Houston Medical Times

HOUSTON

Volume 14 | Issue 9

Inside This Issue

September Edition 2024

Artificial Intelligence: Emerging Issues in Healthcare and Insurance Public Policy

By Remi Stone, JD Director, Government Relations The Doctors Company

T Recovering Heart Patient Highlights National Honors earned by Harris Health See pg. 9

INDEX Oncology Research......... pg.3 Mental Health...................... pg.4 Legal Matters ...................... pg.5 Hospital News....................... pg.6 Financial Forecast............ pg.12

Take Charge of Your Health Be Your Own Advocate See pg. 10

he use of artificial intelligence (AI) in the healthcare setting and its effects on professional liability insurance are rapidly evolving. As AI technology advances and becomes more integrated into healthcare, the legislative and regulatory framework is just starting to catch up — as is always the case with new and emerging technologies.

Across the nation, public policymakers are attempting to balance the integration of AI in the healthcare environment with safeguarding positive patient outcomes.

In addition, matters relating to liability remain unsettled. The distribution of liability will likely shift as device manufacturers, algorithm developers, facility leaders, and other parties involved in healthcare choose to integrate AI into more diagnostic and treatment tools.

Causes of action involving professional, vicarious, and product liabilities may become more common in the court systems, and while we have not yet seen legislation enacted that specifically assigns AI liability or targets professional liability tort statutes, we anticipate the future will bring a deluge of bills that attempt to add clarity to this unsettled legal and public policy topic.

Nevertheless, legislation addressing traditional liability concer ns increasingly touches on AI issues.

AI-related proposals have addressed matters that include patient informed consent, scope of practice, admission decisions, and care plan development, as well as those focusing on more common issues involving data and patient privacy.

Some state legislatures have

put forward ideas, such as banning healthcare insurers from using AI to discriminate on the basis of a patient’s race, gender, national origin, age, or disability. Other states are attempting to regulate the use of AI in diagnosing and treating patients.

For example, patient consent and scope of practice are central to legislation pending before the Illinois legislature (HB1002). One proposal would require that patients be informed and provide consent before a diagnostic algorithm is used, with patients having the option of being diagnosed without it. Any algorithm used must be certified by the state’s Departments of Public Health and Innovation and Technology and known to achieve results as accurate or more accurate than other diagnostic means. In addition, lawmakers are considering legislation (HB 3338) that touches on scope of practice by proposing that healthcare facilities be prohibited from substituting health information technologies or algorithms for a nurse’s human judgment.

The public policy discussion at the federal level is also accelerating.

Last October, President Biden issued Executive Order 14110 to promote

responsible development of AI in the healthcare arena. The executive order and subsequently announced public-private partnerships with providers and payers focus on the “safe, secure, and trustworthy use and purchase and use of AI in healthcare.”1 In February 2024, lawmakers formed the Congressional Digital Health Caucus with the goals of educating policymakers about the rapid changes in digital health innovation, showing its potential effects on patients and the healthcare system, and ensuring that all Americans benefit from advancements.

On the international front, the European Union (EU) Parliament adopted the Artificial Intelligence Act in March 2024. The act—the first of its kind in the world—covers the 27 member EU countries with a comprehensive approach to regulating AI, including its use in healthcare.

This comes on the heels of the 2022 EU report, Artificial Intelligence in Healthcare, which discussed the clinical, social, and ethical risks posed

by AI in healthcare.2 The report is see AI ...page 14

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Page 3

Oncology Research Not All Cancers Have Tumors: More Than 4,000 Texans Diagnosed With This Blood Cancer Each Year

By Andrew Jackson, M.D., Texas Oncology

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or most people, the word cancer implies that there’s a tumor or mass growing somewhere in the body.

However, contrary to popular belief, not all cancers form tumors.

While many cancer patients are likely to hear the word tumor when they are diagnosed, that might not be the case for the more than 4,700 Texans expected to be diagnosed with leukemia this year.

What is leukemia?

Unlike most cancers, which occur when abnormal cells multiply to form masses, leukemia occurs when abnormal blood cells are generated

within the bone marrow, multiply, and spread throughout the body, crowding out platelets and healthy white and red blood cells. These abnormal cells make it difficult for normal blood cells and platelets to function properly within the body, making a person prone to infection, anemia, bruising, and bleeding.

The four most common leukemia subtypes are: • Acute lymphocytic leukemia (ALL) • Acute myeloid leukemia (AML) • Chronic lymphocytic leukemia (CLL) • Chronic myeloid leukemia (CML) Acute leukemia is characterized by rapidly growing cells and quickly diminishes a person’s health, and chronic leukemia develops and progresses slowly over time.

How is leukemia staged?

For most cancer types, the stage

of the cancer is based on the size and spread of the primary tumor. However, leukemia staging is determined based on blood cell counts and the accumulation of leukemia cells in organs like the liver and spleen. First, the leukemia subtype is determined using cytologic (cellular) tests, flow cytometry, or other lab tests. Then, each leukemia subtype is staged using a specific system which may include molecular testing results for determining the level of risk: • ALL looks at the type of lymphocyte and the maturity of the cells.

• AML considers the number of healthy blood cells, size and

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number of the leukemia cells, changes in the chromosomes of the leukemia cells, and other genetic abnormalities.

CLL uses the number of lymphocytes in the blood; the degree of lymph node, spleen, or liver enlargement; and the presence of anemia or thrombocytopenia.

CML measures the number of diseased cells found in blood and bone marrow tests. see Oncology ...page 14

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Mental Health Excessive Heat and Its Impact on Mental Health

By Baylor College of Medicine

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natural climate disaster can increase the risk of depression by more than 30%, anxiety by 70% and both by over 87%.

“Children are a vulnerable population due to their physical and cognitive immaturity. They are exposed to more pollutants and allergens as they spend more time outdoors,” Shah said.

Previous studies on emergency room visits explore hospital visits due to heat and mental health. A study in JAMA Psychiatry reported about an 8% increase in emergency visits due to the effects of heat on mental health. If you feel affected by severe heat, speak with your primary care provider or mental health specialist. 

RELAX

xtreme heat this summer is affecting people across the country – mentally as well as physically. While heat can make anyone irritable, the impact can go beyond that, especially for people with mental health conditions. A Baylor College of Medicine psychiatrist explains how heat affects mental health.

Excessive heat causes changes in emotions and behavior that can result in feelings of anger, irritability, aggression, discomfort, stress and fatigue. Heat alters those behaviors because of its impact on serotonin, the primary neurotransmitter that regulates your mood, leading to decreased levels of happiness or joy and increased levels of stress and fatigue.

The most vulnerable groups affected by heat and mental health include people with preexisting conditions and people who use substances like alcohol. People who

already suffer from stress, anger or anxiety will experience increased serotonin. If people use substances, especially alcohol, they need to be more hydrated. Combining substance use with heat requires even more hydration.

“All mental illnesses increase with heat because it results in more fatigue, irritability and anxiety, and it can exacerbate depressive episodes,” said Dr. Asim Shah, professor and executive vice chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor.

Signs of heat impairing mental health start with irritability, decreased motivation, aggressive behavior and sometimes mental fogging. In worse cases, it can cause confusion and disorientation. While avoiding the heat may not be possible, Shah recommends hydrating with electrolytes and keeping your head covered when going outside.

In addition, pour some water on your head to cool down and try doing things

in the shade. If you normally go for walks outside, move them inside by walking in the mall or a large space with air conditioning.

If you take medications, consult with your provider before mixing your dose with excessive heat.

Some medications for mental health, such as lithium for bipolar patients, might not pair well with heat. Lithium goes through the kidney, so if you sweat more, levels of lithium fluctuate.

“If you are out in the heat and using lithium, levels may fluctuate.

In that scenario, we have to be very careful and either adjust the dosage of lithium or avoid heat,” he said.

Climate changes, including droughts and extreme changes in temperature, can cause negative effects by increasing pollutants and allergens and worsening air quality.

These worsen mental health issues like depression, anxiety or PTSD. Some studies show that exposure to any

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In the Heart of the Medical Center

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Page 5

Legal Matters FSMB Vs. Skynet: 5 Rules for Keeping AI in Check in Medicine

By Alexis Angell, J.D. Polsinelli, PC

»

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here has been a significant development that may impact healthcare providers using artificial intelligence (AI) in their practice. The Federation of State Medical Boards (FSMB) has recently released a report providing essential guidance to state regulators on the responsibilities of physicians when incorporating AI into patient care.

5 Key Take-Aways from the FSMB’s New Guidance: » Emphasis on Education and Proficiency: Physicians must be well-informed about the AI tools they use, understanding both their capabilities and underlying

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technologies. This includes being aware of the data on which AI tools are trained and their operational methodologies.

Accountability and Ethical Use: The guidance reinforces that physicians hold ultimate responsibility for AI-facilitated decisions in patient care. This involves ensuring that AI tools augment, but do not replace, professional medical judgment and maintaining a rationale for AI-recommended treatments.

Informed Consent and Transparency: Clear communication with patients about the use of AI in their care is mandatory. This includes discussing how A I impacts treatment decisions and ensuring patients are fully informed about their care options.

Data Privacy and Security: Physicians must ensure that patient data used by AI tools are handled

with strict privacy measures and comply with all relevant laws and regulations. » Regulatory Considerations: While state medical boards do not directly regulate AI as a healthcare device, they are empowered to oversee physicians using AI. The report suggests setting up standards that keep pace with the evolution of AI technologies without stifling innovation.

Why It Matters & What’s Next As AI continues to integrate into healthcare settings, understanding the legal and ethical implications becomes increasingly vital. The American

Medical Association and other stakeholders are actively discussing the balance between embracing AI advancements and protecting both patients and healthcare providers from potential pitfalls associated with AI. Potential pitfalls include bias and inaccuracy, over-reliance on technology, and privacy concerns.

States are beginning to evaluate the role of medical boards in regulating AI use within medical practice, with some states starting to enact comprehensive AI statutes that

see Legal Matters ...page 13

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Hospital News Memorial Hermann’s Chief Information Officer Amanda Hammel Honored as One of Houston’s Top 30 Influential Women of Houston 2024

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emorial Hermann Health System is proud to announce that Amanda Hammel, Senior Vice President and Chief Information Officer, has been recognized as one of Houston’s “Top 30” Influential

Women for 2024.

Each year, the “Top 30 Women” celebrate the accomplishments and giving spirit of diverse, influential and powerful women in the Greater Houston Region and its surrounding areas. According to “Top 30 Women,” its honorees “have all taken risks, embraced falls, believed in themselves, and remained courageous and resilient throughout their climb. Their fearless attitudes have allowed them to break glass ceilings and establish themselves as leaders committed to growth and professional excellence in their respective fields and in the community.”

Under her leadership, Hammel’s team of more than 500 full-time employees has designed and implemented

innovative IT solutions aimed at improving patient health outcomes.

Notable examples of their work include a user-friendly app designed to help patients manage their health care—from viewing health records and test results to scheduling in-person and virtual appointments; the rapid creation and scaling up of a mass vaccination clinic launched at the height of the COVID-19 pandemic; and the strategic leadership of Memorial Hermann’s ongoing system-wide transition to Epic, one of the largest and most comprehensive technology upgrades in the organization’s history.

“I am deeply honored to be recognized together with such accomplished women leaders in every sector of this region’s workforce,” said Hammel. “I am fortunate to work with a team dedicated to driving health care innovation, delivering safe and high-quality care to our patients and

creating a workplace where all are valued and welcomed.”

David L. Callender, MD, President and CEO of Memorial Hermann Health System, said, “Amanda is an outstanding model of a mission-driven leader who possesses a clear vision for health care system transformation and an unwavering commitment to excellence. Through her wonderful leadership, Amanda is building a legacy of excellence and service, and we are proud to see her recognized among the region’s leaders.”

Hammel is an active member of multiple professional, non-profit and community service see Hospital News ...page 13

Amanda Hammel

Houston Methodist ECED – gives surgeons the power from toxins and pathogens can also Study Shows New, More Precise to design the delivery path and block delivery of important medical potentially cover brain lesions and treatments. Further research is needed Way to Deliver Medicine before Faraji and team can bring this tumors better.

“Delivering therapeutics investigational therapy to humans. to The Brain A “Behind the Paper” blog on by way of ECED has many

H

ouston Methodist researchers have discovered a more accurate and timely way to deliver life-saving drug therapies to the brain, laying the groundwork for more effective treatment of brain tumors and other neurological diseases.

In a study published this mont h in Commu nication s Biology, an open access journal from Nature Portfolio, investigators used an electric field to infuse medicine from a reservoir outside

September 2024

the brain to specific targets inside the brain. This adds a new dimension to the 30-year-old process of injecting therapeutics into the brain through convection-enhanced delivery (CED), which uses continuous pressure over time to inject a fluid containing therapeutics into the brain. Because CED follows the path of least resistance, therapeutics don’t always hit the target.

Introducing an electrical field to the process – called electrokinetic convection-enhanced delivery or

applications,” explained Dr. Amir Faraji, principal investigator and Houston Methodist neurosurgeon.

“It has the potential to improve gene therapy and tumor treatment, as well as treatment for traumatic brain injury and degenerative diseases – any number of situations where we need to get vital treatments to the brain in a more targeted manner.”

Delivering the correct dosage of drugs to the right place in the brain has long been a challenge.

The same natural blood-brain barrier that protects our brains

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the study - by Houston Methodist research scientist and co-author Jesus G. Cruz-Garza – explains how ECED can infuse macromolecules into the brain from a hydrogel reservoir placed at the brain’s surface.

“The brain acts as a charged porous scaffold that, in the presence of an electric field, allows for electroosmosis: bulk fluid flow in a porous media.” From the hydrogel reservoir, Cruz-Garza explains, this bulk flow of fluid enables the delivery of therapeutic agents. see Brain Medicine ...page 13

Houston Medical Times

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Memorial Hermann– Texas Medical Center Earns Magnet Redesignation

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emorial Hermann-Texas Medical Center (TMC) has been designated as a Magnet Recognition Program by the American Nurses Credentialing Center (ANCC) for a third time. The campus, which includes Children’s Memorial Hermann Hospital(CMHH) and Memorial Hermann | Rockets Orthopedics Hospital (MHROH), first earned the prestigious designation in 2014.

The Magnet Recognition Program recognizes health care organizations for quality patient care, nursing excellence and innovation in professional nursing practice. Magnet recognition is the highest possible organizational credential granted by the ANCC, the largest and most prominent nursing credentialing organization in the United States.

Hospitals must excel in several areas, including nursing standards and practices, patient care, and innovations in nursing leadership and management

to earn Magnet status.

Studies have demonstrated that Magnet-recognized hospitals typically provide a higher quality of patient care, including lower mortality rates and better patient satisfaction. Magnet hospitals also experience lower turnover and lower rates of burnout among nursing staff. The recognition is also directly linked to a hospital’s ability to attract and retain qualified, highly educated nursing staff.

“Magnet redesignation is a testament to our collaborative culture – one that empowers our clinical teams to have a voice in the lifesaving work they perform each and every day,” said Jason Glover, CEO of Memorial Hermann-TMC Adult Services. “This achievement highlights the incredible competency of our workforce and demonstrates to our patients that we uphold our steadfast commitment to provide evidence-based and patient-centered health care.”

Memorial Hermann-Texas Medical Center (TMC) has been designated as a Magnet Recognition Program® by the American Nurses Credentialing Center (ANCC) for a third time. The campus, which includes Children’s Memorial Hermann Hospital(CMHH) and Memorial Hermann | Rockets Orthopedics Hospital (MHROH), first earned the prestigious designation in 2014.

Before a hospital is selected for Magnet recognition, the ANCC completes a rigorous evaluation process that includes on-site visits, reviews of written documentation, staff and patient satisfaction surveys and interviews. Initial Magnet recognition is valid for four years and, during that time, hospitals and nursing staff are closely monitored, evaluated, and surveyed to ensure they remain in compliance with the program’s high standards. At the end of the four-year period, hospitals must re-apply and again undergo the challenging

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evaluation process.

“I am incredibly proud to celebrate our hospital’s third designation. This remarkable achievement reinforces our commitment to excellence in patient care, innovation, and teamwork,” said Leah Blackwell, Chief Nursing Officer of Memorial Hermann-TMC. “Thanks to the unwavering dedication and expertise of our nursing staff and health care professionals, we continually strive to elevate our standards. Together, we are making a profound impact on the health and well-being of our community.” 

September 2024

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The Texas Heart Institute Provides BiVACOR Total Artificial Heart Patient Update Successful First-In-Human Bridge to Heart Transplant with Revolutionary Valveless Artificial Heart

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he Texas Heart Institute (THI), a globally renowned cardiovascular health center, and BiVACOR®, a leading clinical-stage medical device company, are pleased to provide an update on the condition of the first patient to receive the BiVACOR Total Artificial Heart (TAH) implant on July 9, as part of the U.S. Food and Drug Administration (FDA) Early Feasibility Study (EFS). On July 17, eight days following the BiVACOR TAH implant, a donor heart became available and was transplanted into the patient, removing the BiVACOR TAH and meeting a goal of the EFS to evaluate the safety and performance of the BiVACOR TAH as a bridge-to-heart-transplant solution for patients living with severe biventricular heart failure or univentricular heart failure in which left ventricular assist device support is not recommended.

“It is rewarding to see this result and having the BiVACOR TAH perform as expected,” said Dr. Joseph Rogers, President and Chief Executive Officer of The Texas Heart Institute and National Principal Investigator of the research. “This successful outcome is a testament to the years of dedication and innovation invested in this project.

The patient continues to do well through their recovery, demonstrating the potential impact of the BiVACOR TAH on the future of heart failure treatment.”

The successful implantation and bridge-to-heart transplant of BiVACOR’s TAH highlights the potential of this innovative technology to address critical challenges in cardiac care, such as long transplantation waitlists. BiVACOR and The Texas Heart Institute remain committed to

Dr. Joseph Rogers, President and Chief Executive Officer of The Texas Heart Institute and Dr. Alexis Shafii, Surgical Director of Heart Transplantation at Baylor St. Luke’s Medical Center

advancing the field of cardiac medicine and improving outcomes for patients worldwide.

“This is an amazing advancement as the BiVACOR TAH may offer hope for countless patients who suffer from end-stage heart failure. This device may serve as a life-saving bridge to a heart transplant; future studies may prove its potential as a long-term pump that can effectively serve as a total replacement for a patient’s heart,” explained Dr. Alexis Shafii, Surgical Director of Heart Transplantation at Baylor St. Luke’s Medical Center and Associate Professor of Surgery, Cardiothoracic Transplant & Circulatory Support at Baylor College of Medicine. “We anticipate the BiVACOR TAH may eventually save numerous lives, as well as improve the

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quality of life for patients who otherwise have no alternative therapy available.”

Heart failure is a global epidemic affecting at least 26 million people worldwide, 6.2 million adults in the U.S., and its prevalence is increasing.

Heart transplantations are reserved for those with severe heart failure and are limited to fewer than 6,000 procedures per year globally. Consequently, the U.S. National Institutes of Health estimated that up to 100,000 patients could immediately benefit from a ventricular assist device (VAD) or TAH, and the European market is similarly sized.

The successful implantation of the BiVACOR TAH marks a new era in cardiac care, offering hope to thousands of patients awaiting heart transplants.

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Page 9

Recovering Heart Patient Highlights National Honors Earned by Harris Health Hospitals

By John F Martinez

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outs of debilitating chest pains and shortness of breath drove Mary Olveda to the emergency center and cardiology department at Harris Health Ben Taub Hospital in 2010. An emergency stent was placed in her heart to clear a clogged artery. It helped, but as she openly admits, her lifestyle didn’t change and in 2022 she required the more invasive open-heart surgery to replace her damaged artery.

“There was no question where I was going to go. This is the hospital where everything has been done for me since 2010,” Olveda recalls. “I trust them, they know me and they know what’s going on with me. I made the right choice by coming here because this is the best hospital.”

Her trust in Ben Taub Hospital is a sentiment shared by the American Heart Association and the American Stroke Association, evident by several national commendations awarded for

the hospital’s heart and stroke services.

Also receiving several national heart and stroke recognitions was Harris Health Lyndon B. Johnson Hospital.

The 2024 awards reflect Harris Health’s elite status and commitment to providing the community with vital life-saving treatment and care for heart and stroke patients.

“Our teams at both of our hospitals have only one thing in mind: providing patients the best possible care that meets or exceeds high national standards,” says Glorimar Medina, MD, executive vice president and administrator, Ben Taub Hospital.

Though best known for trauma and emergency care, Ben Taub and LBJ hospitals are building national reputations for cardiology and stroke care—particularly ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) at Ben Taub Hospital.

STEMI and NSTEMI are the deadliest types of heart attacks.

Cardiology and stroke care at Harris Health Ben Taub and Harris Health Lyndon B. Johnson hospitals are on the map with national recognitions from the American Heart Association and The American Stroke Association

“These recognitions demonstrate Harris Health’s commitment to provide evidence-based cardiac and stroke care to our community,” says Patricia Darnauer, executive vice president and administrator, LBJ Hospital. “Our patients and our community can trust that their care at our hospitals is the best when they need us most.”

Olveda agrees. She is currently recovering from another STEMI procedure and a stent placement in another clogged artery in May 2024.

“This was my wake-up call,” she says. “I don’t want to go through this again. I

want to enjoy life and spend more time with my family.”

Ben Taub Hospital is a Comprehensive Stroke Center certified

by DNV Healthcare and a Chest Pain Center reaccredited in 2024 by the American College of Cardiology (ACC). Additionally, the chest pain center recently received awards of Primary PCI and a 2024 MI Registry Platinum Performance from ACC. LBJ Hospital received a 2024 reaccreditation for its Echocardiography Laboratory from the Intersocietal Accreditation Commission. The accreditations are for three-year terms.

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Page 10

Take Charge Of Your Health Journey: Be Your Own Advocate.

By Andrew Gerber, M.D., Internal Medicine

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aintaining your health is a lifelong commitment. Addressing evolving priorities becomes increasingly important as we age, and we need to know how to best approach these evolving needs and more frequent visits with your doctor.

Appointments addressing specific health concerns with your doctor can be overwhelming. New, complex information and stress can cause patients to miss important information.

How can you manage this complexity and be an effective advocate for your health?

Before your visit: • Gather and bring all your medications to your appointment.

• Bring your medical records, such as notes and recommendations from specialists and details of recent hospitalizations.

Your doctor may have access to some of these records, but systems do not always

communicate with one another effectively.

• Write down a list of questions and concerns that you would like to talk about. It is easy to forget issues during a clinic visit. If there is not enough time to cover all topics effectively, make a follow-up appointment to address everything you wanted to cover.

During your visit, you may not always feel as though you have a lot of time to get through all the important issues. So how can you make your visit with your provider as productive as possible?

• Stay focused on the priorities.

Keeping the conversation on track ensures that you can cover as many items on your list as possible and that your doctor can discuss and manage the issues they identify as being critical for your health, such as disease prevention.

• Take notes during your appointment. There may be many things to discuss during

•

•

your appointment. Taking notes is useful to ensure no details are lost.

Often, your doctor can provide or recommend resources for further education.

Review after your appointment.

Review your notes, educational materials, and updated medication list if needed, and contact your doctor if you have any questions.

Schedule a follow-up appointment to review any other questions not addressed at the appointment.

Consider bringing a friend or family member, especially if an appointment is likely to involve learning new information, such as management of a newly diagnosed

condition, learning the results from a recent test or screening, or building a new nutrition or physical fitness routine. Having someone you trust with you can help you remember details and decisions and provide reinforcement and accountability to the management recommendations.

Facing new diagnoses or tests: Learning about a new health condition, test, or screening can be stressful. When your doctor recommends a test based on age, health conditions, family history, or other factors, ask questions to gain a see Take Charge...page 13

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Page 12

Financial Forecast

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By Grace S. Yung, CFP Midtown Financial Group, LLC

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There are other potential positives, too, with a cash out refinance, such as a possible increase in your credit score, especially if you used the funds from the refinance to consolidate higher interest debts.

Yet, even given all the benefits of a cash out refinance, there are possible drawbacks to consider. For example, doing so can increase your debt obligations, while also decreasing the equity you have in your home.

Further, “starting over” with a new home loan can mean that you’ll be paying your mortgage for a longer period of time. So, you should consider your budget before moving forward, particularly if you are approaching retirement and trying to reduce your monthly expenses.

The Financial Consultants at <DBA Name> are registered representatives with, and securities and advisory services are offered through LPL Financial (LPL), a registered investment advisor and broker-dealer (member FINRA/SIPC). Insurance products are offered through LPL or its licensed affiliates. [Credit Union name] and [DBA name] are not registered as a broker-dealer or investment advisor. Registered representatives of LPL offer products and services using [DBA name], and may also be employees of [credit union name]. These products and services are being offered through LPL or its affiliates, which are separate Sentities ecuritiefrom, s andand advnot isoraffiliates y serviceof, s o[credit ffered tunion hrougname] h LPL For ina[DBA ncialname]. , a regisSecurities tered invesand tmeninsurance t advisor, M emberthrough FINRA/S IPCor . Lits PL affiliates Financialare: and Midtown Financial offered LPL Group, LLC are separate entities.

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is a major financial decision, though, so it is important to understand the pros and cons, and how doing so could impact other areas of your financial plan.

Advantages and Drawbacks of a Cash Out Refinance There are advantages and drawbacks to doing a cash out refinance.

On the plus side, this strategy allows you access to money at a potentially lower interest rate compared to taking out a personal loan or borrowing cash from a credit card. In addition, if you itemize deductions on your tax return, the interest on the refinanced home loan may be tax deductible.

If you refinanced to a new loan with a fixed interest rate, you would also have predictable monthly payments, which can make budgeting easier. This is not necessarily the case with other cash out alternatives like a home equity line of credit that oftentimes carries a variable interest rate.

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Considerations for Cash Out Refinance in Texas While cash out refinancing is allowed in Texas, the state imposes some different rules than in other states, such as: − The new loan amount may not exceed 80% of your home’s value. − Closing costs may not exceed 2% of the new loan amount. − All liens on the home, such as a second mortgage, must be paid off before moving forward with a cash out refinance. − Home equity loans or home equity lines of credit are not allowed if you already have a cash out refinance loan in place. − There is a six month waiting period after purchasing your home before you can implement a cash out refinance. − Cash out refinanced loans are not see Financial Forecast...page 14

Houston Medical Times

Legal Matters Continued from page 5 directly and indirectly regulate the use of AI in health care. For example, in May of this year Colorado enacted a comprehensive state AI law that will go into effect on February 1, 2026, and which places certain limits and obligations on developers and entities that deploy AI including for use in health care services. Similarly, the Utah Department of Commerce’s Office of Artificial Intelligence Policy has proposed regulations governing the use of AI chatbots and interactions by mental health care providers that is likely to be taken up by the Utah legislature later this year. Decisions and further regulatory frameworks are expected in the upcoming months, which could set precedents for how AI is integrated into healthcare nationally.

Hospital News Continued from page 6 organizations, including the IGNITE Steering Committee, which awards more than $775,000 annually to women leading digital health and medical

Brain Medicine Continued from page 6 This project was supported by the Houston Methodist Foundation and the Houston Methodist Research Institute Clinician-Scientist Award.

Take Charge Continued from page 10 more complete understanding of your health, risk factors, and test benefits.

Asking questions can help you be more confident in actively managing your own health.

Questions to ask about screening tests: • Why do you recommend this test for me specifically?

• What is the cost of this test? Is it covered by my insurance?

• What should I know about the test itself?

Page 13

Speaking of AI . . . Use of AI in Recording Privileged and Confidential Peer Review Meetings: While not discussed in the FSMB’s report, considering the growing integration of AI tools in healthcare settings, it is important to address AI use in sensitive areas such as privileged and confidential peer review meetings.

For example, if a practitioner relies on AI as opposed to exercising their professional medical judgment and this action jeopardizes patient care, peer review in healthcare settings should be triggered. Further, using AI for recording and transcribing peer review meetings poses specific challenges and risks beyond a typical business meeting.

Without carefully crafted protocols, there is a risk of breaching the confidentiality that is foundational to the peer review process, as AI generated meeting minutes or summaries may

not be considered privileged material.

Such breaches could undermine the legal protections typically afforded to these activities and potentially expose healthcare providers to legal liabilities.

It is vital for healthcare institutions to establish and enforce strict guidelines that govern the use of AI in these sensitive settings, if AI is to be allowed at all, to maintain the integrity and confidentiality of the discussions.

As hospitals consider and develop AI policies and protocols we recommend they consider the following: • Announce at the beginning of any meeting in which AI is being used to record and summarize the meeting, that AI will be used to do so, and that no other recordings of the meeting are authorized; • Require that any AI assisted documents will be marked

device startups. She is a College of Healthcare Information Management Executive member, on the Advisory Board of Inspire CIO and has served as a Health Evolution Forum Fellow.

Under Hammel’s leadership, Memorial Hermann has been recognized as the “Most Wired” for

16 consecutive years and was the first health system to receive the Healthcare Information and Management Systems Society’s (HIMSS) Davies Award in back-to-back years. Hammel has received multiple professional honors, including the Houston Business Journal’s “Women Who Mean Business

Award” in 2022 and recognition on Becker’s Hospital Review’s list of “Chief Information Officers to Know” in both 2023 and 2024.

It also received philanthropic funding from Paula and Rusty Walter and Walter Oil & Gas Corp Endowment at Houston Methodist: the John S. “Steve” Dunn, Jr. & Dagmar Dunn Pickens Gipe Chair in Brain Tumor Research; and grant number

RP190587 from the Cancer Prevention and Research Initiative (CPRIT).

Conducted at Houston Methodist Department of Neurosurgery, Houston Methodist Research Institute, Center for Neural Systems Restoration, Center for Neuroregeneration, in conjunction

with Texas A&M University College of Medicine and School of Engineering.

•

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solutions. They can guide you toward positive, healthy outcomes.

You have enough to worry about when you go to see the doctor. As we age, there are many things that we cannot control. It is important to remember that there are many aspects of our health, healthcare, and behaviors that we can control. Taking a proactive approach to your own care will go a long way to reducing your stress and improving your health for years to come.

What should I do ahead of time to prepare? For example, some medical tests require you to fast ahead of time.

• Are there risks or side effects? How would they be managed?

• How long will it take to get the results? What are our next steps after receiving them?

If your results show you have or are at risk for a medical condition, there are questions you may want to ask: • What may have caused or contributed to this new condition?

• Is the condition permanent? How is it treated?

Does the treatment itself carry the potential for side effects?

Your doctor is an ally who is there for you to help with sensitive and social issues that can affect your health – such as social isolation, risk of falling, and urinary incontinence.

While these issues may seem difficult to talk about, they all can become more prominent as we age. Your doctor is also focused on prevention through helping you manage unhealthy habits and promoting positive health habits.

They may seem uncomfortable or embarrassing to talk about, but doctors are eager to talk about these issues and help you feel comfortable about

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accordingly and require review prior to being adopted as an official medical staff record; Prohibit AI from being used to make decisions, and require that any decisions remain in the sole discretion of the medical staff based on independent verified information; Require that all recordings are erased as a matter of routine within 30 days after the meeting; and If AI may be used to draft letters and memos, then require careful personal review of the AI generated document to ensure accuracy before being finalized. Any AI generated or assisted draft letter or draft memo must be marked accordingly.

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AI

Continued from page 1 expected to serve as a roadmap for regulating AI in healthcare as the EU builds out the Artificial Intelligence Act’s regulatory framework.

Closer to home, the American Medical Association (AMA) provides a succinct view on physician liability, patient safety, and risk management in Principles for Augmented Intelligence Development, Deployment, and Use. As the AMA writes, “The question of physician liability for use of AI-enabled technologies presents novel and complex legal questions and potentially poses risks to the successful clinical integration of AI-enabled technologies.”3 The AMA further outlines an approach to addressing liability concerns raised by the deployment of AI in the healthcare

Oncology Continued from page 3

arena: Current AMA policy states that liability and incentives should be aligned so that the individual(s) or entity(ies) best positioned to know the AI system risks and best positioned to avert or mitigate harm do so through design, development, validation, and implementation.

Where a mandated use of AI systems prevents mitigation of risk and harm, the individual or entity issuing the mandate must be assigned all applicable liability.

Developers of autonomous AI systems with clinical applications (screening, diagnosis, treatment) are in the best position to manage issues of liability arising directly from system failure or misdiagnosis and must accept this liability with measures such as maintaining appropriate medical liability insurance and in their agreements with users.

• • • •

Radiation therapy Surgery Surveillance Targeted therapy

What treatment options are available for leukemia?

Treatment for leukemia varies depending on the type and stage of leukemia, as well as the patient’s age, medical history, general health, and treatment goals. However, patients with acute leukemia must start treatment immediately due to the rapid progression of the disease. Treatment options for leukemia can include: • Blood and bone marrow transplant • CAR-T therapy • Chemotherapy • Immunotherapy • Monoclonal antibodies • Palliative medicine

What else should I know about leukemia?

Although leukemia is the most common childhood cancer, most cases are in adults over 55. It is also slightly more common in men than women, but everyone should be aware of the signs and symptoms associated with this cancer type, which include swollen lymph nodes, frequent fevers or night sweats, weakness, shortness of breath, and reoccurring infections, among other symptoms.

Thanks to ongoing research and clinical trials, medical advancements have improved survival rates for many types of leukemia. For example, the

Financial Forecast

only apply to your primary residence, and not to second homes or investment property.

Should You Consider a Cash Out Refinance?

There are many factors to consider before you move forward with a cash out refinance, including: − Interest rate − New payment amount − Tax deductions

Continued from page 12 backed by the federal government. − Minimum credit score and maximum debt-to-income ratio.

It is important to note that the Texas-specific cash out refinance rules

September 2024

Health care AI systems that are subject to non-disclosure agreements concerning flaws, malfunctions, or patient harm (referred to as gag clauses) must not be covered or paid and the party initiating or enforcing the gag clause assumes liability for any harm.

When physicians do not know or have reason to know that there are concerns about the quality and safety of an AI-enabled technology, they should not be held liable for the performance of the technology in question.3 The Doctors Company, like the AMA, will continue to advocate to limit healthcare practitioner liability in the AI space and ensure that it follows the established legal framework for medical malpractice litigation.

We will also continue to monitor this important issue and work to protect healthcare practitioners as AI gains momentum.

survival rate for chronic myelogenous leukemia is now 70% — three times higher than it was in the 1970s.

September is Blood Cancer Awareness Month, and while leukemia accounts for only 3.2% of new cancer diagnoses nationally, for the more than 62,770 people who will be diagnosed this year, understanding the potential risk factors, symptoms, and unique characteristics of this disease is crucially important.

− Cash out refinance alternatives Because everyone’s financial needs and objectives are different, a cash out refinance may or may not be right for you. Therefore, you should discuss your short and long-term plans with a CERTIFIED FINANCIAL PLANNER professional who can help you look at all of the angles and determine whether you should move forward. 

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