Birmingham Medical News July 2023

The Health Risks of Loneliness

By lAurA FreemAn

There are no vaccines to protect us from this epidemic. Even before COVID, it was sweeping the nation, increasing the risks for disease and premature death. The Surgeon General’s recent call to action has been echoed by the CDC and the American Heart Association.

Loneliness and social isolation are having roughly the same impact on our health and lifespan as smoking 15 cigarettes a day. The physical health consequences of this failure to connect are increasing the risk of heart disease by 29 percent, stroke by 32 percent, dementia 50 percent and premature death 60 percent.

The causes for this disconnect are widespread. Although the problem is too broad for the healthcare sector to solve alone, providers are in a position to spot the negative physical effects of loneliness in their patients, opening the potential to recognize developing health issues while intervention is still possible.

There are obvious links between feeling alone and mental health issues like depression and anxiety. But how do these feelings affect physical health? We’ve all heard about cases of broken heart syndrome when one spouse dies soon after the other. We’ve read studies about orphanages in eastern Europe where children who weren’t touched or nurtured

failed to thrive. But why do married men tend to live longer than single men?

“The support of someone who cares goes a long way toward reducing the impact of stress on the body,” clinical psychologist and associate professor at UAB Medicine Megan Hays, PhD, ABPP, FAACVPR said. “Relationships

can also have a positive biochemical effect. Just petting a therapy animal, getting a big hug from someone you love or having a satisfying romantic encounter releases Oxytosin, a hormone that has a lot of positive health effects. Known as the bonding hormone, it can improve mood,

Shortage of Providers and Beds Creates a Crisis in Mental Health Care

Alabama is Ranked 50th in Mental Health

By mArti WeBB slAy

It’s no secret that Alabama is facing a shortage of resources and beds for mental health patients. The repercussions of that shortage are being felt in a variety of ways.

“The lack of state beds for committed patients is putting a lot of pressure on mental health facilities,” said Amy Gillott, BSN, Service Line Director at Decatur Morgan West Behavioral Medical Center. “On top of that, most psychiatrists are unwilling to do inpatient care, causing us to resort to telehealth which may not be

as effective. This lack of providers is causing a lot of outpatient facilities opt out of the volume. It’s a multi-faceted issue, but when the state decreased its beds in 2015, it has had a ripple effect.

“We seek placement for patients using tele-screening in seven locations in the Huntsville system. We look for placement as far as Dothan, southeast Alabama, and Tennessee. We have a list we go down, and it’s amazing how many places are on diversion because their beds are full. Work on bed placement is ongoing.”

There’s also a shortage of providers to

provide post-hospitalization care. “We try to make sure patients have follow-up care once they leave the hospital,” said Cayley Edmonds, MS, LPC-S, Clinical Services Manager at Decatur Morgan West Behavioral Medical Center. “The first 30 days after discharge are a precarious time, especially for someone experiencing suicidal issues. We work hard to ensure they have follow-up care, but one of the issues is that there aren’t enough outpatient providers to get people in to see someone in a reasonable amount of time. Psychiatrists are

(CONTINUED ON PAGE 4)

(L to R) Cayley Edmonds, MS and Amy Gillott, BSN

HIPAA WEBINAR

The world’s least boring on healthcare cyber fraud

For practice managers and providers who never want to be the reason their practice falls victim to ransomware and cyber criminals. Get the intel and strategies you need to keep your practice safe from cunning cyberattacks. These experts will fill you in on the latest strikes, the strongest defenses, and how HIPAA plays a part.

July 27

12:30-1:30 CDT REGISTER HERE

Can’t make it? Sign up and we’ll send you the recording.

Ron Shoe – The CybertechnoLOLogist

The IT guy who understands cybersecurity and HIPAA. Can talk tech without boring normal humans to tears.

Joe Parker – The Fed

Part of CISA, America’s cyber defense agency. Fortifying the nation’s organizations to prepare, respond, and mitigate the impact of cyberattacks.

Thomas Stroud – The Banker Shrewd in the ways of medical fraud and armed with PNC Healthcare’s unique prevention tools.

From Singing On the Big Stage to Practicing Medicine in Alabama

Cullman Regional Medical Group Doctor Sang at NBC’s The Sing-Off

By Ansley FrAnco

The story begins with five-year-old Dan McNeill, MD, receiving the Beatles Sgt. Pepper’s Lonely Hearts Club Band album as an Easter present. His love for music began there. “I just took off, memorizing songs, learning a lot more about The Beatles, and getting interested in that style. As I got older, I got more interested in current music,” McNeil said.

By grade school, he was in his school choir and taking guitar lessons during his free time. Wanting to try out something new, he picked up acting. “I’m five-foot four, and in ninth grade, I looked around and realized it was time to stop playing basketball. And in tenth grade, on a whim I tried out for the school musical,” he said. After landing that initial role, McNeill performed in four plays and four musicals throughout high school, including ‘Oklahoma’, ‘Little Shop of Horrors’ and ‘Into the Woods’.

“I don’t know if there was a singular moment when I knew I loved singing,” McNeill said. “It always was a big part of my life in terms of playing guitar and being in musicals. I knew whether I pursued it as a career or not, I would always enjoy it. That’s why I continued to look for opportunities while in college.”

During his Freshman year at Mercer University, he chatted with his girlfriend, Morgan, about The Melodores, an allmale acapella group at Vanderbilt where Morgan was in school. She sent him a video of the group’s performance, and he loved their music.

McNeill transferred to Vanderbilt and joined the group. A few years later, in 2014, NBC’s The Sing-Off, was looking for acapella groups to compete in their holiday special. The show hosted auditions in a handful of towns, and luckily enough for The Melodores, The Sing-Off was searching for talent in Nashville.

The group arranged and choreographed two songs to perform for a set of judges during the audition, and a month later, they got a phone call inviting them to compete on the show in Los Angeles. Because the show was a holiday special, there were two rounds of competition.

“The first round was overwhelming,” McNeill said. “We performed in the Kodak Theatre in Los Angeles, which is where they do the Oscars. It was crazy to be standing on that stage and to look out at this beautiful theater, and then to have these people who have an incredible writing and vocal career standing in front of you.”

The Meledores performed Trumpets by Jason Derulo, and McNeill was glad

he didn’t sing the lead. But for the second round, McNeill took a bigger role and sang the lead of Take Me to Church by Hozier.

After giving a performance he was proud of, McNeill and his fellow acapella group members shared the stage with the two other competing groups as Nick Lachey waited to announce the winner. Letting the anticipation build, Lachey announced the winners from Vanderbilt University, The Melodores. The group members jumped and hugged each other. McNeill’s girlfriend, Morgan, along with his parents and sister made the trip out to see his performance and were thrilled.

The Melodores were awarded $50,000, which they split evenly among themselves. McNeill’s portion went towards an engagement ring for Morgan. They married a year after graduating college in 2016 and found their home in Birmingham after both were accepted into medical school in town. McNeill now works at Cullman Regional Medical Group as a pediatrician.

“I always had a passion for serving families and kids,” he said. “I think that had I pursued singing, there would have been ways to use that for service. But it felt more tangible to me to be sitting in front of families every day, examining kids and talking with them about life.”

As McNeil settles into his new home in Cullman, he continues to look for a church band and always keeps his eye out for an open mic night to sing his go-to song – Blackbird by The Beatles.

Dan McNeill, MD with a pediatric patient.

The Melodores with McNeill front row in bow tie.

The Health Risks of Loneliness, continued

reduce blood pressure and cortisol levels and ease anxiety. It can also moderate pain and help people better tolerate it.

“Inflammation, immune response, and sleep problems, which are linked to other health risk factors, all seem to be better in people with good relationships. Across the lifespan, physical health and mental health are inextricably linked to each other and to the quality of our relationships.”

There has been a lot of concern about the impact of loneliness on older people. Some surprising research shows that the two highest peaks in loneliness are in young people in their teens and early 20s, and in adults in their 40s. It is lowest in people in their early 60s.

Why is GenZ, one of the most active groups on social media, also the most likely to suffer from social isolation? “Screen time doesn’t replace the real life interaction that we need,” said UAB assistant professor Margaret Canter, PhD. “Texts can’t provide the same level of connectedness. The more time people spend with digital media, the less time they have to interact in real life situations.

“Since quarantining during the pandemic, young people seem more inclined to see home as their safe place, especially with the wave of mass shootings and violence. And with the spike in inflation, it’s harder to pay for after-school activities and sports programs, which was where many children learned how to make friends.

“Young people are under a lot of pressure as they move away from home, and go out into the world to establish their own identity. At a time in life when building new relationships is so important, it’s getting harder.”

Lonely teens and young adults may be more inclined to turn to drugs to dull the ache of depression, or to negative behaviors like cutting or eating disorders. Anger unbuffered by the support of good relationships may be turned inward

into thoughts of suicide, or outward in thoughts of violence.

The next spike in loneliness comes in the 40s, a time of transition.

“Many of the factors involved in social isolation tend to cluster around milestones in life,” Hays said. “In their 40s, people’s children leave the nest. They may be dealing with divorce, the aging or loss of their parents and possibly the early loss of a spouse, sibling or friend. They may have lost touch with the friends and support structures of their youth and are coming to terms with how the passage of time is shrinking the unlimited possibilities of their early years.”

In these years, alcoholism or substance abuse may become a pattern of selfmedication. Suicide rates tend to climb as stress and disappointment increase in isolation. Negative health behaviors may lay the groundwork for future chronic illnesses through poor eating habits, lack of activity and no one to help them buffer stress.

“The impact of isolation varies from one person to another depending on whether they tend to be introverts or extroverts,” Hays said “An introvert may interpret time alone as an enjoyable interlude of quiet. However, for an extrovert, being alone is a recipe for disaster.

“Being married or in a relationship tends to be protective, but it is no guarantee. Relationships can also be unhappy. It

may be necessary to grow beyond a bad relationship to establish a good one.”

Retirement is another milestone when people need to be aware of maintaining and building new friendships. The early 60s statistically tend to be when family, social and work relationships are at their best. However, how the years that follow go can depend on whether people think of retirement as something they retire from or retire to.

Despite intentions to stay in touch, contact with long-time work friends tends to lessen. These relationships need to be replaced with new friends met through shared interests.

“People should prepare as much for the emotional and social side of retirement as they do the financial side,” Hays said. “Everyone needs either meaningful work or a purpose that gives them a reason to get up in the morning. Think about new things you’d like to try. Join a group that shares that interest. That’s how you meet interesting people you will enjoy being around.”

In the later senior years, relationships shift as health, mobility and access to transportation change. Loss of a spouse and friends can make life more lonely, and loss of health and autonomy can make keeping a positive outlook more difficult. However the positive effects on the risks of illnesses and dementia make social contact worth the effort.

What can health professionals do to reduce the effects of loneliness on their patients? The Surgeon General’s plan includes screening questions in regular health assessments and advises providers to be aware of milestones that may increase the risk of isolation.

Canter said, “Part of my job is teaching our pediatric residents how to recognize loneliness, depression, anxiety and other emotional challenges in children. It’s a skill we need to pass on when dealing with patients throughout their lives.”

Shortage of Providers and Beds,

continued from page 1

typically scheduling out a month or two, sometimes more. Most of our patients are on medication when they leave here, so they need someone to follow up with that. Finding psychiatrists and counselors who are accepting new patients is difficult, and this is especially important for patients coming out of the hospital because there’s more acuity there.

“We have to get very creative, but most of the time we are able to find something. They may have to go to their family doctor until they can get in with a psychiatrist. If a therapist doesn’t have an opening, we get them on a waiting list. But there’s only so much we can do. Once they leave the hospital, they may decide for a variety of reasons not to follow up, and they end up back here.”

Medicaid patients have even fewer resources to draw on. “They don’t get appropriate outpatient care, which makes the recidivism rate high,” Gillott said.

“There are almost no psychiatrists in private practice that accept Medicaid, so those patients have to go to a community mental health center,” Edmonds said. “It’s been difficult to get appointments with some of those centers. With staffing issues, it’s hard to get them to even answer the phone.

“Most children have insurance, even if it’s Medicaid. But a lot of adults come through here without any insurance, and that’s even tougher. They need to see somebody, and that is very expensive. Most of the uninsured patients don’t have an income.”

COVID has also been a factor. “Mental health has really gone by the wayside during COVID. We call the mental health crisis the fourth wave of the pandemic,” Gillott said. “So many people went without medicine and treatment for so long.”

“There’s such a great need right now, post-pandemic,” Edmonds said. “I see children in my private practice, and most of the issues I’ve seen have been triggered by the anxiety of the pandemic. Testing is an additional problems for children as a result of the provider shortage. Psychologists who do testing for ADHD, learning disabilities, or other kinds of mental disorders, have a six to 12 month wait.”

There are no easy solutions. “Alabama is so far behind, to catch us up to where we need to be is going to take a lot of work and plenty of advocates,” Gillott said. “We aren’t seeing much of that. There’s such a stigma to advocating for mental health. We need someone who understands it and speaks to it in such a way to get this issue the attention it needs. We just aren’t there yet.”

Megan Hays, PhD, ABPP, FAACVPR Margaret Canter, PhD

Common Mistakes in IT Incident Response

By JAne ehrhArdt

Last year, U.S. healthcare entities were hit on average with 1,410 cyberattacks each week, up 60 percent from the year before, according to Check Point Research. These incidents could be anything from a third-party vendor’s outage to a tornado to a data lockdown. According to Nick Cofield at Jackson Thornton Technologies, most healthcare practices tend to make one or more of five common mistakes in readying for potential cyberattacks.

The first mistake is that many practices don’t have a written, step-by-step response to use when IT fails. “When practices with a plan get hit, there’s a sense of urgency, but their response is structured and efficient,” Cofield says. “When they don’t have a plan, everyone runs around like their hair is on fire. And the practice and patients suffer for that. The HIPAA fine for willful neglect currently costs a practice $12,794 per incident.

“Some practices may have a written plan, but they have relied too heavily on a stock template for the plan. When they get into a significant incident, they find that the plan is not relevant to their practice. Either the incident is not cov-

ered in the template or the response may not relate to their equipment, their data handling setup, or their staffing.”

To offset those errors, Cofield recommends holding brainstorming sessions with your staff to think through scenarios that could affect your ability to see patients. Review the list of details required to restore your operations and how each function would be affected. For example, what are your plans if the building be-

comes inaccessible? Who can work from home? Can you provide virtual visits? Will you need a temporary office?

The second mistake lies with the data backup because recovery relies on this. There is no magic wand to recover data if the backup is corrupted or inaccessible. To avoid that scenario, test the access to the backups and the data’s viability at least annually from outside the practice’s system. A test can uncover concerns in how long it takes to recover or realize systems you’re not backing up.

The third common mistake is not ensuring that every staff member memorizes the steps they take for each type of IT incident. Even the best plan won’t work if staff is unaware of their responsibilities in these situations. “The receptionist may not know that she needs to contact the practice manager when she gets a suspicious email,” Cofield says. Hold a monthly, 15-minute meeting on what to do in a specific incident, such as a ransomware attack. Ask someone from each department what they would do.

The fourth error practices make is that many administrators and physicians mistake IT support for data forensics. “There’s a big difference between managing an IT system and managing a cyberattack,” Cofield says. “A well-

meaning IT provider could make a mistake that exacerbates the situation. I remember an incident where the IT provider company paid the cyberattack ransom on behalf of their client, thinking it would go away and save the client any problems. But they were not authorized to do that, and there was no data forensics done, and it didn’t go away. IT needs to know the limits of their role. They are not the incidence response mechanism.”

The last of the top common errors in planning is stagnation. The practice creates a plan, and then it gets left on the shelf. Even when your practice has a minor incident that you contain, you should evaluate what went well and what didn’t. Evaluation may uncover that everyone was quick to respond, but that someone didn’t identify the suspicious email quick enough. Or a minor incident might reveal a limitation in insurance coverage that needs to be remedied. “Implement additional safeguards,” Cofield says. “Ask how the incident happened, how to prevent it, and if there’s anything to plan to put us in a better position for next time.

“Healthcare entities need to view their IT incident plan as a living document. It’s continuously evolving, because the threats change constantly.”

Nic Cofield

Building MFA into the Workflow

By JAne ehrhArdt

“It’s not an option as to whether you use MFA or not under HIPAA. If it’s available and you don’t use it, you’ve got problems,” says Russ Dorsey, CIO with Kassouf & Co. Multifactor authentication (MFA) requires a user to present a combination of credentials to verify their identity to gain access to a device or software.

The multifactor refers to the many forms in which a user can prove their identity. The five basic MFA categories are knowledge, such as a password; possession, like getting a code sent to the user’s phone; biologically with face recognition or fingerprints; a behavior, like drawing a shape on a screen; and location.

“Implementing MFA is also key to cyberinsurance,” says Ed Lawrence, chief technology officer with Simplified Medical Management. “If you don’t use it, it can dramatically increase your premiums. Even worse, claiming to use MFA, but not implementing it means the insurer will not pay resulting claims.

“We still see practices that don’t implement MFA at all because it’s a disruption, especially in healthcare, where providers need to move throughout the facility, making it a pain to retype in cre-

dentials and one-time passwords (OTP) every time the provider enters another exam room.”

But other measures can be taken to shore up exposure points and lessen the need for continuous MFA usage. “If it’s a big inconvenience as you go in and out of rooms, it would be appropriate to say, while I’m in the clinic, all I need is my username and password,” Dorsey says.

This would allow access to the EMR or devices only while in the clinic. Users would then need to enter the onetime code sent to their phone or fob just once or twice a day, because the geolocation authentication replaces that OTP step. “Then they’re good for eight hours. All you need is your user name

Banking Aligned with Your Financial Purpose

codes can be scanned, because they’re not encrypted,” Lawrence says, listing social engineering, SIM card swapping, and man-in-the-middle as tactics used by malicious actors.

and password from then on,” Dorsey says, though he suggests a second OTP sign-in after lunch.

Limiting access by time also shrinks that vulnerability bubble. This is accomplished, for example, by not allowing log-ins on the EMR or admin files during certain times of day and blocking emails from overseas. Use a geofilter with webmail to limit sources to within the US or even the clinic. “Office 365 has some of these options, and IT vendors know how to turn that on,” Dorsey says. “These things minimize that footprint, so users don’t have to hit those codes every 10 minutes.”

OTP itself is now coming under fire. “The problem is texted one-time pass-

In 2021, Syniverse, a company that routes 740 billion text messages each year for 319 carriers, including Verizon, T-Mobile, and AT&T, revealed a hacker had been accessing its databases for five years. “They could have been just watching texts go back and forth. That’s why OTP codes and SMS codes are not considered safe. But you have to be fairly sophisticated to take advantage of them,” Dorsey says.

That texted code also generally stays valid a long time in cyber terms — ten to 30 minutes. The new, more secure venue for delivering the code or allowing for facial recognition lasts only ten to 60 seconds. Dubbed time-based onetime password, TOTP is generated by third-party apps, primarily Cisco Duo, Microsoft Authenticator, and Google Authenticator. “In the last two years, Microsoft, Google, all the big online vendors have been moving away from SMS text messaging,” Lawrence says. Hackers have already found a loophole, called push fatigue. Users can choose to set their authenticator app to

(CONTINUED ON PAGE 20)

Ed Lawrence

Russ Dorsey

The Role of Artificial Intelligence in Cybersecurity

By BriAnA houston

As we all know, technology has changed our world, and amazingly enough, the pace of this change might actually be accelerating with the fast-moving developments in Artificial Intelligence (AI). This will affect everyone and all industries, including healthcare. In fact, at this very moment, the integration of AI is beginning to revolutionize healthcare delivery with providers using it to streamline many of their processes and to enhance diagnostics, among other things, all in an effort to improve patient care. However, as healthcare increasingly relies on digital systems and interconnected devices, robust cybersecurity measures are more important than ever.

The rise of artificial intelligence presents both opportunities and challenges in cybersecurity. While cybercriminals can use AI to launch more sophisticated attacks, medical providers can use it as a powerful tool for defense. You can prepare your organization by:

Implementing AI-Powered Security Solutions

AI algorithms can analyze vast

amounts of data, identify patterns, and detect anomalies that will enhance a practice’s threat detection capabilities. Your practice can use AI security solutions to stay ahead of evolving threats and minimize the risk of successful attacks. Also, by continuously monitoring network traffic, AI systems can respond to security incidents quickly, thereby preventing data breaches and safeguarding patient privacy.

Enhancing Employee Awareness and Training

It’s crucial for your practice to educate employees about the potential risks of AI-driven attacks and to train team members on how to recognize and respond to these threats. By fostering a cybersecurity-conscious culture, your organization can empower employees to identify and report any suspicious activities they spot.

Enhanced Incident Response

In the event of a security breach, AI can assist in your incident response process. AI-powered systems can swiftly analyze vast quantities of data to identify the extent of the breach, trace the attack,

and to pinpoint affected systems or equipment. Automated incident response mechanisms can also isolate compromised systems and mitigate the spread of malware. By improving incident management efficiency, AI empowers healthcare organizations to minimize the potential damage caused by cyber-attacks.

Predictive Analytics and Risk Assessment

While analyzing data, AI systems can sometimes recognize patterns that human operators might miss. By leveraging predictive analytics, AI can identify potential security risks, predict emerging threats, and assess vulnerabilities in your infrastructure. These insights enable healthcare organizations to allocate resources efficiently, prioritize security measures, and stay ahead of threats, giving your practice the ability to be proactive with your cyber defense.

As the digital landscape evolves and healthcare providers embrace the benefits of Artificial Intelligence, it’s critical to have robust cybersecurity measures. While AI can be a powerful tool in enhancing cybersecurity for healthcare providers, we need to acknowledge that, like any technology, it also poses potential risks. To protect a healthcare organization against AI-related threats, ensure that you regularly monitor, audit, and test AI systems. You need to ensure data integrity, and maintain human oversight to detect and mitigate potential risks. Don’t let your AI systems give you a false sense of security, as they can fail or be manipulated by bad actors. Collaborative efforts between your cybersecurity experts, AI developers, and your leadership team are essential to address these challenges and ensure the responsible use of AI within healthcare.

Alabama Pain Physicians is celebrating our fourteenth anniversary of providing the best comprehensive pain management care to the greater Birmingham area. We’ve worked hard to become the practice we are today. Thank you to our staff, patients, and referring physicians for your support over the past fourteen years!

Briana Houston is the Vice-President of Sales & Marketing with Simplified Medical Management.

Briana Houston

OUR BIRTHDAY –LET’S CELEBRATE TOGETHER!

HIPAA Oversights by Practices in IT

By JAne ehrhArdt

“HIPAA is the biggest regulated gray area out there,” says Aaron Woods, manager of security services at Dynamic Quest. “HIPAA states that to protect patient information, you must do what is feasible and what you can afford.” The generality in these guidelines has led healthcare entities to falsely believe that some IT security protocols are HIPAA compliant.

“Security is not the same as compliance,” says Ron Shoe, president of SIP Oasis. “If you mandate multifactor authentication (MFA) and everybody uses it to log in, that is still not HIPAA compliant. HIPAA auditors need to see written policies requiring MFA and attestations to using MFA from all employees, along with monitoring reports proving MFA was in place.”

Those policies and reports must be retained for six years. “Compliance lives in the past,” Shoe says. “Like with OSHA, HIPAA requires proof that the protections were in place when the problem started, which could have happened years before when a negligent employee clicked on something that allowed spyware in to sit undetected.

Many healthcare professionals com-

plain that HIPAA is too burdensome, a stick with no carrot. But, in fact, following HIPAA standards can save a provider from big problems. For example, HIPAA practices recently saved a medical lab that faced a lawsuit when a woman working at the lab told her daughter that the daughter’s husband had been tested for STDs. The husband sued the lab. The lab won the case because the documentation required by HIPAA proved the mother-in-law had signed an understanding of non-disclosure, attended a training through their portal, and had attested to completing it, proving the lab wasn’t at fault.

Besides a lack of documenting their

IT protocols, practices also make the mistake of assuming anything in the cloud is HIPAA compliant. “The cloud is still vulnerable, just in different ways,” Woods says. “In 2018, two of Allscripts data centers fell victim to a SamSam ransomware. The attack affected 1,500 of their customers using their cloud-based EHR. So ask your hosting environment for their documents on how they’re protecting your data on their system, including your role if they get breached. Add that to your HIPAA handbook, so when you get audited, you’ve done your due diligence.”

Mobile devices present another HIPAA blind spot for healthcare entities.

“The mandate is for encryption, when it

comes to protected health information (PHI) on phones, tablets, and computers used outside the network,” Shoe says. “If the data is accessed using both a secured, compliant portal and app to access it on the device, then it meets HIPAA standards. But the portal also needs to be reporting who is logging in.

“The rule needs to be that if a phone is going to access PHI, in any form, then it is subject to anything a computer is. The ideal is for staff to use devices devoted solely to business purposes, and only those corporate devices can access PHI. That allows IT to remotely shut them down or wipe them clean when lost or if a threat appears.”

Three months ago, someone stole the laptop from a remote worker in a large dermatology group. Not only was the machine not encrypted or protected by MFA, the practice could not state whether PHI had been stored on the laptop. “They had no policy in place about where data could be stored,” Woods says. “So they had to report to HIPAA that data may have been breached.”

Even in the office, PHI floats among devices unknowingly exposing data, such as scanning patient documents into a scanner and sending it to a computer.

“If you’re not cleaning that scanner out,

(CONTINUED ON PAGE 20)

Experienced, subspecialty radiologists provide a collaborative approach to enhance patient care. Accurate imaging reports – any time, any day.

Ron Shoe

Aaron Woods

Do I Believe You?

Scienter Standard in a FCA Case

By Kelli c. Fleming And JAmes A. hoover

Two False Claims Act (“FCA”) cases have recently been decided by the United State Supreme Court, further clarifying one aspect of the FCA. In the recent decisions in U.S. ex rel Proctor v. Safeway, Inc. and U.S. ex rel. Schutte et al. v. SuperValu Inc. et al., the Supreme Court ruled that FCA liability will depend, in part, on whether the defendant subjectively (not objectively) believed the claim was false, focusing on the scienter requirement of the FCA.

In these two sister FCA cases, the whistleblowers accused the supermarkets of wrongly and knowingly failing to offer all discounts when computing the

pharmacies’ “usual and customary,” or “U&C”, prices they offered to Medicaid and Medicare beneficiaries for generic drugs. The whistleblowers alleged that the supermarkets’ generic drug sales to retail customers used the price of $4.00 for a 30-day supply. However, the U&C prices charged to Medicare and Medicaid did not take into consideration the $4.00 price when calculating the “usual and customary” charge for the drugs. Thus, arguably, the U&C charges to Medicare and Medicaid were artificially high.

A district court agreed that SuperValu’s discounted prices were its U&C prices and that by not reporting them, it had made false claims. However, the FCA requires not only falsity but also scienter. The district court found that the supermarket had not acted with the requisite scienter. On appeal, the Seventh Circuit subsequently affirmed the rulings, saying that the retailers had made “objectively reasonable” interpretations of ambiguous law that they were not otherwise warned away from by “authoritative guidance,” and, thus, did not possess the requisite scienter.

The United States Supreme Court reversed the Seventh Circuit Court of Appeals “objective reasonable” standard and replaced it with the defendant’s subjective belief. In order for liability to exist under the FCA, not only must the claim be false, but the actor-defendant must act with “actual knowledge” of falsity or act with “reckless disregard” or “deliberate ignorance” of the truth otherwise referred to as “scienter.” According to the recent opinions, reckless disregard includes defendants “who are conscious of a substantial and justifiable risk that their claims are false, but submit the claims anyway.” Left unanswered in the opinion is what constitutes a “substantial and unjustifiable risk.”

According to Justice Clarence Thomas, who drafted the unanimous opinions, “What matters for a FCA case is whether the defendant knew the claim was false. Thus, if respondents correctly interpreted the relevant phrase and believed their claims were false, then they could have known their claims were false.” Under this standard, determining scienter in a FCA case will require analyzing the defendant’s knowledge and subjective belief, not examining whether there was an objectively reasonable belief to support the defendant’s actions.

Further, the opinions clarify that the belief that existed at the time the claim was filed is what is relevant, not the belief afterwards. This interpretation opens the door to fact-intensive inquiries and litigation discovery around intent and essentially shuts the door on dismissing a FCA case early in its lifecycle with a Motion for Summary Judgement based upon scienter, as proving or disproving subjective intent will almost certainly be a question of fact. Thus, due to the increased likelihood of discovery, providers must be careful when discussing billing issues, particularly in emails or other written documentation.

In light of these recent opinions, companies filing claims with the federal government need to closely scrutinize how to handle ambiguous law, guidance, or regulation, which is common in

Bilateral Retroperitoneoscopic Adrenalectomy

UAB is First in Alabama and Possibly the Southeast to Perform

By lAurA FreemAn

Overproduction of adrenal hormones can usually be addressed without the need to remove both glands. When it can’t, the situation becomes more difficult for both the patient and the surgical team.

“In most cases, we can stop the flood of cortisol, adrenalin and other hormones up-stream at the pituitary,” UAB surgeon Brenessa Lindeman, MD, MEHP said. “Tumors or other pituitary abnormalities may be increasing the flow of hormones that stimulate overproduction in the adrenals. Removing the tumor usually corrects the problem. But when it fails, or when pituitary surgery is too dangerous, it may be necessary to remove both adrenal glands.”

Adrenal hormones such as cortisol and adrenalin are survival mechanisms that gear the body up for a fight or flight response to deal with stress, fear or danger. However, an unrelenting excess of these hormones would be like living in a perpetual panic attack.

“We aren’t meant to be under stress

all the time,” Lindeman said. “It can wear our bodies down. Excessive adrenal hormones can cause thinning of bones, wasting of muscles, high blood pressure, heart issues and many metabolic problems. It must be addressed.

“30 years ago, removing adrenal glands required big incisions.

Laparoscopic surgery was an improvement, but patients were positioned on their side for access through the abdomen all the way through to the back. The distance and working around other organs wasn’t ideal. When both adrenals had to be removed, they couldn’t be accessed at the same time, so that meant two entirely separate surgeries. Patients were under anesthesia twice as long, and for some, especially more fragile patients, that could be a problem. It also meant surgical teams were working twice as long and fatigue tends to make precision more challenging.”

Lindeman learned the retroperitineoscopic technique during fellowship training at Brigham and Women’s Hospital in Boston. She brought the technique with her when she came to UAB in 2017.

“We position patients face down on their abdomen so we can go directly through the back,” she said. “It’s a shorter distance and allows two surgeons to work together at the same time. Access through the back also works better for single adrenalectomies. It’s a shorter distance, so there’s less pain than an abdominal approach, no risk of hernia and recovery is faster. Patients having a single gland removed can often go home the same day.

“Only a handful of centers in the U.S. are performing two-surgeon bilateral adrenalectomies. UAB is the first in Alabama and likely the first in the southeast. I’m passing on the technique

by training our residents in surgical fellowships. Both Jessica Sazendin, MD, and Andrea Gillis, MD, have worked with me in the second surgical position to perform the procedure.”

Another thing Lindeman likes about the surgery is that it’s more collaborative.

“If one of us comes across something unusual and wants a consult, all we have to do is speak with the surgeon across the table,” she said. “Our patients have done well. I just caution them not to lift anything heavy for a while. We keep the bilateral patients an extra day or so to closely monitor their hormone levels as they transition to hormone replacement. They will need to continue to replace hormones for the rest of their lives, much the same as patients who have thyroid surgery.”

Healing usually progresses rapidly after surgery. Patients are free of the excess stress hormones that had been keeping them on edge and have been wearing away at their bodies. They can relax and enjoy getting back to normal life again.

Brenessa Lindeman, MD, MEHP

Shifting Hormones Affect Women’s Oral Health

By lAurA FreemAn

From preterm birth to an increased risk of heart disease, oral health can affect the health of the body. For women, the reverse is also true. Starting with the first fluctuations of estrogen and progesterone that come with puberty, the hormones a woman’s body produce make protecting her gums and teeth more challenging.

“When estrogen and progesterone increase, blood flow to the gums also increases. Bacteria in the mouth change and the immune system’s response to plaque also changes, increasing inflammation,” Mia Geisinger, DMD, of the UAB School of Dentistry, said. “Although advanced gum disease is seen more often in men, primarily due to lower rates of regular dental care, the shift in hormones every month put women at greater risk of developing red and swollen bleeding gums, swollen salivary glands, and mouth ulcers. In severe cases, pyogenic granulomas can develop. The tumor is noncancerous, but it can be painful and bleeding.”

Hormonal shifts occur monthly during menstruation, when using oral contraceptives, and during pregnancy and at menopause. Physicians and dentists need

to work together to protect oral health, body health and the health of pregnant women and their babies.

“During hormonal shifts, women should be extra vigilant about brushing, flossing and keeping up-to-date on dental exams and cleanings.” Geisinger said. “We hope to partner with gynecologists, obstetricians and primary care providers to make sure that women who are pregnant or plan to be are current on their dental visits and have a dental home to help them maintain good oral health during their child bearing years. Periodontal disease has been linked to poorer pregnancy outcomes, including preterm delivery and lower birth weight.”

Physicians and dentists may also need to coordinate their efforts during menopause. It’s no coincidence that “long in the tooth” became a term for aging, since receding gums, periodontal disease and other oral health problems tend to become more pronounced as people age. In addition to nutritional problems that can be related to the loss of teeth or painful teeth and gums, inflammation and bacteria that gets into the bloodstream can endanger the valves of a weak heart and add to the burden of other parts of the body.

“Mouth dryness also tends to increase with age,” Geisinger said. “Some prescription drugs can make the dryness worse. Since a dry mouth is more at risk for decay, patients experiencing the symptom or taking medications than increase dryness should have a plan for keeping their mouth clean and well-hydrated.

“Estrogen also plays a role in osteoporosis and the loss of bone strength in the body and jaw. In the past, some medications prescribed for osteoporosis were suspected in the development of osteonecrosis of the jaw which made oral surgery and reconstruction of the jaw and face

after an accident more difficult and risky. Now the problem seems to be related to using certain drugs in people who have specific health problems.”

Still, the recommendation to make sure any dental issues are addressed and preventive care is up-to-date before beginning difficult treatments is likely to put the patient in a better position to focus on getting better. Recovering from heart surgery or chemotherapy can be demanding enough without the pain of suddenly needing a root canal.

If you want to see a picture of health, look for a healthy smile.

“You can tell a lot about a person’s overall well-being just looking in their mouth,” Geisinger said. “How well they are taking care of their teeth and gums is a clue to how well they are taking care of the rest of their body. The mouth is where good health begins, supporting and nourishing every cell of the body. Early warnings often show up in the mouth first. You can see stress and anxiety in how people grind their teeth or clench sore jaws at night. Side effects of medication and the symptoms of some diseases show up here first. The better doctors and dentists communicate, the better we can take care of our patients.”

Mia Geisinger DMD

HHS Proposes HIPAA Changes to Protect Reproductive Health Information

By elizABeth neAl PitmAn And Ashley l thomAs

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) recently published a Proposed Rule proposing amendments to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to strengthen privacy protections for reproductive health information. According to OCR, the Proposed Rule is intended to strengthen patient-provider confidentiality and facilitate full exchange of healthcare information between healthcare providers and patients.

As a result of certain state laws passed and pending following the Dobbs v. Jackson Women’s Health Organization decision, there have been growing concerns that law enforcement and others are increasingly likely to request protected health information (PHI) from healthcare providers and others, such as technology vendors, for use against individuals, healthcare providers and others, solely because such persons sought, obtained, provided or facilitated lawful reproductive healthcare services. Developments in the aftermath of Dobbs have made information related to reproductive healthcare more likely to be of interest for punitive non-healthcare purposes. Furthermore, OCR believes that additional privacy protection would reduce the risks that medical records relating to legal reproductive healthcare would be inaccurate or incomplete.

OCR has determined, in accordance with other federal agencies, that information about reproductive healthcare is particularly sensitive and requires heighted protections, similar to the nature and treatment of mental healthcare in psychotherapy notes. OCR acknowledges, that in most cases, information about an individual’s reproductive healthcare includes the kind of highly sensitive information that patients would be reluctant to share if they knew it could be disclosed and used against them, thus leading to inaccurate and incomplete medical records.

OCR set out a proposed definition for reproductive health information (RHI), as a subset of PHI, but recognized the need to establish a shield against certain uses of RHI rather than creating a protected category of information. The proposed restrictions on disclosure are purpose-based as opposed to category-based.

OCR intends to interpret “reproductive healthcare” to include, but not be limited to:

• contraception, including emergency contraception

• pregnancy-related healthcare, including but not limited to miscarriage management, molar or ectopic

pregnancy treatment, pregnancy termination, pregnancy screening, products related to pregnancy, prenatal care and similar or related care

• fertility- or infertility-related healthcare

• other types of care, services or supplies used for the diagnosis and treatment of conditions related to the reproductive system

Prohibitions in Disclosures of RHI

Under the Proposed Rule, disclosures of PHI would be prohibited when RHI is sought for the purpose of con-

ducting a criminal, civil or administrative investigation into or proceeding against an individual, a healthcare provider or other person in connection with seeking, obtaining, providing or facilitating repro-

ductive healthcare that 1) is provided outside of the state where the investigation or proceeding is authorized and where such healthcare is lawfully provided, 2) is protected, required or authorized by federal law, regardless of the state in which such healthcare is provided, or 3) is provided in the state in which the investigation or proceeding is authorized and that is permitted by the law of that state.

The Proposed Rule would also prohibit a covered entity from using or disclosing an individual’s PHI for the purpose of identifying an individual, healthcare provider or other person for

Elizabeth Neal Pitman Ashley L. Thomas

HHS Proposes HIPAA Changes to Protect

the purpose of initiating such an investigation or proceeding against an individual, a healthcare provider or other person in connection with obtaining or providing reproductive healthcare that is lawful under the circumstances in which it is provided.

Under the HIPAA Privacy Rule, as it currently stands, the law permits but does not require certain disclosures to law enforcement and others, subject to specific conditions, and which are referred to as “required by law” disclosures. In 2022, OCR published clarifying guidance on the HIPAA Privacy Rule’s requirements around sharing PHI with law enforcement. OCR explained that disclosures for non-healthcare purposes, such as disclosures to law enforcement officials, are permitted only in narrow circumstances tailored to protect the individual’s privacy and support their access to healthcare.

Takeaways

The definition and scope of RHI encompasses a wide range of healthcare providers and business associates and includes over-the-counter medications. State laws that are contrary to the proposed regulations will be preempted by HIPAA.

The Proposed Rule would prohibit disclosure of RHI related to interstate reproductive healthcare services if the services are received in a state where it is lawful to receive such care.

If the reproductive health services sought or obtained are illegal under state law in which the services are provided, there is no protection against disclosure –except in situations where there are federal requirements to provide services (i.e., under the Emergency Medical Treatment and Active Labor Act (EMTALA) or services provided by the U.S. Department of Veterans Affairs). Assuming law enforcement subpoenas or requests for information are otherwise permissible, disclosures of this information would also be permitted. This means that PHI could potentially be disclosed for patients receiving reproductive healthcare in states where the procedure is illegal when the procedure is performed in that state.

If a request is received for PHI that is potentially related to reproductive healthcare, the covered entity or business associate will be required to obtain a signed attestation that the use or disclosure is not for a prohibited purpose. This will likely be an administrative burden on

healthcare providers to obtain and verify information contained in an attestation. Furthermore, if a healthcare provider becomes aware of an attestation that has been falsified or misrepresented, the healthcare provider may be required to report it as a data breach to the individual and OCR.

The Proposed Rules apply to only HIPAA-covered entities and business associates and do not apply to healthcare

apps or products that fall outside of the scope of HIPAA; therefore, direct-toconsumer female technology (FemTech) apps or products may not have the same restrictions with respect to sharing information for law enforcement purposes.

Direct-to-consumer health apps and products not offered on behalf of a covered entity are subject to oversight by the Federal Trade Commission (FTC). The FTC has also recognized that informa-

tion related to personal reproductive matters is “particularly sensitive.” The FTC has published its own guidance indicating that it will pursue enforcement against any unauthorized disclosure made in violation of federal or state law or contrary to the statements made in public privacy notices.

Elizabeth Neal Pitman is a partner in Holland & Knight’s Birmingham office. Ashley L. Thomas is senior counsel in Holland & Knight’s Washington, D.C., office.

X-RAY & IMAGING

The Practice is Always a Tenant

By rich A. cAmPBell, iii ccim

Many medical practices assume that owning their real estate is something to be aspired to, while in reality owning the property where a medical practice sees patients may not always be the best option. When weighing out leasing versus owning, it is important to look at the occupancy cost of leasing regardless of the ownership of the physical building. There are plenty of instances where leasing creates not only a more flexible arrangement, but may also be the better financial decision as well. In any event, the practice itself should never be the purchasing entity of a real estate asset. The practice needs to always be a tenant through a lease that is signed with a separate building ownership.

When searching for real estate, the practice must do so with the intent of taking care of “practice needs” as the most important priority. Ownership should be of lesser importance. Once the appropriate location is determined, the practice should be prepared to sign a lease agreement with whomever the owner is, regardless if members of the practice also own the building. If there is an ownership opportunity available, the owners of the practice will want to run a pro forma to assess the value of ownership of the building. The pro forma helps determine what the cost of occupancy (rent plus expenses) needs to be to create a viable purchase opportunity. The cost of occupancy that is in the practice lease has to be a fair market value rent and not a “boosted” rent to justify the purchase of the asset.

In purchasing the real estate, a separate building ownership is typically in the form of a limited liability company

(LLC). This LLC will own 100 percent of the building with the physicians having the option to own portions of the LLC or the entire LLC. The cleanest way in which to set up the LLC is when the owners of the practice acquire the same percentage of ownership in the real estate LLC, however this set up is not mandatory. As the practice moves forward, a buy/sell provision can be incorporated to accommodate any makeup of ownership that is not equal. Buy/ sell provisions can be found within the Operating Agreement and the provision will exist with or without equal ownership. Having a good buy/sell provision in the beginning of a new acquisition may save partners from unnecessary emotional hardship when they need to move in and out of the LLC. The management and control of the LLC is also very flexible and can be drafted in the operating agreement to give control elements to an LLC manager even if they are not 51 percent owners of the LLC.

Most medical building acquisitions involve properties that are either nonmedical buildings needing to be converted to medical, or existing medical buildings that require a good amount of work to accommodate the new practice needs. If a fair market deal is achievable and maintained, there are some advantages of being an owner occupant, including the ability to contain turn-key tenant improvements in the budget, financing the improvements over 20 to 25 years which may render financial benefits, possibly limit up-front cash, and keep the occupancy cost lower for the tenant.

The bottom line is that it is imperative that the practice is not unnecessarily weighed down

Jasper

Do I Believe You? Scienter Standard in a FCA Case, continued

the highly-regulated healthcare industry. When it comes to billing issues associated with Medicare, it is oftentimes hard for providers to obtain guidance, even when requested. Further, by reaching out for guidance, a provider may actually be highlighting that it knows there is ambiguity and risks involved, and thus essentially prove for the government that it satisfies the scienter standard under the FCA. In light of these opinions, providers must exercise extreme caution in situations where the guidance is unclear. The provider must decide if it moves forward with what it believes to be a rea-

from page 10

sonable interpretation of the guidance, even though there is a doubt that the interpretation may be incorrect.

While the recent decision is significant, it leaves many questions unanswered and some items left to be litigated regarding the scienter requirement under the FCA.

Kelli Fleming is a Partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Practice Group. Kelli may be reached at (205) 458-5429 or kfleming@burr.com. Jim Hoover is a Partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Practice Group. Jim may be reached at (205) 458-5111 or jhoover@burr.com.

Building MFA into the Workflow,

continued from page 7

replace entering the sent code into the website or app with simply punching “yes” in response to a push notification. Cybercriminals found that if they sent a bunch of push notifications at awkward times, like in the night or during mealtimes, people got frustrated by the endless alerts and finally hit ‘yes.’ “It’s a convenience, but it turned out to be a bad thing,” Dorsey says. “You want the authenticator app to give you a number

to put back into the website. That’s considered about the safest option.”

The unending need to adapt can frustrate people. “Doctors say MFA is too much, so they just don’t do it, and that’s the wrong choice,” Dorsey says. “These types of authentications are never going to be bulletproof, but they are HIPAA-proof. And there’s a way to do it and not kill your workflow.”

HIPAA Oversights by Practices in IT,

continued from page 9

you have sensitive information on your devices,” Woods says. “For HIPAA compliance, all of these exposures and how they are being addressed need to be documented in policies.”

“Set things up as zero trust,” Shoe says, as a way to interpret HIPAA compliance. A zero trust approach to IT assumes that any person, device, or service attempting to access the practice’s data, even from inside the network, cannot automatically be trusted.

That means monitoring network activity. “If you’re not monitoring, how do you know what’s broken or what’s going on?” Woods says. He recently got a monitoring alert at one client that a staffer was visiting a suspicious website. It turned out

that the user had downloaded a TOR browser, which is designed for anonymous web surfing and often used to access the dark web.

If monitoring or any other security measure is too costly, note that in the practice’s risk assessment and policies. “Write that you looked into full-blown monitoring and couldn’t afford it,” Woods says. Then describe the actions taken to mitigate the risk, such as inhibiting the ability of users to install software and keeping security patches and software updated.

“The common misconception is that HIPAA mandates perfection,” Shoe says. “What they actually mandate is a to get better every year.”

How Obesity In-Utero Affects Offspring

We’re Growing To Serve You Better Now With 10 Locations

A new study, published in the Journal of the American Heart Association, suggests that what happens in the womb could determine whether the offspring will develop obesity or other metabolic diseases later in life.

Three groups of UAB researchers analyzed the mechanisms of the transgenerational impact of the mother’s obesity and the effects on offspring.

The first group, led by Timothy Garvey, MD, Kirk Habegger, PhD, and fellow Rogerio Sertie, PhD, looked at how a mother’s diet during pregnancy affected her offspring’s body composition and metabolism. They found that a protein-restricted diet during gestation produced smaller offspring with more muscle and less fat. On the other hand, when mothers had a high-fat diet during pregnancy, their offspring had a greater risk of obesity and consumed more food, despite having high levels of hormones that regulate hunger and metabolism.

They also found that differences in DNA methylation at specific gene sites are associated with obesity and metabolic diseases in the offspring. This provide insights into how early-life events can impact health later in life and could lead to new ways to prevent these conditions.

The second study group, led by Ashley Battarbee, MD and Lorie Harper, MD, aims to understand how the in-utero environment affects the health of newborns and infants up to three months.

They enrolled pregnant women who were separated into groups based on their weight status and whether they had gestational diabetes, and tested to see whether the differences in the in-utero environment led to differences in the health

of their babies.

The researchers hypothesized that the same epigenetic modifications associated with cardiometabolic disease traits in older children would also be present at the time of birth. They hope to identify modifiable risk factors that can prevent lifelong obesity and cardiometabolic disease in infants with in-utero exposure to maternal obesity and/or gestational diabetes. The study was completed in December 2021, and analyses are currently underway.

The third study group, led by Paula Chandler Laney, PhD, Bertha Hidalgo, PhD, and fellow Samantha Martin, PhD, enrolled mother-child pairs to investigate the effects of maternal obesity with and without gestational diabetes on obesity and cardiometabolic traits in both mothers and children.

The researchers found that mothers with a history of obesity during pregnancy had a poorer cardiometabolic phenotype compared to mothers who had a normal body mass index during pregnancy. However, the severity of this phenotype varied depending on whether the mother also had gestational diabetes. Children’s cardiometabolic traits were modestly correlated with those of their mothers.

The researchers suggest that cardiometabolic health following in-utero exposure to maternal obesity or gestational diabetes may become more pronounced once children reach adolescence. The study’s findings could help identify modifiable risk factors for lifelong obesity in infants exposed to maternal insulin resistance and obesity, and may pave the way for new interventions.

Birmingham Medical News SCHEDULE BLOG

JULY 18 Peter Jameson of Veritas Medical Real Estate Advisors: Top 10 Real Estate Questions Asked by Physicians

JULY 23 Andy Baer, MD of MagMutual: Returning Youth Athletes to School and Sports after a Concussion

AUGUST 1 Samantha Hill of Interior Elements: Creating the Right Waiting Room Atmosphere

ENT Associates of Alabama, P.C. is the largest Otolaryngology practice in Alabama with 10 locations,15 physicians, and over 600 years of combined staff and physician experience.

throat, head and neck diseases and surgeries, cosmetic surgery, robotic procedures, inoffice balloon sinuplasty, allergy treatment, and hearing solutions. We concentrate our training and experience in these areas to provide the best possible medical care for our patients.

Our practice includes general ear, nose, and throat, head and neck diseases and surgeries, cosmetic surgery, robotic procedures, inoffice balloon sinuplasty, allergy treatment, and hearing solutions. We concentrate our training and experience in these areas to provide the best possible medical care for our patients.

At ENT Associates of Alabama, P.C. the patient’s experience matters. We treat each patient as a person, not just another case. We pride ourselves in delivering a positive personal experience along with a positive outcome

At ENT Associates of Alabama, P.C. the patient’s experience matters. We treat each patient as a person, not just another case. We pride ourselves in delivering a positive personal experience along with a positive outcome

Birmingham - Princeton - Hoover - Cullman - Gardendale

Alabaster - Jasper - Pell City - Trussville - Valleydale Rd. www.entalabama.com or call toll free 888-368-5020

Timothy Garvey, MD Bertha Hidalgo, PhD Ashley Battarbee, MD

UAB Part of NIH Program to Advance Precision Medicine Nutrition How Does Each Individual Respond to Specific Foods?

The National Institutes of Health is now enrolling for the Nutrition for Precision Health (NPH), powered by the All of Us Research Program in collaboration with UAB and other partners. The project, which is the largest precision nutrition effort of its kind, aims to engage a diverse group of participants to learn more about how our bodies respond differently to food.

NPH will use artificial intelligence to analyze information provided by participants to develop algorithms that predict responses to dietary patterns. The study’s findings may one day allow clinicians to offer more customized nutritional guidance to improve overall health.

Current dietary recommendations do not consider individual biological differences in how people respond to foods or ways and timing of eating. NPH will study how a range of factors, including genes, lifestyle, health history, gut microbiome, and social determinants of health, influence a person’s response to diet.

NPH plans to enroll 10,000 participants age 18 or older from diverse backgrounds. To participate, individuals must be enrolled in NIH’s All of Us Research Program. All of Us aims to engage at least one million participants in building a health database that reflects the diver-

sity of the United States to help speed up medical research and enable individualized prevention and treatment.

The study consists of three modules. In the first module, participants will complete surveys, report their daily diets, and give blood, urine and stool samples for lab tests, including microbiome analysis. In the second module, a subset of participants will be given diets selected by researchers. In the third module, participants will also be given diets selected by researchers, but will

be asked to stay in a research center while on the diets.

All participants will take part in meal challenge tests, where physiological changes will be measured after they eat a standardized meal. Participants will receive interpreted information from the study on their health, including body composition, microbiome makeup, metabolism and diet composition.

At UAB, participants in module three will have the opportunity to spend three, two-week blocks of time living

in Wi-Fi-enabled cottages on the Lakeshore Foundation campus. Participants will be able to take advantage of the facilities at Lakeshore — such as the gym, pool and walking trails — throughout their stay. Participants will receive compensation for their time, as well as all meals and snacks for the duration of their stays.

NPH will link participants’ data from the study to information obtained through the All of Us Research Program, including genetics information and data from electronic health records and additional surveys. The study use AI to analyze this data from participants to develop algorithms predicting how a person will respond to a particular food. This information will ultimately be accessible through the All of Us data platform, the Researcher Workbench, to support other studies on health and disease. Strict safeguards are in place to keep the data secure and protect participant privacy.

EDITOR & PUBLISHER

Steve Spencer

VICE PRESiDENT OF OPERATIONS

Jason Irvin

CREATIVE DIRECTOR

Katy Barrett-Alley

CONTRIBUTING WRITERS

Jane Ehrhardt, Ashley Franco, Laura Freeman, Lynne Jeter, Marti Slay

Birmingham Medical News

270 Doug Baker Boulevard, Suite 700-400, 35242 205.215.7110

AD SALES:

Jason Irvin, 205.249.7244

All editorial submissions should be e-mailed to: editor@birminghammedicalnews.com

FOLLOW

Brookwood Baptist Opens New

In May, Brookwood Baptist Medical Center opened its new operating room. The 18,822-square-foot facility has 10 new operating rooms and shelled space for three more. The OR suite will allow for advanced cardiac and vascular procedures, along with robotic-assisted minimally invasive surgeries. There is also a new pedestrian bridge, as well as administrative spaces, and a 3,500-square-foot post-anesthesia care unit.

Robins & Morton Corporation served as the general contractor on the $30 million project which broke ground in November 2021.

Jefferson County Health Department Files Contempt Petition Against Bluestone Coke

In May, the Jefferson County Department of Health filed a Contempt Petition in its lawsuit against Bluestone Coke. The Petition is based on Bluestone Coke’s failure to pay the monetary penalties required by the parties’ Consent Decree. Over $90,000.00 of the money that Bluestone Coke has refused to pay has been previously set aside by the Health Department for the benefit of the communities surrounding Bluestone Coke’s facility.

“We look forward to resolving this matter in the best interests of the public and the Health Department,” said Mark Wilson, MD, Jefferson County Health Officer.

Brian Massey Joins Children’s of Alabama

Children’s of Alabama has appointed Brian Massey as director of government affairs. Massey is coming to Children’s from Ascension St. Vincent’s where he was the Alabama Chief Advocacy Officer. He is replacing long-time vice president of government relations Suzanne Respess, who retired in June.

$3.3 Million Grand Funds Research on Cardio Program for Wheelchair Users

There are roughly 5.5 million wheelchair users in the United States. Most live predominantly sedentary lifestyles, which leads to higher cardiometabolic risk factors. Researchers at UAB hope to minimize some of these risk factors through a new study.

The NIH awarded Jereme Wilroy, PhD, assistant professor for the UAB Department of Physical Medicine and Rehabilitation, $3.3 million to study the effects of live telehealth exercise training on cardiometabolic outcomes in wheelchair users.

“We are building on our previous

In this role, Massey will monitor and negotiate all federal, state and local legislation and regulations impacting operations and pediatric healthcare. He will act as a liaison with government entities, industry and community organizations that regulate or influence healthcare policy and hospital operations.

Massey graduated from Belmont University with a Bachelor of Business Administration in Healthcare Management. He received a Master of Business Admin-

success with Movementto-Music, a rhythm-based exercise program that has proved effective in improving health,” Wilroy said. “We’re adapting the M2M telehealth delivery method to develop a program with a cardio emphasis.”

The 24-week M2M-C program includes a remote training system with built-in videoconferencing and realtime monitoring of vital sign data. The aim is to examine the average treatment effects of the M2M-C program on core indicators of cardiometabolic risk factors.

istration and Master of Science in Health Administration from UAB. Massey is on the Birmingham Business Alliance Government Affairs Committee, the Mobile Area Chamber of Commerce Government Affairs Committee and the Alabama Hospital Association State and Federal Policy Committee. In 2022, he served as the board chair for the Shelby County Chamber of Commerce, and from 2019 to 2023 he was the vice chair for the Alabama Care Network Mid-State.

birminghammedicalnews.com

Jereme Wilroy, PhD