Skip navigation

As mobile device and app makers focus their attention on improving user experience and workflow issues, healthcare organizations continue to strive for the best mix of technology suitable for the enterprise.


Having spent the past few years deploying apps to smartphones and managing end user demand for the more feature and information rich tablets, health IT professionals are finding there’s a process for choosing the best tablet for their increasingly mobile workforces.


At Louisville, Ky.-based All Children Pediatrics, for example, CIO J. Barron Breathitt tells me his top-two criteria for laptops and tablets are reliability and durability.


The physicians practice group is using Fujitsu T730s and T731s, which typically are outfitted with the fastest i7 processors available to extend the lifespan of the units. Breathitt also has them configured with solid state drives to boost performance and durability.


Since the doctors at All Children Pediatrics require the ability to ink on the screen for signing and noting issues on charts, IT’s approach to selecting mobile devices centers largely around user acceptance and meeting interdepartmental goals--two metrics that fall in line with recent industry guidance.


Recently, J. Gold Associates released a white paper entitled, Picking the Right Enterprise Tablet: Things to Consider. Among the practical steps healthcare organizations can take to match tablet choice with end user and corporate requirements, the research recommends adopting the following seven-step approach:


• Create a strategic vision. In other words, think proactively, not reactively.

• Look beyond the device. Better to focus on the solution.

• Define requirements. Start by determining your specific goals.

• Build an app portfolio.

• User acceptance is critical.

• Support users while planning for obsolesence.

• Determining technology/infrastructure requirements.


If you haven’t read it yet, I recommend checking it out here.


Tablets offer many advantages to mobile workforces, and the technology’s role in healthcare is clearly established and growing. Formulating a sound tablet strategy, based on analysis, is the best way to support the deployment and utilization of tablets across the healthcare enterprise.


Doing so will enable the technology to achieve its full potential while helping your organization cut costs, satisfy end users, and deliver a higher quality of care.


What questions do you have about tablets in health IT?


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent. See his other Intel Healthcare blog posts here.


Nurses are vital to the implementation and adoption of healthcare technology. In the above video conversation, Intel expert Joan Hankin, MSN, RN, sits down with Elizabeth "Betty" T. Jordan, DNSc, RNC, FAAN and Associate Professor University of South Florida College of Nursing, to discuss healthcare technology, how IT impacts patient care, and how generational attitudes shape health IT adoption.


Give a listen and hear what these two nurses have to say about healthcare IT. What questions to you have?

Below is the fifth in a series of guest posts from Nirav R. Shah, MD, MPH, the commissioner of health for the state of New York. Look for more of his blogs in the Intel Health & Life Sciences Community in the coming months.


You’re heading to the couch for a post-dinner nap when you get a text message asking if you’ve taken a walk today. You bypass the couch, lace up your sneakers and hit the nearby park for a 15-minute walk. 


For someone at risk for diabetes, that simple walk could be a lifesaver – and the key to preventing diabetes. A little exercise after a meal is often all it takes to usher glucose out of the bloodstream and into your cells, where it’s used up for energy. And the text reminder to take that walk? That could be just one of many new high-tech ways to prevent diabetes, perhaps even “prescribed” for you by your doctor and paid for by your health insurance.


The text app was the winning concept at New York State’s first-ever Health Data Code-a-thon, a 24-hour coding event staged by the New York State Department of Health at the EMPAC Theater on the Rensselaer Polytechnic Institute campus on Troy, N.Y. in December. The event was funded by a grant from the New York State Health Foundation, with additional support provided by Socrata.


Participants were invited to use health data to create applications that can help stem the state’s two biggest health challenges: diabetes and obesity. The code-a-thon was part of a larger event called NY Innovates, which brought together health and technology stakeholders for collaborations and conversations about software development tools and techniques.


The easy-to-use texting app, which was called Vera, won its creators -- Raymond Jacobson, Olufemi King and Ethan Bond -- the top prize of $6,000. Vera asks you to enter your age, height and weight, and then lets you know if you’re at risk for diabetes. If you are, you’ll receive text reminders to make smart food choices, exercise regularly and manage your blood glucose.


Second prize went to ActiveSideKicks, a mobile app that allows users to join groups anonymously or with friends and family, to track exercise and health stats with the support of group members. Third place was awarded to DOEFANI (Diabetes and Obesity Education using Franchise and Nutrition Information), a web app that helps users find restaurants in their area while providing nutritional information about the foods there and restaurant health inspection data.


The Code-a-thon is only the beginning. All three teams will have the chance to participate in the New York State Health Innovation Challenge in 2014. With any luck, these tools will be brought to market.


But for now, we’ve had the chance to see what can happen when tech savvy coders get their hands on health data. The possibilities are in a word, endless.


What questions do you have about health apps?

Mobile point-of-care has dramatically changed clinicians’ workflows. An additional benefit may be the impact on patients. Mobile technology has empowered patients and brought a renewed sense of involvement in their own care.


How clinicians and patients interact using mobile technology is in its infancy, according to one prominent physician. Andrew Watson, a chief medical information officer and the medical director for the Center of Connected Medicine at the University of Pittsburgh Medical Center, says a cultural shift is underway and that by using mobile technology patients can have access to care wherever they may be. Watch his video interview above to learn more.


What's your take on the direction of mobile health IT?

Below is a guest blog from Terri Kennedy, Director of Product Management at Allscripts.


In his keynote address at the Allscripts Client Experience (see video below), Dr. Rasu Shrestha from University of Pittsburgh Medical Center said, “He who tames the data wins.”


As healthcare organizations manage evolving delivery and payment models, an analytics strategy is top of mind for many. Big Data is the next frontier for analytics and offers them access to rich data they can use for population health, research and consumer marketing and satisfaction.


Quickly emerging Big Data technologies augment traditional business intelligence technologies by efficiently and affordably acquiring and storing enormous amounts of data. Providers can query and re-query information without retooling the data model every time. This capability is particularly important with the mountains of data we have access to today.


3 opportunities to get value from Big Data


With so much data coming from so many different places, how can healthcare providers tame Big Data? There are different opportunities, depending on the type of information:


1. Join the conversations happening on the Internet – Patients are posting status updates in Facebook, Twitter and other social media that give valuable information about their own health. They’re also talking about their experience with their hospitals and clinics.


Monitor these status updates to find out if patients are unhappy with wait times, how they were treated by staff, or overall condition of facilities. Chances are good that patients are “hash-tagging” your organization. Do you know what they are saying?


2. Mine clinical documentation for critical nuggets of information – Even with the heavy adoption of electronic health record (EHR) technology, a significant amount of clinical documentation is still unstructured. Clinical notes and reports hold valuable information that providers can use to better measure quality, support research and feed predictive models.


Use Big Data technology to manage volumes of unstructured documentation in various formats. If you apply text mining techniques, you can drive near real-time clinical decision support. You can also use predictive algorithms to help understand what might indicate an adverse event before it occurs.


3. Harness and analyze device data – Medical devices and smartphone applications are capturing a wealth of healthcare data that could easily become overwhelming. But think about the possibilities of capturing this data and applying analytics improve clinical interventions.


What if monitoring streaming device data in the hospital such as heart rate and respirations could feed predictive models for detecting sepsis? Or caregivers could monitor populations of diabetics using smartphone apps to report weight, glucose levels and blood pressure so that care teams can easily identify patients that may be trending out of control?


Health care is not lacking for data. But we must tame it to recognize its true value. Big Data technology and our partnership with Intel can help transform enormous amounts of data into insight that can ultimately result in better quality of care and more rapid interventions.


What do you think about health IT Big Data?


Below is a guest blog submission from Ashley Rodrigue, Healthcare Ambassador at Lenovo.


Without a doubt, technology has transformed how healthcare providers deliver care. Providers are increasingly using technology in the management and treatment of their patients, and this surge is a result of federal guidelines that were passed requiring hospitals to demonstrate “meaningful use” of electronic health records. And if certain criteria are met, providers are eligible to earn incentive payments.


We talk a lot about what technology is doing for providers, but what can it do for patients?  There’s growing appeal for technology to target end users, or patients, in addition to providers. In fact, providers and organizations are investing in technology that not only meets IT requirements, but patient requirements, as well.


Hospitals are starting to explore how technology, can improve the inpatient experience. Imagine you’re a patient. You walk through the doors of your hospital and when you check in, you’re handed a tablet – and it’s yours to use until you check out. A recent Wall Street Journal article discusses the variety of ways tablets are being used by inpatients. From the comfort of their beds, they can use their tablet to contact their doctor with questions, notify nurses if they need meds, access hospital paperwork that needs sign off, and turn the lights on and off in their room.


Tablets that are equipped with mobile point of sale (mPOS) solutions can even be used by patients to make secure electronic payments. With an easy swipe, they can order meals from the hospital cafeteria, a movie if they’re bored, access Facebook and Skype with family and friends.


By the time patients check out of the hospital, they leave having been more connected and engaged with their doctors, nurses and the management of their health. And it doesn’t have to stop there. Other healthcare environments – like ambulatory care and long term care facilities – can leverage tablets.


Patients can use a tablet to check into their appointment at an ambulatory care facility. If it’s a routine visit, they can check in, log in how they’re feeling, sign into their patient portal to review their medical history, access their co-pay information and sign off on relevant documents. And how about using a tablet to occupy your time as you’re sitting in the waiting room, waiting for your name to be called? Imagine having the opportunity to read your email, play a game, or check Facebook or Twitter to pass the time.


There’s also significant opportunity for tablets to be “leased” to long term care patients. It is estimated that the population of adults 65 years and older will expand to 72 million by 2030.1 As part of a home care preventative maintenance plan, or a long term care facility inpatient plan, a tablet equipped with what patients need, like apps, can make a significant difference to their health. For instance, just think how a grandparent can benefit from understanding how to video chat with their families that live far away or can’t visit all the time.


What do you think of this growing trend, and how tablets can improve the patient experience?


1 U.S. News & World Report. How Baby Boomers Will Change the Economy.

It used to be so simple.


A patient arrived at the office, the clinicians analyzed their problem, performed a service, and sent a bill. Next.


Even though I am wildly overstating the simplicity of fee for service (the method described above), at a very basic level it is pretty straightforward. The complexities primarily originate from the fact that we have over 1,000 health insurance companies each with slight variations (a single payer system would be a lot easier).


Even though fee for service (FFS) hardly seems simple, the future may be significantly more complex. We all know the reason: under the current system, which is dominated by FFS, the nation is approaching spending 20 percent of GDP on healthcare, an unsustainable level for individuals, companies and the country (on personal note, my premiums have doubled in the last five years—ouch.)


The one thread throughout all payment reforms schemes is an increased burden on providers and their organizations to deliver higher quality and lower cost care. This will require a significant transition in delivery models—the way medical work is done. More on that later. 


Here are some of the new payment modes on the near horizon.


Bundled Payments: instead of receiving a fee for each specific service, a bundled payment defines a flat fee that will be paid for a particular episode of care. Let’s say a patient is diagnosed with congestive heart failure or needs a new knee, under bundled payments a fee would be calculated for the diagnosis and then divvied out to the various providers that care for the patient. To prevent underutilization of services, quality measures are attached to payment. To prevent over-utilization, the fee is fixed and may specifically define what is allowed for a patient with a particular episode—anything above that will not be paid. It encourages coordination because all providers are on the hook for achieving desired outcomes. Although the details of this approach are daunting for any organization that has not fully integrated hospital, primary care, and specialty services, it does get the incentives right. If providers are getting a fixed fee and are judged on outcomes, the incentive is for efficient, high quality care. The devil is in the details which will mean some pretty sophisticated IT to operationalize it.


Modified Capitation: under a capitated plan providers receive a flat monthly fee for every member that is assigned to them. Version 1.0 of capitation got a black eye because of the overzealousness of some plans in restricting care as a means of controlling costs. In the new iteration of capitation, quality performance measures have been added so that plans and providers are incentivized to keep care standards high as well as keeping costs low. Patients are risk-adjusted (with an associated modification of fees), so that providers are not punished for having an unhealthy panel. I love the basic simplicity of capitation (like all of these systems, the under the hood details are brutal) and it can be lucrative for practices that perfect the model. Since providers are taking risk, they have strong incentives to keep people healthy. It does favor integrated delivery systems or medical homes that are actively coordinating care across settings. The challenges: collecting and managing to quality metrics and dealing with difficult, non-compliant, chronically ill patients. 


Hybrid Models: Some schemes will blend fee for service plus either rewards, penalties or supplemental fees to drive the right behavior. Example: providers that transition to a patient centered medical home (PCHM) may be eligible for monthly per member care coordination fee. This is a great idea since a huge hunk of medical costs are driven by individuals with chronic illnesses bouncing through the health care system. A fundamental principle of medical homes is help the chronically ill navigate this maze more effectively and with better outcomes. Physicians on FFS that are part of larger group or ACO (accountable care organization) may be able to participate in gain sharing in which bonuses are provided based on the ability of the group to achieve annual cost savings while meeting specified quality metrics.


Whatever ends up sticking, provider organizations will have to adopt their operations to fit the payment model. ACOs and the Patient Centered Medical Home (for primary care) are the two most prominent examples of modified delivery systems built to fit the new payment models.


Where are we now in payment reform? Still very early in the transition. Advocacy group Catalyst for Payment Reform recently reported that only about 11 percent of medical payments are outcome or value based. Report is here.


Since we are now in period of experimentation with new payment models, it is premature to predict what methodology will prevail; over the next five years there will be detailed analyses of pilot projects using these systems to see what works and what doesn’t. One thing is certain: the existing system will not stay the same.


What do you see coming down the road for healthcare payment reform?


Bruce Kleaveland is President of Kleaveland Consulting and a sponsored health IT correspondent for Intel

I have been going to the mHealth Summit for the past four years. As much as the mHealth industry is progressive and dynamic, it is also in some ways very slow to develop as many of the discussions and keynotes from this year were not altogether different from those of four years ago.


However, I do see progress and I’m optimistic about the positive impact mHealth will eventually have. Here are three developments that I find encouraging:


1.) Doctor Prescription of Apps. According to PC Magazine(1), doctors are now starting to prescribe mobile apps. Some of the top prescribed apps mentioned included:


• Allergist- four-day pollen forecast

• Cardiologist- Smoking cessation support

• Dentist- tooth brushing education

• Dermatologist- mole tracking

• Obgyn- Pregnancy education and social support

• Pediatrician- activity tracking

• Nutritionist- glucose trending


I can envision additional Apps that enable consumers to take a more proactive approach to their health (e.g., quality of sleep tracking and education).  Are there other Apps that you would consider using if your doctor prescribed it?


2.) Patient Engagement. In the U.S., several of the Meaningful Use capabilities that are being incentivized from the HHS HITECH Act promote mHealth for patient engagement. These include:


• Patient ability to view online, download electronic copies of their health information and clinical summaries

• Patient reminders for preventive/ follow-up care

• Patient-specific education resources

• Electronic messaging to communicate between patients and care providers

• Access to self-management tools


Mobile devices will make it easier to use these capabilities and should result in better informed, engaged consumers. If these capabilities were available now from your Provider, would you take advantage of them?


3.) Proven Results. There have been many trials and implementations with positive outcome indicators as follows:


• 30 percent reduction in medication errors (2)

• 50 percent reduction in wait time (ER, admission, transport) (3)

• 85 percent faster to transact admission, discharge, and transfer changes (4)


Driving costs down will continue to be a high priority for care centers and proven ROI savings from mHealth implementations are important to increase adoption.


The mHealth initiative is moving forward and will inevitably impact our lives and change the way we approach our health.  While the market is not transforming as fast as some anticipated, there is no denying that we are making progress.  I’m encouraged by the developments discussed above and am looking forward to what is to come in the future.


What are your thoughts on mHealth advancement?




2) Wireless at El Camino Hospital, California

3) St. Luke’s Episcopal Hospital, Houston, Texas

4) RFID at St. Vincent’s Hospital, Alabama

As the healthcare industry transitions from fee-for-service to fee-for-value, and to team-based care models that require a high degree of care coordination (such as PCMH), a more holistic, 360 degree view of the patient is needed. Over time, this patient view will be built not only from traditional data types such as claims data and healthcare data (e.g. from the EHR), but also non-traditional data types such as patient or member sentiment data from social networks. So what new approaches are needed to respond to this changing data landscape?


Organizations need to be able to apply analytics to Big Data; data from varied repositories that exist structured, semi-structured and unstructured form.  Solutions that enable this need to be high performance, horizontally scalable, and balanced across compute, network and storage domains (e.g. to mitigate impact of I/O bottlenecks). High-performance analytics software, with capabilities such as natural language processing, machine learning, and rich visualization also enable these Big Data solutions. 


Innovative Payers and Providers are pursing these solutions to improve the user experience for their patients and members, better market produces and improve outreach to encourage healthy lifestyles. Take a look at this paper to learn what Blue Cross Blue Shield of North Carolina and Carolinas HealthCare System are doing in these areas.


The paper also describes 5 steps for getting started with Big Data:


1. Work with business units to articulate opportunities

2. Get up to speed on technology

3. Develop use cases

4. Identify gaps between current and future state capabilities

5. Develop a test environment


Payment reform and care models that foster a patient-centric approach have the potential to transform healthcare.  Analytics solutions that break down traditional data silos to develop a complete view of the patient, enable effective outreach programs, and promote collaboration across the continuum of care will be the technical foundation of this transformation.


Are any of you deploying Big Data or advanced analytics solutions in your organizations? Please feel free to share your observations and experiences below.  You can follow me on Twitter @CGoughPDX.

For the past four years, I’ve watched thousands of health and technology influencers, developers, policy makers, business leaders, and others pack themselves into the mHealth Summit for a glimpse at the latest in mobile and wireless health technology. And why not? It’s a good time, and the policy changes, apps launches, and new comers to the field are always worth noting.


But this year, as we head into the 5th Annual mHealth Summit, I’m looking beyond the 300 exhibitors and 450 speakers—I’m following the money to the most promising new mHealth tech.


What choice do I have? Last quarter, as reported by CB Insights, venture capital investors deployed some $1.2 billion to U.S. mobile-related companies, making Q3 2013 the wildest VC financing quarter in history for the Mobile & Telecom sector.


Health IT overall drew $2 billion in funding this year, according to a Healthcare IT News report, but if you look at VC deal volume in mobile, the Health & Wellness sub-industry barely registered in Q3. So, yes, investment dollars are flowing to mHealth, but my take is that, despite the boom, we’re just getting started. That’s likely to be good news for mHealth entrepreneurs as they continue to bring their own innovations to market, and the money works its way deeper into the health niche.


Although VC funding is hardly the end-all-be-all for tech entrepreneurs—and somewhat less relevant to healthcare CIOs—financing trends obviously play an important role in the growth and evolution of mHealth. To the extent that new mobile and wireless devices (and apps) will need to be added, integrated, and supported by health IT professionals, these funding trends could prove very relevant to CIOs indeed.


That’s why one of the presentations I’m most interested in this year is the Venture+ Forum.


Keynoted by Qualcomm Life Fund’s director Jack Young—an electrical engineer and former EVP with the world’s fourth largest mobile phone manufacturer (ZTE)—this session should be eye-opening.


Young, who has questioned the sustainability of current funding trends, believes digital health is at a crossroads. Among other things, he’s planning to talk about the viability of today's boom in mHealth funding, and where investment dollars might trend over the coming years.


Personally, I welcome input from Young and others on this topic, as the industry prepares for the next wave of mHealth technologies that promise to span everything from mobile-clinical integration platforms, to personal genomics, to clinical research technologies.


The Venture+ Forum also will review presentations from 11 mHealth startups, which is always fun and inspiring. So, whether you have a mobile solution on the market, in the works—or you’re just wondering how the next wave of mHealth offerings will impact workflows—there should be some actionable information coming out of the Venture+ Forum. Hope to see you there!


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.

The 2013 mHealth Summit is coming up next week and will feature a tremendous lineup of sessions and exhibitors all focused on mobile health IT. Below is a guest blog from Ken Jarvis, Director, Health & Life Sciences Industries, Americas Region at HP.


In the lead up to the fifth annual mHealth Summit next week, HP is working with Intel to highlight how clinician mobility is transforming patient care and access to data capturing. As the vision of mobility in healthcare becomes reality, we are seeing a transformational shift in the way health is managed and care is delivered. Mobile health technology gives healthcare providers the power to offer care at the right time and place.


The use of mobile devices has the potential to save time, enhance accuracy and improve bedside attention. Tablet PCs, notebook PCs, mobile workstations and mobile thin clients give hospitals the option to choose the product, or combination of products, that best suit their needs. Companies like HP aren’t just offering options in devices, but rather an opportunity for change, which can help providers create better experiences for patients during their medical stay.


For example, physicians use tablet PCs like the HP ElitePad 900 to be more efficient and accurate in their day-to-day activities. With remote access to medical records, the physician is able to have productive face-to-face interactions with patients by providing them with personalized healthcare information in real-time. The physician can also use the tablet to capture patient information digitally in the moment so detailed information can be created and retained faster and more efficiently. For practices that want to streamline processes, windows-based tablet PCs are a smart choice as they can run the same programs available on their existing desktop PCs.


Next week, we’ll be on the mHealth show floor at Intel’s booth #1311. HP’s mobile portfolio will be on display including the HP ElitePad 900, HP EliteBook Revolve and HP EliteBook Folio. For more on what you can do to improve your mobile strategy, HP’s Ken Jarvis will be speaking in his session on the general stage on Monday December 9 at 2:45 p.m. about Creating a Secure, Effective and Popular BYOD Policy.


Learning objectives in this session will include:

• Enablers and inhibitors to an effective BYOD policy

• Current and future landscape of BYOD

• Tips from practitioner experiences on how to develop an IT strategy and foundation for an expected surge in clinicians’ adoption of BYOD


What questions do you have? If you will be at the event stop by the Intel booth #1311 and say hello.

Below is a guest blog from Alice Borrelli, director of Global Healthcare Policy for Intel.


During today’s forum, hosted by Intel Corporation, The Aspen Institute and Bipartisan Policy Center, we will discuss how the promise of technology solving society’s complex goals will rely, in part, on how we manage the information explosion. And, nowhere is the challenge more evident than in personalized medicine where the human genome consists of 3 billion DNA based pairs. Intel and our partners are compressing processing time for genome sequencing to accelerate targeted and personalized medicine.


In a new policy paper -- Compute for Personalized Medicine -- Intel gives seven policy recommendations that will accelerate the usage of this critically important health information. We invite policy makers to join us in the quest to make genomics information accessible and clinically useful by considering the following recommendations:


1. Share the Data: Create and ensure the interoperability of technical standards for managing and sharing sequenced data in research and clinical samples.

2. Show me the Evidence: Determine clear guidelines for data sharing from clinical trials.

3. Streamline privacy regulations: Harmonize existing privacy laws to protect patient data while offering a pathway to maximizing the research data available today.

4. Show me the Money: Provide reimbursement models for clinical use of genomics and predictive modeling.

5. Clarify the Regulations : Provide guidance to reduce the regulatory overlap between CMS and FDA.

6. Protect My Predictions: Ensure that current genomic privacy laws provide adequate coverage for non-discrimination.

7. Bring it Now: Integrate the scientific discoveries into everyday clinical usage.


What questions do you have?

I recently joined a panel of learned colleagues working in public health, telemedicine and acute care at an Institute of Medicine (IOM) forum focusing on the state of our nation’s healthcare system relating to population health and emergency preparedness and response due to natural disaster or other factors.


Along with seeking programmatic opportunities within the Affordable Care Act (ACA), I was asked to represent the view of the healthcare information technology sector on ways to advance resilience through technology that keeps the focus on the patient.


Doing so means establishing an infrastructure around current national standards (such as Direct & C-CDA) for data exchange and readable content, as well as increasingly open architectures around application programming interfaces (APIs) that expand integration with emergency response departments, responders, hospital EDs and HIEs, along with the current integration of electronic health records.


The expansion of patient portals, personal health records and cloud technology must also keep pace with available standards such as Blue Button, along with the ability for providers to utilize mobile EHR innovations to access these standard and readable patient records. After all, hospitals and practices are not immune to disaster, as the nation experienced certainly with Hurricane Katrina and most recently during Hurricane Sandy.


Also, a national patient identifier strategy is equally crucial to develop, one that can link the needed clinical information to the right displaced patient.


Both the American Recovery and Reinvestment Act (ARRA, 2009) and ACA provide the means to put this infrastructure in place, and in fact such networks are already taking shape. The ACA’s Health Center Controlled Networks fund was primarily focused on EHR and meaningful use adoption in the front lines, and provides the opportunity for resiliency expansion.


ARRA’s HIE Cooperative Agreement Program seeded state and regional HIEs, from which a debut collaboration this year of 10 HIEs has formed under the name SERCH, specifically to manage emergency response using vetted exchange standards, all while some individual state HIEs are expanding linkage to include EMS and fire departments.


And yes, taking a measured, national and analytical approach to resilient, technology-driven strategies is a best practice for achieving best practices in the field. Here too, ACA can be leveraged through a pair of well-funded and important programs, the Patient Centered Outcomes Research Institute (PCORI) and the Prevention and Public Health Fund, where respectively analysis and additional research options for emergency healthcare and IT exist, and where implementation can follow.


And finally, it’s again not just emergency response, but also preparedness, where for example outbreak surveillance, immunizations and registries have long been a national goal. Here there are new and existing collaborations between ONC, CDC and EHR developers that can be further integrated.


Right now the opportunities far outweigh the barriers toward establishing a coordinated national approach to population health when we may need it most, and it’s important to continue this discussion as the health IT industry itself continues to mature.


See the IOM panel presentation slides here.


Justin Barnes is a vice president with Greenway Medical Technologies, chairman emeritus of the national Electronic Health Record Association (EHR Association), co-chair of the Accountable Care Community of Practice (ACCoP) and a board member of the CommonWell Health Alliance.

To fully realize the benefits of personalized medicine while avoiding negative impacts such as breaches, we must minimize the associated privacy and security risks. Personal information, including a patients genetic data, used to support personalized information is considered sensitive information, and is regulated in the US by the Genetic Information Non-Discrimination Act (GINA) and the HIPAA Privacy Rule. This prevents abuse of this information, for example for discrimination based on genetic information for employment or health coverage, or breaches.


A best practice in identifying and mitigating such risks is to follow the sensitive information through its lifecycle, identifying and assessing risks, and implementing safeguards to mitigate at each stage. In previous blogs we discussed the collection, use, retention, and disclosure stages. In this blog I’ll focus on the disposal stage. This last stage is often overlooked in privacy and security risk assessments, and can be the source of security incidents such as breaches. Several examples of breaches resulting from improper disposal of protected health information can be seen on the HSS Breaches Affecting 500 or More Individuals, by searching on “disposal.”


More examples can be found globally, for example in Britain: Buy A Computer On eBay, Find Sensitive Health-Care Records!, where computers containing sensitive patient health information (that as not properly disposed of) were sold on eBay. As we can see from this last reference, impacts of such breaches can easily run into several hundreds of thousands of US dollars. In fact, the impact of such breaches can even run into millions of dollars as reflected by the Ponemon 2013 Cost of a Data Breach Study which found that in the US breaches on average cost US $5.4 million.


In order to minimize these kinds of risks, a best practice is to securely dispose of patient information used for personalized medicine when it is no longer required for the purpose to which the patient has consented, and is outside of any regulatory/legally or policy imposed mandatory retention periods. Disposal could also be explicitly requested by a patient. In this case the healthcare organization should inform the patient of the benefits of retaining their information, for example to ensure the completeness of their longitudenal patient record. However, in the event that the patient record must be securely disposed of, the last thing a healthcare covered entity or data controller wants is to have a breach and then have it further exacerbated by the scope of the breach include patient information they should no longer have.


To accomplish secure disposal, all of the sensitive data for a given patient, throughout the personalized medicine process needs to be securely disposed of. It is helpful to review some of the key data records created in personalized medicine process.


This starts with blood or saliva samples taken from patients, then the raw genetic data produced from sequencing the DNA in these samples. A variance file is then produced from the raw genetic data, in comparison with baseline genetic data, to produce a variance file highlighting specific variations in the patient genetics from the norm. Lastly a risk factors report is produced from the variance file that identifies patient propensities to specific traits such as diseases, and pharmacogenetics or the efficacy or toxicity of specific medicines to the patient based on their genetics. We also need to consider any personal information in backups, archives, or offsite for example to support business continuity/disaster recovery.


Any information shared with third parties, known as Business Associates in the US, or data processors in Europe, should also be securely disposed of. Disposal methods can range from incinerating samples, to shredding paper records, to secure wipe of storage media, physical destruction of hardware devices, encrypting and securely disposing of the key, and so forth. In the case of backups and archives it may not be practical to delete a specific record. However, in such cases if the patient record is disposed of in the online tier 1 storage, eventually within a set time period as backups / archives reach end of life, for example after 6 months, the deletion of the patient record will effectively propagate to those backups/archives as well.


There are several places a patients personal information can hide to make this job even tougher. An example is caches, for example in web applications, proxies, performance caches and so forth. Another example is the patients personal health information exchanged with other healthcare organizations through health information exchanges. Fortunately, once exchanged through such HIE’s the patient information retained by another healthcare organization is subject to their regulatory compliance.


Unfortunately for the patient this may mean that they need to go to the various independent entities holding their information and explicitly request disposal of their information if their goal is deletion of their record more broadly than a single healthcare organization. As healthcare workers are increasingly empowered with more devices, apps, online services, and also wearables and Internet of Things, the risk of sensitive patient personal information being retained or transmitted in places or ways that it should not be, increase considerably. Examples today can be seen in Workarounds in Healthcare, a Risky Trend, driven by healthcare workers use of workarounds. DLP (Data Loss Prevention) can be an effective tool in discovering such personal information at rest or in transit, enabling a healthcare organization to securely dispose of it or move it somewhere more secure as needed.


Lastly, but not least, one should keep a good audit log of such disposal activities, to enable effective audit and compliance and implementation of policy, as well as demonstrate due diligence should you ever need to in the event of a breach.


What kinds of challenges are you seeing with securely disposing of health information used for personalized medicine?

Remember when the iPad arrived on the healthcare scene? As a non-enterprise device, it snuck in the back door—often in doctors’ pockets—and redefined user expectations in the process. Health IT professionals hated the idea at the time, but they slowly came around to it as Apple added basic enterprise features and let third-parties add incremental support. Of course, that was back when healthcare organizations had few viable alternatives to the iPad. Times have changed.


When I reached out to CIOs for a sense of their familiarity with some of the extreme low power Windows tablets that are coming to market, I was surprised to find that many, if not most, weren’t very familiar with them at all. But there is a sense of growing interest at healthcare organizations of all sizes.


J. Barron Breathitt, CIO at Louisville, Ky.-based All Children Pediatrics, is among those concerned with power consumption and battery life. The 57-employee physician’s practice group, which is in the process of merging two offices, upgrading its servers, and moving to a virtualized environment, currently runs on upgraded Fujitsu T730s and T731s. Right now, he’s sizing up the T734, which has the Haswell chipset, uses less power, and extends battery run time.


“It makes sense for us because our physicians require the ability to ink on the screen for signing and noting issues on charts,” Breathitt says. “They also use iPads when working remotely.”


Healthcare CIOs across the board—especially those looking to standardize away from the iPad—might want to check out the latest offerings from vendors like Dell, HP, and Lenovo.  With the combination of Intel Clover Trail and Windows* 8, devices such as the Dell Latitude 10, the HP ElitePad 900, and the Lenovo ThinkPad Tablet 2 are blending the best consumer elements of the iPad with the enterprise features that HIT professionals wants in their next generation tablets.


For starters, the new breed of enterprise tablets’ base battery life is competitive and can be configured to last twice as long as the iPad 4. They also deliver both more baseline expandability and additional expandability, with optional manufacturer-supported accessories. Plus, they offer the same PC enterprise features already deployed and in use at healthcare organizations.


These extreme low power Windows tablets also support touch-based scenarios with known IDE, while supporting backward compatibility with legacy peripherals and software. That’s a significant advantage over iPad, which requires new apps be written with new IDEs and don’t support legacy OSX apps and hardware.


When you factor in the cost of additional management tools, iPads are just more expensive. For a detailed breakdown of the latest tablets, check out a new report from Moor Insights & Strategy, entitled The Latest Extreme Low Power, Windows Tablets Now Ready for the Enterprise.


As a B2B journalist, John Farrell has covered healthcare IT since 1997 and is Intel’s sponsored correspondent.