Legal Matters

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,

see Legal Matters...page 13

New Study Looks at Long-Term Outcomes and Costs Of High-Risk Non-Muscle Invasive Bladder Cancer Treatment

Study Provides Data to Assist Physicians in Treating a Potentially Lethal Type Of Bladder Cancer

Anew research study leveraging a database from the largest equal access health system in the US, the Department of Veteran Affairs, offers insight into the outcome of specific treatment patterns for advanced bladder cancer patients. Lead author Dr. Stephen Williams of the University of Texas Medical Branch says it is one of the first comprehensive studies looking at both the outcomes and the costs of treating a potentially lethal and devastating type of bladder cancer. The study was published today in JAMA Network Open, a medical journal focused on clinical care, and healthcare innovation. The study looked at the results of using bacillus Calmette-Guérin (BCG) therapy for patients with high-risk non-muscle invasive bladder cancer (NMIBC). The analysis involved 412 high-risk NMIBC patients culled from a database of 63,139 patients diagnosed with bladder cancer who had received more than one dose of BCG within VA centers across the United States from Jan. 1, 2000, to Dec. 31, 2015. “Studies like this are incredibly important in allowing physicians to understand the effectiveness of a specific treatment and downstream costs. It is particularly important when dealing with a cancer that is increasing in numbers over the last three decades with a high mortality rate with advanced cases,” said Williams, who is Tenured Professor and Chief of the Division of Urology as well as Director of Urologic Oncology at UTMB. In addition, the study looked at the costs of treating bladder cancer for this same population. Bladder cancer has one of the highest lifetime treatment costs of all cancers. The cost of treating bladder cancer in the United States in 2020 approached nearly $6 billion alone. According to the study, total median costs at one, two and five years from start of BCG induction were $29,459 ($14,991-$52,060), $55,267 ($28,667-$99,846), and $117,361 ($59,680-$211,298), respectively. Patients who progressed had significantly higher costs (5-yr, $232,729 median cost), with outpatient care, pharmacy, and surgery-related costs contributing largely to the higher costs associated with disease progression. “This study allowed us to determine where differences in treatment patterns led to differences in outcomes according to specific features of this disease. This is important as this group of patients are at increased risk of progression to advanced stage disease which is a deadly diagnosis. It also underscores the need for additional therapies to reduce the risk of disease progression and further improve outcomes,” Williams said.

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