October 2009

New Federal Rules Address Patient Record Breaches

By Brian McCurdy, Senior Editor

   Podiatry practices already spend a great deal of administrative time complying with the rules of the Health Insurance Portability and Accountability Act (HIPAA). However, practices will now need to adjust to new patient privacy provisions that ensure no personal health records are breached.

   The new regulations, which are part of the American Recovery and Reinvestment Act (ARRA), require “vendors of personal healthcare and related entities” to report to consumers any breaches in their personal health information, according to the Federal Register. The rules affect HIPAA-covered entities such as hospitals, physician offices and health insurance plans. The rules took effect Sept. 24 with full compliance required by Feb. 22, 2010.

   The rules define a security breach as acquiring a patient’s identifiable health information without the patient’s authorization. Examples of breaches include: theft of a laptop that contains personal health records; unauthorized downloading or transfer of records by staff; and remote electronic break-ins by hackers. As the Federal Register notes, if a breach in medical records affects more than 500 people, organizations must report the incident to the media as well as the Department of Health and Human Services.

   Bruce Werber, DPM, FACFAS, compares the new regulations to rules for credit card records and transactions. As he says, if there is a breach in such records, credit card companies must report it immediately to the affected customers.

Keys To Improving EMR Security

   In the wake of the new privacy rules, Dr. Werber advocates that podiatric practices reevaluate the electronic medical record (EMR) systems in place for the front and back offices. He says the evaluation should include ensuring the digital system is approved and certified by Certification Commission for Health Information Technology (CCHIT), and that the system documents who has accessed patient records. One should also limit the availability of records to those who have a demonstrable need for access, according to Dr. Werber, a Past President of the American College of Foot and Ankle Surgeons.

   Dr. Werber says physician practice owners should ensure that their staff has been given instruction on proper patient record protections and how to answer the phone without giving away diagnosis or procedure information. When there are third-party requests for patient records, the staff should double-check that the patient has authorized such a release.

   Dr. Werber also suggests secure log-on procedures, regularly changing passwords and restricting off-site access. He also says staff should turn off all computers when they go home and not hide user names and passwords in easy to discover spots.

   In addition, if all records are still in paper format, Dr. Werber says the practice needs to have logs to show who accessed records and when. As he suggests, this may require restricted physical access to the records. He says it may be sufficient just having proper office procedures to prevent staff from taking charts off site.

   Podiatrists cannot neglect training their staff to adhere to the regulations, according to Dr. Werber.

    “No longer is it sufficient to buy a manual and put it on the shelf,” maintains Dr. Werber. “Every staff member must document that he or she understands the rules and will comply with office policies.”

Can Nasal Swabs Help Identify MRSA In The Foot?

By Lauren Grant, Assistant Editor

   With the rise in methicillin-resistant Staphylococcus aureus (MRSA), physicians must be vigilant in screening for the infection in the lower extremity. A recent study assessed whether nasal swabs could be helpful in identifying MRSA in diabetic foot infections (DFI).

   The study, which was presented as an abstract at the 2009 American Podiatric Medical Association Annual Scientific Meeting, obtained nasal swabs for 62 patients who were admitted with DFIs over a 14-month period. Researchers noted a 24.19 percent prevalence of MRSA and 14.51 percent had positive nasal swabs. Out of the patients with positive nasal swabs, 77.8 percent had MRSA positive cultures from their foot wounds, according to the study.

   Lawrence A. Lavery, DPM, a co-author of the study, says he was “pleasantly surprised” by the findings of the study.

    “I really did not think that there would be good predictive value in nasal sawbs and MRSA in the foot,” acknowledges Dr. Lavery, a Professor in the Department of Surgery at the Texas A&M Health Science Center College of Medicine. “The positive and negative predictive value of nasal swabs in identifying MRSA in DFIs was 77.8 percent and 84.9 percent respectively. The sensitivity and specificity of nasal swabs in predicting MRSA in DFI was 46.7 percent and 95.7 percent respectively. That is pretty good.”

   Dr. Lavery says the impetus for the study was to develop more research into MRSA and DFIs. He notes that it is “very expensive” to get routine nasal cultures so an objective of the study was determining whether this expense makes any difference in patient care or diagnosis, or if it helps to diagnose a resistant foot infection.

   According to Dr. Lavery, this ongoing study will also look at common risk factors (such as previous antibiotic use and hospitalization) for MRSA in diabetic foot infections.

Can Proprioception Help Athletes Avoid Recurrent Ankle Sprains?

By Brian McCurdy, Senior Editor

   After athletes suffer ankle sprains, it can be a challenge to avoid recurrent injuries. A new study in the British Medical Journal says proprioceptive training may help in that regard.

   The study evaluated the efficacy of unsupervised proprioception training in preventing recurring ankle sprains in athletes. Researchers focused on 522 athletes who had sustained lateral ankle sprains within two months before the study. There were 256 patients in the intervention group and 266 patients in the control group. All patients received standard care but those in the intervention group also did an eight-week proprioception program at home.

   In one year of follow-up, researchers noted that 22 percent of athletes in the intervention group self-reported a recurrent ankle sprain in comparison to 33 percent of those in the control group. The study says the proprioception program resulted in a 35 percent reduction in the risk of a recurrent ankle sprain. Researchers added that the program was most effective in patients whose original sprains did not receive medical treatment.

   Michelle Butterworth, DPM, “strongly” supports the use of proprioception in attempting to prevent further ankle sprains. She also notes that ankle braces may be able to trigger a “functional proprioception” in patients.

   When it comes to returning athletes to their activities quickly and safely, Dr. Butterworth says the keys are initial immobilization, the length of which depends on the injury’s severity, and reducing pain and swelling.

    “You need to assess the injury and determine what additional damage can occur if the athlete returns too soon,” says Dr. Butterworth, a Fellow of the American College of Foot and Ankle Surgeons.

   To that end, she says athletes must pass a “return to play” evaluation. This starts with straight line jogging, then slow turns and advances to straight line sprinting, quick turns (90 degree turns), balancing on one foot, and finally hopping on one foot. She says athletes have to be able to perform all of these activities without significant pain before they return to their sport. Athletes will not be back to 100 percent during that season, which Dr. Butterworth says is “very important to relay to both the athlete and the coach.”

Emerging Evidence Suggests SSRIs May Erode Bone

By Brian McCurdy, Senior Editor

   A number of podiatric patients may be taking selective serotonin reuptake inhibitors (SSRIs) for conditions including neuropathy. A recently published review indicates that SSRIs have been linked to bone erosion.

   The review, which was recently published in the Harvard Mental Health Letter, notes a Canadian study that followed 5,008 people over the age of 50 for five years. Researchers found that the 137 patients who were taking SSRIs daily had bone density measurements that were 4 percent lower in the hip in comparison to those not taking SSRIs. In contrast, the Harvard review cites another study of more than 4,000 postmenopausal women, which found no relationship between antidepressants (including SSRIs) and lower bone mineral density, although there was a link between antidepressants and a higher risk of bone fracture.

What Is The Potential Impact For Podiatric Patients?

   Raymond Abdo, DPM, feels the review can have an impact in podiatric patients. As he notes, those taking SSRIs usually have diabetes, which may lead to problems during surgery or when it comes to healing factures or Charcot-related problems.

   Therefore, Dr. Abdo suggests switching such patients to medicines with fewer side effects and with no link to bone loss. He says one such agent is pregabalin (Lyrica, Pfizer), which is FDA approved for painful diabetic neuropathy. Patients can also take bisphosphonates such as alendronate sodium (Fosamax, Merck) for strengthening bones or to prevent bone loss, according to Dr. Abdo, who is in private practice at St. Louis Foot and Ankle in St. Louis.

In Brief

   Students from the American Podiatric Medical Students Association (APMSA) have voted ProLab Orthotics the 2009 Company of the Year. The students selected the company because of its support of podiatry students and the APMSA, according to ProLab Orthotics.

   The company received the award at the 2009 American Podiatric Medical Association Annual Scientific Meeting in Toronto. The company notes it is a longtime advocate of education, funds student scholarships.

   In addition, ProLab Orthotics sponsors a custom orthotic program for podiatry students and is part of the APMSA Corporate Advisory Board.

Editor’s note: To access the archives or get reprint information, visit www. podiatrytoday.com.

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