The pace of Internet technology adoption in healthcare has been accelerating over the last three years, helped along by the dramatic democratization of access to technology and the passage of the healthcare law.
Paper patient records are giving way to electronic health records (EHR). Paper prescriptions are giving way to e-prescriptions, whereby the doctor directly sends the prescription order electronically to be filled or refilled by the patient’s choice of pharmacy. The patient then simply shows up at the pharmacy to pick it up. Video, e-mail, and social media technology are allowing improved access to doctors, with patients able to rate their experiences.
Doctors and nurses are increasingly using tablets and other handheld devices to manage patient visits. Patients are able to view their health information and make and change appointments online using their own computers, tablets, or other handheld devices. Technology is being used to monitor patient status and provide patients with discharge instructions and reminders about how and when to take their medications.
Major EHR vendors are building Health Information Exchanges (HIE) to allow care providers to exchange patient information and access a complete picture of a patient’s health in order to provide better care. Major hospitals are signing up with vendors to participate in these exchanges.
To make it easy for doctors to adopt technology into their practices, several options are available. Many doctors simply sign up with a free EHR provider, which eliminates the need to hire and manage technology staff or maintain servers. The major disadvantage is that the doctor has to plan for a possible service outage, which is frequently mitigated by requiring the provider to maintain a local copy of the data. The other disadvantage is that the service provider may sell de-identified patient data for research purposes (something that HIPAA allows).
Other options include hiring a managed services organization (MSO) to provide hosting and management services or to facilitate a transition for the doctor’s practice into a third-party managed service. Eligible doctors, hospitals, and care providers can recoup expenses of migrating to an EHR by filing for Meaningful Use incentive payments.
Maryland recently became the first state to connect all of its hospitals to a health information exchange (HIE). Maryland's HIE is a mechanism for transport, connection, and exchange of medical information. This system does not store patient data. Patients are opted in by default but can opt out of the system if they wish.
In 2009, Maryland also adopted rules to allow doctors to practice telemedicine, and legislative bills that would allow doctors to be reimbursed by insurers for telemedicine visits are underway. Maryland has also received a grant to build a health insurance exchange.
The big question now: What happens if the federal healthcare law is overturned by the Supreme Court? Chances are high that efforts in some states will continue unabated -- though funding could become challenging.
In other states, such as Maryland, where the state law refers to the federal law instead of incorporating its provisions into the state law as some states did, overturning the federal law will most likely overturn the state law as well. Thus a period of confusion and uncertainty may persist. However, the genie is out of the bottle!
What a great example, syedzunair, that is very good progress.
In many instances, I believe that the international community is advancing the use of technology in healthcare more so than the hospital systems in the United States. We will have to catch up.
Tech adoption has to go a long way in the field of healtcare. However, there are some promising examples that are paving the path for others to follow.
In general I would agree with you on the fact that most organization haven't established sound systems to facilitate their daily work. On the other hand, I have recently had the experience of visiting a paperless hospital here in Pakistan. I was shocked to see that everything thing from in patient admissions, doctors appointments, X-Rays, blood test reports etc all being handled through the use of software. With barely a paper trial for operations the hospital seems to be doing a great job in managing the data and ensuring that doctor client confidentiality is being maintained.
That is shocking, Mary. In defense, if you will, excellent organizations such as you describe are primarily focused on the clinical/care processes. They have not established sound organizational systems that "manage" the operations, and particularly the areas of IT. So not only are they not managing the new threats, they really do not have the workflow infrastructure to even present major disruptions in information, etc., such as you point out.
The good organizations will get there, but there is a lot of work to do.
It's shocking to hear that most healthcare security breaches result from insider malfeasance. Come to think of it, though, the hospital where I see my doctor was the subject of a big breach earlier this year -- and the reason was a disgruntled employee. This is a world-class institution with teaching affiliations. I found it really demoralizing.
Kim, I fully agree, but you are being too logical. Actually, it does not make sense and Mansur has hit the nail on the head. Healthcare (which I have worked with for 20 years), has not created the internal systems to take advantage of the technology. They are still treating it as a "processing" IT system, so they do not use the data they have, let alone integrate it.
There are huge opportunities to improve efficiencies for all stakeholders. However, you can also imagine the security vulnerability in the design of most healthcare providers.
One outstanding exception is Kaiser Healthcare, who have an integrated system that actually serves its members and extends to online appointments. So there is hope in the examples of leading healthcare systems.
Thanks for the link, Mansur. It looks like many of these issues are out in the open. Still, as long as there are just guidelines for reuse of patient data, it's likely to lead to some problems and then eventually to some legislation that is more specific.
It's too bad it has to be done that way, but I suppose that is the usual flow of things.
Nicole, my doctoral research is around your question. I think more CEO and top level administrator engagement in business risk management of information security is needed. There has been a tendency to view it as a technology problem. Most organizations focus on fixing it through technology alone. The data in the health sector show that 90% of breaches happen as a result of insider action. The following site on health IT security is helpful: http://www.healthcareinfosecurity.com/
Am I worried? Yes to a certain extent but being a proactive person I try to help by continuing to learn and teach others.
There are some very encouraging developments here, but as a consumer of health sentences I still despair when confronted by a series of forms each time I register for treatment which require the same information - again, and again, and again.
Why haven't hospitals and clinics adopted a system whereby name/address/social security/insurance (etc) information automatically populates all records associated with the same patient? Drives me crazy that this hasn't been figured out yet.
Almost anything we do has risk - think of the risks of driving a car. Information security in any sector is risk management. HIPAA does allow de-identified data to be used for research and has some rules. Yes researchers have proven the ease with which re-identification is possible. There was some discussion about making re-identification illegal. This is not such a great solution either, because it will then go underground and will cause even more problems. The right policy balance is needed here. Some guidance for HIEs are coming out and this will continue to evolve:
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In all my years interacting with CFOs, I have not met one who actually understood IT -- not that I expected them to.
Why, then, do I continue to see ads seeking a strategic CIO who will report to the VP of Administration and Finance or the CFO? Sometimes ads are slightly better: CIOs report to the Chief Operating Officer. Those conducting the recruitment will sagely say: “The CIO will have complete empowerment and access to all cabinet members and the president.” However, these organizations appear to lack an understanding of the role of the CIO and the CFO.
After observing and writing about CEOs who do not leverage their CIOs to propel their organizations forward, it was very refreshing to learn about the great CEO/CIO partnership at Kaiser Permanente at this year’s World Health Congress held in Maryland.
Despite an initial round of federal funding to develop state health information exchanges (HIEs) as part of Obamacare, these clearinghouses were challenged to develop a financially sustainable model. Because it addressed sustainability early, the Delaware Health Information Network is viewed by many as a template for HIE success.
It began as a relaxing visit with my college buddy and his family. It became a glimpse into the technology-enabled future of worldwide collaboration in engineering.
True story: Despite the HITECH Act of 2009, the CEO of a major urban hospital continued his institution's policy of not hiring a CIO or CISO. Like many others, he took a wait-and-see attitude, even though HITECH strengthened the enforcement of healthcare security and privacy laws, and provided financial incentives for healthcare organizations to adopt electronic health records and information security.
Healthcare providers have been moving to telemedicine treatments, where the patient and doctor can meet online, but insurance carriers are not required to pay for such treatments. This may change, though, as Maryland recently passed a law mandating that insurers pay up.
Congress is considering a bill to extend a moratorium on Internet regulation changes for two years. But with issues like service quality, cloud performance, and privacy looming, we risk contaminating the Internet with fraud.
The new Network Functions Virtualization (NFV) initiative of operators is being run out of Europe's ETSI and not here in the United States, even though the issues have been here for five years. The US needs to step up; otherwise, it's surrendering leadership.
US counterterrorism expert Richard Clarke, who came to prominence with his prescient warnings before the 9/11 attacks, tells Smithsonian Magazine the US was responsible for the Stuxnet supersmart worm that attacked parts of nuclear reactors in Iran – and in the process, has given away one of the world's most sophisticated cyberweapons.
ICANN is in a crisis. But if it goes away, so will its unique "multistakeholder model," which allows Internet users to participate alongside business, government, and industry.
Jane Williams, technology training manager for Multnomah County, says the ability to share resources is just one of the coming benefits of moving the county's intranet to a Drupal Commons platform hosted in the cloud.
When it comes to Internet-related research, the gap between the real world and academia is widening. Indeed, a few boffins may be up so high in their ivory towers that Earth is invisible. Sadly, some of this research is probably costing the US government – and US citizens – real money.
New York's Metropolitan Transit Authority is conducting a pilot test of digital kiosks to guide subway users to where they want to go more efficiently and at lower cost.
The whole Amazon.reader debate is a double-stupid. It's stupid to think that there's any e-book buyer who doesn't know Amazon's URL, and it was stupider to let ICANN launch the whole free-form TLD initiative to start with.
While NFC's original goal was to enhance mobile commerce applications, it is finding its way into a number of other uses, which is creating both opportunity as well as challenges for IT departments.
Enterprises would like to move to cloud computing but are hesitant because they are concerned about providers’ ability to secure company data. Here are some tips that help to ensure that if breaches occur, the business is not left holding the bag.
Edmunds separates customers into segments based on the info it collects on its site and from partners, and uses that to push out custom content, said Brian Baron, director of business analytics for Edmunds.com, at Predictive Analytics Innovation Summit.
The automotive website uses propensity modeling to target ads and customer registration forms, said Brian Baron, director of business analytics for Edmunds.com, at Predictive Analytics Innovation Summit.
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