Legal Matters

Hospital News

Keeping Virtual Meetings and Electronically Distributed Documents Secure

By Erin L. Muellenberg Polsinelli, PC

COVID-19 has pushed the healthcare industry across the Rubicon on the legitimacy of virtual meetings and it appears there is no going back. The COVID-19 pandemic has created a rapid transition to a world of “new” technology where meeting virtually will be strongly favored over in-person meetings.

Privacy and security are of the utmost importance for medical staff meetings because of the sensitive nature of the issues presented. There will be discussion of specific peer review issues and practitioner performance that require absolute confidentiality. When a case is identified for peer review as the result of an adverse event or near miss, the practitioner reviewing the case is charged with determining whether the event or near miss was avoidable. While the initial review usually occurs outside a meeting, questions may arise requiring collaboration to determine whether the care was appropriate. This may result in the committee seeking to review the record during a meeting.

With the electronic medical record comes the challenge of sharing records during a peer review committee meeting without violating patient privacy or leaving a footprint in the record that later becomes discoverable. The convenience of virtual meetings with screen sharing provides a secure way to share only certain portions of a record allowing for collaboration and full discussion. This requires the medical staff to think in advance and develop policies that will address information security issues. When crafting policies and protocols for virtual meetings, medical staff members should keep the following tips in mind: • Ensure that the conferencing platform the medical staff is using meets the enhanced requirements for telehealth conferencing. There are multiple platforms available with enhanced security features to protect sensitive healthcare information. • Password protect meetings to prevent uninvited attendees. When possible, create a new meeting login

ID for each meeting and require each participant to have a unique participant

ID. The host should ask each attendee to identify him or herself and not allow any unidentified attendee to participate. • The meeting host should utilize a

“waiting room” for participants. For the greatest level of protection, the meeting host should also disable the “Join Before Host” function and admit each participant individually.

Ensure that the meeting host “locks” the meeting once all participants have joined. The host should expel any individual from the meeting who is not an invited participant if the hosting platform allows the host that ability. • As a confidentiality requirement, a rule or policy can be established requiring individuals to keep their video on at all times and use earphones. They may also be asked to confirm they are in a secure private location and based on the type of meeting can be asked to show the

group a video of the area from where they are taking the meeting. The chair of the meeting should issue a confidentiality reminder at the start of all meetings. • Many video conferencing platforms have the ability to record the meeting. A medical staff may want to record its video conferences for record-keeping purposes in certain circumstances which should be clearly defined in a policy. One instance might be in the event of a hearing or appeal procedure from an adverse action. Medical staff legal counsel should be consulted to determine if this is appropriate under the circumstances. Otherwise,

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Esophageal Cancer Rates on the Rise, More Advanced at Diagnosis Among Younger Adults

New findings showing that esophageal cancer rates have been steadily increasing among the under-50 crowd, and that people in this age group are more likely to be diagnosed with advanced stage cancer compared to older counterparts. The rising numbers have prompted digestive health experts to call for greater awareness about prevention and screening for this deadly disease. A recent study published by the American Association for Cancer Research followed more than 34,000 cases of esophageal adenocarcinoma tracked in a national database from 1975 to 2015. People diagnosed with esophageal cancer below the age of 50: • Experienced an increase in esophageal cancer rates by about 3 percent every year over the 40-year study period; • Were more likely to be diagnosed with advanced stage cancer compared to older counterparts, with about 85 percent versus 67 percent, respectively; • Had a five-year cancer-free survival rate of only 23 percent, compared to about 30 percent for adults over 50. “A late-stage esophageal cancer diagnosis generally means poorer survival rates than when the cancer is identified in the earlier stages,” said Deepak Agrawal, M.D., MPH, medical director of Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, the clinical practice of Dell Medical School at The University of Texas at Austin. “But the good news is that with early screening and treatment, we can avoid esophagectomy and esophageal cancer-related death altogether,” said Agrawal, who is also chief of Gastroenterology and Hepatology and associate professor for Dell Med’s Department of Internal Medicine. Experts on the Digestive Health team point to GERD (gastrointestinal reflux disease), commonly known as heartburn or acid reflux, as a key factor that raises the chances of developing of esophageal cancer. About 15% of patients with chronic GERD develop a condition known as Barrett’s esophagus. “Barrett’s esophagus is considered a pre-malignant condition that predisposes patients to esophageal adenocarcinoma,” says F. Paul “Tripp” Buckley, M.D., Digestive Health surgical director and associate professor of Surgery and Perioperative Care at Dell Med. “About 3.3 million people in the U.S. have Barrett’s esophagus, and while the risk of esophageal cancer is low in patients with Barrett’s esophagus, overall about 0.5% of people with the condition still go on to develop malignancies. And that’s still a lot of people and actually oversimplifies the problem,” Buckley explains. Since GERD has been occurring in increasingly younger patients, esophageal cancer is also becoming more common in people under age 50, says Buckley. 

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