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Practical Steps to Rebuilding from Hurricane Ian

All Americans are heartbroken at the devastation people are feeling in the aftermath of hurricane Ian. Conditions remain challenging, including offices without power, internet, and ruined medical records from water damage. We think of the patients who may face increased stress, depression, and pain from the ordeal. During this time, we also empathize with offices walloped by the COVID pandemic, who now take another punch from Ian.

In the clean-up efforts from Hurricane Ian, physicians are faced with the question of what to do with medical records that have been damaged or destroyed by water and wind. Even though areas of Florida are a disaster, it is essential to salvage your life, your family, and your practice to benefit those patients who put their care in your hands.

The administrative requirements of the HIPAA Privacy law require physicians and other health care "covered entities" to undertake reasonable and appropriate administrative, technical, and physical safeguards to prevent intentional or unintentional use or disclosure of protected health information ("PHI"). In other words, patient-protected health information must be gathered and restored with urgency. Health and financial records are vital commodities that should be salvaged whenever possible.

The HIPAA Privacy Law dictates that an emergency plan is in place for all covered entities. It can be argued that the severity and destruction of Hurricane Ian could not be foreseen. Still, every doctor should make an extraordinary effort to salvage and guard their patients' medical records.

To maintain continuity of patient care and to grant patient access to their medical records, PhI must be quickly and efficiently restored to a usable manner. Every effort must be made if documents can be fixed, even partial files.

To aid our colleagues, I have gathered information that may guide you in your endeavor to rebuild your practice. The American Health Information Management Association (AHIMA) provides guidance on action steps to take if medical records are destroyed. First, try to salvage any documents that you can. If your records have been damaged by water, if the pages can be dried, they may be used to provide context for medical conditions and treatments your patients received.

Although help in this recovery effort is welcomed, well-intentioned personnel helping in the salvage may come upon sensitive protected health information about the patient. Whether a professional restoration service or friends and family are helping you, it is wise to have them sign a business associate agreement to ensure patient information is protected. Even in trying times, it is essential to document your efforts and to make a good-faith effort to protect your patient's privacy.

An example of ways to restore records is to dry paper records initially. You may wish to consider scanning the pages you were able to salvage. If the paper is at risk for mold and mildew, electronic scanning of the records to a pdf saves the image of the documents for later use.

Patients have a right to know if their records are lost. It is advisable to keep a log of the patient names and dates of records that were affected by the damage. If records were lost or unsalvageable, it is recommended to document the records' disposition as clearly as possible. This step should not be taken lightly. Attempts must be made to obtain records through electronic data recovery or with the professional services of a damage restoration company.

Access other data sources that may contain physician records. Computer records showing dates of services, services rendered, and the diagnoses assigned may help create a partial historical record of the patient's care. Radiology reports previously gathered from other sources may have to be requested again to supplement the documentation. Laboratory records, backup services, and notes sent to consultants for review may be able to be retrieved. Suppose if you previously submitted reports to insurance companies, lawyers, or other physician offices, they may be able to send you copies of those records that are no longer in your possession.

If the retrieval and restoration of records are impossible, document your efforts, what you were able to salvage or reconstruct, and what you believe was lost, including the dates of service that were affected. You must document the date and type of damage, the information lost, and the mode of the patient information loss. In other words, were the documents ruined by standing water in the office, taken by the water surge, or the subject of wind and tornados? If any of the affected charts are requested for an insurance review or by the patient, submit the documentation of what was lost and your recovery efforts. Submit that documentation with a cover letter explaining the circumstances. The degree of loss may be staggering, but accurate and comprehensive documentation is vital to restore billing and patient care issues.

You want to re-establish patient care and cash flow in the office. As long as your office is cleared for business and structurally sound, you want to provide care for injured patients who need your services. Use Facebook, outdoor signs, and other social media to communicate your status. If you are seeing a patient on a limited basis, indicate what hours and under what circumstances you will see a patient. Suppose your telephone system is destroyed or inoperable, consider buying an inexpensive mobile phone, also known as a burner phone. In that case, that temporary telephone may temporarily route calls to you meant for the office. Consider publishing the temporary telephone number on social media so patients know how to reach you.
Due to the devastation, many insurance companies, including Medicare and Medicaid, will grant a delay in the required response time or an extension of submission of the requested documentation. Please do not take it for granted that any requests for records will be temporarily delayed. Rapid response to the request with the documentation of the disaster circumstances will work in your favor. If there is a complete loss of records, the insurance carrier may accept an attestation that the services were provided and for what reason (diagnosis). If you can reconstruct any of the requested records, submit those with the attestation letter for the missing documents. When submitting reconstructed records, clearly label the records with a statement that indicates, "This record was reconstructed because of disaster."

In addition, use this experience to formulate new policies and procedures to mitigate another disaster if it should occur. Experience is the best teacher. We must always be prepared to learn from our experiences. Even if your office had relatively minor damage, consider what would have happened if the hurricane hit your home or office. A solid plan to prevent loss is more effective than a recovery plan.

Lastly, know that you are not alone. Your life may be affected by struggle after struggle. If you are struggling with anxiety, depression, or a feeling of hopelessness, reach out for help. The Florida Chiropractic Association has enlisted resources and people who can help you rebuild your life. You have been placed on Earth with a purpose in life. Hang on to that thought. Many colleagues around the country are available to help you gain clarity in this situation. If you feel you need professional help, reach out, tell your story, and accept the service that is offered to you. You deserve a safe and calm environment to face your challenges and get help from others fighting the same battle as you. No one deserves to suffer, especially in their own mind.

Dr. Mario Fucinari is a frequent lecturer on issues of documentation and HIPAA. If you need help, contact the Florida Chiropractic Association, colleagues, and friends. If you wish to contact Dr. Fucinari with any questions about your office recovery, he has availed his help to our colleagues in Florida. Dr. Fucinari can be reached at doc@AskMario.com