President’s Message

Posted on Oct 1, 2021 in President's Message | 0 comments

First of all, I want to say thank you. The past few months have been pretty rough, with short staffing at ABSMC coinciding with the recent surge in COVID cases. Thanks for complying with the California healthcare worker vaccine mandate: to keep ourselves, our families, and our patients safe. And lastly, thanks for participating in the most recent physician engagement survey. Your responses are critical to making a better working environment at Summit.

A bit of good news: COVID cases across the system are finally on the decline. The graph below illustrates the daily case count over time within the Sutter geographic footprint.

Flu cases during the pandemic have been thankfully sparse, but as we are approaching the winter months, it is vital that we also get vaccinated for influenza to help avoid a twindemic of COVID and flu. Below is the schedule for the flu/TB clinics for the East Bay.

The CDC is currently also recommending a COVID booster (for those who received the Pfizer series) for age greater than 65 and those who work or live in high risk settings. That would include most of us, but it has not yet been yet determined that a booster is necessary for those that received the Moderna or J&J vaccine.  The news came unfortunately a bit late to incorporate Pfizer boosters to the flu/TB clinic schedule, so I encourage you to get your shot through your primary physician or your local pharmacy, or through https://myturn.ca.gov/

We continue to highlight the importance of wellness and mental health during these difficult times. Please see below for a list of resources.

EPIC refuel is coming soon – November 6. This is a major revision to EPIC that will bring the EHR more to a native state and make future upgrades less time consuming.

The Best of Epic:

Upgrades and Enhancements coming November 6th!

Secure Chat: fully integrated text messaging

  • Securely share patient information and images
  • Expanded to ALL Epic users on the desktop
  • Bonus: Physicians and Advanced Practice Clinicians can also use their mobile devices!
  • Facilitate team communications

Care Everywhere Image Exchange

  • Send and receive images with other Epic health systems
  • Phase 1: Outgoing images include clinical photographs, consents, POLST forms, and other items in the media tab
  • Incoming images include all of the above PLUS reference quality radiographs and ECG’s from other organizations that choose to send them

Efficiency and Usability Tools Including…

  • Personalization: Customizable SmartSets, Consolidated My Tools menu, modifiable Chart Review reports and Navigators
  • Efficiency: Improved patient search across the system, exempting orders from reconciliation, note template speed buttons, enhanced pre-charting
  • Enhanced Communications management function

As we approach the release date we will send out additional details about the new tools, but wanted to give you a sneak peek at what’s coming

Lastly, I wanted to share a letter from Barbara Kivowitz, a patient family advisor. Her words and thoughts capture a lot of the emotions we have been feeling recently.

Nature is good for us: Why I prescribe outside

Posted on Oct 1, 2021 in Wellness Committee | 0 comments

Nature is good for us:

Why I prescribe outside

A silver lining of the pandemic is that many of us have been forced to spend more time outside; we haven’t been able to do anything else!  I have been able to ditch my car and more safely pedal the 3.5 miles on pedestrian friendly streets to work.  One morning last spring, I was reflecting on how good the ride outside made me feel when I walked in to see Mr. T., a 68-year-old with several significant behavioral and medical problems.

Before I could say a thing, he jumped in as if in mid-conversation. “Dr Hass, I can’t thank you enough.  I swear that prescription you gave me mid- Covid lockdown saved my life!”  Nodding, I tried to hide the fact I didn’t recognize him and assumed he was talking about an antibiotic or some other medicine. 

“I was so depressed and isolated”, he said.  “You gave me a prescription to ride my bike to the marina and watch the sunset.  I have been watching that sunset almost every day until I got sick last week.  And the prescription is still on the fridge!  I can’t thank you enough!”

I have been giving out “old school” paper prescriptions for about 2 years now where I prescribe non-pharmaceutical  things that have been proven to make people healthier.  Apparently, I had given him one to get outside and take in the natural beauty of the sunset.

“Thank you, Mr. T.  that means a lot to me.”  I said, “Your feedback really helps!”

I had heard that nature can make people happier and healthier, but embarrassingly, revealing my bias, I envisioned it primarily for more “outdoorsy” people like me, whatever that means.  Also, I assumed it would just a slight bump in the happiness quotient.  Mr. T had shown me that I had underestimated both the impact of getting outside and who could be helped.

I became determined to dig a little deeper to understand the health benefits so I could do more with these prescriptions.

While much of the research has been done in the USA, Japan is where the science has been most readily embraced.  Starting with research on blood pressure and stress hormone levels in the early 2000’s, there is now a medical specialty in Forest Bathing and more than 25% of Japanese partake in the activity.  There are nearly 100 officially sanctioned forest where the benefits have been demonstrated and with guides to help visitors the get the most from their time in the forest. A measure of the Japanese commitment to health through nature is that the director of the ministry of forestry is a social scientist not a botanist.  Trees are seen more as a health resource than an extractable resource

What are the benefits?  Lower blood pressure, heart rate and stress, improved mood and immune function, better sleep and increased creativity.  There are surprising social benefits, too.   During early forest bathing experiments, Dr Qing Li found that after a couple hours in the woods, blood pressure went down an average of 5 points. The effects didn’t end once people left the trees; stress hormones were measurably lower for a week. After 3 days with 2 hours of forest bathing, markers of immune health showed improvement that last 7 days (researchers at the GGSC confirmed this finding in Yosemite!). And of course, almost all the people would say they just felt better, too!

What is forest bathing? It is essentially taking it all in – with all our senses.  In fact, looked at individually, all our senses have a role in nature’s restorative power.

Dr Qing Li’s group found that when people slept overnight breathing in essential oil from the sacred Japanese cedar tree, they reported better sleep and had lower stress hormone levels.  Since then, researchers at Vanderbilt have demonstrated nurses report less stress if this same oil is infused in their hospital workplace.

Sound researcher Joshua Smyth at Penn State has documented decreased the tension in our nervous system as measured by heart rate variability when people listen to songbirds.  It increases with rumble of cars and roar of airplanes.   Researchers with the Nation Park Service found their parks “look” worse when people hear man-made sounds and thus, view noise pollution as an important issue for the parks.  Man-made noise can be more than an irritant. Research in Bonn Germany found that kids at schools subject to a lot of airplane noise have a tougher time learning than those in control schools across town.

We are primarily visual creatures, so it is not surprising that simply looking at beautiful natural scenes makes us feel good.  A heart surgeon at Vanderbilt suspected it did more than that.  Looking at it closely, he found that his patients whose hospital room faced the forest healed faster than those who faced the parking garage. I never knew why hospitals are full of nature scene until I researched for this project.  Strange that this bit of data reached the architects, but not the doctors!

So why is the natural world good for us? The Biophilia Theory suggested that since we evolved in nature, our senses and body rhythms are best suited for that environment. According to biologist E. O. Wilson, there is an “innate emotional affiliation with other living organisms” that makes us calm and comfortable in nature.  The sounds, smells, sights are our evolutionary “happy place” where we can rest and rejuvenate.  We are deeply tied to a world from where have strayed, despite the comforts and safety of the modern world, there is a price to pay for urban living.

Other scientists espouse the Attention Restoration Theory, Rachel Kaplan at Michigan says the “soft fascination” with the beauty of the natural world along with its subtle mysteriousness draws us in.  It is “enticing but not demanding”.  fMRI data by her student Stephen Kaplan showed that looking at nature pictures let the hard-working executive function parts of the brain recover compared to looking at urban landscapes.

Emotion scientists like the GGCS’s own Dacher Keltner believe there is something else going on as well: awe.  It’s that feeling we get from seeing something vast, wonderous that challenges our comprehension; with it our jaw drops, and we get goose bumps as we say, “Awe-some.”  But more than that happens, we have the same physiological effects that are seen as we forest bathing where heart rate and blood pressure drop.  The “awe walks” the Dr Keltner recommends where one slows down and looks for the beauty as opposed to racing along are essentially a way to forest bathe.  Beyond the physiological there are pro-social effects of awe: less concern for self, increased generosity and more cooperation.  This might be why research suggests there is less violence when trees are incorporated into low income housing developments.

So, what do I prescribe now?  Researchers from Finland suggest that 5 hours a month is the minimum to have lasting effects (leave the technology behind or at least in your pocket).  It doesn’t have to be the forest; water, even urban parks, can be healing, too.   For those with the resources, I prescribe breaks to a quiet cabin or tent of at least 3 days once or twice a year.  I also recommend house plants for home and office, microbreaks of stopping work to look out the window or a nature video for one minute and a couple short 5-minute walks even if it is in an urban environment.

But how in our busy lives? Well, the pandemic has helped with that.  Many of us have taken our physical activities and social activities outside.  Skip the gym and coffee house.   A walk with a friend outside is a Greater Good “three-fer”: exercise, friendship and nature all at once.

We should also be thinking beyond of selves.  Access to the natural world is far from equitably distributed.  While access to green space is foundational in public health and urban planning, my country, the USA, is far behind, Japan, Korea, Singapore, and many European countries in efforts to integrate this idea into our society.  Yet through efforts of hard-working citizens, vets can get outdoor therapy for PTSD.  The SHINE program in the Bay Area is one of several park-healthcare collaboratives that get kids out of their tough city lives to nature once a week.  We should all be inspired by these efforts and find ways to advocate for green access as best we can.

We see the effects of this lack of access every day.  Last week, I was taking care of Ms. S, a 58-year-old woman with mental health and mobility issues complicated by poor social support.  She came to the hospital with abdominal pain.  Sitting down and talking to her I could see her mood and isolation were her biggest issues.  Notes in her medical record recommend psychiatric care and medications, but now I start with a different approach.  “What brings you joy, Ms. S?”, I asked.

“Well, I loved my flower boxes I had outside my apartment” she said.   “I planted herbs and flowers.  Tending the plants made me feel good, but the manager said it was a fire hazard and I have hardly been outside since they hauled them away.” Her comments are in line with data on the benefits of touch – hands or feet in the dirt – and wellbeing. There is also a large body of research on the positive social and health benefits of gardening.

Before she went home, our team gave her resources about community gardens and I gave a prescription to bus to Redwood Park and the lake.  While that felt insufficient, at least she felt buoyed that our health care team felt her garden was as important to her health as she did.

This is a lesson we all should learn from Ms. S: don’t underestimate the benefits of engaging with nature.  Researchers repeatedly found we tend to discount the wellbeing boost we get from nature. Coming out of this long public health crisis we all should cherish all the good we can.   I have tried to make this cognitive shift:  every episode outside is an opportunity to access the healing power of nature.  I try to see each tree as an incredible living being and forests, the shoreline and even my neighborhood park as sacred sites for communing with the wonderous natural world and restoring my body and mind.  And when I watch the sun set, I think of what it did for Mr. T.

Leif R. Hass, MD
Summit, Wellness Chair

Health Information Management Update

Posted on Oct 1, 2021 in Uncategorized | 0 comments

The Survey Window is open!

  • Complete and timey documentation
  • Sign you incomplete charts timely
  • Do your Verbal Orders often

Chart Completion:  Courtesy Text Message

  • Medical Record Committee members requested a more direct way to contact physicians.  A courtesy text message was proposed and sent to Medical Executive Committee for review and approval.
  • A courtesy text message was approved.  Physician cell phone numbers will be obtained from the Medical Staff Office.
  • The courtesy text message will replace the courtesy phone call made by HIM. 
  • Physicians will continue to receive other delinquency notifications via their notification preference (email, FAX or EHR inbasket)
  • The new text message was implemented June 2021.
  • When you receive an HIM text message, please complete your delinquent medical records before Thursday at noon.

Verbal Order Compliance:

Providers are required to cosign Verbal/Telephone Orders in fewer than 48 hours.  When a provider fails to do so, the provider is out of compliance and a deficiency is created. Our goal is to increase our compliance to a minimum of 95%.

Handy Tips:

  • Hardwire signing your Verbal/Telephone Orders by signing them when you end your shift.
  • Be sure to Sign all Verbal/Telephone orders including Discontinued and Canceled orders.
  • Work with your group to sign orders for each other.
  • Haiku provides access to your In Basket and you can quickly cosign there.
  • Email Reminders can be set up from your EPIC In Basket.


If you having difficulty reaching or exceeding the 95% goal, please contact your EHR Physician Liaison for assistance!

Surgery Documentation:

  • Please remember to include the EBL and Specimens removed in your IPON and or Operative Reports.  These elements are required.

Alisa Stinn, RHIT, Manager Health Information Department

ABSMC, SEBMF | 350 Hawthorne Ave | Oakland, CA 94609| P: 510.869-8741 | F: 510.869-8856 | M: 510.381-5181

Sutter Community Connect

Posted on Oct 1, 2021 in Uncategorized | 0 comments

New Physicians Memo

Posted on Oct 1, 2021 in New Physicians | 0 comments

President’s Message

Posted on Sep 2, 2021 in President's Message | 0 comments

I felt a pit in my stomach that weighed a ton. I had just gotten out of a code, a cardiac arrest that had sadly not survived. He was a relatively young man, and had a sudden and dramatic collapse, with not too many comorbidities. In short, his demise was quite unexpected. We had done everything possible, but that day was just not meant to be.

A short while later, my charge nurse notified me that his family had arrived and were waiting to hear news. Of course, I was encumbered, mired in the details of my other patients, but I knew that talking to the family was going to be the most important thing I did that day.

I had Stevie, the chaplain, as backup for some emotional support – not just for the family, but for me as well. When delivering bad news, you can never know how a family will react. Most of the time, it’s just sadness, but sometimes, it’s anger that can be misdirected at physicians and nurses.

As I walked toward a private room where the family was waiting, my brain had to switch gears. While working, I tend to be pretty analytic, almost a bit too calculating and cold in allowing logic to dominate my decision making. Though cognitive neuroscientists have dispelled the myth of a strict right/left brain divide, there are some useful distinctions between the two halves that interact. Take for example Broca’s area, the portion on the parietal lobe that encodes speech/language: the left side typically analyzes the content of the language, while the right side interprets the prosody and emotional content of speech.

I sat down with the deceased patient’s wife and his brother. Behind masks, our eyes met, and I could see that she was still hopeful. As I delivered the bad news, I could tell that she needed to hold my hand. She grasped very tightly on my every word. And as I tried to be analytical, I knew that that was not what she needed. She needed more, that human connection of grief. I hugged her as she sobbed. She thanked me for all I had done.

When I left that room, the pit I had in my stomach was gone. Perhaps it was a sense of relief on my part that the ominous task was complete, but I think that it was actually that I was able to help a family get some closure.

These are the challenges we face everyday, as we get lost in the minutiae of medical data. Our patients expect a translation of data into something more relatable, more personal. This is not only in times of bad news, but with equivocal and good news as well.  

On the business side of things, I hope you all have read the emails from the system, the medical staff, and our chief medical executive, Dr. Boynton.

Below is additional information to help us be compliant with the public health order recently instituted.

Vaccinated (at a Sutter hospital Dec 2020 – Mar 2021)

We should have your vaccination records. No further action is required.

Vaccinated (not at a Sutter hospital via myEHS)

If you are already fully vaccinated but did so in an outpatient setting or a non-Sutter hospital you should have received an email requesting you to submit your information. If you have not already done so, please use the following link to provide your vaccination information:  http://covid19.sutterhealth.org/VaccinationProof/external

Not vaccinated

If you are not yet vaccinated, then by Sept 30, 2021 you will need to submit either/or:

  1. Valid proof of vaccination: http://covid19.sutterhealth.org/VaccinationProof/external
  2. Valid religious or medical exemption via the following links:

http://covid19.sutterhealth.org/ReligiousExemption/external

http://covid19.sutterhealth.org/MedicalExemption/external

In addition, you will need to provide negative test results semi-weekly starting August 23, 2021 in order to continue treating patients in the hospital setting. Please use this link to submit your test results: http://covid19testresult.sutterhealth.org/external

  • Recommendations on testing frequency and timing can be found in CDPH guidance for acute care hospitals and all other clinical environments.
  • Clinicians do not need to submit proof of their test results. The state only requires they report the result of the test. However, it is recommended they retain proof of each test.

If you plan to be fully vaccinated, you will be exempt from the bi-weekly testing requirement two weeks after receiving either a single-dose COVID vaccine or the second dose of a two-dose vaccine and no further action will be required.

Please contact Leanna Hudson (Manager, ABSMC Medical Staff Services) if you have any questions or need assistance with your submission.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

It’s time again for the NRC Physician Engagement Survey!

Posted on Sep 2, 2021 in Uncategorized | 0 comments

It’s time again for the NRC Physician Engagement Survey! 

This year it will run for the entire month of September. We will be raffling AfterShoks headphones on a weekly basis for the duration of the survey window. Winning names will be randomly selected by NRC, so you must participate to be eligible to win. The sooner you complete the survey, the more chances you have to win!


Look for an email invitation from NRC Health <WorkforceSurveyInfo@nrchealth.com> with the subject line “Please Respond! 2021 Physician Engagement Survey for Alta Bates Summit Medical Center”. It only takes 10 minutes to complete! All responses will remain confidential, so you can feel comfortable sharing your thoughts and input anonymously. As a reminder, if a question asks your opinion of a service or specialty that is not a part of your usual practice, please skip the question rather than answering neutrally. If you receive more than one survey request, please complete one for each facility.

Thank you in advance for participating!

Ursula Boynton, MD
Chief Medical Executive
Alta Bates Summit Medical Center
Office: 510-869-6785│Cell: 510-703-7334
Administrative Assistant: Maria Freeman
Office: 510-869-8766│E-mail: freemamd@sutterhealth.org

Patient Experience

Posted on Sep 2, 2021 in Announcements | 0 comments

Below are our patient experience scores from the HCAHPS patient satisfaction surveys. MD Communication is the black line and represents the monthly overall score for this domain. The blue line is answering the question “How often did your doctor explain in a way you could understand?” The green line is the CMS 50th percentile. I sure feel that we provide better than average care, but these numbers suggest we are just below it.

So what can we do to improve?

Hospitalist Paul Cheung interviewed a group of high performing doctors to learn best practices on improving patient satisfaction.  Here are a few tips he recommends:

  • Anticipate our patients’ fears and address them proactively. For example, “You must be scared by the words ‘heart failure’, well, your heart might be pumping weakly, but it is not about to stop on you.  We will get it pumping normal!”
  • The next step discussion: helping the family and patients understand what will be happening going forward. I like to talk about ‘the plan for the day’ and ‘the plan for the stay’ so the patient and family know what to expect going forward.

 Thanks for all your work on this!

 Leif Hass, MD and the MD Communication Task Force

Tragic Optimism vs Toxic Positivity

Posted on Sep 2, 2021 in Wellness Committee | 0 comments

Tragic Optimism vs Toxic Positivity – it is important to find meaning in hardship rather than try to gloss over life’s realities, especially when times are tough!

Ms. S is a 75 yo who recently lost a child to a violent crime and another to Covid and kidney complications. Now she lives alone and has just found out about a lung mass.  During one of our conversations she said, “God helps us find a way when there is no way.”  I got goosebumps, my body’s signal to me that I was in the presence of something awesome.

My younger defiantly atheistic self would have questioned the merits of that answer, but now I see the wisdom of it – even for those of us who don’t believe in a guiding deity.  We can find transcendence in suffering.

 I am a big fan of gratitude and looking for the positive in life, but to be human is to suffer loss.  A meaningful life is derived in large part by how well we grow during these inevitable times of hardship. Covid, climate change, political and economic uncertainty, we are all suffering now or have our heads in the sand.

How does gratitude fit into this idea of “post-traumatic growth”?  Gratitude should not be “I’m lucky for all I have”, but “I am grateful for what others have given me and for the opportunities life has presented for making a meaningful life.” With that comes a desire to give back, strengthen relationships, build culture and grow spiritually.  Gratitude researchers call this existential gratitude: being grateful for all that life brings, both the good and the bad.

Gratitude can help us appreciate the little good things at the fringes of our suffering and also help us face the suffering with a growth mindset.

Loss is a defining part of the human experience.  Fully feeling our losses can tie us to others who have suffered and those who have worked to lighten our burden.  As health care providers, we should all feel grateful for the opportunity we have to lessen the burden of those we care for.  We might not do it through a cure, it might just happen with an open-ended question and a quiet presence that invites sharing of hard-won wisdom.  We can learn from our patients about grace and gratitude – a gratitude with depth.

The day Ms. S went home I took her hand and thanked her. “Your grace amidst suffering is a thing of beauty.” I said.

“Your loving presence might be the best medicine I have on God’s journey.” She said

No Pollyannaish “lucky me’s” or blithely blind positivity.  Just some old fashion thanks for sharing ourselves with each other.

Leif Hass, MD
Summit Wellness, Chair

Spotlight on Affordability: Alta Bates Summit Outpatient Pharmacy Achieves Zero Out-of-Pocket Costs for Patient Receiving Brand New Medication

Posted on Sep 2, 2021 in Uncategorized | 0 comments