From the President, May 2016

Posted on May 5, 2016 in President's Message | 0 comments

Dear Members of the Medical Staff,Dr Tigno MS President

Here are the following updates and highlights for May.

–  Vicky Limbrick is the new Supervisor of the EHR Application Team, position previously held by Paul Fong.

– I am very interested in promoting Physician Mindfulness and Wellness. Physicians have increasing burnout and stress. There are many causes for this; some we can influence and others we can’t.

I want to generate ideas on how as a Medical Staff we can address this issue. Some of you are already one step ahead and have created unique avenues and solutions to confront this problem. For instance, there is a Physician Mindfulness Group that meets and meditates on Wednesdays at 5pm. (for more details and interest please ask Dr. Leif Hass, Dr. John Mouratoff and Dr. Manj Gunawardane). Yoga Sessions are being held at the Summit South Pavilion Family Resource Center Monday afternoons from 4-5 pm and 5:15-6:15 pm. There is a Dance Party every Thursdays at 4 pm in Room 2308 (2 East Hallway of the old Merritt Pavilion). One song/one dance as a quick break from work. There is not a dress code, but bring your groove on and drop by. Many of you have thought of great ideas like massage and yoga. I have been asked to explore the idea of a gym. So let’s continue the conversation.

-Friendly Reminder: We have been doing very well with timely documentation for H&P, discharge summaries, etc. However, we are still not in compliance with verbal orders signage. It becomes deficient if not signed within 48hrs. Please do your best to co-sign verbal orders. You may also co-sign your colleague’s orders if you happen to see them in the chart.  Please see the article below for instructions and screen shots. Thank you!

– Joint Commission Survey- Recently the Alta Bates Campus successfully completed their inspection; so congratulations to all involved! The Summit visit will be coming up very soon. There are still plenty of Blue Books/2016 Survey Readiness Handbooks and now a Sample Questions Q and A Handout in the Medical Staff Office.

– The Oncology Service Committee, which is multi-disciplinary, is now meeting monthly. The Chair of the Committee is Dr. Ostap Melnyk.

– Wednesday, May 11th is the Summit Hospital Week BBQ.  Breakfast is 6:30-10 a.m. in the cafeteria.  Lunch is 11 a.m. – 1:30 p.m. in the Plaza Park (outside Merritt Pavilion).   Dinner is 5-7 p.m. in the Plaza Park (outside Merritt Pavilion.  Physicians and all staff welcome.

Have a great month. Happy Mother’s Day to all the moms!

Be well,

By Donna D. Tigno, M.D.


Cosigning Verbal Orders

Posted on May 5, 2016 in EHR Updates | 0 comments

Verbal Orders by physicians are transcribed into the EHR by nurses. The orders must be cosigned by a physician member of the treatment team within 48 hours. There are 3 popular methods for cosigning Verbal Orders are shown below. See quick tips here.

Using the Manage Orders Navigator to Cosign: (with this method, you can also cosign for your colleagues and other physicians on the treatment team)

  1. Open the patient’s chart and select “Manage Orders.”
  2. Select the tab entitled “Cosign.”
  3. Click the “Sign All Orders” hyperlink in blue to sign all the verbal orders en masse.
  4. Click “Sign Section” or
  5. Use the “Sign” button for the individual order.

Signing Verbal orders from In Basket: (to cosign your own verbal orders)

  1. Click on the In Basket icon on the header tool bar.
  2. Click the “x Chart Completion” folder.
  3. Highlight the verbal order cosign message with the patient’s name by clicking on it one time. Order Details appear on the bottom (or right) of the screen.
  4. Click the “Sign” hyperlink to the right to sign individual orders.
  5. Click the “Sign” button above the message to sign all the orders at once.
  6. Click the “Refresh” button and the messages with “Done” status will drop off your message list immediately.

Signing Verbal Orders from Your MyPatient List (with this method, you do not need to open the charts; you can also cosign for your colleagues and other physicians on the treatment team)

  1. Click on your MyPatient List.
  2. Click on the “Cosign Ord” header
  3. Click on the Cosign Orders Report (mid-page report bar)
  4. Click to Sign Section


For assistance, contact your EHR Physician Liaison, Patty Fitzgibbons at or 510-325-9618.

Inpatient Status

Posted on May 5, 2016 in Uncategorized | 0 comments

  • Appropriate for:
    • A patient whose medical condition, safety or health would be significantly threatened if care is provided in a less intensive setting, ­and
    • Who requires 2 or more midnights of medically necessary services in the hospital
  • Orders in Sutter EHR (EPIC)
    • Admit to Inpatient
    • Admit Direct
    • Admit to Inpatient from Observation
    • Includes Emergency & Laboratory/Radiology services, MD Office visits, and Same Day Surgeries, Observation, Ambulatory Surgery, Outpatient in a Bed
  • Observation is appropriate for:
    • Short term evaluation and/or treatment
    • Further work up is needed before a decision can be made to admit or discharge
    • Decision to admit or discharge made within 48 hours, usually < 24 hours
      • Examples: Abdominal Pain, Chest Pain, Gastroenteritis
    • Unexpected complication following an outpatient procedure
      • Examples: Delayed recovery from anesthesia, protracted vomiting
  • Observation is not appropriate for:
    • Medically stable patients requiring diagnostic or outpatient procedures
    • Procedures routinely performed as an outpatient
      • Laparoscopic cholecystectomy, Kyphoplasty, Pacemaker battery replacement
    • Patients awaiting placement: SNF, Board & Care, Conservatorship, etc.
  • Orders in Sutter EHR (EPIC)
    • Initiate Outpatient Observation
    • Change Patient Class from Inp to Obs
  • Outpatient in a Bed (OIB) or Ambulatory Surgery is appropriate for:
    • Patients within the “recovery” state following an outpatient procedure or surgery
      • Appendectomy, Thyroidectomy, TURP
      • Non-emergent, elective Cardiac Catheterization
  • Patients who need an overnight stay after an Outpatient procedure (late case)
  • Patients who do not meet medical necessary criteria for Inpatient or Observation and have non-clinical or social issues presenting barriers to discharge
    • Examples: Failure to thrive, patients dropped off in the ED for placement
  • Orders in Sutter EHR (EPIC)
    • Outpatient in a Bed
    • Ambulatory Surgery

By Manj Gunawardane, M.D., Summit Hospitalist Director; Physician Advisor, Utilization Management

Understanding Clinical Documentation Integrity/Improvement

Posted on May 5, 2016 in Clinical Documentation | 0 comments

The transition to ICD-10 necessitates that physicians document more precisely, completely and consistently than before.

Clinical Documentation Integrity/Improvement (CDI) is the link between physicians and the coding department. Coders translate physician documentation into ICD-10 codes.

These codes are the basis of MS-DRG assignment, severity of illness, other risk rankings and observed:expected mortality scores.

Because coding terms are often not the same as commonly used clinical language, it’s not always obvious how to best document a condition. When clarity is needed, a query is a way to obtain this information.

There are two types of queries—CDI and coding. The former usually occurs during the hospitalization, the latter occurs after discharge. Queries aren’t trying to question your diagnosis, they are to help optimize your documentation.

Try to answer the CDI query promptly. Any clarified diagnoses should then be documented in the progress note and discharge summary.

If you don’t understand the query, contact the CDI team, especially before selecting the “unable to determine” option.

At Summit, call Ext. 7945 or 7946 to reach Sandra Christensen-Waldear, R.N., or Jane Banks, R.N., and 510-612-7085 to reach Beth Gong, M.D.

Please document diagnoses rather than just symptoms and lab findings (e.g. “pneumonia” rather than

“infiltrate and cough” and “lactic acidosis” rather than “elevated lactate”)

ICD-10 is about specifics such as acuity, type and etiology. For example, “acute diastolic heart failure due to rapid atrial fibrillation” is more specific than “CHF and atrial fibrillation”)

Clearly state conditions present on admission (POA) —especially catheter-related infections and pressure ulcers. Physicians should document the location of the ulcers but can leave the staging to the wound R.N.

It is important to be clear when there is an association or linkage between conditions. For example, it is clearer to the coder if you document “gastroparesis due to type 2 diabetes” rather than “gastroparesis in the setting of diabetes” or “diabetes and gastroparesis.”

When there is diagnostic uncertainty, inpatient coding allows for use of modifiers such as “suspected,” “possible” and “probable.” If a diagnosis remains “likely” or “suspected” at the time of discharge, be sure to document this in the discharge summary. Similarly, be sure to document when such diagnoses are “ruled out.”

Just because we can copy and paste, doesn’t mean we should. Without careful editing, inaccurate and outdated information keeps moving forward with copy and paste.

Specific words matter—physician documentation should be complete and precise for both the principal diagnosis as well as all the secondary diagnoses and co-morbidities—this is how you show how sick your patient really is.

By Beth Gong, M.D.
CDI Physician Champion, Alta Bates Summit

Welcome, Vicky Limbrick

Posted on May 5, 2016 in Uncategorized | 0 comments

We are excited to report that Vicky Limbrick has been selected to the BA Acute IP Clinical EHR Applications Manager position.

Vicky, who replaces Paul Fong, has more than 17 years of experience in health care and information technology, with 6 ½ years at Sutter, and most recently 3 ½  years as an applications tem supervisor.  She is EpicCare Ambulatory, Orders and ClinDoc Certified and possess a bachelor’s degree in information systems.

Her experience includes supervision of optimization and implementation projects as well as support. She also has Epic End User experience as a medical assistance and worked on the PAMF Epic rollout from 1999-2003.

Please join me on congratulating Vicky on her new role.  Her start date was March 28.

By Sameh Nasser
Acute director, Sutter Health Bay Area, Information Services



Medical Device Security Guidelines

Posted on May 5, 2016 in Announcements | 0 comments

1. Medical devices should not be connected to the internet, unless connection to the internet is required for the purpose of operation.

2. Medical devices should not be used to surf the internet at any time.

3. Medical devices should not be used to check personal email or Sutter Health email. This includes Sutter Health Web Mail, Outlook Web Access,  Email is the most common entry point for malware.

4. Do not open any programs or view, download or edit any documents or applications that are not required for use of the medical device.

5. All abnormal behavior should be reported immediately to Information Services.

6. Only approved software should be installed on medical devices. Users should not install any software on a medical device, only Biomed, IS or the vendor should modify a device.

7. Consider placing stickers on Medical Device computers to warn users that this is a medical device, and should be treated accordingly.

8. Only approved portable storage devices (USB, portable hard drives, etc.) should be plugged into medical devices. Portable devices can carry and transfer malware and/or spyware to a medical device.

By Jeff Trudeau, Information Security Officer Sutter Health,
Bay Area Office of the General Counsel

Sutter Community Connect

Posted on May 5, 2016 in EHR Updates | 0 comments


Topics of Interest

Posted on May 5, 2016 in Announcements | 0 comments

All Medical Staff members:

We are interested in hearing about topics of interest regarding any unique clinical activities you are involved in or have undertaken.  It was wonderful to hear from Dr. Frierson this month about what he is doing in retirement (It sounds like a busy retirement!!).   Let’s hear from more of you!


By Joanne Jellin, PsyD
Director, Medical Staff Services
Alta Bates Summit Medical Center – Summit Medical Staff


Blog Focusing on History of Medicine

Posted on May 5, 2016 in Announcements | 0 comments

I am a retired member of the Summit Staff, now in Palo Alto, and was a member of the Oakland Medical Group, specializing in internal medicine and infectious diseases. I recently started a blog, focusing on stories from the history of medicine. I thought the staff might be interested, particularly those whom I knew. The link is:

By Gordon Frierson, M.D.

Bio: After Dr. Frierson retired he took up photography for a while and is now spending time with the blog, travel, taking some courses and relaxing. He also works two half days in a free clinic doing general medicine.  He owned and operated “The Travel Doctor” – an immunization clinic for overseas travel for a little over 15 years.





Welcome New Physicians

Posted on May 5, 2016 in New Physicians | 0 comments

Lejla Delic, MD
Gynecology Oncology
3838 California St. Rm. 410
San Francisco, CA. 94118-1506
(415) 751-1847

Bradley Engwall, MD
2001 Dwight Way Ste. 4190
Berkeley, CA 94704
(510) 204-4635

Edward Holt, MD
3300 Webster St.  Ste. 202
Oakland, CA 94609-2130
(510) 208-1777

David Kagan, MD
Hospitalist, Medical
350 Hawthorne Ave.  Rm. 2346
Oakland, CA 94609
(510) 869-6883

Susan Nguyen, MD
Hospitalist, Medical
2450 Ashby Ave. Rm. 5505
Berkeley, CA. 94705
(510) 204-1893

Kavita Patankar, MD
Hospitalist, Medical
2450 Ashby Ave. Rm. 5505
Berkeley, CA. 94705
(510) 204-1893

Lynell Williams, Jr, MD
Critical Care Medicine
350 Hawthorne Ave. Rm. 2346
Oakland, CA. 94609
(510) 869-6883