American Academy of Pediatrics (AAP): 2012 National Conference and Exhibition

NEW ORLEANS – An electrocardiogram isn’t necessary for student athletes or children taking stimulant medications for attention disorders unless the child has cardiac risk factors or a family history of early-onset heart disease.

ECGs are not always easy to obtain, and they cost parents money, time, and anxiety, Dr. Christopher Snyder said at the annual meeting of the American Academy of Pediatrics. To be really useful, he said, they should be read by a pediatric cardiologist – a specialist in remarkably short supply.

©wakila/istockphotos.com

"Just don’t do it. You don’t need to do it!" said Dr. Snyder, a pediatric cardiologist at the Rainbow Babies and Children’s Hospital in Cleveland.

The American Heart Association (AHA) recommends against routine ECGs in student athletes. The only children who really need the test before playing sports are those with a family or personal history of specific cardiac findings, including:

• Unexplained fainting.

• Excessive fatigue with exercise.

• Abnormal blood pressure.

• Heart murmur.

• A relative who developed or died from heart disease at younger than 50 years.

• Signs of Marfan syndrome.

High school and college athletes should receive a biennial 12-item exam focused on personal and family findings, with a preparticipation history taken between the screenings, the guideline states.

Things aren’t quite so clear-cut with regard to ECGs for children beginning a stimulant medication. "There is no evidence that this is needed, but we do it because we think we should," Dr. Snyder said. Medications for attention-deficit/hyperactivity disorder (ADHD) "have never been shown to cause heart problems, although there might be a slight increase in blood pressure of about 1 mm Hg and a slight increase in heart rate – about 1 beat per minute. Sudden cardiac death has been reported and linked to ADHD medications, but it’s never been proven to have any causal association."

The AHA’s 2008 ADHD medication cardiac screening recommendation contributed to the confusion about the necessity of an ECG for these children, Dr. Snyder said. "It’s not mandatory, and it’s left to the physician’s discretion," but the guideline suggests that an ECG will strengthen the accuracy of any cardiac risk screening.

The minimal screen before starting a stimulant medication should include looking for cardiac structural abnormalities, heart murmurs, hypertension, palpitations, arrhythmia, syncope, signs of Marfan syndrome, and family history, the guideline noted. But, it added, "Some of the cardiac conditions associated with sudden cardiac death might not be detected on a routine physical examination. Therefore it can be useful to add an ECG, which may increase the likelihood of identifying significant conditions ... that are known to be associated with sudden cardiac death."

Despite suggesting ECGs, the AHA guideline gave them a class IIa recommendation and a C evidence level. It also recommended that the test be read by a pediatric cardiologist, and that it might need to be repeated after the onset of puberty, if symptoms develop, or if cardiac problems develop in a family member.

Shortly after the AHA recommendation came out, the American Academy of Pediatrics (AAP) published its own guideline, which called the cardiology paper "controversial" and made clear its disagreement with the guideline.

"The AAP and its constituent groups disagree with the AHA statement as to both the classification and the level of evidence. ... Moreover, the substantial expert opinion and reasoning outlined in the AHA statement suggests that harm outweighs the benefit of recommending routine ECGs for healthy children who are starting stimulant medication for ADHD. Accordingly, the AAP would recommend against such routine ECG screening."

There’s no good evidence that sudden death occurs any more frequently among children taking the medications, AAP asserted. Therefore, a targeted cardiac personal and family history, combined with a thorough physical, is adequate not only to identify any cardiac risk factors, but to pinpoint any other health concerns that might warrant attention.

"Electrocardiography or echocardiography in this population would not otherwise be routine or recommended," according to the AAP statement.

Dr. Snyder did not disclose any relevant financial conflicts.

NEW ORLEANS – An electrocardiogram isn’t necessary for student athletes or children taking stimulant medications for attention disorders unless the child has cardiac risk factors or a family history of early-onset heart disease.

ECGs are not always easy to obtain, and they cost parents money, time, and anxiety, Dr. Christopher Snyder said at the annual meeting of the American Academy of Pediatrics. To be really useful, he said, they should be read by a pediatric cardiologist – a specialist in remarkably short supply.

©wakila/istockphotos.com

"Just don’t do it. You don’t need to do it!" said Dr. Snyder, a pediatric cardiologist at the Rainbow Babies and Children’s Hospital in Cleveland.

The American Heart Association (AHA) recommends against routine ECGs in student athletes. The only children who really need the test before playing sports are those with a family or personal history of specific cardiac findings, including:

• Unexplained fainting.

• Excessive fatigue with exercise.

• Abnormal blood pressure.

• Heart murmur.

• A relative who developed or died from heart disease at younger than 50 years.

• Signs of Marfan syndrome.

High school and college athletes should receive a biennial 12-item exam focused on personal and family findings, with a preparticipation history taken between the screenings, the guideline states.

Things aren’t quite so clear-cut with regard to ECGs for children beginning a stimulant medication. "There is no evidence that this is needed, but we do it because we think we should," Dr. Snyder said. Medications for attention-deficit/hyperactivity disorder (ADHD) "have never been shown to cause heart problems, although there might be a slight increase in blood pressure of about 1 mm Hg and a slight increase in heart rate – about 1 beat per minute. Sudden cardiac death has been reported and linked to ADHD medications, but it’s never been proven to have any causal association."

The AHA’s 2008 ADHD medication cardiac screening recommendation contributed to the confusion about the necessity of an ECG for these children, Dr. Snyder said. "It’s not mandatory, and it’s left to the physician’s discretion," but the guideline suggests that an ECG will strengthen the accuracy of any cardiac risk screening.

The minimal screen before starting a stimulant medication should include looking for cardiac structural abnormalities, heart murmurs, hypertension, palpitations, arrhythmia, syncope, signs of Marfan syndrome, and family history, the guideline noted. But, it added, "Some of the cardiac conditions associated with sudden cardiac death might not be detected on a routine physical examination. Therefore it can be useful to add an ECG, which may increase the likelihood of identifying significant conditions ... that are known to be associated with sudden cardiac death."

Despite suggesting ECGs, the AHA guideline gave them a class IIa recommendation and a C evidence level. It also recommended that the test be read by a pediatric cardiologist, and that it might need to be repeated after the onset of puberty, if symptoms develop, or if cardiac problems develop in a family member.

Shortly after the AHA recommendation came out, the American Academy of Pediatrics (AAP) published its own guideline, which called the cardiology paper "controversial" and made clear its disagreement with the guideline.

"The AAP and its constituent groups disagree with the AHA statement as to both the classification and the level of evidence. ... Moreover, the substantial expert opinion and reasoning outlined in the AHA statement suggests that harm outweighs the benefit of recommending routine ECGs for healthy children who are starting stimulant medication for ADHD. Accordingly, the AAP would recommend against such routine ECG screening."

There’s no good evidence that sudden death occurs any more frequently among children taking the medications, AAP asserted. Therefore, a targeted cardiac personal and family history, combined with a thorough physical, is adequate not only to identify any cardiac risk factors, but to pinpoint any other health concerns that might warrant attention.

"Electrocardiography or echocardiography in this population would not otherwise be routine or recommended," according to the AAP statement.

Dr. Snyder did not disclose any relevant financial conflicts.

NEW ORLEANS – An electrocardiogram isn’t necessary for student athletes or children taking stimulant medications for attention disorders unless the child has cardiac risk factors or a family history of early-onset heart disease.

ECGs are not always easy to obtain, and they cost parents money, time, and anxiety, Dr. Christopher Snyder said at the annual meeting of the American Academy of Pediatrics. To be really useful, he said, they should be read by a pediatric cardiologist – a specialist in remarkably short supply.

©wakila/istockphotos.com

"Just don’t do it. You don’t need to do it!" said Dr. Snyder, a pediatric cardiologist at the Rainbow Babies and Children’s Hospital in Cleveland.

The American Heart Association (AHA) recommends against routine ECGs in student athletes. The only children who really need the test before playing sports are those with a family or personal history of specific cardiac findings, including:

• Unexplained fainting.

• Excessive fatigue with exercise.

• Abnormal blood pressure.

• Heart murmur.

• A relative who developed or died from heart disease at younger than 50 years.

• Signs of Marfan syndrome.

High school and college athletes should receive a biennial 12-item exam focused on personal and family findings, with a preparticipation history taken between the screenings, the guideline states.

Things aren’t quite so clear-cut with regard to ECGs for children beginning a stimulant medication. "There is no evidence that this is needed, but we do it because we think we should," Dr. Snyder said. Medications for attention-deficit/hyperactivity disorder (ADHD) "have never been shown to cause heart problems, although there might be a slight increase in blood pressure of about 1 mm Hg and a slight increase in heart rate – about 1 beat per minute. Sudden cardiac death has been reported and linked to ADHD medications, but it’s never been proven to have any causal association."

The AHA’s 2008 ADHD medication cardiac screening recommendation contributed to the confusion about the necessity of an ECG for these children, Dr. Snyder said. "It’s not mandatory, and it’s left to the physician’s discretion," but the guideline suggests that an ECG will strengthen the accuracy of any cardiac risk screening.

The minimal screen before starting a stimulant medication should include looking for cardiac structural abnormalities, heart murmurs, hypertension, palpitations, arrhythmia, syncope, signs of Marfan syndrome, and family history, the guideline noted. But, it added, "Some of the cardiac conditions associated with sudden cardiac death might not be detected on a routine physical examination. Therefore it can be useful to add an ECG, which may increase the likelihood of identifying significant conditions ... that are known to be associated with sudden cardiac death."

Despite suggesting ECGs, the AHA guideline gave them a class IIa recommendation and a C evidence level. It also recommended that the test be read by a pediatric cardiologist, and that it might need to be repeated after the onset of puberty, if symptoms develop, or if cardiac problems develop in a family member.

Shortly after the AHA recommendation came out, the American Academy of Pediatrics (AAP) published its own guideline, which called the cardiology paper "controversial" and made clear its disagreement with the guideline.

"The AAP and its constituent groups disagree with the AHA statement as to both the classification and the level of evidence. ... Moreover, the substantial expert opinion and reasoning outlined in the AHA statement suggests that harm outweighs the benefit of recommending routine ECGs for healthy children who are starting stimulant medication for ADHD. Accordingly, the AAP would recommend against such routine ECG screening."

There’s no good evidence that sudden death occurs any more frequently among children taking the medications, AAP asserted. Therefore, a targeted cardiac personal and family history, combined with a thorough physical, is adequate not only to identify any cardiac risk factors, but to pinpoint any other health concerns that might warrant attention.

"Electrocardiography or echocardiography in this population would not otherwise be routine or recommended," according to the AAP statement.

Dr. Snyder did not disclose any relevant financial conflicts.

NEW ORLEANS – Protecting children by vaccinating parents comes with some baggage that needs to be sorted out before the idea can become a reality, according to Dr. Herschel Lessin.

There’s no longer any doubt that cocooning, or spinning a cocoon of communicable disease protection around infants and young children, does protect them from illness, said Dr. Lessin, who coauthored the American Academy of Pediatrics 2012 report on the issue (Pediatrics 2012;129:e247-53).

Design Pics

The review found lots of evidence supporting the practice – including one study showing that up to half of infant pertussis cases could have been prevented if parents had been immunized (Pediatr. Infect. Dis. J. 2004;23:985-9).

Two other studies have shown a significantly reduced incidence of influenza among infants whose mothers were vaccinated during pregnancy (Am. J. Obstet. Gynecol. 2011;204[suppl. 1]:S141-8; New Engl. J. Med. 2008;359:1555-64).

Unfortunately, Dr. Lessin said, "adults’ physicians do an awful job of immunizing patients, so most adults are not fully immunized." Obstetricians and neonatal intensive care units "are good at vaccinating mom, but not dad, so these infants are clearly at risk," he added.

The pediatrician’s office can make a difference. "We’re perfectly suited to be a good place to immunize adults," said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In fact, he said, this setup may be particularly attractive to parents who are already taking off time to bring their children in for immunizations.

"These visits represent an opportunity to immunize parents or other adult caregivers with minimal disruption for both the adults and the practice," Dr. Lessin and his colleagues wrote in the AAP report. "Immunizations represent a major focus for pediatric care, and many educational opportunities exist for the pediatrician to explain the benefits of immunization for the child and for close family contacts. Thus, convenience, physician vaccine knowledge and encouragement, and vaccine availability are strong factors for immunizing parents and close family contacts in the pediatric office."

In theory, this sounds great, Dr. Lessin said at the annual meeting of the American Academy of Pediatrics. In practice, immunizing parents can be challenging and even somewhat risky. Questions about liability, how much vaccine to purchase and administer to adults, documentation, and reimbursement remain.

He addressed each of these issues:

• Liability. The Vaccine Injury Compensation Program covers all vaccines recommended for routine use in children, regardless of the age of the person being vaccinated. Since the Tdap and influenza vaccines are recommended for children, the pediatrician who also gives them to adults would be covered.

• Vaccine supply. Offering adult immunizations would mean walking a fine line between having enough vaccine and wasting money on too much. The problem could be exacerbated in years of influenza vaccine shortage. In addition, the AAP report noted that "because nearly all privately supplied influenza vaccine is preordered months in advance, there is a risk of using the ordered supply too quickly when immunizing both close family contacts and children. ... Alternatively, too much vaccine might be ordered ... leaving practices at economic risk of unused doses. This is a significant concern, given the narrow financial margins for immunizations."

• Documentation. The pediatric office would have to document these immunizations, which would entail creating some kind of brief medical record – perhaps a vaccination card. There should probably be some communication with the adult’s primary care provider as well.

• Reimbursement. Some offices that provide adult immunizations require up-front payment, and leave insurance filing to the individual. "You need to ask yourself if you’re willing to get into the insurance hassle because you’re not the adult’s primary care doctor. It’s up to you," he said.

The AAP report also offered a few warnings about adult vaccine billing: "In most states, vaccines supplied to pediatricians by the Vaccines for Children Program may not be used for adults and certainly cannot be billed. If a practice chooses to involve itself in the insurance coverage of parents and close family contacts, it will produce a significantly increased burden that may make the provision of such services nonviable."

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – Protecting children by vaccinating parents comes with some baggage that needs to be sorted out before the idea can become a reality, according to Dr. Herschel Lessin.

There’s no longer any doubt that cocooning, or spinning a cocoon of communicable disease protection around infants and young children, does protect them from illness, said Dr. Lessin, who coauthored the American Academy of Pediatrics 2012 report on the issue (Pediatrics 2012;129:e247-53).

Design Pics

The review found lots of evidence supporting the practice – including one study showing that up to half of infant pertussis cases could have been prevented if parents had been immunized (Pediatr. Infect. Dis. J. 2004;23:985-9).

Two other studies have shown a significantly reduced incidence of influenza among infants whose mothers were vaccinated during pregnancy (Am. J. Obstet. Gynecol. 2011;204[suppl. 1]:S141-8; New Engl. J. Med. 2008;359:1555-64).

Unfortunately, Dr. Lessin said, "adults’ physicians do an awful job of immunizing patients, so most adults are not fully immunized." Obstetricians and neonatal intensive care units "are good at vaccinating mom, but not dad, so these infants are clearly at risk," he added.

The pediatrician’s office can make a difference. "We’re perfectly suited to be a good place to immunize adults," said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In fact, he said, this setup may be particularly attractive to parents who are already taking off time to bring their children in for immunizations.

"These visits represent an opportunity to immunize parents or other adult caregivers with minimal disruption for both the adults and the practice," Dr. Lessin and his colleagues wrote in the AAP report. "Immunizations represent a major focus for pediatric care, and many educational opportunities exist for the pediatrician to explain the benefits of immunization for the child and for close family contacts. Thus, convenience, physician vaccine knowledge and encouragement, and vaccine availability are strong factors for immunizing parents and close family contacts in the pediatric office."

In theory, this sounds great, Dr. Lessin said at the annual meeting of the American Academy of Pediatrics. In practice, immunizing parents can be challenging and even somewhat risky. Questions about liability, how much vaccine to purchase and administer to adults, documentation, and reimbursement remain.

He addressed each of these issues:

• Liability. The Vaccine Injury Compensation Program covers all vaccines recommended for routine use in children, regardless of the age of the person being vaccinated. Since the Tdap and influenza vaccines are recommended for children, the pediatrician who also gives them to adults would be covered.

• Vaccine supply. Offering adult immunizations would mean walking a fine line between having enough vaccine and wasting money on too much. The problem could be exacerbated in years of influenza vaccine shortage. In addition, the AAP report noted that "because nearly all privately supplied influenza vaccine is preordered months in advance, there is a risk of using the ordered supply too quickly when immunizing both close family contacts and children. ... Alternatively, too much vaccine might be ordered ... leaving practices at economic risk of unused doses. This is a significant concern, given the narrow financial margins for immunizations."

• Documentation. The pediatric office would have to document these immunizations, which would entail creating some kind of brief medical record – perhaps a vaccination card. There should probably be some communication with the adult’s primary care provider as well.

• Reimbursement. Some offices that provide adult immunizations require up-front payment, and leave insurance filing to the individual. "You need to ask yourself if you’re willing to get into the insurance hassle because you’re not the adult’s primary care doctor. It’s up to you," he said.

The AAP report also offered a few warnings about adult vaccine billing: "In most states, vaccines supplied to pediatricians by the Vaccines for Children Program may not be used for adults and certainly cannot be billed. If a practice chooses to involve itself in the insurance coverage of parents and close family contacts, it will produce a significantly increased burden that may make the provision of such services nonviable."

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – Protecting children by vaccinating parents comes with some baggage that needs to be sorted out before the idea can become a reality, according to Dr. Herschel Lessin.

There’s no longer any doubt that cocooning, or spinning a cocoon of communicable disease protection around infants and young children, does protect them from illness, said Dr. Lessin, who coauthored the American Academy of Pediatrics 2012 report on the issue (Pediatrics 2012;129:e247-53).

Design Pics

The review found lots of evidence supporting the practice – including one study showing that up to half of infant pertussis cases could have been prevented if parents had been immunized (Pediatr. Infect. Dis. J. 2004;23:985-9).

Two other studies have shown a significantly reduced incidence of influenza among infants whose mothers were vaccinated during pregnancy (Am. J. Obstet. Gynecol. 2011;204[suppl. 1]:S141-8; New Engl. J. Med. 2008;359:1555-64).

Unfortunately, Dr. Lessin said, "adults’ physicians do an awful job of immunizing patients, so most adults are not fully immunized." Obstetricians and neonatal intensive care units "are good at vaccinating mom, but not dad, so these infants are clearly at risk," he added.

The pediatrician’s office can make a difference. "We’re perfectly suited to be a good place to immunize adults," said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In fact, he said, this setup may be particularly attractive to parents who are already taking off time to bring their children in for immunizations.

"These visits represent an opportunity to immunize parents or other adult caregivers with minimal disruption for both the adults and the practice," Dr. Lessin and his colleagues wrote in the AAP report. "Immunizations represent a major focus for pediatric care, and many educational opportunities exist for the pediatrician to explain the benefits of immunization for the child and for close family contacts. Thus, convenience, physician vaccine knowledge and encouragement, and vaccine availability are strong factors for immunizing parents and close family contacts in the pediatric office."

In theory, this sounds great, Dr. Lessin said at the annual meeting of the American Academy of Pediatrics. In practice, immunizing parents can be challenging and even somewhat risky. Questions about liability, how much vaccine to purchase and administer to adults, documentation, and reimbursement remain.

He addressed each of these issues:

• Liability. The Vaccine Injury Compensation Program covers all vaccines recommended for routine use in children, regardless of the age of the person being vaccinated. Since the Tdap and influenza vaccines are recommended for children, the pediatrician who also gives them to adults would be covered.

• Vaccine supply. Offering adult immunizations would mean walking a fine line between having enough vaccine and wasting money on too much. The problem could be exacerbated in years of influenza vaccine shortage. In addition, the AAP report noted that "because nearly all privately supplied influenza vaccine is preordered months in advance, there is a risk of using the ordered supply too quickly when immunizing both close family contacts and children. ... Alternatively, too much vaccine might be ordered ... leaving practices at economic risk of unused doses. This is a significant concern, given the narrow financial margins for immunizations."

• Documentation. The pediatric office would have to document these immunizations, which would entail creating some kind of brief medical record – perhaps a vaccination card. There should probably be some communication with the adult’s primary care provider as well.

• Reimbursement. Some offices that provide adult immunizations require up-front payment, and leave insurance filing to the individual. "You need to ask yourself if you’re willing to get into the insurance hassle because you’re not the adult’s primary care doctor. It’s up to you," he said.

The AAP report also offered a few warnings about adult vaccine billing: "In most states, vaccines supplied to pediatricians by the Vaccines for Children Program may not be used for adults and certainly cannot be billed. If a practice chooses to involve itself in the insurance coverage of parents and close family contacts, it will produce a significantly increased burden that may make the provision of such services nonviable."

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – While vaccinations are certainly a health benefit to pediatric patients, they may be a financial risk for pediatricians, according to Dr. Herschel R. Lessin.

"Vaccines are expensive, complicated, and require a lot of time-consuming communication with parents. If they’re not managed correctly, they can bankrupt your business," he said at the annual meeting of the American Academy of Pediatrics. "Vaccines are the second-largest budget item in your business, after payroll, and can tie up enormous amounts of capital. You need to be smart about how you use them and how you buy them."

©Design Pics

It’s hard to judge how much vaccines really cost a practice, said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In addition to the actual cost of the product, the equation has to include the cost of time spent on counseling about vaccines’ risks and benefits, defusing the popular mythology attached to them, and taking calls about reactions. Add to that the equipment necessary to administer and store them, and you have a situation that may very well be costing more than it brings in.

"It’s a question of opportunity cost," he said. "Ask yourself, ‘What other things could I have done with that money?’ "

Purchasing is the biggest up-front outlay. "The absolute worst way to buy these is to purchase them on your own from the drug company. It’s a little bit more economical if you’re part of a practice group and you share the cost with your colleagues. Or you can team up with other practices in your area and create a group purchase organization [GPO]."

But this kind of business relationship works only if the group provides enough financial incentive to offset the headaches of joining.

GPOs combine buying power from multiple members to get better prices on vaccine. The organizations deal directly with vaccine manufacturers to negotiate what usually turn out to be the best prices. Another benefit is that orders are placed individually. Practices can order just what they need and not be forced to order a large volume to get a discount.

But they almost always come with rules designed to keep a practice connected with the group, and with the manufacturers who participate. "All GPOs have rules you must abide by and products you must use to get the savings. If you see a good price on a vaccine and switch to it, you might be financially punished" for buying it, by being forced to pay list price on the vaccine you do order through the group, he said.

Another option is to collaborate with other practices in the community to negotiate deals directly with the manufacturer. Dr. Lessin said his practice did just that a few years ago. Although collaborating with a competitor was initially uncomfortable, it actually became a first step toward improving relations between the two businesses.

"We found out they weren’t quite the ogre that we thought they were," he said.

Cost concerns don’t evaporate even after the vaccine is delivered and safely tucked in the refrigerator. That’s when some of the thorniest issues arise, he said. Vaccines don’t administer themselves. They require equipment, providers, and communication that are specialized.

"The real cost of vaccines is much, much more than the price," Dr. Lessin said. The hidden costs include equipment, syringes, waste handling, and simple things such as gloves, swabs, and Band-Aid strips. Other less-tangible costs are time spent preparing the vaccine, counseling the parents, and documenting the procedure.

The usual per-patient profit for an office visit ranges from 30% to 50%, but drops off sharply when vaccines are figured into the mix, Dr. Lessin said. "If it’s your second-biggest expense, you better be making a profit of it. Vaccine is a product and we are selling product." Some practices have decided to increase their fees in order to cover the cost of vaccine administration.

"You deserve to make a profit margin on administrative costs," he said.

The American Academy of Pediatrics offers several free resources on building a successful vaccine practice model.

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – While vaccinations are certainly a health benefit to pediatric patients, they may be a financial risk for pediatricians, according to Dr. Herschel R. Lessin.

"Vaccines are expensive, complicated, and require a lot of time-consuming communication with parents. If they’re not managed correctly, they can bankrupt your business," he said at the annual meeting of the American Academy of Pediatrics. "Vaccines are the second-largest budget item in your business, after payroll, and can tie up enormous amounts of capital. You need to be smart about how you use them and how you buy them."

©Design Pics

It’s hard to judge how much vaccines really cost a practice, said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In addition to the actual cost of the product, the equation has to include the cost of time spent on counseling about vaccines’ risks and benefits, defusing the popular mythology attached to them, and taking calls about reactions. Add to that the equipment necessary to administer and store them, and you have a situation that may very well be costing more than it brings in.

"It’s a question of opportunity cost," he said. "Ask yourself, ‘What other things could I have done with that money?’ "

Purchasing is the biggest up-front outlay. "The absolute worst way to buy these is to purchase them on your own from the drug company. It’s a little bit more economical if you’re part of a practice group and you share the cost with your colleagues. Or you can team up with other practices in your area and create a group purchase organization [GPO]."

But this kind of business relationship works only if the group provides enough financial incentive to offset the headaches of joining.

GPOs combine buying power from multiple members to get better prices on vaccine. The organizations deal directly with vaccine manufacturers to negotiate what usually turn out to be the best prices. Another benefit is that orders are placed individually. Practices can order just what they need and not be forced to order a large volume to get a discount.

But they almost always come with rules designed to keep a practice connected with the group, and with the manufacturers who participate. "All GPOs have rules you must abide by and products you must use to get the savings. If you see a good price on a vaccine and switch to it, you might be financially punished" for buying it, by being forced to pay list price on the vaccine you do order through the group, he said.

Another option is to collaborate with other practices in the community to negotiate deals directly with the manufacturer. Dr. Lessin said his practice did just that a few years ago. Although collaborating with a competitor was initially uncomfortable, it actually became a first step toward improving relations between the two businesses.

"We found out they weren’t quite the ogre that we thought they were," he said.

Cost concerns don’t evaporate even after the vaccine is delivered and safely tucked in the refrigerator. That’s when some of the thorniest issues arise, he said. Vaccines don’t administer themselves. They require equipment, providers, and communication that are specialized.

"The real cost of vaccines is much, much more than the price," Dr. Lessin said. The hidden costs include equipment, syringes, waste handling, and simple things such as gloves, swabs, and Band-Aid strips. Other less-tangible costs are time spent preparing the vaccine, counseling the parents, and documenting the procedure.

The usual per-patient profit for an office visit ranges from 30% to 50%, but drops off sharply when vaccines are figured into the mix, Dr. Lessin said. "If it’s your second-biggest expense, you better be making a profit of it. Vaccine is a product and we are selling product." Some practices have decided to increase their fees in order to cover the cost of vaccine administration.

"You deserve to make a profit margin on administrative costs," he said.

The American Academy of Pediatrics offers several free resources on building a successful vaccine practice model.

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS – While vaccinations are certainly a health benefit to pediatric patients, they may be a financial risk for pediatricians, according to Dr. Herschel R. Lessin.

"Vaccines are expensive, complicated, and require a lot of time-consuming communication with parents. If they’re not managed correctly, they can bankrupt your business," he said at the annual meeting of the American Academy of Pediatrics. "Vaccines are the second-largest budget item in your business, after payroll, and can tie up enormous amounts of capital. You need to be smart about how you use them and how you buy them."

©Design Pics

It’s hard to judge how much vaccines really cost a practice, said Dr. Lessin, a pediatrician in private practice in Poughkeepsie, N.Y. In addition to the actual cost of the product, the equation has to include the cost of time spent on counseling about vaccines’ risks and benefits, defusing the popular mythology attached to them, and taking calls about reactions. Add to that the equipment necessary to administer and store them, and you have a situation that may very well be costing more than it brings in.

"It’s a question of opportunity cost," he said. "Ask yourself, ‘What other things could I have done with that money?’ "

Purchasing is the biggest up-front outlay. "The absolute worst way to buy these is to purchase them on your own from the drug company. It’s a little bit more economical if you’re part of a practice group and you share the cost with your colleagues. Or you can team up with other practices in your area and create a group purchase organization [GPO]."

But this kind of business relationship works only if the group provides enough financial incentive to offset the headaches of joining.

GPOs combine buying power from multiple members to get better prices on vaccine. The organizations deal directly with vaccine manufacturers to negotiate what usually turn out to be the best prices. Another benefit is that orders are placed individually. Practices can order just what they need and not be forced to order a large volume to get a discount.

But they almost always come with rules designed to keep a practice connected with the group, and with the manufacturers who participate. "All GPOs have rules you must abide by and products you must use to get the savings. If you see a good price on a vaccine and switch to it, you might be financially punished" for buying it, by being forced to pay list price on the vaccine you do order through the group, he said.

Another option is to collaborate with other practices in the community to negotiate deals directly with the manufacturer. Dr. Lessin said his practice did just that a few years ago. Although collaborating with a competitor was initially uncomfortable, it actually became a first step toward improving relations between the two businesses.

"We found out they weren’t quite the ogre that we thought they were," he said.

Cost concerns don’t evaporate even after the vaccine is delivered and safely tucked in the refrigerator. That’s when some of the thorniest issues arise, he said. Vaccines don’t administer themselves. They require equipment, providers, and communication that are specialized.

"The real cost of vaccines is much, much more than the price," Dr. Lessin said. The hidden costs include equipment, syringes, waste handling, and simple things such as gloves, swabs, and Band-Aid strips. Other less-tangible costs are time spent preparing the vaccine, counseling the parents, and documenting the procedure.

The usual per-patient profit for an office visit ranges from 30% to 50%, but drops off sharply when vaccines are figured into the mix, Dr. Lessin said. "If it’s your second-biggest expense, you better be making a profit of it. Vaccine is a product and we are selling product." Some practices have decided to increase their fees in order to cover the cost of vaccine administration.

"You deserve to make a profit margin on administrative costs," he said.

The American Academy of Pediatrics offers several free resources on building a successful vaccine practice model.

Dr. Lessin disclosed that he is on the speakers board of GlaxoSmithKline and the advisory boards of Merck, Novartis, and Pfizer. He is also a senior consultant for the Verden Group, a practice management company.

NEW ORLEANS  – It’s time for more pediatricians to step into the digital world.

Facebook pages, Twitter accounts, and direct e-mail to patients are nothing to be scared of, according to Dr. Todd Wolynn. In fact, if your practice isn’t connecting with families over the Internet, competitors are, he said at the annual meeting of the American Academy of Pediatrics.

"Pediatrics is rapidly changing, facing threats on all sides," said Dr. Wolynn, a pediatrician in group practice in Pittsburgh. "When I started, I did everything for my patients, from NICU visits to inpatient care and house calls. But our practice size is shrinking. Now most general pediatricians just see outpatient, sick calls, and well calls. There’s even increasing competition for those from urgent care facilities, and even clinics in retail stores and pharmacies."

Before the age of constant connection, pediatricians were part of an extended family centered on the patient and parents, and sometimes grandparents as well. "It was a trust-based relationship based on ties with several generations," he said. Now, young "Generation Y" parents are likely to pay more attention to their virtual friends than to their real parents, Dr. Wolynn said.

"Your target audience is GenY. These are the parents making decisions now, and if you don’t know them, you will quickly become meaningless and fail to reach their children," he said.

Connectedness can be a double-edged sword. "It’s not just Facebook. It’s like Facebook on steroids," capable of generating medical myths so entrenched they become almost impossible to expunge. On the other hand, Facebook and its "ADHD relative" Twitter, can spread positive feedback about your practice like never before.

For the pediatrician who’s open to it, this paradigm shift can be a grand moment of expansion. "Now, 50% of our new patient visits are related to some sort of social media. This is where you can really begin to grow your practice."

He offered some tips for getting started:

• Start slow. "Don’t waste the time if your parents aren’t interested. Do a simple paper-and-pencil survey in your office. Find out if people are interested in e-mail, Twitter, Facebook, or a Web page for your practice. Once you figure that out, you can target your efforts," Dr. Wolynn advised.

©audioundwerbung/iStockphoto

• If you can afford it, hire someone to create your Web page. It should be full of colorful graphics, easy to navigate, and constantly refreshed with new offerings – blogs, conversations about seasonal health issues, links that allow parents to "meet" staff, and even general information about the larger community. "We have even added a jobs page [with openings at our practice] for parents, and a link to the local center for breastfeeding."

• Consider video. "In 2012, 50% of Internet traffic was driven by video. GenY wants to see it – not read it. We use YouTube as a way of introducing our doctors. We do pay someone to do the videos, but the investment pays for itself," Dr. Wolynn said. Videos introducing our physicians are especially popular with parents. "You can offer general parenting tips as well, not just medical information." Dr. Wolynn said a video he did on "five places to cool off for free" in Pittsburgh was one of the most popular on the site.

• Allow parents to ask general questions and to expect a timely response. "It has to be clear that this isn’t intended for emergency use, and you do need to vet the information you provide. But it’s perfect for general things like, ‘My baby has a fever – what can I give?’ This can actually start taking away some of your triage nurse’s calls. Other parents will jump in as well, responding to the post," he said.

• Don’t simply wait for families to come to you – push your information to them. "They can make an agreement, and your information will come to them in their preferred media," he said.

• Be clear with staff about the site’s use and limits. "You don’t want your staff posting things like, ‘We were really overworked today.’ They can say things like that on their own site – that’s their right. But not on the practice site. We have never had a negative employee comment posted," Dr. Wolynn said.

• Consider privacy laws and seek advice if you need to. It’s always best to err on the side of caution when parents ask specific questions. "We have someone monitor the site. If something acute comes up, we call the person as quickly as possible," he said. Patient privacy law for Internet communication is "evolving as we go along. We’ve talked to our lawyer and been told that ‘precedent on this is being set daily,’ " Dr. Wolynn noted.

He said he had no relevant financial disclosures.

NEW ORLEANS  – It’s time for more pediatricians to step into the digital world.

Facebook pages, Twitter accounts, and direct e-mail to patients are nothing to be scared of, according to Dr. Todd Wolynn. In fact, if your practice isn’t connecting with families over the Internet, competitors are, he said at the annual meeting of the American Academy of Pediatrics.

"Pediatrics is rapidly changing, facing threats on all sides," said Dr. Wolynn, a pediatrician in group practice in Pittsburgh. "When I started, I did everything for my patients, from NICU visits to inpatient care and house calls. But our practice size is shrinking. Now most general pediatricians just see outpatient, sick calls, and well calls. There’s even increasing competition for those from urgent care facilities, and even clinics in retail stores and pharmacies."

Before the age of constant connection, pediatricians were part of an extended family centered on the patient and parents, and sometimes grandparents as well. "It was a trust-based relationship based on ties with several generations," he said. Now, young "Generation Y" parents are likely to pay more attention to their virtual friends than to their real parents, Dr. Wolynn said.

"Your target audience is GenY. These are the parents making decisions now, and if you don’t know them, you will quickly become meaningless and fail to reach their children," he said.

Connectedness can be a double-edged sword. "It’s not just Facebook. It’s like Facebook on steroids," capable of generating medical myths so entrenched they become almost impossible to expunge. On the other hand, Facebook and its "ADHD relative" Twitter, can spread positive feedback about your practice like never before.

For the pediatrician who’s open to it, this paradigm shift can be a grand moment of expansion. "Now, 50% of our new patient visits are related to some sort of social media. This is where you can really begin to grow your practice."

He offered some tips for getting started:

• Start slow. "Don’t waste the time if your parents aren’t interested. Do a simple paper-and-pencil survey in your office. Find out if people are interested in e-mail, Twitter, Facebook, or a Web page for your practice. Once you figure that out, you can target your efforts," Dr. Wolynn advised.

©audioundwerbung/iStockphoto

• If you can afford it, hire someone to create your Web page. It should be full of colorful graphics, easy to navigate, and constantly refreshed with new offerings – blogs, conversations about seasonal health issues, links that allow parents to "meet" staff, and even general information about the larger community. "We have even added a jobs page [with openings at our practice] for parents, and a link to the local center for breastfeeding."

• Consider video. "In 2012, 50% of Internet traffic was driven by video. GenY wants to see it – not read it. We use YouTube as a way of introducing our doctors. We do pay someone to do the videos, but the investment pays for itself," Dr. Wolynn said. Videos introducing our physicians are especially popular with parents. "You can offer general parenting tips as well, not just medical information." Dr. Wolynn said a video he did on "five places to cool off for free" in Pittsburgh was one of the most popular on the site.

• Allow parents to ask general questions and to expect a timely response. "It has to be clear that this isn’t intended for emergency use, and you do need to vet the information you provide. But it’s perfect for general things like, ‘My baby has a fever – what can I give?’ This can actually start taking away some of your triage nurse’s calls. Other parents will jump in as well, responding to the post," he said.

• Don’t simply wait for families to come to you – push your information to them. "They can make an agreement, and your information will come to them in their preferred media," he said.

• Be clear with staff about the site’s use and limits. "You don’t want your staff posting things like, ‘We were really overworked today.’ They can say things like that on their own site – that’s their right. But not on the practice site. We have never had a negative employee comment posted," Dr. Wolynn said.

• Consider privacy laws and seek advice if you need to. It’s always best to err on the side of caution when parents ask specific questions. "We have someone monitor the site. If something acute comes up, we call the person as quickly as possible," he said. Patient privacy law for Internet communication is "evolving as we go along. We’ve talked to our lawyer and been told that ‘precedent on this is being set daily,’ " Dr. Wolynn noted.

He said he had no relevant financial disclosures.

NEW ORLEANS  – It’s time for more pediatricians to step into the digital world.

Facebook pages, Twitter accounts, and direct e-mail to patients are nothing to be scared of, according to Dr. Todd Wolynn. In fact, if your practice isn’t connecting with families over the Internet, competitors are, he said at the annual meeting of the American Academy of Pediatrics.

"Pediatrics is rapidly changing, facing threats on all sides," said Dr. Wolynn, a pediatrician in group practice in Pittsburgh. "When I started, I did everything for my patients, from NICU visits to inpatient care and house calls. But our practice size is shrinking. Now most general pediatricians just see outpatient, sick calls, and well calls. There’s even increasing competition for those from urgent care facilities, and even clinics in retail stores and pharmacies."

Before the age of constant connection, pediatricians were part of an extended family centered on the patient and parents, and sometimes grandparents as well. "It was a trust-based relationship based on ties with several generations," he said. Now, young "Generation Y" parents are likely to pay more attention to their virtual friends than to their real parents, Dr. Wolynn said.

"Your target audience is GenY. These are the parents making decisions now, and if you don’t know them, you will quickly become meaningless and fail to reach their children," he said.

Connectedness can be a double-edged sword. "It’s not just Facebook. It’s like Facebook on steroids," capable of generating medical myths so entrenched they become almost impossible to expunge. On the other hand, Facebook and its "ADHD relative" Twitter, can spread positive feedback about your practice like never before.

For the pediatrician who’s open to it, this paradigm shift can be a grand moment of expansion. "Now, 50% of our new patient visits are related to some sort of social media. This is where you can really begin to grow your practice."

He offered some tips for getting started:

• Start slow. "Don’t waste the time if your parents aren’t interested. Do a simple paper-and-pencil survey in your office. Find out if people are interested in e-mail, Twitter, Facebook, or a Web page for your practice. Once you figure that out, you can target your efforts," Dr. Wolynn advised.

©audioundwerbung/iStockphoto

• If you can afford it, hire someone to create your Web page. It should be full of colorful graphics, easy to navigate, and constantly refreshed with new offerings – blogs, conversations about seasonal health issues, links that allow parents to "meet" staff, and even general information about the larger community. "We have even added a jobs page [with openings at our practice] for parents, and a link to the local center for breastfeeding."

• Consider video. "In 2012, 50% of Internet traffic was driven by video. GenY wants to see it – not read it. We use YouTube as a way of introducing our doctors. We do pay someone to do the videos, but the investment pays for itself," Dr. Wolynn said. Videos introducing our physicians are especially popular with parents. "You can offer general parenting tips as well, not just medical information." Dr. Wolynn said a video he did on "five places to cool off for free" in Pittsburgh was one of the most popular on the site.

• Allow parents to ask general questions and to expect a timely response. "It has to be clear that this isn’t intended for emergency use, and you do need to vet the information you provide. But it’s perfect for general things like, ‘My baby has a fever – what can I give?’ This can actually start taking away some of your triage nurse’s calls. Other parents will jump in as well, responding to the post," he said.

• Don’t simply wait for families to come to you – push your information to them. "They can make an agreement, and your information will come to them in their preferred media," he said.

• Be clear with staff about the site’s use and limits. "You don’t want your staff posting things like, ‘We were really overworked today.’ They can say things like that on their own site – that’s their right. But not on the practice site. We have never had a negative employee comment posted," Dr. Wolynn said.

• Consider privacy laws and seek advice if you need to. It’s always best to err on the side of caution when parents ask specific questions. "We have someone monitor the site. If something acute comes up, we call the person as quickly as possible," he said. Patient privacy law for Internet communication is "evolving as we go along. We’ve talked to our lawyer and been told that ‘precedent on this is being set daily,’ " Dr. Wolynn noted.

He said he had no relevant financial disclosures.

NEW ORLEANS – More physicians are using text messaging to communicate with each other and their teams in hospitals, a hint toward a shift from pagers, which have been a regular accessory to scrubs and white coats for the past 30 years.

The trend is driven by the surge in cell phone use and advances in technology, not to mention the new crop of tech-savvy interns and residents, according to the few studies that have focused on text messaging among health care professionals.

©Yankin Chauvin/Fotolia.com

The studies are quick to point out one major caveat: Most text messages are not encrypted, and many hospitals and health systems have yet to implement policies and secure programs to protect the exchanged information.

"This is a wake-up call," Dr. Stephanie Kuhlmann said at the annual meeting of the American Academy of Pediatrics. "Hospitals need to be aware of this trend and need to find a way to secure these text messages."

Dr. Kuhlmann, who is a pediatric hospitalist and assistant professor of pediatrics at the University of Kansas, Wichita, doesn’t carry a pager. She receives pages on her cell phone. She uses text messaging with colleagues, residents, and other members of the hospital team, whether it’s for administrative purposes, patient-care issues, or arranging a meetup.

Seeing the trend in her workplace, Dr. Kuhlmann and her colleagues decided to conduct an electronic survey of pediatric hospitalists about their use of text messaging.

The survey revealed that although face-to-face and phone communication were the most common types of contact (92% each) among the 106 surveyed, nearly 60% of the respondents said they received work-related text messages and 12% said they sent more than 10 messages per shift.

The text messages were to or from other pediatric hospitalists 59% of the time, from fellows or residents 34% of the time, and from subspecialists and consulting physicians 25% of the time. Nearly half of the respondents said that they received text messages when they were not on call.

"It’s a quick way to communicate or ask a quick question. You don’t have to stay on hold on the phone," Dr. Kuhlmann said.

Meanwhile, 41% of the respondents said they were worried about violating the Health Insurance Portability and Accountability Act (HIPAA), highlighting a need for text messaging encryption, said Dr. Kuhlmann.

In another survey, conducted by the IT security company Imprivata, more than 60% of hospital IT executives said that they were very concerned about HIPAA compliance.

Roughly 72% of the 114 respondents said that they had policies in place to prevent personal health information from being included in text messages. Yet, some 60% said they didn’t have a secure text messaging solution in place.

Almost two-thirds said that they believed pagers will be replaced by secure text messaging within 3 years.

Imprivata is among a handful of companies to offer HIPAA-compliant or encrypted text messaging programs and software for hospitals and health care systems.

Dr. Kuhlmann said that she wasn’t aware of any head-to-head comparisons for the available encrypted texting programs.

She and her colleagues, who are conducting more studies on the subject, said that there’s a need for more research on the accuracy and effectiveness of text message communication in hospitals and patient privacy issues.

Dr. Kulhmann said she had no relevant financial disclosures.

NEW ORLEANS – More physicians are using text messaging to communicate with each other and their teams in hospitals, a hint toward a shift from pagers, which have been a regular accessory to scrubs and white coats for the past 30 years.

The trend is driven by the surge in cell phone use and advances in technology, not to mention the new crop of tech-savvy interns and residents, according to the few studies that have focused on text messaging among health care professionals.

©Yankin Chauvin/Fotolia.com

The studies are quick to point out one major caveat: Most text messages are not encrypted, and many hospitals and health systems have yet to implement policies and secure programs to protect the exchanged information.

"This is a wake-up call," Dr. Stephanie Kuhlmann said at the annual meeting of the American Academy of Pediatrics. "Hospitals need to be aware of this trend and need to find a way to secure these text messages."

Dr. Kuhlmann, who is a pediatric hospitalist and assistant professor of pediatrics at the University of Kansas, Wichita, doesn’t carry a pager. She receives pages on her cell phone. She uses text messaging with colleagues, residents, and other members of the hospital team, whether it’s for administrative purposes, patient-care issues, or arranging a meetup.

Seeing the trend in her workplace, Dr. Kuhlmann and her colleagues decided to conduct an electronic survey of pediatric hospitalists about their use of text messaging.

The survey revealed that although face-to-face and phone communication were the most common types of contact (92% each) among the 106 surveyed, nearly 60% of the respondents said they received work-related text messages and 12% said they sent more than 10 messages per shift.

The text messages were to or from other pediatric hospitalists 59% of the time, from fellows or residents 34% of the time, and from subspecialists and consulting physicians 25% of the time. Nearly half of the respondents said that they received text messages when they were not on call.

"It’s a quick way to communicate or ask a quick question. You don’t have to stay on hold on the phone," Dr. Kuhlmann said.

Meanwhile, 41% of the respondents said they were worried about violating the Health Insurance Portability and Accountability Act (HIPAA), highlighting a need for text messaging encryption, said Dr. Kuhlmann.

In another survey, conducted by the IT security company Imprivata, more than 60% of hospital IT executives said that they were very concerned about HIPAA compliance.

Roughly 72% of the 114 respondents said that they had policies in place to prevent personal health information from being included in text messages. Yet, some 60% said they didn’t have a secure text messaging solution in place.

Almost two-thirds said that they believed pagers will be replaced by secure text messaging within 3 years.

Imprivata is among a handful of companies to offer HIPAA-compliant or encrypted text messaging programs and software for hospitals and health care systems.

Dr. Kuhlmann said that she wasn’t aware of any head-to-head comparisons for the available encrypted texting programs.

She and her colleagues, who are conducting more studies on the subject, said that there’s a need for more research on the accuracy and effectiveness of text message communication in hospitals and patient privacy issues.

Dr. Kulhmann said she had no relevant financial disclosures.

NEW ORLEANS – More physicians are using text messaging to communicate with each other and their teams in hospitals, a hint toward a shift from pagers, which have been a regular accessory to scrubs and white coats for the past 30 years.

The trend is driven by the surge in cell phone use and advances in technology, not to mention the new crop of tech-savvy interns and residents, according to the few studies that have focused on text messaging among health care professionals.

©Yankin Chauvin/Fotolia.com

The studies are quick to point out one major caveat: Most text messages are not encrypted, and many hospitals and health systems have yet to implement policies and secure programs to protect the exchanged information.

"This is a wake-up call," Dr. Stephanie Kuhlmann said at the annual meeting of the American Academy of Pediatrics. "Hospitals need to be aware of this trend and need to find a way to secure these text messages."

Dr. Kuhlmann, who is a pediatric hospitalist and assistant professor of pediatrics at the University of Kansas, Wichita, doesn’t carry a pager. She receives pages on her cell phone. She uses text messaging with colleagues, residents, and other members of the hospital team, whether it’s for administrative purposes, patient-care issues, or arranging a meetup.

Seeing the trend in her workplace, Dr. Kuhlmann and her colleagues decided to conduct an electronic survey of pediatric hospitalists about their use of text messaging.

The survey revealed that although face-to-face and phone communication were the most common types of contact (92% each) among the 106 surveyed, nearly 60% of the respondents said they received work-related text messages and 12% said they sent more than 10 messages per shift.

The text messages were to or from other pediatric hospitalists 59% of the time, from fellows or residents 34% of the time, and from subspecialists and consulting physicians 25% of the time. Nearly half of the respondents said that they received text messages when they were not on call.

"It’s a quick way to communicate or ask a quick question. You don’t have to stay on hold on the phone," Dr. Kuhlmann said.

Meanwhile, 41% of the respondents said they were worried about violating the Health Insurance Portability and Accountability Act (HIPAA), highlighting a need for text messaging encryption, said Dr. Kuhlmann.

In another survey, conducted by the IT security company Imprivata, more than 60% of hospital IT executives said that they were very concerned about HIPAA compliance.

Roughly 72% of the 114 respondents said that they had policies in place to prevent personal health information from being included in text messages. Yet, some 60% said they didn’t have a secure text messaging solution in place.

Almost two-thirds said that they believed pagers will be replaced by secure text messaging within 3 years.

Imprivata is among a handful of companies to offer HIPAA-compliant or encrypted text messaging programs and software for hospitals and health care systems.

Dr. Kuhlmann said that she wasn’t aware of any head-to-head comparisons for the available encrypted texting programs.

She and her colleagues, who are conducting more studies on the subject, said that there’s a need for more research on the accuracy and effectiveness of text message communication in hospitals and patient privacy issues.

Dr. Kulhmann said she had no relevant financial disclosures.

NEW ORLEANS – Beginning in 2013, vaccines will need to be stored in a full-sized, freezerless refrigerator, the temperature of which is constantly monitored by a digital 24-hour temperature-recording device.

The new storage guidelines, issued in early October by the Centers for Disease Control and Prevention, also require the use of a biosafe glycol-encased temperature probe because these devices more accurately approximate the temperature of stored liquids, Dr. Herschel Lessin said at the annual meeting of the American Academy of Pediatrics.

The regulation will go into effect on Jan. 1, 2013, said Dr. Lessin, a pediatrician in group practice in Poughkeepsie, N.Y.

"You also won’t be able to use a dormstyle refrigerator or a refrigerator/freezer combination," he said. "In these units, the freezer is actually what chills the fridge, and when the freezer cycles on and off, it can change the temperature of the refrigerator."

The 24-hour data recording of temperature is intended to ensure that vaccine remains within its constant recommended range of 35°-46° F. "If the data logger hits outside that range, it’s the kiss of death for your store of vaccine," he said.

The recording unit has to be able to store at least 4,000 readings so it won’t overwrite old data or stop recording because the memory is full.

In addition to the hardware changes, human systems will need an update, said Dr. Lessin, who is also a member of the AAP committee on practice and ambulatory medicine. Someone in the office needs to review the temperature log daily. "You have to have a system that if the temperature gets close to being out of the range, you get that vaccine out of there and into an appropriate storage container."

The system should also include a weekly review of expiration dates to facilitate stock rotation, and people who can serve as "vaccine coordinators." These staffers should be trained in proper vaccine storage and handling, and be able to perform accountability checks to make sure the protocol is followed.

In writing the new recommendation, the CDC relied on a 2010 study on refrigerator types and how they can affect vaccines. The study tested two types of refrigerators – household and dormstyle. After 19 thermometer-recorded temperatures in different parts of the devices and on the outside of vaccine bottles were taken, a regular full-sized freezerless refrigerator was found to be "fully adequate" at keeping the vaccines at the optimum temperature. Dormstyle units showed quite a lot of temperature drift, especially when they were heavily loaded. "These problems make the dormitorystyle refrigerator unsuitable for vaccine storage," Dr. Lessin said.

Dr. Lessin said he had no relevant financial disclosures.

NEW ORLEANS – Beginning in 2013, vaccines will need to be stored in a full-sized, freezerless refrigerator, the temperature of which is constantly monitored by a digital 24-hour temperature-recording device.

The new storage guidelines, issued in early October by the Centers for Disease Control and Prevention, also require the use of a biosafe glycol-encased temperature probe because these devices more accurately approximate the temperature of stored liquids, Dr. Herschel Lessin said at the annual meeting of the American Academy of Pediatrics.

The regulation will go into effect on Jan. 1, 2013, said Dr. Lessin, a pediatrician in group practice in Poughkeepsie, N.Y.

"You also won’t be able to use a dormstyle refrigerator or a refrigerator/freezer combination," he said. "In these units, the freezer is actually what chills the fridge, and when the freezer cycles on and off, it can change the temperature of the refrigerator."

The 24-hour data recording of temperature is intended to ensure that vaccine remains within its constant recommended range of 35°-46° F. "If the data logger hits outside that range, it’s the kiss of death for your store of vaccine," he said.

The recording unit has to be able to store at least 4,000 readings so it won’t overwrite old data or stop recording because the memory is full.

In addition to the hardware changes, human systems will need an update, said Dr. Lessin, who is also a member of the AAP committee on practice and ambulatory medicine. Someone in the office needs to review the temperature log daily. "You have to have a system that if the temperature gets close to being out of the range, you get that vaccine out of there and into an appropriate storage container."

The system should also include a weekly review of expiration dates to facilitate stock rotation, and people who can serve as "vaccine coordinators." These staffers should be trained in proper vaccine storage and handling, and be able to perform accountability checks to make sure the protocol is followed.

In writing the new recommendation, the CDC relied on a 2010 study on refrigerator types and how they can affect vaccines. The study tested two types of refrigerators – household and dormstyle. After 19 thermometer-recorded temperatures in different parts of the devices and on the outside of vaccine bottles were taken, a regular full-sized freezerless refrigerator was found to be "fully adequate" at keeping the vaccines at the optimum temperature. Dormstyle units showed quite a lot of temperature drift, especially when they were heavily loaded. "These problems make the dormitorystyle refrigerator unsuitable for vaccine storage," Dr. Lessin said.

Dr. Lessin said he had no relevant financial disclosures.

NEW ORLEANS – Beginning in 2013, vaccines will need to be stored in a full-sized, freezerless refrigerator, the temperature of which is constantly monitored by a digital 24-hour temperature-recording device.

The new storage guidelines, issued in early October by the Centers for Disease Control and Prevention, also require the use of a biosafe glycol-encased temperature probe because these devices more accurately approximate the temperature of stored liquids, Dr. Herschel Lessin said at the annual meeting of the American Academy of Pediatrics.

The regulation will go into effect on Jan. 1, 2013, said Dr. Lessin, a pediatrician in group practice in Poughkeepsie, N.Y.

"You also won’t be able to use a dormstyle refrigerator or a refrigerator/freezer combination," he said. "In these units, the freezer is actually what chills the fridge, and when the freezer cycles on and off, it can change the temperature of the refrigerator."

The 24-hour data recording of temperature is intended to ensure that vaccine remains within its constant recommended range of 35°-46° F. "If the data logger hits outside that range, it’s the kiss of death for your store of vaccine," he said.

The recording unit has to be able to store at least 4,000 readings so it won’t overwrite old data or stop recording because the memory is full.

In addition to the hardware changes, human systems will need an update, said Dr. Lessin, who is also a member of the AAP committee on practice and ambulatory medicine. Someone in the office needs to review the temperature log daily. "You have to have a system that if the temperature gets close to being out of the range, you get that vaccine out of there and into an appropriate storage container."

The system should also include a weekly review of expiration dates to facilitate stock rotation, and people who can serve as "vaccine coordinators." These staffers should be trained in proper vaccine storage and handling, and be able to perform accountability checks to make sure the protocol is followed.

In writing the new recommendation, the CDC relied on a 2010 study on refrigerator types and how they can affect vaccines. The study tested two types of refrigerators – household and dormstyle. After 19 thermometer-recorded temperatures in different parts of the devices and on the outside of vaccine bottles were taken, a regular full-sized freezerless refrigerator was found to be "fully adequate" at keeping the vaccines at the optimum temperature. Dormstyle units showed quite a lot of temperature drift, especially when they were heavily loaded. "These problems make the dormitorystyle refrigerator unsuitable for vaccine storage," Dr. Lessin said.

Dr. Lessin said he had no relevant financial disclosures.

NEW ORLEANS – In response to the rising rates of overweight and obesity among children, the American Academy of Pediatrics has launched a new institute to provide pediatricians with tools and resources to fight the epidemic.

The Institute for Healthy Childhood Weight is housed within the AAP and is funded by government grants and corporate sponsors.

"Over the past decade we’ve been building the effort, and this institute serves to integrate the obesity efforts across the academy," said Dr. Sandra Hassink, chair of the institute’s steering committee.

In a video interview, Dr. Hassink, who is the director of the Nemours Obesity Initiative at Alfred I. duPont Hospital for Children in Wilmington, Del., further explained the role of the Institute, and talked about how it can benefit pediatricians and their practices:

Dr. Hassink said she had no disclosures.

NEW ORLEANS – In response to the rising rates of overweight and obesity among children, the American Academy of Pediatrics has launched a new institute to provide pediatricians with tools and resources to fight the epidemic.

The Institute for Healthy Childhood Weight is housed within the AAP and is funded by government grants and corporate sponsors.

"Over the past decade we’ve been building the effort, and this institute serves to integrate the obesity efforts across the academy," said Dr. Sandra Hassink, chair of the institute’s steering committee.

In a video interview, Dr. Hassink, who is the director of the Nemours Obesity Initiative at Alfred I. duPont Hospital for Children in Wilmington, Del., further explained the role of the Institute, and talked about how it can benefit pediatricians and their practices:

Dr. Hassink said she had no disclosures.

NEW ORLEANS – In response to the rising rates of overweight and obesity among children, the American Academy of Pediatrics has launched a new institute to provide pediatricians with tools and resources to fight the epidemic.

The Institute for Healthy Childhood Weight is housed within the AAP and is funded by government grants and corporate sponsors.

"Over the past decade we’ve been building the effort, and this institute serves to integrate the obesity efforts across the academy," said Dr. Sandra Hassink, chair of the institute’s steering committee.

In a video interview, Dr. Hassink, who is the director of the Nemours Obesity Initiative at Alfred I. duPont Hospital for Children in Wilmington, Del., further explained the role of the Institute, and talked about how it can benefit pediatricians and their practices:

Dr. Hassink said she had no disclosures.

NEW ORLEANS – Few adolescent girls who visited an emergency department were screened for pregnancy, even if they presented with lower abdominal pain or underwent a radiologic exam, according to analysis of national data.

Several factors could contribute to the lapse, according to lead author Dr. Monika Goyal.

"We, as providers, consider pregnancy to be more an adult issue and often fail to consider it when evaluating teenagers," said Dr. Goyal of the departments of pediatrics and emergency medicine at George Washington University, Washington.

Dr. Cora Collette Breuner, discussant and a member of the AAP Committee on Adolescence, noted that it can be difficult to see an adolescent confidentially in the ED setting. "We’re afraid of offending the patients and their families," she said.

Indeed, interventions that standardize sexual history taking for every adolescent, and pregnancy screening when patients may be exposed to teratogenic tests is among the solutions to increase the screening rates, said Dr. Goyal, who is also an attending ED physician at Children’s National Medical Center in Washington.

In her retrospective analysis, Dr. Goyal and her colleagues used the National Hospital Ambulatory Medical Care Survey from 2000 to 2009, identifying 22,866 records of female patients aged 14-21 years who were evaluated in EDs.

Of the 77 million female adolescents who visited ED during the 9-year-period, about 19% (14.5 million) received a pregnancy test.

Of those who presented with lower abdominal pain, 42% were tested. Meanwhile, 22% of those who underwent radiologic imaging were tested for pregnancy, so did 28% of the patients were exposed to potentially teratogenic radiation, such as chest radiographs or CT scans. Black patients, as well as those with non-private health insurance, who were admitted, and those with a chief complaint of lower abdominal pain or genitourinary symptoms were significantly more likely to be screened for pregnancy.

"This is a well-done study, and the findings are a bit surprising," commented Dr. Breuner, who is also a professor of adolescent medicine at the University of Washington, Seattle. "I really thought the numbers [for pregnancy screening] would be higher for abdominal pain."

Dr. Goyal advised pediatricians to conduct a confidential sexual history with every adolescent patient.

"Furthermore, we should have standardized protocols for pregnancy testing for complaints that may be associated with pregnancy related symptoms or anytime a patient may be exposed to therapies or diagnostics that may be harmful if pregnant."

Dr. Goyal and Dr. Breuner had no disclosures.

NEW ORLEANS – Few adolescent girls who visited an emergency department were screened for pregnancy, even if they presented with lower abdominal pain or underwent a radiologic exam, according to analysis of national data.

Several factors could contribute to the lapse, according to lead author Dr. Monika Goyal.

"We, as providers, consider pregnancy to be more an adult issue and often fail to consider it when evaluating teenagers," said Dr. Goyal of the departments of pediatrics and emergency medicine at George Washington University, Washington.

Dr. Cora Collette Breuner, discussant and a member of the AAP Committee on Adolescence, noted that it can be difficult to see an adolescent confidentially in the ED setting. "We’re afraid of offending the patients and their families," she said.

Indeed, interventions that standardize sexual history taking for every adolescent, and pregnancy screening when patients may be exposed to teratogenic tests is among the solutions to increase the screening rates, said Dr. Goyal, who is also an attending ED physician at Children’s National Medical Center in Washington.

In her retrospective analysis, Dr. Goyal and her colleagues used the National Hospital Ambulatory Medical Care Survey from 2000 to 2009, identifying 22,866 records of female patients aged 14-21 years who were evaluated in EDs.

Of the 77 million female adolescents who visited ED during the 9-year-period, about 19% (14.5 million) received a pregnancy test.

Of those who presented with lower abdominal pain, 42% were tested. Meanwhile, 22% of those who underwent radiologic imaging were tested for pregnancy, so did 28% of the patients were exposed to potentially teratogenic radiation, such as chest radiographs or CT scans. Black patients, as well as those with non-private health insurance, who were admitted, and those with a chief complaint of lower abdominal pain or genitourinary symptoms were significantly more likely to be screened for pregnancy.

"This is a well-done study, and the findings are a bit surprising," commented Dr. Breuner, who is also a professor of adolescent medicine at the University of Washington, Seattle. "I really thought the numbers [for pregnancy screening] would be higher for abdominal pain."

Dr. Goyal advised pediatricians to conduct a confidential sexual history with every adolescent patient.

"Furthermore, we should have standardized protocols for pregnancy testing for complaints that may be associated with pregnancy related symptoms or anytime a patient may be exposed to therapies or diagnostics that may be harmful if pregnant."

Dr. Goyal and Dr. Breuner had no disclosures.

NEW ORLEANS – Few adolescent girls who visited an emergency department were screened for pregnancy, even if they presented with lower abdominal pain or underwent a radiologic exam, according to analysis of national data.

Several factors could contribute to the lapse, according to lead author Dr. Monika Goyal.

"We, as providers, consider pregnancy to be more an adult issue and often fail to consider it when evaluating teenagers," said Dr. Goyal of the departments of pediatrics and emergency medicine at George Washington University, Washington.

Dr. Cora Collette Breuner, discussant and a member of the AAP Committee on Adolescence, noted that it can be difficult to see an adolescent confidentially in the ED setting. "We’re afraid of offending the patients and their families," she said.

Indeed, interventions that standardize sexual history taking for every adolescent, and pregnancy screening when patients may be exposed to teratogenic tests is among the solutions to increase the screening rates, said Dr. Goyal, who is also an attending ED physician at Children’s National Medical Center in Washington.

In her retrospective analysis, Dr. Goyal and her colleagues used the National Hospital Ambulatory Medical Care Survey from 2000 to 2009, identifying 22,866 records of female patients aged 14-21 years who were evaluated in EDs.

Of the 77 million female adolescents who visited ED during the 9-year-period, about 19% (14.5 million) received a pregnancy test.

Of those who presented with lower abdominal pain, 42% were tested. Meanwhile, 22% of those who underwent radiologic imaging were tested for pregnancy, so did 28% of the patients were exposed to potentially teratogenic radiation, such as chest radiographs or CT scans. Black patients, as well as those with non-private health insurance, who were admitted, and those with a chief complaint of lower abdominal pain or genitourinary symptoms were significantly more likely to be screened for pregnancy.

"This is a well-done study, and the findings are a bit surprising," commented Dr. Breuner, who is also a professor of adolescent medicine at the University of Washington, Seattle. "I really thought the numbers [for pregnancy screening] would be higher for abdominal pain."

Dr. Goyal advised pediatricians to conduct a confidential sexual history with every adolescent patient.

"Furthermore, we should have standardized protocols for pregnancy testing for complaints that may be associated with pregnancy related symptoms or anytime a patient may be exposed to therapies or diagnostics that may be harmful if pregnant."

Dr. Goyal and Dr. Breuner had no disclosures.