Rural and Community Health

MessengerWinter 2015 Vol.13/No. 1

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eThe Role of Regional Extension Centers in Practice TransformationBy: Bruce Carlos Edmunds, M.Ed., PMP, CHTS- IM, IS, PW

In this Issue:

• The Role of Regional Extension Centers in Practice Transformation

• Executive Vice President’s Corner

• Telemedicine Update

• West Texas Cancer Survivors Network

• New Technology Meets Research

• Rural Health Conference: Telehealth Meets Practice Transformation

• Practice Transformation and Privacy

• Southwest Center for Agricultural Health, Injury Prevention, and Education

Presentation at TTUHSC

• AHEC Update

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A publication of the F. Marie Hall Institute for Rural and Community Health

Health Information Technol-ogy (health IT) is founda-

tional to the pursuit of the triple aim of achieving better care, bet-ter health, and reducing costs . Despite the potential benefits of health IT, adoption of electronic health records (EHRs) had been slow . In 2008, only 8 percent of hospitals , and 13 percent of physicians practicing in ambu-latory settings had adopted at least a basic EHR. Small prac-tices and critical access hospitals (CAHs) historically have had lower rates of EHR adoption, raising concerns of a “digital divide” in access to health IT among rural and underserved populations. In order to bridge this gap, the Health Informa-tion Technology for Economic and Clinical Health (HITECH) Act of 2009 spurred the adop-tion of health IT by offering financial incentives and techni-cal assistance for the adoption and meaningful use (MU) of EHRs as well as the exchange of

health information. HITECH appropriated $2 billion to Office of the National Coordinator (ONC) for health IT, and the Secretary of Health and Human Services delegated authority to ONC to establish the health IT Regional Extension Center (REC) program.

As of February 2015, REC suc-cess has shown:• Over 157,000 providers are

currently enrolled with a REC. Of these, more than 144,000 are now live on an EHR and more than 112,000 have demonstrated Mean-ingful Use

• 47 percent of primary care providers (PCPs) nation-wide are enrolled with an REC; 55 percent of rural PCPs are enrolled

• 92 percent of REC-enrolled providers are live on an EHR vs. 62 percent live on an EHR in the general pro-vider population

• 1,403 CAHs/RHs are enrolled with an REC. Of these, 84 percent have dem-onstrated Meaningful Use

The success of the REC program has allowed for a transition and new focus known as Practice Transformation. Currently RECs are part of eight working groups on emerging business lines in support of practice trans-formation including: privacy and security, accountable care organizations, patient centered medical home, health informa-tion exchange, and patient en-gagement. Across these business lines, REC support has resulted in over 100 million patients hav-ing access to:

• Electronic prescriptions, resulting in reduced medi-cation related errors;

• Patient visit summaries, allowing patients to more fully understand and par-ticipate in their health;

• Evidence-based care recom-mendations based on qual-ity measures and indicators.

With changes in physician fee schedules, migration from pay-for-performance to value based care, and other payment reform

T E X A S T E C H U N I V E R S I T Y H E A L T H S C I E N C E S C E N T E Rcontinued on page 4...

Executive Vice President’s Corner

Dr. Philips

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It would be very hard to find anyone that has not heard of the Affordable

Care Act, or as it’s called in most circles, “Obama Care”. If you talk to people about it as I do in my role at Texas Tech Univer-sity Health Sciences Center, there would be a range of opinions about it. Most everyone would say that Obama Care is health insurance. It is health insurance, but the real impact is far beyond that; the true change is transformation of health care from the way care is delivered and co-ordinated to how and what is paid for. This includes community-based health teams to support chronic care management, and ultimately to change outcomes. To change outcomes, all of us will be transformed from solely people who are covered - because we pay our insurance premiums - to people who become part of the health team. That well means that we must make different life choices so that we can achieve better health and sustain those changes.

The purpose of this transforma-tion is shown in this graphic and is called, “The Triple Aim”. Many factors have led to this situation, but I think the most profound factor is health care spending that now takes 20 percent of our overall domestic product. That’s major dollars and big business, and like in other business, demands greater stewardship. We must get a better value for every dollar that is spent and we must spend our dollars in a smarter way. We all have stories about the difficulties of obtaining care through emergency rooms and the long wait times for appointments for certain kinds of specialty care. People are now demanding greater access to care. The fact is these are all related and each factor – greater access, better outcomes and smarter spending – drive each other.

Moreover, we read daily about the obesity epidemic among young people where 40 percent are classified as overweight and 20 percent are already dealing with pre-diabetic conditions. That fact alone means that we must focus on populations, in this case, teens that are obese. But, with just a little thought others might be imagined, such as seniors with other chronic condi-tions like high blood pressure and heart disease. The mobile communications industry has shown the power of technol-ogy and in health care, another revolution is occurring with the use of electronic health records. Both of these industries are about information. Harnessing the power of information now makes it possible to have the capacity to identify risks that can be modified and that can be monitored by healthcare providers.

Moreover, what can be monitored can be measured and what can be measured can be improved, and that is the purpose of the focus on quality. The fact that one major focus of our national debate is about Obama Care should not overlook the need for serious concerns about effective ways to engage people as equal members of the health team. Truly “accountable care” will require that a critical mass of people who

have modifiable health risks must take more responsibility for their own wellness, or the transformation could be hindered.

The fact is, that for a century people have been led to believe and practitioners have been trained to think in line with what Dr. Rene Dubois, Nobel laureate, said in his book The Ecology of Health, “People as a rule find it easier to rely on the healing power of their physician than to attempt the more difficult task of living wisely.”

This summer, two of the programs, Telemedicine and the Area Health Education Center, that c,omprise the F. Marie Hall Institute for Rural and Community Health will jointly host a confer-ence to begin discussing how to break down the silos between com-munity and population education and engage-ment, and the use of technology to focus on patient-centered health care. Patients and physi-cians alike will need to

be coached in using technology to achieve their mutual goals, which is to optimize quality. New engagement platforms, like telemedicine to extend care beyond the provider’s walls, are a growth industry. New social media technology makes use of the cloud and mobile devices to help connect patients with their doctors and, crucially, their peers – enlisting family, friends, personal trainers, health educa-

What Do You Want to Buy With Your Health Care Dollar?By: Billy Philips, Ph.D., M.P.H., Executive Vice President & Director

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There are many ways in which telemedicine can be a vital part of practice transformation. From accessing specialty care to re-mote patient monitoring, the introduction and integration of technology into a clinic practice helps serve patients on a much

broader scale.

1. Providing patients with the option to see specialty providers from the convenience of their area primary care clinic also allows the provider to sit in on the visit and form a more collaborative team with the specialist to better care for the patient locally when possible. In addition, it also serves to broaden the specialists’ outreach.

2. Remote patient monitoring allows providers to care for patients in their homes, skilled nursing facilities, or in hospitals by gathering patient data (weight, heart function, pulse, blood pressure, etc) and transmitting it to home health or to the provider. Decisions on patient care can be made on a daily basis if necessary with-out either provider or patient needing to travel.

3. Institutions such as state schools, skilled nursing facilities, correctional facilities, and other such populations could be transformed by greater and more diverse ac-cess to care via telemedicine. This would also allow staffing at such facilities to not be burden by having to travel with patients to offsite appointments.

At TTUHSC Telemedicine, we look forward to continuing to learn and share all that we can about telemedicine and its benefits to us all.

For more information on the Telemedicine program, please contact Laura Lappe at laura.lappe@ttuhsc.edu.

Telemedicine and Practice TransformationBy: Laura Lappe, Associate Director of Telemedicine

tors, and others to help support smoking cessation, weight loss, and medication adherence. And to this mix of therapeutic agents, add the power of each other to achieve better sustained health outcomes. This is exciting stuff, it might even feel like we are evangelizing, trying to con-vince physicians and patients that answers lie in what has always been the heart of good health care – the doctor/patient relationship. What is new is equal footing mediated by technology.

Where we are in the transformation of health care is at the beginning, not the end. We should probably think of this as a courtship, not a date, a long engage-ment preceding a lifelong marriage. Like

in any new relationship, there are going to be days when we are passionately in love and can’t imagine ever facing life apart. Then there are going to be days when the reality of daily life brings us to the grimy work of married life. It’s not like we are going to flip some switch and doctors and patients are going to use all of this new information and technology to solve all of their problems. What we must forge is a bedrock love that will weather the ups and downs that will mark our lifetime together. This is where the metaphor falls apart because unlike in marriage, divorce is not an option. Payment reform will force us to find ways to stay together.

I hope you are as intrigued with this view

of the future as we are in the F. Marie Hall Institute at Texas Tech University Health Sciences Center. Join us this summer and enter the discussion at the 2015 Cross-roads Conference. Read more about it later in this issue of The Messenger.

-Billy U. Philips, Jr.

Some of you in the Panhandle Plains are already familiar with the West Texas

Cancer Survivors Network (WTCSN), some since we began in the fall of 2010. Since that time, we continued the project, funded by the Cancer Prevention and Research Institu-tion of Texas (CPRIT), until its ending date in August 2012. WTCSN-2 was renewed for three more years starting December 1, 2013. West Texas Cancer Survivors Network Phase-2 (WTCSN-2) continues to provide many supportive resources and a lot of excit-ing news about cancer survivorship on our website and in our patient and professional newsletters.

WTCSN-2 is providing more education, resources and opportunities for pilot stud-ies in healthy eating and increasing physical activity to not only our current survivors, but to also expand the service area to the 108 West Texas counties within the Texas Tech University Health Sciences Center (TTUH-SC) catchment area. We are very excited to provide these new opportunities to reach all of the cancer survivors in West Texas, thanks to the continued funding from CPRIT and

support from TTUHSC.

Our mission is to develop regional partner-ships to help us reach cancer survivors in west Texas with a message of quality of life, nutrition, activity, and health habits. By encouraging life style behavior improve-ments, our goal is to lead cancer survivors to improve overall health and to reduce the risk of recurrence of cancer for survivors in our region. The lifestyle message is important through each stage of cancer survivorship. Our partners are instrumental in helping us reach the far corners of West Texas, where they are already engaged in relationships with cancer survivors in the entire west Texas region.

Partners:• Texas Tech University Health Sciences

Center Department of Family Medicine• Texas Tech University Health Sciences

Center Department of Pathology• Texas Tech University Health Sciences

Center Workplace Overall Wellness• Cancer Prevention & Research Institute

of Texas

• American Cancer Society of Lubbock• F. Marie Hall Institute for Rural and

Community Health• Hendrick Cancer Center• Laura W. Bush Institute for Women’s

Health• Southwest Cancer Treatment & Research

Center• Texas A&M AgriLife Extension• Texas A&M AgriLife Extension Family

Development & Resource Management• Texas Rural Health Association• West Texas Area Health Education

Center (AHEC)

activities, RECs are responding to advanced primary care providers with regional, op-timized support. Recently, the West Texas Health Information Technology Regional Extension Center (WTxHITREC) became a founding member of the Texas Coalition for Practice Transformation (TCPT), a group of organizations and individuals who have come together, as a cohesive whole, to par-ticipate in Texas communities as they seek to transform themselves. TCPT’s mission is to create a statewide quality improvement mechanism, culture, and environment that administers and sustains high-impact leader-ship and practices and makes a meaningful and substantial impact on the Triple Aim.

TCPT is a collaboration led by the Texas

Hospital Association Foundation (THAF) that exhibits and fosters a transparent boundary less environment while remaining relentlessly committed to:

1. Patient- and family-centered care across the continuum of care;

2. Engaging and supporting clinicians and front-line staff in work to achieve trans-formation; and

3. Improving health outcomes for all Texans.

More than ten Texas health organizations, including all four Texas Regional Extension Centers, have partnered to create the TCPT. Bringing together quality improvement orga-nizations, hospitals, medical schools, physi-cian groups, and other health care providers,

the TCPT is uniquely positioned to achieve the goals laid out by the Centers for Medi-care & Medicaid Services’ Transforming Clinical Practice Initiative.TCPT and its collaborative partners have the insight, expertise and resources necessary to successfully implement the most ambitious and most effective peer-based clinical prac-tice improvement initiative in Texas. Serving as trusted partners, TCPT will provide best practices, coaching, technical assistance, QI training and support to practices across the state as they prepare and begin clinical and operational practice transformation.

To learn more about this initiative, visit http://innovation.cms.gov/initiatives/Transforming-Clini-cal-Practices/.

RECs in Practice Transformation continued from page 1

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1 Berwick, D. M., T. W. Nolan, and J. Whittington. 2008. “The Triple Aim: Care, Health, and Cost.” Health Affairs 27 (3): 759–69. Blumenthal, D. 2010. “Launching HITECH.” New England Journal of Medicine 362 (5): 382–5. Jha, A., C. ResRoches, P. Kralovec, and M. Joshi. 2010. “A Progress Report of Electronic Health Records in US Hospitals.” Health Affairs 29 (10): 1951–7. DesRoches, C. M., E. G. Campbell, S. R. Rao, K. Donelan, T. G. Ferris, A. Jha, R. Kaushal, D. E. Levy, S. Rosenbaum, A. E. Shields, and D. Blumenthal. 2008. “Electronic Health Records in Ambulatory Care—A National Survey of Physicians.” New England Journal of Medicine 359 (1): 50–60 Mostashari, F., M. Tripathi, and M. Kendall. 2009. “A Tale of Two Large Community Electronic Health Record Extension Projects.” Health Affairs 28 (2): 345–56.

West Texas Cancer Survivors Network is back!By: Janet Basom, RD, LD, Project Associate Director

Cancer Survivors – We are looking for you!

Our website has beneficial resources and helpful links for cancer survivors, caregivers, or professionals:

• http://www.ttuhsc.edu/wtcsn/nsights/default.aspx

Enrollment is available online—or by calling 806-743-6153:

• www.ttuhsc.edu/wtcsn/enroll/

Current and archived Nsights and Nsights Professional are available at:

• http://www.ttuhsc.edu/wtcsn/nsights/default.aspx

Great changes have been occurring in the world of medicine over the past 60 years.

Vast new technologies have enabled so much more information to be obtained during medical examinations, which is then stored for sharing with the array of professionals providing health care. This sharing of infor-mation can then lead to better, more efficient, and cost effective care. Yet, the integration of health care technology with clinical and epidemiological research into how we func-tion as biological organisms and the factors affecting health and disease is what will truly transform health care in the years to come.

For example, medical data contained in a person’s medical record can now be used to calculate a person’s individualized risk for hypertension, atrial fibrillation, cardiovascu-lar disease, coronary heart disease, conges-tive heart failure, type 2 diabetes, or stroke using Framingham Heart Study data. Such risk assessments are based on age, gender, and race and would be almost impossible to calculate for each patient in a clinical prac-

tice without there being an integration of the research data with electronic health records. Research into risk factors for cancers involv-ing the breast or colon is also integrated into electronic health records and flag medical providers to perform screening tests when certain “threshold” risks are met.

Moreover, expert diagnostic decision systems are being developed to integrate research findings with electronic health records information to identify less common and potentially more serious diseases before they become life threatening. Such systems can examine so many more potential disease op-tions and treatments than can the individual physician. This can lead to more rapid treat-ment or specialist referral, decreased suffer-ing, and reduce health care costs.

With this transformation of health care, there is also a transformation of the doctor-patient experience. While the increasing use of technology can cause the patient to feel like an object versus a person, it can also enable

greater patient freedom and self-control. Patients can be less bound by the traditional office visit, enabling quality and individual-ized health care to be obtained when needed instead of only during regular office hours. Moreover, since each person owns their own health care information, it can be taken with them wherever they go. This allows for more time to be spent focused on a patient’s health care needs during a clinical encounter versus spending time collecting the same informa-tion over and over.

While many of us who seem ‘long in the tooth’ may fret over these changes, the good that can come fully outweighs the frustration always associated with change.

For more information on the Rural Health Research Group, visit www.ttuhsc.edu/ruralhealth/research-group.

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New Technology Meets ResearchBy: Matthew E. Lambert, Ph.D., Director of Rural Health Research

Telehealth Meets Practice TransformationBy: Carson Scott, Director, TexLa Telehealth Resource Center

With the success of the 2014 TexLa Telehealth Summit and the prog-

ress of telehealth in Texas and Louisiana, the second annual event looks to be widely attended and offer a robust group of sessions. If you or your organization may benefit from learning the current and future state of telehealth and how to plan for practice transformation, please plan ahead and look to attend this event taking place June 24th-26th at the Grand Hyatt Hotel on the Riverwalk in San Antonio, TX.

Additionally, to help further develop and expand telehealth programs throughout Texas and Louisiana, the TexLa Tele-health Resource Center (TRC) requests a few minutes of your time to complete a

brief survey. The information you share with the TRC will be used to create a current listing of Texas and Louisiana telehealth programs and specialties. The goal of the survey is to identify telehealth programs operating in each state and to better understand any barriers and needs existing to telehealth program adoption. This information will not only be very valuable to current and future telehealth programs and patients, but will help bet-ter inform policymakers of the current telehealth environment.

Please contact the TRC with any questions you may have or if you may need technical assistance and resources. Furthermore, to learn more about this event, sponsorship opportunities, conference registration, and to complete a brief telehealth survey, please contact the TRC at 806-743-7960, texlatrc@ttuhsc.edu or visit www.texlatrc.org.

Savethe

Date2015 Rural Healthat the Crossroads:Telehealth Meets Practice Transformation

June 24-26Grand Hyatt Hotel

San Antonio, TX

www.texlatrc.org

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Practice Transformation and PrivacyBy: Debbie Curti, Cole Johnson, and Melanie Teague, Office of Contracting, Reporting and Data Management

Practice Transformation involves many components. One com-ponent is family involvement in patient care. Studies show that

family involvement is a crucial part of a child’s medical care and has proven to increase medical outcomes. Additionally, families are a patient’s prime support and bring culture and other dynamics to a patient’s medical environment, thus aiding the healthcare provider in medical decision-making.

The Healthcare Portability and Accountability Act (HIPAA) may present problems when a family member tries to access patient information of another family member. Often, institutions may not provide family members access to a patient’s health record as pro-viders may have concerns about privacy breaches and unauthorized disclosures. This affects access to both the Electronic Health Record (EHR) and Patient Portals. To aid in preventing a HIPAA violation and allow a family member access to health records, a personal rep-resentative should be appointed. A personal representative will have the same rights as the patient to access the patient’s protected health information (PHI).

Parents are usually personal representatives to their minor children and a legal guardian is usually appointed to a mentally incompetent adult; however, in some instances confidentiality protections are available to patients, which may interfere with family involvement in medical decision-making. For example, under the HIPAA Pri-vacy Rule, a parent is not considered the personal representative of a minor for purposes of access and inspection of the minor’s PHI if: (1) the minor consents to a healthcare service where no other consent is required and the minor does not request that a parent be

considered his personal representative; (2) the minor consents to a health care service to which he is legally permitted to consent (or a court or other authorized person consents on his behalf); or (3) the parent assents to a confidential agreement between the minor and a covered healthcare providers.1 Additionally, when a Care Partner, who is usually a family member, is involved in the care of the elderly, disabled, or chronically ill, the HIPAA Privacy Rule may limit family access to information that the Care Partner may need to communi-cate with a healthcare provider, thereby necessitating the need for the Care Partner to become a personal representative of the patient they are providing assistance to.

As providers move towards practice transformation, they will need to ensure that sufficient policies and procedures, such as unique IDs, emergency access procedures, automatic logoff, encryption, and other means of data protection, are in place in order to protect a patient’s PHI. Additionally, providers must develop policies for how to exercise their discretion relating to sharing a family member’s PHI and have the capability to effectively segment sensitive health information contained in an individual’s PHI to prevent unauthor-ized disclosures. Furthermore, providers should identify a patient’s personal representative as part of the intake process.

It is prudent that providers know and understand the HIPAA Pri-vacy Rule and their respective state laws and regulations regarding privacy to ensure compliance. Compliance will ultimately depend on the cooperation of the patient, the physician, and any health plan or insurer that is involved.

1For comparison purpose, Texas law, in general, is strongly supportive of parental access to a minor’s PHI as physicians have more limited discretion about whether to withhold information from parents of a minor. For example, although a minor may have the ability to consent to treatment, a provider may advise the minor’s parents of the treatment given to or needed by the child without the consent of the minor patient.

Southwest Center for Agricultural Health, Injury Prevention, and Education Presentation at TTUHSC

The F. Marie Hall Institute for Rural and Community Health sponsored a presentation this past February for the Southwest Center for Agricultural

Health, Injury Prevention, and Education. The Agricultural Center, based at UT Health Science Center at Tyler, gave a presentation on opportunities for improving health and safety outcomes of agricultural, forestry, and fishing workers. The center funds feasibility and pilot studies each year to help iden-tify and mentor researchers who are new to agricultural safety. These research projects aid in the effort to improve agricultural safety and health outcomes. Funds awarded could be up to $20,000 for a single year. The Agricultural Cen-ter also funds safety internships for graduate and undergraduate students.

For more information on the Southwest Agricultural Center, please visit http://www.swagcenter.org/. Pictured above: (L to R) Melanie Teague, TTUHSC

Rural and Community Health; Vanessa Casanova, Ph.D., UT Health Science Center at Tyler and Debbie Curti, TTUHSC Rural and Community Health

The role of technology is constantly changing how services are provided or the speed at which they are available. An example is the streaming of movies instantly onto

your television or laptop. It was only a few years ago that you had to drive to a local movie rental store to rent a movie. This technological innovation is not just limited to how you watch the latest blockbuster, it also applies to health care as it continues to uti-lize technology more each day, to improve care. As health care evolves with the imple-mentation of technology, so do the careers. At the same time, new fields are emerging in health care to support the use of health information technology. With so many careers and options in health care it can be confusing to high school students to know all of the options available to them in health care. To help students gain exposure to the full array of health careers, the West Texas AHEC program hosts a number of summer camps for students to partake in and learn about all the career opportunities available in the health care field.

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For Upcoming Activites, Visit your Regional AHEC’s Website

Big Country AHEC

Desert Mountain AHEC

Panhandle AHEC

Permian Basin AHEC

AHEC of the Plains2417 Yonkers; P.O. Box 1116Plainview, TX 79072806.291.0101www.ahecplains.org

Desert Mountain AHEC440 ReynoldsEl Paso, TX 79905915.783.6211www.desertmountainahec.org

Big Country AHEC3702 Loop 322Abilene, TX 79602325.972.0495www.bigcountryahec.org

Panhandle AHECWTAMU Box 61003Canyon, TX 79016806.651.3480www.panhandleahec.org

Permian Basin AHEC3600 N. GarfieldTechnology Center, RM 140Midland, TX 79705432.685.4794www.permianbasinahec.org

AHEC of the Plains

Like us on Facebook! https://www.facebook.com/WestTexasAHEC/

Health Care Careers for StudentsBy: Chris Felton, Associate Director, West Texas AHEC

Check out our H.O.T. Jobs website for health care opportunities in Texas:http://www.texashotjobs.org

Visit our website to stay up-to-date on AHEC events at:www.westtexasahec.org

West Texas AHECSummer Camps

AHEC of the PlainsJune 14-18

Plainview, TX

Big Country AHECJune 8 (Nursing Camp)

June 9-12 (Health Matters Summer Camp)

Abilene, TX

Concho Valley AHECJune 15-18 (Health Exploration Camp)

San Angelo, TX

Desert Mountain AHECMarch 19-20 (Spring Camp)

June (Nursing Camp)

July 20-23 (Health Exploration Camp)

El Paso, TX

Panhandle AHECJuly 13-16 (Basic Camp)

July 20-23 (Advanced Camp)

Canyon, TX

Permian Basin AHECJune 15-18

Midland, TX

3601 4th Street STOP 6232 Lubbock, TX 79430-6232

ADDRESS SERVICE REQUESTED

HEALTHBeat

5 Health tips for 20151. Drink Your Water

Water is one of the key foundations to promoting wellness. It can help boost your energy, transport important nutrients throughout the body, slim your waistline,fuel your muscles, and give you glowing skin by flushing out toxins. 2. Pack Your Snack

Having a small, healthy snack on the go is great when hunger strikes. Something salty like nuts or something sweet like dark chocolate can help give you that boost of energy between meals.

3. Magnesium

Magnesium helps to calm tension, relax muscles and promote a great quality of sleep. In addition, magnesium helps to regulate blood pressure and constipation.Magnesium-rich foods include dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados, yogurt, bananas, dried fruit, dark chocolate, and more. The cur-rent daily value (DV) for magnesium is 400mg.

4. Think Green

There are many studies showing the benefits of eating more plant based foods which include weight, heart health, cancer prevention, and pain reduction. Think about including at least ½ of your plate veggies, ¼ whole grains, and ¼ lean pro-tein like beans/legumes.

5. Vitamin D

Your body needs D-3 (the sunshine vita-min) for things such as calcium absorption and bone strength, and it contributes to your overall health as well.

Source:http://revivelifeclinic.com/top-5-health-tips-for-2015/

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