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● Tactical Operations

example, a nurse or doctor jots down a few notes after meeting with a patient and then walks up to a local scanning device, such as a multifunction printer (MFP) or scanner, and scans in the document. T is solves the time issue in the centralized approach, but it requires careful attention to who has access to the scanning application as well as how the information is categorized and added to the electronic record. Given the abundance of paper in healthcare, the optimal

approach to paper documents is not an either/or solution, but rather may be a complementary workfl ow that includes both centralized and decentralized components, especially as organizations make the shift to hybrid paperless systems.

Ensure security, manage output and cut costs While the benefi ts of electronic data are signifi cant, so is the need to implement strict security safeguards and moni- tored access with respect to this data. HIPAA was originally enacted to ensure confi dentiality and availability of patient records, but has recently evolved with the Omnibus Rule, which adds data privacy regulations and stricter penalties. With these changes, those impacted by non-compliance now include business associates of medical offi ces, and civil penalties can reach up to $250,000 for fi rst-time of- fenses, and up to $1.5 million for repeated off enses. For healthcare providers, this means added incentive to ensure all electronic health records and information are secure and meet applicable compliance standards. T e importance of safeguarding patient data, especially in the modern healthcare climate, may seem obvious. But understanding where information is accessible, and there- fore potentially vulnerable, isn’t always evident. Printers and MFPs have hard drives that store data similar to those on computers and mobile devices. T is means that residual data may remain on a printing device after recent tasks have been completed. Further, printed and faxed documents with PHI may be left on a MFP’s output tray, creating the potential for exposure to unintended personnel and possible serious regulatory breaches. A few simple steps can help prevent such data breaches and should be standard practice for modern-day healthcare IT. For instance, authenticating MFP users through card or keypad access will help control who within the organization can use specifi c features like copy, scan, send and print. Each transaction can be recorded to make responding to a security incident a more informed process. In addition, consider encrypting your devices’ hard disks to protect the stored data and make it unreadable to unauthorized par- ties. T is will help limit the amount of people who have access to data traveling into (or out of) your MFP. Further, features like secure printing allow employees to queue a document to print and then hold it until the user logs in at the desired device, helping to prevent patient data from sitting on a device’s outbox. Also, many network scanners off er added security with a fi ngerprint reader to verify the identity of registered users. Features that ensure device security, such as authentica- tion, also help health IT departments monitor usage and manage output costs. For example, output management

14 June 2014

HL7 FHIR when ready

As a society that is always looking for “the next big thing,” we constantly think about ways to build upon existing technology to create something better, but sometimes there is lag between vision and execution. Arguably, no industry feels this painful gap as keenly as healthcare. The primary goal of healthcare organizations, after all, is delivering the best care to their patients. Everything else comes second. Outdated systems, incompatible platforms, disparity in employees’ IT savvy, and lack of time and resources have created a perfect storm of frustration for physician practices, hospitals, clinics and health systems alike - regardless of size or revenue.

Willie Tillery, Director of

Image Exchange, Nuance


Unfortunately, in our current healthcare system, barriers to sharing information often are tied to technological incompatibility or systems that don’t talk to each other. In fact, Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center and Co-Chair of the Federal Health IT Standards Committee, recently remarked to Dr. Keith Dreyer, Vice Chairman of Radiology at Massachusetts General Hospital at a technology panel, “Our institutions are actually 50 feet away from each other. How often in the last 10 years have we exchanged images electronically between our two institutions? Not so much.” Although this elicited a laugh from those in attendance, the underlying truth is unnerving And that is what is so promising about HL7’s Fast Health

Interoperable Resource (FHIR) initiative. While some have pointed out it is too flexible to be a standard, I would note its intrinsic value to healthcare. It allows organizations to develop customized bridges between systems, leveraging cloud-based apps and device integration to drive more tailored workflows for clinical teams. The end result is better information in less time, collaborative care and better patient outcomes. In radiology, we are starting to see the benefits of

interoperability with image-sharing networks, which are being used to exchange billions of images between clinicians, patients and healthcare organizations to participate in collaborative patient care. Relying on the simplicity of social networks, image-sharing networks enable an individual to upload images and reports to a secure, cloud-based server and share a link for that particular image with a physician, specialist or other relevant party. These images are available to ordering and treating clinicians within their electronic health record (EHR) workflow. This simple interface removes the need for a user to log in to a virtual private network (VPN) or on-premise servers, which can be expensive and complicate the process. With such a long and costly history of cumbersome health IT technologies, it is not a surprise that organizations are skeptical of health information exchanges (HIE). It will take small steps and carefully thought-out processes, but it is clear that we are heading toward light-weight interoperability that will use different modules that can be integrated into the EHR to provide instant access to life-saving data.


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