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Charts in the Cloud, who owns the data?

saved by the cloud... or not

When we buy a paper book or a DVD video what we are really doing is assuring access to that “content” whenever we want. If we want to read it or view it we just go to the shelf and get it. But if we can just go to the Internet and get it streamed to our e-reader we have the same benefit of ownership we just don’t actually have a physical book. But do you really own that e-book?

So how about a patient chart? We have charts stacked on shelves because we need assured access to that info whenever we need it. However if we could get the same chart info from the cloud anywhere any time wouldn’t that be just as good. In fact better as you could get the data at home or while traveling you don’t have to actually be at your office.

From a purely intellectual point of view cloud storage of digital content makes perfect sense it just seems strange and risky to us. Just as we are becoming comfortable with storing important information in the cloud another huge data breach is announced on the news. Then there is the other question. Who owns data in the cloud?

The vast majority of reported data breaches in healthcare (62%) are the result of lost or stolen computers. Not malicious hackers. That means that cloud based record storage is actually safer than storing the data on a computer in your closet. If the data is in the cloud there is no need to have the data stored on a local computer. If a burglar steals a computer out of the office that has no patient data on it there is no breach.

Data storage is just one aspect of cloud computing. What is even better but also even harder to accept is that the actual computing takes place in the cloud. We don’t have any software applications installed on our local computer we just exchange data with a big server in the sky and the actual processing of the data takes place in the cloud.

This idea was originally called ASP (Application Service Provider) and has been a wonderful but elusive geek dream for almost twenty years. Several dental management systems have been launched based on the ASP or cloud model and the early ones all failed. As have most of the general cloud based business applications. They failed for a variety of reasons including people’s distrust of the Internet and worries about the system failing.

With the new attitude, faster Internet access and just overall better systems cloud based dental systems are back. They are Curve Dental, Dentrix Ascend and PlanetDDS.

Originally published on Emmott on Technology.

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How to kick start a new system at your office

staff-training

Only One is Good

There are three possible outcomes when adding technology to the office only one of which is good.

One: The office buys a new high tech system then throws team members at it with little or no training and no plan for implementation. This all too common approach almost always results in frustrated staff and wasted money.

Two: The dental office spends the money to buy a technology system then spends additional time and money training a staff person to use it. The staff person clings to the old way of doing things, fails to implement the system and blames the technology for the failure. She is the wrong person for the job and either quits or even worse stays in place like a roadblock preventing things from progressing. The result again is frustrated staff and wasted money.

Three: The dental office buys the system, sets up multiple training sessions, develops protocols to use it effectively and engages team members to use the system, learn and get better. The result is faster better service, decreased costs and happy staff.

The determining factor in our three outcomes is not the technology – the stuff. It is the people using it – the staff. How they are trained, how the office explains the benefits of the technology and helps the team learn makes the difference.

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Saved by the Cloud… or not

saved by the cloud... or not

When you visit a medical or dental office in the future you won’t be handed a clip board and paper forms, all your personal and medical data will be stored on the cloud. The medical / dental office will merely request a download and all the data will be available instantly. No forms, no guessing about medications, no forgetting your last visit, no confusion about insurance.

Isn’t that great all your highly personal medical data will be available to anyone with access through the cloud!

That will be really great because we wouldn’t want out personal stuff available to any old hacker so we will have the same level of protection that people had for their nude photos or that Target had for purchases or …well maybe it won’t be so great.

As much as I love technology and see the incredible potential of cloud based data and want it to be safe and secure, clearly it is not.

As digital technology and electronic health records stored in the cloud continue to develop they generate legal, moral and philosophical questions our existing ethical framework is simply not equipped to handle.

Most of these ethical questions can be summed up as:

Who owns the data?

Patients? If you ask patients the immediate and unequivocal answer is that they do. That seems right, each patient should have control of their medical information. That is what the HIPAA privacy rules are supposed to address. Yet that is not how the system works.

Doctors? If you ask a dental practice management software company (PMS) who owns the data the immediate and unequivocal answer is that you do the doctor owns the data.
Yet again this is not how the system works.

If as a dentist I own the data, I should be able to exercise the basic rights of ownership including using or transferring the data. However current systems do not allow me to transfer the data to another dentist or to use it as I wish for analysis. Plus as a dental professional I am obligated ethically and legally to protect the data as confidential.

If I have the data but can’t access parts of it or more commonly can’t transfer parts of it do I really own it?

Public? One of the most significant benefits of large online data bases of medical information is the aggregation of data for medical research purposes. Already there have been important findings resulting in improved patient care based in data base analysis. It seems axiomatic that more data from a wide range of sources will ultimately lead to better results. That is a good thing, but.
Is it OK to use personal medical data in a study without the patient’s permission? What if the personal identifiers are removed?

Then there is the issue of privacy. The primary issue driving HIPAA privacy rules is that a patient’s information must be protected. HIPAA is not about speaking a patients name aloud in the waiting room, it is about electronic medical data and making it available to others is wrong. Wrong morally and legally. That seems to be obviously true on the surface. Our personal data should be held in confidence. But what if we choose to make it public by participating in a study? Do we still own that data? Who does; the researchers, the web aggregator or the public, as in the public good?

In an ideal world all our medical data could be accumulated in a huge national (or for that matter global) data bank. This mass of data would be used by benevolent researchers to delve into disease patterns and treatment outcomes to provide a vastly improved understanding of the human condition.

But of course in the real world we have fear, politics, hackers, bureaucrats, proprietary data bases, the nightly news and less than benevolent people.

Check out more articles on Dr. Emmott’s Blog >

 

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