Fam Pract Manag. 2018 Jan-Feb;25(1):34.


As a growing number of patients are asking about genetic testing, I have discovered that the potential privacy implications of receiving positive test results are not well understood by patients, physicians, or even some genetic counselors.

Under HIPAA, “protected health information” does not specifically include genetic data. While many think the Genetic Information Nondiscrimination Act of 2008 covers the bases on privacy, it does not. In fact there are no protections against discrimination on the basis of genetic testing results for long-term care insurers, disability care insurers, or employers with fewer than 15 employees.

However, HIPAA does provide a powerful tool for patient confidentiality that we inform our patients about as needed. If a patient pays for a visit entirely out-of-pocket, that visit and the results associated with it, such as genetic testing, can be kept confidential from insurers. You would have to consider how to record this information in your electronic health record (EHR) to protect it from inadvertent disclosure. Some EHRs provide for sealed folders.

Patients look to us for health care advice. We can also help them in protecting themselves and their health care information.


Some patients who would otherwise get flu shots do not schedule an appointment for one because they forget or don't know when the flu vaccine is available. A recent study found that an effective, low-cost way to increase flu shots is to send reminders to patients by text message.

Researchers identified high-risk patients who had not already received a flu shot and randomly notified half of them through a text message that the flu shot was available. The text also provided the phone number for the practice so patients could call to make an appointment. The other half of patients were not notified.

The study found that the parents of children younger than 5 years old were more than twice as likely to get their child vaccinated when they received a reminder than if they did not. Overall, 12 percent of the notified group received a vaccine during the study period compared with 9 percent of the control group.

The researchers determined they achieved an additional immunization for every 29 messages sent — a good result for a low-cost intervention.


Regan AK, Bloomfield L, Peters I, Effler P. Randomized controlled trial of text message reminders for increasing influenza vaccination. Ann Fam Med. 2017;15(6):507–514.


Improving the patient experience in your practice often involves ensuring your staff members enjoy their jobs. One way to do this is to make sure they get plenty of recognition and appreciation when they do good work. Providing feedback directly to your staff is obviously helpful, but there are two other ways to let staff (and physicians) know how they are doing:

  • Encourage staff members to submit notes complimenting each other on particular jobs well-done. Post these notes (anonymous or otherwise) on a “brag board” in the practice break room.

  • Place comment boxes in the waiting room or exam rooms. We label these boxes “Catch Me at My Best.” When patients leave notes complimenting staff or making other suggestions, read them during staff meetings.


Babbitt N, Vaughn A. Experience is everything. Talk presented at: Medical Group Management Association 2017 Annual Conference; Oct. 10, 2017; Anaheim, Calif.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


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