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Ebola Update from NYSDOH 10.20.14

The CDC and the NYS Department of Health continue to issue guidance updates for diagnosis and handling of potential Ebola Virus Disease (EVD) cases.  NYS Acting Commissioner of Health Howard Zucker yesterday issued an “extraordinary order” setting forth actions to be taken by all general hospitals, diagnostic and treatment centers, off-campus emergency departments and ambulance services to manage and treat persons with confirmed cases of Ebola or with symptoms and risk factors indicative of Ebola.   Specific information is included in an FAQ document  for other settings such as private practices and pharmacies.   The following updates should be immediately reviewed by all physicians and other health care providers:

Previous Posts:

The NYSDOH is advising health care providers and facilities to review the new CDC health advisory regarding recommendations for evaluating patients for possible Ebola virus disease (EVD).  Main points from previous advisory are reminders to:

  • Increase vigilance in inquiring about a history of travel to West Africa in the 21 days before illness onset for any patient presenting with fever or other symptoms consistent with EVD
  • Isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting EVD  symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); and
  • Immediately notify the local health department 

Travel history should be asked of all patients who present with symptoms such as fever (greater than 101.5°F or 38.6°C), severe headache, muscle pain, vomiting, diarrhea, abdominal (stomach) pain, or unexplained hemorrhage (bleeding or bruising) at initial presentation in EDs or reception in primary or urgent care settings. Signage asking patients to provide travel history should also be prominently posted. Rapid recognition of possible EVD cases is critical to protecting health and safety.
The NYSDOH is also advising health care providers and facilities to review previously released CDC and NYSDOH guidance on EVD. See the full PDF attached.
The NYSDOH is advising health care providers and facilities to utilize the algorithm/decision guide included in this advisory when evaluating patients for potential EVD.
Hospitals and other healthcare providers are strongly encouraged to perform drills in the early identification and isolation of suspected EVD patients to review plans for hospitalization of a suspect or confirmed EVD patient, and to identify and train staff who would provide care to a suspect or confirmed EVD patient. The drills should include staff and rehearse procedures for the use of personal protective equipment (PPE).
We have also received the following updated message from the CDC - Ebola Key Messages - please click here.

NY State Physician Organizations and Public Health Officials Launch "IMMUNIZE NY"

In an effort to address the rise of preventable diseases due to lack of immunization, New York State physician groups and public health officials have launched a program to encourage New Yorkers to be vigilant in keeping their immunizations up-to-date.

The New York Chapter of the American College of Physicians (NYACP), along with The Medical Society of the State of New York (MSSNY), the New York State Chapter of Academy of Family Physicians and the New York State Association of County Health Officials have launched "IMMUNIZE NY" to promote immunizations within the adult population. The campaign strongly encourages adults to discuss immunizations with their physicians and to ask specifically about pertussis, influenza, pneumococcal, HPV and shingles vaccinations. 

Preventing diseases through vaccine is one of the five public health priorities for the New York State Department of Health.  The Affordable Care Act's prevention provisions now cover vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) with no co-payments or other cost-sharing requirements when those services are delivered by an in-network provider.

For information on how to stay vaccinated this season, as well as more comprehensive background information, check out these websites:

New CDC Recommendations for 65+ for Pneumcoccal Vaccination

The Advisory Committee on Immunization Practices (ACIP) published its Morbidity and Mortality Weekly Report (MMWR) on 9/19/14. The report details new recommendations for pneumococcal vaccination in older adults. More details on the recommendations can be read here.

Free Smoking Cessation Learning Module Available Online!

Tobacco use is leading cause of preventable death in the U.S., and as health care professionals we are in a prime position to help our patients successfully quit tobacco, while simultaneously lowering their risk of heart disease, stroke, COPD and other diseases.

Recently, the NYC Health Department has developed an excellent and free online learning module to assist physicians by enhancing your knowledge on how to effectively assess, counsel, and treat tobacco use, greatly improving patients’ chances of successfully quitting. For medical residents, this module meets five of the six Accreditation Council for Graduate Medical Education core competencies and is able to be placed in your learning management system. For attending physicians, this module provides 1 CME credit.

Highlights of the module include:

  • The “5 A’s” model of treating tobacco use
  • Provider/Patient communication techniques
  • Treatment options and guidance, including combination therapy
  • New York State Medicaid Benefits
  • Billing information for smoking cessation counseling

Click here to access the online module and here to access additional provider resources.

NYSDOH Outreach To Physicians On Ebola Virus Disease:

Update On Management, Prevention, and Containment

In recent weeks, there has been a growing concern over the potential spread of Ebola Virus disease (EVD) from its native locus of Western Africa to the United States and other parts of North America. The Centers for Disease Control and New York State Department of Health have both released guidelines for proper care and handling of patients with potential cases of EVD along with any laboratory material with suspected EVD exposure.

Ebola Virus is transmitted via bodily fluids of those infected with Ebola and through the handling of rodents and primates infected with the virus; it is NOT transmitted through the air or respiratory droplets. Clinical criteria includes pyrexia along with severe headache and generalized muscle pain and malaise, GI upset including vomiting and diarrhea along with potential hemorrhage. It is important to note that while there have been a total of 1,323 cases of EVD as of July 27th, 2014; there have been no reported cases of the virus in North America. However, it is prudent to understand the guidelines and regulations in handling suspected cases of the virus as international spread is always a possibility.

For any patient with suspected features of EVD with recent travel to known areas of primary EVD disease, the attending physician should take extreme caution when examining patient, place patient in private room with a closed door, instruct patient on how to use rubber gloves and surgical mask and to abstain from touching items in the exam room. All medical staff should be alerted of the potential EVD case on premises, the amount of staff that come in contact with said case should be limited and those who do should use the proper personal protective equipment (gloves, fluid impermeable gown, eye protection, facemasks, leg and shoe coverings) in cases with open wounds or bodily fluid, clean room suits should be used.
Once patient is sequestered and safely kept, the attending physician should call the Local Health Department with the following information:

  • The patient's risk factors and travel history, including dates, destinations and other potential contact including contact with animals and other people.

  • The patient's current status including physical and mental along with pressing concerns for the patient's immediate health.

The Local Health Department will then confer with the attending physician regarding the testing procedures (as outlined below) and any further information regarding a potential transfer to another medical facility.

Laboratory guidelines are as follows:

  • When possible, tests should be done in patient's isolation room using Point-Of-Care (POC) instruments and testing methods. Transferring specimen from isolated room to other rooms should be done as minimally as possible and should be done with extreme caution using Clean Room Suits and hand carried in a container that has been thoroughly wiped down with 10% bleach. All specimen manipulation must be done in a Class 2 biosafety cabinet (BSC2)

  • Guidelines for specific laboratory procedures can be viewed in the attached NYSDOH Brief.

Member Benefit Highlight:  ACP Smart Medicine

A free benefit of your ACP membership, Smart Medicine is a new clinical decision support tool that allows you to browse evidence-based recommendations on diagnosis, therapy and more.  Content can be searched alphabetically or by specialty and covers categories including prevention, screening, diagnosis, therapy, patient education and follow-up.  The program is accessible through PC and mobile units, and integrates with the Annals of Internal Medicine, ACP Journal Wise, clinical guidelines and high-value care recommendations.  Why not browse what's here for you and take advantage of this free clinical decision support resource:

Virtual Patients

Did you know…That the Annals of Internal Medicine released a new interactive medical education tool designed to test physicians' decision-making skills? The Annals “Virtual Patients” is a complex clinical simulation which covers the examination, diagnosis, and treatment of a virtual patient. Selecting a response prompts a detailed explanation of the medical consequences based on the answer chosen. At the end of each case, the physician is presented with a complete summary of the clinical problem and solution. Upon completion of each case, physicians may earn Continuing Medical Education (CME) and Maintenance of Certification (MOC) credits (2 CME credits and 2 MOC credits per case).

The first sample case is free.  Additional cases can be purchased by members at a discount.  To learn more go to:

Open Payments Sunshine Program Increases Transparency in Health Care

As part of the Open Payments program, the Centers for Medicare & Medicaid Services (CMS) will soon make data about the financial relationships between the health care industry and physicians (e.g. including medical doctors, doctors of osteopathy, dentists, chiropractors, and others) and teaching hospitals available to the public. Open Payments, previously known as the Sunshine Act, is a federal transparency program enacted by Congress in 2010. Under this program, CMS collects and publicly reports data about payments (“transfers of value”), ownership, or investment interests between drug and device manufacturers and physicians and teaching hospitals. Beginning with the last five months of 2013, CMS will collect this data annually from industry and make it publicly available, downloadable, and searchable. Every year CMS will continue to release this financial information as it becomes available about the prior year (e.g. by June 30, 2015 for 2014 data).

These financial interactions can happen for many reasons: research, conference travel and lodging, gifts, and consulting. They can foster collaboration among physicians, teaching hospitals, and industry manufacturers that may contribute to the design and delivery of life-saving drugs and devices. However, they also can potentially lead to conflicts of interest in how health care providers prescribe medications or give medical care.

While CMS doesn’t make assumptions or draw conclusions about the reported information, the Agency will take steps to ensure that only accurate information is made public. For example, as part of this initial data collection process, CMS has engaged stakeholders as pilot users to ensure that reporting systems are user-friendly and performing properly. In addition, CMS will give physicians and teaching hospitals an opportunity to be sure that information reported about them is accurate. In order to review the data and make corrections if necessary, physicians and teaching hospitals must first register in CMS’ Enterprise Portal starting on June 1, 2014. Then, starting in July, they must register in the Open Payments system (via CMS’ Enterprise Portal). This voluntary review and dispute period is open for 45 days. CMS strongly encourages physicians and teaching hospitals to register in our Enterprise Portal and Open Payments systems so they can review their specific data. Any data that physicians or teaching hospital dispute, but is not corrected by industry within the dispute resolution period, will be included when the data is made public and marked as disputed.

It is important that physicians or teaching hospitals know about this program, how and what financial relationships are reported, and how to answer questions from patients. Visit: to get more information about Open Payments (the Sunshine Act) and the resources available to understand the program. Health care providers and others with questions and concerns can be emailed to

This information is provided by the United States Department of Health and Human Services.

New York State Dept. of Health - Measels Advisory Alert

A total of 477 confirmed measles cases have been reported to the Centers for Disease Control and Prevention (CDC) nationwide as of 6/13/2014, surpassing the highest reported yearly total of measles cases since measles was eliminated in the U.S. Sixteen outbreaks throughout the U.S. have accounted for 84% of the cases reported. This includes an outbreak in Ohio with 316 cases to date, the largest single outbreak reported in the U.S. since 2000. The large number of cases this year emphasizes the need for health-care providers to have a heightened awareness of the potential for measles in their communities and the importance of vaccination to prevent measles.
Read Alert Here!

Prescribe Opioid's Safely
Access this FREE online educational program to help you safely prescribe opioids and manage patients with chronic pain.
Online CME is available.
Find out more.


Counsel's Forum
Laurie Cohen, Esq., Partner at Wilson, Elser, Moskowitz, Edelman, and Dicker LLP and the Chapter's attorney provides members with support and direction through articles and answering questions relevant to general practice.

Managing Your Patients With Diabetes - Tools & Resources
Useful Links:

Public Health
An overview of the Chapter's public health initiatives.

Health Information Technology
Learn about NY's information network, Meaningful Use, e-Prescribing, privacy and security and best practices.

Running a Practice
ACP has a broad array of products, services and expertise to help you run and grow your practice.

Patient Centered Medical Home - ACP has gathered a comprehensive collection of information, resources and demonstration projects to assist you in planning for a complete Patient-Centered Medical Home.

Physician Quality Reporting System - tools and resources to help guide you through collecting and reporting quality measure data.

Patient Care and Education
The following patient-related resources provide guidance in effectively maintaining and enhancing the doctor-patient relationship.

Last updated: 10.14.14

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