Health Care and Endocrinology

You may have heard the word Endocrinology used in a sentence by a health care professional, like your family physician or someone that has had to visit an endocrinologist, but not really know what it is or what part of your body is the primary focus for this type of medical need. is a specialty of medicine; some would say a sub-specialty of internal medicine, which deals with the diagnosis and treatment of diseases related to hormones.

Endocrinology also focuses on the endocrine glands and tissues that secrete hormones, and it is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones.

From a clinical and research perspective, the Endocrine Society (100 years old this year) does a significant amount of scientific study about this particular field of medicine. The Society offers scientific statements to educate basic scientists, clinical scientists, and clinicians on the scientific basis of disease and its application to the practice of medicine with regard to both prevention and management.

Scientific statements provide an overview of basic and clinical science content on topics of emerging importance. Content is evidence-based to the extent possible but also identifies areas of basic or clinical knowledge that require additional research. Topics are selected on the basis of their emerging scientific impact on disease and broad clinical relevance to the general population. Much more detailed material is located at this website: http://www.endocrine.org/about-us .

According to the Society for Endocrinology, at its simplest, a hormone is a chemical messenger from one cell (or group of cells) to another. Hormones are released in the body and have an effect on other parts of the body. The effect is to communicate with other distant parts of the body. So for example, the adrenal glands may secrete adrenalin, which has an effect on several different organs. An endocrine gland is a gland which secretes hormones. Not all glands are classified as endocrine glands. For example, sweat glands or lymph glands are not endocrine glands).

Hormones are found in all organisms with more than one cell, and so they are found in plants and animals. They influence or control a wide range of physiological activities, such as growth, development, puberty, level of alertness, sugar regulation and appetite, bone growth and other bodily functions. You also find that problems with hormones and the way they work contribute to some of the major diseases of mankind; for example, diabetes, thyroid conditions, pituitary conditions, some sexual problems, some neurological problems, appetite and obesity, bone problems, cancer, and more. Additional info is found at this site: http://www.endocrinology.org/ .

The Journal of Endocrinology is a leading global journal, available through the Society of Endocrinology, that publishes original research articles, reviews and science guidelines. Its focus is on endocrine physiology and metabolism, including hormone secretion; hormone action; biological effects. The journal publishes basic and translational studies at the organ, tissue and whole organism level. You can find more information at this site: http://joe.endocrinology-journals.org/  

The American Association of Clinical Endocrinologists (AACE), founded in 1991, now has over 7,000 members who work together as a professional community of physicians specializing in endocrinology, diabetes, and metabolism committed to enhancing the ability of its members to provide the highest quality of patient care. Their website has significant information on the study of endocrinology and provides a detailed list of definitions for anyone seeking to know more about this type of medicine. More info can be found at this website: https://www.aace.com/about/mission .

On a more detailed basis, according to the American College of Physicians, endocrinologists are frequently involved with the diagnosis and management of these health care problems:

·         Hypothalamic disorders (abnormal sodium and water balance)

·         Pituitary diseases (tumors, over- or underproduction of pituitary hormones)

·         Parathyroid abnormalities (hypercalcemia, hypocalcemia)

·         Thyroid diseases (hyperthyroidism, hypothyroidism, goiter, nodules)

·         Adrenal cortex dysfunction (mineralcorticoid, glucocorticoid, sex hormone abnormalities)

·         Gonadal disease (hypogonadism and reproductive disorders)

·         Pancreatic endocrine disease (diabetes mellitus)

·         Bone metabolism (osteoporosis)

·         Lipid metabolism

·         Iatrogenic effect of glucocorticoids

Training in endocrinology includes two years of additional training following successful completion of a basic internal medicine residency training program. More details are found at this website: https://www.acponline.org/about-acp/about-internal-medicine/internal-medicine-subspecialties/endocrinology-diabetes-and-metabolism .

An additional materials resource is this site: http://www.nature.com/nrendo/index.html , where you can find detailed scholarly journals and research information about endocrinology. And, Healio online has some very good materials about this type of medicine: http://www.healio.com/endocrinology .

There are many good hospitals and health care organizations in the US that have special sections and staff allocated to the study of endocrinology. One of them is Children’s Hospital of Dallas, and you can find more details about their treatment options at this site: https://www.childrens.com/specialties-services/specialty-centers-and-programs/endocrinology .

Another great location for treatment, especially for adults who need specialty care, is located at the University of Chicago Department of Medicine. Their 3-fold mission: (1) to provide excellence in patient care; (2) to perform cutting-edge basic, clinical and translational research in endocrine diseases, diabetes, obesity and hypertension; and (3) to provide outstanding educational opportunities for medical students, house staff and fellows. More information is located at this site: http://medicine.uchicago.edu/endo/index.html .

Hormones are a huge part of what makes your body tick. Endocrinologists are medical specialists that can help determine what may be out of whack if you are experiencing symptoms or medical issues that need more detailed study and care. Talk with your doctor or a medical professional who can assist you in getting the quality of care you need for any problems dealing with hormonal imbalances. It’s worth your time.

Until next time. 

Health Care and Data Breaches

This blog post is my 500th article!!! 

One of the most critical issues in the healthcare field today, for medical providers and facilities and for consumers, is the breach of personal health care information. The theft of personal medical records is big money on the black market, and ID theft due to that crime is rampant.

According to Modern Healthcare magazine, 2016 is being deemed the “year of data security” in healthcare—if only because 2015 was a substantial wake-up call for the industry. Nearly 90 percent of healthcare providers have been hit by data breaches in the last two years, according to security research firm Ponemon Institute, with many large-scale and criminally driven attacks publicized in 2015. More details are located at this website: http://www.modernhealthcare.com/article/20160227/SPONSORED/160229900/2016-the-year-of-data-security

HIT Consultant reports that one in three Americans were victims of healthcare data breaches in 2015, attributed to a series of large-scale attacks that each affected more than 10 million individuals. These and other statistics are contained in Bitglass’ 2016 Healthcare Breach Report.

Among the most significant findings of the report was that in 2015, 98 percent of record leaks were due to large-scale breaches targeting the healthcare industry. These high-profile attacks were the largest source of healthcare data loss and indicate that cyber attackers are increasingly targeting medical data.

Such breaches include the widely publicized Premera Blue Cross hack involving 11 million customers, and the Anthem hack which resulted in 78.8 million leaked customer records. More info is located at this website: http://hitconsultant.net/2016/01/28/hackers-caused-98-of-healthcare-data-breaches/ .

According to Health IT Security, 80 percent of organizations handling sensitive information report concern for large-scale data breaches, based on a survey conducted by Advisen. This survey included organizations from several different industries, but the most highly represented industry was healthcare, comprising 22 percent of the respondent sample.

Despite the growing concern for large-scale data breaches, the study’s authors report that organizations may not be doing enough. While three quarters of respondents report having some sort of data breach response plan, these plans may not go through rigorous enough testing. You can find more material on this subject at this site: http://healthitsecurity.com/news/large-data-breaches-top-worry-for-health-pros-survey-shows .

Forbes Magazine reported that 2015 was the worst year yet for data breaches. The online mechanism for the Office of Civil Rights (OCR) under Health and Human Services publishes data breaches as reported to them and required by HIPAA. The numbers last year are just staggering:

·         According to OCR, there were 253 healthcare breaches that affected 500 individuals or more with a combined loss of over 112 million records.

·         The top 10 data breaches alone accounted for just over 111 million records that were lost, stolen or inappropriately disclosed.

·         The top six breaches affected at least 1 million individuals–and four of the six were Blue Cross Blue Shield organizations.

While HIPAA is the legislation (passed in 1996) designed to protect patients against loss, theft or disclosure of their sensitive medical information, the fines and penalties don’t appear to be having a discernible effect on either patient privacy or data security.

A recent data breach study estimates that breaches cost the healthcare industry about $5.6 billion annually. As healthcare moves toward connected care, the amount of data exchanged between organizations is only going to grow. So what does this mean? It means that in 2016, the healthcare industry is going to see a huge movement towards encryption in hospitals and other healthcare facilities in order to protect EHRs (electronic health records) and other vulnerable PHI (Personal Health Information). More detailed material is located at this website: http://www.forbes.com/sites/danmunro/2015/12/31/data-breaches-in-healthcare-total-over-112-million-records-in-2015/#3f9cb33b7fd5 .

Oddly enough, however, according to Health IT Security, the first few months into 2016 are showing a slightly different trend, with results from the Department of Health and Human Services (HHS) indicating that stolen devices and improper disposal are the top threats currently facing the industry. Patient names, addresses, phone numbers, Social Security numbers, dates of birth, health insurance numbers, other medical status and assessment information as well as some financial information have been exposed with these incidents.

The top five healthcare data breaches of this year so far do not involve hacking or an IT incident, according to the HHS Office for Civil Rights (OCR) data breach reporting tool. Instead, theft, loss, improper disposal, and unauthorized email access or disclosure have caused the largest incidents in 2016. More info is located at this website: http://healthitsecurity.com/news/top-5-healthcare-data-breaches-in-2016-not-from-hacking .

According to IT Business Edge, a big part of the problem is that security organizations are still focused on preventative security — looking for a silver bullet that will keep an attacker out of their networks in the first place. Despite a Gartner recommendation that organizations shift security efforts toward the detection of network intruders and the emergence of promising new behavioral analytic tools and security strategies, well under 1 percent of enterprises have the ability to find a post-intrusion network attacker. Cyber criminals continue to have the potential for unimpeded, long-term success. More info is located at this site: http://www.itbusinessedge.com/slideshows/2016-security-trends-whats-next-for-data-breaches-06.html .

Hospitals, health systems, payers and any organization with stewardship of healthcare data are prime targets for cyberattacks, according to Becker’s Hospital Review (BHR). And there are plenty of cautionary tales showing just how much damage hackers can do. While no healthcare organization will ever be completely invulnerable to such attacks, they can learn from others' mistakes.

Here are four lessons, according to BHR, healthcare providers can consider when thinking about data breach prevention and preparedness:

1.    Don't fall prey to known vulnerabilities.

2.    Utilize experience-based training.

3.    Consider a third party for security audits.

4.    Create a contingency plan.

More information about this topic is available at this website: http://www.beckershospitalreview.com/healthcare-information-technology/4-healthcare-data-breach-lessons-to-take-to-heart.html .

Businesses, especially in the healthcare field, must always make every effort to protect patient information. That is their responsibility, and they can be held civilly responsible, and criminally responsible if there is a proven negligent act. As a consumer, you may receive a letter or an email informing you that your personal information may have gotten into the wrong hands as a result of a data breach.  Perhaps a media report alerted you to a security breach at a company where you do business.

Regardless of the type of data breach, medical information is more difficult to recover, manage, and restore, especially for consumers. According to Privacy Rights Clearinghouse, there are helpful tips on what to do if a breach has occurred. Much more detail is located at this website: https://www.privacyrights.org/how-to-deal-security-breach .

Always be diligent to monitor your healthcare information. Take steps to protect your personal data, and never provide your information to businesses that have no protection or privacy capabilities in place. Always ask who will see your information, and request a copy of their privacy policies. If you discover that a breach has occurred, take quick action to reduce the exposure and limit the damage that can be done. It’s your life. Keep it secret. Keep it safe.

Until next time. 

Health Care and FMLA

The Family and Medical Leave Act (FMLA) was passed as a federal law in 1993, requiring covered employers to provide employees job-protected and paid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. The FMLA was intended "to balance the demands of the workplace with the needs of families."

According to the US Department of Labor, the FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to the following benefits:

--Twelve workweeks of leave in a 12-month period for:

·         the birth of a child and to care for the newborn child within one year of birth;

·         the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;

·         to care for the employee’s spouse, child, or parent who has a serious health condition;

·         a serious health condition that makes the employee unable to perform the essential functions of his or her job;

·         any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;” or

--Twenty-six workweeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin (military caregiver leave).  More information is available at this website: http://www.dol.gov/whd/fmla/ .

But there are some qualifiers for someone who is employed that wants to use this as a legal way to take time off from work for medical or family reasons. In order to be eligible for FMLA leave, an employee must have been at the business at least 12 months, and worked at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. The FMLA covers both public- and private-sector employees, but certain categories of employees are excluded, including elected officials and their personal staff members.

Generally, the FMLA requires an employee to give his or her employer 30 days' notice of intention to take FMLA leave, and the reason for the leave, according to FindLaw.com. There is no "magic language" that the employee must use in notifying the employer, nor does the employee need to mention the FMLA by name. Instead, the notice must give the employer enough information to know the employee is requesting time off, and why.

This allows the employer to determine if the request qualifies under the FMLA, and allows time to find a replacement for the employee. When the need for FMLA leave arises suddenly, like an unexpected medical emergency, employees may take FMLA leave without prior notice. However, employees must give the employer as much notice as is reasonable under the circumstances. More detailed material about this law is available at this site: http://employment.findlaw.com/family-medical-leave/family-and-medical-leave-act.html .

According to the National Partnership for Women and Families (NPWF), America's workers have used the FMLA at least 200 million times to take time off when they need it most, without having to worry about losing their jobs or their health insurance. However, About 40 percent of the workforce is not eligible for leave under the FMLA. More info is located at this website: http://www.nationalpartnership.org/issues/work-family/fmla.html .

The FMLA can be abused by employees in some cases, especially on intermittent leave. Employers have some options to monitor the requests. One of the biggest employer complaints about FMLA is the productivity problems caused by employees’ use—and abuse—of FMLA intermittent leave. The problem: employees with chronic health problems often take FMLA leave in short increments of an hour or less. According to Business Management Daily, here are four tips on certifying FMLA intermittent leave requests:

1. Ask about the specific condition. Medical certification must relate only to the serious health condition that is causing the leave. Employers can’t ask about the employee’s general health or other conditions.

2. Give 15 days to respond. After requesting certification, give employees at least 15 calendar days to submit the paperwork. If the employee’s medical certification is incomplete or insufficient, specify in writing what information is lacking and allow the employee seven days to cure the deficiency.

3. If the need for leave is doubted, investigate the certification. Under the updated FMLA regulations, an organization can contact the employee’s physician directly to clarify the medical certification. The contact person can be a health care provider, a human resources professional, a leave administrator (including third-party administrators) or a management official, but not the employee’s direct supervisor.

4. If the request is still not convincing, require (and pay for) a second opinion. Use an independent doctor selected by the employer, not a doctor who works for your organization. If the two opinions conflict, the employer can pay for a third and final, binding medical opinion

The law gives employers the right to demand certification from the employee’s doctor of his or her need for leave. More information on this topic is found at this website: http://www.businessmanagementdaily.com/glp/25988/FMLA-Intermittent-Leave.html .

According to FMLAOnline.com, the Family and Medical Leave Act is an on-going challenge for HR professionals. Because its rules are so complex, companies are vulnerable to FMLA abuse, exploitation, and miscomprehension. It takes only one confused or misinformed employee to cost a business tens of thousands of dollars in FMLA lawsuits. There are three different kinds of FMLA leave:

·         Continuous FMLA leave: An employee is absent for more than three consecutive business days and has been treated by a doctor.

·         Intermittent FMLA leave: An employee is taking time off in separate blocks due to a serious health condition that qualifies for FMLA. Intermittent leave can be in hourly, daily, or weekly increments. Intermittent FMLA is often taken when an employee needs ongoing treatment for their condition.

·         Reduced schedule FMLA leave: An employee needs to reduce the amount of hours they work per day or per week, often to care for a family member or to reduce stress.

All FMLA forms and information about an employee’s FMLA leave and condition must be kept confidential and separate from other employee files. It is an FMLA violation for an employer to share information about an employee’s FMLA leave with other employees. Additional material on FMLA policies is located at this site: http://fmlaonline.com/ .

According to HRHero.com, employers must keep accurate records pertaining to the leave and either physically or electronically post a notice of employees’ rights under the FMLA so that the information is accessible to both employees and job applicants. Furthermore, the FMLA requires employers to maintain the employee’s group health benefits while on leave on the same terms that it provided them when the employee was working.

Leave taken under the FMLA is job-protected, which means that employees must be given the same job or an equivalent job when they return. Employees or the Department of Labor can sue the employer for lost wages, benefits, reinstatement, attorneys’ fees, and liquidated damages for willful violations. Additional information is located at this site: http://topics.hrhero.com/family-and-medical-leave-act-fmla/ .

The FMLA is a definite benefit for qualified employees, and employers have certain protections under the law if there is suspected abuse or violation of FMLA. Going forward, both employees and employers must know the law and follow it to avoid any problems. Both family and medical leave is important in circumstances that mandate time away from work. The key is to understand how it works and how to manage it.

Until next time.