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Meaningful Health Care Informatics Blog


January 8, 2012  8:05 PM

CMS releases final notice for initial 26 quality measures



Posted by: RedaChouffani
Affordable Care Act, AHRQ, CMS, Core measures, EHR, Meaningful use, Quality reporting

On Jan. 4, 2012, the Department of Health and Human Services (DHHS) released the final notice for the initial core set of health care quality measures for Medicaid-eligible adults, a requirement from Section 2701 of the Patient Protection and Affordable Care Act of 2010 (PPACA).

There are 26 quality measures included in the list, which the Centers for Medicare & Medicaid Services (CMS partnered with the Agency for Healthcare Research and Quality (AHRQ) to identify.The categories listed in the document include the following:

  • Prevention & Health Promotion
  • Management of Acute Conditions
  • Management of Chronic Conditions
  • Family Experiences of Care
  • Care Coordination
  • Availability

CMS will soon issue guidance for how to submit the initial core set to CMS in a standardized format. As the current reporting of quality measures is voluntary and not set to begin until December 2013, many of the states that will collect these initial measures will use a temporary reporting template to submit their data.

January 1, 2012  11:46 PM

Which topics will be significant for health care IT in 2012?



Posted by: RedaChouffani
BI, business intelligence, cloud computing, Data analytics, HIPAA 5010, ICD-10, mhealth, mobile health, SaaS, Virtualization and cloud computing

As we ring in the New Year, we are faced with a myriad of questions regarding the new technology trends and changes that 2012 will bring, specifically those that stand to impact the health care arena. Below are just a few of the topics that will be widely discussed in the industry in the upcoming months, including Accountable Care Organizations (ACOs), HIPAA 5010, ICD-10, data analytics and business intelligence (BI) tools, cloud computing and virtualization, mobile health and more.

ACOs: As CMS begins its official kick off for ACOs and their formation in January 2012, several health organizations will sit by the sidelines and watch others participate, while others will be embarking on a new journey for their organization and the patients. Congratulations to the 32 pioneers chosen to participate in the program’s initiation.

Migration from 4010 to 5010: Survey results from MGMA show that there are still a number of health organizations that have not fully or successfully implemented the 5010. X12 required changes. And with the delays in 5010 announced by HHS, this extension will provide many with an opportunity to complete their implementation and tests of the 5010 during 2012.

Data analytics: Analytics in health care has been gaining more and more momentum in recent years, and health care professionals and executives are now using business intelligence (BI) tools that can deliver real-time reporting capabilities and measures directly to mobile devices or desktops. This coming year will see an increase of BI tools and an expansion for use in compliance, outcome measurement, trending and finance.

Mobility: In the mobile health sector, more and more organizations are starting to see the reality of BYOD (bring your own device), a trend that is here to stay. The burden is now on IT staff to ensure that they can be successfully supported and managed. We will also see users from the clinical side utilizing their mobile devices more and more as the increase in mobile applications available continues to rise, including the many of the electronic health record related ones.

Security concerns: With the increasing number of mobile users, there are significant concerns around securing the mobile devices. There are of course other concerns as well, such as hacking attempts against mobile users and their organizational data.

Social media: For several health care organizations that experimented with social media in 2011, they are able to point to numerous values and benefits that it can provide, including increasing patient engagement and collaboration in health ownership. It has proven to be a powerful tool that can not only help market the organization and reach out to their patients, but can also help patients have more control and access to their care delivery.

ICD-10: While ICD- 10 is not required until Oct. 1, 2013 there are still many items that will need to be started this year as part of the implementation and planning process. Software upgrades and clinical and billing staff training will be part of the items that many hospitals and physician groups will be working with this year.

Cloud computing: Health care executives and CIOs are fully aware that there are several different cloud-based services available for their organizations. Services ranging from software as a service (SaaS), infrastructure, and even platform as a service (PaaS) provide cost effective, valuable options for many, and 2012 will require that many of the executives look for technology partners that can assist them in managing these different environments and provide security, compliance and governance.


January 1, 2012  11:45 PM

Temporary Payroll Tax relief Passed with the Doc Fix



Posted by: RedaChouffani
Doc-fix, HR 3765

President Barack Obama has signed the temporary Payroll Tax relief into law on December 23rd, of 2011. This is a two-month extension on the payroll tax cut and several other extensions including the one for the Medicare reimbursement cuts that were scheduled for January 1st.
The Temporary Payroll Tax Cut Continuation Act of 2011 (HR 3765) includes the following provisions:

  • Temporary payroll tax relief
  • Temporary Extension of unemployment compensation provisions
  • Temporary Extension of health provisions
  • Mortgage Fees and Premiums
  • Other provisions such as:
  • Keystone XL Pipeline
  • Budgetary Provisions

In the case of healthcare provisions these were the items included in the bill starting with the one with the most financial significant one:

  • Medicare physician payment update.
  • 2-month extension of MMA section 508 reclassifications.
  • Extension of Medicare work geographic adjustment floor.
  • Extension of exceptions process for Medicare therapy caps.
  • Extension of payment for technical component of certain physician pathology services.
  • Extension of ambulance add-ons.
  • Extension of physician fee schedule mental health add-on payment.
  • Extension of outpatient hold harmless provision.
  • Extending minimum payment for bone mass measurement.
  • Extension of the qualifying individual (QI) program.
  • Extension of Transitional Medical Assistance (TMA).
  • Extension of the temporary assistance for needy families program.

The US president will face a significant challenge when working toward extending the tax cuts as well as Doc Fix after the end of February of this year. While ultimately everyone is looking to identify a permanent fix or resolution for some of the deficit and the challenges it poses, many associations and healthcare professionals are seriously concerned about continuing to have the uncertainty on the reimbursement cuts.


December 18, 2011  9:51 PM

Lessons for EHR vendors from Office 365 and Google Docs



Posted by: RedaChouffani
EHR, EHR functionality, EHR usability, EHR vendors, Electronic health records, Electronic medical records, EMR, Google, Google Docs, mhealth, mHealth apps, Microsoft, Office 365

For a while now, Google has been the front runner when it comes to web-based productivity applications.  With their Google Docs application, the company released a 100% browser-based solution that allows end users access to and use of a cost effective substitute to the Microsoft Office suite. But Microsoft was not about to throw in the towel to Google, and after a long beta phase has finally released its own version of web-based business productivity tools called Office 365.

The Office 365 products and services go well beyond the simple creation of presentations, web pages and spreadsheets via web tools.  They contain a valuable set of features and functionalities that end users are dependent on for day-to-day work.  And as we look at health care and its own line of applications that enable better, more connected patient care, one must wonder if there will be a time where electronic health records (EHRs) will learn from the lessons that companies such as Microsoft and SalesForce have identified as critical for success in the software industry.

The following is a list of eight takeaways from cloud-based applications that EHR vendors should consider as part of their long term software development strategy:

Make it cloud or browser-based:  Given the pace at which technology change is moving today, IT is more focused on aligning organizational objectives and ensuring compliance rather than managing physical servers and the downtime associated with them.  For that reason alone, many organizations are now looking to leverage cloud-based or browser-based products that require low up-front costs and offer higher up time, availability and redundancy.  Vendors such as Cerner, AthenaHealth and others provide a full hosted application model where there is very little need for a full infrastructure in-house to maintain the application.  In addition, with this model, a cloud-based application requires very little maintenance and experiences very little downtime that could be associated with upgrades, conversions or system updates.

Low up-front cost:  In every EHR implementation, there are several items that contribute to the high costs.  From workflow redesign, training and hardware procurement, to software licensing, maintenance and product support, many see the future in solutions that are provided at a monthly fee per user or business unit.  This reduces the up-front costs and allows for the organizations to appropriately budget and justify the use of the new products and solutions.

Scalability:  For products that are offered through SalesForce, Google, or Microsoft office 365, it takes the same effort to sign up 5 users as it does to sign up 5000 users; the system is designed to easily scale out.  This is all done behind the scenes, where the client is ready to start using the application right away.  This capability would benefit EHR vendors greatly as their products continuously need to have the ability to scale out, especially when there are clear indicators of health systems mergers, acquisitions and growth.

Easy to use UI:  One of the critical success factors for any user-facing product in the market, including EHR packages, is an easy to use, functional and feature rich user interface (UI).  Many EHR systems fail to impress clinicians simply due to the busy and cumbersome UI.  These products must be  easy to use and allow health professionals to attend to their patients without feeling lost in the software.

Integration: As we move toward a health care model that rewards for outcome measures, complete patient care and care team collaboration, many applications are starting to look for ways to allow for protected health information (PHI) to be exchanged, safely and securely.  For Google docs and Office 365, having the ability to connect to other systems, as well as the collaboration platforms, was a useful function in the products.  This would also be a significant feature for EHR packages.  While some do provide the ability to receive and submit health information across a given HIE, there is still a significant lack of adoption from physicians.

Collaboration: Microsoft and Google chose their own collaboration platform as part of their products.  Within Office 365 and Google Docs, there are capabilities for end users to use video conferencing and chatting capabilities.  This provides a useful method for users to communicate beyond the simple email messages.  As accountable care organizations (ACOs) begin to implement their collaboration platforms, there will be a clear demand for chat, audio and video conferencing capability.

Platform agnostic: For software vendors in today’s market, the big question from the majority of prospects and potential buyers is: “Do you have an app for that?”.  That said, for many of these products, having the mobility capability as part of their offerings is now a must-have for clinicians.  Whether it is a hospital system or a small independent physician practice with two physicians, a medical application should have some sort of mobile application that will allow its user access to the information from smartphones, tablets and many other mobile devices.

Power is in the numbers: There are clearly some very powerful players in the EHR marketplace.  These are the groups of vendors that are well established and have had incredible success with high number of users.  However, this does not always mean that there would not be a place for a disruptor.  And in the world of technology, especially the world of software products, it is all about the new, functional differentiators that a product brings to the table and the perceived the value that the software has from users in the market.  Similar to SaleForce, AthenaHealth, Facebook, Chatter, LinkedIn and the other very successful sites, there will continue to be room for new innovators that can disrupt the marketplace and continue to push the technology buck forward, especially in health care.


December 18, 2011  9:48 PM

Doc-fix passed the senate but faces a potential no in the house



Posted by: RedaChouffani
Doc-fix, doc-xix, Medicare, medicare cuts, Medicare overhaul plan, Medicare reimbursement, MU

On Dec. 17, 2011, the Senate passed a bill that will provide a short term “doc-fix”. This bill was passed as part of a larger bill that extends a cut in the payroll tax and pushes back the 27% Medicare cut that was originally scheduled for Jan. 1, 2012 until the end of February.  The Senate voted 89-10 Saturday morning to delay the cuts to physician Medicare payments for two months, however the House will still need to approve the bill before it goes to the president for signing.

At this stage,   according to the House Speaker John Boehner (R-Ohio) the GOP majority in the House opposes the two month fix.  But no one know for sure until the vote that will take place tomorrow.

These cuts significantly concern physicians, providers and health care organizations as a whole, as they stand to have a significant impact on their reimbursements and bottom lines.  The bill contained other extensions, such as the payroll tax, as well as an extension in unemployment benefits until the end of February 2012.

There have also been talks about other changes to Medicare recently, via a proposed plan by Sen. Ron Wyden (D-Ore.) and Rep. Paul Ryan (R-Wisc.), who released the Medicare overhaul plan last week.  The new plan proposes a private insurance option with subsidies, which they believe will cut Medicare costs.

Given the plethora of changes that have come down the pike as of late, namely the delay in meaningful use stage 2, HIPAA 5010, as well as the ever-changing landscape at the policy level in Washington, many health care professionals are watching closely to see how these will not only affect their reimbursements and bottom lines, but also their overall project and implementation timelines as well as their incentives.


December 11, 2011  8:08 PM

Google TV and what it means to healthcare



Posted by: RedaChouffani
Apple TV, google tv, IP TV, iTV, Patient engagement

With the significant increase in smartphone and mobile device adoption in the health care setting in recent years, 2012 will definitely add more emphasis on mobility integration at the organizational and enterprise strategy level, as well when looking at an organization’s technology budget. The new capital commitment needed to support mobile device management, security assurance and security updates, as well as the evaluation of different mobile apps that can help with patient care must be top of mind considerations as an organization continues to map its strategy in the coming years.

In this same vein, another area that may require some additional consideration is in terms of planning for upgrades to a hospital or health system’s interactive television system.Similar to how consumers, patients and clinicians continue to drive the adoption of smartphones in the arena, a similar trend may be on the horizon with interactive TV in the health care setting. Except, this time, the device in question is in a majority of living rooms across the nation.

Television has seen some drastic changes and great technological advancements over the past decade.Projection TV, plasma, LCD, and 3D TV have all been part of the evolution of television technology. But it does not stop there; TVs are now turning to mobile platforms to become smarter, more interactive units.

While traditionally you can connect a PC or gaming console to your TV to take advantage of the integrated, advanced capabilities, Apple and Google took different approaches. Sony and Logitech partnered with Google to implement Google TV in some of their devices.Sony was the first to embed the actual Android based platform in its televisions, with Android being the platform of choice for many smartphone users in the market. Google TV also provides the ability to develop and deploy apps (native, HTML5, or a mix) and make them available for use on any Google-capable TV.

The integration of mobile platforms and interactive programming with television technology seems to hold great potential for the health care industry. Personally I have been using Google TV for about a month now and the feedback I’ve gathered from both colleagues and family, as well as the many potential uses I’ve considered, support the incredible promise this technology has for health care and the future of patients who will use and interact with programs and content at the bedside.

For hospitals who currently have interactive TVs in their patient rooms, there are many possibilities for Google TV:

  • Interactive patient education
  • Customized hospital content feeds (news, community based events)
  • Online and interactive dining services
  • Interactive patient charts or health records (integration with PHR or hospital EHR)
  • Patient surveys
  • Teleconferencing with family, friends and care givers (Medical home can contact patients and do conference calls regardless of TV hardware used)
  • Social media services (Facebook, Twitter and other social sites accessibility).
  • Access to commonly used apps
  • Remote control from any smart phone device (iPhone, Android based remote control)
  • Health & fitness tracking, interactive/reward based capabilities
  • Interactive schedules
  • Access to clinicians for hospital based and health apps used in the enterprise from anywhere in the network
  • Interactive entertainment and on demand (watch your own movies from your own Netflix subscription
  • Gain access to work related items without the need of a laptop on hand
  • Cost effective
  •  Integration capability with IP-based TVs and other online TV providers

While not all TV stations are available via the internet, many are considering moving in this direction. And should this trend continue to take off, this would one day mean that all TV programming will be IP (internet protocol) based, significantly justifying the use of a smart TV.And with the use of Android and iOS platforms, this add more content availability and other possible uses for the larger displays.


December 11, 2011  8:03 PM

Delays to meaningful use stage 2



Posted by: RedaChouffani
EHR, EHR adoption, Electronic health record, HHS, Meaningful use, MU, MU stage 2, Stage 2
On Nov. 30, 2011, the Secretary of Health and Human Services announced a policy change effectively delaying stage 2 meaningful use. The goal of the change is to allow for a greater increase in the adoption of electronic health records (EHRs) by delaying the stage 2 meaningful use requirements until 2014.

This change will allow hospitals and other eligible providers (EPs) additional time to demonstrate that they are meaningful users of EHR technology per stage 2 compliance measures. For those who have already attested to stage 1, they now have until 2013. For all others who plan to meet the requirements of stage 1 during 2012, they are allowed until 2014 for meaningful use stage 2. And while stage 2 criteria are not yet finalized, health care organizations are waiting eagerly to see what changes and potential new challenges are contained in it.

There are additional details outlining the increase in adoption of EHR according to surveys by CDC as well. The news release and survey findings indicate that approximately 52% of office-based physicians in the US intend to take advantage of the payments available through the Medicare and Medicaid EHR Incentive Programs. Extending the deadline will allow providers the opportunity to catch up with many of the other projects that are currently underway, ranging from infrastructure updates to HIPAA 5010 and ICD 10 migration planning, as well as the review of meaningful use stage 1.

Stage 2, as noted in the proposed measures, does require more patient interactions as well as an increase in measurements and the amount of data collected. This extension will enable many to ensure a successful implementation of many of the new workflows and application components that will assist with the criteria of stage 2.


December 4, 2011  5:35 PM

The next generation of consumer friendly medical devices



Posted by: RedaChouffani
Apps, health & fitness devices, mhealth, mHealth apps, mHealth devices, mobile health, Remote patient monitoring, telehealth, Zeo

With the rise of smartphones and other mobile devices, many physicians are wondering how these technologies are going to impact their patient / physician relationships. For most, these smarthones are allowing caregivers to communicate with their patients, while providing the ability to access their patient’s charts from anywhere, at any anytime.

And as we continue to discover the value that these devices bring to the health care industry, there are some key areas that starting to show the most promising impact on both improving patient care as well as helping patients manage their chronic conditions.

Telehealth and remote patient monitoring is one area that has been proving to be a significant value-add. With over 37% of all mobile subscribers using mobile devices in the US, coupled with the hight cost of care, many hospitlas and health care systems are looking at how to start using these devices in their organizations. But to be able to truly appreciate how consumers (who happen to be patients in some form or fashion) are reacting to these devices as part of their care, you can simply look at the success of several of the health and fitness tracking devices in the market.

The Zeo Sleep Manager is just one example of a health and fitness product / app combination currently in the market that has experienced a high adoption rate from consumers. Zeo Sleep Manager helps to monitor sleep through tracking brain waves and transmitting information collected to a compatible smarthone or device. This patented device helps track the different cycles of the user’s sleep and provides feedback on how one can improve their sleep while reviewing their progress. Below are seven benefits and criteria that made this product a successful one in the mHealth arena:

Easy of use: From a user prospective, the Zeo Sleep Manager is extremely easy to use. With a few simple and easy to follow steps, you can unpack the device, install the app on your smartphone, sign up for the online account and you are ready to start using it. The point being that it is easy to use, and this should be the case for any remote health-monitoring device. This will ensure that regardless of patient demographics the devices will be easy to use.

Cross platform: There are several new mHealth health devices available in the market that require special software that can only run on certain platforms. Some even require their own special docking station that transmits the information. With the Zeo device, the application connects via Bluetooth to several widely used platforms. From the iPhone to Android powered devices, this enables the users to use their existing smartphone without any additional hardware or device purchase.

Coaching abilities: Another useful function that this tool provides, and one that is a critical as part of any future telehealth and monitoring device, is the coaching and mentoring capability. Zeo provides tips on improving your sleep and allows users to see if they are making progress after adopting some of the recommendations from the Zeo site.

Cost effective: The device costs $99.00, which makes is a very cost effective to own. And for health care providers, having inexpensive and effective devices will allow them to easily send them home with their patients.

Collection of health information: For health care providers, when the patient leaves the health care facility, it becomes challenging to retrieve health related data directly from them. Zeo has shown that it can collect sleep related data and report on it real-time to a web portal or SD card. Health care professionals are looking for similar devices that can collect information such as patient’s weight, pulse, glucose levels, and vitals. It can also transmit that information over to them.

Portable: Zeo provides its users with a device that is small and lightweight. It can be used during a trip or while visiting family without the need to reconfigure anything, unlike some of the previous generation health devices that required analog lines, pre-configuration and the home network and such.

As we are reminded of the increasing cost of chronic disease management in our own population, the need for creative and effective ways for care professionals to work closer with the patients without constant trips to the facility becomes all the more vital. Telehealth monitoring devices will need to take a greater role in facilitating the transfer of information and supporting health care providers in connected care delivery. Zeo is just one example of how a consumer-based device has been adopted by many, and has proven that if a device meets some of the requirements outlined above, it has a great chance to become a significant asset to both caregivers and patients.

 


December 4, 2011  5:33 PM

Top 6 ACO considerations to watch for 2012



Posted by: RedaChouffani
Accountable care organizations, ACO, Health information exchange, HIE

As 2012 approaches and CMS kicks off the official start for Accountable Care Organizations (ACO), we are reminded of the changes that participating physicians in an ACO will face. Below is a list of 6 considerations that need to be on their agendas in 2012.

Defining the ACO structure: As an organization, the ACO is comprised of health care professionals coming from a range of entities (hospitals, independent physician groups, physician’s associations), and defining the ACO structure will be the first step to be addressed. As part of this consideration, an organizational structure must be defined, with steering committees over all stakeholders or entities.

Performance measurements and reporting: While the final ruling requires only 50% of the participants to have electronic health records (EHRs), outcomes measurement and reporting would be a key performance indicator for the ACO. This would require the ACO to set up an environment, processes, and workflows that will allow the capture of all required electronic information that will be utilized for reporting purposes, including information from non-EHR users.

Legal framework: In the final rule released on Oct. 20, 2011, CMS issued an interim final fraud and abuse waiver rule. This was intended to remove the existing legal impediments in the areas of fraud and abuse. FTC/DOJ did issue an antitrust guidance and clarifications for ACOs as well. The ACO organization must also ensure that it defines all its legal clarifications with its members as well as patients.

Technology considerations: As many of the health information exchange (HIEs) become increasingly available in new states and communities, they will serve as the vehicle that will allow many of the ACOs to achieve true health information exchange among its members. However, almost all ACOs will be required to invest capital toward an infrastructure that will enable: Data collection, collaboration tools, business intelligence platforms for reporting, hardware, connectivity and a technical support team that will oversee the ACO infrastructure.

Financial modeling: An ACO is intended to help health care physicians work as a group to improve patient care and reduce health care costs. But an ACO will need to first define the business model in order to be a successful and sustainable for collaborative work. This would require the definition upfront of how shared savings are literally shared amongst different participating members as well as how expenses are shared.

Care delivery: ACO members will become responsible for the complete care of patients. This will require health professionals to be in more contact with their patients and use effective ways to do so. Whether it is by using patient health monitoring devices or evisits to follow up with a patient who is at home, physicians will need to adapt to using these effective methods to communicate and be in touch with their patients.


November 27, 2011  10:28 PM

Steps to secure mobile devices in health care



Posted by: RedaChouffani
data breach, Data privacy and security, HIPAA, mhealth, mHealth security, Mobile device security, mobile health, mobile HIPAA, smartphones

Unless you’ve been living under a rock, the rising adoption rate of mobile devices, specifically smartphones and tablets, has been hard to ignore.

While mobile devices are opening access to online information like never before for both patients and clinicians, these fast growing computing platforms are proving to be quite challenging for many security specialists and IT departments across the health care industry as a whole. As many of these platforms are being used to access medical data for patients, as well as other enterprise wide applications such as email, prescriptions, lab orders and the like, the risks associated with a breach in privacy grow greatly.

In the PC world, hospitals and other organizations have full control of what goes on those devices. But with the advent of BYOD (Bring Your Own Device) that many organizations have begun to adopt, it is becoming far more challenging to control what goes on each device and maintain secure access to the network. And while attacks and viruses on mobile devices are still not as widespread as the infections on PCs, there is a growing concern of malware and hacks that are now being reported, forcing many to reevaluate their security and control processes on these devices.

The following are some of the steps that should be taken to properly protect both your network and the data that is being accessed from mobile health devices:

Securing the devices through software applications: While there are several products that help protect PCs, many vendors have also begun to develop similar applications and utilities that can secure mobile platforms from infections and attacks.While they are still not fully adopted by all, they are certainly a “must have” in health care to ensure the protection of data and regulatory compliance.

Mobile device management: In order to efficiently protect and safeguard the network and infrastructure from attacks and data breaches, IT departments use several different applications and products that can monitor and manage all devices connecting to the infrastructure.But as many of the end users bring in their own devices to work, managing what is deployed on these smartphonesm and whether or not the publisher of the apps are trusted, can be quite challenging.This is where it is critical to use applications that can manage and secure all mobile devices that are being used in the organization.This will help ensure they are configured and monitored throughout their presence on the network and off the grid.

Use policies and procedures: When devices are deployed for users who have access to clinical and other sensitive data on the network, it is important to have processes and procedures that describe, in detail, a policy of what is acceptable use of the devices.In addition, there should be a process in place that can identify the steps to be taken in case of the loss or theft of the device.Examples can be notifying IT within one or two hours of the incident in order to locate or initiate remote kills procedures.

Requiring strong security and protection:There are many cases where the mobile devices allow access to their functionality without challenging the identity of the user.Recently we saw this security flaw when the iPhone shipped with SIRI and allowed access to anyone to the device even when it was locked.There are also other vulnerabilities such as hacks through Bluetooth and wireless capabilities of the devices.Thus the importance of implementing best practices for adequately protecting devices’ mobile security.It is also recommended to properly encrypt the communication between the device and network.This will help ensure that the data exchange is properly protected and secured even when a device is connected to a public network.

Mobile devices have seen an incredible adoption rate in health care that is only going to continue to grow.And with that comes the bigger challenge, which is how to adequately secure them.With these devices being target by thieves and at times simply misplaced, it can result in a legal nightmare and cause sensitive patient information to fall into the wrong hands.An example of the potential disasters associated with data breach is the $1B class action lawsuit against Sutter Health.


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