Imagine if you had a trained nurse whose job is to be your personal health guide, a care coordinator.

Not only could you call them, whenever you feel like it, but they call you.

“Care coordinators” call you to see if you have questions after a doctor’s visit. They want to know about any issues you’re having. They talk with all your doctors and specialists, to make sure everyone’s on the same page and that treatments are coordinated.

And imagine that this care coordinator is your advocate within the system.

This is the promise of a new model of health care, called a “medical home.”

It’s designed to give you that personal guide, and put all your health care under one umbrella.

“And I think the reason that it’s called ‘home’ is the notion that everyone should have one,” says Anne Weiss. She’s the senior program officer at the Robert Wood Johnson Foundation, a national philanthropy that’s funded medical home initiatives across the country.

“I think one of the most frustrating things I have experienced as a patient, and most all of us have experienced, is the complete absence of coordination. To me the concept of the home is the notion that there is one place that knows where you are, knows everything about you, and is helping you make decisions and staying in touch with you,” Weiss says.

Minister Kenneth Taylor serves at Mt. Pleasant Baptist Church on Cleveland’s east side. It hasn’t been easy for him to stay healthy.

“I been through a lot, with its ups and downs, with this diabetes. I never thought I was going to get on track with it,” says Taylor.

In 2009, MetroHealth enrolled Taylor and more than 10,000 other Northeast Ohio patients in a medical home pilot program.

And the results are promising.

Patients in the program had more office visits in the first year, but they had 35 percent fewer hospitalizations and about 7 percent fewer ER visits than similar patients not enrolled.

And Metro’s overall costs were lower for patients in the medical home.

Dr. Jim Misak is a physician at MetroHealth. He says the program works because it adds a new member to the healthcare team:

“The care coordinators really are the secret sauce to this program,” says Misak.

Care coordinators not only help patients navigate the system; they also keep people from falling through the gaps. They check up on them. They make sure they understand their doctor’s instructions and take their meds. They connect them to services they might need, like mental health or substance abuse.

Minister Taylor was a little taken aback when he first got a phone call from his care coordinator.

“At first I took it as a little…she was pushy! How dare she call me and tell me, you know?”

Geneva Jones laughs. She’s Taylor’s care coordinator. They’ve worked out a good relationship now.

“I think he realized the value of the relationship when he was able to call me and say this is happening, should I go to the ER or do you think I should get an appointment or I don’t have this medication, what’s available?” says Jones.

The program has paid off for Taylor. He feels better. His diabetes is under control.

He trusts his medical team, which is made up of Jones, his care coordinator, his primary care doctor, Kenneth Frisof, and other specialists.

Taylor voice tracks as he talks about when he was in a bad spot, Dr. Frisof went to personal lengths to make sure he stayed on track.

“I remember coming here and I couldn’t get my insulin one day, and he reached in his pocket and said ‘This is not a loan, but go get your insulin.’”

These programs are still in the experimental phase and still face a major hurdle: how to pay for it all. Right now, insurance doesn’t cover the services.

But as the healt hcare industry tinkers with how best to deliver care, the medical home could end up with a starring role.

OSU researchers say the number of surgeons needed to care for patients will increase in the next 20 years as more surgeons retire and other surgeons demand fewer hours on the job. Dr. Bhagwan Satiani is lead author of a study on the impending shortage of surgeons.

Satiani says some patients already experience a wait time of up to 3 weeks when they need surgery.

“I don’t think its vacations and things like that. I think it’s just people don’t want to work 100 hour weeks like we did. And I don’t blame them,” says Satiani.

The study looked at 7 surgical specialties including, obstetrics and orthopedics. By 2030, the shortage of surgeons will be as high as 39% for Thoracic surgery. Neurology will have the least deficit where the amount of surgeons needed will be short by 6%. Dr. Satiani says the number of residents cannot be increased because of stagnant federal funding that has capped medical and surgical residents at about 105,000 per year in the U.S.

But, demanding work schedules are a concern for some medical students.

27 year old Charron Johnson in her second year at OSU’s medical school already has already decided on a practice in Pediatrics and not surgery.

“I still probably wouldn’t choose it just because you still have the stress level of being in the O.R. and I like the more patient interaction, so surgery still probably wouldn’t be for me,” says Johnson.

2nd year OSU medical student 23 year old Kalen Riley has not made up his mind.

“I think I want to do what interests me the most, but I think that a life- work balance is really important for me, Riley says.

27-year-old Rachel Voss is a 4th year medical student at Ohio State. She says despite the tough demands, surgery is her passion.

“I love surgery, I love being in the O.R. It more or less picked me when I got into the O.R. I realized this is what I love to do, this is why I went to medical school, this is why I want to be a doctor. The demands to me were worth it, because it’s something that I love,” says Voss.

Voss is applying for a residency in surgery and then plans to specialize in either oncology or pediatric surgery. She admits though that she wants to have time for a family life later.

Dr. Satiani says one-way to keep future surgeons like Voss in the operating room would be to offer part time positions and flexible hours.

“Studies have shown basically the quality of care, everything else is no different with a part- time physician, then it is with a full-time,” says Satiani.

These days, those cabinets are disappearing, sometimes quickly, sometimes slowly. The health care system, from small doctors offices to multi-hospital system, is moving those records to electronic form.

“It’s a big job,” said Phyliss Teter, interim chief information officer for the OSU Medical Center. OSU has converted many of its out-patient records to electronic form. Now it’s working on converting its in-patient hospital records. It will cost the medical center tens of millions of dollars and take more than two years.

“It’s like replacing all your electrical wiring, your PC, your dishwasher and your refrigerator, and everything that runs from power in your house in the same day and hoping it works,” said Teter.

OSUMC, Ohio Health and the Mount Carmel System are all in the process of converting to electronic medical records (EMRs). They are transferring millions of files, integrating scores of different computer systems and converting hundreds of doctors offices. Where they stand in the process varies. But they all are about half way and they expect to complete the task in 2012.

The goal is to have each patient’s medical history available at the click of a mouse. Ohio Health vice president Dr. Murnal Shah is overseeing his system’s electronic transition.

“A chart on paper locked in a cart somewhere is not going to help ED physician do the best thing then can for you having that available information at the point of care at the moment you need it most is absolutely the scenario we are trying to build towards,” said Shah.

Dr. David McClure of Ohio Health has for the most part gone paperless.

“I generate my letter, messages to my staff, prescriptions; all of that is done out of the electronic medical records,” he said.

He was in private practice in 2006 when he converted. Now he’s part of the Ohio Health System. He says he would not go back. Instead of spending up to an hour and a half a day filling out paperwork, he enters it into a computer as he sees patients. That extra 90 minutes he now spends with patients. Compared to other industries, like banking for instance, healthcare is slow to the electronic conversion. As a system, the United States finds itself far behind other counties when it comes to electronic health records. A Commonwealth Fund survey found while American use of electronic records has doubled in the past three years, less than half of American doctors are using them. In the Netherlands, New Zealand, Australia, and the UK, at least 95 percent of doctors store health information on computers.

One reason for the disparity is those countries have nationalized health care. The other, not unrelated, issue is cost. In the U.S., hospitals are asked to pay for electronic records and on average, it costs a large system $50 million. But it’s the insurance companies that reap the greatest financial benefit.

“So really, the brunt of the cost versus the benefit acquisition is not equal,” said OSU’s Phyllis Teter.

Hospitals do save money with e-records billing efficiency, the elimination of transcription costs and reduced errors. Patients benefit with better monitoring, quicker doctor visits and quick access to medical information in an emergency.

Mount Carmel chief information officer Cindy Sheets said money is not the driving factor for hospitals.

“I tend to look at this as the right thing to do for patient care; it’s not about how much money you save,” Sheets said.

To help hospitals and doctors with the cost, the federal government promises millions of dollars in stimulus money – $44,000 per doctor and millions of dollars in other incentives. Health care providers have until 2013 to prove they’ve made the switch.

Hospitals and doctors welcome the money but Mount Carmel’s Cindy Sheets worries that the rush to meet the deadline will cause unforeseen problems.

“As a technologist, I worry that we’ve put a carrot out there that’s going to incite a lot of people to implement systems that are really crappy,” she said. And then there is the electronic medical records nirvana getting competing hospitals to share information with each other. Experts agree that will come after each system gets their own system in order.

A state law allows insured individuals to challenge insurance company refusals to cover expenses for surgery and other medical treatment.

Assistant director of the state insurance department Ann Jewel says her office has been trying to get the word out.

Jewel notes, no attorney is required for individuals to take their appeal to the next level – an independent review board.

Co-owner of reTagit Paul Childress says a customer saw the medical equipment on his company’s website. Childress says he had no reason to think the items were stolen because the man who brought them in had done legitimate business before.

“Some of these items had been taken out of use and now we’ve learned that several of the items were still in use and have actually been stolen.” Childress says.

Columbus police recovered five defibrillators from reTagit. Three were from OSU medical center and two were from Riverside and Grant Hospitals. Spokesman for Ohio Health, Chuck Smith says the thefts began at Grant in November and spread to OSU. In all, 20 medical devices including 13 defibrillators were taken. Smith says the equipment is left on carts in hallways and in patient rooms so it is accessible in emergencies.

“This equipment to be available for patients cannot be locked in a room, can’t be somewhere locked up or even chained to a cart because it has to be readily available.” Smith says Smith says backup equipment was used and at no time was patient care compromised. At OSU medical center, Director of clinical engineering, Robert Howard says 5 defibrillators were stolen over two December weekends.

“I really didn’t see any resale value for these things because their serial numbers are tracked by manufacturer and eventually should they go in for repair the manufacturer would always be able to return it to us.” Howard says.

Howard estimates the value of each stolen defibrillator at about 12 thousand dollars. A suspect was arrested last week at Grant with 3 stolen laptop computers. Hospital officials at OSU and Ohio Health are working to tighten security.

“[The] announcement about Cardinal Health’s reduction in workforce is affecting our Clinical and Medical Products businesses that are headquartered in San Diego and are expected to be spun off as a publically traded company later in the year,” Kirkpatrick says.

“The announcement in no way affects our operations and facilities in Central Ohio.”

Cardinal Health’s central Ohio operations employ between 2,500 and 3,000 workers.

Cardinal Health Inc. says it will take a $33 million restructuring charge in fiscal 2009, which ends in June, and a $24 million charge in fiscal 2010. It said the cuts will save it $110 million to $130 million annually within two years.

Cardinal employed more than 47,000 as of last June.

“Ohio State is on the map and people know it,” Gabbe said.

Dr. Wiley Souba took over the medical center leadership after Dr. Fred Sanfilippo left the university last summer. Both Gabbe and Souba will take over the responsibilities of the former senior vice president. Gee says he hopes the new leadership model will help move the medical center forward.

“We don’t need to worry about internal politics. We don’t need to worry about sharp elbows,” Gee said. “We only need to worry about the opportunities that exist.”

The Medical Center is currently undergoing a billion dollar expansion project expected to be completed by 2016.

“I’ve had diabetes for nearly 50 years.” Says Christina Staccia. She is one of an estimated 685,000 Ohioans who have diabetes. But, unlike many adults, she was diagnosed as a young child and since that time has managed her condition with a combination glucose monitoring, insulin, and other presriptions. And so far, has staved off many of the complications of diabetes.

“It can cause blindness and kidney failure, and heart failure and major organ shutdown damage. And so as a result that can become incredibly perplexed to manage and to cope with on a day-to-day basis.” Says Staccia.

Staccia made her comments during a Global Summit on diabetes in Columbus. The summit was hosted by Ohio State University. O-S-U Doctor Dara Schuster says current research is revealing more details about how glucose and insulin are regulated in the body,sometimes with the help of prescription drugs. But, she says managing diabetes is complicated for those who suffer and for the physicians who treat them.

“I think the problem with managing diabetes is its not one single thing we have to fix. Because there are several hormones that are typically disregulated. I think that some researchers and investigators had thought maybe we could find a genetic reason for diabetes and we’re still looking for that but we haven’t found a single gene that causes diabetes. And so because of that we’re targeting our therapy to those problems we know like insulin resistance or beta cell failure or inappropriate regulation of the liver to make glucose.” Says Doctor Schuster. Schuster adds that during the past five years, Ohio State University Medical Center has beefed up its research on diabetes.

“We are really on a mission to be one of the best areas for research on diabetes in the country.” Says Doctor Schuster.

But, she says research is expensive and so in addition to grants from the National Institutes of Health and from foundations , the university also collaborates with major drug manufacturers to help fund on-going studies. Many of the presenters at the diabetes summit disclosed financial ties with major pharmaceutical companies. Doctor Schuster discloses she is an advisory board member at Pfizer. At the summit, held at the Hilton Easton, vendors from Merck, Novo-Nordisk, Lilly and other companies involved in treatment and monitoring of diabetes lined the halls outside the meeting rooms. One researcher estimates that, during 2007, the U-S health care system will spend more than $20,000,000,000 dollars or 14% of all health care costs on diabetes. Christina Staccia works with the National Diabetes Resource Center. She helped calculate individual costs for monitoring her diabetes.

“Depending on whether or not the individual is on insulin injections medications can run as much as between $35 and $40 dollars a bottle of insulin, syringes. You’re talking a good $100 to $150 dollars a month. And if you add the cost of glucose monitoring strips, those are running between $75 to $80 dollars per month. So, you’re talking $2,000 to $3,000 dollars per year.” Says Staccia. Staccia says 80 percent of her costs are covered by private insurance. But, she says other insurance companies pay only 30 percent of diabetes expenses. Ohio is one of only a few states which has no requirement for health insurance policies to cover diabetes. But, Staccia says the Diabetes Resource Council is also working to get out word that adult-onset diabetes is mostly preventable.

“Its due to lifestyle, how we’re living, access to fast foods, weight gain, environmental factors. And then what’s really interesting is that 90 percent of the diabetic population today either has the ability to manage the disease and not have any complications or even reverse the disease by having some lifestyle changes.” Staccia says if the fight against diabetes fails and current projections come true, the chronic illness threatens to overwhelm the U-S Health care system during the next 20 years.

OSU Senior Vice President of Business and Finance Bill Shkurti says he agrees that resolving the internal problems will help retain top physicians. He says disagreements on a project of this size are healthy but in this case, disagreements reached an unhealthy level.

“This is normal in a project of this size in a medical center because you have a lot of people who feel strongly about what they are doing. Those are the kind of people you want to bring in but these disagreements need to be worked out and resolved before we can move on to further design and construction,” he said.

The internal rifts center around deciding which programs within the medical center will receive top priority in the expansion.

“Issues that everyone in the university and the medical center is concerned about is that we don’t have the money, even as big as this university is, to do everything we want or we think we need to do exactly the when we need to do it. So that’s part of this planning process is prioritization deciding what goes first and making sure it gets paid for,” he said.

Shkurti says they have slowed the project timeline to address the issues. Detail design work has been delayed.

For the first time, doctors have injected genetic material directly into the brains of patients with advanced Parkinson’s disease. The disease causes patients to experience symptoms like tremors, rigidity and inability to move. Clinical trials show that the new therapy is safe. Study participants also experienced improvement in the symptoms of the disease.

Ohio State University professor of molecular virology, immunology and medical genetics, Matthew During, led the study.

During said the goal of the study was to “treat people with advanced Parkinson’s who no longer respond to drug treatment and come up with a new strategy to try and reverse the negative changes in the brain and reverse their symptoms and free them up to be able to move and walk normally again.”

The therapy delivers genetic material directly into affected regions of their brains.

“We inject deep into the brain a drop of fluid that contains about 3-30 billion particles of virus,” During said. “That virus contains a human gene and delivers this gene into a critical part of the brain that’s involved in Parkinson’s disease.”

The part of the brain affected by Parkinson’s disease is overactive it sends too many signals, leading to poor control of movement. The gene delivered in the new therapy allows the brain to make a molecule called GABA, which calms the overactivity.

“The brain essentially operates in two modes either go or stop,” During said. “It’s like a car which has an accelerator and a brake. The GABA is essentially the brake.”

Once the brain can make GABA and calm its overactivity, patients experience relief from their symptoms.

The study represents an advance not only in treatment of Parkinsons disease, but also in the development of gene therapies for other diseases. The idea of gene therapy has been a subject of research and clinical trials for nearly 20 years. Nonetheless, no gene therapies are approved for use in the U.S.

“This particular trial is a major advance because it’s the first really successful trial that’s been published now, in the brain, of any neurological disease,” During said.

Even so, he expects it will be at least 4 to 5 more years before the therapy could be approved for use.

“We need to go through a more definitively gold standard trial,” he said. “This is a very promising trial but it’s not controlled. We need to be a little bit cautious about overreading, overinterpreting the results.”

Whereas the completed study focused on the safety of the treatment, the next stage is designed to confirm the effectiveness of the treatment. The next round of clinical trials will begin later this year.