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Winter 2021 PIERCE COUNTY MEDICAL SOCIETY

BULLET N Serving Our Members and Community Since 1888

Inside this Edition

• PCMS Announces New President • TPCHD: Overcoming COVID-19 • Executive Director Report with Teamwork

Visit us at www.pcmswa.or g

Table of Contents PCMS Officers/Trustees

PIERCE COUNTY MEDICAL SOCIETY

BULLET N

Ann Goetcheus Gehl, MD, President Dina C. Titova, MD, PhD, President-Elect A. Alex Mohit, MD, PhD, Past President C. Blake Perry, MD, Vice President Courtney M. Kennel, DO, Secretary/Tresurer Julian S. Arroyo, MD H. Matt Davis, MD Irene Grias, DO Christine L. Hammer, MD Nicholas Rajacich, MD Camille P. Samujh, DO, MPH

Serving Our Members and Community Since 1888

PCMS Foundation Charles Weatherby, MD, President Lawrence A. Larson, DO, Vice President Mark S. Grubb, MD Mary Eversole, Secretary

PCMS appoints first female president in nearly 20 years

PCMS honors Dr. Anthony Chen with 2020 Community Service Award

Feeling Inspired

TPCHD: Overcoming COVID-19 with Teamwork

The Bulletin

What COVID-19 Vaccine Should I Get? What to Tell Your Patients

The Bulletin

Opening Act

Staff Executive Director: Mary Eversole Membership Coordinator: Tanya McClain is published quarterly by PCMS. Contact Tanya McClain regarding deadlines for submitting articles and advertisements: tanya@pcmswa.org or 253-572-3667. is dedicated to the art, science and delivery of medicine and the betterment of the health and medical welfare of the community. The opinions herein are those of the individual contributors and do not necessarily reflect the official position of PCMS. Acceptance of advertising in no way constitutes professional approval or endorsement of products or services advertised. The Bulletin reserves the right to reject any advertising. Managing Editor: Mary Eversole Advertising Information: 253-572-3667; tanya@pcmswa.org

Cover photo: “Park shadows” by Kevin Tuck, www.rgbstock.com

223 Tacoma Avenue South, Tacoma, WA 98402 Phone (253) 572-3667 Fax (253) 572-2470 Email pcms@pcmswa.org

PIERCE COUNTY MEDICAL SOCIETY

President ’s Page

PCMS Appoints First Female President in Nearly 20 Years

or the first time in nearly 20 years, the Pierce County Medical Society (PCMS) has named a woman as its board president. Community Health Care’s (CHC) Dr. Ann J. Goetcheus Gehl was elected president of the organization and Dr. Dina C. Titova of MultiCare Rheumatology Specialists was named president-elect at the organization’s annual meeting held on December 8, 2020. Goetcheus Gehl serves as a medical provider at Eastside Family Medical Clinic in the Salishan neighborhood of Tacoma and Lakewood Family Medical Clinic in the City of Lakewood. She also teaches full-spectrum Family Medicine to the CHC Family Medicine Residents. Prior to this, she served as a faculty member at the Georgetown Providence Family Resident Program in Washington, D.C. She also has served on medical missions in Nigeria, Zambia and Eritrea. Prior to her career as a physician, Goetcheus Gehl served as a registered nurse at D.C. General Hospital in Washington, D.C. Her parents founded Christ House, a medical facility that provides comprehensive and compassionate health care to the homeless community in Washington, D.C. It is there where she attributes her foundation to serving her community. “As only the fourth woman to hold this office since 1888, I am humbled and honored to stand on the shoulders of the great medical leaders who came before me, and I can only hope that I will pave the way for future leaders,” said Dr. Goetcheus Gehl. “PCMS is well positioned for the future, and the board and staff are dedicated to growing the membership of the society and reflecting the rich diversity in Pierce County.” Goetcheus Gehl holds a Bachelor of Science in Nursing from The Catholic University of America and her Medical Doctorate from Howard University College of Medicine, both in Washington, D.C.

Ann Goetcheus Gehl, MD

Other PCMS board members include the following: President-Elect Dr. Dina C. Titova MultiCare Rheumatology Specialists Past President Dr. A Alex Mohit Harbor Spine and Joint Center Vice President Dr. Clifton Blake Perry Aesthetic Surgery Centre Secretary/Treasurer Dr. Courtney Kennel Physician Care NW Trustee Dr. Julian S. Arroyo Puget Sound Orthopedics Trustee Dr. Henry M. Davis MultiCare Tacoma General Hospital Trustee Dr. Irene Grias Franciscan Women’s Specialty Associates Trustee Dr. Christine Hammer Franciscan Neurosurgery Associates Trustee Dr. Nicholas Rajacich Mary Bridge Children’s Health Center Trustee Dr. Camille P. Samujh Rainier Anesthesia Associates Ex-Officio Dr. Anthony L-T Chen Tacoma-Pierce County Health Department Ex-Officio Dr. William K. Hirota Franciscan Digestive Care Associates

WINTER 2021

In Memoria m

PIERCE COUNTY MEDICAL SOCIETY

PCMS Honors Dr. Anthony L-T Chen with Community Service Award The Pierce County Medical Society (PCMS) presented Anthony L-T Chen M.D., MPH, Director of Health of Tacoma-Pierce County Health Department, with the PCMS Community Service Award. The award recognizes physicians who have made outstanding contributions to the community since 1992. Dr. Chen was chosen by PCMS for his exceptional dedication and leadership during the on-going COVID-19 public health crisis. His life of service has been devoted to health equity and access to healthcare. “It is a privilege to present Dr. Chen with the PCMS Community Service Award honoring his tireless leadership during a rapidly changing public health crisis,” said PCMS President Alex Mohit, M.D., PhD. “He has strived to balance all the needs of the County, recognizing harms and benefits with any decision and fulfilled his duty as our Chief Health Officer with persistence and compassion. Dr. Chen is a beacon in challenging times and sets a high bar in delivering public health services to all the citizens of Pierce County.” The award was presented to Dr. Chen during the PCMS Virtual Annual Meeting earlier this week.

Formed in 2000, the PCMS Foundation exists to raise funds to contribute to local non-profit agencies in efforts to provide assistance for those needing help in Pierce County. The Foundation awards grant monies to Pierce County non-profit agencies that provide direct services for Pierce County citizens who are most in need. Feeding the hungry, offering clothing, shelter and protection for the most vul-

nerable, and providing health care for those without access are the missions of the agencies they are proud to fund. The Foundation would not exist without the generosity of Pierce County Medical Society members. For more information or to make contribution contact the Medical Society office at 253-572-3667.

WINTER 2021

The holiday sharing card campaign helped raise nearly $15,000 for Pierce County non-profits!

PIERCE COUNTY MEDICAL SOCIETY

Donate anytime by mailing a check to: Pierce County Medical Society Foundation 223 Tacoma Ave S, Tacoma WA 98402 donations are tax deductible

E xecutive Director Report

Feeling Inspired Mary Eversole

t’s been almost 180 days since I took the helm at PCMS. Leading an organization that supports first responders during a public health crisis is a privilege. As the COVID-19 vaccine rollout started in the medical community, a need for the next phase was realized. Our health systems and health department would need clinical volunteers to help vaccinate Pierce County.

Like everything COVID-19, there were barriers with liability and licensing issues with volunteer vaccinators, especially for retired members. Fortunately, with assistance from Jeb Shephard at WSMA, we were able to resolve those issues in a reasonable amount of time. The PREP Act was invoked by Secretary Shah and the first hurdles for providers were cleared to help vaccinate Pierce County. We took a targeted approach and reached out first to our retired members. The response was tremendous! Those that had dedicated their careers to healing others were once again at the ready to help vaccinate Pierce County. That motivated us to expand volunteer recruitment to our full membership. As the volunteers responded to the call it was inspiring to read the responses and the comments. The most inspiring responses were those that were willing to volunteer on the weekends after working all week at their practices. At the end of the day, we are not out of the woods, but together we are living our mission. Inspiration at its best.

Bulletin Submissions If you have a clinical best practice to share with your colleagues, a success story about individual physicians or PAs or a health system, or news about health care innovation taking place in Pierce County that you would like considered for inclusion in an upcoming edition of the PCMS Bulletin, please send your submission to Mary Eversole at mary@pcmswa.org.

WINTER 2021

RESIDENTS' PICNIC August 19, 2021 | 5 pm to 7 pm* Time subject to change

HOLIDAY SHARING CARD CAMPAIGN November 15, 2021 ANNUAL MEETING December 7, 2021 Check pcmswa.org for updates or call 253.572.3667 for more info

PIERCE COUNTY MEDICAL SOCIETY

The Health Status of Pier ce Count y

Overcoming COVID-19 with Teamwork

am so grateful for all of you who remain on the front lines of the COVID-19 pandemic. January 20th marked the anniversary of the first case in Washington and the country. It has been a grueling journey and emotional rollercoaster.

While my public health team and I are right behind you supporting your work, you endure health risks and confront your vulnerability daily. The work at times is nonstop. With your team, you celebrate the recoveries and suffer the heartbreaking deaths of patients. At various times you may have felt angry, sad, scared, frustrated, numb, or tired. “Physician heal thyself” is not a pithy slogan; it is good advice. Let us start by taking a big breath. Stay in the moment and check in with yourself. What are you feeling and how are you doing? Visit this website to see where you fall on the Stress Continuum. Check in with friends, colleagues, and team members. Offer support to those who need it. Ask for support if you need it. We can create a gracious space. If you have an Employee Assistance Program (EAP) through work, do not hesitate to access its services. The American Medical Association recommends strategies to manage our distress during COVID-19 in three categories: 1. Take care of yourself 2. Take care of your staff 3. Take care of your patients Colorado’s COVID Healthcare Worker Resources has strategies to cope with stress, burnout, and trauma. Some are exactly what we often counsel patients: • Take care of your body through movement and nutrition. • Get enough rest and sleep. • Don’t rely on alcohol, drugs, or compulsive behaviors to reduce stress. Some are practical coping mechanisms: • • • •

Practice assertiveness skills. Develop time and task management skills. Take a personal day to regroup. Set boundaries.

Anthony Chen, MD, MPH

Others help us shift perspective and become resilient: • • • •

Accept that there are events that you cannot control. Cultivate a positive attitude. Engage in mindfulness practices. Reflect on what brings meaning and joy to your life.

Pulling together The strength of the Pierce County medical community was clear in December, when members of the Pierce County Council attempted to dissolve the Health Department. Together with hundreds of Pierce County residents, you rallied to support us and the measure failed. On behalf of my team, thank you for your critical support. A year into this pandemic, the medical community, public health, and our residents have shown our strength. We worked together through three surges to preserve our medical capacity and keep our cases and deaths among the lowest in the country. Many of you continue to communicate and mobilize your social networks to encourage people to wear masks, keep their distance, avoid gatherings, and stay close to home. We have graphics and videos you can share about masks and distancing. Vaccine is arriving in increasing numbers and shining a light at the end of the tunnel. Thank you to all the medical providers who are vaccinating our essential workers and community members . As of February 1st, there were 123 Pierce County providers with 43 more awaiting approval. Those interested in enrolling to provide vaccines can do so through the Department of Health. Thank you to members of the medical society who have volunteered at vaccination clinics and other parts of the emergency response. We will continue to need volunteers in the future ; you can sign up through the Pierce County Medical Reserve Corps. We also have graphics and videos you can share about vaccination. The past year has not been easy. Take care of yourself and let us take care of each other. Together, our community will put the pandemic behind us.

WINTER 2021

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Which COVID-19 Vaccine Should I Get? What To Tell Your Patients by Sara Berg, Senior News Writer AMA

hich COVID-19 vaccine did you get? This is a question that physicians and other health professionals are beginning to hear as the first wave of vaccinations is finally underway. While there are now two vaccines available that have received emergency use authorization in the United States—those made by Pfizer-BioNTech and Moderna—it is less important which one a person gets. Instead, says a leading physician expert, it is imperative that everyone simply gets vaccinated. Share that you’d get either option Physicians should share which COVID-19 vaccine they received, but it should come “with that disclaimer that I would have gotten whichever one was offered,” said Dr. Fryhofer. “I was able to get a dose of a vaccine, so now I tell patients which one I got. I didn't care which one it was. I just wanted to get a dose of a vaccine and I will also make sure to get my second dose in the series.” It is important for physicians to tell their patients, “You have to decide if you're going to get vaccinated,” she said. “My recommendation to you is to go for it. Take the one you can get because the sooner you get that first dose, the sooner you can get that second dose and you have to have both doses in the series to get that 94–95% protection.” Organizations get different types Which vaccine a patient gets is dependent on the organization. While one organization may get the Moderna vaccine, another might have Pfizer-BioNTech. “My hospital has both the Moderna and the Pfizer, but the most important thing is whatever you get for the first dose, you have to get for the second dose—there’s no mixing and matching,” she said. “You want to get the full dose.” Remind that payment’s not required “If you go someplace and they’re wanting you to pay for the vaccine, that is a red flag,” said Dr. Fryhofer. “We have all paid for these vaccines, with our tax dollars, through Operation Warp Speed. “Now, you might be asked to show your insurance card,” she added. “The places that do administer vaccines are allowed to bill your insurance company for the administration fee, but you should not be paying.” “I would also encourage patients to go on their department of health website and take a look at the forms that are

being offered and read them,” said Dr. Fryhofer. “They're going to have to read and understand them sooner or later, and that also can give you a feel as to whether or not this place is legitimate.” However, “the best bet is to call your physician,” she added. Explain potential side effects “Trust and open communication are so important,” said Dr. Fryhofer. “If you don't tell people what to expect, physicians are going to be sorry because they're going to get phone calls from patients about side effects.” That is because after getting a COVID-19 vaccine, “most people are going to have some sort of side effect,” she said. Both vaccines “are going to cause a sore arm. You may feel a little bad, maybe a little tired, muscle aches, but it is so much better than getting COVID—and you do have to get that second dose.” “You do expect to have more side effects with that second dose,” said Dr. Fryhofer, adding that “if day one is the day you get vaccinated ... most symptoms are going to be on day two, day three, possibly day four and then they're usually gone. But for some people, they're enough to make you not be able to go to work.” Have patients sign up for v-safe Once a patient does receive their first dose of a COVID-19 vaccine, Dr. Fryhofer recommends signing up for the v-safe vaccination health checker, which is a smartphone-based tool from the CDC. “They'll text you every day and you can tell them what your symptoms are, because you're going to share your experience with others and everyone can learn from your experience,” said Dr. Fryhofer, adding that it is important to not only sign up for v-safe, but to also “get that second dose.” WINTER 2021

Opening Act New federal rules will give patients unprecendented access to their electronic health records by Sean Price, Associate Editor, Texas Medicine

tarting April 5, physicians must be ready to electronically share with patients more of the information generated during office visits.

This change comes thanks to “information blocking” rules that are part of the 21st Century Cures Act, passed by Congress in 2016 and put into regulation i n2020 by the U.S. Department of Health and Human Services’ Office of the National Coordinator (ONC). The Cures Act regulations eventually will enable widespread access and sharing of electronic health information (EHI) among physicians and their patients, for example, through smartphones or other devices. Physicians, hospitals, electronic health record (EHR) vendors, health information exchanges (HIE), and health information networks (HIN) must comply with the regulations, says Joseph Schneider, MD, a pediatrician and chair of the Texas Medical Association’s Committee on Health Information Technology. “Starting April 5, patients who request access to certain physician notes and reports in the EHR must be given electronic access to them, with a few exceptions,” he said. Legally, patients already can obtain their entire medical record in printed form. The Cures Act gradually extends electronic access to those same records over the next two years.

“Transparency will help strengthen that doctor-patient relationship - if it’s done correctly,” he said, “And I think there’s some preparation that needs to take place to recognize the full potential.” Getting ready - The provisions that take effect in April require physicians to give their patients immediate electronic access to significant portions of their EHI upon request. This includes eight types of clinical notes; discharge summaries; history and physicals; progress notes; consult notes; imaging reports; laboratory reports; pathology reports; and procedure notes. ONC does not specifically state the “open notes” are required (“open notes” refers to the automatic release of all clinical notes), Dr. Naik says. “Our interpretation of the guidelines in April is that [doctors] don’t have to automatically release clinical notes,” he said. “But physicians and physicians groups should be preparing for that to come.” Physicians will have two immediate avenues for providing the patient information electronically: patient portals in EHRs or third-party companies that can send a secure email, Dr. Schneider says.

ONC extended the original November ”You won’t be able to compliance deadline to April because phyAll physicians can expect to spend time do this overnight.” sician offices have been preoccupied with and resources on compliance, but that COVID-19 (www.texmed.org/DataSharingwill vary based on factors such as physiDelay). While another extension could take place if the pan- cian specialty and EHR vendor preparedness, he says. Some demic remains sever, physicians should not expect one, Dr. specialties will not have to focus heavily on privacy issues. Schneider says. Any physician offices that have not begun planning for the April 5 deadline need to start as soon as “But if you’re a pediatrician, [for instance], and take care of possible, he says. adolescents, you have some big challenges in terms of how you’re going to preserve the privacy that they’re entitled to “You won’t be able to do this overnight,” Dr. Schneider said. and still comply with the laws,” he said. But once physicians do, it likely will be worthwhile, says Manish Naik, MD, chief medical information officer at Austin Regional clinic and a member of TMS’s Committee on Health Information Technology. 12

PIERCE COUNTY MEDICAL SOCIETY

Notable exceptions - Physicians first must understand what is considered “information blocking” under the Cures Act, Dr. Schneider says. They also must understand the law’s detailed exceptions (tms.tips/CuresActExceptions).

TMA and the American Medical Association have extensive resources to help. For example, a physicians who withholds a medical record to protect a patient from harm would not be considered to be information-blocking, Dr. Schneider says. This often comes up in cases of child abuse. If one parent suspects another parent of abuse and that is recorded in the physician’s notes, the physician must keep in mind that both patents have access to the records, he says. This could open up the child or reporting partner to further harm.

A March 2020 web survey of 1,628 physicians and other clinicians with a history of sharing notes with patients found that 74% agreed that it was a good idea, and 74% viewed it as useful for engaging patients in their care, according to JAMA Network Open (tma.tips/OpenNotesSurvey).

“Technologically, you have to prepare to make your notes available,” he said. “But depending upon your type of practice, you have to think about what you put in those notes and what notes that you wouldn’t share because they fit one of the exceptions.”

“We went live with a patient portal in 2013 and gradually built upon it,” he said. “We started with just showing the lists of diagnoses, medications, allergies, and immunizations. Then we added labs, and then we added imaging. It has helped our patients understand much better what’s going on with their own health and has been a huge benefit in terms of communicating with patients.”

Many practices rely on third-party services to deliver HIPAA-protected information to patients in print, and that third party also could handle electronic requests, Dr Naik says.

Austin Regional Clinic is transitioning to meet the law’s requirements, but its patient portal has gradually opened access to patient records, Dr. Naik says.

But the JAMA report warns of at least on major drawback. “Approximately one-third of clinicians report that because of open notes they are spending at least some additional time in documentation,” the survey found.

But for now, patient portals in EHRs are a better long-term solution, he says, In fact, physicians who rely on their patient portal heavily may be well-prepared for the April 5 deadline. That additional time often takes “Transparency will help strengthen that Those practices already likely rethe form of making notes easier doctor-patient relationship lease information o medications, for patients to understand, Dr. Naik if it’s done correctly.” lab results, and imaging results says. For instance, a physician might over the portal, and adding paadjust a typical note that reads “abtient notes should not be difficult. normal scan - rule out cancer” to something more patient-friendly, like: “There’s an abnormal“Enabling the ability to do that through the patient portal is ity on the chest X-ray. Elaborate on differential diagnoses. the most direct way to go about meeting this requirement,” I’m not as concerned about cancer because the patient’s not Dr. Naik said. a smoker, but we need to rule that out.” Physicians should speak to their EHR vendors about their capabilities and what the new law might cost their practice, Dr. Schneider says.

While this might take more time at first, physicians will learn to better address potential patient concerns in their notes, Dr. Naik says.

“The answer depends on the EHR company and the relationship you have with them,” he said. “In some places it will cost. In others it will be part of an upgrade that’s already covered.”

“You don’t have to take out the clinical terminology, but I think you do have to expound a little bit more on what the game plan is for the patient,” he said.

Physicians also should train staff to understand the new requirements and their role in enforcing any changes, Dr. Schneider adds. Again, the time and resources involved will depend on the practice.

Any drawbacks to open notes need to be weighed against the benefits, the JAMA report says. Previous studies show that patients who are able to access their medical records electronically feel more in control of their care and have a better grip on what their clinician is thinking, study authors reports.

He acknowledges physicians may fear that patients will “be calling up their physicians saying, “i disagree with this in my notes and you need to change this or that,’” but said, “so far in terms of the open note experience, that doesn’t seem to be a major problem.” Open and effective - The law is designed to promote greater openness with patients, and many physicians who have tried it say it works, Dr. Naik says, pointed to recent studies.

Also, patients can go back and review information, giving them a better chance to absorb what’s there and make sense of it, Dr. Naik says. Reprinted from Texas Medicine, January 2021

WINTER 2021

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Pierce County Medical Society has been supporting Pierce County physicians and patients over 130 years. PCMS represents the interests of local physicians and physician assistants from all specialties and practice types at all stages of their careers.