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EHRs: The new lightning rod in healthcare
Posted on Oct 20, 2014
By David Blumenthal, MD, president, The Commonwealth Fund
When Texas Health Presbyterian Hospital failed to diagnose the first known case of Ebola in the U.S., the hospital initially blamed its electronic health record (EHR). As it turned out, the problem was the humanware, not the software. The culprit was a mundane and all-too-common failure by people to communicate in a fast-paced and stressful medical setting.
For those who follow the ongoing conversion of U.S. healthcare from paper to electronic information systems, Texas Health Presbyterian's reflex to blame its EHR was revealing at many levels.
First, it showed that, in the face of error, health are providers often look for scapegoats. This is a long, inglorious pattern in human behavior, to which health care officials are evidently not immune.
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Intermountain forges new kind of clinic
Posted on Oct 24, 2014
By Madelyn Kearns, Associate Editor, Medical Practice Insider
When faced with the fact that just 5 percent of the patient population was responsible for nearly half the money it spent on healthcare each year, Utah’s Intermountain Healthcare decided to make some radical changes to keep these most vulnerable patients from falling through the cracks.
Intermountain leaders knew that primary care doctors are up against a universal influx in patient volume and could not set aside enough time and attention to treat the multiple chronic conditions – physical, social and psychological – presented by this most at-risk group. And hospitals were unable to offer these patients personalized, cost-efficient care.
This is not a challenge unique to Salt Lake City, of course.
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Karen DeSalvo steps down from ONC post; Jacob Reider to leave in November
October 23, 2014 | By Dan Bowman
Editor's Note: This story has been updated to include news of Deputy National Coordinator Jacob Reider's departure.
Karen DeSalvo will step down from her role as National Coordinator for Health IT, effective immediately, to serve as Acting Assistant Secretary for Health at the U.S. Department of Health and Human Services at the behest of HHS Secretary Sylvia Mathews Burwell, an ONC spokesperson confirmed to FierceHealthIT on Thursday afternoon. In her new role, DeSalvo will work with Burwell on "pressing health issues, including becoming a part of the department's team responding to Ebola," the spokesperson said in an email.
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Ebola Misdiagnosis: Experts Examine EHR Lessons
10/23/2014 11:30 AM
Putting fault aside, facts of the case align with a common pattern where the use of EHRs contributes to medical errors. What should this unusual case teach us about EHRs and routine?
A team of researchers studying the safety hazards of electronic health record (EHR) systems suggests there may be lessons to be learned from the Ebola scare, even though the Dallas hospital where a man died and infected two healthcare workers swiftly retracted its claim that its EHR was at fault.
Despite that backtracking, the facts of the case align with a common pattern of medical errors where the use of EHRs is, if not the sole cause, often an aggravating factor, according to Hardeep Singh, chief of the health policy, quality, and informatics program at the Veterans Affairs Center for Innovations in Quality, Effectiveness, and Safety, based at the Michael E. DeBakey VA Medical Center in Houston, and an associate professor at Baylor College of Medicine. He was the lead author on a recent study on usability flaws in EHRs that can lead to medical errors.
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Track IT!
The roll-out of blood tracking across the NHS has been slow, but it is gathering pace. Meantime, trusts are finding other uses for real-time location services, as Jennifer Trueland discovers.
As a blood transfusion co-ordinator of many years’ standing, Angela Green is really looking forward to ditching the paper.
East Kent Hospitals University NHS Foundation Trust, where she works, is in the process of moving to an electronic blood tracking system that will see staff using Apple iPod devices at the bedside, to ensure that patients get the right blood, every time, with no delays or wastage.
“The real advantage of the new system is that we get data in real-time,” she says. “The paper systems mean we are always a few days behind. And because we can use it at the bedside for a verification check, it eliminates the human factor where something can go wrong.”
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Mobile EHR Users More Satisfied Than Desktop, Laptop Users
OCT 23, 2014 7:36am ET
A new survey of nearly 600 physicians reveals that those accessing electronic health records from mobile devices report higher levels of satisfaction and fewer challenges with their EHRs than non-mobile users.
The annual survey, which research firm
Software Advice commissioned polling firm Research Now to conduct,
indicates that 58 percent of mobile users are "very satisfied" with
their EHR versus only 28 percent of non-mobile users. In addition,
mobile users are less affected by common EHR software challenges than
non-mobile users. Just 39 percent of mobile users report that learning
how to use their EHR system was challenging compared to 58 percent of
non-mobile users.
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Mobile Tool to Provide Early Warning of Declining Health
OCT 22, 2014 2:42pm ET
The University of Michigan Center for Integrative Research in Critical Care is co-developing technology to predict declining health status in acute and critically ill patients and to alert appropriate clinicians via smartphones.
The university is working with AirStrip, a vendor of software to transmit patient data from monitoring devices and electronic health records to a clinician’s mobile device. The product being developed, called the mobile Acute Care Early Warning System (mACEWS), initially will focus on identifying hemodynamic decompensation, an inability of the heart to adequately circulate blood. The goal is to create a decision support tool that can identify risk factors that warrant early intervention.
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Study: MU program may not have been best ROI for feds
October 20, 2014 | By Marla Durben Hirsch
The Meaningful Use incentive program may not have been the best use of the government's money since the industry was already moving toward using electronic health records and would have met the same adoption goals just two years later, according to a new paper from the Cambridge, Massachusetts-based National Bureau of Economic Research.
The paper, "Investment Subsidies and the Adoption of EMRs in Hospitals," compiled and analyzed data from HIMSS' database, the Medicare Healthcare Cost Report Information System and information from the American Hospital Association. The research revealed that while the adoption rate of EHRs grew from 48 percent of hospitals in 2008 to 77 percent in 2011, since the HITECH Act didn't target only new EHR adopters, only 10 percent of hospitals adopted EHRs because of the HITECH Act. Moreover, without the incentives, the adoption rate would have been 67 percent in 2011, and 77 percent in 2013, since adoption was already a "preexisting trend."
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Without a UPI, healthcare awash in SSNs
Posted on Oct 23, 2014
By Mike Miliard, Managing Editor
The healthcare industry is swimming in Social Security numbers, thanks to the necessities of patient record management systems. But balancing those requirements with fraud mitigation and privacy protections is proving a big challenge.
That's according to a LexisNexis Risk Solutions study published this week, which examines four different industries' reasons and methods for collecting, storying and using personal identification information, or PII.
The report looks at the practices of healthcare, financial services, retail and government – taking stock of these sectors' varying approaches to identity verification and consumer behavior.
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National systems to become 'glue' of NHS
23 October 2014 Lis Evenstad and Lyn Whitfield
Key systems will provide the “electronic glue” that will enable different parts of the health service to work together, according to NHS England’s Five Year Forward View.
The report, issued today by the commissioning board’s chief executive, Simon Stevens, sets out to try and close the £30 billion gap that could open up between funding and demand by 2020-21.
It says this can be done if the NHS takes action on prevention, on giving patients more control over their own care, and on “reshaping care delivery” around fewer acute centres and new models of community and primary care.
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DHS to investigate med devices, hospital equipment for cybersecurity issues
October 23, 2014 | By Katie Dvorak
Medical devices and hospital equipment are under investigation by the U.S. Department of Homeland Security after suspected cybersecurity flaws that could allow the tools to be hacked, according to a Reuters article.
The products--which include an infusion pump from Hospira Inc. and implantable heart devices from Medtronic Inc. and St Jude Medical Inc.--are under review by DHS' Industrial Control Systems Cyber Emergency Response Team, according to the article.
However, no instances of hackers attacking patients through the devices are known, according to sources cited in the article. Still, DHS has concerns that the tools could be activated remotely, and is working with manufacturers to identify and repair software bugs and vulnerabilities.
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4 goals of the federal Health IT Safety Center
October 22, 2014 | By Susan D. Hall
Goals for the new federal health Information technology safety center, an idea initially proposed by the Institute of Medicine in a report published in November 2011, are outlined in a new article published this week the Journal of the American Medical Informatics Association.
While its functions are still being defined, the safety center is envisioned as a public-private entity working with key administrative and policy stakeholders, healthcare organizations and HIT vendors.
The center's four goals, according to the paper, include
1. To create a nationwide HIT-related patient safety surveillance system to monitor HIT-related patient safety events, including events that lead to patient harm and 'near misses.'
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Many Docs Believe Mobile Health Apps Can Improve Patient Care
Most apps related to diet and fitness, do not require published evidence on clinical effectiveness
Most apps related to diet and fitness, do not require published evidence on clinical effectiveness
FRIDAY, Oct. 17, 2014 (HealthDay News) -- A Manhattan Research survey recently found that many physicians believe digital communication technologies, including mobile apps, can be used to improve patient outcomes, according to an article published Oct. 8 in Medical Economics.
Noting that more than one-third of physicians have recommended the use of mobile health apps -- mostly those related to diet and fitness -- to their patients, the article discusses the "mobile revolution" in relation to health care.
Karen DeSalvo: Interoperability won't come easy
October 22, 2014 | By Dan Bowman
After five years of efforts fueled by the HITECH Act, which mainly served to push providers to use electronic health records, it's time to earn a return on investment, Karen DeSalvo says.
Speaking at the Workgroup for Electronic Data Interchange's annual fall conference in Reston, Virginia, on Tuesday, the National Coordinator for Health IT (pictured right) reiterated the challenges and goals associated with implementing ubiquitous interoperability throughout the healthcare industry.
"When we take a look at where we are today as a country and where we're going, this is our chance to say 'we've built infrastructure for health IT on the front lines, we've built infrastructure around information exchange,'" DeSalvo said.
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ResMed launches HIE platform
ResMed has launched ResMed Data Exchange, a suite of software and services for home medical equipment and healthcare providers that allows access to critical patient information.
The Data Exchange integrates data from ResMed's patient management platform into in-house or third-party EHR platforms.
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Do Physicians Hold the Key to Consumer Mobile Health App Adoption?
Wednesday, October 22, 2014
Consumers looking to monitor their health through a mobile application have no dearth of options, and the recent announcements of new products by big name companies -- such as Apple, Google and Verizon -- will further expand their choices. But despite all those options, research shows only a fraction of people regularly use mobile health tools.
Mobile Health App Use
The latest data from the Pew Research Internet Project show that nine out 10 of U.S. residents ages 18 and older had a cell phone as of January 2014, while 58% of U.S. adults had a smartphone.
Of those who use smartphones, about one-third -- or about 46 million users -- accessed fitness or health care-related apps in January 2014, according to data compiled by the Nielsen Company.
Similarly, a survey conducted by Kantar Media showed 32% of U.S. adults -- or about 55.7 million -- used diet and fitness apps in 2013.
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Health IT Interoperability Up To Market, Say Feds
10/21/2014 09:06 AM
Jason Task Force co-chairs say government should exercise its regulatory powers only to guide process along.
The co-chairs of the federal Health IT Policy Committee's Jason Task Force (JTF) are advocating a mix of mostly market-led initiatives and some government action to spur adoption of open standards for electronic health information sharing in the US.
In comments to InformationWeek on Monday, David McCallie and Micky Tripathi of the JTF both recommended an approach where healthcare providers and vendors of healthcare systems take the lead in addressing technology interoperability issues, with the government intervening where necessary.
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http://www.healthdatamanagement.com/news/Heightened-Role-for-EHR-Vendors-in-Ebola-Fight-49041-1.html
EHR Vendors See Heightened Role in Ebola Fight
OCT 21, 2014 7:43am ET
Health Data Management spoke with a broad mix of electronic health vendors to understand the benefits and potential pitfalls of leveraging EHRs for screening suspected Ebola patients.
Mark Segal, vice president of government and industry affairs for GE Healthcare IT, emphasizes that while Ebola is currently a “critical public health issue” EHRs are “really designed to be general purpose tools that can be used for a range of healthcare needs.” At the same time, Segal argues that an EHR system can be customized to “meet the particular needs for Ebola” and to “enable workflows that a hospital may want to put in place.”
According to Sarah Corley, M.D., chief medical officer for NextGen Healthcare, EHRs typically contain templates or prompts for information about the symptoms (vomiting, diarrhea and fever) that patients are presenting, as well as travel history, to help healthcare workers identify individuals that may be at risk for Ebola. In particular, she reveals that—rather than just asking a series of questions—EHR systems can provide an electronic prompt that serves as an interruptive alert to the workflow.
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What Ebola tells us about health IT outbreak needs
By John W. Loonsk, MD FACMI, CMIO CGI Federal and Johns Hopkins Bloomberg Center for Population Health IT
The Ebola cases in the United States, despite their limited numbers, have generated considerable discussion and anxiety. The discussion has included health IT because of the initial assertion that the Dallas hospital's electronic health record led to the first US Ebola case being sent home. That claim was subsequently refuted, but it initiated conversation about whether the EHR was really to blame and, eventually, how EHRs might lean forward and help in such circumstances. Unfortunately, either way, the focus on EHRs in these Ebola discussions does not recognize more prominent outbreak health IT needs nor the ways we have yet to meet most of these needs with incentives and infrastructure.
Outbreak health IT and case reporting need attention too
The general outbreak anxiety is distressing and sometimes misplaced, but it does play an important role in motivating action. It is an unfortunate truth that emergency preparedness only gets attention during and shortly after emergency events. Work like health IT which requires sustained attention, incentives, standards, certification, and information exchange particularly suffers under these dynamics. An EHR did not cause the initial Ebola illnesses in the US, but health IT is also not yet aligned to substantially help with outbreaks either. Without adding to the anxiety, we should recognize the needs now and address them as soon as we can.
The general outbreak anxiety is distressing and sometimes misplaced, but it does play an important role in motivating action. It is an unfortunate truth that emergency preparedness only gets attention during and shortly after emergency events. Work like health IT which requires sustained attention, incentives, standards, certification, and information exchange particularly suffers under these dynamics. An EHR did not cause the initial Ebola illnesses in the US, but health IT is also not yet aligned to substantially help with outbreaks either. Without adding to the anxiety, we should recognize the needs now and address them as soon as we can.
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First wave of Apple HealthKit apps are out
Apple’s announcement of HealthKit and the Health app was a bell-ringing or sorts for many in the healthcare industry including clinicians, CIOs and practice managers.
Indeed, it was a milepost signifying that technology titans — not just Apple, of course, but also IBM, Google, Microsoft, Samsung, each in distinct ways — had arrived in the healthcare realm.
And while much of the attention thus far has focused on fitness and wellness apps, a new class of medical programs that integrate with IT vendors' platforms is emerging for doctors and patients under their care.
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Wearable tech must get smart with data
Posted on Oct 21, 2014
By Mike Miliard, Managing Editor
For wearable technology to live up to the hype, especially when it comes to healthcare, it will have to be "interoperable, integrated, engaging, social and outcomes-driven," according to PwC.
One in five American adults already own a wearable device, according to PwC's new series, "The Wearable Future," a rapid adoption rate that's only expected to increase.
But in a related report from PwC's Health Research Institute, "Health wearables: Early days," data suggests many of the fitness bands and step-tracking smartwatches flooding the market have "under-delivered on expectations." To wit: 33 percent of consumers who purchased a wearable technology device more than a year ago now say they no longer use it, or do so infrequently.
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Wikipedia and Facebook for clinical documentation
Posted on Oct 21, 2014
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
Over the past several years I've written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for billing/legal purposes not for care coordination.
One of the most frequent complaints in my email box these days is a sense that the current record is filled with data, but little knowledge and wisdom. It's hard to understand each patient's individual story. Notes are filled with cutting/pasting, inaccuracies and redundancy. Sometimes among the dozen notes written each day by the medical student, resident, fellow, attending, and consultants there is inconsistency.
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Patient early warning detection system reduces mortality rates by 35 percent
October 21, 2014 | By Katie Sullivan
Patient early warning detection system alerts staff to minor changes in a patient's conditions and can help prevent more serious events down the line and reduce mortality rates.
St. Joseph Mercy Oakland hospital in Michigan implemented a detection system with the overall goal of reducing mortality rates, David Bobryk, clinical informatics project, said in a video interview with Suzanna Hoppszallern, senior editor of Hospitals & Health Networks.
Patients wear a monitor on their wrists that continually tracks their vital signs--blood pressure, respiratory rate, pulse rate, pulse oximetry and body temperature--and sends the information to an electronic health record. The stats then travel to monitors that calculate a wellness index measured from a 0 to 5 scale. If patients' vitals rank from 0 to 2.9, they're in the clear "green" zone, but if they jump to 3.0 or above, a dangerous "red" zone, nurses on the unit are alerted to check on the patients.
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Medical identity theft proves lucrative in myriad ways
October 21, 2014 | By Susan D. Hall
With healthcare breaches becoming routine, there's a thriving black market for medical identity information. And criminals are using the information in a variety of ways, according to a Fortune article.
Basic identify information--names, birth dates and health insurance contract and group numbers--fetches just $20 on the black market, according to researchers at Aberdeen Group. But deluxe, ready-to-use identity theft kits can fetch nearly $1,500. Those kits include Social Security numbers, banking credentials, credit card information and PINs, as well as custom-made physical credentials such as insurance membership cards, Social Security cards, driver's licenses and credit cards.
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To manage health IT effectively, spread the responsibility
October 21, 2014 | By Susan D. Hall
Managing health IT effectively requires strong governance and shared decision-making, according to consultant Dick Taylor, M.D., in an article at InformationWeek.
"Advanced governance is allowing some front-running organizations to rationalize IT spending, achieve unprecedented automation, and use critical data to drive the organization. But others ... struggle with ineffective steering committees, budgets that slash critical IT support, and disengaged and oppositional users," writes Taylor, managing director and chief medical officer of the Advisory Services Division of MedSys Group.
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London should be digital health pioneer
16 October 2014 Lis Evenstad
London should lead the digital health revolution and create an ‘Institute for Digital Health’, according to a report by the London Health Commission.
The report, drawn up by a committee chaired by Imperial College surgeon and former health minister Lord Darzi, says that London “has the potential to lead the way” in the new health economy and global trends.
However, it adds that the capital is a difficult market in which to launch digital health products, especially for small and medium enterprises.
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How Telehealth Pays Off for Providers, Patients
Scott Mace, for HealthLeaders Media , October 21, 2014
Mainstream healthcare is seeing returns on virtual care investments. Banner Health, which identifies itself as "one of the top three performers for tele-ICU systems in the country," is just one provider that has reported major gains in quality and lower costs since adopting telemedicine.
If you need any further evidence that the world has gone online, consider this: According to a story in the August 22 issue of the Wall Street Journal, the Home Depot is now selling actual bricks and mortar over the Internet.
So is it any wonder that healthcare, a profession with more than its share of services that are rendered by listening to people and talking to people, is inevitably transitioning into an online experience?
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Penn Clinicians Develop Automated ‘Sepsis Sniffer'
OCT 17, 2014 9:50am ET
An automated early warning and response system for sepsis developed at the University of Pennsylvania has resulted in a marked increase in sepsis identification and care, as well as fewer deaths due to sepsis.
The Penn prediction tool, dubbed the “sepsis sniffer,” uses laboratory and vital-sign data (such as body temperature, heart rate, and blood pressure) in the electronic health record of hospital inpatients to identify those at risk for sepsis. When certain data thresholds are detected, the system automatically sends an electronic communication to physicians, nurses, and other members of a rapid response team who quickly perform a bedside evaluation and take action to stabilize or transfer the patient to the intensive care unit if warranted.
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Prescription drug database poised to become law in Pennsylvania
October 20, 2014 | By Susan D. Hall
A bill to create a prescription database to deter doctor shopping and prevent overdoses is headed for the Pennsylvania governor's desk after passing both houses of the state General Assembly last week.
The database would be accessible to medical professionals and law enforcement officials pursuing active investigations. Although medical organizations and state officials support the bill--including Gov. Tom Corbett (R)--it has drawn criticism from privacy advocates as a government overreach, according to PennLive.com.
"This is going to save lives; it's going to address doctor shopping; it's going to address drug diversion" and address the epidemic of opiate drug use, state Rep. Matt Baker (R-Tioga County) said in an article at TribLive.com.
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Nurses Dissatisfied with EHRs, Report Finds
October 17, 2014 by Gabriel Perna
69 Percent Say “IT Department is Incompetent”
Much has been made of doctors’ dissatisfaction with electronic health records (EHRs) but a new report details that nurses are as equally disenchanted with the software systems.
Authors of the report, from the New York-based Black Book Research, polled nearly 14,000 licensed registered nurses from forty states, all utilizing implemented hospital EHRs over the last six months. A whopping 92 percent of them are dissatisfied with their inpatient EHR system. Eighty-four percent of those polled said that EHR’s causing disruptions in productivity and workflow have negatively influenced their job satisfaction.
Most telling, 88 percent blame nonclinical administrators and CIOs for selecting inferior systems based on EHR pricing and government EHR incentives only. Most say that the EHR selection did not account nursing workflow into account. An astoundingly high 69 percent of nurses in for-profit inpatient settings say their IT department is incompetent.
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Volume of e-mails nearly tripled, but number of messages per 100 patients stabilized from '05 to '10
FRIDAY, Oct. 17, 2014 (HealthDay News) -- From 2001 to 2010 the volume of patient-to-physician electronic messages increased, but the rate per-capita stabilized, according to research published in the October issue of Health Affairs.
Bradley H. Crotty, M.D., M.P.H., from the Beth Israel Deaconess Medical Center in Boston, and colleagues examined the volume of messages in a large academic health system's patient portal from 2001 to 2010. Data were used to examine trends in secure e-mail messaging between patients and physicians.
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Government Indifference Must Not Stand in the Way of Mobile Health Innovation
Monday, October 20, 2014
Outdated elements of health care regulation pose a serious threat to innovation. Without substantial changes, new technologies that can improve the lives of patients and the capabilities of their caregivers will remain out of reach to most consumers.
Scores of mobile health companies have shared stories about federal regulatory requirements that fail to keep pace with advancing technology. These companies are providing critical services to patients and providers in both consumer and enterprise settings. They have become frustrated with factions within HHS that stand in the way of mobile health innovation.
A glaring example of how bad the situation has become can be found on the HHS website. This is where developers go to find compliance documentation for HIPAA. As the principal statute that governs privacy requirements for patient data, HIPAA is a critical area of concern for mobile health application developers. Unfortunately, much of the guidance focuses on what cannot be done, providing few examples for improving patient access to information. Moreover, key sections of the guidance have not been updated since 2006.
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Enjoy!
David.
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