Sleep disturbances and stroke link

Sleep apnea and/or poor sleep habits may increase stroke risk according to a recent large literature reviews. Meta-analysis of 29 studies and 2,343 patients with an ischemic or hemorrhagic stroke or transient ischemic attack showed that more than 72% had sleep disordered breathing (SBD). Insomnia, hypersomnia, and restless leg were also cited as increasing stroke risk. Poor sleep may relate to more than slow healing. Asking patients about sleep patterns should be included in basic intake forms.

Tri-Cities CE event registration now open!

The CHP Group (CHP) is excited to announce our upcoming continuing education and networking event for integrative healthcare providers in the Tri-Cities area!

We invite you to join your friends and colleagues for two hours of free continuing education followed by hosted drinks and appetizers!

Boundaries for Integrative Healthcare Providers

Our clinical expert, Dr. Minga Guerrero, CHP’s Regional Medical Director and past president of the Oregon Board of Chiropractic Examiners, has created an engaging two-hour continuing education program specifically for integrative healthcare providers in Washington. Dr. Guerrero will use this two-hour session to:

  • Explore the various aspects of the provider/patient relationship, explain situations that may cause concern, and how to proactively prevent situations from escalating to a complaint.
  • Review recently-updated Washington state laws and regulations regarding provider/patient boundaries and how these updated regulations impact all providers.
  • Present boundaries violations drawn from real practice situations and discuss how such situations can be avoided.

The CHP Group has been working with integrative healthcare (IH) providers and providing IH-targeted continuing education for over 25 years in the Pacific Northwest. We look forward to seeing you in Tri-Cities!

This course has been approved by the NCCAOM for two (2) PDA points in Ethics.

Click here to register!

Bonus – Networking Event!

Stay for hosted drinks and appetizers after the continuing education concludes and visit with fellow providers and CHP staff! If you’ve attended one of our networking events in the past, you know what a great time is had by all!


3:30 – 4:00 pm | Doors open and attendee check-in

4:00 – 6:00 pm | Boundaries for Integrative Healthcare Providers

6:00 – 7:30 pm | Networking event with hosted drinks and appetizers!

Combating provider burn-out

Finding ways to deal with burn out due to work stress is important, especially for healthcare providers. At a panel discussion at Medscape’s New York City headquarters, participants reported EHR as one primary cause of work-based stress. In addition, higher patient quotas, changing insurance reimbursements, and simply listening to patients in stress were also cited as causes. Medscape’s recent lifestyle survey of 16,000 physicians across 25 specialties noted stress levels (burn-out) reported at up to 55% for some specialties.

Is there a way to combat the potential for burnout in a healthcare career? Panel participants identified taking the time to find the joys in practice such as appreciation from patients, relieving pain, and making the world a better place as a good way to begin relieving stress. Additionally, making time to play, taking time to enjoy family and friends, and distancing oneself from normal work routines were also suggested as highly necessary in medical practice lifestyle.

Can you recover from a worst case scenario?

Does a power failure keep you awake at night?
Are you fretting about a loss of power to your network?
Are you worried that you’ll lose vital information if your computer malfunctions?

If these questions sound familiar you’re not alone. Worry about the integrity of the systems used to run your practice – computers, networks, electronic devices or other technology in your office – is common. However, your worries can be mitigated with a tested, secure back-up system in place to prevent loss of data. You have one, right?

No? Then we encourage you to read on for tips on how to put together a backup solution for your office.

Tip 1 – Get a UPS for each computer

No, not an account with United Parcel Service. Instead, invest in an Uninterruptable Power Supply for each computer in your office. Usually shaped like an overgrown extension cord, UPS devices allow the user enough time to properly power down a computer in the event of a loss of main power. Most devices also function as surge protector, keeping a steady flow of electricity to the computer and minimizing the chance of loss due to power surges.

While a UPS will protect your computer in the event of power loss, they won’t protect you from basic machine failure, which leads us to tip number 2…

Tip 2 – Backup your important files

Patient files. Financial records. Correspondence. If it’s important to you and/or your practice and is stored on a computer, it should be backed up. At its most basic, a backup is simply a duplicate copy of a file that resides separate from the original – it could be on a CD stored in a cabinet, on an external storage device such as a flash drive or external hard drive, or in the cloud (a network of servers used to store data that are usually geographically separate from your location). The three basic items that need to be considered for your backup process are what, how, and where to backup.

  • What: If your office or practice could not function without the information, it needs to be backed up. Additionally, if the information is not in use now, but could be useful in the future or must be retained for tax or other legal purposes, back it up.
  • How: Backup methods run the gamut from manually copying files to a storage device to using software that automates the backup process for you. For more on software to automate your backup process, check out this March 2016 review of four backup software packages.
  • Where: There are many options for where your backup information can reside. Two of the most popular are external hard drives and the cloud. There are pro’s and con’s for each location depending on whether you need to carry the backup with you, speed of internet access to upload/download backups, ongoing cost, and more. Only you can make the right choice for your business. Google “cloud vs onsite back-up” for more information or visit this com Small Business Hub article for more info.

Tip 3 – Save your data with compliance in mind

Whatever backup method and storage location chosen, you must ensure that it is HIPAA-compliant. If you’ve chosen a software that backs up to the cloud, have you confirmed that that data is encrypted and the encryption is HIPAA-compliant? Do you have a Business Associate Agreement with the vendor you’ve chosen? If you’re using a local storage device, is it encrypted and password-protected? Is it stored in a physical location that in accessible only to the appropriate personnel?, the national website devoted to information technology in healthcare, has published an information-packed booklet entitled Privacy and Security of Electronic Health Information. Download it for more information on understanding your role in keeping your patient’s data secure.

While CHP does not endorse any particular method for the backup of your important files, we do encourage all providers to have a backup plan in place and test it regularly, because, in the immortal words of Winston Churchill “He who fails to plan is planning to fail.”

Medication mixing a problem for heart failure patients

The American Heart Association (AHA) issued a scientific statement on July 11, 2016 urging providers caring for heart failure patients to discuss ALL the medications the patients taking to reduce the risk of exacerbating heart failure. Dr. Robert L. Page II corresponded with Reuters Health by e-mail and noted, “When a patient takes at least four medications the risk for a drug-drug interaction increases to 38 percent; this number increases to 82 percent when patients are taking seven or more medications, which many patients with heart failure do.”

The statement from the AHA encourages providers to discuss all prescription medications, over-the-counter medications, and nutritional or vitamin supplements with their patients at every visit, as some of these can have unintentional side effects or additives that are contraindicated for heart failure patients.

A list of medications that can worsen heart failure is in the July 11, 2016 early edition of the Circulation.

HIPAA and your electronic communications

Checking your weather app on your phone for today’s forecast before you leave the house.
Tweeting your response to a news article.
Reading your e-mail on the light rail during your commute.
Paying for your coffee with your electronic wallet.
Liking your friend’s Instagram post.

Likely one or all of these activities describes part of your day. Electronic devices are ingrained in our daily habits and communication on them is second nature to most of us. We may rarely stop to think about the consequences of using them when corresponding with patients or using patients’ protected health information (PHI). However, if you are a healthcare provider, there are things that you must be aware of when using your device via text, e-mail, or social media.

Type of Network: Know what type of wireless or cellular network you are on when texting or e-mailing. PHI is vulnerable to being intercepted via unsecured networks such as the public WiFi at a local coffee shop or hotel. It is important to think about HIPAA security and privacy concerns whenever communicating with patients or other providers.

Size of Device: One area of risk when texting and e-mailing using a handheld device such as an iPhone, tablet or Android device is their size. They are generally small and can be easily stolen, thereby allowing PHI to be accessible to the thief. The device passcodes and biometric identifiers (such as touch ID on iPhones) may help to deter access but do not provide secure protection of the information contained in the memory of the device.

Internet: The internet can be a great way to advertise and/or educate your patients; however, it is vitally important to be sure the person managing this area of your practice understands the professional obligations pertaining to HIPAA. Think carefully before posting on the internet. Do not assume an online forum is private or secure. Be aware that information posted on the internet may remain there permanently, even if you delete your comment or post.

How can you ensure a secure electronic communication? There are methods available to assist with data security when transmitting PHI electronically such as encryption or subscription to a secure messaging service. For more information on securing your digital information, is an excellent resource that offers training materials and guidance on this topic.

“Sweet relief” for chronic pain?

The importance of diet on overall health has been documented in many areas including heart disease, diabetes, dementia, and skin disorders. What possible impact could diet have on chronic pain? This daily wellness tip from the Cleveland Clinic highlights the connection between sugar and simple carbohydrate consumption – like honey, corn syrup, white rice, and wheat flour – and chronic pain. Dr. Brenda Powell, an integrative medicine specialist and fellowship director at Cleveland Clinic’s Center for Integrative & Lifestyle Medicine, noted that these foods all stimulate increased insulin levels which, in turn, causes pain-producing inflammatory markers. The Clinic’s recommendation? An anti-inflammatory diet that can assist in controlling chronic pain caused by these inflammatory markers. What should it include? Dr. Powell encourages lots of fruits and vegetables with an ideal meal plate template that includes two-thirds fruits and vegetables and one-third protein, grains, and nourishing fats. While there are sugars in fruit and some vegetables, there is a balance of fiber that allows them to be broken down more slowly without an inflammatory reaction.

If you are treating patients with chronic pain conditions, talking with them about an anti-inflammatory diet may be appropriate.

The “wonder drug”?

What if there was a magical “wonder drug” that could improve your patient’s (and your) health in a number of ways? What if it treated a multitude of conditions including musculoskeletal diseases, hypertension, diabetes, Parkinson’s disease, and depression? What if it was free, easy to access, and didn’t require a prescription?

Would you make sure everyone knew about it? Would you discuss it openly with your patients?

Great news – it exists! However, it’s not a pill, powder, or injection. It’s simply… exercise.

A recent column by Aaron E. Carroll in The New York Times noted that the outcomes achieved with the recommended 150 minutes/week of moderate physical activity for health-related conditions can’t be claimed by any other single intervention. While it is not a “miracle cure” for all ailments, the authors of a editorial in the BMJ call it “the best buy for public health”; it has been linked to improved health in many areas including the ones mentioned above. Mr. Carroll also notes that “Moderate intensity is probably much less than you think”. A brisk walk, a leisurely bicycle ride, or even vacuuming floors will qualify.

A systematic review and meta-analysis of physical activity promotion, published in 2012, showed that provider advocacy and recommendation of activity in a primary care setting works. If you are not already doing so, why not add a question to your intake form about how much moderate physical activity your patients are getting? Make time to discuss the benefits of just 30 minutes a day of physical activity with your patients and offer suggestions for incorporating physical activity into daily routines.

Will it cure every disease? No. Can it have an beneficial impact on you and your patients? Yes, definitely. Why not try and recommend the “wonder drug” of moderate physical activity today?

More best practices on informed consent

The topic of informed consent has been discussed in the medical community for many years, yet there still exist problems with the informed consent process that many patients face. A recent article in JAMA noted that “… informed consent documents are often signed minutes before the start of a procedure, a time when patients are most vulnerable and least likely to ask questions…”

CHP recommends the use of the PARQ format for obtaining informed consent. Informed consent forms come in many sizes and content formats, but, for all providers, the basic rule is to include:

  • P = Procedures explained
  • A = Alternatives given and providers may choose to explain what may happen with no treatment rendered
  • R = Risks explained
  • Q = Questions from the patient

The PARQ format is designed to be used BEFORE the patient signs the informed consent document and includes both appropriate time for verbal discussion and proper documentation. (See our best practices blog post on PARQ here and documenting PARQ here.) The use of PARQ protects both the patient and the provider.

A recent trend in informed consent documents among multiple professions has been the addition of indemnification language. A sample of indemnification language seen in recent forms is below:

“The patient will hold the provider, all its agents, employees, family and corporation harmless from any and all claims, demands damages and causes of action present or arising in the future from any injuries or harm received during treatment, even in cases of negligence by the provider or its’ employees. I understand this release of liability and assumption of risk and fully accept this agreement, affirming with my signature.”

While indemnification language may seem like a smart provision for protections, providers are advised to check with their malpractice companies before using it. A chiropractic malpractice insurance carrier we consulted with advises against using this type of language in consent forms; University of Western States does not use indemnification language in its curriculum and advises against using it in practice. Local law firms also warn of the potential fallout if a case were to come before a judge or jury. Further, a provider may not indemnify against negligence when coming before a licensing board.

If you are currently using indemnification language on any of your forms, you are encouraged to consult with your legal counsel.

Meta-analysis shows tai chi lowers blood pressure as well as prescription medication

Researchers from the University of Connecticut presented their findings on the blood pressure-lowering effects of tai chi at the American College of Sports Medicine 2016 Annual Meeting. Their meta-analysis of 28 studies on tai chi practiced by adults with a median age of 62 years, showed that tai chi can lower blood pressure as effectively as drugs or aerobic exercise. This may be good news to elderly patients who are more adapted to low intensity exercise. On average, subjects practiced tai chi for 61 minutes twice a week for 20.6 weeks. Systolic pressure was lowered 6 mm Hg and diastolic was lowered 3mm Hg. The researchers noted that with greater frequency of tai chi practice, the blood pressure was lowered even more.

If you treat elderly patients who are open to adding low-intensity exercise to their daily routine, tai chi may be an appropriate recommendation, especially if they have high blood pressure.