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ONC Plans Mobile Device Security Guidance For Smaller Practices

Posted on August 22, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In an effort to help them avoid joining the long list of mobile device-based security failures, ONC has set plans to release guidance for small- and mid-sized providers on securing mobile devices. The agency, which has projects underway studying how mobile devices are used by smaller providers, expects to release its conclusions in the spring, reports HealtcareInfoSecurity.com.

If you read medical business trades, it’s hard to miss that slip-ups with mobile devices and mobile data sources (such as flash drives) have been a major source of security breaches.  In fact, it seems that 54 percent of the 464 HIPAA breaches affecting 500 or more individuals reported to HHS between September 2009 and July 2012 involved the loss or theft of unencryped mobile devices.

To see how smaller medical practices are doing in this area, ONC is conducting an effort dubbed the Endpoint Security Project, for which it has built a health IT implementation typical of mid-sized and small doctor practices, including tablets, laptops, smartphones, storage devices and desktops. When the project is done, ONC plans to release configuration settings which should help these smaller practices protect their mobile device data.

This is all well and good. After all, smallish practices seldom have an IT staffer to advise them on such things, and a simple set of best practices can go a long way.

Still, what strikes me is that time and again, it’s the larger providers whose data breaches are making the news.  That’s no surprise — big providers and hospitals simply have more data endpoints to control — but given this, ONC might make slapping larger organizations into shape more of a priority.

Of course, it’s also true that we don’t want small providers being the “weakest link” in HIEs, or compromising even a comparatively small amount of patient data in their practices. But if ONC’s assuming that big practices and hospitals can take care of themselves, they’re ignoring a truckload of evidence that it ain’t so.

What’s Next For Physician Tablet Use?

Posted on July 23, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Not long ago, Manhattan Research released a study offering details on how doctors’ consumption of digital devices and media is progressing.  The survey, which surveyed 3,015 physicians in 25 specialties, looked at doctors who were online in the first quarter of 2012.

Among the most interesting — if not surprising — findings was that tablets have more or less officially hit the medical mainstream. According to the research firm, tablet use among doctors has nearly doubled since last year, hitting a whopping 62 percent in this year’s study.  You also won’t be shocked to learn that iPads dominate medical tablet use, in part due to their high-res screen and ease of  use.

Why the greater rush to adoption?  I think the following comment, which Monique Levy of Manhattan Research made to InformationWeek, offers a nice insight:   “It used to be that you had to solve the problems of security access, validation, and data security first and then adopt,  (but) what’s happened is that the system has turned upside down. We’re now at adoption first and solve the problem later.”

As Levy notes, the first wave of adoption has been driven largely by access to lower-risk information, and less for patient data. We can expect to another round of resistance when physicians are tethered to EMRs largely by tablets, she predicts.  I’d add that as long as there’s no native client physicians can use to access EMRs on the iPad, it will make things worse.

Given that resistance, maybe medical use of tablets will expand in other areas first. According to IT prognosticators and researchers at the Gartner Group, top medical uses of tablets also include waiting rooms, e-prescribing, diagnostic image viewing and appointment scheduling. (I’m amazed more practices aren’t doing the waiting room check-in thing.) Maybe one of these other areas will evolve breakout apps before doctors are really hooked up with patient data on their tablet.

Will Carts Delay Adoption of Hospital Mobile Devices? Could Be…

Posted on June 24, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I just caught an interesting piece in on the use of plain old, unsexy carts in hospitals — one whose conclusions which may surprise you a bit.  The piece argues that since hospitals are comfortable using carts to haul around full-sized equipment, they may be slower than expected to adopt hot portable devices in care delivery.

The article notes that while mobile devices remain on hospital IT execs’ radar, carts laden with standard technologies like barcode scanners and laptops continue to be popular.

IT administrators interviewed by Health Data Management magazine said that hauling IT equipment with carts may be a better option than mobile deployment.  And research suggests that they’re not alone. According to a HIMSS study quoted in the article, carts are being used by 45 percent of hospitals in 2011, up from 26 percent in a related 2008 study. That’s a pretty dramatic leap.

It certainly makes sense. The fact is, carts make it possible to haul around a full-size keyboard (along with barcode scanners and medication), which allows nurses to work comfortably with EMRs at the bedside.

On the other hand, the small screens and awkward typing mechanisms used by mobile gear can actually slow down the care process.  Not only that, the small text used by mobile devices can be hard for an aging nursing workforce to read, according to Joan Harvey, RN, clinical nurse specialist at Ocean Medical Center, who was interviewed by HDM.

That being said, hospital IT leaders aren’t ignoring the mobile device explosion. At least one hospital interviewed by the reporter, Good Samaritan of Vincennes, Ind., is testing mobile devices for future use. But execs there are frustrated by problems with compatibility between the different operating systems used by the devices, and differences between devices using the same operating environment. When you consider how much easier it may be to just have nurses drag along a standard PC and keyboard, why would they consider buying an Android tablet or iPhone?

Unless this author’s got his facts completely wrong, he’s made a really important point — that mobile device makers had better get their act together if they want to really step into the healthcare market. No matter how fascinating their potential use cases may be, the reality is that mobile vendors won’t make major headway in hospitals unless they get smart about barriers like the ones mention here.  The cool factor just won’t cut it.

Another Example: Astronomically Expensive EMR in Place, Paper Use At the Bedside

Posted on April 15, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Just the other day, I went on sort of a rant complaining about the excessive hype around iPad use in healthcare. I wasn’t suggesting that using iPads is a bad idea,  but I was venting about the hyperbole around Apple’s latest darling.

That being said, I’ve just had a chance to be reminded why putting iPads into the hands of clinicians, or at least smart tablets, is long overdue.

Just a few days ago, a relative was in a large suburban hospital which has sunk big bucks into GE’s  Centricity (one of those big gun EMRs our illustrious publisher John Lynn calls “Jabba the Hutt” products).  While I sat in the room with my friend for a while, nurses came in and out a few times to take vital signs, document medication allergies and check in on my friend’s level of pain.

Do I even need to say that despite the frighteningly powerful engine sitting there rumbling within the desktops at the nurses’ stations, every one of these interactions was documented on paper?

I can only imagine a few ways that these nursing notes could get into Centricity, and none of them fill me with confidence:

*  Nurses may be scanning in their documentation as they create it, then they or someone else double-checks the OCR results

*  Transcriptionists could be entering data from paper notes into the Centricity system, with all the attendant potential for error this creates

*  The hospital — which is otherwise extremely automated and seemingly very efficient — has just decided to create a “church and state” environment where some forms of data get into the EMR immediately and some stay on paper

Don’t get me wrong: I realize some of you reading this may already have or be developing  solutions to solve just this problem.  The systems I’ve seen to date, however, seem to be aimed at smaller doctors’ offices and probably wouldn’t scale to a huge tertiary care facility.

I do wish there were better point of care data collection options out there. If, in fact, tablets like the iPad are the best fit, I swear I’ll buy a few for physician friends myself.  But shouldn’t hospitals and practices be doing that?

 

iPads Could Boost The Value of EMR Installations

Posted on March 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I was hanging around the #hcsm (healthcare social media) chat tonight on Twitter, and caught some interesting comments from physicians on how they use tablets.  While it’s hard to tell how unusual this approach is — the #hcsm chat attracts cutting edge types — one physician noted that he shows the patients what he’s doing on his iPad.

Now, in this case the physician said he does so simply to demonstrate that he’s not texting on their time. But that could be just the beginning. As doctors increasingly adopt iPad, Android and other tablets, they’re in a much better position to turn encounters into information sharing moments.

As a patient, I’ve already hit a few practices that have implemented EMRs. While big changes may be happening in the back offices of these practices, things haven’t been much different during my time with the physicians.  Arguably, they’ve seemed a bit better prepared, and in at least one case, they seemed more efficient at note-taking, but it wasn’t some kind of breakthrough moment.

On the other hand, if they used iPhone or Android apps to share key EMR data with me, in real time, it could be a real game-changer.

For example, imagine that you’re a diabetic, and you’ve come in for a regular screening.  Usually, you’ll get some feedback on your overall health status, commentary on test results and suggestions on how to move ahead, but it’s a bit superficial and rushed unless there’s an emergency afoot.

What if the same diabetic got to see a graph, drawing on data in the EMR, which offered a personalized analysis of how their A1c, glucose levels and other key metrics were trending. The same iPad display could offer a printable list of suggestions, and if you really got tricky, brief educational videos providing more background on each step as needed.

In short, a tablet is more than just a portable physician convenience; it’s a powerful display device which could greatly improve patient/doctor communication.  And if it leverages the well-indexed EMR, that data will be offer more than a recap of the conversation.

Given tablets’ potential for improving clinical encounters, I think practices should plan their EMR and iPad investments in tandem. Tablets can be a doorway to better counseling, education and collaboration with patients.  I hope to see more physicians move in this direction.