Tuesday, March 26, 2013

Social Media for Physicians

Doctors are no longer the gate keepers to medical information. The internet has ushered in an era of unlimited access to health information. All it requires is a simple Google search of the name of a disease or medication to see an endless list of images, videos, message boards, websites, and blogs. Competing with the likes of WebMD and Wikipedia may seem like a daunting task for any physician, but there is a simple way to join the online conversation. Engage in social media.

Physicians are starting to realize the impact social media can have on patient education and communication with peers. There are unlimited possibilities in engaging others when using social media. Doctors are sharing information via Twitter, teaching patients about new treatments on Facebook, and offering educational videos on YouTube. It is time to take advantage of the educational and growth possibilities social media has to offer. Pay attention to the following do’s and don’ts when establishing a presence on the internet.

Do understand the importance of privacy and protected information. The most significant concern for any provider using social media is respecting patient privacy. All HIPAA rules are applicable to social media. Never discuss a case that is specific to one patient and never use any identifying information.

Don’t commit to social media you don’t have the time for or interest in. Having a blog is a commitment. It takes several hours a week (if not a day) to write, promote, and maintain. Facebook may be a better option if time is an issue. If an ongoing exchange or conversation is preferred, Twitter is a great option. Explore all the options and choose the platform(s) that work best for you.

Don’t limit social media to Facebook only. Even though Facebook seems to have cornered the market, there are multiple platforms that serve vastly different purposes. Doctors that have an instructional component to their patient education, such as an optometrist who teaches contact lens insertion or a physical therapist that teaches specific stretches, find sharing videos on YouTube to be an excellent resource. Pinterest is effective for physicians who are sharing materials that have a visual element, such as diabetic recipes, heart healthy exercises, or best products for allergy sufferers. However, beware of attempting to keep up too many accounts.

Do share information that is interesting and educational. Avoid the urge to share items that appeal only to other doctors or healthcare providers. While social media is a very good way to connect with others in the medical community, it is also important to provide information that is accessible to patients and potential patients. Look for articles, tips, statistics, links, and tools that engage the audience.

Don’t engage with patients in direct conversations. If a patient attempts to use social media for a specific conversation, direct them to contact the office via phone or email. A public forum is not the place to advise patients. If they are resistant or persistent remind them that protecting all aspects of their health information is of upmost importance and that the best way to do that is a private discussion.

In June 2011 The American Medical Association (AMA) released guidelines for healthcare providers using social media. The report stresses the importance of privacy, and addresses ethical and professional issues. It emphasizes the importance of maintaining the appropriate boundaries, including separating personal and professional profiles on social media. Physicians are encouraged to inform a colleague that has inappropriate content posted to remove it and/or report them to the proper authorities. The report also reminds providers that any information posted on the internet is public and can affect their career, public image, trust of patients and peers, and the image of the medical community as a whole.

Studies show that 80% of adult internet users have looked online for health information. Social media is an excellent way to meet patients, potential patients, and peers in a space that they are already occupying. Maintaining a presence on various social media platforms allows doctors to have a voice outside of the office. As long as the physician uses social media in a way that is consistent with the ethical and professional ideals of the medical community, it is an invaluable way to enhance relationships with both patients and peers.

A Tweet a Day Keeps the Doctors Away. (n.d.)  Allied Health World. Retrieved March 26, 2013 from http://www.alliedhealthworld.com/visuals/tweet-day-keeps-doctors-away.html

Cooper CP, Gelb CA, Rim SH, Hawkins NA, Rodriguez JL, Polonec L. Physicians who use social media and other Internet-based communication technologies.External Web Site Icon (2012) Journal of the American Medical Informatics Association. Retrieved March 26, 2013 from http://www.cdc.gov/cancer/dcpc/research/articles/socialmedia.htm

Fox, Susannah. The Social Life of Health Information, 2011. (May 12, 2011). Pew Internet. Rerieved on March 26, 2013 from  http://www.pewinternet.org/Reports/2011/Social-Life-of-Health-Info/Summary-of-Findings.aspx

Opinion 9.124 – Professionalism in the Use of Social Media. (November 2011) American Medical Association. Retrieved March 26, 2013 from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page

Tuesday, March 19, 2013

Drug Testing Employees

It is estimated that lost productivity, accidents, and missed work resulting from drug and alcohol use costs companies an average of $7000 annually. The best way to prevent some of these unnecessary costs is through the implementation of both a drug use policy and a drug testing policy. It is important to be aware of the pertinent federal and state law, any laws applicable to the type of work the company does, as well as any state law pertaining to workman’s compensation.

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At the federal level, the Substance Abuse and Mental Health Services and Administration (SAMSHA), part of the US Department of Health and Human Services, has strict policies outlining the standard procedure for workplace drug screening. Such policies apply to most federal employees, the armed forces, companies contracted by the federal government, and those that receive federal grants. They also apply to those in the transportation industry. In the private sector, an employer’s ability to screen for drugs and alcohol is governed by state law. Private companies are not compelled to adhere to SAMSHA guidelines, but it is considered good practice to do so in case the legality of the testing ever be called into question. Furthermore, administering testing only at SAMSHA approved testing facilities, and testing only for approved substances, is a prudent course of action. As of March 4, 2013, the only approved lab in North Carolina is Laboratory Corporation of America (also known as LabCorp).  Both state and federal law allow for the testing of amphetamines, cannabinoids, cocaine, phencyclidine, and opiates. Approved testing methods are urine, saliva, blood and hair. According to North Carolina state law, if an individual tests positive for an illegal substance, the employer must notify the individual within 30 days (whether it is an applicant or employee) and explain rights for retesting, which is required by law.

Substance abuse on the job can also be a workman’s compensation issue. In most cases, employee’s injured on the job that are found to be under the influence of drugs or alcohol will not be covered by their worker’s comp. Some states even have laws that provide discounts on worker’s comp premiums when approved drug and alcohol programs are maintained.

The Americans with Disabilities Act of 1990 does not protect anyone who is found to currently be abusing drugs or alcohol. However, the Act does allow employers to implement policies prohibiting employees from using illegal substances and to conduct drug testing. Furthermore, the ADA covers individuals who have completed, or are undergoing rehabilitation, and are no longer using. It is important to consult your attorney when developing your drug policy to ensure that it does not violate the ADA.

According to one national survey, more than 60% of working Americans have attended work while under the influence of drugs or alcohol. It is important for employers to be aware of the signs that a person is using illegal substances. Management and HR should be trained to detect symptoms of drug use, as well as the proper steps to take if an employee is suspected of such behavior. Education should be provided company-wide to ensure that all employees understand the drug policy, any testing that will be done, and what their rights are.

Consult an attorney to determine the best approach to drug testing for your company or to review the rules already in place. It is important that the policy abides by any applicable federal and state law. Having such a policy will create a drug free workplace to help keep your workplace safe, productive, and healthy.

Compliance with State and Federal Mandates.(n.d.)  National Drug Screen. Retrieved March 9, 2013 from  http://www.nationaldrugscreen.com/dfmanual-compliance.html
How does substance abuse effect the workplace? (n.d.) United States Department of Labor. Retrieved March 9, 2013 from http://www.dol.gov/elaws/asp/drugfree/benefits.htm
North Carolina—State Law Drug and Alcohol Testing Issues at a Glance. (n.d.) Pocket Part40 North Carolina. Retrieved on March 9, 2013 from http://www.part40northcarolina.blogspot.com/
The Cost of Employee Substance Abuse. (n.d.)  National Drug Screen. Retrieved March 9, 2013 from  http://www.nationaldrugscreen.com/costs.html

Thursday, March 7, 2013

How to Dismiss a Patient

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From time to time, circumstances arise which make it difficult, and even impracticable, for a health care provider to continue to render effective treatment to certain patients. Legitimate reasons can range from the need to refer to a specialist, physician retirement, moving, development of an inappropriate emotional attachment, non-compliance and missed appointments, to threatening or overly demanding behavior.  When it becomes clear, for whatever reason, that a provider can no longer treat a particular patient, the next step requires more than making a simple phone call or a refusal to schedule future appointments. There are both legal and ethical obligations that the provider must adhere to in order to avoid a claim of abandonment.

The most important step for a provider ending a provider/patient relationship is notifying the patient.  This should be done with a letter sent by certified mail, return receipt requested, that includes the following:
  •     A brief reason for the dissolution of the doctor-patient relationship.
  •    Agreement to provide care for a set period of time (normally 30 days).
  •    Information and resources to refer to another qualified physician.
  •    A thorough explanation of health risks if care is not continued.
  •    Indicate that you will provide records once the proper forms have been signed.

The provider should retain a copy of the letter and the certified receipt to be kept in the patient’s chart. Also added to the patient’s chart should be a written document stating the reason for dismissal, including any problematic interactions between the patient and the provider’s staff. Additionally, the patient’s chart should be flagged as “dismissed” to ensure that the patient is not scheduled for future appointments.  It is very important that staff is trained on the proper ways to handle possible situations that can arise when a patient receives a letter of dismissal.

The biggest hurdle in establishing a policy for terminating the provider/patient relationship is ensuring that the patient has no grounds for an abandonment claim. Abandonment is defined by the American Medical Association as “the termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement.” It is imperative that providers exercise extreme care when dismissing a patient with an on-going health issue that requires strict management. It is not advisable for a provider to dismiss a patient while treating an acute problem. In some situations it may be appropriate to make a referral to ensure continued care, instead of simply providing resources to help the patient find a new provider.  Consult your attorney when preparing to dismiss a patient to ensure that the situation is handled according to the law.

Ending the Patient-Physician Relationship.  (n.d.).   American Medical Association.  Retrieved February 27, 2013 from http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/ending-patient-physician-relationship.page
Harris, Steven.  (February 4, 2008).  Take care when firing a patient.  amednews.com.  Retrieved  February 28, 2013 from http://www.ama-assn.org/amednews/2008/02/04/bica0204.htm
Jacobson, MS, PA-C, Abby. (June 5, 2010).  Four Steps to Follow When Dismissing a Patient.  The Clinical Advisor. Retrieved February 28, 2013 from http://www.clinicaladvisor.com/four-steps-to-follow-when-dismissing-a-patient/article/172535/#

Tuesday, March 5, 2013

HIE: A Work in Progress

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As electronic medical record technology continues to gain more and more mainstream acceptance in the health care industry, this new technology has opened the door for new practice management tools intended to improve quality of care and increase provider efficiency. One of those new and emerging tools is the Health Information Exchange (HIE). HIE technology is a primary focal point of the HITECH Act of 2009, legislation driven by a policy to promote provider access to pertinent patient health information through the use of computers, the internet and related technology. The legislation calls for the establishment of a Nationwide Health Information Network (NwHIN), a secured electronic exchange network through which providers can access patient health information, as well as standards, services and policies that may apply to the provider. The ultimate aim is to make it easier for providers to access all pertinent patient health information, so they can make more informed treatment decisions, more closely manage demanding medical conditions, and eliminate inefficiencies like duplication of services, all while reducing operational costs.

Unlike many data storage systems which exist in the form of warehouse-sized servers, the HIE is administered through a secured network over the internet. This network connects computer systems and allows for the secured sharing of health information between the different providers which may treat an individual patient. As a result, when a patient is referred to a new physician, admitted to a new hospital, or involved in an emergency, whoever treats that patient will have immediate access to that patient’s medical records through the HIE, and the delay of otherwise having to deliver the records are avoided.

At this point, HIE is still a work in progress. Part of the HIE implementation strategy involved collaboration with individual states. In an effort to bring the states on board, the Federal Government established the State Health Information Exchange Cooperative Agreement program. This program provides funding for the individual states to implement technology which allows for both statewide and interstate mobility of electronic health information.

Another dilemma in the HIE implementation process is the issue of EMR compatibility. Being that EMR is still an emerging technology, all EMR systems are not yet developed to a point where there is a standardized mode of communication across different software platforms. This would be akin to trying to communicate using different languages. To redesign and/or rewrite the different EMR systems is sure to prove time-consuming and costly for all involved. Furthermore, in addition to being able to communicate across software platforms, EMR must be able to share patient information with the HIE networks. This is done using a patient identifier code. Like a Social Security number, the code would be issued at a national level, and would be recognizable by all EMR systems and HIE networks. There has been some clamor, however, surrounding the use of these government-issued identifier codes. Some have expressed sentiments against allowing the government control over access to these medical, for fear of government meddling in protected health information.

As it stands, a great strides must still be made before HIE becomes a part of everyday practice. Despite opposition, the government continues to move forward in implementing these new policies, and it appears as though HIE will eventually become a reality. There are a number of predictions which attempt to forecast the point at which HIE will come to fruition, some say two years, others say it may take up to a decade. Until then, we will continue to trust the fax machine, the postal service, and our colleagues to make sure medical records get where they need to go.
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