Orlando Medical News February 2021 by Orlando Medical News

FEBRUARY 2021

Proudly Serving Central Florida, North Central Florida & Volusia-Brevard

Itâ&#x20AC;&#x2122;s Heart Month! New Therapeutics for Some Heart Failure Patients

ACC Releases Latest Information on Treating HFrEF

6 PHYSICIAN || SPOTLIGHT TOTALLY AT HOME IN FLORIDA Adam Parker, DO Medical Director, Trinity Medical Group

VIEW FROM THE TOP

STAYING AHEAD IN HEALTHCARE: LOOKING FOR A PRACTICE PARTNER President of InnovaCare Health shares thoughts on navigating change

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FEBRUARY 2021

CONTENTS || FEATURES

Totally at Home in Florida Adam Parker, DO – Medical Director, Trinity Medical Group

PUBLISHER John Kelly jkelly@orlandomedicalnews.com

FEATURES

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COVER STORY It’s Heart Month! New Therapeutics for Some Heart Failure Patients

AD SALES John Kelly, 407-701-7424 ———————

EOCC MEDICAL CITY Resetting Our Leadership Pathway

EDITOR PL Jeter editor@orlandomedicalnews.com

PHYSICIAN SPOTLIGHT Totally at Home in Florida

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VIEW FROM THE TOP Staying Ahead in Healthcare: Looking for a Practice Partner. President of InnovaCare Health shares thoughts on navigating change

CREATIVE DIRECTOR Katy Barrett-Alley kbarrettalley@gmail.com ——————— CONTRIBUTING WRITERS April Boykin Brian C. Evander

Telescope Health Founder Dr. Matthew Rill Demonstrating Foresight, Nimbleness in Current Crisis

John Fogarty

Pandemic Fatigue: Its Real and Affecting Us All

Michael R. Lowe

OCR-HIPAA Right of Access Initiative

Meaghan Hislop

Sara D. McLaughlin Steve Melco Andrew Mintz Paula Wyatt

Your Reputation Precedes You

Are Your COVID-19 Disinfection Efforts Backfiring?

Dorothy Hardee

——————— UCF INTERN Brianna Kirby ——————— CIRCULATION jkelly@orlandomedicalnews.com

Safety Makes Even Stronger Demands on Construction During Pandemic

——————— All editorial submissions and press releases should be emailed to editor@orlandomedicalnews.com

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NORTH CENTRAL FLORIDA & VOLUSIA/BREVARD GRAND ROUNDS

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Orlando Medical News January 2021 is published monthly by K&J Kelly, LLC. ©2021 Orlando Medical News. All Rights Reserved. Reproduction in whole, or in part without written permission is prohibited. Orlando Medical News will assume no responsibility unsolicited materials.

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FEBRUARY 2021

A Deeper Dive

It’s Heart Month!

Fully explore the 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart

New Therapeutics for Some Heart Failure Patients

CLICK HERE TO DOWNLOAD THE PDF

ACC Releases Latest Information on Treating HFrEF Heart failure (HF) continues to rise alongside an aging population.

The TreatHF app is available through both the App Store for Apple and Google Play. There isalso a web version available through the American College of Cardiology site. For more information, go to the “Tools and Practice Support” tab on the ACC.org homepage and click on ‘Mobile and Web Apps’ to access this and other interactive tools.

versity School of Medicine in St. Louis. “One of the things we try to do with these expert consensus decision pathways is make them really practical for the frontline clinician.” The hands-on information and decision flow charts can easily be translated into machine language and imported into an electronic health record. There is also a downloadable TreatHF smartphone app that puts this latest information at a clinician’s fingertips.

The most recent statistical update from the American Heart Association notes: “An estimated 6.2 million American adults ≥20 years of age had HF between 2013 and 2016, compared with an estimated 5.7 million between 2009 and 2012.” The report added approximately half of hospitalized heart failure events are characterized by reduced ejection refraction (HFrEF). To optimize heart failure treatment, the American College of Cardiology (ACC), along with its partner the American Heart Association (AHA), published an in-depth heart failure clinical practice guideline in 2013 and produced a focused update four years later. However, since that last update, exciting new therapies for HFrEF have emerged. The ACC has just published the latest evidence-based update, including details on new drugs that have a clinically demonstrable impact on hospital readmissions, mortality and disease progression. Thomas M. Maddox, MD, MSc, FACC, chaired the writing committee for 2021 Update to the 2017 Expert Consensus Decision Pathway for Optimization of Heart Failure: Answers to Pivotal Issues About Heart Failure with Reduced Ejection Fraction. He recently sat down with Medical News to discuss the importance of ACC guidance and new opportunities to improve patient management.

New & Noteworthy Maddox said the new ECDP highlights the use of two newer therapeutics for HFrEF. “We are now recommending people use ARNIs, which are angiotensin receptor-neprilysin inhibitors,” he explained. “It’s a combination medicine of an ARB (angiotensin receptor blocker), which we’ve had for a long time, and a neprilysin inhibitor.” He said both molecules primarily exert their impact via relaxation of the relative blood pressure and improvement in the efficiency of cardiac function. “We learned that the combination of these two molecules reduced heart failure readmissions and morality by 20 percent compared to the ACE Inhibitors, which was the previous standard of care,” Maddox said of clinical trial results, adding the 20 percent reduction occurred in both outcomes. The second significant recommendation is to incorporate a sodium-glucose cotransporter-2 (SGLT2) inhibitor. “It’s a molecule that blocks the kidney from absorbing both sodium and glucose,” Maddox said. The mechanism behind SGLT2 inhibitors is that patients urinate out glucose and sodium, which is why this particular therapeutic got its start in the diabetic patient population. However, clinicians also observed better heart failure control in patients with both diabetes and heart failure. Since diuretics work much the same way, perhaps seeing some improvement in HFrEF control wasn’t completely surprising. The 2019 DAPA-HF (dapagliflozin) trial focused on the benefits of the SGLT2 inhibitor vs. placebo specifically for heart failure patients. “Only about half the patients (in the trial) had diabetes, but the group that didn’t have diabetes saw the same benefits,” said Maddox. “This drug works on heart failure regardless of your need to control glucose.” The cardiologist added, “In my mind now, this is more a heart failure drug than a diabetes drug.” In May 2020, the FDA approved dapagliflozin specifically for treatment of HFrEF. Barring a contraindication, Maddox said he couldn’t see a reason not to use a SGLT2 inhibitor in HFrEF patients. “We just have such good evidence on this,” he noted. Maddox added that if he had a new heart failure patient not already on a treatment regimen, in short order he would get them on a beta blocker, ARNI, aldo-

Keeping Current “The College is the largest professional society for cardiac care teams,” said Maddox, who is an incoming American College of Cardiology Trustee and chair of the Science and Quality Committee. “Part of our mission is to provide actionable knowledge and clinical guidance to those teams to optimize cardiac care.” He continued, “The centerpieces of our clinical guidance efforts are the clinical practice guidelines, and we produce those with the American Heart Association.” Maddox added the clinical practice guidelines are major undertakings with enormous literature reviews that typically come out every four to five years. “But four or five years is a long time … so we issue interim clinical guidance, such as expert consensus decision pathways, to bridge the gap between guidelines.” The ACC has made “actionable knowledge” a priority with an emphasis on presenting guidance in a way that is easier to read, share, update and integrate into clinical practice. This clinical guidance is organized into solution sets, which bring together related activities around a specific cardiovascular condition, such as heart failure. Solutions sets include policy updates, decision support and mobile apps. Another key component of these sets are expert consensus decision pathways (ECDPs) like the one just released for HFrEF. “The last five years has seen an explosion of new pharmaceutical targets for heart failure, which is great but dizzying if you’re trying to quarterback a patient’s care,” said Maddox, who is a professor of medicine and executive director of the Healthcare Innovation Lab, a joint effort of BJC HealthCare and Washington Uni-

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FEBRUARY 2021

sterone antagonist and a SGLT2. The new ECDP also provides guidance on 10 critical issues from how to initiate, add or switch to new evidence-based therapies for HFrEF and how to address challenges of care coordination to ways to improve medication adherence and how to help patients with cost and access to medications. Maddox said the high price tag on newer therapies remains an initial barrier for many patients. However, he added, “There’s a variety of strategies now to try to knock those costs down.” From apps like GoodRx to financial assistance programs from manufacturers, there are a number of routes for physicians and patients to explore to ensure everyone has access to the best care. Maddox noted this ECDP “does not supersede or take away from the clinical practice guidelines but is a bridge between guideline updates. As part of the College’s mission to transform cardiovascular care and improve heart health, we need to provide the best clinical guidance possible as ongoing evidence evolves.”

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CALENDAR: EOCC Virtual Office Hours MONDAY FROM 9:00 – 10:00 AM Got questions? Need help? Sign up & Sign in! We’ve got you covered

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Resetting Our Leadership Pathway

Testimonial Tuesday

BY DOROTHY HARDEE, CHAMBER ADMINISTRATOR

TUESDAY, FEB 9 - 9:00 – 1:00 PM (2nd Tuesday of the month) East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828 Sponsorships Available (2-3 doz. Donuts)

Member Academy WEDNESDAY, FEB 10 - 8:30 AM – 10:30 AM Hybrid Event - East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828

Healthcare Council Collaborative Virtual Meet, Greet & Panel Discussion THURSDAY, FEB 11 - 7:45 AM – 9:00 AM 3 Things You Should Know: Telehealth Telemedicine for Doctors. Powered by Powernet

EOCC Spark 365 Brain Trust Follow Up THURSDAY, FEB 11 - 9:15 – 10:45 AM East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828 Member Exclusive with Limited space

The Real Scoop on the 2021 Tax Laws with Kurt Alter (Hybrid Event) TUESDAY, FEB 16 - 8:30 – 9:30 AM East Orlando Chamber office (or Virtually) 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828 Space is limited. FREE for EOCC Members $10 for Non-Members

EOCC Spark 365 Brain Trust – After Hours TUESDAY, FEB 16 - 4:00 – 5:30 PM East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828 Member Exclusive with Limited space

Coffee Club Nona Live & In-Person THURSDAY, FEB 18 - 8:30 – 9:30 AM (3rd Thursday of the month) Wendy Brandon, UCF Lake Nona Medical Center CEO Sam’s Club Lake Nona 11920 Narcoossee Road, Orlando, FL 32832 FREE to EOCC Members | $10 for Non-Members

Be Our Guest - #Buzz4Biz – Meet & Greet for Chamber Curiosity Seekers TUESDAY, FEB 23 - 8:30 – 9:30 AM Considering Chamber Membership? Looking for unique value? Ready to Invest in YOUR business? Join us for an enlightening opportunity to hear from other business professionals like yourself! Arthur Murray Dance Studio Waterford Lakes. FREE to Non-members interested in Membership but still on the fence

Testimonial Tuesday on Location TUESDAY, FEB 23 - 11:00 – 11:30 AM Little Greek Fresh Grill Waterford Lakes Live on Facebook

Misters & Sisters Great Lunch Adventures – Little Greek Fresh Grill Waterford Lakes TUESDAY, FEB 23 - 11:30 AM – 12:30 PM Little Greek Fresh Grill Waterford Lakes 855 N Alafaya Trail, Orlando, FL 32828

EOCC Spark 365 Brain THURSDAY, FEB 25 - 8:00 – 9:30 AM East Orlando Chamber office 12301 Lake Underhill Road, Ste. 245, Orlando, FL 32828 Member Exclusive with Limited space

Please visit EOCC.org for a complete listing of February events

It comes as no surprise that 2020 was a tumultuous year requiring businesses to shift normal operating procedures to adjust to an ever-changing environment, courtesy of the global pandemic. While this caused heartburn for most of us, it also forced us to analyze our business models considering new possibilities in more efficient, effective operations. William Stafford said, “There’s a thread you follow. It goes among things that change. People wonder about what you are pursuing. You have to explain about the thread. But it is hard for others to see. While you hold it, you can’t get lost. Tragedies happen; people get hurt or die; and you suffer and get old. Nothing you do can stop time’s unfolding. You don’t ever let go of the thread.” When we examine our goals, objectives, and organizational vision along with threading these together with long range planning through our leadership pathway, success may be on the horizon. Effective board leadership is critical to an organization, furthering the mission, helping to adapt during changing circumstances, responding to crisis, identifying opportunities for growth and change, as well as creating future leaders. They are champions serving as the “quarterback” for companies. It is important that each member has a clear purpose to elevate the organization working together with staff. The East Orlando Chamber is fortunate to have this level of leadership in our 2021 Board of Directors; twenty-one passionate & committed visionaries, led by Martha Santoni, Government Relations Coordinator with Nemours Children’s Hospital. Martha is an experienced professional and community leader with an executive and entrepreneurial background. As a servant leader she empowers and uplifts directors, seeking to unlock their potential, creativity, and sense of purpose as a leader within the Chamber. “I am proud to lead a dynamic group of influencers and trailblazers in one of the most active, innovative Chambers in Central Florida”, say Martha. “I am thrilled with the many businesses and organizations, large and small, who tell us how greatly they have benefited from their membership. Connectivity, advocacy, service, economic development and an engaged membership are all the hallmarks of our organization.” Joining Martha in one of the “oldest established, but most original, creative thinking chambers around, celebrating 75 years” is her executive team, Immediate Past Chair, Karen Jensen, Vice President & COO, Orlando Health; Vanessa Bershad, Executive Director Market and Business Development at AdventHealth; Corie Comer, Vice President Business Relationship Bank at Florida Capital Bank; Jennifer Englert, Managing Partner at The Orlando Law Group and Don Whyte, Vice President Planning at Deseret Cattle and Citrus. Our 2021 Board of Directors also includes: Jessi Blakely, Tavistock Development Company; Barbara Bombalier, WELBRO Building Corporation; Evelyn Cardenas, Central Florida Auto Dealers Association, Inc.; Heather Frebe, Orlando VA Healthcare System; Joseph Genovesi, Orlando Lighting Systems; Eric Gray, Christian Service Center for Central

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Florida; Graciela Noriega Jacoby, Heart of United Way; Dr. Capildeo Jadonath, Orange Technical College; Fred Kittinger, University of Central Florida; Roger Lear, OrlandoJobs.com; Lora Miller, CHEP North America – CHEP Cares Foundation; Wanda Parisi, Embroidery Plus Promotions, Inc.; Sabrina Persaud, Nadini Printing & Marketing; Brenda Sanabria, Hampton Inn & Suites UCF and Ray Villegas, CareerSource Central Florida. The East Orlando Chamber is here to help with unique offerings to help elevate your businesses visibility and connect you with others helping your business thrive. Testimonial Tuesday features our members on a live broadcast allowing them to share personal and professional information with listeners. The Member Academy shows new members how to use the valuable resources provided with hands-on training to jump start their chamber journey. Taking it one step further is our newest offering, the EOCC Spark 365 Brain Trust, an intimate meeting of the minds helping to decode problems, design solutions and offer leads members desire. Our recent attendee, Craig Accardo with Elevate Medical Resources said, “Thanks for arranging this SPARK, we definitely benefited from this morning!” Anthony DeMeis and Adrian Hernandez with D65 Next Level Baseball shared, “Tremendous job this morning…!  Thank you for your excellent organization, planning, execution and leading the Spark meeting. Adrian and I found significant value in

CONTINUED P.6

PHYSICIAN || SPOTLIGHT PRESENTED BY

Totally at Home in Florida Adam Parker, DO – Medical Director, Trinity Medical Group said. “Being trained in manipulation is something that has helped me be well-rounded in my craft and serve our area more holistically.” Lifelong learning has also been an important part of Parker’s path. In addition to being a member of the American Osteopathic Association (AOA) and the American Academy of Family Physicians (AAFP), he has relationships with local hospitals, Lakeland Regional and Bartow Regional Hospitals. Working with multiple teams in a variety of settings has helped him sharpen his skills, better understand the needs of his community and continually grow as a physician.

Adam Parker, DO, has always been interested in helping and healing people. Growing up around a family friend who was a Doctor of Osteopathic Medicine (DO) helped him see a model physician in-action and when a motor vehicle accident gave him perspective as a patient, he was even more interested in becoming a doctor. But, of importance, he knew that he wanted his efforts and impact to be felt nearby: at home in Florida. Medicine hooked him as a career path and Florida helped him establish a career. Today, as a board-certified physician in Florida and the Medical Director of Trinity Medical Group, Parker has a deep affection for the Sunshine State. He is a Lakeland native and a graduate of the University of Florida. Though he earned his medical degree from Philadelphia College of Osteopathic Medicine, he eventually found his way home to complete his residency in Orlando at Florida Hospital East. Dr. Parker’s close ties to Florida has driven a devotion to the preservation of the area’s local healthcare.

Practicing at Home Base At Trinity, Parker has a role to play in fostering a strong sense of culture and collaboration amongst his teams. In addition to overseeing the care provided by the practice and broadly leading team members, he is responsible for treating patients and generating continuity in their care. This helps patients feel a sense of consistency no matter what provider or team member is treating them, and regardless of the Trinity location they visit. Generating a support network, atmosphere rooted in ongoing education and bold spirit of collaboration has helped build the sense of stability and community for which Trinity is known, both internally and externally in Central Florida. Building and maintaining community is critical for any medical practice, since the doctor-patient relationship is founded upon integrity, trust, and honesty. Parker maintains a responsibility to preserve that in his work, each and every day, and help colleagues do the same.

Treating the Whole Person In terms of specialty, Parker originally pursued osteopathic medicine as a mechanism to serve his patients, but that choice has also ended up serving him well personally. The license offers the comprehensive fouryear medical-school training of an MD coupled with the additional skill of osteopathic manipulative medicine and techniques. These techniques have been shown to improve treatment results when used in conjunction with traditional surgery and prescriptions. “I knew that the training to become an osteopath would be extra work, but also of tremendous value to my patients,” he

CONTINUED ...

Resetting Our Leadership Pathway participating in the gathering and look very much forward to future Spark events!  We commit to following up on our actionable items in the next 48 hours everyone. We look forward to learning from you all and contributing to your success in the coming months and years!” Dr. Colin Bartoe with Functional Neurology Chiropractic Center added, “Agreed, Anthony! That was a great meeting and I gained so much insight from it. I too will be working on my action steps promptly and hope to continue finding ideas for the rest of our cohorts.”  Ready to take the leap in a Chamber that thinks differently for their members? Give us a call at (407) 2775951 or visit our website at eocc.org.  The East Orlando Chamber of Commerce everywhere East of I-4.

Dorothy Hardee is the Administrator of the East Orlando Chamber of Commerce

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The Critical Nature of Managed Care Medicine Managed care medicine is another aspect for which Parker is passionate and what makes his locally-driven care effective. Clinics, like Trinity, that practice this variety of healthcare enable patient-centric care and the “VIP” treatment, which allows them to spend more time with patients and focus on the quality of the care provided rather than the quantity of patients who come through a center’s doors. This idea coupled with the national support of Trinity’s practice management partner, InnovaCare Partners, has helped make the concept a reality. “We hone in on each of the individuals we see and often take more of their care in-house than refer them to specialists,” he said. “This results in both convenience and cost savings for our patients, a win-win.” Ultimately, Parker and his teammates know that the success or failure of their work comes down to the patient experience, and that’s something upon which he has a profound impact at the local level. Patients travel to central Florida from other parts of the state just to receive the customized, personalized care from the hometown doctors they know and trust, like Parker. “I love being able to help people and educate patients about the intricacies of their health. The deal is sweetened knowing that these people are my friends, my neighbors, the people I see at the gym, my bank tellers, my family,” he said. “I have the best job on the planet because I have the ability to help my fellow community members when they’re truly in need. That’s tremendously rewarding.”

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Staying Ahead in Healthcare: Looking for a Practice Partner

President of InnovaCare Health’s Florida market shares thoughts on navigating change BY ANDREW MINTZ

• Expanded access to technology to support better outcomes. There is no shortage of new technology in the healthcare space that has the potential to improve both the patient experience and contribute to better outcomes. For example, telemonitoring systems can keep PCPs connected to high-risk patients, maintaining open lines of communication and empowering providers with the information they need to intervene quickly and course correct before their patients’ health declines. There is also a critical patient education component that comes along with new technology, especially among the senior population. Working with an experienced partner, providers and their patients can access new technology and tools that have the potential to lead to better outcomes and the best practices needed to encourage adoption.

The healthcare industry is constantly evolving. That’s always been true, but it has been especially true over the past year as the COVID-19 pandemic has illuminated challenges and shortcomings in just about every facet of the industry – from supply chain to healthcare inequities and access and affordability. Historically, providers have carried the burden of an ever-changing landscape. Even before the pandemic our doctors were being asked to do more with less – adapting to challenges brought on by changing reimbursement models, the emergence of new technologies and treatments and more. The pressure to innovate and keep pace with where healthcare is going is only increasing. Patient expectations are changing, too. Experience, access, technology, convenience and affordability are top-of-mind when choosing a healthcare provider, and with more choices than ever before, it’s not enough to simply provide good healthcare. These are complex challenges for any healthcare provider to solve, especially an independent physician practice already tasked with effectively running a business while working to maintain the experience and quality today’s healthcare consumers expect from their physician’s office. All providers want the best for their patients – that’s why they began practicing – but many are simply becoming overburdened. An increasing number of physicians are looking outside for solutions that meet their long-term needs as businessowners, as well as the needs of the patients they serve. Joining a network of physician practices united by a single purpose can empower physicians to keep pace with the industry, navigate the business of running a successful practice in the current environment, while also positioning them to make a bigger difference in the lives of the people they serve. It’s important to consider the potential patient and provider benefits of aligning with a larger, more established network of physician practices, including:

• An experienced partner in the shift to value-based care. Value-based models are better for the people who are delivering care and the people receiving care, but the transition from fee-for-service to value-based payment models can be an overwhelming feat to tackle alone. A strong partner can help successfully manage that transition by focusing on key areas like coding, HEDIS scores, medical management initiatives and more. • A shared commitment to the patient and provider experience – and best practices for meaningful improvement. Engaged, supported providers deliver a better patient experience. Focusing on key aspects of the provider experience can lead to higher retention, lower turnover rates and a stronger patient-provider relationship. At the same time, providers can take advantage of proven initiatives to create a better patient experience, including access to patient survey tools, training curriculum, evidence-based solutions to strengthen CAHPS scores and more. There isn’t a one-size-fits-all solution to meeting the increasing demands put on healthcare providers today, and it’s difficult to predict where the pressure points in healthcare will be in the next 10 or even five years. However, we know the pace at which the industry is changing will only continue to accelerate. Change can be difficult, but with a strong partner, facing the headwinds in healthcare doesn’t have to be unimaginable.

• A true partner with a proven infrastructure for practice administration and operations. A proven, but flexible model to practice management is key. Providers know their patients and their practice better than anyone else. A true partner will look to build on what’s working today while bringing resources, technology, capital and more to the table to capture new opportunities – like establishing a call center – and take the administrative burden off of the provider so that they can focus on building the patient-provider relationship.

Andrew Mintz serves as president of InnovaCare Health’s growing Florida market. Local members of the InnovaCare Partners physician network include Orlando Family Physicians and Trinity Medical Group. Visit InnovaCareHealth.com

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FEBRUARY 2021

Telescope Health Founder Dr. Matthew Rill Demonstrating Foresight, Nimbleness in Current Crisis BY JOHN FOGARTY

require an adjustment, they can have a telemedicine visit to inform the patient and call in new drugs and repeat. In the meantime, the patient doesn't have to travel to the office, and the doctor's staff can do the follow-up. Under Rill's leadership, Telescope Health and Emergency Resources Group will continue to be on the cutting edge of health care doing the best for their patients and the overall health systems. His team may be coming to Orlando in the future. The crisis has accelerated telemedicine's use by three to five years, including third-party payers' acceptance to begin paying. Telemedicine is also a much more costeffective method to treat non-emergency conditions reducing the cost from $1300 per visit to $69 for a onetime visit Telescope charges. Doctor Rill is CEO and Co-Founder of Telescope Health, a health care solutions company that initially began in May of 2019 with a telemedicine service. Since COVID, Telescope Health has evolved to become a key provider for COVID-19 services for the Northeast Florida community, including telemedicine patient visits and consultations, COVID testing, and safe event services. “Telescope Health has been on the frontlines of coronavirus response since before the virus entered the U.S.,” said Rill. “We’ve had many resources at our disposal—including our emergency physicians from ERG—that were deployed to support Jacksonville’s

Prior to the Coronavirus spreading into the U.S., Telescope Health leadership, Dr. Matthew Rill and co-founder Dr. Matt Thompson, understood the potential risk of overextension of services across Emergency Departments as patients looked for testing and medical care. Working with the City of Jacksonville, they set up a testing site in less than three days to reduce the emergency rooms' load. In the early spring of 2020, people feared coming to emergency rooms and doctors' offices. The result was an increase in the demand for telemedicine. The demand went from ten patients a day to over three hundred a day. Fortunately, during that same time, the demand in the emergency rooms fell to about 40 percent. Since Telescope Health and Emergency Resources Group are led by Rill, they can shift resources from the emergency room (ERG) to Telemedicine through Telescope Health. Even before the COVID-19 crisis, Rill and his team realized the model that medicine was operating in wasn't working. As a result of the ACA, the move from fee-forservice health care to value-based reimbursement has accelerated. Recognizing that the change was necessary, Telescope Health launched its telemedicine program. Rill’s vision of using the emergency room staff from the Emergency Resources Group gives them an advantage over others without the Emergency room experience. Telescope Health providers are accustomed to dealing with emergencies, even if the patient has an emergency that telemedicine cannot handle. They can direct the patient to the correct facilities that can handle the issue. They also can contact the facilities they are en route to, and they are familiar with key things the treating physicians in the emergency room needs and wants to know. In addition to those cases that don't need emergency care but may require follow-up with a specialist, the staff’s expertise acts as the correct specialist's connector. That is part of what every emergency room doctor and staff do—connect the patient with the next level of care. Rill’s future vision includes even more technology and a different approach to delivering medical services. He sees that remote patient monitoring (RPM) will have a crucial role in telemedicine moving forward. Combined with chronic care management, RPM will help improve patients' overall care with two or more chronic conditions by ensuring they are following their care plans between office visits and giving the care team access to vital information. Another use of telemedicine would be the follow-up visit. For example, if a patient is diagnosed with hypertension during his annual visit, the doctor will prescribe medicine and an RPM blood pressure measuring device. After monitoring the pressure for several days, the care staff can review the measurements and decide if the medications need to be adjusted. If no adjustment is necessary, they can communicate with the patient and repeat the check-in for two weeks. If the medicines

public health initiatives. As we watch our health care system evolve due to this virus, Telescope Health has seen areas of opportunity to improve care by working with hospitals, health systems and even businesses, and we’ve gladly expanded our service offerings.” Emergency Resources Group is based in Northeast Florida. ERG is an independent contractor of 225+ physicians and advanced practice clinicians, treating patients in 11 different clinical settings across 9 Northeast Florida hospitals and 2 Southeast Georgia hospitals. Dr. Rill is the CEO of ERG. John Fogarty is regional Developer for RX2Live. He has spent 21 years in nuclear generation, transmission and distribution. He holds a master’s in International Management. He became an RX2Live developer to improve patient care and help providers and practices succeed. Contact him at jfogarty@rx2live.com or visit www.rx2live.com.

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Exhausted? Distracted? Experiencing brain fog? Sad or lonely?

• Accept your feelings: Remember it is okay and normal not to feel great right now. Recognize how you are feeling, anxious? sad? frustrated? We all have times where things are tough or feel bad, and now may be one of those times. We have to learn to live with discomfort and know we will be okay.

A year into the pandemic and we are all frayed around the edges. Disconnected from our friends and families, skipping our traditional holiday practices, vacations on hold, and getting little quality downtime – our tried-and-true coping skills are just not available to us now. If you feel like you are on the verge of burnout, you are not alone. Pandemic Fatigue is real and is affecting us all. It is a state of physical, emotional, and psychological fatigue caused by the increased chronic stress of pandemic demands on individuals, families, businesses, and communities. For almost a year we in the healthcare industry have been hyper-vigilant creating new standards of care, caring for our patients in new ways, keeping our office and staff safe, and managing all the same adjustments for our families. Rarely do we live in shared circumstances with our patients like we are now, and that takes its toll on our mental, emotional, and physical wellbeing. We are overworked and pulled in so many directions, dealing with the most “basic-need” fears we all experience. As the Pandemic has continued the prolonged exposure has caused countless problems associated with all the things we have lost, given up, or changed.

• Positive self-talk: Remember to watch your thoughts, identify distorted or negative thoughts, and remind yourself “I’m okay, things will get better, I can handle this.” • Self-care is not an option - it is a necessity! If you have slacked off or never started, now is the time. Do something every day to take care of yourself-a walk, hot Epsom salt bath, stretching, meditation, etc. Do something to give back to yourself. • Meet your basic needs everyday: Now is the time to check back into Maslow’s hierarchy of needs and make sure you are meeting those basic physiological needs. Am I so busy I am forgetting to eat? Am I staying up late working and not getting enough rest? Am I not feeling safe? Am I isolated? Am I not finding satisfaction in the things I am getting done?

Recognize the signs Anxiety, depression, sadness, irritability, and changes in eating or sleeping are all symptoms of pandemic fatigue. However, the most common characteristic is feeling chronically worn out, and being excessively tired after an adequate night's sleep. Additionally, many people are feeling ineffective in their personal or professional life, feeling they can’t “get their bearings” in a new routine, feeling that they don’t recognize themselves or their behavior, and some are even feeling hopeless for the future. If you are sick and tired of worrying about COVID-19 you are likely suffering from Pandemic Fatigue.

Coping Skills Some of us started strong, making the most of the pandemic, adding in exercise, or working from home with a flexibility that allowed us to see our kids and animals all day. Others of us got pulled into the ever-rising demand of patient care and had no time for anything else. And still, others were thrown into the chaos of declining work with the goal to survive the financial changes. Wherever we started, we are not likely in the same place. Most of us have had to continue to adjust to the changing landscape with little guidance or support. So, it is time to reevaluate where you are and how you are caring for yourself, and to encourage others to do the same. • Give yourself grace and forgiveness: More than anything else, be kind and gentle to yourself and accept that you may not perform at your normal level, and ac-

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• Connect with others: Another area where many of us have dropped off our efforts is prioritizing connections. It is time to reconnect and make sure you are connecting by whatever means you can. You may schedule a regular Zoom happy hour, driveway dinners, exercise dates, or some other social distant activity. • Set attainable realistic goals: Many of us are having difficulties finishing, or even starting projects and tasks around the house or at work. Consider breaking the projects down into small tasks, creating short-term goals, and approaching them without judgment. • Take time off: Really use your PTO. Shut off the phone and email and check out from your daily stressors. Notice the urge to connect when you disconnect and remind yourself of the importance to recharge. • Do things that are healing: Hobbies such as reading, planting things, knitting, doing crafts, or cooking can all be self-soothing. Do something that is creative, distracting, and has nothing to do with the pandemic.

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OCR-HIPAA

Right of Access Initiative BY MICHAEL R. LOWE, BRIAN C. EVANDER AND SARA D. MCLAUGHLIN

reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding). In October of 2020, RPMG provided the patient all of the requested medical record information, excluding psychotherapy notes. RPMG agreed to take corrective action with two years of monitoring and pay a $25,000 fine. On November 12, 2020, the OCR sent out a press release regarding the settlement of the eleventh case. This case involved Dr. Rajendra Bhayani, who is a private practitioner specializing in otolaryngology in Regal Park, New York and a complaint the OCR received in September of 2018 from a patient alleging that Dr. Bhayani failed to provide the patient with access to the patient’s medical records. And after the OCR’s investigation, the complainant received a complete copy of the requested medical records in September 2020. In the settlement, Dr. Bhayani agreed to take corrective actions with a corrective action plan along with two years of monitoring and pay a $15,000 fine. In the press release, OCR Director Roger Severino stated, “Doctor’s offices, large and small, must provide patients their medical records in a timely fashion. We will continue to prioritize HIPAA Right of Access cases for enforcement until providers get the message.” On November 19, 2020, the OCR sent out a press re-

In early 2019, the Office for Civil Rights (OCR) commenced its Right of Access Initiative, an enforcement priority to support individuals’ right to timely access to their health records at a reasonable cost. This article is the first in a 2-part email blast series examining the implications and key takeaways from the OCR’s Right to Access Initiative. On September 9, 2019, the OCR sent out a press release that they settled the first case in Health Insurance Portability and Accountability Act (HIPAA) Right of Access Initiative. This settlement was with Bayfront Health St. Petersburg (Bayfront) in Florida and consisted of a $85,000 fine and a corrective action plan. This complaint was sent to OCR by a mother who Bayfront failed to provide timely access to medical records concerning her unborn child. The HIPAA access rule (45 CFR 164.524) generally requires covered entities to provide medical records requested by a patient within 30 days of the request and extends to parents requesting information about their minor children. Applicable Florida medical records laws generally require a “timely” response to a request for access or copies of records and medical information without defining a specific amount of time for a health care provider to respond and/or allow access. In the announcement, OCR Director Roger Severino stated, “Providing patients with their health information not only lowers costs and leads to better health outcomes, it’s the law.” Mr. Severino reiterated the promise to enforce compliance with these rules, asserting, “We aim to hold the health care industry accountable for ignoring peoples’ rights to access their medical records and those of their kids.” Since September 2019, the OCR has successfully settled fourteen (14) cases to date, with the five (5) most recent settlements taking place since November of 2020. On November 6, 2020, the OCR sent out a press release that they settled the tenth case. This settlement was with Riverside Psychiatric Medical Group (RPMG) based in Riverside, California. In March of 2019, OCR received a complaint from a patient alleging that RPMG failed to provide a copy of medical records despite multiple requests. According to the press statement, RPMG claimed that because the requested records included psychotherapy notes, they did not have to comply with the access request. While the HIPAA Rules do not require production of psychotherapy notes, they do require covered entities to provide: (1) requestors a written explanation when it denies any records request in whole or in part (which RPMG did not do), and (2) the individual access to his or her medical records other than psychotherapy notes (and information compiled in

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lease on the settlement regarding the twelfth case. This case involved the University of Cincinnati Medical Center, LLC (UCMC) and a patient complaint from May of 2019 alleging that UCMC failed to respond to a records access request directing UCMC to provide electronic health records to the patient’s attorney. In this case the OCR determined that UCMC failed to timely provide a copy of the requested medical records in potential violation of the HIPAA Rules, which include the right of patients to have electronic copies of records in an EHR transmitted directly to a third party. “OCR is committed to enforcing patients’ right to access their medical records, including the right to direct electronic copies to a third party of their choice. HIPAA covered entities should review their policies and training programs to ensure they know and can fulfill all their HIPAA obligations whenever a patient seeks access to his or her records,” said Roger Severino, OCR Director. UCMC has agreed to pay a $65,000 fine and undertake a corrective action plan that includes two years of monitoring. On December 22, 2020, the OCR sent out a press release on the recent settlement regarding the thirteenth case. This case involved Peter Wrobel, M.D., P.C.,

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Your Reputation Precedes You Four tips for Online Reputation Management BY PAULA WYATT

It is true in healthcare, in life, and in business that a milligram of prevention is worth a kilogram of cure.

What is Your Current Reputation Management Strategy? Investing time in conducting an Annual Reputation Refresh will polish all the “word-of-mouth” outlets floating around on the internet and ensure you are leading the online conversation “about YOU.” To get started, define your current growth strategy for your practice. Which are you?

In the healthcare industry, more so than in most others, your reputation does in fact precede you — it defines you. As a physician your reputation is built not only on the positive outcomes you provide for your patients but also on the strength of the bonds you build with patients through positive experiences, and then through their enthusiasm to share their experience, whether it be perceived as positive or negative. Your reputation is further illustrated through the dynamics of your staff, your alliances with referring physicians, and your reputation among other health-care industry professionals. The term “word of mouth” was coined before we had keyboards. Now, it is easier than ever, with the “stroke of a key,” to praise or hurt a physician’s reputation. Everyone gets to vote. In comparing a one-star “my pasta was cold” review that a restaurant might receive to a one-star “this doctor and his entire office are incompetent” review a medical practice might receive, it is clear that both reviews take about the same amount of time to create but have vastly different impacts. This is great news — if you choose to leverage this opportunity to grow your practice. Elevating your online footprint (reputation) is a central part of a comprehensive medical marketing and communication strategy (MCS). Your MCS defines and illustrates your values and commitments to your patients, your practice, and your team, and it establishes a plan (tactics, timelines, and processes outlining how you are elevating your unique specialties and distinctive approaches to enforce your reputation among your patients, your potential patients, and your health-care peers and affiliates). Within the combination of tactics are some that you can control (such as website, social media, email marketing, and outreach efforts) and some that you cannot (such as word of mouth and online reviews). A strong MCS helps you and your staff excel in the things you can control and manage well the things you cannot. If you do not currently have an MCS fueling the growth and ensuring the harmony of your practice, you are not alone. In my experience working with physicians to grow their practices, I would say less than 20 percent have an MCS, and of those who do not, most are not even considering it, which makes having an MCS a clear competitive advantage. Developing a strong MCS is quite an undertaking. It involves integrating long-term financial goals with situational analysis, understanding your patient profiles, evaluating referral paths, and developing your “products” (procedures, treatments, and specialties) as well as tying it all together with an ROI reporting mechanism. If you are like almost every physician I know, you are busy—so I am offering you an effective, inexpensive FIRST STEP.

• My strategy is that patients will find me because I am a qualified physician. I am busy with patients. I do not have time for anything else. • I usually have some people in my office who, when they are not doing their main job, can post on our Facebook page. We try to respond to negative reviews if we see them. • I have a dedicated marketing and communication professional (either an employee or a marketing contractor) who manages the reputation and branding strategy that fuels the growth of my practice.

How to Conduct an Annual Reputation Refresh • Who: Confirm who will be the author of the plan; it can be you, an employee, or a contractor. • When: If you are doing it yourself, plan a weekend in front of your computer to complete 90 percent of it. • How: Start with a blank document in your favorite font, size 10, and double spaced — your logo is the cover page. Then, scan this QR code for an easy-to-follow process.

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Step One | Storytelling • Clear your Google browsing data, and then search (your name and your practice) 10 pages deep on Google. Remember to search Google images, videos, and news. • Copy links of all the places you appear. • Create or refresh the story of your practice (300 or fewer words). • Create or refresh short and engaging bios for yourself (and all physicians in your practice). • Refresh your headshots, group shots, and casual images, for website and social media. • Integrate affiliations, such as hospitals, universities, and medical organizations. • Integrate charitable causes that pertain to your areas of expertise.

Step Two | Physician Review Sites • Of the many physician review sites, I suggest owning at least the top five (Vitals, Healthgrades, ZOCDOC, RateMDs, and doctor.com). Depending on the site, you can establish a free account. You may also consider the benefits of paid membership on a few. • View each referral source, and update image, bio, links, hours, and information. • Create a monitoring schedule and a reporting mechanism. • Address negative reviews with the patient directly.

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OCR-HIPAA Right of Access Initiative

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Your Reputation Precedes You

Pandemic Fatigue

d/b/a, Elite Primary Care (Elite), providing primary care services in Georgia and a complaint by a patient claiming that Elite failed to respond to request for access to the patient’s medical records. Elite has greed to pay a $36,000 fine and undertake a corrective action plan including two years of monitoring. Finally, on January 12, 2021, the OCR sent out a press release on the most recent settlement to date regarding the fourteenth case. The case involved Banner Health, a nonprofit health system based in Phoenix, AZ that operates 30 hospitals and numerous other health care facilities, and two (2) separate complaints to the OCR from individuals alleging Banner Health affiliated entities failed to provide timely access to their medical records. Ultimately, Banner Health settled and will pay $200,000 to resolve potential violations and undertake a corrective action plan that includes two years of monitoring. In the press release, OCR Director Roger Severino ominously stated, “This first resolution of the year signals that our Right of Access Initiative is still going strong and that providers of all sizes need to respect the right of patients to have timely access to their medical records.” Health care providers routinely receive requests for medical records and other records. Reviewing and responding to those requests can be time consuming and administratively burdensome. However, putting in place policies and procedures, developing template forms for intake and response, and assigning responsibility and training regarding answering medical records requests are successful tools in minimizing the risk of an OCR enforcement action. In short, Covered Entities should be ready for the Right of Access Initiative by reviewing their policies and practices to ensure that they timely respond to patient requests for access to medical records in compliance with HIPAA rules. Health care providers should also be aware of State (in this case Florida) law in this area, which may impose additional or more strict obligations that are not preempted by HIPAA. In the event that the State law grants greater rights to patients, for example, the State law requires a response to request for records in a shorter timeframe than HIPAA, then the State law must be followed. The Healthcare Team at Lowe & Evander, P.A. understands the hard work and sacrifices it takes to become a health professional or provider and aggressively defends health professionals regarding protecting their license, practice, career, assets and reputation. Using our experience and expertise, we navigate the obstacles our clients face, serving not only as their attorneys, but also as their legal strategists, trusted advisors and protectors of their rights and interest against government investigations and lawsuits when necessary, and we help chart a course through the maze of state and federal health care laws, rules and regulations. Look for our next installment in this series shortly!

• Turn off the news: News stories can be alarming and can create anxiety and fear in your conscious and unconscious mind. These stories draw you in, and you can get stuck watching them for hours without realizing the emotional effect. • Stay away from Social Media: There is nothing worse than opening Facebook and realizing you have been scrolling for an hour without awareness of the time - it is called the death scroll. Set limits on your phone or unplug from social media all together. • Stress Management: Don’t wait until the end of the day, or the end of the week to discharge stress. Incorporate stress management techniques throughout the day whenever you feel tension. Gentle breaths, yoga poses, or laughing, are just a few. • Routines: When everything feels out of control, one of the quickest ways to feel back in control is to create a routine. Consider a pandemic routine that includes multiple aspects of self-care. • Get Help: Mental health counseling is a great option to help ourselves, our families and patients get through this difficult time. Pandemic fatigue is REAL. Identifying your thoughts and reactions is an important first step. Do you feel like you ‘are just not yourself?’ Do you feel that your old tools and techniques are not working? Do you feel that you are reacting to things you wouldn’t have previously reacted to? If so, it is important to STOP, listen to yourself, and implement consistent daily self-care tools needed to facilitate your personal wellness, both for yourself, and for those you care for. April Boykin is a Licensed Clinical Social Worker and cofounder of Counseling Resource Services (CRS). Established in 2013, CRS is a community-based in-home integrated behavioral health agency serving the aged and disabled population in Central Florida. As a mental health counselor, she has provided individual, family and caregiver counseling to children, teens and adults. She can be reached at april@counselingresourceservices.com

Michael R. Lowe, Esquire is a Florida board-certified health law attorney at Lowe & Evander, P.A. Brian C. Evander , Esquire and Mr. Lowe regularly represent providers, physicians and other licensed health care professionals, and facilities in a wide variety of health care law matters. For more information regarding those health care law and such matters please visit our website www.lowehealthlaw.com or call our office at (407) 332-6353. The information provided in this article does not, and is not intended to, constitute legal advice; instead, all information and content in this article are intended to convey general informational only and may not constitute the most up-to-date legal or other information. Readers of this article should contact their attorney to obtain advice with respect to any particular legal matter. No reader of this article should act or refrain from acting on the basis of information in this article without first seeking legal advice from counsel in the relevant jurisdiction. Only your individual attorney can provide assurances that the information contained herein – and your interpretation of it – is applicable or appropriate to your particular situation.

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• Address erroneous reviews left by someone other than a patient or for another physician (by mistake) with the physician review site (the appeal process takes a while but stay with it).

Step Three | Google Listing • Take ownership of your Google Business Page (GBP) and map listing for all your locations and for each physician. • Make a list of your top 50 key search terms. • Monitor Google Reviews. • Create a Google QR Review Campaign offering patients a link at checkout.

Step Four | Aligning Social Media • Ensure your social “about” sections are enforcing the same story you are sharing on your website. • Update your profiles, images, hours, and links. • Eliminate those you do not use. It is best to focus on doing one or two well, rather than trying to keep up with all of them. • Check the status of your business and personal accounts. • Build a content calendar that plans your key topics for the year.

So, there you go! These are the four steps to conducting your Annual Reputation Refresh. Remember to assign someone to monitor it throughout the year on a schedule that makes sense for you. If you are managing it yourself, maybe you monitor it annually. If you have a staff member managing it, try for monthly or quarterly. And, if you hire a contractor, they should be looking at it daily. Paula Wyatt is excited about helping you grow your medical practice through the development of impactful Marketing and Communication Strategies. Paula is a native Floridian, passionate about Orlando. Living up to her title as Chief Excitement Officer at Anything is Posh Able, she runs a boutique Image Building and Event Planning firm. She is the founder of a nonprofit organization called Posh Abilities, providing free event planning and image-building services to Central Florida nonprofit organizations. Email her at paula@anythingisposhable.com

Are Your COVID-19 Disinfection Efforts Backfiring? BY MEAGHAN HISLOP

sterilization, has indeed been successfully killed. Unfortunately, if you’re using an electrostatic or other disinfection surface spray, it is difficult to know or measure quality control—it’s basically “spray and pray” that it kills what and where you think it does. Additionally, if you can’t use a biological indicator with your UV light, how do you know it worked?

Your current COVID-19 disinfecting practices may be making things worse, even if you think you’re doing everything “right.”

• Understand the potential dangers. Many commercial solutions on the market today have been proven to leave behind dangerous, toxic residues that collect grime and cause corrosion to surfaces, materials, and electronics and have been linked to neurotoxicity, allergies and anti-microbial resistance in humans. According to the American Lung Association, exposure to chemicals from cleaning supplies has been linked to occupational asthma and other respiratory illnesses. The safest and most reliable systems use smart technology that enables remote manual operation without ever coming into contact with dangerous germs or harmful chemicals.

If you’re adhering to your organization’s best practices for regularly wiping down every surface with an EPA-approved COVID-19 disinfectant, using UV lights, or even using some commercial spraying systems to disperse chemicals, then you may believe you’re doing all you can to help combat the spread of COVID-19. However, well-established research tells us those efforts may actually be making things worse, by increasing the chances for bacteria to grow and spread and eventually become resistant to our current disinfectant methods. According to a study from the National Institutes of Health, CDC, UCLA, and Princeton University scientists in The New England Journal of Medicine, the virus that causes COVID-19 (SARS-CoV-2) can persist for up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. These results suggest that people may acquire the virus after touching contaminated objects. Some bacteria, including E. coli and MRSA, can survive for several months on inanimate surfaces, while infectious yeasts, including candida, can last for weeks. This underscores the importance not only of regular disinfection, but also of getting those disinfection techniques correct. While most healthcare practitioners and facility staff understand the importance of regular cleaning and disinfection for infection control, many are using products without understanding how they are meant to be used, and not achieving an optimal kill. For instance, a product may boast a 99.999% kill but not explain that this requires following very strict usage guidelines. Many are fooled by “magic marketing” which claims they can achieve wonders with a product, leaving out the details of what it takes for those marketing headlines to be achieved. So how do you know your cleaning and disinfecting methods are truly effective and aren’t just making things worse? Here are some guidelines that will help:

• Know the 9’s in your disinfectant (99.9% to 99.9999%). Many of the most commonly used cleaning methods approved for COVID-19, including ammonium chloride mixtures commonly found in disinfectant wipes, sprays and other household and commercial cleaners, only kill 99.9% of germs. We say “only” because this means they can leave up to 1,000 harmful organisms behind in any one spot, including those that have the potential to create germ breeding grounds. The most effective disinfection solutions achieve a 99.9999% kill rate, or log reduction, which refers to the number of living microbes that are virtually eliminated by disinfection. • Switch it up. The Center for Disease Control recommends alternating disinfectants to prevent organisms from developing resistance. Similar to preventing antibiotic resistance in people, bringing in a new disinfecting product can keep the pathogens guessing and be the strong arm needed to combat the spread of pathogens on environmental surfaces.

The bottom line is that using the right disinfection techniques and products is clearly critical. There’s much evidence to show that the risk of secondary infections due to bacteria picked up by patients in hospitals is considerable. A study in The Lancet of two hospitals in China showed that 50% of patients who died in their care from COVID-19 were also infected with another pathogen. The CDC recently highlighted a case report

• Lower your risk of human error. Make sure you read and fully understand how to properly use disinfecting tools. For example, a UV light might need 8 inches of proximity to the target surface to achieve its strongest kill, otherwise, you might be leaving behind a lot more germs than you think. If a spray product needs to be manually applied, it can pose a risk of human error. Surface areas can be missed, required dwell times can be ignored or unknown, and unwiped residues can build up and cause areas for bacteria to grow. • Remember: If it’s sticky, it’s tricky. How many times have you wiped a surface with a disinfectant cleaner and felt or seen a sticky, tacky residue? If you’re like most observant people, probably often. Aside from potentially causing corrosion to many surfaces and equipment, this stickiness may create a germ reservoir where bacteria and other organisms remain and even thrive. When you use a cleaning cloth to wipe off a sticky disinfectant chemical, you may be inadvertently moving germs from one surface to another because of those very same adhesive qualities of the disinfecting agent. • Prove you’re killing something. The best disinfection methods should include biological indicators that are placed in the area to show that a hard-to-kill organism, like what is used in proving

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from the Florida Department of Health showing 35 of 67 patients admitted to a facility for COVID-19 were also colonized with the multi-drug resistant yeast, Candida auris, over a two-week period. It’s important to note that there are products on the market today that exhibit absolutely no known pathogen resistance, such as oxidative products, where organisms haven’t figured out how to evolve and adapt to them yet. Hydrogen peroxide disinfection, as an oxidizer, is among the best options for facilities to overcome the risk of pathogen resistance on environmental surfaces. Pathogens will always be in our environment, but fortunately we are getting smarter at understanding how to effectively kill them and stop the spread, so we can combat today’s outbreaks as well as be better prepared for future ones. Meaghan Hislop graduated with a degree in Biology from Roger Williams University in RI. With research experience in the Virgin Islands, Meaghan joined CURIS to lead their Science Team in 2019. She has developed decontamination protocols for N95 masks, studied efficacy in Life Science applications, analyzed disinfection protocols and feasibility for commercial applications, and implemented systematic testing to ensure CURIS continues to lead in high-level, consistent performance for all its products. Visit www.curissystem.com.

Safety Makes Even Stronger Demands on Construction During Pandemic BY STEVE MELCO

This prevents any possibility of potentially contaminated air, dust, or particles from reaching those occupying the space during the renovation. This method, in conjunction with other procedures, prevented any potential spread of the virus at their recent job site, a renovation for the Westminster Communities in Winter Park. Some of the procedures included: adherence to the facility’s requirements, limited work area access, air separation barriers, air movement equipment to isolate the work areas, masking of all personnel, hand washing stations, communication with facility personnel prior to entry of occupied areas, proper usage of PPE, sanitization of construction areas every morning, and communication with the facility to ensure updated procedures and processes. By implementing these procedures, the company was able to keep those working on the site and within the facility safe while maintaining the timeline and projected budget. “I must also commend WELBRO for their culture of safety,” said the associate executive director of Westminster Winter Park & Baldwin Park. “During the scope of our project, we had the additional layer of complexity brought on by the COVID-19 pandemic. It was clear their concern for the health and safety for all stakeholders involved was unwavering.” The construction industry has been ruled essential work and therefore it is paramount that companies within this industry follow procedures to prevent any potential spread of COVID-19. While following CDC guidelines is a solid starting point, it is critical that these

The impact of the COVID-19 pandemic has been felt throughout the construction industry. Projects have been canceled or delayed, supply chains have been interrupted, and working remotely has disrupted team communication in this highly collaborative business. Construction operations at the job site have experienced the most challenges – specifically, those in occupied facilities operating in the healthcare and senior living sectors where safety and wellbeing of the staff, patients, and residents is vital. Due to the inherent danger in the industry, safety is a top priority among most construction firms. However, when faced with a global crisis such as COVID-19, the construction industry had to adapt to an onset of changes and find new ways to operate safely. “The success of our company is built around its sound Safety Management Program which involves the participation and cooperation of all company personnel,” Ken Wuenschell, President of WELBRO says. “Our core values are the driver of the development and execution of the procedures and practices that create a safe and healthy work environment for all.” Depending on the site, the Site Manager will hold a safety meeting once-a-week to once-a-day to ensure the team is up to date on COVID-19 policies. Prior to anyone joining a job site, they must go through an orientation process covering both standard and COVID-19 safety procedures. This process is to be carried out by all employees assigned to the job site including any subcontractor or team member outside of the company assigned to the site as well. Kevin Boland, safety manager for WELBRO Building Corporation, said the company is following Occupational Safety and Health Administration (OSHA) and Center for Disease Control and Prevention (CDC) guidelines. This means regular hand washing at onsite handwashing stations, mask-wearing and social distancing practices are implemented and enforced throughout the company and large posters encouraging safety guidelines are displayed in central areas of the construction site. “We believe that through educating our workers and implementing the CDC guidelines that we can maintain the construction site as well as the safety of our workers,” said Boland. In addition to following these guidelines, they currently implement systems such as COVID tracing, scheduled shifts to assist with social distancing and negative air pressure for renovation projects. For renovation sites, where nursing staff and residents share the space as the construction crew, fire rated Edge Guard Barriers are placed as dividers. Any openings that aren’t blocked off by the barrier system, are secured using fire rated material to ensure the area is completely sealed off. To create negative air pressure, air scrubbers, similar to air purifiers, are used throughout the building to push the air from within the building to the outside. In addition, Dwyer Pressure Gages are used to monitor the air pressures for the site at all times to verify that the occupied side of the building has negative air pressure.

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groups take it a step further, especially while operating in highly sensitive areas such as the healthcare and senior living facilities. It is unclear as to when, or even if COVID-19 will soon cease to be a global battle. For now, maintaining and enforcing strict policies and procedures have proven to limit exposure and further spreading. As work returns to the construction industry, it can be assumed that these new safety measures must be adopted and adapted for the long-haul. Steve Melco joined WELBRO in 1994, with positions including Project Manager, Senior Preconstruction Manager, and Special Services Director. As Operations Manager, Steve will lead the effort to expand WELBRO’s portfolio in the assisted living and skilled nursing facility area, overseeing all projects in the Senior Living & Healthcare sector. WELBRO Building Corporation was founded in 1979. The company covers over a dozen markets such as healthcare and wellness, senior living, education, industrial, hospitality, and so much more. They offer a broad range of services to clients planning projects such as new construction, additions, and renovations, from preconstruction, consulting to design/build projects. Visit www.welbro.com

ORLANDO || GRAND ROUNDS

The Physicians Society of Central Florida Welcomes Dr. Charles Chase as President

New Interactive Dashboard Reveals Health Opportunities for Seminole County Residents A new dashboard, (https://dashboards.mysidewalk.com/ seminole-health/), designed by the Florida Department of Health in Seminole County and mySidewalk, gives Seminole residents insights into the social and economic drivers of health. At no time in recent history has attention to the root causes of health been so critical. The COVID-19 pandemic has shined a spotlight on public health; this comprehensive assessment takes the conversation beyond disease outcomes and explores the relationship between environments, behaviors, illness, and length of life.

The PSCF held the 2021 Virtual Annual Meeting on January 26th and welcomed Dr. Charles Chase as the 3rd President of the organization. Dr. Ryan Hall was recognized for his year of service to the PSCF in 2020 as was Dr. Darin Wolfe for his service as President of the PSCF Foundation over the past year. Dr. Cecil Wilson was presented with the Dr. James Wood Hicks Lifetime Achievement Award and honored for his years of service to the medical community. The PSCF also welcomed American Medical Association President, Susan R. Bailey, MD as a guest speaker as well as FMA President, Michael Patete, MD. Both shared what the state and national associations have done in response to the pandemic and plan to do moving forward as the vaccination campaign moves along. If you were unable to make the meeting, you can watch a copy of the recording by clicking below. View the Meeting

First Look At The Seminole County, Fl Community Health Dashboard This interactive dashboard gives the community access to health data indicators and allows residents to stay informed about what is happening in their county. Included are insights into social determinants of health, leading causes of death and disease, COVID-19 and other public health threats. The graphs and maps are available for public download, and all of the data is exportable in multiple formats. Some compelling findings include: 1. Seminole County is ranked 3rd out of 67 counties in Florida for Health Outcomes and 2nd for Health Factors.

Florida's VirtaMed Launches Surgical Gynecology Simulation Suite The need to learn surgical skills outside the clinical environment has never been greater: COVID-19 pandemic has reduced medical training opportunities in the traditional apprenticeship method, with fewer elective procedures and reduced access for residents to operating rooms. VirtaMed has the world leading validated simulator for hysteroscopy training, and an innovative solution for the acquisition of laparoscopic skills. Unique to VirtaMed’s Gynecological Laparoscopy simulator is the ability to correctly position the patient, surgeons and assistant for a gynecological procedure, and to appropriately place trocars. For the first time, this gives the gynecological trainee a simulation set up that reflects what they will encounter in the operating room, rather than inheriting positions derived from general surgery training. Laparoscopic procedures can be time consuming, and VirtaMed’s innovative approach uses task decomposition to teach key skills needed for ureter identification, tubal patency and ligation, and management of ectopic pregnancies. Organ-specific tissue feedback during tasks such as grasping and cutting, and accurate fluid simulation mirror a real-life experience, allowing for skill translation to the operating room. VirtaMed’s hysteroscopy training has been updated for 2021 to include 16 cases for MyoSure® tissue removal, added to over 50 cases in diagnostics, polypectomy, myomectomy, tissue ablation and advanced electrosurgical resection. All cases include competency-based objective feedback and a variety of pathologies with increasing procedural difficulty, including complication handling. VirtaMed believes combining the highlights of the new LaparoS with all the experience from GynoS Hysteroscopy will be a great step forward in safe, realistic, proficiencybased healthcare simulation training for surgical gynecology. The simulator will continue to be aligned with the Accreditation Council for Graduate Medical Education and European Board and College of Obstetrics and Gynecology training guidelines and milestones. VirtaMed is the world leader in data-driven medical education using mixed reality simulators for minimally invasive diagnostic and therapeutic interventions in obstetrics and gynecology, including ultrasound, hysteroscopy, laparoscopy, IUD placement and embryo transfer. VirtaMed simulators provide the most realistic training environment, combining photorealistic graphics with adapted surgical instruments and anatomically correct rubber models. Physicians around the world use the VirtaMed GynoS™ to learn in a risk-free training environment, and VirtaMed has partnered with medical societies and associations to develop standardized simulation courses using competency-based proficiency assessments and eligible for Continuing Medical Education (CME) Credits.

County Health Rankings from the Robert Wood Johnson Foundation help provide a standard for understanding how healthy we are overall, ranging from healthy behaviors such as regular exercise to outcomes such as rates of chronic disease. 2. The leading cause of death in Seminole County is cancer. Understanding the leading causes of death in our state and community is key to identifying and addressing barriers to optimal health. In 2018, Seminole County reported a rate of 145.3 cancer deaths compared to the State of Florida with a rate of 141.7. The most common cause of cancer deaths in Florida and Seminole County is lung cancer. 3. In Seminole County, 43,707 people (10%) are without health insurance. For uninsured workers and their families, obtaining insurance coverage can be cost prohibitive. The 2019 U.S. Census data shows Seminole County healthcare coverage enrollment for Medicare is 3%, Private Insurance is 80% (Affordable Care Act, direct pay, and employer insurance is included in private insurance), and Medicaid/public 8%.

Central Florida Regional Hospital Earns Three-Year CARF Accreditation Central Florida Regional Hospital, an affiliate of HCA Healthcare’s North Florida Division – Orlando Market, announced its acute inpatient rehabilitation program has again earned three-year accreditation from CARF International. Central Florida Regional Hospital’s CARF recognition represents the highest level of accreditation that can be given to an inpatient rehabilitation program, highlighting the hospital’s conformance to CARF’s high standards for continuous performance improvement. An organization receiving a three-year accreditation has put itself through a rigorous peer review process. It has demonstrated to a team of surveyors during an on-site visit its commitment to offering programs and services that are measurable, accountable and of the highest quality. “Since its founding, Central Florida Regional Hospital has been dedicated to providing our community with highquality healthcare,” said Trey Abshier, CEO. “By striving for and receiving a prestigious three-year CARF accreditation, our inpatient rehabilitation team demonstrates our commitment to providing the highest quality care to patients striv-

ing to regain their independence and quality of life after a serious illness or injury.” CARF is an independent, nonprofit accrediting body whose mission is to promote the quality, value and optimal outcomes of services through a consultative accreditation process, as well as continuous improvement services that center on enhancing the lives of the persons served. Founded in 1966 as the Commission on Accreditation of Rehabilitation Facilities (now known as CARF International), the accrediting body establishes consumer-focused standards to help organizations measure and improve the quality of their programs and services. For more information about the accreditation process, please visit the CARF website at www.carf.org.

Orlando Health Cuts Ribbon on Newest Hospital in Central Florida WINTER GARDEN - Orlando Health held a ribboncutting ceremony for its newest facility, the Orlando Health - Horizon West Hospital. Located in Winter Garden in the rapidly developing community of Horizon West, Orlando Health leaders, physicians and team members were on hand to celebrate the completion of the latest phase of the Horizon West medical campus. Horizon West Hospital will be the health system’s 10th acute care facility and the organization’s first newly constructed hospital in more than 15 years. “We’re very excited to be here today to celebrate another milestone for our Horizon West medical campus,” said Brian Wetzel, chief operating officer, Orlando Health – Horizon West Hospital. “We’ve been proud to serve the growing community of Horizon West since we opened our emergency department and medical pavilion here in 2018 and the hospital is a vital piece of our community commitment.” The six-story, 228,000 sq. ft. facility will initially open with 30 acute care patient beds, four surgery suites, a cath lab and imaging services including MRI, X-Ray and CT, and was constructed with the capacity to add an additional 90 patient beds, surgery suite and cath lab to meet future demands. “The hospital not only allows us to provide an even ||

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higher level of care to the residents who call this community home,” said Wetzel, “but we’ve built the medical campus in such a way that as Horizon West grows, our facilities can also grow to meet the inevitable growth in demand for healthcare services.” The hospital’s patient bed tower is adjacent to the 78,000 sq. ft. emergency department and medical pavilion Orlando Health opened on the site in September 2018. The emergency department includes 24 total patient exam rooms and six patient observation rooms and the medical pavilion features services that include primary care, family medicine, OB/GYN, general surgery, laboratory, orthopedics, neurology, urology, cardiology, pharmacy, outpatient rehabilitation and a center for health improvement. The hospital is set to begin receiving patients on January 30. Once fully operational, the Orlando Health – Horizon West Hospital will create more than 150 new permanent healthcare jobs in phase 1 of operations. The total hospital project cost is $145 million. Orlando-based Robins & Morton Corp. is the project general contractor and HuntonBrady Architects PA is the architect.

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NORTH CENTRAL FLORIDA || GRAND ROUNDS

VOLUSIA-BREVARD | | GRAND ROUNDS

DOH-Marion Continues to Increase Vaccine Efforts in Community; Residents Able To Pre-Register For Vaccine The Florida Department of Health in Marion County is increasing the number of COVID-19 vaccinations it provides in the community. DOH-Marion provided 3,508 vaccinations at the Paddock Mall last week; this week, a total of 6,597 vaccinations are scheduled at the mall. The number of vaccinations is increasing as the first large group of individuals who need their second dose of vaccine are having their appointments. Days of operation at the mall vaccination site continue to expand to accommodate the increase in vaccinations. Vaccinations are now provided Monday through Friday and some select Saturdays. Hours of operation run from approximately 8 a.m. to 7:30 p.m. depending on the number of doses scheduled per day. Vaccinations are available by appointment only. The site is a joint venture of the Department of Health in Marion County, AdventHealth Ocala, Marion County Emergency Management and Paddock Mall. The site provides both Moderna and Pfizer vaccine.

The state of Florida has developed a statewide COVID-19 vaccine pre-registration system. Through signing up in the system, residents are placed in a queue to be proactively contacted once vaccine is available in their community at state-supported vaccination sites. To pre-register for vaccine in Marion County, visit https://myvaccine.fl.gov/ or call 866-201-6768 (833-476-1519 TTY). For questions relating to sign-ups, residents can call 833-540-2070. Residents who have already pre-registered with the Department of Health in Marion County during its COVID-19 vaccine signups in late December and early January do not need to sign up for vaccine through the new state site. DOH-Marion will continue to contact and schedule individuals for vaccinations through its original pre-registration system. Once this effort is complete, the department will begin pulling registrants from the new state system vaccination queue.

Encompass Health Rehabilitation

The Orlando VA Healthcare System has awarded the lease for the Daytona Beach VA Multi-Specialty Clinic. Carnegie Management and Development Corporation will build and lease the new clinic. The Daytona Beach VA Multi-Specialty Clinic will be located off Williamson Blvd, just south of Technology Blvd (West of N. Williamson Blvd. and North of LPGA Blvd.), Daytona Beach, FL 32124. The new clinic will provide 106,826 net square feet of space which allow services to be located in one facility. Services provided

at the clinic will include primary care, mental health, specialty services, and support services such as radiology and lab. Parking at the new clinic will include 750 spaces. The Daytona Beach VA Multi-Specialty Clinic design and construction is expected to be completed in the fall of calendar year 2023. Once construction is complete, the VA will install equipment and furniture prior to the clinic’s activation, and relocation of staff and services. Patients will be seen at the clinic in early 2024.

Jess Parrish Medical Foundation and Parrish Medical Center Auxiliary Now Accepting Scholarship Applications for Students Pursuing Career in Healthcare

After suffering a stroke, Thomas Bologna, 64, had little hope that he would be able to return to his former life. When he entered Encompass Health Rehabilitation Hospital of Ocala, he was skeptical that therapy could make a difference. He had Bells palsy, and the stroke left him extremely weak on the left side. He needed assistance with what were once automatic tasks, such as walking, getting out of the bed and dressing himself. It was those basic tasks that he wanted to return to, so he could care for himself, as well as his beloved dog. Though Thomas was skeptical that therapy could help him at first, his care team quickly changed his attitude. During his two weeks at Encompass Health Ocala, Thomas participated in extensive physical and occupational therapy that focused on improving his strength, balance, gait and mobility and activities of daily living. He practiced using adaptive equipment for self-care and walking. His care team also used various neurodevelopment treatment approaches to aid in his recovery. “He consistently gave 100% and smiled even when his therapy was challenging,” said Andrea, his physical therapist. “He never said no and was a true inspiration to others.” By the time Thomas left Encompass Health Ocala, he was walking 220 feet with a walker and was independent with transfers.

Jess Parrish Medical Foundation (JPMF) and Parrish Medical Center (PMC) Auxiliary are now accepting scholarship applications from high school seniors who plan to pursue a career in a medical or healthcare field. The organizations have combined their scholarship programs and will announce scholarship recipients in May 2021. Scholarships will be awarded to graduating high school seniors who reside in the Parrish Medical Center service area. Undergraduate students pursuing a degree in the human health/medical field are also eligible to apply. Students must have a 3.0 grade point average or greater, based on a 4.0 scale. Students who

AIM ImmunoTech Enters into Agreement for Proposed Intranasal Safety Study of Ampligen OCALA — AIM ImmunoTech Inc. (NYSE American: AIM) today announced that it has entered into a sponsorship agreement with the Centre for Human Drug Research (CHDR) for the proposed AMP-COV-100 (CHDR2049) clinical study on the safety of AIM’s drug Ampligen as an intranasal therapy, a critical step in the company’s ongoing efforts to develop Ampligen as a COVID-19 treatment. CHDR, an independent institute located in Leiden in the Netherlands, will conduct and manage the proposed clinical study, titled “A Phase I, Randomized, Double-Blind, PlaceboControlled Study to Evaluate the Safety and Activity of Repeated Intranasal Administration of Ampligen (Poly I:Poly C12U) in Healthy Subjects.”

New Daytona Beach VA Multi-Specialty Clinic

Current study plans call for the enrollment of eight healthy subjects in each of four Ampligen treatment groups and one placebo group, for a total of 40 healthy subjects. They will receive intranasal dosing every other day for 13 days, for a total of seven doses each. AIM is funding the clinical study. The company is working to finalize the study protocol and will announce new information as it becomes available. AIM ImmunoTech Inc. is an immunopharma company focused on the research and development of therapeutics to treat multiple types of cancers, immune disorders, and viral diseases, including COVID-19, the disease caused by the SARS-CoV-2 virus.

have been awarded a JPMF scholarship in previous years may reapply provided they are continuing in a medical/healthcare field and have maintained at least a 3.0 grade point average. Graduate students are not eligible. High school students who attend Astronaut High School, Space Coast Jr./Sr. High School and Titusville High School may obtain an application from the Guidance Office at their school. Others may obtain an application by calling the Jess Parrish Medical Foundation at 321-269-4066 or by visiting www.parrishmedfoundation.com/ scholarships. The deadline for submitting applications is Friday, March 5, 2021.

Parrish Medical Group Welcomes Gastroenterology Physician Dwarka Nath, MD Parrish Medical Group welcomes Dwarka Nath, MD, as its newest boardcertified physician in gastroenterology. Dr. Nath offers gastroenterology care at two convenient locations: Parrish Healthcare Center 5005 Port St. John Parkway, Cocoa, FL 32927 and Parrish Healthcare Center 250 Harrison Street, Titusville, FL 32780. Dr. Nath completed his medical studies at Mysore Medical College of Mysore University, India. After postgraduate training in Bombay, he then went on to serve in Africa as a staff medical officer. For the past 38 years, Dr. Nath has been practicing gastroenterology and internal medicine in the United States. Having presented on topics relating to gastroenterology and holding positions in a variety of practice committees, Dr. Nath

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is an active community leader. During his professional career, Dr. Nath has developed specialties in advanced endoscopic procedures and gallstone removals. “I want to bring a gastrointestinal service of excellence to the Parrish community,” said Gastrointestinal Physician Dr. Dwarka Nath. “My goal is to provide care in early detection of cancer and advanced management of gastrointestinal cancer, ulcers, gallstones, liver diseases, and pancreatic disorders.” Parrish Medical Group and Dr. Nath are accepting new patients. To schedule an appointment, call 321-268-6868 for Titusville or 321-633-8660 for Port St. John.

Orlando Medical News February 2021

Articles inside

ORLANDO GRAND ROUNDS

Safety Makes Even Stronger Demands on Construction During Pandemic

OCR-HIPAA Right of Access Initiative

Your Reputation Precedes You

VIEW FROM THE TOP Staying Ahead in Healthcare

Are Your COVID-19 Disinfection Efforts Backfiring?

PHYSICIAN SPOTLIGHT Totally at Home in Florida

Pandemic Fatigue: Its Real and Affecting Us All

Telescope Health Founder Dr. Matthew Rill Demonstrating Foresight, Nimbleness in Current Crisis