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ADVANCE Perspectives: Healthcare Information Professionals

Don’t Be Played for a Health Information Fool
April 27, 2016 2:05 PM by ADVANCE Perspectives

By Tamer Abouras                                                                                          

 

Try as we might, it’s very difficult to resist running to stereotypes. At some point — perhaps carelessly or unwittingly — we all succumb to lazy generalizations based upon little (if any) empirical evidence.

 

It’s human and even in the instances where a stereotype is broadly correct, the idea behind avoiding them is largely to help avoid entering a situation prejudiced or lacking in objectivity. If you naturally assumed all college students were glued to their smartphones and incapable of holding an in-person conversation, for instance, you might be a little flummoxed if one did.

 

Still, inasmuch as you don’t want to go ahead and designate all southerners as lovers of country music or all Californians as instinctively laidback, the results of data-gathering such as surveys and polls are that they help increase our understanding about particular groups. So if someone were to tell you that people with lower literacy levels were more likely to obtain their health information from commercial sites several levels below a peer-reviewed journal, would you be all that surprised?

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According to findings published in the ARC Journal of Urology from researchers at Loyola Medicine and Loyola University Chicago Stritch School of Medicine, you shouldn’t be — but the degree to which these less educated and less literate people are being mislead may be worse than imagined.

 

A EurekAlert! press release about the article, entitled “The influence of literacy and education on online health information seeking behavior in cancer patients,"  stated that, “Researchers conducted a prospective study of 27 patients who were newly diagnosed with urologic cancer such as cancer of the bladder, kidney, prostate or testicles. Patients were asked to do an internet search about their cancer, and the computer was equipped with software that tracked their activity. Participants also took a literacy test and were asked about their education.”

 

"These findings should encourage physicians to guide patients towards appropriate high quality websites, particularly patients with low literacy and/or education levels," senior author Gopal N. Gupta, MD and colleagues wrote in the article.

 

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And what were those findings? See for yourself:

 

·         17 patients sought information from advertisement websites. Of those, 71% had below-average literacy scores

·         10 patients sought information on non-advertisement websites. Of those, 80% had above-average literacy scores

·         Of the websites visited by those with a high school education, 32.9% were advertisements

·         Among patients with at least a bachelor's degree, only 12.7% of the visited websites were advertisements

 

So there are plenty of causes for concern, just in terms of how many people lack college degrees, but here’s something a little more worrisome that the study bears out: The National Adult Literacy Survey estimates that as many as 50 million Americans have marginal literacy skills.

 

In a day and age where health misinformation runs rampant throughout the internet and can be packaged as new therapy or alternative forms of treatment, Gupta and his colleagues wrote that the study’s findings put an extra onus on medical professionals to fully inform patients and direct them to accurate, reliable sources of information.

 

“Clinicians need to be mindful of the variability in literacy and education of their patients in order to guide their patients towards balanced and reputable online health information sources," the researchers concluded.”

 

In the meantime, borrow one journalistic tip if you find yourself confronted by a “can’t believe it’s true” sort of health fact before subscribing to it: triple-check your sources.

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Highly Evolved
April 14, 2016 1:38 PM by ADVANCE Perspectives

By Marie Miguel

 

Healthcare has truly evolved and the medications and sophisticated machines currently present in hospitals are clear indications of this. Thanks in large part to new inventions that have made a huge impact to how medicine is practiced, patient care has improved dramatically in recent years. High-tech machines and gadgets for healthcare are no longer figments of the imagination, but are regularly finding new treatments for diseases, as well as diagnosing and recording patient information with ease.

 

New technology is now being used to create a standard health record for patients in the form of electronic health records (EHRs). EHRs enhance communication and collaboration between health practitioners, thereby promoting patient care. All information including previous medications, test and examinations, family health history and current health of the patients are stored in EHRs, serving as a point of reference to avoid repeated exams, missed information or misinformation.

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One of the biggest of innovations of the last year have been new types of EHR devices, such as wearables and biosensors, which allow for more control of your own health. Jawbone, for example, is a type of fitness wearable that has features for sleep monitoring, step tracking and a heart rate checker. Wearables are very useful in helping people become aware of their activities.

 

Biosensors, on the other hand, have the potential to become more advanced in the years to come. There is a possibility that they will not only be attached to clothing but within the body itself. When they occur, changes inside the body will likely be easily detected and early diagnosis and immediate treatment can be administered.

 

There seems to be no halting the progress of inventing machines and tools that can help raise our collective quality of life. As for the future of healthcare, there are more inventions to look forward to. You may be using nanotechnology, robotics and devices that offer needleless blood extraction and more just a few short years from now.

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Smartphone Blood Testing
April 6, 2016 2:23 PM by ADVANCE Perspectives

By Tamer Abouras

 

One of the defining characteristics of life in the 21st century is the degree to which we idiosyncratically track things about ourselves. As I’ve written about previously, some of the most popular apps are those that allow us to meticulously monitor our daily habits.

 

Whether it’s what we’re eating, how far we’re running, what we’re listening to — and have been for some time — or a chronology of our reading habits, our increasing interest in analytics and the usage of layman’s statistics continues to shape American society. We want to be fully aware of all the passive data we’re generating while going about our normal routines.

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As long as that doesn’t end up driving you crazy, it’s probably a positive thing all in all. And in a lot of ways, it can be fun. We all love making progress and anything that can be measured numerically can demonstrate whether or not we really are moving forward. But as I said at the outset, we all have varying degrees of idiosyncrasy when it comes to what we monitor and how aggressively we seek out that information.

 

For instance, I consider myself a reasonably healthy person and I keep track of how far I’ve run, what I weigh and things of that nature, but I don’t track my blood pressure, blood sugar or insulin. Perhaps, though, that’s because I largely haven’t been able to do so on my smartphone — until now.

 

According to gizmag, Massachusetts based Cor “comprises a web and smartphone app (initially for iOS, with an Android version planned), a blood reader and single-use cartridges that are used to take blood samples. The cartridges each have a fine needle that takes a surface-level blood sample when pressed against the arm. The process is said to be both quick and painless, with the cartridges able to be ordered on a subscription basis.”

 

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Bob Messerschmidt, founder and CEO of Cor said, "The greatest barrier for people to live a healthy life is really information. The idea was: what if we could bring blood chemistry testing directly to the home so that people could use that as a tool to know whether the things that they're doing to maintain a state of health and wellness are really working properly."

 

Stu Robarts of gizmag continues to explain, saying, “Once a blood sample has been taken, the cartridge is slotted into the reader for analysis. The reader employs vibrational spectroscopy, which uses infrared light to identify chemicals in the blood. Analysis is said to take a matter of minutes, and data extracted by the reader is sent to the cloud and processed using Cor's algorithms. Cor says that all data is encrypted and that it follows best practice and HIPAA guidelines. The interpreted data is then returned to the user via the accompanying app, along with tailored recommendations.”

 

“The app is designed to explain data in a straightforward manner, with its reports detailing health indicators like cholesterol (HDL, LDL and total), fasting blood glucose, inflammation (fibrinogen), and triglycerides. Tailored recommendations for improving the user's health are also provided, such as changes to diet, supplements, relaxation and exercise. These are based on the user's own experiences, guidance from the firm's "medical advisory board" and data from other users in the Cor community.”

 

So the long and short of Cor appears to be that it provides yet another way for us to collectively obsess over our own health and make sure we’re living the right way. If Messerschmidt is right, though, and that information really is the solution to myriad societal health problems, then the problems themselves can lead us to another conclusion: when it comes to our wellbeing, ignorance is not bliss.

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Catching Up to the Cloud
March 24, 2016 1:46 PM by ADVANCE Perspectives

By Tamer Abouras

 

In the past decade or so, we’ve become an increasingly data-centric, numbers obsessed society in recent years. Analytics have completely integrated and taken over the way we assess sports, business and all manner of polling data. On some level, it seems as though our ability to crunch numbers and look in between them is limited only by our level of interest, since virtually anything can be measured.

 

When it comes to your mobile phone, among the most popular are health and fitness apps. We love tracking how fast we’ve run, how far we’ve gone and what our heart rate was doing while we were on that jaunt. And many of us enjoy monitoring things like blood pressure, with or without the introduction of exercise, since apps designed for tasks like that are much more convenient and organized than manually using a machine and writing out numbers longhand.

 

Yet, in spite of the convenience of logging and storing all of this information, there’s likewise an ongoing chronicling of the ease with which our personal records can be at risk of hacking and theft, with some even speculating that hacking might now be considered an epidemic. Regardless of your particular opinion on that matter, the bottom line is that our mobile and wireless health data is vulnerable without some sort of privacy protections written into law. And for as much as technology routinely speeds past our lawmakers, concerted effort on their part can often mitigate the damages.

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According to Bloomberg BNA, “The Department of Health and Human Services Office for Civil Rights published guidance to aid in determining when and how the Health Insurance Portability and Accountability Act (HIPAA) applies to mobile health applications.

 

Health App Use Scenarios & HIPAA, published in February to the OCR’s mHealth Developer Portal, includes six scenarios to help developers that are not covered entities (health plans and health providers directly covered by HIPAA) determine when they are considered business associates (not directly covered but still subject to HIPAA).”

 

The guidance received a positive review from Paula M. Stannard, counsel with Alston & Bird in Washington, who said, “I think that this guidance is helpful in that it clearly reminds people, both covered entities and health app developers, of instances where the author of the health app is clearly not regulated under HIPAA as a business associate: When it's the consumer that's ultimately using the app and making the decision as to whether the covered entity receives data from it, and/or there's no relationship between the app developer and the covered entity (except for an interoperability arrangement).”

 

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The U.S. House of Representatives joined HHS recently in addressing these issues, as the House Subcommittees on Information Technology and Health Care, Benefits, and Administrative Rules suggested that some laws we have on the books now may be woefully ineffective or taken for granted.

 

“HIPAA was passed in 1996 before broad adoption of the mobile revolution, HITECH was passed in 2009 before much of cloud computing existed,” Rep. Ted Lieu (D-CA) said.

 

“Right now old and unclear privacy laws hinder interoperability between health IT systems and devices,” Rep. Will Hurd (R-Texas) said at the hearing.  “In today’s hearing I hope to hear specifically what laws or regulations need to be changed or updated and how they should be changed or updated or abandoned.” 

 

This positive step in the protection of privacy helps delineate how far HIPAA and HITECH can go in keeping your information safe. The only problem, of course, is how much more innovation will come to market by the time we truly get a handle on what we have now?

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Clarifying the Telemedicine Connection
March 18, 2016 10:45 AM by ADVANCE Perspectives

By Tamer Abouras

 

In ADVANCE for Speech & Hearing’s January/February 2016 Digital Edition cover story, we examined the role telemedicine and teleintervention were playing in early intervention for speech-language pathologists and other behavioral therapists.

 

In that article, the way in which teleintervention was reaching far-flung patients was explored, as were the techniques employed that effectively put parents of pediatric patients in the role of therapists and caregivers to enhance the quality of care. The doctor ADVANCE spoke to as the primary source for the piece was unequivocal: teleintervention and telemedicine are fantastic, cost-effective things and they ought to be expanded and used as widely as possible so long as they continue to prove effective and helpful.

 

As telemedicine and teleintervention continue to rise as viable alternatives to in-person care, standards and regulations for best practices will necessarily also continue to emerge. One such set of proposals was put forth recently by The District of Columbia Department of Health, rules which (if enacted) “ … would constitute the first regulations on telemedicine practice standards in the nation’s capital,” according to The National Law Review. “Other than a 2014 policy statement, D.C.’s current laws are silent as to telemedicine practice.”

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The comment period, where interested companies and healthcare providers will have the ability to review the proposed rules and contact policymakers with questions and concerns, will last until March 26.

 

The National Law Review lays out eight major points of emphasis from the proposed rules, including a clear definition of telemedicine, a requirement of what it calls a “valid doctor-patient relationship” and also clauses pertaining to the secure and confidential exchange of information.

 

With regard to the defining of telemedicine in particular, the rules say that it is “the practice of medicine by a licensed practitioner to provide patient care, treatment or services, between a licensee in one location and a patient in another location with or without an intervening health care provider, through the use of health information and technology communications, subject to the existing standards of care and conduct.”

 

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In terms of a valid doctor-patient relationship, The National Law Review article summarizes, “A physician must create a valid doctor-patient relationship and perform a patient evaluation to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication. However, an in-person exam is not required if the physician uses real-time auditory communications or a combination of real-time visual and auditory communications to allow a free exchange of protected health information between the patient and the physician performing the patient evaluation.”

 

The complete list of takeaways —  available at natlawreview.com/article/dc-proposes-new-telemedicine-rules-what-you-need-to-know — are worth taking a look at not just for D.C. residents, but also as a potential template for specific rules and regulations for telemedicine moving forward.

 

Telemedicine is on the rise — and it could give the old-fashioned term “house call” a whole new meaning.

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Unity Ticket
March 10, 2016 1:59 PM by ADVANCE Perspectives

By Tamer Abouras

 

Unity is an elusive concept and a curious term in how it’s interpreted. While it is rarely substituted for genuine friendship, the context in which it is used definitely matters. A united movement of activists, for instance, is probably populated by many people who have a lot in common.

 

The United States, on the other hand, is huge and disparate. A Pennsylvanian and a Californian are both Americans, but they may have fewer areas where they agree. Even if they voted for the same political party or stood shoulder-to-shoulder serving in the armed forces, they could be as different as two people from completely different countries and cultures — because in a lot of practical ways, they very nearly are. And, yet, they’re united.

 

If you’ve been keeping track of the 2016 presidential race recently, you’ve no doubt heard the rumblings of a “unity ticket” on the republican side. The theory is that with frontrunner Donald Trump consistently failing to achieve much more than 35-40% of the vote in most primary and caucus states, the unity ticket of rival senators Marco Rubio and Ted Cruz (and possibly Ohio governor John Kasich) could unseat the New York billionaire by combining their respective voters.

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 Unifying — whether suggested by the joining parties themselves or external forces — is oftentimes not the first choice of those involved. It’s usually the result of a “greater good” type of determination, where it’s the best overall solution, even if some enter into the arrangement reluctantly.

 

Whether or not that’s the case for several health IT providers this week, they are answering the bell and coming together in a major way — just one month after some prodding on the part of the American Academy of Family Physicians (AAFP).

 

“Just a month after the AAFP suggested how legislators should press electronic health record (EHR) vendors to make sure their various systems can exchange data, the companies that provide 90% of EHR systems — along with some of the largest private health care systems — agreed to improve data sharing,” Jessica Pupillo wrote in an AAFP News release this week.

 

According to Pupillo, “Cerner Corp., Epic Systems Corp., Allscripts, NextGen Healthcare Information Systems Inc. and GE Healthcare were among the 17 health IT vendors to commit to improving EHRs, according to an HHS factsheet. Sixteen health care systems, including Ascension Health, Catholic Health Initiatives, Community Health Systems, Hospital Corporation of America, Kaiser Permanente and Trinity Health, also made the pledge.”

 

AAFP Board Chair Robert Wergin, MD, expressed his excitement saying, “The siloed type of records we have now sometimes creates obstacles for using information to create the best care for patients, especially for those in transition or with complex illnesses. … Interoperability, the ability for different health IT systems to communicate with each other and exchange data, is critical for family physicians. We are a specialty that interacts with all phases of the healthcare system. We must have the information we need to formulate treatment plans and create the best outcomes. Lack of interoperability creates problems.”

 

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Wergin also did not fail to cite the aspects of this grand bargain that might’ve been tougher for the companies to swallow — specifically that blocking the flow of EHR information has been something of a business model for a while now.

 

"It might be a good business model, but it's not a good healthcare model." When healthcare professionals' EHR systems can't communicate with each other, physicians resort to printing and faxing lengthy reports and discharge summaries. The current system of faxing information is really a page back to our old paper charts."

 

As with Cruz and Rubio, this is the sort of unification that might not be desirable, at least in the short-term. But for the greater good, isn’t it nice to know some unity or dream tickets really can come to life?

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Interoperability & Learned Skepticism
March 3, 2016 12:56 PM by ADVANCE Perspectives

By Tamer Abouras

 

The term “peer pressure” probably first emerges as a buzzword in early adolescence. Around that time, at perhaps age 11, you’ll recall the barrage of advice from parents, relatives, teachers and the police officers in your D.A.R.E. program urging you to avoid smoking, drinking and use of illicit drugs.

 

Even prior to that time in your life — during which these suggestions come fast and furious and essentially endlessly all throughout your teens — you’re implored by parents not to speak with strangers (or take their candy or get in their cars). In short, to grow up — in America, at least — is to be conditioned with a healthy, necessary amount of learned skepticism.

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Above all else, there’s high importance placed upon the tenet that even if everyone around you was jumping off a bridge (or engaging in some other silly, dangerous activity), it’s crucial to retain the good sense and objectivity not to follow their collective lead — regardless of how much lobbying they use to bring you along.

 

Strangely, however, consensus is often expected to replace that skepticism when we enter the so-called “real world” as adults. We look to form consensus in the workplace, in any sort of organized gathering and even democracy itself hinges upon the basic principle that majority should rule, without ever questioning the morality or ethical implications of a given majority’s choice.

 

Which is how situations and conflicts such as the one currently going on between government and the private sector, pitting Health and Human Services and Centers for Medicaid Services on one side and health information organizations on the other, become all-too familiar and ironic.

 

Speaking at a panel discussion at the HIMSS 2016 conference on EHR and interoperability, Federal Times reported that Acting Assistant Secretary for Health Karen DeSalvo and Centers for Medicare & Medicaid Services’ acting administrator Andy Slavitt pushed for cooperation (through regulation) between private companies and the government.

 

“Physicians are hampered and frustrated by the lack of interoperability,” Slavitt said, “but it’s more practical than that. I don’t think anybody but we policy people actually use the word interoperability regularly. It’s usually, ‘I can’t track my patient’s referral’ or ‘I sent them to the hospital and I don’t know what happened.’”

 

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DeSalvo then suggested the way forward in order to alleviate that frustration, before Slavitt gave a rather interesting interpretation of the private sector’s inherent purpose in a free market.

 

“We’re working to see that as federal partners, we are giving clear signals to the private sector that we really want to see this new open, connected community of health,” DeSalvo said. “That we expect the health IT system to get on the same language. We want to get over that artificial barrier and always want to keep putting the consumer at the center.”

 

“There has to be a private sector commitment to a greater good,” Slavitt said. “Regulations like those that require open (application program interface) can help and they’re vital. But frankly, there are just too many ways to step in the way of true interoperability. No regulation can anticipate all of them.”

 

Just as a reminder: the interoperability that’s being very strongly pushed for here comes at a time when 90% of companies in all industries — healthcare or otherwise — have suffered a breach of their medical data as of 2016.

 

Are those words about peer pressure really any less true now just because we’re older?

 

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Putting the ‘Web’ in WebMD
February 25, 2016 2:13 PM by ADVANCE Perspectives

By Tamer Abouras

 

Speaking from my own perspective, it’s incredibly hard to remember what life was like before the internet touched virtually every part of mine. I don’t remember looking at paper maps for directions — or being particularly adroit when I did. I vaguely recall lugging around a portable CD player (as well as a booklet of CDs), but never once attempted going for a run or bike ride with one of those.

 

It seems preposterous that my morning sports page regularly didn’t have the results from late-ending west coast games or that anyone would have to wait hours upon hours for news to break on television. And how in the world did anyone choose the right restaurant to eat at before the advent of services like Yelp!

 

I’ve used the internet to secure every job I’ve ever had — and, by and large, to do every job I’ve ever had, including my current one. I read news articles and magazine features from around the world without getting lost in a paper chase, I buy, sell and pay bills all from the comfort of my desk (or simply by pulling out my phone) and I never have to sit and wait for the weather or traffic reports on morning radio.

 

And I certainly wouldn’t dream of making any substantial decisions, financial or otherwise, without doing a significant amount of research on what was once colloquially referred to as the “information superhighway.”

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One such beneficiary of our addiction to this sort of easy-access internet information is the concept of comparison shopping, which has now been seamlessly integrated into the routines of most people before making even tedious decisions, such as the aforementioned “what restaurant should I eat at?” query.

 

As such the popular health information website, WebMD, is wisely looking into ways that it can further insert itself into our own carousel of options when we require medical attention — beyond its maligned but widely used “Symptom Checker.” According to MobiHealthNews, “WebMD may soon begin to offer healthcare price transparency tools to users, and is even looking at becoming involved in telehealth, CEO David Schlanger said on a recent earnings call.”

 

With earnings for the company continuing to climb, Schlanger seems unwilling to sit back and lose out on a WebMD share of the casual comparison shopping that internet users now collectively take for granted.

 

“Unfortunately it's far easier to compare prices, relative service levels, and quality of restaurants, hotels, or virtually any other product online than it is to make a fully-informed decision regarding the purchase of a healthcare product or service. Even a simple generic prescription, you often don't know the price you'll have to pay for the product until you are standing at the register at the pharmacy counter ready to check out. We have begun to address this problem with enhancements to our provider directory that, among other things, will allow users to compare physician experience levels around specific procedures and conditions. We continue to work on other opportunities to better inform consumer decision-making,” Schlanger said.

 

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With regard to telehealth — something that is rapidly rising across healthcare disciplines — Schlanger also remarked that, “I think we believe as a company that alternative primary care like telehealth will eventually gain a wider adoption. We think that WebMD is well-positioned to provide access to those services because of the trust in our brands and our distribution.”

 

Schlanger’s overall point is very sound — there’s a yawning gap for the sort of one-stop comparison shopping mobile app and healthcare site that’s as widely used as Yelp! or TripAdvisor. The company’s success in filling that void will rely heavily upon its willingness to embrace the sort of constant change that life on the internet demands.

 

Fortunately, for those of us who already use WebMD’s product and services regularly, they’re not showing any symptoms of slowing down.

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Big Data, Pregnancies & the Inconceivable
February 18, 2016 11:23 AM by ADVANCE Perspectives

By Tamer Abouras

 

Have you ever wondered if the term “conspiracy theorist” perhaps gets a bad rap? That may sound strange at first, but consider all of the science fiction and futuristic films you’ve watched or books you’ve read.

 

More often than not, they’re dystopian in nature. An intrusive, all-powerful, all-knowing government constantly peering over the collective shoulders of its citizenry at all times, never for a moment letting even the smallest measure of dissent be fomented. And even though there’s something to be said for drawing a distinction between believing in conspiracy theories and merely being entertained by them, the point is that their potential reality is something we’re by and large curious about.

 

The big news in Big Data yesterday, of course, revolved around Apple CEO Tim Cook’s letter to customers detailing the reasons behind his decision not to essentially create a new iOS operating system that is capable of being unlocked by anyone and which is stripped of some vital layers of security — such as encryption — which are presently in place.

 

In light of the numerous data breaches companies across the spectrum suffer, now would seem like the worst possible time for providers of devices such as the iPhone or iPad to be loosening their built-in security and privacy apparatuses. Seeing the ways in which we voluntarily offer up our own information, however, makes crystal clear the reason why those protections are more necessary than ever.

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Just take this very recent example from a Fortune feature detailing the work of Piraye Yurttas Beim, PhD, the CEO of a company called Celmatix. Clematix has developed new software for fertility doctors called Polaris and although its methods are commendable, there are justifiable reasons to feel concerned about its privacy aspects.

 

In the key passage of senior writer Leena Rao’s article, Polaris’s process is explained:

 

“Polaris takes all of a patient’s health information and compares the profile to successful outcomes with similar health characteristics. The software will then make recommendations on a course of action for the patient to get pregnant. For example, the software might tell a patient that if they continue to try to conceive naturally for the next six months, they have a 4% chance of getting pregnant. But with IVF, or in vitro fertilization, the same patient may have a 60% chance of pregnancy, taking into account her health. The software can also predict how a patient’s chances of getting pregnant will evolve as she ages, and the chances of having multiple pregnancies.”

 

While not without merit — as the article mentions the more than 12 fertility clinics making use of Clematix products including Polaris to help the more than seven million women in the U.S. who have issues becoming pregnant — that excerpt is exactly where the conspiracy theories and problems come to light.

 

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For those who have watched films such as Gattaca, or heard scientists bemoan all the negative consequences of an ever-growing human population (and suggest curbing that growth), it’s a matter of connecting the dots: the government wants to know quite a bit about us — even when they say it’s limited only to certain cases — and the handing over of our medical information through software like Polaris and the United States’ request of Tim Cook and Apple aren’t mutually exclusive things.

 

Eugenics is over 100 years old. China’s one child policy is still in place, albeit (slightly) relaxed. It seems inconceivable and confined to the realm of conspiracy theories, but the fact of the matter is that there are serious reasons both to stand squarely with Apple’s defense of encryption and to be leery of any product or software that could potentially leave your or your family exposed.

 

You could argue that some conspiracy theories are more believable because we’re so often entertained by them. But you could also point that some are more believable because they’ve become objectively more plausible.

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Wearables Wearing Out Their Welcome?
February 8, 2016 10:57 AM by ADVANCE Perspectives

By Tamer Abouras

                      

Many of our grandparents — and many people over the age of 50 — have probably uttered at some point, some variation of the expression, “What’s the point of social media? Who needs a picture of your lunch? Who cares?”

 

Hearing something like that — perhaps almost verbatim — has a way of putting us back on our heels just a little bit, doesn’t it? On one hand, people railing against the advance of technology and its ongoing, unending assault on the status quo is nothing new — it may not have even been that revolutionary when the Luddites were doing it over a hundred years ago.

 

With that being said, there’s certainly some salience to the overall point — even if it comes off a little cranky — which is almost implicitly accepted by the fact that criticism of the “Oh, grandpa” argument doesn’t so much refute the initial comments as chide their obviousness. “Of course selfies are a bit self-serving, but that can be a good thing” is essentially the counter.

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As has been demonstrated many times on this blog, however, sharing too much of your own personal information can be far more dangerous for things other than your reputation or self-esteem. And when it comes to wearable health devices such as fitness trackers, that can mean losing your health information all because the devices themselves weren’t secure — and may not have even been designed to be.

 

According to the Toronto newspaper, The Star, reporting on a study by digital research group Open Effect and U of T’s Citizen Lab, “ … many of the most popular devices leak information and are vulnerable to manipulation of recorded data.”

 

The article continued, “The devices, which can track everything from heart rate to quality of sleep, collect fitness data that wearers use to keep track of their health goals. These trackers aren’t just for the health conscious: lawyers and insurance companies have used data to verify users’ fitness. … But while the devices collect an enormous amount of personal health information, key security flaws make it easy to tamper with the data, the study found.”

 

When it came specifically to fitness-based wearables, only Fitbit received a clean bill of health when it pertained to keeping your personal health information safe.

 

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“Only Fitbit used end-to-end encryption, which protects data going into the device and the data going out of it. Without such protection, a motivated user could gain access to their data after the fact and manipulate it — a concerning finding if the device is used in a court of law. Researchers did not test Apple for end-to-end encryption. One device, Garmin Vivosmart, didn’t even encrypt fitness data sent over the Internet, leaving users’ health information vulnerable not only to fakery but to eavesdroppers who might be collecting their data.”

 

Jeffrey Knockel, a senior research fellow at Citizen Lab and one of the authors of the study, had this to say about the security of wearables and how they should serve as a cautionary tale for other devices holding even more of our sensitive information going forward: “They’re worn by tens of millions of people, if we can’t get this right, what hope do we have for our TVs and appliances?” 

 

So, without being a buzzkill, here’s a nod to the oldest among us for unintendedly offering sage advice. While they may not be able to identify all the benefits products such as wearables and social media have to offer us in general, they can certainly spot one crucial flaw and offer a corrective measure. There really is value in discretion. 

 

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Fit for Duty
January 28, 2016 2:21 PM by ADVANCE Perspectives

By Tamer Abouras

 

There’s something tragically ironic about decrying government surveillance programs like the NSA or defending encryption in 2016. In a day and age where our personal information — name, address, email, phone number, geographic location — are all sold by social networks to advertisers almost constantly, the protest that anything about our lives be kept private is one that increasingly seems at odds with the direction society is headed.

 

Perhaps that’s why — even twenty years ago when HIPAA was passed — we’ve turned to the next best thing: not allowing others to freely obtain or share our information without permission. There’s a reasonable expectation and desire to keep some things just for yourself — beyond the reach of others in your life that aren’t loved ones. When applied to your employer, for instance, this is one of the very important functions of your organization’s human resources department.

 

One place we’re terribly persnickety about keeping our secrets is with regard to health information and our medical records. In spite of the fact that one in three Americans had their healthcare information breached in 2015, according to The International Data Corp., there’s still an instinctive protectiveness we have about those records being made public.

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Considering all of this — and that job interviewers aren’t even allowed to ask you questions about your age, much less your health — a recent report by The Wall Street Journal about a push by a handful of large companies to create “employee health metrics” or ratings seems more than a bit intrusive and beyond the pale, even in these times.

 

According to the article, “A group of employers, including International Business Machines Corp., PepsiCo Inc. and Johnson & Johnson, are weighing how to publicly report — and measure — the health of their workforce. Such ratings would give shareholders, corporate directors, managers and consumers insight into a company's commitment to improving employee health, and whether such efforts are getting results. Chronic illness, tobacco use and obesity can drive up a company's medical costs, but a growing body of research suggests they can also affect productivity and performance.”

 

Although there’s a stipulation that the information would be presented in the aggregate, rather than illegally distributed, the language of the article suggests that the implementation of such a rating could open the door to terminations which are ostensibly the result of poor health.

 

Just listen to Derek Yach, chair of the aforementioned working group and chief health officer of the Vitality Group, a unit of South African insurer Discovery Ltd., who says “ … rating workforce health gives investors and consumers another way to assess a given company's productivity, management and commitment to employees' wellbeing.”

 

"We want this to be a serious management tool that goes alongside financial management tools," said Yach. "The level of obesity in the workforce, stress and depression I consider material to the business performance of a company."

 

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While the article notes that assigning one general score to possibly thousands of workers is a “tricky proposition,” there’s still every indication that some employers unsurprisingly want the innovation and see it as the best way forward, according to Paul Mendelowitz, medical director, health informatics at Active Health, a New York health analytics firm and an independent subsidiary of Aetna Inc.

 

And here’s the best news: Mendelowitz’s Active Health is working to develop such an algorithm for a company’s overall employee population’s health, something they plan to begin testing with employer clients in a few months. 

 

Here’s the thing — the differentiating physical qualities between professional athletes and average schleps are patently obvious. There’s no need to create systems which will invariably start tying the number of sales calls you made (or didn’t make) in a month to the four pounds you’ve gained since winter began.

 

And how’s this for a novel idea: Instead of worrying about who else our health information could be shared with, how about working a little harder to make sure the records we aren’t voluntarily offering up don’t suffer security breaches so often?

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Why Not
January 21, 2016 9:16 AM by ADVANCE Perspectives

By Tamer Abouras

 

One of the clearest differences between humans and animals is our capacity for intellectual inquiry. Your dog may be interested in what’s on your plate, but when you oblige and give him a piece, he’s not going to eat it, sit down and ponder where exactly it came from or whether or not it was locally and ethically sourced.

 

At the risk of stating the obvious, the human ability — and relentless desire — to continually ask “why?” is a catalyst for discovery, change and growth. And it’s also an existential request that’s never quite fulfilled. We never seem to run out of questions about our family ancestry, the history of planet Earth and certainly not about the universe, which seems largely unknowable due to its sheer size.

 

Still, while there’s much to be gleaned by looking outwardly, there’s a significant amount we can learn from taking a peek within. Enter DNA testing. Since Friedrich Miescher first discovered DNA in 1869 — with research that was later expounded upon in James Watson and Francis Crick’s proposal of the Double Helix in 1953 — scientists have studied these genetic code materials in order help us gain a greater understanding of ourselves, both in the form of our strengths and our weaknesses.

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Whether or not you consider it a bad thing, market capitalism has a tremendous ability to exploit this gnawing, constant need to have all the answers — often as soon as possible. Even for those whose primary purpose isn’t crudely separating our money from us, the effect is almost always the same: if someone advertises a product or service — these days usually an app — purporting to scratch that curious itch, people will pay up.

 

In the same haste with which we receive our “answers,” we tend to ignore potential flaws in their accuracy, all of which all leads us to a great piece (http://slate.me/20gG3D9) that ran in Slate yesterday from freelance journalist Rob Arthur, a PhD in evolutionary genetics, on this very topic and a service known as “SNPedia.”

 

According to Arthur, “As its name suggests, SNPedia is a Wikipedia-style repository of knowledge but specializing in the health information associated with the sort of genetic variants 23andMe tests for. (The technical name for this kind of variant is ‘single nucleotide polymorphism,’ which provides the site its prefix.) SNPedia turned out to be the database for a product called Promethease, which offered to connect my genetic variants to each record in SNPedia’s voluminous database for the price of only $5.”

 

The entire article is pretty deep and absolutely worth a read, but the crux of SNPedia’s problem is outlined by Arthur in this paragraph.

 

“In theory, SNPedia is a democratization of science: Like other Wiki-style databases, anyone can contribute to any article, regardless of his or her qualifications. As co-founder Mike Cariaso wrote, ‘You are judged by the quality of your work, not the degrees you hold.’ In practice, Cariaso, co-founder Greg Lennon, and an army of Internet-crawling bots create and edit most of the articles, harvesting variants from the latest issues of scientific journals. Of the past 1,000 edits, only about 60 came from independent contributors’ accounts. Cariaso controls the quality of SNPedia articles rather strictly, and he was able to point me to several cases in which he modified or deleted pages when scientific articles were criticized or withdrawn.”

 

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He goes on to elaborate exactly what SNPedia’s deficiencies are, while still noting that, “For all of the confusion SNPedia generates, its efforts seem largely well-intentioned. … Other sites are more predatory, playing on the scientific sheen of genetic testing to recommend vitamins, supplements, and alternative medicine.”

 

One such site, according to Arthur: NutraHacker.

 

“For the price of $37, NutraHacker will produce a custom report that analyzes your genome and recommends (but does not sell) various vitamins, supplements, and foods. NutraHacker claims that its reports can help customers avoid harmful supplements, optimize their athletic training, and ‘detoxify.’”

 

“The trouble is that there’s little scientific backing for such a report. Most people in the developed world do not suffer from vitamin deficiencies, and when they do, it’s because of malnourishment or starvation, not their genes. While nutritionists hope that genetic information may in the future enable more precise vitamin prescriptions, the consensus is that the science isn’t advanced enough to guide recommendations yet.”

 

As stated earlier, the entire article is worth looking over — especially if you’re type jump at one of these services purporting to provide you with all sorts of previously unknown information about yourself.

 

With that being said, be cautious and do your homework beforehand. Curiosity already killed the cat; don’t let your credit be next.

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The Health Information Food Chain
January 14, 2016 2:01 PM by ADVANCE Perspectives

By Tamer Abouras

 

At parties and social gatherings, or (especially) on the internet, you’re bound to encounter that one “deep” person asking some rhetorical questions such as, “Why do we ask for a ‘Kleenex’ instead of a tissue?” The point — usually made through one-too-many examples) — is that some brands become so well entrenched in our everyday lives, we substitute their names for the actual product or service.

 

While not the most original or insightful line of thinking, it is worth bringing up within the context of digital health information. Especially with smartphone and tablet-based apps, one name towers above them all when it comes to researching your aches, pains and fevers: WebMD. Even its “Symptom Checker” is standalone and famous, if no longer completely unique. Got a health issue you can’t quite pinpoint? “Check WebMD.”

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Founded all the way back in 1996, WebMD’s mission to provide consumers with health data and advice has been an overwhelming success. According to data from Alexa, the web analytics provider, the site now averages 201 million unique users per month and ranks as the No. 104 most visited site in the U.S.

 

Which all makes a recent report from Financial Times that much more interesting: WebMD is possibly looking to sell (tinyurl.com/j8msu9h). As is noted in the original article, “… bidders might include retail pharmacy chain Walgreens and insurance provider United Health.

 

While WebMD said it is “not currently in any negotiations to be acquired” after the initial Financial Times report saying otherwise (and hiring bankers to explore the possibility of a sale last year), it was noted by the article that “WebMD and Walgreens already collaborate on a number of initiatives, including a virtual wellness-coaching program that can be downloaded as an application on smartphones. Other companies that may be interested include CVS, a U.S. rival to Walgreens and health insurer Aetna.”

 

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And according to Financial Times, it’s not just big pharmaceutical companies that may want in on the WebMD action, should there be any. There’s quite a bit of interest on the part of large media companies as well, as the article notes that, “Analysts say traditional media companies looking for a big digital audience could also target the site. The company’s dominant footprint in the consumer and physician web market gave it “scarcity and strategic value,” said analysts at Royal Bank of Canada.

 

While the particulars of a sale itself — which could be for upwards of $2 billion dollars — are largely hot topics of discussion for those more involved in business, the mere idea of a sale generating so much buzz and involving the transfer of so much money is a reminder of how far digital health information has come.

 

So if there’s still time to make them, here’s a bold prediction for 2016: By the end of this year, the place where you check whether or not you have a cold or something far more serious will no longer be independently owned. WebMD will be swallowed up by an even bigger fish in the healthcare pond.

 

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Politics, Privacy and Pulling the Trigger
January 8, 2016 12:01 PM by ADVANCE Perspectives

By Tamer Abouras

 

On Monday, January 4, 2016, President Obama spoke to the nation, as expected, and issued an executive order regarding gun safety and measures he feels will help to curb what he called the “epidemic of gun violence.”

 

His address was heartfelt, emotional and — predictably — polarizing. Conservatives panned what they perceived to be an overreach and an attack on the Second Amendment, while liberals lauded the president taking action where Congress hadn’t. Both sides conceded that the enhancement on background checks would not have affected or prevented recent mass shootings such as the tragedy in San Bernardino.

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One of the more sweeping, lesser noted aspects of the executive order’s proposal was its enabling mental health providers a simpler way to disclose information to National Instant Criminal Background Check System (NCIS). Billed largely as a way to prevent suicides — which account for about two-thirds of all annual gun deaths in America, according to the CDC — it was noted by Healthcare Informatics that “… the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a final rule, which takes effect next month, removing legal barriers preventing states from reporting relevant information to NICS.”

 

This idea of removing the legal barriers put in place by HIPAA has actually been a few years in the making, according to Politico’s Morning eHealth report.

 

“The idea initially came three years ago in the wake of the Newtown, Conn., shootings, but has been languishing. The 1993 Brady law disqualified certain people from buying guns, including individuals involuntarily committed to mental health care and those found incompetent to stand trial or otherwise deemed to be a danger to themselves or others. But HIPAA prohibited providers from sharing the information with the FBI’s National Instant Criminal Background Check System. The rule, which takes effect next month, changes that.”

 

The complete text of the rule can be found here.

 

The overarching question is whether or not this amendment of HIPAA will prove to be problematic. While the United States government in the 21st century has consistently found itself infringing upon privacy and civil liberties in the name of security — NSA, anyone? — it is, as Healthcare Informatics senior editor, Rajiv Leventhal put it, “ … an issue that can certainly become very fuzzy.”

 

Leventhal continued, citing a blog post from Mental Health America, which stated, “ … what the rule says is this: (1) a firearms control data center housed in a HIPAA-covered entity can share limited demographic information with the national registry; and (2) a HIPAA-covered entity that is participating in a judicial proceeding to determine that a person cannot lawfully have a firearm (such as ordering an involuntary commitment) can share limited demographic information with the registry.”

 

Mental Health America’s CEO, Paul Gionfriddo added, “This change will affect a relatively small number of people (maybe in the hundreds, maybe in the thousands). So why does it matter? It has already been determined that it is illegal for the individuals whose names will be added to the list to own or possess firearms. So this might prevent a tragic event without infringing on the rights of anyone who can possess firearms.”

 

Ultimately, Leventhal agrees in his analysis that this is both a targeted, specific change that will not wrongfully affect the wrong people — and that privacy for those individuals should not supersede public safety. “Indeed, while the patient-provider relationship is one that should certainly be respected, it is more important to potentially save lives by providing these mental health records to the people who need them,” he said.

 

While the more libertarian-leaning among us may raise an eyebrow at statements like that — and more conspiratorial sorts would note that nothing is explicitly stopping the administration from tweaking or changing HIPAA further to expand this information disclosure to more patients with mental health issues, it’s certainly a topic that has the American people talking and has smart people working around the clock to address.

 

The president’s executive order takes aim at the gun violence problem. Time will tell if he hits the mark.

 

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Frenemies
December 31, 2015 12:07 PM by ADVANCE Perspectives

By Tamer Abouras

 

There’s something all at once comforting and disconcerting about superhero comics and cartoons. While the black and white, good and evil dynamic depicted within most of them is indicative of childhood and that kind of clarity is something adults often sorely miss, there’s an odd level of security in knowing that while reality may not hold our heroes, it also has virtually no room for the supervillains either.

 

In the absence of evidence proving otherwise, there aren’t any bad guys hell-bent on world domination that live alone in secret towers far away. Or if there are, they don’t appear to be any sort of serious threat to the average person.

 

On the other hand, the comfort of those cartoons comes precisely from that lack of confusion. It might be nice to know that most people — even the bad ones — are complex and ambivalent, but there are many instances where those behaviors wander into the realm of being duplicitous and differentiating between friends and enemies can become challenging.

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The one thing you can be absolutely certain of, however, is that even in instances where the matter in question doesn’t involve a person or organization being actively harmful, you should probably assume they don’t have your particular best interests at heart when the thing they want most from you is your business.

 

Case in point: This report from ProPublica, which cites CVS, Kaiser Permanente, Walgreen’s, and Veterans Administration (VA) as the nation’s top HIPAA violators. According to American Journal of Managed Care (AJMC), ProPublica’s investigative series “ … has revealed that top retail pharmacy chains, health plans and the VA routinely violate the Health Insurance Portability and Accountability Act (HIPAA), both through sloppy mistakes and rogue acts of spying.”

 

AJMC’s Mary K. Caffrey continued, writing “Cases reviewed by ProPublica included honest but distressing errors, such as delivering cancer medication to the wrong address. Worse are the purposeful, intrusive lapses such as sharing patient photos on Snapchat or the male VA worker who allegedly used records to look up information on a patient he wanted to date. ProPublica found that the HHS Office of Civil Rights has enormous discretion under HIPAA — it can settle cases quietly, which seems to be the modus operandi — or it can impose fines of up to $50,000 per violation, up to a maximum of $1.5 million per year. Criminal charges are possible in the most egregious cases, and complaints can be posted online if patient information is withheld.”

 

If Caffrey’s reporting is any indication, the punishments for repeat offenders err on the side of being awfully light. “The HHS Office of Civil Rights issues only a handful of fines—fewer than 30 since 2009 — on the more than 18,000 HIPAA complaints it receives each year,” she said. And while CVS reportedly did pay a $2.25 million fine in 2009 for “tossing prescription bottles in a dumpster,” there were still nonetheless over 200 complaints about them between 2011 and 2014, according to the ProPublica report.

 

The threat of having our information stolen by hidden thieves is something we have to accept and be wary of, but the threat of carelessness — or even malicious behavior — on the part of our purportedly friendly neighborhood pharmacies is something that hits just a little bit closer to home.

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