Healthcare providers may integrate sensor-based inhalers into their workflows to improve medication adherence and support children with asthma.

Inhalers Boost Adherence

The CDC offers an updated guidance on what to do about asymptomatic healthcare providers who are exposed.

COVID-19 Creates Worker Shortages

Dr. Sachin Jain of SCAN Health challenges health systems to ask this question when tackling the issue of diversity in the workforce.

Who's Not in the Room?

Scott Harrison, vice president and chief data officer, Parkland Hospital

Scott Harrison is the vice president and chief data officer at Parkland Hospital in Dallas County, Texas. Parkland is a safety net hospital that provides care to the needy and indigent patients that don’t often have other forms of receiving medical attention.

™ about how Parkland is benefiting from real-world data, interoperability, and how the hospital maintains privacy.

: How is Parkland leveraging data and technology, especially now during COVID-19?

 Data have always played a very critical role at Parkland more so in the most recent years. I've been there for about two years and since my arrival, they've really put a lot of effort and a lot of investment in improving our abilities to manage data and to curate data in a very efficient manner. And so those investments just aren't immediately plugged in and able to realize the value. So, you have to grow those over time. Over the last couple of years, those investments, from capital investments that were made in the mid 2000s-2015 timeframe, have really started to mature and now we're starting to see an evolution of being able to take data from just about any type of system and blend those data with what we're capturing in our medical records that are electronic, and really pushing that data out to our clinicians and business operations folks that can take that information and make very sound decisions.

What we saw with the pandemic when it hit is that data were at the center point of everything that we needed, we had a command center that was stood up, really to help converge all of the business, clinical, and financial operation teams in one place to focus on what we needed to do to keep our hospital operations going, because there was so much unknown early on in the pandemic. And of course, they came to our teams really asking for help to say, “Hey, we need a dashboard,” or “We need some way of really managing what we're telling these folks to do. What do you know, how can you guys help us?” That was really our moment to start giving some free promotion and marketing material to the products that my team produces, which are, the dashboards.

So, we built a dashboard that is put up in a lot of big screens throughout the command center and that really drives a lot of our executive huddle in the mornings. We don't have that anymore, but early on in the pandemic, the executive huddle really was kind of the focal point that all of our teams would rally around and look through the metrics, look through the numbers on the dashboard, we would make decisions from that, like, “Hey, we need to staff up here,” “We need to talk to our supply chain to get more supplies in.” It really became, a very big tool that was leveraged across the organization and not just in certain pockets, which was kind of a shifting paradigm for Parkland.

I would say within the last year, year and a half, they've always felt data were important, but never did data have the full enterprise visibility that they did, when we had our big dashboard up in the command center with everybody sitting around it. That thing's getting hit more than 2,000 times a month being accessed and the next closest ones about 40 times a month. So that gives you some perspective as to how important data have played at an enterprise level and more specifically with the COVID-19 response.

 When you think about data, you often think about interoperability or a lack thereof. How has that affected your operation at Parkland, especially during the pandemic when you have people presenting that you might have never seen before?

 The interoperability piece, I think is challenging, because the patients don't often hold the information on their person that's contained about their medical history. I mean it's housed in these various healthcare organizations data centers. And for the patient getting access to that, and being able to transport that, to give insights to other care providers who may be providing care, where they are, logistically, it's just been challenging.

When the pandemic hit, we were a mobile society, so being able to seamlessly exchange those records, we could in some instances. Our EHR vendors are stepping up their capabilities. But a lot of times, the devil’s in the details. Somebody maybe has transcribed some information incorrectly, and so that data item doesn't transition over as part of that interoperability piece. And so those are the challenges that we're faced with is how do we get out of the areas that don't exchange easily? Or if there's mistakes, how do we correct those? And so that always becomes an exercise in how well we are actually governing the information that's being housed and stored as part of our legal medical record.

We're fortunate, we've got a very mature team that handles a lot of those exchanges. My role from a data side of things is to make sure that what we're curating and putting available for those teams has high quality. So, we try to get the data on the front end and really make sure they’re scrubbed, indexed, catalogued, and defined. Then also, now the teams know where they can go to retrieve that information. I think that's key in showing how my role can play a facilitating role in interoperability. I'm not really the guy that's going to produce that for the exchanges, but I can make sure that the data are high quality and able to be exchanged and once the recipient gets the data, they know where the data go.

: Increasingly, the need for real-world data is becoming more and more important. Patients are using Apple Watches and other wearable devices and smartphones to leverage data. How have you been using real-world data at Parkland?

 We are just beginning our journey into real-world data and it's something that I've been talking about over the past couple of months with my teams to really up their literacy. We're really shifting the paradigm right now in healthcare, not just a Parkland, moving from a system of record, which is largely EHR systems, over into a system of reference where we're

taking data from multiple systems, we're referencing that and we're blending it together in a comprehensive universe, like our warehouse.

Then I think the area that we're moving towards is more of that system of engagement where patients are in charge of a wearable or a smartwatch or heart rate monitor. We've got our CMO and some of our physician leaders pushing virtual care where patients are actually taking devices home and we're connecting them in their home so that they can manage their disease conditions or their illness at home and not have to come into the hospital. All of those are really cool capabilities. But from a data guy like myself, it creates quite the conundrum of what do we do with all of those various entities? And how do we reference those in a single catalog so that people know what they're using? Those attributes are collected in multiple different systems, once again, we have to blend those in like that system of reference. And so, think it becomes super critical that you focus on data quality and entity resolution and making sure that we know what that attribute is, and it's defined, and if it's referenced in another system, we can then blend it together to enhance that attribute.

So, it's used across multiple systems, and not just one. And I think that's where we really see the future of healthcare going is to be more in the patient's hand where these wearables, these at-home medical devices are telling a story. That’s where we're really focusing our efforts at Parkland to become a little more agile. How can we integrate and persistently integrate those data points into our warehouse so that it tells the story and it's once again providing that information to our clinicians, business, and clinical operations so that they can drive decision making?

: What about privacy concerns when it comes to all these data sets?

 I’m not just the data guy, we're also a government entity. So, we're highly scrutinized at how we're protecting not just the data, but the rights and any of that sensitive information from getting out. So, the good thing is that I'm not in charge of applying or creating a lot of those rules. We have a very robust team and comprehensive group that really sets the tone that I follow.

Articles

The vice president and chief data officer at Parkland Hospital in Dallas discusses how the health system leverages data.

Q&A: Scott Harrison of Parkland Hospital Discusses Leveraging Data, Interoperability

Patients with ischemic stroke treated at hospitals with telestroke capacity are more likely to receive reperfusion treatment and have lower 30-day mortality.

Telestroke has the potential to extend stroke expertise to hospitals without on-site stroke expertise. Consultations consist of a real-time videoconference between the patient, remotely located stroke specialist, and a bedside healthcare professional in the emergency department.

Andrew Wilcock, Ph.D., and colleagues described differences in care patterns and outcomes among patients with acute ischemic stroke who presented to hospitals with and without telestroke capacity. The team focused only on patients presenting to a hospital without on-site stroke expertise. They matched patients with acute ischemic stroke who presented to a hospital who recently introduced telestroke capacity to control patients who presented to a hospital without telestroke. Matches were done 1:1 based on hospital and patient characteristics.

The investigators used 100% Medicare Inpatient and Outpatient Standard Analytic Files to identify all acute stroke admissions in the U.S. within the traditional fee-for-service Medicare program from January 2008 to June 2017. Admissions included inpatient or outpatient emergency department/observation stays in short-term acute care or critical access hospital. Patients had a primary diagnosis of acute ischemic stroke.

Wilcock and the team measured receipt of reperfusion treatment through administration of intravenous thrombolysis with alteplase or endovascular thrombectomy using procedure and diagnosis codes. They used the date of death field from the beneficiary summary files to create indicators for mortality seven, 30, 90, and 180 days from admission.

Overall, the team identified more than 369,000 stroke episodes that met their patient and hospital inclusion criteria. Of those, 87.338 patients received care at one of 643 hospitals with telestroke capacity. Prior to matching, those treated at a hospital with telestroke capabilities were more likely to live in an urban area and have hyperlipidemia and diabetes. They matched 76,636 telestroke admissions to controls. In the final sample, 57.7% were female and the mean age was 78.8 years old.

Among those treated initially at a hospital with telestroke capability and their matched controls, 6.8% and 6%, respectively, received reperfusion treatment (absolute difference, .78 percentage points; 95% CI, .54-1.03; 

 <.001). In a comparison with their matched controls, the risk ratios for treatment were higher for patients cared for at telestroke hospitals for any reperfusion treatment (RR, 1.13; 95% CI, 1.09-1.17; 

 <.001), drip-and-ship cases (RR, 1.38; 95% CI, 1.3-1.45; 

 <.001), and thrombectomies (RR, 1.42; 95% CI, 1.25-1.62; 

There was lower mortality (13.1% vs 13.6%; difference, .5 percentage points; 95% CI, .17-.83; 

=.003) at 30 days from admission. For postadmission mortality, the risk ratios were .95 (95% CI, .92-.99; 

 = .02) at seven days, .96 (95% CI, .94-.99; 

 = .003) at 30 days, .98 (95% CI, .96-1; 

 = .04) at 90 days, and .98 (95% CI, .97-1; 

The team found no significant differences between telestroke and control patients for returns to the hospital, spending, and living in the community.

Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity

Telestroke capabilities may extend stroke expertise to hospitals without on-site stroke experts.

Telestroke Capabilities Increase Chances of Stroke Patients to Receive Reperfusion Treatment

Patients’ preferences of receiving clinical diagnoses from artificial intelligence (AI) and human clinicians were generally unaffected by the COVID-19 pandemic.

The findings may guide policies that are relevant to the development of AI-based healthcare.

Wai-Kit Ming, M.D., Ph.D., M.P.H., and colleagues aimed to quantify and compare patient’s preferences for AI clinicians and traditional clinicians before and during the COVID-19 pandemic. They further wanted to assess whether preferences were affected by the pressure of the pandemic.

The team designed a web-based questionnaire to collect participants’ demographic information and investigate patients’ preferences for different diagnosis strategies. The questionnaire had seven similar hypothetical scenarios and respondents had to choose a preferred diagnosis strategy for each one. The investigators used the propensity score matching method to match two different groups of respondents — a 2017 group and a 2020 group — with similar demographic characteristics. There were 2,048 respondents who completed the questionnaire and included in the analysis.

Participants could choose different levels of healthcare services for each diagnosis attribute. Patients were prompted to hypothesize which diagnosis methods or attributes had a large impact ono their decision. The team then included six diagnosis attributes and their respective levels in their questionnaire: diagnostic method, outpatient waiting time before the start of the diagnosis process, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expenses.

The discrete choice experiment had two parts, the first of which required respondents to fill in their demographic information, including age, sex, and educational level. The second part required participants to consider seven different scenarios. For each one, respondents were supposed to imagine they were in an outpatient queue waiting for a diagnosis and were asked to choose a preferred diagnosis strategy. Then at the end of the questionnaire, the respondents were asked to estimate the number of years it would take for AI clinicians to surpass human clinicians.

There were 1,317 patients who completed the questionnaire in 2017 and 84.7% believed AI clinicians would surpass or replace human clinicians. Of those recruited in 2017, 40.1% were matched to the 528 respondents who were recruited in 2020.

Those in both groups generally believed accuracy was the most important diagnosis attribute. The importance value of accuracy was 38.53% in the 2017 group and 40.55% in the 2020 group. Diagnosis time was the least important attribute (2.69% in 2017 and 1.16% in 2020). Respondents in both groups preferred to receive combined diagnoses from both AI and human clinicians over AI-only diagnoses or human clinician-only diagnoses (2017: OR, 1.645, 95% CI, 1.535-1.763; 2020: OR, 1.513, 95% CI, 1.413-1.621).

A latent class model identified three classes with different attribute priorities. In the first class, preferences for combined diagnoses and accuracy were constant in 2017 and 2020, and high accuracy was preferred. In the second class, the matched data from 2017 and 2020 were similar, Combined diagnoses from both AI and human clinicians and outpatient waiting time of 20 minutes were consistently preferred. In the third class, respondents in both groups preferred different methods, with those in 2017 preferring clinician diagnoses while respondents in 2020 preferred AI diagnoses.

Preferences for Artificial Intelligence Clinicians Before and During the COVID-19 Pandemic: Discrete Choice Experiment and Propensity Score Matching Study

The findings could guide policies relevant to the development of AI. 

Patients' AI Diagnosing Preferences Unchanged During COVID-19

Hospitals are increasingly billing for inpatients stays at the highest severity level — the most expensive one — according to recent findings.

Because of the findings, study investigators at the Office of Inspector General recommended the Centers for Medicare & Medicaid Services (CMS) conduct targeted interviews of Medicare Severity Diagnosis Related Groups (MS-DRGs) and stays that are vulnerable to upcoding, along with hospitals that frequently bill them.

The team analyzed paid Medicare Part A claims for inpatient hospital stays from fiscal year 2014 through fiscal year 2019. They identified trends in hospital billing and Medicare payments for stays at the highest severity level. Severity levels were determined by the MS-DRG.

The Office of Inspector General found hospitals billed Medicare for 8.7 million inpatient hospital stays in fiscal year 2019 and 40% of them (3.5 million stays) were billed at the highest severity level. In fiscal year 2019, Medicare spent $109.8 billion for inpatient hospital stays and nearly half of that ($54.6 billion) was for stays billed at the highest severity level. In fact, Medicare paid an average of $15,500 per stay billed at the highest severity level. The most frequently billed MS-DRG was septicemia or severe sepsis with a major complication in fiscal year 2019.

While the number of stays billed at the highest severity level has increased almost 20% from fiscal year 2014 to fiscal year 2019, the number of stays billed at each of the other severity levels decreased. Still, the average length of stays at the highest severity level decreased from 6.9 days to 6.4 days, while the average length of all stay remained fairly similar, decreasing by .1 days.

Further, the Office of Inspector General investigators found hospitals varied significantly in their billing of stays at the highest severity level, with some billing far differently than most. Despite some variation expected, the amount of variation and the differences seen in some hospitals were considered further indications that stays with certain characteristics were vulnerable to inappropriate billing practices like upcoding.

Aside from the Office of Inspector General team recommending CMS conduct targeted reviews of MS-DRGs and stays that are vulnerable to upcoding and hospitals that frequently bill them, they also think more work needs to be done by the agency. The Office of Inspector General continues to recommend CMS conduct targeted review to identify stays involving upcoding and hospitals with patterns of upcoding.

Investigators at the Office of Inspector General identified trends in hospital billing and Medicare payments for stays at the highest severity level.

Hospitals Increasingly Billing for Inpatient Stays at Highest Severity Level

Virtual reality technology has been moving into healthcare for years. And Ryan Ribeira, M.D., M.P.H., co-founder and CEO of SimX, a medical device company that develops medical simulation software for virtual and augmented reality, believes there is potential to use the technology to train nursing students and healthcare providers.

 spoke with Ribeira about a partnership between SimX and Elsevier to bring realistic and highly effective VR simulations to nursing schools through Simulation Learning System for RN with Virtual Reality, what healthcare executives should look for when they want to implement such technology, and challenges associated with VR.

Podcasts

Ryan Ribeira, M.D., M.P.H., co-founder and CEO of SimX, talks to Chief Healthcare Executive about all things virtual reality in healthcare.

Podcast: VR to Train Nursing Students with Ryan Ribeira, M.D., M.P.H.

There’s no question that President Joe Biden comes into office with healthcare landscape forever changed by COVID-19. But once the dust settles, health system administrators may find that some of the aggressive steps seen during the Trump administration on drug costs, pricing transparency, and the 340B program may continue, according to Dr. Kavita Patel, a primary care physician and fellow at the Brookings Institution.

In a wide-ranging talk Monday, which kicked off the virtual meeting of the Association of Community Cancer Centers. Patel covered the future of telehealth, the need to deal with healthcare worker burnout, and the shortcomings of the Oncology Care Model, among other topics.

Patel, who served as a policy adviser under President Barack Obama, opened her talk by explaining the political reality Biden faces: super slim Democratic majorities in Congress will force the president to rely on executive actions to reverse some Trump policies and expand access to care. But in other areas that affect hospital and provider revenue, there’s bipartisan agreement on the need for action, she said.

For starters, CMS will look at changes in the Physician Fee Schedule with an eye toward keeping Medicare afloat past 2024.

Both parties believe drug costs too much, Patel said. Because Trump’s most far-reaching actions to rein in drug prices were blocked in court or lawsuits were threatened, “I predict we’re going to see legislation on drug prices. It might not be in the 2021 timeframe,” she said, but everyone from House Speaker Nancy Pelosi to Republican members “are very keen on seeing something happen. … In my opinion, it’s not a question of if, but when and what does it look like?”

Trump’s regulation requiring hospitals to disclose prices went into effect on January 1, 2021, and more transparency rules will take effect in 2022. Patel is not sure how much effect this will have, based on existing research. “What we see today is not going to make a meaningful change unless there’s something built on top of it,” she said.

But she does see possibilities from a more assertive Department of Justice, one that will take steps to enforce antitrust law. “We 're already seeing a record number of mergers,” she said, noting that many oncology practices have been forced to consider a private equity backed option, or have weighed being acquired by a hospital. Another oncology practice group, the Community Oncology Alliance, has argued that acquisitions drive up cancer care costs.

“Are we just going to have in 10 years about 10 hospital systems that dominate the preponderance of the healthcare market landscape?” Patel asked. “I think the answer is that you'll start to see a Department of Justice that tries to challenge that.”

She also predicted greater investment in community health centers, more attention to and investment in basic science, and a renewed dialogue about issues that have been temporarily shelved during the pandemic: equity in site-of-service costs, and “ongoing action” to bring reform the 

. The dispute has been the subject of multiple lawsuits from independent practices and hospital groups, with one drug manufacturer arguing last month that 340B has been “transformed” from a program “to assist vulnerable patients into a multibillion dollar arbitrage scheme that benefits national for-profit pharmacy chains and other for-profit intermediaries.”

The latest chapter in the 340B saga involves drug manufacturers' argument that contract pharmacies are not "

" under the program. (In late December, the Trump administration issued 

 that the discounts did apply.) Patel noted that the administrator of the Health Resources and Services Administration, who will manage this issue, hasn't even been appointed.

“This one this is one of those things where what's old is new again,” Patel said.

Similarly, there is “incredible bipartisan agreement” that if certain services are “exactly the same” in an inpatient or outpatient setting, there is no need for one to receive a higher facility fee. “This is going to be an ongoing issue,” she said.

Speaking to a group of oncology providers, Dr. Kavita Patel, a former Obama administration official, predicted that issues affecting hospital revenue would be revisited under Biden. 

Patel Predicts 340B, Site of Service Reform to Be Ongoing Issues Under Biden

At the end of January, Sharecare announced it acquired doc.ai, an AI platform accelerating the digital transformation in healthcare.

Sharecare is a digital health and well-being platform bringing multiple different platforms together to keep data in one place, Anil Menon, executive vice president of community and urban services, said in a recent interview with 

. The idea is to bring all the different elements of a healthcare journey together to improve outcomes and help patients take ownership of their health.

Doc.ai allows Sharecare to take all forms of data from different sources, integrates it on a platform, and allows the company to train the data. The platform is edge-native rather than cloud-native. Users can also provide different levels of privacy and have control over their data.

Menon said today we have sick care rather than patient care. It is important to be able to treat a person, not just a disease, and to move from healthcare to health and well-being. And instead of paying for service, it will be possible to pay for outcomes.

“Doc.ai allows us to become data-driven — evidence-driven where you come back with more and more insights on how to take control of our health and provide better outcomes,” Menon said.

Mergers and acquisitions are increasing drastically in healthcare. If companies can align, it might be beneficial to work together in some capacity.

The company is focused on improving a patient's health and overall well-being by leveraging health tech.

Sharecare Acquires doc.ai: Anil Menon on Healthcare Mergers and Acquisitions

Healthcare is an intensely data-driven industry, and the volume of patient data — clinical, financial, demographic — has grown exponentially in recent years. The evolution from fee-for-service to value-based care, with its emphasis on the continuum of care and interoperability, bring the need for providers to share and aggregate from multiple stakeholders at multiple access points.

Unfortunately, that expanded access has spawned more opportunities for targeted assaults on data networks. Sometimes, data are compromised or stolen because healthcare entities neglected to take proper care of it or due to significant events such as the COVID-19 pandemic that increased the need to exchange large amounts of patient information.

Smaller healthcare stakeholders have their own particular cybersecurity challenges. Although they may handle less data than their larger brethren, smaller stakeholders often lack the budget and/or in-house or consulting expertise to manage a cybersecurity team that can diagnose data vulnerabilities and implement remedies for them.

The pandemic-instigated explosion in work-from-home arrangements has greatly increased the need to remotely access data networks. Correspondingly, it also has raised the risk of cyberattacks. 

 magazine reports that business organizations will boost their 

Healthcare stakeholders must protect a broad spectrum of sensitive, high-value patient information. Besides a patient’s medical history and protected health information (PHI), this can include healthcare insurance data, Social Security numbers, demographic information, and credit card accounts. Between January and October 2020, healthcare network server breaches increased 23% over the same 10-month span in 2019. The average cost of a 

 is more than $7 million, the highest industry and nearly double the global average of breaches in other industries.

Just as healthcare providers can deliver preventive medicine to preserve their patients’ long-term health, they can similarly safeguard their data networks and patient data by taking a comprehensive, yet highly focused look at their cybersecurity profiles.

Advanced-technology assessment products can examine a company’s data network to answer a few key questions: Where are my data exposed and vulnerable? How do I prioritize my risks and what’s the first thing I must do to eliminate that exposure? How do I improve data protection across the enterprise?

Technology assessment solutions can answer those questions through three primary tasks:

An open, agnostic architecture aggregates scan data, ACL (access control list) data and log/big data to yield an exhaustive risk assessment. The entire analysis — the vast majority of it automated — can be conducted remotely, which lowers the product cost.

Sophisticated tools visualize the data network and convert what is discovered into simple, easily understood illustrations.

Powerful analytics examine a myriad of potential data threats, rank the severity of threats to the most critical assets — such as payroll systems and intellectual property — and determine if that critical-asset data faces a direct or indirect risk.

The process described above enables healthcare stakeholders to gain a complete picture of vulnerabilities to cyber disruption and a strategic plan to address any deficiencies. The process is scalable to accommodate data network growth.

The goal is to target the most consequential security gaps. For instance, an unknown access point from outside a data network is far more critical than a server that sits by itself and doesn’t interact with other servers. Focusing attention on the most-pressing risks and prioritizing remedies for high-value assets and their related ACLs makes life easier for the IT workers tasked with closing the vulnerabilities.

The potential for liability exposure gives healthcare stakeholders an especially powerful incentive for protecting their data, as some cyber insurers won’t underwrite an insurance policy if organizations haven’t rigorously assessed their cyber vulnerability with, for example, a penetration test that simulates an assault on the network. A new class of litigation dealing with cyber negligence is being directed against company officers and directors for failing to perform assessments like these and devoting the necessary attention to their high-value assets. And if negligence is proven, coverage may be denied for those officers and directors, leaving them personally liable.

Vulnerability assessments that include pen tests are now available that exceed cyber-insurance threshold standards. They go beyond the four standard assessment levels typically used to gauge an organization’s cyber-theft exposure by furnishing a vulnerability dashboard with additional rankings that indicate whether a high-value asset target’s vulnerability can be exploited. Moreover, if an assessment reveals serious potential for imminent data disruption, the assessment service can notify the endangered client immediately, without waiting to deliver a final report.

Timeliness, flexibility needed to uncover the most common data exposures

Organizations should conduct network assessments at least annually, but it’s preferable to conduct quarterly scans because a vulnerability assessment report that detects no serious data exposures may give a company a false sense of security. The average time to identify and contain a healthcare breach is 

 (329 days) versus an average of 280 days.

Even the successful remediation of an identified issue doesn’t lessen the need for vigilance. Cyber criminals are constantly trying to find a way around remedial defenses that have been installed. Mature organizations and those that work with extremely critical information and must meet HIPAA compliance standards — such as hospital systems — should seriously consider monthly scans.

Assessments also are necessary when healthcare businesses undergo major changes such as a merger or acquisition. A merger or acquisition brings new physical locations and business associates, which means added data and potential liability for the network.

Two areas where these new assessment offerings have shown promise are the use of deep web scans to discover compromised credentials in corporate accounts and the detection of potential EternalBlue and BlueKeep ransomware vulnerabilities. A report from one assessment solution provider noted success rates of 75% and 90-95%, respectively, in performing such web scans and identifying ransomware problems. EternalBlue and BlueKeep are software vulnerabilities in Microsoft Windows operating systems.

Whether the fault lies in human error or with systematic shortcomings, data breaches are preventable. Properly safeguarding the data requires an affordable, yet advanced, solution that accurately assesses how and where vital data is endangered so that healthcare facilities can implement failsafe deterrence against cybercriminals.

Data breaches are preventable. Here's how a health exec can safeguard health data.

Guarding Against Negligence: How Healthcare Providers Can Detect and Diagnose Cyber Risks

Last year, the Trump administration’s push for hospitals to publicly share 

 of their own healthcare information prompted lively debates about who “owns” the data, whether it should be shared and when.

Benefits of data sharing include improved care coordination, the ability to find outlying areas of waste to reduce costs, and the opportunity to improve quality and safety. These are necessarily balanced against the risks, which 

 that have happened with increased frequency, involving millions of patient records.

In the United States, armies of lobbyists and experts weighed in as the 2020 regulations were discussed. But in the year before the COVID-19 pandemic hit, researchers in the United Kingdom—where data debates are no less heated—tried a different approach to gain insights from ordinary citizens, whom they say are often not consulted in these discussions.

Calling their installation, the “Can of Worms,” the group from the Institute for Global Health Innovation created a public engagement installation at a London hospital that featured a series of cans that each contained an audio recording; each “story” would present the user with a data-sharing scenario in one of seven different areas: diagnosis, individual care, planning, policy, social services, treatment and prevention, and understanding disease. The researchers gathered demographic information and then asked the participants questions about the stories they had heard.

“Topics included international data sharing among patients with chronic diseases, genomic analysis, and data-powered predictive algorithms,” the authors wrote. “The fictional stories were developed by researchers based on anecdotal evidence of risks and benefits of data sharing to represent a balanced view.”

The authors, who report that 352 people took part in the qualitative study between November 2018 and June 2019, published their results 

Their title: Opening a "Can of Worms" to Explore the Public's Hopes and Fears About Health Care Data Sharing: Qualitative Study.

Participants have a mixed view of using health care data, which emerged in their responses. The researchers found six themes of hope, starting with the idea that having better access and ownership of their data would lead to more empowerment over their own care.

Participants also said they hoped for increased interoperability and collaboration, which they expressed as an interest in seeing the health system become less fragmented and more unified. Other “hopes” included the generation of evidence for better and safer care, improved timeliness and efficiency, the delivery of more personalized care, and greater equality of care. 

The participants also identified five fears, the greatest of which was inadequate security and exploitation—which did not surprise the researchers, because the May 2017 

 was still fresh on the minds of UK residents. Other fears were that data were inaccurate, that data could be used to discriminate against patients, and that widespread sharing of data would negatively affect the doctor-patient relationship.

While the study was small, the authors said it shed new light on public fears that widespread data use in healthcare could expand, rather than reduce, health disparities—and that it could make care 

 patient-centered. If health system designers are to rely on patient data to engineer solutions, they write, talking to those who are doing the data-sharing is essential.

“Incorporating the knowledge generated and focusing on co-designing solutions to tackle these concerns is critical to engage the public as active contributors and to fully leverage the potential of health care data use,” they wrote.

UK researchers have just published a novel study on the hopes and fears of ordinary citizens about how their healthcare data will be used.

Opening the Can of Worms: What the Public Says About Sharing Healthcare Data

Family caregivers—important gatekeepers to care for seniors—have doubts about the safety of the COVID-19 vaccine that leave this vulnerable group at risk according to new 

 an emergency use authorization (EUA) on Saturday to Johnson & Johnson’s single-dose COVID-19 vaccine, which many have heralded as an important new tool in creating herd immunity, because it allows for easier use among hard-to-reach populations. Besides only requiring a single dose, the J&J vaccine does not need to be frozen while being shipped. An advisory panel unanimously the vaccine Friday.

But these advantages won’t matter if vulnerable populations harbor doubts about vaccine safety, which may be rooted in 

 of the medical establishment or cultural beliefs.

The new survey, conducted by Wakefield Research on behalf of SCAN Health, a non-profit Medicare Advantage plan based in Long Beach, California, found only 63% of family caregivers who have doubts about the COVID-19 vaccine say they will take the senior in their care to be vaccinated.

What’s more, almost half of family caregivers in the United States—47%--said they would delay or refuse the vaccine if offered, which could put seniors in their care at risk.

Safety is on the minds of these caregivers: three in four who would reject or delay vaccination say safety concerns are the top reason.

Seniors in minority groups, which data have shown have been especially hard hit by the COVID-19 pandemic, could remain at risk if their family members do not take them to be vaccinated. And the SCAN survey found that 13% of Hispanic caregivers and 25% of Black caregivers said they did not plan to take the senior in their care to be vaccinated.

“These findings should ring alarm bells throughout the country,” Eve Gelb, senior vice president of healthcare services for SCAN, said in statement released with the results. “Family caregivers are the linchpin in our healthcare system. They make crucial decisions every day that affect the health of the people they care for. That’s why it’s so important that they trust the vaccines and get the person under their care vaccinated.”

The SCAN Health survey polled 1,000 U.S. family members who arrange for medical care for someone older than age 65. The survey included 400 Hispanic and 400 Black respondents. Nationwide, there are 53 million family members taking care of adults and children in the United States, providing everything from transportation and assistance with logistics to ensuring nutritional needs are met.

Among those surveyed, 71% said they had concerns about the vaccines’ safety, with about 1 in 5 caregivers (19%) saying they do not plan to take the person in their care to be vaccinated.

When caregivers refuse to be vaccinated themselves, it can be just as risky for seniors, said Dr. Romilla Batra, SCAN’s chief medical officer. “In addition to exposing their loved one to the virus, if they become sick themselves, they may not be able to provide vital day-to-day care for the person they support.”

SCAN’s Gelb said overcoming the historic lack of trust that some members may have in vaccine safety may not be easy, but the trust that patients have in their physicians and public health officials can offer a good starting point. According to the group’s statement, SCAN has implemented programs with both groups to emphasize the importance of vaccinations.

“We know we have our work cut out for us,” Gelb said. “But the good news is we know exactly what that work is.”

Longstanding distrust of the medical establishment plays out in a lack of confidence in safety of the COVID-19 vaccine. This gives health plans and systems the task of building bridges with at-risk groups.