Take Two Aspirin and Text Me in the Morning: Will healthcare technology implementations raise new privacy concerns?

Is the healthcare industry ready for secure texting?

A new HIPAA compliant texting app is in beta testing at about 80 hospitals around the US right now. It is secure, traceable, encrypted and recorded. In other words, the HIPAA aspects are all covered so physicians who use texting as a means of communication are no longer breaking the rules. But what about human error?

I love technology. I've made information technology my career. Technology touches nearly every part of my life. And, as I've said before, I am a technical early adopter.  I’m in favor of technical progress, new innovations, and using technology in as many ways as is possible to improve my life and work. Despite popular belief, a lot of doctors,
clinicians, and nurses are too.

I’m also as addicted to texting as anyone out there (OK, middle school kids might have one up on me) and I use it as a primary method of communication.

For those of you who know the feeling, you also know the feeling of sending the wrong text to the wrong person occasionally. What's to prevent a doctor, nurse, or a medical assistant from sending your information to another person via text?

Medical records are not always pristine. I have a colleague whose medical records are actually mixed with another person of the same name, stating he has ailments and a prescription regimen he is not actually on, and who receives mail for Medicare insurance despite the fact that he is in his 40's. That's an entirely different matter for later discussion, but it does have relevance.

If it can happen in the back office of a healthcare organization, it can certainly happen via text.

I can understand the need for instantaneous communication within a healthcare organization and can understand the benefits. The worst case scenario is that a texting app along with human error sends my information to the wrong department or doctor within an HCO. My information is not publicly compromised.

My concern is that human error via texts intended for me could do just that.

I’m sure technology providers and HCO's will secure my data with unique ID's such as a SSN, patient number, or something similar, but that’s only as good as the human doing the texting. I am sure mistakes aren't commonplace but, through my experiences working with technology and in healthcare IT staffing, they do happen on nearly every level of every organization.

A famous quote from Alexander Pope states, 'To err is human; to forgive, divine.'

On the surface I love the idea of texts from my doctor. Who wouldn't want information or test results as soon as they come in? I love the idea until the doctor sends it to my wife, or child, or mother by accident because they have the same last name, or initials.

I don't know how many people would forgive a mistake such as leaking private medical information in today's litigious society.

Perhaps a safer method would be that the texting is not actually sent by a human at all. Rather; it’s an integration into the EMR product that then sends out the texts to the phone number on file.

Unfortunately, although more secure, this brings up two other problems:

1. My phone number on record is wrong at two different doctor's offices I've visited in the in the last year alone due to moving; which means that whomever has my old number would receive my medical information. 


2. I often give my phone to a friend or relative to play a game, look at pictures, or hop on the web.  A big text box popping up with an image of my MRI results isn’t exactly information I want shared.

We discuss data security and healthcare in these blogs frequently and, I’m sorry but, unless there is a way (and maybe there is) that text providers can ensure texts are going to the right person; 100% of the time, without fail; this seems like a disaster waiting to happen.

I think I may have an alternate solution to reduce the chances of human error.

The large EMR vendors could develop a healthcare app for smart phones that ties into your electronic medical record for which you would have a secure login with a password and username that can't be stored. You can see the information as it gets put into your electronic records. It would be as simple as checking on your bank account online. You could sign up for instant notifications that alert you a new message has arrived, instead of sending the confidential information.

Regardless of the technology, employees at every level of healthcare organizations are craving a solution. Beta testing is just that: testing. Just because it works does not make it as functional and secure as it can be. We would be wise to make sure we have this right before a widespread beta roll-out turns out to be very wrong as a result of our desire to have the products now.

Josh Kaplan writes on various subjects including information technology breakthroughs, healthcare IT recruitment and innovations, big data, IT staffing and recruitment, and technical industry news and trends.

Could your iPhone be hazardous to your healthcare?

Does new map technology pose a risk to users?

A few weeks ago I wrote about the dangers cloud computing poses to your data and private information. We've also discussed the responsibility companies like Go Daddy and Apple have towards protecting our data and providing reliable services.

Then the iPhone 5 was released, and along with it, the much anticipated iOS 6 upgrade.

Let's just say; it's not the same iPhone you've been using in releases one through four. Google Maps has been replaced by Apple's own mapping technology that uses Tom Tom GPS data. There are a few other changes fans of the old iOS might miss, but I am most concerned by the GPS issue.

Why?

The story takes a left turn in that, Hospitals and ER's are not showing up on the new iOS mapping software. Mass transit locations are also omitted. One Twitter user reported that, following the upgrade, Apple's new maps wanted to send him to Kaiser, MO instead of his local clinic. I find these omissions a bit alarming if not downright dangerous.

I travel a lot for my work in healthcare IT staffing. I decline the GPS for my rental cars because my phone is a reliable GPS. Why pay for something when you get it for 'free'? I also find it kind of comical that with the new OS (to which I immediately upgraded because I was really looking forward to the turn-by-turn directions) I might not be able to find my healthcare IT clients anymore.

In all seriousness, what if I find myself in some unfamiliar town and I have a medical emergency and the fastest way to get there is mass transit? (OK, I might be going overboard, but this is a potential real-life scenario for many people.)   

Sure, I can ask someone for directions or download another app like MapQuest, but I will not have the most robust mapping tool I have come to rely on; day in and day out. However, in a life or death situation, I might not have the clarity of thought or the time to do so.

That's really my whole point.

I also upgraded to iOS 6 immediately based on my past flawless experiences with the process. So did millions of others. We all expected an improved upon and reliable product. What was delivered was a 'not ready for prime time' mapping tool and a few 'negative experience' reports ranging from some data loss all the way to a reset back to factory settings from friends and family.

Apple understands there are problems with the mapping tool and have said they are working hard to fix them. What responsibility do they have to deliver consistency and reliability in their products?

If phones were not locked into two-year contracts, I’m willing to bet that people would look at potentially switching because of this issue.  Maybe that’s a stretch. People love their phones, but it’s these little and sometimes big stumbles that can make product popularity change, sometimes overnight. Those with the means could be prompted to jump on the Android platform and get Google Maps with turn by turn directions (and directions to hospitals).

If you haven't upgraded yet, you may want to wait until the iOS 6.1 is ready to ship.

What do you think? Do companies like Apple have a responsibility to deliver on expectations based on past successes or will you give them a pass on this stumble?

Josh Kaplan writes on various subjects including information technology breakthroughs, big data, IT staffing and recruitment, healthcare IT recruitment, and technical industry news and trends.

Novocain Immunity and Meaningful Use: How prepared are patients and practitioners for 2014?

Can Meaningful Use eliminate the pain red tape causes?

If you talk to anyone in the medical community and say the words 'meaningful use,' chances are any clinician or physician will understand what you mean. What about patients? This is probably going to be the biggest change in the way doctors and patients interact on every level yet, if one were to coin the phrase 'meaningful use' in general public; the response would likely be something akin to a deer caught in the headlights.

Simply put, Meaningful Use is very important yet, no one knows about it.

The fact is that most patients have no idea that the days of going to this specialist and signing a release of these records to that other specialist and back on to your general practitioner are numbered. They have no idea that secure, instant messaging with your doctor, all of your doctors for that matter, is right around the corner. Meaningful Use Stage 2 goes into full effect in 2014.

I have a feeling some practitioners and HCO's would like to keep it that way. Because Meaningful Use is more patient focused and keeping them satisfied as a consumer is more important; practitioners without a good 'bedside manner' will have to develop one quickly.

You see, Meaningful Use completely revamps the way doctors and patients will communicate. On many levels, it makes physicians more accountable for getting the whole story and getting it right the first or second time. It all but eliminates the 'take two aspirin' syndrome when a patient comes in and hands over health records that clinically spell out what they often cannot verbalize. It allows for instant communication and eliminates the need for countless (and billable) follow up visits due to incomplete paperwork.

In other words, Meaningful Use will make healthcare more efficient for everybody, but only if doctors and HCO's are on board.

So where does Novocain immunity fit into all of this?

Upon joining Talascend, I relocated to Maryland: New doctors, new dentists, new everything. Shortly after moving and during a routine checkup, I found I needed a filling. There's only one small problem: I am immune to Novocain in regular, recommended doses. My old dentist knew how to keep my mouth numb. My new dentist didn't believe me. Three shots later and only about a 15 minute window to work with, she was a believer. The third shot wore off in the last 5 minutes and they couldn't give me more, so I had to deal with the pain while we were wrapping up.

Why bring it up? The whole conversation and disbelief would have been avoided if meaningful use were in full force. If I could have instantly requested my dental records from my old dentist in Upstate New York, not only would my new dentist have learned I wasn't full of hot air, but that my old dentist has figured out a way to keep my mouth numb so that work could be completed without rushing. Because of current HIPAA laws, I had to fill out paperwork; in person; in Upstate New York, to get my old dentist to share the process with my new one. Not even a phone call is considered legal without a signed document.

This plays out in nearly every medical office that has not participated in the first stage of Meaningful Use. There is so much waste to be eliminated through implementation. Doctors have instant access and can see more patients, or, spend more time with patients during a day. They can order a prescription for you right from their smart phone. Patients get the benefit of clarity when talking in a clinical setting. They also have something to back up their claims when going into a new physician's office right then and there: not while waiting for their paperwork to arrive.

As a Healthcare IT staffing professional, I know one thing is for certain: There will be a big rush in the next two years for HIT talent in order to become Meaningful Use compliant. Then again, it could go 'bust' because of lack of buy-in from physicians and HCO's; but I wouldn't count on it.

What do you think?

Mobile App Medicine: It's here. Are patients and providers ready?

Is medicine via smart phone alive and well?

Earlier this month, Healthcare IT News' Michelle McKnickle posted an article regarding five new mobile medical apps that improve doctor patient communication. Her case is pretty solid in that these apps do improve the flow of information and streamline a lot of what goes into a normal patient visit to the physician's office.

Medical and many other related apps have the potential to revolutionize the way healthcare providers and patients interact, with one small caveat: Only if doctors are willing to embrace the technology and use it.  

While the technology is here and constantly evolving (which in itself could be part of the adoption problem), there are several factors that could stall implementation into the healthcare consumer marketplace; the first and foremost of which is physicians themselves.

Doctors, especially some of the more established professionals are often not only technology averse, but actively untrusting of it. If it's not on a chart or recorded on a microcassette, it is not real, tangible information. These are the same professionals who are already cynical toward the Internet due to the fact that it allows people to self-diagnose and come into an exam with what they've already decided they have, and demand a prescription for the medicine they want (or one that has been best advertised).

I am not saying these professionals are wrong for holding these attitudes. A patient comes in convinced that they have thyroid cancer and it turns out, they need to drastically change their diet to feel better. The patient is meanwhile thinking of ways to expose the doctor for fraud because obviously, they know better. After all, it is their body.

What's my point?

Communication is the key. Also, that one to two hours waiting for an appointment that was supposed to start two and a half hours prior, could be a thing of the past if all of that paperwork could be handled ahead of time in the days leading to an appointment or with a 'bump' of  smart phone.

On the surface and in practice, mobile technology is a perfect fit for healthcare.

There is however, a distinct problem with regulation and implementation of this technology. The government is slow to move on regulation, and, the legal aspects of such implementation are often overwhelming for HCO's and private practices. These are doctors we're talking about, not lawyers. Shouldn't a doctor be thinking more about how to make you better or keep you well than worrying about malpractice and privacy breaches?  What's best for the patient in a 'common sense' sense is not always what is right legally.

Here's are some other points to ponder.

Doctors only get paid when you have a billable appointment with them.  In our instant access culture, with smart phones in our pockets, and Google effectively negating the entire futuristic feel and wonder of the Hitchhiker's Guide to the Galaxy, will doctors really be open to this technology? 

If they can share results with patients, potentially do follow ups through a quick instant survey instead of billable in-person visits, and share records and results instantly; will they be willing to give up the associated revenue simply to make their patients happier?  Will they even believe that it will make their patients happier? With so much of a patient's attitude toward a doctor having to do with bedside manner, does this type of technology strip away any of that patient doctor relationship?

Mobile apps provide the healthcare industry with a multitude of benefits. However, implementation will likely have to be a patient-pushed initiative, in a situation where there is no real call to action. Nobody is dying because this doesn’t exist and not even a thousand small puppies can be shown in an onslaught of commercials to pull our heart strings enough to mobilize and demand progress.

As a healthcare IT staffing professional, I have to remain on top of industry news and trends. I don’t see adoption of medical apps as part of mainstream medicine until the 'younger' generation, who has and is growing up with this technology, makes it part of their daily life at work in the ER and everyday practice.