Next week Thursday May 9th 2013, we will celebrate President’s night.
I am planning to talk about the exciting new technologies that will be available in Ob/Gyn and it’s subspecialties. I will also explore the future of healthcare practice in view of recent policies.Despite all the challenges, I believe that we live in remarkable moments. To succeed we need to be involved in the changes ahead to revitalize medicine, as we know; to transform the face of medicine, rejuvenate current practicing physicians and inspire the generations to come.
Please join us for the final meeting of this year.
Warmest regards
Albert El-Roeiy MD, MBA-President

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NIPD allows prenatal testing to be per­formed on a sample of maternal blood rather than a patient’s undergoing an invasive procedure, such as amniocente­sis or chorionic villus sampling (CVS). There are several different ways to ana­lyze fetal DNA in maternal serum. NIPD enables one to look at fragments of cell free fetal DNA as opposed to whole fetal cells in maternal serum. This technique could potentially be implemented ear­lier in pregnancy than more traditional testing, giving patients the advantage of more time to think about what to do with their results. The noninvasive nature of the testing spares the mother dis­comfort and negates the risk of fetal loss associated with amniocentesis or CVS.

Critical Evaluation of the Newest Gadget in Uro/Gyn

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I am sure that you are aware of the power that the Internet and social media have provided patients. My patients know the pregnancy rates of my clinic’s IVF procedures, see the feedback and testimonials that my previous patients have posted, and after their first visit, they in turn post their impressions. So the questions we practicing physicians need to answer are:

1. Do we need to be involved? Do we need to become a part of the social media community, in order to ensure that our roles as “healthcare authorities” remain robust?

2. What are the constraints of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that might prevent doctors from using email, text messaging, or even Facebook and Twitter, to communicate about patient care, without the risk of being fined or fired?

It is my belief that physicians must be involved in social media because our role as “healthcare authorities” is leaking from our exam and consultation rooms to the unchartered territory of the Internet. How many of us have received a deluge of calls to our offices after publications about cancer screening or estrogen replacement therapy hit the media? If we were to have a constant vehicle with which we could provide context for these publications or study findings, then our roles as “healthcare authorities” would be maintained.

The Internet can help us decode myths. I was stunned by a study that showed that almost fifty percent of respondents believed that autism and vaccinations are related. Those who are not held accountable by their statements, such as celebrities and politicians, have repeatedly made these allegations. Following such assertions, vaccination rates have dropped in the past few years. Physicians can use social media to debunk claims that are false and may cause harm to others.

The use of social media can lend transparency to the provision of healthcare by allowing physicians and patients to provide direct feedback to each other. Patients complain that physicians are now occupied with their laptops instead of interacting with their patients. Physicians can educate their patients about related to bureaucracy, paperwork and the “time pressures” associated with the use of electronic medical records (EMR). By using social media to influence their constituents, physicians can affect change on the legislative frontlines, especially in the realm of healthcare regulation.

In an online forum, patients can vent their frustrations regarding paperwork, healthcare coverage, and the waiting time for a visit or the lack of response from their providers. I believe that although these issues can be initially unpleasant, the transparent feedback will improve the quality of healthcare as a whole.

How do we get involved?

I believe that many physicians can utilize Facebook, Twitter or Blogging websites to relay their point of views to their patients and to the general population. Although the frequency of updates may differ, all three services can be very effective.

Challenges

There are challenges involved in using the web. It is important to remember that what you post on the web is indexed by Google almost immediately and instantly becomes searchable. Consider whatever you post online as being permanently “tattooed” onto the web and whatever you post or what others post about you as forming your “digital footprint”.

Although information is becoming more ubiquitous via the Internet, it is also less secure, and enforcement of information breaches is becoming more stringent. According to a recent study from the Ponemon Institute*, many hospitals and healthcare organizations believe they have insufficient security and privacy budgets, and impacted patients are not always receiving the privacy they are promised. Similarly, data breaches alone have risen by 32%. Ninety-two percent of all healthcare institutions report they have experienced a data breach in the past two years. Each such incident costs an average of $2.2 million. At the same time, the Department of Health and Human Services recently began conducting formal audits of HIPAA compliance, with the accompanying risk of civil and even criminal penalties. The Joint Commission on Accreditation of Healthcare Organizations has announced a “ban” on physician texting, stating that using a Short Message Service (SMS) is not an acceptable method of communicating patient information.

A sampling of HIPAA crackdown stories in 2011 include the following:

February 2011: Massachusetts General Hospital was ordered to pay a $1 million federal fine after a hospital employee left patient medical records on a subway train.

April 2011: A Rhode Island physician was fired, fined and officially reprimanded by the state licensing board for posting about a patient online, despite not including patient’s identifying information.

July 2011: UCLA agreed to pay an $865,000 fine to settle possible privacy violations involving improper disclosure of medical records.

August 2011: A Detroit nurse lost her job after posting about, but not naming, a patient on Facebook.

September 2011: Stanford University was hit with a $20 million lawsuit over a data breach that exposed the names and diagnoses of 20,000 patients online.

October 2011: Two class action lawsuits were brought against Sutter Health following the theft of a desktop computer that contained information affecting over four million patients.

How do we get involved responsibly?

As physicians, how can we responsibly involve ourselves in social media? The following principles are extremely important:

• Patient privacy always comes first.

• HIPAA regulations should provide the minimum threshold for divulging information.

• When posting online, be professional. Be aware of how your words may be manipulated or misinterpreted.

• When using social media, follow guidelines provided by professional organizations and medical societies.

Physicians and hospital administrators need to come together to use secure (encrypted), efficient, convenient and HIPAA compliant methods to discuss and coordinate patient care.

Research has shown that as far as technology goes, doctors have proven themselves to be early adopters to the phenomenon of social media. Facebook and Twitter are already showing us how effectively networked communities can transmit important data, and even bring obscure new ideas to the forefront of cultural debate. More importantly, by posting, sharing, and commenting on articles and published studies and medical information discussed on radio and TV, physicians will become more active and engaged and continue to be the “healthcare authority” in their patients’ eyes.

Although the challenges discussed above can be empowering, we are fortunate to have Fay Rozovsky JD, MPH** to educate us on how to safely navigate involvement in the sometimes troubled waters of social media. Please join us for a wonderful evening in February 14th 2013.

* http://www.ponemon.org/

** http://www.therozovskygroup.com/

For January’s joint meeting with the Philadelphia Area Reproductive Endocrine Society (PARES), we have invited Dr. Norbert Gleicher of the Center for Human Reproduction in New York to discuss two very important issues that raise moral and ethical questions in assisted reproductive technology:

• The number of embryos transferred during in vitro fertilization (IVF) and
• The issue of gender selection.

Number of Embryos Transferred During IVF

In an effort to reduce the number of higher-order multiple pregnancies, the American Society for Reproductive Medicine  (ASRM) 1, recently revised its recommendations regarding the number of embryos to be transferred during IVF. It is well established that multiple gestations have an increased risk of complications for both fetuses and mothers. Ideally, the goal of IVF is to achieve a singleton gestation.  In some countries, laws impose strict limitations on the number of embryos transferred. In the United States, physicians have the option to individualize the number of embryos transferred to each patient, based on the patient’s age, embryo quality and the opportunity for cryopreservation.  ASRM took into consideration favourable conditions and defined the ideal number of embryos to be transferred. In this newsletter, Dr. Steve Sondheimer  (Reproductive Endocrinology) and Dr. Nancy Roberts (Maternal Fetal Medicine) summarized their views regarding this issue. Dr. Gleicher will present a contrasting view via data that argues against transfer of  a single or a limited number of embryos and the current push to reduce twin rates in IVF.

Gender selection

For most of human history, the gender of a new-born child has been a surprise and an aspect of life not under human control. Today’s technology allows parents to not only know the gender of their child before birth, but to choose the child’s gender, if undergoing IVF. The use of IVF in combination with preimplantation genetic screening  (PGS) to prevent chromosomal or gender-linked disorders is not a new technology and has been deemed ethical2.  Using these technologies to select gender has recently become a controversial issue with regards to reproductive freedom. In the case of the medical need to provide the best outcome for both mother and child, the use of PGS is an ethical practice, but what are the moral and ethical issues related to gender selection?

One of the arguments to justify gender selection is “Family balancing”; the technology gives parents the joy of raising both boys and girls. Family balancing can also be viewed as a parent’s wish to have children of a specific gender in a specific order. Some Asian cultures hold belief systems wherein first born males are preferred over females. 2

Proponents of gender selection support the practice in the name of “Procreative Autonomy,” defined as the liberty to decide when and how to have children according to what parents judge is best.”3 Many parents feel that if the technology exists, then they should have the procreative right to choose the gender of their child in order to create the type of family they desire. Is this argument ethical?

Since people increasingly want control over every possible aspect of their lives, 4 some argue that gender selection might become the gateway to other forms of trait selection for parents who can pay for the procedures? The dilemmas associated with this topic are significant. I am certain that Dr. Gleicher will address these most vital and provocative concerns. I encourage our members to attend the upcoming lecture and partake in what is certain to be a most enlightening meeting.

Although we expect a wonderful evening on January 10^th 2013, it is hard to ignore that healthcare faces significant challenges throughout the upcoming year.

These challenges include:

• Increases in Premiums

•  Medicare Cuts  – The Independent Payment Advisory  Board (IPAB) will look for ways to cut Medicare and cut  Payments to physicians. We must also contend with the cuts to Medicare required by the president’s Affordable Care Act (ACA). The ACA took more than $700 billion from Medicare to help pay for the new entitlement programs and the expansion of Medicaid. This reallocation will undoubtedly detract from care for seniors who desperately need it and will also affect physicians’ incomes.

• Hospitals and health systems need to become more lean and efficient.

•  The  “Silver Boom”, the U.S.  population’s changing demographics.  Ten thousand plus baby boomers will enter retirement age every day for the next 20 years, increasing the demand for quality care and accessible coverage and causing increased financial constraints on the healthcare industry.

• Risk Sharing – We will begin to see an increase in hospital alliances, payer/provider collaboration and shared costs.

•  Buying Exchanges  – Many states have deferred to the federal government’s sponsored exchange, but there are still projects underway to develop state managed exchanges.

•  New Channel of Engagement  – Communication and collaboration between health care providers and consumers will increase, as our population becomes more techs savvy.

Though these challenges are enormous, the Obstetrical Society of Philadelphia will continue to promote an environment where education and discussions amongst colleagues will address strategies to help all of us become more successful. Please encourage your peers to join our great society in these important times.

Elective Gender Selection and Single Embryo in IVF
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