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October 2017

Radiology Information System Set to Move to Epic

On October 7, the Imaging Services division in Des Moines and Peoria will transition from Sunquest, the current version of their Radiology Information System, onto the Epic platform via Radiant, the radiology module that provides documentation, film tracking and viewing of images. The transition will take place at five major affiliate hospitals, four rural affiliate hospitals and 52 clinics in these two regions. Pekin’s transition will happen in 2018.

The implementation of Radiant will integrate radiology into the electronic medical record, creating improved workflows and better processes that will ultimately improve care coordination across the continuum. After this implementation, all of UnityPoint Health (UPH) will be using Epic Radiant. After this implementation is completed, the Sunquest interface can be eliminated. This will result in fewer downtimes and better information flow within Epic for Radiology. BENEFITS

Elimination of interface connecting current RIS system to Epic EMR.

Improved user efficiencies by elimination of duplicate work.

Better flow of information from Epic EMR into Radiant.

Improved workflow for Imaging staff, as it places everything into one system, since Radiant is a piece of Epic.

Improved ability for data collection and analysis.

Allows techs and radiologist to jump into the chart directly from their daily workflow. IMPACTS

Transition is not expected to impact ordering providers and staff directly.

The charges for the contrasts will be through Willow charging, which is different from the site-specific Sunquest/Charge Capture charges that sites had in place prior to Radiant.

The charges are standardized throughout all of UPH.

Revenue Cycle Directors need to be aware of administration and billing of contrast charges coming. Des Moines will utilize multi-dose and Peoria is moving away from it.

No workflows should change for providers. Here are a few of the comments we’ve received from regions that have already implemented Radiant:

“Radiant has helped everyone simplify workflows. Exams are easily accessed, modified and transcribed. Being able to access all patient information easily within one system is great,” said Lori Raisbeck, system administrator and credentialed trainer of medical imaging at Meriter. (Madison went live September 2015.)

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“Those outside of Imaging noted the go-live went so smoothly and seamlessly, they couldn’t even tell the go-live was going on. Overall, it was a smooth transition for the Wave 2 regions, and a seamless experience for radiology patients,” said Becky Halsch, Radiology Director at St. Luke’s. (Cedar Rapids and Quad Cities went live June 2016.)

“What a great way to start 2017! Rolling out Radiant is a very large undertaking. I would say this has been successful,” said Kelly Frick, business sponsor. (Dubuque, Fort Dodge, Sioux City and Waterloo went live January 2017.)

Thank you in advance for your patience as we work together to create an integrated medical record. If you have any questions about the Radiant rollout, please contact Rachel Agans.

FLU SEASON IS RIGHT AROUND THE CORNER! Here is some important information from the 2015-2016 season you may want to know:

What flu viruses will the 2016-2017 vaccine protect against?

A/California/7/2009 (H1N1)pdm09-like virus

A/Hong Kong/4801/2014 (H3N2)-like virus

B/Brisbane/60/2008-like virus (B/Victoria lineage)

Four component vaccines will include the same three viruses above, plus an additional B virus

B/Phuket/3073/2013-like virus (B/Yamagata lineage)

What will UnityPoint Health - Des Moines (UPHDM) be doing to protect patients, families and staff this year?

Required participation the Employee Influenza Prevention Campaign.

Annual vaccination for eligible staff (>98.8% vaccination rate for the past 7 seasons).

If unable to be vaccinated, staff must wear a mask in clinical areas when influenza is active in the community.

Use of DROPLET PRECAUTIONS for all patients with confirmed or suspected influenza.

INFLUENZA AT UNITY POINT HEALTH DES MOINES

2014-2015 2015-2016

63 Pediatric Hospitalizations 17

192 Adult Hospitalizations 55

18 Number of Patients Ventilated 7

2 Pediatric Deaths 0

16 Adult Deaths 2

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Promotion of respiratory hygiene/cough etiquette.

Visitor restrictions activated when/if indicated during peak activity in the community.

When will the 2016-2017 Employee Influenza Prevention Campaign begin?

The annual Employee Influenza Prevention Campaign provides the best protection for our patients, our families, our

colleagues and us.

UPHDM has received the 2016-2017 ordered supply of employee vaccine.

Quadravalent injectable vaccine will be available free of charge to all hospital employees.

No live nasal vaccine provided.

Limited number of high-dose vaccine available for those who qualify.

Plans are being made to begin Employee vaccination clinics the first part of October. Specific detailed information will

be forthcoming from the Employee Health/Safety and Public Relations Departments.

When will vaccine be available for inpatient administration?

Vaccine supply for all three campus locations is in.

Please offer all eligible in-patients the influenza vaccine.

Information regarding free employee vaccination clinic dates, times and location will be forthcoming. Specific questions

can be directed to the Employee Health and Safety Department at your campus location.

UnityPoint Health – Des Moines Excellence in Patient

Experience Awards

The new UnityPoint Health – Des Moines’ Excellence in Patient Experience Awards debuted in January 2017 as a way to

recognize teams for their continued focus on the patient experience and outstanding achievement. The quarterly

awards continued in Quarter 2 with recognition of Most Improved (from Q1 2017 to Q2 2017) and Award of Excellence

(highest performance) in Q2 2017.

Q2 2017 Excellence in Patient Experience Award Winners:

CAHPS Award of Excellence: Blank Children’s Pediatric Clinics – Cancer and Blood Disorders Center (91.7% top-box

score)

CAHPS Most Improved: Iowa Methodist Medical Center - Powell 5 (+13.4%age points in top-box score)

Press Ganey Award of Excellence: Methodist West Hospital – Outpatient Radiology (75th percentile)

Press Ganey Most Improved: Iowa Lutheran Hospital – Cardiac Cath Lab (+40 percentile points)

A big THANK YOU to all of the providers that practice in these areas for helping provides an EXCELLENT patient

experience! Below are the criteria for the UPHDM Excellence in Patient Experience Awards.

4 CAHPS: awarded to an individual inpatient unit, Ambulatory Surgery department or BCPC Clinic (excluding Psych) based on Rate Hospital 0-10, Rate Facility 0-10 or Rate Provider 0-10 Top-Box Score

1. Award of Excellence – based on highest top box score for HCAHPS “Rate Hospital 0-10”, OAS-CAHPS “Rate Facility 0-10” or CG-CAHPS “Rate Provider 0-10”.

2. Most Improved – based on most improved top box score for HCAHPS “Rate Hospital 0-10”, OAS-CAHPS “Rate Facility 0-10” or CG-CAHPS “Rate Provider 0-10”.

Press Ganey: awarded to an individual campus-specific department based on percentile rank (includes Emergency Department, Outpatient Behavioral Health, Inpatient Behavioral Health, Outpatient Services, Blank Children’s Inpatient, Blank Children’s Outpatient Psych, Radiation Oncology, TCU & Rehab)

3. Award of Excellence – based on highest Press Ganey percentile rank for “Standard Overall”.

4. Most Improved Score – based on most improved Press Ganey percentile rank for “Standard Overall”.

Excellence in Patient Experience Awards – Award Criteria

Awards will be given out on a quarterly basis (January, April, July and October) as well as the annual awards (January). The quarterly awards will be based solely on quarterly performance, not YTD performance.

In order to be eligible to win an award, the unit or department must have at least 30 returned surveys (n) during the allotted time period.

The awards will be a poster signed by the UPHDM Board of Trustees that can be hung in each unit/department. The posters will be modeled after the clinical award posters that are currently in circulation.

The award will not travel and can be displayed in each area indefinitely.

The same unit/department cannot win the Award of Excellence (highest score/percentile rank) for more than one quarter each year. However, the unit/department could win the Award of Excellence for a quarterly award and the annual award if it has the highest score/percentile rank for the entire year as well.

If a unit or department has both the highest score and the most improved for the quarter or year, they are eligible to win both awards.

Once award winners are chosen, Paige Moore, Director of Patient Experience, will reach out to unit/department leader for patient experience stories in order to encompass the entire care team (inclusion of EVS, Food & Nutrition, ancillary services, nursing, providers, etc.).

EPIC UPDATES:

Error with Loading Physical Exam or Review of System forms using Copy a Previous Note functionality

An error message can be seen when using the “copying a previous note” functionality with physical exam and review of

system SmartBlocks. With the Epic 2017 upgrade, all SmartTexts (including note templates) were switched

HHS 49001 – PHYEXAMBYAGE changed to HHS 49007 – PHYSEXAM

HHS 147 – ROS changed to HHS 49150 – ROSBYAGE

5 Therefore, the error message can populate when a physician loads a previous note with one SmartLink (i.e.

PHYEXAMBYAGE) into a prepopulated note template with a different SmartLink (i.e. PHYSEXAM). In this case, the

physician has two options:

1. Document on the prepopulated note template, instead of copying a note forward, with the updated

SmartLinks. Use this note to “copy previous note” in the future.

2. Use the “copy previous note” functionality with a BLANK NOTE template

Note: This will open the old SmartLinks, which will not have all of the updated options that the new SmartLinks.

Caveat: This is a current workaround, but will be an issue with the next Epic upgrade when they retire the old

SmartLinks.

Violent Restraint Options

Additional options have been added to the violent restraints order. Prior to the change, unlocked options did not

differentiate between twice-as-tough and less restrictive soft restraints. With the change, there will be additional, less

restrictive options available within the order for: R wrist soft, L wrist soft, R bicep soft, L bicep soft, R ankle soft, L ankle

soft.

Care Everywhere Iowa Health Information Network (IHIN)

The Iowa Health Information Network has undergone some changes recently to improve the level of information that is

shared between members. As a result of this change, existing patients linked to the IHIN will be removed.

In the past there was only one entry in the Epic phone book for the IHIN. Going forward there will now be three entries

in the phone book. They are:

1. IHIN Genesis Quad Cities 2. IHIN Great River Burlington 3. IHIN

If you are seeking information from Genesis or Great River, you will query them respectively. The third option is a

collection of health systems and providers across Iowa. The third option is comprised of the organizations listed below.

1. Henry County Hospital 2. Trinity Health System (Dubuque, Sioux City) 3. Mercy Medical Center – Sioux City, IA 4. Mercy Medical Center – North Iowa, Mason City IA 5. Mercy Medical Center – Dubuque IA 7. Mercy Medical Center – Clinton, IA 8. Decatur County Hospital 9. Burgess Health System 10. Broadlawns Medical Center

11. Dallas County Hospital 12. Jefferson County Hospital 13. Hillcrest Health 14. Clarinda Regional 15. Spencer Hospital 16. Cass County Hospital 17. Pella Hospital 18. Fort Madison Hospital 19. Floyd County Hospital

If you want to access information from one of these organizations you should target the IHIN entry in the

phonebook. Please note, going forward we have configured the Epic system to always auto query the IHIN (3rd option).

We are working with Genesis and Great River to evaluate auto querying these organizations.

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Care Everywhere – Veterans Affairs

The Veterans Affairs (VA) Care Everywhere report has undergone some significant improvements. You may now see

more information such as notes and labs for those patients that have opted in the VA's exchange (VLER).

If you need a refresher on how to query the VA records for the Care Everywhere Tip Sheet.

Net I/O Calculations

Net I/O is now calculated for the previous two weeks instead of for the entire admission. When a patient has been

hospitalized for greater than two weeks, the label changes from "Since Admission" to list the date two weeks ago.

Patient List Printing Updates

Previously, when printing a Patient List, it automatically included all of the columns that were on the list in Epic. A new

Patient Lists print window gives staff a chance to create a more usable and printer-friendly version of their list. Staff

can choose one of the following options:

Suggested - optimized mode for printing that automatically includes defined columns

Custom - staff can select which columns they would like to include in their printout

Staff can also add a blank column for notes and select the size they want for their notes column. The Suggested mode

will be selected by default and a small notes column will be added by default. After printing a list for the first time, the

print preferences will be saved per user, per list.

H&P Interval Notes in Haiku

The Add Interval button will no longer appear in the H&P Interval Note activity in Haiku if the patient is not admitted. In

addition, the warning below will appear for providers.

Determine Where Clinicians See Additional NoteWriter Reports

After the Upgrade to 2017, NoteWriter settings for the report pane didn't "stick" for clinicians who had set preferences

on where to see reports.

If clinicians who used to write NoteWriter notes in the main workspace had configured NoteWriter reports to appear

on the right or left side, those user preference settings are now respected once again.

Show More Orders in the Preference List Browser

You can now see more orders at a time on the Browse tab of the Preference List Browser by clicking the wrench and

selecting three columns instead of two.

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Abnormal Results Highlighted in Yellow in Result Reports

Epic previously removed yellow highlighting from abnormal results in print group reports to make the appearance of

abnormal results more consistent between inpatient and outpatient settings. Since then, they have received feedback

from the Epic community that providers and clinical staff prefer to keep the highlighting to help them identify abnormal

results more easily. The highlighting for abnormal results will be brought back as it was previously in Epic. To recap,

abnormal results will be highlighted in yellow, critical results will highlight in red.

Set the Default Cursor Position in Notes – All Clinicians

To help improve efficiency and give clinicians more control over their note workflows, they can now personalize where

the cursor appears by default when they open notes.

Clinicians can click the wrench icon in a note editor to open their personalization settings and choose one of three

options for the initial cursor position:

Beginning of note

End of note

End for my notes, beginning for others' notes

4 Clinicians can also access this setting from the Notes activity by clicking the Note Editor Settings button.

The initial cursor position that a clinician sets applies to all types of notes that they write, including notes written in the

NoteWriter.

If a clinician doesn't personalize the default cursor position, it now always appears at the beginning of the note to help

provide a more consistent editing experience.

Warning Prevents Resolving a Problem Linked to a Treatment or Therapy Plan – Providers

If a clinician attempts to resolve or delete a problem that is associated with an active therapy plan, a warning now

appears and they are prevented from completing the action. These plans must have a linked diagnosis for billing and to

allow orders to be released.

After encountering this message, the clinician most likely should do one of the following:

If cleaning up duplicative problems, try resolving the other duplicative problem. If that problem isn't linked to a

plan, the clinician can resolve it.

To resolve the linked problem, contact the appropriate clinician to update the diagnoses linked to the patient's

treatment or therapy plan.

Automatically Changed Doses Are Now Set in Terms of the Maximum or Minimum Units – Pharmacists and Providers

An issue where dose warnings were presented in mismatched units has been resolved. From now on, if the ordered

dose is outside the recommended range, and the dose is automatically changed to match the maximum or minimum

dose, dose warnings present this information solely in terms of the maximum or minimum units, and the dose is

adjusted so that it's in terms of the maximum or minimum units. If clinicians are required to place the medication order

in weight-based units, they can change the dose back to a weight-based dose before signing the order.

5 For example, consider a scenario where a clinician places a 5 mg/kg medication order for a pediatric patient who

weighs 35 kg, which equals a raw dose of 175 mg. The maximum daily dose for the medication is 75 mg, so the dose is

changed to 75 mg. The dose warning states that the dose has been automatically changed to 75 mg, rather than

attempting to translate that back to a weight-based dose of 2.5 mg/kg.

EPIC: NICE TO KNOW INFO

o Incision Closure - The incision closure SmartLink was removed from Operative Report Notes template. o Ambulatory SmartSets - Ambulatory SmartSets will no longer be available in the Inpatient context. To find

Ambulatory SmartSets, providers must be in the Ambulatory context. o New SmartLink for Discharge Medications - The SmartLink “UPHDCMEDPROSE” was created so that Providers can

pull discharge medications in to a note in paragraph form. Providers can still use “UPHDCMED” to pull discharge medications into a note in table form.

o New SmartText and SmartPhrase for Oxygen Device - Three new SmartTools are available to assist in documentation related to Oxygen Delivery.

The SmartPhrase “OXYGENDEVICE” will pull information from a flowsheet row to show what device the patient is using for oxygen.

The SmartText “UPH IP ON ROOM AIR” will evaluate if a patient is on room air. The SmartText “UPH IP OXYGEN DETAILS” will retrieve the last value for flowsheet rows FIO2and Flow Rate.

Haiku/Canto Additional Notes - Op Notes and Discharge Summaries are now viewable in Haiku and Canto. Additionally,

the Vitals tab has been added in Haiku and Canto.Attend the following sessions to learn how to make Epic work better

for you and your workflow.

Thursday, Sept 6 7:00 - 8:00 a.m. MWH Computer Lab

Can’t find a time that fits your schedule? Please call 515-241-5557 to schedule an individual session with the

informaticist.

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KUDOS!

Dr. Richard Sidwell, Trauma Services In early spring, Dr. Sidwell had a big idea: to educate 1,000 UnityPoint Health – Des Moines team members face-to-face on basic hemorrhage control techniques. Beginning May 1 and lasting 6 weeks, Dr. Sidwell and trauma services staff visited over 80 departments with two goals: teach how to apply pressure to control severe bleeding and how to apply a tourniquet. Dr. Sidwell would be quick to say that these goals were achieved through the commitment of the entire department. That is true, but our success was because of his vision and dedication to this important topic. Dr. Sidwell’s energy and excitement were contagious. Team members learned important skills they could use if they were called to assist a bleeding victim, but they were also able to interact with the trauma team in a meaningful way. Everyone had fun practicing the skills and was appreciative that the trauma staff – especially the surgeons – took time to personally visit them in their department. Thank you, Dr. Sidwell, for Championing Excellence to provide this important, life-saving education to so many.

Welcome New Providers to UnityPoint Clinic

Rebekah Corbin, PA-C – UnityPoint Clinic Urgent Care - Altoona UnityPoint Clinic® is proud to welcome Rebekah Corbin, PA-C to our team of dedicated and experienced Urgent Care providers. Rebekah completed her medical education at Des Moines University and she received her undergraduate degree from Dordt College in Sioux Center, Iowa. She wants her patients to know that she’s committed to working with you to find the best plan and she feels privileged to have a chance to help you. When she isn’t in the clinic you can likely find her spending time with family and friends, biking, running, reading cooking or traveling!

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Christine Davis, DO – UnityPoint Clinic Family Medicine – Kettlestone (Opening Late Fall 2017) UnityPoint Clinic is proud to welcome Christine Davis, DO to our team of experienced and dedicated family medicine providers. She completed her medical education at Des Moines University and she received her undergraduate degree from St. Olaf College in Northfield, MN. Dr. Davis completed her residency within the UnityPoint Health family at Iowa Lutheran Family Medicine Residency and she is board-certified by the American Board of Family Physicians. Dr. Davis’ clinical interests include Pediatrics, Osteopathic manipulative treatment, Family Medicine, Adolescent Medicine, Adult Medicine, Women’s Health, Preventative Medicine and Contraception. Christine became a physician because she experienced firsthand what a difference superior medical care can make for a family going through one of the worst times in their life. She wants to bring compassion and excellence to every patient and family that she encounters. When she isn’t in the clinic, you can likely find her playing music (violin and piano), competitively swimming, reading and/or spending time with her family.

Nate Fuller, PA-C – UnityPoint Clinic Family Medicine – Kettlestone (Opening Late Fall 2017) UnityPoint Clinic is proud to welcome Nate Fuller, PA-C to our team of experienced and dedicated providers. Nate completed his medical education at Des Moines University and received his undergraduate degree from Iowa State University. He is board-certified by the National Commission on Certification of Physician Assistants (NCCPA). Nate’s clinical interests include adult medicine, acute and chronic illnesses, adolescent health care, diabetes, hypertension and cardiovascular health. Nate believes in personal responsibility and accountability when it comes to healthcare; and as a provider, he can only do so much, but he strives to help people take charge of their lives and seek to prevent disease and live healthy. When he isn’t in the clinic you can likely find him living a healthy lifestyle!

Stephanie Wadle, ARNP – UnityPoint Clinic Urgent Care – Ingersoll (Opening October 23) UnityPoint Clinic is proud to welcome Stephanie Wadle, ARNP to our team of experienced and dedicated urgent care providers. Steph completed her medical education at Kaplan University and she received her undergraduate degree from DMACC/Grand View College. She is board-certified as a Family Nurse Practitioner. Her clinical interests include Urgent Care and Health and Wellness. Steph wants her patients to know that the patients' involvement in their care is as valuable as the providers' input. When she isn’t in the clinic you can likely find her outdoors and spending time with her family!

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CEU Opportunity:

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CME Opportunities:

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HAWAII43

$100 hotel credit for those that register and reserve their room by October 1

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2017 Hospital Provider Directories are available – please call or email Monica Aunan to receive a copy.

To submit articles, please send to Monica Aunan, Physician Liaison at

monica.aunan@unitypoint.org or call 515-241-3480

UnityPoint Health - Des Moines Region ACO Members

Abrahamson, Tim, MD (Dermatology)

Allergy and Asthma Associates, PC

Associated Ophthalmologists

Associates in Kidney Care

Blank Health Providers-UPHDM

Boone County Comprehensive Specialty Care

Boone County Family Medicine

Boone County Hospital

Broadlawns Medical Center

Bussey Family Health Center

Cass County Hospital

Central States Medicine (Iowa Pain Clinic)

Clarke County Hospital

Dermatology, PC

Des Moines Anesthesiologists

Des Moines Eye Surgeons

Des Moines Internal Medicine

Des Moines Orthopaedic Surgeons, PC

Des Moines Pastoral Counseling Center

Des Moines Pediatric & Adolescent Clinic

Des Moines University Medical Clinic

Eyerly Ball

Ganske, John Gregory (Greg) MD

Greater Regional Medical Center

Greene County Medical Center

Guthrie County Hospital

Huxley Physical Therapy

Iowa Arthritis & Osteoporosis Center

Iowa Diabetes and Endocrinology Center

Iowa Digestive Disease Center PC

Iowa Endoscopy Center

Iowa Ear Center

Iowa ENT, INC

Iowa Head & Neck, PC

Iowa Kidney Physicians, PC

Iowa Pathology Associates, PC

Iowa Radiology, PC

Iowa Retina Consultants, Inc.

Iowa Surgery Center, PC (Dr. Praveen Prasad)

Koch Facial Surgery

Lakeview Surgery Center

Lifeworks

Lucas County Health Center

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Madrid Family Practice- Boone County Hospital

McClairen, Willie C., Jr MD (Surgery) Gen Surg Physician, PC

McFarland Clinic, P.C.

McFarland Clinic - Jefferson

Medical Oncology & Hematology Assoc (MOHA)

Metro Anesthesia and Pain Management

Mid-Iowa Fertility, PC

Midwest Oral and Facial Surgery, PC

New Sharon Medical Clinic

Newton Clinic, PC

Orchard Place

Orthopaedic Outpatient Surgery Center (OOSC)

Pediatric and Adult Allergy, PC

Pediatric Cardiology, PC

Pella Medical Clinic

Pella Regional Health Center

Physicians' Eye Clinic

Porto, Dennis P MD (ENT)

River Valley Therapy Clinic, LLC

Story County Medical Center

Surgery Center of Des Moines East and West

The Iowa Clinic

The Iowa Clinic Endoscopy Center

The Iowa Clinic West Lakes

The Iowa Clinic West Lakes-Cardiology

The Iowa Clinic - Family Medicine

The Iowa Clinic - Internal Medicine

UnityPoint Health - Des Moines

West Des Moines Children's Clinic

Wolfe Eye Clinic, PC

Wolfe Surgery Center

Women's Care Clinic, PC

West Lakes Sleep Center

**Skilled Nursing Facilities**

The Bridges at Ankeny

Calvin Community

Edgewater

Fountain West

Hearthstone

Kennybrook Village

Mill Pond

North Ridge Village - Ames

Norwalk Nursing and Rehab Center

On with Life, Inc.

Parkridge Specialty Care

Prairie Vista Village

Spurgeon Manor

Sunnyview Care Center

Urbandale Health Center

Valley View Village

Wesley Retirement Services-UnityPoint Health Des Moines

List updated 5/30/2017