HIPAA Regulations Research Articles

Implications of telemedicine

This article explores the transformative impact of telemedicine on spine surgery, tracing its evolution from historic roots to its expansion during the COVID-19 pandemic. The widespread adoption of telemedicine is discussed, highlighting some of its benefits such as increased patient accessibility and satisfaction. Despite its advantages, telemedicine introduces complex legal considerations, specifically concerning licensure, malpractice and data security. The article examines the challenges spine surgeons face when practicing telemedicine across state borders, the nuances of malpractice liability in virtual settings, and the importance of maintaining high standards of care. It also highlights the importance of adhering to HIPAA regulations, ensuring secure data transmission, and navigating reimbursement complexities. This article should serve as a thorough guide for spine surgeons navigating the evolving telemedicine landscape, balancing innovation with patient safety and legal accountability.

Healthcare Professional’s Knowledge, Awareness, and Attitude toward Patients’ Data Privacy and Security in Clinical Research

Introduction: The privacy and security of healthcare information are essential to maintaining good patient-physician relationships, protecting individuals’ interests, and respecting their dignity and worth. This study assessed healthcare professionals’ (HCPs) knowledge, awareness, and attitudes toward patients’ data privacy and security in clinical research. Methods: The study consisted of a cross-sectional survey in which 108 HCPs’ awareness and knowledge of HIPAA and NCBE rules and regulations were measured, followed by an in-depth semistructured interview to explore HCPs’ attitudes and perspectives. The study was conducted between January and May 2022. Results: Most participants agreed that the IRB/REC rules and regulations strengthened participants’ trust in the researchers, enhanced confidentiality, and improved the privacy and security of patients’ information. HIPPA knowledge was affected by prior participation in research (β: 1.16; p = 0.001) and NCBE knowledge by working on a research project (β: 0.87; p = 0.001), years of work experience (β: 0.35; p = 0.003), and age (β: −0.28; p = 0.04). Participants believed that the nature of research, involvement of inexperienced persons, and human errors could affect patients’ privacy and security in clinical research, which could be improved by limiting the number of personnel who access the data, continuous education, and sending reminders about the rules and regulations. Conclusions: Patients’ data privacy and security remain vital to clinical research. HCPs realize the role of IRB/REC to maintain data privacy and security. Enrollment of HCPs in clinical research and continuous education could improve HCP knowledge of regulatory rules.

Telemedicine in orthopaedics during the COVID-19 pandemic: a comparative landscape.

The purpose of this study was to provide a comprehensive analysis on observed trends regarding the impact of the COVID-19 pandemic on telemedicine application in orthopaedics compared to other procedural, non-emergent specialties. This was a retrospective review of all telemedicine and in-person visits at a large single institution from January to December 2020. The number of patient visits, visit type, location, and provider specifics were collected. Comparisons were made between subspecialties (orthopaedic surgery, oncology, family medicine, rheumatology) for analyses. All specialties included were not conducting virtual visits at the beginning of 2020. By April 2020, orthopaedic virtual visits spiked to an all-time high of 33.5% of all patient visits as compared to oncology at 25.5%, rheumatology at 92.9%, and family medicine at 94%. By the end of the study period, orthopaedic virtual visits decreased back down to 6.5% of patient visits compared to oncology at 7.0%, and family medicine (17.4%) and rheumatology (26.2%). Orthopaedic providers practicing greater than 20years had the highest average virtual visit rates. Although the COVID-19 pandemic has posed unique challenges for healthcare providers, there was a great advancement in the rollout and application of telemedicine. To mitigate the spread of infection from coronavirus and given the recent adjustments to reimbursement policies and HIPAA regulations, orthopaedics saw a dramatic expansion of telemedicine since April 2020. The pandemic may have served as a catalyst to adopt telehealth into clinical practice. However, telehealth saw a downtrend trend by December 2020, particularly in procedure-based fields like orthopaedics and oncology.

Fibromyalgia Review: Remembering What it is and Differentiating What it is Not

1.1. Introduction: Fibromyalgia has become the catch-all disorder for unexplained pain syndromes. As a result, many other disorders (e.g., Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder) have been misdiagnosed and, as a result, mismanaged. Fibromyalgia is a defined Rheumatological disorder characterized by chronic pain from 11 of 18 tender points typically bilateral and above and below the diaphragm lasting more than 6 months. 1.2. Methods: We studied 418 patients previously diagnosed with Fibromyalgia, who presented to five suburban autonomic clinics. All patients submitted to Parasympathetic and Sympathetic (P&S) monitoring as part of the standard of care in these clinics and treated for P&S dysfunction and pain as diagnosed. Data were compiled under HIPAA regulations and statistical analysis performed in SPSS v27.

An advanced data fabric architecture leveraging homomorphic encryption and federated learning

Data fabric is an automated and AI-driven data fusion approach to accomplish data management unification without moving data to a centralized location for solving complex data problems. In a Federated learning architecture, the global model is trained based on the learned parameters of several local models that eliminate the necessity of moving data to a centralized repository for machine learning. This paper introduces a secure approach for medical image analysis using federated learning and partially homomorphic encryption within a distributed data fabric architecture. With this method, multiple users or clients (hospitals/medical data centers) can collaborate in training a machine-learning model without exchanging raw data. The approach complies with laws and regulations such as HIPAA and GDPR, ensuring the privacy and security of the data. The study demonstrates the method’s effectiveness through a case study on pituitary tumor classification, achieving a significant accuracy of 83.31%. However, the primary focus of the study is using the data fabric architecture to securely store and analyze medical images while complying with HIPAA and GDPR regulations. The results highlight the potential of these techniques to be applied to other privacy-sensitive domains and contribute to the growing body of research on secure and privacy-preserving machine learning.

Hyperpolarized Xenon-129: A New Tool to Assess Pulmonary Physiology in Patients with Pulmonary Fibrosis.

The existing tools to quantify lung function in interstitial lung diseases have significant limitations. Lung MRI imaging using inhaled hyperpolarized xenon-129 gas (129Xe) as a contrast agent is a new technology for measuring regional lung physiology. We sought to assess the utility of the 129Xe MRI in detecting impaired lung physiology in usual interstitial pneumonia (UIP). After institutional review board approval and informed consent and in compliance with HIPAA regulations, we performed chest CT, pulmonary function tests (PFTs), and 129Xe MRI in 10 UIP subjects and 10 healthy controls. The 129Xe MRI detected highly heterogeneous abnormalities within individual UIP subjects as compared to controls. Subjects with UIP had markedly impaired ventilation (ventilation defect fraction: UIP: 30 ± 9%; healthy: 21 ± 9%; p = 0.026), a greater amount of 129Xe dissolved in the lung interstitium (tissue-to-gas ratio: UIP: 1.45 ± 0.35%; healthy: 1.10 ± 0.17%; p = 0.014), and impaired 129Xe diffusion into the blood (RBC-to-tissue ratio: UIP: 0.20 ± 0.06; healthy: 0.28 ± 0.05; p = 0.004). Most MRI variables had no correlation with the CT and PFT measurements. The elevated level of 129Xe dissolved in the lung interstitium, in particular, was detectable even in subjects with normal or mildly impaired PFTs, suggesting that this measurement may represent a new method for detecting early fibrosis. The hyperpolarized 129Xe MRI was highly sensitive to regional functional changes in subjects with UIP and may represent a new tool for understanding the pathophysiology, monitoring the progression, and assessing the effectiveness of treatment in UIP.

Abstract 2803: A renewable IHC control tool CytoSections࣪ for defining MAGEA3, MAGEA4, and MAGEA9 antibody specificity

Abstract Melanoma-associated antigen gene A (MAGEA) family proteins are expressed in a variety of tumors with each MAGEA protein having unique roles in cancer pathogenesis. The MAGEA members lack of expression in normal tissue and their role in cancer make them well suited for targeted cancer immunotherapy. Thus, knowing which MAGEA protein expression exists in a tumor is important. However, the MAGEA family shares sequence similarity that makes it difficult to find antibodies that are specific to just one family member. It is also challenging to source tissue generally with HIPAA regulation and even more so to get tissue representation of all 12 MAGEA family members. Here we present CytoSections as an alternative to patient control tissues. CytoSections are formalin fixed, paraffin embedded (FFPE) section of over-expression cell pellets. These cells were transfected with expression plasmids coding for genes of individual MAGES family. In this study, CytoSections are used to screen antibodies to all 12-member MAGEA family of proteins. The MAGEA family members were initially shown positive by targeted protein expression in western and immunohistochemistry using DDK tag antibody. Then multiple MAGEA3, MAGEA4, MAGEA9 antibodies were assessed by IHC to determine their specificity to their intended target. Using MAGEA family as a pilot project, we show that CytoSections is a verified, reproducible, and renewable alternative to human control tissues and serves as an ideal tool for antibody specificity assessment. Citation Format: Eden B. Zewdu, Rachel M. Gonzalez, Yan Ma, Derek Ling, Xiaomin Hu, Qi Ren, Ranran Zhang, Li-Hui Lei, Krishnan Allampallam, Dezhong Yin, Xuan Liu, Wei Fu. A renewable IHC control tool CytoSections࣪ for defining MAGEA3, MAGEA4, and MAGEA9 antibody specificity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2803.

Meeting Needs of Pediatric Patients in Grades K-12 with Telehealth: A Case Study

Viewers will gain a deep understanding of school setting and challenges schools can meet medical needs. Topics will include FERPA and HIPAA rules and regulations, proper consent for medical care in schools, understanding how enrollment and engagement affects access, reimbursement challenges and engagement with local resources and primary care clinics to identify gaps in care.

Telemental Health

Telemental Health

Optimal Design for an On-Wall Mounted Loudspeaker

The increased number of Internet services and the exposure of the personal information to the public network, create a problem with the privacy of the personal data. This problem is extremely impactful in the healthcare systems where the sensitive medical data circulate in the network. The emerging Blockchain technologies offer properties and tools for better personal data access management. The integration of the Blockchain technologies into the healthcare systems can provide better data privacy. However, beside the attractive properties, the current Blockchain technologies cannot achieve sufficient scalability to serve a global public healthcare system and cannot provide compatibility with the GDPR and HIPAA regulations. To overcome these limitations, this paper introduces new deducted Blockchain-based public healthcare system, the BloHeS, with main focus on several functional entities, such as optimal consensus mechanism, better storage organization, improved network organization and compatibility with GDPR and HIPAA regulations. It also defines a procedure for patient-centric data access management, protocols for Island management and new block structure.

Guidance for Professional Use of Social Media in Nutrition and Dietetics Practice

Guidance for Professional Use of Social Media in Nutrition and Dietetics Practice

THE LONG HAUL: A FOLLOW UP STUDY OF PATIENTS DIAGNOSED WITH COVID-19 ONE YEAR AGO AT AN URBAN MEDICAL CENTER IN NEW JERSEY

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Many patients diagnosed with COVID-19 develop a post-viral syndrome commonly known as Long COVID-19. Long COVID is described as when a patient experiences persistent symptoms for more than 12 weeks after their initial infection. Recent studies have shown that patients may experience long covid for as many as 6 months after initial infection. We conducted a follow up study on patients diagnosed with COVID-19 one year ago at one of the worst affected tertiary hospitals in the state of New Jersey. METHODS: This was a prospective cohort study consisting of patients with a confirmed positive COVID-19 test by PCR in the months of March and April of 2020 in the St. Joseph’s University Hospital network. Individuals who were either admitted to the hospital or tested positive in the outpatient setting with Sars- CoV2 were included in the study. Patients under 18 years of age or those with cognitive impairment or inability to complete the survey were excluded. Informed consent was taken over the telephone. The participants completed a comprehensive questionnaire including sociodemographic information and a review of systems to evaluate for persistent symptoms they have experienced over the past year directly due to COVID-19. All patient identifying information was de-identified in compliance with HIPAA rules and regulations. RESULTS: There were 91 inpatients ( 91/173 [52.6%]) and 82 outpatients (82/173 [47.4%]) with a mean age of 51.5. The most common ethnicities were Hispanic (80/173 [46.24%]) African American (48/173 [27.74%]), Caucasian (32/173 [18.49%]) and the most common comorbidities were hypertension (68/173 [39.5%]), obesity (45/173 [26.9%]) and diabetes (33/173 [19.1%]). There were 91 inpatients ( 91/173 [52.6%]) and 82 outpatients (82/173 [47.4%]), of which 85 were male (85/173 [49.42%]). Overall 83 patients (47.9%) still experienced at least one persistent symptom after initial infection. The most commonly reported symptoms were shortness of breath (44/173 [25.4%]), fatigue (43/173 [21%]), anxiety (36/173 [20.8%]), difficulty focusing/brain fog (32/173 [18.5%]), body aches (32/173 [18.5%]), headaches (29/173 [16.8%]), memory loss (25/173 [14.5%]), cough (23/173 [13.3%]), depression (22/173 [12.7%]), chest pain (19/173 [11%]), palpitations (15/173 [8.7%]), lightheadedness (15/173 [8.7%]), runny nose (12/173 [6.9%]) and loss of taste (11/173 [6.4%]). CONCLUSIONS: In our patient population nearly half of all patients (47.9%) still experienced at least one symptom 12 months after their initial infection. In both patient populations the most common persistent symptoms were shortness of breath, fatigue, anxiety and difficulty focusing/brain fog. The risk factors and pathophysiology of long covid remain unknown, highlighting the importance of further research into the topics. CLINICAL IMPLICATIONS: Nearly half of our patient population still experienced at least one symptom from their COVID-19 infection after one year. This further suggests that infection with COVID-19 may carry a risk of developing long term and possibly permanent sequelae from the virus. As more patients continue to be infected with COVID-19 and subsequently develop long covid, a public health crisis may be looming in the future. This highlights the need for continued public education on COVID-19 as well as the critical importance of widespread vaccination across the world to end the pandemic. DISCLOSURES: No relevant relationships by Polina Aron, source=Web Response No relevant relationships by Hamdallah Ashkar, source=Web Response No relevant relationships by Sohail Chaudhry, source=Web Response No relevant relationships by Arslan Chaudhry, source=Web Response No relevant relationships by Beenish Faheem, source=Web Response No relevant relationships by Alisa Farokhian, source=Web Response No relevant relationships by George Horani, source=Web Response No relevant relationships by Humberto Jimenez, source=Web Response No relevant relationships by Christina Kmiecik, source=Web Response No relevant relationships by Patrick Michael, source=Web Response No relevant relationships by Christopher Millet, source=Web Response No relevant relationships by Spandana Narvaneni, source=Web Response No relevant relationships by Sherif Roman, source=Web Response No relevant relationships by Fady Shafeek, source=Web Response No relevant relationships by Yezin Shamoon, source=Web Response No relevant relationships by Jin Suh, source=Web Response

Spine Surgeons Social Dilemma: Benefits and Risks of Social Media for Spine Surgery Practice in the 21st Century.

Cross-sectional observational. The use of social media by providers can enhance patient education, complement offline information, facilitate patient support, stimulate brand building, and strengthen the organization's market position. Risks of social media include, but are not limited to, a lack of quality, reliability, misrepresentation of credentials, influence of hidden and overt conflicts of interest, content that may jeopardize patient privacy, HIPAA regulations, and physicians' credentials and licensure. Physicians' use of social media may also expose him/her to lawsuits if providing specific medical advice on media platforms. To document the social media presence of a broad cohort of spine surgeons, and to discuss the benefits and risks of a social media presence. Cross-sectional observational of 325 Spine Surgeons from 76 institutions across the US. Description statistic and Pearson's correlation were used to investigate the relationships between the variables. Out of the 325 surgeons, 96% were male with an average age of 51.5 ± 10.7 years and 14.1 ± 9.6 years of experience. The frequency of social media use included 57.2% of surgeons had professional LinkedIn, 17.8% had professional Facebook, and less than 16% had other social media platforms. When combining all platforms together, 64.6% of all surgeons had at least one professional social media platform. 64.0% of these surgeons had no social media activity in the past 90 days, while 19.4% and 10.9% were active once and twice a month, respectively. Surgeon age (P = 0.004), years in practice (P < 0.001), and practice type (P < 0.001) were strongly correlated with social media activity. Given the scarcity of research on this topic and the novelty of the platforms, social media and online services continue to be utilized at a low level by spine surgeons. Issues regarding the risks of privacy issues with social media users continue to be a concern among medical professionals adopting this technology. This can largely be mitigated with the combination of physician education and informed consent from patients. The ability to connect with patients directly, and provide access to high-quality education and information will be of considerable benefit to our field well into the future.

Reimagining Residency Selection: Part 1-A Practical Guide to Recruitment in the Post-COVID-19 Era.

Reimagining Residency Selection: Part 1-A Practical Guide to Recruitment in the Post-COVID-19 Era.

Radiology on Instagram: Analysis of Public Accounts and Identified Areas for Content Creation

Radiology social media research has focused on Twitter, Facebook, and YouTube, with minimal attention to Instagram, which may be a natural platform for engagement. We evaluated features of public radiology-related Instagram accounts. Instagram accounts were searched using the term "radiology." Two independent raters used a coding system developed through initial content review to categorize account user types and post aims over the study month (October 2019). Multivariate linear regressions were performed. 49 Instagram accounts and their 459 posts were retrieved. Users had median 117 total posts (interquartile range 43-203), 9 posts during the study month (1-16), 3079 followers (695-19,600), and 106 followed users (50-351). Most users were radiologists (41%, most commonly academic), radiology practices (12%, most commonly academic) and 10% radiology professional societies. The 459 posts had median 178 likes (interquartile range 51-353) and 2 comments (0-5); single videos had median 4693 views (2183-6080). 75% of posts were radiology images or videos (of these, 29% MRI, 28% CT). 65% of posts were clinical imaging cases (most commonly neuroradiology). Seven posts violated HIPAA regulations, all originating outside the U.S. When controlling for number of account followers, posts by radiology society (β = -130.6, p = 0.017) and practice accounts (β = -90.6, p = 0.049) had fewer post likes. An artwork post was the only significant predictor of greater post likes (β = +866.2, p < 0.001) and comments (β = +14.3, p < 0.001). Instagram is commonly used by academic radiologists to present clinical imaging cases. Radiologists should consider opportunities for greater application of this unique image-based social media platform.

Who Has My Data? Factors Contributing to HIPAA (Non)Compliant Behaviors

HIPAA noncompliance has become an increasingly regular occurrence throughout the healthcare industry, leading practitioners to seek ways to minimize the phenomenon. Healthcare workers are hired into the field with limited knowledge of the implications of sharing patient information. One of the objectives of this research was to show that providing deterrent information regarding real cases of HIPAA noncompliance will increase overall levels of HIPAA compliance. We surveyed two groups: one provided with deterrent case information regarding real-life individual healthcare workers imprisoned following HIPAA noncompliance, and one not provided with such information. We also questioned individuals about whether their compliance level would change if they were offered an incentive to be noncompliant, and explored individuals’ ethical level, knowledge of HIPAA regulations, and belief in the justice system. We then developed a tool for healthcare practitioners to provide incoming healthcare workers with information that explains that being HIPAA noncompliant can impact them personally, not just the financial health of their organization. This awareness may lead to higher levels of HIPAA compliance.

Honesty Is the Best Policy

Honesty Is the Best Policy

Ethical and Legal Manifestations of Informed Consent

Informed consent to medical or surgical treatment, or "permission granted in the knowledge of the possible consequences” is an important, and sometimes contentious and controversial component of clinical practice. From an ethical, legal and philosophical perspective; informed consent has significant implications for health care providers. The three principal elements of informed consent are 1) thorough presentation of information, 2) patient’s capacity to comprehend (competence), 3) patient’s voluntary willingness to undergo or refuse treatment. The history of informed consent is highlighted by precedent-setting legal cases, the atrocities of World War II and subsequent 1947 Nuremberg Trials and, current HIPAA regulations and guidelines. Informed consent involves shared decision-making between provider and patient. Including patients acknowledges and safeguards patient autonomy such that health care decisions are made based on respecting individual preferences, goals, values, beliefs, objectives, and desires. Providers act as advocates for patients' rights. These are fundamental premises of today’s patient-centered care.

PCN216 HEALTHCARE INSTITUTION COMPLIANCE WITH THE HIPAA RIGHT OF INDIVIDUAL ACCESS: A SURVEY AND PATIENT REQUEST PILOT STUDY

HIPAA regulations provide patients with a legal, enforceable right to receive copies of their full medical record upon request. The current study assesses the state of healthcare institutions' compliance with the HIPAA right of access regulations.

HIV May Accelerate Coronary Artery Disease Progression Through Promoting the Adverse Effects of Conventional Cardiovascular Risk Factors and Illicit Drugs

Background: Only the independent effect of human immunodeficiency virus (HIV)-infection on coronary artery disease (CAD) has been investigated in cross-section studies, while rather than directly, HIV-infection may accelerate CAD through promoting the effects of risk factors. Furthermore, there is no information on the potential effects of HIV-infection on coronary plaque volumes. Therefore, we investigated whether HIV-infection directly or indirectly promotes clinical and volumetric characteristics of CAD in a observational longitudinal study. Methods: 300 individuals without cardiovascular symptoms (210 male; age: 48·0±7·2 years; 226 HIV-infected) underwent coronary CT angiography at two time points (mean follow-up: 4·0±2·3 years). We quantified Agatston-score, number of coronary plaques, segment stenosis score, and also segmented the coronary plaques to enumerate total, noncalcified (-100–350HU) and calcified (≥351HU) plaque volumes. Linear mixed models were used to assess the effects of HIV-infection, atherosclerotic cardiovascular disease (ASCVD) risk, years of cocaine use and high-sensitivity C-reactive protein on CT markers of CAD. Findings: There was no significant difference in annual progression rates between HIV-infected and -uninfected (p>0·05 for all). Multivariately, HIV-infection was not associated with any CAD parameter (p>0·05 for all). However, among HIV-infected individuals, each year of cocaine use significantly increased all CAD parameters (p<0·05 for all), while ASCVD risk score was significantly associated with CAD parameters except for Agatston-score (p<0·05). However, these associations were only apparent among HIV-infected individuals. Importantly, none of the HIV-medications were associated with any of the CAD outcomes. Interpretation: HIV-infection is not directly associated with CAD and therefore HIV-infected are not destined to have worse CAD profiles as compared to uninfected individuals. However, more aggressive management of conventional cardiovascular risk factors and abstinence from illicit drugs may be needed to achieve similar CAD status. Funding Statement: Procedures and tests were funded by the National Institute on Drug Abuse, and the National Institutes of Health (NIH R01DA12777, R01DA15020, R01DA25524, R21DA048780 and U01DA040325). Declaration of Interests: None. Ethics Approval Statement: The Committee on Human Research at the Johns Hopkins School of Medicine (Baltimore, MD) approved the study protocol, and all study participants provided written informed consent. All procedures used in this study were in accordance with HIPAA, local and federal regulations, and the Declaration of Helsinki.