Skype and unbridled communication between caregivers and their patients has opened a great many opportunities for care to be offered the world round, from a variety of locations within our own communities to remote and unconventional places in other areas of the world.
In a nutshell, Dr. DeShan spends several months in Russia each year leading an international medical mission where he serves some of Moscow’s most needy, as well as delivers care to some of the world’s remote people through journeys into the wilderness.
When he’s in Moscow serving patients, she’s able to stay connected to his practice in Midland Texas, where he’s a partner at a thriving OBGYN. Aside from relinquishing a few of his daily duties, such as delivering, he’s able to maintain a full patient load and he does that in part using the web and tools like Skype to maintain contact with them and with his practice.
Personally, I believe the work DeShan is doing is fascinating. He’s using his talent and skill to follow his passion and his calling in life. His practice and his patients are in support of his work and in no way does he keep it from them. Those patients that were not comfortable with interacting with him part time through the web were assigned to other practitioners.
However, I’ve always wondered if Skype is a tool that can be trusted for such work. Despite his good deeds, I always wondered he’s in HIPAA compliance.
According to a recent article in Medical Office Today, I’m not the only one. According to the article, “Notwithstanding the fact that Skype is ubiquitous, its use may be inappropriate for healthcare providers as web-based platforms raise a number of significant HIPAA privacy and security issues:
Many platforms are proprietary, meaning that healthcare providers have no way to determine if and what information is stored
Users cannot reliably develop and verify an audit trail
There is no reliable way to verify transmission security
Users have no way to know when a breach of information occurs
There is a lack of integrity controls to ensure that electronic protected health information is not altered
Also, according to the piece, HIPAA and its resulting regulations pertaining to privacy and security require covered entities such as healthcare providers to protect the confidentiality of protected health information and guard against unauthorized access, use, and disclosure of such information.
Among other things, the HIPAA rules require:
Access controls
Audit controls
Person or entity authentication
Transmission security
Business Associate access controls
Risk analysis
Workstation security
Device and media controls
Security management process
Breach notification
“The use of web-based platforms, especially those that are proprietary, makes it difficult for healthcare entities to meet many of their HIPAA obligations,” the article states. “As a consequence, telehealth providers carry a higher risk of potentially violating HIPAA rules when they use services such as Skype.
According to the Health Information and Trust Alliance, the organization recommends against the use of Skype and similar platforms for communications involving health information, concluding that web-based platforms are not secure, and are an inappropriate way by which to communicate with patients, especially when the communication involves health information. Their view was confirmed late last year when a security flaw was discovered in Skype that put users’ personal information at risk of disclosure.
“All of this does not mean a healthcare professional should not use Skype to communicate to patients, only that they be aware of the increased risk of violating HIPAA and think long and hard prior to using such technology.”
However, should a provider insist on using Skype, there are some steps they should consider to better protect themselves from potential HIPAA liability (all good tips, according to the magazine):
Have patients sign HIPAA authorization and a separate informed consent as part of intake procedures when using web-based platforms
Develop specific procedures and protocols regarding use of Skype, similar platforms
Train workforce on the use of these platforms
Exclude the use of these platforms for vulnerable populations
Limit to certain clinical uses (i.e., only intake or follow up)
Use secure platforms with audit trail, breach notification, other capabilities.
Only HIPAA-compliant technologies can truly protect a physician and a patient. These steps may help. In the long run, though, as I’m sure Dr. DeShan would agree, don’t let the cost of the work keep you from doing it.
A special day here today; time to reflect on the direction of one’s life and its path. The past, its present and the future. It’s a hard process sometimes to think about where one has come from and, and most difficulty, where one is going; where one wants to go.
My time off the grid today was spent with those that matter most, because I could. Left it all behind and felt like I went back in time before technology placed me in the always on mentality. It felt nice taking the time to focus on other priorities and spending time disconnected.
Have to admit, the time away did make me think about life back on the ranch, though. Specifically, the promises told of health IT and how they make the lives of those who use the systems in their professional lives better, easier and efficient.
It might be a bit cliché by now, but during my time serving the health IT industry and its professional partners, I’ve told and been told countless times how systems like EHRs allow physicians to practice more effectively in a shorter amount of time and essentially lock up shop within minutes after the final patient has left.
In fact, I’ve seen testimonials by clients of one vendor say nearly this exact thing, and I understand from personal experience that this can be an actualized reality if a proper plan is put in place and a procedure is established for getting there.
And, just recently, in this forum, I featured Dr. David DeShan who is now able to follow his dream of heading up a medical mission in Russia while also maintaining his partnership at a practice in Texas, all because of his EHR.
So, despite all of the marketing speak and the canned comments, the question is: Do these healthcare technologies actually allow providers a better quality of life?
Are you able to hit the road a lot sooner now that you have a system in place or are you just a workaholic and despite the tools you have you’ll always find a way to work more than you should?
Does health IT make your lives easier? Are you able to spend more time with loved ones or more time on the links? Are you more flexible and able to live a richer more fulfilling life because of your technology or is it all wishful thinking as far of you are concerned?
Finally, have you been able to create more balance between work and personal life since you implemented your system and implemented equipment like tablet PCs or has access to work information while on the run been that more pressure on you to perform.
My situation is different, obviously. I simply turn off my computer and ignore my phone. I’m not in the business of saving lives; I just help people and companies tell their stories.
I’d love to know, once and for all, does it really matter or are these “potential” benefits just a bunch of marketing speak?
Dr. David DeShan leads a global healthcare mission from Moscow. Because of his work with Agape Unlimited, he supports thousands of poor and under served Russians while maintaining a full-time practice in Midland, Texas. Agape is a medical mission serving thousands of people
Dr. DeShan’s medical mission, through Agape Unlimited, provides everything to its patients for free. There’s no cost for the consultation, for medication or for the glasses received. Because of the care provided for the folks in the rural areas, sometimes this is the only medical treatment they’ll receive for years. Word of mouth spreads and people come for miles. In one instance, a group of patients rode on a reindeer-pulled sleigh for more than 24 hours for a visit with an Agape physician.
Agape Expedition Life
Each expedition outside of Moscow has its own set of challenges depending on where the group of volunteers is going and the time of year, but each has several things in common. First, the expeditions to the remote areas are all two weeks long, primarily because there is a tremendous amount of travel involved. From the U.S. to Moscow takes between 20 and 24 hours then there is the travel to region where the work is done, which can take between 24 and 36 hours by train. Once the crew reaches the region, there is often another eight to 10 hours of travel by vehicle to get to the area where they will work. This is typically a large village in the region where they stay with a host family.
Once they reach the area they’ll be working in, each day the crew goes out to different villages for anywhere from one to three days. This is where the work of seeing patients begins.
Each team consists of four to six people and is a combination of Russians and foreigners, with a doctor, translator and others who fit people for eyeglasses, take vital signs, do basic lab work and patient education. Often they arrive in the morning and work late into the night as they attempt to see everyone who comes for a visit.
When they arrive in the tundra or taiga, little clinic areas are set up in any area that can accommodate volunteers – in churches, homes or government-owned buildings.
Often, the temperatures are extreme and basic comforts are a luxury. Roads are few, the people are scattered and the towns are made up of 19th century-like structures.
The medicine that is dispensed is the most readily available to those living in the area, making it easier for people to acquire drugs once the team of doctors has left.
For those treating patients in Moscow, they travel to various sites throughout the massive city, caring for the sick and poor. The story is much the same here as it is in the countryside: far too many people need care for anyone to provide in their lifetimes.
“Because of the lack of care and education about personal health, the results, in many cases for patients, are not good. Ailments of all types are seen, and too many of the devastating kind seem to appear,” DeShan said. “We’ve seen men in their 40s who have had a stroke.”
Home on the Range
Back in Texas, most of his patients have been very supportive of Dr. Deshan’s global work.
“When this all started, the big concern I had was if I was going to have any patients left,” he said. “I’ve lost a few, but gained more. They and my partners are very supportive.”
Midland Women’s Clinic office manager Marge Bossler never thought DeShan was going to be able to connect to the EHR from Moscow to make his global pursuits a viable reality. “It’s really quite amazing how he can work, respond to emergencies and attend to the needs of his patients from half a world away,” Bossler said.
“In many ways, when he’s in Moscow, it’s as if he’s only in another area of the building, not in another area of the world. He responds to alerts and takes action for his patients as needed. He’s totally aware of what’s happening back home, and gives his recommendations when required,” she said.
“Now when he leaves, there’s no hopeless feeling that he won’t be reachable,” she added. “The EHR made this possible. This approach gives him the capability to do what he feels he needs to do to answer his calling. Besides, there’s nothing he can’t do from there that he can’t do from his office.”
Where Agape Goes
To the Tundra:
In Russia’s northernmost zone is a treeless, marshy plain. The journey takes days. First, volunteers travel by jet to the region and then use 6×6 Russian trucks to travel up to 24 hours across the Tundra. There are no roads. Sometimes progress can only be measured in inches. They continue by snowmobile to the teepees where the local people live. Once there, they provide medications, medical consultations, health kits and eyeglasses that are often lifesaving for the Nenet people.
To the Taiga:
The world’s largest forest is an area about the size of the United States and spans 11 times zones across Northern Russia. Here in the Taiga, people are extremely distant from the rest of the world, both geographically and communicatively, and some still speak their own ethnic language.
To Southern Siberia:
Deep in the mountains of Southern Siberia, most people are shepherds who tend sheep and goats in these vast valleys. The closest medical help for them is often a three-day trip away, with much of the traveling done on rut filled dirt roads.
Agape Unlimited opened Medical Center Agape in Moscow in 2004, the first Christian Family Practice clinic in Russia. Since 2004, Medical Center Agape has grown to a staff of more than 50 and seeks to provide quality compassionate Christ-centered care to the people of Moscow, to send medical teams to the remote rural areas of Russia, and to provide free medical care to the poor and destitute of Moscow.
In 2007, Medical Center Agape began working in cooperation with several of the leading medical universities and residency training programs in the Moscow area. Agape asked, “How can we help?” They answered that they wanted the mission to teach their doctors to be compassionate. Through this arena, Apage’s goal is to grow a new generation of Russian medical personnel who can continue the work initially started by Agape.
Currently, there are more than 400 written invitations to come and serve in different parts of Russia, some of them are as far as 11 time zones away.
The program is open to doctors, dentists, nurses, dental hygienists, chiropractors, med-techs, residents, interns and even medical students who are in their clinical clerkship years.
Want to Help?
Agape Unlimited is always seeking volunteers to serve in clinics throughout Moscow and to travel on medical expeditions to rural areas of Russia. One- and two-week slots are available.
The cost for the two-week program in Moscow is $2,200 per person or $1,500 for a one-week program. The cost of going on one of the remote expeditions is $3,000 per person. The programs begin on Saturdays. An initial deposit of $1,000 is required to reserve your space in the program, and the balance is due eight weeks before departure.
What is Covered:
Airport pickup and return
A clean bed at the guest flat with bathroom, shower, and kitchen
Breakfast
Public transportation around Moscow
Medical translators for the clinic, medical university, and medical expedition
A medical expedition to a poor region near Moscow
Sightseeing, translators, and touring on the weekends to selected spots (Red Square, Christ the Saviour Cathedral, Ismaylovo market for souvenirs, Mega Mall, underground metro station tour, Arbat Street, Botanical Gardens, and church on Sundays).
One Texas physician leads a global healthcare mission from Moscow, supporting thousands of poor and underserved Russians, while maintaining a full-time practice in Midland, Texas.
Part 1 of a two-part series.
For more than 10 years, Dr. David DeShan has been traveling between Midland, Texas, and Moscow, Russia. DeShan is a physician and a missionary — serving patients at Midland Women’s Clinic in Texas and providing needed prescriptions, exams or treatment to hundreds of indigenous Russians.
The contrasts between the two worlds in which DeShan lives are stark. Here in the United States, he’s connected to his patients through electronic health records and secure web-based practice portals that allow him to communicate, share records and provide consultative services. Likewise, his patients can connect with him through any web-enabled device from anywhere in the world where there’s an Internet connection. His practice, which is building a new state-of-the art clinic, provides 21st century medical care.
In Russia, he is the president of Agape Unlimited, an international Christian medical mission program. Through Agape he visits people that are often secluded in very remote villages far removed from first-world creature comforts. Sometimes, as part of his medical mission work, he travels days into the lost wilderness of one of the world’s most vast and remote regions.
Four to five times a year he ventures outside of Midland, Texas, for up to four weeks on each trip. The majority of his travels are to Moscow where he oversees the nonprofit and its network of clinics. His involvement with Agape includes both the oversight of the organization in addition to traveling to the countryside to administer medical care. Despite being half way across the world he is able to effectively take care of his patients and colleagues in Texas.
In 2002, when Dr. Deshan first started his missionary work in Russia, he was completely detached from his practice in Texas. Needing to reach his patients, he eventually secured a satellite phone. Today, with the help of his EHR, he is fully connected irrespective of his location. Dr. Deshan has access to patient charts and tracks their progress remotely. Occasionally, he will use the information from the EHR and Skype his clients if a face-to-face conversation is warranted. Either way, when he returns to his patients in Texas, he never misses a step.
“None of what I’m now able to do through the ministry and the practice would have been possible without our EHR,” Dr. DeShan said recently. “I run the ministry over there, provide medical education over there, conduct outreach in Siberia and bring doctors here to the U.S. to train. The EHR really allows me to stay connected, in a fashion not available just a few years ago. It’s nice to have the opportunity to live in two worlds at the same time, and the EHR technology really makes it possible.”
Empowering an impassioned dream
Being a full-time physician and president of Agape is highly demanding and Dr. Deshan works up to 90 hours a week.
He has been on 14 expeditions into central Siberia and has made another 16 trips to Russia working in Moscow for a total of 30 trips since 2002. Outside of the expeditions to the countryside he does not practice medicine in Russia. “My role with our organization is to administer, encourage and enable our Russia staff to do the work and to invite others to join us,” DeShan said. “I have also been spending more time in medical education working with the medical schools and hospitals in Russia.”
Healthcare is different there than in the United States, as would be expected. The system is more socialized and less open compared to the U.S. Technology is also limited and use of such tools like EHRs are minimal. In fact, DeShan says there are just a few EHR-like systems in place in Moscow at elite practices.
Each workday, he logs in remotely to his EHR, reviews the pap smears, lab work and patient calls that need his response. His nurse highlights any abnormal mammograms and scans them into the system for his review, and he reviews the physician assistant encounters with his patients. The only things remaining when he gets back home is to go through the mail and review the bone density exams and normal mammograms, usually taking about 30 minutes.
“The EHR is truly what enables me to work in Russia yet still stay caught up. Since I can do this from Russia, it greatly reduces the burden on my partners and most of my patients really don’t miss me while I am gone because everything is still answered in a very timely fashion,” DeShan said.
From Midland to Moscow
DeShan said he’s always been drawn to serving his faith through medicine.
“I’ve always been very interested in Christian outreach, and I see medicine as a tool to this end. I wanted to find an organization for Christian doctors and I went to Russia once and kind of got hooked. I just felt like I was supposed to do more. It called to me,” he said.
He leads a handful of international volunteers from Germany, Canada and the U.S. and a staff of 10 in Russia working on the ministry and 40 working at Agape’s clinic. About 50 serve on expeditions each year. Despite resources, these folks see more than 365,000 patients a year at the group’s clinical network throughout Moscow and provide more than 2,000 pairs of eyeglasses to people throughout the country. Outside Moscow, more than 70,000 consultations have been given since DeShan became involved with the mission.
Though Russia is considered a first-world country, more than 75 percent of its rural residents don’t have plumbing. Without running water, medical infrastructure is not just impossible, it is a wishful hope.
“There’s a tremendous need for care, especially in rural areas out there, for medicine, and things like glasses,” he said.
What is Agape Unlimited?
Agape goes where no others go, taking action to improve the health of people who may have never seen a physician. This takes the organization to remote areas in Siberia and beyond, as well as to Moscow, meeting the needs of the medically underserved in the capital city, DeShan said.
Since 1993, Agape has been providing medicine, medical consultations and assistance to those who have little or no access to medical care in Russia. Agape sends teams to areas where the need for medical help is urgent , focusing on both the most remote and isolated people in the Arctic and Siberia, as well as the poor and overlooked in rural and urban areas,.
Agape’s medical expeditions always work in conjunction with a church within the region; this way the work continues in the community after the medical missionaries leave.
Agape provides everything to its patients for free. There’s no cost for the consultation, for medication or for the glasses received. Because of the care provided for the folks in the rural areas, sometimes this is the only medical treatment they’ll receive for years. Word of mouth spreads and people come for miles. In one instance, a group of patients rode on a reindeer-pulled sleigh for more than 24 hours for a visit with an Agape physician.
For more about Agape Unlimited, visit www.agaperu.org.
