‘Skype on steroids:’ iPads battle healthcare costs

I recently attended a healthcare summit near Washington, D.C. that included a segment on telehealth. The use of iPads and other tablets in healthcare has been a growing trend and all over the country, hospitals and agencies have been experimenting with this technology to solve problems.

Tara Courtland

Communications Director Tara Courtland

Dr. Katherine Wibberly, director of the Mid-Atlantic Telehealth Resource Center, recently explained the use of tablets in taking healthcare on the road.

Wibberly referred to telehealth as “Skype on steroids” and said the technology will allow all types of medical equipment and tests to be performed remotely, from heart monitoring to diabetes testing to weight monitoring.

It also has promising implications for stroke patients. An ambulance crew equipped with tablets can start processing the patient while en route to the hospital, saving minutes that are vital when a patient has had a stroke.

But it’s not all lifesaving moments. The most widespread use of telehealth will be in saving time and money on routine matters.

Wibberly gave the example of a child at school who goes to the nurse’s office with an earache. Currently, the nurse calls the child’s parent, who leaves work, drives to the school, picks the child up and takes him to the doctor’s office. The doctor looks in the child’s ear, diagnoses an ear infection, calls in a prescription and tells the parent that the child can return to school.

But by that time, both the parent and child have missed most of the day.

Instead, a telehealth-enabled tablet would allow the nurse to check the child’s ear and send the images directly to the doctor. The doctor would then make the diagnosis remotely and call in the prescription. The parent could pick up the prescription on the way home and no one need miss school or work.

That same kind of remote diagnosis is already being used by ambulance crews to keep non-critical cases out of the emergency room.

Earlier this year, a story on NPR detailed a program in Houston where ambulance crews are using telehealth and taxis to help patients who are ill but not critical to avoid the ER. Ambulance crews there are equipped with tablets and when someone calls 9-1-1 for a medical issue that doesn’t seem to require the emergency room, the EMTs call in a doctor via video chat, just to be sure. The doctor can then talk to the patient and make a preliminary diagnosis remotely. But it doesn’t stop there — the doctor also sets the caller up with a clinic appointment for the next morning. And sends a taxi over to pick them up and return them home — for free.

Houston’s pilot program costs more than $1 million a year to run and it’s being paid for with city money plus grants, including one from the Medicaid program.

But the city spends far more than that each year in ER visits that could have been handled by a primary care physician. Officials estimate using video chat plus free taxis and clinic visits will save more than $2 million a year.

We’ve spent years talking about the growing cost of healthcare and the seemingly insurmountable political obstacles that prevent a solution. How ironic that Apple may end up solving the problem using the same platform we use for playing Candy Crush.

For more information on the Mid-Atlantic Telehealth Resource Center and a list of telehealth providers in the region, visit www.matrc.org.

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Interoperability – easier said than done

Interoperability, one of the key themes at HIMSS in April, is the next frontier for healthcare organizations once the ICD-10 hurdle is vaulted. That’s easier said than done.

NEMT CEO Linda Sullivan

NEMT had a recent experience of attempting to disconnect a series of servers and create new connections when moving from one collocation site to another. It took more than one attempt creating planned downtime twice.

Planned or not, downtime is not something that is acceptable for more than a short, rigorously planned period of time. Several staff members have significantly more gray hair after the experience.

Analogous to this experience is the attempt for healthcare systems to achieve interoperability. The number of systems that are now operating inside of even small healthcare facilities is mind-boggling. Moving beyond the obstacle of vendors not playing nicely in the sandbox to the fact that there are so many systems, so many different connections, so many interfaces, interoperability may turn out to be the biggest challenge healthcare facilities have faced to-date.

And the pressure is mounting via numerous requirements in Stage 2 meaningful use criteria in the electronic health records incentive program.

In June of this year, AHIMA and Integrating the Healthcare Enterprise (IHE) released a white paper encouraging HIM participation in interoperability efforts. According to the report “IHE provides a forum for care providers, HIT experts and other stakeholders in several clinical and operational domains to reach consensus on standards-based solutions to critical interoperability issues.”

It’s an important step on the road to improved and safe universal access to patient health information. It’s worth reading — take a look: AHIMA-IHE White Paper June 2015.

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Protect your computer — from your family

With the summer in full swing and summer holidays here, I started thinking about those of you who work from home. These days, most facilities either have work-at-home staff or have given staff members the ability to do so. It is important to realize that the luxury of working from home brings with it an additional level of responsibility.

NEMT President Linda Allard

Do you have an office with a door that locks? How do you handle house guests who want to use your computer to check email or Facebook? Do you log out of programs that access PHI when you leave your office?

These are a few of the things you need to think about if you work from home. You also need to make sure that your computers are password protected, and you should not share passwords with others. Passwords should not be written down on sticky notes attached to your computer or placed in any other visible or easily accessible location.

Working at home and logging into a system that stores PHI means that you are accessing protected information just like you would if you worked inside the facility. If you have any kind of papers that you bring home to work on or papers that you print out using your home printer, those items need to be shredded or returned to the facility for destruction, depending on your facility’s policies.

Is your home computer encrypted? Remember that vacation you might be going on? Make sure that your computer is protected in case it’s lost or stolen. If you listen to PHI and you have guests, you should be using a headset. Just like in a facility where you should not be discussing patient data on an elevator, you should not talk out loud about it at home where others can here you.

It really doesn’t take much to make your home office HIPAA compliant, but you do need to think about it. With summer here, what better time is there to do it than when you can go outside after a day at work and enjoy the beautiful weather?

Happy summer!

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Don’t curse the darkness

I was recently made aware of an email that’s going around warning people that their free flashlight app is stealing their personal data (banking information, photos, videos, etc) and sending it to cybercriminals in India, China, and Russia.  I found this information hard to believe, so I did a bit of research.

Andrew Clarke

First I looked at a video of the news report that apparently started this whole thing.  It involved someone from a cyber security company being interviewed.  What immediately jumped out at me, although he did not make it clear, was the fact that the apps being discussed were primarily those available for download for Android phones.  As far as I can tell, the built-in flashlight in your iPhone seems to be safe.  Android apps might prove to be more susceptible to exploitation because apps for Android phones, unlike apps for iPhones, can be obtained from multiple sources. Apple tightly controls which apps can be installed on the devices they manufacture.  If an Android user wants to install an app obtained outside of the Play Store, all he or she has to do is change a security setting allowing this activity.  No such setting exists on the iPhone.  He also didn’t mention that any app, not just free flashlight apps, could be used in such a manner.

All apps can request permission to certain parts of your phone (photos, address book, etc).  A lot of apps request access when it makes no sense.  For example, it makes sense that a wifi phone app would ask for access to your contacts.  Why would a flashlight app need such access?  That being said, just because the access is requested doesn’t mean it’s being used for some criminal purpose.  As pointed out by the writer of a Snopes article on the subject (www.snopes.com/computer/internet/flashlight.asp), if you’re using a free app it is entirely possible that information about you is being collected and sold for marketing purposes.

Before you think that iPhone apps are immune to such use, you need to make sure you pay attention to what permissions are being given to those apps as well.  The iPhone maintains this information in the Privacy area of its settings.  There you can deny or grant access to various information stored on your phone.

This  is a good place to remind you to turn off location services for your camera if it’s on.  Such access allows “the bad guys” to figure out where each of your pictures was taken.  If you post pictures on Facebook, such information can allow criminals to know when you’re on vacation, where you go to school, where your kids go to school, etc.  Programs exist that allow anyone to figure out your daily routine by using the pictures you post.

No matter what type of phone you have, you need to pay attention to the access being granted to any apps you install, free or otherwise.  As such, it’s best to have the smallest number of apps installed.  In this case, less is more … more secure, that is.

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GOP wins the Obamacare jackpot

The Supreme Court upheld Obamacare last week, handing a major win to Republicans.

It’s not a typo. The biggest winner in the Affordable Care Act ruling was the Republican Party, which dodged a bullet and picked up a golden opportunity all at the same time.

Tara Courtland

Communications Director Tara Courtland

How does that work? Like this:

Had the justices overturned Obamacare, millions of currently insured people would have lost their coverage. The Republicans, in control of both houses of Congress, would then be under tremendous pressure to do something; pressure increased by Democrats as an election year looms in the not-too-distant future.

Republicans, of course, don’t want to do anything. Healthcare reform is a political quagmire that was a messy, unpleasant and politically damaging business when it was passed the first time. Since then, it’s only gotten more politically dangerous so any politician tasked with fixing or changing it now is looking at political suicide.

Republicans are more than happy not to have found themselves in that position, facing millions of angry, suddenly-uninsured voters while being pushed by vocal Democrats reminding the public that it’s all their fault and all their responsibility to fix it, and at the same time, being monitored by their base threatening excommunication to anyone who compromises or strays from the conservative orthodoxy.

“Political disaster” would be putting it mildly.

But the GOP didn’t just avoid a bad situation – they’re also getting the chance to spin straw into gold.
The Supreme Court ruling means the Republicans don’t have to do anything AND they can complain about it. As the presidential election nears, they can use Obamacare in their campaign literature, in their ads and in their debates. They can rail against a hated program that they now have no chance of overturning — and as overturning it would mean they’d have to come up with a different solution, they are now safely in the heckler seats. They can throw rocks without being responsible for any alternatives. Even better, they can point out the importance of the presidential election in Supreme Court politics.

“You see?” the argument goes, “This is why you must elect a Republican for president — to ensure that the next few Supreme Court justices are chosen by a president who opposes such travesties as Obamacare!”

This is not just a Republican strategy thought up by cold-blooded (or right-thinking, depending on your point of view) GOP politicians. This is standard political science. In similar positions, Democrats have done the same things. In 2010 and 2011, for instance, Democrats were hit by a series of staggering losses on abortion and birth control. They spun it into gold by parlaying the losses into a brilliant series of campaign pieces painting Republicans as Haters Of Women just in time for the 2012 presidential election.

It worked well. And it’ll work well when Republicans use the same strategy in 2016 to springboard from an Obamacare loss toward an electoral victory.

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