In This Issue:
  • 2015-'16 flu season American Academy of Pediatrics
  • Meaningful Use Stage 3 a mistake??
  • Halloween Safety Tips
  • Tier3MD Partner Notes- Dedra Dyer (PAHCOM Manager of the Year)
  • CEO Note: Tier3MD 10th Anniversary
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American Academy of Pediatrics

Updated AAP guidance will help you prepare for 2015-'16 flu season

1. Henry H. Bernstein, D.O., M.H.C.M., FAAP and
2. Carrie L. Byington, M.D., FAAP

The 2015-'16 influenza season is on the horizon. The Academy has updated its recommendations for the prevention and treatment of influenza in children.

The policy statement, Recommendations for Prevention and Control of Influenza in Children, 2015-2016, is available at here and is published in the October issue of Pediatrics. Key points are highlighted below.

Providers must remain vigilant, as the influenza virus is unpredictable. The influenza season may start early in the fall/winter, have more than one disease peak and extend into late spring. Therefore, as soon as the seasonal influenza vaccine is available locally, health care personnel should be immunized, parents and caregivers should be notified about vaccine availability, and immunization of all children 6 months and older, especially children at high risk of complications from influenza, should begin. There is no evidence that administering the vaccine early in the influenza season increases the risk of infection.

The influenza vaccine for the 2015-'16 season is available in both trivalent and quadrivalent formulations (no preference).
The trivalent vaccine contains the following virus strains:
· A/California/7/2009 (H1N1)-like virus,
· A/Switzerland/9715293/2013 (H3N2)-like virus and
· B/Phuket/3073/2013-like virus (B/Yamagata lineage).

The quadrivalent influenza vaccine includes the same three strains as the trivalent vaccine plus B/Brisbane/60/2008-like virus (B/Victoria lineage).
The influenza A (H3N2) and B (Yamagata lineage) vaccine strains differ from those contained in the 2014-'15 seasonal vaccines.


Special outreach efforts should be made to vaccinate people in the following groups:
· children with conditions that increase the risk of complications from influenza (e.g., asthma, diabetes mellitus, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders);
· children of American Indian/Alaska Native heritage;
· all household contacts and out-of-home care providers of:
o children with high-risk conditions and
o children younger than 5 years, especially infants younger than 6 months;
· all health care personnel;
· all child care providers and staff; and
· all women who are considering pregnancy, are pregnant, are in the postpartum period or are breastfeeding during the influenza season.

· Children 6 months through 8 years receiving the seasonal influenza vaccine for the first time should receive a second dose this season at least four weeks after the first dose.
· Children 6 months through 8 years need only one dose if they have received at least two doses of seasonal influenza vaccine prior to July 1, 2015. The two previous doses need not have been received during the same or consecutive influenza seasons.

In the 2014-'15 season, the predominant circulating influenza A (H3N2) viruses were antigenically distinct from the vaccine strains, resulting in reduced vaccine effectiveness for all ages. Live attenuated influenza vaccine (LAIV) did not offer greater protection than inactivated influenza vaccine against H3N2 viruses. The Academy does not recommend one vaccine over another.

The seasonal vaccine is not 100% effective, but it is the best strategy available to prevent illness. Either vaccine should be used when available, and vaccination should not be delayed to obtain a specific product. Additional experience over multiple influenza seasons will help determine optimal utilization of these two vaccine formulations in children.

The safety of LAIV in people with a history of asthma, diabetes mellitus or other high-risk medical conditions associated with an elevated risk of complications from influenza has not been established. These conditions are listed as precautions in the LAIV package insert. Although LAIV has been used in young children with some chronic medical conditions, including asthma, outside the U.S., data are considered insufficient to support a recommendation for such use in the U.S.

To reduce the risk of contagion, this practice (called "cocooning") helps protect children at high risk of influenza-related complications, such as infants who are too young to be immunized. Women can receive influenza vaccine any time during pregnancy because they are at high risk of complications from influenza. This approach also protects their infants during the first 6 months through transplacental transfer of antibodies.
Pediatric offices may choose to provide influenza immunization to health care personnel. This strategy is not intended to undermine the adult medical home but could serve as an additional venue for vaccine administration. Documentation of vaccination in a state registry can enhance communication with the adult medical home.
Regardless of influenza immunization status and whether illness onset has been less than 48 hours, treatment should be offered as early as possible for:
· any hospitalized child clinically presumed to have influenza disease or with severe, complicated or progressive illness attributable to influenza, and
· children with influenza infection of any severity who are at high risk of complications.
Treatment should be considered for:
· Any otherwise healthy child clinically presumed to have influenza disease for whom a decrease in duration of clinical symptoms is felt to be warranted. Although the greatest effect on outcome will occur if treatment is initiated within 48 hours of illness onset, treatment should be considered later in the course of illness.
· Children clinically presumed to have influenza disease and whose siblings either are younger than 6 months or have underlying medical conditions that predispose them to complications of influenza.

Clinical judgment (based on underlying conditions, disease severity, time since symptom onset and local influenza activity) is an important factor in treatment decisions for pediatric patients who present with influenza-like illness. Antiviral treatment should be started as soon as possible after illness onset and should not be delayed while waiting for a definitive influenza test result. Influenza diagnostic tests vary by method, availability, processing time, sensitivity and cost, which should be considered in making the best clinical judgment.

Marc Probst: Meaningful Use Stage 3 a mistake

October 21, 2015

by Dan Bowman

After serving six years on the federal government's Health IT Policy Committee, Intermountain Healthcare CIO Marc Probst's term ended in June. And while, he said, many smart and passionate people are working to improve the industry, lobbies are just as influential in terms of change.

"The concept and the power of special interests is alive and well, particularly when you're talking about a $35 billion program," Probst said, referring to the Meaningful Use incentive program. "The federal advisory committees tried to filter through that, but I'm not sure that was always accomplished."

In an interview with FierceHealthIT at the recent College of Healthcare Information Management Executives fall forum in Orlando, Probst expanded on his committee efforts. He also talked about Meaningful Use and Intermountain's role in the Department of Defense's electronic health record contract.

FierceHealthIT: You've been outspoken about the focus of Stage 2 of Meaningful Use; how do you feel about Stage 3?
Probst: I can just tell you I'm incredibly disappointed we even have a Stage 3. It's just a mistake. It's just prolonging the program. We should have claimed victory, frankly after Stage 1, but clearly after Stage 2, and stopped the program. There's no real additional benefit.

Do I like the open APIs strategy? Absolutely. I think it's a great idea. It shouldn't be driven by Meaningful Use.
What I said around Stage 2 was, it should only be about interoperability and standards. That's all it should have been about. I'll tell you the same thing for Stage 3. If we have to have it, that's all it should be about. We're not getting to the real root of the problem.
FHIT: Karen DeSalvo has spoken recently and frequently about the need for standards and how it should have been addressed earlier. Is that encouraging?

Probst: Yes, it's encouraging. I'm a huge proponent of Karen DeSalvo; I think she's excellent. She gets it, she really does. She inherited Meaningful Use and she acknowledged that we need these standards. She's struggled with how to implement them and I don't think she's in full agreement with me. I believe they need to be legislated and created as law and forced upon the industry; I think she goes with probably the more realistic view of politics and how it can happen. But this is a national safety issue.

It's costing us money; we're losing lives every year; and even from a defense perspective, our national security is at risk because of all the costs and challenges of healthcare. This is something the government needs to take seriously.

They need to legislate this, and they need to just get it done.

FHIT: Clearly Congress has taken an interest in all of this. Is there hope that such legislation will actually happen?

Probst: The nature of Washington is to politicize things. This isn't popular. It would be really difficult. You're basically going to choose the winners and the losers, and likely, everyone will be a loser when you come up with standards because no one is standard--none of the vendors.

You're talking about a massive infrastructure lift. Like the railroads, it could be expensive, logistically very, very difficult and it's going to slow things down for a number of years. But what happens afterwards, once you've done that, progress is just rampant.

There are people that get it. We spend a lot of time with people in D.C. and they get the issue; I just don't think anyone wants to be as extreme in their language as I am. Of course, I'm not a politician, so I can be more extreme


Happy 10th anniversary to Tier3MD! I can't believe that it has been 10 years already. October 1, 2005, was the date of my first invoice to my first client. Fast forward 10 years and we are still going strong! It seems when you have an anniversary, it makes you take a look back through the years, and remember all the fine moments...and not so fine moments. It makes me thing...IT Support. Then and Now. Do you remember what it was like in 2005? I sure do!


* Pc's were around $1800 - $2000 a piece. I could walk in an office and fix the PC (yes, I used to do that myself) spend three hours, and walk out with a check for $300 plus travel.
* We used to have to go onsite to install a printer
* The internet was 56K with a phone line and modem. I had a T1 line in my house. It was expensive, but I was COOL!
* Laptops were around $3000,
* No Cloud of course.
* Floppy disks were the storage of choice
* EMR's were expensive, and not that I reflect...hard to use.
* Apple's were for geeks and people who just wanted to be different.
* Not everyone had a PC in their house
* No one paid attention to HIPAA security
* Doctors made a lot of money


* I would rather tell someone to go get a new computer than charge them $300 to fix it.
* We can use one of many remote tools to connect in to install a printer, saving practices tons of money, and doing the job much faster.
* The internet is blazing fast!!
* Almost everyone uses a cloud in some capacity, whether it be email, backup, web based apps, etc.
* What is a floppy disk? There are actually kids growing up today who never heard of them!
* Everyone has a PC in their house...ok, almost everyone.
* Medical practices are well aware of HIPAA security
* Doctors make a lot less money! [:(]
I feel very fortunate to have been in business for 10 years, and to have our business continue to grow like it has. I can't wait to blog this same article in 2025!

Thank you Tier3MD current and future customers for your support!

Sheryl J. Cherico,
CEO/COO, Co-Founder

Sheryl is the CEO of Tier3MD and one of the leading Healthcare IT Consultants in the country.

TIER3MD Partner Notes:

Dedra Dyer (Atlanta Lung Specialists) is Named PAHCOM Manager of the Year

Tier3MD is proud to announce that Dedra Dyer is named PAHCOM Manager of the Year, at this years PAHCOM conference in Clearwater Beach Florida. Dedra, the practice manager for Atlanta Lung Specialists is extremely deserving of this award. "She is not only a great customer, she is my "go to" person when I have questions," says Sheryl Cherico, CEO. "Dedra is knowledgeable, professional, and probably one of the most responsible, dedicated practice managers that I have ever met. She ranks up there with the best of them."

Dedra helped start the Southeastern PAHCOM chapter back in 2011. She had been a member of the National PAHCOM organization prior to that, and had obtained her CMM through the organization. She has always been a true supporter of the organization, and has taken advantage of the training, workshops, webinars and exams that PAHCOM has to offer. She is constantly increasing her knowledge in the medical industry and works hard to keep on top of all the current issues. Dedra is also a Certified Professional Coder.

Along with Dedra from the Atlanta Chapter, past medical mangers of the year have been Margie Warnock and Sarah Holmes. They too, have been very deserving of this award. Atlanta has been front and center for the past 3 years! Go girls!!

Tier3MD is very proud to know that Dedra, Margie and Sarah's hard work has been acknowledged on a national level. They deserve it!

PAHCOM is a national organization dedicated to promoting professionalism in physician office practice by providing professional development opportunities, continuing education in health care office management principles and practice, and certification for health care office managers.

Halloween Safety Tips

Halloween is an exciting time of year for kids, and to help ensure they have a safe holiday, here are some tips from the American Academy of Pediatrics (AAP). Feel free to excerpt these tips or use them in their entirety for any print or broadcast story, with acknowledgment of source.


* Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
* Consider adding reflective tape or striping to costumes and trick-or-treat bags for greater visibility.
* Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes.
* When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
* If a sword, cane, or stick is a part of your child's costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he stumbles or trips.
* Obtain flashlights with fresh batteries for all children and their escorts.
* Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.
* Review with children how to call 9-1-1 (or their local emergency number) if they ever have an emergency or become lost


* Small children should never carve pumpkins. Children can draw a face with markers. Then parents can do the cutting.
* Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest.
* Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and should never be left unattended.


* To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations.
* Parents should check outdoor lights and replace burned-out bulbs.
* Wet leaves or snow should be swept from sidewalks and steps.
* Restrain pets so they do not inadvertently jump on or bite a trick-or-treater.


* A parent or responsible adult should always accompany young children on their neighborhood rounds.
* If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.
* Only go to homes with a porch light on and never enter a home or car for a treat.
* Because pedestrian injuries are the most common injuries to children on Halloween, remind Trick-or-Treaters:
* Stay in a group and communicate where they will be going.
* Remember reflective tape for costumes and trick-or-treat bags.
* Carry a cellphone for quick communication.
* Remain on well-lit streets and always use the sidewalk.
* If no sidewalk is available, walk at the far edge of the roadway facing traffic.
* Never cut across yards or use alleys.
* Only cross the street as a group in established crosswalks (as recognized by local custom). Never cross between parked cars or out driveways.
* Don't assume the right of way. Motorists may have trouble seeing Trick-or-Treaters. Just because one car stops, doesn't mean others will!
* Law enforcement authorities should be notified immediately of any suspicious or unlawful activity.


* A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats.
* Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
* Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items.
* Try to ration treats for the days following Halloween.

- See more at here

  Michael H. Brown  
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