Birmingham Medical News June 2023

How to Diagnose Polycystic Ovary Syndrome Cases are Presenting More Frequently

By Jane ehrhardt

“I see this syndrome frequently in my office, at least three to four times a week, sometimes in a single day,” says Mackenzie Woodson, MD, an OB/ GYN with Complete Women’s Care of Alabama. Affecting about five million women in the United States, polycystic ovary syndrome (PCOS) is one of the most common causes of female infertility, according to the CDC.

Typically, PCOS is seen in women ages 18 to 35 with the hallmark symp-

tom of irregular periods. The cause of the syndrome is unknown, though the problem rests with abnormal androgen hormones with small cysts forming on the outer edge of the ovary that fail to regularly release eggs.

“PCOS comes up a lot in other specialties, not just obstetrics because those with the syndrome often have metabolic syndrome as well,” Woodson says. “Those symptoms lead them to their primary care provider or an endocrinologist who may not immediately think to suspect the presence of PCOS.

“If a provider notices skin changes on the back of the neck, this can be a clue to ask for more information about the patient’s menstrual cycle and even check for prediabetes, which are all signs of PCOS and metabolic syndrome.”

On lighter skin tones, the changes on the back of the neck, called acanthosis nigricans, appear as a darkened area as if tanned in that spot. On darker skin tones, the dark patches present more as a thickened, velvety texture. Besides the neck, these anomalies may be found in the arm-

(CONTINUED ON PAGE 4) Mackenzie Woodson, MD

Alabama Rock Star Turned OB-GYN His Band Once Opened for Bob Seger

By anSley FranCo

Sitting at his desk, Randy Yarbrough, MD glances over to an old Polaroid taken for a publicity shot in 1969 as he talks about his band.

Yarbrough always had a knack for picking out the drum parts in the 50s and 60s songs his older sister would play. Despite being the youngest player at 12 years old, Yarbrough helped form a band comprised of his four 16-yearold neighbors in Graysville, Alabama. The group decided to name their band Chapter Five after the five original members.

Despite the lead singer leaving the

band, Chapter Five continued to practice anywhere from Yarbrough’s sister’s basement to the bass player’s back porch. To go along with their shoulderlength hair, the band played all the big tunes of the day from Led Zeppelin to Credence Clearwater Revival. This practice led to their success at a Battle of the Bands competition, where the firstplace prize was a booking contract with Southeastern Attractions.

From this contract, Chapter Five got to play at proms, as well as Auburn University and the University of Alabama fraternity parties. Each member would take turns driving to their

Randy Yarbrough, MD (left) with the band.

Increase in Workplace Violence Demands

Heightened Training and Attention

By Marti WeBB Slay

As workplace violence becomes a growing issue in healthcare, many hospitals are beginning to develop programs to keep employees safe.

“We’ve had workplace violence as long as I’ve been in healthcare, but it has increased,” said Kelli Powers, president of Decatur Morgan Hospital. “I’m a flagbearer for it in a way, to protect my employees. We all have a shortage of employees everywhere, and I want to make sure we have as little violence as possible. Of course, I’d like to have none, so I’m a constant advocate for how we can minimize workplace violence.”

According to the American Nurses Association, one in four nurses is assaulted, but only an estimated 20 to 60 percent of incidents are reported. The organization has launched A Nurse’s Call to Action, encouraging nurses to pledge to share the program, support zero tolerance policies and report abuse. Nurses can take the pledge at Nursingworld.org/Pledge.

It’s not always easy for healthcare workers to take such a pledge and follow through. “Healthcare workers are there to care for people, so it’s not in their nature to move forward with actions like this, but it’s important,” said Amy Shelton, MSN, RN, chief nursing officer of St. Vincent’s Ascension. “It’s a felony in the state of Alabama to assault a healthcare worker. As leaders of healthcare organizations, we have to support our associates and have an environment that’s safe for them and for our patients, so our providers are able to deliver care.

“We support our associates with a no tolerance policy. We will stand behind them in the event an incident may occur. We’ve seen a rise in healthcare violence towards workers, and it’s important that our associates know they have our support. We have a prevention plan in place, but if some unfortunate event should occur, they are totally, 100 percent supported by us.”

lnspirien, manager of the Healthcare Workers’ Compensation Fund (HWCF) as well as Inspirien Insurance Company, a medical malpractice carrier in the state, has developed classes for its insureds and members focusing on this issue. “We are doing our own initiatives to bring awareness to workplace violence. We see it every day when the claims come in, so we are gathering that data and seeking opportunities to support our healthcare partners,” said Cindy Sawyer, Marketing Manager. lnspirien is highlighting Violence Against Healthcare Workers by making it one of the featured topics in their annual Risk Seminar this year. Participation is open to all healthcare workers in Alabama. Find out more information on their website, inspirien.net.

Decatur Morgan’s Powers said it’s

important to acknowledge that workplace violence is an increasing problem in many industries beyond healthcare. “I don’t want healthcare to get the total blame,” she said. “We see this everywhere. You want to be honest with people, but you don’t want them to be afraid to work at a healthcare provider.

“A key first step is to talk about it and heighten awareness. If we can minimize a situation ahead of time, it doesn’t lead to violence. All our employees are taking a computer-based learning module, based on MOAB (Management of Aggressive Behavior). Some of that is online, and there are four-hour and eight-hour classes.”

Since the emergency department is often a target for violence, the Decatur Morgan ED staff is taking the eight-hour MOAB class module in person. “You

can’t do it all on the computer,” Powers said. “A lot of it is body language.

“It’s also important to be aware that violence doesn’t always come from the patient. It can be family too. Some of it comes with family members to each other. You can get a family here that doesn’t always get along, and they are stressed out with a short time to make decisions that aren’t always easy to make. Disagreements can escalate quickly in that situation. Also, violence doesn’t have to be physical. It can be mental and verbal as well.”

In addition to the training, Decatur Morgan has added more security staff, and they now have a safety officer, a nurse by training whose responsibility is to stay focused on security. They are also meeting with local law enforcement, their district attorney, and mental health offi-

cers to work on solutions.

Powers emphasized the importance of recognizing a potentially violent situation and taking steps early to de-escalate. She cites a recent case, when a homeless patient, irritated with the emergency department staff, came to the administration offices. Concerned that the patient was likely high on illegal drugs, the staff offered him a meal, which calmed him down and kept him from escalating to violence. “We try to be as accommodating as possible, but we aren’t going to tolerate aggressive behavior,” Powers said.

She believes it is reassuring to the employees to know violence is being addressed. “People are glad to talk about it, and they are glad to see that as president, it’s on my radar to do something about it,” she said. “We are addressing it and have options for them. And again, if you can get ahead of it, you can minimize so much of it. Be proactive instead of reactive.”

Powers encouraged other hospital administrators around the state to work together and share ideas. “Don’t ignore that it’s an issue,” she said. “Let’s work together to come up with solutions to help each other. I think your employees deserve that, to know we are all working together to make a safer environment for everybody.”

Rich and the Veritas team were professional, hardworking and discrete during our search for and acquisition of a new location for our practice. They guided us at each step and were able to accommodate meetings after clinic. We give them our highest recommendation.

Amy Shelton, MSN, RN Cindy Sawyer Kelli Powers

954-2514 abeesley@alamedical.org

How to Diagnose Polycystic Ovary Syndrome,

pits, groin, or under the breasts, as well.

A diagnosis of PCOS requires the presence of at least two of these three conditions: irregular periods, high levels of androgen, and polycystic ovaries. An irregular period would be more than 60 days apart, often as rarely as three times a year. The excess hormone levels may show as acne or excess hair growth such as on the face, and can be determined with a blood test for testosterone.

The third criteria of ovaries appearing polycystic requires only an ultrasound to confirm. “We actually don’t need imaging to confirm two of these conditions” Woodson says, stressing how simple the diagnosis can be. “But even if I see those first two, I usually corroborate it with a pelvic ultrasound. I also recommend that the blood test cover all hormones, which can be tricky to assess so this sometimes requires an OB/GYN or an endocrinologist. And providers should test the A1C, which can diagnose metabolic syndrome. Most of women who have metabolic syndrome will also have PCOS, but those with PCOS do not always have metabolic syndrome.

“The sneakiest people to diagnose are the thin women who come in with infertility, and it turns out they have polycystic ovaries, so are not ovulating. They’re tricky because most medical training pushes doctors to assume obesity is a prime condition of polycystic ovary syndrome. Even normal BMI woman can have PCOS. It comes down to menstrual history and physical features, such as the skin changes or excess hair.”

Undiagnosed, the syndrome can lead to endometrial cancer. “When you’re not having a period, you have low progesterone which makes higher estrogen that can place the uterus endometrium at risk for cancer, especially if you have a BMI of 40 to 60,” Woodson says. “The obesity component can put even younger women at risk for the cancer.

“We want to get women diagnosed for PCOS to be preventive. We can pro-

continued from page 1

tect her uterus and endometrium by giving progesterone, if her natural levels are low.” Generally, that requires only a prescription for tablets, an IUV, or birth control.

When PCOS is diagnosed, the treatment tends to be individualized depending on the patient’s stage of life and fertility desires. She may have infrequent ovulation, but no problems with extra hormones. Or she may or may not have metabolic syndrome.

“There are so many nuances, and because we’re getting a wider variety of treatment options we really can individualize our approach,” Woodson says. “If a woman has PCOS as well as metabolic syndrome, we get them on metformin.” Metformin, a biguanide, decreases glucose absorbed from food and produced by the liver, which helps prevent the progression into diabetes among this younger demographic.

For overweight patients, weight loss by itself can greatly improve or sometimes completely resolve their PCOS problem, making weight loss a viable treatment. “As little as a five percent body weight loss can help get a PCOS patient to ovulate spontaneously on her own with more regularity and fertility,” Woodson says.

Woodson has been seeing more women coming in with infertility or irregular menstruation issues. “It feels like a movement among women wanting to be in tune with their bodies,” she says. “They no longer want to be on anything hormonal, so they stop their birth control and start tracking their cycle closely with apps. They’re finding it empowering to know about their reproductive health, which is exposing more PCOS cases and this is why primary care providers and specialists should keep PCOS on their diagnostic radar.”

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Potential Hipaa Changes Related To Reproductive Health On The Horizon

By: Kelli C. FleMing

On April 12, 2023, the Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced proposed changes to HIPAA’s Privacy Rule with regard to reproductive health information. The proposed changes are set out in a Notice of Proposed Rulemaking (“NPRM”) and are part of HHS’s broader goal to strengthen the privacy protections concerning individuals’ reproductive information. Comments on the NPRM must be filed by June 16, 2023.

In the NPRM, HHS proposes to limit the use and disclosure of protected health information (“PHI”) in certain circumstances. Particularly, the NPRM proposes to limit the use and disclosure of PHI in (i) a criminal, civil, or administrative investigation into or (ii) proceeding against an individual seeking or obtaining reproductive health care or a HIPAA-regulated covered entity providing or facilitating reproductive health care, where such care is lawful under the circumstances in which it is provided.

The NPRM further proposes to limit the use and disclosure of PHI to identify any person for the purpose of initiating such an investigation or proceeding. However, the NPRM does not impact a covered entity’s ability to use or disclose such information for purposes otherwise permitted by the Privacy Rule where the use or disclosure is not made primarily for the purpose of investigating or imposing liability on any person for the act of seeking, obtaining, providing, or facilitating reproductive health care.

Reproductive health care involves care, services, or supplies related to the reproductive health of the individual, including but not limited to prenatal care, abortion, miscarriage management, infertility treatment, contraception use, and treatment of reproductive-related conditions. “Seeking, obtaining, providing or facilitating” includes “expressing interest in, inducing, using, performing, furnishing, paying for, disseminating information about, arranging, insuring, assisting, or otherwise taking action to engage in

reproductive health care.”

In scenarios where the request for PHI relates to reproductive health care, the NPRM proposes changes that would require covered entities to obtain an attestation from the person requesting the PHI that the use or disclosure is not for a prohibited purpose. The attestation would need to include confirmation regarding the types of PHI requested and the identity of the person whose information is being requested, if practicable. The attestation is designed, in part, to help covered entities assess whether the request is prohibited.

The NPRM also proposes changes to the information covered entities would need to include in their Notice of Privacy Practices (“NPP”). The proposed changes would require the NPPs to include information regarding the prohibition on the use and disclosure of reproductive health information. These proposed changes are based on HHS’s concern that NPPs, as currently written, focus on the permitted uses and discloses of PHI and do not provide adequate assurances to individuals that their reproductive health information is protected.

After the Supreme Court overturned Roe v. Wade, President Biden signed an executive order directing HHS to consider ways to strengthen the protection of information related to reproductive health care services. This NPRM is consistent with such directive. The NPRM is aimed to increase privacy protections related to reproductive health information in order to prevent negative outcomes such as the deterioration of the physician-patient relationship.

While HHS has stated that the proposed modifications are intended to provide additional protection of reproductive health information, the proposed changes do present some concerns and tensions among stakeholders. Accordingly, all stakeholders, including patients, families of patients, health plans, health care providers, health care professional associations, and consumer advocates are encouraged to participate in the public comment and feedback process. Stakeholders must submit their comments by June 16, 2023. Until a Final Rule is published and takes effect, the current HIPAA Privacy Rule remains in effect.

Jessica Ramos, DO Family Medicine Medical West Parkwest Health Center

Dornier,

Kelli Fleming

How Physicians Can Help Their Dyslexic Patients

By Jane ehrhardt

“Pediatricians and primary care providers have a unique opportunity to help families concerned with their child’s reading ability,” says Stephanie Denton, MD, CEO and president of Alabama Game Changers (AGC).

Denton, a pediatrician, and certified pediatric nurse Karen Belcher founded the nonprofit in 2014 to accurately diagnose dyslexia in children and guide their parents toward support services. Their focus was to bring educational and medical professionals together in this effort. This is reflected in their Board of Directors, which includes an Assistant Principal in an Alabama Public School, along with two pediatricians a pharmacist, an RN, and DNP. In addition, four of the board members are parents of dyslexic children, and two were diagnosed with dyslexia themselves.

In 2020, AGC expanded their purpose. “Just having a diagnosis isn’t enough,” Denton says. “What really matters is what is done next.” Their end goal now includes treatments to lessen learning struggles in both children or adults by strengthening their skills, minimizing bar-

riers, and adjusting environments using scientifically proven methods backed by years of research by the National Institute of Child Health and Human Development (NICHD).

That same year, Alabama Game Changers opened the state’s first multidisciplinary treatment center in Birmingham that provides a medical approach to building literacy. Partnered with Florida-based The Morris Center and Neurodevelopment of Words Programs (NOW! Programs), their treatments utilize science to promote neural plasticity for effective, long-lasting learning. The approach builds a foundation of sensory processing and thinking skills to improve the most likely cause of that individual’s learning difficulties.

Physicians perform the initial screenings for AGC. “A lot of the struggles can be tracked in their medical history,” Denton says. “We can see where the crack in that foundation started.” A host of medical conditions can impede learning, including sensory disorders, autism, cleft lip, neurodevelopment issues, and depression. Utilizing healthcare providers as evaluators has the added benefit of possible treatment coverage by insur-

ance, including speech, language, and fine motor deficits.

Environmental or developmental causes also get identified, such as in utero drug exposure, prematurity, and fetal-alcohol syndrome. Adoption is a common factor. “70 percent of children who are adopted will have learning issues,” Denton says. “With that in mind, we work with the adoption center at UAB.

“Diagnostic testing at AGC is designed to identify a child’s strengths and weaknesses, to holistically evaluate factors that impede progress. And then to make recommendations for evidence-based interventions that address the specific needs

of the child in a way that is feasible for the family.”

The interventions vary as needed, utilizing a wide variety of specialists from occupational and speech therapists to neuropsychologists. Some may only require an advocacy plan to work with schools.

The sessions at AGC can be as simple as individual reading programs once a day or even in-house stays. “Some stay with us for months under a home-school umbrella where we’re working not on academics, but on teaching the basics,” Denton says. “Some children have complex needs.” Some of those have traveled

(CONTINUED ON PAGE 9)

Karen Belcher

How Furniture Materials Impact the Waiting Room in Post-COVID Environment

By SaMantha hill

Over the last three years, people have become accustomed to hearing words like community spread, isolation, incubation period, transmission and infection prevention. Just the thought of visiting the doctor can spark anxiety for many and now even more so. With infection control being a concern for both clinicians and patients, how can we maintain a warm, welcoming waiting room environment while using materials that promote health and safety?

Standards of care for patient wellness has long been established in healthcare facilities. Materials used in those spaces should also be considered a standard of care. Two considerations when reviewing materials to use in a healthcare environment are: will this material harbor bacteria and infectious agents, and will this material withstand the immense wear and tear of patient use and repeated application of cleaning agents?

I am very cautious about woven materials when entering a healthcare facility. In fact, I try to avoid woven materials in all public locations. Fabrics for healthcare environments have evolved beyond a vinyl only available in unsightly colors and lim-

ited patterns. Today, silicabased, PVC-free, and clean vinyl products are available and are collectively known as coated upholstery. As technology has improved, so have the available colors and patterns. Coated upholstery is much easier to clean and disinfect than woven fabric, which decreases the spread of infectious agents. Woven upholstery can easily harbor bacteria and cleaners used by many facilities are not accepted for use. Conversely, to get the most life and longevity from your coated upholstery, it is imperative to understand and follow the manufacturers’ cleaning recommendations.

Many healthcare facilities no longer accept wood. Although wood has traditionally be used to provide a warmer, biophilic environment, it is also difficult to disinfect and maintain water resistance. It is a porous material and can harbor bacteria. As an alternative, metal is a nonporous material that promotes infection control and can withstand harsh cleaning agents used in healthcare settings. With more powder coat color options now available, metal seating can be designed

to feel inviting and comfortable.

It should also be mentioned that wall-saver chair frames should be used for chairs that sit against a wall. A wall-saver leg design prevents the chair from damaging or scratching the wall. Not only is a damaged wall ugly, dust and debris can build-up in scratches or cuts.

A chair clean-out (or crumb sweep) is also essential. Clean-outs allow furniture to be easily wiped between the seat and back to prevent debris from accumulating and becoming a breeding ground for bacteria.

There are many benefits to using solid surface materials in a healthcare facility. Although the material is more expensive than alternate solutions like laminate, the long-term benefits certainly outweigh the upfront cost. Solid surface is stain-resistant

making cleaning between patients easy and efficient. It is also resistant to bacteria growth. As a nonporous material, solid surface has seamless joints so there are fewer areas to harbor bacteria growth. Solid surfaces are impact resistant. They are a very durable surface that requires minimal maintenance. If ever needed, scratches can be buffed out and cracks can easily be repaired. For chair arm caps, occasional table tops, and worksurfaces, solid surface is a great alternative.

As healthcare practices are ever evolving and improving, the products and materials used in healthcare environments are doing the same. Organizations like The Center for Health Design provide access to a wealth of resources to guide a standard of care when selecting materials for a healthcare environment.

Samantha Hill is in charge of Healthcare Market Development for Interior Elements, which specializes in commercial furnishing.

Coated upholstery Chair clean out Samantha Hill

Alabama Rock Star Turned OB-GYN,

continued from page 1

gigs, but because Yarbrough wasn’t old enough, his mom drove when his turn rolled around

“When it was my week, my mother would drive us. So we would unpack our trailer and play, but my mother would visit with the fraternity house mother upstairs. It was hilarious,” Yarbrough said.

In the Summer of 1969, Chapter Five opened for The Bob Seger System. With a lot of confidence in themselves, they decided to play one of Seger’s songs, Ramblin’ Gamblin’ Man. Yarbrough said the booking agent told them, “I came to see two good bands tonight and I only saw one, and it was you.”

“The Bob Seger System performance was okay, but they were not 100 percent that night,” Yarbrough said. “We were just a little band that went to church together and none of us smoked or drank, but the Seger band was pretty stoned. You could tell the only serious one who wanted to make something of themself was Bob Seger.”

Two years later in 1971, the bass player in Chapter Five was drafted into the Vietnam War, and the band broke up.

“We sort of expected it,” Yarbrough said. “We were sad that the band broke up, but since the rest of the band members were four years older than me, who knows how long it would have lasted with them being through with high school and getting out into the world. Of course, we were little bit nervous for our bass player. Fortunately, he didn’t have to get into any kind of action.”

When the band split up, Yarbrough had three more years left of high school and he spent that time getting good grades and becoming the class valedictorian. He later attended the University

of Alabama for his undergraduate degree and the University of Alabama at Birmingham for medical school.

“I originally wanted to be in internal medicine, but when I started doing clinical rotations, I discovered that it wasn’t like House or The Good Doctor where you’re diagnosing someone with a rare disease every day,” he said.

After trying his hand at cardiac surgery, radiology and other fields, Yarbrough decided on a career in Obstetrics and Gynecology. “Because UAB Medical School had a good rotation in OBGYN, I got to do a little bit of surgery, and it’s not super-long like cardiac surgery. Plus, the patients are usually pretty healthy and you get to do some endocrinology,” Yarbrough said. “It’s turned out to be great because you still get to help people and make their lives better.”

After choosing a specialty, Yarbrough’s mom, a former nurse, said she would rather have her son play the drums because the hours were better than an OB/GYN doctor. Luckily, he can now do both because after five decades, Chapter Five is back together with three of the original bandmates. The group plays a couple of times a month locally.

“It’s a big part of my time-off life,” Yarbrough said. “It keeps you youthful. The band still plays music from the 60s and 70s, but we’re not a tribute band. We’re a transport band.”

Reminiscing on his life choices that led him to a wife and two children, Yarbrough is proud of himself for taking the “easy way out”, and attending medical school. “I ended up choosing the more rewarding route and had the best of both worlds,” he said.

How Physicians Can Help Their Dyslexic Patients,

continued from page 7 from out of state, making regular trips impossible. AGC has drawn children from 16 states and as far as Brazil. In the last two years, AGC has provided 32,724 individualized 45-minute instructional dyslexia interventions.

“As a state-of-the-art interventional treatment center, therapy follows a neurodevelopmental hierarchy so that skills are built from the foundation up, across all disciplines,” Denton says. Specialty therapeutic services are geared to combat the individual’s learning struggles, while also addressing the associated medical and mental health conditions. Some of the session might look like playtime, as a child swings facedown in a pseudohammock while carefully moving plastic blocks into position.

“It is never too late to change the trajectory of a child’s scholastic course,” Denton says. “But it is easier and more costeffective to address the struggle early on,

rather than later. Research has shown that dyslexia can often be prevented in at-risk kindergarten-aged children and that large gains can be made in children ages eight to 10 years who struggle with reading. The evidence indicates that these results can be achieved by using a transdisciplinary team of educators, neuropsychologists, psychologists, speech language pathologists, occupational therapists, and physicians.”

Clinically, Alabama Game Changers providers have seen major improvements for individuals from the ages five years old to over 60. “Through early identification and intervention, pediatricians and family practitioners can serve as the first line of defense against preventable, lifelong struggles related to dyslexia,” Denton says. “Thus minimizing or even eliminating its effects entirely.” To refer families for early identification and intervention, call 205-364-2347 or email IntakeCoordinator@AlabamaGameChangers.org.

WE MAKE REFERRING EASY:

ONC Proposes Updates to Information Blocking Regulations

By elizaBeth neal PitMan, eddie WilliaMS iii, SaKinah n. JoneS

A recently published Proposed Rule will implement certain provisions of the 21st Century Cures Act (Cures Act) to “advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information,” according to the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC).

The Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing Proposed Rule (HTI-1 Proposed Rule) will modify and expand exceptions in the information blocking regulations to support information sharing, as well as implement other provisions related to health information technology (health IT) and certification.

Key elements of the HTI-1 Proposed Rule include:

• implementing the Electronic Health Record Reporting Program as a new Condition of Certification for developers of certified health IT under the ONC Health IT Certification Program (Certification Program)

• modifying and expanding exceptions in the information blocking regulations to support information sharing

• revising several Certification Program criteria, including adopting the United States Core Data for Interoperability (USCDI) Version 3

• updating standards and implementation specifications adopted under the Certification Program

Information Blocking Enhancements

Information blocking enhancements in the HTI-1 Proposed Rule include additions and revisions to several definitions and exceptions in the original Cures Act Final Rule intended to provide clarity and enhance compliance with the regulations.

First, HTI-1 seeks to clarify what it means to offer “health IT.” The current regulation, which includes “an individual or entity that under any arrangement makes certified health IT available for purchase or license,” appears to pull into its radius healthcare providers acting in the ordinary course and others provid-

ing health IT under arrangements not intended to resell, sublicense or otherwise supply health IT for profit.

The proposed clarification excludes healthcare providers or other health IT users who are engaging in certain customary and common activities. Activities expressly excluded from the proposed definition are:

1. arrangements structured for the purposes of subsidizing health IT for providers in need, such as a health system supplying an EMR to a safety-net provider

2. issuing login credentials to employees, supplying API technology, online portals or issuing public health authorities with login credentials and providing login credentials to independent providers for treatment purposes at healthcare facilities

3. entities providing comprehensive administrative or operational management consultant services involving health IT

Exceptions would exclude from the definition traditional forms of management services agreements, the majority of which are administrative, credentialing and other business services for the healthcare recipient of health IT, and self-developing healthcare providers who fall within the exceptions.

Next, ONC proposes changes to the Infeasibility Exception by revising one condition and proposing two new conditions. First, ONC proposes to revise the uncontrollable events condition. Under the proposed revision, an actor must demonstrate a causal connection between not providing access, exchange or use of EHI and the uncontrollable event (i.e., natural/human-made disaster, public health emergency (PHE) or war). Second, ONC proposes to add two new conditions to the infeasible under the circumstances condition. The first new condition, “third party seeking modification use,” would apply to an actor’s practice of denying a third party’s request to enable use of EHI in order

(CONTINUED ON PAGE 11)

Elizabeth Neal Pitman Eddie Williams III

ONC Proposes Updates to Information

Blocking Regulations , continued from page 10

to modify EHI and, particularly, requests to create or delete EHI. The second new infeasibility condition, “manner exception exhausted,” would apply where an actor is technically unable to fulfill the request or cannot reach agreeable terms with the requestor, an alternative manner was offered but no agreement reached, and the actor does not provide access, exchange or use to others similarly situated. To encourage alternative solutions, ONC proposes to exclude from information blocking fees charged by the actor and license of interoperability elements, without requiring compliance with the Fees and License exception.

Further, ONC proposes an additional condition for a Qualified Health Information Network (QHIN), Participant or Subparticipant to Trusted Exchange Framework and Common Agreement (TEFCA) to encourage participation in this common framework for network-tonetwork exchange of information. The proposed new condition offers actors certainty that qualified practices required for compliance with the Common Agreement are covered by the Manner Exception if the elements are met.

HIPAA Implications

Health IT limitations related to data segmentation and patient preferences,

specifically a patient’s right to request restrictions pursuant to the Health Insurance Portability and Accountability Act (HIPAA) were also addressed in HTI-1. ONC recognized a healthcare provider’s desire to grant a patient’s request for release of information to the patient or others and the difficulties arising from limited data segmentation functionality. ONC set out specific non-exclusive examples of when this may occur and requested comments on capabilities of health IT to segment data to support granting of such requests.

The HTI-1 Proposed Rule also recommends revisions to a new certification criterion focused on supporting patient right to request a restriction on certain uses and disclosures of their personal health information (PHI) under the HIPAA Privacy Rule. This proposed functionality is focused specifically on supporting one health IT enabled mechanism for a patient to request a restriction on disclosure and for a covered entity to honor that restriction using a certified Health IT Module.

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Hospital Websites Potentially Expose Patients to Fraud and Hospitals to HIPAA Sanctions

By BeCKy gillette

Most people who use the internet are accustomed to getting unsolicited advertisements after shopping for a certain product. But what about a patient diagnosed with a serious medical condition who starts receiving unsolicited online advertisements for “cures”? First, it is a violation of privacy for highly sensitive personal health information to be disclosed to an advertiser. Second, some patients may make the mistake of believing snake oil salesmen instead of their healthcare providers about the best treatments.

Shockingly, the potential for breaches of private health information through hospital websites is very common. According to a recent study by the University of Pennsylvania published in Health Affairs, 99 percent of U.S. hospitals have third-party tracking on their hospital websites. By allowing third-party tracking of confidential patient data on websites, hospitals are violating Health Insurance Portability and Accountability Act (HIPAA) regulations, exposing patients to being targeted with advertisements for fraudulent health cures while opening hospitals to liabilities that could include sanctions and the loss of Medicare and Medicaid reimbursements, according to Marcus Schabacker, MD,

PhD, president and CEO of ECRI, which is a nonprofit dedicated to improving the safety, quality, and cost-effectiveness of care across all healthcare settings

“It is understandable there is third-party tracking on hospital websites since that information can be used to determine what parts of the website are getting good traffic and provide information for improving websites,” Schabacker said. “But third-party tracking that allows the transfer of sensitive health data to technology and social media companies, advertising firms, and data brokers should stop immediately. Hospitals should also, if necessary, notify patients of a breach in security regarding their private health information.”

Marcus Schabacker, MD, PhD

ECRI recommends updating HIPAA laws to address these violations of privacy that can allow nefarious actors to target vulnerable people living with severe health conditions with advertisements for non-evidence-based treatments that are expensive, and at best, do nothing. At its worst, they can cause delays in proper treatment, injury or even death.

“Illegal transfers of health informa-

tion are annoying and an invasion of privacy, but what we are most concerned about is there is a potential for real harm,” Schabacker said. “It can expose patients who may be frightened and vulnerable to approaches from vendors who don’t necessarily provide approved remedies for a particular disease. Imagine someone is in dire straits and trying to find as much information as possible for themselves or loved ones. Then this kind of tracking allows companies that don’t have an approved product for specific diseases to target vulnerable people who are desperate for additional information. Technically, it is also a HIPAA violation because the government clarified in December that HIPAA applies to hospital websites and that IP addresses do qualify as a patient identifier—just as do names, birthdates and Social Security numbers. This could be considered a violation of HIPAA and hospitals might be sued.

“This could happen because sometimes hospitals can get their website services at a discount by allowing tracking. Trackers charge hardly anything, but hospitals don’t understand what is going

on in the background. The IT department and senior management probably are not even aware it’s happening. Under HIPAA, there is a business associates’ agreement that clearly identifies what can be done with confidential patient data and specifies that data must be protected. You need business protection agreements with vendors if you are going to use this third-party tracking service.”

Individual users can take action to prevent websites from tracking their information. But many people might not be sophisticated enough with their IT knowledge to know how to block trackers.

In addition to legal exposure for lawsuits, ERCI sees other liabilities including penalties and even losing the hospital’s license with the Centers for Medicare and Medicaid Services. ECRI proposes a holistic overhaul of HIPAA laws to start addressing the state of IT today regarding the capabilities of data collections and analytics. A lot of HIPAA laws were created in 1996, when the internet was in its infancy.

“The whole medical field is still behind in the IT consumer area,” Schabacker said. “It will take a concentrated effort for all involved—the healthcare industry, IT people and the government-to review this and make sure patients are protected from advertising of unsolicited offers of remedies and products.”

Welcome Our Newest Provider

Gregory L. Bearden, MD General Surgery

Gregory L. Bearden, MD is a board-certified general surgeon with over 25 years of medical experience in Birmingham, AL. He attended Birmingham-Southern College and the University of Alabama School of Medicine at UAB. He completed his residency with Baptist Health System and opened his practice at Princeton in 2009. He is a fellow of the American College of Surgeons and a member of the Society of Breast Surgeons and Wound Healing Society.

Special Interests Include:

• General Surgery

• Gastrointestinal/ Colorectal

• Abdominal Hernia

• Breast Biopsy/ Breast Cancer

• Endoscopy

• Thyroid/ Parathyroid

Dr. Bearden is accepting new patients.

Brookwood Baptist Health Princeton Surgical Specialists 801 Princeton Ave. SW, POB I, Suite 520 Birmingham, Alabama 35211

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The place for Alabama healthcare jobs

American Urological Association Recognizes David Joseph, MD

EBSCO Partners with Longleaf to Build Recovery Centers

EBSCO Industries is partnering with Longleaf to build recovery and mental health wellness centers in three locations across Alabama.

The need for mental health services has increased dramatically in recent years. Recent data from the Centers for Disease Control shows that addition-related deaths have risen fivefold in the last two decades. In fact, annual deaths caused by overdoses number more than those caused by gun violence and automobile accidents combined.

Longleaf broke ground on their first wellness center location last fall in Hoover. That center will serve 60 clients. Construction on the first Longleaf Recovery Center began this spring in Madison County. Like Birmingham, the Huntsville-area location will provide substance abuse recovery treatment, while also hosting support groups and retreats. A third facility for substance use treatment is set to be built in the Baldwin County area, with a groundbreaking later this year.

The American Urological Association has recognized David Joseph, MD with the Distinguished Service Award. Joseph, who practices with Children’s of Alabama, has special interests in pediatric urology, urinary reconstruction, disorders of sex development and neurogenic dysfunction of the bladder.

After earning his medical degree from University of Wisconsin Medical School, Joseph did an internship at the University of Wisconsin before doing fellowships at Harvard Medical School and Children’s Hospital in Birmingham.

UAB Partners with Bibb Medical Center

The University of Alabama at Birmingham is partnering with Bibb Medical Center to provide screening and diagnostic modalities for colon and stomach cancers, in addition to reflux disease and swallowing difficulty.

“Our goal at UAB is not only to provide high-quality care to the people of Birmingham, but to help eliminate health care disparities in Alabama,” said Drew Gunnells, MD, assistant professor in the UAB Marnix E. Heersink School of Medicine’s Department of Surgery.

“60 percent of colorectal cancer deaths could be prevented with early screening,” said Joseph Marchant, CEO and president of Bibb Medical Center. “This partnership with UAB ensures that our community has access to quality providers here at home.”

David Joseph, MD

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King Honored by United States Department of Veterans Affairs

Peter King, MD, professor in the Department of Neurology, Heersink School of Medicine at the University of Alabama at Birmingham, has received the Wolcott Award for Excellence in Clinical Care Delivery from the United States Department of Veterans Affairs. King is also the chief of the Neurology section of the Birmingham VA Health Care System.

The prestigious award is given to a VA health care practitioner who has demonstrated excellence and dedication to the delivery of patient care as recognized by patients, colleagues and leadership. It is the highest honor for health care providers within the VA.

As clinical chief of Neurology since

2001, King has created a large comprehensive department with nationally sponsored programs, including Centers of Excellence in epilepsy, multiple sclerosis and headache. The Neurology service provides subspecialty care to veterans in the Southeast. Many of these programs provide unique services that are not available in private or even academic hospitals.

King earned his medical degree from Duke University and did postdoctoral training at Duke and the Cleveland Clinic. He joined the faculty of UAB in 1992.

Photo: (L to R) VA Deputy Under Secretary for Health, Dr. Steven Lieberman and Dr. Peter King

Brookwood and Princeton in List of Best Maternity Hospitals

Brookwood Baptist Medical Center and Princeton Baptist Medical Center were two of only three Alabama hospitals that were included in Newsweek’s 2023 list of Best Maternity Hospitals.

The evaluation is based on three data sources: a nationwide online survey in which hospital managers and maternity healthcare professionals were asked to recommend leading maternity hospitals; performance indicator data relevant to maternity care (e.g. a hospital’s rate of cesarean births); and patient satisfaction data based on how patients rated a hospital’s medical staff for responsiveness and communication.

The Brookwood Women’s Center includes an electronic security system, an online nursery and specialized birthing rooms, as well as a Level III Neonatal Intensive Care Unit, high-risk pregnancy units and breastfeeding/lactation centers.

In addition to delivery services, Princ-

eton Baptist offers birthing mothers the opportunity to use a certified nursemidwife. The center is a Baby-Friendly® birth facility, encouraging mother and

baby to remain together in the same room throughout their stay while fostering skin-to-skin contact. Princeton has a Level III Neonatal Intensive Care Unit.

Birthing suite at Brookwood.