occurred,” said spokesman Robert Nellis. The move is part of an outreach strategy. “There’s an overarching strategy inside Mayo. It’s called ‘here, there and everywhere,’ and that’s a theme that exists throughout the clinic from the very top, and what it refers to is playing a role and influence in the quality of healthcare, not just where Mayo physically sits but anywhere in the world,” Nellis said. Although this has included training doctors and residents, conducting and publishing research, sharing and presenting findings and holding educational events, Mayo Clinic is also formalizing collaborative projects that have existed on a research level around the world for many years.

“Interactions internationally have been going on way back to the days of the Mayo brothers in the first part of the 20th century. In a sense we have always had some sort of international interactions going on, but what we’re seeing this fall are three significant relationships being signed,” Nellis said. This includes one being signed relatively soon, in October, with India. Mayo Clinic also plans to formalize a pre-existing relationship and sign a comprehensive agreement with the Karolinska Institutet in Sweden, which evolved out of research collaborations and meetings going back 17 years.

Mayo Clinic’s biggest tie to the Czech Republic institute in Burno is Dr. Tomas Kara, who originally came to Mayo Clinic as a visiting trainee and scientist. The research grew out of a relationship between Kara and Dr. Virend Somers at Mayo Clinic in early 2000. As the research and collaboration grew, so did the idea of a more comprehensive research collaboration.

Mayo Clinic believes it makes sense to complement and leverage relationships both domestically and internationally where similar or complementary skills and experience and common research interests exist. Similar relationships with key research entities or institutions domestically include the clinic’s growing relationships with Arizona State University, the University of Minnesota and the University of Illinois.

“The venture reflects Mayo Clinic’s commitment to serve patients and medical providers around the world by sharing our knowledge in new ways, improving global health and advancing healthcare delivery,” spokesman Bryan Anderson said on Monday.

Last June, GMR Group spoke with various potential hospitals, including Mayo Clinic, about a potential $1 billion hospital project in Hyderabad, one of the most populous cities in the country. Anderson did not comment on the status of this possible joint-venture project, nor would he answer any other questions about the Indian market or Mayo’s interests there.

Mayo Clinic seems to have international expansion on the horizon. They recently signed an agreement to collaborate with International Clinical Research Center, a European Union-funded research center in the Czech Republic. Last June, Mayo Clinic signed a deal to work with physicians in China, and it recently added Spanish-language healthcare social media to accommodate Mayo patients from Central and South America.

And Mayo Clinic has long worked on strengthening its ties with the medical community in India, visiting major cities and meeting with hospital group leaders. In particular, Mayo has focused its efforts around diabetes.

Mayo’s expansion overseas would be a little late to the party compared to its American competitors. Johns Hopkins has a research center in Singapore and Cleveland Clinic has planted its flag in the Middle East with its venture in Abu Dhabi, among other places. It’s unclear what percentage of Mayo’s current international patient population comes from India.

There may need to be talk of an “India bubble” pretty soon in the life sciences and healthcare. Along with Mayo’s interest, Medtronic is planning to get much more aggressive there, as are other medical device companies. Many are attracted to an Indian healthcare system largely based on patient pay.

More than 1,000 people joined the free online health community when it launched on July 5. Lee Aase, director for Mayo’s Center for Social Media, said Mayo hoped to gather 5,000 users by year’s end.

“We are continually revising our goal. I think we’d like to have 10,000 by the end of the year,” Aase said. “I think we’re well on pace to surpass that.”

Mayo said in July it launched its own social network because it wanted control over design, content and site policies it didn’t have with its Facebook page. Still, Mayo’s site holds only a fraction of the members its Facebook page (61,300) and Twitter account (239,303) have.

Users on the Mayo Clinic social network spend an average of nearly five minutes on the site and access more than 6 pages per visit. While the most popular area for activity is discussions.

Aase said he’s learned how to manage the Mayo social network from watching the hospital’s Facebook page. “What we’ve appreciated is that there’s an appetite for people to go and have health-related discussions in a place that wasn’t Facebook,” he said, adding: “It’s commercial-free environments that I think people appreciate.”

Aase said they’ve so far only made minor tweaks, such as changes to discussion links that now make it clearer which topic users are on. A new feature will be launched sometime in October, he added.

Chris Boyer, director of digital marketing at Inova Health System, said the real success for the site will be if patients find information that will help them manage their care or seek out or find healthcare research that they didn’t have before.

“I know that the Mayo Clinic also looks at interaction and engagement of patients as a secondary measure, but I think finding information is the ultimate measurement,” Boyer said.

“With a name like Mayo Clinic, they have enough name recognition, which makes it easier to launch a community that will have international impact,” Boyer added. “I don’t think that the majority of hospitals could do that because they don’t have such international name recognition behind them. Smaller hospitals launching an online community would have much more limited success because they do not have the brand of Mayo Clinic.”