PROVIDER FOCUS

DECEMBER 2014

Ebola Update: IDPH News Release

Iowa Hospitals, EMS, and Lab Partner as Ebola Response Precaution

No cases of Ebola have been identified in Iowa; IDPH stresses the likelihood of an Ebola case in Iowa is extremely low

The Iowa Department of Public Health (IDPH) today announced it is collaborating with the Iowa State Hygienic Lab (SHL), three EMS providers and three Iowa hospitals for testing, screening, or treatment of an Ebola patient, if required. Iowa does not have any cases of Ebola, nor has it had any cases of Ebola in the past. IDPH stresses the likelihood of an Ebola case in Iowa is extremely low; however, the designation of partner hospitals, EMS providers and the ability to test for the Ebola virus in-state is another step in the extensive and continuing preparedness efforts on the state, county and local levels.

University of Iowa Hospitals and Clinics in Iowa City has agreed to serve as an Ebola treatment facility. Mercy Medical Center – Des Moines and UnityPoint Health – Iowa Methodist Medical Center, Des Moines have agreed to be screening facilities for an Ebola patient. EMS providers who have agreed to be designated as transporters are Area Ambulance, Cedar Rapids; Medic EMS, Davenport; and Iowa EMS Alliance (West DSM EMS), West Des Moines. In addition, the State Hygienic Lab has been certified by the Centers for Disease Control and Prevention to test for Ebola, if such a test is requested by IDPH.

There are many other Iowa hospitals and providers who have indicated willingness to serve if called upon. “I am proud of these partners for stepping up to the challenge to ensure that Iowa is prepared,” said IDPH Director GerdClabaugh. “Iowans should be confident that while the chance of a confirmed or suspected Ebola case in Iowa is highly unlikely, the public health and state health care systems are prepared for that possibility.”

The federal government is working closely with states, and states in turn with local public health agencies, to track travelers returning from Ebola-affected West African countries. All of these travelers are routed to one of five screening airports.

  • Well travelers are allowed to go on to their final destination.
  • The CDC then notifies the receiving state of that traveler’s final destination.
  • If, for instance, the final destination is Iowa, IDPH contacts local public health officials to conduct a risk assessment of the individual and issue appropriate health orders.
  • Local public health officials notify key partners that an order exists in the service area; however, no details regarding the types of orders, numbers, or patient identifiers are given. This is required by Iowa law that prohibits potential identification of an individual.

Public health orders are based on a risk assessment (low, some, or high).

  • Low Risk – individual is ordered to take their temperature and notify local public health of the results twice daily. The individual is allowed to go about normal activities.
  • Some Risk – individual is ordered to home quarantine; this allows for outdoor non-congregate activities and requires the individual to take their temperature twice daily with local public health observing.
  • High Risk – individual is ordered to home quarantine, additional activity is limited and the individual must take their temperature twice daily with local public health observing.

These orders are issued to ensure an early as possible warning of the appearance of symptoms which allows time to arrange for appropriate transport and care of patients to one of the facilities listed above. If an individual under health orders were to develop symptoms of Ebola, IDPH would be notified and IDPH would coordinate transportation with a pre-identified EMS to a designated screening facility. This will ensure that no exposure to unprotected and unprepared healthcare workers occurs.

For more information on Ebola, visit Outbreak or

Annual Medical Staff Meeting

Please save the date for the annual UPH-DM Medical Staff meeting!

Tuesday, January 13, 2015

6:00 pm hors d’oeuvres

7:00 pm business meeting and presentation by Stephen Beeson, M.D., Physician/Author/Educator

Door prizes will be given away, but you must be present to win!

Dr. Stephen Beeson is a nationally recognized author, physician and speaker who has provided tools and tactics for engaging and training physicians for hundreds of medical groups and hospitals throughout the country.

A board-certified family medicine physician, Dr. Beeson practiced with the Sharp Rees-Stealy Medical Group in San Diego County for 18 years. During his tenure with the medical group, Dr. Beeson was selected by Sharp HealthCare leadership to serve as the Physician Director for the “Sharp Experience,” an organizational commitment to service and operational excellence. Dr. Beeson's patient satisfaction ranked him in the 99th percentile nationwide, and the San Diego County Medical Society voted Dr. Beeson as one San Diego’s best physicians for eight consecutive years. During this time, the medical group improved their patient satisfaction scores from the bottom to the top decile, won three AMGA Acclaim Awards for clinical performance, and received the 2007 Malcolm Baldrige Award.

Dr. Beeson’s first book “Practicing Excellence: A Physician's Manual to Exceptional Health Care,” became a national best seller that articulates a prescriptive "how-to" approach to improve physician performance and drive organizational success. In 2009, he released his second book, “Engaging Physicians: A Manual to Physician Partnership.” This critically acclaimed book takes system leaders on a staged journey to physician enrollment in organizational change efforts.

Most recently, Dr. Beeson founded The Physician Effectiveness Project at PracticingExcellence.com as a national physician skill-building software platform to help physicians both contribute to and benefit from the health care revolution we find ourselves in.

Dr. Beeson also serves as a faculty member for the American Association for Physician Leadership (formerly the American College of Physician Executives) to broaden the impact he can make for physicians, leaders, care teams and patients.

New Surgeon at DMOS

Des Moines Orthopaedic Surgeons (DMOS) is pleasedto announce the addition of Dr. Bryan Den Hartog to its practice. Dr. Den Hartog returns to his native Iowa, where he practiced at DMOS from 1991 to 1995, after completing his undergraduate degree at Northwestern College, his medical degree at the University of Iowa, and his orthopaedic Foot and Ankle Fellowship at the Medical College of Wisconsin. Most recently, Dr. Den Hartog practiced at the Black Hills Orthopaedic and Spine Center in

Rapid City, SD, giving him over 24 years of clinical experience and expertise. As one of the only fellowship-trained orthopaedic Foot & Ankle Surgeons in the state of Iowa, Dr. Den Hartog specializes in complex cases involving lower extremities. These may include treatment of sports injuries and complex deformities related to the foot and ankle, as well as hip and knee disorders. He has a profound interest in education, which lead him to develop a website for surgeons called footinnovate.com. He has also instructed and trained other foot and ankle surgeons for over 15 years, both nationally and internationally. His passion for innovation has driven him to develop over 13 patents for the design and development of orthopaedic implants used around the world, as well as author more than 20 peer-reviewed scientific papers, all with the goal of improving the quality of surgeries and outcomes for patients with complex lower extremity injuries and conditions. He has been a reviewer for the Foot & Ankle international publication of the AOFAS since 2005, and served on the board of directors for the AOFAS from 2006 to 2008.

Dr. Den Hartog is happy to return to Iowa, where he can continue his extensive lower extremity orthopaedic practice, while also enjoying some time with his family. For patient referrals to Dr. Den Hartog, please call (515) 224-5207 to schedule an appointment.

EPIC Update – Tumor Staging

Physician Tumor Staging

To assist in the tumor staging workflow, there is a new deficiency in the physician’s inbasket. Physicians will find the “cancer staging” deficiency in the Hospital Chart Completion folder. Please see the attached tip sheet for additional information.

Ordering Miscellaneous Labs

Due to a recent patient order issue, please consider the following reminders when ordering miscellaneous labs:

Only 1 lab per Miscellaneous Lab order in Epic – do not list multiple orders under 1

Example of incorrect order:

Example of correct order:

Lab Orderables

In an effort to avoid duplicative and unnecessary laboratory testing; the daily quick button will be removed. The daily frequency may still be used; however it is now a searchable item rather than a standing quick button.

A Timed button will also be added to use when you have lab draws that need to occur at a specified time.

The quick-button for the “once” frequency was changed to “Today-Next Draw” to indicate that this is considered a routine lab and should only be used for routine draws.

Micro Orders

Specimen source will now be a required field when ordering micro specimens at discharge.

Problem List BPA change

If you are in the chart of a patient that doesn’t have a problem on the problem list, a Best Practice Advisory (BPA) will fire. Originally, you could defer adding a problem to the problem list for 24 hours, however that is changing to a new deferment button/time of one (1) hour. After that time, the BPA will fire again. This will go-live on Tuesday, December 2, 2014.

Problem List SmartPhrase

The physician builders have made a smart link to easily add in the problem list information in a more detailed view. .hprobdetailed will show diagnosis codes, principal problem, resolved hospital problems along with the date noted as well as date resolved.

Results Routing

Beginning November 25th all laboratory and diagnostics ordered and collected during the hospitalization, then resulted after discharge will be routed to the primary provider as well as the ordering. The definitive ownership and responsibility of follow up will remain with the ordering provider. The impetus for this routing default is continuity of care.

Physician Tumor Staging

1. The physician receives a deficiency in the inbasket.

2. Inside the hospital chart completion folder, the physician will find the Cancer Stage deficiency.

3. The physician double clicks the deficiency to go to the patients chart. The physician chooses the notes activity, and go to all notes or physician query to stage the tumor.

*The note can be found in physician query tab or in all notes tab

4. Inside the note, the physician will find the links to staging documents.

Notewriter can open in different ways. If the tumor staging form is not available, click the tumor staging button to open the form. When finished, sign the note.

3 UnityPoint Clinics Earn National Recognition

UnityPoint Clinic has been awarded recognition for the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home 2011 Program at five Des Moines-area clinics:

  • Family Medicine - Pleasant Hill (1205 Copper Creek Drive)
  • Internal Medicine - West Des Moines (6010 Mills Civic Parkway)
  • Pediatrics - Waukee (40 East Hickman Road)

UnityPoint Clinic is transforming its primary care practices to a medical home model to improve patient-centered, coordinated care for the patients and communities it serves. The NCQA Patient-Centered Medical Home 2011 standards emphasize the use of systematic care management that supports access, communication and patient involvement.

“The NCQA Patient-Centered Medical Home is a model of 21st century primary care that combines access, teamwork and technology to deliver quality care and improve health,” said NCQA President Margaret E. O’Kane. “NCQA’s PCMH 2011 Recognition shows that UnityPoint Clinic has tools, systems and resources to provide their patients with the right care at the right time.”

“A medical home emphasizes the importance of an ongoing patient-provider relationship to ensure that an individual’s health is managed over time,” remarked Dr. Patricia Newland, physician lead of the medical home implementation team for UnityPoint Clinic. “The provider leads a team of nurses, medical assistants and other staff who are collectively responsible for providing or coordinating the care, education and support that patients need to be successful.”

UnityPoint Clinic has added care coordinators to their medical home team to help empower patients to be active participants in their health care. A care coordinator is a registered nurse who provides additional education on medication, nutrition, exercise and other topics important to a patient, assists them with goal setting and coaches them to develop a plan to achieve their goals.

Patient-Centered Medical Home data shows promising results in improving care quality and lowering costs by increasing access to more efficient, coordinated and responsive care.

Infection Prevention

Early data suggest the 2014 – 2015 flu season could be severe. WHY?

  • Thus far this year, influenza A H3N2 viruses have been the prevailing type.
  • Historically, when H3N2 predominate, there are more flu illnesses, hospitalizations and deaths.
  • Roughly HALF of the H3N2 viruses are drift variants. These are viruses with antigenic drift resulting in differences from the H3N2 strains included in this year’s vaccine.
  • Decreased vaccine effectiveness may occur with antigenic drift. However, there may be cross protection which modifies disease/reduces complications AND the vaccine will still protect against circulating strains that have not undergone drift.

What do the viral notations mean?

  • Influenza viruses are classified as A or B based on major antigenic differences.
  • Influenza A is divided into subtypes based on the major structural proteins:
  • H = hemagglutinin
  • N = neuraminidase

How is the decision made regarding what virus strain is included in the influenza vaccine?

  • A committee of experts chooses which viruses to include in the vaccine many months in advance to allow for production and delivery of vaccine; Antigenic drift can occur during that time.

What is circulating in Iowa?

  • A (H3N2)
  • A (H1N1)
  • B (Victoria linage)

How can we protect our patients, ourselves and our families?

  • VACCINATE!!
  • Prompt antiviral treatment, especially for people at high risk of complications
  • Oseltamivir (Tamiflu) and zanamavir (Relenza) can shorten duration of fever/other symptoms, reduce the risk of complications (otitis media, pneumonia) and reduce the risk of death among hospitalized patients.
  • Educate patients and families on PREVENTIVE HEALTH MEASURES:
  • Stay HOME when sick
  • Respiratory etiquette
  • Cover mouth and nose with a tissue when coughing/sneezing
  • Ensure appropriate tissue disposal
  • If there is no tissue available, cough/sneeze into upper sleeve or elbow, not hands
  • Perform hand hygiene; wash hands often with soap and water or use an alcohol based hand rub
  • Participation in our influenza prevention program
  • Receive vaccine OR wear a mask while at work when influenza is active in the community

BRAVO!! Last year our UPH-DM achieved a 99.9% employee vaccination rate! BRAVO!! Way to go UnityPoint Health DM!!!!!!!!!!

Opioid Prescribing Book Available

Opioid Prescribing Book Available in IMMC Health Sciences Library

The Iowa Board of Medicine has announced that an updated edition of the book “Responsible Opioid Prescribing: A Clinician’s Guide” is now available. Since 2011, the Board has distributed more than 3,000 copies of this book free of charge to Iowa licensed physicians.

The 2014 edition is accredited for up to 7.25 hours of CME through October 1, 2016, through the University of Nebraska Medical Center. This meets the IBM’s mandatory chronic pain management CME requirement for physicians providing primary care.

A copy of this book is available in the Health Sciences Library on the Iowa Methodist campus.

In Stitches