From the President, March 2017

Posted on Mar 7, 2017 in President's Message | 0 comments

Dear Medical Staff Colleagues,

I hope this newsletter reaches you in good spirits and in good health. Spring is around the corner, March 20, to be precise and although the rain has been much needed, I am looking forward to sunnier skies. Another important date to remember is Doctor’s Day which is March 30. Thank you all for your caring attitude and delivery of quality care for our patients at Alta Bates Summit Medical Center.

The Physician Engagement Survey results were released and although there are still areas that can be improved, overall the scores are much better compared with last year and show a significantly more positive trend. For more details please ask Dr. Ursi Boynton and Dr. Steve O’Brien.

The Wellness Committee continues to focus on physician burnout, stress and wellness. Here are dates to remember:
1) May 6th retreat at Green Gulch
2) April 29th at UC Berkeley – The Science of Burnout, What it is, Why it Happens and How to avoid it (see information below).

On a more serious note, as a reminder, if there are any changes to your attestation on the application and reapplication to the Medical Staff which pertains to malpractice lawsuits, medical board actions, restriction or suspension of your privileges or criminal activity other than a misdemeanor, including for instance DUI, please inform the medical staff office in a timely fashion. This has always been required in the Medical Staff Bylaws which is not new but can be overlooked and at times forgotten.

There is going to be construction to the ED parking lot and the timeline and details of this project will be announced as we get closer to the date. An important detail is that as construction ensues and as parking space becomes limited, the ED parking lot will be restricted to physicians who are on call, i.e. you won’t be able to badge in for access.

– New Appointments

Vice Chair of Emergency Department- Dr. Jeff Chen
Vice Chair of Anesthesiology Department – Dr. David Blacklock

As a reminder, if there are highlights you would like me to announce from your department, please let me know. We can include the information either in my President’s Report or as an article in the newsletter.

Be well,

Donna D. Tigno, M.D.
President of Summit Medical Staff
Co-Director of Critical Care at Summit Medical Center

“The Science of Burnout” Event

Posted on Mar 7, 2017 in Events | 0 comments

Please clink on link to register for the upcoming event, The Science of Burnout, What Is It, Why It Happens, and How to Avoid It:

From Leif Hass, MD
Wellness Branch Co-Chair

Get to Know Your Compliance, Privacy, and Information Security Officers

Posted on Mar 7, 2017 in Announcements | 0 comments

At Sutter Health, following our core values of honesty and integrity enables us to deliver positive patient experiences.  We build trust with our patients and colleagues by protecting their confidential information and doing the right thing every time.

Our Compliance, Privacy, and Information Security Officers are here to help us achieve these goals.  Many of you have met us in training’s and meetings and at last fall’s very popular Ethics and Compliance Campaign.  By partnering with one another, we raise awareness about recognizing, preventing, and reporting potential issues.

We welcome any questions from you and are glad to join your teams’ huddles and meetings.  Please also feel free to contact us if you are working on a project that involves patient information.   Below is our contact information and some common reasons to reach out to us.  Thank you for promoting our culture of ethics, honesty, and integrity across the organization.

Nathan Perumal, Compliance Officer

 Fraud, waste, and abuse

  • Billing and coding compliance
  • Proper documentation
  • Conflicts of interest
  • Physician contracting
  • Research compliance
  • Identity theft

Nicholas So, Privacy Officer

  • Patient information disclosed to wrong person/place
  • Privacy training
  • Patient privacy rights
  • Access to electronic systems with patient information
  • Business associate agreements
  • Advice on privacy laws and regulations

Dana Carter, Information Security Officer

 Email encryption

  • Information Security training
  • Phishing or whaling emails
  • Strong passwords
  • Lost or stolen computers
  • Advice on Information Security laws and standards

Nicholas So
Privacy Officer

Tips for your Preoperative H&P

Posted on Mar 7, 2017 in Health Information Management | 0 comments

For those performing surgeries and procedures, please review the following regarding your H&P’s.  One of the many important points to remember is that if your patient is receiving anesthesia other than local anesthesia, an interval H&P is needed after your patient is “checked-in / admitted” for a procedure whenever the H&P is done within 30 days.  This includes H&Ps that may have been done in your office only hours before.

1. H&P completed after check in / admission, no interval update is required.

2. Inpatient and Outpatient procedures: H&P within 30 days:

– H&P update / Interval note must be completed and documented within 24 hours after admission but always prior to surgery for an operation or procedure requiring anesthesia, other than local.
– H&Ps done within 30 days of admission are acceptable if the Physician documents an “H&P interval note”  that includes the fact that the patient was re-examined and the full HP was reviewed, no changes or changes documented.
– Update must be signed, dated and timed.
– It is recommended that the H&P update / Interval note be documented directly into EPIC.  If entering directly into EPIC the following navigators tools are available for your use.
– Access the Preop tab within the Periop navigator.  There is an activity that says “H&P interval notes”, click on the button that says “add interval”.
– A template is available called “General H&P update note”.  Template can be reached through your note navigator.

3. All H&P’s must:

– Include date, time and signature.
– If using your office H&P do not use white out to change dates and do not obliterate by writing over the old date of H&P.
– Do not use signature stamps.
– Documentation in the body of the H&P must coincide with the H&P dates.
– H&P performed more than 30 days prior to admission does not comply with timeliness requirements and a new H&P must be performed.

Entering H&P directly in EPIC?

– Ensure H&P is entered on the correct surgical encounter.

From Alisa Stinn, RHIT

EHR Upgrade Alert!

Posted on Mar 7, 2017 in EHR Updates | 0 comments

Our next EPIC Upgrade will take place on April 11, 2017.  Below are a few highlights.  Training materials will be available closer to the release date.  For additional details, please contact Patty Fitzgibbons, EHR Physician Liaison, at 510-325-9618.

  • Leave of Absence (LOA) Functionality for patients going from one Sutter facility to another for the purpose of having an outpatient procedure, when the patient will be returning to the original location.
  • Modifications to the Discharge to SNF workflow
  • ICU Liberation Bundle
  • Adding Affiliate Metadata to patient notes

From Patty Fitzgibbons
Physician Liaison

Investigation of Seoul Virus Outbreak

Posted on Mar 7, 2017 in Announcements | 0 comments

Please click on link to review the official CDC Health Advisory regarding the Investigation of Seoul Virus Outbreak Associated with Home-based, Rat-breeding Facilities in Wisconsin and Illinois:

Sutter Community Connect

Posted on Mar 7, 2017 in Announcements | 0 comments

Please click on link to review the Sutter Community Connect: Providing Clinical Connectivity for Independent Practices:

Welcome, New Physicians

Posted on Mar 7, 2017 in New Physicians | 0 comments

Emily Baldwin, MD
2001 Dwight Way
Berkeley, CA  94704
(510) 204-4635

Yunjing Fang, MD
2001 Dwight Way
Berkeley, CA  94704
(510) 204-4635

Rita O. Kwan-Feinberg, MD
General Surgery
2850 Telegraph Ave Ste 120
Berkeley, CA 94705
(510) 204-8168

Siva P. Raman, MD
Diagnostic Radiology
2125 Oak Grove Rd. Ste 200
Walnut Creek, CA 94598
(925) 296-7150

Shawn D. Rosen, MD
Internal Medicine
1 Country Club Plz.
Orinda, CA 94563
(925) 254-3805

Scott A. Werden, MD
Direct Radiology
1839 N. Government Way Ste B
Coeur d Alene, ID 83814

From The Medical Staff Office

From the President, February 2017

Posted on Feb 8, 2017 in President's Message | 0 comments

Dear Medical Staff Colleagues,

When it rains it pours… the hospital is in full swing and at full capacity.

If you feel that you are working harder than ever, it’s because you are. In the month of December 2016 there were 890 admissions and in January 2017, the latest numbers are 902 admissions from the Summit Emergency Department. We are talking historic numbers! Yet despite this daunting number, our ED length of stay was lower in December than the same time last year. In addition, this holds true for our hospital acute care length of stay.

This takes cooperation and collaborative efforts from multiple departments, Administration and Medical Staff.

So thank you everyone for maintaining a commitment to delivering quality care to our patients and maintaining a professional collegiality which is so tough under this degree of stress.

Special “thank you” to the ED department, hospitalists, surgeons, and intensivists for all your hard work. Please let them know your appreciation when you see them in the hospital.

Influenza: we are also seeing a higher number of test positive +influenza cases. This is also a historic high compared to prior years. Please take care of yourselves and wear appropriate protective masks when you care caring for your patients.

Cardiac Cath Labs: Renovation and upgrades to each room continue in this phased project.

MPI program: our inpatient chemical dependency program recently passed an accreditation survey, CARF. Congratulations team! (see below)

Podiatry now has a regular call schedule. Many days of the month are covered but not all. You can refer to the Central Logic call schedule available on the Intranet to determine who might be taking call that day.

Wellness Retreat on May 6th at Green Gulch, please register for the event and mark your calendars. If you want more information please contact Dr. John Mouratoff or come by the Medical Staff Office.

Until next time,

Be well, Donna

Donna D. Tigno, M.D.

President of Summit Medical Staff

Co-Director of Critical Care at Summit Medical Center


MPI Passes CARF Survey

Posted on Feb 8, 2017 in Announcements | 0 comments

I am happy to announce that MPI, our adult chemical dependency treatment services on the Summit Campus, has successfully completed its CARF Survey. Based on comments from the surveyors at the exit conference, we anticipate that we will receive a full three year re-certification. The surveyors summarized their findings by noting, “we rarely encounter this level of excellence in the programs and organizations we survey.” 

I would like to thank and congratulate the MPI leadership team, particularly Terry Arnold, Irene Fernicola and Josh Kayman, M.D., for their outstanding work in preparing for the Survey. Additional thanks to Francie Pierce, Catherine Thorndal, Holly Colin, Rick Luna, Sunil Krishnan, Christine Carrizo, Anne-Marie Bondad, Sameh Nasser, Erika Wright and Rebecca Hummel-Moore, who all contributed to our success. 

The MPI staff are a special group of caring people who have dedicated their careers to the treatment of individuals suffering from addiction. It is difficult and important work. Please join me in congratulating them all for their accomplishment. 

Thank you.

 Tom Bonas, Ph.D.
Administrative Director
Behavioral Healthcare Services
o: (510) 204-5808
f: (510) 204-5992