Best Practices: Material Risk Notice for Opioid Prescription

Opioids can be useful tools for both chronic and acute diagnoses. The Oregon Medical Board (OMB) requires all providers who prescribe their use accompany it with a ‘Material Risk Notice’. This form outlines parameters, risks, and alternative therapies for patients using these substances. Using this form as outlined will keep providers who prescribe opiates in compliance with OMB standards.

Duty to report: What does it mean for you?

What is a “duty to report” law? A “duty to report” law requires all medical providers for the living and deceased – including mortuary workers and veterinarians – must report information to their board that covers information on themselves such as convictions, pending criminal investigations, DUI and any malpractice settlements, including those reached out of court. In addition it requires these same providers to report any information they may have on other providers where a suspicion of unprofessional conduct is known. There must be compelling circumstances to drive the report.

Who has to follow this rule? Many states have a duty to report law. In Oregon, all medical providers are required to follow ORS Chapter 676 reporting obligations, defined as:

ORS 676.150 Duty to report prohibited or unprofessional conduct, arrests and convictions; investigation, confidentiality; immunity from liability.

What are some examples? The following are two scenarios that could prompt a provider to think about making a report to a licensing board.

Scenario 1: You are chiropractor with a new patient – “Mrs. Smith”. Mrs. Smith reports to you an incident where another doctor was palpating her low back and got too close to her buttocks without warning her about what he was going to be doing. The patient felt like the treatment ‘wasn’t right’. She didn’t continue seeing that doctor because the lack of communication before touching made them uncomfortable. Mrs. Smith explained that the treatments helped her pain, but the doctor moved too fast and didn’t explain procedures before touching her.

Is this a duty to report situation? No, probably not. It is more likely a problem of poor communication between doctor and patient. This example is not meant to minimize the patient’s discomfort or invalidate their feelings, however without clear malicious intent, it’s unlikely this would rise to the level of a sexual misconduct or unprofessional misconduct claim.

Scenario 2: You have a new patient scheduled for a 2 pm appointment. At the appointment time, your new patient accidentally shows up at a chiropractic office across the street from yours. The patient’s mother had given her son (the new patient) paperwork to fill out and he hands that to the receptionist. The receptionist thanks the young man for the paperwork – while seeing that it clearly has another office address and other identifiers on it. She then hands him a set of their new patient intake to fill out. He objects and notes that he just gave her the paperwork. The receptionist indicates that the doctor needs a second set done. The new patient dutifully begins filling it out. At this point, he’s 15 minutes late for his appointment with you. Your receptionist calls the mother to see why the son hasn’t shown up. She tells your receptionist that he left in plenty of time and gives your office the son’s cell number. When he answers and says he’s in the office it’s then discovered by both the new patient and your office that the office across the street has ‘hijacked a patient’. The doctor at the incorrect office is with the new patient as he’s speaking on the phone. The doctor tells the patient “You don’t have to go to another office, since you’ve never seen that doctor and you’re already here and I’m ready to begin treatment.” The patient is upset that he’s now late and was made to fill out extra forms. He leaves and arrives late to the correct office, yours.”

Is this a duty to report situation? Yes, it is. This is an example of unprofessional conduct by the chiropractor at the incorrect office. The doctor of origin is within his/her rights to file a complaint to the licensing board, even though most of the conversation between the patient, receptionist, and wrong chiropractor were related secondhand.

Syphilis in Oregon shows 1500% increase – Proactive providers steps to protect patients

The Centers for Disease Control (CDC) and the Oregon Health Authority (OHA) have recently posted a bulletin for all Oregon healthcare providers due the massive increase in syphilis cases since 2007 – from fewer than 30 cases reported in 2007 to about 450 cases statewide during 2015. Providers should be on alert to provide intake forms that may capture a need for further screening. Because you can’t tell by simply looking at a patient whether or not they need testing, certain behaviors may suggest a need for screening. Providers should take a good sexual and drug use history from all patients.

To read the full text of the bulletin and get more information on Oregon’s fight against sexually transmitted diseases visit the Oregon Health Authority’s Public Health page at

Weight loss programs may prevent lumbar spinal stenosis

A recent cohort study indicates that assisting arthritic, obese patients with weight loss programs may signal better outcomes to both prevent onset and assist with improved surgical outcomes with lumbar spinal stenosis. Obese and overweight persons are at a higher risk for developing LSS (lumbar spinal stenosis). Furthermore, results indicate that obesity might be a novel explanation for the increased number of patients with clinical LSS. Weight loss provides a good treatment option that may deter LSS onset and produce better surgical outcomes.

My computer isn’t a phone charger?

It’s quite common to walk through an office (medical or otherwise) these days and see cell phones connected to computers via a USB cable. The most likely cause? The phone needs to be charged and there’s not a wall outlet or adapter available. But are they any safety and security concerns that providers should know about this practice?

As it turns out, there are some issues that you need to be aware of when connecting your phone to your computer, even if it’s just to charge it. Some phones are recognized by the computer as a small, portable hard drive; others will request that software be installed to manage the phone. Either of these two scenarios can create security issues and concerns. has a section devoted to Mobile Device Privacy and Security that covers topics including management of mobile devices, frequently asked questions, case studies, and information on protection and encryption of mobile devices. If you or your staff use mobiles devices in your practice, we encourage you to visit to obtain more information about this topic.

Another good reason not to charge your phone via USB on your computer? The power flow from a USB drive is not consistent and can cause the battery on your phone to degrade prematurely.

Surgery for Your Lumbar Spinal Stenosis Patients?

In two studies, outcome predictors for lumbar spinal stenosis surgery shows a distinct initial improvement in activities of daily living and decreased pain the first four years following surgical intervention. However, these good effects begin to gradually deteriorate over year 5, 6 and 7; until by year 8, these randomized controlled groups, are nearly indistinguishable, with respect to symptoms.

According to the study’s lead author, Dr. Jon Lurie, “This may not fundamentally change how the process of shared decision-making should happen, but it adds new information to that process. For spinal stenosis, the pros and cons of surgery are very individual and related to the severity of the disease and the limitations of the individual, what the individual likes to do, and how well he or she is able to manage disease symptoms.”

Long-term outcomse of lumbar spinal stenosis: eight-year results of the Spine Patients Outcomes Research Trial (SPORT)

Surgery versus physical therapy for treating lumbar spinal stenosis

Looking for chiropractic practice information?

If you’re a chiropractor looking for practice information and guidelines on a variety of chiropractic-related topics, with links peer-reviewed articles on integrative healthcare, original blog content, and integrative healthcare resources, check out (registration may be required to access certain features). This site, started in 1995 by a group of chiropractors who wanted to feature the “best information and communication possible”, offers original content blog posts on integrative healthcare topics, (Chiropractic Reaches Consensus on Terminology for States for Care), as well as literature synthesis and integrative healthcare resources (Low Back Pain and Chiropractic section).

Review all they have to offer at

To meat or not to meat, that is the question?

Recent well-publicized concerns about the consumption of processed meats such as bacon, ham, and sausage as a link to increased risk of colon cancer has us all wondering, is this the end of “everything is better with bacon”? The evidence as explained in the March 30, 2015 and November 3, 2015 editions of TheUpshot by Aaron E. Carroll helps to provide some balance to this ham-bashing.

Best Practices: HIPAA and Mobile Devices – Part 2

Are your mobile devices secure when it comes to protected health information (PHI)? Here are some tips to expand your awareness in this area. These tips and more can be found on, an excellent HIPAA resource for providers!

Can I use texting to communicate protected health information, even with another provider or professional?
It depends but generally no. Text messages are not secure because they lack encryption. Even if your device is encrypted, you still cannot be certain your text message was received by the intended recipient. If texting is an important means of communication for you there are third-party solutions available; diligence in researching their compliance is a must.

What do I need to consider when using my mobile device in public?
Public Wi-Fi is unsecured. Working from a local coffee shop, for example, to perform billing or charting would not be not a good idea. On that same note, do you let employees catch up work from home, like billing or charting? If yes, do you know the security of the PHI that may be downloaded on their personal devices? What is your company policy on employees using their own equipment to perform office work?

Do I need to be concerned about talking to my office staff via Bluetooth?
Yes. You must be sure to know your cell phone capability in this area. Many phones have a “turn off” or set the Bluetooth capabilities to “non-discoverable.” In this mode, the Bluetooth-enabled mobile device is invisible to other devices not authorized to access or monitor the data in your device.

Note: Please consult with a security and privacy professional for advice and guidance for your specific situation.

Less May Be More: Breast Cancer Screening Recommendations & Changing Physician Behaviors

Transparent evidence-based recommendations for appropriate breast cancer screening provide the best approach to early detection while minimizing the costs associated with false positives. With respect to the issues around breast cancer, this may involve doing less – and it’s very difficult to get physicians to do less. Review the current recommendations here and read about the challenges accompanying the implementation of a less-may-be-more approach.