CIVIL WAR: Protecting Health Information Security

For this week, we were tasked list down questions where answers should be able to identify risks to securing electronic health information. The scenario is that we are part of a group practice that has decided to implement an electronic solution for clinical documentation. However, we came across many horror stories regarding health information security that have led to failed clinical information system implementations. How would you prevent this from happening to your group practice?

To facilitate my discussion, I prepared a short comic strip to lay down the facts and bring to your consciousness the risks in electronic health information. (No copyright infringement intended for the photos and are used for educational purposes only).

Slide1Slide2Slide3Slide4Slide5

Slide6Slide7Slide8Slide9Slide10Slide11Slide12Slide13Slide14Slide15Slide16Slide17

Slide18

Slide19Slide20Slide21Slide22Slide23

Slide24Slide25Slide26

In the scenario above, a breached in the information system happened when an outsider tried to access the system, delete, tamper, and corrupt all the health data stored in the system.

Many factors led to the breach such as blatant disregard for the security of the physical server, weak user authentication, security of the health information, lack of encryption, among others.

This could have been prevented or minimized should the ‘Avengers’ considered and discussed first and foremost the safety and security of the health information system. Here some of the questions that they should have considered answering when they developed the system.

  1. WHO: Who has access to the information? Who can edit and view the codes?
  2. When: When can they access the information?
  3. How: How can they access it? Would it be cloud based, local area network? Exclusive to a identified computer or network?
  4. Where: Where will the main server be stored? Is it safe?
  5. What: What encryption mechanism will be used? What is the back-up mechanism

By answering these questions, although loopholes may still persist, it is somehow reduced.

Advertisements

REVIEW: LOVE YOU TO THE STARS AND BACK

love-you-to-the-stars-and-back-poster.jpg
 
(Spoiler alert)
Wanting to be abducted by the aliens with all the chants and the journey to Mt. Milagros symbolizes death, giving up, and ending one’s suffering. The characters (Caloy and Mika) is too devastated with what’s happening in their lives they’re trying to find the easy way out– get abducted by the aliens. To me, other than the pa-tweetums, kilig, and pacute cute brought by the two young lead stars, the movie delivers a strong message of holding on to life and having that strong will to live because of the people who love you. The story injects the many reasons of why we have to live even if life is difficult, and especially when life is difficult. A reason to hold on and carry on.
 
This reminds me of the #TalkToSomeJUAN video we made for suicide prevention (Check here: bit.ly/MHPHTalkToSomeJuan). “Magpahinga ka, pero wag kang sumuko. May nagmamahal sa yo. ❤ ❤ ❤
 
On Julia and Joshua’s acting. Julia was okay, there was no ‘wow’ moment for her, but overall she was great. I did not expect it from her. She was able to deliver the right act for every scene. Joshua continues to impress me with his acting skill (See Vince, Kath, and James). He’s unexpectedly good! He is very natural, charming, and convincing. Although alam ko may ikalilinis pa ang acting niya para sobrang on point talaga. Pero pagaling siya ng pagaling! Ahh. #DiscreetJoshLiaFan talaga si aquh hihi.
 
Lastly, cinematography and scoring. Ganda ng mga locations na pinili nila at ang ganda ng nag color grade! Nakakakilig ng kantang Torete. Nakaka LSS. haha! Gusto ko yung iniba iba nila ng treatment ang kantang Torete. Galing!
 
Overall: Yes, sobrang worth it niya panoorin! Please support! 🙂 #ArtAppreciation

THE WALL: Implementation of Electronic Medical Record

For this week we’ve been tasked to highlight three barriers to EHR implementation that we believe to be the most important ones that might adversely affect your implementation. 

To “creatively” discuss my points, I’m going to use some pop reference from the recently concluded season of Game of Thrones.

A brief background of myself before proceeding, I am Roy Dahildahil, a BS Public Health graduate from UP Visayas. For the past two years I’ve been working in National Telehealth Center (NTHC) and traveled to different Rural Health Units and Hospitals in different municipalities in the Philippines. NTHC is the institution that pioneered Community Health Information System (CHITS) that has been implemented to 160+ RHUs all over the Philippines. And thus, in addition to the articles provided to us, majority of my points are based on the stories and concerns I received while doing the field work.

  1. Change in workflow; cause of delays. Waiting

The initial implementation of the EMR is faced with a lot of challenges and adjustments to the Physicians. Especially those who are not tech savvy, or not into computers. Although, generation of reports, and some point and click functions of the EMR makes the job faster, when the Physician is not very adept to computer i.e. slow typing skills, visually challenged, not friends with their mouse or track pad, the usual encounter with the patient could actually be more time consuming because of EMR. Some of the Physicians I met in the field are more accustomed to writing and actually prefers to write. Challenge now happens when they are now forced to use the keyboard instead of pen. Their writing speed is not always proportional to their typing speed. Thus longer queues in the clinic.

In addition, since EMR are housed usually in a computer (others in a tablet), technology sometimes fails them. Lag, errors, loading, and other technical difficulties are often encountered why they are at point of care. This error, regardless how faultless techs are, are unavoidable.

2. Implementation CostsFinancial

In every municipality I’ve been to and physicians I talked to, I’ve always been asked about the cost of the project. I only thought about the “cost of buying project”, thus I always think it’s free. But then, as I went to other municipalities and witnessed how the RHU squeeze their budget to purchase additional computers, routers, keyboards, laptops, etc. in order to implement the project; I realized there is more (cost) than just buying the project. Human resource, facilities, equipment, and maintenance costs should be considered. In one of the RHUs I’ve been to, because of this additional costs the physician opted not to adopt the system because it is not the priority of their budget. If the plan is to implement EMR all over the Philippines, the government should plan how to lessen and eliminate the costs of implementing the EMR.

3. Not all Physicians are tech savvy

Training and expertise

Somehow related to number 1, struggle of some physician to fully implement the EMR is the fact that they have to learn how to use the computer . This is I think the very minimum requirement. However, most implementers assumes that physicians have background or efficient in using their computers. Only a few or none actually go back and train the basics of using a simple computer. Understanding how to use the EMR in itself is challenging, how much more to doctors who don’t even understand how to use the computers. As DOH program manager, or implementer, before conducting the training I should conduct training needs analysis and ensure that all of the physician being trained to implement EMR knows and has the basic skill set in using a computer or gadget (depends on platform)

4. Leadership and political will

leadership 2

Lastly, big factor for the nurses and midwives I’ve been to in implementing the EMR is the leadership of the doctor. When the doctor himself doesn’t use or reinforces his staff to use the technology, the technology always fails. In the same way with the physicians, should EMR be strongly implemented, a higher governing body must be strong and firm enough (on the premise that 1-3 are addressed) to reinforce his constituents to use the technology. For sure, at certain time it will be part of their system and will get use to using. It still boils down in institutionalizing the implementation of the EMR. A big step that could be achieved with strong political will of the leader governing them.

 

 

Credits to the owner of the Game of Thrones memes. 

Journal Digest: Understanding Factors Influencing the Adoption of mHealth in Elderly

For the requirement of this course, we were tasked to digest an academic journal relating to the adoption or use of an any telehealth system.  I chose this article from the 2017 International Journal of Medical Informatics published by Rakibul Hoque  and Golam Sorwar, “Understanding factors influencing the adoption of mHealth by the elderly: An Extension of the UTAUT model”.

You can access the abstract of the article here.

Unified Theory of Adaption and Utilization of Technology (UTAUT) was first described by Venkatesh et al in 2002 to explain user intentions to use a technology and subsequent use of the technology [1]. UTAUT suggest that there are four main constructs that determines user’s intent to use, and use behavior: Performance Expectancy (PE), Effort Expectancy, (EE) Social Influence (SI), and Facilitating Conditions (FC). PE, EE, SI are direct determinants of behavioral Intention(BI) where BI determines Use Behavior, while facilitating condition is a direct determinant of Use Behavior (Figure 1) [1].

4-Figure1-1

Further, there are four factors that moderates the determinants of the four constructs: Gender, Age, Experience, Voluntariness of Use.

In the paper of Hoque and Sorwar, they explored further the applicability of the model to the elderly population, and hypothesized two new factors that might affect behavior intent: Technology Anxiety and Resistance to Change.

They were testing the following hypothesis.

H1. PE has positive impact on the elderly’s intention to use mHealth
H2. EE has a positive impact on the elderly’s intention to use mHealth.
H3. SI has a positive impact on the elderly’s intention to use mHealth.
H4. FC has a positive impact on the elderly’s inention to use mhealth.
H5. FC has a positive impact on the elderly’s actual use of mHealth.
H6. BI has positive impact on the actual use of mHealth.
H7. (New) TA has negative impact on the elderly’s intention to use mHealth.
H8. (New) RC has a negative impact on the elderly’s intention to use mHealth.

The eight (8) hypothesis can be summarize by the figure below.

Summary.png

The study found out that performance expectancy, effort expectancy, social influence, technology anxiety, and resistance to change had significant impact on the user’s behavioral intention to adopt mHealth services. The facilitating condition, however, showed no significant relation to behavioral intention to adopt mhealth Services. 

This study is significant in the Philippine setting as the mobile penetration rate of the country as of 2016 is at 87%[3]. Also, hospitals in Geographically Isolated Areas and other Rural Health Units are now gearing towards improvisation of health systems by implementing telehealth services such as electronic medical records, telemedicine, etc. This initiatives are supported by private institutions, NGOs, and government offices (DOH, DOST, PhilHealth etc.). some projects are even lead by these government offices themselves. However, although the the intentions of implementing these initiatives are good, there are very few studies conducted in the Philippines on how these technologies be easily adopted by the end users, and thus sustainable also. Adding to the fact, that majority of the implementers of these technologies, especially in Rural Health Units, are tenured individuals and therefore (most but not all) belong to an older age bracket. This recent study emphasizes special consideration to the elderly and adds new factors to test and consider to improve behavioral intent, and use behavior.

References:

1. V. Venkatesh, M.G. Morris, G.B. Davis, F.D. Davis, User acceptance ofinformation technology: toward a unified view, MIS Q. 27 (3) (2003).

2. R. Hoque, G. Sorwar, Understanding factors influencing the adoption of mHealth by the elderly: An extension of the UTAUT model

3. http://wearesocial.com/uk/special-reports/digital-in-2016

The Night We Met

by Lord Huron
The Night We Met
I am not the only traveler
Who has not repaid his debt
I’ve been searching for a trail to follow again
Take me back to the night we met
And then I can tell myself
What the hell I’m supposed to do
And then I can tell myself
Not to ride along with you
I had all and then most of you
Some and now none of you
Take me back to the night we met
I don’t know what I’m supposed to do
Haunted by the ghost of you
Oh, take me back to the night we met
When the night was full of terrors
And your eyes were filled with tears
When you had not touched me yet
Oh, take me back to the night we met
I had all and then most of you
Some and now none of you
Take me back to the night we met
I don’t know what I’m supposed to do
Haunted by the ghost of you
Take me back to the night we met

Off the Grid

I (was and) will be off the grid indefinitely to physically, mentally, and emotionally prepare for July onwards. 

Beginning and the entire month of May took a toll on me that the dark cloud almost got me. I was slipping to wilderness, I almost lose control. I almost did something irreversible.

These coming days, things will be different. I’m not sure if it will be better or it will be more difficult. But for whatever the universe gives me, I have to be emotionally, physically, and mentally ready. 

I have to be grounded, focused, and balanced.

Breathe, let go, and let life happen.

20170605

I hope (and I know) that someday you will find someone who will love you more than I have loved you; and who will not hurt you the way that you hurt me.