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PHYSICIAN SPOTLIGHT

Richard Brown, MD

ONLINE:TAMPABAYMEDICALNEWS.COM

ON ROUNDS

(CONTINUED ON PAGE 7)

By LyNNE JETER

St. Joseph’s Hospital recently opened new and expanded operating and interventional ra-diology suites, bringing the total to 18.

The $43 million, 18-month project con-nects the new suites to the existing surgical unit in a way that administrators say provides the ideal layout for the growing number of minimally invasive, robotic, and conventional procedures. Among the upgrades: more space, fewer hazards, and a highly sophisticated inte-gration and technology system.

“These improvements give us more capabilities for orthopedic and neurological

St. Joseph’s Hospital Opens Newly Expanded Operating Suites$43 Million Project Brings Total to 18 Suites

Taylor Architectural Photos


By LyNNE JETER

Editor’s Note: This article is part of a Medi-cal News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine.

Several years ago, Christine A. Sinsky, MD, FACP, made two signifi cant time-sav-ing changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests.

The first: taking a streamlined ap-proach to prescription management.

Second: taking proactive planned care

measures with patients via previsit labora-tory tests.

“Just making a single change – pre-scription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes of nursing time per doctor per day,” said

W H O ’ S T E N D I N G O U R D O C T O R S ?

The AMA Steps Up with STEPS ForwardAmbitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care

Fifth Third Bank is Launching Third SU2C Campaign More Than $4.2 Million has Been Raised Nationwide ... 7

UF Health Researchers Discover Signal That Impacts the Link Between Body Fat, Stress and Metabolism ... 8

Telemedicine: A Virtual Compliance Jigsaw PuzzleA Closer Look at the New Wave in Healthcare Delivery ... 9

2 > SEPTEMBER 2015 t a m p a b a y m e d i c a l n e w s . c o m

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t a m p a b a y m e d i c a l n e w s . c o m SEPTEMBER 2015 > 3

By JEFF WEBB

SARASOTA - As life-changing events go, it was prodigious.

Richard Brown, a 20-year-old stu-dent at the University of Rochester, came home to New York City for a weekend visit with his family. He had planned to have dinner with his older sister Wendy that evening in 1975, but first he went to his aunt’s house, which was right next door to the home where his parents, Hun-garian immigrants, had raised him. When he got there, his aunt was crying because his brother-in-law had called to say that Wendy had been killed in a car accident.

“I had to go next door to my parents’ house and tell them their 24-year-old daughter had died. It was the hardest thing I’ve ever done in my life,” said Brown. “It had a significant impact on my life. … I realized the frailty of human existence. I became a much more serious person and wanted to make something meaningful with my life. I guess you could say my childhood ended as a result of this trag-edy,” recalled Brown. “My mother had always said that when she and my dad got old my sister would take care of them. I said to myself ‘Well, this is my responsi-bility now,’ and I took that responsibility seriously. … I grew up fast.”

Brown returned to college and earned his degree in social psychology, but still pondered his future. “I was publishing an article with a professor on a research proj-ect. I asked him what I should do in way of a profession. He suggested either teach-ing or getting an MBA in organizational behavior. I chose to go for MBA as part of a scholarship package I received from Boston University,” he said. But after sev-eral months in graduate school he soon realized he “needed more in my life than being in business,” he said.

“I went through a period of despon-dency. I was living in the back bay of Boston and would walk along the Charles River and see Massachusetts General Hospital daily. This put the notion of medicine in my head. After much soul searching I recognized I could have mean-ing in my life by going to medical school,” said Brown. He completed his MBA and worked on pre-med courses concurrently. Following the advice of his professor, he applied and was accepted to the Univer-sity of Vermont College of Medicine.

For his internship and residency in internal medicine, Brown went to the University of Minnesota in Minneapolis, where he briefly considered becoming a gastroenterologist. “But I eventually realized what I was really interested in was hematology, so I changed my plans” and accepted a fellowship in hematology and oncology at New York University,” Brown said. “It was time to get back home

to New York.”And “back home” is where he met

Pam, with whom he soon will celebrate his 26th wedding anniversary, on blind date. “As soon as I saw her that was it! I had just met the woman I was going to marry,” Brown remembered, his voice still rising with first-crush excitement. “Our first date was on Nov. 22, 1988 and I asked her to marry me on Feb. 4. We hadn’t even met each other’s families, but we both knew it was meant to be. We were married the fol-lowing December.”

On the way to honeymoon in Grand Cayman, the newlyweds had a stopover in Tampa. “My wife’s friend’s mother lived in Longboat Key and we had some time to kill. We took a ride down here and said ‘Wow! This is really nice. We could live here!’” he said.

Brown remains “very, very happy with our decision” to move to Sarasota and accept a job with Oncology/Hema-tology Consultants, where he worked from 1991 until 2014, when the practice was acquired by Florida Cancer Specialists. Brown said he and his partners “realized the changes that were occurring in medi-cine and that we were better off joining a larger, stronger group. … In retrospect, it was a very good decision.”

Brown works exclusively in FCS’ downtown office on Golf Street. And

when he is not seeing patients in his of-fice, he is making rounds at Sarasota Me-morial Hospital, where he “has been on just about every single committee you can be,” said Brown, 59. He currently is direc-tor of Cancer Care Services and is serv-ing on several active committees; he also has been chief of staff and physician of the year at SMH.

The Browns are adjusting to be-coming empty-nesters. Their daughters, Sammy, 21, and Jordan, 19, both are

communications majors and attend the University of Florida and the University of Michigan, respectively. “Pam has more time to pursue her volunteer activities, but my time is still taken up mostly by my job and hospital responsibilities,” said Brown.

However, the couple is taking steps of different sort as they plan for the future. “We’ve taken up dance lessons. When it comes time for my daughters’ weddings, I don’t want to embarrass myself. I’m start-ing now because it may take me a long time to learn” Brown laughed.

But the dances Brown is more famil-iar with are touchdown celebrations at Raymond James Stadium, where he is a longtime Tampa Bay Buccaneers season ticket holder. “I go to every single game and I have great seats,” said Brown, who has been an honorary team captain and participated in a pre-game coin toss when the Bucs played division rival New Or-leans Saints.

But on Mondays, Brown is back in his clinic “to provide the care and meet the needs of each individual I face,” he said. As is inherent in his speciality, sometimes that means delivering bad news, a circumstance he first faced as a grieving college kid.

“I always try to understand what they are going through. That makes me a bet-ter doctor,” said Brown. “It never gets easier, and hopefully it never will.”

PhysicianSpotlight

Finding a Meaningful Life Tragedy shaped the future for Richard Brown, MD

BayCare Medical Group WelcomesRichard A. Cain, MD | Orthopedic Surgery

BayCareMedicalGroup.org

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Dr. Richard Cain has joined BayCare Medical Group and is welcoming new patients at his new location in southern Hillsborough County.

Education■ Doctor of Medicine – University of South Florida

School of Medicine; Tampa, Florida

Residency■ Orthopedic Surgery – University of South Florida

School of Medicine; Tampa, Florida

Fellowship■ Shoulder and Elbow Surgery – Cleveland Clinic;

Cleveland, Ohio

Now accepting new patients age 18 and older. Most major insurance plans are accepted.

Connect with Dr. Cain: (813) 397-1274

10141 Big Bend Road, Suite 103, Tampa


St. Joseph’s Hospital Opens, continued from page 1

Sinsky, an internist and partner in Medical As-sociates Clinic, a multi-specialty group practice with sites in Iowa, Wis-consin and Illinois.

Sinsky is also the point person at the American Medical As-sociation (AMA) for an ambitious new initiative offering physi-cians strategies to revitalize their medical practices and improve patient care. The practice changes she references are found in the initial 16 modules available online – free for AMA and non-AMA members – via www.STEPSforward.org.

“If you can follow one or two recom-mendations and go home earlier by reen-gineering the way you do your work, that’s a win-win all around,” said Sinsky.

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfaction physicians derive from their work is quickly eroding as time contin-ues to be taken away from direct patient care because of grueling, bu-reaucratic obstacles.

“Research shows that rates of overall burnout among U.S.

physicians approach 40 percent,” said AMA CEO James L. Madara, MD. “That’s why the AMA is taking a hands-on approach to meeting their day-to-day concerns through the new online series, AMA Steps Forward.”

Broadly, the 16 modules address four key areas: practice efficiency and patient care, patient health, physician health, and technology and innovation.

Specifically, the modules cover these topics:

• Conducting effective team meetings• Creating strong team culture• Electronic health record (EHR)

implementation• EHR software selection and pur-

chase• Expanding rooming and discharge

protocols• Improving blood pressure control• Improving physician resiliency• Medication adherence• Panel management• Preventing physician burnout• Preventing type 2 diabetes in at-risk

patients• Pre-visit laboratory testing• Pre-visit planning• Starting lean healthcare• Synchronized prescription renewal• Team documentationEach module requires only snippets

of time to study either online or printed

in PDF format for a more traditional ap-proach to learning. Live events provide yet another learning option. To earn AMA PRA Category 1 Credit™, par-ticipants must view the module content in its entirety, successfully complete the quiz answering four of five questions correctly, and complete the evaluation.

Modules include steps for implemen-tation, case studies and downloadable vid-eos, tools and resources.

“Within 30 minutes, physicians will know how to take the next step in their practices to work smarter, not harder,” said Sinsky.

For example, the module on effec-tive team meetings begins with a 10-step process:

• Identify the team.• Meet routinely and “on the clock.”• Agree on ground rules.• Set a consistent meeting agenda.• Rotate meeting roles.• Solve problems as a group.• Record action steps, owners and

due dates.• Practice good meeting skills.• Have fun!• Celebrate success.Under ground rules, helpful hints in-

clude starting and ending each meeting on time, being fully present in the moment, staying on topic, focusing on the issue and not the individual, stepping up or back as needed, and giving thanks to the staff for

their time. To stay on topic and maintain ef-ficiency during the dedicated meeting time, it’s suggested that: “if the discussion wan-ders, the chair or other member can say, ‘Let’s take that offline,’ or ‘that sounds like an issue to put in the “parking lot” to talk about at another meeting.’ If the discussion strays, there may not be time at the end of the meeting for all the items on the agenda.”

In October, 10 modules will be added to the website. By the end of 2016, the AMA plans to have up to 50 modules available online.

Concurrently with the rollout, the AMA and the Medical Group Manage-ment Association (MGMA) issued a prac-tice innovation challenge, seeking more high-value, easy-to-adopt, and transfor-mative medical practice solutions. Pro-posals were submitted through Sept. 1; the best solutions were eligible for one of several $10,000 prizes, in addition to hav-ing the ideas developed into future STEPS Forward modules. Winners will be an-nounced at MGMA’s annual conference Oct. 11-14 in Nashville, Tenn.

“We issued the innovation challenge to tap into the creative energy that we know is present among physicians,” said Sinsky. “The goal is to help physicians take better care of themselves and their practices so they can, in turn, take better care of their patients.” Dr. James L.

Madara

Dr. Christine Sinsky

The AMA Steps Up with STEPS Forward, continued from page 1

surgeries, creating greater efficiency for care providers and ultimately an optimum patient experience,” noted Lorraine Lutton, president of St. Joseph’s Hospital, part of the BayCare Health System.

The official opening of St. Joseph Hospital’s expanded operating suites took place July 7, highlighting the new VI-SIUS Surgical Theatre with an intraop-erative MRI (iMRI) Suite, an advanced neurosurgical operating room in which a diagnostic quality scanner moves to the patient using ceiling-mounted rails. This approach incorporates imaging and sur-gery in the same setting without introduc-ing additional risk to the patient associated with transport. Concurrently to improve patient outcomes, real-time information is delivered to clinicians.

The ease of accessibility to patient infor-mation via electronic health records is con-nected to audio, video, lighting and medical equipment to allow surgeons to control all devices from a single touch screen. All op-erating rooms (ORs) now have teleconfer-encing capabilities. Another nice touch: all wires and cords are off the floor and out of the way, reducing safety hazards.

“In February 1996, we opened what we called the new ORs – now the old ORs – and at that time, we thought they were huge, that we’d never outgrow them,” said Mary Robinson, director of surgical services for St. Joseph’s Hospital. “Nineteen years later, we’ve outgrown many of them, due the amount of technology we’re utilizing in our surgical cases these days. These old rooms

got to be quite small, and about two years ago, the surgeons started talking about being cramped, which led to the development of these new operating suites. Once again, we’re saying, oh, boy, they’re huge.”

The largest OR is 760 square feet, compared to 595 square feet, the largest OR from the 1996 redesign. Parentheti-cally, since the hospital was established by the Franciscan Sisters of Allegany in 1926, it has expanded from 40 to 470 beds.

Also part of the 2015 redesign: the old pediatric OR, with multiple venue changes for pre- and post-operative care, has been streamlined into a single space.

“The children and their families would come into one area, and then go to another area for pre-op work, another for surgery, and yet another for post-op care,” said Robinson. “Now, children and their fami-lies come through the children’s hospital entrance, and all processes take place in one area.”

Also, the newly renovated interven-

tional radiology suite houses a sophisti-cated imaging system, including advanced 3-D images via CT, MR, PET and SPECT scans for interventional radiolo-gists, blended road mapping that helps in-terventional radiologists easily and clearly navigate complex anatomy via high-quality digital images, and TrackVision to provide live 3-D guidance to help the radiologists precisely plan needle procedures and high-light deviations from the desired path.

AngioViz shows the vascular flow on a single image, while digital subtraction an-giography (DSA) generates vascular flow data, allowing radiologists to easily compare images with just a glance. Also, St. Joseph’s Hospital employs the 3T MRI-Ultra Field Tesla MRI, the strongest clinically available scanner, allowing for more comfort, quicker exams and high-quality images.

BayCare, a not-for-profit healthcare system, is comprised of 13 hospitals and associated clinics and practices, through-out Tampa Bay and Central Florida.

Taylor Architectural Photos

ST. JOSEPH’S HOSPITALS FOUNDATION EVENTS

OCT. 3: A Night with a Starfish includes a silent auction, entertainment and formal dinner at the USF Alumni Center.

OCT. 5: The 2015 Annual Golf Classic will take place at Streamsong, a newer resort that’s already recognized among the nation’s best courses.

DEC. 4: Georgette’s Celebrity Holiday Fashion Show, a long-standing Tampa tradition, will benefit emergency obstetrics at St. Joseph’s Women’s Hospital.

SAVE-THE-DATE:


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By LyNNE JETER

As Fifth Third Bank was rolling out its new campaign for Stand Up to Cancer (SU2C), Jose Pena received the unfortu-nate news that one of the Florida region’s banking center managers was diagnosed with Stage 4 cancer.

“We were heartbroken,” said Pena, senior vice president and Florida regional director for retail at Fifth Third Bank (NASDAQ: FITB). “She’s an advocate for the support of cancer research and has inspired me and all of our team-mates to join her in the fight.”

Pena has also dealt with cancer closer to home. Six years ago, his wife, Edith, was diagnosed with thyroid cancer. Since having the diseased thyroid gland and connected lobes removed, she’s been cancer-free, and remains a staunch sup-porter of Fifth Third’s efforts to raise awareness of the disease.

“Like me, many team members have experienced cancer in some form – themselves or a loved one – and for

the same reason, cancer really resonated with employees and customers,” he said.

Fifth Third Bank recently launched its third campaign for SU2C, a charitable program of the non-profit Entertainment Industry Foundation tasked with raising money to accelerate innovative cancer re-search, enabling scientific collaboration to quickly connect new therapies to cancer patients.

A $142 billion bank headquartered in Cincinnati, Ohio, Fifth Third Bank has raised more than $4.2 million for SU2C. The latest campaign launched July 27 and runs through Oct. 17.

When customers open a new Essen-tial Checking Account with $150, with di-rect deposit and three online bill payments made, Fifth Third Bank will donate $150 to SU2C. The bank will also donate $1 to SU2C when people share eligible posts using the #howifight hashtag on Face-book, Instagram, Twitter and Vine, up to $100,000 during the campaign.

The promotion, at 53.com/how-ifight, follows the national trend of compa-

nies giving customers a variety of ways to give back to the community as they shop or conduct business.

“With cancer impacting so many, we asked ourselves, ‘Could a bank help in the fight against this disease?’” noted Maria Veltre, senior vice president and chief marketing officer for Fifth Third Bank. “That was more than two years ago, and we’ve proven since that we can make a difference with the help of our customers, employees and members of our communi-ties, and we’re now leveraging the power of celebrity with (actor and cancer advo-cate) Patrick Dempsey. With this cam-paign, we want to highlight all the ways that we help fight (cancer) every day.”

A $50 minimum deposit is required to open all accounts and obtain the $150 bonus. All requirements must be met and qualifying activity must be initiated and post to the account within 90 days of ac-count opening. The bonus will be depos-ited into the new account within six weeks of completing requirements, and may be taxable as interest income and reported on

IRS Form 1099-INT. The offer is limited to one bonus per account per household.

Fifth Third began working with SU2C in 2013 when the bank rolled out exclusive SU2C credit and debit cards, which generate donations to SU2C for every qualifying purchase made using those cards. Fifth Third Bank is the only card issuer to offer the SU2C payment cards.

“Through this campaign, Fifth Third has made an everyday necessity a more meaningful experience for their customer by supporting Stand Up To Cancer’s in-novative cancer research,” said Rusty Robertson, co-founder of the organiza-tion, pointing out the dismal national sta-tistics: one in two men and one in three women will be directly affected by cancer in their lifetime, according to statistics col-lected by the Surveillance Epidemiology and End Results program at the National Cancer Institute. “We’re humbled by the incredible engagement this campaign has received from Fifth Third customers, and

Fifth Third Bank is Launching Third SU2C Campaign More Than $4.2 Million has Been Raised Nationwide

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UF Health Researchers Discover Signal That Impacts the Link Between Body Fat, Stress and Metabolism

By LyNNE JETER

GAINESVILLE — A group that in-cludes two University of Florida Health researchers has found that body fat can send a signal that affects the way the brain deals with stress and metabolism.

Even though the exact nature of those signals remains mysterious, researchers say simply knowing such a pathway ex-ists and learning more about it could help break this vicious cycle: Stress causes a desire to eat more, which can lead to obe-sity. And too much extra fat can impair the body’s ability to send a signal to the brain to shut off the stress response.

Findings of the NIH-funded study are important and unique because they show that it’s not simply the brain that drives the way the body responds to stress, said James Herman, PhD, a co-author of the paper and a professor in the department of psychiatry and behavioral neuroscience at the University of Cincinnati.

“It moved our understanding of stress control to include other parts of the body,” explained Herman. “Before this, everyone thought the regulation of stress was mainly due to the brain. It’s not just in the brain. This study suggests that stress regulation occurs on a much larger scale, including body systems controlling metabolism, such as fat.”

The findings, which reveal a novel fat-to-brain feedback network, were pub-lished in Psychoneuroendocrinology, “Adipocyte Glucocorticoid Receptors Mediate Fat-to-brain Signaling,” by a group that included Annette D. de Kloet, PhD, a research assistant professor in the

UF College of Medicine’s department of physiology and functional genomics, and Eric Krause, PhD, an assistant professor in the UF College of Pharmacy’s depart-ment of pharmacodynamics.

Researchers discovered that a gluco-corticoid receptor in fat tissue can affect the way the brain controls stress and metabo-lism. Initially, such signals from the recep-tor can be lifesavers, directing the brain to regulate its energy balance and influencing stress responses in a beneficial way.

“The stress response in the short term is adaptive. It’s going to help you cope with stress,” Krause said. “The idea that fat is actually talking to the brain to

dampen stress is new.”The researchers found that steroid

hormones known as glucocorticoids acti-vate their receptors within fat tissue in a way that affects a main component of the metabolic stress response. Using mouse models, they found a unique connection between glucocorticoid signaling in fat tis-sue and the brain’s regulation of energy balance and stress response. Because glu-cocorticoid signaling is crucial to regulat-ing the hypothalamic-pituitary-adrenal axis, fat tissue can directly affect central nervous system functions that link obesity, metabolic disease and stress-related prob-lems, researchers concluded.

Understanding fat-to-brain signaling is a first step toward someday being able to influence the broad, complex relationship between stress, obesity and metabolism. Herman credited de Kloet for pressing the search for a fat-to-brain signaling network.

Now that researchers have estab-lished that a fat-to-brain signaling path-way exists, a fuller understanding of how it functions could someday lead to drugs or other therapies that ward off the negative effects of long-term stress, said Herman.

“The big question is the nature of that signal to the brain,” he said. “We need to learn how to go in and break that cycle of stress, eating and weight gain.”

honored to continue this collaboration.”SU2C was founded in 2008 on the

belief that everyone can make a difference in the fight against cancer, Robertson pointed out.

“We’re profoundly grateful to each and every donor, of any level,” said Rob-ertson.

Celebrity Patrick Dempsey will lend his image to Fifth Third’s new SU2C Campaign this year. He will be featured in a Fifth Third Bank and SU2C spot highlighting ways people can fight cancer.

As SU2C’s scientific partner, the American Association for Cancer Research (AACR) and a Scientific Advisory Commit-tee led by Nobel Laureate Phillip A. Sharp, PhD, conduct rigorous, competitive review processes to identify the best research pro-posals to recommend for funding, oversee grants administration, and provide expert review of research progress.

Fifth Third Bank, continued from page 7


By LyNNE JETER

Telemedicine has quickly become the hottest topic in healthcare delivery, as the industry strives to adapt to its murky waters of compliance. New services, such as Zwivel, a cosmetic surgery consultation service, are coming online with unprec-edented frequency, piquing the interest of physicians and administrators about the unknown possibilities of telemedicine.

“Perhaps we shouldn’t be surprised by this trend,” said Michael Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Ser-vices, a 4,000-member group with physi-cians in all 50 states. “High speed internet connections are now the norm. Services like Facetime and Skype are more popu-lar than ever. Under continued pressure to cut costs and cope with declining re-imbursements, administrators believe telemedicine offers a tool for increasing ef-ficiency. Patients also like the convenience and increased options that flow from tele-medicine. So what’s not to like? Shouldn’t we embrace the ‘new normal’ and sign on to a great, brave new world? Maybe, first let’s proceed with caution.”

Among the state and federal compli-ance requirements when taking a practice online are licensure, professional liability considerations, standard of care, patient privacy, informed consent, and referrals for emergency surgery.

LicensureMedical providers “must be licensed

by, or under the jurisdiction of, the Medi-cal Board of the State where the patient is located,” according to the Federation of State Medical Boards’ Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

“Unfortunately,” noted Sacopulos, “this requirement imposes traditional state boundaries on the cyber world. Efforts need to be made to identify the residences of prospective telemedicine patients so the medical provider does not accidentally practice in a state without a license.”

Professional LiabilityMost professional liability insurance

policies provide state-specific coverage, meaning that if a provider accidentally prac-tices telemedicine on an out-of-state patient, there may be no coverage, said Sacopulos.

“Providers wanting to expand into the area of telemedicine should check with their insurance carrier,” he suggested. “An-other consideration relates to cyber issues. Traditional medical malpractice policies provide little to no coverage for electronic breaches. The nature of a telemedicine generates exposures to a variety of cyber risks. Any practice moving forward with offering telemedicine should have a com-

prehensive cyber insurance policy.”

Standard of Care It’s imperative to note that telemedi-

cine is the practice of medicine, and not “medicine lite,” Sacopulos pointed out.

“All the duties and obligations that come with in person consultations are owed to the remote telemedicine patient,” he explained.

The American Medical Association (AMA) recently stated there’s a general consensus among AMA members that care provided via telemedicine needs to meet the same standard as care provided in person.”

Also, the Federation of State Medical Boards made clear the position by stat-ing: “In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method in enabling physician-to-patient communications.”

“Before starting to use telemedicine as a tool to consult with remote patients, a practice should plan how it will meet the standard of care it provides for its in-office patients,” said Sacopulos. “For example, how will it document a dermatological con-dition? If the condition is normally photo-graphed when a patient is in the office, then the practice should be ready to capture the same quality of image via telemedicine. Each step of the consultation should be planned in advance to ensure it is equal in quality to an in-office evaluation.”

Patient PrivacySacopulos said it’s also important to

note that any form of electronic communi-cation with a patient should immediately bring to mind HIPAA and HITECH Act obligations.

“Whether the electronic connection with the patient is via email, text mes-saging, or video conference, the platform should be secure,” he said. “Private and confidential patient information is being transmitted and the patient has a legal right to protect the information in transit.”

The Federation of State and Board Telemedicine (FSMB) Guidelines spe-cifically state: “Physicians should meet or exceed applicable federal and state require-ments of medical/health information pri-vacy, including compliance with HIPAA and state privacy, confidentiality, security, and medical retention rules,” said Sacopu-los, adding that FSMB Guidelines suggest maintaining written policies to address:

• Privacy; • Healthcare personnel who will be

processing messages and patient communications;

• Hours of operations; • Types of transactions that will be

permitted electronically; • Required patient information to

be included in the communication, such as patient’s name, identifica-

tion number and type of transaction; • Archival and retrieval; and • Quality oversight mechanisms. “Finally, telemedicine practitioners

are cautioned to periodically evaluate their policies and procedures to insure they re-main current and readily accessible,” he said. “FSMB informs us that electronic communications received from patients must be maintained within secured tech-nology password-protected encrypted electronic prescriptions, or other reliable authentication and techniques.”

Sacopulos said it’s reasonable to assume that additional patient privacy requirements will be coming in the near future.

“This well may be in reaction to large scale breaches, such as Anthem Insurance experienced earlier this year,” he said. “Studies show that medical identity theft grew at an alarming rate in 2014. Govern-ment officials, including the FBI and Cali-fornia Attorney General, have specifically cautioned medical providers that their patients’ electronic data is at risk for hack-ing and theft. All of this should serve as a warning to telemedicine providers to com-ply with existing state and federal regula-tions. Telemedicine providers should also anticipate increasing privacy standards.”

Informed ConsentBefore practicing telemedicine, a

medical provider should obtain appro-priate patient informed consent. The in-formed consent document should:

Clearly state the patient’s identity; Clearly state the physician’s identity

and qualifications; Specify the scope of activities the

practice will be using telemedicine tech-nologies to fulfill, such as patient educa-tion, prescription refills, and scheduling appointments;

The patient must acknowledge that it is within the medical provider’s sole discretion to determine if the available telemedicine technologies are adequate to diagnose and/or treat the patient;

The patient should acknowledge the possibility of, and hold harmless the medi-cal provider for, any technology failures and/or interruptions;

The practice should, as part of the informed consent process, provide infor-mation on the telemedicine technologies privacy and security standards, such as the inscription of data and firewalls; and

The informed consent document should specify express patient consent to forward patient information to a third party if necessary.

Referrals for Emergency Service“The FSMB suggests that telemedi-

cine practitioners have a written protocol in the event that a remote patient needs emergency services,” said Sacopulos. “This

emergency protocol should cover possible scenarios when patients require acute care. How and where referrals are to be made should be covered in this protocol.”

State-Specific RequirementsThe scope of permissible telemedicine

varies significantly by state. Some states specifically require a physician/patient re-lationship to be established first in person with an exam and diagnosis and treatment plan, including prescriptions. Only then may telemedicine be conducted.

“Telemedicine is receiving much atten-tion at the moment,” said Sacopulos. “The American Medical Association is in the pro-cess of adopting a Code of Ethics for physi-cians who provide clinical services through telemedicine. Texas has recently issued new telemedicine guidelines to its practitioners. All of this should serve as a warning to those interested in telemedicine to consult with their State Board of Medicine before engag-ing in telemedicine activities.”

Telemedicine: A Virtual Compliance Jigsaw PuzzleA Closer Look at the New Wave in Healthcare Delivery

Physicians interested in electronically in-teracting with their patients should first work their way through this checklist:

• Examine the electronic commu-nication between the practice and its patients. From patients portals to staff testing, a complete picture is needed of the practice’s electronic communica-tions before engaging in telemedicine;

• Make sure forms of electronic pa-tient communications are HIPAA-com-pliant and secure;

• The internet may know no bounds, but a medical license does. Be careful not to provide medical services to indi-viduals who live in states in which there’s no license;

• Check with the State Board of Med-icine to determine state-specific tele-medicine limitations;

• Develop a specific informed con-sent document that complies with state requirements and also the Federation of State Medical Board’s suggestions;

• Develop a list of disclosures to pro-vide to prospective patients before en-gaging in telemedicine services; and

• ºMake sure there’s adequate insur-ance coverage. Check with a professional liability carrier and secure a cyber-insur-ance policy.

“With advanced planning and a little effort, you’ll be able to weave your way through the compliance requirements to practice telemedicine, leaving you and your patients to enjoy the benefits of a telemedicine practice,” said Michael J. Sacopulos, JD, CEO of Medical Risk In-stitute and general counsel for Medical Justice Services.

SOURCE: Michael J. Sacopulos, JD.

Physicians’ Telemedicine Checklist


Advanced Technology for Early Detection of Lung Cancer Available at Blake Medical Center

Blake Medical Center is pleased to bring advanced technology for early detection of lung cancer to our commu-nity. In July physicians at Blake Medical Center treated the fi rst patient utilizing the SPiNView® Thoracic Navigation System. This system aids physicians in the early detection of lung cancer.

The system allows access to many peripheral lung lesions previously not accessible according to Floyd Wells, MD, Pulmonologist on staff at Blake Medical Center. With the system, small nodules can be biopsied without a di-rect airway using the navigated percu-taneous approach. Being able to diag-nose and treat patients earlier leads to better patient outcomes.

Lung cancer is the leading cause of cancer deaths, killing more Americans each year than breast, prostate, colon and pancreatic cancers combined. Ac-cording to the American Cancer Soci-ety, more than 224,000 Americans are diagnosed with lung cancer each year. The good news is that with early detec-tion, the survival rate increases from 15 percent (stage IV) to as high as 92 per-cent (stage I).

The SPiNView system allows physi-cians to accurately access small lung lesions via multiple approaches. This assists physicians in detecting lung cancer earlier and without the need for multiple hospital visits for diagnostic procedures.

For more information contact [email protected].

Candace Smith Appointed Chief Nursing Offi cer at Manatee Memorial Hospital

Kevin DiLallo, Group Vice President, UHS Acute Care Division, CEO, Manatee Healthcare System is pleased to announce the appointment of Candace Smith, MPA, RN, to the position of Chief Nursing Offi -cer at Manatee Memorial Hospital.

Prior to joining Manatee Memorial Hospital, Candace has most recently

served as the CNO of Voalte, a clinical technology communications company in Sarasota, Florida and was the CNO and Vice President of Nursing Care Services at Unity Hospital in Rochester, New York, where she managed over 700 employees at a 681-bed facility.

Candace is a Doctoral Candidate in Education and Organizational Leader-ship and holds an MPA from State Uni-versity of New York at Brockport, NY and a BS in Nursing from D’Youville College in Buffalo, NY. She is also Board Certi-fi ed from American Nurses Credential-ing Center, a subsidiary of the American Nurses Association as an Advanced Nursing Executive.

Candace and her husband Bill reside in Parrish, Florida. Candace was born at Manatee Memorial Hospital and has maintained a community connection throughout her career.

Northside Hospital’s Tampa Bay Heart Institute Recognized for Surgical Excellence

Northside Hospital is proud to an-nounce that its Tampa Bay Heart Insti-tute has been recognized by the Soci-ety of Thoracic Surgeons for excellence in surgical care. The 3-Star Rating was awarded for overall quality in Coronary Artery Bypass Grafting Surgery; it is the highest ranking that can be achieved.

This rating is further evidence that patients who undergo cardiac surgery at Northside Hospital receive the high-est level of excellence in surgical care said Dia Nichols, FACHE, President and CEO of Northside Hospital.

The Society of Thoracic Surgeons has developed a comprehensive rat-ing system that allows for comparisons regarding the quality of cardiac surgery among hospitals across the country. Only 9% of more than 1,000 hospitals nationally received a 3-Star Rating in Coronary Artery Bypass Grafting Sur-gery. Based on current national data, the cardiac surgery performance of Northside Hospital’s Tampa Bay Heart Institute was determined to be in the highest quality tier.

The quality rating system is based on a combination of 11 National Quality Forum endorsed process and outcomes measures. To assess overall quality, the 11 National Quality Forum measures are grouped into four domains. These include:• Low mortality rates• Proper medication usage around the

time of surgery• Low number of complications of surgery• High quality surgical care

Memorial Hospital Of Tampa Announces Multi-Phase Facility Renovations And Expansion

Memorial Hospital of Tampa, an HCA West Florida facility, is pleased to announce a $14 million multi-phase hospital expansion and renovation. The project will include the creation of 47 private patient rooms and 18,500

square feet of new surgical space. Con-struction has begun and is expected to last approximately 22 months.

The project will allow the hospital to further reduce ER and surgical wait times and improve the patient and guest experience. The expansion includes ad-ditional surgical services support space and two new operating rooms with shell space for a third, bringing the total to nine operating rooms when the project is completed.

All patient rooms will be renovated to enhance healing and encourage fam-ily participation in the recovery process. Forty-seven rooms will be private and patients and guests will be supported through a new concierge service cen-ter, renovated lobby and waiting room amenities. The hospital will continue to provide free parking.

Since its acquisition of Memorial Hospital of Tampa and with input from the medical staff, HCA has provided ex-tensive capital resources for facility im-provements and technology upgrades, including the latest da Vinci robotic surgical system according to Alejandra Kalik, MD, Chief of Staff.

Expansion & Renovation Highlights:• 47 private rooms• 18,500 square feet of new surgical

space• 2 new operating rooms• New lobby & concierge service center• $14 million expansion & renovation• 18 Surgical Prep & Recovery Rooms

and additional support space

Moffi tt Cancer Center Seeks Breast Cancer Survivors for Genetic Counseling Study

Moffi tt Cancer Center is looking for breast cancer survivors for a study eval-uating the effectiveness of new educa-tional materials about genetic counsel-ing. An estimated 10 percent of breast cancers are thought to be hereditary. Genetic counseling gives individuals an opportunity to learn if his or her person-al or family history of breast cancer may be due to an inherited gene mutation.

The National Institutes of Health-funded study requires participants to have a previous breast cancer diagnosis and to not have participated in genetic counseling or testing. Interested indi-viduals should also have a family history of breast or ovarian cancer.

Study participants will be asked to review information about genetic counseling and complete three ques-tionnaires. The questionnaires can be completed online, over the phone or by mail. Compensation will be provided at the end of each questionnaire.

Those interested in participating in the study can call Kelli Nam, M.P.H. at 813-745-1015 or GeneticEducation-Study@Moffi tt.org.

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Tampa Bay Medical News September 2015