#ConnectAThon

[faiz-shaikh01]

Boost your marketing game with Connect-A-Thon! 💡📊 Develop cutting-edge strategies for brand visibility in finance.

Join the revolution! For more information, visit www.worldtradingleagues.com

[april]

linkedin is kind of a collectathon if you're using it right

[worldtonki]

Thon mail call

THON MAIL CALL HOW TO

THON MAIL CALL UPDATE

THON MAIL CALL ANDROID

THON MAIL CALL SOFTWARE

Step 2: Under All apps, tap on the three-dot icon at the top-right corner. Step 1: Open Settings and go to Apps/Application Manager. To reset app preferences, follow these steps: Again, that will not delete any data, but some settings such as notifications, permissions, etc. Reset App PreferencesĪs the issue is with the phone app mainly, resetting app preferences could prove beneficial to you like many other users out there. If it’s still there, tap on Clear data/storage depending on the option available on your phone. Restart your device and see if the issue is gone. Step 2: Tap on the Phone app followed by Storage. Step 1: Open Apps/Application Manager under Settings. To clear cache and data, follow these steps: Kindly note, clearing data will clear your call history and reset the Phone app settings. If clearing cache doesn’t help, delete data for the app. Don’t worry as doing that won’t delete your data. Then again select ‘Make Sound and pop up on Screen.’ Note: Clear Cache and DataĪnother simple solution that you should try is clearing the cache for the Phone app. If it’s already set to that, change it to some other option to reset the setting. Change it to ‘Make Sound and pop up on Screen.’ Tip: If the behavior shows ‘Show silently and minimize,’ you have found your culprit. Make sure Show notification toggle is enabled.

THON MAIL CALL ANDROID

Tap on Notifications (on Android Pie devices) and App notifications (Oreo). Step 1: Open Settings on your phone and go to Apps/Application Manager. To check and change the settings, follow these steps:

THON MAIL CALL UPDATE

However, you will be able to change it if an app or update caused to change it. Usually, one cannot even change the setting as it is grayed out. Enable Notifications for Incoming CallsĮven though the notifications for incoming calls are enabled by default on every phone, sometimes a third-party app, or an update changes the setting. Restart your phone and see if the problem is solved. Restart Your Phoneīefore tinkering with any setting, let’s try the supreme solution of all. Let’s check out what you need to do to fix the issue of call screen not visible for incoming calls. You just need to tweak a few settings, and everything is going to be alright. Jembi Health Systems NPO, its subsidiaries and associated companies is not liable for the security of information sent by e-mail and accepts no liability of whatsoever nature for any loss, damage or expense resulting, directly or indirectly, from the access of this e-mail or any attachments hereto.If you are also facing a similar issue, don’t worry. If you are not the intended recipient you must not use, disclose, distribute, copy, print or rely on this e-mail. If an addressing or transmission error has misdirected this e-mail, please notify the author by replying to this e-mail and then deleting same. This e-mail contains proprietary and confidential information some or all of which may be legally privileged. Self-organise into learning sessions and create breakaway groups to discuss topics / show ideas.Jointly work together to implement common use-cases within an OpenHIE architecture.

THON MAIL CALL HOW TO

Learn how to implement workflows within their tools.

Connect existing tools to OpenHIE foundational registries.

The attendees of the connect-a-thon are aiming to: Recognising that many attendees may be new to OpenHIE there is no better way than actively engaging in designing, developing, configuring, implementing and connecting to an OpenHIE architecture to learn the fundamentals and build the relationships that you will need going forward. Combining the principles of a connectathon and a hackathon we are excited to provide a space for teams to connect their existing tools to OpenHIE workflows and use-cases as well as give the community an opportunity to propose low hanging fruit use cases for the groups to work on.

THON MAIL CALL SOFTWARE

This is a technical space for software teams and architects to engage and get their “hands-in” or “on” OpenHIE itself and see it materialised. The OpenHIE Hackonnect-a-thon is a merger of two exciting types of meetings. See here for an idea of some of the tools and challenges that were addressed at last year’s Hackonnect-a-thon. If so, please add this directly to the Hackonnect-a-thon wiki page, or alternately, let me know here and I’ll add it in.**

Do you have a challenge you’d like to see addressed at this year’s Hackonnect-a-thon?.

**- Do you have an OpenHIE component tool/solution that you can make available for participants at the event? The OHIE 19 Hackonnect-a-thon is scheduled for Friday 8th November at this year’s OpenHIE Community Meeting, and we’re looking to the community to bring their technical strengths and priority use cases to the table.

[schmanguss]

#Cleveland #conference #exploring #fooding #cocktails #burgers #kielbasa #pierogis #lunch #travels #worktrip #connectathon #interoperability #clinicalsolutions @harryraj93 #tourguide (at Cleveland, Ohio) https://www.instagram.com/p/B7r-hHijT7a/?igshid=1rrwde3ixp4ai

[sparrowsabre7]

Carried on my connectathon and set up more chiral network knots. Had a rather hairy trip through MULE territory (enemy scavengers). I walked right up to one of their sensors thinking it was left by another player but then it pinged and in the distance I saw some people start to scurry over.

I have to say it was pretty intense. They never got too close but in a way that was more eerie, just seeing these malevolent forces seeking you, hunting you, while powerless.

Something was wrong with BB so had to plug her in at the nearest facility, whereupon Deadman dropped some creepy af knowledge about how BBs work. They are connected to the world of the dead through their "stillmothers", braindead women.

So far that's not great on the feminism front. We've had the obligatory femme fatale/possible love interest, a dead mother, a damsel, and now a bunch of almost literal women in fridges keeping the BBs working. Boy are we checking off the stereotypical women tropes quickly, Hideo.

Heartman keeps insisting I piss, shit, and shower, for "research" which is still creepy. Plus the hilarious "watch Ride with Norman Reedus on AMC" each time you take a dump. I know Kojima's never been shy about leaning on the fourth wall but that's a bit kick it down and punch you in the face.

[azveille]

Cinq orientations et vingt-six actions articulent la feuille de route du numérique en santé

Attendue, la feuille de route qui articulera le numérique en santé pour les trois prochaines années a été présentée. Pilotée par une délégation ministérielle, elle permettra entre autres d'intensifier la sécurité et l'interopérabilité des systèmes d'information. Des mesures auxquelles ont été intégrés les établissements sociaux et médico-sociaux.

Il manquait une vision globale au numérique en santé, c'est désormais chose faite avec la présentation ce 25 avril de la feuille de route "Accélérer le virage numérique". La ministre des Solidarités et de la Santé, Agnès Buzyn, l'a souligné : "Aujourd'hui, l'État se dote d'une vision stratégique" qu'il propose à tous les acteurs concernés. Articulée autour de cinq orientations déclinées en vingt-six actions (à télécharger ci-dessous), elle sera portée par une gouvernance consolidée "afin de cibler toutes les parties concernées", à savoir la Délégation ministérielle du numérique en santé (DNS). Copilotée par Dominique Pon et Laura Létourneau, respectivement responsable et déléguée ministériels du numérique en santé (lire notre article), elle est symboliquement, et en guise de signal fort envoyé à l'ensemble de l'écosystème, rattachée directement au ministère de la Santé. "Le souci et la réflexion qui nous ont animés est qu'il faut être pragmatique avec une gouvernance forte tout en restant souple et agile", a expliqué Dominique Pon.

Une DNS comme pilote

Sa mission, est-il rappelé dans le document de présentation, est de "définir la politique du numérique en santé, d'en garantir la cohérence au travers de ses arbitrages, de soumettre annuellement à la ministre une feuille de route et les budgets associés, de coordonner l'ensemble des acteurs institutionnels nationaux et régionaux et de superviser le pilotage de l'ensemble des chantiers". Elle intègrera une partie de la délégation à la stratégie des systèmes d'information (DSSIS) actuelle ainsi que la délégation à la stratégie d'information en santé (Spis). De son côté, l'Agence des systèmes d'information partagés de santé (Asip Santé) cesse d'exister pour devenir officiellement en décembre 2019 l'Agence du numérique en santé (ANS). Sa mission est recentrée sur la mise en œuvre opérationnelle de la stratégie définie par la DNS. Cette dernière assurera le pilotage resserré de cette nouvelle agence. Le versant éthique, cher à Dominique Pon et Laura Létourneau, n'est pas oublié puisqu'une cellule dédiée — "garante d'un cadre de valeurs humanistes" — sera créée au sein du Conseil du numérique en santé. Ce dernier sera quant à lui relancé comme instance de concertation sur le virage numérique en santé. La prochaine réunion est d'ores et déjà programmée pour juin prochain.

Nouvelle directrice de l'ANS

La ministre des Solidarités et de la Santé, Agnès Buzyn, a décidé de nommer comme directrice de l'Agence du numérique en santé (ANS), Annie Prévot. Elle pendra ses nouvelles fonctions le 1er juillet prochain, a indiqué Dominique Pon, responsable ministériel du numérique en santé. Annie Prévot est l'actuelle directrice des systèmes d'information de la Caisse nationale des allocations familiales (Cnaf). Au passage, Dominique Pon a remercié Pascale Sauvage qui assurait l'intérim de la direction de l'Agence des systèmes d'information partagés de santé (Asip Santé, lire notre article).

Un fournisseur national d'identité sectoriel

La feuille de route s'appuiera également sur une doctrine technique assortie d'un schéma d'architecture cible. Cette "bible du numérique en santé", comme l'a qualifiée Dominique Pon, sera élaborée avec les acteurs concernés. Une première version sera disponible en septembre et soumise ensuite à concertation jusque fin 2019 afin de disposer dès 2020 d'un schéma technique pour que tout le monde se positionne. Comme l'a détaillé lors du Connectathon Laura Létourneau (lire notre article), cette doctrine s'appuiera sur un "socle de base de la e-santé", "indispensable". Elle a d'ailleurs indiqué ce 25 avril que ces "fondations" sont "régaliennes" et correspondent à la traduction technique des valeurs portées par l'État. Ces services socles permettront en outre "que tous les services développés prennent racine dans un espace de confiance, sécurisé et qu'ils jouent le jeu de l'ouverture et donc de l'interopérabilité". Dans ce cadre, les bases de données mais aussi les référentiels doivent être travaillés, a poursuivi Laura Létourneau. "Il est nécessaire que, par exemple, les auxiliaires de vie puissent être identifiés comme tels dans un référentiel national et puisse se connecter de manière simple", a-t-elle détaillé. Dans ce cadre, l'identification numérique des acteurs du système de santé sera généralisée d'ici fin 2021 et la e-carte professionnel de santé (e-CPS), assortie d'un fournisseur national d'identité sectoriel, dit pro-santé connect, pour l'authentification numérique des acteurs de santé, sera mise à disposition. De premiers tests avec l'Assurance maladie et les industriels auront lieu à partir de juin jusque décembre.

Un plan ESMS numérique

Un plan de financement pluriannuel dont l'amorçage serait assuré par la Caisse nationale de solidarité et de l'autonomie (CNSA) sur ses fonds propres doit être engagé et ceci afin de combler le retard des établissements sociaux et médico-sociaux (ESMS), indique la feuille de route. Ce plan ESMS numérique, au-delà du soutien à l'investissement, doit permettre l'élaboration d'un dispositif d'accompagnement sur l'ensemble des enjeux des systèmes d'information (SI). Par ailleurs, et dans la lignée de ce que le rapport de Dominique Libault a préconisé (lire notre article), il est nécessaire d'harmoniser les SI de gestion de la prestation autonomie sur 2020-2024, afin de créer un fichier national des bénéficiaires. Enfin, afin d'inscrire le développement des SI des établissements de santé publics et privés, un référentiel et un dispositif de certification devront être élaborés en concertation avec les parties prenantes concernées. Une déclinaison sera prévue pour les SI médico-sociaux en tenant compte de leur maturité et en proposant des guides de référence pour le choix des solutions logicielles. Un groupe de travail pour élaborer ce référentiel sera mis en place en octobre 2019 avec de premiers pilotes au deuxième semestre 2020 pour une généralisation sur 2021-2022.

Focus sur la sécurité

La sécurité opérationnelle des systèmes numériques en santé sera renforcée. Dans ce cadre, le dispositif de déclaration des incidents de sécurité sera étendu en 2020 à l'ensemble des acteurs de santé. Et, surtout, un service national de cybersurveillance en santé sera mis en place. Le but étant, avec ces deux mesures, de rechercher et de détecter de façon préventive les failles potentielles des systèmes numériques en santé face aux cyberattaques.

Mise en place de structures 3.0 tests

Côté start-up, la DNS prévoit la création en son sein d'un lab e-santé qui se positionnera comme un guichet national de l'innovation du numérique en santé. Il permettra, a détaillé Dominique Pon, de tester de nouveaux concepts, de les diffuser mais aussi d'aiguiller les acteurs du marché dans l'ensemble des dispositifs existants. Ce lab, créé en mars 2020, pourra aussi mettre en relation des concepteurs, des utilisateurs et des investisseurs. En juin 2020, la DNS prévoit aussi de lancer un appel à candidatures pour créer et piloter un réseau national de structures dites 3.0 (hôpitaux, pharmacies, Ehpad, maisons de santé...). L'objectif, a expliqué Dominique Pon, est de tester en conditions réelles les innovations proposées par les start-up, avec pour chaque innovation un rapport d'évaluation. En outre, un tour de France de la e-santé sera organisé dans toutes les régions pour coconstruire la feuille de route "au plus proche des acteurs", a souligné le délégué ministériel. Ces rencontres auront lieu dès le mois de septembre jusque février 2020. Avec ces différentes actions, une nouvelle étape est franchie, a indiqué la ministre de la Santé. "Il s'agit désormais de mettre en mouvement", a-t-elle ajouté. Et les moyens financiers seront au rendez-vous des besoins, a souligné Agnès Buzyn, rappelant que des enveloppes sont déjà engagées avec le programme Hop'en, le dossier médical partagé ou encore la télémédecine, etc. Autant de dispositifs qui participent à la construction du numérique en santé.

Les cinq orientations de la feuille de route :

renforcer la gouvernance du numérique en santé (actions 1 à 3) ;

intensifier la sécurité et l'interopérabilité des systèmes d'information en     santé (actions 4 à 9) ;

accélérer le déploiement des services numériques socles (actions 11 à 14) ;

déployer au niveau national des plateformes numériques de santé (actions 15 à 17) ;

stimuler l'innovation et favoriser l'engagement des acteurs (actions 19 à 26).

[biztalkin]

The First Microsoft HL7 FHIR Implementation

The First Microsoft HL7 FHIR Implementation

My co-author Vikas Bhardwaj and myself took part in the 5th HL7 FHIR Connectathon

The 5th HL7 FHIR connectathon was held in San Antonio on January 18/19, 2014. This video provides some impressions from the connectathon, it contains statements by the attendees as well as presentations of those that implemented/tested their application during the connectathon.

We wanted to demonstrate how…

[healtycaremega]

A Brief Reflection on 3 decades of interoperability at The IHE USA Connectathon conference

http://bit.ly/2GeKjjZ

[sandovaldeb94]

A Brief Reflection on 3 decades of interoperability at The IHE USA Connectathon conference

http://dlvr.it/RNYnqy

[kristinsimmons]

Patient-Directed Uses vs. The Platform

By ADRIAN GROPPER, MD

It’s 2023. Alice, a patient at Ascension Seton Medical Center Austin, decides to get a second opinion at Mayo Clinic. She’s heard great things about Mayo’s collaboration with Google that everyone calls “The Platform”. Alice is worried, and hoping Mayo’s version of Dr. Google says something more than Ascension’s version of Dr. Google. Is her Ascension doctor also using The Platform?

Alice makes an appointment in the breast cancer practice using the Mayo patient portal. Mayo asks permission to access her health records. Alice is offered two choices, one uses HIPAA without her consent and the other is under her control. Her choice is:

Enter her demographics and insurance info and have The Platform use HIPAA surveillance to gather her records wherever Mayo can find them, or

Alice copies her Mayo Clinic ID and enters it into the patient portal of any hospital, lab, or payer to request her records be sent directly to Mayo.

Alice feels vulnerable. What other information will The Platform gather using their HIPAA surveillance power? She recalls a 2020 law that expanded HIPAA to allow access to her behavioral health records at Austin Rehab.

Alice prefers to avoid HIPAA surprises and picks the patient-directed choice. She enters her Mayo Clinic ID into Ascension’s patient portal. Unfortunately, Ascension is using the CARIN Alliance code of conduct and best practices. Ascension tells Alice that they will not honor her request to send records directly to Mayo. Ascension tells Alice that she must use the Apple Health platform or some other intermediary app to get her records if she wants control.  

Disappointed, Alice tells Ascension to email her records to her Gmail address. In a 2021 settlement with the Federal Trade Commission, Facebook and Google agreed that they will not use data in their messaging services for any other purposes, including “platforms”. Unfortunately, this constraint does not apply to smaller data brokers.

Alice gets her records from Ascension the old-fashion way, by plain Gmail under the government interpretation of her right of access. The rules even say that Alice can request direct transmission of her records in an insecure manner such as plain email if she chooses. But Alice can’t send them directly to Mayo because Mayo, also following CARIN Alliance guidelines, insists that Alice install an app on her phone or sign up for some other platform. 

Alice wonders how we got from clear Federal regulations for patient-directed access to anywhere to the situation where she’s forced to wait days for her records, receive them by email and then mail them to Mayo. Alice wonders.

—

It’s December 2019. 

This post is about the relationship between two related health records technologies: patient-directed uses of data and platforms for uses of patient data. As physicians and patients, we’re now familiar with the first generation of platforms for patient data called electronic health records or EHR. To understand why CARIN matters, the only thing about EHRs that you need to keep in mind is that neither physicians nor patients get to choose the EHR. The hospitals do. The hospitals now have bigger things in mind, but first they have to get past the frustration that drove the massively bipartisan 21st Century Cures Act in 2016. The hospitals and big tech vendors are preparing for artificial intelligence and machine learning “platforms”. Patient consent and transparency of business deals between hospitals and tech stand in their way.

A platform is something everything else is built on. The platform operator decides who can do what, and uses that power for profit. We’re familiar with Google and Apple as the platforms for mobile apps. Google and Apple decide. A platform for use of health data will have the inside track on machine learning and artificial intelligence for us as patients and doctors. The more data, the better. What will be the relationship between the hospital controlled platform of today’s EHRs and tomorrow’s AI-enabled platforms? Will patients choose a doctor, a hospital, or just send health records to the AI directly? Will US health AI compete with Chinese AI given that the Chinese AI has access to a lot more kinds of data from a lot more places? The practices that will control much of tomorrows digital health are being worked out, mostly behind closed doors, by lobbyists, today.

Three years on, the nation still awaits regulations on “information blocking” based on the Cures Act. Even so, American Health Information Management Association (AHIMA), American Medical Association (AMA, American Medical Informatics Association (AMIA), College of Healthcare Information Management Executives (CHIME), Federation of American Hospitals (FAH), Medical Group Management Association (MGMA), and Premier Inc. are sending letters to House and Senate committees hoping for a further delay of the regulations. 

Access to vast amounts of patient data for machine learning is also driving efforts to weaken HIPAA’s already weak privacy provisions. Here’s a very nice summary by Kirk Nahra. Are we headed for parity with Chinese surveillance practices? 

For their part, our leading health IT academics propose “… strengthening the federal role in protecting health data under patient-mediated data exchange…” Where is this data we’re protecting? In hospital EHRs, of course. We’re led to believe that hospitals are the safe place for our data and patient-directed uses need to be “balanced” by the risk of bypassing the hospitals and their EHRs. Which brings us back to CARIN Alliance as the self-appointed spokes-lobby for patient-directed health information exchange.

According to CARIN, “Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR § 164.524) and requests their digital health information from a HIPAA covered entity (CE) via an application or other third-party data steward.” (emphasis added) A third-party data steward is a fancy name for platform. But do you or your doctor need a platform to manage uses of your data?

HIPAA does not say that the individual right of access has to involve a third party data steward. We are familiar with our right to ask one hospital to send health records directly to another hospital, or to a lawyer, or anywhere else using mail or fax. But CARIN limits the patient’s HIPAA right of access dramatically: “All of the data exchange is based on the foundation of a consumer who invokes their individual right of access or consent to request their own health information. This type of data exchange does not involve any covered entity to covered entity data exchange.” (emphasis added)

By restricting the meaning of patient-directed access beyond what the law allows, everybody in CARIN gets something they want. The hospitals get to keep more control over doctors and patients while also using the patient data without consent for machine learning and artificial intelligence in secret business deals. The technology vendors get to expand their role as data brokers. And government gets to outsource some of their responsibility for equity, access, and patient safety to private industry. To promote these interests, the CARIN version of patient-directed access reduces the control over data uses for physicians as well as patients much beyond what the law would allow.

The CARIN model for digital health and machine learning is simple. Support as much use and sale by hospitals and EHR vendors without consent while also limiting consented use to platform providers like Amazon, Google, IBM, Microsoft, Oracle and Salesforce, along with CARIN board member Apple. 

CARIN seems to be a miracle of consensus. They have mobilized the White House and HHS to their cause. Respected public interest organizations like The Commonwealth Fund are lending their name to these policies. Is it time for this patient advocate to join the party?

Some of what CARIN is advocating by championing the expansion of the FHIR interface standards is worthwhile. But before I sign on, what I want CARIN to do is:

Remove the scope limitation on hospital-to-hospital patient-directed sharing.

Suspend work on the Code of Conduct – here’s why.

Separate work on FHIR data itself from work on access authorization to FHIR data.

Do all work in an open forum with open remote access, open minutes, and an email list for discussion between meetings. Participation in the HEART Workgroup (co-chaired by ONC) and also designed to promote patient-directed uses would be part of this.

Digital health is our future. Will it look like The Mayo Platform with Google and Google’s proprietary artificial intelligence behind the curtain? Will digital health be controlled by proprietary and often opaque Google or Apple or Facebook app store policies?

The CARIN / CMS Connectathon and CARIN Community meeting are taking place this week.  Wouldn’t it be a dream if they would engage in a public conversation of these policies from Alice’s perspective. And for my friends Chris and John at Mayo, what can they do to earn Alice’s trust in their Platform by giving her and her doctors unprecedented transparency and control.

Adrian Gropper, MD, is the CTO of Patient Privacy Rights, a national organization representing 10.3 million patients and among the foremost open data advocates in the country.

The post Patient-Directed Uses vs. The Platform appeared first on The Health Care Blog.

Patient-Directed Uses vs. The Platform published first on https://wittooth.tumblr.com/

[lauramalchowblog]

Patient-Directed Uses vs. The Platform

By ADRIAN GROPPER, MD

It’s 2023. Alice, a patient at Ascension Seton Medical Center Austin, decides to get a second opinion at Mayo Clinic. She’s heard great things about Mayo’s collaboration with Google that everyone calls “The Platform”. Alice is worried, and hoping Mayo’s version of Dr. Google says something more than Ascension’s version of Dr. Google. Is her Ascension doctor also using The Platform?

Alice makes an appointment in the breast cancer practice using the Mayo patient portal. Mayo asks permission to access her health records. Alice is offered two choices, one uses HIPAA without her consent and the other is under her control. Her choice is:

Enter her demographics and insurance info and have The Platform use HIPAA surveillance to gather her records wherever Mayo can find them, or

Alice copies her Mayo Clinic ID and enters it into the patient portal of any hospital, lab, or payer to request her records be sent directly to Mayo.

Alice feels vulnerable. What other information will The Platform gather using their HIPAA surveillance power? She recalls a 2020 law that expanded HIPAA to allow access to her behavioral health records at Austin Rehab.

Alice prefers to avoid HIPAA surprises and picks the patient-directed choice. She enters her Mayo Clinic ID into Ascension’s patient portal. Unfortunately, Ascension is using the CARIN Alliance code of conduct and best practices. Ascension tells Alice that they will not honor her request to send records directly to Mayo. Ascension tells Alice that she must use the Apple Health platform or some other intermediary app to get her records if she wants control.  

Disappointed, Alice tells Ascension to email her records to her Gmail address. In a 2021 settlement with the Federal Trade Commission, Facebook and Google agreed that they will not use data in their messaging services for any other purposes, including “platforms”. Unfortunately, this constraint does not apply to smaller data brokers.

Alice gets her records from Ascension the old-fashion way, by plain Gmail under the government interpretation of her right of access. The rules even say that Alice can request direct transmission of her records in an insecure manner such as plain email if she chooses. But Alice can’t send them directly to Mayo because Mayo, also following CARIN Alliance guidelines, insists that Alice install an app on her phone or sign up for some other platform. 

Alice wonders how we got from clear Federal regulations for patient-directed access to anywhere to the situation where she’s forced to wait days for her records, receive them by email and then mail them to Mayo. Alice wonders.

—

It’s December 2019. 

This post is about the relationship between two related health records technologies: patient-directed uses of data and platforms for uses of patient data. As physicians and patients, we’re now familiar with the first generation of platforms for patient data called electronic health records or EHR. To understand why CARIN matters, the only thing about EHRs that you need to keep in mind is that neither physicians nor patients get to choose the EHR. The hospitals do. The hospitals now have bigger things in mind, but first they have to get past the frustration that drove the massively bipartisan 21st Century Cures Act in 2016. The hospitals and big tech vendors are preparing for artificial intelligence and machine learning “platforms”. Patient consent and transparency of business deals between hospitals and tech stand in their way.

A platform is something everything else is built on. The platform operator decides who can do what, and uses that power for profit. We’re familiar with Google and Apple as the platforms for mobile apps. Google and Apple decide. A platform for use of health data will have the inside track on machine learning and artificial intelligence for us as patients and doctors. The more data, the better. What will be the relationship between the hospital controlled platform of today’s EHRs and tomorrow’s AI-enabled platforms? Will patients choose a doctor, a hospital, or just send health records to the AI directly? Will US health AI compete with Chinese AI given that the Chinese AI has access to a lot more kinds of data from a lot more places? The practices that will control much of tomorrows digital health are being worked out, mostly behind closed doors, by lobbyists, today.

Three years on, the nation still awaits regulations on “information blocking” based on the Cures Act. Even so, American Health Information Management Association (AHIMA), American Medical Association (AMA, American Medical Informatics Association (AMIA), College of Healthcare Information Management Executives (CHIME), Federation of American Hospitals (FAH), Medical Group Management Association (MGMA), and Premier Inc. are sending letters to House and Senate committees hoping for a further delay of the regulations. 

Access to vast amounts of patient data for machine learning is also driving efforts to weaken HIPAA’s already weak privacy provisions. Here’s a very nice summary by Kirk Nahra. Are we headed for parity with Chinese surveillance practices? 

For their part, our leading health IT academics propose “… strengthening the federal role in protecting health data under patient-mediated data exchange…” Where is this data we’re protecting? In hospital EHRs, of course. We’re led to believe that hospitals are the safe place for our data and patient-directed uses need to be “balanced” by the risk of bypassing the hospitals and their EHRs. Which brings us back to CARIN Alliance as the self-appointed spokes-lobby for patient-directed health information exchange.

According to CARIN, “Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR § 164.524) and requests their digital health information from a HIPAA covered entity (CE) via an application or other third-party data steward.” (emphasis added) A third-party data steward is a fancy name for platform. But do you or your doctor need a platform to manage uses of your data?

HIPAA does not say that the individual right of access has to involve a third party data steward. We are familiar with our right to ask one hospital to send health records directly to another hospital, or to a lawyer, or anywhere else using mail or fax. But CARIN limits the patient’s HIPAA right of access dramatically: “All of the data exchange is based on the foundation of a consumer who invokes their individual right of access or consent to request their own health information. This type of data exchange does not involve any covered entity to covered entity data exchange.” (emphasis added)

By restricting the meaning of patient-directed access beyond what the law allows, everybody in CARIN gets something they want. The hospitals get to keep more control over doctors and patients while also using the patient data without consent for machine learning and artificial intelligence in secret business deals. The technology vendors get to expand their role as data brokers. And government gets to outsource some of their responsibility for equity, access, and patient safety to private industry. To promote these interests, the CARIN version of patient-directed access reduces the control over data uses for physicians as well as patients much beyond what the law would allow.

The CARIN model for digital health and machine learning is simple. Support as much use and sale by hospitals and EHR vendors without consent while also limiting consented use to platform providers like Amazon, Google, IBM, Microsoft, Oracle and Salesforce, along with CARIN board member Apple. 

CARIN seems to be a miracle of consensus. They have mobilized the White House and HHS to their cause. Respected public interest organizations like The Commonwealth Fund are lending their name to these policies. Is it time for this patient advocate to join the party?

Some of what CARIN is advocating by championing the expansion of the FHIR interface standards is worthwhile. But before I sign on, what I want CARIN to do is:

Remove the scope limitation on hospital-to-hospital patient-directed sharing.

Suspend work on the Code of Conduct – here’s why.

Separate work on FHIR data itself from work on access authorization to FHIR data.

Do all work in an open forum with open remote access, open minutes, and an email list for discussion between meetings. Participation in the HEART Workgroup (co-chaired by ONC) and also designed to promote patient-directed uses would be part of this.

Digital health is our future. Will it look like The Mayo Platform with Google and Google’s proprietary artificial intelligence behind the curtain? Will digital health be controlled by proprietary and often opaque Google or Apple or Facebook app store policies?

The CARIN / CMS Connectathon and CARIN Community meeting are taking place this week.  Wouldn’t it be a dream if they would engage in a public conversation of these policies from Alice’s perspective. And for my friends Chris and John at Mayo, what can they do to earn Alice’s trust in their Platform by giving her and her doctors unprecedented transparency and control.

Adrian Gropper, MD, is the CTO of Patient Privacy Rights, a national organization representing 10.3 million patients and among the foremost open data advocates in the country.

The post Patient-Directed Uses vs. The Platform appeared first on The Health Care Blog.

Patient-Directed Uses vs. The Platform published first on https://venabeahan.tumblr.com

[nyhealthscape]

Interoperability and the Women Leading the Digital Transformation

See on Scoop.it - HealthlinkNY

The healthcare marketplace is evolving from a business-to-business to a business-to-consumer model and research shows that these consumers are overwhelmingly female. As healthcare becomes more consumer driven and consumers demand interoperable solutions, it’s important to make sure women have a seat at the table when making strategic tech decisions about interoperability. In order to meet this shifting market demand, organizations must reflect their constituents to better grasp the problems they are trying to solve. A recent study showed that publicly traded companies with “two-dimensional (2D) diversity” – with senior leaders who embody or embrace difference – are 45 percent more likely to report that their company has grown market share in the last year and 70 percent more likely to report that their company captured a new market in the past year. RELATED: Painting a Vivid Picture of Effective Organizational Change The healthcare industry must build trust with consumers and industry leaders recognize trust can’t be built until we truly understand the primary decision makers in healthcare. Consumer loyalty is being replaced by consumer demand for access to information and to a streamlined user experience through interoperable solutions. Meet the women who are leading strategy and solutions discussions to accelerate digital transformation and interoperability across the healthcare spectrum. These executives are committed to improving the experience of patients and clinicians and their perspectives as leaders in their organizations are improving outcomes and innovation. What #WomenInHIT Colleagues are Saying about Interoperability “According to HIMSS’ Interoperability Call to Action, patients’ lives, the health and security of our nation’s citizens, and the health of the U.S. economy are reliant on ensuring the right people have the right access to the right health information at the right time. To date, we have not delivered on that promise, and to do so will require a collaborative effort of engaged individuals and organizations from across the health ecosystem. A diversified workforce is essential to bring forward thought leadership from the full spectrum of health and care, including consumers, patients, their families and those that deliver care in order to meet our interoperability goals. Embracing this diverse resource will ensure that the essential stakeholder perspectives are considered including the potential impacts of social and behavioral determinants of health.” – Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS, FAAN, vice president informatics, Office of the Chief Information and Technology Officer, HIMSS "Interoperability requires a living process to refine and improve capabilities over time. Be part of a growing movement to broaden connectivity to improve patient care in the U.S." – Didi Davis, vice president, Informatics, Conformance & Interoperability, The Sequoia Project; part of the HIMSS Women in Health IT initiative “In the 15 years since I joined the journey towards healthcare interoperability, the industry has made leaps and bounds towards improved sharing of health information thanks to programs like Canada Health Infoway, and the ONC [U.S. Office of the National Coordinator for Health Information Technology] certification and many provincial, state, and national health information exchange programs. But there is still a long way to go to seamlessly share information between providers, health organizations, vendors, and quality and public health associations. 15 years ago the problem was how to connect to each other at all, these days the problems are more complex and advanced, such as how do we map data from one setting to another. The more complex the setting, the more diversified a team is needed: many of my current projects benefit most from a collaboration of clinicians, data experts, interoperability experts, IT professionals, and government or not for profit organizations.” – Gila Pyke, certification test proctor, Drummond Group; testing technical lead, HIMSS Immunization Integration Program; part of the HIMSS Women in Health IT initiative   THE POWER OF WOMEN IN HEALTH IT Women in Health IT at the IHE Connecathon Engage with key leaders at the IHE NA Connectathon to collaborate and test implementations of IHE Profiles and other world-class standards and participate in the HIMSS Women in Health Information and Technology Mentor Breakfast. Women in Interoperability Get involved with the Interoperability & HIE Committee, Community, Task Forces and Work Groups HIMSS19 Plan to attend our various Women in Health IT events during the HIMSS Global Conference & Exhibition for face-to-face networking. Learn more about #WHIT networking opportunities during HIMSS19 | Register

[franklinhall-blog]

 The IHE  North American Connectathon 207 brought together a large and diverse group of  Health IT vendors. Log on https://www.dcmsys.com/

[sparrowsabre7]

Played a smidge more. Starting the connectathon and really please that the compass mode let's you see how far away the ground is so you know if your rope will reach.

The post box thing is neat too if you are overloaded en route. I am now carrying silly amounts of cargo that balances precariously on Sam's back. I dread having to face a BT when loaded up though because I knocked half of my pack off just ducking into a cave to escape the time fall.

[kristinsimmons]

Patient-Directed Uses vs. The Platform

By ADRIAN GROPPER, MD

It’s 2023. Alice, a patient at Ascension Seton Medical Center Austin, decides to get a second opinion at Mayo Clinic. She’s heard great things about Mayo’s collaboration with Google that everyone calls “The Platform”. Alice is worried, and hoping Mayo’s version of Dr. Google says something more than Ascension’s version of Dr. Google. Is her Ascension doctor also using The Platform?

Alice makes an appointment in the breast cancer practice using the Mayo patient portal. Mayo asks permission to access her health records. Alice is offered two choices, one uses HIPAA without her consent and the other is under her control. Her choice is:

Enter her demographics and insurance info and have The Platform use HIPAA surveillance to gather her records wherever Mayo can find them, or

Alice copies her Mayo Clinic ID and enters it into the patient portal of any hospital, lab, or payer to request her records be sent directly to Mayo.

Alice feels vulnerable. What other information will The Platform gather using their HIPAA surveillance power? She recalls a 2020 law that expanded HIPAA to allow access to her behavioral health records at Austin Rehab.

Alice prefers to avoid HIPAA surprises and picks the patient-directed choice. She enters her Mayo Clinic ID into Ascension’s patient portal. Unfortunately, Ascension is using the CARIN Alliance code of conduct and best practices. Ascension tells Alice that they will not honor her request to send records directly to Mayo. Ascension tells Alice that she must use the Apple Health platform or some other intermediary app to get her records if she wants control.  

Disappointed, Alice tells Ascension to email her records to her Gmail address. In a 2021 settlement with the Federal Trade Commission, Facebook and Google agreed that they will not use data in their messaging services for any other purposes, including “platforms”. Unfortunately, this constraint does not apply to smaller data brokers.

Alice gets her records from Ascension the old-fashion way, by plain Gmail under the government interpretation of her right of access. The rules even say that Alice can request direct transmission of her records in an insecure manner such as plain email if she chooses. But Alice can’t send them directly to Mayo because Mayo, also following CARIN Alliance guidelines, insists that Alice install an app on her phone or sign up for some other platform. 

Alice wonders how we got from clear Federal regulations for patient-directed access to anywhere to the situation where she’s forced to wait days for her records, receive them by email and then mail them to Mayo. Alice wonders.

—

It’s December 2019. 

This post is about the relationship between two related health records technologies: patient-directed uses of data and platforms for uses of patient data. As physicians and patients, we’re now familiar with the first generation of platforms for patient data called electronic health records or EHR. To understand why CARIN matters, the only thing about EHRs that you need to keep in mind is that neither physicians nor patients get to choose the EHR. The hospitals do. The hospitals now have bigger things in mind, but first they have to get past the frustration that drove the massively bipartisan 21st Century Cures Act in 2016. The hospitals and big tech vendors are preparing for artificial intelligence and machine learning “platforms”. Patient consent and transparency of business deals between hospitals and tech stand in their way.

A platform is something everything else is built on. The platform operator decides who can do what, and uses that power for profit. We’re familiar with Google and Apple as the platforms for mobile apps. Google and Apple decide. A platform for use of health data will have the inside track on machine learning and artificial intelligence for us as patients and doctors. The more data, the better. What will be the relationship between the hospital controlled platform of today’s EHRs and tomorrow’s AI-enabled platforms? Will patients choose a doctor, a hospital, or just send health records to the AI directly? Will US health AI compete with Chinese AI given that the Chinese AI has access to a lot more kinds of data from a lot more places? The practices that will control much of tomorrows digital health are being worked out, mostly behind closed doors, by lobbyists, today.

Three years on, the nation still awaits regulations on “information blocking” based on the Cures Act. Even so, American Health Information Management Association (AHIMA), American Medical Association (AMA, American Medical Informatics Association (AMIA), College of Healthcare Information Management Executives (CHIME), Federation of American Hospitals (FAH), Medical Group Management Association (MGMA), and Premier Inc. are sending letters to House and Senate committees hoping for a further delay of the regulations. 

Access to vast amounts of patient data for machine learning is also driving efforts to weaken HIPAA’s already weak privacy provisions. Here’s a very nice summary by Kirk Nahra. Are we headed for parity with Chinese surveillance practices? 

For their part, our leading health IT academics propose “… strengthening the federal role in protecting health data under patient-mediated data exchange…” Where is this data we’re protecting? In hospital EHRs, of course. We’re led to believe that hospitals are the safe place for our data and patient-directed uses need to be “balanced” by the risk of bypassing the hospitals and their EHRs. Which brings us back to CARIN Alliance as the self-appointed spokes-lobby for patient-directed health information exchange.

According to CARIN, “Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR § 164.524) and requests their digital health information from a HIPAA covered entity (CE) via an application or other third-party data steward.” (emphasis added) A third-party data steward is a fancy name for platform. But do you or your doctor need a platform to manage uses of your data?

HIPAA does not say that the individual right of access has to involve a third party data steward. We are familiar with our right to ask one hospital to send health records directly to another hospital, or to a lawyer, or anywhere else using mail or fax. But CARIN limits the patient’s HIPAA right of access dramatically: “All of the data exchange is based on the foundation of a consumer who invokes their individual right of access or consent to request their own health information. This type of data exchange does not involve any covered entity to covered entity data exchange.” (emphasis added)

By restricting the meaning of patient-directed access beyond what the law allows, everybody in CARIN gets something they want. The hospitals get to keep more control over doctors and patients while also using the patient data without consent for machine learning and artificial intelligence in secret business deals. The technology vendors get to expand their role as data brokers. And government gets to outsource some of their responsibility for equity, access, and patient safety to private industry. To promote these interests, the CARIN version of patient-directed access reduces the control over data uses for physicians as well as patients much beyond what the law would allow.

The CARIN model for digital health and machine learning is simple. Support as much use and sale by hospitals and EHR vendors without consent while also limiting consented use to platform providers like Amazon, Google, IBM, Microsoft, Oracle and Salesforce, along with CARIN board member Apple. 

CARIN seems to be a miracle of consensus. They have mobilized the White House and HHS to their cause. Respected public interest organizations like The Commonwealth Fund are lending their name to these policies. Is it time for this patient advocate to join the party?

Some of what CARIN is advocating by championing the expansion of the FHIR interface standards is worthwhile. But before I sign on, what I want CARIN to do is:

Remove the scope limitation on hospital-to-hospital patient-directed sharing.

Suspend work on the Code of Conduct – here’s why.

Separate work on FHIR data itself from work on access authorization to FHIR data.

Do all work in an open forum with open remote access, open minutes, and an email list for discussion between meetings. Participation in the HEART Workgroup (co-chaired by ONC) and also designed to promote patient-directed uses would be part of this.

Digital health is our future. Will it look like The Mayo Platform with Google and Google’s proprietary artificial intelligence behind the curtain? Will digital health be controlled by proprietary and often opaque Google or Apple or Facebook app store policies?

The CARIN / CMS Connectathon and CARIN Community meeting are taking place this week.  Wouldn’t it be a dream if they would engage in a public conversation of these policies from Alice’s perspective. And for my friends Chris and John at Mayo, what can they do to earn Alice’s trust in their Platform by giving her and her doctors unprecedented transparency and control.

Adrian Gropper, MD, is the CTO of Patient Privacy Rights, a national organization representing 10.3 million patients and among the foremost open data advocates in the country.

The post Patient-Directed Uses vs. The Platform appeared first on The Health Care Blog.

Patient-Directed Uses vs. The Platform published first on https://wittooth.tumblr.com/

[azveille]

Le cadre d'interopérabilité existe depuis dix ans et doit se faire connaître des start-up

Le cadre d'interopérabilité s'est depuis dix ans enrichi au travers des différents projets menés par la puissance publique. Le prochain enjeu sera celui de l'identifiant national de santé mais aussi d'amener la majorité des établissements de santé à se conformer aux standards bases, sans pour autant parler d'opposabilité.

La 19e édition du connectathon, organisée du 8 au12 avril à Rennes (Ille-et-Vilaine), a aussi coïncidé avec les dix ans du cadre d'interopérabilité du système d'information en santé (CI-SIS). L'occasion pour l'association

Interop' santé et l'Agence des systèmes d'information partagés de santé (Asip Santé) de se pencher sur les enjeux de l'interopérabilité au regard des ambitions portées par Ma Santé 2022.

Lors de son intervention, Claire Lenain, directrice de l'offre de services et de la communication à l'Asip Santé, a rappelé les étapes d'évolution du CI-SIS, notamment au gré des projets portés par la puissance publique. Ainsi, en 2013-2014, il a évolué pour favoriser les échanges de données avec la messagerie sécurisée de santé (MSSanté). En 2015, un process a été mis en place pour faire remonter les demandes et les questions soulevées par exemple par la mise en place d'Hôpital numérique afin de les intégrer au cadre d'interopérabilité. Au fur et à mesure, a-t-elle rappelé, ce cadre s'est enrichi de tous ces projets. Désormais, il compte une trentaine de volets répartis entre les couches qui le composent (documents communs, couches métier, service et transport). Certains sont en cours de consultation comme le volet "consultation d'agendas partagés". Dernièrement, l'Asip Santé a commencé à prendre en compte le nouveau standard HL7 Fhir (pour Fast healthcare interoperability resources), en traduisant par exemple des spécifications pour la couche transport.

Acculturer les start-up à l'interopérabilité

Pour autant, l'interopérabilité, si elle est prise en compte par un grand nombre d'éditeurs, reste majoritairement méconnue des start-up. Comme l'a indiqué Baptiste Le Coz, directeur général adjoint du Sib et secrétaire de l'Association des structures d'informatique hospitalière publique autonomes (Asinhpa), l'association est régulièrement sollicitée par les start-up sur l'interopérabilité, "une problématique importante dans le développement des applications pour les établissements de santé". Au delà des événements comme le connectathon qui permettent d'informer et de tester, des initiatives sont mises en place à l'image des meet up développés par Julie Dumons, product manager interopérabilité chez Lifen. Ouverts à tous et gratuits, a expliqué Julie Dumons, ces meet up sont organisés tous les deux mois et permettent de s'informer entre autres sur les standards en cours. À ce titre, la directrice des systèmes d'information du CHU de Rennes, Christine Pichon-Abarnou, a invité les start-up à se caler sur ces standards. "On gagne du temps avec les nouveaux entrants qui ont une prise déjà toute prête à être branchée sur le système d'information hospitalier (SIH)", a-t-elle précisé.

Opposabilité de l'interopérabilité ?

Autre point soulevé lors des discussions concernant les start-up : le retard des établissements de santé dans l'interopérabilité. Comme l'a indiqué le président d'Interop'santé, Jean-Christophe Cauvin, "sur les produits proposés, nous sommes sur des exigences fortes, notamment sur l'interopérabilité, pour qu'elles fonctionnent mais le déploiement se révèle difficile dans les établissements de santé car le socle minimum n'est pas mis en place". Ainsi, naturellement, la question de l'opposabilité est intervenue dans les débats. Claire Lenain a rappelé que, pour l'heure, les référentiels sur la sécurité sont opposables et que des discussions sont en cours au ministère "pour savoir ce qui peut être rendu opposable". De son côté, Yvon Merlière, responsable du dossier médical partagé (DMP) à la Caisse nationale d'assurance maladie (Cnam), a précisé : "on ne peut pas tout obliger, nous arriverons par les usages". "La technologie va nous aider à construire sans entrer dans le carcan et permet de ne pas rendre tout opposable", a-t-il ajouté. De son côté, Gilles Hebbrecht, chef du programme Simphonie à la DGOS, a estimé que la question de l'accompagnement sur l'interopérabilité est plus importante que celle de l'opposabilité. "Il faut donner du sens à l'utilisation des standards, en faire un enjeu collectif", a-t-il souligné.

Le prochain enjeu de l'interopérabilité que les établissements de santé et éditeurs devront relever sera celui de l'identifiant national de santé.

Cinq jours pour tester l'interopérabilité

Le connectathon Europe est organisé à tour de rôle entre les pays de l'Union européenne sous l'égide de l'association Integrating the healthcare enterprise (IHE). Cette année pour sa 19e édition c'est à Rennes qu'il a lieu. Durant cinq jours, du 8 au 12 avril, 350 personnes, dont 300 testeurs venus de plus de 70 entreprises, se sont réunies pour tester l'interopérabilité de leurs solutions. À l'issue des essais, 50 moniteurs vérifient et valident ou non les tests. Différents profils, 150 en tout, sont testés comme la radiologie, le laboratoire, le partage de document... En amont du connectathon, un travail est effectué pour valider la possibilité d'y participer. Les 350 personnes travaillent sur la plateforme Gazelle, un outil open source développé par la société Kereval. En parallèle, l'Asip Santé a proposé des tests sur le compte-rendu de biologie et le carnet de liaison dans le cadre d'un projectathon dédié.