In high-level sports teams (whether college or professional teams), there is a lot that is done for the athletes. Logistics are coordinated for them and tutors may be arranged when necessary. Food, travel, and training are all figured out on the athletes' behalf. Schedules are usually pretty tightly controlled, and everything is customized for the individual player.

Most of the time, this is a pretty fantastic arrangement. The athlete doesn't have to worry about the details outside of his or her athletic performance (and in the case of the college athlete, his or her academic performance.) And the team is able to use its perspective and knowledge to choose the best structures and support for the team.

Things start to get a little less clear, however, when there is a health issue or injury. Very quickly, "Plan A" becomes irrelevant, and the trainer, coach, player, and medical providers have to come up with a Plan B. All of which, of course, forces the question:

When athletes are sick or injured, where do their rights end and the team's rights begin? Do trainers and coaches have a right to share health information and take part in decisions?

Especially with more severe health issues, conflicts can emerge between the interests of the team and the interests of the athlete. For instance, if an athlete could continue playing with a knee issue for a few years, but would experience restricted mobility 5 years down the road, what should be done? Often, the athlete himself would choose to keep playing despite the long-term consequences, but what if he wishes not to while the team needs him to play? Interestingly, the National Athletic Trainers Association does not seem to address this conflict in their code of ethics. As we discussed recently: "there can sometimes be a contradiction between supporting a young athlete in reaching his full potential today and preparing him for his life after sports. Second, the athletic trainer and department must consider the needs of not just "this" athlete -- but of all the athletes on the team, present and future."

These are complex issues with no easy answer. However, as medical providers who have worked with athletes and teams from Little League to the Major Leagues, we have noticed some patterns. In short: the more that the athlete's medical providers collaborate and communicate, the fewer conflicts arise. When we've used iClickCare to facilitate communication among a surgeon, an athletic trainer, a physical therapist, and the family doctor, everyone seemed to quickly arrive at a good conclusion. However, when there is little collaboration or communication, that's when folks seem to dig in and see less alignment and more conflict.

How have you made sure that team and athlete interests are all respected when health issues occur? We'd love to learn from your experience in the comments below.

Read more about how medical collaboration changes things:

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As medical providers, we want all of our patients to stay healthy, have as few medical interventions as possible, and return to health quickly after sickness or injury.

For our patients who are athletes, the consequences of injury or illness are particularly great. When players -- whether amateurs or professionals -- get injured, they may be putting their careers on the line. Additionally, a single player's injury can endanger the viability of the entire team. Despite the consequences, injury remains a huge part of the experience of athletes who are performing at a high level. And athletic trainers are the primary line of defense against these injuries.

The Athletic Trainers that I know are concerned by trends like the ones acknowledged in a recent New York Times article about the epidemic of baseball players who are having the "Tommy John" ligament surgery:

• The volume of injured pitchers in MLB is huge and growing: "The year with the most documented Tommy John surgical procedures was 2012; there were 69 between the majors and the minors."
• Many pitchers are playing year-round to satisfy the level of performance required of them, which can increase injury rates.
• 1 in 5 professional players who have surgeries like this one never make it back to full strength.

Some Athletic Trainers, however, manage to flip the statistics and keep their players injury-free at greater-than-average rates and help their players recover faster than other athletes.

We've found that successful trainers focus on 3 specific things:

• Prevention. This is the real forté of Athletic Trainers. Through careful, consistent attention and thoughtful pre-injury measures, the best Athletic Trainers prevent dramatic injuries and interventions. The best way to solve the problem is to keep it from happening.
• Collaboration. The best Athletic Trainers know that they are not the only member of an athlete's medical team. They find ways to collaborate with other medical providers to shorten the length of time between diagnosis and treatment, drop transport and wait time, improve medical decisions, and make the best possible plan for that particular patient. We've seen Hybrid Store-and-Forward Telemedicine to have dramatic results in improving athletes' medical outcomes. 
• Rehabilitation. As all medical providers know, rehabilitation is a fundamental part of wellness. It's a piece of the puzzle that can get lost in the shuffle, especially when many providers are on the medical team. But with good medical collaboration and consistent engagement by the Athletic Trainer, rehablitation can happen with surprising speed. 

To learn how Hybrid Store-and-Forward Telemedicine can help you keep players and patients injury free:

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Student athletes face a challenging set of pressures. Like any young people, they must navigate their own aspirations, work with their family's needs, and juggle academics. But students that are also athletes face the additional pressures to maintain scholarships, perform on the field, adhere to team requirements, and keep up demanding practices and training schedules. In fact, a 2011 NCAA survey showed that football and men’s basketball players identify themselves more strongly as athletes than as students. For that reason -- we discuss the ways in which an athlete's pressures almost match that of a job -- the National Labor Relations Board ruled that Northwestern University’s football team was eligible to unionize.

The pressures that student athletes face, however, don't necessarily imply that the team is in any way exploitative -- or under any less pressure than the athlete herself. Teams face a myriad of pressures as well, and often with insufficient resources to meet them. Despite widespread beliefs that sports teams are money-making machines, only 10% of Division I college sports programs turn a profit. Teams -- and the coaches, athletic trainers, and other staff that make them up -- are under pressure from the university, their own budgets, professors, parents, and the athletes themselves. It's a delicate balance with high stakes. An injured player can present a set of difficult decisions and each stakeholder may have a different opinion on the right course forward.

One example of the recognition of these pressures is Natasha's Law, which requires high school coaches and trainers to make sure that a player with a concussion doesn't experience any further symptoms for a full 30 minutes before putting back her into play. Some coaches, trainers, or players may object to this kind of regulation, arguing that they can make better decisions than the law can. But sometimes this kind of regulation actually makes athletic trainers' lives easier by mitigating demands.

As the New York Times recently wrote: 

"Strong athletic departments do two things well. They afford young athletes the chance to reach their full potential, and they prepare them for life when the cheering stops."

Athletic trainers walk this line every day. First of all, there can sometimes be a contradiction between supporting a young athlete in reaching his full potential today and preparing him for life after sports. Second, the athletic trainer and department must consider the needs of not just "this" athlete -- but of all the athletes on the team, present and future.

What pressures do you face as medical providers treating athletes? Have you noticed them increasing over time? We look forward to hearing, in the comments below. 

And get our guide on how telemedicine can help deal with the pressures you face as an athletic trainer:

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Athletic Trainers are skillful folks who often work in in-between spaces: they're not a coach but they guide athletes; they're not physicians but they provide crucial medical care; they're not professors but they work in universities.

So when it comes to Patient Health Information (PHI), and the management of that information, Athletic Trainers have also existed in an in-between spot. These professionals are left with confusion as to whether HIPAA -- and its fearsome set of regulations and punishments -- apply to them. Can they email a picture of a patient's ankle to an Orthopedist? How do they need to save patient information at the right level of security? With whom -- The patient's family? The coach? A doctor? The patient's professor? -- can they share patient medical information?

It is certainly understandable that an Athletic Trainer might be confused, because this is a rapidly evolving field and set of rules with a knot of confusing laws. A college or university may be considered a "covered entity" or hybrid - with a health center being a covered entity and an academic department, not. "Covered entities", of course, do need to comply with HIPAA… but Athletic Trainers are not billing the patient, so it's possible that there is a loophole there.

Despite the confusion, some legal precedent is beginning to make it clear that Athletic Trainers must be aware of, and for the most part, adhere to HIPAA.

As summarized in HIPAA Solutions' Compliance Alert, "Court rulings, along with recent updates to Federal and state regulations reveal that, in fact, HIPAA has a broad reach in relation to health information associated with students."

In particular, another ruling, drills down into the exact HIPAA status of Athletic Trainers themselves: "a Federal District Court applied both HIPAA and FERPA to Penn State University, concluding that both statutes apply to athletic trainers."

Given the legal precedent and ramifications of not complying, here are our 3 tips for Athletic Trainers on staying in compliance with HIPAA:

• Protect PHI. Especially given the legal precedent above, it's clear that PHI must be protected by Athletic trainers. That means protecting it from people that aren't allowed to access it, making sure it's stored securely, and making sure it's shared securely.
• Consult an attorney if in doubt. Because there are some grey areas here, you'll certainly need to make the best decision you can, but don’t ignore it. Get the information that exists and then decide what makes sense in your unique situation. 
• Stop using email to send pictures. When any PHI is sent by electronic means, it is protected under HIPAA. Email isn't HIPAA-secure, so if you want to collaborate with other providers, you'd need to use a telemedicine platofrm like ClickCare that promises HIPAA compliance. 

As Athletic Trainers, how has HIPAA come into your practice? What precautions do you take? Share your experiences in the comments below.

And if you're curious how telemedicine can help you come into HIPAA compliance as an Athletic Trainer, get our free quick guide here:

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