A better way to document patient end-of-life treatment wishes

For decades, Oregon has led the country in systems change to assure the treatment wishes of those nearing the end of life are consistently honored. The last thing any patient wants is to have clearly documented their wishes through a delicate and thoughtful conversation with their health care professional and family members, and by filling out Physician Orders for Life-Sustaining Treatment (POLST) form, and then not have those wishes honored.

That’s why Oregon Health & Science University launched ePOLST, a fully integrated online version of POLST. ePOLST will assist OHSU, and other health systems across the country that use the Vynca software, in more accurately recording and accessing the wishes of patients who are nearing the end of life.

Harriet, the patient whose POLST form could not be found

A better system

Why do we need a new system? Because there are too many stories like those of Harriet, a 94-year-old Oregon woman, now deceased, who signed a POLST form with her doctor two years ago. She needed to go to the hospital because her broken hip caused so much pain, but being admitted to intensive care was against her wishes.

Health care providers weren’t able to find her POLST form. Harriet’s family hopes that OHSU’s new ePOLST system will make POLST orders available right away so that other families can avoid the anguish of having to stop unwanted treatments.

The POLST form was created in 1990 in an effort to ensure the wishes of those with advanced illness or frailty are followed. POLST programs have been adopted or are in development in 43 states across the country.

POLST forms are strongly associated with desired care received. A survey of patients showed that less than 10 percent of patients want to die in the hospital. Unfortunately, without a POLST form, four times that many still do.

Knowing we needed to continue evolving the POLST program, we connected with Ryan Van Wert, M.D., the co-founder of Vynca and a critical care physician who comes from Stanford Biodesign.

Having seen the end-of-life care wishes of patients ignored simply because they couldn’t find their POLST form, his team worked collaboratively with OHSU’s EPIC support team, the OHSU Center for Ethics in Health Care, Oregon POLST Registry and Oregon POLST to pilot ePOLST, which launched in April.

Phase One

In the first phase of the launch, ePOLST allows OHSU clinicians to electronically and more quickly and accurately submit a POLST form, drastically reducing the need for paper forms, which are error-prone. (The current statewide error rate for paper POLST forms submitted to the Oregon POLST Registry is 18 percent.)

Vynca team that developed ePOLST

OHSU clinicians can also now easily view a patient’s POLST form, which is located at the top of their EPIC electronic health record, if they have one.

This is critical in crisis situations where care teams are making decisions about treatment options.

Phase Two

In the next phase, OHSU clinicians will be able to electronically search the Oregon POLST Registry through ePOLST, which will make it easier to find POLST forms from other health care systems.

In Oregon, more than 250,000 POLST forms have been submitted to the registry since its inception in 2009.

More than 5,000 health care professionals have called the registry seeking forms in a time of urgent need — 2,000 of those patients had POLST forms provided to guide their care.

What’s next?

After almost two years, we’re happy to report the system is working well and is on track for the next phase! The fewer errors we have with POLST forms, and the easier we can find forms, the better care we can give to our patients, while also respecting their wishes.

Learn more about OHSU’s POLST Paradigm Initiative, or get involved with POLST Oregon.


Susan Tolle, M.D. is the Director of the OHSU Center for Ethics in Health Care and Chair of the Oregon POLST Task Force.

Skin care event brings together researchers, registry participants

Join us Saturday, May 30, at the OHSU Center for Health & Healing for our Skin Cancer Research Expo and Sun Safety Event!

The expo differs from many other health events in that it will give community members an opportunity to take part in ongoing research.

Sancy Leachman, M.D., Ph.D., the director of the Melanoma Research Program at the Knight Cancer Institute and chair of the OHSU Department of Dermatology

The research expo is our first major OHSU melanoma-related event since Sancy Leachman, M.D., Ph.D., director of the OHSU Knight Cancer Institute’s Melanoma Research Program and chair of the OHSU Department of Dermatology, launched the Melanoma Community Registry in May 2014.

The first event was a symposium in November that attracted about 125 patients, friends and family; the registry has grown to more than 3,330 participants since launching.

The registry’s aim is to develop a cohort of survivors, family members and others to help researchers understand how to best prevent, treat and detect melanoma, and the Skin Cancer Research Expo is a significant opportunity to be face-to-face with physicians, scientists, survivors and advocates to help expand those efforts. About 10 researchers, including nine from OHSU, will be on hand to connect with attendees about research opportunities.

Among the researchers participating in the expo:

  • Leachman, who will ask survivors and advocates to join the Melanoma Community Registry. She will also have three surveys on hand: one is for all registry members intended to ascertain what information and research projects they would be interested in participating; another asks survivors about their quality of life; and the third is about sunscreen use.
  • The OHSU Knight BioLibrary, which will invite all attendees to donate blood for research. Attendees will be invited to join the Personalized Cancer Medicine Registry to become a donor and help grow this vital research resource.
  • Paul Spellman, Ph.D., professor of molecular and medical genetics, OHSU School of Medicine, and a researcher in the OHSU Knight Cancer Institute, who will seek blood donations from a subset of melanoma survivors. Free-floating DNA in the blood will be sequenced to determine if researchers can measure tumor DNA in the blood stream with the intention of developing a simple, non-invasive way to detect recurrence of cancer at a much earlier point than is currently possible.
  • Andrew Trister, M.D., Ph.D., a senior physician with Sage Bionetworks in Seattle, Wash., and Dan Webster, Ph.D., developer of an iPhone application called Mole Mapper (which measures and tracks moles), who will solicit feedback about the app.

The expo will also include information on how attendees can monitor their skin health, the best sunscreens to use and games for attendees of all ages. OHSU and Portland dermatologists will be on hand to offer free skin checks in a private clinic room, as well.

You can join the registry here, and visit our site to learn more about the research expo. We’d also love for you to connect with the Knight Cancer Institute on Facebook and Twitter.


Matt Wastradowski is a Communications Specialist for the Knight Cancer Institute.

Your health questions answered: Managing stress and seasonal allergies

You ask. OHSU health experts answer. This month, our psychology and pharmacy experts are on the hot seat.

Q. How can I better manage my stress?

A. Stress affects our lives through worry, comparison and perfection around issues including finances, parenting, work performance, relationships, health and self-esteem.

Small amounts of anxiety may propel us to move forward. But when it becomes chronic, our ability to manage stress lessens. This affects our most basic functions: sleep, focus, vitality, health, relationships, joy and balance.

  • Think about what works best for you, and consider re-evaluating your needs.
  • Reset high expectations to realistic ones.
  • Let planning replacing worrying.
  • Set boundaries and limits that promote self-care in the form of relaxation, time management, rest, good food and simple activity.

Deep breathing, focusing on the present and appreciating yourself more for who you are than what you do can help calm the heart-pounding “fight or flight” experience that occurs with stress and let you feel more at ease.

Q. How can I treat seasonal allergies?

A. If you have seasonal allergies, you might notice they’ve started sooner this year: Our warm winter has led plants to bloom earlier. But allergies can occur year-round and may include pets and environmental factors such as carpet, perfumes or detergents.

Many allergies can be treated with over-the-counter medications including Claritin (loratadine), Zyrtect (cetirizine) or Allegra (fexofenadine).

Topical steroid nasal sprays such as Flonase (flucticasone nasal) and Nasacort (triamcinolone acetonide) treat nasal passages and provide the advantages of steroids without side effects.

Allergic reactions might make your eyes red or watery: Patanol (olopatadine), Pataday (olopatadine hydrochloride) or Cromolyn are prescription eye drops that can help. Non-prescription eye drops including Alaway (ketotifen).

If these don’t work, talk to your primary care provider; you may need to see a specialist.


Dr. Lisa Schimmel is a clinical psychologist and consultant, who has been in practices for 20 years. She is an assistant professor at OHSU and a staff psychologist at the university’s Joseph B. Trainer Health and Wellness Center. Join Dr. Schimmel June 10 at the Ask the Health Expert seminar “Dealing with stress” at OHSU’s center for Health and Healing. Click here to register.

Pharmacist George Harvey is part of the OHSU pharmacy team. The Department of Pharmacy Services operates six outpatient pharmacies, where patients may have prescriptions filled, as well as a mail-order pharmacy. Find more information, including hours and directions, here.

Breaking new ground in global health for girls and women

What happens when you get nutrition scientists and nutrition program practitioners from around the globe together?

It turns out these two groups rarely interact, resulting in both having less than a full picture of the barriers each face in implementing their work.

The OHSU Bob and Charlee Moore Institute for Nutrition & Wellness  recently hosted the International Summit on the Nutrition of Adolescent Girls and Young Women. The summit brought together 67 delegates from 17 countries.

About half of the group represented the world’s leading nutrition scientists, while the other half represented major aid organizations, donor organizations and smaller groups working to implement nutrition programs for girls and women in developing nations.

The two groups spent several days sharing what they do and learning from each other.It turns out both groups ultimately want the same outcome – a healthier global population built through a focus on the nutritional status of girls and women.

Maternal and child undernutrition is the underlying cause of some 3.5 million deaths annually and accounts for more than a third of the disease burden in children younger than five.

Delegates at The International Summit on the Nutrition of Adolescent Girls and Young Women

We know that women who are healthy and well-nourished before and during pregnancy will have healthier children, resulting in a healthier population.

After three days of discussion, debate, and sharing of much good, nutritious food the delegates found several common threads had emerged, including a need to:

  • Empower young girls and women around the world
  • Keep girls in school
  • Delay marriage and first pregnancy
  • Drastically reduce adolescent pregnancy rates
  • Incorporate adolescent voices in the conversation about their health needs
  • Increase collection of data on adolescents to inform programs and policies
  • Determine the right nutrients and best delivery methods to improve nutrition

While many of these ideas are not new, looking at them through the lens of nutrition and long-term population health offers a new perspective and an increased urgency to act. The delegates left with a better understanding of each other’s work, and a focus on finding ways to implement strategies discussed during their time together.

Their next steps include developing a list of specific action items and a robust consensus statement to be published later this year. They also have plans to continue their conversations and further develop their working relationships in order to overcome the barriers of implementing the latest nutrition science into culturally appropriate, accessible and feasible programs and policies.

Explore ways you can get involved at betterthefuture.org




Kent Thornburg, Ph.D. is Director of the Moore Institute for Nutrition & Wellness.

10 things we love about OHSU nurses

National Nurses Week is May 6-12. We adore our nurses, which made it very difficult to narrow the list of things we love about them to only ten.

Here are just a handful of the many reasons these hard-working, skilled and dedicated men and women are so good at what they do.

1. They put patients first. Our nurses consistently put patients at the center of everything that is done here — every patient, every time.

2. They heal. They partner with our community and each other to provide innovative, compassionate and excellent patient-centered care.

3. They learn. Our nurses excel in educational achievement, with 79 percent of nurses holding a bachelor’s or masters’ in nursing and 41.7 percent of nurses earning certification in their specialty practice.

4. They are practitioners. 75% of nursing units are in the top quartile for preventing pressure ulcers and injury from falls.

5. They are community leaders. OHSU nurses are currently leading the work to develop a freestanding, in-patient psychiatric hospital.

6. They value integrity. They hold themselves to the highest ethical standards. Our Chief Nurse, Dana Bjarnason, contributed to the 2015 revised Nursing Code of Ethics.

7. They are scientists.  In our fifth year of Nursing Fellowship and Evidence-Based Practice, six groups of nurses are conducting clinical inquiry projects to improve care in their areas.

8. They teach. Last year alone, our nurses precepted 600 nursing students from 18 different schools of nursing.

9. They seize opportunity. Staff nurse champions take the lead to improve glycemic care, pain management, skin care, and infection prevention, demonstrating peer leadership as they effectively change practice.

 10. They volunteer. Many of our nurses travel for international medical mission trips across the globe.

Join us in saying thank you to all our nurses who provide excellent patient care every day.



Dana Bjarnason, PhD, RN, NE-BC
Vice President and Chief Nursing Officer, OHSU Healthcare
Associate Dean for Clinical Affairs, OHSU School of Nursing





Deborah Eldredge, PhD, RN
Director, Nursing Quality, Research, & Magnet Recognition




Interested in a nursing career here at OHSU? Learn more.

Research Week: Three Questions for OHSU’s Evan Lind, Ph.D.

Research Week, a university-wide annual event celebrating research performed by students, faculty, research-ranked employees, postdocs and staff, launched today!

We’re marking the occasion by featuring a question-and-answer session with Evan Lind, Ph.D., an assistant professor of molecular microbiology and immunology with an appointment in the Department of Cell, Developmental and Cancer Biology and a researcher with the OHSU Knight Cancer Institute.

Lind spoke with the OHSU School of Medicine about the importance of research relating to immunotherapies, which uses the body’s immune system to fight cancer, and the collaborative environment among researchers in the OHSU Knight Cancer Institute.

Q. What’s been the most interesting development in your area in the last two years?

Dr. Lind: The last two years have been a boom time for my field of cancer immunotherapy. There have been nearly amazing clinical results from the use of so called “checkpoint inhibitors” in several cancer types. In 2013, immunotherapy was declared the “Breakthrough of the Year” by the journal Science. Things are happening so fast it is hard to keep up. The best part is that patients with previously untreatable cancers are responding and living longer.

Q. What projects are you currently working on?

Dr. Lind: I am currently studying the feasibility of applying immunotherapies to hematological malignancies, specifically the type of leukemia known as AML. The biology of the immune system in patients with AML is not well understood at this time.  Hopefully our work will identify possible immune-based therapies for this terrible disease.

Q. What is the most important aspect of support that OHSU provides to you currently and how would you like this or other support to grow in the future?

Dr. Lind: The biggest support I have had at OHSU is by far the collaborative environment that exists here. Without Drs. Jeff Tyner and Brian Druker, I would not be able to conduct my research in the same way.  I have only been at OHSU for one year and the support from my colleagues has been amazing. I think if we can keep this spirit of discovery and teamwork intact in the “post-Knight Challenge” era, this will be a unique and amazingly productive place to work.

Learn more about Dr. Lind and his research by reading a recap of a Twitter chat hosted by the National Cancer Institute this April. Lind was joined in the chat by Matthew Taylor, M.D., a physician with the OHSU Knight Cancer Institute.


This blog post originally appeared on OHSU’s internal “Inside the SOM” blog, authored by Rachel Shafer, Senior Communications Specialist in the OHSU School of Medicine.

A glimpse of Heartopia at the Heart & Stroke Walk

In a perfect world, what would you do for your heart? Would you exercise more? Manage your stress better?

We asked our experts at the OHSU Knight Cardiovascular Institute what they think a perfect cardiovascular world would look like. They said things like “diets would be based on science, not fads” and “meetings would take place on treadmills, instead of sitting at tables.”

Me? In a perfect world I would see more money spent on cardiovascular research. Which is exactly why I’m walking in the 2015 Portland Heart & Stroke Walk to raise money for critical research through the American Heart Association.

Our institute is working to create new ways to attack cardiovascular disease with help from research funding by the American Heart Association. But in 2014 there was a $2.1 million gap in critical research funding for Oregon. The American Heart Association needs our help to close that gap.

I hope you will join us at the Portland Heart & Stroke Walk at the Portland International Raceway on May 16th and get a glimpse of our vision of Heartopia at the OHSU tent. There will be prizes, special guests and health tips for leading a heart-healthy life.

Even if you’re not perfect, you still can make strides toward a healthy heart. Join us for the Portland Heart & Stroke Walk on May 16th to learn what you can do.


Sanjiv Kaul, MD directs the OHSU Knight Cardiovascular Institute and is the Ernest C Swigert Chair of Cardiology and Professor of Medicine and Radiology in the School of Medicine. Dr. Kaul pioneered a powerfully effective screening test for the early detection of coronary heart disease. Used more than five million times in patients around the world, myocardial contrast echocardiography combines microbubbles and ultrasound technology to create images of the heart. 

One dinner party. Three transplants. Six lives changed.

By Mark Menotti, Director of Clinical Transplant Services at OHSU

More than 100,000 people in America are waiting for a kidney transplant; sadly, about 13 of these patients die every day because there aren’t enough organ donors.  Many kidney patients have someone who is willing to donate, but because of immune system or blood type incompatibilities, they are not able to give a kidney to their loved one.

The National Kidney Paired Exchanges were created to help.  

Kidney paired donation matches one incompatible donor/recipient pair to another pair in the same situation, so that the donor of the first pair gives to the recipient of the second, and vice versa.  In other words, the two pairs swap kidneys, regardless of where they are located.

Ray and his donor, Kendal.

Paired exchanges also utilize altruistic, or good Samaritan donors.  Altruistic donors are able to start new “chains” through their donation into the exchange itself, versus donating to a specific recipient.   

Sound complicated?  It is!

These transplants involve many additional hours of planning, coordination, and scheduling on the part of countless departments at OHSU and the other transplant centers.

OHSU’s nationally-regarded kidney transplant program is now participating in the paired exchanges.  We recently performed both “paired exchange” and “altruistic chain” transplants.

A fortuitous dinner party.

Our first two OHSU donors were involved in an “internal chain”transplant in early December, which actually started at a party in early 2014.  Donor A’s intended recipient was incompatible. That recipient had been fortunate to find another, compatible donor and was successfully transplanted.

Donor A didn’t stop there, however; they chose to be an altruistic donor and started a new chain.  They matched a recipient with an incompatible donor, whose donor then closed the chain by donating to an unknown recipient on the waiting list. All the surgeries were performed here at OHSU on the same day (watch a FOX 12 news story to meet the recipients and donors).

Six people are now linked together by three living kidney donors.

The very next week, OHSU performed our first “paired exchange” transplant with Swedish hospital in Seattle.  An incompatible donor-recipient pair from OHSU and two other such pairs from Washington state were matched.

All six surgeries were scheduled on the same day, with the donor kidneys being shipped to their compatible recipients. Through this exchange, three recipients got off the waiting list and three donors were able to help their loved one receive a living donor transplant (read the Seattle Times article to learn about the donors and recipients).

I am very happy to report that all patients, both recipients and donors, are doing great!

Click here to learn more about OHSU”s Clinical Transplant Services.

Dine out for life with the OHSU Partnership Project

For it’s 7th year Dining Out For Life comes to Portland on Thursday, April 30, 2015.

In the early 1990s, AIDS looked very different than it does today. In Oregon, approximately 350 people were dying a year from AIDS. Today, fewer than 100 Oregonians are dying from AIDS, thanks to a number of advancements:

  • The development of medications successfully fighting the virus
  • Increased testing, so people know their status earlier
  • Systems put into place, linking people to care when they test HIV+
  • Systems supporting people’s efforts to reach 100% adherence to their medication

Both OHSU/Partnership Project and EMO’s HIV Day Center have been part of the HIV system of care in Portland helping thousands of persons living with HIV/AIDS live healthy lives since the early 1990s.

While these organizations are small in staffing and budgets, they stretch grant and fundraising dollars as far as possible to provide critical services.  In 2009, these organizations came together to produce the 1st Dining Out for Life in Portland.

The national event started in 1991 in Philadelphia by Action AIDS and is now in 60 cities across the country!

How can you participate?

Dine Out at a participating restaurant during breakfast, lunch or dinner!  Each location is donating between 20-30% of your bill to EMO’s HIV Day Center and Partnership Project .

Partnership Project

The program is in its 18th year of providing critical services to HIV positive individuals in the Portland Metro area. Last year 950 people living with HIV/AIDS were served through our Social Work and Nursing Case Management services.

We help individuals get into medical care, maintain insurance, take their medications and connect to essential supportive services.  We also provide risk reduction counseling.

EMO’s HIV Day Center

Celebrating its 25th anniversary this year, the center is the oldest multi-service drop in center for low-income individuals infected and affected by HIV/AIDS in the United States.

The Center serves approximately 300 people yearly, providing them with two hot meals a day, information and referral services, computer and internet access, phones, shower and laundry facilities and recovery support as well as volunteer professionals who provide services such as massage therapy, acupuncture and haircuts. The Daily Bread Express program delivers weekly meals and supplemental groceries to more than 60 homebound individuals.

Learn more by visiting www.oshu.edu/partnership and http://www.emoregon.org/HIV-day_center.


Julia Lager-Mesulam, LCSW is the Director of OHSU/Partnership Project. Julia has been with OHSU/Partnership Project since 2000 and working in the field of HIV/AIDS since 1994.  Partnership Project is a multi-health care consortium housed within OHSU that was developed in 1995 and provides medical case management to approximately 900 Persons Living with HIV/AIDS annually. 


OHSU Casey Eye Institute Collaborates with American Samoa

On April 14, the OHSU Casey Eye Institute community gathered to celebrate our growing collaboration with the health care community in American Samoa.

Our initial program with the good people of American Samoa is wrapping up this month as Dr. Benjamin Siatu’u finishes his intensive ophthalmology training in Oregon.  A surgeon from American Samoa, he has spent the last four years at OHSU acquiring the specialized skills needed to provide eye care in this distant U.S. territory.  He will be returning to his home in the South Pacific to finish his training with support from Casey Eye faculty members.

The ceremony not only honored Dr. Siatu’u’s accomplishments, but marks the beginning of Casey’s long-term partnership with the medical community in American Samoa – a relationship that signifies a major step forward in our mission to address avoidable blindness abroad.

When it comes to eye care, American Samoans are arguably one of the most underserved populations in the United States.  

During my three years as an ophthalmologist at the Lyndon B. Johnson Tropical Medical Center – the territory’s only health care facility – I saw firsthand the immense challenges posed by the region’s isolation, and the unique health problems of its people.  Nearly half of the adults in American Samoa suffer from diabetes and are at risk of losing eyesight from its complications.

American Samoa also has one of the highest rates in the world of pterygium: an eye growth on the cornea caused from sun exposure.  These and other conditions, such as cataract and eye trauma, contribute to the islands’ large burden of eye disease and vision loss.

Dr. “Ben” (as he likes to be called) will be one of only two eye doctors serving American Samoa’s 55,000 residents, and its only eye surgeon.  While his background, medical skills and strength of character make him ideally suited for his new role, he will also need the backing of a high quality health care system to successfully care for his people.

Working with Dr. Siatu’u and relying on his expertise as a Samoan practitioner, the Casey Eye Institute is partnering with American Samoa to build up the other critical components of a regional eye care program.

For example, we are designing training programs for clinical and operating room staff.  These programs will let Dr. Ben’s team ramp up the quality and efficiency of patient care in the hospital there. We will teach technicians how to properly maintain delicate equipment like slit lamps and surgical microscopes, which can be easily damaged from the islands’ humid climate and periodic electrical surges.

Public health education and eye health screening campaigns are also in the works, as the local public health and community groups on these islands welcome Casey as a proven and trusted partner in the territory.

Our U.S. – based ophthalmology residency program is a key element in this collaboration.

Casey residents who opt for an international elective in American Samoa will hone their diagnostic and treatment skills in a diverse health care setting with limited medical resources.  These residents will have the opportunity to treat patients with unusual and often severe eye diseases, and to build surgical abilities where surgical services are in dire need.

To help fund these programs, we are seeking grants from the USDA, World Health Organization and other agencies.  We also rely on philanthropic support here in Oregon to keep this program moving forward.

This is an exciting new chapter in Casey’s outreach efforts, an idea conceived and nurtured by our Chairman, David Wilson, M.D., and enthusiastically embraced by the Casey’s faculty, staff and ophthalmology residents.

American Samoa may be on the other side of the equator, but we are working together to reach our shared vision of ending avoidable blindness for many years to come.



Mitchell Brinks, M.D., M.P.H., is assistant professor of ophthalmology at OHSU Casey Eye Institute, where he specializes in comprehensive ophthalmology and is co-director of the International Ophthalmology program. His international teaching and research activities have taken him to Cambodia, Bhutan, East Timor, Guatemala the Marshall Islands and the Samoas. 

Why 96,000 Square Miles?

OHSU Health Fair at Pioneer Square.

President Robertson is fond of saying that OHSU has a 96,000 square mile campus, serving Oregonians “from Enterprise to Coos Bay, from Portland to Klamath Falls.”

This blog aims to highlight that breadth. 96,000 Square Miles (96K for short) will focus on the people of OHSU, the Oregonians we serve and the ripple effect of our work in Oregon and beyond.

Read more

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