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Are You Ready for IoT in Healthcare?

Posted on March 19, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Are you worried about how to leverage IoT in your healthcare organization? Do you know what IoT even is?

You may or may not know what it is, but no doubt IoT is part of your life. Here’s the wikipedia definition of IoT or Internet of Things:

The Internet of things (IoT) is the network of physical devices, vehicles, home appliances and other items embedded with electronics, software, sensors, actuators, and connectivity which enables these objects to connect and exchange data. Each thing is uniquely identifiable through its embedded computing system but is able to inter-operate within the existing Internet infrastructure.

It’s easy to see how much IoT is impacting our lives. Is there any reason to think that IoT won’t make its way into our healthcare lives as well?

David Chou recently shared an example IoT ecosystem that’s being built along with a number of the players in the space:

To me, this graphic illustrates two important truths about the future of IoT.

First, IoT is happening in a really big way with some really enormous companies driving it forward. Plus, the infrastructure to make it a reality is being built out and it’s going to impact all of our lives even more than it does today.

Second, IoT is a complex beast and so don’t be surprised if it takes healthcare a little while to fully embrace everything that’s possible with IoT. Healthcare is so risk averse that it will wade into the IoT waters very slowly. IoT won’t be disrupting healthcare tomorrow, but it will disrupt healthcare in new and interesting ways.

What do you think of the potential for IoT in healthcare? Do you see any companies bucking the above two observations? Where are you starting to see IoT get implemented today?

#HIMSS18 First Day:  A Haze Of Uncertainty

Posted on March 7, 2018 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.

Entering the HIMSS exhibit area always feels like walking straight into a hurricane. But if you know how to navigate the show, things usually start to come into focus.

There’s a bunch of young, scrappy and hungry startups clustered in a hive, a second tier of more-established but still emerging ventures and a scattering of non-healthcare contenders hoping to crack the market. And of course, there are the dream places put in place by usual suspects like Accenture, SAP and Citrix. (I also stumbled across a large data analytics company, the curiously-named splunk> — I kid you not – whose pillars of data-like moving color squares might have been the most spectacular display on the floor.)

The point I’m trying to make here is that as immense and overwhelming as a show like HIMSS can be, there’s a certain order amongst the chaos. And I usually leave with an idea of which technologies are on the ascendance, and which seem the closest to practical deployment. This time, not so much.

I may have missed something, but my sense on first glance that I was surrounded by solutions that were immature, off-target or backed by companies trying to be all things to all people. Also, surprisingly few even spoke the word “doctor” when describing their product.

For example, a smallish HIT company probably can’t address IoT, population health, social determinants data and care coordination in one swell foop, but I ran into more than one that was trying to do something like this.

All told, I came away with a feeling that many vendors are trapped in a haze of uncertainty right now. To be fair, I understand why. Most are trying to build solutions without knowing the answers to some important questions.

What are the best uses of blockchain, if any? What role should AI play in data analytics, care management and patient interaction? How do we best define population health management? How should much-needed care coordination technologies be architected, and how will they fit into physician workflow?

Yes, I know that vendors’ job is to sort these things like these out and solve the problems effectively. But this year, many seem to be struggling far more than usual.

Meanwhile, I should note that there seems to be a mismatch between what vendors showed up and what providers say that they want. Why so few vendors focused on RCM or cybersecurity, for example? I know that to some extent, HIMSS is about emerging tech rather than existing solutions, but the gap between practical and emerging solutions seemed larger than usual.

Don’t get me wrong – I’m learning a lot here. The wonderful buzz of excited conversations in the hall is as intense as always. And the show is epic and entertaining as always. Let’s hope that next year, the fog has cleared.

The New World of Health Monitoring

Posted on December 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I thought that this image was really interesting in the context of another post about the medical smart phone. Ironically, I think the image below actually only depicts a small part of the health monitoring that’s coming. I’m sure that scares the heck out of many people and excites many people. It’s a hard balance. Personally, I’m on the excited side of things. Chew on this graphic as you open your various health tracking devices this Christmas.
New Extreme Health Monitoring

FTC Gingerly Takes On Privacy in Health Devices (Part 2 of 2)

Posted on February 11, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first part of this series of articles laid out the difficulties of securing devices in the Internet of Things (particularly those used in the human body). Accepting that usability and security have to be traded off against one another sometimes, let’s look at how to make decisions most widely acceptable to the public.

The recent FTC paper on the Internet of Things demonstrates that they have developed a firm understanding of the problems in security and privacy. For this paper, they engaged top experts who had seen what happens when technology gets integrated into daily life, and they covered all the issues I know of. As devices grow in sophistication and spread to a wider population, the kinds of discussion the FTC held should be extended to the general public.

For instance, suppose a manufacturer planning a new way of tracking people–or a new use for their data–convened some forums in advance, calling on potential users of the device to discuss the benefits and risks. Collectively, the people most affected by the policies chosen by the manufacturer would determine which trade-offs to adopt.

Can ordinary people off the street develop enough concerned with their safety to put in the time necessary to grasp the trade-offs? We should try asking them–we may be pleasantly surprised. Here are some of the issues they need to consider.

  • What can malicious viewers determine from data? We all may feel nervous about our employer learning that we went to a drug treatment program, but how much might the employer learn just by knowing we went to a psychotherapist? We now know that many innocuous bits of data can be combined to show a pattern that exposes something we wished to keep secret.

  • How guarded do people feel about their data? This depends largely on the answer to the previous question–it’s not so much the individual statistics reported, but the patterns that can emerge.

  • What data does the device need to collect to fulfill its function? If the manufacturer, clinician, or other data collector gathers up more than the minimal amount, how are they planning to use that data, and do we approve of that use? This is an ethical issue faced constantly by health care researchers, because most patients would like their data applied to finding a cure, but both the researchers and the patients have trouble articulating what’s kosher and what isn’t. Even collecting data for marketing purposes isn’t necessarily evil. Some patients may be willing to share data in exchange for special deals.

  • How often do people want to be notified about the use of their data, or asked for permission? Several researchers are working on ways to let patients express approval for particular types of uses in advance.

  • How long is data being kept? Most data users, after a certain amount of time, want only aggregate data, which is supposedly anonymized. Are they using well-established techniques for anonymizing the data? (Yes, trustworthy techniques exist. Check out a book I edited for my employer, Anonymizing Health Data.)

I believe that manufacturers can find a cross-section of users to form discussion groups about the devices they use, and that these users can come to grips with the issues presented here. But even an engaged, educated public is not a perfect solution. For instance, a privacy-risking choice that’s OK for 95% of users may turn out harmful to the other 5%. Still, education for everyone–a goal expressed by the FTC as well–will undoubtedly help us all make safer choices.

FTC Gingerly Takes On Privacy in Health Devices (Part 1 of 2)

Posted on February 10, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Are you confused about risks to privacy when everything from keystrokes to footsteps is being monitored? The Federal Trade Commission is confused too. In January they released a 55-page paper summarizing results of discussions with privacy experts about the Internet of Things, plus some recommendations. After a big build-up citing all sorts of technological and business threats, the report kind of fizzles out. Legislation specific to the IoT was rejected, but several suggestions for “general privacy legislation” such as requiring security on devices.

Sensors and controls are certainly popping up everywhere, so the FTC investigation comes at an appropriate time. My senator, Ed Markey, who has been a leader in telecom and technology for decades in Congress, recently released a report focused on automobiles. But the same concerns show up everywhere in various configurations. In this article I’ll focus on health care, and on the dilemma of security in that area.

No doubt about it, pacemakers and other critical devices can be hacked. It could be a movie: in Scene 1 a non-descript individual is moving through a crowded city street, thumbing over a common notepad. In Scene 2, later, numerous people fall to the ground as their pacemakers fail. They just had the bad luck to be in the vicinity of the individual with the notepad, who implanted their implants with malicious code that took effect later.

But here are the problems with requiring more security. First, security in computers almost always rests on encryption, which leads to an increase in the size of the data being protected. The best-known FTC case regarding device security, where they forced changes for cameras used in baby monitors, was appropriate for these external devices that could absorb the extra overhead. But increased data size leads to an increase in memory use, which in turn requires more storage and computing power on a small embedded device, as well as more transmission time over the network. In the end, devices may have to be heavier and more costly, serious barriers to adoption.

Furthermore, software always has bugs. Some lie dormant for years, like the notorious Heartbleed bug in the very software that web sites around the world depend on for encrypted communications. To provide security fixes, a manufacturer has to make it easy for embedded devices to download updated software–and any bug in that procedure leaves a channel for attack.

Perhaps there is a middle ground, where devices could be designed to accept updates only from particular computers in particular geographic locations. A patient would then be notified through email or a text message to hike it down to the doctor, where the fix could be installed. And the movie scene where malicious code gets downloaded from the street would be less likely to happen.

In the next part of this article I’ll suggest how the FTC and device manufacturers can engage the public to make appropriate privacy and security decisions.