Should patients be worried about the security of their health information? August 30, 2006
Posted by Hans in : analysis, news , add a commentShould people be worried about the security of their health information? In the past, I used to believe that perhaps the issues of security and privacy (an issue that is related to but NOT identical to security) were overblown. I would go so far as to suggest that those with vested interests used these two issues to maintain control and prevent sharing of information (that was the cynic in me). Around the same time, I also held a similar idea that patients didn’t really concern themselves with privacy so much. Most patients assume that health providers share information as needed and that explicit consent to share information between providers was the strangest (if not the dumbest) thing. I also believed that health care organizations seemed relatively secure, based on the measures they take which include triple identity verification and limiting remote access.
Today, I’m not so sure if I feel as confident about the security of my health information. Recently, a family member of mine was almost a victim of fraud (a stranger tried to withdraw a few thousand dollars from a personal account). This incident is my personal connection with the issue of security. The news has some more spectacular reports about security of health information: a stolen laptop with data on 28,000 home care patients and a hospital firm is robbed of 10 computers. To make matters worse, a survey finds that the majority of IT professionals don’t “feel confident they can prevent data breaches” (you can view the full report here). Whoa – if IT professionals don’t feel that they have the necessary resources, are we waiting for a catastrophe? Unfortunately, the survey doesn’t break down the results based on industry. As a result, we don’t know if health care is any better (or worse) than the rest.
I’m not trying to sound like I’m paranoid or some cynic about ehealth and maintaining electronic records of our information. I actually believe that we need to make more of our health information available in electronic format. But, we need to be more vigilant about securing our health information. For example, maybe IT professionals should draft some guidelines (if not rules) on how to dispose of technology, be it CDs/DVDs, hard-disks, or whatever else may contain health information. As we slowly move away from paper, we will need to be more careful about how to dispose of old storage media. For example, patients, in particular, should take care to learn how to dispose of their computers.
So, should you be worried about the security of your health information? I would say “yes” only so that we don’t become lazy in protecting our information. As individuals, some simple precautions could include:
- Shred paper records – use a shredding device to dispose of paper based records (i.e., health information, bills, and any other information with your identity on it). I would recommend a shredder that cuts in “diamond” shaped patterns. I find that the “strip” method is easier to re-assemble paper records. A friend of mine goes so far as to throw out shredded documents over the course of several weeks (handfuls at a time in different bags containing “wet” materials from the kitchen).
- Do not give out personal information over the phone: Unless you’re absolutely sure about the identity of the person on the other line, don’t give out personal information. In fact, if someone calls and asks for your information for “verification” purposes, ask them to tell you what they have. If it’s incorrect, call them back using the official number provided by the company. I’ve had to teach my parents not to give out their information over the phone (they’re a bit too trusting). Now, when they get a call from a credit card company or some other institution, they listen to what the person has to say and hang-up. They call the company back in five minutes and provide any information (if necessary). I’m sure if this method is not fool-proof, but it’s better than giving out your information willy-nilly.
- Use pseudonyms on the Internet: I would suggest you create some fake online identity and use it for registering on websites. Try not to use websites that keep your credit care “on file” for your convenience.
- Ask your health care provider about their security measures: I think we all need to keep our health care providers (be it your physician or your hospital) accountable about keeping our health information secure. Health care providers are busy and often over-worked and usually don’t have excess time to think about things other than taking care of people. As patients, we need to keep reminding them to remain vigilant. We, as patients, also need to help our health care providers too.
I’m pretty much out of ideas as to what else to do to help keep your health information safe. As individuals, we have to put a great deal of trust in the institutions that store and collect our health information. After the terrorist attack on September 11th, 2001, the American government told its citizens that everyone has to play a part in keeping one another safe. Sounds like good advice.
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Disruptive Technologies in Health Care: A summary August 21, 2006
Posted by Hans in : analysis, opinion , 7commentsMy apologies for not getting to this post sooner, but this past year has been … eventful. Here is my list of disruptive technologies that could be used in to improve and change health care. I have included links to the entries highlighting each technology – no need to rehash what’s already been written.
Disruptive technology #1: Video games
Disruptive technology #2: Mobile devices
Disruptive technology #3: The digital home
Disruptive technology #4: Ebay, auctions, and markets
Disruptive technology #5: Patient Reports
Disruptive technology #6: Wearable technologies
I thought about adding a few other technologies to this list, but decided otherwise. I do, however, have a few “honourable” mentions that I want to highlight.
- Peer-To-Peer (P2P) networking: Originally, I thought about distributed computing and possibly tapping into (then) popular file-sharing applications like Napster or Kazaa. But, as I continued to think about this technology, I couldn’t really think of any health care specific applications. In some way, applications like Skype could bring cheap voice over IP (VOIP) services by utilizing all the computers being deployed by health care institutions. But, is this “application” disruptive? Perhaps a very useful application of P2P networking may be the emergence of “grid computing” in health care. Maybe we can begin to harness computer power to address some of the very complex and processor intensive modeling of proteins or gene sequencing.
- Quantum/Nano computing: If the quantum computer gets developed, I think there will be an overall change in society’s ability to do things with a computer, not just in health care. Unfortunately, this technology is still too far removed from any real world application, stuck in the development stage. But, imagine the possibilities with almost limitless computing power…some of those disruptive technologies I highlighted would sure be taken to another level.
- Radio Frequency Identification (RFID): RFID is supposed to be the next big thing in business, particularly in asset management and inventory tracking. But, I’m not convinced that there will be such a large impact in health care. Already, we’re beginning to see simple RFID being extended to another level. HP announced the development of their “memory spot” technology. Just as well, I suppose that RFID and the subsequent developments will ultimately lead to the concept of ubiquitous computing.
This “runner-up” list and the highlighted disruptive technologies do have some very interesting possibilities for changing the health care system in many different ways. Ultimately, I believe that the most disruptive of all “technologies” will be the patient. Helping the patient is ultimately what this entire enterprise is about. And so, as long as the patient continues to challenge, to prod, to demand a better, more caring, and responsive system, the system will be forced to respond. These changes may take time and may not be right at first, but I’m confident that the changes will come. So, let’s keep empowering the patient!
I’d love to hear if anyone thinks that I have omitted any specific technologies or have included a technology that should not be included. I will try and revisit this topic in a year (or two) to see how my predictions have fared and whether and changes need to be made.
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Upcoming Conference: Games for Health 2006 – Sept. 28-29, 2006 August 15, 2006
Posted by Hans in : conferences & conventions , add a commentHere’s an announcement for an exciting upcoming conference: Games for Health 2006 Third Annual Conference Covering Intersection of Games, Health and Healthcare – September 28-29, 2006 – Baltimore.
Here’s a description of the goal of the conference:
Summarizing the importance of the event, Ben Sawyer said, “Slowly but surely the last year has seen a growing appreciation for what modern day videogames can offer to healthcare. The combination of powerful technology, evolved interface design, and growing use among the next
wave of health care workers is creating a ripe environment for further growth in this field. What once seemed like an idea on the fringes is gaining impressive momentum and becoming a mainstream reality. Our goal each year with the Games for Health Conference is to move the space forward until the role games, game developers, and game technologies can play in something as critical as our own health is fully realized.”
This conference does sound interesting and exciting. Almost a year ago, in a series on disruptive technologies in health care, I posted an entry (Disruptive Technology #1: Video Games) wondering what role video games could have in transforming and improving our health care system. Looks like some people in the US are already started.
In addition to content sessions, Games for Health 2006 features on-site demos of the latest efforts in the field, poster sessions, and important meet-up opportunities for researchers, assessment experts and various government and non-government health initiatives. Critical networking time is woven throughout the conference agenda, and the meeting features an evening reception sponsored by Virtual Heroes. “The Games for Health conference is designed to strengthen the intersection between health care and gaming. We’re excited to see more and more innovators from the health and gaming arenas working together to make a real impact on people’s health everywhere,” said Ben Sawyer, co-founder of the Games for Health Project. The Games for Health Project is supported by the Robert Wood Johnson Foundation’s Pioneer Portfolio, which funds innovative projects that may stimulate breakthrough change in health and health care.
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To PhD or not Phd? August 12, 2006
Posted by Hans in : academics , add a commentI’ve been asked on several occasions about studying ehealth/health informatics at the graduate level (i.e., masters or doctoral/PhD degrees). Some seem to be interested in advancing their own knowledge so that they can use their new found knowledge and skills to further their career in the workplace. For those interested in pursuing a doctoral degree (PhD), here’s a great resource that may help determine if the PhD/doctoral degree is right for you (http://www.cs.purdue.edu/homes/dec/essay.phd.html)
The information is provided by Purdue University and seems to be written with computer science students in mind, but the concepts seem applicable to other disciplines. Since I’m currently going through the PhD progress, I would have to say that this degree is not for everyone. You may have the skills and talent to complete the PhD, but all of the other aspects of the degree may not be a good “fit” for you. One thing that I’ve learned is that completing a PhD is like a marathon (not that I’ve ever run or completed one). The journey is quite lonely, as you only have yourself to get everything done. Basically, you have to love your topic so much that you are willing to forego other opportunities (a night out, vacations, relaxation, etc) so that you can work on your research. Usually, this means reading the latest journal articles, preparing a manuscript for publication, reviewing your data, or just thinking about your topic.
I’ve been thinking about a post about possible career options for those interested in ehealth/health informatics, so I’ll try and get something written up for the near future.
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A look at the "dark side" of ehealth August 10, 2006
Posted by Hans in : analysis, opinion , 2commentsA look at the “dark side” of ehealth
In his book Amusing Ourselves to Death: Public Discourse in the Age of Show Business,
Neil Postman writes about the unconscious effects of television in society. He later generalizes that technologies inherently favour certain types of interaction, thinking, conceptualization, and communication. For example, the written word (i.e., text) emphasizes rational, logical thought and expression, whereas multimedia (like television of the computer) utilizes and favours emotional responses visual stimulation. These technologies (unconsciously) change how we interact with and conceptualize the world around us. A good example is when movies switched from silent to spoken word pictures, or from black and white to colour. For more on this topic, you can read the works of Marshall McLuhan.
So what does all of this have to do with ehealth? As we move from the current versions of our health care system to one that is increasingly electronic, what types of changes can we expect to see? Much has been written about all the potential positive effects of using ehealth, most notably making health care safer, more dynamic, and more cost-effective. I do not doubt that some of these possibilities will be realized some time in the future. But, what of the potential negative effects of ehealth? Are we overlooking the “dark side” of ehealth? (Note: I’m going to focus on some of the systematic changes that we might see as Gunther Eysenbach has done some interesting work on the quality of health information and possible negative outcomes)
In the past, health care (or more aptly, medicine) has already seen a dramatic shift in the mid 1900’s. Physicians were originally considered extended family members, making house calls and acting as healer, confidante, psychologist, and more. With the advances in microbiology and emergence of science based medical programs like Johns Hopkins, community based practitioners were replaced by scientist-physicians who relied upon new scientific discoveries and now, the “best available evidence”. Health care has seen a shift from individual to community based care. In Canada, this shift has also been further institutionalized and cemented by the passing of legislative acts. I’m not suggesting that these changes are bad. I’m just recounting what has happened to try and see what might happen as we embark on the new ehealth world.
So, what’s in store for health care? Here are some of thoughts on the potential dark side of “ehealth”:
- Everything is electronic: Having your personal health information in an electronic format is very useful and beneficial. But, have you ever thought of the possible negative consequences? I’m not trying to sound alarmist, but let’s examine the possible scenarios. When everything is electronic, this information becomes available to anyone who can legally (or illegally) access it. The Veteran’s Affairs services had a laptop computer containing health information of 26.5 million patients stolen. Luckily the computer was recovered with no apparent information compromised. Does your local family practice have sufficient electronic security and privacy protection in place? Also, when everything is electronic, information (either correct or incorrect) can be spread across the “system” at an alarming rate. We learn from identity theft of credit fraud that having out-dated or incorrect information can be very problematic. Will health care be any different? I honestly don’t know.
- Have you paid your electricity bill? As we move towards everything ehealth, are we setting ourselves up for a calamity? Electricity is something that we all need. If the power black-out of 2002 didn’t remind us, we should take note of what technology firms are doing because of the rising cost of electricity. Google and Yahoo are building server farms in rural areas to get access to electricity and purchasing lower powered equipment. What are our health care organizations and providers doing to ensure there will be electricity during times of crisis? I know that hospitals have gas generators to provide electricity, but petroleum is also becoming very expensive too. If our electrical systems were to go down, how will we get to the data when physical storage (i.e., paper) is no longer maintained? It’s just a thought.
- Me, myself, and I: One of the assumptions with ehealth is that individuals will become “consumers” of health care, thus becoming more responsible over the management of their own health. I’m not opposed to this change as individuals should take care of themselves. But, aren’t we making a big assumption that people want this responsibility? This change means individuals will need to become more responsible over their own health information (e.g., who has access to it, where it is stored, etc.) and coordinating their care. If individuals are to maintain their own personal health records, what technical skills and resources do they need to be able to do this? In the past two weeks, I’ve had two computers die on me – recovering my information was a pain in the ass, but I was able to recover my data. If this happened to my parents when I wasn’t around, they’d be lost. Will individuals (or practitioners) be up to the task?
- The disappearance of the family physician?: Okay, this one’s probably what I’m most interested in. As individuals become more involved and active in their own care, will we see the loss of general practitioners and family physicians? One of the advantages of ehealth is purportedly being able to access services irrespective of geography. In other areas of society, we have seen technology cut out the “middle-men”, allowing the individual to interact directly with the producers of the goods. Does this mean that we will see individual patients contacting specialists directly? Recently, my uncle had a need to see a specialist. Unfortunately, the specialist was only able to see him 6-8 months in the future. So, I asked around to see if some of my physician friends could help my uncle. They were. Unfortunately, my uncle’s family physician decided not to forward a referral and so my uncle couldn’t see the specialist a colleague suggested (even though he could be seen in a week or two). Will patients decide to skip seeing a family physician and go straight to the specialist?
- Health care’s “last mile”: Because health care must be delivered by a person (at least until we develop electronic delivery systems), we still have to deal with what I will call “health care’s last mile”. In the telecommunications industry, the “last mile” is what they call the effort required to get the new technology to the consumer’s home (e.g., high-speed internet). Someone has to go and physically connect and configure connections (depending on the technology). In health care, people are needed to deliver care. Combined with the disappearance of the family physician, will we see our health care evolve into groups of specialists (who diagnose and consult) and nurses (who follow-up on the instructions at the local level)? We see this type of phenomenon occurring in business circles – the “bar-bell” effect. The “middle layers” of organizations are thinned out so that you are left with highly skilled executives overseeing a vast army of workers with very few middle-level managers. Maybe that’s why I don’t see overseas outsourcing as a viable option in healthcare. But, with more electronic resources being developed, what will the role of the family physician be? Nurses, of various qualifications, will likely be around to provide home care services, work in hospitals, and generally deliver care that individual patients cannot.
I’m not suggesting that we revert back to the “good ol’ days” of paper. But, I think we need to examine some of the potential changes that may occur. It’s this idea of informed consent (i.e., being aware of and understanding the potential risks and benefits). Do we really know what will happen as we move towards a completely ehealth system? Have we even thought about this issue? Or are we so enthralled by the new technologies, moving pictures, and sounds that we forget about what the consequences might be? After looking at some of these potential negative aspects/scenarios, I’m still a supporter of ehealth. I just think we need to start thinking more about what we want the technology to do for us, and to accept potential side-effects after some thought, rather than reacting to changes in a haphazard fashion.
One last thought to end this post. Noted futurist, Alvin Toffler, predicted that advanced technological societies will need to deal with something called massification and demassification – I’ll call it the paradox of the individualized groups. Are we going to see a fragmentation of the health care system because of our increased ability to access information and services irrespective of geography?
Author’s Notes:
- I wrote this post using the new plug-in for Microsoft Word. Not sure that I like it, but I’ll give it a few more tries. On the plus, I can write a post without being connected to the Internet with all of the features of Word (I’m not sure if that’s a benefit, but it seems like an advantage over typing in a browser window on Blogger).
- Sorry for not writing posts over this past summer, but I’ve been going through a series of minor health issues that have kept me from doing pretty much anything. As I get over one thing, another issue seems to pop up. Added to all of this fun was the fact that both my laptop and desktop died on me within a span of two weeks. Data recovery and trying to set-up a computer is not fun.
- I have a few other posts planned, so be on the look-out. I’m hoping to write about open source in health care, a summary of my disruptive innovations in health care, and a few others.
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