Austin Medical Times by Rick Delarosa

December Edition 2020

Inside This Issue

Smartphones, Texts, and HIPAA: Strategies to Protect Patient Privacy By Kim Hathaway, MSN, CPHRM Patient Safety Healthcare Quality & Risk Management Consultant The Doctors Company

P Can You Get COVID-19 Twice? See pg. 12

INDEX Legal Matters....................... pg.3 Mental Health...................... pg.6 Oncology Research......... pg.8 Healthy Heart....................... pg.9

Age Well LiveWell See pg. 13

hysicians have embraced smartphone technology, with the vast majority using phones to communicate via text messages and access medical information. The attraction is obvious: Smartphone applications place libraries full of information at users’ fingertips— including drug alerts (such as PDR. net) that are literally a click away. Texting via secure messaging systems is instantaneous, convenient, and direct. It reduces the time waiting for colleagues to call back and it can expedite patient care by facilitating the exchange of critical lab results and other necessary patient data. S m a r t p h o n e technology is not just for peer-to-peer use: To manage their own healthcare needs, empowered patients are requesting more access to their physicians and medical records. Patients are also investing in mobile health technologies that provide continuous vital sign monitoring and generate health data that can be sent to their physicians. (For more information on this topic, see our articles “Wearables Offer Wealth of Data During COVID-19, but Liability Risks Remain” and “Remote Patient Monitoring.”) Technology is becoming

essential to the patient experience and increasingly important to younger, technology-savvy patients. Safeguard Against HIPAA Violations The very convenience that makes using smartphone technologies

Accountability Act (HIPAA). Physicians and other team members must not communicate with patients using their personal text messaging systems. Before communicating with patients through electronic technologies, a practice must have in place a secure HIPAA-compliant messaging platform that interfaces with the electronic health record (EHR) and strong administrative procedures. HIPAA compliance is paramount to the physician’s ability to communicate safely and send appointment reminders, alerts, and other follow-up reminders. Text messages among colleagues should also be encrypted and exchanged in a closed, secure network designed specifically to protect PHI, not on personal messaging systems. A secure messaging platform allows for the encrypted flow of information and storage in the medical record. Many EHR products now interface with secure messaging systems or the secure systems are integrated into the EHR product. Implementing a secure messaging platform must include establishing electronic communication policies regarding the proper and improper uses of texting—which means specifying what types of information may or may not be texted. Patients must also be educated

Texting patient information among members of the healthcare team is permissible if accomplished through a secure platform. so inviting may also create privacy and security violations if messages containing protected health information (PHI) are not properly safeguarded. It is important that physicians and their teams understand that communications between patients or other providers have the potential to lead to violations of the Health Insurance Portability and

see HIPAA... page 14

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Legal Matters Gaps in Payment for Covid-19 Laboratory Testing Plague Providers and Patients

By Colleen Faddick, J.D. Sara Iams, J.D. Polsinelli, PC

he federal government declared a Public Health Emergency (“PHE”) in response to the COVID-19 pandemic effective January 27, 2020. While the health care industry has been continually adapting to new clinical information and regulatory challenges, the need for rapid and reliable COVID-19 laboratory testing has stayed constant. At the outset, both providers and patients were led to believe that all testing would be free or paid for by insurance. Much of it is. But the ongoing nature of the pandemic has exposed gaps in this payment structure,

leading to uncertainty by providers and patients. The goal of this article is to identify the key payment sources and to highlight ongoing issue areas. I. Payment for COVID-19 Laboratory Services Rather than a national payment resource for COVID-19 testing, a patchwork of coverage and payment has developed through federal statutes, state and local health departments, and employers. The key sources are: • Commercial Payers and Federal Health Care Programs. New federal laws require most commercial health insurance plans, Medicare, Medicare Advantage, and Medicaid to cover COVID-19 testing at no charge to the beneficiary when determined to be medically appropriate by a health care provider. This includes out-of-network commercial plans that, by law, must pay a provider’s posted cash price for COVID-19 tests. It

generally does not include nondiagnostic testing for surveillance. • HRSA Program for the Uninsured. The federal Health Resources and Services Administration (“HRSA”) also administers a reimbursement program through which providers can submit claims and receive Medicare rates for testing uninsured individuals for COVID-19. • State and Local Health Departments. State and local health departments have also established free COVID-19 testing sites, typically funded by relief

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funds from the federal or state government and operated by the government or providers under contract. • Employers. As employers have encouraged or mandated employees to return to work, they have sought testing solutions to ensure a safe workplace. Per EEOC guidelines, employers are financially responsible for the cost of testing. II. Unexpected Gaps and Regulatory Hurdles see Legal Matters...page 12

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Study Suggests That Losing Fat Mass, But Not Lean Mass, Is Key for Heart Health In Obese Patients With Type 2 Diabetes

educing the level of body fat and waist size are linked to a lower risk of heart failure in patients with type 2 diabetes, a study led by UT Southwestern researchers indicates. The findings, reported today in Circulation, suggest that all weight loss isn’t equal when it comes to mitigating the risk of heart disease. The burden of diabetes is increasing, with an estimated 700 million adults worldwide predicted to have this disease by 2045. The vast majority of cases are type 2 diabetes, characterized by insulin resistance, an inability for cells to respond to insulin. Type 2 diabetes doubles the risk of cardiovascular events such as heart failure and heart attacks. Being overweight and obese are strong risk factors for both type 2 diabetes and heart disease, and patients are often counseled to lose weight to reduce the likelihood of developing both conditions. However, not all weight loss is the same, explains Ambarish Pandey,

M.D., senior author of the study and assistant professor of internal medicine at UTSW. “We have long counseled patients to lower their body-mass index into the ‘healthy’ range. But that doesn’t tell us whether a patient has lost ‘fat mass’ or ‘lean mass,’ or where the weight came off,” Pandey says. “We didn’t know how each of these factors might affect patients’ risk of heart disease.” Fat mass accounts for fat in different parts of the body while lean mass is mostly muscle. Understanding the relationship between heart disease and body composition has proven especially challenging, Pandey explains, because there hasn’t been an easy and inexpensive way to evaluate body composition. The gold standard of determining fat mass and lean mass is to measure it directly with tools like dual-energy X-ray absorptiometry (DXA), a scan that’s cumbersome, expensive, and exposes patients to radiation.

To help answer how different types of weight loss can affect cardiovascular d i s e a s e , Pandey and his colleagues used data from the Look AHEAD (Action for Health in D i a b e t e s) Trial, which investigated the effects of either an intense lifestyle intervention focused on weight loss and physical activity or diabetes support and education in more than 5,000 overweight or obese adults with type 2 diabetes. The study collected information on the volunteers’ weight, body composition, and waist circumference at the baseline and again one and four years later. It also tracked the incidence of heart failure in this group over a 12-year period. The Look AHEAD Trial determined body composition with DXA. But Pandey and his colleagues used a new equation that incorporates age, sex, race/ethnicity, height, body weight, and waist circumference to estimate fat and lean mass – producing results that closely matched those from

DXA scans. Among the 5,103 participants in the Look AHEAD Trial, 257 developed heart failure over the follow-up period. Pandey and his colleagues found that the more these volunteers lowered their fat mass and waist circumference, the lower were their chances of developing heart failure. Just a 10 percent reduction in fat mass led to a 22 percent lower risk of heart failure with preserved ejection fraction and a 24 percent lower risk of heart failure with reduced ejection fraction, two subtypes of this condition. A decline in waist circumference significantly lowered the risk of heart failure with preserved injection fraction

see Obesity Study... page 14

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Mental Health How to Cope with Pandemic Loneliness This Holiday Season

he holiday season can be a joyous, but many suffer from depression during this time of year. A number of factors can contribute to the “blues” during the holidays, including social isolation, grief and financial strain. This year, you may also experience feelings of depression and loneliness due to the pandemic. “People are grieving for similar reasons: loss of family members, jobs, relationships, friendships and physical touch. Everyone is suffering,” said Dr. Asim Shah, professor and executive vice chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. “Holiday blues will affect a lot of people this year, including those who haven’t suffered from it before.” Develop new traditions The key to handling loneliness? Stop using the phrase “social distancing,” as it can make others feel more depressed during this time.

Instead, practice “physical distancing” by socializing outdoors with a small group of loved ones to create new holiday traditions. Follow guidelines and socialize by keeping your distance in open spaces. Social and digital media has played a large role in the pandemic in terms of connection, as well as helping reduce loneliness. Many families won’t have the chance to visit each other this year, so Shah suggests socializing in the backyard with a few people while video chatting with family members in another city. Shah also stresses the importance of having a positive circle around you to defeat loneliness. The circle should be made up of loved ones outside of your immediate family members who live with you to create a safe, friendly environment. “That safe environment will be your crutch and your help, and you will be their help. Everyone needs socialization,” Shah said.

Know the signs Symptoms of holiday depression include feeling withdrawn or disconnected, not enjoying things you used to enjoy, lack of motivation, problems with sleeping, lack of appetite, difficulty concentrating, feeling irritable, fatigue or trouble making decisions. If isolation or loneliness leads to depression, seek help immediately. Connect with professionals with telehealth opportunities and join self-help groups. Social support is key, and a lot of these feelings can be eased by connecting with your social circle. If you’re aware that someone near you is suffering from holiday depression, lead them to professional help. “Don’t be judgmental. Give your loved ones options and be supportive. Be a good listener and guide them through this time,” Shah said. Survivor’s guilt Many are also experiencing

survivor’s guilt with the loss of loved ones to COVID-19. They feel guilty for surviving tragedy while family or friends suffered from the illness. Shah shares these tips to cope with survivor’s guilt this holiday season: • Practice mindfulness: focus on breathing techniques and meditation • Practice self-care: read, listen to music, exercise • Be optimistic and help others: Volunteer, help your elderly neighbors, help others financially if possible, donate blood and educate people on how to wear a mask 

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Oncology Research

MARINE MILITARY ACADEMY

When Your Cancer Spreads: Three Things to Know About Metastatic Cancer By Andrew Shaw, M.D., Texas Oncology

ancer is life-altering at any stage, and the subsequent cancer journey has the power to impact the physical, mental, and emotional health of patients and often those who love them. This is particularly true for patients who learn their cancer has metastasized or spread from the primary cancer location into other organs or areas of the body, which may indicate the disease will be a chronic condition. Sometimes called stage IV or advanced cancer, metastatic cancer can travel through the bloodstream or lymph system and develop a tumor in a new location. While cancer can spread to many areas of the body, it most commonly spreads from the primary

managed as a chronic illness. Metastatic cancer impacts patients differently based on their individual disease and risk factors. According to the American Cancer Society, many types of metastatic cancer cannot be eliminated from a patient’s body. Learning that you or a loved one has metastatic cancer can be devastating, but treatment options are available. For patients with metastatic or advanced cancer, treatment may not make the cancer go away, but it can help in other ways such as slowing the growth of a cancerous tumor, relieving symptoms, improving quality of life as well as prolonging life. The future of treatment for metastatic cancer is promising. Scientists, oncologists, and cancer researchers are focused on finding new and innovative ways to treat cancer and improve the lives of patients. This includes exploring the evolution of cancerous tumors and mutations from a primary cancer to metastatic cancer and working to better understand types

cancer site to the bone, liver, or lungs, as well as the lymph nodes, according to the National Cancer Institute. When it comes to cancer – or any serious illness – it’s important to understand what a diagnosis means for your current and long-term health. Here are considerations if you or someone you know is diagnosed with metastatic cancer. Recurrent cancer and metastatic cancer are not the same thing. Cancer recurrence is when cancer returns after treatment and after a period of time when no cancer was detected, whereas metastatic cancer means a primary cancer has spread to other parts of the body. Recurrent cancer may return where it previously occurred or in another part of the body. Recurrence can happen if cancer cells were resistant and survived the original treatment, developing into detectable tumors over time. Always ask your physician if you have questions about words used to describe your diagnosis. Metastatic cancer may be

of tumor growth and metastases. With better understanding of what drives tumor growth, spread, and resistance we develop more successful treatment. For example, metastatic and recurrent cancer are generally treated with systemic therapy – any treatment directed at destroying cancer cells throughout the body – such as chemotherapy, radiation, immunotherapy, or a combination of several modalities. Some types of immunotherapies can target and attack certain cells in the body, enhancing the immune system’s ability to fight cancer. Some targeted therapies impair the growth process triggers that may be unique to some cancers. Having cancer that spreads is understandably difficult to accept and to discuss. Your physician and care team should always serve as your best resources when you have questions or concerns about your health. At Texas Oncology, we want patients to feel empowered to make informed decisions about their care – and walk beside them every step of the way. 

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Austin Medical Times

Healthy Heart In Light of Pandemic, Flu Vaccinations More Important Than Ever for People at Highest Risk By Suzanne Hanshaw American Heart Association

he American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives, is helping to keep families and communities safe from the flu by providing facts, resources and encouraging people to get a flu vaccine. “Getting the flu vaccine is especially important this year. If you get it, you may need to be hospitalized, in this time of COVID-19, in an already overwhelmed healthcare system,” said Eduardo Sanchez, M.D., M.P.H., FAAFP, American Heart Association chief medical officer for prevention and former commissioner of health for the state of Texas. “In a normal year, the flu is serious and can even cause death. While it is important for almost everyone six months and older to get a flu vaccine, it’s especially important

for those at highest risk: • Seniors and people with underlying risk factors such as heart disease, stroke, and diabetes, among others. According to the Centers for Disease Control (CDC), those 50 years-old and older, living with one or more chronic conditions, are at high risk for the flu. Those who aren’t vaccinated are six times more likely to experience a heart attack • Children, especially those who are under 5 years-old and those who are back in school. Children who are vaccinated are 74% less likely to be hospitalized due to the flu. • Pregnant women – those who are vaccinated are 40% less likely to be hospitalized due to the flu. • According to the CDC, people who are Black or Latinx may be at increased risk for the flu and are least likely to get the flu shot.

S o m e people have misinformation and concerns about the flu vaccine, causing them to skip it altogether. Here are some facts: The vaccine does not cause the flu. It may cause very mild side effects. The most common are soreness, swelling or redness on your arm near the site of the shot that might last only 1 or 2 days. However, the mild symptoms you might experience from the vaccine are much less severe than the flu itself. It is safe and effective and easy to access. The flu vaccine is safe and effective for places that are taking extra safety measures like your doctor’s office, pharmacies, and some employers that are providing drive-thru vaccinations. It is accessible even without insurance. Many community pop-up vaccination sites, federally funded programs, local health departments, community health centers, and some

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places like churches and community centers offer the vaccination at no cost for those who qualify. It is not too late to get vaccinated. Flu season typically peaks between December and February, so getting the vaccine now is better than waiting. You need at least two weeks for your body to develop antibodies to the virus. However, being vaccinated anytime during flu season is better than not at all. “No one wants the flu. The best way to keep your family and yourself safe from the flu is by getting the flu vaccine and as with COVID-19 prevention, wearing a mask, washing your hands often, and social distancing helps,” said Dr. Sanchez. “Don’t forget to take your mask when you go for your flu vaccine.”

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COVID-19 Surges Linked to Hungry Children, Families in Travis County

s rates of COVID-19 cases grew in Travis County during the spring and summer, researchers from Dell Medical School at The University of Texas at Austin found another troubling phenomenon alongside the pandemic: food insecurity. Before COVID-19 struck, 1 out of every 5 children and 1 in 4 adults in Travis County were food insecure – meaning they suffered from limited or uncertain availability of food. In a new study, a Dell Med Department of Pediatrics research team led by Megan Gray, M.D., MPH, and Ana Avalos, M.D., partnered with CommUnity Care Health Centers to conduct a study of 645 Austin-area families between April to August 2020 who sought care at two CommUnityCare clinics. The study showed food insecurity affected families surveyed 33% to 70% during this time, with an average of 47%. The fluctuations corresponded to Travis County COVID-19 rates and hospitalizations, and with changes in the labor market. “In May, when steps were taken

to reopen the Texas economy, food insecurity flexed downward, only to peak at 70% of families during July, when local COVID rates worsened,” said Gray, an assistant professor in the departments of Pediatrics and Population Health at Dell Med. “While these numbers of increased or decreased percentages of food insecurity give us a snapshot of what our community is facing, the reality of food insecurity goes beyond just having enough money to buy food. It’s about the chronic stress and mental health impact of families who are worried about not being able to meet their children’s needs,” said Gray. “And looking at these numbers, it’s very concerning that COVID-19 has erased decades of progress in food access and food equity, which will likely get worse this winter as COVID-19 rates rise in our community.” Asking the Right Questions In the 20-week study, Gray’s team screened CommUnityCare patients and their families for food insecurity. Most patients received assistance through

Medicaid and were under 2 years of age partly because CommUnity Care prioritized access for the youngest pediatric patients at the start of the pandemic. The standardized screening process consisted of two questions posed to parents about having enough money to buy food and worries about food running out. Researchers asked additional questions about recent job loss in the family and reliance on community resources. The increases in food insecurity were most significant among Hispanic and Spanish-speaking families. Some of the factors that families cited were being out of work due to having COVID-19 illness themselves or a need to quarantine. A Call to Action For – and Beyond – Health Care Providers As COVID-19 numbers have begun to surge again in Travis County, Gray said she hopes her research will spark more discussions among providers and families. “Food insecurity is hiding in plain sight. We don’t know unless we ask,” said Gray, who adds that pediatricians see families along the food insecurity spectrum daily, but they may not be aware without proactively addressing it. The American Academy of

Pediatrics calls for pediatricians and family care providers to proactively “screen, intervene and advocate,” to identify food insecurity among their patients. But asking isn’t as simple as one would hope, said Gray. “We need to get past the fear of feeling awkward or upsetting patients by asking about their access to foods. The overwhelming majority of our patients were incredibly appreciative that we brought this up,” she said. However, Gray believes the duty to show concern extends beyond the medical community. “Anyone in a public-facing job needs to educate themselves about resources to refer families to,” she said. “We’re in this for the long haul, but we’re in this together, and we are in an excellent position to help.”

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VID-19 and the FLU: Avoiding double trouble No one wants to catch COVID-19 AND

A FLU SHOT •

IS SAFE: It’s administered with COVID-19 safety precautions

•

IS EASY: It takes just a few minutes out of your day

•

PROTECTS YOUR KIDS: Getting them vaccinated reduces their chances 74%

•

HELPS AVOID STROKE: you will also have a stroke jump by 40% for up to one year

•

PROTECTS YOUR PREGNANCY: 40%

THINKING OF SKIPPING THE FLU SHOT? If you have factors that increase your risk: • 65+ • Heart disease • Diabetes • Weakened immune system

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You’re

SIX TIMES more likely to experience a

HEART ATTACK

December 2020

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Austin Medical Times

Can You Get COVID-19 Twice? What We Know about Reinfections

t’s a question that has loomed since the start of the coronavirus pandemic: Once a person has recovered from COVID-19, can they get it again? According to a case study published last month and a handful of confirmed reports around the world, it is possible, but rare. In this video, https:// u t e x a s .b o x . c o m /s /j q x t d11l 8 n8pcpx0gjeil4tlp3bv4xec Aliza Norwood, M.D., says doctors and researchers are especially interested in what reinfections can tell us about our natural, long-term immunity to COVID-19 and what it means for a vaccine. “Just to be clear, reinfection means a totally new infection,” says Norwood, a primary care physician in the departments of Internal Medicine and Population Health at Dell Medical School. “That’s different than somebody who has

recovered from COVID-19, but still may have a positive test for a while after they recover.” According to the Centers for Disease Control and Prevention (CDC), antibodies can protect a recovered COVID-19 patient for at least three months, and possibly more. Norwood says a COVID vaccine will provide an added layer of protection for people who’ve already been exposed to the virus. “Even if reinfection is possible, a vaccine is a powerful tool that helps our bodies recognize the most common virus strains early and prevents against severe COVID-19 disease,” Norwood says. “We (also) hope that the vaccine will give us a more powerful antibody that may be able to protect us from different strains of COVID if it mutates in the future.” But a vaccine alone won’t be enough to stop COVID-19 in its

According to the Centers for Disease Control and Prevention (CDC), antibodies can protect a recovered COVID-19 patient for at least three months, and possibly more. tracks, she says. “In order to keep ourselves and our loved ones safe, we need to continue to do all the things that reduce virus spread, even after a

vaccine is here. So that means…. social distancing as much as you can, wearing a mask in public and handwashing, even if you’ve had COVID-19.”

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Age Well, Live Well Texas Talks Addresses Important Topics with Older Adults By Chelsea Couch, CHES Texas Health and Human Services

amily, traditions, travel and festivities are hallmarks of the holiday season. Managing the holidays may also mean coping with stress, worry and conflict along with the ongoing COVID-19 pandemic. It can be tempting to prioritize the happiness of others during the holidays but taking time for yourself is more important than ever, particularly this year. Review the self-care checklist and resources below for tips on how to take care of yourself and make your holiday season merrier. Which self-care habits do you practice? Eating nutritious foods daily. Getting restful sleep each night. Taking medications as prescribed. Scheduling “you” time. Engaging in regular physical activity. Asking for help when needed. Saying “no” and putting your needs first. Addressing stress and difficult emotions in a timely manner.

Helpful Self-Care Resources Eating well during the holidays can be an uphill battle. SNAP food benefits can help put healthy food on your table throughout the year. Visit yourtexasbenefits.com for more information on what SNAP offers and how you can apply. Staying mentally and emotionally well may be particularly difficult with the added stress of the season and COVID-19. Visit the Texas Statewide Behavioral Health Coordinating Council website (mentalhealthtx.org) to access mental wellness resources as well as information on finding help for you or someone you love. Texas

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Health and Human Services launched its Statewide COVID-19 Mental Health Support Line to help Texans experiencing mental or emotional challenges due to the COVID-19 pandemic. You can call toll-free, 24/7, at 833-986-1919. Regular physical activity can help us stay healthy and manage stress. Texercise, an HHS health promotions initiative, offers free resources and programs to engage adults 45 years and older in regular physical activity and a good diet. Visit www.texercise.com to learn more about healthy aging and to request a free copy of the Texercise handbook. Staying on top of caregiving responsibilities while managing the holidays can be challenging. Caring for others is difficult work and taking time for yourself is essential. You can call the

Caregiver Action Network Help Desk Monday through Friday, from 7 a.m.–6 p.m. Central Time at 855-227-3640. For additional caregiving tips, visit the following resources: • Take Time Texas offers short-term respite care services to provide caregivers with brief periods of relief or rest. Use its search tool to find respite near you. https://apps. hhs.texas.gov/taketimetexas • 10 Tips for Family Caregivers from the Caregiver Action Network. caregiveraction.org/sites/ default/files/10%20Tips%20for%20 Family%20Caregivers.pdf • Caregiving and the Coronavirus: Tips for Caregivers from the Family Caregiver Alliance. www. caregiver.org/sites/caregiver.org/ files/pdfs/caregiving-and-coronavirus-tipsheet-v2-200408.pdf

payment for a baseline test, but not recurring tests, and others have offered payment on an invoice basis, but only after the facility seeks payment from all possible payers. All in all, there is the potential for facilities to incur tremendous costs for an indefinite period, and both state and federal governments may need to act to resolve the payment uncertainty around payment. Patient-Directed or Self-Pay Testing. Laboratories are also confronting challenges associated with patients seeking COVID-19 testing without a practitioner order and with self-pay testing. The lack of a physician order can present issues under FDA Emergency Use Authorizations, which typically call for testing to be done upon the order of a qualified person, and under state laws, which may not

permit so-called “direct access testing.” In other scenarios, the lab may want to offer (or the patient may seek) a test on a self-pay basis to avoid the uncertainty around payer coverage. In such cases, although patients may agree to pay out-of-pocket, Medicare and Medicaidparticipating providers (in particular) must grapple with mandatory claim submission provisions, which require claim submission for all covered services. Whether these regulatory hurdles come into play depends on the facts, but they are nonetheless potential barriers to payment. 

Legal Matters

Continued from page 3 Despite these funding sources, several gaps and regulatory hurdles have made obtaining consistent payment more difficult. Authorization and Infrastructure to Bill Payers. Almost all provider types have been asked to join in the testing effort. As a practical matter, though, some providers—like pharmacies—did not have the enrollments, contracts, or claims processing infrastructure to shift from billing drugs or other services to billing for laboratory services. While Medicare fast-tracked enrollment processes to enable payment, other payers did not, and the administrative burden of adapting to new codes and billing processes has been a significant hurdle. Non-Covered Testing. Payers may also deny payment for testing. For example, although federal statute

mandates payment in many cases, there is concern about payment for testing asymptomatic patients with no known exposure and about whether payers will adopt frequency limitations for repeat testing. In addition, the federal government has said that payers are not required to pay for screening tests for general workplace safety, for public health surveillance, or for “any other purpose” not intended for diagnosis or treatment of COVID-19. Thus, providers offering tests are well-served to develop protocols for testing that follow federal guidelines. Mandatory Testing. CMS recently instituted mandatory testing for staff and residents of certified long-term care facilities, but offered no options for reimbursement (except coverage otherwise available through insurance). Some states have offered

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HIPAA

Continued from page 1 on how the practice uses electronic communications and/or texting and be given the option of consenting or opting out of those communications. In addition to using a secure messaging platform, other minimal protections include automatic screen locking settings and remote wiping programs. An automatic screen locking setting secures a device when it is inactive, requiring a password to unlock it. Timing can be changed to shorten the interval before locking the screen. Remote wiping programs can erase data, texts, and email. Both safeguards provide additional protection in the event a device is lost or stolen. The government website HealthIT.gov provides tips and information for individuals and organizations related to securing mobile devices. Compliance is a challenge when the technology options and HIPAA security rules are not known or they are misunderstood. We have found that some clinicians are still using unsecured personal messaging systems and consumer apps to text images and send files containing PHI. With penalties up to $50,000 per HIPAA violation, safeguarding communications should be of the utmost priority. Texting Orders In December 2017, the Centers for Medicare and Medicaid Services issued a clarification regarding texting patient information among healthcare providers. The recommendations include the following: • Texting patient information among members of the healthcare team is permissible if accomplished through a secure platform. • Computerized provider order entry is the preferred method for submitting orders. • The current prohibition on secure text messaging of patient care orders is continued. Ensure Accuracy to Avoid Liability

Concerns Shorthand and abbreviations are commonly used in text messaging. The informal nature of text messages can increase the chances of miscommunication. It is important to ensure accuracy and use standardized and approved abbreviations, particularly when patient information is exchanged over text. Texting cannot substitute for a dialogue with a colleague concerning a patient. If the matter is critical or you have any doubt about the communication, it is best to speak directly with your colleague. Discoverability Just as phone records are discoverable during litigation, so are the text messages on personal and work-designated smartphones. When changes occur in the patient’s condition or a serious event takes place, limit texting to messages over a secure messaging platform, and ensure that message content is appropriate for the medical record. Do not use personal messaging systems for any messages containing PHI or that are not compliant with the HIPAA Security Rule. For example, if you don’t have access to a secure messaging system and need to use your personal phone, text a generic message such as “please call urgently.” Communication about patient care information should be made in person or by person-to-person phone call and documented in the medical record. If texting is the only way to communicate, keep texts brief, professional, and to the point. If you would not document the communication in the medical record, do not say it in a text message. Avoid expressing your opinion in a text about the care others have provided, unexpected events, or possible errors. Instead, communicate your understanding of events using an appropriate format, such as in an incident report or during a postevent investigation. Text messages from medical

device representatives and other vendors who are present during patient care are also discoverable. Text messages should not contain discussions, opinions, or comments that would not be included in the medical record. Take Steps to Protect Your Practice Consider the following strategies for safeguarding your practice: • Conduct a risk assessment to evaluate the risks of texting—including message content and security measures that have been taken. • Use a secure messaging platform to send communications, not a personal or unsecure messaging system. • Enable encryption on your mobile device. • Set screens to lock automatically if inactive, and use the remote wiping function to prevent lost devices from becoming data breaches. • Ensure that your system has a secure method for verifying provider authorization. • Have a texting policy that outlines the acceptable types of text communications and specifies situations in which a phone call is warranted. Specify any applications that would be used in conjunction with texting. • Know your recipient and double check the “To” field to prevent sending confidential information to the wrong person. • Minimize identifying patient details in texts. • Assume that your text can be viewed by anyone in close proximity to you, and always maintain physical control of your device. • Ensure that the metadata retention policy of the device is consistent with the medical record retention policy and/or that it is in accordance with a legal preservation order. • Report to the practice’s privacy officer and your malpractice carrier any incidents of lost devices or data breaches.

all, body composition parameters are linked to heart failure,” Patel says. More studies are needed to determine if reducing fat and retaining or increasing muscle may be more effective at decreasing the risk of heart failure, research that’s facilitated with the new equation to estimate body composition, Pandey adds. In the meantime, he says, patients may benefit from incorporating

strategies toward this goal – such as resistance training – into their weight loss efforts. “Our study suggests that simply losing weight is not enough,” Pandey says. “We may need to prioritize fat loss to truly reduce the risk of heart failure.”

Obesity Study

Continued from page 4 but not heart failure with reduced ejection fraction. However, a decline in lean mass didn’t change the risk of heart failure at all. These findings provide important insights, says Kershaw Patel, M.D., study author and former UTSW cardiology fellow who is now a cardiologist at Houston Methodist Hospital. “We showed that reductions in specific, not December 2020

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