Epic upgrade – Sunday, Sept 8 Sunday Down Time: 2-4: 00 am

On Monday morning September 9th your screens will be re-arranged and I expect there to be some slowdown in your work flow.

You …. Can minimize this by taking time to do some work in the playground or at least view a video or two about the changes you will see and how to navigate.

If you will be at work Sept 9th, I encourage you to block some time in the weeks leading up to this to review a video or play in the playground to familiarize yourself with the new screens. As always, the informaticist will try to accommodate instruction requests but any lead time you can give will make it more likely you can get assistance. Call 241-5557, daytime hours to schedule your help: See additional EPIC information on pages 2-6 of this issue of the Provider Focus.

Concussion Awareness Month On July 30, Governor Kim Reynolds signed a proclamation designating August as Concussion Awareness Month in Iowa, acknowledging an important need to educate the public and bring awareness about concussions. Troy Kleese, Athletic Trainer at UnityPoint Clinic Sports Medicine and Concussion Center attended the event on behalf of UnityPoint Clinic Concussion Center and on behalf of the Iowa Athletic Trainers’ Society.

PROVIDER FOCUS

INSIDE THIS ISSUE EPIC UPGRADE SEPTEMBER 8TH CONCUSSION AWARENESS MONTH PROCLAMATION EPIC UPGRADE “NEED TO KNOW” INFECTION PREVENTION: CRE PHARMACY UPDATES PATIENT EXPERIENCE

WELCOME NEW PROVIDERS

CME/EDUCATION OPPORTUNITIES UPDATED: UNITYPOINT HEALTH-DES MOINES REGION ACO MEMBERS

2019 Hospital Provider Directories are now available in the Physician Lounge on all three campuses or by reaching out to Monica Aunan Monica.aunan@unitypoint.org or 515-241-3480.

September 2019

EPIC UPGRADE UPDATES Highlights of the changes you will see:

1. Storyboard: Redesigned workspace to provide quicker access to key details without switching screens.

2. Customize your activities such as adding Medical Navigator, (includes admission, consult rounding transfer,

discharge, procedures and provider tools) by clicking on the wrench.

3. Providers can now right click on a medication in the manage orders activity and choose hold medication

4. Providers can send to multiple pharmacies by clicking on the Pharmacy in Medication Reconciliation this screen opens and the provider can add other pharmacies to the list and then click Send to Multiple Pharmacies.

5. Discharge Medication Reconciliation will look different. Instead of choosing order, resume, discontinue you will click on the icons to continue, change/new prescription or stop a Home Medication. Inpatient Medications will show as Do prescribe or do not prescribe icons. The review and sign tab is gone. You will just review in side bar and sign.

Personalization of Workspace “Sticks” with Upgrade All The personalization you have made to your Epic workspace is not for naught. And you can continue to personalize up to the time of upgrade.

When the Epic Upgrade occurs on September 8th, your personalization will "stick" and be ready for you to start using with the new look and feel of the workspace. Specific personalization that will remain includes, but is not limited to:

• Toolbar and Epic Menu (includes Activities) • Theme • Sidebar reports • Favorites

Cardiac Monitoring

Bed shortages are often linked to availability of the specific bed capability requested by the admitting or ED provider.

Problems:

1. Telemetry is ordered as a surrogate for get a Cardiac Bed • All telemetry is remotely monitored (even on N3/N4). • The presence or absence of telemetry does not determine a need for a Cardiac Bed

2. Telemetry is ordered but then never discontinued … for days. • Currently there is no way to alert the nurse to an ended order • After the upgrade in September a better work flow for notifying the nursing staff that the initial order, for X #

of days, has been completed will be available. This will help get monitors off and then available for the next patient that needs one.

3. Telemetry is ordered without appropriate diagnosis for use. • Education on the indications for use of telemetry, based on the new American Heart Assoc. guidelines will be

more readily available for use at the time of ordering. • Currently the ED is working off the following guidelines:

DIAGNOSIS DRIVEN CARDIAC MONITORING Indication for Use Duration

Chest Pain / Coronary Disease

o Early-phase ACS Cardiac monitoring for 24 hours - 48 hours or until chest pain free and negative cardiac biomarkers

o Vasospastic angina (i.e., Prinzmetal) or apical ballooning syndrome (stress cardiomyopathy) Cardiac monitoring until symptoms resolved.

Arrhythmias o Ventricular tachycardia, non-sustained VT, post-resuscitation from

VT/VF cardiac arrest or hemodynamically unstable VT Cardiac monitoring until discharge

o Atrial fibrillation (new, recurrent, hemodynamically unstable, symptomatic, requiring rate control or initiation of new antiarrhythmic agent) NOT CHRONIC A. FIB

Cardiac monitoring until treatment strategy determined

o Symptomatic sinus bradycardia or asymptomatic sinus bradycardia requiring chronotropic medications Cardiac monitoring until resolved.

o Second degree Mobitz II or third degree heart block Cardiac monitoring until resolved o Congenital or genetic arrhythmic syndromes (e.g., WPW, Brugada,

LQTS) with hemodynamically unstable, recurrent syncope, increased arrhythmia susceptibility

Cardiac monitoring until appropriate therapy is delivered

o Evaluation of syncope Cardiac monitoring until cause and treatment identified

o Transcutaneous or temporary transvenous pacing wires Cardiac monitoring until pacing is no longer necessary or pacer placement

o ICD shocks, requiring hospital admission Cardiac monitoring for duration of related hospitalization until precipitating event treated

Other Cardiac

o Acute decompensated heart failure Cardiac monitoring until precipitating event is successfully treated

o Infective endocarditis Cardiac monitoring until clinically stable

Medical indications

o Stroke or Stroke rule-out Cardiac monitoring for 24 hours - 48 hours

o Moderate to severe electrolyte disturbance Cardiac monitoring until normalization of electrolytes

o Drug overdose Cardiac monitoring until free of the influence of the drug(s) Procedures (Major Cardiac Interventions and PCIs from CP/CAP Diagnosis) o Transcatheter structural interventions

• TAVR • Other transcatheter interventions (VSD, AD, valvuloplasty)

Cardiac monitoring for 72 hours Cardiac monitoring until discharge

o After non-urgent PCI, with complications Cardiac monitoring for 24 hours or until complication resolved.

EP Procedures/Devices o Complex Ablation Cardiac Monitoring for 12 hours – 24 hours o Atrioventricular Nodal Ablation with Concomitant Pacemaker

Implantation Cardiac Monitoring for 12 hours – 24 hours

o Transcutaneous or Temporary Transvenous Pacing Wires Cardiac Monitoring until pacing is no longer necessary or pacer placement

o ICD Shocks, requiring hospital admission Cardiac Monitoring for duration of related hospitalization until precipitating event treated

o Implantation of Permanent Pacemaker or ICD Cardiac Monitoring for 12 – 24 hours Surgery o Open heart surgery

• Uncomplicated • High risk for AF

Cardiac monitoring for 48 – 72 hours Cardiac monitoring until discharge

o Non-cardiac Major Thoracic Surgery Cardiac Monitoring for 48 – 72 hours o Non-cardiac Major Thoracic Surgery at High Risk for Atrial

Fibrillation Cardiac Monitoring until discharge

PROVIDERS PLEASE NOTE: When ordering telemetry, please initiate a nursing communication to contact the provider when the telemetry order is about to expire. Link to Guideline: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000527 MyUnityPoint Discharge Summary Release All Clinicians

On September 8th, to improve patient engagement and comply with CMS requirements, we release the signed Discharge Summary to the MyUnityPoint patient portal. Multiple communications around open notes in general have focused on the style of communication we have with our patients. Remember to consider these recommendations:

1. Substance vs. Tone 2. Be Accurate 3. Be Clear 4. Be Concise 5. Be Respectful 6. Addressing Sensitive Topics

Review with FAQ sheet sent to provider e-mails around August 22 Where can I learn more about Open Notes? You can learn more about the Open Notes project, including research results, testimonials and additional FAQs, at www.opennotes.org

Tip of the Month: New Oncology Flowsheet: Physicians, Advanced Practitioners and Clinical Staff: A new oral chemotherapy flowsheet, UPH ONC Oral Chemotherapy Assessment, has been created for use with oncology patients.

Cardiology Medication Preference List Updates Cardiology Physicians, Advanced Practitioners and Clinical Staff All medications on the Cardiology preference list will have the 365-day end date removed and this field will remain blank. If the medication being prescribed needs to have an end date, you will need to manually enter that date in the End Date field.

This change was brought about in response to patient safety concern and was approved by the Physician Ambulatory Advisory Committee (PAAC).

New Myelopathy Indications Available MRI and CT spine procedures now have the following myelopathy related indications to choose from:

• Myelopathy, acute or progressive • Myelopathy, painful • Myelopathy, trauma

Implants to Display on Patient List Column A new Patient List Column is now available to display implants that have a status of “Implanted” within the Implant activity. This Patient List column will not display implant documentation from the Flowsheet activity.

Carbapenem-Resistant Enterobacteriaceae (CRE)

What are CRE?

• CRE = Carbapenem Resistant Enterobacteriaceae. Enterobacteriaceae are a family of bacteria that live in people’s GI tract. Members of the Enterobacteriaceae family include: Klebsiella, Escherichia, Citrobacter, Enterobacter, Proteus (and others).

• Most Enterobacteriaceae are not highly antibiotic resistant but resistance varies.

• CRE are Enterobacteriaceae that are resistant to the carbapenem antibiotics.

Why the Concern?

• CRE are often resistant to multiple other antibiotics severely limiting treatment options. • The resistance can be spread to other bacteria.

▪ Mechanism of resistance varies. The most concerning mechanism is production of an enzyme (carbapenemase) that inactivates the antibiotic. This gene, KPC, is located on a mobile element that can be spread from one bacterium to another. There are multiple other carbapenemases (NDM, VIM, IMP) that are seen more commonly in other countries.

• The mortality rate in patients with CRE bloodstream infection approaches 50%.

How is CRE different from MRSA?

• MRSA, in general, represents one resistance mechanism, which is non transferrable, in one species of bacteria. Enterobacteriaceae include more than 70 different genera with multiple resistance mechanisms including carbapenemase genes which are transferrable.

• UPHDM no longer isolates for MRSA or VRE, but it is imperative to place patients with CRE on CONTACT precautions and adhere to strict hand hygiene guidelines.

How to Prevent CRE Transmission?

• Recognize cases

• Place both colonized and infected patients on CONTACT

• Limit medical devices when possible

• Use antimicrobials wisely. Reference: Centers for Disease Control and Prevention. (2015). Carbapenem-resistant Enterobacteriaceae in Healthcare

Settings. Retrieved from https://www.cdc.gov/hai/organisms/cre/index.html. For questions, call Infection Prevention at 241-6826.

Generic Lyrica® (pregabalin) Now Available in Pharmacies

Multiple drug manufacturers have received FDA approval to market the generic version of Lyrica®, pregabalin, following the expiration of Pfizer’s patent on June 30, 2019.

Similar to gabapentin, pregabalin is used to treat neuropathic pain and seizures. Pregabalin is more bioavailable and more lipophilic than gabapentin. While greater potency and shorter titration time are benefits of pregabalin, there are no large randomized controlled clinical trials that show differences in efficacy of the 2 products. In many cases, pregabalin can be dosed twice daily versus three times daily for gabapentin which may assist patients where adherence is an issue.

Pregabalin, like gabapentin, can cause dose-dependent dizziness and sedation. Lower starting doses and slower titration can lessen these side effects. Administer pregabalin cautiously with opioids due to an increased risk of opioid-related toxicity.

The lowest price for a 30-day supply of Lyrica® 150 mg two times daily (GoodRx.com) was $460, while the lowest generic price is listed at $18. Currently, a generic extended release version is not available.

For more information on pregabalin, see link below.

https://www.fda.gov/news-events/press-announcements/fda-approves-first-generics-lyrica

Aspirin Use in Primary Prevention: Changing Recommendations

The routine use of aspirin for cardiovascular primary prevention has been scrutinized based on recent clinical trials demonstrating lack of net benefit. National organizations, such as The American College of Cardiology, American Heart Association and American Diabetes Association have recently updated their clinical guidelines limiting the widespread use of aspirin for primary prevention. It should be noted that the use of aspirin in secondary prevention is still warranted.

Aspirin should be avoided in persons with increased risk of bleeding, including a history of GI bleeding or peptic ulcer disease, bleeding from other sites, age >70 years, thrombocytopenia, coagulopathy, chronic kidney disease, and concurrent use of nonsteroidal anti-inflammatory drugs, steroids, and anticoagulants.

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Identified Inpts & Outpts with CRE Q42018 – 1 pt identified

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ACC/AHA Guidelines

• Low-dose aspirin may be considered for primary prevention of ASCVD in select higher ASCVD adults aged 40-70 years who are not at increased bleeding risk.

• Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults >70 years given the high risk of bleeding.

• Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults <40 years due to lack of evidence to justify the benefit:risk ratio.

• Low-dose aspirin should not be administered for primary prevention among adults at any age who are at increased bleeding risk.

ADA Guidelines • Aspirin therapy (75–162 mg/day) may be considered as a primary prevention strategy in those with diabetes

who are at increased cardiovascular risk, after a discussion with the patient on the benefits versus the increased risk of bleeding.

Links:

ACC/AHA - https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/03/07/16/00/2019-acc-aha-guideline-on-primary-prevention-gl-prevention

ADA - https://clinical.diabetesjournals.org/content/diaclin/early/2018/12/16/cd18-0105.full.pdf

Patient Experience – Awards The 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 awards for Quarter 2 2019 were revealed with recognition of Most Improved (from Q1 2019 to Q2 2019) and Award of Excellence (highest performance) in Q2 2019.

Q2 2019 Excellence in Patient Experience Award Winners:

CAHPS Award of Excellence: Blank Children’s Hospital – 4th Floor (93.9% top-box score)

CAHPS Most Improved: Iowa Methodist Medical Center – North 5 (+16.4%age points in top-box score)

Press Ganey Awards of Excellence: Blank Children’s Pediatric Center – GI Clinic (97th percentile)

Press Ganey Most Improved: Iowa Lutheran Hospital – Penn Avenue Outpatient Therapy (+67 percentile points)

A big THANK YOU to all of the providers that practice in these areas for helping provide an EXCELLENT patient experience! Below are the criteria for the UPH-DM Excellence in Patient Experience Awards.

CAHPS: awarded to an individual inpatient unit or Ambulatory Surgery based on Rate Hospital 0-10 or Rate Facility 0-10 Top-Box Score

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

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

Welcome New Providers

Blank Children’s Hospital - Cancer and Blood Disorders Center

Cristiana Hentea, MD, is joining us after completing fellowships pediatric hematology-oncology fellowship and children’s health services research from Indiana University. She also completed her pediatric residency at Indiana University. Dr. Hentea went to medical school at Northwestern University.

Dr. Hentea will be working in the Blank Children’s Cancer and Blood Disorders Center with Nick Fustino, Samantha Mallory, Christopher Rokes, Wendy Woods-Swafford and Sarah Seehase. You can reach the clinic at (515) 241-8912.

Blank Children’s Hospital - Pediatric Palliative Care

Lane Moser, MD, MPH, joins us after completing his pediatric palliative care fellowship at Akron Children’s Hospital. He is returning to Des Moines where he completed his residency at Blank Children’s. Dr. Moser went to medical school at the University of Iowa Carver College of Medicine. While there, he also earned a master of public health degree.

Dr. Moser will be working with Rich Robus, Melissa Lipovac and Stephanie Nemmers-Bello. You can reach him at (515) 241-3218.

Blank Children’s Hospital - Pediatric Infectious Diseases

Joel Waddell, DO, joins us after completing his fellowship in pediatric infectious diseases and clinical pharmacology from the University of Missouri-Kansas. He completed his residency at Kansas University and went to medical school at Des Moines University.

Dr. Waddell will be working in the Blank Children’s Infectious Diseases Clinic with Veena Ramachandran, MD. You can reach the clinic at (515) 241-8300.

Midwife Services

Dawn Corriere, CNM, MSN, is joining us from Metro OB/GYN in Council Bluffs. She has a master’s degree in nurse midwifery from Frontier Nursing University in Hyden, Kentucky. Prior to that, she received her BSN from Midwestern State University in Wichita Falls, Texas.

Dawn will be working in Midwife Services with Justine Burris, Sea Fey, Susan Hernandez, Sara Johnson, Khara Keegan, Brooke Knop, Melissa Koch, Autumn Schmoker and Emily Walden. You can reach the clinic at (515) 309-6011.

Blank Children’s Hospital - Developmental Center

Michelle Ewest, DO, FAAP, is returning to Blank Children’s Hospital after working at Broadlawns Medical Center. Prior to that, she completed her pediatric residency at Blank Children’s. Dr. Ewest went to medical school at A.T. Still University, Kirksville College of Osteopathic Medicine.

Dr. Ewest will be working in the Blank Children’s Developmental Center with Nate Noble, Cynthia Hockman, Kristi Schmall and Amy Yuska. You can reach the clinic at (515) 241-3434.

STAR Center and Developmental Center

After earning her advanced degree from Maryville University, Kristi Schmall, NP, MSN, is transitioning from her role at Blank Children’s as a registered nurse to work as a nurse practitioner. She will be splitting her time between the STAR Center and Developmental Center. You can reach Kristi at the STAR Center by calling 515-241-4311.

Laura Nielsen, DO - Family Medicine - Norwalk Dr. Laura Nielsen completed her medical education at Des Moines University and she received her undergraduate degree from the University of Iowa. Laura completed an internship at Beaumont Hospital - Farmington Hills, formerly known as Botsford Hospital, is a 330-bed health care facility. She is board-certified American Osteopathic Board of Family Physicians. Dr. Laura enjoys taking care of patients of all ages and specifically finds interest in preventive care such as cancer screenings and weight management, chronic care management like diabetes, hypertension and mental health. Together, you’ll find the ideal way for you to go from getting well to living well. Her clinical interests are in women’s health, preventative medicine, family medicine, adolescent medicine, primary care and chronic disease management. When Laura isn’t in the clinic, you can find her spending time outdoors with her family, exploring new places, cooking, practicing yoga, staying active in dance classes and chasing her two little kids.

Ojash Raval, DO - Family Medicine - West Des Moines Dr. Raval completed his medical education at Des Moines University and received his undergraduate degree from Iowa State University. Dr. Raval completed his residency at Mercy Family Medicine and is board certified by the American Board of Family Physicians. Ojash is excited to begin providing comprehensive care in theWest Des Moines community. Dr. Raval's clinical interests include diabetes, preventive medicine, urgent care, newborn care, disease management, health and wellness, pediatric care and adult medicine.When Dr. Raval isn't in the clinic, you can find him downhill skiing, fishing, golfing, playing tennis or attending a concert!

John Melchert, MD Neurology and Epilepsy at Multi-Specialty - Methodist Plaza Dr. Melchert believes in patient-centered care with compassion. He does not see patients as a 'next' or a 'number', but a person with a potentially scary situation. He wants to help patients feel calm and explain the complicated jargon of medicine into simple and digestible language. Dr. Melchert is board certified by the American Board of Psychiatry and Neurology, and board eligible for Clinical Neurophysiology. His clinical interests are in seizures, epilepsy, neurological disorders and electrophysiology. When Dr. John isn't in the clinic, you will likely find him singing in his church's choir, traveling, exercising, hiking, playing board games or watching movies.

Christopher Ketter, DO - Family Medicine - Ankeny Prairie Trail Dr. Chris Ketter completed his medical education at Rocky Vista University College of Osteopathic Medicine in Colorado and he received his undergraduate degree from Kansas State University. Chris completed his fellowship at Southern Illinois University at Carbondale Sports Medicine Fellowship. He is board-certified by the American Board of Family Physicians.

He believes in preventative medicine and going the extra distance for his patients. Dr. Ketter blends osteopathic manipulative therapy with family and sports medicine to augment healing and promote healthy living. Together, you’ll find the ideal way for you to go from getting well to living well. His clinical interests are in adult and adolescent medicine, joint injections, osteopathic manipulative treatment, family medicine and sports medicine. When Chris isn’t in the clinic, you can find him exercising, reading, watching movies and listening to music.

Meredith Swenson, DO - Family Medicine - West Des Moines Dr. Swenson completed her medical education at Des Moines University and her undergraduate degree from Calvin College in Grand Rapids, Michigan. She completed her residency within the UnityPoint Health family at Iowa Lutheran Family Medicine Residency. Meredith is also board certified by the American Board of Family Medicine. Meredith’s clinical interests are in women’s health, pediatrics and preventive health. She is excited to begin caring for families in the Des Moines community, and building lifetime relationships with her patients. When she is not in the clinic, you can find her spending time with her family at the lake or traveling.

Amber Schardt, ARNP - Internal Medicine - Penn Avenue Amber completed her medical education at Clarkson College and her undergraduate degree from The University of Iowa. Amber is board certified by the ANCC. After serving years as a critical care nurse, Amber went on to pursue her current role as a nurse practitioner. Her clinical interests include preventative health, women's health, nutrition and disease management. Amber is as active outside the clinic as she is in it – when she's not treating patients you can find her biking, weightlifting, cooking, practicing yoga, hiking, running or spending time with her family.

Jenna Murray, DO - Pediatrics - Lakeview Dr, Murray completed her medical education at Des Moines University and she received her undergraduate degree from the University of Northwestern – St. Paul in Roseville, MN. Dr. Murray completed her residency within the UnityPoint Health family at Blank Children's Hospital and she is board certified in pediatrics. Dr. Murray's clinical interests include newborn care, pediatric preventative care, pediatric cardiology, sports medicine and adolescent medicine. Jenna is excited to be a part of your child's pediatric care.When she isn't in the clinic you can likely find her attending live music concerts, trying new coffee shops or spending time with her friends and family!

Jodi Jans, PA-C - Weight Loss - West Des Moines Jodi completed her medical education at the University of Alabama's Physician Assistant program in Birmingham, AL, and received her undergraduate degree from Iowa State University. Jodi is certified by the National Committee on Certification of Physician Assistants. Jodi's fascination with the human body led her to have clinical interests in weight loss management. She is excited to provide care for Central Iowa and be a part of your health and wellness journey. Aside from her passion to help her patients, Jodi is also passionate about animal rescue.

Michael Valliere, MD joined The Iowa Clinic because of our positive and collaborative atmosphere and focus on optimal care for every patient. General surgery affords Dr. Valliere the opportunity to treat a wide variety of patients and diseases, as well as work among a multi-specialty group. He understands preparing for and going through surgery can often evoke worry and stress, which is why reassuring his patients and their families is a top priority. Outside of work, he enjoys spending time with his wife Markita (who also works for The Iowa Clinic’s Palliative Care Department) and two sons, as well as bicycling and running. If he wasn’t a Surgeon, he wishes he could be a professional cyclist.

Daniel Dodge, DO joined The Iowa Clinic because, during medical school, he and his wife spent seven years in Des Moines and loved the city and people in this community. In 2016, while completing his Internal Medicine residency at UnityPoint Des Moines, Dr. Dodge worked closely with our Pulmonary & Critical Care physicians and considered them some of his best mentors. His interest in the field of pulmonary and critical care comes from his desire to meet the challenges of caring for critically ill patients and their families. The relationships and trust he builds with them are an equally important part of the experience he hopes to provide. Dr. Dodge grew up in a small rural community in Colville, Washington. He and his wife are excited to be back in Des Moines where they feel “at home.” Outside of work, he has many interests, which include spending time with his wife, son and their dog, as well as golfing, hunting, camping, shooting sports, and football.

Muhammad Awan, MD joined The Iowa Clinic after living in both the northeast and south during his fellowship and residency. But after experiencing “Iowa nice,” he and his wife decided Des Moines would be a great place to raise their family - among friendly and hardworking Iowans. The welcoming of the staff at The Iowa Clinic plus our academically oriented cardiovascular practice is what ultimately lead him here. His interest in cardiology stems from, not only his fascination with the heart, but the sense of satisfaction he develops while caring for and building relationships with his patients and their family. Outside of work, Dr. Awan enjoys spending time with family and friends, playing basketball, and traveling.

Allison Whitney, MD chose pediatrics because the field combines her passion for medicine, science, and teaching young children. She enjoys building long-term relationships and knowing that she’s part of helping her patients mold their future. She knows, as a pediatrician, this is a huge responsibility as well as incredibly rewarding. Following families and watching the children she has cared for grow up, makes her job worth it. Dr. Whitney was born in Indianola but spent the majority of her childhood in central Illinois. She has lots of family in Iowa and is excited to be closer to them. Outside of work, she enjoys spending time with her husband, son, and chocolate lab, as well as reading, spending time outdoors and traveling.

CME/Education Opportunities

“Understanding Codependency”

October 4, 2019 9:00 am to 3:00 pm

Iowa Lutheran Hospital

700 East University Avenue, Des Moines, IA 50316 Conference Room A/B, Level B

Audience: Hospital staff members, Behavioral Health staff-includes clinical partners and therapists in mental health departments, case managers, social workers, chemical dependency therapists, counselors and clients

Purpose: To enable the learner to apply evidence-based information to develop healthy client relationships

Objectives:

• Describe the characteristics of codependency • Identify the impact of codependency on client relationship and behaviors • Recognize the impact of manageable and unmanageable events and behaviors on therapeutic and

interpersonal relationships • Identify behaviors and beliefs that support healthy behaviors • Discuss effective communication and behavioral skills to develop healthy therapeutic client

relationships Presented by: Kristin Hocker (Hepworth), LMFT, CADC, Powell CDC Family Services Program Fee: Powell CDC Clients & Family Members: $25

UPHDM Staff: $50 NON- UPHDM Staff: $60 NON-UPHDM Nursing Staff: $60 + $12 IBN Recording Fee

Approved for 5 Contact Hours by Iowa Board of Nursing, Provider #31, UnityPoint Health-Des Moines

Additional $12 IBN Contact Hours recording fee for non-UnityPoint Health Nurses 5 CEU’s by Iowa Board of Certification for CADC

5 CEUs for Social Work/Mental Health

CASH OR CHECK ONLY

Lunch is not provided ~ it is recommended that you bring your lunch OR food can be purchased in the ILH cafeteria.

Register at Powell CDC with Family Staff or contact

Kristin Hocker (Hepworth) at kristin.hepworth2@unitypoint.org or 515-263-4007

Registration is now open!

We will be celebrating our 45th consecutive year hosting this self-sustaining conference. You are what makes this a success and we are looking forward to another great year of learning and collaboration. Reserve your spot now, as space is limited. You can register at unitypoint.org/hawaii For more information and questions please contact Melissa Berry at melissa.berry@unitypoint.org or (515) 471-9331

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UnityPoint Health - Des Moines Region ACO Members Albrecht Foot and Ankle

Allergy Institute, P.C.

Allergy|Asthma Associates, PC

Ankeny Medical Park Surgery Center, LC

Associated Anesthesiologists, PC

Associated Ophthalmologists PC

Associates in Kidney Care

Boone County Comprehensive Specialty Care

Boone County Family Medicine

Boone County Hospital

Broadlawns Medical Center

Brooklyn Medical Clinic

Central States Pain Medicine

Clarke County Public Hospital

Dermatology, PC

Des Moines Anesthesiologists PC

Des Moines Eye Surgeons

Des Moines Internal Medicine

Des Moines Orthopaedic Surgeons

Des Moines Pediatric and Adolescent Clinic

Des Moines University Osteopathic Medical Center

Ducharme Dermatology, Inc.

Family Medicine, L.L.P.

Foot & Ankle of Iowa

Gallagher, James MD

Ganske, Greg MD

Greater Des Moines Dermatology

Greater Regional Medical Center

Greene County Medical Center

Grinnell Regional Medical Center

Guthrie County Hospital

Huxley Physical Therapy, Inc

Iowa Arthritis and Osteoporosis Center PC

Iowa Diabetes and Endocrinology Center

Iowa Digestive Disease Center, PC

Iowa Ear Center

Iowa Endoscopy Center, Inc.

Iowa ENT Center, PLLC

Iowa Head & Neck, PC

Iowa Kidney Physicians, PC

Iowa Pathology Associates, PC

Iowa Radiology

Iowa Retina Consultants, Inc.

Iowa Surgery Center, PC

Koch Facial Plastic Surgery and Spa

Lakeview Surgery Center, LLC

Lucas County Health Center

Madrid Family Practice - Boone County Hospital

Mary Greeley Medical Center

McFarland Clinic, PC

Medical Oncology and Hematology Associates

Metro Anesthesia and Pain Management LLP

Mid Iowa Fertility

New Life Family Medicine

Newton Clinic P.C.

Pediatric and Adult Allergy, P.C.

Pediatric Cardiology, PC

Pella Regional Health Center

Physicians Eye Clinic PLLC

Porto, Dennis, M.D.

Select Specialty Hospital-Des Moines, Inc

Story County Hospital

Surgery Center of Des Moines, LTD

Surgical Associates, LLP Grinnell

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The Iowa Clinic Endoscopy Center

The Iowa Clinic PC

Waggoner Pediatrics of Central Iowa

West Des Moines Children's Clinic

West Lakes Medical Equipment LLC

West Lakes Sleep Center

Westown Ambulatory Center

Wolfe Eye Clinic

Wolfe Surgery Center LLC

Women's Care Clinic, PLC

Skilled Nursing Facilities Brio of Johnston Calvin Community Edgewater Fountain West Health Center Hearthstone Heritage and Halcyon House Iowa Jewish Senior Life Center Kennybrook Village Mill Pond Retirement Community Northridge Village Norwalk Nursing and Rehabilitation Center On With Life Park Centre Parkridge Specialty Prairie Vista Village Spurgeon Manor, Inc St. Francis Manor Sunny View Care Center The Bridges at Ankeny The Village Urbandale Health Care Center Valley View Village Wesley Acres

Behavioral Health - Counseling Services

515 Therapy & Consulting

Alicia Rowley Counseling and Consulting, LLC

Amy J Ugulini Pals, LMHC, LLC

Audrey Giese, LMHC, LLC

Campbell Neuropsychological Services, P.C.

Capstone Behavioral Healthcare

Child Psychiatry Associates, PC

Clinical Assessment & Treatment Services, PC

Clinical Psychology, PLC

Compass Clinical Associates PLLC

Counseling Associates of Central Iowa P.C.

Counseling for Growth and Change

Des Moines Pastoral Counseling Center

Dustin Daugherty, LISW, LLC

Eyerly Ball Community Mental Health Services

L. Miller Counseling, LLC

Lifeworks, Inc.

Mosaic Family Counseling Center Inc.

Orchard Place

Patti Campidilli, LLC

Pine Rest Christian Mental Health Services

Prairie Wellness

River Valley Therapy Clinic, LLC

UCS Healthcare

Whispering Pines Counseling, LLC

Willow Grove Therapy Group, LLC

If you have articles to submit for publication, please send to Monica Aunan, Physician Liaison, UPHDM Monica.aunan@unitypoint.org or 515-241-3480

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