Legalities of Social Media

Taken from http://www.healthcareitnews.com/news/5-keys-legal-issues-social-media:

Social media is without a doubt playing a major part in patient engagement, marketing efforts, and an overall sense of communication within the industry. Yet with the growth of these tools come other issues to keep in mind — like the legal ramifications of using outlets like Twitter, Facebook, and LinkedIn within a healthcare setting.

"These social media sites have moved beyond the novelty stage and into the mainstream," read a recent whitepaper by Actiance. "They have become so pervasive that they have emerged as effective tools within the corporate setting as well. The line separating the recreational use of these tools from legitimate business purposes has become increasingly blurred."

"The potential legal issues that can arise from social networking activities run the gamut," it continued. "Privacy, unauthorized activities, and intellectual property issues stand top-of-mind for many individuals and enterprises. Other areas, such as content ownership, regulatory compliance, and even criminal activity, are impacted by social media, too."

Here are five keys to the legal issues of social media, as outlined in the report.

1. Privacy. According to the report, no issue resonates so strongly with the legal aspects of social media as privacy. "With so much content out there, and so many ways to access these social media tools, privacy has become somewhat elusive for many," it reads. "From a legal standpoint, whether an individual has a reasonable expectation of privacy or not is the critical factor in determining whether one’s actions are protected by privacy laws." When thinking about social media in the workplace, the report notes that determining if an employee has a reasonable expectation of privacy hinges on whether or not the website is password protected. "If it is, then the argument that the employee has a reasonable expectation of privacy is strengthened. If not, then employers may have the justification to monitor the activities of that site." The key takeaway, the report concludes, is individuals should always be mindful of privacy settings on these sites, along with the corporate policy for using social media tools within the enterprise.

2. Content ownership. As with many sites that are "content-rich," the issue about who owns the content is inevitable, according to the report. "Typically, each site has its own 'Terms of Use page,' detailing the extent of its rights over end users' content," it reads. "Great care must be taken by end users to fully understand what they are getting into." For example, it continued, when you close a Facebook account, do you no longer own the rights to your content? "At the very least, end users should think twice about disclosing sensitive or proprietary information on social networking sites," it notes.

3. Intellectual property infringement. "Not surprisingly, given the abundance of content and the myriad ways to access it, intellectual property infringement is an area generating much legal interest," reads the report. For example, copyright infringement comes into play when there are photos, videos, graphics and blogs being exchanged and posted on social media sites. "From posting someone else's photo on a Facebook wall to sending a song to a friend via Twitter, using any third-party content without permission can result in both criminal and civil liability." It adds that protection of trade secrets is another aspect of intellectual property infringement that warrants attention; for example, if an ex-employee shares a former employer's confidential information, they would be held liable.

4. Unauthorized activities. Several legal issues fall under the umbrella of unauthorized activities, according to the report, with many of these issues evaluated under the same criteria that existed before the advent of social media platforms. The report outlined several unauthorized activities – including harassment, discrimination, defamation, disclosure of confidential information and criminal activity – which are all addressed in the same manner as if they happened offline.

5. Regulatory compliance. The last key area were social sites have gained more scrutiny is in regard to regulatory compliance. "The high-profile financial scandals of the last 10 years have brought to the fore front tighter regulation of certain industries," the report reads. "The rapid growth of social networking sites has driven these industries to develop or refine guidelines specifically for social networking, or, at the very least, electronic communications." When looking at healthcare, HIPAA requires a patient's identity and personal health information to be protected. "Specifically, it applies to 'covered entities' and 'business associates' – essentially anyone with patient demographic or clinical information."

Social Media has clearly taken over all aspects of business including healthcare.  Most hospitals have a social media account of some sort.  Usually the postings revolve around accomplishments or recognition received and serve as a means to market the hospital.  A lot of the legal issues of social media are obvious, yet some are not that cut and dry.  For example, would you ever think that something you post on facebook could get you accused of intellectual property infringement?

Tech Team for Docs

Taken from http://blogs.computerworld.com/17068/supporting_technology_infrastructure_for_physician_practices:

Technology is being used to create an integrated system of care that connects patients, clinicians, payers, and support organizations so that all key stakeholders can exchange information more effectively. Among the business challenges that confront the healthcare industry are service, quality, safety, rising costs, and a shortage of skilled staff to meet the needs of an expanding number of stakeholders.

With an ever increasing amount of information being transferred electronically -- from not only healthcare providers but all stakeholders in the US healthcare system -- IT professionals are taking a stake in how to design and implement electronic healthcare records (EHR). When the EHR system is down, it can cripple a healthcare organization and trickle down to the key stakeholders involved. For instance, physicians cannot effectively see patients if they can't pull up their patient records.  When systems are down, they are unable to document visits for insurance, order tests with labs, or provide referrals with associated hospitals or specialty groups.  Physician practices would benefit tremendously from support across a spectrum of services, including remote monitoring, help desk and technical field support.

Stabilize Your IT Efforts

Supporting the automation of an EHR within a healthcare network creates many challenges. For instance, one physician practice may seem insignificant from an IT perspective but usually it's hundreds of practices that need to be tied back to a hospital and associated payers. This can be an IT nightmare, and happens when practices do not have an in-house healthcare IT professional and use outsourced IT resources that are not experienced working within healthcare IT.  Today, such resources are woefully inadequate, falling short of correctly automating and supporting practices. 

Ultimately a "Tech Team for Docs" comprised of healthcare IT professionals, would remedy such a situation.  The team would evaluate the current state of the target model office environment to understand the primary applications being used in order to automate processes.  An initial assessment would include the examination of gaps in coverage for meeting a secure and effective healthcare IT network infrastructure. The next step would be the development of a clear roadmap of all milestones, activities, timelines and costs associated with meeting the specific requirements derived from an initial assessment.   

Workflow in healthcare is an important term for the healthcare IT Professional and needs to be part of an initial assessment.  The workflow describes the full process of how the office, patient, hospital, payers and associated groups work with each other -- from the moment the patient calls to setup an exam, to the billers working on the claims.  Healthcare organizations receives hundreds, maybe thousands, of documents each day --all of which contain data that needs to be entered into back-end systems.

There is a need for ongoing support that proactively and remotely monitors mission critical systems (early indicators, rapid responses), and offers help desk support or on-site field service support.  Help desk support can troubleshoot and correct the majority of practice-level issues.  It looks at the most current and most requested research, and interprets how that affects the day-to-day clinical practice.  With so much involved in installing a new system, it's not possible for an office to learn everything about the software in the first couple of months. The help desk provides information and assistance to a practice's users of the computer network, streamlining traffic, activity, and third parties on behalf of a physician practice.  It also helps in minimizing communications that can occur when multiple vendors are involved.  If remote monitoring or help desk support can't resolve such issues, then on-site field service support can be valuable.

"With EHR implementation comes the need to have a trained and skilled IT manager to oversee issues like hardware and software upgrades, network connectivity, and the assured privacy and security of patient health information," states Dr. Amanda Parsons, Assistant Commissioner for the Primary Care Information Project at the NYC Health Department.  "In fact, we have made it a mandatory component for practices who wish to receive subsidized licenses or technical assistance from us because we have learned over time that those who don't get IT support end up with complications that hinder practice workflows and negatively impact patient care."

IT managers don't want to be called into the physician group in the midst of a crisis. By being proactive before any issue causes a surprise and working with a carefully chosen IT resource -- a "Tech Team for Docs" -- should prevent calamities and offer support across the entire spectrum of a physician organization for remote monitoring, help desk, and field service.

This is actually something that we've had at St. Francis Hospital for quite some time now.  We call this team Physician Support Services and it is a team that I used to work for.  PSS basically works with doctor's offices and oversees their implementation of EMR and a practice management system.  PSS then provides ongoing support of these applications and IT infrastructure.

What Mobilty Really Means to Healthcare

Taken from http://blogs.computerworld.com/healthcare-it/20545/what-mobility:

Much thought and focus is being devoted to the future of health care delivery and the role that  mobility will play. For example, Fierce Mobile Healthcare’s Sara Jackson recently brought up an interesting question: will hospitals need chief mobility officers? She argues that mobility represents a transformational paradigm shift in our ability to deliver and receive care, and such a shift needs an enterprise-level focus that crosses people (HR/COO), process (COO) and technology (CIO/CTO) functions.

But while organizations and solution providers are identifying mobility needs and executing mobility programs, they often fail to think deeply about what mobility truly means. As a result, mobility is often defined in narrowly technical terms, with the focus placed on devices (iPhone, Blackberry), operating systems (Android, Blackberry OS, iOS, Symbian, and others), and the related issues of signal coverage, bandwidth (3G/4G/LTE), system security, and data management.

However, mobility in health care is about more than just mobile devices. For example, when I asked fifteen Kaiser Permanente physicians what mobility meant to them, I got many answers: “remote monitoring,” “care anywhere,” “telemedicine,” and “virtual diagnosis.” All focused on the ability to provide service anywhere; none dwelled on technology.

All of which brings me to my central stance: The most effective way to frame a mobile strategy is as an ecosystem comprised of multiple components that work together to enable mobile behavior.

Patients, providers, and payers are already buying into the mobile way because it is convenient and effective. Care interactions are happening in an increasingly wide range of locations: hospitals, rural clinics, mobile health vans, homes, or even during the course of a person’s daily activities. The core objective of a mobility strategy should be to develop processes, organizational structure, and technologies that support and nurture these interactions.

With a mobile strategy focused on outcomes, we can make these experiences even richer and more capable, delivering daily care and monitoring, critical care, health administration, specialty care, and ancillary support services “anywhere, anytime.” As David Aylward points out in his HBR Blog, mobile health could be a major force multiplier, empowering multiple constituents by breaking physical boundaries and providing true end-to-end information transparency across the care continuum.

By thinking about mobility as a business and functional proposition, not merely a technical one, we can use the familiar “people, process, technology” framework to develop some useful models for a mobile environment.

We already know that the people will be mobile. The process—the health care organization’s core operating model, its end-to-end process of delivering care to its customers, its malleability to the new care continuum—should be amenable to a world where physical boundaries are immaterial—even irrelevant.
The technology then becomes whatever is necessary to deliver that experience in a scalable, secure manner while adhering to the needs and standards of each health care organization. Take some simple examples: a patient’s health records should be instantly available no matter where they are: hospital, clinic, or pharmacy. From the care professional’s perspective, mobility might mean the consistent ability to access support resources no matter where they are, whether it’s traveling from location to location, or even room-to-room within a single facility. Mobile devices may play a part in delivering these services, but they’re only the visible tip of a much broader supporting infrastructure. In some cases, the endpoints that deliver these mobile services may not be mobile themselves.

So, while gadgets and applications are glamorous and exciting, the true measure of mobility is far broader and multi-dimensional than just the devices we hold in our hands.

I guess you can say this article is all about perception.  For us IT folk, we think of mobility in terms of phones, tablets, and laptops.  In this article, we learn that healthcare professionals have an entirely different meaning for it.  For the most part, technology in terms of electronics devices was not their idea of mobility.  It's also not that far off, however, as technology does play an important part in things like remote monitoring, care anywhere, telemedicine.

Social Media Site for Healthcare

Taken from http://www.technewsworld.com/story/74445.html:

Former Sun Microsystems CEO Jonathan Schwartz is offering caregivers a social networking service designed to be free of confusing privacy policies and invasive advertising.

Social networking is far older than Facebook, MySpace or even Friendster, according to Schwartz, CareZone founder and CEO. Family is actually the world's oldest social network, and whether by birth or by choice everyone is pretty much part of it.

However, this original social network doesn't always make for a good fit with today's online social media, he maintained -- especially when it comes to privacy.

For many social media sites, the user isn't the customer but the rather the product. The goal of CareZone is to change this so that productivity and privacy don't have to be mutually exclusive.

"The network's goals are to serve the needs of those that care for their parents, their children or the loved ones we consider part of our family," Schwartz told TechNewsWorld.

"We believe with life expectancies extending nearly everywhere on Earth, and with the burdens falling increasingly on those already challenged with kids, our service is timely and high value," he added.

Entirely Private

The concept behind CareZone is to provide an online account that can be opened on behalf of a loved one, and which remains entirely private and available by default only to the person who opened it. The service, which launched this week, offers subscriptions ranging from US$5 a month to $48 a year per individual.

Accessible online, the CareZone could be used to provide a permanent reference for key information including names and addresses, blood type and allergies. It also provides a way to manage medications and therapies, including dosage, frequency and reactions.

General purpose social networks have played a huge role in encouraging people to share more, but as the online social world evolves, participants will look for networks that offer more value for their personal and professional interests. But will Schwartz's background bring the attention that CareZone might need to succeed?

"It may mean something in Silicon Valley VC circles, but consumers in virtually all markets don't know who he is," said Josh Crandall, cofounder of Netpop Research. "They won't take it into consideration when evaluating the service."

This service is thus a significant departure from the Facebook-type social networking sites that provide the usual "what you're doing right now" type of social commentary, but for this reason it could offer something unique as well.

"Launching a social network for a niche audience requires deep expertise and passion for the subject," Crandall told TechNewsWorld.

The challenge is to differentiate itself through specialization from general purpose social networks, he said. "By focusing on a particular niche, the product team must focus on building features that general purpose social networks don't have time and bandwidth to tackle."

Not a Niche

However, Schwartz doesn't even believe that there is such a selective market.

"We don't view taking care of an older parent or a child as niche: It's what the vast, vast majority of people on Earth do every day," he said.

Technology will not be a barrier, in his view. "We're focused on those that are responsible for care -- not necessarily the objects of their caring attention -- and those that are already connected via smartphones, tablets and PCs. That's 4 billion and counting. It doesn't matter to us whether your Mom has access to the network, it's whether you and your sisters do -- you're the ones whose challenges we can lighten with the smart application of basic technologies."

The fastest-growing segment on popular social networking sites such as Facebook is comprised of those 50 and older, noted Lynne A. Dunbrack, program director, connected health IT strategies, at IDC Health Insights.

"There are already plenty of people who want to share health issues, good or bad," she told TechNewsWorld, "and this could be a good extension of that."

This is one of those things that I would have to see to believe in terms of success.  I was actually shocked to see that there will be subscription costs in order to use this site.  This totally isolates itself from other social networks and this is the first one I've heard of that requires it's user community to pay up.  Would you be interested in a healthcare version of Facebook that you have to pay for?

Ethical Use of Big Data

Taken from http://www.businessweek.com/articles/2012-05-17/the-health-care-industry-turns-to-big-data:

When patients show up at a hospital, something dangerous happens: They’re looked at by humans. Because of the hustle in busy emergency rooms and admission wards, many patients get only a cursory review of their health, according to Nicholas Morrissey, a surgeon at New York-Presbyterian Hospital. Mistakes can lead to complications or missed warning signs and may increase a patient’s chance of winding up back in the hospital. So Morrissey is working with Microsoft to train computers to make the kind of snap judgments about new patients’ risk factors that hurried humans often flub. “We don’t want to take the intuition and clinical decision-making out of the process,” he says. “We want to facilitate it.”

As hospitals digitize patient records and amass huge amounts of data, many are turning to companies such as Microsoft, SAS, Dell, IBM, and Oracle for their data-mining expertise, which can help medical providers perform detective work and improve care. The so-called Big Data business has already permeated other industries and generated more than $30 billion in revenues last year, according to research firm IDC. It’s expected to grow to close to $34 billion this year in part because of increased use in the health-care industry. Crunching numbers is potentially good business for hospitals as well. By making “meaningful use” of computer systems, they’re eligible for millions of dollars in government funding from the Obama administration’s $14.6 billion program launched in 2009 to encourage adoption of electronic medical records.

The use of data-mining technology has already led to some measurable improvements in patient care. New York-Presbyterian, which started using Microsoft technology to scan patient records in 2010, has reduced the rate of potentially fatal blood clots by about a third, says Morrissey. “I wouldn’t be out there saying we’ve solved the problem, but we’re definitely making progress. That was a significant drop,” says Morrissey.

Seton Healthcare Family, a hospital system in central Texas, learned from IBM software last year that a bulging jugular vein is a strong—and easily observed—predictor that a patient admitted for congestive heart failure is likely to wind up back in the hospital. “We’ve gotten some really tremendous results,” says Ryan Leslie, Seton’s vice president of analytics and health economics.

Patients don’t usually know when their records are being analyzed in this way. Federal law prohibits medical providers from disclosing certain health information without patient consent, but there is an exemption for activities that fall under “quality improvement,” says Susan McAndrew, deputy of health information privacy at the U.S. Department of Health and Human Services’ office for civil rights. During the analyses done at New York-Presbyterian and Seton, for example, patients weren’t informed their medical records were being studied by outsiders’ software.

“People do not like to have researchers of any stripe using their electronic health records,” says Deborah Peel, founder of Austin (Tex.)-based Patient Privacy Rights. “As a matter of respect and autonomy and patient-centeredness, patients want to be asked. When they are asked, by and large they support this. It’s the not-being-asked stuff that’s really bad.”

Deven McGraw, director of the health privacy project with the Center for Democracy & Technology in Washington, disagrees. Notifying patients too often can be unnecessarily confusing. Only ask for permissions, she says, when data “is used in ways that people might not expect,” she said.

An interest debate is presented in this article.  In Seton Hospital, the use of big data has shown to have positive results in patient diagnosis using technology from Microsoft.  While the use of this technology has helped patients immensely, they are not told that their ailments are being analyzed by a third party.  The law, however, does state that the uses of big data in this manner are acceptable and that the patient does not need to be notified under these circumstances.  The other view presented here is that, out of respect, a patient should be notified when their medical information is being seen by a third party.  What do you think?

Big Data Clouds

Taken from http://blogs.computerworld.com/cloud-computing/20488/centralizing-healthcare-big-data-cloud:

Can the medical community make better use of big data, government regulations and the cloud to improve service and save lives?

There is a lot of buzz going around about big data and cloud computing, but there is also a lot of confusion about how to incorporate them for an advantage. Cloud computing is all about providing services over the network, and big data is all about analyzing lots of data to gain insights and find trends. Government regulations are all about protecting the data and forcing the owners of the data to save it, just in case.

The problem is many folks are afraid of cloud-based solutions because they feel the data may not be secure, and sometimes big data may really just contain useless or redundant (what I call fat data), and regulations are just a pain to accommodate. There needs to be a better way.

In a previous blog, Reduce healthcare costs with cloud computing, I covered the notion of hospitals transforming their data centers from cost centers to profit centers by implementing cloud services for their affiliated physicians. The idea is to solve the Health Insurance Portability and Accountability Act (HIPAA) compliance issue for doctors by using hospitals’ IT departments as central locations for patient records for all affiliated physicians. (Many physicians are lost when it comes to IT, and they are struggling to figure out how to comply with HIPAA regulations related to securing patient records.)

Taking that concept a step further, there is a possibility we could improve overall healthcare in the country while reducing costs and speeding services if hospitals joined together with insurance companies to provide centralized, secure access to patient information. Now THAT would be big data. Imagine the ability to sift through clinical data from every hospital in the U.S. to look for trends in healthcare. It would be much easier to share important test results between doctors and specialists when required. Patients would benefit by having their entire medical histories readily available in an emergency. There are thousands of examples of the benefits of moving patient data to the cloud.

All it would take to enable this capability is better standardization and security. As an example, X-ray data and other clinical information are stored in multiple formats, so it's hard to share information unless everyone uses the same application. Even with standards such as Digital Imaging and Communications in Medicine (DICOM), many manufacturers implement technology differently, so data interchange remains difficult.

The insurance companies figured out how to handle this a long time ago, as most billing data includes sensitive patient information, but much of it is done electronically. The insurance companies rely on medical billing clearing houses to consolidate records into a standard electronic format . A similar methodology could be leveraged to start on the path to cloud-based medical information. The U.S. needs to invest in a secure electronic data interchange (EDI) standard for medical data (there are EDI solutions available for DICOM already) so hospitals and insurance companies can begin to securely connect their data centers to share information and analyze big data to spot trends and speed up diagnoses. The regulatory mandates of storing patient records for life would then actually provide a benefit, as that data could be used to gain insight into the long-term effectiveness of treatments for specific diseases and positive or negative patient outcomes.

I would love to be handed an iPad rather than a clipboard at my doctor’s office to input my family and medical history.  My information would be electronically encrypted and immediately replicated to the local hospital’s database, where it would also be available to emergency room staff (as long as I approved of this up front). If I were ever in a car accident, all my medical information (such as blood type, allergies, X-rays and family history) would be immediately available, so my treatment could be more efficient and perhaps save my life.

I know some folks will have issues with their data being in the cloud, even if it is encrypted and secure, so there should be an option to opt out. For the rest of us, though, cloud-based medicine could have a dramatic impact on improving healthcare while reducing medical costs in the U.S. 

Insurance companies harbor a great deal of patient data.  The data might be even be more accurate than a patient's medical chart itself.  Think about it... every prescription, procedure, and doctor's visit is sent to the insurance companies for billing, compiling a very accurate and detailed account for the patient's medical history.  The idea of a big data collaboration with hospitals and insurance companies would create a strong base in which a patient medical record is compiled accurately and accessed easily.

Cloud Computing Reduces Costs

Taken from http://blogs.computerworld.com/16534/the_real_costs_of_healthcare:

The health care industry has always been a leader when it comes to leveraging technical innovation to provide better quality services. Wonders such as Computer-Aided Tomography (CAT) scans, sonograms and even nuclear medical imaging technology allow doctors to peer inside the human body and diagnose problems, without the need for expensive and intrusive surgery.

Although the cost of these highly technical machines can be high, they enable doctors to diagnose illnesses without the need for risky and costly surgery, which minimizes the hospital stay to recuperate, which in turn reduces those costs.

So why are health care costs still rising? Shouldn't they actually be going down?  Inefficiency drives up costs, and inefficiency in information technology can be a major factor in higher costs.

Why is this the case?

As the population grows, so does the need to keep medical records. From the time you are born to the time you die, a record needs to be kept and stored for every tooth pulled, tonsil removed or other medical procedure performed. Government regulations also dictate that doctors, hospitals and insurance companies keep these patient records available for many years, if not forever.

The problem arises from the fact that in many cases the same doctors who perform highly technical, lifesaving procedures in the hospital may still be storing patient records on paper in their office.

Have you ever tried to change your primary care physician? Have you ever had to pick up an X-ray from one doctor and deliver it to a specialist? It seems any time I or my family members change or see a new doctor or specialist, they always ask me to fill out a new chart with my insurance information, family history and medical history. Why can't the specialist just download that information from the primary care physician's office?
All of this wasted time and duplication of efforts drives up costs and adds inefficiency. Think of all the wasted office space dedicated to storing patient records!

Physicians could reduce their costs in office space and personnel and become much more efficient and secure in sharing patient data between other providers by outsourcing the storage of patient record data to a cloud service provider. One way I see for this to happen quickly is for hospitals to become the IT cloud service providers for their affiliated physicians. 

Each affiliated doctor would procure application and patient records services from a central IT department at the hospital. The physicians would scan all their records into an appliance in their office where the data would be encrypted and deduplicated prior to transmission into the cloud. Patients and doctors could access the records securely by exchanging secure electronic keys, similar to the way secure credit card transactions occur over the internet.

The doctors would use the appliance in their office to input and retrieve records. Patient records could be securely transferred between physicians and specialists by providing access to the key, and hospitals could transmit and store data in a secure fashion between their affiliated physicians and even other hospitals.

Hospitals that sign up for this could transform their IT departments from a cost center into a new stream of revenue, enable their affiliated doctors to reduce the costly burden of having their own IT staff, and provide a simple means for them to cost effectively achieve regulatory compliance for their patient records.

Some hospitals are already seeing the light and getting on board. For instance, Steve Aylward, general manager of U.S. Health & Life Sciences writes on The Official Microsoft Blog about how cloud computing promises enormous benefits for the health care world.

My hope is that soon practices such as these are standardized around the world so that we all can benefit.

A centralized national EMR solution remains the primary goal of healthcare today.  This article shows us how we might be able to achieve that using cloud technology as a means of accessing patient medical records from anywhere in the world.  Of course, in order for this to work, a computing language standard must be put in place so that different EMR applications can access and decrypt the data.  Perhaps the government can create and develop its own cloud for this purpose.