DFMLG+Updates

This page will start with update #8 and go in reverse chronological order.  toc

Peer review learning points will not be included (since they contain patient information, even if information that can clearly identify the patient have been removed).

=Update #17=

Neil Jayasekera (on Lotus Notes) helps organize an annual ultrasound course. Please contact him if interested in attending. This year, it will be Saturday June 20 and Sunday June 21, 8 AM - 5 PM. A sample schedule from last year is attached.
 * Ultrasound course**

 Here are extracts from a blurb he provided me:  " Want to learn how to do basic bedside echocardiograms by Denis Mahar, Chief of Cardiology?  Want to learn how to evaluate for gallstones, ureteral stones, abdominal aortic aneurysm, DVT, CHF, CAP (and the list goes on)?

 The course costs $499, and each participant will be given a manual, 15 CME credits by AAFP and a certification of completion which can be used to help apply for ultrasound privileges at another institution. Similar two-day courses elsewhere  cost over a $1000. The $499 is __tax deductible__, because the money will help support the residency fund for Global Health and help offset the costs for any resident physician taking the course. We had 8 other people besides residents take the course last year, and we received great reviews.

 To ensure that everyone gets plenty of hands on experience with u ltrasound and time with our instructors we are limiting the number of participants in the course. Please let me know if you are interested.

 Thanks,  Neil Jayasekera MD"  

The __Code Blue Committee__ is looking for a representative in ambulatory care. Please contact Sonia Sutherland if interested.
 * Openings**

The __Administrative Affairs Committee__, which is chaired by Sara Levin, has openings. The committee's functions include: a) Review and propose revisions to the Medical Staff Bylaws b) Provide recommendations on other administrative matters referred to it by MEC c) Oversee the Institutional Review Committee (IRC) It meets roughly quarter, on the 4th Tuesday of a month, from 1 PM - 2 PM. The next meetings are May 26, then in September and December. Please tell me if you are interested.

__Prashanthi Gujjula__ has started working at Brentwood Health Center. Please see her attached picture. Prashanthi recently completed her residency at Mercy Medical Center, Redding, CA. She is interested in Women's Health and pediatrics. She completed her medical school in India. She is married and has one child 6 years old. Her hobbies include cooking and traveling. She speaks Telugu and Hindi.
 * Arrivals**

__Karla Ballesteros__, FNP, started working at Bay Point Health Center. She completed her Master's Degree/FNP training at UCSF in 1999. From 2008 - 2014, she worked for UCSF at a clinic in the Tenderloin called Glide Health Services. Most recently, she was working at La Clinica de la Raza in Concord. Her areas of clinical interest include diabetes and Women's health, and she would like to get more training in cardiology in the future. She enjoys teaching new nurse practitioners and nurse practitioner students. Her hobbies include spending time with her family, gardening, home improvement, and serving as a Sunday school teacher to first and second graders. She has been married to her husband Victor for nearly 13 years, and they have a ten year old son. She and her family moved from Nicaragua to San Francisco when she was nine years old. She speaks, reads, and writes Spanish fluently.

I am sad to announce that we have had several departures from family medicine clinic or in the near future, though most of the people will continue work in our system.
 * Departures**

__Nishant Shah__'s last work day is May 1. He is moving to Baltimore, where his wife will start a 1-year accelerated nursing program. Nishant graduated from our residency in 2008 and since then has done an amazing number of things in our system. Currently, he is Medical Director for Healthcare for the Homeless, Public Health Physician for TB and Communicable Disease, and a family physician at North Richmond Health Center.

__John Lee__ will be stopping family medicine clinic in Martinez after many years (decades) of service. He will continue doing dermatology clinics.

__Jose Yasul__ is stopping family medicine clinic in Martinez to become the Assistant Medical Director of CCHP. Congratulations, Jose. Thankfully, he will continue to help DFM with recruitment.

__Dave MacDonald__ is stopping family medicine clinic in Martinez, but he will continue doing inpatient work and orthopedics clinics.

__Analisa Loewen__ is stopping family medicine clinic in Pittsburg, but she will continue doing short notice clinics, newborn clinics, and some cross-coverage.

I've attached extracts of the minutes from the January and the February MEC meetings. Just for full disclosure, when I'm given an electronic packet with these minutes, there are a ton of other pages that relate to what was discussed at MEC, but I suspect few of you would have the time or interest to slog through them. So I extract just the transcribed minutes.
 * MEC Minutes**

In case you missed it in Troy's recent ccLink tips, I want to remind you that if certain criteria are met (such as presence of visit diagnosis, level of service, a progress note from an FNP or doctor), a clinic visit encounter may be automatically closed in a few days.
 * Automated closure of open encounters**

However, this automated closure mechanism has no way of knowing if your progress note is incomplete, is a draft, or even has errors. Also, you aren't notified if one of your encounters is automatically closed. This can create a patient safety issue.

While I encourage you to complete your progress notes as timely as possible (and please see below for Med Staff Bylaws regarding this), since that is best for patient care and safety, if you are concerned that one of your encounters will be closed prematurely, I've been told that if you have not selected a level of service, the encounter will not be automatically closed.

The Bylaws state:

" a. Providers are encouraged to chart as soon as possible after a visit. At a minimum, the diagnosis and treatment plan shall be charted at the time of the visit. The provider note must be complete within twenty ‐ four (24) hours."

= Update #16 =

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">***Paid* retreats** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">Thank you to everyone who participated in our retreat this past Sunday. I may not have communicated well to new-comers to our system: these are paid retreats, typically 7 hours, along with CME. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**Departures** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">I'm sad to announce that Ken Brooks, who has been at PHC for about 3 years, is leaving February 1. Among many things, his warm smile and sense of humor will be missed. He may continue doing some work in Contra Costa Health Services on a part-time basis. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**Home address updates** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">Please keep the medical staff office updated when you change your mailing address. There are a number of important things that get communicated with "snail" mail, such as: applications for re-credentialing, ballots for voting in elections. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**MEC updates** Please see the attached minutes from the December 15 MEC meeting. Also attached are some of the reports presented at the January MEC meeting, including an analysis from CCHP about Prior Authorizations. CCHP is definitely working on improving the prior authorization process and examining whether it might make sense to reduce the number of drugs requiring PAs. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**ECGs and Holter monitoring** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">The Medicine department attempts to interpret ECGs and Holter monitoring in less than 48 and 74 hours, respectively. If you are concerned that your patient's ECG was not interpreted in that time frame, please contact Gabriela Sullivan. If you are concerned that there is a delay in interpreting a Holter Monitoring, please contact Janyth Bolden. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**Walk-in Mammograms** Just a reminder that at Martinez, WCHC, and PHC, your patient may be able to have a same-day, walk-in mammogram. After you order the mammogram, you can encourage your patient to go to diagnostic imaging (except at lunch or just before clinic closure). If the wait is less than 20 minutes, your patient will be invited to have the mammogram then. Otherwise, they can schedule it. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**Openings** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;"> <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**Updated definition of an "active" patient** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">For the purpose of whether a patient is counted in your panel, the definition of an "active" patient has been slightly modified. If a patient has CCHP and is assigned to you, that patient remains counted in your panel regardless of how long it has been since that patient was seen. For non-CCHP patients, a patient has to have had a visit within the last 18 months to be counted. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">**Limited time window to get CSF sample to lab** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;">Dr. Kim (pathology department) asks me to notify everyone that if you do a lumbar puncture in clinic and obtain a CSF sample, you have very limited time to get that sample to the Martinez lab. The sample must be less than half an hour old to get a cell count and less than 2 - 3 hours old for chemistry tests. So unless you are planning on driving the sample over immediately, it may be impracticable to do tests on a CSF sample from an outlying clinic. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.8000001907349px;"> =Update #15=
 * Rajiv Pramanik stated that he is still looking for providers interested in participating in a workgroup around "Open Notes", i.e. progress notes being made available (on myccLink) to patients.
 * We have openings in the Peer Review Committee for representatives from Martinez, East County and Far East County. The Peer Review Committee meets the 3rd Thursday of each month from 2 PM - 5 PM. This is an opportunity to hang out with a nice group of colleagues, learn a lot, and contribute to the quality of care provided by the department, so I strongly encourage people to consider this. If you have clinic then, it can be canceled. If you have admin time then, you can bill ST/OT for doing that admin at another time.

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;">** Survey on adequacy of our “provider network” ** <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> In case you missed a prior email: the State requires health plans like CCHP to survey its providers annually about access for our patients (California Code of Regulations 1300.67.2 ), i.e. do we have an adequate network? You can do the survey online (but the survey may be configured to allow only one survey per IP address, so you might need to complete it at home) or complete and fax the attached survey. I encourage you to do the survey, as it is an important means to give feedback to CCHP. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;">** Interested in having the ability to schedule appointments for your patients yourself? ** Several providers piloted having the option (it was not required) to schedule appointments for their patients and found it to be nice. For instance, if they called a patient to discuss some issue and then decided it would be good to see the patient, they could schedule an appointment and immediately tell the patient the date and time, without having to go through an intermediary (such as their care coordinator). Plans are afoot to give all providers this option, and training materials are being prepared. The appointment unit will want to know who is interested in getting this ability. Please notify your division head if interested. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;">** Openings ** The __DFM Peer Review Committee__, which meets in Martinez on the 3rd Thursday of each month, 2 - 5 PM, is looking for new members. Current members include Annie Cherayil (chair), Dawn Marie Wadle, Will Sheldon, Stasia Tell, Karen Alingog, David Hearst, Kate Goheen, and Donna Kaufman. We want representatives from all regions of the county, so we are looking ideally for one or two people to represent the Martinez Division, one for East County, and one for Far East. If you have clinic then, it can be canceled. If you have admin time (or are off), you can get ST/OT for the work. You also get the time from 1 - 2 PM that Thursday to do any of the preparation you need to do for the meeting itself. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;">__ Sonia Sutherland __ wants you to know that if you have interest in __patient safety and quality improvement__, there are educational opportunities and projects. Please contact her directly if interested. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> West County Health Center may need a provider for their __Wound Clinic__ (your home clinic does not have to be WCHC to work there). Here are some things that a current provider wrote about the clinic. " Currently the clinic is on Friday mornings, but there is a possibility of changing it to another day if it works with nursing staff and space. The schedule is set up for 6 patients only, although we have been overbooking up to 8 or 10... Two great nurses will work with you in each clinic and the cast techs are very helpful with UNNA boot and cast applications. Dr. Dosanjh and the Orthopedic service have been very helpful with referrals for extensive surgical debridements, flaps or cases of osteomyelitis." <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.7272720336914px;">** Departures ** I'm sad to announce several upcoming departures. Benjamin Ordaz's last day of work will be around January 2. I believe he will be joining a Sutter clinic very close to his home. Joanna Mandell is moving out of state. Her last clinic will be a little before Christmas. As Dave Solomon already announced, he is moving down to southern California. He will work at Venice Family Clinic, an FQHC in Venice Beach. His last day of clinic will be December 19.

=Update #14= <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Tentative date for next retreat is Sunday, January 25** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">We are still working on the agenda for the retreat, but Mark Wille has said he will come speak about thyroid disorders, so that should be a great talk. Nishant Shah and Ken Saffier will talk about SBIRT screening and how to respond to positive screens.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">We are thinking of making the retreat a teensy bit shorter, so that people don't have to get up so early and fill as much of their Sunday, though this means you would get paid for less time. Please tell me your thoughts about that.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**MEC updates** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">To help you all learn more about what happens at the Medical Executive Committee (MEC) meetings, I will start attaching the MEC minutes.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Openings** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">__Lead preceptor:__ The lead preceptors have an opening. As a lead preceptor, you would get to join a great group of other faculty (i.e. it includes me, hee hee) who have three primary roles: 1) precepting one half day per week 2) Be available to do fill-in precepting at any of the four sites where we have residents 3) Do administrative and leadership work for the residency (up to 8 hours per week). You also would attend a meeting on Tuesday PMs, every 4 weeks, that rocks!

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">If interested in applying or learning more about the position, please contact Lisa Quinones (another great faculty). A document further describing it is attached.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">__Residency interviews__ <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">The residency program needs volunteers to help with interviewing applicants. The interviews will be on Tuesdays, morning and afternoon, from November 25 to January 27 (and also the Mondays of November 17 and December 15). You can cancel clinic to do interviews. Ideally, you would commit to doing at least 2 half days of interviews (with 2 interviews per half day). Please inform Kristin Moeller or Rebecca Lee if interested.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">__Working with cute babies__ <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">The peds department has two opportunities to work with newborns. First, they are rolling out new newborn clinics for follow-up after discharge from the hospital. The provider works with a lactation consultant. See the attached document that describes this more.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Also, the hospital needs providers interested in weekend or holiday rounding from 8 AM to noon.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">For both of these positions, contact Francine Jolton via Lotus Notes if interested.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">__Committees__ <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">We have several openings for membership in committees, some of them official MEC committees. A propos to committees, I thought you should know that there is discussion within MEC about enacting a new requirement of medical staff: each member would have to serve on at least one committee. This requirement would serve at least two purposes: one, engage medical staff more in participating in the work needed for a high-functioning medical staff; two, help fill holes in committees, which often have vacancies.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Here are two openings:

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">1) Open Notes: Rajiv Pramanik would like to lead a group that will discuss the possibility of our system adopting an Open Notes policy, i.e. patients would be able to see our notes. Please contact Rajiv directly if you are interested.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">2) Cancer Committee: Michael Gynn chairs this committee that meets 6 times per year, typically on the first Monday of each even-numbered month, usually 12:15 to 2 PM in Martinez. Next meeting is December 1. This committee needs at least one outpatient primary care representative (who can attend at least 4 of the 6 yearly meetings). The goal of the committee is to ensure best quality cancer care, from screening, to diagnosis, treatment, survivorship, palliative care, and community outreach. This includes meeting the standards set by our national accrediting body, the Commission on Cancer. Contact me if interested.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**New representative to Ambulatory Care Redesign** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Rohan Radhakrishna, who recently graduated from our residency program, is now the DFM representative to ACR and will meet with DFMLG about twice per month. Also, he has volunteered to try to write a monthly update of happenings with ACR. He and I will ponder more whether it makes sense for him to send out that update (and have people reply to him directly) or for me to include it in these periodic updates. If you have an opinion, please tell me.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Arrivals** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Here are a couple new hires, both going to Martinez.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Chris Zamani, who graduated from our residency about a little over 2 years ago, just returned. He is coming from the Native American Health Center, in Oakland. He will be doing staff development in minor procedures clinic.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Anita Heart starts in mid-November (if all goes well with finalizing her credentials). Anita trained at Mercy Medical Center, in Des Moines, Iowa. She is coming from Marshall Medical Center, in Placerville, CA. She is interested in evidence-based medicine, geriatrics and procedures. She is a movie buff and enjoys reading. She is married with 2 children. Her husband works for Intel. She speaks also Tamil and Telugu. Here is a link to a photo of her.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Prior authorizations for medicines, any progress?** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">James Tysell wants you all to know that CCHP is still working on getting data or reports about prior authorizations for medicines, regarding whether it makes financial sense for us to even require prior authorizations. =Update #13=

Every year, we try to send a couple people to this annual event at Santa Rosa, to recruit graduating residents to come work for us. This year, it is going to be held at the Hilton Sonoma Wine Country Hotel in Santa Rosa on January 22. Please tell me if you are interested in going. You can get paid for your time, ST/OT, including the travel time (and I imagine for mileage and a bridge toll, with a receipt). Last year, Joann Mandell and Brea Bondi-Boyd went and said they had a good time. Though I periodically send out notices when a particular clinic is especially in need of a provider (so if someone wants to transfer there, it would be great), I do not announce every opening. There is periodic turnover at all the sites, so now and then, each site may have an opening. If you think you are interested in transferring sites, please notify me, and even if there isn't an opening, you can be put on a list that the division heads and I keep track of. Generally, we will give people already in the system priority over possible new hires.
 * Santa Rosa Family Medicine Residency Recruitment dinner**
 * Openings**

By data that I track, from the "Provider Open Panel report", it appears that there are about 10,000 more patients assigned to family medicine providers in September, compared to April (but only 3,000 more compared to December, 2013). The clinic most impacted has been North Richmond (with Antioch perhaps second), where the number of assigned patients has gone up more than 40% since December. Thankfully, we have a new provider joining NRHC soon (see below).
 * Influx of patients**

I aim to send out announcements about new hires before they start, but a high percentage of a time, there is some kind of hiccup with onboarding, so the new provider doesn't start when hoped. I mention this just in case you wonder why someone I mention doesn't appear as scheduled.
 * New hires**

She likes to go by Ali. She starts around October 1 at WCHC. She will also be helping administer the residency's Gyn-Peds block and working in EPL clinic.
 * Alison Block**

Dr. Block recently completed training at Santa Rosa Family Medicine Residency program and is thrilled to be joining the CCRMC team. She is particularly interested in full-scope women's reproductive health care, as well as in providing care to underserved populations from an Integrative Medicine perspective. She speaks Spanish and is looking forward to working with the large Latino population in Contra Costa. Originally from New York City, she has called the Bay Area home for over 10 years. In her free time, she loves to explore the woods as well as the city with her husband Tim and daughter Stella.

Margaret will start at NRHC around October 6.
 * Margaret Kray**

Margaret completed her Bachelor's at UC Berkeley in Environmental Science and her nurse practitioner training at UCSF. She has worked the last 6 years in a private family practice called Piedmont Primary Care (previously Clinica la Luna y el Sol). She loves primary care and is also interested in global health and infectious disease. She enjoys running, yoga, (very controlled) rock climbing, surfing (which means a lot of falling down), cooking and traveling. She was born and raised in southern CA, along with both of her parents, and has lived in the Bay Area since 1998. She speaks Spanish and Italian and is currently trying to learn Turkish.

Dr. Moring-Parris will start at Martinez Health Center on October 6. He will also precept and do staff development in Positive Health Clinic.
 * Daniel Moring-Parris**

He attended medical school at SUNY at Buffalo and completed family medicine residency (including being a chief resident) at San Jose O'Connor. He is currently working at the Gilroy Health Center, part of the Santa Clara County Health System. He is interested in outpatient procedures, prenatal care, and effective EMR utilization. He enjoys hiking, climbing, skiing, and disc (golf and ultimate), The New Yorker, cooking, and eating burritos. He grew up in "slightly" upstate New York. He just go married on September 6 to Ruxi Radu-Radulescu (who is joining our OB department, I believe). He speaks Spanish.

Brandy Danison is remaining at Contra Costa doing full-time work with the cardiology department, but she is stopping her family medicine clinics in Martinez October 1.
 * Departures**

Just a reminder that if you wish to get some one-on-one training with a SuperUser to help you get more efficient with ccLink, you can do so. The policy per administration is that one of the two of you (either you or the superuser) can cancel a clinic to do so, not both. If either of you does it on admin time, you can charge ST/OT.
 * ccLink efficiency training**

Nikita Hughes in the appointment slot says that starting last week, the appointment unit has been working to update our templates so that effective October 13, we will not have a double slot at the start of clinic. Instead, the template will look like:
 * No more double slot at 8 AM (1 PM), effective October 13**

8:00 Office visit 8:15 Office visit 8:30 Provider approved 8:45 Office visit 9:00 Provider approved 9:20 New OB 9:40 Office visit10:00 ER/Hosp 10:20 Office visit 10:40 Care coordinator only 11:00 Provider approved

Be on the watch October 13 for glitches in your template.

**Update #12** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Openings**

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Please tell me if you are interested in any of these positions.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">1) Ambulatory Care Redesign (ACR) team: DFM really needs someone to represent us at ACR. Major decisions involving clinic work are made at those Thursday afternoon meetings.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">2) NCQA PMCH Recognition: Our organization is pursuing recognition by NCQA as a Patient-Centered Medical Home. We need someone to work with Donna Kaufman to help with this project. Donna would do the majority of the work, but you would help advise Donna on how our current medical home functions and where we meet or don't meet criteria. You would help communicate to the medical staff what efforts we must undertake to achieve PMCH recognition. Chris Farnitano says you can charge ST/OT for time spent on this project.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">3) Concord Wellness Center: we need a physician (I believe not an FNP, since we already have FNPs there) interested in doing primary care at this unique integrated behavioral-physical health center.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">4) Bay Point: This cozy clinic needs a half-time provider, preferably Spanish speaking, to work alongside Greta Perez

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Robo-calls** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">In case you weren't aware or had forgotten, this is a reminder that our patients get automatic calls to tell them to schedule an appointment, based on what we click in the "Follow-up" section in ccLink. So when you accidentally just type 6 (without clicking on "months") and it defaults to 6 days, when you meant 6 months, that explains why a diligent patient may show up in a week. This happened to me recently.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">The clock (for deciding when the patient gets a call) is based on the patient's last visit in the department (not necessarily the last visit with the PCP). Short-notice visits reset the clock. After the amount of time specified in "Follow-up" has elapsed, if the patient was not seen in the department or does not have an appointment scheduled, an automated phone call is generated.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">One reason I mention this is because to improve access in our system, we all need to consider carefully how soon our patients really need to be seen back. Specifying a time interval in "Follow-up" may impact when the patient calls for an appointment.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**New hires** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Ahmed Farrag will be joining Martinez Health Center, with hopefully his first day of his own clinic being the 11th. He shared the following about himself:

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">He graduated from AinShams University in Cairo, Egypt and did residency training at Adventist La Grange Memorial Hospital 20 miles out of Chicago. He has been working for Mercy Health System for 5 years in their outpatient clinic. Mental health is really "intriguing" to him, and DM, HTN, CAD, STDs and skin procedures are "fun". He is married to Jolanta, and they have 2 children, a 2-month old and a 22-month old. He also speaks Arabic, and his wife speaks Polish and has taught him some Polish. His current hobbies have everything to do with raising his children. He loves swimming, walking, and cars, and he shoots hand guns.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">So I'll try hard not to mess with him....

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">...since I have a fear of people who can walk **AND** swim. Hee hee.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">**Departures** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">I am very sad to announce that Elise Lewis is leaving Contra Costa Health Services. I hope people won't mind that I write at a little greater length than usual about this departure, since I have known Elise since I started here as a resident 12 years ago (she was one year ahead of me in residency) and for a period of time worked closely with her. She did great work as a chief resident, served as Associate Program Director (during which time among other things she created the lead preceptor group and brought order to preceptor and resident clinic scheduling), and served on DFMLG. Her patients at Brentwood Health Center will also miss her and her compassionate care. We and her patients have lost a great doctor and leader.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;">Thank you everyone for all your continued hard work. =Update #11= Results of survey about 11-slot template Thank you everyone who participated in the survey about how to configure the template for 11 patients. The results were the following:

Double slot at 8 AM: 5 votes "Strong" front loading (8:00, 8:10, 8:20, 8:40, etc): 4 votes q15 minutes from 8 - 9: 11 votes q15 minutes from 9 - 10: 3 votes Evenly spaced (from 8:00 to 11:20): 11 votes

This means that it was a very close vote.

Overall, there was leaning towards front loading the clinic at least a little bit, so DFMLG has decided that we will work with the appointment unit to implement the q15 minutes from 8 - 9.

Openings 1. Post-partum rounding: Help is needed on Monday, Wednesday and possibly Friday morning. 2. Kaizen, August 25 - 29. The focus of the event is still to be determined.

Please notify me if you are interested in either opportunity.

25% open panels Due to the possibility of a large influx of new patients under the Affordable Care Act, at least 50% of all providers (at a given site) were open to new patients from January - June. In July, we are reverting to the usual policy of at least 25% (please note, providers with an adjusted panel size of less than 1500 are open regardless).

Medical Staff Dinner Reminder that it is on September 26. Mark your calendars!

Departures I am sad to announce that two members of our department will cease to do family medicine clinic: Jamie Navel will soon become a nocturnist in our hospital. Kaaren Nelson-Munson will be departing for another job.

Arrivals We have many new hires in the works, with signed offer letters or extended offer letters, but none has arrived quite yet. I'll "introduce" them when they start work.

Peer review learning points Here are two cases from the Peer review committee:

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 16.3636360168457px;"> 1) We reviewed the case of a 20 y/o pregnant patient who was Rh negative and not given Rhogam till 35 weeks.The patient was seen in family medicine clinic for her 25 and 29 week visits by the same provider who is also her pcp.The problem list did not have Rh negative status. The initial prenatal visit was in the prenatal clinic.

Learning point: (From Uptodate) Routine administration of anti-D immune globulin is recommended early in the third trimester [in Rh-negative patients]. The optimum dose regimen in the United States is 300 micrograms at 28 weeks of gestation. This practice reduces the incidence of antenatal alloimmunization from 2 to 0.1 percent compared to just the single postpartum dose. 2) We also reviewed the case of a 50 y/o patient with long history of back pain with a questionable change in her incontinence. The provider was concerned about Cauda Equina syndrome as documented in the chart and ordered neurosurgery urgently, though this was delayed due to insurance issues.

Learning point: Cauda Equina is considered a medical emergency, and, if suspected, the patient needs to be sent to an emergency room for a stat MRI. Since we don’t have a neurosurgeon in Martinez, this might mean sending the patient to alternate hospitals (Summit, John Muir). See also Dr.Tzvieli’s email sent 4.17.14.

Per Uptodate, in cauda equina, "Bowel or bladder dysfunction may be a symptom of severe compression of the cauda equina, which is a medical emergency. Urinary retention with overflow incontinence is typically present, often with associated saddle anesthesia, bilateral sciatica, and leg weakness. The cauda equina syndrome is most commonly caused by tumor or a massive midline disk herniation."

Using "Patient List" functionality in ccLink to help your care coordinator schedule certain patients The following is my totally unofficial suggestion about how you can use an aspect of ccLink to increase the chance that patients you wish to see fill up your "provider approved" and "care coordinator only" slots and thus reduce the chance those slots are filled by patients not assigned to you. I've attached some screen shots to help demonstrate this process.

The general concept is to maintain (so this takes a little work on your part, but it is probably worth it) a list of patients (called something like "Needs appointment") you wish to see back, without necessarily a specific time frame. You share this list with your care coordinator. The care coordinator periodically checks your schedule (perhaps a week in advance) to see if there are empty slots and schedules patients on this list into those slots.

This has been working well with my care coordinator.

For now, I have been asking her NOT to remove patients from the list (after they have been scheduled). I will remove them if they actually show up for the appointment. But an alternative is to create a second list called something like ("Got appointment") and to have your care coordinator transfer names from the first list to this second list as appointments get made. This way you can still keep track.

Here are the steps to create and share a list (with corresponding screenshots): 1) Click on the "Patient List" icon (see the arrow) 2) Click on "Edit List", and then select "Create My List", to create a new list 3) Name the list 4) Specify that you want "Patient Name" and "MRN" to be columns in the list 5) Click on "Advanced" and type in your care coordinator's name to grant access 6) Click on the "magnifying glass" in "Access Level" to pull up a list of 5 levels of access you can provide your care coordinator. "Add/Remove Patients" or "View Only" should be good, depending on what arrangement you make with your care coordinator. Click "Accept" when you are all done. 7) Now you are all ready to add patients using the "Add Patient" button. Patients can be removed by right clicking on them.

=<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Update #10 =

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Please remember to do the survey on priorities for clinic improvement. We've gotten about 30 responses, which is pretty good (thanks!), but we would like far more to make sure it is fairly representative of our department. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Attached is a copy of the annual report I submitted to MEC, including the 3 attachments (labeled A – C). It is not light reading. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Please also find attached the second edition of the Ambulatory Scoop. Thank you very much to Emily Cotter, for creating this great document. Several people helped edit it, too (but sorry, I don't know all their names).

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">**Retreat, June 8 **

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Please remember to RSVP for the retreat on June 8. Thank you to Joe Chavez Carey for organizing a great program. Here is a tentative schedule:

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 8:15 Breakfast <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 8:35 Patricia Tanquary: update on the effect of the Affordable Care Act on CCHP <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 9:25 Chris Farnitano: Ambulatory administrative update <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 10:15 Bill Walker: Administrative update <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 11:05 Howard Shaw: dermatology for primary care, part 2 <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 12:05 Lunch <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 1:00 Guest outside speaker: Ashby Wolfe, on Top legislative issues affecting California Family Practice in 2014 <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 2:00 Vijay Bhandari: new statin guidelines <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;"> 3:00 Lisa Quinones and Lary Boly: Pain management update, with small group breakout session

<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">**Openings** <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">**Locums** <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Jose Yasul informs me that we now have at least two locums interested in working in clinic. Craig Desoer has volunteered to help DFMLG in managing locums, including keeping a close eye on the quality of the care they provide. DFMLG has an agreement with administration that any locums will NOT remain here long-term as a locums. After a brief trial period in which the locums can check us out and vice-versa, the locums will be offered either a permanent position or be asked to leave. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">**11th slot** <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">The templates are being put in place. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Several people (or groups) have raised concerns about the double slot at the start of clinic ( 8 AM for the morning). The double slot is still being implemented, but administration appears open to the possibility that if it turns out to be a bad decision, a different template can eventually be put in place. As I mentioned in a prior email, this double slot was decided upon unfortunately in a hurried fashion. DFMLG would approach any revision of the template in a more deliberate, inclusive fashion. We are working on finding out the details of what is actually feasible, and then we will present several options in a survey. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">The “care coordinator only slot” will in fact be implemented. However, apparently due to limitations of the system, it will not be possible to make a hard stop such that only care coordinators can access it. It will be available to nursing (no differently from “provider approved”). Hopefully, the name will give people pause and make clear any violations. Like any other time that you discover clear violations of appointment guidelines, if you find misuse of the slot, please send details to Nikita Hughes (but there have been many times when I thought an appointment slot was misused and turned out to be okay, so please do a little homework before sending off your email). <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">**New hires** <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Great news. Thanks to Jose Yasul, we continue to do well in hiring people. Please thank your division head for helping out with this, too. In the first 10 months of my tenure, we have done about 26 interviews! <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Emma Winfield, FNP, will hopefully start in June at Antioch. Sorry, I don’t have a blurb of her to share with you. <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Ian Wallace starts in few weeks, at Martinez. He kindly submitted the attached photo (wearing sunglasses is an autosomal dominant trait, but his two-year old daughter received one recessive allele from each parent). Ian did medical school at the University of Colorado, completed residency at Ventura, and is finishing an Advanced Procedures Fellowship (colonoscopies/EGDs/cardiac stress tests) in Longmont, CO. Prior to medical school, he was a software/network engineer and helped Ventura roll out its EMR. He enjoys telemark skiing, sailing and traveling. He and his wife are expecting their second child in August. They will be looking for someone to deliver their baby (it will be a tough delivery if that baby inherits the sunglasses trait). He speaks "mediocre" (his description) Spanish.
 * 1) <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">The next two Kaizens (Rapid Improvement Events) are scheduled for July 7 – 11 (focused on an improved process for establish care visits) and August 25 – 29 (topic to be determined). Please email me if you would like to participate.
 * 2) <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">North Richmond Health Center has openings, so please notify me if you are interested in changing your clinic location
 * 3) <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Bay Point Health Center has an opening too. Spanish-speaking would probably be much better for all involved, since Bay Point has the highest percentage of visits in which patients specify Spanish as their preferred language (over 50%).
 * 4) <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">The Martinez Wellness Center opened May 7. If you are interested in doing some short-notice clinics there, please tell me. These will be unique in having some slots designated for ER follow-ups, such as wound checks, infection checks (i.e. close follow-up for a febrile kid, outpatient pneumonia treatment). Though they will have the same number of appointment slots as other short-notice clinics, Dr. Farnitano believes most of these ER follow-ups will be easier, making for an overall easier clinic with some variety
 * 5) <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">The likely closure of Doctors San Pablo Medical Center (the ballot measure failed) will likely mean an increase demand, especially in West County. Details are still being worked out, but we will be looking for people interested in doing more short-notice clinics, probably at West County Health Center.

=<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">**Update #9** = <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**New hires** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">The most exciting thing is that we have several new hires in the works.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Monica Laimayum, MD, will start in early April at Martinez.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Chere Sealey, FNP, will start in early April in Concord.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We have another doctor who will start in Martinez in June, but I'll have more to tell about that person in an update closer to then.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Four graduating residents will be staying within DFM. Jim Walls will remain at WCHC. Rohan Radhakrishna will be moving to WCHC. Leah Schweid Romito will stay at PHC. Geena Jester will join the DFM inpatient division but hopes to share a panel in Concord.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We continue to interview a lot of candidates. I'd like to give a special thanks to Howard Shaw for the extra work he does to screen and then interview the FNP candidates.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We expect to have several more offer letters out within the next few weeks.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Superoverbook slot** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">I mentioned this special slot in my previous update. It has now been implemented. Your care coordinator (and no one else), and only with your explicit request to use your "superoverbook" slot, can now overbook a patient at 9:30 AM or 2:30 PM.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**New "Chronic Pain Medicine Agreement" is posted at iSite** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Thank you to Dawn-Marie Wadle and others (sorry that I don't remember who else) who put in a lot of time to revise the document.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">The link at iSite is: @http://isite3/Policies/MEDSRV/Chronic%20Pain%20Medicine%20Agreement.docx

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">A copy is attached.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Time sheet tips**

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Peer Review** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">The DFM Peer Review committee wants more referrals. You can even self-refer patients (it can be a valuable way to learn as well as to start an exploration of systems issues that impact care).

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">The committee is looking for new criteria to expand the number of cases that are reviewed. If you have ideas, please tell me or your division head. We may have a session at the retreat on this topic.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Current criteria are: <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> 1) A patient is prescribed >200 tablets of opiates without a utox in the last 12 months 2) A p atient with pre-existing diagnosis of CHF with an admission for heart failure was seen in clinic within 30 days prior of admission 3) Suicides and attempted suicides are automatically referred if seen in FM clinic in the last 30 days.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">More details on the opiate and CHF criteria are attached.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Here are some highlights from some recent peer review cases:

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> 1. A 50s y/o male, with a history of admission for MRSA cellulitis, was seen in short notice clinic for a skin infection. The provider’s note described the lesion as a pimple and listed a diagnosis of cellulitis. The treatment was topical muciprocin. The patient called his PCP later and got oral antibiotics. The problem identified was a mismatch between the description of lesion and the diagnosis and between the diagnosis and treatment.There was no mention of his past history in the note. Learning Point: Better documentation was essential in this case. A shortened summary of Cellulitis from Uptodate is attached for quick reference. 2. The committee also reviewed two CHF clinic visits seen within 30 days prior of hospital admission. Both providers did excellent documentation of almost all the required criteria. Great job! Learning Point: Ejection fraction is an important indicator in CHF which is sometimes missed in documentation.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Other goings on in DFMLG meetings** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Please note, we spend a huge portion every meeting talking about interviews, hiring, etc. Also, some topics are not felt to be appropriate to broadcast so publicly. So if it ever feels like these highlights are sparse, it does not truly reflect what happens at our meetings.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We started and hope to continue to find time to brainstorm on ideas about measures to make "establish care" visits better for patient and provider.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Around Mother's Day, ccLink will support "dual coding" under both ICD-9 and ICD-10. When that goes live, it may be worthwhile to start using ICD-10 codes, so then your problem lists will be better prepared for when ICD-10 is required October 1. Troy Kaji will come back to us with more information on how dual coding will work, and some (minimal) training is planned.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We are investigating what is the proper means to get feedback to the pharmacy techs (who help process refill requests), to help them improve their work.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">A proposal is in the works for how providers who do inpatient work (for Family Medicine-Surgery) can share a panel of patients in family medicine clinic.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Joe Chavez Carey participated in a Kaizen regarding various aspects of the appointment system, and a trial will be done in a couple clinics to improve how we provide notification when we sick. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> =<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.727272033691406px;">Update #8 = <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Some good news for our patients** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">These are just reminders of things previously announced.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">All MediCal patients can now be seen in our podiatry and dental clinics.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">If you missed Natasha Pinto's email announcing several developments in mental health resources, here is a wiki page repeating her points. Thank you to Natasha for this great work. <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;"> http://ccrmc.wikispaces.com/Updated+Mental+Health+coverage

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Trial of "superoverbook" slot** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">DFMLG has had discussions with Chris Farnitano and gave approval to conduct a trial of a new appointment slot called a **superoverbook** slot. This is an 11th slot in the template (at 9:30 in the morning and 2:30 in the afternoon) that will be used for overbooks and can be scheduled **only by care coordinators**, **only when the provider explicitly states to use the superoverbook slot**(by direct provider-> care coordinator communication). It has been used with success by the pediatric department since May with no complaints about its misuse. The purpose of the slot is to make overbooks easier to use and better for patients: patients get a definite appointment time, get a phone call reminder, and also get a rescheduling call if you cancel a clinic or call in sick. For the provider, it is easier to keep track of whether you have already overbooked someone for a given clinic. For registration, they are not surprised when a patient shows up saying he/she has an appointment.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">This slot in NO WAY means that you are expected to start scheduling 11 patients per clinic. It is just a way to make more convenient what many of you are already periodically doing.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Openings**:

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">1) We have an opening coming up at the end of March for another ccLink superuser. The superusers participate in ccLink improvement projects (such as piloting myChart and electronic prescribing of controlled substances) and training other users. Please contact me if you are interested. Current superusers, who can tell you more about what they are doing these days, include Patty Glatt, Nishant Shah, Jamie Pehling, Jose Yasul, Joseph Chavez Carey, Chandra Wildfire, Zita Latona, and Kwan Chun)

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">2) The residency has several openings in the Lead Preceptor group. As a lead preceptor, you would participate in projects to improve residency training in family medicine clinic, and you would do fill-in precepting across our system. Please contact Lisa Quinones if interested

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">3) There is space in Concord and Martinez. If you are interested in moving your home site, please notify me. If you are looking to move to a place with a lower cost of living, we can also probably find space for you in Brentwood.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Departures** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Asiya Khan left our system this month. Asiya started in our system as a Mark Stinson Fellow (in global health) and worked in Concord Health Center from 2010 to 2014. During her fellowship time, she completed an MPH from Berkeley and worked on developing a model for integrating behavioral health in primary care in underserved countries. She is moving to San Jose and will start a new job at Take-care Health.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**News from Medical Executive Committee (MEC)** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Some of you may recall that we did a "Culture of Safety" survey in about May 2013. Results will be presented at the end of March at another MEC meeting.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">There has not yet been a big influx of new patients. Panel sizes remain about the same.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">The Martinez Wellness Center will hopefully open in April.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">A new Antioch Health Center, slightly larger, is being planned with a goal of opening it in spring, 2015. It may include a lab and a mammography suite.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">**Some goings on within DFMLG** <span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We are interviewing lots of applicants (8 in February). We have some acceptances of offer letters!

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Michelle Orengo-McFarlane is DFM's temporary representative to the Ambulatory Care Redesign group, while Jamie Navel is abroad.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We discussed whether in-basket messages to the scheduling pool, asking for a patient to be reassigned to us, are not processed quickly. Nikita Hughes (head of appointment unit) wishes for providers to give examples if we discover this happening.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Andrea Sandler is participating in a 6-month collaboration with Kaiser to learn about Quality Improvement, especially as applied to improving mammography screening.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">Some members of DFMLG have been using with success the online method to complete patient disability forms, and others are encouraged to give it a try.

<span style="background-color: #ffffff; color: #222222; display: block; font-family: arial,sans-serif; font-size: 12.7272720336914px;">We are investigating what is the proper way to provide feedback to the pharmacy division and the pharmacy techs (who handle refill rewrites).

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