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Data Freedom and Regulation Expand / Collapse
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Posted Sunday, February 10, 2013 10:17 PM


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Comments posted to this topic are about the item Data Freedom and Regulation






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Post #1418200
Posted Monday, February 11, 2013 3:16 AM


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I would go so far as to say that some businesses need to evaluate their business rules as well as too often the complexity is poorly understood (even by all areas of the business), difficult to maintain an implementation of and can reduce business flexibility.

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Post #1418278
Posted Monday, February 11, 2013 7:34 AM
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what concerns me is how hospitals interpret HIPAA to slow access to patients medical records. we requested my wife's records well over a year ago and have not formally received them. Many providers are failing meaningful use because they cannot get patients their records in 3 days. Privacy needs to be balanced with portability - the entire intent of the original bill, that seems to have been forgotten.


Post #1418423
Posted Monday, February 11, 2013 9:37 AM
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Steve,

Agreement on this "The problem is ensuring the people writing the code understand all of the rules for the exceptions."

In some development cycles we find that for the first time all the business rules are documented. And all the external system data requirements are exposed. With so many of the business and decision making tools buried on peoples desks and away from view we find that the event of System s Development brings all players to the table to discuss what that functional matrix really is. Only then do you have the complete target and a chance.

Without the understanding of the rules for exceptions and exclusions our solutions are at best failures. You are spot on!

M.


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Post #1418522
Posted Monday, February 11, 2013 10:56 AM
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This problem is not limited to the medical industry it happens in every app that mimics life events. In my experience there are three groups at fault here. 1. The programmer who doesn't analyze the problem space and identify the exceptions (one offs) 2. The SEO marketing guy who wants to keep the application as simple as possible and 3. Management who hires the cheapest labor.
Life is not simple! Life is complicated! Applications that mimic life are complicated.

I recently asked somsome for an exception report and he didn't know what I was talking about. I am a software engineer whose code has to handle all the exceptions gracefully; but I appear to be a dying breed.



Pamela Reinskou
Post #1418568
Posted Monday, February 11, 2013 9:28 PM


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I work for a company that produces SW for the health care industry, more specifically nursing homes. We live in the guts of HIPAA compliance. The programmers commonly build in the roles so the nutritionist can see what they need to see, the physical and occupational therapists are limited, the financial people are separated from the clinical.

The setup and assignment of roles are relatively easy and logical.

Then the support people get called to see why data is messed up. I then get to delve into the GUIDs to see who did what. I then find the lowly nutritionist is in a clinical administrator role that should be reserved for the Director of Nursing. The accounting clerk who is in charge of payroll only has a role assigned that allows them to see the resident trust and A/R. They could issue an invoice and divert the funds.

And when you talk to that end-user, you realize they can barely type up a letter in MS Word, let alone actually having been trained to use our SW properly. And on-line training is free. The implementation training is done as a "train the trainer" method.

I will admit that it can vary depending on the size of the facility or chain, but it is too common to be considered our fault.

This is as bad as back in the NT4 and 2000 implementations. You walk into a large company that they invested in IT and you would see laid out groups and users. You walk into a small company and half the user were admins, and didn't even know it. The same thing is happening with the HIPAA standards.

The problem is even worse because most of the medical community doesn't consider computers as their primary tool. It is a bothersome side effect they have to use. Or worse a necessary evil. Add in that a large portion of the jobs in some medical fields, such as transport, minor bedside care, and others are filled with persons that are English as a Second Language (ESL).

We have three separate small companies in a minor metropolitan area that contracted with the same IT contractor. We, on the support team, had to rescue his butt from several issues more than once. It was so bad that he physically sent us a server to recover the data after the facility's server crashed.

"After you've done a thing the same way for two years, look it over carefully. After five years, look at it with suspicion. And after ten years, throw it away and start all over." --Alfred Edward Perlman



But I also do put some of the fault on the SW companies as well. If you can ever get around the desk and see the SW that some of the hospitals are still using -- you will see SW that is based off of Foxpro, VB5, DBase V, VPro5, and other ancient programming technology.

Most of the healthcare SW companies don't have the weight of M$, Oracle, formerly SUN, and the rest. They can't say "We won't support WinXP any longer." If they do then they can lose a 1/4 of their market. The five doctors in a small practice don't consider that the cost of upgrading 15 work stations and a server to Win8/Server2008 worth the money.

So don't necessarily blame the programmers or SW support staff. It is all a compromise between all parties.




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Post #1418738
Posted Tuesday, February 12, 2013 9:26 AM
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Jim P. (2/11/2013)
-- you will see SW that is based off of Foxpro, VB5, DBase V, VPro5, and other ancient programming technology.


Excellent snapshot of reality in this post of yours. We also find users who are admins, who input, verify, sign, challenge, audit and you name it all to the same data in the same process. There is little separation of roles and responsibilities, and when they are questioned we often hear that "You are lucky we even have a person who understands this and has the time."

We plan for secure systems with distinct roles and in reality we find shared passwords, shared accounts, Admins who have no clue, and users who call the help line even before they start the process just to have you on the line to help coach them through the process. It is not that users are challenging, it is that users are challenged and need help in this complex technical world of ours. And they need more and more help if they are trying to do three jobs at the same time.

Again Jim, excellent! Only one thing, if you consider these programming technologies "ancient" what do you say about COBOL, PL/1 and Assembler?

M.


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