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Iowa News

Britt hospital nurse receives IHERF scholarship
Deena Zadow, Kanawha, an employee of Hancock County Health System who is earning a bachelor of science degree in nursing at Briar Cliff College, has been awarded a $3,500 scholarship from the Iowa Hospital Education and Research Foundation (IHERF), which is supported by the Iowa Hospital Association (IHA). She is among 33 outstanding students from Iowa who have received assistance this year from the IHERF Health Care Careers Scholarship Program.

Insurers dictate health care costs
we feel obligated to take issue with the Times’ editorial board stating as fact that hospitals “overcharge” privately insured patients to make up for losses created by serving patients on Medicaid. While it is true that private insurance does help hospitals cover some of those losses, this is not a result of overcharging, which implies hospitals can charge whatever they want. In the Iowa insurance market where a single company has cornered 75 percent of the market, it is hardly hospitals that are calling the shots on pricing. (Quad-City Times)

Iowa Department of Corrections shifts money to cover effects of MHI closures, hospitalizations
Officials in the Iowa Department of Corrections have shifted money legislators set aside for staff to cover other expenses. Closing the Mental Health Institutes (MHIs) in Clarinda and Mount Pleasant a year ago caused problems in the prison system’s budget. Prison staff work on the campuses in those two communities and $1.2 million was shifted to cover those salaries. Officials say they also had to pay more overtime to staff who took inmates to the University of Iowa Hospitals and Clinics for medical care. (Radio Iowa)

Iowa hosts Cancer Moonshot Summit site
“We’re making progress faster than ever before in cancer research and in bringing the advances of cancer research to our patients,” said Dr. George Weiner, who came all the way from the Holden Comprehensive Cancer Center at the University of Iowa. Holden was one of 270 sites around he country that hosted a satellite summit Wednesday. Weiner says there are still many obstacles to curing cancer — administrative and organizational. (KCRG)

National News

Medicaid reporting error just the latest fiasco in Kansas
The state reported to federal authorities that the number of people awaiting approval of their Medicaid applications was about 3,500. It turns out the real total is more than four times that much – nearly 15,500. What’s more, most of that increase is among people waiting more than 45 days (the federal approval deadline). The processing delays can endanger the lives of vulnerable Kansans. But this is just the latest in a long string of problems related to application approvals. (Wichita Eagle)

Maryland hospitals launch effort to inform consumers on changing landscape
Hospitals in Maryland are changing the way they deliver care, focusing more on coordinating services and preventing complications. This week, they launched a campaign to inform the public about it. Called “A Breath of Fresh Care,” the campaign’s goal is to get patients to engage in their care by directing them to hospital wellness and chronic disease management initiatives. To that end, the Maryland Hospital Association has set up a website called with links to individual hospital websites. (Baltimore Sun)

Louisiana, the U.S. incarceration capital, prepares for expanded Medicaid
In the state that imprisons more of its citizens per capita than any other, the long-awaited July 1 launch of expanded Medicaid coverage will give those leaving prison a chance to at least continue what many describe as spotty treatment for the conditions that plagued them while behind bars. Without access to health care when they leave prison, it’s often only a matter of time until many prisoners return. The imminent expansion at least gives many hope they can get some help for problems that helped send them to prison in the first place. (USA Today)

Mobile app uses analytics to predict hospital readmissions
A mobile application that uses analytics to predict hospital readmissions and allows patients to more easily communicate with providers has the potential save the health care industry billions of dollars, its developers say. Researchers at Binghamton University in New York created the app, the Post Discharge Treatment and Readmissions Predictor or PdtRp, which calculates a patient’s probability for readmission by mining historical records and comparing those to present-day status. (Fierce Healthcare)

States offer privacy protections to young adults on their parents’ health plan
The health law opened the door for millions of young adults to stay on their parents’ health insurance until they turn 26. But there’s a downside to remaining on the family plan. Chances are that mom or dad, as policyholder, will get a notice from the insurer every time the grown-up kid gets medical care, a breach of privacy that many young people may find unwelcome. With this in mind, in recent years a handful of states have adopted laws or regulations that make it easier for dependents to keep medical communications confidential. (Kaiser Health News)

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(This article, by Shefali Luthra, was provided by Kaiser Health News.)

Some people receive constant reminders on their personal smartphones: birthdays, anniversaries, doctor’s appointments, social engagements. At work, their computers prompt them to meet deadlines, attend meetings and have lunch with the boss. Prodding here and pinging there, these pop-up interruptions can turn into noise to be ignored instead of helpful nudges.

Something similar is happening to doctors, nurses and pharmacists. And when they’re hit with too much information, the result can be a health hazard. The electronic patient records that the federal government has been pushing — in an effort to coordinate health care and reduce mistakes — come with a host of bells and whistles that may be doing the opposite in some cases.

What’s the problem? It’s called alert fatigue.

ElectronicElectronic health records (EHRs) increasingly include automated alert systems pegged to patients’ health information. One alert might signal that a drug being prescribed could interact badly with other medications. Another might advise the pharmacist about a patient’s drug allergy. But they could also simply note each time that a patient is prescribed painkillers — useful to detect addiction but irrelevant if, say, someone had a major surgery and is expected to need such meds. Or they may highlight a potential health consequence relevant to an elderly woman, although the patient at hand is a 20-something man.

The number of these pop-up messages has become unmanageable, doctors and IT experts say, reflecting what many experts call excessive caution, and now they are overwhelming practitioners.

Clinicians ignore safety notifications between 49 percent and 96 percent of the time, said Shobha Phansalkar, an assistant professor of medicine at Harvard Medical School.

“When providers are bombarded with warnings, they will predictably miss important things,” said David Bates, senior vice president at Brigham and Women’s Hospital in Boston.

Now, doctors, health information technologists and software vendors are trying to fix the problem.

Research on this human-computer interaction is starting to explore the degree of risk posed by excessive alerting versus the benefits the alerts produce. The companies selling electronic health records say advances are moving their systems toward more targeted, relevant warnings, instead of broad-brush signaling.

“This is an issue that everyone’s going to have to wrestle with eventually,” said Bill Marella, executive director of patient safety operations and analytics at ECRI Institute, a nonprofit organization that studies health care safety and quality issues. In April, the institute ranked design and implementation of new health IT systems as its top safety concern for 2016.

Some hospitals and health systems are already paving the way.

Take Children’s Hospital of Philadelphia. In 2012, the inpatient facility switched over to a new electronic health record, said Eric Shelov, a physician and the hospital’s associate chief medical information officer. Immediately, he said, practitioners began seeing far more alerts, to the point that doctors were overriding almost all of them. The problem, Shelov said, is that “if you see enough nonsense, you’re going to start ignoring it.”

That has consequences. In one instance at Children’s, doctors ignored relevant information about how a patient might respond to a drug, Shelov said, because it appeared alongside heaps of other superfluous notifications — warnings, for instance, about drugs that posed minimal risk of interfering with each other. Consequently, the patient received medication that induced a potentially lethal reaction.

The hospital caught the mistake in time, but the incident spurred a series of changes. A team of pharmacists, doctors and other clinicians have sorted through what triggered alerts in their system, turning off the ones they decided weren’t actually relevant or necessary. That has helped. But it’s still an ongoing battle, Shelov said. “It’s a little bit of trying to turn off the firehose.”

Systems such as Cleveland-based MetroHealth, the University of Vermont Medical Center and Group Health Collaborative of Southern Wisconsin have undertaken similar projects. Still others, like Brigham and Women’s, are working on it.

But figuring out what merits a computer warning takes time, manpower, expertise and money. Not all hospitals have those resources, Bates said. It’s inherently subjective. Some stakeholder groups have put out recommendations, and hospitals like Children’s have presented on ways to combat alert fatigue. But individual hospital task forces often end up deciding for themselves what’s risky enough to warrant an alert.

Patients, meanwhile, aren’t standing beside their doctors as they scroll through their medical records, noted Helen Haskell, a patient safety advocate. Patients can request access to their records, but that’s a static page they’ll see only after getting care. That means that, while this hyper-alerting poses a danger, there’s no way for consumers to know if, say, they got worse care because the doctor missed a warning.

“It’s very rare that patients are granted that perspective,” she said.

Software vendors say they’re trying to make their systems smarter.

Epic Systems, outside Madison, Wisconsin, for example, has been hearing feedback for years from doctors about redundant or irrelevant alerts, said Bret Shillingstad, a physician who works on Epic’s clinical informatics team. They’ve added in functionality for hospitals to turn those alerts off. They’re working now to develop software that might target alerts based on things like a patient’s health condition or recommend medications that better match someone’s overall profile. Then there are simpler adjustments, like changing a system so that if a patient needs a vaccine, reminders just go to the primary care doctor, not the orthopedist, too.

In the long term, system designers are trying to better consider the nuances of a patient’s medical needs so that they can use fewer warnings and send them only when they matter, said Terry Fairbanks, an emergency physician and director of MedStar Health’s National Center for Human Factors in Healthcare in Washington, D.C. For instance, people with advanced cancer often need doses of morphine that might be unsuitable for other patients. A smarter system would warn doctors about that morphine order for patients who don’t have cancer but would treat it as normal for someone in the disease’s late stages.

Such a change could limit distractions so that physicians act upon pressing reminders — like notifications highlighting if a patient is at risk for sepsis, which can be deadly if it’s not noticed early.

But there’s still debate. Haskell said she would argue doctors should always be warned about certain medications and drug interactions.

“All of these alerts have really reduced medication interactions. It’s a service,” she said. “It just needs to be refined.”

But there’s clearly a cultural shift underfoot, added Phansalkar, who also works as director of informatics and clinical innovation at Wolters Kluwer Health, which supplies drug information to electronic health record systems. Alert fatigue is no longer “just something providers complain about,” she said. In health care, people are trying to devise more effective, nuanced ways for electronic systems to improve care.

“Because it’s so easy to put an alert to address a problem, that’s people’s natural, knee-jerk reaction,” said Douglas Gentile, medical director of clinical information systems at the University of Vermont Medical Center. But “as you add those, it creates additional problems. And you get collateral damage.”


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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Iowa taking ‘moonshot’ at ending cancer
Cancer researchers across the country are on the brink of groundbreaking discoveries and lifesaving treatments, but various hurdles, red tape and inefficiencies are slowing them down. Eliminating those obstacles and identifying avenues for collaboration are among topics scientists, doctors, patients and survivors will discuss Wednesday during a “Cancer Moonshot Summit” in Washington, D.C. and at satellite locations — including the University of Iowa (UI). The UI’s Holden Comprehensive Cancer Center was among 10 initially invited to host a satellite summit. (Cedar Rapids Gazette)

A third of Iowans don’t earn enough to pay for basic living
To survive in Iowa, it takes an income of about twice the federal poverty rate. That figure was among the findings of a new United Way report that explored why nearly one in three Iowans struggles to afford basic living expenses. United Way officials hope the findings will draw attention to Iowans who are above the federal poverty line, yet remain unable to afford basic necessities such as food, rent and medicine. The findings could add fuel to Polk County’s fiery debate over raising the minimum wage above the state and federal standard of $7.25 an hour. (Des Moines Register)

Family keeps their son’s memory alive with big donations
Though their baby boy died two years ago, an Iowa family has turned their grief into a way of giving back to the community and helping hundreds of families. The Anderson family became well-acquainted with the third floor of Mercy Children’s Hospital when their son, Fisher, who was born with a congenital heart disease, stayed there in 2014. The Anderson family makes a big donation to the Ronald McDonald House every year on June 27, celebrating Fisher’s birthday. Their donations include paper plates, plastic containers, shampoo, conditioner and food. (KCCI)

National News

Advocates criticize Kentucky’s proposed Medicaid overhaul
Bobby Paisley’s health insurance covers his vision and dental care. He knows, because he and his wife pay for it. “I don’t have to do community service, I don’t have to earn points and I don’t have to wait,” he said. But that’s exactly what some 400,000 Kentuckians would have to do under Governor Matt Bevin’s proposal to overhaul the state’s Medicaid program. Bevin’s plan would eliminate dental and vision coverage for able-bodied Medicaid beneficiaries, but they could earn those benefits back by getting a job, volunteering for a charity or taking a class at a community college. (Associated Press/Daily Nonpareil)

Louisiana hospitals, health department in wait-and-see mode
Louisiana’s Department of Health and the privately operated safety net hospitals under contract with the state escaped a grueling legislative session with their funding mostly intact. But the hospitals and state officials say the funding is based on assumptions that are riddled with uncertainty about Medicaid expansion. Paul Salles, CEO of the Louisiana Hospital Association, said he thinks the hospitals will have to wait and see whether the funding levels were on the mark. But he said this year’s legislative session brought a broad discussion about patient access. (New Orleans Times-Picayune)

Don’t keep cheating kids in Florida on Medicaid
As a result of settling a class-action lawsuit, Florida must significantly change the government insurance program for low-income children. State leaders have a choice: They can continue to grudgingly invest in Medicaid for children and provide minimal oversight, or they can significantly increase financial support for the program and demand that the managed care companies in charge efficiently and effectively serve the patients and their parents. (Miami Herald)

MACRA rule raises patient privacy concerns
Physicians and health care organizations have flooded the Centers for Medicare & Medicaid Services (CMS) with concerns about the Medicare Access and CHIP Reauthorization Act (MACRA), the proposed changes to the way Medicare pays providers. “Although the clinicians participating in shared savings-only models are working hard to support CMS’s goals to transform care delivery, under CMS’s proposal they will not be recognized for those efforts,” said Tom Nickels, the American Hospital Association’s executive vice president of government relations and public policy. (Modern Healthcare)

How the Dollars for Docs hospital data was compiled
The goal of Dollars for Docs was to compare U.S. hospitals based on the percentage of their affiliated physicians who receive payments of various sizes from pharmaceutical and medical device companies. For information about a hospital’s characteristics, including address and ownership, researchers relied on Medicare’s Provider of Services file from 2014, as well as data from the American Hospital Association Annual Survey. The analysis included 4,815 hospitals. (Boston Globe)

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Dubuque County supervisors urges state-level action on mental health funding
Dubuque County supervisors Monday took state leaders to task for an alleged failure to address inequalities in county contributions for mental health funding. Supervisors unanimously approved a resolution calling on the Legislature and Governor Terry Branstad to equalize the funding basis for mental health services across the state. Dubuque County is one of nine Iowa counties that form Mental Health/Disability Services of the East Central Region. Each county contributes mental health funding for the region as a whole. (Dubuque Telegraph Herald)

Link between gut bacteria, MS discovered
Researchers are now saying bad gut bacteria – or an insufficient amount of good bacteria – may have a direct link to multiple sclerosis (MS). “Every human carries trillions of bacteria in their gut and recent advances in research indicate that these tiny passengers play an important role in our overall health maintenance,” says Ashutosh Mangalam, PhD, assistant professor of pathology at the University of Iowa Carver College of Medicine. In a study published online in the journal Scientific Reports, Mangalam and his team say that MS patients do have a distinct microbiome from their healthy peers. (Science Daily)

National News

Judge sides with hospitals over California ballot initiative to cap executive pay
A Sacramento County judge has ruled that a proposed ballot initiative to limit hospital executives’ pay violates a prior deal between the labor union that backs it and the California Hospital Association (CHA), which opposes it. The judge ruled Friday in a case involving a proposed November initiative asking voters to limit any hospital executive’s salary and expense allowance to that of the president of the United States. CHA sued, arguing that the initiative violated a previous settlement with United Healthcare Workers-West. (Associated Press/Mercury News)

Storm clouds gather around Kentucky Medicaid plan
A thunderstorm rumbled through Frankfort Wednesday as Kentucky Governor Matt Bevin laid out his sweeping proposal to reshape the state’s Medicaid plan into one he predicts will encourage responsible health choices and teach Kentuckians the basics of paying for health care. But Bevin’s plan has stirred up a storm among health advocates opposed to changes that would have a profound impact on hundreds of thousands of the 1.3 million Kentuckians on Medicaid. (Courier Journal)

How technology can deliver broad improvements in health care
According to Kenneth Kizer, director of the Institute for Population Health Improvement at the University of California, Davis, using technologies to improve population health is still in its infancy, but it is clear that they will fundamentally change the nature of health care in coming years by connecting patients and caregivers in ways previously unimaginable, making health care more convenient, helping people stay healthy and patients recover from illness more quickly. (Wall Street Journal)

Sub-specialty hospitalists on the rise
The hospital-only specialty, which originated in primary care in the 1990s, has caught on throughout numerous sub-specialties such as gastroenterology and general surgery services. The growth of the hospitalist is driven in part by physicians’ desires for greater work-life balance, particularly when it comes to call coverage. Hospitals themselves are also embracing the trend, as patients increasingly expect prompt, high-quality care. The role of the hospitalist is alluring to physicians and hospitals and its growth is well established. But cultural and recruiting challenges remain. (HealthLeaders Media)

Retail clinics: Convenience comes at a cost in health care
While they are convenient, retail clinics and urgent care centers are driving up health spending because more people are seeking care for routine illnesses more often, according to a new report from PwC’s Health Research Institute. That shift may reduce costs in the long-run by improving patients’ overall health and wellness, but the increased use of convenient care will be a major reason for medical cost inflation for the foreseeable future. (Fierce Healthcare)

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Scott County’s mental health court aims to offer treatment, not jail
Scott County will soon become home to the first mental health court in Iowa. The new mental health court procedure is part of an effort to cut back on the number of people with mental health conditions being put in jail. The project is a collaborative partnership between Interfaith Quad Cities and Genesis Philanthropy. The new court comes at a time when the state of Iowa has been under fire for lagging behind other states in providing access to mental health treatment. (WQAD)

Heroin’s hold: Iowa legislation allows responders to use ‘opioid antagonists’
Iowa lawmakers took steps this year to better equip emergency first responders and medical technicians to help deal with people experiencing a life-threatening drug overdose. Under legislation that took effect April 6, law officers, firefighters, emergency medical personnel and others are authorized to procure, possess and administer emergency drugs known as opioid antagonists to people who are experiencing an overdose. The new law also allows “people in a position to assist” to possess and administer the opioid antagonist if they believe it is necessary. (Cedar Rapids Gazette)

Medication historians help prevent adverse drug interactions
Being a medication historian is more of an art than a science. Martin Cortez and Andrew Welding interview patients who are admitted to UnityPoint Health-St. Luke’s about the medications they’re taking, which can range from a couple of prescription drugs to more than a dozen. “We try to figure out what they’re all taking for medications currently and get that up-to-date for the hospitalists, the nurses and everybody else here,” Welding explained. (Sioux City Journal)

National News

NC lawmakers consider undoing regulations that ‘ration’ where hospitals can build
Last year, the North Carolina House voted 114-2 to designate the bobcat as the state’s official state cat. Now the bobcat bill is a threat to community hospitals, says the N.C. Hospital Association. Not with the bobcat provision, but with the new text that replaced the bobcat language which has nothing to do with bobcats. Instead, it would repeal a special health care law that controls where new hospitals, surgical centers, medical scanning clinics, drug rehab centers, hospices and other medical services are placed. (Fayetteville Observer)

Time to fix Georgia’s health care provider shortages
Georgia needs a health care system that is sustainable. When a hospital closes, it hurts the whole community and carries ramifications for the entire state’s economy. Closing Georgia’s health insurance coverage gap through expanded Medicaid eligibility is a critical step to help the state’s medical providers get paid for services they now deliver charitably, while also giving more than 300,000 people who fall into the gap access to treatment. (Atlanta Journal-Constitution)

Real-time sharing of records ‘virtual safety net’ for patients at California Hospitals
Six East Bay-area hospitals in California plan to share patient records in real-time to create a “virtual safety net” for patients. “We’re trying to use technology and available information to make it so no matter what door a patient walks through in Alameda County, we’re all on the same page,“ said Jim Hickman, CEO of Better Health East Bay. The secure data-sharing platform integrates with each hospital’s electronic health record system and will help care teams understand each patient’s usage patterns and care needs in the community. (Fierce Healthcare)

How telemedicine is transforming health care
After years of big promises, telemedicine is finally living up to its potential. Driven by faster internet connections, ubiquitous smartphones and changing insurance standards, more health providers are turning to electronic communications to do their jobs—and it’s upending the delivery of health care. Telemedicine’s future will depend on how—and whether—regulators, providers, payers and patients can address the challenges. (Wall Street Journal)

Without federal funding, counties brace to confront Zika on their own
Communities across the country are preparing for the arrival of the Zika virus, but they aren’t preparing equally. With no aid in sight from the federal government, local officials are preparing as best they can for the possibility that Zika could soon spread within the United States. But the task has fallen to a patchwork of state and local programs that have a huge disparity in financial resources and manpower. (Washington Post)

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