Fiber optic cable gets installed at IHA offices in Des Moines.

Construction has begun on the fiber optic connection to the Iowa Rural Health Telecommunications Program (IRHTP) network for IHA. The work is part of the IHA –coordinated network that is connecting dozens of hospitals all over the state. 

The Iowa Rural Health Telecommunications Program (IRHTP) is a joint effort consisting of a consortium of more than 80 Iowa rural and urban hospitals, IHA and the Iowa Communications Network (ICN) with the purpose to connect Iowa hospitals to a dedicated broadband fiber network using existing ICN infrastructure. 

The fiber build-out provides “last mile” fiber connection for the hospitals, Radiology Consultants of Iowa, Iowa Radiology and IHA to the closest appropriate ICN point of presence. 

With the fiber build-out complete for 12 IRHTP hospitals, another 17 in progress and another 10 connected by indefeasible right of use contracts (a 20-year lease of two strands of fiber), the build out of the IRHTP network is well underway.  Once the electronic network core is tested and operational the hospital end point electronics will be installed and tested to complete the connection to the IRHTP network. 

What does connecting to a fiber optic network mean for Iowa hospitals?  The primary benefit is being able to quickly transfer massive amounts of data to and from the hospital.  This ability is especially valuable in the area of medical imaging; high-resolution x-rays, CT, MRI and PET scans create very large files that are slow to transfer and have a tendency to “bog down” typical networks.  But with fiber-based networks, these images can be shared quickly and efficiently, a crucial tool for hospitals that need images analyzed by a radiologists in other locations. 

Fiber technology also offers opportunities to use “tele-health” to connect individual health care professionals and patients.  This technology is already being used to connect remote sessions between mental health professionals and patients, making it an important tool for states like Iowa, which has a severe shortage of psychiatrists.

For IHA, the broadband network holds the promise of bringing together hospital leaders and staff from all over the state without requiring travel, increasing IHA’s ability to provide education and information to Iowa’s hospitals and their 74,000 employees. It will also provide more efficient data transmission between IHA and hospitals, an important function as IHA continues to be the hub for a growing collection of hospital-based data in Iowa.

Dartmouth is a natural for this sort of endeavor primarily because it is home to the Dartmouth Institute for Health Policy and the Dartmouth Atlas of Health Care, which have been studying variation in health care delivery and spending for a couple of decades.  But while the Atlas gives Dartmouth the data, the college’s home state, New Hampshire, isn’t exactly a shining example of health care value. 

At more than $7,800 per Medicare recipient per year, New Hampshire spends nearly 20 percent more than Iowa ($6,686).  Of course, that’s not nearly as bad as nearby Massachusetts ($9,568) or New York ($9,995), both of which should provide convenient laboratories for what not to do for value-based health care delivery. 

This is worth noting because of something Dartmouth’s president, Jim Yong Kim, mentioned when the center was announced over the weekend.  According to Associated Press coverage of the story, Kim and state leaders have “discussed using the center to make New Hampshire a model for innovative health care.” 

This brings one thought immediately to mind: Why not Iowa? 

Obviously, Dartmouth has every right and reason to focus on its home state.  But this deserves serious consideration in Iowa, where IHA has made “value” a health care watchword.  Certainly, the tools and the people are there. The Iowa Healthcare Collaborative has united hospital and physician interests under the value flag and, like the Dartmouth Atlas, has become a vast data collector.  

The University of Iowa (UI) and Des Moines University both offer excellent schools of health care administration and medicine with easy access to not only urban medical centers but also nearby rural referral centers and Critical Access Hospitals, many of which are on the cutting edge of innovative health care delivery models.  The schools of engineering at UI and Iowa State, along with major businesses (including hospitals) that have adopted ideas like Lean and the Toyota model of process improvement, offer expertise and laboratories for systems analysis. 

What Iowa doesn’t have is seed money, like the $35 million that was anonymously donated to fund the Dartmouth center.  Perhaps if we can broaden our state leaders’ views on what drives a healthy economy (hint: it’s more than wind turbines and gambling halls) and quality of life (more than good schools and smooth roads) to realize the impact of high-value health care, some investment capital might emerge.

Iowa Headlines

Hospice workers get life out of caring for dying
Joyce  Hutchison continues to use her passion and years of experience to educate others about the benefits of hospice. Part of that is overcoming fear. Going to hospice won’t make patients die any sooner, she said.  (November 4, Des Moines Register)

Genesis will demonstrate da Vinci surgery system
Da Vinci offers a precise, minimally invasive procedure for hysterectomies and prostatectomies. Patients benefit with a faster recovery time, shorter hospital stay, less pain, less scarring and quicker return to normal activities.  (November 5, Quad-City Times)

Harkin asks big insurers to explain rate practices
Sen. Tom Harkin said this week he was launching an investigation into health insurance pricing, asking four major insurers to justify their pricing practices.  An industry spokesman called the move unfair and misguided.  (November 4, Des Moines Register)

U.S.  Headlines

Costs at urban hospitals may get extra scrutiny in health bill
As Congress struggles to rein in health care costs as part of its sweeping reform efforts, hospitals in New York City and other urban areas that provide some of the most expensive care are among the primary targets.  (November 2, New York Times)

Health bills aim a light on doctors’ conflicts
As part of the health care overhaul under consideration by Congress, lawmakers have included so-called sunshine provisions intended to shed light on the financial relationships between the medical industry and doctors.  (November 3, New York Times)

Program will monitor Maryland doctors’ hand-washing
State officials said this week they’re creating teams of staff members at hospitals around the state to secretly monitor their colleagues’ hand-washing habits as part of a first-of-its-kind program. The monitors will contribute to a systemwide report on hand-washing, using $100,000 in federal stimulus money.  (November 3, Associated Press)

Texas lawmakers try to give doctor-owned hospitals a dose of help
Texas House members are mounting a late effort to delay new limits on physician-owned hospitals, putting them at odds with Democratic leaders who think the facilities drive up health care costs.  (November 5, Dallas Morning News)

Nurses union reaches deal on H1N1 safety in U.S.
The H1N1 pact, announced on Monday as part of a contract settlement between the California Nurses Association and Catholic Healthcare West, averted a one-day strike threatened by thousands of registered nurses at more than 30 hospitals.  (November 2, Reuters)

Hospitals make slow progress in harnessing the ‘social’ aspects of social media
Hospitals’ current social media activties can be classified across to five major areas: brand management, real-time public relations, volume generation, non-marketing functions and community building. But only a small amount of hospital activity in the social media space could be described as “social.”  Rather, the majority of these efforts are either one-way “monologues” or bounded two-way conversations with little staying power.   (October 31, iHealthBeat)

• Medical education in the United States has become specialized, centralized and urban.
• Many practitioners emerge from medical programs with a staggering amount of debt and go on to practice in urban areas, where they often receive a higher salary.

More doctors is not the answer

Simply increasing medical school slots is not the answer. According to the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, “Sizeable growth of the physician workforce in the last two decades has not resolved the maldistribution of physicians.”  On March 24, 2009 — House Energy and Commerce Committee Chairman Henry A. Waxman said that a congressional overhaul of the health care system must not only provide for universal coverage but also for more primary care doctors and nurses to ensure that an insurance card actually gives the holder access to treatment.

Physicians need to be rooted in the rural community

In a joint 2008 statement, the American Academy of Family Physicians and the National Rural Health Association stated that medical education anchored in rural places, nourished and funded through significant federal, state and local community support, and meaningfully connected to both regional academic institutions and local physicians in practice has great potential to address both present and future needs for physicians who provide care to rural populations.

DMU launches program to combat rural physician shortage with incentives

Concerned about the growing physician shortage in rural Iowa, Des Moines University (DMU) has embarked upon a “grow your own” program.  DMU and its Area Health Education Center have created the Rural Iowa Provider Education (RIPE) Program.

The RIPE Program provides specialized education, training and tools to better prepare students for service in rural, underserved areas of Iowa.  Because one of the known barriers for students choosing a rural medical practice is the tuition debt load from medical school, DMU has made an on-going commitment to annually provide the equivalent of six full tuition scholarships to students enrolled in the Rural Medicine Educational Pathway. In return, graduates agree to maintain a fulltime primary care medical practice in an approved Iowa community for a period of four years.

Are plans like DMU’s RIPE the answer to the shortage of physicians in rural areas? Are there other concerns or issues at hand? How would you bring more physicians into rural areas?

You can find more information about the RIPE Program on DMU’s website.

The eight hospitals participating in the demo project used a central hospital in Duluth to review all medication orders after rural hospital pharmacists were off duty.

According to the report funded by the Agency for Healthcare Research and Quality and appearing in the American Journal of Health-System Pharmacy, pharmacists at the hub hospital identified potential drug problems for patients in the rural hospitals n more than 700 occasions in the first 20 months. Researchers compiling the report suggested that the ARPOE system played a large role in providing safer patient care than if no pharmacist had been available to review orders.

As health IT continues to assist hospitals in providing better care, similar networks such as this may prove to be effective in assisting critical access hospitals who need help or additional resource.

[via AHRQ]