2020 ECMS May/June Bulletin Newsletter

Editors: Maureen Padden, M.D. | Erica Huffman, Executive Director

www.escambiacms.org

MAY/JUNE 2020 VOLUME 50, NO. 3

CONTENTS What an exciting and challenging time to be a physician! Practicing medicine during a pandemic has presented many unprecedented challenges when trying to take care of our patients. Not only have we had to change the way we interact with our patients, but we have had to find new ways to protect the health of our families, employees, and ourselves. My daily work routine has become an ever-changing process for the past three months and I am personally grateful for the support and resources our medical society has provided to myself and other physician members, our community leaders and our patients during this trying time. I am proud to be a member of such an active medical society that has proven to be an “essential” resource for our community during the COVID pandemic.

On March 31, 2020, the ECMS sent a letter to the Escambia County Board of Commissioners advising against the premature re-opening of our local beaches. The letter received support from our local hospitals’ leadership, the Florida Academy of Family Practice, and the Florida Medical Association and was recognized in the local news media. Our voices were heard, and the beaches did not reopen early!

The ECMS has formed a partnership with Pensacola Mayor Grover Robinson to help provide physician leadership and support in his plan for re-opening Pensacola. On May 7, 2020, Dr. Maureen Padden, ECMS Secretary/Treasurer, did a live video update with Mayor Robinson on the coronavirus and how it is affecting our patients in the Pensacola area.

Several of our members have been active in projects to help provide COVID-19 information to our community. Dr. Michelle Brandhorst has been instrumental in helping develop a flyer

about COVID-19 to distribute to our physician members, local businesses, and patients. Dr. Michelle Greer-Hall has led a task force providing COVID-19 information to our local African American community. This is just a few examples of the superior physician leadership we have in this group.

Our Executive director, Erica Huffman, has gone above and beyond to provide our members with information pertaining to the COVID pandemic via social media and email. Information provided includes webinars about telemedicine, FMA webinars about the virus, updates from local hospitals, updates on Governor DeSantis’ plan to reopen the state of Florida, updates on the Pensacola Chamber’s Reopening Escarosa plan, updates from Dr. John Lanza and the Florida Department of Health in Escambia County, updates from the Florida Department of Health, information about Disaster Relief Funds available to physician practices, and special offers from local and national businesses for front line workers. Erica has maintained a connection with the Pensacola Chamber of Commerce, local hospital leadership, local politicians, local businesses and local physicians during the pandemic. She has help facilitate the medical societies efforts to provide

Page 3 - New Members Page 5 - Announcements Page 6 - Events Page 8 - Medical/Legal Page 10 - Practice

Management Page 12 - Foundation Page 14 - Community

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Founded in 1873

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

1 | ECMS

Open for appointments Fully prepared for your patients’ safety in our care Florida Medical Association Annual Meeting Update At Ascension Sacred Heart, the care your patients need is available today. From routine visits and health screenings to surgical procedures and specialty care, our caregivers are fully prepared for your patients’ arrival.

As we all embrace a new care experience, Ascension Sacred Heart will continue to maintain strict precautions for patient safety in our care including screenings, social distancing and protective equipment. Yet our compassionate, personalized care remains unchanged. When patients enter our open doors, they’ll be greeted by the Ascension Sacred Heart caregivers you know and trust.

We are now open to schedule appointments for urgent and ongoing care needs, including: back surgery, joint surgery, heart screenings, mammograms, pediatric vaccinations, annual wellness visits, prenatal care visits and more.

Schedule now. Ask about virtual visits.

GetSacredHeartCare.com

Listening to you, caring for you.™

© Ascension 2020. All rights reserved.

ECMSECMS |2 |2

Each year the Escambia/Santa Rosa County Medical Society is given delegate slots to the FMA Annual Meeting. This year our membership has selected the following delegates to serve: Dr. John Lanza, Dr. Karen Snow, Dr. Maureen Padden, Dr. Brian Kirby, Dr. Hillary Hulstrand, Dr. Jennifer Miley, Dr. Ellen McKnight, and Dr. Kacey Montgomery.

In the past our delegates have written resolutions on a variety of topics ranging from Maintenance of Certification, Local Alliances for Drug Endangered Children, Protecting the Right of Privacy and Access for the Medicare Patient and Preserving Solo/Small Group Practices, and many more topics.

The ECMS Delegation wants to hear from YOU! Do you have a topic for a resolution?

Please submit your written topic with a few sentences to Erica Huffman (director@ escambiacms.org) for consideration.

Membership

4771 Bayou Blvd., Pensacola, FL 32503 Ph: 850-478-0706 Fx: 850-474-9783 Email: info@escambiacms.org www.escambiacms.org

E.C.M.S. Bulletin

The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/Feb, Mar/Apr, May/Jun, Jul/Aug, Sept/Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/legal articles, and practice management.

•

•

Vision for the Bulletin:

Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond.

A powerful instrument to attract and induct members to organized medicine.

NEW MEMBERS Jenna Beasley, M.D., Board-certified Dermatologist & Dermatopathologist Vital Dermatology 6202 N 9th Ave, Suite 2 Pensacola, FL 32504 (850) 888-2424 Fax: (620) 710-7703 www.vitaldermatology.com *opening June 2, 2020

President’s Letter Continued medical guidance and leadership to the community when needed. Did you see the ad in the Pensacola News Journal on Doctor’s Day 2020 thanking our members for their service in our community? You can check out the physician shout out and much more information on the ECMS’s Facebook page.

Our next general membership meeting will take place on June 23, 2020 at Garden

ECMS

Mission:

Advancing physicians’ practice of medicine in our community.

and Grain. I look forward to being able to socialize with my colleagues again, even if it is at an appropriate distance. Also, it is not too late to become a member of this active and energetic medical society. We are open to new ideas on how we can provide value to our physician members and continue to be a strong leadership voice in our community.

PHYSICIAN SPEED NETWORKING

Tuesday, June 23, 2020 Garden & Grain (50 East Garden Street) Rejoin your colleagues old and new. This is a great opportunity to network for referrals. We will have high top tables 6' apart, no more than a few to a table with rotation for networking, encourage mask wearing, and no direct contact

Ad placement Contact Erica Huffman at 478-0706 x2 Ad rates 1/2 page: $350 · 1/4 page: $200 · 1/8 page: $150

View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission.

Event Sponsored by Underwood Anderson & Associates, Lighthouse Healthcare

5:30 pm-6:00 pm Cocktails & hors d'oeuvre 6:00 pm speed networking ECMS Members are FREE Non-Member Physician $50 or FREE if you join as an ECMS member www.escambiacms.org/membership To RSVP Call/Text 561.414.6113 or EMAIL director@escambiaCMS.ORG https://secure.affinipay.com/pages/ecms/payments

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

3 | ECMS

The flyer below has been created by the Community Health Action Team Covid-19 Task Force under the leadership of ECMS Member, Dr. Michelle Grier-Hall. In the coming days we will be distributing these flyers to local area businesses.

PHASE 2

PHASE 1 "Wait. Don't Congregate."

Wait...

CONGREGATE

As businesses are reopening and stay- at- home orders are lifting, we urge you to take precautions to protect yourself and others from COVID-19.

COVER YOUR FACE.

KEEP HANDS CLEAN.

Safely.

MAINTAIN YOUR SPACE.

WAIT...

CONGREGATE SAFELY.

IF YOU ARE AFRICAN AMERICAN:

Studies show that you may have a significantly increased risk of contracting COVID-19 and developing more serious complications from COVID-19 illness...which could even lead to death.

Continue to stay home if possible, especially if you are 65 or older and/or have serious underlying health issues.

If you are around other people (even family members) or you absolutely must go out, follow the rules above.

Continue to see your doctor for any chronic health conditions, such as diabetes, high blood pressure, asthma, heart disease and lung disease.

Don’t delay getting tested for Covid-19 or seeking medical attention for any new symptoms.

Congregate safely! Your actions right now, including self-advocacy, could very well save your life!

In partnership with local pastors, community leaders and healthcare organizations, the "Wait. Don't congregate" movement was created to promote continued safe social distancing practices to protect you, your loved ones and the community at large.

#WaitDontCongregate #WaitCongregateSafely ECMS | 4

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Announcement ECMS Letter to Escambia Board of County Commissioners

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

5 | ECMS

Practice Management Emergency Preparedness and Management in Your Healthcare Organization

By Mallory Earley, JD, Senior Risk Resource Advisor Healthcare emergency preparedness and management can take many forms. Unanticipated events, such as a physical altercation, an infection outbreak, or a natural disaster, can affect patient care and panic the public. With proper training and preparation, your organization can respond appropriately to a broad range of incidents and disasters.

In developing your plan, consider the specific risks associated with each type of event, including the challenges of using social and traditional media to alert your patients and the public. Regardless of the type of emergency, its impact can be reduced when staff are prepared, risks are assessed, and contingency plans are implemented before a disaster hits.

The Four Phases In healthcare organizations, emergency management programs usually consist of four main phases: mitigation, preparedness, response, and recovery. These components can help facilities prevent some emergencies, decrease other vulnerabilities, and improve responses after an event.1 The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) requires accredited organizations to have an emergency management plan that includes each of these four phases.

Mitigation and Preparedness Regardless of the type of disaster, proper mitigation and preparedness can reduce severity before an incident occurs and possibly even prevent its occurrence. Mitigation can save money on the front end by ensuring appropriate safeguards are in place to avoid likely risks. Preparedness relates to the facility’s ability to manage its response and recovery from an emergency. JCAHO recommends that organizations have an emergency operations plan (EOP) and practice using it by training employees, conducting mock drills, reviewing the plan, and coordinating with local, state, and federal emergency response agencies.2 Response and Recovery Response is the third phase of managing an emergency. It usually focuses on providing emergency medical treatment to those affected, minimizing secondary impacts, and limiting the negative effects of the situation. The last phase, recovery, is the where a healthcare organization resumes its normal operations and services. Keep in mind that recovery seeks to return your facility to normal operations while caring for your staff who have experienced the event.3 Regardless of when an event occurs at your healthcare organization, keep in mind that the phases of your EOP are fluid and can overlap.

Proper mitigation and preparation can help your organization respond and recover more effectively after a serious incident.

When developing your plan, address the specific risks for the many types of emergencies your facility may face. These can include physical violence, infection outbreaks, and natural disasters.

Physical Violence and Active Shooter Violence in healthcare organizations can occur despite the location, size, or type of hospital or facility. It can range from verbal abuse to physical assaults against providers, patients, family members, or others. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”4 The Bureau of Labor Statistics cites that 18,400 workers experienced nonfatal workplace violence in 2017.

Of those who experienced workplace violence, 71% worked in the healthcare and social assistance industry.5 Being properly trained and prepared for such incidents can help save lives.

Risk Factors Although violence against healthcare workers can occur in any ECMS | 6

patient care setting, certain risk factors increase the potential for violence. Violence against healthcare workers may typically come from patients, clients, or residents at their facility. Even though there is no way to predict future violent behavior in any specific patient population, certain types of inpatient care may be at a higher risk for physical violence: psychiatric services, long-term care settings, emergency departments, and residential services.6 Other factors may include working with patients who have a past history of violence or substance abuse, a facility located in a high crime area or where weapons are prevalent, poor emergency communication protocols, and property concerns such as poor lighting in parking lots or around your buildings. High employee turnover rates, understaffed departments, long wait times, inadequate policies and procedures for staff who deal with hostile behaviors, and a lack of physical security can also increase your organization’s risks.7 Security Measures There are several physical security measures that can help prevent or mitigate violent acts against providers or patients. Consider the use of video cameras in areas where patient care is not taking place such as waiting rooms, hallways, or other common areas. Silent alarms or panic buttons may add security to general admissions areas.

In addition, review your check-in procedures for patients, visitors, and vendors to limit the number of people entering your facility.

Larger hospitals and facilities might employ security guards to patrol their campus. Consider limiting the number of entrances that are accessible to the public. Talk with your local police or security about safety plans and exit routes to ensure the safety of those involved in an incident as well as ancillary patients, visitors, or staff who might be on campus.

One of the most important security measures is an automatic lockdown system with a code all staff and providers will recognize. Practice drills for significant weather alerts, active shooters, violent altercations, and other lesser used codes to speed everyone’s response to an actual emergency.

Employee Considerations When hiring, conduct criminal background checks prior to employment. Once hired, staff should learn how to evaluate likely threats as part of an ongoing training process. Educate all staff on how to recognize and manage potential dangers. In addition to considering selfdefense training, teach your staff de-escalation techniques for helping difficult patients or visitors redirect their anger to avoid violent outbursts.

Infection Control and Outbreak Despite advances in technology and healthcare, healthcareassociated infections (HAIs) remain a top concern for healthcare organizations when it comes to patient safety. According to the Centers for Disease Control and Prevention (CDC), about one in 31 hospital patients has at least one HAI at any given time.8 HAIs are potentially preventable, but antibiotic-resistant bacteria can cause infections that lead to sepsis or death. Data can help protect patients by showing how to prevent infections and ensure proper use of antibiotics.

The CDC has resources that can help organizations win the battle against HAI, including evidence-based recommendations for prevention and control in the hospital setting.9 The federal government established goals through the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.10 Once the problem is outlined, the next step is determining how to implement change and work toward reducing or eliminating HAIs. Healthcare organizations often begin by promoting a ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Practice Management culture where HAIs are not acceptable. There needs to be buy-in from all levels involved in patient care: federal, state, and local governments as well as the healthcare system, facility, provider, and patient. There has to be transparency and accountability, including an internal root cause analysis, when there is a breakdown in infection control policies and procedures.

One state has made dramatic improvements in patient safety regarding HAI. Tennessee used actionable data from the National Healthcare Safety Network to improve healthcare in their state.

Tennessee’s Example In 2008, Tennessee was one of only two states that had a central line-associated bloodstream infection (CLABSI) standardized infection ratio (SIR) significantly higher than the national average. Six years later, Tennessee had reduced CLABSI to 52% below the national average. With help from the Tennessee Department of Health, the state looked at its own data, identified where HAIs were occurring, and targeted prevention efforts at problematic locations in specific facilities. Dr. Marion Kainer, Tennessee Department of Health HAI Program Director, stated, “We’ve embraced the Target Assessment for Prevention strategy in Tennessee for several reasons. We feel it has the greatest return on investment, by targeting facilities with the potential to prevent the greatest number of infections.”11 Pandemic Another scenario that has become a reality for healthcare organizations around the world in the spring of 2020 is preparing for and operating during a global pandemic. In the midst of the COVID-19 outbreak, preparation for high numbers of critical patients as well as necessary precautions and supplies for staff and providers were critical in the local management of the pandemic. Quick response and proper planning led to many changes in facilities such as screening procedures for employees at each shift, eliminating unnecessary visitors, and close examination of infection protocols. The Department of Health and Human Services Office of the Assistance Secretary for Preparedness and Response developed a comprehensive checklist12 that relates to general pandemics as well as the COVID-19 outbreak.

The checklist considers topics such as safety/infection control activities, EMS activities, and hospitals and health care activities that include inpatient and outpatient recommendations. The CDC continues to examine and evaluate recommendations and provide a variety of specific guidance.13 For state-specific recommendations, consult your state medical boards and hospital associations for local guidance.

Resources for Managing and Preventing Outbreaks If your healthcare organization faces an HAI outbreak, the CDC will often work with the health departments and Food and Drug Administration to provide assistance for patients and stop the spread of the outbreak. The most common reasons for an outbreak are a breakdown in infection control procedures or contaminated equipment or medicines. In these scenarios, the CDC might release information to the public or help coordinate the prevention of future incidents, as well as work from a regulatory standpoint to reduce the risk of further outbreaks.14 Healthcare organizations need to have updated infection control policies and procedures. Working with your organization, you can develop educational tools for your staff, patients, and visitors that address germs’ sources and their transmission through human contact, contact with surfaces, inhalation, or ingestion.15 APIC has a number of resources and information on prevention and protocols for visitors and patients if you are considering updating your policies. Infection control education for your providers, patients, and guests is an important part of providing a safe environment for everyone at your facility.

Natural Disasters Natural disasters can strike in a number of ways from wildfires

to hurricanes to earthquakes. The lack of predictability and the potential long-term effects can cripple an unprepared healthcare organization. The CDC has a number of specific resources on how to prepare for and manage dangerous natural events, including severe temperatures, storms, wildfires, and earthquakes.16 Keep in mind that your options for evacuation or sheltering in place could depend on your organization’s policies and ability to continue providing proper care in emergency circumstances. If your entire geographic area is impacted, your facility may become a refuge even for those who do not need medical treatment.

Prepare for Power Failures and Staffing Shortages As with any potential emergency, organization before a natural disaster event will be important. Keeping patients calm and properly cared for will be two of the most important elements during this type of emergency. Without electricity, healthcare organizations may need to use a numbering system to track patients, their diagnoses, and treatment. Patient access and financial services staff can use this basic information to follow up when electronic systems are restored.17 Consider the need for increased staffing immediately after a natural disaster because some staff may be unable to continue working. You also may have to grant temporary privileges to providers during a disaster. Natural disasters can also have a larger impact on your organization’s staff since they may also have lost personal property, homes, or loved ones.

Use of Social Media in Emergency Planning With the rise in technology and smartphones, the public often turns to social media to alert others of an event regardless of the type of emergency. Keep in mind that HIPAA still applies to protected health information during a crisis and a facility needs to include processes for patient identification and family notification in an emergency. Consider having a designated person update social media to keep the public notified as circumstances change. Disseminating accurate, timely, and appropriate updates can help calm both patients and family members as well as reduce overall panic.

Be Ready for Rumors Social media platforms can easily spread misinformation during emergencies, but proper monitoring can dispel rumors and reduce panic. For example, Massachusetts General Hospital monitored Twitter as part of its response plan during the Boston Marathon bombing. They found Tweets falsely claiming the hospital was on lockdown and treating the surviving bomber.

The hospital quickly used Twitter to set the record straight.18 Regardless of your healthcare organization’s size, emergency preparedness and management needs to be a top priority in your training and education of staff. Putting in the time and effort during a time of peace can have immense payoff when an emergency occurs.

Endnotes 1. Department of Homeland Security, “Emergency Management Programs for Healthcare Facilities: The Four Phases of Emergency Management,” p. 1, https://www.hsdl. org/?view&did=765520 accessed November 6, 2019.

2. Ibid.

3. Ibid., p. 3.

4. Occupational Safety and Health Administration (OSHA), “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers,” p. 2, https://www.osha.gov/ Publications/osha3148.pdf accessed October 9, 2019.

5. “Centers for Disease Control and Prevention (CDC)–The National Institute for Occupational Safety and Health (NIOSH), “Occupational Violence: Fast Facts– Fatality Data,” https://www.cdc. gov/niosh/topics/ violence/fastfacts.html accessed October 9, 2019.

6.

OSHA, op cit., p. 3-4.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTAMEDICAL ROSA COUNTY ESCAMBIA COUNTY SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

7ECMS | ECMS |7

Practice Management 7.

Ibid., p. 4-5.

8.

CDC, “HAI Data,” https://www.cdc.gov/ hai/data/index.html accessed October 9, 2019.

9.

CDC, “Healthcare-Associated Infections,” https:// www.cdc.gov/hai/ index.html accessed October 9, 2019.

10. Office of Disease Prevention and Health Promotion, “National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination,” https://health.gov/hcq/ prevent-hai-action-plan.asp accessed October 9, 2019.

11. CDC, “Winnable Battles: Healthcare-Associated Infections (HAIs),” https://www.cdc.gov/winnablebattles/ report/HAIs.html accessed October 9, 2020.

12. PHE, “COVID-19 Healthcare Planning Checklist,” https://

www.phe. gov/Preparedness/COVID19/Documents/COVID-19%20 Healthcare%20Planning%20Checklist.pdf accessed April 20, 2020.

13. https://www.cdc.gov/coronavirus/2019-ncov/communication/ guidance-list.html?Sort=Date::desc accessed April 20, 2020.

14. CDC, “Healthcare-Associated Infections: Outbreak Investigations in Healthcare Settings,” https://www.cdc.gov/ hai/outbreaks/index.html accessed October 9, 2019.

Florida State University College of Medicine Match 2020 Pensacola Alicia Bishop, Emergency Medicine Wake Forest Baptist Med Ctr-NC Brian Bowden, Opthomology University Hosps-Jackson-MS Olenka Caffo, Family Medicine Swedish Med Ctr-WA Conor Cronin, Psychiatry U South Alabama Hospitals Alyssa Davis, Internal Medicine Vanderbilt Univ Med Ctr-TN Nidhi Desai, Radiology-Diagnostic U Florida COM-Shands Hosp Wesley Earl, Internal Medicine NYP Hosp-Columbia Univ Med Ctr-NY Justin Gallagher, Surgery-General San Diego Naval Medical Center

ECMS | 8 8 | ECMS

William Kortbein, Psychiatry San Antonio Military Medical Center Lauren Luscuskie, Anesthesiology NYP Hosp-Columbia Univ Med Ctr-NY Shannon Lyons, Emergency Medicine Wake Forest Baptist Med Ctr-NC Matthew Metzger, Pediatrics Sinai Hospital of Baltimore-MD Daniel Pierce, Urology University of South Florida Ariana Trautmann, Emergency Medicine Carolinas Med Ctr-NC Grant Wallenfelsz, Emergency Medicine U Texas Southwestern Med Sch-Dallas

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Practice Management

Practice Management

Is Your Practice Cyber Secure?

By Robin Beasley, JD, Senior Market Manager With the increased use of technology in healthcare comes the growing risk of cyberattacks and cyber liability, as well as regulatory investigations, fines, and penalties. Anything created, stored, or transmitted electronically is at risk of being compromised by an innocent mistake or—worse yet—maliciously stolen by a criminal.

When it comes to data breaches, not all industries are on equal ground.

Some have traditionally been much bigger targets than others, and this includes healthcare.

According to an analysis of U.S. healthcare data breach statistics, “2018 saw a 157.67% year-over-year increase in the number of compromised healthcare records. 13,236,569 healthcare records were breached in 2018.”1 The report further notes that nearly 195 million healthcare records—equating to the records of 59.80% of the U.S. population—have been reported stolen, exposed, or disclosed since the Department of Health and Human Services’ Office for Civil Rights began publishing summaries in October 2009.2 Another article shows that as of mid-2019, 11 of the 13 largest data breaches affected medical or healthcare organizations.3 Many people don’t believe—or understand why—medical information is valuable or at risk.

Thieves target medical records because they contain a variety of patient information: social security numbers, as well as financial, health, demographic, and family information. Criminals can use the stolen information to steal identities and apply for credit cards, store accounts, or other lines of credit. They also use the information to purchase medical equipment and pharmaceuticals for resale.

Criminals also can pose as healthcare providers and fraudulently bill health insurers or the government for fictitious medical care. One cybersecurity expert estimates that a medical record can fetch hundreds or even thousands of dollars on the black market. Meanwhile, a credit card number may go for as little as a quarter, and a social security number for as little as a dime.4 Big or small, all healthcare organizations are at risk.

Healthcare organizations of all sizes—from large healthcare systems to solo practices—have all been attacked, but the size of the entity does not necessarily determine the size of the breach. One need only reference the HIPAA data breach portal5 to verify the truth of this assertion. Data breach incidents at very large organizations have exposed anywhere from several hundred to several million patient records. Likewise, cyberattacks on solo practices—though frequently in the range of several hundred to several thousand patient records— have exposed tens of thousands of patient records with a single breach.

Transition to EHRs, dated systems, and weak security measures pave the way for cyberattacks.

The transition to electronic health records has given criminal hackers more opportunities to steal medical records, and the biggest reason is ease of access. Healthcare is susceptible to attacks due to

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

its valuable data and rising complexity of systems on interconnected networks. In addition, some hospitals do not have cyber teams or adequate funding for tech security. They may not fully appreciate cyber risks, given their focus on improving patient outcomes and investment in new medical equipment.6 Once a hacker penetrates whatever security the system does have, the exposed information is easily compromised. The operational disruptions that can occur as a result can be debilitating.7 Cyberattacks on EHR systems take many forms.

In addition to outright theft of medical information, emerging cyber threats also include various forms of cyber terrorism and cyber extortion. Recent reports of ransomware attacks are particularly troublesome. Sophisticated hackers launch malicious codes (typically via entry through email) that crawl through a target’s computer system, encrypting and locking up data files, and then demand payment (ransom) in exchange for providing the decryption key. Cybersecurity experts believe healthcare providers make good targets for ransomware attacks; they do not typically have the advanced backup systems and other resilience measures in place that are typical of other types of organizations.8 What can you do to help safeguard EHRs and protect patient information?

Patient trust in your practice’s ability to protect medical information is critical. To earn and maintain that trust, it is important to have safeguards in place that help prevent data breaches. When implementing or updating an EHR system, talk to your vendor about cybersecurity. Ask whether electronically stored and transmitted information is encrypted. It is also a good idea to determine if or when the vendor will provide security updates for your EHR software.

You may need to invest more resources in shoring up the walls around your electronically stored and transmitted data. Cybersecurity is a highly specialized area that requires a certain degree of expertise and experience. Your EHR vendor may be able to provide some assistance in this area, but remember their expertise is more about creation and functionality, and less about security. Depending on the size of your practice, your best option may be hiring an inhouse cybersecurity expert or contracting with a cybersecurity firm specializing in healthcare to protect your practice and your patients.

There are, of course, a myriad of technical safeguards—like using a firewall, installing and maintaining anti-virus software, regularly updating software, and routine operating system maintenance—you should have in place to protect the security of electronically stored and transmitted information. But not all cybersecurity measures have to be technical in nature. In fact, much of cybersecurity follows good common sense. One particularly helpful resource in this regard is HealthIT.gov, which is the official website for The Office of the National Coordinator for Health Information Technology (a division 9 | ECMS

Practice Management of the Department of Health and Human Services). They publish and regularly update a document titled “Top 10 Tips for Cybersecurity in Health Care.”9 Some of their recommendations fall into the common sense category, and can be found in the adjacent box.

The “Top 10 Tips for Cybersecurity in Health Care” and other resources—such as the Department of Homeland Security, the American Hospital Association, the Centers for Medicare & Medicaid Services, and the National Institute of Standards and Technology— are listed at the end of this article.10 These are just a few of the vast resources available to hospitals and facilities regarding cybersecurity.

Top Tips for Cybersecurity in Healthcare 1.

Establish a Security Culture. First and foremost, create a culture of compliance and cybersecurity awareness. HealthIT.gov states, “[t]he weakest link in any computer system is the user,” and “[s]ecurity practices must be built in, not bolted on.” The importance of cybersecurity awareness and compliance must be instilled at every level, and it must become part of your practice’s culture. The level of commitment that your practice makes to patient safety should be the same level of commitment to the safety and security of patient information.

2.

Maintain Good Computer Habits. Another common sense cybersecurity tip is simply maintaining good computer habits.

Basic measures like logging off and not sharing passwords can prevent unauthorized access issues that lead to data breaches. Also, understanding how to identify phishing scams—where email is used to entice a user to click on a link or open an attachment that downloads malware into your computer system—is an essential skill, especially for those who interact with systems that store and transmit patients’ medical information. Additionally, adhering to safe and responsible online practices can greatly reduce exposure to threats from hackers, swindles, malware, and more. For example, be wary of suspect-looking websites and selective about what you click on.

3.

Use Strong Passwords and Change Them Regularly.

Speaking of passwords, encourage and promote proper password hygiene. Enforce strong user password standards. Passwords should have at least eight characters and include uppercase and lowercase letters, numerals, and special characters. It is also important to configure systems so that passwords must be reset on a regular basis.

4.

Control Physical Access. The most common way electronically stored information is compromised is from the loss of devices through theft or accident. Flash drives, cell phones, tablets, and laptops are particularly vulnerable to theft or loss due to their portable nature. However, thieves have also ripped hard drives out of machines and stolen entire network servers from offices. For portable devices, the best practice is to not permit electronic health information to be stored on or transmitted by such devices. If it is necessary, then cybersecurity experts recommend that the data always be encrypted. As for the physical security of desktop computers, terminals, hard drives, backup tapes, and servers, you can minimize the risk of overt theft by securing machines in locked rooms, limiting the number of physical

ECMS | 10

keys, restricting access in general, and limiting the ability to remove devices from secure areas.

5.

Plan for the Unexpected. Finally, recognize that despite your best efforts, sooner or later something bad will happen, so be prepared for when it does. Create backups. Have emergency and recovery plans in place for quick implementation in the event of a breach. Also, have a breach notification and patient support plan ready in the event a data breach requires one.

Endnotes 1.

“Analysis of 2018 Healthcare Data Breaches,” HIPAA Journal, January 28, 2019 https://www.hipaajournal.com/analysis-ofhealthcare-data-breaches/ accessed October 8, 2019.

2. Ibid.

3.

Novison, M., “The 13 Biggest Data Breaches of 2019 (So Far),” CRN, July 16, 2019, https://www.crn.com/slide-shows/security/ the-13-biggest-data-breaches-of-2019-so-far- accessed October 8, 2019.

4.

Yao M., “Your Electronic Medical Records Could Be Worth $1000 To Hackers,” Forbes, April 14, 2017 https://www.forbes.com/ sites/mariyayao/2017/04/14/your-electronic-medical-records-can-beworth-1000-to-hackers/#c2b077350cf1 accessed March 22, 2018.

5.

U.S. Department of Health and Human Services Office for Civil Rights, “Breach Portal: Notice to the Secretary of HHS Breach of Unsecured Protected Health Information,” https://ocrportal.hhs.gov/ ocr/breach/breach_report.jsf accessed September 27, 2019.

6.

Garrity, M. “Five Reasons Healthcare has Become More Susceptible to Cyberattacks,” Becker’s Health IT & CIO Report, April 24, 2019 https://www.beckershospitalreview.com/cybersecurity/5reasons-healthcare-has-become-more-susceptible-to-cyberattacks.html accessed October 8, 2019.

7.

Johnson C., Zapotosky M., “Under Pressure to Digitize Everything, Hospitals are Hackers’ Biggest New Targets,” The Washington Post, April 1, 2016, https://www.washingtonpost.com/ news/wonk/wp/2016/04/01/under-pressure-to-digitize-everythinghospitals-are-hackers-biggest-new-target/?utm_ term=.9ed3a0ec1464 accessed October 8, 2019.

8.

Conn, J., Hospital pays hackers $17,000 to unlock EHRs frozen in “ransomware” attack. Modern Healthcare, February 18, 2016 http://www.modernhealthcare.com/article/20160217/ NEWS/160219920 accessed September 26, 2019.

9.

Top 10 Tips for Cybersecurity in Health Care. HealthIT.gov website, https://www.healthit.gov/sites/default/files/Top_10_Tips_for_ Cybersecurity.pdf accessed September 26, 2019.

10. Additional resources: http://www.dhs.gov/topic/ cybersecurity, http://www.aha.org/advocacy/leveraging-technology/ cybersecurity, http://www.nist.gov/cyberframework, and http://www. cms.gov accessed September 27, 2019.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Foundation Foundation ESCAMBIA COUNTY MEDICAL SOCIETY FOUNDATION Dear Medical Society Physicians; I hope this finds you healthy and everything “stable” in your practices. There is a new normal in medicine as in everything, but the Foundation has been able to maintain programs and even investigate a new one!

• The Blood Pressure Cuff Program; the BP Cuff program continues to supply cuffs to indigent patients, even with the recent obstacles. We are maintaining delivery to the indigent clinics, and anticipate taking delivery of more cuffs as needed. This has made a big difference in monitoring patients’ blood pressures.

• The We Care Program; the We Care program continues to provide indigent care to patients through participating Medical Society physicians. But as with everything that has been disheveled, it has been more difficult. As things quiet down, please consider donating your time and expertise.

• The Go Seniors Program; the Go Seniors vouchers continue to be used by indigent patients to enable making doctor’s appointments. As we transition away from telemedicine, and if your administrators have any questions, have them get hold of Erica.

• Scholarship Programs; as you know, the Foundation sponsors and facilitates two scholarship programs.

The FSU Medical School Scholarship and the Pensacola State College Endowment are two programs that the Foundation has been involved with for many years – and will continue to do so!

• The Physician Wellness Program; the PWP continues to serve members who need help in navigating their practices. Help is probably needed more now than ever. It is anonymous, first three sessions are free, and can be done via telemedicne. Access more information through our web site.

• “New Program”; we are exploring a new program for physician mind-body medicine wellness. It is run by a local physician who has been trained at the Benson-Henry Institute for Mind Body Medicine at Mass General.

As it is performed in a classroom setting, we are reviewing the best options to get it started. More info forth coming!

• The 1873 Society; this is our program that helps you fund our programs, while obtaining a tax deduction.

Consider joining the Society, which commemorates the founding date of ECMS. Thanks again to all who have supported our community through the Foundation.

Take care as we all transition back to a semblance of normal!

Kurt A. Krueger, MD Pres., ECMS Foundation

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Foundation Foundation 11 | ECMS 11 | ECMS

Foundation Physician Wellness Burnout Inventory This is an adapted version of the Oldenburg Burnout Inventory, one of several such validated instruments used to assess the presence of burnout in many occupations. Each of these instruments, including this one, has its own unique advantages and limitations. This sample is provided not as a definitive measure of the presence or absence of burnout, but merely as one potential piece of data for you to consider as you explore issues related to physician wellness and resilience.

By answering the questions and tallying your score, you will be able to determine your score. Scores range from 16-64. Scores above 35 have been correlated with higher rates of burnout. If you are an Active member of Escambia/Santa Rosa County Medical Society and would like to seek free wellness coaching services, please visit https://escambiacms.wildapricot.org/PhysicianWellness

Agree (+2) Disagree (+3) Strongly Disagree (+4) 8. During my work, I often feel emotionally drained.

Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1) 9. Over time, one can become disconnected from this type of work.

Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)

1. I always find new and interesting aspects in my work.

Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)

10. After working, I have enough energy for my leisure activities.

Strongly agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)

2. There are days when I feel tired before I arrive at work.

Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)

11. Sometimes I feel sickened by my work tasks.

Strongly agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)

3. It happens more and more often that I talk about my work in a negative way.

Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)

12. After my work, I usually feel worn out and weary.

Strongly agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1)

4. After work, I tend to need more time than in the past in order to relax and feel better.

Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1) 5. I can tolerate the pressure of my work well.

Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4) 6. Lately, I tend to think less at work and do my job almost mechanically.

Strongly Agree (+4) Agree (+3) Disagree (+2) Strongly Disagree (+1) 7. I find my work to be a positive challenge.

Strongly Agree (+1) 12 |ECMS ECMS| 12

13. This is the only type of work that I can imagine myself doing.

Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4) 14. Usually, I can manage the amount of my work well.

Strongly agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4) 15. I feel more and more engaged in my work.

Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4) 16. When I work, I usually feel energized.

Strongly Agree (+1) Agree (+2) Disagree (+3) Strongly Disagree (+4)

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Foundation

ECMS Foundation Physician Wellness Program Helping Healers Heal

TELEMEDICINE APPOINTMENTS NOW AVAILABLE To schedule an appointment 1) Email patrick@psyassociates.com or call (850) 434-5033 x8 2) Identify yourself as a member of Escambia County Medical Society and that you wish to utilize the Physician Wellness Program

FREE & CONFIDENTIAL MEMBER BENEFIT ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

13 | ECMS

Foundation

THE 1873 SOCIETY Since 1873, Escambia and Santa Rosa County Medical Society physicians have dedicated themselves to their patients and the people of Escambia/Santa Rosa County. To further our mission and build on the loyal support of our members, the Board of Directors approved the formation of The 1873 Society, a special recognition opportunity to formally honor physicians who contribute to our organization and have demonstrated a long-term commitment to the quality of health care and well-being of our community.

As a member of The 1873 Society your good name as a physician will be honored in our community forever – entwined with the good works of the medical society in a cherished legacy.

Membership in The 1873 Society is for physicians who have chosen to pledge $3,000 to Escambia County Medical Society Foundation, Inc. This can be accomplished through a single gift or a recurring gift of $1,000 over three years, THREE IN THREE! The 1873 Society members are recognized and awarded with their names permanently engraved on a traveling Wall of Honor to be displayed in the ECMS office and at ECMS and ECMSF events.

THE 1873 SOCIETY MEMBERS The individuals listed below are both founding members as well as others who have joined The 1873 Society since its founding.

We thank you for joining their distinguished ranks.

Joanne Bujnoski, D.O.

Jennifer Miley, M.D.

Robert Sackheim, M.D.

Kurt Krueger, M.D.

Jack Kotlarz, M.D.

Michelle Brandhorst, M.D.

Ken Long, M.D.

Hillary Hultstrand, M.D.

Steve Ziller, M.D.

Ellen W. McKnight, M.D.

Brett Parra, M.D.

Who is the Escambia County Medical Society Foundation?

The Escambia County Medical Society Foundation is a non-profit organization dedicated to providing healthcare services on a volunteer and funding basis through its members. The Foundation was created in 1994. The primary goal is to assure access to adequate healthcare for the medically indigent citizens of the area, to study and promote improved methods and facilities for healthcare, to pursue the protection of public health, implement the means of financing healthcare at reasonable costs to cooperate with other organizations and institutions interested in pursuing these goals, and disseminate information concerning healthcare in general. Current Foundation programs include “We Care” and “Go Seniors!”

Contact the ECMS Foundation for more information | 850.478.0706 or info@escambiaCMS.org

ECMS | 14

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

the Community Community InInThe Ascension Sacred Heart Comprehensive Stroke Center Designation Ascension Sacred Heart Regional Stroke Center in Pensacola has received certification from DNV GL - Healthcare as a national Comprehensive Stroke Center, reflecting the highest level of competence in treating serious stroke events.

The DNV GL - Healthcare Comprehensive Stroke Center Certification is based on standards set by the Brain Attack Coalition and the American Stroke Association, and affirms that the Regional Stroke Center addresses the full spectrum of stroke care – diagnosis, treatment, rehabilitation and education – and establishes clear metrics to evaluate outcomes.

Dr. Terry Neill, Medical Director of Neurocritical Care, said this achievement has come through years of planning and tireless collaboration of numerous clinical service lines, administrators, and support staff members.

Podiatrist Dr. Matthew Cummins has joined Ascension Medical Group and will see patients in the DePaul building on the Pensacola campus.

He has a special interest in peripheral nerve surgery, orthoplastic limb preservation, deformity correction, limb arthroscopy, painful flatfoot and bunion correction.

Pediatric orthopedic surgeons Dr. John Killian and Dr. Sharon Mayberry have joined the pediatric specialist team of the Studer Family Children’s Hospital at Ascension Sacred Heart. They will see patients full time in the Children’s Hospital and in the outpatient Pediatric Specialist Tower on the Pensacola campus.

Both Dr. Killian and Dr. Mayberry are fellowship-trained and boardcertified in pediatric orthopedics.

Pediatric cardiologist Dr. Joseph Davenport has joined the faculty of the University of Florida College of Medicine, which is affiliated with the Studer Family Children’s Hospital at Ascension Sacred Heart. Dr. Davenport will see patients full time in the Children’s Hospital and in his new outpatient office on the Pensacola campus. Dr. Davenport is boardcertified and fellowship-trained in pediatric cardiology.

Dr. Sharon Guttmann, audiologist, joins the practice of pediatric ear, nose and throat specialist Dr. James Coticchia. She will see patients in the Children’s Hospital and the outpatient Pediatric Specialist Tower on the Pensacola campus.

Baptist Hospital Baptist Medical Group Welcomes Dr. Puente Jairo Puente, M.D., has joined Baptist Medical Group Family Medicine at Baptist Medical Park - Nine Mile. Dr. Puente is a board-certified family medicine physician who is fluent in Spanish. He earned his medical degree from Universidad Metropolitana in Barranquilla, Colombia and completed a residency at University of Texas Health Center in McAllen, Texas, where he was chief resident, family medicine. Dr. Puente welcomes new patients from children and teens to adults. More information is available at BaptistMedicalGroup.org.

Dr. Manis Joins Baptist Medical Group’s Senior Health Program Baptist Medical Group is pleased to welcome board-certified physician Peter M. Manis, M.D., FACEP, to its Senior Health program. Dr. Manis specializes in post-acute and long-term care for patients in rehab and nursing facility settings. He earned his medical degree from John Hopkins School of Medicine and completed his internship in internal medicine and a residency in ophthalmology from the Greater Baltimore Medical Center, both in Baltimore. More information about Dr. Manis and the Senior Health program is available at BaptistMedicalGroup.org.

Baptist Heart & Vascular Institute and Cardiology Consultants Open Brewton Clinic Baptist Heart & Vascular Institute and Cardiology Consultants have opened a new office in Brewton, Ala. located at 1121 Belleville Avenue. The new clinic provides greater access to BHVI services for residents of Brewton and the surrounding area.

Telehealth services are also offered. More information is available at eBaptistHealthCare.org/Heart or by calling 850.484.6500.

Baptist Takes a Safe, Careful and Compassionate Approach to Resuming Services With a continued diligent watch over COVID-19 developments, Baptist Health Care is resuming services, including elective surgeries, in a phased and structured approach to ensure the highest level of safety and care. Safety measures include ongoing adherence to all CDC guidelines and protocols, and state and federal safety requirements. More details are available at https:// www.ebaptisthealthcare.org/Health/safety-on-our-campuses.

Baptist Medical Group Family Medicine & WalkIn Care – Navarre Moves to New Location The office of Drs. Mark Benton and Joseph Foust at Baptist Medical Group Family Medicine & Walk-In Care – Navarre has moved to a new clinic in the Medical Office Building, Suite 106, at Baptist Medical Park – Navarre, 8880 Navarre Parkway. The phone number is 850.437.8800.

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

15 | ECMS

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