Organization Newsletter

July 2018

In this issue...

  1. Executive Director Update
  2. Getting to Know Your Board Member - Geri Forbes
  3. Striking A Cord With Stroke Recovery
  4. Becoming A Mentor
  5. Welcome New & Returning Sponsor and Organizations!
  6. Life Flight Network Introduces New App for Hospitals and First Responders
  7. Clallam County Public Hospital District No 1: Lessons Learned
  8. Keeping You in the Know
  9. Resourcing A HIPAA Security Program
  10. The Most Persistent Job Seekers in U.S. Nursing
  11. Last But Not Least
  12. PNWU Students Inspire Others to Give Back!
  13. What You Need to Know About Transmitting PHI


Welcome to the
July 2018 issue of the Washington Rural Health Association e-Newsletter.
Inside this issue you will find news and information from the Executive Director and board of directors, members, and community partners from across the state of Washington. 

If you would like to submit your own story, please click here.

The WRHA e-newsletter is a publication of Washington Rural Health Association, a not-for-profit association composed of individual and organization members who share a common interest in rural health. This e-newsletter seeks to disseminate news and information of interest to rural health professionals and stakeholders to help establish a state and national network of rural health care advocates.

WRHA Members

WRHA members include administrators, educators, students, researchers, government agencies and workers, physicians, hospitals, clinics, migrant and community clinics, public health departments, insurers, professional associations and educational institutions. If you are interested in joining or renewing your membership with WRHA click here.


Executive Director Update


Submitted by: Beionka Moore
[email protected]

Summertime is Here…

Welcome to Washington Rural Health Association Summer 2018 e-Newsletter.  Over the past couple of months, we’ve been gearing up for summer by providing presentations to rural community members.  As Executive Director, I’ve been involved in rural health issues for many years and am currently busy executing WRHA strategies and initiatives, as well as promoting advocacy for and understanding of rural issues in Washington, promoting education, and providing support to improve delivery of health care in our rural communities. 

I intend to operate the association as transparently as possible and welcome your input and suggestions. I encourage you to stay informed about offerings by visiting our website and following us on FacebookTwitterLinkedIn.

WRHA recently partnered with National Rural Health Association and had the pleasure to support and participate in the All of Us Research Program.  The event took place in beautiful Pasco, Washington.  It was important for the WRHA to be involved to ensure that the rural community is represented in the program and that our State Rural Health Association had the opportunity to be active in the launch day activities, as well as the information dissemination process.  The program aims to speed up health research and medical breakthroughs by asking one million people to provide the kind of information that can help create individualized prevention, treatment, and care for all of us.  It was wonderful to be able to connect with so many people in the community!  **See additional content on this program below.

We continue to address rural health care and access issues at the national level, and we also continue to engage extensively at the local level.   I am passionate about the sustainability of the organization and providing access to quality health care in rural communities.  One of the associations' goals is to increase communication among interested individuals and organizations with common goals to help promote partnerships, coalitions and other cooperative agreements to benefit rural healthcare delivery. 

Advocacy is about courage, fortitude and standing up for necessary changes.  Activism is about speaking up against injustices---Perhaps there is something that you want to change in your community? Maybe it is about finding the courage to share and voice your beliefs with coworkers, friends or family?  You might even be wondering if it’s even worth it, why speak up, especially in this current, sometimes hostile environment.  I spend a good amount of time wondering whether my own son will have less rights than I’ve had.  That alone is enough motivation for me to stay encouraged, engaged and keep advocating for those less fortunate.  Which brings me to an exciting new area of focus for WRHA.

Washington Rural Health Association has partnered with the Federal Reserve Bank of San Francisco to host a series of rural health listening session with local health care leaders.  First, a gathering took place in Spokane on June 20.  Although it was a small gathering, it was successful and meaningful.  It was great being able to develop intra-community contacts and learning about the issues of specific areas.  Questions were focused on identifying the current and future needs of rural Washingtonians.  Participants had the opportunity to highlight community concerns and join their voice with other rural citizens.  The next Rural Health Listening Session will be held at Columbia County Health System in Dayton, WA, on July 27.  I hope you can join us, we want to hear from as many rural citizens as possible!  Look for registration details on WRHA events calendar or contact me for questions.  More details to come. 

With an informed and involved membership and the support of a truly dedicated board of directors, WRHA is well positioned to meet any challenges ahead.  I am optimistic about the future of our association and I am committed to making sure it remains as strong as it is today, or better!

Finally, as we enjoy the warmer weather over the summer, it’s important to remember that anxiety doesn’t just impact people in the fall and winter months, but can affect people in the summer months too.  Check in on your loved ones and remember to practice best self-care.  I hope you have a wonderful summer!

About the All of Us Research Program
The All of Us Research Program began national enrollment on May 6, 2018, inviting people ages 18 and older, regardless of health status, to join this momentous effort to advance individualized prevention, treatment and care for people of all backgrounds.  Part of the National Institutes of Health, All of Us is expected to be the largest and most diverse longitudinal health research program ever developed.

Participants are asked to share different types of health and lifestyle information, including through online surveys and electronic health records, which will continue to be collected over the course of the program.  Those who join will have access to study information and data about themselves, with choices about how much or little they want to receive.

Data that are collected will be broadly accessible to researchers of all kinds, including citizen scientists, to support thousands of studies across a wide range of different health topics.  By doing so, they are hoping to discover how to more precisely prevent and treat other health conditions.  Knowledge gained from this research could help researchers improve health for generations to come.

Why All of Us is Important for Patients
Health care is often “one size fits all” and is not able to fully consider differences in individuals’ lifestyles, environments, or biological makeup.  This is because we have limited data from past research studies about how those elements interact.  The average patient is often prescribed drugs and treatments as if they are all the same.  Learning more about the differences between individuals can help researchers develop tailored treatments and care for all people.

How All of Us Benefits Health Care Providers
Today there are too few conditions with evidence and options for individualized care. Too often, patients from underserved communities have not been included in clinical research, and our ability to care for diverse populations is diminished as a result.  More data, discoveries, and tools can help providers to give their patients customized care more easily, especially for those communities that are disproportionately impacted by health issues.

Why Diversity Matters
Historically, many segments of the U.S. population have been left behind in medical research, including people of color, sexual/gender minorities, those with lower socioeconomic and educational status, rural communities, and other groups.  The result is significant health disparities.  The All of Us Research Program seeks to help fill in the gaps of information about those communities that previously have not been well represented.

How to Join the All of Us Research Program
The program is seeking one million or more people from all walks of life to participate in this historic endeavor.  Those interested in joining the program can do so by visiting,  Washington Rural Health Association supports @AllofUsResearch in seeking to change the future of health! #JoinAllofUs.

As always, thank you for reading and for your continued support.

All my best,

Beionka Moore 

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Getting to Know your Board Member!

With each publication, we would like to introduce a member of the WRHA Board of Directors.
This edition features Geri Forbes, CEO WhibeyHealth:

Geri Forbes started her hospital career in Clearwater, Florida at MPM Hospital and evolved from manager to senior leader in the chronic disease treatment and prevention arena.  As a portion of that ten-year role she led the partnership with the Joslin Center of Boston and opened new programs such as wound care and hyperbaric medicine. This is where her training and work in strategic planning and process improvement began.

Geri added in a 6 year stint in retail and incorporated women’s apparel store ownership to her daily life.

Then she left Hospital Leadership to join GE Medical Systems as a senior consultant in clinical program development and process improvement. While at GE trained in Six Sigma and certified in GE Change Management methodologies. These new skills combined with her prior educational training led her to become a Master Trainer in Change Management and Senior Consultant in Project Management.

After almost 5 years on the road it was time to come home. Now living in Tallahassee Florida where her husband was training at Florida State in the Professional Golf Management Program, she accepted a leadership position at Tallahassee Memorial HealthCare. She served as senior leader of Medicine Services at this 660 bed hospital.  At the encouragement of her system CEO she took on the challenge to design and develop the newly identified Population Health and Regional Development Division. This led her to sitting on small regional hospital boards, which eventually led to interim placements as CEO.

The interim roles led to a full time CEO position at Doctors’ Memorial in rural north Florida.  After leading a financial turnaround as CEO at Doctors Memorial Hospital, Geri and her husband John took on a new adventure and moved from 25 years in Florida to the magnificent Pacific NW. There she began the role of CEO at WhidbeyHealth Medical Center, in the Spring of 2015.  In that role she has developed a strong team of executive leaders, built and opened a new 39 bed patient care area and worked to develop a population health model of care delivery for those served on Whidbey Island.

Geri completed her Masters is in Healthcare Administration, with a focus in Rural Health and Telemedicine.  Geri and John have one daughter, Amanda that resides in Florida with her husband Bobby.  Their interests include Kayaking, Entertaining, Birding, Music, Movies, Theater, Gardening and FUN!

Boards: (All non-profit)

  • Washington Hospital Association Patient Safety Board
  • Washington Rural Health Association Board
  • Washington Rural Health Collaborative Board
  • Whidbey Island Center for the Arts Board

Degrees received:

  • BSW/Psychology and Special Education – Eastern Michigan University, Ypsilanti MI
  • MHA – Strayer University, Washington DC

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Striking A Cord With Stroke Recovery


Submitted by: Meagan Pierluissi
[email protected]

Bass player for the Spokane Symphony, Patrick McNally had played a Labor Day concert in Spokane and the very next day just didn't feel himself.  The 38-year-old musician says he felt extremely tired then felt numbness on one side of his body.  "I sat down and Googled the symptoms," Patrick says.  "Based on the symptoms, it said I was probably having a stroke. I said to my wife, 'You better call 911,' and she did."  Within two hours of his initial symptoms, Patrick was at Providence Sacred Heart Medical Center, undergoing tests and receiving the clot-busting shot, tissue plasminogen activator (tPA).  "I could always talk," Patrick says.  "And my face was never drooping; I didn't have any memory issues, but I was really weak and could barely lift my arm and leg on the left side."

"My week at Sacred Heart was great," Patrick says.  "I was able to start therapy while there, and got excited to go to St. Luke's where I could really start moving around."  Patrick received the rehabilitative care continuum at St. Luke's with occupational, physical and speech therapies physiatrist, a doctor specially trained in physical medicine and rehabilitation, reassured Patrick he would play the upright bass again.  "I brought a bass guitar with me to St. Luke's and the occupational therapist recommended I wait a bit because I might become frustrated-my left-side coordination in my hand just wasn't there yet," Patrick says.  "Meeting the physiatrist every day always gave me confidence.  He had worked with musicians before and reassured me that I'd be back and I'd be fine.  It's not always easy to think that when you're in the hospital separated from your family." 

Patrick did return to playing with the Spokane Symphony for his eleventh season and his teaching positions with Whitworth College and Spokane Falls Community College.  "I don't know if we'll ever know what set off the stroke," Patrick says, "but I'm back doing just about everything I was doing before it happened."  Learn more about Providence Sacred Heart Medical Center's Neuroscience Institute and St. Luke's Stroke Program and how their coordinated care, from immediate acute care to focused rehabilitative medicine, can help in lasting recovery.  [photo by Hamilton Studios]

Becoming A Mentor


Submitted by: Michelle Fleming
[email protected]

On July 2, Dr. Kim Kardonsky will begin a new chapter in her life.  She will join the University of Washington School of Medicine, working with the Office of Rural Programs and serving as the new director of the Underserved Pathway with the Department of Family Medicine Medical Student Education section.  She is looking forward to working with the medical students and is excited to be part of their training and help develop their interests in primary care. 

Dr. Kardonsky grew up in Pacific Northwest, spending her formative years in The Dalles, Oregon and graduating high school in Vancouver, Washington.  She attended the Medical College of Wisconsin in Milwaukee and after a random conversation with a fellow student during her first year, she met and worked under Dr. Paul Webber, a family medicine physician in Burlington, Wisconsin.  It was through Dr. Webber's superlative mentorship that she developed her interest in primary care.  Dr. Kardonsky completed her residency training at what now known as Swedish Family Medicine - Cherry Hill, working primarily at the Seattle Indian Health Board.  This experience lead to her current position at the Family Medicine Tulalip Tribal clinic, where she has been for the past 8 years. 

When I asked Dr. Kardonsky why she wanted to work at the School of Medicine, she responded that throughout her life, she's been fortunate to know people who have inspired her to discover her path to medicine in addition to working with the underserved.  She understands the intensity of medical student training and knows what it takes to be a mentor and support students in their journey of becoming a physician.  In her spare time, Dr. Kardonsky loves spending time with her family, going on bike rides, and taking her two children, ages 8 and 4, to the local library.

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Welcome and Thank you to New & Returning Members!

Submitted by:  Beionka Moore
[email protected]


Les Meredith, Premier Inc.


Charles Westerholm, Soderstrom Architects

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Life Flight Network Introduces New App for Hospitals and First Responders

Submitted by: Jacob Dalstra
[email protected]

Life Flight Network, the largest not-for-profit air medical transport service in the United States has released a new app called LFN Respond that allows hospitals and first responders to call for a life-saving air ambulance transport with the touch of a button.  The tool, developed in partnership with dispatch software creator Flight Vector, saves valuable time when every second counts.  In emergency medicine, prompt medical attention can mean the difference between life and death.  The faster a patient gets to definitive care, the better their chance of survival. 

"With LFN Respond, approved hospital and emergency responders can instantly request a Life Flight Network aircraft by tapping the flight call button in the app, sending vital information and GPS location directly to dispatch personnel at our Communications Center," said Life Flight Network CEO Michael Griffiths.  "LFN Respond saves precious seconds and makes calling for air ambulance transport easier for hospitals and first responder teams working to save lives."  The free app is designed for use by approved agencies to send activation requests to Life Flight Network.  Those agencies include hospitals, first responders, fire departments, EMS, law enforcement, search and rescue, ski patrols, and other qualified agencies currently working with Life Flight Network.  Life Flight Network's service area covers Oregon, Washington, Idaho, and Montana.  The LFN Respond app provides additional functions including a searchable hospital directory, a landing zone guide, access to Life Flight Network's calendar of outreach education training, and push notifications from Life Flight Network on education and training events.  Once a flight call has been made using the app, users can view a real-time progress tracker that shows the aircraft's location while en route and when it's expected to arrive. 

LFN Respond integrates seamlessly with Life Flight Network's computer-aided dispatch and flight tracking software. "Life Flight Network's investment in this technology will help us work together better and more efficiently to get people the emergency care they need, as quickly as possible," said South Lane County Fire & Rescue Fire Chief John Wooten.  "Especially in rural parts of our state, air medical transport is critical to saving lives and being able to communicate with Life Flight Network through LFN Respond will improve the process." 

LFN Respond is available on the Apple app store or Google Play to approved hospital and emergency response personnel.  The app is also web-based for utilization by computer.  Life Flight Network is inviting hospitals and first responders in its service area to register and start using LFN Respond.  Hospitals and emergency response agencies in Life Flight Network's service area interested in LFN Respond should contact their Life Flight Network Customer Service Manager, or call (503) 678-4364. 

Life Flight Network offers memberships for a $65 annual fee.  Members incur no out-of-pocket expense if flown for medically necessary emergent conditions by Life Flight Network or one of their reciprocal partners. To request more information about the membership program, or if organizations would like an in-person presentation, they should contact the Life Flight Network membership office at 800-982-9299.



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Clallam County Public Hospital District No 1: Lessons Learned

Submitted by: Sarah Huling
Forks Community Hospital
[email protected]

The economic impact report of Clallam County Public Hospital District No 1 Critical Access Hospital is an informative engagement tool in the revitalization of the hospital’s foundation.  The research study by the National Center for Rural Health Works, “Economic Impact of a Critical Access Hospital on a Rural Community”, offers an economic tool for rural communities.   The article provides a template for each specific Critical Access Hospital to apply to their location which will determine the economic impact in their local community.  The only limitation using the template is that they are averaged multipliers and not locally specific to the applied hospital.  The data is specific to the Clallam County Public Hospital District No 1 with the total number of employment, total wages, salaries, and benefits and total annual hospital construction expenditures all including contract labor.  The findings showed the impact of direct employment, secondary employment, direct wages/salaries/benefits, secondary wages/salaries/benefits, total wages/salaries/benefits, and total taxable retail sales generated.  The economic impact results were then proposed as a tool to be used in starting the conversation about the hospital foundation to create a venue for community engagement and better health outcomes.

Keywords: Economic, critical access hospitals, community engagement, foundation.

YouTube link to presentation:   CLICK HERE


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 Keeping You in the Know


Submitted by: Beionka Moore
[email protected]

Declining Number of Rural Pharmacies ‘A Worrisome Trend’ 
Highlights research focused on small-town pharmacies closing in Washington state. Nearly 500 rural communities in Washington lost their only retail pharmacy between 2003 and 2013. 
Source: Washington State University 

Senators Target Medicaid in Telehealth Bills Tackling Opioid Abuse 
Four bills introduced in the U.S. Senate aim to use telehealth to address the opioid epidemic and to reach more people on Medicaid and in rural areas. All of these bills have bi-partisan co-sponsors. 
Source: HealthIntelligence

New Resources

Care Coordination Canvas Guide
A framework and resources for developing effective care coordination programs. Includes worksheets, guides, and case studies describing different care coordination approaches: care coach, clinical, community health worker, and school-based. Based on a survey of rural health networks engaged in implementing care coordination initiatives.See also Case Studies From the 2017 Care Coordination Comparative Study. Sponsoring organizations: National Rural Health Resource Center, Rural Health Innovations 

The Health Care Workforce: Addressing Shortages and Improving Care 
Testimony in the U.S. Senate Committee on Health, Education, Labor & Pensions on May 22, 2018. Examines the growing problem of healthcare shortages in rural areas and the response by the federal government. Also explores how well healthcare professionals are being trained and why they choose the geographical areas where they work. Focuses on shortages of physicians, nurses, and professionals specializing in care of older adults.
Additional links: Testimony by Elizabeth A. PhelanTestimony by Julie Tanner SanfordTestimony by Kristen H. Goodell 
Sponsoring organization: Senate Committee on Health, Education, Labor & Pensions

In rural areas hit hard by opioids, a new source of hope

USDA has announced it will dedicate at least $20 million of a $49 million rural telehealth and distance-learning fund for projects related to opioid addiction. It also has committed to spending $5 million of a $30 million grant program that pays for buildings and equipment in rural areas for projects related to opioids. According to NRHA’s Maggie Elehwany, it makes sense for the USDA to support rural health systems since hospitals are often the economic backbone of rural communities. “If you don’t have those, you don’t have a community,” she says. While Elehwany and other rural health advocates say the grants and loans will be helpful, they say it won’t solve the direst health care challenges in rural areas, such as doctor shortages and low reimbursement rates.

Oregon Washington Health Network and Yellowhawk Tribal Health Center “Tackle Everything” to Improve the Health of Local Community Members

The Oregon Washington Health Network and Yellowhawk Tribal Health Center are addressing behavioral health challenges through peer counselors and heart disease/cancer prevention through community education. In addition, they’re collaborating with local healthcare facilities and medical schools to improve recruitment and retention.

Rethinking Rural Healthcare: How to Improve Healthcare in Rural Areas 
Jun 11, 2018 -- Modern Healthcare released an edition focused on rural healthcare, touching on topics like the opioid crisis, telehealth, the healthcare workforce, population health, the risk of rural hospital closures, and more, including highlighting efforts in specific states. (May require registration for full articles.) 
Source: Modern Healthcare
Submitted by:  WSHA Senior Vice President, Patient Safety & Quality, [email protected]

Lake Chelan Community Hospital partners for rural residency program

Like many rural communities, Chelan is facing a shortage of providers to care for residents.  To address this, Lake Chelan Community Hospital & Clinics will partner with the University of Washington and Columbia Valley Community Health (CVCH) to offer a rural residency program in town.  The program is scheduled to begin in August 2020 with two residents, though that number will double in size the second year, reaching its full capacity.

Each resident will spend two-thirds of his or her time at CVCH and the remaining time practicing at Lake Chelan Community Hospital, working in the hospital’s ER, medical/surgical unit and addiction recovery unit. CVCH and CVCH's family physician Dr. Kari Bergeson were the main drivers behind the program, and Lake Chelan Community Hospital serves as the participating hospital.
Read more >

Suicide Rates Increase in Washington

recent report by the CDC shows that the national suicide rate increased by over 25 percent from 1999 to 2016.  Washington's suicide rate increased by 18.8 percent during that time period.  Washington's suicide rate has remained slightly higher than the national rate since 1999.  In 2016, the national average was 15.4 per 100,000 and Washington's rate was 17.6.  But the rate varies by county, with Clallam County reporting 31.7 compared to Grant County's 7.5 per 100,000 in 2015.

We lost a great mental health champion and advocate, Randy Revelle.  He will be missed tremendously!

With sadness I wish to share former long-time Washington State Hospital Associations senior vice president of policy and advocacy Randy Revelle passed on Sunday, June 2.  It’s an enormous loss.  Randy made our state better and worked tirelessly to break the stigma of mental health illness.  He wore his cape every day, was seen as a mental health advocate and hero.  Randy has impacted thousands of individuals that live with mental illness, and many of them may have never heard of him, but his work has improved life for each one of them.  Cassie Sauer, CEO of WSHA, gave an interview to The Seattle Times to contribute to their article about Randy.  You can read it here.  I’m grateful to Randy for many things among them helping me and others find their voice to be strong and become even stronger by speaking out for mental health and fighting the stigma.

Western State Hospital loses federal certification
CMS has notified the Department of Social and Health Services (DSHS) that Western State Hospital has lost its federal certification, and $53 million in federal funding. Despite improvements over the last two years, Western did not meet the Medicare Conditions of Participation in four areas: governing body, quality assessments and performance improvement, nursing services, and physical environment. 

Western will lose about 20 percent of its funding. Starting July 9th, Medicare will not pay for new patients. Payments for existing patients can continue for up to 30 days. DSHS says improvements will continue to be made at Western and the report supports Governor Inslee's five year plan to transform the state's mental health system. We have comments from Reps. Laurie Jinkins and Christine Kilduff here

Alzheimer's Caretakers: How To Make Your Home Safe And Comfortable

Submitted by: Lydia Chan, Alzheimer's Caregiver
[email protected]

Despite ongoing, rigorous research, statistics indicate that every 65 seconds, someone in the U.S. develops Alzheimer’s disease. Even more disturbing is the fact that by 2050, 14 million American adults are projected to be affected — up from the current total of 5.7 million.

As the numbers continue to rise, the need for caretaker assistance will become even more crucial. With 16.1 million unpaid caretakers valued at $232 billion, it’s clear that not everyone can afford in-house care. If you’ve suddenly found yourself taking care of a loved one with Alzheimer’s, it’s not unlikely to feel overwhelmed. No matter what your specific situation may be, preparing your home — and your mind — for what lies ahead is a preliminary step in the right direction.

Modify Your Home: DIY Versus Pro
Home modifications can be costly, yet it’s absolutely necessary that you’re making the thoughtful changes to ensure the safety of your loved one. Some projects such as improved lighting, simplifying space while adding function (think replacing busy wallpaper with a painted wall in a neutral hue to add contrast); removing clutter and tripping hazards; and placing safety locks on cabinets and drawers with prescriptions, cleaners, and sharp objects are considered DIY. Even a wheelchair ramp can be built and installed on your own providing you have the proper tools to do the job.

Unless you’re extremely handy and have a lot of spare time on your hands, other projects are better left to a pro — some are even required due to permit-related reasons. For example,, installing more outlets to avoid copious cords; replacing polished, slippery floors with non-slip surfaces; installing an accessible shower and height-adjustable sink; and adding a chair lift at the staircase. Before beginning or investing in any project, check to see if you qualify for a grant to help pay for home modifications.

Getting Help Does Not Mean You Failed
If you find that there’s no time left in the day for self-care, then it’s time to admit you need additional help. Home health services and adult day care are options to help alleviate some of your caretaker responsibilities while your loved one is still living under your roof, while residential care (assisted living facility, nursing home, special care unit) is a consideration for advanced Alzheimer’s. Of course, these options come with a price tag not everyone can afford — but don’t give up hope.

Along with taking stock of available family resources, look into other potential forms of aid to include: resources provided by your local Alzheimer’s Association chapter, community-based home services (typically less expensive than home care), nurses and social workers who may be able to pitch in for a tolerable hourly rate and looking into any untapped benefits for anything from medication to food to health care and more.

Implement Self-Care
Being a caregiver is among one of the most difficult roles you can take on, but it’s important that you’re taking care of yourself — both physically and mentally —  in order to be at your best for your loved one. Schedule time for activities such as exercise (consider making a space for a home gym to make this an easier goal to accomplish), have coffee with a friend, meditate, eat a proper meal and get adequate sleep.  

It’s important to remember that each case of Alzheimer’s is different to include the rate at which the disease progresses — it can typically last more than a decade. You will have to adapt your home and care along the way. Having regular conversations with your loved one’s doctor can give you the direction you need to ensure you’re meeting their physical and mental needs to the best of your ability. 

Resourcing a HIPAA Security Program

Submitted By: Alan Davis, Proteus Consulting
[email protected]

Building on last newsletter’s discussion about how rural community Covered Entities or Business Associates may approach their Health Insurance Portability and Accountability Act (HIPAA) security program, we’ll share some best practices to improve program effectiveness, reduce electronic protected health information (ePHI) risk and to protect the company from the financial consequences of an unauthorized disclosure event (i.e. an ePHI breach).  We realize that some programs may not be managed formally and we encourage compliance officers to integrate these recommendations as company’s culture allows.  First is to establish a formal program sponsor.  This sponsor should be someone in the senior leadership team, should ensure the program is resourced, and should confirm program accountability. 

Second, fund the HIPAA Security program as an operating expense.  Compute how much time a compliance officer or part-time HIPAA security officer spends working on their program (e.g. .2 FTE).  The program sponsor should work with the Human Resources and Finance Officer teams to create this budget line item.  The HIPAA Security Rule 164.308(a)(2) standard, “Assigned Security Responsibility”, requires a CE or BA identify a security official to develop and implement Security Rule policies and procedures; in simple terms, your program requires a HIPAA security officer in writing. 

Third, create a capital project budget line item that considers:

  • security officer training that includes risk assessment, risk management, audit preparation, breach notification, and project management - 164.308(a)(2)
  • workforce members’ training development and management - 164.308(a)(5)(i)
  • periodic technical and non-technical testing, based on Security Rule standards and changes to environmental or operational changes affecting the security of ePHI - 164.308(a)(8)
  • a bona fide HIPAA security risk analysis - 164.308(a)(1)(ii)(A).

Every fiscal year may include different requirements, based on company size and resources. 

Lastly, develop meaningful data points that best capture how the program demonstrates progress and success.  Some metrics worth considering include security incidents, workforce training comprehension and number of unauthorized disclosure events.  We advocate that what gets resourced gets accomplished, and understand that some rural organizations may tackle HIPAA “ad-hoc”.  Each compliance or HIPAA security officer should work closely within the parameters of their organization’s culture, while consistently advancing a program that protects patient information and the company’s reputation.

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 The Most Persistent Job Seekers in U.S. Nursing


Submitted by: Phil Slaton
[email protected]

Among foreign-educated nurses, Filipinos are still the most persistent job seekers in the United States.  Filipino nurses in America work in hospitals, physician's offices, home healthcare services, and nursing care facilities, while others work in outpatient clinics and schools.  NCLEX refers to the NCSBN's National Council Licensure Examination, and the number of foreigners taking the eligibility test for the first time are strong indicators as to how many of them are trying to obtain gainful employment in America.  U.S. National Council of State Boards of Nursing Inc. (NCSBN), reported that 7,791 Filipino nurses took the U.S. licensure examination for the first time in 2017, hoping to practice their profession in America.  The figure is up 23 percent versus the 6,322 Philippine-educated nurses that took America's eligibility test, or the NCLEX, for the first time in 2016. 

Newly released statistics from the U.S. National Council of State Boards of Nursing Inc. (NCSBN), noted that a total of 1,305 Indians, 820 Puerto Ricans, 749 South Koreans and 586 Jamaicans also took the NCLEX for the first time in 2017. The statistics indicate that Nigerians and Cubans also compete with Filipinos in the U.S. nursing labor market. However, without question, among foreign-educated nurses, Filipinos remain the most persistent job hunters in America has been noted by the statistics.  I have learned in over 18-year of recruiting foreign educated nurses, compared to other countries, many Filipino nurses still prefer the U.S. because, apart from the superior hourly pay, they also find it easier to work and live here, considering their cultural affinity with America.  The median pay of registered nurses in America was $70,000 per annum, or $33.65 per hour in 2017, according to the U.S. Bureau of Labor Statistics (BLS).  Since 1995, a total of 176,801 Filipino nurses have taken the NCLEX for the first time, without counting repeaters.   We place Filipino nurses to careers in the United States.

Best Wishes,
Phil Slaton, The Icon Group
[email protected] - [email protected]
Telephone - 360-697-7880 

"Diversity Builds Community"

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Last but not Least, More Items of Interest....


Have you visited our new Career Center?
Whether you’re looking for your next career move or looking for that next great hire, we believe Washington Rural Hospital Association’s Career Center is your best source in Washington State.

Email content for employers/corporate partners:
The best and brightest healthcare professionals are out there. Access a targeted and qualified pool of talent by advertising your job openings on our recently updated Career Center.

Visit today and create your profile at

  • Easily post jobs to gain direct access to highly qualified, professional job seekers in the rural healthcare industry here in Washington and nationwide
  • Set-up pre-screen filters to deliver you only the best candidates
  • Put your posting in front of more job seekers with frequent job alerts sent to all job seekers in the database.

Looking for even more visibility? You can feature your open position and logo on the Career Center homepage to increase click through on your open position by up to 35%

  • Save time by easily managing and tracking all your applicants right from WRHA’s Career Center
  • Set up resume alerts and receive automatic emails when an applicant meets job posting criteria
  • Use our Career Center as one stop shop for all your hiring needs by sending your job postings to our partner network sites like Google for Jobs, Jobs2Careers, Ziprecruiter, and others for increased exposure
WRHA’s Career Center has the qualified talent you’re looking for.


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The Washington Rural Health Association is a 501(c)(3) not-for-profit organization supported by individual donors, corporations, foundations, and government grants. Donations to the WRHA go an extremely long way. Donations go directly towards helping us improve healthcare for our rural communities across the State.

Join your voice with other WRHA supporters. There are many  ways to contribute: by going to our website and click on the Donate Now link, or to our Facebook page and click on the blue donate button at the top of the page. And don't forget to select WRHA as your charity of choice on Amazon Smile.

Shop HERE and Amazon will donate to Washington Rural Health Association.

Reminder: Member Benefit – Events Calendar

WRHA members now have a new way to share community events affecting rural health in and around Washington State.  As members, you can now post your community event on the WRHA website calendar so that others from across Washington can stay current and share information about what is happening in your town.

To submit a calendar event, simply click here or go to  and hover over “Events” and select “Calendar of Events”.  You can view current events on the WRHA calendar or submit your own event by clicking “Submit an event” in the bar just above the calendar.  Once you have submitted your event, the WRHA support team will review and approve it for posting. 

WRHA Members also enjoy these membership benefits: 
*Discounted registration to the Annual Northwest Rural Health Conference (March 25-27, 2019)
*Representation in Statewide Office of Rural Health
*Representation in State Association Council of National Rural Health Association
*Networking opportunities with other advocates of rural health from across Washington
*Individual members have one vote pertaining to Association matters
*Publications and social media platform updates, stay informed about rural health scholarships, funding, education, and other networking opportunities
*Receive the electronic newsletter 6 times annually
To join the WRHA, click here!
WRHA Membership:

Updating Your Organizational Membership Profile

Would you please help us update our membership records?  Please review your organizational membership profile(s) to make sure they are current.  We know folks move on, or interests change.  We want to ensure you are taking full advantage of your organizational membership and that communications are reaching appropriate individuals.  We need your help in growing the WRHA and reaching more rural health advocates.  Organizational members have three additional member profiles that can be utilized.  If you want to add additional individuals, or edit existing profiles to your organizational membership, please follow instructions listed below:

1.  Login to your WHRA account
2.  Hover your mouse pointer over “My Profile”
3.  To view your “relationships” and edit/delete profiles associated with your organizational memberships, select “RELATIONSHIPS” from the drop-down menu seen when hovering on the “My Profile” tab.
4.  Things to know:

  • Parent Profile (Organizational Member) is only member that can access the renewal function.
  • Additional third profiles are off-shoots of the Parent profile “My Profile” tab also offers views of your transactions, ability to edit your photo, send emails, many other tasks!  
  • If you see anything that doesn’t look right, please call and let us help you!  There can be occasions when the database was manipulated internally.

Keeping our membership database updated will help us better care for and communicate with our members.   Thank you!

 PNWU Students Inspire Others to Give Back Through Partnership with Yakima Neighborhood Health Services

 Submitted by: Paul Bubluski, Marketing Coordinator - Pacific Northwest University of Health Sciences

As a second-year student, PNWU’s Daniel Ojala was driven to help one of Yakima’s most vulnerable populations, spearheading a push to organize a partnership    program with Yakima Neighborhood Health Services (YNHS). As the end of the school year approached, Ojala prepared to move away from Yakima for his third-year   rotations. Before doing so, however, he met with PNWU students Kathryn Wanat and Jamie Welch — then first-year students— passing the reigns onto them before   leaving campus. 

 YNHS aims to provide affordable, accessible, quality health care, promote learning opportunities for students of health professions, end homelessness and improve  quality of life in our communities.  

On Monday, Welch and Wanat, who have led the partnership program for the past year, met with the next generation of program leaders, sharing their experiences,  advice and words of encouragement in hopes that the recently-formed partnership will continue to grow and flourish as they too move onto rotations. 

 “I became interested in the program instantly and feel a strong draw to the struggles so often seen in homeless populations,” explained Welch. “I have always found  myself interested in their stories and wonder often about the lives that led up to life on the street.” Welch’s interest was spurred when she met a man in downtown Bellingham who was selling CD’s he had made from his favorite artists at the local library. 

“As we chatted, he explained to me that the most difficult thing about being homeless wasn’t the daily struggle of basic needs going unmet, but being invisible,” she explained. “It was the people constantly walking by, avoiding eye contact and ignoring him when he spoke to them. He thanked me for “seeing him”, handed me the CD I bought and meandered on. That interaction inspired me to be a part of, and pour my time into, this program. People deserve to be seen, and their stories deserve to be acknowledged.” 

Now moving onto rotations, herself, Welch hopes to see the partnership continue to grow. 

“My hope for the new leadership team is that they dream big for those who cannot always do so. I hope that they hear so many stories and, through those relationships, are given the opportunity to bring healthcare to those who desperately need it. I hope that with each year of this program we learn more about the specific struggles of the Yakima homeless population through research and volunteer experience and with each year more awareness is drawn to a population with many barriers to healthcare. This partnership program will hopefully become a significant source of both funding and volunteers for YNHS, and also provide a path for future physicians to have the opportunity to develop the kind of compassion and understanding needed to work with a population so often misunderstood and misrepresented.”

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What You Need to Know About Transmitting Protected Health Information


Submitted by: 
Rick Ensenbach, CISSP, CISA, CISM, ISSMP, CCSFP;Senior Manager at Wipfli LLP
[email protected]

A recent survey of 600 workers across the U.S. found that 87% of health care employees have used non-secure email to transmit sensitive data and information.1

The HIPAA Security Rule requires anyone who is transmitting protected health information (PHI) over an open network to first encrypt the information.2   Open networks include email, text messages, faxes and the internet in general.  Since transmitting unencrypted PHI is a reportable breach, the Office of Civil Rights (OCR) can impose strict penalties on offending organizations.

Do you know if your employees are transmitting unencrypted PHI? Chances are, your health care organization is vulnerable to this risk. However, there are things you can do to reduce risk and help avoid not just a fine but also a major security incident such as a data breach.

How to Encrypt Data
Your employees can’t encrypt PHI if you don’t provide the tools to do so.  There are third-party solutions you can leverage in different ways.  For example, ShareFile integrates with Microsoft Outlook to provide a ShareFile button option that employees can click on to encrypt an email’s contents.  Other vendors require the sender to add “Secure” to the subject line, which tells the software to encrypt that email.

Another solution is an email encryption gateway, which secures all email leaving the network according to configurable encryption rules, eliminating the need for client software and further user intervention.  Take a look at all the options available and decide which solution best fits your organization.

The Human Factor
There’s no way to look over your employees’ shoulders and make sure every email, text message and fax they send is encrypted.  For one, not every email contains PHI or other sensitive data.  For another, people determined to get around controls will find a way to do so.

But the main reason employees send PHI over open networks is not because they’re malicious or want to commit a crime.  It’s because they’re simply not aware of their responsibilities.  They don’t know when they need to encrypt something, and they often don’t know how to encrypt it.

Health care organizations can address these knowledge gaps through training.  Ongoing awareness training should be structured to help employees understand what types of information need to be encrypted and what types do not.  It should also go over non-compliance consequences for both the organization (e.g., fines) and the individual employee involved (e.g., termination), and it should review what the organization’s encryption option is and how employees can use it.

When a human factor is involved, education is key to compliance.

The Responsibility of Health Care
Did you know health care employees are 36% more likely to share data such as patient and payment information using non-secure email than those working in the finance industry?  The health care industry as a whole lags behind other industries when it comes to information security, and large health care data breaches over the past two years have highlighted weak spots.

Ask yourself: Does your health care organization have on staff a dedicated and experienced security and/or privacy officer who manages your cybersecurity and privacy policies?  How often do you perform risk assessments to determine what and where your vulnerabilities are?  Are your employees continually educated on their own responsibilities in protecting patient data and other sensitive information?

Answering these questions is crucial to helping ensure you can protect both your patients and your organization.  If you come up short, there’s a lot you can do to mitigate risks — and that’s where a firm like Wipfli can help. Our Risk Advisory Services (RAS) Health Care team can help you assess your security risks and implement a customized risk management program for your organization.  Contact us to learn more.

[1] “Most Healthcare Workers Admit to Non-Secure Healthcare Data Sharing,” Fred Donovan,, May 21, 2018,, accessed June 14, 2018

[2] “Does the Security Rule allow for sending electronic PHI (e-PHI) in an email or over the Internet?  If so, what protections must be applied?”  HHS, July 26, 2013,, accessed June 14, 2018

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Join the discussion, connect with us! Share your stories and ideas, get the latest news, and act to help preserve rural health care and access in Washington state!  Please head over to Facebook, Twitter or LinkedIn and look us up at WASHINGTONRURALHEALTH!  

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